Seventh Day Of Hospitalization Research Articles

Tuberculous Meningitis Complicated Without Deep Sylvian Cerebral Infarction: About an Immunocompetent Patient with HIV-AIDS

Introduction: Neuromeningeal tuberculosis is the most common form of extra-pulmonary tuberculosis in developing countries. It is the most serious form of Mycobacterium tuberculosis infection. Vascular complications of tuberculous meningitis involve functional prognosis of patients. Observation: In our daily practice, we frequently encounter cases of cerebral infarction associated with neuromeningeal tuberculosis in the infectious etiological balance. We report the case of an HIV immunocompetent patient hospitalized for neuromeningeal tuberculosis complicated with ischemic stroke. It was a 39-year-old patient, right-handed, admitted to the Neurology department of University Hospital of Cocody in whom the diagnosis of neuromeningeal tuberculosis was retained. She received treatment for tuberculosis in emergency. On the seventh day of hospitalization, she suddenly presented with a massive motor deficit of the left hemibody. The MRI performed was compatible with meningoencephalitis associated with recent deep right Sylvan ischemia foci. The evolution was marked by partial recovery of the left hemiplegia, right retro-bulbar neuritis, and iatrogenic hepatic cytolysis. Comments: Tuberculous meningitis remains today one of the most serious neurological conditions involving the vital and functional prognosis of patients. Association of cerebral infarction and tuberculous meningitis is of variable occurrence. There are reported cases in which cerebral infarction is a complication of tuberculous meningitis. On the other hand, the discovery of tuberculous meningitis can be observed in the assessment of a cerebral infarction in young subjects. Tuberculous meningovascularitis remains a rare condition in immunocompetent patients for HIVAIDS. It results from arterial occlusion by thrombosing and obliterating endarteritis. It represents a medical emergency requiring starting anti-tuberculosis treatment. The evolution depends on the precocity of the diagnosis and the speed of treatment. Conclusion: The sudden appearance of a neurological deficit in à patient with tuberculous meningitis even under specific treatment should suggest an ischemic stroke, especially if the symptomatology respects an anatomo-functional vascular systematization.

'Evaluation of beta-2-microglobulin and neuron-specific enolase as prognostic factors in patients over 65 years of age with frailty syndrome hospitalized for acute coronary syndrome'.

The aim of the study is to assess the value of beta-2-microglobulin (B2M) and neuron-specific enolase (NSE) as prognostic factors in the population of patients over 65 years of age with frailty hospitalized due to acute coronary syndrome (ACS). Patients aged ≥65 years with ACS were included. Assessment of frailty was carried out using the FRAIL scale. The measurement of NSE and B2M was carried out three times during hospitalization: (1) at the time of admission, (2) on the second day of hospitalization, (3) on the seventh day of hospitalization, or the day of discharge if it was before the seventh day. The primary endpoint was all-cause mortality, and the secondary endpoint was unscheduled rehospitalization. Of the 127 patients, frailty was identified in 39.3%. Multivariate analysis of variance showed significantly higher levels of NSE (P = 0.012) and B2M (P < 0.001) in patients with frailty compared to the nonfrail group and significant changes in marker levels during hospitalization - decreased NSE (P < 0.001) and increased B2M levels (P < 0.001). Elevated B2M-1 level was an independent marker of the occurrence of frailty [odds ratio (OR), 1.98 (1.09-4.00); P = 0.044], and the optimal cutoff point for the diagnosis of frailty was 2.85 mg/l [area under the curve (AUC), 0.718 (0.632-0.795)] with sensitivity 52% and specificity 84.4% (P < 0.001). Elevated NSE-3 level was associated with all-cause mortality, and each 1 ng/ml increase in NSE-3 increased the risk of death by 1.07-fold [OR, 1.07 (1.03-1.10]). Meanwhile, elevated B2M-3 level was associated with unscheduled rehospitalization, and each 1 mg/l increase in B2M-3 increased the risk of unscheduled rehospitalization by 1.21-fold [OR, 1.21 (1.03-1.42)]. The Harrell's C-index for all-cause mortality was higher for NSE-3 [0.820 (95% confidence interval {CI}, 0.706-0.934)] compared to frailty assessed by the FRAIL scale [0.715 (95% CI, 0.580-0.850)], which means that additional NSE-3 assessment may improve the prediction of all-cause mortality. However, Uno's C-Statistic analysis showed that the difference was not statistically significant (Pr>chi-square 0.556). Harrell's C-index for unscheduled rehospitalization was higher for frailty assessed by the FRAIL scale compared to B2M-3. Monitoring NSE and B2M marker levels in patients over 65 years of age with frailty and ACS does not provide additional benefits in terms of prognostic ability compared to tests assessing frailty. B2M, assessed upon hospital admission and monitoring NSE and B2M levels during hospitalization may be considered in the diagnosis of frailty and risk stratification in a group of patients for whom currently available frailty diagnostic tools cannot be used.

Case Report of Polycystic Kidney Disease in a Persian Cat in IPB University Veterinary Teaching Hospital

A 7-year-old male Persian cat was referred to IPB University Veterinary Teaching Hospital with clinical signs of lethargy, weight loss, and loss of appetite and was diagnosed with nephrolithiasis before being referred to IPB University Veterinary Teaching Hospital. Physical examination revealed tachycardia, tachypnoea, pale mucous membrane, 5–6% dehydration rate, cachexia, and palpated masses on the left and right side of the abdominal region. The abdominal cavity was seen as more radiopaque, which resulted in some organs being invisible in the radiographic view. Abdominal ultrasonography showed abnormalities in the liver, gall bladder, and kidneys. The patient was diagnosed with polycystic kidney disease (PKD) with the prognosis of infausta, as the patient was already in a sternal recumbency and could not stand by himself. During hospitalization, the patient was force-fed with a commercial renal diet, and the medical treatments given were intravenous ceftriaxone, vitamins, furosemide, Azodyl®, and intravenous infusion. The patient regained standing ability and survived until the seventh day of hospitalization. However, the owner persisted in bringing the patient home on the seventh day of hospitalization, and the patient died the next day after being brought home.

A Lower Lip Infection (Furuncle) Complicated by Abscess of the Lip, Suppurative Cheilitis Glandularis, Lip Necrosis, Septic Bilateral Multilobar Necrotizing (Destructive) Pneumonia, and Pleurisy (Pleuritis): A Case Report and Literature Review

Infection of the lower lip can manifest differently. The likelihood of such prompt life-threatening septic complications, as thrombophlebitis, pneumonia, pleurisy, etc, may be underestimated due to the small size of the local inflammation of the lip. We present a 21-year-old Caucasian female with a Staphylococcus epidermidis infection of the lower lip (furuncle) complicated by lip abscess, suppurative cheilitis glandularis, lip necrosis, septic bilateral multilobar necrotizing (destructive) pneumonia, pleurisy (pleuritis), and pulmonary insufficiency of the first degree (type I). Clinical photos of the report demonstrate all stages of the course of inflammation and treatment of the severe lower lip infection from the moment of admission. Preoperative condition, the period of formation and demarcation of necrosis, cleaning of the wound from purulent content, demonstration of fibrinous exudate (also known as fibrinous plaques), the appearance of granulations, and visualization of lip scars as of the day of discharge from the hospital (day 26) are presented. The article also includes a chest X-ray at the time of admission, on the second day, and on the seventh day of hospital stay. The report is enriched as well by three-dimensional multi-slice computed tomography (3D MSCT) images on the eighth, eighteenth, and fortieth days from the moment of admission to our hospital. 3D MSCT of the lungs is showing the areas of pulmonary tissue necrosis and the healing phase. The article contains two videos (cine images) with a duration of 21 seconds and 2 minutes 11 seconds, which demonstrate chest MSCT on the hospital day 8 and 18. The patient was discharged on the 27th day of admission. According to our English-language literature search, it's a first ever reported case of the lower lip furuncle which led such a unique combination of severe local and septic complications documented at all stages of treatment from both aspects clinical and radiological. An update of the classification of uncomplicated and complicated forms of development of furuncles (i.e., boils) and carbuncles is done and presented. More than 37 literary sources were analyzed, and their key aspects complemented our report. Articles with necrotizing fasciitis of the lips were also analyzed.

Evaluation of nonpharmacological nursing practices related to thirst and the thirst of patients in the intensive care unit

Introduction and aim. Thirst is a significant symptom and stressor among patients in the intensive care unit. The aim of this study is to assess the severity of thirst and associated symptoms experienced by patients in the intensive care unit, and to evaluate the nursing practices related to addressing thirst. Material and methods. This descriptive and correlational study involved a total of 66 patients in the intensive care unit. Severity of thirst experienced by these patients was assessed using a numeric rating scale. The nursing practices related to assessing thirst severity on admission to the unit, on the third day, and on the seventh day were also recorded. Results. Our findings showed a statistically significant increase in the levels of thirst, dry mouth, bad taste and odor in the mouth, as well as sensitivity and dryness in the throat among patients on the seventh day of hospitalization (p&lt;0.05).Among nursing interventions, communication with the patient was the most frequently applied intervention during the seven-day period, with a range of 98.5% to 100%. biochemical control (100%), ventilation of the unit (100%), and temperature regulation (100%) were also frequently applied. Conclusion. The patients had all the symptoms of thirst.The frequency of nursing interventions increased in parallel with the severity of thirst.

CHALLENGES OF PULMONOLOGIST IN COVID-19 PATIENTS TREATMENT - THE SIGNIFICANCE OF MONITORING THE LEUKOCYTE FORMULA AND INFLAMMATION MARKERS

Introduction: The pathophysiology of COVID-19 is still not fully understood, but is considered to be the result of strong production of pro-inflammatory cytokines and imbalance of the coagulation process. Based on this, we aimed to examine the significance of monitoring the leukocyte formula and the available inflammation parameters in COVID-19 patients. Methods: The study included 100 patients divided into two groups: with moderate and severe disease. The counts of leukocytes, neutrophils and lymphocytes, neutrophil-lymphocyte ratio (NLR), the values of C-reactive protein, ferritin and D-dimer were monitored on the first, seventh and fourteenth day of hospitalization, as well as the initial values of IL-6. The data were statistically processed with a significance threshold of p&lt;0.05. Results: The leukocytes and neutrophils counts change statistically significantly during the follow-up period and differ between the studied groups. CRP and D-dimer values decrease statistically significantly during the follow-up period. The NLR on the seventh day, the values of ferritin and D-dimer after the seventh day of hospitalization, as well as the initial values of IL-6, are statistically significantly higher in patients presenting severe disease. An increase in the number of leukocytes above 12.25x109 /L and NLR above 7.08 on the seventh day of hospitalization, as well as initial IL-6 values above 40.75 pg/ml are predictors of disease severity. Conclusion: The leukocytes, neutrophils and lymphocytes counts, the neutrophil-lymphocyte ratio, as well as the values of D-dimer and ferritin on the seventh day of hospitalization are statistically significantly different in patients with moderate and severe COVID-19. The mentioned parameters, along with the initial values of IL-6, can be used as predictors of the disease severity in COVID-19

Acute encephalopathy bilirubin in the first week of life: A case of G6PD-deficient neonate

Background. Acute bilirubin encephalopathy is an acute neurological manifestation due to indirect bilirubin deposits in the basal ganglia and brainstem nuclei. In several developed countries, the incidence reaches 0.6-2.5 cases/100,000 births, while a recent study in 8 hospitals in Indonesia showed an incidence rate of 2%. In this paper, we describe an acute bilirubin encephalopathy in a neonate with G6PD deficiency. Case Presentation. A 5-day-old male neonate was admitted to the ER with recurrent generalized tonic seizures which started 6 hours prior to admission. Post seizure, the neonate cried then fell asleep. He had seemed less active and did not want to breastfeed for the last 12 hours. The neonate was born at full term (3160 grams) by a spontaneous vaginal delivery in the hospital, APGAR score 7/9, mother blood type AB+. He was exclusively breastfed with adequate intake. Physically examined, the neonate was lethargic with flat anterior fontanelle, Kramer V jaundice, fever, hypertonia, decreased sucking reflex, physiologic reflexes +2/+2, Babinski +/+, without cranial nerve paresis. Laboratory results of total bilirubin 44.79 mg/dL (indirect 43.04 mg/dL; direct 1.75 mg/dL), Hb 14.2 g/dL, WBC 15,000/μL, reticulocytes 124,500/μL, negative Coombs’s test, blood type A+, peripheral blood morphology within normal limits. The neonate was planned for exchange transfusion, intensive (triple) phototherapy was performed while waiting for the exchange transfusion. Bilirubin levels fell significantly within 12 hours after phototherapy initiation. Phototherapy was continued, the neonate was discharged on the seventh day of hospitalization in good condition. During treatment, etiology tracking was performed towards G6PD (G6PD level: 6.6 U/dL). Conclusion. Acute bilirubin encephalopathy is a rare morbidity found in newborns. ABE that occurs in the first week of life, prompt further investigations other than physiologic jaundice. Most frequent etiologies are ABO incompatibility, G6PD deficiency, sepsis and hereditary spherocytosis. In this case, we found G6PD as the cause of acute bilirubin encephalopathy in the first week of life.

Risk factors for mortality in fulminant acute necrotizing encephalopathy following influenza A in an adolescent boy

Acknowledging the risk factors of mortality and morbidity of each disease is effective for its final outcome. Recognizing these cases can have the value of preventing the occurrence of unfortunate events, such as not recommending the use diclofenac in an influenza epidemic.

Transient cognitive impairment in the acute phase of stroke – prevalence, risk factors and influence on long-term prognosis in population of patients with stroke (research study – part of the PROPOLIS study)

BackgroundCognitive impairment is a common complication of the acute phase of stroke, which can be transient and resolve while still in the hospital. This study evaluated the prevalence and risk factors for transient cognitive impairment and their impact on long-term prognosis in a population of acute-phase stroke patients.MethodsConsecutive patients admitted to a stroke unit with acute stroke or transient ischemic attack were screened twice for cognitive impairment using the parallel version of Montreal Cognitive Assessment: the first time between the first and third day and the second time between the fourth and seventh day of hospitalization. If the second test score increased by two or more points, transient cognitive impairment was diagnosed. Patients were scheduled for follow-up visits three and 12 months after stroke. Outcome assessment included place of discharge, current functional status, dementia, or death.ResultsFour hundred forty-seven patients were included in the study, 234 (52.35%) were diagnosed with transient cognitive impairment. Delirium was the only independent risk factor for transient cognitive impairment (OR 2.417, 95%CI 1.096–5.333, p = 0.029). In the analysis of effects on three- and twelve-month prognosis, patients with transient cognitive impairment had a lower risk of hospital or institution stay 3 months after stroke compared with patients with permanent cognitive impairment (OR 0.396, 95%CI 0.217–0.723, p = 0.003). There was no significant effect on mortality, disability or risk of dementia.ConclusionsTransient cognitive impairment, which often occurs in the acute phase of stroke, does not increase the risk of long-term complications.

Study of the Responsiveness and Minimal Clinically Important Difference of the Trunk Impairment Scale in Patients With Acute Stroke.

Trunk function is a prerequisite for functional activity; thus, it is crucial to carry out proper assessments and interventions. However, there is no clear indicator for trunk function evaluation in patients with stroke. To understand the effects of interventions over time, it is important to adopt responsive clinical indicators. To examine the Trunk Impairment Scale (TIS) (Fujiwara version) in terms of responsiveness and the minimal clinically important difference (MCID). In total, 55 patients who experienced an acute stroke were evaluated on the seventh day of hospitalization and the day before discharge. The responsiveness of the TIS was assessed by the effect size and standardized response mean (SRM). Additionally, an MCID study was conducted to examine the amount of change in TIS scores required to indicate a clinically meaningful change, which was determined by the presence or absence of improvement in the activities of daily living. The SRM of the TIS was 1.42. Additionally, the MCID was determined to be 3 points. The TIS score improved over time and a 3-point improvement in the TIS score was associated with improvement in the activities of daily living. Thus, this scale's clinical sensitivity and MCID have been established in patients with stroke.

An abnormal multidrug-resistant and hypervirulent &lt;i&gt;Klebsiella pneumoniae&lt;/i&gt; clinical isolate without &lt;i&gt;rmpA&lt;/i&gt; or &lt;i&gt;rmpA2&lt;/i&gt;

&lt;i&gt;Klebsiella pneumoniae&lt;/i&gt; is a notorious opportunistic pathogen, especially hypervirulent &lt;i&gt;K&lt;/i&gt;. &lt;i&gt;pneumoniae&lt;/i&gt; (hvKp). Fortunately, most classical hvKp strains are antibiotic-susceptible. However, in recent years, reports of multidrug-resistant hvKp (MDR-hvKp) have increased dramatically, threatening the health and safety of people worldwide. Here, we report the discovery of MDR-hvKp without &lt;i&gt;rmpA&lt;/i&gt; and &lt;i&gt;rmpA2&lt;/i&gt; in a 92-year-old patient with chronic obstructive pulmonary disease. The patient died on the seventh day of hospitalization. Phenotyping experiments and whole-genome sequencing of &lt;i&gt;K&lt;/i&gt;. &lt;i&gt;pneumoniae&lt;/i&gt; isolate 21072329 isolated from the patient’s sputum were performed. Moreover, 21072329 belongs to ST11-KL47 MDR-hvKp, which was highly lethal to &lt;i&gt;Galleria mellonella&lt;/i&gt;. Meanwhile, 21072329 had a strong viscosity, and it was difficult to completely centrifuge it; 21072329 carried ESBL genes (&lt;i&gt;bla&lt;/i&gt;&lt;sub&gt;CTX-M-65&lt;/sub&gt;, &lt;i&gt;bla&lt;/i&gt;&lt;sub&gt;SHV-158&lt;/sub&gt;, and &lt;i&gt;bla&lt;/i&gt;&lt;sub&gt;TEM-1&lt;/sub&gt;) and a carbapenemase gene (&lt;i&gt;bla&lt;/i&gt;&lt;sub&gt;KPC-2&lt;/sub&gt;), and it was resistant to carbapenem antibiotics and third- and fourth-generation cephalosporins. Although 21072329 had the characteristics of hvKp, &lt;i&gt;rmpA&lt;/i&gt; and &lt;i&gt;rmpA2&lt;/i&gt; could not be found in its genome; it also only carried a siderophore of yersiniabactin. This may indicate that other hypervirulence factors promote the formation of hvKp. MDR-hvKp has already brought an enormous burden to global medical care, and those carrying unknown hypervirulence factors are new threats, so urgent prevention and control with research are urgently needed.

The Youngest Palestinian Case of Multisystem Inflammatory Syndrome in children (MIS-C)

The multisystem inflammatory syndrome in children (MIS-C) considers a post-infectious immunological response to coronavirus illness (COVID-19) that was originally identified in the United Kingdom and later identified in other countries. A previously healthy 3-month-old boy was admitted to hospital context with -5-day history of fever, gastrointestinal symptoms [diarrhea, vomiting of normal gastric contents], hypoactivity, and poor oral intake, but so far no history of covid-19 active disease. The infant was dehydrated, with macular non-blanching skin rash everywhere over his body and widespread non-pitting edema. With supportive measures, methylprednisolone and IV immunoglobulin, the child improved, with his fever, skin rash, and laboratory tests returning to normal. On the seventh day of hospitalization, he was discharged. This is identified as the youngest reported case of MIS-C since the beginning of the COVID-19 pandemic

Bullous systemic lupus erythematosus in a 16-year-old male patient

Bullous systemic lupus erythematosus (BSLE) is a vesiculobullous disease mediated by autoantibodies in patients with systemic lupus erythematosus (SLE). Tense vesicles and bullae are seen on an edematous, erythematous and sometimes normal skin in any body region, including mucous membranes and non-photoexposed areas. This is the case of a 16-year-old male patient with lupus nephritis who, on the seventh day of hospitalization, presented multiple serous and hemorrhagic blisters on the face, trunk, abdomen and upper extremities. The histological study showed a subepidermal bullousdermatosis with numerous neutrophils.

Oral health and the presence of infectious microorganisms in hospitalized patients: a preliminary observational study

Objective Characterise oral health, and the presence in the oral cavity of pathogenic non-oral microorganisms potentially associated with nosocomial infections and antimicrobial resistance in non-intubated patients admitted to a Brazilian university hospital. Materials and methods An intraoral examination and oral swab were performed on hospitalized individuals at three different times, T1 (within 48 h of hospitalization), T2 (48 h after T1) and T3 (7 days after hospitalization). The oral health status was defined by the Oral Health Assessment Tool (OHAT) and Tongue Coating Status (TCS). The swabs were processed and microorganisms potentially related to nosocomial infections were phenotypically identified through colony morphology, staining and microscopy. Results The most prevalent microorganisms were Escherichia coli, Enterococcus spp., Enterobacter spp., Pseudomonas spp., Candida albicans and Staphylococcus aureus. The oral health status was considered median, and the tongue coating index was considered high throughout the study period. The prevalence of potentially pathogenic non-oral microorganisms was high and constant from the first 48 h to the seventh day of hospitalization. Conclusions The results point out that the mouth can act as a reservoir of epidemiologically important pathogens within hospital settings, even in patients without mechanical ventilation, thus increasing the risk of nosocomial infections in susceptible individuals. KEY MESSAGES The present study investigated the oral health status and the presence of pathogenic non-oral microorganisms in the oral cavity of patients hospitalized in the ward, non-intubated and mostly independent of self-care. The presence in the mouth of microorganisms related to the epidemiology of nosocomial infections and resistance to antimicrobials was high and constant from the first 48 h to the 7th day of hospitalization. The results of this study point out that the mouth can act as a reservoir of epidemiologically important pathogens within hospital settings even in patients without mechanical ventilation, increasing the risk of nosocomial infections in susceptible individuals.

A randomized clinical trial to assess the effect of zinc and vitamin D supplementation in addition to hypertonic saline on treatment of acute bronchiolitis

BackgroundBronchiolitis, the most common cause of hospitalization in infancy has not yet a definitive treatment. This study was conducted to assess the effect of Zinc and vitamin D on treatment of infants with bronchiolitis.MethodsIn this double blind, randomized clinical trial, 94 infants aged 2 to 23 months, admitted in Mousavi Hospital in Zanjan, Iran, with the diagnosis of acute bronchiolitis were randomly assigned into 3 groups. The control group was only treated with hypertonic saline. The two case groups received either 100 unit/kg/day of Vitamin D or 20 mg/day of zinc in addition to hypertonic saline. Wheezing, duration of hospital stay, cough, cyanosis, respiratory distress and the respiratory rate in the first, third and seventh day of hospitalization were evaluated.ResultsThere was no significant difference between groups in terms of age, sex, weight, passive smoking, wheezing, oxygen saturation, cyanosis and type of delivery. On the third day of hospitalization, the respiratory rate/min in the control group, the groups receiving vitamin D and zinc were 45.2 ± 10.7, 37.8 ± 3.9 and 41.1 ± 9.1 respectively and the result of repeated measure analysis didn’t show any significant difference between the 3 groups (P = 0.562). Duration of hospitalization in the group receiving Vitamin D or zinc and in controls were 4.2 ± 2.6, 4.4 ± 2.2 and 5.1 ± 2.4 days respectively and this difference was not significant. Zinc receiving patients did not differ from the control group regarding to respiratory rate, cyanosis and wheezing.ConclusionVitamin D or zinc administration was not effective in reducing respiratory rate in children with bronchiolitis.Trial registration This project was approved by the Institutional Ethics Committee (IR, ZUMS.REC.1396.50), and registered on IRCT (IRCT20131217015835N7).

Takotsubo Syndrome Presenting with Syncope and Third-Degree Atrioventricular Block Requiring Permanent Pacemaker Implantation

Takotsubo syndrome (TS) is an acute but transient heart failure syndrome and it is very uncommon for TS to present with syncope and complete atrioventricular (AV) block. In this report, we discuss a case of TS complicated by a third-degree AV block presented to the emergency department with syncope and requiring permanent pacemaker implantation. A 53-year-old female was admitted to our emergency department with complaints of syncopal episodes and chest pain. Due to ongoing chest pain, electrocardiography (ECG) findings and segmentary wall motion abnormality on the transthoracic echocardiography (TTE), she was immediately transferred to the cardiac catheterization laboratory. Coronary angiogram revealed normal coronary arteries and left ventriculography demonstrated apical ballooning and hypokinesis of the apex. Once the diagnosis of TS was established, the patient was transferred to the coronary intensive care unit (CICU). Initial ECG at CICU demonstrated complete AV block with a heart rate of 35 beats/min. On the third day of hospitalization, repeat TTE showed improved left ventricular functions with an ejection fraction of 50%. During the follow-up period in CICU, complete AV block persisted and the rhythm did not return to normal sinus rhythm after six days of monitorization. An electrophysiological study demonstrated supra-hisian atrioventricular block and atrioventricular dissociation. On the seventh day of hospitalization, TTE demonstrated recovered ventricular functions with an ejection fraction of 65%, and a dual pacemaker was then implanted. Her third-month followup was uneventful and TTE showed normal left ventricular functions but pacemaker interrogation revealed 99% of ventricular pacing. This case report demonstrated that the decision to implant a permanent pacemaker in such patients should be considered on a case-by-case basis, and an electrophysiological study could be valuable on this decision.

Successful IgM-enriched immunoglobulin treatment in severe COVID-19 pneumonia: a case report

Coronavirus disease (COVID-19) pandemic has turned into one of the most considerable challenges worldwide. The optimal treatment strategy, particularly in severely ill patients, is still unrecognized. IgM-enriched immunoglobulin (Pentaglobin®, Biotest AG, Dreieich, Germany) contains IgM, IgA and IgG against a variety of pathogens representing passive immune protection for affected individuals and it may be effective in the treatment of COVID-19. On March 16, 2020, a 32-year-old woman presented to Masih Daneshvari Hospital, Tehran, Iran. On admission, the peripheral oxygen saturation (O2 Sat) was 84%. Spiral chest computed tomography (CT) scan revealed bilateral ground-glass opacification (GGO) involvement. On March 19, 2020, the clinical condition was deteriorated, and her O2 Sat decreased to 70% in ambient air. Treatment with IgM-enriched immunoglobulin was immediately initiated over the course of three days (total dose for the patient was calculated to be 1500 ml). On the seventh day of hospitalization, the patient was discharged with satisfactory general condition, without any complaints, and with stable vital signs and O2 Sat of 95% on room air. In conclusion, IgM-enriched immunoglobulin could be considered as a potential option for the treatment of severely ill patients with COVID-19.

Long-Term Electrocardiographic Follow-Up of a Patient with Light-Chain Cardiac Amyloidosis

Amyloid light-chain (AL) cardiac amyloidosis can cause restrictive cardiomyopathy, which has a poor prognosis. Although electrocardiography (ECG) is useful for its diagnosis and management, there are few reports on the long-term follow-up of electrocardiographic changes in affected patients. The present patient was a 62-year-old woman who visited our hospital for assessment of palpitations and lower leg edema. A chest radiograph showed cardiac enlargement, and ECG revealed sinus rhythm, first-degree atrioventricular block, low QRS voltage in the limb leads and a pseudo-myocardial infarction pattern in the precordial leads. Echocardiography revealed left ventricular hypertrophy with systolic and diastolic dysfunction. Immunoelectrophoresis demonstrated M-protein (IgGλ), and bone marrow biopsy suggested IgGλ-type plasmacytoma. Myocardial biopsy findings were compatible with cardiac amyloidosis. On the basis of these findings, we diagnosed AL cardiac amyloidosis. Melphalan-prednisolone (MP) therapy was started in conjunction with treatment for non-sustained ventricular tachycardia and congestive heart failure. Two years and 4 months later, the sinus rhythm converted to atrial tachycardia. At a follow-up examination at 4 years and 8 months, right branch block appeared. After that, intraventricular conduction worsened, and the low voltage in the limb leads was not observed. Seven years after diagnosis, she was hospitalized for treatment of pneumonia and heart failure with tachycardia. On the seventh day of hospitalization, heart rhythm changed to atrial stand-still with escaped ventricular rhythm and she died of cardiac arrest. These ECG changes are valuable information regarding the pathophysiological changes that occur in AL cardiac amyloidosis.

The Association Between Quality of Nursing Care in the ICU and Severity of Illness

Background: The quality of nursing care can be affected by a variety of factors. This study aims to determine the correlation between quality of nursing care and severity of illness (SOI) in patients admitted to intensive care unit (ICU). Methods: This descriptive-correlational study was performed during November 2018 to January 2019 in Ayatollah Mousavi Hospital, Zanjan, Iran. The sample included 50 ICU patients who were recruited by convenience sampling. The data were collected using ICU quality of nursing care scale and the Sequential Organ Failure Assessment (SOFA) score within the first seven days of hospitalization and were analyzed by descriptive and non-parametric statistical tests (Friedman, Wilcoxon signed-rank, and Spearman’s rho) using SPSS software version 22. The significance level was set as 0.05. Results: The mean score of quality of nursing care was 86.62(2.19) and there was a significant difference among the seven days (p&lt;0.001). Also, the mean score of SOI was 6.4(2.31) and it was constant in the first to third days of hospitalization and decreased by the fourth day of admission. There was a significant indirect correlation between the quality of nursing care and SOI from the fourth day onwards (p&lt;0.05). Conclusion: There was a significant inverse relationship between quality of nursing care and SOI from the fourth to the seventh day of hospitalization. It seems that nursing care delivery in the ICU is mainly routine and does not follow the holistic model of care. Therefore, the severity of the illness and the changing needs of patients admitted to the ICU require that care models be tailored to these changes.

Percutaneous Drainage as The Management of Amebic Liver Abscess (ALA): A Case Report

Background: Amebic liver abscess (ALA) is the most common extraintestinal manifestation of amebiasis caused by Entamoeba histolytica infection. Clinical diagnosis of ALA is often uncertain due to no specific signs and symptoms. Abscess aspiration or drainage had a vital role in the management of ALA, mainly in cases with inadequate treatment response and large abscesses at risk of rupture. Case Presentation: A 66-year-old male patient presented with right upper quadrant abdominal pain for two weeks. He was diagnosed with a liver abscess in another hospital and then referred to our hospital due to inadequate clinical response after the treatment. Ultrasonography showed a solitary hypoechoic lesion in the right lobe of the liver and the CT scan revealed a well-defined hypodense lesion with regular margins in segment VII of the liver. Metronidazole and ceftriaxone were given intravenously during hospitalization. Percutaneous drainage of the liver abscess was performed on the seventh day of hospitalization with the indication of inadequate treatment response, size, and location of the abscess. The culture of the discharge showed growth of E. histolytica. No complications were found and the patient was discharged on the twelfth day of hospitalization with optimal clinical improvement. Conclusion: We report a case of ALA with inadequate response to the conservative treatment. The percutaneous drainage was performed for abscess decompression based on the preoperative ultrasound and CT scan. There is no complication was found and the patient was discharged on the twelfth day of hospitalization with optimal clinical improvement.