Present Case Research Articles

Pregnancy-related intracranial venous sinus thrombosis secondary to cryptococcal meningoencephalitis: a case report and literature review

BackgroundCerebral venous sinus thrombosis (CVST), a serious cerebrovascular and neurological emergency, is common in pregnant individuals and accounts for approximately 0.5–1.0% of all cerebrovascular diseases. However, CVST with cryptococcal meningoencephalitis in immunocompetent pregnant patients is rare.Case presentationA 30-year-old woman who was 33 weeks pregnant presented with recurrent dizziness, headache, and vomiting as the main clinical manifestations, all of which were initially nonspecific. After assessment of the cerebrospinal fluid, skull computerized tomography, magnetic resonance imaging, and other laboratory and imaging examinations, the patient was diagnosed with secondary pregnancy-related CVST with cryptococcal meningoencephalitis. Despite receiving potent anticoagulant and antifungal treatment, the patient’s condition deteriorated, and the patient’s family opted to cease treatment.ConclusionsWe present a rare case of CVST with cryptococcal meningoencephalitis in an immunocompetent pregnant patient. The difficulty of diagnosing and treating secondary pregnancy-related CVST caused by cryptococcal meningoencephalitis, as well as the great challenges faced at present are highlighted. One crucial lesson from the present case is that when clinical and imaging signs are unusual for CVST during pregnancy, it is essential to account for the possibility of other central nervous system (CNS) diseases, such as CNS infections with Cryptococcus, which may cause CVST.

Intraspecific diversity of Myrmecophilus acervorum (Orthoptera: Myrmecophilidae) indicating an ongoing cryptic speciation

Myrmecophilus acervorum, previously considered a parthenogenetic species widely-distributed in Europe, has been observed to have both sexes in populations inhabiting the central part of the distribution range. Specimens from those heterosexual populations have been found being infected with Wolbachia. New mitochondrial data (COI and 16S markers) revealed the well-supported differentiation of M. acervorum populations inhabiting western Polesie (Poland) and southern Europe. In turn, analyses of EF1α marker support the hypothesis on the unfinished lineage sorting at the nuclear DNA level. Interestingly, we found that parthenogenetic populations inhabiting western Polesie are infected with Wolbachia belonging to supergroup A, while endosymbionts occurring in sexual populations of M. acervorum observed in Romania belong to supergroup B. Furthermore, new and potentially diagnostic characteristics in the external structures of the eyes of M. acervorum were identified. The surface of ommatidia in specimens occurring in southern Europe was smooth. In contrast, the ommatidia surface of individuals collected in Poland was visibly sculptured. To sum up, the significant genetic variability found in the present case, and the differentiating morphological character, are almost certainly effects of cryptic species being present within M. acervorum. This is indicative of ongoing speciation within the populations of this insect, and of simultaneous unfinished lineage sorting at the nuclear DNA level.

Secondary amyloidosis treated with tocilizumab as a complication of temporal arteritis

Background: Temporal arteritis is a large-vessel vasculitis mostly seen in the elderly. Amyloidosis may be secondary to a chronic inflammation of body organs. Here, we present the second case report of temporal arteritis complicated by amyloidosis that was successfully treated by tocilizumab. Case presentation: A 64-year-old female presented complaining of fatigue, fever, and diarrhea accompanied by abdominal pain. One year before presentation, she was diagnosed with temporal arteritis. She was treated with 15 mg/day oral prednisone for the last 6 months, with partial remission, but persistence of the fatigue and an elevated erythrocyte sedimentation rate (ESR, 56 mm/h). Physical examination showed tenderness of both temporal arteries and a soft abdomen. Colon tissue biopsy showed amyloid depositions in the vessels and stroma that were positive for Congo red staining. Tocilizumab was started with 8 mg/kg intravenous, the diarrhea resolved, and the arthralgia improved within 1 month, with a decrease in the ESR to 8 mm/h, and a C-reactive protein (CRP) level of 0.98 mg/dl. Monthly tocilizumab therapy remains efficacious 12 months later and was stopped due to lack of tocilizumab from the hospital. No side effects of tocilizumab were registered. Conclusion: Chronic inflammation may be complicated by amyloidosis in patients with rheumatic diseases and genetic predisposition. Therefore, it is important to screen for intestinal Amyloid A (AA) amyloidosis in individuals with gastrointestinal disorders complicated by rheumatic disorders. AA amyloidosis may be complicated by temporal arteritis and presented with gastrointestinal symptoms such as diarrhea.

Pseudo-Hyperaldosteronism Arising from Licorice Cough Syrup Self-Ingestion: A Case Report

Background: Licorice (glycyrrhiza glabra) cough syrup intoxication is manifested with refractory hypokalemia, hypertension, and metabolic alkalosis. The transformation of glycyrrhiza glabra metabolic into glycyrrhetic acid after ingestion further inhibits the 11-β-hydroxysteroid dehydrogenase-2 enzyme, impeding the conversion of cortisol into cortisone. The accumulation of cortisol can also stimulate mineralocorticoid receptors, which leads to a pseudo-hyperaldosteronism-like effect. Case Presentation: We report a 60-year-old male patient with licorice intoxication due to the chronic consumption of licorice cough syrup. He exhibited a transient seizure lasting approximately one minute. Initially, hypokalemia (potassium level was 2.0 mmol/L), metabolic alkalosis, and QT interval prolongation with premature ventricular complexes were demonstrated on his electrocardiogram. Despite the administration of both intravenous and oral potassium supplements over two days, there was no significant improvement in hypokalemia. Spironolactone, an aldosterone receptor antagonist, was administered in addition to ongoing potassium supplementation from the 3rd day. This intervention led to a rapid normalization of hypokalemia in one day. The patient was ultimately discharged on the 6th day without any subsequent complications. Conclusions: The licorice-induced chronic intoxication, which led to pseudo-hyperaldosteronism and refractory hypokalemia, was successfully managed with aggressive potassium supplementation and spironolactone treatment.

IDENTIFICAÇÃO E ABRANGÊNCIA DA AUTONOMIA PRIVADA

Private autonomy is a fundamental concept in democratic societies, recognizing individuals' capacity to exercise their will and make decisions within the context of their private relationships. This article aims to provide an understanding of the identification and scope of the principle of private autonomy in the legal sphere, its interaction with other relevant legal principles, the limits imposed by public order and fundamental rights, its evolution and challenges. Special attention will be given to how this principle is understood and applied in the Brazilian legal system. The presentation and analysis of practical cases in different legal relationships intends to clearly demonstrate the evolution of the autonomy of the will to private autonomy, to highlight the limits and extent of its application and to contribute to the academic debate and the development of Civil Law.

An Unusual Cause of Erythroderma.

Indeterminate dendritic cell tumors are exceedingly uncommon and have been described mainly in adults with cutaneous involvement mainly in the form of nodules only. To the authors’ knowledge, this is the first case of an erythrodermic presentation of underlying IDCT. This condition is known to involve the skin in existing reports and is important for a dermatologist to suspect in order to facilitate the correct diagnosis and treatment.

Feasibility and safety of two weeks of blood flow restriction exercise in individuals with spinal cord injury

Context Reduced muscle strength and function are common after spinal cord injury (SCI). While low-load blood flow restriction exercise (BFRE) enhances muscle strength in healthy and clinical populations, its safety and feasibility in individuals with SCI remain underexplored. Objectives To investigate the feasibility and safety of low-load BFRE in individuals with incomplete SCI. Study Design Case series. Setting SCI rehabilitation center. Participants Six participants with motor incomplete SCI were enrolled in the study. Intervention A two-week BFRE intervention for the lower limbs was conducted twice weekly at 40% total arterial occlusion pressure, using 30-40% of 1-repetition maximum loads. Outcome Measures Feasibility measures, specifically recruitment and eligibility rates and intervention acceptability, were collected. Blood pressure (BP) responses and specific coagulation markers for deep vein thrombosis (DVT) were assessed as safety measures. Results Recruitment and eligibility rates were 2.8% and 6.6% for individuals admitted for first-time rehabilitation (subacute SCI) and 8.3% and 13.9% for 4-week readmission rehabilitation stays (chronic SCI), respectively. Intervention acceptability was high, characterized by 95.8% training adherence and low-to-moderate self-reported pain levels. BP responses and changes in C-reactive protein, Fibrinogen, and D-dimer during the intervention remained within clinically acceptable levels. Conclusion BFRE was feasible in an SCI rehabilitation setting despite a low recruitment rate. BFRE imposed no heightened risk of DVT or severe BP fluctuations in the present case series. Additionally, no severe adverse events occurred, and only mild complaints were reported. More extensive safety considerations warrant larger-scale exploration. Trial registration ClinicalTrials.gov identifier: NCT03690700.

The blind HR: Why do people leave managers not companies? A case of inconsistency in performance appraisal and performance outcome

Learning outcomes The learning outcomes are as follows: to benchmark and compare the theoretical models of the performance management and appraisal processes. (Questions 1 and 2) Remembering-in Bloom’s Taxonomy; to understand the importance of practicing fair performance appraisal process. (Question 4) Understanding-in Bloom’s Taxonomy; to analyze the implementation and effectiveness of 180-degree performance appraisal method and rating system prevalent in the IT Sector. (Question 1) Applying and Analyzing-in Bloom’s Taxonomy; to assess the impact of perceptual biases on human behavior and performance (Questions 2 and 3) Evaluating-in Bloom’s Taxonomy. Case overview/synopsis The case study entitled “Is HR Blind? Why do People Leave Managers Not Companies? A Case of Unfair Performance Appraisal and Biases” is a classic example of a flawed and biased performance appraisal process and perceptual biasness, which resulted in the loss of a valuable and talented resource in a leading Indian IT MNC. The present case had been based upon the real-life experience of an employee (i.e. Rahul Verma), who worked with the company from year 2010 to 2021. It was among the top ten IT MNCs employing about 0.1 million people. The objective of the case was to highlight real time issues existing with HR practices, mainly in IT sector organizations. For example, in the present case, do the HR seek proper justification from the manager before taking a harsh decision like forcibly asking an employee to sign a termination contract without looking at the contributions of his qualitative performance or even performance rating (refer to the transcript) for that matter? Was the job of the HR to only ensure how to fit in employees in the faulty bell curve system? Whether the performance appraisal system being followed at the company is adequately capable of identifying and recognizing the talent. Do the different functions really work cohesively and organically toward achieving the intended goals and objectives of the organization? Was this a failure of the manager in recognizing talent or something went wrong at the employee’s part? Was this a failure of the entire HR system or performance management process at the organization that was unable to filter out the capable and skilled resources out of the crowd? Was this a problem of organizational culture that put on stake its most critical resource – the human capital – by allowing the appraisers to evaluate them just because of the hierarchical structure, and not because they are not being competent enough to perform this most critical job objectively? Who ensures the appraiser is free from any kind of prejudice or bias and is capable of fairly assessing the talent resource? So, the present case was a deliberate attempt to throw out these burning questions to the practitioners and students to ponder upon. Does HR really follow the blind process merely acting on the feedback received from the different units of the organization? With the help of strong theoretical foundation and practical applications, the following objectives and questions have been framed to deliberate and propose the workable solutions for the benefits of the relevant stakeholders. Complexity academic level HR practitioners, HR managers, supervisors, senior management and HR students, IT heads, project managers. Supplementary material Teaching notes are available for educators only. Subject code CSS 6: Human Resource Management.

A frequency-domain finite element model for simulating high temperature superconductors using the J-A and T-A formulations

Abstract The AC losses, the current density and the magnetic field are important variables to design devices made of High Temperature Superconductors (HTS). These variables are often numerically computed using a transient finite element analysis even though the interest may lay in the steady-state regime of the device. The need for solving time-dependent variables has led to improve the computation time with efficient finite element models (FEM) relying on different formulations. These transient FEM are computationally slow and demanding in terms of resources. In the present work, an alternative path is taken with the development of a frequency-domain FEM using a phasor representation to alleviate the computation burden. This model does not have the versatility of the transient models. However, it can generate the initial steady-state conditions for a subsequent transient analysis. It is perfectly adapted to study the steady-state regime of HTS devices operated in AC conditions. In this phasor modelling approach, the Root Mean Square (RMS) resistivity of the superconductor is introduced. It is subsequently approximated by an exponential function introducing a factor to ease its implementation in the commercial software COMSOL Multiphysics with the most recent and fastest formulations T-A and J-A. The case studies encompass single BSCCO and REBCO tapes as well as a CORC cable or specifically, in the present work, a CORT (Conductor on Round Tube). The results of the time- and frequency-domain FEM simulations are compared against experimental data. The comparison of the models' results is carried out comparing the current density distributions as well as the AC losses. The comparison against experimental data is only conducted on the AC losses. In the present case, it is used to quantify thoroughly the accuracy of the numerical results compared to the measurements. A reasonable agreement between those results and the experimental data was found. 

Pulmonary hyalinizing granuloma: literature review and case presentation

Pulmonary hyalinizing granuloma (PHG) is an extremely rare condition. Only 170-200 cases have been described until now all over the world. There have been no reports in the Russian medical literature. Etiology of the disease is unknown. The X-ray picture is very unspecific. Tumors of lungs and pleura and infectious diseases are included in the differential line. Patients with pulmonary hyalinizing granuloma have long stabile progression of the disease, and the treatment with glucocorticoids can lead to the long lasting remission.The aim of the review was to inform pulmonologists, general practitioners, infectious disease specialists, thoracic surgeons, and oncologists about the existence of pulmonary hyalinizing granuloma, its diagnosis, clinical course, and treatment. Also we present one clinical case of patient with pulmonary hyalinizing granuloma.Conclusion. Because of very low incidence of PHG, an internist or a pulmonologist can never encounter it in their professional life. However it is worth keeping this condition in mind and including it into the diagnostic process when focal and focused shadows are identified in the lungs during chest X-ray. Probably, the disease is caused by different immune-mediatory processes, but the exact pathogenesis is still unknown. Biopsy of the lung tissue by means of lung resection is crucial for the morphological verification of the diagnosis. The prognosis of the disease is favorable. The timely initiation of treatment can sufficiently prolong the remission.

Treatment Options in Bilateral Diffuse Uveal Melanocytic Proliferation (BDUMP): Case Presentation and Review of the Literature

ABSTRACT Purpose To outline the therapeutic approach for a rare case of Bilateral Diffuse Uveal Melanocytic Proliferation (BDUMP) and examine the current management recommendations of this uncommon condition. Methods-Results Literature review on the current treatment options in BDUMP cases. An 82-year-old woman was referred to our clinic due to bilateral visual loss. She was treated elsewhere with anti-vascular endothelial growth factors (anti-VEGF) in both eyes for presumed choroidal neovascularization (CNV) without improvement. Her past medical history (PMH) entailed colon cancer, treated with surgical resection and adjuvant chemotherapy 15 years ago. The patient presented with low visual acuity in both eyes, multiple oval orange patches in the fundus with striking hyperfluorescent pattern in fluorescein angiography (FA), giraffe pattern in fundus autofluorescence (FAF) and rapidly progressive cataracts. Intravitreal dexamethasone implants were administered with mild improvement and subretinal fluid absorption. Conclusions The management strategy in BDUMP should focus on the systemic, often occult malignancy. There is no standard treatment protocol for BDUMP; however, plasmapheresis in combination with primary malignancy treatment seems to yield promising results in current literature reports. Anti-VEGF injections failed to control BDUMP sequelae, however intravitreal dexamethasone implants may offer temporary relief.

Diaphragmatic Palsy Due to a Paraneoplastic Autoimmune Syndrome Revealed by Checkpoint Inhibitors

Background and Clinical Significance: Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment but may underlie diverse and potentially life-threatening immune-related adverse events (irAEs). They may cause various conditions leading to respiratory failure, including myasthenic syndromes and myositis. However, diaphragmatic paralysis (DP) has rarely been reported. To describe patients with diaphragmatic paralysis in a pharmacovigilance registry, we searched the prospective REISAMIC registry at the Gustave Roussy Cancer Center (Villejuif, France) for cases of diaphragmatic palsy (DP) occurring from September 2014 to December 2021. Case Presentation: We identified three patients, in whom DP was confirmed by diaphragmatic ultrasonography, pulmonary function tests, and/or diaphragmatic electroneuromyogram. Diaphragmatic palsy was life-threatening in all patients, as it caused respiratory failure requiring mechanical ventilation. In all cases, a pre-existing subclinical paraneoplastic syndrome was detected. Onconeural antibodies (anti-titin and anti-VGCC) were detected in these patients before and after the initiation of ICI therapy, suggesting a mixed paraneoplastic syndrome with features overlapping those of myasthenic syndrome (myasthenia gravis in one patient and Lambert–Eaton syndrome in another) and myositis. Conclusions: Diaphragmatic palsy is a severe irAE potentially resulting from different mechanisms, including myositis and neuromuscular junction involvement (myasthenia gravis, Lambert–Eaton). Antineuronal antibodies associated with such conditions were already present in our patients prior to immunotherapy initiation, suggesting ICIs could trigger flare-ups of pre-existing silent paraneoplastic autoimmune conditions.

Estimation of Reservoir Storage Capacity Using the Gould-Dincer Formula with the Aid of Possibility Theory

This paper presents a method for estimating reservoir storage capacity using the Gould–Dincer normal formula (G-DN), enhanced by the possibility theory. The G-DN equation is valuable for regional studies of reservoir reliability, particularly under climate change scenarios, using regional statistics. However, because the G-DN formula deals with measured data, it introduces a degree of uncertainty and fuzziness that traditional probability theory struggles to address. Possibility theory, an extension of fuzzy set theory, offers a suitable framework for managing this uncertainty and fuzziness. In this study, the G-DN formula is adapted to incorporate fuzzy logic, and the possibilistic nature of reservoir capacity is translated into a probabilistic framework using α-cuts from the possibility theory. These α-cuts approximate probability confidence intervals with high confidence. Applying the proposed methodology, in the present crisp case with the storage capacity D = 0.75, the value of the capacity C was found to be 1271×106 m3, and that for D = 0.5 was 634.5×106 m3. On the other hand, in the fuzzy case using the possibility theory, the value of the capacity for D = 0.75 is the internal [315,5679]×106 m3 and for D = 0.5 the value is interval [158,2839]×106 m3, with a probability of ≥95% and a risk level of α = 5% for both cases. The proposed approach could be used as a robust tool in the toolkit of engineers working on irrigation, drainage, and water resource projects, supporting informed and effective engineering decisions.

Development of decision support methods for efficient maintenance of urban wastewater systems

The sanitation network is a vital urban infrastructure that requires systematic and co-ordinated activities and practices to realize lowest life cycle cost. The sustainable management of this asset is based on the efficient acquisition of diagnostic data from the sanitation network in order to analyze the defects of each section, then to assess their condition to prioritize and consider the effective mode of maintenance of sections deemed failing. In this perspective, knowledge of the sanitation networks is essential for reliable classification of defects and effective maintenance. A numerical model based on weighted criticality is developed to evaluate and prioritize the defects in an urban sanitation network. It is based on the combination of two methods: Fuzzy Analytic Hierarchy Process (F-AHP) and Weighted Product Model (WPM). A case study of a real sanitation network in Bejaia city (Algeria), consisting mainly of non-visitable pipes evaluated from television inspections, is used to illustrate and validate the proposed model. The results show that the weighting of criticality parameters has a considerable influence on the classification of defects in a sanitation network. The weighted criticality results obtained in the present case are significantly better than those obtained using a method based on the notion of classical criticality. This clearly indicates the relevance of the proposed numerical model.

Traumatic Tension Pneumocephalus with mount Fuji sign and air bubble sign

Introduction: Tension Pneumocephalus is a rare but a life threatening neurosurgical emergency which may need urgent surgical intervention. For diagnosis Brain imaging preferably Brain CT scan is mandatory. Case presentation: We present a rare case case of post traumatic tension Pneumocephalus in 40 years old man who sustained a road traffic accident. Brain CT scan shows Mount Fuji sign and air bubble sign, which are the typical signs of tension Pneumocephalus. Emergency burr-hole evacuation was carried out and after the procedure the patient was followed by control lateral skull X-ray and then discharged after 10 days of hospital Stay with GCS of 15. Conclusion: Tension Pneumocephalus is a clinical diagnosis. History with Brain Imaging can easily diagnose it but invasive surgical intervention may be Mandatory to overcome the problem. Knowledge of risk factors ,radiographic findings and clinical signs/symptoms associated with Tension Pneumocephalus is crucial to its Prompt identification and treatment.

The Use of Social Media in Orthopedic and Trauma Surgery Education: A Cross-Sectional Survey of German-Speaking Residents and Medical Students.

Social media has become a significant part of daily life, with platforms like Facebook and WhatsApp dominating usage. The COVID-19 pandemic further increased social media activity, including within the orthopedic community due to restrictions on physical gatherings. Despite the benefits of instant access to educational resources and interaction with experts, the lack of regulated editorial oversight on social media raises concerns about misinformation and privacy. This study aimed to evaluate the role of social media in orthopedic and trauma surgery education, focusing on platform use, user behavior, and engagement with educational content. A web-based survey was distributed to 912 residents and 728 medical students from the German-speaking Association for Arthroscopy and Joint Surgery (AGA) between June and July 2022. The questionnaire included 21 items covering demographics, platform use, activity patterns, engagement with educational content, and concerns about privacy. Of the 339 respondents (129 medical students), 87% reported daily social media use, primarily via smartphones (93%). The most commonly used platforms were WhatsApp (84%), Instagram (68%), and YouTube (54%). About 26% of the content consumed was related to orthopedics or trauma surgery. While 70% engaged with specialist content by liking, commenting, or sharing, only 32% posted their own content. Additionally, 77% followed healthcare professionals or institutions, and 65% benefited from case presentations with images. Notably, 15% observed content that could violate patient privacy. Orthopedic residents and students are high-volume social media users but engage more passively with professional content. While most value educational material, concerns about privacy violations and inappropriate posts remain prevalent.

Critical Management in a Resource-Limited Setting of Amitraz Overdose Case Report

Background: Amitraz poisoning, though rare, poses significant health risks, particularly in developing regions like Africa where its use as an insecticide and acaricide is widespread. Case Presentation: A 24-year-old female in Southwest Uganda was brought to the Emergency Department after intentional ingestion of Amitraz. Initial assessment revealed somnolence, bradycardia, hypotension, and respiratory distress. Despite decontamination, intravenous fluids, and atropine administration, the patient's condition deteriorated, necessitating intubation and transfer to an ICU. Discussion: Amitraz toxicity manifests primarily through central α2 adrenergic receptor agonism, resembling clonidine overdose, with symptoms including hypotension, bradycardia, altered mental status, and respiratory depression. Differentiating Amitraz poisoning from organophosphate toxicity is crucial due to overlapping clinical features but distinct management strategies. Supportive care, including airway management and cardiovascular support, is essential. Conclusion: This case highlights the critical need for awareness and preparedness for Amitraz poisoning in resource-limited settings. Effective supportive care can lead to successful outcomes despite severe initial presentations. Further education and preventive measures are recommended to mitigate risks, especially among vulnerable populations.

Solitary Peritoneal Metastasis in Case of Osteosarcoma Detected by FDG PET/CT.

Primary osteosarcomas predominantly originate in the metaphyseal region of long bones. The introduction of 18F-FDG PET/CT imaging has revealed unusual and often rare sites of metastatic spread. Peritoneal deposits in osteosarcoma are not a commonly reported finding in the literature. The present case highlights the 18F-FDG PET/CT findings in a case of osteosarcoma of the left fibula with isolated peritoneal metastasis with no regional or distant metastases.

Acute Respiratory Syndrome Mimicking Shipping Sickness in Theileria buffeli Infected Buffalo Calf.

Benign theileriosis, caused by the members of the Theileria orientalis complex, can develop fatal clinical outbreaks characterized by acute respiratory manifestation in stressful conditions. This report describes the molecular diagnosis and clinical management of a recently transported buffalo calf with severe Theileria buffeli infection and associated acute pneumonia. A five-month-old male buffalo calf having an inter-state travel history three days back was presented with pyrexia, anorexia, weakness, mucoid rhinorrhoea, dyspnoea and diarrhoea from the day of procurement. The history and physical examination revealed a clinical presentation similar to shipping fever. Whereas, severe parasitemia of Theileria spp. with anaemia, thrombocytopenia and granulopenia were evident on laboratory investigation. The Theileria spp. infection was confirmed by PCR method using specific primers and the authentication was made by detailed sequence analysis. The small subunit rRNA was amplified using universal apicomplexan primers and the phylogenetic analysis was carried out for further characterisation. The animal was stabilized by steroid nebulization therapy and the specific chemotherapy was instigated using buparvaquone and sulphamethoxazole-trimethoprim combination. Supportive medications like non-steroidal anti-inflammatory drugs, antihistamines, antidiarrhoeals and vitamins were provided symptomatically. The animal showed a good response to therapy and recovered from parasitemia by day 10 and the molecular clearance was later confirmed on day 70 of therapy. The present case of Theileria buffeli infected buffalo calf with acute respiratory signs points towards the possible hemoparasitic outbreaks in transport-stressed animals with the signs of shipping fever-associated syndrome.

Bipolar disorder and early childhood trauma

Case Background There is a reported 48.8 million case of bipolar disorder (BD) world- wide. It can also be one of the most challenging disorders to manage clinically as patients often have poor medical compliance and numerous relapses throughout their lifetime. The etiology of this illness is still poorly understood, but it is recognized to compromise both genetic and environmental factors. Regarding the latter, abuse and instability in childhood and adolescence was reported as an important area of consideration in regard to the development and prognosis of bipolar disorder. We report here the case of a female who exemplifies the significance of early childhood experience in this disorder. Case Presentation Isabelle is a 21 year old, female, with a background history of bipolar disorder. She presented to the Cork University Hospital accident and emergency 2 weeks after discharge after a 4 week admission for a depressive episode. Isabelle was referred from the home-based team with an acute episode of mania and was detained involuntarily under the Mental Health Act. Her history is significant for childhood neglect, physical, emotional and sexual abuse, along with multiple foster care placements. She was managed as an inpatient with antipsychotics and a mood stabilizer before being discharged after a lengthy, arduous, admission. Conclusion Childhood trauma is an important consideration in BD. Therefore, practitioner awareness of the role of such trauma with regard to its etiology and prognosis is of great importance. It is also essential to the practice of preventive medicine. Patient Consent Obtained: Yes