Detailed Anamnesis Research Articles

A rare case of Munchausen syndrome: foreign body ingestion

Munchausen Syndrome (MS) is characterized by mental or physical diseases intentionally induced by the patients. In this case report, we aimed to present MS and review current literature. A 36-year-old female patient was admitted to the emergency room with the complaint of abdominal pain that developed after swallowing stitch needles. Physical examination revealed minimal tenderness in the abdomen with palpation. The plain abdominal X-ray revealed more than ten needle-shaped opacities. During the anamnesis, the patient was incoherent and too determined to have a surgical intervention, which gave rise to a suspicion of MS. A psychiatrist consultation was conducted, she was diagnosed with MS and hospitalization of the patient was planned. Clinical suspicion and detailed anamnesis are the key for the diagnosis. Physicians should bring to mind the diagnosis of MS and seek psychiatric support in patients with frequent hospital admissions, incompatibility between their complaints and a history and examination findings.

The Day after Mass COVID-19 Vaccination: Higher Hypermetabolic Lymphadenopathy Detection on PET/CT and Impact on Oncologic Patients Management

Simple SummaryThe mass COVID-19 vaccination led to unexpected PET findings. Notably, axillary and interpectoral lymphadenopathies ipsilateral to the vaccine inoculation were observed, but could be wrongly interpreted, complicating cancer patients’ management. Our study aimed to assess the hypermetabolic lymphadenopathy detection rate on PET/CT and investigated factors that might help in lymphadenopathy interpretation. A significantly higher vaccine-related lymphadenopathy detection rate resulted in the vaccinated population, as well as in younger and vaccinated patients within 20 days before PET. SUVmax significantly changed during different time intervals, with the lowest values beyond 20 days. To minimize misdiagnosis, a detailed vaccination anamnesis must be recorded and should take into account the appropriate PET schedule, preferable to be performed 20 days after vaccine. Since this health emergency situation will probably continue in the near future, with the need for a strong vaccination campaign for the whole population, it is essential to keep in mind these considerations in order to better manage and take care of oncologic patients.The widespread COVID-19 vaccination led to unexpected PET findings. Notably, axillary and interpectoral lymphadenopathies ipsilateral to the vaccine inoculation were observed. We aimed to assess the hypermetabolic lymphadenopathy (HLN) detection rate on PET/CT. Secondly, we investigated factors that might help in HLN differential diagnosis. A retrospective analysis on 1196 consecutive patients referred for a PET/CT was performed. All patients were asked about the date, type and site of vaccine injections. HLNs were recorded and categorized according to risk classes and SUVmax grades. A statistical analysis was performed to assess the correlation between HLN detection and different clinical/vaccine data. HLN detection rate was 15% and 27% in the No Vac- and vac-groups (p < 0.001), respectively. In the Vac-group, age (p < 0.001) and time interval from vaccine-to-PET (p = 0.010) were inversely correlated with HLN detection. Furthermore, SUVmax significantly changed during time intervals, with lower values beyond 20 days (p < 0.001). In the era of mass COVID-19 vaccination, a higher axillary and interpectoral lymphadenopathies detection ipsilateral to vaccine injection was observed. These PET findings can be wrongly interpreted, complicating cancer patients’ management. To minimize these pitfalls, a detailed vaccination anamnesis must be recorded and should take into account the appropriate PET schedule.

The importance of Pediatric Dentistry in identifying child sexual abuse situations

Introduction: Human Papilloma Virus (HPV) is a virus prevalent in the general population and is considered a sexually transmitted infection, and can be transmitted by non-sexual forms such as casual contact and vertical transmission. The virus is considered the etiologic agent of some carcinomas, inducing the appearance of pathologies such as cervical cancer and oropharyngeal cancer. When it occurs in children, it may be the first indication of sexual abuse, emphasizing that sexual assault represents the main form of contamination by human papillomavirus (HPV) in children from five years old. Objective: To report a case of diagnosis of injury from the Human Papilloma Virus (HPV) and identification of sexual abuse in a child, with the purpose of showing the importance of pediatric dentistry in the diagnosis of violence suffered by patients, raising awareness among the dental class. Results and Discussion: The closest family members are the main responsible and often the child aggressors themselves and, therefore, it is worth noting that those responsible for mistreating their children hardly take their children to the pediatric dentist more than once, in order not to be discovered4. Thus, it is up to the professional to pay attention to the child's behaviour during the consultation and carry out detailed anamnesis and clinical examination. Final considerations: In addition, the professional has the obligation of reporting cases of abuse to the competent body, thus promoting the removal of the child abuser and preventing further episodes like this from continuing to cause traumas in them.

A importância da Odontologia na assistência a indivíduos com defeitos congênitos

Introduction: Birth defects are structural or functional changes that occur during intrauterine life. The dentist must recognize the craniofacial defects, complement the phenotypic characterization and manage them within a multidisciplinary team. The present review aims to assist the dentist to diagnose these findings and present syndromic conditions typically associated with craniofacial malformations&#x0D; Literature Review: Craniofacial manifestations of birth defects are conditions that must be recognized by dentists, as they are frequently present in their daily practices, and this professional may be the first to identify such findings. The main syndromic clinical pictures typically associated with micrognathia, oral clefts and skeletal dysplasias with craniofacial manifestation are presented, pointing out their clinical and genetic features. Discussion: The dentist must perform a detailed anamnesis including family history, as well as should recognize both clinical and radiographically the dysmorphisms, observing the patient systemically. Conclusion: Dentistry professionals should receive theoretical-practical training for the diagnosis, treatment and surveillance of individuals with congenital defects, either in individual assessment or as part of a multiprofessional team.

Once a Known Veterinary Pathogen, Now a Forgotten Zoonosis. Case Report of An Invasive Staphylococcus intermedius Group Infection

Introduction: Staphylococcus intermedius group (SIG), a known veterinary pathogen with the potential for zoonotic human infections, comprises S. intermedius, S. pseudintermedius, and S. delphini, which are not easily distinguishable. Without the proper equipment and procedures, it cannot be distinguished from Staphylococcus aureus (SAu), which causes underestimation of its true incidence. Case Presentation: A 52-year-old male with diabetes presented with complaints of fever and malaise. He developed respiratory failure and altered mental status; hence, intensive care was provided to him. Blood cultures and bronchoalveolar lavage culture developed methicillin-resistant SIG. Despite rapid adjustment of empiric antibiotic therapy, he died of multiple organ failure. Conclusions: Incorporating knowledge about this new pathogen and its aggressiveness into daily clinical practice can, through a high index of suspicion and detailed anamnesis, reduce misdiagnoses.

Uptake of exogenous estrogen as a differential diagnosis of ovarian-remnant-syndrome in a bitch: a case report

BackgroundClinical signs of heat in bitches that have been previously spayed are often associated with the presence of ovarian remnant syndrome. The inclusion of exogenous estrogens as a differential diagnosis in this regard is often ignored and may lead to misinterpretation of the case.Case presentationHerein, we report a case of exogenous estrogen exposure over several months to a 6.5-year-old spayed crossbred bitch, weighing 8.4 kg. The bitch presented in the clinic because of suspected ovarian remnant syndrome. Castration was performed within the first 6 months after birth. Important endocrine parameters measured at the first appointment were Anti-Müllerian hormone (< 0.01 ng/mL), progesterone (0.36 ng/mL), estradiol-17ß (20.7 pg/mL), and luteinizing hormone (< 0.1 ng/mL). After an extensive conversation with the owner, it was revealed that she was using an estrogen spray because of severe menopausal symptoms. After the owner stopped using this spray, the symptoms of the bitch disappeared.ConclusionTherefore, the uptake of estrogens should be a differential diagnosis for symptoms of the ovarian remnant syndrome. A detailed anamnesis is crucial to identify the source of estrogen in the environment of the affected bitch.

Mediastinal and subcutaneous emphysema after manual strangulation

Pneumomediastinum is a disease characterized by the presence of air in the mediastinum. The disease is examined in two categories as spontaneous and secondary and frequently seen as a result of traumatic causes. In our study, we present a case of diffuse mediastinal and subcutaneous emphysema after strangulation, unrelated to penetrating injury. After detailed anamnesis, it was understood that it was not a simple penetrating injury but a complicated trauma. Anamnesis, clinical findings, and radiology should be compatible with each other. When necessary, detailed anamnesis should be insisted and the etiology of blunt trauma should be investigated, especially if mediastinal emphysema is detected. Complications such as tension pneumomediastinum, pneumopericardium, and mediastinitis can be seen which complicates the disease and can result in death.

Endodontic Treatment in a single session in a patient with Chronic Non-Progressive Encephalopathy: Case report

This study aims to report a one-session endodontic treatment of a patient with chronic Non-progressive encephalopathy (CNPE). A patient with CNPE attended our postgraduate clinic for patients with special needs. During the anamnesis, the patient's brother, who is his legal representative, reported discomfort with the esthetics of the patient's anterior tooth and that the patient felt discomfort when touching the same dental element. After detailed anamnesis and elaboration of the treatment plan, endodontic treatment of element 11 (upper right central incisor) and coronary reconstruction were performed. Taking care of patients with cerebral palsy is still a challenge in dentistry. This is because care has to be taken when carrying out necessary interventions in these patients. This treatment aims at the positive resolution of their pathological condition and well-being. The possibility of endodontic treatment in a single session makes treatment more humane and less mutilating.

Dental Anomalies in Consanguineous Marriage: A Clinical-Radiological Study

ObjectiveThis study aimed to evaluate nonsyndromic developmental dental anomalies (DDAs) in individuals born from consanguineous and nonconsanguineous marriages and the possible effects of these marriages on self-reported systemic diseases. MethodsThe study comprised a total of 880 patients aged 16 years or older who applied to our clinic for various dental problems. Based on detailed anamnesis, the patients were divided into 2 groups: individuals born from consanguineous (study group, n = 445) and nonconsanguineous (control group, n = 435) marriages. The parents’ consanguinity type was also recorded, as well as the presence of any self-reported systemic diseases. The number, size, erupted, and morphological DDA types were investigated with both clinical and radiological examinations. All data from the 2 groups were recorded, and a statistical analysis was performed. ResultsThere was a statistically significant relationship between the consanguineous marriage and the size (microdontia), and morphological (dilaceration and taurodontism) DDA types. Additionally, a significant relationship was found between consanguineous marriage and self-reported systemic disease but not between the parents’ consanguinity type and systemic disease. ConclusionThe results of this study suggest that consanguineous marriage affects DDAs.

Hygiene measures in antenatal care

HintergrundDie Infektionsprävention in der Schwangerenbetreuung hat eine herausragende Bedeutung, zum einen mit Blick auf die Erreger konnataler Infektionen, zum anderen durch die Assoziation von mütterlichen Infekten mit vorzeitiger Entbindung.FragestellungWelche Maßnahmen sind zur effektiven Vermeidung geburtshilflich relevanter bakterieller und viraler Erkrankungen zu empfehlen?Material und MethodeLiteraturrecherche zu Maßnahmen der Prophylaxe der Übertragung von Erregern konnataler Infektionen sowie maternaler Infektionen im geburtshilflichen Kontext.ErgebnisseDie physiologische Vaginalflora der schwangeren Frau ist ein fundamentaler Faktor der natürlichen Infektionsprävention. Ihre Störung – auch durch antimikrobielle Therapien – hat einen nachgewiesenen Einfluss auf den Schwangerschaftsverlauf (vorzeitiger Blasensprung, Frühgeburt). Sie führt aber auch zu einem gestörten intestinalen Mikrobiom beim Neugeborenen, was Langzeitfolgen für dessen neurologische, respiratorische, metabolische und immunologische Entwicklung hat und die Mortalität erhöht. Der Fokus sollte daher auf der Prävention – und nicht der Therapie – von Infektionserkrankungen in der Schwangerschaft liegen. Dazu sind in der Schwangerenbetreuung eine detaillierte Anamnese, eine Kontrolle und Aktualisierung des Impfstatus und ggf. eine Abklärung des Infektionsstatus durch gezielte serologische Tests erforderlich. Dann kann der Gynäkologe individuell zu Präventionsmaßnahmen beraten. Der Artikel gibt gezielte Empfehlungen zu ausgewählten geburtshilflich relevanten Infektionen.SchlussfolgerungenDie Fokussierung auf Hygienemaßnahmen zur Infektionsvermeidung in der Geburtshilfe kann die Gesundheit von Mutter und Kind verbessern.

Evaluation of quality of life in patients with type 2 diabetes Mellitus with symptomatic distal symmetric polyneuropathy / Avaliação da qualidade de vida em doentes com diabetes Mellitus tipo 2 com polineuropatia simétrica distal sintomática

INTRO/BACKGROUND The complications of Diabetes Mellitus (DM) are traditionally categorized as micro and macrovascular disorders. Among them, diabetic polyneuropathy (DPN) is one of the most common, presenting with or without associated neuropathic pain, and its morbidity exerts a significant impact on the quality of life (QOL) of these patients. About 50% of individuals with type 2 DM (T2DM) suffer from this condition and the distal symmetric polyneuropathy (DSPN) constitutes its most frequent clinical form. OBJECTIVE: To demonstrate the effect of symptomatic DSPN on the QOL of T2DM patients in a sample of the Brazilian population, correlating clinical and electrophysiological findings, besides comparing the results obtained by the Medical Outcomes Study Questionaire 36-Item Short Form Health Survey (SF-36) among patients with painful and non-painful diabetic DSPN. METHODS: This study comprised 25 outpatients with DSPN and T2DM submitted to a detailed anamnesis to identify clinical and demographic characteristics, besides comorbidities and complications of DM. Clinical evaluation was performed through neurological physical examination, in addition to specific scales for neuropathy as the Neuropathy Disability Score (NDS). In order to assess the health-related quality of life (HRQoL) of these patients, the SF-36 translated and adapted for the Brazilian population was applied. Nerve conduction study (NCS) was performed for the examined nerves (motor part of peroneal nerve and sensory part of the sural nerve). The following parameters were assessed: motor conduction velocity (MCV), amplitude of the compound muscle action potentials (CMAP) and amplitude of the sensory nerve action potentials (SNAP). RESULTS: Role Physical (RP) domain of SF-36 was significantly related to some of the clinical and electrophysiological factors measured. RP had an inverse and significant relationship with the NDS values (Rho: -0.44), showing the impact of neuropathy severity on these patients’ QOL. The sural nerve SNAP and peroneal nerve MCV showed a significant and positive relationship with RP (Rho: 0,52 and 0,36, respectively). The Mental Health (MH) domain showed a statistically significant difference between those patients with pain and without pain (p = 0.002), and patients without pain had higher mean values, as well as a higher minimum and maximum value. The Role Emotional (RE) domain also showed a significant difference between patients with and without pain, and patients with pain had a lower mean value (p = 0.04). For all other domains, patients with pain showed lower mean values than those without pain, however without statistical difference in the test performed. Between DM complications, only nephropathy presented statistically different RP scores from those without nephropathy (p = 0.02). CONCLUSION: There was a significant inverse relationship between the severity of DSPN and the QOL of the evaluated patients, as evidenced by lower values in the SF-36 specific RP domain, as polyneuropathy becomes more severe. This domain also presented significantly lower values in patients with associated nephropathy. The presence of pain negatively affected the QOL of patients with painful DPN, who presented significantly lower mean values in the MH and RE domains when compared to patients without pain.

Psittacosis in a traveller.

A 48-year-old male was admitted with severe community-acquired pneumonia after a family visit to turkey. Upon specific questioning he reported having close contact to a tame budgerigar. Sputum PCR for Chlamydia psittaci turned positive. After treatment adaptation to doxycycline he quickly improved. Detailed anamnesis is paramount for establishing correct diagnosis.

BORDERLINE PERSONALITY DISORDER WITH PARANOID ELEMENTS

The case of patient V is one you want to dig for, being an example in which a Cluster B disorder (i.e., borderline personality disorder) is also accompanied by elements from Cluster A (such as those in the paranoid area). Symptoms from the dependent personality can be involved.&#x0D; Objective: The presentation of a medical case of an 18-year-old young man, initially diagnosed at the age of 16 with Bipolar Affective Personality Disorder, and whose personality structure is better explained by a Borderline Disorder is the aim of the present article.&#x0D; Method: The patient was hospitalized involuntarily. He was under medical supervision and treatment. He also underwent specialized investigations (EEG, brain CT), psychological and personality tests, as well as daily monitoring. Throughout the procedure there have been a collaboration with his family and the authorities.&#x0D; Results: From the detailed anamnesis and the reconstruction of the significant life events, a borderline personality structure emerged, having a paranoid core that provided V the capacity of being goal-oriented. The personality scales also showed elements of an antisocial nature, manipulation and desire to be socially liked. Psychodynamic interpretations show an emotional flattening, avoidance of being in touch with he's own emotions and feelings, his unconscious mind housing an unbearable pain.&#x0D; Conclusions: The diagnosis of Bipolar Personality Disorder, sustained two years ago, is refuted, the patient being included in an axis II frame (i.e. borderline personality with a strong paranoid core and pathology of addiction)

Diagnostic approach and differential diagnosis of mon- andoligoarthritis

Reasons of mon- and oligoarthritis are heterogeneous. The diagnostic approach includes a detailed medical anamnesis, physical examination and imaging (conventional X-ray, sonography, MRI and, CT). Analysis of the synovial fluid is required in suspected septic arthritis and frequently helps in diagnosis and differential diagnosis of crystal arthropathies. Dual-energy-CT (DECT) detects sodium urate crystals and can replace joint puncture in some cases. In addition to crystal arthropathies and septic arthritis, differential diagnosis of mon-/oligoarthritis includes reactive arthritis, arthrosis and monarthritic courses of SpA/PsA. A rheumatologist should be consulted particularly in the case of persistent monarthritides, in order to initiate a specific therapy to prevent secondary damage.

Olfactory rehabilitation and olfactory bulb volume changes in patients after total laryngectomy: a prospective randomized study

IntroductionAfter total laryngectomy, decreased olfactory function and olfactory bulb volume shrinkage have been reported to occur due to olfactory deprivation caused by nasal airflow interruption. There is evidence that the olfactory system can be modulated by repeated exposure to odors in a procedure called olfactory training. However, it is not known whether any recovery of the lost olfactory bulb volume is possible by eliminating olfactory deprivation via olfactory rehabilitation long after laryngectomy. ObjectiveThis study examined the recovery of olfactory function and the change in olfactory bulb volume via long-term olfactory rehabilitation after total laryngectomy. MethodsPossible causes of olfactory dysfunction in the study participants were evaluated by collecting detailed anamnesis. As olfactory tests, orthonasal butanol threshold and odor discrimination tests were performed. Three-dimensional olfactory bulb volumes were calculated using manual segmentation on T2-weighted coronal magnetic resonance images. In olfactory rehabilitation, four different odors were applied to all patients orthonasally, using a larynx bypass technique for 30 min per day for 6 months. Olfactory tests were performed before the rehabilitation and after 6 months of rehabilitation, and olfactory bulb volume measurements were performed using magnetic resonance images. ResultsEleven patients diagnosed with advanced laryngeal cancer who underwent total laryngectomy and postoperative radiotherapy with a follow-up of 5–10 years were included in the study. All patients were male, and the mean age was 58.18 ± 4.17 years. In total laryngectomized patients, the olfactory bulb volumes measured on magnetic resonance images were 42.25 ± 12.8 mm3 before and 55.5 ± 11.22 mm3 after rehabilitation, and this increase was highly significant. Olfactory test scores were 2.3 ± 1.27 before and 4.39 ± 0.86 after rehabilitation, and this increase was also highly significant. ConclusionAs a result of the olfactory rehabilitation applied by providing orthonasal air flow, the olfactory function lost after total laryngectomy was improved considerably, and the olfactory bulb volume was significantly increased. The increase in olfactory bulb volume in total laryngectomy patients via olfactory rehabilitation to eliminate olfactory deprivation due to nasal airflow interruption was demonstrated for the first time in this prospective longitudinal study.

Shaken Baby Syndrome: Magnetic Resonance Imaging Features in Abusive Head Trauma.

In the context of child abuse spectrum, abusive head trauma (AHT) represents the leading cause of fatal head injuries in children less than 2 years of age. Immature brain is characterized by high water content, partially myelinated neurons, and prominent subarachnoid space, thus being susceptible of devastating damage as consequence of acceleration–deceleration and rotational forces developed by violent shaking mechanism. Diagnosis of AHT is not straightforward and represents a medical, forensic, and social challenge, based on a multidisciplinary approach. Beside a detailed anamnesis, neuroimaging is essential to identify signs suggestive of AHT, often in absence of external detectable lesions. Magnetic resonance imaging (MRI) represents the radiation-free modality of choice to investigate the most typical findings in AHT, such as subdural hematoma, retinal hemorrhage, and hypoxic-ischemic damage and it also allows to detect more subtle signs as parenchymal lacerations, cranio-cervical junction, and spinal injuries. This paper is intended to review the main MRI findings of AHT in the central nervous system of infants, with a specific focus on both hemorrhagic and non-hemorrhagic injuries caused by the pathological mechanisms of shaking. Furthermore, this review provides a brief overview about the most appropriate and feasible MRI protocol to help neuroradiologists identifying AHT in clinical practice.

Brachial Plexus Injury: Recent Diagnosis and Management

Brachial plexus injury is known to be one of the most serious upper limb injuries, causes paralysis of the upper limbs and changes in activity of daily living, with the consequence disruption of activity of daily living, socio-economic problems, depression, and hopelessness. Management must be done properly. The evaluation and examination consist of detailed anamnesis on chronological events, complete physical examination, imaging studies, and electrophysiology study. Management can be done nonsurgically and surgically. Knowledge of the history of injury, timing of surgery, priority in restoring function, and managing patient expectations are important concepts in treating patient with brachial plexus injury. Timing is a very important thing. The results of these interventions vary depending on several parameters. Recognizing the basic principles of managing brachial plexus injuries is indispensable for all clinicians who treat these injuries.

Retrospective Analysis of Patients Admitted to Otorhinolaryngology Outpatient Clinics of a Tertiary Hospital with Epistaxis

Aim: In this study, it was aimed to make a general evaluation of patients who applied to our outpatient clinic with epistaxis.Methods: The files of approximately 300 patients who were admitted to the Otorhinolaryngology outpatient clinics of a tertiary hospital with the complaint of nasal bleeding between January 2009 and January 2019 were retrospectively evaluated. The patients were analyzed in terms of age, gender, month of epistaxis, etiological factors, concomitant diseases, whether blood transfusion was required, treatment methods applied and length of hospital stay.Results: Of the 300 evaluated patients, 128 were female (42.8%) and 172 (57.2%) were male. The mean age of the patients was determined as 34.38 ± 23.63 (min 1-max: 89). The patients applied most frequently in February (14%) and at least in July (2.6%). The number of patients detected idiopathically was 240 (80%). Among the identified reasons, the most frequent use of anticoagulants was 11% and hypertension was 4.6%. Conservative treatment was applied to 98.4% of the patients. Hospitalization periods ranged from 1 to 11 days. Only 2 patients needed blood transfusion.Conclusion: Considering the possible complications and mortality; Taking detailed anamnesis from patients and planning the necessary treatment as soon as possible constitute the basis of diagnosis and treatment management in patients with epistaxis.

Headache with occipital neuralgia phenotype: Report of four cases

Background: The International Headache Society defines Occipital neuralgia as an unilateral or bilateral paroxysmal, shooting or stabbing pain in the posterior part of the scalp, in the distribution(s) of the greater, lesser and/or third occipital nerves. The most common pain trigger in this area result from chronically contracted muscles. Different aetiologies of headache with occipital neuralgia phenotype have been described. Case: We report four cases in which pain with occipital neuralgia phenotype was the initial symptom of a clivus chordoma; a para-pharyngeal carcinoma; a vertebral dissection; and a brachial plexitis due to zoster. Conclusion: A detailed anamnesis and physical examination should be performed in these patients. If during follow up atypical finding appears, we recommend head and neck gadolinium-enhanced MRI and biochemistry to exclude secondary causes.

CME: Elevated Creatine Kinase as a Diagnostic Parameter of Rhabdomyolysis

CME: Elevated Creatine Kinase as a Diagnostic Parameter of Rhabdomyolysis Abstract. Elevated CK values with or without symptoms require clarification in order to rule out possible secondary complications. Adequate hydrogenation, discontinuation of possibly triggering drugs and noxious agents, and close laboratory controls are decisive for the outcome. Acute rhabdomyolysis can have various causes, which can generally be classified as traumatic or atraumatic. In case of recurrent occurrence, genetic or autoimmunological diseases must also be excluded. In addition to a detailed anamnesis, physical examination, laboratory and urine tests, a variety of diagnostic methods are available, which should be used selectively. The aim of this work is to address possible clarification strategies, causes and differential diagnoses of an increase in creatine kinase and rhabdomyolysis. We illustrate these with a case.