European Journal of Medical and Health Sciences European Journal of Medical and Health Sciences European Open Science en-US European Journal of Medical and Health Sciences 2593-8339 <p>Authors retain the copyright of their work, and grant this journal the right of first publication with the work simultaneously licensed under a <a href="">Creative Commons Attribution 4.0 International License</a> that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.</p> Multiple Myeloma Revealed by a Plasmacytoma of the Sphenoid Sinus in a Young Subject: Case Report <p>Extramedullary plasmacytomas are a rare entity. They represent less than 1% of malignant head and neck tumors. We report the case of a 42-year-old patient complaining of headache, ptosis of the right eye and hypoesthesia of the face evolving for a few weeks. MRI showed a mass in the sphenoid sinus with local extension. The myelogram objectified the presence of 60% dystrophic plasma cells, which confirms the diagnosis of multiple myeloma. The patient received chemotherapy with a good course. Here, we report a rare case of sphenoidal sinus plasmacytoma that evolved into multiple myeloma.</p> Wafaa Bennane Hanaa Bencharef Bouchra Oukkache Copyright (c) 2024 Wafaa Bennane, Hanaa Bencharef, Bouchra Oukkache 2024-05-13 2024-05-13 6 3 1 3 10.24018/ejmed.2024.6.3.2092 Spinal Trauma Revealing a Metastatic Medullary Lesion: A Case Report <p><em>Introduction and Importance</em>: Intramedullary spinal cord metastases (ISCM) are a rare and devastating complication of malignant disease with a poor prognosis. Prompt and accurate diagnosis is necessary for effective treatment, and magnetic resonance imaging (MRI) is the preferred imaging technique. In this article, a rare case of an ISCM presenting with motor weakness after trauma is described.</p> <p><em>Case Presentation</em>: The patient showed progressive severe paraplegia and urinary retention, and a thoraco-abdomino-pelvic scan showed a mediastinal pulmonary process and mediastinal adenopathies with adrenal lesions. He was admitted and a total resection of the processus was performed. After surgery, the patient showed partial neurological improvement, but two weeks later, he had a consciousness impairment. A cerebral CT scan showed multiple round lesions, with perilesional edema, and the patient died one month later.</p> <p><em>Discussion</em>: The article discusses the pathogenic mechanisms of ISCM and its diagnosis, treatment, and management, which are controversial due to the multitude of clinical circumstances and the lack of controlled studies on the efficacy of the different therapeutic approaches.</p> <p><em>Conclusion</em>: In conclusion, this rare case of Intramedullary Spinal Cord Metastases (ISCM) offers several important take-away lessons for clinicians and researchers alike.</p> Btissam Faham Zaari Nahla Jamal Oufaa Bouhou Oumaima Said Hilmani Khadija Ibahioin Abdelhakim Lakhdar Copyright (c) 2024 Btissam Faham, Zaari Nahla, Jamal Oufaa, Bouhou Oumaima, Said Hilmani, Khadija Ibahioin, Abdelhakim Lakhdar 2024-05-17 2024-05-17 6 3 4 7 10.24018/ejmed.2024.6.3.2090 Psychotic Disorders in Behçet’s Disease: Unraveling the Intricacies of Neuropsychiatric Manifestations: A Case Report <p>This case report describes a 33-year-old patient with Behçet’s disease who presented with chronic delusions and hostility. Despite receiving immunosuppressive treatment for Behçet’s disease, the patient exhibited unsystematized delusions, disorganized speech, and intense psychic dissociation. Neurological examination and MRI showed no abnormalities, suggesting a psychiatric etiology. Treatment with risperidone and lorazepam led to partial improvement in psychiatric symptoms. The case raises the possibility of schizophrenia co-occurring with Behçet’s disease, although psychosis is rare in this condition. Further research is needed to understand the relationship between psychiatric and neurological manifestations of Behçet’s disease.</p> Saadia Karroumi Fakhita Simou Hanane Elfaricha Imane Adali Fatiha Manoudi Copyright (c) 2024 Saadia Karroumi, Fakhita Simou, Hanane Elfaricha, Imane Adali, Fatiha Manoudi 2024-05-24 2024-05-24 6 3 8 9 10.24018/ejmed.2024.6.3.2110 Two Cases of Postpartum HELLP Syndrome: A Rare Presentation of Preeclampsia-Associated Liver Disease and Hepatocellular Dysfunction <p><em>Background</em>: HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) is a severe and sometimes fatal pregnancy condition characterized by hemolysis, increased liver enzymes, and low platelet count. While most cases occur before delivery, approximately 25% of cases manifest within 48 hours after delivery. One rare but life-threatening complication of HELLP syndrome is intraparenchymal liver hematoma.</p> <p><em>Case</em>: In this report, we present two postpartum HELLP syndrome patients with diverse clinical manifestations. Case 1 involves a 30-year-old woman who presented with a significant subcapsular liver hematoma as a complication of postpartum preeclampsia-associated liver illness. Following conservative treatment, she improved significantly, and no surgical intervention was required. This type of subcapsular hematoma occurs in less than 2% of pregnancies complicated by HELLP. Case 2 describes an unusual HELLP presentation in a 38-year-old woman who was diagnosed with postpartum HELLP syndrome with acute liver injury and hepatic hemorrhage.</p> <p><em>Conclusion</em>: These unique presentations underscore the significance of early detection and prompt treatment of postpartum HELLP syndrome, as it can significantly reduce risks to the mother’s health and improve overall outcomes.</p> Van Anh Do Arvind R. Murali Rutva Vora Christine Greves Steve J. Carlan Copyright (c) 2024 Van Anh Do, Arvind R. Murali, Rutva Vora, Christine Greves, Steve J. Carlan 2024-05-24 2024-05-24 6 3 10 14 10.24018/ejmed.2024.6.3.2051 Suspected Case of Histoplasmosis-Related Immune Reconstitution Inflammatory Syndrome Manifesting as Unilateral Pleural Effusion <p><em>Background</em>: Histoplasmosis is a prevalent endemic mycosis that frequently causes opportunistic infections among individuals living with HIV (human immunodeficiency virus), and acquired immunodeficiency syndrome (AIDS). The initiation of antiretroviral therapy (ART) can result in a rare histoplasma-associated immune reconstitution inflammatory syndrome (IRIS) that may be difficult to distinguish between active progressive disease and inflammatory reaction to the medication.</p> <p><em>Case report</em>: A 35-year-old male with newly diagnosed HIV and cervical biopsy-confirmed histoplasmosis was admitted from the emergency department with disseminated histoplasmosis for HIV antiretroviral treatment and antifungal treatment. Discharged after a 2-week inpatient treatment the patient returned 1 week later with a large left pleural effusion. Two liters of serosanguinous fluid were removed and all fluid cultures and cytology were negative. An extensive work-up remained negative, and given the timeline of presentation in relation to the initiation of ART, it was felt that this isolated left-sided pleural effusion was a manifestation of IRIS. Eventually, corticosteroids were given for IRIS and the patient improved and was discharged on long-term treatment.</p> <p><em>Conclusions</em>: Immunocompromised subjects are at serious risk for a virulent, aggressive, rapidly advancing histoplasma infection and should be counselled accordingly. Any clinical signs or symptoms of organ system deterioration or compromise should be reported to the provider and a workup for histoplasmosis considered. In patients treated with antiretrovirals, IRIS is particularly confounding since it is difficult to differentiate from active disease. Using corticosteroids in already immunocompromised patients with an established fungal infection requires caution. Compliance with treatment is one of the most important components of care, especially considering the months of protocol.</p> Van Anh Do Raihaan Khattak Jacqueline Kropf Patricia Couto Steve J. Carlan Copyright (c) 2024 Van Anh Do, Raihaan Khattak, Jacqueline Kropf, Patricia Couto, Steve J. Carlan 2024-05-27 2024-05-27 6 3 15 18 10.24018/ejmed.2024.6.3.2053 Dehydrated Amniotic Membrane in Pterygium Surgery <p>Pterygium is a degenerative tissue of the conjunctiva that can extend to the cornea and can cause vision loss with astigmatism. Different surgical techniques exist to treat this condition. Amniotic membrane graft is an emerging option. We report this new technique in the case of a 44-year-old male who presented a temporal pterygium. We excised it and grafted an amniotic membrane on the site. During follow-up, we found no complications and no sign of recurrences. The amniotic membrane is the inner layer of the placenta facing the fetus. It has been described to have many benefits. It is more and more used in the medical field and ophthalmology. It has multiple indications for ocular diseases and one of the themes is for pterygium excisions. The surgical procedure is easy and can be reproduced.</p> Mehdi Khamaily Othman Haddani Loubna Mouhib Amine Razzak Mohamed Bouazza Mohamed Elbelhadji Copyright (c) 2024 Mehdi Khamaily, Othman Haddani, Loubna Mouhib, Amine Razzak, Mohamed Bouazza, Mohamed Elbelhadji 2024-05-31 2024-05-31 6 3 19 24 10.24018/ejmed.2024.6.3.2088 Scrotal Dermatofibrosarcoma Protuberance: A Case Review at Mankweng Academic Hospital <p><em>Background</em>: Dermatofibrosarcoma Protuberance (DFSP) is an uncommon slow-growing soft tissue tumour. The overall incidence of DFSP in the population ranges from 0.3–5 per million and is more common in blacks than whites, males and females are affected equally. The main objective of this case report is to share our experience with Dermatofibrosarcoma Protuberance and give a literature review on the standard of care.</p> <p><em>Case Presentation</em>: A 28-year-old male presented to the outpatient department with a five-year history of a painless right inguinoscrotal mass. On physical examination the mass was lobulated, fixed to the underlying tissue, it was non-tender measured 8 X 8 cm and there were no inguinal lymph nodes palpable. Ultrasound showed a hypervascular soft tissue tumour not involving the testicle. Wide Local Excision was performed, and histology showed a protuberant ulcerated nodule. A staging CT scan of the chest and abdomen was normal with no features of any metastatic lesions.</p> <p><em>Conclusion</em>: DFSP is a slow-growing and locally aggressive tumor. Therefore, early diagnosis and complete surgical resection can result in patients being cured. Mohs micrographic surgery is becoming the treatment of choice for DFSP as it results in complete surgical clearance. Imatinib is a novel treatment option for DFSP and is increasingly being used.</p> Lerato Hector Nong Fumani Makhandule Dumisa Ntshani Mirza Bhuiyan Copyright (c) 2024 Lerato Hector Nong, Fumani Makhandule, Dumisa Ntshani, Mirza Bhuiyan 2024-06-07 2024-06-07 6 3 25 28 10.24018/ejmed.2024.6.3.2123 Extended Post-Traumatic Pneumorachis: A Case Report and Review of the Literature <p>Pneumorachis is an uncommon condition wherein air infiltrates the spinal canal. The pathophysiology of this condition is still a matter of debate, depending on the type of traumatic mechanism (open or closed) and the assessment of the associated injuries. This report aims to present a case of pneumorachis and comprehensively review the literature to gain a better understanding of the etiologies, associated lesions, and neurological symptoms. By doing so, we hope to enhance our knowledge of the management and modalities of treatment for this condition. Although there are many cases of pneumorachis reported in the literature, none are widespread.</p> Salma Lahlou Karim Baayoud Amine El Khamouye Abdelmajid Chellaoui Khadija Ibahiouin Abdelhakim Lakhdar Copyright (c) 2024 Salma Lahlou, Karim Baayoud, Amine El Khamouye, Abdelmajid Chellaoui, Khadija Ibahiouin, Abdelhakim Lakhdar 2024-06-12 2024-06-12 6 3 29 31 10.24018/ejmed.2024.6.3.2111 Corneal Melting in Undiagnosed Goujerot Sjogren’s Syndrome: A Case Report <p>Keratolysis or corneal melting is a very rare situation that might occur in different inflammatory systemic diseases such as Sjogren syndrome. In the case of sterile corneal ulcers, characterized by the absence of ocular inflammation, the optimal treatment has not yet been established. We report the case of a unilateral aseptic keratolysis revealing primitive Sjogren guzzler syndrome and having responded well to the treatment. Clinical case: a 56-year-old woman who presented with a notion of inflammatory polyarthralgia for 4 years with self-medication by oral non-steroidal anti-inflammatory drugs NSAID presented a month before her first examination, a reduced visual acuity with foreign body sensation in both eyes. After a month of ophthalmic examination for a corneal ulcer, the visual acuity dropped to HM, and the examination found a corneal perforation measuring less than 1 mm with a positive spontaneous seidel and an athalamia. A treatment with cyanoacrylate glue was performed along with medical treatment. A labial biopsy performed found a lymphoplasmacytic infiltration of the exocrine gland in favor of a primitive Gougerot Sjogren syndrome. Gougerot-Sjögren syndrome is a systemic autoimmune disease characterized by damage to the exocrine glands, in particular the lacrimal and salivary glands. The treatment of corneal perforations is based on different choices such as cyanoacrylate glue, amniotic graft, conjunctival recovery, and keratoplasty.</p> Naoual Mtalai Sara Ettourni Kawtar El Hadi Zyad Laftimi Ghizlane Daghouj Loubna El Maaloum Bouchra Allali Asmaa El Kettani Copyright (c) 2024 Naoual Mtalai, Sara Ettourni, Kawtar El Hadi, Zyad Laftimi, Ghizlane Daghouj, Loubna El Maaloum, Bouchra Allali, Asmaa El Kettani 2024-06-12 2024-06-12 6 3 32 34 10.24018/ejmed.2024.6.3.2116 A Case of Oncocytoma of Adenomhypophysis Discovered by a Head Injury <p>Adenohypophysis oncocytoma is a rare tumor of the pituitary region. In clinical and biological terms, the oncocytomas with fusiform cells are identical to other sellar tumors. We report a new case of oncocytoma of adenomhypophysis discovered by a head injury. The only diagnosis was confirmed by the presence of richly vascularized fusiform tumor cells whose cytoplasm is oncocyte and contains many mitochondria with no necrosis and some mitoses in anatomopathologic examination. The basic treatment is surgical excision by the endonasal endoscopic route. Radiotherapy and surgical revision are essential in the event of tumor recurrence.</p> Masina Ndalana d’Assise Rakotozanany Patrick Sandra Harimbonona Zo Miantsa Ratovondrainy Willy Romuald Seizeur Elsa Magro Copyright (c) 2024 Masina Ndalana d’Assise, Rakotozanany Patrick Sandra, Harimbonona Zo Miantsa, Ratovondrainy Willy, Romuald Seizeur, Elsa Magro 2024-06-13 2024-06-13 6 3 35 37 10.24018/ejmed.2024.6.3.2084 Investigating the Relationship between Serum Levels of PAPP-A and Free β-hCG in the First Trimester of Pregnancy with Placental Thickness and Percentile of Fetal Weight in Third Trimester Ultrasound <p><em>Introduction</em>: Fetal growth disorder is one of the most important factors in the morbidity and mortality of newborns. Investigating the factors and predicting them can be done through biochemical markers and sonography. The quality of the placenta was measured by measuring PAPP_A and free B_HCG and its quantity by examining the placenta by ultrasound. This study aimed to determine the correlation between fetal growth percentile and these three variables.</p> <p><em>Methods</em>: This prospective cohort study was conducted on 462 pregnant mothers in Ahvaz. The criteria of this study were singleton pregnancies, accurate knowledge of last menstrual date, non-smoking, no drug or alcohol consumption and consent to participate in the research exclusion criteria were fetal anomaly, chromosomal disorder and lack of ultrasound in the third trimester. PAPP-A and free B-HCG were measured in the 11–13 + 6 weeks of pregnancy, and then in the third trimester fetal placental thickness and fetal weight were measured by two-dimensional sonography. The data was analyzed using SPSS software version 26 as well as Pearson statistical logistic test and the results were analyzed.</p> <p><em>Results</em>: Out of the 462 fetuses none of them were under the 10% weight percentile. 187 fetuses were between 10%–50% of the weight percentile and 260 fetuses were between 50%–90% weight percentile and 15 fetuses were above the 90% weight percentile. The level of free B-HCG was significantly different in the three weight groups, the uppermost level of B-HCG was in the 90% weight percentile group (p-value = 0.008). The level of PAPP-A also correlated with the fetuses’ weight percentiles (p-value = 0.002). There was a positive and significant correlation between placental thickness in the third trimester in the three groups (p-value = 0.004) which means that with the increase in the thickness of the placenta, the fetus’s weight increases.</p> <p><em>Conclusio</em>n: Based on this study, the measurement of placental markers and diameter helps predict birth weight and is expected to help in deciding the time and type of pregnancy termination.</p> Bahar Amirgholami Sara Masihi Golshan Tahmasebi Reza Samie Copyright (c) 2024 Bahar Amirgholami, Sara Masihi, Golshan Tahmasebi, Reza Samie 2024-05-31 2024-05-31 6 3 10 15 10.24018/ejmed.2024.6.3.2107 Optimizing Patient Safety and Security Management in Zambian Mental Health Facility: A PDSA Quality Improvement Study <p>Delivering specialized and top-tier psychiatric care necessitates an intricate and well-thought-out plan focusing on the safety and security of both healthcare professionals and patients. In the realm of mental health, particularly in specialized clinics and hospitals where patients may require admission and intricate treatment plans, the safety and security of the healthcare environment are paramount. It is crucial to ensure the comprehensive and tailored protection of mental health workers, particularly those operating in shift patterns. A well-devised strategy can significantly enhance the overall safety and security within a healthcare facility, potentially streamlining operational costs while minimizing both immediate and long-term risks associated with breaches in safety and security protocols. The aim of this research was to bolster safety and security protocols within mental health treatment establishments by identifying and addressing operational hurdles faced by ancillary mental health staff. To achieve this, the study implemented the Plan-Do-Study-Act (PDSA) cycle, a cornerstone methodology in quality management systems. The PDSA cycle’s pragmatic ethos encourages a methodical, iterative approach to integrating new methodologies into any process, particularly those aiming to elevate security and safety standards. This model was specifically employed to refine the functioning of the security and safety department at a private mental health facility in Lusaka, Zambia. The anticipated outcome is that this approach will not only safeguard the immediate and future well-being of healthcare personnel and patients but also foster a holistic and efficient operational environment for mental healthcare services.</p> Anatolii Tsarkov Andréa Ferraz de Arruda Fernandez Marcelo Leite Ribeiro Petro Petlovanyi Copyright (c) 2024 Anatolii Tsarkov, Andréa Ferraz de Arruda Fernandez, Marcelo Leite Ribeiro, Petro Petlovanyi 2024-05-30 2024-05-30 6 3 1 9 10.24018/ejmed.2024.6.3.2112