Open Access Case Report

Acute Myocardial Infarction Fallowing Blunt Chest Trauma-the Need for Third-Line Investigations in Medico-Legal Practice

S. R. Hulathduwa, S. Raveendran

Asian Journal of Case Reports in Medicine and Health, Page 12-17

Acute myocardial infarction is relatively uncommon among the young adults. Blunt trauma to chest is one rare mechanism of acute myocardial infarction specially among young adults.  A 35-year-old male had sustained among other injuries, a blunt impact on the left side of his front chest and abdomen when his motor bike collided with a van from behind. ECG on admission to the accident and emergency unit showed ST segment elevations from V2-V6 together with elevated CPK and periodic changes of Troponin T. He was managed as for acute myocardial infarction. Streptokinase was not given due to high risk of bleeding following trauma. He had an uneventful recovery. Myocardial infarction could be precipitated by damage to coronary arteries due to non-penetrating blunt impact on the chest, the possible mechanisms being coronary artery dissection, intimal tears, sub-intimal hemorrhages, intra-luminal thrombosis and spasm. CT/MRI guided coronary angiography is considered the best investigation to exactly identify the aetiology. Blunt impact may also cause myocardial contusions which can also lead to an outcome similar to a myocardial infarction. The objective of this case report is to highlight that trauma and infarction (specially in a person with pre-existing ischaemia) will pose a wide array of medico-legal issues some of which are difficult to be answered by the clinician or the pathologist with certainty.

Open Access Case Report

COVID-19 Reinfection in a Nurse Working in Emergency Hospital in Duhok City, Kurdistan Region of Iraq

Nawfal R. Hussein, Dildar H. Musa, Nashwan Ibrahim, Zana Sidiq M. Saleem, Ibrahim A. Naqid

Asian Journal of Case Reports in Medicine and Health, Page 27-30

Novel coronavirus disease (COVID-19) or SARS-CoV-2 infection was discovered in December 2019 in Wuhan City, China. The infection became a global pandemic over a period of few months. Post-infection immunity and susceptibility for reinfection is still under investigation. In this report, we present a case of a COVID-19 reinfection in patient who had recovered from an initial infection.

Case Report: 41-year-old male, nurse working in emergency hospital, presented in August 2020 with two days history of fever, sore throat, myalgia, lower back pain, shortness of breath. Then, his oxygen saturation dropped to 80%.  COVID-19 infection was proved by a positive RT-PCR for SARS-CoV-2 and CT scan of the chest demonstrated bilateral ground glass opacities. After clinical improvement, the patient was discharged from hospital. On 26th of October, he developed fever, and fatiguability. RT-PCR for SARS-CoV-2 resulted as positive twice. The infection was mild and no specific treatment was administered to the patient during the second infection. On 6th of November, the patient was asymptomatic. On 7-8th of November, he consecutively tested negative for SARS-CoV-2 twice.

Conclusions: Mild SARS-CoV-2 reinfection may occur rarely due to repeated exposed to the virus in hospital setting. If the occurrence of reinfections is demonstrated to be true, it may change the strategy of infection prevention. Further studies are needed to confirm the possibility of COVID-19 reinfection.

Open Access Case Study

Monomorphic T-Cell Post-Transplant Lymphoproliferative Disorder: A Case Report

Khalil Kusaybani, Bassel Abdallah, Ahmad Al-Akkari

Asian Journal of Case Reports in Medicine and Health, Page 1-5

The study reports a case of T-cell PTLD in a kidney recipient with a review of literature. Solid organ or bone marrow transplantation is the only curative treatment for a variety of diseases. Paradoxically, it accounts for several potentially life-threatening complications for the recipient that are often inevitable. A 53-year-old male patient presented to our hospital with dry cough and high-grade fever of 1 day duration. The patient had a history of diabetes mellitus and hypertension that were complicated by end-stage renal disease and hemodialysis until he underwent kidney transplant 3 years prior to presentation. Diagnostic thoracentesis was performed, and according to light’s criteria, the pleural fluid was consistent with lymphocytic exhudate. This result raised the concern of an underlying malignancy (PTLD in particular) which necessitated a tissue biopsy in order to be confirmed. The patient was started on chemotherapy with CHOP protocol (Doxorubicin, cyclophosphamide, Vincristine, and Prednisone).

Open Access Case Study

Unexpected Finding in Gastrointestinal Bleeding: A Case Report

Ramazan Serdar Arslan, Suleyman Diker, Sirin Kucuk

Asian Journal of Case Reports in Medicine and Health, Page 6-11

Gastrointestinal bleeding and foreign body ingestion are the big part of the emergency gastroscopic procedure.  Foreign bodies such as sharp and pointed ones associated with complications. The most feared complications are perforation, obstruction and bleeding. Toothpicks are very rare among accidentally ingested foreign bodies, but they can cause serious complications and mortalities. In this case, we present a 50 year-old male patient who presented with abdominal pain and melena. During endoscopy a toothpick detected in stomach antrum that penetrated to the gastric mucosa. The toothpick was successfully removed by endoscope without any complication. Mucosal biopsy pathology result was reported as chronic active gastritis.

Open Access Case Study

The State Programmed Preparedness for COVID-19 Speedy Transmission Controlling

Abdur Rashed, Deb Proshad Halder

Asian Journal of Case Reports in Medicine and Health, Page 18-26

This paper is constructed on the secondary data mostly taken from recent publications, organizational webpage information publicity, and online newspaper articles in order to make a case study on the COVID-19 preparedness from the state authority of Bangladesh. This paper takes two- tiers study: Pre-incident arrangement and during- incident arrangement for normalization of rapid transmission of coronavirus pandemic across the country. This paper critically evaluates what the demographic setup the country possesses to justify the galvanizing critical concerns for coronavirus infection, how the state authority delayed at precautionary stage to make all concerned sectors prepared against any mass infection, and how the state authority acted amid the considerable cases identification tackling crowding of people, ensuring social distancing etc. This paper tends to highlight the grieving situation on three dimensions: the impact of mass entry of Expatriate Bangladeshis from viral infected countries, the deplorable preparations of health sectors and the apparent suicidal impact of lock down on the people of Bangladesh. Few recommendations emerged through the case study which has been attached as time befitting steps which should be taken for granted amid this surging concern.