Camel-Hump T-Wave, Tee-Pee Sign, and Wavy Triple Sign (Yasser’s Sign) with Hypocalcemia and Hyperkalemia in Covid-19 Pneumonia with Lacunar Infarction

Rationale: A novel COVID-19 is a multi-systemic critical worldwide pandemic infection. Certainly, associated multiple electrolytes imbalance in COVID-19 pneumonia is a remarkable decisive event. Camel-hump T-wave, Tee-Pee sign, and Wavy triple sign (Yasser’s sign)are novel highly significant descriptive electrocardiographic signs that are seen in calcium and potassium disturbance. There is an established and strong relationship between and electrocardiographic abnormalities and electrolytes imbalance. COVID-19 pneumonia and cerebrovascular stroke are commonly seen in a patient with Coronavirus infection. Patient concerns: A 69-year-old married worker Egyptian male patient was presented to the emergency department with COVID-19 pneumonia and cerebrovascular stroke. Diagnosis: COVID-19 pneumonia with lacunar infarction, hypocalcemia, and hyperkalemia. Interventions: Chest CT scan, brain CT scan, electrocardiography, oxygenation, and echocardiography. Outcomes: Initial bad and deterioration outcome but, the dramatic outcome had happened after later management. Lessons: The understanding of electrocardiographic signs regarding metabolic disorders such as electrolytes imbalance and other associated systemic diseases is very important. Elderly male sex, heavy smoker, COVID-19 pneumonia, cerebrovascular stroke, chronic renal impairment, ischemic heart disease, hypokalemia, hypocalcemia, and hypernatremia represent bad prognostic points and is indicating a high-risk condition.

Scrub typhus, a rare of cause of fulminant hepatic failure: A common disease with uncommon presentation

Scrub typhus (bush typhus) is a potentially lethal mite-borne, acute febrile infectious illness caused by Orientia tsutsugamushi, reported precipitating frequent outbreaks in the Asia-pacific belt. Usual presentation after a median incubation period of 10–14 days, stretches from pathognomonic eschar, high-grade fever, centrifugal skin rash, jaundice, regional lymphadenopathy to frontal headache, nevertheless complicated at times with myocarditis, acute respiratory distress syndrome, acute kidney injury, encephalitis, and shock. Although patients with scrub typhus invariably do display mild liver injury, fulminant hepatic failure (FHF) is rarely reported. We describe herein, a case of FHF in an elderly male that responded well to antibiotics. Early diagnosis and sensitive antibiotic administration aids in mortality prevention of the former.

Comprehensive Analysis of Perioperative Anaesthesia Concerns in Covid Associated Mucormycosis: A Retrospective Study of Surgical Patients

Background: Data regarding sudden surge of mucormycosis cases with COVID-19 outbreak and its impact on anaesthesia management are lacking. This retrospective study was designed to analyze the number and characteristics of patients posted for mucormycosis surgery in COVID19 pandemic while emphasizing upon the anaesthesia concerns. Methods: Data was collected from all patients who were admitted with mucormycosis in our institute from the year 2020 onwards. Further analysis of patients who were surgically treated was carried out in terms of demographic characteristics, association with COVID19 and perioperative course of mucormycosis and anaesthetic management. All statistical analyses were performed with the Statistical package for social sciences (SPSS) version 25·0 software. Results: We report an incidence of 30 operated patients of the average age 52.60 years with mucormycosis from August 2020 to May 2021. Diabetes as a comorbidity was common (86.90%). Previous infection with COVID-19 was observed in 29 (96.60%) out of which 80% patients had residual pulmonary involvement. Concomitant medical therapy with Amphotericin B was received by 90% patients and subsequently 70% had deranged renal profile. While 20 % patients had compromised airway, 60 % required blood transfusion and 76.6% patients were electively ventilated while 1 patient (3.3%) succumbed amounting to a survival rate of 96.6%. Conclusion: To conclude elderly male diabetic patients with history of COVID19 infection is the most vulnerable population for developing mucormycosis. Airway management, glycemic control, concomitant Amphotericin B therapy and intraoperative bleeding are the major challenges for anaesthesiologist along with an element of post Covid respiratory compromise.

Association Between Basal Metabolic Rate and All-Cause Mortality in a Prospective Cohort of Southern Chinese Adults

Objective: The aim of this study was to assess the relationship between basal metabolic rate (BMR) and all-cause mortality in southern Chinese adults.Methods: We prospectively examined the relationship between BMR and all-cause mortality in 12,608 Southern Chinese adults with age ≥ 35 years who participated in the National Key R&D Program from 2013–2014 to 2019–2020. Cox proportional hazard models were used to examine the association between BMR and all-cause mortality.Results: A total of 809 deaths (including 478 men and 331 women) occurred during a median follow-up period of 5.60 years. All-cause mortality was higher in elderly individuals than in non-elderly individuals (11.48 vs. 2.04%, P < 0.001) and was higher in male subjects than in female subjects (9.84 vs. 4.56%, P < 0.001). There was a significantly inverse relationship between BMR levels and all-cause mortality in elderly male individuals (adjusted-HR per SD increase: 0.80, 95% CI: 0.70–0.91, P < 0.001). Compared with BMR levels ≤ 1,115 kJ/day, there was lower all-cause mortality in third and highest BMR quartiles in the elderly male subjects (adjusted-HR: 0.71, 95% CI: 0.53–0.95, P = 0.022; adjusted-HR: 0.60, 95% CI: 0.43–0.84, P = 0.003, respectively).Conclusion: An elevated BMR was independently inversely associated with all-cause mortality in elderly male subjects in a southern Chinese population.

Sportolás elektronikus monitorozással időskorban

Összefoglaló. Idősebb korban a testgyakorlás különösen fontos az izmok sorvadásának megelőzése, valamint a vérnyomás és a testsúly kontrollja céljából. Ma már egyre gyakoribb az időskorúak részvétele sportversenyeken is. Esettanulmányunk célja a késő felnőttkori, illetve időskori versenyszerű sportolás egészségi alkalmassági feltételeinek, kockázatainak és a teljesítőképesség változásainak bemutatása az elektronikus monitorozás és virtuális versenyzés korában. Esetünkben ez egy időskorú személy 16 év során (54–70 éves kor) teljesített maratoni futóversenyeinek, valamint virtuális evezőversenyek részvételi és felkészülési adatainak elemzésével valósul meg. Esetünk illusztrálja, hogy az észszerű túlterhelés elve alapján az izmok adaptációja akkor következik be, amikor az edzés terhelése meghaladja az addig már elért terhelési szintet. A sportóra használata az elektronikus pulzusszám és a teljesítmény monitorozásával nemcsak a versenyek és edzések alatt a pulzusszám céltartományban tartására, de hosszabb távú tendenciák felismerésére is hasznosnak bizonyult. Az egészségi állapotnak megfelelő (sportág és intenzitás) időskori testgyakorlás és sportversenyen való részvétel nemcsak az erőnlét megtartását tűzheti ki célul, hanem értékes erőnlétfejlesztést is. Orv Hetil. 2021; 162(51): 2061–2066. Summary. With advancing age, exercise becomes particularly important to prevent muscle atrophy and to control blood pressure and weight. Today, participation of aging people in athletic competitions is increasingly common. The aim of our case study is to explore and illustrate the health conditions, development and risk factors of competitive sporting activities of late adult and elderly athletes in the age of electronic monitoring and virtual racing. We processed the preparation and participation data of a total of 16 years of marathon races as well as rowing machine races of an elderly male person (age 54–70). Using a sports watch with electronic heart rate and performance monitoring has proved useful not only for keeping the heart rate in target range, but also for assessing trends in the long run. Our case underscores the value of reasonable overload with advancing age; beneficial muscle adaptation occurs when the workload of an exercise exceeds the previously reached level. Gradual exercise of older adults and participation in athletic competitions can not only maintain fitness but also develop valuable additional strength. Orv Hetil. 2021; 162(51): 2061–2066.

A rare case of aggressive primary pulmonary synovial sarcoma: A case report

Synovial sarcoma is a malignant mesenchymal tumour which mostly affects young adults and is mostly seen in extremities. Primary synovial sarcoma arising from the lung is rare, accounting for less than 0.5% of all lung carcinomas. Most commonly it arises from the lung followed by pleura and mediastinum. Primary pulmonary synovial sarcoma is an extremely aggressive malignant tumour that can invade adjacent organs and give distant metastasis. Histologically it is of two main types – monophasic and biphasic. IHC is a must for diagnosis following clinical examination and imaging. Here we report a case of an elderly male with right lung mass lesion infiltrating the visceral and mediastinal pleura. PET – computerized tomography (CT) guided biopsy was s/o synovial sarcoma monophasic type which was further confirmed by IHC. The multimodality treated for this includes wide resection, chemotherapy and radiotherapy. Synovial sarcoma is relatively chemosensitive though it is considered as a high grade tumour with a poor prognosis. Because of the advanced stage of the disease our patient was not a candidate for surgery and was taken up for chemotherapy. He had a survival of 6 months but had succumbed due to non – cancer related cause.

Synovial chondromatosis of the foot: A case report with brief review

Synovial chondromatosis is a rare, benign disorder which commonly involves the large joints and is characterised by the proliferation of cartilaginous nodules beneath the synovial membrane. We report a case of an elderly male who presented with pain and swelling of the right foot since five years. Proper clinico- radiological and histological evaluation of this case led to the diagnosis of synovial chondromatosis which was managed surgically and patient’s symptoms were relieved. The rare occurrence of this entity in the small joints of hands and feet and the presence of several close differentials, warrants a thorough clinico-radiological and histological work-up to prevent unnecessary surgical exploration.

Hyperferritinemia in a Case of Soft Tissue Sarcoma

An elderly male presented with symptoms suggestive of anemia. During workup for the same he was found to have very high levels of serum Ferritin along with a normocytic, normochromic peripheral blood film and no other apparent cause for hyperferritinemia .A swelling which incidentally found on his shin was further investigated by FNAC confirmed presence of soft tissue sarcoma.