Paediatric tic-like presentations during the COVID-19 pandemic

Background and aimClinical centres have seen an increase in tic-like movements during the COVID-19 pandemic. A series of children and adolescents are described.MethodsA retrospective chart review of 34 consecutive paediatric patients presenting with sudden onset tic-like movements, seen over 6 months.Results94% of patients were female, with an average age of sudden onset or increase of tic-like movements of 13.7 years. 44% had a previous diagnosis of tics, and 47% initially presented to an emergency department. Comorbid psychiatric and neurodevelopmental disorders were reported in 91% with 68% reporting anxiety.ConclusionWe highlight a dramatic presentation of sudden onset functional tic-like movements in predominantly female adolescents to help inform identification and management. There is need to research the neurobiological underpinnings and environmental exacerbating factors leading to these presentations and to explore effective therapeutic strategies.

Septic shock due to Escherichia coli meningoencephalitis treated with immunoglobulin-M-enriched immunoglobulin preparation as adjuvant therapy: a case report

Background Gram-negative bacteria are an uncommon etiology of spontaneous community-acquired adult meningitis and meningoencephalitis. Escherichia coli is a Gram-negative bacterium that is normally present in the intestinal microbial pool. Some Escherichia coli strains can cause diseases in humans and animals, with both intestinal and extraintestinal manifestations (extraintestinal pathogenic Escherichia coli) such as urinary tract infections, bacteremia with sepsis, and, more rarely, meningitis. Meningitis continues to be an important cause of mortality throughout the world, despite progress in antimicrobial chemotherapy and supportive therapy. The mortality rate fluctuates between 15% and 40%, and about 50% of the survivors report neurological sequelae. The majority of Escherichia coli meningitis cases develop as a result of hematogenous spread, with higher degrees of bacteremia also being related to worse prognosis. Cases presenting with impaired consciousness (that is, coma) are also reported to have poorer outcomes. Case presentation We describe the case of a 48-year-old caucasian woman with meningoencephalitis, with a marked alteration of consciousness on admission, and septic shock secondary to pyelonephritis caused by Escherichia coli, treated with targeted antimicrobial therapy and immunoglobulin-M-enriched immunoglobulin (Pentaglobin) preparation as adjuvant therapy. Conclusion Despite the dramatic presentation of the patient on admission, the conflicting data on the use of immunoglobulins in septic shock, and the lack of evidence regarding their use in adult Escherichia coli meningoencephalitis, we obtained a remarkable improvement of her clinical condition, accompanied by partial resolution of her neurological deficits.

Primary breast carcinoma en cuirasse. A rare presentation of an aggressive malignancy and review of the literature

Breast carcinoma en cuirasse is a very rare form of cutaneous metastases of breast cancer. The clinical presentation is that of a diffuse indurated carcinomatous infiltration of the skin and subcutaneous tissues of the mammary region and the anterior aspect of the chest. In most cases, breast carcinoma en cuirasse develops post-mastectomy and represents a dramatic presentation of an aggressive tumor associated with a dismal prognosis. Because of the rarity of this type of malignancy, the optimal approach to treatment has not been clearly defined. The systemic treatment has been associated with limited efficacy, and the primary goal is palliative care and preservation of the quality of life through skin-directed therapies. Herein, a very rare case of primary breast carcinoma en cuirasse is presented, along with a review of the literature. Early diagnosis and prompt treatment of any potential skin metastases of breast cancer are essential to prevent the catastrophic natural progression of the disease.

MIGRAINOUS VERTIGO. An APPROACH

Background: Migraine and vertigo are highly prevalent; their simultaneous presentation is frequent and may require a different diagnostic approach than that used for migraine and vertigo separately. Migraine vertigo is recognized as a defined entity within the IHS classification of headaches. Methods: We reviewed the principal manifestations of peripheral and central affection (brainstem) that explain this clinical picture presentation, reviewed the general characteristics, epidemiology, semiology, treatment and prognosis. Results: The symptomatology suggest that the pathophysiology occurs as a vascular problem with aseptic inflammation and also affects the posterior territory. Although the condition's evolution is usually favorable, its dramatic presentation requires a detailed diagnostic approach (clinical and image), although the treatment does not differ from migraine's general management. Conclusion: The vestibular migraine or Migrainous Vertigo is an already defined entity, although the treatment is similar to the migraine with and without aura.

Shakespeare and Mercy at the Vatican, 2016

This article explores a central chapter in the history of the Catholic reception of Shakespeare’s work during the contemporary age: the Catholic readings in 2016 of Shakespeare’s dramatic presentation of mercy in the context of the celebrations of the 400th anniversary of Shakespeare’s death and the Holy Year of Mercy. This study directs its focus first to Catholic public manifestations on mercy −such as printed volumes, articles and cycles of lectures− which incorporated Shakespeare’s reflections on mercy within their religious debate. Second, it studies how the Globe to Globe Hamlet performance at the Holy See on 13 April 2016 triggered the interpretation within the Vatican context of Hamlet as a play which, despite its focus on revenge and crime, opens up glimpses of mercy that allow a redefinition of justice.

Recurrent left ventricular pseudoaneurysm with an ominous presentation

We present a case of a 58-year-old male with a recurrent left ventricular pseudoaneurysm. Two years before, the patient underwent repair of an apical aneurysm with a thrombus, which was very likely infected and complicated by huge pseudoaneurysm. The dramatic presentation of the recurrent pseudoaneurysm, as it invaded the left chest wall tissue and protruded into the skin through an intercostal space, and the complexity of the procedures are well documented by surgical and accompanying technical images.