Polymyositis and covid-19: A morbide association (a case report).

The COVID-19 pandemic and its impact on health systems had a significant effect on the management of inflammatory diseases in the long term and myopathies could be signs of COVID-19, making it difficult to diagnose the cause and effect relationship. An unvaccinated 62-year-old female patient followed for polymyositis was tested positive for COVID-19 on polymerase chain reaction (PCR) of nasopharyngeal swab revealed by dyspnea and rhinorrhea with fever and pulmonary involvement of 75%. She had an enlarged left ventricle with complete left branch block, inaugural diabetes mellitus with ketosis, kidney dysfunction, and inflammatory syndrome. Despite the early initiation of invasive ventilation in combination with the national protocol against covid-19, the patient died on day 4 of care. The best management should anticipate comorbidities and the evolutionary profile would guide the continuation of the treatment. Polymyositis like other rheumatic diseases was associated with a very high risk of developing a severe form of COVID-19. The combination of elder age and comorbidities led to a severe form of COVID-19 and therefore to a poor prognosis. The article aimed to show the severity of the association of covid-19 with polymyositis at the comorbid stage.

Covid-19 decompensating epilepsy in the elderly: A case report.

The COVID-19 pandemic has had a great impact on chronic diseases, including epilepsy. The imbalance of antiepileptic drugs in case of intercurrent infection with COVID-19 leads to worsening seizures. A 71-year-old man, followed for post-traumatic epilepsy for 30 years, was stabilized with phenobarbital and topiramate. He presented generalized tonic-clonic epileptic seizures without meningitis. He improved well on midazolam combined with the usual treatment before the diagnosis and worsening of the covid-19. The severity of the lung damage led to hypoxia, recurrence of seizures, and poor prognosis. The association between covid-19 and epilepsy remains pejorative despite management. An epileptic seizure should always be considered as a possible manifestation of COVID-19. The article aimed to establish the relationship between covid-19 and the risk of worsening seizures and to demonstrate the severity of the association between covid-19 and epilepsy in elderly patients.

Intrathecal use of amikacin: a case report

Meningitis caused by Acinetobacter baumannii is rare and are mostly hospital acquired after neurosurgical procedure. We report a case of a 40-year old man was admitted to the intensive care unit due to subarachnoid haemorrhage. Our patient developed a ventriculitis due to A.baumannii treated successfully with sulbactam IV and intrathecal amikacin.

Intrathecal use of amikacin: a case report.

Meningitis caused by Acinetobacter baumannii is rare and are mostly hospital acquired after neurosurgical procedure. We report a case of a 40-year old man was admitted to the intensive care unit due to subarachnoid haemorrhage. Our patient developed a ventriculitis due to A.baumannii treated successfully with sulbactam IV and intrathecal amikacin.

[Extra cellular volume assessment methods in dialysis, a critical analysis]. / Analyse critique des méthodes de mesures du volume extra-cellulaire en dialyse.

The extra cellular volume is strictly proportional to the amount of sodium present in the body. Its clinical evaluation on dialysis (through clinical story, weight and blood pressure changes) often needs probing for dry weight by reducing progressively the post dialysis weight down to the point where hypotension regularly occurs. Common critics addressed to the clinical assessment of dry weight include lack of sensitivity, of objectivity and of repeatability. But non clinical methods are far from perfect. They are non invasive, but they are poorly sensitive and reproducible (except for bio impedance, but in very strictly equal operational conditions). Most of them (natriuretic peptides, inferior vena cava echography, on-line volemia) measure exclusively the plasma volume but not the extra cellular volume. Besides, they increase dialysis complexity and cost. None of them is so far validated for dialysis. The accurate and absolute value of extra cellular volume is useless in clinical daily practice. What is needed is a simple fast evaluation of the actual extra cellular volume relative to its ideal level (dry weight). The clinical method based on two very simple, costless objective measurements, weight and blood pressure, allows for fulfilling the goal, the continuous adjustment of extra cellular volume and blood pressure normalization.

[Low sodium diet for dialysis patients: myth or reality?]. / Diététique hyposodée chez le patient dialysé: mythe ou réalite?

Low salt diet for dialysis patients was recommended at the very beginning of dialysis treatment. It was issued from Kempner and Guyton studies who have established the relationship between salt, hypertension, and the role of the kidney in sodium balance. This recommendation vanished from dialysis literature during the seventies and eighties and is currently on the way back. Salt intake has been evaluated in a small number of patients, found between 8.3 to 14.1 gram/day. Interventional studies for salt intake restriction have been efficient to reduce high blood pressure and decrease the interdialytic weight gain. In our unit, salt restriction is systematically prescribed to chronic kidney failure patients. We have evaluated from food recall or 3-day questionnaires the salt intake in 91 hemodialysis patients during the year 2005. Daily salt intake, not including salt added during cooking, was found at 3.8 g/day. This intake is correlated to interdialytic weight gain, water and phosphate intakes, and to BMI. Then a significant reduction in salt intake is possible in dialysis patients. This result may be obtained by the fruitful collaboration involving nurses, dietitians and the nephrologists.

[Sodium at the crossroads of history and culture]. / Le sodium au carrefour de l'histoire et de la culture.

Although the efficacy and the health benefits of sodium restriction are clear, such restrictions continue to be met with the greatest reluctance, most particularly--as underscored by the historian Bergier in his hypothesis--because profoundly symbolic values are unfailingly related to salt. This brief report summarizes several historical aspects of salt's role as a substance participating in religious rites and linguistic contexts where its past role can still be seen today. It broaches the important question of "salt hunger" of the vital role of salt in past times, a costly substance because it was indispensable, and the basis of a tax (the salt tax) which underlay the French Revolution.

[Electrophysiological aspects of intermediate syndrome in organophosphate poisonings]. / Aspects électrophysiologiques du syndrome intermédiaire au cours des intoxications aux organophosphorés.

Acute organophosphate poisoning, whether accidental or suicidal, is frequent in developing countries and produces significant morbidity and mortality. Organophosphates inhibit cholinesterase activity at the neuromuscular junction and cause extensive muscle paralysis, particularly for respiratory function. Poisonings evolve in three stages: cholinesterase crisis, intermediate syndrome and delayed neuropathy. Electrophysiological aspects have been poorly studied. We report the case of a 25-year-old woman admitted to intensive care unit with muscarinic signs and respiratory failure after attempted suicidal organophosphate poisoning. Cholinesterase activity was low and the electrophysiological study disclosed the characteristic aspect of intermediate syndrome. The patient died due to septic complications. This syndrome is exceptional with a poorly understood pathophysiology. The electrophysiological study is essential for diagnosis.

[Clinical and electrophysiological aspects of acute organophosphate intoxication]. / Aspects cliniques et électrophysiologiques de l'intoxication aiguë aux organophosphorés.

INTRODUCTION: Acute organophosphate (OP) intoxications, accidental or voluntary, are responsible for a high mortality. They cause extensive muscular paralysis by acetyl cholinesterase activity inhibition at the neuromuscular junction level. AIM: To underline the rarity and the characteristic electrophysiological pattern during cholinergic crisis. OBSERVATION: A 28-year-old woman was admitted to the medical intensive care unit for Malathion acute intoxication with signs of glandular hypersecretion, complicated tetraparesis, and respiratory distress. The cholinesterase activity was 17%. The electroneuromyography showed multiple motor responses to the same stimulation, which is characteristic of the cholinergic crisis. Other electrophysiological parameters, in particular low-frequency repetitive stimulations, were normal. The evolution was favourable after symptomatic treatment and respiratory assistance. DISCUSSION AND CONCLUSIONS: Organophosphate intoxications evolve in three phases: acute cholinergic crisis, intermediate syndrome, and delayed neuropathy. While the electrophysiological aspects of delayed neuropathy are best characterized, those of crisis and intermediate syndrome remain very little studied. The persistence of acetylcholine in the synaptic slit would explain the multiple motor responses to single stimulation during the crisis.