A case of afterload mismatch associated with shivering leading to fetal hypoxia in a COVID-19 patient

Abstract Background Fever and associated shivering are frequent symptoms in patients with coronavirus disease 2019 (COVID-19). High body temperature activates the immune system, which might be beneficial. However, shivering leads to high oxygen demand. Case presentation A 38-year-old man diagnosed with COVID-19 was transferred to our intensive care unit (ICU). His oxygen saturation (SpO2) level was approximately 92–95% and was managed with a high flow nasal cannula. Six hours after admission to the ICU, he started shivering, and his systolic blood pressure rose above 200 mmHg. Concomitantly, his SpO2 levels decreased rapidly. Mechanical ventilation was started, but oxygenation could not be maintained, requiring the establishment of extracorporeal membrane oxygenation (ECMO). Conclusions COVID-19 is known to cause thrombosis in the pulmonary microvasculature at the early stage of the disease. Under these circumstances, caution should be paid since shivering may worsen the patient’s condition

日本に於る子宮頚部ヒューマンパピローマビールス感染症（コンジローマ）

Fifty-seven cases previously diagnosed as either dysplasia or carcinoma in-situ by three Japanese medical centers were reviewed and reclassified as either condyloma, CIN I, II, III or squamous metaplasia. Of 46 cases previously diagnosed as mild or moderate dysplasia (CIN I-CIN II) 13 were reclassified as condylomata. Immunoperoxidase localization of human papilloma virus antigens was negative in 21 cases of CIN and positive in 3 of 5 cases classified as condylomata. The prevalence of human papilloma virus infection in these Japanese women appears to be similar to that reported in other countries including Western Europe and the United States.This work was supported in party by National Institutes of Health Grant No. PO 1AI16959-0