RESUMO
Demyelinating central nervous system (CNS) disorders are a diverse group of conditions characterised by damage to the myelin sheath. These include not only primary autoimmune disorders such as multiple sclerosis (MS) or neuromyelitis optica spectrum disorder (NMOSD), but secondary demyelinating conditions caused by infection and neoplasm, where immunosuppressive therapy may worsen the condition or delay definitive treatment. We describe a young man with an unusual presentation of CNS demyelinating disease associated with HIV infection and positive syphilis serology. MRI brain and spine showed a demyelinating tumefactive lesion accompanied by longitudinal extensive transverse myelitis, and we initially suspected NMOSD. However anti-aquaporin 4 antibodies were negative, going against a diagnosis of NMOSD and he then tested positive for HIV which led us to consider TB myelitis, neurosyphilis and HIV vacuolar myelopathy. He was commenced on highly active retroviral therapy and treated with steroids and immunosuppression. He did not respond to treatment as expected so a brain biopsy was required to narrow the differential. Brain biopsy initially raised the possibility of progressive multifocal leukoencephalopathy which is associated with infection with the John Cunningham (JC) virus. Ultimately JC Virus PCR on the biopsy was negative, the final report suggesting nonspecific active chronic inflammation. We detail his clinical course and the diagnostic challenges along the way.
RESUMO
PURPOSE: Facial trauma is a frequent presentation to the emergency department following alcohol-related injuries. Brief alcohol intervention (BAI) is a form of a motivational interview which is implemented in the postinjury phase to educate patients on the detrimental effects of their alcohol drinking behavior and reduce their future consumption. This systematic review and meta-analysis aims to assess the impact of BAI on alcohol drinking behavior in the emergency department setting. METHODS: An extensive systematic literature review was implemented from 21 October 2020 to 23 November 2020. All clinical studies that reported the outcomes of brief alcohol intervention on alcohol consumption in patients who attended the emergency department with facial injuries were included in the systematic review. The data sources utilized include Google Scholar, PubMed, ISI, Scopus, EMBASE, SIGLE, Virtual Health Library, NYAM, ClinicalTruaks.Gov, Controlled Trials (mRCT), and ICTRP. RESULTS: The current systematic review included 8 articles encompassing 941 patients. Of the included patients, 304 (32.3%) patients were subjected to BAI, while the remaining 637 (67.7%) were not subjected to BAI. BAI significantly decreased the amount of alcohol consumption 3 months after intervention (SMD -0.596; 95% CI -1.067, -0.126; P = .013). Patients who received BAI were 1.89 times more likely to reduce their alcohol consumption (OR 1.89; 95% CI 0.59, 6.11; P = .29). CONCLUSIONS: BAI is an efficacious motivational tool for patients with facial trauma in the emergency setting. It can effectively reduce the amount and rate of alcohol consumption after facial trauma in the short-term. However, a higher level of evidence is required to reach long-term conclusions.