Concomitant acute transverse myelitis (ATM) and Guillain-Barre syndrome (GBS) is described as GBS and ATM overlap. Its presentation varies greatly, thus making the diagnosis difficult. Overlap syndrome is more commonly associated with acute motor axonal neuropathy (AMAN) subtype of GBS. However, we present a case of a middle-aged gentleman with combined ATM and acute motor and sensory axonal neuropathy (AMSAN) subtype of GBS. This combination is quite rare, and only a few cases have been reported so far.

Valproic acid, a broad-spectrum anticonvulsant drug, commonly causes elevated ammonia levels, which is usually asymptomatic in most cases. On rare occasions, potentially fatal hyperammonemia-induced encephalopathy can occur. We present a case of a 24-year-old female who presented to the emergency department with status epilepticus that was being managed with valproic acid. Further workup was done because of prolonged postictal state, which revealed increased ammonia levels; she was eventually diagnosed with valproic-induced hyperammonemic encephalopathy. Discontinuing valproic acid resulted in drastically improved symptoms and a gradual decline in ammonia levels. A clinician should be aware of rare drug adverse effects and drug interactions to conclusively reach the correct diagnosis. A prolonged postictal state should warrant further workup to rule out other possible etiologies.

In stroke patients, a high neutrophil-to-lymphocyte ratio (NLR) has been associated with poor functional outcome at 3 months, higher mortality, and a higher hemorrhagic transformation. We assessed the role of NLR in patients with acute ischemic stroke who received thrombolysis. The charts of 98 patients treated between 2015 and 2019 were retrospectively reviewed. The mean NLR was compared using an independent Student's t test. At 3 months, a good functional outcome was seen in 31 patients (32%) and a poor functional outcome was seen in 67 patients (68%). Patients with NLR >2.39 had a poor functional outcome (odds ratio 2.7; 95% confidence interval 1.11-6.39; P < 0.02). Our study revealed that patients who present with acute ischemic stroke and have an increased NLR at the time of administration of thrombolysis have a poor functional outcome at 3 months.

Introduction The efficacy of high-resolution computed tomography (HRCT) chest in common respiratory infections is well-established; however, its use in the diagnosis of COVID-19 pneumonia is less popular. The previous studies have failed to establish the efficacy of HRCT in the diagnosis of COVID-19 pneumonia. Objective The current study aimed to assess the efficacy of HRCT as compared to a polymerase chain reaction (PCR) in diagnosing COVID-19 pneumonia in patients in our setting. Methodology A prospective observational study was conducted at the Department of Chest Medicine, Shifa International Hospital from April 2020 to December 2020. A total of 250 patients were admitted to medical intensive care units. Findings of HRCT and PCR were documented. The accuracy of HRCT compared with PCR was assessed. Data were analyzed using SPSS version 24 (IBM Corp., Armonk, NY). Results COVID-19 infection was more prevalent in male patients (62.8% vs 37.2%). The mean age was 60 years (interquartile range, IQR, 49-72). Sensitivity and specificity of HRCT segregated into typical, indeterminate, and atypical HRCT were (94.8%, 56.8%), (92.7%, 47.2%), and (91.7%, 76.8%), respectively. The positive predictive value for typical HRCT was 84.3% (p≤0.001). Conclusion We concluded that typical HRCT findings have diagnostic utility in the diagnosis of COVID pneumonia. Similarly, a negative HRCT chest reliably excludes the possibility of COVID pneumonia. HRCT chest is a reliable alternative to RT-PCR.

Typhoid, otherwise known as enteric fever, and measles both have a high incidence worldwide. However, a coincidence of both has been only documented twice previously in 1866 and 1949. We present a case of a 24-year-old male who presented with high-grade fever and diffuse abdominal tenderness. He was diagnosed with typhoid initially, but during the course of his illness, he developed a maculopapular rash and pathognomonic Koplik’s spots. Further investigations confirmed measles that was concurrent with typhoid. This highlights the importance of further comprehensive investigations even in diagnosed cases, and that overlapping symptoms should raise the clinical suspicion of concurrent diseases. One should always keep an open mind when assessing a patient, not just at the time of making a diagnosis but throughout the course of illness.