OSP Journal of Case Reports

Anti-N-methyl-D-aspartate receptor encephalitis (anti-NMDAR) is a rare autoimmune encephalitis, recently described and characterized by neuropsychiatric symptoms associated with antibodies directed against the RN1 or RN2 subunits of NMDA receptors. We are reported a rare case of autoimmune encephalitis in a 9-year-old girl admitted for a convulsive state with behavioral disturbances and abnormal movements. The cerebrospinal fluid tested positive for anti-NMDAR antibodies and no association with teratoma was found. The patient was treated initially with intravenous corticosteroid therapy, then with intravenous immunoglobulin, and finally with rituximab. Rituximab resulted in a clear clinical improvement as the regained the ability to eat and social interaction with resumption, without behavioral disturbance.

Immunotherapy, particularly the BCG vaccine, is one of the most used means in NIMBC therapy and the indications for which are well known. Urinary cytology is, along with cystoscopy, one of the benchmark examinations for the detection and monitoring of NIMBC, especially of high grade. This surveillance for NIMBC is essential because the risk of recurrence and progression. Few data exist in the literature mentioning the place of post-BCG bladder biopsies up to date. So, should you do it? As a result, we carried out this study to assess the place of post-BCG bladder biopsies

We conducted a retrospective study in the urology department of CHU Bichat-Claude-Bernard from January 2016 to December 2019 at (i.e. 4 years) in patients followed for high risk muscle bladder tumor that did not infiltrate BCG post-instillation biopsies. We included all patients with non-infiltrating bladder tumors and we did bladder biopsies after the induction phase of BCG instillation, who then had urine cytology.

A total of 62 patients were included, including 47 men (76%) and 15 women (24%). The median age was 71 years. After BCG, a total of 342 bladder biopsy were taken with a median of 5 (IQR 2) per case. The biopsy was positive in 13 patients (21%). The median number of positive biopsy was 2 (IQR 1) and the total number of positive biopsy was 27 (8%). The biopsy was positive at the initial tumor site in 8 patients (61.5%). We found a significant association of positive biopsy with positive urinary cytology (p <0.001) and the presence of erythematous lesions (p <0.02) or visible tumors (p <0.001) at cystoscopy. The pre-BCG stage T (p = 0.32), the presence of CIS (p = 0.71), the multifocal tumor (p = 0.41) and the size (p = 0.52) were not associated with a positive biopsy occurrence.

In summary, routine transurethral bladder biopsies are not required after induction therapy for BCG. However, a personalized approach is recommended based on cystoscopy and cytology.

Lung cancer is the most common primary malignancy, with typical sites of metastasis including the liver, brain, bone, and adrenal glands. Reports of metastasis to the gastrointestinal tract are uncommon, ranging from 0.2-0.5%, but higher rates are seen in autopsy reports at up to 1.8%. Since gastrointestinal (GI) symptoms may be misattributed to treatment side effects, GI track metastases can be missed clinically. Here we report a case of metastatic non-small cell lung cancer to the sigmoid colon and discuss the presenting symptoms, diagnostic work-up, and imaging and pathology findings.

Case: We report a case of non-small cell lung cancer metastasis to the sigmoid colon.

Conclusion: Lung cancer patients presenting with GI obstruction or other new or worsening abdominal symptoms may warrant a search for GI tract metastasis secondary to primary lung tumor, which is clinically underdiagnosed and signals poor prognosis.

In a series of papers published last few decades, we offered data and explanation that variation of quantitative characters could not be explained only on the basis of classical hypothesis of cumulative effects of individual loci , but, in addition, on the necessary balances of homo- and heterozygous pair- relationships in corresponding groups of polygenes. It correlates with a cumulative effect of homo-vs. hetero- combinations of corresponding allelogenes, that contribute to a more efficient reduction from a huge theoretical, to an adaptively restricted and limited variation.

Approximately 12.4% of all diseases seen by family physicians were dermatological, and types of dermatitis represented a large proportion of these disorders. However, there are rarer skin conditions mimicking dermatitis, and there are clinical pearls to facilitate appropriate diagnosis and management decisions. For instance, angioma serpiginosum (AS) is a rare vascular disorder resembling purpura that features dilated and proliferated upper dermis capillaries. Herein we present a case of angioma serpiginosum in the upper extremity of an adolescent male which was initially misdiagnosed as atopic dermatitis and treated with topical betamethasone for two years. He was eventually referred to a dermatological specialist who suspected the possibility of angioma serpiginosum, which was confirmed by skin biopsy and histopathological analysis. Clinical pearls to distinguish AS and mimics such as atopic dermatitis, angiokeratoma, capillaritis are discussed.

Since the Covid 19 broke out, people are all looking for the cure. Many people died from this fetal disease; and cytokine storm is one of the most dangerous complications. For some low income people, they are not eligible to get tested for Covid; and they might not get the proper medical care. In these cases, self-care procedures, such as exercise, clear the airway, handwashing, wearing mask, taking meds on time, and proper diet become crucial in deciding the prognoses. This research is about a case study of a patient who is not eligible for a Covid 19 lab test; and how she dealt with a severe flu-like disease.

Tuberculosis of the central nervous system remains a serious infection that can be life-threatening. This encourages us to systematically evoke the diagnosis in front of any symptomatology suggestive of central nervous system involvement, particularly in our endemic context. Tuberculosis of the CNS is very polymorphous, sometimes with deceptive clinical and radiological pictures, more so when it comes to meningoencephalomyelitis, as was the case for our patient. The diagnosis of these neurological forms has long benefited from the contribution of medical imaging, including computed tomography (CT) and magnetic resonance imaging (MRI). Its bacteriological confirmation is not always easy and when it exists, it is often late. Our work reflects this great clinical polymorphism and illustrates the variety of localization of neuromeningeal tuberculosis. Despite the existence of powerful anti-tuberculosis drugs, tuberculosis remains a severe infection that can affect the functional and vital prognosis. Only early diagnosis and treatment initiated early enough guarantee a good prognosis.

Takotsubo Cardiomyopathy (TCM), also known as Broken Heart Syndrome, is an acute stress-induced cardiomyopathy with transient cardiac failure. It is triggered by preceding extreme physical or psychological stress.  The etiology remains unclear, however, pathophysiological activation of the adrenergic system causing catecholamine-induced myocardial dysfunction is proposed. Use/overuse of short acting beta-2-agonist (SABA) is a possible predisposing factor.

We report a case of TCM in a 64-year-old female after bronchoscopy with endobronchial ultrasound (EBUS) and transbronchial needle aspiration biopsy (TNAB). The case shows a possible delay from symptom onset to echocardiographic visibility of TCM on and underlines the importance of reviewing a patient's use of SABA prior to invasive procedures.

Brucellosis is one of the commonest zoonotic diseases worldwide and is an endemic disease in Saudi Arabia. It can present with a variety of clinical manifestations; fever is the most common presenting symptom. Genitourinary brucellosis is a rare complication of the disease. We report a case of a 42-year-old patient who presented with fever and lower abdominal pain. Imaging identified bilateral tubo-ovarian abscesses. All initial microbiological tests were negative. The patient continued to be febrile despite being on antimicrobial therapy. Brucella serology was requested as well as a fastidious culture of the drain fluid and both confirmed the diagnosis of brucellosis. The patient was treated with a combination of Ceftriaxone, Doxycycline, and Trimethoprim-sulfamethoxazole with a good clinical and serological response. This case highlights a unique and rare presentation of Brucellosis. This is a unique presentation of Brucellosis provides an interesting dilemma regarding the causes of Tubo-ovarian abscesses. Clinical suspicion of such a rare presentation of a common disease should be included while managing patients even in the absence of obvious risk factors especially in endemic areas such as Saudi Arabia

Aims: Cranioplasty and facial bone reconstruction are surgical procedures used for craniofacial defects following trauma or neurosurgical procedures like decompressive craniectomy; with the aid of prosthesis made from several materials. Implant customized manufacturing for craniofacial defects allows for a precise and anatomical reconstruction in a shorter operating time but the prosthesis production is often costly and requires complex intraoperative processes. In this case report we introduce a simple, low-cost method for prosthesis manufacturing.

Case Presentation: We present the case of a 30-year-old male patient with skull and facial bone comminuted fracture who received three-dimensional (3D) printing customized polymethyl methacrylate (PMMA) prosthesis for facial bone and frontal bone defects reconstruction. Post-operative 10 months follow-up showed excellent patient, family, and surgeon satisfaction at a fraction of the cost associated with commercially available implants.

Conclusion: The use of customized 3D PMMA prosthesis could be an attractive option to all patients undergoing cranioplasty.

Swallowing of foreign body is a common problem in children. Although most foreign bodies in the gastrointestinal tract will pass spontaneously, passage of sharp and pointed object such as a long nail is unusual. We report a case of a 2-year old female who swallowed a 3-inch nail and passed the nail per rectum spontaneously without problems while preparations were being made for the removal of the nail. The rarity of this event makes it worthy of being reported

In this paper, the author analyzed his 1,706 meals that was segregated into two major groups, five different eating places, and six nations, using waveform characteristics analysis and energy theory to understand the moving trend and pattern of glucose, as well as its associated energy level.

In this paper, the author describes his hypothesis on the probable partial regeneration for some insulin production capability of the pancreatic beta cells on a type 2 diabetes (T2D) patient via his collected finger-piercing postprandial plasma glucose (PPG) data from 6/1/2015 to 4/27/2020.

The arcuate uterus though a classified mullerian duct anomaly but is mild anatomic variant without any association with reproductive failure. The adenomyosis is abnormal ectopic location of endometrium in the myometrium which can be focal and diffuse, and assumes cystic appearance on repeated haemorrhages. The medical resonance imaging is important imaging modality to establish both the diagnosis and both the condition in the same patient is rare and not reported in the literature so far.

In this paper, the author describes his research results of comparing the associated energy of glucose between liquid meals versus solid meals. This energy difference is resulted from his previous discovery of a hypothetical neural communication model between the brain’s cerebral cortex and certain internal organs such as the stomach, liver, and pancreas. Applying frequency domain analysis technique, his new finding of differences of associated energy via postprandial plasma glucose (PPG) provides further evidence of possible impact or damage on human organs resulted from the origins of these two different meals.

Introduction: Right hemi-diaphragmatic stimulation is a rare complication of dual chamber pacemaker. We report a case of 55 year old male who developed sudden onset right hemi-diaphragmatic contractions after 5 weeks of dual chamber pacemaker implantation.

Case Summary: A 55 years old male with a dual chamber pacemaker implanted for complete heart block presented with persistent uncomfortable rhythmic contractions of the right hemi-diaphragm five weeks after. Device interrogation suggested atrial lead dislodgement and fluoroscopy confirmed atrial lead dislodged into the superior vena cava. Diaphragmatic rhythmic contractions stopped when device was reprogrammed to VVI mode. Atrial lead was removed and replaced with a new lead. No rhythmic contractions of the right hemi-diaphragm were observed after reprogramming the device mode to DDD.

Conclusion: If diaphragmatic twitching is as a result of atrial pacing in a dual chamber device, reprogramming of the pacemaker mode to VVI will stop the diaphragmatic twitching.

The patient was a 24-year-old woman with a history of depression and panic disorder. She attempted to commit suicide by burning charcoal in a sealed bathroom by placing charcoal on a steel mesh grate and igniting it from the bottom using a barbecue stove. The bathroom was filled with white smoke. After experiencing dyspnea, she opened the door of the bathroom and telephoned a friend who called an ambulance. She was transported to a local hospital by the ambulance. On arrival, she showed mild consciousness disturbance. A physiological examination revealed no specific findings. Thoracic computed tomography showed a diffuse patchy ground glass appearance. The results of an arterial blood gas analysis revealed carboxyhemoglobinemia and methemoglobinemia. She was diagnosed with carbon monoxide poisoning, methemoglobinemia and chemical lung edema. She was transferred to another hospital for hyperbaric oxygen therapy. After 5 days of hyperbaric oxygen therapy, she was discharged without sequelae.

The present report shows extremely rare combination of carbon monoxide poisoning, methemoglobinemia and lung edema after a suicide attempt in which an individual burned charcoal on a steel mesh grate. Physicians should pay attention to the burned materials and the systemic condition of the patient when treating patients who have inhaled smoke from burning materials.

Pregnancy is the fertilization and development of one or more offspring, known as an embryo or foetus in a woman’s uterus. It is a critical stage of development during which maternal nutrition can strongly influence obstetric and neonatal outcomes. The aim of this study was to determine the effect of pregnancy on serum zinc and copper levels among pregnant women in Sokoto, North Western Nigeria. This case- control study included 74 pregnant women as the subjects and 22 non-pregnant women as controls. The zinc and copper levels were determined using each reagent produced by Diagnostic Reagents Ltd (UK). There was no statistically significant difference in the serum zinc and copper levels between the pregnant subjects and non-pregnant controls (19.1 ± 1.47 and 41.5 ± 1.53) versus (16.8 ± 1.95 and 38.1 ± 3.84 (t=-0.954 and -0.954; p= 0.434 and 0.342) respectively. The serum zinc and copper level were compared based on trimester. There was no statistically significant difference in the serum zinc and copper levels based on trimester (21.7 ± 2.47, 18.0 ± 2.76, 17.4 ± 2.40 and 39.2 ± 2.31, 42.3 ± 3.65, 43.1 ± 1.69) (F=0.848 and 0.644; p=0.471 and 0.589) respectively. This study was unable to demonstrate any significant variation in the level of serum zinc and copper levels among pregnant subjects and the non-pregnant controls.  Trimester appears to have no significant effect on the serum copper and zinc levels among pregnant women of African descent in Sokoto, North Western Nigeria.

In today's world, the spread of coronavirus has disrupted the lives of society as a whole, and the goal of all research groups is to discover a cure for this emerging virus.Now, based on the studies we have done in this article, we have examined a research title that requires extensive experiments in this field so that we can achieve effective therapeutic results with this type of laser.

This paper describes the author’s application of Spatial Analysis and Forecasting to manage Type 2 Diabetes (T2D) conditions.

Common signs of corona virus infection include respiratory symptoms, fever, and cough, shortness of breath and breathing difficulties. In more severe cases, infection can cause pneumonia, severe acute respiratory syndrome, kidney failure and even death. People who are suffering from prevailing chronic diseases such as cancer, heart disease, high blood pressure, diabetes, chronic kidney disease, etc. may die due to their weaker immunity system. Most of the people around the world died due to panic attack and due to extreme fear. A fear of not having vaccination for the virus infections has also taken a big death toll.Therefore, it is very important to build a stronger robust immune system and patients need to think positive and follow the positive approach to combat the disease [1].

Ischial pressure sore is a common trophic complication of the re-educated paraplegic patient. The treatment is usually surgical and involves the use of reconstruction flaps. The aim of this work was to report the case of a patient with a bilateral ischiatic pressure sore treated with the inferior gluteus maximus muscle flap. The patient was a 45-year-old paraplegic with bilateral ischial pressure ulcers who had been developing bilateral ischial pressure ulcers for 10 years. At the time of the examination, he had a type IV (NPUAP) pressure sore with bone exposure associated with urinary and rectal incontinence. We decided on a reconstruction using the inferior gluteus maximus muscle flap with an inferior gluteal rotational skin flap. A small wound disunion occurred and complete healing was achieved within 23 days.

Introduction: During embryology of the nasal cavity, posterior choana forms by canalization or obliteration of the fold between olfactory groove and roof of the primitive oral cavity. A failure of canalization of this aperture is referred to as choanal atresia.

Case Summary: A 10-day old female neonate was admitted into the out-born section of our special care baby unit (SCBU) via the children emergency ward (CHEW) on account of nasal obstruction and difficulty to breath which was noticed immediately after birth. A diagnosis of bilateral mixed (bony and membranous) choanal atresia was made and child subsequently had bilateral choanoplasty. Nasal stents remained insitu for 3 months from the day of operation, after which stents were finally removed.

Conclusion: Diagnosis of Choanal atresia should be preceded by a high index of suspicion following clinical presentation of respiratory difficulty which improves with crying in a new-born baby and inability to suction through the nasal cavities following birth. In the absence of conventional instruments for choanoplasty, an improvised metallic probe can be used to canalise the posterior choana.

Recommendation: We advocate that stent stays for at least 12 weeks before removal to ensure long lasting patency of posterior choana.

Auto-immune thyroiditis, papillary thyroid carcinoma and primary hyperparathyroidism due to adenoma as single entities are common. Hashimoto thyroiditis is mostly related to thyroid lymphoma. Here we present the case of a 60-year-old Greek female patient presented with paresthesias of the lower extremities. Her laboratory findings were consistent with hypercalcemia, hypophosphatemia, increased urine calcium excretion and elevated parathyroid hormone levels. On suspicion of primary hyperparathyroidism with simultaneous loss of bone mass, surgical treatment was decided. She proved to suffer simultaneously from Hashimoto thyroiditis, papillary thyroid carcinoma and parathyroid adenoma. In our patient the simultaneous appearance of these three entities, Hashimoto thyroiditis, parathyroid adenoma, and papillary thyroid carcinoma, do not seem to be connected. Papillary thyroid carcinoma was an accidental finding. What is interesting about this case is that the patients’ only symptom was paresthesias of the lower extremities.

The author developed his GH-Method: math-physical medicine (MPM) by applying mathematics, physics, engineering modeling, and computer science (big data analytics and AI) to derive the mathematical metabolism model and three prediction tools for weight, FPG, and PPG with >30 input elements.  This study includes 11 categories: weight, glucose, blood pressure, lipids, food, water, exercise, sleep, stress, life pattern regularity, time with ~500 input and output elements.  He collected more than 1 million “clean” data over 7 years.

Introduction: Ectopic thyroid is more commonly seen at base of tongue hence called lingual thyroid. It can cause range of symptoms like dysphagia, dysphonia and dyspnea. We utilized Transoral Robotic surgery [TORS] to excise ectopic lingual thyroid tissue using the da Vinci Si system.

Case: A 16-year-old female presented with chief complaints of dyspnoea and foreign body sensation in the throat. Upon examination, a protruding solid, pink, spherical 4cm x 3cm mass located at the base of the tongue. Ultrasonography (US) revealed a mass 5x4 cm in size.

Methods: Resection carried out from the anterior border of the lingual thyroid along the capsule of ectopic thyroid tissue using 12mm 30 degree face-up endoscope, 5mm spatula cautery robot and a 5mm Maryland forceps.

Discussion: Symptomatic lingual thyroid mostly demands surgical excision. Transoral approach is much preferred, excluding disadvantage of cervical open approaches. Transoral robotic surgery decreases the technical difficulties encountered in other transoral approaches. The 7 degrees of freedom of da Vinci robotic arms allow it to access difficult to reach regions, providing an excellent wide-angle view of the surgical field and thus lesion could be resected in multiple planes.

Spontaneous Hemomediastinum is a rare pathological disorder. Multiple underlying causes and contributory factors can be identified, such as trauma, malignancy, iatrogenic, bleeding disorder or mediastinal organ hemorrhage.

Using contrast enhanced computed tomography (CT) of the chest, hemomediastinum can be adequately diagnosed.

Spontaneous hemomediastinum may occur due to multiple and contributory causes such as: secondary to hemorrhagic disorders, mediastinal tumors or after sudden increase in intrathoracic pressure, (e.g. during coughing, sneezing or vomiting, or sudden sustained hypertension) [1, 2].

In this case report, a 76-year-old male is presented with of thyroid artery aneurysm resulting in hemomediastinum causing thoracic pain.