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Reactivation of tuberculosis in Covid-19 infected patient: Case report Covid-19感染患者结核病再激活:病例报告

Medical reports & case studies

Pub Date : 2023-10-31 DOI: 10.5897/mcs2023.0139

Megrelishvili Tamar, Ratiani Levan, Gaprindashvili Tinatin, Saralidze Nana, Nemsadze Grigol, Chikovani Irakli, Jashi Tornike, Nemsadze Vera, Silagava Mariam

Tuberculous meningitis is a severe manifestation of extrapulmonary tuberculosis, often associated with substantial morbidity and mortality. This case report discusses a unique presentation of tuberculous meningitis in a 39-year-old male who was concurrently positive for COVID-19. The patient initially presented with symptoms of COVID-19, including fatigue, fever, and respiratory distress. However, subsequent neurological symptoms, including facial asymmetry, ptosis, and dysphagia, led to further evaluation. Imaging and cerebrospinal fluid analysis confirmed the diagnosis of tuberculous meningitis. Treatment involved a multidrug regimen and supportive care in an intensive care unit. The patient was eventually discharged with residual neurological deficits. This case emphasizes the importance of considering tuberculous meningitis in the context of COVID-19, particularly in regions with a high burden of tuberculosis. Timely diagnosis, through clinical evaluation and diagnostic tools such as cerebrospinal fluid analysis and radiographic imaging, is crucial for effective management. The potential risk of TB reactivation in COVID-19 patients underscores the need for continued vigilance and prompt intervention to prevent severe disease outcomes. Key words: Covid-19, tuberculous meningitis, reactivation

结核性脑膜炎是肺外结核的一种严重表现，通常与大量发病率和死亡率相关。本病例报告讨论了一名39岁男性同时呈COVID-19阳性的结核性脑膜炎的独特表现。患者最初出现COVID-19症状，包括疲劳、发烧和呼吸窘迫。然而，随后的神经系统症状，包括面部不对称、上睑下垂和吞咽困难，导致进一步的评估。影像学和脑脊液分析证实了结核性脑膜炎的诊断。治疗包括多药治疗方案和重症监护病房的支持性护理。患者最终因残余的神经功能缺陷出院。这一病例强调了在COVID-19背景下考虑结核性脑膜炎的重要性，特别是在结核病高负担地区。及时诊断，通过临床评估和诊断工具，如脑脊液分析和放射成像，是有效管理的关键。COVID-19患者结核病再激活的潜在风险突出表明，需要继续保持警惕并及时采取干预措施，以防止严重的疾病后果。关键词:新型冠状病毒，结核性脑膜炎，再激活

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引用次数: 0

Electrophysiological Analysis of Traumatic Optic Neuropathy and Traumatic Brain Injury Among Active Military. 现役军人创伤性视神经病变和创伤性脑损伤的电生理分析。

Medical reports & case studies

Pub Date : 2022-06-01 Epub Date: 2022-07-10

Charles S Zwerling, Lea Carter, Brandon Lucke-Wold

Background: Traumatic Optic Neuropathy (TON) can cause persistent visual deficits and is a known sequala of Traumatic Brain Injury (TBI). Little is known regarding appropriate diagnosis, management, and treatment.

Methods: we performed a prospective cohort study with 356 active military personnel using electrophysiological Visual Evoked Potential (VEP) testing for TON in the context of known or suspected TBI. This was done with the intent to review and revise management protocol for patients who are susceptible to TON. This new VEP protocol was incorporated with kinetic and static visual field testing to uncover occult cases of TON previously missed in the current disability examination, as well as aid in evaluation of patients with borderline concussive cases that do not meet current diagnosis of mild, moderate, or severe TBI by the Veteran's Disability Exam.

Results: 80 patients were diagnosed with TON. Average age of TON patients was 37.4 years, with most patients being male. Of those patients with TON, 45% had reported TBI, whereas an additional 54% had suspected history of concussion. Patients presented with bilateral TON (65.8%, n=52), while unilateral TON cases occurred less frequently (35.4%, n=28). Visual field defects were apparent in both static and kinetic visual field testing in 54% of cases. VEP sensitivity in our study was 88%. Military parachute jumpers (paratroopers) represent the highest risk group for undiagnosed TBI and TON.

Conclusions: we recommend periodic static and kinetic visual field testing in high-risk individuals working in fields with high concussion rates. Focused collaboration for safer helmet design is imminent. By improving helmet design, we can reduce mTBI and related TON, as well as reduce costly medical care and disability payments after military discharge.

背景：创伤性视神经病变（TON）可导致持续性视觉障碍，是创伤性脑损伤（TBI）的一种已知后遗症。方法：我们对 356 名现役军人进行了一项前瞻性队列研究，使用电生理视觉诱发电位 (VEP) 测试对已知或疑似创伤性脑损伤的 TON 进行检测。这样做的目的是为了审查和修订对易受 TON 影响的患者的管理方案。这一新的 VEP 方案与动态和静态视野测试相结合，以发现当前伤残检查中遗漏的 TON 隐匿病例，并帮助评估不符合当前退伍军人伤残检查轻度、中度或重度 TBI 诊断的边缘脑震荡病例患者：80 名患者被诊断为 TON。TON患者的平均年龄为37.4岁，大多数患者为男性。在TON患者中，45%曾报告过创伤性脑损伤，另有54%怀疑有脑震荡病史。患者表现为双侧TON（65.8%，n=52），而单侧TON病例较少（35.4%，n=28）。54%的病例在静态和动态视野测试中均出现明显的视野缺损。在我们的研究中，VEP 的灵敏度为 88%。结论：我们建议在脑震荡发生率较高的领域工作的高危人群定期进行静态和动态视野测试。为更安全的头盔设计开展集中合作迫在眉睫。通过改进头盔设计，我们可以减少 mTBI 和相关的 TON，并减少昂贵的医疗费用和退伍后的残疾赔偿金。

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引用次数: 0

Interventions in women with one blocked oviduct, lessons learnt and recommendations: A case report 对单侧输卵管阻塞妇女的干预措施、经验教训和建议:一份病例报告

Medical reports & case studies

Pub Date : 2019-05-31 DOI: 10.5897/MCS2019.0126

Cosmas Josiah Musewu

Women can still conceive naturally or through in vitro fertilization (IVF) with the one oviduct that is properly functioning if only one oviduct is blocked, however, the chances are decreased particularly if the blockage is close to the ovary (hydrosalpinx) because of wash out phenomena and toxic fluid produced by the fallopian tube that is blocked. In situations where only a single tube has hydrosalpinx specialists should advise patients appropriately and must be given options, to choose between undergoing salpingostomy, a surgical process that involves tubal reconstruction to expand their odds of getting pregnant naturally by removing the blockage or IVF treatment. For women with one working oviduct specialists must be on the lookout for ectopic pregnancy. This will enable early diagnosis of ectopic pregnancy and a treatment technique that spares the tube can be utilized. The patient is a woman of African origin with blood group O staying at Manyame Park Harare. She has never married before and has been trying to get pregnant from 2005. She eventually got a successful pregnancy in 2014 and delivered first child in 2015 after several interventions. Her infertility was initially due to the presence of hydrosalpinx on the left fallopian tube, scarring in the fimbriae of left tube, high prolactin level and was subsequently due to loss of the only working tube after ectopic pregnancy. The patient got pregnant whilst she was on bromocriptine, unfortunately the pregnancy did not last to full term. Chlomiphene was later added to her drug regiment and after six cycles she had an ectopic pregnancy which destroyed her only working tube. The patient then tried IVF treatments to achieve pregnancy. She underwent two IVF treatment cycles which failed to achieve pregnancy. The patient finally underwent tubal reconstruction microsurgery which enabled her to have two successful natural pregnancies. Gynaecologists must be vigilant in diagnosis of infertility factors and should give enough appropriate information to female patients when making decisions concerning fertility interventions. Key words: Fertility, in vitro fertilization (IVF), salpingostomy, hydrosalpinx, prolactin, fimbriae.

如果只有一条输卵管被堵塞，女性仍然可以自然怀孕或通过体外受精(IVF)，但如果堵塞靠近卵巢(输卵管积水)，由于被堵塞的输卵管产生的冲洗现象和有毒液体，几率会降低。在只有一根输卵管积水的情况下，专家应该适当地建议患者，并且必须给予选择，在接受输卵管造口术(一种包括输卵管重建的手术过程，通过去除堵塞来扩大她们自然怀孕的几率)或体外受精治疗之间做出选择。对于只有一条正常输卵管的女性，专家必须注意是否有异位妊娠。这将使异位妊娠的早期诊断和一种治疗技术，省去了试管可以利用。患者是一名非洲裔O型血女性，住在哈拉雷的Manyame Park。她从未结过婚，从2005年开始就一直试图怀孕。她最终在2014年成功怀孕，并在多次干预后于2015年生下了第一个孩子。她的不孕症最初是由于左输卵管输卵管积水，左输卵管内膜瘢痕，催乳素水平高，随后由于异位妊娠后唯一的工作管丢失。病人在服用溴隐亭时怀孕，不幸的是，怀孕没有持续到足月。克罗米芬后来加入了她的药物团，六个周期后，她发生了宫外孕，破坏了她唯一的工作管道。随后，这位患者尝试了体外受精治疗以实现怀孕。她接受了两次试管受精治疗，但都未能成功怀孕。患者最终接受了输卵管重建显微手术，使她成功地进行了两次自然妊娠。妇科医生在诊断不孕因素时必须保持警惕，并在作出有关生育干预的决定时向女性患者提供足够适当的信息。关键词:生育，体外受精，输卵管造瘘，输卵管积水，催乳素，菌膜。

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引用次数: 0

Case report: Challenges in diagnosis and treatment of Small bowel diverticulitis presenting with acute abdomen 病例报告:以急腹症为表现的小肠憩室炎的诊断和治疗的挑战

Medical reports & case studies

Pub Date : 2018-08-31 DOI: 10.5897/MCS2018.0121

J. J. Yahng

Small bowel diverticulitis is a rare condition that is often excluded in the differential diagnosis of acute abdomen. We herein present two cases of patients with small bowel diverticulitis who presented with acute abdomen. First case was a 72-year-old lady who presented to emergency with 2 days of sudden-onset worsening generalized abdominal pain. The computed tomography (CT) revealed a segment of abnormally thickened jejunum with marked adjacent inflammatory mesenteric fat stranding and adjacent extraluminal gas locules, in keeping with complicating perforation. The patient was subsequently taken to the operating theater for an emergency laparotomy which revealed a contained perforation of the proximal jejunum secondary to a ruptured diverticulum. 20 cm of proximal jejunum containing the perforation was resected. The patient recovered uneventfully and was discharged day 7 following the operation. Second case was a 78-year-old lady who presented with 12 h of sudden-onset right-sided abdominal pain. The CT revealed the presence of multiple diverticula in the jejunum associated with diffuse wall thickening and marked peridiverticular inflammatory changes. This was most in keeping with small bowel diverticulitis, however, there was no definite extraluminal gas to suggest any evidence of perforation. The patient was managed conservatively with intravenous antibiotics and bowel rest. The patient’s pain improved with improving inflammatory markers during the hospital stay. The patient was discharged day 4 following the admission. We believe that there is a need to devise a comprehensive treatment guidelines specific for small bowel diverticulitis. In the meantime, it is deemed safe to conservatively manage uncomplicated cases without perforation. Key words: Intestine, small, abnormalities, abdomen, acute, diverticulosis, colonic, diverticulitis, colonic, clinical protocols, tomography, computed.

小肠憩室炎是一种罕见的疾病，经常被排除在急腹症的鉴别诊断之外。我们在此报告两例以急腹症为表现的小肠憩室炎患者。第一个病例是一名72岁的女士，她因2天突然发作的全身性腹痛恶化而就诊。计算机断层扫描(CT)显示一段异常增厚的空肠，伴有明显的炎性肠系膜脂肪链和邻近的腔外气体室，与并发症穿孔一致。患者随后被送往手术室进行紧急剖腹手术，发现继发于憩室破裂的空肠近端穿孔。切除含穿孔的近空肠20cm。患者顺利康复，术后第7天出院。第二个病例是一位78岁的女士，她表现为12小时的突然发作的右侧腹痛。CT显示空肠多发憩室伴弥漫性壁增厚及明显的憩室周围炎性改变。这与小肠憩室炎最一致，然而，没有明确的腔外气体提示任何穿孔的证据。患者接受静脉注射抗生素和肠道休息的保守治疗。在住院期间，患者的疼痛随着炎症标志物的改善而改善。患者于入院第4天出院。我们认为有必要为小肠憩室炎制定一个综合性的治疗指南。同时，保守处理无穿孔的简单病例被认为是安全的。关键词:肠，小，异常，腹部，急性，憩室病，结肠，憩室炎，结肠，临床方案，断层扫描，计算机。

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