Dubai Medical Journal

Recurrent Right-side Bell’s Palsy in Association with Neurovascular Cross-compression: A Case Report

Mohamed Anas Mohamed — 2024-07-26

Introduction: Bell’s palsy is a lower motor neuron (LMN) palsy that affects the facial nerve (CN VII) and causes weakness or paralysis of the facial muscles. It can be associated with various causes, including neurovascular cross-compression (NVCC). This case report highlights the challenges in treating recurrent Bell’s palsy caused by NVCC and the need for a multidisciplinary approach.

Case report: A 17-year-old girl presented with recurrent right-side Bell’s palsy along with NVCC involving the right and left anterior inferior cerebellar artery forming a loop around the VII and VIII cranial nerve complex. Motor Nerve Conduction Studies (NCS) indicated a right-side facial nerve lesion with prolonged distal latency.

Discussion: Despite prior physiotherapy sessions, which proved effective, the patient showed no improvement after five sessions, leading to further investigations. This case also underscores the diagnostic and therapeutic complexities associated with NVCC-induced Bell’s palsy, which emphasizes the urgency of quick diagnosis and intervention to prevent functional limitations.

Conclusion: Continued research and advancements in diagnostic and therapeutic modalities are required for better outcomes and improving the quality of life in such patients, particularly in such cases.

Transtheoretical Model-based Interventions are Effective in Promoting Healthy Behaviors Related to Modifiable Risk Factors of Noncommunicable Diseases: A Systematic Review

Salwa B. El-Sobkey — 2024-11-21

Introduction: Noncommunicable diseases (NCDs) such as heart diseases, type II diabetes mellitus, cancers, and stroke represent significant public health challenges globally. Modifiable risk factors, including insufficient physical activity (PA), overweight or obesity, and smoking, contribute significantly to the prevalence of these diseases. The transtheoretical model (TTM) offers a structured approach to behavior change, identifying stages of readiness and change processes. This systematic review (SR) aims to evaluate the effectiveness of TTM-based interventions in promoting healthy behaviors to mitigate these risk factors.

Methods: This systematic review addresses the PICO question: In adults aged 18 years and older with modifiable risk behaviors related to NCDs, how effective are TTM-based interventions compared to standard care in increasing physical activity levels (PAL), reducing weight or body mass index, improving dietary habits, and promoting smoking cessation (SC)? A comprehensive search of predetermined databases was conducted using nine research strings, adhering to strict inclusion and exclusion criteria. A six-stage process was employed to select studies for inclusion, followed by data extraction and narrative synthesis to identify relevant patterns, trends, and associations.

Results: Of the 259 articles retrieved, eight met the inclusion criteria. Baseline assessments determined participants’ readiness for change. TTM-based interventions included feedback or counseling sessions, feedback materials, and reports delivered in-person, online, and by telephone. Follow-up durations varied from 2 weeks to 2 years. Five out of six studies supported the effectiveness of TTM-based interventions in enhancing PAL. Four out of five studies demonstrated their efficacy in weight management and improving dietary habits. However, only two out of five studies confirmed their effectiveness in SC.

Discussion: The findings indicate that TTM-based interventions are promising for improving PAL and, to a lesser extent, for managing weight and promoting healthy dietary behaviors. The limited effectiveness observed in SC interventions suggest a need for further research and possibly tailored strategies within this context.

Conclusion: TTM-based interventions effectively promote PA and weight management, with moderate success in improving dietary habits. However, their effectiveness in SC remains inconclusive, highlighting the necessity for further investigation and potential refinement of intervention strategies.

Sepsis, Hypothermia, and the Emergence of Osborn Waves: A Case Report

Amr Elfaramawy — 2024-11-21

Hypothermia and sepsis are two serious clinical entities with overlapping presentations, both capable of inducing electrocardiogram (ECG) abnormalities. We present a rare case of a 43-year-old male patient with coincident sepsis, acute kidney injury, and profound hypothermia that was complicated by the development of Osborn ( J) waves and conduction abnormalities on the ECG. The patient’s core temperature was gradually restored to normal utilizing both passive and active rewarming techniques, resulting in the disappearance of the Osborn wave. Concurrently, his cognitive state and cardiovascular parameters became stable after intensive sepsis treatment. Osborn waves arise from changes in the action potential and ion channel activity between the epicardium and the endocardium. These phenomena can be detected in several medical circumstances, including hypothermia, sepsis, subarachnoid hemorrhage, Brugada syndrome, and acute coronary syndrome. This case highlights the complexity of the diagnosis and management of such clinical scenarios.

Aortic Dissection that Presented to a Tertiary Hospital’s ED in Dubai, UAE: A Descriptive Study with Literature Review

Ivyan Kambal — 2024-11-21

Objectives: Aortic dissection is a life-threatening condition, with a high mortality rate. It can be classified into Stanford type A or type B. This study reports the clinical presentation, risk factors, systolic blood pressure, and the mortality rate of patients with confirmed aortic dissection on computed tomography (CT) imaging. Mortality rate on weekends, weekdays, daytime, and night-time were also reported.

Methods: A retrospective review of electronic health records of all patients requiring CT aortogram in the emergency department (ED) between 2013 and 2022 were examined. Patients with confirmed acute aortic dissection on CT were included. Presenting symptoms, demographics, and mortality rate were described and reported for type A and type B aortic dissection.

Results: Of 315 patients, 65 had confirmed acute aortic dissection on CT imaging. The mean age at presentation was 50.6 years and the majority of the cohort were male (83%). Chest pain was the most common symptom (43%). A history of hypertension was present in 65% of the subjects. D-dimer was elevated in 95% of the patients. The overall in-hospital mortality was 18.5%, with a mortality rate of 40% in type A aortic dissection.

Conclusion: Aortic dissection can occur with various symptoms, and therefore, requires a high index of suspicion. Chest X-ray has a low sensitivity in detecting aortic dissection and should not be used to rule out aortic dissection. D-dimer can be used as a diagnostic assay in ruling out aortic dissection. Type A aortic dissection has the highest mortality rate and hence necessitates prompt intervention.

Neuroendoscopic Lavage in Hydrocephalus with Ventricular Empyema: A Case Report

Farhad Bal’afif — 2024-11-21

Introduction: Ventricular empyema, or pyogenic ventriculitis, is a severe condition characterized by pus accumulation in the cerebral ventricles due to intracranial infection, often caused by Gram-negative bacteria. Early diagnosis and treatment are crucial to prevent fatal neurological damage.

Case Report: A 3-month-old infant with severe hydrocephalus and ventricular empyema was admitted with symptoms of seizures, fever, and diarrhea. Initial examination showed decreased consciousness and significant leukocytosis. CT scans confirmed severe hydrocephalus and ventricular empyema. Despite resistance to standard antibiotics, neuroendoscopic lavage (NEL) and bilateral external ventricular drainage (EVD) were performed, leading to substantial improvement.

Discussion: The patient’s condition improved significantly post-surgery, with a decrease in leukocyte count and resolution of empyema as shown in follow-up imaging. This case demonstrates the efficacy of NEL in treating complex pediatric neurosurgical conditions.

Conclusion: NEL proves to be an effective treatment for intraventricular empyema in pediatric patients, improving clinical outcomes and reducing hospital stays. The success of this approach emphasizes the need for tailored neurosurgical interventions and regular follow-ups to ensure patient recovery and prevent recurrence.

Moschcowitz Syndrome – A Rare Conundrum with Acute Pancreatitis – Case Report and Narrative Review of Literature

Debashish Mishra — 2024-11-21

Introduction: Moschcowitz syndrome or Thrombotic Thrombocytopenic Purpura (TTP) is a thrombogenic condition due to deficiency or dysfunction of A disintegrin and metalloproteinase with a thrombospondin type 1 motif member 13 (ADAMTS13), which causes a myriad of clinical presentations. The association between acute pancreatitis and TTP is a conundrum as both can be etiology and effect of one another. We describe a clinical case and review the available literature to understand this conundrum better.

Case: A 52-year-old male was admitted to our setting with acute pancreatitis and on further evaluation was found to have deranged renal function with anemia and thrombocytopenia. He had multiple seizures during his stay requiring mechanical ventilation. Based on clinical findings a diagnosis of TTP was suspected which was confirmed on relevant investigations. His course and management were a challenge for the team.

Discussion: A thorough literature search was conducted to identify all published reports/case series on acute pancreatitis and TTP. Of 38 identified publications, 20 case reports were reviewed as a cohort of acute pancreatitis and TTP. All cases had acute pancreatitis before TTP, alcohol being the most common cause. Early diagnosis and initiation of plasma exchange improves prognosis.

Conclusion: Acute pancreatitis is a sinister trigger for TTP. Vigilance, suspicion, and early diagnosis are crucial to manage these cases. Early plasma exchange reduces mortality and hospital stay.

Elevated Seminal Plasma TLR-2 Levels are Associated with Leukocytospermia

Rehab Sh. Al-Maliki — 2024-11-21

Introduction: Leukocytospermia is associated with male infertility, but its underlying mechanisms are not fully understood. This study aimed to investigate the association between seminal plasma toll-like receptor 2 (TLR-2) and prostaglandin E2 (PGE2) levels and leukocytospermia in infertile Iraqi men, and to evaluate their potential as differential biomarkers.

Methods: Eighty infertile men attending an infertility clinic in Iraq were enrolled. Semen analysis was performed according to WHO 2010 criteria. TLR-2 and PGE2 levels in seminal plasma were quantified using ELISA. Participants were categorized based on leukocytospermia status, varicocele presence, and smoking habits. Statistical analyses included correlation tests and receiver operating characteristic (ROC) curve analysis.

Results: Seminal plasma TLR-2 levels were significantly higher in leukocytospermic patients compared to non-leukocytospermic men (15.14 ± 1.06 vs. 9.27 ± 1.42 ng/mL, p < 0.05). TLR-2 levels showed strong negative correlations with sperm concentration (r = -0.675), total sperm count (r = -0.673), progressive motility (r = -0.669), and normal morphology (r = -0.616) (all p < 0.001). Positive correlations were observed between TLR-2 and round cell concentration (r = 0.684) and white blood cell count (r = 0.668) (both p < 0.001). Smoking and varicocele did not significantly influence TLR-2 levels. ROC analysis revealed high diagnostic accuracy for TLR-2 in identifying leukocytospermia (AUC = 0.993, p < 0.05). In contrast, PGE2 levels showed no significant differences or correlations with semen parameters.

Discussion: The elevated TLR-2 levels in leukocytospermic samples and strong correlations with semen parameters suggest a potential role for TLR-2 in inflammationrelated male infertility. The persistence of this association regardless of smoking status or varicocele presence further supports TLR-2’s specificity as a biomarker for leukocytospermia.

Conclusion: Elevated seminal plasma TLR-2 levels are associated with leukocytospermia and poor semen parameters in infertile Iraqi men. TLR-2 shows promise as a differential biomarker for male infertility, particularly in cases of leukocytospermia.