International Journal of Medical and Pharmaceutical Case Reports

Tetanus Adverse Event after VMMC for HIV Prevention in a Pre-circumcision Tetanus Immunized Male from Uganda: A Case Report

E. Lugada — 2021-02-12

Background: Although tetanus is a life-threatening disease, its occurrence is rare in the post-vaccination era, especially in developed countries. The US President’s Emergency Plan for AIDS Relief (PEPFAR) has supported scale up of Voluntary Medical Male Circumcision (VMMC) to reduce female-to-male HIV transmission in countries with a high prevalence of HIV. VMMC is generally safe, with less than 2% of clients experiencing moderate to severe adverse events. However, in most sub-Saharan countries with a high HIV prevalence and low male circumcision coverage, tetanus vaccination coverage among infants, especially male, remains suboptimal. This is a case report of a 45-year-old male who developed tetanus after pre-circumcision tetanus vaccination in a VMMC HIV/AIDS prevention intervention program in Uganda.

The Case: A healthy 45-year-old male presented for voluntary circumcision at field VMMC centre. He received a standard pre-circumcision tetanus immunization and had no incident immediate post-operative. 14 days later he reported at a local health facility with a history of difficulty in swallowing, difficulty in breathing, loss of speech and was ultimately diagnosed with tetanus after 2 days. The patient was immediately admitted in intensive care unit, treated, improved and eventually discharged.

Conclusions: This report highlights the possibility of tetanus vaccine failure and importance of prompt diagnosis and treatment of tetanus. It also highlights the need for institution of aggressive quality improvement and pre-circumcision tetanus vaccination procedures. Post vaccination surveillance for possible vaccine failure is recommended in addition to a review of existing national immunization medical practice and policies.

Multiple Inflammatory Fibrous Hyperplasia in Upper Lip: A Case Report

Joyce K. N. Azevedo — 2021-02-24

Aims: This study aimed to report a case of multiple inflammatory fibrous hyperplasia in the upper lip, resulting from the association of lip sucking habit and the use of orthodontic appliance, treated with high-powered laser.

Presentation of Case: A 42 years-old male patient, anxious, presented with five lesions in upper lip in close contact with dental appliance. Also, he had a habit of sucking his lip. After the removal of the appliance, it was performed a surgery using a diode laser (Thera Lase Surgery λ=808 nm, P=2.5 W).

Discussion: The removal of the traumatic etiological agent is essential for the treatment of proliferative lesions, such as hyperplasias. After removal, if there is no complete regression of a small hyperplasia, surgical removal will be necessary. Diode surgical laser is a good alternative, due its advantages.

Conclusion: It is very important to advise patients with harmful habits, as lip sucking, that with the persistence of the habit, new lesions will arise again. Monitoring psychological factors is also essential.

New Kid on the Block: A First Look at the Clinical Use of Pitolisant for Narcolepsy

Andrea Cuamatzi Castelan Castelan — 2021-02-01

Aims: Highlight pitolisant as an effective treatment for narcolepsy.

Case Report: We describe two patients treated with pitolisant. Patient A showed decreased daytime sleepiness and improved social functioning. Patient B struggled to find a dose that kept side effects at a minimum.

Discussion: This orphan drug has a unique mechanism of action, that combined with dosing flexibility allows for a treatment option that can better attend to individual differences in patient needs.

Conclusion: The use of pitolisant presents some benefits and challenges, nonetheless offering a promising treatment for narcolepsy.

Acute Apical Abscess Treatment with an Iranian Folk Remedy: A Case Report

Selda Ghahramani — 2021-03-04

Background: There are only a few treatment approaches for periapical abscess as a prevalent complication and as the most common type of dental abscess. Drainage and/or antibiotic therapy is the first step to treat this infection, depending on its severity and symptoms.

Case Presentation: Amoxicillin/clavulanate (TID for 3 days), clindamycin (QID for 3 days), and a single local dose of an Iranian home remedy called metmeto, a mixture of toasted flour and ghee covered with a sterile piece of cotton fabric-, were respectively prescribed, for a 32-year-old male patient with a spreading periapical abscess. The first two antibiotics were not able to mitigate the symptoms (pain, inflammation,infection, etc.), while the abscess disappeared remarkably the morning after using a single dose of metmeto “as a dressing” for 6 hours. To eliminate the possible riskof recurrence, the patient underwent an endodontic retreatment after 2 weeks.

Conclusion: Some folk home remedies such as metmeto can be considered for treatment of dental problemsas noninvasive and safe choices. Further studies are necessary to conclude a causal association.