Thyroid storm in a pregnant woman with COVID-19 infection: A case report and review of literatures

BACKGROUND The severe acute respiratory syndrome coronavirus-2(SARS-CoV-2) has been found to be responsible for the recent global pandemic known as coronavirus disease 2019(COVID-19). SARS-CoV-2 infections not only result in significant respiratory symptoms but also cause several extrapulmonary manifestations, such as thrombotic complications, myocardial dysfunction and arrhythmia, thyroid dysfunction, acute kidney injury, gastrointestinal symptoms, neurological symptoms, ocular symptoms, and dermatological complications. We present the first documented case of thyroid storm in a pregnant woman precipitated by SARS-CoV-2.CASE SUMMARY A 42-year-old multiparous woman at 35 + 2 wk of gestation visited the emergency room(ER) with altered mentation, seizures, tachycardia, and high fever. The patient showed no remarkable events in the prenatal examination, and the nasopharyngeal COVID-19 polymerase chain reaction(PCR) test was positive two days before the ER visit. The results of laboratory tests, such as liver function test,serum electrolytes, blood glucose, blood urea nitrogen, and creatinine, were all within the normal ranges. However, the thyroid function test showed hyperthyroidism, and the nasopharyngeal COVID-19 PCR test was positive, as expected. No specific findings were observed on the brain computed tomography,and there were no signs of lateralization on neurological examination. Fetal heartbeat and movement were good, and there were no significant uterine contractions. The initial impression was atypical eclampsia. However, the patient’s condition worsened, and a cesarean section was performed under general anesthesia;a healthy boy was delivered, and 12 h after delivery, the patient’s seizures disappeared and consciousness was restored. The patient was referred to an endocrinologist for hyperthyroidism, and a thyroid storm with Graves’ disease was diagnosed. Here, SARS-CoV-2 was believed to be the trigger for the thyroid storm, considering that the patient tested positive for COVID-19 two days before the seizures.CONCLUSION In pregnant women presenting with seizures or changes in consciousness, the possibility of a thyroid storm should be considered. There are various causes for a thyroid storm, but given the recent pandemic, it is necessary to bear in mind that the thyroid storm may be precipitated by COVID-19.

T/myeloid mixed-phenotype acute leukemia treated with venetoclax and decitabine:A case report

BACKGROUND Mixed-phenotype acute leukemia(MPAL)is characterized by acute undifferentiated leukemia with blasts co-expressing myeloid and lymphoid antigens.However,consensus regarding the ideal management strategy for MPAL is yet to be established,owing to its rarity.CASE SUMMARY A 55-year-old male was diagnosed with T/myeloid MPAL.Vincristine,prednisolone,daunorubicin,and L-asparaginase were administered as induction chemotherapy.Septic shock occurred 10 days after induction,and bone marrow examination following recovery from sepsis revealed refractory disease.Venetoclax and decitabine were administered as chemotherapy-free induction therapy to reduce the infection risk.There were no serious infections,including febrile neutropenia,at the end of the treatment.After receiving two additional cycles of venetoclax/decitabine,the patient underwent haploidentical peripheral blood stem-cell transplantation and achieved complete response(CR)to treatment.CONCLUSION CR was maintained in a patient with MPAL who underwent haploidentical peripheral blood stem-cell transplantation after additional venetoclax/decitabine cycles.

Resveratrol prevents hypoxia-induced retinal ganglion cell death related with ErbB2

AIM: To confirm the changes in proteins related with hypoxia-induced retinal cell death and to assess the effects of resveratrol(Res).METHODS: The therapeutic effect of Res was verified using an ischemic/reperfusion(I/R) model in vivo and a hypoxia modelin retinal ganglion cells(RGCs) in vitro.Death of RGCs were confirmed by TUNEL assay.Protein expression was confirmed by Western blotting and immunohistochemistry.In addition, flow cytometric analysis was used to confirm the response in the cell unit to obtain more accurate data.RESULTS: ErbB2 expression and apoptosis in the ganglion cell layer(GCL) increased after I/R injury.Treatment of Res rescued I/R-induced ganglion cell death, downregulated apoptosis and ErbB2 protein expression in the retina.In subsequent in vitro models, Res affects apoptosis by regulating the phosphorylation and expression of mouse double minute 2 homolog(MDM2), along with those of ErbB2.These results suggest that Res reverses GCL-specific apoptosis via downregulation of ErbB2 in ischemic injury.CONCLUSION: In light of Res favorable properties, it should be evaluated in the treatment of RGC death and related retinal disease characterized by ErbB2 and MDM2 expression.Therefore, Res is appropriate therapeutic agent for treating ischemic injury-related eye diseases by targeting the expression of ErbB2 and MDM2.

Restenosis of a drug eluting stent on the previous bioresorbable vascular scaffold successfully treated with a drug-coated balloon: A case report

BACKGROUND The in-stent restenosis(ISR)rates are reportedly inconsistent despite the increased use of second-generation drug eluting stent(DES).Although bioresorbable vascular scaffold(BVS)have substantial advantages with respect to vascular restoration,the rate of scaffold thrombosis is higher with BVS than with DES.Optimal treatment strategies have not been established for DES-ISR to date.CASE SUMMARY We report on a case of a 60-year-old man patient with acute coronary syndrome.He had a history of ST-segment elevation myocardial infarction associated with very late scaffold thrombosis and treated with a DES.Coronary angiography revealed significant stenosis,suggesting DES-ISR on the previous BVS.Optical coherence tomography(OCT)identified a plaque rupture and a disrupted scaffold strut in the neointimal proliferation of DES.To treat the DES-ISR on the previous BVS,we opted for a drug-coated balloon(DCB)after a balloon angioplasty using a semi-compliant and non-compliant balloon.The patient did not experience adverse cardiovascular events on using a DCB following the use of intensive dual antiplatelet therapy and statin for 24 mo.CONCLUSION This case highlights the importance of OCT as an imaging modality for characterizing the mechanism of target lesion failure.The use of a DCB following the administration of optimal pharmacologic therapy may be an optimal strategy for the treatment and prevention of recurrent BVS thrombosis and DES-ISR.

Occult hepatitis B virus infection is not associated with disease progression of chronic hepatitis C virus infection

AIM To clarify the prevalence of occult hepatitis B virus(HBV) infection(OBI) and the association between OBI and liver disease progression, defined as development of liver cirrhosis or hepatocellular carcinoma(HCC), worsening of Child-Pugh class, or mortality in cases of chronic hepatitis C virus(HCV) infection. METHODS This prospective cohort study enrolled 174 patients with chronic HCV infection(chronic hepatitis, n = 83; cirrhosis, n = 47; HCC, n = 44), and evaluated disease progression during a mean follow-up of 38.7 mo. OBI was defined as HBV DNA positivity in 2 or moredifferent viral genomic regions by nested polymerase chain reaction using 4 sets of primers in the S, C, P and X open reading frame of the HBV genome. RESULTS The overall OBI prevalence in chronic HCV patients at enrollment was 18.4%, with 16.9%, 25.5% and 13.6% in the chronic hepatitis C, liver cirrhosis and HCC groups, respectively(P = 0.845). During follow-up, 52 patients showed disease progression, which was independently associated with aspartate aminotransferase > 40 IU/L, Child-Pugh score and sustained virologic response(SVR), but not with OBI positivity. In 136 patients who were not in the SVR state during the study period, OBI positivity was associated with neither disease progression, nor HCC development. CONCLUSION The prevalence of OBI in chronic HCV patients was 18.4%, and OBI was not associated with disease progression in South Koreans.

Effect of incision types for Artisan phakic intraocular lens implantation on ocular higher order aberrations

AIM： To evaluate the effect of incision types for Artisan phakic intraocular lens （PIOL） implantation on ocular higher-order aberrations （HOAs）.METHODS： A retrospective review was conducted of the patients who had undergone Artisan PIOL implantation for the correction of myopia and followed up for at least 6mo. Patients are classified into 2 groups considering the incision type： cornea group with patients undergone clear corneal incision; sclera group with patients undergone sclera tunnel incision. All patients with postoperative astigmatism of under 1 diopter （D） were included to minimize the effect of residual astigmatism on postoperative HOAs. Visual acuity, special equivalents, astigmatism, predictability （±1 D from target refraction）, HOAs （coma, trefoil, spherical aberration）, and corneal endothelial counts were analyzed preoperatively and 6mo postoperatively.RESULTS： At the postoperative 6mo, all patients of both groups achieved uncorrected visual acuity of 16/20 or better, and significantly decreased the spherical equivalents compared with preoperative values. The predictability of refractive correction was 96% in the former, and 94% in the latter. Unlike the sclera group, preoperative astigmatism decreased significantly in cornea group at postoperative 6mo. The HOAs increased significantly at postoperative 6mo compared to the preoperative values in both groups, and the root mean square （RMS） total and trefoil wavefront aberration of cornea group were significantly higher than those of sclera group.CONCLUSION： Although corneal incision significantly reduces preexisting astigmatism, the postoperative 6mo of total RMS and trefoil aberration change may deteriorate the visual quality after Artisan PIOL implantation.

Epstein-Barr virus-positive diffuse large B-cell lymphoma with human immunodeficiency virus mimicking complicated frontal sinusitis:A case report

BACKGROUND Primary non-Hodgkin’s lymphoma of the frontal sinus is extremely rare.In addition,Epstein-Barr virus(EBV)has been reported to play a role in the development of human immunodeficiency virus(HIV)-related malignant lymphomas.To the best of our knowledge,there is no report for the HIVassociated,EBV-positive primary diffuse large B-cell lymphoma(DLBCL)in the frontal sinus.CASE SUMMARY We present a unique case of HIV-associated,EBV-positive DLBCL in the frontal sinus in a 46-year-old man.Computed tomography of paranasal sinuses revealed dense opacification of the right frontal sinus with combined soft tissue swelling.Based on the clinical and radiological findings,the initial diagnosis was complicated frontal sinusitis,presenting Pott’s puffy tumor.Unexpectedly,HIV testing was positive on preoperative laboratory test,and the frontal sinus lesion was confirmed as EBV-positive DLBCL on biopsy.CONCLUSION Through this article,we suggest that EBV-positive DLBCL should be considered as possible diagnosis for patients with nonspecific space-occupying lesion of the paranasal sinuses.We also highlight an importance of clinical suspicion in diagnosing HIV infection because HIV serology is not routinely tested in patients with paranasal sinus problem.

Comparison of anterior segment optical coherence tomography findings in acanthamoeba keratitis and herpetic epithelial keratitis

This study is to investigate the characteristic features of Acanthamoeba keratitis（AK） that differentiating it from herpetic epithelial keratitis（HEK） using anterior segment optical coherence tomography（AS-OCT）. Medical records of three eyes of each AK and herpetic keratitis who had AS-OCT examination were reviewed in this study. Slitlamp biomicroscopy and AS-OCT was performed on the initial visit and on every follow-up visits in all patients. In all three AK cases, reflective bands in the corneal stroma that correspond to the area of radial keratoneuritis were observed. The depth of the reflective bands varied in each case. After AK treatment, slit-lamp biomicroscopy confirmed that radial keratoneuritis had resolved and AS-OCT confirmed that reflective bands in the corneal stroma had also disappeared in all patients. Unlike the AS-OCT results found in AK, highly reflective HEK lesions were observed only in the subepithelial area, not in the stroma. AS-OCT seems to be helpful analyzing the specific depth of the lesion which enables to distinguish AK from HEK.

Screening antioxidants for the protection of cochlear sensory cells

Sensory cell damage is a major cause of hearing loss： Sensorineural hearing loss （SNHL） is a common sensory deficit characterized by tissue damage and/or cell death in the cochlea. Moderate and severe SNHL causes deficits in communication, associated with increased isolation from human relationships, and negativly impacts employabflity. Many etiologies have been associated with SNHL： Noise overexposure, certain drugs, inner or middle ear infection or immune-induced inflammation being common. However, the most prevalent form of SNHL is presbycusis or age-related hearing loss, often aggravated by other factors including a history of noise exposure, diabetes or high blood pressure （Wong and Ryan, 2015）. Though systemic steroids are used in the treatment of sudden SNHL, other drugs to prevent or cure hearing loss have not yet been developed. Cochlear sensory cells, known as hair cells （HCs） and neurons have very limited repair capacity. Moreover since these cells do not regenerate, making any loss permanent, prevention of cell damage is critical to protecting hearing.

2018 update of expert consensus statement on antiplatelet therapy in East Asian patients with ACS or undergoing PCI

East Asians are the most populous race in the world and their health status is an important global issue.Compared with Caucasian populations, East Asian patients have a different benefit/risk ratio when using antithrombotic treatment. Despite this observation, treatment strategies in East Asian patients are mostly based on the American and European guidelines. Despite a lower platelet inhibitory response to clopidogrel, East Asian patients show a similar or even a lower rate of ischemic event occurrence and higher bleeding risk compared with Caucasian patients. For potent P2Y_(12) inhibitors(ticagrelor and prasugrel),East Asian patients have shown less favorable net clinical benefits compared with Caucasian patients,which may be related to differences in pharmacokinetic/pharmacodynamic profiles and therapeutic zone of antiplatelet effect. This updated consensus mainly focuses on state-of-the-art and current controversies in the East Asian population. In addition, when East Asian patients are administered potent P2Y_(12) receptor inhibitors, the strategies and ongoing trials to overcome the related hurdles are discussed.

Different cutoff values of methacholine bronchial provocation test depending on age in children with asthma

Background:Bronchial hyperresponsiveness (BHR) is a fundamental pathophysiological characteristic of asthma.Although several factors such as airway caliber can affect BHR,no study has established age-dependent cutoff values of BHR to methacholine for the diagnosis of asthma in children.We investigated the cutoff values of the methacholine challenge test (MCT) in the diagnosis of asthma according to age.Methods:A total of 2383 individuals aged from 6 to 15 years old were included in this study.MCTs using the five-breath technique were performed in 350 children with suspected asthma based on symptoms by pediatric allergists and in 2033 healthy children from a general population-based cohort.We determined the provocative concentration of methacholine producing a 20% decrease in forced expiratory volume in 1 second from baseline (PC20).A modified Korean version of the International Study of Asthma and Allergies in Childhood questionnaire was used to distinguish asthmatics and healthy subjects.Receiveroperator characteristic curve analysis was used to assess the cutoff value of PC20 for the diagnosis of asthma.Results:Cutoff values of methacholine PC20,which provided the best combination of diagnostic sensitivity and specificity,showed an increasing pattern with age:5.8,9.1,11.8,12.6,14.9,21.7,23.3,21.1,21.1,and 24.6 mg/mL at ages 6,7,8,9,10,11,12,13,14,and 15 years,respectively.Conclusion:The application of different cutoff values of methacholine PC20 depending on age might be a practical modification for the diagnosis of asthma in children and adolescents with asthmatic symptoms.

Electrical Stimulation of Auricular Acupressure for Dry Eye:A Randomized Controlled-Clinical Trial

Objective： To evaluate the clinical efficacy of electrical stimulation（ES） of auricular acupressure on reducing the ocular symptoms and signs before and after treatment for dry eye. Methods： The inclusion criteria were the tear film break-up time（TFBUT） below 5 s and a Schirmer test-Ⅰ below 5 mm in dry eyes with ocular symptoms for at least 6 months. Subjects were randomized into a treatment group（50 cases） with continuous low frequency ES under auricular acupressure at acupoints and a no ES under auricular acupressure（no-ES, control group, 50 cases） on the same acupoints. Auricular acupressure were stimulated with ES at 4 master points of both ears, which were performed twice a week for 4 weeks at each point for 30 s. The ocular symptoms, the TFBUT, and Schirmer test-Ⅰ were evaluated before and after this procedure. Results： There were significantly better scores in TFBUT（P=0.032）, the Schirmer test-Ⅰ（P=0.044） and ocular symptoms（P=0.029） at 3 months post-treatment in the treatment group than in the control group. The total effective rate in the treatment group was accomplished in 41（82%） of the 50 cases of dry eye. Conclusions： Auricular acupressure with ES at auricular acupoint improves ocular symptoms and signs of dry eye for a period of at least 3 months.