OSP Journal of Case Reports

Introduction: Pigmented villonodular synovitis (PVNS) is a rare, benign disease of the synovial tissue resulting in synovial hyperplasia, pigment deposition (hemosiderin), and swelling inside the affected joints, tendon sheaths, and bursae. In PVNS, there is no conservative management as PVNS continues to grow without surgical intervention. Currently, there is limited research for physical therapy rehabilitation role in post-operative intervention. This case report describes the outpatient physical therapy management of a patient who underwent a synovectomy to remove a recurrence of diffuse PVNS.

Case Description: A 20-year-old male was referred to physical therapy after a synovectomy to remove the recurrent diffuse PVNS on his left knee. The recurrence of symptoms resulted in difficulty performing activities such as: bed mobility, home-related activities, ascending and descending stairs, and walk longer distances.

Intervention: 12 weeks program, including aerobic, eccentric, and proprioception exercises.

Outcome: Post-operative rehabilitation program had a beneficial impact on improving functional mobility (Lower Extremity Functional Scale score improved from 41/80 to 78/80 and 10 Meters Walk Test score

improved from 0.83 m/s to 1.1 m/s.). Post-operative recovery proceeded without complications. He was discharged following visit 22.

Acute coronary syndromes (ACS) are a common ischemic heart disease (IHD) with high morbidity and mortality. Anxiety is common among cardiac patients, has potentially serious consequences if untreated, and is infrequently assessed or managed appropriately. The co-occurrence of anxiety symptoms and ACS is responsible for decreasing the quality of life (QoL) of patients with ACS. Anxiety is a common emotional response among acute coronary syndrome (ACS) patients. Anxiety is frequently encountered in ACS. It is believed that the prevalence of anxiety among cardiac patients is between 15 and 50%. Patients with ACS often experience anxiety due to the sudden onset of symptoms, the potential severity of their condition, and the uncertainty of their prognosis. Anxiety can also be a risk factor for adverse cardiac events and may interfere with treatment adherence and rehabilitation efforts. Therefore, it is important for healthcare providers to recognize and address anxiety in patients with ACS. This can involve a combination of pharmacological interventions, such as benzodiazepines or selective serotonin reuptake inhibitors (SSRIs), and non-pharmacological interventions, such as cognitive behavioural therapy, relaxation techniques, and stress management strategies. Additionally, healthcare providers can provide education and support to help patients better understand their condition and manage their symptoms. The importance of increased awareness and treatment of anxiety among patients with cardiac disease is stressed.

Trauma to the abdomen can result in various injuries, including splenic rupture or laceration. The diagnosis of a shattered spleen can be challenging as symptoms can be nonspecific, and imaging findings can be ambiguous. The Tc-99m Nano-Colloid Scintigraphy has emerged as a useful tool in the diagnosis of post-traumatic splenic injuries. In our case report, we aim to highlight the value of Tc-99m nano-colloid scintigraphy as an alternative for Tc99m sulfur colloid scan in the diagnosis of a post-traumatic shattered spleen. We presented two cases in this article who suffered from post-traumatic shattered spleen and how Tc-99m nano-colloid scintigraphy played a crucial role in their diagnosis. Both cases involved adult patients who sustained blunt abdominal trauma resulting in splenic injuries. In both cases, initial imaging was equivocal, but Tc-99m Nano-Colloid Scintigraphy revealed a shattered spleen, leading to appropriate management. In conclusion Tc-99m Nano-Colloid Scintigraphy is a cheap and readily valuable radiotracer that can assess patients and help in the management of post-traumatic shattered spleen. It can be used as a good alternative for Tc-99m sulfur colloid.

Myasthenia is an autoimmune disease characterized by the destruction of postsynaptic acetylcholine receptors in striated skeletal muscles and is most common in young women. Myasthenia can be diagnosed through the detection of anti-acetylcholine receptor antibodies. Its treatment includes anticholinesterase drugs, thymectomy, and restrictive drugs that may aggravate the myasthenic crisis. We herein report a rare case of accidental revelation of a myasthenic crisis in a 26-year-old woman triggered by a SARS COV-2 viral pneumopathy.

Endometrial stromal uterine sarcoma is distinguished by a high degree of malignancy. There is an aggressive course of the disease, as a result of which additional tumor nodes may appear, both in nearby organs and in distant organs (metastases). The cause of death in about 90% of cancer patients is not a tumor, but a metastasis. Endometrial stromal uterine sarcoma is characterized by a rather unfavorable prognosis with a high degree of hematogenous localization, as a result of which the sarcoma spreads through blood vessels to all human organs. The number of mitosis for an enlarged microscope is greater than 10 out of 10 fields of view. Endometrial uterine sarcoma is observed in women aged 45-50 years. The diagnosis is most often made after the histological analysis of the operating room. The classic treatment is abdominal hysterectomy with bilateral appendectomy.

Uterine sarcomas are a heterogeneous group of high-malignancy cancers that develop from the uterine body. Common manifestations include abnormal uterine bleeding and pelvic pain or mass. We report the case of a 70-year-old patient, widow, mother of a child, postmenopausal 12 years ago, followed for high-grade invasive ductal breast carcinoma, luminal B Her2 positive dating back to 11 years, admitted for postmenopausal menometrorrhagia. Ultrasound and MRI revealed a globose uterus measuring 8.8 cm, thickened endometrium measured at 10mm, then the patient underwent biopsy endometrial curettage, the results were in favor of high-grade endometrial stromal sarcoma. The patient underwent a total hysterectomy with bilateral appendectomy. The histological study with immunohistochemical complement concluded that there was high-grade endometrial stromal sarcoma with hormone receptor negative.

Through this rare case, we insist on the epidemiological, diagnostic, therapeutic and prognostic characteristics of this entity.

Factor VIII is a clotting factor that plays a crucial role in the coagulation cascade. Above normal levels are found in 11% of the general adult population. Various studies have established a causal association between elevated factor VIII and venous thrombosis; some studies also suggest a relation with arterial thrombosis, particularly myocardial infarction and stroke.

Ischemic strokes may be caused by cumulative or independent effects of a variety of risk factors. High factor VIII level is one of those important but less known risk factors for arterial and venous thrombosis. We hereby provide a comprehensive review of the role of high factor VIII levels as a risk factor of arterial thrombosis. Moreover, we illustrate a case of 40-year-old Moroccan male patient with Ischemic stroke whose only identifiable risk factor was revealed to be an elevated factor VIII level.

The increased deposition of iron in gastric mucosa is known as gastric siderosis. We describe a case of a 69-year-old woman with dyspepsia, who had previously consumed oral ferrous sulfate tablets. Gastroscopy revealed inflammation in the gastric antrum. Histologically, there was evidence of mild chronic gastritis and Perl’s stain positive for iron. Iron studies were unremarkable. There have been three distinct patterns of histology identified in the literature for gastric siderosis. This case is unique given the combination of histopathological crossover between two different patterns.

Background: Tocilizumab is a recombinant humanized anti-interleukin 6 (IL-6) receptor monoclonal antibody that inhibits the binding of IL-6 to both membrane and soluble IL-6 receptors, blocking thereby IL-6 signaling and dampening inflammation. Although it has been the second drug ever recommended by the world health organization for Covid-19 treatment after recommending dexamethasone, the role of IL-6 inhibition in reducing Covid-19 severity and mortality remains controversial since several large-scale, multi-center observations and randomized controlled trials have shown minimal benefits whereas others such as the REMAP-CAP and Recovery trials have suggested that tocilizumab in combination with systemic corticosteroids would be expected to improve outcomes in hospitalized covid-19 patients. Herein, we report a hospital-based prospective monocentric study of a series made up of 22 adult patients who received tocilizumab out of a total of 139 patients admitted to the medical intensive care unit for moderate to severe forms of Covid-19 between February 2021 and October 2021.

Objective: The aim of this study is to assess the impact of tocilizumab on clinical outcomes mainly on oxygen needs and mortality along with summarizing the available evidence regarding its efficacy in hospitalized covid-19 patients.

Location: The study was conducted in the medical intensive care unit in the Ibn Rochd University Hospital of Casablanca, Hassan 2 University of Casablanca, Morocco.

Participants: The study consisted of a series of 22 adult patients out of a total of 139 patients admitted to the unit between February 1,2021 and October 7,2021 for moderate, severe, or critical form of Covid-19. Recruitment of patients was based upon inclusion and exclusion criteria.

Intervention: Tocilizumab with concomitant systemic corticosteroids along with usual standard of care.

Main measurements: Oxygen requirements and overall mortality. The study focused on the impact tocilizumab has on reducing oxygen needs and therefore improving respiratory status and mortality.

Results: A beneficial effect of the combination tocilizumab and systemic corticosteroids on oxygen needs and mortality has been suggested by the study (P=0,008).

Conclusions: An early combined use of tocilizumab and systemic corticosteroids may improve clinical outcomes and overall mortality in hospitalised Covid-19 patients. Further randomized controlled trials would therefore be of paramount to pinpoint the subgroups that are most likely to benefit from tocilizumab treatment.

Sparganosis is a rare parasitic infection caused by plerocercoid larvae tapeworms of the genus Spirometra sparganum (Spirometra sp.), known to be transmitted through ingesting freshwater or an infected host organism, or via direct contact through an open wound. While sparganosis features a wide variety of clinical presentations including dermatological, muscular, ocular and neurological abnormalities, this is the first documented instance in which sparganosis presented with myoclonus. This case report highlights the possible diagnosis of sparganosis in patients presenting with myoclonus and pruritus, as well as the importance of gathering past medical history involving past ingestions.

Background: Patient safety is an undeniable important aspect in the context of improving the quality of the entire health system. Improving patient’s safety should be comprehensive and include two dimensions of safety – technical and functional. One source of information about the level of patient’s safety are medical staff, but there is a gap here, which is no central system that would collect, analyze and draw conclusions from a sufficiently large number of problems reported by stakeholders.

Objectives. The aim of this study was to evaluate the patient’s safety on the basis of the declaration of nurses.

Material and Methods: The study involved 160 professionally active nurses. The study was performed by the authors questionnaire based on the questionnaire “Hospital Survey on Patient Safety Culture” developed by the Agency for Healthcare Research and Quality. The selection of the sample was based on the availability of respondents. The study was performed in January 2021. More than ¾ of respondents indicated the hospital as a place of employment.

Results: Nearly 40% of respondents said that their boss rarely and very rarely takes into account the suggestions of employees for the improvement of patient’s safety. Over 40% of respondents said that their workplace is often and very often trying to do too many tasks and too fast.

Conclusions: It is necessary to create a culture of safety by improving communication between doctors and nurses or line manager and nurses. There is a need for greater involvement of line manager in solving problems reported by nurses in terms of providing safe care to patients (Piel. Zdr. Publ. 2021, 5, 1, 33–39).

Background: Bilateral Bony choanal atresia is an uncommon congenital malformation seen in early neonatal life which could result in death if unrecognized early. The incidence of choanal atresia is 1:5000-10000 live births.

Aim: To report the first bilateral bony choanal atresia in University of Port Harcourt Teaching Hospital.

Case Report: We report a case of bilateral, bony, choanal atresia presenting at birth at the University of Port Harcourt Teaching Hospital, a tertiary institution. Emergency oropharygeal airway was used to secure airway patency. The diagnosis was confirmed by choanography using paediatric (foley’s catheter French gauge 8) catheter, and low osmolar contrast medium (iopamdol) 10mls.

• After the clinical/radiological diagnosis, surgical treatment was instituted.

Conclusion : Bilateral bony choanal atresia is an uncommon condition. Being rare, a high index of suspicion is required. It is confirmed by diagnostic imaging and relieved by surgery.

Background: Brucellosis is the most common zoonotic infection worldwide. The infection is caused by the bacterial genus Brucella. It is transmitted from animals by consumption of unpasteurized milk or milk products, or by direct contact with infected livestock. In countries of high prevalence, such as in Saudi Arabia, brucellosis continues to be of public health and economic significance. Brucellosis is a multisystem disease and infected persons may present with a wide spectrum of manifestations. The most common feature of systemic brucellosis in humans is fever, followed by myalgia and arthralgia, sweating, and constitutional symptoms.

Case: We report a young patient presenting with a post stroke epilepsy secondary to Neurobrucellosis infection

Conclusion: Neurological symptoms and stroke of undetermined etiology in patients living in an endemic area should prompt testing for brucellosis.

Gunshot wounds are a type of craniocerebral trauma that has become increasingly common in recent years in neurosurgical practice. This is especially true in developing countries due to armed conflicts and public unrest. Their prognosis is bad and they are associated with a high death rate. In this article, we report the case of a craniocerebral bullet wound that occurred during public demonstrations in Dakar, Senegal, and was treated at the Fann University Hospital. We highlight the problem of managing this type of injury in our less developed environment.

The neurological manifestations of the pandemic during coronavirus (COVID-19) has attracted the attention of several authors including stroke However, cases associating an hemorrhagic vascular  accident on Moyamoya angiopathy to covid19 viral pneumonitis have only been rarely reported in the worldwide, and this was the first case reported in Morocco.

Any infection like SARS Cov-2, could precipitate the onset of the angiopathy of Moyamoya. However, the exact pathogenesis remains to be elucidated; the potential mechanisms may be related to the increase of cardioembolic events; an infectious process and hypercoagulability state in COVID-19.

We will first present the case; of a parturient with SARS CoV-2 who developed a Moyamoya Angiopathy and suffered an intracerebral hemorrhage. We will then discuss the management issues related to this situation.

SARS-COV2 has been shown to be highly thrombogenic owing to the surge of pro-inflammatory cytokines during the cytokine storm requiring therefore high doses of anticoagulant agents. Nonetheless, hemorrhagic events among COVID-19 patients have been well-documented making the prognosis even poorer.  

Herein, we describe a case of life-threatening iliopsoas hematoma (IPH) during the clinical course of Covid-19. The patient had been recovering gradually from an acute respiratory failure when he suddenly developed iliopsoas hematoma. The aim of this report is to highlight the severity of this complication as well as the judicious use of anticoagulation therapy during Covid-19.

Myxedema coma is a life-threatening complication of decompensated hypothyroidism and remains a difficult diagnosis in the absence of known hypothyroidism. The treatment of myxedema coma consists of hormone substitution, treatment of the triggering factor such as infection, as well as adjuvant measures of resuscitation. Herein, we report a case of myxedema coma caused by SARS-CoV-2 pneumonia and discuss how Covid- 19 has unveiled an undiagnosed hypothyroidism in our patient.

Long-standing mitral valve disease is associated with enlargement of the left atrium as a compensatory mechanism. Giant left atrium is seen in only 19% of patients and such a low incidence is probably related to an early development of pulmonary hypertension.

We report the case of a giant left atrium with big thrombus diagnosed during an echocardiography done systematically as part of an etiologic assessment of a stroke.

Goodpasture's syndrome (GPS) remains a very rare disease entity in the pediatric population characterized by the presence of pulmonary hemorrhage and rapidly evolving glomerulonephritis. Without any appropriate treatment, the disease is generally fulminant and patient and kidney survival is poor. We hereby describe the case of a 15-year-old boy who presented as an early symptom poorly tolerated anemia, with normal renal function and no oliguria nor respiratory symptoms. Past medical history was significant with an episode of transfusion on severe anemia and taking corticosteroids for pneumonia. Bronchoscopy revealed pulmonary hemorrhage and the diagnosis was confirmed by histological exam after kidney biopsy. He was treated with corticosteroids and cyclophosphamide, with a positive response to treatment. He is currently in a stable condition.

Transplantation of a tooth is often associated with the resorption of the root, frequently followed by ankylosis. In this case report, a female patient with an external root resorption following transplantation of her immature lower left premolar tooth into the socket of the upper right second premolar tooth, was investigated clinically and radiographically, and then successfully treated by the root canal medication with Calcium hydroxide (Ca(OH)2) paste. This case presentation suggested that in the case of transplantation of an immature tooth, endodontic treatment or pulp removal should be initiated as soon as the root apex is closed enough to allow preparation of the root canal, and Ca(OH)2 paste can arrest the progression of root resorption.

This research note describes the author’s investigation on differences among his three meals, which include breakfast, lunch, and dinner, in terms of their influential factors and their respective PPG data and waveforms. He further described the relationship between his body weight and meal quantity percentage for his normal portion. During this period, from 5/5/2018 to 7/14/2020, he collected detailed information of his 2,403 meals and ~64,000 glucose data.

Cardiac rehabilitation is strongly recommended for patients with chronic heart failure (CHF) with preserved, or reduced left ventricular ejection fraction (LVEF) A cardiac rehabilitation program is combination of physical exercise, diet counseling, educational lectures on lifestyle changes, and disease management as well as psychosocial support. Exercise training remains core component of the comprehensive cardiac rehabilitation program and is strongly recommended in combination with pharmacological treatment to patients with CHF. Exercise-based cardiac rehabilitation affects positively functional capacity, exercise tolerance, and quality of life in CHF patients due to cardiorespiratory, metabolic, and autonomic response. The physical inactivity rate in the Kingdom of Saudi Arabia is still extremely high, due to weather conditions and sociocultural barriers. We present a case that demonstrates tremendous improvement in the physical capacity and the left ventricular systolic function of a patient with CHF and review of literature.

With the diffusion of the various Social Networks, Facebook- Twitter-Istagram-Tik Tok, and above all with the immoderate use in this quarantine-virus period, it happens more and more often to create more and more profiles, finding yourself with a delicate simple but decisive choice: Which photo to choose? There are those who put the close-up of their face, who a whole picture of themselves, who children, who the pet, who the landscape, who a quote. But if the goal is to be attractive or interesting, who doesn't want to?!, The best choice is a group photo with friends. And once again science comes to meet us: two researchers from the University of San Diego, D. Walker and E. Vul, have shown that faces appear more attractive when they appear in a group, the so-called "cheerleader effect". For example, let's take Cheerleader girls.

Metformin is an oral antidiabetic used in the treatment of type 2 diabetes mellitus. More precisely, it belongs to the class of biguanides; Metformin is used in the treatment of type 2 diabetes mellitus both as monotherapy and in combination therapy with other oral antidiabetic agents or with insulin, when dietary interventions and exercise are not sufficient to control the disease.

When used in overweight diabetic patients, metformin also causes a decrease in the complications of diabetes and its use has been associated with stabilization and, albeit modest, loss of body weight. In type 2 diabetes mellitus (called also DM2 and in the past 'adult diabetes' or 'food') the insulin produced by the pancreas is unable to fully exert its action so that the body even produces it in excess, with the result on the one hand of making increasing weight and on the other hand progressively depleting the pancreas, is unable to meet the body's needs. It is as if the body were resisting the action of insulin. Metformin reduces insulin resistance. It is taken by mouth and is the only drug useful in all stages of type 2 diabetes. It also helps improve the balance of fats and, to a limited extent, blood pressure.

Metformin alone has important effects on blood sugar. Accompanied by physical exercise, weight loss and possibly other medications, it is often an effective therapy. It does not cause hypoglycaemia, helps not to gain weight or even reduces it. The main feature of Metformin is to interact strongly with AMPK by regulating its expression. In fact, it’s down regulation leads to consuming ATP, synthesizing cholesterol and fatty acids and consuming glucose: a situation in which insulin levels are quite high (therefore energy abundance). On the contrary, it’s up regulation leads to the creation of ATP, consuming more fatty acids for energy purposes and it is a metabolic situation similar to caloric restriction in which insulin levels are kept low (therefore energy scarcity).

Metformin by up regulating AMPK has therefore shown to have a somewhat transversal therapeutic use in the treatment of metabolic dysfunctions.