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.
- Issue: 7, Volume: 1
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...
Use of Carotid Artery Compressibility Detected on Ultrasonography During Chest Compression to Validate Return of Spontaneous Circulation
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...
- Issue: 6, Volume: 1
Opioid Response in an Individual with Altered Cytochrome P450 2D6 Activity: Implications of a Pharmacogenomics Case
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.
Eosinophilic Abscess of the Small Intestine in Treatment-Resistant Transmural Eosinophilic Gastroenteritis
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...
Brain Metastasis from Pancreatic Adenocarcinoma in a Patient with Previous Good Response to Chemotherapy - a Case Report
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...
Traumatic Vertebral Fracture with Coexisting Enchondroma: a Case-Report and Review of the Literature
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...
- Issue: 5, Volume: 1
Endomorphin-2 Derivatives: Rapid Relief of Various Pains by Topical Administration or by Superficial Local Injection
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.
Sulcal Artery Syndrome as Atypical Ischemic Complication after Anterior Cervical Discectomy and Fusion: a Case Report
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...
Similarities and Differences among Genetic Prionopathies: Comparative Description of Familial Creutzfeldt-Jakob Disease and Familial Fatal Insomnia
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.
- Issue: 4, Volume: 1
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...
- Issue: 3, Volume: 1
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 . 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...
Massive Residual Cyst Involving Mandibular Edentulous Jaw- A Misleading Entity and the Treatment Challenges: A Case Report
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 ...
- Issue: 2, Volume: 1
Vitamin D Repletion Plus Sitagliptin is Associated with Increases in Serum C-Peptide and Decreases in Gad-65 and Islet Cell Antibodies and Hemoglobin A1c in a Patient with Latent Autoimmune Diabetes of Adults (LADA)
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...
Role of Adjuvant Steroid Therapy to Limit Radiation Pneumonitis in Stereotactic Body Radiation Therapy (SBRT) Treated Lung Cancer
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.
Apoplexy of an Adrenocorticotrophic Pituitary Macro Adenoma After Treatment of 1 Acute Myocardial Infarction
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...
Terlipressin as Salvage Therapy in Mixed Polypharmacy Overdose with Refractory Circulatory Shock and Pathological Diuresis
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...
- Issue: 1, Volume: 1
Evaluation on Quality of Life in Patients with Low Back Pain Preoperatively and After Undergoing Cryoablation of the Facet Joints
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.
A Case of Pulmonary Arterial Hypertension Secondary to Hepatitis C Treatment with Ledipasvir/Sofosbuvir Combination
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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