Pub Date : 2022-07-25DOI: 10.36502/2022/asjbccr.6268
A. Narwan, A. Sauer, Tanya Talwar, Olivia Willes, Nalin E. Ranasinghe, L. Ranasinghe
Mesenteric ischemia is a phenomenon that occurs when arteries supplying the gastrointestinal tract either become narrowed or obstructed, thus reducing or halting downstream perfusion. This case study will explore a case of mesenteric ischemia caused by SMA vasculitis, a nonatherosclerotic abdominal arterial vasculopathy (NAV), in which a 57 y/o woman with history of hyperlipidemia and GERD presented to the ER with chest and upper back pain. Initial work up for MI and PE were inconclusive and the patient was discharged. Patient then returned the next day complaining of chest and additional abdominal pain radiating to her back. An abdominal CTA, venous ultrasound, and MRI revealed findings highly suggestive of ischemia caused by vasculitis of the superior mesenteric artery, for which the patient was treated with tapering prednisone. Evaluation for mesenteric ischemia in patients presenting with nonspecific trunk pain will allow physicians to provide more prompt and catered care. Additionally, with the ubiquity of COVID-19 and its role in downstream inflammatory processes, atypical causes of mesenteric ischemia may be an increasingly important differential to consider.
{"title":"A Rare Presentation of SMA Vasculitis with Chest and Upper Back Pain: Case Report","authors":"A. Narwan, A. Sauer, Tanya Talwar, Olivia Willes, Nalin E. Ranasinghe, L. Ranasinghe","doi":"10.36502/2022/asjbccr.6268","DOIUrl":"https://doi.org/10.36502/2022/asjbccr.6268","url":null,"abstract":"Mesenteric ischemia is a phenomenon that occurs when arteries supplying the gastrointestinal tract either become narrowed or obstructed, thus reducing or halting downstream perfusion. This case study will explore a case of mesenteric ischemia caused by SMA vasculitis, a nonatherosclerotic abdominal arterial vasculopathy (NAV), in which a 57 y/o woman with history of hyperlipidemia and GERD presented to the ER with chest and upper back pain. Initial work up for MI and PE were inconclusive and the patient was discharged. Patient then returned the next day complaining of chest and additional abdominal pain radiating to her back. An abdominal CTA, venous ultrasound, and MRI revealed findings highly suggestive of ischemia caused by vasculitis of the superior mesenteric artery, for which the patient was treated with tapering prednisone. Evaluation for mesenteric ischemia in patients presenting with nonspecific trunk pain will allow physicians to provide more prompt and catered care. Additionally, with the ubiquity of COVID-19 and its role in downstream inflammatory processes, atypical causes of mesenteric ischemia may be an increasingly important differential to consider.","PeriodicalId":93523,"journal":{"name":"Asploro journal of biomedical and clinical case reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45622719","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 : 2022-07-25DOI: 10.36502/2022/asjbccr.6269
Mazaher Hassan Jaffer
Introduction: DPP-4 inhibitors are an integral part of the treatment of type 2 diabetes mellitus in Kenya. Most diabetics suffer from a lack of adherence due to a high pill burden due to multiple co-morbidities and the stigma of dependence on medication. Trelagliptin is a unique DPP-4 inhibitor due to its long biological half-life making it acceptable to be taken as a once-a-week dose. It was first accepted for use in Japan in 2015 and only got into the Kenyan market about 3 years ago. Here we have examined the effects of introducing this molecule into the regimen of a diabetic with extremely poor adherence due to a busy schedule and another diabetic who had multiple co-morbidities and subsequently a high pill load – with the benefits of its use in each case over a period of 6 months of observation. Methods: These cases reported are the first of a 39-year-old female businessperson with a busy schedule and known to have mild hypothyroidism – yet always missing her medication. She was not confident in her consistency of medication uptake and always slacked in coming in for her tests because of the same. She is diagnosed to have diabetes with strong family history and thereafter she declined to add to her medication with daily metformin. She improved tremendously upon commencing trelaglyptin. The other is of an elderly woman who also had diabetes mellitus type 2, dyslipidemia, BPPV, and hypertension. She was unhappy about her results for diabetes and due to inconsistency in taking her medication but agreed to start on the trelaglyptin since it was once a week. Her outcomes were also very good from the same. Conclusion: The use of trelaglyptin with the patients in Kenya could potentially lead to reduced stigma and inertia toward commencing medication and improved adherence to medication regimens in diabetes.
{"title":"Impact of Reduction in Pill Load Upon Use of a Once Weekly DPP-4 Inhibitor in 2 Cases of Type 2 Diabetes","authors":"Mazaher Hassan Jaffer","doi":"10.36502/2022/asjbccr.6269","DOIUrl":"https://doi.org/10.36502/2022/asjbccr.6269","url":null,"abstract":"Introduction: DPP-4 inhibitors are an integral part of the treatment of type 2 diabetes mellitus in Kenya. Most diabetics suffer from a lack of adherence due to a high pill burden due to multiple co-morbidities and the stigma of dependence on medication. Trelagliptin is a unique DPP-4 inhibitor due to its long biological half-life making it acceptable to be taken as a once-a-week dose. It was first accepted for use in Japan in 2015 and only got into the Kenyan market about 3 years ago. Here we have examined the effects of introducing this molecule into the regimen of a diabetic with extremely poor adherence due to a busy schedule and another diabetic who had multiple co-morbidities and subsequently a high pill load – with the benefits of its use in each case over a period of 6 months of observation.\u0000Methods: These cases reported are the first of a 39-year-old female businessperson with a busy schedule and known to have mild hypothyroidism – yet always missing her medication. She was not confident in her consistency of medication uptake and always slacked in coming in for her tests because of the same. She is diagnosed to have diabetes with strong family history and thereafter she declined to add to her medication with daily metformin. She improved tremendously upon commencing trelaglyptin. The other is of an elderly woman who also had diabetes mellitus type 2, dyslipidemia, BPPV, and hypertension. She was unhappy about her results for diabetes and due to inconsistency in taking her medication but agreed to start on the trelaglyptin since it was once a week. Her outcomes were also very good from the same.\u0000Conclusion: The use of trelaglyptin with the patients in Kenya could potentially lead to reduced stigma and inertia toward commencing medication and improved adherence to medication regimens in diabetes.","PeriodicalId":93523,"journal":{"name":"Asploro journal of biomedical and clinical case reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42987632","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 : 2022-07-23DOI: 10.36502/2022/asjbccr.6267
H. Bando, Kenji Hayashi, Kyoko Sumitomo, Kazuya Miki, Asami Kamoto
Background: Oral semaglutide (Rybelsus) has been in focus for type 2 diabetes (T2D). Case Presentation: The patient is a 73-year-old male with T2D treated with metformin, Ipragliflozin, and rosuvastatin. He was diagnosed with depression by the Geriatric depression scale (GDS) with a stable condition by mirtazapine. His diabetic control was exacerbated to HbA1c 8.8% and weight 63.5kg in Feb 2022. Results: He started to take Rybelsus, and then clinical improvement was found as HbA1c 6.9% and weight 57.5kg for 4 months. Discussion: Remarkable effect of HbA1c and weight may be from longer fasting time after post-med, and regular lifestyle from the stable psychosomatic situation.
{"title":"Rapid Reduction of HbA1c and Weight in Elderly Patient with Type 2 Diabetes (T2D) And Depression by Oral Semaglutide (Rybelsus)","authors":"H. Bando, Kenji Hayashi, Kyoko Sumitomo, Kazuya Miki, Asami Kamoto","doi":"10.36502/2022/asjbccr.6267","DOIUrl":"https://doi.org/10.36502/2022/asjbccr.6267","url":null,"abstract":"Background: Oral semaglutide (Rybelsus) has been in focus for type 2 diabetes (T2D).\u0000Case Presentation: The patient is a 73-year-old male with T2D treated with metformin, Ipragliflozin, and rosuvastatin. He was diagnosed with depression by the Geriatric depression scale (GDS) with a stable condition by mirtazapine. His diabetic control was exacerbated to HbA1c 8.8% and weight 63.5kg in Feb 2022.\u0000Results: He started to take Rybelsus, and then clinical improvement was found as HbA1c 6.9% and weight 57.5kg for 4 months.\u0000Discussion: Remarkable effect of HbA1c and weight may be from longer fasting time after post-med, and regular lifestyle from the stable psychosomatic situation.","PeriodicalId":93523,"journal":{"name":"Asploro journal of biomedical and clinical case reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49386447","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 : 2022-06-27DOI: 10.36502/2022/asjbccr.6266
Ashwin Sidhu, Harrison Chu
A significant portion of all invasive fungal infections in solid organ transplants are due to cryptococcus. It can be a debilitating infection and affects the quality of life in transplant patients. We report a case of a 57-year-old male patient with recent kidney transplant, who presented with cryptococcal meningitis, after exposure to birds during a trip to Mexico 1 week ago. In addition to a two-day history of generalized weakness, dizziness, intermittent fever, and lightheadedness, the patient presented with on and off headaches, increased sinus pressure, neck stiffness, clogged ear sensation, confusion, and night sweats. The patient was initially treated empirically with fluconazole. Lumber punctuation showed elevated opening pressure, increased WBC, with neutrophil predominance. Cryptococcal antigen tests were positive in both serum and cerebrospinal fluid sources. After confirmation from CSF analysis, he was administered liposomal amphotericin B and flucytosine. Patient’s symptoms rapidly improved. Due to his immunocompromised state, the patient will require lifelong fluconazole maintenance therapy. Even though kidney transplant recipients have a positive outcome in terms of longevity, they are at increased risk of post-transplant infection, such as zoonotic infections. Therefore, in any recent kidney transplant patient with meningitis symptoms, cryptococcal meningitis should always be considered. We report the appropriate criteria, procedures, and tests that allow for a cryptococcal meningitis diagnosis in immunocompromised patients.
{"title":"Case Report: Cryptococcal Infection in Renal Transplant Patient","authors":"Ashwin Sidhu, Harrison Chu","doi":"10.36502/2022/asjbccr.6266","DOIUrl":"https://doi.org/10.36502/2022/asjbccr.6266","url":null,"abstract":"A significant portion of all invasive fungal infections in solid organ transplants are due to cryptococcus. It can be a debilitating infection and affects the quality of life in transplant patients. We report a case of a 57-year-old male patient with recent kidney transplant, who presented with cryptococcal meningitis, after exposure to birds during a trip to Mexico 1 week ago. In addition to a two-day history of generalized weakness, dizziness, intermittent fever, and lightheadedness, the patient presented with on and off headaches, increased sinus pressure, neck stiffness, clogged ear sensation, confusion, and night sweats. The patient was initially treated empirically with fluconazole. Lumber punctuation showed elevated opening pressure, increased WBC, with neutrophil predominance. Cryptococcal antigen tests were positive in both serum and cerebrospinal fluid sources. After confirmation from CSF analysis, he was administered liposomal amphotericin B and flucytosine. Patient’s symptoms rapidly improved. Due to his immunocompromised state, the patient will require lifelong fluconazole maintenance therapy. Even though kidney transplant recipients have a positive outcome in terms of longevity, they are at increased risk of post-transplant infection, such as zoonotic infections. Therefore, in any recent kidney transplant patient with meningitis symptoms, cryptococcal meningitis should always be considered. We report the appropriate criteria, procedures, and tests that allow for a cryptococcal meningitis diagnosis in immunocompromised patients.","PeriodicalId":93523,"journal":{"name":"Asploro journal of biomedical and clinical case reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49274442","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 : 2022-05-21DOI: 10.36502/2022/asjbccr.6265
Y. Kato, H. Bando, Y. Kato, K. Ogura, H. Yamashita
The patient is an 83-year-old male, who smoked 20-40 cigarettes daily during 20-75 years and quit after that. In March 2021, he revealed normal chest X-P and was explained to take chest computed tomography (CT) next year. In April 2022, chest X-P was unremarkable, but CT showed a small solid abnormal shadow in the upper left lung region nearby aortic arch and abdominal aortic aneurysm (AAA) in the upper abdomen. Almost lung cancer cases are found in current smokers or ex-smokers. Using CT, lung cancer screening shows a 20-26% decrease in cancer death. Consequently, Low-Dose CT (LDCT) for smokers would be recommended.
{"title":"Clinical Significance of Chest CT Scan for Previous Heavy Smoker","authors":"Y. Kato, H. Bando, Y. Kato, K. Ogura, H. Yamashita","doi":"10.36502/2022/asjbccr.6265","DOIUrl":"https://doi.org/10.36502/2022/asjbccr.6265","url":null,"abstract":"The patient is an 83-year-old male, who smoked 20-40 cigarettes daily during 20-75 years and quit after that. In March 2021, he revealed normal chest X-P and was explained to take chest computed tomography (CT) next year. In April 2022, chest X-P was unremarkable, but CT showed a small solid abnormal shadow in the upper left lung region nearby aortic arch and abdominal aortic aneurysm (AAA) in the upper abdomen. Almost lung cancer cases are found in current smokers or ex-smokers. Using CT, lung cancer screening shows a 20-26% decrease in cancer death. Consequently, Low-Dose CT (LDCT) for smokers would be recommended.","PeriodicalId":93523,"journal":{"name":"Asploro journal of biomedical and clinical case reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49168851","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 : 2022-05-02DOI: 10.36502/2022/asjbccr.6264
Cristianne Confessor Castilho Lopes, D. D. Santos, Gizele Locatelli, T. G. Dias, Ana Paula de Oliveira Barbosa, Eduardo Barbosa Lopes, Lucas Castilho Lopes, Vanessa da Silva Barros, Paulo Sergio Silva, F. H. Pitanga, Liamara Basso Dala Costa, Youssef Elias Ammar
Covid-19 is an infectious disease that causes inflammation in the respiratory system, is contagious and spreads rapidly. The sequelae caused after infection and treatment of Covid-19 are not fully known. The study aims to evaluate the quality of life and respiratory capacity of individuals who have been contaminated by the Covid-19 virus. This study is characterized as descriptive, with a cross-sectional design and a quantitative-qualitative approach. The sample consisted of 54 participants, of both sexes, diagnosed with Covid-19, who were hospitalized or not. Data collection was carried out through a mixed online questionnaire, developed on the Google Docs® platform. The results pointed to a worse quality of life in the domains Limitations due to physical aspects, Pain, Vitality, Limitations due to emotional aspects and a better quality of life for the domains Functional Capacity, General State of Health and Mental Health. And a worse quality of life assessed from the respiratory disease. It is concluded that the quality of life was affected and impaired after being affected by Covid-19 and that Physiotherapy helps to improve the sequelae and resumption of day-to-day activities, generating a good recovery.
{"title":"Assessment of Quality of Life and Respiratory Functional Capacity in Individuals Recovered from COVID-19","authors":"Cristianne Confessor Castilho Lopes, D. D. Santos, Gizele Locatelli, T. G. Dias, Ana Paula de Oliveira Barbosa, Eduardo Barbosa Lopes, Lucas Castilho Lopes, Vanessa da Silva Barros, Paulo Sergio Silva, F. H. Pitanga, Liamara Basso Dala Costa, Youssef Elias Ammar","doi":"10.36502/2022/asjbccr.6264","DOIUrl":"https://doi.org/10.36502/2022/asjbccr.6264","url":null,"abstract":"Covid-19 is an infectious disease that causes inflammation in the respiratory system, is contagious and spreads rapidly. The sequelae caused after infection and treatment of Covid-19 are not fully known. The study aims to evaluate the quality of life and respiratory capacity of individuals who have been contaminated by the Covid-19 virus. This study is characterized as descriptive, with a cross-sectional design and a quantitative-qualitative approach. The sample consisted of 54 participants, of both sexes, diagnosed with Covid-19, who were hospitalized or not. Data collection was carried out through a mixed online questionnaire, developed on the Google Docs® platform. The results pointed to a worse quality of life in the domains Limitations due to physical aspects, Pain, Vitality, Limitations due to emotional aspects and a better quality of life for the domains Functional Capacity, General State of Health and Mental Health. And a worse quality of life assessed from the respiratory disease. It is concluded that the quality of life was affected and impaired after being affected by Covid-19 and that Physiotherapy helps to improve the sequelae and resumption of day-to-day activities, generating a good recovery.","PeriodicalId":93523,"journal":{"name":"Asploro journal of biomedical and clinical case reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44973982","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 : 2022-04-04DOI: 10.36502/2022/asjbccr.6263
Facundo Rodríguez Ayala, Néstor Cardinali, R. Grau
Objective: Obesity is a worldwide endemic disease with limited options for treatment. Studies have indicated that the probiotic Bacillus subtilis can reduce weight gain and serum lipid levels in animal models. However, there are no publications showing positive results on the anti-obesity effect in humans. Here, we investigated the anti-obesity effect of the probiotic B. subtilis DG101 (i.e., reductions in weight, corporal fat content, and BMI) on overweight/obese subjects and the management of their HbA1c and insulin values. Design: A randomized, double-blinded, placebo-controlled study. Methods: A total of 294 subjects were divided into two groups according to sex. The subjects were randomly assigned to receive a daily dose of the probiotic B. subtilis DG101 or pure water (placebo) in all cases combined with a low-caloric/low-fat diet for 12 weeks. Weight, fat percentage, and BMI were measured, as well as HbA1c and insulin levels before and after the intervention. Results: The probiotic B. subtilis DG101 significantly reduced weight, fat percentage, and BMI after 12 weeks of the intervention compared to the placebo (p<0.05). There was a significant reduction of HbA1c and insulin levels between the groups (p<0.05). Conclusions: Ingestion of the probiotic B. subtilis DG101 as an adjuvant in the anti-obesity therapy compared with placebo for 12 weeks significantly reduce obesity related parameters. Our finding of lower HbA1c and insulin levels in pre-diabetic and diabetic patients during ingestion of the probiotic B. subtilis DG101 validated one of our previous reports.
{"title":"Efficient Weight Loss and Type II Diabetes Control in Overweight and Obese Patients Consuming the Probiotic Bacillus Subtilis DG101: A Randomized Double-Blind Placebo-Controlled Study","authors":"Facundo Rodríguez Ayala, Néstor Cardinali, R. Grau","doi":"10.36502/2022/asjbccr.6263","DOIUrl":"https://doi.org/10.36502/2022/asjbccr.6263","url":null,"abstract":"Objective: Obesity is a worldwide endemic disease with limited options for treatment. Studies have indicated that the probiotic Bacillus subtilis can reduce weight gain and serum lipid levels in animal models. However, there are no publications showing positive results on the anti-obesity effect in humans. Here, we investigated the anti-obesity effect of the probiotic B. subtilis DG101 (i.e., reductions in weight, corporal fat content, and BMI) on overweight/obese subjects and the management of their HbA1c and insulin values.\u0000Design: A randomized, double-blinded, placebo-controlled study.\u0000Methods: A total of 294 subjects were divided into two groups according to sex. The subjects were randomly assigned to receive a daily dose of the probiotic B. subtilis DG101 or pure water (placebo) in all cases combined with a low-caloric/low-fat diet for 12 weeks. Weight, fat percentage, and BMI were measured, as well as HbA1c and insulin levels before and after the intervention.\u0000Results: The probiotic B. subtilis DG101 significantly reduced weight, fat percentage, and BMI after 12 weeks of the intervention compared to the placebo (p<0.05). There was a significant reduction of HbA1c and insulin levels between the groups (p<0.05). Conclusions: Ingestion of the probiotic B. subtilis DG101 as an adjuvant in the anti-obesity therapy compared with placebo for 12 weeks significantly reduce obesity related parameters. Our finding of lower HbA1c and insulin levels in pre-diabetic and diabetic patients during ingestion of the probiotic B. subtilis DG101 validated one of our previous reports.","PeriodicalId":93523,"journal":{"name":"Asploro journal of biomedical and clinical case reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44526439","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 : 2022-04-02DOI: 10.36502/2022/asjbccr.6262
Jasminder K Malhi
ACE-inhibitor induced angioedema is a rare, potentially life-threatening phenomenon with unpredictable symptoms. With advanced angioedema, orotracheal intubation may not be possible necessitating nasotracheal intubation or cricothyroidotomy. This case describes a 76-year-old male with a history of hypertension controlled with lisinopril-hydrochlorothiazide who developed sudden-onset angioedema. Additionally, this case was complicated by the patient’s anticoagulation after recent abdominal aortic aneurysm repair. The patient’s acute respiratory distress was managed with nasotracheal intubation because of severe edema of the oral cavity including at the base of the tongue without improvement with epinephrine, a corticosteroid, or an antihistamine. He was extubated the following day, but mild edema of the oral cavity and left side of face persisted at discharge 4 days after presentation. When presenting to the emergency room with angioedema mediated via ACE-inhibitor use, time is of the essence to avoid cardiopulmonary arrest secondary to hypoxemia. Rapid identification and management of this condition is key to improve outcomes. After acute management, patients should be advised to avoid all ACE-inhibitors in the future.
{"title":"Chronic ACE-Inhibitor Induced Angioedema Requiring Emergent Nasotracheal Intubation: A Case Report","authors":"Jasminder K Malhi","doi":"10.36502/2022/asjbccr.6262","DOIUrl":"https://doi.org/10.36502/2022/asjbccr.6262","url":null,"abstract":"ACE-inhibitor induced angioedema is a rare, potentially life-threatening phenomenon with unpredictable symptoms. With advanced angioedema, orotracheal intubation may not be possible necessitating nasotracheal intubation or cricothyroidotomy. This case describes a 76-year-old male with a history of hypertension controlled with lisinopril-hydrochlorothiazide who developed sudden-onset angioedema. Additionally, this case was complicated by the patient’s anticoagulation after recent abdominal aortic aneurysm repair. The patient’s acute respiratory distress was managed with nasotracheal intubation because of severe edema of the oral cavity including at the base of the tongue without improvement with epinephrine, a corticosteroid, or an antihistamine. He was extubated the following day, but mild edema of the oral cavity and left side of face persisted at discharge 4 days after presentation. When presenting to the emergency room with angioedema mediated via ACE-inhibitor use, time is of the essence to avoid cardiopulmonary arrest secondary to hypoxemia. Rapid identification and management of this condition is key to improve outcomes. After acute management, patients should be advised to avoid all ACE-inhibitors in the future.","PeriodicalId":93523,"journal":{"name":"Asploro journal of biomedical and clinical case reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48837004","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 : 2022-03-02DOI: 10.36502/2022/asjbccr.6261
Satori Iwamoto, Harrison Chu
Tetanus is commonly seen in the emergency department with a puncture wound. This is an unusual presentation of tetanus without an open wound. A 59 year old male with a past history of hypertension, hepatitis C, prior injection drug use, and homeless presented to the emergency department with altered mental status and hyperthermia with fever of 105 F on a hot July afternoon. Patient was found in his car sleeping. Initially, the patient declined medical care, but was later found unresponsive with a methadone bottle next to him. Given Narcan on field with improvement of mental status. Patient developed acute ridged abdominal pain. A CT scan raised concern for acute abdomen, with portal venous gas, and intestinal pneumatosis. Surgery consulted and was concerned for ischemic colon with perforation. Vancomycin, ceftriaxone and metronidazole were given. Emergency exploratory laparotomy was performed with a small serosal injury on colon repaired with suture. Blood culture came back positive for Clostridium tetani and Mobiluncus curtisii. Infectious disease consulted. Felt tetanus cannot be ruled out. Patient was given tetanus immune globulin (TIG), metronidazole and later tetanus vaccine. Patient has fully recovered, tolerates oral diets, and has been discharged to a nursing facility without any neurological deficit. Tetanus is a neurological disorder caused by the tetanus toxins produced by clostridium tetani, which is a gram positive obligate anaerobes commonly found in soil. It is relevant to note that this bacterium can also be found inside the gut of animals and humans. The disease is well characterized by ancient Greeks, and common symptoms include trismus (“lockjaw”), opisthotonos, and a board-like rigid abdomen. Incubation is usually 7-21 days and this disease is usually prevented by vaccination. This case is unusual because there is no open wound and PE is limited due to patient’s overdose on opiates (methadone). Possible cause for this particular case may be that since there was no open wound, the blood could have been seeded by the perforated bowel because they may also be found in the gut. The patient was given metronidazole as part of Tx for acute abdomen, which happens to also be a treatment for tetanus. Diseases can be presented atypically. This case illustrates the importance of differential diagnosis when considering treatments in any pathology.
{"title":"Tetanus Presented as Acute Abdomen","authors":"Satori Iwamoto, Harrison Chu","doi":"10.36502/2022/asjbccr.6261","DOIUrl":"https://doi.org/10.36502/2022/asjbccr.6261","url":null,"abstract":"Tetanus is commonly seen in the emergency department with a puncture wound. This is an unusual presentation of tetanus without an open wound.\u0000A 59 year old male with a past history of hypertension, hepatitis C, prior injection drug use, and homeless presented to the emergency department with altered mental status and hyperthermia with fever of 105 F on a hot July afternoon.\u0000Patient was found in his car sleeping. Initially, the patient declined medical care, but was later found unresponsive with a methadone bottle next to him. Given Narcan on field with improvement of mental status.\u0000Patient developed acute ridged abdominal pain. A CT scan raised concern for acute abdomen, with portal venous gas, and intestinal pneumatosis. Surgery consulted and was concerned for ischemic colon with perforation. Vancomycin, ceftriaxone and metronidazole were given.\u0000Emergency exploratory laparotomy was performed with a small serosal injury on colon repaired with suture. Blood culture came back positive for Clostridium tetani and Mobiluncus curtisii. Infectious disease consulted. Felt tetanus cannot be ruled out. Patient was given tetanus immune globulin (TIG), metronidazole and later tetanus vaccine.\u0000Patient has fully recovered, tolerates oral diets, and has been discharged to a nursing facility without any neurological deficit.\u0000Tetanus is a neurological disorder caused by the tetanus toxins produced by clostridium tetani, which is a gram positive obligate anaerobes commonly found in soil. It is relevant to note that this bacterium can also be found inside the gut of animals and humans. The disease is well characterized by ancient Greeks, and common symptoms include trismus (“lockjaw”), opisthotonos, and a board-like rigid abdomen. Incubation is usually 7-21 days and this disease is usually prevented by vaccination.\u0000This case is unusual because there is no open wound and PE is limited due to patient’s overdose on opiates (methadone). Possible cause for this particular case may be that since there was no open wound, the blood could have been seeded by the perforated bowel because they may also be found in the gut. The patient was given metronidazole as part of Tx for acute abdomen, which happens to also be a treatment for tetanus. Diseases can be presented atypically. This case illustrates the importance of differential diagnosis when considering treatments in any pathology.","PeriodicalId":93523,"journal":{"name":"Asploro journal of biomedical and clinical case reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41554644","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 : 2022-02-22DOI: 10.36502/2022/asjbccr.6260
H. Bando
As recommended pharmacological agents for type 2 diabetes mellitus (T2DM), Glucagon-Like Peptide 1 receptor agonist (GLP-1Ra) is highly evaluated for its various beneficial effects. Among them, semaglutide (Rybelsus) has been in focus for useful oral formation with useful oral hypoglycemic agent (OHA). Administration per os is possible due to the developed technique of absorption enhancer sodium N-(8-[2-hydroxybenzoyl] amino) caprylate. Clinical efficacy was shown by a series of Peptide Innovation for Early Diabetes Treatment (PIONEER) with enough weight reduction and decreased HbA1c. From the results of several PIONEER programs, oral semaglutide 14 mg/day had reduced HbA1c values by approximately 1.0-1.4%.
{"title":"Useful Oral Administration of Glucagon-Like Peptide 1 Receptor Agonist (GLP-1RA) as Semaglutide (Rybelsus) for Type 2 Diabetes Mellitus (T2DM)","authors":"H. Bando","doi":"10.36502/2022/asjbccr.6260","DOIUrl":"https://doi.org/10.36502/2022/asjbccr.6260","url":null,"abstract":"As recommended pharmacological agents for type 2 diabetes mellitus (T2DM), Glucagon-Like Peptide 1 receptor agonist (GLP-1Ra) is highly evaluated for its various beneficial effects. Among them, semaglutide (Rybelsus) has been in focus for useful oral formation with useful oral hypoglycemic agent (OHA). Administration per os is possible due to the developed technique of absorption enhancer sodium N-(8-[2-hydroxybenzoyl] amino) caprylate. Clinical efficacy was shown by a series of Peptide Innovation for Early Diabetes Treatment (PIONEER) with enough weight reduction and decreased HbA1c. From the results of several PIONEER programs, oral semaglutide 14 mg/day had reduced HbA1c values by approximately 1.0-1.4%.","PeriodicalId":93523,"journal":{"name":"Asploro journal of biomedical and clinical case reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41599699","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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