Brain fog is one of the most well-known sequelae of long COVID. It causes cognitive problems, mostly short-term memory disturbances, attention impairments, and problems with concentration. Although trials for treatment methods for brain fog have been carried out worldwide, effective methods have not yet been reported. Neurofeedback is effective for several common disorders and symptoms, including anxiety, depression, headaches, and pain. Neurofeedback is also reported to improve cognitive functions, such as processing speed and executive functions, including attention, planning, organization, problem-solving, and performance. Furthermore, neurofeedback is effective for "chemofog" and "chemobrain," which occur after chemotherapy and cause cognitive impairments in a similar manner to brain fog. However, there have been no reports of neurofeedback treatments for brain fog. Therefore, we have started to develop an original neurofeedback treatment method for brain fog using a Z-score neurofeedback technique. In this study, we present the first case report of a patient who has successfully recovered from brain fog via neurofeedback. Pain and psychological assessments revealed that the patient's pain improved and that the patient recovered from anxiety. Electroencephalograph data revealed several noble findings. C4 was thought to be the most affected site by brain fog, and this improved after treatment. The percentage increase at alpha wavelengths increased at almost all sites, and beta 1, beta 2, beta 3, and Hi beta decreased at almost all sites. The increased values at theta and alpha wavelengths after the 1st and 2nd sessions and the decreased values at higher beta wavelengths, such as beta 3 and Hi beta, were shown at all sessions.

Coronavirus disease 2019 (COVID-19)-induced pericarditis and pericardial myocarditis are common entities; however, the development of pericardial effusion post-COVID-19 infection has only been reported in about 5% of cases. Rapid and acute progression to pericardial tamponade is uncommon, and progression to effusive constrictive pericarditis (ECP) and pericardial decompression syndrome (PDS) is an even rarer phenomenon. We describe these phenomena in this report to raise awareness and aid clinicians in the early diagnosis and management of these conditions. We report a case of a 45-year-old female with a past medical history of recent COVID-19 infection, uncontrolled diabetes mellitus, and hypertension who presented with severe chest pain, which was determined to be acute pericarditis post-COVID-19 infection. The patient developed a large pericardial effusion leading to cardiac tamponade within one day of initial presentation. Urgent pericardiocentesis was performed but was complicated by rapid decompensation of the patient, which has been assumed to be ECP following pericardiocentesis and PDS.  Close monitoring of acute pericarditis with pericardial effusion is required in these patients for the early detection of cardiac tamponade, which requires urgent pericardiocentesis. Judicious post-pericardiocentesis follow-up is also required for the early diagnosis of conditions such as ECP and PDS. These cases are generally managed symptomatically, but in cases of severe ECP syndrome, pericardial stripping may be required.

Leukostasis is a non-infectious complication of acute leukemia. Pathophysiologically, it is characterized by an accumulation of blasts in the pulmonary capillaries. Clinically, this syndrome of hyperleukocytosis or leucocytosis leads to pulmonary and/or neurological lesions. This is why it must be treated urgently to prevent it from progressing to acute respiratory distress. In 2020, the World Health Organization (WHO) declared a pandemic caused by a novel coronavirus called SARS-CoV-2, which may cause respiratory distress or other clinical, biological, and radiological signs that some may confuse with those of leukostasis. In this context, we present a compelling case study of a 64-year-old patient with no notable pathological antecedents and not vaccinated against COVID-19, who presented with acute respiratory distress. The purpose of our article is to succeed in differentiating between the two pneumopathies, thus making it possible to orient the doctor toward the right decision-making. As known, early recognition enables timely interventions, reducing disease progression and associated complications while also preventing unnecessary treatments, optimizing healthcare resources, and advancing medical knowledge for improved patient care in both acute leukemia and COVID-19 management.

Platypnea-orthodeoxia syndrome (POS) is a rare clinical condition characterized by positional dyspnea and/or hypoxia. We report two cases of patients with COVID-19 bronchopneumonia with a torpid evolution. Due to clinical suspicion of POS, a diagnostic workup was performed, including a bubble echocardiography, which revealed a patent foramen ovale (PFO) with early and massive passage of bubbles to the left cavities. Both patients underwent percutaneous PFO closure with a resolution of POS. Here, we present the second and third cases of POS associated with PFO successfully closed during the acute phase of COVID-19. This suggests that PFO closure could be a potential treatment option for this condition.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, commonly known as COVID-19, has been associated with various neurological complications. However, the mechanisms underlying these neurological manifestations remain incompletely understood. We present a case of a 63-year-old male who was admitted to the intensive care unit with severe COVID-19 pneumonia. Following recovery from respiratory symptoms, he was found to have weakness in the limbs. Months later, he also developed altered mental status, hallucinations, and behavioral changes. Neurological examination revealed signs consistent with polyneuropathy and autoimmune encephalitis. Further investigations, including nerve conduction studies, cerebrospinal fluid analysis, and response to steroids, supported the diagnosis of COVID-19-related polyneuropathy and autoimmune encephalitis. This is a rare presentation of COVID-19 and has only been described in a few case reports. Further research is warranted to elucidate the pathophysiological mechanisms underlying neurological sequelae of COVID-19 and to develop targeted therapeutic strategies.

We present a clinical case of a 79-year-old male admitted to inpatient care for longstanding asthenia and respiratory symptoms. Associated features were polyserositis, multiple enlarged lymphatic nodules, acute kidney injury, and heart failure. The patient's recent medical history revealed SARS-CoV-2 vaccination a week prior and an upper respiratory tract infection. The laboratory results from thoracentesis were compatible with a transudate, with no immunological stain. Epstein-Barr virus polymerase chain reaction (PCR) was positive. The thoracic, abdominal, and pelvic CT scans revealed multiple enlarged lymphatic nodules, worsening the pre-existent polyserositis and hepatosplenomegaly. The patient began to show signs of neurologic symptoms and deterioration of the global health status. An enlarged lymphatic nodule was excised and the pathology showed human herpesvirus 8 multicentric Castleman disease. The disease evolved rapidly into hematological dysfunction and blood transfusions were necessary. Even though the patient was started on high-dose rituximab therapy combined with etoposide, the disease evolved into multiorgan dysfunction with a fatal outcome.

Cerebral venous sinus thrombosis (CVST) is a rare cause of strokes and is most common in younger patients particularly those less than 50 years of age. It is more common in females than in males and is known to be associated with pregnancy, puerperium, oral contraception, congenital and acquired thrombophilia, and malignancy. Less commonly, it has been shown to be associated with infections and more recently has been found to be associated with COVID-19 infection with thrombocytopenia and the COVID-19 vaccine AstraZeneca. Rare cases have been reported in association with varicella zoster virus (VZV) infection (chickenpox) and its reactivated version of herpes zoster virus (HZV) infection (shingles). We report the case of a 68-year-old lady with herpes zoster ophthalmicus ophthalmoplegia who developed cerebral venous thrombosis (CVT).

Moyamoya arteriopathy is a condition where chronic, progressive stenosis of large intracranial arteries, primarily of the anterior circulation, results in ischemia and the growth of small, abnormal collateral vessels. There is increasing evidence that infectious pathologies, such as COVID-19, may serve as a sort of trigger, or "second hit," for the development of moyamoya arteriopathy. In this article, we present the case of a 13-year-old female with Down syndrome and unilateral moyamoya arteriopathy who developed contralateral internal carotid artery (ICA) dissection and thrombus in the setting of a positive COVID-19 test and subsequently developed rapidly progressive contralateral ICA and bilateral anterior cerebral artery (ACA) moyamoya-like stenosis. The rapidly progressive contralateral ICA and bilateral ACA moyamoya-like stenosis are likely multifactorial in nature. The contralateral ICA may have had a predisposition for injury and stenosis due to the preexisting moyamoya arteriopathy, making stenosis more likely after COVID-19-induced vascular inflammation and injury as well as after a possible thrombectomy-associated injury. Based on this presentation, patients with moyamoya arteriopathy may be at risk for rapid progression of their moyamoya pathology when exposed to catalysts, including infection, such as COVID-19, and vascular injury, such as thrombectomy-induced injury. In these circumstances, high suspicion and close monitoring are essential for addressing ischemia related to the stenosis before permanent injury.

COVID-19 had a psychological impact on the population, particularly those affected. Our objective was to investigate stress and resilience factors in the Senegalese soldiers affected during the first wave of COVID-19. Our retrospective and qualitative study included military personnel listed as contacts, suspects, or positive cases and supported by the Armed Forces Psychological Support Program during the period of isolation. The stress factors were health-related, sociological, and occupational. The conditions and the experience of isolation, stigmatization, and suspension of their professional projects were concerns for the soldiers. They had relied on personal, familial, and professional resources to cultivate resilience during the quarantine. Isolation during the pandemic showed psychological consequences, the foundations of which have been found in our study.

An HIV-negative 9-year-old female was admitted to the pediatric ward at a tertiary hospital in Johannesburg, South Africa for investigation of a suspected rheumatic disorder complicated by proteinuria. She was subsequently diagnosed with pediatric systemic lupus erythematosus complicated by class IV lupus nephritis. Further into her admission, the patient developed hospital-acquired SARS-CoV-2 infection with mild clinical symptoms. Three weeks after her initial COVID-19 diagnosis, the patient developed multisystemic inflammatory syndrome. She was successfully treated with intravenous immunoglobulin therapy, intravenous corticosteroids, and thromboprophylaxis.

There is evidence that COVID-19 vaccines may affect the lymphatic system. We report a case of a 40-year-old female who had undergone lymph node transfer for treating primary lymphedema of the legs. Six months later, the patient developed lymphedema of the right arm closely related to mRNA vaccination against COVID-19.

Paraguay is currently facing a new outbreak of Chikungunya virus. This report summarizes two severe cases of Chikungunya (CHIKV) infection, confirmed by real-time reverse transcription polymerase chain reaction. We present the cases of patients with acute CHIKV infection and multisystem involvement, with fever, rash, abdominal pain, vomiting, myocarditis, and coronary artery anomalies, very similar to the cases described in MIS-C related to SARS-CoV-2 during the COVID-19 Pandemic. Both patients received IVIG and methylprednisolone, with good clinical response. In this setting of cytokine storm in Chikungunya, can we call it "Multisystem inflammatory syndrome associated with Chikungunya"?.

Autonomic nervous system (ANS) regulation in hereditary angioedema (HAE) and coronavirus disease 2019 (COVID-19) is unknown. ANS alterations could be manifested during both the acute and post-acute phases of COVID-19. Implications of acute and chronic inflammation on ANS in HAE need to be addressed. In this case report, we monitored the systolic arterial blood pressure variability and baroreflex sensitivity in a female HAE patient both before experiencing COVID-19 symptoms and one month afterward. We also tracked the heart rate variability on the day preceding symptom onset, the day of symptom onset (SYM), the day following SYM, five days after SYM, the day of the first negative nasopharyngeal swab (i.e., 12 days after SYM), and one month after symptom onset. The results of this case report provide the characterization of vascular and cardiac autonomic profiles in an HAE patient until the resolution of an acute infection, a potential trigger for the acute HAE attack.

In this report, we present a case of a woman currently on HIV antiretroviral therapy who presented with oral mucosal and cutaneous skin lesions with a target-like appearance following completion of a five-day course of Paxlovid™ for symptomatic COVID-19 infection. The patient was treated with intravenous steroids and oral antihistamines with mild improvement. However, she returned in one week with worsening skin lesions. The biopsy and infectious workup were non-contributory. It was determined that the patient had developed erythema multiforme (EM), secondary to Paxlovid™.

Following infection with severe acute respiratory syndrome coronavirus, a post-infectious multisystem inflammatory syndrome in adults (MIS-A) has been identified. It affects multiple organ systems and can lead to multi-organic failure.

COVID-19 has a wide range of clinical manifestations. Apart from respiratory symptoms, neurological manifestations and cognitive impairment are commonly seen. Due to lack of a clear consensus on the definition of long COVID a pragmatic approach of assessing change from neurological baseline has become prevalent. We present the case of a high functioning woman in her late 40s who had a mild course of acute illness but developed cognitive difficulties. No organic causes for her cognitive difficulties were found. Neuropsychological testing showed impairment in right frontal lobe functioning. The patient showed a response to empirical treatment with Attention deficit hyperactivity disorder (ADHD) medications. Repeat neuropsychological testing 1 year later showed continued dysfunction in executive functioning. We present the details of her test findings and discuss the proposed pathophysiology behind neurocognitive effects of long COVID.

The coronavirus disease 2019 (COVID-19) infection has led to accelerated development and utilization of vaccines to prevent its implications on health. One of these vaccines is a vector-based, Oxford-AstraZeneca Vaccine (AZD1222). Frequently reported side effects are related to host-immune response. While dermatologic manifestation is peculiar in nature and denotes a serious eruption that might defer future vaccination. Herein, we present a case of a medically free 37-year-old female who developed clinical and histological evidence of pityriasis rosea (PR) after administration of a second-dose vaccination of AZD1222. The first dose of vaccination was administered as Pfizer BioNTech COVID-19 mRNA (BNT162b2) vaccine. This case is unique in nature as this patient developed AZD1222-induced PR, while some reports in the literature have linked PR to the BNT162b2 vaccine. This patient continued to receive a booster vaccination with BNT162b2 with no reportable side effects.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection usually affects the respiratory system; however, a number of atypical manifestations of this disease have also been reported, especially in children. The present study reports a case of a 12-year-old presenting with right unilateral parotitis and sialadenitis and SARS-CoV-2 infection. The young patient, after a 3-day history of fever, was brought to our clinic (Polyclinic University Hospital 'G. Rodolico', Catania, Italy) for the sudden onset of unilateral parotitis accompanied by sialadenitis and hyperaemia of the skin, which was tender to touch. The SARS-CoV-2 molecular swab was positive; the ultrasound of the affected region showed an increase in the volume of the parotid and sublingual gland and reactive lymph nodes compatible with parotitis and sialadenitis. This case suggests that, in the present Coronavirus disease 2019 pandemic, SARS-CoV-2 should be included in the differential diagnosis of parotitis and sialadenitis along with mumps and flue. Notably, a respiratory panel and serology for other potential causes are needed in case of parotitis-like disease.

JC polyomavirus (JCPyV) is a human polyomavirus that can establish lifelong persistent infection in the majority of adults. It is typically asymptomatic in immunocompetent individuals. However, there is a risk of developing progressive multifocal leukoencephalopathy (PML) in immunocompromised or immunosuppressed patients. Though JCPyV commonly resides in the kidney-urinary tract, its involvement in urinary system diseases is extremely rare. Here, we reported a case of a 60-year-old male patient with coronavirus disease 2019 (COVID-19) infection who developed hemorrhagic cystitis after receiving treatment with nirmatrelvir 300 mg/ritonavir 100 mg quaque die (QD). Subsequent metagenomic next-generation sequencing (mNGS) confirmed the infection to be caused by JCPyV type 2. Then, human immunoglobulin (PH4) for intravenous injection at a dose of 25 g QD was administered to the patient. Three days later, the hematuria resolved. This case illustrates that in the setting of compromised host immune function, JCPyV is not limited to causing central nervous system diseases but can also exhibit pathogenicity in the urinary system. Moreover, mNGS technology facilitates rapid diagnosis of infectious etiology by clinical practitioners, contributing to precise treatment for patients.

Extracorporeal Carbon Dioxide Removal (ECCO2R) is used in acute respiratory distress syndrome (ARDS) patients to facilitate lung-protective ventilatory strategies. Electrical Impedance Tomography (EIT) allows individual, non-invasive, real-time, bedside, radiation-free imaging of the lungs, providing global and regional dynamic lung analyses. To provide new insights for future ECCO2R research in ARDS, we propose a potential application of EIT to personalize End-Expiratory Pressure (PEEP) following each reduction in tidal volume (VT), as demonstrated in an illustrative case. A 72-year-old male with COVID-19 was admitted to the ICU for moderate ARDS. Monitoring with EIT was started to determine the optimal PEEP value (PEEPEIT), defined as the intersection of the collapse and overdistention curves, after each reduction in VT during ECCO2R. The identified PEEPEIT values were notably low (< 10 cmH2O). The decrease in VT associated with PEEPEIT levels resulted in improved lung compliance, reduced driving pressure and a more uniform ventilation pattern. Despite current Randomized Controlled Trials showing that ultra-protective ventilation with ECCO2R does not improve survival, the applicability of universal ultra-protective ventilation settings for all patients remains a subject of debate. Inappropriately set PEEP levels can lead to alveolar collapse or overdistension, potentially negating the benefits of VT reduction. EIT facilitates real-time monitoring of derecruitment associated with VT reduction, guiding physicians in determining the optimal PEEP value after each decrease in tidal volume. This original description of using EIT under ECCO2R to adjust PEEP at a level compromising between recruitability and overdistention could be a crucial element for future research on ECCO2R.

BACKGROUND CRS (cytokine release syndrome) is a massive activation of the inflammatory system characterized by a supra-physiological rate of inflammatory cytokines. The interleukin 6 cytokine plays a central role in CRS. The main clinical sign of CRS is fever, but CRS can lead to multiple organ failure in severe cases. CRS is usually described in sepsis, more recently in SARS COV-2 infection, and in chimeric antigen receptor T-cell therapy. However, it can also be associated with immune checkpoint inhibitors (ICIs), which is infrequently described. ICI have growing indications and can lead to CRS by causing an uncontrolled activation of the immune system. There are currently no treatment guidelines for ICI-induced CRS. CASE REPORT We report a rare case of grade 3 CRS induced by nivolumab associated with 5-fluorouracil and oxaliplatin for gastric cancer. The patient was 65-year-old man with an adenocarcinoma of the cardia. CRS developed during the tenth course of treatment and was characterized by fever, hypotension requiring vasopressors, hypoxemia, acute kidney injury, and thrombopenia. The patient was transferred quickly to the Intensive Care Unit. He was treated for suspected sepsis, but it was ruled out after multiple laboratory examinations. There was rapid resolution after infusion of hydrocortisone. CONCLUSIONS The use of ICIs is expanding. Nivolumab-induced CRS is rarely described but can be severe and lead to multiple organ dysfunction; therefore, intensive care practitioners should be informed about this adverse effect. More studies are needed to better understand this condition and establish treatment guidelines.

A 67-year-old male, with a history of severe COVID-19 infection and exposure to talc was seen for worsening shortness of breath for months, requiring supplemental oxygen. He was treated for COVID-19 infection and suspected pneumonia with no improvement. His pulmonary function test (PFT) worsened and computed tomography (CT) showing bilateral airspace opacities with ground-glass opacities (GGO), also worsened over time. He underwent bronchoscopy, bronchoalveolar lavage and pathology revealed pulmonary alveolar proteinosis (PAP). He subsequently underwent whole lung lavage (WLL) which significantly improved his crazy paving pattern on CT and was successfully weaned off supplemental oxygen.

The ongoing global pandemic caused by the SARS-CoV-2 virus, known as COVID-19, has disrupted public health, businesses, and economies worldwide due to its widespread transmission. While previous research has suggested a possible link between environmental factors and increased COVID-19 cases, the evidence regarding this connection remains inconclusive. The purpose of this research is to determine whether or not there is a connection between the presence of fine particulate matter (PM2.5) and meteorological conditions and COVID-19 infection rates in Bangkok, Thailand. The study employs a statistical method called Generalized Additive Model (GAM) to find a positive and non-linear association between RH, AH, and R and the number of verified COVID-19 cases. The impacts of the seasons (especially summer) and rainfall on the trajectory of COVID-19 cases were also highlighted, with an adjusted R-square of 0.852 and a deviance explained of 85.60%, both of which were statistically significant (p < 0.05). The study results assist in preventing the future seasonal spread of COVID-19, and public health authorities may use these findings to make informed decisions and assess their policies.