Guillain-Barré syndrome is immunogenic in SARS-CoV-2 infected.

With interest, we read the article by Khan et al. about five adult patients with SARS-CoV-2 associated Guillain-Barré syndrome (SACAG) of whom one tested positive for virus RNA in the cerebrospinal fluid (CSF). Three patients were classified as acute, inflammatory, demyelinating polyneuropathy (AIDP) and one each as acute, motor, axonal neuropathy (AMAN) respectively acute, motor, and sensory, axonal neuropathy (AMSAN). It was concluded that “in a few cases where the symptoms of COVID-19 and GBS occur concurrently (corresponding to the viremic phase), a separate, para-infectious pathogenesis needs to be thought of”. The study is appealing but prompts comments and concerns

Broadening the diagnostic approach for SARS-CoV-2 associated myopathy and rhabdomyolysis

With interest, we read the article by Sabljic et al. about a 63-year-old female with a second renal transplant under mycophenolate mofetil, tacrolimus, and steroids, who experienced a severe SARS-CoV-2 infection manifesting as pneumonia. Her COVID-19 infection was managed with ceftriaxone, remdesivir, dexamethasone, tacrolimus reduction, and discontinuation of mycophenolate mofetil. A few days after discharge, the patient developed proximal quadriparesis and rhabdomyolysis. The study is appealing but raises comments and concerns

Impact of COVID-19 on medical students aspiring toward a career in otolaryngology: a medical student's perspective

While its adverse impacts on health care setups are conspicuous, coronavirus disease 2019 continues to impede medical education. Exponential increases in the number of cases globally lend to the implementation of a nationwide lockdown. In Europe in general and Ireland in particular, the lockdown significantly limits medical students' clinical exposure and access to clinical sites. For medical students, this portends numerous implications, such as limited patient contact and an inability to explore the various medical and surgical specialties in profundity. Nevertheless, medical students continue to aspire to pursue various specialties-including otolaryngology-for which the clinical contact remains exceedingly limited

Painful pachydermodactyly in a 39-year-old woman: case report and review of the literature

We chronicle the case of a 39-year-old female who presented to the rheumatology clinic with a history of chronic, symmetrical polyarticular pain in her hands. Meticulous diagnostic workup to exclude ubiquitous culprit aetiologies, such as rheumatoid arthritis and psoriatic arthritis, was performed. A detailed clinical examination was performed and, coupled with the radiological imaging findings, divulged an underlying diagnosis of pachydermodactyly. The patient was commenced on etoricoxib to alleviate the pain, and was advised to avoid repetitive trauma to her hands. The present report delineates a unique case of painful pachydermodactyly, affecting both proximal interphalangeal joints as well as distal interphalangeal joints. To the best of our knowledge, this is the first case from the state of Kuwait. We further review the literature in order to better elucidate the varying clinical manifestations of an elusive and rare rheumatological condition.</p

Reply to “SARS-CoV-2-associated Takotsubo is not necessarily triggered by the infection”

We hereby take the opportunity to thank Dr. Finsterer for his comments on our manuscript titled, ‘‘COVID-19 Presenting as Takotsubo Cardiomyopathy (TTC) Complicated with Atrial Fibrillation”. The points raised by Dr. Finsterer are indeed very pertinent and ought to be addressed. In accordance with the question raised by the author, the exclusion of acute coronary syndrome (ACS) prior to the diagnosis of TTC is mandated in order to meet all inclusion criteria stipulated by the Mayo Clinic. In our manuscript, we have highlighted that coronary angiography was not performed due to a concoction of factors. Our patient manifested a predilection towards not wanting to undergo angiography.</div

Towards pragmatic adaptations: orthopedic surgery amidst the coronavirus disease 2019 pandemic

Since its inception, the coronavirus disease 2019 (COVID-19) has proliferated rapidly, eliciting debilitating ramifications for patients, physicians, and healthcare setups alike. Due to the exorbitant infection related admissions, healthcare setups have been stretched to their horizons with a resultant depletion of essential resources. Consequently, time-sensitive decisions vouching for the prioritization of infected patients have been made, calling for unprecedented transformations in orthopedic surgical practice. Despite these significant reforms, novel guidelines surrounding the orthopedic surgical milieu remain at the epicenter of an elusive public healthcare conundrum. We hereby delineate these transformations and propose pragmatic strategies to mitigate the concomitant risks. </div

Coronavirus disease 2019 presenting as abdominal distension in a mesothelioma patient: do we need to think outside the box?

The coronavirus disease 2019 (COVID-19) remains a major source of mortality globally. Although it usually presents with flu-like symptoms such as fever and sore throat, the intensity of the symptoms varies, constituting a spectrum ranging from asymptomatic to severe cases of acute respiratory failure. The highest proportion of severe cases occurs in older individuals and in those who have underlying health conditions and chronic comorbidities. We chronicle an atypical case of a 46-year-old male with stage IV mesothelioma who presented exclusively with complaints of acute abdominal pain and distension. Despite his cancer status, the patient's respiratory functions remained unremarkable, accentuating the peculiarity of the case

Does everybody with mildly elevated HsTnT without ECG changes have a high risk of cardiovascular events and mortality?

With interest we read the study by Mahmoud et al. about ‘‘Comparative outcome analysis of stable mildly elevated high sensitivity troponin T in patients presenting with chest pain”. The author reported higher frequency of all-cause and cardiovascular mortality up to 1 year in patients with low level hsTnT elevation.</p

Towards effective management protocols: a transnational review of the state-of-the-art of coronavirus disease 2019 (COVID-19) in Pakistan and the United Arab Emirates

Coronavirus disease 2019 (COVID-19) has proliferated rapidly in Pakistan, adversely affecting every province. The grave repercussions that the pandemic has elicited in Pakistan have evoked a dire need for drastic measures to be employed at both the governmental and provincial levels. Due to the inequitable appropriation of healthcare resources with respect to the various provinces, however, a stark contrast in terms of morbidity and mortality persists. Furthermore, considering that Pakistani citizens constitute a noteworthy proportion of expatriates residing in the United Arab Emirates (UAE) and the close proximity of the two countries, due consideration of the situation in the UAE is also warranted. We present a transnational review to delineate the current state-of-the-art in Pakistan and the United Arab Emirates and evaluate pragmatic management protocols that remain at the epicenter of a national healthcare conundrum

Liver transplantation for hepatocellular carcinoma: improving eligibility without compromising outcomes

Background: In the context of liver transplantation for hepatocellular carcinoma (HCC), traditional transplant criteria appear restrictive. The objective of the current study was to determine risk factors for recurrence and improve transplant eligibility in patients with HCC. Materials and methods: This was a retrospective study of patients who underwent living donor liver transplant (LDLT) for HCC (n = 219). Largest tumor diameter, tumor number, AFP and neutrophil to lymphocyte ratio were assessed. Multivariate analysis was performed to develop risk scores. The new model was compared with seven previously published transplant criteria using receiver operator curves. Results: Largest tumor size >3.7 cm [HR:2.6, P = 0.02], and AFP > 600 ng/ml [HR:4.7, P = 0.001] were independent predictors of recurrence. Patients with risk scores of 0, 1-3, 4-6 and 7-9 had recurrence rate of 5.9%, 12.5%, 25% and 58.4% respectively. When compared with Milan criteria, Metro ticket 2.0, AFP model and Samsung criteria; transplant eligibility increased by 31.5%, 22.9%, 8.7%, and 7% respectively. Recurrence rate with the current model was 16/199 (8%) (P Conclusions: Low AFP can be used to select patients for LDLT outside traditional criteria for HCC, with comparable recurrence rates.</p