Multisystem Inflammatory Syndrome Due to COVID-19 Infection in Vaccinated Versus Unvaccinated Adolescents: A Case Report.

Symptoms of COVID-19 infection are usually mild in the healthy pediatric population. In some pediatric patients, COVID-19 infection can lead to multisystem inflammatory syndrome in children (MIS-C). We report two cases. Case 1 is a rare case of MIS-C symptoms, presenting with myalgia, chest pain, and fever three days after the second dose of the Pfizer-BioNTech COVID-19 vaccine, which is compared with Case 2, which is a case of MIS-C in an unvaccinated patient with COVID-19 infection who was noted to have acute kidney injury and fluid refractory hypotension. Although MIS-C was reported as a vaccine side effect, we conclude that COVID-19 infection led to the development of MIS-C in our case, not the COVID-19 vaccine. MIS-C symptoms were also noted to be less severe after the COVID-19 vaccine than in the unvaccinated patients.

Current Evidence and Practice Guidelines of Systemic Complications of 2022 Mpox Outbreak: A Scoping Review.

In May of 2022, the World Health Organization declared a worldwide Mpox virus (MPXV) outbreak. Due to the widespread implementation of vaccination protocols and heightened awareness among the general population, there has been a notable decline in the incidence of Mpox (formerly known as Monkeypox) cases since March 2023. Nevertheless, it is crucial to remember that Mpox has the potential to impact multiple physiological systems in humans, encompassing the cardiovascular, gastrointestinal, ear/nose/throat, and ocular systems. The mortality rate of the Mpox disease is comparatively lower than that of smallpox. However, it is essential to note that this disease can still lead to significant systemic consequences. The specific pathophysiological mechanisms by which the virus affects various physiological systems are now being investigated. Direct inoculation through mucosal damage or intranasal exposure, direct viral toxicity, and lymphatic transmission via the seminal fluid are all viable hypotheses. The prompt recognition of such complications is crucial to decrease morbidity and mortality.

A rare case of eczema herpeticum associated with HIV: A case report.

Eczema herpeticum (EH), also known as Kaposi's varicelliform eruption, is a disseminated herpes simplex virus infection seen in patients with underlying skin conditions, most commonly atopic dermatitis. Monomorphic vesicles and "punched-out" erosions with hemorrhagic crusts over eczematous regions are the hallmarks of EH's presentation. Here, we discuss a first reported case of eczema herpeticum in a patient living with well controlled HIV with prior steroid use. A 30-year-old male patient living with HIV presented to the hospital with a generalized rash involving the face, neck, arms, hands, low back region, and both feet. Herpes simplex 1 and 2 by PCR DNA were detected from external auditory ear canal drainage. The patient was treated with intravenous acyclovir and responded well. He had long term history of eczema and required acyclovir prophylaxis later.

A Hitchhiker's Guide to Worldwide COVID-19 Vaccinations: A Detailed Review of Monovalent and Bivalent Vaccine Schedules, COVID-19 Vaccine Side Effects, and Effectiveness Against Omicron and Delta Variants.

For the primary prevention of coronavirus disease 2019 (COVID-19), there are currently four different vaccines available in the USA. These are Pfizer (messenger RNA [mRNA]), Moderna (mRNA), Novavax (recombinant protein), and Jansen/Johnson & Johnson (adenoviral vector). All individuals should get vaccinated, and the Centers for Disease Control and Prevention (CDC) has provided comprehensive guidelines on recommended doses, their frequency by age group, and vaccine types, all discussed in detail in this article. Vaccines are a critical and cost-effective tool for preventing the disease. Prior to receiving a vaccine, patients should get adequate counseling regarding any potential adverse effects post vaccination. Appropriate safety precautions must be taken for those more likely to experience adverse consequences. Healthcare professionals should be aware of the symptoms, indicators, and treatment of any adverse event post-vaccination. We have provided a comprehensive review of the different characteristics of COVID-19 vaccines available in the United States, including their effectiveness against various variants, adverse effects, and precautions necessary for healthcare professionals and the general population. This article also briefly covers COVID-19 vaccines available worldwide, specifically their mode of action and effectiveness.

Monkeypox - An emerging pandemic.

Monkeypox-a zoonotic disease caused by the monkeypox virus, an orthopoxviruses family member. Recently monkeypox cases are increasing at an alarming rate in the US and worldwide. Health care professionals should keep a high index of suspicion for the disease in anyone with new onset fever, a vesicular or pustular rash with central umbilication, and lymphadenopathy. Such patients should be isolated at home or the hospital to prevent secondary transmission. The cases are typically self-limited, and most people only need home supportive care. However, as recommended by CDC, immunocompromised patients, pregnant patients, and children younger than eight years should be offered pre- or post-exposure prophylaxis with vaccines. The current outbreak explicitly targets a cohort of homosexual and gay patients. The role of sexual transmission of the virus needs to be explored further. Patients with severe symptoms or respiratory complications can also be treated with antivirals such as tecovirimat (TPOXX) and brincidofovir or with intravenous vaccinia immune globulin (VIGIV).

Prevention and Treatment of Monkeypox: A Step-by-Step Guide for Healthcare Professionals and General Population.

The World Health Organization (WHO) recently declared the monkeypox virus a Public Health Emergency of International Concern (PHEIC). As the cases of the COVID-19 pandemic start to get under control, we have seen the monkeypox virus, found predominantly in Africa, spread in non-endemic countries worldwide. In the 1970s, after the smallpox virus eradication and the vaccine's discontinuation, the monkeypox virus infection started to gain attention. The first United States outbreak happened in 2003; since then, more sporadic cases of monkeypox have gained media attention. With cases spreading worldwide, without epidemiological links with outbreaks among men who have sex with men (MSM), it warrants urgent public health control measures to contain the spread of the monkeypox virus and investigate the underlying pathophysiology, including genetic modification of the virus. This review highlights the epidemiology, transmission, pathogenesis, clinical manifestation, diagnosis, prevention, and management of the current human monkeypox virus infection.

Novel Presentation of Parechovirus Encephalitis in Children: Two Unique Cases.

Human Parechovirus encephalitis is an uncommon infection. Very few of the cases have been reported in the literature so far. These reports are mainly about neonatal encephalitis, primarily affecting preterm neonates. Parechovirus encephalitis in otherwise healthy pediatric populations is a rare entity. Here, we present two unique pediatric cases secondary to Parechovirus infection, one with hemidystonia and another with acute onset of altered mental status, confusion, and headache.

Recent Advances in the Endoscopic Management of Gastro-esophageal Reflux Disorder: A Review of Literature.

Gastro-esophageal reflux disorder (GERD) is the most common gastrointestinal tract disorder with high morbidity and heavy economic burden. Despite being treated with high-dose proton-pump inhibitors or H2 receptor blockers, a considerable percentage of patients have GERD that is only partially controlled or refractory. The majority of these patients forego surgical treatment for fear of adverse outcomes, putting them at a financial disadvantage and causing loss of productivity. Untreated GERD is the sole known risk factor for developing Barrett's esophagus and esophageal adenocarcinoma if left untreated. With the advancement in therapeutic modalities in recent years, and given the issues such as medication compliance, the risk of adverse events with long-term antisecretory treatment, and fear of undergoing surgical treatment, endoscopic treatments such as Stretta and transoral incisionless fundoplication (TIF) have become a safe, cost-effective, and resilient option for the treatment of refractory GERD. Patients with refractory GERD ineligible for endoscopic therapies due to a large hiatal hernia can have their hiatal hernia corrected simultaneously with TIF (C-TIF). For the treatment of refractory GERD, endoscopic therapy is a viable and compelling option. Endoscopic therapies for refractory GERD patients are highly recommended due to their reproducible and standardized results as well as the potential to address the fundamental mechanical issue.

A Review of National Level Guidelines for Risk Management of Cardiovascular and Diabetic Disease.

Cardiovascular diseases and diabetes are among the leading preventable causes of morbidity and mortality. Cardiovascular disease risk reduction aimed to address the significant modifiable risk factors, including lifestyle-related risk factors, hypertension, hyperlipidemia, and diabetes. Given the severity and disease burden, many insurances, including Medicare, cover the annual counseling for risk reduction of cardiovascular disease. Although numerous national-level guidelines are available for managing these conditions, most of them focus on disease management. Given the broad areas covered in these recommendations, a concise review summarizing the measures addressing the preventive approach in these conditions is not readily available. Herewith, we review and outline the currently available guidelines from national-level publications with principal attention to the primary prevention measures to provide a broad overview and assist providers with the risk reduction counseling.

Ivermectin-Induced Acute Psychosis in Patients Infected With COVID-19 Pneumonia.

Coronavirus disease 2019 (COVID-19) pneumonia is an infection of the lungs that causes severe inflammation in the lungs' alveoli. It causes alveoli to fill with fluid, blood clots, and sometimes even pus. Patients who are infected with COVID-19 pneumonia experience severe cough, shortness of breath, fever, fatigue, chest pain, night sweats, chills, loss of appetite, etc. During the initial phase of the COVID-19 pneumonia pandemic, it was thought that ivermectin might be helpful in patients infected with COVID-19 pneumonia, but this was later proven to be false due to its severe risks/side effects. Infectious Disease Society of America (IDSA) suggests against the use of ivermectin for COVID-19 pneumonia. However, some providers continue to use ivermectin as one of the treatments for patients infected with COVID-19 infection. In this case report, we will discuss ivermectin causing acute psychosis in healthy 45- and 51-year-old patients with no known history of any mental health illness.

Tinnitus and Mild Hearing Loss From a Kiss.

Hearing loss is a common problem that everyone faces at some point in their life. There are three main types of hearing loss: conductive, sensorineural, and mixed. Conductive hearing loss occurs when an external sound is not able to gain access to the inner ear because of some type of obstruction, e.g., cerumen in the auditory canal and fluid in the middle ear. Sensorineural hearing loss (SNHL) is due to damage to the inner ear, which affects the nerve conduction pathway from the inner ear to the brain. Mixed hearing loss is a combination of both conductive and sensorineural hearing loss. Sensorineural hearing loss (SNHL) is one of the most common types of hearing loss. A kiss on an external auditory canal can create a negative pressure that can affect the bones in the inner ear, therefore causing tinnitus and hearing loss. This case report will discuss sensorineural hearing loss (or sudden sensory neural hearing loss (SSNHL)) caused by an innocent kiss on the patient's ear.

Osteoporosis: A Step-by-Step Case-Based Study.

Osteoporosis is a common disease that affects our elderly population. This disease usually gets undiagnosed for an extended period. Osteoporosis increases the risk of fracture in our elderly population and increases morbidity. The cost associated with osteoporosis does carry a substantial burden in our society. Here, we present a case of osteoporosis with a fracture diagnosed in clinical settings. We discuss different etiology, pathophysiology, and treatment options available to treat this medical condition.

Reoccurring Episcleritis and the Role of Antioxidants.

Episcleritis is an irritation of the episclera of our eyes. Episclera is a thin layer of tissue present between the conjunctiva and sclera. There are mainly four causes of episcleritis: an allergic response, autoimmune, vascular disease, or infections. The symptoms are redness, erythema, discomfort in the eyes, and clear discharge. It can sometimes be painful as well. In this case presentation, we will discuss the role of vitamin c in the prevention and reoccurrence of autoimmune episcleritis.

A Rare Case of Risperidone-Induced Hypothermia and Thrombocytopenia.

Psychosis is a term defined in medical literature broadly as someone who has lost contact with reality. Psychosis is typically seen in multiple psychiatric disorders, for example, schizophrenia, bipolar disorder, and severe depression. It is also seen in patients abusing drugs and other underlying medical conditions like hepatic impairment, renal failure, etc. Typically, patients with psychosis will present with hallucinations, delusions, disorganized speech, and behavior. Patients with psychosis are usually treated with antipsychotic medications. There are two types of antipsychotics: typical and atypical antipsychotics. Typical antipsychotics have a low safety profile and are associated with side effects like pancytopenia, hyperthermia, and hypothermia. Therefore, physicians and other medical professionals try to avoid prescribing typical antipsychotics for long-term use. Risperidone, an atypical antipsychotic, is considered relatively safe in patients compared to other antipsychotics. This case study will see risperidone causing hypothermia and thrombocytopenia in a healthy 34-year-old patient.

Gastrointestinal Complications of COVID-19 Vaccines.

Much of the control over the coronavirus disease 2019 (COVID-19) pandemic has been achieved by mass vaccination against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the etiologic agent that causes COVID-19. The COVID-19 mRNA (messenger RNA) vaccines are relatively newly approved and have been widely used in the US since they first became available. However, with passing time, data regarding adverse events associated with the mRNA vaccines have become clearer. Vaccines are safe in general, and the benefits outweigh the risks of adverse events. In this case report, we present the first documented case report of post-vaccination acute diverticulitis and colon micro-perforation following Moderna booster dose (Moderna Inc, Cambridge, USA) in a young adult. Vaccine recipients should be educated on vaccine-associated gastrointestinal (GI) adverse events in order to reduce morbidity and mortality. We also recommend that vaccine recipients with pre-existing GI disorders should be carefully monitored for the worsening of pre-existing conditions post-COVID-19 vaccination.

Fatal Case of Rhabdomyolysis Post-COVID-19 Vaccine.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or COVID-19 pandemic has taken away the lives of many people (>4 million per WHO) around the world as of July 2021. With the advancement of the vaccine against COVID-19, in less than a year since the start of the pandemic, the infection rate has come under control in certain regions but is still rising in many more. However, with time, we are also learning a lot more about the adverse events related to the vaccine. This report documents the first fatal case of rhabdomyolysis potentially associated with the COVID-19 vaccine and supports the possibility that autoimmunity is a major risk factor for covid vaccine-related rhabdomyolysis.

Initial response to chemotherapy, not delay in diagnosis, predicts overall survival in inflammatory breast cancer cases.

OBJECTIVES: To determine whether chemotherapy response and diagnostic delay affect overall survival (OS) of classic inflammatory breast cancer (IBC) cases receiving chemotherapy as initial treatment and to determine whether OS differs between classic and "atypical" IBC cases. METHODS: This is a prospective cohort study of 155 patients enrolled in the IBC Registry. "Classic" IBC cases met AJCC or SEER case definitions. "Atypical" IBC cases exhibited classic features but involved <1/2 breast without documented dermal lymphatic invasion. Variables included OS (years from initial chemotherapy treatment until death or last contact), chemotherapy response (complete, partial, or none), diagnostic delay (days from first medical contact for signs/symptoms of abnormal breast to definitive pathologic IBC diagnosis), age at diagnosis (y), and triple-negative status (yes or no). OS curves stratified by individual predictors were estimated and compared using Kaplan-Meier methods and log-rank tests. Associations between OS and predictors were examined collectively using Cox proportional hazards regression. RESULTS: Classic IBC cases with complete, partial, or no response had respective median (95% confidence interval [CI]) OS times of 10.30 (6.78, +), 6.27 (4.42, +), and 2.86 (1.11, 11.42) years (P=0.0072). Chemotherapy response was significantly associated with OS after controlling for covariates (P=0.003). Women not responding to chemotherapy had a significantly higher hazard of death compared with women with complete (hazard ratio [HR]=5.76; 95% CI, 2.09-15.84) or partial (HR=3.40; 95% CI, 1.27-9.10) response. Diagnostic delay was not significantly associated with OS (HR=1.003; 95% CI, 0.999-1.007). OS did not differ significantly between classic and "atypical" IBC cases (P=0.60). CONCLUSIONS: Response to standard IBC chemotherapy is a dominant prognostic factor in determining patient outcomes. In our study, with limited statistical power, delay in diagnosis defined as >60 days from the time of first physician contact did not seem to affect patient outcomes. Data support similarities between classic and "atypical" IBC.

Ultrasound-guided arthrocentesis of the elbow: a posterior approach.

BACKGROUND: Identification of fluid in the elbow joint by physical examination alone can be challenging. Ultrasound can assist in the diagnosis of elbow effusion, and guide aspiration of the effusion. OBJECTIVES: We illustrate the anatomy and ultrasound guidance technique of a posterior approach to elbow arthrocentesis using examples of normal and pathologic elbow joint ultrasound images. DISCUSSION: The posterior distal humerus at the level of the olecranon fossa provides an excellent acoustic window into the joint space. This location also provides a safe path for the performance of ultrasound-guided arthrocentesis. CONCLUSION: Ultrasound-guided arthrocentesis of the elbow from a posterior approach is a helpful technique to guide the aspiration of the painful swollen elbow.