Purpura Fulminans (PF) is a disease that occurs after septicemia. It has a rapid course. PF causes disseminated intravascular coagulation and severe organ failure. Extremity amputation and fatality rates are very high, even if it is diagnosed and treated promptly. This case report presented a 59-year-old man who developed purpura fulminans after Endoscopic Retrograde Cholangiopancreatography (ERCP).
Rapidly developing colitis induced by combination therapy of lenvatinib and Anti-PD-1 antibody in the treatment of hepatocellular carcinoma
Although diarrhea caused by Immune Checkpoint Inhibitors (ICIs) or Tyrosine Kinase Inhibitor (TKI) are common, server colitis caused by tyrosine kinase inhibitor (TKI) combined with anti-PD-1 has not been paid attention to, which is extremely dangerous for patients who were immune compromised or bearing tumor. Lenvatinib is an oral multi-target TKI as the first line treatment for Hepatocellular Carcinoma (HCC).
Labrune disease or Leukoencephalopathy with brain calcifications and cysts (LCC) is a rare genetic disease. It distinguishes by a triad of leukoencephalopathy, calcifications, and intracranial cysts. Recently, a mutation in the SNORD118 gene has been identified as the genetic basis involved in the disease. A 34-year-old woman presented with progressive left hemiparesis. Neuroimaging reveals multiple parenchymal cysts, diffuse white matter hyperintensities, and scattered calcifications.
X-Ray is one of the oldest, convenient, and cost effective imaging techniques commonly employed in the diagnosis of numerous clinical conditions. The differential X-Ray absorption capacity, or contrast of the biological system is a determining factor in the biomedical X-Ray picture interpretation. Due to the tendency of air and gas (such as oxygen, carbondioxide, nitrogen) to have low radiographic density, they tend to be radiolucent (i.e., not absorb X-rays).
We present a case of successful programmed death ligand 1 inhibitor therapy of a recurrent exophytic bulky lip carcinoma. The frail, old-old patient had been ineligible for radical tumor resection or curative intended, high-dose chemoradiation. A palliative radiation therapy led to a near complete remission, although the tumor recurred nine months later.
Comparison of angular cephalometric measurements between CBCT mid-sagittal plane projections and conventional lateral cephalometric radiographs
The purpose of this study was to verify the angular measurement values of conventional Lateral Cephalometric Radiographs (LCRs) and Cone-Beam Computed Tomography (CBCT) Mid- Sagittal Plane (MSP) projections when using the same cephalometric analysis method. CBCT images and LCRs of 43 patients were randomly selected. Thirty-three landmarks were manually located on CBCT scans three times by two experienced operators.
Cold Agglutinin Disease (CAD) is a rare entity of Autoimmune Hemolytic Anemia (AHAI) type immunoglobulin M characterized by destruction of red blood cells at low temperature. It affects one person in a million. Etiological evaluation is essential for managing the cause in addition to symptomatic treatment. A distinction is made between idiopathic forms and forms secondary to viral infections, auto immune diseases and hemopathies.
Anterior Cruciate Ligament (ACL) injuries have amplified dramatically in the last years in female team sports due to the incrementing number of teams and players, an increase in speed and competitivity, and in some areas due to insufficient strength training in young athletes. Return to play is main goal after ACL reconstruction. Access to surgery and rehabilitation is mandatory for an successful return to sport after the injury.
Bardet-Biedl Syndrome (BBS) is a rare autosomal recessive disorder of the primary cilia with plenty of clinical manifestations secondary to the involvement of multiple organs, and difficult to diagnose. We describe an atypical case of an obese patient with metabolic syndrome and hepatosplenomegaly diagnosed with BBS after genome sequencing.
A 74-year-old male patient presented to the emergency department with hematochezia and dizziness. Seven years ago, the patient had a colonoscopy at another hospital, during which a perforation in the sigmoid colon was found; consequently, he underwent a loop colostomy. He was pale, with a blood pressure of 70/40 mmHg and a pulse of 130 beats per minute.
Central hyperthermia in CNS disorders is often misdiagnosed or under diagnosed due to in adequate data. Current diagnosis is one of exclusion. Existing treatment modalities as per guidelines are symptomatic and supportive. Fever after Traumatic brain injury may worsen functional outcome and prolong hospital stay, hence need to be evaluated and treated prompl.
Pott’s puffy tumor is a subperiosteal abscess due to frontal osteomyelitis. It may occur in the setting of a local trauma or as a rare complication of frontal/ethmoid sinusitis. We report the case of a 14-year-old boy, with no particular history and no recent trauma, who was admitted for headaches associated with a frontal and orbital swelling of inflammatory appearance. On workup, the child presented a hyperleukocytosis of 14210/ uL with a predominance of neutrophils at 9670/ uL and lymphocytes at 2730/ uL and a CRP of 157 mg/L.
Diffuse Esophageal Spasm (DES) and Achalasia have similar clinical and manometric traits. Though it might not happen often, certain reports seem to support the idea that DES can develop to achalasia. It is still difficult to determine the frequency of DES development to achalasia and the factors that influence this progression. An elderly man with dysphagia is the subject of a case study, and the manometry results showed a pattern shift from DES to Type II Achalasia.
Carotid Webs (CW) are an under-diagnosed cause of embolic stroke especially in young patients with no vascular risk factors. Strokes associated with CW are frequently severe, with a high proportion of Large Vessel Occlusion (LVO). They are frequently considered cryptogenic, and sub sequently, treatment with aspirin is initiated as secondary prevention.
X-ray is one of the oldest, convenient, and cost effective imaging techniques commonly employed in the diagnosis of numerous clinical conditions. The differential X-ray absorption capacity, or contrast of the biological system is a determining factor in the biomedical X-ray picture interpretation. Due to the tendency of air and gas (such as oxygen, carbon-dioxide, nitrogen) to have low radiographic density, they tend to be radiolucent (i.e., not absorb X-rays) and hence, produce no shadow on X-ray film and appear black.
Divers have sought in the oceans food and valuables for centuries. More recently, scuba diving became associated with the military. In the 1950s, scuba diving evolved into a recreational sport for pleasure and leisure. It was greatly popularized after the invention of the “Aqua-Lung” made famous by oceanic explorers like Jacques Cousteau. A
Back problems (dorsopathies) are one of the most common locomotor system conditions. Back problems are usually categorised as specific and non-specific back complaints. Specific causes for back problems are hardly ever identified, approximately 90% are non-specific. Back problems lead to pain and reduced functioning. Important symptoms of non-specific back problems are diffuse, nagging pain and reduced physical functioning when carrying out daily activities.
A 25-year-old young man came to the emergency department of our hospital with sudden dizziness and vomiting for one day. The neurologist performed a physical examination of the patient, found no positive signs, and ordered the patient to perform a head Computed Tomography (CT) examination, which showed a left cerebellar hemisphere mass with obstructive hydrocephalus.
In recent decades, organ transplantation has largely benefited from advances in immune suppressive therapy and surgical techniques. The reproductive function, alongside the patient’s quality of life and survival, has also been improved. However, close follow-up for early detection of any renal injury is crucial, since the occurrence of acute rejection, dysfunction, or allograft loss, is unpredictable.
Mechanical thrombectomy is now a recommended treatment for large vessel occlusion in acute ischemic stroke. However, it is associated with a number of complications, which need to be minimized and effectively managed to maximize the benefits of thrombectomy. We describe an unusual and rare complication of microcatheter fracture after a successful thrombectomy for middle cerebral artery occlusion.
Intracardiac flow analysis utilizing non-invasive imaging methods is an increasingly attractive approach to evaluate cardiac function. Ultrasound-based modalities offer a low-cost bedside method to visualize and quantify intracardiac flow dynamics but are currently limited to primarily 2D. This study aims to propose and evaluate a new, novel parameter based on known healthy flow patterns in the Left Ventricle (LV) and 2D velocity field data.
Hydrocephalus is a condition that results from increased intracranial pressure. It can be caused by various conditions, including intracranial tumors, brain malformations, as well as disturbances in cerebrospinal fluid production and drainage. However, regardless of etiology, ventriculoperitoneal (VP) shunt is a common procedure used to reduce intracranial pressure.
A 12-month-old boy, previously healthy, presented to our Emergency Department (ED) with 7 episodes non-bilious vomiting, parents gave history of mild head injury the night before. Clinical examination was unremarkable. According to pediatric Computerized Tomography (CT) head rule (PECARN) in less than 2 years old he would be low risk for intracranial pathology and would not require CT of the brain.
Penetrating orbital trauma necessitates a multidisciplinary approach because complex orbital injuries often encompass damage to the brain, the eyes, and the disfigurement of the face. The prognosis depends on the location of the injury, the type and size of the foreign body, and the subsequent complications
Heavy metal intoxication is a consequence of the accumulation of metals in the body. The toxicity of heavy metals, particularly lead, arsenic, cadmium and mercury, remains a significant problem and challenge for future investigations. The toxic metals compete with or replace some vital biogenic metals in the course of which some of the biosystems could be affected.
Life-threatening event after injection laryngoplasty in a patient with chemotherapy-induced vocal-fold motion impairment: A case report
Although chemotherapy-induced vocal-fold motion impairment was first reported in 1971, there are few reports. Herein, we describe a case in which life-threatening side effects occurred after injection laryngoplasty for the treatment of chemotherapy-induced vocal-fold motion impairment accompanied by dysphonia and aspiration in a patient with lymphoma.
COVID-19 pathogenesis involving B cells and serum cytokines: A case report of hereditary bone marrow failure
In primary antibody deficiency (PAD) patients, the course of the coronavirus disease (COVID-19) varies from asymptomatic to fatal. Inflammatory cytokine level and B cell function influence the COVID-19 pathogenesis in PAD patients. Previous studies were often inadequate and did not demonstrate a clear relationship between PAD and COVID-19 severity.
This was a retrospective study performed to evaluate the clinical impact of bacteremia due to Staphylococcus pettenkoferi and to determine the usefulness of Matrix-Assisted Laser Desorption/Ionization Mass Spectrometry with Time-of-Flight detector (MALDI-TOF MS) as a diagnostic tool. We retrospectively reviewed the blood culture results and medical records of all patients with a history of visits or hospitalizations at the Jichi Medical University Hospital in Japan.
Heterotopic hip ossification in patients with severe acquired brain injury: When surgical intervention is recommended
The production of ectopic lamellar bone in soft tissues is known as Heterotopic Ossification (HO). HO is a common consequence following trauma, burns, brain injuries, and major orthopedic surgery. It can be thought of as abnormal tissue repair. The hip is the joint most frequently affected after a severe acquired brain injury, affecting the prognosis of patients.
Against the background of the COVID-19 pandemic, the number of patients with co-infection - HIV infection + COVID-19 - has increased critically. The features of the interaction of these two infections are of scientific, clinical and practical interest. On the one hand, the combination of two severe viral infections should aggravate the patient’s health, on the other hand, people living with HIV infection receive antiviral therapy, which can have a positive effect on the course of COVID-19
Impact of atrial fibrillation ablation on right ventricular failure and manifestation of heart failure with preserved ejection fraction symptoms: A case report
Catheter ablation is an important treatment modality for management of Atrial Fibrillation (AF). AF is a responsible factor in the pathophysiology of Heart Failure with Preserved Ejection Fraction (HFpEF). However, the relationship between AF and Right Ventricular (RV) dysfunction has not been completely distinguished.
Tuberous Sclerosis Complex (TSC) is a neurocutaneous syndrome with a prevalence of around nine in 100,000 cases. It is characterized clinically by a triad of seizures, intellectual disability, and adenoma sebaceum. However, approximately 50% patients have normal intellect, and 15% with no seizures. Cutaneous findings are the most common as well as readily appreciable manifestations of Tuberous Scleorsis Complex (TSC).
A 36-year-old male with no medical history was referred to the Emergency Room (ER) with complaints of vomiting and progressive dysphagia for solids and liquids over a two-week period. The patient denied other symptoms. Upon presentation to the ER, both the physical examination and the blood analysis were unremarkable, but the chest X-ray revealed widening of the upper third of the mediastinum.
The increasing use of a double-J (DJ) stent in urological diseases has also increased complications. In this report, we describe two cases presenting with early spontaneous DJ stent fragmentation. The first patient was referred to our outpatient clinic due to pregnancy hydronephrosis. A DJ stent was placed in her right kidney.
Application of workplace-based assessment for family medicine postgraduates students in faculty of medicine Menoufia university
Formative assessment is one of the most valuable approaches that could help medical students to learn and improve their clinical knowledge and skills. Its value comes from the informative and constructive feedback after careful observation of the candidates by their medical educators.
Nodular pulmonary amyloidosis is rare in our environment with a low incidence. A 77-year-old female patient, who began her illness 20 days before hospital admission with sporadic non-productive cough without attack to the general condition. Computed tomography scan of the chest showed multiple nodular images of heterogeneous density, some of them hyperdense in calcific range, poorly defined borders, patchy in both hemithoraxes with confluence in basal regions.
The superior mesenteric artery syndrome is an uncommon entity included in the spectrum of vascular syndromes. The low presentation, variety of in specific symptoms and shortage of bibliography presents a challenging diagnosis for both clinicians and radiologists. Our aim is to present a 63 years-old male patient with pancreatitis history and repeated symptoms.
Leprosy remains a public health problem in many developing countries, especially, in tropical regions. Even though the prevalence rate of leprosy in Indonesia has decreased, however from 2001 to 2019, there has been an increasing trend of leprosy cases with disabilities. The rate of grade 2 disability cases is an indicator of the effectiveness of leprosy health services, especially in terms of case detection.
TA is a large vessel vasculitis involving mainly the aorta and its primary branches resulting in segmental stenosis, occlusion or aneurysms. Angiography is the gold standard for diagnosing TA but may miss wall changes in the early stages of disease. So bedside ultrasonography can serve as a valuable tool in ED for diagnosing early TA. The role of B mode ultrasound for detection of arterial thickening and follow up of patients is supported by previous studies.
74-year-old woman with primary biliary cirrhosis under immunosuppression with azathioprine (50 mg/day) presented multiple violaceous papules and plaques with some associated edema on the distal lower right extremity. Physical examination also revealed multiple right inguinal adenopathies. She had no history of fever, weight loss, or night sweats.
The correct diagnosis of patients with disorders of consciousness is still challenging. The accurate observation of the behavioral responses in patients with Disorders Of Consciousness (DoC) is crucial to avoid misdiagnosis. We observed changes in the behavioral response in a patient diagnosed with Unresponsive Wakefulness Syndrome/Vegetative State onlyafter nociceptive stimulation, administered following the Nociception Coma Scale indication.
Moebius syndrome in association with hypogonadotrophic hypogonadism and focal motor demyelinating peripheral neuropathy with persistent conduction blocks
Congenital, non-progressive facial paralysis and a restricted abduction of one or both eyes are symptoms of Moebius Syndrome (MBS). Peripheral neuropathy, Kallmann syndrome, intellectual disability, and social impairment are also evident in a subgroup of people with inherited congenital facial nerve atrophy and oculomotor nerve palsy