Infantile Neurodegeneration and Hair Changes: A Rare Case of Menkes Disease

A 4-month-old, previously healthy boy presented with acute onset of prolonged, recurrent seizure activity followed by neurodevelopmental deterioration and concurrent hair shaft hypopigmentation with fragility. Initial evaluation revealed significant low serum copper and ceruloplasmin, electrical status epilepticus on electroencephalography, and generalized subcortical white matter changes with diffuse tortuosity of intracranial vessels on MRI brain. In addition, a genetic study with whole-genome sequencing demonstrated a hemizygous pathogenic variant at c.2179G>A p(Gly727Arg) on ATP7A, thereby confirming the diagnosis of Menkes disease. Symptomatic treatment with antiepileptic medications was provided along with an urgent referral to an advanced center for multidisciplinary care and copper histidine replacement therapy.

Splenic Infarction in a COVID-19 Patient without Respiratory Symptoms

High rates of thromboembolic events have been seen in cases of COVID-19. Here, we report a case of 23-year-old previously healthy female presented with left-sided abdominal pain associated with vomiting. The computed tomography scan showed multiple ill-defined wedge-shaped low attenuating areas of the spleen, suggesting splenic infarction. In the absence of other thromboembolic contributing factors, we believe this was a thromboembolic event in splenic circulation in relation to COVID-19 infection. Our case adds to the evidence of an arterial thrombotic event in a noncritical COVID-19 patient, emphasizing the importance of addressing thromboembolism diagnosis and management measures to avoid potentially deadly consequences.

Effect of Caring of Critically Sick Patients with COVID-19 Pneumonia at Undesignated ICU Wards on Secondary Infections

<b><i>Introduction:</i></b> COVID-19 has caused high rates of mortality. During pandemic peak, a significant number of patients were admitted to undesignated ICU areas before transferring to designated ICU, owing to unavailability of ICU beds. We aimed to record the effect of care of critically sick patients with COVID-19 on prevalence of secondary bacterial infection. <b><i>Methods:</i></b> We retrospectively studied all critically ill patients with COVID-19 pneumonia meeting ICU admission criteria who were admitted to Dubai hospital between January 1, 2020, and June 30, 2020. All the patients who transferred to wards other than designated ICU constitute category as cases. All patients who directly admitted to the designated ICU ward from emergency department constitute controls. The demographics, clinical parameters, and treatment profile of these patients were recorded and compared. Prevalence of secondary bacterial infection was calculated. <b><i>Results:</i></b> Patients with COVID-19 had high prevalence of secondary bacterial infection. Patients who stayed at undesignated ICU wards had higher occurrence of inpatient fever, hypoxemia, and they were more likely to be sedated and paralyzed than patients who stayed in designated ICU wards. Multiple logistic regression analysis showed care outside designated ICU ward does not predict increase in secondary nonviral microbial infections. <b><i>Conclusion:</i></b> Care of patients at undesignated ICU wards prior to admission to designated ICU does not impact prevalence of secondary bacterial infection.

Bartsocas-Papas Syndrome: Case Report

Bartsocas-Papas syndrome (BPS) is a rare form of autosomal recessive disease, which is often severe and most of the time lethal. Only a few cases have been reported in the literature, so far mainly from the Mediterranean ancestry. We are describing here a case of severe form of BPS, which we encountered in our hospital in Dubai, UAE, which was diagnosed by antenatal scan; the baby had typical features of BPS and died immediately within few hours of life. Parents were first-degree consanguineous couples, and there was a family history of this disorder.

Rapunzel Syndrome – A Case Report: Trichobezoar as a Cause of Gastric Outlet Obstruction and Intestinal Perforation

Rapunzel syndrome is described as a rare manifestation of gastric trichobezoar extending throughout the bowel and is associated with psychiatric disorders. Its incidence in Pakistan is very rare and is found characteristically in adolescent females. Large or complicated trichobezoars are best managed by surgery. Psychiatric follow-up is essential to diminish the frequency of recurrence. We report an unusual case of Rapunzel syndrome causing gastric outlet obstruction and intestinal perforation.

Table Sugar as a Bridge from Emergency to Elective Perineal Proctosigmoidectomy for Incarcerated Rectal Prolapse

Incarcerated rectal prolapse is a rare pathology and is considered an emergency, using table sugar can shift the emergency surgery to an elective one. If left untreated, rectal prolapse may present as an emergency, be it incarceration or strangulation. In an emergency presentation for incarcerated rectal prolapse every attempt should be taken to reduce the prolapsed rectum, if not successful, emergency surgery is indicated, with perineal approach being the first choice in elderly with multiple comorbidities.

Surveillance of COVID-19 Using Geospatial Data: An Emergency Department Perspective

<b><i>Background:</i></b> The outbreak of coronavirus 2019 (COVID-19) which emerged in December 2019 spread rapidly and created a public health emergency. Geospatial records of case data are needed in real time to monitor and anticipate the spread of infection. <b><i>Methods:</i></b> This study aimed to identify the emerging hotspots of COVID-19 using a geographic information system (GIS)-based approach. Data of laboratory-confirmed COVID-19 patients from March 15 to June 12, 2020, who visited the emergency department of a tertiary specialized academic hospital in Dubai were evaluated using ArcGIS Pro 2.5. Spatiotemporal analysis, including optimized hotspot analysis, was performed at the community level. <b><i>Results:</i></b> The cases were spatially concentrated mostly over the inner city of Dubai. Moreover, the optimized hotspot analysis showed statistically significant hotspots (<i>p</i> &#x3c; 0.01) in the north of Dubai. Waxing and waning hotspots were also observed in the southern and central regions of Dubai. Finally, there were nonsustaining hotspots in communities with a very low population density. <b><i>Conclusion:</i></b> This study identified hotspots of COVID-19 using geospatial analysis. It is simple and can be easily reproduced to identify disease outbreaks. In the future, more attention is needed in creating a wider geodatabase and identifying hotspots with more intense transmission intensity.

Early, Subacute Coronary Stent Thrombosis: A Complication of COVID-19 Infection

Soon after it was discovered in Wuhan, China, in December 2019, coronavirus disease 2019 (COVID-19) blow-out very fast and became a pandemic. The usual presentation is respiratory tract infection, but cardiovascular system involvement is sometimes fatal and also a serious personal and health care burden. We report a case of a 57-year-old man who was admitted with anterior wall acute myocardial infarction secondary to early coronary stent thrombosis and associated with COVID-19 infection. He was managed with primary coronary angioplasty and discharged home. Procoagulant and hypercoagulability status associated with severe acute respiratory syndrome coronavirus 2 infection is the most likely culprit. Choosing aggressive antithrombotic agents after coronary angioplasty to prevent stent thrombosis during the COVID-19 pandemic may be the answer but could be challenging.

Aortic Impingement in Displaced Traumatic Spine Fracture with Complete Spinal Cord Transection: A Case Report

Aortic impingement associated with traumatic thoracic spinal fractures is a rare and potentially lethal complication that creates management challenges in an already complex clinical problem. Traumatic aortic injury is one of the leading causes of death in blunt trauma. Magerl divided thoracic and lumbar fractures into 3 categories; the primary focus of this report, type C fractures, describes rotational injury and is one of the less common types, especially associated with aortic impingement as such. In this case, a young man was admitted following a near-fatal fall resulting in blunt force trauma to the midthoracic region. Emergency CT revealed a type C complete transection at the level of T11 and a grade I aortic injury. Definitive fixation of the spinal injury was delayed in favor of preventing further vascular injury by prioritizing the securing of hemodynamic stability. In traumatic thoracolumbar injuries, blunt traumatic aortic injury is often managed conservatively. However, blunt thoracic aortic injury is one of the leading causes of death from trauma, and each case requires its own case-by-case multidisciplinary management. In this occasion, management of the vascular insult was paramount to ensuring patient survival and favorable outcome.