COVID-19 Presenting As Miller Fisher Syndrome in a Patient With a History of Guillain-Barré Syndrome: A Case Report.

Coronavirus disease 2019, caused by severe acute respiratory syndrome coronavirus 2, primarily affects the respiratory system. While coronaviruses are not a common cause of neurological disease, they have been reported to cause direct central nervous system infection, as well as presumed para-infectious disorders. Here we report a very rare case of SARS-CoV-2 infection presenting as Miller Fisher syndrome with positive anti-GQ1b antibodies in a patient with a history of Guillain-Barré syndrome, which was treated with IV immunoglobulin resulting in marked improvement in her symptoms. Thus, a high index of suspicion and meticulous observation are the cornerstones to identifying possible uncommon presentations of COVID-19.

Ruptured Sinus of Valsalva Aneurysm in Apert Syndrome: Case report.

Background: Sinus of Valsalva aneurysm (SOVA) is a rare anomaly of the aorta that can be congenital or acquired. It can be associated with syndromes such as Marfan syndrome and Ehlers-Danlos syndrome. However, to our knowledge, it has never been described in a patient with Apert syndrome. Although it often presents as an incidental finding on imaging, SOVA is associated with the risk of serious complications, including rupture. A possible connection between the conditions might be the FGFR2 gene mutation in Apert syndrome and the influence of a mutation in fibroblast growth factor 2 (FGF2) on heart development. Here we report a case of acute heart failure secondary to rupture of SOVA into the right atrium in a patient with Apert syndrome. Case presentation: A 47-year-old Caucasian woman with a history of Apert syndrome and rheumatoid arthritis presented with shortness of breath, orthopnea, paroxysmal nocturnal dyspnea, and progressive bilateral lower extremity edema for 2 weeks. She was diagnosed with acute right heart failure due to ruptured SOVA. The patient underwent surgical repair of the ruptured SOVA. Unfortunately, her postoperative course was complicated by a stroke leading to brain death. Conclusion: Ruptured SOVA is a quite rare but serious condition that can cause life-threatening complications. In this case, SOVA occurred in a patient with Apert syndrome. The case may suggest that these two conditions may be related through the FGFR2 gene mutation associated with Apert syndrome and the related growth factor FGF2 involved in heart development.

Health care workers attitudes toward COVID-19 vaccination and the effect on personal and professional life.

INTRODUCTION: While the discovery of the Coronavirus disease 2019 (COVID-19) vaccine renewed the hope to restore normal life, the attitude of Health Care Workers (HCWs) towards vaccination and its impact on their life are yet to be evaluated. METHODS: We conducted a cross-sectional study from late January to mid-February at the MedStar Health Hospitals in Baltimore, Maryland. Eligible HCWs completed the questionnaires anonymously. The primary outcomes were attitudes of HCWs towards vaccination and the impact on HCWs' comfort and anxiety in caring for patients, sleep, mood, attendance of social gatherings, and utilization of health clubs, before and after vaccination. RESULT: A total of 300 respondents completed the questionnaires. The mean age was 37.2 years with 37.7% physicians and 45.7% registered nurses. Of the respondents only, 15.7% refused vaccination. The most common reason for refusal was concerns for long-term adverse effects, cited by 59.5%. Following vaccination, comfort level in caring for patients with COVID-19 and other illnesses improved (6.3 (2.8) to 8.2 (2.0), p < 0.005, and 8.4 (2.4) to 9.1 (1.0), p < 0.005, respectively). Additionally, a significant decrease in anxiety was noted in HCWs caring for patients with COVID-19 and other illnesses (5.0 (3.3) vs. 3.5 (3.2), p < 0.005 and 2.7 (3.3) vs. 2.3 (3.4), p = 0.001, respectively). Significant improvement in mood scores (6.9 (2.4) vs. 7.7 (2.1), p < 0.005) and comfort level at social gatherings (4.3 (3.2) vs. 6.3 (3.0), p < 0.005) were also noted. CONCLUSION: Vaccination against COVID-19 resulted in overall improvement in HCWs physical and mental wellbeing.

Cognitive Stimulation in an Intensive Care Unit: A Qualitative Evaluation of Barriers to and Facilitators of Implementation.

BACKGROUND: Delirium in the intensive care unit is associated with poor patient outcomes. Recent studies support nonpharmacological therapy, including cognitive stimulation, to address delirium. Understanding barriers to cognitive stimulation implemented by nurses during clinical care is essential to translating evidence into practice. OBJECTIVE: To use qualitative methods through a structured quality improvement project to understand nurses' perceived barriers to implementing a cognitive stimulation intervention in a medical intensive care unit. METHODS: Data were collected through semistructured interviews with nurses in a medical intensive care unit. Data were categorized into themes by using thematic analysis and the Consolidated Framework for Implementation Research. During cognitive stimulation, nurses reviewed with patients a workbook of evidence-based tasks (focused on math, alertness, motor skills, visual perception, memory, problem-solving, and language). RESULTS: The 23 nurses identified 62 barriers to and 26 facilitators of cognitive stimulation. These data were summarized into 12 barrier and 9 facilitator themes corresponding to the following Consolidated Framework for Implementation Research domains: Intervention Characteristics, Outer Setting, Inner Setting, and Characteristics of Individuals. Nurses also identified several facilitators within the Process domain. Patient-specific variables, including sedation, were the most frequently reported barriers. Other barriers included cognitive stimulation not being prioritized, nursing staff-related issues, documentation burden, and a lack of understanding of, or appreciation for, the evidence supporting cognitive stimulation. CONCLUSIONS: Implementation of cognitive stimulation requires a multidisciplinary approach to address perceived barriers arising from the organization, context, and individuals associated with the intervention, as well as the intervention itself.

A rare case of spontaneous tumor lysis syndrome in multiple myeloma.

Spontaneous tumor lysis syndrome is an uncommon oncologic emergency. It occurs when a massive number of malignant cells release their contents to the blood stream without previous cancer treatment. TLS carries a mortality rate exceeding 15%. Because of the high mortality rate, the key to the management of TLS continues to be early recognition of high-risk patients and using prophylactic measures to prevent its occurrence. However, it remains difficult to completely eradicate TLS, as a small proportion of patients with aggressive tumors develop spontaneous TLS prior to receiving any therapy. We present a case of 58-year-old male with recently diagnosed multiple myeloma. He was found to have hyperkalemia, hyperphosphatemia, hyperuricemia, hypocalcemia, elevated LDH levels, and acute renal failure, fulfilling the criteria of clinical TLS. He was treated with rasburicase, continuous renal replacement therapy, and dexamethasone.