The Egyptian Journal of Internal Medicine最新文献

Human monkeypox (MPOX) which recently hit the headlines is a rare, emerging zoonotic disease, only next to smallpox yet never attended adequately to halt the epidemic outbreak threat. MPOX is caused by Orthopox virus, which is a double-stranded, linear DNA virus, transmitted from infected animals, commonly rodents to humans. Monkeypox is endemic to the tropical jungles in Central-West Africa; occasional cases reported in other nations could be due to people traveling from endemic regions of MPOX. Transmission may occur via direct contact with human body secretions, cutaneous or mucosal lesions in the mouth or throat or respiratory droplets, and contaminated objects. Typical MPOX symptoms are fever, lymphadenopathy, skin rashes, intense headache, muscle, back pain, etc. Lesions can range from a few to numerous and may be filled with clear or yellowish fluid that later dries up or crusts, eventually falling off. MPOX is often considered as infrequent and self-limiting; nonetheless, the latest sporadic reports call for urgent vigilance, precautionary preparedness, and immediate response. Paucity of the data available about MPOX virus diversity and incomplete information on validated management protocols instigate a sense of impending danger and loom large as a global health emergency. MPOX is a completely preventable infection, and this article will cater to the need for creating general awareness and developing cutting-edge surveillance measures to curtail the spread of the disease. Genomic investigations of new cases of MPOX must be undertaken to check for mutations which can lead to higher human susceptibility. Local health stakeholders and clinicians should emphasize early identification and give out appropriate treatment as per the existing protocol.

Background: Large numbers of elderly patients are admitted to hospitals in acute confusional states. In many, the underlying causes are easily found; in some, correct diagnosis is difficult. Pulmonary embolism (PE), the most serious clinical presentation of venous thromboembolism, is often misdiagnosed because of its non-specific features including delirium.

Case presentation: A 73-year-old woman was admitted to our hospital in a confused state with no obvious risk factors of PE. D-dimer levels were elevated and contrast-enhanced high-resolution computed tomography (HRCT) of the chest confirmed the diagnosis of PE. She was treated with enoxaparin and discharged on dabigatran. Her symptoms had resolved at the time of discharge, and she has been stable for over three month's follow-up visit.

Conclusion: PE should be regarded as a differential in elderly patients with an acute confusional state despite the absence of obvious risk factors. Investigating for and treating when confirmed may save a life.

Background: Necrotising granulomatous diseases of the lungs exhibit a narrow range of differential diagnoses. Tuberculosis accounts for most of these cases, while sarcoidosis is an uncommon entity in this group but both possess similar clinical and radiological similarities. One must consider a diagnosis of sarcoidosis once the standard anti-mycobacterial medications fail to achieve a clinical improvement. The case described highlights the coexistence of tuberculosis and sarcoidosis which is a rare entity in the medical literature.

Case presentation: A 57-year-old male presented with respiratory symptoms and was diagnosed with tuberculosis (TB) demonstrating a polymerase chain reaction (PCR) test positive showing microbial DNA in bronchial washing. The patient started standard anti-TB treatment; however, he did not respond initially. Further investigations led us to diagnose pulmonary followed by skin sarcoidosis, based on histology. After confirmation of sarcoidosis, administered corticosteroids for 6 months simultaneously along with anti-TB treatment; however, anti-TB treatment was prolonged for a total of 9 months. The patient was found clinically symptomless after the completion of treatment during subsequent follow-ups.

Conclusion: The use of corticosteroids as an adjunct with standard anti-TB treatment proves beneficial effects on the recovery of patients having a coexistence of pulmonary mycobacterium tuberculosis and sarcoidosis disease conditions.

Background: The COVID-19 pandemic has been associated with millions of deaths around the world. One of the important causes of death associated with COVID-19 was pulmonary thromboembolism. The risk for venous thromboembolism was markedly increased in patients with COVID-19 especially those admitted to the intensive care unit. The aims of our study were to measure the protein C and S levels in COVID-19-infected patients in comparison with the normal population and to assess the correlation of protein C and S levels in the plasma to the severity of infection.

Methods: This was a case-control study measuring the protein C and S levels in patients infected with COVID-19 at the time of diagnosis compared to the normal population. The study included one hundred participants, sixty of them are patients with COVID-19, and forty of them are normal healthy adults. The patient group was subclassified into three subgroups according to disease severity: mild, moderate, and severe COVID-19 infections.

Results: The activity of protein C in the patient group serum was significantly lower than that in the control group serum (79.35 ± 26.017 vs 97.43 ± 15.007; p < 0.001). Protein S is also significantly decreased in patients' serum when compared to the control group (70.233 ± 22.476 vs 91 ± 14.498; p < 0.001). There was a statistically significant decrease in the levels of protein C and S associated with the increase in disease severity (p < 0.05). However, protein S showed no statistically significant difference between the moderate and severe disease subgroups.

Conclusion: The study concluded that the levels of protein C and S activities were both decreased in patients with COVID-19 when compared to the healthy population. It also concluded that the decrease in their levels is statistically significant in relation to the disease severity.