Coronavirus Disease (COVID-19) Associated Rhinocerebral Mucormycosis and Complications: A Case Report

Background: Mucormycosis is a rare fatal infection caused by a ubiquitous fungus from the order of Mucorales, which can have varying clinical presentations. Immunocompromised patients are particularly susceptible to mucormycosis and can suffer fatal consequences if not treated adequately. COVID-19 infection with its immunomodulatory properties has been associated with a wide range of secondary bacterial and fungal infections. We present a case of rapidly progressive rhinocerebral mucormycosis post-COVID-19 infection with the subsequent development of several complications associated with the disease. Case Report: A 62-year-old male patient with a history of hypertension and diabetes mellitus type II, presented 14 days post-COVID-19 recovery with right facial swelling, erythema, and right eye proptosis. Throughout his disease, the patient developed blindness and cranial nerve palsies. He was also found to have palatal necrotic lesions, consistent with the diagnosis of mucormycosis. The patient’s disease was complicated by Garcin syndrome, meningitis, orbital apex syndrome, cavernous sinus thrombosis, brain infarction, and hemorrhage. Despite all measures and interventions, the patient died. Conclusion: COVID-19 infection and its treatments are associated with an increased risk of secondary fungal infections like mucormycosis. As such, a high index of suspicion is needed amongst healthcare workers for the early diagnosis and treatment of such opportunistic infections since prompt treatment is associated with a marked improvement in outcome. Furthermore, optimal glucose control and judicious use of corticosteroids in COVID-19 patients decreases the risk of developping such life threatening superinfections.

Borderline Serous Papillary Tumor Arising in a Paraovarian Cyst: A Case Report and an Extensive Review of the Literature

Background: Paraovarian cysts are benign cysts that develop near the ovaries and fallopian tubes in the pelvic region. They can cause mass effects requiring excision. In rare cases, tumors may develop inside these cysts. These tumors may be benign, malignant, or borderline. Case Report: A 26-year-old lady presented for excision of a paraovarian cyst. Pre-operative imaging showed the presence of few undulating folds at the periphery of the cyst. The patient underwent laparoscopic pelvic cystectomy without intra-operative drainage. Pathological examination of the specimen revealed a borderline serous papillary tumor protruding from the cyst wall. Conclusion: The occurrence of a borderline tumor, also known as a tumor of low malignant potential, in a pre-existing paraovarian cyst is very rare and has only been reported few times in the literature. A thorough review of these cases showed that the most common imaging finding that raises suspicion for a borderline tumor within a paraovarian cyst is the presence of small intracystic projections within the unilocular adnexal cyst. However, since evaluating the presence of an intracystic tumor is not always possible, performing a fertility-preserving laparoscopic cystectomy without cyst content spillage, is recommended. If properly excised, the prognosis of this tumor is good, and recurrence is rare.

Coronary Artery Disease and its Psychosocial Risk Factors: A Narrative Review

Objective: Whenever the subject of coronary artery disease (CAD) and myocardial infarctions is discussed, the focus is usually shifted towards biological factors such as smoking, diabetes, or obesity; consequently, the management aims at addressing these factors. This paper approaches the subject from a psychosocial perspective and highlights the importance of these risk factors and their inclusion in CAD screening. Background: CAD is one of the most common diseases worldwide and also one of the leading causes of death in multiple countries. Although we have a proper understanding of its pathogenesis and risk factors, we sometimes tend to overlook the psychological factors that affect the patient both pre- and post-diagnosis. The purpose of this paper is to present these underestimated factors and convey their importance. Methods: To accomplish this, an extensive review of the literature was done using PubMed and Google Scholar, and articles were chosen based on the specified keywords. The references of these articles were also screened to identify more related studies and clinical trials. Discussion: This paper is composed of multiple subsections that go over the epidemiology of the disease as well as its pathogenesis and known biological risk factors, before delving into the psychosocial aspects associated with CAD including the effects of depression, anxiety, social support, and sex differences on a patient’s prognosis. Conclusion: CAD is a disease for which the management is through multifactorial interventions. Although the pathogenesis is well understood, there is a clear gap when it comes to appreciating the patients’ mental health when living with this diagnosis. Additionally, it has been shown that there is an increase in morbidity and mortality in the patients struggling on a psychosocial level, thus these factors should be included in the screening process.

SARS, MERS, COVID-19: Identification of Patients at a Higher Risk: A Narrative Review

The different presentations, comorbidities, and outcomes of COVID-19 highlight the importance of early identification and proper triage of patients. High-risk patients can be divided into patients with common comorbidities and patients with special categories. Common comorbidities include, but are not limited to, Cardiovascular Disease (CVD), Diabetes Mellitus (DM), immunosuppression, underlying respiratory disease, and obesity. Certain categories of COVID-19 patients are also at increased risk, including neonates and pregnant women. In the present article, we delineate the reported risk factors for acquisition of infection, and for increased severity of the clinical disease. We also comparatively analyze those risk factors associated with COVID-19 and with the antecedent human acute respiratory syndrome-causing viruses, SARS-CoV-1 and MERS-CoV. We hypothesize that the structural similarities of the three viruses predict a similarity in the profile of high-risk patients. Several pathophysiological patterns have been detected to support this theory.

A Cross-Sectional Study of the Alarming Prevalence of Smoking Among Lebanese Physicians and Its Negative Impact on Promoting Cessation

Background: There is a paucity of data on the prevalence of smoking among physicians. As physicians are on the front line caring for patients’ health, a detailed analysis of their smoking habits and its impact on counseling their patients to quit is warranted. So far, no study in Lebanon has addressed the real prevalence of physicians smoking and its impact on promoting cessation. This study aims to fill this purpose. Methods: A cross-sectional study conducted using a web-based self-administered questionnaire was e-mailed to 4037 Lebanese physicians between November 2015 and February 2016. The questionnaire included 11 questions about basic sociodemographic information (age, gender, work province, specialty), smoking habits and attitude towards smoking cessation. SPSS was used for analysis. The main outcome was to calculate the percentage of physicians that smoke, its relationship to gender and age, and its impact on counseling their patients about smoking cessation. Results: 529 responders were analyzed (13.1% response rate). A high rate of physician ever-smokers was noted at 37% (n=195) whereas the prevalence of current smokers was 13% (n=70).. In addition, there was a difference in the gender of ever-smoking physicians where 47% of males were smokers compared to 20% of females only. Regarding the prevalence of smoking within different specialties, it was noted that 35% (n=74) of internal medicine physicians were ever-smokers compared to approximately 50% (n=51/102) of surgeons. There was a statistically significant difference between former-smokers and current-smokers in regards to how frequently they urge their patients to quit smoking. Conclusion: The high prevalence of smoking among Lebanese physicians is depicted and its negative impact on counseling patients to quit is a serious consequence. This is a major drawback in the fight against tobacco and further awareness may be needed among our future doctors to increase smoking cessation counseling and decrease the burden of smoking in Lebanon and worldwide.

A Case of HLA-B51 Positive Mucocutaneous Variant of Behçet’s Disease in a Young Indian Male: A Case Report

Background: Behçet’s disease is a rare, systemic inflammatory disorder of unknown etiology affecting the mucocutaneous, vascular, skeletal, ophthalmic, gastrointestinal, and neurological systems. While the exact etiopathogenesis of Behçet’s disease is yet to be established, numerous studies have supported a strong possibility of underlying genetic factors. It is comparatively more common in Turkey, the Middle East, and Mediterranean regions, and only a few cases have been reported from the Indian subcontinent so far. Although several immunological and genetic associations have been suggested, the diagnosis of Behçet’s disease remains primarily clinical and of exclusion. Case Report: In this report, we describe the case of a 22-year-old Indian male who developed multiple aphthous ulcers over his tonsillar pillars and pharyngeal wall following an episode of acute tonsillopharyngitis. Over the course of the next few days, he reported the presence of a genital ulcer and papulopustular lesions over his chest, back and face, eventually prompting a diagnosis of Behçet’s disease. He was treated with oral colchicine and was found to be in remission during a six-week follow-up. Conclusion: This case emphasizes the importance of awareness regarding Behçet’s disease among clinicians in India and warrants further studies on the epidemiology, immunopathogenesis, and management protocols of Behçet’s disease, especially in this country for a better understanding of its prevalence, manifestations, and disease course.

COVID-19 Infection Post-Laparoscopic Sleeve Gastrectomy: A Case Report and Review of Literature

Background: COVID-19 caused the suspension of elective surgeries in several hospitals around the world, in an attempt to help contain the spread of the virus. However, a safe resumption of such surgeries is warranted to reduce further burden on patients. It is important to understand when, how and where to resume elective surgeries, as published data suggested that peri-operative COVID-19 infection incurred an increased risk of morbidity and mortality to surgical patients. Case Report: A 25-year-old patient presented for fever 5 days post Laparoscopic Sleeve Gastrectomy. He was diagnosed with COVID-19 using a PCR test. The patient was managed at home with symptomatic therapy. No life-threatening complications were reported during or after his infection. Conclusion: Based on available data, our literature review regarding peri-operative COVID-19 complications, bariatric surgeons have to balance between the risk of undergoing an elective surgery like metabolic bariatric surgeries and the risk of postponing this procedure and thus delaying the resolution of obesity along with its comorbidities.

Multisystem Inflammatory Syndrome due to COVID-19 in a Newborn Patient: A Case Report from Lebanon

Background: Multisystem inflammatory syndrome in children (MIS-C) is a hyperinflammatory condition associated with COVID-19 in children, with features that are similar to Kawasaki disease and toxic shock syndrome. Several reports are emerging from all over the world on this condition that is associated with increased fatality rate. Case Report: In this article, we present one of the first reports of a newborn diagnosed with MIS-C attributed to COVID-19. In addition, we discuss the diagnostic criteria and the possible pathophysiology. Conclusion: Although COVID-19 does not frequently affect newborns, when it does, it may lead to devastating complications, such as MIS-C. As a result, providers should be on the lookout for any symptoms that can indicate a complicated infection. Further studies are still needed to develop a better understanding of the pathophysiology of this disease and establish appropriate therapeutic guidelines.

Lyme Borreliosis Associated with Sensorineural Hearing Loss: A Case Report

Background: Lyme borreliosis is a tick-borne infection caused by Borrelia species. It has a geographic distribution that makes it more frequent in certain regions like like North America and Europe. It manifests in a wide range of symptoms but is often under-investigated in patients presenting with sensorineural hearing loss (SNHL). Case Report: In this report, we describe a case presenting with SNHL as a manifestation of neuroborreliosis in a female adult patient suffering from Lyme disease, with multiple metachronous symptoms, including arthritis and seizures. Lyme borreliosis (LB) was clinically diagnosed and supported by positive serologic tests, along with Babesiosis. The patient was treated with intravenous (IV) ceftriaxone and azithromycin, in addition to oral atovaquone. Improvement after 4 weeks of IV ceftriaxone was noted in all aspects, including SNHL and arthritis. Conclusion: LB is a possible, but rare, etiology of hearing impairment. It has been documented that if treatment is initiated early, improvement and even complete recovery are possible. Hence, in a patient presenting with SNHL and a high index of suspicion for LB, assessment for LB is warranted.

Successful Resection of an Endobronchial Pleomorphic Adenoma Using Cryotherapy: A Case Report

Background: Pleomorphic adenomas are very rare benign bronchial tumors. They are typically either removed surgically, or if not amenable to surgery, via therapeutic bronchoscopy. We present the first case of an endobronchial pleomorphic adenoma removed by cryotherapy. Case Report: This is the case of a 54-year-old man with a right middle lobe pleomorphic adenoma that was detected incidentally during a bronchoscopy, which was performed due to acute respiratory failure and presence of ground glass opacities on imaging. The tumor led to a chronic cough and partial right middle lobe atelectasis. It was resected successfully using endobronchial cryotherapy without any noted complications. There has been no recurrence of disease one year after the intervention. Conclusion: This is the first report in the literature of a pleomorphic adenoma successfully removed via cryotherapy without recurrence. Endobronchial cryotherapy appears to be an effective and safe method of removing endobronchial pleomorphic adenomas.