Journal of Clinical Case Studies Reviews & Reports
Editor-in-Chief Stacey Sears Specialty Coordinator Pediatric Acute Care Nurse Wayne State University United States ORCID: https://orcid.org/0000-0002-0944-6194 Journal of Clinical Case Studies Reviews & Reports is an open access peer-reviewed journal from the publishers of Scientific Research and Community (SRC) which publishes articles in the form of written, video and power-point presentations from the arena of Clinical Case Studies Reviews & Reports. The journal focuses to build up accessing the complete content of articles freely from online for reader’s perusal. Call for Papers: Special Issue on Emerging Trends in Clinical Case Studies: Rare Diseases, Complex Diagnoses and Innovative Therapies Articles can be submitted through online from https://srcpublishers.com/clinical-case-studies/user/register or can send through an e-mail with attachment for clinicalreports@onlinescientificresearch.info 2.023 Impact Factor 84.5% Citations 65% Acceptance
Validation of a Moroccan Arabic Version of the Dizziness HandicapInventory (DHI-M)
Objective: To Develop and validate the dizziness handicap inventory questionnaire to the Moroccan dialect version. Method: We conducted a prospective study over a year (January 2025-January 2026) in the Otolaryngology Department of Casablanca University hospital. The questionnaire was translated by a forward–backward procedure. The translated version was then tested using 40 patients with vestibular disorders, and then analyzed. Results: patients included filled the questionnaire twice before liberation and once after. Conclusion: The Moroccan version of DHI showed satisfactory measurement properties and turns out to be a valid and reliable for evaluating the dizziness effects on quality of life in Moroccan population.
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Surgical practice in northwestern Syria during the war presented a stark reality for the medical professionals on the front lines: a collapsed health system, destroyed infrastructure, and severe shortages of medical supplies and equipment. Amidst this devastation, surgery emerged as the sole lifeline for many of the wounded. In the midst of this ruin, innovative solutions for surgical care delivery began to take shape—solutions designed to address the prevailing challenges: adapting to scarcity, fostering collaboration, improving supply chain logistics, and leveraging technology, such as telemedicine. These strategies are not merely transient measures for wartime; rather, they constitute a fundamental necessity for the post-conflict era, where the construction of a resilient health system—supported by effective partnerships—has become a prerequisite for the comprehensive revitalization of the region.
Unusual Cause of Septic Arthritis in a Young Woman During Puerperium
Sights and Sounds of Grief: Ancestral Voices and Pictorial Images as Posthumous Neurocognitive Means of Healing and Hope
This research study conducted examined how digital photographic legacies expressed in both pictorial images and media voice recordings affect, shape and impact mourning and remembrance relative to a person’s experience with grief and loss. Efforts were initiated to examine a person’s ability to address grief and also emotionally heal in the face of death and loss. A qualitative methodology was utilized in collecting archival and social data gathered through intensive media-elicitative interviews, journal articles, professional reports, researcher-generated photography, and extant data collections.
Therapeutic Potentials of NIGELLA SATIVA L. Extract in Bridging the Gap of Larval Development and Urinary Schistosomiasis Transmission
Background and Aims Schistosomiasis is a neglected tropical disease that affects mainly the health of school-aged children in endemic communities. This study determined the therapeutic effect of Nigella sativa extract on egg viability, multiplication, and cercaria infectivity of Schistosoma haematobium lifecycle stages in South-Eastern Nigeria. Methods The study was conducted using standard parasitological and malacological techniques. Snail intermediate hosts were collected from surrounding water bodies and subjected to cercarial shedding to assess their viability and transmission potential. Nigella sativa seed extract was applied at varying lethal concentrations to inhibit further transmission from the snail hosts. In addition, clinical samples were collected from pupils who frequented the same water bodies to determine infection status and assess seasonal prevalence. Results The egg viability assay for Schistosoma haematobium exposed to Nigella sativa seed extract showed a progressive increase in egg calcification, rising from 38.88% at 30 minutes to 94.37% after 4 hours of exposure. Analysis of variance (ANOVA) indicated no statistically significant differences (P > 0.05) in egg viability, calcification, or survival across the different exposure times. Similar effects were observed following exposure of cercariae to N. sativa seed extract, where a clear time-dependent pattern was evident, characterized by increased cercarial mortality and reduced survival with prolonged exposure. Conclusion The present findings on the therapeutic activity of Nigella sativa seed extract suggest that this plant has the potential to inhibit schistosome larval development and disrupt the transmission of Urinary Schistosomiasis.
The Synergy of Real-World Evidence and Clinical Trials
Randomized controlled trials (RCTs) have traditionally served as the cornerstone of clinical research, offering structured and highly regulated environments to assess the safety and efficacy of new medical products. While RCTs provide robust and scientifically controlled evidence, they often lack representation of diverse patient populations and real-world clinical behavior. In recent years, Real-World Evidence (RWE), derived from Real-World Data (RWD) such as electronic health records, patient registries, health insurance claims, and digital health platforms, has emerged as a valuable complement to traditional trial data.The integration of RWE with RCT methodologies represents a notable evolution in medical research and drug development. This convergence aims not only to enhance scientific rigor but also to ensure that treatments proven effective in controlled settings remain meaningful, accessible, and truly beneficial in routine clinical practice. By examining current research and frameworks, this review highlights how RWE can inform trial feasibility, refine eligibility criteria, strengthen external validity, and offer insights into long-term safety and effectiveness that may not be fully captured during pre-approval studies.A comparative assessment of RWE and RCT processes reveals complementary strengths: while RCTs excel in internal validity, RWE contributes broad applicability, patient diversity, and real-time feedback across large populations. The collaboration of these approaches is particularly valuable for rare diseases, accelerated approval pathways, post-marketing surveillance, and personalized medicine models. Emerging evidence suggests that thoughtfully integrating RWE into clinical development can support regulatory decision-making, optimize study designs, and shorten timelines without compromising scientific integrity. Ultimately, this blended model reflects a shift toward more holistic, patient-centered, and data-driven healthcare innovation. As adoption continues to grow, RWE paired with traditional clinical trials may reshape the future of evidence generation and support more impactful, equitable therapeutic advancements.AI-Powered Digital Adoption Platforms Enhancing User Experience: A Comprehensive Analysis of Implementation Strategies and Performance Outcomes
Isolation and Characterization of Small Pluripotent Stem Cells (SPSCs) from Human Peripheral Blood: A Novel Cold-Enrichment Protocol
Introduction: Small Pluripotent Stem Cells (SPSCs) represent a novel population of blood-derived stem cells exhibiting key pluripotency markers (OCT4, NANOG, SOX2, SSEA-4), measuring <5 μm in size. Isolated through a non-manipulated, cold-enrichment protocol from peripheral blood, SPSCs demonstrate nuclear integrity, high viability, and potential for both local and systemic therapeutic delivery. Unlike larger stem cells such as mesenchymal stem cells (MSCs), which are often sequestered in pulmonary capillaries, the small size of SPSCs may allow for wider biodistribution. Their autologous origin and compliance with FDA and EMA minimal manipulation guidelines make them an ideal candidate for future regenerative applications. Methods: Peripheral blood samples (10 ml) were collected from healthy adult volunteers n=233 total, (200 for baseline, 23 for enrichment, 10 for staining) to be centrifuged according to the SBSC protocol published by Filidou et al. (2023). Cell concentration and viability were measured before and after cold storage using the LunaStem™ automated cell counter. Immunocytochemistry was performed using the Invitrogen™ Pluripotent Stem Cell Immunocytochemistry Kit (OCT4, SSEA-4, NANOG, SOX2). Images were captured using a Magus Lum D400 fluorescence microscope with MAGUS CLM30 digital camera. Results: LunaStem™ analysis showed that the total nucleated cell concentration increased from ~20 million/ml to ~40 million/ml after 4.5h in cold storage, most prominently in the 1–3 μm size range. In multiple independent experiments for enrichment (n=23), a consistent ~2–3-fold increase in viable small cells (~1 μm) was observed. Pluripotent markers from separate blood samples (n=10) were shown and presented using immunofluorescence microscopy. Conclusion: This study introduces a novel, minimally invasive method for isolating and enriching Small Pluripotent Stem Cells (SPSCs) from human peripheral blood. We observed a statistically significant 2-fold increase (p=0.0001) of pluripotent cells with yields ranging from 200–500 million SPSCs from 60 ml whole blood. AI-Powered Digital Adoption Platforms Enhancing User Experience: A Comprehensive Analysis of Implementation Strategies and Performance Outcomes
Gastroenteritis and its Effect Locally and Globally on General Health and its Complications
Gastroenteritis is a common and often self-limiting inflammation of the gastrointestinal tract, primarily affecting the stomach and intestines. It is characterized by symptoms such as diarrhea, vomiting, abdominal cramps, nausea, and sometimes fever. The condition can be caused by a variety of infectious agents including viruses (e.g., norovirus, rotavirus), bacteria (e.g.,Escherichia coli, Salmonella, Shigella), and parasites (e.g., Giardia lamblia). Non-infectious causes, such as medications, toxins, and food intolerances, may also trigger gastroenteritis.Gastroenteritis is a leading cause of morbidity worldwide, particularly in low- and middle-income countries where sanitation and access to clean water may be limited. It disproportionately affects children under five years and the elderly, who are at higher risk of dehydration and its complications. In children, rotavirus is a major causative agent, while norovirus is more common in outbreaks among adults, especially in communal settings such as nursing homes and cruise ships.The health impact of gastroenteritis ranges from mild discomfort to severe illness requiring hospitalization. Dehydration, the most serious complication, can result in electrolyte imbalances, renal impairment, and even death if untreated. In chronic cases or repeated infections, particularly in malnourished populations, gastroenteritis may contribute to impaired growth and cognitive development in children.Prevention strategies include improving sanitation, hand hygiene, safe food preparation, and vaccination—most notably against rotavirus. Management is primarily supportive, focusing on rehydration through oral or intravenous fluids. In some bacterial or parasitic cases, antimicrobial therapy may be indicated.Overall, gastroenteritis remains a significant public health concern globally. Effective prevention, early recognition, and prompt management are critical to reducing its burden and preventing long-term health consequences, especially in vulnerable populations. Ongoing efforts to improve access to clean water, nutrition, and healthcare are essential in mitigating the impact of this disease.
Prevalence of Microbial Infections Detected in the Urine Examination in Patients in the Area of Moldova in 2020 – 2024
Urinary infections localized in any of the segments of the urinary system, from the urethra to the bladder are among the most widespread bacterial infections. They can occur in various causal situations, from an early age to old age. Following the centralization and analysis of the data, it was found that the bacteria that produced bacterial infections identified at an analysis laboratory in the area of Moldova are: E coli in a proportion of 69%, Klebsiella spp. 9%, Proteus spp. 3% followed in a small percentage by: Enterobacter spp., Enterococcus spp., Staphylococcus spp., Citrobacter sp., etc. The method of diagnosis of bacterial infections was uroculture on selective media, supplemented with the performance of the antibiogram as appropriate.
Decoding the Human Microbiome: Implications for Health, Disease, and Therapeutics
Abstract The human microbiome, comprising trillions of microorganisms residing in and on the human body, plays a crucial role in maintaining physiological homeostasis. Advances in molecular sequencing technologies have significantly enhanced our understanding of the complex interactions between host and microbial communities. The gut microbiome, in particular, influences metabolism, immune regulation, and protection against pathogenic organisms. Alterations in microbial composition, known as dysbiosis, have been associated with a wide range of diseases including metabolic disorders, inflammatory bowel disease, autoimmune conditions, and neuropsychiatric illnesses. Emerging evidence highlights the potential of microbiome-targeted interventions such as probiotics, prebiotics, dietary modifications, and fecal microbiota transplantation in restoring microbial balance and improving clinical outcomes. Understanding the structure and function of the human microbiome may therefore open new avenues for personalized medicine and novel therapeutic strategies. Continued research is essential to translate microbiome science into effective clinical applications and improve overall human health outcomes.
Biophoton Therapy Enhances Endogenous Stem-Cell Production: A Non-Invasive Approach to Regenerative Medicine
Abstract Background Endogenous stem-cell mobilization represents a promising alternative to transplanted stem-cell therapies, which are limited by poor survival, immune incompatibility, and procedural risks. Biophotons—ultra-weak, non-thermal photons generated by biological systems—have been increasingly implicated in mitochondrial regulation, redox signaling, and cellular repair. Whether controlled biophoton exposure can safely stimulate endogenous stem-cell production in humans has not been previously tested in a randomized clinical setting. Objective To evaluate whether a non-invasive, non-thermal biophoton generator can increase circulating stem/progenitor cell counts and improve functional health outcomes in adults. Methods In a randomized, double-blinded, placebo-controlled clinical trial (FIAM-SC255; NCT06855459), 71 adults underwent 14 days of nighttime exposure to either an active Tesla BioHealing® biophoton generator or a visually identical placebo. Circulating CD34+, CD133+, and CD34+CD133+ stem/progenitor cells were quantified by flow cytometry at baseline and follow-up. Quality-of-life (SF-36) and Pain Disability Index (PDI) scores were assessed concurrently. After the blinded phase, placebo participants crossed over to active treatment. Safety monitoring occurred throughout. Results Active biophoton exposure produced significant increases in circulating stem/progenitor cells compared with baseline and placebo, including a 2.7-fold rise in CD34+, 3.5-fold rise in CD133+ (leukocyte population), and 3.1-fold rise in CD34+CD133+ cells (all p < 0.01). No significant changes were observed during placebo exposure. SF-36 scores improved by 16–30% following active treatment (p < 0.05), and PDI scores decreased by an average of 7.35 points (p < 0.00001). Improvements replicated in the crossover cohort. No adverse events occurred. Conclusion Non-thermal biophoton therapy safely and robustly enhances endogenous stem-cell mobilization while simultaneously improving pain-related function and overall quality of life. The magnitude of stem-cell elevation is comparable to levels typically achieved through exogenous stem-cell infusion—yet without invasive procedures or safety risks. These findings support biophoton therapy as a clinically meaningful, noninvasive regenerative modality with potential relevance to neurological, metabolic, and age-related conditions.
Reflections of Labor Law Reforms on Employee Psychology: A Human-Centered Legal Approach
The rapidly changing economic, technological, and socio-cultural conditions of the 21st century directly impact the structure of working life and the psychological well-being of employees. This transformation necessitates redefining the traditional protective function of labor law and evolving towards a human-centered perspective. The study examines the impact of labor law reforms on employee psychology, particularly within the framework of the concepts of perception of justice, job security, psychological safety, and organizational belonging. This research compares labor law reforms enacted in Turkey and the European Union over the past decade. The qualitative analysis reveals that when legal regulations are limited solely to the goals of economic efficiency and employment market flexibility, they lead to a decline in employees’ psychological well-being. In contrast, the human-centered legal approach stands out as a legal paradigm that aims to protect individuals’ psychological integrity, emotional resilience, and professional satisfaction. The results demonstrate that labor law in the modern era should be considered not only a “rights system” but also a “psychosocial balance mechanism.” Legal systems that support employee satisfaction and motivation have been found to reduce workplace accidents, increase productivity, and strengthen corporate sustainability in the long term. In this regard, a human-centered labor law model is proposed as a new protection paradigm that integrates ethical, psychological, and economic dimensions.
Labor Law Reform, Employee Psychology, Human- Centered Law, Psychological Safety, Perception of Justice, Legal Sustainability, Psychosocial Well-being, Institutional Resilience
A Comprehensive Risk Mıtıgation Framework for Reducing Occupational Accidents in Construction Projects
This study is based on a comprehensive survey designed to identify the key variables affecting occupational accidents in construction projects and to ground risk reduction strategies scientifically. Face-to-face surveys conducted with 412 workers from 18 construction projects across Turkey revealed that behavioral, organizational, and environmental variables, as well as technical factors, play a significant role in the occurrence of occupational accidents. The scales developed for the study were designed to measure sub-dimensions such as safety culture, risk perception, team communication, training adequacy, personal protective equipment usage habits, and site layout. Structural equation modeling (SEM) and multivariate regression analyses revealed that employees’ risk perception accounts for 41% of the likelihood of an occupational accident, while a strong safety culture reduces the likelihood of an occupational accident by 37%. Furthermore, training frequency, the level of field inspections, and management support were identified as factors that significantly increased safe behavior. The study demonstrates that the combined implementation of digital monitoring systems, proactive risk assessment, and behavior-focused safety interventions provides the greatest protective effect. In conclusion, this article presents an empirically grounded, holistic risk-reduction framework for reducing occupational accidents in the construction industry and provides measurable, actionable recommendations for managers and policymakers.
Labor Law, Occupational Safety in the Construction Industry, Sustainable Construction, Sustainability, Construction Workers’ Rights, Awareness Levels and Personal Protectors
Global Monetary Policy Coordination and the Spillover Effects of Federal Reserve Decisions on Exchange Rate and Interest Rate Dynamics
This study investigates the reflections of Federal Reserve (FED) monetary policy decisions on global exchange rate and interest rate markets within the framework of international monetary policy coordination. In an increasingly financially integrated world, policy actions undertaken by the FED extend beyond domestic economic stabilization objectives and generate significant spillover effects across advanced and emerging economies. The research aims to analyze how changes in the FED’s policy stance particularly interest rate adjustments and forward guidance signals affect exchange rate volatility, sovereign bond yields, and cross-border capital flows. Using a quantitative methodology, the study employs a Structural Vector Autoregression (SVAR) model and panel data analysis covering selected developed and developing economies over the period 2005–2024. The empirical framework evaluates both short-term shock transmission and long-term dynamic interactions between U.S. monetary policy indicators and global financial variables. Additionally, impulse-response functions and variance decomposition analyses are conducted to measure the magnitude and persistence of policy spillovers. The findings reveal that contractionary FED decisions significantly increase global bond yields and trigger depreciation pressures in emerging market currencies. Moreover, the results indicate asymmetric transmission effects, with financially fragile economies exhibiting higher sensitivity to U.S. policy shocks. Evidence also suggests partial policy synchronization among major central banks, particularly during periods of global financial stress. The study contributes to the literature by integrating monetary policy coordination theory with empirical spillover analysis, highlighting the systemic role of the FED in shaping global financial conditions. The results underscore the importance of macroprudential preparedness and coordinated policy responses in mitigating external vulnerability risks.
Federal Reserve (FED), Monetary Policy Spillovers, Exchange Rate Volatility, Interest Rate Transmission, Global Financial Integration
When Home Cooking Turns Hazardous: Two Botulism Cases
Introduction: Botulism is a rare, potentially life-threatening neurotoxin-mediated disease caused by the anaerobic, grampositive bacterium Clostridium botulinum, and occasionally by related species such as C. baratii and C. butyricum. The diagnosis of botulism relies on clinical suspicion and a comprehensive neurologic examination. Timely diagnosis is crucial. Case Report: A 62-year-old woman presented to our department with diplopia, dysarthria, dysphagia, and hoarseness, which had developed over the past four days. She had a recent history of vomiting 48 hours after consuming homemade pumpkin preserves, followed by the onset of dysphagia, diplopia, dysarthria, and hoarseness 48 hours later. Neurological examination revealed dysphonia with a “hoarse” voice and an asymmetry of the pharyngeal reflex, more pronounced on the right. Laboratory tests showed no significant abnormalities. Brain CT scan results were unremarkable. Botulinum toxins were detected in her blood, and botulinum toxin-producing clostridia were found in rectal swabs. A diagnosis of foodborne botulism was established, and botulinum antitoxin was administered. The patient’s symptoms improved rapidly, with diplopia being the only persisting symptom. She was discharged after 7 days with indications for orthoptic rehabilitation. Several days later, the patient’s husband, who had also consumed the homemade preserve, was admitted to the emergency room with similar symptoms, including constipation, dysphagia, dysarthria, diplopia, and eyelid ptosis. Botulinum toxins were not detected in his blood, but botulinum toxin-producing clostridia were found in rectal swabs. He received antibotulinum serum, leading to symptom improvement. He was discharged after five days with mild eyelid ptosis, and orthoptic rehabilitation was recommended.
A Case Report of Acute Ischemic Stroke with ST-Elevation Myocardial Infarction in the Emergency Department (ED)
Background: Simultaneous cardiocerebral infarction (CCI) is a rare occurrence of acute ischemic stroke and acute myocardial infarction. The treatment of the former can compromise the latter and the contrary. Case History: A previously healthy 76 years old man arrived in ED with dysarthria and dysphagia, left hemiparesis started two hours earlier. Epigastrial and retrosternal pain began a few days before. Arterial pressure was 110/70mmhg, glycemia 107 mg/ dl; ECG showed ST elevation in anterolateral derivations;NIHSS was 14. Brain angioCT and angioRMN showed loss of both vertebral vessels, chest angioCT was negative for dissections. The echocardiography showed severely reduced ejection fraction with unknown before akinesia of the apex; tnThs was 8591pg/ml. The patient underwent fibrinolytic therapy with alteplase, early on he was intubated due to clinical worsening and cardiogenic pulmonary edema. He was admitted in ICU.
Evaluation of Incidence and Mortality in Patients with Diabetic and Respiratory Comorbidities (Non-Neoplastic and Non-Covid 19-Related). Period 2018-2023.
Background and Aims: The population with T2D (Type 2 Diabetes) has an increased risk of hospitalization and mortality. The authors examined hospitalizations at the Internal Medicine Units and Emergency Medicine of the “G. Rummo” Hospital in Benevento from 2018 to 2023 with primary diagnosis of respiratory disease (non-neoplastic and non-Covid19- related) and comorbidity with T2D. Materials and Methods: Hospital Discharge Records from January 2018 to June 2023 from the Internal Medicine Units and Emergency Medicine of the “G. Rummo” Hospital in Benevento. Results: A progressive increase in the number of patients with a respiratory diagnosis associated with T2D was observed (from 7.4% to 13.4%). In 2020, compared to the previous two years, a higher number of subjects with respiratory disease and compensated T2D was observed (69%). In 2021-2022, there was an increase in patients with decompensated diabetic comorbidity (55-45%). In 2020, the recorded incidence of these hospitalizations was 10.9%, with a mortality rate of 16.67%. In the following years, both the number of hospitalizations and the number of deaths decreased.
Background: Thrombotic Microangiopathies (TMA) are rare but serious disease with a pattern of damage that can occur in smallest blood vessels inside many vital organs. Case History: Female, 62y.o, entered ER due to worsening asthenia, thrombocytopenia and anemia on laboratory tests. Confirmed hemolytic anemia (increased LDH, indirect bilirubin, rare schistocytes on peripheral smear) anti-ADAMTS13 activity assay is performed, which is almost suppressed (< 5%) confirming diagnosis Thrombotic Thrombocitopenic Purpura (TTP). Plasma exchange, caplacizumab and steroids (1mg/kg body weight) were started. During hospitalization, due to increased inflammation indices during an episode of recrudescence (thrombocytopenia and undetectable ADAMTS13 activity) laboratory tests were performed, confirming diagnosis of septic state secondary to Salmonella typhi infection, complicated by septic arthritis. Rituximab and antibacterial therapy were started, achieving resolution of the septic state, but due to the persistence of thrombocytopenia (with normal ADAMTS13 activity) and finding of hepatosplenomegaly, was documented reactivation of Cytomegalovirus infections, therefore therapy with Ganciclovir was started, with resolution of the infectious state and TTP. Discussion: Bacterial/viral infections are commonly observed amongst TMA hospitalized patients and may act as a trigger (including recrudescences and relapses) or a consequence of immunosoppressive therapy; timely diagnosis and most appropriate treatment can help resolve PTT.
Background: Hypokalemia is present when serum levels of potassium are lower than normal. It is a rather common electrolyte disturbance, especially in hospitalized patients, with various causes and sometimes requires urgent medical attention (1). Hypokalemic paralysis is a relatively rare but potentially life-threatening clinical syndrome. If recognized and treated appropriately, patients recover without any clinical consequences. Case History: We describe the case of a 45-year-old woman who developed symptoms of asthenia and weakness of the lower limbs and subsequently the right upper limb, progressively over the last three days, until paralysis. In her medical history, the patient reported diarrhea in the last week following the intake of laxatives. Potassium values : 1.6 mEq/l. CT examinations excluded other acute neurological pathologies. She underwent potassium implementation with constant electrocardiographic and vital signs monitoring. The potassium returned to normal values with progressive improvement and functional recovery of the limbs. The patient left against the advice of the doctors.
Xa-I Levels in Patients in Patients with Occult Bleeding During Chronic Treatments with Doacs
Background: The increasing use of DOACs around world has been associated to an increase of patients with occult bleedings with decrease of haemoglobin > 2 g\ dL according to ISTH criteria and without overt major clinical bleeding. The use of Xa levels to screen patients at risk of major bleedings is discouraged by all scientific societies because with negative predictive value regaring that outcome; yet the same outcome is not screened in Literature for occult bleeding requiring blood trasfusion. We evaluated the outcome at 10 days and 30 days of patients admitted in internal medicine for anemia without overt bleeding dosing Xa-I during DOACs treatment. Patients and Methods: 15 patients with severe anemia with needful blood trasfusion and without overt bleeding were scrrened. HB, PLT, BUN, creatinine and Xa-i levels were ruled out toghether with the type and osage of DOACs in anamnestic treatment.
Pneumonia Caused by the Ascaris Lumbricoides: A Case Report
Background: Ascaridosis is widely spread in low-income countries because of poor hygienic conditions. This parasitosis is rare in Italy and the sporadic cases are reported in travelers from high-risk areas or infestation conveyed by contact with canine stool. Case History: A 58-year-old man with chronic obstructive pulmonary disease (COPD) was admitted to the emergency Medicine Department for acute respiratory failure. He had taken cortisone and ceftriaxone at home for 10 days. Chest CT showed bilateral multiple pericentimetric pulmonary nodulations. Abdomen CT was normal. He complained of irregular alvus, so he performed pancolonscopy, which showed the presence of actively moving roundworms, so he was transferred to the Infectious Diseases Department. Three coproparassitological samples were positive for Ascaris lumbricoides. Blood exams were negative for peripheral eosinophilia, at bronchoalveolar lavage fluid mild increased eosinophils (6%). The patient was treated with albendazole 200 mg bid for three days with pulmonary and gastroenteric symptoms resolution.
A Complicated Case of Recurrent Visceral Leishmaniasis in an HIV-Negative Immunodepressed Patient
Background: Visceral leishmaniasis (VL) has a lower relapse rate in immunocompetent patients and a higher rate in immunosuppressed patients particularly in patients affected by HIV, but also in other immunosuppressive conditions [1, 2]. Case History: A 74-year-old woman with mixed connective tissue disease on steroid therapy had previously treated visceral leishmaniasis with liposomal amphotericin B (L-AmB). She admitted to Emergency Department for progressive asthenia and periodic low-grade fever. Exams showed pancytopenia, hypergammaglobulinemia and hepatosplenomegaly. Patient admitted to the Infectious Diseases ward and underwent a first bone marrow biopsy (BOM) negative for amastigotes. She developed fever and respiratory failure, requiring transfer to Emergency Medicine. Lung CT showed severe bilateral interstitial and parenchymal pneumonia with positive PCR nasal swab for Influenza A and positive blood culture for carbapenem resistant Acinetobacter Baumannii (CRAB). Patient was treated with Oseltamivir, Cefiderocol, and NIV; her condition resolved and she was retransferred to Infectious Diseases ward. A second BOM was positive for Leishmania PCR. She was successfully treated with L-AmB and Miltefosine.
A Patient who has only one Lung Experiences Severe Hypercapnia. How the use of HFNC Has Had a Positive Impact on Patient life: A Case Report
Background: The literature doesn’t contain examples of patients with one lung who were treated with High Flow Nasal Cannula (HFNC) after identifying hypoxemic and hypercapnic respiratory failure secondary to pneumonia. Discussion: A 69 years-old male COPD associated, who had already a posttraumatic exeresis from an accident at work, went to the ER of our Hospital to severe dyspnea. At CT of thorax, an consolidation was found in the left basal region. Arterial blood gas analysis revealed severe hypercapnia and severe hypoxemia. The patient was admitted to the Emergency Medicine, where NIV + OLT was administered. We were contacted for a transfer. In our department, a bronchoscopy was performed, which documented the presence of dense secretions. A new antibiotic therapy was initiated and was placed on High-Flow Nasal Cannula (HFNC). The decision to use HFNC was considered for better secretion management, for CO2 wash-out effect and humidified gas mixtures. During hospitalization, the patient adapted to this system, and a progressive improvement was observed.
Food Supplement Based on L-Arginine and Grape Extract for the Control of Blood Pressure
The treatment of most patients with elevated blood pressure requires drug therapy, as well as lifestyle measures to achieve optimal blood pressure control. There are numerous side effects resulting from the use of these drugs: from the persistent dry cough of ACE inhibitors, to the headache, dizziness and tiredness of CCBs, to the slow heartbeat and sleep disturbances of betablockers. Scientific research in recent years is focusing attention on safer alternative therapeutic remedies, possibly of natural origin, also in support of classic pharmacological therapies, in order to reduce the doses of active ingredients and, consequently, their side effects. The present project aims to clinically test a nutraceutical product consisting of a formulation based on L-arginine and grape pomace extract of the Aglianico cultivar microencapsulated into maltodextrin. The formulation acts by: favoring the NO-soluble GC (sGC)-cGMP pathway; with an antioxidant effect on the heme group Fe+2, with a greater production of cGMP. The study involves the enrollment of 80 patients in 3 internal medicine units adhering to FADOI Campania. The treatment involves 1 tablet/ day. Project duration for each UOC: 80 days.
Splenic Abscess due Salmonella Typhimurium: A Case Report
Background: Splenic abscess is an uncommon clinical entity, often secondary to hematogenous dissemination from infective endocardi- tis or other sources. Salmonella spp., although a rare cause, can lead to splenic abscess formation, particularly in immunocompromised individuals. Case Presentation: A 74-year-old male with a medical history of diabetes mellitus and chronic obstructive pulmonary disease (COPD) presented to the emergency department with dyspnea and abdominal pain. Laboratory tests revealed significantly elevated inflamma- tory markers. Imaging studies, including abdominal ultrasound and computed tomography (CT) scan with contrast, identified an oval- shaped, mixed echostructure abscess in the splenic region measuring 74 x 71 mm. An ultrasound-guided percutaneous drainage proce- dure yielded approximately 150 cc of purulent fluid, which was cultured for microbiological analysis. Gram staining of the culture re- vealed Gram-negative, rod-shaped bacteria, and further microbiological investigation identified the organism as Salmonella Enteritidis spp., later confirmed to be a monophasic variant of Salmonella Typhimurium by the Regional Salmonella Typing Center using ISO 6579-3 serotyping.
Cancer Associated Thrombosis: A Balancing Act
Background: Cancer-associated thrombosis is a major health problem that affects morbidity and mortality of people with cancer, and is a leading cause of mortality after cancer itself, despite being a largely preventable disease. Surgical and systemic pharmacological anticancer treatments have a significant impact on thrombotic risk. Case History: Male, 64 yo. entered ER due to severe anemia, worsening asthenia and melena. Gastroscopy was performed, detecting gastric cancer; during hospitalization, while waiting for histological typing, patient develops an episode of deep venous thrombosis complicated by threatened extremity (Phlegmasia Cerulea dolens), despite mechanical elastic compression (unstable Hb values did not allow starting pharmacological prophylaxis). In accordance with vascular radiology, patient underwent aspiration thrombectomy (Penumbra system): preprocedural clot burden was significant (involved cava, iliac and femoropopliteal left veins), but we obtained adequate clot clearance, resulted in great acute symptoms improvement.
Antimicrobial Stewardship: When Less is More.
Antimicrobial Stewardship Programs (ASPs) have been proven to help reduce antibiotic consumption, promote appropriate use, and decrease the incidence of antimicrobial resistance (AMR). In this study, we aimed to evaluate the impact of ASPs on antibiotics consumption and AMR spread in a Southern Italy hospital from May 2023 to December 2023 (IIP), compared to the same period in 2022 (IP). The results of the study showed the number of hospitalizations increased by 24%, from 109,584 to 135,874, while the total amount of antibiotics administered decreased from 52.1 to 38.6 defined daily doses (DDD) per 100 bed-days. There was a significant increase in the number of rectal swabs taken to detect carbapenem-resistant Enterobacteriaceae (CRE) and methicillinresistant Staphylococcus aureus (MRSA), while the positivity rate of these infections decreased significantly. The incidence of several infections decrease, including CRPsA, MRSA, PDR, and VanA infections. This study provides further evidence that ASPs can be effective in reducing antibiotic consumption and preventing the spread of AMR. By promoting the appropriate use of antibiotics and implementing infection control measures, we can help preserve the effectiveness of these life-saving drugs and promote better patient outcomes. However, more efforts are needed to improve healthcare practices and reduce costs.
Study on Changes in the Microcirculation Highlighted with Capillaroscopy in Patients with Diabetic Nephropathy: Preliminary Data
Background and Aims: Nailfold-Videocapillaroscopy (NCV) is a non-invasive diagnostic tool of now proven efficacy in the evaluation of the microcirculation alterations characterizing various connective tissue diseases and also other several systemic diseases, such as diabetes mellitus. Diabetic nephropathy (DN) is a microvascular complication of diabetes. To our knowledge, a few researches have been conducted to investigate the relationship between DN and NVC. We evaluated nailfold capillaries (NC) in type 2 diabetes mellitus(T2DM) patients(pts) to determine any correlation between the development of nephropathy and changes in NC. Materials and Methods: We underwent NCV 30 pts (18M and 12F) affected by T2DM and a control group of 28 healthy individuals (16M and 12F). T2DM pts were separated into groups of normoalbuminuric, microalbuminuric and macroalbuminuric DN stages according to the albumin/creatinine ratio. GFR was evaluated using the CKD-EPI formula. We used Videocap 3.0, 200x magnification and software (DS Medica, Italy).
“A simplified Therapeutic Approach in Patients with Type 2 Diabetes Mellitus Through the Use of the Fixed-Ratio Combination of Insulin Glargine Plus lixisenatide (iglarlixi): An Account of Our Experience in Frail Elderly Patients”
Background and Aims: Approximately 50% of patients with type 2 diabetes mellitus do not reach glycemic targets and need treatment intensification or simplification. The aim of the study was to reduce the use of basal bolus approach among frail elderly patients to avoid hypoglycemia or to intensify treatment in case of hyperglycemia. The application of fixed-ratio combination of insulin glargine/ lixisenatide (iGlarLixi) promotes the mechanism of action of both drugs on hyperglycaemia while minimizing adverse effects. Materials/Patients and Methods: We enrolled 70 patients (aged>65) from July to December 2023 referred to our outpatients visit or admitted to Endocrine Diseases department. 60% of patients presented basal bolus therapy and with at least 3 episodes of recent hypoglycaemia, while 40% of patients severe hyperglycaemia, requiring therapy intensification. Results: 45% of patients treated with iGlarLixi achieved an improvement in glycated hemoglobin already in the first 3 months of therapy with an average reduction of approximately 1 unit. Additionally, 30% of patients who transitioned from basal bolus therapy to iGlarLixi achieved an average weight loss of 4 kg.