Open Access Case Report

Melatonin Involvement in Syncope Associated with Sleep Disturbance: A Case Report

Osah Martins Onwuka, Adaobi Linda Okerulu, Nkechi Clara Nwosu

International Journal of Medical and Pharmaceutical Case Reports, Page 6-9
DOI: 10.9734/ijmpcr/2022/v15i430162

Background: Syncope or fainting associated with sleep disturbance is mostly diagnosed as vasovagal syncope and has also been linked to orthostatic or postural hypotension. The physiological basis of syncope associated with sleep disturbance is not fully elucidated. In this report a rare case of melatonin involvement in syncope associated with sleep disturbance was presented.

Case Presentation: A case of a 21-year-old female with syncope associated with sleep disturbance was examined with 1 hour post syncope melatonin concentration of 33pg/ml (daytime evaluation) which is on the increase when compared to its female referenced average value (10pg/ml daytime evaluation). Some vital physiological variables associated with syncope like heart rate, blood pressure, hemoglobin concentration and packed cell volume were normal compared to referenced value (Table 1 and Table 2).

Conclusion: Considering the evaluations presented, it is suggested that melatonin could be involved in the sleep disturbance induced syncope and this report has created de novo insight that will aid elucidation, diagnosis and intervention of syncope induced by sleep disturbance or obstruction.

Open Access Case Report

Primary Systemic Amyloidosis of Tongue: Pitfall and Challenges in the Diagnosis

Agarwal Anshoo, V. Vladimirovich Ermilov, N. Alexeevich Dorofeev, Singh Yanina, T. Ibrahiem Afaf

International Journal of Medical and Pharmaceutical Case Reports, Page 30-34
DOI: 10.9734/ijmpcr/2022/v15i430165

Amyloidosis is caused by the deposition of insoluble fibrillary protein in tissues and organs resulting in severe organ dysfunction. The clinical presentation for the diagnosis of amyloidosis is nonspecific, making it one of the most underdiagnosed conditions. Treatment is now available and is effective in improving patients’ survival and quality of life. We present a case of generalized amyloidosis in a 71-year-old patient admitted with a diagnosis of benign neoplasm of the root of the tongue. Subsequently, she underwent surgical treatment followed by purulent-septic complications developed leading to death. Microscopic examination of the biopsy tissue revealed deposits of amyloid and the patient was diagnosed to have primary generalized amyloidosis. These facts confirm the essential need to differentiate tumors from amyloidosis. Hence, this paper aims to provide physicians with knowledge about the clinical presentation that raises the suspicion of amyloidosis, bearing in mind the importance of early diagnosis.

Open Access Case Report

Catecholamine Induced Polymorphic Ventricular Tachycardia

Shrushti Dalal, Prateek Dalal

International Journal of Medical and Pharmaceutical Case Reports, Page 53-55
DOI: 10.9734/ijmpcr/2022/v15i430169

Aim: To describe a rare case of catecholamine induced polymorphic ventricular tachycardia.

Presentation of Case: Intermittent attacks of Ventricular fibrillation and syncope.

Summary: Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a familial cardiac arrhythmia that is associated with ryanodine receptor gene (RYR2) or calsequestrin 2 (CASQ2) gene mutation. It is a rare condition that occurs in patients with structurally normal heart and leads to exercise/emotion triggered syncope and cause fatal arrhythmias. We present the case of a 21- year old female patient who was diagnosed with this condition at the age of 10 years and continues to live a healthy life.

Conclusion: Patients with CPSVT require life-long beta-blockers and might need an implanted defibrator.

Open Access Case Report

Extensive Foveoschisis in an Emmetropic Patient Associated with Vitreomacular Traction: A Case Report

Andreas Katsimpris, Aristotelis Karamaounas, Dimitra Mitsopoulou, Ilias Georgalas, Petros Petrou

International Journal of Medical and Pharmaceutical Case Reports, Page 95-99
DOI: 10.9734/ijmpcr/2022/v15i4319

Aims: To report a rare case of foveoschisis caused by vitreomacular traction in a young emmetropic female patient.

Presentation of the Case: A 37-year-old woman, without any systemic or ocular disorders, presented with progressively reduced visual acuity in her right eye over the last 3 months. Best-corrected visual acuity (BCVA) was counting fingers in the right eye. Optical coherence tomography revealed foveoschisis with foveal detachment in her right eye, which was successfully treated with pars plana vitrectomy without internal limiting membrane peeling and gas tamponade. Three months post-operatively the BCVA improved to 6/12.

Discussion and Conclusion: Although high myopia is the main cause of foveoschsis, vitreomacular traction can rarely be associated with foveoschisis, specially in young patients without myopia or any other ocular history. In these cases pars plana vitrectomy with extensive posterior vitreous detachment induction may have favorable visual outcomes.

Open Access Case Report

Internal Carotid-internal Jugular Vein Arteriovenous Fistula: Case Report of an Incidental Radiological Finding

Gbenga Jacob Aderibigbe, Vivian Ndidi Akagbue

International Journal of Medical and Pharmaceutical Case Reports, Page 100-108
DOI: 10.9734/ijmpcr/2022/v15i4320

Internal carotid-internal jugular vein fistula is a direct abnormal connection between the internal carotid artery and internal jugular vein. This entity, be it congenital or acquired is rare. We present a case report of a 67 years old woman with an incidental left internal carotid-internal jugular fistula diagnosed on routine contrast enhanced CT of the brain and carotid duplex ultrasound scan. Radiologists can play a vital role in arteriovenous fistula diagnosis and treatment. Adequate assessment of cross-sectional imaging studies can identify uncommon asymptomatic arteriovenous fistulae.

Open Access Case Report

Rare Presentation of Disseminated Tuberculosis in the Present Era of Modern Tuberculosis Management

Alwin Anilkumar, S. Manikandan, V. Sreenivasan

International Journal of Medical and Pharmaceutical Case Reports, Page 88-94
DOI: 10.9734/ijmpcr/2022/v15i4318

Background: Disseminated tuberculosis (TB) is defined as two or more noncontiguous sites resulting from lymphohematogenous dissemination of Mycobacterium tuberculosis. In an immunocompetent host, it is uncommon. The presentation varies, and non-specific early infection symptoms can be noted on chest radiography. Early medication beginning is linked to significantly better outcomes in cases of disseminated tuberculosis. The current case report describes the series of incidents that resulted from a 50-year-old man's excessive usage of the corticosteroid medication tablet Betamethasone, which he was taking for a cough and cold related to his chronic obstructive pulmonary disease (COPD).

Case Presentation: A 50-year-old Indian male patient with osteoporosis, drug-induced adrenal insufficiency, and bilateral pleural effusion who is receiving anti-tuberculosis therapy which he is on now is presented to the outpatient department of a tertiary hospital with complaints of fever associated with shivering on & off for 4 months, generalized tiredness. He had a history of loose stools for 2-3 days, small joint pain, left knee joint pain and swelling, loss of weight, and loss of appetite.

Conclusion: The right diagnosis, treatment, patient counseling, diet, and family support helped him recover despite his turbulent recovery phase. As far as steroid therapy is concerned, it is a double-edged sword, meaning that taking (OTC) over-the-counter steroid drugs without first seeking adequate medical advice could have serious negative effects.

Open Access Case Study

Modified Clinical Practice of Sariva Kshara Sutra with Partial Fistulectomy in the Management of Bhagandara (Fistula-In-Ano)

Niket Shah, Om Prakash Dave

International Journal of Medical and Pharmaceutical Case Reports, Page 1-5
DOI: 10.9734/ijmpcr/2022/v15i430161

Bhagandara is Ashta Mahagaroga (8 major disease) by Sushruta because of highest recurrence. Anorectal disorders are at peak, because to sedentary lifestyle and many other factors. 2 words Bhaga and Darana is bifurcation bhagandara, it is a common disease occurring in Anorectal region around the anus which may extends up to Genitalia. Pidika creation causes Bhagandara to develop, which is countered by opening up in the Guda Pradesh region with suffering and discharge. Kshara Sutra therapy is the one-of-a-kind, specific Parasurgical procedure that is employed in Fistula in Ano. Bhagandara is treated using a variety of modern scientific modalities, but to far no single modality has proven to be comprehensive for Fistula. The goal of the current study was to evaluate the modified way to treat fistula-in-ano with Sariva Kshara Sutra with partial fistulectomy. Case was taken from OPD/IPD of SHAH PILES FISTULA HOSPITAL, AHMEDABAD.

CASE 1: - Age 31 yrs. Male Patient came to our hospital with complain of pain, swelling, discharge in scrotal to anterior anal canal (scrotal extension) treated with Sariva Kshara Sutra with partial fistulectomy considering its a best procedure in the treatment of Bhagandara preserving the Sphincter it treats the track.

Open Access Case Study

Plexiform Neurofibroma of Arm: A Case Report

O. R. Hamdaoui, O. Kardi, H. Tabakh, A. Siwane, N. Touil, O. Kacimi, N. Chikhaoui

International Journal of Medical and Pharmaceutical Case Reports, Page 25-29
DOI: 10.9734/ijmpcr/2022/v15i430164

Plexiform Neurofibroma (PNF) is a rare benign nerve tumor. It is usually considered pathognomonic of neurofibromatosis type 1 (NF1 or Von Recklinghausen disease). MRI is the examination of choice in the exploration of this pathology. It provides decisive arguments for the positive diagnosis, the evaluation of the prognosis and the follow-up of the lesions. Histological confirmation is sometimes necessary, especially in cases other than NF1. We report the observation of a 22-year-old woman who consulted for a mass of the left arm.

Open Access Case Study

Polycythemia Rubra Vera: A Case Report

. Ambika, Ujjawal Rawat, Piyush Mittal, Ajay Kumar

International Journal of Medical and Pharmaceutical Case Reports, Page 35-39
DOI: 10.9734/ijmpcr/2022/v15i430166

Polycythemia vera, also denoted as polycythemia rubra vera is a Philadelphia chromosome (Ph)-negative myeloproliferative neoplasm which usually affects 2.5-10 people per 100000 people. Max cases are present in people age 60 years of age, out of which 10% patients are under the age of 40. The below presented case is an original case of 37-year-old female who presented to us with this condition with a history of insomnia, Fronto- parietal headache, a systemic itch that deteriorates after a hot water bath along with loss of concentration from last 6 weeks and early satiety, discomfort in the upper right abdomen and drastic weight loss from previous one month. The blood test depicted markedly increased hemoglobin (23.8g/dl). A bone marrow biopsy was done and it was confirmed that the patient is suffering from PRV. The patient was treated with phlebotomy, aspirin, and Ruxolitinib.

Open Access Case Study

Eagle Syndrome: A Case Report and Review of the Literature

Oum Rachad Hamdaoui, Y. Sakhy, M. Labied, G. Lembarki, M. Sabiri, S. Lezar, F. Essodegui

International Journal of Medical and Pharmaceutical Case Reports, Page 40-42
DOI: 10.9734/ijmpcr/2022/v15i430167

Eagle's syndrome, stylo-carotid syndrome, elongated styloid process syndrome or American syndrome is a rare and controversial entity. It is characterized by a long styloid process causing irritation of the surrounding structures. We report a case of Eagle's syndrome of incidental discovery in a 53-year-old patient, with no particular history, who presented with intense left retro-mandibular pain evolving for two years. A computer tomography angiography (CTA) of the supra-aortic trunks was ordered and showed two bilateral bony processes extending from the styloid process towards the lesser horn of the hyoid bone, indicating ossification of the stylohyoid ligament, which led to the diagnosis of Eagle syndrome.

Open Access Case Study

Status of Maternal, Neonatal and Child Health Services in Primary and Secondary Health Facilities of Public Sector in Pakistan: A Cross-Sectional Case Study

Shumaila Nargus

International Journal of Medical and Pharmaceutical Case Reports, Page 43-52
DOI: 10.9734/ijmpcr/2022/v15i430168

The case study aimed to assess the efforts being carried out by the public sector to decrease Maternal, Neonatal, and Child mortality in Pakistan to establish an information base for future planning, and assessment of the Maternal, neonatal, and child health services being provided in primary and secondary health facilities to establish an information base for future planning. It was a descriptive/cross-sectional case study. A universal sample of the District Head Quarters Hospitals, Tehsil Head Quarters Hospitals, Rural Health Centers, and 20%  Basic Health Units by using a stratified sampling technique surveys were conducted. Data was collected by using a questionnaire. The findings of the study showed the assessment of the availability of essential staff as per the required standard of the facility and availability was determined at 4,33, 53, and 86 percent in public sectors respectively. Preventive services are rendered at 86% of Basic Health Units, basic emergency obstetric and newborn care at 6% of Rural Health Centers, and comprehensive emergency obstetric and newborn care is being rendered at 4% and 33of by District Head Quarters Hospitals, Tehsil Head Quarters Hospitals respectively. Status of resuscitation with incubation is poor in Tehsil Head Quarters Hospitals (17%) and District Head Quarters Hospitals (51%), it is a very essential service to save the life of neonates if in the presence of staff at 4% of District Head Quarters Hospitals. The study recommended the expedited indefinite quantity of Maternal, neonatal, and child health services in primary and secondary health facilities of public sectors to drop off the mortality rate and to achieve targets regarding maternal and child mortality.

Open Access Case Study

Role of Anti Snake Venom in Snake Bite in Third Trimester of Pregnancy

Pediredla Sri Sowmya, Tanuraj Sirohi, Nitesh Jindal, Sanchit Bhandari

International Journal of Medical and Pharmaceutical Case Reports, Page 66-70
DOI: 10.9734/ijmpcr/2022/v15i4314

A case of pregnancy associated with neurotoxic snake bite presenting with Neuropathic symptoms and systemic envenomation complicated by disseminated intravascular bleeding is uncommon. We present a case of 22-year-old Primigravida at 32 weeks gestation with snake bite on left-hand, with left-hand swelling, nasal bleeding and neuropathic signs. At presentation, there was pallor, tachycardia, hypotension, a gravid uterus with a single live fetus, & regular fetal heart rate. Primi Gravida with venomous snake bite with Neuropathy with disseminated intravascular Coagulation was diagnosed. Conservative management with Anti Snake Venom instituted led to survival of both mother and continuation of pregnancy.

Open Access Case Study

Voriconazole Associated Hypertension: A Case Report

Lin Tuo, Tingting Luo, Xingxiang Yang

International Journal of Medical and Pharmaceutical Case Reports, Page 71-76
DOI: 10.9734/ijmpcr/2022/v15i4315

Objective: The study report a case of a young female with candida tropicalis and candida krusei infection who developed severe hypertension after she had repeated received voriconazole for few days.

Case Presentation: A 23-year-old female was admitted to hospital because of recurrent urinary tract infection. She underwent horseshoe nephrectomy, extracorporeal lithotripsy treatment and double J-tube placement in the past 5 years. After multiple surgeries, she developed recurring fungal urinary tract infections and underwent anti-infective treatment. Twenty days ago, the patient developed chills, fever, dizziness, fatigue, urinary tract irritation signs and bilateral low back pain. Urine culture suggests Candida croco (resistant to fluconazole). After taking antifungal therapy with voriconazole 300 mg q12h, the patient experienced an unexplained increased blood pressure and transient loss of consciousness.

The patient began to experience an increase in blood pressure (140-160/90-100 mmHg) on the second day of voriconazole treatment. After 5 days of taking voriconazole, the patient developed fatigue, dizziness and blurred vision with persistent hypertension (150/100 mmHg), and temporary loss of consciousness and syncope on day8, when blood pressure was measured at 175/95 mmHg.

Conclusion: This case illustrates that acute blood pressure elevation may manifest in patients taking normal doses of voriconazole, which deserves the attention of clinicians.

Open Access Case Study

A Case of Thyroid Storm Complicated with Cardiorespiratory Failure without Obvious Trigger: Early Suspicion is the Key

Padmaja Deb Roy, S. M. Iram Shahzed, Ammy Shankar Ghosh, Sharar Naiarin Haque, Kaniz Ferdouse Mou, Aditi Roy, Khondokar N. Hassan, Syed Nurul Aziz, Nuzhat Tamanna, Nisha Bhowmick, Tutul Chowdhury

International Journal of Medical and Pharmaceutical Case Reports, Page 77-82
DOI: 10.9734/ijmpcr/2022/v15i4316

Thyroid storm, also known as thyrotoxic crisis is an acute, rare life-threatening condition of thyroid gland; possessing 100% mortality when it’s not treated in time. Thyroid storm coexisting with respiratory failure further can contribute to this mortality. Respiratory collapse can be irreversible. This is an endocrine emergency first described in 1926.  This is important to recognize it early and treat to reduce mortality.   Herein, we review a case of 75 years of male who developed Cardio-respiratory failure while he was manifesting clinical features thyroid storm.

Open Access Case Study

Alkaline Diuresis as Treatment for 2, 4-D Dimethylamine Herbicide Intoxication: A Case Report

Nitesh Jindal, Tanu Raj Sirohi, Patamsetti Anil Kumar, Mohammad Shoeb, Gali Shabarish, Pediredla Sri Sowmya

International Journal of Medical and Pharmaceutical Case Reports, Page 83-87
DOI: 10.9734/ijmpcr/2022/v15i4317

The use of 2, 4-D dimethylamine is expanding as a result of the rise in glyphosate and paraquat resistance in weeds [1]. Instances of 2,4D dimethylamine intoxication have been on the rise. This herbicide exhibits a range of dose-dependent harmful mechanisms, including cell membrane destruction, disruption of acetyl coenzyme A metabolism, and oxidative phosphorylation uncoupling [2]. The neurological system, heart, lungs, liver, muscles, and endocrine system may all be affected by toxic effects [3]. Results in male cases are fatal [2,4]. The usefulness of alkaline diuresis as a life-saving treatment for 2,4-D dimethylamine poisoning with severe symptoms is discussed in this paper. 2, 4-D dimethylamine intoxication can be fatal if not treated promptly.  There is no particular antidote and alkaline diuresis shows good result in the patient who present with severe intoxication of 2, 4-D dimethylamine.

Open Access Case Study

Fentanyl Intoxication in an Eight Years Old Child after Application of 75 µg/h Transdermal Patch: A Case Report

A. Chlouchi, R. Cherkaoui, H. Lahyani, A. Bentalha, A. Elkoraichi, S. Echcherif El-Kettani

International Journal of Medical and Pharmaceutical Case Reports, Page 109-113
DOI: 10.9734/ijmpcr/2022/v15i4321

Opioid intoxication in pediatrics is rare in Morocco. In the children’s hospital of Rabat, it is the third case that has been recorded in recent years. It is about a boy of 8 years old who after a benign trauma at the level of the back, his father attached to him a patch of fentanyl dosed at 75 µg/h given by a friend returning from abroad. After 8 hours, the father found his child unconscious with abnormal breathing, motivating him to bring him back to the emergency room of the hospital. He presented a convulsive seizure before being urgently intubated and transferred to intensive care unit. He received a triple dose a day in addition to a contininious infusion of 0,4 milligram of Naloxone. The patient woke up and was extubated after 24 hours, but he kept a divergent strabismus of the right eye for which he was sent to the ophthalmology department for further management. We highlight through this case report the severity of pediatric opioid intoxication and underscores the importance of primary prevention in combating this scourge.

Open Access Case Study

Stage IV Non-small Cell Lung Adenocarcinoma in Complete Response for 5 Years Post-first-line Nivolumab Immunotherapy: Are We Talking about a Cure?

Aref Chelal, Ashraf Alakkad, Ashok Uttamchandani, Sonia Otsmane

International Journal of Medical and Pharmaceutical Case Reports, Page 56-65
DOI: 10.9734/ijmpcr/2022/v15i430170

Background: Metastasis of the Central Nervous System (CNS) is one of the frequently occurring complications of advanced Non-Small Cell Lung Cancer (NSCLC) and has been observed in 24–44% of patients. Patients suffering from NSCLC along with CNS metastases have a generally poor prognosis.

Case Report: A 57-year-old nonalcoholic, non-diabetic, heavy smoker male patient was diagnosed with stage IV NSCLC (non-small cell lung cancer) (Adenocarcinoma), PD-L1 expression 80% with liver, spleen, and brain metastases. In June 2016, the patient was diagnosed with Stage III-A EGFR wild right-sided lung adenocarcinoma (T4N0M0), for which he underwent Curative Concurrent chemo-radiotherapy in Jordan, followed by two cycles of Etoposide plus CDDP (Cisplatin). In February 2017, the patient came to the hospital with the chief complaint of massive hemoptysis. His CT scan showed an appearance in keeping with the right upper-lobe cavitating tumor with possible contralateral lung, splenic, and hepatic metastases. The patient was offered pneumonectomy but refused it. Interventional radiology (IR) tumor embolization of the apical and posterior (A1 and A2) branches of the right superior pulmonary artery with no procedural complication was performed to stop the bleeding.

At the end of that same month, on February 28, 2017, he presented to emergency with seizures, for which a contrast CT scan showed two enhancing lesions, one of the left parietal lobe posteriorly 1.8 cm with marked white matter oedema causing a mass effect and the effacement of the posterior horn of the left lateral ventricle. The second is a small ring-enhancing deposit of the right occipital lobe 6 mm with surrounding oedema.

The liver biopsy failed to show any malignancy. After the MDT discussion, the largest lesion in the brain was removed and a small lesion was kept. The left occipital metastasis was resected and was found to be a metastatic adenocarcinoma of lung origin. It was positive for TTF-1 and positive for Moc 31. P63 and CK5/6 were negative (no squamous component is seen). No brain radiotherapy was offered. First-line palliative Nivolumab was started on March 20, 2017. Nivolumab first proved to be highly successful against brain metastases. However, it was discontinued as the patient developed myelitis after seven months of continuous treatment. After the discontinuation and improvement of myelitis symptoms, Nivolumab was resumed. The amazing thing about this treatment approach was that his disease was completely cleared up and he had been in complete remission for five years. Additionally, all of his tumor indicators had decreased and normalized.

Conclusion: Our case report demonstrated a full response to first-line Nivolumab in a patient with PD-L1-positive NSCLC having visceral and brain metastases. However, our patient suffered from myelitis, which may have been a Nivolumab-related adverse event.

The important point is that he has been achieving a durable complete response for nearly 5 years, so are we talking about the certain biology of a tumor that can be cured by immunotherapy?

Open Access Original Research Article

Pharmacognostic, Acute Toxicity Profile and Comparative Leaf Characteristics of Desmodium velutinum, Mallotus oppositifolius and Synedrella nodiflora

Ifeanyi Peter Onyeka, Felix Ahamefule Onyegbule, Chioma Ifeoma Ibe, Hope Morris Ifebi, Christopher Obodike Ezugwu

International Journal of Medical and Pharmaceutical Case Reports, Page 10-24
DOI: 10.9734/ijmpcr/2022/v15i430163

Plant leaf parameters such as stomatal index, stomata type, leaf microscopic features, and leaf powder microscopy are important taxonomic parameters used to properly identify species and to differentiate one species from another and these is a vital keys in the pharmacognostic study of the medicinal plants because leaf parameters play a vital role in distinguishing crude drugs even when they are fragmented or powdered. Also, extractive index, retention factor, ash value, and phytochemical parameters are vital in the standardization of crude drugs for the establishment of pharmacopeia and monograms. Therefore, the study seeks to validate the use of the phytochemistry and molecular systematics among Asteraceae, Euphorbiaceae, and Fabaceae to support their circumscription and therefore evaluated the pharmacognostic profile of Desmodium velutinum, Synedrella nodiflora and Mallotus oppositifolius folklorically used in South East Nigeria using standard laboratory protocols. The result of the leaf microscopy showed that Desmodium velutinum, Synedrella nodiflora, and Mallotus oppositifolius all had irregular shaped leaf epidermis, and stomata was present only in the abaxial surface respectively. The result showed both D. velutinum and S. nodiflora powder showed the presence of lignin, starch, cystoliths, tannin, and Oil body while calcium oxalate was absent whereas, Mallotus oppositifolius showed the presence of lignin, starch, tannin, and Oil body while calcium oxalate, and cystoliths were absent. Also the result of the TLC showed that M. oppositifolius had 3 visible spots with retention factors (RF) of  0.363, 0.425, and 0.5 in that order  respectively, D. velutinum had 4 visible spot with retention factor (RF) of  0.425, 0.5, 0.550 and 0.66 in that order  respectively  while S. nodiflora had 6 visible spot with retention factor (RF) of  0.255, 0.363, 0.438, 0.538, 0.600 and 0.688 in that order  respectively. The result also showed that methanol exhaustible extracted the phytochemicals in the crude dried plant. The acute toxicity studies showed that Desmodium velutinum, Synedrella nodiflora and Mallotus oppositifolius individually had LD50 greater than 5000mg/kg. This study validates the claim that leaf parameters such as stomatal index, stomata type, leaf powder microscopy are important parameters used for the identification of crude drugs.