Alopecia by COVID-19: About a Case

Some research that has been carried out in patients who have already undergone COVID-19, indicate that between 20%-30% of these will suffer intense hair loss, multiplied by 4 or 5 after 2 to 4 months later of the illness. This exaggerated hair loss is known as telogenic effluvium. In telogenic effluvium, it is produced by an alteration in the hair growth cycle that generates an alarming loss for a limited period of time. As in any infection or period of stress, the root of the hair weakens and months after having overcome it, the hair falls in an abnormal and exaggerated way. The objective of presenting this case is to describe one of the most important and rare dermatological manifestations, which has been derived from SARS-CoV-2 infection. We present the case of a 41-year-old female patient, who was admitted to the emergency department after presenting a clinical picture of 8 days of evolution consisting of dry cough, tachycardia and diaphoresis, for which the antigen test for SARS-CoV-2, revealing a positive result, so it was decided to enter for medical management.

Clinical Features, Risk Factors and Hospital Mortality of Acute Stroke Patients

Background: Stroke is a leading cause of mortality and disability worldwide. To prevent complications and permanent defects, early diagnosis, distinguishing the type and risk factor of stroke is crucial. Methodology: It was a hospital based cross sectional study, purposive sampling method was used, and a total of 469 stroke patients admitted into Department of Medicine, Rangpur medical college hospital, Bangladesh were included in this study. Results: In this study we have studied of 469 acute stroke patients. Among them 81% (380) were ischemic stroke patients and 19% (89) were hemorrhagic stroke. Overall male were more than female 308 (65.7%) vs 161(34.4%). The mean age for the ischemic stroke group was 64.1 ± 10.9 years, which was significantly higher than that of the hemorrhagic group (59.8 ± 9.60years) (P<0.05). Acute hemorrhagic stroke patients presented with acute onset of focal neurological deficit 61.8%, headache 64%, vomiting 59.6%, alteration of consciousness 48.3% and convulsion 27%. On the other hand, acute ischemic stroke patient presented with alteration of consciousness 65.5%, acute onset of focal neurological deficit 39.5%, paralysis 41%, deficit after awakening 32.4% and aphasia 34.7%. Among the risk factors of stroke in acute ischemic stroke patients hypertension was 59.2%, diabetes mellitus 20%, history of previous stroke 16.1%, ischemic heart disease 14.5% and atrial fibrillation 10.3% were present, on the other hand in acute hemorrhagic stroke patients hypertension 76.4%, smoking 70.8% and diabetes mellitus 6.7% were present. 26.97% of the acute hemorrhagic stroke and 13.9% of the acute ischemic stroke patients died in hospital. Conclusion: Common presentation of stroke was acute onset of focal neurological deficit; headache and vomiting were more in hemorrhagic stroke patient; alteration of consciousness, paralysis was predominant in ischemic stroke patient.

Current Status of Low Dose Overnight Dexamethasone Supression Test (LODST)

Introduction: Low Dose Overnight Dexamethasone Supression Test (LODST) is a diagnostic tool for spontaneous Cushing’s Syndrome (CS). A LODST negative excludes CS. But there are 2 exceptions - testing during silent period of Cyclic Cushing’s Disease (CD) or a false negativity by one mg dexamethasone in mild CD. Method: We analyzed age and sex data of 154 LOSDT to see their risk association for CS. Result: The detection rate of CS by LOSDT is 26% and with Cortisol (211.27 to 373.69 nmol/L as 95% CI). Among the cases, 29.2% are pediatric and 70.8% are female. CS group do not differ from rest in sex and age group distributions (sig.> 136) but CS is older group with a mean difference of 2.46 - 13.31 years (sig 005). Logistic equation documented CS is a different population (sig 000) and which is influence by their age (sig 021) but not by sex or age group (sig > 743). Therefore, age is an independent risk factor for CS. Conclusion: We opine to use LODST as the first tool for CS. And LODST negative cases to be evaluated by newer imaging and biochemical tests. Only in imaging positive are to be managed as per guideline(s) for incidentaloma. Both negative cases are to be enrolled in follow up if age > 30 years or symptoms score suggest CD and rest are to be excluded. Cumulative diagnostic and outcome data will then may be used to formulate cost-effective management policy for CS.

The Mycophenolate Mofetil Therapy in Corticoresistent Idiopathic Focal Segmental Glomerulosclerosis

The Focal Segmental Glomerulosclerosis (FSGS) is one of the most frequent glomerular nephropathies affecting both children and adults. The aim of this study is the evaluation of the effects of Mycophenolate Mofetil (MMF) in Nephrotic Syndrome (NS) with biopsy proven Focal Segmental Glomerulosclerosis (FSGS) resistant to other therapies. We treated 20 patients, of which 12 males, with a median age of 39 years (ranging between 18 and 62 years), with Nephrotic Syndrome, all being resistant to or relapsing on steroid and immunosuppressive therapy. They were treated with MMF (1-2 g/day) and Methylprednisolone 0.5 mg/kg at alternate days for an average period of ten months (ranging between 3 and 13 months). Two patients discontinued treatment after three and five months respectively, for gastric intolerance. Another patient discontinued MMF after six months due to deterioration of kidney function. No significant differences were observed between pretreatment values and at the end of the treatment for plasma creatinine, Glomerular Filtration Rate (GFR), while the excretion rate of urinary proteins was significantly reduced from 7.68 ± 3.54 to 3.20 ± 2.92 g/day, (p<0.001). After MMF we observed a complete remission in two patients (10%), an incomplete remission in three patients (15%), a partial remission in six patients (30%), no response in eight patients (40%) and a worsening of kidney function in one patient (5%). It was concluded that in resistant Nephrotic Syndrome by FSGS, MMF can favor stable remission, preserving renal function and hence being considered as an alternative therapy to calcineurin inhibitors, but with lower toxicity.

Nutritional Profile of Clients with Obesity Treated at the School Clinic

Introduction: Obesity can be conceptualized in a simplified way, as a condition of abnormal or excessive accumulation of fat in the body. Objective: To characterize the nutritional profile of the clients with obesity treated at the Integrated Clinic of Health Care at UNA University Center, Belo Horizonte, Brazil. Methods: This is a longitudinal observational study performed with men and women with obesity in the second half of 2017. Sociodemographic, clinical, anthropometric and nutritional data were collected from 216 clients. The greatest demand for the service was of women, in the age group of 20 to 59 years, in the masculine sex there was the greater amount of stylist. Regarding the level of schooling and physical activity the predominance was female, but the number of smokers was equal in both sexes. Results and Discussion: The reported diseases were 16.47% with arterial hypertension in the female sex. However, a 24.07% share of total treatment withdrawal occurred. The female sex obtained the highest number of consultations performed on average (2.62), but there was a satisfactory weight loss, established according to the number of consultations performed. The greatest weight loss was in the male sex, equivalent to (12kg). Conclusion: The prescribed diet needs to be well planned according to the individuality of each patient, performed and evaluated throughout the process; it requires continuity, effort and permanence in the treatment.

Clinical Coping with Prescribing Opioids within the Context of Obesity and Diabetes Mellitus

The purpose of this article is to provide podiatric physicians with the strategies for identifying, assessing and responding to patients who may have changes in opioid pharmacokinetics and pharmacodynamics due to sex and age differences and disease states. First of all, possible opioid drug interactions that exist within the context of patient demographics and disease states are presented and described. Secondly, both pharmacokinetic and pharmacodynamics changes of opioid agents within certain patient demographics are presented. Lastly, the art of clinical coping mechanism to prescribe opioids to patients that may be elderly or presenting with disease states that may alter opioid pharmacokinetics.

Diabetic Peripheral Neuropathies (DPNs) from Basic and Clinical Aspects

Diabetes has been one of the crucial diseases worldwide, which has to be controlled adequately for long years. It has three diabetic complications of micro-angiopathy such as neuropathy, retinopathy and nephropathy. Among them, Diabetic Peripheral Neuropathies (DPNs) are most prevalent to manage in primary care setting. In this article, recent topics concerning DPNs are introduced [1]. DPNs have a variety of symptoms and signs, then DPNs are often described in plural forms [2]. DPNs are classified into two categories, which are local and general. The former includes mononeuropathy and multifocal neuropathy. The latter includes diabetic polyneuropathy (DPN) and others. DPN has Distal Symmetric Polyneuropathy (DSPN) and Diabetic Autonomic Neuropathy (DAN) [2]. For examples, DSPN shows bilateral numbness of extremities and DAN shows Orthostatic Hypotension (OH).

Both Fasting Blood Glucose (FBG) and A1c Drop in Less than One Month after Starting Lysulin Supplementation

When a diabetes treatment is changed, patients are eager to see their FBG and A1c changes as a result on the new treatment. We examined these changes in 20 subjects with Type 2 diabetes for 1 week prior to starting Lysulin and then for the following 30 days. While both FBG and A1c drop in less than 1 month, the change in A1c was more rapid than the change if FBG. Possible reasons for the differences between FBG and A1c are presented

Lysulin and Testing HbA1c in the Pharmacy or at Home-How the Pharmacist can help their Customers with Diabetes to Better Health

Pharmacists can be part of the healthcare team to help people with diabetes and prediabetes to better health. Obesity and type 2 diabetes are a worldwide epidemic and a problem that can be helped dramatically with lifestyle changes (diet and exercise) combined with treatment with drugs and supplements. Lysulin is a patent-pending nutritional supplement that contains lysine, zinc and vitamin C and has been shown in double blind placebo controlled studies to help people with prediabetes and type 2 diabetes to better glycemic control and lower their HbA1c. The pharmacist needs to be aware of this breakthrough and inform his customers of the availability of this new product for improving their health. In addition, HbA1c testing at the pharmacy or at home can be very useful in helping people with diabetes know how well their diabetes management program is working.

Diffuse Lymph-Nodes Microangiopathy as Concurrent Cause of Immunodeficiency in Long-Term Insulin-Dependent Diabetic Patients

Immune abnormalities have been demonstrated in vitro models in genetic (type1) autoimmune (type 2) and metabolic (type 1 and type 2) Insulin-Dependent Diabetes Mellitus (IDDM). However, the precise reason for increased susceptibility to frequent and protracted infections in diabetic patients is still unclear, despite a multitude of in vitro studies which have focused on the metabolic and functional modifications of immune cells Diabetes microangiopathy, which is a peculiar alteration of the disease, has been extensively described in the retina, renal glomeruli, skin, skeletal muscles, peripheral nerves, and other organs but not in lymph nodes. We report our histological and immunohistochemical observations in lymph-nodes removed in multiple sites during autopsy from four patients with long-term IDDM, severe lymphocytpenia and several infectious diseases during their life. The peculiar microangiopathic modifications made by presence of hyaline substance thickening basal membrane of thin vessels and capillaries appear concurrent with lymphodepletion of B and T cells dependent areas of lymph-nodes and with jointed marked reduction of Follicular Dendritic Reticulum Cells (FDRC). Indeed microangiopathy further compromise the traffic and diapedesis of T and B lymphocytes may prevent the transformation of endothelial cells into FDRC with severe immune failure of lymphoid follicles. The histological and immunohistochemical data in this study could provide additional insights into the complex problem of the immunodeficiency in diabetic patients.