We treated a patient with pyogenic spondylitis complicated by septic shock, who was saved by emergency surgery. The patient was a 75-year-old man with back pain, fever, and weakness in the lower limbs four days before. Upon admission to our hospital, he had tachycardia, tachypnea, fever, and fluctuating vital signs. His quick sequential organ failure assessment (SOFA) score was 2. Emergent magnetic resonance imaging showed scattered intramuscular abscesses and an epidural abscess. Gram-positive cocci were detected in a blood sample. He was diagnosed with pyogenic spondylitis complicated by sepsis. Intravenous antimicrobial therapy with cefepime, vancomycin, and clindamycin was added. However, he developed tachycardia and hypotension three hours after arrival at our hospital, so he received a blood transfusion and noradrenaline and underwent emergent surgical open drainage since percutaneous drainage was difficult to perform because of scattered abscesses. Paralysis of the proximal lower extremities was recovered after surgery. Postoperatively, the causative organism was found to be methicillin-susceptible Staphylococcus aureus and intravenous antimicrobial therapy for 81 days. Three years after surgery, the patient remains free of recurrence with improvement in the activity of daily living to the extent that he could walk. The outcome of our patient suggests that surgery may be a lifesaving measure in cases whose uncontrollable vital signs by pyogenic spondylitis are complicated by sepsis. Preoperative judgment is extremely important in difficult-to-control cases because surgical invasion can be lethal.

UNASSIGNED: Exercise therapy for patients with pediatric nephrotic syndrome is necessary to improve physical function to maintain the patient\'s activities of daily life and school life while managing the risk of relapse; however, few studies have examined exercise therapy in the acute phase of the syndrome. This case study aimed to evaluate the efficacy and safety of exercise therapy in a patient with acute pediatric nephrotic syndrome being treated with steroids.
UNASSIGNED: The patient was a 10-year-old boy diagnosed with primary nephrotic syndrome. Prednisolone (50 mg) was started on the 3rd day of hospitalization. Exercise therapy (moderate-intensity, 40 min, five times a week) was started on the 15th day. The urine protein/creatinine ratio from the 15th day (at the start of rehabilitation) to discharge decreased from 1.1  to 0.4, with no recurrence of nephrotic syndrome. At the initial, middle, and final evaluations, respectively, the grip strength was 10.1, 8.9, and 8.3 kg; the knee extension strength was 0.38, 0.46, and 0.45 kgf/kg; the sit-up test results were 18, 18, and 15 times; the side-step test results were 34, 36, and 31 times; the sit-and-reach test results were 22.9, 24.5, and 23.8 cm; and the 6-min walk test results were 420, 490, and 520 m. Leg muscle strength and exercise tolerance improved, but upper limb strength, trunk muscle strength, and agility decreased.
UNASSIGNED: Moderate-intensity exercises may be effective and safe for pediatric patients with nephrotic syndrome in the acute phase. Exercise therapy may be beneficial to improve physical function and prevent decline during hospitalization in pediatric nephrotic syndrome patients.

A case of ruptured anterior cerebral artery (ACA) dissection was treated with multiple neck-bridge stents, with modification of antiplatelet administration according to changes in the shape of the aneurysm in the acute phase. A 67-year-old woman presented with severe subarachnoid hemorrhage and fusiform dilatation was observed in the left ACA between the A1 and A2 segments. The use of stents in the acute phase is associated with high risk of ischemic complications. Prasugrel administration, which is considered to have low drug resistance, may have allowed safe stent use in the acute phase.

Management of frequent epileptic seizures in febrile infection-related epilepsy (FIRES) is often challenging. FIRES is an uncommon disease condition. Children with FIRES develop refractory epilepsy with severe cognitive deficits that affect the function of the temporal and frontal lobes. However, better seizure control during the acute stage of FIRES could protect against injury to the nervous system. Ketogenic diet (KD) can effectively resolve super-refractory status epilepticus (SRSE) in the acute phase and improve the prognosis of FIRES. We present the case of a previously healthy 3-year-old male with new-onset status epilepticus (SE) admitted to the paediatric intensive care unit for 55 days. Despite treatment with multiple anti-epileptic agents in addition to IV anaesthetics, the patient remained in SRSE and continued to have generalised epileptic activity on electroencephalography (EEG). KD therapy was initiated on the 14th day of the onset, and the patient achieved complete neurological recovery following the KD. Throughout the remainder of admission, the patient was successfully weaned off the ventilator, tolerated oral meals, and worked with occupational and physical therapists to return to his baseline functional status. The convulsions were well controlled after discharge. We discuss the treatment strategies for FIRES and highlight the role of KD therapy in the acute phase to control disease progression and improve the prognosis, and early diagnosis of FIRES and early initiation of KD therapy combined with anti-epileptic drugs (AEDs) could improve the prognosis.

The outbreak of coronavirus disease 2019 (COVID-19) has put health systems worldwide under great pressure on numerous levels. COVID-19 is a heterogeneous situation where some people experience mild symptoms for which no serious intervention is needed, while others may experience serious situations ranging from acute respiratory distress syndrome (ARDS) or even respiratory failure and end organ damage. Serious COVID-19 cases may be complicated with a cytokine storm caused by hemophagocytic lymphohistocytosis, which is a life-threatening situation. Efforts should be directed to reveal accompanying diseases that may trigger the cytokine storm. Early diagnosis leads to a better understanding of how to deal with this emergency status; however, even with early intervention, outcomes are still very poor.

The aim of this report was to examine the safety of physical therapy for hemiplegia in a patient with neuromyelitis optica in the acute phase. A 32-year-old female with neuromyelitis optica diagnosed by magnetic resonance imaging had a T2-weighted hyperintense lesion in the central cord from C2 to T2 and was positive for serum anti-aquaporin-4 antibodies. Upon admission to the hospital, her Expanded Disability Status Scale, Medical Research Council scale for muscle strength score, and sensory score (according to the American Spinal Injury Association sensory assessment) were 9.0, 37, and 158, respectively. The patient commenced physical therapy on day 4. A locomotion exercise using an orthosis was started as soon as possible. Her left-side limb muscle strength improved to approximately grade 4 by a manual muscle test with improvements in the Expanded Disability Status Scale score (from 9.0 to 6.0), Medical Research Council scale for muscle strength score (from 37 to 54), sensory score (from 152 to 203), and all functional independence measure dominants compared with the respective values on admission. This report shows that a carefully supervised physical therapy program did not cause deterioration of the patient\'s symptoms.