Clinical and Medical Case Reports

Horner’s syndrome, characterized by clinical signs including ptosis, pupillary miosis resulting in anisocoria, and facial anhydrosis, is a rare ocular complication following internal jugular vein catheterization. We report a case occurring in a 23-year old female who developed acute left-sided Horner’s syndrome after uneventful insertion of a left-sided permanent dialysis catheter. Ultrasound revealed no evidence of hematoma or carotid dissection. The catheter was left in place, and her symptoms resolved completely after 2 days. Clinicians should be alert for Horner’s syndrome in these patients, to assure appropriate diagnosis, documentation, and follow-up are provided, aiming at greater understanding of risk factors for and potential consequences of this rare complication.
Establishing reliable vascular access is essential for successful hemodialysis in patients with end stage renal disease (ESRD). A cuffed, tunneled catheter (permacath) is often used for prolonged renal replacement therapy, with internal jugular vein access preferred due to its accessibility, low malposition rate, and overall low complication rate. However, up to 35% of internal jugular vein catheterization attempts across all indications may be unsuccessful, and complication rates up to 19% have been reported.
Horner’s syndrome is a rare ocular complication that may occur after internal jugular vein catheter insertion, which usually resolves spontaneously. Because of its rarity, only a paucity of information is available about its specific etiology and course. Additionally, Horner’s syndrome is considered to be underdiagnosed. Awareness of this condition is important to foster appropriate diagnosis, documentation, and follow-up for patients who develop its signs. Accordingly, we report a self-limiting case of Horner’s syndrome that developed after internal jugular vein permacath insertion, and compare it with other cases reported in the literature.

Background: Continuous Glucose Monitoring (CGM) has been in focus for treatment of diabetes. Recently, a sensor-based flash glucose monitoring system, FreeStyle Libre (Abbott), has been introduced to clinical practice.
Case and results: The patient was 53 year-old female with type 1 diabetes mellitus (T1DM), who showed BMI 25.1 kg/m², HbA1c 9.5% in January, 6.0% in June and 7.7% in November, 2017 as data on outclinic. CGM measured glucose every 15 minutes in 24 hours for 14 days on June and November, and estimated HbA1c was 5.4% and 6.1%, respectively with discrepancy.
Discussion and conclusion: The beneficial points of FreeStyle Libre have been accurate, convenient and small size for clinical use for lessen hypoglycemia episodes. Key benefits of CGM monitoring are frequency of testing, trends, alarms, therapy optimization. Former studies for FreeStyle Libre tended to show lower values and larger mean absolute relative difference (MARD) in lower range of glucose levels, suggesting possible cause of the discrepancy for HbA1c levels. FreeStyle Libre for CGM would lead to better balance optimization of glucose control and current results would become basal data for future investigation of CGM.

Neonatal sepsis (NS) is the third most common contributor to neonatal deaths worldwide, the majority of which occur within the first 72 hours of life (Early-onset sepsis [(EOS)]). Diagnosis of EOS is challenging due to limitations with blood volume, poor sensitivity of culture, delay in culture results, and most importantly, lack of bacterial blood culture capacity in high burden settings. Current syndromic algorithms for diagnosis of EOS lack validations and are needed to enable clinical decision making for management. To evaluate the diagnostic performance of a severe illness syndromic algorithm in distinguishing culture-proven or probable EOS from unlikely sepsis. Neonates with their mothers with suspected neonatal sepsis that gave a written consent and made the enrollment criteria that fulfilled the WHO case definition of septicemia within the first 72 hours of life were enrolled from maternity and newborn units at Kisii and Homa Bay District hospitals in Kenya. Blood samples (1-2 mLs) for culture were collected and cultured for bacteria. Between April 2015 to Jan 2016, Out of the 256 newborns infants were enrolled. Fourteen (5.7%) infants had a bacterial pathogen identified on culture, 3 were, 1 Escherichia coli, 1 Klebsiella, 1 Staphylococcus 1 Aureus and 3 Enterobacter spp. number at risk, 14 had sepsis giving an early onset sepsis prevalence of 5.7%, (81.6%) had a negative culture but had probable sepsis and (13.29%) Of the confirmed sepsis the majority the neonates had more than one neonatal and maternal factor of which premature rapture of membranes (PROM) was the most common maternal risk factor and refusal to feed and chest in drawing were the most common clinical featured. Out of the 223, which were followed up to day 7, we had 18(7.03%) death of probable sepsis and 0(0.00) of confirmed sepsis.

Bronchogenic cysts are the most commonly found mediastinal masses which is asymptomatic in most of the cases. They are mostly found in the mediastinum and location outside of the mediastinum is rare. This is a case of 25-year-old female who is found to have a paraesophageal mass discovered incidentally in pregnancy which was is serially imaged until the delivery of the baby. This mass was later found to be an esophageal bronchogenic cyst.

In this case report, we present patients who presented to emergency department with gastrointestinal symptoms developing after consumption of a plant known by local people for its medicinal properties, and had prolonged coagulation test parameters and elevated liver transaminase levels 15-20 times of the reference limit. The consumed plant was examined, and identified as ferulacomunis. The patients who developed toxic hepatitis showed spontaneous clinical resolution within a 6-7 days period.