Volume 30, Issue 1, 2022
Review
A review of adverse effects of COVID-19 vaccines
Mushtaq Hisham Ahmed,
Khedr Anwar,
Koritala Thoyaja,
Bartlett Brian N.,
Jain Nitesh K.,
Khan Syed Anjum
The COVID-19 pandemic has led to unanticipated pressures on all aspects of human life. Multiple approaches to eliciting protective immunity must be rapidly evaluated. Numerous efforts have been made to develop an effective vaccine for this novel coronavirus, resulting in a race for vaccine development. To combat COVID-19, all nations must focus their efforts on widespread vaccination with an effective and safe vaccine. Globally, concerns about potential long-term adverse effects of vaccines have led to some apprehension about vaccine use. A vaccine’s adverse effect has an integral role in the public’s confidence and vaccine uptake. This article reviews the current primary literature regarding adverse effects associated with different COVID-19 vaccines in use worldwide
Awaiting a cure for COVID-19: therapeutic approach in patients with different severity levels of COVID-19
Alfano Gaetano,
Morisi Niccolò,
Frisina Monica,
Ferrari Annachiara,
Fontana Francesco,
Tonelli Roberto,
Franceschini Erica,
Meschiari Marianna,
Donati Gabriele,
Guaraldi Giovanni
COVID-19 is an unpredictable infectious disease caused by SARS-CoV-2. The development of effective anti-COVID-19 vaccines has enormously minimized the risk of severe illness in most immunocompetent patients. However, unvaccinated patients and non-responders to the COVID-19 vaccine are at risk of shortand long-term consequences. In these patients, the outcome of COVID-19 relies on an interplay of multiple factors including age, immunocompetence, co-morbidities,
inflammatory response triggered by the virus as well as the virulence of SARS-CoV-2 variants. Generally, COVID-19 is asymptomatic or mildly symptomatic in young people, but it may manifest with respiratory insufficiency requiring mechanical ventilation in certain susceptible groups of patients. Furthermore, severe SARS-CoV-2 infection induces multiorgan failure syndrome by affecting liver, kidney heart and nervous system. Since December 2019, multiple drugs have been tested to treat COVID-19, but only a few have been proven effective to mitigate the course of the disease that continues to cause death and co-morbidity worldwide.
Current treatment of COVID-19 patients is essentially based on the administration of supportive oxygen therapy and the use of specific drugs such as steroids, anticoagulants, antivirals, anti-SARS-CoV-2 antibodies and immunomodulators. However, the rapid spread of new variants and the release of new data coming from the numerous ongoing clinical trials have created the conditions for maintaining a continuous updating of the therapeutic management of COVID-19 patients. Furthermore, we believe that a well-established therapeutic strategy along with the continuum
of medical care for all patients with COVID-19 is pivotal to improving disease outcomes and restoring healthcare care fragmentation caused by the pandemic. This narrative review, focusing on the therapeutic management of COVID-19 patients, aimed to provide an overview of current therapies for (i) asymptomatic or mildly/moderate symptomatic patients, (ii) hospitalized
patients requiring low-flow oxygen, (iii) highflow oxygen and (iv) mechanical ventilation.
Long Covid-19 syndrome as a fourth phase of Sars-CoV2 infection
Staffolani Silvia,
Iencinella Valentina,
Cimatti Matteo,
Tavio Marcello
The SARS-CoV2 pandemic has affected in the last two years a large number of subjects, with a high cost in terms of morbidity and mortality. The scientific community made progress in understanding risk factors, pathophysiology, clinical manifestations, diagnosis and treatment of acute SARS-CoV2 infection. In the last months, another condition has become evident and caught the attention of the scientific community: the so-called long COVID syndrome. The pathophysiology of this condition is not known, even if some hypothesis have been made but not demonstrated yet. Long COVID is characterized by a very heterogeneous group of subacute and/or chronic symptoms and signs that follow the acute phase of SARS-CoV2 infection and have a very variable duration. The presence of this syndrome in an individual is not dependent from the severity of the acute SARS-CoV2 infection. Because of the extreme clinical heterogeneity, and also due to the lack of a shared and specific definition of the disease, it is very difficult to know the real prevalence and incidence of this condition. Some risk factors for the development of the disease have been identified: advanced age, elevated body mass index, comorbidities, specific symptoms of acute COVID-19 (in particular dyspnea), number of symptoms in the acute phase and female sex.
The number of individuals affected by long COVID is high, even if it occurs only in a part of the subjects who had COVID-19. Therefore, long COVID constitutes now a major health issue and has to be managed in order to ensure an adequate access to care for all the people that need it.
“Post COVID” clinics have been created in various countries, especially in Europe, for the management of people affected by long COVID syndrome. Guidelines have been written to help clinicians. An important role in the management of long COVID patients is played by the general practitioner, directly or indirectly linked to post COVID hospital clinics. The extreme heterogeneity of clinical presentation needs a patient-tailored, multidisciplinary approach. As NHS guidelines say, the three principal of care for long COVID patients are personalized care, multidisciplinary support and rehabilitation.
More studies are needed in order to know better the pathophysiology of the disease. It is also necessary to create standardized and shared definitions of the disease, in order to better understand the epidemiology, the diagnostic criteria and to offer the right treatment to all the individuals who need it, without social or economic differences.
The impact of COVID-19 on communicable and non-communicable diseases in Africa: a narrative review
Formenti Beatrice,
Gregori Natalia,
Crosato Verena,
Marchese Valentina,
Tomasoni Lina Rachele,
Castelli Francesco
The global pandemic of coronavirus disease 2019 (COVID-19) has disproportionately impacted global human health, economy, and security. Because of weaker health-care systems, existing comorbidities burden (HIV, malaria, tuberculosis, and non-communicable conditions), and poor socioeconomic determinants, initial predictive models had forecast a disastrous impact of COVID-19 in Africa in terms of transmission, severity, and deaths. Nonetheless, current epidemiological data seem not to have matched expectations, showing lower SARS-CoV-2 infection and fatality rates compared to Europe, the Americas and Asia. However, only few studies were conducted in low- and middle-income African settings where high poverty and limited access to health services worsen underlying health conditions, including endemic chronic infectious diseases such as HIV and tuberculosis. Furthermore, limited, and heterogeneous research was conducted to evaluate the indirect impact of the pandemic on general health services and on major diseases across African countries. International mitigation measures, such as resource reallocation, lockdowns, social restrictions, and fear from the population have had multi-sectoral impacts on various aspects of everyday life, that shaped the general health response. Despite the vast heterogeneity of data across African countries, available evidence suggests that the COVID-19 pandemic has severely impacted the control and prevention programs, the diagnosis capacity and the adherence to treatment of major infectious diseases (HIV, TB, and Malaria) - including neglected diseases - and non-communicable diseases. Future research and efforts are essential to deeply assess the medium- and long-term impact of the pandemic, and to implement tailored interventions to mitigate the standstill on decades of improvement on public health programs.
COVID-19-induced immune thrombocytopenic purpura; Immunopathogenesis and clinical implications
Bahadoram Mohammad,
Saeedi-Boroujeni Ali,
Mahmoudian-Sani Mohammad-Reza,
Hussaini Helai,
Hassanzadeh Shakiba
Following the outbreak of the COVID-19 pandemic, millions of people around the world have been affected with SARS-CoV-2 infection. In addition to the typical symptoms, thrombotic events, lymphopenia, and thrombocytopenia have been reported in COVID-19 patients. Immune thrombocytopenic purpura (ITP) is one of the thrombotic events that occur in some COVID-19 patients. Hyperinflammation, cytokine storms, and immune dysregulation in some patients are the cause to the main COVID-19 complications such as ALI (acute lung injury), acute respiratory distress syndrome (ARDS), and multiple organ failure. Disruption in the differentiation of T-cells, enhanced differentiation of Th17 and Th1, cell death (pyroptosis), hyper-inflammation and dysfunction of inflammatory neutrophils and macrophages, and hyperactivity of NLRP3-inflammasome are among the important factors that may be the cause to COVID-19-induced ITP. This study aimed to give an overview of the findings on the immunopathogenesis of ITP and COVID-19-induced ITP. Further studies are required to better understand the exact immunopathogenesis and effective treatments for ITP, especially in inflammatory disorders.
Differential mortality with COVID-19 and invasive mechanical ventilation between high-income and low- and middle-income countries: a systematic review, meta-analysis, and meta-regression
Khedr Anwar,
Al Hennawi Hussam,
Rauf Ibtisam,
Khuzzaim Khan Muhammad,
Mushtaq Hisham A.,
Lodhi Hana Sultana,
Domecq Garces Juan Pablo,
Jain Nitesh K.,
Koritala Thoyaja,
Khan Syed Anjum
The COVID-19 pandemic has markedly affected the health care of patients in low- and middle-income countries (LMICs), but no systematic study to corroborate this effect has been undertaken. In addition, the survival outcomes of patients with COVID-19 who received invasive mechanical ventilation (IMV) have not been well established. We pooled evidence from all available studies and did a systematic review and meta-analysis to assess and compare mortality outcomes between LMICs and high-income countries (HICs). We searched MEDLINE and the University of Michigan Library according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines from December 1, 2019, to July 15, 2021, for case-control studies, cohort studies, and brief reports that discussed mortality ratios and survival outcomes among patients with SARS-CoV-2 who received IMV. We excluded studies and case reports without comparison groups, narrative reviews, and preprints. A random-effects estimate of the arcsine square root transformation (PAS) of each outcome was generated with the DerSimonian-Laird method. Seven eligible studies, consisting of 243,835 patients with COVID-19, were included. We identified a significantly higher mortality rate (i.e., a larger PAS) among the patients receiving IMV in LMICs (PAS, 0.754; 95% CI, 0.569-0.900; P<.001) compared to patients in HICs (PAS, 0.588; 95% CI, 0.263-0.876; P<.001). Considerable heterogeneity was present within the individual subgroups possibly because of the extent of the included studies, which had data from specific countries and states but not from individual hospitals or health care centers. Moreover, the sample population in each study was diverse. Meta-regression showed that a higher mortality rate among patients with COVID-19 who received IMV in both HICs (P<.001) and LMICs (P=.04) was associated with chronic pulmonary disease. Our study suggests that chronic pulmonary diseases and poor demographics lead to a worse prognosis among patients with COVID-19 who received IMV. Moreover, the survival outcome is worse in LMICs, where health care systems are usually understaffed and poorly financed.
Can food matrices be considered as a potential carrier for COVID-19?
Abbasi Amin,
Kafil Hossein Samadi,
Ozma Mahdi Asghari,
Sangtarash Narges,
Sabahi Sahar
Humanity is currently facing a life-threatening challenge from the infectious and epidemic disease SARS-CoV-2. To date, the various modes of transmission of the virus have not been fully elucidated. In this regard, there is a possibility of transmission of the virus through food products. The COVID-19 pandemic disease, like those associated with SARS and MERS, is transmitted mainly through the respiratory tract and airborne aerosol particles, but the presence of fragments of the genetic virus (RNA) in the feces of numerous patients proposes that their fecal-oral pathway may be expanded. In addition, people with gastrointestinal disorders such as atrophic gastritis and metaplasia may be susceptible to COVID-19 infection. Accordingly, food may act as a potential carrier of COVID-19 due to environmental or cross-contamination. According to the available evidence, the spread and possibility of transmission of COVID-19 contamination from humans to food products are possible. Beyond that, there is some evidence that some food sources of animal origin, such as pigs and rabbits, can be contaminated by COVID-19. Therefore, the transmission of the virus through some meat products may be conceivable. Due to the rapid release rate of COVID-19 and its stability in various milieus, especially food manufacturing circumstances, it may enter the matrix during different stages of traditional or industrial food processing. Therefore, preventive measures are recommended to be utilized in the food manufacturing sector. The present study explored the risk of different food matrices, including dairy products, bread, meat and meat products, vegetables, fruits, and processed foods, as potential carriers for the transmission of COVID-19.
Antimicrobial therapy in resource-limited settings with high antimicrobial resistance: a case-based approach
Gupta Nitin
Choosing antimicrobial therapy in resource-limited settings is challenging because of the lack of advanced diagnostics and limited treatment options. Furthermore, since most international guidelines do not account for settings with high antimicrobial resistance, it is difficult for primary care physicians to choose the right antibiotic. This review, therefore, attempts to summarise the principles of antimicrobial therapy in such settings through six hypothetical case scenarios.
Original article
Liver involvement and mortality in COVID-19: A retrospective analysis from the CORACLE study group
Boglione Lucio,
Corcione Silvia,
Shbaklo Nour,
Rosso Tiziana,
Lupia Tommaso,
Mornese Pinna Simone,
Scabini Silvia,
Ciccone Giovannino,
De Benedetto Ilaria,
Borrè Silvio,
De Rosa Francesco Giuseppe
Introduction: liver abnormalities are common in COVID-19 patients and associated with higher morbidity and mortality. We aimed to investigate clinical significance and effect on the mortality of abnormal liver function tests (ALFTs) in COVID-19 patients.
Methods: we retrospectively evaluated in a multicentre study all patients admitted with confirmed diagnosis of COVID-19
Results: 434 patients were included in this analysis. Among overall patients, 311 (71.6%) had normal baseline ALT levels. 123 patients showed overall abnormal liver function tests (ALFTs) at baseline [101 ALFTs <2x UNL and 22 ≥2 UNL]. Overall in-hospital mortality was 14% and mean duration of hospitalization was 10.5 days. Hypertension (50.5%), cardiovascular diseases (39.6%), diabetes (23%) were frequent comorbidities and 53.7% of patients had ARDS. At multivariate analysis, the presence of ARDS at baseline (OR=6.11; 95% CI: 3.03-12.32; p<0.000); cardiovascular diseases (OR=4; 95% CI: 2.05-7.81; p<0.000); dementia (OR=3.93; 95%CI:1.87-8.26; p<0.000) and no smoking (OR=4.6; 95% CI: 1.45-14.61; p=0.010) resulted significantly predictive of in-hospital mortality. The presence of ALFTs at baseline was not significantly associated with mortality (OR=3.44; 95% CI=0.81-14.58; p=0.094)
Conclusion: ALFTs was frequently observed in COVID-19 patients, but the overall in-hospital mortality was mainly determined by the severity of illness, co-morbidities and presence of ARDS.
Evolution of prescribing practices and outcomes in the COVID-19 pandemic in metropolitan areas
Diaczok Benjamin,
Nair Girish,
Lin Chun-Hui,
Paxton James H.,
Abbas Amr,
Barkley Greg,
O’Neil Brian,
O’Neil William,
Patel Kirit,
Sims Matthew,
Poisson Laila,
Sule Anupam Ashutosh
Introduction: We wanted to characterize the evolution of the COVID-19 pandemic in a typical metropolitan area.
Methods: Data were extracted from the Detroit COVID-19 Consortium database for hospitalized COVID-19 patients treated in Southeast Michigan over the 12-month period from March 2020 to February 2021. Demographic and outcomes data were compared to CDC data.
Results: A total of 4,775 patients were enrolled during the study period. We divided the pandemic into three phases: Phase-1 (Spring Surge); Phase-2 (Summer Lull); and Phase-3 (Fall Spike). Changes in hydroxychloroquine, remdesivir, corticosteroid, antibiotic and anticoagulant use closely followed publication of landmark studies. Mortality in critically-ill patients decreased significantly from Phase-1 to Phase-3 (60.3% vs. 47.9%, Chisq p=0.0110). Monthly mortality of all hospitalized patients ranged between 14.8% - 21.5% during Phase-1 and 9.7 to 13.4% during Phase 3 (NS).
Discussion: The COVID–19 pandemic presented in three unique phases in Southeast Michigan. Medical systems rapidly modified treatment plans, often preceding CDC and NIH recommendations. Despite improved treatment regimens, intubation rates and mortality for hospitalized patients remained elevated.
Conclusion: Preventive measures aimed at reducing hospitalizations for COVID-19 should be emphasized.
Comparison of COVID-19 characteristics in Egyptian patients according to their Toll-Like Receptor-4 (Asp299Gly) polymorphism
Taha Sara I.,
Shata Aalaa K.,
El-Sehsah Eman M.,
Mohamed Manar F.,
Moustafa Nouran M.,
Youssef Mariam K.
Background: Toll‐like receptor (TLR)-4 plays a vital role in recognizing viral particles, activating the innate immune system, and producing pro-inflammatory cytokines. Objectives: This cross-sectional study aimed to compare COVID-19 severity, progression, and fate according to TLR-4 (Asp299Gly) polymorphism in Egyptian patients. Methods: A total of 145 COVID-19 patients were included in this study. TLR-4 (Asp299Gly) genotyping was done using the PCR restriction fragment length polymorphism (PCR-RFLP) approach. Results: The most commonly encountered TLR-4 genotype in relation to the amino acid at position 299 was the wild-type AA (73.1%); meanwhile, the homozygous mutant GG genotype (8.3%) was the least encountered. At hospital admission, 85.8% of the AA group had free (with no ground glass opacities) chest computed tomography (CT) examination, and 16.0% were asymptomatic. On the other hand, of the AG and GG groups, 81.5% and 83.3%, respectively showed bilateral ground-glass opacities in chest CT, as well as 25.9% and 75.0%, respectively were dyspneic. Values of the total leucocytic count, C-reactive protein (CRP), ferritin, and D dimer increased in the AA
AG>GG sequence. ICU admission (83.3%) and in-hospital death (33.3%) rates were significantly higher in the GG group. Conclusions: In COVID-19 patients, the TLR-4 mutant G allele may be associated with a more aggressive disease course and in-hospital death. New therapeutic alternatives could be aimed at this area.
The COVID pandemic has forcefully turned the spotlight on the importance of the diagnosis of respiratory virus infections. Viruses have always been a frequent and common cause of respiratory tract infections. Rapid molecular diagnostics applied to the diagnostics of respiratory virus infections has revolutionized microbiology laboratories only a few years ago. Few studies illustrate the epidemiology of respiratory viruses, and fewer still those that have compared the pre-pandemic to the pandemic period. During the first year of the pandemic (2020-2021) it was clear to everyone to witness a sudden disappearance of the circulation of all the other respiratory viruses, especially those typically isolated during the winter time, such as RSV and Influenza virus. In our study we wanted to verify this phenomenon and to study the epidemiology of our local reality, analyzing three consecutive flu seasons (2018-2019, 2019-2020, 2020-2021). The results lead us to note that the prevalence of positivity to respiratory virus infections went from 49.8% (2018-2019) and 39% (2019-2020) to 13.4% (2020-2021). This decrease is at least partly attributable to the security measures adopted (social distancing and mask), but it certainly opens up new scenarios when the restriction measures will be terminated. We believe such studies can provide real-world evidence of the effectiveness of public health interventions implemented during current and future pandemics.
Phylogeographical and evolutionary history of variola major virus; a question of timescales?
Bergna Annalisa,
Della Ventura Carla,
Marzo Rossella,
Ciccozzi Massimo,
Galli Massimo,
Zehender Gianguglielmo,
Lai Alessia
Aim of this study was to reconstruct the phylogeography of variola virus (VARV) in the XX century, using 47 VARV whole genome sequences available in public databases, through two different methods for ancestral character reconstruction: a frequently used Bayesian framework and a fast maximum-likelihood (ML) based method.
The substitution rate of the whole VARV genome was estimated to be between 6.7x10-6 and 1.1x10-5 substitutions/site/year. Both ML and Bayesian methods gave similar trees topology, showing two distinct monophyletic groups: one (known as P1) including the great part of variola major and the second (P2) including West African and American (variola minor) isolates and close evolutionary rate estimations, between 6.73x10-6 and 1.1x10-5 for the whole genome.
The phylogeographical reconstruction of P1 suggested that the common ancestor of the variola major circulating in the Old World between the 1940s and the 1970s most probably originated in the Far East in the first decades of the XX century, and then spread to Indian subcontinent in the 1920s. India represented a center of further spread of VARV to eastern Africa in the 1940s and to the Middle East in the 1960s.
The phylogeographic scenario obtained by the maximum-likelihood based method was congruent with that obtained by Bayesian framework, but the analysis was faster indicating the usefulness of this method in the analyses of large viral genomes.
Our results may help to explain the controversial reconstructions of the history of VARV obtained using long or short timescale for calibration.
The serious threat of late presenters HIV-infected patients in the context of the COVID-19 pandemic
Brugnaro Pierluigi,
Morelli Erika,
Cattelan Francesca,
Petrucci Andrea,
Colombo Francesco,
Caputo Sara,
Laurino Licia,
Panese Sandro
The impact of current SARS-CoV-2 pandemic on the healthcare services had serious consequences, especially for the most fragile populations such as HIV-positive subjects. In the period April to September 2020 we reported four cases of HIV-infected late presenters with an AIDS-defining life-threatening condition that, due to the difficult access to the hospital during the pandemic, were characterized by a delayed HIV recognition and institution of correct treatment. Even after two decades of highly active antiretroviral therapy late presenters HIV-infected patients still represent a serious clinical challenge.
Case report
Trueperella bernardiae bloodstream infection following onco-gynaecologic surgery and literature review
Casale Roberto,
Bianco Gabriele,
Cosma Stefano,
Micheletti Leonardo,
Comini Sara,
Iannaccone Marco,
Boattini Matteo,
Cavallo Rossana,
Benedetto Chiara,
Costa Cristina
Trueperella bernardiae is a Gram-positive commensal bacillus of the human skin and oropharynx. It is known as an opportunistic human pathogen causing surgical wound, skin, and soft tissue, osteoarticular, and bloodstream infections (BSIs) with severe complications. We report a case of surgical wound related T. bernardiae BSI following onco-gynaecologic surgery together with a comprehensive literature review of T. bernardiae infections to alert clinicians about this emerging pathogen.
Recurrent erysipelas led to diagnosis of hereditary hemorrhagic telangiectasia
Yamaoka Mari,
Kanzawa Yohei,
Tatehara Shun,
Sasaki Koji,
Mizuki Shimpei,
Ohnishi Jun,
Nakajima Takahiro,
Ishimaru Naoto,
Kinami Saori
Hereditary hemorrhagic telangiectasia (HHT) is a risk of infection, such as by brain abscess associated with pulmonary arteriovenous malformations. However, association between HHT and recurrent erysipelas is not well described. HHT can cause vessel malformations in organs, leading to various serious outcomes. Prophylactic treatment is effective, but many people with HHT are undiagnosed. HHT is not described as a risk factor for soft tissue infection, but may increase the risk of serious infections requiring hospitalization.
Our 72-year-old female patient was admitted for recurrent erysipelas. Pulmonary nodules indicated pulmonary arteriovenous fistula on chest computed tomography. By recognizing this combination, although seemingly unrelated problems, we could diagnose HHT and the patient could receive adequate treatment to prevent life-threatening events.
The recurrent erysipelas was likely associated with HHT. Recurrent erysipelas is an important presentation which may facilitate early diagnosis of HHT.
Spondylodiscitis associated with skin lesions caused by Rhizopus in a patient with systemic lupus erythematosus
de Saboya Larissa Silva,
Borges Moara AlvesSanta Bárbara,
Camargo Diego Gonçalves,
Cysneiros Maria Auxiliadorade Paula Carneiro,
Oliveira Murilo Eugênio,
Guilarde Adriana Oliveira
Mucormycosis is a serious and rare fungal disease caused by opportunistic fungi of the zygomycete class, order Mucorales. The main clinical presentations are rhinocerebral, pulmonary, cutaneous, gastrointestinal, and disseminated infections. There are few reports in the literature of spondylodiscitis caused by mucormycosis. We report a 53-year-old male patient presenting with subcutaneous nodules and severe low back pain radiating to the lower limbs. The patient had systemic lupus erythematosus (SLE) for 8 years and corticoid-induced diabetes. He had been using 60 mg/day of prednisone in the last year, with a recent pulse therapy regimen with methylprednisolone and cyclophosphamide to control the renal dysfunction. Nuclear magnetic resonance (NMR) of the spine showed spondylodiscitis. The patient underwent spinal arthrodesis and lesion biopsy. The histopathological study of the vertebra reported a necro suppurative inflammation with numerous fungal structures described as a wide range of hyaline hyphae. The histopathology of the cutaneous nodule exhibited an extensive suppurative lesion centered on the subcutaneous tissue, associated with a large amount of hyphae, similar to that found in the spinal lesion, suggestive of mucormycosis. The fungal culture showed the growth of Rhizopus spp. Treatment was performed with amphotericin B lipid complex 5 mg/Kg/day for 60 days. After antifungal treatment, there was a progressive reduction in the number of subcutaneous nodules and total improvement of the patient's low back pain, with recovery of his gait. At the 18-month outpatient visit follow-up, the patient was stable and without recurrence. In our case, timely diagnosis enabled the removal of the osteoarticular focus and the targeted therapy resulted in a satisfactory clinical response, without sequelae or complications, despite the patient's underlying immunosuppressed status.
Whipple’s disease: a case report in Santa Catarina, Brazil
Kleber Stroher Camila,
Lichs Marçal Santos Arthur,
Ceron Leandra,
Luisa Fabrin Liandra
Whipple's disease is a rare systemic infection caused by a diastase-resistant and Gram-positive bacillus called Tropheryma whipplei. The diagnosis of the disease is difficult and often late due to the variety of the symptoms. The objective of this study was to report a rare case of Whipple's disease treated at the Internal Medicine service of a hospital in the Midwest of Santa Catarina, Brazil. The patient was invited for an interview to describe the history of symptoms and previous treatments. Additionally, test results and treatments performed during hospitalization were assessed through the medical records. The case report describes a 39-year-old white male who presented, at the time of diagnosis, severe diarrhea, hematochezia, weight loss, fever, and inguinal adenomegaly, in addition to preceding migratory polyarthritis. After investigation, the diagnosis of Whipple's disease was achieved in conjunction with antibiotic treatment, with improvement of clinical and laboratory symptoms after 15 days. This case highlights the broad array of symptoms and the non-specific features of the Whipple's disease. Establishing an early diagnosis is essential for the success of the treatment, avoiding a long-lasting escalation of symptoms, which lead to cachexia and a devastating loss of the patient's quality of life.
The Infections in the History of Medicine
Royal disease (Vasilios nósos): Substantiating one of the names of tuberculosis in Greek, from “Atakta” dictionary by Adamantios Korais, (1832- 1835)
Kazana Aikaterini A.,
Gourgoulianis Konstantinos I.
The purpose of the present article is to substantiate the Greek name of Βασίλειος νόσος (Vasilios nósos) about tuberculosis, with the analysis of what Adamantios Korais mentions about scrofula in his dictionary “Atakta”.
Korais relates the story of medicinal Royal touch about scrofula connects and identifies the king with the name of the disease.
Mortality and morbidity from infectious and non-communicable diseases in Greece during Axis/Nazi military occupation (1941-1944)
Rachiotis Georgios,
Papagiannis Dimitrios,
Dardavesis Theodoros,
Behrakis Panagiotis
Greece has been severely damaged by the Second World War and the subsequent military occupation of the country by the Axis forces headed by Nazi Germany. The Greek society and economy were dislocated as a result of plundering of the country’s vital resources, as well as enforces payments paid to the occupying forces. The dramatic food shortages and famine appeared plaguing especially large cities. There is very limited information on the trends of mortality and morbidity (1941-1944) at a national level. The morbidity and mortality statistics of the General Statistical Service of Greece were assessed and the incidence morbidity and mortality rates have been calculated. As denominator population we used the population of Greece according to 1940 census. The morbidity due to exanthematic typhus, typhoid fever, dysentery and meningitis has been elevated over the period 1940-1944. An elevated specific mortality due to tuberculosis, malaria and typhoid fever was observed over the period 1940-1941. Regarding non-communicable diseases, the mortality due to hemorrhagic stroke was increased after 1940. In conclusion, we found that the Axis/Nazi military occupation of Greece had considerable health effects on infectious diseases and hemorrhagic stroke mortality. Deaths ostensibly due to infectious diseases (e.g. tuberculosis or malaria), were expedited by the hunger famine of the period under investigation. With regard to the elevated mortality due to hemorrhagic stroke, we believe that the stressful events of occupation and famine have triggered increased psychosocial stress which in turn may have increased the risk of hemorrhagic stroke mortality during the period of Axis/Nazi occupation of Greece.
