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There is little research that focuses on the relationship between the gut, metabolism, nutritional support and COVID-19. As a group of Chinese physicians, nutritionists and scientists working on the frontline treating COVID-19 patients, we aim to integrate our experiences and the current clinical evidence to address this pressing issue in this article. Based on our clinical observations and available evidence, we recommend the following practice. Firstly, the Nutritional Risk Screening 2002 tool should be used routinely and periodically; for patients with a score ≥3, oral nutritional supplements should be given immediately. Secondly, for patients receiving the antiviral agents lopinavir/ritonavir, gastrointestinal side effects should be monitored for and timely intervention provided. Thirdly, for feeding, the enteral route should be the first choice. In patients undergoing mechanical ventilation, establishing a jejunal route as early as possible can guarantee the feeding target being achieved if gastric dilatation occurs. Fourthly, we suggest a permissive underfeeding strategy for severe/critical patients admitted to the intensive care unit during the first week of admission, with the energy target no more than 20 kcal/kg/day (for those on mechanical ventilation, this target may be lowered to 10-15 kcal/kg/day) and the protein target around 1.0-1.2 g/kg/day. If the inflammatory condition is significantly alleviated, the energy target may be gradually increased to 25-30 kcal/kg/day and the protein target to 1.2-1.5 g/kg/day. Fifthly, supplemental parenteral nutrition should be used with caution. Lastly, omega-3 fatty acids may be used as immunoregulators, intravenous administration of omega-3 fatty emulsion (10 g/day) at an early stage may help to reduce the inflammatory reaction.
The aim of this study was to identify factors impacting recipient sensitization rates and paediatric renal transplant patient outcomes.
For this purpose, a retrospective analysis of 143 paediatric renal transplants was carried out. This included the evaluation of patient's and donor's demographic data, HLA mismatches, immunosuppressive therapy, rejection episodes, panel reactive antibody (PRA) and post-transplant lymphoproliferative disease (PTLD).
The mean patient age at the point of transplant receival was 11.5 years with a mean follow up time of 9.33±5.05 years. It was noted that graft survival rates for donors over 59 years had the worst outcome. HLA match did not show statistically significant influence on graft outcome. Graft survival for more than one biopsy-proven rejection was also significantly shorter (p=0.008). PRA were found in 28% of the recipient's post-transplantation and showed association with lower graft survival rates (p<0.001). In the present study, 22.7% (5/22) of the patients with EBV infections presented a PTLD.
In conclusion, good graft survival with reduced sensitization for future transplantations and minimize the risk of PTLD, can be ensured through a balance between donor age, HLA match and condition of the recipient should be sought. Furthermore, paediatric patients should preferably receive organs from donors between the age of 10 and 59. EBV infection could be a relevant factor for developing PTLD.
In conclusion, good graft survival with reduced sensitization for future transplantations and minimize the risk of PTLD, can be ensured through a balance between donor age, HLA match and condition of the recipient should be sought. Furthermore, paediatric patients should preferably receive organs from donors between the age of 10 and 59. EBV infection could be a relevant factor for developing PTLD.
Carotid sinus syndrome (CSS) is a hypersensitivity of the carotid sinus manifested by atrioventricular sinus bradycardia or decreased arterial pressure of at least 50 mmHg. Triggering factors can be neck movements, shaving of the beard or too-tight collars. CSS can be rarely caused by the presence of malignant or benign masses in the head and neck area.
A 49 years-old white woman with a laterocervical mass presented recurrent episodes of sinus bradycardia related to head's rotation. Neck CT scan revealed a right piolaryngocele and internal left laryngocele. Episodes of bradycardia were disappeared after endolaryngeal carbon dioxide laser assisted marsupialization.
Laryngocele should be sought in the differential diagnosis of patients with bradycardia episodes due to carotid sinus compression. Surgical treatment of laryngoceles can lead to the termination of such episodes.
Laryngocele should be sought in the differential diagnosis of patients with bradycardia episodes due to carotid sinus compression. Surgical treatment of laryngoceles can lead to the termination of such episodes.
Verruciform xanthoma (VX) is an uncommon benign lesion with the subepithelial accumulation of foamy histiocytes and superficial papillary proliferations with a bright orange hue. This lesion exhibits an oral region predilection. Its clinical differential diagnosis includes verrucous leukoplakia, verrucous carcinoma, squamous papilloma, verruca vulgaris, condyloma accuminatum, squamous cell carcinoma, and fibroepithelial polyp.
This report presents a case of VX of the ventral surface of the tongue afflicting a 33-year-old otherwise healthy male.
This case report can be valuable as a consequence of VX rarity and the similarity of its clinical features to papillary lesions. 4-Chloro-DL-phenylalanine A biopsy is required for its definite diagnosis particularly when it occurs at sites with a high-risk of squamous cell carcinoma development, such as the lateral border and ventral surface of the tongue.
This case report can be valuable as a consequence of VX rarity and the similarity of its clinical features to papillary lesions. A biopsy is required for its definite diagnosis particularly when it occurs at sites with a high-risk of squamous cell carcinoma development, such as the lateral border and ventral surface of the tongue.
Warthin's tumor (WT) is the second most common neoplasm of the parotid gland and consists of two components, including lymphoid stroma and glandular epithelium. The malignant transformation of this tumor occurs most often in the lymphoid component; however, the carcinomatous transformation of the epithelial component is rare.
We present a patient who had a mass in the right mandibular angle two years before referral. A cystic mass was reported on sonography, and the patient underwent superficial parotidectomy with a pre-operative impression of lymphangiomatouse-like lesions. In the microscopic view, the sections revealed salivary gland neoplastic lesion with the diagnosis of WT. On the periphery of the neoplasm, another neoplastic lesion was observed along with infiltrative borders and diagnosis of mucoepidermoid carcinoma.
The WT is one of the most common tumors of the salivary glands. Malignancy transformation of the WT is a rare event. However, due to the importance of the treatment type, the surgeon should consider this issue in cystic lesions suspected of WT.
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