COVID-19 has brought up the interest about hyperferritinemic syndromes.  Though often seen in COVID-19, especially within the frame of COVID-CSS, hyperferritinemia needs a systematic diagnostic approach, as co-infections or other causes may also increase ferritin. In this article, we present a case report of extreme hyperferrinemia in an male criticall ill patient with COVID-19 and we perform a short synthesis of the available literature. Continue reading
Therapy armamentarium for multpile sclerosis include a variety of drugs. Natalizumab, a humanized antibody, is widely used in relapsing-remissing multiple sclerosis. Anticonvulsants, like topiramate, are also widely used for symptomatic relief. We hereby describe a case of Status epilepticus and topiramate induced metabolic acidosis in a female patient with multiple sclerosis under natalizumab therapy. Continue reading
Respiratory failure due to Coronavirus 2019 (COVID-19) disease has triggered a debate about when and how to apply mechanical ventilation in these patients, as it has been proposed that severe "atypical" ARDS of COVID-19 cause an ARDS pandemic. As global database grows, it is evident that about 6% of patients will need admission to the ICU. About 75% of these will require invasive ventilation, and approximately 10% will need ventilation beyond 14 days. Different ventilation strategies are followed yet there is no strong evidence in favor of anyone. The present article attempts to gather the daily evolving evidence on the subject. Continue reading
Patient care in Intensive Care Units is characterized be high demanding tasks, which lead in daily high workload. In the present study, a questionnaire-based evaluation of ICU nurse’s workload was conducted at the adult general 7 - beds ICU of a small urban hospital. NASA Task Load Index (TLX) along with other two tools, used for the first time in healthcare environment: Instantaneous Self-Assessment (ISA) and Crew Status Survey (CSS) were used for that purpose. Information about every nurse’s professional background and basic demographics were also collected. Responses from 70% of total nurse staff were collected. Continue reading
Hemophagocytic Lymphohistiocytosis (HLH) is a life-threatening syndrome of excessive immune activation that mostly occurs as primary (hereditary) disease in children. Acquired HLH is associated with infections, cancer of rheumatological conditions. Both are rare in adults. Turicella otitidis is a bacterium, that is associated with ear infections and there is only one case report of bacteraemia. The present report describes a case of acquired HLH with invasive pulmonary Aspergillosis and Turicella otitidis bacteraemia in an adult patient; and also reviews the relative literature. In conclusion though rare, acquired HLH is a devastating condition that clinicians should have in mind when managing patients with multiple infection or underlying immunosuppression. Continue reading
West Nile virus is an RNA virus, member of the Japanese encephalitis serogroup of the genus Flavivirus, family Flaviviridae. First isolated in 1937, the virus has re-emerged after giving several outbreaks after the 1990 both in Europe and North America. Though severe neurological infection is only 1% of the total cases, mortality can reach 14% after CNS involvement. The present case report describes a case of WNV encephalitis with concomitant acute flaccid paralysis. Continue reading
Coronaviruses are a large family of viruses that cause illnesses ranging from the common cold to more severe diseases. SARS-CoV-2 is a new virus that has not been previously identified in humans. Patients with SARS-CoV-2 commonly develop acute respiratory distress syndrome (ARDS), myocardial injury, ventricular arrhythmias, and shock, all of which increase their risk of cardiac arrest. The main objective of this brief review is to raise the discussion on the possible indication of cardiopulmonary resuscitation in a patient with SARS-CoV-2 in prone position as a way to save time, since the entire process of decubitus change is complex and often slow, due to the number of devices used in these patients, such as catheters, infusion pumps and monitors. In addition to a price of high demand for stressed human resources. Continue reading
COVID-19 pandemic has created an unprecedented citation for the healthcare system; such that its effects are now started to become obvious. The main aim of this report is to describe the time trends of utilization of prehospital emergency medical system in a region of northern Greece from first confirmed case of the COVID-19 in the country, at 26/02/2020, till the first order for loosing lockdown at 04/05/2020. Use of data retrospectively collected for PEMS usage, in the regional unit of Thessaloniki, Northern Greece 26/02/2020, till the first order for loosing lockdown at 04/05/2020. The area of interest represents a little more than 10% of the total population of Greece. Daily cases of selected categories (suicides, assaults, animal bites, cardiac arrests, and car accidents) were recorded. Comparison with the daily cases in the previous 2 years (2019,2018), for the same period was performed. Continue reading
Intravesical bacillus Calmette-Guerin (BCG) therapy, recommended for superficial bladder tumors, triggers side effects in fewer than 5% of patients. Yet, when encountered, high level of suspition and early detection is essential for their succesfull management. In the present article, we present a case of severe sepsis and Steven Johnson syndrome in a male patient after intravesical BCG instillation. Intravesical instillation of Bacillus Calmette-Guérin (BCG) is frequently used as the treatment of choice for carcinoma in situ and non-invasive high-grade superficial tumor of the urinary bladder1. BCG is a live attenuated strain of Mycobacterium bovis and is the most widely used intravesical agent2. Adverse events occur in fewer than 5 % of cases, ranging from mild local symptoms to severe sepsis and death1-3. In the present article, we report a case of successful management of septic shock with concomitant Steven Johnson syndrome after intravesical BCG instillation and perform a short review of the relevant literature. Continue reading
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