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Tuberculosis is a worldwide health concern with a wide range of clinical manifestations. Rarely, it can involve the central nervous system in the form of tuberculomas. Although cranial nerve palsies or localized neurological signs are the most frequent presentations of tuberculoma, isolated sixth nerve palsy is unusual and rare. We report the case of a 17-year-old female who presented with isolated sixth nerve palsy, an unusual early manifestation of intracranial tuberculoma. We established the diagnosis through clinical, radiological, and laboratory evaluations and successfully managed the patient with antitubercular therapy. This case highlights the importance of considering tuberculoma as a differential diagnosis in cases of isolated cranial nerve palsies, especially in regions with a high prevalence of tuberculosis.
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Madras motor neuron disease (MMND) is a rare childhood or juvenile motor neuron disease. Herein, we present a unique case of MMND in an 18-year-old patient, which challenges the conventional understanding of the disease's onset and progression. The patient, a previously healthy adolescent, presented with insidious onset and gradually progressive weakness of all four limbs, wasting, tongue fasciculation, and bilateral sensorineural hearing loss. Neurological examination revealed signs consistent with lower motor neuron involvement. Electromyography (EMG) and nerve conduction studies (NCS) supported the diagnosis of MMND. The patient's clinical course exhibited rapid deterioration, leading to significant functional impairment within a short timeframe. Treatment modalities, including supportive care and symptomatic management, were implemented; however, disease progression remained relentless. This case highlights the significance of considering MMND in the differential diagnosis of motor neuron diseases, even in young individuals. It highlights the importance of conducting more studies to comprehend the underlying mechanisms and consider potential therapeutic strategies for this uncommon ailment.
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Phenytoin is a first-generation anticonvulsant medicine that efficiently cures a wide range of seizures, including status epilepticus, complex partial seizures, and generalized tonic-clonic seizures (GCTS). The major advantage of phenytoin is that its neurological functions are preserved. Phenytoin works by inhibiting voltage-dependent membrane Na channels, which are essential to generate action potential. This function inhibits the positive feedback, leading to high-frequency repeated firing, reducing seizure spread in the focal region. A purple color rash on the chest, abdomen, and trunk developed in a 21-year-old female patient after being treated with phenytoin is being reported. The presentation, pathophysiology, and management are also reviewed.
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This comprehensive review explores the complex dynamics of nosocomial infections in individuals with sickle cell anemia (SCA) and advocates for a collaborative strategy to enhance prevention. SCA patients, marked by compromised immunity and susceptibility to infections, face unique challenges that necessitate tailored preventive measures. The review underscores the importance of vaccination, antibiotic prophylaxis, education, and environmental hygiene in mitigating the risk of nosocomial infections. Addressing socioeconomic factors, healthcare system limitations, patient-related issues, and cultural considerations is imperative for effective prevention. The call to action emphasizes the pivotal roles of healthcare professionals, policymakers, researchers, and community engagement in implementing targeted interventions. By fostering a collective effort, this review envisions an improved landscape for infection prevention in SCA patients, enhancing their overall health outcomes and quality of life.
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Post-burn necrotizing fasciitis (PBNF) is a serious and potentially life-threatening infection that occurs after a burn injury. It is characterized by rapid destruction of soft tissue and muscle and is usually caused by a bacterial infection. Diabetic ketoacidosis (DKA) is another serious complication of diabetes, which can occur when the body does not have enough insulin to break down glucose for energy. This causes the body to start breaking down fat for energy instead, leading to various complications. The present study discusses the association between PBNF and DKA in a patient with diabetes. Here is a case of a post-auricular abscess and a precipitated DKA. The abscess was located near the site of the previous burn injury that happened 20 years ago and was believed to have developed as a result of thick scar tissue. The patient was given adequate hydration, intravenous antibiotics, and insulin therapy. However, the abscess continued to grow with increasing insulin requirements and the patient underwent incision and drainage to remove the infected tissue, and an aggressive debridement was carried out. Thus, this case highlights the importance of closely monitoring blood sugar levels in patients with a history of burn injury and diabetes, as well as the potential for infections to precipitate DKA. Timely intervention, including incision and drainage, can lead to successful resolution of symptoms and improved outcomes.
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Superior vena cava syndrome (SVCS) is a collection of signs and symptoms resulting from superior vena cava obstruction which is either partial or complete. SVCS is a rare clinical entity, often associated with various malignancies. T-cell lymphoblastic lymphoma (T-LBL) primarily of the mediastinum (thymus) is a rare and aggressive non-Hodgkin lymphoma that can lead to SVCS. We discuss the case of a 19-year-old male who arrived at our emergency department with symptoms of cough, breathlessness, and facial puffiness along with swelling in the right anterior mediastinum for two weeks suggestive of acute SVCS. An anterior mediastinal mass was confirmed on a chest X-ray and computed tomography. A biopsy of the mass revealed primary mediastinal (thymic) T-LBL. This case report focuses on the unique presentation of a T-LBL as SVCS in a 19-year-old male. Moreover, it highlights the need for vigilance among healthcare providers in recognizing this atypical complication and underscores the critical importance of early diagnosis and timely intervention.
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Introduction Even after the breakthrough advancements in the management and prognostic scoring of sepsis, it remains an important cause of morbidity and mortality encountered in intensive care units (ICUs) throughout the globe. This study highlights the utility of platelet indices as prognostic markers of sepsis. Methods In the present prospective cross-sectional study, a total of 177 patients with sepsis were enrolled using the Sepsis-3 criteria. The platelet indices were then linked to severity using the Acute Physiology and Chronic Health Evaluation (APACHE) II score. The correlation of platelet indices to morbidity in terms of the length of ICU stay, need for a mechanical ventilator, types of infection, and mortality was also assessed. Results The results showed that mean platelet volume (p = 0.004) and platelet distribution width (PDW; p = 0.009) were positively correlated with the severity of sepsis. Among all the parameters, plateletcrit (%) was the best predictor of the need for an invasive mechanical ventilator at a cutoff point of ≤0.22 with a 60.90% chance of correctly predicting the need for an invasive mechanical ventilator, as was mortality at a cutoff point of ≤0.22 with a 67.30% chance of correct prediction. Among the platelet indices, only PDW showed a significant association with growth in culture because patients with growth had significantly higher PDW as compared to those who did not have growth (22.4 ± 4.47 vs 20.81 ± 4.29, p = 0.011). Conclusion The difference between the survivors and non-survivor groups was statistically significant for platelet indices, making them easily available, cost-effective, and useful prognostic markers for patients in septic shock. This will help in easy understanding and preventing its morbid complications, even at the primary care physician level.
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Posterior reversible encephalopathy syndrome (PRES) is a clinical-radiological illness characterized by neurological symptoms and reversible changes in neuroimaging. We discuss the case of a 45-year-old patient with an alcohol use disorder who presented with an altered mental state in the emergency room. Home-made alcohol, known to contain significant quantities of methanol, was recently consumed in excess by the said patient. The diagnosis of PRES was supported by magnetic resonance imaging (MRI), which showed bilateral hyperintense regions in the temporo-occipital lobes and diffuse cerebral edema. The development of PRES and chronic alcoholism, as well as binge drinking and possible endothelial dysfunction, are all highlighted in this case study. For individuals with PRES, early identification and adequate care are essential for reducing complications and improving outcomes.
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Pantothenate kinase-associated neurodegeneration (PKAN) is a rare and complex neurodegenerative disorder. It occurs due to mutations in the sequencing of the PANK2 gene. Here, we describe the case of a 22-year-old male patient who presented with severe blepharospasm; he had abnormal facial distortions, shaky limbs, rigid muscles, and a slow pace of movement, making a diagnosis tricky. Accumulation of iron in excessive amounts in the basal ganglia, a part of the brain that governs movement, is linked to PKAN. In this case, the "eye of the tiger" indication, a distinctive pattern only seen by MRI, supported PKAN. The anticholinergic medications helped him alleviate his symptoms to some extent, but he still had some degree of impairment. This instance emphasizes the mysterious character of PKAN and the significance of keeping an eye out for unusual symptoms in neurodegenerative conditions. This case report emphasizes the significance of recognizing unexpected effects that brain disorders can have on people's lives and calls for increased clinician awareness and understanding.
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Heavy menstrual bleeding (HMB) or abnormal uterine bleeding (AUB) is a common cause of gynecological complaints in perimenopausal women. The treatment chosen by most of the women having HMB/AUB in the perimenopausal age group when medical therapy fails is hysterectomy, which unfortunately has significant issues related to safety and long-term quality of life apart from being a burden on the health care system and cost to patients. Minimal access surgical techniques like hysteroscopic targeted therapies are available which are conservative and spare the uterus and major surgery and its complications and sequelae. Hysteroscopic management of HMB is a minimally invasive and targeted approach in diagnosing and treating the pathological lesions causing the symptoms and not radical like hysterectomy which has more chances of occurrence of adverse events both intra and postoperatively. In terms of health-related quality of life, women suffering from HMB who underwent a hysteroscopic conservative approach had better scores when compared to those with hysterectomy. The present review aims to review the evidence generated to compare the two surgical modalities, hysteroscopic targeted therapy and hysterectomy, in terms of their effectiveness, safety, and effect on the quality of life of these perimenopausal women having HMB/AUB.
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Chorea is a disorder characterized by irregular, involuntary movements affecting the limbs, trunk, neck, or face. It can be a significant symptom in various neurologic diseases, including metabolic, autoimmune, and neurodegenerative conditions. The neural foundation that underlies the genesis of chorea appears to be fairly diverse, even though its pathophysiology is frequently associated with the malfunctioning of inhibitory circuits within the basal ganglia. Movement disorders such as tremors, myoclonus, ataxia, chorea, and Parkinsonism may arise due to renal dysfunction or complications from management like renal transplant and hemodialysis. Uremic encephalopathy is a rare but potentially life-threatening neurological complication of chronic kidney disease. We present a case of a 50-year-old male with a known history of chronic kidney disease and chronic alcoholism, who exhibited abnormal movements resembling chorea upon presentation. Initially suspected as alcohol withdrawal-related chorea, further evaluation revealed concurrent rising creatinine levels, acidosis, and hyperkalemia. Hemodialysis was initiated, resulting in a significant improvement in choreoathetoid movements. This case implies the importance of considering uremic encephalopathy in the differential diagnosis of movement disorders in patients with underlying kidney dysfunction, even in the context of chronic alcoholism.
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Introduction Asthma is defined as a chronic inflammatory airway disease. The prevalence of both asthma and obesity has been rising simultaneously, demonstrating a parallel trend. Obesity is a significant factor in metabolic syndrome, and numerous studies have indicated a connection between metabolic syndrome and bronchial asthma. Aims and objectives The aim of this paper is to evaluate the association of asthma with patients diagnosed with metabolic syndrome. The main objectives were to analyze the clinical profile and spirometric indices in patients with metabolic syndrome and to assess asthmatic patients among them with spirometry and clinical parameters at a tertiary care hospital in Chennai. Materials and methods This hospital-based cohort study was conducted on 73 patients attending the outpatient department who had a known case of metabolic syndrome and were evaluated for asthma through history, physical examination, and a pulmonary function test. A history of cough, expectoration, shortness of breath, wheezing, chest tightness, allergy, seasonal variation, and smoking habits was asked, and a thorough physical examination was performed. Bronchial asthma was confirmed with airflow reversibility by spirometry as per the Global Initiative for Asthma Guidelines. Metabolic and spirometry parameters were examined, such as body mass index (BMI), waist circumference, waist-hip ratio, fasting blood sugar (FBS), postprandial blood sugar, hemoglobin A1C (HbA1C), serum insulin, lipid profile, C-reactive protein (CRP), forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), and FEV1/FVC pre- and post-reversibility (baseline vs. six months). Results and discussion The average BMI of all participants was 29.6511 ±2.64564. The waist-hip ratio was 0.5512 ±0.43855, which decreased during the follow-ups, demonstrating a decline in the risk of obesity in study participants. The level of HbA1C showed a drop from 6.1% to 5.9% at the first follow-up. This exhibited a further reduction at the six-month follow-up in addition to a positive reflection in insulin sensitivity, indicating successful control of diabetes among study participants. It was discovered that this was statistically significant (p<0.001). At the third and sixth months of follow-up, the FEV1/FVC ratio increased by 38% and 37%, respectively, when metabolic syndrome was under control. The results show that controlling diabetes, hypertension, obesity, and triglyceride values improved asthmatic symptoms, and this was determined to be statistically significant (p<0.001). Conclusion The results of the current study demonstrated that the regulation and maintenance of metabolic parameters such as BMI, diabetes, hyperlipidemia, and hypertension aid in improving asthma control.
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Ultrasound is the modality of choice for detecting the causes of acute scrotal pain and diagnosing scrotal pathologies. Pyocele is a term used for describing the purulent fluid collection in the scrotal sac, which may present to the hospital as a complication of testicular abscess, epididymal-orchitis, or post-trauma. Ultrasound is the modality of choice for diagnosing such pathologies. The presented case is of a young male from rural India who developed a pyocele post-trauma and underwent an ultrasound examination, where it was found to be a ruptured pyocele with contents spreading into the hemi-scrotum. Rupture of the tunica is frequently associated with the hematocele; however, pyocele is less commonly associated with rupture. The case report discusses the causes of pyocele, imaging features, management, and complications of this pathology along with other possible differential diagnosis.
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Patients present to the orthopedic outpatient department with complaints of shoulder pain on movement or restriction of movement in the shoulder joint and are referred for magnetic resonance imaging (MRI) of the shoulder joint. Almost all the patients have similar complaints but may have a wide range of pathology affecting the joint and causing pain. Rotator cuff tears or tendinopathy are the most common causes of shoulder pain. Ultrasound (USG) and MRI are the most commonly used imaging modalities for assessing rotator cuff pathologies. There is a wide range of pathologies affecting the shoulder joint, other than rotator cuff tendinopathies or tears, for which USG is less sensitive and specific in detecting accurate pathology. MRI is the choice of imaging for shoulder joint pathologies. We present a pictorial review discussing and depicting MRI features of a wide list of pathologies of the shoulder joint complex that should be kept in mind when the patient presents with shoulder pain.
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Germ cell tumors usually occur in the gonads. Extragonadal germ cell tumors (EGCTs) are uncommon, and the head and neck region is a rare primary location. In this region, endodermal sinus tumors are relatively uncommon; they are typically recorded alongside teratomas and infrequently by themselves. When an endodermal sinus tumor arises in the neck, it can present with unique clinical and radiographic features and can be challenging to diagnose and manage. We report the peculiar case of a 25-year-old young adult who was suffering from a painful left-sided neck swelling for a year. Fine needle aspiration cytology (FNAC) of neck mass was performed and the cytomorphological features were suggestive of germ cell tumor. After the diagnosis, the patient received chemotherapy and was posted for wide local excision of the tumor. On microscopic examination, the tumor mass showed histopathological features suggestive of an endodermal sinus tumor.
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Polypharmacy refers to using and consuming multiple drugs as part of the treatment for a disease or disorder. Polypharmacy can lead to an increase in the number of drug overdose emergencies. Age-related metabolic changes and reduced drug clearance in older adults can result in severe drug reactions and other clinical consequences, which can sometimes be fatal, raising concerns about the safety of polypharmacy. We discuss a case of a 50-year-old female who presented to us in a drowsy state after an antipsychiatry (antipsychotic and antidepressant) polypill overdose with 200 tablets and was successfully treated with hemodialysis. This case report highlights that prompt treatment initiation based on the patient's clinical status and drug serum levels is crucial to achieving the best outcomes.
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Chemical pneumonitis caused by dimethanol and glutaraldehyde exposure is a serious medical condition that requires prompt and effective treatment. As per a literature search in Google Scholar, PubMed, and Scopus, this is the first instance of chemical pneumonitis caused after fumigation with dimethanol and glutaraldehyde inhalation. This article discusses the factors that can contribute to the development of chemical pneumonitis and outlines the diagnostic and treatment options available to healthcare professionals. By understanding the causes and consequences of dimethanol- and glutaraldehyde-induced chemical pneumonitis, medical professionals can provide better care to their patients and help prevent future cases of this potentially life-threatening condition. This describes a case of a 60-year-old female who presented to the emergency department complaining of acute onset of shortness of breath approximately 48 hours after being exposed to dimethanol and glutaraldehyde while working in intensive care. After 13 days, the patient's symptoms subsided and she was discharged. On follow-up, after 1 month, there was a marked resolution of the initial symptoms.
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In this case report, we highlight a case of a 24-year-old primigravida who suffered a sudden and painless loss of vision and headache in the immediate postpartum period. Vision loss was transient and remarkable. Her brain magnetic resonance imaging revealed vasogenic edema in parieto-occipital white matter, suggestive of posterior reversible encephalopathy syndrome. Posterior reversible encephalopathy syndrome is a clinical-radiological entity, having hemodynamic catastrophe also known as reversible posterior cerebral edema syndrome. It tends to occur during pregnancy complicated by eclampsia. Hypertension and a hypercoagulable tendency tend to engulf the entire homeostasis into its deadly clutches sending the autoregulation into a frizzy. It presents with a gamut of red flags like headache, seizures, encephalopathy, amaurosis fugax, cortical visual disturbances, and even blindness. Clinical improvement was seen with supportive treatment in this patient. Thus, timely diagnosis and intervention help reverse the dire consequences.
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Erythema multiforme (EM) is a rare immune-mediated condition that can manifest as cutaneous, mucosal, or both types of lesions. The target lesion, with concentric zones of color change, is a cutaneous feature that is typical of this illness. Despite the fact that a number of factors can lead to EM, the most common being Herpes simplex virus (HSV) infection, drug-induced EM is a rare entity. As disease severity and mucosal involvement vary across individuals, treatment should be optimized for each patient, considering the risk versus benefit ratio. To distinguish EM from other clinical imitators and to confirm the diagnosis, histopathologic tests and other laboratory procedures may be utilized. Our patient presented with symptoms suggestive of a viral infection, such as fever and rash, but the RTPCR report for various viral infections came out to be negative, hence indicative of the diagnosis of drug-induced erythema multiforme.
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Degeneration of the lumbar intervertebral disc is the most common cause of lower back pain. It is directly related to daily activities, mechanical stress, and other biological factors. We use imaging modalities to assess the degree of disc degeneration, out of which magnetic resonance imaging (MRI) is the most popular non-invasive modality. It is believed that early changes in disc degeneration are due to the biochemical events in the disc and can be evaluated by sequences in MRI involving the diffusion of water molecules. The apparent diffusion coefficient (ADC) is one such sequence that captures the signals based on the diffusion of water molecules. Ten articles were chosen from PubMed and Google Scholar using the MeSH terms 'lumbar spine degeneration' and 'apparent diffusion coefficient'. This review article has summarized various studies intending to gain a better understanding of the biochemical events leading to the development of disc degeneration. This study has also gathered the role of various sequences in MRI that can quantitatively assess disc degeneration.