Healthy Man Research Articles

Nonbacterial thrombotic endocarditis of mitral valve associated with a lymphoproliferative malignancy: case report and literature review

BackgroundNon-bacterial thrombotic endocarditis (NBTE) is a rare condition marked by sterile vegetations on cardiac valves, often linked to rheumatologic diseases, autoimmune disorders, and advanced solid malignancies. An early diagnosis and treatment of the associated clinical condition are mandatory, although they do not usually eliminate valvular vegetations, making anticoagulation essential to prevent embolic events. Despite variability, the prognosis of NBTE is usually unfavorable due to recurrent embolic events and the severity of the primary condition, typically advanced cancer.Case presentationWe present a case of a 57 years-old male who presented to the emergency department with a 5-day history of painful bilateral digital edema and color change episodes (from pallor to cyanosis). Physical examination revealed erythrocyanosis in the distal extremities, prompting consideration of secondary Raynaud syndrome.Despite medical therapy, progressive digital ischemia led to multiple finger amputations. During etiological investigation, anticoagulation tests and autoimmune analysis yielded negative results. A transesophageal echocardiogram was performed, revealing an irregular hyperechogenic mass on the anterior leaflet of the mitral valve without valve dysfunction, and a thoracic computed tomography scan with contrast showed an enlarged right paratracheal lymph node. Histopathological analysis from a transthoracic needle biopsy of the paratracheal lymph node revealed diffuse large B-cell lymphoma. The patient underwent aggressive R-CHOP chemotherapy, achieving a favorable complete response.ConclusionThis is a particular case involving the occurrence of NBTE and Raynaud phenomenon as the initial paraneoplastic manifestations in a previously healthy young man. Reports of NBTE associated with lymphoproliferative conditions are quite rare, with fewer than ten cases described in the literature. To our knowledge, this is the first case of NBTE specifically associated with diffuse large B-cell lymphoma.

Diurnal fluctuations in steroid hormones tied to variation in intrinsic functional connectivity in a densely sampled male.

Most of mammalian physiology is under the control of biological rhythms, including the endocrine system with time-varying hormone secretion. Precision neuroimaging studies provide unique insights into how the endocrine system dynamically regulates aspects of the human brain. Recently, we established estrogen's ability to drive widespread patterns of connectivity and enhance the global efficiency of large-scale brain networks in a woman sampled every 24h across 30 consecutive days, capturing a complete menstrual cycle. Steroid hormone production also follows a pronounced sinusoidal pattern, with a peak in testosterone between 6-7am and nadir between 7-8pm. To capture the brain's response to diurnal changes in hormone production, we carried out a companion precision imaging study of a healthy adult man who completed MRI and venipuncture every 12-24 hours across 30 consecutive days. Results confirmed robust diurnal fluctuations in testosterone, 17β-estradiol - the primary form of estrogen - and cortisol. Standardized regression analyses revealed widespread associations between testosterone, estradiol, and cortisol concentrations and whole-brain patterns of coherence. In particular, functional connectivity in the Dorsal Attention Network was coupled with diurnally fluctuating hormones. Further, comparing dense-sampling datasets between a man and a naturally-cycling woman revealed that fluctuations in sex hormones are tied to patterns of whole-brain coherence in both sexes, and to a heightened degree in the male. Together, these findings enhance our understanding of steroid hormones as rapid neuromodulators and provide evidence that diurnal changes in steroid hormones are associated with patterns of whole-brain functional connectivity.Significance Statement Diurnal variation is an essential biorhythm, yet the relationship between diurnal fluctuations in steroid hormones and the functional architecture of the human brain is virtually unknown. This precision neuroimaging study suggests that endogenous fluctuations in testosterone, estradiol, and cortisol concentrations are tied to rhythmic changes in coherence across the brain. Precision imaging studies that track individuals across endocrine rhythms (e.g. the diurnal cycle and menstrual cycle) demonstrate steroid hormones' ability to modulate the functional architecture of the brain in both sexes and provide a roadmap for future studies to probe the functional significance of these rhythms for behavior.

Elevated interleukin-8 expression by skin fibroblasts as a potential contributor to pain in women with Fabry disease.

Fabry disease (FD) is a lysosomal storage disorder of X-linked inheritance. Mutations in the α-galactosidase A gene lead to cellular globotriaosylceramide (Gb3) depositions and triggerable acral burning pain in both sexes as an early FD symptom of unknown pathophysiology. We aimed at elucidating the link between skin cells and nociceptor sensitization contributing to FD pain in a sex-associated manner. We used cultured keratinocytes and fibroblasts of 27 adult FD patients and 20 healthy controls. Epidermal keratinocytes and dermal fibroblasts were cultured and immunoreacted to evaluate Gb3 load. Gene expression analysis of pain-related ion channels and pro-inflammatory cytokines was performed in dermal fibroblasts. We further investigated electrophysiological properties of induced pluripotent stem cell (iPSC) derived sensory-like neurons of a man with FD and a healthy man and incubated the cells with interleukin 8 (IL-8) or fibroblast supernatant as an in vitro model system. Keratinocytes displayed no intracellular, but membrane-bound Gb3 deposits. In contrast, fibroblasts showed intracellular Gb3 and revealed higher gene expression of potassium intermediate/small conductance calcium-activated potassium channel 3.1 (KCa 3.1, KCNN4) in both, men and women with FD compared to controls. Additionally, cytokine expression analysis showed increased IL-8 RNA levels only in female FD fibroblasts. Patch-clamp studies revealed reduced rheobase currents for both iPSC neuron cell lines incubated with IL-8 or fibroblast supernatant of women with FD. We conclude that Gb3 deposition in female FD patient skin fibroblasts may lead to increased KCa3.1 activity and IL-8 secretion. This may result in cutaneous nociceptor sensitization as a potential mechanism contributing to a sex-associated FD pain phenotype.

A case of severe Plasmodium ovale malaria with acute respiratory distress syndrome and splenic infarction in a male traveller presenting in Italy

BackgroundPlasmodium ovale malaria is usually considered a tropical infectious disease associated with low morbidity and mortality. However, severe disease and death have previously been reported.Case presentationA case of severe P. ovale malaria in a healthy Caucasian man with a triangle splenic infarction and clinical progression towards Acute Respiratory Distress Syndrome was reported despite a rapid response to oral chloroquine treatment with 24-h parasitaemia clearance.ConclusionPlasmodium ovale malaria is generally considered as a benign disease, with low parasitaemia. However, severe disease and death have occasionally been reported. It is important to be aware that occasionally it can progress to serious illness and death even in immunocompetent individuals.

Leveraging Space-Flown Technologies to Deliver Healthcare with Holographic Physical Examinations.

INTRODUCTION: Musculoskeletal injuries are one of the more common injuries in spaceflight. Physical assessment of an injury is essential for diagnosis and treatment. Unfortunately, when musculoskeletal injuries occur in space, the flight surgeon is limited to two-dimensional videoconferencing and, potentially, observations made by the crew medical officer. To address these limitations, we investigated the feasibility of performing physical examinations on a three-dimensional augmented reality projection using a mixed-reality headset, specifically evaluating a standard shoulder examination.METHODS: A simulated patient interaction was set up between Western University in London, Ontario, Canada, and Huntsville, AL, United States. The exam was performed by a medical student, and a healthy adult man volunteered to enable the physical exam.RESULTS: All parts of the standard shoulder physical examination according to the Bates Guide to the Physical Exam were performed with holoportation. Adaptation was required for the palpation and some special tests.DISCUSSION: All parts of the physical exam were able to be completed. The true to anatomical size of the holograms permitted improved inspection of the anatomy compared to traditional videoconferencing. Palpation was completed by instructing the patient to palpate themselves and comment on relevant findings asked by the examiner. Range of motion and special tests for specific pathologies were also able to be completed with some modifications due to the examiner not being present to provide resistance. Future work should aim to improve the graphics, physician communication, and haptic feedback during holoportation.Levschuk A, Whittal J, Trejos AL, Sirek A. Leveraging space-flown technologies to deliver healthcare with holographic physical examinations. Aerosp Med Hum Perform. 2024; 95(4):214-218.

AN UNCOMMON PRESENTATION OF SEPTUM PELLUCIDUM ANATOMICAL VARIATIONS: A CASE REPORT OF GENERALIZED TONIC-CLONIC SEIZURE IN A HEALTHY ADULT

ABSTRACT:
 Introduction: The septum pellucidum (SP) is a thin, transparent, dual-membrane structure located between the lateral ventricles of the brain. Incidentally identified through imaging modalities, this variation, while rare, may manifest with symptoms such as neuropsychiatric disorders, headache, dizziness, seizures, nausea, and vomiting. In this report, we present the case of a healthy middle-aged man with CV and CSP, who sought medical attention in the emergency department (ED) due to a generalized tonic-clonic seizure (GTCS).
 Case Report: A 40-year-old male without any known medical history presented to our emergency department with a GTCS. Considering this as the first seizure, blood and imaging tests were conducted, all of which showed no abnormalities. Non-contrast computed tomography revealed sequel cystic encephalomalacic areas in the left occipital and right frontal cerebral hemispheres, consistent with a parapharyngeal epidermoid cyst, and the presence of cavum septum pellucidum et vergae. Emergency consultation from the neurological clinic was sought, and an electroencephalogram showed no seizure activity. He was subsequently discharged with a recommendation for follow-up at the neurology outpatient clinic.
 Conclusion: This case prompts critical considerations in the emergency medicine realm regarding the potential relationship between anatomical variations in the septum pellucidum and emergent seizure activity.
 Keywords: Septum pellucidum, seizure, cavum vargae, emergency

Ambroxol-induced leukocytoclastic vasculitis: A case report and literature review

Cutaneous leukocytoclastic vasculitis (LCV) that primarily affects the skin, can be idiopathic or linked to infections, autoimmune diseases, neoplasms, and medications. An immune complex-mediated vasculitis of the dermal capillaries and venules is the histological hallmark of LCV, a small vessel vasculitis. This case report describes a 36-year previously healthy man who was presented to the outpatient department (OPD) with complaints of edema and development of numerous reddish-purple patches (caused by petechiae) after intake of cough syrup containing ambroxol. Ambroxol affects human monocytic cells THP-1, and prevents the generation of platelet-derived growth factor (PDGF)-AB that is produced by lipopolysaccharide (LPS) by inhibiting the expression of PDGF-A messenger Ribonucleic acid (RNA). An extracellular signal-regulated kinase (ERK) on p44/42 is activated by LPS, and ambroxol reduces this activation. In addition, 2-(2-amino-3-methoxyphenyl)-4H-1-benzopyran-4-one (PD 98059), a Mitogen-Activated Protein Kinase Inhibitors (MEK), MEK-1-specific inhibitor, prevents p44/42 ERK activation and PDGF synthesis brought on by LPS. Megakaryocytes, erythrocytes, leukocytes, and their progenitors are stimulated to multiply by PDGF to the numerous endogenous growth factors that mesenchymal stem and stromal cells secrete. Ambroxol reduces the number of megakaryocytic progenitors and boosts apoptosis by inhibiting the production of PDGF and related signaling pathways. It is strongly advised that patients must be made more aware of the risks associated with using such over-the-counter medications.

Histoplasmosis peritonitis in an immunocompetent patient: case report

Histoplasmosis is a fungal infection most frequently seen in immunocompromised patients. It is endemic in Central and South America and in Africa. The infection is usually asymptomatic in a healthy individual. Extrapulmonary dissemination can be seen in immunocompromised hosts. Gastrointestinal manifestations frequently involve the terminal ileum and cecum, mimicking Crohn’s disease or malignancy. We describe the case of a 36-year-old healthy man from Cameroon, living in Switzerland for 13 years and without any medical nor surgical history, who presented peritonitis not responding to antibiotics. CT-scan showed bowel obstruction and signs of peritonitis. We opted for an explorative laparoscopy, which was converted to laparotomy with extensive adhesiolysis. Diagnostic of histoplasmosis was confirmed by histology and PCR analysis on biopsy. To our knowledge, this is the first described case of peritonitis as main outcome of a disseminated histoplasmosis involving the peritoneum in an immunocompetent patient.

Long-term follow-up of a healthy man with endogenous Streptococcus anginosus endophthalmitis

We report the long-term follow-up of an immunocompetent patient who presented with slowly progressive endogenous endophthalmitis secondary to Streptococcus anginosus. A 46-year-old healthy man presented with a two-month history of right eye iritis. On examination, visual acuity was 20/60 with intraocular pressure of 6 mm Hg. There was a small layer of hypopyon with non-granulomatous anterior uveitis and vitritis. On funduscopy, fluffy white peripheral retinal and pre-retinal lesions were noted in superonasal periphery. The patient denied any present or past illness. Diagnostic pars plana vitrectomy was performed. Culture and polymerase chain reaction of the vitreous sample were positive for Streptococcus anginosus. Intravitreal vancomycin and ceftazidime and systemic ceftriaxone were administered. Work-up which included blood and urine cultures, chest x-ray, echocardiography and abdominal ultrasound was unyielding. Subsequently and because of persistent post-infectious inflammatory reaction, intravitreal and oral steroids were administered in addition to oral azathioprine later on. After one year of follow-up, visual acuity was 20/20 with near vision of Jaeger 3 + and no signs of active uveitis were seen. Therefore, Streptococcus anginosus should be considered in the differential diagnosis of a slowly progressive endophthalmitis also in immunocompetent individuals.

EN PARTANT D’UNE METAPHORE: PHENOMENOLOGIE DU STATUT DE L’INERTIE

My paper highlights some meanings of the metaphor of aging, used by André Gorz (1923-2007) in his homonymous article published in Les Temps Modernes in December 1961 and January 1962, the first part of which was republished by Gallimard in 2005 (copyright Éditions Galilée in 2004) as a coda to the new edition of one of his "most philosophical" pieces, The Traitor (1958), as noted by Christophe Fourel in André Gorz, a thinker for the 21st century (Éditions La Découverte, 2009, p. 10). Aging is a process based on inertia and generating – because aging also generates – more and more inertia. But what kind of inertia, that of continuing the movements testifying to the vivacity of body and mind, or that of resisting them, therefore of stopping the rest, of flowing into it while forgetting the previous momentum? To the healthy young man of 36, the metaphor of aging appears to have a bitter correspondence with the shock of suddenly feeling the end of existence while living it. The well-known tripartite division of life – childhood youth, maturity, old age – has been transformed into the youth, old age diptych because maturity itself has become the negation of youth, not a mere stable state but already a slope, a masked old age, a fact. If yet young, "he started over again" (André Gorz, The traitor, followed by The aging, p. 377) that is to say, he was the author of audacious movements that took into account only his aspirations of creativity, aging requires of him only the qualities that conform to the specific roles that are asked of him and that are expected to be assumed without the slightest doubt. The phenomenology of this becoming, meticulously dissected, envisages not only the transformation of the unique being who is the subject of the story (but not the master of the phenomenological approach as such because he is desperate before "the cowardice" of his “free choice” of “integration” into the anonymity of the “Others” producing the society which imposes this decline on him (“Aging (II)”, Les Temps Modernes, nº 188, January 1962, p. 829- 852 (830-832). Because the picture of the individual, torn between his existential resistance against all the factors that impose inertia and, on the other hand, the conformism that has become "his nature", extends into the representation of society which is the counterweight to this individual and at the same time frames him. The development of the metaphor of aging has involved the phenomenology of its elements, among which the principal, inertia, and the phenomenology itself has generated messages of social philosophy, pioneers of the powerful ideas commented on in the philosophical thought of the decades later. The phenomenology of the text is and describes awareness, namely the awakening of consciousness, and the metaphor is a manifestation of this process. The metaphor of the aging of the individual thus resonates with the theoretical descriptions of crises and decadence, of degeneration: here, of the capitalist society. The construction of André Gorz is a suggestive model. Today our conclusion in front of such models can only forget the hypocritical criticisms of the phases of the decline, indeed accomplices for their persistence: and, thus, to learn from the previous models. But, it must be emphasized, the metaphor of inertia refers to the awareness of the limits of the figurative meanings of such – and these – metaphors. The awareness of the text is an awareness of metaphors, too, and thus, they become means of intellectual resistance for man. 

ATYPICAL MYCOBACTERIAL INFECTION

We describe a 47-year-old healthy man who, after an injury to the third finger of the right hand, developed a reddened papule that did not disappear. Over a period of three months, edema developed on the finger and dorsum of the right hand, followed by several variegated nodules along the 3rd finger, dorsum of the right hand, and right forearm. There are no subjective complaints. The patient has an aquarium at home, and the complaints coincide with a period of growth of the fish in it. The diagnosis of Mycobacterium marinum infection is made on the basis of history, clinical picture, histology and molecular genetic testing for mycobacteria. Treatment with numerous antibacterial agents was carried out, and the long-term (9 months) therapy with clarithromycin, rifampicin and ethambutol, appointed after the diagnostic clarification, led to the cure of the infection. A brief review of the literature on the issue is made.

EXPERIMENTAL EVALUATION OF VAJIKARANA KARMA OF TILAGOKSHURA SIDDA DUGDA WITH SPECIAL REFERENCE TO APHRODISIAC ACTIVITY

Infertility is a disease of the male or female reproductive system defined by the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse. Estimates suggest that approximately one in every six people of reproductive age worldwide experience infertility in their lifetime. Conventional management need long term therapy and are not devoid of ADR’s. Vajikarana is one among Astanga Ayurveda that deals with the preservation and amplification of sexual potency of a healthy man and conception of healthy progeny. Vajikarana yogas helpful in management of Shukra dusti and Vandytava were documented in the classics. ‘TilaGokshura Sidda Dugdha’ is one such formulation explained by Chakradatta in Vajikarana chapter indicat-ed in Shandatva (Impotency). The ingredients of yoga are Tila and Gokshura processed in Aja ksheera (Gaot milk) which are having Shukrala and Vrishya karma. Thus, yoga was selected to evaluate the Vajikarana karma. Also, an additional attempt is made to evaluate the same yoga by changing the processing agent as Go-Dugda(Cow milk) in another group. MATERIAL AND METHODS : Wister rats were grouped in to 5 groups of 6 animals each. Experimental period was 28 days study. Oligospermia was induced by administrating Metroni-dazole for initial 14 days. Group one as Normal, Group 2 as Disease control, Group 3 was treated with Clomi-phene citrate, Group 4 and Group 5 were treated with Tila Gokshura Sidda Dugda (Aja Dugda Saditha) and Tila Gokshura Sidda Dug-da (Go-Dugda Saditha) respectively for next 14 days. Sexual Behaviour Pattern, Sperm count, Serum parameters, Tissue parameters and Histopathological changes in testis tissue were Observed. DIS-CUSSIONS AND CONCLUSION : Tila Gokshura Sidda Dugda (Aja Dugda Saditha) showed effective Vajika-rana karma in experimental rats when compared to standard drug. RESULTS : The results of the experimental study reveal that TilaGokshura Sidda Dugda has significant Vajikarana karma when compared with standard drug.

Temporal Interactions between Maintenance of Cerebral Cortex Thickness and Physical Activity from an Individual Person Micro-Longitudinal Perspective and Implications for Precision Medicine.

Maintenance of brain structure is essential for neurocognitive health. Precision medicine has interests in understanding how maintenance of an individual person's brain, including cerebral cortical structure, interacts with lifestyle factors like physical activity. Cortical structure, including cortical thickness, has recognized relationships with physical activity, but concepts of these relationships come from group, not individual, focused findings. Whether or how group-focused concepts apply to an individual person is fundamental to precision medicine interests but remains unclear. This issue was studied in a healthy man using concurrent micro-longitudinal tracking of magnetic resonance imaging-defined cortical thickness and accelerometer-defined steps/day over six months. These data permitted detailed examination of temporal relationships between thickness maintenance and physical activity at an individual level. Regression analyses revealed graded significant and trend-level temporal interactions between preceding activity vs. subsequent thickness maintenance and between preceding thickness maintenance vs. subsequent activity. Interactions were bidirectional, delayed/prolonged over days/weeks, positive, bilateral, directionally asymmetric, and limited in strength. These novel individual-focused findings in some ways are predicted, but in other ways remain unaddressed or undetected, by group-focused work. We suggest that individual-focused concepts of temporal interactions between maintenance of cortical structure and activity can provide needed new insight for personalized tailoring of physical activity, cortical, and neurocognitive health.

“Does a healthy man need vaccination?”: Attitudes of older adults toward COVID-19 vaccine in South-East Nigeria

The COVID-19 pandemic appears to be impeding the progress of the United Nations’ Sustainable Development Goal and the African Union’s Agenda 2063 in achieving optimal health and well-being for individuals, particularly older adults. Numerous older adults have succumbed to the virus, exacerbating existing global health challenges. In response, scientists worldwide have developed a vaccine to alleviate the substantial disease burden. The Nigerian government has mandated the prioritized vaccination of older adults. This study aims to investigate the attitudes of older adults toward the COVID-19 vaccine. Data were collected from 32 older adults through in-depth interviews and focus group discussions. Thematic analysis was employed to derive meaningful patterns from the collected data. The findings reveal a prevailing lack of awareness among older adults regarding the COVID-19 vaccine. They asserted that they perceived no need for vaccinations, asserting their current state of health. In addition, concerns were raised about potential adverse effects of the vaccine, including the onset of other illnesses. This study suggests that the Nigerian government, through its orientation agencies, undertakes comprehensive public education campaigns highlighting the importance of COVID-19 vaccine uptake.

The Diagnostic Challenge of Distinguishing Temporal Lobe Encephaloceles from Sphenoid Sinus Mucoceles

Introduction: Temporal lobe encephaloceles are rare malformations defined as brain parenchyma herniation through a skull base structural defect into adjacent structure such as sphenoid sinus, while sphenoid sinus mucoceles are expansive cystic lesions caused by mucus buildup and thinning of the sinus wall, mostly involving the frontal and ethmoid sinus. Both illnesses may present similar clinical symptoms, such as neurological symptoms, nasal and ophthalmologic symptoms. However, misdiagnosis of temporal lobe encephaloceles can have significant clinical implications, as the best treatment plans vary depending on the disease. Case report: A 27-year-old healthy man who presented with seizure and loss of consciousness in public gave a history of head trauma 13 years back. Upon physical examination, the patient had normal cranial nerve function, and no cerebellar or meningitis signs. Rigid nasoendoscopy showed unremarkable findings. A computed tomography scan revealed an expanded left sphenoid sinus likely mucocele with a left temporal lobe encephalomalacia. Further investigations with brain magnetic resonance imaging (MRI) discovered temporal lobe encephalocele and transcranial repair of sphenoid encephalocele was arranged. Conclusion: Imaging results interpreted incorrectly may result in significant clinical ramifications. Distinguishing between both diseases with a complete investigation including MRI scan is crucial for appropriate management and treatment planning.

PARACENTRAL ACUTE MIDDLE MACULOPATHY ASSOCIATED WITH SEVERE PLASMODIUM FALCIPARUM MALARIA.

To report a case of bilateral paracentral acute middle maculopathy (PAMM) lesions on spectral domain-optical coherence tomography (SD-OCT) secondary to severe Plasmodium falciparum malaria. Retrospective case report. SD-OCT, ultra-widefield fluorescein angiography, and OCT-angiography were performed and analysed. A 54-year-old healthy man presented with acute vision loss in both eyes few days after being diagnosed with severe Plasmodium falciparum malaria. Ophthalmoscopic examination was unremarkable but near-infrared reflectance imaging showed patchy hyporeflective areas located at the terminal tips of the venous branches. Corresponding SD-OCT demonstrated alternating bands of hyperreflectivity involving the inner nuclear layer and consistent with skip PAMM lesions. OCT-angiography illustrated corresponding flow signal loss at the level of the deep capillary plexus. Ultra-widefield fluorescein angiography showed peripheral retinal vein staining and capillary non-perfusion. PAMM may be an OCT manifestation of malaria retinopathy associated with severe Plasmodium falciparum infection.

Heterotopic Ossification of Bilateral Hips Post-COVID-19 and Prolonged Immobilization: A Case Report.

A 43-year-old healthy man developed hip pain post-coronavirus disease 2019 (COVID-19) immobilization. Imaging confirmed bilateral bridging heterotopic ossification (HO) of the hips, Brooker Class IV. Bilateral HO caused functional arthrodesis (45° flexion: -20° internal rotation). Bilateral HO resection resulted in almost full mobility at 1-year follow-up (90° flexion; 30° internal rotation). Many cases of HO after immobilization for COVID-19 have been reported, but as far as we know, this is the first case report describing surgical intervention as an adequate treatment option for severe restricted mobility caused by HO due to COVID-19-induced prolonged immobilization. Caution and preoperative 3D planning are recommended of HO formation near neurovascular structures.

Bilateral Elbow Dislocation Without Fracture After Minor Trauma in a Healthy Adult Man

The elbow is the second most frequently dislocated major joint in adults. Elbow dislocation is a common traumatic injury, occurring in approximately 20% of all joint dislocations. Falling onto an outstretched hand is the most prevalent cause of elbow dislocation. Simultaneous bilateral elbow dislocation is a rare presentation, and reports of similar injuries are very limited. A 21-year-old male patient was brought to the emergency department after landing on both hands with flexed elbows from a height of one meter while doing home decoration work. The posterolateral dislocations was detected in both elbows without a fracture on the plain radiographs. The patient's elbows were reduced under procedural sedation analgesia in the emergency department. The patient's splints were removed in the orthopedics outpatient clinic after a 2-week follow-up, and he had no complications. It should be noted that serious bilateral dislocations can occur even in minor traumas like this. Procedural sedation not only prevents the delay of the procedure and the occurrence of complications, especially during the treatment of such multiple dislocations, but also increases patient comfort.

Severe axonal motor neuropathy after heat stroke

A 22-year-old healthy man experienced heat stroke while hiking and collapsed, resulting in multiorgan failure, cerebral edema, and prolonged intensive care unit stay. He developed flaccid tetraplegia, facial weakness, and dysphagia, and was diagnosed with severe axonal sensorimotor polyneuropathy. Rehabilitation improved dysphagia, but he remained dependent on daily activities and required assistance for transfers. The prognosis of critical illness polyneuropathy is typically good in young, healthy individuals. Peripheral neuropathy is a rare complication of heat stroke due to hyperthermia-induced neuronal injury. As global temperatures continue to rise, it is essential to recognize the potential impact of climate change on the incidence of heat stroke and to implement public health interventions to mitigate its effects.

Bilateral Facial Nerve Palsy Following Antibiotic Treatment for Listeria Monocytogenes Meningitis

Listeria monocytogenes (LM) is an intracellular, facultative, gram-positive bacillus transmitted mainly through contaminated food, particularly dairy products and cold deli meats. It typically affects immunocompromised patients, and a rarely neuroinvasive disease in immunocompetent healthy adults has been described in the literature. Despite the timely intervention, neurologic morbidity has been observed after extended periods of recommended antibiotic regimens. This case study highlights the challenges in diagnosing and managing LM meningitis, especially when atypical symptoms and complications arise. Herein, we describe the case of a 57-year-old healthy man admitted with symptoms of nausea, vomiting, headache, neck pain, and stiffness, who was eventually diagnosed with LM-related meningitis and treated with antibiotics. The patient’s hospital course was complicated by bilateral facial nerve palsy, while other symptoms improved with antibiotic treatment, raising suspicion for parainfectious immunological response, which improved with a short course of steroids. This case contributes to the medical literature by providing insights into the immunological response for treating LM meningitis and managing LM meningitis–associated complications. To our knowledge, this could potentially be the first case of LM meningitis causing the parainfectious immunological response of bilateral facial nerve palsy after antibiotic treatment.