Hospital Practices and Research

Abstract Background: Pneumomediastinum and pneumothorax are usually rare conditions after pneumonia. This study examines the progress of pneumonia of the coronavirus disease 2019 (COVID-19) to spontaneous pneumothorax and pneumomediastinum in a patient.
Case Presentation: The patient was a 40-year-old man who complained of nonproductive cough and dyspnea. He also complained of fever, sore throat, back, and chest pain. The patient used to smoke but now he quit .His O2 saturation was 89% at the time of admission. He was assessed with suspicion of COVID-19. CT scans of the chest showed brief changes of emphysema and a ground glass view was also seen in the lungs. In the patient’s tests, RT-PCR testing of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was performed and it was positive. Treatment was initiated and because of the progression of symptoms, the serial CT scanning of the patient’s lungs was performed daily; and cavitary changes, air-fluid appearance, and destructive changes of lungs were reported. After eight days, the patient’s cough worsened. CT scans of the patient’s lungs showed some bullaes, pneumothorax, and pneumomediastinum, thus a chest tube was inserted and oxygen therapy was begun on the patient with 3-6 L/min. After 5 days in CT, the patient was relieved of pneumothorax and pneumomediastinum and after a week, the chest tube came out.
Conclusion: Pulmonary lesions of COVID 19 can progress to bullae, pneumomediastinum, and pneumothorax. Deterioration of dyspnea and respiratory symptoms can be a warning of pneumomediastinum and pneumothorax that can be confirmed by graphics and timely treatment of the patient can be life-saving.

Abstract Introduction: Hemochromatosis of the pituitary gland is a form of iron overload disease which occurs in different clinical conditions related to multiple blood transfusions.
Case Presentation: We present a case of secondary hemochromatosis involving the pituitary gland and choroid plexus in an eight-year-old female with imaging findings and a review of the relevant literature. Our patient has had a history of cessation of growth in height for the last 1 year. She was diagnosed with a thalassemia major at the age of 6 months. She has been on regular blood transfusions since then. Magnetic resonance imaging (MRI) revealed evidence of iron deposition in the pituitary gland.
Conclusion: This diagnosis should be suspected on clinical presentation and history of multiple blood transfusions. It can be confirmed based on characteristic imaging findings. The patient should be strictly monitored with serum iron levels, and a tailored iron chelation therapy should be initiated.

Abstract Introduction: The motor function is associated with the activity of both the motor and prefrontal cortices. The efficacy of transcranial direct current stimulation (tDCS) over specific brain cortices has been examined in many psychiatric and neurologic disorders. This study aims to report the tDCS effects on two females of advanced age with idiopathic Parkinson’s disease (PD).
Case Presentation: We considered 50-minute sessions of bilateral primary motor cortices and left dorsolateral prefrontal cortex (DLPFC) anodal stimulation using tDCS with passive stretching exercises simultaneously for a total of 20 sessions in 7 weeks. Clinical signs and electroencephalography (EEG) waveform were assessed at distinct times. Both of the two patients showed improved motor function for a short time. EEG changes to some extent concerned clinical states.
Conclusion: It seems that tDCS can be an auxiliary treatment for motor dysfunction in PD; however, further studies must be carried out to prove the claim.

Abstract Background: Abdominal trauma whether blunt or penetrating is a harbinger of the possibility of genitourinary injuries. The kidney is an organ frequently injured when there is a genitourinary injury. The menace of armed banditry has led to the increased presentation of life-threatening organ system injuries to our facilities such as a shattered kidney. The associated mortality can be significant even where there is a functioning trauma system.
Objectives: The aim of this study was to investigate a patient who survived shattered kidney injury despite non-existent functioning trauma system.
Case report: A 75-year-old farmer presented with a 4 h history of gunshot injury to the right flank and left cheek associated with bleeding, haematuria, and shock was investigated. His admitting packed cell volume was 16.4%. The serum chemistry was within normal range and no features of peritonitis was observed. He had resuscitation according to the principle of the Advanced Trauma Life Support protocol and emergency exploratory laparotomy with right simple nephrectomy.
Conclusion: The management of shattered kidneys involves prompt and simultaneous resuscitation using the Advanced Trauma Life Support (ATLS) protocol including emergency exploratory laparotomy and simple nephrectomy to guarantee patient survival.

Abstract Introduction: Histoplasmosis is a granulomatous fungal disease, caused by Histoplasma capsulatum; an intracellular dimorphic fungus, usually found in soil contaminated with bird and bat excreta; transmitted by aerosolized microconidia inhalation. The most common clinical presentation is acute or chronic Pulmonary Histoplasmosis.
Case Presentation: In this case report, a perplexing diagnostic scenario involving a 56-year-old patient who was HIV-negative but had diabetes mellitus and hypertension, in conjunction with unclear dermatological lesions has been presented. Despite treatment, the lesions did not respond favourably, posing a diagnostic dilemma. The identification of yeast forms in skin biopsy indicated progressive disseminated histoplasmosis, a diagnosis validated by PCR analysis, detection of Histoplasma galactomannan antigen in urine, and a positive fungal culture. A course of IV Liposomal Amphotericin B followed by oral Itraconazole, resulted in a favourable response.
Conclusion: Immunocompromised patients often exhibit mucocutaneous involvement, which is uncommon in immunocompetent individuals without specificity, leading to diagnostic difficulties. Although the patient lived in a non-endemic region, a travel history to Gangetic Plains, an endemic area for histoplasmosis, was elicited. Therefore, a comprehensive patient history is essential for diagnosis, in addition to microbiological and histopathological results.

Abstract Background: Electrical injuries can be life-threatening, ranging from mild skin burns to serious organ damage. Low-voltage electric shocks (<1000V) are more common than high-voltage electric shocks. Phone chargers have been used quite frequently in recent years, especially at night, to charge portable phones. Cases of burns due to phone chargers have been reported.
Case Presentation: In this case report, a 30-year-old woman developed chest pain and symptomatic bradycardia after exposure to low-voltage electricity (5 V, 3 A) from the connector of a phone charger.
Conclusion: This case describes transient symptomatic sinus bradycardia temporally associated with contact with a mobile phone charger connector. However, causality cannot be established based on a single case. In symptomatic patients after such exposure, ECG assessment and short-term emergency department monitoring may be considered.