I am involved in the care of a 49 year old patient who returned from a trip in Vietnam. A week and a half ago, when he was still in Vietnam, he claims to have had a fever and was diagnosed with dengue fever (there are no medical notes available). Now, he has presented with bilateral lower limb heaviness. Power in both legs is 3/5 and absent tendon reflexes in lower limbs with downgoing plantars. His blood work shows thrombocytopenia, leukopenia, mild hyponatremia, and mild transaminitis. Hemoglobin is normal and fever has gone. Nerve conduction studies show demyelinating polyneuropathy, predominantly involving motor nerves. It appears he is suffering from Guillain-Barre syndrome. Is this consistent with dengue fever? We have not started immunotherapy as the symptoms don't seem to be ascending at the moment.

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Hi colleagues, I was wondering if anyone could help me with a  21 year old patient. She presented to emergency with a few days' history of upper and lower limb weakness, resulting in falls. 

Her past medical history is quite significant - over the last 12 months, she has visited the ER on 8 separate occasions with abdominal pain and dysuria. Bloods including blood count, inflammatory markers and renal function, were always normal. The CT abdomen and pelvis on one of her admissions was also normal. On another occasion, she had an endoscopy, which showed gastritis, and was discharged with analgesia and PPI. Other times, she was discharged with antibiotics for UTIs. She had also been referred to the mental health team for ?eating disorder as she has had reduced oral intake with sequential weight loss of 10kg and BMI of 14.5. 

On THIS occasion, examination revealed right upper arm weakness but no sensory deficit. Abdomen was soft and non-tender. She was tachycardic and hypertensive, and hyponatraemic at 121mmol/L (serum). Inflammatory markers, renal function, cortisol and TSH remained normal. Unfortunately, treatment with NaCl dropped her sodium further to 114. Osmolalities and electrolytes were suggestive of SIADH. 

What are your differentials for a young female with recurrent abdominal pain, hyponatremia, neuropathy, and neuropsychiatric symptoms? And what further investigations would you do? 

Any ideas would be greatly appreciated. Thank you for your collaboration.  

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Muscle involvement and peripheral nerve affection are common problems after infection with coronavirus disease 2019 (COVID-19), even among individuals who were asymptomatic, according to a study published in the International Journal of Rheumatic Diseases.

The purpose of this real-word evidence (RWE) cohort study was to evaluate whether utilization of Cyclical Pressurized Topical Oxygen (TWO2) therapy had any impact on the incidence of Diabetic Foot Ulcer related hospitalizations and amputations over a 12-month period in patients with hard to heal Diabetic foot Ulcers (DFU). An IRB approved retrospective review of deidentified DFU patient medical records was conducted at 2 US Veterans Affairs Medical Centers in Illinois and Virginia, which included demographic information on wound characteristics, clinical characteristics, neuropathy, cardiovascular disease (CVD), peripheral vascular disease (PVD), pain levels and kidney disease etc. Within the unmatched cohorts of the 202 DFU patients (91 TWO2, 111 NO TWO2)there was an 88% reduction in hospitalizations and a 71% reduction in amputations over a 12-month period for the patients treated with TWO2 therapy compared to those that did not receive TWO2 therapy. Propensity score matching was conducted showing similar outcomes and a regression analysis as preformed along with a budget impact model which demonstrated significant cost saving to the payor system. This large RWE study demonstrates the TWO2 therapy positively impacts patients quality of life and the costs associated with treating their DFU by forcing them into remission, resulting in significantly reduced rates of hospitalizations, amputations and cost outlay. 

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