Managing Intracranial Pressure in HIV-associated Cryptococcal Meningitis Saves Lives: Case Report of Two Patients Admitted to a Tanzanian Hospital

Arnold Chiari malformation type I is a developmental pathology characterized by herniation of the cerebellar tonsils towards to the spinal canal through the foramen magnum. The herniation of the cerebellar tonsils can also compress or stretch anatomical structures in the brainstem, leading to various symptoms. This condition is rarely seen, due to common and non-specific complaints, it may be confused with other diseases, and patients may get misdiagnosis. In this article, a patient who applied to hospital with the complaint of hypoesthesia and diagnosed as Arnold Chiari malformation type 1 is reported.

Introduction: Hypopituitarism is a clinical syndrome characterized by deficiency of pituitary hormone production. Snake bite is an uncommon cause of hypopituitarism. Envenoming by poisonous animals is an occupational hazard often faced by farmers and farm laborers in tropics. Viperine snake bites cause local cellulitis, tissue necrosis, bleeding manifestations, disseminated intravascular coagulation (DIC), acute kidney injury (AKI), shock, cardiac arrhythmia, neurotoxicity, coma, and death. Worldwide estimates vary from 1.2 to 5.5 million snakebites, 421,000 to 2.5 million envenomings, and 20,000 to 125,000 deaths

Case Report: We report case of a 37-year-old female who was bitten by a Saw scaled viper snake and developed chronic hypopituitarism diagnosed after 11 months. Patient improved with treatment of essential hormones

Conclusion: Hypopituitarism after a snake bite is often insidious in onset and a rare complication. Diagnosis is often delayed due to unawareness causing significant morbidity. Physicians should have a low threshold to suspect hypopituitarism in snake bites

We report a 47-year-old Caucasian man, a construction worker, with multiple asymptomatic hyperkeratotic lesions on the palms and soles. The lesions developed after puberty and slowly increased in size and number thereafter. His father, sister, and son had similar lesions on the palms and soles. Examination revealed numerous yellowish brown hyperkeratotic papules varying in size from 1 to 3 mm irregularly distributed on his palms, fingers, and soles. Central depressions were observed in some of the larger lesions. Some of the papules were coalesced to form larger hyperkeratotic plaques on the weight-bearing areas of his soles. A diagnosis of punctate palmoplantar keratoderma type 1 was made based on a positive family history, typical lesions (punctate hyperkeratotic papules), typical locations (palms and soles), and typical course (lesions increased in size and number with time)

Medical knowledge is the result of individual and collective experience produced over time. It has been that way since the medicine was recognized as a science and since this is provided in a collegial way [1].

Since the knowledge of the human anatomy, physiology of its different systems, the behavior of different diseases to the application of new diagnostic technologies and innovative therapeutic techniques based on molecular medicine, this has been the result of the gathering of individual experiences based on observation and experimentation [1,2]

Isoniazid is one of the commonest drugs used for treatment and prophylaxis of tuberculosis especially in developing countries. The commonest adverse effects of isoniazid are mild increased liver transaminases (10-20%), peripheral neuropathy (dose-related incidence, 10-20% incidence with 10 mg/kg/d), loss of appetite, nausea, vomiting, abdominal pain and weakness. Adverse effects also include fever with rash but only fever without any other adverse effects or rash is uncommonly reported. We report a patient with pulmonary tuberculosis developing isoniazid induced pyrexia without rash with first dose of treatment. It can occur within 8 hours of starting the first dose. Patients may have drug allergies even though they might not report. High index of clinical suspicion is required for diagnosis as serology and other investigations have limited value

Dialysis disequilibrium syndrome is a rare but well-known serious complication of dialysis. Cerebral edema associated with increase intracranial pressure has been considered to be main reason of dialysis disequilibrium syndrome. However, the direct evident of intracranial pressure changes in dialysis disequilibrium syndrome has been rarely described. Here, we reported a case of dialysis disequilibrium syndrome in a patient with acute stroke and intermittent hemodialysis. The changes of intracranial pressure levels before and during hemodialysis were analyzed and the results provided a significant evident to support the previous hypothesis.

We present a case report of a middle age female with a cysticercosis with a clinical feature resembling a triceps enthesitis. The absence of improvement with conventional enthesitis treatment and the inflammatory signs conducted to perform an ultrasound scan. It demonstrated two rounded lesions and an intense inflammatory reaction. Two cysticerci were surgical removed after antibiotic and antiparasitary treatment.

Suicide is the 10th leading cause of death worldwide with an increasing trend and accounted for 187,000 deaths in 2010 in India. Super Vasmol 33™ is a low cost, freely available, emulsion based hair dye used with main components of Paraphenylene Diamine (PPD), resorcinol, propylene glycol and sodium Ethylene Diamine Tetra Acetic Acid (EDTA). We report hair dye poisoning in a 50 year old male patient who consumed around 50 ml of Super Vasmol 33™ and expired on day 3. PPD component of hair dye can cause rhabdomyolysis, laryngeal edema, severe metabolic acidosis, Acute Kidney Injury (AKI) and myocarditis. No known specific antidote is available at present and treatment is supportive. Public awareness of the toxic potential and regulating the PPD concentration in hair dyes is to be done

Chondrodermatitis nodularis helicis also known as Chondrodermatitis Nodularis Chronicus Helicis (CNCH), typically presents as a tender, solitary, firm, well-demarcated, dome-shaped, erythematous or skin-colored papule/nodule on the pinna. The condition is usually unilateral, although cases of bilateral CNCH have also been described. Bilateral CNCH lesions are usually symmetrical. We herewith report a 63-year-old man with a CNCH lesion on the right antihelix and another CNCH lesion on the left helix.

Only authors know how tough is today to publish an interest case report in ophthalmology. Even the case is not previously described and for sure its publication will help other clinicians to better treat their patients, many submitted case reports are rejected quickly by most clinical journals.

Although it’s noticeable that some case reports still make a valuable contribution to medical literature [1], there is a trend to think that the reputation of the journal depends on the lower case report published. Often, you will find them at the end of the journal, after the editorials and scientific studies. It is true that the description of a case report takes less time that the design and the performance of a prospective study. Besides, the impact factor of the journal might easily grow publishing scientific studies. However, the reader will find more information to use in clinical practice in case reports, as it’s a challenge way to learn more about its specialty