With no ideal specific therapy confirmed by the science community, and many low income countries barely being able to obtain a sufficient number of vaccines, as well as the long-term mental health impact, the COVID-19 infection makes for a worldwide health and global problem.Case report A COVID-19 positive patient was admitted due to poor condition, malaise and bilateral interstitial pneumonia with borderline oxygen saturation of 94%, hypoxemia with pO2 of 64mmHg, and elevated C reactive protein (CRP) of 70. The patient was put on oxygen support of 3l/min, and started parenteral antibiotic and LMWH in prophylactic doses -a combination that primarily improved the patient's condition. Three days after hospitalization marked shortness of breath with a drop in oxygen saturation of 62% referred. With further increasing of the oxygen flow, and a transfer to ICU, gas pressures showed significant worsening and the patient was put on mechanical support with a CPAP mask.Despite adding pulsed doses of potent corticosteroid, rapid acting insulin for blood glucose control, and administerring convalescent plasma and parenteral nutrition, the CRP levels were increasing and oxygen was decreasing. Hypotensive, tachycardic and with reduced urine output, the patient was intubated and set up on IPPV mechanical support. Vasopressor stimulation didn't improve the diuresis and elevation of degradation products followed, as well as elevation of the troponin and cardiospecific enzymes -non of which was caused by sepsis.Eight days after admission, the left arm presented as pale, cool and cyanotic. Fully deteriorated laboratory findings of multiple organ system failures (MOFS) were undoubtable; with the oxygen levels incompatible of life, and a CT scan with ARDS presentation, a continuous heparin infusion was the only solution. At the beginning, nothing indicated the deleterious outcome; however, with a highly unusual presentation of arterial thrombosis, the upper limb gangrene became too much and the patient died.COVID-19 is primary a respiratory infection, but the virus can affect other organs and systems, with some very rare presentations and deleterious outcomes.

Purpose: Previous studies suggested pressure‐related factors to be involved in the pathogenesis of diabetic retinopathy. In this study, we aim to correlate systemic and ocular pressure‐related factors with anatomic parameters in control subjects and in patients with and without diabetic retinopathy (DR). Methods: We included 31 control subjects, 32 patients with diabetes mellitus (DM) without DR and 37 patients with DR. The following parameters were evaluated: best corrected visual acuity, intraocular pressure (IOP) (mmHg), body mass index (BMI), mean blood pressure (MBP) (mmHg), HbA1c (%), estimated cerebrospinal fluid pressure (CSFP) (mmHg), trans‐laminar pressure difference (TLPD) (mmHg), ocular perfusion pressure (OPP) (mmHg), axial length (AL) (mm), spherical equivalence (SE) (D) and OCT parameters (optic disk area (mm2), optic cup/disk (C/D) ratio, retinal nerve fibre layer thickness (NFLT) (μm), foveal thickness (μm), average macular thickness (AMT) (μm)). We used either Pearson's or Spearman' coefficient of correlation depending on data distribution. Results were considered statistically significant with p value < 0.05. Results: Presence of DM had a significant low association with CSFP (Rs = 0.28, p = 0.006), BMI (Rs = 0.24, p = 0.019) and with AL (Rs = −0.27, p = 0.011). CSFP had a significant low association with SE (R = −0.38, p = 0.002) and with NFLT (R = 0.27, p = 0.046) only in patients with DM. TLPD had a significant low association with optic C/D ratio in control subjects (R = 0.45, p = 0.014) and a significant low association with NFLT in patients with DM (R = −0.35, p = 0.007). In patients with DM, IOP had a significant low association with MBP (R = 0.26, p = 0.032), BMI (R = 0.29, p = 0.017) and CSFP (R = 0.29, p = 0.017), whereas in control subjects IOP had a significant moderate association with optic C/D ratio (R = 0.57, p = 0.001) and a significant low association with AMT (R = −0.43, p = 0.016). Conclusions: Systemic and ocular pressure related factors have different correlation patterns in patients with DM than in control subjects.

Introduction: Graft-versus-host disease (GvHD) is the major complication arising after allogeneic hematopoietic cell transplantation (allo-HCT). It can present as acute and/or chronic GvHD. The purpose of this study was to describe the incidence of acute and chronic GvHD in patients treated with allo-HCT.Materials and methods: This study was designed as a retrospective study, which included 65 patients treated with allogeneic transplantation from a human leukocyte antigen identical donor at the University Clinic of Hematology in Skopje, North Macedonia.Results: Acute GvHD (aGvHD) was observed in 28 patients, with the most common localization on the skin (75%). Post-transplant phase had a significant effect on the frequency of skin aGvHD (p =0.038). Also a statistically significant difference was confirmed between patients with and without acute skin GvHD in terms of conditioning regimen (p =0.034). Chronic GvHD (cGvHD) was diagnosed in 10 patients, mostly progressing from previously acute GvHD (9.23%). Post-transplant phase had also a significant effect on the frequency of skin cGvHD (p =0.018). Patients with a higher European Society for Blood and Marrow Transplantation risk score had significantly more frequent skin cGvHD than did the others.Conclusions: Acute and chronic GvHD are leading causes of morbidity and mortality of patients after allo-HCT. GvHD remains a major risk for patients with allo-HCT, regardless of diagnosis or type of transplantation.