Open Access Case Study

Hyperesthesia Secondary to Centipede Bite- A Case Report

Huldah I. Nwokeukwu, Ugochukwu Onyeonoro, Chidinma Amuzie, Debra Inya-agha, Igbani Uchendu

International Journal of Medical and Pharmaceutical Case Reports, Page 22-26
DOI: 10.9734//IJMPCR/2015/13284

Background: Centipede bite is a major public health problem among rural communities of Nigeria. This can be attributed to thick bushes around residential homes and humid weather peculiar to these regions, which favor the survival of this group of arthropods. However, presentations of cases to hospitals are rare.
Objective: To report a case of hyperesthesia secondary to centipede bite in Nigeria.
Methods: The case note of the patient was retrieved and relevant data were extracted and summarized.
Results: An 80 year old retired civil servant, now a farmer, presented to the outpatient clinic, with a history of severe pains following centipede bite two weeks prior to presentation. Pains were so severe that he could not stand without support. He was later diagnosed with avascular Necrosis of right head of femur and presently on physiotherapy regimen.

Open Access Case Study

Reactive Hypoglycemia Associated with Mild Adrenal Dysfunction, So-called Adrenal Fatigue

Hiroshi Yamaguchi, Anna Kobayashi, Atsuhisa Shirakami, Naoko Hashimoto

International Journal of Medical and Pharmaceutical Case Reports, Page 27-35
DOI: 10.9734/IJMPCR/2015/12994

We here described a case of a 38-year-old woman who was referred to our hospital for general malaise, slight fever, and palpitations after a meal for the past several years. She became hungry at approximately 3:00 or 4:00 p.m. every day, and simultaneously felt the urge to eat something sweet. During a five-hour 75g OGTT test, her blood glucose level dropped sharply twice (79 mg/dL at 60 min and 76 mg/dL at 300 min) due to the excessive secretion of insulin (29.9μU/mL at 30 min and 43.1μU/mL at 120 min). She was diagnosed with a mild adrenal insufficiency due to a decrease in her serum cortisol value in the early morning and an insufficient response to the rapid ACTH stress test. We speculated that the reactive hypoglycemic symptoms observed in this patient may have developed due to the inadequate secretion of serum cortisol as a counter-regulation against insulin, which resulted in a relative excess of serum insulin after a meal. Her clinical manifestations and laboratory data were similar to a state called adrenal fatigue. Since the presentation of mild adrenal insufficiency is often insidious and difficult to recognize, careful examinations are required to prevent a delay in diagnosing this condition. We here described an educative case of reactive hypoglycemia associated with so-called adrenal fatigue, and recommended a thorough examination.

Open Access Case Study

Raltegravir in the Treatment of HIV–2 Infection: A Report of Eight Cases

Diana Póvoas, Sara Lino, Maria José Manata, João Machado, Fernando Maltez

International Journal of Medical and Pharmaceutical Case Reports, Page 36-43
DOI: 10.9734/IJMPCR/2015/13078

Background: Although endemic in West Africa, HIV-2 infection dissemination is limited to about 1.2 million people worldwide. However, the prevalence of HIV-2 infection is in Portugal disproportionately high, similarly to other countries with strong socioeconomic ties with West African former colonies. Due to HIV-2 intrinsic resistance to non-nucleoside reverse transcriptase inhibitors (non-NRTIs) and enfuvirtide, along with reduced susceptibility to several of the protease inhibitors (PI), antiretroviral therapy (ART) relies on a regimen containing two NRTIs and a selected boosted PI. The integrase inhibitor raltegravir (RAL) showed, in vitro, activity against HIV-2 infection, and small case series published report RAL efficacy in the treatment of HIV-2 infection.
Methods: We report eight HIV-2 ART-experienced patients treated with a RAL-containing regimen.
Results: In this small series of eight patients, medium time of known HIV-2 infection before RAL introduction was 9.4 years; all had previous exposition to ART, some with more than 3 past therapeutic regimens. The majority had low CD4+T cell count. Despite these clinical aspects, the majority showed undetectable viral load (75%) and improvement or stability of the CD4+ T cell count (63%).
Conclusion: Despite limitations inherent to this small case series, RAL proved to be useful in the treatment of HIV-2 infected patients, with beneficial effect in virus control and CD4+T cell preservation. In the presence of extensive resistance to other antiretrovirals, the benefit of RAL seems to be decreased. Accordingly to other emergent data, RAL may represent a novel therapeutic possibility for HIV-2 infected patients.

Open Access Case Study

Which is the Best Treatment in High Suspicion Embolic Stroke of Undetermined Etiology? A Case Report

M. G. Delgado, A. Sáiz, R. García, E. Murias, E. Santamarta, S. Calleja

International Journal of Medical and Pharmaceutical Case Reports, Page 44-47
DOI: 10.9734/IJMPCR/2015/13663

Aims: Presence of aphasia or cortical stroke on neuroimaging suggests an embolic etiology of the stroke. However sometimes it is difficult to discover the source of the emboli doing the decision of the optimal treatment a challenge.
Presentation of Case: 75-year old female was admitted on February 2007 due to a sudden left hemiparesis. Cranial MRI showed two right parietal cortical ischemic lesions. Cardiological and neurovascular studies were normal. Despite the high suspicion of embolic etiology, the patient was discharged home with clopidogrel and low molecular weight heparin (LMWH). Transesophageal echocardiography was later made and showed a minor atherosclerosis of the aortic artery. Patent foramen ovale and atrial aneurism were discarded. LMWH was stopped. On April 2007, the patient was admitted due to global aphasia and right hemiparesis. Cranial CT showed a cortical subacute ischemic stroke in the left middle cerebral artery territory. A complete etiological study (including systemic study) was normal. Anticoagulation was initiated. The patient has remained stable since then (mRS 3: moderate disability).
Discussion: The American and European guidelines do not include the possibility of highly probable embolic stroke of undetermined cause. In these patients, anticoagulation treatment might increase the possibility of intracranial hemorrhages. On the other hand, antiplatelet treatment does not prevent the recurrence of embolic events with devastating consequences.
Conclusion: This case illustrates the controversy about antithrombotic treatment when the etiology remains unknown in highly suspicious embolic stroke. Even if the source of stroke remains unknown, an oral anticoagulation should be carefully considered in these patients.

Open Access Case Study

Topical Treatment of Oral Mucositis in Cancer Children with Triticum vulgare (Triticum L. 1753) Extract: A Case-Series

E. Muñoz Lòpez Eliana, G. Saponati

International Journal of Medical and Pharmaceutical Case Reports, Page 48-52
DOI: 10.9734/IJMPCR/2015/11798

Aims: The clinical effects of a Triticum vulgare-containing mouth gel on oral mucositis were evaluated.
Presentation of Cases: Five children suffering from oral mucositis due to chemo/radiotherapy were treated with a Triticum vulgare-containing mouth gel, spreaded three times in a day as thin layer on the mucosal lesions for 14 days. Control visits were conducted at the days 4th, 7th and 14th. During each visit both the capabilty of ingesting solid food and beverage were evaluated, as well as the pain intensity - judged by VAS (Visual Analog Scale, graded 0-10). Before the treatment, the pain intensity was ranging from 8 to 10 in all subjects; at the day 4th the mean VAS value decreased to 4.6 and at the day 7th to 1.3 At the day 14th no pain was referred by all patients. At the day 4th, 4/5 patients were able to ingest liquids and food.
Conclusions: The results show that the Triticum vulgare–containing mouth gel may be a safe and effective treatment for the oral mucositis in children with cancer.