Introduction: Kidney transplant recipients have a 2 to 5-fold risk of developing malignancy due to the long-term use of immunosuppressive agents for preserving graft function.
This case report presents the successful use of ketamine infusion therapy as pain relief for a patient with bilateral neurogenic Thoracic Outlet Syndrome (TOS) combined with arterial TOS after bilateral first rib resection surgery. The patient did not respond well to medical management due to limited effects and severe side effects. However, surgical treatment resulted in temporary relief. After ketamine infusion, quality of life has improved considerably because of increased functional capacit...
An eighteen-month-old infant with ocular secretion and edema in one eyelid was taken to the Emergency Pediatric Unit. The laboratory analysis identified Neisseria gonorrhoeae in the ocular secretion, and treatment with third-generation cephalosporin was administered, with a favorable outcome. During the infant’s hospitalization, her mother was diagnosed with pelvic inflammatory disease.
Haematochezia is the most common presentation of lower gastrointestinal bleeding and is a frequent diagnosis resulting in admission or outpatient attendance to gastroenterology and colorectal services. We report the first case of hospital admission with a benign presentation of blood-red stools following red dragon fruit ingestion and details of his evaluation, including biochemistries and endoscopy. We review the available literature regarding the fruit and betacyanins and offer clinical pearl...
Solitary Fibrous Tumors (SFT) are rare fibroblastic mesenchymal neoplasms that most often arise from the visceral pleura, abdomen/pelvis, extremities, and neck. However, SFTs have been reported at any anatomical site. Solitary fibrous tumors occurred in patients over a wide age range with a median age of 60 years. Most SFTs have an indolent course, but 11% to 22% of the SFTs show a more aggressive behavior with distant metastasis and malignant transformation.
Crohn’s Disease (CD) is a complex inflammatory disease of the gastrointestinal tract, which is often associated with Extra-Intestinal Manifestations (EIMs). The estimated prevalence of ocular manifestations in patients with CD is 3.5%–6.8%, with uveitis, episcleritis, and scleritis comprising most of these cases. Orbital Myositis (OM) is an exceedingly rare ocular EIM which has also been reported. We present a case of a 22-year-old female patient with CD on ustekinumab monotherapy in clinical r...
Oral health is a source of psychological and physical comfort. A 59-year-old male patient presented five weeks after receiving the first dose of the Pfizer COVID-19 vaccine. He experienced physical and psychological distress, anxiety, fear, and pain from perioral swelling, cracked lips, numbness, and xerostomia. These signs and symptoms negatively affected his smile and overall facial expression. His condition worsened over time and included dryness around the mouth and chapped lips. Within fou...
Breast conservation therapy with excision and adjuvant radiation has become an acceptable alternative to mastectomy in treating early-stage breast cancer. This report of a case of severe radiation-induced fibrosis following breast conservation therapy serves to inform the oncologic community of the multimodal approach to non-operative management of radiation-induced fibrosis and indications for surgery in the treatment of this complication arising from external beam radiation.
According to the patient’s wishes, hyperthermia is an adjuvant therapy with an image as a treatment option; however, facilities that can provide this treatment are limited. We prioritize patients’ wishes at our hospital. Herein, we report the current situation along with reports of five patients who were treated with hyperthermia combined with extremely low-dose chemotherapy with in over 6 years. Five patients in their range of 42 years–72 years were histologically diagnosed with prostate cance...
Reports of thrombosis post-Coronavirus disease 2019 (COVID-19) vaccine have raised safety concerns. Report a rare case of possible vaccine-induced immune thrombotic thrombocytopenia diagnosed after the Pfizer vaccine in a Crohn’s disease patient who had been advised to discontinue his combination treatment (adalimumab plus azathioprine) before vaccination to improve antibodies response. Evidence-based medical advice by physicians remains crucial in vaccination campaigns.
Improving survival for children with cancer has been attributable to the provision of intensive therapies (i.e., high-dose chemo/radiotherapy and Hematopoietic Cell Transplantation-HCT). However, as a result of these treatments, most children suffer and experience severe and distressing treatment-related symptoms such as taste and smell alterations that can hamper the quality of life of these patients by influencing their appetite, body weight, and psychological well-being. In addition, one of ...
Background: In recent years, several new biologics, such as benralizumab has been developed to treat patients suffering from asthma poorly controlled by high-dose Inhaled Corticosteroids (ICS) and long-acting bronchodilators. Benralizumab is a humanized, interleukin (IL)-5Ra-specific monoclonal antibody that effectively ameliorates asthmatic episodes by inducing rapid and nearly complete depletion of eosinophils.
We report a clinical case of an 8-year-old with a history of penetrating trauma in the right eye. Surgical innervation was performed due to a corneo-limbo-scleral wound. After one year, he presented to our department with decreased vision and discomfort in the right eye. Upon examination, a traumatic iris cyst is observed. The cyst was treated with Nd-YAG laser, obtaining a size reduction and visual acuity improvement.
Background: Langerhans Cell Histiocytosis (LCH) is a relatively rare disorder with a strong inflammatory component. It has diverse clinical manifestations, which range from a single lesion or multiple bony lesions to severe multi-system involvement. Approximately 10% to 20% of cases of LCH occur in the jaw, with the posterior mandible being the most frequently involved site. The majority of patients are children younger than three years, and the incidence in adults is approximately 1-2/million....
Background: Vasospastic angina is caused by vasospasm of the coronary arteries. Aldehyde dehydrogenase 2 (ALDH2) is involved in nitroglycerin metabolism and reduces oxidative stress, thereby suppressing vasospasm. However, it is unclear whether a change in the expression level of human ALDH2 in the blood correlates with the regulation of vasospastic angina.
Objectives: Present a clinical case of C1 Jugulotympanic Paraganglioma (JTPG), emphasizing treatment decision and surgery planning to improve and optimize timing and result.
Anaphylactic reactions to the Pfizer-BioNTech mRNA vaccine may occur, but their etiology is unclear. We are suspicious of a possible link between the first dose of the Pfizer vaccine and generalized gingival inflammation associated with hyperemic, erythematous gingival enlargement that was noticed one week after vaccination. The patient was a breastfeeding woman who presented with a chief complaint of a sudden change of normal pink gum tissue to fiery red, swollen, and bleeding one week after r...
Diagnosing abdominal wall hernias remains challenging due to the occurrence of multiple symptoms. Only a few reports have been published describing the combination of rare abdominal wall hernias. We report the case of a 69-year-old woman with abdominal pain lasting three days. During diagnostic imaging using a CT scan, seven abdominal hernias were discovered. Although all individual hernias have been reported before, the combination of an umbilical hernia; a left femoral hernia; a bilateral hig...
Introduction: Primary cutaneous gamma-delta T-cell lymphoma (PCGD-TCL) is a rare lymphoma that accounts for 1% of all cutaneous T-cell lymphomas. The average age at onset of the disease is 42 years. We present a cutaneous gamma-delta T-cell lymphoma case in a 26-year-old patient with hemophagocytic syndrome and simultaneous cerebellar pilocytic astrocytoma manifestations.
The World Health Organization (WHO) approved the AstraZeneca/Oxford COVID-19 vaccine (ChAdOx CoV-19) for emergency use in February 2021. The WHO’s Strategy Advisory Group of Experts on Immunization recommended use for all age groups 18 and above. However, after the ChAdOx CoV-19 vaccine rollout, allergic reaction following ChAdOx CoV-19 vaccination was reported, causing vaccine hesitancy. Although a heterologous prime-boost strategy could be used in those who have had such an allergic reaction,...
A clinical case of the lymphangioma in a child and the role of both anamnestic, clinical, and paraclinical data, as well as histopathological data in the differentiation of intra-abdominal tumors and the prognosis, are reported.
A 54-year-old asymptomatic male with a ten-year history of a left lung nodule presented after a follow-up chest scan showed an increased nodule size and multiple perivascular cysts. Histopathological examination showed necrotizing, granulomatous inflammation with neutrophils, eosinophils, lymphocytes, and plasma cells, with surrounding vasculitis; another section showed accumulation of amorphous, eosinophilic material without granulomas or vasculitis. This case was initially broadly classified ...
A rare clinical case of the pediatric solid-pseudopapillary tumors of the pancreas is described. The diagnostic techniques and the choice of surgical procedures and adjuvant chemotherapy, using own experience, are presented. In addition, the literature data that reveal many novelties regarding the complications and the exodus of the disease is discussed.
Clinical case of a 36-year-old man with symptomatic peripheral visual field loss. Electroretinography showed severely reduced rod function. The DNA test revealed homozygous deletion mutation in CNGB1, associated with Retinitis Pigmentosa type 45, characterized by an early onset with a rather slow progression of the disease.
Vaccines against Sars-CoV-2 (Severe acute respiratory syndrome coronavirus 2) have demonstrated a crucial role in overcoming the Covid-19 (coronavirus disease 2019) pandemic, and a worldwide vaccination campaign has started at the end of December 2020. However, those subjects who exhibit contraindications to vaccines are at risk of remaining excluded from immunization. A severe allergy to a vaccine or a vaccine component represents such a condition. Nevertheless, an accurate allergological eval...
Introduction: Hypokalemic periodic paralysis (HPP) or Westphall’s disease is a genetic channelopathy with autosomal dominant transmission at the origin of transfer hypokalemia. We report the first observation of a Malagasy patient in Madagascar to incite physicians to evoke it in front of an association of hypokalemia and a neurological deficit.
Introduction: Glomerular involvement is a common renal complication associated with Hepatitis B infection. Although membranous nephropathy is the pathology most frequently encountered, other glomerular diseases, such as focal and segmental glomerulosclerosis (FSGS), are rare. We report a rare case of hepatitis B-associated FSGS.
Cutaneous Squamous Cell Carcinoma (cSCC) is the second most common type of skin cancer, characterized by the uncontrolled proliferation of keratinocytes. Treatment options depend on the stage of the disease, with systemic therapy reserved for locally advanced and metastatic disease. Cemiplimab, an anti-PD 1 monoclonal antibody, has proven efficacy against this highly immunogenic tumor, increasing evidence of its usefulness in unresectable, metastatic, and locally advanced diseases.
Case summary: A 67 elderly female patient suffered from a postoperative non-healing wound after craniocerebral trauma surgery, and effective debridements and local anti-infection therapies were tried, but the effectiveness was limited. An adapted fire needle therapy was tried. The fire needle therapy used was divided into two stages. In the 1st stage, a thick fire needle was used once a day for four days, four times total. During the 2nd stage, a thin fire needle was adopted once every other da...
A 65-year-old male smoker with a history of hypertension presented to the emergency department with a two-day history of slurred speech and left-sided hemiplegia followed by a status epilepticus. After initial resuscitation, requiring mechanical ventilation and anticonvulsants, a head Computed Tomography (CT) scan was performed and showed an approximately 4.5 cm enhancing right frontal intra-axial tumor complicated by diffuse perilesional edema and a mass effect on median structures (Figure 1A)...
A 60-year-old patient presented for complete maxillary and mandibular dentures following extractions and alveolar bone remodeling. However, once the extractions and alveoloplasty were complete, the lack of depth or width of the alveolar ridge precluded the placement of a quality mandibular denture following the conventional protocol. A modified treatment technique was therefore created to enable a complete mandibular denture. A full-thick flap had been laid from mandibular premolar to premolar,...
Subglottic cysts are a rare cause of respiratory distress in infants. The primary risk factors for subglottic cyst formation are prematurity, low birth weight, and prolonged intubation. Therefore, early recognition and treatment are essential to prevent potentially fatal airway obstruction.
Colorectal cancer (CRC) is a common type of malignancy. However, metastatic CRC is rare and difficult to diagnose. We present a case of metastatic ovarian cancer mimicking primary rectal cancer. Our 76-year-old patient was diagnosed via immunohistochemical staining of an endoscopic biopsy sample and underwent surgery for low anterior resection and Hartmann’s procedure. With acceptable results, this was followed by chemotherapy based on cisplatin and paclitaxel regimens for ovarian carcinoma wit...
Carbon monoxide (CO) poisoning causing lung parenchymal damage is uncommon. We illustrate a case of a 27-year-old gentleman with a recent history of self-inhalation of CO who, following an uneventful recovery, presented with acute cardiorespiratory symptoms and was subsequently diagnosed with inhalational pneumonitis. We describe the case with delayed complications pertaining to the respiratory system and its likely pathogenesis. Obtaining an accurate exposure history is key to identifying the ...
Background: The available scientific data on the oral manifestations of the new coronavirus is contradictory. Some scientists report that the oral and nasal mucosa is particularly affected during SARS-CoV-2 infection. However, others report infrequent involvement of the oral mucosa. Unlike oral lesions, orofacial symptoms such as anosmia/hyposmia and/or ageusia/dysgeusia/hypogeusia are better documented. We want to describe oral lesions in a patient with confirmed SARS-CoV-2 infection and assoc...
This paper compares the effects of 7-day “dry” water immersion (DI) and intermittent muscle contractions on electrical and mechanical failure during muscle fatigue in the human Triceps Surae (TS) muscle electrically stimulated at 50 impulses s-1 via its motor nerve. 1-s intervals separated intermittent contractions of 60-s duration for the identical duration of tension development. The 60-s intermittent contractions decreased tetanic force to 57% (p < 0.05) of initial values, but force reductio...
Spontaneous occurrence of pelvic floor hematoma is not common, and there is no specific figure in literature for its incidence. Most cases of pelvic hematomas arise from bleeding lacerations following operative deliveries or episiotomies; therefore, a high index of suspicion is needed when a patient presents with excessive perineal and back pain following a normal vaginal delivery as early detection of puerperal hematomas prevents morbidity and mortality. Most cases of large vaginal hematomas a...
Optimal laser tattoo removal in fewer sessions has been consistently investigated. As a result, dermatologists and laser surgeons have been leading the way to develop techniques and methods to remove tattoos in the fastest and safest possible way effectively. Acoustic Shock Wave Therapy has been recently described as an adjuvant in enhancing tattoo clearance by increasing lymphatic drainage and increasing metabolic activity in the treated area, thereby accelerating the clearance of dermal pigme...
Adnexal torsion sometimes causes diagnostic challenges, mainly in a pediatric patient and when it lacks an ovarian tumor. For four days, a 9-year-old girl presented to the medical service complaining of right lower abdominal pain. Laboratory data showed mild leukocytosis and an elevated C-reactive protein. Abdominal ultrasound showed an enlarged right ovary measuring 57 mm x 38 mm. A pelvic computed tomography showed a small amount of free fluid in the peritoneal cavity. These data suggested an...
Thyroid carcinoma is treated by near-total or total thyroidectomy, followed by 131Iodine (131I) ablation of any remnant thyroid tissue. 131Iodine whole-body scan (WBS) has been used for the follow-up of differentiated thyroid carcinoma for several decades. The specificity of the 131I whole-body scan for detecting residual, metastatic, and recurrent differentiated thyroid carcinoma is reported to be higher than 90%. However, radioiodine uptake is not specific to thyroid tissue. It could also be ...
ackground: Minocin is an antibiotic used in the treatment of adolescent acne. Overall, Minocin is considered safe and effective with proper usage. As its use has increased, more severe reactions have been identified, including anaphylaxis, lupus-like syndrome, hypersensitivity syndrome reaction (DRESS syndrome), and hepatitis. In this paper, we present the case of a 17-year-old Jewish female who presented with fever, pharyngeal pain, rash, and elevated transaminases; her medical history was ...
Hormone receptor-positive breast cancer is the most common subtype in women. Endocrine therapy is the recommended first-line therapeutic approach as research shows that it has the highest efficacy in managing carcinoma. Our case presents a 28-year-old female patient diagnosed with left hormone receptor-positive breast cancer that had metastasized to her bones, lymph nodes, and liver. Due to her increasingly adverse condition, chemotherapy was used as a first-line treatment, followed by endocrin...
The autoimmune syndrome induced by adjuvants (ASIA) is a little-known entity that includes silicone implant incompatibility syndrome (SIIS) or siliconosis. Its most common clinical presentation is nonspecific symptoms such as myalgia, arthralgia, fever, dry mouth, fatigue, paresthesias, or headache.
Introduction: Myelitis in Neuromyelitis Optica spectrum disorder can have an abrupt onset. Observation: A 17-year-old woman presented March 17, 2017 brutal tetraplegia associated with vesical sphincteric disorders with no history, preceded by intense interscapulum pain. The neurological examination objected to a flaccid muscle deficiency of the four limbs. Medullar MRI showed a hyperintensity on T2 from C2 to D2 with “Snake eye” in the axial view. The diagnosis of medullary ischemia was held...
In Indonesia, most otitis media patients do not seek medical advice except when pain occurs, discharge increases, or complications. This is a case report of a chronic suppurative otitis media with multiple intracranial complications such as subdural empyema, epidural abscess, and bacterial meningitis previously misdiagnosed as tuberculous meningitis.
Primary choriocarcinoma of the liver is a rare malignant tumor derived from trophoblast cells or pluripotent hepatocytes. Its main hallmark is ß-HCG increased significantly. It occurs in older men very rarely and has a poor prognosis. Choriocarcinoma is a kind of malignant tumor that originated from trophoblast cells or pluripotent stem cells. It mostly occurs in the gonad with a high degree of malignancy and poor prognosis. Choriocarcinoma usually occurs in infants and women after pregnancy, w...
Background: Paracoccidioidomycosis (PCM), caused by the fungus Paracoccidoides brasiliensis, is the most common endemic systemic mycosis in Latin America. It is a granulomatous systemic disease affecting mostly the skin, upper respiratory tract, and lungs and is treated with oral itraconazole or other antifungals. Oesophageal involvement is rare.
Pemphigus Vulgaris (PV) is a rare autoimmune disorder characterized by the presence of blisters on the mucous membranes and skin. Autoimmunity is a crucial complication developing in Predominantly Antibody Deficiencies (PADs), a subgroup of Primary Immunodeficiencies (PIDs). Herein, we present a case with PV who had PAD and whose disease relapsed in the maintenance period of conventional immunosuppressive treatments but was promoted to remission by high-dose Intravenous Immunoglobulin (IVIG) th...
Classical/mechanobullous Epidermolysis Bullosa Acquisita (EBA) presents with acquired fragility, trauma-induced blistering, milia, and scarring. Bullous SLE BSLE is an inflammatory disease with neutrophil-rich blisters on sun-exposed sites. We present a rare case of chronic SLE who developed an acquired immunobullous disease with clinical features of EBA rather than BSLE.
Spontaneous heterotopic pregnancy is a rare condition and can present with signs of hypovolemic shock due to rupture. A 31-year-old woman presented in the emergency department with lower abdominal pain with signs of peritoneal irritation and hypovolemic shock. She was eight weeks pregnant via spontaneously conceived intrauterine pregnancy confirmed on an ultrasound scan. Her past medical history was significant for a C-section 2 years ago. Initially managed in the resuscitation room in ED, she ...
Background: Cardia-preserving proximal gastrectomy (CPPG) is a function preserving surgery for treating early gastric cancer (EGC) of the upper stomach, which aims to reduce the incidence of complications and improve the quality of life after surgery. The clinical outcomes and quality of life (QOL) of CPPG were evaluated.
Background: Neurological complications after Radiotherapy of Nasopharyngeal Carcinoma (NPC) are frequent. The most frequent physiopathological effect is the structural change of the vasculature. According to the specific topography of irradiation and the dose, the artery can suffer from this treatment. This study aims to describe an uncommon acute neurovascular complication after Radiotherapy of nasopharyngeal carcinoma. However, it is difficult most of the time to establish a correlation betwe...
A 94-year-old male was admitted to the hospital with a UTI and found to be COVID-19 positive. Due to patient delirium and difficult venous access, a PICC line was placed for antibiotics and lab draws. The PICC line was subsequently found to be coiled in the left axillary vein. It was still functional and able to be used. The patient’s hospitalization was significantly complicated by COVID-19 and patient agitation. Additionally, the patient was located at a smaller facility without a vascular su...
The rising rate of the morbidly obese population has created a need for intraoperative anesthetic management to be adjusted according to anatomic and physiological changes. In this case study, the goal is to explore and detail the beneficial effects of utilizing a combination of regional anesthesia and Enhanced Recovery After Anesthesia (ERAS) techniques to improve outcomes and decrease anesthesia-related morbidity and mortality.
Endoscopic reduction in pediatric cases of acute Gastric Volvulus (GV) is rarely reported, especially cases of GV associated with Beckwith-Wiedemann Syndrome (BWS), which is a condition with congenital malformation. A 4-year-old girl with BWS presented to the emergency room with a complaint of abdominal pain while eating lunch. Physical examination revealed abdominal distension and severe tenderness but no peritoneal signs. A chest x-ray taken three months ago when she presented to the emergenc...
Mental health presentations and Black male patients are independent features predictive of a difficult clinical encounter. The Motivational Interview (MI) technique was used to facilitate compliant psychiatric care for a Black male presenting to the Emergency Department (ED) with Suicidal Ideation (SI). The MI technique established a therapeutic alliance for shared decision-making. This case report reviews the four core MI skills by highlighting its culturally sensitive application for motivati...
A 28-year-old woman underwent fertility-sparing surgery with a right salpingo-oophorectomy for a Stage IA well-differentiated mucinous cystadenocarcinoma. She remains disease-free at twenty months of follow-up. A literature review suggests that among young women with early-stage epithelial ovarian cancer, conservative, fertility-preserving surgery is safe. In a well-staged patient, neither ovarian preservation nor uterine conservation had an adverse impact on survival. Advanced stage, grade, an...
This case report describes the use of bioimpedance spectroscopy (BIS) to monitor changes in hydration status and cellular function in a 73-year-old male patient with non-small cell lung cancer (NSCLC) undergoing a 12-week immunotherapy course. The parameters monitored were phase angle (PA), impedance ratio (IR), and cell membrane capacitance (Cm).
Magnetic Resonance Imaging (MRI) is very useful for diagnosing brain melanoma (or its metastasis); however, its diagnosis is sometimes challenging. We present a case of a 65-year-old woman admitted to the hospital with an epileptic seizure. Brain MRI revealed multiple lesions, suggestive of chronic granulomas, possibly of parasitic origin, such as neurocysticercosis. The patient then underwent numerous examinations, which did not coincide with neurocysticercosis. Brain biopsy confirmed a melano...
Emergency Department (ED) based Trauma-Informed Care (TIC) was applied on a black male gunshot victim. The operational structure of University Medical Center New Orleans (UMCNO) ED has established an optimal interdisciplinary TIC foundation that addresses the health crisis of gun violence by accounting for its epidemiology. This foundation reinforces bedside emergency physician TIC with an ED-based Hospital Violence Intervention Program (HVIP) for TIC continuity. The approach mitigated the re-t...
This case report illustrates a stricturing Crohn’s disease insidiously progressing over several months into the intestinal obstruction. Extensive out-patient examination by Computed Tomography (CT), CT angiography, endoscopy, and plain nuclear Magnetic Resonance Imaging (MRI) showed no obvious pathology until complications manifested as an ileus. Abdominal pain without obvious pathology should be investigated further with advanced imaging methods rather than establishing a diagnosis of function...
Aggressive and avoidant behavior are risk factors for disruption of necessary medical therapy and challenge for medical staff. This case report offers a classification of stress reactions in very young children during oncological medical treatment. Moreover, it illustrates a best-practice case of interdisciplinary treatment to explain medical procedures and improve the compliance of young children with chronic illnesses and language barriers.
Objective: Susac Syndrome is a rare disease of unclear pathology and is often misdiagnosed as multiple sclerosis due to its variable appearance. The scope of this case report comprises presenting symptoms, diagnostic measures in terms of different treatment approaches, and possible therapeutic recommendations.
Objective: Older adults with cardiovascular diseases are especially prone to polypharmacy due to comorbidities and consequent complexity of medication regimens. Prescribing cascades can occur when a side effect is misinterpreted as a new medical condition. Although the act of deprescribing is an integral part of good prescribing practice, it can be difficult to initiate without surveillance, appropriate communication, and primary care physician advocacy.
Malignancy presenting as polyarthralgia is rare, and correct diagnosis requires complete history, physical examination, imaging, and laboratory workup. We report a case of a 64-year-old male with abrupt severe debilitating migratory polyarthralgia as the initial presenting symptom of invasive ductal carcinoma. His joint pain was refractory to traditional analgesic medications, and his polyarthralgia resolved after surgical excision of his malignancy.
Babesiosis is a tick-borne disease parasitic protozoan infection characterized by the invasion of red blood cells leading to hemolytic anemia. Splenic infarction is a rare but severe manifestation of Babesiosis, which can be life-threatening. We present a case of an 86-year-old man that presented with generalized weakness, fever, chills, dark urine, and altered mental status. However, the patient had been on chronic anticoagulation with warfarin and had a supratherapeutic International Normaliz...
A 49-year-old healthy man with a history of exogenous anabolic steroid use presented with acute anterolateral ST-elevation myocardial infarction (STEMI). Coronary angiography revealed an 80% thrombotic occlusion of the proximal left anterior descending artery (LAD) without angiographic disease in other coronary arteries. Optical Coherence Tomography (OCT) imaging of the LAD, performed after improved flow with aspiration thrombectomy, revealed residual red thrombus. Following repeat aspiration t...
Pericardial effusions are not unusual in Chronic Kidney Disease (CKD). They can be related to renal disorder or have different etiologies, which must be investigated in each patient. We report an 8-year-old with CKD and asymptomatic pericardial effusion and discuss the diagnostic considerations and investigative paradigm. After an extensive investigation, we concluded that our patient represents the first pediatric case of Minoxidil-associated pericardial effusion.
The etiology of perinatal death often remains unidentified, yet proper diagnosis is crucial for appropriate family counseling and future pregnancy planning. We present a neonate delivered at 30 weeks and four days gestational age in the setting of hydrops fetalis and intrauterine growth restriction to non-consanguineous parents. Gross morphology was consistent with Fetal Akinesia Deformation Sequence (FADS) in addition to the hydropic changes.
Covid infection is known to have a low fatality rate in young people and those without comorbidities. The classic triad of high temperature, new continuous cough, and loss of smell may not be present in all cases. Unusual presentations and initial negative Covid test can be detrimental in accessing treatment, leading to dangerous consequences in young people.
A 65-year-old man with a VVI pacemaker and persistent Ventricular Tachycardia (VT) was referred to catheter ablation. The successful ablation site was 5 mm under the left pulmonary cuspid valve and 2 mm from the Right Ventricular (RV) electrode. No significant change on pacing thresholds, perception thresholds, and pacing impedance of pacemaker electrode before and after VT ablation.
Orbital granulocytic sarcoma involving the central nervous system and coinciding with acute megakaryoblastic leukemia is a rare complication of this disease. We report a case of a previously healthy male infant 20-month-old who developed acute megakaryoblastic leukemia and in whom the initial diagnosis was difficult because of associated severe myelofibrosis. We focus on this report on the clinical and cyto-histological features and problems concerning differential diagnosis and the importance ...
We describe a case of a newborn presenting type III esophageal atresia associated with unilateral pulmonary atresia and dextrocardia. To our knowledge, this combination of congenital defects has never been reported before. We discuss the difficulties in diagnosis.
A young gentleman aged 22-year-old was referred to the trauma and Orthopaedics department with post-traumatic swelling and pain in his right hand for -one week- duration. The mechanism of trauma was due to uncouth crush injury. The underlying lesion was a dorsal dislocation of the carpometacarpal (CMC) joints of the right ring and little fingers. Despite being lately presented to us due to a delay in the diagnosis, a closed reduction trial under local anesthetic infiltration was performed. The ...
In 2002, Active Citizenship Network (ACN), together with 12 citizen organizations from 15 different EU countries, established the European Charter of Patients’ Rights, which lists fourteen fundamental patients’ rights which each EU country must protect and guarantee. The fourteen rights apply to all individuals and, together, aim to guarantee a “high level of human health protection”, as claimed in Article 35 of the Charter of Fundamental Rights of the European Union, and to assure the high qua...
Background: Different therapies have been studied in patients with cardiac arrest due to ST-Elevation Myocardial Infarction (STEMI). However, none of the anti-arrhythmic or vasopressor medications have consistently been shown to improve these patients’ survival or neurological outcomes. Recent studies show that administration of fibrinolytic drugs during cardiac arrest may improve survival outcomes and neurological status.
Purpose: Patients affected by polypharmacy are at higher risk for significant multi-drug interactions. Inadequate management of these multi-drug interactions in patients discharged from the hospital can lead to readmission and/or medication-related morbidity.
Hereditary Hypophosphatemic Rickets with Hypercalciuria (HHRH) is a rare autosomal recessive form of hypophosphatemic rickets. It is caused by mutations in the SLC34A3 gene, which encodes the renal sodium-dependent phosphate cotransporter 2c (NaPi-IIc). It is characterized by normal plasma levels of calcium and 25-hydroxyvitamin D, an elevated level of 1,25-Dihydroxyvitamin D [1,25(OH)2D], a low level of parathyroid hormone, hypophosphatemia, hyperphosphaturia, hypercalciuria, and a low level o...
Background: Hemoptysis is caused by several lung diseases and can be fatal in some cases. However, the risk factors of hemoptysis and prognosis remain unclear. Methods: We present the cases of 15 patients with hemoptysis who had undergone Bronchial Arterial Embolization (BAE) at our hospital. We also analyze the patient’s background, hemoptysis risk, and prognosis.
Background: Takostubo cardiomyopathy is defined by the presence of transient wall motion abnormalities, most of the time in the form of an apical ballooning and without coronary occlusion. Causes remain unclear. Psychological or physical stress could cause this pathology related to catecholamine cardiotoxicity. The distinction between Takotsubo cardiomyopathy and myocardial infarction is not always easy to make. This particular clinical case is a good illustration of that situation.
Dr. William Stewart, surgeon and chief of staff of Johns Hopkins Medical School in the 1880s, devised a grueling and prolonged training program for his residents in which they basically lived at the hospital and worked extremely long days with very little sleep or rest. In this manner, he believed physicians would truly be trained to the maximum extent that they could. This training regimen caught on and became the prevailing training method of residency programs throughout the US.
Allergic Bronchopulmonary Aspergillosis (ABPA) is an uncommon, frequently unrecognized or misdiagnosed pulmonary disease, which occurs predominantly in patients with asthma or cystic fibrosis. It is estimated that ABPA affects more than 4.8 million asthmatic patients worldwide. In Croatia, the prevalence of aspergillosis is unknown, and very sparse clinical reports have been published, mainly on the invasive form of the disease. However, some ecological and animal studies pointed to the possibi...
Background: The current Cardiopulmonary Resuscitation (CPR) guidelines recommend a cardiac rhythm check every 2 min to evaluate the Return of Spontaneous Circulation (ROSC). Central artery pulse checks are generally performed manually when an organizing rhythm is recognized on the monitor, but several studies have shown that this method is not reliable. Recently, a case series of a novel approach can be used to determine the presence or absence of pulses using direct Point-of-Care Ultrasound (P...
The benefits of opioid use in older adults to manage chronic non-cancer pain must outweigh the risks as these individuals are more susceptible to the side effects and drug interactions associated with opioids. Pharmacogenomic testing supports clinicians in selecting appropriate opioid therapy while minimizing these risks.
In patients with treatment-resistant transmural eosinophilic gastroenteritis, a submucosal eosinophilic abscess may be an important pathologic finding.
COVID-19 called Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is an ongoing outbreak that has caused a crucial global public health issue over many countries. The incidence rate is significantly increased in the entire world, including Korea. In this study, we conducted an in-depth analysis of mutations using 126 sequences available in public. In total, 177 mutation sites were detected using multiple sequences alignment. We observed that the only 30 mutations were shared with mor...
Pancreatic adenocarcinoma usually metastasizes to the liver, lungs, lymph nodes, or bones. However, brain metastases have also been shown in some rare documented cases and usually predict a very poor prognosis. We present the case of a 56-year-old male who was diagnosed in June of 2017 with primary metastasized pancreatic adenocarcinoma and, after a good initial response to palliative chemotherapy started to complain about headaches and altered visual acuity, with evidence of a left occipital i...
Enchondroma of the vertebral spine is a rare clinical entity. For symptomatic enchondroma, surgical resection is the treatment of choice. Here we present the atypical case of a patient with non-symptomatic spinal enchondroma (D9), discovered because of a dorsal trauma that led to a D9 fracture. The pre-operative diagnostic workup gave a suspicion of a co-existing neoplastic lesion, leading to the consideration of a more likely pathologic fracture than a traumatic lesion, with no segmental insta...
Background and purpose: Endomorphin-2 is a physiologic tetrapeptide amide, Tyr-Pro-Phe-Phe-NH2, which has been shown to provide an analgesic effect in mice and rats by injection into the brain. In our previous report, we showed that certain Endomorphin-2 derivatives, such as N-Ac-Tyr-Pro-Phe-Phe-NH2 could provide instant analgesia on topical application. The case reports presented herein reveal that a number of N-substituent radicals enhance analgesic effects of the derivative applied topically...
Publications on Caudal Regression Syndrome (CRS) have preferentially addressed the diagnosis and treatment of such cases. There has been little discussion about related bioethical dilemmas. Objective: To analyze ethical conflicts relating to adolescents with CRS.
Anterior Cervical Discectomy and Fusion (ACDF) are frequent interventions. Neurologic worsening and Horner syndrome are known as very rare complications, but none described a Brown-Sequard syndrome as clinical feature of a sulcal artery syndrome. We report a case of a 47-year-old woman who underwent a double level ACDF with plating (C3–C5) and who developed 7–10 hours after the surgery a progressive anesthesia on the right side, with a level on D3, associated with impairment in discriminating h...
Demodicosis is a common parasitic infection of the pilosebaceous unit caused by Demodex mites. This is the case of facial demodicosis of atypical presentation that appears as a unilateral erythemato-squamous plaque, whose initial possible diagnosis was seborrheic dermatitis and seborrheic pemphigus. The skin biopsy revealed an increased number of Demodex organisms in the pilosebaceous unit. Our patient was treated with topical metronidazole, topical tacrolimus, and oral ivermectin, and showed n...
Human prionopathies can be sporadic, hereditary, or acquired disorders. Familial Creutzfeldt-Jakob (F-CJD), Familial Fatal Insomnia (FFI), and Gerstmann-Sträussler-Scheinker (GSS) are the main hereditary variants. We describe the first FFI case in Galicia and other F-CJD, underlying their similitudes and differences.
Introduction: The Human bocavirus was identified from the nasopharyngeal aspirate specimen in 2005, that it includes four subtypes (HBoV 1–4). The HBoV-1 is a major subtype in children’s acute respiratory infections, and others (HBoV 2–4) were in stool specimens. The pathogenic role of Human bocavirus 2–4 in acute Gastroenteritis has not confirmed yet, and therefore all of the reports were done to confirmation of this issue.
Burkholderia cepacia is an aerobic, glucose non-fermenting, motile, and multidrug-resistant gram-negative bacteria, which is not considered from the normal human flora. It is a rare cause of sepsis in newborns, and its transmission involves human contact with heavily contaminated medical devices and disinfectants.
Hemophilia A is a bleeding disorder characterized by a decreased level of factor VIII inherited by the X chromosome. Preoperative and postoperative planning is crucial in the presence of fractures requiring surgical treatment in hemophilia patients. A 16-year-old adolescent hemophilia A patient with a trivial fall on his left elbow applied to the emergency room, and a Mayo type 2A olecranon fracture was detected. 40 IU/kg Factor VIII replacement was performed since the preoperative level was 8%...
Although pertussis alone is a disease that usually has a benign course and a favorable outcome, we must keep in mind that children can have a respiratory viral coinfection associated with a pertussis infection. Mixed respiratory tract infections may be responsible for more severe disease. The rapid microbiological analysis contributes to their adequate diagnosis and timely treatment.
The study of the functioning of the heart is significant for the diagnosis of different cardiac pathologies. The Phonocardiogram Signal (PCG) is the signal generated after converting the sound noises coming from the heart into an electrical signal, it groups together a set of four cardiac noises (S1, S2, S3 and S4) which are in direct correlation with cardiac activity. The Short-Term Fourier Transform (STFT) is an analytical technique that describes the evolution of the time and frequency behav...
Fibromyalgia (FM) is a chronic syndrome characterized by widespread musculoskeletal pain, fatigue, stiffness, and associated features such as insomnia, mood and anxiety symptoms and cognitive dysfunction. In the general population, FM is prevalent with a rate of 2%–4% -mainly women- and causes functional impairment and disability [1]. Most patients with FM require a combination of medications and other interventions [2,3]; yet a partial response is common. FM supposedly results from the enhance...
Residual inflammatory odontogenic cysts are formed at the region of the previous extraction of the tooth. It can also form due to incomplete removal of other common odontogenic cysts of the jaw. A residual cyst occurs commonly in the maxilla than mandible and shows more of male predilection. Usually, residual cysts are asymptomatic, and the patient normally seeks treatment once it gets infected or causes any other discomfort. It can sometimes diagnose as an incidental finding in radiographs.
The concept of general pathology is cornerstone for the theoretical medicine. In addition to the General Human Pathology we have managed to discover General Pathology Markers (GPM), which are sensitive to all types of diseases. Using GMP enables us to find a strict quantitative boundary between organism’s normal and pathological conditions.
Dermoidcysts of the auricle are extremely rare. A 13-year-old female patient was admitted to our clinic with the complaint of a painful, slowly growing mass that had been present behind her right ear since birth. Ear examination revealed a soft, approximately 2 cm x 2 cm cystic mass on the posterior aspect of the right auricle. Histopathological examination of the excised mass was reported as dermoid cyst. The patient, who had no problem after the operation, was called to the controls and disch...
The study of pharmacogenetics aids in the identification of variable therapeutic responses, identification of adverse reactions to drugs, and supports development and discovery. While advances in pharmacogenetic testing have been significant in recent years, The U.S. Food and Drug Administration (FDA) cautions against using this information solely as the basis to alter therapeutic treatments.In the case presented below, a patient with lung cancer was prescribed the standard dose of codeine for ...
LADA is characterized by adult-onset and circulating autoantibodies e.g., glutamic acid decarboxylase (GAD-65). LADA may be misdiagnosed, as it has features of both Type 1 and Type 2 diabetes. Dipeptidyl Peptidase-4 (DPP-4) (CD26) is a transmembrane glycoprotein immunomodulator causing a Th1/Th17 dominant milieu while suppressing anti-autoimmune Th2/Treg expression. Th1 and Th17 secrete pro-inflammatory cytokines that mediate ß cell autoreactivity. DPP-4 inhibitors (DPP4I), e.g., sitagliptin (S...
Background: The median age of lung cancer diagnosis is 70 years with patients often precluded as surgical candidates due to comorbidities, tumor location, and refusal of surgery. In these cases, stereotactic body radiation therapy (SBRT) has become the treatment of choice. With SBRT, there remains a risk of radiation pneumonitis (RP) and other toxicities. Adjuvant corticosteroids could be a tool to diminish radiation toxicity. However, little data exists exploring this treatment.
Background: Cushing's disease is associated with high vascular morbidity and mortality. A pituitary adenoma apoplexy is a rare but a potentially life-threatening clinical syndrome, occurring as a result of hemorrhage or infarction in a pituitary adenoma. An important risk factor for a PA is the administration of anticoagulants. Patients with Cushing’s disease have prothrombotic changes and impairment in fibrinolysis resulting in increased risk of thromboembolism. Also an increased activation of...
Presentations of mixed polypharmacy overdose are increasingly common and frequently require treatment within the Intensive Care Unit (ICU). We present the novel use of Terlipressin acetate to rapidly overcome refractory shock in a patient that presented with mixed polypharmacy overdose. The Shock was refractory to conventional vasopressors and use of terlipressin acetate reduced length of stay in the ICU.
"Spice" synthetic cannabinols, and as new psychoactive drugs. Studies have shown that many spice products are sprayed with synthetic cannabinoids, substances that cause intoxication. Despite widespread use in Europe, spice products were introduced to the United States only recently. In the world literature data on the Spice intoxication clinic is not enough. To provide preliminary management experience for future cases, we describe 5 patients with Intoxication from smoking “Spice” after who con...
Goal of the research: Although studies show good results on relief of Low Back Pain (LBP) after cryoablation of the facet joints, we wished to evaluate the changes in patient’s quality of life. This included factors such as their participation in daily activities, social life, work performance, mental health and overall self esteem.
The new Direct Acting Antivirals (DAA) have revolutionised the treatment of hepatitis C virus (HCV), replacing interferon (IFN) regimes which are known to cause adverse events with lower success rates. However, as these are relatively new drugs, all adverse events in the heterogeneous population outside of a clinical trial environment have yet to be determined. We report a case of newly diagnosed Pulmonary Hypertension (PHTN), where completion of treatment with Sofosbuvir (trade name Harvoni©) ...
Epidermoid cysts should be considered as part of a differential for lesions causing bony erosion in the sinuses and diploic bone spaces.
A 62-year-old male patient presented with pain accompanied by lack of motion in his right shoulder joint. The MRI finding was humeral head and glenoid osteonecrosis of the right shoulder. Although rare, osteonecrosis of the humeral head is sometimes accompanied by simultaneous osteonecrosis of the glenoid cavity thus blocking the motion in the shoulder. Reversed shoulder arthroplasty is the best option for restoration of the pain free mobility of the joint.
Fitzsimmons-Walson-Mellor (F-W-M) syndrome is a rare disease characterized by progressive kidney failure, sensorineural deafness, and variable spastic paraparesis. We report the case of a 30-year-old male who had been diagnosed with non-progressive connatal encephalopathy, spastic tetraparesis of paraplegic predominance, and intellectual retardation at the age of 14 months. During adolescence, he developed proteinuria, with the subsequent detection of hypertension and elevated plasma creatinine...
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