scholarly journals Cocaine-Induced Midline Destructive Lesions (CIMDL): A Real Challenge in Diagnosis

2021 ◽  
Vol 18 (15) ◽  
pp. 7831
Author(s):  
Michele Di Cosola ◽  
Mariateresa Ambrosino ◽  
Luisa Limongelli ◽  
Gianfranco Favia ◽  
Andrea Santarelli ◽  
...  
Keyword(s):  
Complete Blood Count ◽  
Correct Diagnosis ◽  
Venereal Disease ◽  
Antibody Test ◽  
Diagnostic Procedures ◽  
Antineutrophil Cytoplasmic Antibodies ◽  
Laboratory Findings ◽  
Detailed Medical History ◽  
Recurrent Sinus ◽  
Conclusive Diagnosis

The prolonged use of intranasal cocaine can destroy the nasal architecture with the erosion of the palate, turbinates, and ethmoid sinuses causing cocaine-induced midline lesions (CIMDL). The CIMDL display a clinical pattern mimicking variable diseases. The aim of this study was to highlight the difficulties in reaching a correct diagnosis through the evaluation of eight new cases. The diagnostic procedures followed in these patients included: detailed medical history, clinical and histological examination, computed tomography and magnetic resonance imaging, laboratory findings (complete blood count, sedimentation rate, antinuclear antibody test, rheumatoid factor, venereal disease research laboratory test, leishmaniasis and fungal serology, antineutrophil cytoplasmic antibodies ANCA test), and chest X-ray. All patients complained of epistaxis, halitosis, nasal scabs and obstruction, decreased sense of smell and/or taste, oro-nasal regurgitation of solids and liquids with recurrent sinus infections, and chronic facial pain. On clinical examination, all patients showed palate perforation with variable nasal structure involvement and presented a strong positivity for ANCA tests with a p-ANCA pattern. The followed protocol for the CIMDL diagnosis allowed for a relatively quick and conclusive diagnosis in all patients. A multidisciplinary approach is mandatory in the management of CIMDL, involving dental professionals, maxillofacial surgeons, and psychologists.

scholarly journals A Rare Case of Pachydermodactyly in 25 years Old Male

2019 ◽  
Vol 12 (6) ◽  
pp. 41-45
Author(s):  
Ennesta A sri ◽  
Jessica Herlianez Saiful
Keyword(s):  
Rare Case ◽  
Morning Stiffness ◽  
Correct Diagnosis ◽  
Plain Radiograph ◽  
Diagnostic Procedures ◽  
Inflammatory Rheumatic Diseases ◽  
Resonance Imaging ◽  
Laboratory Findings ◽  
Inappropriate Treatment ◽  
Invasive Diagnostic Procedure

Pachydermodactyly is a rare digital fibromatosis that can be misdiagnosed with inflammatory rheumatic diseases. So far in the literature only about 150 cases of PDD have been reported. A prompt clinical diagnosis of the disease would prevent inappropriate treatment and unnecessary expensive diagnostic procedures such as biopsy or magnetic resonance imaging. Gold standard therapy for pachydermodactyly is not established yet.A rare case of a 25 years-old male patient with pachydermodactyly is reported. He complained swelling and thhickening around joints in both hands since 7 months ago. He denied having any pain or morning stiffness of the joints and was also free other symptomatic symptomps. Family history was not significant. Dermatological state showed skin colouredhyperkeratotic patches. Laboratory showed no abnormalities. Radiology results shows no bone and joint abnormalities. Dermoscopy examination on lesion shows whitish scaling and cobblestone appearance. Diagnosis of pachydermodactyly is based on anamnesis, physical examination, laboratory findings, and plain radiograph. Early and correct diagnosis is important to prevent unnececessary, expensive, and invasive diagnostic procedure

scholarly journals Pruritus, as a Neglected Symptom, in Opioid Poisoning in Children

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Fariba Farnaghi ◽  
Marjaneh Abbasi Ghadi ◽  
Latif Gachkar ◽  
Hossein Hassanian Moghaddam
Keyword(s):  
Complete Blood Count ◽  
Demographic Data ◽  
Correct Diagnosis ◽  
Clinical Manifestations ◽  
Patient Specific ◽  
P Value ◽  
Specific Information ◽  
Laboratory Findings ◽  
Clinical Scenarios ◽  
Significant Difference

Background: Opioid poisoning is common and fatal childhood poisoning in Iran with nonspecific, hidden, vague, and misleading clinical manifestations in some cases. Objectives: The aim of this study was to investigate and emphasize pruritus, as a neglected and helpful symptom in this important poisoning. Methods: In this cross-sectional study, one hundred pediatrics patients (< 14 years) with opioid poisoning who were referred to Loghman Hakim Hospital, Tehran-Iran, from April 2018 to April 2019 were enrolled the study. Demographic data including age, sex, type of poisoning, clinical manifestations including pruritus, its onset, location, duration, and therapy, also laboratory findings including complete blood count (CBC) and Eosinophilia recorded in patient-specific information forms. The collected data were analyzed using SPSS 21 software. Results: The patients’ mean age was 43.4 ± 31.4 months. Fifty-seven (57%) of them were male. Fifty-two (52%) of them reported Pruritus that in 84% observed in face. In 31% of children, itching resulted in skin scratches. The most common clinical manifestations were CNS depression (93%), respiratory suppression (68%), vomiting (52%), pruritus (52%), and meiosis (51%). There was no significant relationship between pruritus and gender, age, laboratory findings, family history of addiction, and allergy. Pruritus had a significant difference with Respiratory suppression (apnea, bradypnea, cyanosis), meiosis, vomiting, and redness of the skin (P-value: 0.05, 0.003, 0.009, and 0.002, respectively). Pruritus was controlled by naloxone in all of our patients. Conclusions: According to the results of the present study, pruritus is a common and helpful clinical manifestation in children with opioid poisoning that helps the physician for correct diagnosis, especially in hidden clinical scenarios.

scholarly journals REACTIVATION OF TUBERCULOSIS AND COVID-19

2021 ◽  
Author(s):  
Gokcen Unal ◽  
Fadime Ceyda Eldeniz ◽  
Asli Yilmaz ◽  
Ozge Metin Akcan ◽  
Necdet Poyraz ◽  
...  
Keyword(s):  
Demographic Data ◽  
Antibody Test ◽  
Viral Disease ◽  
Immunosuppressive Drugs ◽  
Laboratory Findings ◽  
Detailed Medical History ◽  
Pediatric Pulmonology ◽  
Novel Coronavirus

Coronavirus disease 2019 (COVID-19) is a viral disease caused by a novel coronavirus that can lead to severe acute respiratory failure. Recent studies have shown that aggravating factors in the etiology of COVID-19 disease include genetic defects and autoantibodies against type 1 interferon. Mycobacterium tuberculosis is an immobile aerobic bacillus that causes tuberculosis disease. SARS-CoV-2 infection and immunosuppressive drugs may temporarily inhibit immunologic system, then may lead to active tuberculosis by reactivation or infection of M. tuberculosis. We aimed to show that there is a relationship between covid-19 infection and an increase in the number of tuberculosis patients. Eight patients diagnosed with tuberculosis in the Pediatric Pulmonology and Pediatric Infectious Diseases Clinics of Necmettin Erbakan University, Meram Medical Faculty between March 2020 and May 2021 were enrolled in this study. The presence of COVID-19 infection was confirmed by COVID-19 antibody test and patient’s detailed medical history. The patient with negative antibody test was also included in the study if other family members confirmed for COVID-19 infection by RT-PCR. We evaluated demographic data, laboratory findings, imaging tests and pathology results of all patients. The remarkable increase in the number of tuberculosis activation in the recent year suggests the role of COVID-19 infection. The pathologic structure of the virus may be responsible of the increase, although the mechanism is not fully understood. Further research should be done on this topic.

Comparative analysis of diagnostic procedures for tumor detection rates in paired data

2018 ◽  
Vol 28 (5) ◽  
pp. 1477-1488
Author(s):  
Yaeji Lim ◽  
Ji Soo Choi ◽  
Kiyoun Kim ◽  
Mira Park ◽  
Seonwoo Kim
Keyword(s):  
Positive Predictive Value ◽  
Predictive Value ◽  
Correct Diagnosis ◽  
Disease Status ◽  
Diagnostic Procedures ◽  
Tumor Detection ◽  
Tumor Location ◽  
Test Statistic ◽  
Paired Data ◽  
Detection Rates

Diagnostic procedures are mostly used to detect a particular disease, and each procedure indicates the presence or absence of the disease in an individual. Sensitivity and positive predictive value, which are measures of the effectiveness of a diagnostic procedure, are simply calculated as the proportion of the individuals diagnosed with the disease by the test among the patients with the disease, and of the diseased persons among the individuals in whom the disease was detected by the test, respectively. For a diagnosis with such a binary result, sensitivity and the positive predictive value of diagnostic procedures can be compared using the chi-square statistic. However, in the treatment of cancer patients, it is important not only to diagnose the disease status of an individual patient but also to detect the correct location of the cancer. The tumor location may be incorrectly identified in some subjects diagnosed with cancer. It is therefore of interest whether a procedure that diagnoses cancer also correctly indicates the tumor location. In this paper, we re-define the sensitivity and the positive predictive value of tumor detection as the ratio of the number of cases with a correct diagnosis of the tumor location by the test to the number of cases of cancer, and as the ratio of patients with a correct diagnosis of the tumor location to the number of individuals diagnosed with cancer by the test, respectively. We refer to these parameters as ‘semi-sensitivity’ and ‘semi-positive predictive value’. To compare these ratios between diagnostic procedures, test statistics are developed from binary diagnostic results. Simulation studies conducted to evaluate the nominal level and power are presented, and two sets of example data are also analyzed using the new test statistic.

Gonorrheal Infection and Diagnostic Procedures: A Response to the Statement of the Committee on Youth

PEDIATRICS ◽  
1973 ◽  
Vol 51 (2) ◽  
pp. 309-310
Author(s):  
Hania W. Ris
Keyword(s):  
Venereal Disease ◽  
Diagnostic Procedures

The report of the Academy's Committee on Youth on "Venereal Disease and the Adolescent," in your September issue1 is most timely. I would like to comment on the diagnosis of gonorrhea. While the cervix is considered the best site for culture of N. gonorrhoeae, our recent study2 of 1,899 girls yielded positive cultures in 213; 94.2% of these were from the vagina, while subsequent cervical cultures revealed only an additional 13 (5.8%) positive cases. Lucas et al3 found only a similar minor difference, with 92.4% of cervical and 89.5% of vaginal cultures positive in the same patient.

scholarly journals Microbiological diagnostics of fungal infections

2013 ◽  
Vol 4 (1S) ◽  
pp. 33-37
Author(s):  
Corrado Girmenia
Keyword(s):  
Pediatric Patients ◽  
Culture Media ◽  
Fungal Infections ◽  
Correct Diagnosis ◽  
Empiric Therapy ◽  
Fungal Colonization ◽  
Laboratory Findings ◽  
Close Cooperation ◽  
Fungal Antigens ◽  
Low Sensitivity

Laboratory tests for the detection of fungal infections are easy to perform. The main obstacle to a correct diagnosis is the correlation between the laboratory findings and the clinical diagnosis. Among pediatric patients, the most common fungal pathogen is Candida. The detection of fungal colonization may be performed through the use of chromogenic culture media, which allows also the identification of Candida subspecies, from which pathogenicity depends. In neonatology, thistest often drives the decision to begin a empiric therapy; in this regard, a close cooperation between microbiologists and clinicians is highly recommended. Blood culture, if positive, is a strong confirmation of fungal infection; however, its low sensitivity results in a high percentage of false negatives, thus decreasing its reliability. Molecular diagnostics is still under evaluation, whereas the detection of some fungal antigens, such as β-D-glucan, galactomannan, mannoprotein, and cryptococcal antigen in the serum is used for adults, but still under evaluations for pediatric patients.

scholarly journals Lupus-like nephritis with positive anti-neutrophil cytoplasmic antibodies and negative antinuclear antibodies

2020 ◽  
Author(s):  
Joana Eugénio Santos ◽  
Rita Vicente ◽  
Beatriz Malvar ◽  
Iolanda Santos ◽  
Miguel Coimbra ◽  
...  
Keyword(s):  
Lupus Erythematosus ◽  
Antinuclear Antibodies ◽  
Kidney Biopsy ◽  
Kidney Injury ◽  
Steroid Treatment ◽  
Antineutrophil Cytoplasmic Antibodies ◽  
Small Vessel Vasculitis ◽  
Laboratory Findings ◽  
Clinical Criteria ◽  
Immunological Markers

Abstract Antineutrophil cytoplasmic antibodies (ANCAs) are associated with small vessel vasculitis but their prevalence is not rare in other immune diseases. In lupus nephritis (LN), their pathological role and clinical relevance have been the target of controversial views. We present a case of acute kidney injury and nephrotic syndrome in a young woman with diffuse global proliferative and membranous nephritis on her kidney biopsy, showing a full-house immunofluorescence pattern, very allusive of class IV + V LN, but lacking associated clinical criteria and laboratory findings to support the diagnosis of systemic lupus erythematosus (SLE). Furthermore, the patient presented with high titers of ANCA, steadily decreasing alongside the renal function and proteinuria improvements, with mycophenolate mofetil (MMF) and steroid treatment. The authors believe this is a case of lupus-like nephritis, in which ANCAs are immunological markers, although they are not directly involved in the pathogenesis.

Difficulties associated with the diagnosis of tuberculous osteomyelitis of the ribs in children

2021 ◽  
Vol 16 (2) ◽  
pp. 74-79
Author(s):  
M.D. Zvereva ◽  
◽  
S.S. Kanash ◽  
S.I. Petrova ◽  
V.A. Evseev ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Clinical Symptoms ◽  
Correct Diagnosis ◽  
Diagnostic Procedures ◽  
Diagnostic Methods ◽  
Mantoux Test ◽  
Comprehensive Treatment ◽  
Tuberculous Osteomyelitis ◽  
The Right ◽  
Tuberculosis In Children

Diagnosis of tuberculosis in children is challenging because of variable clinical symptoms and no specific signs. We report a case of tuberculous osteomyelitis of the ribs, which demonstrates difficulties associated with the diagnosis of generalized tuberculosis in an 8-year-old child (correct diagnosis was established after 1.3 years). Diagnostic procedures included: Mantoux test, skin test with recombinant tuberculosis allergen, computed tomography, pathomorphological and bacterioscopic testing. The patient presented with disease progression and lesions to the lung tissue, pleura, and ribs and did not respond to antibacterial therapy, hormones, and cytostatics. This required repeated diagnosis revision. The diagnosis of tuberculosis of the right 4th and 5th ribs was confirmed after surgery using bacterioscopic and immunohistochemical examinations. The child received comprehensive treatment in a specialized tuberculosis hospital and had positive dynamics. Despite the correct routing, low suspicion for tuberculosis in primary and secondary healthcare institutions has led to an insufficient use of currently available diagnostic methods and late diagnosis of tuberculosis in a child residing in a megapolis. Key words: generalized tuberculosis, children, tuberculosis of the rib, immunodiagnostics, diagnosis of tuberculosis, immunohistochemistry

scholarly journals Systemic Bartonellosis Manifesting With Endocarditis and Membranoproliferative Glomerulonephritis

2020 ◽  
Vol 8 ◽  
pp. 232470962097072
Author(s):  
Gulvahid Shaikh ◽  
Elvira O. Gosmanova ◽  
Natacha Rigual-Soler ◽  
Paul Der Mesropian
Keyword(s):  
Membranoproliferative Glomerulonephritis ◽  
Correct Diagnosis ◽  
Systemic Infection ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Immunofluorescent Staining ◽  
Partial Recovery ◽  
Laboratory Findings ◽  
Pattern Of Injury ◽  
Limiting Condition

Cat scratch disease caused by Bartonella species is mostly benign and self-limiting condition. Systemic infection is uncommon in immunocompetent host. We describe the case of a 66-year-old male who presented with sudden painless left eye blindness and brown-colored urine. Laboratory findings revealed progressively rising serum creatinine in association with nephrotic-range proteinuria at 7 g/day and glomerular hematuria on urinalysis. An echocardiogram demonstrated mitral and tricuspid valve vegetations despite multiple negative blood cultures. The left eye blindness was attributed to retinal artery occlusion from septic valvular embolus. Kidney biopsy showed membranoproliferative glomerulonephritis pattern of injury with “full house” pattern on immunofluorescent staining with subendothelial deposits on electron microscopy. Markedly elevated IgG (immunoglobulin G) titers for B henselae and B quintana were discovered. The patient had several cats at home. Kidney failure rapidly progressed to require hemodialysis. Once the diagnosis of systemic bartonellosis was confirmed, doxycycline (for 4 months) with rifampicin (for 3 months) were initiated. Repeat echocardiogram in 4 months demonstrated a resolution of valvular vegetations; however, the left eye blindness was permanent. In the present case the correct diagnosis of systemic bartonellosis allowed institution of appropriate antibiotic therapy and to also achieve a partial recovery of renal function and to discontinue hemodialysis.

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