Repeated atrial arrhythmia induced by cochineal red poisoning:A case report

BACKGROUND Cochineal red is an organic compound widely used in food,cosmetics,pharmaceuticals,textiles,and other fields due to its excellent safety profile.Poisoning caused by eating foods containing cochineal red is rare,and repeated atrial arrhythmia due to cochineal red poisoning is even rarer.CASE SUMMARY An 88-year-old Asian female patient was admitted to hospital due to a disturbance of consciousness.Twelve hours prior to presentation,the patient consumed 12 eggs containing cochineal red over a period of 2 h.At presentation,the patient was in a coma and had a score of 6 on the Glasgow Coma Scale(E2+VT+M4).The patient’s skin and mucous membranes were pink.Electrocardiography(ECG)revealed rapid atrial fibrillation without any signs of ischemia.We prescribed cedilan and fluid replacement for arrhythmia correction.Shortly after admission,the atrial fibrillation corrected to a normal sinus rhythm.On the day 2 of admission,the patient had a sudden atrial flutter accompanied by hemodynamic instability and rapidly declining arterial oxygen saturation between 85%and 90%.The sinus rhythm returned to normal after two electrical cardioversions.Six days after admission,the skin color of the patient returned to normal,and the ECG results were normal.The patient was transferred out of the intensive care unit and eventually discharged after 12 d in hospital.At the 2-mo follow-up visit,the patient was in good health with no recurrence of arrhythmia.CONCLUSION Although cochineal red is a safe,natural food additive,excessive consumption or occupational exposure can induce cardiac arrhythmias.

Neurological recovery and antioxidant effects of resveratrol in rats with spinal cord injury: a meta-analysis

Objective:To critically assess the neurological recovery and antioxidant effects of resveratrol in rat models of spinal cord injury.Data sources:Using“spinal cord injury”,“resveratrol”and“animal experiment”as the main search terms,all studies on the treatment of spinal cord injury in rats by resveratrol were searched for in PubMed,EMBASE,MEDLINE,Web of Science,Science Direct,China National Knowledge Infrastructure,Wanfang,VIP,and SinoMed databases by computer.The search was conducted from their inception date to April 2017.No language restriction was used in the literature search.Data selection:The methodological quality of each study was assessed by the initial Stroke Therapy Academic Industry Roundtable recommendations.Two reviewers independently selected studies according to the title,abstract and full text.The risk of bias in the included studies was also evaluated.Meta-analyses were performed with Review Manager 5.3 software.Outcome measures:Neurological function was assessed by the Basso,Beattie,and Bresnahan scale score,inclined plane score and Gale’s motor function score.Molecular-biological analysis of antioxidative effects was conducted to determine superoxide dismutase levels,malondialdehyde levels,nitric oxide synthase activity,nitric oxide levels,xanthine oxidase and glutathione levels in spinal cord tissues.Results:The methodological quality of the 12 included studies was poor.The results of meta-analysis showed that compared with the control group,resveratrol significantly increased the Basso,Beattie,and Bresnahan scale scores after spinal cord injury(n=300,mean difference(MD)=3.85,95%confidence interval(CI)[2.10,5.59],P<0.0001).Compared with the control group,superoxide dismutase levels were significantly elevated(n=138,standardized mean difference(SMD)=5.22,95%CI[2.98,7.45],P<0.00001),but malondialdehyde levels were significantly diminished(n=84,SMD=–3.64,95%CI[–5.84,–1.43],P=0.001)in the spinal cord of the resveratrol treatment group.Conclusions:Resveratrol promoted neurological recovery and exerted antioxidative effects in rat models of spinal cord injury.The limited quality of the included studies reduces the application of this meta-analysis.Therefore,more high-quality studies are needed to provide more rigorous and objective evidence for the pre-clinical treatment of spinal cord injury.

Camrelizumab-induced anaphylactic shock in an esophageal squamous cell carcinoma patient:A case report and review of literature

BACKGROUND Camrelizumab(SHR-1210),an immune checkpoint inhibitor,is clinically used as a therapeutic option for various types of tumors.However,reports of adverse reactions associated with camrelizumab are gradually increasing.Anaphylactic shock due to camrelizumab has not been reported previously,until now.We report here,for the first time,a case of anaphylactic shock associated with camrelizumab in a patient with esophageal squamous cell carcinoma.CASE SUMMARY An 84-year-old male esophageal cancer patient received radiotherapy and chemotherapy 11 years ago.He was diagnosed with advanced esophageal squamous cell carcinoma with liver metastasis(Tx N1 M1)and received the first immunotherapy(camrelizumab 200 mg/each time,once every 3 wk)dose in December 2020,with no adverse reactions.Three weeks later,a generalized rash was noted on the chest and upper limbs;palpitations and breathing difficulties with a sense of dying occurred 10 min after the patient had been administered with the second camrelizumab therapy.Electrocardiograph monitoring revealed a 70 beats/min pulse rate,69/24 mm Hg(1 mm Hg=0.133 k Pa)blood pressure,28 breaths/min respiratory rate,and 86%pulse oximetry in room air.The patient was diagnosed with anaphylactic shock and was managed with intravenous fluid,adrenaline,dexamethasone sodium phosphate,calcium glucosate,and noradrenaline.Approximately 2 h after treatment,the patient’s anaphylactic shock symptoms had been completely relieved.CONCLUSION Due to the widespread use of camrelizumab,attention should be paid to anti-programmed cell death 1 antibody therapy-associated hypersensitivity or anaphylactic shock.

Endoscopic retrograde cholangiopancreatography in the treatment of pancreaticopleural fistula in children

BACKGROUND Pancreaticopleural fistula(PPF)is a rare disease,especially in children.Conservative treatment and surgery are traditional therapies,but surgery is invasive.The emergence of endoscopic retrograde cholangiopancreatography(ERCP)has provided a new noninvasive treatment for PPF and may become the first choice for children with PPF.AIM To explore the treatment response to ERCP for PPF in children.METHODS Seven children with PPF were hospitalized in the Gastroenterology Department of Beijing Children’s Hospital from December 2007 to May 2019.Data on these seven patients’clinical characteristics,diagnosis,treatments,and outcomes were analyzed,and their treatment responses following surgery and ERCP were compared.The correlation between the length of hospital stay and conservative treatment was analyzed.Peer-reviewed articles written in English and Chinese published from January 2009 to December 2019 were obtained from various open data sources and reviewed.RESULTS The seven patients comprised three boys and four girls with a mean age of 6.57±3.26 years.The main symptoms were chest tightness and pain(n=4),intermittent fever(n=3),dyspnea(n=3),and abdominal pain(n=1),and all patients had bloody pleural effusion.All seven patients were diagnosed with PPF by magnetic resonance cholangiopancreatography,and all were initially treated conservatively for a mean of 34.67±22.03 d with a poor response.Among five patients who underwent ERCP,one required surgery because of intubation failure;thus,the success rate of ERCP was 80%.Two patients were successfully treated with surgery(100%).The postoperative hospital stay of the two patients treated by surgery was 20 and 30 d,respectively(mean of 25 d),and that of the four patients treated by ERCP ranged from 12 to 30 d(mean of 19.25±8.85 d).The recovery time after ERCP was short[time to oral feeding,4-6 d(mean,5.33±1.15 d);duration of closed thoracic drainage,2-22 d(mean,13.3 d)].Analysis of previous cases of PPF published worldwide during the past decade showed that the treatment success rate of ERCP is not lower than that of surgery.There was no significant difference in the postoperative hospital stay between surgery(16±10.95 d)and ERCP(18.7±6.88 d,P>0.05).A positive linear correlation was found between the overall hospital stay and ERCP intervention time(R2=0.9992).CONCLUSION ERCP is recommended as the first-choice treatment for PPF in children.ERCP should be performed as early as possible if conditions permit.

Acute respiratory distress syndrome following multiple wasp stings treated with extracorporeal membrane oxygenation:A case report

BACKGROUND It is necessary for clinicians to be aware of a rare but possible acute respiratory distress syndrome(ARDS)complication caused by multiple wasp stings.Severe ARDS has a high mortality rate but no specific pharmacotherapies have been identified to date.This case study presents the first case of severe ARDS caused by multiple wasp stings,treated successfully with extracorporeal membrane oxygenation(ECMO).It also emphasizes the effectiveness of early ECMO treatment for severe ARDS with persistent hypoxemia.CASE SUMMARY A 24-year-old woman was admitted to the emergency department after being stung by more than 10 wasps within a 30-min period,with clinical symptoms of multiple rashes,dizziness,chest tightness,nausea,and vomiting.On the 2nd day of admission,the patient developed progressive dyspnea.The patient was diagnosed with ARDS based on clinical manifestations and lung computed tomography(CT)scan.Because of the progressive dyspnea,the intensive care unit physician performed endotracheal intubation and continued to provide ventilator support,but the patient’s respiratory distress worsened,as indicated by the ratio of arterial partial pressure of oxygen to fraction of inspired oxygen.Veno-venous ECMO was initiated for 6 d.On day 7 of admission,ECMO was stopped.On the 11th day of admission,CT scan of the lungs revealed significant reduction of ground-glass opacities and consolidations.After about 2 wk,the patient recovered completely from ARDS and was discharged to home.At the 2-mo follow-up,the patient was in good health with no recurrence of dyspnea nor chest tightness.CONCLUSION ARDS complication caused by multiple wasp stings may be fatal when mechanical ventilation becomes dangerous due to persistent hypoxemia and despite optimization of ARDS management.We propose that the early implementation of ECMO is a relatively effective treatment,although the evidence is relatively limited.

Diagnosis,treatment and prevention of severe acute respiratory syndrome coronavirus 2 infection in children:experts'consensus statement updatedforthe Omicron variant

It has been more than 3 years since the novel coronavirus(SARS-CoV-2)pandemic raged globally.The coronavirus disease 2019(COVID-19)has greatly influenced human society.According to data from the World Health Organization(WHO),there were over 656 million confirmed cases of COVID-19 in the world as of January 1,2023,including over 6.6 million deaths[1].

Diagnosis,treatment,and prevention of monkeypox in children:an experts'consensus statement

Monkeypox is a zoonotic disease.Since the first human monkeypox case was detected in 1970,it has been prevalent in some countries in central and western Africa.Since May 2022,monkeypox cases have been reported in more than 96 non-endemic countries and regions worldwide.As of September 14,2022,there have been more than 58,200 human monkeypox cases,and there is community transmission.The cessation of smallpox vaccination in 1980,which had some cross-protection with monkeypox,resulted in a general lack of immunity to monkeypox,which caused global concern and vigilance.As of Sep-tember 14,2022,there are four monkeypox cases in China,including three in Taiwan province and one in Hong Kong city.Previous foreign studies have shown that children are vulnerable to monkeypox and are also at high risk for severe disease or complications.In order to improve pediatricians'understanding of monkeypox and achieve early detection,early diagno-sis,early treatment,and early disposal,we have organized national authoritative experts in pediatric infection,respiratory,dermatology,critical care medicine,infectious diseases,and public health and others to formulate this expert consensus,on the basis of the latest"Clinical management and infection prevention and control for monkeypox"released by The World Health Organization,the"guidelines for diagnosis and treatment of monkeypox(version 2022)"issued by National Health Commission of the People's Republic of China and other relevant documents.During the development of this consensus,multidisciplinary experts have repeatedly demonstrated the etiology,epidemiology,transmission,clinical manifestations,laboratory examinations,diagnosis,differential diagnosis,treatment,discharge criteria,prevention,disposal process,and key points of prevention and control of suspected and confirmed cases.

Characteristics and clinical role of bronchoscopy in diagnosis of childhood endobronchial tuberculosis

Background:Endobronchial tuberculosis (EBTB) is the most frequent complication of primary pulmonary tuberculosis (PTB) in children.The aim of the study was to analyze characteristics and clinical role of bronchoscopy in diagnosis of childhood EBTB.Methods:A retrospective,descriptive study was undertaken in 157 children with EBTB undergone flexible bronchoscopy (FB) between January 2006 and June 2014.Results:The median age of the enrolled patients was 3.4 years,with 73.2% of patients under five years old.The most common subtype was tumorous type (145/157,92.4%).If only involved bronchus were considered,the common affected sites were right middle lobe bronchus (49/228,21.5%),left upper lobe bronchus (41/228,18.0%),right upper lobe bronchus (41/228,18.0%),right main bronchus (35/228,15.4%),respectively.Children younger than five years old were at higher risk to have multiple endobronchial lesions (P=0.044),with an odds ratio of 2.313 (95% confidence interval:1.009-5.299).Before the bronchoscopy,only 16 (10.2%)patients were highly suspected of EBTB,while the others were diagnosed as PTB without EBTB (69.4%),or misdiagnosed as pneumonia or foreign body aspiration (20.4%) on admission.Conclusions:The patients under five years old are at high risk to progress to EBTB and have multiple endobronchial lesions.The most frequent subtype of EBTB in children is tumorous type.The lesions are seen in the right bronchial system more frequently.FB should be performed to detect the endobronchial lesions in suspected patients as soon as possible.

Updated diagnosis, treatment and prevention of COVID-19 in children: experts' consensus statement (condensed version of the second edition)

In the early February,2020,we called up an experts' committee with more than 30 Chinese experts from 11 national medical academic organizations to formulate the first edition of consensus statement on diagnosis,treatment and prevention of coronavirus disease 2019 (COVID-19) in children,which has been published in this journal.With accumulated experiences in the diagnosis and treatment of COVID-19 in children,we have updated the consensus statement and released the second edition recently.The current version in English is a condensed version of the second edition of consensus statement on diagnosis,treatment and prevention of COVID-19 in children.In the current version,diagnosis and treatement criteria have been optimized,and early identification of severe and critical cases is highlighted.The early warning indicators for severe pediatric cases have been summarized which is utmost important for clinical practice.This version of experts consensus will be valuable for better prevention,diagnosis and treatment of COVID-19 in children worldwide.

Pseudo-Bartter Syndrome in a Chinese Infant with Cystic Fibrosis Caused by c.532G〉A Mutation in CFTR

To the Editor： We present a Chinese case of cystic fibrosis （CF） with Pseudo-Bartter syndrome （PBS） in a 6-month-old female infant. She started to have recurrent cough and wheezing after ＂a common cold＂ at 3-month-old and had been hospitalized several times for＂pneumonia＂. She received oral antibiotics and nebulized bronchodilators which resulted in no improvement. In addition, she developed hypokalemia （2.5 mmol/L） and metabolic alkalosis.

Expert consensus on COVID-19 vaccination in children

Coronavirus disease 2019(COVID-19)is a public health disaster that has not been encountered for a hundred years.On January 12,2020,the World Health Organization(WHO)confirmed and named the coronavirus which caused unexplained pneumonia as 2019 novel coronavirus(2019-nCoV).Since then,the disease caused by this virus had been named as coronavirus disease 2019(COVID-19).On February 11,2020,the International Committee on Taxonomy of Viruses announced that the English name of the novel coronavirus was severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)[1].At present,SARS-CoV-2 infection is still rampant worldwide.As of September 10,2021,there were about 222 million confirmed cases of COVID-19 and more than 4.5 million deaths worldwide[2].According to the American Centers for Disease Control and Prevention,by July 29,2021,4.19 million pediatric COVID-19 cases had been reported in the United States。

Global Pediatric Pulmonology Alliance(GPPA)proposal for COVID-19 vaccination in children

Coronavirus disease 2019(COVID-19)remains a global epidemic.As of August 18,2021,the number of reported cases has exceeded 207 million globally,with more than 4.3 million deaths.COVID-19 has brought devastating losses to human society.The overall crude mortality rate is 1-3%.Although pediatric deaths from COVID-19 are rare,they do occur,as over 9,000 children have died from COVID-19 globally to date[1].With the gradual and broad application of COVID-19 vaccines around the world,the rising proportion of cases among children and unvaccinated young adults demands attention.According to World Health Organization surveillance data.

Global Pediatric Pulmonology Alliance recommendation to strengthen prevention of pediatric seasonal influenza under COVID-19 pandemic

The World Health Organization(WHO)announced COVID-19 as a global pandemic in March of 2020[1].The COVID-19 pandemic may persist for a long period of time.Global prevention and control becomes a complex and challenging task,and such efforts should be sustained.Although general measures,such as social distancing,face masks,respiratory hygiene and hand sanitization,will bear fruits for decreasing spread of other respiratory illnesses including influenza,the specific prevention through vaccination is a key focus especially in the upcoming winter and spring seasons[2].