COVID-19 Infection and Late Manifestation of Pulmonary Aspergillosis

We present the case of a 56-year-old woman who was diagnosed with severe coronavirus disease 2019 (COVID-19) pneumonia complicated by severe acute respiratory distress syndrome who was intubated for 19 days. She recovered from COVID-19 after a month. A computed tomography (CT) scan of the chest, after a month, showed improved infiltrates with a small residual cavity within the lingula. A CT angiogram showed a more confluent density in the lingular portion on follow-up 2 months later. She developed intermittent hemoptysis after 3 months in December 2020, which persisted for almost 6 months, and CT of the chest showed the lingular nodular with resolution of the cavitation. She underwent bronchoscopy with bronchoalveolar lavage, confirming Aspergillus fumigatus by galactomannan assay and histology showing branching hyphae. Once she started treatment with itraconazole, her hemoptysis resolved. The follow-up CT of the chest after 2 months of treatment did not show a cavity or a nodule in the lingula. Our patient developed invasive pulmonary aspergillosis (IPA) as a sequela of severe COVID-19 infection. COVID-19-associated invasive pulmonary aspergillosis (CAPA) is an underrecognized complication that needs to be investigated on whether prophylactic treatment is required. Our case also demonstrates that the diagnosis of IPA needs to be considered months after COVID-19 infection when a superimposed fungal infection can occur after a viral infection if the patient continues to have persistent symptoms.

Spinal Muscular Atrophy 5q under the Mask of Myopathy: 10 Clinical Cases

Background. Spinal muscular atrophy 5q (5q SMA) is the most frequent autosomal recessive hereditary neuromuscular disease. Molecular genetic testing is used for SMA diagnosis, and it can confirm only 5q SMA. The clinical findings and results of paraclinical studies may overlap with hereditary primary-muscular diseases making the diagnosis difficult and delaying the administration of pathogenetic treatment for 5q SMA.Clinical case description. Clinical description of 10 patients with 5q SMA aged from 3 months to 25 years with different severity of proximal tetraparesis, skeletal muscular atrophy and tendon reflexes depression is given. 3 patients under 2 years of age with myogenic pattern at needle electromyography (nEMG) in lateral vastus muscle and 7 patients over 2 years of age with increased levels of creatine phosphokinase (CPK) in blood serum were mistakenly diagnosed for inherited primary-muscular diseases for the period from 1 month to 12 years. After the genetic counselling based on the disease course and clinical findings we suspected and later confirmed 5q SMA.Conclusion. In case of flaccid proximal tetraparesis associated with myogenic pattern at nEMG in young children or with increased CPK levels at late manifestation it is crucial to perform differential diagnosis of 5q SMA since there are options of pathogenetic therapy.

NEONATAL LISTERIOSIS: AN ALMOST FORGOTTEN INFECTION OR RENAISSANCE OF THE DISEASE

Maternal neonatal listeriosis is less common desease, but contributes significantly to neonatal and infant mortality rates. The survey presents data on the the pathogen, epidemiology of the disease, and risk factors. Attention is paid to the pathogenesis of the development of this intrauterine infection. The emphasis is placed on the development of neonatal (congenital) listeriosis, as well as the risk of serious complications for the child. The article describes the symptoms of the disease at early and late manifestation, variants of the clinical course, the results of autopsy of dead newborns. Attention is drawn to the problems of treatment and prevention of neonatal listeriosis. Doctors of related specialties (obstetricians-gynecologists, neonatologists, pediatricians) should have up-to-date information about this disease.

The Spatial History of Revelation in Carl Ritter’s Erdkunde (1817–59)

Traditional theological concepts, including revelation, shaped academic disciplines as they emerged in nineteenth-century Germany. The first university professor of geography, Carl Ritter, crafted an intriguing spatial history of revelation in his masterful Earth Science in Relation to Nature and the History of Man (1817–1859). The teleological bent of Ritter’s geography and his commitment to intelligent design have encouraged most commentators to regard Ritter as a late manifestation of physicotheology. However, this long-standing explanation of a crucial geographer’s religious platform misconstrues the field’s theological commitments. Physicotheology suffered irreversible losses in the German states in the late eighteenth century. Ritter’s adherence to primordial revelation and biblical literalism typify the religious awakening of the Napoleonic period more than enlightened rationalism. He is best understood as a geographer of religion, dedicated to evangelical missions and intrigued by how the Earth’s features shaped the spread and transformation of religious ideas and practices, including Buddhism.

Prevalence and predictors of bradyarrhythmias requiring Permanent Pacing in patients with Anderson-Fabry disease.

Introduction: Bradyarrhythmias are an established red flag for storage cardiac conditions including Anderson-Fabry disease (AFD). The prevalence of bradyarrhythmias requiring a pacemaker (PM) and their timing in AFD is unresolved. We evaluated prevalence and predictors of PM requirement in a large AFD cohort, investigating the occurrence of bradyarrhythmias as initial versus late manifestation. Methods: we retrospectively evaluated 82 consecutive AFD patients referred to our multidisciplinary referral centre from 1994 to 2020 with a median follow up of 6.9 years, identifying those requiring pacing. Univariable analysis was performed to identify cardiac features associated with PM implantantion. Results: Five of 82 (6%) AFD patients required PM implantation (5/39, i.e. 13% of those with cardiac involvement), always in the context of advanced cardiomyopathy. In none, bradyarrhythmias were the presenting feature. Indications included sick sinus syndrome in 3 patients, advanced atrio-ventricular block in 2 patients. QRS prolongation during follow up strongly correlated with the onset of bradyarrhythmias. Conclusions: Severe bradyarrhythmias are relatively frequent in patients with AFD cardiomyopathy, but do not represent a mode of presentation, occurring late in the disease course and always in the context of advanced cardiac involvement. Monitoring QRS variations over time may help to identify patients requiring pacing.

Unilateral Pyosalpinx in an Adult Female presenting with Features of Acute Abdomen: A Case Report

Pyosalpinx is defined as collection of pus in the fallopian tube and is a late manifestation of pelvic inflammatory disease. Pelvic inflammatory disease refers to a spectrum of inflammatory changes of the female genital tract. It comprises of endometritis, salpingitis, cervicitis, pyosalpinx, tubo-ovarian abscess and peritonitis. Pyosalpinx may progress to tubo-ovarian abscess which may rupture leading to peritonitis. In addition, pelvic inflammatory disease commonly affects both side of the tube. Thus, early diagnosis and proper intervention plays a great role in the management of pyosalpinx. We report a case of unilateral left sided pyosalpinx which presented with features of acute abdomen.

Hemodynamics changes in late manifestation of natal trauma of spinal cord’s cervical department

Hemodynamics of children with natal trauma of spinal cords cervical department was studied. It was determined, that among numerous manifestations of late complications of natal cervical traumas amyotrophy syndrome of shoulder girdle is widely spread, in which in 65% of cases hemodynamics insufficiency is determined in the carotid region, and in 37% - in vertebro-basilar region. Functional tests allowed to determine occult blood flow insufficiency in vertebro-basilar region in 80% of cases, thus confirming presence of chronic circulatory insufficiency in the system of vertebral arteries in patients with amyotrophy syndrome of shoulder girdle.

Metastasis of Osteosarcoma to the Abdomen: A Report of Two Cases and a Review of the Literature

Two cases of primary distal femur osteosarcoma with subsequent metastasis to the abdomen are presented. In both cases, the development of abdominal metastasis was quickly followed by patient decline and death. A review of the literature was performed, assessing the presentation and survival of patients with osteosarcoma metastasized to the abdomen. As illustrated by the current cases and the literature review, abdominal metastasis in osteosarcoma is often a late manifestation and terminal prognostic indicator. Nonetheless, early detection and prompt intervention of this less common site of disease metastasis may improve patient care and palliative therapy.