Case Report of Cerebral Sinus Thrombosis Related to Immune Thrombotic Thrombocytopenia Following Administration of ChAdOx1 nCoV-19 for Vaccination against COVID-19.

Vaccine-induced immune thrombotic thrombocytopenia (VITT) with cerebral venous sinus thrombosis (CVST) has been recently reported after vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We present a case of a patient with fulminant CVST and thrombocytopenia after receiving the ChAdOx1 nCoV-19 vaccine. Although the patient received immediate anticoagulant and intravenous immune globulin treatment, he died within 24 h after hospital admission. VITT and CVST are rare conditions; however, the course may be fatal. Therefore, clinicians should be familiarized with the clinical and laboratory features of VITT.

Cerebrovascular accidents differ between patients with atrial flutter and patients with atrial fibrillation.

INTRODUCTION: Few studies have explored the potential impact of atrial flutter (AFl) on ischaemic stroke (IS) outcome. The aim of the present study was to compare the clinical course of IS in patients with AFl and patients with atrial fibrillation (AF). MATERIAL AND METHODS: A retrospective analysis of patients consecutively admitted to a tertiary care centre between 2013 and 2015 due to IS or transient ischaemic attack with permanent AFl or permanent or persistent AF was performed. RESULTS: The study groups consisted of 528 patients, including 490 (92.8%) patients with AF and 38 (7.2%) patients with AFl. The mean age and prestroke CHA2DS2-VASc scores were similar between the patients with AFl and those with AF. Most IS cases in the AF group were classified as cardioembolic strokes (74.9% vs. 39.5% in AFl, p < 0.01), and lacunar strokes were the most common in the AFl group (47.4% vs. 14.3% in AF, p < 0.01). The multivariable analysis revealed that the presence of AF (OR = 8.6, 95% CI: 1.2-57, p = 0.02), lacunar stroke (OR = 0.1, 95% CI: 0.03-0.31, p < 0.001), baseline Rankin scale score (OR = 16.6, 95% CI: 9.8-28), lack of prestroke therapeutic anticoagulation (OR = 6.1, 95% CI: 1.1-33), diabetes (OR = 2.9, 95% CI: 1.3-6.5, p < 0.01), chronic heart failure (OR = 14.2, 95% CI: 5.8-34, p < 0.001), and current smoking (OR = 0.92, 95% CI: 0.39-0.99, p < 0.01) were significantly associated with the stroke outcome. CONCLUSIONS: Disabling or fatal IS was observed less often in patients with AFl than in patients with AF. This finding can possibly be explained by the more frequent occurrence of lacunar strokes in the AFl group compared with that in the AF group.

Food exchange estimation by children with type 1 diabetes at summer camp.

BACKGROUND: As exchange counting poses difficulty for children with type 1 diabetes (T1D) attending diabetes camps, they often guesstimate food amount without performing an exchange calculation. The aim of the study was to compare the accuracy of estimation with exchange counting using the mobile food exchange calculator (MFEC). METHODS: During a summer camp, 25 children with T1D on pumps estimated the number of carbohydrate (CE) and fat/protein exchanges (FPE) appropriate for main meals. Afterwards, the number of exchanges was counted with MFEC and electronic scales. RESULTS: There was a difference between CE (p<0.0001) and FPE (p<0.0001) estimations and counting using MFEC. The youth miscalculated the true values of ≥1 CE and ≥1 FPE by 31% and 23%, respectively. They more often underestimated than overestimated CE and FPE (p<0.0001). The estimation error increased with younger age. CONCLUSIONS: Carbohydrate counting caused significant error in the exchange number. The use of MFEC facilitates correct exchange calculation. Patients should weigh food and calculate exchanges themselves using mobile applications.

High Frequency of Diabetic Ketoacidosis in Children with Newly Diagnosed Type 1 Diabetes.

AIM: The aim of this study was to evaluate the incidence of diabetic ketoacidosis in children and adolescents with newly diagnosed type 1 diabetes in 2006-2007 and 2013-2014. METHOD: The study group consisted of 426 children aged 0-18 years with type 1 diabetes onset admitted to our hospital in 2006-2007 (group A) and 2013-2014 (group B). The study comprised the analysis of medical and laboratory records from patients' medical charts and the electronic database. RESULTS: There was no difference between groups A and B in the percentage of children admitted with diabetic ketoacidosis (25% versus 28%, resp., P = 0.499). Among children with diabetic ketoacidosis, severe metabolic decompensation (pH < 7.1) appeared in similar frequency in groups A and B (28% versus 30%, resp., P = 0.110). In group B, children with diabetic ketoacidosis were statistically younger compared to patients without ketoacidosis (P = 0.015) and had higher HbA1c levels (P = 0.006). In both groups, a 2-fold increase in diabetic ketoacidosis was noted in children under the age of 3, compared to overall frequency. CONCLUSION: No decrease in diabetic ketoacidosis has been noted in the recent years. Although the prevalence and severity of diabetic ketoacidosis remain stable, they are unacceptably high. The youngest children are especially prone to ketoacidosis.