by Hendro Sudjono Yuwono
Case Study
A case report of a chronic wound complication, in a 63-year-man, suffered diabetic mellitus type 2, that successfully treated using coffee powder. The coffee powder has used as a topical dressing in many wound cases with a useful result and faster healing. It is an effective topical dressing through maintaining contact of coffee powder along the wound bed to prevent any manipulation and protect the new superficial cell growth. The method claimed to be the best to protect the cells in superficial wound bed by the coffee powder producing a best toleration, comfort, adaptable, cost-effective, and create a new paradigm of wound management.
American Journal of Medical Case Reports. 2019, 7(5), 94-96. DOI: 10.12691/ajmcr-7-5-5
Pub. Date: May 25, 2019
9891 Views1854 Downloads
by Salem Bouomrani, Karama Regaïeg, Nesrine Belgacem, Mouna Guermazi, Sami Krimi and Abdelfatteh Zakhama
Original Research
Granulomatosis with polyangiitis (GPA), formerly known as Wegener's disease, is a rare necrotizing and granulomatous systemic vasculitis of small vessels. Cardiac involvement in GPA is unusual and the heart is part of the so-called "atypical" locations of this vasculitis. This complication is often little-known and overlooked by clinicians despite its severity and high mortality. Symptomatic acute myocardial infarction is an exceptional presentation of cardiac involvement associated to GPA. We report an original observation of fatal cardiac damage revealing GPA in a 50-year-old Tunisian man with no pathological medical history. The diagnosis was made on post-mortem examination.
American Journal of Medical Case Reports. 2019, 7(5), 90-93. DOI: 10.12691/ajmcr-7-5-4
Pub. Date: May 21, 2019
11473 Views1682 Downloads
by Aazim Arif, Cilia Nazef, Karolain Garcia, Aman Kataria, Alexander Baradei and Kristy Crawford D.O.
Case Report
Background: One of the most common surgical problems that requires emergent intervention during pregnancy is acute appendicitis [1]. The incidence of appendicitis during pregnancy is 1 in 766 births, with 16% of the diagnoses occurring within the third trimester [1,2]. Acute appendicitis, with subsequent wall-off perforation, can pose a great risk to both the mother and the fetus. Thus, it is extremely important to recognize and correctly diagnose acute appendicitis, in all trimesters of pregnancy. Case Presentation: This case report discusses a 30-year-old G1P0 with a gestation age of 39.6 who presented to the hospital with complaint of flank pain that waxed and waned. The medical team consisting of labor and delivery nurses, obgyn attending physician and a general surgery attending. Possible etiologies for such presentation including UTI, nephrolithiasis, pyelonephritis, uterine abruption, uterine rupture or musculoskeletal causes were all effectively ruled out. MRI was then performed and suggested appendicitis with associated appendicolith. The risk of perforation and potential complication was discussed amongst the patient, obstetrician and general surgeon. The patient was given an active participation in the decision making and ultimately decided that she would like to proceed with cesarean and appendectomy. Conclusions: Given the nonclassical presentation of acute appendicitis in pregnancy, a closer evaluation for the underlying etiology is warranted. Acute appendicitis in pregnancy should not be excluded based on clinical evaluation alone, as there is great risk posed to the mother and fetus if missed. Imaging should be performed if no other underlying etiology can account for the clinical features. Any diagnostic uncertainty may delay surgical intervention resulting in risk of maternal morbidity and potential fetal mortality. In term patients, expeditious delivery followed by appendectomy may be warranted.
American Journal of Medical Case Reports. 2019, 7(5), 87-89. DOI: 10.12691/ajmcr-7-5-3
Pub. Date: May 17, 2019
7445 Views1697 Downloads
by Jehad Azar, Ali Varasteh, Daniel Iltchev, Mona Soliman, Victor Baez and Basel Altaqi
Case Report
Pulmonary arterial hypertension (PAH) describes a rare, progressive disease of the pulmonary vasculature, involving a group of clinical conditions that result in precapillary pulmonary hypertension (PH). PAH is characterized by proliferative vasculopathy, and subsequent right heart failure. For the past several decades research has focused on identification of underlying molecular causes of this disease. Recently, there have been a number of reported cases of patients with scurvy developing pulmonary arterial hypertension. Thus, it has been hypothesized that vitamin C deficiency results in non-hypoxic activation of hypoxia inducible transcription factors (HIF) and low nitric oxide (NO) level in the pulmonary vasculature, leading to subsequent pulmonary vasculopathy and an exaggerated pulmonary vasoconstrictive response. Immediate supplementation of vitamin C is considered the definitive treatment, preventing an otherwise fatal outcome. In this paper, we describe a patient with a fatal case of scurvy related PAH, who was admitted with ecchymosis, oral ulceration, and dyspnea.
American Journal of Medical Case Reports. 2019, 7(5), 79-86. DOI: 10.12691/ajmcr-7-5-2
Pub. Date: May 11, 2019
9767 Views1790 Downloads
by Perry Wengrofsky, Pramod Theeta Kariyanna, Eric Kupferstein, Howard Levitt, Sudhavna Hegde and Samy I. McFarlane
Case Report
Coronary artery fistulas (CAFs) represent a spectrum of abnormal connections between a coronary artery and another coronary artery, vein, or major blood vessel, known as coronary-vascular fistulas, or between a coronary artery and a cardiac chamber, known as coronary-cameral fistulas. While CAFs generally remain asymptomatic into the fifth decade of adult life, they can present with a diverse symptomatic profile, typically with angina from abnormal myocardial perfusion, or in the setting of larger fistulas, as right- or left-heart failure from pulmonary or left ventricular circulatory overload. CAFs rarely manifest as myocardial infarction in the absence of thrombosis within the fistula. When clinically suspected based on a continuous murmur on physical exam or an accidental finding on radiology, computed tomography angiography (CTA) and coronary angiography are the preferred diagnostic imaging modalities. Fistula anatomic and patient specific characteristics guide clinical decisions on transcatheter or surgical management strategies. We present the case of a right coronary artery-superior vena cava fistula manifesting as a non-ST elevation myocardial infarction. We also present a review of the imaging techniques available for evaluation of CAFs, and a summary of the major national and international cardiology society guidelines on the diagnosis and management of CAFs.
American Journal of Medical Case Reports. 2019, 7(5), 74-78. DOI: 10.12691/ajmcr-7-5-1
Pub. Date: May 04, 2019
8124 Views1858 Downloads