scholarly journals Oropharyngeal tularemia cases admitted to a military hospital in Ankara, Turkey

2014 ◽  
Vol 8 (08) ◽  
pp. 994-999 ◽  
Author(s):  
Ahmet Karakas ◽  
Omer Coskun ◽  
Cumhur Artuk ◽  
Umit Savasci ◽  
Hanefi Cem Gul ◽  
...  
Keyword(s):  
Cervical Lymphadenopathy ◽  
Military Hospital ◽  
Tuberculous Lymphadenitis ◽  
Treatment Results ◽  
Laboratory Findings ◽  
Duration Of Symptoms ◽  
Laboratory Results ◽  
Sources Of Infection ◽  
The Mean ◽  
Prompt Diagnosis

Introduction: This study aimed to review the possible sources of infection of 16 oropharyngeal tularemia hospital cases, and to document their epidemiological and demographical characteristics, laboratory findings, treatment methods, and treatment results. Methodology: Sixteen cases from a Turkish military hospital between January 2011 and December 2012 were retrospectively evaluated. The age, sex, occupation, place of residence, symptoms, duration of symptoms, laboratory results, treatment and duration, and treatment results were recorded. Tularemia was diagnosed through tularemia-specific tests once the other conditions that may have caused lymphadenopathy were excluded. Results: Twelve of the patients included in this study were males. The average age of the patients was 32.1±17.2 years. Sore throat, fatigue, and fever were the most frequent symptoms. The mean duration of symptoms was 21.6±6.9 days. All the patients had been treated for tonsillopharyngitis in primary healthcare institutions previously. However, despite the treatment, cervical lymphadenopathy had developed in these cases. Patients were given streptomycin, doxycycline, and ciprofloxacin monotherapy or in combination. Ten of the cases fully recovered, while five required surgical lymph node drainage. Spontaneous drainage occurred in the single remaining case. Conclusions: Turkey is considered to be an endemic country with regards to tularemia. Prompt diagnosis and proper treatment of the disease is imperative in providing cure. Since it can be potentially confused with tuberculous lymphadenitis, differential diagnosis is vital. Patients presenting with a condition of tonsillopharyngitis in endemic areas must be carefully monitored.

scholarly journals 1365. How Severe Are Rickettsial Infections Among Children

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S693-S693
Author(s):  
Fatma Hammami ◽  
Makram Koubaa ◽  
Amal Chakroun ◽  
Khaoula Rekik ◽  
Fatma Smaoui ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Close Contact ◽  
Duration Of Treatment ◽  
Disease Evolution ◽  
Rickettsial Infections ◽  
Laboratory Results ◽  
Laboratory Investigations ◽  
The Mean ◽  
High Index Of Suspicion ◽  
Prompt Diagnosis

Abstract Background Rickettsial infections (RI) usually mimic benign viral infection due to similarities in clinical symptoms. However, severe forms and complications have been reported with rickettsiosis. Children can be affected as well. We aimed to study the particularities of RI among children. Methods We conducted a retrospective study including all patients aged ≤ 18 years hospitalized for RI between 2000 and 2018. The diagnosis was confirmed by serologies (seroconversion). Results In total, we encountered 59 children with confirmed RI, among whom 45 were male (76.3%). The mean age was 14 ±3 years. Forty children had a close contact with animals (71.4%). All patients consulted for a febrile maculopapular skin rash, which was associated to headache in 45 cases (76.3%), vomiting in 28 cases (47.4%) and cough in 8 cases (13.5%). Physical examination revealed an eschar in 13 cases (22%) and meningeal syndrome in 11 cases (18.6%). Laboratory investigations showed thrombocytopenia (31 cases; 52.5%) and liver cytolysis (26 cases; 44%). Severe forms of RI were represented by meningitis in 11 cases (18.6%), pneumonia in 2 cases (3.3%) and myocarditis in one case (1.6%). The treatment was based on doxycycline in 42 cases (71.2%), fluoroquinolones in 10 cases (17%) and macrolide in 7 cases (11.8%) for children aged less than 8 years. The mean duration of treatment was 9 ±3 days. The disease evolution was favourable in all cases. Conclusion The diagnosis of RI among children should be largely based on high index of suspicion, careful clinical and laboratory results. Prompt diagnosis is crucial in order to start antibiotics and avoid, therefore, fatal untreated forms. Disclosures All Authors: No reported disclosures

scholarly journals Pronostics Factors of Csm; Experience of Military Hospital of Rabat/Maroc about 107 Cases

2021 ◽  
Vol 6 (07) ◽  
pp. 418-423
Author(s):  
Niamien Patrice Koffi ◽  
Frank Kouakou ◽  
Laaguili Jawad ◽  
Mandour Cherkaoui ◽  
Gazzaz Miloud ◽  
...  
Keyword(s):  
Cervical Spondylotic Myelopathy ◽  
Clinical Signs ◽  
Neurological Status ◽  
Military Hospital ◽  
Duration Of Symptoms ◽  
Surgery Outcome ◽  
The Mean ◽  
Prognostics Factors

Background: The surgery outcome of cervical spondylotic myelopathy (CSM) for some authors depend to the clinical signs (obesity, smoking, sex, age, patient’s activity, and the surgery delays). Nevertheless, for others authors it’s depending to the chirurgical approach (anterior or posterior or the levels number of decompression in the cervical spine). There is no consensus although some arguments prevail over to others in the literature. Our study purpose was to determine the important clinical factors predictors of surgical outcome in patients with CSM. It’s a retrospective study of 107 patients admitted to the Mohamed V hospital in Rabat over 06 years from January 2013 to December 2018 for cervical spondylotic myelopathy (CSM) operated and were followed up for 1year. Their neurological status pre and postoperative was assessed using the Japan Orthopedic Association (JOA) score and others prognostics factors such as sex, age, duration of symptoms, Cobbs angle, number of discs compressed, MODIC class signal and, (P<0.05) was statistically significant. Patients were classified into 02 groups, youngers patients in group 1 = G1 (<60 years of age; n = 70) and an elderly patients group = G2 (>/=60 years of age; n = 37). The mean age = 52.72 years [42.27-63.16], male 64.5% against 35.5% of women, a sex ratio = 2/1 in favor of men. In G1, mean age X1= 45.6 years. In G 2, mean age X2 = 61.85 years. The average delays for surgery = 11.28 months [6-18.19]. In G1 it was 10.30 months and 16.34 months in G2. The pre operatory JOA score (JOA PREO) = 9.87 +/- 2.033. JOA PREO score was 11 and 7 respectively in G1 and G2. The prevalence of MODIC (MC) = 52.23% and type 2 of MC was predominant in both groups, with p> 0.05. G1 patients underwent an ACDF in 82% and laminectomy in 18%. In G 2 laminectomy was performed in 50% and the anterior discectomy in 21.73%, corporectomy in 28.27%. After surgery, JOA score passed to severe to moderate 13.48 and 13.27 after 1year of follow-up in G1 and G2. In conclusion those factors such as sex, number of discs involved, and Cobbs angle on prognosis were not statistically significant (P>0.05) but patient’s age and duration of symptoms < 1 year predict to have more neurologic improvement (P<0.05) according to the JOA score.

scholarly journals Kikuchi disease: An unusual cause of cervical lymphadenopathy in a young female

2021 ◽  
Vol 73 ◽  
pp. 357-359
Author(s):  
Vidyulata Madhu ◽  
Ruma Sreedharan ◽  
V. Vinukumar
Keyword(s):  
Young Adults ◽  
Lupus Erythematosus ◽  
Cervical Lymphadenopathy ◽  
Young Female ◽  
Tuberculous Lymphadenitis ◽  
Neck Swelling ◽  
Loss Of Weight ◽  
Necrotizing Lymphadenitis ◽  
Prompt Diagnosis

Kikuchi-Fujimoto disease (KD), also known as histiocytic necrotizing lymphadenitis, is a rare cause of unilateral cervical lymphadenopathy usually described in adolescents and young adults with female preponderance. Clinically patients present with palpable lymphadenopathy, fever, and loss of weight. Hence, it should be differentiated from other causes of lymphadenopathy such as tuberculosis, lymphoma, or malignancy. Although the majority resolve spontaneously without treatment some may require non-steroidal anti-inflammatory drug or steroids. It may also be associated with systemic lupus erythematosus. Hence early detection, prompt diagnosis, and follow-up of the patient are essential in all cases of unilateral cervical lymphadenopathy in young adults. Here, we describe a 22-year old female who presented with unilateral neck swelling and was clinically diagnosed initially as a case of tuberculous lymphadenitis which on biopsy turned out to be KD.

Cerebral Venous Thrombosis at High Altitude: Analysis of 28 Cases

2019 ◽  
Vol 48 (3-6) ◽  
pp. 184-192
Author(s):  
Wahaj Ul Hassan ◽  
Maryam J. Syed ◽  
Wasim Alamgir ◽  
Safia Awan ◽  
Simon M. Bell ◽  
...  
Keyword(s):  
High Altitude ◽  
Sinus Thrombosis ◽  
Cerebral Venous Sinus Thrombosis ◽  
Military Hospital ◽  
Published Data ◽  
Laboratory Findings ◽  
Patient Demographics ◽  
The Mean ◽  
D Dimer

Objective: An association between cerebral venous sinus thrombosis (CVST) and high altitude has been previously proposed, but limited published data exist to support this association. We investigated 28 cases of CVST occurring at high altitude and sought to describe patient demographics, altitude and acclimatization, hematological laboratory findings, neuroimaging, treatment, and prognosis in these cases. Methods: Twenty-eight cases of symptomatic CVST occurring at high altitude were identified between the months of August 2017 and December 2018, in collaboration with Military Hospital, Rawalpindi and Combined Military Hospital, Skardu (Pakistan). Follow-up visits were performed at 1 and 6 months. Results: Twenty-seven (96%) of the patients were males, and the mean age was 33 years. In total, 32.1% were smokers. The mean NIHSS score on presentation was 5.5. 85.7% of the cases occurred at altitude higher than 8,000 feet. On average 107.8 days were spent at a high altitude prior to CVST. Totally, 71.4% had acclimatized for >2 weeks. The mean hemoglobin (Hb) value was 16.7 g/dL and 50% had d-dimer levels higher than 1,000 ng/mL. On MRI, 25% showed signs of hemorrhage and 14.3% showed infarcts. Treatments provided include low-molecular-weight heparin and Rivaroxaban and were associated with good outcomes. Conclusion: CVST is not uncommon at high altitude (>8,000 feet). It is predominantly a male disease. Most patients have high Hb and high D-dimer levels. The overall outcome was good.

scholarly journals Evaluation of Tubercular Cervical Lymphadenopathy: Diagnostic and Therapeutic Utility

2020 ◽  
Vol 23 (2) ◽  
pp. 127-132
Author(s):  
AKM Asaduzzaman ◽  
Md Kabir Uddin ◽  
Mohammmad Ali Azad ◽  
Abdullahis Safi ◽  
Wasim Selimul Haque
Keyword(s):  
Treatment Failure ◽  
Cervical Lymphadenopathy ◽  
Military Hospital ◽  
Excision Biopsy ◽  
Laboratory Findings ◽  
Surgical Interventions ◽  
Time Period ◽  
Tubercular Lymphadenitis

Introduction: Lymphadenitis is the most common extrapulmonary manifestation of tuberculosis. It remains both diagnostic and therapeutic challenge as not only mimics other diseases but also inconsistent physical and laboratory findings. Diagnosis is difficult often requiring biopsy. Aim: Aim of the study was to evaluate the role of surgical dissection of tuberculous cervicle lymphadenopathy for diagnosis as well as therapeutic purpose. Methods: This observational study was conducted during the time period of 01 july 2015 to 30 june 2017 in ENT & Pulmonology department, combined military hospital Dhaka on 100 patients who have undergone surgical neck dissection. Result: In our study total 100 patients were biopsied. Among them 56 patient was diagnosed as tubercular lymphadenitis after lymphnode excision biopsy. Among them 47 tubercular lymphadenitis patient responded to ATT (CAT-1), only 2 patient developed cold abscess which required further surgery. Six patient showed relapse during follow-up and 9 patient did not respond to CAT-1 treatment (treatment failure). Surgical intervention along with CAT-2 treatment showed cure in all of them. 2nd surgical interventions were done in total 17 patients, 2 TB abscess during ATT (CAT-1 HRZE), 9 treatment failure patients and 6 relapse patients along with ATT (CAT-2 SHRZE) and all these patients had no relapse or treatment failure during further follow up. Bangladesh J Otorhinolaryngol; October 2017; 23(2): 127-132

scholarly journals Incomplete Kawasaki disease - a diagnostic and therapeutic challenge

2014 ◽  
Vol 9 (4) ◽  
pp. 30-35
Author(s):  
S Datta ◽  
S Maiti ◽  
G Das ◽  
A Chatterjee ◽  
P Ghosh
Keyword(s):  
Kawasaki Disease ◽  
Intravenous Immunoglobulin ◽  
Incomplete Kawasaki Disease ◽  
Duration Of Symptoms ◽  
Clinical Criteria ◽  
Echocardiographic Finding ◽  
2D Echocardiography ◽  
Acquired Heart Disease ◽  
The Mean ◽  
One Year

Background The diagnosis of classical Kawasaki Disease was based on clinical criteria. The conventional criteria is particularly useful in preventing over diagnosis, but at the same time it may result in failure to recognize the incomplete form of Kawasaki Disease. Objective To suspect incomplete Kawasaki Disease, because early diagnosis and proper treatment may reduce substantial risk of developing coronary artery abnormality which is one of the leading causes of acquired heart disease in children. Method Nine cases of incomplete Kawasaki Disease were diagnosed over a period of one year. The diagnosis of incomplete Kawasaki Disease was based on fever for five days with less than four classical clinical features and cardiac abnormality detected by 2D- echocardiography. A repeat echocardiography was done after 6 weeks of onset of illness. The patients were treated with Intravenous Immunoglobulin and/or aspirin. Result The mean age of the patients was 3.83 years and the mean duration of symptoms before diagnosis was 12.1 days. Apart from other criteria all of our patients had edema and extreme irritability. All the patients had abnormal echocardiographic finding. Five patients received only aspirin due to nonaffordability of Intravenous Immunoglobulin and four patients received both aspirin and Intravenous Immunoglobulin, but the outcome was excellent in all the cases. Conclusion Incomplete Kawasaki Disease can be diagnosed with more awareness and aspirin alone may be used as a second line therapy in case of non affordability of Intravenous Immunoglobulin. Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-4, 30-35 DOI: http://dx.doi.org/10.3126/jcmsn.v9i4.10234

scholarly journals POS1281 HOW DOES OBESITY INFLUENCE THE FEATURES OF KNEE OSTEOARTHRITIS?

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 923.4-924
Author(s):  
H. Hachfi ◽  
D. Khalifa ◽  
M. Brahem ◽  
N. Ben Chekaya ◽  
M. Younes
Keyword(s):  
Knee Osteoarthritis ◽  
Functional Impairment ◽  
Statistical Significance ◽  
Obese Group ◽  
University Hospital ◽  
Obese Patients ◽  
Cross Sectional ◽  
Duration Of Symptoms ◽  
Lequesne Index ◽  
The Mean

Background:Knee osteoarthritis and obesity are both major health problems. It is now admitted that the prevalence of knee osteoarthritis gets higher with obesity and that weight loss helps knee function and allows patients to avoid surgery.Objectives:The aim of this study was to study the influence of obesity on knee osteoarthritis features.Methods:A cross-sectional study was conducted in the university hospital Taher Sfar of Tunisia over a period of 6 months. Patients who had knee osteoarthritis confirmed by radiographs were included. Sociodemographic, clinical, radiological and therapeutic data were collected from medical records and visits. Obesity was defined by a body mass index (BMI) ≥30. Functional impairment was assessed by the Womac index and Lequesne index.Results:The study included 186 patients. There were 31 males and 155 femmes. The mean age was 60±10 years. The percentage of obese patients was 53,8%. The mean age was similar in both groups obese and non obese. There were more women in the obese group compared to the non obese group (p=0.0001), more patients who had diabetes mellitus and dyslipidemia (p=0.002). Non-obese patients had a shorter duration of symptoms with no statistical significance (p=0.151). Obese patients had more involvement of both knees (p<0.0001). Obesity did not have an impact on pain severity. Severity of radiological images (p=0,0001) were more frequent in obese patients. Functional impairment was similar in both groups. However, the percentage of patients having a very important functional impairment with Lequesne index was higher in obese patients (p<0.029). Obese patients also needed more physical therapy sessions (p=0.035).Conclusion:Knee osteoarthritis in obese patients is characterized with the femlae gender predominance, bilateral knee involvement, and a more severe images on radiographs. Thus the need for better control of weight and the importance of physical activity.References:[1]Coggon D, Reading I, Croft P, et al. Knee osteoarthritis and obesity. Int J Obes Relat Metab Disord J Int Assoc Study Obes 2001; 25: 622–627.Disclosure of Interests:None declared

scholarly journals RT-01 Treatment results of salvage gamma knife and bevacizumab (AVAgamma therapy) for recurrent glioblastoma

2020 ◽  
Vol 2 (Supplement_3) ◽  
pp. ii11-ii11
Author(s):  
Kenichi Sato ◽  
Taku Asanome ◽  
Yuuki Ishida ◽  
Hironori Sugio ◽  
Yoshimaru Ozaki ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Initial Treatment ◽  
Progression Free Survival ◽  
Recurrent Glioblastoma ◽  
Treatment Results ◽  
Free Survival ◽  
Life Prognosis ◽  
Irradiation Volume ◽  
The Mean ◽  
Extended Discussion

Abstract Purpose: We report the treatment results of AVAgamma therapy combining gamma knife (GK) and bevacizumab for recurrent glioblastoma. Subjects: From August 2013 to April 2020, 44 patients (88 lesions) with recurrent glioblastoma treated with AVAgamma therapy as salvage therapy at the time of relapse after initial treatment. The average age is 61.5 years, with 26 men and 18 women. The tumor volume is 150 ml or less, and KPS is 40% or more as the indication of AVAgamma therapy. When the irradiation volume of GK is 15 ml or less, a single irradiation with a boundary dose of 20 to 26 Gy was performed, and when the irradiation volume was 15 ml or more, a single irradiation boundary dose was divided into two divided irradiations of 12 to 15 Gy. The mean therapeutic borderline dose was 24 Gy. Bevacizumab was administered 10 mg / kg or 15 mg / kg 1 to 10 times after GK. Methods: Median progression-free survival (mPFS), 6-month progression-free survival (PFS-6m), 6-month survival (OS-6m), median survival (mOS) from treatment with AVAgamma Considered mOS from initial treatment. Results: The mPFS from AVAgamma therapy was 5 months, PFS-6m was 37%, OS-6m was 79%, and mOS was 9 months. The mOS from initial treatment were 25 months. In relapsing glioma RPA classification, NABTT CNC class 5 mOS is 5.6 months, class 6 mOS is 6.4 months, but mOS from AVAgamma therapy is 9 months in class 5, 9 months in class 6. The survival time has been extended. Discussion: By AVAgamma therapy, it was thought that recurrent lesions were locally controlled and life prognosis was prolonged. Conclusion: AVAgamma therapy is thought to prolong the survival of recurrent glioblastoma and play an important role as salvage treatment.

scholarly journals Chronic vulval problems: A gynaecologist’s perspective

2016 ◽  
Author(s):  
Akanksha Sharma ◽  
Saritha Shamsunder ◽  
Geetika Khanna ◽  
Neeti Khunger ◽  
Vijay Zutshi
Keyword(s):  
Sensitivity And Specificity ◽  
Clinical Examination ◽  
Squamous Cell ◽  
Well Being ◽  
Careful Examination ◽  
Blue Dye ◽  
Lichen Sclerosus Et Atrophicus ◽  
Cell Hyperplasia ◽  
Duration Of Symptoms ◽  
The Mean

Introduction: Chronic vulval symptoms are common complaints in women seeking health care and can significantly interfere with a woman’s sexual function and sense of well being. Many practitioners feel diagnostically challenged, particularly by chronic or recurrent forms of vulval disease. The aim of this study was to assess the role of various diagnostic modalities in evaluation of chronic vulval symptoms. Methods: Between August 2012 and February 2014, 100 women presenting with chronic vulval symptoms (i.e. ≥ 3 months duration) were evaluated. All of them had a thorough clinical history taken including use of vulval washes and creams, a general and gynaecological examination. Patients having chronic vaginal discharge in addition had urethral, vaginal and cervical smear and culture. All women had a careful examination of the vulva with and without magnification. Vulval scrape cytology was taken after moistening the vulva with normal saline and stained by Pap stain. Colposcopy of the vulva was then carried out after applying 5% acetic acid and 1% toluidine blue dye. Vulval biopsy was taken from suspicious areas on colposcopy and further management was based on histopathology report. Results: The mean age of women in our study was 43.57 years (range 22-80 years.), 70% women were pre-menopausal and 30% were post-menopausal. The mean duration of symptoms was 1.625 years (range 6 months - 15 years) and atypical vulval hygiene practices (excessive washing with soaps) was used in 77% of women. The commonest presenting complaint was pruritus in 92% of women; visible lesions on vulva were seen in 20%, pain in 6% and burning sensation in vulva in 5% of women. The histopathology was abnormal in 77 patients; the most common histopathological finding was non-neoplastic epithelial disorders in 64 women {Squamous cell hyperplasia (n=52), Lichen Sclerosus et atrophicus (n=6), other dermatoses including lichen Planus (n=6)}. Vulvar Intra-epithelial Neoplasia (VIN) was seen in 6 patients, 5 were squamous type VIN and 1 was non-squamous type (Paget’s disease). Squamous cell carcinoma was seen in 3 patients; malignant melanoma, benign appendiceal tumor, angiofibroma and neurofibroma in 1 patient. Examination without magnification had sensitivity of 25.97% and with magnification was 29.87% and specificity was 100% for both of them. Cytology had sensitivity and specificity of 75.32% and 86.95% respectively and sensitivity and specificity of colposcopy was 77.92% and 17.39% respectively. Conclusion: Clinical examination with and without magnification had low sensitivity but were highly specific in diagnosing vulvar lesions. A normal vulval smear and colposcopy have a high negative predictive value and are very reassuring. Colposcopy and biopsy is the gold standard for diagnosis, however clinical examination with naked eyes and magnifying glass are invaluable and can diagnose most of the neoplastic lesions.

Multiple Outbreaks of Gastroenteritis That Were Associated with 16 Funerals and a Unique Caterer and Spanned 6 Days, 2011, Québec, Canada

2013 ◽  
Vol 76 (9) ◽  
pp. 1582-1589 ◽  
Author(s):  
COLETTE GAULIN ◽  
SOULYVANE NGUON ◽  
MARIE-ANDREE LEBLANC ◽  
DANIELLE RAMSAY ◽  
SOPHIE ROY
Keyword(s):  
Public Health ◽  
Food Samples ◽  
Viral Gastroenteritis ◽  
Epidemiological Investigation ◽  
Food Handlers ◽  
Duration Of Symptoms ◽  
Causative Agents ◽  
Stool Samples ◽  
The Mean ◽  
Over Time

In January 2011, multiple acute gastroenteritis outbreaks that spanned many days and were related to attendance at funerals were reported to public health units in Quebec. An epidemiological investigation was initiated to identify the source of the contamination and to explain the extent of the contamination over time. Thirty-one cohorts of individuals attended different funerals held between 14 and 19 January. All attendees were served a cold buffet made by the same caterer. Of these 31 cohorts, 16 (with a total of about 800 people) contained individuals who reported being ill after the funeral. Symptoms were mainly diarrhea (89 to 94% of individuals), vomiting (63 to 90%,) and fever (26 to 39%), with a median incubation period of 29 to 33 h and a median duration of symptoms of 24 to 33 h, suggesting norovirus-like infection. Among the 16 cohorts, 3 were selected for cohort studies. Among those three cohorts, the mean illness rate was 68%. Associations were found between those who fell ill and those who had consumed pasta salad (relative risk [RR] = 2.4; P = 0.0022) and ham sandwiches (RR = 1.8; P = 0.0096). No food handlers reported being sick. No stool samples were provided by individuals who became ill. Environmental and food samples were all negative for causative agents. Although the causative agent was not clearly identified, this investigation raised many concerns about the importance of preventing foodborne transmission of viral gastroenteritis and generated some recommendations for management of similar outbreaks.

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