Minor Symptoms Research Articles

Revision for cage migration after transforaminal/posterior lumbar interbody fusion: how to perform revision surgery?

BackgroundSymptomatic pseudarthrosis and cage migration/protrusion are difficult complications of transforaminal or posterior lumbar interbody fusion (TLIF/PLIF). If the patient experiences severe radicular symptoms due to cage protrusion, removal of the migrated cage is necessary. However, this procedure is sometimes very challenging because epidural adhesions and fibrous union can be present between the cage and vertebrae. We describe a novel classification and technique utilizing a navigated osteotome and the oblique lumbar interbody fusion at L5/S1 (OLIF51) technique to address this problem.MethodsThis retrospective study investigated consecutive patients with degenerative lumbar diseases who underwent TLIF/PLIF. Symptomatic cage migration was evaluated by direct examination, radiography, and/or computed tomography (CT) at 1, 3, 6, 12, and 24 months of follow-up. Cage migration/protrusion was defined as symptomatic cage protrusion > 5 mm from the posterior border of the over and underlying vertebral body compared with initial CT. We evaluated patient characteristics including body mass index, smoking history, fusion level, and cage type. A total of 113 patients underwent PLIF/TLIF (PLIF n = 30, TLIF n = 83), with a mean age of 71.1 years (range, 28–87 years). Mean duration of follow-up was 25 months (range, 12–47 months).ResultsCage migration was identified in 5 of 113 patients (4.4%). All cases of symptomatic cage migration involved the L5/S1 level and the TLIF procedure. Risk factors for cage protrusion were age (younger), sex (male), and level (L5/S1). The mean duration to onset of cage protrusion was 3.2 months (range, 2–6 months). We applied a new classification for cage protrusion: type 1, only low back pain without new radicular symptoms; type 2, low back pain with minor radicular symptoms; or type 3, cauda equina syndrome and/or severe radicular symptoms. According to our classification, one patient was in type 1, three patients were in type 2, and one patient was in type 3. For all cases of cage migration, revision surgery was performed using a navigated high-speed burr and osteotome, and the patient in group 1 underwent additional PLIF without removal of the protruding cage. Three revision surgeries (group 2) involved removal of the protruding cage and PLIF, and one revision surgery (group 3) involved anterior removal of the cage and OLIF51 fusion.ConclusionsThe navigated high-speed burr, navigated osteotome, and OLIF51 technique appear very useful for removing a cage with fibrous union from the disc in patients with pseudarthrosis. This new technique makes revision surgery after cage migration much safer, and more effective. This technique also reduces the need for fluoroscopy.

Blueprinting in Coherence to Diagnostic Momentum: On Account of Cancer Detection in Bahawalpur Community

In the current era, cancer is a critical health problem. Purpose of the study was symptomatic analysis of cancer patients and medical evaluation of hematological and biochemical parameters of patients from different geographical areas of district Bahawalpur. A crosssectional study was done to find out the diagnostic timeliness in cancer patients. Out of 150 cancer patients, 53% patients were males and 47% females with age from 15 years to 75 years. It has been shown that 76% of patients represent major symptoms of cancer while 24% of patients were showing minor symptoms. Furthermore, cancer patients were disturbed metabolical, hematological, and biochemical profiling. There were 83% of patients with anemia and 17% patients have normal hemoglobin count in males and 85 % of total female patients have low hemoglobin level while rest of 15% have normal hemoglobin count. Illiteracy is positively influencing the factors responsible for causing cancer with 53%, whereas 23% less than primary level education and only 1% of patients had completed their graduation. There were 31% of the patients lies in upper lower class of society, 28% lower class, Lower middle class 19%, middle class 14%, upper middle class 7% and only 1 % patients belong to high social status. This study will help to diagnosis the early cancer detection via biochemical and metabolic profiling.

Ivermectin associated adverse events in the treatment and prevention of COVID-19 reported to the FACT pharmacovigilance project

Background In August 2021, the Centers for Disease Control and Prevention (CDC) released a health alert following the rapid increase in ivermectin prescriptions and reports of severe illness associated with use of products containing ivermectin for the prevention or treatment of COVID-19 infections. The United States Food and Drug Administration (FDA) and the CDC have explicitly discouraged the use of ivermectin in the prevention or treatment of COVID-19 outside of clinical trials. The study aims to describe the adverse events (AEs) related to ivermectin use for the prevention or treatment of COVID-19. Methods This is a prospective case series of adverse events related to therapeutics used in the prevention or treatment of COVID-19 submitted to the FDA ACMT COVID-19 ToxIC (FACT) Pharmacovigilance Project sub-registry between October 2020 and December 2021. This is an ongoing toxico-surveillance system at 15 major academic medical centers in 12 states. Data collected included sociodemographics, exposure related information including dose, frequency, route, duration, and reason for taking ivermectin as well as a clinical description of the adverse event and the outcome. Results A total of 40 patients who developed AEs following ivermectin use were reported to FACT over 15 months. Self-medication with veterinary formulations were reported in 18/40 patients Thirty-three patients presented to emergency departments and nineteen patients were admitted to the hospital. Patients reported using ivermectin for prevention (24/40), treatment of symptoms (19/40), and for treatment of documented COVID-19 (8/40). Neurological toxicity was the most frequent finding. Fifteen patients had minor symptoms while 25 developed severe toxicity. Conclusions Ivermectin use for the attempted treatment of COVID-19 has potential adverse health effects primarily related to neurological function. This is especially true when patients are self-treating with this medication and when they are using formulations intended for non-human use.

Abstract #1151796: Hypophosphatasia and Microcephalic Osteodysplastic Primordial Dwarfism type II: Diagnosing patients with minor symptoms

Hypophosphatasia (HPP) and Microcephalic Osteodysplastic Primordial Dwarfism type II (MOPD II) are rare inherited diseases which arise from the ALPL gene and PCNT gene respectively. HPP has nonspecific alkaline phosphatase (TNSALP) deficiency which causes the manifestations of skeletal deformities, fractures, nephrocalcinosis, seizures, respiratory failure and poor dentition. While in MOPD typically presents with bone, vascular and hematological abnormalities. Both of these diseases have a variety of symptoms which can vary in severity which can make the diagnosis difficult but important to avoid future complications.

Machine learning used in detection & diagnosis of human diseases

One of the most important topics in society is human health care. It looks to get the best diagnosis of a serious illness so they can get the care they need right away it is possible. Other fields, such as mathematics and computer science, are required to part of the search health as this awareness is often difficult. Function of following new trends is a challenge for these sectors, moving forward common. The actual number of new strategies makes it possible give a broad view that avoids certain features. In this case, we suggest a systematic analysis of human diseases related to machine learning. This paper focuses on existing strategies related to the growth of machine learning in which it is used diagnostics in the medical field to find interesting trends, make unimportant predictions, and assist in decision- making. People often feel it hesitation to go to the hospital or doctor or minor symptoms. However, in many places in some cases, these minor symptoms may cause serious health risks. Like online life advice is easily accessible, it can be a good start for users.

Laparoscopic Proximally Extended Colorectal Resection With Two-Stage Turnbull-Cutait Pull-Through Coloanal Anastomosis for Late Complications of Chronic Radiation Proctopathy.

BackgroundChronic radiation proctopathy (CRP) is a common complication after radiation therapy for pelvic malignancies. Compared with diversion surgery, resection surgery removes the damaged tissue completely to avoid the risks of recurrence and improve patients' outcome. Hence, resection surgery could be an optimal surgical approach when CRP is complicated by late complications. This study aimed to describe a modified surgical procedure of resection surgery and report its preliminary efficacy and safety in treating patients with CRP with late complications.MethodsWe retrospectively reviewed the patients who were diagnosed with CRP with late complications and underwent the modified surgical procedure of laparoscopic proximally extended colorectal resection with two-Stage Turnbull-Cutait pull-through coloanal anastomosis (PE-Bacon) between November 2019 and October 2020 in the Sixth Affiliated Hospital of Sun Yat-sen University.ResultsA total of 15 patients were performed the modified laparoscopic procedure of PE-Bacon, of which 1 patient underwent conversion from laparoscopic to open operation for intraoperative massive hemorrhage. Overall, the major (Clavien-Dindo III-V) postoperative complications occurred in 1 patient, anastomotic leakage was observed in 2 (13.3%) patients, and anastomotic stricture was observed in 4 (26.7%) patients. No patient had to be reoperated and died. Up to now, at the average follow-up of (524.40 ± 108.39) days, the preoperative symptoms of 93.3% (14/15) patients were relieved, with nine patients achieved complete remission, five patients only suffered minor symptoms. Because of the progression of radiation uropathy, one patient still had a vesicovaginal fistula as pre-operative complication. Colostomy reversal has been performed on 8 (53.3%) patients at an average postoperative duration of 299.5 ± 92.68 days, among whom only 2 patients suffered from major Low Anterior Resection Syndrome (LARS) until now.ConclusionsLaparoscopic PE-Bacon surgery is a safe and feasible surgical procedure for late complications of CRP with low morbidity and high symptom remission rate.

The Novel Virus: Covid-19

In December 2019, a very fatal and highly communicable viral disease emerged in Wuhan city of China, and within a spam of few days it was spread globally and become a global threat, hence it is termed as a pandemic situation in certain place. This viral infection is termed as Covid- 19 or the novel corona virus. It was named ‘corona virus’ because it is genetically related to SARS virus, because of which it is also called as SARS COV-2. After the analysis and study of this virus, it was considered to be originated from bats, because SARS COV-2 is phylogenetically related to bat virus. Bats is considered as primary spreader of this virus, but the source of transmission of the virus in humans is unknown . The mode of the transmission of this disease by the respiratory droplets which contaminated to surface. Normally this disease shows some minor symptoms like fever, fatigue, dyspnea, cough etc, but in case of improper precautionary measures it may become fatal to health. This diseases may turn deadly for the people with comorbidities and may cause other gives diseases like the pneumonia, aacute respiratory diseases syndromie and therefore affects on ability of person to breathe which leads the patients to being put on Ventilators. The incubation period of this diseases range from 5-14 days or more. T

Effects of Jianpi Lishi Jiedu granules on colorectal adenoma patients after endoscopic treatment: study protocol for a randomized, double-blinded, placebo-controlled clinical trial

BackgroundColorectal adenomas (CRAs) are precancerous lesions of the large intestine presenting as colorectal polyps. At present, the conventional treatment methods for CRA mainly include high-frequency electrocoagulation and electroexcision, biopsy forceps polypectomy, cauterization by laser and microwave, and other endoscopic interventions. The principal advantages conferred by these treatment strategies include less trauma, quick postoperative recovery, and simplicity to perform. However, the higher recurrence rates and insignificant improvement of postoperative symptoms after endoscopic surgery are considerable drawbacks to this approach. Besides, there is currently no effective pharmacotherapy to prevent the recurrence of CRA. Jianpi Lishi Jiedu (JLJ) granules are a form of traditional Chinese medicine (TCM) used to manage postoperative patients with CRA, which has shown a certain degree of efficacy in clinical practice. However, its effectiveness and safety profile have not been convincingly evaluated. The purpose of this study is to evaluate the clinical efficacy and safety profile of JLJ granules in the management of postoperative patients with CRA and to observe the recurrence rate of adenoma in these patients.MethodsA randomized, double-blind, and placebo-controlled clinical trial is performed in this study. A total of 80 postoperative patients with CRA will be randomly classified into the Jianpi Lishi Jiedu granules group or the placebo control group. Patients in both groups shall receive 3 months of intervention, after which medical follow-up and safety evaluation will be performed for all of the patients. The primary outcome is the recurrence rate of adenomas within 12 months. The secondary outcomes are the cardinal TCM symptom scores, minor TCM symptom scores, Bristol Stool Scale, efficacy of TCM symptoms, safety indicators, and blinding assessment.DiscussionIn this study, the impact on the recurrence of adenomas and the efficacy and safety of JLJ granules in terms of improving the clinical symptoms of postoperative patients with CRA will be evaluated.Trial registrationTrial registration Chinese Clinical Trial Registry ChiCTR 2100044297. Registered on March 16, 2021

The Importance of Understanding the Risk Factors for TIA

Transient ischemic attack (TIA) and minor ischemic stroke are associated with brain dysfunction in a circumscribed area caused by a regional reduction in blood flow (i.e., ischemia), resulting in transient or minor observable clinical symptoms. We reported a case study of a female patient with a TIA with symptoms of dizziness, weakness of the left limb, and tingling for about 30 minutes. She was admitted to the emergency room and underwent several tests, including ECG, CT scan, and laboratory test to confirm the diagnosis. The patient probability of stroke infarct was determined by the ABCD2 score. Through ABCD2 score, the patient had 4.1% probability of Ischemic stroke without looking at the imaging features on a CT scan or MRI. By knowing the risk factors of TIA, the patient was suggested to modify lifestyle to prevent the occurrence of TIA due to TIA can be an early sign of ischemic stroke. Keywords: TIA, risk factors of TIA, TIA’s risk stratification.

Resection of Skull Base Meningioma With Extensive Extracranial Extension: 2-Dimensional Operative Video.

Jugular foramen meningiomas are rare tumors with distinguishing clinical, radiological, and surgical considerations.1,2 They involve the lower cranial nerves, invade the temporal bone, occlude jugular vein and sigmoid sinus, and involve internal carotid and vertebral arteries. Their location is prime for an extensive extracranial cervical extension. They might reach giant size with extension from the Meckel cave in the cerebellopontine angle to the carotid bifurcation in the neck while exhibiting only minor symptoms. Surgical morbidity is associated mainly with lower cranial nerves deficits. Radical surgical removal has been considered impossible with vascular encasement and is associated with a considerable risk of vascular injury. With careful and thorough preoperative evaluation, including evaluating the adequacy of the cerebral collateral and applying an appropriately tailored skull base approach,3 radical tumor resection can be achieved with the expectation of a good outcome.3,4 Meticulous microsurgical dissection of the tumor involving the internal carotid artery in the neck would permit radical resection without vascular damage and avoiding the need for vascular reconstruction.5 We demonstrate this technique in a 47-year-old female patient presented in the year 2007 having a giant jugular fossa tumor with extensive neck extension who consented to surgery. Image at 2:23 reused with permission from Al-Mefty O, Teixeira A. Complex tumors of the glomus jugulare: criteria, treatment, and outcome. J Neurosurg. 2002;97(6):1356-1366, by permission from JNSPG. {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"","caption":"","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_vf9v0duk"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]}

Does interactive ultrasound intervention relieve minor depressive symptoms and increase maternal attachment in pregnancy? A protocol for a randomized controlled trial

BackgroundPerinatal depression, especially minor depression, is common during pregnancy and is likely to continue into the postpartum period. It may impair the mother’s health, the infant’s neurodevelopment, and the mother-infant relationship. Screening for perinatal depression is recommended; however, there is no consensus on how to treat depressive symptoms while simultaneously supporting the mother-infant relationship. Ultrasound examination has been shown to improve maternal-fetal attachment among pregnant women. Our aim is to develop a four-dimensional (4D) based interactive ultrasound intervention and test whether it relieves minor depressive symptoms and improves maternal-fetal attachment. Previous studies show that supporting the mother-infant relationship aids in relieving maternal depression. Until now, few studies have combined pregnancy ultrasound and psychological support.MethodsA controlled randomized setting was designed to assess whether interactive 4D-ultrasound intervention would decrease maternal depressive symptoms, strengthen maternal-fetal attachment, and mother-infant relationship. An obstetrician and a psychologist specialized in infant mental health conduct the interventions. The focus is to jointly observe the behavior of the fetus according to the mothers’ wishes. Altogether, 100 women scoring 10–15 on Edinburgh Pre-/Postnatal Depression Scale (EPDS) and with singleton pregnancy are recruited using a web-based questionnaire. Half of the participants will be randomized to the intervention group and will undergo three interactive ultrasound examinations. The primary outcomes are a decrease in perinatal depressive symptoms assessed with EPDS and an increase in maternal attachment. The maternal attachment was assessed using the Working Model of the Child Interview (WMCI), the Maternal Antenatal Attachment Scale (MAAS), and the Maternal Postnatal Attachment Scale (MPAS). Secondly, we hypothesize that if the intervention decreases prenatal depressive symptoms and improves prenatal attachment, the decrease in depressive symptoms and improvement in mother-infant relationship is seen postnatally.DiscussionUltrasound is widely used during pregnancy. The interactive approach is unique and may be feasible as part of routine screenings and maternity clinic visits. Intervention that decreases depression and simultaneously supports maternal-fetal attachment would be a valuable addition to the treatment of minor depression among pregnant women.Trial registrationClinicalTrials.gov NCT03424642. Registered on January 5 2018.

Campaign for the optimal treatment of varicose veins: welcoming the declaration of the Code of Ethics issued by the Korean Society for Phlebology

Background: Varicose veins (VV) is a common chronic venous disorder that is often left untreated due to its minor symptoms. However, recent developments in minimal invasive surgery has resulted in a rapid increase of VV treatment cases. Unfortunately, there have been some ethical issues regarding the high cost of intervention and non-professional treatment administered for VV at some private clinics.Current Concepts: Most endovenous therapies for VV are not reimbursed by the national health insurance but are only covered by personal health insurance plans in Korea. Rapid increase in the coverage costs for VV treatment has led to conflicts between the insurance companies and doctors in several cases. Recently, the Korean Society for Phlebology declared the Code of Ethics to support evidence-based treatment and warn against unethical practices related to interventions for VV.Discussion and Conclusion: The Korean Society for Vascular Surgery and Korean Society for Phlebology have just launched a campaign for the optimal treatment of VV on their YouTube channel, which shares accurate information regarding VV treatment to inform patients and doctors. To strengthen doctor-patient relationship and to avoid falling prey to unethical practitioners, it is critical to educate and update patients and healthcare service providers regarding the options available for VV treatment.

Community pharmacy professionals\u2019 practice in responding to minor symptoms experienced by pregnant women in Ethiopia: results from sequential mixed methods

BackgroundIn countries with limited access to healthcare services, community pharmacists’ management of minor symptoms experienced by pregnant women could be beneficial in terms of alleviating the burden of other health professionals and cost of services. However, evidence is limited regarding the practice of community pharmacy professionals in responding to minor pregnancy-related symptoms more generally, particularly in Ethiopia.ObjectiveThe aim of this study was to evaluate actual and self-reported practice of community pharmacists in the management of minor symptoms during pregnancy in Ethiopia.MethodsA sequential mixed method study using self-reported survey from 238 community pharmacists followed by 66 simulated client visits was conducted from March to July 2020 in six towns of the Amhara regional state in Ethiopia. Independent samples t-test and one-way Analysis of Variance was used to test the mean difference of practice score among subgroups of study participants.ResultsThe self-reported survey showed that most community pharmacist would ‘always’ gather most symptom-related information particularly about ‘duration of symptoms,’ ‘frequency of symptoms,’ and ‘gestational age’ and provide medication-related information on ‘how to use the medication’ and ‘duration of use.’ The highest mean practice scores were observed in relation to information gathering about ‘gestational age’ and information provision on ‘how to use the medication.’ In contrast, the lowest mean practice scores were observed in relation to information gathering about ‘weight of the woman’ and information provision on ‘dosage form.’However, the actual practice, as revealed by the simulated client visits, demonstrated that most community pharmacists would rarely gather symptom-related information nor provide medication-related information. In addition, dispensing of non-prescribed medications to pregnant women was also common. The extent of self-reported practice differed among subgroups of study participants.ConclusionsThis study highlights extent of practice of community pharmacy professionals during the management of minor symptoms in pregnancy in Ethiopia. Discrepancies of results between self-reported and actual practices of community pharmacy professionals were observed. The inadequate actual practice of symptom-related information gathering and medication-related information provisions needs considerations of implementing interventions to minimize potential harms.

Neglected cervical spondyloptosis of the 5TH - 6TH cervical spine following cervical manipulation: A case report.

A 16-year-old boy was diagnosed with spondyloptosis of the cervical spine at the C5–6 level with a neurologic deficit following cervical manipulation. He could not move his upper and lower extremities, but the sensory and autonomic function was spared. The pre-operative American Spinal Cord Injury Association (ASIA) Score was B with SF-36 being 25%, and Karnofsky's score was 40%. The patient was disabled and required special care and assistance. We performed anterior decompression, cervical corpectomy at the level of C6 and lower part of C5, deformity correction, cage insertion, bone grafting, and stabilization with an anterior cervical plate. The patient's objective functional score had increased after six months follow up and assessed objectively with the ASIA Impairment Scale (AIS) E or Excellent, SF-36 score 94%, and Karnofsky score was 90%. The patient could carry on regular activity with minor signs or symptoms of the disease. This case report highlights severe complications following cervical manipulation, a summary of the clinical presentation, surgical treatment choices, and a review of the relevant literature. In addition, the sequential improvement of the patient's functional outcome after surgical correction will be discussed.

Predicting the likelihood of successful medical treatment of early pregnancy loss: development and internal validation of a clinical prediction model.

STUDY QUESTIONWhat are clinical predictors for successful medical treatment in case of early pregnancy loss (EPL)?SUMMARY ANSWERUse of mifepristone, BMI, number of previous uterine aspirations and the presence of minor clinical symptoms (slight vaginal bleeding or some abdominal cramps) at treatment start are predictors for successful medical treatment in case of EPL.WHAT IS KNOWN ALREADYSuccess rates of medical treatment for EPL vary strongly, between but also within different treatment regimens. Up until now, although some predictors have been identified, no clinical prediction model has been developed yet.STUDY DESIGN, SIZE, DURATIONSecondary analysis of a multicentre randomized controlled trial in 17 Dutch hospitals, executed between 28 June 2018 and 8 January 2020.PARTICIPANTS/MATERIALS, SETTING, METHODSWomen with a non-viable pregnancy between 6 and 14 weeks of gestational age, who opted for medical treatment after a minimum of 1 week of unsuccessful expectant management. Potential predictors for successful medical treatment of EPL were chosen based on literature and expert opinions. We internally validated the prediction model using bootstrapping techniques.MAIN RESULTS AND THE ROLE OF CHANCE237 out of 344 women had a successful medical EPL treatment (68.9%). The model includes the following variables: use of mifepristone, BMI, number of previous uterine aspirations and the presence of minor clinical symptoms (slight vaginal bleeding or some abdominal cramps) at treatment start. The model shows a moderate capacity to discriminate between success and failure of treatment, with an AUC of 67.6% (95% CI = 64.9–70.3%). The model had a good fit comparing predicted to observed probabilities of success but might underestimate treatment success in women with a predicted probability of success of ∼70%.LIMITATIONS, REASONS FOR CAUTIONThe vast majority (90.4%) of women were Caucasian, potentially leading to less optimal model performance in a non-Caucasian population. Limitations of our model are that we have not yet been able to externally validate its performance and clinical impact, and the moderate accuracy of the prediction model of 0.67.WIDER IMPLICATIONS OF THE FINDINGSWe developed a prediction model, aimed to improve and personalize counselling for medical treatment of EPL by providing a woman with her individual chance of complete evacuation.STUDY FUNDING/COMPETING INTEREST(S)The Triple M Trial, upon which this secondary analysis was performed, was funded by the Healthcare Insurers Innovation Foundation (project number 3080 B15-191).TRIAL REGISTRATION NUMBERClinicaltrials.gov: NCT03212352.

Vaccine Strain and Wild-Type Clades of Varicella-Zoster Virus in Central Nervous System and Non-CNS Disease, New York State, 2004-2019.

Since the introduction of the varicella-zoster virus (VZV) vaccine in the United States in 1995, there has been a dramatic decrease in both the number and severity of varicella cases. However, VZV surveillance data and information on the VZV clade distribution in central nervous system (CNS) disease and non-CNS disease in New York State is not available. To investigate this, cerebrospinal fluid (CSF) samples from patients with encephalitis or meningitis and non-CSF samples from patients with non-CNS disease manifestations consistent with VZV, collected from 2004 to 2019, were tested with molecular VZV assays. A total of 341 CSF and 1,398 non-CSF samples that tested positive by a VZV-specific real-time PCR assay were further characterized as wild-type or vaccine strain by 3 biallelic real-time PCR assays targeting single nucleotide polymorphism (SNP) markers in open reading frame (ORF) 62. Genotyping was then performed on wild-type strains by conventional PCR and sequencing of 500-bp regions in ORFs 21, 22, and 50. Sequence analysis identified clades 1 to 5 in both sample types with a virtually identical clade distribution between CSF and non-CSF samples. In addition, 19 clade 6 and 13 clade 9 samples were detected in non-CSF samples after implementation of an expanded genotyping scheme, including ORF 29, 38, and 67. These clades were not detected in any CSF samples. Finally, a total of 28 vaccine strains were detected, 25 in the non-CSF samples and 3 in the CSF samples. All three cases of vaccine strain with CNS involvement experienced relatively minor symptoms of aseptic meningitis and fully recovered. These results support the evidence that while the VZV vaccine is capable of causing CNS disease, it is still a rare event and symptoms are typically less severe than those caused by wild-type infection.

Can Lenalidomide Protect against Severe COVID-19 Symptoms in Multiple Myeloma Patients? A Case Series and Review of the Literature.

We present a case series of three multiple myeloma (MM) patients on lenalidomide for maintenance therapy who were at high risk of coronavirus disease 2019 (COVID-19) complications and mortality. However, our patients had minor symptoms after testing positive for COVID-19 although they were unvaccinated. We think that lenalidomide might have a protective effect against severe COVID-19 symptoms.LEARNING POINTSMultiple myeloma (MM) patients with active disease need treatment to avoid morbidity and mortality; the risk of relapse is also higher without treatment.Our three unvaccinated patients had mild COVID-19 infection while being treated with lenalidomide despite having high-risk comorbidities generally associated with severe COVID-19.Some small studies have reported that lenalidomide is protective against severe COVID-19, but larger clinical trials are required to determine whether or not to continue lenalidomide in MM patients with COVID-19.

COVID-19 Infections in Pediatric Renal Transplant Recipients.

The new coronavirus SARS-CoV-2 (COVID-19) first appeared in Turkey in March 2020, spread rapidly, and caused many deaths. Although COVID-19 is mostly a respiratory disease, it can cause kidney and multiorgan failure in some cases. We believe that by sharing information about the course and effects of COVID-19 infection in kidney transplant recipients receiving long-term immunosuppressive therapy our understanding will improve. Between March 2020 and October 2021, COVID-19 was researched in kidney transplant recipients under the age of 20 years who were followed at the Başkent University Transplantation Center. We documented the clinical characteristics and prognosis of pediatric kidney transplant recipients with COVID-19 disease. Our study group included 23 patients with COVID-19 infection from 215 pediatric kidney transplant recipients. The mean age of the patients was 14.6 ± 4.7 years; there were 9 female patients. The mean follow-up time posttransplant was 62.3 ± 43.2 months. In 13 patients (56.5%), fever was the most frequent symptom. Most patients (n = 18, 78%) had minor symptoms and recovered completely after receiving supportive treatment. Four patients (17%) required hospitalization. One was diagnosed with COVID-19 infection 1 week after being treated with rituximab for acute antibody-mediated rejection. That patient died because of significant lung disease and multiorgan failure. Despite the fact that most of our pediatric transplant recipients had mild symptoms of COVID-19, we believe that particular caution should be observed in patients who have recently received intensive immunosuppressive medications. As a result of potential new vaccines, national immunization programs, and the emergence of novel virus strains, the clinical picture may change in the future. We believe that, as information sharing increases, we will learn more about COVID-19 in renal transplant recipients.

Minor stroke, major questions: How to treat patients with large vessel occlusion and minor symptoms.

There are no data available for this article that could be shared.

PREVALENCE OF HEAT-RELATED SYMPTOMS UNDER HEAT STRESS AMONG THAI TIRE MANUFACTURER WORKERS

Tire manufacturer workers who work in hot environments in the workplace may suffer a variety of heat-related symptoms. The purpose of this study was to investigate the prevalence of heat-related symptoms under heat stress. The cross-sectional study was carried out in a tire plant in Nakonpathom province, Thailand. A total of 343 workers (n = 343) were interviewed using a modified questionnaire. The body temperature and wet bulk globe temperature (WBGT) were measured. The mean, Adjust Relative Risk Ratio (Adjust RRR), and 95 % Confidence Interval (CIs) for the association between chosen factors were estimated using multinomial logistic regression. As a result, the most prevalent heat-related symptoms in workers who were exposed to heat in production plants were heavy sweating (70.71%), red rashes (54.55%), and weakness/fatigue (52.02%). The Adjust RRR heat-exposed was three times higher experienced minor symptoms (Adjust RRR = 2.87, 95%CI = 1.43-5.76) and five times higher experienced moderate symptoms (Adjust RRR = 5.00, 95% CI = 2.25-10.82). Females were found six times more likely to experience minor symptoms (Adjust RRR = 6.11, 95%CI = 2.02-18.48) and ten times more likely to experience moderate symptoms (Adjust RRR = 9.57, 95%CI = 2.94-31.19) than the control group. The mean ear temperature did not exceed 38.0°C for safety reasons. Tire workers reported a high burden of heat-related symptoms. On-site care, training programs, and health monitoring strategies are necessary, especially for workers who intake high antihistamines to reduce the risk of heat strain, not only during the summer season but also during the rainy season.