Mad Honey Intoxication: A Case Series of 21 Patients

Background. The “grayanotoxin (mad honey)” poisoning is not known commonly, there are some case series and case reports in the medical literature about it, especially in Turkey. The aim of this study was to describe the presentation of 21 natural honey intoxication cases and to review the literature. Material and Method. This study is retrospective analysis of twenty one patients who were admitted to the emergency department due to honey poisoning. Results. Median age of 21 patients was 55. The mean length of delay after consumption is 3.4 hrs. Dizziness, weakness, excessive perspiration, nausea-vomiting, and low blood pressure were the most observed symptoms. Mean pulse rate was 56/min. Mean systolic blood pressure was 102 mmHg. The mean length of hospital stay is 14.7 hrs. Patient rhytms on arrival were as follows: 10 patients were in normal sinus rhytm, 7 sinus bradycardia, 3 nodal rhytm, 1 atrial fibrillation. Atropine was given to 18 patients. None of our patients died and all were discharged home without any complication. Discussion. In the emergency setting, poisoning is a clinical state which is very hard to identify. We have to keep in mind that drugs and toxins may cause lethal dysrhythmias.

Download Full-text

Analysis of Clinical, Imaging, and Pathologic Features of 36 Patients with Primary Intraspinal Primitive Neuroectodermal Tumors: A Case Series and Literature Review

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0041-1723810 ◽

2021 ◽

Author(s):

Xuefeng Wei ◽

Xu Zhang ◽

Zimu Song ◽

Feng Wang

Keyword(s):

Literature Review ◽

Single Case ◽

Case Reports ◽

Case Series ◽

Subtotal Resection ◽

Study Cohort ◽

Primitive Neuroectodermal Tumors ◽

Pathologic Features ◽

Neuroectodermal Tumors ◽

The Mean

Abstract Background and Study Aims Primary intraspinal primitive neuroectodermal tumors (PNETs) account for ∼0.4% of all intraspinal tumors, but information about these tumors in the medical literature is limited to single case reports. We report four cases of primary intraspinal PNETs and present a systematic literature review of the reported cases. Materials and Methods We retrospectively reviewed and analyzed the clinical data of 4 patients with primary intraspinal PNETs who underwent neurosurgical treatment at our clinic between January 2013 and January 2020, and of 32 cases reported in the literature. Results The female-to-male ratio was 2.6:1. The mean patient age was 21.42 ± 15.76 years (range: 1–60 years), and patients <36 years of age accounted for 83.30% of the study cohort. Progressive limb weakness and numbness were the chief symptoms (accounting for ∼55.6%). The mean complaint duration was 0.89 ± 0.66 months for males and 2.72 ± 3.82 months for females (p = 0.028). Epidural (41.7%) was the most common site, and thoracic (47.3%) was the most frequent location. Most PNETs were peripheral, and magnetic resonance imaging (MRI) appearance was isointense or mildly hypointense on T1-weighted images and hyperintense on T2-weighted images. Homogeneous contrast enhancement was observed. The 1-year survival rate of patients who underwent chemoradiation after total or subtotal lesion resection was better compared with patients who did not undergo chemotherapy, radiotherapy, or total or subtotal resection. The modality of treatment was associated with survival time (p = 0.007). Conclusion Primary intraspinal PNETs mainly occur in young people with a female preponderance. In patients with a rapid loss of lower limb muscle strength and large intraspinal lesions on MRI, PNETs should be considered. Surgical resection and adjuvant radio chemotherapy are key prognostic factors.

Download Full-text

Sporadic Schwannomatosis: A Systematic Review Following the 2005 Consensus Statement

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0038-1655548 ◽

2018 ◽

Vol 79 (05) ◽

pp. 408-415 ◽

Cited By ~ 1

Author(s):

Jan Victor ◽

Thibault Poujade ◽

Nadine Hollevoet ◽

Gregoire Chick

Keyword(s):

Systematic Review ◽

Consensus Statement ◽

Case Reports ◽

Case Series ◽

Spinal Tumors ◽

The Mean ◽

Tumor Distribution ◽

Key Aspects ◽

Number Of Individuals

Aims To identify the frequency of reports of sporadic schwannomatosis, the types of patients affected, and the nerves affected. Patients and Methods We identified all case reports and case series that reported on patients with sporadic schwannomatosis according to established criteria. Results The initial search yielded 1,597 studies, of which 15 were included. A total of 38 of 55 individuals met the inclusion criteria. The mean age of the patients was 48 years; 41% were male. Thirty-three patients had peripheral nerve tumors, and 17 had spinal tumors. Twelve had tumors in both locations. Tumor distribution was unilateral in 25 of 30 cases (83.3%) and segmental (limited to one limb or five or fewer contiguous segments of the spine) in 28 of 38 cases (73.7%). Conclusion This systematic review quantified the number of individuals who meet the criteria for sporadic schwannomatosis and better described this population to facilitate the classification of neurofibromatosis in regard to the 2005 consensus statement. Unilateral or segmental distribution of nerve tumors are key aspects when dealing with multiple noncutaneous schwannomas without involvement of the vestibular nerve.

Download Full-text

COVID-19 in HIV: a Review of Published Case Reports

SN Comprehensive Clinical Medicine ◽

10.1007/s42399-020-00593-6 ◽

2020 ◽

Vol 2 (12) ◽

pp. 2647-2657

Author(s):

Zoya Morani ◽

Saumil Patel ◽

Sudeshna Ghosh ◽

Falah Abu Hassan ◽

Shriya Doreswamy ◽

...

Keyword(s):

Morbid Obesity ◽

Web Of Science ◽

Case Reports ◽

Case Series ◽

Hiv Patients ◽

High Burden ◽

Cardiovascular Comorbidities ◽

Life Threatening ◽

The Mean ◽

Immunocompromised State

AbstractPatients with COVID-19 present with a myriad of comorbidities. An immunocompromised state like HIV in patients with COVID-19 can be life-threatening. We searched PubMed/Medline, Scopus, and Web of Science for case reports and case series about COVID-19 in HIV patients. We finally reviewed 20 case reports including cases of 43 patients with HIV and COVID-19. The mean age of 43 adult patients was 51.56 ± 27.56 years (range 24–76 years). Of these, 30 were male (69.77%), 11 were female (25.58%), and 2 were transgender (4.65%). A total of 25 patients (58.14%) were above 50 years of age. The most common cardiovascular comorbidities were hypertension and hyperlipidemia (48.8%), diabetes (20.93%), and morbid obesity (11.63%). Out of 43 HIV patients with COVID-19, 6 resulted in death (13.95%). All the patients who died were elderly above 50 years and required mechanical ventilation. HIV patients infected with COVID-19 had a high mortality rate. A high burden of pre-existing comorbidities and an advanced age in these patients make them prone to disease progression and worse outcomes.

Download Full-text

Hereditary leiomyomatosis and renal cell carcinoma: a case series and literature review

Orphanet Journal of Rare Diseases ◽

10.1186/s13023-020-01653-9 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Zahraa Chayed ◽

Lone Krøldrup Kristensen ◽

Lilian Bomme Ousager ◽

Karina Rønlund ◽

Anette Bygum

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Renal Cell ◽

Case Reports ◽

Case Series ◽

Surveillance Program ◽

Uterine Leiomyosarcoma ◽

Dermatological Examination ◽

The Mean ◽

Hereditary Leiomyomatosis

Abstract Background Hereditary leiomyomatosis and renal cell carcinoma (HLRCC) is a rare genodermatosis characterized by cutaneous leiomyoma (CLM), uterine leiomyoma (ULM) and renal cell carcinoma (RCC). Five HLRCC patients are presented with a compiled database of published HLRCC cases to increase understanding of HLRCC. Furthermore, a surveillance program is suggested. Our review is based on a PubMed search which retrieved case reports and cohort studies published before November 2019. The search yielded 97 original papers with a total of 672 HLRCC patients. Results CLMs were present in 474 patients (71.5%), developed at the mean age of 28 years. Five patients had cutaneous leiomyosarcomas. ULMs were present in 356 women (83%), while two had uterine leiomyosarcoma. ULMs were diagnosed at a mean age of 32 years, with the youngest diagnosed at age 17 years. The most common surgical treatment for ULMs was hysterectomy, performed at a mean age of 35 years, with the youngest patient being 19 years old. RCCs were present in 189 patients (34.9%), of which half had metastatic disease. The mean age of diagnosis was 36 years with the youngest patient diagnosed with RCC at the age of 11 years. Conclusion We suggest a surveillance program for HLRCC including a dermatological examination once every 2 years, annual magnetic resonance imaging starting at the age of 10 years to monitor for early RCCs, annual gynecological examinations from the age of 15 years and counseling regarding risk of hysterectomy and family planning at the age of 18 years. CLMs are often the earliest manifestation of HLRCC, which is why recognizing these lesions, performing a biopsy, and making a prompt referral to genetic counseling is important in order to diagnose HLRCC early.

Download Full-text

Efficacy and Safety of Timolol-Dorzolamide Fixed-Combination Three Times a Day Versus Two Times a Day in Newly Diagnosed Open Angle Glaucoma

10.20944/preprints201804.0310.v1 ◽

2018 ◽

Author(s):

Mohammad Pakravan ◽

Afsaneh Naderi Beni ◽

Shahin Yazdani ◽

Hamed Esfandiari

Keyword(s):

Blood Pressure ◽

Primary Open Angle Glaucoma ◽

Fixed Combination ◽

Open Angle Glaucoma ◽

Case Series ◽

Open Angle ◽

Newly Diagnosed ◽

Efficacy And Safety ◽

The Mean

Purpose: To compare the therapeutic efficacy and safety of dorzolamide/timolol fixed-combination in newly diagnosed primary open angle glaucoma patients. Methods: In this prospective, interventional case series, newly diagnosed primary open angle glaucoma (POAG) patients that had not been treated for glaucoma were included. Patients were started on Cosopt twice a day (BID) for 1 month and then switched to three times a day (TDS) for additional 1 month. Patients underwent comprehensive ophthalmic examination, diurnal intraocular pressure (IOP), blood pressure (BP) and 24-hours heart rate (HR) measurements at baseline, month 1( BID), and month 2( TDS). IOP, systolic and diastolic pressures were measured at 8:00 AM,12:00 AM, 4:00 PM, 8:00 PM and 12:00 PM. Throughout the study, all adverse events were recorded and monitored by the investigators. Results: In 31 POAG patients that completed the study ,mean baseline IOP was 23.1±3.15 mmHg . IOP was decreased significantly 16.5 ± 2.21 at 1 month (P < 0.0001) and 13.9 ± 2.23 mmHg at 1 and 2 month follow up. (P < 0.0001) IOP was significantly lower in month 2 compared to month 1 (P = 0.0004). While Cosopt BID significantly reduced the mean 24-hour systolic BP and mean 24-hour HR from baseline (P < 0.0001), the mean 24-hour systolic BP and HR remained unchanged 2ith Cosopt TDS compared to BID (P = 0.62). Conclusions: Cosopt TDS has a superior IOP-lowering effect than Cosopt BID in POAG patients with comparable safety profile.                 

Download Full-text

Abstract 52: Case Reports of Short-Term Outcome Following Mechanical Thrombectomy for Childhood Stroke May Be Overly Optimistic

Stroke ◽

10.1161/str.51.suppl_1.52 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Catherine Amlie-Lefond ◽

Dwight Barry ◽

Keyword(s):

Mechanical Thrombectomy ◽

Care Delivery ◽

Case Reports ◽

Case Series ◽

Arterial Ischemic Stroke ◽

Short Term ◽

Term Outcome ◽

The Mean ◽

Meta Analyses ◽

Iv Tpa

Background: Meta-analyses of case reports and case series of mechanical thrombectomy in childhood arterial ischemic stroke (AIS) suggest that mechanical thrombectomy is associated with good short-term outcomes in approximately three-quarters of children. Methods: Retrospective data on 38 children treated between 2010-2019 with mechanical thrombectomy for stroke were collected from former Thrombolysis in Pediatric Stroke (TIPS) sites. To minimize reporting bias, sites were required to report all patients ≤ 17 years treated with mechanical thrombectomy either at the study site or at an outside hospital prior to transfer. Short-term outcomes, defined as change in NIHSS prior to and following mechanical thrombectomy (MT), were compared with 85 children from case reports/case series published between 2010-2019. Results: The mean age of children from former TIPS sites was 11.9 years, 50% male, 34% treated with IV tPA prior to thrombectomy. The mean age of published cases was 10.4 years, 65% males, 19% treated with IV tPA prior to thrombectomy. Case reports had a wider distribution of before-MT NIHSS scores, and a steeper decrease in distributions of after-MT NIHSS scores than those from study sites within 24 hours of MT (Figure 1A; medians: 15 to 4 in published cases, 12 to 8 in cases from sites) and at discharge (Figure 1B; medians: 15 to 3 in published cases, 12 to 5 in cases from sites). Conclusion: Patients reported to former TIPS sites had discernably lower rates of good short-term outcomes compared with published case reports and case series, suggesting publication bias. Capturing key metrics of safety and effectiveness of MT in children with AIS, including variations in care delivery in actual practice, will be critical in the creation of evidence-based guidelines for acute management of pediatric AIS.

Download Full-text

Valproic Acid in the Management of Delirium

American Journal of Hospice and Palliative Medicine® ◽

10.1177/10499091211038371 ◽

2021 ◽

pp. 104990912110383

Author(s):

Carlos Fernandez Cuartas ◽

Mellar Davis

Keyword(s):

Valproic Acid ◽

English Language ◽

Retrospective Studies ◽

Case Reports ◽

Controlled Trial ◽

Case Series ◽

Open Label ◽

Mesh Terms ◽

Starting Dose ◽

The Mean

Context: Antipsychotics and benzodiazepines do not improve delirium. Valproic acid (VPA) has been used recently to treat agitation in delirium. Objectives: To review the evidence for VPA in the management of Delirium. Methods: Systematic review. English language, age 19 and above, from 1946 to January 12, 2021. Mesh Terms: “Valproic acid”, “valproate”, “sodium valproate”, “delirium”, “acute mania with delirium” in PubMed and Ovid. Exclusion: Studies of VPA used for diagnoses other than delirium. Results: 21 abstracts were identified and 10 studies were included in the review (252 patients): One prospective open label study (n: 7), 2 case series (n: 22), 4 retrospective studies (n: 219) and 3 case reports (n: 4). No randomized controlled trial (RCT) evaluates the effect of VPA in delirium. 237/250 (94.8%) patients were in the ICU. Mean age was 59.7 (27-87). 153/204 (74%) were male. The mean starting dose was 733 mg/day in 148 patients and the mean dose at follow up was 1061 mg/day in 205 patients. CAM ICU was used to diagnose delirium in 6 reviews. Delirium improved in case series in 19/22 patients. Delirium improved in retrospective studies at day 3 compared to day 1. VPA levels were not consistently reported. Hyperammonemia (12-19%) and thrombocytopenia (9-13%) were the most common side effects. No deaths were attributed to VPA. Conclusion: VPA is being used more frequently for delirium. The evidence is limited to retrospective studies and case series. There is a need for RCT to evaluate the effect of VPA in delirium compared to other alternatives and placebo.

Download Full-text

625 EFFICACY OF MYOTOMY IN PATIENTS WITH SIGMOID MEGAESOPHAGUS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Diseases of the Esophagus ◽

10.1093/dote/doab052.625 ◽

2021 ◽

Vol 34 (Supplement_1) ◽

Author(s):

Marina Orlandini ◽

Maria Carolina Serafim ◽

Letícia Datrino ◽

Clara Santos ◽

Luca Tristão ◽

...

Keyword(s):

Systematic Review ◽

Heller Myotomy ◽

Selection Process ◽

Case Reports ◽

Meta Analysis ◽

Case Series ◽

Cochrane Library ◽

Cross Sectional ◽

Manual Search ◽

The Mean

Abstract Megaesophagus progress to sigmoid megaesophagus (SM) in 10–15% of patients, presenting tortuosity and sigmoid colon aspect. Esophagectomy is the choice treatment but is associated with high complications and mortality rates. To avoid the esophagectomy inherent morbidity, several authors recommend Heller myotomy (HM) with pull-down technique for SM, mainly for patients with comorbidities and the elderly. This systematic review and meta-analysis is the first to analyze the effectiveness of HM for treating SM. Methods A systematic review was conducted in PubMed, Embase, Cochrane Library Central, Lilacs (BVS), and manual search of references. Inclusion criteria were: a) clinical trials, cohort studies, case series; b) patients with SM and esophageal diameter ≥ 6 cm; and c) patients undergoing primary myotomy. The exclusion criteria were: a) reviews, case reports, cross-sectional studies, editorials, letters, congress abstracts, full-text unavailability; b) animal studies, c) previous surgical treatment for achalasia; and d) pediatric studies. There were no restrictions on language or date of publication, and no filters were applied for the selection process. Random model and a 95% confidence interval (CI) were used. Results Sixteen articles were selected, encompassing 231 patients. The mean age ranged from 36 to 61 years old, and the mean follow-up ranged from 16 to 109 months. The analyzed outcomes include mortality, complications (pneumonia, pneumothorax, gastroesophageal reflux), need for reintervention (remyotomy, dilation and esophagectomy), and results classified as ‘good’ and ‘excellent’. Mortality rate was 0.035 (CI: 0.017–0.07; p < 0.01). Complications rate was 0.08 (CI: 0.04–0.153; p = 0.01). Need for retreatment rate was 0.161 (CI: 0.053–0.399; p < 0.01). Probability of good or excellent outcomes after myotomy was 0.762 (CI: 0.693–0.819; p < 0,01). Conclusion Heller myotomy is an option for avoiding esophagectomy in achalasia, with a low morbimortality rate and good results. It is effective for most patients but will fail in a minority of patients and demand retreatment, be it a remyotomy, endoscopic treatment or esophagectomy.

Download Full-text

Treatment of ruptured lenticulostriate artery aneurysms

Journal of Neurosurgery ◽

10.3171/jns/2008/109/7/0028 ◽

2008 ◽

Vol 109 (1) ◽

pp. 28-37 ◽

Cited By ~ 30

Author(s):

Chirag D. Gandhi ◽

Ronit Gilad ◽

Aman B. Patel ◽

Abilash Haridas ◽

Joshua B. Bederson

Keyword(s):

Case Reports ◽

Case Series ◽

Single Institution ◽

Neurological Outcomes ◽

Ruptured Aneurysms ◽

Mean Size ◽

Lenticulostriate Artery ◽

The Mean ◽

Associated Risk Factors ◽

Surgical Treatments

Object Lenticulostriate artery (LSA) aneurysms are rarely reported in the literature, making management decisions challenging. Conservative, endovascular, and surgical treatments have been described primarily through case reports and reports of individual authors' experiences. The purpose of this study is to report neurological outcomes in a single-institution experience of ruptured lenticulostriate aneurysms treated surgically. Methods The authors have conducted a retrospective review of all cases involving patients with ruptured LSA aneurysms who presented to the Mt. Sinai Hospital neurosurgical service between September 2001 and January 2007. Results Over 5.4 years, the authors treated 6 patients with 7 LSA aneurysms—6 ruptured and 1 unruptured. The Hunt and Hess grade on admission ranged from I to IV, with subarachnoid hemorrhage in 5 of the 6 patients. Catheter angiography confirmed the presence of the aneurysms, and all patients underwent a pterional craniotomy and clipping or resection of the aneurysm, performed by a single surgeon. Associated risk factors in our series of patients included hypertension, cocaine abuse, and intracranial occlusive disease suggestive of moyamoya disease. Two types of LSA aneurysms were identified. The mean size of the 6 ruptured aneurysms was 3.2 mm. The LSA was preserved in 3 of 6 patients, but LSA preservation did not correlate with development of a postoperative infarct, clinically or radiologically. In patients with ruptured aneurysms, the mean modified Rankin Scale score at discharge was 1.7. The 3 patients in whom the LSA was sacrificed had good outcomes, suggesting that loss of the artery is clinically well tolerated. Conclusions This case series demonstrates that surgical treatment of ruptured LSA aneurysms can be an appropriate, effective, and safe therapy.

Download Full-text

Gastric peroral endoscopic myotomy for the treatment of refractory gastroparesis: a multicenter international experience

Endoscopy ◽

10.1055/a-0596-7199 ◽

2018 ◽

Cited By ~ 11

Author(s):

Michel Kahaleh ◽

Jean-Michel Gonzalez ◽

Ming-ming Xu ◽

Iman Andalib ◽

Monica Gaidhane ◽

...

Keyword(s):

Gastric Emptying ◽

Hospital Stay ◽

Case Series ◽

Length Of Hospital Stay ◽

Novel Therapy ◽

Gastric Emptying Scintigraphy ◽

Post Procedure ◽

The Mean ◽

Procedure Duration

Abstract Background Gastroparesis is a difficult-to-treat motility disorder with a poor response to medical therapy. Gastric peroral endoscopic pyloromyotomy (G-POEM) has been offered as a novel therapy in the treatment of refractory gastroparesis. We present a multicenter case series of our experience with G-POEM. Methods This is an international multicenter case series of patients who underwent G-POEM for the treatment of gastroparesis. The severity of gastroparesis was assessed by delayed gastric emptying scintigraphy (GES) and an elevated gastroparesis cardinal symptoms index (GCSI). Patients then underwent G-POEM using the submucosal tunneling technique. The primary endpoint was improvement in the GCSI score and improvement in gastric emptying on repeat scintigraphy. Secondary endpoints were technical success, complication rate, procedure duration, and length of hospital stay post-procedure. Results G-POEM was technically successful in all 33 patients. Symptomatic improvement was seen in 28/33 patients (85 %), with a decrease in symptom score by GCSI from 3.3 to 0.8 at follow-up (P < 0.001). The mean procedure duration was 77.6 minutes (37 – 255 minutes). Mean GES improved significantly from 222.4 minutes to 143.16 minutes (P < 0.001). Complications were minimal and included bleeding (n = 1) and an ulcer (n = 1) treated conservatively. The mean length of hospital stay post-procedure was 5.4 days (1 – 14 days). The mean follow-up duration was 11.5 months (2 – 31 months). Conclusion G-POEM is a technically feasible, safe, and successful procedure for the treatment of refractory gastroparesis. A further multicenter comparative study should be performed to compare this technique to laparoscopic pyloromyotomy.

Download Full-text