Dramatic Recovery Research Articles

Factors associated with neurological outcomes in patients experiencing out-of-hospital cardiac arrest and severe acidaemia: retrospective analysis of a nation-wide registry

Background and objectiveAcidaemia is common among individuals who experience out-of-hospital cardiac arrest (OHCA). While severe acidaemia is a strong predictor of unfavourable outcomes, a subset of patients exhibits dramatic recovery. Despite these conflicting outcomes, little is known about the factors associated with neurological outcomes in those who experience OHCA with severe acidaemia. MethodsThis retrospective analysis used data from a Japanese multicentre nationwide database, the Japanese Association for Acute Medicine OHCA Registry. The analysis included data from adult patients with OHCA for whom blood pH data were available upon arrival to hospital. The primary outcome was 30-day survival with favourable neurological outcomes, defined as a Glasgow-Pittsburgh cerebral performance category score of 1 or 2. Patients were categorised with severe acidaemia if their blood pH was ≤ 6.8. Factors associated with favourable outcomes were investigated using multiple logistic regression analysis. ResultsData from 49,044 patients were included in the analysis, of whom 16,620 exhibited severe acidaemia with a median pH of 6.70 (interquartile range [IQR] 6.61–6.76], and 0.5% (86/16,620) experienced a neurologically favourable outcome. After adjustment for important prognostic factors, witnessed status exhibited a strong association with favourable neurological outcome (adjusted odds ratio [aOR] 6.46 [95% confidence interval (CI) 2.64–15.8]), while initial blood pH exhibited no significant association (aOR 0.90 with every 0.1 unit increase [95% CI 0.71–1.14]). ConclusionAlthough the number is small, a notable number of patients with severe acidaemia exhibited good neurological recovery. Witness status was critical for the prognosis of these patients.

Hurricane-induced dramatic decline and natural recovery of a vulnerable sportfish population: Shoal bass (Micropterus cataractae) in the Chipola River, Florida

Freshwater fishes are among the most biodiverse vertebrate groups and among the most threatened by anthropogenic activities. Many occur in small and geographically restricted populations that are increasingly subject to catastrophic events (hurricanes, wildfires, extreme floods and droughts), but it has rarely been possible to assess the impacts of such events. Here we document the decline and recovery of a regularly monitored, small shoal bass (Micropterus cataractae) population in the Chipola River, Florida following a catastrophic hurricane disturbance. The Chipola River population has the lowest level of interspecific hybridization (over 90 % non-introgressed shoal bass) within the species' range, a census population size of 2165 (95 % CI [1,383, 3,801]) in 2009 and a genetically effective population size Ne of 135 (95 % CI [70, 472]). In 2018, Hurricane Michael devastated the Chipola River and watershed. A survey conducted in 2019 indicated a severe decline (91 %) in relative population abundance and a very low Ne at 21 (95 % CI [16, 29]). However, the detection of young-of-year fish indicated that the depleted population had experienced successful reproduction. In fall 2021, the census population had recovered to 1039 fish (95 % CI [660, 1,814]) and Ne at 40 (95 % CI [31, 50]). While the population has shown considerable resilience in the face of hurricane disturbance, it remains vulnerable to future catastrophic events and may also suffer a long-term reduction in its adaptive potential due to a relatively low effective population size. To address these threats, continued monitoring is necessitated and targeted measures such as translocation of non-introgressed individuals from neighboring populations or establishment of a captive population of sufficient effective population size may be required to conserve the species in the long term.

Using marine protected areas to assess the status and recovery of the spiny lobster Jasus edwardsii fishery in the Hauraki Gulf, Aotearoa New Zealand

The value of no-take marine protected areas (MPAs) in providing fisheries-independent information to evaluate the status of adjacent fish stocks is increasingly being recognised. However, to ensure robust assessments of fisheries using this approach, MPAs need to be representative of the wider fished area and sampling should include multiple MPA and fished locations spanning the area of interest. The spiny lobster Jasus edwardsii fishery in Aotearoa New Zealand’s Hauraki Gulf has been in decline since the late 1990s, but latest stock estimates suggest a dramatic recovery following catch reductions in 2018. We compared J. edwardsii populations on shallow reefs (<20 m depth) in three marine reserves with six fished locations across the Hauraki Gulf to provide a fisheries-independent assessment of this important fishery and the degree of recovery following catch reductions. Region-wide surveys found that J. edwardsii populations within protected areas were dominated by large, legal-size individuals, whereas lobster in fished locations were mostly below or around legal-size. Total, vulnerable, and spawning stock biomass was 12-43 times higher within MPAs compared to fished locations. Overall, biomass at fished locations was <10% of that in reserves and there was little evidence of recovery following catch reductions. Our fisheries-independent data suggest that recent stock assessments have severely overestimated the recovery and state of lobster populations in the Hauraki Gulf and that populations on shallow reefs remain depleted. These findings highlight the critical need for fisheries-independent data and the value of MPA monitoring data in evaluating population status and recovery following fisheries management actions.

Damage recovery stages revisited: Thermal evolution of non-saturated and saturated displacement damage in heavy-ion irradiated tungsten

Establishing the correlation between damage recovery and temperature in nuclear materials is vital to understanding material property degradation. Among the handful of topics related, one long-standing concern is the differences in damage recovery caused by different initial defect concentrations, with respect to ranges below and beyond the damage saturation limit. In this study, the temperature dependence of damage recovery has been comprehensively elucidated for pure tungsten, irradiated with 6 MeV copper ions at room temperature (RT), up to 0.05 dpa (non-saturated damage, n-SD) and 0.6 dpa (saturated damage, SD), and followed by isochronal annealing. Coupled transmission electron microscopy and Doppler broadening positron annihilation spectroscopy characterizations provided a full-probe-range picture of defect evolution. The varied initial defect concentrations caused retaining differences in damage recovery, but no substantial influence on temperature-dependent defect evolution. Moderate and dramatic damage recovery were identified below 973 K and above 1123 K in n-SD and SD tungsten, respectively. Most strikingly, nano-sized voids were confirmed at 473 K in both samples. Annealing at 1873 K saw the complete removal of defects in n-SD tungsten, but survival of a few dislocations via void pinning in SD tungsten. Full damage recovery in SD tungsten was projected to be ∼2000 K. The current revisit of damage recovery stages demonstrated the significance of encompassing scenarios of non-saturated and saturated defect concentrations. Accordingly, four damage recovery stages were redefined for heavy-ion irradiated tungsten, namely stage I (20 K–RT), stage II (RT–653 K), stage III (653–1123 K), and stage IV (1123–2000 K).

The Challenge of Lorazepam Failure: Malignant Catatonia Treated Successfully with Valproate

IntroductionDespite the unclear nature of catatonia, the treatment response of catatonia to benzodiazepines is widely known for its typical, dramatic recovery. The neurobiological correlates of this phenomenon regarding specific receptors and neurotransmitters are unclear, as are the potential treatment options. This is important to consider when the most commonly recommended treatments of catatonia with Lorazepam or Electroconvulsive Therapy (ECT) are unavailable or unsuccessful. In this report, we describe a case of severe, malignant catatonia and psychosis mostly unresponsive to Lorazepam during two different hospitalizations, but with eventual return to baseline after successful treatment with Valproate.Objectives-To describe a unique case of malignant catatonia that was unresponsive to Lorazepam-To illustrate the potential utility of Valproate as an alternative treatment strategy for catatonia MethodsThis is a case report.ResultsA 19-year-old Hispanic male presented to our hospital initially with family reports of severe and sudden depression with bizarre behavior. Prior to this admission, the patient had been discharged recently from another tertiary hospital following a 2-week admission for severe catatonia. Chart review from that admission scored the patient’s Bush-Francis Catatonia Rating Scale (BFCRS) at 16, which remained mostly unchanged after numerous additional intramuscular doses and standing oral doses of Lorazepam, with a reduction of BFCRS the next day of only 2. During the patient’s admission at our hospital, the patient endorsed bizarre, guilt-related delusions, and his catatonia was more severe and malignant with a BFCRS of 19, with tachycardia and diaphoresis. The patient was initially given a total of seven doses of a mix of intramuscular and oral Lorazepam (total 18mg), with a minimal 2-point reduction in BFCRS. As ECT was unavailable, Lorazepam was discontinued in favor of a trial of oral Valproate 500mg twice daily, and after his catatonia subsided (with a serum level of 60.8), he was started on oral Risperidone 0.5mg once at night, titrated up to 3mg twice daily, and eventually returned to baseline as confirmed by his family members.ConclusionsThe treatment of catatonia with Lorazepam is usually reliable and has been found to be up to 80% effective, but when the recommended use of benzodiazepines and ECT fail or are unavailable, there are few studies exploring the viability of alternative treatment options. With the use of Valproate, previous studies have shown it can treat even severe catatonia (KrÜger, J Neuropsychiatry 2001; 13:303-304), or can actually be its cause (Lauterbach, Neuropsychiatry, Neuropsychology, and Behavioral Neurology. 1998 Jul;11(3):157-163). As such, this case report highlights the importance of exploring alternative treatments for catatonia, including Valproate, in order to better tailor the management of this unique syndrome.Disclosure of InterestNone Declared

Are marine reserves and temporary closed areas effective in enhancing blue cod (Parapercis colias) sub-populations?

ABSTRACT The primary aim of this study was to determine if blue cod (Parapercis colias) sub-populations demonstrate increases in abundance and size when protected from fishing. (1) Four South Island, New Zealand no-take marine reserves (MR) (Long Island Kokomohua, LIMR; Hikurangi, HMR; Ulva Island, UIMR; and Five Fingers, FFMR), and areas directly outside these MRs were surveyed using potting surveys. Abundance was higher and mean length larger inside than outside the MRs in thirteen and eleven of the fourteen surveys, respectively. Protection from fishing within three of the four MRs (LIMR, HMR, UIMR), appears to have allowed recovery of blue cod to a lesser or greater extent. (2) Three potting surveys spanned the temporary 2.5 year (2008–2011) closure of the inner Queen Charlotte and Pelorus Sounds to blue cod fishing. Blue cod abundance and mean length increased after closure for two years, and then decreased 30 months after opening as did blue cod presence. Growth alone may be sufficient to account for the observed increases in abundance and size during the closure. Protection from fishing during the temporary inner sounds closures, resulted in a dramatic recovery of blue cod followed by a return to towards pre-closure levels after re-opening.

P14 Bullous sweet syndrome as a presentation of chronic myelogenous leukaemia

Abstract A variety of cutaneous lesions are frequently encountered in clinical practice that could be secondary to allergic reactions, infections or an underlying systemic illness, including malignancy. Some of the most commonly observed paraneoplastic dermatological manifestations include acanthosis nigricans, necrolytic migratory erythema, acrodermatitis paraneoplastica, exfoliative erythroderma, paraneoplastic pemphigus, pyoderma gangrenosum and Sweet syndrome. Sweet syndrome is a neutrophilic dermatosis characterized by a particular constellation of clinical symptoms, signs and histopathological findings: pyrexia; peripheral leucocytosis; and painful erythematous skin lesions (papules, plaques and nodules) that typically reveal a dense dermal neutrophilic infiltrate and dramatic recovery of both symptoms and physical findings following treatment with systemic corticosteroids. Sweet syndrome is frequently related to malignancies and chronic inflammatory disorders, and it can also be caused by drugs. It can also be triggered by past infections or during pregnancy. We present a case of bullous variant of Sweet syndrome associated with chronic myelogenous leukaemia (CML) where the patient presented with crusted bullae and tender erythematous crusted plaques on all four limbs and face. Investigations revealed leucocytosis with peripherally circulating blasts, myelocytes and metamyelocytes. Skin biopsy revealed Sweet syndrome and bone marrow biopsy confirmed evidence of CML in the accelerated phase. The skin lesions, which had previously been resistant to therapy, surprisingly disappeared within 3 days of initiating systemic corticosteroids. In this case, the skin lesions were a crucial clinical finding in detecting and treating the underlying CML. Because of the early intervention, our patient had a good outcome.

Analysis of Factors Affecting Outcome of Acute Extradural Hematoma—Our Observation in Dhaka Medical College and Hospital

Abstract Background Extradural hematoma (EDH) is a leading cause of death in young population. Timely intervention gives dramatic recovery but often fatal if not treated in time. The surgical outcome of EDH depends on many variables that strongly affect the prognosis of the disease, which are preoperative Glasgow coma scale (GCS), overlying skull fracture, time interval between injury and surgery, other associated intracranial injuries (like cerebral contusion, subdural hematoma, or intracerebral hematoma), pupillary abnormalities (anisocoria), and hematoma volume. But no correlation was found between surgical outcome of EDH and age, sex, etiology, and site of hematoma. Objective We want to identify the factors affecting the surgical outcome of EDH that will help us in preoperative prioritization of the cases for intervention, adequate resuscitation, and counselling the attendant regarding the outcome. Our ultimate goal was to reduce the mortality and morbidity from this disease. Methods This study was conducted on the patients admitted through neuroemergency and diagnosed as EDH by computed tomography scan of head, in the department of Neurosurgery of Dhaka medical college and hospital from January 1, 2017 to December 31, 2019. This is three-year prospective interventional study where all the patients underwent surgical evacuation of EDH on emergency basis and outcome was measured by Glasgow outcome scale (GOS) after 48 hours of admission and at discharge. Results Outcome was divided into good (GOS 4,5) and poor (GOS 1–3) groups. Pre-operative GCS, overlying skull fracture, time interval between injury and surgery, associated intracranial injuries, anisocoria and hematoma volume were the factors affecting the surgical outcome significantly. Conclusion Good surgical outcome is associated with EDH volume less than 40cc, preoperative GCS more than 8, absence of anisocoria, overlying skull fracture, no associated intracranial injury and surgery within 12 hours of injury. But age, sex and site of EDH has no definite correlation with outcome.

Influencing factors of early dramatic recovery of neurological function after intravenous thrombolysis in patients with branch atheromatous disease.

Intravenous thrombolysis can significantly improve the neurological function of patients with acute ischemic stroke. However, the expected early dramatic recovery (EDR) of neurological function after thrombolysis is not achieved in some patients with branch atheromatous disease (BAD). Here we evaluated the factors associated with EDR after thrombolysis in BAD patients. We conducted a retrospective study on 580 consecutive BAD patients. All patients met the diagnostic criteria of BAD and received intravenous recombinant tissue-type plasminogen activator (rt-PA). EDR was defined when the improvement of National Institutes of Health Stroke Scale (NIHSS) score was >8 points within 2 or 24 hours after rt-PA, or the total NIHSS score was 0 or 1. The factors associated with EDR were analyzed with multivariate logistic regression analysis. Among 580 patients, the incidence of EDR was 35.2% (204 cases). Compared with patients without EDR, patients with EDR had lower incidence of diabetes (15.7% vs 29.3%, P < .001), lower NIHSS scores at 2 and 24 hours after rt-PA (P < .001), less cerebral hemorrhage (0% vs 5.3%, P = .001), and shorter onset to treatment time (OTT) (P < .001). Multivariate logistic regression analysis in propensity score-matched cohort showed that EDR was associated with OTT (adjusted OR = 0.994; 95% CI, 0.989-0.999) and NIHSS score after rt-PA (adjusted OR = 0.768; 95% CI, 0.663-0.890). Notably, diabetes (adjusted OR = 0.477, 95% CI, 0.234-0.972) was an independent factor related to EDR of neurological function in BAD patients. In the subgroup analysis, a lower incidence of diabetes (adjusted OR = 0.205, 95% CI: 0.059-0.714, P = .013) and a lower NIHSS score after thrombolysis in patients with paramedian pontine infarction (adjusted OR = 0.809, 95% CI: 0.656-0.997, P = .047) were significantly associated with EDR. Diabetes is not conducive to EDR of neurological function in patients with BAD, especially in patients with paramedian pontine infraction. Low NIHSS score and short OTT after thrombolysis may be closely related to EDR after intravenous thrombolysis.

Electrochemical behavior of steel bars in magnesium phosphate cement

The electrochemical characteristics of steel bars in magnesium phosphate cement (MPC) are crucial when applying MPC to reinforced concrete. In this study, the electrochemical behaviors of steel bars in MPC were investigated via electrochemical tests combined with surface analyses. The results indicated that the steel bars in the simulated MPC pore solution could effectively passivate, forming films that mainly consisted of FePO4. In the MPC matrices, the continuous precipitation of phosphates led to the accumulation of passive films, which were responsible for the superior corrosion protection of MPC compared to traditional cement materials. MPC exhibited a self-healing corrosion feature after the depassivation of steel bars, which could be characterized by the dramatic recovery of passive film resistance and charge transfer resistance. Furthermore, the corroded steel bars in MPC with a low magnesia-to-phosphate ratio could re-passivate and stabilize for long periods of time.

A case report of systemic lupus erythematosus coinciding with rhabdomyolysis: a dramatic recovery via therapeutic plasma exchange

A case report of systemic lupus erythematosus coinciding with rhabdomyolysis: a dramatic recovery via therapeutic plasma exchange

GASTROINTESTINALTRACT: THE WORLD OF ‘SECOND BRAIN’

Mothers gift not just life but also a microbial profile to their babies, i.e., for vaginally delivered babies, these communities resemble the specific microbial communities found in the mother’s birth canal; for babies delivered by caesarean section, the communities resemble the skin communities of the mother. These gut microbiota, via a complex bidirectional communication system, interact with the Central Nervous System, the enteric nervous system, and the hypothalamo-pituitary-adrenal axis (HPA) (cognitive and emotional centers), referred to as the Gut-Brain axis. Though in contemporary societies microbes have a strong negative connotation and are viewed in a warlike context, not all are harmful but beneficial and indeed crucial for a normal healthy life. As many ongoing research studies link the pathogenesis of various diseases to altered gut microbiota, many studies on the other hand show dramatic recovery with faecal microbiota transplantation, confirming the earlier.

Ochrobactrum anthropi: An unusual opportunistic pathogen causing septicemia and Pneumonia

is being increasingly recognized as an opportunistic human pathogen, causing severe infections mostly in debilitated or immunocompromised patients. It has been implicated in causing nosocomial infections, particularly in those with indwelling catheters, which can lead to catheter-related bloodstream infections. We report the constellation of clinical, microbiological and radiological findings of a case of septicemia and pneumonia caused by this unusual pathogen. Treatment of anthropi infection is challenging because of an unpredictable resistance to antibiotics. Correct identification and timely initiation of an appropriate antimicrobial therapy proves to result in the dramatic recovery of the patient.

Case report: Recovery of hallucinations and cognitive impairment after administration of donepezil in a patient with schizophrenia and carbon monoxide poisoning

This report aims to introduce a rare case of a dramatic recovery by donepezil with a patient with schizophrenia who suffered from remaining psychotic symptoms despite proper treatment and had a cognitive impairment by carbon monoxide (CO) poisoning sequelae. A 38-year-old male who developed schizophrenia 2 years ago had attempted suicide via CO inhalation due to his uncontrolled symptoms. He was hospitalized with delayed neurological sequelae (DNS). Though hyperbaric oxygen therapy (HBOT) was applied 10 times, his cognitive impairment did not recover. Surprisingly, with 5-10 mg donepezil, both cognitive function and the psychotic symptoms of the patient remarkably improved. This case showed a good response of donepezil for a patient with schizophrenia and CO-induced DNS after ineffective HBOT. Although the mechanism of the phenomenon is unclear, it can be possible reasons that the neuroprotective effect of donepezil and white matter insult by CO poisoning.

Experimental Evaluation of Foam Diversion for EOR in Heterogeneous Carbonate Rocks

Immiscible gas injection applied to heterogeneous carbonate reservoirs can be inefficient due to poor conformance control. Foam mobility control is proposed in this work as a solution for gas conformance issues in such reservoirs. A unique experimental program was developed to evaluate alkyl polyglucoside (APG) stabilized foam for foaming ability, emulsion-forming tendency and resistance to oil. Dynamic methane foam behavior is systematically studied through single and dual injection core flooding experiments, simulating foam diversion during immiscible methane flooding in a layered reservoir with a significant layer permeability contrast. Results show a stable foam-oil system with no viscous emulsions at very high formation brine salinity (144,000 ppm total dissolved solids). Single-core floods for the high permeability layer (Unit-A) showed that foam viscosity of 27 cP could be achieved at 11% oil saturation (So). Under similar oil-wet condition, the low permeability zone (Unit-B) could generate foam of 21 cP at 18.9% So, indicating an increase in injected fluid mobility reduction with permeability. Dual-core injection experiments, which is designed to evaluate accurately fluid diversion capacity of such foams, reveals remarkable dynamic foam behaviors. While the water-wet condition indicates the scalability of foam behaviors (i.e., the ability of foam to control fluid mobility against the variation of rock permeability) between the single and composite core systems, the oil-wet condition confirms good foam resistance to residual oil that resulted in an increase in Unit B production from 46 to 82%, and 74 to 85% for Unit-A. Moreover, dual-core floods representing premature waterfloods (i.e., higher oil saturation) shows even more dramatic incremental oil recovery (44 to 81% in Unit-A and 17.5 to 71% in Unit-B), evidencing the ability of foam to self-viscosify with permeability variation at varying oil saturations.

A Rare Scenario of Acute Traumatic Thoracic Disc Herniation and Review of the Literature

Background and Importance: Sequestrated thoracic disc herniation after a traumatic event without an apparent spinal fracture or dislocation is an extremely rare scenario. Case Presentation: Evaluation of an elderly female with acute paraparesis secondary to a fall down to the ground revealed a right-sided extruded disc at the level of T10-T11. At 6-month follow-up, she made a dramatic recovery following an appropriate surgical intervention. Conclusion: With occurrence of acute paraparesis following a traumatic event, MRI of the vertebral column is necessary, even in the absence of tomographic evidence of fracture-dislocation.

Preparation of mesoporous carbon containing Polyurethane/Clay nanocomposite membrane based sensors for sensitive and selective determination of vitamin D2 in urine samples

Mesoporous carbon containing polyurethane/clay membrane based sensors were produced for the rapid and sensitive electroanalytical determination of fat-soluble vitamin D2. Mesoporous carbon structures were prepared by the carbonization of bee pollens which were easily available in nature. These structures were combined with clay and polyurethane structures. The determination of vitamin D2 with modified electrodes was carried out by using square wave voltammetry in acetonitrile containing 0.1 M LiClO4. According to the response of modified electrode, a linear relationship was obtained between the anodic oxidation peak currents and concentrations of vitamin D2 in the linear concentration range (23 µM − 844 µM) with a low detection limit (0.73 µM) was obtained. The sensitivity (4.65 μA cm−2 μM−1) and reproducibility (RSD%, 1.87 %) of the prepared novel sensor were found to be quite satisfactory. The proposed method and applicability of the electrode were tested in urine samples, achieving dramatic recovery values (99.99 %).

Unique Compensation Effects of Heavy Metals and Phosphorus Copoisoning over NOx Reduction Catalysts.

Selective catalytic reduction (SCR) of NOx from the flue gas is still a grand challenge due to the easy deactivation of catalysts. The copoisoning mechanisms and multipoisoning-resistant strategies for SCR catalysts in the coexistence of heavy metals and phosphorus are barely explored. Herein, we unexpectedly found unique compensation effects of heavy metals and phosphorus copoisoning over NOx reduction catalysts and the introduction of heavy metals results in a dramatic recovery of NOx reduction activity for the P-poisoned CeO2/TiO2 catalysts. P preferentially combines with Ce as a phosphate species to reduce the redox capacity and inhibit NO adsorption. Heavy metals preferentially reduced the Brønsted acid sites of the catalyst and inhibited NH3 adsorption. It has been demonstrated that heavy metal phosphate species generated over the copoisoned catalyst, which boosted the activation of NH3 and NO, subsequently bringing about more active nitrate species to relieve the severe impact by phosphorus and maintain the NOx reduction over CeO2/TiO2 catalysts. The heavy metals and P copoisoned catalysts also possessed more acidic sites, redox sites, and surface adsorbed oxygen species, which thus contributed to the highly efficient NOx reduction. This work elaborates the unique compensation effects of heavy metals and phosphorus copoisoning over CeO2/TiO2 catalysts for NOx reduction and provides a perspective for further designing multipoisoning-resistant CeO2-based catalysts to efficiently control NOx emissions in stationary sources.

E-cigarette or Vaping product use Associated Lung Injury (EVALI) in a 15 year old female patient – case report

BackgroundE-cigarettes are devices which allow to aerosolize liquids containing nicotine or other substances. Ever since they were released on the market in 2006, the number of users have been constantly increasing, especially among adolescents, ranging from 7,6% to 9,3% in the age group 18–24 years old from 2014 to 2019. Hand in hand with the spread of E-cigarettes many have been the efforts to understand their impact on health. EVALI (E-cigarette or Vaping product use Associated Lung Injury) is an emerging condition with a heterogeneous presentation with several reported cases worldwide. We mean to report a case of EVALI in a 15-year-old female Caucasian patient, who's currently attending her clinic follow-up at Bambino Gesù Pediatric Hospital in Rome.Case presentationThe patient was admitted to the Emergency Room due to acute respiratory failure in November 2020. At admittance, she was severely dyspneic (HR 120 bpm, SatO2 75%). As she was hospitalized amid the COVID-19 pandemics, she underwent a nasopharyngeal swab for SARS-CoV2, which turned out negative, and a chest CT scan. Chest CT scan showed a central ground grass pattern with peripheral sparing. At the anamnestic recall, it was disclosed she was an e-cigarette smoker and occasional marijuana user. The microbiological work-up proved only positive for Rhinovirus. Her clinical and radiological case was discussed with our radiologist who suspected EVALI. She was assisted through HFNC, antibiotical therapy and corticosteroids with a dramatic recovery within the first 48 h.ConclusionsEVALI started being recognized a specifically nosological entity in summer 2019, with increasing cases being reported. No diagnostic criteria have been agreed upon yet, but its usual presentation includes respiratory, gastrointestinal and systemic symptoms of different degree and the diagnosis can be hypothesised in case the patient has an evocative clinical and radiological presentation and has been an E-cigarette smoker in previous 90 days. Due to the novelty of the condition and its heterogeneous presentation it is of interest to report the cases in which EVALI is identified to raise awareness about this emerging new-age disease.

Childhood Vasculitis Syndrome Mimicking Guillain Barre Syndrome

Background: Childhood vasculitis is a heterogeneous disorder, characterized by inflammation of the blood vessel walls. Multiple organs and/or tissues are affected, either simultaneously or successively. Vascular neuropathy occurs when the vasa nervorum is affected. Presentation includes mononeuritis multiplex, acute motor/motor-sensory axonal neuropathy, pure sensory neuropathy, and chronic inflammatory demyelinating polyneuropathy. Making a diagnosis is a challenge when neurological manifestations appear for the first time or are isolated. Clinical Description: A 12-year-old girl presented with acute pain and progressive weakness of both lower limbs for 12 days, followed by diffuse abdominal pain and low-grade fever. Salient neurological findings were diminished power and hyporeflexia in all limbs. Guillain–Barre syndrome was suspected in view of symmetric ascending paralysis and a suggestive nerve conduction study. The child had neutrophilic leukocytosis but sterile cultures. The successive development of inflammatory demyelinating polyneuropathy, persistent fever, vasculitic phenomena (hypertension, severe myalgia, rashes, multiple infarcts, acute renal cortical necrosis, and gangrene of the digit), and elevated acute-phase reactants was suggestive of a multisystemic small-vessel and medium-sized vasculitis syndrome, such as polyarteritis nodosa (PAN). A diagnosis of PAN was established based on the satisfaction of clinical criteria. Management: The patient was administered pulse methylprednisolone and oral steroids, with which there was a dramatic recovery. Monthly cyclophosphamide was continued in view of major systemic involvement. Conclusion: Early recognition and management of childhood vasculitis syndrome is associated with good outcomes.