Panorama of Emergency Medicine

Subarachnoid hemorrhage associated with ecstasy abuse in a young adult: a case report

2024-05-22T11:17:24-04:00

3,4-Methylenedioxymethamphetamine (MDMA), is a synthetic amphetamine derivative. Its usage can be complicated by intracerebral or subarachnoid hemorrhage. Drug-related intracranial hemorrhage (ICH) is a relatively uncommon occurrence, often associated with an underlying vascular anomaly,

We report the case of a 28-year-old male with a history of Ecstasy abuse prior to the onset of a sever holocranial headache. Cerebral computed tomography angiography revealed a right sided sub-arachnoid hemorrhage and blood within all four ventricles, as well as a right sided pontine hematoma and an arteriovenous malformation.

As the drug epidemic continues to worsen, it is important to take a full drug history in patients presenting with a severe headache, and to not overlook ICH as a potential complication of recreational drug abuse.

Hippocampus infarct following a posterior cerebral artery occlusion.

2024-06-25T04:51:39-04:00

A 64-year-old gentleman, presented for subacute onset of short-term memory problem, preceded by headache, right arm numbness and visual disturbances. On neurological exam, he had anterograde amnesia, decreased pinprick sensation on his right arm and right homonymous hemianopsia.

Brain Magnetic Resonance imaging (MRI) and Magnetic Resonance Angiography (MRA) showed subacute ischemic lesions in the left occipital lobe, hippocampus and thalamus, caused by a distal occlusion of the left Posterior Cerebral Artery (PCA). A distal occlusion of the PCA led to multiple infarcts in different anatomical structures, causing a constellation of variant neurological signs.

Our case demonstrates an anterior hippocampus predominantly irrigated by the PCA.

Influenza Associated Pulmonary Aspergillosis: A Retrospective Study from a Tertiary Care Center in Lebanon

2024-06-19T07:17:48-04:00

Introduction

Influenza-associated pulmonary aspergillosis (IAPA) has been reported in multiple cohort studies, typically in the immunocompromised host. Limited data is available from the Middle Eastern region.

Methods

This is a retrospective study conducted at the American University of Beirut Medical Center (AUBMC) between January 1 2014 and March 1 2019, to describe the clinical characteristics, risk factors and outcomes of patients with influenza and invasive pulmonary aspergillosis (IPA). Six hundred fifty six patients were admitted with influenza pneumonia. Data about positive cultures for Aspergillus sp. isolated from sputum, deep tracheal aspirates (DTA) or bronchoalveolar lavage (BAL) or a positive aspergillus galactomannan test (GM) in serum or BAL was collected. Cases were identified based on the definitions and criteria for influenza and invasive aspergillosis suggested by the European Organization for Research and Treatment of Cancer/Mycoses study Group (EORTC/MSG), EORTC/MSG intensive care unit (EORTC/MSGERC ICU) Working Group, and IAPA definition.

Results

Nine patients had a positive result for Aspergillus sp. in culture or GM. Based on the EORTC/MSG criteria, 7 patients were classified as probable cases of IPA, and one as a possible case. On the other hand, only 2 patients were classified as probable cases of invasive fungal infection (IFI) based on the IAPA criteria. Only 1 out of 9 patients died. There was a preponderance of aspergillosis among immunocompromised patients.

Conclusion

Our study showed that the incidence of IPA in influenza patients was low compared to the data reported from European countries. This calls for national and regional surveillance to better understand the epidemiological variation in the regions.

Bacteriophage-Based Treatment in Infectious Diseases: What Do We Know So Far? A Narrative Review

2024-06-26T12:20:58-04:00

Purpose: To summarize the literature on bacteriophage use in human infection

Methods: Using the MeSH terms “Phage” “Therapy”, “Treatment” “Outcome”, a search was performed in ScienceDirect, Scopus and Pubmed databases, including narrative review, systematic reviews and clinical trials, dating from 2020 till June 2023. A total of 191 articles and 389 articles were retrieved respectively from each database, which after duplication removal, added up to 505. After the primary screen, 131 texts were collected. Following that, a secondary ended up with 56 articles included.

Conclusion: With the constant increase in antibiotic resistance, there is a need for newer antimicrobial agents, which led to the revival of bacteriophages. Due to advances in molecular microbiology, phages became a possibility that has proven itself promising. More studies and funding are needed towards this field, that offers us a promising salvation from the antimicrobial resistance pandemic.