Ten-day Course Research Articles

Legionella Pneumophila Presenting as a Rare Cause of Acute Thrombocytopenia: A Case Report and Review of Literature.

Legionella pneumophila can cause a wide spectrum of clinical manifestations, ranging from a mild flu-like illness to fulminant multi-organ involvement, characterised by severe pneumonia, diarrhoea, encephalopathy, shock, hepatic dysfunction and renal failure. Very rarely, it can be associated with haematologic conditions such as thrombotic thrombocytopenic purpura (TTP), haemolytic uraemic syndrome (HUS) and immune thrombocytopenic purpura (ITP). We report a rare case of L. pneumophila causing ITP and review previously published cases of thrombocytopenia associated with Legionellosis in the literature. A 53-year-old male presented with fevers, chills, a productive cough and severe haemoptysis. Blood work was remarkable for leukocytosis, severe thrombocytopenia and hyponatraemia. Computed tomography (CT) imaging showed left lower lobe lung consolidation, and a peripheral blood smear showed giant platelets consistent with ITP. Legionella urine antigen testing returned positive. He was treated with intravenous immunoglobin, steroid taper and a ten-day course of azithromycin, which led to normalisation of his platelet count and resolution of the pneumonia. L. pneumophila can lead to complement-mediated destruction of platelets resulting in ITP. Antibodies against L. pneumophila can also cross-react with the enzyme ADAMTS13, inhibiting its function and resulting in TTP and HUS. Additionally, L. pneumophila can infect vascular endothelial cells causing their death and stimulating release of von Willebrand factor (vWF) multimers into the bloodstream, promoting thrombosis and platelet consumption. It is important for internists to consider L. pneumophila in the differential for any patient presenting with pneumonia and severe thrombocytopenia. Earlier detection and intervention can lead to prevention of critical bleeding and better outcomes. Legionella pneumophila is rarely associated with different haematologic disorders resulting in severe bleeding diathesis as well as thrombosis.It is important for internists to consider Legionella pneumophila in the differential diagnosis for any patient presenting with pneumonia and severe thrombocytopenia.Earlier detection and intervention can lead to prevention of critical bleeding and better outcomes.

The Effect of Three Ten-Day Courses of Yoga Exercises and Zinc Sulfate Supplementation on Prostaglandin E in Non-athletic Young Women with Primary Dysmenorrhea

Background: Dysmenorrhea (painful menstruation) is a common health problem in women of reproductive age, affecting the individual’s health, job performance, and quality of life. Objectives: This research investigated the effect of three ten-day yoga courses and zinc sulfate on primary dysmenorrhea in non-athlete girls. Methods: Forty-eight girls (18 to 25 years old) suffering from dysmenorrhea in Karaj participated in this clinical trial. Cluster sampling was used to select the subjects, and they were allocated to four groups: The placebo group, the yoga and placebo group, the zinc sulfate group, and the yoga and zinc sulfate group. Before the research, the serum levels of prostaglandin E were measured in the laboratory using the ELISA method. Then, the yoga training group (from the 22nd day of menstruation to the third day of bleeding for ten days, 45 minutes every day) performed yoga exercises. The exercise program of this research was five asanas. Also, yoga, stretching, strength training, and breathing and relaxation techniques were performed between the asanas training, which mainly involved the abdomen and lower back. Results: The results showed that yoga exercises and zinc sulfate supplementation significantly affected (decreased) the levels of prostaglandin E in non-athlete girls (F1,43 = 17.564, P = 0.001, η = 0.290). Also, exercise alone affected prostaglandin E levels significantly (P < 0.05) compared to other groups. However, the supplement alone did not influence prostaglandin E levels significantly (P > 0.05). In addition, exercises and zinc sulfate supplementation significantly affected anthropometric measures. Conclusions: According to the results, three ten-day yoga exercise programs and zinc sulfate supplements improved primary dysmenorrhea.

The mechanism and kinetics of antianginal effect formation after laser therapy course in patients with angina pectoris

Purpose: To assess some mechanisms of antianginal effect formation under low-level infrared laser irradiation in patients with angina pectoris, as well as to clarify the kinetics of this clinical effect after laser therapy course. Materials and methods. 88 male patients, aged 54.2 ± 3.7, with angina pectoris of functional class II–III were examined. 63 patients of the main group had a ten-day course of laser therapy. 25 patients were included in the control group in which laser irradiation was only simulated. At the initial stage and one month after laser therapy or its imitation, and in the main group additionally after 3 and 6 months, bicycle ergometric tests were performed to determine exercise tolerance and evaluate the double product indicator at the level of initial (P1) and maximum (P2) threshold load, if its threshold power exceeded the initial one. Results and discussion. The increase of exercise tolerance was observed in 79.5 % of patients from the main group one month later and in 81.7 % three months later after finishing laser therapy course, with the increase in exercise tolerance by 19.1 W (+ 30.4 %; p = 0.023) and by 22.7 W (36.2 %; p = 0.009), respectively. The antianginal effect lasted for about 6 months of follow-up in 62.0 % of treated patients. The double product indicator reflecting myocardial oxygen consumption at P1 level after laser irradiation had a pronounced downward trend. This indicator increased at maximum load (P2) by 19.1 % (p = 0.04) and by 24.1 % (p = 0.006) during repeated examinations in 1 and 3 months, respectively. By the sixth month of observation, studied parameters returned to the initial levels. There were no statistically significant changes in the studied parameters in patients from the control group. Conclusion. The data obtained indicate that a ten-day course of laser therapy triggers high and long-lasting antianginal effect in patients with angina pectoris. The mechanism of its action is caused with the economization factor of cardiac activity and with the increase of coronary blood flow productivity.

Рецидивуючий бактеріальний вагіноз: варіативний підхід з урахуванням можливих патогенетичних аспектів

Purpose - to evaluate the effectiveness, duration of the clinical result, safety and tolerability of the complex treatment of recurrent bacterial vaginosis (BV) with the sequential use of an antibacterial agent and probiotic suppositories. Materials and methods. 91 women of reproductive age with a symptomatic course and a diagnosis of recurrent BV participated in the study. Primary decontamination of the vaginal tract was performed by all subjects and consisted of a 10-day intravaginal administration of the drug Terzhinan. Subsequently, the participants were randomized into three comparable groups. After primary remediation, no additional medication was prescribed to patients in the Group 1 (n=30). Subjects of the Groups 2 (n=30) and 3 (n=31) were recommended daily administration of vaginal probiotic suppositories Bifolak for a 10-day course, followed by prolongation of their use twice a week for 2 months in the Group 3. The effectiveness of BV therapy was evaluated immediately after antibacterial treatment and after a 6-month follow-up period based on the results of clinical examination, microscopic analysis of smears, and determination of vaginal pH with litmus strips. Results. At the end of the 10-day course of vaginal sanitation, subjective and objective signs of bacterial infection were not detected among all study participants, the pH of the vaginal secretion was within physiological limits and did not differ statistically between the Groups. At the stage of the sixth month of observation, data from a gynecological examination, smear microscopy and pH-metry confirmed 4 recurrences of the disease in the Group 1. In the Group 2, whose women additionally received a ten-day course of probiotic therapy, the number of episodes of repeated development of the disease was significantly lower, and amounted to 1 case for the entire observation period. Patients of the Group 3 did not notice manifestations of reinfection during the study and had no objective signs of BV. The use of a probiotic for a continuous course of 10 days in the Group 2, as well as its prolongation in a maintenance regimen (twice a week for 2 months) in the Group 3, was combined with a stable normalization of the acidity of the vaginal secretion, which was evidenced by the preservation of optimal pH until the end of the observation period (4.07±0.14 and 3.94±0.17, respectively, in the Groups 2 and 3 against 4.43±0.14 in the Group 1, p<0.05). The complete absence of repeated cases of BV and the lower pH values (p>0,05) in the Group 3 allowed us to consider the greater anti-relapse effectiveness of the long-term use of the probiotic at the trend level. Conclusions. Traditional schemes for the use of antibacterial agents in the treatment of BV allow to achieve a clinical and laboratory effect at the end of the course, but do not ensure its complete preservation for a long period of time. The disadvantage of the etiotropic approach to the treatment of BV is the lack of attention to the competitive properties of the indigenous flora as a factor in countering dysbiosis. Taking into account the pathogenetic essence of BV, which consists in the violation of the growth balance between conditionally pathogenic microorganisms and its own flora, classical antibacterial schemes can be successfully supplemented by the external introduction of eubiotic strains. Our study showed the benefits of complex therapy with an antibacterial agent and a probiotic, which consisted in stabilizing the acidity of the vaginal space and reducing the rate of disease recurrence, with a tendency to increase the effect in parallel with the duration of treatment. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Complex Fistula Management: Interval Tightening of Rubber Seton and Regular Wound Dressing Case Study

Anorectal abscess and fistula in ano pose common challenges in colorectal surgeons. This case series of 25 patients with complex fistula in ano highlights the importance of precise preoperative evaluation, including imaging modalities such as CT scan and MRI. Surgical management involved the placement of cutting rubber setons in most cases, combined with a ten-day antibiotic course. Follow-up evaluations at six months revealed successful outcomes in terms of wound healing and continence maintenance through patient education on kegel exercises. This study emphasizes the significance of individualized treatment strategies and meticulous postoperative care for achieving favorable results in complex fistula cases.

Purple Urine Bag Syndrome in a Woman with Squamous Cell Cervical Cancer

Purple urine bag syndrome is a rare phenomenon whose striking presentation can lead to earlier recognition and treatment of a potentially serious medical condition. This is a unique condition of long11 term indwelling catheter associated urinary tract infection with distinct, purple-colored urine caused by bacterial metabolites. This infrequent occurrence was seen in a patient with stage IIIb squamous cervical cancer who presented to the emergency department with symptoms of a urinary tract infection in setting of indwelling bilateral percutaneous nephrostomy tubes. The patient’s physical exam was notable for left costovertebral tenderness, purple urine in bilateral nephrostomy bags and urine culture significant for proteus mirabalis. The patient was treated with intravenous antibiotics and fluid resuscitation. She unfortunately left against medical advice shortly after being admitted. She re presented to an outside hospital with fevers and non-draining nephrostomy tubes notable to have purulent discharge at the nephrostomy sites. The scant urine through the nephrostomy tubes was also noted to have a purple hue. She was found to have another urinary tract infection with Enterobacter cloacae and subsequently treated with intravenous antibiotics. During this admission, she underwent bilateral nephrostograms notable for significant clogging of tubes and bilateral ureteral patency. After the study, she underwent removal of the long-term indwelling catheters and was able to continue voiding spontaneously. She was discharged in good condition on a ten-day course of oral antibiotics. The occurrence of purple urine is highly associated with urinary tract infections. This process is thought to be caused by a metabolism of dietary tryptophan by intestinal bacteria to indole that is then absorbed into the circulation and then converted to indoxyl sulfate by hepatic enzymes. This substrate returns to circulation and is excreted in the urine where in the presence of bacteria with sulfatase and phosphatase activity converts indoxyl sulfate to indigo and indirubin resulting in the characteristic purple hue of the urine. Catheter associated urinary tract infections require antibiotic treatment and timely removal of catheter when appropriate to prevent complications including pyelonephritis and sepsis.

EVALUATION OF THE THERAPEUTIC EFFECTS OF TRANSCUTANEOUS INTERFERENTIAL CURRENT THERAPY AND THERAPEUTIC EXERCISES ON MUSCULOSKELETAL SYMPTOMS IN PATIENTS WITH POST COVID-19

The aim of this research was to investigate the therapeutic effectiveness of a multi-component rehabilitation program including: transcutaneous interferential current therapy and therapeutic exercises in patients with musculoskeletal symptoms in post COVID-19 syndrome. Materials and Methods: 62 patients, mean age 55.9(13.99), aged 21 to 79 years, with persistent musculoskeletal symptoms in the recovery phase after experiencing COVID-19 were included in this study. All patients underwent a ten-day treatment course in an outpatient setting, including transcutaneous application of interferential current with four electrodes. The therapeutic parameters were selected with analgesic, trophic and stimulating effects (90-100 Hz, 5min and 0-100 Hz, 15min). Immediately after electrotherapy, kinesitherapy was performed including: breathing exercises, aerobic training, active and resistance exercises for the limbs, postural control exercises and exercises to improve the mobility of the peripheral joints and the axial skeleton. Results were evaluated by: Visual Analogue Scale (VAS) for assessment of back pain, Numerical Rating Scale (NRS) for arthralgia and myalgia assessment, Brief Fatigue Inventory (BFI) – fatigue assessment, functional tests of mobility, Goniometry in the spine, Ott Sign- for measuring the range of motion (ROM) of the thoracic spine, Schober’s test to determine a lumbar spine range of motion (flexion), Tom Meyer’s test for total hip joint and spine flexion mobility. The results were reported before and after the rehabilitation. The statistical significance level was specified as (p<0.05). Results: Musculoskeletal symptoms in the observed patients persisted for an average of 12 weeks, ranging from 7 to 20 weeks, and included: myalgia in 46.8% (29), arthralgia 29.0% (18), pain in various back departments 79.0% (49), fatigue 66.1% (41). Inpatient treatment for acute COVID-19 was performed in 35.5% (22) of patients, and home and outpatient treatment in 64.5% (40). There was a statistically significant reduction (Mean (SD)) after therapy in back pain (VAS) from 4.88(1.5) to 1.93(1.1), myalgia (NRS) from 3.66(1.2) to 1.29(1.1), arthralgia (NRS) from 3.27(1.2) to 0.89 (0.8), and fatigue index (BFI) showed a reduction from 5.73(1.4) to 3.22(1.4). There was an increase in mobility in Ott’s symptom from 2.24(1.2) to 2.86(0.9) cm, Schober’s test 1.41(1.2) to 2.38(0.9) cm, Tom Meyer’s test from - 8.23(6.5) to - 2.46(3.7) cm. Conclusion: In the recovery phase post COVID-19, some of the patients had long-time persistent musculoskeletal symptoms (fatigue, myalgia, arthralgia, back pain). These are a common reason for these patients to be referred for outpatient rehabilitation. In order to design a multi-component rehabilitation programme, it is necessary to take into account individual characteristics and comorbidities. The inclusion of physical modalities such as electrotherapy requires an accurate assessment of the rehabilitation potential and the presence of any counterindications. Therapeutic exercises have been proven to be effective in post COVID-19 patients. The results of this study show that the combination of interferential current therapy and therapeutic exercise can effectively reduce back pain, myalgia, arthralgia, and perception of fatigue. On the other hand, this multicomponent program resulted in improvement in functional tests in the studied patients. Due to the small sample size, it is advisable to continue the study in the future, covering a larger number of patients with long-standing musculoskeletal symptoms as part of post-COVID-19 syndrome, in order to design an effective strategy that can efficiently reduce negative health consequences and improve functional activity in these patients.

Investigation of the Relationship between Aspirin-Sensitivity and Poor Response to Medical Management in NSAIDs-exacerbated Respiratory Disease Patients with Sinonasal Polyposis.

NSAID-exacerbated respiratory disease (N-ERD) is a highly heterogeneous disorder with various clinical symptoms. The aspirin challenge test is a gold standard method for its diagnosis, and there are still no reliable in vitro diagnostic biomarkers yet. Oral challenge tests are time-consuming and may be associated with a risk of severe systemic reactions. This study aimed to evaluate whether patients with poor responses to medical management are more susceptible to being aspirin-sensitive. In this cohort study, after CT scanning of all patients and subject selection, conventional medical treatment was started as follows and continued for three consecutive months: at first, saline nose wash twice per day, intranasal beclomethasone spray one puff in each nostril twice per day, montelukast 10 mg tablet once daily, a ten-day course of oral prednisolone starting with the dose of 25 mg per day and taper and discontinued thereafter. Sinonasal outcome test 22 (SNOT22) was used for the evaluation of symptom severity. Statistical analyses were performed with SPSS version 23, and data were analyzed using an independent samples T-test, paired T-test, and Receiver operating curve analysis. 25 males and 53 females were enrolled in this study, with an average age of 41.56 ± 11.74 years old (18-36). Aspirin challenge test results were positive in 29 (37.2%) patients. The average SNOT22 scores before the treatment were 52.97 ± 17.73 and 47.04 ± 18.30 in aspirin-sensitive and aspirin-tolerant patients, respectively, and decreased to 27.41 ± 16.61 and 24.88 ± 16.72 in aspirin-sensitive and aspirin-tolerant patients after the treatment, respectively. There was no significant difference in SNOT22 scores between the groups. The severity of symptoms before treatment and clinical improvement after treatment are not good predictors of N-ERD.

Diffuse Variant of Nodular Lymphocyte-Predominant Hodgkin Lymphoma in A 39-Year-Old Female: A Rare Case Report from Syria

Introduction: Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) represents a rare subtype of Hodgkin Lymphoma that constitutes approximately 5% of all HL cases, with an annual incidence of 1-2 per 1,000,000. Histological diagnosis requires detecting the lymphocyte-predominant (LP) cells, characterized by their popcorn-like contours and distinct immunophenotypic features, including the expression of the B cell surface marker CD20, with negative expression of CD15 and CD30, within a characteristic tumoral microenvironment. Case Presentation: A 39-year-old Syrian female was admitted to our hospital due to a painless, palpable mass in the left axilla, accompanied by no other symptoms. Three months earlier, the patient noticed the mass and visited an external clinic, where she received a ten-day course of antibiotics without experiencing any improvement. Physical examination revealed a firm, round mass devoid of signs of inflammation. An ultrasonography was performed and identified six enlarged lymph nodes in the left axilla displaying signs indicative of malignancy. These nodes were surgically excised, and the subsequent microscopic examination unveiled a biphasic nodular and diffuse proliferation of small lymphocytes, follicular dendritic cells, and epithelioid histiocytes, mixed with large distinct tumor cells recognized as LP cells, that are characterized by multilobulated nuclei with finely granular chromatin and prominent nucleoli. Immunohistochemical examination demonstrated positive expression for CD20 and CD45 in the LP cells, along with CD57 in the background cells, with negative expression for CD15, CD30, and BCL6, while CD10, CD3, BCL2, and Cyclin D1 markers yielded inconclusive results. Consequently, the final diagnosis was confirmed as NLPHL-Diffuse variant. Conclusion: In our manuscript, we presented a diagnostically challenging case of NLPHL diffuse variant in a middle-aged otherwise healthy woman. This case emphasizes on the importance of thorough microscopic examination with the use of immunostaining to make an accurate histopathological diagnosis and thus to provide the best possible medical care in similar cases.

ACUTE DIGITAL GANGRENE TRIGGERED BY COVID-19 COAGULOPATHY

ACUTE DIGITAL GANGRENE TRIGGERED BY COVID-19 COAGULOPATHY

S3111 An Unusual Case of Acute Liver Failure Secondary to Autoimmune Hepatitis (AIH) From Drug-Induced Liver Injury (DILI)

Introduction: A broad differential diagnosis and detailed workup is necessary in the evaluation of acute liver failure, as the below case demonstrates. Case Description/Methods: A 68-year-old Caucasian man presented to the ED complaining of chronic right lower quadrant pain, worsening over the last few weeks. He reported taking up to 20 tablets of naproxen a day. Review of systems was positive for diffuse pruritis of recent onset. Past medical history consisted of COPD, inguinal hernia status post mesh repair, knee osteoarthritis and a cholecystectomy. He endorsed daily tobacco use and minimal alcohol intake. Medications consisted of Albuterol inhaler and Naproxen. He had been diagnosed with a urinary tract infection one month prior that was treated with a ten-day course of Cephalexin. Exam was notable for diffuse excoriation and right upper/lower quadrant tenderness. Initial labs demonstrated creatinine 0.87, AST 2635, and ALT 887, with the remainder of his comprehensive metabolic panel being normal. Contrasted CT scan of the abdomen and pelvis revealed no abnormalities. A right upper quadrant ultrasound was notable for left sided intrahepatic biliary dilatation. Over the next day, his mentation worsened, with repeat labs notable for bicarbonate 13, creatinine 3.08, AST 12050, ALT 3950, total bilirubin 2.4 with direct bilirubin 1.5, INR 3.11 and ammonia 164. A broad infectious workup was unremarkable including negative viral hepatitis serologies. Smooth muscle antibody was weakly positive at a low titer of 1:20. Anti-nuclear and anti-mitochondrial antibodies were negative. Serum IgG level was normal. Endoscopic retrograde cholangiopancreatography revealed a severe left intrahepatic biliary stricture with resulting stent placement into the left hepatic duct. Bile duct brushing was negative for atypical cells. Liver biopsy demonstrated centrilobular necrosis and parenchymal collapse with focal bridging necrosis and mixed inflammatory infiltrate. A diagnosis of AIH secondary to DILI leading to acute liver failure was made, with either Naproxen or Cephalexin being the inciting drugs. Discussion: He was started on a prednisone taper and showed improvements in mental status and kidney and liver function on lab-work prior to discharge. Labs obtained on clinic follow-up one month after discharge revealed complete resolution of his kidney and liver injury. This case illustrates a rare clinical entity as neither Naproxen nor Cephalexin are classically associated with causing AIH or acute liver failure.

Lečenje zanemarene rane od ujeda mačke kod deteta - prikaz slučaja

Cat bites make up 10% of all animal bites and have a high incidence of infection. Cat bites can cause severe deep bacterial infection in closed spaces such as tendon sheath, joints, and bones due to their sharp teeth. Generally, cat bite wound infections are reported at 30%-60%, which is double compared to rat or dog bites. However, cat bites are easily misjudged due to their minimal appearance of tissue injury. Case Report:We hereby present a case of a neglected cat bite wound complicated with infection in a healthy child. The wound was debrided in the operation theatre, and a ten-day course of antibiotics was completed. No further infection was noted and the child was discharged home well. Conclusion: There is no exact algorithm of treatment for cat bites. However, cat bites are nasty wounds that should be treated early and aggressively. Empirical oral or intravenous antibiotics should be started immediately, and adequate surgical debridement is indicated to provide a better outcome as there are no standardized protocols for initial management.

Clinical and prognostic effect of repeated ten-day courses of low-intensity laser exposure in patients with coronary heart disease

To assess the clinical and prognostic value of repeated courses of low-intensity LT in patients with CHD for 24 months. The study involved 40 men (mean age 56.6±8.2 years) with exertional angina pectoris with high (0-I functional class - 40%) and lower (II-III functional class - 60%) exercise tolerance (according to the classification of the Canadian Heart Association). Duration of the study was 24 months. All patients underwent 10-day courses of skin LT in the infrared radiation range every 6 months. Initially and after each course of LT, a bicycle ergometer test was performed with an assessment of the threshold values of blood pressure (BP), double product (DP=systolic BP×heart rate) and the ratio of DP to load power (DP/W). The blood levels of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) were studied after each course of LT. Patients had an improvement in their well-being during LT: a decrease in the number of angina attacks, the need for nitroglycerin, antianginal and antihypertensive drugs. A statistically significant increase in exercise tolerance by 33.2-40.1% was revealed since 1 month after each course of LT, according to the results of stress tests. At the same time, the threshold values of blood pressure remained at the initial level, which was regarded as a manifestation of the hypotensive effect. The decrease in the DP/W index by 18.2-29.6% compared with the initial data indicates the energy economization of cardiac activity. LT was accompanied by a statistically significant decrease in blood cholesterol from 6.15±1.26 to 4.84±1.28-5.25±1.53 mmol/l and LDL-C from 4.70±1.16 to 3, 29±1.26-3.96 mmol/l. Long-term clinical and preventive effect, good tolerability, availability, absence of side effects substantiate the possibility of widespread use of repeated courses of laser exposure in coronary heart disease.

Dexamethasone Alters Tracheal Aspirate T-Cell Cytokine Production in Ventilated Preterm Infants.

Postnatal corticosteroids improve respiratory status and facilitate respiratory support weaning in preterm infants with bronchopulmonary dysplasia (BPD). Older literature describes characteristic cytokine profiles in tracheal aspirates (TA) of BPD patients which are altered with corticosteroids. Corticosteroids also influence peripheral blood T-cell presence. However, little is known regarding TA T-cell phenotype and cytokine production before or after exogenous corticosteroids. We hypothesized that postnatal dexamethasone alters the TA T-cell cytokine profiles of preterm infants. TA samples were collected from 14 infants born from 23 0/7 to 28 6/7 weeks who were mechanically ventilated for at least 14 days. Samples were collected up to 72 h before a ten-day dexamethasone course and again 1 to 3 calendar days after dexamethasone initiation. The primary outcome was change in T cell populations present in TA and their intracellular cytokine profile after dexamethasone treatment, ascertained via flow cytometry. Following dexamethasone treatment, there were significant decreases in respiratory severity score (RSS), percent CD4+IL-6+ cells, CD8+IL-6+ cells, CXCR3+IL-6+ cells, and CXCR3+IL-2+ cells and total intracellular IFN-γ in TA. RSS significantly correlated with TA percent CD4+IL-6+ cells. To our knowledge, this is the first study demonstrating that dexamethasone reduced T-cell IL-6 and this reduction was associated with improved RSS in pre-term infants with evolving BPD.

The use of whole-body cryotherapy for increasing the stress resistance of female athletes in group types of gymnastics

Background. Representatives of complex coordination sports are most susceptible to psychoemotional stress, since they demonstrate high sports results already at a young age. The tightening of anti-doping control has significantly reduced the possibility of using pharmacological and biologically active drugs to speed up the recovery of athletes. Against this background, in sports medicine, more attention is paid to the use of non-drug methods to improve performance and recovery in athletes. Aim to study the efficiency of the introduction of whole-body cryotherapy in the training process of female athletes of complex coordination sports (for example, group gymnastics) to increase stress resistance and reduce violations of adaptation processes as a result of neuropsychiatric overstrain. Materials and methods. During the academic-training year, 22 gymnasts received six ten-day courses of whole-body cryotherapy in the ICEQUEEN cryosauna. 19 athletes were included in the control group. The studies were conducted 3 times: before the start of the procedures, after the first course of procedures, at the end of the training year. The diagnosis of nocturnal bruxism and the definition of the psychological component of health were carried out. Total and effective albumin concentrations were determined in the blood serum with the calculation of the albumin binding reserve, helper T-lymphocytes and killer T-lymphocytes with the calculation of the immunoregulatory index. Results. After one course, there was an increase in the functional activity of serum albumins, a decrease in the number of episodes of involuntary contractions of the masticatory muscles at night, and an increase in the psychological component of health according to SF-36. After six courses of cryotherapy, the functional activity of serum albumins and the initial values of the immunoregulatory index were preserved by the end of the season, and the psychological component of health according to SF-36 was increased, while these indicators decreased in the control group. There was also a decrease in the number of episodes of involuntary contractions of the masticatory muscles at night with an increase in their number in the control group of female athletes. Conclusions. Considering the obtained results, it is possible to recommend the use of whole-body cryotherapy in gymnasts during the preparatory and recovery periods of the annual training cycle in order to increase stress tolerance and prevent psychoemotional overstrain.

Ten-Day Decitabine Treatment in AML Associated with Reversible Non-Ischemic Cardiomyopathy

Decitabine (5-aza-2'-deoxycytidine), a DNA methyltransferase inhibitor, is used to treat patients with IPSS intermediate 1 or higher Myelodysplastic Syndrome (MDS) and elderly patients with Acute Myeloid Leukemia (AML) not able to receive standard treatment (Blum et al., 2010). Decitabine induced non ischemic cardiomyopathy (NICM) has not been observed in large trials, however, isolated cases of reversible cardiomyopathy have been published (De C et al., 2012). We present two cases of NICM resulting from ten-day course of decitabine treatment for AML; one of which had improved cardiac function with aggressive cardiac management and reduced five-day decitabine course.Case 1A 69 year old African American male with history of hypertension presented with fatigue and thrombocytopenia (platelet 18k/uL). Bone marrow biopsy showed MDS. Treatment was delayed by 2 months due to lack of insurance and he had worsening cytopenias. Repeat bone marrow biopsy showed AML transformation from MDS (60% myeloblasts). FISH revealed deletion 7 and deletion 5. Echocardiogram (echo) done prior treatment showed borderline concentric left ventricular hypertrophy with ejection fraction (EF) of 55%.Treatment was initiated with Decitabine 20mg/m2 ten-day course every twenty-eight days. On cycle 2 day 23, patient presented with lower extremity edema, and fatigue. Repeat echo revealed severe reduced left ventricular ejection fraction (LVEF) 30% and moderate mitral regurgitation. EKG did not reveal ischemia. Troponin was 0.100ng/mL and NT-proBNP was raised at 14,609pg/mL. Cardiac MRI with and without contrast revealed ventricular dysfunction but did not show myocarditis or myocardial infarction.Bone marrow biopsy at the end of cycle two showed remission with underlying MDS changes. Treatment was switched to Azacitidine 75mg/m2 for 5 days. Repeat echo to reassess is pending at the time of this report.Case 262 year old African American female with history of alcohol abuse presented with pancytopenia (WBC 2.7/uL, Hb 9.1g/dl, platelets 35/uL). Bone marrow biopsy revealed 30% myeloblasts, dyspoetic megakaryocytes and 15% ringed sideroblasts. Cytogenetics were complex including deletion 7. Molecular testing was negative for FLT3, NPM and CEBPA mutations. Echo showed EF of 60% with diastolic dysfunction.Decitabine 20mg/m2 x 10 days was given for two cycles. She presented with increasing fatigue and dyspnea on day 15 of cycle 2. Physical exam showed jugular venous distention and peripheral edema. NT-proBNP was markedly elevated at 78,705(pg/mL) and troponin I was 0.254 ng/mL. EKG did not reveal ischemia. Echo demonstrated severely reduced LVEF to <20% with moderate mitral regurgitation. Cardiac MRI, performed without gadolinium because of acute kidney injury, confirmed the echo findings. Patient was started on standard cardiac medications by our cardio-oncologist. Repeat bone marrow prior to cycle three-showed remission. The shorter course decitabine (20mg/m2x 5 days) with close cardiology monitoring was initiated. Patient went on to receive cycles 3- 5 without clinical symptoms or signs of heart failure (HF). Repeat echo after three short course decitabine cycles showed improved LVEF to 45% and resolution of mitral regurgitation. The patient progressed after 6 cycles of Decitabine requiring treatment change to Azacitadine and Revlimid. She died from severe sepsis three months later.ConclusionCardiac dysfunction caused by permanent myocardial cell injury is a serious side effect of conventional chemotherapies including anthracyclines and antimetabolites. We report two cases of ten-day decitabine regimen causing severe LV systolic dysfunction that were treated with heart failure therapy. Reversal of cardiac complications were seen despite continued therapy with shorter course decitabine suggest that this may be a toxicity of the extended ten-day treatment. DisclosuresNo relevant conflicts of interest to declare.

Antioxidant effect of cortexin, cerebrolysin and actovegin in rats with chronic cerebrovascular insufficiency

To compare the antioxidant effects of cortexin, cerebrolysin and actovegin in rats with chronic brain ischemia. Chronic brain ischemia was modeled in male rats by 50% stenosis of the common carotid arteries. Forty days after surgery, the animals received 2 ten-day courses of therapy, separated by a break of 10 days. Placebo, cortexin (0.3, 1 and 3 mg/kg), cerebrolysin (0.8, 2.5 and 7.5 ml/kg) and actovegin (5 ml/kg) were administered to animals as treatment. The concentration of malondialdehyde (MDA) in the homogenates was determined by the reaction with thiobarbituric acid, the concentration of reduced glutathione was determined by the reduction reaction of 5.5-dithiobis- (2-nitrobenzoic acid); determination of catalase activity, as well as the content of lactate and pyruvate, by commercially available reagent kits. The activity of superoxide dismutase (SOD) was determined by the photometric method based on an assessment of the degree of inhibition of the epinephrine oxidation reaction. All reactions were carried out in triplicates. Modeling of chronic brain ischemia led to the statistically significant decrease in the content of lactate and pyruvate (p<0.001, when compared with the control group), which was not accompanied by a significant decrease in their ratio (p>0.05), as well as to the decrease in SOD, catalase activity, restored glutathione and increase in MDA concentrations. Compared with the control group, in the groups that received cortexin at a dose of 3 mg/kg/day, cerebrolysin at a dose of 7.5 ml/kg/day and actovegin at a dose of 5 ml/kg/day, there were an increase in the content of lactate and pyruvate (without a significant change in their ratio), restoration of glutathione levels and the activity of SOD and, to a lesser extent, catalase, combined with a decrease in the concentration of MDA. Course administration of cortexin (3 mg/kg), cerebrolysin (7.5 ml/kg) and, to a lesser extent, actovegin (5 ml/kg) has a positive effect on the state of the antioxidant system of the brain in rats with chronic brain ischemia.

COVID-19-associated pulmonary aspergillosis: a case report from the COVID-19 surveillance program.

A 72-year-old male was brought to the hospital following a motorcycle crash and was admitted for multiple trauma management. His initial course of hospitalization was complicated by mild hypoxemia and altered mental status. Respiratory workup and imaging were consistent with SARS-CoV-2 pneumonia. He completed a five-day course of remdesivir and a ten-day course of dexamethasone. Twenty days later, he developed a low-grade fever. His chest computerized tomography (CT) showed gas and fluid containing parenchymal collection in the anteromedial right middle lobe measuring up to 4.8 cm, most consistent with a pulmonary abscess. Antimicrobial treatment was started.

Teaching Industrial Internet-of-Things-Based Model-Predictive Controller

Contribution: This article explores how the Industrial Internet of Things (IIoT) could be leveraged to enhance the teaching/learning experience of advanced control techniques [e.g., model-predictive control (MPC)] for complex systems (nonlinear and multivariable) for undergraduate students. Background: The IIoTs' features, such as ubiquitous sensing, open connectivity, and distributed control, are expected to transform the way control is implemented in the industries. The students need to be prepared for this development. Courses on advanced control techniques should be revamped considering this change. In particular, deploying advanced controllers in IIoT scenarios could make the students ready for Industrie 4.0 and enhance the teaching-learning experience. Intended Outcomes: To reduce the cost for setting up laboratories; to make students appreciate IIoT benefits in industries and study the enhancements in teaching/learning advanced control techniques, such as MPC. The focus is on implementing MPC for a complex process, i.e., nonlinear, multivariable, and having interactions and their deployment on IIoT hardware. Method: A ten-day course on IIoTs' benefits and implementing advanced control techniques for a complex process with lecturing and hands-on sessions for undergraduate students is used. The course focuses on understanding basic concepts to deploy advanced control techniques on IIoT hardware in industries. Findings: The learning experience is enthralling, and the students are appreciative of the IIoT benefits to the industries and in their learning experience, which is demonstrated by their in-depth understanding of concepts on system complexity and implementing MPC.

Infection After Endoscopic Dacryocystorhinostomy: Incidence and Implications

Endoscopic dacryocystorhinostomy (EN-DCR) is an increasingly common procedure performed by otolaryngologists. While EN-DCR has a high rate of success at relieving blockage of the lacrimal system, little is known regarding associated postoperative infection (POI) rates and risk factors. The purpose of this study was to identify factors associated with the occurrence of postoperative orbital and rhinologic infection in a large cohort of patients undergoing EN-DCR. A retrospective review of 582 patients who underwent EN-DCR was performed. All patients received antibiotic prophylaxis as a single intraoperative intravenous administration and a ten-day postoperative oral course. Clinical and demographic information was reviewed, including the occurrence of acute orbital or rhinologic infection within 30 days of surgery. Multivariable analysis was performed to identify risk factors associated with POI. Fifteen of 582 patients (2.6%) developed POI following EN-DCR. The most common POI was acute rhinosinusitis (10/15, 66.7%), followed by acute dacryocystitis (2/15, 13.3%), preseptal cellulitis (2/15,13.3%), and acute bacterial conjunctivitis (1/15, 6.7%). The majority of patients (464/582, 79.7%) underwent concurrent endoscopic sinus surgery (ESS). In most cases (302/464, 65.1%), ESS was performed to address comorbid rhinosinusitis, whereas 7.8% (36/464) of patients underwent surgery to enhance surgical access to the lacrimal sac. Patients who underwent concurrent ESS were less likely to develop POI (OR: 0.17, CI: 0.04-0.80, p < 0.05). Evidence of mucopurulence at surgery increased the likelihood of POI (OR: 6.24, CI: 1.51-25.84, p < 0.05). Mucopurulence at the time of surgery significantly increased the risk of POI, whereas concurrent ESS, performed most commonly to address comorbid rhinosinusitis, significantly decreased the risk of POI. Awareness of risk factors for POI and appropriate surgical management of concurrent rhinosinusitis can lead to reduced infectious complications after EN-DCR.