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We retrospectively investigated the clinical outcomes of favipiravir in patients with COVID-19 pneumonia. Patients who between 23 May 2020 and 18 July 2020 received ≥ 24 h of favipiravir were assigned to the favipiravir group, while those who did not formed the non-favipiravir group. The primary outcome was 28-day clinical improvement, defined as two-category improvement from baseline on an 8-point ordinal scale. Propensity scores (PS) for favipiravir therapy were used for 1:1 matching. The unmatched cohort included 1493 patients, of which 51.7% were in the favipiravir group, and 48.3% were not receiving supplemental oxygen at baseline. Significant baseline differences between the two unmatched groups existed, but not between the PS-matched groups (N = 774). After PS-matching, there were no significant differences between the two groups in the proportion with 28-day clinical improvement (93.3% versus 92.8%, P 0.780), or 28-day all-cause mortality (2.1% versus 3.1%, P 0.360). Favipiravir was associated with more viral clearance by day 28 (79.8% versus 64.1%, P

Key Clinical Message Visceral leishmaniasis and hemophagocytic lymphohistiocytosis share many features in common and may coincide in the same patient. Timely diagnosis and management of visceral leishmaniasis could save patients from unnecessary toxic treatment. Abstract Visceral leishmaniasis and hemophagocytic lymphohistiocytosis share many clinical features in common and may coexist in the same patient. Visceral leishmaniasis should be promptly ruled out in patients coming from endemic areas before starting immunosuppressive therapy for hemophagocytic lymphohistiocytosis. The mainstay treatment, in this case, is anti‐leishmania medications preferably liposomal amphotericin‐B.

Background: Candida is a frequent respiratory tract colonizer. True candida pneumonia is rare and seen with predominance in immunosuppressed patients. Our aim is to document a previously unreported case of Candida pneumonia in a young and immunocompetent patient, highlighting, an unusual pathological manifestation of this infection in immunocompetent individuals. Case summary: We report a previously healthy young lady who remained symptomatic with fever, cough and shortness of breath for three weeks duration despite treatment with extensive antibiotics regimen for community acquired pneumonia. She was eventually treated as a probable, rare case of candida pneumonia. The patient demonstrated a dramatic response to single antifungal treatment both clinically and biochemically within the first 24hrs of treatment. Candida albican was isolated on repetitive cultures form the sputum and bronchoalevolar lavage samples. The patient had negative blood cultures. Her HRCT scan revealed bilateral basal air space opacities with peri bronchovascular distribution and centrilobular nodules with branching pattern suggestive of tree in bud predominantly in lower lobes. Her endobronchial biopsies was mostly unremarkable apart from rare non-necrotizing granuloma. Conclusion: Candida can rarely cause clinically significant pneumonia in immunocompetent patients and should be considered in the differential diagnosis of granulomatous lung disease.

Abstract Pulmonary actinomycosis is a rare chronic granulomatous bacterial disease caused by Actinomyces species. Given its nonspecific clinical and radiological manifestations, the diagnosis might be delayed or even missed. Pulmonary actinomycosis mimics tuberculosis, aspergillosis, or malignancy both clinically and radiographically, and it should be considered in patients with chronic lung diseases.

Several articles have demonstrated an association between specific pregnancy-related medical issues and the prevalence of the umbilical coiling index. The objective: to determine the potential impact of the aberrant coiling index of the human umbilical cord on thyroid function content and its potential deleterious effects on infant health. Materials and methods. Umbilical cord samples were taken from 105 practically healthy pregnant women. Umbilical cords were collected immediately after delivery and stored in formalin (10%) based on the type of coil. Umbilical cords were divided into three categories of 35 samples for each experimental group – normocoiled, hypercoiled, and hypocoiled. This division was performed according to the umbilical cord index. Thyroid hormones (thyroid-stimulating hormone – TSH), triiodothyronine – T3 and thyroxine – T4) were determined using the enzyme immunoassay method in maternal venous blood serum and umbilical cord blood. Results. There was no significant difference in the concentration of TSH, T3 and T4 hormones in the blood serum of mothers between the three different study groups (P>0.05). There was also no statistically significant difference (P>0.05) when comparing the levels of TSH and T3 in the umbilical cord in all three study groups. Regarding concentration of T4, the data showed a significant difference in the obtained values (P<0.01) when comparing venous blood samples in normocoiled cords compared to hypercoiled and hypocoiled cords. In addition, comparison of thyroid hormone levels in maternal venous blood and umbilical cord blood demonstrated that in all study groups there was a significant difference (P<0.05) in TSH levels between maternal and umbilical cord blood serum. The concentration of T3 did not differ significantly (P>0.05) in maternal blood serum compared to umbilical cord blood. In the statistical analysis, the levels of T4 in venous blood samples from normocoiled and hypocoiled umbilical cords differ significantly from the level of this hormone in the mother’s blood (P<0.01, P<0.05). There was no significant difference in the concentration of T4 in hypercoiled umbilical cord blood samples (P>0.05) compared to maternal blood serum. Conclusions. The concentration of T4 increases in the fetal circulation with normocoiled umbilical cord, since this form of coiling is the best situation for proper feto-maternal exchange function of this hormone. [ABSTRACT FROM AUTHOR]

The abnormal umbilical cord coiling pattern affects the well-being of the newborn in different ways. Moreover the differentiation of mast cell according to these patterns may also varies. The objective: to investigate the detection and enumeration of mast cells in different patterns in human coiling cords in order to explore their effect on the newborn baby health. Materials and methods. Umbilical cord samples were collected from 105 healthy pregnant women. The cords were collected immediately after labor and kept in formalin (10%), according to coil type. Three major categories of umbilical cord coiling (normocoiled, hypercoiled, and hypocoiled) were determined according to the Umbilical Cord Index (UCI). The histological sections of the umbilical cord were collected according to UCI. This step is followed by using different histological stains, including hematoxylin and eosin and toluidine blue stains. The expression of the CD117 mast cell population in the umbilical cord tissue was determined using the immunohistochemical method in the subamniotic, perivascular and central areas. The enumeration of mast cells was done by direct counting and using Image J software. Results. The comparison of mast cell counts using Image J showed statistically significant variations (P<0.05) between normocoiled and hypercoiled cords in mast cell populations. No significant changes (P>0.05) were found in mast cell counts between normocoiled and hypocoiled umbilical cords. Conclusions. The mast cell distribution interpretation suggested that mechanical coiling during embryonic growth affects mast cell dispersal in sectioned umbilical cords. This interpretation’s functional relevance should be applied to coiling events that do not have harmful outcomes on the fetus. Future research could be done on the distribution of mast cells in the abnormally coiled umbilical cords associated with negative perinatal outcomes. [ABSTRACT FROM AUTHOR]