scholarly journals A Diagnostic Dilemma of Cryptogenic Organising Pneumonia

2012 ◽  
Vol 52 (188) ◽  
Author(s):  
K Gurung
Keyword(s):  
Steroid Therapy ◽  
Lung Biopsy ◽  
Early Recognition ◽  
Steroid Treatment ◽  
Age Group ◽  
Shortness Of Breath ◽  
Diagnostic Dilemma ◽  
Good Outcome ◽  
Lung Condition

Cryptogenic Organising Pneumonia is a rare lung condition, which has incidence of 6-9 cases per 1000,000 people with onset at age group between 50-60. The pathogenesis of this condition remains unknown. It mimics like pneumonia but has a good outcome with steroid treatment. Early recognition is very important and treatment with steroid therapy can save lives. This case highlights the unusual cause of shortness of breath due to COP and co existing incidental severe AS where we faced a diagnostic dilemma till lung biopsy was performed. Keywords: Cryptogenic organising pneumonia; Pneumonia.

scholarly journals Meningococcemia Presenting as a Myocardial Infarction

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
Daniel Lachant ◽  
David Trawick
Keyword(s):  
Myocardial Infarction ◽  
Emergency Department ◽  
Chest Pain ◽  
Cardiogenic Shock ◽  
Neisseria Meningitidis ◽  
Early Recognition ◽  
Myocardial Dysfunction ◽  
Shortness Of Breath ◽  
Gram Negative ◽  
St Elevation

Neisseria meningitidisis an encapsulated gram negative diplococcus that colonizes the nasopharynx and is transmitted by aerosol or secretions with the majority of cases occurring in infants and adolescents. Meningococcemia carries a high mortality which is in part due to myocarditis. Early recognition and prompt use of antibiotics improve morbidity and mortality. We report a 55-year-old male presenting to the emergency department with chest pain, shortness of breath, and electrocardiogram changes suggestive of ST elevation MI who developed cardiogenic shock and multisystem organ failure fromN. meningitidis. We present this case to highlight the unique presentation of meningococcemia, the association with myocardial dysfunction, and the importance of early recognition and prompt use of antibiotics.

scholarly journals A Five Years Old Child with Failure To Thrive and Vomiting Presenting as a Diagnostic Dilemma: A Case Report

2020 ◽  
Vol 58 (228) ◽  
Author(s):  
Anita Lamichhane ◽  
Rupesh Sharma ◽  
Ramana Rajkarnikar ◽  
Rubee Awale ◽  
Prapti Shrestha ◽  
...  
Keyword(s):  
Failure To Thrive ◽  
Exploratory Laparotomy ◽  
Age Group ◽  
Older Children ◽  
Diagnostic Challenge ◽  
High Resolution Computed Tomography ◽  
Diagnostic Dilemma ◽  
Recurrent Vomiting ◽  
Colicky Pain ◽  
Band Failure

Vomiting with failure to thrive in older children is a diagnostic challenge due to the diversity in the diagnosis. We report a case of a five-years-old girl with failure to thrive, history of recurrent vomiting and intermittent colicky pain abdomen since 45 days of life. Intestinal malrotation with Ladd’s band was diagnosed based on clinical acumen, high- resolution computed tomography, barium follow through and intraoperative findings. Exploratory laparotomy with Ladd’s procedure was performed under general anesthesia which showed malrotation at the duodenojejunal junction with a short route of mesentery with floating caecum with Ladd’s band. Failure to thrive with malrotation of the gut in the older age group is rare in itself. As there are very few cases reported in this age group, so we undertook to report this case to increase the awareness of knowledge concerning the diagnosis and timely management to prevent the comorbidity of this condition.

scholarly journals An investigation of the diagnostic, predictive, and prognostic impacts of three colonic biopsy grading systems for acute graft versus host disease

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0256543
Author(s):  
Andreas Kreft ◽  
Katrin Hippe ◽  
Eva Maria Wagner-Drouet ◽  
Isabelle Ries ◽  
Arne Kandulski ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Steroid Therapy ◽  
Graft Versus Host Disease ◽  
Steroid Treatment ◽  
Systemic Steroid ◽  
Hematopoietic Stem ◽  
Host Disease ◽  
Graft Versus Host ◽  
Grading Systems ◽  
Acute Graft

Acute graft versus host disease (aGvHD) is an important, life-threatening complication after allogeneic hematopoietic stem cell transplantation (alloHSCT). To investigate the value of multiple simultaneous colon biopsies in improving diagnostic accuracy in patients with aGvHD, we retrospectively analyzed 157 patients after alloHSCT. The biopsies were evaluated individually using three established histological grading systems (Lerner, Sale, and Melson). The maximum, minimum, median, and mean histological aGvHD grades were calculated for each patient, and the results were correlated with the Glucksberg grade of clinical manifestation of GvHD, steroid therapy status, and outcome. We found that multiple colon biopsies enhanced diagnostic sensitivity. Moreover, higher histological grades correlated with steroid therapy initiation and refractoriness; the latter particularly occurred when advanced damage was present in all samples and healthy colon mucosa was reduced or absent. On multivariate analysis, the minimal Lerner and Glucksberg grades for intestinal aGvHD were significantly associated with steroid treatment failure. Ninety-nine patients died. The median survival was 285 days after the biopsies were taken. Fifteen patients died from relapse of their underling disorder and 84 from other causes, mostly infection (53 patients) and GvHD (14 patients). Multivariate analysis revealed a significant association between none-relapse mortality and the mean Lerner grade, minimum Melson grade, Glucksberg organ stage, and platelet counts. Thus, we found the Lerner system to be superior to the other grading methods in most instances and histologic evaluation of multiple simultaneously obtained biopsies from the colon to result in a higher diagnostic yield, which helps plan systemic steroid treatment while predicting treatment response and outcome.

scholarly journals GUILLAIN BARRE SYNDROME;

2013 ◽  
Vol 20 (03) ◽  
pp. 348-353
Author(s):  
SOHAIL ASHRAF ◽  
ARSHALOOZ J. RAHMAN
Keyword(s):  
Mechanical Ventilation ◽  
Clinical Features ◽  
Acute Flaccid Paralysis ◽  
Early Recognition ◽  
Age Groups ◽  
Rapid Onset ◽  
Flaccid Paralysis ◽  
Initial Symptom ◽  
Age Group ◽  
Main Factor

Background: Guillian Barre Syndrome is a polyradiculopathy characterized by symmetric ascending paralysis andareflexia. It affects all age groups and both sexes with an unpredictable outcome. Objectives: The aims of this study were to identify thevarious diseases presenting as Acute Flaccid Paralysis and notice clinical features and outcome of cases of Guillian Barre Syndrome.Materials and Methods: Retrospective analysis of 53 patients presenting as Acute Flaccid Paralysis was done. Clinical features andlaboratory investigations of 39 patients of Guillian Barre syndrome were reviewed. Results: Among all cases of Acute Flaccid Paralysis,Guillian Barre syndrome formed the bulk of the cases (73.6%).It was more common in females and in age group of 10 years or below. Inmajority of the cases, rapid onset of weakness was the initial symptom. Mortality was 100% in patients who had respiratory muscleinvolvement and who required mechanical ventilation. Conclusions: In our study the main factor causing death in a case of Guillian Barresyndrome was bulbar involvement requiring mechanical ventilation. Early recognition of the prognostic factors may lead to decreasedmortality in case of Guillian Barre syndrome.

scholarly journals An Evaluation of the Results of the Steroid and Non-steroidal Anti-inflammatory Drug Treatments in Subacute Thyroiditis in relation to Persistent Hypothyroidism and Recurrence

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Muhammed Erkam Sencar ◽  
Murat Calapkulu ◽  
Davut Sakiz ◽  
Sema Hepsen ◽  
Arif Kus ◽  
...  
Keyword(s):  
Steroid Therapy ◽  
Protective Factor ◽  
Laboratory Data ◽  
Steroid Treatment ◽  
Subacute Thyroiditis ◽  
Long Term Results ◽  
Thyroid Peroxidase ◽  
Therapeutic Effects ◽  
Acute Phase Reactants ◽  
Anti Inflammatory

AbstractSubacute thyroiditis (SAT) is an inflammatory thyroid disease. The main purpose of the treatment is to relieve pain and control the inflammatory process. The aim of the present study was to evaluate the therapeutic effects of steroid and non-steroidal anti-inflammatory drugs (NSAIDs) in SAT. Initial laboratory data, treatment response, and long-term results of 295 SAT patients treated with ibuprofen or methylprednisolone were evaluated. After the exclusion of 78 patients, evaluation was made of 126 patients treated with 1800 mg ibuprofen and 91 patients treated with 48 mg methylprednisolone. In 59.5% of 126 patients treated with ibuprofen, there was no adequate clinical response at the first control visit. In 54% of patients, the treatment was changed to steroids in mean 9.5 days. Symptomatic remission was achieved within two weeks in all patients treated with methylprednisolone. The total recurrence rate was 19.8%, and recurrences were observed more frequently in patients receiving only steroid therapy than in patients treated with NSAID only (23% vs. 10.5% p:0.04). Persistent hypothyroidism developed in 22.8% of patients treated only with ibuprofen and in 6.6% of patients treated with methylprednisolone only. Treatment with only ibuprofen (p:0.039) and positive thyroid peroxidase antibody (anti-TPO) (p:0.029) were determined as the main risk factors for permanent hypothyroidism. NSAID treatment is not as effective as steroid treatment in early clinical remission. Steroid treatment was detected as a protective factor against permanent hypothyroidism. Therefore, steroid therapy may be considered especially in anti-TPO positive SAT patients and patients with high-level acute phase reactants.

scholarly journals Pelvic tuberculosis: from millets to masses

2019 ◽  
Vol 8 (7) ◽  
pp. 2943
Author(s):  
Nitin H Shah ◽  
Aditi Vivek Joshi ◽  
Sunita Mourya
Keyword(s):  
Adnexal Mass ◽  
Age Groups ◽  
Reproductive Age ◽  
Clinical Impression ◽  
Age Group ◽  
Diagnostic Dilemma ◽  
The Tropics ◽  
Author Report ◽  
Ovarian Masses ◽  
Reproductive Age Group

An adnexal mass is a common entity in the reproductive age group. Ovarian masses form a majority of this condition. Tuberculosis is a disease commonly encountered in the Tropics and is endemic to India. Abdominopelvic affliction of this disease is common in women especially in the reproductive age groups. It may present with variety of non-specific clinical features and often poses an enormous diagnostic dilemma Author report one such case, presenting with a clinical impression of ovarian malignancy, however, was diagnosed to be a case of extensive pelvic tuberculosis on laparoscopy. Tissue biopsy was consistent with the finding of tuberculosis.

Intratympanic Steroid Treatment for Sudden Hearing Loss after Failure of Systemic Steroid Therapy

2012 ◽  
Vol 105 (6) ◽  
pp. 513-520
Author(s):  
Toshiro Kawano ◽  
Junichi Ishitoya ◽  
Mariko Hirama ◽  
Yukiko Yamashita ◽  
Ryo Ikoma ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Steroid Therapy ◽  
Sudden Hearing Loss ◽  
Steroid Treatment ◽  
Systemic Steroid ◽  
Systemic Steroid Therapy

scholarly journals Yield of Echocardiogram and Predictors of Positive Yield in Pediatric Patients: A Study in an Urban, Community-Based Outpatient Pediatric Cardiology Clinic

2018 ◽  
Vol 5 ◽  
pp. 2333794X1876914
Author(s):  
Ramya Deepthi Billa ◽  
Susan Szpunar ◽  
Lida Zeinali ◽  
Premchand Anne
Keyword(s):  
Pediatric Patients ◽  
Pediatric Cardiology ◽  
Age Group ◽  
Shortness Of Breath ◽  
Cumulative Yield ◽  
Community Based ◽  
Cardiology Clinic ◽  
First Time ◽  
Community Teaching ◽  
Echocardiographic Findings

The yield of outpatient echocardiograms varies based on the indication for the echocardiogram and the age of the patient. The purpose of this study was to determine the cumulative yield of outpatient echocardiograms by age group and reason for the test. A secondary aim was to determine the predictors of a positive echocardiogram in an outpatient cardiology clinic at a large community teaching hospital. We retrospectively reviewed the charts of 891 patients who had a first-time echocardiogram between 2011 and 2015. Positive yield was defined as echocardiographic findings that explained the reason for the echocardiogram. The overall positive yield was 8.2%. Children between birth and 3 months of age had the highest yield (34.2%), and children between 12 and 18 years of age had the lowest yield (1%). Patients with murmurs (18.1%) had the highest yield compared with patients with other signs or symptoms. By age group and reason, the highest yields were as follows: 0 to 3 months of age, murmur (39.2%); 4 to 11 months of age, >1 symptom (50%); and 1 to 5 years of age, shortness of breath (66.7%). Based on our study, the overall yield of echocardiograms in the outpatient pediatric setting is low. Age and symptoms should be considered before ordering an echocardiogram.

Invasive Aspergillosis: A Life-Threatening Complication of Short-Term Steroid Treatment

1995 ◽  
Vol 29 (12) ◽  
pp. 1235-1237 ◽  
Author(s):  
Dolors Conesa ◽  
Jordi Rello ◽  
Jordi Vallés ◽  
Dolors Mariscal ◽  
Joan Carles Ferreres
Keyword(s):  
Respiratory Failure ◽  
Invasive Aspergillosis ◽  
Steroid Therapy ◽  
Invasive Pulmonary Aspergillosis ◽  
Significant Risk ◽  
Steroid Treatment ◽  
Chronic Obstructive ◽  
Short Term ◽  
Pulmonary Aspergillosis ◽  
Progressive Respiratory Failure

Objective: To describe a patient with invasive pulmonary aspergillosis related to short-term steroid treatment. Case Summary: A 78-year-old man with chronic obstructive pulmonary disease (COPD) developed an invasive pulmonary aspergillosis after short-term (less than 1 week) intravenous steroid therapy. The diagnosis was established by recovering Aspergillus fumigatus from a bronchoalveolar lavage and was confirmed by autopsy, with the additional finding of an aspergilloma. Discussion: This case is of interest for 3 reasons: (1) it illustrates that invasive aspergillosis may be followed by a rapidly progressive respiratory failure, even in the absence of a fever; (2) this patient had simultaneously an aspergilloma and an invasive aspergillosis; and (3) it confirms reports indicating that short-term steroid therapy for COPD represents a significant risk factor for opportunistic lung infections. Conclusions: In patients with COPD who receive even short-term steroid therapy and who have progressive respiratory failure caused by pneumonia, invasive aspergillosis should be suspected early and acted upon accordingly.

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