occasionally subtle
Love Begins
taylor price
Not today Justin
EXPECTATIONS
Cosimo Galluzzi
RMH
noise dept.
roma★
pixel skylines
Game Changer & Make Some Noise
oozey mess
KIROKAZE
Keni
YOU ARE THE REASON
No title available
No title available
#extradirty
Monterey Bay Aquarium
shark vs the universe
seen from United States
seen from Russia
seen from Spain
seen from Australia
seen from Türkiye
seen from Switzerland
seen from Germany
seen from United Kingdom
seen from Brazil
seen from Türkiye
seen from Netherlands
seen from Hungary
seen from Netherlands
seen from Canada
seen from Chile
seen from United States
seen from Saudi Arabia
seen from United States
seen from South Africa
seen from Brazil
@juniperpublisherscasestudies
Happy Easter Day from Juniper Online Journal of Case Studies
Wishing you an egg-ceptionally wonderful Easter. Celebrate this day with peace, love, and gratitude. Have a blessed Easter. Hope your day is blooming with love and laughter.
Malignant Arterial Hypertension Revealing Focal Segmental Hyalinosis
Abstract
Malignant arterial hypertension (MAH) is a hypertensive emergency associated with grade III or IV retinopathy. Focal segmental hyalinosis (FSH), of late onset, is one of its rare entities, with an incidence of 7 per million, responsible for 15-20% of nephrotic syndromes in adults. We report a case of segmental and focal hyalinosis in a 27-year-old patient with no previous history of malignant hypertension, who consulted us for neurosensory signs and ocular redness. The clinical examination showed a hypertensive peak at 240/150mm Hg with myocardial hypertrophy confirmed by electrocardiogram and transthoracic echo. A fundus examination completed by an optical coherence tomography revealed a KIRKENDAL stage III retinopathy associated with an occlusion of a branch of the central retinal vein. An impure nephrotic syndrome associated with renal failure was observed. A biopsy of a fragment of renal parenchyma supplemented by pathology was performed in favour of FH with chronic tubulointerstitial disease. The patient was managed urgently with nicardipine 3-5mg/hr by electric syringe within 24 hours, followed by a triad of antihypertensive drugs consisting of amlodipine, indapamide and Ramipril at full dose combined with prednisone 60mg/day for 4 months with a 6 month taper. The evolution was marked by a normalisation of the renal function, disappearance of the proteinuria and even a normalisation of his eye fundus after one year. FSH constitutes a group of heterogeneous pathologies with multiple causes, of which malignant hypertension is a secondary one, requiring not only symptomatic but also etiological management.
Read More about this Article: https://juniperpublishers.com/jojcs/JOJCS.MS.ID.555843.php
Read More Juniper Publishers Google Scholar: https://scholar.google.com/citations?view_op=view_citation&hl=en&user=rp_7-igAAAAJ&cstart=20&pagesize=80&citation_for_view=rp_7-igAAAAJ:3fE2CSJIrl8C
Takotsubo Caused by Pulmonary Embolism
Abstract
Takotsubo is a transient acute coronary myocardial infarction due to a catecholaminergic discharge accounting for 1 in 36,000 adults after intense physical or psychological stress. Most often found in women over 50 years of age. Its association with pulmonary embolism is very rare.
With this in mind, we report the case of a 76-year-old female patient with poorly followed chronic obstructive pulmonary disease (COPD). She presented to the emergency department with acute respiratory distress and lipothymia. Clinical examination revealed hypoxia with SaPO2 at 86% in free air, blood pressure at 120/80mmHg, tachycardia at 112 beats/min. The electrocardiogram showed S1Q3, hyper-right axial deviation, complete right bundle branch block with fragmented QRS, positive AVR with a tachycardia of 125 beats/min. A thoracic angioscan was performed, showing a bilateral pulmonary embolism of segmental and sub-segmental level. Ultrasensitive troponins were highly elevated at 1530ng/l with transthoracic echocardiography showing signs of acute pulmonary heart disease associated with apical ballooning, very akinetic with hyperkinesia of the bases, LVEF 26% suggestive of takotsubo confirmed by coronary angiography coupled with ventriculography giving an amphora-like appearance with a healthy coronary. The patient was initially admitted to the intensive care unit and then to the hospital for an intermediate-high risk pulmonary embolism complicated by takotsubo. The etiological work-up of the pulmonary embolism was normal. She received apixaban, Ramipril and bisoprolol. The evolution was marked by a recovery of the bi ventricular function with an LVEF of 58% in 1 month.
Takotsubo was secondary to respiratory failure caused by pulmonary embolism through catecholaminergic discharge resulting in a redistribution of beta receptors in the myocardium.
Read More about this Article: https://juniperpublishers.com/jojcs/JOJCS.MS.ID.555846.php
Read More Juniper Publishers Google Scholar: https://scholar.google.com/citations?view_op=view_citation&hl=en&user=rp_7-igAAAAJ&cstart=20&pagesize=80&citation_for_view=rp_7-igAAAAJ:_FxGoFyzp5QC
An Uncommon Localization of a Hydatid Cyst Presenting with Pulmonary Embolism
Abstract
Human echinococcosis is an important infection in undeveloped and developing countries, caused by larval forms of the genus Echinococcus. In western countries this disease is sporadic. The organs mostly involved by the cysts are the liver (70%) and the lungs (20%) [1]. Cardiac hydatid cyst is a rare condition, and the location of a hydatid cyst in the interventricular septum is exceptional. Cardiac echinococcosis is not frequent, only 0.01%-2% of all hydatid infestations [2]. The left ventricle is the heart chamber most frequently involved (55-60%) and the involvement of the interventricular septum is reported in 4% of cardiac cases. Chest pain, palpitations, and dyspnea are the most frequent symptoms associated with cardiac echinococcosis. We describe a case of an unusual presentation of this disease.
Read More about this Article: https://juniperpublishers.com/jojcs/JOJCS.MS.ID.555847.php
Read More Juniper Publishers Google Scholar: https://scholar.google.com/citations?view_op=view_citation&hl=en&user=rp_7-igAAAAJ&citation_for_view=rp_7-igAAAAJ:hqOjcs7Dif8C
Wolf`s Isotopic Response: A Case of Metastatic Gastric Adenocarcinoma
Abstract
Wolf’s isotopic response is defined as the occurrence of a new skin disease at the site of a previous treated or untreated skin disease, mostly herpes zoster. A 70-year-old man, presented with persistent lesions at the same location of previously healed herpes zoster infection. Histopathology revealed diffuse infiltration of signet-ring form neoplastic cells. Further evaluations confirmed gastric adenocarcinoma in the patient. Rare etiologies of Wolf`s isotopic response should be known by physicians and early histopathologic assay when face to this phenomenon in order to early diagnosis is essential.
Read More about this Article: https://juniperpublishers.com/jojcs/JOJCS.MS.ID.555849.php
Read More Juniper Publishers Google Scholar: https://scholar.google.com/citations?view_op=view_citation&hl=en&user=rp_7-igAAAAJ&citation_for_view=rp_7-igAAAAJ:roLk4NBRz8UC
A Randomized, Double-Blind, Placebo- Controlled Study Trial to Evaluate the Potential Effects of Naticol®, Fish Collagen Peptides on Symptoms of Sarcopenia in the Elderly
Abstract
Background: Previous research has shown the potential effects of different doses of specific fish collagen peptides (Naticol®) on muscle mass and muscle function. In addition to these benefits, clinical studies have suggested that ingestion of specific fish collagen peptides (Naticol®) might also have beneficial effects on joint health such as osteoarthritis. Joint health, loss of muscle mass, and loss of muscle function are all symptoms experienced by elderly adults, and especially elderly adults suffering from sarcopenia, suggesting a possible role for Naticol® to help to reduce these symptoms in this vulnerable population.
Aim: The aim of this study was to determine the effect of 24 weeks’ supplementation of Naticol® on symptoms of sarcopenia in an elderly population.
Methods: In a randomized, double blind, placebo-controlled, clinical trial 28 elderly adults consumed one 15g sachet of either Naticol® or the Placebo product (maltodextrin) mixed into 20cl of cold water daily before breakfast, for 24 weeks. Symptoms of sarcopenia were assessed using dual x-ray absorptiometry (DXA) to measure lean body mass, the Short Physical Performance Battery to assess physical performance, the handgrip strength assessment to assess upper body muscle function, and the chair stand test to assess lower body muscle function.
Results: This study showed that 24 weeks of supplementation with Naticol® significantly improved symptoms of sarcopenia compared to placebo, by increasing lean muscle mass and increasing muscular function in the handgrip strength assessment, Short Physical Performance Battery, and Chair Stand Test.
Conclusion: The results of this study demonstrated that daily supplementation of Naticol® (containing fish collagen peptides) in elderly adults can improve symptoms of Sarcopenia, increasing lean muscle mass and increasing both upper and lower body muscle function.
Read More about this Article: https://juniperpublishers.com/jojcs/JOJCS.MS.ID.555850.php
Read More Juniper Publishers Google Scholar: https://scholar.google.com/citations?view_op=view_citation&hl=en&user=rp_7-igAAAAJ&citation_for_view=rp_7-igAAAAJ:LkGwnXOMwfcC
Three Patients with Dysphagia Following Hospitalization and Respiratory Support for Severe COVID-19 Pneumonia
Abstract
Background: During the coronavirus disease 2019 (COVID-19) pandemic, patients with severe pneumonia may require hospitalization and respiratory support. Oropharyngeal dysphagia may occur due to lack of muscle coordination of the respiratory and swallowing mechanisms in acute respiratory distress syndrome (ARDS) or as a consequence of intervention for respiratory support. This report is of a series of three patients who were hospitalized for severe COVID-19 pneumonia who developed dysphagia.
Case Series: Three patients patients were diagnosed with severe COVID-19 pneumonia with positive reverse transcription-polymerase chain reaction (RT-PCR) testing for SARS-CoV-2. Case 1: A 69-year-old man hospitalized with COVID-19 pneumonia and who underwent noninvasive mechanical ventilation followed by difficulty in swallowing. Case 2: An 84-year-old woman hospitalized with COVID-19 pneumonia and developed confusion, disorientation, swallowing difficulties, and aspiration pneumonia. Case 3: An 87-year-old man who developed ARDS following hospital admission with COVID-19 pneumonia.
Conclusion: These cases have shown that dysphagia may develop in patients hospitalized with severe COVID-19 pneumonia, either due to respiratory interventions or due to ARDS, and should be identified and actively managed to prevent further complications due to aspiration of gastric contents.
Read More about this Article: https://juniperpublishers.com/jojcs/JOJCS.MS.ID.555851.php
Read More Juniper Publishers Google Scholar: https://scholar.google.com/citations?view_op=view_citation&hl=en&user=rp_7-igAAAAJ&citation_for_view=rp_7-igAAAAJ:UebtZRa9Y70C
Relationship Between Early Menopause, Estrogens Receptor A Polymorphism, Vitamin D3 Receptor Polymorphisms and Osteoporosis in a Mediterranean Population
Abstract
In order to clarify the role of candidate genes for the osteoporosis related phenotypes, we have investigated among polymorphism of the ESR1 gene and polymorphism of VDR3 gene in the relation to BMD and bone loss in a population of women of the southern Italy who underwent early (35-45 years old) menopause. The bone mineral density of all subjects was measured by Dual energy x-ray absorptiometry (DEXA). Molecular analyses were performed on ERa and VDR3 genes exons using both sequencing and RFLP technology. All women showed an average DEXA value less than -2,5. We have identified polymorphisms in the coding region of ESR1 gene that is well correlated with the bone status of the affected subjects. Vitamin D3 receptor also presents polymorphisms and is evident only in the affected subjects. The identified polymorphism of ESR1 is present only in osteoporotic patients and absent in normal subjects, such as the vitamin D receptor. Furthermore all the subjects that show such polymorphisms have DEXA values lesser than -2.5 showing a relationship between the above polymorphisms and bone loss. This let us to hypothesize that identification of polymorphism of ESR1 and vitamin D3 receptor could be a tool for early diagnosis of osteoporosis in early menopause woman.
Read More about this Article:https://juniperpublishers.com/jojcs/JOJCS.MS.ID.555852.php
Read More Juniper Publishers Google Scholar: https://scholar.google.com/citations?view_op=view_citation&hl=en&user=rp_7-igAAAAJ&citation_for_view=rp_7-igAAAAJ:ufrVoPGSRksC
Mature Cystic Teratoma in the Mediastinum
Abstract
This case is a presentation of mature cystic teratoma (MCT) in the mediastinum. A 24-year-old female presented with acute, sharp, and non-radiating chest pain, and anxiety. Her lab findings were significant for elevated WBC, ESR, and CRP. X-ray and CT scans of chest revealed a fat-containing mass in the anterior mediastinum extending to the lung and compressing the pulmonary artery. The mass was subsequently resected via thoracic surgery. Further pathology study revealed skin folds establishing the diagnosis of MCT. This case emphasizes the need for clinicians to include mature cystic teratomas in the differential diagnosis.
Read More about this Article: https://juniperpublishers.com/jojcs/JOJCS.MS.ID.555853.php
Read More Juniper Publishers Google Scholar: https://juniperpublishers.com/jojcs/JOJCS.MS.ID.555853.php
Holistic Approach for Intervention in Geriatric Male Patient with Parkinson’s Disease: A Case Study
Abstract
Parkinson’s disease (PD) occurs most often in the people in their 50’s and 60’s. Hypokinetic dysarthria has been reported to occur in 73% of the patients suffering from PD [1]. The disease is closely related to cognitive difficulties such as impaired attention, disorganized thinking, inefficient processing of abstract new/old information. Speech Language Pathologist’s (SLP) role in the intervention of individuals with PD is not limited to working upon speech impairment but also improving various cognitive functions. This case study reflects the importance of inter-professional collaboration between neurologist, SLP along with other professionals and training of caretaker which plays a crucial role in intervention of individual with Parkinson’s disease. Also, SLP’s focus upon cognitive linguistic deficits, augmentative communication method and communication enhancement strategies could result in achieving communication goals.
Read More about this Article: https://juniperpublishers.com/jojcs/JOJCS.MS.ID.555854.php
Read More Juniper Publishers Google Scholar: https://scholar.google.com/citations?view_op=view_citation&hl=en&user=rp_7-igAAAAJ&citation_for_view=rp_7-igAAAAJ:YsMSGLbcyi4C
Recovery from Alopecia Universalis after Bilateral Lung Transplantation
Abstract
Alopecia areata (AA) is an immune-mediated form of hair loss that occurs in all ethnic groups, ages, and both sexes, with an estimated lifetime risk of 1.7% among the general population. Approximately 15-25% of all AA cases progress to Alopecia universalis (AU), which is a complete loss of scalp and body hair. Complete recovery from AU is rare (<10%). We report a case of AU in a patient who was referred to us for lung transplantation due to advanced bronchiectasis. The patient recovered from AU within three months of bilateral lung transplant using standard triple immunosuppressive therapy. To our knowledge, this is the first case report of AU recovery with standard immunosuppression use after lung transplantation.
Read More about this Article: https://juniperpublishers.com/jojcs/JOJCS.MS.ID.555855.php
Read More Juniper Publishers Google Scholar: https://scholar.google.com/citations?view_op=view_citation&hl=en&user=rp_7-igAAAAJ&citation_for_view=rp_7-igAAAAJ:W7OEmFMy1HYC
Whole Exome Sequencing Identifies Two Mutations in an Indian Patient with KBG Syndrome
Abstract
KBG syndrome is a condition characterised by macrodontia, neurological disturbance, short stature, a distinct cranio-facial appearance, and also the skeletal anomalies. The authors describe what appears to be the first case of KBG syndrome with mutation in two different gene reported from the Indian subcontinent. Meticulous evaluation of the patients helps to classify such cases which may otherwise remain undiagnosed. Further research is reasonable to regulate the classic and the variant presentations of this condition, with the follow-up of the patients that provides the valuable data insights into its natural history and long-term prognosis. As per database these variants have been not reported till date, we found two variants in an Indian patient.
Read More about this Article: https://juniperpublishers.com/jojcs/JOJCS.MS.ID.555856.php
Read More Juniper Publishers Google Scholar: https://scholar.google.com/citations?view_op=view_citation&hl=en&user=rp_7-igAAAAJ&citation_for_view=rp_7-igAAAAJ:WF5omc3nYNoC
Clinical, Radiographic, and Histologic Outcomes of Ankle Arthrodesis in a Diabetic Patient using a Biphasic Calcium Phosphate Bone Graft with a Novel Submicron Needle-shaped Surface Topography
Abstract
Patients with diabetes mellitus who sustain ankle fractures are at increased risk of complications including non-union, malunion, wound dehiscence, soft tissue infection, osteomyelitis, deterioration to Charcot arthropathy, and amputation [1-3]. Multiple publications have evaluated treatment options for diabetic patients with ankle fractures; management options include non-surgical treatment and immobilization, open reduction internal fixation, arthrodesis of the tibiotalar joint, arthrodesis of the tibiotalocalcaneal joints, external fixation, and amputation [4-7]. It is important to identify an effective bone graft for these cases, as well as to understand the science behind the bone graft selected. In recent years, the study of osteoimmunology has confirmed the reciprocal interaction of bone forming mesenchymal stem cells and immune cells on bone growth. This report describes an adult female patient with a late presenting ankle fracture dislocation, initially treated with ankle arthrodesis using a novel bone graft with submicron needle-shaped surface topography. The patient developed Charcot arthropathy and was revised to a tibiotalocalcaneal (TTC) nail. During revision, a biopsy was taken of a solidly fused segment and sent for histology. Radiographic, clinical, and histological data were tracked and showed solid fusion at 6 weeks radiographically, which was confirmed via histology and surgical exploration at 12 weeks, indicating notable results in this challenging arthrodesis case using a novel bone graft with submicron needle-shaped surface topography.
Read More about this Article: https://juniperpublishers.com/jojcs/JOJCS.MS.ID.555857.php
Read More Juniper Publishers Google Scholar: https://scholar.google.com/citations?view_op=view_citation&hl=en&user=rp_7-igAAAAJ&citation_for_view=rp_7-igAAAAJ:Tyk-4Ss8FVUC
Periprosthetic Joint Infection after High-Dosage Cortison-Therapy
Abstract
Periprosthetic joint infections are a serious complication after total knee replacement. By now there are no common guidelines or recommendations regarding the handling of a high-dosage cortisone therapy after total knee replacement. In this case we present a periprosthetic knee infection likely caused by a high-dosage cortisone therapy or an intravenous drip infection resulting in revision surgery. A sufficiently long-time interval between total knee replacement and immunosuppressive therapy of at least 3-6 months is requested.
Read More about this Article: https://juniperpublishers.com/jojcs/JOJCS.MS.ID.555828.php
Read More Juniper Publishers Google Scholar: https://scholar.google.com/citations?view_op=view_citation&hl=en&user=rp_7-igAAAAJ&citation_for_view=rp_7-igAAAAJ:4TOpqqG69KYC
A Case Report on a Rare Cervical Polyp
Abstract
Background: Giant cervical polyps are rare. They are commonly asymptomatic and diagnosed incidentally on pelvic examination.
Case: This is a 59-year-old multiparous who had a giant cervical polyp diagnosed on speculum examination after presenting to her general practitioner reporting symptoms of pelvic pressure and heaviness. The polyp was successfully resected with hysteroscopy.
Conclusion: A giant cervical polyp in a multiparous female which was successfully resected during hysteroscopy.
Read More about this Article: https://juniperpublishers.com/jojcs/JOJCS.MS.ID.555858.php
Read More Juniper Publishers Google Scholar: https://scholar.google.com/citations?view_op=view_citation&hl=en&user=rp_7-igAAAAJ&citation_for_view=rp_7-igAAAAJ:zYLM7Y9cAGgC
A Rare Case of Metastatic Malignant Paraganglioma : Following with F-18 FDG PET/MRI
Abstract
Paragangliomas are rare tumors arising from undifferentiated cells of the primitive neural crest. We present a 43-year-old male patient with a glomus tumor in the left carotid space and a retroperitoneal tumor with bone metastases, with invasion of the left renal vein in the left paraaortic area posterior to the third part of the duodenum. Serum epinephrine and norepinephrine levels were high. A CT-guided trucut biopsy was performed from this lesion, and histopathological examination and immunohistochemical analyzes concluded the diagnosis of retroperitoneal paraganglioma. The tumor was judged to be secretive and inoperable; therefore, it was decided to treat it with radiotherapy and systemic chemotherapy.
Read More about this Article: https://juniperpublishers.com/jojcs/JOJCS.MS.ID.555859.php
Read More Juniper Publishers Google Scholar: https://scholar.google.com/citations?view_op=view_citation&hl=en&user=rp_7-igAAAAJ&citation_for_view=rp_7-igAAAAJ:UeHWp8X0CEIC
A Case Study on Birth Experience
Abstract
Background: Normal consciousness may be profoundly changed during labour. Access to heightened states of personal and existential awareness may be part of the uninhibited ritual of natural childbirth.
Aim: Validate the possibility of heightened awareness and transcendence that can occur beyond the province of normal human experience. Peek experiences may bring life changing realizations of deep universal connection and personal insight.
Findings: Breakthrough experiences may occur in any state of intense physical focus, including the mindfulness of supported birth practices.
Discussion: The perspective reiterates the importance of rational, individualized, woman-centred care in birth.
Conclusion: The environment of birth, the safety and support of known and trusted care givers can allow birth events to unfold with the least possible intrusion. A hitherto under-recognized sequalae for such freedom may be the possibility of connecting to a state of expanded awareness that can bring profound unveiling of inner being and self-acceptance.
Read More about this Article: https://juniperpublishers.com/jojcs/JOJCS.MS.ID.555861.php
Read More Juniper Publishers Google Scholar: https://scholar.google.com/citations?view_op=view_citation&hl=en&user=rp_7-igAAAAJ&citation_for_view=rp_7-igAAAAJ:IjCSPb-OGe4C