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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Carotid and vertebral Doppler ultrasonography (USG) is the primary diagnostic tool for the detection of extra cranial atherosclerotic disease and measurement of posterior fossa blood flow volume. The examination is performed while the patient lies on supine position. However, in daily practice we occasionally encounter patients who are not able to lie down on supine position for different reasons, such as kyphosis, severe dyspnea, or severe back pain. ⋯ Our results suggest that CV doppler examinations may be performed in the sitting positions. Examination in the sitting position may be helpful in recognizing pre-steal and retrograde flows.
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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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Studies evaluating immunization data quality and its determinants in low- and middle-income countries are scarce. ⋯ Routine immunization data are not always accurate in Enugu state. Continuous efforts to improve the data monitoring system, supervision, data audits, funding, and staffing are warranted.
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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.