Management of cardiogenic shock is complex. It’s important to know the underlying mechanism. Two of many underlying mechanisms are critical aortic stenosis and Type-1 NSTEMI. Aortic stenosis can rarely present with a troponin leak high enough to resemble a Type-1 NSTEMI, making it hard to diagnose aortic stenosis early.
Issue 2 (Feb)
The most common “vanishing” central nervous system (CNS) tumor is a primary lymphoma. After steroid administration, patients usually experience partial or complete remission. Importantly, CNS lymphomas are almost entirely intra-axial, and the complete remission of extra-axial tumors is rarely discussed in the literature.
A 63 year-old male with severe heart failure was implanted with a CardioMEMS™ pulmonary artery pressure sensor and received usual anti-aggregation therapy. Six months later, he was admitted for chest pain without respiratory or hemodynamic compromise. The CT-scan showed recent complete thrombosis of the pulmonary branch downstream of the CardioMEMS™.
Postoperative cerebral embolism after video-assisted thoracic surgery is a severe complication. However, it is still unclear how the cerebral embolism developed after operation, and how can we treat the stroke and prevent further embolism. We present three cases suffering cerebral embolism after lung surgery transferred from another chest hospital.
Mucormycosis is a rare and fatal infection that occurs commonly in immunocompromised patients such as those with hematological malignancies. Rhizomucor miehei usually cause bovine mycotic abortion and mastitis and is rarely described in human disease. Here, we report a rare case of pulmonary mucormycosis in a 29-year-old patient with an acute myeloid leukemia.
Hydatidosis is a parasitic disease caused by Echinococcus granulosus or echinococcal tænia, preferentially localized in the lung (20 to 30%) and in the liver (60 to 70%). Intraosseous localization is extremely rare. Imaging features takes a very important place for the diagnosis and therapeutic management such as ultrasound, CT and MRI.
Perioperative anaphylaxis is a life-threatening, immediate hypersensitivity reaction, which occurs rarely, but carries a high rate of morbidity and mortality. Multiple causative factors have been attributed, where antibiotics and neuromuscular blockers are among the leading causes.
A 19-year-old male patient presented with a 2-week history of right hip and buttock aches. His past medical record was unremarkable, except for severe diffuse acne, for which he was recently started on isotretinoin. Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) scans displayed changes consistent with active sacroiliitis.
Aspergillosis includes a group of disorders caused by Aspergillus species that affect the respiratory system most commonly. The clinical spectrum of respiratory aspergillosis is divergent. Allergic bronchopulmonary aspergillosis is a result of hypersensitivity to Aspergillus antigens. Although it is known for many years, pathogenesis is not entirely clarified and there are no exact diagnostic criteria.
Fournier’s gangrene is a rare and serious event, primarily caused by bacteria. Candida species, mainly Candida albicans (C.al) are infrequently isolated, usually as a part of polymicrobial infection. Non-C.al Fournier’s gangrene was reported in immunocompromised and diabetic patients.
Cystic Hygroma is a rare congenital lymphatic malformation; more so rare is the bilateral cystic Hygroma. Bilateral Giant cystic Hygroma is a potential life-threatening congenital malformation as it may cause airway obstruction, difficulties in nursing and feeding and failure to thrive. We present a case of a female infant with bilateral giant cystic hygroma.
Explore the cause of rapid advancing nature of double mutant strain in Indian Population especially in Northern Province and to access the deterioration of the patient’s condition from day 1 of admission to rapid decline in oxygen saturation with gross lung involvement noticed in CT Chest reports.
Sprengel’s deformity is a rare condition, due to the congenital failure of the descent of the scapula. We report the case of an eleven (11) year old patient presenting a permanent flexion attitude of the cervical spine with posterior thoracic swelling in the inner edge of the left scapula and shoulder asymmetry, evolving from early childhood.
Leishmania Spp. are a group of protozoan parasites which cause a wide range of human diseases from localized self-healing cutaneous lesions to fatal visceral infections. Isoenzyme characterization by using various enzyme systems is a reliable and important tool for differentiation between various species of protozoa especially family trypanosomatidae including genus Leishmania.
Sacrococcygeal Teratomas (SCTs) are rare childhood tumors, commonly seen in the neonatal period. The mainstay of their diagnosis is both clinical and radiological. Early gross-total surgical excision has the best prognostic outcome, especially for benign tumors. We present the case of a 12-year old girl with recurrent infected right gluteal benign SCT.
Neurofibromatosis Type 2 (NF2) is an autosomal dominant genetic disease characterized by the presence of bilateral vestibular schwannomas. We report the case of a 21-year-old patient, followed up for neurofibromatosis type 2, operated two times for right parietal and orbital meningioma that complained for headache and dizziness.
Aspergillus coinfection with Scopulariopsis brumptii in an immunosuppressed adult male is rare. Patients with Aspergillosis have been described to be coinfected with other organisms, including fungi but the combination with fungi from the Scopulariopsis group has not been so far reported to the best of our knowledge.
Diarrhoea due to intestinal parasites and bacteria are prevalent in individuals belonging to the lower socio-economic strata. Infectious intestinal diseases are often self-limiting. They are usually treated without proper diagnosis or information about the etiology. Important bacteria causing diarrhoea are diarrhoeagenic Escherichia coli, Shigella spp, Salmonella spp, and Vibrio cholerae.
Interferon (IFN) signaling is important for host cells in defending microorganisms. “Self” and “non-self” recognition is the key step for proper IFN functioning. Pathogen-derived double-stranded RNAs (dsRNAs) are immunogenic to the cytosolic sensor, RIG-I and MDA5. Together known as RIG-I-like receptors (RLRs), they form filament along the length of dsRNA substrate which in turn activate downstream cascades.
Large controlled studies of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) have shown no effective medical treatment for this disorder. There are individual patients, however, with dramatic responses to some medications. We report two patients with clear responses to rintatolimid and galantamine characterized by rapid reduction of symptoms on starting treatment and return of symptoms on withdrawal.
The treatment of solid tumors sees an increasing use of immune checkpoint inhibitors (anti PD-1/PDL-1, anti CTLA-4). The new drug combinations have revolutionized the treatment of different types of cancer, from melanoma to chest neoplasms, renal and esophageal cancer.
Ganglioneuromas (GN) are benign and well-differentiated tumors originated from the sympathetic chain of the neural crest. They can affect any part of the body along the autonomic ganglia, however the two most common sites of presentation are in the retroperitoneal space (32-52%) and posterior mediastinum (39-43%), followed by the cervical region (8-9%).
Congenital muscular dystrophies (CMDs) are a heterogeneous group of disorders presenting early in life during infancy or soon after birth with muscle weakness and hypotonia, sometime associated to severe brain involvement and histologically presenting with dystrophic lesions.
A 59-year old male patient with no past medical history presented to the emergency department with fever and impaired oxygenation after spending holidays in the Austrian Alps before the country was declared high-risk for COVID-19 infections. Due to clinical deterioration, admission to ICU was necessary for non-invasive ventilation (NIV).
To investigate the characteristics of chest Computed Tomography (CT) images of corona virus pneumonia in India. Clinical data and CT images of 1000 cases of NCP were collected. Lesions were scored and characterized. The clinical manifestations and laboratory test results of the patients were analysed.
Voriconazole is a second generation broad spectrum triazole antifungal agent which is commonly used for prophylaxis and treatment of invasive aspergillosis, especially in patients with solid organ and hematopoietic stem cell transplants. One of the rare, adverse effects of long-term use is periostitis which is caused by increased circulating levels of fluoride.
Congenital chylothorax is known as abnormal leakage and accumulation of chyle in the pleural space. As one of the minimally invasive treatments, chemical pleurodesis has been more frequently used in treating pediatric chylothorax in recent years. We report through this observation the clinical case of a newborn male with Down’s syndrome born at 38 weeks of amenorrhea admitted to our unit for a respiratory distress after his birth.
An arab four years old boy presented with macrocephaly and autism spectrum disorder (ASD). His father’s head circumference was 64 cm (> 97°C) without any significant behavioral problems. Skin lesions suspected of trichilemmomas was visible on the father’s face. His mother and two brothers had no macrocephaly or other dysmorphisms.
Review objectives: (1). To describe what exercises and intervention variables are used in resistance training interventions in randomised controlled trials for lower limb tendinopathy. (2). To assess completeness of reporting as assessed by the Consensus on Exercise Reporting Template (CERT) and the Toigo and Boutellier framework. (3). To assess the implementation of scientific resistance training principles.
Venous leg ulcers are common. They are usually chronic, costly, and recurrent. They adversely impact patients psychologically and physically. Despite the availability of simple, cost-effective measures to heal them and prevent their recurrence, their incidence has not been decreasing.
To the best of our knowledge, the association of hiccups and ablation for atrial fibrillation as a late manifested complication has not been reported. The case was a 48-year-old patient presented with refractory hiccups after ten days of successful bilateral pulmonary vein isolation. All investigations did not find any specific cause for hiccups other than late complication of ablation.
Patients with psoriasis and HIV infection often present with more severe and treatment refractory cutaneous disease. We report two clinical cases in which psoriatic erythroderma revealed HIV infection, and who have responded well to antiretroviral therapy.
Shiga-like toxin (Stx) producing Escherichia Coli (STEC) is the most common type of enterohemorrhagic Escherichia Coli (EHEC) and is responsible for outbreaks of acute diarrhoea every year and potential life-threatening events such as hemolytic huremic syndrome. These conditions are usually the result of a severe colitis, with extensively and well described endoscopic features.
Lumbar Disc Herniation (LDH) may be triggered by many factors acting on the posterior kinetic chain as foot posture, foot and ankles malalignment and abnormal proprioception. Achilles Tendon (AT) rupture can impact heel position, ankle biomechanics, proprioceptive regulation and promote postural instability.
Focal nodular hyperplasia is a benign disorder of the liver, and it rarely occurs among children. It is characterized by hepatocyte hyperplasia with a central stellate scar. The diagnostic is usually based on radiological investigations, yet a needle biopsy could be necessary if there is still a diagnostic doubt. The difficulty lies in managing children without comorbidities and underlying liver disease.
Pancreatic ductal adenocarcinoma (PDAC) is the most common type of malignant tumour in the pancreas. It is a highly aggressive tumour with poor prognosis. The liver and peritoneum are the most common sites of metastasis, and metastasis to colon and cervix are extremely rare. We herein report a case of metastatic PDAC presented as a cervical mass and rectal mass.
Hydatid Disease (HD) is a mild endemic disease caused by ecchinococus granulosus. It can affect any system of the body, with hepatic predilection. Most often asymptomatic, the literature describes 5 evolutionary stages ranging from simple cysts, with it poses a problem of differential diagnosis in its simple form to complicated forms that may or may not be calcified.
Embolization with N-butyl-2-cyanoacrylate (NBCA) is an effective and safe procedure recently used for closure of upper tract urinary fistula. However, NBCA constitutes a foreign body for human organs, so it can cause complications. In our case a 56-year-old man underwent an endoscopic embolization of urinary fistula with NBCA.
A 21-year-old man presented to our emergency department suffering for right arm tightness and stiffness with mild pain following a high-pressure air working injury. On examination, the right hand palm showed a small gunshot wound, a swelling and crepitus was palpable from the tips of the fingers through to the whole upper limb extending up to the lateral right cervical region.
Hemangioma is the most common neoplasm of the liver, affecting 0.4-20% of the general population. The incidence of hemangiomas is highest in the third to fifth decade of life and is more common in women. Most hemangiomas are asymptomatic and diagnosed incidentally.
Acetabular osteoid osteoma is very rare entity. The author reports on a lesion in a 33-years-old lactating female after 12 months of delay in diagnosis. Its periarticular location on the quadrilateral surface of the medial wall and its proximity to the obturator neurovascular bundle made its accessibility.
To report a pregnant patient with impaired vision due to macular involvement of valsalva retinopathy associated with subhyaloid hemorrhage, who was effectively treated with Nd:YAG laser hyaloidotomy and led to successful visual recovery.
Every day, new knowledge on the SARS-CoV-2 epidemic spreads throughout the globe. It presents typically with fever and respiratuar symptoms like shortness of breath and cough but neurologic complications aren’t still well known. Although neurologic complications of SARS CoV-2 infection have been reported, particularly in adults, rarely reported in children.
Intrauterine infections lead to involvement of various organs in fetus, including the eye. The aim of this study was to determine the frequency and clinical response of ocular lesions to specific drugs in infants with congenital Toxoplasma and cytomegalovirus infections.
Rhino-Orbito-Cerebral Mucormycosis (ROCM) is an invasive fungal infection. An under diagnosed and underreported disease in India, it is rapidly fatal without an early diagnosis and treatment. We report the survival rate in our hospital, significant association with sinus involvement and therapy.
This case report focuses on the body and tail pancreatic tumor, one of the rarest locations of a tumor. We describe an interesting case of thirty-year-old women from a rural region presenting with a giant and a life-threatening pancreatic tumor. The information obtained from the patient revealed a modification of the women’s general condition.
Mucormycosis is a rare life-threatening fungal infection caused by group of molds called Mucormycetes. Mucormycosis is particularly dangerous because it spreads quickly throughout the body. Left untreated, the infection can spread to the lungs or the brain and may cause brain infection, paralysis, pneumonia, seizures, death.
The study investigated prevalence, clinical manifestations and co-infections of buruli ulcer in parts of Imo State, Nigeria. The sampled human population was physically examined for buruli ulcer infection, in ulcerative stages wound swab samples were collected using sterile swab sticks and taken to the laboratory for microbial analysis.
A previously healthy 37-year-old man was admitted to a nephrology clinic due to the left-sided abdominal pain, petechiae and recurring hematuria. Laboratory tests revealed high levels of C-reactive protein and Antineutrophil Cytoplasmic Antibodies (cANCA). On this basis, vasculitis was suspected and prednisone in high doses was administered.
The neurological complications of coronavirus disease 2019 (COVID-19) are well known and well documented. With advancements in vaccination programs for COVID-19, the pandemic appears to be under control for the most part. With mutating strains of COVID-19 and given that the efficacy of vaccines is still being evaluated.
Descending necrotizing mediastinitis is a rare and fatal condition that results from the spread of cervicofacial infections to the mediastinum. Early and appropriate management is needed to reduce mortality and morbidity rates. Imaging, especially CT, plays a central role in the diagnosis, treatment, and monitoring of patients.
Fetal megacystis is an enlargement of the fetal urinary bladder that is a rare ultrasonography finding during routine antenatal screening. Though intrauterine genetic screening is widely used to determine the prognosis of this condition in resource rich settings, in the developing world, clinician often has to rely on clinical judgement.
The World Health Organization (WHO) visualizes a world where “every pregnant woman and new-born receive quality care throughout pregnancy, childbirth and postnatal period” . Antenatal Care (ANC) reduces maternal and perinatal morbidity and mortality both directly and indirectly.
Lissencephaly represents a rare subgroup of genetically distinct neurological disorders of neuronal migration characterized by a paucity or absence of cerebral gyration. The most common form of lissencephaly has been isolated and referred to as classic or type 1 lissencephaly.
One major drawback of the present National Cervical Cancer Screening programme is, the suboptimal sensitivity (53%) of the pap smear to detect Cervical Intraepithelial Neoplasia (CIN). HPV/DNA test is highly sensitive (92.9%) for CIN II viral load and the feasibility of HPV/DNA screening with conventional cytology for screen positive follow-up was successfully attempted.
The testis sparing surgery is a safe and feasible procedure for patients with small testicular masses, which are defined in literature as not palpable and/or <2 cm in diameter masses, and may be benign in 80% of cases. We report our experience on TSS of one patient with small testicular nodules, that was diagnosed as an adenomatoid tumor.
Transforaminal epidural corticosteroid injections (TFESI) are widely used for subacute lumbosacral radicular pain and are typically applied during the time frame of potential evolution to neurological complications. We present a case report of a patient with lumbar spinal canal stenosis who developed a cauda equina syndrome (CES) after lumbar TFESI requiring emergency decompression.
Arterial manifestations of Behcet’s disease are challenging and can lead to fatal complications. One of the causes of carotid aneurysm is Behcet’s disease. Extracranial internal carotid artery aneurysms are rare. This aneurysm is rare but important because it is associated with a high risk of neur thromboembolic events, cranial nerve damage, and rupture.
The current COVID-19 pandemic was caused by a new strain of coronavirus that arose in Wuhan (Hubei, China). Dr. Li Wenliang, a 33-year-old ophthalmologist from the Central Hospital of Wuhan, who has unfortunately died from the infection was one of the first to notify about the new form of viral pneumonia.
By a diagnostic routine of a “burn-out”-patient, additionally claiming an electrosensitivity, there was tested the activity of the autonomic nervous system by electromyogram (EMG). Analyzing the frequency we found an artificial 10 Hz-component like those of WLAN-emitters as a dominant signal.
A 42-year-old lady presented with complaints of a slow growing fungating growth over the left shoulder of 3 months duration. This was associated with pain of 2 weeks duration and occasional sero-purulent discharge. Past history of burns to the upper torso, neck and back sustained 15 years ago was elicited.
Liver cirrhosis is generally known as an end-stage process where healthy normal liver tissue is replaced by connective tissue. Neutrophil to lymphocyte ratio (NLR) is an inexpensive, readily available and reproducible test and has emerged as a marker of systemic inflammatory response.
Uterine rupture in pregnancy is associated with severe maternal and fetal complications. Although it is a rare event, uterine rupture has been associated with certain risk factors. We present the case of a 30-year-old parturient fourth gesture, third par, all delivered vaginally admited to the emergency room for spontaneous uterine rupture.
Renal transplantation is the treatment of choice for end stage kidney disease. It gives better quality of life and patient survival than hemodialysis. Renal transplant ladies regain fertility within six months after renal transplantation. Pregnancy is allowed in the most of guidelines after one years of rejection free renal transplant period.
Organophosphates are pesticides used for agricultural purposes, and their poisoning has critical complications. The purpose of this study was to determine the estimated Red Blood cell distribution width (RDW) prognostic role in patients with organophosphate poisoning in the emergency department.
Our report details the clinically significant presentation of a large non neoplastic prostatic-type polyp found in a 37-year-old male patient seeking management for a pelvic mass involving the seminal vesicles and prostate. Prostatic-type polyps uncommonly present within the urothelial tract, with the majority arising within the prostatic urethra.
Few reports are available on Cushing’s Disease (CD) occurrence in pregnancy. We report two cases of pituitary macroadenoma with initial remission, who experienced uneventful pregnancies in the setting of CD recurrence in the postpartum period. The cases were two women in their 30s with irregular menses, weight gain, and other CD symptoms.
Postpartum affects the well-being of mothers. Examining the approaches that could reduce the maternal side effects such as pain and bleeding, are among the top research priorities in midwifery. The present research aims to determine the effects of Portulaca Oleracea capsules on hemorrhage volume and postpartum pain.
Pulmonary cryptococcosis has various CT findings which can be often misdiagnosed as other diseases to delay patient’s treatment. It is actually very difficult to diagnose pulmonary cryptococcal pneumonia on chest CT, especially for inexperienced residents. To investigate whether there are new CT findings that may be helpful to residents when diagnosing cryptococcal pneumonia with CT.
Gastric amyloidosis is a very rare cause of gastric outlet obstruction. Therefore, general treatment recommendations are missing. A 61-year-old man with multiple myeloma and cast-nephropathy with suspected manifestation of amyloidosis was admitted for gastroscopy because of nausea and emesis. Video fluoroscopy demonstrated a gastric outlet obstruction with subtotal stenosis of the pylorus. Gastric amyloidosis (AL-amyloid) was confirmed histologically by deroofingbiopsies which was consistent with the clonotype of the patient’s myeloma. Botox injection was ineffective for control of symptoms. Therefore, endoscopic balloon-dilatation (15 mm to 20 mm) was performed with a long-lasting clinical response of 3 to 6 months.
Neurocysticercosis (NCC), which is typically caused by the tapeworm Taenia solium after ingesting contaminated food or water, is one of the most common parasitic diseases of the nervous system (NS) in humans, and constitutes a major public health problem for most of the developing countries.