Relation between Guillain-Barré syndrome and Covid-19: Case-Series.

Approximately two-thirds of the Guillain-Barré syndrome (GBS) cases are preceded by upper respiratory tract infection or enteritis. There has been previous documentation of a clear association between Covid-19 and GBS. Covid-19 can affect the nervous tissue either through direct damage or through triggering a host immune response with subsequent development of autoimmune diseases such as GBS. Covid-19 can affect the host`s immune system through the activation and interaction of the T-and B-lymphocytes with subsequent production of antibodies that cross-react with the gangliosides. Depending on the nature of the neuronal autoimmune destruction, the affected individual may have either a demyelinating or axonal subtype of GBS. These subtypes differ not only in symptoms but also in the likelihood of recovery. This report presents two cases of GBS that developed after the respiratory symptoms of Covid-19. Their neurological features indicated demyelination, axonal damage, irritation of spinal nerve roots, and impaired sensory and motor transmission with additional facial nerve palsy in the second-studied case. This case report highlights the relationship between GBS and Covid-19 infection.

Acute cerebrovascular events and inflammatory markers associated with COVID-19: An observational study.

The novel Coronavirus disease (COVID-19) is associated with an increased risk of cerebrovascular events. About 1,228 cases of severe COVID-19 were hospitalized in the West Kazakhstan Medical University Hospital, in Aktobe, Kazakhstan, 1.22% (N=15) of whom were clinically diagnosed with acute cerebrovascular events and were included in the current study. COVID-19 was diagnosed using a nasopharyngeal polymerase chain reaction (PCR) test, blood count, inflammatory markers, and chest computerized tomography. The diagnosis of acute cerebrovascular events was based on the clinical manifestation. The participants' data were reviewed to detect the prevalence of acute cerebrovascular events and the inflammatory markers associated with COVID-19 infection. The mean age of the participants was 66.9 years (±11.07), 53% (N=8) of them were male, while 47% (N=7) were female. Moreover, 13% (N=2) presented a history of cerebrovascular events, 87% (N=13) of the participants had hypertension, 47% (N=7) had coronary heart disease, 33% (N=5) had diabetes mellitus (DM), 13% (N=2) had cardiac arrhythmia, and 13% (N=2) had chronic obstructive pulmonary disease (COPD). The C-reactive protein was high in 100% (N=15) of participants, D-dimer in 87% (N=13) of them, and both the ferritin and interleukin-6 were high in 60% (N=9) of the participants. SARS-CoV-2 causes a systemic inflammatory response, and the presence of comorbidities increases the risk of acute cerebrovascular events in COVID-19-infected individuals. The elevated inflammatory markers in severely COVID-19-infected individuals support the inflammatory "cytokine storm" response theory.

The role of magnetic resonance imaging in refining the diagnosis of suspected fetal renal anomalies.

OBJECTIVE: This prospective study was designed to detect the role of magnetic resonance imaging (MRI) in refining the diagnosis of suspected fetal renal anomalies detected during screening sonography. MATERIAL AND METHODS: 54 pregnant women, with suspected fetal renal anomalies detected during routine ultrasound screening, were rescanned by MRI to refine the diagnosis of the suspected renal anomalies. The pregnancy outcome was examined externally and by postnatal ultrasonography. RESULTS: Fifty-four cases of suspected renal anomalies detected during screening sonography of 8400 pregnant women (0.6%), were res-canned by MRI in this study. The MRI gave a similar diagnosis to postnatal ultrasound in 46 cases (16 cases of hydronephrosis, 14 cases of Polycystic Kidney Disease (PCKD), 9 cases of Multicystic Kidney Disease (MCKD), 2 cases of Renal Agensis (RA), 3 cases of single renal cyst and 2 cases of megacystis+hydroureter), while it gave a different diagnosis (false positive) in 6 cases (4 cases of hydronephrosis diagnosed by MRI confirmed to be PCKD by postnatal ultrasound, also, 1 case of MCKD diagnosed by MRI confirmed to be hydronephrosis by postnatal ultrasound and 1 case of RA diagnosed by MRI confirmed to be normal by postnatal ultrasound). The prenatal ultrasound gave a similar diagnosis to postnatal ultrasound in 43 cases (14 cases of hydronephrosis, 13 case of PCKD, 9 cases of MCKD, 2 cases of RA, 3 cases of single renal cyst and 2 case of megacystis+hydroureter), while it gave a different diagnosis (false positive) in 9 cases; 4 cases of hydronephrosis diagnosed by prenatal sonography confirmed to be PCKD by postnatal ultrasound, one case of PCKD+one case of MCKD, and one case of megacystis+hydroureter confirmed to be hydronephrosis by postnatal ultrasound, while one case of MCKD diagnosed by prenatal sonography was confirmed to be PCKD by postnatal ultrasound and one case of RA diagnosed by prenatal ultrasound was confirmed to be normal by postnatal ultrasound. CONCLUSION: The MRI can be used as a complementary adjunctive modality with excellent tissue contrast, especially in equivocal cases or inconclusive sonographic findings.

Pipelle endometrial sampling versus conventional dilatation & curettage in patients with abnormal uterine bleeding.

OBJECTIVE: This study was designed to compare the diagnostic accuracy of Pipelle endometrial sampling with conventional dilatation & curettage in patients with abnormal uterine bleeding. MATERIAL AND METHODS: One hundred and forty patients with abnormal uterine bleeding were included in this comparative study; where endometrial sampling was carried out before cervical dilatation by Pipelle device followed by conventional dilatation & curettage (D&C). The histopathology report of the Pipelle sample was compared with that of the dilatation & curettage sample and the dilatation & curettage reports were considered as the gold standard. RESULTS: 100% of the samples obtained by conventional D&C, while 97.9% of the samples obtained by the Pipelle device were adequate for histopathological examination. The histolopathological examination of 140 samples obtained by conventional D&C revealed proliferative endometrium in 37 specimens, secretory endometrium in 33 specimens, endometrial hyperplasia in 49 specimens (45 without atypia & 4 with atypia), endometritis in 8 specimens, endometrial polyps in 3 specimens and malignant endometrium in 10 specimens. In this study; the Pipelle device had 100% sensitivity, 100% specificity and 100% accuracy for diagnosing endometrial hyperplasia, endometrial carcinoma, proliferative and secretory endometrium. Also, it had 88.9% sensitivity, and 99.2% negative predictive value (NPV) and 99.3% accuracy for diagnosing endometritis and it had 60% sensitivity, 89.6% NPV and 98.6% accuracy for diagnosing endometrial polyps. CONCLUSION: The endometrial sampling using Pipelle is a safe, accurate, cost effective outpatient procedure, which avoids general anesthesia and has a high sensitivity and specificity for detection of endometrial hyperplasia and endometrial malignancy.

Relation between single serum progesterone assay and viability of the first trimester pregnancy.

OBJECTIVE: This study was designed to detect the relation between serum progesterone and viability of pregnancy during the first trimester. MATERIAL AND METHODS: Two hundred and sixty women during the first trimester of their pregnancies were hospitalised due to vaginal bleeding and/or abdominal pain and were included in this study. Criteria for inclusion in this study were: certain dates, foetus conceived spontaneously with no history of infertility and a positive serum pregnancy test. Blood samples were taken from women included in this study for serum progesterone assay; the patients were followed by ultrasound until the end of the first trimester for the viability of the pregnancy and the outcome of their pregnancy was recorded. RESULTS: BY THE END OF THE FIRST TRIMESTER, WOMEN INCLUDED IN THIS STUDY WERE CLASSIFIED INTO: viable pregnancy group (n=178; 68.5%) and non-viable pregnancy group (ended by miscarriage) (n=82; 31.5%). The mean serum progesterone of the studied population was significantly higher in the viable pregnancy group (46.5±7.4 ng/mL) compared to non-viable pregnancy group (9.9±4.8 ng/mL; p<0.05). The serum progesterone cut-off level of 10 ng/mL was 79.3% sensitive for diagnosing non-viable pregnancy and 93.3% specific for the diagnosis of viable pregnancy, while a cut-off level of 20 ng/mL was 95.1% sensitive for the diagnosis of non-viable pregnancy and 98.9% specific for diagnosing viable pregnancy. CONCLUSION: Serum progesterone is a reliable marker for early pregnancy failure and a single assay of its serum level can differentiate between viable and non-viable pregnancies.