Alterations of adipokines, pancreatic hormones and incretins in acute and convalescent COVID-19 children.

BACKGROUND: The Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), accountable for Coronavirus disease 2019 (COVID-19), may cause hyperglycemia and additional systemic complexity in metabolic parameters. It is unsure even if the virus itself causes type 1 or type 2 diabetes mellitus (T1DM or T2DM). Furthermore, it is still unclear whether even recuperating COVID-19 individuals have an increased chance to develop new-onset diabetes. METHODS: We wanted to determine the impact of COVID-19 on the levels of adipokines, pancreatic hormones, incretins and cytokines in acute COVID-19, convalescent COVID-19 and control children through an observational study. We performed a multiplex immune assay analysis and compared the plasma levels of adipocytokines, pancreatic hormones, incretins and cytokines of children presenting with acute COVID-19 infection and convalescent COVID-19. RESULTS: Acute COVID-19 children had significantly elevated levels of adipsin, leptin, insulin, C-peptide, glucagon and ghrelin in comparison to convalescent COVID-19 and controls. Similarly, convalescent COVID-19 children had elevated levels of adipsin, leptin, insulin, C-peptide, glucagon, ghrelin and Glucagon-like peptide-1 (GLP-1) in comparison to control children. On the other hand, acute COVID-19 children had significantly decreased levels of adiponectin and Gastric Inhibitory Peptide (GIP) in comparison to convalescent COVID-19 and controls. Similarly, convalescent COVID-19 children had decreased levels of adiponectin and GIP in comparison to control children. Acute COVID-19 children had significantly elevated levels of cytokines, (Interferon (IFN)) IFNγ, Interleukins (IL)-2, TNFα, IL-1α, IL-1ß, IFNα, IFNß, IL-6, IL-12, IL-17A and Granulocyte-Colony Stimulating Factors (G-CSF) in comparison to convalescent COVID-19 and controls. Convalescent COVID-19 children had elevated levels of IFNγ, IL-2, TNFα, IL-1α, IL-1ß, IFNα, IFNß, IL-6, IL-12, IL-17A and G-CSF in comparison to control children. Additionally, Principal component Analysis (PCA) analysis distinguishes acute COVID-19 from convalescent COVID-19 and controls. The adipokines exhibited a significant correlation with the levels of pro-inflammatory cytokines. CONCLUSION: Children with acute COVID-19 show significant glycometabolic impairment and exaggerated cytokine responses, which is different from convalescent COVID-19 infection and controls.

A case of an upper anterior abdominal wall extra-skeletal Ewing sarcoma- soft tissue reconstruction with medial intercostal artery perforator flap and free anterolateral thigh fasciocutaneous flap with arteriovenous loop graft.

INTRODUCTION: Extra-skeletal Ewing sarcoma - a rare clinical entity. After the tumour resection, a huge upper anterior abdominal wall defect poses a challenge in soft tissue reconstruction in a thin individual. CASE PRESENTATION: We report an anterior abdominal wall Ewing sarcoma in a 22-year-old gentleman, arising from the left rectus abdominis muscle. After wide local excision, the reconstruction was achieved with free anterolateral thigh(ALT) fasciocutaneous flap with arteriovenous(AV) loop graft, right medial intercostal artery perforator(MICAP) flap and split-thickness skin graft(SSG). DISCUSSION: The goals of anterior abdominal wall reconstruction are to restore the integrity of the abdominal wall, prevent visceral eventration, and provide functional support. In view of the size of the defect, a free ALT flap was harvested and anastomosed to the left deep inferior epigastric bundle with the AV loop graft. Although the current trend is skewed towards the use of biologic mesh, an on-lay prolene mesh was used due to its affordable cost and that the biologic mesh was not available in Malaysia. The options of further reconstruction after the patient developed marginal flap necrosis and surgical site infection were also discussed. Post-operation 3 months, there was denser hair growth on the ALT flap. This finding has never been reported before and warrants further studies. CONCLUSION: The use of combination of various technique, namely free ALT fasciocutaneous flap with AV loop graft, right MICAP flap and SSG in reconstruction ensures a satisfactory functional and aesthetic outcome in the upper anterior abdominal wall reconstruction.

Use of dermal regeneration template (INTEGRA) in reconstructive burn surgery.

We present our two year experience with a dermal regeneration template (INTEGRA) in burn reconstructive surgery for contracture release as well as a reconstructive tool for management of soft tissue loss.