Calciphylaxis, also known as Calcific Uremic Arteriolopathy (CUA), is a rare condition often but not exclusively seen in end stage renal disease. Current literature recommends trial of Sodium Thiosulphate (STS) in all CUA patients. The long - term use of STS is limited by the adverse effect of Anion Gap Metabolic Acidosis (AGMA) which can be managed timely to maximize the benefits of STS.
Issue 3 (May & Jun)
A 35-years-old man with an underlying lymphoma presented with the complaint of progressive dyspnea. The left hemithorax was dull on percussion with a significant reduce air entry. Chest x-ray showed a total ‘white-out’ of the left hemithorax suggestive of pleural effusion. A medical officer inserted a left chest tube with the sharp trochar provided.
Thyroid hormones are essential for the normal growth, development, and function of body organs. These hormones regulate the basal metabolic rate of all cells, including hepatocytes. A complex interplay exists between the thyroid and the liver. Thyroid dysfunction can cause liver function test abnormalities, usually reverted by normalizing thyroid status.
Primary hyperoxaluria as an indication of liver and kidney transplantation: Case report and literature review
Primary Hyperoxaluria (PH) is a metabolic liver disease that results in oxalate overproduction that cannot be metabolized by the liver. PH is caused by mutations in one of three genes that encode enzymes involved in glyoxylate metabolism. As oxalate is primarily excreted in the urine, the kidney is the prime target for oxalate deposition, which leads to end-stage kidney disease.
Chikungunya virus infection is an emerging arbovirus with a global distribution that can cause significant morbidity and also death in infected fetuses and neonates. Unfortunately, there is still lack of data about the incidence of Chikungunya in pregnant women and the consequences for their fetus. This is a case series report including clinical presentation, images and clinical assessment.
An 83-year-old woman presented to emergency department with fever, low level of consciousness and right deviation in the conjugate gaze. Neurological examination revealed a spontaneous, slow, horizontal and continuous conjugate eye deviation alternating every 2 to 3 seconds. An electroencephalogram revealed periodic paroxysmal activity with a frequency of 2-3 Hz in left frontal hemispheric.
A 32-year-old female was found to have an elevated lymphocyte count and referred to haematology. Initially she presented to her GP in 2018 with fatigue and dizziness. The symptoms had fully resolved by the time she was reviewed in haematology.
Factor VII deficiency is a rare inherited disorder. Clinically the patient presents with bleeding tendencies. Diagnosis is made by prolonged prothrombin time, normal activated partial thromboplastin time and low functions factor VII assay or factor VII antigen. Therapy involves factor VII concentrates, recombinant factor VII, fresh frozen plasma and fibrinolytic inhibitors.
Entrapment of coronary angioplasty hardware during coronary artery interventions is rare but in most cases requires prompt treatment. This article reported a case of 65-year-old woman who underwent a percutaneous transluminal coronary angioplasty to the circumflex artery. A ruptured angioplasty balloon was entrapped in the circumflex artery with proximal end of the guidewire placed in the descending aorta.
Erythema multiforme is an autoimmune mediated reaction pattern with diverse clinical manifestations characterized by the formation of multiple areas of erosion and ulcer in the oral cavity and haemmorhagic crusting of lips. such a case of Erythema multiforme in a 75 -year-old male is described here.
A case report of a child with autism spectrum disorder grieving after losing her father during covid-19 pandemic
Bereavement is one of the least studied conditions in children, especially among the ones diagnosed with ASD. Lack of enough understanding about what to expect from a grieving child with ASD complicates how to help them and their caregivers. In this paper, we present a 13-year-old girl with ASD who lost his dad recently due to myocardial infarction during COVID-19 pandemic period.
39-year-old woman was admitted to surgery department for epigastric pain, upper abdomen was tender on palpation without signs of peritoneal irritation. Abdominal plain X-ray and ultrasound showed no significant pathology, there were mild microcytic anemia and leukocytosis, serum amylase was normal, initial C-reactive protein 6 mg/l rose to 142 mg/l during 2 days.
An efficient multidisciplinary approach in a pregnant patient with hereditary spastic paraparesis treated by intrathecal baclofen therapy: A case report
Literature regarding cases of pregnant patients with hereditary spastic paraparesis (Strumpell-Lorrain disease) and those treated by intrathecal baclofen therapy is sparse. There are currently no specific guidelines to manage pregnancy and delivery in these patients. A 42-year-old woman presented to our clinic with hereditary spastic paraparesis.
Decisions enable us to consider our actions while adjusting behaviors to a relentlessly changing environment. Since conscious decision making requires our full attention and is therefore expensive, we use a cheaper system for everyday and repetitive tasks that run automatically without conscious evaluations, commonly described as habits.
We are presenting here a case of polycystic ovarian syndrome, an endocrine disorder, afflicting 5-13% females of reproductive age, causing 70-80% infertility associated with pituitary macroadenoma i.e. size >10mm& prolactin level >250 ng/mI. PCOS has a higher relationship with metabolic disturbance and hypothalamic-pituitary-ovarian axis function disorder.
Perioperative adolescent serotonin syndrome secondary to methadone and fentanyl administration: A case report
Serotonin Syndrome (SS) is a serious toxidrome associated with significant morbidity when undiagnosed or improperly managed. We report a perioperative case of serotonin syndrome in an adolescent male on fluoxetine (selective serotonin reuptake inhibitor-SSRI) therapy secondary to an intraoperative combined opioid analgesic regiment.
Optic neuropathy secondary to Cystic Fibrosis (CF) has been described as a manifestation of chloramphenicol toxicity. Inflammatory optic neuritis and Myelin Oligodendrocyte Glycoprotein (MOG)-related disorders have not been previously described in patients with CF. We report the case of a 19-year-old woman with cystic fibrosis who presented for sub-acute onset decreased visual acuity.
Aortic dissection is a life-threatening vascular emergency that requires a prompt diagnosis and management. Isolated spinal transient ischemic accident is an extremely rare manifestation of Aortic Dissection (AD) type A. Thus, AD should be on the top of the aetiology list, despite the isolated character of the neurological presentation.
An analysis of eight family cluster cases in Wuhan, China: Peripheral blood lymphocyte count may predict Covid-19 mortality
Since December 2019, a novel coronavirus (SARS-CoV-2) causing COVID-19 has spread across the world in a global pandemic. Tens of thousands of people were infected, several thousand patients died. However, key risk factors for predicting mortality remain unclear. This study aims to analyze the differences in mortal risk factors between fatal and non-fatal cases within each family, to identify the key risk factors for COVID-19 mortality.
Infants have an intense need to suck since birth and often cry because of various reasons including cry, anger, frustration etc, the situation become more challenging when kids are admitted in hospitals. Some babies may cry more often than others, even when there is nothing wrong.
Neurocysticercosis is endemic in many regions of the world. Extra parenchymal forms of neurocysticercosis are infrequent but may be associated with hydrocephalus. We report the case and show a typical MRI of fourth ventricle ependymitis caused by cysticercosis.
Tyrosine Kinase Inhibitors (TKI) have dramatically changed the prognostic of chronic myeloid leukemia. However, they have been associated with several side effects. We describe a case of a patient admitted for bilateral exudative pleural and pericardial effusions. After a complete work-up, we concluded to a dasatinib-related side effect.
The osteoarticular tuberculosis is a uncommon diease, which is accout for 0.1%-0.3% of Tuberculosis (TB). The involoment of foot and ankle is only 0.01%-0.03% of TB, particularly the bilateral feet and ankles are affected is extremely rare. Futhermore, its clinical manifestation is atypical and similar with autoimmune disorder, subacute or chronic pyogenic arthritis.
Co-infection with nocardia and mycobacterium tuberculosis in a patient with systemic lupus erythematosus: A case report
Pulmonary infection is an important cause of morbidity and death in immunosuppressed patients. Recent studies showed that infections caused by Nocardia are quite rare, especially mixed infections with Nocardia and Mycobacterium Tuberculosis (MTB). This case emphasizes the importance of being alert to the possibility of co-infection in immunosuppressed patients.
Nosographic considerations on obsessive-compulsive disorder occurring exclusively during the menstrual phase
The relationship between the menstrual cycle and mood disturbances has been described in the literature and is linked to changes in the secretion of sex hormones. Rare studies have reported the exacerbation of obsessions during menstruation, while no case reports the onset of premenstrual Obsessive-Compulsive Disorder (OCD).
Labor and delivery, while perceived as gratifying and joyful, are nonetheless among the most painful events women can experience in life. Treating pain is nowadays one of the essential elements in assisting women during labor. Epidural analgesia is the best option to ensure the optimal control of pain for the mother without compromising the well-being of the fetus.
An unusual case of delayed and recurrent bleeding after renal biopsy in a patient with malignant hypertension
We report a 35-year-old Asian man who presented with symptomatic malignant hypertension with complications of acute kidney injury, thrombocytopenia and microangiopathic haemolytic anemia. A renal biopsy done led to recurrent bleeding needing repeated embolization.
Patients with acute respiratory distress syndrome due to pandemic Coronavirus disease 2019 (COVID-19)
We report on a case study of patients with Coronavirus disease 2019 (COVID-19). Evaluation of factors predicting outcome in patients with COVID-19 are very important. Both patients developed respiratory failure complicated by acute respiratory distress syndrome. Patients were intubated and invasively ventilated, underwent prone positioning and careful ventilation according to criteria for acute respiratory distress syndrome.
A 31 year old, female presented at 36 weeks gestation after an out-of-hospital cardiac arrest. Resuscitation resulted in return of spontaneous circulation (ROSC); however, the patient was unresponsive upon hospital arrival. She underwent TTM, was cooled and rewarmed without incident. She underwent cesarean delivery 36 hours after cardiac arrest.
High risk of delayed or missed diagnosis of mucinous appendiceal neoplasm by transvaginal ultrasound: A case series
Appendiceal Neoplasm is a rare tumour with a vague and nonspecific clinical presentation. Delayed or missed diagnosis could result in mucin spill into the peritoneal cavity because of cancer infiltration or spontaneous rupture of appendix. This condition is called Psuedomyxoma Peritonei (PMP) and has a very poor prognosis if not treated properly.
Recurrent soft tissue infections associated with complex regional pain syndrome type ll: Reports of two unusual cases
Complex Regional Pain Syndrome (CRPS) (Synonyms: Reflex Sympathetic Dystrophy, Causalgia, Sudeck’s atrophy, Algodystrophy) is a chronic neurological condition, usually involving the limbs, that is characterized by severe pain along with sensory, autonomic, motor and trophic involvement. CRPS type ll is when there is an identifiable preceding event causing nerve damage.
Complicated intra-abdominal focal fat infarction: Emphasis on falciform ligament infarction with abscess formation: A case series
The term "Intra-Abdominal Focal Fat Infarction" (IFFI) encompasses a range of conditions where infarction of fatty tissue is the underlying pathological process, including Epiploic appendagitis, omental infarction, fat necrosis related to trauma or pancreatitis as well as rarer entities such as falciform ligament infarction.
SOX2 is a transcription factor that activates or suppresses genes .involved in cellular differentiation, proliferation, and apoptosis. The deregulation of gene expression programs can lead to cancer initiation, promotion, and progression. The present study investigated SOX2 immunolocalization and expression in Invasive Ductal Carcinoma (IDC), and its correlation with clinical-pathological characteristics of the tumor.
Madelung's Disease (MD), also known as benign multiple symmetric lipomatosis or Launois-Bensaude syndrome, is a rare condition. The characteristic feature is the presence of numerous diffuse lipomas at the level of the neck or upper limbs. The etiology is unknown, but a close association with ethyl abuse has been observed. The use of radiological examinations such as ultrasound, computed tomography and magnetic resonance imaging is helpful for the differential diagnosis.
Pure Ankle dislocation is an ankle dislocation without any associated fractures of the ankle and an intact tibiofibular syndesmosis. Only a few isolated case reports and small series of cases are reported in literature. We report a posterior dislocation of ankle joint without any bony fractures with description of its mechanism, management, and literature review.
A 31-year-old woman presented with chief complaint of muscle weakness. As this complaint was the most bothersome of all, the patient forgot to mention many other problems that she had. Asking her to remove the face-mask, made us to look for other problems because the typical moon face was masked under the mask!. The other problems were recent weight gain, purple striae on the abdomen.
Brigatinib treatment for primary lung lesions in non-small-cell lung cancer based on ALK gene rearrangement detected in resected brain metastases: A case report and literature review
Lung cancer is the main cause of brain metastasis, primary lesions in patients with brain metastases from lung cancer are most often treated with surgery, and adjuvant chemoradiotherapy and other therapeutic methods are used to control disease progression based on the characteristics of the primary lesions.
Refractory chronic otitis media and mixed hearing loss due to infection with levaquin-resistant KERSTERSIA GYIORUM: A case report and review of the literature
A 39-year-old Caucasian male, with a past medical history of purulent drainage of both ears as an infant and multiple tympanostomy tube placements in childhood, presented our ENT clinic complaining of right ear fluid drainage and hearing loss for the past year. Two months prior to presentation, he began to have increased fluid drainage from the right ear.
An unusual presentation of bradycardia, acidosis, and right ventricular dysfunction after left ventricular assist device implantation: A case report
Right Ventricular (RV) dysfunction is a common complication seen in 20-50% of patients after Left-Ventricular Assist Device (LVAD) implantation. Although prediction models exist, it is challenging to prevent RV dysfunction and even more difficult to manage. Early recognition is crucial to determine the appropriate pharmacological therapies and decide if implementation of Mechanical Circulatory Support (MCS) is needed.
Breast MRI in the setting of breast carcinoma with suspected microcalcifications and his predictive value in breast cancer management: An interesting case report
The Breast Imaging Reporting and Data System (BI-RADS®) is a standardized system of reporting breast pathology used also for Magnetic Resonance Imaging (MRI). It facilitates clear communication between the radiologist and other physicians as surgeons involved in senology, by providing a lexicon that compares breast gland structures to assessment categories in the management recommendations for the onco-surgical choices.
Lung adenocarcinoma characterized by multiple thromboemboli was misdiagnosed as primary anti-phospholipid syndrome: A case report
Antiphospholipid antibodies are a heterogeneous group of antibodies against anionic phospholipids. Antiphospholipid antibodies can be found in patients with many diseases including antiphospholipid syndrome and malignancies. In this report, we described a case of lung adenocarcinoma in which the presenting symptoms were multiple organ thrombotic phenomena, misdiagnosed as Primary antiphospholipid syndrome.
Giant Cell Arteritis (GCA) is an immune-mediated vasculitis of large- and medium-sized vessels. Stroke happens in 3% to 7% of the cases, and identifying GCA properly is important because potentially curative treatment exists. We present a case of an 83-year-old woman, in whom suspected GCA was revealed by stroke caused by Vertebral Artery (VA) inflammation.
In this report, the authors discuss the case of a 49-year-old male presenting with sudden onset moderately severe left-sided Sensorineural Hearing Loss (SNHL), tinnitus, left otalgia, and disequilibrium. Prior to referral to our facility, an MRI was obtained which demonstrated non-specific asymmetric enhancement of the left cochlea that was initially suspected to be labyrinthitis.
Bilateral cochlear implantation in a patient with osteopathia striata voorhoeve and cranial sclerosis
Osteopathia Striata with Cranial Sclerosis (OS-CS) is a rare form of X-linked dominant sclerosing bone dysplasia. The estimated prevalence of OS-CS is less than 1 in 1,000,000 in the general population with a little over 100 reported cases so far. Up to half of the patients suffer from hearing loss. Hearing loss is usually conductive rather than mixed or sensorineural in patients with OS-CS sclerosis.
The Purple Urine Bag Syndrome (PUBS) is a rare condition in which the urine turns purple. It may occur in Urinary Tract Infections (UTIs) when bacteria metabolize dietary tryptophan to indole resulting in indigo (blue) and indirubin (red). This condition is mostly seen in elderly female patients with permanent urinary bladder catheterization. Patients, relatives and health professionals may be concerned about this discolouration.
Post-Infarction Ventricular Septal Defect (PIVSD) are a rare complication of Acute Myocardial Infarction (AMI). According to clinical guidelines, surgical repair of a PIVSD is the recommended acute-stage course of treatment. Nevertheless, thoracotomy is not always clinically suggested for patients with unstable hemodynamics and otherwise at high risk.
Renal biopsy teaching case: A patient with scleroderma, hypertension, acute kidney injury and PR3 ANCA positivity
Scleroderma Renal Crisis (SRC) is the most common cause of Acute Kidney Injury (AKI) in scleroderma and occurs early during the disease course while ANCA Associated Vasculitis (AAV) is a rare cause of acute kidney injury occurring late in the disease course. We report a case of AKI with positive PR3 ANCA serology late in the disease course with a renal biopsy revealing findings of SRC.
Ocular syphilis and neurosyphilis are infrequently reported in immunocompetent patients. Generally, these conditions are seen in HIV positive individuals and commonly present with uveitis. Here, we describe a 40-year-old immunocompetent female who presented with ocular symptoms, found to have papilledema and was diagnosed with neurosyphilis.
Occult strongyloides stercoralisinfection masquerading as a drug reaction with eosinophilic pneumonia
Pseudomelanosis or melanosis duodeni is seen in association with drugs, microorganisms or occasional bleeding, usually from peptic ulceration. We present a case of Strongyloides stercoralis presenting as pseudomelanosis duodeni during anemia workup after patient's initial presentation as eosinophilic pneumonia.
Myocarditis caused by nontyphoidal salmonellae is very rare in immunecompetent individuals. We present a case of a previous healthy 19-year-old male suffering from chest pain. Laboratory findings, ECG, echocardiogram and blood cultures led to the diagnosis of salmonella myocarditis. Cardiovascular magnetic resonance is a promising noninvasive diagnostic tool which is useful for follow-up and might help to confirm diagnosis.
Hypothyroidism is a common disease in elderly people. Although hypothyroidism can theoretically have clinical implications related to nearly all major organs, it is often excluded from diagnostic algorithms for elderly patients with multi-system disease because its symptoms are non-specific.
We are progressively learning about COVID-19 every day. An aspect that we would like to highlight and that is becoming increasingly clear is that patients develop a hypercoagulable state that causes microthrombi and becomes life threatening. We are considering starting the use of early anticoagulation in these cohort of patients who become critically ill to halt and prevent progression of the disease.
Fahr's Syndrome (FS) is a rare neurological disorder of abnormal calcium deposition. FS is most notably characterized by deterioration of motor function, neuropsychiatric impairment and seizures. These symptoms are primarily due to calcification of the basal ganglia and cerebral cortex. Although there are currently no curative therapies, treatments are available which can significantly improve quality of life, making early diagnosis and identification of etiology essential.
IgG4-related disease (IgG4-RD) is an immune-mediated fibroinflammatory disease that responds to glucocorticoids, which is gradually well known in recent years. It can involve multiple organs of patients, including pancreas, bile duct, gallbladder, salivary gland, orbital tissue, lung, liver, lacrimal gland, kidney, retroperitoneal, aorta, thyroid and lymph node.
Gout is a rare cause of tenosynovitis and is difficult to diagnose based on clinical symptoms and imaging modalities. We present a case of gouty tenosynovitis of the proximal interphalangeal joint. A 32-year old male patient presented with a swollen, painful proximal interphalangeal joint of the 3rd digit on his right hand for 2 weeks with flexion contracture.
This case report illustrates a very rare problematic after Total Knee Arthro-plasty (TKA), yet that you have to think of if posterolateral pain appears. The postoperative outcome of our patient was initially very good, but pain appeared after 6 weeks, in an atypical mode, that couldn’t be attributed to the most common differential diagnosis. The characteristics of the symptoms directed us to a mechanical cause.
Organizing pneumonia is a process of lung parenchymal injury caused by multiple etiologies. Although organizing pneumonia may be an idiopathic process, it usually occurs secondary to infection, aspiration, autoimmune disease, and after organ transplantation or radiation. We present a case of organizing pneumona after confirmed SARS-CoV-2 (COVID-19) infection manifesting as chronic cough.
To report feasibility and efficacy of high-tech Radiotherapy (RT) for the treatment of synchronous Multiple Primary Malignancies (sMPM) for elderly patients with primary Prostate Cancer (PC). Two elderly patients with PC and synchronous Anal Cancer (AC) and sacrum chordoma, respectively, were described.
Efficacy and safety of Chinese herbal medicine longdanxiegan decoction combined with val-acyclovir in herpes zoster: A systematic review and mate-analysis
Herpes zoster is a global public problem that is characterised by a painful blistering rash and unilateral lesions and has a significant negative impact on the quality of patients' lives. Longdanxiegan Decoction (LDXGD) is a classic herbal formula, and LDXGD combined with valacyclovir is widely used for herpes zoster patients in China. However, evidence-based medicine is not available.
Tumor necrosis factor-alpha (TNF-alpha), a basic cytokine is an immunosuppressive agent used intensively in the treatment of systemic diseases. various side effects have been reported with the use of these powerful immunosuppressive drugs. In this case we report an autoimmune hepatitis an uncommon side effect of infliximab perfusion.
A 53-year-old man with a known allergy to metamizole presented for acute gonalgia, receiving metamizole by mistake. He suffers a severe allergy reaction accompanied by chest pain and signs of acute lower myocardial infarction, which subsides with treatment of anaphylactic shock and fibrinolysis, without observing intracoronary thrombus or signs of complication of atherosclerotic plaque.
A 71-year-old man, who is non-smoker with past medical history notable for hypertension and right lower extremity deep vein thrombosis three years prior, presented with progressive dyspnea on exertion of two weeks duration. He did not have any chest pain; heart rate and blood pressure were normal. His DVT had occurred in the setting of trauma, where he was injured by a falling tree.
Cronkhite-Canada Syndrome (CCS) is a rare non-hereditary protein-losing enteropathy, and characterized by ectodermal and gastrointestinal abnormalities. The etiology remains unclear, however, some studies suggest the likelihood of immune dysregulation. The diagnosis of CCS is challenging because the clinical symptoms are non-specific and the endoscopic and pathologic findings can overlap with other processes.
Syphilis is a disease that has not been eradicated in part due to inadequate management of antibiotic therapy which is selected according to the stage of the disease and to the misuse of the type of penicillin. Treatment of this disease should be done to prevent it´s chronic complications, to avoid infecting sexual partners and the fetus in a pregnant woman.
Severe asthma is a complex airway disease characterised by multiple aggravating-factors, and frequent comorbidities. Poor asthma control does not always correspond to the severity of airflow obstruction. One cause of disproportionate breathlessness in asthma is dysfunctional breathing/hyperventilation syndrome which is increasingly recognized.
In this report, we present a case of rapid otic capsule obliteration within an exceedingly short timeframe in the setting of Chronic Suppurative Otitis Media (CSOM) in an immunocompromised pediatric patient with Down Syndrome. Following maximal therapy for a right sided cholesteatoma, the patient developed a multi-drug resistant infection that cause CSOM.
The coronavirus disease 2019 (COVID-19) has been associated with coagulopathy that can lead to thrombotic complications such as stroke. There are increasing reports of association between active COVID-19 infection and Cerebral Venous Thrombosis (CVT). However, the complication of coagulopathy, like CVT, has only been reported only in active ongoing infections.
Congenital diaphragmatic hernia, is a congenital abnormality, rare in adults with a frequency of 0.17-6%. We present the case of an 88-year-old female patient with a history of arterial hypertension, obesity and bronchial asthma. She attended the emergency department of our center with diffuse abdominal pain associated with vomiting, absence of intestinal transit for 4 days and respiratory distress.
Primary Sjögren's Syndrome (PSS) is a systemic autoimmune disorder characterized by chronic inflammation of exocrine glands. Neurological manifestations are sometimes found in patients with PSS, and both the Central Nervous System (CNS) and Peripheral Nervous System (PNS) can be involved. Psychiatric disorder is a rare manifestation caused by PSS.
The Gastrointestinal (GI) tract is the most frequent site of extranodal lymphoma involvement. Most GI lymphomas are non-Hodgkin's mature B-cell lymphomas, being diffuse large B-cell lymphoma one of the most common histologic subtypes. About 7% of GI lymphomas are located in the colon, usually at the ileocecal valve, and may grow into the terminal ileum.
Foramen of Winslow hernias are a rare type of internal hernia that account for less than 1% of all cases of intestinal obstruction. It is extremely rare surgical condition with estimated mortality of about 50%. Timely diagnosis aided by computed tomography (CT scan) can facilitate proper planning and surgical treatment. Optimal treatment depends on patient’s condition, status of the incarcerated structure as well as surgeon’s comfort and preference.
Dexmedetomidine induced diabetes insipidus is extremely rare phenomenon and typically seen in surgical cases. There are only a handful of case reports of dexmedetomidine induced diabetes insipidus in non-surgical settings. The mechanism of diabetes insipidus is unclear but thought to be secondary to inhibition of the neurohypophysis release of Antidiuretic Hormone (ADH).
A 6-year-old girl with long-standing Graves’ Disease (GD) presented with a left oblique non-displaced humeral fracture. Examination reveals signs of thyrotoxicosis and mild swelling of her left humerus. Investigations confirmed severe overt hyperthyroidism due to GD. A dual-energy X-ray Absorptiometry (DXA) of the lumbar vertebrae (L1-4) and femoral neck revealed that Z-score were -2.9 and -2.1.
Successful repair of an anomalous right coronary artery arising from the pulmonary artery in a 10 month-old
Echocardiogram (Figure 1A-B) in an asymptomatic 6 monthold raised suspicion for anomalous Right Coronary Artery (RCA) from the Pulmonary Artery (ARCAPA) with retrograde flow from the RCA to the main pulmonary artery. The patient’s left ventricular systolic function was normal. Subsequent cardiac catheterization confirmed the diagnosis as angiography.
Arcuate ligament syndrome results from the compression of the celiac artery by the diaphragmatic fibers. It is asymptomatic in most cases and has an incidence of 2 to 24% of the population. In liver transplantation, it has great relevance, since it can be related to various postoperative complications.
COVID-19 in a pediatric cancer patient with T-lymphoblastic lymphoma: Response to convalescence plasma and subsequent induction of SARS-CoV-2 specific humoral and cellular immunity despite strong B-cell lymphopenia
We report on an 11-year old pediatric cancer patient with T-lymphoblastic lymphoma who acquired a severe SARS-CoV-2 pneumonia immediately after the start of oral maintenance treatment with mercaptopurine. He was admitted to our hospital on day 7 after onset of symptoms (day 5 after diagnosis). Due to respiratory failure, he was transferred to the pediatric intensive care unit (from day 8 for 5 days) for high-flow-nasal cannula respiratory support.
Intraoperative trans-esophageal echographic evaluation of the celiac artery flow after arcuate ligament resection in a case of Dunbar Syndrome. A case report
Dunbar Syndrome (DS), also known as Median Arcuate Ligament (MAL) syndrome, is a rare disease in which the celiac trunk is compressed by a fibrous attachment at the diaphragmatic crura causing abdominal angina with a large spectrum of symptoms including nausea, vomiting, weight loss, and postprandial epigastric pain.
Spinal intradural extra-arachnoid inflammatory myofibroblastic tumor (IMT): Case report and review of the literature
In recent years, molecular genetics studies have highlighted the pathogenesis of IMT, more and more studies have been conducted to explore ALK gene. Literaturelly, the expression of ALK gene in IMT is very rare in central nervous system, while is relative common in noncentral nervous system. The present case is the first reported patient with spinal intradural extra-arachnoid Inflammatory Myofibroblastic Tumor (IMT) with overexpressed ALK1.
Bilateral symmetric ankle and feet cellulitis after fish pedicure: Case report and review of the literature
Fish pedicure (feet immersion in a tank containing fish Garra rufa or Cyprinion macrostomus) is a widely diffuse cosmetic practice, usually considered safe. However, this practice is regulated only in a few Countries, and the risk of infection related to this practice is not quantified. We report a case of bilateral symmetric ankle and feet cellulitis in a previously healthy young woman without risk factors for infections, after a fish pedicure in Greece.
A nine-year-old girl, with no personal or familial medical past history, presented with skin thickness near the left big toenail. It appeared 6 months prior to presentation, initially as a white spot. There is no history of trauma to this site. We found a nodular thickness of the lateral side of the first toenail with axis deviation. The dermoscopy revealed small thin vessels. The others nails of both feet were normal. We completed with an X-ray.
Sudden onset hearing and visual loss: An unusual presenting manifestation of chronic phase chronic myeloid leukaemia
Chronic Myeloid Leukaemia (CML) commonly presents with generalized weakness, splenomegaly, leucocytosis with basophilia, while neurological manifestations like convulsions, hearing loss, papilledema are rare. Moreover, hearing and or vision loss is seldom encountered as a primary manifestation, with various mechanisms implicated for vascular obstruction and end organ dysfunction.
Aphallia is an extremely rare genitourinary anomaly occuring once in 30 million births. Fewer than 100 cases have been reported worldwide till now. It results from non-formation of genital tubercle or its failure to develop during the 4th week of embryonic development. We report a case of 5 year old child, resident of Iraq, born through a non consanguineous marriage.
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2) predominantly affects the respiratory system. However, COVID-19 associated Multisystem Inflammatory Syndrome in Children (MIS-C) is a state of hyper inflammatory shock affecting the cardiovascular, gastrointestinal, hematologic and central nervous system. Isolated neurological manifestations have rarely been reported, especially in children and adolescents.
Hepatoportal Sclerosis in patient with Systemic Sclerosis and Sjogren's Syndrome: A rare association
We present the case of a 51 years-old woman who was referred to our Liver Unit for suspected dysmetabolic liver disease. She had a previous diagnosis of Systemic Sclerosis and Sjögren’s Syndrome and had altered hepatic enzymes with a positive anti-Nuclear Antibodies centromeric pattern, anti-Cardiolipin Antibodies and anti b2 Glycoprotein I Antibodies.
Malignant nodular hidradenoma, also known as Malignant Hidradenocarcinoma (MHA), is a rare tumor of sweat glands that accounts for less than 0.001% of all tumors. Although it typically arises de-novo, MHA rarely progresses from hidradenitis suppurativa (HS), a disorder of apocrine glands characterized by chronic inflammation.
A 92-year-old woman presented to the operating room with a right femoral neck fracture. She had a past medical history significant for atrial fibrillation, coronary artery disease with a history of coronary bypass, severely stenotic aortic valve, diabetes, dyslipidemia, hypertension and dementia. She underwent general anesthesia with continuous Transesophageal Echocardiographic (TEE) monitoring for a right hemi-arthroplasty.
ST-Elevation Myocardial Infarct (STEMI) is the most common emergency condition that causes sudden death. The revascularization speed of the occluded coronary artery is the key to success in STEMI management in both aspects of reducing morbidity and mortality. Primary Percutaneous Coronary Intervention (PCI) is the first line of reperfusion management in the treatment of STEMI patients, but in some conditions.
A rare case of pituitary apoplexy complicated by internal carotid artery occlusion: Severity obscured by primary collaterals
Pituitary apoplexy complicated by internal carotid artery occlusion was encountered in a patient with surprisingly moderate symptoms at presentation. For a short period of watchful waiting, primary collaterals obscured the emergent need for decompressive surgery, which after the sudden onset of neurological deterioration fortunately salvaged imminent cerebral infarction.
Staphylococcus aureus bacteremia can infrequently present as vasculitis or Acute Glomerulonephritis (AGN). The association between Staphylococcus aureus bacteremia and these immune-mediated responses is rare and remains a diagnostic challenge. We present a case of a 62-year-old man with hypertension, hyperlipidemia, and type II diabetes mellitus who presented with joint pain.
Short-limbed dwarfism, knock knees and joint hypermobility are the classical clinical criteria encountered in patients with pseudoachondroplasia. Progressive kyphoscoliosis was the main clinical presentation in our patients with pseudoachondroplasia. Preoperative spine radiographs in an 13-years-old-girl showed severe kyphoscoliotic deformity.
Sugammadex, an antagonist of neuromuscular blocking drugs, was used to rapidly reverse rocuronium induced neuromuscular blockade by encapsulating free rocuronium molecules as inclusion complexes. Because it can enhance the rapid recovery after surgery, summadex is gradually used in clinical. There are relatively few reports about anaphylactic reaction to it. We will present a case of severe anaphylactic shock induced by summadex, as the first in China.
Osmotic demyelination syndrome is a rare disease, clinically presented as a global reduction in strength, tetraparesis, variations in the level of consciousness, and its content, and comatose status, associated with rapid variances in serum sodium levels (whether hyponatremia or hypernatremia). The neuroimaging findings are mainly in the pontine region, but currently the number of reports of extrapontine involvement has increased.
Transvenous pacemakers are associated with major complications. Transcatheter leadless pacemaker has reduced the incidence of these complications and the recent accelerometer based atrial sensing algorithm permits restoration of atrioventricular synchrony. We report utilizing cardiac output measurements using Transthoracic Echocardiography (TTE) to determine optimal programming for leadless pacemaker.
A 65-year-old woman was treated for vertebroplasty (cement injection). 24 hours after the procedure, she complains chest pain. A CT scan was performed which revealed on the same image section the presence of highly radiopaque material in a right basal segmental artery the density of which is strictly identical to that of the cement of the treated vertebra (yellow arrows).
For a long time, different approaches to minimize the dimensional ridge alteration following tooth extraction have been described even though none of them was capable to avoid alveolar bone loss. The Socket-Shield Technique (SST) seems to be an alternative for alveolar bone preservation in dental extraction planning. This technique conventionally uses a flapless approach and the buccal root portion retention to prevent bone loss.
Complementarity of clinical trials, model systems, and metabolomic workflow to unravel the healthy effects of foods: BEBESANO vs MODELSANO: A case study
Nowadays, the health benefits associated with the consumption of plant-based food constitute a hot topic. To further demonstrate such benefits, related to antioxidant, anti-microbial, and anti-inflammatory activities, as well as the reduction of the risk of several pathophysiological conditions, the study of bioaccessibility and bioavailability of specific food's constituents, which require interdisciplinary networks, is essential.
New corona virus named as COVID-19 can presented not only by respiratory symptoms, but also with other organs involvement such as gastrointestinal, cardiac, renal and neurological symptoms. We reported a patient who presented with peripheral facial nerve palsy and evaluations revealed COVID-19 infection. We suggest from this case, that COVID-19 infection may be a potential cause of facial paralysis and during this terrible pandemic
Tracheal intubation in complex settings (i.e. difficult airway, hemodynamic instability) means a challenging procedure. It must be performed very quickly, being obviously essential to confirm the adequate positioning of the tube tip as soon as possible. Capnography is the most recommended tool in spite proper evaluation also includes clinical exam and X-ray, which implies some delay.
Benign tumors of the acetabular roof are a therapeutic challenge. Percutaneous ablations avoid complicated surgery. These tumors are close to the cartilage and therefore there is a risk of damaging and causing chondropathy. We propose here the case of an osteoid osteoma treated by cryobablation associated with a hip traction with arthro-CT with warmed serum.
Evaluation of the morphometric relationship between the alveolar bone and gingival dimensions in the maxillary anterior teeth using cone-beam computed tomography imaging: A cross-sectional study
The purpose of this study was to investigate the relationship between the alveolar bone and gingival dimensions in the maxillary anterior teeth. Cone-beam computed tomography images of 160 maxillary anterior teeth were evaluated. The Bone (BT) and Gingival Thickness (GT) and distances between Cemento-Enamel Junction (CEJ) and alveolar Bone Crest (CEJ-BC) and Cemento-Enamel Junction and Gingival Margin (CEJ-GM) were measured on the labial surface at the cervical third of the tooth root.
Labial adhesions are defined as fusion of the Labia minora in the midline. It is one of the most common pediatric-gynecological problems with an estimated prevalence of 0.6 to 5%, with a peak incidence between 13 to 23 months of age. Chronic inflammation of the labia minora combined with the hypoestrogenic state of the female infant is considered as the possible explanation of the condition.
Wilson's disease is an autosomal recessive disorder caused by a mutant ATP7B gene on chromosome 13. This mutation causes a reduction in hepatic copper excretion, which accumulates in hepatocytes and deposits in other tissues and organs (brain, cornea, kidney, etc.) as the disease progresses. Wilson's disease was described worldwide, with estimated prevalence of one case per 30,000 live births.
A 19-year-old young woman was admitted to our Unit for irregular menstrual cycles within 40- to 60-day intervals for 7 months. She had no history of abdomino-pelvic surgery or acute pelvic pain. Pelvic magnetic resonance imaging revealed a right ovarian mass (Figure1A & B), measuring 6.0 cm X 5.1 cm X 5.0 cm. The patient underwent laparoscopy. At the laparoscopic examination, we evidenced a right ovarian teratoma about 6.0 cm X 6.0 cm.
Synchronous HPV positive bilateral palatine tonsillar squamous cell carcinoma – Brief review of current literature on the role of magnetic resonance imaging
Synchronous bilateral palatine tonsillar Squamous Cell Carcinoma (SCC) is a rare presentation and less than 10 cases of Human Papillomavirus (HPV) mediated synchronous bilateral palatine tonsillar SCC has been reported. We report case of a patient who presents with a painless left sided neck swelling and was subsequently diagnosed by imaging and histopathology with bilateral Squamous Cell Carcinoma (SCC) of the palatine tonsil and cervical nodal metastasis.
Marburg type is a rare variant of Multiple Sclerosis (MS) characterized by a severe and progressive course/evolution leading to exitus in few months. Its radiological presentation commonly raises suspicion of a malignancy, often requiring a brain biopsy for histological confirmation. Hereby we report an atypical radiological presentation and progression of a pathologically confirmed case of Marburg MS.
A case report of an intra-oral exophytic growth in reaction to Gore-Tex expanded PTFE membrane left in situ for eighteen years
This case report explores the challenging multidisciplinary management of a gentleman over the course of 28 years. It begins with resection of a maxillary ameloblastoma, describes an 18-year period of elusive discomfort, culminating in an exophytic lesion associated with a retained Gore-Tex membrane. Retained foreign bodies can cause a multitude of complications including chronic infection, discomfort and reactive tissue growth.
A 66-year-old man ingested sodium hydroxide in a suicide attempt in June 2018. In emergency room, he presented burning of the tongue and uvula and supraglottic and vocal cords edema. Because of the risk of airway obstruction, the patient underwent endotracheal intubation and started invasive mechanical ventilation.
The immune system is a host protection system that includes numerous biological structures and processes in an organism which protects from diseases. It has been showed that there is significant relationship between immune system function and infectious diseases both in animal models and in humans. The aim of this research is to investigate whether Complementary and Alternative Medicines (CAMs) can be useful in boosting immune system.
Tattooing has a long and varied history and has been practiced across the world from Neolithic times. Tattoos fall into three main categories, the purely decorative, symbolic and pictorial. As a sub-type "Medical" tattoos have been used in radiotherapy and to document medical information such as blood type and medical diagnosis as well as in breast reconstruction and to cover areas of vitiligo.
Persistently elevated quantitative hCG levels in a patient with gestational choriocarcinoma: A case report of simultaneous de-novo renal clear cell carcinoma and gestational choriocarcinoma
Choriocarcinoma (CCA) is a rare form of gestational trophoblastic neoplasia. Early recognition and treatment are essential to reducing morbidity and mortality. We report the first case of concurrent CCA and renal cell carcinoma. A 35-year-old female presented postpartum with heavy vaginal bleeding. She underwent a dilation and curettage and was diagnosed with CCA.
T2* relaxometry mapping has found diverse applications in neuroradiology but was insufficiently evaluated in pelvis MRI. Further, staging of the uterine-related cancers may be sometimes a cumbersome. Our aim is to present the T2* relaxometry maps respectively relaxometry and proton density values in patients with endometrial and cervical cancer, together with their postoperative outcomes.
Comparison and analysis of applications of ID3, CART decision tree models and neural network model in medical diagnosis and prognosis evaluation
To analyze the performance of each algorithm model under different processing conditions such as data preprocessing (standardization, normalization and regularization), balancing and shuffling based on the data attributes of three common research types in clinical studies as the research examples. To compare and analyze advantages and disadvantages of the decision tree model and the neural network model in clinical studies as well as their scope of application.
Spine cord infarction is a rare neurological disease. The MRI can show T2 hyperintense signals, and these lesions can be associated with a vertebral body lesion, that supports the ischemic etiology. We present a 54 year-old-woman with an acute spinal cord syndrome, with a final diagnosis of spinal cord infarction. The initial MRI showed no abnormalities.
The expression and biological function of DKK1 in oral squamous cell carcinomas by bioinformatics analysis
To clear the expression of transcription factor Dickkopf-1 (DKK1) in Oral Squamous Cell Carcinoma (OSCC) using the method of bioinformatics analysis. And to clarify the relationship between the expression of DKK1 and the clinicopathological characteristics of OSCC using the method of molecular biology and cytobiology, in order to determine the early diagnosis and significance of OSCC according to the marker of DKK1.