scholarly journals Neuropathies in Sepsis: a Difficult Situation to Wean from Ventilator

2009 ◽  
Vol 21 (1) ◽  
pp. 53-55
Author(s):  
Md Mozaffer Hossain ◽  
SMA Alim ◽  
Muslema Begum ◽  
Nasiruddin Ahmed ◽  
UH Shahera Khatun
Keyword(s):  
Early Diagnosis ◽  
Artificial Ventilation ◽  
Electrophysiological Study ◽  
Diagnostic Challenge ◽  
Difficult Situation ◽  
Post Operative Period ◽  
Long Time ◽  
Cause Of Failure ◽  
Electrophysiological Examination ◽  
High Index Of Suspicion

Neuromuscular weakness in critically ill patients is diagnostic challenge. Septic Polyneuropathy is an important cause of failure to wean from artificial ventilation. We studied patient of septic polyneuropathy to highlight the importance of regular neurological examination in the early diagnosis of this conditions. Availability of facilities for bed side electrophysiological study & histopathology of muscle are important to diagnose these entity. A 56 years old lady was admitted in gastro-enterology unit with complains of abdominal pain & fever, subsequently she was diagnosed as a case of burst appendix with septicemia in Surgery Unit. Appendicectomy and surgical toileting was done under general anaesthesia. In the early post-operative period the patient developed respiratory failure and was transferred to ICU. She was on ventilator for a long time with all other investigation electrophysiological study of nerve conduction showed septic polyneuropathy. On 21st POD the patient could be withdrawn from ventilator and after T-piece trial extubation was done on the next day. Neuropathies in sepsis, an important cause of failure to wean from ventilator, a high index of suspicion and regular bed side neurological & electrophysiological examination is required to make an early diagnosis.   Journal of BSA, Vol. 21, No. 1, January 2008 53-55

scholarly journals Mucormycosis of stomach

2019 ◽  
Vol 6 (11) ◽  
pp. 4173
Author(s):  
Gaurav Joshi ◽  
Devender Singh ◽  
Yashwant Singh Rathore ◽  
Bhanupratap Singh
Keyword(s):  
Foreign Body ◽  
Early Diagnosis ◽  
Fungal Infection ◽  
Gastrointestinal Endoscopy ◽  
Upper Gastrointestinal Endoscopy ◽  
Diagnostic Challenge ◽  
Food Material ◽  
High Index Of Suspicion ◽  
Upper Gastrointestinal ◽  
Very High

Gastrointestinal mucormycosis is invasive fungal infection with very high mortality if not treated. Early diagnosis is critical. We managed a case of mucormycosis of stomach which was a diagnostic challenge. As symptoms are not specific an upper gastrointestinal endoscopy plays the most important role in the diagnosis of mucormycosis of stomach. Upon endoscopy it may be confused with food material (bread) or a foreign body (Bezoars). Diagnosis is easily missed unless there is very high index of suspicion. Surgical resection of involved organ in combination with systemic administration of amphoterecin B is treatment of choice.

Atlanto-axial subluxation (Grisel's syndrome) following otolaryngological diseases and procedures

1995 ◽  
Vol 109 (10) ◽  
pp. 1005-1009 ◽  
Author(s):  
D. Samuel ◽  
D. M. Thomas ◽  
P. A. Tierney ◽  
K. S. Patel
Keyword(s):  
Natural History ◽  
Early Diagnosis ◽  
Neck Region ◽  
Rare Condition ◽  
Cervical Pain ◽  
Head And Neck Region ◽  
Post Operative Period ◽  
Grisel’S Syndrome ◽  
High Index Of Suspicion ◽  
Otolaryngological Diseases

AbstractGrisel's syndrome is a rare condition of uncertain aetiology characterized by atlanto-axial subluxation following an infection in the head and neck region. The condition most frequently affects children and characteristically presents in the post-operative period with cervical pain and torticollis. We describe three cases and discuss the aetiology and pathogenesis. A high index of suspicion may lead to early diagnosis in its natural history thereby preventing potentially serious complications.

scholarly journals Relapsing Polychondritis: An Otolaryngologist's Perspective

2017 ◽  
Vol 9 (1) ◽  
pp. 17-20
Author(s):  
P Naina ◽  
Sheeja S John ◽  
Kamran A Syed
Keyword(s):  
Autoimmune Disease ◽  
Early Diagnosis ◽  
Clinical Condition ◽  
Clinical Signs ◽  
Relapsing Polychondritis ◽  
Diagnostic Challenge ◽  
Diagnosis And Management ◽  
Clinical Presentations ◽  
High Index Of Suspicion ◽  
Nose And Throat

ABSTRACT Relapsing polychondritis (RP) is an uncommon autoimmune disease with varying clinical presentations. Relapsing polychondritis frequently involves the ear, nose, and throat cartilages, often causing subtle and episodic symptoms that can pose a diagnostic challenge to the otolaryngologist. A high index of suspicion is needed to identify these subtle signs leading to early diagnosis. Here, we report a case of RP presenting with hoarseness of voice; we reviewed the literature and clinical signs discussed from an otolaryngologist's perspective. Greater awareness about its episodic and myriad presentation is needed for early diagnosis and management of this uncommon clinical condition. How to cite this article Syed KA, Naina P, John SS, Varghese AM. Relapsing Polychondritis: An Otolaryngologist's Perspective. Int J Otorhinolaryngol Clin 2017;9(1):17-20.

scholarly journals Implantable loop recorder: experience of a center

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
C Marques Pires ◽  
P Medeiros ◽  
C Oliveira ◽  
I Campos ◽  
M Flores ◽  
...  
Keyword(s):  
Positive Impact ◽  
Blood Pressure Monitoring ◽  
Electrophysiological Study ◽  
Stress Test ◽  
Sinus Node ◽  
Oral Anticoagulants ◽  
Paroxysmal Supraventricular Tachycardia ◽  
Implantable Loop Recorder ◽  
Diagnostic Challenge ◽  
Loop Recorder

Abstract Funding Acknowledgements Type of funding sources: None. INTRODUCTION Symptoms like syncope and palpitations are frequent and represent a diagnostic challenge. The implantable loop recorder (LR) is an important diagnostic tool, in selected cases. AIM To describe the main implantation indications of LR and to evaluate the diagnostic findings and therapeutic interventions. METHODS A retrospective study of patients (pts) that underwent LR implantation in our hospital from 2014 to 2019. For each pt the indication for implantation, baseline characteristics, previous study, recorded tracing and interventions were evaluated. RESULTS A total of 52 pts were included, 56% women, with a mean age of 60 years old. The implantation indications were recurrent syncope/ presyncope in 47 pts (90%) and palpitations in 5 pts (10%). All pts had a baseline echocardiogram and electrocardiogram, with 90% in sinus rhythm. QRS complex and atrial-ventricular conduction was normal in 50% of the pts. Previous to LR implantation, 46 pts (89%) had performed Holter, 19 (37%) carotid sinus massage, 14 (27%) Tilt table test, 29 (56%) stress test, 11(21%) ambulatory blood pressure monitoring and 9 (17%) electrophysiological study. During the monitoring period, 27 pts (52%) had recurrence of the symptoms. In this subgroup, we observed that 67% had a rhythmic cause capable of justified the symptoms, with a median of 5 months since implantation until diagnosis. In addition, the LR was useful in ruling out a rhythmic cause for symptoms in 33% of the cases. In the 47 pts with syncope/presyncope: 6(13%) had sinus node dysfunction, 4 (9%) had atrioventricular conduction disturbance, 1(2%) had atrial fibrillation (AF) and 3 (6%) had ventricular dysrhythmias. In the 5 pts with palpitations: 1(20%) had AF ad 3 (60%) had paroxysmal supraventricular tachycardia. LR results led to cardiac device implantation in 13 pts (pacemaker-9, implantable cardioverter desfibrillator-4). In addition, 2 pts are waiting for electrophysiological study and eventual ablation and 3 pts initiated antiarrhythmic therapy, and those with new diagnosis of AF also initiated oral anticoagulants. CONCLUSION In this study, the implantation of LR was useful to clarify the cause of the symptomology in 52% of the pts. In 35% of pts with symptom-rhythm correlation it ensured timely introduction of therapeutic approach with a positive impact on life quality.

Wegener’s granulomatosis: diagnostic dilemma

2001 ◽  
Vol 115 (1) ◽  
pp. 46-47 ◽  
Author(s):  
A. Banerjee ◽  
J. M. Armas ◽  
J. H. Dempster
Keyword(s):  
Early Diagnosis ◽  
Wegener’S Granulomatosis ◽  
Systemic Disease ◽  
Wegener's Granulomatosis ◽  
The Body ◽  
Facial Nerve Paralysis ◽  
Diagnostic Dilemma ◽  
Nerve Paralysis ◽  
Atypical Presentations ◽  
High Index Of Suspicion

Wegener’s granulomatosis is a systemic disease characterized by a granulomatous lesion that can affect any organ throughout the body.This case-report illustrates the problem posed by a patient presenting with bilateral serous otitis media with marked sensorineural hearing loss, facial nerve paralysis and an atypical serological picture. The importance of early diagnosis and the protocol for the management of a patient with an uncertain diagnosis is discussed. Due to atypical presentations, only a high index of suspicion will ensure an early diagnosis.

Unusual Nasogastric Tube Position Leading to Delay in Diagnosis of Tracheoesophageal Fistula

2021 ◽  
pp. 097321792110367
Author(s):  
Monika Kaushal ◽  
Saima Asghar ◽  
Ayush Kaushal
Keyword(s):  
Early Diagnosis ◽  
Nasogastric Tube ◽  
Common Type ◽  
X Ray ◽  
Delay In Diagnosis ◽  
Atypical Symptoms ◽  
Tube Position ◽  
Esophageal Pouch ◽  
High Index Of Suspicion ◽  
Surgical Unit

Aim: This case highlights the importance of high index of suspicion for early diagnosis and thorough clinical examination of a newborn with tracheoesophageal atresia and fistula. Case Report: We report a case of most common type of tracheoesophageal atresia with fistula where diagnosis was missed due to unusual gastric position of nasogastric tube. Nasogastric tube reached stomach in esophageal atresia with fistula, delaying the diagnosis and management of condition. After accidental removal of tube and failure to pass again raised suspicion and was confirmed with coiled tube in esophageal pouch in X-Ray chest. Baby shifted to surgical unit for treatment, fortunately baby recovered and discharged home after surgical correction. Conclusion: Tracheoesophageal atresia with fistula can present with atypical symptoms and unusual events, challenging the early diagnosis and treatment of common types of conditions. Other association like VACTERL should be looked for, in patients.

scholarly journals Pompe Disease: Cyanosed Hypotonic Infant with Normal Respiratory Rate

2017 ◽  
Vol 13 (2) ◽  
pp. 172-174 ◽  
Author(s):  
S. Koirala ◽  
A. Poudel ◽  
R. Basnet ◽  
K. Subedi
Keyword(s):  
Respiratory Rate ◽  
Pompe Disease ◽  
Clinical Findings ◽  
Diagnostic Challenge ◽  
Floppy Infant ◽  
History Of ◽  
Infantile Pompe Disease ◽  
High Index Of Suspicion ◽  
To Receive ◽  
Remote Part

Infantile hypotonia or floppy infant is a diagnostic challenge when it presents with other presenting complaints such as fever, cough or diarrhea. Many times the hypotonia goes unnoticed when other symptom covers the hypotonia and child continues to receive the treatment for other symptoms. We report a rare case from Nepal of infantile Pompe disease who presented with the history of fever and cough in the recent earthquake disaster camp at remote part of Sindhupalchowk, Nepal. He was being treated as a case of pneumonia.Pompe disease can be diagnosed clinically by taking detailed history and correlating the clinical findings during the presentation with other symptoms. In our case the normal respiratory rate, reduced Spo2 and presence of crackles dominated the hypotonia and was mistreated as pneumonia. High index of suspicion is necessary in diagnosing Pompe disease.

scholarly journals Diffuse infiltrating retinoblastoma: A diagnostic conundrum

2021 ◽  
Vol 7 (2) ◽  
pp. 204-206
Author(s):  
Harsha Bhattacharjee ◽  
Aditi Mehta ◽  
Dipankar Das ◽  
Kasturi Bhattacharjee ◽  
Manabjyoti Barman ◽  
...  
Keyword(s):  
Family History ◽  
Multimodal Imaging ◽  
Positive Family History ◽  
Neovascular Glaucoma ◽  
Exudative Retinal Detachment ◽  
Imaging Features ◽  
Diagnostic Challenge ◽  
Progressive Loss ◽  
History Of ◽  
High Index Of Suspicion

Diffuse infiltrating retinoblastoma (DIR) is characterized by absence of intraocular mass, lack of calcification. It may mimic inflammatory uveitis or exudative retinopathy. An eight-years-old boy presented with progressive loss of vision in left eye. Clinical evaluation revealed neovascular glaucoma with a yellow–gray fundal glow, exudative retinal detachment, subretinal exudation and telangiectatic vessels. The presentation was consistent with exudative retinopathy (Coat’s disease) but for the presence of a family history of retinoblastoma in the younger sibling. Despite the absence of an intraocular mass or calcification on multimodal imaging, the enucleation was done on the basis of clinical suspicion of retinoblastoma. Histopathology confirmed a diagnosis of DIR.: DIR can pose a diagnostic challenge due to its non-characteristic clinical and imaging features and atypical presentation. A high index of suspicion along with a positive family history was key to diagnosis in our case; histopathology was confirmatory.

scholarly journals Peritoneal Tuberculosis Presenting as Chronic Ascites With Scrofula: A Case Report

2019 ◽  
Vol 13 (1) ◽  
Author(s):  
Galina Bogoslovskaya ◽  
Jose Zaldivar
Keyword(s):  
Case Report ◽  
Early Diagnosis ◽  
Extrapulmonary Tuberculosis ◽  
Young Female ◽  
Ca 125 ◽  
Test Results ◽  
Peritoneal Tuberculosis ◽  
Clinical Presentations ◽  
High Index Of Suspicion ◽  
Diagnostic Delays

Peritoneal tuberculosis (PTB) is a common type of extrapulmonary tuberculosis; however, due to variety of clinical presentations, diagnostic challenges do occur. The nonspecific features of this disease can lead to diagnostic delays and the development of complications. In addition, PTB can mimic a malignancy, especially in women who present with ascites and elevated cancer antigen (CA) 125 levels. A high index of suspicion is an important factor in an early diagnosis. Moreover, an early diagnosis and the initiation of antituberculous therapy are essential for preventing morbidity and mortality. Fortunately, most of these patients respond very well to standard antituberculous therapy.Here, we have reported the case of a young female patient who presented with chronic ascites, mild abdominal tenderness, and later, scrofula. Ultimately, she was diagnosed with PTB based on her test results. We expect that this case report will contribute to the existing literature on this subject.

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