The poorly understood yet potent risk of pulmonary artery thrombosis in-situ in Post-Acute COVID-19 syndrome

Pulmonary artery thrombosis in-situ is a term used to describe a pulmonary embolism occurs in the absence of deep vein thrombosis in the lower extremities. Most cases occur in a patient who had a recent traumatic injury to the chest. Other risk factors include the presence of hypercoagulable conditions, including inflammatory state, hypoxia and vascular endothelial injury. Although it has been discussed extensively in the acute COVID-19 disease, pulmonary artery thrombosis in-situ that occur in the setting of Post-Acute COVID-19 syndrome is not commonly reported and poorly understood.

Sensory Predominant Guillain-Barré Syndrome Concomitant with Dengue Infection: A Case Report

Guillain-Barre syndrome is an acute demyelinating polyneuropathy disease which is autoimmune in nature and usually follows gastrointestinal or respiratory infections. Dengue fever is however not a common trigger to the condition. Here, we report a patient who developed sensory predominant demyelinating polyradiculopathy during febrile phase of dengue fever. It was later confirmed with serology test and nerve conduction study. He was successfully treated with intravenous immunoglobulin and discharged home well. The purpose of this case report is to highlight that Guillain-Barré syndrome can occur as an uncommon neurological complication of dengue fever which can occur during any phase of the illness.

Unusual Presentation of Cerebral Lupus: A Case Report of Parkinsonism in Cerebral Lupus

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with multisystem involvement that follows a relapsing and remitting course. It is characterized by an immune-mediated response to own body defense mechanism and mistakenly attacked healthy cells of the skin, joints, kidneys, blood cells, and nervous system. Cerebral lupus refers to a constellation of neurological and/or behavioral clinical syndromes in patients with SLE. The spectrum of presentation can vary widely ranging from mild symptoms such as headaches, slight cognitive dysfunction, and mood disorders to more serious conditions like seizures, stroke, or coma. This case report is about a case of cerebral lupus manifested with symptoms of Parkinsonism. The purpose of this case report is to share an uncommon occurrence of cerebral lupus which manifested as Parkinsonism and to highlight the importance of early diagnosis of the condition which is potentially reversibility with prompt treatment [4].

Comparison of Nutritional Knowledge, Attitudes and Practices between Urban and Rural Secondary School Students: A Cross-Sectional Study in Sabah, East Malaysia

Nutritional knowledge, attitudes and practice (KAP) may guide healthy meal choices. Here, nutritional KAP was compared across school students in Sabah based on locality and gender. A cross-sectional survey of students aged 15-19 years was conducted using multistage sampling. Nutritional KAP was measured via questionnaire. Anthropometric measures of weight and height were taken in person to calculate body mass index (BMI). Among the 994 participants, 80% were urban and 60% were female (mean age 16.5 ± 0.6 yr). Most were of Kadazan-Dusun (23%) ethnicity. Measured height for age Z score (HAZ) and BMI for age Z score (BAZ) differed between urban and rural students (-1.2 ± 0.8 versus -1.5 ± 0.7 for HAZ; p < 0.001; 0.2 ± 1.4 versus -0.1 ± 1.3; p = 0.02, respectively). No difference in nutritional knowledge was found, although urban students prioritized having a healthy/balanced diet (59.55% versus 48.50%, p = 0.03) and ate daily breakfast (57.4% versus 10.2%, p < 0.001) compared to rural. Females scored higher on nutritional knowledge than males (18.9 ± 2.8 vs. 18.1 ± 3.4, respectively, p = 0.0001), yet males selected more healthy/balanced foods (63.3% versus 53.3%, p = 0.041). The gap remains between nutritional KAP and translating this to healthy eating among adolescents, related to locality and gender.

SARS-CoV-2 infection of the nervous system: A review of the literature on neurological involvement in novel coronavirus disease-(COVID-19)

The novel coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is believed to have emerged from an animal source and has been spreading rapidly among humans. Recent evidence shows that SARS-CoV-2 exhibits neurotropic properties and causes neurological diseases. Here, we review the literature on neurological involvement in SARS-CoV-2 infections and the possible mechanisms of invasion of the nervous system by this virus, to provide a summary and critical analysis of the early reporting of neurological involvement in COVID-19. An exhaustive search of scientific articles on neurological involvement in COVID-19 was performed in the Web of Science, Scopus, Medline/PubMed, and several other databases. Nineteen relevant articles that had been published or were in preprint were carefully selected according to the inclusion and exclusion criteria. Based on our research, we found that patients with COVID-19 can present with neurological symptoms that can be broadly divided into central nervous system involvement, such as headache, dizziness, altered mental state, and disorientation, and peripheral nervous system involvement, such as anosmia and hypogeusia. Most of these patients are in the older age group and exhibit comorbidities, especially hypertension, and severe infection. In extreme presentations of COVID-19, some patients exhibit seizures, stroke, flaccid paraparesis, corticospinal weakness, and even coma. Moreover, the neurological man-ifestations can occur independently of the respiratory system. In conclusion, SARS-CoV-2 infection can cause multiple neurological syndromes in a more complex presentation. Therefore, this review elucidated the involvement of the nervous system in SARS-CoV-2 infection and will hopefully help improve the management of COVID-19.

Decoupling in International Business

Following the academic discourses that the International Business (IB) has not yet seen the levels of academic intrusions on decoupling a thorny ethical dilemma evident in other fields that explains why organizations when strive for conformity, they may attempt to preclude the necessity of their formal structure with an intention to show obedience towards institutional settings while at the same time actually practicing business in ways that they believe are more efficient. This study attempts to bridge this important gap and understanding of decoupling in the burgeoning stream of IB where export organizations decouple from the actual substantive conformity to the Intellectual Property Rights and the Protected Designation of Origin certification requirements. This policy to practice decoupling in the form of avoidance from institutional pressures and concealment manifest itself in the organizations zeal to placate the pressures of resource criticalities brought about by this unique isomorphic setting of the home and host country institutional landscape(s). Thus theoretically, tight coupling between institutional rules (and pressures) and export organizations does not necessarily translate from form to function but rather ceremonial conformity, which may further be heightened by onward problems of enforcement of these rules in the same institutional settings therein.

Prolonged paralysis with atracurium use in a patient with Rubinstein-Taybi syndrome

Rubinstein-Taybi syndrome (RTS) is a rare autosomal dominant disorder that occurs due to a microdeletion of chromosome 16p13. The craniofacial abnormalities in these patients may pose a challenge for anaesthetist performing tracheal intubation. However, there are no known reported cases of drug interaction with non-depolarising muscle relaxant in patients with RTS. This young patient with RTS presented with an unexpected prolonged atracurium effect during the course of anaesthesia. After ruling out other possible causes, we have come to a conclusion that RTS itself could have played a role in the prolonged effect of atracurium. However, further studies will be needed to confirm this hypothesis. In the meantime, care should be used when using muscle relaxants in patients with RTS.