High Degree Of Clinical Awareness Research Articles

Don't Miss Me: Midfoot Sprains, A Point-of-Care Review.

Athletes practicing high-contact sports are exposed to an increased risk of midfoot injuries, namely midtarsal sprains. The complexity of reaching an accurate diagnosis is clearly depicted in the reported incidence of midtarsal sprains, ranging from 5% to 33% of ankle inversion injuries. Because the focus of the treating physician and physical therapist is on lateral stabilizing structures, midtarsal sprains are missed at initial evaluation in up to 41% of patients, with delayed treatment as a result.Detecting acute midtarsal sprains requires a high degree of clinical awareness. Radiologists must become familiar with the characteristic imaging findings of normal and pathologic midfoot anatomy to avoid adverse outcomes such as pain and instability. In this article we describe Chopart joint anatomy, mechanisms of midtarsal sprains, clinical importance, and key imaging findings with a focus on magnetic resonance imaging. A team effort is essential to provide optimal care for the injured athlete.

ISOLATED ENTERIC SPLENIC LESION IN AN IMMUNOCOMPETENT HOST: AN INTERESTING CASE REPORT

Splenic abscess is often an unrecognized complication of enteric fever. Diagnosis is difficult because of its rarity, insidious onset, and non-specific presentation. We report an interesting case of splenic lesion in an immunocompetent adolescent with no other comorbidities, who presented with history and clinical presentation more suggestive of tubercular etiology. However, culture from the CT-guided fine-needle aspirate grew Gram-negative bacilli, identified as Salmonella Typhi which was sensitive to ampicillin, cotrimoxazole, azithromycin, and ceftriaxone. He responded favorably with oral antibiotics without any further surgical intervention. High degree of clinical awareness with timely and appropriate microbiological evaluation helped into an early definitive diagnosis of enteric splenic abscess. This case highlights that in this era of emerging infections, we should not miss the atypical presentations of the endemic diseases. Safe and minimally invasive radiological intervention with good microbiological correlation is a successful spleen conserving treatment alternative to surgery in suitable patients of splenic abscess.

Pulmonary bullet embolism following cardiac gunshot wound: case report of a bullet that traversed the heart twice

BackgroundCardiac gunshot wounds with bullet embolism (BE) into the pulmonary artery are rare. Most pulmonary BE follow injuries of peripheral veins without concomitant cardiac injury. Herein, we describe a case of cardiac gunshot injury in which the bullet migrated from right atrium through the inferior vena cava down to right internal iliac vein and back to the left pulmonary artery. Such bullet migration is too rare and unusual and to our knowledge not reported before.Case presentationOn March 4, 2019, a man of 39 had a bullet injury during celebratory gunfire. He was clinically stable with entrance on right posterior chest but no exit. Chest CT scan showed a bullet in the right atrium. The next day, the bullet migrated to the right pelvis as shown by plain chest and pelvic radiographs. CT angiography 3 weeks afterwards displayed the bullet in the right internal iliac vein. Meanwhile, the patient was asymptomatic, thus discharged home. However, 3 months later, he was readmitted because of chest pain, dyspnea, and sweating. A repeat chest CT scan showed the bullet in the left lower lobe pulmonary artery. Hence, pulmonary BE was suspected and eventually a 0.36 bullet was removed via left thoracotomy.ConclusionsThis is a case of symptomatic venous BE with typical diagnostic criteria (a small low-velocity bullet with inlet but no exit located away from anticipated trajectory with migration proven by serial radiographs). Endovascular removal was preferred but was not available. BE of the heart is exceedingly rare. Hence, diagnosis requires a high degree of clinical awareness.

Transmission and prevention of acute viral respiratory tract infections in hospitals.

Transmission of acute respiratory tract viral infections in healthcare environments is a major problem worldwide. We review recent literature of viruses imported to hospitals from the local community and from abroad, their modes of transmission and measures required to reduce and contain them. Common causes of outbreaks include influenza viruses, respiratory syncytial virus, adenovirus, and coronaviruses. Major lethal outbreaks of viral respiratory infections in hospitals have been caused by coronaviruses imported from abroad by travelers. Although viruses circulating in the local community are common causes of hospital outbreaks, major outbreaks have been caused by the coronaviruses imported from abroad by travelers. A high degree of clinical awareness and rapid enforcement of infection control measures are required to prevent transmission and spread.

THE PATIENT HAS LISTERIOSIS MENINGITIS AT 33-34 WEEKS OF PREGNANCY. THEMULTIDISCIPLINARY SOLUTION

In connection both with the continuing prevalence of the listeriosis disease, and polymorphism of clinical manifestations, as well as the high lethality rate, it is necessary to better understand this problem. Listeriosis infection often affects patients with the weakened immunity, the elderly persons, pregnant women, and newborns. In particular, in pregnant women, the risk of infection with listeriosis is 18 times higher than in the general population. This feature is due to cell-mediated immune suppression in pregnant women and placental tropism of the causative agent of listeriosis L. monocytogenes. The problem of listeriosis during pregnancy includes the maternal, fetal and neonatal disease. Listeriosis in a pregnant woman is usually characterized by a sharp onset, rapid development, and a high incidence, and often it does not take much trouble. Along with this, there are cases of asymptomatic, complicated and atypical variants of the disease, which requires a high degree of clinical awareness of various specialists and the implementation of adequate screening. Fetal listeriosis is characterized by the high mortality rate amounting to up 25-35%, depending on the gestational age at the time of the onset of infection. Clinical manifestations of listeriosis in newborn infants depend on the time and pathway of infection (antenatal or intranatal infection). Neonatal listeriosis can manifest as sepsis or meningitis with severe consequences and high mortality rate (up to 20%). The appropriate treatment of maternal listeriosis is aimed at preventing the fetal disease, it also has important therapeutic value for newborn babies. The empirical use of antibiotics may appear to be ineffective for listeria. Amoxicillin or ampicillin are at the first line of the treatment in pregnant women, alone or in the combination with gentamycin, followed by trimethoprim /sulfamethoxazole. The aim of the work is to summarize the available knowledge about the problem of listeriosis, including the features of the course of the disease during pregnancy, with presenting the example of a clinical case. The article reports a clinical case demonstrating the clinical problem of listeriogenic meningitis in a pregnant woman aged 35 years. Data showing different treatment strategies are also presented.

Topiramate Induced Myopic Shift With Anterior Angle Closure In A 16 Year Old Female

Topiramate is a commonly prescribed medication in the adult and pediatric population. It is most commonly used in migraine prophylaxis. This case report focuses on an uncommon but potentially dangerous side effect of topiramate use, and how it affects the ocular system of the patients that use it. This case increases awareness of Topiramate usage in the pediatric population. It also demonstrates need for high degree of clinical awareness, so treatment can be initiated promptly to lower risk of long-term squeal.

Risk factors associated with pulmonary tuberculosis

Tuberculosis (TB) remains a global emergency and continues to kill 1.4 million people every year. The interaction between noncommunicable and infectious diseases like TB has important implications with regard to the attainment of the Millennium Development Goals (MDGs). Smoking, diabetes mellitus, anti-TNFα drugs and other immunosuppressive therapies are well known major risk factors associated with TB. The purpose of this review is to summarize the recent literature on these risk factors and interventions that reduce the risk. Mathematical models and aggregate data from the field show that smoking, diabetes and anti-TNFα drugs independently increase the risk of developing active TB. There is consensus on the great need for screening for active TB disease in patients with these conditions and targeted preventive interventions through a combined multidisciplinary approach. Smoking, diabetes mellitus, anti-TNFα drugs and new immunosuppressive treatments represent important common risk factors for TB. A high degree of clinical awareness of the possibility of TB should be considered in patients with these risk factors, and active screening and prevention should be undertaken. Further operational research is needed to optimize screening for latent Mycobacterium tuberculosis infection, instituting preventive intervention measures.

Update on the Diagnosis, Treatment, and Prognosis of the Catastrophic Antiphospholipid Syndrome

The catastrophic antiphospholipid syndrome (APS) is a potentially life-threatening condition, the diagnosis of which requires a high degree of clinical awareness on the part of attending physicians. Patients with APS present with 1) clinical evidence of multiple organ involvement developed over a very short time; 2) histopathologic evidence of multiple small-vessel occlusions; and 3) laboratory confirmation of the presence of antiphospholipid antibodies, usually in high titer. A combination of anticoagulants, corticosteroids, intravenous immunoglobulins, and plasma exchanges is the basic treatment for all patients with this severe condition. Unfortunately, despite current therapies, the mortality rate is still high (around 30%). However, once patients with catastrophic APS have recovered, they usually follow a stable course with continued anticoagulation and few patients present with a relapse of the catastrophic episode.

Coenzyme Q 10 : a progress towards the treatment of neurodegenerative disease

Coenzyme (, or ubiquinone) is an electron carrier of the mitochondrial respiratory chain (electron transport chain) with antioxidant properties. In view of the involvement of in oxidative phosphorylation and cellular antioxidant protection a deficiency in this quinone would be expected to contribute to disease pathophysiology by causing a failure in energy metabolism and antioxidant status. Indeed, a deficit in status has been determined in a number of neuromuscular and neurodegenerative disorders. Primary disorders of biosynthesis are potentially treatable conditions and therefore a high degree of clinical awareness about this condition is essential. A secondary loss of status following HMG-CoA reductase inhibitor (statins) treatment has been implicated in the pathophysiology of the myotoxicity associated with this pharmacotherapy. and its analogue, idebenone, have been widely used in the treatment of neurodegenerative and neuromuscular disorders. These compounds could potentially play a role in the treatment of mitochondrial disorders, Parkinson's disease, Huntington's disease, amyotrophic lateral sclerosis, Friedreich's ataxia, and other conditions which have been linked to mitochondrial dysfunction. This article reviews the physiological roles of , as well as the rationale and the role in clinical practice of supplementation in different neurological diseases, from primary deficiency to neurodegenerative disorders. These will help in future for treatment of patients suffering from neurodegenerative disease.

Coenzyme Q10 in Neuromuscular and Neurodegenerative Disorders

Coenzyme Q10 (CoQ10, or ubiquinone) is an electron carrier of the mitochondrial respiratory chain (electron transport chain) with antioxidant properties. In view of the involvement of CoQ10 in oxidative phosphorylation and cellular antioxidant protection a deficiency in this quinone would be expected to contribute to disease pathophysiology by causing a failure in energy metabolism and antioxidant status. Indeed, a deficit in CoQ10 status has been determined in a number of neuromuscular and neurodegenerative disorders. Primary disorders of CoQ10 biosynthesis are potentially treatable conditions and therefore a high degree of clinical awareness about this condition is essential. A secondary loss of CoQ10 status following HMG-Coa reductase inhibitor (statins) treatment has be implicated in the pathophysiology of the myotoxicity associated with this pharmacotherapy. CoQ10 and its analogue, idebenone, have been widely used in the treatment of neurodegenerative and neuromuscular disorders. These compounds could potentially play a role in the treatment of mitochondrial disorders, Parkinson's disease, Huntington's disease, amyotrophic lateral sclerosis, Friedreich's ataxia, and other conditions which have been linked to mitochondrial dysfunction. This article reviews the physiological roles of CoQ10, as well as the rationale and the role in clinical practice of CoQ10 supplementation in different neurological and muscular diseases, from primary CoQ10 deficiency to neurodegenerative disorders. We also briefly report a case of the myopathic form of CoQ10 deficiency.

Infants hospitalised with pertussis: Estimating the true disease burden

New Zealand (NZ) has a large pertussis disease burden compared with other developed countries. Accurate ascertainment of disease burden is fundamental to controlling pertussis and informing immunisation policy. Disease burden estimates are primarily from passive surveillance, which underestimates disease incidence. The aim of this study is to use active surveillance to determine pertussis disease burden in infants hospitalised in NZ. Using the NZ Paediatric Surveillance Unit, active surveillance from 08/2004 to 07/2005 for infants <12 months old, hospitalised with pertussis. 110 infants identified (196 per 100,000), including six with complications, eight intensive care admissions and one death. The hospitalisation rate (per 100,000) varied with ethnicity, being higher for Maori (296) and Pacific (358) compared with European/other (117). Twenty-four per cent were too young to be immunised. Of infants 6 weeks and older 46% had received no immunisations. Despite being more likely to be immunised Pacific infants had a higher hospitalisation rate owing to a larger proportion acquiring pertussis prior to age 6 weeks. Cyanosis and apnoea were frequent symptoms in young infants. Under-identification, estimated using capture-recapture analysis, was modest for both active surveillance (16%) and passive notification (19%). Infant pertussis hospitalisation rates are three to six times greater than rates in the USA, England and Australia. Underestimation of disease burden by passive notification in hospitalised infants is modest, suggesting a high degree of clinical awareness by paediatricians in NZ. New immunisation strategies are needed to protect infants from a younger age.

Catastrophic antiphospholipid syndrome: therapeutic developments

The catastrophic antiphospholipid syndrome is a potentially life-threatening condition with a high mortality rate, the diagnosis of which requires a high degree of clinical awareness on the part of attending physicians. Patients with this syndrome have various symptoms in common: clinical evidence of multiple organ involvement developed over a very short time period, histopathological evidence of multiple small-vessel occlusions and laboratory confirmation of the presence of antiphospholipid antibodies, usually in high titers. The combination of high doses of intravenous heparin, steroids, γ-globulins and/or repeated plasma exchanges are the basic treatment of choice for all patients with this severe condition.

Catastrophic Antiphospholipid Syndrome

The catastrophic antiphospholipid syndrome is a potentially life-threatening condition with a high mortality, which requires a high degree of clinical awareness on the part of attending physicians. Patients with this syndrome have in common: a) clinical evidence of multiple organ involvement developed over a very short time period; b) histopathological evidence of multiple small vessel occlusions, and c) laboratory confirmation of the presence of antiphospholipid antibodies, usually in high titre. The combination of high doses of intravenous (iv) heparin, iv steroids, iv gamma globulins and/or repeated plasma exchanges is the basic treatment of choice for all patients with this severe condition.

Angiosarcoma de bajo grado tras radioterapia en cáncer de mama

Angiosarcoma of the skin (AS) is a rare complication of radiotherapy. It is characterised by its aggressive clinical progression and is distinct from other forms of angiosarcoma in that it does not always present with chronic lymphedema. A survey of the literature reveals that these lesions are difficult to diagnose because of their rarity and variable appearance, and because they can mimic radiation-induced changes in the skin. The majority of articles describe high-grade lesions. We report, here, a case of low-grade angiosarcoma following radical mastectomy, axillar node dissection and radiotherapy for infiltrating ductal carcinoma. Prompt diagnosis is very dependent on a high degree of clinical awareness. A biopsy should be considered in patients who present new skin lesions following radiotherapy for breast cancer.

Screening for neonatal endocrinopathies: rationale, methods and results

The measurement of thyrotropin or thyroxine from dried blood spots collected from neonates allows diagnosis before clinical manifestations develop, and prevents mental deficiency from congenital hypothyroidism. However, severely hypothyroid newborns remain at risk of cognitive problems that may be avoided if they are treated within two weeks of birth, hence the importance of a quick turnaround time of the screening programme. This also applies to screening for congenital adrenal hyperplasia due to 21-hydroxylase deficiency based on the measurement of 17-hydroxy-progesterone from dried blood; this was primarily designed to prevent neonatal deaths from acute adrenal insufficiency. This goal can be achieved by a high degree of clinical awareness of the diagnosis, but this has only been reported in a few jurisdictions. Furthermore, biochemical screening allows earlier treatment. On the other hand, there are many false positives, mostly in premature infants, so screening for 21-hydroxylase deficiency has not been universally adopted.

Myoclonic Epilepsy — Pitfalls in Diagnosis and Management

Three cases of myoclonic epilepsy presenting in adolescence are described. Seizures were uninfluenced by treatment with carbamazepine. Substitution of sodium valproate in early adult life resulted in all becoming seizure-free. A high degree of clinical awareness is required in making the correct diagnosis and in choosing appropriate therapy for this form of epilepsy which can present with generalised tonic-clonic or partial seizures.

Percutaneous Drainage of Splenic Abscess: Case Report and Review of Literature

Splenic abscess is an uncommon entity, reported in 0.14% to 0.70% of several autopsy series. Untreated, the mortality approaches 100%.1 When the diagnosis is made preopenatively and treated by antibiotics and splenectomy, there is a 17% mortality, but preoperative diagnosis was made only in 33% of the cases in one review.2 High degree of clinical awareness and aggressive diagnostic approach are essential for early diagnosis. percutaneous drainage of splenic abscess has been demonstrated to be a safe and effective method of treatment in adults in eight cases,3-5 without mortality or significant complications. We present the first pediatric age patient who was successfully treated by percutaneous drainage.

Prevalence and clinical picture of adult gluten-induced enteropathy in a Norwegian population.

Peroral jejunal biopsies were performed in 63 adult patients from a population of 40,000. Twenty-two patients had definite pathologic biopsy findings; 20 of these had gluten-induced enteropathy. With the 15 previously known patients in the region, this makes a minimum prevalence of 1 per 1,143. Subtotal villous atrophy was found in 8 patients, whereas partial villous atrophy was found in 12 patients. The clinical picture varied considerably, borborygmia, diarrhoea, abdominal pain, and psychiatric symptoms being the most commonly encountered symptoms. Steatorrhoea was found in only two patients with subtotal villous atrophy. In all the remaining patients, including six with subtotal villous atrophy, the faecal fat excretion was normal. A low whole blood folic acid concentration was the most consistent laboratory finding, although some patients had values slightly above the lower normal limit. Anaemia was not pronounced. Iron deficiency, as measured by the erythrocyte protoporphyrin IX concentration, was not common. A high degree of clinical awareness and broad indications for jejunal biopsy-taking is recommended.