International Journal of Clinical Research
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Colocolic Hepatic Angle Intussusception due to Ascending Colon Giant Lipoma: A Case Report and a Review of Literature
Get PDFBackground: Colon lipomas are rare benign lesions taking place mostly in the right colon with a female predomination. They are mainly submucosal and symptomatic when becoming more than 2 cm in size.
Case Report: This is the case of a 43 years old female patient presenting with bowel obstruction associated with colocolic intussusception due to a giant colonic lipoma. A segmental partial colectomy has been performed followed by a favorable postoperative course.
Conclusion: Giant colon lipomas presenting with intussusception is a rare finding. Surgery is the major treatment but, unfortunately, there is no clear consensus on the recommended procedure in the literature
Barriers and Facilitators for Setting Upper Limb Reconstruction Services.
Get PDFMicrosurgical limb reconstruction is a complex surgical technique that aims to preserve an extremity that has been affected by acquired conditions, such as trauma or cancer. It involves the transfer of free tissue flaps, which are micro-surgically revascularized in the recipient site to reconstruct a variety of defects. This can be not only technically demanding for the surgeon leading this type of procedure but also requires a well-set-up perioperative team and service. This article aims to present the experience of the first author setting up a new microsurgical service.
A Case of HLA-B51 Positive Mucocutaneous Variant of Behçet’s Disease in a Young Indian Male: A Case Report
Get PDFBackground: Behçet’s disease is a rare, systemic inflammatory disorder of unknown etiology affecting the mucocutaneous, vascular, skeletal, ophthalmic, gastrointestinal, and neurological systems. While the exact etiopathogenesis of Behçet’s disease is yet to be established, numerous studies have supported a strong possibility of underlying genetic factors. It is comparatively more common in Turkey, the Middle East, and Mediterranean regions, and only a few cases have been reported from the Indian subcontinent so far. Although several immunological and genetic associations have been suggested, the diagnosis of Behçet’s disease remains primarily clinical and of exclusion.
Case Report: In this report, we describe the case of a 22-year-old Indian male who developed multiple aphthous ulcers over his tonsillar pillars and pharyngeal wall following an episode of acute tonsillopharyngitis. Over the course of the next few days, he reported the presence of a genital ulcer and papulopustular lesions over his chest, back and face, eventually prompting a diagnosis of Behçet’s disease. He was treated with oral colchicine and was found to be in remission during a six-week follow-up.
Conclusion: This case emphasizes the importance of awareness regarding Behçet’s disease among clinicians in India and warrants further studies on the epidemiology, immunopathogenesis, and management protocols of Behçet’s disease, especially in this country for a better understanding of its prevalence, manifestations, and disease course
Hereditary Multiple Osteochondroma with Incomplete Penetrance in a Lebanese Family: A Case Report
Get PDFBackground: Hereditary multiple osteochondroma (HMO) is a rare autosomal dominant disease with high penetrance reaching 95 to 100%. It manifests during childhood in most of the times. The spectrum of the disease is wide. It is classified into 2 types depending on the number of cases and the penetrance in the same generation. The most feared complication of this disease is the malignant transformation. Establishing a screening protocol requires the identification of the true prevalence and penetrance of the disease.
Case Report: A 17-year-old girl presented with multiple painful lesions in the lower extremities. Physical examination of the patient and her siblings allowed the diagnosis of HMO with incomplete penetrance, and the construction of a pedigree of the family. Surgical treatment was sufficient to control the patient’s symptoms.
Conclusion: Being the first case in Lebanon, this report adds more awareness about this rare disease. By increasing awareness, this report can have an impact on the transmission and the number of affected cases in the country. Furthermore, these data, when added to the available evidence worldwide, can be used in the determination of true penetrance of the disease, and the creation of accurate classification and screening protocol
Human Immunodeficiency Virus type 1 Drug Resistance Mutations in Patients Failing Antiretroviral Therapy in Lebanon from 2009 to 2013
Get PDFBackground: Antiretroviral drug resistance remains a significant problem in the clinical management of patients infected with the Human Immunodeficiency Virus type-1.
Aim: This study investigates and reports data on the molecular characterization of HIV-1 isolates from patients who are in a state of therapy failure.
Methods: This is a retrospective study conducted on 65 patients in therapy failure. Inclusion criteria included patients diagnosed as being in therapy failure between the years 2009 and 2013. We defined ART failure as either a failure to achieve viral suppression or a failure to detect viral loads below 500 copies/mL after virological suppression in at least two plasma samples. We used the published WHO list for surveillance of transmitted resistance and the Stanford HIV Drug Resistance Database to identify drug resistance mutations.
Results: 65% of the participants had at least one drug resistance mutation (DRM). 12% of the population sampled had resistance to only one ART class, 32% presented with resistance to two classes of antiretroviral drugs, and 20% had resistance to all three classes of drugs. The prevalence of nucleoside transcriptase inhibitor (NRTI) mutations was 55%, the most common DRM being M184V. The prevalence of non-nucleoside reverse transcriptase inhibitor (NNRTI) mutations was 58%, with the most common mutation being the K103N mutation. The prevalence of protease inhibitors drug resistance mutations was 23%, with mutations V82A and I47V being present in 10% of the study population.
Conclusion: Our study is the first molecular characterization of DRM emergence in HIV-1 strains from patients failing antiretroviral therapy in Lebanon. Continuous monitoring of resistance patterns for HIV in the country is necessary to tackle the emergent drug resistance
Coronary Artery Disease and its Psychosocial Risk Factors: A Narrative Review
Get PDFObjective: Whenever the subject of coronary artery disease (CAD) and myocardial infarctions is discussed, the focus is usually shifted towards biological factors such as smoking, diabetes, or obesity; consequently, the management aims at addressing these factors. This paper approaches the subject from a psychosocial perspective and highlights the importance of these risk factors and their inclusion in CAD screening.
Background: CAD is one of the most common diseases worldwide and also one of the leading causes of death in multiple countries. Although we have a proper understanding of its pathogenesis and risk factors, we sometimes tend to overlook the psychological factors that affect the patient both pre- and post-diagnosis. The purpose of this paper is to present these underestimated factors and convey their importance.
Methods: To accomplish this, an extensive review of the literature was done using PubMed and Google Scholar, and articles were chosen based on the specified keywords. The references of these articles were also screened to identify more related studies and clinical trials.
Discussion: This paper is composed of multiple subsections that go over the epidemiology of the disease as well as its pathogenesis and known biological risk factors, before delving into the psychosocial aspects associated with CAD including the effects of depression, anxiety, social support, and sex differences on a patient’s prognosis.
Conclusion: CAD is a disease for which the management is through multifactorial interventions. Although the pathogenesis is well understood, there is a clear gap when it comes to appreciating the patients’ mental health when living with this diagnosis. Additionally, it has been shown that there is an increase in morbidity and mortality in the patients struggling on a psychosocial level, thus these factors should be included in the screening process
Presumed Ocular Histoplasmosis Syndrome in the Middle East: A Case Report
Get PDFBackground:Presumed ocular histoplasmosis syndrome (POHS) occurs secondary to infection with Histoplasma Capsulatum (HC), which is an endemic organism in many tropical areas, especially in the United States. However, it has never been proven that HC directly causes POHS, hence the name presumed ocular histoplasmosis syndrome. Patients are usually asymptomatic, but some may present with blurring of central vision.
Case Report:A 15-year-old girl, previously healthy, presented with a 2-months history of visual disturbance of the right eye. On physical examination, the visual acuity of the left eye was 20/20 while the right eye was only seeing “hand motion”. Fundus exam of the right eye showed juxtapapillary infiltrates with serous macular detachment, and small retinal and choroidal lesions, while the left eye showed only some small retinal and choroidal lesions. Fluorescein angiography of both eyes showed evidence of chorioretinitis with probable choroidal neovascularization (CNV). The diagnosis of POHS was made and the patient was treated with bevacizumab injections. Follow-up was done clinically and through spectral domain optical coherence tomography (SD-OCT) and showed marked improvement at the level of the macular thickness and CNV.
Conclusion: Diagnosing POHS can be quite challenging, especially in cases coming from non-endemic areas. Our case emphasizes the importance of considering POHS in patients presenting with visual disturbance, even in these non-endemic areas, through a careful clinical evaluation and appropriate imaging modalities
Multisystem Inflammatory Syndrome due to COVID-19 in a Newborn Patient: A Case Report from Lebanon
Get PDFBackground: Multisystem inflammatory syndrome in children (MIS-C) is a hyperinflammatory condition associated with COVID-19 in children, with features that are similar to Kawasaki disease and toxic shock syndrome. Several reports are emerging from all over the world on this condition that is associated with increased fatality rate.
Case Report: In this article, we present one of the first reports of a newborn diagnosed with MIS-C attributed to COVID-19. In addition, we discuss the diagnostic criteria and the possible pathophysiology.
Conclusion: Although COVID-19 does not frequently affect newborns, when it does, it may lead to devastating complications, such as MIS-C. As a result, providers should be on the lookout for any symptoms that can indicate a complicated infection. Further studies are still needed to develop a better understanding of the pathophysiology of this disease and establish appropriate therapeutic guidelines
Recurrent Diverticulitis in a Neutropenic Patient: A Case Report
Get PDFBackground: Neutropenic patients are at an increased risk of infections. These infections can originate from several sites including the respiratory, urinary or gastrointestinal systems. Diverticulitis is one such infection, that carries a high morbidity and mortality risk in such patients. The management remains controversial and involves deciding between a conservative medical approach and surgical intervention. Regardless, these patients should be closely monitored due to a high risk of developing complications including septic shock.
Case Report: In this article, we discuss the case of a patient with acute myeloid leukemia (AML) presenting with neutropenic fever and found to have a recurrent episode of diverticulitis. The patient was quickly managed with medical therapy, and surgery was therefore deferred.
Conclusion: In conclusion, physicians should always maintain diverticulitis as a differential diagnosis in neutropenic patients who present with abdominal pain, especially in those who have had a previous episode. This allows for rapid and more efficient management
Incidental Appendiceal Diverticulosis Associated with Acute Appendicitis: A Case Report and Review of Literature
Get PDFBackground: Appendiceal diverticulum (AD) is a rare surgical finding. This entity is classified as either congenital or acquired, with a reported incidence of 0.014% and 0.2-1.7%, respectively. AD can often be associated with acute or chronic appendicitis. Clinically, AD must be identified before any surgical procedure as its concomitant presence with acute or chronic appendicitis increases the risk of perforation and may be associated with underlying neoplasia such as low-grade mucinous adenoma. We hereby report a case of incidental appendiceal diverticulosis associated with acute appendicitis in an attempt to increase the physicians’ perception, knowledge, and awareness of this rare medical condition.
Case Presentation: We report a 40-year-old male patient, with no relevant family history, who presented to the Emergency Department after four days of vague and moderate epigastric pain and nausea. The physical examination upon presentation was unremarkable. Computed Tomography (CT) scan was done and was suggestive of an inflamed appendix. The patient underwent an urgent laparoscopic appendectomy. The removed appendix was inflamed and grossly abnormal with multiple diverticulae. The patient had a smooth recovery.
Conclusion: Diverticulosis of the appendix is a rare clinical entity and, as in our case, is often diagnosed during or after appendectomy. When associated with acute appendicitis, it may be suspected preoperatively with the appropriate imaging technique. This is of paramount importance as it can rapidly progress to perforation and/or lead to a higher mortality rate