scholarly journals Complex Polypathology Infectious, Rheumatological, Neurological and Orthopedic – Real Challenge for Functional Rehabilitation - Case Report

2020 ◽  
Vol 26 (2) ◽  
pp. 52-57
Author(s):  
Libu Cristiana ◽  
Iliescu Mădălina Gabriela ◽  
Bobe Zoe Maria ◽  
Arghir Oana Cristina ◽  
Bilous Dana-Maria ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Infectious Diseases ◽  
Clinical Manifestations ◽  
New Drugs ◽  
Chronic Infections ◽  
Functional Rehabilitation ◽  
European League Against Rheumatism ◽  
Insidious Onset ◽  
The Common ◽  
Real Challenge

Abstract Introduction. Infectious and autoimmune rheumatic diseases (ARDs) are closely linked. Apart from the challenging, sometimes differential, diagnosis between these conditions, it is recognized that microbes play an important role in the pathogenesis of the latter. Material and method. We present the case of a 45-year-old female patient from our rehabilitation department, with complex pathology (infectious, neurological, rheumatological and orthopedic pathology) that began more than 15 years ago. The patient’s pathological history began insidiously at theage of 30 when she was diagnosed with neurotoxoplasmosis. She received anticoagulant, antiepileptic, steroidal, antibiotic and antihelmintic treatment. After four years, the patient shows insidious onset of inflammatory pain in the large joints and in 2010 is diagnosed with seropositive rheumatoid arthritis, according to American College of Rheumatism/European League against rheumatism (ACR/EULAR) criteria with symmetric impairment of the large joints (shoulder, elbow, hip, knee, ankle). Despite the treatment with disease-modifying anti-rheumatic drugs (DMARDs) received, in the following years she needed 4 arthroplasties in the large joints due to osteonecrosis. Conclusions. On clinical grounds, infections, especially chronic infections, can cause a plethora of autoimmune phenomena, thus mimicking ARDs. Therefore, the differential diagnosis between ARDs and infectious diseases is sometimes challenging as they often display similar clinical manifestations. It is highlighted that the immune system can be our friend or our foe considering that its function and dysregulation are the common denominators in autoimmune and infectious diseases. In the era of new drugs and new therapeutic strategies, safety of the patients should always be our first concern.

Effect of Chronic Administration of Recombinant Bovine Tumor Necrosis Factor to Cattle

1989 ◽  
Vol 26 (6) ◽  
pp. 462-472 ◽  
Author(s):  
H. Bielefeldt Ohmann ◽  
M. Campos ◽  
M. Snider ◽  
N. Rapin ◽  
T. Beskorwayne ◽  
...  
Keyword(s):  
Tumor Necrosis Factor ◽  
Infectious Diseases ◽  
Tumor Necrosis ◽  
Clinical Signs ◽  
Clinical Manifestations ◽  
Prolonged Treatment ◽  
Chronic Infections ◽  
Necrosis Factor Alpha ◽  
Fat Depots ◽  
Necrosis Factor

Cachectin/tumor necrosis factor-alpha (TNF), a protein produced by macrophages upon stimulation, has been implicated as an important mediator of inflammatory processes and of clinical manifestations in chronic infectious diseases. In order to study further the potential role of TNF in infectious diseases, a homologous system was employed in which recombinant Escherichia coli (E. coli) derived bovine TNF (rBoTNF) was injected in cattle, either as a single bolus or in a repetitive treatment-regime. No clinical signs were observed, although changes occurred in hematologic and immunologic parameters when less than 0.5 mg of TNF/100 kg body weight was administered twice daily for 18 days. Prolonged treatment with 0.05–0.5 mg/100 kg induced histologic but no gross changes in the kidneys and liver. When doses were increased above 0.5 mg/100 kg, depression, anorexia, cachexia, and diarrhea appeared rapidly. Pathologic changes were apparent in various tissues including liver, kidneys, and lymphoid organs; body fat depots were depleted. Most of these changes appeared to be reversible; return to normal tissue-morphology occurred within 3 weeks of withdrawal of rBoTNF. The clinical and pathologic changes induced by prolonged rBoTNF administration resembled those observed in some chronic parasitic and viral infections of cattle in which macrophage-activation characteristically occur. Our finding may be relevant to the elucidation of the pathogenesis of these and other chronic infections.

A glance on dystonias, how to recognize and handle them

2019 ◽  
pp. 22-29
Author(s):  
F. N. Mercan ◽  
E. Bayram ◽  
M. C. Akbostanci
Keyword(s):  
Differential Diagnosis ◽  
Movement Disorder ◽  
Age Of Onset ◽  
Clinical Manifestations ◽  
Body Part ◽  
Classification Model ◽  
Treatment Choices ◽  
Muscle Groups

Dystonia refers to an involuntary, repetitive, sustained, painful and twisting movements of the affected body part. This movement disorder was first described in 1911 by Hermain Oppenheim, and many studies have been conducted to understand the mechanism, the diagnosis and the treatment of dystonia ever since. However, there are still many unexplained aspects of this phenomenon. Dystonia is diagnosed by clinical manifestations, and various classifications are recommended for the diagnosis and the treatment. Anatomic classification, which is based on the muscle groups involved, is the most helpful classification model to plan the course of the treatment. Dystonias can also be classified based on the age of onset and the cause. These dystonic syndromes can be present without an identified etiology or they can be clinical manifestations of a neurodegenerative or neurometabolic disease. In this review we summarized the differential diagnosis, definition, classifications, possible mechanisms and treatment choices of dystonia.

scholarly journals The Main Challenges in Systemic Lupus Erythematosus: Where Do We Stand?

2021 ◽  
Vol 10 (2) ◽  
pp. 243
Author(s):  
Matteo Piga ◽  
Laurent Arnaud
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Systemic Disease ◽  
Unmet Need ◽  
Clinical Manifestations ◽  
New Drugs ◽  
Systemic Lupus ◽  
Major Step ◽  
Damage Accrual

Systemic lupus erythematosus (SLE) is an immune-mediated multi-systemic disease characterized by a wide variability of clinical manifestations and a course frequently subject to unpredictable flares. Despite significant advances in the understanding of the pathophysiology and optimization of medical care, patients with SLE still have significant mortality and carry a risk of progressive organ damage accrual and reduced health-related quality of life. New tools allow earlier classification of SLE, whereas tailored early intervention and treatment strategies targeted to clinical remission or low disease activity could offer the opportunity to reduce damage, thus improving long-term outcomes. Nevertheless, the early diagnosis of SLE is still an unmet need for many patients. Further disentangling the SLE susceptibility and complex pathogenesis will allow to identify more accurate biomarkers and implement new ways to measure disease activity. This could represent a major step forward to find new trials modalities for developing new drugs, optimizing the use of currently available therapeutics and minimizing glucocorticoids. Preventing and treating comorbidities in SLE, improving the management of hard-to-treat manifestations including management of SLE during pregnancy are among the remaining major unmet needs. This review provides insights and a research agenda for the main challenges in SLE.

scholarly journals Excited delirium syndrome from psychostimulant abuse can mimic a violent scene of death

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Shatishraj Jothee ◽  
Mohamed Swarhib Shafie ◽  
Faridah Mohd Nor
Keyword(s):  
Clinical Manifestations ◽  
The Body ◽  
Law Enforcement Agencies ◽  
Manner Of Death ◽  
Case Presentation ◽  
Excited Delirium ◽  
The Common ◽  
Violent Scene ◽  
Naked Body ◽  
Psychostimulant Abuse

Abstract Background Previous reported cases on excited delirium syndrome studied on the common clinical manifestations of the syndrome. The usual forensics implication for the syndrome is that death commonly is associated with restraint procedures by law enforcement agencies; however, not many cases reported highlights the difficulties in attributing a violent scene of death to the syndrome. Case presentation We present a case of a partially naked body found in an apartment unit under suspicious circumstances with multiple injuries. The scene of death was violent, and the body was found with blood wiped all over the floor and walls. Investigators believed a violent crime had occurred, and a suspect was reprimanded. However, upon autopsy, it was found that all injuries were superficially inflicted and were unlikely to have been part of an act of commission or caused his death. Internal examination found no remarkable pathology. Toxicology revealed a presence of psychostimulants, that is, methamphetamine, MDMA, and ethyl alcohol. Reconstruction of events by the witness, who was initially suspected of the ‘murder’, revealed that the injuries and his death could likely be explained by an episode of excited delirium. Conclusion The case highlights the challenges faced when attributing excited delirium syndrome as a cause of death. The syndrome can present with injuries from aggressive or bizarre behaviour, coupled with the destruction of property, which may confuse investigators on the possible manner of death.

scholarly journals Pulvinar sign in a case of anti-HU paraneoplastic encephalitis

2016 ◽  
Vol 29 (6) ◽  
pp. 436-439 ◽  
Author(s):  
Pierre-Luc Gamache ◽  
Maude-Marie Gagnon ◽  
Martin Savard ◽  
François Émond
Keyword(s):  
Magnetic Resonance Imaging ◽  
Differential Diagnosis ◽  
Magnetic Resonance ◽  
Clinical Manifestations ◽  
Resonance Imaging ◽  
Paraneoplastic Encephalitis ◽  
Jakob Disease ◽  
Magnetic Resonance Imaging Mri ◽  
Work Up

This article reports the case of a 68-year-old patient with anti-HU antibodies paraneoplastic encephalitis. The clinical manifestations were atypical and the paraclinical work-up, notably the magnetic resonance imaging (MRI) showing bilateral posterior thalamic hyperintensities (pulvinar sign), misleadingly pointed towards a variant Creutzfeld–Jakob disease. After presenting the case, the differential diagnosis of the pulvinar sign is discussed along with other important diagnostic considerations.

TRANSIENT ISCHEMIC ATTACKS: ETIOPATHOGENESIS, CLINIC. (Literature review)

Vestnik ◽  
2021 ◽  
pp. 91-96
Author(s):  
Г.Ж. Жакенова ◽  
Р.Б. Нуржанова ◽  
К.Б. Сраилова ◽  
Ж.С. Шерияздан ◽  
А.Б. Ташманова ◽  
...  
Keyword(s):  
Risk Factors ◽  
Differential Diagnosis ◽  
Literature Review ◽  
Clinical Manifestations ◽  
Transient Ischemic Attacks ◽  
Review Of The Literature ◽  
Imaging Signs

В данной статье представлен обзор литературы по транзиторным ишемическим атакам: эпидемиология, этиология, патогенез, классификация, основные характеристики с учетом факторов риска, визуализационных признаков МРТ и КТ, клинических проявлений и дифференциальной диагностики данного заболевания на основе современных исследований. This article presents a review of the literature on transient ischemic attacks: epidemiology, etiology, pathogenesis, classification, main characteristics taking into account risk factors, imaging signs of MRI and CT, clinical manifestations and differential diagnosis of this disease based on modern research.

scholarly journals Non-tuberculous Mycobacterium Disease: Radiologic Manifestation in an Infant presenting with Respiratory Distress

2017 ◽  
Vol 5 (1-2) ◽  
pp. 13-20
Author(s):  
Rupesh Gautam ◽  
Maria Isabel Atienza ◽  
Maika Noda ◽  
Mariaem Andres
Keyword(s):  
Hypersensitivity Pneumonitis ◽  
Pulmonary Infection ◽  
Clinical Manifestations ◽  
Distinct Group ◽  
Middle Lobe ◽  
Air Trapping ◽  
Pulmonary Tb ◽  
Radiologic Findings ◽  
The Common ◽  
Common Manifestation

Non-tuberculous mycobacterium (NTM) comprises distinct group of organisms with lymphadenitis and pulmonary infection as the common manifestation. The diagnosis of pulmonary disease is based on clinical manifestations, radiologic findings and microbiologic culture. The classic NTM infection may be indistinguishable from pulmonary TB. Non-classic infection has predilection to the middle lobe and lingula unlike tuberculosis which is commonly seen in the upper lobes. The disease may also present as hypersensitivity pneumonitis with ground glass like opacities, centrilobular nodules and air trapping on imaging. The knowledge of imaging manifestations of NTM will aid in timely diagnosis and treatment of the disease.Nepal Journal of Radiology Vol.5(1-2) 2015: 13-20

scholarly journals Melioidosis in Bihar, India: unearthing the first of many?

2021 ◽  
Vol 3 (9) ◽  
Author(s):  
Isra Halim ◽  
Prathyusha Kokkayil ◽  
Ravi Kirti ◽  
Rajeev Nayan Priyadarshi ◽  
Asim Sarfraz ◽  
...  
Keyword(s):  
Clinical Manifestations ◽  
Clinical Suspicion ◽  
Radiological Features ◽  
First Case ◽  
Insidious Onset ◽  
Ankle Joints ◽  
The World ◽  
Resource Poor ◽  
Empirical Antibiotics ◽  
The Right

Melioidosis, a disease with protean clinical manifestations, is prevalent in many parts of India, with established endemic hotspots on the southern coast of the country. However, it is still underdiagnosed in many resource-poor regions of the country. We report what is, to the best of our knowledge, the first case of melioidosis diagnosed and treated in Bihar, an economically underdeveloped state in East India. The patient, a 52-year-old diabetic male, presented to the outpatient department with a fever of insidious onset along with pain and restriction of movement in the right shoulder joint and right knee joint, and swelling and tenderness of bilateral ankle joints. Radiological features were suggestive of multiple joint and organ abscesses. A diagnosis of disseminated septicaemic melioidosis was confirmed microbiologically. The patient improved clinically following aggressive treatment with meropenem and cotrimoxazole. The case highlights the need for increased clinical suspicion of melioidosis and adequate diagnostic facilities, as well as the need for early institution of appropriate empirical antibiotics in suspected cases of melioidosis in this region of the world.

scholarly journals Dynamic neuropathy of the common peroneal nerve at the level of the fibular head (literature review and case report)

2019 ◽  
Vol 21 (1) ◽  
pp. 54-59
Author(s):  
M. G. Bashlachev ◽  
G. Yu. Evzikov ◽  
V. A. Parfenov ◽  
N. B. Vuitsyk ◽  
F. V. Grebenev
Keyword(s):  
Ankle Joint ◽  
Peroneal Nerve ◽  
Correct Diagnosis ◽  
Clinical Manifestations ◽  
Common Peroneal Nerve ◽  
Diagnostic Methods ◽  
Fibular Head ◽  
Study Objective ◽  
The Common ◽  
The Right

The study objective is to report a case of dynamic neuropathy of the common peroneal nerve at the level of the fibular head and to discuss diagnostic methods and neurosurgical treatment. Materials and methods. We report a case of dynamic neuropathy of the common peroneal nerve at the level of the fibular head in a female patient. The patient was treated in the Neurology Clinic of I.M. Sechenov First Moscow State Medical University. We analyzed clinical manifestations and compared them with the data described in research literature. Results. Upon admission, the patient complained of pain in the anterolateral surface of the right shin and in the dorsum of the foot during walking. At rest, the patient experienced no pain. We observed no motor or sensory disorders typical of nerve root disorders at the level of L5. Lasegue’s test was negative. The patient had a positive Tinel’s sign in the area of the right fibular head. In order to clarify the diagnosis, we performed a repeated extension test in the right ankle joint and it was positive. The patient underwent surgery that included peroneal nerve decompression and neurolysis at the level of the fibular head. In the postoperative period, the patient had complete pain relief. Conclusion. Due to the difficulties in the diagnostics of dynamic neuropathy of the common peroneal nerve, this disease is often mistaken for radiculopathy at the level of L5. Thorough clinical examination, testing for Tinel’s sign in the area of the fibular head, and repeated extension test in the ankle joint ensure the correct diagnosis and reduce the frequency of ineffective surgeries on the lumbar spine. Surgical decompression of the common peroneal nerve at the level of the fibular head with obligatory opening of the entrance to the nerve canal is an effective method of treatment in such patients.

scholarly journals Penile angioedema in a child: A nightmare to parents!

2022 ◽  
Vol 1 ◽  
pp. 21-23
Author(s):  
K. S. Lakshmi Srividya ◽  
Vidyasagar P
Keyword(s):  
Differential Diagnosis ◽  
Early Diagnosis ◽  
Clinical Manifestations ◽  
Diagnosis And Management ◽  
Fatal Complications

Angioedema is a transient, non-pitting oedema that involves subcutaneous or submucosal tissue. Angioedema in children can have varied aetiology and clinical manifestations, unlike that in adults. We report a case of angioedema of penis in a child resulting from insect bite and treated successfully with anti-histamine and leukotriene inhibitor. Penile angioedema should be kept in mind as a differential diagnosis of penile swelling, as early diagnosis and management may prevent fatal complications.

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