Cryptococcal meningitis post-covid-19 infection: Immunomodulation, a double-edged sword.

Cryptococcal meningitis is an opportunistic infection associated with altered immunity. Immunomodulatory agent use in severe coronavirus disease 2019 (COVID-19) may predispose such infections. Here, we present a 75-year-old male patient who presented with fever and altered general status after severe COVID-19 infection and developed cryptococcal meningitis. Opportunistic infection may arise from the use of immunomodulation in severe COVID-19, especially in the elderly population. This article describes the case and extensively reviews cryptococcal disease post-COVID-19 literature, highlighting the risk from immunosuppressive treatment.

Intravenous high dose vitamin C and selected antiviral drugs in hospitalized COVID-19 patients: a descriptive cohort study.

INTRODUCTION: There is lack of universal agreement on the management of COVID-19. Intravenous high dose vitamin C (HDVC), remdesivir (RDV), and favipiravir (FPV) have been suggested as part of the treatment regimens and only RDV is approved by the Food and Drug Administration (FDA) so far. There is no study in Lebanon that addresses the descriptive cohort of HDVC and antiviral therapy amongst COVID-19 inpatients. Our goal was to highlight such a cohort. METHODOLOGY: A retrospective electronic chart review of COVID-19 inpatients was done over a period of 10 months (August 2020 to April 2021). Comparative data analysis was performed between HDVC and non-HDVC (NHDVC) groups, and RDV and FPV groups. RESULTS: Among HDVC patients, 70.1% (p = 0.035) and 67.2% (p = 0.008) had dyspnea and desaturation respectively. Patients on HDVC were less likely to remain in hospital for more than 20 days (p = 0.003). HDVC patients were more likely to be on oxygen therapy with 74.7% (p = 0.002). RDV patients were more likely to be on other COVID-19-related medications during hospitalization including the use of tofacitinib, baricitinib, tocilizumab, and anticoagulation as recommended in the guidelines. Statistical significance was noted for the status on discharge as 90.1% of the patients that received RDV were discharged after clinical improvement, compared to the 74.2% of the FPV patients. CONCLUSIONS: Further research is needed to establish local guidelines for the treatment of COVID-19. A significant role of HDVC and FPV might resurface if randomized control trials are conducted.

The Lebanese Healthcare Crisis: An Infinite Calamity.

In the past, a number of events rocked Lebanon, a small region of the previously prestigious Phoenician civilization. Whether it was mandates, wars, or economic compromises, the country always seemed to rise up again to a prominent stature in the Middle East. Once known as Switzerland of the East, Lebanon was torn apart by the works of sectarian battles during the civil war from 1975 to 1990. Since then, the country has never been the same with the turmoil left and right. Despite all of that, the healthcare sector has been one of the most prominent in the Middle East and the entire Arab world with accomplished physicians returning from immigration to serve their country. Lebanon excelled in holding first-time international conferences, performing medical interventions, and offering one of the best healthcare education and training to its juniors. The most recent setbacks since late 2019 have, however, held Lebanon back and subsequently handcuffed the healthcare system, leading to the impactful demise of the once glorious care. Nevertheless, the healthcare system remains one of the top-tier domains fighting against the coronavirus disease 2019 (COVID-19) pandemic and the failings of the rocked state.

A case of massive saddle pulmonary embolism and benign tracheal stenosis in a patient with COVID-19 infection.

Since December 2019, the novel coronavirus disease 2019 (COVID-19) outbreak that started in Wuhan, China, has become a global pandemic affecting millions of people around the globe. These patients are prone to a number of complications either related to their disease or to the different treatment modalities. Pulmonary embolism (PE) and benign post-intubation tracheal stenosis (BTS) are among these complications. In this study, we report the case of a patient with a recent COVID-19 infection that got complicated by a massive PE as well as a BTS.