Background: There is an ongoing critical need to improve therapeutic strategies for COVID-19 pneumonia, particularly in the most severely affected patients. Adult mesenchymal stem cell (MSC) infusions have the potential to benefit critically ill patients with acute respiratory syndrome SARS-COV-2 infection, but clinical data supporting efficacy are lacking. Methods: We conducted a case-control study of critically ill patients with laboratory-confirmed COVID-19, severe acute respiratory distress syndrome (ARDS). To evaluate clinical responsiveness in the most critically ill patient we examined outcomes in a sub-group of those requiring extracorporeal membrane oxygenation (ECMO) support. Patients (n=9) were administered with up to 3 infusions of intravenous (IV) MSCs and compared to a local ECMO control group (n=31). The primary outcome was safety, and the secondary outcomes were all-cause mortality (or rate of hospital discharge), cytokine levels, and viral clearance. Findings: MSC infusions (12 patients) were well tolerated and no side effects occurred. Of ECMO patients receiving MSC infusions, 2 out of 9 died (22.2%; 95%CI: 2.8%, 60.0%) compared with a mortality of 15 of 31 (48.4%; 95%CI: 30.2%, 66.9%; p = 0.25) in the ECMO control group. Isolated plasma exosomes containing the SARS-COV-2 Spike protein decreased after MSC infusions between day 14 or 21 after administration (p=0.003 and p=0.005, respectively) and was associated with a decrease in COVID-19 IgG Spike protein titer at same time points (p = 0.006 and p=0.007, respectively). Control ECMO patients receiving convalescent plasma did not clear COVID-19 IgG over the same time frame. Interpretation: Together these findings suggest that MSC IV infusion is well tolerated in patients with a broad range of severity including the most severe COVID-19 ARDS requiring ECMO. These data also raise the possibility that MSCs, in addition to exerting an immunomodulatory effect, contribute to viral clearance and strongly support the conduct of randomized placebo-controlled trial.

Appendiceal perforation and shigella enteritis were concomitantly observed in a 5-year-old boy. S. Sonnei was recovered from peritoneal exudate and faeces. This association must be kept in mind when treating patients with abdominal pain and gastroenteritis.

1) Perineal canal is a malformation that may involve the genitourinary system as well as the rectum and perineum. This developmental disturbance of the caudal end is profound as judged by the vaginal duplication and the nearly cloacal pattern of some cases. 2) Repair may be as challenging as that of a regular cloaca requiring an individualized approach.

Traumatic arteriovenous fistula is rare in children. We describe one case resulting from a small glass-fragment stab wound in the left leg. There was an associated false aneurysm of the anterior tibial artery. The patient was cured after multiple ligation and excision of the aneurysm.

Nasal regurgitation of milk and choking after feeding were observed in a 1,450 g newborn boy. A nasogastric tube was inserted and several episodes of aspiration pneumonia occurred after every interruption of gavage. Weight gain was very slow. At the age of 7 months, cineradiographic studies depicted cricopharyngeal spasm and passage of the barium into the nasopharynx and larynx. Pharyngo-oesophageal manometry showed incoordination, high cricopharyngeal pressure and incomplete relaxation of the muscle. Extended lower oesophageal pH-metering revealed severe gastro-oesophageal reflux. After cricopharyngeal myotomy and fundoplication the patient recovered, x-ray findings improved, and so did manometry except for a persistent incoordination. Functional studies are mandatory for diagnosis of this complex clinical pattern. The need for ruling out gastrooesophageal reflux before myotomy in order to prevent subsequent severe aspiration, is pointed out.