Late-Onset Leigh Syndrome With Protracted Gastrointestinal Manifestations: A Rare Case Report.

Although Leigh syndrome (LS) is a neurodegenerative disorder of infancy, adult-onset LS has also been rarely reported. We report a case of late-onset LS in a 42-year-old female who presented with protracted gastrointestinal manifestations, chronic headaches, ataxia, and loss of consciousness. Brain magnetic resonance imaging (MRI) revealed hyperintensities in the bilateral basal ganglia and brain stem. Serum and cerebrospinal fluid lactate levels were significantly raised. Muscle biopsy showed reduced cytochrome oxidase (COX) activity. She was diagnosed with probable diagnosis of late-onset LS based on her clinical features, radiological findings, biochemical results, and biopsy findings. She responded well to intravenous thiamine, and her symptoms gradually improved.

Neurosarcoidosis and Transverse Myelitis: Life-Threatening Manifestations of Sarcoidosis.

Sarcoidosis, a systemic granulomatous disorder, typically involves the lungs, skin, and lymph nodes. Neurological manifestations are diverse and may include longitudinally extensive transverse myelitis (LETM), an uncommon inflammatory disorder of the spinal cord. We present a case of a 62-year-old female with LETM as the initial manifestation of sarcoidosis. The patient exhibited progressive bilateral lower extremity weakness, urinary retention, and sensory disturbances. Diagnostic workup revealed characteristic findings on spinal magnetic resonance imaging (MRI), cerebrospinal fluid analysis, and thoracic biopsy. Treatment with high-dose corticosteroids and subsequent immunomodulatory therapy resulted in significant improvement. Our case highlights the importance of including sarcoidosis in the differentials of LETM, particularly in patients with no respiratory manifestations.

Evaluation of In Vitro Antioxidant, Anti-Obesity, and Anti-Diabetic Activities of Opuntia ficus Cladodes Gel and Its Application as a Preservative Coating for Shrimp during Refrigerated Storage.

Opuntia ficus cladodes (OFC) are considered one of the wastes that result from opuntia cultivation, and their disposal by traditional methods results in many environmental problems. Therefore, this study was conducted with two aims. The first was the production of OFC gel, and the evaluation of its in vitro antioxidant (by two methods, DPPH and ABTS), anti-obesity, and anti-diabetic activities. The second was an investigation of the effects of different concentrations of this gel (0, 50, and 100%) as an edible coating on the quality of shrimp during 8 days of refrigerated storage. The results showed that this gel was characterised by a high content of ash (10.42%), total carbohydrates (75.17%), and total phenols (19.79 mg GAE/g). OFC gel contained six types of sugars: arabinose, xylose, galactose, rhamnose, glucose, and uronic acid, and the most abundant was xylose (36.72%). It is also clear from the results that the OFC gel had high antioxidant properties, which were higher against DPPH than ABTS at the same concentration. OFC gel showed a high inhibition activity against lipase, α-glycosidase, and α-amylase enzymes, and their IC50 values were 1.43 mg/mL, 0.78 mg/mL, and 0.57 mg/mL, respectively. The results also stated that shrimp coated with OFC gel had lower pH, drip loss, TVB-N, and TBA values through the days of refrigerated storage. Moreover, the shrimp coated with 100% OFC gel were better than those coated with 50% OFC gel. In conclusion, OFC gel showed high potency as active antioxidant, for its enzyme anti-activities, and as an edible coating for shrimp.

Takotsubo Cardiomyopathy: A Possible Rare Complication of Guillain-Barré Syndrome.

Dysautonomia is a common and severe complication of Guillain-Barré syndrome (GBS), which may manifest as cardiac arrhythmias, labile blood pressure, diaphoresis, and changes in gastrointestinal motility. Takotsubo cardiomyopathy (TCM) is a life-threatening manifestation of dysautonomia in patients with GBS, which is not widely underlined in the literature. The association between GBS and TCM has been well-documented in previous studies; however, there are few reported cases with GBS who developed TCM following their diagnosis with GBS. In this case report, we will discuss our experience treating a 59-year-old female patient who became hemodynamically unstable while recovering from an acute GBS infection. She was diagnosed with TCM after undergoing an echocardiogram and coronary angiogram ruling out thrombotic or obstructive coronary disease and myocarditis.

Atrial Myxoma: An Unusual Etiology of Ischemic Stroke in an Adult Patient.

Atrial myxoma is the most frequent primary cardiac tumor; however, it is a rare, substantial cause of cardiogenic emboli causing a stroke, especially in young adults. A cardiac myxoma has no specific clinical presentation, ranging from constitutional symptoms to non-cardiac symptoms and emboli, which leads to a diagnostic challenge in the clinical process. We report a case of a left atrial myxoma in an adult female who presented with sudden onset of right-sided weakness, headache, and numbness. Imaging confirmed cardiogenic emboli from the cardiac myxoma, which was reflected in an ischemic stroke.

Acute Pancreatitis Simulating Myocardial Infarction: A Challenging Case.

Acute pancreatitis is an inflammatory condition with varying local and systemic complications and variable severity. Although rare, cardiovascular complications induced by acute pancreatitis are rarely described in the literature. Epigastric pain with acute pancreatitis often simulates electrocardiographic changes in the absence of coronary artery abnormalities, resulting in a diagnostic dilemma for optimal treatment and management. We underline a case of acute pancreatitis complicated by acute coronary syndrome in a patient who presented with chest heaviness, dyspnea, nausea, and worsening epigastric pain associated with vomiting. Clinical and laboratory evaluations and using imaging modalities were suggestive of acute pancreatitis mimicking myocardial infarction (MI) in the absence of coronary artery abnormalities.

Non-ST-Segment Elevation Myocardial Infarction As Initial Thrombotic Event of Thrombotic Thrombocytopenic Purpura: A Rare Challenging Case.

Thrombotic thrombocytopenic purpura (TTP) is a rare autoimmune and devastating blood disorder that results in micro-clots throughout the body, leading to tissue damage and organ dysfunction resulting in widespread microangiopathic hemolytic anemia, thrombocytopenia, fever, and neurological symptoms. TTP patients commonly manifest renal and neurological symptoms; however, cardiovascular involvement is not widely reported in the literature. We report a case of non-ST-segment elevation myocardial infarction (NSTEMI) as an initial manifestation of TTP. Although rare, TTP complications must be considered among other possible causes of unexpected thrombocytopenia during acute phase treatment of acute coronary syndrome because of high morbidity and mortality.

Immune Thrombocytopenia and Cerebral Venous Sinus Thrombosis Following COVID-19 Vaccination: A Case Report.

Mass vaccination against coronavirus disease 2019 (COVID-19) has been safe and effective. The ongoing emergence of vaccine-induced complications has challenged the public trust in vaccination programs and, though uncommon, can lead to significant morbidity and mortality. Vaccine-induced immune thrombocytopenia and thrombosis (VITT) is a rare and fatal complication of the COVID-19 vaccine. We present a rare case of VITT in a young female who presented with worsening headache, body rash with deteriorating neurological deficit after 12 days of the second dose of the ChAdOx1 COVID-19 vaccine. Initial blood tests showed thrombocytopenia with deranged clotting time and D-dimer levels. Her computed tomography venogram showed thrombosis in the left transverse sinus, and she was diagnosed with a provisional diagnosis of VITT. She initially managed with dexamethasone, intravenous immunoglobulins, and apixaban to reverse the autoimmune process. Our case highlights the clinical course, diagnosis, and management of VITT, which will assist physicians in the timely recognition and adequate management of VITT.

Antineutrophil Cytoplasmic Antibody (ANCA)-Associated Renal Vasculitis Following COVID-19 Vaccination: A Case Report and Literature Review.

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is an immune-mediated disorder of small and medium-sized vessels, characterized by the production of autoantibodies that target the neutrophilic antigens leading to mononuclear cell infiltration and destruction of blood vessels in lungs, skin, and kidneys. Although rare, the coronavirus disease 2019 (COVID-19) vaccine may trigger autoimmune vasculitis. We report a rare case of ANCA-associated renal vasculitis following COVID-19 vaccination in a 59-year-old male who presented with flu-like symptoms and deranged renal function tests. He received his second dose of the Pfizer COVID-19 vaccine 17 days ago. His clinical picture, serological testing, and radiological imaging were concerned with glomerular disease. His serum was positive for ANCAs, and the renal biopsy specimen revealed pauci-immune glomerulonephritis. He was diagnosed with AAV-associated renal vasculitis following COVID-19 vaccination because no other etiology was identified. His clinical improvement after starting rituximab and steroids reinforced the diagnosis.

COVID-19-Induced Seizures: A Meta-Analysis of Case Series and Retrospective Cohorts.

The adverse events and complications of coronavirus disease 2019 (COVID-19) continue to challenge the medical profession despite the worldwide vaccination against the severe acute respiratory coronavirus 2 (SARS-CoV-2), the causative agent of COVID-19. Other than typical respiratory manifestations, COVID-19 also presents a wide range of neurological manifestations. This article underlines the pooled incidence of COVID-19-induced seizures in patients with epilepsy and without epilepsy. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocols, we conducted a bibliographical search, and an initial search revealed 1,375 articles. In total, 21 articles were included in the final analysis by following the inclusion criteria. A total of 11,526 patients from 21 published articles that met the predetermined search criteria were included. The median age of the patients was 61.9 years, of whom 51.5% were males. A total of 255 patients presented with seizures as the first manifestation of COVID-19 with a prevalence of 2.2% (95% confidence interval = 0.05-0.24, p < 0.01) (I 2 = 97%), of which 71 patients had previously been diagnosed with epilepsy. Among patients with epilepsy, 49 patients had seizures as an initial presentation of SARA-CoV-2 with an incidence of 72% (0.54-0.85, p = 0.1) (I 2 = 34). Although the incidence of COVID-19-induced seizures is not high compared to other neurological manifestations, seizure incidence in epileptic patients with COVID-19 is remarkably high. New-onset seizures in any patient should be considered a presentation of COVID-19 in the absence of other causative factors.

Multiple Sclerosis Following SARS-CoV-2 Infection: A Case Report and Literature Review.

Coronavirus disease 19 (COVID-19) is caused by severe acute respiratory coronavirus 2 (SARS-CoV-2). Apart from respiratory manifestations, COVID-19 can affect the nervous system due to its neurotropic features. Neurological manifestations and complications include headache, polyneuropathies, cerebrovascular accidents, seizures, encephalopathy, and demyelinating disease. We describe a case of multiple sclerosis, a demyelinating disease following COVID-19 infection, rarely reported in the literature. A 47-year-old female presented with fatigue, blurry vision, numbness, and signs of upper motor neuron lesions that had occurred three weeks after COVID-19 infection. Magnetic resonance imaging of the brain revealed demyelinating lesions in the periventricular area of both hemispheres, suggesting a demyelinating disease. A provisional diagnosis of multiple sclerosis was made. Her condition improved after the commencement of methylprednisolone.

Neuropsychiatric Systemic Lupus Erythematosus: A 2021 Update on Diagnosis, Management, and Current Challenges.

Patients with systemic lupus erythematosus (SLE) experience neuropsychiatric symptoms. The term neuropsychiatric SLE (NPSLE) is a generic term that refers to a series of neurological and psychiatric symptoms directly related to SLE. In approximately 30% of patients with neuropsychiatric symptoms, SLE is the primary cause (NPSLE), and symptoms manifest more frequently around SLE onset. Neurovascular and psychotic conditions can also lead to NPSLE. Pathogenesis of NPSLE is implicated in both neuroinflammatory and ischemic mechanisms, and it is associated with high morbidity and mortality. After diagnosing and assigning causality, NPSLE treatment is individualized according to the type of neuropsychiatric manifestations, type of the predominant pathway, activity of SLE, and severity of the clinical manifestations. There are many problems to be addressed with regards to the diagnosis and management of NPSLE. Controlled clinical trials provide limited guidance for management, and observational cohort studies support symptomatic, antithrombotic, and immunosuppressive agents. The purpose of this review was to provide a detailed and critical review of the literature on the pathophysiology, diagnosis, and treatment of NPSLE. This study aimed to identify the shortcoming in diagnostic biomarkers, novel therapies against NPSLE, and additional research needs.

A Case of Acute Encephalitis in COVID-19 Patient: A Rare Complication.

Coronavirus disease 19 (COVID-19) is a respiratory disease, has a variable presentation, and neurological involvement in COVID-19 is not widely reported. We report a rare case of acute encephalitis in a COVID-19 patient presented with fever, dry cough, and dyspnea. She had a fever, tachypnea, and tachycardia. On auscultation, she had scattered wheezing in both lung fiends. Chest X-ray revealed small infiltrates in the lower lobe of both lungs. A nasopharyngeal swab for the COVID-19 polymerase chain reaction was positive. Later on, she developed sudden onset confusion accompanied by restlessness and visual hallucinations. Neurological examination revealed an altered level of consciousness, slight trembling of the limbs, psychomotor restlessness, and poor speech with no signs of meningeal irritation. Magnetic resonance imaging of the brain revealed diffuse hyperintense signals. A possible diagnosis of acute encephalitis was made due to concurrent COVID-19 infection and lack of other findings suggesting a diagnosis other than COVID-19. She was treated with azithromycin, tocilizumab, and methylprednisolone. Her condition started improving gradually.

Chordoid glioma: a rare old foe but a new pathological and radiological presentation.

Chordoid glioma (CG) is a rare WHO Grade II neoplasm of the anterior third ventricle. We report two cases of CG with new presentation in terms of histopathology and location: a case of CG with osseous metaplasia evident on imaging, and another CG, unusually located in the posterior portion of the third ventricle.

Brain-responsive neurostimulation in adult-onset rasmussen's encephalitis.

Epilepsy associated with Rasmussen's encephalitis (RE) is highly resistant to standard therapy and continues to present a therapeutic challenge. While epilepsy surgery remains the most effective management for patients with drug-resistant focal epilepsy and RE, hemispherotomy may debilitating consequences on adult patients. Here we present the outcome of a 32-year-old woman with adult-onset Rasmussen's, who was treated with brain-responsive neurostimulation (RNS) after failure of several immunotherapeutic and anti-seizure medications.

Post-COVID-19 Acute Transverse Myelitis: A Case Report and Literature Review.

Acute transverse myelitis (ATM) following coronavirus disease 19 (COVID-19) is rarely reported in the literature. We report a case of ATM after COVID-19 infection in a female who presented with sudden onset bilateral lower limb weakness, paresthesia, and urinary retention. She developed fever, cough, dyspnea two weeks ago, and her COVID-19 test was positive one week later. After a complete physical examination and detailed investigations, including cerebrospinal fluid analysis, autoimmune screening, and infectious workup, a diagnosis of ATM due to COVID-19 was made. Magnetic resonance imaging of the whole spine confirmed the diagnosis of ATM. She was managed with intravenous methylprednisolone, physical therapy, and bladder training and her condition improved gradually.

Effects of Chemical and Natural Additives on Cucumber Juice's Quality, Shelf Life, and Safety.

Microbial contamination affects beverages' lifetime, quality, and safety. Cucumber crops are seasonally spoiled because of the overproduction. The current study aimed to maximize the importance of natural preservatives and reduce the usage of artificial ones to prolong the cucumber juice's storage life, enhance flavor, and control the microorganisms after protein isolate and organic acids supplementation. The additions included control (no addition), citric, benzoic acid, sodium salts, kidney bean pepsin hydrolysate (KPH), chicken egg protein isolate (CEPI), duck egg protein isolate (DEPI), and quail egg protein isolate (QEPI) as J-Control, J-Citric, J-Benzoic, J-sod. Citrate, J-sod. Benzoate, J-KPH, J-CEPI, J-DEPI, and J-QEPI, respectively. The antioxidant activity of these additives and juices was evaluated by DPPH radical scavenging activity. The antimicrobial activity, including antibacterial and antifungal activities, was evaluated by using disc assay and the radial growth of fungal mycelium, respectively. The phenolic compounds and flavonoids were estimated by a spectrophotometer as Gallic acid equivalent (GAE) and quercetin equivalent (QE), respectively. Moreover, chemical parameters such as pH, total soluble solids (TSS), Titratable acidity (TTA), and Vitamin C were evaluated by AOAC. Finally, the color properties were estimated by a spectrophotometer, using the Hunter method. KPH had higher significant (p ≤ 0.05) antioxidant activity (88%), along with antimicrobial activity. It significantly (p ≤ 0.05) reduced the growth of G+ and G- bacteria by 71%-97% and 58%-66% respectively. Furthermore, it significantly (p ≤ 0.05) inhibited the tested fungi growth by 70%-88% and the other additives less than that. During the storage of cucumber juice for an interval of zero, two, four, and six months, the phenolic compounds and flavonoids were significantly (p ≤ 0.05) decreased. Consequently, the potential activity of the juice was reduced; in addition, pH and vitamin C were significantly (p ≤ 0.05) decreased during the storage period. Meanwhile, the TSS and Titratable acidity were significantly raised. As for color and sensory properties, J-sod. Benzoate, J-KPH, J-CEPI, and J-DEPI had significantly (p ≤ 0.05) high scores in color, taste, and flavor against the control. Generally, the usage of natural additives extends the cucumber juice's lifetime and increased the manufacture of high-quality and valuable juice.