Background: Neurofibromatosis-2 (NF2) is a rare neurocutaneous syndrome that typically presents with hearing loss, tinnitus, or weakness associated with few subcutaneous nodules. In contrast to neurofibromatosis-1 (NF1), NF2 presents clinically with more central lesions rather than peripheral lesions. The presence of bilateral vestibular schwannomas through imaging studies distinguishes NF2 from other neurocutaneous syndromes. Case: This is a case of an 18-year-old male who presented with lower paraparesis with associated hearing loss, cataract, and a few subcutaneous nodules. Centrally located lesions were suspected, thus brain and spine magnetic resonance imaging (MRI) were done revealing bilateral vestibular schwannomas and spine neurofibromas. The patient and family were advised for tumor surveillance, and apprised of surgical intervention once with brainstem compression symptoms. Conclusion NF2 is a rare debilitating disease that may lead to multiple neurologic deficits. The absence of recommended medical treatment and the multifocality of the tumors leave surgical resection a high-risk treatment option. Early recognition by tumor surveillance may give patients with NF2 a better prognosis and survivability.
Neurofibromatoses ; Neurilemmoma ; Neurofibroma ; Paraparesis ; Bevacizumab

Introduction: Gitelman Syndrome (GS), a rare autosomal recessive inherited disorder, is frequently unrecognized in the clinical setting. GS typically manifests with severe hypokalemia with debilitating and potentially fatal consequences if untreated. As of writing, confirmatory genetic assays are currently unavailable in the country, and the diagnosis of GS is primarily based on several biochemical laboratory tests. This results in the difficulty with prompt diagnosis of GS in the locality. Case: We present a 52-year-old male who came in with chronic, intermittent paraparesis associated with persistent hypokalemia. A diagnosis of GS was made biochemically based on renal wasting of potassium and magnesium, hypocalciuria, and metabolic alkalosis. Electrolyte correction with lifelong supplementation, and administration of Spironolactone resulted in the resolution of bilateral leg weakness. Electrolyte levels were maintained within normal limits in the outpatient setting. Conclusion GS is an uncommon potentially debilitating disorder that may lead to problematic, potentially fatal consequences to electrolyte abnormalities if left untreated. The lack of awareness and consequent delay in the diagnosis, and the unavailability of confirmatory genetic testing remains a clinical challenge. Timely recognition and initiation of treatment leads to early control of electrolyte levels, and better prognosis.
Gitelman&rsquo ; s Syndrome ; Paraparesis ; Hypokalemia ; Hypomagnesemia ; Spironolactone ; Case Report

Background: Studies on previous viral pandemics showed poorer outcomes of patients with concomitant bacterial infection. During the early period of COVID-19 pandemic, empiric antibiotic therapy is commonly given among COVID-19 patients despite lack of strong recommendations for its use. Objectives: We determined the prevalence of bacterial co-infection and of empiric use of antibiotics among COVID-19 admissions. We also determined association between COVID-19 severity, ICU admissions, length of hospital stay, and mortality outcomes of those with and without bacterial co-infection. Methods: A total of 159 patients hospitalized with COVID-19 from April 2020 to April 2021 were analyzed in this crosssectional chart review study. Data on empiric antibiotic administration and cultures taken within 3 days of admission were collected. Chi-square, Fischer-Exact, and T-tests were used to analyze the data. Results: Empiric antibiotics were given in 94.97% of COVID-19 admissions with azithromycin as the most common agent. The prevalence of bacterial co-infection among COVID-19 admitted patients was 10%. There were higher ICU admissions and longer hospital stay among those with bacterial co-infection although it did not reach statistical significance. No mortality was seen among patients with bacterial co-infection. Conclusion There was a high use of empiric antibiotic treatment in hospitalized COVID-19 patients despite the low prevalence of bacterial co-infection among these cases. This warrants development of strategies for antimicrobial stewardship programs especially during the COVID-19 pandemic.
COVID-19 ; Pneumonia