Term Neonate Born With Right Upper Extremity Skin Necrosis at Birth: A Case Report.

Congenital skin and soft tissue necrosis is a rare condition associated with significant morbidity and mortality in neonates. The authors treated a neonate born with significant skin necrosis of the right forearm. The case report is followed by a literature review and discussion of previously published reports of neonatal skin necrosis. A term female neonate was admitted to our hospital at 24 h of age for skin necrosis of the right forearm with sloughing and edema below the right elbow and contractures of her fingers. Topical treatment with cleansing and antibiotic application was initiated. The LUNA florescent microangiography showed superficial perfusion defects in the arm and dorsum of the hand along with overt ischemia over the dorsal aspect of the forearm. She was treated with intravenous antibiotics following a sepsis evaluation. Subsequently, she developed hypotension treated with fluid boluses, dopamine, and stress dose steroids. Concerns of wound infection and sepsis led to debridement of the necrotic area within the first 24 h post-admission. Wet-to-dry dressing changes using Vashe wound solution were begun postoperatively.; followed by placement of Integra on postoperative day-of-life (DOL) 7; dressing takedown on DOL 12; and autografting of the right hand and forearm with disarticulation of the 4th distal interphalangeal joints and right 5th distal interphalangeal transection on DOL 24. Postoperative dressing care was continued during the remainder of the hospital stay, she remained stable without any further complications and was discharged home on DOL 34 with outpatient clinic follow-up.

COVID-19 and Sleep Disturbances: A Literature Review of Clinical Evidence.

The need for adequate good quality sleep to optimally function is well known. Over years, various physical, psychological, biological, and social factors have been investigated to understand their impact on sleep. However, understanding the etiological processes that are involved in causing sleep disturbances (SD) as impacted by stressful phases such as pandemics has not been well studied. Many such etiological and management strategies have surfaced during the latest "coronavirus disease of 2019 (COVID-19) pandemic. The occurrence of these SD in the infected and uninfected individuals poses a need to investigate factors linked to such occurrence during this phase. Some of such factors include stressful practices such as social distancing, masking, vaccines, and medications availability, changes in routines, and lifestyles. As the status of infection improved, a collective term for all the prolonged effects of COVID-19 after the resolution of the primary infection called the post-COVID-19 syndrome (PCS) surfaced. Apart from impacting sleep during the infectious phase, the aftereffects of this virus left an even greater impact during the PCS. Various mechanisms have been hypothesized to be linked to such SD during the PCS, but the available data are inconclusive. Further, the varied patterns of incidence of these SDs differed by many factors, such as age, gender, and geographical location, making clinical management even more challenging. This review elucidates the impact of coronavirus 2 (SARS-CoV-2) (COVID) disease on sleep health during the various phases of the COVID-19 pandemic. We also investigate different causal relationships, management strategies, and knowledge gaps related to SD during the COVID-19 pandemic.

Sleep and Safety among Healthcare Workers: The Effect of Obstructive Sleep Apnea and Sleep Deprivation on Safety.

Almost one billion people worldwide are affected by Obstructive Sleep Apnea (OSA). Affected individuals experience disordered breathing patterns during sleep, which results in fatigue, daytime drowsiness, and/or sleep deprivation. Working under the influence of these symptoms significantly impairs work productivity and leads to occupational accidents and errors. This impact is seen in healthcare workers (HCWs) who are not immune to these conditions. However, poorly controlled OSA in this subset of individuals takes a heavy toll on patient care due to the increased risk of medical errors and can also alter the mental and physical well-being of the affected HCW in various ways. OSA and safety issues have been recognized and mitigated among the airline and transport industries; however, the healthcare industry lags in addressing these concerns. This article reviews hypersomnolence and sleep disorder as key clinical features of OSA and their effect on HCW safety.

COVID-19 Misinformation: A Potent Co-Factor in the COVID-19 Pandemic.

COVID-19, the biggest global health crisis of our times was complicated by an equally potent co-factor: the misinformation infodemic. A confluence of unique factors led to the emergence of the crisis of misinformation, including the widespread reach of social media, the lack of credible sources and strategies for information dissemination, and the sticky and virulent nature of the misinformation campaigns. One of the primary targets of the misinformation campaign was the COVID-19 vaccine effort, leading to significant impediments to implementing an effective and successful vaccination campaign. The time to act is now and will need a concerted multipronged approach with a close partnership between scientists, public health agencies, government agencies, and social media companies to foster accuracy in the exchange of health information in social media and curb the menace of misinformation. This paper aims to review the scope of the problem and examine strategies to help mitigate it.

Review of Application of Machine Learning as a Screening Tool for Diagnosis of Obstructive Sleep Apnea.

Obstructive sleep apnea syndrome (OSAS) is a pervasive disorder with an incidence estimated at 5-14 percent among adults aged 30-70 years. It carries significant morbidity and mortality risk from cardiovascular disease, including ischemic heart disease, atrial fibrillation, and cerebrovascular disease, and risks related to excessive daytime sleepiness. The gold standard for diagnosis of OSAS is the polysomnography (PSG) test which requires overnight evaluation in a sleep laboratory and expensive infrastructure, which renders it unsuitable for mass screening and diagnosis. Alternatives such as home sleep testing need patients to wear diagnostic instruments overnight, but accuracy continues to be suboptimal while access continues to be a barrier for many. Hence, there is a continued significant underdiagnosis and under-recognition of sleep apnea in the community, with at least one study suggesting that 80-90% of middle-aged adults with moderate to severe sleep apnea remain undiagnosed. Recently, we have seen a surge in applications of artificial intelligence and neural networks in healthcare diagnostics. Several studies have attempted to examine its application in the diagnosis of OSAS. Signals included in data analytics include Electrocardiogram (ECG), photo-pletysmography (PPG), peripheral oxygen saturation (SpO2), and audio signals. A different approach is to study the application of machine learning to use demographic and standard clinical variables and physical findings to try and synthesize predictive models with high accuracy in assisting in the triage of high-risk patients for sleep testing. The current paper will review this latter approach and identify knowledge gaps that may serve as potential avenues for future research.

Paradoxical increase in ambulatory SBP in coarctation of aorta a compared to essential hypertension.

BACKGROUND: The relationship between office vs. ambulatory blood pressure (BP) indices are well-studied in patients with essential hypertension and based on these data, it is known that the average 24-h ambulatory BP is typically lower than office BP. However, emerging data show that office SBP underestimates arterial afterload in patients with coarctation of aorta (COA), and a minimal increase in stroke volume during low-intensity exercise results in an exaggerated rise in SBP as compared to those with essential hypertension. We hypothesized that COA patients will have higher ambulatory SBP and a higher prevalence of masked hypertension compared to patients with essential hypertension. METHODS: Case-control study of 118 COA patients and 118 patients with essential hypertension matched by age, sex, BMI and office SBP. RESULTS: Although both groups had similar office SBP (132 ± 17 mmHg) by design, the COA group had paradoxical increases in 24-h ambulatory SBP (135 ± 14 vs. 126 ± 13; P < 0.001) and daytime ambulatory SBP (142 ± 16 vs. 130 ± 13; P < 0.001), and less nocturnal dipping (-3 ± 5 vs. -9 ± 4; P < 0.001). The COA group also had a higher prevalence of masked hypertension [36 (31%) vs 14 (12%); P < 0.001), and worse arterial function indices. CONCLUSION: These findings underscore the potential limitations of relying on office SBP for screening/monitoring of hypertension in COA and potential pitfalls in extrapolating essential hypertension guidelines recommendations to the treatment of COA. It also provides the rationale for further studies to determine if pharmacologic BP interventions guided by ambulatory BP data will improve clinical outcomes in the COA population.

An Atypical Case of Extrapulmonary Sarcoidosis.

Sarcoidosis is an idiopathic, inflammatory condition that affects nearly all organs in the body. Lungs are the most frequent and among the earliest sites for detecting it. The most common extrapulmonary manifestations involve the ophthalmic, cardiac, nervous, reticuloendothelial, cutaneous, hepatosplenic, and renal systems. These extrapulmonary manifestations of sarcoid may be misdiagnosed in the absence of the classical pulmonary features, given the high overlap of features with other chronic immunologic diseases. The diagnostic workup to differentiate sarcoid from other similar conditions is extensive, amongst which histology remains a gold standard tool for the diagnosis. Our patient presented with a chronic history of multiple vague complaints including nausea, vomiting, progressive malaise, vision changes, and weight loss. After extensive workup, a diagnosis of sarcoidosis along with multiple rare extrapulmonary involvements was made. The authors highlight essential implications including primary practice goals to avoid misdiagnosis or missed sarcoid diagnoses thus helping improve clinical outcomes in similar populations.

Rare Case of Osteochondroma on the Dorsal Aspect of the Scapula.

Osteochondroma, often referred to as exostosis, is the most common benign bone tumor characterized by a bony protuberance surrounded by a cartilaginous surface. Most osteochondromas are found on the metaphysis of long bones, with the dorsal aspect of the scapula being a rare site of occurrence for an exostosis. Radiographic imaging, preferably through MRI or CT, assists in the identification of benign growth; however, a definitive diagnosis requires a biopsy. Open surgical resection and arthroscopic excision are the definitive treatment modalities of the nidus. Postoperative care requires immobilization of the limb for two months, with at least four months being the appropriate timeline for complete recovery.

Parvovirus Infection and Thrombotic Thrombocytopenic Purpura in an Adult Patient With Sickle Cell Beta-Thalassemia.

Parvovirus infection and thrombotic thrombocytopenic purpura (TTP) are rare manifestations in adults with sickle cell beta-thalassemia. Due to the lack of a clear demarcation between the complications related to sickle cell disease (SCD) and TTP, the diagnosis is often challenging. The treatment requirements for both these entities are divergent and complicated, thus necessitating a careful plan of action during atypical presentations. Here we present a case of a 22-year-old woman during the peripartum period with fever, generalized body aches, and large joint pains that soon evolved into labor. The patient's history was suggestive of an undiagnosed and inherited blood disorder. The presentation of aplastic crisis-splenic sequestration during early adulthood is atypical for the SCD course in general populations. Moreover, as the patient's clinical status deteriorated with blood transfusion, the diagnosis and management of a sickle cell crisis event and TTP added to the dilemma in the presence of non-classic parvovirus infection. Though the causation of TTP due to SCD-parvovirus infection is questionable, the treatment of the baseline sickle cell crisis with the novel supportive measures resolved the underlying complications in our patient, suggesting the causal effect. As a result of this, we emphasize the importance of being vigilant about such atypical presentations to avoid delays in diagnosis and treatment of such life-threatening emergencies like TTP.

A Spectrum of Pulmonary Complications Occurring in End-Stage Renal Disease Patients on Maintenance Hemodialysis.

Objective To investigate the trends of end-stage renal disease (ESRD) in patients undergoing maintenance hemodialysis (MHD) and find the correlation with effects on the pulmonary system in such patients. Methodology A multicentric prospective study was conducted in the city of Solapur, India. Data were collected from 250 patients through interpersonal interrogation using a questionnaire to capture basic demographic details, the history of ESRD, and relevant respiratory symptoms like breathlessness, cough, fever, etc. related to their disease. Symptoms that are likely associated with the pulmonary system were analyzed and referred to the pulmonology department. Appropriate diagnoses were made using relevant diagnostic tools like X-rays and sputum studies. The association between various disease attributes and pulmonary diagnoses was analyzed using the chi-square (χ2) test, with a p-value of value less than or equal to 0.05 considered statistically significant. Various socio-demographic variables, existing comorbidities, occupation-related risk factors, smoking history, past or current history of any respiratory conditions, the association between the causes of ESRD, time since the first dialysis and sociodemographic factors, and frequency of pulmonary complications were the other covariates in the study. Results Our study reports that 31.6% of our patients had significant impairment in their functioning due to respiratory complaints. The prevalence of respiratory complications was 27.2%. Major contributors were pleural effusion (33.8), pneumonia (25), pulmonary edema (20.58), pleuritis (11.76), collapse (8.8), tuberculosis (5.8), fibrosis (4.4), pericardial effusion (4.4), calcification (2.9), and hydrothorax (1.47). We report one case of Urinothorax as a rare cause of hydrothorax in such patients. Overall, our analysis found a significant association between non-reporting of respiratory complaints and acute admissions to the intensive care unit (ICU) with a respiratory cause at p-value 0.0076 with a greater predilection toward the rural populations. Conclusion Our study results highlight the prevalence of pulmonary complications in ESRD patients. The occurrence of pulmonary complications, irrespective of the presence of symptoms and a greater association between non-reporting of respiratory symptoms and acute admissions to the ICU, is a hallmark to consider the importance of history and clinical vigilance during patient visits.

Effect of Combined Ventricular-Arterial Stiffening on Exercise Hemodynamics in Adults With Repaired Coarctation of Aorta.

BACKGROUND: Patients with coarctation of aorta (COA) have arterial stiffening, and this is associated with impaired cardiac reserve and hypertensive systolic blood pressure (SBP) response during exercise. However, whether patients with COA have concomitant left ventricular (LV) stiffening and the potential impact of combined ventricular-arterial stiffening on exercise hemodynamics are unknown. METHODS: We studied 174 patients with repaired COA (aged 39 ± 11 years and male 103 [59%]) and 174 matched controls. Our study hypotheses are: (1) patients with COA have higher ventricular-arterial stiffness (end-systolic elastance [Ees] and arterial elastance [Ea]) as compared with controls; (2) ventricular-arterial stiffness was associated with LV stroke volume augmentation (ΔLVSV) and SBP augmentation (ΔSBP) during exercise among patients with COA. RESULTS: Despite similar systolic SBP, patients with COA had higher Ea (1.8 ± 0.4 vs 1.4 ± 0.4 mm Hg/mL, P < 0.001), higher Ees (2.41 ± 0.65 vs 2.17 ± 0.40 mm Hg/mL, P < 0.001), but similar Ea/Ees (0.87 ± 0.29 vs 0.83 ± 0.33, P = 0.2). ΔLVSV was 6.1 ± 1.4 mL/beat. Combined ventricular-arterial stiffness had a stronger correlation with ΔLVSV as compared with Ea alone (r = -0.53 vs r = -0.41, P = 0.006) and as compared with Ees alone (r = -0.53 vs r = -0.46, P = 0.02). ΔSBP was 48 ± 21 mm Hg. Combined ventricular-arterial stiffness had a stronger correlation with ΔSBP as compared with Ea alone (r = 0.57 vs r = 0.43, P < 0.001) and as compared with Ees alone (r = 0.57 vs r = -0.39, P < 0.001). CONCLUSION: Patients with COA had combined ventricular-arterial stiffening, and this was associated with impaired cardiac reserve and hypertensive SBP response during exercise. These findings provide foundation for further studies to determine whether drugs that reduce both ventricular and arterial stiffness will improve exercise capacity and hemodynamics in this unique population.

CONTEXTE: La coarctation de l'aorte (CA) s'accompagne d'une rigidification des artères, qui est à son tour associée à une altération de la réserve de force du cœur et à une augmentation de la pression artérielle systolique (PAS) à l'effort. On ne sait toutefois pas si la CA entraîne aussi une rigidification du ventricule gauche, et on ne connaît pas les répercussions possibles d'une rigidification ventriculaire et artérielle sur les paramètres hémodynamiques à l'effort. MÉTHODOLOGIE: Nous avons étudié 174 patients présentant une CA corrigée (âge : 39 ± 11 ans; hommes : 103 [59 %]) et 174 témoins appariés. Nos hypothèses étaient les suivantes : 1) la rigidité ventriculaire et artérielle (élastance télésystolique [ETS] et élastance artérielle [EA]) est plus importante chez les sujets présentant une CA que chez les sujets témoins; 2) la rigidité ventriculaire et artérielle est associée à une augmentation du volume d'éjection ventriculaire gauche (ΔVEVG) et à une augmentation de la pression artérielle systolique (ΔPAS) à l'effort chez les patients présentant une CA. RÉSULTATS: Malgré une PAS comparable, les patients présentant une CA avaient une EA plus élevée que les sujets témoins (1,8 ± 0,4 vs 1,4 ± 0,4 mmHg/ml, p < 0,001) et une ETS également plus élevée (2,41 ± 0,65 vs 2,17 ± 0,40 mmHg/ml, p < 0,001), mais un rapport EA/ETS similaire (0,87 ± 0,29 vs 0,83 ± 0,33, p = 0,2). La ΔVEVG était de 6,1 ± 1,4 ml/battement. La rigidité ventriculaire et artérielle mixte était plus fortement corrélée avec une ΔVEVG, comparativement à l'EA seule (r = -0,53 vs r = -0,41, p = 0,006) et à l'ETS seule (r = -0,53 vs r = -0,46, p = 0,02). La ΔPAS était de 48 ± 21 mmHg. La rigidité ventriculaire et artérielle mixte était plus fortement corrélée avec la ΔPAS, comparativement à l'EA seule (r = 0,57 vs r = 0,43, p < 0,001) et à l'ETS seule (r = 0,57 vs r = -0,39, p < 0,001). CONCLUSION: La CA s'accompagnait d'une rigidification ventriculaire et artérielle, elle-même associée à une altération de la réserve de force du cœur et à une augmentation de la PAS à l'effort. Ces résultats pourront servir de fondements à des études complémentaires visant à déterminer si un traitement qui réduit la rigidité ventriculaire et artérielle pourrait améliorer la capacité à l'effort et les paramètres hémodynamiques dans cette population particulière.

Recurrent sustained atrial arrhythmias and thromboembolism in Fontan patients with total cavopulmonary connection.

BACKGROUND: Total cavopulmonary connection (TCPC) is associated with a lower risk of incident atrial arrhythmias as compared to atriopulmonary Fontan, but the risk of recurrent atrial arrhythmias is unknown in this population. The purpose of this study was to determine the incidence and risk factors for recurrent atrial arrhythmias and thromboembolic complications in patients with TCPC. METHODS: This is a retrospective multicenter study conducted by the Alliance for Adult Research in Congenital Cardiology (AARCC), 2000-2018. The inclusion criteria were TCPC patients (age > 15 years) with prior history of atrial arrhythmia. RESULTS: A total of 103 patients (age 26 ± 7 years; male 58 [56%]) met inclusion criteria. The mean age at initial arrhythmia diagnosis was 13 ± 5 years, and atrial arrhythmias were classified as atrial flutter/tachycardia in 85 (83%) and atrial fibrillation in 18 (17%). The median duration of follow-up from the first episode of atrial arrhythmia was 14.9 (12.1-17.3) years, and during this period 64 (62%) patients had recurrent atrial arrhythmias (atrial flutter/tachycardia 51 [80%] and atrial fibrillation 13 [20%]) with annual incidence of 4.4%. Older age was a risk factor for arrhythmia recurrence while the use of a class III anti-arrhythmic drug was associated with a lower risk of recurrent arrhythmias. The incidence of thromboembolic complication was 0.6% per year, and the cumulative incidence was 4% and 7% at 5 and 10 years respectively from the time of first atrial arrhythmia diagnosis. There were no identifiable risk factors for thromboembolic complications in this cohort. CONCLUSIONS: Although TCPC provides superior flow dynamics and lower risk of incident atrial arrhythmias, there is a significant risk of recurrent arrhythmias among TCPC patients with a prior history of atrial arrhythmias. These patients may require more intensive arrhythmia surveillance as compared to other TCPC patients.

A Case Report of Nonketotic Hyperglycemic Seizures: A Diagnostic Dilemma.

Nonketotic hyperglycemia (NKH) is a rare but serious complication of uncontrolled diabetes mellitus that occurs acutely with a mortality rate of more than 50%. This condition presents with a clinical syndrome consisting of profound hyperglycemia, hyperosmolality, and dehydration. Infrequently, the patients also present with seizure activity. The most common types of seizures observed in this condition are focal seizures, as opposed to the generalized seizures observed in hypoglycemia-induced seizures. Though various hypotheses tried to explain NKH-induced seizure activity, the actual mechanism remains unknown. The treatment modalities include the management of hyperglycemia and circulatory collapse. However, the role of anti-epileptics is controversial. We herein illustrate an atypical case of focal faciobrachial seizures in a young female patient, which occurred as a rare complication of NKH. A 21-year-old female was admitted with multiple jerking and spasmodic movements of the right upper limb and face, with no significant neurological findings. Past medical history was significant for uncontrolled type 2 diabetes mellitus and multiple episodes of focal seizures. On laboratory examination, serum osmolarity was 309 mOsm/L, blood glucose was 364 mg/dL, HbA1c was 12.1%, and ketone bodies were absent. MRI brain showed large subtle T2 FLAIR (T2-weighted fluid-attenuated inversion recovery) cortical hyperintensities in the left frontal, temporal, parietal, and occipital regions with subcortical hypointense areas. The EEG illustrated a background slowing and generalized spikes, polyspikes, and sharp-wave discharges with post-ictal slowing. The patient's seizures were initially refractory to insulin therapy and resolved with the use of dual anti-epileptics. Thus, to conclude, our case represents a diagnostic dilemma with MRI findings pointing towards NKH as the underlying etiology of focal seizures, with the resolution of seizures only occurring with the addition of anti-epileptics to insulin therapy.

Gut-Brain Axis and its Neuro-Psychiatric Effects: A Narrative Review.

The gut microbiota regulates the function and health of the human gut. Preliminary evidence suggests its impact on multiple human systems including the nervous and immune systems. A major area of research has been the directional relationship between intestinal microbiota and the central nervous system (CNS), called the microbiota-gut-brain axis. It is hypothesized that the intestinal microbiota affects brain activity and behavior via endocrine, neural, and immune pathways. An alteration in the composition of the gut microbiome has been linked to a variety of neurodevelopmental and neurodegenerative disorders. The connection between gut microbiome and several CNS disorders indicates that the focus of research in the future should be on the bacterial and biochemical targets. Through this review, we outline the established knowledge regarding the gut microbiome and gut-brain axis. In addition to gut microbiome in neurological and psychiatry diseases, we have briefly discussed microbial metabolites affecting the blood-brain barrier (BBB), immune dysregulation, modification of autonomic sensorimotor connections, and hypothalamus-pituitary-adrenal axis.

Solitary Sign of Third Nerve Palsy in a Conscious Patient With Epidural Hemorrhage.

Epidural hematoma is a life-threatening complication of head injury, which often occurs as a result of blunt trauma to the skull. Unregulated hematoma expansion in any setting results in elevated intracranial pressure and may contribute to the compression of the oculomotor nerve among several other adversities culminating in various long-lasting complications in the future. In this case report, we present the findings of a rare, insightful case of a 47-year-old Southeast Asian male with no established prior medical history apart from being a victim of blunt trauma attributable to a fall four days before presenting to the emergency department with abrupt onset of diplopia and drooping of the left eyelid. The initial physical examination helped to establish a diagnosis of third nerve palsy. A non-contrast CT of the head was conducted, and its findings revealed the presence of a right temporal-parietal-occipital epidural hemorrhage, with no mass impact on the cerebral hemisphere. The patient later underwent a successful left temporoparietal craniotomy, during which 100-125 ml of blood was drained out. Post-surgery, a near-full reduction of ptosis was recorded at the end of the first week. This case report summarizes this ingenious depiction of a partial third nerve palsy presenting as the sole sign of the epidural hemorrhage in a cognizant patient.

Joubert Syndrome: A Molar Tooth Sign in Disguise.

Joubert syndrome (JS) is a rare genetic ciliopathy characterized by the aplasia or malformation of the midbrain and or hindbrain structures. It usually manifests during the early stages with nonspecific neurological symptoms that progress to involve multiple systems. Its presentation similarity to other neurological disorders makes the diagnosis difficult, hence causing a delay in treatment and worse prognosis due to complications. If undiagnosed during childhood, it often presents during adolescence with the most common complication of acute kidney injury due to nephronophthisis. Here, we present a case of JS in late adolescence with renal complications and other neurological abnormalities. We aim to emphasize the importance of its early diagnosis by physicians in childhood to prevent further complications. It also highlights the possible diagnostic value and significance of brain imaging in the early stages when only mild mental retardation signs may be the only clues.

Secondary Postpartum Hemorrhage Presenting With Bombay Blood Group: A Case Report.

Bombay blood group is a rare blood group. Due to its rarity and limitations for transfusions, it is often challenging to manage individuals with Bombay groups in emergencies. Here, we present a case of a 26-year-old woman with the Bombay blood group who had premature rupture of membranes at the 39th week of pregnancy while delivering a male child vaginally. The patient suffered from postpartum hemorrhage due to retention of the placenta and needed an immediate blood transfusion. During the antenatal screening, she was noted to have the O-positive blood group. Cross-matching of her blood was incompatible with O-positive blood and was identified as the Bombay blood group after having tested for anti-H antibodies. The patient underwent transfusion by identifying individuals with the O-positive Bombay blood group. As a result of this, we emphasize the diagnosis and identification of the individuals with the Bombay blood group and make blood available especially in medical emergencies.

Neuropsychiatric Atypical Manifestation in Wilson's Disease: A Case Report and Literature Review.

Wilson's disease (WD) is a rare genetic disorder of copper metabolism that often manifests several clinical signs at the time of diagnosis. Typically it affects the liver in the early stages of the disease course and tends to show neuropsychiatric involvement in the later stages. Early diagnosis of WD holds a prognostic value, and an atypical presentation of the disease adds complexities in diagnosis. Even though we need to consolidate further the treatment guidelines for managing psychiatric and neurological symptoms optimally in the patients of WD, identifying signs at the early stages of the disease is crucial to avoid its detrimental effects on the human body. In this case presentation, a patient with no family history of psychiatric condition showed an early onset of neuropsychiatric symptoms without any other clinical signs of WD. Through this clinical case, we emphasize the importance of ruling out WD in patients that predominantly presents with psychiatric symptoms as a lone symptom. It also highlights the possible diagnostic value and significance of the ceruloplasmin level in identifying WD disease in early stages, when other clinical signs are absent, including liver abnormalities.

Novel and Controversial Therapies in COVID-19.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the coronavirus disease (COVID-19) pandemic, which has led scientists all over the world to push for the identification of novel therapies for COVID-19. The lack of a vaccine and specific treatment has led to a surge of novel therapies and their publicity in recent times. Under these unprecedented circumstances, a myriad of drugs used for other diseases is being evaluated and repositioned to treat COVID-19 (example- Remdesivir, Baricitinib). While multiple trials for potential drugs and vaccines are ongoing, and there are many unproven remedies with little or no supporting evidence. Presently, discussions are revolving around the use of multivitamins (Vitamin, C, D, A), minerals (selenium, zinc), probiotics, flavonoids, polyphenols, and herbal remedies (curcumin, artemisinin, herbal drinks). Our review delves further into the details of some of these controversial therapies for COVID-19.