Cases Blog
Yesterday was World Leprosy Day, an event to raise awareness of this age-old disease, particularly to spread understanding that leprosy is cureable and manageable.
Our journals have published several case reports of patients with leprosy, and of course we welcome more to help share knowledge and experience of this disease.
Single lesion multibacillary leprosy, a treatment enigma: a case report Sapkota BR, Neupane KD, Maharjan RK
Intraneural injection of corticosteroids to treat nerve damage in leprosy: a case report and review of literature Nashed SG, Rageh TA, Attallah-Wasif ES, Abd-Elsayed AA
Concomitant age old infections of mankind – tuberculosis and leprosy: a case report Sreeramareddy CT, Menezes RG, Kishore PV
Posted by Elizabeth.Slade at 16:33 Comments (0)
Google Flu Trends predicts US flu activity
Google have launced a new online tool, Flu Trends, that can predict influenza outbreaks in different areas of the US. The tool works by monitoring how many flu-related internet searches are carried out - Google have previously correlated this with data on flu outbreaks from the US Center for Disease Control (see graph, below).
Users can check Flu Trends to check the level of 'flu activity' in their state day by day - currently Arkansas, Mississippi, Kentucky, Delaware, Maine and Hawaii have the highest incidence.
Has flu season reached your area yet? Don't forget to write up a case report for your interesting cases, such as this recent report from En Kimura et al, "A reversible lesion of the corpus callosum splenium with adult influenza-associated encephalitis/encephalopathy".
Posted by Elizabeth.Slade at 15:56 Comments (0)
Anabolic steroid use resulting in multi-organ failure
A new article in JMCR from Ali Samaha and colleagues reports a case of multiple organ failure in a 24-year old man who had been taking testosterone injections three times a week for two months, as well as diuretics and amino acid supplements.
The patient presented at the emergency room with abdominal pain, nausea and vomiting, and was admitted for management with a primary diagnosis of acute pancreatitis, acute renal failure and hypercalcemia.
Read the case report in full here.
Posted by Elizabeth.Slade at 15:02 Comments (0)
Popliteal venous aneurysm diagnosed in primary care
A new case report in JMCR, 'Diagnosing a popliteal venous aneurysm in a primary care setting' is one of the journal's first to be written by general practitioners.
The report describes the case of a 68-year-old woman presenting to her general practitioner with a history of local discomfort and swelling in the right popliteal fossa, with pain during palpation. Colour Doppler ultrasonography revealed local widening and saccular dilatation in the right distal popliteal vein. Click here to read more.
We particularly welcome GPs to become involved with the journal - we know that the experience of family doctors is not often shared in the medical literature, and with JMCR and Cases Journal we offer a route for any patient's story to be published.
Posted by Elizabeth.Slade at 14:24 Comments (0)
Living with osteoarthritis: a patient's perspective
Osteoarthiritis is a life-changing, degenerative joint disease. It affects millions of people worldwide, both those who live with the disease and those who care for them.
Helen Burrell, along with her GP Dr Christian Mallen and researcher Dr Jane Richardson, tells the story of how osteoarthritis affects her and her experiences of it in a primary care setting in this alternative case report.
Dr Jane Richardson says, "The idea for this report was generated by one of the authors (Helen Burrell) who was diagnosed with osteoarthritis at an early age following childhood Perthes disease. She approached her general practitioner wanting an opportunity to tell her story. Using Helens’ poems to illustrate her experiences, we have produced a multidisciplinary case report involving a patient, a sociologist and a general practitioner.
Whilst
this may not fit the model for a traditional case report, the strong messages
arising from this narrative are important for clinicians and researchers to
consider. The emotional, social and psychological aspects of a chronic disease
are frequently neglected and Helen's experiences are both moving and thought
provoking. We feel this innovative
multidisciplinary approach has much to offer and hope that patient orientated
case reports become more widespread."
This is a great example of the patient's perspective featured in our case reports, helping to enhance the clinical details of a case by including real-life experiences of the most important person - the patient.
Posted by Miriam Kingsley at 14:06 Comments (0)
JMCR and Cases Journal at Wonca
Thanks to all of you who visited us at the BioMed Central booth at the Wonca Europe conference in Istanbul last week.
It was great to meet so many who have published in JMCR and Cases Journal, and of course also all those who are new to the journals and are now looking to publish their first case report.
We will also be exhibiting at the Wonca Asia Pacific meeting in Melbourne in October, so do visit us at booth number 50 if you are attending.Posted by Elizabeth.Slade at 17:35 Comments (0)
Richard Smith's guest blog post: The still small power of medicine
Medicine has made progress from Voltaire's famous aphorism that “the art
of medicine consists of amusing the patient while nature cures the disease,”
but two articles just published in Cases
Journal show that progress is slow and not all that it appears to be. Tom
Jefferson and Enzo Grossi describe the agonising and currently insoluble
problem of advising individuals based on evidence gathered in populations.
Let me try and illustrate with the following dialogue:
Inquisitive patient: If I take this drug will I be cured?
Complacent doctor: Yes.
Inquisitive patient: How do you know?
Complacent doctor: The drug company told me. They kindly sent me reprints from a prestigious medical journal.
Inquisitive patient: Did you read them critically?
Complacent doctor: Well no. In fact I didn't read them at all. I don't have time. But the drug rep who gave them to me was charming and convincing.
Inquisitive patient: What did he say?
Complacent doctor: He said that there was strong evidence from large randomised trials that the drug I'm prescribing you works.
Inquisitive patient: What's a randomised trial?
Complacent doctor: Some say it was the most important medical discovery of the 20th century. In a randomised trial a large number of people randomly receive either the drug or a dummy pill. Researchers then see what happens to the patients. Nearly a thousand people were given the drug I'm prescribing for you and about the same number were given the placebo. In the treated group 50 died while in the untreated group it was 200. So the drug clearly works.
Inquisitive patient: What happened to the others?
Complacent doctor: They're still alive.
Inquisitive patient: But are they cured?
Complacent doctor: Well, no. They still have the condition, but it's clearly much better to have the treatment.
Inquisitive patient: OK, so I won't be cured. I accept that, but are you sure the drug will benefit me?
Complacent doctor: Of course. Look at the difference between those who took the drug and those who didn't. Those who didn't had four times the chance of dying.
Inquisitive patient: It seems to me that there are four possible outcomes here. I might take the drug and still die. I might take the drug and not die but still have the condition. I might not take the drug and die. Or I might not take the drug and not die but still have the condition. How do I know which group I'll be in?
Complacent doctor: Well, clearly you should take the drug because you quarter your chances of dying. That's a big difference.
Inquisitive patient: But I might take the drug and still die or I might not take the drug and live. How do you know what will happen to me?
Complacent doctor: I don't.
Inquisitive patient: And just because this drug worked in some people in this trial how do you know it will work in the future? Aren't you making the mistake of Bertrand Russel's “inductive turkey,” who assumed that because he got fed at 9 every morning he would always be fed—until Christmas Eve when he had his throat cut at 9 am?
Complacent doctor: I'm only a doctor not a philosopher.
Inquisitive patient: That's your problem.
The articles in Cases Journal describe two ways to move on.
Tom describes the first method, which would be to create a giant reliable database of what happens to individual patients rather than to populations, but we would need it to be truly giant (ideally including every patient ever treated) and we would need a very sophisticated search engine. Cases Journal is working towards both ends.
The second method described by Enzo would be to gather huge amounts of variables on patients within large trials and then match the individual patient to patients in the trials using new methods of searching.
Both methods will need currently unimaginable computing power, new methods of searching, and - most difficult of all - a fundamental change in the working practices of doctors.
Richard Smith
Editor-in-Chief
Cases Journal
Posted by Elizabeth.Slade at 13:44 Comments (0)
First report of ambiguous genitalia in diabetic fetopathy
A recently
published article in Journal
of Medical Case Reports describes the case of an infant born to a 19-year-old Thai
woman with familial history of diabetes mellitus, which showed evidence of
diabetic fetopathy with classic facial malformation and ambiguous genitalia. Although maternal
diabetes is known to increase the risk of congenital malformations, this is the
first reported case of ambiguous genitalia. 
The infant died shortly after birth; the autopsy showed multiple facial anomalies including a prominent forehead, an absent nose, absent bilateral ears and a median cleft lip and palate. The most unusual finding was bilateral adrenal hyperplasia with ambiguous external genitalia, with clitoral hypertrophy and hyperpigmentation. Other anomalies found included preaxial polydactyly of the right hand, accessory spleens and a single umbilical artery.
Chromosomal
examination revealed the infant was female, (46, XX) with virilization of
female external genitalia. The uterus and both ovaries were in the normal
anatomical position.
Have you seen any
unusual complications arising from gestational diabetes? Share your
experience by posting a
comment on this case report, or submit a case report describing
what happened.
Posted by Emma Pettengale at 14:57 Comments (0)
Web 2.0 technologies in healthcare
A new article from the NHS Resource Centre, 'Web 2.0 technologies in healthcare', discusses what patients, doctors and policy makers are doing with collaborative and multi-media technologies.
Cases Journal is cited as an example of how Web 2.0 technologies are changing the way that medical and scientific knowledge is disseminated. The article includes views from Richard Smith, Editor-in-Chief, on why doctors have been slow to connect in online communities and collaborative tools, compared to patients. PatientsLikeMe is an example of a formalised patient network that connects patients with similar treatment experiences, and as the article explains, patients are often very willing to discuss their problems and experiences openly online.
What do you think? Which Web 2.0 networks and collaborations are you involved with, and why? Do you use Facebook? (Don't forget to become a fan of Cases Journal if so!) Tell us what you and your colleagues' views are on the future of online communication and collaboration.
Posted by Elizabeth.Slade at 12:22 Comments (0)
Two cases of anaphylactic reaction to ranitidine
Journal of Medical Case Reports has just published its second case report on a patient experiencing anaphylactic shock on injection of ranitidine.
The first case report, published in August last year by UK authors, described the case of a patient with acute pancreatitis being treated with ranitidine for gastric discomfort. The patient rapidly lost consciousness and went into cardio respiratory arrest after treatment with adrenaline, hydrocortisone and high flow oxygen. The patient was successfully resuscitated, and recovered after three days in the ICU.
The new case report, from Antonio Oliva et al, the patient received routine ranitidine administration 24 hours after transurethral resection of the prostate. Within minutes the patient developed wheezing, dyspnea and hypotension and lost consciousness. Despite intensive attempts, the patient could not be resuscitated.
Have you seen an anaphylactic reaction to ranitidine? Share your experience by posting a comment on these case reports, or submit a case report describing what happened.
Update 29 July 2008: Read Dr Ghanshyam Palamaner Subash Shantha's comment on the latest ranitidine reaction case report! On attending to one of his own patients he writes: "Only on reading this case report I understand in retrospect that ranitidine could be the culprit in this patient’s death."
Posted by Elizabeth.Slade at 09:49 Comments (0)
Nominations for best case report now open
Nominations are now open for the BioMed Central Research Awards, which will include a prize for the best case report, to be awarded at the ceremony in March 2009.
Any case report published in 2008 in Journal of Medical Case Reports or Cases Journal will be eligible for the award. Case reports will be judged on their originality and significance to clinical practice, and the winning authors will receive a $2000 prize. Cases from any area of medicine will be considered.
Nominate a case report by filling in the simple online form.
If you haven't yet published a case report, submit today to have a chance of winning the award.
The first award for best case report was given to Dr Phuong Mai, for her case report A
possible new syndrome with growth-hormone secreting pituitary adenoma,
colonic polyposis, lipomatosis, lentigines and renal carcinoma in
association with familial testicular germ cell malignancy: A case report.
Watch Dr Mai's acceptance speech on BioMed Central's YouTube channel.
Posted by Elizabeth.Slade at 15:59 Comments (0)
Do we have to understand every sentence?
A new editorial from Richard Smith, Editor-in-Chief of Cases Journal, explains the journal's position on the thorny issue of standards of English in published case reports.
All articles in Journal of Medical Case Reports, Cases Journal's more selective sister publication, are copyedited before they appear on the journal website. The journal also has a rigorous peer review process that ensures that the accepted articles are in the best possible shape. JMCR's case reports are of broad interest across medicine and need to be unambiguously understood.
However, Cases Journal has a bias to publish, accepting case reports on any patient, provided that the case is authentic, ethical, includes all essential information, and is understandable. Dr Smith's editorial elaborates to explain how a case report needs only to be 90% understandable to be accepted. Authors are encouraged to clarify any ambiguities by posting a comment on the published article.
Cases Journal aims to be inclusive. Having English as a second or third language shouldn't be a barrier to publication. We ask authors to get their article into as good a shape as possible before peer review, but if the reviewer deems the case report to be understandable (and it meets our other criteria) it will be published.
We encourage you as readers to post a comment on any article that you think has ambiguities, or simply if you would like to know more - we hope that publication becomes the start of a dialogue between readers and authors.
Posted by Elizabeth.Slade at 16:00 Comments (0)
A figure is worth a thousand words
You asked for more figures and we listened! Authors are now invited to submit up to 10 accompanying figures with their case reports. Of course, all of our images are open access - the images can be reused, provided they are cited correctly. If you have clinical images you would like to share through publishing a case report then visit our instructions for authors to find out more.
Posted by Miriam Kingsley at 12:09 Comments (0)
Ketamine use linked to cystitis
A newly-published article in Journal of Medical Case Reports describes the case of a 20-year-old man who had suffered from urinary frequency, nocturia, urgency, suprapubic discomfort during micturition and episodes of severe haematuria for seven months. The symptoms had started shortly after he began weekly use of ketamine, a dissociative anaesthetic increasingly used as a recreational drug by young adults. Antibiotics and anticholinergics had not improved the symptoms.
Ketamine-associated cystitis has been reported among daily users of ketamine, but this is the first report in a patient who used the drug less frequently.
Read the full report for more information, including details of the previous cases of ketamine-associated cystitis.
Posted by Elizabeth.Slade at 17:26 Comments (1)
Hydrocarbon pneumonitis caused by fire-eating
Efrosni Myloniki and colleagues, from Thessaloniki in Greece, report a case of a 16-year old boy presenting with dyspnea, cough, chest pain and fever after fire-eating at a party.
A chest radiograph showed infiltration in the right middle lobe which was diagnosed as aspiration pneumonia, and the patient was treated with antibiotics.
However, after five days, the patient's condition deteriorated, and he was referred to a pulmonary clinic.
Spirometry revealed severe restriction of lung function, and a CT scan of the chest showed consolidation with an air bronchogram in the right middle lobe, and areas of atelectasis and ground glass opacities in the middle and lower right lobes. Bronchoalveolar lavage fluid was hemorrhagic and revealed cytoplasmic vacuolation of the macrophages, lipid-laden alveolar macrophages and neutrophilia.
These findings, and the use of liquid paraffin in the fire-eating routine, led the team to a diagnisis of hydrocarbon pneumonitis. The patient was treated successfully with systemic steroids and intravenous antibiotics.
Read the full case report for more details of the case, including images from the CT scans.
Posted by Elizabeth.Slade at 11:39 Comments (0)