Cryptoccoccal meningitis in post-covid 19 patient in the city of manaus: Case report

Cryptococcosis is a cosmopolitan and opportunistic mycosis, caused mainly by the etiological agent Cryptococcus neoformans, through the inhalation of fungal structures, especially in bird feces. The aim of this study was to report a reported case of cryptococcal meningitis in an immunosuppressed patient due to previous COVID-19 infection in the city of Manaus-AM, as well as to implement health education actions to prevent cryptococcosis in the region of the disease. Information about the case was obtained through access to the database of the Information System for Notifiable Diseases (SINAN), made available by the Center for Control of Zoonoses Dr. Carlos Durand (CCZ), an agency belonging to the Municipal Health Department of Manaus (SEMSA). The case patient, male, presented symptoms such as headache, fever, vomiting, seizures, neck stiffness, petechiae and hemorrhagic suffusions, hearing loss and signs of Kernig and Brudzinski. In a zoosanitary visit to the site of the injury, the presence of pigeon excreta on the walls of the residence was found, and cleaning was carried out without the use of personal protective equipment (PPE’s). The contact with the residents evidenced the lack of information about the zoonosis addressed, including the risk of transmission of cryptococcosis by pigeons, facts that make necessary more sanitary actions on zoonoses among the population of Manaus.

The effects of virtual reality telemedicine a single pediatric use case patient with PTSD, post COVID-19: Exploratory research method. (Preprint)

UNSTRUCTURED This paper is an exploratory research comparison between using standard tele psych over 2D devices with HMD ( Head Mounted Device) using the Thera VRTM software. The single case example is with the pediatric mental health subject, and was specifically used to treat PTSD and co morbid symptoms related to the impact of COVID-19. The case usage was all delivered as telemedicine, and was conducted in private practice. Interventions used on all devices were Trauma Focused CBT. Results suggested a positive improvement on both patient engagement and outcome in treatment after continuous use of Virtual Reality as telehealth with avatar technology. Written informed consent was obtained from the minor’s legal guardian under the THERA VR™ agreement, for the publication of any potentially identifiable images or data included in this article.

Clinical Case: Patient with Mixed Graft Rejection Four Days after Kidney Transplantation Developed Specific Antibodies against Donor Bw4 Specificities

Kidney transplantation, like other transplants, has the risk of producing graft rejection due to genetic differences between donor and recipient. The three known types of renal rejection are listed in the Banff classification: T-cell-mediated rejection (TCMR), antibody-mediated rejection (ABMR), and mixed rejection. The human leukocyte antigens (HLA) are highly polymorphic and may be the targets of donor-specific antibodies, resulting in ABMR. Therefore, prior to transplantation, it is necessary to analyze the HLA genotype of the donor and recipient, as well as the presence of DSA, in order to avoid hyperacute rejection. However, due to the shortage of kidneys, it is very difficult to find a donor and a recipient with completely matched HLA genotypes. This can trigger a future rejection of the kidney, as is reported in this work. We describe a patient who received a kidney transplant after a negative DSA test, who developed graft rejection with antibodies against the donor’s HLA-Bw4 public epitope and lymphocytic infiltrate four days after transplantation, whose differential diagnosis was mixed rejection.

Ipsilateral penetrating rotational autokeratoplasty: case report and literature review

Purpose. To assess the features and results of post-traumatic reconstruction of the anterior part of the eye in a child with ipsilateral rotational autokeratoplasty (IRAK). Clinical case. Patient I. 5.5 years old, on the right eye performed a reconstructive surgery of the anterior part of the eye with IRAK, including synechiotomy, iridoplasty, phacoaspiration of traumatic cataract and implantation of an intraocular lens. The analysis of literature data has been carried out The restoration of the transparency of the optical axis and increase in visual functions were obtained – the diameter of the autokeratograft was 8.0 mm with a rotation angle 110°. The most preferred for IRAK are central post-traumatic corneal scars, which have a linear shape with significant areas of the transparent corneal periphery preservation. Conclusion. IRAK does not require donor material, it is recommended for limited central corneal sports, eliminates the risk of graft rejection due to incompatibility, and does not require the usage of systemic corticosteroids and immunosuppressants. IRAK is highly effective in childhood when it is necessary to perform combined reconstructive interventions such as «open sky» on the cornea, iris and lens. Key words: ipsilateral rotational autokeratoplasty, post-traumatic scars, ophthalmology reconstruction surgery.

Clinical case: patient treated for vulvovaginal candidiasis

Case study of acute vulvovaginal candidiasis treated with medication containing dequalinium chloride as an active ingredient has been reported. Patient A. aged 26 complaining of vaginal and perineal burning, itching, as well as of profuse white, whitish vaginal discharge, was under observation. Vulvovaginal candidiasis was diagnosed based on the laboratory tests. After verifying the diagnosis the patient was prescribed a medication containing dequalinium chloride, with beneficial effect. No vaginal dysbiosis was reported after exposure to medication.

Mycobacterium bovis Bacillus Calmette-Guérin Cross-Contamination in the Operating Room: A Case Report

Mycobacterium tuberculosis complex (MTBC) false-positive cultures are commonly attributed to laboratory cross-contamination, but cross-contamination in the operating room (OR) is seldom reported. We report an investigation of cross-contamination in the OR for our case patient, who underwent surgical intervention for a chronic, left-sided breast lesion. Although the case patient had never received Mycobacterium bovis bacillus Calmette-Guérin (BCG) vaccine or chemotherapy, a subsequent surgical sample culture was identified as MTBC by high-performance liquid chromatography and M. bovis BCG-type by genotyping. A collaborative false-positive investigation was initiated, and we discovered a cross-contamination event in the OR from a source case who received BCG intravesical instillation. Clinicians, public health, and infection control staff should be aware that MTBC cross-contamination in the OR is rare, but possible, and should recognize the importance of conducting thorough false-positive investigations.

A rational approach to opioid dose reduction in the treatment of bone pain. Clinical discussion

Narcotic drugs have become more available for use, but it is obvious that monotherapy of pain syndrome with narcotic drugs is not always effective. Patients sometimes change prescribed opiates to NSAIDs on their own, because it is more effective despite the high risk of complications. In this case patient has a grade 2 pain syndrome associated with bone metastases despite taking the maximum daily dose of tramadol complicated by nausea. Treatment was successfully changed with medium doses of tramadol and dexketoprophen. We consider the combination of narcotic drugs and NSAIDs as opiate-sparing and suggest that dexketoprophen is effective for treatment of pain associated with bone metastases because of the effect on neuropathiс and central components of pain syndrome. We have analyzed the main mechanisms and options for systemic pharmacotherapy of pain syndrome in bone metastases. Some NSAIDs are known to have central analgesic effects. For example, the analgesic effect of ketorolac after an injury of sciatic nerve is explained by its ability to inhibit the synthesis of algogenic peptides in the posterior horns of the spinal cord and the decrease in astrocyte activation. However, it is the dexketoprofen/tramadol combination that is recognized as the most effective in the world.

Diastematobulbia type II without associated dermoid tumor: case report

Split cord malformation (SCM) is a term used for all double spinal cords. It represents 3.8%–5% of spinal dysraphisms. Pang et al.’s embryological theory proposes the formation of an “accessory neurenteric canal” that communicates with the yolk sac and amnion. To the authors’ knowledge, only three cases of diastematobulbia (basicranial SCM) associated with a spur or dermoid have been reported in the literature.The case patient is a newborn girl with an occipitocervical meningocele and dermal sinus associated with an anomaly of notochordal development in the transition between the medulla oblongata and the spinal cord (diastematobulbia) without a bony septum or dermoid cyst. The patient also has agenesis of the atlas and an absence of corticospinal tract decussation. This patient underwent reconstruction of the occipital meningocele and dermal sinus excision.To the authors’ knowledge, this is the first described case of type II diastematobulbia (basicranial SCM), without a dermoid cyst. The authors analyzed the embryological errors present in the case patient and considered the option of further surgical treatment depending on the evolution of the patient’s condition. At the time of this report, the patient had shown normal psychomotor development. However, this fact may only be due to the patient’s young age. Considering that after initial untethering the patient remained clinically asymptomatic, conservative and close surveillance has been and continues to be the proposed treatment.

Fatal Cross-Border Plague in Zombo District, Uganda, March 2019

Background: Plague, which is caused by Yersinia pestis, is a priority zoonotic disease targeted for elimination in Uganda. Untreated bubonic plague, resulting from a flea bite, can develop into pneumonic plague, or pneumonic plague may be transmitted in respiratory droplets from person to person. On 6 March 2019, the Uganda Ministry of Health was notified of a patient in Zombo District with clinical presentation similar to pneumonic plague, and a positive plague rapid diagnostic test (RDT). The patient had family links to the Democratic Republic of Congo (DRC). We determined the scope of the outbreak, determined the mode of transmission, and recommended evidence-based control and prevention measures.Methods: A suspected pneumonic plague case was ≥2 of: cough (bloody or wet), chest pain, difficulty in breathing, or fever in a resident of Zombo District during February 1-March 31, 2019. A confirmed case was a suspected case testing positive for Yersinia pestis by rapid diagnostic test, culture or serology. We actively searched for case-patients, traced contacts and took samples as appropriate. We performed descriptive epidemiology of the outbreak.Results: We identified one suspected and one confirmed pneumonic plague case. On February 26, 2019, a 4-year-old boy was buried in DRC near the Uganda border after reportedly succumbing to a disease consistent with bubonic plague. Case-patient A (35-year-old mother to the boy), fell ill with suspected pneumonic plague while attending to him. She was referred to a health facility in Uganda on February 28 but died on arrival. On March 4, Case-patient B (23-year-old sister to Case-patient A), who attended to Case-patient A, presented with pneumonic plague symptoms to the same Uganda facility and tested plague-positive by RDT, culture, and serological tests. Contacts (n=114) were traced and given antibiotics as prophylaxis; no new cases were reported.Conclusion: This fatal plague outbreak started as bubonic and later manifested as pneumonic. There was cross-border spread from DRC to Uganda with no cross-border efforts at prevention and control. Person-to-person transmission appears to have occurred. The quick and effective response likely minimized spread.

Limits and Possibilities of Orthodontic Treatment of Patients with Skeletal Forms of Sagittal Anomalies

The need to develop and improve methods of diagnos is and treatment of patients with deformities of the jaws is determined primarily by the frequency of it prevalence. Dental anomalies occur in 33.7 - 49% of those examined. To improve the effectiveness of orthodontic treatment of patients with skeletal forms of sagittal anomalies of occlusion of the dentition, it is necessary to conduct additional methods of examination, computer modeling of treatment results, drawing up a comprehensive treatment plan. Clinical case. Patient 33 years old. Skeletal III class, Mesial occlusion of dental arches, Narrow upper jaw, Tooth crowding, periodontal problems, gingival loss. After additional diagnostic methods, computer simulation of treatment was performed, various treatment options were considered.