Laboratory Findings In Diagnosis Research Articles

Cases with Recurrent Hospitalization due to Unexplained Ileus: Paraduodenal Hernia

Internal hernia is one of the rare causes of surgical pathologies in the abdomen.Paraduodenal hernia (PDH) is the most frequent subtype of internal hernia. There are no specific clinical and laboratory findings for diagnosis. This situation may cause delays in diagnosis and adverse clinical outcomes in patients. Computed Tomography (CT) is an imaging method that can help in the diagnosis of internal hernia. A case report of our two patients who were followed up in the clinic, who had been hospitalized with similar complaints in the past and operated for paraduodenal hernia (PDH) has been prepared. Internal herniation is one of the pre-diagnoses that should be kept in mind, especially in the history of unexplained and recurrent hospitalization in patients with abdominal pain and signs of intestinal obstruction. Observation of hernia sac on CT and observing small intestinal loops trapped in it are the only objective findings that can help us in the diagnosis of internal herniation.

A Case Report of Likely Nosocomial-Acquired COVID-19 in a Trauma Patient

As the pandemic of coronavirus disease 2019 (COVID-19) continues to spread worldwide, there has been an increase in unique clinical presentations leading to delayed diagnoses and nosocomial transmissions. One of the patient populations most at risk includes patients in the critical care units. Early diagnosis and isolation are paramount to avoid nosocomial transmission amongst these closely hospitalized patients. While quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR) is the current method for testing, we highlight the importance of utilizing chest computed tomography (CT) and laboratory findings for early diagnosis. We report a 48-year-old trauma patient who suddenly became hypoxemic, nine days postoperative from uncomplicated right lower extremity fracture repair. CT angiogram chest revealed bilateral extensive consolidations, hazy opacities, and pleural effusions. The patient continued to desaturate on noninvasive respiratory support and eventually required intubation. He was empirically treated with azithromycin and hydroxychloroquine due to high clinical suspicion of COVID-19, despite negative qRT-PCR results. The patient progressed clinically and was successfully extubated after 5 days. This unique presentation of acute hypoxemic respiratory failure warrants a discussion on the importance of clinical manifestations, CT findings, and laboratory findings in diagnosis of COVID-19, to prevent further nosocomial spread within a closed critical care unit. J Curr Surg. 2020;10(3):37-40 doi: https://doi.org/10.14740/jcs409

Kedi ve Köpeklerde Karaciğer Hastalıklarının Tanısında Laboratuvar Bulgularının Değerlendirilmesi

Karaciğer; anatomik ve fonksiyonel olarak gastrointestinal kanal ve dolaşım sistemi arasında yer alan, sindirim sisteminin önemli bir organıdır. Karaciğer, safra yolları veya portal ven hastalıklarının kesin tanısı genellikle çok-adımlı bir yaklaşım gerektirir. Bu hastalarda ortaya çıkabilecek klinik semptomlar genellikle spesifik değildir. Karaciğer hastalığı için spesifik klinik semptomların olmaması nedeni ile, karaciğer hastalığı şüphesi olan hastalarda klinik bulguların yorumlanmasına yardımcı olabilecek bazı faktörlerin göz önünde bulundurulması gerekir. Karaciğer testleri hepatik problemlerin teşhisi, kontrolü ve prognozu için gerekli bilgileri sağlamak amacıyla uygulanmalıdır. Laboratuvar; bulgular ilgili patolojik gelişmenin çeşidini belirlemede, takip edilmesi gereken tedavi şeklinin tespitinde ve prognozda yardımcı olur. Karaciğer fonksiyonundaki bozukluklar, karaciğerden ziyade diğer organ sistemlerinin fonksiyonunu etkileyebilir. Karaciğer ayrıca sıklıkla ikincil olarak diğer organ sistemlerinin hastalıklarına da (ikincil karaciğer hastalığı) katılır; böylece aynı belirtiler, anormal laboratuvar ve morfolojik bulgular primer karaciğer hastalığında olduğu gibi ortaya çıkabilir. Hücresel, biliyer ve vasküler karmaşıklık nedeni ile, karaciğer fonksiyonunu değerlendiren birçok test geliştirilmiştir. Bu testler ve incelemeler hepatosit fonksiyonu ve membran bütünlüğü, portal dolaşım, hepatobiliyer fonksiyon ve enterohepatik dolaşımı değerlendirmeyi amaçlar. Hepatik bileşenlerin yakın anatomik ve iç içe geçmiş fonksiyonel ilişkileri nedeni ile, çeşitli karaciğer patolojileri, portal dolaşım ve ekstrahepatik hastalık bulguları örtüşmektedir. Kesin tanı genellikle sadece laboratuvar bulgularını değil, aynı zamanda histolojik değişikliklerle birlikte alınan görüntüleme (radyoloji, ultrasonografi ve sintigrafi) verilerini kapsayan bilgileri de içerir.

Predictive value of clinical and laboratory findings in diagnosis of brucellosis

Aim: Although the definitive diagnosis of brucellosis requires isolation of the Brucella species, diagnosis is usually made based on both clinical and laboratory findings. The aim of this study was to determine the minimum required parameters that could be valuable in the diagnosis of brucellosis. Material and Method: A retrospective study was performed to compare the clinical and laboratory findings in 50 patients who were confirmed to have brucellosis by cultures with 50 patients with fever. Features independently predictive of brucellosis were assessed by multivariate logistic regression. Sensitivity, specificity and positive and negative predictive values were estimated. Results: Significant clinical features of brucellosis were hepatomegaly, splenomegaly, arthritis, RF positivity, leucopenia, thrombocytopenia, anemia, and elevated ALT levels. Five of these features were found to be predictive for the diagnosis of brucellosis; splenomegaly, arthritis, RF positivity, thrombocytopenia and elevated ALT levels. Conclusion: For the diagnosis of brucellosis, serum aglutination test does not have high specificity and sensitivity and waiting the results of cultures will delay the proper treatment. Predictive value of these results are worth taking into consideration in endemic regions.

Recurrent hyponatremia due to tolterodine

A 65-year-old woman came to the endocrinology clinic of our hospital with fatigue, muscle weakness and urinary incontinence. She has had these complaints for five months and was hospitalized at the neurology department and diagnosed with hyponatremia, urge incontinence, hypertension, diabetes mellitus and cerebrovascular disease. Her history included hospitalization for recurrent hyponatremia two times in the last five months; she could not walk due to muscle weakness. Her medications were tolterodine (six months), metformin, amlodipin and insulin aspart 30% and aspart protamin 70% (for three years). On admission, her blood pressure was 130/80 mmHg, pulse rate 80/min and neurological examination revealed left hemiparesis. Laboratory analyses are listed in Table 1. Table 1 Laboratory analyses Ejection fraction was 60% by echocardiography. After 2 liters of saline infusion, her blood sodium level was 126 mmol/L. After discontinuing tolterodine the serum sodium levels returned to normal in a few days. Hyponatremia is a common and important electrolyte abnormality in hospitalized patients causing a wide range of neurological symptoms. The differential diagnosis of hyponatremia is mandatory since there is a risk of neurological sequels during the treatment. Tolterodine-associated hyponatremia is especially seen in the elderly; our case is the fourth case of tolterodine-associated hyponatremia.1,4,5 Drug-induced syndrome of inappropriate antidiuretic hormone secretion (ADH) can occur due to an increase in ADH production centrally or an increased sensitivity to ADH in the nephron.3,5 Tolterodine (Detrol, Detrusitol) is an anti-muscarinic used to treat urinary incontinence. Tolterodine might induce hyponatremia by either increasing the ADH secretion or ADH action.4 Laboratory findings in diagnosis of syndrome of inappropriate ADH include:3 (1) hyponatremia 20 mEq/L; (3) normal serum creatinine; (4) low uric acid; and (5) normal adrenal and thyroid function. Our findings were consistent with syndrome of inappropriate ADH; when we stopped tolterodine, serum sodium levels returned to normal. Urinary incontinence is a common and distressing complaint in the elderly.2 In this report, we wanted to draw attention to a very rare adverse event caused by tolterodine, a drug mostly prescribed for the elderly.

Nephrotic Syndrome Due to Primary Nephropathies

The nephrotic syndrome is characterized by massive proteinuria, hypoproteinemia, and usually hyperlipemia and generalized edema, with or without varying degrees of hematuria, hypertension, and azotemia. Normally, children excrete less than 60 mg of protein in an overnight 12-hour collection of urine, and less than 150 mg in a 24-hour sample. In the nephrotic child, the magnitude of proteinuria exceeds 200 mg in an overnight sample and 1.5 gm in a 24-hour collection. Recognition that the underlying renal histopathology in a nephrotic child has significant implications for response to treatment and for prognosis has led to attempts to predict the type of lesion using various criteria. The associated presence of hematuria, hypertension, or azotemia in individual nephrotic children is remarkedly inconsistent and does not correlate accurately with the underlying histopathology. However, consideration of these plus additional readily obtained data frequently will permit a more reliable prediction of the probable histopathology and potential response to therapy. Such information will include the age of the patient, ancillary physical findings, and selected laboratory studies. From that perspective, the purpose of this review is to discuss the implications of the composite clinical and laboratory findings for diagnosis and management in the child with the nephrotic syndrome. These will include indications for renal biopsy, which is the definitive test in these conditions.

Utilization of laboratory findings in diagnosis and control of hospital staphylococcal infections.

Utilization of Laboratory Findings in Diagnosis and Control of Hospital Staphylococcal Infections Joseph A. Bass, and Harriet M. Felton CopyRight https://doi.org/10.2105/AJPH.49.11.1512 Published Online: August 29, 2011