Deterioration Of General Condition Research Articles

Methemoglobinemia due to local anesthesia: a rare cause of cyanosis and chest pain after placement of implantable cardioverter defibrillator.

Although methemoglobinemia is rare in adulthood, it may have fatal consequences if unnoticed. We planned to implant an implantable cardioverter defibrillator ICD in a 50-year-old male patient for primary prevention. Following sterile draping, prilocaine 5 mg/kg (400 mg) was injected subcutaneously for local anesthesia. We injected an additional dose of 200 mg due to pain during subclavian vein puncture. A DDD-R ICD was placed successfully within approximately 40 minutes. The patient complained of sudden chest pain and dyspnea 15 minutes after bed rest and was transferred to the coronary care unit due to cyanosis and deterioration of general status. Physical examination revealed blood pressure of 110/80 mmHg, pulse rate of 110 bpm, and otherwise unremarkable signs. Peripheral oxygen saturation was determined as 83% by pulse oximeter. Possible pneumothorax and cardiac perforation were excluded by emergency chest radiograph and echocardiography. Blood gas analyses was performed to assess for methemoglobinemia, which revealed pH 7.41, pCO2 40 mmHg, oxygen saturation 98.2%, and methemoglobin 7.9% that peaked to 12.3%. Methylene blue (1%) was slowly injected over 10 minutes at a dose of 1 mg/kg. Cyanosis waned and methemoglobin values decreased to 4.1%, 2.1%, and 1.1% at 2, 8, and 16 hours following the administration, respectively. The patient was safely discharged 2 days after implantation of pacemaker. Methemoglobinemia should be considered in cases presenting with cyanosis, non-diagnostic ECG, and a discrepancy in oxygen saturation between pulse oximetry and blood gas analyses.

Etiological characteristics and management of patients with epistaxis in Aksaray

Aim: Epistaxis is a common condition in humans, particularly in patients with hypertension, and is one of the most common presenting symptoms in ear, nose, and throat emergency consultation. The present study aimed to examine the treatment and hospitalization characteristics of the patients who presented with epistaxis in Aksaray city and to propose an optimized and updated protocol.Material and Methods: The present study retrospectively evaluated 758 patients who presented with epistaxis to the Training and Research Hospital in Aksaray between January 2016 and February 2020. The patients were analyzed in terms of age, sex, seasonal characteristics, hospitalization rates, pathogenesis of epistaxis, sites of bleeding, and treatments.Results: The study included 349 females (46.1%) and 409 males (53.9%); mean patient age was 60.9 ± 9.3 years (range: 3–89 years). The most common comorbidity was hypertension (47.3%), and the most common site of bleeding was the anterior region including the Kiesselbach’s plexus (88.2%). Nasal packing (58.5%) and electrocauterization (29.9%) were performed in most cases. The treatment success was defined as no instance of re-visit by the patients to the hospital due to nasal bleeding within 24 h after the procedure; the treatment was successful in 698 patients (92.1%).Conclusion: Most cases of epistaxis are successfully treated using endoscopic electrocauterization on an outpatient basis. Hospitalization is indicated if surgical intervention, posterior packing, or embolization is required and if deterioration of general condition is observed. The present study proposes an updated protocol optimized for the management of epistaxis.

Rechute d’une leucémie aigüe lymphoblastique révélée par une fissure anale

Proctological damage is very frequently encountered in acute leukemia (AL), it can be indicative of the disease and occur latter. We report the observation of a 65-year-old patient with no known comorbidities, followed for 2 years for lymphoblastic leukemia Phenotype B with PH positive, treated by GRAAPH protocol associated with a 1st generation tyrosine kinase inhibitor (TKI). She relapsed a year after the end of chemotherapy and presented with severe terminal constipation with proctalgia progressing in a context of fever, deterioration of general condition and anorexia. The clinical examination found intense paleness, performans status at 3, without organomegaly or hemorrhagic signs, the proctological examination found a large posterior anal fissure very painful with hypertonic sphincter. The biological exam shows normochromic normocytic anemia at 5g/L and thrombocytopenia at 3000 element/mm3 and blast hyperleukocytosis at 70,000 element/mm3. The bone marrow aspiration coupled with immunophenotyping confirms relapse of ALL phenotype B, and karyotype and FISH demonstrate the presence of t (9.22) and the Bcr-Abl rearrangement. A medical treatment of the fissure was instituted based on laxatives and healing ointment, associated with salvage chemotherapy and 2nd generation TKI. Proctologically, the outcome was favorable with the disappearance of proctalgia and the onset of healing of the anal fissure. On the other hand, on the hematological level, the patient was refractory to chemotherapy and died due to the evolution of her disease.

SARS-CoV-2 in Animals-Evolution and Associated Risks

It is emphasized that the medical staff is subject to a maximum risk, and so it is. Due to permanent contact with potentially contaminated patients, carriers may be infected or carry the virus. In this context, it is highlighted that veterinarians may have a high risk of infection. In the world literature, and international epizootic forums, it reports and publishes information on the presence of COVID19 in animals. Some animals have been confirmed with this virus, generally pets that come from families where there have been several carrier members. Pets that tested positive showed clinical signs of dyspnea, fever, impaired general condition, difficulty breathing. The International Office of Epizootics cites a few scattered cases in which they tested positive in laboratory tests, but their study led to some findings essential for understanding the epidemiology of the new disease. Obviously, in the case of dogs and cats found positive, the SARS-CoV-2 infection was linked to the situation of the owners, who were also positive. The thorough investigations revealed that in fact dogs and cats had not been the source of infection of the owners, but, they contracted the infection from their owners. And more clearly, it was not humans who turned out to be victims of animals, but vice versa. Among pets, cats and ferrets are the most blamed, they were also present in clinical manifestations and may possibly transmit the disease to other cats. Dogs don’t seem to be as sensitive. Veterinary medicine is in this situation caught in the middle: on the one hand it is obliged to investigate the possible source of animal infection, using its own and specific means of investigation, but on the other hand it has the professional duty to defend the innocence of some animal species, unjustly suspected and possibly incriminated. Let’s not forget that Covid 19 is a syndrome not a specific disease, and therefore clinical confusions are not impossible.

Clinical case of a noncompaction cardiomyopathy with restrictive filling diastolic dysfunction in a 5-year-old girl

Noncompaction cardiomyopathy is a rare cardiomyopathy, which is characterized by trabeculations and deep intratrabecular recesses, forming a sponge-like appearance of the myocardium. Clinical variability is possible – from asymptomatic patients to congestive heart failure, tromboembolic complications, and even sudden cardiac death. Two-dimensional echocardiography is the preferred diagnostic tool, based on specific criteria, which are not yet definite. Discovery of specific genetic mutations support the diagnosis. The main therapeutic approach is symptomatic – treatment of congestive heart failure and anticoagulant medications. We present a case of a 5-year-old girl, without a family history of chronic diseases, who was referred to our department because of a fever, cough and bilateral pneumonia. Upon admission she was with impaired general condition, with signs of respiratory and congestive heart failure. Echocardiography examination demonstrated noncompaction cardiomyopathy, mostly for the left ventricle, with leading diastolic left ventricular dysfunction with restrictive filling pattern, evaluated by tissue doppler, and pulmonary hypertension. This clinical case demonstrates the rare combination of noncompaction cardiomyopathy with restrictive left ventricular filling pattern, clinically manifested by congestive heart failure and pulmonary hypertension.

Acute respiratory viral infections in children

Acute respiratory viral infections in children lead in the structure of child morbidity. The defeat of the upper respiratory tract accompanied by fever and impaired general condition, the main symptoms of acute respiratory viral infections. Diagnosis of most acute respiratory viral infections is based on the assessment of clinical manifestations and does not require the use of specific laboratory and instrumental methods. Modern approaches to treatment are timely and adequate symptomatic therapy.

Efficiency and safety of phenylephrine and tropicamide used in premature retinopathy: a prospective observational study

BackgroundTo determine effects and side effects of topical application of phenylephrine 2.5% and tropicamide 0.5% combination in preterm infants.MethodsIn this prospective observational study, 60 infants undergoing retinopathy of prematurity (ROP) screening were prospectively observed. Pupillary diameter, blood pressure, heart rate, and oxygen saturation were monitored before and after up to 24 h during ROP screening examinations.ResultsThe mean pupillary diameter 1 h after the instillation of drops was 5.58 ± 0.75 mm for both eyes. The mean systolic and diastolic pressure and oxygen saturation of infants did not change statistically until the end of the study. The average heart rate decreased by a mean of 4.96 beats/minute from the baseline following eye drops instillation. General condition deterioration, fall in oxygen saturation and bradycardia were observed in 4 infants that already had respiratory distress syndrome.ConclusionThe phenylephrine 2.5% plus tropicamide 0.5% drop is effective and safe as mydriatic combination for retinopathy of prematurity screening. In infants with an additional systemic disease such as respiratory distress syndrome, the side effects of mydriatic drops may be more common. Such babies should be kept under close observation.Trial registrationThe trial was retrospectively registered on 28 February 2018. The ClinicalTrials.gov Identifier is NCT03448640.

Outcomes in children evaluated but not transported by ambulance personnel: retrospective cohort study

BackgroundNot all children with an out-of-hospital emergency medical contact are transported by ambulance to the emergency department (ED). Non-transport means that after on-scene evaluation and possible treatment, ambulance personnel may...

An endometrial cancer patient with sudden loss of consciousness

Abstract A 67-year-old female patient with metastatic endometrial cancer received carboplatin and paclitaxel combination therapy as the first-line treatment due to chronic kidney disease (Cr 1.18 mg/dL, eGFR 35.8 mL/min/1.73m2). Her electrocardiogram and ejection fraction (63.8%) before the start of chemotherapy were normal. On cycle 2 day 11, she had an emergency visit due to persistent severe nausea. Laboratory studies revealed that she had acute kidney injury (Cr 2.45 mg/dL, eGFR 16.1 mL/min/1.73m2), severe electrolyte imbalance (Na 130 mmol/L, K 3.0 mmol/L, Cl 83 mmol/L, corrected Ca 8.6 mg/dL, and Mg 1.4 mg/dL), and no CK elevation (85 IU/L). She was admitted as an emergency case and received intravenous fluids and antiemetic drugs, but response was poor. On cycle 2 day 13, she experienced sudden loss of consciousness. An electrocardiogram showed intermitted torsade de pointe (TdP) and long QT interval (QTc 536 ms), and she was transferred to the coronary care unit. Additional laboratory studies found persistent severe electrolyte imbalance (Na 130 mmol/L, K 2.8 mmol/L, Cl 90 mmol/L, corrected Ca 8.1 mg/dL, and Mg 1.2 mg/dL), no hypothyroidism and reduced left ventricle contraction (ejection fraction 36.2%). Carboplatin can trigger renal tubular dysfunction and electrolyte imbalance. In addition, QTc alterations have been reported with the use of both carboplatin and paclitaxel regardless of electrolyte imbalance. On this basis, a diagnosis of chemotherapy-induced long QT syndrome which led to TdP was made, although the baseline chronic kidney disease might also have been involved. Because of the lack of tumor response and deterioration of general condition, chemotherapy was terminated, and she was transferred to a hospice. The occurrence of TdP is a rare but potentially life-threatening cardiotoxicity. Because many anticancer treatments are known to prolong the QT interval through a variety of mechanisms, clinicians should keep this potential in mind.

P14.87 Leptomeningeal dissemination in high grade glioma: Correlation of MRI, cytology and standard CSF indices

Abstract BACKGROUND Only few studies report the incidence of leptomeningeal dissemination (LMD) in patients with high grade glioma (HGG), although LMD is not a rare condition of recurrence. We aimed to describe the diagnostic features and treatment modalities in a series of patients treated for HGG in our institution. METHODS Review of clinical presentation, radiological features and CSF analysis in a case series. RESULTS 17 patients from our institution were diagnosed with LMD. The diagnosis of LMD was based on magnetic resonance image and/or cerebrospinal fluid (CSF) analysis. The spectrum of clinical presentation was broad, mainly intracranial hypertension, impaired general condition, pain, worsening of pre-existing symptoms, and epileptic seizures. Median time from onset of clinical deterioration to diagnosis of LMD was 3 weeks (0–16). Leptomeningial involvement was reported in 6/17 at initial MRI reading, whereas reassessment with careful comparison to previous MRI showed signs of LMD in all patients. CSF analysis revealed pleocytosis (11/17), high proteinorrachia (13/17), elevated lactate levels (15/16), low glucose levels (5/17), and increased CSF pressure (5/9). Nevertheless, diagnostic accuracy of initial CSF cytological analysis was low (2/17). A reassessment of the specimen by an experienced neuropathologist disclosed 1 additional positive and 1 additional suspect cytology. After diagnosis of LMD, salvage treatments comprised Bevacizumab, Lomustine, Fotemustine, liposomal cytarabine and best supportive care. The median overall survival after the diagnosis was 3 months. DISCUSSION AND CONCLUSIONS LMD in HGG is not a rare condition of recurrence, and its outcome is poor. It remains a diagnostic challenge, as it may be overlooked on MRI follow-up at its early stage. In case of clinical progression with no overt cause reported on MRI, we recommend careful second MRI reading. In case of doubt lumbar puncture should be performed in order to prove LMD and eliminate infection (i.e. HSV). Upon standard CSF indices, elevated lactate levels should give rise to the suspicion of LMD. Cytological CSF analysis seems to be of low diagnostic yield: This may be improved by faster processing after sampling and by standardized workup including staining with IDH, GFAP and Olig2.

Laparoscopic colectomy after transcatheter aortic valve implantation in an elderly patient with obstructive descending colon cancer and severe aortic stenosis: a case report

BackgroundThe demand for laparoscopic colectomy is increasing due to greater number of elderly colon cancer patients, and it is important to evaluate existing comorbidities to ensure perioperative safety. Aortic stenosis (AS) is one of the most common heart diseases in the elderly, and elderly cancer patients with severe AS may be considered ineligible for optimal cancer treatment if they cannot endure surgical aortic valve replacement (SAVR). Recently, transcatheter aortic valve implantation (TAVI) has become a valid option in patients who are high risk for SAVR. We herein present the first case of an elderly cancer patient with severe AS who underwent laparoscopic colectomy after TAVI.Case presentationAn 87-year-old woman with a history of multiple cardiovascular diseases was diagnosed with obstructive descending colon cancer and initially underwent colonic stenting. However, as preoperative echocardiography revealed severe AS, she underwent TAVI prior to the colectomy to reduce perioperative risk. TAVI was chosen instead of SAVR due to high SAVR mortality risk, and laparoscopic colectomy was performed 22 days after TAVI. Her postoperative course was uneventful, and she was discharged 14 days later without any deterioration in general condition. No recurrence was observed at more than 1 year, even without adjuvant therapy.ConclusionTAVI facilitated subsequent laparoscopic colectomy in an elderly cancer patient with severe AS. Our case report shows that TAVI may enable further cancer treatment even in patients with severe AS, who may otherwise be considered not suitable for such treatments.

Feed refusal in fattening bulls because of maize silage contamination by Jimson weed (Datura stramonium)

A sudden decrease in feed intake (within 24 hours) without an impaired general condition occurred on a bull-rearing and -fattening farm in western Germany in December 2017. One day later, some of the bulls displayed signs of ruminal tympany (free gas bloat) and the reduction in feed intake became more severe. The maize silage was recognized as the cause of the observed symptoms, because clinical signs first appeared after taking the silage from a different localization within the bunker silo. Maize in this particular section was harvested from a separate area previously affected by wind damage (numerous bent maize plants), where no crop protection (herbicide application) was performed. Fruits and seeds of Jimson weed were identified in the incriminated maize silage samples. Following replacement of the contaminated parts of the maize silage with non-contaminated material and treatment of the clinically affected animals (anti-tympanic medication plus live yeast preparation), the feed intake returned to the normal level and the affected animals recovered within 6 days. The cause of the symptoms was probably the anti-nutritive properties of Datura stramonium that affect the motor function of the gastrointestinal tract.

Tuberculome cérébral un challenge diagnostic: à propos d’un cas et mise au point

La tuberculose du système nerveux central est le deuxième site le plus fréquent après la méningite tuberculeuse. Elle est une cause majeure de morbidité et de mortalité dans les pays en développement et représente 10 à 30% des lésions expansives intracrâniennes dans ces pays contre 0,2% dans certains pays occidentaux. Le but de cet article est de présenter un cas atypique de tuberculome cérébral dans sa présentation clinique et radiologique (l'IRM cérébrale et de la spectroscopie), de faire une mise au point à partir de cette observation sur cette pathologie infectieuse. Il s'agit d'une patiente de 44 ans, sans antécédent médico-chirurgical, qui a présenté depuis un an des céphalées, compliquées 08 mois après de crises d'épilepsies partielles à généralisation secondaire et de lourdeur de l'hémicorps gauche avec des épisodes de vomissements sans trouble visuel ni fièvre ni altération de l'état général. L'examen clinique trouvait une patiente consciente GCS= 15, pupilles égales et réactives, station debout et marche possible sans anomalie, avec hémiparésie gauche 4/5 sans autres signes neurologiques. L'IRM cérébrale objectivait en séquence T1 non injectée une lésion pariétale droite sus tentoriel plurilobées iso intense mal limitée, en séquence T2 elle est hétérogène avec un liseré hyper intense et un fond hypo intense traduisant un processus charnu avec des zones de nécroses centrales et un œdème péri-lésionnel en doigt de gans en séquence FLAIR, avec une prise de contraste annulaire intense après injection de gadolinium. L'analyse de la spectroscopie était en faveur d'une tumeur gliale. La patiente fut mise sous anticonvulsivant et a bénéficié d'un abord direct avec exérèse macroscopiquement complète. L'analyse anatomopathologique était en faveur d'un tuberculome cérébral. Elle a été mise sous traitement antituberculeux avec arrêt des crises et récupération du déficit après 04 semaines. A travers ce cas nous entrevoyons le polymorphisme clinique et radiologique qu'est le tuberculome cérébral. Il est évoqué devant un faisceau d'argument clinique, biologique et radiologique mais le diagnostic de certitude reste essentiellement anatomopathologique. La prise en charge ne saurait tarder car les complications sont néfastes et de mauvais pronostic lorsqu'il est détecté tardivement.

Acute hemorrhagic edema of infancy

In infants less than 2 years of age, acute hemorrhagic edema of infancy (AHEI) is characterized by the rapid onset of annular purpuric lesions associated with initially localized edemas affecting the extremities. This disorder is usually benign, without visceral involvement. Diagnosis is based on clinical examination, no specific laboratory findings exist and the histological examination of the lesions (which is unnecessary in the majority of cases) is most often nonspecific (sometimes patients have nonspecific leukocytoclastic vasculitis). Nosological status of AHEI remains unclear, but some reports suggest it is a clinical manifestation of rheumatoid purpura. Rhinopharyngeal episodes in the days before its onset have sometimes been reported, suggesting a viral cause. There is a net mismatch between patient's good general condition and the remarkable dissemination of the lesions. Infants monitoring must be rigorous in the first days, even though complications are exceptional (acute intussusception). Patients recover spontaneously within 12 days. Therapeutic management is based on accurate monitoring of the infant's general status. Fever, the extension of the purpuric lesions and, in particular, signs of impaired general condition may suggest the diagnosis of purpura fulminans. Another differential diagnosis is acute hemorrhagic or ecchymotic urticaria. We here report the case of a 3-month old infant with diffuse pseudoannular lesions within a context of apyrexy and preservation of patient's general condition. Patient's outcome was favorable without any treatment, confirming the diagnosis of AHEI.

Un syndrome coronaire aigu particulier : maladie de Horton

The pathophysiology of acute coronary syndromes is in most cases due to the erosion or rupture of a plaque with consequent thrombotic obstruction of coronary artery. In a few cases, the mechanism is different, this not modifying the initial management but imposing special techniques for diagnosis and therapeutic management. We report a clinical case of a patient supported for an acute coronary syndrome, in a context of impaired general condition and biological inflammatory syndrome revealing a Horton's disease.

Manifestation of malaria in Mangaluru, southern India

BackgroundSevere and fatal vivax malaria is increasingly reported from India. In Mangaluru, southern India, malaria is focused in urban areas and associated with importation by migrant workers. In Wenlock Hospital, the largest governmental hospital, the clinical, parasitological and biochemical characteristics of malaria patients were assessed.MethodsDuring the peak malaria season in 2015 (June to December), outpatients were interviewed and clinically assessed. Malaria was ascertained by microscopy and PCR assays, concentrations of haemoglobin, creatinine and bilirubin, as well as thrombocyte count, were determined, and severe malaria was defined according to WHO criteria.ResultsAmong 909 malaria patients, the vast majority was male (93%), adult (median, 26 years) and of low socio-economic status. Roughly half of them were migrants from beyond the local Karnataka state, mostly from northern and northeastern states. Vivax malaria (69.6%) predominated over mixed Plasmodium vivax–Plasmodium falciparum infection (21.3%) and falciparum malaria (9.0%). The geometric mean parasite density was 3412/µL. As compared to vivax malaria, patients with falciparum malaria had higher parasite density and more frequently showed impaired general condition, affected consciousness and splenomegaly. Also, they tended to more commonly have anaemia and increased creatinine levels, and to be hospitalized (7.3%). Mixed-species infections largely assumed an interim position. Severe malaria (3.5%) was not associated with parasite species. No fatality occurred.ConclusionIn this study, uncomplicated cases of malaria predominated, with P. falciparum causing slightly more intense manifestation. Severe malaria was infrequent and fatalities absent. This contrasts with the reported pattern of manifestation in other parts of India, which requires the analysis of underlying causes.

Epidemiological specificities of acute metabolic decompensation in diabetes: Case of tertiary healthcare center in Tunisia

Introduction Diabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. It is considered a major public health problem with significant social and economic consequences. Yet, it continues to have an upward trend worldwide. Acute complications of diabetes remain relatively frequent, for which these patients continue to consult the emergencies. It can lead to increase morbidity and mortality if not efficiently and effectively treated. The aim of this work is to specify the epidemiological and some clinical characteristics of patients consultants at the emergency department of the university hospital center Farhat Hached of Sousse (Tunisia) for acute complications. Materials and methods We conducted a prospective study of 168 consecutive patients who were admitted to emergency department at the Farhat Hached University Hospital Center, Sousse, Tunisia between January 2016 and July 2016 for acute decompensation of diabetes and whose age is older than 15 years. We included the five types of acute complication diabetic has to know: the hyperglycemia, hypoglycemia, the hyperglycemic hyperosmolar state, the ketosis and the ketoacidosis. Study was performed using a pre-tested questionnaire completed by the doctor at emergency department. Main sources of data were patients’ medical records, anamnesis and clinical examination. Variables measured were related to: patients’ general characteristics, clinical profiles, etc. For each estimate, a confidence interval was calculated according to the conventional formula. When the application conditions of the conventional formula were not met, the Wilson procedure with continuity correction was used. Results The mean age of patients was 45 ± 17.7 years. Almost 83.9% of them were under the age of 65 years with extremes ranging from 16 to 87 years and predominately female (53.6%). Among all cases, 35.7% reported that they fortuitous discovered that they are diabetic versus 64.3% who are already diagnosed with diabetes. According the type of diabetes, we noted that type 1 diabetes mellitus (T1DM) were more frequent than type 2 (T2DM) (59.25% versus 40.75%), 71 patients (65.74%) were treated by insulin including 27 patients with T2DM. The proportions of acute complications in decreasing order were ketosis (36%), ketoacidosis (30%), hyperglycemia (25%), hypoglycemia (25%) and finally hyperglycemic hyperosmolar state (2%). Concerning hypoglycemia, it was significantly predominant in T1DM (P = 0.004). Thus, no cases of lactic acidosis has been noted in our cohort. The major reasons of consultations were no specific one such as fever, chest pain (25.6%) and deterioration of general status (20.8%). Inaugural diabetes and poor compliance to treatment were mostly the precipitating causes of acute complications with percentages of 32.2% and 31.6%, respectively. Furthermore, anamnesis and clinical examination revealed that 37.9% of patients were at degenerative complications stage. One case of death at emergency was reported. Conclusion Diabetic Ketosis and ketoacidosis are still frequent complications and commonly encountered medical emergencies among patients with diabetes mellitus. Hypoglycemia is significantly more observed with T1DM. Henceforth, diabetes and its complications are preventable. More emphasis is required in order to decrease the prevalence of diabetes and to improve the prognosis in the short- and long-term. This concern should be shared by all healthcare providers and not be limited only to clinical experts.

Descending necrotizing mediastinitis after sequestrectomy in a patient with bisphosphonate-induced osteonecrosis of the jaw: A case report.

An 83-year-old woman underwent mastectomy for breast cancer of the right breast in 2008. In addition to hormone therapy and irradiation, zoledronate was started for bone metastasis 6 months postoperatively. Five years after the operation, the patient developed osteonecrosis of the jaw, and underwent sequestrectomy because of uncontrollable pain in the mandible. The patient visited our hospital for a 1-week history of fever and right facial swelling with pain, and was diagnosed with right mandibular cellulitis. Despite antibiotic therapy, the patient fell into shock. Follow-up computed tomography showed gas formation extending down to the posterior mediastinum, which was compatible with descending necrotizing mediastinitis (DNM). The patient succumbed to septicemia on the third hospital day. The mortality rate of DNM greatly increases in patients with advanced cancer because clinicians cannot perform radical treatment due to the impaired general condition and limited life expectancy. DNM advances by the hour; therefore, repeated computed tomography is essential when antibiotic therapy does not improve the patient's condition. Attention must be paid to detect signs of DNM in such patients. To the best of our knowledge, this is the first report in English regarding DNM caused by bisphosphonate-induced osteonecrosis of the jaw.

Hepatobiliary diseases in people with HIV infection at the Lome, Togo, University Hospital: epidemiologic and diagnostic aspects.

To determine the epidemiological and diagnostic aspects of hepatobiliary diseases in people with HIV infection at the Lomé University Hospital. This 5-year retrospective descriptive and analytic study included all people with HIV infection aged 15 years and older of either sex admitted with a hepatobiliary disease. Among all patients admitted for hepatobiliary diseases, people with HIV infection accounted for 2%. They were predominantly women. Our patients' mean age was 43.03±10.3 years. The principal reasons for consultation were asthenia (95.2%), jaundice (93.7%), and abdominal pain (80.9%). The main clinical symptoms were by deterioration of general status (84.1%) and pain of the right hypochondrium (66.7%); 63.5%were classified at WHO disease stage III or IV for HIV infection and disease. All our patients were positive for HIV1; and 86.5% had a CD4 count < 350 cells/mm3. We noted HVB/HIV coinfection in 39.6% and HVC/HIV coinfection in 19%. Cirrhosis had been diagnosed in 44.4%, hepatocellular carcinoma in 12.6%, and toxic or drug-induced hepatitis in 46%, while 8% had acute acalculous cholecystitis. No case of alcoholic steatohepatitis or AIDS cholangiopathy was noted. Hepatobiliary diseases are infrequent and varied among people with HIV infection; the most common are toxic hepatitis, cirrhosis, and hepatocellular carcinoma, and they do not differ according to CD4 counts.

Urinary tract infections in the geriatric patients

Objective:Urinary tract infections (UTI) are the second most common infection in geriatric population. This study investigated clinical findings, diagnostic approaches, complicating factors, prognosis, causative microorganisms and antimicrobial susceptibility in geriatric patients diagnosed with UTI.Methods:A total of 140 hospitalised patients with UTIs were evaluated within three years between January 2011-January 2015 at the Eskisehir Yunus Emre State Hospital. UTI diagnosed when there were systemic and urinary signs and symptoms and a positive dipstick test and urine culture result, leukocyte and CRP like serum parameters.Results:Among the studied patients, 41.4% had urological diseases, 20.7% had diabetes mellitus and 19.2% had neurological diseases. The most common symptoms and signs were fever, dysuria nausea/vomiting, general condition impairment, pyuria, haematuria. The laboratory values for CRP, ESR and leukocyte count were 84 mg/dL, 56 mm/s and 11.9 (10^3μL), with mean values being determined. Among patients having a urinary catheter (17.1%), 27.9% had a history of UTI, while 29.3% had been hospitalised. Escherichia coli and Klebsiella pneumoniae were the most commonly identified microorganisms. The mean duration for hospitalisation was 7.6 days, while a 5% mortality rate was observed over the course of the disease.Conclusion:Because of the potential for serious complications and mortality, elderly patients with urinary tract infection, should receive immediate empirical treatment based on anamnesis, clinical evaluation and urinalysis and should be re-examined using results from cultures and antibiograms upon follow-up.