Asploro Journal of Biomedical and Clinical Case Reports [ISSN: 2582-0370]

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.

As a reliable psychological test, Tokyo University Egogram (TEG) 2^nd has been used widely. TEG was recently revised to TEG 3^rd. Authors continued TEG research on university students for long, in which results of 2018 by TEG 2^nd and results of 2019-2022 by TEG 3^rd were compared. For the 3^rd 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.

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.

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).

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.

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”.

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.

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.

The incidence of moderate to severe pain after total knee arthroplasty (TKA) ranges from 30-60% [1]. 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 [2]. We report a case of genicular nerve block combined with iPACK block for postoperative analgesia after total knee arthroplasty.

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.