Charting the Unknown: Green Urine After Propofol in Pediatric Trauma

The phenomenon of green urine discoloration, while rare, represents a captivating clinical puzzle that challenges the distinction between benign and pathological conditions. In this report, we present an intriguing case involving a 15-year-old trauma patient admitted following a motorcycle collision, where the ensuing unconsciousness necessitated propofol induction for intubation and sedation. Remarkably, around 48 hours post-admission, the patient displayed green urine discoloration, which resolved spontaneously within just 12 hours. This case serves as a compelling illustration of the uncommon occurrence of propofol-induced green urine in the context of critical care management, underscoring the imperative need to discern and appreciate medication-related chromatic alterations in urine.

Pneumosinus Dilatans of the Frontal and Ethmoidal Sinuses Revealed by Conscience Disorder and Respiratory Distress: Case Report and Literature Review

An abnormal enlargement of the air-filled paranasal sinuses is referred to as pneumosinus dilatans. Typically discovered incidentally through radiological examinations, it infrequently manifests as cosmetic, neurological, ocular, or rhinological pathologies. Thorough evaluation for associated conditions is essential in patients with pneumosinus dilatans, including meningiomas of the anterior skull base or the optic nerve sheath. In our work, we report a 75-year-old female patient who presented with dysarthria and lower facial asymmetry. The computed tomography (CT) scan revealed pneumosinus dilatans of the frontal and ethmoidal sinuses with subfalcine herniation. During hospitalization, the patient presented with conscience disorder secondary to ischemic stroke and respiratory distress secondary to aspiration pneumonia. In our work, we also discuss reported cases of the English literature.

Severe Sepsis Secondary to Toxic Megacolon Revealing an Inflammatory Bowel Disease

Patients with inflammatory bowel disease can present with numerous infectious complications, including intra-abdominal abscess, perforations of the intestine, fistula formation, and the occurrence of septicemia. Toxic megacolon (TM) is a potentially fatal complication of inflammatory bowel disease (IBD) and is associated with high morbidity and mortality. In this case report, we report a 49-year-old male patient who was admitted to the intensive care unit for the management of severe sepsis that was secondary to an inaugural toxic megacolon complicating a silent inflammatory bowel disease, with a Lichtiger score of 11. Nonresponse to anti-bacterial therapy, noradrenaline, and intravenous corticosteroid therapy required an emergency total colectomy. After surgery, the patient died because of his unresolved septic shock. Correct management of this condition requires an accurate assessment of the patient's history, a correct physical examination, abdominal radiographs, and sigmoid coloscopy, and frequently requires surgery. The indications for surgery in cases of toxic megacolon, massive hemorrhage, perforation, peritonitis, or non-response to medical therapy are the most important ones. Patients with a history of inflammatory bowel disease are particularly prone to infectious complications since therapy for these inflammatory diseases is based on the use of immunosuppressive drugs and frequent abdominal surgeries.

Therapeutic plasma exchange in the treatment of COVID-19 induced cytokine storm: the first Moroccan experience

INTRODUCTION

COVID-19 induced cytokine storm is a well-documented phenomena that contributes significantly in the disease's evolution and prognosis. Therefore, therapies such as therapeutic plasma exchange, constitute a mainstay of therapeutic management especially for critically-ill patients.

METHODS

We conducted a monocentric retrospective cohort study in the Resuscitation Department of the Mohammed VI University Hospital of Oujda-Morocco, to evaluate the efficiency of therapeutic plasma exchange on critically-ill COVID-19 patients over a 6 months period. We divided our patients into two groups: patients who received TPE (Therapeutic Plasma Exchange) sessions (TPE group) and patients who only benefited from the standard protocol treatment (non TPE group).

RESULTS

Our study included a total of 165 patients, 34.5% of which benefited from TPE sessions. We observed an improvement of oxygenation parameters (SpO2 and PaO2/FiO2 ratio) and a progressive respiratory weaning, as well as a significant decrease of biomarkers indicative of inflammation (lymphocyte count, CRP (C Reactive Protein), IL-6, Ferritin) and coagulopathy (d-dimers, fibrinogen) in the TPE group after 5 consecutive TPE sessions. In comparison with the non-TPE group, The TPE-group patients had a shorter ICU (Intensive Care Unit) length of stay, required less frequently mechanical ventilation, and we more likely to be extubated. Furthermore, the TPE group had a lower mortality rate.

DISCUSSION

Multiple studies have reported the safety and efficiency of therapeutic plasma exchange in the COVID-19 induced cytokine storm. Given the urgent character of the pandemic at the time, each center followed its own protocol in implementing plasma exchange.

CONCLUSION

Similar to the results reported in the literature, our study reports positive results after using TPE specifically in terms of respiratory weaning and an improvement of the cytokine storm biomarkers, and more importantly a lower mortality rate.

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.

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.

Acute neurogenic stunned myocardium in a patient with Guillain-Barré syndrome: case report

Autonomic dysfunction is a prevalent symptom of Guillain-Barré syndrome (GBS); cardiovascular involvement in this scenario has been mentioned infrequently in the literature.

Case Presentation

A 65-year-old man with GBS presented with reversible left ventricular systolic failure. On first presentation, our patient had no history or indications of heart malfunction. During the clinical manifestation of his autonomic dysfunction, he had electrocardiographic alterations, modestly increased cardiac enzymes, significant left ventricular systolic dysfunction, and segmental wall motion irregularity. Once the initial episode was over, these anomalies and his symptoms resolved quickly.

Discussion

We believe the reversible left ventricular dysfunction was caused by the toxic impact of elevated catecholamines as well as transiently injured sympathetic nerve endings in the myocardium, which was apparently caused by GBS. We recommend that echocardiography be performed in patients who exhibit clinical signs of autonomic dysfunction, particularly if they are associated with abnormal electrocardiographic findings, cardiac enzyme elevation, or hemodynamic instability, so that appropriate medical therapy can be instituted as soon as possible.

Conclusion

GBS is a not a very rare situation in our context. Thus, doctors are supposed to know the life-threatening complications such as neurogenic stunned myocardium and be prepared to dodge it.

Chemotherapy-Induced Leukoencephalopathy Revealed by Seizure and Alteration of the Mental Status

Leukoencephalopathy is progressive demyelination of the white matter, induced by a variety of factors. Among the causes of leukoencephalopathy, chemotherapy is an uncommon cause that generates potentially reversible lesions. The clinical presentation is classically made of alterations in mental status, hallucinations, hypertension, seizures, and acute visual changes. Imaging plays an important role in the diagnosis of this entity, especially by conventional and diffusion-weighted magnetic resonance imaging which enables an accurate diagnosis by identifying symmetric white matter lesions, especially in the parietal and occipital lobes. Herein, we report a 54-year-old female patient, newly diagnosed with non-metastatic moderately differentiated adenocarcinoma of the cecum. The patient received her first cancer chemotherapy (5-fluorouracil at 300 mg/m²). Five days later she was admitted to the intensive care unit for confusion following two generalized seizures. Conventional and diffusion-weighted magnetic resonance imaging was performed and showed diffuse white matter lesions of the parietal and occipital lobes. A diagnosis of 5-fluorouracil-induced leukoencephalopathy was established. The diagnosis of leukoencephalopathy should be considered in patients receiving cancer chemotherapy with alterations in mental status and seizures.

Wernicke encephalopathy revealed by areflexic flaccid tetraparesis associated with gravidarum hyperemesis

Wernicke's encephalopathy is an acute neuropsychiatric syndrome resulting from thiamine deficiency, which is associated with significant morbidity and mortality. The diagnosis of Wernicke's encephalopathy is based on the clinical manifestations and rapid reversal of symptoms with thiamine.

Case presentation

The authors present the case of a 25-year-old female patient at the 19th week of gestation (Gravid 1 para 0) with an unremarkable medical history who was admitted to the hospital for an areflexic flaccid tetraparesis with ataxia after persistent vomiting. The brain and spinal MRIs did not reveal any abnormalities, and the evolution was marked by an important improvement after supplementation with thiamine.

Conclusion

Gayet Wernicke encephalopathy is a medical emergency. Clinical symptoms are inconstant and varied. MRI is the reference examination to confirm the diagnosis, but in 40% of cases it is strictly normal. Early thiamine administration can prevent morbidity and mortality in pregnant women.

The Efficacy and Safety of Prolonged Oral Anticoagulation for the Prevention of Thromboembolic Events in Patients Recovered From COVID-19 1 Year After Hospital Discharge: The SARCOV-19 Prospective Registry

Our objective in this study is to know the predictors of thromboembolic events 1 year after hospitalization for severe COVID-19 and the benefit of preventive oral anticoagulation for 1 month to placebo after release. We conducted a prospective study to determine the benefit of preventive anticoagulation upon discharge from the hospital and to determine the predictive factors of thromboembolic events. We included 720 patients in the SARCOV-19 Registry, with a mean age of 62.07 (±18.11), and 61.1% male. After 1 year, 60 thromboembolic events were observed, 45 in patients on a placebo, and 15 in patients on a direct oral anticoagulant. The predictive factors determined for these events were the presence of cardiac disease, elevation of D-dimer during hospitalization, myocardial damage defined by elevation of troponins more than 6 times normal, and the use of mechanical ventilation. However, the use of preventive anticoagulation protects against thrombotic events and reduces the risk of a thromboembolic event at 1 year with a relative risk of 0.49 compared to a placebo. The prolongation of the preventive anticoagulation at the exit will protect with a decrease of almost 50% of the risk against thrombotic events and this without increasing the risk of bleeding.

Acute kidney injury in critically ill patients with COVID-19: prevalence, risk factors and mortality in eastern Morocco

INTRODUCTION

Acute kidney injury (AKI) is commonly seen in critically ill hospitalized patients with COVID-19 and its incidence reaches 60% in this setting. The aim of this work was to determine the prevalence, characteristics, risk factors and mortality of AKI in patients admitted to the intensive care unit (ICU) for COVID-19.

PATIENTS AND METHODS

This observational retrospective case series was conducted between February 1, 2020 and December 31, 2020 at the ICU of the university hospital Mohammed VI of Oujda, Morocco. all COVID-19 patients hospitalized in the ICU with acute respiratory failure were included. AKI was defined and classified into three stages using the KDIGO criteria 2012. We excluded patients with end-stage kidney disease and those who were under 18 years old.

RESULTS

Six hundred adult patients were included and 65.5% of them were men. Sixty patients had minimal lung damage (< 25%), 105 patients had mild lung damage (25-50%), 186 had severe lung damage (50-75%) and 193 patients had very severe lung damage (> 75%). A total of 210 patients (35%) developed AKI, of whom 78 (37.2%) had mild AKI (stage 1) and 132 (62.8%) severe AKI (stages 2 and 3). Patients in the severe and mild AKI groups had a higher rate of comorbidities, especially hypertension (mild AKI [46.2%] vs. severe AKI [36.4%] vs. no AKI [27.4%], p = 0.002) and diabetes (mild AKI [52.6%] vs. severe AKI [33.3%] vs. no AKI [26.4%], p < 0.001). During hospitalization, 23.3% of patients with AKI received kidney replacement therapy. In-hospital mortality was observed in 51.3% for mild AKI, 55.3% for severe AKI and 21% in patients who did not have AKI (p < 0.001).

CONCLUSION

Our findings revealed that not only severe AKI, but also mild AKI was correlated to in-hospital mortality. Whatever the severity of the kidney impairment, it remains a major prognostic element.

C-Reactive Protein (CRP): A poor prognostic biomarker in COVID-19

INTRODUCTION

The COVID-19 pandemic continues to be rampant with considerable morbidity and mortality worldwide since its emergence in December 2019. Several studies have focused on identifying different predictive factors of poor prognosis, including biological markers, such as C Reactive Protein among others. The objective of our work was to determine whether the CRP levels on admission to the intensive care unit are predictive of an unfavorable evolution of patients with COVID-19 through the experience of the Anesthesia and Intensive Care Unit of the University Hospital of Oujda and to compare our results with those reported in the literature.

METHODS

We conducted a retrospective, monocentric, descriptive and analytical study in the Department of Anesthesia and Intensive Care of the Mohammed VI University Hospital of Oujda, Morocco, between March 2020 and October 2021, including all critically ill patients admitted to the department during this period and meeting the inclusion criteria. The baseline admission CRP value was arbitrarily set at 100mg/d, thus conditioning the division of our patients into two groups (group 1: CRP < 100mg/L, group 2: CRP ≥ 100mg/L).

RESULTS

Among our 1035 included patients, 291 patients with had a CRP<100mlg/L (group 1) and 744 presented a CRP level equal or superior to 100mg/L (group 2). Lung parenchymal involvement was more severe or even critical (CT involvement > 75%) in group 2 (60.8%) compared to group 1 (39.2%). In group 2, 79.8% of patients were mechanically ventilated, compared to 20.2% of patients in group 1. Finally, the mortality rate in patients with a CRP ≥ 100mg/l was 77.4%, compared with 22.6% for patients with a CRP < 100mg/l. These findings are all statistically highly significant (p<0.001).

CONCLUSION

Given the high contagiousness of the virus and the emergence of several variants, the management of the COVID-19 pandemic has focused more on prevention through vaccination against the virus, but also on an early identification of patients likely to evolve unfavorably for a personalized management.

Acute pancreatitis secondary to hypercalcemia in a patient with primary hyperparathyroidism: An uncommon association

Introduction

An uncommon cause of acute pancreatitis, primary hyperparathyroidism accounts for less than 1% of cases.

Case presentation

A 41-year-old male with acute pancreatitis and hypercalcemia is described in this case. Primary hyperparathyroidism was discovered during the work-up for hypercalcemia. During the first 24 hours after his hospitalization, the patient was monitored in the intensive care unit, and after a positive outcome, he was discharged.

Discussion

Pancreatitis is a rare presentation of hyperparathyroidism. The first documented case of this association was by Erdheim in 1903 on a post-mortem study (2). Hyperparathyroidism is often only discovered after two or three episodes of recurrent pancreatitis (5), thankfully, in this case, the patient has been diagnosed from its first episode and eventually treated to prevent any other ones. hypercalcaemia leads to increase calcium in the pancreatic responsible for aggression of the pancreatic parenchyma and ducts, Other authors suggest that the pancreatic secretion in patients with hypercalcaemia is lower than normal, but the enzyme activity remains normal, resulting in the formation of protein plugs in the pancreatic ducts leading to their obstruction and self-digestion.

Conclusion

Hypercalcemia can cause acute pancreatitis. This report describes rare case of a patient with acute pancreatitis caused by hyperparathyroidism.

Mirizzi SD caused a rare case of Angiocholitis ictero-uremigene with shock septic: Case report and review of literature

Introduction

Mirizzi syndrome is an obstructive jaundice caused by extrinsic compression of the common bile duct by a stone embedded in the cystic duct [1].

Cholangitis is a diagnostic and therapeutic emergency whose main risk is that of septic shock [1]. It can also progress to “Ictero-Uremigenic Angiocholitis” associated with sometimes extremely serious renal failure [2].

Case presentation

We reported the case of a 73-year-old patient admitted to the emergency room with septic shock on severe cholangitis. Given the presence of acute febrile cholangitis with criteria of septic shock on the one hand and acute renal failure on the other hand, the diagnosis of ictero-uremigenic Angiocholitis was made.

Discussion

Angiocholitis is an inflammation and infection of the bile ducts, the etiologies of which are diverse, among them: Mirizzi's syndrome [1].

The anatomical basis of Mirizzi syndrome has generally been attributed to an abnormal relationship between the cystic duct and the common hepatic duct [3]. Angiocholitis constitutes a diagnostic and therapeutic emergency, its complications threaten the vital prognosis [4]. Ictero-uremigenic Angiocholitis where the septic component dominates represents a real picture of sepsis, cholestatic jaundice, oliguria with renal failure [2].

Conclusion

fortunately rare, but always to be feared, the ictero-uremigenic Angiocholitis produces a typical picture of Angiocholitis, accompanied by a serious septic shock which passes largely to the fore associating in a very short period of time an organic renal insufficiency [2], the Age over 70 is a serious factor, it constitutes a therapeutic emergency requiring desobstruction of the main bile duct and possibly recourse to hemodialysis [4].

•

Angiocholitis is a diagnostic and therapeutic emergency. The main risk is that of septic shock.

•

Angiocholitis can also develop into “ictero-uremogenic cholangitis”, associated with renal failure which is sometimes extremely serious.

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Age Over 70 years is considered as a severity factor.

•

It constitutes a therapeutic emergency requiring disobstruction of the main bile duct and possibly recourse to hemodialysis.

Factors influencing the length of stay in the moroccan intensive care unit in patients surviving critical COVID-19 infection

Introduction

Methods

Results

Conclusion

•

Our objective is to determine the factors that influence the length of hospitalization of patients admitted to an intensive care unit.

•

The average length of hospitalization for a critical infection with COVID-19 is 6 days (SD = 7Days).

•

The length of time between the consultation and the onset of symptoms higher than 8 days affects the length of hospitalization.

•

During hospitalization, the use of mechanical ventilation, the use of tocilizumab, having a billateral nosocomial pneumonia are all factors that impact the length of hospitalization.

Acute ischemic stroke after first dose of inactivated COVID-19 vaccine: A case report

The acute cerebral ischemia induced by the COVID-19 vaccine is one of the side effects. We report the first case of a patient who suffered from a neurological deficit mimicking a stroke after receiving his 1st dose of the inactivated COVID-19 vaccine BIBP (Sinopharm) and who mainly developed cerebral venous thrombosis. Our reported case is a 36-year-old man who was admitted to our intensive care unit 2 days after his first injection dose of the inactivated COVID-19 vaccine BIBP (Sinopharm). He presented a numbness in his left arm and legs with headaches 24 hours after the vaccine injection. In the second day, he had asymmetry of the face which was aggravated by the installation of disturbance of consciousness and a state of agitation. His vital signs were normal. A brain CT scan without injection was done showing a right deep parietal ischemic stroke. The treatment was initiated by aspirin. cerebral MRI showed a very extensive stroke ischemic in the superficial and deep right parietal territory with the onset of hemorrhagic rearrangement of the right basal ganglia, magnetic resonance imaging angiography of the supra-aortic trunks was normal. The patient gradually improved and was discharged after 15 days of his stay in the intensive care unit. The installation of ischemic stroke reported in our young patient after receiving his first dose of inactivated COVID-19 vaccine BIBP; could be a new immune response to the vaccine.

A rare case of cade oil poisoning complicated by acute pancreatitis and acute tubular necrosis

Introduction

Cade oil is often used in traditional medicinal practices despite of its toxic effects, hence the occurrence of intoxication incidents often requiring intensive care.

Case presentation

We present the case of a young patient with no prior medical history who was exposed to significant doses of Cade oil both on skin and ingested, and who subsequently developed an apyretic consciousness disorder warranting an admission to our ICU department for specialized management.

Discussion

in this chapter we discuss the place of cade oil within Morocco's unsupervised medicinal practices. We also detail the spectrum of cade oil poisoning which is rarely reported in the literature, before discussing the therapeutic options.

Conclusion

The phenol derivatives of Cade oil, which is still used frequently and widely, are responsible of an acute intoxication, mainly impairing the cardiovascular, respiratory and renal functions. A pancreatic involvement is rarely reported.

•

Regardless of its documented toxic effects, Cade Oil is still a popular substance used in medicinal practices in many countries including Morrocco

•

Cade Oil toxic effects are consequent to its phenol derivatives.

•

Cade Oil-induced intoxication often involves a cardiovascular, respiratory and renal impairment.

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.

Special case of a patient in the blast phase of chronic myeloid leukemia successfully treated with tocilizumab during critical SARS-CoV-2 infection

The medical care of patients with hematological malignancies who develop coronavirus disease 2019 (COVID-19) has been a major challenge during the current pandemic. We herein describe a patient in the blast phase of chronic myeloid leukemia who was hospitalized for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The patient was successfully treated with tocilizumab, and intubation was avoided. The severity of SARS-CoV-2 infection is mostly related to a severe acute respiratory distress syndrome that develops secondary to cytokine release syndrome, and interleukin 6 is the main cytokine involved in cytokine release syndrome. Very few reports have described the use of tocilizumab in patients with hematologic malignancies who develop SARS-CoV-2 infection, although a few cases of patients with multiple myeloma have been reported. To our knowledge, however, this is the first report of a SARS-CoV-2–infected patient in the blast phase of chronic myeloid leukemia who had a favorable response to treatment with tocilizumab. The management of patients with hematological malignancies who become infected with SARS-CoV-2 is a major challenge for practitioners, necessitating more specific research in this direction.

Pneumorachis and pneumocephalus: Case report of a rare blunt chest trauma complication

Introduction

Pneumorachis, air in the spinal canal, is very rare and its association with pneumocephalus following blunt thoracic trauma remains exceptionally uncommon.

Case presentation

We present the case of a 65-year-old patient, a pedestrian hit by a car driving at very high speed. The lesion assessment on admission showed a bilateral hemothorax of moderate abundance, a right pneumothorax of low abundance and a left pneumothorax of moderate abundance, subcutaneous cervico-dorsal emphysema, pneumocephalus and significant pneumorachis at the cervico-dorsal level without fracture of the base of the skull, sinuses or the spine.

Discussion

We discuss the different etiologies of pneumorachis, the main hypotheses of the constitution of this air effusion and the principles of management.

Conclusion

Pneumorachis associated with pneumocephalus in a traumatic context without bone lesions is an extremely rare entity, its discovery should lead to further investigations to look for any spinal or basilar skull fracturethat could expose to an infectious risk or require a surgical procedure.

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The pneumorrachis was first described in 1977.

•

Pneumorachis is mainly reported as an iatrogenic complication, and more rarely traumatic.

•

Pneumorachis associated with pneumocephalus in a traumatic context without bone lesions is an extremely rare entity.

A case of limbic encephalitis associated with severely COVID-19 infection

Introduction

SARS Cov-2 infection is a pandemic that continues to ravage the world. The list of its complications continues to grow every day.

Case presentation

We report the case of a young patient admitted to intensive care for limbic encephalitis associated with severely COVID-19 infection.

Discussion

With the COVID-19 outbreak being a global pandemic, various neurological manifestations have been reported. On the other hand, diverse cases of limbic encephalitis related to COVID-19 have been recently described, they are related either to hyper inflammation syndrome with massive release of inflammatory cytokines or to secondary autoimmune response.

Conclusion

Seriously ill COVID-19 patients are at a higher risk of limbic encephalitis. It is therefore important to monitor Neurological Events in COVID-19 patients. This makes it possible to start the appropriate treatments quickly and avoid complications.

•

Several studies have demonstrated an association between SARS-CoV-2 and encephalitis event.

•

Limbic encephalitis complication is usually associated with severe respiratory symptoms of COVID-19.

•

Delayed onset of neurological symptoms compared to respiratory involvement, with a median of two weeks.

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Limbic encephalitis is a serious neurological complication of SARS-CoV-2 infection.

Plasmapherisis in Covid-19 patient under ECMO: A Moroccan case report experience

Introduction

Sars-CoV-2 induces an intense cytokine response called cytokine storm at the origin of acute respiratory distress syndrome, multiple organ dysfunction syndrome and death. In this context, several treatments have been proposed; and plasmapheresis appears as a promising treatment.

Case presentation

We report the case of a 57-year-old patient admitted for Sars-CoV-2 infection, who requiried the use of mechanical ventilation, assistance by veno-venous extracorporeal membrane oxygenation ECMO and treated by plasmapheresis plugged on the ECMO circuit.

Discussion

We discuss the mechanisms responsible for the Sars-CoV-2 induced cytokine storm leading to an acute respiratory distress syndrome and the main therapeutic alternatives with emphasis on plasmapheresis.

Conclusion

Reduction of cytokines by plasmapheresis may be very useful in the management of Covid-19 infection if it is undertaken early even on an ECMO circuit.

•

Most patients infected with Sars Cov-2 have a mild to moderate form but some patients develop acute respiratory distress syndrome.

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Cytokine storm is at the origin of this acute respiratory distress syndrome.

•

Reduction of cytokines by plasmapheresis may be very useful in the management of COVID-19 infection even on an ECMO circuit.

Cardiogenic shock revealing myocarditis after mRNA vaccination against covid-19: Case report and brief review for the first case in Morocco

Introduction

and importance: After its unexpected effectiveness in the clinical trials, the anti-COVID-19 vaccine type mRNA was launched on December 11, 2020, but a few months later, several reports of post-mRNA vaccination myocarditis were published, but without any proven causal link.

Case presentation

We report the case of a 14-year-old teenager admitted to the emergency department for a cardiogenic shock, the patient mentioned that he had an anti-COVID 19 vaccination 10 days before his admission. First, the vasoactive drugs had stabilized the patient; the troponins came back highly favorable but later confirmed myocarditis by magnetic resonance imaging. In this sense an etiological analysis was made and it came back without any particularities, leaving us relating the myocarditis to the vaccination.

Clinical discussion

Post-vaccination myocarditis is a rare event, with very few reports in the literature. After the introduction of COVID vaccination, several reports were published, mostly after the mRNA vaccine. Until now, no causal link has been proven, so we need to have more reports in this sense to have a better knowledge of this phenomenon.

Conclusion

Until we obtain a more precise explanation of the mechanism of myocarditis after vaccination with the anti-COVID-19 vaccine, all symptoms suggesting myocarditis should be systematically monitored during the first 7 days after vaccination.

•

Myocarditis after COVID 19 vaccination is currently a controversial issue.

•

Cardiac MRI is the gold standard for diagnosis.

•

Cardiogenic shock is a serious complication of acute myocarditis.

The Impact of Prior Antithrombotic use on Thromboembolic Events in Patients with Cardiovascular Disease and Severe COVID-19 Infection

OBJECTIVE

Our objective in this study was to determine the predictive factors of thromboembolic complications in patients with previous heart disease and severe covid-19 infection and the impact of previous use of antithrombotics on protection against these complications.

METHODS

We conducted a single-center retrospective study of 158 patients with heart disease admitted to an intensive care unit for severe SARS-COV-2 infection. In order to determine the predictive factors, we used logistic regression analysis.

RESULTS

Out of 158 patients, 22 were complicated by a thrombo-embolic event (13.9%), mean age of our population 64.03 (SD = 15.27), with a male predominance of 98 (62%). For the predictive factors of thromboembolic complications, and after multivariate analysis, we find the short duration of hospitalization (OR = 0.92; 95%CI (0.863-0.983), P = .014, previous use of antithrombotic drugs ((OR = 0.288, 95%CI (0.091-0.911), P = .034 for antiplatelet agents) and (OR = 0.322, 95% CI (0, 131-0.851), P = .021) for anticoagulants) as protective factors, and admission thrombocytosis as a risk factor (OR = 4.58, 95%CI (1.2-10.627), P = .021). D-dimer was not detected as a risk factor, and this can be explained by the characteristics of our population. Although prior use of antithrombotic drugs protects against thromboembolic complications during severe infection, there was no benefit in mortality.

CONCLUSION

Prior use of antithrombotic drugs is a protective factor against thromboembolic complications in patients with a history of heart disease but without effect on mortality.

Cerebral thrombophlebitis revealing SARS-CoV-2 infection: About one case

INTRODUCTION

SARS-CoV-2 infection is a pandemic that continues to ravage the world, the list of its complications continues to grow longer every day.

CASE PRESENTATION

We report the case of a patient admitted to intensive care for cerebral thrombophlebitis revealing a SARS-CoV-2 infection.

DISCUSSION

The inflammatory nature of SARS-CoV-2 infection exposes an increased risk of thrombosis.In this article, we will discuss its mechanism and the anticoagulant treatment modalities.

CONCLUSION

Besides the typical clinical signs, SARS-CoV-2 infection can manifest as thromboembolic complications such as pulmonary embolism, deep vein thrombosis, and less frequently cerebral thrombophlebitis.

Surgical and anesthetic management of paraganglioma diagnosed in a 2nd trimester parturient: Case report

Introduction

Neuroendocrine tumors represent a rare entity whose diagnosis is based on clinical, biological and radiological arguments. When they are secreting, they expose the patient to serious complications that can be much more severe during pregnancy and engage the vital prognosis of both the mother and the fetus, which requires multidisciplinary management: anesthesiologist resuscitator - obstetrician – endocrinologist.

Case presentation

In our article, we report the case of a patient with an estimated pregnancy at 25 weeks of amenorrhea (WA) with a history of 3 miscarriages related to atypical gravid hypertension.

The treatment consisted of preoperative medical preparation followed by removal of the paraganglioma and postoperative monitoring. The maternal-fetal evolution was favorable.

Conclusion

The non-negligible morbi-mortality of this type of tumors require a multidisciplinary management.

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Neuroendocrine tumors represent a rare entity whose diagnosis is based on clinical, biological and radiological arguments.

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The treatment consisted of preoperative medical preparation, removal of the paraganglioma and postoperative monitoring.

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The anesthetic and surgical management of pheochromocytomas and paragangliomas in pregnant women presents a real challenge.

Bilateral spontaneous pneumothorax in critically-ill COVID-19 infants: About two cases

Introduction

COVID-19 is an emerging infection, it is the first large-scale pandemic of the 21st century. Several complications have been described during this infection but spontaneous pneumothorax remains an uncommon complication, even more so in infants.

Clinical presentation

We report two cases of a 9-month-old and 18-month-old males admitted to our department for the management of an acute respiratory distress due to a COVID-19 infection associated to a spontaneous pneumothorax successfully drained.

While one patient had a favorable outcome, the other was readmitted to our department for the management of a septic shock secondary to a urinary tract infection with a deadly outcome.

Discussion

In this paragraph we describe known causes behind spontaneous pneumothorax, before detailing the different pathogenesis hypotheses linking pneumothorax to COVID-19, all while comparing data to the literature related to the adult population.

Conclusion

Spontaneous pneumothorax is a serious complication associated with severe COVID-19 that can occur in infants and must be considered in the event of a respiratory aggravation or a persistent hypoxia.

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The full scope of COVID-19's complications is widening with every related work reported in the literature.

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Spontaneous pneumothorax in infants infected with COVID-19 is an unprecedented complication.

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Multiple hypotheses were proposed to explain the occurrence of a spontaneous pneumothorax but none have been conclusively proven

SARS-CoV-2 infection presenting as rhabdomyolysis: case report and review

Coronavirus disease 2019 (COVID-19) is the health crisis of our time and a great challenge we face, requiring the implementation of worldwide general containment. The symptoms and complications of COVID-19 are diverse, and rhabdomyolysis is an atypical manifestation. We report a case of a 63-year-old patient, admitted to the emergency room for myalgia and fever evolving over 5 days, in whom laboratory and other examinations indicated rhabdomyolysis complicated by renal insufficiency. During the diagnostic workup, the real-time polymerase chain reaction (RT-PCR) test result for COVID-19 was positive, revealing infection with sudden acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although the severity of COVID-19 infection relates mainly to acute respiratory syndrome, other complications can be prognostic, and these complications make the management of this disease difficult. Rhabdomyolysis is one of the fatal complications; first, because the pathophysiological mechanism is not yet understood, and second, because rhabdomyolysis, itself, is usually complicated by acute renal failure. This complication makes the disease management difficult, especially in patients with SARS. Rhabdomyolysis during COVID-19 infection represents a significant challenge, given the few reported cases, and further research is required to develop a therapeutic consensus.

Spontaneous spinal epidural hematoma in a patient on acenocoumarol for valvular atrial fibrillation: A rare case report

INTRODUCTION

Spontaneous spinal epidural hematoma (SSEH) is a rare finding, but one with serious clinical implications. Oral anticoagulant drugs are known to be associated with the SSEH onset, particularly when combined with drugs increasing the bleeding risk.

CASE PRESENTATION

We present the case of a 62-year-old female on acencoumarol for her atrial fibrillation complicating severe mitral stenosis with a history of Ketoprofen use for the onset of her first symptoms. She presented to our emergency room with paraplegia and sphincter disturbance. Spinal magnetic resonance imaging (MRI) revealed a posterior SSEH extended from T10 to T12 requiring an urgent decompression of the spinal cord by laminectomy performed within 48 hours from the symptom's onset. After 3 months of rehabilitation, the patient improves partially her muscular strength with mostly unchanged sensitive and sphincteric levels.

CLINICAL DISCUSSION

Vitamin K antagonists (VKA) use appears to be a high suspicion index for SSEH diagnosis resulting in earlier surgery and improving neurological outcome. Also, it is important to pay attention to the concomitant use of VKA and non-steroidal anti-inflammatory drugs which increase the risk of bleeding and may worsen the neurological outcome.

CONCLUSION

SSEH is a rare and serious finding which should be especially searched when a history of oral anticoagulation is reported in presence of neurological symptoms. A prompt and suitable management may improve the patient outcomes.

Diabetes as a predictive factor for severe form and high mortality risk of COVID-19: Retrospective cohort study of 188 cases

Introduction

Since the appearance of the first case of the SARS CoV 2 infection, several studies have been conducted to identify the predictive factors of mortality in patients with COVID-19. According to previous reports, diabetes seems to be associated with severe clinical forms of the new coronavirus (SARS CoV 2).Our study aimed to identify the epidemiological, clinical, radiological and prognostic profile of diabetic patients with COVID-19.

Methods

This retrospective study included diabetic patients diagnosed with COVID-19 and admitted to the Resuscitation Department of our university hospital center From Mars 1st 2020, to December 31st, 2020.

Results and discussion

In this study, we collected the data of 600 patients admitted to the Anesthesia and Resuscitation Department of the Mohammed VI University Hospital of Oujda, a group of 188 (31.3%) had diabetes.The median age of our patients was 67 [25-75]. Were noted in the majority, of patients 69.6% with diabetes have developed a severe or critical injuries in the Chest CT Scan. Furthermore, we found that the mortality rate in this category of patients was higher 65/188 (34.60%) compared to non-diabetic patients, 130/412 (31.60%) (34.60%vs 31.60%; p: 0.464).

Conclusion

Based on the results of this retrospective study, we concluded that diabetes is predictive factor for the need of an intensive care as well as a high risk of mortality related to COVID-19.Practically speaking, diabetic patients should be monitored more closely and need an aggressive preventive management protocols in order to prevent severe forms of the disease and a drastic evolution.More research is direly needed to identify patients of a higher risk of developing severe forms of COVID-19.

A case report of idiopathic spontaneous peritoneal and retroperitoneal hematoma of a pregnant woman

Context

Peritoneal and retroperitoneal hematoma are usually secondary to trauma, an obstetrical pathology, an aneurysmal pathology or a tumorous pathology. A spontaneous idiopathic form remains rare, especially when it occurs to a pregnant woman, which makes the clinical and etiological diagnosis difficult, as well as the therapeutic management both the mother and the fetus.

Case report

We report the case of a spontaneous idiopathic hemoperitoneum and hemoretroperitoneum of a 26-year-old woman, pregnant (30th week of amenorrhea), presenting a hemodynamic instability and a clinical acute surgical abdomen. No secondary cause was identified during exploratory laparotomy, neither through imaging. The therapeutic management relied on hemodynamic stabilization after exploratory laparotomy.

Conclusion

Idiopathic spontaneous peritoneal and retroperitoneal hematoma -in the presence of several differential diagnoses-remain an extremely rare entity to evoke in front of an acute surgical abdomen in a pregnant woman.

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Idiopathic spontaneous hemoperitoneum and hemoretroperitoneum is a rare condition, with only few cases reported in literature.

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The occurrence of an idiopathic spontaneous hemoperitoneum and hemoretroperitoneum in pregnant women is a serious condition engaging both the patient's and the fetus's prognosis.

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Management consist of a thorough investigation in search of an etiological process before retaining the diagnosis, as well as a hemostatic procedure.

Management of post cardiac transplantation immunosuppression and COVID-19: A case report

BACKGROUND

There is very limited experience in management of heart transplant (HT) recipients and their immunosuppressive drug therapies while confronted with a SARS-CoV-2 infection.

CASE DETAILS

We report the case of a 60-year-old male, heart transplant recipient patient, admitted in our ICU for severe COVID-19. His immunosuppressors were discontinued. He presented an ARDS, a multiple organ failure and a refractory septic shock that eventually resulted in his death.

DISCUSSION

Multiple studies reported a lower incidence of SARS-Cov-2 infection in HT recipients compared to the general population, probably due to their prior knowledge and use of protective and barrier measures; but when infected they tend to have poorer outcomes and higher fatality; on account of their pre-existing comorbidities and immunodeficiency. Therefore, the management of the immunosuppressive therapy raises a challenge, in the absence of trials. Physicians rely on experts' recommendations, to maintain the immunosuppressors in case of mild COVID-19, lower to the bare minimum or even discontinue them in case of critical COVID-19 or systemic complications.

CONCLUSION

COVID-19 infection is associated with poor outcomes and high mortality in HT recipients, and their immunosuppressive therapy management still raises questions and challenges in the absence of trial-validated data.

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.

Incidental diagnosis of a large cardiac thrombus swinging through an interatrial communication in a COVID-19 patient: Case report and literature review

Introduction

The hypercoagulability state induced by COVID-19 has been well established and various forms of subsequent thromboembolic events have been reported throughout literature including multiple cases of intracardiac thrombi, four of which in our center alone, this case being the fifth.

Case report

We report the case of a 38-year-old male with no prior cardiovascular history who -subsequently to a COVID-19 infection-developped a right atrial thrombosis associated to a pulmonary embolism, and in whom cardiography revealed an interatrial communication. Management relied upon curative doses of low molecular weight heparin (LMWH) with favourable outcome.

Discussion

In our discussion, we lay out the various physiopathological mechanisms incriminated throughout literature in the genesis of a hypercoagulability state distinctive of COVID-19, before highlighting the incidence of an interatrial communication (whether a Potent Foramen Ovale or Atrial Septal Defect) discovered in patients with COVID-19, and the potential paradoxical embolization risks they imply as well as reported cases. A mention of hemostatic parameters monitored was also warranted. Finally we discuss the guidelines in terms of prophylactic and therapeutic anticoagulation in hospitalized patients before discussing cardiac thrombosis's therapeutic options.

Conclusion

Our case highlights various key points which could change the prognosis of COVID-19 patients, whether related to the underdiagnosis of interatrial abnormalities or with regards to the diagnosis to thromboembolic events, but also the indisputable place of anticoagulation in COVID-19 management.

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Thromboembolic events complicating COVID-19 have been well described and are attributed to a hypercoagulability state distinctive of COVID-19.

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A pre-existing Potent Foramen Ovale (PFO) or Atrial septal Defect (ASD) in COVID-19 patients is unknown as only a handful of studies covered the subject.

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The association of a cardiac thrombosis with a pulmonary embolism and interatrial communication exposes patients to risks of paradoxical embolization and subsequent arterial thrombotic events.

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Prophylactic and curatrive anticoagulation is unrefutably a key pillar in the management of COVID-19.

Acute Disseminated Encephalomyelitis: A rare form of COVID-19's neurotropism

Introduction

the COVID-19 pandemic still accounts for thousands of cases every day. It's neurological involvement has been well documented most likely due to auto-immune mechanisms than the virus itself.

Case report

we report the case of a 38 years old women who developed an Acute Disseminated Encephalomyelitis following a COVID-19 infection, with a favorable outcome after immunosuppressive therapy.

Discussion

In this chapter, we discuss ADEM's pathogenesis as well as its clinical and radiological features before detailing its relationship with infectious and vaccination episodes. We also discuss how our patient disease evolved.

Conclusion

Acute Disseminated Encephalomyelitis is an immune-mediated disorder in which the widespread inflammation of the brain and spinal cord is responsible for a variety of symptoms. The novel COVID-19 virus and its vaccine are both a newly incriminated etiologies of this demyelinating disorder.

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COVID-19 neurotropism has been well established and its neurological manifestations are varied.

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Demyelinating disorders are immune-induced disease most likely due to an antigenic analogy between the virus and myelin constituents.

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COVID-19 induced ADEM is extremely rare, only a dozen cases have been reported worldwide, and ours is the only case reported in our country.

Prone position during ECMO in patients with COVID-19 in Morocco: Case series

Introduction

The main manifestation of COVID-19 pneumonia is acute respiratory distress syndrome (ARDS), which in some cases can be more severe, requiring Veno-venous extracorporeal membrane oxygenation (VV-ECMO) to ensure hemostasis. Despite support from Veno-venous extracorporeal membrane oxygenation, some patients may remain hypoxemic. One possible therapeutic procedure for these patients is the application of the prone position (PP).

Objective

The aim of this study was to investigate the effect of VV-ECMO on arterial oxygenation and compliance of the respiratory system in mechanically ventilated patients with refractory hypoxemia. The secondary objective was to evaluate the safety and feasibility of prone position for ECMO.

Methods

We retrospectively reviewed the electronic records of all 23 COVID-19 patients on ECMO who were placed for the first time in prone position with an average duration of 16 h. Patient characteristics, pre-ECMO characteristics, changes in ventilator/ECMO settings and blood gas analysis before and after PP.

Results

A total of 23 position changes to prone position were performed. Oxygenation and respiratory compliance improved 16 h after adoption of prone position without any accidents during PP.

Conclusions

The use of prone position during Veno-venous extracorporeal membrane oxygenation demonstrated an improvement in oxygenation as well as lung compliance. It is a safe and reliable technique.

Acute limb ischemia in patients with COVID-19 pneumonia

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic developing since the late 2019 and early 2020 has caused thousands of deaths and has had an enormous impact on our health systems and economies. Thrombotic complications associated with coronavirus disease 2019 (COVID-19) have been described. Acute limb ischemia is associated with complications related to cytokine storm syndrome and acute respiratory distress syndrome. that can result in significant morbidity and mortality. However, limited published data is available regarding thrombosis in coronavirus disease 2019 (COVID-19). Here we are presenting 2 cases of COVID-19 infection complicated by arterial thrombosis in the form of acute limb ischemia.

Brainstem stroke: A fatal thromboembolic event after new onset atrial fibrillation during covid-19 infection: A case report and literature review

Coronavirus disease (COVID-19) disease is a serious pandemic that put the world on an exceptional sanitary alert. It is a multifaceted disease, since it can affect the lung, the cardiovascular system and the central nervous system at the same time. A 66-year-old man, diabetic, hypertensive, admitted to the emergency room for medical management of acute dyspnea, diagnosed with COVID-19 infection. The evolution is marked by respiratory distress as well as new onset atrial fibrillation and a severe ischemic stroke of the brainstem. COVID-19 disease is associated with very serious thromboembolic complications of high incidence, and this is explained by the coagulopathy secondary to the alteration of the microcirculation after the hyper-inflammatory state. Ischemic stroke is one of these complications. The occurrence of new onset atrial fibrillation during COVID-19 infection makes the incidence of ischemic stroke very high and the prognosis more severe. The treatment is mainly based on antithrombotic therapy. Thromboembolic complications remain a real problem to manage in COVID-19 patients given the several mechanisms that promote this situation.

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.

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Infections due to Covid-19 are represented mainly by respiratory symptoms.

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Guillain barre syndrome has been mentioned as a rare sequela occurring usually after viral infection.

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This case report suggest the probable causal link between COVID 19 and GBS.

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COVID-19 associated GBS it seems to be more severe than non-COVID-19 GBS.

Acute limb ischemia with concomitant splenic and renal infarcts: Thromboembolic events revealing COVID-19

Introduction

Since December 2019, the coronavirus 19 (COVID-19) pandemic continues to spread worldwide and has caused millions of deaths. Although the main manifestation of the disease is acute respiratory distress syndrome, hypercoagulability resulting from hypoxemia leads to venous thromboembolism and arterial thrombosis, which have a fatal prognosis for COVID-19.

Case report management

We report the case of patient admitted to our unit for management of a concomitant limb ischemia, splenic and renal infarcts associated to a COVID-19 infection with favorable outcomes after thrombectomy and therapeutic doses of heparin.

Conclusion

Systemic procoagulant manifestations related to a COVID-19 infection is a newly described phenomenon responsible of cardiovascular and neurological disorders.

Acute pancreatitis as an atypical manifestation of COVID-19: A report of 2 cases

INTRODUCTION

Respiratory signs are the main revealing symptoms of the COVID-19 infection, however extra respiratory symptoms might as well occur, including digestive manifestations.

CASE REPORT

In this paper, we report two cases of acute pancreatitis at the front line of the patient's symptomatology revealing a COVID-19 infection. Both patients had respiratory symptoms suggestive of COVID-19 and abdominal symptoms consistent with acute pancreatitis later-on confirmed through laboratory and CT findings. Our conservative management led to an improvement of the pancreatitis, though the first patient suffered from a severe form of COVID-19 justifying the using of mechanical ventilation and ECMO, while the second patient exhibited a milder form of COVID-19. Although both patients improved in terms of pancreatitis, the overall evolution was very different due to the extent of the respiratory involvement of COVID-19, as one patient exhibited a spectacular improvement of her respiratory state leading to a full recovery, the other patient suffered a rapid worsening of her acute respiratory distress leading to death following ECMO complications. Our two cases join only few cases of COVID-19-induced pancreatitis that have been reported in the literature.

DISCUSSION

in our discussion we highlight the association of COVID-19 and acute pancreatitis as it has been reported throughout literature, we then dive into the suggested physiopathological mechanisms that lay grounds for that association, before discussing our two cases, and emphasizing on the need of further studies to fully apprehend the scale of COVID-19's extra-pulmonary involvement in general, and pancreatic in particular.

CONCLUSION

Acute pancreatitis is a sever condition involving potentially severe complications, COVID-19 is an emergent rare etiology recently identified as a causality.

Peripheral facial paralysis as the only symptom revealing sars cov 2 infection: Case report

The SARS cov 2 infection was initially marked by its respiratory symptomatology. Nevertheless, other non-respiratory manifestations have been raised as atypical revealing symptoms, namely cardiac and neurological attacks. Several neurological manifestations have been described during this pandemic. We describe in this case report the clinical, biological and radiological characteristics of two patients presenting to the emergency department with facial paralysis revealing a Sars cov 2 viral infections after investigation.

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.

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.

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.

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Several studies have demonstrated that Spontaneous gas effusion unrelated to assisted ventilation is a newly recognized complication of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

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The objective of the present study was to examine the incidence, risk factors and the outcomes of Spontaneous gas effusions.

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Spontaneous gas effusions during COVID-19 should not be neglected as it is associated with severe outcomes.

Inferior mesenteric artery aneurysm revealed by massif rectal bleeding, case report

INTRODUCTION

Inferior mesenteric aneurysms are rare, usually asymptomatic. Their diagnostic is challenging based on clinical examination, ultrasonography, and abdominal CT scan; surgery remains the gold standard of treatment.

CASE REPORT

In this paper, we will report a clinical case of 62 years old man admitted to the emergency department for massif rectal bleeding due to inferior mesenteric aneurysm fistulization in the transversal colon one month after a left colectomy; the treatment was surgical consisted of a Ligation.

CONCLUSION

IMA aneurysm is a rare condition, usually asymptomatic, and it might be revealed by various symptoms, including massif rectal bleeding.