International Journal of Clinical Research
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Complicated Appendicitis in a Pediatric Patient with SARS-CoV-2 Infection: A Case Report
Get PDFBackground: Appendicitis is a common acute surgical condition in the pediatric population. With the rise of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), many efforts have been made to understand the association of this virus with other disease entities. However, the association of acute appendicitis and SARS-CoV-2 infection in children has not been well established. Few cases have been described in the literature with different hypotheses attempting to link the two entities. This highlights the need to be aware of such possible associations to achieve proper diagnosis and management and avoid complications.
Case Report: In this report, we describe the case of a seven-year-old boy who presented to our institution with uncomplicated appendicitis. The child was found to have SARS-CoV-2 infection on routine hospital testing. His condition deteriorated within hours, and he progressed from uncomplicated to complicated appendicitis. The child underwent surgical management followed by further medical management until he recovered. He had a smooth recovery and experienced no complications.
Conclusion: There is still no definite explanation concerning the effect of COVID-19 on appendicitis. Clinicians should be aware of the possibility of acute appendicitis in the context of pediatric SARS-CoV-2 infection and anticipate a possible progression of the disease course triggered by the virus
Patient Characteristics, Clinical Courses, Fatality Rates, Predictors of Severe Diseases, and Deaths in Intensive Care Unit: A Lebanese Retrospective Cohort of COVID-19 Patients
No full textBackground: The novel coronavirus 2019 (COVID-19) pandemic is straining Intensive Care Units’ (ICU) capacities worldwide. It was demonstrated that the ICU mortality rate from Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is higher than from other viral pneumonia.
Aim: The goal of this research is to determine ICU COVID-19 patient characteristics, clinical courses, fatality rates, as well as risk factors for severe diseases and mortality in Lebanon, a country known to suffer from a deficiency in ICU capacity as well as a high COVID-19 infection rate.
Methods: We conducted a retrospective monocentric cohort study that enrolled COVID-19 patients admitted to the ICU at Baabda Governmental Hospital, between January 1, 2021, and March 31, 2021. Demographics, clinical, radiological, laboratory characteristics, treatments, and medical and infectious complications were gathered and compared between survivor and non-survivor groups, as well as between mild/moderate and severe/septic groups. Parameters were then entered in a multivariate regression analysis to identify predictors of death and disease severity.
Results: A total of 191 patients were included in our study. The fatality rate reached 35.6% in our population with a median ICU length of stay of 8 days. Non-survivors were more likely older (p<0.001), active smokers (p=0.008), and in severe or septic stage at admission (p<0.001). Elevated levels of neutrophils (p=0.013), ferritin (p=0.002), lactate dehydrogenase (p<0.001), and C-reactive protein (p=0.008) were more frequently encountered in non-survivors. The latter were more commonly intubated (p<0.001) and suffered from complications such as ventilator-associated pneumonia, sepsis, cytokine storm, myocardial infarction, and pulmonary embolism (p<0.001). Multivariate analysis showed that older age, intubation, and severe/ septic stage at admission were associated with an increased risk of death.
Conclusion: Older COVID-19 patients who were intubated, and those who were in severe or septic stages at ICU admissio
Hemothorax Occurring After Central Venous Catheter Removal: A Case Report
Get PDFBackground: Central venous catheterizations are used frequently in critical care unit. The procedure is associated with various complications ranging from mechanical ones during insertion and the possibility of vessel laceration and dissection to infections, not to forget haemothorax and pneumothorax that may require chest tube insertion. However, some complications may also origin from its removal.
Case Report: This is a case of a 72-year-old patient with multiple comorbidities admitted to the Intensive Care Unit (ICU) for respiratory distress. A central line was inserted because a peripheral line was hard to establish, and as a consequence of catheter removal, he had a massive right-sided hemothorax.
Conclusion: Central venous line removal could cause fatal complications such as massive hemothorax that should be looked for. We emphasize monitoring of patients after catheter removal because the uncommon nature of this complication can lead to diagnosis delay and even misdiagnosis
Cardiac Sarcoidosis Managed by Biventricular Pacing: A Case Report
Get PDFBackground: Cardiac sarcoidosis (CS) is a rare pathology that affects the middle-aged population. Its diagnosis, as well as its treatment, can be quite challenging, especially dealing with device management. We hereby discuss a case of CS, managed by a biventricular pacemaker in a 43-year-old man.
Case Report: A 43-year-old male presented to the emergency department with a 15-day history of chronic cough and worsening dyspnea. On examination, he was found to be bradycardic in the context of a third-degree heart block on ECG as well as bilateral hilar lymphadenopathy on chest radiography. Based on these findings, cardiac sarcoidosis was suspected. A temporary right internal jugular transvenous pacemaker was implanted in the right ventricle and empiric corticosteroid management was commenced. Lung tissue biopsies were obtained via bronchoscopy and were positive for granulomas consistent with a diagnosis of sarcoidosis. Even though the patient showed a partial positive response to corticosteroid treatment, he required a permanent pacemaker. A dual-chamber implantable cardioverter-defibrillator (ICD) was implanted and the patient was discharged on prednisone. His follow-up plan consisted of serial echocardiography and consideration of a new coronary sinus lead in the event of left ventricular dysfunction in the future.
Conclusion: Cardiac rhythm management in the context of CS is often difficult, with decisions that need to be made between a pacemaker, a defibrillator, or a cardiac resynchronization device. The idea that biventricular pacing has a preventative role against heart failure in patients with normal left ventricular ejection fraction and CS deserves more attention and discussion.
A Special Technique to Remove a Jammed Cephalic Screw from an Intramedullary Nail: A Case Report
Get PDFBackground: The complexity of implant removal is a well-known problem in the field of orthopedics. It is encountered mainly during the removal of plates and screws and understood by the phenomenon of seizing or cold-welding, formerly known in mechanics. In this case study, we describe a complex experience during a gamma nail removal in a 21-year-old male patient, explained by the same phenomenon of seizing or cold-welding. The case is rather unusual and rare, with no similar reports in the literature, and required a special technique of extraction.
Case Report: A 21-year-old male presented to our clinic with a 5-months history of right groin pain radiating to the anterior thigh. The patient was a victim of a car accident three years ago that resulted in right femoral neck and shaft fractures, which were managed by open reduction and internal fixation by a long gamma nail with distal locking. After proper examination, the team decided to remove the implant. There was difficulty loosening the cephalic screw as it was welded to the nail. For this reason, we opted for a technique that involved making a transverse slit at the level of the anterior part of the nail which is in contact with the cephalic screw. It was followed by a hammer blow at the level of the cephalic screw, allowing it to loosen and thus allowing the screws along the femoral nail to be removed successfully.
Conclusion: Our report describes a rare case of a cephalic screw cold-welded/seized into the intramedullary nail, which can be an unexpected and serious complication during intramedullary nail removal. However, our technique described in this case can be an effective way to treat such a complication
Vitamin D Deficiency Mimicking Pseudohypoparathyroidism Type II in an Adolescent Boy: A Case Report
Get PDFBackground: Vitamin D deficiency in children is common and usually characterized by hypocalcemia, hypophosphatemia, and elevated serum parathyroid hormone level. However, vitamin D deficiency can be associated with parathyroid hormone resistance in the kidneys which may cause hyperphosphatemia instead, mimicking thus pseudohypoparathyroidism type II. The exact pathogenesis for parathyroid hormone resistance remains unclear, and the distinction between the two conditions remains difficult. We describe the case of an adolescent who presented with seizures and was found to have biochemical features consistent with pseudohypoparathyroidism, likely related to vitamin D deficiency.
Case Report: A 13-year-old previously healthy adolescent presented with seizures. He experienced back pain during the previous month prior to the presentation. He did not have features of Albright hereditary osteodystrophy. His laboratory studies were significant for hypocalcemia, hyperphosphatemia, elevated serum alkaline phosphatase level, elevated parathyroid hormone level, and a deficient vitamin D level. Magnetic resonance imaging of the spine revealed multiple compression fractures. The child was treated with intravenous calcium and vitamin D administration with rapid improvement and his seizures resolved.
Conclusion: Hypocalcemia from vitamin D deficiency can mimic pseudohypoparathyroidism type II. The principles of treatment for hypocalcemia in both conditions are similar and patients require timely intervention with close follow-up to ensure the resolution of symptoms. Patients with resolution of symptoms after adequate treatment may not require further evaluation for other types of pseudohypoparathyroidism
Clinical Correlation Between Pre and Post ERCP Laboratory Values
Get PDF Background: Endoscopic retrograde cholangiopancreatography (ERCP) has evolved from a diagnostic modality to a primarily therapeutic procedure for pancreatic as well as biliary disorders. However, several complications were described post-procedure such as pancreatitis, perforation, cholangitis, post-sphincterotomy bleeding, etc. Data concerning variation in laboratory values before and after ERCP and its clinical significance with respect to endoscopic findings and possible complications is lacking in the literature.
Aim: To analyze the clinical significance of laboratory values in patients before and after ERCP.
Methods: From a total of 723 patients, 363 with different sets of findings on ERCP were eligible to be included in the study and were divided into 8 different groups. Serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), Gamma-glutamyl transferase (GGT), Alkaline phosphatase (ALKP), bilirubin, amylase, lipase, c-reactive protein (CRP), white blood count (WBC), neutrophil, lymphocyte, monocyte, eosinophils, basophils, platelets counts and creatinine were determined preoperatively as well as postoperatively in these patients.
Results: AST and direct bilirubin showed a significant difference in all patients between pre and post-ERCP (p-value<0.01 and p-value<0.05, respectively). Liver tests were significantly higher in the malignant obstruction group than in the bile duct stones group (P <0.05) and decrease more significantly (P <0.05) after the procedure. A significant increase in lipase (p-value<0.05) among all groups was found, and interestingly, the lymphocytic count showed a significant decrease (p-value<0.01).
Conclusion: In conclusion, (1) ERCP significantly decreases AST, direct bilirubin, lymphocytes, and monocytes count post procedure among all stratified groups of obstructive etiology thus proving its therapeutic value for biliary system obstructions. (2) Higher baseline disturbances in laboratory values at T0, especially in liver function tests such as ALT, AST, GGT, and ALKP as well as a bigger decrease in lymphocyte count at T1 are noted to be linked with malignant obstructions (tumor group), rather than benign obstructions (stone, sludge, stone+ sludge, and stricture). (3) Finally, stone and stricture groups are at the highest risk of post-ERCP pancreatitis owing to those groups having the highest pancreatic enzyme levels post ERCP, and thus should be the best candidates for a pre-ERCP pharmacologic prophylaxis (such as diclofenac, etc) and post ERCP close monitoring
Therapeutic Approaches in Youth Psychiatry: The Art of Balancing Between ‘Do not Harm’ and ‘Best Possible Care’: An Editorial
Get PDFAdolescence is one of the most critical periods of an individual’s life where the bulk of neurological, biological, and social development occur. During this stage, adolescents are forced to get out of their comfort zones such as home or school, to experience true variability and independence in their new environments. While this transition may be easy for some, it can be very cumbersome for others leading to the emergence of maladaptive behaviors and the manifestation and intensification of underlying disorders.
Hepatic Vein Thrombosis in a COVID-19 Patient with Hereditary Thrombophilia: A Case Report
Get PDFBackground: COVID-19 is an infection secondary to the novel SARS-COV-2 virus with a well-established increased risk for thrombotic events. However, the interaction between COVID-19 and other patient-specific hereditary or acquired thrombophilias remains a poorly explored area.
Case Presentation: We herein report a case of a 23-year-old Caucasian female with known risk factors for coagulopathy (smoking, oral contraceptives, anti-phospholipid (aPL) antibodies, heterozygous Factor V Leiden mutation, and homozygous methylenetetrahydrofolate reductase (MTHFR) mutation) who developed a Budd-Chiari syndrome after testing positive for COVID-19. To our knowledge, this is the first report of a case of splanchnic vein thrombosis in a COVID-19 patient with the above risk factors.
Conclusion: Such a presentation underscores the additional increased thrombotic risk attributed to COVID-19 infections in the setting of underlying hereditary or acquired thrombophilias
Buccal Mucosal Metastasis of Renal Cell Carcinoma: A Case Report and Review of Literature
Get PDFBackground: Intraoral metastasis of RCCs are unusual, especially when it comes to buccal mucosal metastases, which are extremely rare, accounting for less than 1% of metastatic RCC. The buccal mucosal metastatic lesion from RCC poses a challenge in diagnosis and treatment. Due to their scarcity, there doesn’t exist any literature primarily concentrating on them.
Case Report: In this work, we describe the case of a 58-year-old man affected and operated on for renal cell cancer, brought to our care for the appearance of a buccal mucosal ulcer. Pathological analysis revealed a metastasis compatible with clear-cell carcinoma. Its renal origin was confirmed by immunohistochemical technique. The patient was evaluated and managed after post multidisciplinary tumor board discussion with palliative radiotherapy for local disease.
Conclusion: There should be no hurry in starting treatment for a buccal mucosal lesion, and it should be histopathologically evaluated keeping in mind a differential of metastasis from the distant primary. Multidisciplinary tumor board discussion plays an important role in such rare scenarios