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Natremia, magnesemia, corrected serum calcium, phosphoremia and thyroid assessment was normal.
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SARS-CoV-2 reverse transcription polymerase chain reaction (RT-PCR) by nasopharyngeal swab was negative, COVID-19 serology (IgM and IgG) was also negative.
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Faced with concept of ischemic lesions on a brain scan, anticoagulation at a prophylactic dose, antiplatelet aggregation with aspirin and statins were initiated as well as an antibiotic therapy at a meningeal dose with ceftriaxone pending results of the lumbar puncture which subsequently showed a clear liquid with a high proteinorachia at 0.58g/l (normal between 0.15 and 0.45), a normal glycorachia/blood sugar ratio at 0.58 (normal at 0.5); with a culture showing less than 3 elements, sterile after 24 hours.
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A cerebral computerized tomography (CT) scan was performed without showing any progressive lesions.
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Faced with installation of lymphopenia (HIV serologies 1 and 2 negative) with increased CRP, a multiplex RT-PCR in protected distal bronchial sample as well as in Cerebrospinal fluid (CSF) were performed, the first was positive to SARS-CoV-2.
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Reverse transcription polymerase chain reaction of SARS-CoV-2 in CSF was positive but with a cycle threshold (CT) of 38.6.
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The diagnosis of SARS-CoV-2 encephalopathy was retained.
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[
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The patient is still in intensive care.
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A 32-year-old female patient with Kniest syndrome presented at our department with a painful pseudarthrosis after femoral valgisation osteotomy 8 years ago.
|
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A Wagner cone stem and acetabular roof cup with a cemented Ecofit cup 2M (dual-articulation acetabular cup system) were implanted due to a dysplastic femur with a small medullary space.
|
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The Ecofit cup itself is associated with a reduced risk of dislocation.
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The patient was satisfied with the range of motion after hip endoprosthesis and reported a significant increase in quality of life.
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The patient is still comfortable with the hip prosthesis at the most recent follow-up 4 years after implantation.
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Urine analysis and culture were performed several times that was negative for infection.
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In order to confirm the diagnosis, magnetic resonance imaging (MRI) of the abdomen and pelvic cavity was done; it revealed a lesion in the dome of the bladder.
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To confirm the diagnosis and for histopathological examination, the patient underwent Transurethral Resection of Bladder Tumor (TURBT) in April 2018.
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Before starting the procedure, the urethra was dilated till Fr: 28; at first, the tumor location was specified by cystoscopy.
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The patient was transferred to the recovery room with complete stability.
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Then, the neck, abdomen, pelvic and chest computed tomography (CT) scans were done that were normal.
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Brain and spine MRI and physical examination showed no evidence of other schwannoma or evidence of neurofibromatosis.
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Skin examination was normal and had no café au lait spot.
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A 34-year-old recently diagnosed HIV positive para 4 was referred to us with a 2-month history of abdominal pain, abdominal distension and backache which had worsened 2 weeks prior to presentation.
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She also had pain on defecation, night sweats and fever.
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On examination she looked ill, in respiratory distress with a respiratory rate of 28 breaths per min.
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She was febrile with a temperature of 38.2 0 C and had unilateral leg swelling.
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The abdomen was asymmetrically distended with an abdominopelvic mass of about 30 weeks size.
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The mass was firm, immobile with an irregular surface not attached to overlying skin.
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There was no ascites and no hepatosplenomegaly.
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The cervix looked grossly normal but was displaced anteriorly.
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Digital rectal examination revealed a mass in the pouch of Douglas not involving the rectal mucosa.
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Examination of the other systems was normal.
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Investigations showed a haemoglobin of 6.5g/dl (NR 12-14g/dl), a slightly elevated cancer antigen 125 of 44U/ml (NR 0-35), serum beta human chorionic gonadotropin (HCG) of 0.258mIU/ml (NR 0-5) and alpha fetoprotein of 7 ng/ml (NR < 10).
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Her CD4 count was 63cells/mm 3.
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Her renal and hepatic function tests were normal.
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0,
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0,
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An ultrasound scan showed a solid mass measuring 19.6cm x 12.5cm, posterior to the uterine fundus and extending to the left adnexa.
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0,
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The uterus and its endometrium were normal.
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Doppler ultrasound scan of the right lower limb showed no evidence of thrombosis and her chest X-ray showed perihilar lymphadenopathy.
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The patient was taken for surgical exploration and staging for ovarian malignancy.
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At laparotomy there was a left ovarian mass attached to a bulky uterus and sigmoid colon.
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The right ovary was enlarged to about 10cm diameter.
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The left fallopian tube and ovary could not be distinguished and separated from the tumour.
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The rest of the abdominal organs and omentum looked grossly normal.
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"CUI_LESS",
"CUI_LESS",
"CUI_LESS",
"CUI_LESS",
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There was no ascites.
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20,
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[
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[
0,
0,
0,
1,
0
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Tumour was friable and was removed by blunt and sharp dissection.
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"CUI_LESS",
"CUI_LESS",
"CUI_LESS",
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0,
0,
0,
0,
1,
0,
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0,
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Total abdominal hysterectomy, bilateral adnexectomy and infracolic omentectomy were done.
|
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[
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"CUI_LESS",
"CUI_LESS",
"CUI_LESS",
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[
0,
0,
1,
0,
0,
1,
0,
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The general surgeons were present and they did a sigmoidectomy and a Hartmann's procedure.
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She had enlarged retroperitoneal lymph nodes which were not dissected to reduce intraoperative bleeding and postoperative morbidity.
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0,
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0,
1,
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We had encountered significant bleeding from the friable tumor.
|
[
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0,
0,
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[
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] |
[
2,
0,
0,
0,
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Patient was sent to the high dependency unit where she recovered postoperatively.
|
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0,
1,
0,
0,
0,
0,
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Histology of the specimens showed a large B cell lymphoma.
|
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[
44,
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[
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0
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[
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In the initial nutrition assessment, the patient was 40 kg weight and 150 cm tall thus the body mass index (BMI) was 17,57 kg/m 2 or underweight.
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Gastrointestinal symptoms and signs were not found.
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Information regarding the patient's dietary intake in the last two weeks and weight change within the last 6 months could not be obtained, but his mother claimed that the patient seemed to lose weight because he refused any food that had been offered to him; he only smoked and drank coffee.
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Albumin level was 3.6 gr/L with imbalanced electrolyte levels.
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Signs of fluid accumulation were not found.
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According to the subjective global assessment (SGA) tool, the patient belonged to group C (severely malnourished).
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Energy and protein were given starting from 30 kcal/kg, increasing gradually to 50 kcal/kg, and 2 gp/kg divided into oral nutrition and oral nutrition supplements (ONS) with a 50:50 ratio.
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The patient was also given micronutrient supplementations, specifically vitamin A 100,000 units for the first week, vitamin C 100 mg 3 times a day, and zinc 20 mg once a day.
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During the early weeks of hospitalization, the patient's weight loss continued.
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On the 28 th day, the patient's body weight was 33 kilograms while his serum albumin level was 2.1 gr/L.
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The patient often writhed in pain and became more aggressive.
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The patient did not respond well to analgesics and sedations.
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Partially parenteral nutrition (PN) enriched with branched-chain amino acid (BCAA) was administered to support protein needs.
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However, his BMI continued to decline, and on the 42 nd day, his body weight dropped to 32 kilograms with a serum albumin level of 2 gr/L.
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Considering the mental and nutrition status of the patient, it was decided not to continue with the skin graft surgery.
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The patient had lost 24% of body weight (BMI 11.96 kg/m 2) and the serum albumin level was 2.5 gr/L.
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99,
100
]
] |
[
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[
"CUI_LESS",
"CUI_LESS",
"CUI_LESS",
"CUI_LESS",
"CUI_LESS",
"CUI_LESS",
"CUI_LESS",
"CUI_LESS",
"CUI_LESS",
"CUI_LESS",
"CUI_LESS",
"CUI_LESS",
"CUI_LESS",
"CUI_LESS",
"CUI_LESS",
"CUI_LESS",
"CUI_LESS",
"CUI_LESS",
"CUI_LESS",
"CUI_LESS",
"CUI_LESS",
"CUI_LESS",
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] |
[
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0,
1,
5,
10,
10,
0,
0,
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0
] |
The patient displayed severe muscle wasting and subcutaneous fat loss.
|
[
"The",
"patient",
"displayed",
"severe",
"muscle",
"wasting",
"and",
"subcutaneous",
"fat",
"loss",
"."
] |
[
[
0,
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],
[
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],
[
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],
[
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],
[
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[
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] |
[
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[
"CUI_LESS",
"CUI_LESS",
"CUI_LESS",
"CUI_LESS",
"C0026846",
"C0026846",
"CUI_LESS",
"C0424631",
"C0424631",
"C0424631",
"CUI_LESS"
] |
[
2,
7,
1,
0,
3,
1,
0,
3,
8,
1,
0
] |
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