{"title":"Remote guidance: enabling tele-supervised community-based rehabilitation worker intervention to facilitate communication in a child with cleft lip and palate.","authors":"Aishwarya Nallamuthu, Vandhana Prabhu, Sivamani Jayakumar, Krupa Venkatraman","doi":"10.1136/bcr-2024-263399","DOIUrl":"https://doi.org/10.1136/bcr-2024-263399","url":null,"abstract":"<p><p>Cleft lip and palate (CLP) significantly impact speech and language development in children. In remote areas, access to specialised services is often limited, necessitating innovative approaches for effective service delivery. This case report explores the potential of tele-supervised intervention provided by community-based rehabilitation workers (CBRWs) to enhance communication outcomes for children with CLP. A comprehensive therapy programme was developed, targeting the child's speech needs and led by a CBRW under remote supervision from speech-language pathologists (SLPs). The SLPs provided real-time guidance to the CBRWs in stimulus selection, trial administration, response monitoring and reinforcement strategies. The tele-supervised intervention led to significant improvement in the child's communication outcomes by encouraging active participation and correct exercise execution. This approach also enhanced service delivery in remote areas by improving access to specialised services, building the capacity of local healthcare providers and facilitating ongoing professional development.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"18 1","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142926622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BMJ Case ReportsPub Date : 2025-01-02DOI: 10.1136/bcr-2024-262234
Yuki Iizuka, Yasunori Urayama, Takeo Yasu, Jun Makino
{"title":"Cholestasis due to biliary obstruction can cause cardiogenic shock with bradycardia by delaying the elimination of arotinolol.","authors":"Yuki Iizuka, Yasunori Urayama, Takeo Yasu, Jun Makino","doi":"10.1136/bcr-2024-262234","DOIUrl":"https://doi.org/10.1136/bcr-2024-262234","url":null,"abstract":"<p><p>Cardiogenic shock with bradycardia due to beta-blockers is well-documented; however, this condition in association with arotinolol is unreported. We present a case of cardiogenic shock resulting from delayed arotinolol clearance caused by bile duct obstruction. A man in his 60s presented to our hospital with jaundice. We suspected acute obstructive suppurative cholangitis; however, the patient did not exhibit fever or abdominal symptoms. Based on the physical examination results, we concluded the patient was in cardiogenic shock as a consequence of delayed arotinolol elimination. We attempted to maintain organ perfusion using norepinephrine and dopamine, with minimal response. On initiating isoproterenol, the heart rate stabilised. After tapering off isoproterenol, endoscopic retrograde cholangiopancreatography (ERCP) was performed. Subsequent serum arotinolol level measurement revealed a significant reduction in the elimination half-life before and after ERCP. In cases of cardiogenic shock associated with arotinolol, presumably eliminated via the bile duct, it is crucial to consider potential delayed elimination and to appropriately time ERCP.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"18 1","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142925949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BMJ Case ReportsPub Date : 2025-01-02DOI: 10.1136/bcr-2024-262693
Shelun Tsai, Nigel Pereira
{"title":"Bona fide diminished ovarian reserve or profound ovarian suppression by long-term oral contraceptive use?","authors":"Shelun Tsai, Nigel Pereira","doi":"10.1136/bcr-2024-262693","DOIUrl":"https://doi.org/10.1136/bcr-2024-262693","url":null,"abstract":"<p><p>Combined oral contraceptives (COCs) are widely used by reproductive-aged women. Current data suggest that long-term use of COCs can suppress ovarian reserve markers, including anti-mullerian hormone and antral follicle count, which may negatively impact ovarian response and oocyte yield in patients undergoing planned oocyte cryopreservation to preserve future reproductive potential. Discontinuation of COCs can improve ovarian stimulation outcomes, though the ideal duration of cessation is unknown. In this case report, we describe a patient with profound ovarian suppression from long-term COC use and her delayed reversal in ovarian suppression as demonstrated by longitudinal assessment of ovarian reserve markers and ovarian stimulation outcomes.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"18 1","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142926437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Fibrolamellar hepatocellular carcinoma with intrapancreatic nodal metastases masquerading as pancreatic neuroendocrine tumour with hepatic metastases.","authors":"Sree Vani Paladugu, Niladri Mohan Raypattanaik, Suvradeep Mitra, Lileswar Kaman","doi":"10.1136/bcr-2024-262872","DOIUrl":"https://doi.org/10.1136/bcr-2024-262872","url":null,"abstract":"<p><p>Fibrolamellar hepatocellular carcinoma (FL-HCC) is a primary liver tumour presenting at a young age. Aggressive surgery of FL-HCC is the mainstay of management unlike other malignancies where metastatic stage precludes curative surgery. There are limited reports of response of FL-HCC to systemic therapies predominantly owing to its rarity. In the index case, a young boy presented with the awareness of abdominal lump with minimal systemic complaints. Radiological imaging showed arterially enhancing liver and pancreatic lesions leading to clinical suspicion of non-functional pancreatic neuroendocrine tumour with neuroendocrine liver metastases in non-cirrhotic liver. Histopathological examination with immunohistochemistry following left lateral hepatectomy with pancreaticoduodenectomy and lymphadenectomy showed FL-HCC with lymph nodal metastases involving intrapancreatic lymph node and station 7, 8 lymph nodes. The patient had an uneventful postsurgical recovery and was kept under close follow-up. FL-HCC with nodal metastasis involving intrapancreatic lymph node is an unusual phenomenon and a challenging clinicopathological diagnosis.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"18 1","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142926583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BMJ Case ReportsPub Date : 2025-01-02DOI: 10.1136/bcr-2024-262238
Ludia John, Narayanan D Cunnigaiper, Chandru Ravindrakumar, Rushab Ranawat
{"title":"Combined laparoscopic and gluteal approach for resection of a sciatic notch dumbbell lipoma.","authors":"Ludia John, Narayanan D Cunnigaiper, Chandru Ravindrakumar, Rushab Ranawat","doi":"10.1136/bcr-2024-262238","DOIUrl":"https://doi.org/10.1136/bcr-2024-262238","url":null,"abstract":"<p><p>The greater sciatic, lesser sciatic and obturator foramina are openings in the pelvis through which pelvic lesions can herniate, leading to the formation of rare dumbbell tumours. We present the case of a man in his late 60s, who presented with obstructed defecation. A per rectal examination revealed a palpable right sided rectal mass. MRI pelvis identified a dumbbell lipoma traversing the right sciatic foramen, with a pelvic component causing displacement of the rectum and a gluteal component impinging on the sciatic nerve. The lipoma was successfully removed by a multidisciplinary team using a dual approach: the pelvic component was excised laparoscopically, and the gluteal component was removed by an open approach. Comprehensive knowledge of pelvic anatomy is required to safely and accurately excise lesions in this region. Laparoscopic approach offers clear advantages over the open approach, while yielding similar results.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"18 1","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142926441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Unintentional exposure to leuprolide acetate during early pregnancy with a huge intramural myoma.","authors":"Prachawanee Nuchpramool, Chatsaran Thanapongpibul, Ratchapol Siriprapaphan, Narathorn Kulthamrongsri","doi":"10.1136/bcr-2024-262211","DOIUrl":"https://doi.org/10.1136/bcr-2024-262211","url":null,"abstract":"<p><p>Leuprolide acetate is commonly used to reduce the size of myomas before surgery. Initially, it stimulates pituitary gonadotropin secretion, followed by sustained suppression of gonadal function. However, the impact on pregnancy outcomes from inadvertent exposure remains unclear. This case involves a woman in her 30s, multiparous, with a 20-week-sized leiomyoma, who received two doses of 3.75 mg subcutaneous leuprolide acetate, 15 days after menstruation, 4 weeks apart. An ultrasound, conducted 2 weeks after the last dose, accidentally revealed a viable intrauterine pregnancy at 8+6 weeks gestation. Her pregnancy progressed without complications, culminating in a term caesarean delivery without fetal anomalies. She opted for a total hysterectomy with bilateral salpingectomy 6 months later. Despite unclear teratogenic effects, evidence suggests that leuprolide acetate does not significantly impact pregnancy outcomes.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"18 1","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142926634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BMJ Case ReportsPub Date : 2025-01-02DOI: 10.1136/bcr-2024-261036
Mortada Elyas, Aly Amer
{"title":"Cerebral aspergillosis in a patient with chronic lymphocytic leukaemia complicated by Evans syndrome.","authors":"Mortada Elyas, Aly Amer","doi":"10.1136/bcr-2024-261036","DOIUrl":"https://doi.org/10.1136/bcr-2024-261036","url":null,"abstract":"<p><p>This case report presents a complex medical scenario involving early 60s female patient with a history of chronic lymphocytic leukaemia (CLL) complicated by Evans syndrome, characterised by autoimmune haemolytic anaemia and immune thrombocytopenia. The patient had received various treatments, including steroids, rituximab, cyclosporine and acalabrutinib. The patient's neurological symptoms began around 3 years prior to presentation, with shaking of her right leg, followed by shaking of both hands, particularly the left hand. She experienced shaking during activities and at rest. Additional symptoms included voice changes, numbness in the feet, dizziness, faintness, fatigue, nausea, vomiting, headaches, walking difficulty, speech changes and back pain. Neurological examination revealed resting tremors, bradykinesia, rigidity and infrequent blinking. An MRI of the brain revealed a 28 mm enhancing intra-axial lesion in the right frontal parietal lobe, accompanied by a 7 mm nodule in the left parietal lobe, both suggestive of neoplastic aetiology. A surgical resection was performed, identifying septate branching fungal hyphae consistent with Aspergillus species, leading to the diagnosis of cerebral aspergillosis. Voriconazole was initiated and subsequently adjusted based on therapeutic drug levels. The patient's treatment course was complicated by declining platelets, diagnosed as thrombocytopenia, and a positive COVID-19 test result. She received rituximab, immunoglobulin therapy and antifungal treatment adjustments. The patient's clinical condition improved, including a reduction in tremors and regained mobility. This case underscores the challenges of managing a patient with CLL-associated immune complications, cerebral aspergillosis and a dynamic treatment plan. Clinicians must consider individualised therapeutic strategies and monitor for treatment-related complications in complex cases like this one.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"18 1","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142926438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BMJ Case ReportsPub Date : 2025-01-02DOI: 10.1136/bcr-2024-263140
Vijayakumar Karthik, Ahmad Alam, Sasikumar Nair, Arsha Chandrasobha Asok
{"title":"Liquorice-induced pseudohyperaldosteronism: a rare cause for severe hypertension.","authors":"Vijayakumar Karthik, Ahmad Alam, Sasikumar Nair, Arsha Chandrasobha Asok","doi":"10.1136/bcr-2024-263140","DOIUrl":"https://doi.org/10.1136/bcr-2024-263140","url":null,"abstract":"<p><p>This case report describes an adult man in his 50s with a history of type 2 diabetes and previously well-controlled hypertension, who presented with uncontrolled hypertension, muscle weakness and fatigue. Biochemical testing revealed hypokalaemia. There was no evidence of renal/renovascular disease. Evaluation for primary hyperaldosteronism revealed suppressed renin concentration with low aldosterone levels. Detailed history taking revealed the daily consumption of three to four cups of liquorice root tea for 3 months. Glycyrrhetinic acid, a metabolite of glycyrrhizic acid found in liquorice, inhibits the 11 beta-hydroxysteroid dehydrogenase-2 (11β-HSD2 enzyme present at the renal tubule, leading to cortisol-mediated mineralocorticoid receptor activation. The diagnosis of liquorice-induced pseudohyperaldosteronism was made, and the discontinuation of liquorice with short-term use of mineralocorticoid receptor blockers led to normalisation of blood pressure and serum potassium. This case highlights the importance of considering the possibility of excess use of liquorice in the differential diagnosis of unexplained hypertension, especially in the context of low-renin hypertension.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"18 1","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142926616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BMJ Case ReportsPub Date : 2025-01-02DOI: 10.1136/bcr-2024-264271
Mariana Martins, Ana Mafalda Gonçalo, Mário Mateus, Jorge Santos Silva
{"title":"Sucking blister in a newborn: atypical localisation.","authors":"Mariana Martins, Ana Mafalda Gonçalo, Mário Mateus, Jorge Santos Silva","doi":"10.1136/bcr-2024-264271","DOIUrl":"https://doi.org/10.1136/bcr-2024-264271","url":null,"abstract":"<p><p>A meticulous examination of the oral cavity is an essential part of the initial newborn assessment. The differential diagnosis can involve benign and self-limiting lesions to those lesions compromising quality of life. We present a clinical case of a newborn born with a purple, hard tumour on the hard palate that spontaneously regressed, being thus compatible with the case of a sucking blister. Neonatal sucking blisters typically result from vigorous sucking in utero, most commonly of the hand or forearm; however, more atypical locations may be involved. These benign blisters should be differentiated from other newborn conditions by their presentation, characteristic morphology and self-limiting course. A high index of clinical suspicion is necessary to avoid unnecessary investigations and treatments.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"18 1","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142926629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}