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100606
15
The rest of the systemic examination was within normal limits.
[ [ "normal limits", "examination" ] ]
100606
16
Considering this as a probable case of TB with COVID-19 he was advised a chest radiograph with sputum microscopy (Ziehl Neelsen (ZN) staining for acid-fast bacilli), Cartridge-based nucleic acid amplification test (CBNAAT) of the sputum and other routine investigations.
[]
100606
17
To check for the COVID-19 he was advised qualitative polymerase chain reaction (PCR) test from the oropharyngeal swab.
[]
100606
18
The results were surprising with Mycobacterium tuberculosis detected on sputum fluorescent microscopy and were also confirmed by the CBNAAT.
[]
100606
19
However, there was no resistance to Rifampicin.
[]
100606
20
The results of the PCR were positive for RNA specific to SARS-CoV-2.
[ [ "positive", "SARS-CoV-2" ] ]
100606
21
Besides, the chest radiograph PA-view was suggestive of bilateral consolidations on the middle lobes of lungs with ill-defined borders.
[]
100606
22
The other investigations revealed a low lymphocyte count (1x 10 9 /L) and increased levels of C-reactive protein (CRP) (57 mg/L), lactate dehydrogenase (LDH) (580 U/L), and erythrocyte sedimentation rate (ESR) (70 mm in the 1 st hour).
[ [ "1x 10 9 /L", "count" ], [ "57 mg/L", "CRP" ], [ "57 mg/L", "protein" ], [ "580 U/L", "dehydrogenase" ], [ "580 U/L", "LDH" ], [ "70 mm", "ESR" ], [ "70 mm", "rate" ] ]
100606
23
Also, a sample for liquid culture (MGIT BACTEC) was sent to the Intermediate Reference Laboratory (IRL) which revealed the growth of Mycobacterium tuberculosis.
[]
100606
24
Computed tomography was not performed as the diagnosis was established by other cheaper and faster methods and also the patient was unwilling for the same.
[]
100606
25
All the other routine investigations were within normal limits.
[ [ "normal limits", "investigations" ] ]
100606
26
He was referred to the nearest designated COVID-19 management center, where he was managed as per national guidelines.
[]
100606
27
Besides, he was also started on an antitubercular treatment of four drugs as per the National Tuberculosis Elimination Program (NTEP) guidelines.
[]
100606
28
He was advised follow-up post completion of his stay at the designated COVID-19 center, but he has not yet reported back for follow-up.
[]
100606
29
Written informed consent was obtained from the patient for using clinical data and images for publication in this study.
[]
100653
1
A 31-year-old woman with no pathological history was admitted to our hospital for chest pain, bone and joint pain, hair loss and asthenia for the last 3 months.
[]
100653
2
On physical examination, we found fever at 38°C, polypnea at 32 cycles/min, arterial hypertension at 160/90 mmHg, malar rash, synovitis of wrists, elbows and ankles, and edema on both legs.
[ [ "38°C", "fever" ], [ "32 cycles/min", "polypnea" ], [ "160/90 mmHg", "hypertension" ] ]
100653
3
Diagnostic assessment: laboratory tests disclosed the following values: Increase level of erythrocyte sedimentation rate 120 mm/1 st hour, C reactive protein was 20 mg/l.
[ [ "120 mm/1 st hour", "rate" ], [ "20 mg/l", "protein" ] ]
100653
4
The blood count showed hemoglobin at 9g/dl, MCV at 85 µ 3, lymphopenia at 400/mm 3, while platelets were normal 450 000/mm 3.
[ [ "9g/dl", "hemoglobin" ], [ "85 µ 3", "MCV" ], [ "400/mm 3", "lymphopenia" ], [ "450 000/mm 3", "platelets" ] ]
100653
5
Direct coombs test was negative.
[ [ "negative", "test" ] ]
100653
6
Serum Albumin was 25g/l; proteins level was low at 50g/l and proteinuria at 3.2g/day.
[ [ "25g/l", "Albumin" ], [ "low", "level" ], [ "50g/l", "level" ], [ "3.2g/day", "proteinuria" ] ]
100653
7
Creatinine was normal.
[ [ "normal", "Creatinine" ] ]
100653
8
Anti-nuclear antibody ANA were positive 1/320 with homogeneous pattern, anti-dsDNA level was 160U/ml.
[ [ "positive 1/320", "antibody" ], [ "positive 1/320", "ANA" ], [ "160U/ml", "level" ] ]
100653
9
Anti-cardiolipin IgG antibodies were positive 25UGPL.
[ [ "positive 25UGPL", "antibodies" ] ]
100653
10
Rheumatoid Factor was negative.
[ [ "negative", "Factor" ] ]
100653
11
C3 and C4 complement fractions were low (0.2 g/l and 0.05 g/l).
[ [ "low", "fractions" ], [ "0.2 g/l", "fractions" ], [ "0.05 g/l", "fractions" ] ]
100653
12
Chest x-ray, electrocardiogram and echocardiography were normal.
[ [ "normal", "electrocardiogram" ], [ "normal", "x-ray" ], [ "normal", "echocardiography" ] ]
100653
13
Chest computed tomography (CT) scan showed proximal pulmonary embolism.
[]
100653
14
Renal ultrasound was normal.
[ [ "normal", "ultrasound" ] ]
100653
15
Renal biopsy reveals immunocomplex nephritis, lupus nephritis, segmental mesangial proliferation, mild activity lupus nephritis class III (A/C).
[]
100653
16
Before starting corticosteroids, we analyzed electrolytes.
[]
100653
17
Serum calcium was elevated 132 mg/l with hyper-calciuria 479 mg/24 h. 25 OHD was normal.
[ [ "elevated", "calcium" ], [ "132 mg/l", "calcium" ], [ "479 mg/24 h", "hyper-calciuria" ], [ "normal", "OHD" ] ]
100653
18
Alcaline phosphatase was 420 UI/l. the patient did not have any symptoms of hypercalcemia.
[ [ "420 UI/l", "phosphatase" ] ]
100653
19
Serum protein Electrophoresis showed polyclonal hypergammaglobulinaemia.
[]
100653
20
Serum and urine immunofixation as well as Bence-Jones proteinuria were negative.
[ [ "negative", "proteinuria" ], [ "negative", "immunofixation" ] ]
100653
21
Intact parathyroid hormone (iPTH) was high 628 pg/ml.
[ [ "high", "hormone" ], [ "high", "iPTH" ], [ "628 pg/ml", "hormone" ], [ "628 pg/ml", "iPTH" ] ]
100653
22
CT scan and ultrasound of parathyroid imaging revealed a lower left parathyroid nodule measuring 2cm x 1 cm.
[ [ "2cm x 1 cm", "measuring" ] ]
100653
23
Femoral and lumbar bone mineral density (BMD) showed osteoporosis (T-score: -2.6).
[ [ "2.6", "T-score" ] ]
100653
24
In addition, we found multiple pelvic osteolytic lesions at CT scan.
[]
100653
25
Other causes of hypercalcemia and bone lysis were excluded.
[]
100653
26
The diagnosis in this case was SLE with lupus nephritis class III and anti-phospholipid syndrome, complicated by pulmonary embolism associated to primary hyperparathyroidism causing severe hypercalcemia, osteoporosis.
[]
100653
27
Therapeutic intervention: the patient was given a pulse of methyl-prednisolone 15 mg/kg/day for 3 days followed by oral prednisone 1 mg/kg/day, associated with intravenous cyclophosphamide 750 mg/m 2 /month for 6 months.
[]
100653
28
Mycophenolate mofetil 2 g/day was prescribed as a maintenance therapy of lupus nephritis with hydroxychloroquine at a dose of 400 mg/day.
[]
100653
29
Treatment of pulmonary embolism was initiated with subcutaneous low molecular weight heparin (enoxaparin 0.1 ml/10 kg/12h) followed by antivitamin K.
[]
100653
30
For Hypercalcemia, patient has received intravenous fluid with furosemide.
[]
100653
31
She also required Alendronate 70 mg/week with Vitamin D 400u/day for osteoporosis.
[]
100653
32
The left parathyroid gland was surgically removed.
[]
100653
33
Histopathological examination revealed parathyroid adenoma.
[]
100653
34
Her immediate postoperative parathyroid hormone level was 64 pg/ml with a calcium level of 98 mg/l.
[ [ "64 pg/ml", "level" ], [ "98 mg/l", "level" ] ]
100653
35
Follow-up and outcomes: forty-eight hours after the surgery she developed oral paresthesia.
[ [ "72 mg/l", "hypocalcemia" ] ]
100653
36
She had hypocalcemia at 72 mg/l.
[]
100653
37
She required oral supplementation for few months.
[]
100653
38
Additional investigations for multiple endocrine neoplasia were negative.
[ [ "negative", "investigations" ] ]
100653
39
The patient remained asymptomatic.
[]
100653
40
Her SLE was calm without any relapse.
[ [ "negative", "Control" ] ]
100653
41
Control of proteinuria was negative.
[]
100653
42
Corticosteroids was dropped.
[]
100653
43
The follow-up was 4 years.
[]
100658
1
A 35-year-old mentally ill man was transferred from a local psychiatric hospital after attempted suicide by fire 3 days before admission.
[]
100658
2
He acquired full-and partial-thickness injury in approximately 38% of his TBSA, including face and neck (5%), both upper extremities (8%), right thigh (4%), left thigh and leg (3%), and most of his anterior and posterior trunk (16%).
[]
100658
3
The patient was hospitalized for 66 days and underwent five debridement surgeries.
[]
100658
4
The psychiatric diagnosis was schizophrenia type ICD 10 F20.3, treated with Haloperidol 1.5 mg and Diazepam 5 mg daily.
[]
100658
5
The patient was occasionally restrained due to rebellious and self-destruction behavior.
[]
100658
6
The nutrition management of this patient was started after a week of hospitalization, which is considered late.
[]
100658
7
In the initial nutrition assessment, the patient was 40 kg weight and 150 cm tall thus the body mass index (BMI) was 17,57 kg/m 2 or underweight.
[ [ "40 kg", "weight" ], [ "150 cm", "tall" ], [ "17,57 kg/m 2", "index" ], [ "17,57 kg/m 2", "BMI" ] ]
100658
8
Gastrointestinal symptoms and signs were not found.
[]
100658
9
Information regarding the patient's dietary intake in the last two weeks and weight change within the last 6 months could not be obtained, but his mother claimed that the patient seemed to lose weight because he refused any food that had been offered to him; he only smoked and drank coffee.
[]
100658
10
Albumin level was 3.6 gr/L with imbalanced electrolyte levels.
[ [ "3.6 gr/L", "level" ] ]
100658
11
Signs of fluid accumulation were not found.
[]
100658
12
According to the subjective global assessment (SGA) tool, the patient belonged to group C (severely malnourished).
[]
100658
13
Energy and protein were given starting from 30 kcal/kg, increasing gradually to 50 kcal/kg, and 2 gp/kg divided into oral nutrition and oral nutrition supplements (ONS) with a 50:50 ratio.
[]
100658
14
The patient was also given micronutrient supplementations, specifically vitamin A 100,000 units for the first week, vitamin C 100 mg 3 times a day, and zinc 20 mg once a day.
[]
100658
15
During the early weeks of hospitalization, the patient's weight loss continued.
[]
100658
16
At the end of the second week, his body weight was 36 kilograms while his serum albumin level was 2.7 gr/L.
[ [ "36 kilograms", "weight" ], [ "2.7 gr/L", "level" ] ]
100658
17
On the 28 th day, the patient's body weight was 33 kilograms while his serum albumin level was 2.1 gr/L.
[ [ "33 kilograms", "weight" ], [ "2.1 gr/L", "level" ] ]
100658
18
Energy and protein intake was maintained, but the ratio of oral intake and ONS was modified to 70:30.
[]
100658
19
During the treatment, the patient's appetite was unstable.
[]
100658
20
The patient was also hardly cooperative with enteral access.
[]
100658
21
The patient often writhed in pain and became more aggressive.
[]
100658
22
The patient did not respond well to analgesics and sedations.
[]
100658
23
Partially parenteral nutrition (PN) enriched with branched-chain amino acid (BCAA) was administered to support protein needs.
[]
100658
24
However, his BMI continued to decline, and on the 42 nd day, his body weight dropped to 32 kilograms with a serum albumin level of 2 gr/L.
[ [ "32 kilograms", "weight" ], [ "2 gr/L", "level" ] ]
100658
25
On the 66 th day, granulation tissues appeared on the wound bed.
[]
100658
26
Considering the mental and nutrition status of the patient, it was decided not to continue with the skin graft surgery.
[]
100658
27
The patient had lost 24% of body weight (BMI 11.96 kg/m 2) and the serum albumin level was 2.5 gr/L.
[ [ "11.96 kg/m 2", "BMI" ], [ "2.5 gr/L", "level" ] ]
100658
28
The patient displayed severe muscle wasting and subcutaneous fat loss.
[]
100658
29
However, the general and mental condition was relatively better.
[]
100658
30
The patient was discharged from the hospital.
[]
100682
1
A 19-year-old healthy man was admitted to our cardiology department following a syncopal episode.
[]
100682
2
His past medical history was unremarkable.
[]
100682
3
He no family history of heart disease or sudden death.
[]
100682
4
Two-days prior the syncope, he developed chest pain and an influenza-like illness consisting of fevers, rhinorrhea, and sore throat.
[]
100682
5
At the physical exam, the patient was febrile at 39°C.
[ [ "39°C", "febrile" ] ]
100682
6
He had an inflamed throat, bradycardia at cardiac auscultation and there were no signs of heart failure.
[]
100682
7
The electrocardiogram (EKG) showed grade III atrioventricular (AV) bloc with a ventricular rate of 38 beats per minute.
[ [ "38 beats per minute", "rate" ] ]
100682
8
Laboratory studies were remarkable for a HS-troponin level 181ng/L, a white blood cell count of 14270/mm³ with 48% lymphocytes, and elevated C-reactive protein at 90mg/L.
[ [ "181ng/L", "level" ], [ "14270/mm³", "count" ], [ "48%", "lymphocytes" ], [ "90mg/L", "protein" ] ]
100682
9
Serum electrolytes, kidney and liver functions were within normal limits.
[ [ "normal limits", "functions" ] ]
100682
10
A chest X-ray showed an appropriate cardiac size.
[]
100682
11
The initial transthoracic echocardiography (TTE) showed a normal global left ventricular function (left ventricular ejection fraction (LVEF) 60%) and wall motion abnormalities (anteroseptal hypokinesia), with reduced left ventricular global longitudinal strain (LV GLS= -14.1%).
[ [ "60%", "LVEF" ], [ "60%", "fraction" ], [ "-14.1%", "GLS" ], [ "-14.1%", "strain" ] ]
100682
12
Cardiac magnetic resonance (CMR) showed increased signal intensity at the mid-lateral wall on T2-weighted images.
[]