Journal of the College of Physicians and Surgeons--Pakistan : JCPSP
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J Coll Physicians Surg Pak · Apr 2022
Case ReportsChryseobacterium indologenes Bacteraemia: A Potential Cause of Early-onset Neonatal Sepsis in a Full-term Baby.
Chryseobacterium indologenes is considered as an emerging pathogen known to cause pneumonia, bacteremia, and meningitis in children. It has been reported previously, mainly from the Indian subcontinent, as a rare cause of early-onset neonatal infection, mostly affecting preterm infants. ⋯ A positive neonatal blood culture of C. indologenes should not automatically be considered as a contaminant; and a joint discussion between neonatologists and microbiologists should determine the appropriate management and antibiotic regimen. Key Words: Early-onset neonatal sepsis, Bacteremia, Chryseobacterium indologenes, Contaminant, Antibiotics.
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J Coll Physicians Surg Pak · Apr 2022
Case ReportsCryptococcal Meningoencephalitis in an Immunocompetent Patient.
Cryptococcal meningitis (CM) is an uncommon opportunistic infection in immunocompetent hosts; and causes significant mortality and long-term morbidity. Cryptococci primarily cause disease in immunocompromised hosts, but rarely can lead to severe disease in immunocompetent individuals. A 64-year man, with no known immunosuppressive illnesses, presented in the Emergency Department with gait disturbances and lethargy for one year, which got worsened recently. ⋯ The patient was treated with anti-fungal medications. It is highly essential for emergency physicians and other clinicians to think of atypical neurological manifestations of meningitis in immunocompetent individuals. Key Words: Cryptococcus, Immunocompetent, Antifungal treatment, Meningitis.
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J Coll Physicians Surg Pak · Apr 2022
Case ReportsSubglottic Hemangioma: Now You See it, Now You Don't.
Subglottic hemangiomas may be missed on flexible laryngoscopy or even bronchoscopy requiring a contrast-enhanced computed tomography scan to clinch the diagnosis. We report an otherwise healthy three-month baby girl presenting with recurrent upper airway obstruction with a history of multiple admissions requiring intubation and artificial ventilation. An initial contrast-enhanced computed tomography scan was performed when the child was intubated, which showed no airway anomalies. ⋯ Following the surgical intervention, the child had persistent stridor and a repeat contrast-enhanced computed tomography scan clinched a diagnosis of a localised subglottic hemangioma at the age of 7 months. In the presence of an endotracheal tube, airway hemangiomas may be missed on bronchoscopy and contrast-enhanced computed tomography scan. Key Word: Subglottic stenosis, Congenital, Hemangiomas, Computed tomography.
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J Coll Physicians Surg Pak · Mar 2022
Case ReportsFollicular Variant of Papillary Thyroid Carcinoma Presenting with Thoracic Vertebral Metastasis: A Rare Phenomenon.
Follicular variant of papillary thyroid carcinoma (FV-PTC) often follows nodal spread; and hematogenous spread is rare. A 77-year male presented to the Neurosurgery Outpatient Clinic with complaints and examination findings of spinal cord compression (SCC) by a mass at the 11th thoracic vertebra (T11). Subtotal mass excision, thoracic corpectomy with cage reconstruction, laminectomy, and posterior spinal stabilisation were performed. ⋯ Even four years after the total thyroidectomy, the neurological status of the patient was still stable and neither tumoral recurrence nor a new metastasis was detected. In the literature, the number of cases with FV-PTC presenting with SCC due to spinal metastasis is limited. Key Words: Thoracic vertebrae, Metastasis, Papillary thyroid carcinoma, Spinal cord compression.
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J Coll Physicians Surg Pak · Mar 2022
Meta AnalysisIntravenous Alteplase Treatment of Acute Ischemic Stroke Patients Exhibiting Mild Neurological Deficits.
Alteplase is increasingly used for treating ischemic stroke cases with low NIHSS scores, but the guidelines and evidence regarding outcomes are lacking. So, the authors conducted an updated meta-analysis to better understand the effects of alteplase for the treatment of acute mild ischemic stroke. PubMed, Cochrane, EMBASE were systematically explored for all relevant investigations published as in September 2021. ⋯ Subgroup analysis showed that the function outcomes was the best within 3-4.5 hours; and the risk and mortality of sICH were the lowest within 3-4.5 hours. Intravenous rt-PA administration is associated with improved functional outcomes at three months after the stroke in mild ischemic stroke patients. Key Words: Acute ischemic stroke, Mild, Alteplase, Meta-analysis.