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  • ISSN: 2373-9819
    Volume 3, Issue 4
    Case Report
    Folusho Balogun* and Adebowale Ademola
    Abstract Nephrotic syndrome is a chronic childhood disease characterized by relapses and children with this condition tend to have behavioural problems associated with the disease. These behavioural problems are usually not anticipated in most resource limited settings and can be frightening thereby making the children and the care givers to be distressed.
    Seven children with nephrotic syndrome who developed various behavioural abnormalities while on admission were discussed. There were four girls and three boys with age range seven to fourteen years. The abnormal behaviours noted were visual and auditory hallucinations, inappropriate speech and behaviour, attempted suicide, attention seeking behaviour and social withdrawal. These behavioural abnormalities were related to prednisolone therapy in five of the children. Diagnosis made were psychosis and delirium while treatment given included counselling, Risperidone, Halloperidol, Diazepam and reduction or withdrawal of Prednisolone.
    Abnormal behaviour was not anticipated in these children so the caregivers were taken unaware. This can be worse in infants or in mild cases. Most of the behavioural abnormalities were also associated with the use of prednisolone. There is an urgent need to design guidelines for the management of behavioural abnormalities in nephrotic syndrome especially steroid therapy in resource limited settings. Harmonisation of the skills of paediatric nephrologist and child psychiatrist is also important to obtain the best outcome.
    Seda Kahraman*, Ozge Gumusay, Kenan Hızel, Onur Ertunc, Guldal Yılmaz and Ahmet Ozet
    Abstract Pineoblastoma are rare malignant embryonal tumors that arise from the pineal parenchyma. We report the case of an adult patient with pineoblastoma who presented with signs and symptoms of central nervous system infection. She was admitted to the emergency room with fever; headache; diplopia and a feeling of numbness in the legs and hands. There were no microorganisms on Gram staining and acido-resistant staining. CSF cytology was also negative for malignancy. On the basis of the patient's history and CSF laboratory findings; a central nervous system infection was not ruled out; and meropenem was started empirically. No acid-fast bacilli were seen through microscopic examination and Tuberculin skin test was negative; but quantiferon blood test was positive. Anti-tuberculosis therapy with isoniazid; rifampicin; pyrazinamide and ethambutol was started. But the patient did not respond to antibiotic and anti-tuberculosis treatment. Repeated lumbar punctures revealed malignant cells consistent with primitive embryonal tumor. In conclusion; PBL is an aggressive tumor that has a tendency to metastasize along neuraxis and also recur locally. Months after tumor resection; the patient may present with the symptoms of meningeal irritation and indiscernible clinical presentation of other causes of meningeal inflammation.
    Batool F. Kirmani*, Ekokobe Fonkem DO and Diana Mungall Robinson
    Abstract We describe a case report of a young woman with long-standing epilepsy since childhood. She has failed three resective surgeries, anterior left temporal lobectomy, complete total lobectomy and frontal resection. Pharmacologically, she has had a therapeutic trial of most of the marketed medications, including the vagal nerve stimulator.She remains intractable with two to three seizures per week on gabitril,tegretol, and vagal nerve stimulator. This has been the best control for more than a decade.
    She was seen in our epilepsy clinic with an increased frequency of seizures ranging from 10-20 per day requiring frequent emergency room and clinic visits. A careful history revealed that the presentation of the spells was atypical.Her usual episodes were characterized by head shaking, confusion, electrical sensation in the head and periods of whole body shaking with no postictal state.
    She was admitted in our epilepsy monitoring unit and intensive video EEG monitoring was performed over a four-day period. We were able to capture all of her spells, revealing no electrographic seizures.
    The diagnosis ofpsychogenic non-epileptic spells (PNES) was made with follow up with psychiatry. Our case report emphasizes the importance of intensive video EEG monitoring in patients with a well-established diagnosis of epilepsy. The idea is to diagnose new, onset frequent atypical events prompting the need for frequent emergency room and clinic visits and hospital admissions.
    Cristina Soeiro*, Tomas Fonseca and Maria Betania Ferreira
    Abstract Auto-immune haemolytic anemias (AIHA) are a group of heterogeneous diseases of acquired immunologic destruction of red blood cells (RBC). Cold AIHA is usually associated with underlining disorders such as infections, autoimmune diseases and neoplastic growth. Infection associated cold AIHA may be severe, but is usually a self-limited disease without chronic complications of hemolysis such as gallstones or nephrolithiasis. We present a case of AIHA with auto-limited production of cold agglutinins associated with an acute infection and several uncommon lithiasic complications that occurred months after resolution of the hemolytic event.
    Ravi Badge*, Jad Mushtaq and I Siddique
    Abstract Wound breakdown of the operative incision can be a devastating complication. Persistent problems with healing can lead to overlying skin loss and thus exposing underlying structures. Patients with underlying metalwork can further increase risk of poor wound healing. Surgical wound healing is a multifactorial event.
    Wound breakdown due to underlying prominent spinous process at cervico-thoracic junction has not been reported in literature. We report a unique case of this complication following posterior spinal fixation of lower cervical vertebra fracture in-patient with underlying Diffuse Idiopathic Skeletal Hyperostosis (DISH) disease.
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