BACKGROUND The recent and still ongoing pandemic caused by the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)entailed various long-term complications,including post-infectious cholangiopathy.AIM To identi...BACKGROUND The recent and still ongoing pandemic caused by the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)entailed various long-term complications,including post-infectious cholangiopathy.AIM To identify the available studies concerning post-coronavirus disease 2019(COVID-19)cholangiopathy.METHODS An extensive bibliographical search was carried out in PubMed and in Cochrane Library to identify the articles(retrospective and prospective studies,cohort studies,case series and case reports)published between January 1,2020 and August 22,2022,using both MeSH terms and free-language keywords:cholangiopathy;COVID-19;post-COVID-19 cholangiopathy;SARS-CoV-2.RESULTS Thirteen studies fulfilled the inclusion criteria,which included 64 patients suffering from this condition.The patients were male in 82.8%of cases.Liver transplant was executed in 6 patients and scheduled in 7 patients,while 2 patients refused the surgical approach.Therefore in 23.4%of the cases,performing this procedure appeared to be necessary.CONCLUSION This review has revealed that generally the involvement of the liver in the course of SARS-CoV-2 infection is mild and transient,inducing cholestasis of cholangiocytes but can also be severe enough to cause organ failure in some cases.展开更多
Post-coronavirus disease 2019(COVID-19)cholangiopathy(PCC)is a rare but lifethreatening complication of COVID-19 infection.PCC typically presents when patients recovering from the contagion and manifests as cholestasi...Post-coronavirus disease 2019(COVID-19)cholangiopathy(PCC)is a rare but lifethreatening complication of COVID-19 infection.PCC typically presents when patients recovering from the contagion and manifests as cholestasis in patients with no history of pre-existing liver disease.The pathogenesis of PCC is little understood.Hepatic injury in PCC could be mediated by the predilection of severe acute respiratory syndrome coronavirus 2 for cholangiocytes.Though PCC shows some resemblance to secondary sclerosing cholangitis in critically ill patients,it is considered as a separate and unique entity in the literature.Various treatment options like ursodeoxycholic acid,steroids,plasmapheresis,and endoscopic retrograde cholangiopancreatography guided interventions have been tried but with limited success.We have noticed significant improvement in liver function with antiplatelet therapy in a couple of patients.PCC can progress to end-stage liver disease necessitating liver transplantation.In this article,we discuss the current knowledge of PCC focusing on its pathophysiology,clinical manifestations,and management strategies.展开更多
BACKGROUND Smell disorders are the most frequent persistent coronavirus disease 2019(COVID-19)complications.AIM To describe the patterns and characteristics of persistent smell and taste disorders in Egyptian patients...BACKGROUND Smell disorders are the most frequent persistent coronavirus disease 2019(COVID-19)complications.AIM To describe the patterns and characteristics of persistent smell and taste disorders in Egyptian patients.METHODS Assessment was done to 185 patients(adults=150,age:31.41±8.63 years;children=35;age:15.66±1.63 years).Otolaryngology and neuropsychiatric evaluations were done.Measurements included:A clinical questionnaire(for smell and taste);sniffin'odor,taste and flavor identification tests and the Questionnaire of Olfactory Disorders-Negative Statements(sQOD-NS).RESULTS Duration of disorders was 11.53±3.97 ms(6-24 ms).Parosmia(n=119;64.32%)was developed months after anosmia(3.05±1.87 ms).Objective testing showed anosmia in all,ageusia and flavor loss in 20%(n=37)and loss of nasal and oral trigeminal sensations in 18%(n=33)and 20%(n=37),respectively.Patients had low scoring of sQOD-NS(11.41±3.66).There were no specific differences in other demographics and clinical variables which could distinguish post-COVID-19 smell and taste disorders in children from adults.CONCLUSION The course of small and taste disorders are supportive of the nasal and oral neuronal compromises.Post-COVID-19 taste and trigeminal disorders were less frequent compared to smell disorders.Post-COVID-19 flavor disorders were solely dependent on taste and not smell disorders.There were no demographics,clinical variables at onset or specific profile of these disorders in children compared to adults.展开更多
目的系统评价中医药对新型冠状病毒肺炎(COVID-19,简称:新冠肺炎)恢复期患者的肺功能影响,以期为临床决策及后续临床研究的开展提供参考。方法计算机检索中国知网(CNKI)、万方数据库(WanFang)、中国生物医学文献数据库(SinoMed)、维普...目的系统评价中医药对新型冠状病毒肺炎(COVID-19,简称:新冠肺炎)恢复期患者的肺功能影响,以期为临床决策及后续临床研究的开展提供参考。方法计算机检索中国知网(CNKI)、万方数据库(WanFang)、中国生物医学文献数据库(SinoMed)、维普期刊数据库(VIP)、PubMed、The Cochrane Library、EMbase数据库,检索时间为建库至2022年7月。由2名研究者按照纳入与排除标准独立筛选文献、提取数据且评估纳入研究的偏倚风险及方法学质量,采用Review Manager 5.4软件进行Meta分析。结果共纳入9项研究,其中5项随机对照试验、2项非随机对照试验、2项队列研究,纳入研究共包含1101例新冠肺炎恢复期患者。Meta分析结果显示:(1)针刺、中西医结合康复训练,可有效提升患者第一秒用力呼气容积(forced expiratory volume in one second,FEV1)水平(SMD=1.43,95%CI[1.10,1.75],P<0.00001)。(2)中西医结合康复训练可提升患者第一秒用力呼气容积占用力肺活量的百分比(forced expiratory volume in one second/forced vital capacity,FEV1/FVC)(MD=12.12,95%CI[9.46,14.79],P<0.00001)。(3)中药联合常规康复训练可有效降低患者改良医学研究学会呼吸困难量表(modified Medical Research Council,mMRC)评分(MD=-0.16,95%CI[-0.17,-0.15],P<0.00001)。(4)针刺、中药可提升肺部CT好转率(RR=1.14,95%CI[1.06,1.23],P=0.0003)。结论中医药可提升新冠肺炎恢复期患者FEV1及FEV1/FVC水平、降低mMRC评分及促进肺部CT好转率,促进新冠肺炎恢复期患者康复。受纳入研究数量限制,结论尚需更多高质量研究予以验证。展开更多
BACKGROUND As a highly contagious disease,coronavirus disease 2019(COVID-19)is wreaking havoc around the world due to continuous spread among close contacts mainly via droplets,aerosols,contaminated hands or surfaces....BACKGROUND As a highly contagious disease,coronavirus disease 2019(COVID-19)is wreaking havoc around the world due to continuous spread among close contacts mainly via droplets,aerosols,contaminated hands or surfaces.Therefore,centralized isolation of close contacts and suspected patients is an important measure to prevent the transmission of COVID-19.At present,the quarantine duration in most countries is 14 d due to the fact that the incubation period of severe acute respiratory syndrome coronavirus type 2(SARS-CoV-2)is usually identified as 1-14 d with median estimate of 4-7.5 d.Since COVID-19 patients in the incubation period are also contagious,cases with an incubation period of more than 14 d need to be evaluated.CASE SUMMARY A 70-year-old male patient was admitted to the Department of Respiratory Medicine of The First Affiliated Hospital of Harbin Medical University on April 5 due to a cough with sputum and shortness of breath.On April 10,the patient was transferred to the Fever Clinic for further treatment due to close contact to one confirmed COVID-19 patient in the same room.During the period from April 10 to May 6,nucleic acid and antibodies to SARS-CoV-2 were tested 7 and 4 times,respectively,all of which were negative.On May 7,the patient developed fever with a maximum temperature of 39℃,and his respiratory difficulties had deteriorated.The results of nucleic acid and antibody detection of SARS-CoV-2 were positive.On May 8,the nucleic acid and antibody detection of SARS-CoV-2 by Heilongjiang Provincial Center for Disease Control were also positive,and the patient was diagnosed with COVID-19 and reported to the Chinese Center for Disease Control and Prevention.CONCLUSION This case highlights the importance of the SARS-CoV-2 incubation period.Further epidemiological investigations and clinical observations are urgently needed to identify the optimal incubation period of SARS-CoV-2 and formulate rational and evidence-based quarantine policies for COVID-19 accordingly.展开更多
The pandemic caused by severe acute respiratory syndrome coronavirus-2(SARSCoV-2)in 2019-2022 leads to a multisystem illness that results in damage to numerous organ systems.In this review,our goal was to assess curre...The pandemic caused by severe acute respiratory syndrome coronavirus-2(SARSCoV-2)in 2019-2022 leads to a multisystem illness that results in damage to numerous organ systems.In this review,our goal was to assess current research on long-term respiratory,cardiac,neurological,digestive,rheumatological,urogenital,and dermatological system complications of coronavirus disease 2019(COVID-19).Bibliographic searches were conducted in December 2021 using PubMed and Google Scholar,retrospectively,covering all COVID-19 literature to determine the consequences of the disease.This review may help to determine the prospects for new studies and predict the upcoming aspects requiring assessment in post-COVID-19 syndrome.展开更多
Objective:The paper was to analyze the investigation and study of the psychological status of children and adolescents during the epidemic period of COVID-19.Methods:From March 5th to 11th,2020,1766 students from 8 to...Objective:The paper was to analyze the investigation and study of the psychological status of children and adolescents during the epidemic period of COVID-19.Methods:From March 5th to 11th,2020,1766 students from 8 to 18 years old in Yan'an area were taken as the research objects,and the psychological characteristics of this group of people during the epidemic period of COVID-19 were analyzed by the online questionnaires.Results:In the questionnaire,all children and adolescents were in good psychological conditions,and they had not shown serious negative psychological emotions,and they attached great importance to COVID-19.Conclusion:The psychological changes of children and adolescents during the epidemic period of COVID-19 are diverse.Most children and adolescents have a good mental state,and a few have negative psychological emotions.It can strengthen the psychological management of children and adolescents during the epidemic,and promote the healthy growth of children and adolescents clinically.展开更多
As the world continues to grapple with the novel coronavirus[coronavirus disease 2019(COVID-19)],many treatments have been proposed to help alleviate the symptoms and reduce the mortality rate.Hydroxychloroquine(HCQ)i...As the world continues to grapple with the novel coronavirus[coronavirus disease 2019(COVID-19)],many treatments have been proposed to help alleviate the symptoms and reduce the mortality rate.Hydroxychloroquine(HCQ)is an antimalarial drug that is typically used for several autoimmune,rheumatic,and dermatological conditions.It has also been considered to treat and prevent COVID-19 and subsequent arthritis associated with the infection.This drug is known to cause retinal toxicity,which can lead to vision impairment or loss.While the exact mechanism is not yet fully understood,it is thought to be due to the accumulation of the drug in the retinal pigment epithelium.The risk of toxicity increases with long-term use or with high doses of the drug and is more likely to occur in patients with pre-existing retinal diseases or those who are predisposed to retinal diseases.In this context,several steps can be taken to monitor and minimize the risk of ophthalmological adverse events when using HCQ to treat patients with COVID-19.展开更多
BACKGROUND Diagnosis of coronavirus disease 2019(COVID-19)-related neurological events in the pediatric population is challenging.Overlapping clinical picture of children with altered neurological state and inborn err...BACKGROUND Diagnosis of coronavirus disease 2019(COVID-19)-related neurological events in the pediatric population is challenging.Overlapping clinical picture of children with altered neurological state and inborn errors of metabolism,in addition to the frequency of asymptomatic COVID-19 cases,pose the main challenges for diagnosis.Diagnostic approaches to the onset post-COVID 19 subacute encephalopathy are still troublesome as seronegative autoimmune encephalitis(AIE)is reported.CASE SUMMARY A 27-mo-old boy was admitted for stormy refractory seizure of polymorphic semiology and altered mental status followed by various neuropsychiatric features that were suggestive of AIE.Brain magnetic resonance imaging and cerebrospinal fluid analysis were normal.Neither the immunological assessment,including viral serologies,antinuclear antibodies,autoimmune antibodies(NMDA,AMPA,CASPR2,LG11,GABARB,Hu,Yo,Ri,CV2,PNMA2,SOX1,Titin,amphiphysin,Recoverin),nor the metabolic assessment for lactate and pyruvate showed significant anomaly.Both positive history of COVID-19 infection and the findings of characteristic repetitive extreme delta brush played a key role in the diagnosis of COVID-19-related AIE.A remarkable improvement in the state of the child was noted after two pulse doses of intravenous Veinoglobulin and high dose of intravenous Corticosteroid.CONCLUSION Diagnostic biomarkers for AIE might aid effective treatment.展开更多
BACKGROUND Chronic liver disease(CLD)was associated with adverse clinical outcomes among people with severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection.AIM To determine the effects of SARS-CoV-2 infe...BACKGROUND Chronic liver disease(CLD)was associated with adverse clinical outcomes among people with severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection.AIM To determine the effects of SARS-CoV-2 infection on the incidence and treatment strategy of hepatocellular carcinoma(HCC)among patients with CLD.METHODS A retrospective,territory-wide cohort of CLD patients was identified from an electronic health database in Hong Kong.Patients with confirmed SARS-CoV-2 infection[coronavirus disease 2019(COVID-19)+CLD]between January 1,2020 and October 25,2022 were identified and matched 1:1 by propensity-score with those without(COVID-19-CLD).Each patient was followed up until death,outcome event,or November 15,2022.Primary outcome was incidence of HCC.Secondary outcomes included all-cause mortality,adverse hepatic outcomes,and different treatment strategies to HCC(curative,non-curative treatment,and palliative care).Analyses were further stratified by acute(within 20 d)and post-acute(21 d or beyond)phases of SARS-CoV-2 infection.Incidence rate ratios(IRRs)were estimated by Poisson regression models.RESULTS Of 193589 CLD patients(>95%non-cirrhotic)in the cohort,55163 patients with COVID-19+CLD and 55163 patients with COVID-19-CLD were included after 1:1 propensity-score matching.Upon 249-d median follow-up,COVID-19+CLD was not associated with increased risk of incident HCC(IRR:1.19,95%CI:0.99-1.42,P=0.06),but higher risks of receiving palliative care for HCC(IRR:1.60,95%CI:1.46-1.75,P<0.001),compared to COVID-19-CLD.In both acute and post-acute phases of infection,COVID-19+CLD were associated with increased risks of allcause mortality(acute:IRR:7.06,95%CI:5.78-8.63,P<0.001;post-acute:IRR:1.24,95%CI:1.14-1.36,P<0.001)and adverse hepatic outcomes(acute:IRR:1.98,95%CI:1.79-2.18,P<0.001;post-acute:IRR:1.24,95%CI:1.13-1.35,P<0.001),compared to COVID-19-CLD.CONCLUSION Although CLD patients with SARS-CoV-2 infection were not associated with increased risk of HCC,they were more likely to receive palliative treatment than those without.The detrimental effects of SARS-CoV-2 infection persisted in post-acute phase.展开更多
文摘BACKGROUND The recent and still ongoing pandemic caused by the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)entailed various long-term complications,including post-infectious cholangiopathy.AIM To identify the available studies concerning post-coronavirus disease 2019(COVID-19)cholangiopathy.METHODS An extensive bibliographical search was carried out in PubMed and in Cochrane Library to identify the articles(retrospective and prospective studies,cohort studies,case series and case reports)published between January 1,2020 and August 22,2022,using both MeSH terms and free-language keywords:cholangiopathy;COVID-19;post-COVID-19 cholangiopathy;SARS-CoV-2.RESULTS Thirteen studies fulfilled the inclusion criteria,which included 64 patients suffering from this condition.The patients were male in 82.8%of cases.Liver transplant was executed in 6 patients and scheduled in 7 patients,while 2 patients refused the surgical approach.Therefore in 23.4%of the cases,performing this procedure appeared to be necessary.CONCLUSION This review has revealed that generally the involvement of the liver in the course of SARS-CoV-2 infection is mild and transient,inducing cholestasis of cholangiocytes but can also be severe enough to cause organ failure in some cases.
文摘Post-coronavirus disease 2019(COVID-19)cholangiopathy(PCC)is a rare but lifethreatening complication of COVID-19 infection.PCC typically presents when patients recovering from the contagion and manifests as cholestasis in patients with no history of pre-existing liver disease.The pathogenesis of PCC is little understood.Hepatic injury in PCC could be mediated by the predilection of severe acute respiratory syndrome coronavirus 2 for cholangiocytes.Though PCC shows some resemblance to secondary sclerosing cholangitis in critically ill patients,it is considered as a separate and unique entity in the literature.Various treatment options like ursodeoxycholic acid,steroids,plasmapheresis,and endoscopic retrograde cholangiopancreatography guided interventions have been tried but with limited success.We have noticed significant improvement in liver function with antiplatelet therapy in a couple of patients.PCC can progress to end-stage liver disease necessitating liver transplantation.In this article,we discuss the current knowledge of PCC focusing on its pathophysiology,clinical manifestations,and management strategies.
文摘BACKGROUND Smell disorders are the most frequent persistent coronavirus disease 2019(COVID-19)complications.AIM To describe the patterns and characteristics of persistent smell and taste disorders in Egyptian patients.METHODS Assessment was done to 185 patients(adults=150,age:31.41±8.63 years;children=35;age:15.66±1.63 years).Otolaryngology and neuropsychiatric evaluations were done.Measurements included:A clinical questionnaire(for smell and taste);sniffin'odor,taste and flavor identification tests and the Questionnaire of Olfactory Disorders-Negative Statements(sQOD-NS).RESULTS Duration of disorders was 11.53±3.97 ms(6-24 ms).Parosmia(n=119;64.32%)was developed months after anosmia(3.05±1.87 ms).Objective testing showed anosmia in all,ageusia and flavor loss in 20%(n=37)and loss of nasal and oral trigeminal sensations in 18%(n=33)and 20%(n=37),respectively.Patients had low scoring of sQOD-NS(11.41±3.66).There were no specific differences in other demographics and clinical variables which could distinguish post-COVID-19 smell and taste disorders in children from adults.CONCLUSION The course of small and taste disorders are supportive of the nasal and oral neuronal compromises.Post-COVID-19 taste and trigeminal disorders were less frequent compared to smell disorders.Post-COVID-19 flavor disorders were solely dependent on taste and not smell disorders.There were no demographics,clinical variables at onset or specific profile of these disorders in children compared to adults.
文摘目的系统评价中医药对新型冠状病毒肺炎(COVID-19,简称:新冠肺炎)恢复期患者的肺功能影响,以期为临床决策及后续临床研究的开展提供参考。方法计算机检索中国知网(CNKI)、万方数据库(WanFang)、中国生物医学文献数据库(SinoMed)、维普期刊数据库(VIP)、PubMed、The Cochrane Library、EMbase数据库,检索时间为建库至2022年7月。由2名研究者按照纳入与排除标准独立筛选文献、提取数据且评估纳入研究的偏倚风险及方法学质量,采用Review Manager 5.4软件进行Meta分析。结果共纳入9项研究,其中5项随机对照试验、2项非随机对照试验、2项队列研究,纳入研究共包含1101例新冠肺炎恢复期患者。Meta分析结果显示:(1)针刺、中西医结合康复训练,可有效提升患者第一秒用力呼气容积(forced expiratory volume in one second,FEV1)水平(SMD=1.43,95%CI[1.10,1.75],P<0.00001)。(2)中西医结合康复训练可提升患者第一秒用力呼气容积占用力肺活量的百分比(forced expiratory volume in one second/forced vital capacity,FEV1/FVC)(MD=12.12,95%CI[9.46,14.79],P<0.00001)。(3)中药联合常规康复训练可有效降低患者改良医学研究学会呼吸困难量表(modified Medical Research Council,mMRC)评分(MD=-0.16,95%CI[-0.17,-0.15],P<0.00001)。(4)针刺、中药可提升肺部CT好转率(RR=1.14,95%CI[1.06,1.23],P=0.0003)。结论中医药可提升新冠肺炎恢复期患者FEV1及FEV1/FVC水平、降低mMRC评分及促进肺部CT好转率,促进新冠肺炎恢复期患者康复。受纳入研究数量限制,结论尚需更多高质量研究予以验证。
基金Supported by National Natural Science Foundation of China,No.81772045Scientific Research Project of Heilongjiang Health and Family Planning Commission,No.2018086.
文摘BACKGROUND As a highly contagious disease,coronavirus disease 2019(COVID-19)is wreaking havoc around the world due to continuous spread among close contacts mainly via droplets,aerosols,contaminated hands or surfaces.Therefore,centralized isolation of close contacts and suspected patients is an important measure to prevent the transmission of COVID-19.At present,the quarantine duration in most countries is 14 d due to the fact that the incubation period of severe acute respiratory syndrome coronavirus type 2(SARS-CoV-2)is usually identified as 1-14 d with median estimate of 4-7.5 d.Since COVID-19 patients in the incubation period are also contagious,cases with an incubation period of more than 14 d need to be evaluated.CASE SUMMARY A 70-year-old male patient was admitted to the Department of Respiratory Medicine of The First Affiliated Hospital of Harbin Medical University on April 5 due to a cough with sputum and shortness of breath.On April 10,the patient was transferred to the Fever Clinic for further treatment due to close contact to one confirmed COVID-19 patient in the same room.During the period from April 10 to May 6,nucleic acid and antibodies to SARS-CoV-2 were tested 7 and 4 times,respectively,all of which were negative.On May 7,the patient developed fever with a maximum temperature of 39℃,and his respiratory difficulties had deteriorated.The results of nucleic acid and antibody detection of SARS-CoV-2 were positive.On May 8,the nucleic acid and antibody detection of SARS-CoV-2 by Heilongjiang Provincial Center for Disease Control were also positive,and the patient was diagnosed with COVID-19 and reported to the Chinese Center for Disease Control and Prevention.CONCLUSION This case highlights the importance of the SARS-CoV-2 incubation period.Further epidemiological investigations and clinical observations are urgently needed to identify the optimal incubation period of SARS-CoV-2 and formulate rational and evidence-based quarantine policies for COVID-19 accordingly.
文摘The pandemic caused by severe acute respiratory syndrome coronavirus-2(SARSCoV-2)in 2019-2022 leads to a multisystem illness that results in damage to numerous organ systems.In this review,our goal was to assess current research on long-term respiratory,cardiac,neurological,digestive,rheumatological,urogenital,and dermatological system complications of coronavirus disease 2019(COVID-19).Bibliographic searches were conducted in December 2021 using PubMed and Google Scholar,retrospectively,covering all COVID-19 literature to determine the consequences of the disease.This review may help to determine the prospects for new studies and predict the upcoming aspects requiring assessment in post-COVID-19 syndrome.
基金Supported by Project Science and Technology Plan Project in Yan'an City No.SL2020ZCSY-004。
文摘Objective:The paper was to analyze the investigation and study of the psychological status of children and adolescents during the epidemic period of COVID-19.Methods:From March 5th to 11th,2020,1766 students from 8 to 18 years old in Yan'an area were taken as the research objects,and the psychological characteristics of this group of people during the epidemic period of COVID-19 were analyzed by the online questionnaires.Results:In the questionnaire,all children and adolescents were in good psychological conditions,and they had not shown serious negative psychological emotions,and they attached great importance to COVID-19.Conclusion:The psychological changes of children and adolescents during the epidemic period of COVID-19 are diverse.Most children and adolescents have a good mental state,and a few have negative psychological emotions.It can strengthen the psychological management of children and adolescents during the epidemic,and promote the healthy growth of children and adolescents clinically.
文摘As the world continues to grapple with the novel coronavirus[coronavirus disease 2019(COVID-19)],many treatments have been proposed to help alleviate the symptoms and reduce the mortality rate.Hydroxychloroquine(HCQ)is an antimalarial drug that is typically used for several autoimmune,rheumatic,and dermatological conditions.It has also been considered to treat and prevent COVID-19 and subsequent arthritis associated with the infection.This drug is known to cause retinal toxicity,which can lead to vision impairment or loss.While the exact mechanism is not yet fully understood,it is thought to be due to the accumulation of the drug in the retinal pigment epithelium.The risk of toxicity increases with long-term use or with high doses of the drug and is more likely to occur in patients with pre-existing retinal diseases or those who are predisposed to retinal diseases.In this context,several steps can be taken to monitor and minimize the risk of ophthalmological adverse events when using HCQ to treat patients with COVID-19.
文摘BACKGROUND Diagnosis of coronavirus disease 2019(COVID-19)-related neurological events in the pediatric population is challenging.Overlapping clinical picture of children with altered neurological state and inborn errors of metabolism,in addition to the frequency of asymptomatic COVID-19 cases,pose the main challenges for diagnosis.Diagnostic approaches to the onset post-COVID 19 subacute encephalopathy are still troublesome as seronegative autoimmune encephalitis(AIE)is reported.CASE SUMMARY A 27-mo-old boy was admitted for stormy refractory seizure of polymorphic semiology and altered mental status followed by various neuropsychiatric features that were suggestive of AIE.Brain magnetic resonance imaging and cerebrospinal fluid analysis were normal.Neither the immunological assessment,including viral serologies,antinuclear antibodies,autoimmune antibodies(NMDA,AMPA,CASPR2,LG11,GABARB,Hu,Yo,Ri,CV2,PNMA2,SOX1,Titin,amphiphysin,Recoverin),nor the metabolic assessment for lactate and pyruvate showed significant anomaly.Both positive history of COVID-19 infection and the findings of characteristic repetitive extreme delta brush played a key role in the diagnosis of COVID-19-related AIE.A remarkable improvement in the state of the child was noted after two pulse doses of intravenous Veinoglobulin and high dose of intravenous Corticosteroid.CONCLUSION Diagnostic biomarkers for AIE might aid effective treatment.
基金Supported by Collaborative Research Fund Scheme,University Grants Committee,No.C7154-20GFData Discovery for Health(D24H)Innovation and Technology Commission,AIR@InnoHK.
文摘BACKGROUND Chronic liver disease(CLD)was associated with adverse clinical outcomes among people with severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection.AIM To determine the effects of SARS-CoV-2 infection on the incidence and treatment strategy of hepatocellular carcinoma(HCC)among patients with CLD.METHODS A retrospective,territory-wide cohort of CLD patients was identified from an electronic health database in Hong Kong.Patients with confirmed SARS-CoV-2 infection[coronavirus disease 2019(COVID-19)+CLD]between January 1,2020 and October 25,2022 were identified and matched 1:1 by propensity-score with those without(COVID-19-CLD).Each patient was followed up until death,outcome event,or November 15,2022.Primary outcome was incidence of HCC.Secondary outcomes included all-cause mortality,adverse hepatic outcomes,and different treatment strategies to HCC(curative,non-curative treatment,and palliative care).Analyses were further stratified by acute(within 20 d)and post-acute(21 d or beyond)phases of SARS-CoV-2 infection.Incidence rate ratios(IRRs)were estimated by Poisson regression models.RESULTS Of 193589 CLD patients(>95%non-cirrhotic)in the cohort,55163 patients with COVID-19+CLD and 55163 patients with COVID-19-CLD were included after 1:1 propensity-score matching.Upon 249-d median follow-up,COVID-19+CLD was not associated with increased risk of incident HCC(IRR:1.19,95%CI:0.99-1.42,P=0.06),but higher risks of receiving palliative care for HCC(IRR:1.60,95%CI:1.46-1.75,P<0.001),compared to COVID-19-CLD.In both acute and post-acute phases of infection,COVID-19+CLD were associated with increased risks of allcause mortality(acute:IRR:7.06,95%CI:5.78-8.63,P<0.001;post-acute:IRR:1.24,95%CI:1.14-1.36,P<0.001)and adverse hepatic outcomes(acute:IRR:1.98,95%CI:1.79-2.18,P<0.001;post-acute:IRR:1.24,95%CI:1.13-1.35,P<0.001),compared to COVID-19-CLD.CONCLUSION Although CLD patients with SARS-CoV-2 infection were not associated with increased risk of HCC,they were more likely to receive palliative treatment than those without.The detrimental effects of SARS-CoV-2 infection persisted in post-acute phase.