Introduction: Elderly patients with ASD often present with chronic atrial fibrillation and large left to right shunt. This study reports the experience of left atrial appendage (LAA) and atrial septal defect (ASD) closure in patients with significant ASD and chronic atrial fibrillation. Methods / Results: We report six consecutive elderly patients with chronic atrial fibrillation and significant ASD who underwent LAA and fenestrated ASD closure from 1 January 2014 until 31 December 2019. All periprocedural and long term (>1 year) outcomes were reported. Six patients (Male: 33.3%; Mean age: 66.8±3.3 years) were included. Mean CHADS2, CHA2DS2-VASc¬ and HAS-BLED scores were 2.33±0.82, 3.83±0.75 and 1.83±0.75. Four patients underwent simultaneous procedure while 2 patients underwent a staged procedure. Procedural success was achieved in all patients. Total occlusion was achieved during LAA occlusion without device embolization prior to ASD closure. Patients who underwent simultaneous procedure had a shorter total hospital stay and lower total hospital stay. During a follow-up period of 32.8±19.4 months, both the devices were well seated. No device-related thrombosis or erosion reported. All patients remained in atrial fibrillation. No patients experienced any thromboembolic stroke or transient ischemic attack. Conclusion: LAA and ASD closure is feasible and can be safely performed in the same seating in elderly patients with a significant atrial septal defect.

Introduction: Severely ill inpatients with SARS-CoV-2 infection, Coronavirus Disease 2019 (COVID-19) require close electrocardiographic (ECG) monitoring due to frequent cardiac involvement of the disease and cardiovascular side effects of therapies. This study aimed to compare ECG parameters measured from conventional 12-lead ECGs to those from a telemetry-generated 7-lead or single lead ECG to determine if the latter may be an alternative for screening and monitoring patients, particularly during a pandemic. Methods and Results: We identified 33 patients with respiratory failure due to COVID-19 undergoing telemetry monitoring in the intensive care unit. Each received a 12-lead ECG utilizing standard lead placement. A concurrent 7-lead ECG and single lead (lead II) tracing were obtained using the central telemetry system. Each ECG was interpreted and intervals manually measured by 2 cardiologists with disagreements adjudicated by a third. Compared to the 12-lead ECG measurement, the 7-lead ECG underestimated the corrected QT by on average 13.45±32.05 msec, and the single lead ECG underestimated corrected QT by 19.62±33.19 msec (Bazett, p < 0.05). Bland Altman analysis also demonstrated evidence of a positive bias, suggesting that the telemetry-derived tracings underestimated the QT interval. The presence of T wave abnormalities and ST segment changes were overestimated by the telemetry-derived tracings as compared to standard ECGs. Conclusion: Though telemetry-derived ECGs may be useful in screening patients for significant ECG abnormalities, they likely do not represent a reliable replacement of the standard 12-lead ECG in the routine diagnosis and management of critically ill patients.

We are facing a new challenge: will imaging be the resolutive tool or will new mapping catheters and mapping system together with mathematical simulation solve this rebus? Clinical imaging will always remain attractive, particularly for elective cases and may add decisive information to best plan an ablation strategy: it represents a great tool in the hands of the electrophysiologist; however, as electrophysiologists, the imaging we should pursue is electrical – the depiction of the entire reentry circuit remains the sole proof of the target to ablate.

Biatrial macro-reentrant tachycardia (Bi-MAT) is a relatively uncommon arrhythmia. Sometimes, it can be produced by the left atrial (LA) anterior or septal-anterior linear ablation. However, data concerning the proarrhythmic role of this ablation lesions are lacking. Here, we reported a case of a single-loop Bi-MAT developing after the LA anterior ablation line performed in one patient with persistent atrial fibrillation.

Introduction: Surface ECG is a useful tool to guide mapping of focal atrial tachycardia (AT).We thought to construct an algorithm, based on paced P wave templates from different anatomical sites in both atria in patients with normal hearts. Methods: We prospectively enrolled consecutive patients who underwent electrophysiology study, having no heart disease. Atrial pacing was carried out at different anatomical sites in both atria. Paced P wave morphology (PWM) and duration (PWD) were assessed. P wave morphology was classified into: positive, negative, biphasic (+/- or -/+) and isoelectric. A proposed algorithm was generated from the constructed templates of each pacing site. Results: Sixty-four patients (25 males) were enrolled. Mean age was 37 ± 13 years. Atrial pacing was performed in 61 patients (95%) at the right atrium and in 15 patients (23%) at the left atrium. A neg/iso P wave in V1, a pos/iso P wave in AVL and lead I identified right atrial pacing sites (p=0.01, p=0.02 and p=0.02, respectively). Negative P wave in lead aVL identified left pulmonary veins when compared to right pulmonary veins (P=0.03). PWD was significantly longer when pacing from lateral tricuspid annulus (TA) as compared to medial TA (136 ± 12ms vs. 99 ± 10 ms , P=<0.001) and when pacing from the left superior pulmonary vein as compared to the right superior pulmonary vein (152 ± 12 ms vs. 135± 10 ms, (P=0.001). Conclusions: PWM and PWD derived from templates generated through atrial pacemapping could be used to guide localization of focal AT.

The first SARS-CoV-2 pandemic has affected most countries causing hundreds of thousands of deaths. Evolution of the pandemic may involve endemicity with or without significant secondary waves. We observed that disease severity (p=0.006) and duration of symptoms (p<0.001) declined over time in an isolated rural community. This decline was not driven by changes in patient age structure nor by changes in temperature or precipitations. The underlying mechanism may be relevant for COVID-19 management.

Introduction: Cystic Fibrosis (CF) is a genetic disease with progressive lung disease, malnutrition, liver disease and CF-related diabetes (1). Viral infections are a major factor causing pulmonary exacerbations in CF (2). COVID-19 has caused a worldwide pandemic with high death rates. As science suggests, patients with CF would be severely affected with a high rate of morbidity, hospitalization and mortality. In a recent study published by Cosgriff et al. (3) people with CF who were 15 years and older, infected with COVID-19 appear to have better outcomes than initially anticipated. We report the only two cases of CF in literature less than 15 years of age with better than expected outcomes post COVID-19 infection and discuss the possible effects of hypertonic Saline as a plausible explanation.

Abstract Purpose To distinguish healthy infants from potential lung disease patients immediately after birth using lung ultrasound (LUS). Design, Setting and Patients This is a nested case-control study containing 22 lung disease patients and 473 healthy infants from a total of 504 consecutive infants. The infants were admitted to the Obstetrics & Gynecology Hospital of Fudan University, Shanghai, China, from 1 January 2020 to 1 April 2020. A newly designed scanning protocol was used to capture LUS images. The sensitivity, specificity, PPV and NPV for predicting healthy infants and patients were calculated individually. The transition process image patterns and their variations are shown. The relationship between clinical signs and high-risk image patterns was calculated by Kendall’s tau-b test. Measurements and main results LUS images were captured, and their predictive value was calculated. Four low-risk patterns could typically be seen only in healthy infants (specificity=86.4%, PPV=99.0%), whereas four high-risk patterns could be seen in both healthy infants and patients (specificity=62.4%, PPV=9.6%). High-risk patterns were more likely to be pathological signs when appearing at the oxter and lower back and physiological signs when appearing at the prothorax. These high-risk patterns are significantly related to clinical signs. All these patterns are consistent during the first 6 hours after birth. Conclusions LUS is a valid modality for differentiating healthy infants from potential patients with mild respiratory difficulty. Four low-risk patterns had high value in predicting healthy infants, but four high-risk patterns were not specific enough to discover lung disease patients.

Adolescent athletes are a particular group requiring special medical attention. Recent literature outlines the growing problem of physical inactivity among young people, exploring various dimensions that may explain lack of physical activity, and potentially relevant interventions and strategies. There is growing evidence that physical inactivity predisposes to the development of asthma. Exercise is one of the most common factors triggering cough, dyspnea, and breathing difficulties in otherwise healthy children. This condition is called exercise-induced bronchoconstriction (EIB). Symptoms of EIB include cough, wheezes, chest tightness, and dyspnea during or after physical education lessons. The number of adolescents suffering from EIB is underestimated and many athletes remain undiagnosed and untreated. In this article we argue that complexity of diagnosing EIB is greater for adolescent athletes than it is for adults. The purpose of this review is to draw the attention of the medical community to the problem of EIB and asthma symptoms among adolescent athletes. We performed a meta-analysis of these two topics, consulting PubMed and ClinicalKey for the terms: “adolescent athletes”, “exercise-induced bronchoconstriction” and “asthma in adolescent athletes”. After analysis of the relevant scientific data, the most important facts and issues related to the study group were listed.

Obesity, hypertension, diabetes, and specific ethnicities (Black and Hispanic) have been reported to be common comorbidities and possible risk factors for the severity of both COVID-19 and H1N1 influenza infections. Thus, it is important to understand why these four risk factors are common to both COVID-19 and H1N1 influenza infections, and whether a common mechanism exists. Respiratory failure is the most important pathology that contributes to the severity of both COVID-19 and H1N1 influenza infections. Additionally, obesity has been reported to be a risk factor for the development of acute respiratory distress syndrome (ARDS), which is a serious clinical manifestation of both COVID-19 and H1N1 infections. Obesity is a risk factor for hypertension. All studies found in the search showing hypertension as a risk factor for the severity of COVID-19 and H1N1 infections were either not based on multiple logistic regression analyses or did not include obesity or BMI as an explanatory variable in their multiple logistic regression models Moreover, similar attention is needed when specifying patients with diabetes or of specific ethnicities (Black and Hispanic) as potentially more vulnerable to either infection, because obesity also correlates with diabetes, and is more prevalent in these ethnicities. Notably, a retrospective cohort study has shown that obesity or high BMI are predictive risk factors for severe COVID-19 outcomes, independent of age, diabetes, and hypertension. Associations between hypertension, diabetes, ethnicities and severity of COVID-19 and H1N1 infections may be confounded by obesity to a considerable extent.

Purpose: To investigate the clinical features and temporal changes of RT-PCR and CT in COVID-19 pediatric patients. Methods: Clinical, RT-PCR and CT features of 114 COVID-19 pediatric inpatients were retrospectively reviewed from January 21st to March 14th 2020. All patients had chest CT on admission and were identified as positive pharyngeal swab nucleic acid test. Clinical features were analyzed, as well as the features and temporal changes of RT-PCR and CT. Results: Fever (62, 54%) and cough (61, 54%) were the most common symptoms. There were 34 (30%) cases of concurrent infections. The most common imaging features on CT were ground-glass opacities (46, 40%) and consolidation (46, 40%). The bilateral lower lobes were the most common pattern of involvement, with 63 cases (55%) involving 1-2 lobes, and in 32 (28%) cases CT was normal. Through the whole duration of COVID-19 in children, the diagnostic positive rate of RT-PCR has been far higher than that of CT (All P＜·05). For RT-PCR follow-up, reliable negative results were obtained only 7 days after the onset of symptoms. Though Lung involvement on chest CT progressed rapidly in several cases, lung involvement in children with COVID-19 is mild, with a median value of 2 on CT score. Conclusion: RT-PCR is more reliable than CT in initial diagnosis of pediatric patients with COVID-19. On follow up, reliable RT-PCR results are available 7 days after initial symptoms. Only if necessary, CT could be used for follow-up.

Long isolation period for suspected child cases was proposed based in one case. New evidence suggests that children are not as dangerous as they seemed, as a vehicle for this infection. We must cautious when making recommendations for a disease that affects millions of people, based on just one case.

To the editor,Dermographism is a secondary temporal linear cutaneous wheal after scratching, stroking, or rubbing the skin. The prevalence of dermographism was estimated as 4%-5% in general population1, with a higher prevalence of 24% in the pediatric population2. From previous reports, dermographism was associated with drug-induced urticaria3, hypereosinophilic syndrome4, and endocrinopathies. However, the above data were mainly derived from case reports or case-control studies of western countries. Moreover, Bolognia et al proposed that dermographism was not related to the atopy, food allergy, autoimmunity diseases5.We conducted a population-based cross-sectional study in China. The first-year college students in three universities of China who consented to participate underwent health examination and an online questionnaire survey. Diagnosis of skin diseases and inquiry of disease history were performed by dermatologists during the health examination. Dermographism was induced by a scratching test and evaluated by a dermatologist. Annual household income and parents’ educational level were determined by a self-reported questionnaire that included six given categories. Itch and pain of the skin were measured by the numeric rating scales. Sleep quality was measured by the Pittsburgh Sleep Quality Index. Symptoms of depression and anxiety were measured by the 2-item Patient Health Questionnaire and Generalized Anxiety Disorder Scale-2, respectively. Mixed logistic models were used to estimate the associations in terms of odds ratios (OR), including crude and adjusted ORs and 95% uncertainty intervals. The effect sizes were adjusted for the individual-level covariates (sex and socioeconomic indicator) and the random effects of sampling units (university). Statistical analyses were performed with SAS 9.4 (SAS Inc., Cary, USA).P <0.05 was considered statistically significant.A total of 16,167 college students was newly enrolled in three universities located in Changsha, Xiamen, and Hohhot, respectively, in 2018. Among them, 12,127 (response rate 75%) completed the questionnaire survey and health examination and were finally analyzed. The mean age of the participants was 18.3±0.8 years, and 52.7% were women. The point prevalence of dermographism was 15.6%, with no sex difference. The prevalence of grade 2–3 dermographism was 1.43%. As shown in Table 1, the prevalence of dermographism was positively associated with socioeconomic status indicators (trend P <0.001). Dermographism was significantly associated with a series of skin comorbidities (Table 2), including atopic dermatitis (adjusted OR=1.39, P =0.008), chronic urticaria (OR=2.56, P <0.001), acne vulgaris (OR=1.29,P <0.001), and warts (OR=2.07, P =0.012). In contrast, dermographism was not significantly associated with a self-reported history of asthma or allergic rhinitis or other diagnosed skin disorders. Regarding other patient-reported outcomes (Table 2), dermographism was only significantly associated with itch (OR=1.20, P =0.005).The high prevalence suggests that dermatologists should not neglect to test relevant patients for dermographism in order to avoid misdiagnosis, especially in patients of younger age and with comorbid conditions such as atopic dermatitis and symptoms of itch. The significant correlation between dermographism and socioeconomic status indicators may be attributable to urbanization, air pollution, and changes in dietary habits. In conclusion, dermographism affects a substantial proportion of Chinese young adults, and is associated with higher socioeconomic status, comorbidities, and symptoms of itch.

Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis(TEN) are considered as delayed hypersensitivity reactions, and are among rare but life-threatening medical emergency conditions. Survival is determined by early diagnosis and appropriate treatment management. The most commonly known reason is antibiotic use and anticonvulsants. However, with the increased use of monoclonal antibodies today, reactions related to these drugs are also reported. Here, we presented a case of Eculizumab-induced Stevens-Johnson Syndrome, which had a monoclonal anti-C5 antibody.

Pesudorabies (PR), also called Aujeszky’s disease, is a highly infectious disaster caused by Pseudorabies virus (PRV). Without specific host tropism, PRV can therefore infect a wide variety of mammals, including pig, sheep, cattle, etc., causing severe neurological symptoms and acute death. This pathogen was first reported in China in 1950s, while outbreaks of variant PRV strains have been documented in partial regions since 2011, leading significant economic losses to swine industry in this country. Although Chinese scientists have made lots of efforts in the design of diagnostic approaches and the development of vaccines during the past years, PRV remains a vital pathogen widely spread in China and poses huge threats to the country’s pig industry. Especially, its potential threat to human has also been described recently. In this review we provide a summary of current understanding of PRV by mainly focusing on the prevalence of PR in China, cases of human infection by PRV, the existing diagnosis methods for the detection and the available vaccines against its infection. Additionally, promising agents including traditional Chinese herbal medicines and novel inhibitors that may be employed to treat this viral infection, are also discussed.

Abstract: Peanut and soybean oils were placed in stainless steel storage tanks in natural environment, static atmosphere tanks, added tertiary butyl hydroquinone (TBHQ) tanks, nitrogen-filled tanks and underground tanks were stored for 18 months. Acid value, peroxide value, fatty acid composition, tocopherols, phytosterols and the volatile flavor compounds were detected. The results indicated that underground storage (no nitrogen adjustment and no antioxidant added) was found to be the most appropriate method for maintaining the quality of peanut and soybean oils over time. Static atmosphere tanks caused the most pronounced losses of tocopherols, phytosterols, and the volatile flavor compounds in peanut and soybean oils. The acid value of the four peanut oils and four soybean oils did not exceed the Chinese GB/T 1534-2017 and GB 2716-2018 standard limit of 1.5 and 3.0 mg KOH/g. However, the peroxide value of peanut oil in static atmosphere tank, nitrogen-filled tank and underground tank exceeded the Chinese GB/T 1534-2017 standard limit of 12 meq O2/kg at 5 months, 11 months and 13 months respectively, but the peroxide value of peanut oil added TBHQ did not exceed the national standard limit. The peroxide value of soybean oil in static atmosphere tank and nitrogen-filled tank exceeded the Chinese GB 2716-2018 standard limit of 20 meq O2/kg at 7 months and 18 months respectively, but the soybean oil added TBHQ and underground did not exceed the national standard limit.

A rapid and eco-friendly method, using ultrasound power, was successfully employed to hydrolyze Crambe oil using lipase enzymes directly from castor seeds, in oil-free and in natura forms. A yield of 86% conversion of triglycerides into free fatty acids (FFA) was achieved in 5 minutes using in natura seeds and 73% of conversion when performing the reaction with oil-free seeds. The operational conditions of ultrasound power, mass ratio of buffer solution and oil, catalyst, and total substrate were evaluated using a central composite rotatable design (CCRD). The hydrolysis yield was optimized by Response Surface Methodology. The optimum conditions were approximately 70% of ultrasound power (350 W), 1.79 buffer solution/oil mass ratio, and 0.25 catalyst/substrate mass ratio for in natura seeds. For the oil-free seeds, the optimal conditions found were 68% (340 W) of ultrasound power, 1.67 buffer solution/oil mass ratio, and 0.06 catalyst/substrate mass ratio. Mathematical modeling was applied to the experimental kinetic data, and it was possible to predict FFA concentration values from independent experiments.

In desert ecosystems, the desertification process is characterized by increasing attenuation of plant productivity and deterioration of soil habitats, leading to enhanced environmental stress gradients for soil microbiomes. Despite the significance of microbial communities for multifunctionality in terrestrial ecosystems, the feedback dynamics of microbiomes and their contributions to maintaining subsurface soil multifunctionality as desertification progresses have yet to be evaluated. Here, we used three sites with different desertification stages and investigated the variation trends of microbiomes in soil profiles (0-100 cm) and their contributions to regulating multifunctionality. We first confirmed that multifunctionality did not exhibit a significant difference between superficial soils (0-20 cm) and deep soils (20-100 cm) and slightly decreased as soil depth increased throughout the entire profile. Desertification progression drove distinct variation trends of microbiomes in vertical soil profiles. Soil bacterial communities received on average more positive and progressive feedback from desertification development than fungal and archaeal communities, characterized by significant variation in bacterial alpha- and beta-diversity and slight variation in fungal and archaeal alpha- and beta-diversity. The most abundant phyla in the microbiomes did not vary between the superficial and deep soils at any desertification stage. Significant declines in microbial clades within Acidobacteria are an important feature as desertification proceeds. Particular microbial taxa rather than total microbial diversity best predict and explain the vertical profile variation in soil multifunctionality in desert ecosystems. Our results highlight the significance of microbial community composition in subsurface soils for regulating multifunctionality in desert ecosystems.

In this study, we introduce the vulnerability index to measure the regional ASF epidemic and present the ASF severity ratings of 31 provincial regions of China. The index is defined based on the data from investigation, national statistical yearbook and reports. The data to be used includes pig breeding, financial resources, human resources, epidemic information of ASF and price fluctuation from the 31 regions. Then we use the data envelopment analysis (DEA) model to define the vulnerability index, the relative severity values for each region which quantitatively reflect the damage degree caused by the epidemic of ASF. The method allows us to provide a systematic classification for regional vulnerability level of ASF in China. Using the index, we find that the vulnerability of the whole country is at a high level, and there is no regional aggregation phenomenon. The vulnerability level of the 31 provinces are quite different and the provinces with high vulnerability level are dispersive geographically. For the five major prevention and control zones for ASF in China, the northern region has the highest vulnerability level, while the level of eastern zoon is the lowest.

The article by Veronese et al.1 on aspirin utilization illustrates a common issue in medicine, validating efficacy and safety of therapeutics and the balance sought. Among the many, often predictable factors affecting clinical efficacy, is the mechanism of action, the physiologic/pharmacologic properties that produce the desired result. For aspirin, the major clinically pertinent effect is reduction of platelet aggregation/stickiness. It was once believed that low dose aspirin was sufficient for this benefit and it was assumed that treatment failures were related to other factors.2However, medicine has moved into the era of evidence-based assessments. And, when efficacy of aspirin in reducing platelet aggregation was actually tested in vitro, routine prescription of aspirin was found to be variable in such reduction. Ten times the 81 mg dose was often required to alter results in the appropriate collagen and ADP platelet function tests.3 Further complicating assessment of aspirin efficacy are individuals with anti-phospholipid syndrome. Anti-phospholipid antibodies are not rare.4 Afflicted individuals require warfarin-induced prothrombin time INRs in excess of standard dosing5 and the very convenient fractionated heparins lack efficacy in preventing thromboembolic events.6 Similar potential issues perhaps deserve consideration in establishing and applying aspirin recommendations. Recognizing that aspirin use carries with it morbidity and even mortality risks,7 should not its efficacy (at the prescribed dose) be routinely subject to in vitro (platelet function) testing? If we are to prescribe a medication for a specific benefit, it seems only reasonable to verify that individual variation does not interfere with the desired mechanism of action? The issue is not whether to use aspirin but, rather, how. Risk without assuring potential benefit should be avoided. Are the individuals who bleed more likely to be those for whom dosage was suboptimal? Perhaps we should assure adequate dose or not use it at all.B Rothschild, 5010 N Weir, Muncie, IN 47303, 785-615-1523, spondylair@gmail.comThere are no financial associations or other possible conflicts .Veronese N, Demurtas J, Thompson T, et al. Effect of low-dose aspirin on health outcomes: An umbrella review of systemic reviews andmeta-analyses. Br J Clini pHarmacol 2020;1-11. Doi: 10.1111/bcp.14310Arnaud L, Mathian A, Ruffatti A, et al. Efficacy of aspirin for the primary prevention of thrombosis in patients with antiphospholipid antibodies: An international and collaborative meta-analysis.Autoimmun Rev 2014;13:281-291.Perneby C, Wallén NH, Rooney C, et al. Dose- and time-dependent antiplatelet effects of aspirin. Thromb Haemost 2006;95:652-658Garcia D, Erkan D. Diagnosis and management of the antiphospholipid syndrome. N Eng J Med. 2018;378:2010-2021.Khamashta MA, Cuadrado MJ, Mujic F, et al. The management of thrombosis in the antiphospholipid-antibody syndrome. N Engl J Med 1995;332:993-997.Ziakas PD, Pavlou M, Voulgarelis M. Heparin treatment in antiphospholipid syndrome with recurrent pregnancy loss: A systematic review and meta-analysis. Obstet Gynecol 2010;115:1256-1262Gaziano M, Brotons C, Coppolecchia R, et al. Use of aspirin to reduce risk of initial vascular events in patients at moderate risk of cardiovascular disease (ARRIVE): A randomized, double-blind, placebo-controlled trial. Lancet 2018;392:1036-1046.

In the search to rapidly identify effective therapies that will mitigate the morbidity and mortality of COVID-19, attention has been directed towards the repurposing of existing drugs. Candidates for repurposing include drugs that target COVID-19 pathobiology, including agents that alter angiotensin signaling. Recent data indicate that key findings in COVID-19 patients include thrombosis and endothelitis Activation of PAR1 (protease activated receptor 1), in particular by the protease thrombin, is a critical element in platelet aggregation and coagulation. PAR1 activation also impacts on the actions of other cell types involved in COVID-19 pathobiology, including endothelial cells, fibroblasts and pulmonary alveolar epithelial cells. Vorapaxar is an approved inhibitor of PAR1, used for treatment of patients with myocardial infarction or peripheral arterial disease. Here, we discuss evidence implying a possible beneficial role for vorapaxar in the treatment of COVID-19 patients and in addition, other as-yet non-approved antagonists of PAR1 and PAR4.

The pandemic condition Coronavirus-disease (COVID-19), caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can take asymptomatic, mild, moderate, and severe courses. COVID-19 affects primarily the respiratory airways leading to dry cough, fever, myalgia, headache, fatigue, and diarrhea and can end up in interstitial pneumonia and severe respiratory failure. Different clinical symptoms caused by involvement of organs outside the respiratory system have been also described. Interestingly, reports about the manifestation of various skin lesions and lesions of the vascular system in some subgroups of SARS-CoV-2 positive patients as such features outside the respiratory sphere, are rapidly emerging. However, knowledge about prevalence and pattern of skin involvement, time of onset, predilection, and its direct or indirect relation to SARS-CoV-2 is still limited. In order to update information gained, we provide a systematic overview of the skin lesions described in COVID-19 patients, discuss potential causative factors and describe differential diagnostic evaluations.

Introduction: The right ventricle (RV) strain measured by speckle tracking (RVS) is a novel method of assessing RV function. We compared RVS to RV fractional area change (FAC%), tricuspid annular peak systolic excursion (TAPSE) and Doppler tissue imaging-derived peak systolic velocity (S’) in the assessment of right ventricular (RV) systolic function measured using cardiac magnetic resonance imaging (MRI). Methods: We enrolled consecutive patients who underwent cardiac MRI between Jan 2012- Dec 2017 and a transthoracic echocardiogram (TTE) within 1 month of the MRI with no interval event. Baseline clinical characteristics and MRI parameters were extracted from chart review. Echocardiographic parameters were measured prospectively. TTE parameters including RVS, TAPSE, S’ and FAC% were tested for accuracy to identify impaired RV EF (EF <45% & <30%) using receiver operator curves. Results: The study cohort included 500 patients with mean age 55 yr ± 18 and right ventricular systolic pressure 33.7 ± 13.6 mmHg. The area under ROC for RVS was 0.69 (95% CI 0.63 – 0.75) and 0.78 (95% CI 0.70 – 0.88) to predict RVEF <45% & RVEF <30% respectively. The RV FAC % had second highest accuracy of predicting RVEF among all the TTE parameters tested in study. Conclusion: Right ventricular strain is the most accurate echocardiographic method to detect impaired right ventricular systolic function when using MRI as the gold standard.

Aims: Lysosomal α-galactosidase A deficiency (Fabry disease (FD)) was considered an X-linked recessive disorder but is now viewed as a variable penetrance dominant trait. The prevalence of FD is 1 in 40000-117,000 but the exact frequency is disputed depending on ascertainment of late-onset cases and degree of female penetrance. Its prevalence in the general population, especially in patients with abnormal renal function is unclear. This study attempted to identify the prevalence of FD in patients with abnormal results identified from laboratory databases. Methods: Electronic laboratory databases were interrogated to identify from clinical biochemistry records patients with a phenotype of reduced estimated glomerular filtration rate categorised by age on one occasion or more over a 3-year time interval. Patients were recalled and a dried blood spot sample was collected for determination of α-galactosidase A activity by fluorimetric enzyme assay in men and mass spectrometry assays of α-galactosidase A and lyso-globotriaosylceramide (lyso-GL-3) concentrations in women. Results: Samples were obtained from 1084 patients identified with reduced renal function. No cases of FD were identified in 505 men. From 579 women one subject with reduced α-galactosidase activity (1.5 µmol/l/hr) and increased Lyso-GL-3 (5.5 ng/ml) was identified and shown to be heterozygous for a FD mutation (c.898C>T; p.L300F; Leu300Phe). It was later confirmed she was a relative of a known affected patient. Conclusions: Pathology databases hold routine information that can be used to identify patients with inherited errors of metabolism. Biochemical screening using reduced eGFR has a low yield for unidentified cases of Fabry Disease.