Clinical Case Reports最新文献

Multiple drug resistance to Acinetobacter baumannii infection treatment is a great challenge for neuro-intensivists due to poor drug penetration through the blood–brain barrier (BBB). Fortunately, the intraventricular administration of polymyxin-B and tigecycline seems to be effective; there are few case reports demonstrating the effectiveness of such treatments. Here, we report the case of a 24-year-old male who presented with fever and neck rigidity after intracranial drainage following lung infection caused by MDR Acinetobacter baumannii. Due to the presence of turbid CSF, the administration of the intrathecal (ITH) route polymyxin-B and tigecycline is not possible. In this situation, the neuro-intensivist decided to start intraventricular tigecycline and polymyxin-B administration along with IV tigecycline and polymyxin-B via the intraventricular route, which was feasible because the patient had an external ventricular drain (EVD) due to obstructive hydrocephalus caused by the neurosurgeon after excision of the tumor.

This case report documents the experience of a 5-year-old girl who showed signs of retinal degeneration as the initial symptom of neuronal ceroid lipofuscinosis (NCLs). She originally presented with visual failure, which rapidly progressed to near total bilateral blindness. Two years later, she developed seizures and cognitive impairment, leading to a diagnosis of NCL7 resulting from a homozygote mutation in the MFSD8 gene. This case underscores the importance of considering NCLs as a potential diagnosis in cases of cone-rod dystrophy and visual loss as the primary clinical feature. It also emphasizes the early onset and initial presentation of retinal degeneration associated with NCL7, before other signs and symptoms manifest, as the second documented case of its kind. Due to the potential for NCL7 to present initially with visual loss before other hallmark signs, it is crucial to consider it among various syndromic and non-syndromic disorders in the differential diagnosis.

Submental intubation offers a valuable alternative for managing airway in patients with complex maxillofacial injuries, providing unobstructed access for surgical intervention and reducing complications associated with traditional intubation methods. It enhances both surgical visibility and patient safety.

Managing chronic, refractory nausea and vomiting in advanced cancer patients is challenging, especially when unrelated to cancer treatment. Mirtazapine, a tetracyclic antidepressant, effectively alleviates these symptoms, improving quality of life. It offers a promising palliative care alternative, addressing multiple symptoms and reducing polypharmacy, thereby enhancing patient satisfaction.

Continuous ambulatory peritoneal dialysis (CAPD) is used for the maintenance dialysis in patients with end stage renal disease. Treatment's complications in CAPD generally exist, of which transudate hydrothorax falls under the minority of the cases. Here, we aim to present a case of a 51 years old female, a newly diagnosed case of chronic kidney disease (CKD) undergoing CAPD for 3 weeks who presented at our institution with complaints of difficulty in breathing. The symptom had gradually progressed after her recent CAPD session. Several investigations were sought out, of which a chest X-ray illustrated a right sided hydrothorax. Pleural fluid analysis showed a transudate characteristic, and other diagnostic tests suggested that a peritoneal fluid leak might have caused the hydrothorax. CAPD induced hydrothorax is one of the uncommon noninfectious complications associated with peritoneal dialysis; its diagnosis can be made by studying both biochemical and radiological parameters of the patient. The definitive diagnosis is made by establishing a pleuro-peritoneal communication using peritoneal scintigraphy. An immediate halt in CAPD will allow the remission of hydrothorax as mentioned below in our case report. The definitive management includes video assisted thorascopic surgery with mechanical pleurodesis. An appropriate diagnostic and management approach should be sought in CAPD induced transudate hydrothorax. An immediate halt in CAPD with surgical interventions can be considered as a treatment options for such complication.

The entrapment of the left renal vein (LRV) may contribute to changes in hemodynamics within kidney and could also be associated with IgA nephropathy (IgAN). Although the relationship between the nutcracker phenomenon and IgAN has not yet been elucidated, it is speculated that this patient's refractory hypertension is a combined effect of nutcracker syndrome (NCS) and IgAN.

The prevalence of hypercalciuria in children is 3%–10% globally and up to 35% in the United States. Hypercalciuria in children has many presentations; it causes different metabolic disorders and can negatively affect a child's growth. It also increases the risk of low bone mineral density and urinary tract infections. In addition, it is the most widespread cause of persistent microscopic hematuria. Changes in the diet and medications in cases of advanced stage can be useful to prevent further complications. This study aimed to determine the prevalence of hypercalciuria and to investigate its relationship with different factors in children aged 2–16 years with asymptomatic microscopic hematuria in 2020 in the Children's Medical Center hospital. This retrospective cross-sectional study was performed in a population of children aged 2–16 years old with asymptomatic microscopic hematuria who were referred to the Children's Medical Center clinic in 2020. Data such as age, sex, serum creatinine level, and proteinuria were extracted from the patient's medical records, and their relationship with hypercalciuria was analyzed using logistic regression analysis. According to the inclusion criteria, 166 children with asymptomatic microscopic hematuria (72 boys and 94 girls) were included in this study. The prevalence of hypercalciuria (ratio of random urine calcium to creatinine more than 0.2) in these patients was estimated at 25% with a confidence interval of 18%–32%. In order of prevalence, the most common conditions accompanying microscopic hematuria were kidney stones, urinary tract infections, and proteinuria. The age of patients with hypercalciuria was 2 years younger on average. Each year of age increase and every 5 years of age increase between the ages of 2 and 16 years reduced the chance of hypercalciuria in this category of patients by 12% and 45%, respectively. Our findings also showed that children with a positive history of kidney stones were about 2.2 times more likely to have hypercalciuria than their counterparts, which is considered a medium effect size. Our results showed that hypercalciuria in children with hematuria is significantly related to younger age and a positive history of kidney stones.