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We describe the acute deterioration of a 29-year-old undergoing in vitro fertilisation. Late-onset critical ovarian hyperstimulation syndrome triggered a massive pulmonary embolism and subsequent cardiac arrest. While the prognosis was deemed to be poor, the patient made a full recovery. The potential reasons for this are explored.

Immunotherapy with BCG is an effective and widely used treatment for non-muscle-invasive bladder cancer. BCG sepsis is a rare but life-threatening and frequently not a straightforward complication of this treatment; in cases with a high index of suspicion, anti-bacillary treatment should not wait for laboratory confirmation and be instituted immediately. We report a severe case of BCG sepsis, in which timely diagnosis and initiation of antituberculosis agents enabled a full recovery.

We report a case of a woman from Thailand, living in Malta, who was diagnosed with concomitant tuberculosis (TB) and HIV with depleted CD4 count. Her case was further complicated by the formation of a fistula between the mediastinal lymph nodes and the oesophagus, an unusual finding but for which she had many risk factors. The diagnosis was suspected on CT scan of the thorax and confirmed via upper gastrointestinal endoscopy. Following the commencement of both anti-TB and antiretroviral therapy, she suffered a lapse of immune reconstitution inflammatory syndrome but with aggressive medical management eventually made a full recovery without the need for surgical intervention.

The concept of futility in the treatment of individuals with severe and enduring anorexia nervosa remains controversial and has significant legal and ethical considerations. For those who have been unremittingly ill for 8 to 12 years, full recovery, although possible, is unlikely, and alternatives to traditional, active treatment must be explored. The harm reduction model, palliative care, and end-of-life care are explored as meaningful and reasonable treatments for this population. Landmark cases demonstrating the legal and ethical controversy of such treatment are explored.

The recalibration of the sunspot number series, the primary long-term record of the solar cycle, requires the recovery of the entire collection of raw sunspot counts collected by the Zurich Observatory for the production of this index between 1849 and 1980. Here, we report about the major progresses accomplished recently in the construction of this global digital sunspot number database, and we derive global statistics of all the individual observers and professional observatories who provided sunspot data over more than 130 years. First, we can announce the full recovery of long-lost source-data tables covering the last 34 years between 1945 and 1979, and we describe the unique information available in those tables. We then also retrace the evolution of the core observing team in Zurich and of the auxiliary stations. In 1947, we find a major disruption in the composition of both the Zurich team and the international network of auxiliary stations. This sharp transition is unique in the history of the Zurich Observatory and coincides with the main scale-jump found in the original Zurich sunspot number series, the so-called "Waldmeier" jump. This adds key historical evidence explaining why methodological changes introduced progressively in the early $20^{th}$ century could play a role precisely at that time. We conclude on the remaining steps needed to fully complete this new sunspot data resource., Comment: 22 pages, 9 figures

Objective There are limited data regarding the hospital and postdischarge course of novel coronavirus disease 2019 (COVID-19) in newborns. This study aimed to present the data of such cases in newborns. Methods We retrospectively evaluated the predischarge and postdischarge records of newborns followed-up in the neonatal intensive care unit between June 2, 2020, and April 30, 2021 and who had positive polymerase chain reaction (PCR) test for COVID-19. Results Eleven newborns had positive PCR tests for COVID-19 during the study period. The prenatal COVID-19 PCR test of the mothers of the newborns was negative. The cases with a postnatal age of 10 to 60 days according to chronological age were hospitalized due to positive COVID-19 PCR test. Either or both the parents of these cases were severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) PCR positive on nasopharyngeal swab obtained simultaneously. All breast milk samples were negative for COVID-19 virus. The mean D-dimer value of the cases was 3,430 µg FEU/L at the time of hospitalization and 307 µg FEU/L after discharge. None of the cases were given any specific antiviral treatment. The cases were discharged with full recovery. No rehospitalizations or deaths occurred during the 3-month follow-up after discharge. Conclusion In most COVID-19 newborns, the disease was transmitted by infected parents, and the course of the infection was either asymptomatic or associated with only mild symptoms. No complications or deaths were observed during the 3-month follow-up after discharge.

Breast cancer is one of the major causes of death among women worldwide. Efficient diagnosis of breast cancer in the early phases can reduce the associated morbidity and mortality and can provide a higher probability of full recovery. Computer-aided detection systems use computer technologies to detect abnormalities in clinical images which can assist medical professionals in a faster and more accurate diagnosis. In this paper, we propose a modified residual neural network-based method for breast cancer detection using histopathology images. The proposed approach provides good performance over varying magnification factors of 40X, 100X, 200X and 400X. The network obtains an average classification accuracy of 99.75%, precision of 99.18% and recall of 99.37% on BreakHis dataset with 40X magnification factor. The proposed work outperforms the existing methods and delivers state-of-the-art results on the benchmark breast cancer dataset.

Резюме. Відомо, що серед усіх ушкоджень нижніх кінцівок переломи надп’ятково-гомілкового суглоба займають досить значне місце. Мета. Визначити та проаналізувати фактори ризику розвитку ускладнень після хірургічного втручання при переломах кісток гомілково-надп’яткового суглоба. Методи. Аналіз та узагальнення спеціальної науково-методичної літератури вітчизняних і зарубіжних авторів та даних мережі Інтернет. Результати. У ході вивчення та аналізу праць вітчизняних та зарубіжних дослідників було встановлено, що помилки при лікуванні даної патології можуть бути на всіх етапах, починаючи від оперативного втручання і закінчуючи неправильною фізичною терапією, через що і виникають ускладнення. Найбільш поширеною серед ранніх ускладнень є хірургічна інфекція, яка може виникнути через недбалість лікарів або самого пацієнта, серед пізніх ускладнень – контрактура, порушення функції суглоба тощо. Акцентується увага на проблемах пацієнтів, які найбільше схильні до отримання післяопераційних ускладнень, і на тому, як з цим боротися в подальшому. З’ясовано, що ключове місце в успішному лікуванні пацієнтів з переломами кісток надп’ятково- гомілкового суглоба займає фізична терапія. Сучасні підходи до фізичної терапії зводяться до максимально раннього її початку (безпосередньо після травми) і закінчення після повного відновлення функції кінцівки. У разі дотримання цих умов пацієнт може досить швидко почати звичайне для нього побутове і трудове життя. Встановлено, що відсутність повноцінного про-ведення комплексної програми фізичної терапії після переломів кісток надп’ятково-гомілкового суглоба є потужним фактором ризику розвитку ускладнень.Ключові слова: фактори ризику, ускладнення, остеосинтез, гомілково-надп’ятковий суглоб, фізична терапія.

The literature on cases of acute disseminated encephalomyelitis (ADEM) associated with SARS-CoV-2 infection has been rapidly increasing. However, the specific clinical features of ADEM associated with SARS-CoV-2 (SARS-CoV-2-ADEM) have not been previously evaluated. We screened all articles resulting from a search of PubMed and Web of Science databases looking for reports of ADEM published between December 01, 2019, and June 5, 2021. Of the 48 ADEM cases identified from 37 studies, 34 (71%) had ADEM while 14 (29%) were of AHLE. RT-PCR for SARS-CoV-2 was positive in 83% (n = 19) of patients. 26 patients (54%) were male, and 18 patients (38%) were female, with a male to female sex ratio of 1.4:1; median age was 44 (1.4–71) years. 9 patients (19%, 9/48) were children. Of the 9 children patients, their median age was 9 years (range 1.4–13 years), 6 patients (67%) were female, and 2 patients (22%) were male, with a female to male sex ratio of 3:1.39 patients (81%) was performed CSF analysis. PCR for SARS-CoV-2 tested positive in 3 patients (14%, 3/22) on CSF sample. 31 (64%) of patients had a poor outcome on discharge from hospital. Five (10%) patients died in hospital. Compared to classic ADEM, SARS-CoV-2-ADEM have a more longer duration between the onset of the antecedent infective symptoms and the start of ADEM symptoms, the older age distribution of the patients, relatively poor outcome, a lower full recovery rate, a more frequently brain lesions involved the periventricular white matter and corpus callosum, and less frequently affected the deep gray matter. Taken together, the present comprehensive review reveals that although rare, ADEM can be associated with SARS-CoV-2 infection. SARS-CoV-2-ADEM seems to share most features of classic ADEM, with moderate discrepancies from the classical ADEM.

Purpose To quantify the effect on strength of semitendinosus (ST) graft harvest by comparing isokinetic and isometric muscle strength. Methods A cohort of 140 patients underwent anterior cruciate ligament (ACL) reconstruction (ACLR) and were randomized to ipsilateral or contralateral ST graft harvest. Isokinetic and isometric muscle strength testing using a dynamometer were collected for the operated and non-operated leg. Patients were assessed pre-surgery and at 6, 12 and 24 months after reconstruction. Results ST graft harvest reduced isokinetic flexion muscle strength for 6 months. At 12 months follow up there was no significant difference between the two groups and they were all stronger than pre-injury. No other significant differences were found in any primary or secondary outcome measurements. Conclusion Solitary ST graft harvest does not appear to result in a permanent reduced isometric or isokinetic quadriceps muscle strength on the side where the graft is harvested. A reduction in hamstring muscle strength of less than 10% can be seen at short-term follow-up with full recovery by 12 months. Most patients report little or no donor site pain. Given these findings, ST autograft is an alternative graft choice that could be used for various reconstructions in terms of donor site morbidity. Level of evidence Level II.

Objective: Coronavirus disease 2019 (COVID-19) is a new disease entity that appeared in late 2019. In this study, we aimed to determine the prevalence of loss of smell and/or taste among patients who tested positive for COVID-19 and identify demographic and clinical differences between patients with and without anosmia/dysgeusia. Methods: The study was performed in a referral center for COVID-19 in Istanbul, Turkey between the months of April and July 2020. The responses from a set of questions in regard to loss of sense of smell and/or taste were collected. None of these patients were exposed to any further examination or testing related to their senses of smell and/or taste. The data in regard to the patients being tested as well as their demographic information and co-morbidities associated with their condition were collected. Results: Twenty patients (10 male, 10 females, mean age 43.3 years) out of 86 patients (49 male, 37 female, median age 49.5 years), who tested positive for COVID-19, declared a loss of smell and/or taste. Nineteen patients (19/20, 95%) had a full recovery, and one (1/20, 5%) had partial recovery at the end of two weeks. Conclusion: Our results indicate that 23.3% of patients who tested positive with reverse transcription-polymerase chain reaction testing for COVID-19 had loss of sense of smell to a certain extent.

Intrauterine limb ischaemia is a rare condition that may have devastating results. Various treatments are reported in the literature; however, results are not always promising and amputations may be required for some patients. Post-natal hyperbaric oxygen treatment (HBOT) may be a useful treatment option for the salvage of affected limbs. A patient who was born with total brachial artery occlusion and severe limb ischaemia was referred for HBOT. The patient underwent the first HBOT session at her 48th hour of life. A total of 47 HBOT sessions were completed (243.1 kPa [2.4 atmospheres absolute], duration 115 minutes being: 15 minutes of compression; three 25-minute oxygen periods separated by five-minute air breaks; and 15 minutes of decompression), four in the first 24 hours. Full recovery was achieved with this intense HBOT schedule combined with anticoagulation, fasciotomy and supportive care. The new-born tolerated HBOT well and no complications or side effects occurred. To the best of our knowledge, our patient is one of the youngest patients reported to undergo HBOT.

Purpose This paper aims to introduce Seikatsu Rinsho, a values-based approach to supporting recovery based on identifying service user values and aspirations that have been developed since 1958 in Japan where mental health services are still hospital-based and user involvement is not well-developed. This paper believes this will be of great implications for future practices around the world. Design/methodology/approach Hope is essential to recovery and that hope is dependent on identifying what service users really want for themselves (aspirations) and then ensuring that these are communicated to – and supported by – professionals and carers. This is achieved through examining the life events, which are likely to trigger relapse for a specific individual, the important choices that the person has made throughout his/her life course and the reasons behind them. Through a process of “co-production”, an attempt is made to understand the values expressed in these choices in the context of family history over several generations. Findings The attempt to examine both life events throughout the life course and family history over generations was found to be an effective way to understand a service user and his/her family and then support recovery. The cases where even people with severe and persistent mental health problems have successfully achieved full recovery have been accumulated. Research limitations/implications The limitations of the approach in the context of Japanese mental health services, and the necessity of additional evidence are acknowledged and some thoughts shall be given to future development. Originality/value Seikatsu Rinsho approach can provide a new angle to understand service users and family and a new way to support recovery.

Endogenous endophthalmitis (EE) is an ophthalmological emergency. We report the long-term outcome of bilateral methicillin-resistant Staphylococcus aureus EE in a 23-year-old healthy immunocompetent athlete who presented with EE secondary to pelvic abscess and remained with excellent vision.

In the long-term phases, clear risk communication in the post-Fukushima era is necessary and significant. It is the most urgent in this post-accident phase is for residents to access to all the information available within the scope of current knowledge in order to support their life decisions. For full recovery, authorities, specialists, international organizations, media, and the public will need to work together. The speed of innovation in risk communication should catch up to the development speed of the internet. Long-term communication will be necessary. Learning about the Fukushima nuclear accident experience is essential for the prevention and risk communication of possible accidents in the future.

Background Homeopathy has had documented success treating epidemics in the last two centuries. We aimed to obtain a clear homeopathic clinical picture of coronavirus disease 2019 (COVID-19) and postulate the genus epidemicus of the disease in order to inform and enhance future treatment and prophylaxis options. Methods We conducted a prospective case series study, collecting data from 19 homeopaths in Catalonia, Spain, from patients who presented with fever and/or cough and/or breathlessness and/or confirmed COVID-19 infection or close contact with a confirmed case. We included 107 patients, and data were recorded through a checklist questionnaire on the day of the case analysis and at day 10–15 after commencing treatment. Symptoms were collected and analyzed with the help of homeopathic repertories. Results A total of 103 cases were mild or moderate; four were severe. The severe cases were excluded from the analysis and the 103 mild and moderate cases were analyzed and a clear overall clinical picture with mental, general, and particular symptoms was achieved. Eighty-eight cases had a complete recorded follow-up. The most prescribed medicines were Bry, Ars, Phos and Gels, whilst those with the best rates of good response were Sulph, Puls and Bry. Time to full recovery after homeopathic treatment ranged from 3.5 to 14.4 days, depending on the medicine used. The potency 200c was associated with faster rates of full recovery and a lesser need to change remedy. Conclusion We have defined the symptomatic homeopathic characteristics of mild and moderate COVID-19 in Spain and established a set of medicines that might be useful to consider as effective genus epidemicus.

The COVID-19 pandemic of 2020 led to a widespread lockdown that restricted human activities, particularly land, air, and maritime traffic. The “quietness” on land and ocean that followed presents an opportunity to measure an unprecedented reduction in human-related seismic activities and study its effect on the short-period range of ambient noise cross-correlation functions (NCFs). We document the variations in seismic power levels and signal quality of short-period NCFs measured by four seismographs located near Canadian cities across the pandemic-defined timeline. Significant drops in seismic power levels are observed at all the locations around mid-March. These drops coincide with lockdown announcements by the various Canadian provinces where the stations are located. Mean seismic power reductions of ∼24% and ∼17% are observed near Montreal and Ottawa, respectively, in eastern Canada. Similar reductions of ∼27% and 17% are recorded in western Canada near Victoria and Sidney, respectively. None of the locations show full recovery in seismic power back to the pre-lockdown levels by the end of June, when the provinces moved into gradual reopening. The overall levels of seismic noise during lockdown are a factor of 5–10 lower at our study locations in western Canada, relative to the east. Signal quality of NCF measured in the secondary microseism frequency band for the station pair in western Canada is maximum before lockdown (late February–early March), minimum during lockdown (mid–late March), and increased to intermediate levels in the reopening phase (late May). A similar pattern is observed for the signal quality of the eastern Canada station pair, except for a jump in levels at similar periods during the lockdown phase. The signal quality of NCF within the secondary microseism band is further shown to be the lowest for the western Canada station pair during the 2020 lockdown phase, when compared with similar time windows in 2018 and 2019.

This case demonstrates the challenges encountered in a case of Neuroleptic Malignant Syndrome in a young woman with moderate Intellectual Disability.

Rationale: Acinic cell carcinoma (ACC) is a rare and indolent malignancy commonly found in the parotid gland. This can give rise to paraneoplastic syndromes, which represent the clinical manifestations of indirect and remote events produced by tumour metabolites. Patient Concerns: A 38-year-old Afro-Caribbean female suffered an indolent parotid mass. She only presented to our tertiary center when it started to ulcerate and bleed. Diagnosis: She was diagnosed with advanced parotid ACC. She also went on to develop an hematological paraneoplastic syndrome resulting in venous thrombi. This was complicated by her developing heparin-induced thrombocytopenia (HIT). Treatment: A difficult multidisciplinary decision was made to proceed with surgery despite her extremely poor condition. Outcomes: After the surgery, the patient made a full recovery. Take-away Lessons: ACC is a relatively uncommon and indolent malignancy that is usually found in the parotid gland. It can be associated with a hematological paraneoplastic syndrome and further complicated by iatrogenic HIT.

The widespread introduction of the destructive methods of treatment into the clinical practice of dermatovenerologists is caused by the significant spread of benign skin and mucous neoplasms. At the same time, any effect on the skin — chemical, physical or mechanical — causes damage. Thus, patients using these procedures need proper care for damaged skin and mucous membranes to prevent secondary infection and scaring. Disruption of the epidermal barrier after removal of benign skin neoplasms, carrying out biopsy and chemical peels always requires application of topical agents promoting full recovery of the epidermis. In addition, many skin diseases are accompanied by inflammatory reactions, which are complicated by secondary infection. The use of drugs with anti­inflammatory and reparative properties reduces the duration of treatment and promotes skin recovery.Objective — to evaluate the clinical efficacy and tolerability of using Topicream soothing cream CICA after derma­tocosmetological procedures on the skin and mucous membranes and to investigate the efficacy of its use at various skin and mucous membranes diseases including children.Materials and methods. The study included 57 patients aged 1 to 75 years with various skin diseases, benign skin and mucosal neoplasms, after punch biopsy and cosmetology procedures. Topical application of the Topicream soothing cream CICA on the damaged skin and mucosal areas was recommended to all participants of the study twice a day. Results and discussion. The use of the regenerating cream after dermatological treatment of benign skin neoplasms with apparatus methods, chemical peelings and punch biopsy, as well as the auxiliary treatment of skin diseases such as cheilitis, herpes, perianal fissure, allergic contact dermatitis (including in children) localized in folds and on the face, contributes to a significant reduction in signs of inflammation and subjective sensations, as well as rapid healing of the affected skin surface. At the same time, there is a good tolerance and the absence of side effects of Topicream soothing cream CICA, which allows it to be widely used in clinical dermatovenerology, gynecology and pediatrics.Conclusions. High efficiency and safety of Topicream soothing cream CICA allow its widespread use in clinical practice of dermatovenerologists, gynecologists and pediatricians.

Background Perampanel (PER) is a novel antiepileptic drug (AED) which employs a completely different mechanism of action compared to existing medications. Overall, PER is considered to be safe up to a dose of 12 mg per day. When used to treat refractory and super-refractory status epilepticus, PER seems to be extremely well tolerated; this is true even when used at doses of up to 32 mg. There are currently only three case reports on the effects of acute PER overdose in epilepsy patients. Case presentation We report a 16-year-old Thai woman with a low body weight, who took PER at a dose of 40 times that of the prescribed daily dose. She experienced only an alteration of consciousness, without any systemic medical effects, and made a full recovery within 3 days without gastric lavage or specific treatment. Conclusion Our report demonstrates that an acute PER overdose may not produce serious adverse systemic effects. Individuals with adverse central nervous system (CNS) effects, such as altered consciousness, can experience a rapid recovery.

Neurological disorders in cats require careful and considered nursing to increase the possibility of a full recovery. Nurses and clinicians are often daunted by nursing cats due to their specific b...

Isolated mononeuropathies are uncommon complications after shoulder dislocations. Of these, injuries to the radial nerve are the rarest. Here, we present a case of an isolated radial nerve palsy after a collegiate athlete was hit during a football game and sustained a glenohumeral dislocation. After reduction of the shoulder, he went on to full recovery of motor and sensory function of the radial nerve 1 year after the injury. This case report is further unique given the long-term follow-up in a young, active patient. We review the sparse literature behind the epidemiology and management of these complications.

Thromboinflammation is a still not well-understood phenomenon, which has recently come to the foreground as a function of its relevance in the pathophysiology of coronavirus disease 2019 (COVID-19). The patient described in the present case report exhibited acute fever, giant urticaria, elevated acute phase reactants, and very high d-dimer levels, thus characterizing thromboinflammation. She was diagnosed as a COVID-19 suspect case, which was not confirmed; urticarial vasculitis was ruled out. Homeopathic treatment was started with the earliest clinical manifestations, resulting in rapid and drastic reduction of inflammation and hypercoagulability within the first 12 hours, and full recovery on 10-day follow-up assessment. This case demonstrates the effectiveness of homeopathy in a severe acute disorder, and points to the need to include laboratory testing in homeopathic clinical assessment to achieve an accurate picture of disease, and to avoid the risk of passing over life-threatening disorders.

Pyogenic flexor tenosynovitis (PFT) is an aggressive infection of the flexor tendon sheath, requiring prompt intervention to minimize adverse outcomes. The diagnosis of pediatric PFT is often delayed due to the variable presence of Kanavel’s signs in children and communication difficulties. A 9-month-old male presented to the emergency department with one of four Kanavel signs. The diagnosis of PFT was delayed until ultrasound was used to identify a fluid collection within the flexor tendon sheath. He was successfully treated with surgical debridement and antibiotic therapy, achieving full recovery by 6-month follow-up. This represents the youngest reported case of PFT. Difficulties with communication and physical exam as well as the variability of Kanavel’s signs in young children can delay the diagnosis of pediatric PFT. Ultrasound can be a useful adjunct when clinical history and exam are equivocal, especially in children who present prior to language acquisition.

Depression is a disorder of the body as much as of the mind. The traditional understanding of pain and depression as separate conditions with overlapping symptoms has evolved through research into an understanding that pain and depression share pathophysiological mechanisms. These shared pathophysiological mechanisms include origins, mechanisms and neurotransmitters, resulting in shared treatments. In addition, pain and depression have a reciprocal relationship in that each heightens the severity of the other. Failure to eliminate the pain symptoms reduces the chances of full recovery from depression: it keeps depressed people from regaining full function in the personal and professional lives, and it raises the danger of suicide. Furthermore, the presence of a depressed mood increases the perception of the severity of, and contributes to distress associated with pain.

Background: An ongoing challenge in sports-related concussion (SRC) is determining full recovery. This study examines performance metrics in baseball after an SRC and provides a template for assessment of return-to-performance parameters. Purpose: To determine whether batting performance returns to baseline after an SRC. Study Design: Descriptive epidemiological study. Methods: Participants were all Major League Baseball (MLB) position players with confirmed SRCs that occurred during the 2011-2015 seasons. A retrospective review and assessment of performance metrics before and after injury were conducted as defined relative to the number of plate appearances (PAs) to yield reliable performance statistics. Seven batting metrics were considered as outcomes in longitudinal regressions: batting average, on-base percentage, slugging percentage, on-base plus slugging, bases on balls, strikeouts, and home runs. Metrics were calculated for each player 60, 30, and 14 days before their SRCs, as well as for the 14, 30, and 60 days after returning to play. Other variables controlled for included defensive position, player age at the time of SRC, number of days missed, mechanism of injury, whether the player completed a rehabilitation stint, and year in which the mild traumatic brain injury (MTBI) occurred (2011-2015). Results: A total of 77 MTBI case events occurred in MLB position players over 5 seasons. These injuries resulted in a mean 11.4 days lost to injury. For all performance metrics using 60 or 30 days before MTBI as baseline, no statistically significant differences were found in batting performance. In total, 63 events met PA criteria before injury. Varying the PA cutoff thresholds to be more inclusive or more restrictive yielded similar regression results. For the 48 events that met PA criteria before and after injury, most performance metrics showed no significant performance change after MTBI and, in some events, a slight though mostly nonsignificant performance improvement after MTBI. Conclusions: MLB position players who are medically cleared to return to play after an SRC perform at the same offensive performance levels as their preinjury statistics when an adequate number of PAs is used to compare performance before and after injury.

Background: Slowed language production and comprehension in people with aphasia (PWA) is frequently cited as a characteristic of the disorder, even after full recovery. However, results supporting ...

This case series highlights rare reversible neurological complications encountered in two children who presented with diabetic ketoacidosis (DKA) and were critically ill. The first child was a 5-month-old baby with transient neonatal diabetes who had prolonged coma, atypical findings of diffusion restriction on neuroimaging and later quadriplegia due to rhabdomyolysis when he presented with DKA. The second child was a 16-year-old boy with classical type 1 diabetes mellitus who developed quadriplegia due to rhabdomyolysis and polyneuromyopathy. Both the children were critically ill with hemodynamic compromise, renal impairment and dyselectrolytemia. Both had full recovery on follow-up at the end of 1 month and 10 months, respectively. The severity of DKA at presentation with altered sensorium and/or hemodynamic compromise with renal involvement and dyselectrolytemia and a coexistent infection may have more propensity for such complications. Strict implementation of DKA management guidelines and a multidisciplinary approach to deal with the critically ill child is needed to optimize the outcome in such situations.

Differences in the excitability of motor generating neural pathways are reported following anterior cruciate ligament reconstruction (ACLR) that is associated with quadriceps dysfunction and theorized to prevent the full recovery of muscle function. The aims of this systematic review and meta-analysis were to compare quadriceps neural excitability between the involved ACLR limb, the uninvolved limb, and uninjured controls, and to determine at what time intervals these differences are present after surgery. We conducted a search of PubMed, SPORTDiscus, Embase, and Web of Science, and extracted measures assessing difference of quadriceps spinal-reflexive, corticospinal, and intracortical excitability from studies that compared (1) involved limb to the uninvolved limb, (2) involved limb to a control limb, or (3) uninvolved limb to a control limb. We stratified time at 24 months, since this represents a period of heightened risk for reinjury. A modified Downs and Black checklist and Egger’s test were used to determine the methodological quality of individual studies and risk of bias between studies. Fourteen studies comprising 611 participants (371 individuals with a history of ACLR; median time from surgery: 31.5 months; range 0.5–221.1 months) were included in the review. Overall, the involved (g = 0.60, 95% CI [0.24, 0.96]) and uninvolved (g = 0.49, 95% CI [0.00, 0.98]) limbs exhibited greater motor threshold (MT) in comparison to uninjured controls. Motor-evoked potential (MEP) amplitudes were greater in the uninvolved limb in comparison to uninjured controls (g = 0.31, 95% CI [0.03, 0.59]). Lesser intracortical inhibition was exhibited in the uninvolved limb compared to uninjured controls (g = 0.54, 95% CI [0.14, 0.93]). When stratified by time from surgery, MEP amplitudes were greater in the uninvolved limb compared to uninjured controls (g = 0.33, 95% CI [0.03, 0.63]) within the first 24 months after surgery. When evaluated more than 24 months after surgery, the involved limb exhibited greater Hoffmann reflex (H-reflex) compared to uninjured controls (g = 0.38, 95% CI [0.00, 0.77]). MT were greater in the involved limb (g = 0.93, 95% CI [− 0.01, 1.88]) and uninvolved limb (g = 0.57, 95% CI [0.13, 1.02]) compared to uninjured controls. MEP amplitudes in the involved limb were lesser compared to uninjured controls when evaluated more than 24 months after ACLR (g = -1.11, 95% CI [− 2.03, − 0.20]). The available evidence supports that there are neural excitability differences within the corticospinal tract in individuals with ACLR when compared to uninjured controls. Future research should focus further on longitudinal assessments of neural excitability prior to and following ACLR. Identifying interventions aimed to facilitate corticospinal excitability after ACLR appears to be warranted to improve quadriceps function. Registered through PROSPERO CRD42020158714.

Background Three infants with different risk factors, behavioral and physiologic audiometric histories, and diagnoses were fit with amplification between 3 and 8 months of age. Two of the three met criteria for cochlear implantation. Purpose This article aims to heighten awareness of the rare possibility of recovery from sensorineural hearing loss in infants with varying histories and emphasize the importance of a full diagnostic test battery in all infants diagnosed with sensorineural hearing loss every 3 months until objective and subjective thresholds are stable to ensure appropriate intervention. Research Design Case reports. Results All three infants demonstrated improvement or full recovery of hearing and cochlear function by approximately 12 months old. Their change in hearing was discovered due to frequent follow-up and/or caregiver report. One of these infants was tentatively scheduled to have cochlear implant surgery 2 months later. Conclusion Appropriate early intervention for infants with hearing loss is critical to ensure maximum accessibility to speech and language cues. The Federal Drug Administration approves cochlear implantation in infants as young as 12 months. When providing audiometric management of infants with sensorineural hearing loss, it is imperative to conduct a full diagnostic test battery every 3 months (including tympanometric, acoustic reflex, and otoacoustic emission measurement) until objective and subjective thresholds are stable. There was no apparent pattern of factors to predict that the infants highlighted in these cases would recover. Discussion among pediatric audiologists and otologists and comparison of data from clinics across the U.S. is needed to identify predictive patterns and determine appropriate, consistent monitoring of infants with sensorineural hearing loss.

The adaptive immune system, regulated by CD4 T cells, is essential for control of many viral infections. Endemic coronavirus infections generally occur as short-term upper respiratory tract infections which in many cases appear to be cleared before adaptive immunity is fully involved, since adaptive immunity takes approximately 1.5–2 weeks to ramp up the response to a primary infection, or approximately 1 week for a recurrent infection. However, the adaptive immune response to SARS-CoV-2 infection will be critical to full recovery with minimal long-lasting effects, and to either prevention of recurrence of infection or at least reduced severity of symptoms. The detailed kinetics of this infection versus the dynamics of the immune response, including in vaccinated individuals, will largely determine these outcomes.

Coronavirus disease 19 (COVID-19) poses the greatest public health threat in 100 years, with cases rising rapidly in many countries around the world. We report a case of a 78-year-old female who exhibited a biphasic course of COVID-19; showing initial clinical improvement followed by deterioration before making a full recovery. The patient was managed with prolonged continuous positive airway pressure (CPAP) and supportive care. In total, 24 days of treatment with CPAP was administered. We emphasize the role of CPAP in the management of severely hypoxemic patients who are inappropriate for mechanical ventilation and describe the role of adequate nutrition and hydration for such patients.

Aiming at providing a new solution for processing and recycling PET, the complete solubilization of PET from water bottles in natural eutectic solvents is demonstrated here as well as its full recovery, while retaining PET properties and recycling the eutectic solvent.

In 1921, at the age of 65, 6 years after completing the final edition of his textbook, 22 years after first proposing the concept of dementia praecox (DP), and 1 year before retiring from clinical work, Emil Kraepelin completed the last edition of his “Introduction to Clinical Psychiatry,” which contained a mini-textbook for students, 10 pages of which were devoted to DP. This work also included a series of new detailed case histories, 3 of which examined DP. This neglected text represents a distillation of what Kraepelin judged, near the end of his long career, to be the essential features of DP. The relevant text and case histories are translated into English for the first time. Kraepelin did not define DP solely by its chronic course and poor prognosis, acknowledging that remissions and even full recovery might be possible. His clinical description emphasized the frequency of bizarre delusions and passivity symptoms. He recognized the heterogeneity of the clinical presentations, outlining 6 subtypes of DP, including dementia simplex, depressive and stuporous dementia, and an agitated and circular DP. Kraepelin’s original concept of DP was not impervious to change and expanded somewhat, especially with the inclusion of Diem’s concept of simple DP. He also reviews several contributions of Bleuler, including his concept “latent schizophrenia.” He writes poignantly of the psychological consequences of DP. His 3 DP cases, for advanced students, included simple DP, “periodic catatonic,” and “speech confusion.”

Summary The study presents the outcomes from platelet-rich plasma (PRP) application in treating acute and potentially problematic skin wounds from 2009 to 2016. Fifty-six hospitalized patients with acute skin wounds were divided into two groups: an experimental group of 30 patients treated with platelet-rich plasma and 26 controls with similar wounds, treated by conventional methods. After platelet-rich plasma treatment of 30 acute and potentially problematic wounds in the Experimental Group patients, 29 (96.7%) of the wounds healed for 16 weeks on average. After applying conventional treatment with surgical wound debridement, of the 26 acute, potentially problematic wounds in the controls, only 2 (7.6%) healed. Since acute and potentially problematic wounds are very likely to become chronic and difficult to heal, we recommend PRP application as a preventive treatment in patients at risk.