Niger J Clin Pract
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Review Case Reports
A POEMS syndrome patient with idiopathic non-cirrhotic portal hypertension received the transjugular intrahepatic portosystemic shunt: a case report and literature review.
Polyneuropathy, organomegaly, endocrinopathy, M-protein, skin changes (POEMS) syndrome is a rare plasma cell dyscrasia disease involving multiple organs combined with idiopathic non-cirrhotic portal hypertension. It has been reported only four times in the English literature. Here, we present the first case of a 62-year-old male POEMS syndrome patient with portal hypertension treated with the transjugular intrahepatic portosystemic shunt (TIPS), after he presented with a 10-day history of melena. ⋯ After TIPS and venous embolization were performed, symptoms of bleeding were effectively controlled, while the patient subsequently developed hepatic encephalopathy, which ultimately led to death. The presence of gastrointestinal bleeding in POEMS syndrome with idiopathic non-cirrhotic portal hypertension indicates a poor prognosis. Given that this was the first patient to receive TIPS, and although the incidence of hepatic encephalopathy has increased, TIPS is still acceptable for refractory variceal bleeding.
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Pediatric celiac disease (CeD) and type 1 diabetes mellitus (T1DM) have well established effects on eye health but comorbid effect is not known. ⋯ The higher IOP and OPA values of the children with T1DM and CeD were considered to be the result of the microvascular pathologies in T1DM and increased inflammation associated with CeD. High IOP and OPA values can lead to damage in the eye as intraocular blood flow and choroidal perfusion are affected. In order to prevent these eye problems, measurement of IOP and OPA should be done in children with diagnosis of T1DM and CeD and also follow up studies needed.
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Case Reports
Diagnostic challenges in the management of septic arthritis of the neonatal hip: A case report.
Septic arthritis of the neonatal hip is a very rare pathology. The clinical features may be different from those associated with older children, resulting in diagnostic challenges. ⋯ The index patient is a 3-week-old neonate who had left hip arthrotomy on account of septic arthritis. The aim of this report is to highlight the challenges encountered in the diagnosis of septic arthritis of the hip in this patient.
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The relationship between oxygen saturation (SpO2) and peak expiratory flow rate (PEFR) in patients with acute asthma is variable. ⋯ Children with SpO2 of <95% are more likely to have an acute asthma exacerbation. While SpO2 and PEFR have more role in identifying children without acute asthma exacerbation and a limited role in identifying children with mild symptoms of asthma due to their exacerbation due to their moderate to poor correlation.
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Cryptococcal meningitis (CM) is underreported in the immunocompetent, the disease being more commonly associated with advanced human immunodeficiency virus (HIV) disease. We report the diagnosis, management, and eventual fatal outcome of CM in a non-HIV-infected man. Late presentation, delayed diagnosis, difficulties in accessing medications, and raised intracranial pressure (ICP) were contributory to his demise. Detailed history, a high index of suspicion, and laboratory workup coupled with prompt antifungal therapy and aggressive ICP management are essential for better outcomes.