This case report highlights a unique case of brain fog in a COVID-19 patient suggesting COVID-19's neurotropic nature. COVID-19 is associated with a long-COVID syndrome that presents with cognitive decline and fatigue. Recent studies show the emergence of a novel syndrome known as post-acute COVID syndrome or long COVID, which constitutes a variety of symptoms that continue for four weeks following the onset of a COVID-19 diagnosis. Numerous post-COVID patients experience both short and long-lasting symptoms affecting several organs, including the brain, which includes being unconscious, bradyphrenia, or amnesia. This long COVID status comprises of "brain fog", which, coupled with neuro-cognitive effects, has a significant role in prolonging the recovery phase. The pathogenesis of brain fog is currently unknown. One of the leading causes might be the involvement of neuroinflammation due to mast cells stimulated by pathogenic and stress stimuli. This in turn, triggers the release of mediators that activate microglia, causing inflammation in the hypothalamus. Its ability to invade the nervous system through trans-neural or hematogenous mechanisms is possibly the chief cause behind the presenting symptoms. This case report highlights a unique case of brain fog in a COVID-19 patient suggesting COVID-19's neurotropic nature and how it may lead to neurologic complications such as meningitis, encephalitis, and Guillain-Barré syndrome.
Atrial fibrillation as an initial presenting symptom of an apathetic thyroid storm is under-reported, especially in the setting of undiagnosed hyperthyroidism. Very rarely, thyroid storm can present with apathetic symptoms. The author presents a case of apathetic thyrotoxicosis with atrial fibrillation. The patient had a generalized weakness, lethargy, and weight loss as initial symptoms and was found to have atrial fibrillation, which was initially thought to be the inciting event. However, further evaluation revealed a new diagnosis of apathetic thyroid storm secondary to uncontrolled Graves' disease. She was managed medically for thyroid storm with hopes to control the tachyarrhythmia by controlling the underlying etiology. Subsequently, her symptoms resolved, and she came back to baseline except for continued atrial fibrillation, which was rate controlled. Early recognition of an apathetic thyroid storm can prevent mortality and morbidity as it can often be missed due to atypical symptoms.
Background: Alzheimer’s disease is a severely debilitating disease that affects the number of elderly across the world. People especially the caregivers are bit reluctant to take care of such patients particularly because of the rapid progression of the disease and very little hopes of them to recover. Aim: To evaluate the awareness, approach and care giving attitude of medical students towards the patient suffering from Alzheimer’s disease. Methods: A cross sectional study was carried out on medical undergraduates in CMH LMC IOD. A questionnaire including demographic profile, 11 awareness and 11 attitude questions was fulfilled by 384 students. Results: Overall,>90% people knew he basic knowledge like primary symptoms, age of onset, genetic predisposition and role of gender in getting disease. About 75% students know about the treatment options, mortality rate and diagnostic techniques. Awareness score revealed that 85% of students had adequate information about Alzheimer’s disease. MBBS students and nursing Students had considerably enhanced understanding in contrast with other undergraduates. As far as attitude is concerned,>70% of students demonstrated positive attitudes amongst which the nursing students were on top. Conclusion: The undergraduates demonstrated better knowledge and positive attitude care giving skills attitudes towards patients of Alzheimer’s disease with a noticeable differentiation as far as various disciplines are concerned. Additional attempts are still needed to remove the stigma and hesitation concerned with such patients. Keywords Alzheimer’s disease, Elderly, Distress, and Stigma Knowledge
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