Palatal tremor (PT) (or myoclonus) is a rare movement disorder comprising 2 forms: essential PT (EPT) and symptomatic PT (SPT). c The rhythmic movement of the PT may be unilateral or bilateral with partial or complete rhythmicity. During sleep, tremor ceases in EPT but not in SPT. c Treatment for SPT includes medication such as valproate, clonazepam, or trihexyphenidyl; botulinum toxin has been successful in only a few reported cases. Oysters c Examination of the palate and careful review of imaging should be done in patients who present with progressive ataxia to recognize the clinical syndrome of progressive ataxia and PT. c MRI may demonstrate olivary pseudohypertrophy with contrast enhancement in PT and should not be confused with malignancy or stroke.

Background Sudden clinical deterioration in coronavirus disease 2019 (COVID 19) patients may be caused by thoracic air leaks. In this review, we aimed to identify the risk factors predisposing to the development of alveolar air leak and outcomes in COVID 19 patients. Method Analysis of 33 studies of COVID – 19 who developed air leaks, published between April 20 to Aug 27, 2020, reviewed. Result Twenty-one females (16.8%) and 104 males (83.2%) were included in this study. Their median age was 44.75 years, ranging from 27.5 to 60.0. Of the 125 patients, 100(80%) developed Spontaneous pneumothorax, 47 (37.6%) had pneumomediastinum, and 37 (29.6%) presented with subcutaneous emphysema. A chest tube was inserted in 63 (50.4%) patients, 97 (77.6%) received supplemental oxygen, 56 (44.8%) required mechanical ventilation, 64 (51.2%) were admitted to the Intensive Care Unit (ICU), 42 (33.6%) were admitted to the floor, and 35(28%) developed acute respiratory distress syndrome. The median length of hospital stay was 12 days (interquartile range=5.6–17.25), 57 (45.6%), patients were discharged with a median length of stay of 9 days (5.25-16.5), while mortality was reported in 29 patients (23.2%) after a longer hospitalization of 15 days (6.0-18.0). Of those who expired, only one was a smoker, and another had chronic obstructive pulmonary disease. Conclusion In COVID-19 disease, air leaks may cause potentially fatal outcomes even in formally stabilized non-smoker patients. Therefore, physicians should be aware of the development of occult air leak disease in rapidly deteriorating cohorts.

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Background: An outbreak of novel coronavirus (SARS-CoV-2) was observed on December 2019 in Wuhan, China which led to a global pandemic declared in March 2020. As a consequence, it imposed delirious consequences in patients with underlying co-morbid conditions that make them immunocompromised. The purpose of this paper is to provide an in-depth review of influence of COVID-19 in patients with underlying HIV in terms of mortality and hospitalization. Authors also aim to provide a thorough risk analysis of hospitalization, ICU admission and mortality of PLWH and COVID-19. The secondary objective was to analyze the CD4+ count variations and outcome of COVID-19 and to correlate if ART provided a protective role. Authors also aim to provide an evaluation of typical clinical presentation of COVID-19 in PLWH. ART is found to show activity against SARS-CoV-2 in vitro, and there is some similarity in the structure of HIV-1 gp41 and S2 proteins of SARS-CoV since they both belong to +ssRNA type. Methods: We conducted a literature review using search engines namely, Cochrane, PubMed and Google Scholar. The following keywords were targeted: "COVID-19," "SARS-CoV-2," and "HIV." We included case reports, case series, and cohort (retrospective and prospective) studies. We excluded clinical trials and review articles. We came across 23 articles that met the inclusion criteria. PRISMA guidelines were followed for study acquisition (Fig. 9). Results: From the 23 studies, we found a total of 651 PLWH with confirmed COVID-19 (549, 91, and 11 in cohorts, case series, and case reports, respectively). The overall risk of hospital admission from pooled data of the 23 reviewed articles was 69.13% (450/651), ICU admission was 12.90% (84/651) in total infected patients, and 18.67% (84/450) among hospitalized patients. The overall case fatality rate from the 23 reviewed articles was 11.21 (73/651).A weak positive correlation was found between CD4+ counts and hospital admissions in case series and case reports, while the weak negative correlation was found in cohorts. For mortality, there was a negative weak association in the cohorts and in case series, while a weak positive was seen in case reports (Fig.7). We assessed the presenting symptoms of PLWH with COVID-19, and our review demonstrated this group does not greatly differ from the rest of the population, as their common presenting symptoms were cough, fever, and SOB. Conclusion: Our results indicated that there was a high rate of hospitalization, ICU admission, and mortality among patients living with HIV and COVID-19. PLWH needs to be noted as a high-risk group for COVID-19 complications and severity. We recommend that PLWH be closely monitored by their physicians and strictly adhere to antiretroviral therapy and standard universal COVID-19 precautions.