COVID-19-A Theory of Autoimmunity Against ACE-2 Explained.

The COVID-19 pandemic caused by the coronavirus SARS-COV-2 has cost many lives worldwide. In dealing with affected patients, the physician is faced with a very unusual pattern of organ damage that is not easily explained on the basis of prior knowledge of viral-induced pathogenesis. It is established that the main receptor for viral entry into tissues is the protein angiotensin-converting enzyme-2 ["ACE-2", (1)]. In a recent publication (2), a theory of autoimmunity against ACE-2, and/or against the ACE-2/SARS-COV-2 spike protein complex or degradation products thereof, was proposed as a possible explanation for the unusual pattern of organ damage seen in COVID-19. In the light of more recent information, this manuscript expands on the earlier proposed theory and offers additional, testable hypotheses that could explain both the pattern and timeline of organ dysfunction most often observed in COVID-19.

A multipronged, nutritional-based strategy for managing Alzheimer's disease.

A nutritional-based strategy has been proposed in order to improve cognitive performance of Alzheimer's disease (AD) patients. The strategy requires daily dietary supplementation with magnesium (Mg), folic acid, and vitamins B6 and B12, daily consumption of silicic acid-rich mineral water in order to lower the body burden of Al, and several plasma exchange procedures in order to replace Aß-bound albumin with fresh albumin. Evidence suggests that the deteriorating cognitive performance associated with AD may be improved by supplementation with either Mg alone or with the combination of the above three B vitamins (B vitamin combo), or by drinking silicic acid-rich mineral water, or by undergoing plasma exchange. However, for the following reasons the combination of all four therapeutic approaches may have a synergistic effect on improving cognitive performance of AD patients.

Superior ophthalmic vein thrombosis as an initial manifestation of antiphospholipid syndrome.

PURPOSE: To report an uncommon case of superior ophthalmic vein occlusion secondary to antiphospholipid syndrome. METHOD: Interventional case report. RESULT: A 41 year old man who presented with acute proptosis and ophthalmoplegia who was initially treated for orbital cellulitis. His CT scan showed changes consistent of that a superior ophthalmic vein thrombosis. He was managed with high dose intravenous steroid and commenced on anticoagulant therapy. He was subsequently diagnosed with antiphospholipid syndrome. CONCLUSION: Although superior ophthalmic vein occlusion is rare it is an important differential. This is the first reported case secondary to antiphospholipid syndrome.

Pulsatile abdominal mass is not always leaking aneurysm!

An 80-year-old male, who presented with a history of unprovoked collapse, was found to have a visible pulsation in the central upper abdomen, which disappeared on raising his arms above his shoulder ('head and shoulder' technique). There was no tenderness noted over the pulsation. He had a ventricular demand inhibited pacemaker inserted 3 weeks ago for a significant bradycardia with atrial fibrillation. His ECG showed heart rate of 32 bpm with underlying atrial fibrillation. No pacing spikes noted. His chest x-ray confirmed displacement of pacing lead into the right subclavian vein. It caused stimulation of phrenic nerve resulting in rhythmical diaphragmatic contraction. He later had his pacemaker re-inserted with no more collapses.