Principles Of Differential Diagnosis Research Articles

Complex therapy for prolonged cough in infectious and inflammatory diseases of the upper respiratory tract: case report

Cough is one of the most common symptoms in primary care. Despite the fact that a persistent cough resolves on its own in most cases and does not require special treatment, it can significantly reduce the quality of life and require large financial costs for treatment. Infectious and inflammatory diseases of the upper respiratory tract are one of the most common pathologies accompanied by cough. Protracted cough can significantly aggravate the course of the disease, and its duration for more than 4 weeks may indicate a chronic process. Drug therapy should be specific and combined, i.e. it should be aimed at the etiology of the disease, the pathogenetic mechanisms underlying it, and at alleviating symptoms, which leads to a speedy recovery of the patient. The article describes the causes leading to a prolonged cough in infectious and inflammatory diseases of the upper respiratory tract, the principles of differential diagnosis and some features of the treatment of persistent cough. Options for both etiotropic and pathogenetic therapy, as well as symptomatic treatment with ivy leaf extract and non-drug methods are given.In cases of infectious and inflammatory diseases of the upper respiratory tract and bronchi accompanied by a non-productive cough, adding of common ivy leaf extract to the treatment allows us to predict relief of sputum discharge, and, consequently, an improvement in the patient’s condition as early as on Day 4-5. It is important to note that this drug should not be used in combination with any antitussive drugs, as it makes it difficult to evacuate thin secret and results in its congestion in the airways. A clinical case of polyetiologic chronic cough combined treatment using reflexology is presented.

Профілактика і лікування пролежнів у відділенні інтенсивної терапії (огляд літератури)

У статті з позиції Міжнародної національної нарадо-рекомендаційної ради з пролежнів, Європейської рекомендаційної ради з пролежнів, Всесвітнього альянсу з проблем пролежнів наведено питання термінології, статистики, факторів ризику розвитку, міжнародної класифікації, основних напрямків профілактики, диференціальної діагностики, інспекції шкірних покривів і документування; наведено шкали для прогнозування ризику розвитку пролежнів (PUSH Toll, 2008); викладені вузлові питання інтенсивної терапії залежно від результатів категорії пролежнів; надано правило SPECIAL; рекомендації робочої групи ICSI. Наведено практичні рекомендації Американської колегії фізіотерапевтів. Особливу увагу приділено принципам нутритивної терапії за наявності пролежнів.

Clinical features and principles of differential diagnosis of erysipelas

Objective. The aim is to find out the common and different features of the clinical course of erysipelas from other diseases that can imitate it.
 Materials and methods. 114 case histories of patients who were hospitalized in the center of purulent-septic surgery in the City Hospital No 3 in Zaporizhzhia for the period 2019-2020 were analyzed. 123 patients, who underwent hospital treatment in the center during this period of time, were with post-injection abscesses of soft tissue, 184 - with soft tissue abscesses, 203 - with phlegmons of various localizations, 49 - with complicated panaritium, 3 of which - subcutaneous. Over the past 5 years, 127 patients were consulted in the clinic and other therapeutic, infectious, neurological and other departments of the city. A number of criteria and signs have been identified to differentiate erysipelas from diseases that may have similar clinical symptoms and a number of circumstances that need to be clarified.
 Results. It is established that the diagnosis of erysipelas does not require special laboratory examination and is made on the basis of examination of the patient, epidemiological history and medical history. Provoking factors in the development of erysipelas are: violation of the integrity of the skin (abrasions, scratches, abrasions, cracks, bruises, injuries); mycoses; a sharp change in temperature (supercooling, overheating); emotional stress; increased insolation. Erysipelas has a characteristic summer-autumn seasonality. In people engaged in physical labor, the disease is registered more often than in other types of work. Hereditary predisposition to the disease is observed in 10-15% of cases. In this regard, the presence of such factors as congenital and acquired venous insufficiency of the lower extremities, fungal infection of the lower extremities, the presence of postoperative and post-traumatic scars, lymphostasis, diabetes, cardiovascular disease and diseases accompanied by the development of edema, intake of corticosteroids or cytostatics are of essential significance in the development of the disease.
 Conclusions. Mathematical modeling between erysipelas and other diseases that have similar syndromes in their clinical picture may be useful in making a differential diagnosis between them.

Evaluation of an educational intervention that aims to improve the keep/refer decision-making abilities of Austrian undergraduate physiotherapy students: a randomised pilot study

Background/Aims An ongoing discussion about direct access to physiotherapy for patients with musculoskeletal pain disorders in Austria requires the development of a curriculum that educates physiotherapy students to make autonomous decisions to treat the patient without the need for medical referral (keep), to treat the patient with additional medical check-up (keep and refer) or to send the patient for medical evaluation without physiotherapeutic management (refer), and to recognise the presence of serious pathologies. The aim of this study was to examine the feasibility, acceptability and potential effectiveness of an educational intervention that was provided to Austrian physiotherapy students in their final semester of the 3-year undergraduate (bachelor) degree. Methods An educational intervention was given to Austrian physiotherapy students in their final semester of the 3-year undergraduate (bachelor) degree, which consisted of a single, 1-hour face-to-face case-based lecture on the principles of differential diagnosis, screening for possible red flag pathologies and review of the body systems. A control group did not receive the intervention, but both groups completed 11 validated vignettes. Results Half of Austrian universities (n=6/12) and 116 final year Austrian undergraduate physiotherapy students took part in the study. All students from the intervention group were satisfied with the intervention and 77.6% found the intervention beneficial for making keep/refer decisions based on clinical vignettes. Overall, 89.7% did not find the intervention too time consuming. A potential effectiveness of the intervention could not be demonstrated. Conclusions Future similar studies need to investigate if more teaching hours and/or if different educational methods are capable of improving the keep/refer decision-making abilities of Austrian undergraduate physiotherapy students.

Syndrome of red eye

In a lecture for general practitioners, a characteristic of diseases which are included in the red eye syndrome. The division of the red eye syndrome into two subgroups is proposed: without a decrease in visual functions and with a decrease in vision. The main classification schemes of these diseases are described. The principles of differential diagnosis are stated methods of treatment and emergency care of the main diseases that can be manifested by redness of the eye are reflected.

Clinical and functional changes in the oral cavity using ceramic-metal dentures

The clinical features, the principles of differential diagnosis, development of the concept of the pathogenesis of changes in the oral cavity using ceramic-metal dentures were determined. The degree of impact of dentures on the tissues of the oral cavity depends on the quality of their manufacture, physical-chemical properties of structural materials. Recently, there has been a tendency to increase the number of patients suffering from intolerance to metal inclusions located in the oral cavity (removable and non-removable dentures). In connection with the development and implementation in practice of a large number of new structural materials, which often have not passed full-fledged laboratory and clinical trials, as well as with the significant prevalence of immunodeficiency conditions among the population, the issues of biological tolerance of materials and prevention of possible electro-galvanic complications are especially important [5]. Thus, the prophylaxis of stomatitis and paresthesias before orthopedic treatment should consist in expanding a comprehensive examination of patients in the following areas: conducting microbiological studies and bio-potentialometry, monitoring oral hygiene, studying somatic status. Measurements of the pH of the patient's oral fluid were performed thrice, the readings of the device were recorded in the examination map. The accuracy of pH determination was established using preliminary testing of the device using standard solutions and litmus paper. Most (66.7%) patients had no visible pathological manifestations in the mouth, only 33.3% showed inflammation of the mucous membrane in the form of hyperemia and edema of the mucous membrane of the mouth, lips, tongue, gingival hyperplasia.

Infantile colic from the perspective of evidence-based medicine: prevalence, principles of differential diagnosis and diet therapy algorithm

The article presents data on the prevalence of infant colic, etiological factors, diagnostic criteria, differential diagnosis and therapy with justification of approaches to the choice of formula in children on artificial feeding. When choosing a formula, it is necessary to take into account the compositional features aimed at overcoming the functional immaturity of the gastrointestinal tract, enteric nervous system, and the ongoing formation of the intestinal microbiome – the presence of a partially hydrolyzed protein, a reduced lactose content, the presence of prebiotics (fructooligosaccharides) and probiotics. The formula Similac Comfort is fully compliant. This formula additionally contains oligosaccharide of the breast milk 2 fucosillactose (2’-FL), 0.2 g / l – identical to that found in breast milk, which has proven positive effects in the form of an immunomodulating effect, anti-infectious effect, is involved in the regulation of growth and maturation of intestinal epithelial cells, in the development of the nervous system.

PEDIATRIC OSTEOBLASTOMA OF C3 LATERAL MASS: CASE REPORT AND LITERATURE REVIEW

The paper presents a clinical case report. Level of evidence - V. Surgical treatment of osteoblastoma of the lateral mass of C 3 vertebra was performed in a 6-year-old child. Follow-up period was 9 months after radical operation including tumor en block resection and local screw fixation of C 2 -C 3 vertebrae. The principles of differential diagnosis of small-sized osteoblastoma (1.5 cm) with nonspecific clinical and radiological symptoms are described.

Pharmacist prescribing: a cross-sectional survey of the views of pharmacists in Nigeria.

This study was carried out to: (1) explore the views of pharmacists in Nigeria on the extension of prescribing authority to them and determine their willingness to be prescribers and (2) identify the potential facilitators and barriers to introducing pharmacist prescribing in Nigeria. An online cross-sectional survey was conducted from August to October 2014 among 775 pharmacists recruited from the Facebook group of the Pharmaceutical Society of Nigeria using a simple random technique. The questionnaire used for the survey was developed based on the review of the literature and previous qualitative studies conducted in Nigeria. The instrument was evaluated for content validity by two external pharmacy practice researchers and the reliability of items assessed using internal consistency tests. Data obtained from the survey were entered into SPSS v.22, and descriptive statistics were generated. Relationships between variables were evaluated using the chi-square test, and P < 0.05 was considered statistically significant. The response rate was 40.6% (315/775). Three hundred and six (97.1%) respondents agreed that pharmacists should be given prescribing authority. Of these 306, 295 (96.4%) were willing to be prescribers, and just over half of them (148/295; 50.2%) would prefer to prescribe in collaboration with medical doctors. Of those willing to be prescribers, 285 (96.6%) reported that they would need additional training. The most perceived areas of training needed were in the principles of differential diagnosis (81.4%), pathophysiology of diseases (74.0%) and interpretation of laboratory results (68.1%). Respondents identified increasing patients' access to care (308/315; 97.8%) and better utilisation of pharmacists' skills (307/315; 97.5%) as the most likely facilitators to pharmacist prescribing in Nigeria. On the other hand, resistance from the medical doctors (299/315; 94.9%) and pharmacists' inadequate skills in diagnosis (255/315; 81.0%) were perceived as the most likely barriers. Pharmacist prescribing represents an opportunity to promote patients' access to care and the utilisation of pharmacists' skills in Nigeria. The majority of pharmacists showed a positive attitude towards pharmacist prescribing and were willing to be prescribers. The findings of this study could potentially contribute to future medicine prescribing policy and pharmacy practice in Nigeria.

TSH-secreting pituitary adenoma: late diagnosis and effectiveness of therapy

The modern therapeutic and diagnostic algorithms allow timely detection of pituitary disorder to prescribe adequate treatment. Meanwhile, when interpreting the thyroid status, physicians need to take into account the extremely rare but the actually existing possibility of central thyrotoxicosis. The worldwide practice shows that diagnosis of this condition is rather challenging.&#x0D; We report a clinical case of a TSH-secreting pituitary adenoma in a 47-year-old female who received a long-term thyrostatic therapy for thyrotoxicosis. The patient was diagnosed with Graves’ disease; however, thyrotoxicosis was actually caused by TSH-oma. The key laboratory signs of central thyrotoxicosis included the combination of episodes of normal or elevated TSH level with the high or normal free T4 level. MRI showed a pituitary macroadenoma. The clinical manifestations of thyrotoxicosis made it possible to rule out the thyroid hormone resistance syndrome. The attempted therapy with octreotide eliminated the clinical and laboratory signs of thyrotoxicosis, so the conservative method was selected as first-line therapy. The features of clinical and laboratory signs, as well as the principles of differential diagnosis and modern methods for treating TSH-secreting pituitary adenomas are discussed.

ГИПОКСИЧЕСКИЕ ЭРИТРОЦИТОЗЫ

The article presents a brief review of literature which shows the characteristic of bronchopulmonary and cardiovascular diseases that most often cause secondary absolute hypoxic erythrocytosis. The information about pathogenesis of blood changes at this nosology is given. The principles of differential diagnosis between secondary absolute hypoxic erythrocytosis and chronic myeloproliferative diseases, i.e. polycythemia vera and idiopathic myelofibrosis in erythremia stage are set. As an example three clinical cases of personal experience of the authors are given: 1) the patient who developed hypoxic erythrocytosis against chronic pulmonary heart disease formed due to a combination of COPD and Pickwick syndrome and &amp;#34;sleep apnea&amp;#34;; 2) the patient admitted to hospital initially only in connection with changes in the blood (erythrocytosis) for differential diagnosis and who was revealed to have arteriovenous malformation of the lung vessels; 3) the case of primary pulmonary hypertension diagnosis in a young patient with multiple comorbidities.

DEEP VENOUS TROMBOSIS OF LOWER EXTREMITIES

The guidelines present the classification, epidemiology, risk factors and risk groups of deep venous thrombosis of lower extremities. Basic principles of clinical and instrumental diagnostics in general practice, diagnostic criteria, and principles of differential diagnosis are presented. The guidelines also present recommendations for pharmacological and non-pharmacological treatment in general practice and indications for surgical treatment of deep venous thrombosis of lower extremities.Clinical guidelines were approved at the meeting of the profile committee on general practice of the Ministry of Health of Russia on 13.10.2015.

DIAGNOSIS AND TREATMENT OF IRRITABLE BOWEL SYNDROME IN GENERAL PRACTICE

The guidelines present the classification, epidemiology, risk factors and risk groups of irritable bowel syndrome. Basic principles of clinical, laboratory and instrumental diagnostics in general practice, diagnostic criteria, principles of differential diagnosis are presented. The guidelines also present recommendations for pharmacological and non-pharmacological treatment in general practice.Clinical guidelines were approved at the meeting of the profile committee on general practice of the Ministry of Health of Russia on 10.13.2015.

Paroxysmal dyskinesia and epilepsy – Basic principles of differential diagnosis

According to their similar clinical picture paroxysmal dyskinesias (PD) and epilepsy have been often misdiagnosed. The aim of the study was to highlight the importance of EEG as non-invasive methods in their diagnosis. The study included 11 children with PD that are clinically, neurophysiological (EEG), neuroradiological (MRI) and molecular genetic examined. Eight children with paroxysmal kinesigenic (DYT10) and three children with nonkinesigenic dystonia (DYT8) have been diagnosed. Provoking factors for dyskinesia were stress, physical activity, hunger, and some drinks. Over 60% of children had dyskinesia attacks preceded by “sensitive aura.” 36% of children had focal onset of attacks with secondary generalized dyskinesia. The frequency of attacks ranged from 30 per day to several a year, and the duration of a single attack from a few seconds to 6 h. Most patients had familial occurrence of the disease (64%) and good therapeutic response to antiepileptic drugs. All children had normal neurologic status, preserved consciousness during the attacks, normal EEG and MRI findings. PD and epilepsy have similar manifestations of the disease and good therapeutic response to antiepileptic drugs. The key method in establishing correct diagnosis of these two entities is the EEG (particularly useful video EEG).

Endometriosis: the role of magnetic resonance imaging

Several imaging options are available today to diagnose endometriosis. Currently, the two techniques most used are sonography and magnetic resonance imaging (MRI). Three-dimensional (3D) sonography has proved to be particularly sensitive in the diagnosis of endometriosis. In recent years, MRI has emerged as a high reproducible method to explore endometriosis; moreover, its capability to evaluate tissue signal is an extremely powerful system in the differential diagnosis with other pathologies and for the identification of malignant degeneration. The purpose of this paper is to present the state-of-the-art of MRI of endometriosis by performing a review of the literature and showing the epidemiology, pathogenesis, and classification of endometriosis. In this work, the technique that should be used, MR findings of endometriosis and the principles of differential diagnosis are explained.

HYPERMOBILITY SYNDROME: CLINICAL MANIFESTATIONS, DIFFERENTIAL DIAGNOSIS, THERAPY APPROACHES

Connective tissue dysplasia (CTD) represents special ontogenetic abnormality which is a complex problem of contemporary medicine. The principles of differential diagnosis of various forms of CTD are considered. A clinical estimation and therapy approaches are discussed with focus on hypermobility syndrome as one of undifferentiated form of CTD.

Anxiety in the medically ill: nosology and principles of differential diagnosis.

Anxiety and anxiety disorder have been estimated to occur in 5% to 20% of medical inpatients and 4% to 14% of medical outpatients. These estimates do not distinguish between anxiety symptoms and anxiety disorders, nor between the various causes of anxiety in the medically ill. This article reviews the epidemiology, nosology, disorders in the differential diagnosis, and principles of differential diagnosis of anxiety in the medically ill. A widely endorsed nosology for anxiety disorders caused by medical illness and its treatments is a relatively recent development. General guidelines for differentiating between specific diagnoses in the differential diagnosis of anxiety in the medically ill are now provided in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, but, as is often the case, it is easier to describe the distinctions in theory than it is to make them in actual practice.

Recent Literature Introduction to the Outlines of the Principles of Differential Diagnosis, with Clinical Memoranda . By Fred J. Smith, M.A., M.D., (Oxon.), F.R.C.P., (Lond.); Physician (with care of out-patients) and Senior Pathologist to the London Hospital. pp. ix, 353. New York: The Macmillan Co. 1899.

Recent Literature Introduction to the Outlines of the Principles of Differential Diagnosis, with Clinical Memoranda . By Fred J. Smith, M.A., M.D., (Oxon.), F.R.C.P., (Lond.); Physician (with care of out-patients) and Senior Pathologist to the London Hospital. pp. ix, 353. New York: The Macmillan Co. 1899.

Introduction to the Outlines of the Principles of Differential Diagnosis, with Clinical Memoranda.

Introduction to the Outlines of the Principles of Differential Diagnosis, with Clinical Memoranda.