Reverse-Zoonotic Transmission of SARS-CoV-2 Lineage Alpha (B.1.1.7) to Great Apes and Exotic Felids in a Zoo in the Czech Republic

We report an outbreak of SARS-CoV-2 lineage alpha in gorillas and felid species in a zoo in Prague, Czech Republic. The course of illness and clinical signs are described, and the particular SARS-CoV-2 variants are characterized by next generation sequencing and phylogenetic analysis. The putative transmission routes are also inferred.

Cortical thickness across the cingulate gyrus in schizophrenia and its association to illness duration and memory performance

Schizophrenia has been associated with structural brain abnormalities and cognitive deficits that partly change during the course of illness. In the present study, cortical thickness in five subregions of the cingulate gyrus was assessed in 44 patients with schizophrenia-spectrum disorder and 47 control persons and related to illness duration and memory capacities. In the patients group, cortical thickness was increased in the posterior part of the cingulate gyrus and related to illness duration whereas cortical thickness was decreased in anterior parts unrelated to illness duration. In contrast, cortical thickness was related to episodic and working memory performance only in the anterior but not posterior parts of the cingulate gyrus. Our finding of a posterior cingulate increase may point to either increased parietal communication that is accompanied by augmented neural plasticity or to effects of altered neurodegenerative processes in schizophrenia.

COVID-19 and Dengue Co-infection in a Young Girl: A Case Report

During COVID-19 pandemic, the increasing incidence of dengue in Monsoon season has become a further threat especially in the dengue endemic countries of Southeast Asia like Bangladesh. Co-infection of dengue with COVID-19 has created a number of practical challenges to combat the diseases simultaneously, especially at a time when healthcare resources are already exhausted tackling the COVID pandemic. We are presenting the case report of a 14 year old girl who suffered from both RT-PCR positive COVID -19 infection & NS1 positive Dengue. She was managed in a Private Hospital of Dhaka as Dengue fever Group C (due to severe plasma leakage) with severe COVID-19 infection (as required oxygen therapy). She had a critical course of illness, having continued fever, cough, breathlessness, desaturation along with thrombocytopenia & plasma leakage. However, to our great satisfaction, the patient was ultimately improved & could be discharged in a happy face. Bangladesh J Medicine July 2022; 33(1) : 104-108

Obstetric Complications and Polygenic Risk Score: Which Role in Predicting a Severe Short-Term Outcome in Psychosis?

Understanding and improving the outcomes of psychosis remains a major challenge for clinical research. Obstetric complications (OCs) as a risk factor for schizophrenia (SZ) have been investigated as a potential predictor of outcomes in relation to illness severity and poorer treatment outcome, but there are less reports on first episode psychosis (FEP) patients. We test whether OCs, collected in a cohort of FEP patients, can predict illness course and psychopathology severity after 2 years from the onset. Moreover, we explore whether the SZ-polygenic risk score (PRS) would predict the illness course and whether the interaction between OCS and PRS shows a significant effect. A cohort of 264 FEP patients were assessed with standardized instruments. OCs were recorded using the Lewis–Murray scale in interviews with the patients’ mothers: 30% of them reported at least one OC. Patients with at least one OC were more likely to have a non-remitting course of illness compared to those without OCs (35.3% vs. 16.3%, p = 0.014). No association between SZ-PRS and course of illness nor evidence for a gene–environment interaction was found. In our sample, poor short-term outcomes were associated with OCs, while SZ-PRS was not a prognostic indicator of poor outcomes.

Men and Women With First Episode Psychosis Present Distinct Profiles of Social Cognition and Metacognition

Deficits in social cognition and metacognition impact the course of psychosis. Gender differences in social cognition and metacognition could explain heterogeneity in psychosis. 174 (58 females) patients with first-episode psychosis completed a clinical, neuropsychological, social cognitive and metacognitive assessment. Subsequent latent profile analysis split by gender yielded 2 clusters common to both genders, a specific male profile characterized by presenting jumping to conclusions and a specific female profile characterized by cognitive biases. Males and females in the homogeneous profile seem to have a more benign course of illness. Males with jumping to conclusions had more clinical symptoms and more neuropsychological deficits. Females with cognitive biases were younger and had less self-esteem. These results suggest that males and females may benefit from specific targeted treatment and highlights the need to consider gender when planning interventions.

Is the Course of COVID-19 Different during Pregnancy? A Retrospective Comparative Study

The COVID-19 pandemic has challenged health systems around the world. Maternal-foetal medicine, which has been particularly affected, must consider scientific data on the physiological processes occurring in the pregnant woman’s body to develop relevant standards of care. Our study retrospectively compared the clinical and laboratory characteristics of 52 COVID-19 pregnant patients with 53 controls. Most of the pregnant patients required medical attention during the third trimester and therefore we propose that vaccination is needed prior to the 30th week of pregnancy. We found no differences between the 2 groups in the course of illness classification system, days of hospital stay, need for oxygen supplementation, need for mechanical ventilation, and ICU admission. Moreover, clinical manifestations and imaging findings were comparable. Pregnant patients needed a greater oxygen flow rate and required high flow oxygen therapy more frequently. Considering pregnancy-related physiological adaptations, we found that COVID-19 infection in pregnant patients is associated with higher levels of inflammatory markers, apart from serum ferritin, than in non-pregnant women, and concluded that biomarkers of cardiac and muscle injury, as well as kidney function, may not be good predictors of COVID-19 clinical course in pregnant patients at the time of admission, but more research needs to be conducted on this topic.

Adjunctive Use of Point of Care Ultrasound to Diagnose Compartment Syndrome of the Thigh

Compartment syndrome is a medical emergency and must be considered in patients who present with severe limb pain. Compartment syndrome is a clinical diagnosis, classically described as presenting with the 5 ‘P’s (pain, pulselessness, pallor, paraesthesia, and paralysis). Apart from pain, the other findings signify acute arterial obstruction and would be late findings. We present a case of a 31-year-old male in which point of care ultrasound (POCUS) expedited this diagnosis by demonstrating a large thigh hematoma in the anterior compartment. This prompted emergent orthopedic surgery consultation, and the diagnosis of compartment syndrome was confirmed both at the bedside and in the operating room. Compartment syndrome can be a challenging diagnosis, especially early in the course of illness. While POCUS should not be used in isolation in the assessment of possible compartment syndrome, it can be used as an adjunct in the workup, especially if it identifies an underlying cause.

COVID-19 and Hemoglobinopathies: A Systematic Review of Clinical Presentations, Investigations, and Outcomes

This systematic review aimed to provide an overview of the clinical profile and outcome of COVID-19 infection in patients with hemoglobinopathy. The rate of COVID-19 mortality and its predictors were also identified. A systematic search was conducted in accordance with PRISMA guidelines in five electronic databases (PubMed, Scopus, Web of Science, Embase, WHO COVID-19 database) for articles published between 1st December 2019 to 31st October 2020. All articles with laboratory-confirmed COVID-19 cases with underlying hemoglobinopathy were included. Methodological quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklists. Thirty-one articles with data on 246 patients with hemoglobinopathy were included in this review. In general, clinical manifestations of COVID-19 infection among patients with hemoglobinopathy were similar to the general population. Vaso-occlusive crisis occurred in 55.6% of sickle cell disease patients with COVID-19 infection. Mortality from COVID-19 infection among patients with hemoglobinopathy was 6.9%. After adjusting for age, gender, types of hemoglobinopathy and oxygen supplementation, respiratory (adj OR = 89.63, 95% CI 2.514–3195.537, p = 0.014) and cardiovascular (adj OR = 35.20, 95% CI 1.291–959.526, p = 0.035) comorbidities were significant predictors of mortality. Patients with hemoglobinopathy had a higher mortality rate from COVID-19 infection compared to the general population. Those with coexisting cardiovascular or respiratory comorbidities require closer monitoring during the course of illness. More data are needed to allow a better understanding on the clinical impact of COVID-19 infections among patients with hemoglobinopathy.Clinical Trial Registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020218200.

Distress Due to Nonpathological Vaginal Discharge: A New Face of Dhat Syndrome in Females

Female Dhat syndrome (FDS) is not yet an established clinical entity, but nonpathological vaginal discharge has been discussed in the scientific literature for quite a long time. Various studies have reported the existence of the phenomenon of nonpathological vaginal discharge. All the existing literature on Dhat syndrome was reviewed. Studies have reported that nonpathological vaginal discharge has a high prevalence among the rural and urban populations of Indian women (around 30%). The symptom of vaginal discharge has been an area of concern for a sizable proportion of women in the community, and anxiety related to this has been a frequent reason to seek medical attention. The ideas associated with vaginal discharge are similar to Dhat syndrome in males. The variations of associated symptomatology, course of illness, and somatization of the complaint make it challenging to diagnose and treat. The diagnostic criterion needs careful evaluation; management needs an appropriate multidisciplinary approach by various health team members, including psychological interventions and adjunct pharmacotherapy in effectively managing the FDS. Dhat syndrome in females has similar phenomenology to that in males. Unfortunately, this is under-researched and hence, underdiagnosed.

The Diagnostic Predictive Value of Aspartate Aminotransferase/Platelet Ratio Index (APRI) in Assessing the Disease Severity of Filipino Dengue Patients in Pampanga, Philippines: A Multicenter Study

Introduction/Objective Lack of good predictive biomarkers tied with its widely varying clinical manifestation make DENV infection a major public health concern especially in developing countries like the Philippines. Liver involvement is found to be a common manifestation among severe dengue patients hence enzymes such as aspartate aminotransferase (AST) is used in determining dengue severity. This study aims to evaluate the predictive value of AST/platelet ratio index (APRI) in assessing disease severity among Filipino dengue patients upon admission. Methods/Case Report Clinical data of 16 dengue patients from two hospitals in Pampanga were analyzed retrospectively. Results for NS1 antigen test, CBC, and AST along with signs and symptoms of patients upon admission were reviewed. ANCOVA was used to compare AST and APRI between the groups while ROC regression and Youden’s index were utilized in identifying severe dengue using AST and APRI. Results (if a Case Study enter NA) Among the 16 patients, 10 were male and 6 were females with a mean age of 17.9 years (range, 6 to 34). There was no evidence that AST (p=0.223) significantly differed between severe and non- severe dengue, with a mean of 131.0±24.5 and 78.5±24.5, respectively. Calculated APRI scores (p=0.604) did not show significant difference between SD and NSD, with a mean of 3.8± 4.1 and 3.7±4.1, respectively. The obtained AST cutoff for SD was 119 U/L; while the APRI cutoff for SD is 4.03. However, considering the age of patients as covariate, both AST [AUC = 0.55 (95% CI: 0.15 to 0.86)] and APRI [AUC = 0.69 (95% CI: 0.27 to 1.00)] was not able to differentiate patients with SD and NSD. Conclusion The parameters AST and APRI were not able to differentiate and predict severity between SD and NSD. A larger cohort with a more specific age group, and collection of samples throughout the course of illness are needed to further substantiate the results.