by Tobin Mathew, Francesca Macaluso and Isabel M. McFarlane
Case Study
Objectives: Ÿ To outline the key components of a pre-operative cardiac risk assessment. Ÿ To review the major guidelines utilized to assess patients¡¯ surgical risks. Ÿ To discuss the perioperative management of surgical patients to prevent cardiac and pulmonary complications. Ÿ To review the utility of biomarkers in the pre- and post-operative period.
American Journal of Medical Case Reports. 2020, 8(10), 374-382. DOI: 10.12691/ajmcr-8-10-15
Pub. Date: July 14, 2020
3433 Views548 Downloads
by Evan Botti, Filip Oleszak, Michelle Likhtshteyn, Andreii Maryniak and Mohammed Rahman
Original Research
A common treatment and management of BPH is transurethral resection of the prostate (TURP) with at least 150,000 TURPs performed per year in the United States. Rates of bacteremia following TURP can be as low as 1% when antimicrobial prophylaxis is given. Patients can develop many common sequelae as a result of bacteremia secondary to TURP including bacteriuria and urinary tract infection; however, more serious complications such as endocarditis are quite rare (~1 in 4200 cases). Here we present a case of a 67 year-old-male with BPH who underwent two TURP procedures; both with appropriate antibiotic prophylaxis who was subsequently diagnosed with endocarditis
American Journal of Medical Case Reports. 2020, 8(10), 370-373. DOI: 10.12691/ajmcr-8-10-14
Pub. Date: July 14, 2020
4141 Views425 Downloads
by Ahmed Al Azri, Sharad S Rajamani, Neeraj Salhotra, Samit Biniwale, Ahmed Tolba and Mahmood Al hatali
Case Report
Treatment of brain abscess is still a subject of controversy. Simple therapeutic approaches like twist drill/burr hole aspiration with or without insertion of a drain are also quite effective. There are reports of encouraging results following endoscopic treatment. We are reporting our case treated by this endoscopic approach.
American Journal of Medical Case Reports. 2020, 8(10), 367-369. DOI: 10.12691/ajmcr-8-10-13
Pub. Date: July 10, 2020
3822 Views374 Downloads
by Dedy Pratama, Hendro Sudjono Yuwono, Rudi Supriyadi and Herry Herman
Original Research
Curcumin has many advantages, i.e., antioxidant, antiplatelet, anti-inflammatory, and antidiabetes. It applied for the maturation of arteriovenous fistula (AVF) in the diabetic end-stage renal disease of two diabetic patients. The administration of oral Curcumin examined the maturation on the 4th week and the 8th week. The results in both cases show maturity at the end of eight weeks without any complication.
American Journal of Medical Case Reports. 2020, 8(10), 365-366. DOI: 10.12691/ajmcr-8-10-12
Pub. Date: July 08, 2020
3302 Views469 Downloads
by Nazish Malik and Munawwar Hussain
Case Report
Thyroid storm is a rare, life-threatening condition characterized by severe clinical manifestations of thyrotoxicosis. Hyperpyrexia to 104 to 106°F is common. It is usually precipitated by noncompliance with medication, infection, thyroid or non-thyroidal surgery, and parturition. In this article, we present a case of a young 39-year-old male patient with no significant history of thyroid disorder who presented with palpitation and shortness of breath. The patient was diagnosed with normothermic thyroid storm without any precipitation factor. The patient had circulatory collapse with shock and acute respiratory failure needing ventilatory and ionotropic support. The patient was appropriately treated and discharged home. The patient was normothermic during the entire hospital stay.
American Journal of Medical Case Reports. 2020, 8(10), 363-364. DOI: 10.12691/ajmcr-8-10-11
Pub. Date: July 03, 2020
2938 Views439 Downloads
by Sadaquat Liaqat, Asghar Marwat and Munawwar Hussain
Case Report
Tumor lysis syndrome (TLS) is an oncologic emergency resulting from a massive breakdown of tumor cells. It causes electrolyte imbalance and acute renal failure. It occurs after the initiation of chemotherapy. Spontaneous tumor lysis syndrome is seen in Burkitt's lymphoma, acute lymphoid leukemia, diffuse large B-cell lymphoma, and solid tumors like breast and prostate cancer. Spontaneous tumor lysis syndrome is exceedingly rare in patients with myeloproliferative disorders. We report a rare case of spontaneous tumor lysis in an 82-year-old female patient with a myeloproliferative disorder.
American Journal of Medical Case Reports. 2020, 8(10), 361-362. DOI: 10.12691/ajmcr-8-10-10
Pub. Date: July 03, 2020
3174 Views578 Downloads
by Sana Ahmad and William Chang
Case Report
Exercise is recommended for both primary and secondary prevention of cardiovascular disease. Exercise-associated elevations of cardiac biomarkers can be present especially after prolonged and strenuous endurance exercise bouts but the exact mechanism and clinical significance is unclear [1]. This case report is of a patient with recent increase in exercise activity who presented to the emergency department with atypical symptoms and increasing cardiac biomarkers concerning for myocardial infarction. He was admitted and taken for left heart catheterization which showed non-obstructive coronary artery disease. The lack of awareness of this phenomenon may lead to inappropriate management of these patients.
American Journal of Medical Case Reports. 2020, 8(10), 358-360. DOI: 10.12691/ajmcr-8-10-9
Pub. Date: July 03, 2020
3037 Views425 Downloads
by Pramod Theetha Kariyanna, Harshith Priyan Chandrakumar, Apoorva Jayarangaiah, Abdullah Khan, Volodymyr Vulkanov, Michael Ashamalla, Moro O. Salifu and Samy I. McFarlane
Original Research
COVID-19 is a pandemic that started in Wuhan city, Hubei province in China in December 2019 and is associated with high morbidity and mortality. It is characterized by a heightened inflammatory and prothrombotic state that are known to cause various cardiovascular manifestations such as thromboembolism, acute coronary syndrome and stroke. We here present a 72-year-old woman with multiple cardiovascular risk factors and COVI 19 pneumonia who presented with acute ischemic stroke. She was also noted to have ST segment elevation myocardial infarction (STEMI) on the electrocardiogram however the imaging and clinical presentation was consistent with apical takotsubo cardiomyopathy. We here discuss the various pathophysiologic mechanisms by which COVID-19 can result in acute stroke. The patient likely developed takotsubo cardiomyopathy because of stroke and acute COVID-19 induced sympathetic stimulation and catecholamine surge. To the best of our knowledge this is the first case of apical variant of takotsubo cardiomyopathy in a COVID-19 report.
American Journal of Medical Case Reports. 2020, 8(10), 350-357. DOI: 10.12691/ajmcr-8-10-8
Pub. Date: July 03, 2020
4738 Views646 Downloads
by Zain AlShanableh, Pimen Kurashvili, Jehad Azar and Basel Altaqi
Case Report
Acinetobacter is a gram-negative coccobacillus associated with various hospital-acquired infections and community-acquired infections including pneumonia as well as urinary tract, skin, and soft tissue infections. Acinetobacter is a rare cause of infective endocarditis reported mainly in hospitalized patients with risk factors, and typically presents with severe disease.
American Journal of Medical Case Reports. 2020, 8(10), 348-349. DOI: 10.12691/ajmcr-8-10-7
Pub. Date: July 01, 2020
3522 Views391 Downloads2 Likes
by Pramod Theetha Kariyanna, Ruchi Yadav, Vivek Yadav, Samuel Apple, Naseem A. Hossain, Neema Jayachamarajapura Onkaramurthy, Apoorva Jayarangaiah, Ayesha Saad and Isabel M. McFarlane
Case Report
The understanding of neural regulation of the cardiovascular function and the implications of a “Heart-Brain Axis “has been a topic of interest for clinicians for many years. Electrocardiographic (ECG) and structural cardiac changes, ranging from mild, asymptomatic, transient alteration in cardiovascular function to severe, irreversible, and potentially life-threatening injury, can actually be a manifestation of several neurological disorders. When managing cardiac disorders, a high index of clinical suspicion, detailed history-taking and physical examination skills, and an extensive workup that covers both cardiac and non-cardiac causes should be utilized. It is important to consider that cardiovascular dysfunction of an underlying neurological etiology may lead to difficulty in diagnosing and optimizing treatment of the latter. We report the case of a middle-aged female with the chief complaint of syncope preceded by a headache with no focal neurological deficits, originally diagnosed with- and whose syncope was attributed to sinus bradycardia and type I sinoatrial (SA) exit block on ECG. Subsequently, when the patient became altered, however, computer tomography (CT) angiography revealed subarachnoid hemorrhage (SAH) with middle cerebral artery aneurysm. This presentation emphasizes the importance of tabulating neurological injury as one of the differential diagnoses while managing ECG changes in cardiovascular disease (CVD), as missing and delaying the former can result in disastrous consequences.
American Journal of Medical Case Reports. 2020, 8(10), 341-347. DOI: 10.12691/ajmcr-8-10-6
Pub. Date: June 22, 2020
4988 Views632 Downloads
by Pramod Theetha Kariyanna, Lyudmila Aurora, Apoorva Jayarangaiah, Vivek Yadav, Naseem. A. Hossain, Nasrin Akter, Moro O. Salifu and Isabel M. McFarlane
Review Article
Coronavirus Disease-2019 (COVID-19) is currently a public health emergency and has been listed by the World Health Organization (WHO) as a pandemic. It has commonly been associated with pulmonary manifestations and there is a growing body of evidence of multisystem involvement of the virus. As evidenced by various case reports and cohort studies, COVID-19-associated coagulopathy has been a common manifestation amongst the critically ill and has been associated with increased mortality. The presence of venous thromboembolic events in patients who are critically ill due to COVID-19 has prompted the adoption of anticoagulation regimens aimed at preventing thromboembolic phenomena. Coagulation abnormalities have also been implicated in the progression and the severity of COVID-19 related acute respiratory distress syndrome (ARDS) and disseminated intravascular coagulation (DIC). There is strong evidence that D-dimer levels help predict which patients are at risk of thromboembolic events, progression to ARDS, DIC, immune dysregulation and mortality. We will review the utility of D-dimer as screening tool and in the risk stratification of COVID-19 patients prone to developing thromboembolic events, DIC, immune dysregulation and death. To date, the studies that have been published show the presence of elevated D-dimer levels in both the adult and pediatric populations and the measured level correlates with disease severity. Studies have also shown the relative increase of D-dimer levels in non-survivors compared to survivors. The elevation of D-dimer levels has shown to guide clinical decision making, namely the initiation of therapeutic anticoagulation and mortality benefit in patients with severe COVID-19 pneumonia compared to severe non COVID-19 pneumonia. Although the current body of literature suggested the use of D-dimer as a risk stratification tool and as a test to augment clinical judgement regarding the initiation of anticoagulation, randomized control trials are needed to fully understand the relationship between COVID-19 infection and the efficacy of D-dimer assays in clinical decision making.
American Journal of Medical Case Reports. 2020, 8(10), 337-340. DOI: 10.12691/ajmcr-8-10-5
Pub. Date: June 22, 2020
3213 Views539 Downloads
by Sana Ahmad and Jacob Schwartz
Case Report
Ketogenic diets are diets based on restricted carbohydrate intake in favor of foods high in protein, fats, and fiber. As a result, blood sugar levels tend to drop. This process ultimately leads to the production of ketones which are then used by the body for fuel resulting in ketonemia. This case report focuses on a non-obese male with no past medical history who presented with several days of nausea and vomiting after recently starting himself on a ketogenic diet. Upon admission, the patient was found to have an increased anion gap metabolic acidosis with a gap of 37. Secondary causes of elevated anion gap metabolic acidosis were ruled out. The patient was appropriately fluid resuscitated with a dextrose containing fluid with improvement in symptoms and closure of the gap. Underlying hepatic steatosis may contribute to the development of euglycemic ketoacidosis in those on a low carbohydrate diet. A minimum amount of carbohydrates (approximately 100 grams) may prevent ketosis in these patients. It is important for providers to understand and recognize that severe euglycemic ketoacidosis can be a complication of a ketogenic diet.
American Journal of Medical Case Reports. 2020, 8(10), 335-336. DOI: 10.12691/ajmcr-8-10-4
Pub. Date: June 18, 2020
3275 Views558 Downloads
by Hira Chaudhary, Peter Gillette, Michael Ashamalla, Angeleque Hartt, Moro Salifu and Samy I. McFarlane
Case Report
Acute chest syndrome (ACS) is associated with prolonged hospitalization and high mortality in sickle cell population. The etiology of ACS is often multifactorial. It is well known that any chest pain that limits ventilation, blood flow or oxygenation establishes the risk of ACS. The independent contributory mechanism is fluid overload, resulting in pulmonary edema. In this report, we present a case of compound heterozygous Hb S/β+ thalassemia in a 32-year-old woman who presented with chest pain complicated by the development of pulmonary edema advancing to acute chest syndrome. We discuss the putative mechanisms might have led to pulmonary edema in this patient including hydration with underlying renal defect, along with a vicious cycle of vascular changes that resulted into pulmonary edema and consequently ACS.
American Journal of Medical Case Reports. 2020, 8(10), 332-334. DOI: 10.12691/ajmcr-8-10-3
Pub. Date: June 18, 2020
5110 Views969 Downloads
by Nyein Nyein Thaw Dar, Ismail Oladeji Malik, Robert Miguel Thomas, Maria Madah, Aye Mar Aung, Dora Izaguirre-Anariba, Simona Bratu and Luqman Salahudeen
Case Report
Varicella zoster viral infection commonly presents as “chickenpox” in children and “shingles” in adults which may be complicated by meningitis in the immunocompromised but very rarely in the immunocompetent. Also, most reported cases of zoster meningitis were associated with the development of crops of vesicular rash at the cranial or cervical dermatomal levels. Here, we present a case of a 55-year-old African man with history of chronic low back pain who presented with frontal headache, fever and rash of the left lower extremity of two days’ duration. He had no neck stiffness, neck pain or mental status changes on presentation. Brain imaging revealed no significant findings but Cerebrospinal fluid (CSF) examination showed lymphocytic pleocytosis and patient was promptly started on IV acyclovir. Biofire CSF analysis detected presence of Varicella Zoster virus (VZV). In this clinical encounter, leg rash and non-specific symptoms of fever and headache in the absence of meningism, confusion or focal neurologic deficits is an unusual presentation of VZV meningitis which may delay diagnosis. Hence, a high index of suspicion and early treatment for neurologic complications of VZV like meningitis is required in order to prevent lethal or severe long-term neurologic deficits in patients.
American Journal of Medical Case Reports. 2020, 8(10), 328-331. DOI: 10.12691/ajmcr-8-10-2
Pub. Date: June 17, 2020
4105 Views565 Downloads
by Andrew Wahba and Rafik ElBeblawy
Case Report
Schwartz-Jampel syndrome (SJS) is a rare autosomal recessive hereditary disorder characterized by the triad of myotonia, facial dysmorphisms, and skeletal deformities. Less than 150 cases have been reported in the medical literature. SJS is caused by mutations in the gene heparan sulfate proteoglycan 2 (HSPG2) located on chromosome 1p34-36.1 which encodes perlecan, a major component of basement membranes. Here we report three novel mutations in a 6-year-old girl.
American Journal of Medical Case Reports. 2020, 8(10), 325-327. DOI: 10.12691/ajmcr-8-10-1
Pub. Date: June 16, 2020
3631 Views435 Downloads