Abstract Stiff Person Syndrome (SPS) is a rare autoimmune disease that is caused by the lack of inhibition to excitatory neurotransmitters in the central nervous system (CNS) which then leads to inappropriate and excessive motor unit firing causing stiffness, a characteristic feature of the disease. SPS has an incidence of one case in a million and occurs in the middle-aged population with a female predominance. SPS mostly occurs in the background of autoimmune disorders like type 1 diabetes, thyroid disorders, pernicious anemia, and less often, vitiligo.. The pathophysiology is not completely understood; however, there is a strong correlation between high titers of anti-glutamic acid decarboxylase antibody (anti-GAD Ab) and the disease. We present an 82 years old man who complained of stiffness and weakness, mostly on the right side, with multiple negative workups. He was then eventually diagnosed with SPS based on the characteristic history and physical examination findings and being positive for anti-GAD Ab. He was treated with a combination of baclofen, gabapentin, intravenous immunoglobulins (IVIG), and physical therapy. We review the case presentation which was unusual in terms of age and sex, and treatment options in the context of a severe presentation of this disabling disease.
{"title":"Stiff Person Syndrome: A Rare Presentation of a Rare Disorder","authors":"Muhammad H. Sharif, B. G. Verghese","doi":"10.53785/2769-2779.1162","DOIUrl":"https://doi.org/10.53785/2769-2779.1162","url":null,"abstract":"Abstract Stiff Person Syndrome (SPS) is a rare autoimmune disease that is caused by the lack of inhibition to excitatory neurotransmitters in the central nervous system (CNS) which then leads to inappropriate and excessive motor unit firing causing stiffness, a characteristic feature of the disease. SPS has an incidence of one case in a million and occurs in the middle-aged population with a female predominance. SPS mostly occurs in the background of autoimmune disorders like type 1 diabetes, thyroid disorders, pernicious anemia, and less often, vitiligo.. The pathophysiology is not completely understood; however, there is a strong correlation between high titers of anti-glutamic acid decarboxylase antibody (anti-GAD Ab) and the disease. We present an 82 years old man who complained of stiffness and weakness, mostly on the right side, with multiple negative workups. He was then eventually diagnosed with SPS based on the characteristic history and physical examination findings and being positive for anti-GAD Ab. He was treated with a combination of baclofen, gabapentin, intravenous immunoglobulins (IVIG), and physical therapy. We review the case presentation which was unusual in terms of age and sex, and treatment options in the context of a severe presentation of this disabling disease.","PeriodicalId":7266,"journal":{"name":"Advances in Clinical Medical Research and Healthcare Delivery","volume":"86 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80699101","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}
Mohamed Salah Mohamed, Syed Hamza Waheed, Amir Mahmoud, Anas Hashem, Bipul Baibhav, Abdullah M Firoze Ahmed
Wellens syndrome usually indicates critical left anterior descending artery (LAD) occlusion. Pseudo-Wellens syndrome consists of criteria of Wellens syndrome in the absence of critical LAD occlusion. We report a case of Pseudo-Wellens syndrome related to cocaine use. A 52-year-old male with a medical history of hypertension and diabetes, presented with acute retrosternal chest pain of 3 days duration. Physical examination was unremarkable. EKG on presentation showed deep T-wave inversions in leads V2 to V5. Highly sensitive troponin was elevated. The patient admitted to using cocaine daily for the past two months. Due to concerns for Wellens syndrome, the patient had an immediate coronary angiography which revealed mild disease of the LAD (< 30%) only. Inpatient echocardiogram revealed preserved left ventricular ejection fraction and no segmental wall motion abnormalities. Subsequent EKG at the cardiology clinic showed improvement in T-wave inversion. The patient was advised to abstain from using cocaine. As Pseudo-Wellens syndrome is a diagnosis of exclusion, patients with a history of recent cocaine use presenting with acute chest pain history, evidence of myocardial injury, and EKG findings suggestive of Wellens syndrome should undergo an emergent coronary angiogram to exclude critical LAD occlusion.
{"title":"Pseudo-Wellens syndrome: A rare entity associated with cocaine use","authors":"Mohamed Salah Mohamed, Syed Hamza Waheed, Amir Mahmoud, Anas Hashem, Bipul Baibhav, Abdullah M Firoze Ahmed","doi":"10.53785/2769-2779.1164","DOIUrl":"https://doi.org/10.53785/2769-2779.1164","url":null,"abstract":"Wellens syndrome usually indicates critical left anterior descending artery (LAD) occlusion. Pseudo-Wellens syndrome consists of criteria of Wellens syndrome in the absence of critical LAD occlusion. We report a case of Pseudo-Wellens syndrome related to cocaine use. A 52-year-old male with a medical history of hypertension and diabetes, presented with acute retrosternal chest pain of 3 days duration. Physical examination was unremarkable. EKG on presentation showed deep T-wave inversions in leads V2 to V5. Highly sensitive troponin was elevated. The patient admitted to using cocaine daily for the past two months. Due to concerns for Wellens syndrome, the patient had an immediate coronary angiography which revealed mild disease of the LAD (< 30%) only. Inpatient echocardiogram revealed preserved left ventricular ejection fraction and no segmental wall motion abnormalities. Subsequent EKG at the cardiology clinic showed improvement in T-wave inversion. The patient was advised to abstain from using cocaine. As Pseudo-Wellens syndrome is a diagnosis of exclusion, patients with a history of recent cocaine use presenting with acute chest pain history, evidence of myocardial injury, and EKG findings suggestive of Wellens syndrome should undergo an emergent coronary angiogram to exclude critical LAD occlusion.","PeriodicalId":7266,"journal":{"name":"Advances in Clinical Medical Research and Healthcare Delivery","volume":"74 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135264039","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}
{"title":"Quality Improvement Project to increase pneumococcal vaccination rates in adults with inflammatory bowel diseases (IBD) being treated with immunosuppressants.","authors":"L. Naing, Sheza Malik, Jay Bapaye, Nagesh Jadhav","doi":"10.53785/2769-2779.1141","DOIUrl":"https://doi.org/10.53785/2769-2779.1141","url":null,"abstract":"","PeriodicalId":7266,"journal":{"name":"Advances in Clinical Medical Research and Healthcare Delivery","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74130277","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}
Christopher R Huber, Don Truong, Joseph Hatem, Joel Thompson, Bryan Scott
Abstract The present case report provides images from computed tomography and histology of a patient with a salivary gland neoplasm consistent with mucoepidermoid carcinoma.
摘要:本病例报告提供了一个涎腺肿瘤与粘液表皮样癌一致的计算机断层扫描和组织学图像。
{"title":"Radiologic and Histologic Findings of Locally Advanced Mucoepidermoid Carcinoma Managed with Total Surgical Excision","authors":"Christopher R Huber, Don Truong, Joseph Hatem, Joel Thompson, Bryan Scott","doi":"10.53785/2769-2779.1155","DOIUrl":"https://doi.org/10.53785/2769-2779.1155","url":null,"abstract":"Abstract The present case report provides images from computed tomography and histology of a patient with a salivary gland neoplasm consistent with mucoepidermoid carcinoma.","PeriodicalId":7266,"journal":{"name":"Advances in Clinical Medical Research and Healthcare Delivery","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76947095","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}
N owadays, medical students are learning in a myriad of ways e some more traditional than others. For example, some students elect to attend class in person, while others take lectures online at 2x speed. While I am one of the only students in my class who still uses the analog pencil and paper, my iPad-laden counterparts and I converge for sessions involving group problem solving. Most American medical schools employ some variation of this idea in their curriculum, and common to academia, institutions often have a proprietary name for their version of it. During a problem-based learning (PBL) session, students are tasked with completing a case-based discussion with their team using pre-existing knowledge in their small group with the help of a preceptor. A recent systematic review of PBL pedagogy by Trull as et al. even asserted that one of the main benefits, in addition to learning objectives, is that this design promotes the development of other professional competencies required of healthcare professionals. In the four meta-analyses included in their review, objective metrics of knowledge acquisition from PBL sessions appear as good or better than traditional methods, but integrating self-learning with communication, social, and problem-solving skills could pay dividends later. Also of note, Trull as found that student satisfaction tended to be higher for PBL sessions compared to lecture-based classes e and I agree. Interestingly, PBL's superiority is unclear when compared to simulation-based activities, where learners apply clinical judgement and skills. Simulations can be even more resource-intensive than PBL methods. My school often uses team-based learning (TBL) sessions, where we similarly engage in solving a problem, now using the information we were assigned to learn beforehand. Unlike a traditional lecture, the learning is done prior to class time, and Q6 during each session, teams are working on applying the new information to a tricky patient vignette (our recent session on SLE was a doozie). Typical to TBL, students complete individual and group evaluations before entering the case time, with peer evaluations at the end (Burgess). These may have an impact on the degree of preparation students arrive with, which is key for getting the most out of the session. Actively engaging with the material is the crux of why these designs are proposed to work. When evaluating hypothetical patient cases, we are encouraged to use outside resources, including recent literature and diagnostic guidelines attempting to fill in gaps in our knowledge. Working with other students in a PBL or TBL session aids in preparing for times when learners will have to have similar discussions on the wards or when presenting a patient. These sessions on the calendar ensure that I take ownership of the material; if no other evaluation lies between myself and the test, it'd be much easier to learn it when I am comfortable, but this compels me to be ready and contribu
{"title":"Pedagogy of Problems","authors":"Ryan Babineau","doi":"10.53785/2769-2779.1158","DOIUrl":"https://doi.org/10.53785/2769-2779.1158","url":null,"abstract":"N owadays, medical students are learning in a myriad of ways e some more traditional than others. For example, some students elect to attend class in person, while others take lectures online at 2x speed. While I am one of the only students in my class who still uses the analog pencil and paper, my iPad-laden counterparts and I converge for sessions involving group problem solving. Most American medical schools employ some variation of this idea in their curriculum, and common to academia, institutions often have a proprietary name for their version of it. During a problem-based learning (PBL) session, students are tasked with completing a case-based discussion with their team using pre-existing knowledge in their small group with the help of a preceptor. A recent systematic review of PBL pedagogy by Trull as et al. even asserted that one of the main benefits, in addition to learning objectives, is that this design promotes the development of other professional competencies required of healthcare professionals. In the four meta-analyses included in their review, objective metrics of knowledge acquisition from PBL sessions appear as good or better than traditional methods, but integrating self-learning with communication, social, and problem-solving skills could pay dividends later. Also of note, Trull as found that student satisfaction tended to be higher for PBL sessions compared to lecture-based classes e and I agree. Interestingly, PBL's superiority is unclear when compared to simulation-based activities, where learners apply clinical judgement and skills. Simulations can be even more resource-intensive than PBL methods. My school often uses team-based learning (TBL) sessions, where we similarly engage in solving a problem, now using the information we were assigned to learn beforehand. Unlike a traditional lecture, the learning is done prior to class time, and Q6 during each session, teams are working on applying the new information to a tricky patient vignette (our recent session on SLE was a doozie). Typical to TBL, students complete individual and group evaluations before entering the case time, with peer evaluations at the end (Burgess). These may have an impact on the degree of preparation students arrive with, which is key for getting the most out of the session. Actively engaging with the material is the crux of why these designs are proposed to work. When evaluating hypothetical patient cases, we are encouraged to use outside resources, including recent literature and diagnostic guidelines attempting to fill in gaps in our knowledge. Working with other students in a PBL or TBL session aids in preparing for times when learners will have to have similar discussions on the wards or when presenting a patient. These sessions on the calendar ensure that I take ownership of the material; if no other evaluation lies between myself and the test, it'd be much easier to learn it when I am comfortable, but this compels me to be ready and contribu","PeriodicalId":7266,"journal":{"name":"Advances in Clinical Medical Research and Healthcare Delivery","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135821205","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}
Dylan Thibaut, Ryan A Witcher, Anitha Kunnath, James Toldi
Abstract Abstract Abstract IntroductionIntroduction: Pigeon Breeder’s Pneumonitis (PBP) results due to a complex pathophysiology that includes exposure to avian antigens. Susceptibility has been linked to human leukocyte antigen (HLA) class II, though consensus has not been reached. The goal of this systematic review is to further elucidate the association between PBP and HLA-DR subtypes. MethodsMethods: Databases utilized included PubMed, Google Scholar, ScienceDirect, and Cochrane Library. Inclusion required a minimum of three studies in English presenting HLA-DR alleles of PBP and control subgroups. Exclusion was due to insufficient data or non-feasible control groups. Forest plots were created for HLA-DR subtypes’ association with PBP. The NIH Bias assessment tool and LFK index assessed bias. ResultsResults: 4 studies were included in the meta-analysis. HLA-DR3 was associated with the pooled PBP subgroups (OR=1.86 [1.13, 3.05], p DiscussionDiscussion: Limitations included limited sources, with multiple study methodology unacceptable to this review. These findings expand on previous research on HLA variants and PBP frequency, and offer further clarity supporting novel approaches in treatment of PBP.
{"title":"Extrinsic Allergic Alveolitis: A Systematic Review of HLA-DR in Pigeon Breeder’s Disease","authors":"Dylan Thibaut, Ryan A Witcher, Anitha Kunnath, James Toldi","doi":"10.53785/2769-2779.1150","DOIUrl":"https://doi.org/10.53785/2769-2779.1150","url":null,"abstract":"Abstract Abstract Abstract IntroductionIntroduction: Pigeon Breeder’s Pneumonitis (PBP) results due to a complex pathophysiology that includes exposure to avian antigens. Susceptibility has been linked to human leukocyte antigen (HLA) class II, though consensus has not been reached. The goal of this systematic review is to further elucidate the association between PBP and HLA-DR subtypes. MethodsMethods: Databases utilized included PubMed, Google Scholar, ScienceDirect, and Cochrane Library. Inclusion required a minimum of three studies in English presenting HLA-DR alleles of PBP and control subgroups. Exclusion was due to insufficient data or non-feasible control groups. Forest plots were created for HLA-DR subtypes’ association with PBP. The NIH Bias assessment tool and LFK index assessed bias. ResultsResults: 4 studies were included in the meta-analysis. HLA-DR3 was associated with the pooled PBP subgroups (OR=1.86 [1.13, 3.05], p DiscussionDiscussion: Limitations included limited sources, with multiple study methodology unacceptable to this review. These findings expand on previous research on HLA variants and PBP frequency, and offer further clarity supporting novel approaches in treatment of PBP.","PeriodicalId":7266,"journal":{"name":"Advances in Clinical Medical Research and Healthcare Delivery","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75213664","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}
Neurodegenerative diseases such as Alzheimer's Disease impact a multitude of individuals worldwide. The neural Glymphatic system is a relatively newly discovered cellular transport pathway within the brain that has been implicated in neurodegenerative diseases. This article serves to provide a journal club review of current literature on the Glymphatic system to raise awareness of this system and its potential for future treatment and prevention of neurodegenerative conditions.
{"title":"Journal Club: Glymphatic System in Neurodegenerative Diseases","authors":"Ronald G Lott, Xavier Zonna, Samuel Wlasowicz","doi":"10.53785/2769-2779.1156","DOIUrl":"https://doi.org/10.53785/2769-2779.1156","url":null,"abstract":"Neurodegenerative diseases such as Alzheimer's Disease impact a multitude of individuals worldwide. The neural Glymphatic system is a relatively newly discovered cellular transport pathway within the brain that has been implicated in neurodegenerative diseases. This article serves to provide a journal club review of current literature on the Glymphatic system to raise awareness of this system and its potential for future treatment and prevention of neurodegenerative conditions.","PeriodicalId":7266,"journal":{"name":"Advances in Clinical Medical Research and Healthcare Delivery","volume":"8 4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72665916","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: During therapeutic thoracentesis (TT), pleural fluid is typically drained to completion. Fluid removal improves oxygenation, and the amount of fluid removed is directly associated with the risk of serious complications. A relationship between the amount of fluid removed during TT and the change in oxygenation has not been found in the literature. A direct relationship was hypothesized in this study. Differences in the change in oxygenation between sexes, age, and pre-procedure oxygen support were secondarily hypothesized. This information would assist in the guidance of future TT protocols. Methods: Subjects of this retrospective cohort study were males and females aged 26-74 years. Of the 166 patients who underwent inpatient TT between February 4, 2020, and December 10, 2022, at Berkshire Medical Center (BMC), 16 met the inclusion criteria. They were identified using CPT codes in the electronic medical record (EMR). Demographics, amount of fluid removed, and type of oxygen support were recorded. Pre and post-TT arterial oxygen partial pressure (PaO2) and fraction of inspired oxygen (FiO2) values were collected to calculate the P/F, a metric for oxygenation status. T-test and correlation coefficient were calculated to analyze the change in the P/F ratio versus the amount of pleural fluid removed. Correlation coefficients or ANOVA were calculated to compare oxygenation changes to sex, age, and supplemental oxygen types. Results: There was no statistical significance (p=0.87) in the linear relationship between the amount of pleural fluid drained (mean=660 mL, range=150-1500 mL) and the change in oxygenation (mean=162, range=34-300). There were no statistically significant differences in oxygenation changes between sex (p=0.60), age (p=0.81), or types of oxygen support pre-procedure (p=0.07). There was a statistically significant difference in pre and post-procedure P/F ratio (p<0.001). Discussion: We found a statistically significant change in oxygenation before and after TT, with no evidence of a direct relationship between amount of fluid removed and improvement in oxygenation. There were no complications when removing up to 1500 mL of fluid. A protocol that halts pleural fluid drainage once it is complete or when the amount removed reaches 1500 mL, whichever occurs first, may be optimal.
{"title":"Comparing Pleural Fluid Removal Volume and Oxygenation Change in Therapeutic Thoracentesis: Is There a Relationship?","authors":"Hannah E. Zazulak, Ryan Burke, Andrea M Bodine","doi":"10.53785/2769-2779.1149","DOIUrl":"https://doi.org/10.53785/2769-2779.1149","url":null,"abstract":"Background: During therapeutic thoracentesis (TT), pleural fluid is typically drained to completion. Fluid removal improves oxygenation, and the amount of fluid removed is directly associated with the risk of serious complications. A relationship between the amount of fluid removed during TT and the change in oxygenation has not been found in the literature. A direct relationship was hypothesized in this study. Differences in the change in oxygenation between sexes, age, and pre-procedure oxygen support were secondarily hypothesized. This information would assist in the guidance of future TT protocols. Methods: Subjects of this retrospective cohort study were males and females aged 26-74 years. Of the 166 patients who underwent inpatient TT between February 4, 2020, and December 10, 2022, at Berkshire Medical Center (BMC), 16 met the inclusion criteria. They were identified using CPT codes in the electronic medical record (EMR). Demographics, amount of fluid removed, and type of oxygen support were recorded. Pre and post-TT arterial oxygen partial pressure (PaO2) and fraction of inspired oxygen (FiO2) values were collected to calculate the P/F, a metric for oxygenation status. T-test and correlation coefficient were calculated to analyze the change in the P/F ratio versus the amount of pleural fluid removed. Correlation coefficients or ANOVA were calculated to compare oxygenation changes to sex, age, and supplemental oxygen types. Results: There was no statistical significance (p=0.87) in the linear relationship between the amount of pleural fluid drained (mean=660 mL, range=150-1500 mL) and the change in oxygenation (mean=162, range=34-300). There were no statistically significant differences in oxygenation changes between sex (p=0.60), age (p=0.81), or types of oxygen support pre-procedure (p=0.07). There was a statistically significant difference in pre and post-procedure P/F ratio (p<0.001). Discussion: We found a statistically significant change in oxygenation before and after TT, with no evidence of a direct relationship between amount of fluid removed and improvement in oxygenation. There were no complications when removing up to 1500 mL of fluid. A protocol that halts pleural fluid drainage once it is complete or when the amount removed reaches 1500 mL, whichever occurs first, may be optimal.","PeriodicalId":7266,"journal":{"name":"Advances in Clinical Medical Research and Healthcare Delivery","volume":"46 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85917531","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}
Myasthenia gravis (MG) is a rare autoimmune condition caused by antibody-mediated disruption of acetylcholine receptors (AChR) or their associated proteins. The age of onset of MG has a bimodal distribution, with a predominance of female cases in the second and third decades and a predominance of male cases in the sixth to eighth decades. MG is often unmasked by stressors such as systemic illness, medication, surgery, and pregnancy. We present a case of late-onset MG in a 65-year-old female with a recent history of prolonged doxycycline use. However, there are aspects of her past medical history, including comorbidities involving the immune system and numerous drug intolerances that should have increased clinical suspicion for MG. Additionally, one medical event that preceded symptom onset was pneumonia treated with doxycycline. This case suggests that doxycycline should be used with caution in MG patients, and that MG should be considered as part of the differential diagnosis in older female patients presenting with neurologic symptoms and suggestive past medical history.
{"title":"Rare Case of Late-onset Myasthenia Gravis in a 65-year-old Female with Prolonged Doxycycline Use","authors":"Angel Wong, Kayvan Mirhadi","doi":"10.53785/2769-2779.1139","DOIUrl":"https://doi.org/10.53785/2769-2779.1139","url":null,"abstract":"Myasthenia gravis (MG) is a rare autoimmune condition caused by antibody-mediated disruption of acetylcholine receptors (AChR) or their associated proteins. The age of onset of MG has a bimodal distribution, with a predominance of female cases in the second and third decades and a predominance of male cases in the sixth to eighth decades. MG is often unmasked by stressors such as systemic illness, medication, surgery, and pregnancy. We present a case of late-onset MG in a 65-year-old female with a recent history of prolonged doxycycline use. However, there are aspects of her past medical history, including comorbidities involving the immune system and numerous drug intolerances that should have increased clinical suspicion for MG. Additionally, one medical event that preceded symptom onset was pneumonia treated with doxycycline. This case suggests that doxycycline should be used with caution in MG patients, and that MG should be considered as part of the differential diagnosis in older female patients presenting with neurologic symptoms and suggestive past medical history.","PeriodicalId":7266,"journal":{"name":"Advances in Clinical Medical Research and Healthcare Delivery","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135821206","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}
Late onset of isolated myositis following a Transobturator (TOT) mid-urethral sling (MUS) is a rare post-operative complication.
经闭锁(TOT)中尿道悬吊(MUS)后迟发性孤立性肌炎是一种罕见的术后并发症。
{"title":"Late-onset Isolated Myositis Following Transobturator Mid-Urethral Sling: A Case Report","authors":"Bruce Lee, Mohamad Mahmoud","doi":"10.53785/2769-2779.1151","DOIUrl":"https://doi.org/10.53785/2769-2779.1151","url":null,"abstract":"Late onset of isolated myositis following a Transobturator (TOT) mid-urethral sling (MUS) is a rare post-operative complication.","PeriodicalId":7266,"journal":{"name":"Advances in Clinical Medical Research and Healthcare Delivery","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135776474","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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