Myasthenia gravis in an old woman discovered during sedation for diagnostic digestive fibroscopy: Case report.

Introduction and importance: Myasthenia gravis is an autoimmune disease characterized by the destruction of postsynaptic acetylcholine receptors in skeletal striated muscles. It is most common in young women. Myasthenia can be diagnosed by the detection of anti-acetylcholine receptor antibodies. Treatment includes anticholinesterase drugs, thymectomy, and restricting drugs that may aggravate myasthenia. The authors report a rare case of accidental revelation of myasthenia gravis in an elderly woman during sedation for diagnostic gastrointestinal fibroscopy. Case presentation: A 85-years-old female patient scheduled for diagnostic gastrointestinal fibroscopy presented signs of myasthenic crisis during the perioperative with severe respiratory failure. The diagnosis of myasthenia was confirmed by bioassay and electromyogram (EMG). Her chest CT scan showed a thymoma. The evolution was favorable as a result of early and appropriate management. Conclusion: Myasthenia can occur in perioperative settings outside the usual circumstances. The prognosis depends on early and adapted management.

COVID-19: Patient care after discharge from the Intensive Care Unit.

INTRODUCTION: The Ibn Rochd CHU is a tertiary care structure that provides care for the most severe cases of COVID-19 requiring hospitalisation in intensive care. The objective of study is to describe the complementary medical and psychological care of patients with COVID-19 in the endocrinology department after a stay in intensive care. PATIENTS AND METHODS: This is a descriptive observational study of patients transferred from the intensive care unit to the endocrinology service following a COVID-19 infection during the period from 17 April 2020 to May 26, 2020. Clinical characteristics of the patients and complications related to COVID-19 infection were studied; a nutritional assessment using the MNA nutritional status assessment questionnaire; psychological assessment using quality-of-life questionnaires (Hamilton depression and anxiety, HAD, SF36, PCLS); a treatment satisfaction questionnaire (TQCMII) and an assessment of patient autonomy by the ADL score. RESULT: Our study included 41 patients with an average age of 55 years (19-85 years), a sex ratio M/F of 1.05, 43.9% were diabetic, 34.1% hypertensive, 4.9% asthmatic and 5% obese, and 51.2% were severe and critical cases. The average ICU stay is 8.42 days, requiring intubation in 12.2% of cases. All patients were treated with the Hydroxychloroquine, Azithromycin, vitamin C, zinc and corticosteroid protocol, 14.6% had undernutrition and 65.9% had a risk of undernutrition. The average BMI was 25.34 kg/m2 (17-42), 61% had experienced weight loss, which was greater than 8 kg in 26.1% of cases, 12.2% of patients were not autonomous, 12.2% had moderate depression, 2.4% severe depression, 14.6% mild to moderate anxiety, 12.2% severe anxiety and 29.3% suffered acute post-traumatic stress disorder. CONCLUSION: Patients with COVID-19 are, in addition to the complications from coronavirus infection, vulnerable to undernutrition, psychological and motor complications. Additional care before discharge is essential for better integration of patients into their families.

Nutritional status assessment in patients with Covid-19 after discharge from the intensive care unit.

INTRODUCTION: The nutritional diagnosis and early nutritional management of COVID-19 patients must be integrated into the overall therapeutic strategy. The aim of our study is to assess the nutritional status of patients with COVID-19 after a stay in intensive care, to describe the prevalence of undernutrition, to determine the factors influencing undernutrition and to describe the nutritional management. TOOLS AND METHODS: This is a descriptive observational study of adult patients admitted to the endocrinology service for additional care after a stay in intensive care during the period from April 17, 2020 to May 26, 2020. The assessment tool used was the Mini Nutritional Assessment (MNA). RESULTS: Our study included 41 patients; the average age of the patients was 55 years, 51.2% had a severe or critical form of COVID-19, 75.6% stayed in intensive care, 12.2% had a loss of autonomy. The average BMI was 25.2 kg/m2 (17-42 kg/m2), 42.5% were overweight, 61% had weight loss, 26.2% had weight loss greater than 10%, 14.6% of our patients were undernourished, 65.9% were at risk of undernutrition, 19.5% had hypoalbuminemia, 17.1% had hypoprotidemia, 19.5% hypocalcemia, 34.1% anemia, 12.2% hypomagnesemia and 51.2% had a deficiency in vitamin D. A positive correlation was found between poor nutritional status and a longer stay in intensive care (>5 days) (p = 0.011) and lymphopenia (p = 0,02). CONCLUSION: Despite a personalized diet, 14.6% of patients presented undernutrition. Particular attention should be paid to patients with a long stay in intensive care.

COVID-19 and fortuitous discovery of chronic lymphocytic leukemia: biological findings and therapeutic challenges.

With the major spread of SARS-COV-2 around the world, its association with various pathologies has been reported. However, hemopathy has rarely been revealed during a coronavirus infection. The authors of this article aim to emphasize the diagnostic and therapeutic challenges faced while treating COVID/hemopathy patients.

Coronavirus disease-19 (COVID-19) associated with acute pancreatitis: case report.

The SARS-CoV-2 primarily attacks the respiratory system and the most common symptoms include cough, shortness of breath, and fever. However, its tropism for the digestive system has been demonstrated and its clinical digestive manifestations are increasingly recognized. Nevertheless, little attention has been paid to pancreatic lesions included in SARS-CoV-2 infection. This case describes the presentation of acute pancreatitis as a complication associated with SARS-CoV-2 infection and the importance of looking for this complication in any patient with COVID-19. Data was collected from a patient admitted with COVID-19 to intensive care in July 2020. The patient was diagnosed with acute pancreatitis associated with SARS-CoV-2. Other causes of acute pancreatitis were excluded for both patients (including alcohol, obstruction/gallstones, drugs, trauma, hypertriglyceridemia, hypercalcemia). This case highlights acute pancreatitis as a complication associated with COVID-19 and highlights the importance of measuring lipasemia and performing an abdominal computed tomography (CT) scan in patients with COVID-19.