Emphysematous pyelonephritis complicated by septic shock treated with antibiotic therapy alone: a case report.

Emphysematous pyelonephritis (EPN) is a rare and serious complication of urinary tract infections that mainly occurs in diabetic patients. It results in the development of aerobic gas-forming bacteria1. Diagnosis is based mainly on a computed tomography scanner. Therapeutic management is based on the patient's clinical condition and radiological classification. Case presentation: We present a case of a 64-year-old female patient with type 2 diabetes under insulin and hypertension under amlodipine, who was admitted to the intensive care unit for a state of septic shock on EPN. The patient received resuscitation measures and antibiotic therapy, and the evolution was favorable. The patient was transferred to the urology unit after 10 days of hospitalization in the intensive care unit. Discussion: EPN is frequently caused by gram-negative cocci and generally develops in diabetics. The clinical signs of EPN are not very specific and are essentially based on the signs of acute pyelonephritis, which responds badly to treatment. Conclusions: It is essential to take preventive measures in diabetic patients to avoid this complication. Early diagnosis allows for avoiding surgery by preserving the kidney.

Acute alithiasic pancreatitis following the use of Risperidone in a young man with schizophrenia: As a rare case report.

Acute pancreatitis due to antipsychotic treatment is a rare but serious complication. Risperidone is among the rarest atypical antipsychotics associated with acute pancreatitis. Here, we report the case of acute pancreatitis developing 2 years after the use of Risperidone in a young man with schizophrenia. The mechanism and the time of occurrence in this case are at odds with what is generally reported in the literature.

Spontaneous liver rupture after uncomplicated delivery: medical case report.

Spontaneous hepatic rupture is an uncommon and fatal complication that most often occurs in the setting of severe pre-eclampsia. Case presentation: In this article, the authors describe a case of spontaneous liver rupture occurring on the sixth day of an uncomplicated pregnancy in postpartum. Discussion: According to the literature, liver rupture in the obstetrical setting is mostly linked to pre-eclampsia and HELLP syndrome. Conclusion: A collaborative multidisciplinary approach is required to define adequate medical and surgical management when there is suspicion of liver rupture in pregnant women.

Post COVID-19 trigeminal neuritis: Case report.

Neurological symptoms are prevalent in Coronavirus disease 2019 (COVID-19) cases, ranging from 30% to 80% depending on the severity of the disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We have documented a case of a 26-year-old woman who suffered from trigeminal neuritis caused by COVID-19, but responded well to corticotherapy. Two primary mechanisms may explain the neuroinvasive and neurovirulent properties of human coronaviruses. Neurological symptoms can persist long after recovery from COVID-19.

Invasive Klebsiella rhinoscleromatis infection leading to ARDS, septic shock, and death: A rare case report.

Rhinoscleroma is an uncommon chronic infection caused by Klebsiella rhinoscleromatis, a gram-negative bacillus that affects the upper respiratory tract. Although the nasal cavity is the most affected area, pulmonary involvement has not been previously documented. This case report describes a 61-year-old man followed for nasal rhinoscleroma who was admitted to the intensive care unit with acute respiratory distress and septic shock due to bilateral infectious bronchopneumonia. Despite immediate intubation and intravenous antibacterial treatment, the patient died 10 days later. Klebsiella rhinoscleromatis was identified in a distal pulmonary swab and blood culture. While cases of rhinoscleroma and bacteremia caused by K rhinoscleromatis infection have been documented, the case we present here is the first to report on acute respiratory distress syndrome caused by fulminant pneumonia along with septic shock.

Malignant ischemic stroke revealing a spontaneous carotid dissection in a young patient: Rare case report.

Ischemic stroke remains today a major health problem that requires adequate management and etiological research. The prevalence in young people has increased. This article is a case report of a 37-year-old female diabetic patient who had an acute ischemic stroke due to spontaneous dissection of the right internal carotid artery. The article discusses the epidemiology, pathophysiology, diagnosis, and treatment of cervical artery dissection, which is a common cause of stroke in young patients. The use of antiplatelet and anticoagulant therapy, as well as endovascular and surgical interventions, is also discussed. Spontaneous carotid bulb dissection is an emergency in ischemic stroke in young people. The prognosis depends on the severity of the initial injury and the extent of collateral circulation, with successful recovery in 75% of cases.

Acute Myocardial Injury Assessed by High-Sensitive Cardiac Troponin Predicting Severe Outcomes and Death in Hospitalized Patients with COVID-19 Infection.

BACKGROUND: Cardiac injury has been linked to a poor prognosis during COVID-19 disease. Nevertheless, the risk factors associated are yet to be thoroughly investigated. OBJECTIVES: We sought to compare demographical characteristics and in-hospital outcomes in patients infected by the SARS-CoV-2 with and without cardiac injury, to further investigate the prevalence of acute cardiac injury as well as its impact on their outcomes in COVID-19-patients. METHODS: We included in a retrospective analysis, all COVID-19 patients admitted between October first and December first, 2020, at the University Hospital Center of Oujda (Morocco) who underwent a troponin assay which was systematically measured on admission. The study population was divided into two groups: cardiac-injured patients and those without cardiac injury. Clinical, biological data and in-hospital outcomes were compared between the two groups. RESULTS: 298 confirmed COVID-19 cases were included. Our study found that compared to non-cardiac-injured, cardiac-injured patients are older, with higher possibilities of existing comorbidities including hypertension (68 [42.2%] vs 40 [29.2%], P = 0.02), diabetes (81 [50.3%] vs 53 [38.7%] P = 0.044), the need for mechanical ventilation, ICU admission and mortality. A Cox proportional hazards regression analysis shows a significantly increased risk of death among cardiac-injured COVID-19-patients as compared to non-cardiac injured. (HR, 1.620 [CI 95%: 2.562-1.024]). CONCLUSION: Our retrospective cohort found that old age, comorbidities, a previous history of CAD, were significantly associated with acute cardiac injury. COVID-19 patients with acute cardiac injury are at a higher risk of ICU admission, and death.

Severe hepatic impairment after sevoflurane anesthesia in a 10-month-old child: Case report.

INTRODUCTION: Like other halogenated agents, sevoflurane can potentially cause a toxic reaction including severe hepatic failure which can lead to the death of the patient. However, Halogen immuno-allergic hepatitis is a very rare complication of anesthesia. We reported a 10 months' child who presented a severe hepatic injury after sevoflurane exposure. CASE MANAGEMENT: A 10-month-old child was scheduled for acute intussusception anesthesia, induction was done with sevoflurane and propofol while maintenance of anesthesia was provided by sevoflurane alone. Three days after the operation, he was developed jaundice and altered general condition. A dramatic increase in liver enzymes was observed. The evolution was marked by an alteration of his consciousness and his hemodynamic state, he was intubated. Without improvement, the patient died on the 4th postoperative day. The autopsy was refused by the family. CONCLUSION: These results underscore the need findings for a global and comprehensive understanding of the potential hepatotoxicity of exposure to volatile anesthetics including sevoflurane in infants and its long-term side effects which can be fatal.

Caesarean section under continuous spinal anaesthesia in a parturient with pulmonary hypertension: A case report.

INTRODUCTION: Women with pulmonary hypertension have high morbidity and mortality during pregnancy. The inability to increase cardiac output can lead to heart failure, while hypercoagulability and reduced systemic vascular resistance also lead to other risks. CASE MANAGEMENT: This paper report the case of a parturient admitted for caesarean section under continuous spinal anaesthesia scheduled at 34 weeks of amenorrhea following severe pulmonary arterial hypertension. She had a history of significant mitral insufficiency. The procedure was performed without incident. The catheter was removed immediately postoperatively. The baby was female and in good health. She was transferred to the resuscitation service with restoration of oral nutrition. CONCLUSION: Loco-regional anaesthesia is to be preferred in pulmonary hypertension associated to pregnancy. In order to reduce the risk of mortality due to general anaesthesia for this type of patient, it is possible to practice the continuous spinal anaesthesia for caesarean section without having hemodynamic consequences.

Dexamethasone or methylprednisolone therapy in covid-19 pneumonia: A retrospective and comparative study of 513 cases.

BACKGROUNDS: Corona virus disease 19 (Covid-19) affects especially the respiratory tract, and induces lung injury which may progress to the acute respiratory distress syndrome (ARDS). Various treatment options were tried all over the world, corticosteroids had showed beneficial effects.The Objective of this study, is to compare the safety and efficiency of two corticosteroids: dexamethasone and prednisolone in the treatment of Covid-19 infection. METHODS: This retrospective and comparative study included 513 patients diagnosed with Covid-19 infection and were admitted to intensive care unit of our university hospital center of MOHAMMED VI Oujda from March 1, 2020, to December 31st, 2020. RESULTS: In this study, 513 cases were included, 230 patients were received methylprednisolone, and 283 were treated with dexamethasone. The median age in methylprednisolone group was 64 years, and 63 years in the second group treated with dexamethasone. Patients treated with dexamethasone had more critically lesions compared to patients treated with methylprednisolone (67.6%), these patients had a good evolution with a significant reduction of oxygen supplementation, lower use of invasive ventilation and a significant improvement in biological parameters. The difference in outcome between the two groups in terms of mortality was significantly reduced in the second group. CONCLUSION: Both steroids are efficient in the management of mild, moderate and severe Covid-19 pneumonia with a clear superiority of dexamethasone especially in severe forms.

Guillain Barre syndrome as a complication of SARS-CoV-2 infection: A case report.

INTRODUCTION: Covid-19 infection usually manifests with respiratory symptoms, but neurological signs might be the mean symptom revealing this infection such as Guillain Barre syndrome (GBS).COVID-19 associated GBS seems to be more severe than non-COVID-19 GBS. CASE MANAGEMENT: We reported a 49 old-man admitted in the intensive care unit for bilateral ascending symmetrical paresthesia associated with lower limb numbness and sphincter disorders two weeks after an upper respiratory infection. The diagnosis of post-Covid-19 GBS was maintained, and the evolution was favorable after Intravenous Immunoglobulin (IVIg) and plasma exchange (PLEX) as a second therapy. CONCLUSION: This case report suggest the probable causal link between COVID 19 and GBS. This severe association prompts us to do further research that may help professionals in an early diagnosis and early treatment thus improving morbidity and mortality.

The impact of mental health on COVID 19 disease progression: Case report.

It has been observed that mental disorder is associated with an aggravation of COVID 19 disease. A 44-year-old male patient, with no medical history, admitted to the emergency room for dyspnea, the exploration revealed SARS-COV-2 pneumonia. The patient was stable until he was aware of the death of his sister by COVID 19, he was admitted into the intensive care unit 24hours later in a serious condition after worsening of the inflammatory balance and pulmonary lesions. COVID 19 requires appropriate mental health management to help improve the prognosis of this disease.

Spontaneous gas effusions: A rare complication of covid 19.

Spontaneous gas effusion unrelated to assisted ventilation is a newly recognized complication of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The objective of the present study was to examine the incidence, risk factors and the outcomes of Spontaneous gas effusions. 610 cases were analyzable, with 3 patients developing spontaneous gas effusion. This latter was associated with increased intubation and a trend towards death in one case. Drainage was required in two cases. In conclusion, spontaneous gas effusions appeared to be a rare complication of severe acute respiratory syndrome. Further research is needed to investigate its pathogenesis.

Myocardial infarction complicated by cardiac arrest revealing SARS-COV-2 infection: Case report.

INTRODUCTION: COVID19 infection is most often reveled by pulmonary symptoms, however cardiovascular manifestations has been observed revealing this infection with absence of respiratory symptoms. CLINICAL CASE: A 62 year old female patient, with no medical history, admitted to the emergency room for epigastric pain, with no respiratory signs, the exploration revealed myocardial infarction with COVID 19 infection. CONCLUSION: COVID19 infection manifest mainly with respiratory symptoms but it can also be revealed by cardiac manifestations with absence of respiratory symptoms.Physicians must be aware of these atypical manifestations and act accordingly to isolate patients to limit the spread of this disease.

Intra cardiac thrombus in critically ill patient with coronavirus disease 2019: Case report.

INTRODUCTION: With the outbreak of COVID-19, the number of cardiac manifestations related to this virus was more remarquable, among them heart thrombus (HTh) which is considered as a rare and severe complication associated with thromboembolic phenomena. METHODS: We present case report of 4 patients who presented heart thrombus as a complication of COVID-19. CASES REPORT MANAGEMENT: During the pandemic, these patients were presented to our center for respiratory symptoms related to COVID-19 infection. All of them was hemodynamically unstable. On further assessment, Diagnosis was confirmed by trans -thoracic echography, one patient (1/4) had left ventricle thrombus, one patient (1/4) had right atrium thrombus and right ventricle thrombus was dominated in the rest of patients (2/4). Therapeutic component was based on unfractionated heparin and fibrinolytic. CONCLUSION: COVID-19 patients could represent a population at high risk of HTh. Multidisciplinary approach and bed routine transthoracic echography can enhance the management of this cardiac complication.

Spontaneous Pneumomediastinum Associated with COVID-19 Pneumonia.

The first case of coronavirus disease 2019 (COVID-19) was declared in December in Wuhan, before becoming a global pandemic in a few weeks. Several complications of this infection have been reported. However, a spontaneous pneumomediastinum has rarely been described. We report the fourth case of this extremely rare complication in a 65-year-old male patient with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pneumonia, discovered during his therapeutic management by a CT scan control.