Clinical Characteristics and main presentation of the COVID19 among Iraqi people

The COVId19 pandemic is a newly emerging infectious disease that needs to be understood thoroughly in order to be controlled. This study aimed to study the clinical and laboratory characteristics of the COVID19 patient. Patient and methods: A cross-sectional study was done in Iraq, at Salahadeen general hospital from the period 1st March to the end of May 2020 on patients diagnosed with COVID 19. A total of 75 COVID19 patients enrolled in the study. a full history was taken, a full physical examination was done, computerized tomography, and laboratory tests. Results: The age distribution of the COVID19 patient were commonly aged (30-50 years) 37(49.3%), and those aged <30 years represented about 6(8%) of the sample. The dominant gender was male 43(57.3%). About 58 (77.3%) of the patient had comorbid disease, coronary vascular disease was 49(65.3%), hypertension was found among 47(62.7%), DM was found among 40(53.3%). Smoking found among 35(46.7%) of the patients. The commonest symptoms were dyspnea 63(84%), fever 51(68%), Myalgia 46(61.3%), loss of smell 8(10.7%), vomiting 8(10.7%), sputum 8(10.7%), loss of taste 6(8%), diarrhea 6(8%), dry mouth found among 6(8%), cough 6(8%), fatigue 5(6.7%)followed by arthralgia 4(5.3%), and chest pain 3(4%). The mean Spo2% was (88±6.6), heart rate was (103±23.3), the mean respiratory rate was (17.7±4.1), the mean temperature value was (38.1±1.1), and the mean C - reactive protein rate was (49.8±41.2). The CBC shows that Lymphopenia was reported among 34(45.3%) of the patient, leukocytosis reported among 19 (25.3%) of the patient. Chest CT revealed that mean lung involvement was (16.6±14.7%). Conclusion: The commonest presentation of the patient was dyspnea, followed by fever. Digestive symptoms and myalgia were common. COVID19 maybe became a stigma in our community and educational programs were needed to overcome this problem. Keywords: COVID19 infection, clinical presentation, CT, Iraq.

Linear discoid lupus erythematosus mimicking en coup de sabre morphea: A case report

Discoid or chronic lupus erythematosus is an autoimmune disease that produces skin lesions on the face and scalp. Rarely do lesions present with linear configuration, but when they do, the lesions often follow the lines of embryologic migration. A 24-year-old man presented with a slowly progressing asymptomatic violaceous linear patch running from the root of his frontal scalp to the nasal tip. A Doppler ultrasound and skin biopsy were performed and the histological findings demonstrated characteristic findings of discoid lupus erythematosus. A full physical examination, review of systems and laboratory investigations showed no indication of systemic lupus. High potency topical steroids and calcineurin inhibitors were prescribed along with photoprotection. At 4-month follow-up, all his lesions had mostly cleared. We report here the first case, to our knowledge, of discoid lupus erythematosus with en coup de saber presentation mimicking morphea.

Peripheral osteoma of the mandible in a cat

A six-year-old, male, castrated domestic shorthair cat was presented for evaluation of an oral mass. Full physical examination revealed a large hard mass arising from the lateral aspect of the caudal part of the left mandible. Abdominal ultrasound and thoracic computed tomography (CT) were performed to rule out metastatic disease. In addition, CT of the skull with intravenous contrast agent was performed. Histopathological examination of extra-oral biopsies confirmed the tentative diagnosis of peripheral osteoma. A three-dimensional printed skull was used in conjunction with the CT images to determine the detailed location and extent of the mass and to identify anatomical spatial relationships with important neurovascular structures. Surgical debulking of the osteoma was performed. The cat recovered uneventfully but the mass regrew nine months after debulking therapy, sooner than expected. Nevertheless, CT scan of the skull was suggestive for regrowth of the peripheral osteoma rather than for malignant transformation. The owners did not elect to pursue caudal mandibulectomy.

Dependent Erythema of the Legs Associated With Mild Autonomic Nervous System Dysfunction

Introduction: Dependent erythema or rubor is an erythematous discoloration of the limbs, most commonly associated with peripheral artery disease. We present a case of florid dependent erythema, associated with additional autonomic symptoms. Methods: Examination and full workup of a 16-year-old healthy girl with an 8-year history of dependent erythema, chronic diarrhea, and mild hyperhidrosis. A literature search was performed to review any similar cases and generate a differential diagnosis. Results: Examination of our patient showed symmetrical, asymptomatic fiery to dusky erythematous patches of the lower legs and feet, with intermittent areas of pallor. These florid changes occurred with erect posture. Resolution to near normal occurred within minutes when the patient was in the supine position. Full physical examination revealed mild erythema and hyperhidrosis of the hands. Conclusions: To our knowledge, there have been no reports of painless dependent rubor associated with sympathetic dysfunction. Literature search reports a few cases of gravitational erythema and angiodyskinesia. This case presentation is most likely part of the spectrum of dependent erythema and may shed light on the underlying aetiology.

Role of anxiety and depression in adolescents with chest pain referred to a cardiology clinic

BackgroundWe carried out this study in order to evaluate the causes of chest pain in teenagers and the role of anxiety and depression in this age group compared with the normal population.MethodsIn this prospective case–control study, all patients aged 11–18 years with chest pain and no history of trauma and referred to a paediatric cardiology clinic from March, 2009–April, 2010 were selected. A chest pain protocol including a detailed history, full physical examination, required blood tests, electrocardiography, and echocardiography was performed for all. The presence of depression and anxiety and their severity were assessed by Beck questionnaires. The patients were compared with age- and sex-matched, randomly selected healthy controls.ResultsIn total, 194 patients with a mean age of 14±2 years were selected. The most frequent presentation was idiopathic chest pain (43.3%), followed by the psychological group (29.9%). These groups had no abnormal points in history, physical, and para-clinical tests. Moderate-to-severe depression was found in 45.9% in the patients group, compared with 17.6% of controls, which was statistically significant (p=0.016). Moreover, anxiety was detected in 67.5% of patients versus 15.4% in controls, which is a statistically significant difference (p=0.009). Cardiac chest pain with 9.27% was the most common type of organic causes.ConclusionChest pain during teenage is more prevalent, but not risky. Undergoing a detailed history and full physical examination can help diagnose the causes in the majority of cases. Given the prevalence of a psychological group as well as role of anxiety and depression in most patients, referring to a psychiatrist is suggested.

Anti-leptospiral agglutinins in marmosets (Saguinus oedipus and Saguinus leucopus) from illegal trade

ABSTRACT Objective. Determine the infection status with pathogenic Leptospira of one Saguinus oedipus and nine Saguinus leucopus at the Cali Zoo that had been confiscated in Colombia from illegal trade. Materials and methods. A full physical examination, blood work, urinalysis were conducted in all individuals during the reception health check-up, in addition to running the microagglutination test with a pool of 19 serovars, with a starting dilution of 1:50. Results. A high positive titer (≥1:3200) to Leptospira alexanderi serovar manhao in an asymptomatic S. oedipus was detected. All S. leucopus tested negative or less than 1:50. Conclusions. Captive locations have been documented to artificially enhance opportunities to come into contact with contaminated bodily fluids from peridomestic rodents. However, infectious diseases acquired during the illegal transport of wildlife to major metropolitan centers are rarely considered a wildlife conservation or public health threat. Infection with zoonotic pathogens should also be considered an additional threat to endangered wild primates involved in illegal trade, which could hamper reintroduction efforts or other population management procedures for primate species with restricted and fragmented distributions.

Prosthetic Arteriovenous Grafts for Hemodialysis

Introduction Prosthetic arteriovenous (AV) grafts are indicated in patients with failed AV fistula (AVF), exhausted superficial veins or unsuitable vessels. Increasing the proportion of prevalent hemodialysis (HD) patients using autogenous AVF should reduce the need for AV grafts and associated morbidity. This paper reviews the current role of prosthetic AV grafts in vascular access for HD. Technical considerations Prior to the insertion of a prosthetic AV graft, a comprehensive review of previous access procedures and full physical examination in addition to vessel mapping is required. Anastomotic technique should take into account the flow diffuser concept, graft geometry and an anastomotic angle of 15° in order to reduce the incidence of intimal hyperplasia. Results Many authors report 1 and 2-yr cumulative graft patency rates of 59–90% and 50–82%, respectively. The major drawbacks with synthetic grafts include: thrombosis, a five-fold increase in infection risk and steal syndrome. The choice between surgical and percutaneous methods of dealing with blocked AV grafts remains controversial, though percutaneous techniques are assuming an increasingly important role. Percutaneous strategies are successful in declotting access in 67–95% of cases. Stenting of stenotic lesions following thrombectomy improves secondary patency rates. Strategies for dealing with AV graft infection include antibiotic prophylaxis, partial, subtotal or total graft excision and the use of biological prosthesis. Conclusions Though more prone to complications than autogenous AVFs, AV grafts offer a short maturation period and are more amenable to thrombectomy by radiological or surgical means. Complex AV grafts may be appropriate in patients with exhausted access sites.

High prevalence of risk factors for physical illness in a long-stay psychiatric unit

Objective: The aim of this study was to determine the prevalence of risk factors for physical illness in a long stay psychiatric unit, where all care (both psychiatric and physical) is provided by the psychiatric team.Method: All patients in the long-stay ward had a full physical examination including calculation of BMI. All patients had blood sampling including FBC, U&E, LFTs, TFTs, lipid profile (total cholesterol, triglycerides, HDL and LDL), glucose, HbA1c, and prolactin. ATP111 criteria were used to determine the presence of the metabolic syndrome.Results: We found the mean number of comorbid medical diagnosis was 2.7. The prevalence of metabolic syndrome was 40.7% (44.4% of females and 24.1% of males). The prevalence of obesity was 51%, and 51% also had a total cholesterols in excess of 5.0mmol/l. Prolactin was elevated in two-thirds of female patients.Conclusion: We conclude that the annual physical examination is of limited value in long-stay psychiatric unit. The high prevalence of physical illness and physical risk factors warrants primary care involvement in screening and treatment of long-stay psychiatric patients.