VOLUME-6 | YEAR-2023
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Case Report | Open Access | Asp Biomed Clin Case Rep. 2023 Jan 25;6(1):1-5
COVID Pneumonia with Immune Thrombocytopenic Purpura and Some Novel Strange Graduated Electrocardiographic T-Wave Abnormalities, Clinical Impact and Interpretation
Yasser Mohammed Hassanain Elsayed*
Pages: 1-5 | First Published: 25 Jan 2023 | DOI: 10.36502/2023/ASJBCCR.6281
Rationale: Immune thrombocytopenic purpura may be associated with severe acute respiratory syndrome (SARS) or Coronaviruses. Probably fatal outcome for the disease has a remarkable effect on morbidity and mortality. T-wave is the positive deflection post-each QRS-complex. Physiologically, it represents ventricular repolarization.
Patient Concerns: A 66-year-old, teacher, married male, Egyptian patient was presented to the physician outpatient clinic with COVID-19 pneumonia with thrombocytopenia and abnormal T-wave.
Diagnosis: COVID pneumonia with immune thrombocytopenic purpura and novel T-wave graduation.
Interventions: Non-contrast chest CT, electrocardiography, oxygenation, and echocardiography.
Outcomes: Good response and better outcomes despite the presence of numerous remarkable risk factors were the results.
Lessons: The association of COVID pneumonia with immune thrombocytopenic purpura and novel T-wave graduation is highly interesting. An elder age, male sex, COVID-19 pneumonia, and immune thrombocytopenic purpura are constellation serious risk factors. Touching radiological variant pericardial injury with mild hypokalemia maybe interpret the novel T-wave graduation.
Short Communication | Open Access | Asp Biomed Clin Case Rep. 2023 Jan 26;6(1):6-10
Recent Psychological Changes in Egogram for University Students by Tokyo University Egogram (TEG)
Tomohiro YOKOYAMA, Hiroshi BANDOiD*
Pages: 6-10 | First Published: 26 Jan 2023 | DOI: 10.36502/2023/ASJBCCR.6282
As a reliable psychological test, Tokyo University Egogram (TEG) 2nd has been used widely. TEG was recently revised to TEG 3rd. Authors continued TEG research on university students for long, in which results of 2018 by TEG 2nd and results of 2019-2022 by TEG 3rd were compared. For the 3rd revision, FC dominant and AC dominant increased markedly, whereas CP dominant and NP dominant decreased. C dominant pattern showed remarkable increase, which is due to increase of AC dominant and FC dominant. This is a characteristic tendency for late teenagers. Further, mixed types of N-shaped and reverse N-shaped patterns were found.
Case Report | Open Access | Asp Biomed Clin Case Rep. 2023 Feb 04;6(1):11-16
Achalasia Following a SARS-CoV-2 Infection and Recent COVID-19 Immunization in a 20-year-old Female
Nadejda Godoroja, Katrina Waters, Austin Ghera, Nalin Ranasinghe, Leonard Ranasinghe*
Pages: 11-16 | First Published: 04 February 2023 | DOI: 10.36502/2023/ASJBCCR.6283
Achalasia is an esophageal disorder characterized by loss of inhibitory neurons of the myenteric plexus in the lower esophageal sphincter, presenting with dysphagia, chest pain, and regurgitation. Although the etiology of achalasia is unknown, it has been associated with viral infections, and recent studies have noted concurrence of achalasia cases with COVID-19 infection. The case discussed in this report pertains to a 20-year-old female with a recent history of COVID-19 infection and subsequent SARS CoV-2 vaccine administration, presenting to the Emergency Department with a complaint of chest pain and shortness of breath. She was incidentally diagnosed with achalasia, after concern for pulmonary embolism prompted CT angiography of the chest. This case is unique due to the patient’s young age and lack of confounding ongoing medical issues to consider when analyzing disease presentation, as well as its potential link to COVID-19 infection. We hypothesize that SARS-CoV-2 might have caused a deviant immune response in this patient, leading to vagus nerve damage and the development of achalasia. With this case report, we hope to further explore the connection between COVID-19 and achalasia to help guide clinicians to potential viral etiologies of achalasia, allowing them for a prompt and efficient diagnosis and patient management.
Case Report | Open Access | Asp Biomed Clin Case Rep. 2023 Feb 04;6(1):17-22
Elderly Female of Type 2 Diabetes (T2D) and Dementia with Clinical Improvement by Imeglimin (Twymeeg)
Masaki OKADA, Hiroshi BANDOiD*, Noboru IWATSUKI, Kazuki SAKAMOTO, Tomoya OGAWA
Pages: 17-22 | First Published: 04 February 2023 | DOI: 10.36502/2023/ASJBCCR.6284
Background: Recent diabetic focus includes imeglimin (Twymeeg).
Case Presentation: The case was an 83-year-old female with 19 years of type 2 diabetes (T2D) associated with recent treatment for dementia.
Result: HbA1c decreased from 10.0% to 6.6% for 4 months by Twymeeg 2000 mg/day. For neuropsychiatric symptoms in dementia, memantine and tiapride were provided and controlled. Furthermore, zinc acetate hydrate (Novelzin) was continued for T2D and dementia.
Discussion and Conclusion: Twymeeg administration was effective as the results of Trials of IMeglimin for Efficacy and Safety (TIMES) 2 and 3. Perspectives on the efficacy of zinc were discussed including Alzheimer’s-Plus with low zinc (APLZ).
Case Report | Open Access | Asp Biomed Clin Case Rep. 2023 Feb 13;6(1):23-29
A Rare, Relapsing Kommerell Diverticulum – A Case Report
Alejandro Bautista-Pérez-Gavilán, Denya Sánchez-Quintero, Ana Gilabert-García, José Emiliano Ríos-Méndez, Santiago Saenz-Ancira, Carlos Alberto Villa-Ramirez, Andrea Ibarra-Moreno, Mariell Rodríguez-Salazar, Sofía Molina Castillo, Jorge Luis Bermudez-Gonzalez, Nilda Espinola-Zavaleta, Leonardo Proaño Bernal, Erick Alexanderson-RosasiD*
Pages: 23-29 | First Published: 13 February 2023 | DOI: 10.36502/2023/ASJBCCR.6285
Kommerell diverticulums are an uncommon congenital vascular disease involving an aberrant origin of the right or left subclavian artery and a dilation of its root. Here, we present the case of a 44-year-old woman with a relapse of a surgically repaired aberrant subclavian artery with a Kommerell diverticulum.
Short Communication | Open Access | Asp Biomed Clin Case Rep. 2023 Feb 17;6(1):30-33
Evidence-based medicine: Challenges and Consensus for Clinicians & Epidemiologists
Duong Dieu, Nguyen Quoc KhoaiD*
Pages: 30-33 | First Published: 18 February 2023 | DOI: 10.36502/2023/ASJBCCR.6286
Clinical epidemiology focuses on issues relevant to clinical medicine, representing a distinctive field that converts clinical practice into a quantitative science. Public health epidemiology is the basis of knowledge about how to prevent and treat disease in populations. Clinicians are concerned with diagnosing disease, making a prognosis, and prescribing specific treatment for each patient. Epidemiologists seek to identify a specific source of infection, mode of transmission, or causative factors in order to identify future trends and specifically recommend control measures. Evidence-based medicine (EBM) is both a challenge and a consensus for clinicians and epidemiologists. Through this article, we review the challenges and consensus of epidemiologists and clinicians on evidence-based medicine towards a future consensus development for the goal of medical ethics (Medical ethics ME) with the spirit of “All for One, One for All”.
Case Report | Open Access | Asp Biomed Clin Case Rep. 2023 Feb 18;6(1):34-39
Interventricular Septal Rupture: An Uncommon Complication of an Acute Myocardial Infarction
Mariell Rodríguez-Salazar, Javier Sánchez-Ham, Malery Torres-Martínez, María José Magallanes-Jiménez, Marian Serna-Murga, Ana Loreto San-Vicente-Iglesias, Javier Lizardi-Montaño, Andrea Ibarra-Moreno, Alejandro Bautista-Pérez-Gavilán, Carlos Alberto Villa-Ramírez, Santiago Saenz-Ancira, Sofía Molina-Castillo, Erick Alexanderson-RosasiD*
Pages: 34-39 | First Published: 18 February 2023 | DOI: 10.36502/2023/ASJBCCR.6287
Ventricular septal rupture is an uncommon but serious complication of acute myocardial infarction that requires prompt and appropriate management. In this case, we present a typical example of a patient diagnosed with a ventricular septal rupture.
Case Report | Open Access | Asp Biomed Clin Case Rep. 2023 Mar 02;6(1):40-46
Detail Measurement of Pre-Prandial and Post-Prandial Blood Glucose during Imeglimin (Twymeeg) Treatment
Kenji Hayashi, Hiroshi BandoiD*, Kazuya Miki, Misaki Hamai, Tatsuo Yasuoka
Pages: 40-46 | First Published: 02 March 2023 | DOI: 10.36502/2023/ASJBCCR.6288
Background: Among oral hypoglycemic agents (OHAs), imeglimin (Twymeeg) would be in focus.
Case Presentation: The patient in this case is a 58-year-old female with a history of obesity and previous operations for posterior longitudinal ligament ossification. In early September 2022, she developed dizziness and a general feeling of unwellness, leading to a diagnosis of Type 2 Diabetes (T2D) with an HbA1c level of 11.1%.
Result: The patient was treated with a low carbohydrate diet (LCD) and Twymeeg, resulting in a significant decrease in HbA1c levels from 11.1% to 9.0%, 6.7%, and 5.9% over the course of three months. Pre-prandial and post-prandial blood glucose levels were measured with great accuracy.
Discussion and Conclusion: The administration of Twymeeg was found to be effective in reducing the patient’s HbA1c levels, and the relationship between HbA1c and glucose variability could be further investigated based on these results.
Case Report | Open Access | Asp Biomed Clin Case Rep. 2023 Mar 18;6(1):47-49
Application of Genicular Nerves Block Combined with iPACK Block in Postoperative Analgesia of Total Knee Arthroplasty
Yan Zeng, Yan Xu*
Pages: 47-49 | First Published: 18 March 2023 | DOI: 10.36502/2023/ASJBCCR.6289
The incidence of moderate to severe pain after total knee arthroplasty (TKA) ranges from 30-60% . In the context of enhanced recovery after surgery, multimodal analgesia with peripheral nerve block as the core has become the main method of postoperative analgesia after TKA, and good analgesia is conducive to the early recovery of patients. Genicular nerve block (GNB) provides good analgesia anterior to the knee, while infiltration between the popliteal artery and capsule of the knee (iPACK) block provides good analgesia posterior to the knee . We report a case of genicular nerve block combined with iPACK block for postoperative analgesia after total knee arthroplasty.
Case Report | Open Access | Asp Biomed Clin Case Rep. 2023 Mar 18;6(1):50-53
“Endo-Oral Contrast-Puffing CT” in Pneumoparotitis: A Case Report
Danilo CaudoiD*, Alessandro Santalco, Simona CammarotoiD, Carmelo AnfusoiD, Ylenia ZulloiD, Daniele Cacopardi, Vincenzo Lo Monte, Caterina Benedetto, Annalisa MilitiiD, Chiara SmortoiD, Fabio Italiano, Ugo BarbaroiD, Ignazio Salamone
Pages: 50-53 | First Published: 18 March 2023 | DOI: 10.36502/2023/ASJBCCR.6290
This case report aims to introduce pneumoparotitis and the correct execution of CT examination to ensure a proper diagnosis. A 45-year-old male presented several times to the ER with Oedema of the left parotid region and neck, along with crackles on palpation. This symptomatology raised suspicion of an inflammatory pathology complicated with abscesses of the parotid gland or a pneumomediastinum due to a traumatic lesion of the airways or oesophagus. Several imaging examinations, such as ultrasound and neck-chest CT, were performed for this suspicion without a correct diagnosis. The use of endo-oral contrast with “puffing” was useful in diagnosing pneumo-parotitis. Therefore, we believe that this procedure could be helpful in the future.
Pneumoparotitis is a pathology caused by incontinence of the Stenone duct which determines the reflux of saliva and air into the gland predisposing to the onset of recurrent infections. This pathology is characterized by swelling and subcutaneous emphysema of the parotid region.
Adequate knowledge of pneumoparotitis and the correct execution of the CT examination is essential to demonstrate the incontinence of the Stenone duct to be able to exclude emergencies such as abscesses, air-gas infections, and traumatic lesions of the airways and oesophagus.
Review Article | Open Access | Asp Biomed Clin Case Rep. 2023 Apr 08;6(2):54-63
Research Progress on Prevention and Treatment of Hypoxemia in Painless Gastroscopy: A Review Article
Jun Ma1, Ling Tan1*
Pages: 54-63 | First Published: 08 April 2023 | DOI: 10.36502/2023/ASJBCCR.6291
Compared to ordinary gastroscopy, painless gastroscopy has more advantages due to the application of anesthesia techniques such as sedation and analgesia, providing patients with comfort and a quick recovery. However, patients undergoing painless gastroscopy are often at risk of hypoxia, which can result in serious complications. Fortunately, more anesthesia providers have recognized this problem. Therefore, it is essential for anesthesia providers to identify risk factors to prevent hypoxemia. In conclusion, this review highlights the assessment of risk factors for hypoxemia in painless gastroscopy and common airway management methods to prevent and treat hypoxemia in high-risk populations during painless endoscopy.
Case Report | Open Access | Asp Biomed Clin Case Rep. 2023 Apr 14;6(2):64-68
Caroli’s Syndrome in Hemodialysis: When Diagnostic and Therapeutic Difficulties can have Serious Consequences
Ennio DurantiiD*, Diletta DurantiiD
Pages: 64-68 | First Published: 14 April 2023 | DOI: 10.36502/2023/ASJBCCR.6292
What we are going to present is the case of a 65-year-old male patient affected by renal and hepatic disease without checking other cases in his family history. He had been submitted to maintenance hemodialysis for 4 months because of an autosomal recessive polycystic kidney disease. At the start of the hemodialysis session, he reported general malaise, abdominal pain, fever, and, during the last two days, even diarrhea. Laboratory workup showed neutrophilic leukocytosis and an increase in serum amylase and C-reactive protein. Abdominal contrast-enhanced CT scan and MRI cholangiography showed hepatic cysts with marked dilatation of the intra- and extrahepatic bile ducts. The patient underwent cholecystectomy with hepatic-jejunal anastomosis on the loop of Roux and was discharged with oral ciprofloxacin. Histology confirmed marked cystic dilatation of biliary ducts and choledochus. Similar episodes continued, and every time ciprofloxacin was prescribed. After 4 months, a retrograde-endoscopic-pancreatography was undertaken, which led to the diagnosis of Caroli’s syndrome associated with polycystic kidneys.
Given the rarity of the disease and the difficulty of diagnosis, it is our opinion that when patients with polycystic kidneys and liver cysts undergo recurrent episodes of septic fever of unknown origin, Caroli’s disease should be considered, and the appropriate tests should be carried out to confirm the diagnosis.
Case Report | Open Access | Asp Biomed Clin Case Rep. 2023 Apr 14;6(2):69-75
Combined Treatment of Vildagliptin/Metformin (Equmet) and Imeglimin (Twymeeg) with Clinical Efficacy
Hiroshi BANDOiD*, Hisako YAMASHITA, Yoshinobu KATO, Katsunori OGURA, Yoshikane KATO
Pages: 69-75 | First Published: 14 April 2023 | DOI: 10.36502/2023/ASJBCCR.6293
Background: Vildagliptin/Metformin (EquMet) and imeglimin (Twymeeg) are effective oral hypoglycemic agents (OHAs) for patients with type 2 diabetes (T2D).
Case Presentation: The patient was a 68-year-old male with T2D and fatty liver for several years. In November 2022, his HbA1c had increased to 8.2%, and he was started on Twymeeg, followed by EquMet.
Results: Over the course of four months, the patient’s HbA1c value successfully decreased from 8.2% to 6.7%, and he did not experience any gastrointestinal adverse effects (GIAEs).
Discussion and Conclusion: The combined treatment of EquMet and Twymeeg demonstrated clinical efficacy without any adverse effects. The Trials of IMeglimin for Efficacy and Safety (TIMES) provided various evidence of imeglimin’s effectiveness.
Case Report | Open Access | Asp Biomed Clin Case Rep. 2023 Apr 17;6(2):76-78
Vogt-Koyanagi-Harada Syndrome in a Pregnant Patient with Azathioprine-Induced Hepatitis and Cholestasis
Pages: 76-78 | First Published: 17 April 2023 | DOI: 10.36502/2023/ASJBCCR.6294
Vogt-Koyanagi-Harada disease (VKH) is a central nervous system condition that specifically affects vision and hearing. Descriptions of this disease date back to the 12th century, but the disease is named after three 20th-century physicians who described the collective manifestations of this disease. Alfred Vogt initially described bilateral iridocyclitis and eyebrow depigmentation in 1906, followed by Yoshizo Koyanagi’s 1926 description of bilateral serous detachments in association with cerebrospinal fluid (CSF) pleocytosis. Einosuke Harada identified the integumentary symptoms of the condition shortly thereafter. The disease presents with signs and symptoms of a loss of immune tolerance to melanocytes within the meninges, eyes, skin, hair, and ears . The exact etiology of VKH is not firmly established, but current theories posit that patients develop T cell-mediated immunity against melanocytes following recovery from an inciting viral environmental factor . Recent genetic studies have implicated the presence of human leukocyte antigen (HLA) cell surface markers HLA-DRB4, HLA-DRB1-04*05, and HLA-DRB-04*01, as well as non-HLA genes involving lymphocyte regulations in IL-12 production and IL-17 production [3,4]. Downregulation of microRNA in the production of interleukins and changes in non-coding RNA may also play a role in this condition .
Case Report | Open Access | Asp Biomed Clin Case Rep. 2023 Apr 21;6(2):79-82
Ultrasound-Guided Transmuscular Quadratus Lumborum Block Provides Effective Postoperative Analgesia for High Ligation of Spermatic Vein
Jun Ma, Hongwei Xu*
Pages: 79-82 | First Published: 21 April 2023 | DOI: 10.36502/2023/ASJBCCR.6295
Postoperative pain management after varicocele surgery poses a challenge for pediatric patients. The quadratus lumborum block (QLB) is a novel regional analgesia technique that entails injecting a local anesthetic around the quadratus lumborum muscle using ultrasound guidance. In this study, we present the utilization of a single transmuscular QLB in two children as an effective postoperative analgesic method for laparoscopic extraperitoneal high ligation of the spermatic vein (LEHLSV).
Case Report | Open Access | Asp Biomed Clin Case Rep. 2023 Apr 29;6(2):83-86
Airway Management of a Patient with Montgomery T-tube in situ undergoing Neurosurgery
Yongwei Su, Xiaoqiang Li
Pages: 83-86 | First Published: 29 April 2023 | DOI: 10.36502/2023/ASJBCCR.6296
This article stipulates the airway management in a patient requiring cranial debridement and cranioplasty with a Montgomery T-tube (MTT) in situ. Anesthetic techniques that have been previously described for surgeries with MTT in situ which can be managed by applying a laryngeal mask or intubating a trachea tube easily. The airway management of patients with an MTT in situ, requiring a supine position with the head rightly tilted and flexed, has not yet been addressed. In this article, we explored some possible approaches to cope with this arising problem. We present how we managed to intubate a double-lumen endotracheal tube onto the superior tracheal limb of the T-tube since the 5.0 mm ID tracheal tube (equivalent to a 6.9 mm ED) could not pass through the tube readily. This technique could possibly be considered for patients in similar clinical scenarios.
Case Report | Open Access | Asp Biomed Clin Case Rep. 2023 May 05;6(2):87-90
Ultrasound-Guided Pericapsular Nerve Group (PENG) Block Combined with Lateral Femoral Cutaneous Nerve Block for Total Hip Arthroplasty
Jun Li, Rurong WangiD*
Pages: 87-90 | First Published: 05 May 2023 | DOI: 10.36502/2023/ASJBCCR.6297
With the arrival of an aging society and the progress of surgical procedures, total hip arthroplasty (THA) has been carried out more and more. However, postoperative pain severely affected the patient’s recovery, and there is currently no reliable analgesic method available. Evidence-based international expert consensus also recommends, compared to LIA, peripheral nerve block (PNB) as a central analgesic approach use in THA for improved outcomes . In this case report, we described 4 cases of postoperative analgesia with pericapsular nerve group (PENG) block combined with lateral femoral cutaneous nerve block (LFCNB) in patients undergoing THA.
Case Report | Open Access | Asp Biomed Clin Case Rep. 2023 May 10;6(2):91-94
Unexpected Bronchomalacia Combined with Excessive Dynamic Airway Collapse was Diagnosed by Intraoperative Bronchoscopy: A Case Report
Yuling Tang, Yu Li*
Pages: 91-94 | First Published: 10 May 2023 | DOI: 10.36502/2023/ASJBCCR.6298
Expiratory central airway collapse (ECAC) comprises tracheobronchomalacia (TBM) and excessive dynamic airway collapse (EDAC). ECAC is a progressive disease that can be congenital or acquired, and it can be confirmed by inspiratory-dynamic expiratory chest CT or dynamic bronchoscopy. We present the case of a 65-year-old man who underwent radiofrequency ablation for hepatocellular carcinoma under general anesthesia. After tracheal intubation in the operating room, the respiratory sound in the left lung disappeared, and the respiratory sound in the right lung was clear during chest auscultation. Bronchoscopy revealed complete collapse of the left main bronchus. Intraoperative bronchoscopy confirmed that the patient had ECAC (both TBM and EDAC).
Case Report | Open Access | Asp Biomed Clin Case Rep. 2023 May 20;6(2):95-102
CT Image of Consolidation and Ground-Glass Opacification (GGO) of COVID-19 in Diabetic Patient
Katsunori Ogura, Hiroshi BandoID*, Yoshinobu Kato, Hisako Yamashita, Yoshikane Kato
Pages: 95-102 | First Published: 20 May 2023 | DOI: 10.36502/2023/ASJBCCR.6299
The case involves a 70-year-old female with Type 2 Diabetes (T2D) who had been prescribed EquMet (vildagliptin/metformin) and had a stable HbA1c. In August 2022, she tested positive for real-time polymerase chain reaction (RT-PCR) without showing any symptoms. By November 2022, her HbA1c had increased to 7.4%, and a chest CT scan revealed a consolidation lesion in her left lower lung, suggesting post-inflammatory pathology of COVID-19. Imeglimin (Twemeeg) was added to her treatment regimen, and it proved effective, resulting in a 0.9% reduction in HbA1c over 4 months without any gastrointestinal adverse effects (GIAEs). The combined treatment of EquMet and Twymeeg was effective, and the interrelationship between T2D and COVID-19 will be followed up.
Case Report | Open Access | Asp Biomed Clin Case Rep. 2023 Jun 06;6(2):109-15
Acute Massive Pulmonary Embolism During Craniotomy: A Case Report
KXuemei He, Rurong Wang, Taoran Yang, Yali Chen*
Pages: 109-15 | First Published: 06 June 2023 | DOI: 10.36502/2023/ASJBCCR.6302
Background: Venous thrombosis is a common complication among critically ill patients with intracerebral hemorrhage, which may lead to pulmonary embolism.
Case Presentation: In this report, we present a case of a man who was diagnosed with left basal ganglia region hemorrhage, hypertension, and venous thromboembolism. Considering the risks, including rebleeding and the expansion of the hematoma, he did not receive any anticoagulation after onset. The thrombus located in the pulmonary artery was found by transesophageal echocardiography after he suffered cardiac arrest during the craniotomy. Additionally, a thrombus attached to the central venous catheter was observed by ultrasound. Unfortunately, he died of PE without receiving any effective treatment.
Conclusions: This case emphasizes the importance of prophylactic and therapeutic strategies for thromboembolic events among critically ill populations. It also underscores the critical role of perioperative ultrasound.