Gastrointestinal Symptoms in Association With Hypokalemia Can Be a Predictor of Inferior Outcomes in COVID-19.

The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus disease-2 (SARS-C0V-2), has affected many lives globally. In Singapore, majority of the infected individuals are foreign workers residing in dormitories. A retrospective review conducted over two weeks (April 13 to April 26, 2020) of migrant workers admitted to a public hospital in Singapore revealed that a significant number of them developed hypokalemia. The purpose of this study was to examine any association that might exist between COVID-19 and hypokalemia. Fifty patients in this study had hypokalemia, translating to a prevalence of 28.4% (95% CI: 21.9-35.7). Gastrointestinal (GI) loss was a significant cause of hypokalemia with a prevalence of GI symptoms in the study group (diarrhea, vomiting, poor oral intake) of 5.7% (95% CI: 2.8-10.2). Clinicians should consider screening for hypokalemia in COVID-19 patients and initiate potassium replacement to mitigate any potential arrhythmias.

Myocardial injury in non-cardiac surgery: complexities and challenges.

The term MINS (myocardial injury after non-cardiac surgery) was coined to broadly describe perioperative troponin elevation that is deemed to be due to a cardiac cause. However, this term is commonly used in literature to represent cases that do not fulfil the criteria for the diagnosis of myocardial infarction. Asymptomatic troponin elevation that does not fulfil the criteria for acute coronary syndrome in the perioperative setting has been shown to be associated with increased mortality. The discovery of MINS presents new opportunities to improve outcomes for surgical patients. Unfortunately, awareness of MINS among practitioners remains low and implementation of perioperative troponin monitoring is poor. Given its significance, the detection, management and prevention of MINS should not be overlooked.

Hypercalcaemia secondary to disseminated Mycobacterium abscessus and Mycobacterium fortuitum.

The incidence and prevalence of nontuberculous mycobacteria (NTM) infection is on the rise with many cases still going unreported. Given the vague and nonspecific clinical features of NTM infections, it is often missed or mistaken for Mycobacterium tuberculosis. The presumption that NTM infections are benign and do not contribute to morbidity no longer holds true. NTM infections need to be considered in patients with disseminated multisystem disease and in those not responding to standard M. tuberculosis treatment. As NTM infection is associated with granuloma formation, it can result in hypercalcaemia. Interestingly, there is evidence that there may be other mechanisms in play contributing to hypercalcaemia besides the increased calcitriol levels.

Bilateral Basal Ganglia Calcification: Fahr's Disease.

Fahr's disease/syndrome is a condition defined as bilateral striato-pallido-dentate calcinosis, a neurodegenerative disease with radiological findings of symmetrical and bilateral idiopathic calcifications of the cerebellum, periventricular white matter, and basal ganglia. Clinical correlation with radiological and a calcium metabolism panel is crucial in differentiating between Fahr's disease and Fahr's syndrome. We describe a case that presented with the clinical feature of a cerebrovascular accident and had an incidental radiological finding of Fahr syndrome. The clinical features, laboratory investigations, and clinical management of Fahr's disease/syndrome will be discussed in detail in the article.

A case of Lemierre-like Syndrome: internal jugular vein thrombosis secondary to Staphylococcus aureus sternoclavicular joint septic arthritis.

Lemierre syndrome is the internal jugular vein (IJV) suppurative thrombophlebitis, usually secondary to oropharyngeal infection. Staphylococcus aureus is an emerging responsible pathogen. We report a unique case of IJV thrombosis secondary to methicillin-susceptible S. aureus sternoclavicular joint septic arthritis. We review the existing literature on Lemierre syndrome: its various manifestations, causative pathogens, treatment and management.

A case of mesenteric panniculitis associated with metastatic poorly differentiated cancer of unknown primary site.

Mesenteric panniculitis is the inflammation of intestinal mesentery. It may be associated with malignancy. We present a case of mesenteric panniculitis that manifested as unresolved fever which subsequently was found to be due to poorly differentiated metastatic carcinoma.

Reset Osmostat: A Challenging Case of Hyponatremia.

Hyponatremia is the most common electrolyte abnormality seen in hospitalised patients with up to 15-20% of patients having a sodium level of less than 135 mmol/L (Reddy and Mooradian, 2009). Cases of hyponatremia were first described in the 1950s (George et al., 1955). As the differential diagnosis for hyponatremia is broad, a systematic and logical approach is needed to identify the cause. We describe a case of a 30-year-old gentleman who was found to have chronic hyponatremia. After a thorough workup, he was diagnosed to have reset osmostat. Reset osmostat is an uncommon and under recognised cause of hyponatremia which does not require any treatment. This diagnosis needs to be considered when the hyponatremia workup suggests SIADH, but the hyponatremia is not amenable to fluid restriction, salt or urea supplementation, and diuretic treatment.

Appendicitis in non-typhoidal salmonella bacteraemia.

Salmonella typhi and paratyphi infections can manifest as acute abdomen due to intestinal perforations, salpingitis and rarely appendicitis. Non-typhoidal salmonella infection that usually only causes self-limiting gastroenteritis, is rarely associated with appendicitis. We present the case of a 78-year-old gentleman with Salmonella bacteraemia complicated by acute appendicitis. He was treated conservatively due to multiple comorbidities. His condition improved after completion of 2 weeks of antibiotics guided by the blood and stool culture results. Appendicitis is a rare but important complication to consider in Salmonella bacteraemia. More research needs to be done with regards to the clinical course of Salmonella related appendicitis.