A case of severe refractive changes induced by Galyfilcon A silicone hydrogel contact lenses

Dear Sir, I＇m Boris Severinsky from the New England College of Optometry, Boston, USA. I write you to present an interesting case of extreme refractive and corneal topography changes induced by daily wearing of Acuvue Advance （Johnson＆Johnson, Vision Care） contact lens （CL）.

Investigation on Factors Associated with Severe Hand, Foot and Mouth Disease

Objective To analyze the clinical and laboratory features of patients with mild and severe HFMD to identify early predictive or diagnostic markers for severe cases. Methods Samples of feces, nasopharyngeal-swab specimens, peripheral blood, serum and cerebral spinal fluid were collected. Postmortem pathological examination was conducted on 2 dead patients with complication due to neurogenic pulmonary edema. Reverse transcription-polymerase chain-reaction(RT-PCR), culture and isolation of enterovirus 71(EV71) were performed to detect EV71 infection. Both univariate and multivariate logistic analysis were used to identify factors associated with severe cases. Results EV71 was mainly responsible for HFMD. In this study, 5 isolated EV71 strains belonged to C4 gene subtype. Compared with mild patients, EV71-RNA detection rate was higher and Cox A16 detection rate was lower among severe patients(P < 0.01). Inflammatory cell infiltration in the lung, cardiac and liver tissues were mild by postmortem pathological examination. It was found that body temperature, vomitting, limb tremor, neutrophil, blood glucose and EV71 infection were significantly related to the severe cases by univariate logistic analysis. However, after multivariate logistic regression analysis, only vomiting(OR 16.1, CI 2.3-110.5, P < 0.01) and limb tremor(OR 117.6, CI 13.8-1004.5, P < 0.01) were significantly and independently correlated with the severe cases.Conclusions EV71 was mainly responsible for HFMD, particularly for severe cases. Vomiting and limb tremor were predictive markers for severe cases.

Potential therapeutic effects of dipyridamole in the severely ill patients with COVID-19

Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection can cause acute respiratory distress syndrome,hypercoagulability,hypertension,and multiorgan dysfunction.Effective antivirals with safe clinical profile are urgently needed to improve the overall prognosis.In an analysis of a randomly collected cohort of 124 patients with COVID-19,we found that hypercoagulability as indicated by elevated concentrations of D-dimers was associated with disease severity.By virtual screening of a U.S.FDA approved drug library,we identified an anticoagulation agent dipyridamole(DIP)in silico,which suppressed SARS-CoV-2 replication in vitro.In a proof-of-concept trial involving 31 patients with COVID-19,DIP supplementation was associated with significantly decreased concentrations of D-dimers(P<0.05),increased lymphocyte and platelet recovery in the circulation,and markedly improved clinical outcomes in comparison to the control patients.In particular,all 8 of the DIP-treated severely ill patients showed remarkable improvement:7 patients(87.5%)achieved clinical cure and were discharged from the hospitals while the remaining 1 patient(12.5%)was in clinical remission.

Recovery of a patient with severe COVID-19 by acupuncture and Chinese herbal medicine adjuvant to standard care

There is currently no drug or therapy that can cure the coronavirus disease 2019(COVID-19), which is highly contagious and can be life-threatening in severe cases. Therefore, seeking potential effective therapies is an urgent task. An older female at the Leishenshan Hospital in Wuhan, China, with a severe case of COVID-19 with significant shortness of breath and decrease in peripheral oxygen saturation(SpO_(2)),was treated using manual acupuncture and Chinese herbal medicine granule formula Fuzheng Rescue Lung with Xuebijing Injection in addition to standard care. The patient’s breath rate, SpO_(2), heart rate,ratio of neutrophil/lymphocyte(NLR), ratio of monocyte/lymphocyte(MLR), C-reactive protein(CRP),and chest computed tomography were monitored. Acupuncture significantly improved the patient’s breathing function, increased SpO_(2), and decreased her heart rate. Chinese herbal medicine might make the effect of acupuncture more stable;the use of herbal medicine also seemed to accelerate the absorption of lung infection lesions when its dosage was increased. The combination of acupuncture and herbs decreased NLR from 14.14 to 5.83, MLR from 1.15 to 0.33 and CRP from 15.25 to 6.01 mg/L. These results indicate that acupuncture and Chinese herbal medicine, as adjuvants to standard care, might achieve better results in treating severe cases of COVID-19.

Patients with severe schistosomiasis mansoni in Ituri Province, Democratic Republic of the Congo

Background:Severe hepatosplenic complications arise in patients with chronic Schistosoma mansoni infection after heavy exposure to disease agents in endemic areas.These complications are rarely reported and,hence,underestimated.Case presentation:We report on eight patients with severe morbidity associated with S.mansoni infection in Ituri Province,northeastern Democratic Republic of Congo(DRC).The patients were identified during a community-based survey in 2017;one patient was seen at the district hospital.After taking the patients'history,a clinical examination and an abdominal ultrasonographical examination were performed.S.mansoni infection was diagnosed in fecal(Kato-Katz technique)and urine(point-of-case circulating cathodic antigen test)samples.These eight patients with severe intestinal and hepatosplenic complications were identified from four villages with high 5.mansoni infection prevalence and related morbidity.The patients'ages ranged from 19 to 57 years;four patients were women.Three patients reported hematemesis.Two patients were severely anemic.All patients reported non-specific abdominal symptoms,such as diarrhea(six patients),abdominal pain(seven patients),and blood in the stool(five patients),as well as weight loss(two patients).Abdominal ultrasonography revealed ascites in four patients.All patients had portal hypertension with hepatomegaly(seven patients)or splenomegaly(five patients).Of the six patients with a discernable liver parenchyma pattern,five displayed pattern F and three patient displayed pattern E.Liver parenchyma was not visible for two patients with severe ascites.An 5.mansoni infection was confirmed in six patients,with infection intensity ranging from light to heavy.All S.mansoni positive patients were treated with praziquantel(40 mg/kg body weight)and referred to the district hospital for follow-up.One patient with severe ascites died two weeks after we saw her.Due to security and accessibility reasons,the villages could not be visited again and the patients were lost to follow-up.Conclusions:Our observations of patients with severe schistosomiasis document the severe degree of endemicity of S.mansoni in the province and suggest an urgent need for adequate schistosomiasis control measures that target vulnerable population groups and address severe complications.

Forecast for peak infections in the second wave of the Omicron after the adjustment of zero-COVID policy in the mainland of China

On December 7,2022,the Chinese government optimized the current epidemic prevention and control policy,and no longer adopted the zero-COVID policy and mandatory quarantine measures.Based on the above policy changes,this paper establishes a compartment dynamics model considering age distribution,home isolation and vaccinations.Parameter estimation was performed using improved least squares and Nelder-Mead simplex algorithms combined with modified case data.Then,using the estimated parameter values to predict a second wave of the outbreak,the peak of severe cases will reach on 8 May 2023,the number of severe cases will reach 206,000.Next,it is proposed that with the extension of the effective time of antibodies obtained after infection,the peak of severe cases in the second wave of the epidemic will be delayed,and the final scale of the disease will be reduced.When the effectiveness of antibodies is 6 months,the severe cases of the second wave will peak on July 5,2023,the number of severe cases is 194,000.Finally,the importance of vaccination rates is demonstrated,when the vaccination rate of susceptible people under 60 years old reaches 98%,and the vaccination rate of susceptible people over 60 years old reaches 96%,the peak of severe cases in the second wave of the epidemic will be reached on 13 July 2023,when the number of severe cases is 166,000.