Methylcobalamin Deficiency Presenting as Thalamic Syndrome in the Elderly: Association or Chance?

Vitamin deficiency is common in the geriatric population and is responsible for majorly imbalanced hematological, neurological, and neuropsychiatric functioning. Methylcobalamin deficiency or vitamin B12 deficiency can be underestimated in some cases and be misdiagnosed as other illnesses, such as thalamic syndrome. Timely diagnosis of this deficiency is essential, especially in the geriatric population, as it might cause irreversible structural brain damage. This is also presented as elevated levels of homocysteine and methylmalonic acid. Clinically, it presents with the following symptoms: lower sensitivity levels to touch and light, psychosis, paresthesia, anemia, imbalance, fatigue, cognitive disturbances, difficulty remembering, and confusion. Symptoms are usually progressive and worsen over a period of time. In this case report, we present the case of a 62-year-old male with clinical symptoms of numbness and tingling in the right side of the body. The neurological presentations resembled left thalamic infarct, but the underlying reason was methylcobalamin deficiency.

A Case of Bilateral Renal Infarct Due to Left Ventricular Thrombus.

Renal infarction is an uncommon illness that can have serious side effects. Patients may be predisposed to the disease by factors including smoking, atrial fibrillation, thrombus, infective endocarditis, myocardial infarction, and prosthetic valves. Patients are most susceptible from 24 hours to 15 days after myocardial infarction, with an increased rate of left ventricular (LV) thrombus development, which raises the probability of thromboembolic events in the cerebrovascular system and might exacerbate morbidity and mortality rate. This can be diagnosed by two-dimensional echocardiography. Different risk factors can contribute to the development of an LV thrombus. Renal infarcts from LV clots are less common but can occur bilaterally in certain situations. A 30-year-old male diagnosed with anterior wall myocardial infarction presented at our hospital and was suspected to have bilateral renal infarcts, possibly due to the LV thrombi. The patient was managed on anti-thrombolytics and was reported to be doing well at a follow-up of one month.

The Importance of Treating Subclinical Hypothyroidism in Patients With Immune Thrombocytopenia: A Case Report.

The leading cause of isolated thrombocytopenia in asymptomatic individuals is immune thrombocytopenia (ITP). It is an autoimmune disease characterized by decreased platelet counts caused by the immune system's destruction of platelets.  Sometimes, autoimmune thyroid diseases and ITP can coexist, which could cause an aggravated immune system response. When thyroid autoimmune diseases are present, treating ITP may become challenging. Treatment of the underlying thyroid disease in such individuals results in a significant improvement in platelet count, along with remission of the disease. It enhances the response to traditional ITP therapy. In this case report, we present a case of a 40-year-old female who was treated for ITP along with hypothyroidism, resulting in a considerable improvement in platelet count and a remission of the condition.

Advancements in Wearable Digital Health Technology: A Review of Epilepsy Management.

This review explores recent advancements in wearable digital health technology specifically designed to manage epilepsy. Epilepsy presents unique challenges in monitoring and management due to the unpredictable nature of seizures. Wearable devices offer continuous monitoring and real-time data collection, providing insights into seizure patterns and trends. Wearable technology is important in epilepsy management because it enables early detection, prediction, and personalized intervention, empowering patients and healthcare providers. Key findings highlight the potential of wearable devices to improve seizure detection accuracy, enhance patient empowerment through real-time monitoring, and facilitate data-driven decision-making in clinical practice. However, further research is needed to validate the accuracy and reliability of these devices across diverse patient populations and clinical settings. Collaborative efforts between researchers, clinicians, technology developers, and patients are essential to drive innovation and advancements in wearable digital health technology for epilepsy management, ultimately improving outcomes and quality of life for individuals with this neurological condition.

Acute Cytomegalovirus Colitis Presenting As Exacerbation of Ulcerative Colitis: A Case Report.

This case report presents a 24-year-old female with a history of ulcerative colitis (UC) who sought care for symptoms initially suggestive of the disease exacerbation but was later diagnosed as acute cytomegalovirus (CMV) colitis. The patient's clinical course, marked by watery diarrhea, blood in stools, vomiting, and fever, raised suspicion of a UC flare. However, a nuanced diagnostic approach revealed CMV superinfection, including computed tomography, colonoscopy, and tissue polymerase chain reaction (PCR). The patient's immunosuppressive history, with prior treatment, including intravenous infliximab and azathioprine, contributed to CMV infection. Treatment involved initiation of tofacitinib and antiviral therapy with valganciclovir. This case underscores the diagnostic challenges in distinguishing between infectious complications and UC exacerbations, necessitating a tailored, multidisciplinary approach for optimal management. It highlights the delicate balance required when managing UC patients on immunosuppressive regimens, emphasizing the importance of timely diagnosis and individualized treatment strategies in complex clinical scenarios.

Unraveling Neurological Shades: Vitamin D Toxication and Central Pontine Myelinolysis Exposed.

This case report is about a middle-aged female who presented with complaints of pain in the abdomen with intractable vomiting for three months, pain and weakness in bilateral lower limbs for two months, and irritability for three days. She was previously treated for lumbar disc bulge and severe narrowing of the spinal cord whose treatment also included vitamin D supplements. After taking high doses of a vitamin D supplement daily for approximately four months, it resulted in vitamin D toxicity. The sodium level of the patient was in the normal range throughout the treatment. Her magnetic resonance imaging brain revealed features of central pontine myelinolysis. The development of central pontine myelinolysis due to vitamin D toxicity, with normal sodium levels, makes this a rare case for discussion.

Concurrent Challenges in Idiopathic Hypereosinophilic Syndrome Complicating Beta-Thalassemia Major: A Case Report.

This case report highlights the uncommon idiopathic hypereosinophilic syndrome (HES) complicating beta-thalassemia major, presenting a diagnostic and management challenge. Beta-thalassemia major, characterized by impaired beta-globin synthesis, necessitates regular blood transfusions and iron chelation therapy. HES, a rare disorder marked by persistent eosinophilia, adds complexity to the clinical course. We present the case of a 27-year-old male with beta-thalassemia major who developed fever, weakness, and weight loss and was subsequently diagnosed with HES. Treatment involved antibiotics, blood transfusions, and corticosteroids, leading to clinical improvement. This case underscores the need to further understand the relationship between thalassemia and eosinophilia and the importance of comprehensive evaluation in patients with overlapping hematological disorders.

A Comprehensive Review of Advanced Biomarkers for Chronic Kidney Disease in Older Adults: Current Insights and Future Directions.

Chronic kidney disease (CKD) is a growing health concern, particularly in older adults, due to its high prevalence and association with increased morbidity and mortality. Early detection and effective management are crucial to slowing disease progression and reducing complications such as cardiovascular events and end-stage renal disease (ESRD). Traditional biomarkers, including serum creatinine and estimated glomerular filtration rate (eGFR), often have limitations in older populations, where age-related physiological changes can obscure early signs of kidney dysfunction. Advanced biomarkers offer a more precise and comprehensive understanding of kidney health, providing insights into pathological processes such as inflammation, fibrosis, oxidative stress, and tubular injury. These biomarkers have the potential to enhance early diagnosis, predict disease progression, and inform personalized treatment approaches, particularly in the elderly. This review explores the current landscape of advanced biomarkers for CKD in older adults, highlighting their clinical utility and limitations. Key biomarkers, including those related to inflammation (C-reactive protein, interleukin-6), fibrosis (transforming growth factor-beta, collagen degradation products), oxidative stress (F2-isoprostanes, malondialdehyde), and tubular injury (kidney injury molecule-1, neutrophil gelatinase-associated lipocalin), are examined in the context of CKD. Emerging technologies, such as multi-omics and machine learning, are also discussed as they offer new opportunities for biomarker discovery and integration into clinical practice. While challenges remain, including the need for longitudinal studies and better standardization, advanced biomarkers hold promise for transforming CKD management in older adults, paving the way for earlier detection, better risk stratification, and more targeted therapeutic interventions.

The Role of Neutrophil-to-Lymphocyte Ratio in Predicting Outcomes of Acute Organophosphorus Poisoning: A Comprehensive Review.

Organophosphorus poisoning (OPP) poses a significant threat to human health, necessitating accurate prognostic markers for timely intervention and improved outcomes. This review evaluates the potential of the neutrophil-to-lymphocyte ratio (NLR) as a prognostic indicator in acute organophosphorus poisoning (AOPP). A comprehensive analysis of existing literature reveals that elevated NLR values correlate with increased severity of poisoning and adverse clinical outcomes, including mortality and morbidity. NLR assessment offers valuable prognostic information beyond traditional markers, aiding risk stratification and guiding clinical decision-making. Integration of NLR into clinical practice holds promise for optimizing patient care through the early identification of high-risk individuals and tailored therapeutic interventions. Further research is needed to validate the utility of NLR in larger patient cohorts and standardize its incorporation into clinical guidelines. Leveraging NLR as a prognostic tool can enhance risk stratification, optimize treatment strategies, and ultimately improve outcomes in AOPP.

Recent Advances in the Management of Non-rheumatic Atrial Fibrillation: A Comprehensive Review.

Atrial fibrillation (AF) is a prevalent cardiac arrhythmia characterized by irregular atrial electrical activity, posing significant challenges to patient management and healthcare systems worldwide. Non-rheumatic AF, distinct from AF due to rheumatic heart disease, encompasses a spectrum of etiologies, including hypertension, coronary artery disease, and structural heart abnormalities. This review examines the latest advancements in managing non-rheumatic AF, encompassing diagnostic approaches, pharmacological therapies, and innovative non-pharmacological interventions. Diagnostic strategies ranging from traditional electrocardiography to advanced imaging modalities are explored alongside emerging biomarkers and wearable technologies facilitating early detection and management. Pharmacological management options, including novel anticoagulants and rhythm control agents, are evaluated in light of current guidelines and recent clinical trials. Non-pharmacological interventions, such as catheter ablation and device-based therapies, are discussed regarding their evolving techniques and outcomes. Special considerations for diverse patient populations, including elderly individuals and athletes, are addressed, emphasizing personalized approaches to optimize therapeutic outcomes. The review concludes with insights into future directions for AF management, highlighting promising avenues in gene therapy, regenerative medicine, and precision medicine approaches. By synthesizing recent research findings and clinical innovations, this review provides a comprehensive overview of the dynamic landscape of non-rheumatic AF management, offering insights for clinicians, researchers, and healthcare stakeholders.

A Case of Zinc Phosphide-Induced Acute Fulminant Liver Failure.

The use of rodenticides such as zinc phosphate is common in tropical countries. However, it has a toxic effect on humans when consumed or absorbed accidentally or deliberately. Although the adverse effects often only last for a short period, acute or fulminant liver failure can occur in few patients. Because the chemicals can create a wide variety of symptoms, it is essential to investigate the progression of symptoms from mild to severe so that treatment protocols can be understood and patients can receive appropriate care. In this report, we detail a case of rodenticide poisoning in a middle-aged man who, initially, had only minor symptoms but ultimately developed fulminant liver failure. In this example, we discuss the case of a 40-year-old man who intentionally consumed 10 gm of rat poison (zinc phosphide (ZnP)) and reported to our department with a complaint of nausea and three episodes of vomiting. A neurological evaluation showed that the patient had a Glasgow Coma Scale score of 9/15 (Eye(E): 2; Motor(M): 4; Verbal(V): 3). Doll's eyes were present, and the patient's pupils were semi-dilated, sluggishly reacting to light. The plantars were bilateral extensor. In the subsequent four hours, the patient developed a deep coma. The patient's lack of awareness, coagulopathy, and abnormal liver enzyme values all pointed to acute fulminant liver failure. His condition improved with supportive therapy over a period of three weeks.

Viral Myocarditis in the Setting of Delayed Manifestation of Hamman-Rich Syndrome.

Acute respiratory distress syndrome (ARDS)-like symptoms and rapid progression characterize the interstitial lung disease known as acute interstitial pneumonitis, also known as Hamman-Rich syndrome. It has a bad prognosis and a high incidence of mortality. We describe the case of a 25-year-old male patient with acute-onset type I respiratory failure with detrimental X-ray abnormalities who presented to the emergency room without any history of pulmonary disease or smoking. The provisional diagnosis of Hamman-Rich syndrome was reached after other clinical entities were ruled out based on CT findings. Myocardial hypokinesis of the apex and septum, as well as a modest systolic dysfunction (ejection fraction: 50%) similar to acute myocarditis, were detected by echocardiogram. Acute myocarditis in the setting of Hamman-Rich syndrome has been anecdotally reported and its mechanism remains to be elucidated.

A Case Report of a High-Altitude Acute Pulmonary Embolism (HA-PE): A Catastrophic Masquerader of High-Altitude Pulmonary Edema (HAPE).

Pulmonary embolism is a life-threatening emergency and, if not identified and treated, can cause catastrophic consequences. The most common cause of pulmonary embolism is deep vein thrombosis (DVT). There are established criteria to diagnose pulmonary embolism. One of the rare causes of pulmonary embolism is exposure to high altitude (HA). We present a case of a 51-year-old male without any co-morbidities, who, after traveling to an HA destination, developed acute onset dyspnea and was labeled as a case of HA pulmonary edema (HAPE). Further investigations in our hospital revealed a massive pulmonary embolism. Post thrombolysis, the patient was comfortable. After 48 hours, the patient started to walk at a normal pace without any symptoms and was discharged after seven days. This case report emphasizes the importance of keeping rare possibilities, such as pulmonary embolism, in such rare scenarios.

Simultaneous Myasthenic Crisis With Thyrotoxic Crisis in an Adult Male: An Autoimmune Overlap.

When it comes to thyroid disorders, Graves' disease (GD) is the most prevalent autoimmune thyroid disorder in which antibodies are formed against thyroid receptors. Myasthenia gravis (MG) is a rare autoimmune neuromuscular junction disorder. Autoimmune antibodies are formed against postsynaptic neuromuscular junctions in MG, interrupting neuromuscular transmission and causing variable muscle weakness and tiredness. It affects older men and young women. The two disorders may coexist in a patient, or either of them may develop first. The thyroid condition GD is most frequently linked to MG. This case report describes an older man who presented with an acute exacerbation of MG along with a thyrotoxic crisis.

Impact of angiotensin receptor blocker as antihypertensive in assessing mortality in patients of COVID-19: A single tertiary care center study.

BACKGROUND: The angiotensin-converting enzyme 2 (ACE2) receptor, a membrane receptor present in the respiratory system, the gastrointestinal tracts, the heart, and the kidney is the entry point for SARS-CoV-2 to enter human cells. Concerns were raised about the influence of using antihypertensive drugs like angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) in individuals with COVID-19 due to its tight relationship with the ACE2 receptor. The aim of this study was to investigate the impact of being on an Angiotensin Receptor Blockers (ARB) on mortality in patients consecutively diagnosed with COVID-19. MATERIAL AND METHODS: This is the retrospective observational study done in all patients consecutively diagnosed with COVID-19 from January 2021 to June 2021. All related patient information and clinical data was retrieved from the hospitals electronic medical record system. RESULTS: In this study, out of 500 patients, 51 died, having mean age of 66.92 ± 10.85 years. 144 (28.8%) patients were on angiotensin receptor blockers as antihypertensive treatment, 142 (28.4%) having other antihypertensive and 214 (42.8%) were not on any treatment. Out of 51 Death 7 (4.9) patients were on ARBs, 15 ± 10.6 were on other medication [OR 2.31 (0.94-6.22, P = 0.077) univariable; OR 2.57 (1.00-7.23, P = 0.058) multivariable] and 29 ± 13.6 had no treatment at all [OR 3.07 (1.38-7.80, P = 0.010) univariable; OR 3.36 (1.41-9.08, P = 0.010) multivariable]. CONCLUSION: Use of ARB medications for the hypertensive patients who acquire COVID-19 infection has shown protective effects of such medications on COVID-19 disease severity in the term of mortality and the mortality rate among hypertensive patients on COVID-19 with ARBs/ACE inhibitors showed significant differences as compared to other antihypertensives.