MicroRNAs (miRNAs), small nucleotide sequences that control gene transcription, have the potential to serve an expanded function as indicators in the diagnosis and progression of neurological disorders. Studies involving debilitating neurological diseases such as, Alzheimer's disease, multiple sclerosis, traumatic brain injuries, Parkinson's disease and CNS tumors, already provide validation for their clinical diagnostic use. These small nucleotide sequences have several features, making them favorable candidates as biomarkers, including function in multiple tissues, stability in bodily fluids, a role in pathogenesis, and the ability to be detected early in the disease course. Cerebrospinal fluid, with its cell-free environment, collection process that minimizes tissue damage, and direct contact with the brain and spinal cord, is a promising source of miRNA in the diagnosis of many neurological disorders. Despite the advantages of miRNA analysis, current analytic technology is not yet affordable as a clinically viable diagnostic tool and requires standardization. The goal of this review is to explore the prospective use of CSF miRNA as a reliable and affordable biomarker for different neurological disorders.

Immune thrombocytopenic purpura (ITP) is defined as an acquired thrombocytopenia with antibodies detected against platelet surface antigens, and it is the most common form of thrombocytopenia in otherwise asymptomatic adults. ITP secondary to an underlying condition is a diagnosis of exclusion that is essential to establish for treatment efficacy. Secondary thrombocytopenia caused by cytomegalovirus (CMV) is common; however, case reports associated with diagnosis in immunocompetent adults are rare, and to the best of our knowledge only 20 publications have been associated with this diagnosis. Our report is based on a clinical presentation of a 37-year-old female complaining of petechiae, heavy menses, shortness of breath, and a platelet count of 1 × 109/L. Treatment with IVIG and steroids failed to improve platelet count. Subsequently, an infectious laboratory workup was performed, detecting CMV infection, and treatment with antiviral agents was initiated, causing platelet count to increase as viral load decreased.

Austrian syndrome consists of a triad of endocarditis, meningitis, and pneumonia caused by Streptococcus pneumoniae. With the arrival of many antibiotic therapies, the disease remains rare, however, it can be overlooked due to the lack of awareness. We present a case of Austrian syndrome in an immunocompromised patient complicated by multiorgan failure.

Reports of spontaneous pneumothorax and pneumomediastinum as a complication of coronavirus disease (COVID-19) have been increasing. COVID-19 causes inflammatory disease mainly affecting the respiratory system. Severity varies from asymptomatic pulmonary findings on imaging to acute respiratory distress syndrome along with pleural effusions, consolidations and spontaneous pneumomediastinum and pneumothorax. The aim of this paper was to review the literature to explore the association between pneumomediastinum/pneumothorax and COVID-19 respiratory disease, both in patients on ventilators and without ventilators, on a spontaneous basis. To this end, we conducted a comprehensive online literature search using PubMed for articles published with the key words of ‘spontaneous pneumothorax’, ‘pneumomediastinum’ and ‘COVID-19’. Further references were obtained through cross-referencing the bibliographies cited in each publication. We found that spontaneous barotrauma is one of the complications associated with COVID-19 infection and has been observed in patients with and without mechanical ventilation. The process of pneumomediastinum and pneumothorax development is not well understood, especially in patients without underlying lung disease or on mechanical ventilation. We identified various factors that predispose to barotrauma. First, the direct infection of the Type I and Type II pneumocytes by the virus. Second, the pressure gradient between the alveoli and the pulmonary interstitium. Finally, barotrauma can occur secondary to the severe inflammatory response from the COVID-19-related cytokine storm. These conditions are all associated with severe alveolar damage and rupture of the alveolar wall that can produce pneumomediastinum and pneumothorax, both in mechanically ventilated patients and non-ventilated patients. COVID-19 is associated complications result in prolonged mechanical ventilation and length of stay, as well as overall increase in morbidity and mortality. Spontaneous pneumothorax and pneumomediastinum are two serious complications. Education regarding the adjustment of ventilation settlings in the ventilator-dependent COVID-19 patient may perhaps offset the iatrogenic component of barotrauma seen in some such patients.