Infective endocarditis secondary to Peptoniphilus Indolicus and Corynebacterium: an amalgamation.

Corynebacterium or diphtheroid's are gram-positive aerobic, pleomorphic skin and mucosal membrane components that are not pathogenic in nature. Peptostreptococcus indolicus belongs to the Peptostreptococcus genus and is a Gram-Positive Anaerobic Cocci (GPAC). Less than one percent of endocarditis is caused by gram-positive anaerobic bacteria. We report the first case of Peptoniphilus indolicus and Corynebacterium endocarditis in a patient with native valves and a pacemaker. In time, diagnosis of a Peptoniphilus indolicus infection can lead to early management of the infection and a decreased incidence of serious complications such as embolization or abscess formation. The combination of aggressive antibiotic administration and surgical intervention can significantly decrease morbidity and mortality. This case report will highlight the importance of Peptoniphilus infective endocarditis, ultimately leading to better diagnostic strategies and management.

Myasthenia Gravis Associated With COVID-19 Infection.

COVID-19 first emerged in Wuhan, China in late December 2019. The disease majorly involves the lungs leading to various respiratory complications; however, neurological manifestations of the disease are also described in the literature. Here, we report a case of COVID-19-induced seronegative myasthenia gravis (MG). We discuss the cases of COVID-19 and MG already described in the literature in regard to their presentation and serological findings to better understand the association between the two disease processes. MG may be missed in patients after COVID-19 infections because of the comorbidities and anti-acetylcholine receptor and anti-muscle-specific tyrosine kinase antibodies being negative. Evidence from more studies will help analyze the pathological timeline of the disease process and the immunological characteristics of COVID-19-induced MG which can prove to have morbidity and mortality benefit in patients with COVID-19-induced MG.

Severe COVID-19-Induced Hemophagocytic Lymphohistiocytosis.

We reported a case of secondary hemophagocytic lymphohistiocytosis (HLH), a rare and life-threatening condition, which was suspected to have been triggered by a severe case of coronavirus disease 2019 (COVID-19). A 50-year-old man with a past medical history of ulcerative colitis with recent pancolitis status post colectomy and ileostomy two weeks before presentation presented to the emergency department with one week of subjective fevers, weakness, watery diarrhea, and decreased oral intake. A CT scan showed fluid in the rectum and post-surgical changes from his recent colectomy along with diffuse reticulonodular opacities of the lungs. His COVID-19 reverse transcriptase-polymerase chain reaction (RT-PCR) test was positive. Over the subsequent days, the patient's condition worsened as he developed worsening acute hypoxic respiratory failure with diffuse lymphadenopathy, splenomegaly, worsening cytopenias, and increased ferritin of >100,000 ng/ml on hospital day six. Hematology oncology was consulted and he was started on empiric steroid therapy followed by etoposide. However, his condition continued to worsen, and eventually, the patient passed away on hospital day eight.

A Case of Left-Sided Infective Endocarditis of Multiple Native Valves Complicated by Valve Leaflet Perforation, Multiple Septic Emboli, Thromboembolic Events, and Cardiac Arrhythmias.

Coagulase-negative staphylococci (CoNS) can uncommonly cause native valve endocarditis. We present a case of left-sided infective endocarditis of native valves presenting with splenic, lung, and brain infarcts along with aortic and significant mitral valve involvement with mitral valve perforation. The patient was also found to be in atrial flutter and atrial fibrillation. Left-sided endocarditis is reported to cause brain and spleen infarcts but pulmonary embolisms are usually a complication of right-sided endocarditis. Atrial fibrillation is also known to increase mortality in patients with infective endocarditis.

The Role and Efficacy of Vitamin C in Sepsis: A Systematic Review and Meta-Analysis.

Clinical rationale for study: Despite advancements in critical care, the mortality rate of sepsis remains high, with an overall poor prognosis. There is a complex pathophysiology of a lethal cascade of cytokines and inflammatory proteins underlying sepsis. The use of vitamin C can theoretically suppress the inflammatory cascade but remains a questionable practice due to a lack of conclusive evidence. Aims of the study: To appraise the therapeutic role of vitamin C in sepsis. Materials and methods: A systematic review was conducted on PubMed, Embase, and the Central Cochrane Registry. The study included randomized clinical trials (RCTs) with vitamin C as an intervention arm in the septic patient population. For continuous variables, the difference in means (MD) and for discrete variables, the odds ratio (OR) was used. For effect sizes, a confidence interval of 95% was used. A p-value of less than 0.05 was used for statistical significance. The analysis was performed using a random-effects model irrespective of heterogeneity. Heterogeneity was evaluated using the I2 statistic. Results: 23 studies were included with the total sample size of 2712 patients. In patients treated with vitamin C, there was a statistically significant reduction in the mortality: OR = 0.778 (0.635 to 0.954), p = 0.016; the sequential organ failure assessment score (SOFA): MD = −0.749 (−1.115 to −0.383), p < 0.001; and the duration of vasopressor requirement: MD = −1.034 days (−1.622 to −0.445), p = 0.001. No significant difference was found in the hospital or ICU length of stay. Conclusions and clinical implications: Vitamin C treatment regimens were associated with reduced mortality, SOFA score, and vasopressor requirement compared to the control in sepsis. Given its low cost and minimal adverse effects, we strongly encourage further large, randomized trials to establish vitamin C as a standard of care in sepsis management.

Cardiopulmonary Arrest After COVID-19 Vaccination: A Case Report.

Coronavirus disease 2019 (COVID-19) emerged in Wuhan in 2019 and by far has affected the whole world, and many people have succumbed to the disease. Vaccination programs introduced around the globe are aiming to reduce morbidity, mortality, and disease spread. We report the case of a 59-year-old male who suffered from cardiopulmonary arrest post-COVID-19 mRNA booster vaccination with no history of any other cardiopulmonary disease. Association between myocarditis and mRNA COVID-19 vaccines have been previously reported. However, this is the first case of cardiopulmonary arrest post-COVID-19 booster vaccination. Further research and cases should be described to confirm if this relationship exists. We need further cases to find this temporal association as such cases can also increase vaccine hesitancy. However, vaccination-associated adverse events should be vigilantly monitored and evaluated from time to time as further reports emerge.

Epidemiology of Depressive Disorders in Patients With Liver Cirrhosis: A Population-Based Study in the United States.

Objective: Major depressive disorder (MDD) is a chronic, debilitating mood disorder associated with poor medical outcomes. MDD has a multifactorial etiology with numerous biopsychosocial factors implicated as risk factors. Functional and psychiatric impairments have been evaluated in patients with liver cirrhosis; however, less is known about the prevalence and risk factors for the development of MDD in those patients. The objective of this study was to evaluate the risk of developing depression among adult patients with liver cirrhosis in the United States.Methods: Data were collected using a commercial database, an aggregate of electronic health record data from 26 major integrated US health care systems consisting of 360 hospitals in the US from 1999 to 2019.The study cohort was retrieved by searching the database for a Systematized Nomenclature of Medicine-Clinical Terms diagnosis of "cirrhosis of liver" during the designated period of the study.The following factors were adjusted for in the analyses: age, sex, race, smoking, alcohol, substance abuse, underlying mental disorders, and comorbidities.Results: 56,197,690 adults were identified between 1999 and 2019. Of those, 293,150 had a diagnosis of liver cirrhosis. The prevalence of depression among those cirrhotic patients was 23.93% versus 7.61% in the noncirrhotic control group (95% CI, 16.1836%-16.4770%; P < .0001). By applying a multivariate analysis model, cirrhotic patients were found to be more likely to develop depression (odds ratio = 2.172; 95% CI, 2.159-2.185; P < .0001) compared to patients with no prior history of liver cirrhosis.Conclusions: Liver cirrhosis is associated with increased risk of depression and is likely to be an independent risk factor in its development. Future efforts should focus on the identification and treatment of this debilitating condition in those with liver cirrhosis via an integrated care model.

Klebsiella Pneumoniae Brain Abscess in a Patient With Chronic Lymphocytic Leukemia.

Klebsiella Pneumoniae (K. pneumoniae) is a common nosocomial pathogen. However, Klebsiella-associated meningitis and brain abscess formation are extremely rare in the United States. We present a case of a 73-year-old male who initially presented for a tonsillar abscess of unknown etiology. While awaiting an abscess biopsy, the patient underwent molar extraction for chronic periodontitis and decay. The patient subsequently developed K. pneumoniae bacteremia and meningitis. As he clinically declined, repeat imaging revealed a brain abscess with eventual hemorrhagic transformation. Notably, the patient had underlying hypogammaglobulinemia from chronic lymphocytic leukemia (CLL), which we believe contributed to the invasive disease. Given the global spread of virulent strains of Klebsiella (such as hypervirulent or hypermucoviscous K. pneumoniae), clinicians must bear this pathogen in mind while treating critically ill and immunocompromised patients.

Prevalence of Myocardial Infarction in Patients With Chronic Pancreatitis.

OBJECTIVE: We conducted this study to ascertain whether chronic inflammation secondary to chronic pancreatitis (CP) has any association with myocardial infarction(MI). METHODS: Data were collected from a commercial database (Explorys, Inc, IBM Watson, Ohio). Adults with the diagnosis of "chronic pancreatitis," based on Systematized Nomenclature of Medicine-Clinical Terms, were included in the CP group, and the rest of the patients were included in the non-CP group. The prevalence of MI was compared in both groups, and statistical multivariate model was performed. RESULTS: A total of 28,842,210 patients were included in the study. The overall prevalence of MI was 14.22% in the CP group as compared with 3.23% in the non-CP group (P < 0.0001). In the multivariate analysis, the odds ratio (OR) for MI in CP group was 1.453 (95% confidence interval, 1.418-1.488, P < 0.0001). Hypertension was a strong predictor for MI in the CP group with an OR of 3.2 (95% confidence interval, 3.0-3.5), followed by chronic kidney disease, older than 65 years, dyslipidemia, diabetes mellitus, obesity, alcohol abuse, smoking, White race, and male sex. CONCLUSIONS: This study showed that CP is associated with comorbidities, which can increase the prevalence and OR of MI.

Multiple Myeloma and Change of ABO Blood Group Type: A Case Report.

Multiple myeloma is a hematopoietic stem cell malignancy that involves the plasma cells. It starts insidiously and usually involves males in their 60's. Clinical manifestations usually include anemia, kidney disease, hypercalcemia, and bone pains. We present a male with multiple myeloma whose blood group changed from AB positive to O positive. ABO blood group change can occur in multiple myeloma so blood group should be checked thoroughly in patients with hematological malignancies to prevent serious hematological reactions.

Bilateral pneumothorax as possible atypical presentation of coronavirus disease 2019 (COVID-19).

Coronavirus disease 2019 (COVID-19) is most frequently associated with a mild presentation of fever, cough, and shortness of breath. Typical radiographic findings of COVID-19 are bilateral ground-glass opacities on computed tomography (CT) scans. However, there have been instances of pneumothorax, giant bulla, and pneumomediastinum, mainly in elderly COVID-19 patients and predominately occurring at least one week after symptom onset. Here, we report a case where a healthy, young Hispanic man presented with three days of fever, cough, and dyspnea. On admission to the emergency department, he was found to have bilateral pneumothoraces, pneumomediastinum, and pneumopericardium requiring bilateral chest tubes. The patient had no predisposing risk factors for pneumothorax, such as a history of trauma, smoking, past intubations, asthma, high pressure oxygen delivery, or a history of prior pneumothorax. The only positive diagnostic test was a SARS-CoV-2 test by real-time reverse transcriptase-polymerase chain reaction assay. This case highlights the potential atypical presentation of a COVID-19 infection and is the first reported case, to our knowledge, that features bilateral spontaneous pneumothoraces, pneumomediastinum, and pneumopericardium as a probable rare presentation of COVID-19.

Understanding the Mosaic of COVID-19: A Review of the Ongoing Crisis.

In late 2019, a queer type of pneumonia emerged in Wuhan city in the central part of China. On investigation, it was found to be caused by the coronavirus. Human coronaviruses were discovered in the 1960s. There are a total of seven types of coronaviruses that infect humans: 229E and NL63 are the alpha coronaviruses; OC43, HKU1, MERS-CoV, and SARS-CoV are beta coronaviruses, and SARS-CoV-2 or COVID-19 is a novel coronavirus. COVID-19 surfaced in China at the culmination of the year 2019. The pandemic then fanned out rapidly, involving Italy, Japan, South Korea, Iran, and the rest of the world.

Non-motor Symptoms in Patients with Parkinson's Disease: A Cross-sectional Survey.

Background In multiple studies around the globe, non-motor symptoms (NMS) have been identified as a source of immense disability in patients with Parkinson's disease (PD). However, there is a scarcity of data from Asia. This is the first study of the Pakistani population to assess the impact of NMS in PD on patients. Objectives To determine the frequency of NMS of PD in the Pakistani population and compare it with existing data. Methods In this cross-sectional survey, patient demographics were retrospectively collected from a tertiary care hospital neurology database. This study population comprised 97 patients at different stages of PD who presented to the neurology outpatient department. Disease severity was assessed using the Hoehn and Yahr scale. The NMS questionnaire was employed to identify the presence of NMS. Medical records were reviewed for demographic data and recent treatment history. Results The mean age was 67 years (76.3% of patients had adult onset PD and 23.7% had young onset PD). The NMS with the highest frequencies were nocturia (77.3%), urinary urgency (61.9%), constipation (59.8%), dementia (58.8%), insomnia (52.6%), and orthostatic hypotension (52.6%). The earliest manifestations of NMS were nocturia, forgetfulness, low mood, and orthostatic hypotension. Sleep abnormalities, falling episodes, and hallucinations are prevalent among patients with advanced disease. Conclusion There is a higher frequency of NMS present in the Pakistani population as compared to existing data in other populations.

A Full-Blown Case of Bronchiectasis: Kartagener Syndrome Without Infertility Diagnosed Later in Life.

Kartagener syndrome (KS) is a rare autosomal recessive genetic ciliary disorder characterized by situs inversus, chronic sinusitis, bronchiectasis, and infertility. KS is associated with ultrastructural anomalies of the cilia in epithelial cells covering the upper and lower respiratory tracts and spermatozoa flagella. This case describes a patient with KS with situs inversus and sudden onset bronchiectasis with a sharp decline in respiratory function presenting later in life but without sinusitis or infertility.

Ischemic Stroke of Midbrain and Cerebellum Involving Reticular Activating System.

The reticular activating system is the part of the brain that maintains the sleep/wake cycle. Any damage to this region can cause hypersomnolence and drowsiness along with altered sensorium. This case presents a patient with cerebellar and midbrain stroke with infarct of the reticular activating system, leading to hypersomnolence, drowsiness, and altered sensorium.

Isolated Homocysteinemia Leading to Thromboembolism in Young Male with Normal Vitamin B12 and Folate Levels.

Pulmonary embolism (PE) with isolated homocysteinemia is a rare disease. The diagnosis demands a proper clinical workup. Timely diagnosis can prevent complications and provide a better quality of life for the patient. We present a young man with homocysteinemia with deep vein thrombosis (DVT), pulmonary embolism, and normal vitamin B12 and folate levels despite being treated with rivaroxaban.

Case of Enteric Fever with Bicytopenia.

Infectious diseases are one of the major causes of morbidity and mortality in developing countries. Typhoid has its own contribution to the disease burden, especially in Pakistan and other tropical countries. Herein, we present a case of enteric fever with a rare presentation. Our patient is a 20-year-old man who gradually developed high-grade fever lasting seven days associated with rigors and chills. No additional accompanying systemic signs helped to localize the infection. After extensive laboratory testing, his typhoid serology was positive along with leukocytopenia and thrombocytopenia. Typhoid fever is typically associated with either diarrhea or constipation and sphygmothermic dissociation (Faget's sign); our patient did not have these symptoms or signs. As leukocytopenia and thrombocytopenia contribute to mortality and complications, it was necessary to monitor the patient accordingly.