Filter options

Publication Date
From
to
Subjects
Journals
Article Types
Countries / Territories
Open Access September 09, 2025

Biopsy-Negative Giant Cell Arteritis Presenting as Stroke Mimic with Vision Loss and Complex Vascular Disease

Abstract A man in his 60s with multiple vascular comorbidities presented with sudden, painless vision loss in one eye. Although he had a high risk for atherosclerotic events, initial evaluation for stroke was negative for acute ischemia, but found to have markedly elevated inflammatory markers. Accordingly, giant cell arteritis was investigated and Ophthalmologic findings and fulfillment of the 2022 [...] Read more.
A man in his 60s with multiple vascular comorbidities presented with sudden, painless vision loss in one eye. Although he had a high risk for atherosclerotic events, initial evaluation for stroke was negative for acute ischemia, but found to have markedly elevated inflammatory markers. Accordingly, giant cell arteritis was investigated and Ophthalmologic findings and fulfillment of the 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology classification criteria supported the diagnosis of giant cell arteritis, despite a negative temporal artery biopsy. Management included high-dose glucocorticoids and delayed tocilizumab initiation due to the need for multiple vascular surgeries. Vision loss was irreversible, but systemic symptoms resolved and vascular interventions were successful. This case highlights the diagnostic and management complexities of biopsy-negative giant cell arteritis in patients with severe atherosclerotic vascular disease, emphasizing the importance of clinical judgment and established classification criteria when imaging and biopsy results are inconclusive.
Figures
PreviousNext
Case Report
Open Access February 24, 2025

Pembrolizumab-induced myelitis in stage 4 renal clear cell carcinoma: a case report

Abstract Pembrolizumab, an immune checkpoint inhibitor targeting the programmed cell death 1 (PD-1) protein, is widely used for renal cell carcinoma but rarely causes central nervous system adverse events such as myelitis. A 58-year-old woman with stage IV renal clear cell carcinoma developed radiating hip pain, paresthesia, hypoesthesia (T10 and below), constipation, urinary retention, and sudden [...] Read more.
Pembrolizumab, an immune checkpoint inhibitor targeting the programmed cell death 1 (PD-1) protein, is widely used for renal cell carcinoma but rarely causes central nervous system adverse events such as myelitis. A 58-year-old woman with stage IV renal clear cell carcinoma developed radiating hip pain, paresthesia, hypoesthesia (T10 and below), constipation, urinary retention, and sudden right-eye blurred vision one month after her sixth cycle of pembrolizumab and lenvatinib. Neurologic examination revealed asymmetrical inferior paraparesis, upper motor neuron signs, and right eye papilledema. MRI demonstrated patchy hyperintensity on C2-C6 and T2-T5, supportive of myelitis. Intravenous methylprednisolone was initiated, leading to pain relief and motor improvement. This is the first reported case of pembrolizumab-induced myelitis in Indonesia, emphasizing the importance of early recognition and corticosteroid therapy for optimal recovery.
Figures
PreviousNext
Case Report
Open Access November 16, 2024

Electrocution Cervical Myelopathy Presenting with Partial Brown Sequard Syndrome: A Case Report and Review of Literature

Abstract Background: Electrical injuries are underreported in literature, but they can affect the peripheral and central nervous system causing permanent disability. Aims and objectives: This case report aims to highlight cervical spinal cord injury secondary to electrocution, a rare cause of spinal cord injury. Case report: We report the case of a 54-year-old housewife who presented [...] Read more.
Background: Electrical injuries are underreported in literature, but they can affect the peripheral and central nervous system causing permanent disability. Aims and objectives: This case report aims to highlight cervical spinal cord injury secondary to electrocution, a rare cause of spinal cord injury. Case report: We report the case of a 54-year-old housewife who presented with transient loss of consciousness and right sided hemiparesis following electrocution, while at home. Results: The patient met clinical critera for partial Brown- Sequard syndrome, which to our knowledge, has not been previously reported. She showed significant improvement over a month and is currently under monitoring. Conclusions: Electrical injury is a rare cause of normal MRI myelopathy and the potential for immediate, delayed, and long- term neurological disability.
Figures
PreviousNext
Case Report
Open Access February 26, 2024

A Case of Early Initiation of Veno-venous Extracorporeal Membrane Oxygen in Morbid Obesity with Severe Legionella Pneumonia

Abstract We present a case of a critically ill patient with severe Legionella pneumonia complicated by morbid obesity (BMI ≥ 40 kg/m2) who was successfully treated with early initiation of veno-venous ECMO (V-V-ECMO) without any sequelae. The patient, a 48-year-old male, initially presented with symptoms of a sore throat, fever, significant fatigue, and decreased appetite. Upon diagnosis of [...] Read more.
We present a case of a critically ill patient with severe Legionella pneumonia complicated by morbid obesity (BMI ≥ 40 kg/m2) who was successfully treated with early initiation of veno-venous ECMO (V-V-ECMO) without any sequelae. The patient, a 48-year-old male, initially presented with symptoms of a sore throat, fever, significant fatigue, and decreased appetite. Upon diagnosis of severe pneumonia complicated by morbid obesity, he was transferred to our hospital for further management. Upon admission, he was promptly intubated and placed on mechanical ventilation. Due to a positive urinary Legionella antigen test indicating a risk of deterioration, V-V ECMO was initiated immediately after intubation. During ECMO support, the patient received Levofloxacin Hydrate at 500 mg/day and Prednisolone Sodium Succinate at 100 mg/day. He was successfully weaned off ECMO after 12 days and transferred back to the referring hospital on day 20. While ECMO therapy for morbidly obese patients was traditionally considered relatively contraindicated, this case suggest that obesity alone is not a contraindication to initiating ECMO.
Figures
PreviousNext
Case Report
Open Access January 03, 2024

Inflammatory Bowel Disease associated with Intestinal Malrotation

Abstract Intestinal malrotation is an embryological abnormality modifying the classic anatomy of the small and large bowels, particularly the topographical one. Inflammatory bowel disease (IBD) is characterised by anatomical lesions with preferential intestinal tropism. These two conditions are rarely associated. They represent a real diagnostic and therapeutic challenge due to the overlap of non-specific [...] Read more.
Intestinal malrotation is an embryological abnormality modifying the classic anatomy of the small and large bowels, particularly the topographical one. Inflammatory bowel disease (IBD) is characterised by anatomical lesions with preferential intestinal tropism. These two conditions are rarely associated. They represent a real diagnostic and therapeutic challenge due to the overlap of non-specific symptoms and the complexity of the clinical management. We report the case of a young woman presenting with a flare-up of her IBD and a partial common mesentery syndrome. Clinicians should be aware of the potential pitfalls of the two entities to propose the adequate therapeutic strategy regarding the full understanding of the anatomy, notably when surgery is needed.
Figures
PreviousNext
Case Report
Open Access November 02, 2023

Off-Label Use of Esketamine

Abstract Major depressive disorder (MDD) is a significant psychiatric condition, with many affected individuals not gaining remission from conventional treatments, leading to classification as treatment-resistant depression (TRD). This study aimed to investigate the potential of intravenous (IV) ketamine, particularly the S-enantiomer esketamine in nasal spray form, for treating patients with TRD and [...] Read more.
Major depressive disorder (MDD) is a significant psychiatric condition, with many affected individuals not gaining remission from conventional treatments, leading to classification as treatment-resistant depression (TRD). This study aimed to investigate the potential of intravenous (IV) ketamine, particularly the S-enantiomer esketamine in nasal spray form, for treating patients with TRD and associated comorbidities. We report three cases of patients with diverse psychiatric and medical backgrounds whom all reported significant symptomatic relief from depressive episodes and suicidal ideation (SI) following esketamine administration. Additionally, esketamine seemed to proffer benefits beyond the primary depressive symptoms, positively impacting other comorbid conditions, such as agitation, self-injurious behavior (SIB), and chronic pain. The goal of this paper is to highlight that while esketamine's primary utility is in addressing TRD, its therapeutic potential may extend to a variety of associated conditions. However, it is crucial to underscore the heterogeneity of MDD, emphasizing the necessity for individualized therapeutic approaches and further research into esketamine's broader applications.
Case Series
Open Access October 13, 2023

A Report of Three Cases with Moderate Psoriasis Treated with New Topical Treatment

Abstract Practice guidelines recommend fixed combinations of calcipotriol, a topical vitamin D analogue, and betamethasone dipropionate, a high potency corticosteroid, as first line topical treatment for mild to moderate plaque psoriasis of the body and scalp. A new foaming lotion for treatment of Psoriasis was developed and patented by the Spanish Ministry of Industry, Trade and Tourism (Invention patent [...] Read more.
Practice guidelines recommend fixed combinations of calcipotriol, a topical vitamin D analogue, and betamethasone dipropionate, a high potency corticosteroid, as first line topical treatment for mild to moderate plaque psoriasis of the body and scalp. A new foaming lotion for treatment of Psoriasis was developed and patented by the Spanish Ministry of Industry, Trade and Tourism (Invention patent reference number 202030824). The foaming lotion is composed of clobetasol, papaverine hydrochloride, spironolactone, milk-peptide-complex and propylene glycol. Three cases with moderate Psoriasis aged 34, 36 and 66 years old were treated with our new foaming lotion for 7-8 days. The three patients reported important improvement in the itching sensations and remission of the scaled lesions. Before and after application of the new foaming lotion, Psoriasis Area Severity Index (PASI) scores improved in the first patient from 24.3 to 1.8, in the second patient from 26.1 to 1.8, and in the third patient from 27 to 1.8. Our results show the short-term effectiveness of the new foaming lotion in treating moderate and extensive Psoriasis. Long follow-up is needed to evaluate the remission period of Psoriasis and possible side effects of the new topical treatment.
Figures
PreviousNext
Case Report
Open Access October 10, 2023

Anaphylaxis and Cardiogenic Pulmonary Edema due to Non ST Elevation Myocardial Infarction NSTEMI: A Case Report

Abstract Anaphylaxis can be associated with hemodynamic shock, which requires the early initiation of adrenaline as part of its management. Cardiogenic pulmonary edema is a frequent entity in emergency services with increased mortality in patients with acute coronary syndrome. The case report presents the case of a 55-year-old male patient who entered the emergency department with a non-ST-segment [...] Read more.
Anaphylaxis can be associated with hemodynamic shock, which requires the early initiation of adrenaline as part of its management. Cardiogenic pulmonary edema is a frequent entity in emergency services with increased mortality in patients with acute coronary syndrome. The case report presents the case of a 55-year-old male patient who entered the emergency department with a non-ST-segment elevation myocardial infarction (NSTEMI) associated to pulmonary edema and anaphylaxis. During his stay in the emergency room, he had an anaphylactic reaction to dipyrone (metamizole) used for pain control. The patient presented signs of acute pulmonary edema, a hypertensive urgency after the use of adrenaline for the management of anaphylaxis.  There was doubt as to whether the dyspnea was of anaphylactic or cardiogenic origin, so an emergency ultrasound was performed, which suggested a bilateral pattern B.  This allowed timely management of ventilatory failure with systemic nitrates, diuretics, and oxygen therapy, which controlled blood pressure and resolved ventilatory failure. Subsequently, he was transferred to an institution with a hemodynamic service for the management of NSTEMI. We highlight the utility of emergency ultrasonography for immediate decision-making and the low prevalence of anaphylactic reaction in a patient with NSTEMI leading to acute pulmonary edema.
Figures
PreviousNext
Case Report
Open Access September 01, 2023

Treatment by Ceftolozane/Tazobactam for Pseudomonas Aeruginosa Pneumonia Patients with or without Bacteremia

Abstract Background: Pseudomonas aeruginosa (P. aeruginosa) is one of the most common pathogens in hospital-acquired pneumonia (HAP) including ventilator-associated pneumonia (VAP). Recently, ceftolozane/tazobactam (CTLZ/TAZ) has been used to treat pneumonia due to P. aeruginosa. Case series: Two cases of P. aeruginosa pneumonia treated by CTLZ/TAZ that had been initially treated by piperacillin/tazobactam (PIPC/TAZ) are presented. (Case 1): A 76-year-old man who underwent esophagectomy developed severe pneumonia caused by P. aeruginosa infection and received oxygen by high-flow nasal canula. PIPC/TAZ was started, and he improved 10 days later. PIPC/TAZ was switched to sulbactam/ampicillin, but on day 14, his respiratory condition worsened, and septic shock developed. P. aeruginosa was isolated from his blood, and CTLZ/TAZ was started because the isolated P. aeruginosa showed resistance to PIPC/TAZ. Although he recovered on Day 28, and CTLZ/TAZ was switched to levofloxacin, his condition worsened again, and P. aeruginosa resistant to CTLZ/TAZ was isolated from his blood on day 32. Finally, he died of septicemia and renal failure. (Case 2) A 51-year-old woman who underwent surgery for a brain tumor developed VAP due to P. aeruginosa and was treated by PIPC/TAZ. Her pneumonia improved, but pneumothorax developed, and she was therefore switched to CTLZ/TAZ on day 7. Her pneumonia improved smoothly without bacteremia 10 days later. Conclusions: These data and cases suggest that CTLZ/TAZ was effective for severe P. aeruginosa pneumonia although the isolated P. aeruginosa was resistant to PIPC/TAZ. However, the duration of CTLZ/TAZ administration may need to be considered for pneumonia cases with bacteremia due to P. aeruginosa [...] Read more.
Background: Pseudomonas aeruginosa (P. aeruginosa) is one of the most common pathogens in hospital-acquired pneumonia (HAP) including ventilator-associated pneumonia (VAP). Recently, ceftolozane/tazobactam (CTLZ/TAZ) has been used to treat pneumonia due to P. aeruginosa. Case series: Two cases of P. aeruginosa pneumonia treated by CTLZ/TAZ that had been initially treated by piperacillin/tazobactam (PIPC/TAZ) are presented. (Case 1): A 76-year-old man who underwent esophagectomy developed severe pneumonia caused by P. aeruginosa infection and received oxygen by high-flow nasal canula. PIPC/TAZ was started, and he improved 10 days later. PIPC/TAZ was switched to sulbactam/ampicillin, but on day 14, his respiratory condition worsened, and septic shock developed. P. aeruginosa was isolated from his blood, and CTLZ/TAZ was started because the isolated P. aeruginosa showed resistance to PIPC/TAZ. Although he recovered on Day 28, and CTLZ/TAZ was switched to levofloxacin, his condition worsened again, and P. aeruginosa resistant to CTLZ/TAZ was isolated from his blood on day 32. Finally, he died of septicemia and renal failure. (Case 2) A 51-year-old woman who underwent surgery for a brain tumor developed VAP due to P. aeruginosa and was treated by PIPC/TAZ. Her pneumonia improved, but pneumothorax developed, and she was therefore switched to CTLZ/TAZ on day 7. Her pneumonia improved smoothly without bacteremia 10 days later. Conclusions: These data and cases suggest that CTLZ/TAZ was effective for severe P. aeruginosa pneumonia although the isolated P. aeruginosa was resistant to PIPC/TAZ. However, the duration of CTLZ/TAZ administration may need to be considered for pneumonia cases with bacteremia due to P. aeruginosa.
Figures
PreviousNext
Case Series
Open Access March 02, 2023

Traumatic Pneumothorax Secondary to Acupuncture Procedure: A Case Report

Abstract Acupuncture is an alternative medicine, actually it has had a greater acceptance in our continent being use for multiple therapeutic purposes. Although it is a minimally invasive procedure it is not exempt from complications, most common minor complications such as infections or local pain have been described, as well as less frequently but potentially fatal complications such as subarachnoid [...] Read more.
Acupuncture is an alternative medicine, actually it has had a greater acceptance in our continent being use for multiple therapeutic purposes. Although it is a minimally invasive procedure it is not exempt from complications, most common minor complications such as infections or local pain have been described, as well as less frequently but potentially fatal complications such as subarachnoid hemorrhage and tension pneumothorax. We report a case of pneumothorax secondary to acupuncture in a patient who was treated for carpal tunnel syndrome.
Figures
PreviousNext
Case Report
Open Access December 29, 2022

Antibiotic treatment for infection with Shiga toxin producing Escherichia coli infection inducing a hemolytic uremic syndrome

Abstract Background: Shiga toxin producing Escherichia coli (STEC) inducing hemolytic uremic syndrome (HUS) with multiple organ involvement is associated with significant morbidity and mortality. The treatment has mostly been focused on kidney, respiratory and cardiovascular supports and not against the bacteria that cause STEC-HUS. The use of bactericidal therapy has been shown to be antibiotic [...] Read more.
Background: Shiga toxin producing Escherichia coli (STEC) inducing hemolytic uremic syndrome (HUS) with multiple organ involvement is associated with significant morbidity and mortality. The treatment has mostly been focused on kidney, respiratory and cardiovascular supports and not against the bacteria that cause STEC-HUS. The use of bactericidal therapy has been shown to be antibiotic dependent and certain antibiotics inhibit the production and release of Shiga toxin, eradicate STEC without harmful effects, and improve outcome. Methods: A previously healthy 18-months-old girl with STEC causing severe colitis, kidney failure and multi-organ dysfunction was treated with antibiotics that were known to inhibit the release of Shiga toxin as a supplement to supportive care. Results: The antibiotic regime stopped the pathophysiological process with prompt clinical improvement in association with the disappearance of the Shiga toxins. Conclusions: The present case report fortifies and recommends appropriate antibiotic treatment during STEC-HUS, suggesting clinicians to consider the use of these in severe STEC-HUS as early as possible.
Case Report
Open Access October 28, 2022

Branch Retinal Vein Occlusion: A Case Report

Abstract To report a case of a major branch retinal vein occlusion (BRVO) in the superotemporal region with superior macular involvement and a review of its natural history. This is a retrospective case presentation of a 49-year-old African Caribbean female patient presented to Accident and Emergency with unilateral persistent acute history of reduced central vision of left eye for 10 days with no other [...] Read more.
To report a case of a major branch retinal vein occlusion (BRVO) in the superotemporal region with superior macular involvement and a review of its natural history. This is a retrospective case presentation of a 49-year-old African Caribbean female patient presented to Accident and Emergency with unilateral persistent acute history of reduced central vision of left eye for 10 days with no other associated symptoms. Treatment options included using scatter (pan-retinal) laser photocoagulation followed by intravitreal injections as the area of non-perfusion is >5-disc area. It is warranted to understand the risk factors associated with BRVO and to develop appropriate treatment and follow-up plans.
Figures
PreviousNext
Case Report
Open Access February 22, 2022

Untreated Anderson Type II Odontoid Fracture with Severe Delayed Atlanto-Axial Dislocation, Lateral Mass Misleading Signs of Fusion, and Posterior Surgical Approach: A Case Report

Abstract We present a case of untreated type II odontoid fracture, which evolved in severe dislocation 18 months later. Delayed dislocations in untreated type II odontoid fractures are already reported in literature. The singularity of our case is that CT-scan showed signs of fusion in the right C1-C2 articulation, which could have required a more complex surgical procedure to realign the upper cervical [...] Read more.
We present a case of untreated type II odontoid fracture, which evolved in severe dislocation 18 months later. Delayed dislocations in untreated type II odontoid fractures are already reported in literature. The singularity of our case is that CT-scan showed signs of fusion in the right C1-C2 articulation, which could have required a more complex surgical procedure to realign the upper cervical spine. Surprisingly, a CT scan performed in the extension position showed complete mobility of C1 and allowed us to perform a one stage posterior fixation. We want to highline both the importance of treating an Anderson type II fracture to prevent dislocation (acute or delayed), and the possibility to perform a flexion-extension CT scan to project a better surgical plan.
Figures
PreviousNext
Case Report
Open Access June 23, 2021

Cavernous Malformations of Septum Pellucidum and Trigeminal Nerve: A Case Report

Abstract Cerebral cavernous malformations are commonly seen in the cerebral parenchyma and are extremely rare in septum pellucidum, with only few case reports in the literature. Similarly cavernous malformation involving cranial nerves is also rare. We report a case of cavernous malformations involving both septum pellucidum and trigeminal nerve in a 73 years old gentleman, diagnosed with dementia two [...] Read more.
Cerebral cavernous malformations are commonly seen in the cerebral parenchyma and are extremely rare in septum pellucidum, with only few case reports in the literature. Similarly cavernous malformation involving cranial nerves is also rare. We report a case of cavernous malformations involving both septum pellucidum and trigeminal nerve in a 73 years old gentleman, diagnosed with dementia two years back, and presented with history of recurrent falls.
Figures
Figure 1 (c)
Figure 1 (d)
Figure 2 (b)
Figure 2 (c)
Figure 2 (d)
Figure 3 (b)
Figure 3 (c)
Figure 4 (b)
Figure 4 (c)
PreviousNext
PDF Html Xml
Case Report
Open Access July 24, 2025

Atypical Presentation of Lemierre’s Syndrome Masquerading as Gastroenteritis Lemierre’s Syndrome Mimicking Gastroenteritis

Abstract Lemierre’s syndrome (LS) is a rare clinical condition characterized by septic thrombophlebitis of the internal or external jugular vein, usually following an oropharyngeal infection. Here, we present a 20-year-old male patient who developed diarrhea, nausea, and vomiting after receiving clarithromycin for an upper respiratory tract infection. On admission, he had fever, hypotension, and elevation in acute phase reactants (WBC: 20,410/µL, CRP: 197 mg/L). Empirical treatment with ceftriaxone and metronidazole was initiated. Stool and throat cultures were negative. On the second day, abdominal tenderness developed; direct abdominal radiograph showed dilated bowel loops, but toxic megacolon was excluded during follow-up. Thoracic CT revealed septic emboli in the lungs. Due to persistent fever despite ceftriaxone and metronidazole therapy, treatment was escalated to meropenem on the fifth day. On the same day, blood cultures grew Fusobacterium necrophorum, raising suspicion of LS. Doppler ultrasound detected a thrombus in the left external jugular vein. Anticoagulant therapy with low-molecular-weight heparin and clopidogrel was initiated. The fever resolved by the seventh day of full antibiotherapy After three weeks of intravenous therapy, follow-up imaging showed regression of the thrombus. The patient completed a four-week course of antibiotics and anticoagulants and was discharged with full recovery. This case highlights the diagnostic challenge of LS presenting with gastrointestinal symptoms and emphasizes the importance of early blood cultures and imaging. External jugular vein involvement due to F. necrophorum [...] Read more.
Lemierre’s syndrome (LS) is a rare clinical condition characterized by septic thrombophlebitis of the internal or external jugular vein, usually following an oropharyngeal infection. Here, we present a 20-year-old male patient who developed diarrhea, nausea, and vomiting after receiving clarithromycin for an upper respiratory tract infection. On admission, he had fever, hypotension, and elevation in acute phase reactants (WBC: 20,410/µL, CRP: 197 mg/L). Empirical treatment with ceftriaxone and metronidazole was initiated. Stool and throat cultures were negative. On the second day, abdominal tenderness developed; direct abdominal radiograph showed dilated bowel loops, but toxic megacolon was excluded during follow-up. Thoracic CT revealed septic emboli in the lungs. Due to persistent fever despite ceftriaxone and metronidazole therapy, treatment was escalated to meropenem on the fifth day. On the same day, blood cultures grew Fusobacterium necrophorum, raising suspicion of LS. Doppler ultrasound detected a thrombus in the left external jugular vein. Anticoagulant therapy with low-molecular-weight heparin and clopidogrel was initiated. The fever resolved by the seventh day of full antibiotherapy After three weeks of intravenous therapy, follow-up imaging showed regression of the thrombus. The patient completed a four-week course of antibiotics and anticoagulants and was discharged with full recovery. This case highlights the diagnostic challenge of LS presenting with gastrointestinal symptoms and emphasizes the importance of early blood cultures and imaging. External jugular vein involvement due to F. necrophorum is rare and should be considered in patients presenting with septic emboli.
Case Report
Open Access July 12, 2025

Nodal Marginal Zone Lymphoma with IgG and IgM Secretion of Kappa Light Chain: Case Report

Abstract Nodal marginal zone lymphomas are indolent and rare non-Hodgkin lymphomas, most often diagnosed at an advanced stage. Their clinical presentations are typically insidious, which can lead to delayed diagnosis. The concomitant secretion of IgM and IgG immunoglobulins with kappa light chains constitutes an exceptional feature in this type of lymphoma, as illustrated by our case. We report the case of [...] Read more.
Nodal marginal zone lymphomas are indolent and rare non-Hodgkin lymphomas, most often diagnosed at an advanced stage. Their clinical presentations are typically insidious, which can lead to delayed diagnosis. The concomitant secretion of IgM and IgG immunoglobulins with kappa light chains constitutes an exceptional feature in this type of lymphoma, as illustrated by our case. We report the case of a 62-year-old man with a history of treated syphilis and inferior vena cava thrombosis managed with rivaroxaban, who presented with a left inguinal mass evolving over three months, accompanied by fever, night sweats, and weight loss. Clinical examination revealed non-inflammatory left inguinal lymphadenopathy without other abnormalities. Laboratory tests showed non-regenerative anemia, leukopenia, and elevated LDH levels. Protein electrophoresis revealed a monoclonal peak in the gamma region, confirmed by serum immunofixation showing two monoclonal bands of IgG kappa and IgM kappa types. Biopsy of the inguinal lymph node revealed histological and immunohistochemical features consistent with a small B-cell marginal zone lymphoma, staged as IV based on the extension workup. A chemotherapy regimen consisting of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) was initiated, resulting in a partial response after four cycles. The coexpression of IgM and IgG kappa light chains in nodal marginal zone lymphomas, which are already rare, is an unusual finding. This particularity warrants multicenter studies to better assess its diagnostic, prognostic, and therapeutic implications.
Figures
PreviousNext
Case Report
Open Access March 08, 2025

A Case of Severe Pulmonary Aspergillosis Successfully Treated by Isavuconazole

Abstract Isavuconazole (ISCZ) is a novel antifungal agent that is expected to be effective against severe fungal diseases. A case of chronic pulmonary aspergillosis that was refractory to existing agents, such as micafungin, but was successfully treated by ISCZ, is presented.
Isavuconazole (ISCZ) is a novel antifungal agent that is expected to be effective against severe fungal diseases. A case of chronic pulmonary aspergillosis that was refractory to existing agents, such as micafungin, but was successfully treated by ISCZ, is presented.
Figures
PreviousNext
Commentary
Open Access March 08, 2025

Between Ptosis and Mandibular Contraction, there is a Hidden Marcus Gunn Syndrome

Abstract Marcus Gunn syndrome or unilateral trigemino-oculomotor syncinesis is a very rare autosomal dominant genetic disorder characterised by a combination of congenital ptosis and mandibulopalpebral syncinesis during certain mandibular movements. We report a series of two cases of children with Marcus Gunn syndrome. Case 1: A 5-year-old boy with no previous pathological findings presented with [...] Read more.
Marcus Gunn syndrome or unilateral trigemino-oculomotor syncinesis is a very rare autosomal dominant genetic disorder characterised by a combination of congenital ptosis and mandibulopalpebral syncinesis during certain mandibular movements. We report a series of two cases of children with Marcus Gunn syndrome. Case 1: A 5-year-old boy with no previous pathological findings presented with unilateral ptosis of the left upper eyelid at the age of 4 months. His visual acuity was 10/10 in right eye on the right and 5/10 in left eye. Second case: a 7-year-old girl, brought in by her parents for a ptosis of the left eye noted at birth. This is a 7-year-old girl brought in by her parents for ptosis of the left eye, diagnosed at birth. She had no particular pathological antecedents. Her visual acuity was 10/10 in right occlusion and 3/10 in left occlusion. Both children had undergone sectioning of the superior levator muscle with frontal suspension using prolene sutures, with good progression, followed by total optical correction and treatment of the amblyopia.
Figures
PreviousNext
Case Report
Open Access February 18, 2025

Late-Onset Rabies: A Case Report Highlighting the Importance of Prompt Medical Attention

Abstract Rabies is a virus present in more than 150 nations and territories worldwide, but it can be prevented through vaccination. Each year, tens of thousands of people die from rabies, primarily in Asia and Africa, with children under the age of 15 representing 40% of these fatalities. Up to 99% of rabies transmissions to humans occur through dog bites, making dogs the leading cause of rabies-related [...] Read more.
Rabies is a virus present in more than 150 nations and territories worldwide, but it can be prevented through vaccination. Each year, tens of thousands of people die from rabies, primarily in Asia and Africa, with children under the age of 15 representing 40% of these fatalities. Up to 99% of rabies transmissions to humans occur through dog bites, making dogs the leading cause of rabies-related deaths in humans. We present a fatal case of rabies after a 5-month exposure incident. The patient, a 55-year-old Nigerian missionary from Enugu state, Nigeria presented with restlessness, hydrophobia, occasional barking gestures, abdominal discomfort and agitation. His condition was said to have progressively worsened as patients was unable to eat and drink fluids for days. His wife reported that the patient had experienced a bite from a stray dog on his right arm 5 months before presentation, for which no antirabies prophylaxis was given. The patient died on the second day of admission to the hospital (within 7 days of symptom onset).
Case Report
Open Access December 26, 2024

Propranolol induced Raynaud phenomenon and facial edema in a patient with Hyperthyroidism: A case report

Abstract Background: Propranolol is a non-cardio-selective beta-blocker, commonly used in patients with hyperthyroidism to treat the hyperadrenergic symptoms but also for its additional effect of blocking the peripheral conversion of inactive T4 to active T3. However, propranolol has many side effects, one of them being secondary Raynaud phenomenon. Case presentation: S.K., 55 years old was [...] Read more.
Background: Propranolol is a non-cardio-selective beta-blocker, commonly used in patients with hyperthyroidism to treat the hyperadrenergic symptoms but also for its additional effect of blocking the peripheral conversion of inactive T4 to active T3. However, propranolol has many side effects, one of them being secondary Raynaud phenomenon. Case presentation: S.K., 55 years old was hospitalized in the Endocrinology Department as an untreated hyperfunctioning goiter with typical clinical manifestations such as fatigue, anxiety, palpitations, heat intolerance, difficulties in swallowing and breathing. Unimazole 5 mg (2-2-2 tb) and Propranolol 40 mg (¼ -0- ¼ tb) were prescribed. Thirty minutes after taking Propranolol (the dose 40 mg), she had difficulties breathing, was agitated, sweating and had nausea. Her face was hyperemic and edematous and her extremities were getting blue and cold. Her vitals remained stable and her airways were opened, as evaluated from laryngoscopy and CT-scan of the neck. 8 hours later, her clinical manifestations got worse: her facial edema spread in her lips and submandibular region. On both cases, she clinically improved after prednisolone administration. 12 hours after taking propranolol, she showed no more signs of cyanosis or edema. Propranolol was replaced by Nebivolol, with no side effects. Conclusion: Secondary Raynaud phenomenon is a common side effect of beta-blockers and should be taken in consideration in very patient presenting with cold and cyanotic peripherals. In these cases, propranolol should be stopped and replaced. Further studies on beta-blockers side effects in patients with hyperthyroidism should be made.
Figures
PreviousNext
Case Report
Open Access October 12, 2024

Case Report: Unmasking Meigs’ Syndrome and the resolution of persistent Ascites after Oophorectomy in an 18-year-old Female at Cleveland Specialized Clinic Wampewo

Abstract Introduction: Meigs’ Syndrome, characterized by a benign ovarian tumor that leads to ascites and occasionally pleural effusion, is a rare condition that often presents significant diagnostic challenges, particularly in young female patients. This case report highlights an 18-year-old-female with persistent gross ascites and pleural effusion unresponsive to diuretics, paracentesis, and [...] Read more.
Introduction: Meigs’ Syndrome, characterized by a benign ovarian tumor that leads to ascites and occasionally pleural effusion, is a rare condition that often presents significant diagnostic challenges, particularly in young female patients. This case report highlights an 18-year-old-female with persistent gross ascites and pleural effusion unresponsive to diuretics, paracentesis, and thoracentesis. Despite extensive diagnostics evaluations including negative results from several tumor makers, histology and pathology reports, Liver and renal function tests, abdominal CT scans, ECHO, Ecg, Chest X-rays and HBV screening PCR test, the underlying causes of the ascites and pleural effusion remained elusive. The diagnosis was only made following an exploratory laparotomy, which revealed the presence of bilateral benign ovarian tumors. Subsequent bilateral Oophorectomy and Salpingectomy resulted in the complete resolution of the ascites. This case underscores not only the importance of considering ovarian pathology in young females with unexplained ascites but also highlights the critical role of exploratory laparotomy when non-invasive diagnostics fails to provide answers. Conclusion: This case emphasizes the need for a high index of suspicious for Meigs’ Syndrome in young females presenting with persistent ascites and pleural effusion, even when standard diagnostic tests yield negative results. It highlights the potential necessity of surgical intervention when other diagnostic approaches fail to identify the underlying causes. Clinicians should be aware of this condition and consider it in their differential diagnosis to ensure appropriate and effective management
Figures
PreviousNext
Case Report
Open Access September 30, 2024

A complication occurred fourteen days following the laparoscopic correction of pelvic organ prolapse using lateral suspension with mesh

Abstract This case report describes a postoperative complication following laparoscopic lateral suspen-sion with mesh for the treatment of pelvic organ prolapse (POP) in a 67-year-old woman. The pa-tient initially presented with grade III anterior vaginal prolapse and grade IV apical uterine pro-lapse. A laparoscopic lateral suspension procedure was successfully performed, and the patient was discharged on [...] Read more.
This case report describes a postoperative complication following laparoscopic lateral suspen-sion with mesh for the treatment of pelvic organ prolapse (POP) in a 67-year-old woman. The pa-tient initially presented with grade III anterior vaginal prolapse and grade IV apical uterine pro-lapse. A laparoscopic lateral suspension procedure was successfully performed, and the patient was discharged on postoperative day two without complications. However, two weeks later, she experienced pelvic discomfort, and examination revealed a recurrence of the prolapse due to the failure of the right lateral arm of the mesh. The mesh was successfully reattached via a second laparoscopic procedure, and the patient had an uneventful recovery. This case highlights the po-tential for mesh dislocation postoperatively, underscoring the importance of secure mesh attach-ment to prevent recurrence of prolapse.
Editorial
Open Access July 06, 2024

A severe scrub typhus case with erythema multiforme caused by Orientia tsutsugamushi

Abstract Scrub typhus is a common disease caused by Orientia tsutsugamushi in the tropical/ temperate zone. It usually shows the skin lesions, including eschar, but erythema multiforme is rare.
Scrub typhus is a common disease caused by Orientia tsutsugamushi in the tropical/ temperate zone. It usually shows the skin lesions, including eschar, but erythema multiforme is rare.
Figures
PreviousNext
Commentary
Open Access October 28, 2022

Traumatic Hyphaema: A Case Report

Abstract Hyphaema is the presence of blood in the anterior chamber (AC) of the eye and is commonly caused by a blunt ocular trauma. In this case report, we discuss a case of a 29-years-old African man presented to the emergency department with severe right ocular pain and blurry vision following a blunt injury. This is a teaching case report aimed to discuss the management options, potential complications [...] Read more.
Hyphaema is the presence of blood in the anterior chamber (AC) of the eye and is commonly caused by a blunt ocular trauma. In this case report, we discuss a case of a 29-years-old African man presented to the emergency department with severe right ocular pain and blurry vision following a blunt injury. This is a teaching case report aimed to discuss the management options, potential complications and visual prognosis of this particular case.
Figures
PreviousNext
Case Report
Open Access October 28, 2022

Giant Cell Arteritis: A Case Report

Abstract Giant cell arteritis (GCA) with ocular involvement is an emergency condition, and treatment with glucocorticoids should be provided immediately upon clinical suspicion of GCA to prevent potential blindness. In this case report, we discuss a case of a 70-years-old Caucasian male presented to the emergency department with one day sudden onset of double vision. This is a teaching case report aimed to [...] Read more.
Giant cell arteritis (GCA) with ocular involvement is an emergency condition, and treatment with glucocorticoids should be provided immediately upon clinical suspicion of GCA to prevent potential blindness. In this case report, we discuss a case of a 70-years-old Caucasian male presented to the emergency department with one day sudden onset of double vision. This is a teaching case report aimed to discuss the management options, potential complications and visual prognosis of this particular case.
Figures
PreviousNext
Case Report
Open Access September 30, 2022

Complicated Monochorionic-Monoamniotic Twin Pregnancy Associated with COVID-19: A Case Report

Abstract Coronavirus infection (COVID-19) has quickly emerged as a global pandemic leading to critical health complications. The possibility and risk of vertical transmission of this virus is still unclear, particularly as it relates to pregnant women and their fetuses. Regarding scientific data, there is insufficient research focused on COVID-19 infection complicated with hydrops fetalis and intrauterine [...] Read more.
Coronavirus infection (COVID-19) has quickly emerged as a global pandemic leading to critical health complications. The possibility and risk of vertical transmission of this virus is still unclear, particularly as it relates to pregnant women and their fetuses. Regarding scientific data, there is insufficient research focused on COVID-19 infection complicated with hydrops fetalis and intrauterine fetal demise. In this study, we report an intra uterus fetal death due to hydrops fetalis and twin-to-twin transfusion syndrome (TTTS) in monochorionic–monoamniotic (MCMA) twin pregnancy associated with mild COVID-19 infection in a 33-week-pregnant woman.
Figures
PreviousNext
Case Report
Open Access June 28, 2022

A Case Report of Sagittal Sinus Thrombosis and Pulmonary Embolism in an Asymptomatic SARS-CoV-2 Infection

Abstract Background: Vascular thrombotic events such as pulmonary embolisms have been frequently reported in the course of SARS-Cov-2 infection. However, sagittal sinus thrombus is extremely rare, and patients may lack other appealing Covid-19 infection symptoms. Case report: 46-year-old female with past medical history of Hyperlipidemia, Hypertension presented to [...] Read more.
Background: Vascular thrombotic events such as pulmonary embolisms have been frequently reported in the course of SARS-Cov-2 infection. However, sagittal sinus thrombus is extremely rare, and patients may lack other appealing Covid-19 infection symptoms. Case report: 46-year-old female with past medical history of Hyperlipidemia, Hypertension presented to Emergency room with headache, chest pain, vomiting. SARS-CoV-2 IgG Antibodies were reactive. Except for elevated PTT-Lupus Anticoagulant at 50 Sec, Hypercoagulable workup was negative. The MRI venogram findings were consistent with the Dural thrombus of superior sagittal sinus. Patient subsequently developed chest pain, and Computed tomography angiography found pulmonary emboli within segmental branches of the right lower lobe pulmonary artery. Patient was managed in the ICU with Heparin and switched to Coumadin for discharged. Conclusion: The incidence of Cerebral Venous Sinus thrombus (CVST) among Covid-19 patients is inferior to 0.02%. And most of the patients lack typical Covid-19 presentations such as pneumonia. The lack of symptoms may promote the insidious course of pre-thrombotic events that lead to CVST. However more Retrospective studies are necessary to established consistent odd ratios. Due to the higher mortality associated with CVST and the ongoing of Covid-19 pandemic, we recommend a higher level of clinical suspicion.
Figures
PreviousNext
Case Report
Open Access February 04, 2022

May-Thurner Syndrome in Pregnancy: A Case Report

Abstract May-Thurner Syndrome, left iliac vein compression by the right iliac artery, is a congenital permissive lesion that requires an additional insult prior to the onset of symptoms. We present a case of a 31-year-old gravida 1 para 0 at 28.6 weeks who presented to the emergency room with a 2-month history of progressive lower left leg swelling since 21.2 weeks’ gestation. The patient endorsed [...] Read more.
May-Thurner Syndrome, left iliac vein compression by the right iliac artery, is a congenital permissive lesion that requires an additional insult prior to the onset of symptoms. We present a case of a 31-year-old gravida 1 para 0 at 28.6 weeks who presented to the emergency room with a 2-month history of progressive lower left leg swelling since 21.2 weeks’ gestation. The patient endorsed incidence of domestic violence at 17 weeks’ gestation. The patient had a twin sister who was also pregnant and had not experienced these symptoms. Physical exam revealed 3+ pitting edema in the left lower extremity from ankle to groin. There was left calf tenderness with negative Homan’s sign bilaterally. Overall finding on magnetic resonance angiography revealed severe compression of the upper left common iliac vein and lower inferior vena cava by gravid uterus. Conservative management and anticoagulation is instrumental in preventing veno-thromboembolic events in pregnancies complicated by MTS.
Figures
PreviousNext
Case Report
Open Access January 10, 2022

Cardiac Hydatid Cyst: A Case Report

Abstract Although rarely, echinococcosis might present cardiac involvement, with cysts growing inside myocardial structures of arising adjacent to heart. A careful differential diagnosis with other mass formations and rare cardiac tumours is necessary, whenever there is a clinical and radiological suspicion. Imaging studies and serology will establish diagnosis. A multidisciplinary approach is warranted in [...] Read more.
Although rarely, echinococcosis might present cardiac involvement, with cysts growing inside myocardial structures of arising adjacent to heart. A careful differential diagnosis with other mass formations and rare cardiac tumours is necessary, whenever there is a clinical and radiological suspicion. Imaging studies and serology will establish diagnosis. A multidisciplinary approach is warranted in all cases, with surgical intervention being unavoidable in most settings. Patients generally present with chest pain and dyspnoea. Cases need a close follow up of their postoperative course, while being treated appropriately with albendazole (or mebendazole) for prevention of recurrences.
Figures
PreviousNext
Case Report
Open Access November 29, 2021

Mucormycosis and Candida Infections in Patients of COVID-19 Pneumonia: A Systematic Review

Abstract Introduction: The city of Wuhan in China reported the first case of coronavirus, termed as SARS-CoV-2, in December 2019. To date, 187,827,660 cases have been reported to the WHO (3). With current research focusing on potential therapeutic agents for the coronavirus disease and vaccines, there remain major gaps in our understanding of the pathophysiology and clinical course of this viral [...] Read more.
Introduction: The city of Wuhan in China reported the first case of coronavirus, termed as SARS-CoV-2, in December 2019. To date, 187,827,660 cases have been reported to the WHO (3). With current research focusing on potential therapeutic agents for the coronavirus disease and vaccines, there remain major gaps in our understanding of the pathophysiology and clinical course of this viral pneumonia. Secondary infections are one of them. In this systematic review, we analyze the outcomes of two fungal infections in patients of COVID-19, viz. Mucormycosis and candida. Methodology: A systematic review has been done on secondary infections with mucor and candida fungi in patients of COVID-19. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were used. Twenty-three studies were included in the final analysis. Our review included studies from various countries across the globe. The risk of bias was analyzed using the NIH Quality Assessment Tool for Case Series Studies. This study did not require ethical approval as data was obtained from already available databases, and patients were not directly involved. Results: A total of 23 articles were included in the final review and the total number of patients included was 79 Male: female ratio was calculated to be 1.6 and the average age of patients was 52 years (ranging from 24-86 years). Various types of comorbidities were seen in the included patients, the most common being diabetes mellitus. Among the 18 patients in the cohort of mucormycosis, 7 patients died and four studies did not report patient outcomes. Among the 61 patients, 13 patients died and one patient was still ventilated at the time of publication. Conclusion: Secondary infections after COVID-19 are a cause of major concerns. Further studies and case reports are needed to better understand the various other types of secondary infections and also to formulate strategies to prevent these.
Figures
PreviousNext
Systematic Review
Open Access November 22, 2021

COVID-19 and Legionella Co-Infection

Abstract Introduction: Concurrent infections or co-infections in patients diagnosed with Coronavirus Disease-19 (COVID-19) are not uncommon and predict a pejorative prognosis. A co-infection accounts for 1 out of every 5 cases of COVID-19 and increases the likelihood of adverse health outcomes such as mechanical ventilations, ICU admissions, and death. Specifically, Legionella spp. [...] Read more.
Introduction: Concurrent infections or co-infections in patients diagnosed with Coronavirus Disease-19 (COVID-19) are not uncommon and predict a pejorative prognosis. A co-infection accounts for 1 out of every 5 cases of COVID-19 and increases the likelihood of adverse health outcomes such as mechanical ventilations, ICU admissions, and death. Specifically, Legionella spp. co-infection presents additional challenges in COVID-19 patients because of its rarity, similar clinical presentation to SARS-CoV-2, and poorer outcomes without prompt treatment. Cases Presentation: Case 1. A 62-year-old female presented with a 3-day history of subjective fever and worsening shortness of breath. Room air saturation (saO2) was 70% and improved to 100% on noninvasive positive- pressure ventilation (NIPPV). Lung auscultation revealed rales BL. Chest X –Ray (CXR) showed patchy airspace opacities bilaterally (BL), SARS-CoV-2 PCR and urine legionella antigen tests were positive. The diagnosis of hypoxic respiratory failure secondary to COVID-19 and Legionella pneumonia was made. Patient was admitted to intensive care unit (ICU) and managed with decadron, remdesivir, one unit of convalescent plasma for COVID-19 and Azithromycin for Legionella. Patient subsequently developed acute respiratory distress syndrome (ARDS). ARDS protocol was initiated. 13 days after, the patient was compassionately extubated. Case 2. A 41-year-old male presented with 5-day history of fever, worsening shortness of breath, cough and diarrhea. Patient admitted history of ethanol abuse. SaO2 was 88% and improved on oxygen canula. Lung auscultation revealed rhonchi BL. CXR showed extensive left lung consolidation. Urine test for legionella antigen was positive. COVID-19 PCR was negative, but SARS-CoV-2 IgG was reactive. The diagnosis of Legionnaire disease was made. Despite initial treatment with Azithromycin, patient's hypoxia continued to worsen requiring NIPPV, and subsequently mechanical ventilation in the ICU. The adjunction of empiric treatment for COVID-19 with convalescent plasma, remdesivir and steroids improved both clinicals and laboratory findings. Discussion: The cases illustrated the practical challenges of managing COVID-19 and legionella co- infection. Legionella spp and SARS-CoV-2 overlapping incubation periods and similar clinical presentations and complications. In the absence of diagnosis and treatment, legionella pneumonia has an intrinsic mortality rate of up to 80%. As some COVID-19 mitigation strategies, such as the closure of businesses, have enhanced the conditions for Legionella spp proliferation, the incidence of Co-infection with COVID-19 may increase. We recommend clinicians to have high-indexed suspicion of COVID-19 and Legionella co-infection in order to obtain complete work up at patient’s initial presentation.
Figures
PreviousNext
Case Report
Open Access November 12, 2021

A Case Report of Stroke While Driving: Minor Traumas Might be not Minor at all

Abstract Stroke while driving is an uncommon occurrence, but which might have serious medical and legal implications. While still reported casually and with very few systematized studies, sources underscore mainly the neurological picture and risk factors that will lead herein. Car crashes follow as a rule the event of the stroke. We describe the case of a middle-aged patient that had an incomplete loss of [...] Read more.
Stroke while driving is an uncommon occurrence, but which might have serious medical and legal implications. While still reported casually and with very few systematized studies, sources underscore mainly the neurological picture and risk factors that will lead herein. Car crashes follow as a rule the event of the stroke. We describe the case of a middle-aged patient that had an incomplete loss of the car control, with a crash of minor severity and with no external signs of trauma. In spite that the patient underwent successfully a thrombectomy intervention, he presented continuously with refractory hypotension. The clinical picture raised suspicions of an internal blood loss and whole body angiography detected the rupture of the mesenteric artery. This sequence of events (stroke while driving – crash – seatbelt injury – mesenteric rupture) is probably not reported before, but mechanistically an unlucky combination to be kept in mind while dealing with such cases.
Figures
PreviousNext
Case Report
Open Access November 05, 2021

Cerebral Palsy and Heterotaxy Syndrome: A Case Report

Abstract Background: Cerebral palsy is not only a serious neurodevelopmental disease causing significant morbidity in children, but also a traumatic experience leading to psychosocial trauma to the parents/caregivers of the affected children. It is usually caused by prenatal or early post-natal insults to the newborn brain which may be associated with some congenital syndromes like congenital heart [...] Read more.
Background: Cerebral palsy is not only a serious neurodevelopmental disease causing significant morbidity in children, but also a traumatic experience leading to psychosocial trauma to the parents/caregivers of the affected children. It is usually caused by prenatal or early post-natal insults to the newborn brain which may be associated with some congenital syndromes like congenital heart disease with transposition of the viscera but rarely a heterotaxy syndrome, a condition characterized with congenitally abnormal arrangement of the thoracic and abdominal viscera. Method: We present a case report of a 12-month-old boy with neurodevelopmental delay, recurrent episodes of non-mucoid and non-bloody diarhoea, occasional constipation, bilious vomiting, abdominal distension and fever with associated cough and difficulty in breathing. Results: We discuss an unusual presentation of cerebral palsy and heterotaxy syndrome diagnosed clinically with supporting evidence from both laboratory and radiological tests. Cerebral palsy was diagnosed from the history of birth asphyxia, delayed developmental milestone, limb spasticity and low values for all sub-scores of Bayley-III scale. Heterotaxy syndrome was diagnosed from the radiologic evidence of dextrocardia, left-sided stomach, centrally located liver and malrotation of gut with volvulus. We also provide a brief literature review of the incidence and prevalence, causes and risk factors, classification, clinical presentation and associated co-morbidities of heterotaxy syndrome. Conclusion: Diagnosis of heterotaxy syndrome in a child with background cerebral palsy is a great challenge to both physicians and radiologists. This is more so in developing countries due to poor availability of good diagnostic apparatus, therefore, a high index of suspicion is needed. A clear understanding of the clinical features, comprehensive history taking and thorough physical examination are important in making prompt diagnosis. Timely and appropriate imaging is necessary to prevent delays in diagnosis and treatment which lead to poor outcomes.
Figures
PreviousNext
Case Report
Open Access July 27, 2021

An Adolescent Case of Influenza-Related Pulmonary Atelectasis

Abstract A 16-year-old female patient had influenza and was treated by inhalation of an anti-influenza agent. However, two days later, she showed slight dyspnea, and massive atelectasis of the left lung with hypoxia was found. She was admitted to our hospital (Day 0) and started on antibiotics and steroids, but the atelectasis was worsend on Day 3. Therefore, bronchoscopy was performed on Day 5. After the [...] Read more.
A 16-year-old female patient had influenza and was treated by inhalation of an anti-influenza agent. However, two days later, she showed slight dyspnea, and massive atelectasis of the left lung with hypoxia was found. She was admitted to our hospital (Day 0) and started on antibiotics and steroids, but the atelectasis was worsend on Day 3. Therefore, bronchoscopy was performed on Day 5. After the pus in the left bronchus was removed, the atelectasis was significantly improved. Atelectasis after influenza may be a rare, but critical complication, and bronchoscopy should be considered to release the obstructive lesions.
Figures
Figure 1 (c)
Figure 1 (d)
Figure 2 (b)
Figure 2 (c)
PreviousNext
PDF Html Xml
Case Report
Open Access July 27, 2021

Painful and Indurated Hyperchromic Cord of the Arm: Thrombophlebitis of the Cephalic Vein

Abstract We here report a case of an acute cephalic vein thrombophlebitis in a 34-year-old female patient with no known thromboembolic risk factors and no medical history or ongoing treatment. We present the images of her diagnosis, which was made in the presence of a painful and indurated hyperchromic cord of the arm and confirmed by Doppler ultrasound. In the absence of deep extension of the thrombus, [...] Read more.
We here report a case of an acute cephalic vein thrombophlebitis in a 34-year-old female patient with no known thromboembolic risk factors and no medical history or ongoing treatment. We present the images of her diagnosis, which was made in the presence of a painful and indurated hyperchromic cord of the arm and confirmed by Doppler ultrasound. In the absence of deep extension of the thrombus, his management was limited to a symptomatic treatment without anticoagulation and the symptomatology was amended without complication or recurrence.
Figures
PreviousNext
Case Report
Open Access February 22, 2023

Navigating the Pharmaceutical Supply Chain: Key Strategies for Balancing Demand and Supply

Abstract The pharmaceutical industry is fundamental to global healthcare, providing essential medicines that improve health outcomes and quality of life. However, the demand and supply dynamics within this sector are highly complex, shaped by various factors including demographic changes, evolving disease burdens, technological advancements, regulatory challenges, and economic pressures. This manuscript [...] Read more.
The pharmaceutical industry is fundamental to global healthcare, providing essential medicines that improve health outcomes and quality of life. However, the demand and supply dynamics within this sector are highly complex, shaped by various factors including demographic changes, evolving disease burdens, technological advancements, regulatory challenges, and economic pressures. This manuscript explores the intricate relationship between pharmaceutical medicine demand and supply, focusing on key strategies that can help companies effectively navigate these challenges. The demand for pharmaceutical products is driven by several factors, such as population growth, the aging population, the rise of chronic diseases, and the emergence of new health threats. Additionally, healthcare accessibility, affordability, and policy changes significantly impact the consumption of medicines, while innovations in medical technologies and therapies create new treatment needs. On the supply side, pharmaceutical companies face challenges related to manufacturing capacity, raw material availability, distribution logistics, and compliance with ever-evolving global regulatory frameworks. To address these challenges, the manuscript discusses strategic approaches to managing both demand and supply in the pharmaceutical sector. Key strategies include advanced demand forecasting through data analytics, optimizing supply chains for efficiency and resilience, implementing just-in-time inventory models, and investing in flexible manufacturing systems. Furthermore, global collaboration and partnerships, as well as effective risk management practices, are highlighted as essential to ensuring the availability of medicines, particularly in times of crisis or global health emergencies. This manuscript also delves into the role of policy advocacy and regulatory harmonization in stabilizing the pharmaceutical market, ensuring that medicines are accessible to all populations. In conclusion, the pharmaceutical industry must continually adapt to meet the evolving challenges of demand and supply, embracing innovation and collaboration while maintaining a focus on patient access and global healthcare equity. Through strategic planning and adaptive solutions, the pharmaceutical sector can ensure the continuous availability of critical medicines worldwide, meeting both current and future health needs.
Case Report
Open Access November 16, 2022

AI-Driven Automation in Monitoring Post-Operative Complications Across Health Systems

Abstract Artificial intelligence systems have been previously used to predict post-operative complications in small studies and single institutions. Here we developed a robust artificial intelligence model that predicts the risk of having cardiac, pulmonary, thromboembolic, or septic complications after elective, non-cardiac, non-ambulatory surgery. We combined structured and unstructured electronic health [...] Read more.
Artificial intelligence systems have been previously used to predict post-operative complications in small studies and single institutions. Here we developed a robust artificial intelligence model that predicts the risk of having cardiac, pulmonary, thromboembolic, or septic complications after elective, non-cardiac, non-ambulatory surgery. We combined structured and unstructured electronic health record data from 3.5 million surgical encounters from 25 medical centers between 2009 and 2017. Our neural network model predicted postoperative comorbidities 15 to 80 times faster than classical models. As such, our model can be used to assess the risk of having a specific complication postoperatively in a fraction of a second. With our model, we believe clinicians will be able to identify high-risk surgical patients and use their good judgment to mitigate upcoming risks, ultimately improving patient outcomes [1].
Figures
PreviousNext
Case Report
Open Access December 27, 2019

Data Engineering Frameworks for Optimizing Community Health Surveillance Systems

Abstract A Changing World Demands Optimized Health Surveillance Systems – and How Data Engineering Can Help There is a growing urgency to manage the public health and emergency response practices effectively today, in light of complex and emerging health threats. Fortunately, a host of new tools, including big and streaming data sources, methods such as machine learning, new types of hardware like [...] Read more.
A Changing World Demands Optimized Health Surveillance Systems – and How Data Engineering Can Help There is a growing urgency to manage the public health and emergency response practices effectively today, in light of complex and emerging health threats. Fortunately, a host of new tools, including big and streaming data sources, methods such as machine learning, new types of hardware like blockchain or secure enclaves, and means of data storage and retrieval, have emerged. But, with these innovations comes a grand challenge: how to blend with, and adapt them to, the traditional public health practices. The long-in-place infrastructures and protocols to protect and ensure the welfare of communities are in need of change, or at least update, to enhance their marked longevity of impact directly on the health outcomes and community wellbeing they were designed to fortify. It is in this vein that the essay is written and composed. The investigation in this essay is to query what, particularly, might be the aspects and influences of the emerging veritable cornucopia of new data engineering frameworks that are either being developed specifically for health surveillance and wellness, or are available to be co opted from devices and services already thriving in the current market and research milieu. Knowing what these ways may be could well aid in molding their uptake and spread, ensuring their beneficial impacts on those communities who stand to gain the most. The essay is divided into several key segments. After this introduction, section two details the research methods. In the section that follows, the maximum health outcome potentials of these novel frameworks are reviewed. Part four of the essay takes a more critical approach, addressing how the success of these methods may be hindered and future research avenues. Lastly, the concluding information suggests some actions to take to aid best suit the implementation of these ways, and suggests some thoughts for further research after the completion of these inquiriestrand [1].
Figures
PreviousNext
Case Report
Open Access December 27, 2022

The Role of AI Driven Clinical Research in Medical Device Development: A Data Driven Approach to Regulatory Compliance and Quality Assurance

Abstract This essay explores how AI can enhance clinical research and, particularly, its pivotal role in the development of medical devices. A data-driven approach to medical device development that can streamline regulatory compliance and quality assurance is discussed. Methods that generate insights from pre-stage data and utilize it during development are detailed. The effectiveness of this approach in [...] Read more.
This essay explores how AI can enhance clinical research and, particularly, its pivotal role in the development of medical devices. A data-driven approach to medical device development that can streamline regulatory compliance and quality assurance is discussed. Methods that generate insights from pre-stage data and utilize it during development are detailed. The effectiveness of this approach in compliance audits, 510(k) submissions, and quality system audits - reducing time, effort, and risks is analyzed. The findings are illustrated with practical examples and takeaway recommendations. When reading a scientific article, how many times have you judged the quality of the research by looking at the methodology section? Artificial intelligence algorithms can be developed with the most robust and innovative technology, but if they are not properly validated, they will be worthless in the eyes of regulatory authorities. Conversely, outdated and simplistic models can still gain regulatory clearance if robustness is effectively demonstrated. For better or worse, ethics, economics, and robustness are often sacrificed in the constant government struggle to keep up with the technological edge of AI development. The slow crawl of lawmakers is constant in every field. Automating small tasks can save time and reduce risks when playing catch-up with a changing regulatory framework so the rest of the AI development can continue uninhibitedly. This dives into using FDA open data to collaborate with a food and drug law company and develop several bottom-up initiatives that supply knowledge needed for regulatory compliance and quality systems development. Methods that input pre-stage data and output actionable insights as models are provided. By sharing these resources and advice as academic researchers, efficiency in streamlining processes is maximized, thereby letting more time and resources be allocated to the actual development [1].
Figures
PreviousNext
Case Report
Open Access December 27, 2022

Advanced Optical Proximity Correction (OPC) Techniques in Computational Lithography: Addressing the Challenges of Pattern Fidelity and Edge Placement Error

Abstract The complexity of manufacturing photolithography has increased significantly. The increase in the level of integration has driven smaller feature-sized integrated circuits (ICs). The evolution in stepper technologies has been geometric. This has enabled the printing of printed ICs with a 45 nm feature size. Improvement in lithographic technology is moving towards 32 nm. This feature-size roadmap [...] Read more.
The complexity of manufacturing photolithography has increased significantly. The increase in the level of integration has driven smaller feature-sized integrated circuits (ICs). The evolution in stepper technologies has been geometric. This has enabled the printing of printed ICs with a 45 nm feature size. Improvement in lithographic technology is moving towards 32 nm. This feature-size roadmap poses many challenges to semiconductor manufacturing technology. Advanced photomask synthesis, high-NA steppers, and computational lithography are some examples of the solution space. Optical proximity correction (OPC) and model-based optical proximity correction (MBOPC) are subsets of this solution space. OPC has matured significantly and is the de facto solution for manufacturing photomasks up to the 65 nm node. The OPC technique has been further refined as model-based OPC and has been applied to advanced printing technology of 45 nm. The OPC solution for 45 nm technology has limitations of mask rule check (MRC) and manufacturability restrictions. These restrictions are inevitable in OPC and MBOPC solutions because of the limits in lithographic technology. The technology evolution towards 32 nm has equally challenged the non-linear treatment of wafer-level problems in OPC solutions. PBOPC has limitations in reducing the wafer optical proximity error of the granny's issue, edge placement, mask rule check, etc. PBOPC also has limitations in reducing the mask error enhancement factor. With all these challenges, it is still a formidable solution methodology to address the wafer and mask level issues. Such a formidable solution architecture can result in a limited number of PBOPC solutions. This text looks at the performance of advanced PBOPC features on exposure tuning and the effects of higher-order wafer and aerial image effects. This text also discusses the performance of continuous process correction of masks, lenses, and scanners.
Figures
PreviousNext
Case Report
Open Access December 27, 2021

Advancing Healthcare Innovation in 2021: Integrating AI, Digital Health Technologies, and Precision Medicine for Improved Patient Outcomes

Abstract Advances of wearables, sensors, smart devices, and electronic health records have generated patient-oriented longitudinal data sources that are analyzed with advanced analytical tools to generate enormous opportunities to understand patient health conditions and needs, transforming healthcare significantly from conventional paradigms to more patient-specific and preventive approaches. Artificial [...] Read more.
Advances of wearables, sensors, smart devices, and electronic health records have generated patient-oriented longitudinal data sources that are analyzed with advanced analytical tools to generate enormous opportunities to understand patient health conditions and needs, transforming healthcare significantly from conventional paradigms to more patient-specific and preventive approaches. Artificial intelligence (AI) with a machine learning methodology is prominently considered as it is uniquely suitable to derive predictions and recommendations from complex patient datasets. Recent studies have shown that precise data aggregation methods exhibit an important role in the precision and reliability of clinical outcome distribution models. There is an essential need to develop an effective and powerful multifunctional machine learning platform to enable healthcare professionals to comprehend challenging biomedical multifactorial datasets to understand patient-specific scenarios and to make better clinical decisions, potentially leading to the optimist patient outcomes. There is a substantial drive to develop the networking and interoperability of clinical systems, the laboratory, and public health. These steps are delivered in concert with efforts at enabling usefully analytic tools and technologies for making sense of the eruption of overall patient’s information from various sources. However, the full efficiency of this technology can only be eliminated when ethical, legal, and social challenges related to reducing the privacy of healthcare information are successfully absorbed. Public and media are to be informed about the capabilities and limitations of the technologies and the paramount to be balanced is juvenile public healthcare data privacy debate. While this is ongoing, the measures have been progressed from patient data protection abuses for progress to realize the full potential of AI technology for hosting the health system, with benefits for all stakeholders. Any protection program should be based on fairness, transparency, and a full commitment to data privacy. On-going innovative systems that use AI to manage clinical data and analyzes are proposed. These tools can be used by healthcare providers, especially in defining specific scenarios related to biomedical data management and analysis. These platforms ensure that the significant and potentially predictive parameters associated with the diagnosis, treatment, and progression of the disease have been recognized. With the systematic use of these solutions, this work can contribute to the realization of noticeable improvements in the provision of real-time, personalized, and efficient medicine at a reduced cost [1].
Figures
PreviousNext
Case Report
Open Access December 18, 2023

Leveraging AI, ML, and Generative Neural Models to Bridge Gaps in Genetic Therapy Access and Real-Time Resource Allocation

Abstract This paper leverages gene and cell therapy research in diverse disorders ranging from monogenic to infectious diseases to cancer and emerging breakthroughs, where one can harness individual genes or a synthetic gene sequence designed based on a shared molecular pattern in infected cells to better fight various disorders [1]. A pivotal task is to predict the performances of candidate gene therapies [...] Read more.
This paper leverages gene and cell therapy research in diverse disorders ranging from monogenic to infectious diseases to cancer and emerging breakthroughs, where one can harness individual genes or a synthetic gene sequence designed based on a shared molecular pattern in infected cells to better fight various disorders [1]. A pivotal task is to predict the performances of candidate gene therapies to guide clinical translational research using methods such as retrospective bioinformatic analyses. Implementing them to a large-scale gene therapy database reveals that it is feasible to construct and apply well-performing interpretable, supervised learning models [2]. Preliminary evidence of machine learning approaches' statistical significance helps clinicians and biomedical researchers, market participants, and regulatory and economic experts derive relevant, practical applications, thereby enhancing the deployment of gene therapy and genomics to achieve positive, long-term growth for humanity while alleviating the ongoing worldwide economic burden precipitated by prolonged and recurring diseases. Deploying machine learning techniques to accelerate gene and cell therapy drug development and trials shall also mitigate the existing obstacle of limited patient access to emerging, transformative medical innovations such as gene therapy due to skyrocketing prices, which often herald gene therapy products as the world's most expensive medicines [3]. Moreover, in preventing patients from accessing effective, life-saving genetic medicines, there commonly exists a multidimensional access gap encompassing the availability, affordability, and quality or acceptability of these clinical treatments. The ensuing substantial gap has repeatedly been documented and mainly emanates from differential institutional and socio-political choices around resource allocation at international and domestic levels [4]. Particularly, it is also due to the stringent licensure and regulatory approval processes underpinned by insufficient evidence for novel safety and clinical efficacy profiles for genetic therapies in multiple micro-local diagnoses and subpopulations. We believe that a higher likelihood of gene therapy adoption shall result when the clinical evidence path contains adequate representation from the most diverse and relevant patient populations [5].
Figures
PreviousNext
Case Report

Query parameters

Keyword:  Case Report

View options

Citations of

Views of

Downloads of