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...
- Volume: 2, Issue: 4
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...
Incompliant and Aggressive Behavior in a 2-Year-Old with Language Barrier During Oncological Treatment: How Can We Proceed with Necessary Therapy?
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.
- Volume: 2, Issue: 3
Optimizing Medications in Patients with Cardiovascular Disease: A Case Report on Unrecognized Prescribing Cascades in Older Adults
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.
Multiple Splenic Infarcts Occurring as a Rare Complication of Babesiosis in an Elderly Patient on Anticoagulation
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...
Optical Coherence Tomography Imaging of Anterior Descending Artery Thrombosis in a Young Bodybuilder
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.
- Volume: 2, Issue: 2
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 ...
Type III Esophageal Atresia Associated with Unilateral Pulmonary Atresia and Dextrocardia in a Newborn: A Case Report
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.
- Volume: 2, Issue: 1
Delayed Closed Reduction and Cast Immobilization for Ring and Little Fingers Carpometacarpal Joints Dislocations of the Right Hand - Success Can Still Happen: A Case Report
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 ...
The Relevance of the European Charter of Patients’ Rights as a Tool for Advocacy in the Framework of the Covid-19 Pandemic
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...
A Case of Protracted Resuscitation and Fibrinolysis During Cardiac Arrest in Emergency Room Due to St-Elevation Myocardial Infarction
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.
Integrating a Novel Medication Risk Score and Use of an Advanced Clinical Decision Support System into a Pharmacist- and Nurse-Coordinated Transition of Care Program to Mitigate Drug Interactions
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.
A Case of Short Stature and Sagittal Craniosynostosis in an Omani Girl with Hereditary Hypophosphatemic Rickets with Hypercalciuria
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...
- Volume: 1, Issue: 7
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...
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...
- Volume: 1, Issue: 6
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...
- Volume: 1, Issue: 5
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.
- Volume: 1, Issue: 4
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...
- Volume: 1, Issue: 3
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 ...
- Volume: 1, Issue: 2
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...
- Volume: 1, Issue: 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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