Disseminated nocardiosis in a patient with alcoholic liver cirrhosis: a case report.

BACKGROUND: Nocardia are Gram-positive, aerobic, filamentous bacteria that can cause localized or disseminated infections. Immunocompromised patients are at a higher risk of developing Nocardia infection and further dissemination of the disease. To date, limited data have documented the relationship between nocardiosis and alcoholic liver disease. CASE PRESENTATION: We report the case of a 47-year-old man with a known history of alcoholic liver cirrhosis. The patient presented to our emergency department with redness, swelling in the left eye, and diminished bilateral vision. Fundus examination of the left eye was obscured, while that of the right eye was consistent with subretinal abscess. Therefore, endogenous endophthalmitis was suspected. Imaging revealed two ring-enhancing lesions in the brain, and multiple bilateral small cystic and cavitary lung lesions. Unfortunately, the left eye eventually eviscerated due to the rapid progression of the disease. Cultures from the left eye were positive for Nocardia farcinica. The patient was started on imipenem, trimethoprim/sulfamethoxazole, and amikacin based on culture sensitivity. The patient's hospitalization course was complicated by his aggressive and advanced condition, which led to his death. CONCLUSIONS: Although the patient's condition initially improved with the recommended antibiotic regimens, it led to death owing to the patient's advanced condition. Early detection of nocardial infection in patients with typical or atypical immunosuppressive conditions may improve overall mortality and morbidity. Liver cirrhosis disrupts cell-mediated immunity and may increase the risk of Nocardia infection.

Rhinocladiella mackenziei cerebral phaeohyphomycosis with a definitive outcome.

A right-handed man in his early 60s with hypertension controlled by a single prescription medication presented with left-sided heaviness and intermittent right occipital headache. Initial diagnostic workup was unremarkable. CT revealed an enhancing lesion located in the right parietal lobe, with mild mass effect on the right occipital horn, indicative of a brain abscess. The patient was initially treated with a course of empirical antibiotics, including ceftriaxone, vancomycin, metronidazole and dexamethasone. The neurosurgery team aspirated the abscess the following day and extracted yellow pus that was sampled for bacterial and fungal cultures. These cultures returned positive for Rhinocladiella mackenziei, prompting a discontinuation of the empirical antibiotics and initiation of intravenous liposomal amphotericin B for 4 weeks. Intravenous posaconazole was added to the patient's existing therapy regimen, which was substituted with oral isavuconazole on discharge. The patient continues to take isavuconazole, and follow-up imaging has demonstrated regression of the abscess.

Sleep quality, daytime sleepiness, and insomnia in patient with epilepsy: A single center experience from Saudi Arabia.

OBJECTIVES: To measure the burden of insomnia and daytime sleepiness (DTS) and their effects on sleep quality, and the risk factors of poor quality of sleep. METHODS: We conducted a cross-sectional study of 218 epilepsy patients. We administered well-validated and previously translated questionnaires to assess sleep quality, insomnia, and DTS using the Pittsburgh Sleep Quality Index, Insomnia Severity Index, and Epworth Sleepiness Scale, respectively. RESULTS: Approximately 75% of participants reported poor sleep quality. Moreover, 42.2% did not have insomnia, while 37.6%, 17.9%, and 2.3% had subthreshold insomnia and clinical insomnia of moderate and severe severity, respectively. Roughly 64.2% of participants had normal sleep, 17.8% had an average amount of DTS, and 16.9% and 0.9% may and should seek medical attention, respectively. Compared to normal sleepers, patients with clinical insomnia were 5.45 times likely to experience poor sleep quality, whereas patients with an average amount of DTS and who were recommended to seek medical attention were 6.84 and 44.15 times likely to experience poor sleep quality, respectively. Patients who had seizures every month were 2.51 times likely to experience poor quality sleep, compared to patients who had seizures annually. CONCLUSION: We found a higher prevalence of poor quality of sleep, insomnia, and excessive DTS in our sample of Saudi epilepsy patients.

Cerebral Venous Thrombosis With Topical Estrogen-Progesterone Use in a Young Heterosexual Male: A Case Report.

INTRODUCTION: Our report sheds light on the risk of topical hormonal use in relation to cerebral venous sinus thrombosis. We diagnosed our patient with cerebral venous thrombosis (CVT) using computed tomography venogram, then detailed history and examination were obtained, and thorough blood tests and imaging were done to exclude other causes of CVT like thrombophilias, infections, and malignancies. CASE REPORT: Our patient is a 37-year-old heterosexual male, presented with headache only. The computed tomography venogram showed extensive CVT in the right internal jugular vein, sigmoid, transverse, and straight cerebral venous; detailed history and investigations suggest that his use of crushed oral contraceptive pills mixed with water topically on the scalp is the most important predisposing factor. This patient was managed with anticoagulants and is being followed in the clinic. CONCLUSION: Oral hormonal use in contraceptives is a known risk factor for CVT. This case sheds light on the importance of topical hormonal use concerning CVT in females and males; it stresses the need for more studies in that area, as it is poorly studied.

Unusual presentation of a giant thoracic spinal cord lipoma.

INTRODUCTION: Non-dysraphic intradural spinal cord lipomas are rare, and true intramedullary cervical-thoracic lipomas are extremely rare. Spinal lipomas usually present with chronic, progressive myelopathic features. Unlike dysraphic lipomas, which are usually located in the lumbo-sacral region, non-dysraphic lipomas are usually located in the cervical or thoracic spine. CASE PRESENTATION: We present an unusual case of a 21-year-old female who presented with four months of severe back pain, progressive spasticity, and weakness in the lower limbs. Magnetic resonance imaging (MRI) revealed a T1- and T2-hyperintense lesion between D4 and D6. DISCUSSION: This fatty intramedullary lesion had undergone evolution and a possible hemorrhagic infarct and cord compression. The patient underwent an urgent dorsal laminoplasty and total resection of this lesion, which histopathology indicated was a fibrous lipoma. Total resection is possible in such cases if a micro-surgical technique that includes neurophysiological monitoring is used.

Electrodiagnostic reference data for sensory nerve conduction studies in Saudi Arabia.

OBJECTIVE: To estimate reference data for the commonly performed sensory nerve conduction studies (NCS) using a cohort of healthy subjects from Saudi Arabia. METHODS: This is a cross-sectional study conducted between May 2015, and June 2019. Sensory nerve action potential (SNAP) amplitude, conduction velocity (CV), and peak latency (PL) were recorded. Associations between these parameters and the covariates (age, sex, height, weight, and body mass index) were tested with Pearson correlations. Reference data were then derived using the lowest percentile that could be reliably determined for SNAP amplitude and CV. Reference data were derived using the highest percentile for PL. RESULTS: Upper and lower limb sensory NCS were performed in 127 and 137 participants, respectively. Age was the only covariate that required adjustment for estimation of SNAP amplitude. Therefore, a prediction model was generated for each nerve. Percentile estimation for PL and CV did not require adjustment for any of the covariates. Hence, it was derived for all the subjects pooled together. CONCLUSION: The sensory NCS reference data were comparable to the data from other countries. However, minimal differences were observed. Further studies are required with a focus on the older age group.

Electrodiagnostic reference data for motor nerve conduction studies in Saudi Arabia.

OBJECTIVE: To determine nerve conduction studies (NCS) reference data for motor nerves and F-waves in the upper and lower limbs of healthy subjects in Saudi Arabia. METHODS: This is a cross-sectional study conducted between May 2015 and June 2019. Healthy subjects without neurological or systemic diseases were recruited. Motor NCS were performed following a standard protocol. Pearson correlations were employed between NCS parameters and age, gender, height, weight, and body mass index. Reference data were generated using the percentile method. RESULTS: A total of 127 subjects were recruited for the upper limb studies and 137 for the lower limb studies. Quantile regression models were generated to estimate compound muscle action potential amplitude (adjusted for age), as well as F-wave minimal latency (adjusted for height). The estimated reference limits of distal motor latency (ms) and conduction velocity (m/s) for the different nerves were, respectively, 3.7 and 50 for the median nerve, 3.3 and 50 for the ulnar nerve, 5.8 and 40 for the tibial nerve, and 5.0 and 40 for the fibular nerve. CONCLUSION: The reference data for motor NCS parameters and F-wave minimal latency are generally comparable with those of Western countries. However, minimal differences were observed. The underrepresentation of the older age group warrants future studies. The reference data for motor NCS parameters and F-wave minimal latency are generally comparable with those of Western countries. However, minimal differences were observed. The underrepresentation of the older age group warrants future studies.

Endocrine disrupting chemicals and impact on male reproductive health.

Endocrine disrupting chemicals (EDCs) have been known to adversely affect the endocrine system leading to compromised functions of hormones. The presence of these compounds in everyday products such as canned food, water bottles, plastics, cosmetics, fertilizers, kid's toys and many others goods is a greater concern for general population. The persistent and long-term use of EDCs has deleterious effects on human reproductive health by interfering with the synthesis and mechanism of action of sex hormones. Any change during the synthesis or action of the sex hormones may result in abnormal reproductive functions which includes developmental anomalies in the reproductive tract and decline in semen quality. The present paper provides an overview of the EDCs and their possible impact on male reproductive health with major focus on semen quality which leads to male infertility.