Journal of Clinical Case Reports

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At the National Cardiovascular Homograft Bank (NCHB), heart transplant patients represent an important source of donor pool. In this case study, we highlight our recipient with the longest follow-up, who was implanted with a pulmonary valve donated by a heart transplant patient three years ago, and his post-implantation outcome. The live donor’s diagnosis and quality of the donated heart valve are also discussed. This is used as a backdrop to explore some risk factors affecting homograft durability and NCHB’s attempts to address the known significant risk factors in homograft processing and storage to maintain the high quality of our homografts.

Gitelman’s syndrome is an autosomal recessively inherited disease with a wide clinical spectrum usually seen in adolescents and adults. Patients have hypokalemia, metabolic alkalosis, hypomagnesemia and hypocalciuria together with normal blood pressure. Effect of GS on pregnancy is not known well. In this study, we presented a pregnant woman who experienced seizure due to electrolyte imbalance and diagnosed with Gitelman’s syndrome.

The present case reports the first ever case of homicidal poisoning due to injection of an organophosphate insecticide with successful resuscitation and reporting. Case: A 7-month-old baby presented to the emergency department with a history of insect bite since 5 hours by his relatives with a main complaint of irritability, disturbed conscious level, irregular respiration and wheezy chest. The injection site has appeared as oval area of redness and swelling at right elbow region that were noticed by the pediatric emergency department physician, with a medical history of resistance to medications for suspected insect bite (antihistaminic and corticosteroids in pediatric dosage) from referral hospital. By toxicological consultation, we revealed disturbed conscious level (GCS 10), pinpoint pupils and increase all body secretions, salivation, bronchorrhea and incontinence in urine and stools. The clinical toxicology consultant suspected a case of acute anticholine esterase toxicity and recommended a plasma pseudocholinesterase level that appeared to be very low, consistent with acute intoxication with organophosphate insecticide. The management of organophosphate poisoning was started, as airway management, administration of oxygen and fluids, as well as atropine in increasing doses and pralidoxime. Our case report emphasizes the necessity of a detailed history taken and careful smart medical examination for the possibility of homicide in such cases. Although injection sites may be the expected results of insect bite, medical treatment, dermal lesions also may be associated with injections of toxic substances.

A case of unusual atrial septal anatomy with right-to-left shunting in a patient with cryptogenetic cerebral ischemia is presented. Percutaneous correction and technical tips are described.

Shewanella algae infections are rare in humans. Previously approximately 65 cases of S. algae causing human infection have been reported and most of them have association with direct contact with sea water. We report a case of primary S. algae soft tissue infection in a patient with diabetic nephropathy after prolonged stay in hospital, without prior exposure to sea water/sea food.

We report a case of severe acute corneal hydrops in a 32-year-old woman with keratoconus associated with Down syndrome. The anterior segment of her right eye showed an extremely diffuse edematous ectasia of acute corneal hydrops. She was observed rubbing her right eye because of itchiness and discomfort in the eye. Complete resolution of the corneal edema and a central corneal scar was seen at the 6th week of follow-up.

Coronary artery dissection is a common occurrence after percutaneous coronary intervention (PCI). We here firstly describe a interesting case of very rapid spontaneous recanalization associated with micro-dissection following PCI in the right coronary artery due to a total occlusion lesion that could not be stented but was associated with very early (a week) spontaneous healing and a favorable outcome.

We report on 16-month-old infant who was admitted to hospital with severe neurological symptoms following passive inhalation of cannabis. To our knowledge and after deep surveying in the literature, we believe that this is one of the few reported clinical case of the acute severe toxicity after passive inhalation of cannabis smoke by an infant. Urine and serum THC (delta-9-tetrahydrocannabinol) Δ9-THC concentrations of 230 and 112 ng/ml were detected. This case report highlights the importance of considering cannabis ingestion in the differential diagnosis of infantile and toddler coma. Moreover, facing the increasing number of cannabis smokers such cases might be more prevalent and therefore physicians, health workers and parents should be alerted about the health hazards of cannabis substances abuse in the presence of children.

The present report describes the relative quantitation of a group of selected miRNAs in a twenty one years old Palestinian woman who experienced 8 unexplained first trimester pregnancy losses. The relative expression of miR-21, miR-126, miR-155, miR-182, miR-222 and miR-517* in her plasma was measured before pregnancy and in the seventh week of her ninth pregnancy. The relative expression of the same miRNAs was also measured before pregnancy and in the eighth week of fifth pregnancy in a healthy control woman who has four live children and without any history of pregnancy loss. The results of the case woman showed an extremely decreased level of all the investigated microRNAs during her pregnancy as compared to their level before being pregnant, except for miR-517* which was elevated. The relative quantitation of miR-21, miR-126, miR-155, miR-182, miR-222 and miR-517* was 0.026, 0.12, 0.23, 0.26, 0.28 and 1.4, respectively. However, the relative quantitation of the respective miRNAs in the control was 0.92, 0.75, 0.6, 1.1, 1.11 and 10.9. Unfortunately, at the end of eighth week of her pregnancy the case woman lost her fetus. We believe that the dysregulation of miRNA is involved in the recurrent pregnancy losses in the case presented in this report.