Background: Obstructive jaundice is common problem in daily clinical practice and among the most challenging conditions for planning current and future management. The causes are varied, but it is most commonly due to choledocholithiasis; benign strictures of the biliary tract, pancreaticobiliary malignancies, and metastatic disease. Surgery in patients with obstructive jaundice is generally considered to be associated with a higher incidence of complication and mortality. Objective: The purpose of the study was to assess outcome of obstructive jaundice and associated factors at Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia. Methods: A longitudinal study design was used to conduct the study and all patients admitted to the surgical wards for whom surgery was done for obstructive jaundice from May 1, 2022 to April 30, 2023 G.C were included. Chi square fisher’s exact test was used to see the association between obstructive jaundice outcome and independent variables, significance was determined by p-value <0.05. Results: In these study 31 patients were enrolled and the mean age was 49.03 SD±16.16 years. Of patients diagnosed to have obstructive jaundice majority are due to benign causes. Common bile duct stones are the commonest benign condition accounting 88.2% and peri-ampullary cancers are the most frequent (48.4%) cause of obstructive jaundice from malignant condition. Among patients operated 38.7% were underwent bypass procedures. Post-operative complications occurred in 9 (24.3. %) of patients, with surgical site infection being commonest (55.5%). Significant association was identified between types of post-operative complication and management outcome (P=0.034). Conclusion: The most common cause of obstructive jaundice was bile duct stone. Post-operative complications were significantly associated with management outcome of obstructive jaundice.
{"title":"Management Outcome Assessment of Obstructive Jaundice and Associated Factor from\u0000Yekatit 12 Hospital Medical College Addis Ababa, Ethiopia","authors":"","doi":"10.47485/2767-5416.1070","DOIUrl":"https://doi.org/10.47485/2767-5416.1070","url":null,"abstract":"Background: Obstructive jaundice is common problem in daily clinical practice and among the most challenging conditions for planning current and future management. The causes are varied, but it is most commonly due to choledocholithiasis; benign strictures of the biliary tract, pancreaticobiliary malignancies, and metastatic disease. Surgery in patients with obstructive jaundice is generally considered to be associated with a higher incidence of complication and mortality. \u0000Objective: The purpose of the study was to assess outcome of obstructive jaundice and associated factors at Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia.\u0000Methods: A longitudinal study design was used to conduct the study and all patients admitted to the surgical wards for whom surgery was done for obstructive jaundice from May 1, 2022 to April 30, 2023 G.C were included. Chi square fisher’s exact test was used to see the association between obstructive jaundice outcome and independent variables, significance was determined by p-value <0.05.\u0000Results: In these study 31 patients were enrolled and the mean age was 49.03 SD±16.16 years. Of patients diagnosed to have obstructive jaundice majority are due to benign causes. Common bile duct stones are the commonest benign condition accounting 88.2% and peri-ampullary cancers are the most frequent (48.4%) cause of obstructive jaundice from malignant condition. Among patients operated 38.7% were underwent bypass procedures. Post-operative complications occurred in 9 (24.3. %) of patients, with surgical site infection being commonest (55.5%). Significant association was identified between types of post-operative complication and management outcome (P=0.034).\u0000Conclusion: The most common cause of obstructive jaundice was bile duct stone. Post-operative complications were significantly associated with management outcome of obstructive jaundice.","PeriodicalId":513191,"journal":{"name":"Journal of Medical Clinical Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140717451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Giggle incontinence (GI) is a socially embarrassing problem characterized by involuntary and complete bladder emptying in response to laughter. Case Presentation: Here, we report a rare case of giggle incontinence in a 15 years old girl. Physical examination, laboratories, and imaging studies were all negative. Our patient was treated successfully with 10 mg PO methylphenidate for one year. Follow-up for more than one year showed a complete resolution of symptoms. Discussion: To our knowledge, there is no a standard plan for treatment such case. Giggle incontinence can be difficult to recognize, as embarrassment can prevent disclosure of symptoms, and it is difficult to treat. Many reports showed a good response to methylphenidate. Conclusion: Giggle incontinence is a rare condition which it can be seen in childhood. Methylphenidate drug is considered an option for treatment.
{"title":"Giggle Incontinence: An Interesting Case Report","authors":"","doi":"10.47485/2767-5416.1069","DOIUrl":"https://doi.org/10.47485/2767-5416.1069","url":null,"abstract":"Introduction: Giggle incontinence (GI) is a socially embarrassing problem characterized by involuntary and complete bladder emptying in response to laughter.\u0000Case Presentation: Here, we report a rare case of giggle incontinence in a 15 years old girl. Physical examination, laboratories, and imaging studies were all negative. Our patient was treated successfully with 10 mg PO methylphenidate for one year. Follow-up for more than one year showed a complete resolution of symptoms. \u0000Discussion: To our knowledge, there is no a standard plan for treatment such case. Giggle incontinence can be difficult to recognize, as embarrassment can prevent disclosure of symptoms, and it is difficult to treat. Many reports showed a good response to methylphenidate.\u0000Conclusion: Giggle incontinence is a rare condition which it can be seen in childhood. Methylphenidate drug is considered an option for treatment.","PeriodicalId":513191,"journal":{"name":"Journal of Medical Clinical Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140731857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Given the rare occurrence, there is a paucity of literature characterizing surgical management of Wassel Type I thumb duplications, especially at an older age where psychosocial factors become a more significant consideration. Case Presentation: We present a 5-year-old girl with right Wassel Type I thumb duplication with delayed initial presentation for treatment. We performed a modified Wassel Type I radial thumb ablation, percutaneous pinning, and nail reconstruction preserving radial nail fold and transferring to ulnar nail plate and fold. Conclusions: This modified approach maximizes functional and aesthetic outcomes and highlights the significance of considering surgical management to improve quality of life in delayed presentations of Wassel Type I thumb duplication.
背景：瓦塞尔 I 型拇指重复畸形是一种罕见的畸形，有关其手术治疗的文献极少，尤其是在年龄较大时，社会心理因素成为更重要的考虑因素。病例介绍：我们介绍了一名患有右侧瓦塞尔 I 型拇指重复症的 5 岁女孩，她初次接受治疗的时间较晚。我们对她进行了改良的 Wassel I 型桡侧拇指消融术、经皮置钉术和甲重建术，保留了桡侧甲皱襞，并将其转移至尺侧甲板和甲皱襞。得出结论：这种改良方法最大限度地提高了功能和美学效果，并强调了考虑手术治疗以提高瓦塞尔 I 型拇指重复症延迟患者生活质量的重要性。
{"title":"Doubling Down on Maximizing Functional and Aesthetic Outcomes: Modified Technique\u0000for Pediatric Wassel Type I Thumb Duplication: A Case Report","authors":"","doi":"10.47485/2767-5416.1067","DOIUrl":"https://doi.org/10.47485/2767-5416.1067","url":null,"abstract":"Background: Given the rare occurrence, there is a paucity of literature characterizing surgical management of Wassel Type I thumb duplications, especially at an older age where psychosocial factors become a more significant consideration. \u0000Case Presentation: We present a 5-year-old girl with right Wassel Type I thumb duplication with delayed initial presentation for treatment. We performed a modified Wassel Type I radial thumb ablation, percutaneous pinning, and nail reconstruction preserving radial nail fold and transferring to ulnar nail plate and fold. \u0000Conclusions: This modified approach maximizes functional and aesthetic outcomes and highlights the significance of considering surgical management to improve quality of life in delayed presentations of Wassel Type I thumb duplication.","PeriodicalId":513191,"journal":{"name":"Journal of Medical Clinical Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140751453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Traumatic Brain Injury (TBI) is the primary cause of death and disability in individuals under 40 globally. Resource constraints exist across the care spectrum, and neurosurgical outcomes remain poorly understood. Objective: The study aims to evaluate the short-term neurological outcomes of patients who underwent surgery for traumatic intracranial hemorrhage at Yekatit 12 Hospital Medical College. Patients and Methods: A longitudinal study design was used. Data were analyzed using SPSS version 27 and binary logistic regression was used to see factors associated with outcomes. P value ≤0.05 was considered significant Result: Total of 34 patients were studied male outnumbered female and mean was age 34.5 ± 12.8. Road traffic accident was the common cause of traumatic brain injury. Acute epidural hematoma accounted the highest proportion (46%) traumatic brain injury. Postoperative mortality rate was 17.6 % and 83.3% was secondary to acute subdural hematoma. On post-operative follow up 64.7% patients have favorable 3 month Glasgow outcome score. The initial pupillary reaction (P: 0.02 COR 0.02(0.002-0.205), postoperative complications (P: <0.01 COR 21(2.099-210.136) and length of hospital stay (P: 0.04 COR0.054(0.07-0.395) showed statically significant association with 03 month Glasgow outcome score. Conclusion: Young male populations are predominately affected from traumatic brain injury. Initial pupillary reactions and postoperative complications significantly affect the neurologic outcome.
{"title":"Assessment of Neurological Outcomes of Patients Following Emergency Neurosurgical Interventions for Intra-Cranial Hematomas in Traumatic Brain Injury at Yekatit 12 Hospital Medical College","authors":"","doi":"10.47485/2767-5416.1065","DOIUrl":"https://doi.org/10.47485/2767-5416.1065","url":null,"abstract":"Background: Traumatic Brain Injury (TBI) is the primary cause of death and disability in individuals under 40 globally. Resource constraints exist across the care spectrum, and neurosurgical outcomes remain poorly understood.\u0000Objective: The study aims to evaluate the short-term neurological outcomes of patients who underwent surgery for traumatic intracranial hemorrhage at Yekatit 12 Hospital Medical College.\u0000Patients and Methods: A longitudinal study design was used. Data were analyzed using SPSS version 27 and binary logistic regression was used to see factors associated with outcomes. P value ≤0.05 was considered significant\u0000Result: Total of 34 patients were studied male outnumbered female and mean was age 34.5 ± 12.8. Road traffic accident was the common cause of traumatic brain injury. Acute epidural hematoma accounted the highest proportion (46%) traumatic brain injury. Postoperative mortality rate was 17.6 % and 83.3% was secondary to acute subdural hematoma. On post-operative follow up 64.7% patients have favorable 3 month Glasgow outcome score. The initial pupillary reaction (P: 0.02 COR 0.02(0.002-0.205), postoperative complications (P: <0.01 COR 21(2.099-210.136) and length of hospital stay (P: 0.04 COR0.054(0.07-0.395) showed statically significant association with 03 month Glasgow outcome score.\u0000Conclusion: Young male populations are predominately affected from traumatic brain injury. Initial pupillary reactions and postoperative complications significantly affect the neurologic outcome.","PeriodicalId":513191,"journal":{"name":"Journal of Medical Clinical Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140214136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Sitagliptin is a dipeptidyl peptidase IV (DPP-IV) inhibitor used as an oral hypoglycemic agent in the treatment of type 2 Diabetes Mellitus. Acute pancreatitis is a rare known complication of sitagliptin, which can occur at any time after initiation of the drug therapy. Case Presentation: A 41 year-old female patient with type 2 diabetes mellitus presented with signs and symptoms of acute necrotizing pancreatitis. Recently, her GP added sitagliptin for more control on her disease. This drug induced acute pancreatitis. We admitted the patient to the ICU for monitoring after cessation of the causative agent. Fluid resuscitation and intravenous antibiotics were the definite treatment. Follow-up for three months showed no recurrence. Clinical Discussion: Our patient had a fatal complication after the use of sitagliptin drug. Computed tomography scan with contrast is usually enough to reach the diagnosis. Early treatment is very important in these cases. Conclusions: Sitagliptin is a good oral hypoglycemic agent to control glucose in patients with diabetes. Serious side effects should be monitored to avoid morbidity and mortality.
{"title":"Sitagliptin-Induced Acute Necrotizing Pancreatitis A Case Report","authors":"","doi":"10.47485/2767-5416.1064","DOIUrl":"https://doi.org/10.47485/2767-5416.1064","url":null,"abstract":"Introduction: Sitagliptin is a dipeptidyl peptidase IV (DPP-IV) inhibitor used as an oral hypoglycemic agent in the treatment of type 2 Diabetes Mellitus. Acute pancreatitis is a rare known complication of sitagliptin, which can occur at any time after initiation of the drug therapy.\u0000Case Presentation: A 41 year-old female patient with type 2 diabetes mellitus presented with signs and symptoms of acute necrotizing pancreatitis. Recently, her GP added sitagliptin for more control on her disease. This drug induced acute pancreatitis. We admitted the patient to the ICU for monitoring after cessation of the causative agent. Fluid resuscitation and intravenous antibiotics were the definite treatment. Follow-up for three months showed no recurrence.\u0000Clinical Discussion: Our patient had a fatal complication after the use of sitagliptin drug. Computed tomography scan with contrast is usually enough to reach the diagnosis. Early treatment is very important in these cases.\u0000Conclusions: Sitagliptin is a good oral hypoglycemic agent to control glucose in patients with diabetes. Serious side effects should be monitored to avoid morbidity and mortality.","PeriodicalId":513191,"journal":{"name":"Journal of Medical Clinical Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140240554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-07DOI: 10.47485//2767-5416.1062
A. Manov, J. Tam, A. Donepudi, S. S. S. Mayesha, Y. Badi, Prof. Andre Manov
In our case series, we are describing 6 patients with uncontrolled, complicated type 2 Diabetes Mellitus (Type 2-DM). Although they were self-monitoring their blood glucose (SMBG) at least 4 times a day, they continued to have suboptimal glucose control. Continuous glucose monitoring (CGM) was started at our Internal medicine residency primary care clinic. The patients were educated on diet, lifestyle changes, and how to adjust their insulin regimen according to their blood glucose results from the CGM as the standard of care. They were called every two weeks by the representative of our CGM team to monitor and answer any queries regarding insulin adjustment, blood glucose monitoring, diet, physical activity, or lifestyle. The CGM team included Internal medicine and transitional year medical residents and a board-certified endocrinologist who was a member of our clinic. Moreover, the patients were seen at the clinic once every month by a member of the CGM team. Long and rapid-acting Insulins were started to achieve optimal glucose control initially. Eventually, Insulin dosage was gradually reduced, and the patients we described were started on alternate agents like oral antidiabetic agents with or without injectable glucagon-like peptide GLP-1 receptor agonists. The five-hour postprandial C-peptide was checked after discontinuation of insulin in all of our patients and was normal. Within a few months of CGM initiation, there was a significant improvement in the patients’ glucose control which was maintained after stopping the Insulin. Some patients were also able to lose weight. We concluded that CGM could be initiated safely in an internal medicine residency clinic not only at specialized endocrine clinics in a project that was managed primarily by internal medicine and transitional year residents under the supervision of a member of the clinic who was board certified in endocrinologists. We also demonstrated the introduction of CGM instead of SMBG in patients with Type 2-DM helped them to achieve better glycemic control with insulin, overcome glucose toxicity, and eventually stop the insulin and maintain excellent glucose control only with oral antidiabetic agents with or without injectable GLP 1 receptor agonist.
{"title":"Case Series on Implementation of Continuous Glucose Monitoring for Better Glycemic Control without Long-acting Insulin","authors":"A. Manov, J. Tam, A. Donepudi, S. S. S. Mayesha, Y. Badi, Prof. Andre Manov","doi":"10.47485//2767-5416.1062","DOIUrl":"https://doi.org/10.47485//2767-5416.1062","url":null,"abstract":"In our case series, we are describing 6 patients with uncontrolled, complicated type 2 Diabetes Mellitus (Type 2-DM). Although they were self-monitoring their blood glucose (SMBG) at least 4 times a day, they continued to have suboptimal glucose control. Continuous glucose monitoring (CGM) was started at our Internal medicine residency primary care clinic. The patients were educated on diet, lifestyle changes, and how to adjust their insulin regimen according to their blood glucose results from the CGM as the standard of care. They were called every two weeks by the representative of our CGM team to monitor and answer any queries regarding insulin adjustment, blood glucose monitoring, diet, physical activity, or lifestyle. The CGM team included Internal medicine and transitional year medical residents and a board-certified endocrinologist who was a member of our clinic. Moreover, the patients were seen at the clinic once every month by a member of the CGM team. Long and rapid-acting Insulins were started to achieve optimal glucose control initially. Eventually, Insulin dosage was gradually reduced, and the patients we described were started on alternate agents like oral antidiabetic agents with or without injectable glucagon-like peptide GLP-1 receptor agonists. The five-hour postprandial C-peptide was checked after discontinuation of insulin in all of our patients and was normal. Within a few months of CGM initiation, there was a significant improvement in the patients’ glucose control which was maintained after stopping the Insulin. Some patients were also able to lose weight. We concluded that CGM could be initiated safely in an internal medicine residency clinic not only at specialized endocrine clinics in a project that was managed primarily by internal medicine and transitional year residents under the supervision of a member of the clinic who was board certified in endocrinologists. We also demonstrated the introduction of CGM instead of SMBG in patients with Type 2-DM helped them to achieve better glycemic control with insulin, overcome glucose toxicity, and eventually stop the insulin and maintain excellent glucose control only with oral antidiabetic agents with or without injectable GLP 1 receptor agonist.","PeriodicalId":513191,"journal":{"name":"Journal of Medical Clinical Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140260464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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