Young Gentleman Research Articles

P40 A challenging case of new systemic lupus erythematosus

Abstract Introduction The diagnosis of systemic lupus erythematosus (SLE) and its distinction from systemic infection can be challenging. We present a case of new systemic lupus alongside endocarditis, which illustrates this problem. Case description A previously well, 35-year-old male tarmacer of mixed ethnicity, presented with a three months’ history of general malaise, arthralgia and weight loss of 20kg. Two weeks prior to admission he developed progressive confusion, headaches and imbalance. Clinical assessment revealed a pyrexial patient in delirium without focal neurological signs, a faint maculopapular facial rash, symmetrical synovitis, very few nailfold infarcts, a systolic and diastolic murmur and sterile haemato-proteinuria. No history of IV drug abuse. Investigations showed elevated ESR 61, CRP 217, WBC 11.70 and procalcitonin 7.0. He had AKI stage 2 (eGFR 35 with a urinary protein/creat ratio 162; homogenous ANA (1:1280) with positive dsDNA and crithidia-luciliae binding. C3 and C4 suppressed (0.59 and 0.13, respectively); One blood culture prior to broad spectrum antibiotics was negative. Assuming the possibility of Libman-Sacks endocarditis, the attending acute stroke physician initially also treated with pulsed IV steroids, as well as antibiotics. Due to the delirium, key diagnostic tests were technically difficult, although a transthoracic ECHO showed moderately severe aortic and mitral regurgitation that were not felt to be typical for infective endocarditis by the attending cardiologist. The ITU team offered sedation and controlled ventilation to enable all necessary investigations: trans-oesophageal ECHO showed vegetations of aortic and mitral valve leaflets with perforations of single leaflets, resulting in severe acute aortic and mitral regurgitation; a renal biopsy showed class 3 lupus nephritis and an MRI/A Brain showed widespread cerebral foci of restricted diffusion imaging. Consultation with the regional cardiothoracic centre advised urgent transfer for double metal valve replacement, performed on Day 8 post admission. Surgical inspection confirmed an aortic root abscess, and enrichment culture of the native valve subsequently grew Staph. aureus. In addition to IV antibiotics for infective endocarditis, he was continued on steroid taper and commenced on MMF for lupus nephritis. Discussion It can be difficult to differentiate between infective endocarditis and Libman-Sacks endocarditis, especially when there are no existing risk factors. In cases like these antibiotics and steroids can be started at the same time. In our case, we had a young gentleman with no prior medical history who had multiple compounding factors and barriers to fully investigate. Because of his agitation, he required sedation and that allowed the team to perform life saving investigations (renal biopsy and TOE). He ended up having a double metal valve replacement within 8 days post-admission. Multidisciplinary team involvement and close collaboration was of crucial importance in this case to ensure a safe patient outcome. Key learning points • This case illustrates the need to vigorously chase the possibility of concurrent infection in severe new SLE. Close collaboration between multiple specialities to achieve this is key, especially when a patient lacks agency due to their illness.

‘This uh. . . young lady young gentleman’: Gender attribution in the context of a gender-ambiguous robot

For humanoid robots, gender-ambiguous presentation is implemented as a potential way to avoid gender-stereotypical design. Using conversation analysis, we look at video recorded user interaction in the presence of a designedly gender-ambiguous robot, showing how this design choice is actually dealt with within a social context. Robot gender becomes relevant initially when a user refers to the robot with a dual-gendered package (‘young lady young gentleman’), with another user proposing ‘her’ for the robot, and the talk then evolving to the pursuit of agreement on the robot’s proposed femininity. Robot gender attribution is treated by these users as a collaborative endeavor rather than an individual choice. It includes displays of accountability and orientations to delicateness of gender attribution. By implication, the analysis shows that ambiguous design shifts the burden of gender attribution from robot designers to users.

Complete Heart Block Secondary To Leptospirosis: A Case Report

Complete heart block (CHB) is a rare but potentially life-threatening complication of leptospirosis, a zoonotic bacterial infection caused by spirochetes of the genus Leptospira. While leptospirosis primarily affects the kidneys and liver, cardiac involvement, including CHB, can occur and has significant clinical implications. The pathogenesis of CHB in leptospirosis is multifactorial and may involve direct cardiac invasion by Leptospira organisms, systemic inflammatory response, autoimmune reactions, electrolyte imbalances, and hemodynamic effects. Prompt recognition and management of CHB are essential to prevent adverse outcomes, including hemodynamic instability and sudden cardiac death. Treatment strategies include supportive measures such as hemodynamic support and correction of electrolyte imbalances, temporary pacing for symptomatic bradycardia, antibiotic therapy for the underlying infection, and consideration of permanent pacemaker implantation in refractory cases. Cardiac manifestations may include myocarditis, pericarditis, arrhythmias, conduction blocks and cardiac failure. We are reporting a case of leptospirosis causing complete heart block in a previously healthy young gentleman.

OA17 An unusual cause of unilateral retroperitoneal fibrosis

Abstract Background/Aims Retroperitoneal fibrosis (RPF) is a rare condition, with an incidence of around 1 per 200,000 to 500,000 per year. It is distinguished by fibro-inflammatory changes in the retroperitoneum, which typically surrounds the abdominal aorta. Idiopathic RPF is common, whilst secondary causes can result from drug therapies, infection, malignancy, or surgery. Early symptoms include dull, poorly-localised back or flank pain, and lower limb swelling. The classical focal mass of primary retroperitoneal fibrosis is typically situated over the distal aorta, anterior to the L4 and L5 vertebra. External compression of the ureter can result in hydronephrosis due to prevention of normal ureteric urinary peristalsis. Management options are limited, generally involving immunosuppression and urological surgery, often necessitating cross-specialty, multidisciplinary input. Methods We report the case of a young gentleman with no past medical or family history who presented with abdominal pain, vomiting, septic shock and metabolic acidosis. To exclude acute abdominal pathology, computed tomography (CT) abdomen and pelvis was performed. Incidentally, this found chronic inflammatory changes in the descending colon and right retroperitoneal soft tissue thickening causing severe right hydroureteronephrosis. This incidental finding of retroperitoneal fibrosis on CT scan prompted an exploration into infective, inflammatory, and malignant aetiological causes of retroperitoneal fibrosis. Results Following initial stabilisation, urological opinion was sought, which concluded that surgical intervention for ureteric stenting was unnecessary. This decision was supported by the absence of obstruction from fibrosis and the lack of signs indicating infection. No medical explanation was found for the initial presentation in extremis. Rheumatological advice was sought for consideration of biopsy and immunosuppressive therapy for this suspected primary retroperitoneal fibrosis. Upon inquiry, the patient divulged a historical occurrence of retroperitoneal fluid accumulation secondary to a paravertebral mass that mandated laparoscopic drainage four years ago overseas. Histopathological analysis of the mass confirmed the presence of tuberculosis (TB), which was treated. His recovery was complicated at that time by right-sided hydronephrosis and fibrosis necessitating decompression. This sequence of events was deemed by a radiologist to also account for the observed bowel findings in the right flank. Conclusion This case report is the first of its kind to document TB, or any infective aetiology, as being the primary cause of unilateral retroperitoneal fibrosis. Unilateral retroperitoneal fibrosis is incredibly rare, and there are only four English language case reports in the literature. Idiopathic RPF typically presents as bilateral concentric tissue around the abdominal aorta, whilst secondary causes can lead to unconventional imaging patterns, as seen in this case. It was only upon direct inquiry that the patient disclosed a prior diagnosis of TB affecting the lumbar spine. This case highlights the importance of meticulous history taking and systematic exclusion of secondary causes of RPF, prior to contemplating invasive biopsies and steroid therapy. Disclosure D. Li: None. M. Renju: None.

Evans Syndrome in Rectal Carcinoma

Malignancy is rarely associated with autoimmune disease, and it may complicate rare condition such as Evans Syndrome (ES). ES is an infrequent condition that manifests as a combination of Autoimmune Hemolytic Anemia (AIHA) with Immune Thrombocytopenic Purpura (ITP). There were reported cases of ES associated with hematological malignancy but association with rectal carcinoma is relatively unknown. We report a case of a young gentleman with stage III rectosigmoid adenocarcinoma who underwent successful oncological resection and presented a month later with severe anemic symptoms. Blood investigations were consistent with AIHA and ITP. He was treated with steroids and received multiple blood transfusions but eventually succumbed to death.

A Case Report of Subacute Degeneration of the Spinal Cord due to Chronic Nitrous Oxide Use with Review of the Literature

Subacute degeneration of the spinal cord (SACD) is an acute medical emergency that requires early detection and management to limit worsening neurological deficit. With the increase in the usage of recreational drugs including nitrous oxide whippets, the incidence of the condition is noted to be rising. Currently it is the second most commonly used recreational drug used in the United Kingdom amongst 18–24-year-olds. Here we present a young gentleman with weakness and numbness following chronic usage of nitrous oxygen whippets.

Ulnar Nerve Reconstruction With a Basilic Vein Tributary Graft: A Practical and Easily Replicable Technique With Favourable Outcomes

A young gentleman presented with a closed fracture of the left radius and an open fracture of the left ulna complicated with segmental loss of the ulnar nerve measuring 1.5cm. After thorough debridement and stabilization of the bone injuries, the ulnar nerve gap was bridged with an autologous venous graft harvested off a tributary of the basilic vein that served as a nerve conduit. At 18 months post-surgery, sensori-motor function of the patient’s left ulnar nerve was nearly fully restored, indicative of successful reconstitution of the ulnar nerve using a basilic vein tributary vein graft.

An interesting case of scrub typhus meningoencephalits

Rickettsial diseases are a re-emerging group of illnesses that are known to show a good response to treatment if diagnosed in time. Here we report a case of Scrub Typhus-related Meningoencephalitis in a young gentleman and the importance of high clinical suspicion with early empirical treatment in patients with consistent epidemiological context.

High Altitude Cerebral Edema with concomittent rhabdomyolysis: A rare presentation

We report the case of a young gentleman who developed High Altitude Cerebral Edema (HACE) along with rhabdomyolysis whilst on a trip to the northern areas of Pakistan. High Altitude Cerebral Edema (HACE) represents a serious and potentially fatal type of Acute Mountain sickness (AMS). Rhabdomyolysis presenting with HACE is uncommon however cases have been reported. In our patient, clinical presentation with severe bilateral lower limb pain and difficulty walking along with the increased agitation and confusion made it difficult to recognize; however early descent and management allowed for good recovery. MRI findings with microhemorrhages as found in our patient are increasingly being recognized in HACE with improving sensitivity of available imaging modalities. This case highlights the diverse clinical presentations that can exist with HACE and hence the need for medical professionals to maintain a high index of suspicion in anyone with a recent ascent to high altitude regions who develop neurological manifestations.

MANAGEMENT OF AMOEBIC LIVER ABSCESS IN AYURVEDA: A CASE REPORT

Liver abscesses are purulent collections in the liver parenchyma that result from bacterial, fungal, or parasitic infection. Antibiotics, percutaneous drainage and surgery are the only therapeutic solution for this condition. A 38- year young gentleman diagnosed with multiple Amoebic liver abscesses visited at Government Ayurvedic college and Hospital. He came with complaints of Jaundice, fever, pain in the abdomen and USG of abdomen showed multiple Liver Abscesses. In this case of liver abscess, after getting informed consent the patient was given an Ayurvedic treatment for 30 days without any Allopathic medicine or any invasive technique. Patient was given Panchtiktghrita guggul, Arogyavardhini vati, Agnitundi vati, Vidang churna etc. There was a significant reduction noted in the symptoms of Abscess. At the end of treatment, USG examination revealed there was no focal defect or lesion in the liver and haematological parameters were found within the reference range. There were no clinically significant adverse reactions noted in the duration of treatment. The results of this study indicate the clinical efficacy of Ayurvedic treatment in the management of liver abscess and patient gave highly satisfactory response after his treatment. The treatment outcomes in the present case indicate that classical Ayurvedic measures may be helpful to the patients of a liver abscess.

СОЦИАЛЬНО-ГИГИЕНИЧЕСКАЯ МОДЕЛЬ ФОРМИРОВАНИЯ У ЮНОШЕЙ ЗДОРОВЬЕСБЕРЕГАЮЩЕГО ПОВЕДЕНИЯ В ОБЛАСТИ РЕПРОДУКТИВНОГО ЗДОРОВЬЯ

The ultra-low birth rate in modern society is the leading cause of depopulation. Changing the standard of youth sexual behavior should be regarded as one of the main ways to preserve the reproductive potential and social stability of the state. The development of methods of preventive work on the formation of health-saving behavior in the reproductive sphere in most works concerns girls. The absence of a socio-hygienic model for the formation of health-saving behavior in the reproductive sphere among young men was the rationale for the development of such a model by the specialists of the children’s polyclinic. The purpose of this work was to present the experience of developing and implementing a socio-hygienic medical-organizational technology for the formation of health protection in young men in the reproductive sphere. Results. The rationale for the development of a socio-hygienic model was the results of a preliminary medical and sociological study – a survey of young men and their parents: a high proportion of sexually active young men with an early sexual debut, using unprotected intercourse, the prevalence of promiscuity against the background of a low level of knowledge about reproductive health, motivation for health protection in the reproductive sphere and the insufficient role of the family in the issues of sexual education of adolescents; a high level of agreement among the parents of young men about the need to involve competent specialists, doctors and psychologists, in the systematic and planned work on the sexual education of their sons. The social and hygienic model was developed on the basis of an interdepartmental and interprofessional approach with the participation of children’s polyclinic doctors, teachers, psychologists and social workers. Structurally and functionally, the model corresponds to the educational cluster, assumes a stage-by-stage implementation of activities, and includes as the main component the innovative educational program “Young Gentleman’s School” within the framework of the School of Reproductive Health for Boys, implemented on the basis of secondary schools territorially attached to the children’s polyclinic. Participation in the program of the School of Reproductive Health for Boys during one academic year was accompanied by an increase in the level of knowledge about reproductive health and a ranked level of motivation of adolescents to preserve health in the reproductive sphere, a smaller increase in the proportion of sexually active boys and a relative increase in those who use protected sexual intercourse among them. Conclusion. The development and implementation of a social and hygienic model for the formation of health savings in the reproductive sphere among young men and the implementation of the innovative educational program “Young Gentleman’s School” are medical and organizational technology for managing health savings in this area. Increasing the level of motivation of young men to preserve reproductive health through obtaining reliable and complete information from competent specialists – a pediatric urologist-andrologist and a psychologist, contributes to the formation of health-saving sexual behavior.

Case report: Anal tuberculosis presenting as an anal fistula

This is a case of a young gentleman, who presented with complaints of hematochezia, weight loss and fluctuating fever for the past five months. The patient was a known case of Hirschsprung disease and Ulcerative colitis (IUC) and underwent a rectal Duhamel procedure in the past. On examination there was a fistula with an external opening at the anal verge. The clinical suspicion at this point was enterocutaneous fistula, abscess, and incontinence secondary to Hirschsprung disease. Investigations including MRI and sigmoidoscopy were carried out. A tissue from the anorectal junction was taken for histopathology review. Histopathological analysis suggested granulomatous inflammation with collection of epithelioid histiocytes along with caseating necrosis. This was consistent with the diagnosis of anal tuberculosis. The patient was started on a quadruple regimen of anti-tuberculous drugs (ATT). The patient six months into treatment has shown significant clinical improvement.

Don’t jump to conclusion – priapism in acute spinal cord injury: a case presentation

Priapism is an uncommon urology emergency. However, if detected late and not classified correctly and treatment not appropriately given can cause necrosis and fibrosis of penis. This will lead to permanent erectile dysfunction and can be devastating to patient. Literature of Spinal Cord Injury with priapism is rare and not many reported. We have a case of young gentleman with priapism secondary to spinal cord injury. It was detected early and treated promptly and patient had good outcome with no evidence of permanent erectile dysfunction.

The Sewing Girl's Tale: A Story of Crime and Consequences in Revolutionary America

The Sewing Girl's Tale: A Story of Crime and Consequences in Revolutionary America

Pulmonary Renal Syndrome due to Atypical HUS in a Young Gentleman.

Pulmonary Renal Syndrome due to Atypical HUS in a Young Gentleman.

Castlemans Disease – Presenting with Recurrent Pleuropericardial Effusions- Mimicking Tuberculosis

Castleman disease (CD) is an uncommon heterogeneous group of lymphoproliferative disorders which can affect the lymph nodes of the neck, chest, abdomen and pelvis. It was first described by Castleman, in 1954, known as benign mediastinal lymph node hyperplasia, which was histologically similar to thymoma of unknown cause. [1] It is divided into unicentric (localized ) Castleman disease (UCD) and multicentric ( generalized) Castleman disease (MCD) based on the number of lymph nodes involved. Castleman disease has varied presentations. Clinically it can present as localized masses, or localized lymph node enlargement. Symptoms can result from compression effects of the enlarged lymph nodes and in asymptomatic patients it can be an incidental finding on radiological imaging. It can also present as diffuse lymphadenopathy with severe systemic symptoms . Rarely it presents with pleuro-pericardial effusions . We present a case of a; young gentleman presenting with anorexia, weight loss and night sweats . He had large exudative pleural effusion with pericardial effusion leading to constrictive pericarditis .He was started on ATT empirically, which was later stopped due to poor response . Extensive radiological work revealed multi loculated pleural effusion and multiple lymph nodes in the axillary and cervical area . Excisional Biopsy of the lymph nodes revealed Castleman disease .

Rib cartilage, the panacea for post traumatic mid face deformity

<p class="abstract">Reconstitution of the facial profile can be achieved in a depressed‘midface “, by supplementation of the nasal osteo-cartilagious skeleton utilizing autologous tissue or synthetic prosthesis, Bone from the iliac crest and cartilages from the septum, cymba conchal and the rib are the accepted grafts in wide use. The costo-chondral junctional cartilage is ideal in situations demanding excess of graft, then can be harvested from the ear or the septum. Moreover, this graft though easily cut and mouldable, gives a rigid sharp profile to the nose. Utilization of the rib cartilage in a young gentleman with a post traumatic midrace deformity is being described.</p><p> </p>

Seronegative Myasthenia Gravis Presenting as Dysphagia in a Young Male- A Diagnostic Dilemma

21year old gentleman presented with insidious onset, gradually progressive dysphagia for 2 weeks. There was no other associated signs or symptoms. Initial blood workup, radiological investigations and diagnostic interventions were non-contributory. In the meantime, dysphagia worsened and was found to be progressive with advancement of the day. Oesophageal manometric studies showed gradual weakening of peristaltic contractions after a string of repetitive swallows. Repetitive nerve stimulation test and edrophonium test were suggestive of Myasthenia Gravis; Anti-acetylcholine receptor antibody and anti-MuSK antibody were negative. He was initiated on Pyridostigmine and had improvement of dysphagia after a few days. He has now achieved remission. Hence, we present a curious case of Seronegative Myasthenia Gravis in a young gentleman who presented with only dysphagia recovered with Pyridostigmine.

OA07 What is effective pain management: an illustrative case report?

Introduction/BackgroundPain is a sensory and emotional experience perceived in terms of tissue damage and expressed in terms of altered behaviour. Chronic, medically unexplained pain is complex, disabling and common. It is important to rule out medical or modifiable causes, but most tests will not result in significant changes in management nor prognosis.Attempting rehabilitation before the patient narrative has been fully explained usually leads to a lack of progress. Sleep deprivation is important to acknowledge and restorative sleep has analgesic and fatigue-improving properties. Prior mood disturbances may alter management, particularly if bereavement or post-traumatic memories are present. Adverse childhood events occur more frequently than expected in this population. Somatisation and personality disorders will need expert evaluation and management. Significant anxiety and depression should be managed independent of pain report.Physical rehabilitation is effective in restoring function which can lead to a recovery of identity and workplace productivity. Altering health beliefs and cognition can be important as part of this process. Exercise prescriptions and access to support during this process are also important. Analgesic medications usually have little to offer other than side effects, but can be used to bridge difficult times, particularly if patient expectations align with their use. Strong opioids should not be started, unless no other options are available, and always with a time- and dose-limit, preferably less than 50mg daily of morphine equivalent for less than 3 months.We present the case of a young gentleman of working age with chronic back pain who underwent effective pain management to restore good function including a full return to work, improvement in his mood, sleep, physical function and quality of life.Description/Method43 year old manager working as a Risk Manager developed back pain without trauma that affected all three segments. There was no morning stiffness, night pain nor gelling history. His pain was worse on exercise and when standing. The pain was intrusive and affecting his quality of life, to the extent that he could not attend work. Time away from the workplace was adding stress and affecting his mood and, intermittently, his sleep. There was no history of night sweats, weight loss, loss of appetite, significant leg pain nor numbness in his feet nor saddle area. There was no loss of control in his bowel nor urine habit.His blood tests (FBC, LFT, Creat, ESR, CRP, vitamin D, ESR, CRP) were normal. An MRI scan of his whole spine showed minor degenerative disc changes but no significant bone changes nor neural compression.His medications were sertraline 50mg once daily, meloxicam 7.5mg once daily and omeprazole 20mg once daily.The pain management programme teaches self-management approaches to patients experiencing chronic pain. It is delivered by a physiotherapist, an occupational therapist, a nurse and a clinical psychologist. Its aim is to help patients to maintain or increase their physical functioning and to regain their sense of control in the context of their life. In turn, patients may improve in their well-being and their quality of life, despite their chronic pain. The programme runs for twelve days with patients attending as out-patients, four days a week for three weeks. Reviews take place at one month, six months and one year following this.Discussion/Results Table 1 outlines the improvement in his outcomes. Self-efficacy scores rose first with associated drops in catastrophisation and kinesiophobia. Anxiety and depression scores also dropped after the first 6 weeks. Pain significantly reduced along with improvements in quality of life and return to full employment 6 months later.OA07 Table 1Patient reported questionnaire outcome measures 02/11/202019/11/202015/12/202007/07/202131/12/2021TimeBaseline2 weeks6 weeks7 months13 monthsBack pain /1097774Leg pain /1021010Leg numbness /1010020Leg tingling/1010010RMDQ149843EQ-5D-5L / 251818161210HAD – A / 2197645HAD – D / 2188534PSEQ / 602238304647PCS /392920151311TSK / 683831322630EmploymentBenefitsBenefitsBenefitsFull timeFull time RMDQ: Roland Morris Disability Questionnaire – lowest scores are healthiest EQ-5D-5L: EuroQoL’s 5 Dimensions with 5 Levels – lowest scores are healthiest HAD – A: Hospital Anxiety and Depression – Anxiety Scale – lowest scores are healthiest HAD – D: Hospital Anxiety and Depression – Depression Scale – lowest scores are healthiest PSEQ – Pain Self-Efficacy Questionnaire – highest scores are healthiest PCS: Pain Catastrophisation Scale- lowest scores are healthiest Tampa Scale for Kinesiophobia – lowest scores are healthiestKey learning points/ConclusionPatients with chronic pain have significant disability, poor quality of life and are not economically productive. Pain management programmes are well evidenced to restore function and improve quality of life. Pain scores typically drop later and full employment can be regained, thus suggesting a cost-effectiveness of such programmes for a population.

Hemothorax From an Anomalous Bronchial Artery Bleed in an Infected Intralobar Pulmonary Sequestration

Pulmonary sequestration is a rare congenital malformation. It represents 0.15-6.4% of all congenital pulmonary malformations. It is characterized by non-functional, dysplastic mass of lung tissue that is not in communication with the normal tracheobronchial tree and is associated with a systemic arterial supply. We report a young gentleman in his mid-thirties who presented with community-acquired pneumonia from an infected intralobar pulmonary sequestration which subsequently developed a hemothorax from an anomalous bronchial artery bleed.