Blurry Diagnosis of Ocular Syphilis.

The incidence of syphilis is on the rise worldwide which may be due to increased diagnosis. Given the wide variety of presenting symptoms, syphilis can pose many diagnostic and therapeutic difficulties for doctors. In turn, these difficulties frequently lead to a noticeable delay in patient care. Here we present a case of ocular syphilis in a homosexual male patient presenting with uveitis with no prior symptoms except for an itchy rash in the pelvic area. The patient was treated with IV penicillin after which full vision was restored. By presenting this case, we hope to stress the importance of adding syphilis in the differential diagnosis of men who have sex with men (MSM) who present with otherwise unexplained rash and/or uveitis.

Hepatitis B Vaccine and Multiple Sclerosis: Cause or Coincidence.

Multiple sclerosis (MS) is an autoimmune disease in which the body's immune system destroys myelin causing disruption of signals from the brain to the rest of the body. MS can be triggered by a variety of reasons. In this study, we present the case of a patient who developed neurological symptoms immediately (one day) after receiving the hepatitis B vaccine. The temporality of symptoms makes us question whether there is an association between the hepatitis B vaccine and MS. We would like to emphasize the importance of considering MS as a side effect of the hepatitis B vaccine and adding MS to the differential diagnosis of a patient who presents with neurological symptoms after receiving the hepatitis B vaccine.

Ketamine infusion as a sedative-analgesic in severe ARDS (KISS).

RATIONALE: Ketamine has been used as a sedative analgesic in trauma setting, but data regarding its efficacy and safety is lacking in severe ARDS. This retrospective study aims to determine if Ketamine is safer as a sedative agent in mechanically ventilated patients. During the COVID pandemic, as there was a shortage of sedative agents, Ketamine was used. OBJECTIVES: The primary objective was to compare the safety of ketamine to other sedatives. The secondary objective was to compare the effect of ketamine to other sedatives regarding the need for vasopressor, incidence of delirium, infectious complications, acute kidney injury, hospital length of stay, and length of ventilator days. METHODS: A retrospective, observational cohort study was conducted. MEASUREMENTS AND MAIN RESULTS: One hundred and twenty-four patients (63 men and 61 women) were included. Thirty-four patients received ketamine, while 90 patients received other traditionally used sedatives such as propofol and midazolam. The patients' median age was 64 years in the ketamine group and 68 years in the non-ketamine group. Seventeen patients in the ketamine group (50%) and 65 patients (72%) in the non-ketamine group had mortality (p < 0.02). The hospital length of stay was 22.85 days (± 16.36) in the ketamine group and 15.62 days (± 14.63) in the non-ketamine group (p < 0.02). There was no statistically significant difference among the outcomes of the need for vasopressor, the incidence of delirium, infectious complications, and acute kidney injury. CONCLUSIONS: Ketamine as a sedative-analgesic agent in COVID-19 patients with severe acute respiratory distress syndrome demonstrated safety with reduced mortality. The ketamine group had a higher hospital length of stay, but a similar complication profile compared to the non-ketamine group. Further prospective randomized controlled trials are warranted to confirm these findings.

False Negative Hepatobiliary Iminodiacetic Acid (HIDA) Scan in a Case of Gall Bladder Perforation.

Gall bladder perforation (GBP) is a rare and life-threatening complication of acute cholecystitis that requires immediate intervention. The diagnosis itself poses a diagnostic challenge, if the patient presents after the perforation of the gall bladder, especially if the initial imaging techniques such as ultrasonogram (US), computed tomography (CT) scan, hepatobiliary iminodiacetic acid (HIDA) scan and magnetic resonance cholangiopancreatography (MRCP) are inconclusive. Subtle clues such as free fluid around gall bladder and contracted gall bladder should warrant the clinician as these might be the only clues suggestive of gall bladder perforation. Here we describe a case of GBP successfully diagnosed by peritoneal drainage and analysis and subsequently managed by endoscopic retrograde cholangiopancreatography (ERCP) and open cholecystectomy.

Tussis for Obstructive Stridor, an Impromptu Cure: A Rare Case of Spontaneous Resolution of Obstructive Fibrinous Tracheal Pseudomembrane (OFTP).

Obstructive fibrinous tracheal pseudomembrane (OFTP) is a relatively rare complication of endotracheal intubation. OFTP, which may cause fatal airway obstruction, is perhaps more common than reported in the literature. Although little is known about the mechanisms that play a role in the development of OFTP, it is hypothesized that OFTP results from ischemic injury to tracheal mucosa. Diagnosis is made using rigid bronchoscopy, which is also used for excision and removal of the pseudomembrane. Here we present a case of OFTP in a patient who was intubated for three days, developed symptoms three days after extubation, and ultimately spontaneously expelled the tracheal pseudomembrane.

Probability of COVID-19 Being the Culprit in Neurocognitive Deception: A Case Series of Incidental Strokes in ICU Patients With COVID-19.

The coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, originated in Wuhan, China, and spread rapidly throughout the world, infecting millions and killing thousands. Although some patients have mild or even asymptomatic responses to this infection, hospitalized patients present with symptoms such as fever, cough, and difficulty breathing. Some patients have a severe response to the insult and experience rapid progression to acute respiratory distress and multiorgan failure. Furthermore, many patients developed complications due to this infection. Here, we present three patients who had strokes during their hospitalization for COVID-19 pneumonia.

Human Immunodeficiency Virus: A Dark Cloud With Silver Lining During the COVID-19 Pandemic.

In December 2019, China reported a cluster of pneumonia patients infected by a new virus from the coronavirus family called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The virus quickly spread around the world and infected millions of people, and the World Health Organization (WHO) declared coronavirus disease 2019 (COVID-19) a pandemic on March 11, 2020. Although some patients show only mild or even asymptomatic response to this infection, severe disease with rapid progression to acute respiratory distress and multiorgan failure is also commonly seen. In this report, we discuss three cases of HIV patients who survived COVID-19.