A 56 year old male with chronic hepatitis B on entecavir therapy with a low viral load who underwent routine HCC screening with transabdominal ultrasound showing a dilated common bile duct. This was followed with MRCP which revealed choledocholithiasis. LFTs minimally elevated and only occasional right upper quadrant pain.
Issue 5 (May)
A 75-year-old Chinese lady with diabetes mellitus, hypertension and history of bilateral knee arthroplasty was diagnosed with gouty arthritis for 14 years following recurrent ankle and knee pain and had normal serum uric acid level. She was given low dose allopurinol, colchicine and non-steroidal anti-inflammatory drugs and the disease controlled with only intermittent flare episodes.
A 4-year-old male child presented to the emergency department after a first seizure. He recently had frequent headaches and consciousness disorders. Magnetic resonance imaging of the brain revealed an arachnoid cyst, measuring 5.0 cm by 9.0 cm by 8.2 cm, lateralized on the left. The cyst is responsible for an elevation of the tentorium of the cerebellum.
Iliopsoas hematoma is an uncommon entity that may develop with Low-Molecular-Weight Heparin (LWMH) use. Here we report the cases of 2 patients who developed this complication. Both patients were admitted for an acute coronary syndrome and received antiplatelet therapy and subcutaneous low-molecular-weight heparin. A few days after their admission, they both developed iliopsoas hematomas revealed by sudden pain and acute anemia.
Spinal Cord Injury (SCI) is a debilitating common neurological condition that can strike unexpectedly and, without caution. SCI is a high-cost chronic disability, and, it is a life-changing experience for persons with SCI (Pw SCI). It is very important to make the Pw SCI and, their caregiver aware of the Spinal cord injury RECOVERY PROCESS. Understanding the recovery process will help them in many ways, such as having realistic expectations, better outcomes of rehabilitation.
Eosinophilic Cystitis (EC) is a rare condition in which the infiltration of eosinophils in the bladder wall causes transmural inflammation. The most common symptoms that occur as a result of mucosal injury consist of frequency, hematuria, dysuria, and suprapubic pain. We report a patient with EC as a manifestation of Hypereosinophilic Syndrome (HES) who is 7 years old girl with urinary symptoms and a mass-like lesion in the ultrasonography of the bladder.
The aim of this study was to evaluate the effect of emotional freedom techniques (EFT) on anxiety and caregiver burden of family caregivers of patients with heart failure. This study was a quasi-experimental randomized study, in which 91 family caregivers participated. The family caregivers were assigned into two groups of intervention (n = 46) and control (n = 45).
Toxocariasis is a zoonotic helminth infection secondary to the infestation of humans by larvae of Toxocara sp. These are nematodes of the Ascaridae family: Toxocara canis (dog parasite) and Toxocara cati (cat parasite). Multiple sero-epidemiological surveys have demonstrated that human toxocariasis is one of the most common cosmopolitan helminthiasis.
Percutaneous Vertebroplasty (PV) involves the injection of Poly Methylmeth Acrylate (PMA) Bone Cement (BC) into the vertebral body. Passing BC into the vertebral venous plexus and then into the lungs is a rare complication of PV. In some series, the reported incidence of Pulmonary Cement Embolism (PCE) ranges up to 26%.
Labyrinthitis Ossificans (LO) is a pathological condition that results in the ossification of the inner ear structures. It occurs mainly due to infection and inflammation with the former being a more common cause. It may occur in patients having tumor, hemorrhage, or trauma of the temporal bone. Inflammation disrupts the neurosensory signal transmission pathway to the brain.
Delirium is a quite common entity in critically ill patients and known to have several predisposing and precipitating factors. Clinically we have seen a strong relationship between delirium occurrence and season. The observation that the general morbidity of the patients varies according to seasonal factors may suggest the possible existence of seasonal differences regarding delirium.
Natural disasters and public health emergencies occur frequently in Yunnan Province, which is facing the double pressures of prevention and control of infectious diseases at home and abroad. Under the background of implementing the national “One the Belt and One Road” initiative strategy, We established Yunnan Disaster Health Emergency Pioneer Assistance Team to deal with the emergency rescue and disposal tasks of natural disasters and major public health emergencies under extreme conditions at home and abroad.
A 50-year-old man presented to our ophthalmology clinic with progressively diminishing vision in the left eye for 6 months. He had sustained a blunt trauma from a fist punch to the left side of his face, 6 months before. His best corrected visual acuity was 20/25 in the left eye and 20/20 in the right eye. The intraocular pressure was 15 mm Hg in both eyes.
A 70-year-old man was admitted to the internal medicine department complaining of productive cough for three days, severe dyspnea and desaturation with oxygen saturations of 87-89%. On arrival he was diagnosed with severe Covid 19 infection and started treatment with dexamethasone and remdesivir. Mechanical ventilation was installed 7 days after admission.Chest x-ray and chest CT scan issued 3 weeks after admission revealed several large pneumatoceles.
Chronic Pulmonary Aspergillosis (CPA) is a destructive pulmonary disease caused by a fungal infection, a frequent complication of treated Tuberculosis (TB). Pulmonary Tuberculosis (PTB) is a major risk factor for Chronic Pulmonary Aspergillosis (CPA) due to residual structural destruction. Numerous studies and literatures show that CPA is the most common infection after PTB and incidences of CPA in high-TB-burden countries are significantly higher than in low TB-load countries.
Scabies is a contagious parasitic skin disease caused by Sarcoptesscabiei. Crusted scabies is a severe form of scabies that usually occurs in immune compromised patients. We report an uncommon case of crusted scabies in a woman followed forsystemic lupus erythematosus with severe and persistent lymphocytopenia.
Up to now, Endomyocardial Biopsy (EMB) is the gold standard for monitoring acute rejection in Heart Transplant (HTx) recipients. This study aims to investigate using the Left Ventricle (LV) deformity index derived from 2-Dimensional Speckle Tracking Echocardiography (2D-STE) for allograft rejection monitoring.
A 82-year-old woman was admitted to the emergency room with dyspnea. On examination she had SaTO2 of 93% with FiO2 of 28%, crackles in the base of both lungs, edema of the lower limbs with godet and also nodular, erythematous, stone-like skin lesions, coalescing in the umbilical region that appeared 6 months before.
Rabies is a life-threatening and vaccine-preventable infectious disease and is triggered by an RNA virus, part of the Rhabdoviridae family, Lyssavirus genus. The rabies virus primarily spreads by saliva and is most frequently contracted through animal bites. It infects mammals, including humans, and generally causes fatal outcomes. Despite the systematic implementation program to eradicate rabies in Romania.
Gastrointestinal (GI) vascular lesions are one of the most common causes of occult bleeding. The term angiodysplasia and telangiectasias are used interchangeably but angiodysplasias are confined to the GI tract and vascular telangiectasias are a part of systemic diseases like systemic sclerosis or genetic disorder like Hereditary Hemorrhagic Telangiectasia (HHT).
Perforation of aortic cusps after Radiofrequency Ablation (RFA) was firstly described by М. Seifert et al. in a 15 yo girl with Wolf-Parkinson-White syndrome. Aortic valve cusps damage after left sided RFA with retrograde approach across the aortic valve varies between 1% and 8%, and is more common in young patients. Considering the rarity of the complications, we decided to share our observation, describing surgical tactic in a patient with severe aortic insufficiency after RFA.
An 86 year-old woman was admitted in the emergency unit with a severe deterioration of her general condition. She was found in her apartment lying on the floor for an unknown period of time. She had no known medical history or treatment. She lived alone without relatives. She suffered from nosocomephobia (fear of hospitals), but was regularly visited by a nurse to treat a 10-year old tumor that she refused to have examined by a doctor.
Small bowel neoplasms consist of adenocarcinomas, carcinoids or neuroendocrine tumors, lymphomas, Gastrointestinal Stromal Tumors (GISTs), and other sarcomas. GISTs are a type of mesenchymal tumors that arise from the intramuscular layer of the bowel wall and are considered a low-grade sarcoma. Small bowel GISTs often present with a wide variety of GI symptoms, including occult bleeding which can be difficult to localize and diagnose.
Juvenile Nasopharyngeal Angiofibroma (JNA) is a rare tumor that affects almost exclusively adolescents and young males and is locally aggressive despite being benign. It presents with symptoms like epistaxis, and nose blocks. A preoperative biopsy is not recommended as the tumor is highly vascular. Diagnosis relies on imaging modalities.
The child presented with a progressively worsening headache and vomiting. On neurological examination, he had left kinetic cerebellar ataxia. A magnetic resonance imaging displayed a left cerebellar hemisphere mass. The patient had a tumor total resection. The diagnosis of GCG was confirmed by histological study.
A 4-year-old male child presented to the emergency department after a first seizure. His family report the recently had frequent headaches and consciousness disorders. Magnetic resonance imaging of the brain revealed an arachnoid cyst, measuring 5.0 cm by 9.0 cm by 8.2 cm, lateralized on the left. The cyst is responsible for an elevation of the tentorium of the cerebellum.
Acute epiglottitis is a life-threatening condition causing an inflammatory swelling of the epiglottis and nearby structures narrowing the upper airway that can lead to respiratory distress then arrest. The origin is often infectious, most frequently due to Haemophilus influenzae type B (HIB).
A 55-year-old female patient was admitted to the emergency room with left peripheral facial paralysis with a day of evolution and no other symptoms. The patient denied any viral infection in the past months and had a personal history of breast cancer in 2007. Cranio-encephalic computed tomography scan demonstrated multiple bone lesions indicative of metastatic lesions.
Acinetobacter is a gram negative cocco-bacillus that is ubiquitous and can be found in hospital settings. A baumannii can colonize ICU wards in hospitals leading to infection of multiple systems in hospitalized patients including the skin, soft tissue, urinary tract, and mainly the respiratory tract. Pneumonia caused by A. baumannii is a threatening condition in mechanically ventilated patients.
Autoimmune myopathies are complex groups of diseases arising from insult to one or more muscle groups. These are characterized by symmetric muscle weakness with evidence of muscle injury on laboratory findings, myopathic changes on electromyography, and typical findings histologically. Depending on the subtype, the skin may also be affected.
Cardiac hemangiomas are rare vascular neoplasms composed of endothelial cells that are often incidentally found in asymptomatic patients. We present a case of a young male who presented after worsening pleuritic chest pain and dyspnea on exertion. Computed tomography of the abdomen demonstrated a large, enhancing, well-defined
Silver-Russell Syndrome 5 (SRS5) is characterized by asymmetric Intrauterine Growth Restriction (IUGR), poor postnatal growth, macrocephaly at birth and feeding difficulties. Other possible features include triangular shaped face, prominent forehead, hypertelorism, epicanthus, micrognathia, brachydactyly, clinodactyly of the 5th hand finger, and syndactyly of the 2nd and 3rd toe fingers. Pathogenic variants of the HMGA2 gene, on chromosome 12q14.
Lung cancers are diagnosed at a metastatic stage in 40% to 50% of cases. Skeletal Muscle Metastases (SMM) are rare and usually discovered at autopsy. We report a case of SMM which revealed an adenocarcinoma of the lung in a 38-year-old patient. The diagnosis was confirmed histologically. Death occured one week after diagnosis.
We present a case of diversion colitis in a 45-year-old male with rectal adenocarcinoma who underwent a low anterior resection of the rectum with diverting ileostomy. Diversion colitis is a frequent sequela of fecal stream diversion. Endoscopic and microscopic findings mimic inflammatory bowel disease. Most patients are asymptomatic. The disorder almost always resolves after reconstitution of the gastrointestinal tract.
Mushroom poisoning is quite common due to the unconscious collection and consumption of wild mushrooms. Mushroom poisonings show clinical changes according to the mushroom species. Clinical findings; gastrointestinal side effects range from neurogenic, psychogenic, cholinergic findings to organ failure and even death. After eating several different types of mushrooms they collected from the plateau, a family consulting of mother, father and son had mushroom poisoning.
Carpal Tunnel Syndrome is the most common compressive neuropathy, affecting 5% of the population. Most cases are idiopathic, but structural and occupational factors play an essential role. Several anatomical variations within the carpal tunnel, including persistent median artery, have been described. This review reports a 17-year-old female student with right-sided Carpal Tunnel Syndrome secondary to a persistent median artery.
To analyze the clinical features and prognosis of datura poisoning in children. Through retrospective investigation of 8 children with datura poisoning in Lanzhou on September 1, 2022, we analyzed the history of clinical features, adjunctive examination, treatment, and follow-up.
Ornithine Trans Carboxylase Deficiency (OTCD) is a rare congenital genetic related disease. Domestic and foreign researches on OTCD are relatively rare till now. The present study reports a case of OTCD deficiency with acute brain injury after pulmonary nodule surgery, and analyzes its pathogenesis, clinical manifestations, diagnosis and treatment based on the literatures, with the aim to provide guidance for clinical practice.
Hematopoietic growth factors play a crucial role not only in hematopoiesis but also in the stimulating of nonhematopoietic cells proliferation, including tumor cells. This study aimed to measure the serum concentrations of a panel of hematopoietic growth factors in patients with Breast Cancer (BC) and healthy controls.
Acute ischemic stroke is a time-sensitive emergency requiring rapid accurate diagnosis and treatment. Stroke Mimic (SM) is a noncerebrovascular condition that presents with acute focal neurological deficts and masquerades as a real stroke. SMs account for 20-40% of stroke presentations in the emergency department. The purpose of this review is to make a summary of SMs, so that clinicians, especially emergency physicians, can improve their knowledges and make accurate diagnoses and treatment.
Herbaspirillum Huttienseis a gram-negative bacteria found in plants and has been isolated from groundwater. It previously identified as an opportunistic pathogen in patients and can cause bacteremia and sepsis rarely. We present a case of H. Huttiense bacteremia in a neonate.
Smoke inhalation injury is a major determinant of morbidity and mortality in fire victims. We report the case of a 3-year-old child with smoke inhalation, presenting with abnormal consciousness: after a neurological examination, he was diagnosed with severe carbon monoxide and hydrogen cyanide poisoning. Patient was treated with mechanical ventilation, bronchoalveolar lavage, hyperbaric oxygen, and hydroxocobalamin, and then discharged in good clinical condition.
Delayed Cerebral Ischemia (DCI) is a frequent and serious complication after Subarachnoid Hemorrhage (SAH), the leading cause of disability and fatality in survivors of SAH, the most important complications of stent-assisted coil embolization of cerebral aneurysms, and one of the complications after clipping surgery of aneurysm. However it has been rarely reported after coil embolization of unruptured cerebral aneurysms without stent assistance.
With the widespread use of low-dose computed tomography for screening of lung cancer in high-risk groups, the detection rate of Pulmonary Nodules (PNs) continues to increase, which raises much concern. The key to accurate treatment is to assess the malignant potential of PNs, although most are small and lack typical imaging signs, thus often requiring follow-up examinations to observe dynamic changes. Prediction of PN growth is essential for the design of personalized treatment plans.