Dyspnea Research Articles

Which Laboratory and Clinical Feature are different in Pregnant and Non-pregnant Women with COVID-19? A Cross-sectional Study in the West of Iran

Background: This study aimed to determine the differences in laboratory and clinical characteristics of pregnant and non-pregnant women with COVID-19 in Hamadan, the west of Iran. Material & Methods: This cross-sectional study compared 135 pregnant with 135 non-pregnant women without underlying diseases and matched by age with COVID-19 from March 2020 to June 2021 in Hamadan, a western city in Iran. Their demographic characteristics, clinical symptoms, vital signs, and laboratory findings were evaluated using a preset checklist and contrasted between the two groups. The adjusted odds ratios (ORs) for the outcomes of illness were presented. A considerable amount of analysis was performed on all data using the SPSS version 26 software. Results: In general, there was a significant association between most clinical symptoms and status of pregnancy. Although the Peripheral oxygen saturation with a pulse oximeter (SPO2) mean was significantly lower among non-pregnant compared to the pregnant women (89.19±4.52 versus 94.91±3.12; p < 0.001), the mean of heart rate was significantly lower among pregnant women compared to non-pregnant women (90.59±11.80 versus 96.50±15.02; p = 0.001). The percentage of low hemoglobin (Hb), abnormal Blood Urea Nitrogen, high Creatinine (CR), high Erythrocyte Sedimentation Rate and high Lactate Dehydrogenase was significantly higher in non-pregnant women compared to the pregnant women. Women with pregnancy compared to non-pregnant women and women with low Hb compared to normal Hb had a considerably increased chance of intensive care unit /death. Each unit increase in SPO2 and pulse rate resulted in a considerable reduction in this risk. In addition, women with high CR, shortness of breath and per unit rise in temperature had a considerably higher chance of staying in the hospital for a longer period of time. Conclusion: The clinical and para-clinical manifestations of pregnant women with COVID-19 are different from non-pregnant women. Although there was a significant difference between the two groups due to mortality, the percentage of admission to the intensive care unit in pregnant women with COVID-19 is higher than in non-pregnant women. To avoid these adverse outcomes, pregnant women should take precautions to avoid COVID-19 infection.

Hidden Behind Chronic Dyspeptic Symptoms: Post-traumatic Diaphragmatic Eventration

Abstract 
 Diaphragmatic eventration is commonly seen following high-energy traumas, particularly due to traffic accidents and falls from significant heights. This pathology has the potential to influence both the gastrointestinal and cardiorespiratory systems, presenting with a variety of symptoms. A 45-year-old male patient, with a history of trauma from falling off a tree, sought medical attention at our clinic with dyspeptic complaints and symptoms of shortness of breath. During the physical examination, diminished sounds were detected in the right lung field, along with epigastric tenderness. For diagnostic purposes, a posteroanterior chest radiograph (CXRs) and thoracic computed tomography (CT) scan were obtained. A subsequent bronchoscopy, performed with a pulmonology consultation, revealed decreased diaphragmatic movements. Taking into account the findings, a thoracic surgery treatment plan was devised for the patient. This case report underscores the significance of considering the seldom-encountered pathology of diaphragmatic eventration in patients presenting with dyspeptic and respiratory complaints. Keeping in mind that patients with such symptoms frequently turn to family physicians, it highlights the pivotal role of a multidisciplinary primary care approach in initiating the diagnostic trajectory.

Electronic Patient-Reported Symptoms After Ambulatory Cancer Surgery

Complex cancer procedures are now performed in the ambulatory surgery setting. Remote symptom monitoring (RSM) with electronic patient-reported outcomes (ePROs) can identify patients at risk for acute hospital encounters. Defining normal recovery is needed to set patient expectations and optimize clinical team responses to manage evolving problems in real time. To describe the patterns of postoperative recovery among patients undergoing ambulatory cancer surgery with RSM using an ePRO platform-the Recovery Tracker. In this retrospective cohort study, patients who underwent 1 of 5 of the most common procedures (prostatectomy, nephrectomy, mastectomy, hysterectomy, or thyroidectomy) at the Josie Robertson Surgery Center at Memorial Sloan Kettering Cancer Center from September 2016 to June 2022. Patients completed the Recovery Tracker, a brief ePRO platform assessing symptoms for 10 days after surgery. Data were analyzed from September 2022 to May 2023. Symptom severity and interference were estimated by postoperative day and procedure. A total of 12 433 patients were assigned 110 936 surveys. Of these patients, 7874 (63%) were female, and the median (IQR) age at surgery was 57 (47-65) years. The survey response rate was 87% (10 814 patients responding to at least 1 of 10 daily surveys). Among patients who submitted at least 1 survey, the median (IQR) number of surveys submitted was 7 (4-8), and each assessment took a median (IQR) of 1.7 (1.2-2.5) minutes to complete. Symptom burden was modest in this population, with the highest severity on postoperative days 1 to 3. Pain was moderate initially and steadily improved. Fatigue was reported by 6120 patients (57%) but was rarely severe. Maximum pain and fatigue responses (very severe) were reported by 324 of 10 814 patients (3%) and 106 of 10 814 patients (1%), respectively. The maximum pain severity (severe or very severe) was highest after nephrectomy (92 of 332 [28%]), followed by mastectomy with reconstruction (817 of 3322 [25%]) and prostatectomy (744 of 3543 [21%]). Nausea (occasionally, frequently, or almost constantly) was common and experienced on multiple days by 1485 of 9300 patients (16%), but vomiting was less common (139 of 10 812 [1%]). Temperature higher than 38 °C was reported by 740 of 10 812 (7%). Severe or very severe shortness of breath was reported by 125 of 10 813 (1%). Defining detailed postoperative symptom burden through this analysis provides valuable data to inform further implementation and maintenance of RSM programs in surgical oncology patients. These data can enhance patient education, set expectations, and support research to allow iterative improvement of clinical care based on the patient-reported experience after discharge.

Merging Two Models of One-Dimensional Convolutional Neural Networks to Improve the Differential Diagnosis between Acute Asthma and Bronchitis in Preschool Children.

(1) Background: Acute asthma and bronchitis are common infectious diseases in children that affect lower respiratory tract infections (LRTIs), especially in preschool children (below six years). These diseases can be caused by viral or bacterial infections and are considered one of the main reasons for the increase in the number of deaths among children due to the rapid spread of infection, especially in low- and middle-income countries (LMICs). People sometimes confuse acute bronchitis and asthma because there are many overlapping symptoms, such as coughing, runny nose, chills, wheezing, and shortness of breath; therefore, many junior doctors face difficulty differentiating between cases of children in the emergency departments. This study aims to find a solution to improve the differential diagnosis between acute asthma and bronchitis, reducing time, effort, and money. The dataset was generated with 512 prospective cases in Iraq by a consultant pediatrician at Fallujah Teaching Hospital for Women and Children; each case contains 12 clinical features. The data collection period for this study lasted four months, from March 2022 to June 2022. (2) Methods: A novel method is proposed for merging two one-dimensional convolutional neural networks (2-1D-CNNs) and comparing the results with merging one-dimensional neural networks with long short-term memory (1D-CNNs + LSTM). (3) Results: The merged results (2-1D-CNNs) show an accuracy of 99.72% with AUC 1.0, then we merged 1D-CNNs with LSTM models to obtain the accuracy of 99.44% with AUC 99.96%. (4) Conclusions: The merging of 2-1D-CNNs is better because the hyperparameters of both models will be combined; therefore, high accuracy results will be obtained. The 1D-CNNs is the best artificial neural network technique for textual data, especially in healthcare; this study will help enhance junior and practitioner doctors' capabilities by the rapid detection and differentiation between acute bronchitis and asthma without referring to the consultant pediatrician in the hospitals.

Effect of Respiratory Telerehabilitation on Pulmonary Function Parameters and Quality of Life in Patients with COVID-19: A Randomized Controlled Trial

Background: Given the heightened impact of post-COVID-19, active involvement in the rehabilitation process, particularly in respiratory rehabilitation, is essential for these patients. This study addresses the urgent need for developing and evaluating remote respiratory rehabilitation methods post-COVID-19, focusing on enhancing patients' quality of life and pulmonary function. Objectives: The study aimed to investigate how respiratory telerehabilitation influences pulmonary function and the quality of life in this patient population. Methods: In this randomized controlled clinical trial, 60 COVID-19 patients from two major hospitals in Mashhad were evaluated during 2021 - 2023. The control group received a training booklet and an incentive spirometer, while the intervention group participated in a telerehabilitation program. This program involved four-week daily respiratory rehabilitation exercises conducted online using the Skyroom platform. At the end of each session, the patient's fatigue and shortness of breath were assessed using the Borg Rating of Perceived Exertion (RPE) Scale and the number of physical exercises completed. All patients completed the Quality of Life (QOL) Questionnaire and undertook the 6-Minute Walk Test (6MWT). Heart rate, respiratory rate, blood oxygen saturation (SPO2), maximum inspiratory pressure (MIP), fatigue, and shortness of breath were measured on the day of discharge and two and four weeks post-discharge. Covariance (ANCOVA) and repeated measures analysis of variance (RMANOVA) were analyzed for data analysis. Results: In both baseline-adjusted and fully-adjusted ANCOVA models, the results indicated a significant intervention effect after 4 weeks for MIP (73.43 ± 5.77), SPO2 (96.90 ± 1.21), Borg scale score (9.77 ± 1.59), and MWT6 (455.90 ± 37.70), (all P < 0.0001), with significantly higher changes observed in MIP, SPO2, Borg Scale score, and MWT6 after 2 weeks as well as after 4 weeks in the intervention group than the control groups. Also, in both models, the results indicated a significant intervention effect after 2 weeks as well as 4 weeks for physical functioning, role physical, vitality, social functioning, role emotional, Physical Health Scale score, and total SF36 score (60.37 ± 6.93) (P < 0.001). Conclusions: Using bidirectional audio and video communication in the telerehabilitation of COVID-19 patients significantly improved their pulmonary function and QOL. Based on these findings, it is recommended that this method be considered as an integral component in rehabilitation programs for COVID-19 patients.

Symptoms 6 months following SARS-CoV-2 infection in Nepali women.

In Nepal, over 1 million individuals have tested positive for SARS-CoV-2. We sought to describe the frequency of nonrecovery from this infection at 6 months and associated symptoms. We conducted a retrospective cohort study of 6142 women who had positive and negative PCR tests for this infection 6 months previously at 3 institutions in Kathmandu. In telephone interviews women provided information on 22 symptoms and their intensities, health status and history, and functional status. Of 3732 women who had tested PCR positive, 630 (16.9%) reported that they were unrecovered. These 630 unrecovered women were distinguished statistically from the 3102 recovered women by more frequent histories of allergies, rheumatoid disease, BCG immunization, Covid vaccination, strep throat and recent URIs, and both weight gain and weight losses of more than 5 kg in the 6 months following testing, and stressful events in the preceding year. Fatigue, pain, difficulty remembering, shortness of breath, heat and cold intolerance and unrefreshing sleep were reported in 41.9% to 10.5% of these 630 unrecovered women. Six months after confirmed SARS-CoV-2 infection 16.9% of Nepali women have long-COVID manifested as an immune, metabolic, and hormonal systems disruptive and dysfunction syndrome.

Cognitive function and related factors in patients with heart failure

Background: Impaired cognitive function is associated with poor outcomes, frequent hospitalization, and high mortality in HF. Purpose: To determine the prevalence of cognitive function in HF and what factors contribute. Method: This study was an observational analysis with cross-sectional. Study subjects: HF patients at the Cardiac Polyclinic of Dr. M. Haulussy Hospital, Ambon, Indonesia from August to September 2023, with Inclusion criteria: aged 40-65 years; able to communicate well; not having a stroke or other neurological disorders (Parkinson's disease, Alzeimer's disease, Multiple Sclerosis) or other cognitive function disorders (such as due to injury or substance abuse); can read and write. Exclusion criteria: worsening of physical condition such as loss of consciousness and worsening of symptoms such as severe shortness of breath, inability to communicate, inability to complete the questionnaire, and worsening of symptoms that do not improve after being rested when data collection is carried out. Results: HF patients were male (56.2%), had ≥ 12 years of education (72.4%), were not actively working (56.9%), suffered from HF with NYHA class II functional status (49.1%), had Coronary Artery Disease (CAD) comorbid only (49.2%), had experienced hospitalization (64.6%), and were obese (51.54%). Respondents had an average age of 57.08 ± 6.78 years, a duration of HF of 3.96 ± 4.35 years, an average body mass index of 25.65 ± 4.5 Kg/m2, normal blood pressure with an average systole of 122.73 ± 17.21 mmHg, and an average diastole of 77.44 ± 10.11 mmHg. HF patients who experienced impaired cognitive function were 87.69% with mild cognitive impairment 73.1%, moderate cognitive impairment 13.1%, and severe cognitive impairment 1.5%. The maximum score of MoCA sub-domains of executive function was 46.2%; visuospatial 35.4%; attention 37.7%, naming and language 20%; abstraction 33.8%, delayed memory 3.8% and orientation 86.9%. There was a significant correlation between cognitive function and age (ρ = 0.000; r = -0.324), education level (ρ = 0.000; r = 0.327), and New York Heart Association functional status (ρ = 0.021; r = -202). Conclusion: There is a high prevalence of impaired cognitive function in chronic HF patients accompanied by a global decline in cognitive function subdomains. Factors that may contribute to HF cognitive function include age, education level, not actively working, New York Heart Association functional status, comorbidities, and obesity.

Fusion mass to pelvis internal distraction technique using multiple-hook fixation for scoliosis correction: illustrative case.

Internal distraction rods have been described as an alternative to halo gravity traction for the treatment of severe scoliosis. Distraction rods can be challenging to use in patients with existing fusion masses. The authors report an internal distraction, construct-to-construct rod technique using multiple-hook fixation in a patient with a sharply angulated cervicothoracic scoliosis fusion mass. A 12-year-old female with previously diagnosed congenital scoliosis who had undergone cervical fusion in situ at age 2 presented to the clinic with shortness of breath exacerbated by increased levels of activity. Standing anteroposterior and lateral scoliosis radiographs revealed a left >150° cervicothoracic curve, right 140° thoracolumbar curve, and left 28° lumbosacral fractional curve with pelvic obliquity. The authors indicated this patient for a 3-stage all-posterior approach for spinal fusion and deformity correction. In the final fusion surgery, the authors set up a construct-to-construct internal distraction configuration connecting the left hemipelvis to the cervicothoracic fusion mass to aid in deformity correction. A construct-to-construct internal distraction rod technique connecting a fusion mass to the pelvis can assist with curve correction in severe scoliosis.

Clinical features and genetic analysis of three children with β-ketothiolase deficiency

To explore the clinical features and genetic variants in three children suspected for β-ketothiolase deficiency (BKTD). Clinical manifestations, laboratory examination and genetic testing of three children suspected for BKTD at Henan Children's Hospital between January 2018 and October 2022 were collected, and their clinical and genetic variants were retrospectively analyzed. The children were all males with a age from 7 to 11 months. Their clinical manifestations have included poor spirit, shortness of breath, vomiting, convulsions after traumatic stress and/or infection. All of them had severe metabolic acidosis, elevated ketone bodies in blood and urine, hypoglycemia, with increased isoprenyl-carnitine and 3-hydroxyisovalyl-carnitine in the blood, and 2-methyl-3-hydroxybutyrate and methylprotaroyl glycine in the urine. All of them were found to harbor compound heterozygous variants of the ACAT1 gene, including c.1183G>T and a large fragment deletion (11q22.3-11q23.1) in child 1, c.121-3C>G and c.826+5_826+9delGTGTT in child 2, and c.928G>C and c.1142T>C in child 3. The variants harbored by children 2 and 3 were known to be pathogenic or likely pathogenic. The heterozygous c.1183G>T variant in child 1 was unreported previously and rated as a variant of unknown significance (PM2_Supporting+PP3+PP4) based on guidelines from the American College of Medical Genetics and Genomics. The large segment deletion in 11q22.3-11q23.1 has not been included in the DGV Database and was rated as a pathogenic copy number variation. The variants of the ACAT1 gene probably underlay the pathogenesis of BKTD in these three children.

Post-acute sequelae of SARS-CoV-2 infection in health care workers from South Africa.

Health care workers (HCWs) are primary health providers therefore ensuring their protection and recovery from Covid-19 is of high interest. We investigated post-acute sequelae of SARS-CoV-2 infection (PASC) in HCWs who had previously been infected with SARS-CoV-2. Overall, 68 HCWs were classified as PASC according to duration of persisting symptoms. The 68 HCWs with PASC were split into two groups according to the mean duration of their symptoms, which were (8 PASC) 122 and (60 PASC) 641 days. The frequencies of common symptoms reported by HWCs with PASC were continuous headaches (45), mild cough (41), fatigue (37), myalgia (25) and shortness of breath (14). When using the Medical Research Council (MRC) dyspnoea scale to examine the degree of breathlessness in relations to activity we found that 4 reported having difficulty breathing after strenuous exercise, 19 were identified with shortness of breath when walking fast or when walking up a slight hill, 2 reported walking slower than most people on level or stopping after 15 minutes walking at own pace, 1 reported stopping to breath after walking 91 meters, or after a few minutes on level ground and 1 reported being too breathless to leave the house, or breathless when dressing/undressing. Our results highlight concern for HCWs with long-term persisting symptoms which may negatively impact their health this represents an emerging public health priority. HCWs with prolonged Covid-19 symptoms especially breathing difficulties need better diagnostic tests and treatments.

Distinct Clinical Manifestations of COVID-19 in Multiple Sclerosis Patients: Unraveling the Clinical Nexus

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is a virus in the coronaviridae, has caused a global pandemic with various symptoms and complications. Among the groups affected by this virus are individuals with multiple sclerosis (MS), a chronic autoimmune disorder that affects the primary central nervous system (CNS). Understanding coronavirus disease 2019’s (COVID-19) impact on MS patients is crucial for optimizing patient management and developing targeted therapies due to the challenges it presents. Objectives: The primary purpose of this study was to investigate the respiratory and neurology symptoms of COVID-19 in patients with MS in comparison to the non-infected group. Furthermore, this study examined how age and gender might affect the symptoms of contracting COVID-19 and the mortality rate in patients with MS. Methods: The data were collected from six hospitals within the Iranian Network for Research in Viral Diseases (INRVD) between March 2020 and July 2021. A total of 63 individuals diagnosed with MS were examined, with 30 testing positive for both COVID-19 and MS; however, 33 individuals were positive only for MS. These individuals had presented at the hospital experiencing respiratory symptoms, including rhinorrhea, difficulty breathing, and cough. Various clinical aspects were evaluated, including age, gender, and the presence of COVID-19 symptoms. Statistical analyses included the Mann-Whitney t-test, Fisher’s exact test, and odds ratio calculations using SPSS-27 and R 4.2.3. Results: The study encompassed 63 MS patients, with 29 (46%) and 34 (54%) males and females, respectively. Of these patients, 30 individuals were positive for COVID-19. Most subjects were from Tehran province, Iran. Patients in the case group were significantly younger than those in the control group. Notably, dizziness, breath shortness, and vomiting were significantly more prevalent in MS patients following COVID-19. Conclusions: This study highlights the distinct clinical presentation of COVID-19 in individuals with MS. Dizziness, breath shortness, vomiting, and increased mortality were significantly associated with MS patients with COVID-19. The aforementioned findings underscore the importance of tailored management strategies for this unique patient population following the disease.

Can we screen for heart disease in children at public health centres? A multicentre observational study of screening for heart disease with a risk of sudden death in children

Sudden cardiac death in children is a rare event, but of great social significance. Generally, it is related to heart disease with a risk of sudden cardiac death (SCD), which may occur with cardiovascular symptoms and/or electrocardiographic markers; thus, a primary care paediatrician (PCP) could detect them. Therefore, we proposed a study that assesses how to put into practice and conduct a cardiovascular assessment within the routine healthy-child check-ups at six and twelve years of age; that reflects cardiovascular signs and symptoms, as well as the electrocardiographic alterations that children with a risk of SCD in the selected population present; and that assesses the PCP’s skill at electrocardiogram (ECG) interpretation. In collaboration with PCPs, primary care nurses, and paediatric cardiologists, an observational, descriptive, multicentre, cross-sectional study was carried out in the Balearic Islands (Spain), from April 2021 to January 2022, inclusive. The PCPs gathered patient data through forms (medical record, electrocardiogram, and physical examination) and sent them to the investigator, together with the informed consent document and electrocardiogram. The investigator passed the electrocardiogram on to the paediatric cardiologists for reading, in an identical form to those the paediatricians had filled in. The variables were collected, and a descriptive analysis performed. Three paediatric cardiologists, twelve PCPs, and nine nurses from seven public health centres took part. They collected the data from 641 patients, but 233 patients did not participate (in 81.11% due to the PCP’s workload). Therefore, the study coverage was around 64%, representing the quotient of the total number of patients who participated, divided by the total number of patients who were eligible for the study. We detected 30 patients with electrocardiographic alterations compatible with SCD risk. Nine of these had been examined by a paediatric cardiologist at some time (functional murmur in 8/9), five had reported shortness of breath with exercise, and four had reported a family history of sudden death. The physical examination of all the patients whose ECG was compatible with a risk of SCD was normal. Upon analysing to what extent the ECG results of the PCP and the paediatric cardiologist agreed, the percentage of agreement in the final interpretation (normal/altered) was 91.9%, while Cohen’s kappa coefficient was 31.2% (CI 95%: 13.8–48.6%). The sensitivity of the ECG interpretation by the PCP to detect an ECG compatible with a risk of SCD was 29% and the positive predictive value 45%. Conclusions: This study lays the foundations for future SCD risk screening in children, performed by PCPs. However, previously, it would be important to optimise their training in reading and interpreting paediatric ECGs.What is Known:• In Spain at present, there is a programme in place to detect heart disease with a risk of sudden death [1], but it targets only children who are starting on or are doing a physical activity as a federated sport. Implementing such screening programmes has proven effective in several countries [2]. However, several studies showed that the incidence of sudden cardiac death is no higher in children competing in sport activities than in those who do not do any sport [3]. This poses an ethical conflict, because at present, children who do not do any federated sport are excluded from screening. According to the revised literature, so far, only in two studies did they screen the child population at schools, and in both, they successfully detected patients with heart disease associated to the risk of sudden death [4, 5]. We have found no studies where the screening of these features was included within the routine healthy-child check-ups by primary care paediatricians.What is New:• We did not know whether—in our setting, at present—the primary care paediatrician could perform a screening method within the routine healthy-child check-ups, in order to detect presumably healthy children at risk of sudden cardiac death, as they present one of the SCD risks. In this regard, we proposed our project: to assess how to put into practice and conduct a cardiovascular assessment via SCD risk screening in the healthy child population by primary care paediatricians and appraise primary care paediatricians’ skills in identifying the electrocardiographic alterations associated with SCD risk. The ultimate intention of this pilot study was to make it possible, in the future, to design and justify a study aimed at universalising cardiovascular screening and achieving a long-term decrease in sudden cardiac death events in children.

PRIMARY SPONTANEOUS PNEUMOTHORAX IN A PATIENT OF MILD COVID-19 WITHOUT ANY RISK FACTORS: A CASE REPORT

A 36-year-old man with a recent history of lower respiratory tract infection of mild COVID-19 was treated at home without any comorbidities or addiction. He was sent to the emergency department after day 14 of COVID-19 infection. He complained of sudden onset right-sided chest pain with gradually increasing shortness of breath on exertion for three days. He received a diagnosis of primary spontaneous pneumothorax clinically and radiologically. An intercostal chest drain was inserted, which was removed after clinical recovery and radiologic re-expansion. He was discharged and followed up at the outpatient department; he was in good health and resumed his usual activities.

Differences in treatment and post-COVID symptoms in elderly and young patients: a cross-sectional study

Background: Long COVID is of particular concern among older people, who are at greater risk than young-er people of persisting symptoms associated with COVID-19. In addition, COVID-19 might trigger or exacerbate chronic conditions that occur commonly in older people, such as cardio-vascular diseases, respiratory diseases and others.Aim of the study: The aim of this study was to investigate the differences in the type of treatment and post-COVID symptoms in the elderly versus young patients.Material and methods:Alternative, non-parametric and correlation analyses were used. Logical units of observation: Two hundred patients suffered from COVID-19 in the period from 01.09.2021 until 01.09.2022.Results:The majority of those examined were women - 58.5%. Age turned out to be a key factor in the disease. As age increases, cardiac complaints also increase p=0.001 (χ2=79.51). The corre-lation relationship is straight and significant p=0.001 (r=0.619).In the studied group, "shortness of breath" was more often experienced by the elderly com-pared to the young patients p=0.001 (χ2=17.90), p=0.001(r=0.278).Regarding the symptom "hair loss" gender was found to have a key role in women p=0.001 (χ2=5.04) and the symptom "fatigue" p=0.001 (χ2=9.60).The analysis of our study shows that the majority were treated on an outpatient basis, and the rest - 29.5% - received their treatment in a hospital.Conclusion:In conclusion, this study underscores the multifaceted nature of post-COVID recovery, influ-enced by demographic factors, vaccination status, and the presence of comorbidities.

A case of Carvajal syndrome presenting with dilated cardiomyopathy.

Carvajal syndrome is a very rare autosomal recessive cardiocutaneous disorder caused by a desmosomal mutation in exon 24 of the desmoplakin gene. It manifests with woolly hair, epidermolytic palmoplantar keratoderma, and arrhythmogenic right ventricular cardiomyopathy. We herein present a patient with heart failure and dilated cardiomyopathy who was diagnosed with Carvajal syndrome because of dermatologic manifestations. A seven-year-old girl was referred to our clinic due to decompensated heart failure and clinical deterioration. The patient had severe weakness, tachycardia, and tachypnea. She had a complaint of getting tired quickly for three weeks, and she had shortness of breath and abdominal pain for the last two days. She had hepatomegaly and woolly hair. Mild keratoderma was present on the soles of her feet. Echocardiography demonstrated biventricular dilatation, significantly impaired left ventricular systolic function (ejection fraction 22%), and moderate to severe mitral and tricuspid regurgitation. Molecular genetic evaluation was performed because of cutaneous and cardiac findings, which demonstrated a desmoplakin gene mutation. Homozygous mutation c.4297C > T (p.Gln1433*) was identified in desmoplakin gene, and the diagnosis of Carvajal syndrome was confirmed. Syndromic types of arrhythmogenic right ventricular cardiomyopathy such as Carvajal syndrome are rare diseases. Awareness about cutaneous manifestations and genetic evaluation would help diagnosis and prevention of sudden death. Genetic counselling is needed in familial cases.

Surgical excision of the right ventricular hydatid cyst: a case report

Hydatid cyst is described as an endemic situation predominantly observed in different undeveloped regions of the world which is caused by Echinococcus granulosus tapeworm. This disease usually affects the lungs or liver. Cardiac location is reported in less than 2 % to 0.5% of patients in all cases and as in our case the intraventricular location is seen seldomly. A 38-year-old female patient with diagnosed systemic hydatid cyst disease was consulted with chest pain, palpitation, and shortness of breath. Transthoracic echocardiography and cardiac computerized tomography imaging showed the location of the cardiac hydatid cyst was the right ventricle. She underwent elective surgery swiftly and was discharged uneventfully.

A register and questionnaire study of long-term general health symptoms following SARS-CoV-2 vaccination in Denmark

Many individuals who refuse COVID-19 vaccination have concerns about long-term side effects. Here, we report findings on self-reported symptoms from a Danish survey- and register study. The study included 34,868 vaccinated primary course recipients, 95.8% of whom received mRNA vaccines, and 1,568 unvaccinated individuals. Participants had no known history of SARS-CoV-2 infection. Using g-computation on logistic regression, risk differences (RDs) for symptoms between vaccinated and unvaccinated persons were estimated with adjustments for possible confounders. Within six weeks after vaccination, higher risks were observed for physical exhaustion (RD 4.9%, 95% CI 1.1% to 8.4%), fever or chills (RD 4.4%, 95% CI 2.1% to 6.7%), and muscle/joint pain (RD 7.0%, 95% CI 3.1% to 10.7%), compared to unvaccinated individuals. Beyond twenty-six weeks, risks were higher among the vaccinated for sleeping problems (RD 3.0, 95% 0.2 to 5.8), fever or chills (RD 2.0, 95% CI 0.4 to 3.6), reduced/altered taste (RD 1.2, 95% CI 0.2 to 2.3) and shortness of breath (RD 2.6, 95% CI 0.9 to 4.0). However, when examining pre-omicron responses only, the difference for reduced/altered taste was significant. As expected, the risk of experiencing physical exhaustion, fever or chills, and muscle/joint pain was higher among persons who responded within six weeks of completing the primary course. No significant differences were observed for the 7-25-week period after vaccination. Associations for the period beyond 26 weeks must be interpreted with caution and in the context of undetected SARS-CoV-2 infection, wide confidence intervals, and multiple testing. Overall, we observe no concerning signs of long-term self-reported physical, cognitive, or fatigue symptoms after vaccination.

Clinical characteristics and prognosis of 8 cases of severe infant botulism

Objective: To summarize the clinical characteristics and prognosis of severe infant botulism and evaluate the therapeutic effect of botulinum antitoxin in the pediatric intensive care unit (PICU). Methods: The clinical data of 8 cases diagnosed with infantile botulism were retrospectively analyzed in the PICU of Beijing Children's Hospital from October 2019 to August 2023. Data of basic demographic information, clinical manifestations, laboratory tests, treatment and prognosis of each child were collected and analyzed using descriptive statistical methods. Results: Eight laboratory-confirmed cases of infant botulism were included in this study, all of which were male infants with an age of 6.0 (3.3,6.8) months. Three of the children were from Inner Mongolia Autonomous Region, 2 of them were from Hebei, and the other 3 were from Beijing, Shandong and Xinjiang Uyghur Autonomous Region, respectively. All the patients were previously healthy. In 4 of these cases, the possible cause was the ingestion of either honey and its products or sealed pickled food by the mother or child before the onset of the disease. The first symptom was poor milk intake (4 cases), followed by shallow shortness of breath (7 cases), limb weakness (7 cases) and so on. The typical signs were bilateral dilated pupils (8 cases) and decreased limb muscle strength (8 cases). The main subtype was type B (7 cases), and only 1 case was classified as type A. Six of the children were treated with antitoxin therapy for a duration of 24 (19, 49) d. Seven of them had invasive mechanical ventilation. All the patients survived upon discharge with a follow-up period of 29 d to 3 years and 8 months. Six patients had fully recovered, and 2 recently discharged patients were gradually recovering. Conclusions: For infants with suspected contact or ingestion of botulinum and presented with bilateral pupillary paralysis, muscle weakness and clear consciousness, the stool should be collected for diagnostic testing using a mouse bioassay as soon as possible. Type B was the most common type. The antitoxin treatment was effectiveness and the prognosis was well.

Severity of COVID-19 manifestations in HIV patients: a systematic review and meta-analysis.

The incidence of coronavirus disease 2019 (COVID-19) pandemic among people living with HIV (PLWH) is experiencing major increases. This demographic is vulnerable due to compromised immune function, but the individuals are subjected to antiretroviral therapy (ART), which shows potential as a treatment for the pandemic. Therefore, this study aimed to investigate the severity of various forms of COVID-19 in PLWH as opposed to the general population. The study followed PRISMA guidelines and included a systematic review of literature from Pubmed, Science Direct, and Cochrane Library, comprising English-language articles from 2019 to 2022. This study included articles discussing HIV and COVID-19 case prevalence data by severity. A random effect model was used to demonstrate the pooled prevalence of COVID-19 among PLWH, as well as the prevalence of moderate and critical severity of COVID-19 among PLWH. The Joanna Briggs Institute checklist was used to assess the quality of studies. This study is registered in INPLASY No. INPLASY2023100063. Out of a total of 1,965 articles relevant to the specified keyword combination, 13 articles conformed with inclusion and exclusion criteria. For HIV and non-HIV COVID-19 patients, the mean age was 52.98 ± 6.45 years and 55.84 ± 9.73 years, respectively. Approximately 73% of HIV COVID-19 patients were male. Symptoms among PLWH included fever (57%), cough (48.9%), and shortness of breath (37%). The pooled prevalence of COVID-19 among PLWH was 3.0% (95% CI, 1.0 - 8.5%), with critical, moderate, and mild severity in 4.8% (95% CI, 1.6 - 13.3%), 24.4% (95% CI, 1.9 - 29.8%), and 9.9% (95% CI, 1.9 - 38%), respectively. PLWHs and HIV-negative individuals showed comparable rates and intensity of COVID-19. ART users exhibited immunological health comparable to immunocompetent people, demonstrating the essential role of ART in reducing the severity and mortality of PLWH with COVID-19.

Characteristics and Outcomes of Coronavirus Disease- 2019 Among Pregnant Women in Saudi Arabia; a Retrospective Study.

Pregnancy-related coronavirus disease 2019 infection ranges from asymptomatic to very serious illness. This study aimed to determine the impact of the COVID-19 infection on pregnant women in the Jazan region of Saudi Arabia. Retrospective observational study of women who had COVID-19 positive test in pregnancy admitted in King Fahd Hospital, Abu Arish General Hospital, and Sabya General Hospital, Jazan, Saudi Arabia during the period between March 2020 and March 2022. Data were extracted from the patient's records. Frequency and percentage distributions were calculated for categorical variables. Descriptive studies and regression analysis were conducted to evaluate the association between selected variables and pregnancy outcomes. Of the 33 pregnant women with confirmed infection, the majority were in their second and third trimester, with approximately 42.4% requiring intensive care unit (ICU) admission and oxygen therapy. The most prevalent symptoms were high respiratory rate and low blood pressure, often accompanied by fever, cough, and shortness of breath. Live births resulted in 54.5% of the cases, while two maternal deaths were reported. Significant associations were found between the need for non-invasive ventilation and timing of infection (p = 0.026), the mode of delivery and timing of infection (p = 0.036), and the mode of delivery and body mass index (BMI) (p = 0.007). COVID-19 poses significant risks to pregnant women, particularly in the third trimester, and emphasized the importance of early identification of high-risk pregnancies, strategic planning, and enhanced monitoring during antenatal care.