A Scoring Tool to Predict Pulmonary Complications in Severe Leptospirosis with Kidney Failure

Rapid identification of patients likely to develop pulmonary complications in severe leptospirosis is crucial to prompt aggressive management and improve survival. The following article is a cohort study of leptospirosis patients admitted at the National Kidney and Transplant Institute (NKTI). Logistic regression was used to predict pulmonary complications and obtain a scoring tool. The Kaplan–Meir method was used to describe survival rates. Among 380 patients with severe leptospirosis and kidney failure, the overall mortality was 14%, with pulmonary hemorrhage as the most common cause. In total, there were 85 (22.4%) individuals who developed pulmonary complications, the majority (95.3%) were observed within three days of admission. Among the patients with pulmonary complications, 56.5% died. Patients placed on mechanical ventilation had an 82.1% mortality rate. Multivariate analyses showed that dyspnea (OR = 28.76, p < 0.0001), hemoptysis (OR = 20.73, p < 0.0001), diabetes (OR = 10.21, p < 0.0001), renal replacement therapy (RRT) requirement (OR = 6.25, p < 0.0001), thrombocytopenia (OR = 3.54, p < 0.0029), and oliguria/anuria (OR = 3.15, p < 0.0108) were significantly associated with pulmonary complications. A scoring index was developed termed THe-RADS score (Thrombocytopenia, Hemoptysis, RRT, Anuria, Diabetes, Shortness of breath). The odds of developing pulmonary complications were 13.90 times higher among patients with a score >2 (63% sensitivity, 88% specificity). Pulmonary complications in severe leptospirosis with kidney failure have high mortality and warrant timely and aggressive management.

Palestinian Experience in Stage Four Pressure Ulcer

Pressure ulcer (now called Pressure injury) happens when the bony prominence like the sacrum exposes to pressure for a long period and also can cause soft tissue injury. In order to prevent and cure pressure-induced wounds, continuous and attentive repositioning is necessary. Wound management begins with the identification and aggressive management of the modifiable factors, such as positioning, incontinence, spasticity, diet, devices, and medical comorbidity, which contribute to pressure injury formation. Initial interventions include washing, cleaning, and maintaining the surfaces of the wound. In certain cases, it may be sufficient to debride the non-viable or contaminated tissue; however, operational care in more severe cases or to encourage patient satisfaction may be necessary. Our patient is a 50-year-old overweighted man, nonsmoker, and confined to a wheelchair presented with a 20*20*8 stages 4 ulcers in the sacral area after multiple failed bedside debridement. When we use the fasciocutaneous we should consider the depth of the wound and fill dead space. Here we the local situation in Palestine as those patients are usually neglected and their management is restricted to bedside debridement, with no experience in flap reconstruction operations which would dramatically improve patients’ lives. We believe that further awareness is demanded for such procedures.

High-Risk Outreach for COVID-19 Mortality Reduction in an Indigenous Community

Indigenous populations have been disproportionally affected by COVID-19, particularly those in rural and remote locations. Their unique environments and risk factors demand an equally unique public health response. Our rural Native American community experienced one of the highest prevalence outbreaks in the world, and we developed an aggressive management strategy that appears to have had a considerable effect on mortality reduction. The results have implications far beyond pandemic response, and have reframed how our community addresses several complicated health challenges. (Am J Public Health. Published online ahead of print October 14, 2021:e1–e3. https://doi.org/10.2105/AJPH.2021.306472 )

COVID-19-Associated Mucormycosis, A New Incident in Recent Time: Is An Emerging Disease in The Near Future Impending?

Mucormycosis (also known as black fungus) is caused by fungi of the Zygomycetes class and is the third most common invasive mycosis after candidiasis and aspergillosis. They colonize a large number of patients without invading them. Systemic glucocorticoids are currently used to treat severe Coronavirus disease 19 (COVID-19). In such patients, opportunistic fungal infections are a problem. Although COVID-19-related pulmonary aspergillosis is becoming more common, mucormycosis is still uncommon. Mucormycosis normally appears 10 to 14 days after being admitted to the hospital. Mucormycosis is a rare but dangerous infection that can make extreme COVID-19 worse.Mucormycosis is more likely to occur in people who have diabetes mellitus and other risk factors. Mucormycosis is most likely exacerbated by concurrent glucocorticoid treatment. To improve outcomes, a high index of suspicion and aggressive management is required. Excessive usage of steroids, monoclonal antibodies, and broad-spectrum antibiotics might cause the formation or worsen of a fungal infection.A high index of suspicion and aggressive management are needed. In patients with COVID-19 infection, physicians should be vigilant of the likelihood of subsequent invasive fungal infections. To enhance results in pulmonary mucormycosis, early diagnosis and treatment are critical. Confirmation of the clinical form necessitates a combination of symptoms that are consistent with tissue invasion histologically. Combining various clinical data and the isolation of the fungus from clinical samples in culture is needed for the probable diagnosis of mucormycosis. The organism that causes mucormycosis is identified using macroscopic and microscopic morphological criteria, carbohydrate assimilation, and the maximum temperature at which they can expand. Mucormycosis must be treated with antifungal medication prescribed by a doctor. It may necessitate surgery in some circumstances, and it can result in the loss of the upper jaw and, in some situations, an eye.

Fungal keratitis after small incision lenticule extraction (SMILE): a case report and review of the literature

Purpose To report a case of perforated fungal keratitis after small incision lenticule extraction (SMILE) treated with penetrating keratoplasty (PKP). Methods Case report and literature review. Results A 41-year-old woman presented with culture-proven unilateral fungal keratitis 4 days after uneventful SMILE. Her visual acuity was hand motion. The patient was treated with voriconazole irrigation (50 μm/0.1 ml) of the pocket and intrastromal voriconazole injection, in addition to systemic and topical antifungals. Despite aggressive management and decreased infiltration, the cornea was perforated and subsequently treated with PKP. Conclusions Infectious keratitis after SMILE is unusual. To our knowledge, this is the first report of perforated fungal keratitis post-SMILE. PKP eradicated the infection.

Acute-onset isolated bilateral palatal palsy in an adolescent

A 16-year-old patient presented with sudden-onset difficulty in swallowing food especially for liquids with nasal regurgitation and rhinolalia with no history of fever and limb weakness. Examination revealed bilateral palatal palsy with absence of gag reflex. Other neurological examinations were normal. Investigations were done to rule out any known pathology leading to such a presentation. The symptoms were attributed to an idiopathic acute-onset-acquired bilateral palatal palsy, in the absence of any identifiable cause. This is a rare presentation in adolescent age with no case reported in the literature so far in this age group. Medical management was started and patient showed complete improvement within 2 weeks of his symptoms. Early diagnosis and aggressive management of this condition lead to a favourable prognosis.

Intussusception as a Manifestation of COVID -19

COVID 19 has created a havoc in the world and has brought the world to a standstill. Everyday we get to learn something new about the powerful virus. COVID has different varied clinical presentations. Besides respiratory symptoms many children present with GI symptoms during this 2nd wave of COVID. We present a case of a 10 year male child who presented with features of intussusception with a history of URTI 5 days prior to acute abdomen. Unlike other cases where children respond nicely to post operative conventional treatment, this child went downhill inspite of aggressive management in PICU. In view of ongoing pandemic and mother who was found to be COVID positive, a thought if the child could be suffering from COVID and its complications. Throat swab for RTPCR SARS CoV-2 was found to be positive and acute viral inflammatory markers were found to be highly elevated. A diagnosis of Severe COVID-19 with cytokine storm manifesting as intussusception was made. All children with acute abdomen should be evaluated for COVID 19. Out of all the atypical manifestations, intussusception being one of the rare manifestations of COVID 19 [1]. Key words: Covid, intussusception, cytokine storm, RTPCR.