Reviews in Clinical Medicine
Volume:10 Issue: 3, Summer 2023

Vacuum assisted delivery might not be the first-choice route for delivery but remains a viable option when shortening of the second stage of labour is needed. Incorrect placement of the vacuum device, incorrect technique, prolonged use, and multiple attempts often lead to subgaleal haemorrhage, which is a collection of blood in the space underneath the galea aponeurotica. Here we would like to report a case of an infant that was delivered via vacuum assisted delivery after multiple attempts. The unfortunate infant suffered from subgaleal haemorrhage and was promptly assessed and treated. After spending 1 week in our center, he was allowed to be discharged home, with subsequent follow-up showing remarkable improvement. We would like to emphasize on the importance of this case because even though it does not occur very frequently, the consequences can be fatal if the condition is not identified and treated early.

The pandemic of COVID-19 created a psychological response. So, the psychological function of COVID-19 patients is an important subject that forces us to follow up with them. Assess the correlation between vitamin D serum concentrations and psychological functions such as insomnia, stress, and depression through the COVID-19 pandemic In this cross-sectional study, blood samples from 120 COVID-19 patients (61 males and 59 females) who had more than 30 years, were taken. Also, 25(OH)D Serum level of COVID-19 patients was analyzed. The Insomnia Severity Index (ISI), Depression anxiety stress scales (DASS), and the Short Form Health Survey (SF-36) were used to analyze insomnia, anxiety, stress, quality of life, and depression. The relationship between temperature (p=0.039), PCO2 (p=0.022), and serum vitamin D level was significant. Additionally, there was a significant correlation between stress (p=-0.023, OR=0.389, 95% CI for OR=0.047, 0.843), depression (p=0.012, OR=0.659, 95% CI for OR=0.476, 0.913), and the concentration of serum vitamin D.This study recommends that vitamin D supplementation improve psychological state in COVID-19 patients.

Pulmonary veno-occlusive disease (PVOD) is a rare and fatal disease with non-specific clinical presentation often misdiagnosed as group 1 pulmonary arterial hypertension (PAH). The rate of occurrence per one million people is reported to be one-tenth to two-tenths of cases, annually. Our case was a 25-year-old young woman who complained of aggravation of dyspnea during exertion and slight chest pain for two months. Her work-up included pulmonary function test (PFT), an echocardiogram, body box plethysmograph test, diffusing capacity of the lungs for carbon monoxide (DLCO) test, positive ventilation/perfusion (V/Q) scan, computed tomography (CT) scan of chest, cardiac catheterization, and video-assisted thorascopic surgery (VATS). Echocardiography showed high pulmonary artery systolic pressure (PASP). The particular aspect of the present case was that due to the V/Q scan, the patient was diagnosed with chronic thromboembolic PH (CTEPH) and treated with anticoagulant, which did not have a good response. The crucial point is that in PVOD patients, V/Q scan can report segmental and subsegmental defects similar to CTEPH patients that creates a diagnostic challenge in patients. Definitive diagnosis of PVOD was based on VATS. Hypoxia, decreased DLCO, normal V/Q scan, and chest CT findings were used to diagnose PVOD. The patient’s treatment with diuretics, bosentan, and tadalafil led to the recovery of the patient’s hypoxia, saving her life for further treatment. With respect to the heterogeneous nature of the clinical presentation in PVOD patients, high clinical suspicion and appropriate diagnostic measures are required for diagnosis. The present study showed that PAH specific drugs in addition to diuretics can be used cautiously to control disease progression and save patients for lung transplantation.

Airway safety for difficult intubation or failure to intubate is important during anesthesia. This study assessed the airway before anesthesia, and the diagnostic value of neck circumference (NC) and sternomental distance (SMD) tests was investigated in predicting difficult tracheal intubation during cesarean section. In a cross-sectional study, 101 women who were candidates for cesarean section were selected through the convenience and non-random sampling method. The modified Mallampati test (MMT), upper lip bite (ULBT), thyromental distance (TMD), neck circumference (NC), and sternomental distance (SMD) tests were performed to estimate the laryngoscopy problem. The success rate of airway assessment by SMD and NC was evaluated using the Cormack-Lehane score. Data analysis was performed using the software SPSS version 16.0. TMD (p=0.034) and NC (p<0.001) indicated substantial association with laryngoscopy grades. The sensitivity was 35.29% and 58.82%, and the specificity was 93.93% and 59.09% for NC and SMD. The accuracy, NPV, and PPV of NC was higher than the SMD test (74% vs. 59%, 73.80% vs. 73.58, and 75% vs. 42.55%). The PPV and NPV were 43.63% and 77.77% for TMD. MMT, with high sensitivity (73.52%) and specificity (90.90%), increased the risk of difficult laryngoscopy up to 24-fold when adjusted for TMD, SMD, and NC [p<0.001; OR=24.38 (6.31-94.25)]. Although NC indicated low sensitivity, it had maximum specificity (93.93%) in predicting difficult intubation. High Mallampati grades increase the risk of difficult laryngoscopy. NC presented low predictive values, and SMD and TMD lack predictive values for difficult intubation.

The symptoms and laboratory findings of Kawasaki disease (KD) and systemic-onset juvenile idiopathic arthritis (SoJIA) may overlap in the early phases. Coronary artery lesions are common complications seen in KD.

Cases Presentation: 

In this article, we report three cases of SoJIA (two males and one female) with prolonged relapsing fever and coronary artery involvement. Initially, all three cases were presumed to have KD and were treated with IVIG. All three cases had arthritis and lymphadenopathy, and one of them had a skin rash. After 3-8 weeks, fever and main clinical symptoms returned. In the second evaluation, they met the criteria for SoJIA and were treated with methylprednisolone, ibuprofen, and methotrexate. High ferritin levels were observed in all three cases (mean=6024 ng/ml).

Coronary artery involvement may rarely be seen in the early phases of SoJIA. Continuing or relapsing fever, late-onset arthritis, and increased serum ferritin levels may help distinguish SoJIA from KD.

Thalassemia consists of a variety of genetic hemoglobinopathies. Thalassemia-major causes anemia in early age. Those suffering from thalassemia need frequent life-long blood transfusions to survive, resulting in iron overload in the body and many health problems. Much improvement has occurred in predicting the course of Thalassemia major thanks to iron chelation therapy. Edible iron chelating agents are the standard of the chelating process. Deferasirox is a newly developed orally active iron chelating tablet which is used on a daily basis. Th present case study investigated severe dermatopathological reactions to the Iranian made product of Deferasirox.

We present a case of adverse drug reactions in a thalassemic patient who was started on Deferasirox orally after receiving Deferoxamine injections for several years with no serious reactions. The patient experiences generalized maculopapular, deep red- blue partially purpuric itchy skin rashes throughout her body. The histopathological biopsy found superficial perivascular or dermatitis with low-grade vasculopathy, few eosinophils, and mild psoriasis form-supraglotticlichenoid epidermal reactions associated with Drug Reaction diagnosis.

With regard to inherent features, caution must be applied to start the original Deferasirox for the patients who will undergo the oral chelation process with a smooth increase in the daily dosage for a few weeks in order to create improved tolerance.

In multiple sclerosis (MS), oxidative stress (OS) performs a vital role in the neurodegeneration process. Cholesterol and lipids in the myelin sheath supplied by low-density lipoprotein (LDL) are also vital for nerve cells. In OS, lipid peroxidation occurs in LDL. To investigate the OS biomarker such as prooxidant-antioxidant balance (PAB), malondialdehyde (MDA) and their correlation with LDL and oxidized LDL (Oxi-LDL) in patients with relapsing-remitting MS. Blood samples from 18 patients with relapsing-remitting MS and 18 healthy subjects were collected to measure the OS biomarkers. In the patients' group in comparison to the control group: PAB, white blood cells (WBC), and neutrophils significantly increased (P<0.05), but there was no difference between the relapsing and remitting phase; MDA significantly increased in the relapsing phase (P=0.013), but marginally significant in remitting (P=0.068). There was no significant difference in LDL and Oxi-LDL between the two groups. Only the lymphocytes were different between the relapse and remission phases. The importance of OS in the process of MS disease was confirmed and a PAB assay can be used for the determination of OS levels.

The potency of health systems to effectively respond to crises varies between high- and low-income countries. The COVID-19 pandemic has presented numerous challenges for hospitals worldwide. In this context, the resilience of health systems and the capacity of health institutions and populations play a key role in mounting an effective response to crises.We gathered data on the condition and resilience of health systems in the two main hospitals in Mashhad, Iran, during three peaks of the COVID-19 pandemic. The results highlighted the fact that health systems officials and managers need to consider the consequences of COVID-19, such as the need for more beds and trained healthcare workers. Hospitals should take into account the impact of the COVID-19 pandemic across all wards and departments and prioritize the well-being of healthcare workers since they are at the forefront of the fight against this pandemic.