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INTRODUCTION: Several publications described neurological manifestations caused by SARS-CoV-2. Immune-mediated neurological damages caused by COVID-19 are increasingly recognized. CASE REPORT: A young male presented in March 2020 with a new-onset seizure. Later, he started to experience a severe headache. During the second admission in May, the MRI of the brain showed left frontal lesion. Nasal PCR for SARS-CoV-2 was negative, but the serology was positive, raising the suspicion of immune-mediated encephalitis. Elevated cerebrospinal fluid immunoglobulin G with two oligoclonal bands were also seen. The patient received IV immunoglobulin and showed improvement in headache. Follow-up MRIs of the brain revealed complete resolution of the lesion. DISCUSSION: Neurological complications from COVID-19 have been increasingly recognized. The proposed pathophysiology is either direct damage of neurological tissues, or indirectly through immune-mediated mechanisms. The timeline of the patient's presentation with seizure, as well as the lesion on the brain MRI with complete resolution after the IV immunoglobulin, strongly suggest that the patient had immune-mediated encephalitis after exposure to SARS-CoV-2. CONCLUSIONS: Several cases of encephalitis caused by SARS-CoV-2 have been reported. Immune-mediated encephalitis as probable pathophysiology is described here.
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Introduction Patients that are presented with acute calculus cholecystitis (AC) and elevated liver enzymes markers (LEM), often require evaluation for concurrent choledocholithiasis (CDL). Currently, evaluation guidelines follow the American Society of Gastroenterology Endoscopy (ASGE) recommendations. Objectives The aim of the study was to externally validate both ASGE and the Chisholm predictors in a community hospital patient cohort. Methods We conducted a retrospective study of patients who presented to Ascension Saint John hospital with AC and elevated LEM over a period of two years. Sensitivity (SEN), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV) were used to test the external validity of ASGE and Chisholm algorithms. Results A total of 132 patients' charts were reviewed, and 87 patients included. Chisholm predictors SEN, SP, PPV and NPV were 50%, 82%, 18%, and 95% respectively versus 100%, 19%, 8%, 100% for the ASGE predictors model. In the ASGE module, SP and PPV can be significantly improved to 60% and 13%, respectively, by changing a few risk categories including age and LEM range. Conclusions External validation of the Chisholm module in our patient cohort showed that it would lead to a low referral rate for unnecessary imaging and thus might be more cost-effective, especially when compared to current ASGE recommendations which would have a higher referral rate. On the other hand, current ASGE recommendations successively labeled all the patients with CDL, while the Chisholm module missed around 50 percent. We also observed that with the current ASGE module, the referral rate for further imaging and diagnostic tests can be possibly improved by adjusting a few of the predictors including the age and the abnormal liver transaminases range, but this observation is arbitrary and will need to be validated in a larger cohort study.
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OBJECTIVE: To evaluate sun exposure behaviours, sun protection practices, general knowledge, attitudes and awareness of University students about the benefits of sun exposure and harmful effects of too much or avoidance of sun exposure. METHODS: This cross-sectional survey study was conducted in December 2014 and January2015 at Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia. A questionnaire consisting of multiple-choice closed questions was used. Sample was collected using cluster sampling method. SPSS 16 was used for data analysis. RESULTS: Of the 399 participants, 200(50.1%) were men and 199(49.9%) were women. The overall mean age was 21±1.82years (range: 18-30 years). Moreover, 217(54.4%) participants intentionally exposed themselves to sun. Spending summer holidays in coastal areas was reported by 150(37.6%). Sunglasses were used by 161(40.4%) participants. Besides, 274(68.7%) participants agreed that sun exposure of 5 to 10 minutes for two or three times per week was very important; 189(47.4%) were aware of the importance of sun exposure for child health. 165(66%), knew that too much sun exposure was harmful and might cause skin cancer. CONCLUSIONS: Most of the participants were aware of both beneficial effects of the appropriate sun exposure and harmful effects of too much exposure or its avoidance. However, proper sun exposure practices and sun protection practices need further guidance and encouragements from health-promoting programmes.
