Pneumomediastinum, pneumopericardium pneumothorax and subcutaneous emphysema in Iranian COVID-19 patients

Recently, spontaneous pneumomediastinum (PM), pneumopericardium (PP), pneumothorax (PT), and subcutaneous emphysema (SE) were reported as infrequent complications in coronavirus disease 2019 (COVID-19) patients in intensive care (ICU). Here we report these complications in nine Iranian patients of COVID-19. Nine patients with reported PM, PP, PT, and SE in COVID-19 who were hospitalized in Arya hospital, Rasht, Iran, for three months, were followed to record demographic data and clinical characteristics of these patients. In nine PM-developed patients, six cases represented PT, one patient with PP, and four patients with PT and SE. Four patents expired and only five patients survived. PM, PP, PT, and SE are uncommon complications in COVID-19 patients and were reported frequently in male patients. Early diagnosis and treatment could save the patients since these complications are related to poor prognosis and prolonged hospitalization. Patients with mild COVID-19 and mild pulmonary damage have a favorable outcome.

Evaluation of Lung Function Tests in the Follow-up of COVID-19 Patients Discharged From Razi Hospital in Rasht, Iran

Background: The COVID-19 pandemic has been a significant concern for the global health community since its onset. This study aimed to evaluate lung function tests in the follow-up of COVID-19 patients discharged from Razi Hospital in Rasht, Iran, in 2020. Materials and Methods: This cross-sectional study evaluated lung functional tests, including spirometry and the six-minute walking test (6MWT), in the follow-up of 239 hospitalized COVID-19 cases. All demographical and clinical data, along with the lung performance test results of the patients, were recorded, and statistical data were analyzed using SPSS, version 24. Results: The mean age of the patients was 51.69±13.98 years, and most of them were females. About 60.25% of patients had underlying diseases. The frequency of positive 6 MWT tests during the first three, six, and nine months after discharge was 7.96%, 8.70%, and 14.29%, respectively. In the first trimester after discharge, the 6MWT test was more positive among females. In addition, forced expiratory volume (FEV1)/forced vital capacity (FVC) showed a significant positive relationship with diastolic blood pressure (DBP) and heart rate (HR). After six months, positive 6MWT results were significantly associated with older ages and underlying diseases. The amount of FVC was positively associated with DBP, distance traveled in the 6MWT test, and HR, but it was negatively related to age. Conclusion: The findings revealed that older age, female gender, and underlying diseases were associated with positive 6MWT results, decreased pulmonary function, and higher DBP and HR

Basic science232. Certolizumab pegol prevents pro-inflammatory alterations in endothelial cell function

Background: Cardiovascular disease is a major comorbidity of rheumatoid arthritis (RA) and a leading cause of death. Chronic systemic inflammation involving tumour necrosis factor alpha (TNF) could contribute to endothelial activation and atherogenesis. A number of anti-TNF therapies are in current use for the treatment of RA, including certolizumab pegol (CZP), (Cimzia ®; UCB, Belgium). Anti-TNF therapy has been associated with reduced clinical cardiovascular disease risk and ameliorated vascular function in RA patients. However, the specific effects of TNF inhibitors on endothelial cell function are largely unknown. Our aim was to investigate the mechanisms underpinning CZP effects on TNF-activated human endothelial cells. Methods: Human aortic endothelial cells (HAoECs) were cultured in vitro and exposed to a) TNF alone, b) TNF plus CZP, or c) neither agent. Microarray analysis was used to examine the transcriptional profile of cells treated for 6 hrs and quantitative polymerase chain reaction (qPCR) analysed gene expression at 1, 3, 6 and 24 hrs. NF-κB localization and IκB degradation were investigated using immunocytochemistry, high content analysis and western blotting. Flow cytometry was conducted to detect microparticle release from HAoECs. Results: Transcriptional profiling revealed that while TNF alone had strong effects on endothelial gene expression, TNF and CZP in combination produced a global gene expression pattern similar to untreated control. The two most highly up-regulated genes in response to TNF treatment were adhesion molecules E-selectin and VCAM-1 (q 0.2 compared to control; p > 0.05 compared to TNF alone). The NF-κB pathway was confirmed as a downstream target of TNF-induced HAoEC activation, via nuclear translocation of NF-κB and degradation of IκB, effects which were abolished by treatment with CZP. In addition, flow cytometry detected an increased production of endothelial microparticles in TNF-activated HAoECs, which was prevented by treatment with CZP. Conclusions: We have found at a cellular level that a clinically available TNF inhibitor, CZP reduces the expression of adhesion molecule expression, and prevents TNF-induced activation of the NF-κB pathway. Furthermore, CZP prevents the production of microparticles by activated endothelial cells. This could be central to the prevention of inflammatory environments underlying these conditions and measurement of microparticles has potential as a novel prognostic marker for future cardiovascular events in this patient group. Disclosure statement: Y.A. received a research grant from UCB. I.B. received a research grant from UCB. S.H. received a research grant from UCB. All other authors have declared no conflicts of interes

Translational glycobiology: from bench to bedside

The importance of sugars to protein function is real and is of significant clinical relevance. Technology advances enable large population studies to be carried out, shedding light on individual sugar variation and variations with time. Three-dimensional mass spectroscopy on solid pathological specimens is going to open up a whole new world of pathology visualisation. The door is now open to exploit carbohydrate recognition in new therapeutics by identifying novel biomarkers in cancer to aid diagnosis, and also providing therapeutic targets for treatment. Glycan age correlates with biological age. This means we can map the reversal of biological age with exercise and diet.status: publishe

Post surgical adhesion prevention: Vitamin C or Satureja Khuzestanica

Abstract    Abdominal surgeries can result in intra abdominal adhesions. Since Satureja Khuzestanica is used for its anti oxidant, anti lipid, anti inflammatory and anti bacterial effects, it might also play a role in preventing intra abdominal adhesion. Therefore, this study was conducted in order to assess the effects of this plant compared with vitamin C in the prevention of post surgical intra abdominal adhesions.Forty rats were used for this experimental study and were randomly allocated into 4 groups of 10 rats. Ten ml of 0.9% normal saline, 250 mg/kg vitamin C, 250 mg/kg Satureja Khuzestanica, and both vitamin C plus Satureja Khuzestanica were used for the first, second, third and fourth group, respectively. Mazuji classification and pathology assessment were used to grade the amount of adhesion. According to our findings, vitamin C in addition to Satureja Khuzestanica is effective in preventing abdominal adhesions

Spontaneous tension pneumomediastinum with pneumothorax and subcutaneous emphysema as a complication of COVID‐19 disease

Key Clinical Message Recently spontaneous tension pneumomediastinum (STM), were reported as infrequent complications in coronavirus disease 2019 (COVID‐19) patients but pneumothorax (PT), and subcutaneous emphysema (SE) are more frequently seen in COVID‐19 patients. PT and SE may present after PTM in COVID‐19. The aim of this presentation is to show the complications of STM in an Iranian patients with COVID‐19 disease with PT and SE, who were hospitalized in Arya hospital, Rasht, Iran. For 3 months, we followed these patients and their condition was good. STM are uncommon complications in COVID‐19 patients and were reported frequently in male patients. Early diagnosis and treatment could save the patients as these complications are related to poor prognosis and prolonged hospitalization. Patients with mild COVID‐19 and mild pulmonary damage may have a favorable outcome

Evaluation of the Relationship Between Primary Spontaneous Pneumothorax and Exercise and Return to Previous Activities in Patients Referring to Hospitals of Rasht during 2015-2017

BACKGROUND: The most common cause of primary spontaneous pneumothorax (PSP) is subpleural bleb apical rupture. Little is known about the relationship between PSP and exercise and return to exercise the time. In this study, we tend to investigate the relationship between training and PSP and time of return to exercise and previous activities.METHOD: This study was designed as a case series and the sample size included all patients diagnosed with PSP in Razi and Poursina and Aria hospitals of Rasht during 2015-2017 based on inclusion criteria. Variables were analyzed using Fisher's exact test, Chi-square, Mann Whitney U and t-test (p<0.05).RESULTS: The most common treatment type in patients was transaxillary thoracotomy with pleurodesis with iodine (TTP) in 58.2% and tube thoracostomy and pleurodesis in 41.7%, which was not statistically significant between athletes and non-athletes (p=0.806). Athletes who underwent TTP after four weeks and those treated with tube thoracostomy and pleurodesis after 8-12 weeks were advised to return to their previous activity. Of athletes, 9.5% had a recurrence; of non-athletes, 9.8% had a recurrence. Of athletes, 4.8% did not tolerate returning to their last activity; of non-athletes, 7.3% did not tolerate returning to their previous activity regardless of treatment, and this difference was not significant.CONCLUSION: Our study showed no significant difference between clinical manifestations and image findings and the frequency of treatment and complications in both athlete and non-athlete patients. There is no increase in recurrence and intolerance at the time recommended for return to previous activity

The association between subclinical hypothyroidism and exacerbation in patients with chronic obstructive pulmonary disease

This study aimed to investigate the association between subclinical hypothyroidism and exacerbation in patients with chronic obstructive pulmonary disease (COPD). This descriptive-analytical study was performed on patients with COPD that were diagnosed by spirometry and GOLD guides. A modified medical research council (mMRC) questionnaire was also used for grading dyspnea. The severity of the disease was determined according to the GOLD criteria. Patients were divided into mild, moderate, severe, and very severe COPD. Then, the patients were included in high-risk (C and D) and low-risk (A and B) groups. Thyroid-stimulating hormone (TSH), free thyroxine, triiodothyronine (T3), and T3 resin uptake tests were assessed. Out of 119 patients with COPD, about 74.8% were males and 25.2% were females. Overall, 50.4% of participants were in an exacerbation state and 49.6% were stable. A significant association was reported between the number and years of cigarette smoking and the exacerbation of COPD (P0.05). There was a significant association between severity in exacerbation and stable groups (P 0.05). The frequency of dyspnea grade with high mMRC scores in the exacerbation group was higher than in the stable group. The mean difference in FEV1, FVC, FEV1/FVC, and T3 variables was significant between the two studied groups. There was a significant difference between the variables of "one-year hospitalization", "one-year exacerbation" and "duration of illness" among the two groups of stable and exacerbation (P0.05). It’s suggested that the mean level of T3 could be used in the future to predict disease exacerbation in COPD.