Neurological manifestation and complications are common due to COVID-19. It affects higher functions, cranial nerves and the motor system. The authors report a case of GBS as an example of a success story in managing a complicated case of COVID-19 in an elderly male with signs of a poor prognosis.

In this article, we report a 34-year-old man who presented with progressive hip pain and osteolytic bone lesions . Primary workup included Core needle biopsies manifested as osteomyelitis; however as no sign of remission was observed, an open biopsy considered which revealed primary bone lymphoma.

Aim Viral blips that occur among virally suppressed HIV-positive patients suggest immune activation and inflammation and associated with slower CD4 count and CD4/CD8 ratio normalisation. With the advances in HIV treatment, lifestyle and comorbidities begin to be a concern despite successful antiretroviral therapy. We reported a study incorporating the effect of CD4 and CD4/CD8 ratio normalisation on viral blips in joint disease progression (DP) and time-to-event (TTE) model. Methods A total of 152 HIV-positive patients receiving efavirenz therapy were recruited. Joint DP and TTE models on viral blip were developed for CD4 and CD4/CD8 ratio separately. Risk factors, such as smoking status, pack-year and comorbidity scores, were included in the analysis. Results Gompertz model best described the CD4 and CD4/CD8 ratio DP models, while viral blips data were fitted with the Cox proportional hazard model. History of opportunistic infections and changing of antiretroviral regimen significantly affect the baseline CD4 and CD4/CD8 ratio. Comorbidity score was significant in both CD4 (asymptote CD4) and CD4/CD8 ratio DP model (recovery rate). Increase in cumulative pack-year resulted in lower CD4/CD8 ratio recovery rate (β -0.02, 95%CI: -0.03 to -0.01; p<0.001). Active smokers with slow CD4 or CD4/CD8 ratio normalisation associated with more viral blips. Conclusion CD4 and CD4/CD8 ratio are significant risk factors of viral blips and potential markers of non-AIDS related morbidities in virally suppressed patients. Early identification of high-risk group with repeated viral load testing, lifestyle modification and comorbidities management should be emphasised in the HIV treatment long-term care plan.

The integration of biodiversity conservation and public health has gained significant traction, leading to new efforts to identify win-win solutions for sustainable development and health. At the forefront of these efforts is pinpointing ways that biodiversity conservation can reduce risk of zoonotic spillover, especially given the consequences of pandemics and epidemics of wild animal origin. However, there is currently an incomplete understanding of the mechanisms by which biodiversity change influences the spillover process, limiting the application of integrated strategies aimed at achieving positive outcomes for both conservation and disease management. One limitation has been a narrow focus on the relationship between infectious disease and species richness only, thus missing other relevant dimensions of biodiversity. Here, we review the literature, considering a broad scope of biodiversity definitions, to identify cases where zoonotic pathogen spillover is mechanistically linked to changes in biodiversity. Extending biodiversity to include other dimensions of it, such as functional diversity, landscape diversity, spatiotemporal diversity, and interaction diversity, allows us to identify potential relationships between biodiversity change and zoonotic spillover. By reframing the discussion of biodiversity and disease using mechanistic evidence while encompassing multiple dimensions of biodiversity, we work toward general principles that can guide future research and more effectively integrate the related goals of biodiversity conservation and spillover prevention.

This clinical case represents an unusual manifestation of COVID-19 pneumonia which started as arterial hypertension as well as the development of post-viral inflammatory complications and long-covid syndrome. Several factors such as hypertension, bile duct disease, and age can affect the duration of COVID which can lead to long COVID

Veillonella species rarely cause serious infections, but the incidence of infection has been increasing among immunocompromised individuals. This case of an epidural abscess and spondylitis caused by Veillonella parvula in a hemodialysis patient illustrates the importance of performing anaerobic blood culture in immunocompromised patients with signs of infection.

Bacterial CNS are rare in COVID 19 patients. We describe a patient with severe pneumonia and meningitis that developed Froin’s syndrome by Staphylococcus aureus; this suggests that immune dysregulation in patients with COVID-19 facilitate disseminating commensal bacterial infections from the skin or the mucous membranes. Keywords: Meningitis, Froin’s syndrome, COVID-19.

A myocardial abscess is a rare and fatal disease, which is known to be challenging to diagnose, especially in case of isolated one without endocarditis. We present a case of emphysematous myocardial abscess detected by computed tomography, and echocardiography, and confirmed by surgery.

Bastomycosis-like pyoderma is a rare skin disorder most commonly caused by bacterial infection. It is usually diagnosed in immunocompromised patients. We report a case of BLP in an immunocompetent woman, who presented with a 6-week history of verrucous cutaneous plaque of the left wrist.

Purpose: We aimed to conduct an updated systematic review and network meta-analysis (NMA) to estimate the efficacy of Helicobacter pylori (H. pylori) treatment strategies in Arab countries. Methods: We systematically searched PubMed, Scopus, Web of Science (WOS), EBSCO, and EMBASE from inception to July 18, 2020, using boolean operators. Retrieved articles were screened, and relevant data were extracted. We used R programming software to analyze extracted data. Results: Fifty-four articles (n= 7829 patients) were included in the NMA. Pooled overall analysis demonstrated that adjuvant therapy (standard triple or sequential therapy plus another adjuvant drug) was the best treatment with higher odds of eradication rate [OR= 6.42, 95% CI (1.37: 30.05), P-score= 0.21]. Moreover, Seqential therapy (SQT) and Quinolone based therapy (QBT) were associated with higher eradication rate compared to other regimens [OR= 4.83, 95% CI (1.49: 15.64), P-score= 0.30] and [OR= 4.32, 95% CI (1.15: 16.16), P-score= 0.36], respectively. In adults, the efficacy of QBT was higher than other stratigies in terms of H. pylori eradication [OR= 2.00, 95% CI (1.09, 3.69), P score= 0.19]. In naïve population, QBT and SQT were associated with substantial eradication rate [OR= 1.94, 95% CI (1.19: 3.16), P score=0.19] and [OR= 1.66, 95% CI (1.10: 2.50), P score=0.33], respectively. Conclusion: Our findings suggest that standard triple or sequential therapy plus another adjuvant drug, QBT and SQT therapies were the most effective regimens for eradicating H.pylori in Arab countries.

AIM: Influenza infection poses a severe threat to pregnant mothers, and antiviral treatment is recommended. However, the safety of neuraminidase-inhibitor antiviral medications during pregnancy has not been well described. METHODS: A systematic review and meta-analysis were performed to evaluate the adverse neonatal outcomes associated with exposure to neuraminidase inhibitors during pregnancy. The PubMed, Embase, and Cochrane Library databases were searched to identify potential studies for inclusion. RESULTS: Nine cohort studies that estimated adverse neonatal outcomes associated with exposure to neuraminidase-inhibitor medication during pregnancy were included. Exposure to a neuraminidase inhibitor during pregnancy was not associated with an increased risk of congenital malformation (odds ratio [OR] 0.9, 95% confidence interval [CI] 0.72–1.12, P = 0.341), low Apgar score (OR 0.96, 95% CI 0.77–1.2, P = 0.733), or preterm birth (OR 0.99, 95% CI 0.89–1.09, P = 0.771) compared with no exposure. However, exposure to a neuraminidase inhibitor was associated with a reduced risk of low birth weight (OR 0.79, 95% CI 0.68–0.92, P = 0.002) and giving birth to a small-for-gestational-age infant (OR 0.78, 95% CI 0.69–0.88, P < 0.001). Further analyses limited to oseltamivir exposure were consistent with the overall results. CONCLUSION: Exposure to neuraminidase-inhibitor medication during pregnancy does not appear to be associated with adverse neonatal outcomes. We recommend further studies to investigate this association, which will help clinicians determine whether to prescribe a neuraminidase inhibitor during pregnancy.

Angiotensin receptor antagonist associated enteropathy is becoming increasingly prevalent within the literature. We report a case of sprue-like enteropathy associated with Losartan with a unique cutaneous manifestation. Our case of Losartan associated enteropathy further suggests that sprue-like disease may be a class effect of ARBs.

Pulmonary cryptococcosis presents as various radiological manifestations depending on the immunological status of the host. The most common chest radiographic findings include single or multiple nodules. Herein, we present a rare case of pulmonary cryptococcosis in a patient with rheumatoid arthritis presenting as multiple cystic lesions that enlarged after treatment.

A 62-year-old man with rare blood type exhibited severe respiratory failure due to novel coronavirus. Extracorporeal membrane oxygenation was inapplicable, which requires numerous blood products with the same blood type. We thoroughly restricted fluid volumes by sacrificing renal function. He was discharged with complete recovery of respiratory and renal functions.

Key points 1. This is the first report of adult primary herpetic oropharyngitis in the view point of the differences between the two types of herpes simplex virus (HSV). 2. 41 (25 type 1 and 16 type 2) HSV specific antigen positive cases among 68 immunoserologically confirmed adult HSV primary infection cases were investigated. 3. Significantly low incidence of oral lesions and high incidence of nausea were seen in HSV type 2 oropharyngitis cases, that might mean particular correlation vagus nerve and HSV type 2. 4. Significantly increased white blood cell count and high C-reacative protein value were seen in oropharyngitis by HSV type 2. 5. HSV type 2 possibly cause more severe symptoms and higher inflammatory reactions than type 1, without oral lesions.

Renal allograft aspergillus is a rare entity with a high mortality due to life-threatening complications. We report a case of renal aspergilloma causing obstructive uropathy after two months of transplantation in a 64 -year- old patient who was managed successfully with antifungal therapy without surgical intervention.

Most but not all observational studies of statin treatment of COVID-19 patients suggest that treatment improves outcomes. However, almost all observational studies fail to consider what cardiovascular investigators have known for 15-20 years: withdrawing statins after hospital admission has detrimental effects on patient outcomes. Continuing (or starting) statin treatment after hospital admission consistently improves COVID-19 patient outcomes, whereas discontinuing treatment does not. Thus, observational studies of the effectiveness of statin treatment of COVID-19 patients must consider the consequences of statin withdrawal.

Background: In children and adolescents, isolated cholestasis rarely is a first clinical sign of severe sepsis. Case: A previously healthy 14-year-old adolescent had severe S. aureus sepsis. Delayed diagnosis required a prolonged antimicrobial treatment. Conclusion: This unique case illustrates the importance of considering jaundice as an early sign of sepsis.

Guillain-Barré syndrome is an immune-mediated neuropathy that was reported following multiple vaccines. We present the case of a gentleman who developed GBS 20 days after the second dose of COVID-19 vaccination. It is important to mention that more research is needed to establish an association between COVID-19 vaccine and GBS.

Hemophagocytic lymphohistiocytosis is a rare condition, characterized by excessive cytokine release and inflammatory response. HLH can be primary or secondary to infections, neoplasm or autoimmune conditions. Management includes immunosuppressive agents. Diagnosis of HLH is difficult in the setting of sepsis. We report a case of Klebsiella pneumonia complicated by HLH.

Systemic lupus erythematosus (SLE) is a multisystem disease with a complex etiology which manifests in a multitude of manners. We present a case of lupus nephritis in a patient who developed complications of immunosuppressive treatment with eventual resolution of her nephritis following cure of her Nocardia brain abscess

This report describes a case of 45 years old male patient who tested positive for COVID-19 presented to the emergency department on March 2021 complaining of fever, cough, runny nose, and shortness of breath. The patient denied any history of nausea or diarrhea who has eventually developed favipiravir-induced nephrotoxicity.

There are few reports on pregnancy and childbirth of HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) patients. We present a woman who diagnosed with HAM/TSP and used a wheelchair in daily life. She had no neurological impairments and no obstetrical complications during her three courses of pregnancy and childbirth.

We report a case of a 35-years-old Lebanese pregnant lady with a background of beta-thalassemia major who was diagnosed with COVID-19 infection (Cycle threshold value 18) during her 23rd gestational week. Unfortunately, the pregnancy outcome was unfavorable. To our knowledge, this is the first report of such a case