Using RhWeBicyclo221heptadiene Factors for the Enantioselective Synthesis of Chiral Amines

We present the case of a healthy 38-year-old male who developed parosmia following a second dose of AstraZeneca with a negative nasal swab of coronavirus disease 2019 (COVID-19) infection. The patient noted parosmia that started suddenly after one week of receiving the second dose of AstraZeneca with no association with other symptoms. The patient has still not recovered from his parosmia until the publication of this article. The olfactory disorder was confirmed using a validated questionnaire for parosmia assessment and examination by rhinoscopy. Parosmia is a rare side effect of COVID-19, and its pathophysiological mechanism is still unknown. More research in the future is needed to know the association of parosmia with COVID-19 vaccine.Hypoglossal nerve palsy is usually associated with glossopharyngeal nerve, vagus nerve, and accessory nerve palsy, and the occurrence of hypoglossal nerve palsy alone is rare. We report a case of a 41-year-old man with unilateral isolated hypoglossal nerve palsy. The patient was aware of a leftward deviation of the tongue along with pharyngeal pain. The pharyngeal pain was quickly relieved by antibiotic treatment, but the deviation of the tongue did not improve, and the patient was referred to our hospital. As a result of the medical examination, a single paralysis of the left hypoglossal nerve and mild swelling of the left lingual tonsil up to the left palatine tonsil were observed. Various tests were performed, but there were no significant abnormal findings other than a suggestion of mild tonsillitis. We diagnosed the patient as idiopathic or tonsillitis-induced unilateral hypoglossal nerve palsy and started medical treatment with corticosteroids and methylcobalamin. The hypoglossal nerve palsy showed a tendency to improve after one month of onset and was almost cured by two months of onset.Colchicine-induced myopathy has been described in patients with chronic renal failure and patients who are using a concomitant drug like a statin. However, pure myopathy caused by colchicine has never been reported in Saudi Arabia. A 64-year-old patient received colchicine for his gout arthritis disease and developed upper and lower limb weakness. He had a proximal weakness, and his muscle enzymes were very high. Furthermore, the needle electromyography (EMG) examination showed abundant fibrillations, myotonic discharges, and myopathic motor units. Two weeks after colchicine cessation, his weakness improved dramatically with normalization of creatine kinase (CK) and disappearance of myotonic discharges in the repeated EMG. This is the first case in Saudi Arabia that showed colchicine-induced myositis. The local clinicians' community needs to be aware of this rare side effect, as clinical suspicion is the most important diagnostic clue and the only effective treatment is the termination of colchicine.The submandibular gland is the most common major salivary gland vulnerable to sialadenitis secondary to sialolithiasis. We report a case of submandibular steinstrasse causing sialadenitis in a 45-year-old male and describe the appearances on high-resolution ultrasonography. Endoscopic-assisted excision of calculi was done. Post-operative recovery was uneventful and the patient was discharged after one week. The patient has been on follow-up for six months with no complaints of recurrence. Multiple stacked calculi within the Wharton's duct is an exceedingly rare occurrence. Steinstrasse creates a dilemma of choice for the intended surgical approach during calculi extraction from the Wharton's duct. Endoscopic guided calculi extraction may be ideal for distally placed calculi along the course of the duct. Submandibular steinstrasse can be a possibility when electrohydraulic or pneumatic techniques have been deployed.Vascular anomalies are present in the posterior circulation. In the case of this stroke patient, the posterior cerebral artery (PCA) was shown to have a fetal origin. A fetal PCA is classified as either a partial or complete fetal PCA, which can be determined by the presence of a remnant or absence of P1, the PCA segment directly arising from the terminal of the basilar artery. If absent, the PCA has arisen completely from the internal carotid artery (ICA) and is termed complete fetal PCA, or cfPCA. A partial fetal PCA, or pfPCA, is what is found when a hypoplastic segment persists. Here, we report a partial infarction of the oculomotor nucleus with ipsilateral fetal PCA in a 59-year-old female.Central pontine myelinolysis is a non-inflammatory neurologic deficit and can have a wide array of clinical features, predisposing risk factors as well as different patterns of onset along with a big difference in prognosis ranging from asymptomatic cases to encephalopathy and also mortality. Apart from the common risk factors like hyponatremia and sudden correction of electrolyte imbalances, sometimes, the least prevalent risk factors such as pregnancy seem to link with the central pontine myelinolysis. Mostly its onset is sudden after the inciting factors. However, it is also likely to have cases of central pontine myelinolysis with gradual onset of clinical features. The purpose of the case report is to highlight the link between pregnancy and central pontine myelinolysis. The slow onset of clinical features in pregnancy-linked central pontine myelinolysis can also be considered. The patient in the case report presented with gradual onset clinical features of osmotic demyelination syndrome during the last months of pregnancy and immediately postpartum. All the possible predisposing risk factors for central pontine myelinolysis were ruled out through history, physical examination, and relevant investigations. The case study of the patient hypothesized that (1) pregnancy should be considered as a risk factor for central pontine myelinolysis in pregnant and postpartum patients presenting with clinical features of the disease, (2) clinical features of central pontine myelinolysis in pregnancy can have a more gradual onset of symptoms compared to other causes of central pontine myelinolysis. Although, this case report signifies a relationship between pregnancy and osmotic demyelination syndrome. However, further studies should be done to develop a causal relationship and preventive measures for the condition.Snakebite is a neglected tropical disease, which is very common in the Indian subcontinent. The severity of respiratory muscle paralysis and the delay in recovery depend upon the dose of the venom injected, the severity of the venom, the species of the snake, the duration of presentation to the hospital, and the time and dose of administration of anti-snake venom (ASV). The reasons for this delayed neuromuscular recovery still remain an enigma. We highlight such a case of a young adult who had delayed neuromuscular recovery and prolonged ventilatory support following a neurotoxic snakebite.The coronavirus disease 2019 (COVID-19) pandemic has caused the world to operate uncharacteristically for almost the last two years. Governments across the globe have taken different control measures to eradicate it. The Oxford COVID-19 Government Response Tracker (OxCGRT) provides open access data for different countries on 20 control measures, including numerous aggregated indices. This paper employs the modified Susceptible-Exposed-Infectious-Recovered (SEIR) epidemiology model to study the COVID-19 pandemic in Saudi Arabia. The modification has been achieved by including control measures and the infectiousness of exposed compartment. A hybrid approach has been used to estimate and incorporate control measures. Selleck Salinosporamide A Initially, a composite control measure has been derived from OxCGRT data to make an attempt to fit the COVID-19 pattern in Saudi Arabia. The derived model has proven to be satisfactory through statistical tests. Nonetheless, the model patterns do not resemble the reported patterns more closely. Hence, a second heuristic approach has been utilized to devise effective control measures from the reported pattern of COVID-19 from the Saudi government agency. A satisfactory model was derived utilizing this approach with successful validation through statistical tests. Also, the model patterns more closely resemble the reported patterns of COVID-19 cases. This hybrid approach proves more robust and ensures the validity of model parameters better. The R naught (R0) value with the current control measures has varied from 0.515 to 1.892, with a mean value of 1.119, and is presently less than 1. The threshold herd immunity, in the absence of any control measure, is estimated to be 47.12% with an R0 value of 1.89 and would end up infecting 76.32% of the population. The scenario analysis with gradual partial and complete relaxations up to December 31, 2021, shows that the peaks are likely to occur in 2022; therefore, Saudi Arabia must continue to inoculate its population to eradicate COVID-19.Despite the decline in COVID-19 cases, the potential threat of multisystem inflammatory syndrome (MIS) - a hyperinflammatory response following acute SARS-CoV-2 infection - looms large. Although initially described in children, it is being increasingly reported in adults. In dengue endemic regions, MIS is likely to cause diagnostic dilemma with dengue due to overlapping clinical and laboratory features. We describe a young male with fever, gastrointestinal symptoms, a transient rash, thrombocytopenia, and positive dengue NS1 antigen test. Early onset of thrombocytopenia, significant gastrointestinal symptoms and protracted fever were atypical, raising suspicion of MIS-A in view of a recovery from a recent SARS-CoV-2 infection. However, absence of neurologic and cardiac manifestations, stable hemodynamics, absence of mucosal involvement and negative inflammatory markers helped in managing the patient conservatively as dengue. This case highlights diagnostic challenges faced by clinicians treating suspected dengue in the face of increasing recognition of MIS and need for systematic research to establish diagnostic criteria for MIS-A.Both SARS-CoV-2 and SARS coronaviruses (CoVs) are members of the subgenus Sarbecovirus. To understand the origin of SARS-CoV-2, sequences for the spike and nucleocapsid proteins from sarbecoviruses were analyzed to identify molecular markers consisting of conserved inserts or deletions (termed CSIs) that are specific for either a particular clade of Sarbecovirus or are commonly shared by two or more clades of these viruses. Three novel CSIs in the N-terminal domain (NTD) of the spike protein S1-subunit (S1-NTD) are uniquely shared by SARS-CoV-2, Bat-CoV-RaTG13 and most pangolin CoVs (SARS-CoV-2r clade). Three other sarbecoviruses viz. bat-CoVZXC21, -CoVZC45 and -PrC31 (forming CoVZC/PrC31 clade), and a pangolin-CoV_MP789 also contain related CSIs in the same positions. In contrast to the S1-NTD, both SARS and SARS-CoV-2r viruses contain two large CSIs in the S1-C-terminal domain (S1-CTD) that are absent in the CoVZC/PrC31 clade. One of these CSIs, consisting of a 12 aa insert, is also present in the RShSTT clCoV-2. Several other CSIs reported here are specific for other clusters of sarbecoviruses including a clade consisting of bat-SARS-CoVs (BM48-31/BGR/2008 and SARS_BtKY72). Structural mapping studies show that the identified CSIs form distinct loops/patches on the surface of the spike protein. It is hypothesized that these novel loops/patches on the spike protein, through their interactions with other host components, should play important roles in the biology/pathology of SARS-CoV-2 virus. Lastly, the CSIs specific for different clades of sarbecoviruses including SARS-CoV-2r clade provide novel means for the identification of these viruses and other potential applications.