Despite the recent advances in HIV treatment, HIV-associated neurocognitive disorder (HAND) prevalence remains high, especially in the mild forms. Current recommendations endorse routine screening for HAND and early identification, but there are several obstacles in diagnosing and managing cognitive impairment in people living with HIV. The purpose of this review is to provide an overview of the concepts and diagnostic tools in the field of HAND and report on the strengths and limitations of currently available approaches.
Infections are a significant cause of movement disorders. The clinical manifestations of SARS-CoV-2 infection are variable, with up to one-third of patients developing neurologic complications, including movement disorders. This scoping review will lay out a comprehensive understanding of movement disorders induced by SARS-CoV-2 infection. We aim to investigate the epidemiology, clinical and paraclinical features, interventions, and diagnostic challenges in patients with different types of movement disorders in the context of SARS-CoV-2 infection. We will search three databases applying appropriate search terms. Inclusion and exclusion criteria are pre-defined; the data of eligible studies will be extracted in standardized forms. We will report the results following Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). We will present information for clinicians and other healthcare professionals, policymakers, and public health researchers. In addition, the results of the present review may assist in the development and confirmation of inclusion criteria and research questions for further systematic review or meta-analysis, with more precise, narrower questions.
Hypersensitivity pneumonia (HP) is an inflammatory lung syndrome due to repetitive exposure to small organic particles. The etiological agents of the disease are diverse and can be represented by fungi, bacteria, small molecule chemical compounds, as well as proteins from animals or insects. We present the case of a 25-year-old male, who was admitted to our Pulmonology Clinic for the following symptoms: morning cough with mucosal sputum for about 2 years, moderate exertional dyspnea (mMRC 3) started for 2 months, weight loss of about 6 kg in the past 5 months and fatigue. Clinical examination revealed bilateral mid- basal crackling rales. Chest high-resolution computed tomography (HRCT) (multiple micronodular opacities, diffuse contoured, bilaterally disseminated), lung function tests (restrictive ventilatory dysfunction with decreased carbon monoxide diffusing capacity), bronchoalveolar lavage (BAL) (lymphocyte alveolitis) and serological tests (positive antibodies for pigeon heathers and dejections) pointed to the diagnosis of hypersensitivity pneumonitis. It was recommended to avoid exposure to pigeons, as the patient was a pigeon breeder. Prednisone treatment was initiated. The general condition of the patient 1 month after diagnosis had improved, the evolution being good under treatment.
Cryptogenic organising pneumonia (COP) is an interstitial lung disease, with an unknown aetiology. Treatment is based on oral corticotherapy, starting with attack doses given for 2–6 weeks, followed by gradual tapering over a period of 3–6 months. Relapses are common, especially in the first year. A 51-year-old patient, former smoker, without exposure to noxious substances, presented to the hospital in January 2020 with fever, dry cough and malaise. On chest radiography, lesions suggestive of bronchopneumonia were revealed and antibiotic treatment was started. The patient did not respond to treatment and chest Computed tomography (CT) was performed, which detected pulmonary condensations, predominantly with a subpleural disposition, predominantly in the lower lobes, as well as pleural effusion and minimal pericarditis. Due to the unfavourable disease evolution despite treatment and according to other investigation results, COP diagnosis was raised and oral corticotherapy was prescribed, with a favourable response. The patient complained of reappearance of the initial symptoms at dose weaning and she was reassessed by CT in June 2020. The Coronavirus Disease 2019 (COVID-19) pandemic raised the suspicion of a severe acute respiratory syndrome coronavirus-2 (SARS-COV2) infection, which was infirmed later. Corticotherapy was resumed, and at a check-up after 10 months, broncho-alveolar lavage was performed, with results within normal limits. The evolution of the patient was favourable. In conclusion, in the case of a pneumonia in which there is a discrepancy between the clinic, biologic and imagistic (possibly with a migratory pattern) and the response to treatment, COP must also be considered. Relapses are relatively common, and may occur both during corticotherapy dose reduction and after the end of treatment.
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