297 results on '"diagnostic challenges"'
Search Results
102. Navigating the diagnostic challenges of bipolar disorder in youth.
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Aguirre, Larry
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DIAGNOSIS of bipolar disorder ,BORDERLINE personality disorder ,PATIENT-centered care ,HEALTH outcome assessment ,DIFFERENTIAL diagnosis ,POST-traumatic stress disorder ,CONTINUING education units ,ATTENTION-deficit hyperactivity disorder ,DIAGNOSTIC errors ,GENERALIZED anxiety disorder ,EARLY diagnosis ,BIPOLAR disorder ,DISEASE risk factors ,ADOLESCENCE - Abstract
Bipolar disorder in youth is difficult to diagnose and treat, but early detection is important to mitigate risks and improve patient outcomes. This article evaluates the unique challenges of diagnosing and treating bipolar disorder in children and adolescents. Bipolar disorder is associated with a significant personal and societal health burden and frequently is misdiagnosed and incorrectly treated. More research is needed to understand the pathophysiology of bipolar disorder and which treatment options are best throughout the lifespan. [ABSTRACT FROM AUTHOR]
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- 2021
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103. Diagnostic Challenges of Medullary Thyroid Carcinoma.
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Leimbach, Robert D., Hoang, Thanh D., and Shakir, Mohamed K.M.
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CANCER cells , *THYROIDECTOMY , *THYROID gland tumors , *CALCITONIN , *MAGNETIC resonance imaging , *TUMOR antigens , *COMPUTED tomography , *NEEDLE biopsy - Abstract
Background: Medullary thyroid carcinoma (MTC) comprises 1–2% of all thyroid cancers, yet 15% of all thyroid cancer-related deaths. While up to 20% of cases may be predicted due to autosomal dominant germline mutations, 80% of cases are sporadic. However, due to non-specific presenting symptoms and diagnostic imaging, prompt diagnosis and treatment has remained elusive. This article will further investigate the limitations of MTC diagnosis and look into future areas for diagnostic improvement. Methods: Relevant articles were identified using a systematic PubMed and Google Scholar search. Results: Prophylactic total thyroidectomy for the 20% of MTC cases that are present in autosomal dominant disorder provides definitive treatment. Serum calcitonin (Ctn) screening has several technical limitations due to population variability and laboratory assay interference, but advances in laboratory technology and combined use with fine needle aspiration increase its sensitivity. Other serum assays such as carcinoembryonic antigen and procalcitonin have limited applicability. Thyroid ultrasound remains the gold standard for the initial diagnostic planning, with limited application for CT, MRI, and PET imaging. Conclusion: With complete surgical resection the only definitive treatment, early MTC diagnosis has presented an elusive challenge, mainly due to its relative rarity and difficulty in finding an economic screening strategy. Careful family history combined with fine needle aspiration with serum Ctn analysis can improve diagnostic sensitivity and specificity to greater than 95%. [ABSTRACT FROM AUTHOR]
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- 2021
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104. Case Report: Complicated Meckel Diverticulum Spectrum in Children
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Gunadi, Wahyu Damayanti, Robin Perdana Saputra, Ramadhita, Ibnu Sina Ibrohim, Andi Lestiono, Devy Melati, Winda Intan Permatahati, Titis Widowati, and Akhmad Makhmudi
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Meckel diverticulum (diagnosis) ,Meckel diverticulum (complications) ,Meckel diverticulum—surgery ,children ,diagnostic challenges ,exploratory laparotomy ,Surgery ,RD1-811 - Abstract
Background: Meckel diverticulum (MD) is the most common congenital anomaly of the intestines, with an incidence of 2% of the general population. It can present as various clinical features with complications and be life threatening if diagnosis is delayed and treatment late.Case Presentation: We report three pediatric cases with complicated MD: one female presented with small-bowel obstruction, one male with peritonitis, and one female with severe iron-deficiency anemia, without gross gastrointestinal bleeding nor any ectopic gastric mucosa. All patients underwent exploratory laparotomy, segmental small-bowel resection, and primary anastomosis. They successfully recovered and were uneventfully discharged on the fourth, seventh, and 10th postoperative days, respectively.Conclusions: MD can present with various complication spectrums, including small-bowel obstruction, peritonitis, and severe iron-deficiency anemia, which may cause difficulty in definitive diagnosis, particularly in children. Segmental small-bowel resection and primary anastomosis are effective surgical approaches and show good outcomes for MD patients.
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- 2021
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105. Painful and non-painful diabetic neuropathy, diagnostic challenges and implications for future management.
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Jensen, Troels S, Karlsson, Pall, Gylfadottir, Sandra S, Andersen, Signe T, Bennett, David L, Tankisi, Hatice, Finnerup, Nanna B, Terkelsen, Astrid J, Khan, Karolina, Themistocleous, Andreas C, Kristensen, Alexander G, Itani, Mustapha, Sindrup, Søren H, Andersen, Henning, Charles, Morten, Feldman, Eva L, and Callaghan, Brian C
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DIABETIC neuropathies , *MEDICAL research , *NEURALGIA , *TYPE 1 diabetes , *GLYCEMIC control , *POLYNEUROPATHIES , *TYPE 2 diabetes , *DIAGNOSIS of diabetic neuropathies , *TREATMENT of diabetic neuropathies , *RESEARCH , *RESEARCH methodology , *MEDICAL cooperation , *EVALUATION research , *COMPARATIVE studies , *RESEARCH funding , *DISEASE complications - Abstract
Peripheral neuropathy is one of the most common complications of both type 1 and type 2 diabetes. Up to half of patients with diabetes develop neuropathy during the course of their disease, which is accompanied by neuropathic pain in 30-40% of cases. Peripheral nerve injury in diabetes can manifest as progressive distal symmetric polyneuropathy, autonomic neuropathy, radiculo-plexopathies, and mononeuropathies. The most common diabetic neuropathy is distal symmetric polyneuropathy, which we will refer to as DN, with its characteristic glove and stocking like presentation of distal sensory or motor function loss. DN or its painful counterpart, painful DN, are associated with increased mortality and morbidity; thus, early recognition and preventive measures are essential. Nevertheless, it is not easy to diagnose DN or painful DN, particularly in patients with early and mild neuropathy, and there is currently no single established diagnostic gold standard. The most common diagnostic approach in research is a hierarchical system, which combines symptoms, signs, and a series of confirmatory tests. The general lack of long-term prospective studies has limited the evaluation of the sensitivity and specificity of new morphometric and neurophysiological techniques. Thus, the best paradigm for screening DN and painful DN both in research and in clinical practice remains uncertain. Herein, we review the diagnostic challenges from both clinical and research perspectives and their implications for managing patients with DN. There is no established DN treatment, apart from improved glycaemic control, which is more effective in type 1 than in type 2 diabetes, and only symptomatic management is available for painful DN. Currently, less than one-third of patients with painful DN derive sufficient pain relief with existing pharmacotherapies. A more precise and distinct sensory profile from patients with DN and painful DN may help identify responsive patients to one treatment versus another. Detailed sensory profiles will lead to tailored treatment for patient subgroups with painful DN by matching to novel or established DN pathomechanisms and also for improved clinical trials stratification. Large randomized clinical trials are needed to identify the interventions, i.e. pharmacological, physical, cognitive, educational, etc., which lead to the best therapeutic outcomes. [ABSTRACT FROM AUTHOR]
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- 2021
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106. 12-YEAR-OLD CHILD WITH SEQUENTIAL OPERATIONS IN PATELLAR TENDON RECONSTRUCTION: A CASE STUDY.
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Tanas, Anatol, Solovastru, Stefania, Trinca, Flavia-Teodora, Butuc, Loredana, Derzsi, Zoltan, and Solyom, Arpad
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PATELLA fractures , *AUTOGRAFTS , *CONFERENCES & conventions , *KNEE joint , *REOPERATION , *PLASTIC surgery , *TENDON rupture , *PATELLAR tendon - Abstract
Introduction: Ruptures of the patellar tendon are rare, resulting from direct or indirect injuries. Patellar fractures with concurrent tendinous damage present unique challenges in pediatric orthopedics, affecting growth and knee functionality. This case report examines a complex injury in a 12-year-old boy, emphasizing diagnostic difficulties, management pitfalls, and a correct surgical solution. Case Report: In July 2023, a 12-year-old boy suffered a lower pole fracture of the right patella, initially treated with immobilization. The lack of progress by September and a misdiagnosis of ossifying myositis in the right quadriceps tendon demanded further investigation. Radiographic and ultrasonographic assessments revealed an older fracture at the inferolateral pole of the patella with an intraarticular bone fragment suggesting a possible rupture of the right patellar ligament. A December 2023 surgical attempt to remove the bony formation and reconstruction failed to repair the patellar tendon rupture, severely impairing the knee's functionality, including the inability to perform active leg extension. Faced with a persistent rupture and a patella ascended by 5 cm, a decisive and innovative surgical strategy was required. On March 5, 2024, a meticulous procedure utilizing autografts from the semitendinosus and gracilis tendons was performed to reconstruct the patellar tendon, aiming to restore knee integrity and functionality. This involved releasing quadriceps muscle, detailed graft preparation, creation of tunnels within the patella, and integration of the tendon pull-through technique into the existing tendon structure, secured with Ti-Cron sutures. The postoperative phase showed a favorable outcome, with the early removal of the Redon drain and continued immobilization for three weeks with regular X-ray monitoring to confirm the correct positioning and to promote healing. Discussions : This case underscores the challenges in diagnosing complex knee injuries in pediatric patients, where misdiagnosis can lead to prolonged discomfort and the potential for long-term functional impairment. The innovative surgical use of semitendinosus and gracilis tendon autografts for patellar tendon reconstruction effectively addresses structural damage and functional deficits caused by the injury. Conclusions: Timely and accurate diagnosis is crucial in managing complex patellar injuries in children to prevent the aftereffects of incorrect treatment approaches. The described surgical intervention showcases the feasibility and effectiveness of autograft augmentation using semitendinosus and gracilis tendons for reconstructing the patellar tendon, offering a promising solution for similar cases. This approach not only addresses the immediate structural issues but also aims to restore long-term knee function, highlighting the importance of tailored surgical strategies in pediatric orthopedic injuries. [ABSTRACT FROM AUTHOR]
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- 2024
107. From inguinal to giant femoral hernia: An unusual postoperative twist - A rare case report.
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Malbul, Kiran and Rajbhandari, Ashish Prasad
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Femoral hernias following inguinal hernia repairs are an unusual occurrence that presents diagnostic challenges for healthcare providers. Surgical repair of inguinal hernias is generally successful, but complications and recurrence can arise. The coexistence of femoral hernias following inguinal hernia repairs is rare, requiring careful evaluation and management. A middle-aged patient sought medical attention with complaints of recurrent groin pain and a palpable bulge in the inguinal region. Initial imaging studies, including ultrasonography and contrast-enhanced computed tomography (CT), pointed towards an inguinal hernia, leading to the scheduling of surgical repair. However, during the operation, the surgeon discovered a femoral hernia, highlighting the limitations of imaging techniques in accurately diagnosing these hernia types. Due to anatomical variations and overlapping signs and symptoms, distinguishing between femoral and inguinal hernias can be challenging. Scar tissue from previous inguinal hernia repairs can further complicate imaging interpretations. Intraoperative exploration becomes crucial to confirm the diagnosis and facilitate proper surgical repair. The reported case emphasizes the importance of maintaining vigilance in evaluating patients with suspected hernias, particularly those with prior inguinal hernia repairs. Relying solely on imaging studies can lead to misdiagnosis, as illustrated by the discovery of a femoral hernia during surgery. Healthcare providers should be aware of the possibility of femoral hernias and conduct comprehensive evaluations to ensure timely intervention and improve patient outcomes. Further research and awareness are essential to optimize the care of such uncommon clinical scenarios. • Rare occurrence: Femoral hernia following inguinal hernia repairs • Imaging limitations: Misidentification of the hernia type due to initial imaging • Giant femoral hernia complexity: Surgical approach challenged by the size of the hernia • Importance of vigilant diagnosis: Accurate management for better patient outcomes [ABSTRACT FROM AUTHOR]
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- 2024
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108. Hepatic tuberculosis with lower gastrointestinal symptoms mimicking hepatic metastasis: A rare case report.
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Shahzad, Farhan, Roghani, Arsalan Shah, Roghani, Faizan Shah, Shah, Zaryab Ali, Fatima, Komal, and Ullah, Inam
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The co-occurrence of Mycobacterium tuberculosis (MTB) affecting both the lungs and abdominal viscera is quite common, but instances of isolated Hepatic tuberculosis (TB) without concurrent clinical signs of TB are exceedingly rare. We present a case of a 55-year-old woman who complained of abdominal pain, weight loss, fever and changes in bowel habits. A definitive diagnosis of hepatic TB was made through microscopic examination, revealing necrotizing granulomatous inflammation accompanied by caseous necrosis. The patient received antitubercular therapy without experiencing any noticeable side effects during follow-up. Hepatic TB without active pulmonary TB is quite rare case. The patient presents with abdominal pain, fever, weight loss and jaundice. The diagnostic process includes CT (computerize tomography) imaging and subsequent biopsy to confirm it histopathologically. Following the same approach, we did biopsy from the targeted hepatic lesion that showed hepatic tuberculosis. In most cases it is treated with anti-tubercular drugs. However, some complicated cases might need surgical intervention. This case report highlights the significance of considering TB into account as a potential cause in patients with lower gastrointestinal symptoms in TB endemic areas by emphasizing the diagnostic challenges posed by hepatic tuberculosis with isolated liver involvement. In order to prevent serious complications of abdominal TB, early diagnosis and timely treatment is crucial. • Hepatic tuberculosis without pulmonary involvement is rare. • Patient presents with right hypochondrial pain, weight loss, fever and altered bowel habits. • Ultrasound and CT scan help in diagnosis which. is confirmed through biopsy from hepatic lesion • Definitive treatment is quadruple therapy with anti-tubercular drugs consisting of isoniazid (INH), rifampicin (RMP), pyrazinamide (PZA), and ethambutol (EMB). • Isolated hepatic tuberculoma or liver abscess might need surgical intervention. [ABSTRACT FROM AUTHOR]
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- 2024
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109. Clinical Characteristics and Diagnostic Challenges of COVID−19: An Update From the Global Perspective
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S. M. Hasan Israfil, Md. Moklesur Rahman Sarker, Parisa Tamannur Rashid, Ali Azam Talukder, Khandkar Ali Kawsar, Farzana Khan, Selina Akhter, Chit Laa Poh, Isa Naina Mohamed, and Long Chiau Ming
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clinical characteristics ,SARS coronavirus (SARS-CoV-2) ,novel coronavirus diseases (COVID-19) ,diagnostic challenges ,systematic review ,Public aspects of medicine ,RA1-1270 - Abstract
Clinical characteristics are essential for the correct diagnosis of diseases. The current review aimed to summarize the global clinical characteristics of the COVID-19 patients systematically and identify their diagnostic challenges to help the medical practitioners properly diagnose and for better management of COVID-19 patients. We conducted a systematic search in PubMed, Web of Science, Scopus, Science Direct, and Google Scholar databases for original articles containing clinical information of COVID-19 published up to 7th May 2020. Two researchers independently searched the databases to extract eligible articles. A total of 34 studies from 8 different countries with 10889 case-patients were included for clinical characteristics. The most common clinical symptoms were cough 59.6, fever 46.9, fatigue 27.8, and dyspnea 20.23%. The prominent laboratory findings were lymphocytopenia 55.9, elevated levels of CRP 61.9, aspartate aminotransferase 53.3, LDH 40.8, ESR 72.99, serum ferritin 63, IL-6 52, and prothrombin time 35.47%, and decreased levels of platelets 17.26, eosinophils 59.0, hemoglobin 29, and albumin 38.4%. CT scan of the chest showed an abnormality in 93.50% cases with bilateral lungs 71.1%, ground-glass opacity 48%, lesion in lungs 78.3%, and enlargement of lymph node 50.7%. Common comorbidities were hypertension, diabetes, obesity, and cardiovascular diseases. The estimated median incubation period was 5.36 days, and the overall case fatality rate was 16.9% (Global case fatality outside China was 22.24%: USA 21.24%, Italy 25.61%, and others 0%; whereas the case fatality inside the Hubei Province of China was found to be 11.71%). Global features on the clinical characteristics of COVID-19 obtained from laboratory tests and CT scan results will provide useful information to the physicians to diagnose the disease and for better management of the patients as well as to address the diagnostic challenges to control the infection.
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- 2021
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110. Understanding the implications of SARS-CoV-2 re-infections on immune response milieu, laboratory tests and control measures against COVID-19
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Jelili Olaide Mustapha, Idris Nasir Abdullahi, Odunayo O.R. Ajagbe, Anthony Uchenna Emeribe, Samuel Ayobami Fasogbon, Solomon Oloche Onoja, Charles Egede Ugwu, Chikodi Modesta Umeozuru, Folake Olubunmi Ajayi, Wudi Natasha Tanko, Pius Omoruyi Omosigho, Abdulmumuni Samuel Aliyu, Halima Ali Shuwa, Justin Onyebuchi Nwofe, Amos Dangana, Ovye Alaba, Peter Elisha Ghamba, Yakubu Ibrahim, Dorcas Aliyu, Olawale Sunday Animasaun, Nkechi Blessing Ugboaja, Mala Alhaji Baba Mallam, Sharafudeen Dahiru Abubakar, Maijidda Saidu Aminu, Hadiza Yahaya, and Silifat Oyewusi
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SARS-CoV-2 re-infection ,Diagnostic challenges ,Immune evasion ,Infection control ,COVID-19 ,Science (General) ,Q1-390 ,Social sciences (General) ,H1-99 - Abstract
Several months after the emergence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), cases of re-infection after recovery were reported. The extent and duration of protective immunity after SARS-CoV-2 infection is not fully understood. As such, the possibility of re-infection with SARS-CoV-2. Furthermore, cases of re-infection were mainly due to different variants or mutant SARS-CoV-2. Following the fast and pandemic-scale spread of COVID-19, mutations in SARS-CoV-2 have raised new diagnostic challenges which include the redesign of the oligonucleotide sequences used in RT-PCR assays to avoid potential primer–sample mismatches, and decrease sensitivities. Since the initial wave of the pandemic, some regions had experienced fresh outbreaks, predisposing people to be susceptible to SARS-CoV-2 re-infection. Hence, this article sought to offer detailed biology of SARS-CoV-2 re-infections and their implications on immune response milieu, diagnostic laboratory tests and control measures against COVID-19.
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- 2021
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111. Where COVID-19 testing is challenging: a case series highlighting the role of thoracic imaging in resolving management dilemma posed by unusual presentation
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Ademola Joseph Adekanmi, Lateef Ayodele Baiyewu, Babatunde Ebenezer Osobu, and Omolola Mojisola Atalabi
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covid-19 ,surge ,diagnostic challenges ,viral pcr testing ,thoracic imaging ,Medicine - Abstract
The COVID-19 pandemic remains an evolving disease posing a challenge of incomplete understanding escalated by random atypical clinical presentations. Numerous challenges still exist with accessibility and availability of standard COVID-19 viral testing using real-time Polymerase Chain Reaction (RT-PCR), in low- and middle-income countries, especially in several hospital settings. The clinical information of three select patients at a major health facility in Southwestern Nigeria with unusual COVID-19 clinical presentation and clinical management dilemma related to challenges with COVID-19 viral laboratory testing, were retrospectively reviewed. The medical history in all three cases closely mimicked that of other medical conditions because of assumptions created by red herrings like an acute exacerbation of an underlying non-communicable disease (diaphragmatic eventration) in case 1, re-activation of a previously treated lung condition (tuberculosis) in case 2 and a sequalae of a previously diagnosed but poorly-managed chronic non-communicable disease (decompensated hypertensive heart disease). Also, viral testing was challenging in all cases due to reasons ranging from late turn-around time to inconsistent results. However, thoracic imaging was employed in all cases to heighten suspicion of COVID-19 infection, resolve management dilemma and limit intra-hospital spread. Thoracic imaging can play a major role within hospital settings in low-and middle-income countries in resolving diagnostic challenges of atypical COVID-19 clinical presentations, raising suspicion for early institution of intra-hospital disease containment measures, limiting exposure among hospital staff and guiding clinical case management of COVID-19; especially where challenges with confirmatory viral testing remain persistent.
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- 2020
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112. Differentiation Between Disseminated Carcinomatosis of the Bone Marrow From Urothelial Cancer and Intravascular Large B-cell Lymphoma: A Case Report.
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Ohta R, Nishikura N, Suyama S, and Sano C
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This case report describes a rare case of intravascular large B-cell lymphoma (IVLBCL), initially presenting with nonspecific symptoms of fever and fatigue, and tentatively diagnosed as disseminated carcinomatosis of the bone marrow originating from urothelial cancer in an 80-year-old woman. The patient's journey began with symptoms treated as common ailments and progressed through multiple differential diagnoses, including giant cell arteritis, TAFRO (thrombocytopenia, anasarca, fever, reticulin fibrosis, and organomegaly) syndrome, and disseminated carcinomatosis of the bone marrow originating from urothelial cancer due to the presence of systemic inflammation, anasarca, and elevated soluble interleukin 2 receptor levels, indicative of an intense immunological response. Despite initial treatments, her condition deteriorated, leading to further investigations that ultimately revealed the presence of malignant cells in the urine and bone marrow, confirming the diagnosis of IVLBCL. This case underscores the diagnostic challenges faced when elderly patients present with systemic inflammation and the critical need for thorough investigation beyond initial impressions. It highlights the importance of considering differentiation between disseminated carcinomatosis of the bone marrow and IVLBCL in the differential diagnosis of persistent inflammation, especially in cases where common causes have been excluded and the primary malignancy is not immediately apparent., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Ohta et al.)
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- 2024
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113. Elephantiasis Nostras Verrucosa in a Patient With Lymphedema Tarda.
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Jaiswal S, Madke B, Singh A, Vangala N, and Jangid SD
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This case report presents a rare and complex clinical scenario of a 42-year-old male diagnosed with elephantiasis nostras verrucosa in the context of lymphedema tarda. The patient's seven-year history of insidious and progressively worsening swelling over the left lower limb, inguino-scrotal region, and left upper limb posed diagnostic challenges, leading to a multidisciplinary evaluation. Clinical examination, imaging studies, and laboratory investigations were integral in confirming the diagnosis. The manifestation of elephantiasis nostras verrucosa, characterized by extensive hyperkeratosis, added a unique dimension to the clinical presentation. A comprehensive treatment approach involving nutritional supplementation and pharmacological interventions was initiated to address the multifaceted aspects of lymphatic dysfunction. This case underscores the importance of a collaborative and holistic approach to managing complex lymphatic disorders, contributing valuable insights to the medical literature., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Jaiswal et al.)
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- 2024
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114. A challenging diagnosis of chronic osteomyelitis in a child with congenital insensitivity to pain: a case report.
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Kamil H, Alassri R, Albelal D, Alassri AB, Martini N, and Mahmod J
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Introduction: Congenital insensitivity to pain (CIP) is a rare condition where individuals are born with an inability to perceive pain. This can lead to various complications in the skin, skeletal system, and other bodily systems. Chronic osteomyelitis is one of the possible manifestations of CIP, which can be difficult to diagnose and treat due to the lack of pain as a diagnostic criterion., Presentation: A 5-year-old boy with CIP developed chronic osteomyelitis in his right leg, presented with fever, claudication, swelling, and local heat for 2 months. He had a history of CIP since birth, diagnosed at 18 months of age. He also had a family history of CIP. He had previously suffered a shoulder fracture and had taken asthma medication for 1 year. He had experienced tonsillitis 2 months ago. On examination, he had hepatomegaly, enlarged lymph nodes in the groin, and a minor swelling on the right knee. He had an audible snapping sound during knee flexion. Blood tests showed increased inflammatory markers. Imaging studies confirmed presence of osteomyelitis, and bone biopsy revealed infection with Staphylococcus aureus . Treatment included vancomycin and cefotaxime., Clinical Discussion: Genetic factors behind CIP were discussed, highlighting challenges in diagnosis. Manifestations of CIP, diverse and age-related, include orthopaedic issues, ophthalmological effects, and thermoregulation disturbances. The patient's case is presented with unique features, necessitating a comprehensive diagnostic approach., Conclusion: This case highlights the challenges faced in diagnosing osteomyelitis among CIP patients and emphasizes the need for other diagnostic criteria apart from pain., Competing Interests: The authors declare that they have no conflicts of interest.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)
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- 2024
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115. Duodenal Crohn's disease: Case report and systematic review.
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Amadu M and Soldera J
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Background: Inflammatory bowel disease, including ulcerative colitis, microscopic colitis, and Crohn's disease (CD), has a global impact. This review focuses on duodenal CD (DCD), a rare subtype affecting the duodenum. DCD's rarity and asymptomatic nature create diagnostic challenges, impacting prognosis and patient well-being. Delayed diagnosis can worsen DCD outcomes., Aim: To report a rare case of DCD and to discuss the diagnostic challenges and its implications on prognosis., Methods: A systematic literature search, following the PRISMA statement, was conducted. Relevant studies were identified and analysed using specific Medical Subject Terms (MeSH) from PubMed/MEDLINE, American Journal of Gastroenterology, and the University of South Wales database. Data collection included information from radiology scans, endoscopy procedures, biopsies, and histopathology results., Results: The review considered 8 case reports and 1 observational study, involving 44 participants diagnosed with DCD, some of whom developed complications due to delayed diagnosis. Various diagnostic methods were employed, as there is no gold standard workup for DCD. Radiology scans [magnetic resonance imaging (MRI), computed tomography (CT), and upper gastrointestinal X-ray], endoscopy procedures (colonoscopy and esophagogastroduodenoscopy), biopsies, and clinical suspicions were utilized., Conclusion: This review discusses DCD diagnosis challenges and the roles of CT, MRI, and fluoroscopy. It notes their limitations and compares findings with endoscopy and histopathology studies. Further research is needed to improve diagnosis, emphasizing scan interpretation, endoscopy procedures, and biopsies, especially in high-risk patients during routine endoscopy., Competing Interests: Conflict-of-interest statement: All authors declare no conflict of interest., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)
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- 2024
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116. Concurrent Challenges in Idiopathic Hypereosinophilic Syndrome Complicating Beta-Thalassemia Major: A Case Report.
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Daiya V, Kumar S, Acharya S, Pradeep U, and Jaiswal S
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This case report highlights the uncommon idiopathic hypereosinophilic syndrome (HES) complicating beta-thalassemia major, presenting a diagnostic and management challenge. Beta-thalassemia major, characterized by impaired beta-globin synthesis, necessitates regular blood transfusions and iron chelation therapy. HES, a rare disorder marked by persistent eosinophilia, adds complexity to the clinical course. We present the case of a 27-year-old male with beta-thalassemia major who developed fever, weakness, and weight loss and was subsequently diagnosed with HES. Treatment involved antibiotics, blood transfusions, and corticosteroids, leading to clinical improvement. This case underscores the need to further understand the relationship between thalassemia and eosinophilia and the importance of comprehensive evaluation in patients with overlapping hematological disorders., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Daiya et al.)
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- 2024
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117. Stercoral Colitis: An Unexpected Presentation in a Young Adolescent.
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Jones MJ, Adeyemi E, and Kouyoumjian S
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Stercoral colitis is an uncommon inflammatory condition primarily affecting individuals with chronic constipation, immobilization, and advanced age, occasionally manifesting in pediatric patients. It arises from the accumulation of impacted fecal matter, leading to colonic distension and subsequent fecaloma formation, culminating in pressure necrosis and perforation. Mortality rates can exceed 60% in vulnerable populations due to complications such as colonic perforation and ischemia. Presented is the case of a 14-year-old female with stercoral colitis, initially presenting with diarrhea, abdominal pain, and metabolic acidosis. Despite improvement followed by a sudden deterioration, diagnostic challenges persisted, highlighting the complexity of diagnosing this condition, especially in pediatric cases. Key diagnostic criteria include vague abdominal symptoms, leukocytosis, and elevated inflammatory markers, alongside potential metabolic derangements. Imaging modalities, such as abdominal CT scans, aid in diagnosis, delineating features like colonic distension and wall thickening. Treatment strategies encompass aggressive bowel disimpaction, with endoscopic or surgical interventions reserved for refractory cases or perforations. Recognition of stercoral colitis is crucial for timely intervention, given its significant morbidity and mortality. Although typically associated with elderly or bedbound patients, the condition can also affect younger individuals, emphasizing the importance of considering it in the differential diagnosis, particularly in cases of chronic constipation. Integration of diagnostic imaging techniques facilitates accurate diagnosis, guiding appropriate therapeutic interventions and potentially mitigating adverse outcomes., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Jones et al.)
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- 2024
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118. Masquerade syndrome: A review of uveitic imposters.
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Dutta Majumder P, Khetan V, and Biswas J
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- Humans, Diagnosis, Differential, Uveitis diagnosis
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Masquerade syndromes in uveitis are complex clinical conditions where non-inflammatory diseases mimic uveitic manifestations, often leading to diagnostic and therapeutic challenges. This review delves into the diverse spectrum of masquerade syndromes, categorizing them into neoplastic and non-neoplastic entities. We explore the prevalence of primary intraocular lymphoma, leukaemia, retinoblastoma, and other malignancies, as well as conditions like retinitis pigmentosa and endophthalmitis that can present as uveitis. Through detailed analysis of symptoms, diagnostic methods, and treatment approaches, the review emphasizes the importance of considering masquerade syndromes in differential diagnoses to prevent mismanagement. The synthesis of current knowledge aims to enhance clinicians' ability to discern these complex presentations, advocating for a multidisciplinary approach to diagnosis and care, thereby improving patient outcomes in cases of uveitic masquerade syndromes., (Copyright © 2024. Published by Elsevier Inc.)
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- 2024
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119. From Antibodies to Artificial Intelligence: A Comprehensive Review of Diagnostic Challenges in Hashimoto's Thyroiditis.
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Kolanu ND, Awan NA, Butt AI, Reza T, Almadhoun MKIK, Janoowala T, Bokhari SFH, Zain Z, Sharif T, Chauhan L, and Choudhari J
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Hashimoto's thyroiditis (HT) poses diagnostic challenges due to its diverse clinical presentation and the intricacies of autoimmune thyroid diseases. This comprehensive narrative review explores the evolving landscape of diagnostic challenges in HT, aiming to provide a thorough understanding of the complexities involved in its diagnosis. The diagnostic criteria for HT involve a multifaceted approach, including clinical features, laboratory findings, and imaging studies. Serum antibodies against thyroid antigens, primarily thyroperoxidase (TPO) and thyroglobulin, play a crucial role in confirming the autoimmune nature of the disease. However, seronegative HT adds complexity by presenting without detectable antibodies. The significance of addressing diagnostic challenges lies in potential delays and misdiagnoses, emphasizing the need for accurate and timely intervention. The review explores future directions, emphasizing molecular and cellular aspects, genetic factors, and the emerging field of thyroid regeneration. Standardized diagnostic criteria are essential, considering the subjective nature of the current process. The heterogeneity of disease manifestations complicates targeted treatments, necessitating a deeper understanding of clinical presentations and underlying pathophysiology. Future research directions and challenges outlined in this review contribute to advancing our understanding and improving diagnostic precision in HT., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Kolanu et al.)
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- 2024
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120. Triplication of the Sigmoid: A Rare Incidental Finding in Association With an Anorectal Malformation During Colostomy Closure.
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Zubar Zain A, Zuheir Fadil S, and Naji H
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This case report presents a rare occurrence of triplication of the sigmoid, an unusual congenital anomaly, in a nine-month-old male with a known history of anorectal malformation. The patient, previously diagnosed with anal atresia and a rectourethral (prostatic) fistula, was admitted for the closure of his divided sigmoidostomy as the final step in correcting his anorectal malformation. Unexpectedly, during the release of the distal stoma, the presence of three distinct bowel lumens was discovered. To discern the native bowel, catheters were introduced into each lumen before proceeding with the excision of the triplicated sigmoid and subsequent stoma closure. This case underscores the complexity of diagnosing and managing unusual GI anomalies in the context of anorectal malformations, emphasizing the challenges encountered during surgical interventions., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Zubar Zain et al.)
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- 2024
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121. Case Report on Adrenal Schwannomas: A Rare Mimic in the Spectrum of Adrenal Masses.
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Garg P, Dharamshi JD, Dhale A, Pendkar R, and Hatwar G
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Adrenal schwannomas are exceptionally rare tumors affecting about 0.2%, originating from the adrenal gland, presenting diagnostic challenges due to their nonspecific clinical features and overlapping radiological characteristics with other adrenal masses. Here, we report the case of a 49-year-old female with no significant medical history presenting with diffuse abdominal pain. Imaging studies, including contrast-enhanced computerized tomography (CECT), revealed a well-defined mass within the right adrenal gland. Given inconclusive radiological findings and persistent symptoms, surgical exploration was performed, leading to the identification and resection of the mass. Microscopic examination, including immunohistochemistry, confirmed the schwannomatous origin of the tumor. The final diagnosis of an adrenal schwannoma was established after a histopathological examination. Postoperatively, the patient was treated with antibiotics and discharged on oral antibiotics after suture removal on advised follow-up after 15 days. This case highlights the diagnostic complexities associated with adrenal schwannomas and emphasizes the necessity of surgical intervention for conclusive diagnosis. The report aims to contribute to the limited literature on adrenal schwannomas, enhancing our understanding of their clinical presentation and reinforcing the importance of a multidisciplinary approach in their diagnosis and management., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Garg et al.)
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- 2024
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122. Coccidioidomycosis as a Potential Trigger for Sarcoidosis: A Case Study.
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Tawde P and Mohammad S
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This study explores the complex interplay between coccidioidomycosis (valley fever) and sarcoidosis through a detailed case study of a 54-year-old male patient. The patient presented with elevated calcium levels, chronic kidney disease (CKD), and unintended weight loss. Interdisciplinary collaboration between nephrologists and pulmonologists played a crucial role in navigating the intricate medical challenges, including hypercalcemia, renal dysfunction, and pulmonary anomalies. The diagnostic journey involved extensive laboratory findings uncovering the involvement of both infectious agents and granulomatous disorders. The patient exhibited positive cocci IgG antibodies, indicating coccidioidomycosis. Further complications included glomerulonephritis, as revealed by ongoing systemic inflammation. Tailored management strategies were implemented, including corticosteroid therapy for sarcoidosis-related inflammation and antifungal interventions for coccidioidomycosis. Vigilant monitoring of renal function, hypercalcemia, and weight loss was essential for comprehensive patient care. The study underscores the significance of interdisciplinary collaboration, systematic diagnostics, and personalized patient care in managing complex medical presentations and contributes to understanding the interplay between these two conditions., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Tawde et al.)
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- 2024
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123. Retrospective Analysis of a Seborrheic Keratosis-Like Melanoma on the Head.
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Martínez-Ortega JI and Ramirez Cibrian A
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We present a clinical case of a 50-year-old female initially suspected of seborrheic keratosis but later diagnosed with melanoma through biopsy. This case highlights the challenges in distinguishing between these two conditions and emphasizes the importance of accurate diagnosis. Overdiagnosis of malignancy in seborrheic keratosis cases and the accurate identification of melanoma through dermoscopy are discussed. Further research is needed to explore potential mechanistic connections between seborrheic keratosis and melanoma., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Martínez-Ortega et al.)
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- 2024
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124. Diagnostic stumbling blocks in the COVID-19 monitoring of medical staff while putting hygiene requirements into practice
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V. Schildgen, J. Lüsebrink, P. Thomaidis, P. Meibert, and O. Schildgen
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Antibody response ,diagnostic challenges ,SARS-CoV-2 ,Infectious and parasitic diseases ,RC109-216 - Published
- 2020
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125. Where COVID-19 testing is challenging: a case series highlighting the role of thoracic imaging in resolving management dilemma posed by unusual presentation.
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Adekanmi, Ademola Joseph, Baiyewu, Lateef Ayodele, Osobu, Babatunde Ebenezer, and Atalabi, Omolola Mojisola
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The COVID-19 pandemic remains an evolving disease posing a challenge of incomplete understanding escalated by random atypical clinical presentations. Numerous challenges still exist with accessibility and availability of standard COVID-19 viral testing using real-time Polymerase Chain Reaction (RT-PCR), in low- and middle-income countries, especially in several hospital settings. The clinical information of three select patients at a major health facility in Southwestern Nigeria with unusual COVID-19 clinical presentation and clinical management dilemma related to challenges with COVID-19 viral laboratory testing, were retrospectively reviewed. The medical history in all three cases closely mimicked that of other medical conditions because of assumptions created by red herrings like an acute exacerbation of an underlying non-communicable disease (diaphragmatic eventration) in case 1, re-activation of a previously treated lung condition (tuberculosis) in case 2 and a sequalae of a previously diagnosed but poorly-managed chronic non-communicable disease (decompensated hypertensive heart disease). Also, viral testing was challenging in all cases due to reasons ranging from late turn-around time to inconsistent results. However, thoracic imaging was employed in all cases to heighten suspicion of COVID-19 infection, resolve management dilemma and limit intra-hospital spread. Thoracic imaging can play a major role within hospital settings in low-and middle-income countries in resolving diagnostic challenges of atypical COVID-19 clinical presentations, raising suspicion for early institution of intra-hospital disease containment measures, limiting exposure among hospital staff and guiding clinical case management of COVID-19; especially where challenges with confirmatory viral testing remain persistent. [ABSTRACT FROM AUTHOR]
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- 2020
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126. Juvenile dermatomyositis in an 11 year old Nigerian-boy: A case report and review of literature.
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Oyedeji, Olusola, Oseni, Saheed, Kayode, Olamide, Kolawole, Oladapo, and Lily, Musa
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- *
LITERATURE reviews , *DERMATOMYOSITIS , *PHYSICIANS , *MUSCLE diseases , *PREDNISOLONE , *THIGH - Abstract
We report the case of an 11-year-old boy with proximal myopathy, heliotrope, and Gottron papule-like rashes. Serum chemistry revealed muscle enzyme elevations, whereas muscle biopsy histology showed necrosis and inflammation, which were in keeping with juvenile dermatomyositis. Plain radiographic examination of the thigh 3 weeks after commencing treatment with prednisolone was normal. The aim of this presentation is to highlight the diagnostic challenges posed by this rare condition in a resource-limited setting and to underscore the need for prompt diagnosis and appropriate management. We hope that this report will assist physicians practicing in similar settings to make a prompt and accurate diagnosis when confronted with the same disease. [ABSTRACT FROM AUTHOR]
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- 2020
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127. Fronto-temporal dementia: a case study and strategies and support for caregivers.
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Mulkey, Malissa A., Everhart, D. Erik, and Hardin, Sonya R.
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- *
ANTIDEPRESSANTS , *BENZODIAZEPINES , *TRANQUILIZING drugs , *BEHAVIOR modification , *BEHAVIOR therapy , *PSYCHOLOGY of caregivers , *COGNITION , *COGNITIVE therapy , *SEIZURES (Medicine) , *SERVICES for caregivers , *NURSING , *QUALITY of life , *SPASMS , *OCCUPATIONAL roles , *FRONTOTEMPORAL dementia , *SYMPTOMS - Abstract
Fronto-temporal dementia, also known as fronto-temporal lobular degeneration, is the second most common form of early-onset dementia with a prevalence equal to Alzheimer's dementia. Behavioural variant fronto-temporal dementia primarily involves the frontal and temporal lobes of the brain. Myelination of nerve fibres in these areas allow for highly synchronized action potential timing. Diagnosis is often significantly delayed because symptoms are insidious and appear as personality and behavioural changes such as lack of inhibition, apathy, depression, and being socially inappropriate rather than exhibiting marked memory reductions. In this article, a case study illustrates care strategies and family education. Management of severe behavioural symptoms requires careful evaluation and monitoring. Support is especially important and beneficial in the early to middle stages of dementia when nursing home placement may not be required based on the individual's condition. [ABSTRACT FROM AUTHOR]
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- 2019
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128. What a type of diabetes is having your patient? Challenges in diagnosing diabetes in children and adolescent - case report.
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Niechciał, Elżbieta, Bogdańska-Kaczmarek, Barbara, and Skowrońska, Bogda
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DIABETES in children ,TYPE 1 diabetes ,APPENDICITIS ,DIABETES ,DIABETIC acidosis ,WEIGHT loss - Abstract
Copyright of Pediatric Endocrinology, Diabetes & Metabolism is the property of Termedia Publishing House and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2019
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129. Difficult differential diagnosis of delayed mesh infection following inguinal hernia surgery involving appendiceal cancer: A case report.
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Kitagawa, Yusuke, Hirasaki, Shigeo, and Bando, Michiya
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We present a case of post-inguinal hernia repair delayed mesh infection that was initially misdiagnosed as appendiceal cancer. The patient was an 82-year-old man who underwent right inguinal hernia repair with a plug mesh 7 years before he presented with a lump in the right inguinal region. No skin infection signs were evident; blood tests revealed no inflammation or abnormal tumor markers. Abdominal contrast-enhanced computed tomography revealed a tumorous lesion in the right lower abdomen, raising the suspicion of appendiceal cancer with lymph node and lung metastases. Lower gastrointestinal endoscopy revealed extrinsic cecal wall compression. During laparoscopic ileocecal resection with lymph node dissection, a pus-filled abscess exposed the mesh in the inguinal region; hence, a diagnosis of a mesh infection was made. There were no macroscopic cancer signs in the appendix or cecum. Partial cecal resection involving the infected mesh was performed. Pathological tests did not reveal cancer, confirming the delayed mesh infection diagnosis. This case presents the diagnostic challenges posed by post-inguinal hernia repair delayed mesh infections, emphasizing the lack of typical clinical and imaging indications and the potential for misdiagnosis as appendiceal cancer. It also highlights the importance of early recognition and appropriate management of these infections. This case emphasizes the complexity of diagnosing post-inguinal hernia repair delayed mesh infections. These infections may mimic other conditions such as appendiceal cancer, stressing the need for vigilance and careful evaluation. Early recognition and proper management are essential to avoid unnecessary extensive surgeries. • Initially thought to be appendiceal cancer post-hernia surgery, presenting with a right inguinal lump. • No apparent signs of infection despite the presence of a lump. • Pus-filled abscess found during surgery, revealing a mesh infection in the inguinal region. • Mesh infections mimicking appendiceal cancer pose challenges when typical indicators are absent. • Early recognition and differentiation crucial; mesh infections may be mistaken for conditions like appendiceal cancer post-hernia surgery when typical signs are lacking. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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130. Idiopathic Sclerosing Encapsulating Peritonitis – Preoperative diagnostic challenges: A case report and review of literature.
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Hakami, Alaa Ali, Al-Nami, Awaji Qassem, and Algasser, Hussein Ibrahim
- Abstract
Idiopathic Sclerosing Encapsulating Peritonitis (ISEP) is an uncommon condition of intestinal bowel obstruction due to encapsulation of the abdominal organs in a thick fibro-collagenous membrane. The case presented here describes the emergency acute presentation of septic peritonitis discovered intraoperatively upon laparotomy. A middle-aged woman was admitted to the emergency department and presented with generalized colicky abdominal pain associated with repetitive vomiting, abdominal distention, and absolute constipation. A digital rectal examination revealed an empty rectum and a bilious output was observed in the nasogastric tube. Abdominal X-Ray demonstrated multiple air-fluid levels with no air under the diaphragm. The patient was treated with fluid therapy and antibiotics intravenously (IV). The clinical impression of acute-on-chronic intestinal obstruction with peritonitis and the possibility of bowel strangulation was made. Emergency exploratory laparotomy revealed viable bowel loops encased in thickened fibrous capsules covering the entire abdominal viscera establishing the existence of ISEP. The fibrous capsule layer was excised out in small pieces from all the abdominal organs excluding stomach through extensive adhesiolysis without loop resection. The emergency presentation of acute peritonitis observed in this study could only be identified through diagnostic laparoscopy and differential radiological imaging techniques. Further, better reporting of such rare cases may help clinicians understand the different clinical features that could indicate the occurrence of ISEP. • ISEP is extremely rare case of small bowel obstruction due to encapsulation in a thick fibro-collagenous membrane. • ISEP poses preoperative diagnostic challenges to the clinicians due to its rarity and atypical clinical symptoms. • This report presents the case of acute presentation of septic peritonitis where preoperative diagnosis was difficult. • Exploratory laparotomy was used as a diagnostic approach to identify the clinical cause in the present case. • A high level of clinical suspicion and aid of radiological characteristics could facilitate in preoperative diagnostics. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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131. Migratory Deposition of Calcium Pyrophosphate in an Older Patient With Several Femoral Neck Implant Infection Episodes: A Case Report.
- Author
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Ohta R, Shigetaka T, and Sano C
- Abstract
This case report describes an 86-year-old female patient who presented with complex post-surgical complications following orthopedic surgery for a femoral neck fracture. Initially diagnosed with septic shock due to methicillin-resistant Staphylococcus aureus (MRSA) bacteremia at the surgical site, the patient's treatment course was complicated, involving multiple hospital transfers and varying treatments, including antibiotics and surgical drainage. Despite the absence of infection indicators post treatment, the patient later developed severe thigh pain and was found to have migratory pseudogout, an unusual diagnosis in the context of MRSA and post-surgical complications. This report emphasizes the diagnostic challenges in distinguishing between surgical site infections and other inflammatory conditions like migratory pseudogout, particularly in older patients with comorbidities. It underscores the importance of comprehensive evaluations and the need for general physicians to maintain a broad differential diagnosis when managing post-surgical infections. The case highlights the persistence and recurrence risk of MRSA infections, even post-appropriate antibiotic therapy, and the necessity of considering migratory pseudogout in patients with recurrent infections and systemic soft tissue involvement. The insights from this case contribute to the understanding of complex post-surgical complications and advocate for meticulous assessment and tailored treatment strategies in similar clinical scenarios., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Ohta et al.)
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- 2023
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132. Complicated Japanese Spotted Fever With Meningitis in an Older Patient: A Case Report.
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Amano S, Suyama S, Nishikura N, Sano C, and Ohta R
- Abstract
Japanese spotted fever (JSF) poses a significant public health challenge, mainly due to its atypical presentation in specific demographics. This report details a unique case of JSF in an 89-year-old female who was admitted to a rural hospital exhibiting generalized pain and rapid cognitive decline but no rash. Initially misdiagnosed as polymyalgia rheumatica, her condition was complicated by thrombocytopenia and altered mental state, prompting consideration of tick-borne illnesses. Subsequent serological analysis confirmed JSF despite the absence of its hallmark rash. The patient's condition escalated to include bacteremia and aseptic meningitis. Treatment involved a regimen of minocycline and meropenem, along with endoscopic cauterization of a bleeding rectal ulcer. After treatment, the patient showed improvement and was transferred for rehabilitation. This case highlights the criticality of considering JSF in elderly patients within endemic areas, even when classic symptoms like erythema and petechiae are absent. It underscores the necessity for broad diagnostic perspectives, especially in atypical presentations, and the integration of comprehensive care approaches. The involvement of caregivers and relatives in early detection and seeking medical care promptly is crucial. The report illustrates the complexities in diagnosing and managing advanced JSF cases and stresses the importance of early serological testing and adaptive treatment strategies in managing such challenging cases., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Amano et al.)
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- 2023
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133. Challenges in Diagnosing Psoriatic Arthritis in Primary Care: A Meta-Ethnographic Study.
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Ohta R and Sano C
- Abstract
Psoriatic arthritis (PsA) is a complex and debilitating chronic inflammatory joint disorder that is often associated with psoriasis and presents significant challenges in its early diagnosis and management. Therefore, this study aimed to investigate the diagnostic intricacies of PsA in primary care settings to shed light on the prevalence, barriers, and implications of delayed diagnosis. To achieve our research objectives, we conducted a qualitative synthesis using the meta-ethnographic method, which is a robust approach for synthesizing qualitative data. We systematically searched the PubMed, Web of Science, and Embase databases for relevant articles using predefined search terms such as "psoriatic arthritis," "diagnosis," and "primary care." The inclusion criteria were narrative articles in English that provided insights into the diagnostic challenges of PsA in primary care. Conference presentations, original articles, and duplicate articles were excluded. Our analysis revealed four key themes that elucidated the multifaceted nature of PsA diagnosis in primary care: (1) a variety of initial and non-specific symptoms, highlighting the diverse clinical presentations that can mimic other conditions; (2) the lack of experience with PsA among primary care professionals, underscoring the importance of education and training; (3) the lack of skin lesions, which can complicate diagnosis when not present; and (4) a delay in diagnosis, with potentially severe consequences for patients' health and quality of life. This study highlights the challenges inherent in the diagnosis of PsA in primary care settings. The multifaceted nature of the disease, coupled with limited experience among primary care providers, often results in delayed diagnosis and subsequent treatment initiation. Early recognition and intervention are pivotal for optimizing patient outcomes. Addressing these challenges necessitates a comprehensive approach involving heightened clinical suspicion, continuous medical education, interdisciplinary collaboration, and utilization of standardized diagnostic criteria. Collaboration between primary care physicians and specialists is crucial for enhancing the accuracy and timeliness of PsA diagnosis and ultimately improving patient well-being and quality of life., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Ohta et al.)
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- 2023
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134. Chilaiditi Syndrome: A Rare Case and Clinical Insights for Diagnosis and Management.
- Author
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Silva FS, Moutinho J, Vasconcelos T, and Simões IG
- Abstract
Chilaiditi syndrome is a rare medical condition characterized by the interposition of a hollow organ, usually the colon, between the liver and diaphragm, leading to abdominal pain, discomfort, bloating, constipation, or nausea; in more severe instances, respiratory symptoms may manifest due to pressure on the diaphragm. The exact cause remains unclear but is thought to present along with various factors such as anatomical anomalies (hepato-diaphragmatic interposition and intestinal malrotation) and chronic conditions (cirrhosis or chronic obstructive pulmonary disease). This case report presents a 78-year-old male with rapid deterioration, confusion, and mild abdominal discomfort. Clinical and radiological examinations confirmed Chilaiditi syndrome, highlighting the challenges in diagnosis. Management strategies range from conservative approaches to surgical interventions, emphasizing the need for increased clinical awareness among physicians to ensure accurate and timely interventions. This case report underscores the importance of recognizing this rare condition., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Silva et al.)
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- 2023
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135. Alcoholic pellagrous encephalopathy: a case report on atypical presentation and diagnostic dilemma in alcohol-related disorders.
- Author
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Yogi TN, B C P, Bhusal A, Limbu S, and Kafle R
- Abstract
Introduction: Alcohol use disorder is a global health concern with various complications, including pellagra, often overlooked due to its rarity. This case explores the neurological presentation of pellagra in a long-term alcohol and substance abuser, emphasizing the diagnostic challenges in resource-constrained settings., Case Presentation: A 36-year-old male with a history of substance abuse presented with multiple symptoms, including hallucinations and neurological deficits. His complex clinical history included alcohol dependence, seizures, and relapses. Physical and neurological examinations revealed characteristic signs of pellagrous encephalopathy. Laboratory findings confirmed anemia and a fatty liver., Discussion: Alcoholic pellagrous encephalopathy (APE) presents a diagnostic challenge due to its atypical symptoms, overlapping with other alcohol-related disorders. Niacin deficiency, central to its pathogenesis, affects neurotransmitter synthesis, contributing to neurological symptoms. Diagnosis relies on clinical presentation, but laboratory tests for niacin levels can aid in confirmation. Neuroimaging can exclude alternative causes. This case underscores the importance of considering pellagrous encephalopathy in alcohol-related disorders with neurological symptoms., Conclusion: This case underscores the importance of recognizing atypical presentations of APE in chronic alcohol-dependent individuals. Prompt diagnosis, nutritional correction, and addressing alcohol use are vital for successful management. Healthcare providers must be aware of the diagnostic complexities and socioeconomic barriers hindering timely intervention in APE., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)
- Published
- 2023
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136. Ectopic Pregnancy in the Round Ligament Following Bilateral Salpingectomy: A Case Report.
- Author
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Guevara CG, Blashinsky ZA, and Cardella IA
- Abstract
Ectopic pregnancies, characterized by the implantation of a fertilized ovum outside the uterine cavity, typically occur in the fallopian tubes. However, rare cases have been reported where implantation occurs in atypical locations. Round ligament pregnancy, a rare form of ectopic pregnancy, poses significant risks and can lead to life-threatening complications. This case report describes the presentation and management of a 31-year-old gravida four, para two (G4P2012) female who presented with acute left lower quadrant and pelvic pain. The patient's medical history included a prior bilateral salpingectomy. Physical examination revealed severe left lower quadrant tenderness with guarding. A positive urine pregnancy test and elevated serum quantitative beta-human chorionic gonadotrophin level of 1,735 mIU/mL (normal range: <5 mIU/mL) confirmed pregnancy. Transvaginal ultrasound revealed an empty intrauterine cavity with no gestational sac or fetal pole. A 2 cm cystic structure was identified attached to the left ovary. Ectopic pregnancy was diagnosed, methotrexate was administered, and the patient was discharged with a scheduled outpatient follow-up. However, she returned to the emergency room within 48 hours reporting persistent pelvic pain. At this moment, it was decided that emergent surgical intervention was required. The surgical exploration confirmed the presence of a ruptured ectopic pregnancy in the round ligament, requiring excision and hemostasis. This case report highlights the importance of considering abnormal localization of ectopic pregnancy as a differential diagnosis in women presenting with pelvic pain, even after bilateral salpingectomies. It emphasizes the challenges in diagnosis and management when ectopic pregnancy occurs in atypical sites and highlights the necessity for vigilant follow-up and prompt surgical intervention when medical management fails., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Guevara et al.)
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- 2023
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137. A Case of Late-Onset Systemic Lupus Erythematosus With Systemic Symptoms Leading to Multiple Organ Failure.
- Author
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Hasegawa T, Nishikawa K, Ohjino Y, Sano C, and Ohta R
- Abstract
This case report discusses the diagnosis and management of late-onset systemic lupus erythematosus (SLE) in an elderly patient. Systemic lupus erythematosus is an autoimmune disease that affects several organs. Sex differences in incidence, especially among women in their childbearing years, have been linked to estrogen fluctuations. This study focuses on an 87-year-old male who initially presented with anorexia, a history of heart failure, pancytopenia, and elevated antinuclear antibodies. His symptoms were initially attributed to heart failure and pneumonia. However, further evaluation led to the suspicion of immune-mediated vasculitis. Treatment with prednisolone improved his condition; however, a recurrent decrease in food intake and increased inflammation prompted the consideration of late-onset SLE. The diagnosis was supported by laboratory results, including antinuclear antibodies and complement levels, in accordance with the diagnostic criteria. This case highlights the challenges in diagnosing late-onset SLE owing to its overlap with other conditions and emphasizes the importance of a multidisciplinary approach for accurate diagnosis and treatment. Early recognition and intervention are crucial for managing late-onset SLE, even in elderly patients, to prevent multiple organ failure and improve outcomes., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Hasegawa et al.)
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- 2023
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138. Prevalence, service use and clinical correlates of hallucinations and delusions in an out-patient population from India
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M Priyanka, Lakshmi Ravikanth, Smriti Vallath, Vishnu Varadarajan, Lakshmi Narasimhan, Science and Society, and Athena Institute
- Subjects
Service (business) ,medicine.medical_specialty ,business.industry ,Public health ,Prevalence ,India ,Service use ,General Medicine ,LMICs ,030227 psychiatry ,diagnostic challenges ,03 medical and health sciences ,Psychiatry and Mental health ,Patient population ,0302 clinical medicine ,SDG 3 - Good Health and Well-being ,medicine ,030212 general & internal medicine ,Psychiatry ,business ,Positive psychotic symptoms ,service use - Abstract
Background: Despite the persistent public health problem of positive psychotic symptoms, understanding of symptom specific prevalence rates, clinical correlates and service utilisation are sparse. Aims: The current study aimed to establish prevalence, clinical and service utilisation correlates of hallucinations and delusions in people accessing outpatient clinics in Tamil Nadu, India. Methods: Secondary patient data from outpatient clinics, over a 12-month period, in 2016, was used for analysis (N = 917). Based on the presence of positive psychotic symptoms (PPSx), the sample was divided into four groups for analysis- hallucinations-only (H), delusions-only (D), both hallucinations and delusions (HD) and neither PPSx (N-PPSx). Results: Findings indicate that the most prevalent PPSx were hallucinations (10.7%) however, barriers to service utilisation and clinical correlates were associated predominantly with the D and the HD group; as was severe work impairment. Yet, this group was most likely to remain with psychiatric services. Lastly, diagnostic challenges were apparent within the sample. Conclusions: The study revealed that despite more barriers to service utilisation, persons with PPSx remain in contact with services. Yet prognosis remains only moderate at best, indicating other mediating and underlying factors impeding recovery may be interplaying and, therefore, a need for enhanced biopsychosocial approaches.
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- 2023
139. Diagnostic challenges in dielectric loss assessment and interpretation: a review.
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Morsalin, Sayidul, Phung, Toan Bao, Danikas, Michael, and Mawad, Damia
- Abstract
In any sustainable electrical systems, various high‐voltage (HV) power apparatuses such as electrical cable, transformer etc. play a pivotal role to transfer electrical energy from the generation end to the consumer end. The degradation due to electrical stress is very unlikely to avoid in operation. Prominently, the insulation system is mostly expected to be strong enough, and its degradation always provides a constant threat to the reliable operation. Moreover, the continual deterioration can gradually lead to the complete breakdown of HV equipment. To assess the overall dielectric properties, the regular monitoring/diagnosing of electrical insulation has a paramount importance in power systems. One of the potential tools for diagnostic assessment is the tan‐delta (tan δ) measurement. Considering different aspects at various frequencies, this study elucidates a comprehensive review of tan δ measurement. First, a detailed review and explanation of multiple challenges associated with dielectric loss measurement are presented. Various dielectric losses, their contribution to tan δ, measurement techniques and their comparisons are also discussed. This study further reviews the analogy of different physical dipolar theories, modelling and a brief analysis of commercially available measurement instruments. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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140. Diverticulitis with coloenteric fistula mimicking gangrenous appendicitis with perityphlitic abscess. An uncommon presentation of a common disease – A case report.
- Author
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Singh, Jessica, Krendl, Felix J., Gasteiger, Silvia, Schneeberger, Stefan, and Perathoner, Alexander
- Abstract
Diverticulitis is a common gastrointestinal disease usually presenting with a typical clinical picture depending on the stage of the disease. In complicated cases, the clinical presentation may be untypical, thus delaying diagnosis and treatment. We present a case of a young patient who was initially treated for obscure intraabdominal abscesses presumably due to gangrenous appendicitis; however, intraoperative exploration revealed a normal appendix and a coloenteric fistula resulting from an unknown and untreated perforated diverticulitis. A patient with a perityphlitic abscess was initially managed with primary non-operative management (NOM) in accordance with the current Jerusalem guidelines, but surgery was eventually necessary due to failure of NOM. Intraoperative findings revealed a sigmoido-ileal fistula, a rare but potentially detectable complication of diverticulitis through colonoscopy. This case highlights the challenges in diagnosing and treating common surgical diseases with uncommon clinical presentations, emphasizing the importance of a detailed patient history and not relying solely on imaging studies. Intraabdominal abscesses require prompt treatment with non-operative management, while intestinal fistulae associated with diverticulitis are a rare consequence of chronic inflammation, often asymptomatic and often detected incidentally during surgery. In most cases simple fistulous tract resection is usually sufficient as first line therapy. • Intestinal fistula formation associated with diverticulitis is a rare complication. • Diagnosis is difficult as there are no specific symptoms suggestive of a coloenteric fistula. • Intraabdominal fistulae are often found incidentally during surgery. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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141. Small intestinal perforation secondary to metastasis from skin squamous cell carcinoma: A case report and literature review.
- Author
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Reynard, Maxence Emmanuel, Strati, Titika-Marina, and Egger, Bernhard
- Abstract
Primary and metastatic carcinoma of the small intestine are rare. While most of these malignancies are adenocarcinomas, squamous cell carcinoma (SCC) of the gastrointestinal tract is uncommon. We present a case report of a rare occurrence of skin SCC metastasizing to the ileum, highlighting diagnostic challenges and clinical implications. An 83-year-old female had a history of cutaneous SCC excision in the right temporal region two years prior to the current emergency department visit, followed by metastatic recurrence in a right intra-parotid lymph node treated with radiotherapy. The patient exhibited septic shock and an acute abdomen, and an abdominal computed tomography scan revealed signs of intestinal perforation. Emergency exploratory laparotomy confirmed purulent peritonitis and perforation of the terminal ileum. Subsequently, a 20 cm intestinal resection was performed. Histopathological examination of the resected specimen revealed a 4 cm perforated SCC of the small intestine (pT4 pN0 L0 V1 Pn0 R0). Metastases of the small intestine are rare. The primary sites for these metastases are typically the uterus, cervix, colon, lung, breast, or melanoma. SCC of the small intestine is particularly rare and poses challenges in diagnosis owing to non-specific symptoms. The prognosis for SCC of the small intestine is generally poor, and the potentially aggressive behavior of some skin SCC emphasizes the need for increased awareness and vigilance in managing such cases. This case report underscores the importance of considering metastatic disease in the small bowel of patients with a history of skin SCC who present with new-onset abdominal symptoms. • Rare case of small bowel perforation caused by metastasis of cutaneous squamous cell carcinoma (cSCC). • SCC of the small bowel is a diagnostic challenge due to nonspecific symptoms. • Increased attention and vigilance is key in effective management of such cases. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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142. Challenges in Laboratory Diagnosis of the Novel Coronavirus SARS-CoV-2
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Nadin Younes, Duaa W. Al-Sadeq, Hadeel AL-Jighefee, Salma Younes, Ola Al-Jamal, Hanin I. Daas, Hadi. M. Yassine, and Gheyath K. Nasrallah
- Subjects
COVID-19 ,SARS-CoV-2 ,viruses ,diagnostic challenges ,molecular testing ,serology ,Microbiology ,QR1-502 - Abstract
The recent outbreak of the Coronavirus disease 2019 (COVID-19) has quickly spread worldwide since its discovery in Wuhan city, China in December 2019. A comprehensive strategy, including surveillance, diagnostics, research, clinical treatment, and development of vaccines, is urgently needed to win the battle against COVID-19. The past three unprecedented outbreaks of emerging human coronavirus infections at the beginning of the 21st century have highlighted the importance of readily available, accurate, and rapid diagnostic technologies to contain emerging and re-emerging pandemics. Real-time reverse transcriptase-polymerase chain reaction (rRT-PCR) based assays performed on respiratory specimens remain the gold standard for COVID-19 diagnostics. However, point-of-care technologies and serologic immunoassays are rapidly emerging with high sensitivity and specificity as well. Even though excellent techniques are available for the diagnosis of symptomatic patients with COVID-19 in well-equipped laboratories; critical gaps still remain in screening asymptomatic people who are in the incubation phase of the virus, as well as in the accurate determination of live viral shedding during convalescence to inform decisions for ending isolation. This review article aims to discuss the currently available laboratory methods and surveillance technologies available for the detection of COVID-19, their performance characteristics and highlight the gaps in current diagnostic capacity, and finally, propose potential solutions. We also summarize the specifications of the majority of the available commercial kits (PCR, EIA, and POC) for laboratory diagnosis of COVID-19.
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- 2020
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143. Diagnostic challenges in cytology of mucoepidermoid carcinoma: Report of 6 cases with histopathological correlation
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Tessy P Joseph, Cicy P Joseph, P S Jayalakshmy, and Usha Poothiode
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cystic lesions ,diagnostic challenges ,fine needle aspiration ,histopathology ,mucoepidermoid carcinoma ,Cytology ,QH573-671 - Abstract
Background: Mucoepidermoid carcinoma (MEC) is a malignant salivary gland neoplasm with extreme morphologic heterogeneity and hence rendering a definitive fine needle aspiration cytology (FNAC) diagnosis of this neoplasm is really challenging. The present study was undertaken to elucidate the cytological features of MEC and explore the diagnostic accuracy and pitfalls by comparing with subsequent histopathology. Materials and Methods: The present study was conducted over a period of 2 years wherein we obtained six histopathologically confirmed cases of MEC. These patients were initially subjected to FNAC. The cytologic features studied included presence of mucous cells, intermediate cells, and squamous cells. Presence of background mucinous material was also noted. The cytological features were compared with the subsequent histopathology. Results: Of the 6 cases of MEC, a definite cytological diagnosis was possible only in 2 cases. Of the remaining 4 cases, 2 cases were broadly diagnosed in cytology as neoplasm with cystic degeneration and 2 cases were underdiagnosed as pleomorphic adenoma. Conclusions: A satisfactory aspirate with all three types of cells; mucous, intermediate and squamous cells may not be obtained in all cases of MEC for providing a definite diagnosis. Hence, a good clinicoradiological correlation, a high index of suspicion and repeated aspirations especially in cystic lesions may be particularly helpful in difficult cases. In addition, while dealing with mucinous cystic lesions with low cellularity, the importance of early excision should be communicated to the clinician since the possibility of low-grade MEC cannot be excluded.
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- 2015
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144. Respiratory Dysfunction in Epileptic Encephalopathies: Insights and Challenges.
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Khan MA, Dev S, Kumari M, Mahak F, Umair A, Rasool M, Kumari A, Payal F, Panta U, Deepa F, Varrassi G, Khatri M, and Kumar S
- Abstract
Epileptic encephalopathies constitute a group of severe epileptic disorders characterized by intractable seizures and cognitive regression. Beyond the hallmark neurological manifestations, these disorders frequently exhibit associated respiratory dysfunction, which is increasingly recognized as a critical aspect of their pathophysiology. Respiratory abnormalities in epileptic encephalopathies encompass a spectrum of manifestations, ranging from subtle alterations in breathing patterns to life-threatening events such as apneas and hypoventilation. These respiratory disturbances often occur during seizures, the interictal period, or even persist chronically, leading to significant morbidity and mortality. We explore the varied clinical presentations and their implications on patient outcomes, emphasizing the need for heightened awareness among clinicians. This review unravels the intricate mechanisms linking epilepsy and respiratory dysfunction. GABAergic and glutamatergic imbalances, alterations in central respiratory centers, and abnormal autonomic control are among the key factors contributing to respiratory disturbances in these patients. We elucidate the neurobiological intricacies that underlie these processes and their relevance to therapeutic interventions. Accurate diagnosis of respiratory dysfunction in epileptic encephalopathies is often hindered by its diverse clinical phenotypes and the absence of routine screening protocols. We scrutinize the diagnostic hurdles, highlighting the necessity of comprehensive respiratory assessments in managing these patients. Timely recognition of respiratory issues may guide treatment decisions and mitigate complications. Management of respiratory dysfunction in epileptic encephalopathies is complex and necessitates a multidisciplinary approach. We explore various therapeutic modalities, including antiepileptic drugs (AEDs), ventilatory support, and novel interventions like neuromodulation techniques. The review emphasizes the individualized nature of treatment strategies tailored to each patient's specific needs. In conclusion, this narrative review offers a comprehensive overview of respiratory dysfunction in epileptic encephalopathies, shedding light on its clinical importance, underlying mechanisms, diagnostic challenges, and therapeutic considerations. By addressing these insights and challenges, we hope to inspire further research and innovation to enhance the care and outcomes of patients with epileptic encephalopathies., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Khan et al.)
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- 2023
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145. A Unique Case of Plunging Dermoid Cyst in an Elderly Male: A Case Report.
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Gaikwad TV, Mishra SS, Maini AP, Das S, and Sarma A
- Abstract
Dermoid cysts are the least commonly occurring developmental cysts in the oral and maxillofacial region. They may be congenital or acquired and are seen as asymptomatic swellings that are slow and progressive. It is very difficult to differentiate plunging ranulas from plunging dermoid cysts as both of them have very similar clinical features. However, since both entities have different treatment strategies, it is important to differentiate one from the other. A 57-year-old male patient reported to the Department of Oral Medicine and Radiology with a large swelling in the submental region. To the best of our knowledge, the present case report is the first one showing such an extensive lesion of plunging dermoid cyst mimicking plunging ranula in an elderly male patient. The report mainly focuses on the diagnostic challenges faced to reach the final diagnosis., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Gaikwad et al.)
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- 2023
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146. Retained Intrauterine Fetal Bone Fragments Causing Secondary Infertility: A Review.
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Reddy LS, Jaiswal A, Reddy K, Jyotsna G, and Yadav P
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Retained intrauterine fetal bone fragments are emerging as a potential yet often overlooked cause of secondary infertility, posing significant challenges for couples who have previously experienced successful pregnancies. This review article explores the association between retained fetal bone fragments and secondary infertility by delving into their impact on fertility, pregnancy outcomes, and diagnostic challenges. The review highlights the underlying mechanisms of fragment retention, including immune response and inflammation, and their detrimental effects on endometrial receptivity and implantation. The diagnostic difficulties and importance of specialized imaging techniques like hysteroscopy for accurate diagnosis are also discussed. The article also provides insights into available treatment options, such as medical management and surgical interventions, focusing on hysteroscopy as the gold standard for diagnosis and treatment. The implications for clinical practice emphasize early diagnosis and intervention to improve fertility outcomes and reduce the emotional burden of secondary infertility. Furthermore, the review discusses preventive strategies and the potential for future research to refine diagnostic methods and explore novel treatments. By recognizing and addressing the impact of retained fetal bone fragments, this review aims to enhance the understanding and management of this condition, providing valuable support to couples seeking to overcome the challenges of secondary infertility on their journey toward parenthood., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Reddy et al.)
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- 2023
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147. Diagnosing and treating rare lesions in a low resource setting: lessons from a hybrid epithelioid trophoblastic tumor and choriocarcinoma.
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Akakpo, Patrick K., Ulzen-Appiah, Kofi, Agbeno, Evans, and Derkyi-Kwarteng, Leonard
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- *
TROPHOBLASTIC tumors , *UTERINE tumors , *SQUAMOUS cell carcinoma , *COMPUTED tomography , *HISTOPATHOLOGY , *DIAGNOSIS - Abstract
Objective: To raise awareness of the existence of a rare type of malignant trophoblastic tumor and discuss the diagnostic challenges and management of this lesion in a low resource setting. Case report and intervention: A 35 -year -old G6P3 woman was referred to our facility on account of persistent vaginal bleeding due to a suspected incomplete miscarriage with a cervical mass. Her serum β-HCG was elevated (36,900 mIU/ml) and examination showed a bleeding cervical mass. An initial histopathological diagnosis of moderately differentiated squamous cell carcinoma was reviewed to epithelioid trophoblastic tumor resulting in an extra-fascial hysterectomy. A final histopathological diagnosis of hybrid Epithelioid Trophoblastic Tumor and Choriocarcinoma (ETT/CC) was made after external review and immunohistochemistry. She received subsequent chemotherapy. Conclusion: Epithelioid trophoblastic tumor and its hybrids are difficult to diagnose. They may be diagnosed as moderately differentiated squamous cell carcinoma especially in low resource settings where cervical squamous cell carcinoma is relatively more common. A high index of suspicion, a serum β HCG test and close collaboration between clinicians and pathologists can help make the diagnosis. [ABSTRACT FROM AUTHOR]
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- 2017
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148. Expert Opinion on the Management of Non-Alcoholic Fatty Liver Disease (NAFLD) in the Middle East with a Focus on the Use of Silymarin
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Yogesh Shastri, Reyaz Ahmad, Saleh Ahmed, Anton Gillessen, Hamouda Ahmed, Mohamed Guda, Ahmed Abdel Rahman Hashem, Malfi Al Otaibi, Fateh Al Idris, Elwin Buchel, and Hussam Saleh
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medicine.medical_specialty ,silymarin ,Disease ,RC799-869 ,Chronic liver disease ,silybin ,03 medical and health sciences ,Liver disease ,0302 clinical medicine ,Quality of life (healthcare) ,milk thistle ,medicine ,Intensive care medicine ,Hepatology ,Milk Thistle ,business.industry ,Fatty liver ,Gastroenterology ,non-alcoholic fatty liver disease ,Non alcoholic ,Diseases of the digestive system. Gastroenterology ,medicine.disease ,digestive system diseases ,diagnostic challenges ,030220 oncology & carcinogenesis ,Expert opinion ,030211 gastroenterology & hepatology ,treatment challenges ,business - Abstract
Non-alcoholic fatty disease (NAFLD) is amongst the leading causes of chronic liver disease worldwide. The prevalence of NAFLD in the Middle East is 32%, similar to that observed worldwide. The clinicians in this region face several challenges in diagnosing and treating patients with NAFLD. Additionally, there are no national or regional guidelines to address the concerns faced with current treatment options. Silymarin, derived from milk thistle, provides a rational and clinically proven approach to hepatoprotection. This article focuses on addressing regional diagnostic challenges and provides clear guidance and potential solutions for the use of Silymarin in the treatment of NAFLD in the Middle East. Both clinical and preclinical studies have highlighted the efficiency of Silymarin in managing NAFLD by reducing liver disease progression and improving patient symptoms and quality of life, alongside being safe and well tolerated. An expert panel of professionals from the Middle East convened to establish a set of regional-specific diagnostics. A consensus was established to aid general physicians to address the diagnostic challenges in the region. In conclusion, Silymarin can be considered beneficial in treating NAFLD and should be initiated as early as possible and continued as long as necessary.
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- 2021
149. Melanotic neuroectodermal tumor of infancy: a rare presentation of an extremely rare neoplasm and diagnostic implications in Gombe, Nigeria
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Babatunde Oludare Fakuade and Joshua Biodun Adeoye
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melanotic neuro-ectodermal tumor of infancy ,benign tumor ,maxillary tumor ,infant ,bony-hard swelling ,firm swelling ,diagnostic challenges ,management challenges ,vanyl mandellic acid ,wide excision ,Medicine - Abstract
Melanotic neuro-ectodermal tumor of infancy is very rare. A unique neoplasm of the formative years, it typically involves the face or cranium; possesses rapid, expansile growth; presents as a firm swelling and displays a high rate of recurrence. Its rarity and unique features make diagnosis and management quite challenging. This challenge is increased in resource-limited settings like ours and with atypical presentation, such as was seen at our center, where patient presented with a bony hard swelling.
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- 2017
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150. Juvenile dermatomyositis in an 11 year old Nigerian-boy: A case report and review of literature
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Saheed B.A. Oseni, Oladapo Adedayo Kolawole, Musa Tawakalit Lily, Olusola Adetunji Oyedeji, and Olamide Kayode
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medicine.medical_specialty ,Case Report ,Disease ,Thigh ,03 medical and health sciences ,0302 clinical medicine ,Proximal myopathy ,medicine ,Juvenile dermatomyositis ,030203 arthritis & rheumatology ,Muscle biopsy ,medicine.diagnostic_test ,business.industry ,Diagnostic challenges, juvenile, myositis dermatoses ,General Medicine ,medicine.disease ,Dermatology ,Muscle enzyme ,Diagnostic challenges ,medicine.anatomical_structure ,juvenile ,myositis dermatoses ,Prednisolone ,Presentation (obstetrics) ,business ,030217 neurology & neurosurgery ,medicine.drug - Abstract
We report the case of an 11-year-old boy with proximal myopathy, heliotrope, and Gottron papule-like rashes. Serum chemistry revealed muscle enzyme elevations, whereas muscle biopsy histology showed necrosis and inflammation, which were in keeping with juvenile dermatomyositis. Plain radiographic examination of the thigh 3 weeks after commencing treatment with prednisolone was normal. The aim of this presentation is to highlight the diagnostic challenges posed by this rare condition in a resource-limited setting and to underscore the need for prompt diagnosis and appropriate management. We hope that this report will assist physicians practicing in similar settings to make a prompt and accurate diagnosis when confronted with the same disease.
- Published
- 2022
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