Jelena Berendika, Gordan Nikic*, Dejan Dokanovic, Milka Vjestica, Sanja Savic, Sasa Jungic, Zdenka Gojkovic, Bozana Babic and Biljana Tubic
Paraganglioma is a very rare extra adrenal nonepithelial tumor. The number of cases of laparoscopic surgery in Paraganglioma is small and controversial. This study encountered a case of successful transperitoneal laparoscopic surgery for a 56 mm paraganglioma in a 53-year-old female. Moreover, previous reports on laparoscopic surgery for paraganglioma are reviewed.
Meghan Ha, Nishita S. Amin, Katie Meyers, Jacques Turgeon and Chandni Bardolia*
Objective: The management of insomnia presents as a challenge for many Parkinson’s disease patients and their care teams. Insomnia in patients with Parkinson’s disease may be attributed to the side effect profile of several medications that are commonly used to treat Parkinson’s disease. Additionally, the progression of the disease is associated with disruption of circadian rhythms, nocturnal symptoms, blunted melatonin secretion, and late melatonin onset. This case report aims to demonstrate how a patient's Parkinson's medication profile could be optimized to control motor symptoms and reduce the occurrence of insomnia through the use of comprehensive medication review services.
Case report: A 71-year-old male with Parkinson’s disease was developing severe symptoms of tardive dyskinesia due to his chronic carbidopa/levodopa/entacapone therapy. In order to address the tardive dyskinesia, entacapone was discontinued and amantadine was initiated to offset the stiffness and bradykinesia. The addition of amantadine resulted in nightmares and poor sleep quality, even though the patient was already taking mirtazapine to treat his depressive status and insomnia. The patient’s healthcare team collaborated with a clinical pharmacist to adjust the Parkinson’s disease regimen and mirtazapine dosage, all of which resulted in notable improvements in his reported insomnia and quality of life.
Discussion and Conclusion: Optimizing motor control in patients with Parkinson’s disease, while mitigating insomnia side effects of medications can be a very complex process. The main goal for patients who encounter this problem is to enhance their Parkinson's disease therapy by identifying medications that can contribute to insomnia while addressing the patient's symptoms and disease progression. Alternative treatments to manage insomnia in patients with Parkinson’s disease should also be considered, including the addition of melatonin and/or the use of bright light therapy.
Salma Mainosh, Ayesha Akbar Khalid*, Mushtaq Ahmed and Syeda Shaheera Hashmi Riaz
Introduction: Glanzmann thrombasthenia is a rare inherited bleeding disorder, with a global prevalence of about one in one million. It is an autosomal recessive condition characterised by episodes of mucocutaneous bleeding. A defect in the membrane protein results in a defective platelet aggregation.
Case presentation: A fifteen-month-old female child presented to the emergency department with nosebleed for the last two days. The patient had two similar episodes of epistaxis in previous few months which were managed at home. There was an accompanying complaint of easy bruising since birth. After emergency management and anterior nasal packing, extensive blood tests were ordered to determine the cause for recurrent haemorrhages. Platelet aggregation study concluded a diagnosis of Glanzmann thrombasthenia and the patient was treated accordingly. Family members were thoroughly counselled, and safety netting was vigilantly done.
Conclusion: Many public tertiary cares set ups in Pakistan lack the adequate diagnostic and therapeutic facilities for bleeding disorders. This does not only result in delaying appropriate care but also causes patients to remain undetected. Through this report, we aim to encourage emergency physicians to have a high index of suspicion for haematological disorders in patients presenting early in life with recurrent bleeding episodes.
Oluwaseun Oluwo*, Anita Vincent-Johnson and Kambiz Kalantari
A young man with a history of pseudo-seizures was admitted after an episode of severe agitation and rigorous physical activity. The patient was febrile on admission with notable leukocytosis and lactic acidosis but a negative infectious workup. During the hospitalization, the patient developed severe Acute Kidney Injury (AKI) despite fluid hydration. Creatinine Phosphoryl Kinase (CPK) was minimally elevated at 693 U/l. Urine
microscopy was significant for many uric acid crystals. Subsequent lab studies revealed an elevated uric acid level of 13.4 mg/dl with fractional excretion of urate (Fe-Urate) of 13%. The patient was treated with rasburicase and allopurinol with the improvement of AKI that paralleled the improvement in hyperuricemia. AKI was likely due to acute urate nephropathy from a pseudo-seizure. AKI following an icteric activity or rigorous physical activity can occur via a mechanism that is independent of rhabdomyolysis. Acute Urate Nephropathy should be considered in cases with no significant elevations of CPK, with prompt initiation of rasburicase and potentially rapid resolution of AKI.
Oluwaseun Oluwo*, Dennis Hu, Ashkan Karimi, Garland Campbell and Negiin Pourafshar
A 75-year-old female with history of a prior right renal artery stent (coronary bare metal stent, duration 3 years), stage IV CKD (baseline serum creatinine (Scr) 2.1-2.3 mg/dL (eGFR 20-23 ml/min/1.73 m2)), diastolic heart failure, and hypertension. She had multiple hospital admissions for acute decompensated heart failure, now presenting with worsening dyspnea, increased oxygen requirements of 4 L oxygen via nasal canula, increased from baseline 2 L. Despite treatment with up to nine anti-hypertensive medications, her systolic BP remained 180-200 mmHg. Her Scr also increased to 3.92. Work-up showed normal kidney sizes and urine protein/creatinine ratio 1.26 g/g. Renal artery duplex revealed right renalartery peak systolic velocity 267 cm/sec, renal-to-aortic ratio 2.68, and resistive index 0.7-0.9, suggestive of right renal artery re-stenosis and some intrinsic damage. Due to progressive volume overload and worsening respiratory status, she required temporary hemodialysis. As her volume status improved, she underwent CO2 angiogram and was found to have 90% diffuse in-stent restenosis with marked deformity of the previous stent. She underwent re-stenting of the right renal artery with a proprietary FDA-approved Herculink Elite® renal stent with only 8 ml of contrast. Immediately post-intervention, her BP dramatically improved and after two months, hemodialysis was stopped, (new baseline SCr 1.5-1.9) and she only required two BP medications.
Venous Thromboembolism (VTE) is a vexing heterogeneous disease that, along with Myocardial Infarction (MI) and stroke, is among the top three cardiovascular killers. VTE's morbidity and mortality globally cause high social, health, and economic impacts. The modern diagnostic strategies of Deep Venous Thrombosis (DVT) and Pulmonary Embolism (PE) developed to aid physicians in diagnosing these presentations and using imaging resources effectively have shown limitations in several subgroups, including patients with recurrent VTE or those who are already on anticoagulation therapy. In the light of a previously reported breakthrough (recurrent) DVT while on rivaroxaban 20 mg PO daily in a 43-year-old Caucasian female, this review discusses the various etiologies, which contribute to anticoagulant's failure and VTE's recurrences in general to increase awareness among practicing physicians about these subgroups. The roles of imaging and D-dimer testing in these subgroups are also discussed, leading the author to cautiously conclude that diagnostic imaging plays a central role in identifying recurrence regardless of D-dimer testing and recommending baseline sonography upon completing DVT anticoagulation therapy for future references. Accurate diagnostic strategies are needed to ensure the best available care and treatment reaches the patient. Based on this review, the author constructs a hypothetical algorithm targeted to diagnose recurrent VTE or breakthrough VTE while on anticoagulants coupled with the possible causes for recurrent and breakthrough VTE. This algorithm should only be considered as hypothesis-generating for specifically designed prospective studies to assess and validate the algorithm's potential in decreasing the incidence of missed diagnosis of VTE and their underlying etiologies in these subgroups.
Zhi Xiao*, Binbin Wang and Yanyu Li
Aortic dissection is a critical cardiovascular disease with extremely high mortality. It has an acute onset and poor prognosis. Patients with uremic
hemodialysis have more risk factors for aortic dissection than ordinary patients. Early diagnosis and treatment have a positive impact on the
prognosis of aortic dissection. This article reports a case of uremic hemodialysis complicated with aortic dissection, aiming to further explore the
clinical diagnosis, treatment and distinguishing characteristics of uremic complicated with aortic dissection, and improve the early diagnosis rate
of the disease.
Ketlin Batista de Morais Mendes, Cristhenise Ragnini Silva*, Bárbara Silvestre Vicentim, ThaÃs Rockenbach Gaona Lenzi, Gabriela Moreira Ferle, Vanessa Almeida Santos, Wülgner Farias da Silva, André Nazário de Oliveira and Antonio Solon Mendes Pereira
Periodic Thyrotoxic Hypokalemic Paralysis (PTHP) is a rare endocrinological complication characterized by hypokalemia, episodes of muscle weakness and thyrotoxic symptoms. The following is a case report of PHHP in a black patient diagnosed with hyperthyroidism during an episode of sudden and progressive weakness associated with hypokalemia. PHHP is often underdiagnosed and should be remembered as a diagnosis of acute muscle weakness in young patients, especially males, regardless of ethnicity, although it is frequent in Asians.
Pregnant women with coronavirus disease 2019 (COVID-19) show overall similar clinical features as that of non-pregnant adults with COVID-19, except perhaps for higher risk of admission to the Intensive Care Unit (ICU) and mechanical ventilation. Apart from the established therapeutic options used in COVID-19 like steroid, low molecular weight heparin role of COVID Convalescent Plasma (CCP) has never been evaluated. We present a case of a pregnant woman, treated with CP at the AMZ hospital, Dhaka, Bangladesh.
Parijat Chakraborty*, Kamlesh Singh, Ragni Tandon, Richa Dhingra and Pranshu Mathur
Ectopic teeth develop when displaced from their normal position. Any permanent tooth can be ectopic, and the cause may be both genetic and environmental. Orthodontic treatment is justifiable for aesthetic reasons. Subsequently a careful diagnosis along with a proper treatment plan for ectopically erupting permanent maxillary canines requires timely management by the orthodontist. The purpose of this case report is to illustrate
an approach involving management using HANT wire.
Hisamichi Yoshii*, Hideki Izumi, Takuma Tajiri, Masaya Mukai, Eiji Nomura and Hiroyasu Makuuchi
Paraganglioma is a very rare extra adrenal nonepithelial tumor. The number of cases of laparoscopic surgery in Paraganglioma is small and controversial. This study encountered a case of successful transperitoneal laparoscopic surgery for a 56 mm paraganglioma in a 53-year-old female. Moreover, previous reports on laparoscopic surgery for paraganglioma are reviewed.
Bijoy Das
The purpose of the study was to explore the impact of graded early mobilization on psychomotor status of patients with mechanical ventilation. To measure the effect of early mobilization on days first out of bed, other motor function, psychological status and length of ICU stay of mechanically ventilated patient. This was a single case study. Sample was selected from BRB Hospitals Limited of Dhaka using convenient sampling method and according to selection criteria. A precise semi structured questionnaire was used for data collection. Graded early Mobilization was provided as intervention to the participant by a Professional qualified Physiotherapist for 10 sessions. Another Senior Physiotherapist was assigned as data collector. He assessed the participant’s Functional Independence Measure (FIM) score and Generalized Anxiety Disorder 7 point (GAD-7) score during discharge from ICU. It was found that Functional Independence Measure (FIM) score was 65 which means the participant was very much independent during discharge from ICU. The finding of GAD-7 was 04, which indicates that the participant was free from any psychological problems. This study showed that graded early mobilization was effective to improve mechanically ventilated patients motor and psychological status.
Since novel coronavirus pneumonia (novel coronavirus pneumonia) novel coronavirus outbreak, countries around the world have accelerated the development of a new coronavirus pneumonia vaccine (new crown vaccine). As of December 2020, 60 candidate new coronal vaccines have been approved for clinical trials, among which 7 vaccines (3 inactivated vaccines, 2 mRNA nucleic acid vaccines, and 2 vector vaccines) have been approved for emergency use or conditional marketing. In this paper, the development progress, advantages, and disadvantages of six new coronal vaccines including inactivated vaccine, nucleic acid vaccine, vector vaccine, protein subunit vaccine, live attenuated vaccine and virus-like particle vaccine was reviewed. The results of the novel coronavirus pneumonia in phase III clinical trials show that the new vaccine has good safety and immunogenicity. The approved vaccine has been proved to have good protective efficacy. However, attention should be paid to the adverse reactions of the vaccine and the long-term protective effect.
Naheed Maqbool*, Rabbia Khurshid, Saleem Ullah Khan and Noor Us Sabah
Purpura fulminans may have infectious, hereditary and idiopathic etiology. We came across a case of purpura fulminans in a 9-year-old boy who
had been healthy for first 4 years of his life and suddenly developed gangrenous lesions on extremities which proceeded to the detachment of
some digits. Laboratory evaluation revealed mild anemia, hypoalbuminemia, high platelet count, elevated aPTT, PT and INR, mild proteinuria and
high urinary protein to creatinine ratio. Child was managed by warfarin therapy.
Metastatic tumors to oral cavity are rare and represent approximately 1% off all cases of oral malignat lesions even though metastatic disease may be present. The 53-year-old female presented in March of 2017 complaining with abdominal pain, weight loss and loose stool not more than 3 times per day. CT scan of the abdomen in July showed retroperitoneal mass expanding along the body of the pancreas. Colonoscopy and gastroscopy with biopsy of mucosa of the stomach showed normal result. The tumor marker Ca 19-9 in July 2018 was 110.3 and in August 2018 350.6. The patient was referred in September of 2018 to the maxillofacial surgery Clinic for examination of the lesion in the oral cavity. She presented with a pain, swelling and occasional bleeding around the lower right second mollar. Immunohistochemical the tumor cells were positive for Cytokeratin (CK) 19, Cytokeratin (CK) 7, and homebox protein (CDX-2) which is highly sensitive markers of pancreatobiliar cancer. Therefore, the patient was diagnosed with pancreatic carcinoma. This report describes a rare metastasis of malignant pancreatic tumor in lower right gingiva and highlights the importance how immunohistochemical examination ped to identify both the origin and the nature of gingival neoplasm.
Bijoy Das*, Sanchita Saha, Feroz Kabir and Sazzad Hossain
Purpose: The purpose of the study was to explore the impact of graded early mobilization on psychomotor status of patients with mechanical ventilation.
Objectives: To measure the effect of early mobilization on days first out of bed, other motor function, psychological status and length of ICU stay of mechanically ventilated patient.
Methodology: This was a single case study. Sample was selected from BRB Hospitals Limited of Dhaka using convenient sampling method and according to selection criteria. A precise semi structured questionnaire was used for data collection.
Graded early mobilization was provided as intervention to the participant by a Professional qualified physiotherapist for 10 sessions. Another senior physiotherapist was assigned as data collector. He assessed the participant’s Functional Independence Measure (FIM) score and Generalized Anxiety Disorder 7 point (GAD-7) score during discharge from ICU.
Results: It was found that Functional Independence Measure (FIM) score was 65 which means the participant was very much independent during discharge from ICU. The finding of GAD-7 was 04, which indicates that the participant was free from any psychological problems.
Conclusion: This study showed that graded early mobilization was effective to improve mechanically ventilated patients motor and psychological status.
Marta Rico Pereira* and Carlos Asencio Cortés
Small lesions invading or compressing dural sinuses are frequent but secondary intracranial hypertension is not very common, with few examples reported in the literature. This event may be explained in the setting of anatomic variants in pattern of venous sinus circulation. We present the case of a patient who presented with papilledema and loss of visual acuity due to a small meningioma located inside the superior sagittal sinus (SSS). The patient underwent a lumboperitoneal shunt placement with recovery of symptoms. Literature available is also reviewed.
Marwa Badawi* and Ahmed Shalaby
Fibroadenoma is a painless, unilateral, benign breast lesion that is a solid in consistency. It occurs most commonly in women between the age of 14 to 35 years but can be found at any age. This is a case report for a young twin who presented to the one stop clinic with a unilateral breast lump in the right upper quadrant of the breast. Both patients were assessed clinically by obtaining detailed history and clinical examination and further evaluation of the lump was done by ultrasound examination, which confirmed diagnosis and patients were reassured and treated conservatively.
We present a one clinical case of patient with metastasis of squamous cell non–small-cell lung cancer in pancreas. A 49-year-old Caucasian male patient presented to our Medical Oncology department with obstructive jaundice and severe abdominal pain, after the last course of chemotharapy. Six months prior to presentation the patient had undergone right bronchoscopy, due to stage IV, moderate-grade squamous cell lung carcinoma. After the bronchoscopy, the patient receives chemotherapy and radiotherapy. Abdominal computed tomography on admission after the last course of chemotharpy, revealed lesion located at the head of the pancreas, causing biliary obstruction. The abdominal computer tomography reveals also lesion in left adrenal gland. Histological examination reveals and changes in grade of the histology from moderate in primary foci in lung to low-grade in metastasis in pancreas. Due to the severe pain in the abdomen and jaudice of the metastatic disease, surgical resection was proposed and the patient underwent pancreaticoduodenectomy. Histological examination of the resected specimen from pancreas confirmed a low-grade squamous cell carcinoma form the lung.
Phani Machiraju*, Rama Narasimhan, Kiran Kompella and Suresh Kumar D
Melioidosis is a granulomatous infectious disease caused by Burkholderia pseudomallei. It is a motile, aerobic, oxidase-positive, gramnegative,
non-spore forming soil saprophyte. It has gained a lot of importance in recent times as one of the most potent emerging
infections in India. The clinical presentation of Melioidosis is highly variable, ranging from benign skin and soft tissue infections to rapidly
fulminant and fatal septicaemia. It is because of this wide range of clinical diversity, it is called "Great mimicker" and poses diagnostic
challenges to clinicians. In this case report, we illustrate the diagnostic difficulties we faced and our management of infrequent complication
of disseminated Melioidosis presenting as broncho-oesophageal fistula with concomitant lung consolidation.
Satya Kant Tiwari* and Richa Patel
A 26-yr old army man of commandant rank posted in forest belt of district Mirzapur Uttarpradesh, presented to the medicine emergency department with a 4-day history of high grade fever which was associated with chills and rigor, vomiting and generalized abdominal pain. Peripheral blood smear stained with leishman demonstrated ring-form trophozoites of P. falciparum with high parasitaemia (62%) with rapid antigen test for P. falciparum was also positive. Chest X-ray was normal. Non contrast computed tomography (CT) scan of the abdomen showing a bulky pancreas with peripancreatic fat stranding suggestive of acute pancreatitis. A diagnosis of severe falciparum malaria with acute pancreatitis was made on basis of investigation. Treatment in form of intravenous quinine 1000 mg as loading dose in 10% dextrose solution followed by 500 mg in same solution and was monitored for hypoglycaemia. Oral quinine tab was started 8th day up to 15th day. The patient was discharged on 18th day and his condition was good on further follow up.
The clinical course of our patient highlights an atypical presentation of thromboembolic disease related to pregnancy, a thrombophlebitis of the right ovarian vein with endocaval floating thrombus. The diagnosis remains difficult since it is a rare entity with an atypical presentation but with serious medical consequences.
Jun Zhang, Yan Dai and Zhongliang Ning*
In late state gastric cancer, combination chemotherapy with targeted therapy has been employed, which may control the tumor growth and recurrence. We here report two patients diagnosed with advanced gastric cancer which were treated with SOX regimen combined with apatinib for conversion therapy. After three cycles of this combination treatment, the lymph node metastases and tumor decreased in size, which enabled the surgery (R0 resection), with no recurrence for more than 1 year. We believe that apatinib combined with SOX regimen can increase the possibility of successful surgical resection, and thereby prolonging the progression-free survival of patients with advanced gastric cancer
Sara M. Zorawski*, Daniel Dubinski, Daniel Cantré, Christian Henker, Andreas Erbersdobler, Florian Gessler, Thomas M. Freiman and Sae-Yeon Won
Background: Mycotic aneurysms are a rare subset of intracranial aneurysms caused by bacterial, viral or fungal sources. Rupture of an intracranial mycotic aneurysm is a life-threatening event untreated with a mortality range up to 80%.
Case description: Here, we report the case of a 21-year-old second year female medical student who suffered from a ruptured mycotic aneurysm of the middle cerebral artery with subarachnoid haemorrhage. After surgical resection of the aneurysm, intensive monitoring and treatment of cerebral vasospasm were performed. Further diagnostics for the focus of infection, including laboratory parameters, transoesophageal echocardiography and otolaryngoscopic diagnostic, showed normal findings without any sign of endocarditis, vasculitis or otolaryngitis. After 3 weeks, the patient was discharged in a very well condition.
Conclusion: Aseptic mycotic aneurysm is a rare subtype with posing significant therapeutic challenge. Surgical resection of those aneurysms might be safe and effective treatment
Samih Badarny*, Yazid Badarny, Kamal Hassan and Adnan Zaina
Introduction: Painful Leg and Moving Toes (PLMT) is a rare disorder of unknown etiology. It is characterized by pain and abnormal movement of toes. These symptoms are troublesome to patients but not life-threatening. There is no curative treatment; however, supportive therapy and symptomatic therapy somewhat ameliorate the conditions. Thus, also to avoid extensive or invasive examinations, physicians should be aware this condition.
Case presentation: The first patient had sensory symptoms that began in both legs, and gradually involuntary movements appeared in the toes of one leg, which spread to the other leg. The second had no leg pain, but involuntary movement of the toes was the sole clinical presentation. Diagnosing these conditions as PLMT, we prescribed pregabalin, clonazepam, baclofen, local corticosteroid injections, epidural blocks and warmwater soaks, which led to partial improvement of these symptoms.
Conclusion: PLMT presents in different forms, symptoms usually do not worsen over time and not life-threatening, and thus, in this sense, benign condition. We, presenting these two cases, wish to update the clinical presentation, electrophysiological findings, pathophysiology, associated diseases, treatment and management of PLMT
Maria Vittoria Matassini*, Michela Coccia, Michela Aringolo, Matilda Shkoza, Francesca Lupidi, Mauro Silvestrini, Maria Gabriella Ceravolo, Marco Marini and Gian Piero Perna
Background: Dilated cardiomyopathy with heart failure is a common cause of morbidity and mortality in patients with Becker muscular dystrophy. An early diagnosis, treatment and a close follow-up are crucial in improving quality of life and prognosis. Neuro-hormonal therapy may improve symptoms and cardiac dysfunction and reduce mortality risk. Little is known about the use of sacubitril/valsartan for heart failure in patients with Becker muscular dystrophy and dilated cardiomyopathy.
Methods: We present a case series of four patients with Becker muscular dystrophy cardiomyopathy followed in a dedicated cardiologic neuromuscular program and treated with sacubitril/valsartan because of severe left ventricular dysfunction with heart failure symptoms.
Results: In our experience sacubitril/valsartan was effective in improving symptoms and functional capacity, in reducing hospital admission for HF and, when early introduced, it promoted positive reverse heart remodeling. Despite a fragile population, sacubitril/valsartan was safe, without episodes of hypotension or renal function worsening.
Conclusion: Sacubitril/valsartan may be considered an effective and safe pharmacological option in patients with Becker muscular dystrophy and dilated cardiomyopathy with reduced ejection fraction.
Michele Gambardella*, Antonino Crocamo, Vincenzo Barlotti, Augusto La Penna and Gerarda Pirofalo
Apergillosis in immunocompetent critical patients has increased incidence over the past two decades. Patients at risk include those with systemic steroid therapies and deteriorate pulmonary functions (COPD). Hemoptysis is a devastating complication of pulmonary aspergillosis reported in 28.9% of cases.
Dichtwald Sara*, Paz Yoav, Dana Elad, Fredman Brian and Chowers Michal
Background: Post-COVID-19 infection syndrome has been described in children, known as Multisystem Inflammatory Syndrome in Children temporally associated with SARS-CoV-2. Clinical signs and symptoms include conjunctivitis, rash, fever, hypotension, gastrointestinal symptoms, myocarditis and coronary abnormalities. Most case reports were described in children, and there are very few case reports of Post-COVID-19 Multisystem Inflammatory Syndrome in Adults (MIS-A). Case report: We describe a case of a healthy 21-years-old man with symptoms of fever, myalgia and loss of taste, followed by severe dyspnea and hypoxemia. Chest computed tomography scan revealed extensive bilateral lung infiltrates. Shock and acute kidney injury followed. Echocardiography showed severe left ventricular dysfunction. The patient was intubated and ventilated. Due to cardiogenic shock and hypoxemia, veno-arterial Extracorporeal Membrane Oxygenation (ECMO) therapy was initiated. A diagnosis of multisystem inflammatory syndrome due to past COVID infection was made. The patient received methylprednisolone pulse therapy and intravenous immunoglobulin therapy. His condition improved quickly, and the patient was weaned off ECMO support. Conclusion: We presented a case of severe MIS-A in a young adult, with recent asymptomatic COVID-19 infection, manifested as cardiogenic shock and pulmonary edema. As MIS-A presentation may mimic other pathologic conditions; high index of suspicion is required.
Background: The coincidence of Moyamoya along with pineal germinoma is not reported in the literature.
Case description: We report an unusual presentation of a 19-year-old young man diagnosed with pineal gland germinoma and Moyamoya syndrome. He presented with Parinaud’s syndrome, with radiological investigations (CT and MRI scans) showing pineal gland enhancing lesion causing obstructive hydrocephalus. Endoscopic third ventriculostomy along with lesion debulking yielded a diagnosis of pineal germinoma. Postoperatively he developed bilateral middle cerebral artery territory infarcts and became aphasic with left hemiparesis. Computed Tomography (CT) angiography revealed bilateral Moyamoya vasculopathy. Two months post-operatively he developed spontaneous left frontal lobe hemorrhage with intraventricular extension; emergent external ventricular drain inserted. The patient was discharged in a vegetative state.
Conclusion: Management of both these conditions pose a therapeutic challenge as chemo-radiation therapy for germinoma holds a risk of potential worsening of neurologic deficits related to Moyamoya.
Claudio Marone*, Mariagiovanna Di Palo, Orazio Nannola, Barbara Flora Russo, Maurizio Sacco, Luisa Isabella Siniscalchi and Mariano Carafa
Introduction: There is a lot of interest and spirited debate about the adverse effects of anti-SARS CoV2 vaccines in the global pandemic context of the SARS Co-V2 infection.
Aim of the study: the purpose of this article is to demonstrate a link between vaccine inoculation and the development of some unusual clinical symptoms.
Methods: We describe the case of a 21-year-old young woman who developed symptoms of fever, chest and limb discomfort in her left upper arm around 10 days after receiving her first dose of Moderna vaccine, necessitating a trip to the emergency room and hospitalization 14 days later. Septic arthritis of the left sternoclavicular joint, mediastinitis, deep vein thrombosis of the left upper limb, and pulmonary embolism were diagnosed as a result of the instrumental tests performed during the hospital stay, particularly the angio TC of the chest and left upper limb; the growth of Staphylococcus aureus on a blood culture. The patient receives bacterial and anticoagulant therapy and recovers clinically and radiologically, allowing him to be discharged 10 days following hospitalization.
Results: Given the chronological sequence, the vaccination's causative role in the formation of the clinical picture is extremely likely in this case, but with a plausible non-specific mechanism including vaccine injection at the venular or arteriolar level and adherence to asepsis.
Conclusion: Although cases of septic arthritis following vaccines have been reported in recent years for influenza and pneumococcal vaccines, as well as more recently for SARS CoV2 vaccines (in particular with involvement of the shoulder joint), the novelty of our finding stems from the fact that it would be the first case of septic arthritis with a sternoclavicular localization, which is unusual in and of itself.
Allison Nitsch*, Mark Kearns, Ashlie Watters and Phil Mehler
Background: The purposes of this case series was to identify clinical characteristics of patients with restrictive eating disorders who have experienced pneumothorax or pneumomediastinum and elucidate possible risk factors for the development of pneumothorax or pneumomediastinum in this patient population through literature review. The scope of the case series is limited to patients admitted for medical stabilization from severe restrictive Eating Disorders (EDs).
Methods: We compiled a series of adult patients with severe EDs who were diagnosed with a pneumothorax or pneumomediastinum while admitted to the ACUTE Center for Eating Disorders at Denver Health between April 2016 and January 2021. Additionally, a series of adult patients who reported a history of pneumothorax on admission to the same institution, during the same time period, were identified and characteristics of their pneumothorax were obtained using outside records provided by the patient at time of their admission. A literature review of cases of pneumothorax and pneumomediastinum in patients with EDs was completed.
Results: Twenty-five cases of pneumothorax were identified in patients with anorexia nervosa (AN) or avoidant/restrictive food intake disorder (ARFID), all of whom were below normal body weight, between cases at our institution and literature review. Additionally, 5 patients at our institution, and 21 patients with EDs from the literature with below normal body weight with spontaneous pneumomediastinum were identified.
Conclusions and limitations: The relationship of spontaneous pneumomediastinum in patients with AN and ARFID and low body weights is well established and can be managed conservatively with good outcomes. It is currently unclear if the starved state, and the lung changes it induces in these patients increases patients’ risk for spontaneous pneumothorax. Patients with AN and ARFID may be at higher risk for iatrogenic pneumothorax with certain invasive procedures. There is direct connection between patients’ eating disorder and occurrence of traumatic pneumothorax. Patients at expected body weights, or in larger bodies with restrictive Eds, were not included in this study and therefore, their risk of pneumothorax and pneumomediastinum in relation to their eating disorder behaviours is unknown.
Maimoona Khan* and Rabia Siraj
Client Z.I was 36 years old man with presenting complaints of sleep disturbance, difficulty in concentration, restlessness, fatigue, lack of interest in anything, suicidal ideation and history of suicide attempt. In Forma assessment; Siddique Shah Depression Inventory (SSDI), Suicidal Ideation Scale (SIS) were used and in informal assessment observations, clinical interview, mental status examination, Dysfunctional Thought Record chart (DTR) used for diagnosis. Client was diagnosed with major depression disorder. Management plan was devised based on cognitive behaviour therapy techniques such as identifying distortions, ABC model, distraction techniques, motivational interviewing and hope box/survival kit, moreover no harm contract, art therapy, social therapy were used. Total 14 sessions were conducted.
Bone Marrow Edema Syndrome (BMES) is a clinical syndrome of unknown etiology characterized by the acute onset of pain gradually worsening over several weeks to months. Radiographic changes occur, but laboratory studies are generally unremarkable. It can primarily affect the foot and ankle and should be considered in the differential diagnosis of patients with acute foot and ankle pain, particularly in middle age men, and women in the third trimester of pregnancy. I here present 2 case reports of BMES of the ankle. Appropriate conservative treatment resulted in resolution of symptoms. Bone marrow edema syndrome can present a diagnostic challenge, but awareness of the typical presenting features and investigation findings can makes the diagnosis more accessible.
DOI: 10.37421/2165-7920.2024.14.1619
A case of extensive irritant contact dermatitis caused by cardol is reported for the first time. A 52-year-old male patient presented with acute dermatitis on trunk and extremities after cashew nut oil fell on his body while he was unloading barrel of oil from a truck. He was diagnosed as a case of irritant contact dermatitis due to cardol and was treated with cold compresses, antihistamines and systemic steroids. Skin lesions subsided in two weeks’ time leaving depigmentation and scarring. As the medical literature is scarce with reports on cardol dermatitis, this case is reported to create awareness among medical fraternity to help make a prompt diagnosis and to render early treatment. Cardol dermatitis is not mentioned in standard dermatology text books or journals.
Ivan Adamovic*, Kostas Michael, Tim Stegemann, Maurus Murer, Alexander Golowan, Hans-Dieter Mäder and Lukas Krähenbühl
DOI: 10.37421/2165-7920.2024.14.1622
Background: Incomplete resection of the gallbladder is not as low as previously thought and occurs in up to 16% of operated patients. In some of these patients, symptoms may persist after surgery. These include upper abdominal pain, fever, dyspepsia, and jaundice. After diagnosis, surgical intervention is necessary to alleviate symptoms and avoid potential complications such as recurrent cholangitis with potential sepsis, Mirizzi syndrome, pancreatitis, or carcinoma.
Case presentation: The patient was a 53-year-old man with previous laparoscopic cholecystectomy in 2002 for acute cholecystitis and postoperatively several years of episodes of upper abdominal pain, discomfort, and dyspepsia. In December 2023, he was hospitalized for a few days due to upper abdominal pain and cholangitis. MRCP revealed no evidence of intra- or extrahepatic cholestasis and showed clipping artifacts in the area of the elongated ductus cysticus remnant of 3 cm. Laparoscopic remnant cystic duct resection was performed without complications. Follow-up has been done for 6 months, and so far, the patient has no symptoms or complaints.
Conclusion: Cystic Duct Remnant Syndrome is more common than previously thought. MRCP should be the gold standard for patients with suspected Cystic Duct Remnant Syndrome. Laparoscopic surgery and resection of the cystic duct remnant are necessary, safe, and successful operations.
Bekkouche Soukaina*, Najem Salma, Harrak Soukaina, Abdi Chaimae, M’rabti Hind, Boutayeb Saber, El Guisssassi Ibrahim and Errihani Hassan
DOI: 10.37421/2165-7920.2024.14.1621
Locally advanced breast cancer presents significant challenges to the multidisciplinary team, particularly in cases involving hormone receptor (HR)-positive, HER2-negative tumors, which typically show lower rates of pathological complete response to chemotherapy. Cyclin-Dependent Kinase (CDK) 4/6 inhibitors are the cornerstone of treatment in metastatic Hormone Receptor (HR)-positive, HER2-negative breast cancer and have more recently been considered in the adjuvant setting. However, their effectiveness in the neoadjuvant setting remains uncertain.
We report the case of a 55-year-old postmenopausal woman initially diagnosed with metastatic HR+/HER2- breast cancer due to a unique L5 bone lesion. Systemic treatment was initiated with an Aromatase Inhibitor (AI) and a CDK4/6 inhibitor. After six months of treatment, imaging reevaluation confirmed that the L5 lesion, which had remained unchanged, was benign, allowing for curative surgery. Final pathology revealed a complete histological response with no residual tumor, highlighting the potential of CDK4/6 inhibitors in managing locally advanced HR+/HER2- breast cancer.
Cui Zhenyu*, Han Suxia and Xiang Yan
DOI: 10.37421/2165-7920.2024.14.1623
Dextrocardia, a rare congenital heart defect, becomes exceedingly unusual when accompanied by Atrial Fibrillation (AF). With the advancements in AF-related guidelines, anticoagulation therapy has become increasingly important. Lifelong oral anticoagulants remain imperative after successful AF ablation. Percutaneous Left Atrial Appendage Occlusion (LAAO) is an efficacious and secure strategy for averting AF-related thromboembolic incidents, thereby confirming the progressive suitability of the one-stop approach of AF ablation + LAAO. Cryoablation, favoured for its short procedural duration and enhanced tolerability, is particularly advantageous for older patients with AF, facilitating a streamlined procedure under local anaesthesia. However, the presence of abnormal anatomical structures presents challenges to this technique. This study describes a case of successful cryoablation + LAAO performed under Intracardiac Echocardiography (ICE) guidance in an elderly patient with dextrocardia and AF, providing a reference for the treatment of AF in patients with ectopic anatomy.
Tatiana Danai Dimitriou* and Evangelia Zacharia
DOI: 10.37421/2165-7920.2024.14.1620
Objective: Symparastasi online programme was created because of the quarantines due to covid-19. The professional care centers were closed. After the quarantines there was a need of professional care for patients who live away from the big city centers. Symparastasi programme aimed to educate the informal dementia caregivers in order for them to be able to perform some non-pharmacological interventions to their patients effectively and safely. The programme offered psychoeducation and multicomponent training programme for the caregivers of patients with Mild Cognitive Impairment (MCI) and mild dementia. The aim of the programme was to examine which group had the best results in 3 domains: a) maintain or enhance cognitive abilities, b) Decrease Behavioural and Psychological Symptoms (BPSD) and c) improve the quality of life of patient and caregivers.
Methods/Design: This is randomized controlled trial with 426 participants of both genders. The participants were randomly assigned into 3 groups of 142 patients each. Group A received only the multicomponent training programme, group B received only the psychoeducation and group C received both interventions. The programme was online and the caregivers should have access to the internet. There were 11 multicomponent training videos with progressive difficulty of the exercises, and 11 psychoeducation videos that were referring to topics regard dementia, its progress, its prognosis, prevention, BPSD, non-pharmacological interventions etc. The 12th session was a private session of each patient and caregiver in order to ask questions and be supported emotionally. The measurements used were: the Timed Up and Go test (TUG), Berg Balance Scale (BBS) and 30second Sit to Stand Test for the physical tests. For the cognitive abilities used: Mini Mental State Examination (MMSE) and Addenbrooke’s Cognitive Examination-Revised (ACE-R). For the neuropsychiatric problems used: Neuropsychiatric Inventory (NPI). For the caregivers the study used the following scales: State Trait Anxiety Inventory (STAI-S) in order to record the anxiety levels, Beck Depression Inventory (BDI) for the depression and NPI and Zarit Burden Interview (ZBI) in order to record caregivers’ burden. The programme lasted for 24 weeks and there was three recordings of the results: at the beginning of the programme (T1), after 6 months of performing the interventions (T2), and 3 months after the end of the programme (T3), as a follow up.
Results: All groups had positive results in the three domains, but group C had the best results. In terms of cognitive abilities the interventions did not enhance the cognitive skills but tried to maintain the good results for a period of time. BPSD were reduced statistically significant and the caregivers’ burden and anxiety and depression levels were also decreased. Some results maintained over time.
Conclusion: The combination of psychoeducation and multicomponent training programme has positive results in maintaining the cognitive abilities, decrease BPSD and improve the general quality of life of both patients and caregivers in patients with MCI and mild dementia.
DOI: 10.37421/2165-7920.2024.14.1624
Background: Human immune deficiency virus weakens a person's defenses against infection and leading to acquired immune deficiency syndrome. The objective of this study was to identify predictors associated with time to viral load suppression among adult HIV positive patients under HAART in public Hospitals in Amhara Region.
Method: This study was conducted at public hospitals in Amhara region, Ethiopia using a Cross sectional study design. The source of data in this study was secondary source obtained from Amhara Public Health Institution. The data were collected by the health staff working at public hospitals in the region.
Result: Among the potential predictor variables under study, Patients aged between 25-34 years (AOR=0.694, 95% CI: (0.408-0.773), p-value=0.020), Tertiary Educated patients (AOR=0.860, 95% CI: 0.762-0.906, p-value=0.001), patients disclosed their disease status AOR=0.972, 95% CI: 0.701–0.997), p-value=0.014), patients with low baseline Viral load (AOR=0.949, 95% CI: 0.815–0.989), p-value=0.018), patients with high number of CD4 cells/mm3 (AOR=0.791, 95% CI: 0.819-0.890), p-value=0.021), good adherent patients (AOR=0.854, 95% CI;(0.746, 0.927), p-value=0.011) significantly associated with short time to viral load suppression. On the other hand, TB/HIV co-infected patients (AOR=1.317, 95% CI: 1.120, 1.436), p-value=0.015) and patients who used substance (AOR=1.241, 95% CI: (1.173, 1.383), p-value=0.026) significantly associated with longer time to viral load suppression.
Conclusion: The result in the current study revealed that significant predictor variables associated to time to viral load suppression were identified. Further studies should be done on HIV positive adult patients by considering other important independent variables not included in this study. Awareness should be created for patients to disclose their disease status and to be good adherent for their medication.
Awoke Seyoum Tegegne* and Getu Degu Alene
DOI: 10.37421/2165-7920.2024.14.1625
Background: Neonatal mortality is the death of the neonate within the first month of life. Globally each year over four million neonates died within 28 days of birth. In Ethiopia, the prevalence of neonatal mortality is not proportional across regions as such the Amhara region was the second highest neonatal mortality with 54 deaths per 1000 live births. Therefore, this study aimed to investigate the prevalence and associated factors of neonatal mortality in Public hospitals in Amhara region, Ethiopia.
Methods: A community-based cross-sectional study was conducted on 1299 randomly selected neonates for the current study from March to May 2023. A multistage sampling technique with Logistic regression model was conducted in current study. Administered structured questioners, prepared by WHO in 2016 were used for data collection. SPSS version 25 software was used for analysis and data entry too.
Results: The risk of neonatal mortality in the study area was 20.9 per 1000 live births. Among the predictor variable; the preterm neonates (AHR=4.54, 95% CI፡ 1.57, 13.17, p-value=0.005), neonates borne from prim parous mother(AHR=4.21, 95% CI፡ 1.39, 12.7, p-value=0.011), neonates from mothers who had a previous neonatal history (AHR 3.50, 95% CI፡ (1.33, 9.20), p-value=0.011), neonates borne for mothers who did not have antenatal care (AHR=3.20, 95% CI፡ (1.10, 9.30), p-value=0.033), neonates whose delivery not at health institutes (AHR=4.17, 95% CI፡ (1.24, 14.08), p-value=0.02) and neonates born from mothers with an abortion history (AHR=4.60, 95% CI፡ (1.90, 11.32), p-value=0.001) had significant role for the existence of neonatal death in the study area.
Conclusion: The risk of nneonatal death was significantly associated with mother’s order of birth, duration of pregnancy, antenatal care, history of neonatal mortality, place of delivery and history abortion. Health related education should be conducted for women of reproductive age to get the antenatal care service and to deliver at health institutes. Hence, it is important to encourage mothers to use antenatal care service and deliver in health institutions.
Deka Mustapha Mohammed, Denekew Bitew Belay and Awoke Seyoum Tegegne*
DOI: 10.37421/2165-7920.2024.14.1626
Background: The practice of contraception remains unpopular in Somaliland often attributed to cultural barriers, and misconceptions associated with practice of contraception, all of which discourage women from accessing reproductive health services. This study aimed to assess the prevalence and associated factors with the practice of contraception among married women of reproductive age in Somaliland.
Methods: The data consists of 2304 married women; only 169 (7.3%) of these women were practicing contraception of any kind. The data source for the analysis was the 2020 SLDHS data, which is secondary. A multilevel binary logistic regression model with random intercept and fixed slope models was used in the current investigation.
Results: Among the respondents in the study area, only 7.3% of them practiced contraception of any kind. Among the predictor variables, urban residence, husband’s support, and secondary education and above, wealth, skilled/manual occupations, awareness of methods, completion of family, women who had access to mass media, and those women visited by FP workers significantly encourage the practice of contraception in the study area. On the other hand, lack of husband’s support (AOR=0.8684, p-value<0.01), lower education (AOR=0.8390, p-value<0.01), women who had no access to mass media (AOR=0.7845, p-value=0.0451) and women not visited by the FP worker (AOR=0.3970, p-value=0.04162) were associated with the less practice of contraception and having a desire of more children in the study area.
Conclusion: The strong patriarchal culture is one of the factors in which husbands do not play a major role in contraceptive choices because of the presence of women empowerment to use the long-term contraception method. Close communication between husband and wife and the socialization of LARC by health workers is expected to increase its use is another methods used to reduce the influence of husbands on contraception use. For those individuals who can’t get access of mass media, family planning campaigns play significant role in implementing contraception.
DOI: 10.37421/2165-7920.2024.14.1627
DOI: 10.37421/2165-7920.2021.11.1474
Rui Tang*, Xiaohong Lyu and Hong Li
DOI: 10.37421/2165-7920.2021.11.1475
Hereditary angioedema is a rare autosomal dominant disorder with prevalence estimated at 1/50,000, C1-INH levels may be decreased or normal, with an accompanied decrease in functionality, characterized by non-itchy and non-pitting swelling of subcutaneous and sub mucosal tissues of the face, extremities, genitalia, gastrointestinal tract, and upper airways, which can be life-threatening when located to the airways. It has been reported hereditary angioedema with ascites, but characterized with pleural effusion is rare. We describe a case of 30-year-old woman with pleural effusion for attracting attention of medical staff.
DOI: 10.37421/2165-7920.2021.11.1476
ELaouni Soukaina*, Jebli Salma, Sassi Samia, Jahid Ahmed, Zouidia Fouad, Elkhanoussi Basma, Bernoussi Zakia and Znati Kaoutar
DOI: 10.37421/2165-7920.2021.11.1477
Extramedullary Hematopoiesis (EMH) is a compensatory phenomenon to insufficient bone marrow function to maintain the circulatory demands. EMH occurs most commonly in the reticuloendothelial system such as spleen, Liver and lymph nodes, or in para osseous sites. EMH in the adrenal is rare with fewer than 10 cases reported, presenting as a giant adrenal mass are extremely rare. We report 38-year-old women with history of β-thalassemia since childhood. Computed Tomography (CT) was revealed a giant right adrenal mass with heterogeneous density mimicking a tumor mass with moderate splenomegaly associated, after excluding hormonal secretion. Ultrasound-guided biopsy was performed and reported fibrocollagenous tissue displaying trilineage haematopoiesis in favor of adrenal EMH, thus malignancy is eliminated. As a giant mass, treatment was an excision surgery associated with iterative transfusions to prevent recurrence. In daily practice, practitioners should pay attention to the differential diagnosis in any patients with chronic hematologic disorders suggestive for EMH even of uncommon location. A confirmatory preoperative biopsy is recommended to avoid unnecessary procedure.
Abdi Feyisa*, Tolesa T, Jirata S. Abose and Yaikob H Tolosa
DOI: 10.37421/2165-7920.2021.11.1478
Objectives: Shoats (sheep and goats) are selective feeders; however, indigestible foreign bodies are ingested mostly as a result of long-term feed shortages, mineral and nutritional deficits. In developing countries like Ethiopia, sheep and goats are commonly kept extensively and they have easy access to household wastes, rubbish on the roadsides, residential and market places. As a result, evidence-based interventions are needed to lessen the effects of foreign bodies on the production efficiency of the small ruminants. The aim of this study was to determine the frequency of foreign bodies in sheep and goats, as well as their gastrointestinal distributions and types.
Result: Foreign bodies were found in the stomachs of 89 (22.08%) of the 403 small ruminants (192 sheep and 211 goats) examined during the study period. Of them, 44 sheep (22.91%) and 45 goats (21.32%) were found to have different types foreign bodies. Plastic 47 (46.0%) was the most frequent foreign body discovered, while mixed plastic and cloth 1 (0.98%) was the least common. The rumen had the largest percentage of foreign bodies (69.6%), followed by the reticulum (16.7%), and the abomasum (13.7%). The prevalence of foreign body recorded in less than 2 years, 2-3 years and greater than 3 years old were 15.73% (28/178), 25.88% (44/170) and 30.9% (17/55), respectively. Besides, 15.58% (31/199), 28.14% (56/199) and 40% (2/5) prevalence of foreign bodies were recorded in good, medium and poor body conditions, respectively. There was a statistically significant variation in prevalence of foreign bodies between age groups and body conditions (p<0.05).
Conclusion: According to this study, the presence of various types of indigestible foreign bodies in three main compartments of the shoats' stomach (rumen, reticulum, and abomasum) has a significant impact on the animals' production. Appropriate waste management and husbandry methods should be designed and executed to reduce the risk of ingestion and the impact of indigestible foreign bodies on small ruminant production.
DOI: 10.4172/2165-7920.10001484
DOI: 10.4172/2165-7920.10001485
Ahmed Rezq*
DOI: 10.4172/2165-7920.10001486
Himmatrao Bawaskar* and Pramodini Himmatrao Bawaskar
DOI: 10.4172/2165-7920.10001487
Insulin autoimmune hypoglycaemic syndrome is characterized by spontaneous symptomatic hypoglycaemia in a non-diabetic patient or without administration of exogenous insulin accompanied with significantly high serum content of total immunoreactive insulin and presence of insulin auto-antibodies in high titer.
Mohamad Hubeish*
DOI: 10.4172/2165-7920.10001488
Journal of Clinical Case Reports received 1345 citations as per Google Scholar report
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