Guillain–Barre Syndrome with Covid-19 Five patients who had Guillain–Barre syndrome 5 to 10 days after the onset of Covid-19 are described. Three had severe weakness and an axonal pattern on electr...

https://www.nejm.org/doi/pdf/10.1056/NEJMc2009191?articleTools=true

Guillain-Barré Syndrome Associated with SARS-CoV-2.

Respiratory viruses infect the human upper respiratory tract, mostly causing mild diseases. However, in vulnerable populations, such as newborns, infants, the elderly and immune-compromised individuals, these opportunistic pathogens can also affect the lower respiratory tract, causing a more severe disease (e.g., pneumonia). Respiratory viruses can also exacerbate asthma and lead to various types of respiratory distress syndromes. Furthermore, as they can adapt fast and cross the species barrier, some of these pathogens, like influenza A and SARS-CoV, have occasionally caused epidemics or pandemics, and were associated with more serious clinical diseases and even mortality. For a few decades now, data reported in the scientific literature has also demonstrated that several respiratory viruses have neuroinvasive capacities, since they can spread from the respiratory tract to the central nervous system (CNS). Viruses infecting human CNS cells could then cause different types of encephalopathy, including encephalitis, and long-term neurological diseases. Like other well-recognized neuroinvasive human viruses, respiratory viruses may damage the CNS as a result of misdirected host immune responses that could be associated with autoimmunity in susceptible individuals (virus-induced neuro-immunopathology) and/or viral replication, which directly causes damage to CNS cells (virus-induced neuropathology). The etiological agent of several neurological disorders remains unidentified. Opportunistic human respiratory pathogens could be associated with the triggering or the exacerbation of these disorders whose etiology remains poorly understood. Herein, we present a global portrait of some of the most prevalent or emerging human respiratory viruses that have been associated with possible pathogenic processes in CNS infection, with a special emphasis on human coronaviruses.

Human Coronaviruses and Other Respiratory Viruses: Underestimated Opportunistic Pathogens of the Central Nervous System?

[Guillain-Barré syndrome].

The novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first identified in December of 2019 in the city of Wuhan, China. Since the outbreak, various reports detail its symptoms and outcomes, primarily focusing on respiratory complications. However, reports are emerging of the virus' effects systemically, including that of the nervous system. A review of all current published literature was conducted, and we report that headache and anosmia were common neurological manifestations of SARS-CoV-2. Less common symptoms include seizure, stroke and isolated cases of Guillain-Barre syndrome. Further research is now warranted to precisely determine the relationship between those patients developing neurological sequelae, their clinical state and any subsequent morbidity and mortality.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/ane.13266

Neurological Manifestations of COVID-19: A systematic review and current update.

The coronavirus 2019 (COVID-19) pandemic has potential to disproportionately and severely affect patients with neuromuscular disorders. In a short period of time, it has already caused reorganization of neuromuscular clinical care delivery and education, which will likely have lasting effects on the field. This article reviews (1) potential neuromuscular complications of COVID-19, (2) assessment and mitigation of COVID-19-related risk for patients with preexisting neuromuscular disease, (3) guidance for management of immunosuppressive and immunomodulatory therapies, (4) practical guidance regarding neuromuscular care delivery, telemedicine, and education, and (5) effect on neuromuscular research. We outline key unanswered clinical questions and highlight the need for team-based and interspecialty collaboration. Primary goals of clinical research during this time are to develop evidence-based best practices and to minimize morbidity and mortality related to COVID-19 for patients with neuromuscular disorders.

https://n.neurology.org/content/neurology/94/22/959.full.pdf

COVID-19 and neuromuscular disorders.

Guillain–Barre syndrome is characterized by progressive motor weakness, sensory changes, dysautonomia, and areflexia. Cranial nerve palsies are frequent in Guillain–Barre syndrome. Among cranial ne...

https://journals.sagepub.com/doi/pdf/10.1177/2050313X19838750

Guillain-Barré syndrome with unilateral peripheral facial and bulbar palsy in a child: A case report.

Preventing extensive venous thrombosis: Sometimes it’s about digging deep into the history

Liver is the organ most frequently injured after blunt or penetrating abdominal trauma, being in pediatrics a pathology that has an increasing incidence; Non-operative management is the hallmark of treatment, however cases of secondary biliary leakage have been described, which may affect the intrahepatic or extrahepatic track. A male 8 years old, with blunt trauma in the right hypochondrium, presenting acute abdomen and hemodynamic instability, requiring exploratory laparotomy with a grade III liver injury in VI and VII hepatic segments. Four weeks after discharge, he presented as a complication a giant biloma in VII and VIII hepatic segments, performing percutaneous drainage guided by ultrasound. The incidence of biliary complications related to hepatic trauma is low, 4% in pediatric patients, dividing into bilomas or biliary fistulas; the presentation of biliary leakage is very non-specific and early diagnosis difficult; in the bilomas, the tomography allows to define precisely its size, nature, distribution and regional anatomy in relation to adjacent structures, as well as underlying cause. The approach of choice is percutaneous or endoscopic drainage, with surgical management being the last option.

Biloma secondary to blunt liver trauma in a pediatric patient: case report

Vesicular agenesis refers to the congenital absence of the gallbladder, however, vesicular agenesia is a very scarce condition worldwide, so there is little information available on its clinical presentation and surgical data. This is a 79-year-old male patient, with a history of diabetes mellitus of long evolution, without a surgical history, who comes for colic pain of 15 days of evolution in right hypochondrium, as well as unquantified fever and jaundice, during its initial evaluation in the emergency room para clinics were requested observing leukocytosis, hyperbilirubinemia and elevation of liver enzymes, ultrasound of liver and bile ducts reported common anatomical situation gallbladder, occupied entirely by multiple hyperechogenic images, configuring sign of W.E.S. and common bile duct of 7.2 mm, concluding gallbladder scleroatrophic and vesicular agenesia during trans-surgery. Vesicular agenesis is an extremely rare condition that is mostly diagnosed during surgery, which can lead to erroneous diagnosis and unnecessary surgery in patients with symptoms including biliary colic, choledocholithiasis with or without cholangitis, and an ultrasound showing a scleroatrophic gallbladder. Surgeons In situations where there is clinical evidence consistent with biliary colic in a context of gallbladder agenesis, and the symptoms persist without finding any other cause, a surgical approach to release adhesions could be considered; since, as observed, this may result in improved symptoms, although the explanation is not yet completely clear.

/pdf/gallbladder-agenesis-in-a-patient-with-choledochoduodenal-3k5fk4me.pdf

Gallbladder agenesis in a patient with choledochoduodenal fistula, report of an exceptional case

Sporotrichosis is a subacute to chronic infection caused by the dimorphic fungal genus Sporothrix. The infection usually affects the skin and subcutaneous tissues, but occasionally it can occur at other sites, mainly in immunocompromised patients. The symptoms of extracutaneous sporotrichosis can be subtle and diagnosis is often delayed. A 54-year-old male was received, originally from Huajuapan de León, Oaxaca; who was with an established diagnosis of type 2 diabetes mellitus; later admitted by the general surgery service with a diagnosis of necrotizing fasciitis of the left and right thoracic limb. When culture was collected with Sporothrix schenckii report, management was established with itraconazole, potassium iodide and with subsequent addition of amphotericin B, with antibiotic therapy directed for superinfection by opportunistic agents. After multiple surgical cleanings with degradation of necrotic tissue, implementation of negative pressure system and amputation of nonviable fingers, it was decided to proceed with the application of skin autografts, despite the persistence of the agent in subsequent culture reports, which are fully integrated, without evidence of new ulcerodular lesions so far. Although there are currently no parameters defined in the literature that guide the time or the appropriate conditions to perform skin grafts in the areas affected by cutaneous sporotrichosis, there are, on the contrary, reports of successful cases where surgical management has been effective even in the presence of positive cultures for Sporothrix schenckii. We consider that these results open the panorama of options for the current management of cutaneous sporotrichosis, making it necessary to consider surgical management in the therapeutic range of the same, allowing the deliberation on other more conservative options before the failure of classical therapy and the imminence of amputation.

Omar Sanchez

Papers

Guillain-Barré syndrome with unilateral peripheral facial and bulbar palsy in a child: A case report.

Preventing extensive venous thrombosis: Sometimes it’s about digging deep into the history

Biloma secondary to blunt liver trauma in a pediatric patient: case report

Gallbladder agenesis in a patient with choledochoduodenal fistula, report of an exceptional case

Is skin grafting in the patient with cutaneous sporotrichosis the definitive therapy?