Early and Progressive Cognitive Disorder Imposes CADASIL Syndrome in the Diagnostic Assumption

The case presented is a diagnostic challenge considering the family and medical history of the 65-year-old patient with a family history of migraine depression, emotional lability, and gait disorders manifested at his grandmother, his mother, and his sister. After multiple hospitalizations for the described symptoms and multiple treatments with questionable results, the diagnosis was imposed by the appearance described by brain MRI to which were added the data from the patient's family and personal history. Of course, a full confirmation of the diagnosis would have required skin biopsies and genetic testing that the patient refused to perform. However, due to its peculiarities, the presented case tries to offer a diagnostic orientation path for practitioners in situations where previous diagnoses and treatments are not sufficiently conclusive either due to the impossibility of performing specific tests at that time or either because of the patient's indifference to his state of health.

Evolutive Aspects Of Patients With Cirrhosis After Harvoni Therapy

Introduction: Cirrhosis, is a final pathway of chronic liver diseases. In recent years, Direct-Acting Antiviral Agents (DAAs) gained a leading role in the treatment of chronic hepatitis of viral etiology. Aim of the study: The proposed aims of this research are to estimate the virological response after 12 weeks after treatment completion and to evaluate the beneficial effects of the treatment on patients with decompensated cirrhosis. Patients and methods: The study was of a descriptive type, longitudinal and retrospective, conducted over a 15 months period, including patients with HCV-related cirrhosis patients. It was established the correlation between liver function, metabolic function, comorbidities and severity of cirrhosis and the level of HCV RNA before and after treatment. It was assessed also the neuroinflammatory activity from the results of Fibromas and the complication after therapy. Results: From January 2018 to April 2019, patients with liver cirrhosis were hospitalized. 48 HCV- related cirrhosis patients have fulfilled the eligibility criteria for antiviral treatment and they have constituted the study group. From all the HCV-infected patients with cirrhosis, 41.66% were women and 58.33% were men, most of them in the interval 60-70 years (37.5%) and 70-80 years (33,33%). 87.5% from the patients had compensated cirrhosis (Child-Pugh A class) and 12.5% had decompensated cirrhosis (Child-Pugh B and C class). 77.08% of the patients had severe neuroinflammatory activity – A3, 10.41% had moderate -A2 activity and 12.5% had lower neuroinflammatory activity-A1. The treatment with direct antiviral agents for the study group consisted in three treatment regimens.60% received a two-drug fixed-dose combination- sofosbuvir (SOF)/ledipasvir (LDV). 10% received SOF/LDV combination with Ribavirin. Only 1 patient with Child-Pugh C decompensated cirrhosis received SOF/LDV combination without Ribavirin. Also, a double combination received 10.48% of the patients- grazoprevir (GZR)/ elbasvir (EBR) 20.83% received quadruple combination ombitasvir (OBV)/ paritaprevir (PTV)/ritonavir(r) and dasabuvir (DSV). After 12 weeks from treatment completion, all the HCV-RNA’s level were undetectable. There were no side effects of the treatment. None of the patients didn’t stop the treatment during the period of treatment. There was a statistically significant difference between the ASAT and ALAT level before and after treatment (p<0.0001). 1 patient with Child-Pugh score C, died and another patient with Child-Pugh score B had an episode of variceal bleeding. Conclusion: Treatment with direct antiviral agents as Harvoni regimen, is a safe therapy and effective for HCV-infection and advanced liver disease. Despite the efficiency of the treatment on HCV-RNA, there were patients with complications due to the cirrhotic status of the subjects. The patients with existing decompensated cirrhosis remain at an elevated risk of numerous other complications.

Applied Successful Treatment of Two Main Post-COVID-19 Symptoms: Anosmia and Ageusia: A Novel Approach

Patients recovering from COVID-19 occasionally reported anosmia (loss of smell) and ageusia (loss of taste). This paper aims to use medications to treat anosmia and ageusia in post-COVD-19 recovered patients. A total of 6391 recovered COVID-19 patients were invited to enroll in this study from all age groups, both genders and different health conditions (immunocompromised and immunocompetent patients). Clinical treatments of anosmia were done by application of Apisal nasal/eye drops (Amman Pharmaceutical Industries, Jordan), used 3 times a day to stimulate nasal epithelial lining cells. It can sensitize the nose then stimulate and induce smelling function. Responders were 2794 (43.72%) of patients who were cured and retained smelling (novel work). Next was application of Vicks inhaler nasal stick which consists of 125 mg menthol, 50 mg camphor and 10 mg Siberian pine needle oil used 3 times a day. Responders were 5884 (92.07%) within 5 days. A combination of Apisal and Vicks recorded 6186 (96.80%) cures. The rest, 205 non-responsive patients to above medications were prescribed Avamys (fluticasone furoate) 27.5 micrograms/spray, nasal spray suspension (GSK, UK), twice a day which gave 203 (99.02%) cures as this is a novel work. Clinical treatment of ageusia involved administration of A-Z vital caplets (Hansal, Germany), an excellent tonic (multivitamins and minerals) once a day for adults, while Pharmaton Kiddi syrup (Boehringer Ingelheim, Germany) was given to children. Hot spices included a mixture of equal volumes of black pepper, ginger, cinnamon, cloves and coriander (doses were not determined but little mixture powder was applied inside the mouth) were advised beside tonics to stimulate taste pads so as to gain its function back to normal. 6382 (99.80%) patients got their taste back to normal within 5 days and this is also a novel work. After massive success of these medications, they were circulated all over Arab homeland as well as expat Arabs across the world.

Glomus Tumors: A Frequent Cause of Finger Pain

There are numerous reasons for one to have finger pain. Coming to a definitive diagnosis can sometimes be difficult. Glomus tumors frequently go undiagnosed because many physicians and healthcare providers are not aware of this diagnosis. Awareness of glomus tumors and the impact they have on someone’s quality of life should be more abundant in healthcare. If these patients were able to seek proper treatment sooner, they could avoid suffering for years.

A Comparison in Work-Up Between the First and Second Covid 19 Infection in the Same Patients in the ED Tawam Hospital, UAE

Aim of study: To identify the significance of routine laboratory investigations conducted in patients infected with COVID-19 for the second time as compared to being infected with COVID-19 for the first time in the UAE. Methods: 345 patients between the ages of 16 and 65 years who were infected with COVID-19 were included in the study. Patient’s charts were reviewed and all laboratory tests and imaging conducted were reviewed. Furthermore, patients were divided into two groups: one as a first time COVID-19 infection group and the other as a second time COVID-19 infection group. Results: Fifteen laboratory tests have been conducted. Of these tests, 44.4% (4 tests) (procalcitonin, phosphate, magnesium, amylase, and lipase) that were abnormally elevated in patients in the first infection group were found to be significantly reduced in patients with a second COVID-19 infection. Also, two imaging modalities done which included Chest–X ray and CT thorax without contrast were abnormal in all the patients in the second infection group. Conclusion and recommendations: We recommend not using the following labs in patients with COVID-19 infection for the second time: procalcitonin, magnesium, lipase, amylase, phosphate. However, we do recommend performing Chest X-ray and CT thorax without contrast in assessing severity of disease in patients with COVID-19 infection for the second time.

Critical Care Neurocardiology

Cardiac disturbances are quite frequent in a stroke patient be it arrhythmia or LV dysfunction. It is becoming quite common to observe the heart and brain interaction in the ICU. Critical care at its core takes into consideration the human body in its entirety. Hence the clinical management of the brain and heart disorders cannot be isolated. The care of neurologic patient is influenced by cardiac diseases, and likewise neurological consideration is essential in many types of heart diseases. Cardiologists and Neurologists view heart and brain alone respectively and ignore the other. There is a lot of literature with evidence regarding the importance of brain–heart interactions from the 80s onwards. However, many do not view them together for management.These relationships in terms of physiological, clinical and management issues daily are of utmost importance in critical care.So, the questions are, can we consider the term Neurocardiology in critical care on a daily basis?What are the interactions between the brain and the heart and what is the concerned pathophysiology? How does it influence in the management and outcomes of patients?In the setting of Critical care, time and proper decision making is a crucial factor. How hemodynamic & intracranial dynamic monitoring helps to determine the immediate and long-term management of the patient and how it influences the outcome will be discussed. We present here a series of two cases which clearly depicted the alterations in the neuro-cardiac axis to reiterate the importance of neurocardiology once again in the critical care setting.

Mucormycosis in COVID Times

Mucormycosis is a disease caused by the fungus of the Mucorales species. These fungi are present in the environment and are common commensals in the human body, mainly in the nose and sinuses, or respiratory tract and lungs. Rarely, in immunocompromised individuals or those who have temporary depression of immunity, these fungus manifest most commonly as rhino-cerebral mucormycosis or pulmonary mucormycosis. At rare times, the skin may also get involved. Recently ICMR has come up with guidelines for mucormycosis, in this commentary, it's our primary focal article.

Usefulness of Osmolar Excretion Rate in the Diagnosis of Fluids and Electrolytes Overlap Syndromes

Clinical practice related to electrolytes and acid-base disorders is commonly approached as a single entity. Overlap syndromes are an uncommon clinical condition that must be considered as part of differential diagnosis when a patient is assessed. The coexistence of electrolytic disorders could make it difficult to interpret certain variables due to the influence of such disorders on the same variable, even in the opposite way. In this context, there are some tools that are very useful in order to establish the correct diagnosis. Thus, osmole excretion rate, tonicity balance, and estimation of electrolyte-free water balance should be considered along with other biochemical variables in order to increase the possibility to make a correct interpretation.

COVID-19 WAR, Unusual Vaccines versus Platelets

As are described/predicted previously, pandemic attacks via COVID-19 mutants cause more than three million causalities, and counting, which exact mechanism is not completely elucidated yet (May 2021). Ironically we are still surviving the global contamination after 20 months neither because of professional scientific-based approaches nor due to excellent specific drugs/ vaccines developed lately. Surprisingly, the detailed mechanism of actions of COVID-19 induction of platelet disorders is not elucidated completely. Moreover, asking frankly whether our turn might be in the near future with(out) vaccines administration or not? Most people still are not sure whether take a vaccine shot or not needed anymore, after 20 months of struggling with biotechnologically developed superbug microorganisms?

Limb Salvage Procedure in a Patient of High-tension Electric Burns Utilising Delay Phenomenon in Perforator-based Flap- A Case Report

Electric burn is a devastating injury causing tissue and organ loss. We present here a case of an electric burn injury over a bilateral lower limb and bilateral upper limb. The patient had undergone left above-knee amputation, thus cross-leg flap from the left side was not possible and due to electric burns, the vascularity of the right leg was also doubtful therefore a delayed flap was planned to cover the exposed defect over the right knee and defect over the right tibia. The Flaps underwent a delay procedure before the final inset so that the flap undergo ischemic preconditioning and the neovascularization that increases the size of the flap and chances of survival of the flap by manifold.