Disease Clinic Research Articles

Yangyinqingfei decoction attenuates PM2.5-induced lung injury by enhancing arachidonic acid metabolism.

Yangyinqingfei Decoction (YYQFD), a traditional Chinese prescription, is well known in the treatment of diphtheria and lung-related diseases in clinic. However, whether it can be used to block the lung injury caused by air pollutant remains unclear. In the present study, the effect of YYQFD was addressed using a PM2.5-induced lung injury mice model. It was shown that YYQFD significantly improved pulmonary functions of mice exposed to PM2.5, the levels of IL-6, TNF-α and MDA were decreased while SOD levels were increased in serum and bronchoalveolar fluid. The potential mechanism of YYQFD was then delved using metabolomic and proteomic techniques. The protein-metabolite joint analysis showed that YYQFD regulated the biosynthesis of unsaturated fatty acids, linoleic acid and arachidonic acid metabolism, causing a significant decrement of pro-inflammatory mediator arachidonic acid with its downstream metabolites like 20-HETE, prostaglandin E2, accompanied by the up-regulation of PTGES2, GPX2 and CBR3 in lung tissue. These data were used to construct a regulatory metabolic network map in terms of the therapeutic role of YYQFD in PM2.5-induced lung injury, thereby provided a novel insight into potential application in the respiratory diseases caused by air pollutants.

Update on Findings about Sudden Sensorineural Hearing Loss and Insight into Its Pathogenesis.

Sudden sensorineural hearing loss (SSNHL) is routinely encountered and is one of the most common emergent diseases in otolaryngology clinics. However, the etiology of SSNHL remains unclear. Due to the inaccessibility of the living human inner ear for biopsy, studies investigating the etiology of SSNHL have been performed by analyzing data obtained from examinations using peripheral blood or imaging. We updated the findings obtained from serological, magnetic resonance imaging, genetic, and viral examinations to reveal the etiology of SSNHL. Regarding viral examination, we focused on sensorineural hearing loss associated with coronavirus disease (COVID-19) because the number of correlated reports has been increasing after the outbreak. The updated findings revealed the following three possible mechanisms underlying the development of SSNHL: thrombosis and resulting vascular obstruction in the cochlea, asymptomatic viral infection and resulting damage to the cochlea, and cochlear inflammation and resulting damage to the cochlea. Thrombosis and viral infection are predominant, and cochlear inflammation can be secondarily induced through viral infection or even thrombosis. The findings about sensorineural hearing loss associated with COVID-19 supported the possibility that asymptomatic viral infection is one of the etiologies of SSNHL, and the virus can infect inner ear tissues and directly damage them.

Pharmacokinetic study of single and multiple oral administration of glutamine in healthy Beagles.

Glutamine is an amino acid that is mainly used for the treatment of gastrointestinal diseases in clinic, but there is a lack of such medicine in veterinary clinic, and its research in dogs has never been seen. This study aimed to investigate the pharmacokinetics of single and multiple administration of glutamine (Gln) tablets in Beagles. Twenty-four healthy Beagles were randomly selected for the pharmacokinetic study of a single dose of low (120 mg/kg), medium (240 mg/kg), and high (360 mg/kg) Gln tablets. After 7 days of washout period, six Beagles in the medium group were selected for a multiple-dose pharmacokinetic study, 240 mg/kg twice a day for 7 days. The Gln concentration in plasma was determined by a validated UPLC-MS/MS method. The results of single oral administration of different doses of Gln tablets showed that Cmax, AUC0→t, AUC0→∝ had a certain linear relationship with the dosage. T-tests were performed for single and multiple administration of Tmax, Cmax, t1/2λz, AUC0→t, and AUC0→∝, and the results showed no significant differences (p > 0.05). Therefore, Gln tablets were absorbed quickly by oral administration, and there was no accumulation in Beagles after 7 days of administration.

Impact of COVID-19 on viral respiratory infection epidemiology in young children: A single-center analysis.

BackgroundThe COVID-19 pandemic impacts different health aspects. Concomitant with the adoption of non-pharmaceutical interventions (NPIs) to reduce the spread of SARS-CoV-2, global surveillance studies reported a reduction in occurrence of respiratory pathogens like influenza A and B virus (IAV & IBV) and respiratory syncytial virus (RSV). We hypothesized to observe this collateral benefit on viral respiratory infection epidemiology in young children.MethodsRespiratory samples of children aged below 6 years, presenting at the outpatient clinic, emergency department, or pediatric infectious diseases department of the University Hospitals Leuven, between April 2017 and April 2021 were retrospectively analyzed. The occurrence (positivity rate), and seasonal patterns of viral respiratory infections were described. Chi-squared or Fisher's exact test (and Bonferroni correction) were used to explore differences in occurrence between 2020-2021 and previous 12-month (April to April) periods.ResultsWe included 3020 samples (453 respiratory panels, 2567 single SARS-CoV-2 PCR tests). IAV and IBV were not detected from March and January 2020, respectively. For IAV, positivity rate in 2020–2021 (0%, n = 0) was significantly different from 2018-2019 (12.4%, n = 17) (p < 0.001) and 2019-2020 (15.4%, n = 19) (p < 0.001). IBV positivity rate in 2020-2021 (0%, n = 0) was not significantly different from previous periods. RSV occurrence was significantly lower in 2020–2021 (3.2%, n = 3), compared to 2017-2018 (15.0%, n = 15) (p = 0.006), 2018–2019 (16.1%, n = 22) (p = 0.002) and 2019-2020 (22.8%, n = 28) (p < 0.001). The RSV (winter) peak was absent and presented later (March-April 2021). Positivity rate of parainfluenza virus 3 (PIV-3) was significantly higher in 2020-2021 (11.8%, n = 11) than 2017-2018 (1%, n = 1) (p = 0.002). PIV-3 was absent from April 2020 to January 2021, whereas no clear seasonal pattern was distinguished the other years. For the other viruses tested, no significant differences in occurrence were observed between 2020-2021 and previous periods. From March 2020 onwards, 20 cases (0.7%) of SARS-CoV-2 were identified.ConclusionThese findings reinforce the hypothesis of NPIs impacting the epidemiology of influenza viruses and RSV in young children. Compared to previous periods, no IAV and IBV cases were observed in the 2020-2021 study period, and the RSV peak occurred later. Since the pandemic is still ongoing, continuation of epidemiological surveillance, even on a larger scale, is indicated.

A sensing strategy combining T7 promoter-contained DNA probe with CRISPR/Cas13a for detection of bacteria and human methyltransferase

Abnormal DNA methylation is closely related to the occurrence and development of many diseases. The determination of human DNA methyltransferase activity and the screening of its inhibitors are extreme important for the diagnosis and the treatment of methylation-related diseases in clinic. Most of the current detection methods have the disadvantages of sophisticated design, high cost and low detection limit. By combining T7 promoter-contained DNA probe as the substrate for methyltransferase with CRISPR/Cas13a sensing strategy, a novel fluorescent sensing platform is designed to achieve simple, specific, sensitive detection of bacteria DNA methyltransferase (DNA-(N-6-adenine)-methyltransferase, Dam MTase) and also human methyltransferase (DNA (cytosine-5)-methyltransferase 1, Dnmt1). A hairpin DNA probe designed for Dam MTase and a double strand DNA probe for Dnmt1 are both methylated followed by the methylation-dependent site-specific cleavage, which result a T7 promoter-contained product and a T7 promoter-free one to respectively open and close the transcription and subsequent CRISPR/Cas13a target-initiated cleavage of fluorescence-labeled reporter RNA. In virtue of the specificity of methylation-dependent cleavage of probe, the efficient transcription amplification and CRISPR/Cas13a sequence-specific sensing, this strategy exhibited remarkable specificity and sensitivity, with the limit of detection of 3.10 × 10−5 U/mL for Dam MTase. Moreover, Dnmt1 activity in MCF-7 cells was detected and the inhibition of Apt. #9 was evaluated. This strategy for methyltransferase detection is convenient and efficient for inhibitor discovery and early cancer diagnosis.

Evaluation of off-label anti-vascular endothelial growth factor and steroid implant medication uses in macular edema due to retinal vein occlusion in Turkey.

Retinal vein occlusion (RVO) is one of the most common causes of vision loss. Anti-vascular endothelial growth factor (anti-VEGF) drugs, ranibizumab and aflibercept, and corticosteroid implants are approved treatment options for RVO-related macular edema (ME) in Turkey. To the best of our knowledge, there is no data regarding the off-label use of these drugs for RVO in English literature. We aimed to evaluate the clinical and demographic characteristics of off-label drug use applications in Turkey for RVO. Applications made to the Turkish Medicines and Medical Devices Agency between January 1 and December 31, 2018, for the use of off-label drugs (ranibizumab, aflibercept, dexamethasone implant) for the diagnosis of RVO from hospitals across Turkey were retrospectively analysed. Data of the applications, such as demographic characteristics, previous treatment regimens, reasons for applications, applicant hospitals and their regions, were recorded. There were 291 approved applications for RVO. The mean age of the patients was 64.88 ± 10.78 years, 48.8% were male, and 51.2% were female. Of these applications, 44.7% were for aflibercept, 35.7% for ranibizumab and 19.6% for dexamethasone implant. No application was made for bevacizumab since it could be used without needing for an application. The most common reasons for applications were due to dose limitations, failure to complete loading doses, and glaucoma, respectively. In terms of the distribution of the applicant hospitals, public university hospitals ranked first with 72.5%, training and research hospitals ranked second with 14.7% and foundation university hospitals ranked third with 13.1% rates. The practice of drug use in RVO in Turkey has changed as of the beginning of 2019. Stepwise therapy has been accepted by the drug regulatory agency Turkish Medicines and Medical Devices Agency. Utilization of licensed drugs, aflibercept, ranibizumab and dexamethasone has been allowed only after administration of 3 doses of intravitreal bevacizumab. After 3 doses of bevacizumab, the physician may continue either with bevacizumab again or a dexamethasone implant. If there is a reason such as the presence of glaucoma, the physician may skip dexamethasone and switch to aflibercept and ranibizumab, but in this case, dexamethasone cannot be administered to the patient for life. The evaluation of the off-label treatments of RVO, which is one of the most frequently followed diseases in retina clinics, not only contributes to the literature but also provides information regarding the most frequently applied treatments and the physicians' off-label drug preferences for RVO.

Perspectives on and prevalence of ticks and tick-borne diseases in Alaskan veterinary clinics.

To assess knowledge, attitudes, and practices (KAP) of veterinary personnel and pet owners regarding ticks and tick-borne diseases in Alaska and to conduct a serosurvey for tick-borne disease pathogens among domestic animals visiting veterinary clinics for preventative care. Across 8 veterinary clinics, we sampled 31 veterinary personnel, 81 pet owners, 102 client-owned dogs, and 1 client-owned cat. Information on KAP among veterinary staff and pet owners was collected via self-administered questionnaires. Tick and tick-borne disease prevalence were assessed via tick checks and benchtop ELISA antibody tests detecting Anaplasma phagocytophilum, Anaplasma platys, Erlichia canis, Erlichia ewingii, and Borrelia burgdorferi. The veterinary personnel KAP survey showed a low average knowledge score (53.5%) but a moderate attitude score (71.7%). In contrast, owner average knowledge score was higher (67.5%) and attitude score was comparatively low (50.6%). Both veterinary personnel and owners had low average practice scores (64.5% and 56.3%, respectively). One dog was positive for anaplasmosis (unknown species) antibody, and 1 dog was positive for B burgdorferi antibody. No ticks were found during the study. This study was the first of its kind in the state and indicated a low prevalence of ticks and tick-borne diseases in the domestic pet population and highlighted significant knowledge gaps that could be targeted by public health efforts. Our results suggest the value of a One Health approach and of the veterinary-client relationship to address ticks and tick-borne diseases.

Centerline extraction by neighborhood-statistics thinning for quantitative analysis of corneal nerve fibers

Objective. Corneal nerve fiber (CNF) has been found to exhibit morphological changes associated with various diseases, which can therefore be utilized to aid in the early diagnosis of those diseases. CNF is usually visualized under corneal confocal microscopy (CCM) in clinic. To obtain the diagnostic biomarkers from CNF image produced from CCM, image processing and quantitative analysis are needed. Usually, CNF is segmented first and then CNF’s centerline is extracted, allowing for measuring geometrical and topological biomarkers of CNF, such as density, tortuosity, and length. Consequently, the accuracy of the segmentation and centerline extraction can make a big impact on the biomarker measurement. Thus, this study is aimed to improve the accuracy and universality of centerline extraction. Approach. We developed a new thinning algorithm based on neighborhood statistics, called neighborhood-statistics thinning (NST), to extract the centerline of CNF. Compared with traditional thinning and skeletonization techniques, NST exhibits a better capability to preserve the fine structure of CNF which can effectively benefit the biomarkers measurement above. Moreover, NST incorporates a fitting process, which can make centerline extraction be less influenced by image segmentation. Main results. This new method is evaluated on three datasets which are segmented with five different deep learning networks. The results show that NST is superior to thinning and skeletonization on all the CNF-segmented datasets with a precision rate above 0.82. Last, NST is attempted to be applied for the diagnosis of keratitis with the quantitative biomarkers measured from the extracted centerlines. Longer length and higher density but lower tortuosity were found on the CNF of keratitis patients as compared to healthy patients. Significance. This demonstrates that NST has a good potential to aid in the diagnostics of eye diseases in clinic.

A Simple and Fast Medical Image Encryption System Using Chaos-Based Shifting Techniques

Medical images such as brain MRI, ultrasound, and X-ray images are currently used by doctors to treat many serious diseases in most hospitals and clinics. These images play a major role in medical diagnosis. Diagnostic images with sensitive patient data are recorded and exchanged owing to the advancement of public networks. As a result, maintaining the privacy of sensitive patient data is becoming increasingly important. In medical imaging, the pixels are highly correlated. To reduce pixel correlation, a variety of complex encryption methods have been used in recent years, increasing the algorithm's computational complexity. This paper proposes an image encryption method based on chaos-based shifting operations. Security, convenience, and speed are all advantages of shifting activities. This method initially executes bit-plane flipping and permutation operations, then block-based flipping and diffusion operations to obtain the cipher images. The simulation and security analysis findings show that the proposed approach performs better.

Deep Residual Network for Diagnosis of Retinal Diseases Using Optical Coherence Tomography Images

Diabetic retinopathy occurs due to damage to the blood vessels in the retina, and it is a major health problem in recent years that progresses slowly without recognizable symptoms. Optical coherence tomography (OCT) is a popular and widely used noninvasive imaging modality for the diagnosis of diabetic retinopathy. Accurate and early diagnosis of this disease using OCT images is crucial for the prevention of blindness. In recent years, several deep learning methods have been very successful in automating the process of detecting retinal diseases from OCT images. However, most methods face reliability and interpretability issues. In this study, we propose a deep residual network for the classification of four classes of retinal diseases, namely diabetic macular edema (DME), choroidal neovascularization (CNV), DRUSEN and NORMAL in OCT images. The proposed model is based on the popular architecture called ResNet50, which eliminates the vanishing gradient problem and is pre-trained on large dataset such as ImageNet and trained end-to-end on the publicly available OCT image dataset. We removed the fully connected layer of ResNet50 and placed our new fully connected block on top to improve the classification accuracy and avoid overfitting in the proposed model. The proposed model was trained and evaluated using different performance metrics, including receiver operating characteristic (ROC) curve on a dataset of 84,452 OCT images with expert disease grading as DRUSEN, CNV, DME and NORMAL. The proposed model provides an improved overall classification accuracy of 99.48% with only 5 misclassifications out of 968 test samples and outperforms existing methods on the same dataset. The results show that the proposed model is well suited for the diagnosis of retinal diseases in ophthalmology clinics.

Evaluation of TyG index and TG/HDL-C ratio in HBeAg negative chronic hepatitis B infected patients.

Patients with hepatitis B e antigen (HBeAg) negative chronic HBV infection are regularly followed up. This study investigates the presence of insulin resistance and the relationship between hepatosteatosis and insulin resistance in patients with HBeAg negative chronic HBV infection using the TyG index and TG/HDL-C ratio. Patients with HBeAg negative chronic HBV infection who applied to the Infectious Diseases and Clinical Microbiology outpatient clinic between January 2019 and December 2020 were included in the study. Glucose, lipid panel, alanine amino transferase (ALT), acetyl amino transferase (AST), body mass index (BMI), TyG index, TG/HDL-C and hepatobiliary ultrasonography (USG) results were evaluated. The data were compared with the control group consisting of 308 HBsAg negative individuals. The study included 132 patients with a median age of 52 years. There was no significant difference between the patient and control groups regarding age, gender and BMI. Glucose, total cholesterol, TG, LDL, AST, ALT, TyG index and TG/HDL-C ratio were significantly higher in patient than in the control group. At the same time, the HDL value was significantly lower in the patients. There was a strong positive correlation between the TG and BMI, and a strong negative correlation between HDL levels and both TyG index and TG/HDL-C ratio. Our findings showed that the TyG index and TG/HDL-C ratio are helpful in the diagnosis of insulin resistance and hepatosteatosis in patients with HBeAg negative chronic HBV infection.

Relapses of idiopathic inflammatory myopathies after vaccination against COVID-19: a real-life multicenter Italian study

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) vaccination plays a crucial role as pivotal strategy to curb the coronavirus disease-19 (COVID-19) pandemic. The present study described the clinical status of patients affected by idiopathic inflammatory myopathies (IIM) after COVID-19 vaccination to assess the number of relapses. We included all patients affected by IIM and followed by Myositis Clinic, Rheumatology and Respiratory Diseases Units, Siena University Hospital, Bari University Hospital, Policlinico Umberto I, Sapienza University, Rome, and Policlinico Paolo Giaccone, Palermo. They underwent a telephone survey. A total of 119 IIM patients (median, IQR 58 (47–66) years; 32males; 50 dermatomyositis, 39 polymyositis and 30 anti-synthetase syndrome) were consecutively enrolled. Except four patients who refused the vaccination, 94 (81.7%) received Comirnaty, 16 (13.9%) Spikevax, 5 (4.4%) Vaxzevria. Seven (6.1%) patients had flare after vaccination. One of them had life-threatening systemic involvement and died two months after second dose of COVID-19 vaccination. From logistic regression analysis, Chi2-log ratio = 0.045,the variable that most influences the development of flare was the number of organs involved (p = 0.047). Sixty-eight patients received the third dose of COVID-19 vaccination: 51(75%) Comirnaty and 17 (25%) Moderna. No patients had flares after third dose. Our study represents the largest cohort of IIM patients in which the incidence of recurrence after anti-SARS-CoV-2 vaccine was assessed. In line with real-life data from other diseases, we found a clinical non-statistically significant risk of relapse in our patients, which occurred seldom, usually mild and in patients with a more severe and aggressive course of disease.

GAO Shu-zhong's clinical experience in "seeking yin from yang needling method" based on "qi street" and "four seas" theories

The paper introduces professor GAO Shu-zhong's understanding on "seeking yin from yang needling method" and its clinical application on the basis of "qi street" and "four seas" theories. Through professor GAO's clinical practice for years, he integrates and extendes the theories of "seeking yin from yang", "qi street" and "four seas" in Huangdi Neijing (The Yellow Emperor's Inner Classic). In this specific acupuncture method, in reference with the theories of "qi street" and "four seas", acupuncture is exerted on yang part of body, e.g. the back and lumber region to treat the diseases of yin parts, e.g. the chest and abdomen, which is differentiated as yin-yang imbalance in pathogenesis. In order to fully explain the clinical curative effect of "seeking yin from yang needling method", the common diseases in clinic, e.g. the disorders of heart, spleen and stomach systems, as well as the gynecology are taken as examples in the paper.

Metabolic cardiocytoprotectors (trimetazidine and trimethylhydrazine) in geriatrics. Short review

The review presents the clinical studies results of the effectiveness of cardiocytoprotectors, fatty acids synthesis inhibitors, trimetazidine (preductal), and trimethylhydrazine (meldonium, mildronate) in the treatment of cardiovascular disease (angina pectoris, chronic heart failure) and the central nervous system disease (dyscirculatory encephalopathy, chronic cerebral insufficiency, stroke) various ages patients. These data indicate the prospects of using these drugs in the complex therapy of cardiovascular and cerebrovascular diseases in the geriatric clinic. Keywords: metabolic cardiocytoprotectors, cardiovascular and cerebrovascular pathology, trimethylhydrazine, elderly

Fragmentation of Healthcare Services as a Possible Determinant of the Low Completion for the Tuberculosis Cascade of Prevention among Asylum Seekers: Results from a Prospective Study with Historical Comparison.

Background: Effective screening for tuberculosis infection (TBI) among asylum seekers (AS) is crucial for tuberculosis (TB) elimination in low incidence countries. Methods: We assessed the proportion of completion of the screening for TBI among asylum seekers with a centralized delivery method compared to the decentralized model previously adopted in the study area (historical control). In the historical model (January 2017 to May 2018) screening of AS was performed at the arrival offering TBI testing (TST followed by IGRA among those positive), radiological investigation, treatment initiation and hospital referral, if needed, at three sites: migrant health clinic, pneumology clinic and infectious diseases department for active disease (decentralized model). In the study model (June 2018, centralized) all steps of screening were performed at a single site, at a minimum of 6 months after arrival. Multivariable Poisson regression analysis, with robust variance, was used to assess variables associated with the completion of screening for infection. Multivariable logistic regression was used to identify factors associated with the diagnosis of TB infection. Results: The intervention approach was offered to 144 AS with an overall 98.6% proportion of completion (98.7% for those with a positive TST). In the historical screening model, 1192 AS were candidates for screening, which was completed by 74.5% of those who started it (44.7% for those resulted TST positive). Major losses (55%) were detected in the TST/CXR-IGRA sequential step, followed by the execution of TST test (25%). The ratio of screening completion was significantly higher in the intervention period (aIRR 1.78, 95% CI 1.68–1.88) and for AS coming from high incidence TB countries (aIRR 1.14, 95% CI 1.04–1.25). Screening after 6 months from arrival and age were associated with TB infection (2.09, 95% CI 1.36–3.2 and 1.14, 95% CI 1.01–1.29). Conclusions: Screening for TBI can be improved by a centralized approach. Higher prevalence of TBI 6 months after arrival could reflect recent (either during travel or in Italy) acquisition of the infection.

A comprehensive review of cycloastragenol: Biological activity, mechanism of action and structural modifications

Cycloastragenol (CAG) is a sapogenin of Astragaloside IV (AG-IV), isolated from the dried roots of legumes Astragalus mongolica or Astragalus membranaceus. Cycloastragenol has a steroidal skeleton of tetracyclic triterpene and possess diverse pharmacological activities such as anti-aging, anti-inflammatory, anti-fibrosis, pro-wound healing, liver protection and endothelial protection. In addition, cycloastragenol is the only telomerase activator reported in natural products, which is closely related to MAPK and PI3K/Akt signaling pathways. This review provides a theoretical basis for the development of cycloastragenol into the candidate for the treatment of multi-factorial diseases in clinic, focusing on the extensively biological activities as well as the mechanism of action and structural modification and aiming to attract researchers to conduct in-depth studies on cycloastragenol. Meanwhile, the pharmacokinetics and toxicology studies of CAG are also described for further druggability exploration to provides valuable reference.

MO101: Atypical Haemolytic Uremic Syndrome Associated with COVID-19: Case Report

BACKGROUND AND AIMSRenal manifestations are common in hospitalized patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We report here the case of a patient with confirmed SARS-CoV-2 infection with the clinical picture of atypical haemolytic uremic syndrome (aHUS).METHODCase reportRESULTSOur case is a 31-year-old man with a nasopharyngeal swab with real-time reverse-transcriptase polymerase chain reaction (RT-PCR) for SARS-CoV-2 positive, who was hospitalized in the Clinic of Infectious Diseases. His medical history had a respiratory illness of 7-day evolution characterized by cough, fever, dyspnoea, muscle pain, nausea, vomiting and non-bloody diarrhoea, and decreased urine output with dark colour urine. The chest computed tomography (CT) scan showed few rounded ground-glass opacities.Laboratory tests at admission revealed the following: (i) acute kidney injury stage 3 with a serum creatinine of 3.85 mg/dL (basal value 0.9 mg/dL); serum urea 221 mg/dL. His urinary volume in the first 24 h of hospitalization was 800 mL. (ii) Severe haemolytic anaemia with haemoglobin (Hgb) level of 3.7 g/dL, and peripheral smear showing large number of schistocytes, haptoglobin <10 mg/dL and indirect bilirubin 9.7 mg/dL, direct coombs testing was negative; reticulocyte count 8.9%. (iii) Severe thrombocytopaenia with platelet count of 25 000/µL, prothrombin time 45%, international normalized ratio 1.7, D-dimer 1082 ng/dL and fibrinogen 880 mg/dL.Increased blood levels of enzymes and inflammatory markers were present: lactate dehydrogenase 1867 U/L and protein C reactive 9.1 mg/dL. Electrolyte disturbances characterized by hyperkalaemia, hyperphosphatemia, hypocalcaemia and severe metabolic acidosis. Dynamic changes of laboratory data are presented in Table 1.Table 1.Dynamic changes of laboratory dataLaboratory dataDay 0Day 3Day 7Day 11Day 15Day 19Total serum bilirubin (mg/dL)16.454.8625.8914.69.74.2PT (%)455867889999LDH (U/L)55218671704768667455Serum urea (mg/dL)22121579635645Serum creatinine (mg/dL)3.851.570.70.60.50.6RBC ×106/µL1.221.611.723.233.763.98Hgb (g/dL)3.75.26.58.99.19.3PLTs (K/µL)2533395698178WBC (K/µL)11.224.522.316.214.511.3D-dimer (ng/dL)108246456893423035001800PCR (mg/dL)8.579.117.625.234.451.62Serum fibrinogjen (mg/dL)880647556550450450PT, prothrombin time; LDH, lactate dehydrogenase; RBC, red blood cell; Hgb, haemoglobin; PLT, platelet cell count; WBC, white blood cell; PCR, protein C reactive.The usual liver panel tests, alkaline phosphatase, γ-glutamyl transferase and albuminemia were normal. Toxic hepatitis was excluded. Hepatobiliary and spleen imaging (ultrasonography) was normal.ELISA serologic tests for HIV, hepatitis B, hepatitis C virus and cytomegalovirus were negative. Serological and virological tests for hepatitis A, B, C, HIV and CMV were negative. Stool was negative for Shiga toxin-producing Escherichia coli (STEC).The results of antinuclear antibodies and anti-smooth-muscle antibodies were negative, C3 serum level was mildly depressed (82 mg/dL; normal range 88–201 mg/dL) and C4 serum level was normal (20 mg/dL; normal range 10–44 mg/dL). ADAMTS13 activity was 90% on day 10.He was treated with broad spectrum antibiotics, intravenous dexamethasone and supportive therapy. One week from admission, renal function recovered, and 1 week after intravascular haemolysis and thrombocytopaenia recovered. The patient was hospitalized for 21 days.CONCLUSIONClose monitoring and early intervention can help for a better outcome of SARS-CoV-2 patients complicated with aHUS.

Pulmonary embolism in patients with dyspnea after COVID-19 infection.

Pulmonary embolism as a potential complication that may occur late in the course of COVID-19 cases. The aim of our study is to evaluate the frequency of pulmonary embolism in patients with new or ongoing dyspnea after a COVID-19 infection. This is a single-center, prospective observational study to evaluate the clinical and radiological outcomes of consecutive patients presenting outpatient clinic diseases to the chest and a new or ongoing dyspnea after a COVID-19 infection. Demographic, clinical and laboratory data were collected. Dyspnea was evaluated according to the New York Heart Association (NYHA) classification. Pulmonary embolism was detected in 23.8% (25/105) of patients with new or ongoing dyspnea after a COVID-19 infection. Proportion of pulmonary embolism in patients with NYHA classes I, II, III and IV were respectively 8.7%, 20.0%, 30.0% and 35.3% (p for trend=0.02). Compared to NYHA class I and II patients with dyspnea, those in NYHA classes III and IV showed a higher rate of pulmonary embolism [31.6% vs. 14.6%, OR: 2.7 (1.0 to 7.1), p=0.04, respectively]. In Logistic Procedures, NYHA classes of dyspnea (OR: 4.3, 95% CI: 1.2 to 16.6, p=0.03) (NYHA class III and IV vs. NYHA class I and II) determine the likelihood of pulmonary embolism after COVID-19 infection. Pulmonary embolism is common in patients with new or ongoing shortness of breath after a COVID-19 infection. Pulmonary embolism is more likely to develop in patients with higher NYHA classes.

Diagnostic markers of exacerbation of chronic obstructive pulmonary disease in workers exposed to industrial aerosols and tobacco

Introduction. Chronic obstructive pulmonary disease (COPD) is one of the most common occupational diseases registered in workers exposed to dust for a long time. This disease significantly worsens the quality of life, requires constant monitoring in the centers of occupational pathology and regular preventive measures. The proportion of COPD in the structure of occupational diseases has not changed significantly for decades, high rates of disability and premature mortality characterized this disease. The study aims to research the diagnostic parameters of COPD exacerbation under the influence of industrial aerosols and tobacco in the clinic of occupational diseases. Materials and methods. Researchers examined 153 patients with occupational COPD (toxic gases and inorganic dust). The comparison group consisted of 103 patients with smoking COPD. We established the diagnosis of COPD in accordance with the criteria of GOLD 2011. The duration of the study was 5 years. The authors conducted a complex of clinical and laboratory studies in all patients with an emphasis on the diagnostic parameters of COPD exacerbation and lung function. The critical significance level is p=0.05. Results. The development of occupational COPD under the influence of industrial aerosols and tobacco affects the frequency and predominant phenotype of exacerbations. Rare but severe exacerbations, mainly with eosinophilic type of inflammation, are present in COPD from the action of toxic gases. They respond well to therapy with systemic GCS. With COPD from the action of dust, hospitalization is not necessary for short-term exacerbations with neutrophilic type of inflammation, since such exacerbations respond to therapy with bronchodilators, and a significant proportion of exacerbations require the use of antibacterial therapy. Also, in COPD from the action of toxic gases, the experience of exposure to aerosols and gases of the production environment is an independent predictor of any exacerbations. But we do not have data on the significance of the length of service and the intensity of dust exposure. Conclusion. The risks of exacerbations of occupational COPD and the predicted features of their course depend on the etiological production factor, its intensity and duration of exposure. Clinical features determine different tactics of treatment and prevention of health deterioration. With the severity of COPD exacerbation from the action of toxic gases, symptoms of emphysema and hypoxemia are characteristic, with COPD from the action of dust, symptoms of bronchial obstruction, emphysema and hypoxemia are characteristic. Obtained results can use to construct risk meters of exacerbations and the scale of effectiveness of rehabilitation measures, to revise the standards of treatment and prevention of patients with COPD of professional genesis, as well as for the differential diagnosis of occupational obstructive pulmonary disease. Limitations. The study was conducted on the basis of Novosibirsk State Medical University and on the basis of the City Clinical Hospital No. 2. The limitations of the study may be the unidirectionality of the study performed and the small sample of patients participating in the research. Ethics. All patients have signed an informed consent form. The study program, the content of the informed consent, and the materials of the article were approved by the local ethics committee of Novosibirsk State Medical University and City Clinical Hospital No. 2.

Renal-clearable dye-conjugated silver nanoparticles for in vivo plasma biothiol sensing through urinalysis

The attractive physical and chemical properties of silver nanoparticles (AgNPs) have enabled their applications in many sectors such as medicine and sensing. Here, we report an ultra-stable AgNPs-based platform for real-time in vivo plasma biothiol sensing through a facile urinalysis. The platform is created by conjugating a renal-clearable organic dye, TAMRA, as a protecting surface layer on glutathione (GSH)-coated AgNPs. This AgNPs-based platform is stable in aqueous solution for at least 4 months; while upon interactions with biothiols like GSH, a 24-fold increase in fluorescence intensity and a 30 nm red shift in UV-Vis spectra can be achieved. After intravenous (i.v.) injection, the AgNPs-based platform can be activated by plasma biothiols. The successful fluorescent imaging of mouse bladder and the following UV-Vis analysis of urine samples at different time points post i.v. injection proved the AgNPs-based platform an efficient tool for plasma biothiol sensing through urinalysis. Taken together, this approach offers a practical pathway for diagnosis of biothiol-associated diseases in clinics, and the synergistic effects generate from the combination of dyes and AgNPs enable them for further in vivo monitoring and detection.