Clinics and Practice

986 KiB

Open AccessCase Report

The Effects of High-Frequency Transcranial Magnetic Stimulation Combined with Transcutaneous Electrical Stimulation in a Severe Stroke Patient

by Soichiro Koyama, Shigeo Tanabe, Kazuya Takeda, Hiroaki Warashina, Hiroaki Sakurai, Yoshikiyo Kanada, Ryuji Okumura, Jun Shinoda, Junji Nagata and Tetsuo Kanno

Clin. Pract. 2012, 2(4), e89; https://doi.org/10.4081/cp.2012.e89 - 18 Dec 2012

Cited by 1

Abstract

The case report describes the effects of 5 Hz repetitive transcranial magnetic stimulation (rTMS) combined with transcutaneous electrical stimulation (TES) in a patient with severe stroke. The patient was a 69-year-old male who was affected by a left middle cerebral artery infarction. The [...] Read more.

The case report describes the effects of 5 Hz repetitive transcranial magnetic stimulation (rTMS) combined with transcutaneous electrical stimulation (TES) in a patient with severe stroke. The patient was a 69-year-old male who was affected by a left middle cerebral artery infarction. The patient had no movement in his right hand. To assess the effects, cerebral blood flow and motor function were measured before and after treatment. This treatment delivered rTMS over the affected M1 with TES at the paretic wrist extensor muscles for 10 days. The regional cerebral blood flow (rCBF) in the entire brain was measured by positronemission tomography. To evaluate the motor function, the Fugl-Meyer assessment (FMA) was used. After treatment, the rCBF was increased (except for the stimulated region), and the FMA score was slightly improved. These results suggest the potential therapeutic use of rTMS combined with TES for recovery in severe stroke. Full article

551 KiB

Open AccessCase Report

Fluoroquinolone Toxicity Symptoms in a Patient Presenting with Low Back Pain

by Megan Strauchman and Mark W. Morningstar

Clin. Pract. 2012, 2(4), e87; https://doi.org/10.4081/cp.2012.e87 - 28 Nov 2012

Cited by 1

Abstract

Fluoroquinolone medications have been shown to contribute to tendinopathies, cardiotoxicity, and neurotoxicity. Low back pain is a common musculoskeletal condition for which chiropractic treatment is most often sought. This case report details a patient presenting with low back pain and a history of [...] Read more.

Fluoroquinolone medications have been shown to contribute to tendinopathies, cardiotoxicity, and neurotoxicity. Low back pain is a common musculoskeletal condition for which chiropractic treatment is most often sought. This case report details a patient presenting with low back pain and a history of fluoroquinolone toxicity. The patient was initially treated with chiropractic manipulation, which increased her symptoms. She was then referred to an osteopathic physician who treated the patient with intravenous antioxidants and amino acids, an elimination diet, and probiotic supplementation. Within 4 months of therapy, the patient reported a decrease in pain, a resolution of her dizziness, shortness of breath, panic attacks, tachycardia, and blurred vision. After an additional 8 weeks of antioxidant therapy, she reported further reductions in pain and improved disability. People susceptible to fluoroquinolone toxicity may present with common musculoskeletal symptoms. A past medical history and medication history may help to identify this population of patients. People presenting with fluoroquinolone toxicity may have unidentified contributing factors that predispose them to this anomaly. This patient reported improvements in pain and disability following antioxidant amino acid therapy for a total of 6 months. The natural history of fluoroquinolone toxicity is unknown and may account for the observed improvements. Full article

684 KiB

Open AccessCase Report

Complications of Untreated Molar-Incisor Hypomineralization in a 12-Year-Old Boy

by Shubha Arehalli Bhaskar and Sapna Hegde

Clin. Pract. 2012, 2(4), e88; https://doi.org/10.4081/cp.2012.e88 - 16 Nov 2012

Cited by 1

Abstract

Complications arising because of untreated molar-incisor hypomineralization (MIH) have received little mention in the dental literature. However, this can be an area of concern, with severe consequences in rare cases. Hence, early recognition and prompt management of MIH is essential for long-term oral [...] Read more.

Complications arising because of untreated molar-incisor hypomineralization (MIH) have received little mention in the dental literature. However, this can be an area of concern, with severe consequences in rare cases. Hence, early recognition and prompt management of MIH is essential for long-term oral health of affected individuals. This paper describes an untreated case of severe MIH that resulted in infection of facial spaces. Full article

730 KiB

Open AccessArticle

Oral Hygiene Status of Individuals with Cardiovascular Diseases and Associated Risk Factors

by Divya Shetty, Mahima Dua, Kiran Kumar, Raghu Dhanpal, Madhusudan Astekar and Devi Charan Shetty

Clin. Pract. 2012, 2(4), e86; https://doi.org/10.4081/cp.2012.e86 - 13 Nov 2012

Cited by 8

Abstract

Dentist and oral health screening may be the latest weapon in identifying persons at risk of cardiovascular disease. Oral infections, specifically periodontitis, may confer independent risks for different systemic conditions. The risk factors associated with cardiovascular diseases also suggest that the relationship between [...] Read more.

Dentist and oral health screening may be the latest weapon in identifying persons at risk of cardiovascular disease. Oral infections, specifically periodontitis, may confer independent risks for different systemic conditions. The risk factors associated with cardiovascular diseases also suggest that the relationship between periodontal disease and diabetes works in both ways. The aim of this study was to support and strengthen the association and relationship between oral hygiene status of individuals with cardiovascular diseases and its associated risk factors. A simple random sampling was carried out in 200 inhabitants of Western Utter Pradesh, India. An oral health visit and examination was made for an equal number of males and females of different age groups with cardiovascular diseases. Evaluation of the oral status was made by means of an oral hygiene index, community periodontal index of treatment needs and loss of attachment. Evaluation of oral status in patients with cardiovascular diseases and in the control group has shown a statistically significant low level of oral health in patients with cardiovascular diseases as compared to control. Prevalence of systemic diseases in different age groups significantly correlated with the prevalence of severe periodontal diseases. Treating gum disease may reduce the risk of heart disease and improve health outcomes for patients with periodontal disease and vascular heart problems. Full article

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Open AccessCase Report

Occult Ectopic Adrenocorticotropic Hormone Secretion: Diagnostic Dilemma and Infective Consequence

by Njideka Momah and Thomas Koroscil

Clin. Pract. 2012, 2(4), e82; https://doi.org/10.4081/cp.2012.e82 - 13 Nov 2012

Cited by 2

Abstract

A 42-year-old male presented with polyuria, polydipsia and weight loss. His initial physical exam showed a paucity of cushingoid features. Diagnostic work up was consistent with an ectopic adrenocorticotropic hormone (ACTH) secretion. Imaging studies showed a small anterior mediastinal lesion without additional metabolically [...] Read more.

A 42-year-old male presented with polyuria, polydipsia and weight loss. His initial physical exam showed a paucity of cushingoid features. Diagnostic work up was consistent with an ectopic adrenocorticotropic hormone (ACTH) secretion. Imaging studies showed a small anterior mediastinal lesion without additional metabolically active tumors. Fine needle aspiration was consistent with a thymic neuroendocrine tumor. Following radical thymectomy, plasma ACTH and cortisol levels remained elevated. Despite medical management, he died within 2 months of presentation of disseminated intracranial aspergillosis. This case underscores the diagnostic dilemma of occult ectopic ACTH-secreting tumors and the fatal consequence of opportunistic infections. Full article

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Open AccessCase Report

The Dilemma of Treating Vertebrobasilar Dolichoectasia

by Yu-Wei Lin, Chih-Hung Chen and Ming-Liang Lai

Clin. Pract. 2012, 2(4), e84; https://doi.org/10.4081/cp.2012.e84 - 17 Oct 2012

Cited by 14

Abstract

Vertebrobasilar dolichoectasia (VBD) is a common phenomenon among people over 50 years old, and the related clinical expressions are varied. One of our VBD patients presented with brainstem infarction initially, received low molecular weight heparin treatment, and developed rupture of the dolichoectasia segment. [...] Read more.

Vertebrobasilar dolichoectasia (VBD) is a common phenomenon among people over 50 years old, and the related clinical expressions are varied. One of our VBD patients presented with brainstem infarction initially, received low molecular weight heparin treatment, and developed rupture of the dolichoectasia segment. Another patient with a similar-sized VBD experienced recurrent brainstem infarction three times over 2 years, despite higher bleeding tendency and long-term antiplatelet treatment. The third patient with a smallersized VBD, had left hemiplegia and received intravenous recombinant tissue plasminogen activator within 3 h, totally recovered with no lesions detected on brain Magnetic Resonance Imaging (MRI). The pathophysiology of VBD is unique, its prevalence and risks of ischemic stroke and intracranial hemorrhage both increase as the degree of arterial dolichoectasia extends, making the strategy of management quite a challenge. The best management of VBD is controlling arterial hypertension and following up with image studies regularly to detect the early extension of VBD degree. Full article

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Open AccessCase Report

Autoimmune Hepatitis Induced by Nitrofurantoin. The Importance of the Autoantibodies for an Early Diagnosis of Immune Disease

by Jagannath M. Sherigar, Richard Fazio, Minsheng Zuang and Edward Arsura

Clin. Pract. 2012, 2(4), e83; https://doi.org/10.4081/cp.2012.e83 - 17 Oct 2012

Cited by 11

Abstract

Nitrofurantoin has been in use since 1953 as an effective agent for the prevention of recurrent urinary tract infection. It is associated with a wide range of adverse drug reactions. Chronic active hepatitis has increasingly been observed and many cases have been reported [...] Read more.

Nitrofurantoin has been in use since 1953 as an effective agent for the prevention of recurrent urinary tract infection. It is associated with a wide range of adverse drug reactions. Chronic active hepatitis has increasingly been observed and many cases have been reported with case fatalities. We present a case of nitrofurantoin induced chronic active hepatitis and briefly review the serology and clinico pathological features of 57 similar cases reported in English literature. The consistent presence of antinuclear antibody, anti smooth muscle antibody, elevated immunoglobulin and pathological feature suggests an immunologic mechanism. Complete recovery is possible in most cases if medication is discontinued in time. Steroids may play a role in management if no improvement occurs despite discontinuation of medication. We suggest all patients who are on prolonged nitrofurantoin therapy be followed up with anti nuclear antibody, anti smooth muscle antibody, serum immunoglobulin and hepatic panel every three months. Full article

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Open AccessArticle

Foot Care and Footwear Practices among Patients Attending a Specialist Diabetes Clinic in Jamaica

by Krystal A.T. Gayle, Marshall K. Tulloch-Reid, Novie O. Younger, Damian K. Francis, Shelly R. McFarlane, Rosemarie A. Wright-Pascoe, Michael S. Boyne, Rainford J. Wilks and Trevor S. Ferguson

Clin. Pract. 2012, 2(4), e85; https://doi.org/10.4081/cp.2012.e85 - 16 Oct 2012

Cited by 10

Abstract

This study aimed to estimate the proportion of patients at the University Hospital of the West Indies (UHWI) Diabetes Clinic who engage in recommended foot care and footwear practices. Seventy-two participants from the UHWI Diabetes Clinic completed an interviewer-administered questionnaire on foot care [...] Read more.

This study aimed to estimate the proportion of patients at the University Hospital of the West Indies (UHWI) Diabetes Clinic who engage in recommended foot care and footwear practices. Seventy-two participants from the UHWI Diabetes Clinic completed an interviewer-administered questionnaire on foot care practices and types of footwear worn. Participants were a subset of a sex-stratified random sample of clinic attendees and were interviewed in 2010. Data analysis included frequency estimates of the various foot care practices and types of footwear worn. Participants had a mean age of 57.0±14.3 years and mean duration of diabetes of 17.0±10.3 years. Fifty-three percent of participants reported being taught how to care for their feet, while daily foot inspection was performed by approximately 60% of participants. Most participants (90%) reported daily use of moisturizing lotion on the feet but almost 50% used lotion between the toes. In conclusion, approximately 85% of participants reported wearing shoes or slippers both indoors and outdoors but over 40% reported walking barefoot at some time. Thirteen percent wore special shoes for diabetes while over 80% wore shoes without socks at some time. Although much larger proportions reported wearing broad round toe shoes (82%) or leather shoes (64%), fairly high proportions reported wearing pointed toe shoes (39%), and 43% of women wore high heel shoes. Approximately 60% of patients at the UHWI diabetic clinic engage in daily foot inspection and other recommended practices, but fairly high proportions reported foot care or footwear choices that should be avoided. Full article

548 KiB

Open AccessCase Report

Optic Nerve Enlargement in Infantile Form of Krabbe Disease

by Dimas Castilha-Neto, Letícia Fernandes Monteiro, Mirella Maccarini Peruchi, João Moreno Filho, Aline Vieira Scarlatelli-Lima and Jaime Lin

Clin. Pract. 2012, 2(4), e81; https://doi.org/10.4081/cp.2012.e81 - 16 Oct 2012

Abstract

Krabbe disease (KD) is an autosomal recessive lysosomal storage disorder caused by dysfunctional galactosylceramidase activity. Infantile form is the most common subtype, occurring at about 6-month of age. We present a rare case of infantile KD with magnetic resonance imaging showing white matter, [...] Read more.

Krabbe disease (KD) is an autosomal recessive lysosomal storage disorder caused by dysfunctional galactosylceramidase activity. Infantile form is the most common subtype, occurring at about 6-month of age. We present a rare case of infantile KD with magnetic resonance imaging showing white matter, thalamic and basal ganglia lesions rarely associated with an enlargement of the optic nerves bilaterally. Full article

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Open AccessCase Report

Pseudotumoral Autoimmune Pancreatitis Mimicking a Pancreatic Cancer: A Very Difficult Disease to Diagnose

by Sadreddine Ben Abid, Rania Hefaiedh, Sameh Zghab, Nizar Miloudi, Lassad Gharbi and Mohamed Taher Khalfallah

Clin. Pract. 2012, 2(4), e80; https://doi.org/10.4081/cp.2012.e80 - 12 Oct 2012

Cited by 3

Abstract

Autoimmune pancreatitis (AIP) is a rare disorder, although the exact prevalence is still unkown. It is a type of pancreatitis that is presumed to have an autoimmune aetiology, and is currently diagnosed based on a combination of 5 criteria. However, in this day [...] Read more.

Autoimmune pancreatitis (AIP) is a rare disorder, although the exact prevalence is still unkown. It is a type of pancreatitis that is presumed to have an autoimmune aetiology, and is currently diagnosed based on a combination of 5 criteria. However, in this day and age, some patients with AIP are likely to be resected for the suspicion of malignancy. The authors report a case of pseudotumoral autoimmune pancreatitis, reviewing some literature about it and underlining the difficulty in the diagnosis. A 56-year-old patient was referred to our unit for upper abdominal pain. In his past medical history we note mellitus diabetes. The clinical examination was unremarkable. Laboratory data showed no abnormal values. Upper endoscopy showed antral gastritis. Transabdominal ultrasonography showed a hepatic steatosis and 5 angiomas. No computed tomography scan was made. Magnetic resonance imaging (MRI) showed 5 angiomas and a lesion of 20x20 mm of the pancreatic tail with decreased signal intensity on T1-weighted MR images, increased signal intensity on T2-weighted MR images. Due to concerns of pancreatic malignancy, the patient underwent open distal spleno-pancreatectomy. Histolo gical analysis of the resected specimen revealed no malignancy. Postoperatively, immunoglobulin G fraction 4 was slightly above of the upper limit of the normal range. After corticotherapy the patient is getting better. This case underlines the difficulties still encountered in the diagnosis of AIP. It has been frequently misdiagnosed as pancreatic cancer and caused unnecessary resection. In order to avoid unnecessary resections for an otherwise benign and easily treatable condition, it is urgent to refine diagnostic criteria and to reach an international consensus. Full article

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Clin. Pract., Volume 2, Issue 4 (December 2012) – 10 articles

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