Monkeypox in humans: Transmission, pathophysiology, diagnosis, treatment, prevention, and all recent updates

The Centers for Disease Control and Prevention (CDC) is monitoring an epidemic of monkeypox infection in the United States. The outbreak is now global and more than 6900 cases have already been reported. There are 83 confirmed cases among children and adolescents, as shown in the report published on November 3, 2022, in the USA. However, monkeypox in pediatric patients is still infrequent (< 0.3% of total cases). Among cases in the United States, 16 cases were in children < 5 years, 12 in the age group 5-12 years, and 55 cases in adolescents 13-17 years old. In the adolescent age group, 89% were male. For children < 12 years of age, close physical contact with an adult household with monkeypox was the primary exposure, but for adolescents, male-to-male sexual contact was found more frequently. The CDC advised United States healthcare providers to remain vigilant for patients with a rash resembling monkeypox, even if there is no history of travel to a country with high risk. This article summarizes the history and epidemiology of monkeypox with a specific emphasis on clinical features and management in pediatric patients.

Ticagrelor Versus Prasugrel in Patients With Acute Coronary Syndrome: A Systematic Review and Meta-Analysis

Limited data comparing prasugrel and ticagrelor in acute coronary syndrome are available. Online databases, including MEDLINE and Cochrane Central, were queried to compare these drugs. The primary outcomes of this meta-analysis are myocardial infarction (MI), all-cause mortality, cardiovascular mortality, noncardiovascular mortality, stent thrombosis, and stroke. The secondary outcome is major bleeding. A total of 9 studies, including 94,590 patients (prasugrel group = 32,759; ticagrelor group = 61,831), were included in this meta-analysis. The overall mean age was 62.73 years, whereas the mean age for the ticagrelor and prasugrel groups was 63.80 and 61.65 years, respectively. Prasugrel is equally effective as compared with ticagrelor in preventing MI. There was no difference between the 2 groups regarding all-cause mortality, stent thrombosis, stroke, or major bleeding. In patients with acute coronary syndrome, prasugrel is equally effective when compared with ticagrelor in preventing MI.

Large Cutaneous Squamous Cell Carcinoma: A Consequence of Elective Surgery Deferment During the COVID-19 Pandemic

Cutaneous squamous cell carcinoma (cSCC) is a common skin cancer that can be treated effectively with limited morbidity if caught and treated early with elective surgical procedures. The COVID-19 pandemic caused most healthcare facilities to delay or defer elective surgeries as they allocated workforce and resources to treating significant increases of critically ill patients. This care delay has increased morbidity and mortality of many conditions treated with surgery. A few case reports exist on delayed elective surgeries' effects on patients and healthcare facilities. We report a case of cSCC enlarging and locally spreading due to elective surgery delay during the COVID-19 pandemic.

Role of Sodium-Glucose Co-Transporter 2 Inhibitors in Chronic Kidney Disease, Congestive Heart Failure and Stroke-A Review and Clinical Guide for Healthcare Professionals

Diabetic kidney disease (DKD) causes a progressive decline in renal function, leading to end-stage kidney disease (ESKD), and increases the likelihood of cardiovascular events and mortality. The recent introduction of the sodium-glucose co-transporter 2 (SGLT-2) inhibitor has been a game changer in managing chronic kidney disease (CKD) and congestive heart failure (CHF). These agents not only slow down the progression of kidney disease but also have cardioprotective benefits, including for patients with congestive heart failure and atherosclerotic cardiovascular disease. Some evidence suggests that they can decrease the risk of stroke as well. This review aims to provide a comprehensive overview of the role of SGLT-2 inhibitors in CKD and CHF and their efficacy in stroke prevention. This review includes a comparison with glucagon-like peptide-1 (GLP-1) agonist and finerenone; focuses on safety data, the potential benefits beyond glycemic control, and a review of significant trials; and provides guidance in clinical practice.

Polymyositis: A Rare Cause of Acute Respiratory Failure and a Diagnostic Dilemma

Polymyositis is an autoimmune multisystemic disorder that affects the body's muscular system. It usually affects the proximal muscles of the shoulder, pelvis, neck flexor muscles, and sometimes, the hip extensor muscles. However, it can also affect the diaphragm causing acute respiratory failure. This case report educates clinicians about the atypical presentation of polymyositis, diagnosis, and treatment of this disease. It also emphasizes the importance of looking for an alternative diagnosis such as polymyositis when the treatment for the more common diagnoses such as community-acquired pneumonia does not improve the patient's respiratory status.

Pseudo-Thrombotic Thrombocytopenic Purpura Due to Severe Vitamin B12 Deficiency: A Case Report

Vitamin B12 deficiency is common in vegetarians, as meat is a common source of vitamin B12. In this case presentation, a patient presented to his primary care doctor with signs of severe vitamin B12 deficiency anemia. He had elevated lactate dehydrogenase levels, indirect bilirubin, and schistocytes on the blood smear, all pointing toward a hemolytic process. A severe vitamin B12 deficiency was deemed the cause of this hemolytic anemia after ruling out other causes. We highlight the importance of knowing more about this pathogenesis to avoid unnecessary workup and management for an elementary disorder that can result from severe B12 deficiency.

Nivolumab-Induced PRES (Posterior Reversible Encephalopathy Syndrome)

PRES (posterior reversible encephalopathy syndrome) is a clinical-radiographic syndrome comprising clinical symptoms, including headache, vision abnormalities, nausea/vomiting, seizures, and posterior cerebral white matter edema seen as radiographic changes. Commonly, PRES is known to occur with severely elevated blood pressure, or eclampsia. However, in recent times, increasing cases of PRES have been observed in patients being treated with immunotherapy or chemotherapy. Nivolumab is an immunotherapy used in the treatment of various cancers and is an increasingly identified cause of PRES. A few case reports exist in the literature. We report a case of nivolumab-induced PRES.

Type 1 Pulmonary Hypertension and Silicosis in a Bluestone Cutter: A Case Report on Raising Awareness

This case report describes a patient who developed pneumoconiosis in the form of silicosis and group 1 pulmonary hypertension (PH) due to his unprotected work as a bluestone cutter. Bluestone is a type of sandstone used in outdoor construction commonly in the North-east region of the US. In the literature and to our knowledge, blue stone mining has not been viewed as a risk factor for pneumoconiosis. This case report aims to increase awareness about this occupational hazard. Additionally, it is known that chronic silicosis with massive pulmonary fibrosis can lead to hypoxemia and group 3 pulmonary hypertension. This case, however, demonstrates a possibility of silica dust exposure leading to group 1 pulmonary arterial hypertension.

Management of Renal Cell Carcinoma With Intra-atrial Tumour Thrombus: A Case Report

Renal cell cancer (RCC) is at times associated with intravascular tumour thrombus (TT), which in rare cases can extend to the right atrium. The management of RCC with intravascular tumour thrombus is complex and requires a multidisciplinary approach involving urologists, vascular surgeons, and cardiologists. The pre-operative workup is extensive and includes imaging studies to determine the extent of the tumour thrombus and assess the patient's overall health status. Here, we present a case report detailing the operative and perioperative management of a patient presenting with renal cell cancer and intravascular TT.

The 2022 Monkeypox Epidemic and What Has Led to the Current State of the Disease in the US: A Systematic Review

Monkeypox virus (MPOX) is a zoonotic disease in humans. It is similar genetically to its virus family member, smallpox. This virus has been studied since the 1970s. The virus remains endemic to the Congo and West African regions, but non-endemic spreads have been cited. The most recent non-endemic outbreak in the spring of 2022 amidst the current COVID-19 pandemic is of interest due to its impact on global medical, economic, and societal climates. This literature review aims to highlight the virology, clinical signs and symptoms, diagnosis, prevention, and treatment of MPOX and discuss the social implications of the recent 2022 outbreak. We hope this review can pinpoint important clinical pearls of the MPOX virus and its societal impacts to further promote important discussion of this virus and its disease.

Pediatric Sickle Cell Disease and Stroke: A Literature Review

Both ischemic and hemorrhagic strokes in children can be a complication of sickle cell disease, which also affects adults. The occurrence is high without any screening or preventative care. This review article found that although transcranial Doppler (TCD) has reduced the prevalence of stroke in pediatric patients, there is still a need for an epidemiological survey to define such screening for adults, the ideal dose of hydroxyurea to reduce the incidence of stroke, and to identify silent cerebral stroke to prevent its complications. Increased hydroxyurea prescription and specific antibiotic and vaccination regimes lowered the occurrence of this condition. In pediatric cases with a time-averaged mean of the maximal velocity greater than 200cm/s, transcranial Doppler screening and preventive chronic transfusion for at least the first year have lowered the occurrence of stroke by up to 10 times. The ideal dose of hydroxyurea is still debatable, but it seems to reduce the risk of the first stroke to a comparable level in the average population. Adult ischemic and hemorrhagic stroke prevention has not yet received the same attention. Though there are fewer studies, sickle cell disease is also more common than age-matched controls in terms of silent cerebral infarction on magnetic resonance imaging (MRI), as well as other neurological problems such as cognitive impairment, seizures, and headaches. Currently, there is no evidence-supported way to prevent ischemic stroke in adults at any age. Also, there is no defined ideal dose of hydroxyurea that can be helpful in preventing strokes. Data also lack a way to identify a silent cerebral infarction, so its complications can be prevented. An additional epidemiological survey may help in the prevention of the condition. The primary aim of this article was to emphasize the importance of information on clinical, neuropsychological, and quantitative MRI assessment of sickle cell patients to understand the epidemiology and etiology of stroke in sickle cell patients to prevent stroke and its related morbidity.

Tizanidine Toxicity From Ciprofloxacin: A Cautionary Tale

Tizanidine is an alpha-2 adrenergic agonist used commonly by medical professionals to treat patients' chronic spasticity, muscle spasms, and neuralgia usually associated with myofascial components. This medication is also used very frequently in detoxification centers on patients treated for analgesic withdrawal, especially those who are suffering from rebound headaches due to the discontinuation of analgesics. Tizanidine is metabolized in the human body by the cytochrome P450 CYP1A2. On the other hand, ciprofloxacin is a common antibiotic belonging to the class of fluoroquinolones and is used to treat various infections. Ciprofloxacin inhibits the bacterial DNA-gyrase enzyme resulting in the destruction of the organism. Ciprofloxacin is also an inhibitor of the cytochrome P450 CYP1A2. Even though these two medications show obvious interaction still, however, both these medications are often prescribed together, and their interactions/contraindications are often overlooked by many physicians and other providers. We hereby describe the case report of the interaction between tizanidine and ciprofloxacin, along with the adverse outcome related to the concomitant use of these two drugs.

Sleep-disordered breathing, sleep apnea, and other obesity-related sleep disorders: An Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) 2022

Background

This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) provides clinicians an overview of sleep-disordered breathing, (e.g., sleep-related hypopnea, apnea), and other obesity-related sleep disorders.

Methods

The scientific support for this CPS is based upon published citations, clinical perspectives of OMA authors, and peer review by the Obesity Medicine Association leadership.

Results

Obesity contributes to sleep-disordered breathing, with the most prevalent manifestation being obstructive sleep apnea. Obesity is also associated with other sleep disorders such as insomnia, primary snoring, and restless legs syndrome. This CPS outlines the evaluation, diagnosis, and treatment of sleep apnea and other sleep disorders, as well as the clinical implications of altered circadian system.

Conclusions

This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) on "Sleep-Disordered Breathing, Sleep Apnea, and Other Obesity-Related Sleep Disorders" is one of a series of OMA CPSs designed to assist clinicians in the care of patients with the disease of obesity.

Hepatitis B Vaccine and Multiple Sclerosis: Cause or Coincidence

Multiple sclerosis (MS) is an autoimmune disease in which the body’s immune system destroys myelin causing disruption of signals from the brain to the rest of the body. MS can be triggered by a variety of reasons. In this study, we present the case of a patient who developed neurological symptoms immediately (one day) after receiving the hepatitis B vaccine. The temporality of symptoms makes us question whether there is an association between the hepatitis B vaccine and MS. We would like to emphasize the importance of considering MS as a side effect of the hepatitis B vaccine and adding MS to the differential diagnosis of a patient who presents with neurological symptoms after receiving the hepatitis B vaccine.

[A case of carcinoma corporis by intra-arterial hypertension chemotherapy]

We report a case in which bone metastasis from carcinoma corporis was treated by intra-arterial hypertension chemotherapy. The patient was a 53-year-old female whom we treated by intra-arterial hypertension chemotherapy of CDDP 80 mg and ADM 30 mg with Angiotensin II. Four weeks later she underwent abdominal total hysterectomy, bilateral salpingo-oophorectomy and right common iliac lymph nodes resection. The response of intra-arterial hypertension chemotherapy was charged microscopically. About half (Grade I b) the carcinoma tissue was necrosed.