Rhino-orbital Mucormycosis in a COVID-19 Patient: The First Case in Malaysia

Mucormycosis is an aggressive and potentially fatal fungal infection caused by fungi of the order Mucorales. There has been an increase in the number of cases of rhino-orbital mucormycosis in people with COVID-19, particularly in India. Rhino-orbital-cerebral mucormycosis is the most common manifestation of mucormycosis associated with COVID-19. We report the first case of rhino-orbital mucormycosis in a diabetic patient with SARS-CoV-2 infection in Malaysia. The diagnosis of mucormycosis was confirmed by histopathological examination, but the fungal culture and PCR results were negative. He was treated with antifungal therapy and had extensive debridement. Treatment of mucormycosis requires a multidisciplinary approach that includes addressing underlying risk factors, effective antifungal therapy, and surgical debridement.

Neurological manifestations of COVID-19: A literature review

A novel coronavirus that started from the Wuhan province of China is affecting the whole world. As of this date, more than 222 million cases are reported with more than 4.60 million fatalities. Nepal has more than 771,000 cases reported with almost 11,000 death recorded to date. Though most of the patients present with flu-like symptoms, people with comorbidities like Diabetes mellitus, hypertension, lung, and heart disease most likely suffer from severe disease and even death. As reported, neurological manifestations are common in critically ill patients. The most common manifestation of CNS is headache, dizziness, and encephalopathy whereas loss of smell and taste is the common PNS manifestation. Other neurological complications seen are fatigue, myalgias, hemorrhage, altered consciousness, Guillain-Barre Syndrome, syncope, seizure, and stroke. Non-specific neurological symptoms may be present in the early stages which can mislead the treatment. In some cases, neurological manifestations precede the typical presentation of fever, cough, and shortness of breath and later develop into typical features. The virus enters the brain through 2 systems: hematogenous route or olfactory route. Angiotensin-converting enzyme-2 (ACE-2) is the port of entry to the brain for COVID- 19(SARS-CoV-2) which was also the entry point for SARS-CoV. Covid-19 cases are increasing in the world and prevention and control of spread are a must. Understanding the neurological invasion pathogenesis, and manifestation will help the neurologists and physicians on frontlines to recognize early cases with nervous system involvement, neurological complications, and sequelae during and after the pandemic.

Extraglomerular immune complex deposition in lupus nephritis

Background Lupus nephritis (LN) is a common manifestation and a major cause of morbidity and mortality in systemic lupus erythematosus (SLE) patients. It is characterized by glomerular and often extraglomerular immune complex deposition. Purpose Given the emerging importance of the tubulointerstitial compartment, we conducted a retrospective study of 78 LN biopsies to enumerate the spectrum of extraglomerular immune complex deposition that can be observed in lupus nephritis by electron microscopy and to identify possible clinical or pathologic correlates. Results The presence of tubulointerstitial immune complex deposition often accompanied interstitial inflammation, but some discrepancies were also seen. Conclusions As target antigens are identified, correlation with glomerular, tubulointerstitial, and vascular immune complex deposition will be of increasing interest.

COVID-19 Induced Immunosuppression resulting in Pulmonary Mucormycosis : A Long COVID sequalae

With increasing incidence of Severe Acute Respiratory Distress Virus 2(SARS -CoV -2) in India, there has been growing reports of super infections in post covid 19 period. Long COVID refers to persistence of COVID19 symptoms for weeks to months. While most common manifestation of long COVID is fatigue and ill health, it may lead to development of life-threatening complications like Pulmonary Mucormycosis. We report a case of 54 year young, non-diabetic previously healthy male who had moderate COVID19 treated with low dose steroids and recovered completely, only to present with hemoptysis 3 months later on High Resolution Computed Tomography Scan of the Chest and Rhizopus fungi on bronchoalveolar lavage confirming Post Covid Pulmonary Mucormycosis in non-immunocompromised host. Patient was managed with dual antifungal therapy intravenous Liposomal Amphotericin B and Posaconazole for 3 weeks, followed by oral Posaconazole. J MEDICINE 2021; 22: 150-154

Effect of Anticoagulants on the Survival Rate in Critically Ill COVID-19 Patients

Background: The World Health Organization (WHO) declared Coronavirus disease 2019 (COVID-19), as a pandemic in January 2020. The morbidity and mortality associated with the disease are enormous COVID-19, with a multi-systemic pathology, exhibits thrombosis as a common manifestation. Disseminated intravascular coagulation (DIC) and thrombotic lesions have been reported in >70% and >30% of patients, respectively, who have died due to the COVID-19 and therefore, heparin is included in the treatment of moderate to severe cases. This retrospective study was undertaken to check the effectiveness of prophylactic therapy with heparin at reducing mortality in critically ill COVID-19 patients. Methodology: The study included retrospective data from case records of 169 critically ill COVID-19 patients with or without comorbidities and an anticoagulant regimen. The data were thoroughly studied for demographic profile, comorbidities, type and dosage of anticoagulants, length of intensive care unit stay, and mortality rates. Results: The male to female ratio of the study subjects was 125/44 (76%/24%). Patients with comorbidities were critically ill as compared to those with none (140/29), and diabetes mellitus was the most common comorbidity, found in 99 patients. Mortality rate was significantly higher in patients who had not received any anticoagulant (p = 0.015) and in patients who had received unfractionated heparin (p =0.036) as compared to those who received low molecular weight heparin (LMWH). Conclusion: The prophylactic administration of heparin improves the survival rate of the critically ill covid 19 patients is more when compared with the patients who do not receive heparin. LMWH is very effective in reducing thrombotic complications and mortality in critically ill COVID-19 patients.

Warm Compress on Lowering Body Temperature Among Hyperthermia Patients: A Literature Review

Hyperthermia increased the core human body temperature above normal 36.7-37.5 °C, usually caused by infection, resulting in fever, and was the most common manifestation. One of the efforts that could be done to overcome the symptoms of hyperthermia was the application of warm compresses to the frontal, axillary, and dorsalis pedis. The study aimed to describe body temperature changes in hyperthermic patients after warm compress was applied. This study used a descriptive design with a literature review approach. Twelve articles were included in this review by six journal databases: PubMed, JSTOR, Wiley Online Library, Sage Journal, Taylor and Francis Online, and Google Scholar. The selection was carried out by assessing articles that met the inclusion criteria, including the publication range for 2008-2021, English and Indonesian languages ??, and open access to full-text pdf. The critical assessment was carried out by using the Critical Appraisal Skills Programmed instrument. The review results showed that the warm compress method had a positive effect in lowering body temperature in the nursing process in patients with hyperthermia. Based on the literature from the reviewed articles, it could be concluded that a warm compress intervention needed to be given to hyperthermic patients to lower the patient's body temperature whether they were undergoing treatment or not

IDH Wild-type Glioblastoma Presenting with Seizure: Clinical Specificity, and Oncologic and Surgical Outcomes.

Background Glioblastoma (GBM) is the most common and aggressive primary brain neoplasia in adults. Seizure is a common manifestation in GBM. Up to 25 to 60% of patients with GBM have seizures. We aim to summarize all the relevant clinical, surgical, radiologic, and molecular features of a cohort of patients suffering from GBM-related epilepsy and measure the outcome, to understand the possible existence of a clinical/phenotypical specificity of this subgroup of patients. Methods We retrospectively analyzed a cohort of 177 patients affected by isocitrate dehydrogenase wild-type (IDH-WT) GBM; 49 patients presented seizure at onset (SaO) and 128 were seizure free (SF). We investigated the relationship between seizures and other prognostic factors of GBMs. Results A statistically significant association between the location of the lesions in the parietal lobe and seizures was observed. The left side was more commonly affected. Interestingly, there was a statistical relationship between tumors involving the subventricular zone (SVZ) and SaO patients. The tumors were also smaller on average at diagnosis, and generalized SaOs were associated with longer overall survival. Conclusions The typical patient with IDH-WT GBM with SaO is a young (<55 year) male without a history of headache. The lesion is typically small to medium in size and located in the temporoparietal dominant lobe, with a high tendency to involve the SVZ.

Symptomatic Medial Bone Excrescence in the Distal Phalanx of the Hallux after the First Metatarsophalangeal Joint Arthrodesis: A Case Report and Radiographic Reviews

Medial bone excrescence at the base of the distal phalanx of the hallux is a common manifestation which is rarely painful. In this case report, we described the first case of the excrescence becoming symptomatic one year after a metatarsophalangeal (MTP) joint arthrodesis of the great toe in a 74-year-old female. The medial bony excrescence which was obscure preoperatively became obvious postoperatively in the anteroposterior foot radiographs. The patient was successfully treated by an excision of the excrescence. In order to clarify the pathology of the excrescence, we reviewed the radiographs with respect to the excrescence before and after hallux surgeries including 97 metatarsal osteotomies and 33 MTP joint arthrodesis. The width of the excrescence measured in the anteroposterior foot radiographs displayed substantial increment one month after the hallux surgeries (osteotomy group: 0.9 ± 0.7 vs. 1.5 ± 0.7 mm , p < 0.01 ; arthrodesis group: 1.3 ± 0.8 vs. 1.8 ± 1.0 mm , p < 0.01 ). However, there was no significant difference in the width of the excrescence between one month after surgery and at the most recent follow-up of around 20 months in average after the surgery (osteotomy group: 1.5 ± 0.7 vs. 1.4 ± 0.7 mm , p = 0.62 ; arthrodesis group: 1.8 ± 1.0 vs. 1.8 ± 0.7 mm , p = 0.37 ). The present case and our radiographic review suggested that the postoperative medial bony excrescence was not the result of change of position of the preexisting excrescence. The correction of pronation deformity through hallux surgeries could emphasize the medial bony excrescence and cause symptomatic irritation upon shoe contact.

Primary Antiphospholipid Syndrome with Livedo Reticularis is Linked to Female Sex and Stroke and Negatively Associated with Thyroid Disease

Aim: To study the clinical and laboratory findings between patients with primary Antiphospholipid Syndrome (pAPS) with and without LR. Background: Livedo Reticularis (LR) is a common manifestation of Antiphospholipid Syndrome (APS). Although no previous study evaluated patients with and without LR. Methods: A transversal study including 66 pAPS patients was performed. Demographical, anthropometric, medication use, antiphospholipid antibodies profile data were evaluated, and LR's clinical and laboratory features. Patients were subdivided into one of two groups: pAPS with LR and pAPS without LR. Results: Both groups were alike concerning demographics and anthropometrics. Interestingly, the frequency of stroke (28.5 vs. 7.5%, p=0.04), as well as of Sneddon’s syndrome (100 vs. 30.0%, p<0.0001), were higher in pAPS with LR than the other group. Conversely, patients in the pAPS without LR group had more thyroidopathy than those in the pAPS with LR group (80% vs. 50% %, p=0.03). Conclusion: Patients with pAPS and LR have more stroke and seem to be protected from thyroidopathy. Careful follow-up of these patients is therefore advised.

CRITIQUE ON JALODARARI RASA - A MIGHTY HEPATOPROTECTOR

Ayurveda is the oldest methodical branch of knowledge that speaks its reality in the sketch of philosophy. It comprises most scientific milieu of derivation. As per ancient Ayurveda scholars for getting a desirable outcome of any medication, it should be precisely analysed before prescribing to the patient. There are several classical formulations successfully practised by Ayurveda physicians for treating various ailments, and also there are few unexplored but potent formulations that need the attention of practitioners to come to light. The present study is based to collaborate various references as well as the Pharmacological importance and mechanism of action of a distinctive hepatoprotection Jalodarari Rasa. The most common manifestation of liver dysfunction is ascites, and the most common cause of ascites is liver disease. Ascites is the accumulation of fluid in the peritoneum. Despite advanced medical facilities still, there is no definite treatment that cures a patient of ascites completely. The modern treatments only provide provisional relief with time dependant recurrence but, the fluid gets collected in the abdominal cavity repeatedly. In such cases, Ayurvedic treatment gives relief without any side effects and can be correlated with Jalodara, mentioned in Ayurvedic medical science. Jalodarari Rasa is a herbomineral preparation that is depicted in Bhaishajya Ratnavali Udararogaprakarana, its fundamental constitution being Jayapala, Tamra bhasma, pippali, maricha which are all having lekhana- pachana-bhedana action and thereby useful to evacuate the excess accumulated fluid which is needed to counteract Jalodara. Hence, here an attempt has been made to address the detailed review of Jalodarari rasa. Keywords: Ascites, hepatoprotective, Ayurveda