Multiple cystic lung disease in an adolescent boy

A 15-year-old previously healthy boy was involved in a traffic accident and presented to our emergency department (ED) with complaints of chest pain and mild shortness of breath. On physical examination, he had complained for the last 2 hours of the right hemithorax pain in the fifth intercostal space radiating to the right midaxillary line. He had no past medical or surgical history. Chest xray demonstrated doubtful multiple thin-walled cystic lesions in the right lung (A). Computed tomography (CT) scan of thorax revealed a well- defined thin-walled, and 9.97 x 8.78 cm in diameter giant air cyst occupying the right upper lobe parenchyma with multiple airspace cysts (B). The patient was finally diagnosed as a multiple cystic lung disease and he underwent elective thoracic surgery for cyst removal. Cystic lung disease is defined as intrapulmonary aircontaining multiple cysts surrounded by sharply demarcated thin walls. CT scanning of thorax is more sensitive than chest radiography in the detection and the distribution of lung cysts. Patients with cystic lung disease may be asymptomatic or present with nonspecific symptoms, such as chronic cough or shortness of breath. They are at increased risk for spontaneous pneumothorax. Surgical treatment of multiple cystic lung disease plays a crucial role in the prevention of pneumothorax.Pan African Medical Journal 2016; 2

Successful Cardiopulmonary Resuscitation in Pregnancy: A Case Report

The management of cardiac arrest in pregnancy is an important task for the emergency physicians. The clinical outcome of mother or fetus will often depend on the successful resuscitation of the first few minutes. Furthermore, the resuscitation team leader should consider the necessity of emergency hysterotomy (cesarean delivery) as soon as a pregnant woman develops cardiac arrest. We report a case of a 28-year-old pregnant woman who had a ventricular fibrillation cardiac arrest. She was successfully resuscitated in our emergency department and a single male healthy infant was delivered via cesarean section at 36 weeks’ gestation. Mother and baby were discharged survival and neurologically intact from the intensive care unit (ICU) on day 25. We emphasize that understanding the causes of cardiac arrest during pregnancy, its early recognition and prompt resuscitation by recent ACLS guidelines may decrease both maternal and fetal morbidity or mortality

A girl with a torticollis without trauma: Grisel’s syndrome

A 7 year-old girl patient was referred from pediatric emergency department (ED) to our emergency department due to cervical pain and neck stiffness. On her physical examination, torticollis was found in the neck. There was no history of trauma. Physical examination showed no focal neurological deficits. On further anamnestic evaluation the patient's parents revealed that she had presented to paediatric ED due to throat and neck pain and put on antibiotics therapy for 5 days. A computed tomography (CT) scan of the patient's neck was performed. A cervical lymphadenopathy associated with atlanto-axial subluxation shadow. The atlas was rotated on one articular process with 3-5 mm anterior displacement, compatible with Type II subluxation. Non-traumatic or inflammatory atlanto-axial subluxation is known as Grisel's syndrome. The subluxation was stabilized with external stabilization (rigid cervical collar). Skeletal muscle relaxants, antibiotics and nonsteroidal anti-inflammatory medications with bed rest were given for further treatment. Early diagnosis of Grisel's syndrome is of crucial importance due to the neurological deficits suc as recurrence or permanent neck deformity. CT, magnetic resonance imaging (MRI) or other imaging tests are required to demonstrate fractures and displaced bone fragments (ie., atlanto-axial subluxation). The primary treatment of early detected Grisel's syndrome is conservative including antibiotic therapy, bed rest, muscle relaxants, external fixation and anti-inflammatory therapy

Isolated Transverse Sacrum Fracture: A Case Report

Sacral fracture commonly results from high-energy trauma. Most insufficiency fractures of the sacrum are seen in women after the age of 70. Fractures of the sacrum are rare and generally combined with a concomitant pelvic fracture. Transverse sacral fractures are even less frequent which constitute only 3–5% of all sacral fractures. This type of fractures provide a diagnostic challenge. We report a unique case of isolated transverse fracture of sacrum in a young man sustained low-energy trauma. The patient presented to our emergency department after several hours of injury, and diagnosed by clinical features and roentgenogram findings

Serum Copeptin Levels in Adult Patients with a Migraine Attack: A Cross-Sectional Study

Aim:This study investigated the potential role of serum copeptin, a mediator of acute pain via sympathetic stress stimulation, as a biomarker of varying degrees of migraine-related disability. Specifically, we aimed to analyze whether the serum copeptin level can be used to differentiate migraine types (e.g., with and without aura).Methods:The study population included 80 consecutively consenting adult patients who had migraine attacks and attended the emergency department from June 2020 through November 2020, as well as 80 age- and sex-matched healthy controls. Using the Migraine Disability Assessment Scale (MIDAS), the same medical professional assessed each patient’s level of headache-related disability. Based on their MIDAS scores, the patients were separated into four groups: no disability (score 0-5; group MIDAS-I); mild disability (score 6-10; group MIDAS-II); moderate impairment (score 11-20; group MIDAS-III); and severe disability (score >20; group MIDAS-IV). There were also two categories of migraineurs: those with auras and those without auras. Upon admission, comparisons were made between the groups’ serum copeptin values.Results:In comparison to the control group, the patient group’s serum copeptin levels were noticeably higher (2113.30±206.20 vs. 1383.40±488.40; p<0.001). The study of the receiving operator’s characteristics showed that the cut-off copeptin level was 1898.5 pg/mL, with 90% sensitivity and 82.4% specificity for distinguishing patients from controls. There were no noticeable differences in the mean serum copeptin levels between the patient groups when compared by MIDAS score. Additionally, patients with and without aura did not differ notably in terms of mean serum copeptin levels. (2118.70±211.60 vs. 2071.10±160.40).Conclusion:Serum copeptin levels may be used as a diagnostic aid to help anticipate migraine-related headache attacks when combined with clinical signs and symptoms

Acute myocardial infarction and coronary vasospasm associated with the ingestion of cayenne pepper pills in a 25-year-old male

Capsaicin, one of the major active components of cayenne pepper pills, is an over-the-counter substance with sympathomimetic activity used commonly by young individuals for weight loss. Here we report the case of a previously healthy young male who developed severe chest pain after using cayenne pepper pills for slimming and sustained an extensive inferior myocardial infarction. Electrocardiography combined with a bedside transthoracic echocardiogram confirmed the diagnosis of acute myocardial infarction. The patient denied using illicit substances, and he had no risk factors for coronary artery disease. His medication history revealed that he had recently started taking cayenne pepper pills for slimming. A subsequent coronary angiogram revealed patent coronary arteries, suggesting that the mechanism was vasospasm. We postulate that the patient developed acute coronary vasospasm and a myocardial infarction in the presence of this known sympathomimetic agent. This case highlights the potential danger of capsaicin, even when used by otherwise healthy individuals