Introduction: Miller Fisher syndrome (MFS) is a variant of Guillain-Barré syndrome (GBS) characterized by an immunemediated polyneuropathy. Diagnosis is largely clinical and spontaneous recovery is observed in most cases. Treatment options such as IVIg, plasmapheresis, and steroids have been studied as options to shorten the disease course, but with inconclusive results. Case: A 25-year-old male complained of sudden onset diplopia, gait instability and hand parasthesia. Diagnosis of MFS was done clinically; chest CT scan, nerve conduction studies, and MRI of brain and orbits were unremarkable. Anti-GQ1b determination was not performed. Low dose oral corticosteroid was initiated with gradual recovery of symptoms noted over two weeks and full recovery in two months. Discussion: Miller Fisher syndrome (MFS) is a rare entity and the least common of the GBS variants. Its incidence as a proportion of GBS accounts for one to five percent in Western countries. Most patients have evidence of an upper respiratory tract infection one to three weeks before symptom onset. MFS is largely considered to be a self-limiting condition, but case series have shown that patients return to normal activities approximately six months after neurological onset. The patient in this report was treated with low dose steroids, with gradual taper over two months. Significant improvement of symptoms was noted over two months, which is shorter than the six months recovery in literature. Conclusion Worldwide incidence of MFS can be underestimated as it is often overlooked during the initial work-up of the disease. The risks of treatment, therefore, should be weighed against the likelihood of spontaneous recovery. Although use of steroids in this case report have noticeably caused a shorter course of the disease, prospective studies are suggested to look into the role of low dose oral corticosteroids in shortening the onset-to-recovery course of this illness.
Miller Fisher Syndrome ; Diplopia ; Steroids

Objective: The aim of this systematic review and meta-analysis is to determine summary estimates of the diagnostic accuracy of mean platelet volume for the diagnosis of myocardial infarction among adult patients with angina and/or its equivalents in terms of sensitivity, specificity, diagnostic odds ratio, and likelihood ratios. Methodology: The primary search was done through search in electronic databases. Cross-sectional, cohort, and case-control articles studying the diagnostic performance of mean platelet volume in the diagnosis of acute myocardial infarction in adult patients were included in the study. Eligible studies were appraised using well-defined criteria. Results: The overall mean MPV value of those with MI (9.702 fl; 95% CI 9.07 – 10.33) was higher than in those of the non-MI control group (8.85 fl; 95% CI 8.23 – 9.46). Interpretation of the calculated t-value of 2.0827 showed that there was a significant difference in the mean MPV values of those with MI and those of the non-MI controls. The summary sensitivity (Se) and specificity (Sp) for MPV were 0.66 (95% CI; 0.59 - 0.73) and 0.60 (95% CI; 0.43 – 0.75), respectively. The pooled diagnostic odds ratio (DOR) was 2.92 (95% CI; 1.90 – 4.50). The positive likelihood ratio of MPV in the diagnosis of myocardial infarction was 1.65 (95% CI; 1.20 – 22.27), and the negative likelihood ratio was 0.56 (95% CI; 0.50 – 0.64). Conclusion The intended role for MPV in the diagnostic pathway of myocardial infarction would perhaps be best as a triage tool. MPV values can discriminate between those who have MI and those without. For a patient with angina presenting with elevated MPV values, it is 1.65 times more likely that he has MI. It is implied that the decision to treat a patient with angina or its equivalents as a case of MI could be supported by an elevated MPV value.
Mean Platelet Volume ; Myocardial Infarction ; Chest Pain

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