Treatment of disseminated TB with drug induced hepatitis/case study

Miliary Tuberculosis (TB) usually has an insidious clinical manifestation including fever, weight loss, night sweats, and little in the way of localizing symptoms or signs. There may be concurrent TB meningitis with associated symptoms. A 35-year old male has known case of pulmonary TB and HCV before three years ago. Presented to emergency department with Fever since 3-weeks ago, abdomen pain, headache since 10 days.

To and TAFRO – a cryptic cause of acute renal failure: a case report

Background TAFRO syndrome is a rare clinical subtype of idiopathic multicentric Castlemans disease characterised by thrombocytopenia, anasarca, myelofibrosis, renal dysfunction, and organomegaly. Renal involvement is common, sometimes requiring temporary renal replacement therapy. Due to the associated thrombocytopenia, renal biopsies are rarely performed limiting descriptions of the renal histopathology in this condition. This case describes a patient with TAFRO syndrome and the associated renal histology. Case presentation A 49-year-old Caucasian man presented to a tertiary hospital in Sydney with a six- week history of malaise, non-bloody diarrhoea, progressive shortness of breath, and drenching night sweats. A progressive bicytopenia and renal function decline necessitating temporary dialysis prompted a bone marrow aspirate and trephine, as well as a renal biopsy respectively. This noted a hypercellular bone marrow with increased granulopoiesis, reduced erythropoiesis, and fibrosis, with renal histology suggesting a thrombotic microangiopathic-like glomerulopathy. Alternate conditions were excluded, and a diagnosis of TAFRO syndrome was made. Glucocorticoids and rituximab were initiated with rapid renal recovery, and normalisation of his haematologic parameters achieved at six months. Conclusion This case describes an atypical thrombotic microangiopathy as the predominant histologic renal lesion in a patient with TAFRO syndrome. This was responsive to immunosuppression with glucocorticoids and rituximab, highlighting the importance of early recognition of this rarely described condition.

Effects of Low Estrogens: Vaginal Atrophy

Estrogens are the group of hormones which makes a woman a woman. Girls at menarche start making it and under normal conditions sufficient levels are maintained in the women's body until menopause. During perimenopause, menopause and postmenopause the hormone levels start fluctuating and if maintained low for a longer period, it starts giving various problems. Fluctuating levels of estrogen causes, hot flashes, night sweats, vaginal dryness, depression, and mood swings. Sleep disturbances brain fog and may be heart disease, osteoporosis, obesity and the appearance of unwanted facial hair. These problems can be overcome by supplementing with phytoestrogens or hormone replacement therapy.

Pathological Approach to Pleural Malignant Mesothelioma

Exposure to asbestos can lead to asbestosis or malignancy 10-40 years after initial exposure [1]. Although its use has been banned in multiple countries, past occupational exposure leads to most cases that we see in present time. Malignant mesothelioma is an insidious and rare neoplasm that can arise from mesothelial surface cells, being Malignant Pleural Mesothelioma (MPM) the most common type. Lifetime risk of developing mesothelioma among asbestos workers can be as high as 10 percent and latency period is approximately 30-40 years since time of exposure to development of disease [2]. Annual incidence in the united states is approximately 3,300 cases per year [3]. Median overall survival of patients with advanced unresectable disease is approximately 12 months [4]. Clinical suspicion should arise in patients with previous exposure to asbestos who present with pleural thickening and/or effusion with associated respiratory symptoms. Most symptoms are nonspecific such as chest pain, dyspnea, cough and night sweats. Initial evaluation includes chest x-ray, contrast enhanced CT of the chest to find pleural abnormalities, thoracentesis and closed pleural biopsy. However, difficulties establishing diagnosis have been illustrated on studies where thoracentesis and pleural fluid cytology only yields diagnosis in 26% of cases. The diagnosis, then, is established by morphologic and immunohistochemistry findings of cytologic and surgical specimens.

Acupuncture In The Real World: Evaluating a 15-Year NADA Auricular Acupuncture Service For Breast Cancer Survivors Experiencing Hot Flushes And Night Sweats As a Consequence of Adjuvant Hormonal Therapies

PurposeWhile clinical trials provide valuable data about efficacy of interventions, findings often do not translate into clinical settings. We report real world clinical outcomes of a 15-year service offering breast cancer survivors auricular acupuncture to manage hot flushes and night sweats (HFNS) associated with adjuvant hormonal treatments. This service evaluation aims to 1) assess whether usual practice alleviates symptoms in a clinically meaningful way and 2) compare these results with scientific evidence. MethodsData were analysed from 415 referrals to a service offering women eight standardised treatments using the National Acupuncture Detoxification Association (NADA) protocol. Outcome measures administered at baseline, end of treatment (EOT), and four- and 18- weeks after EOT included Hot Flush Diaries, Hot Flush Rating Scale (HFRS) and Women’s Health Questionnaire (WHQ).Results2285 treatments were given to 300 women; 275 (92.3%) completed all eight treatments. Median daily frequency of HFNS reduced from 9.6 (IQR 7.3) to 5.7 (IQR 5.8) at EOT and 6.3 (IQR 6.5) 18 weeks after EOT. HFRS problem rating showed a clinically meaningful reduction of ≥2 points at all measurement points. WHQ showed improvements in several symptoms associated with the menopause. Two adverse events were reported, neither were serious. Results are comparable to published research.ConclusionThis first analysis of a long-term auricular acupuncture service compares favourably with outcomes of other studies for reducing HFNS frequency and associated menopausal symptoms. In day-to-day clinical practice, NADA appears to be a safe effective intervention for breast cancer survivors.

Incidence of amenorrhea and premature ovarian failure in women who underwent uterine fibroid embolization: single centre study

Purpose: To retrospectively determine the incidence of amenorrhea and premature ovarian failure in women who underwent uterine fibroid embolization (UFE) in King Fahad Specialist Hospital in Dammam (KFSH-D). Patients and methods: All women who had undergone UFE in KFSH-D from August 2007 to October 2015 were included for a total of 82 patients. Follow up consisted of a questionnaire inquiring about symptoms, improvement after the procedure and whether menstruation resumed or not. The pre-procedure and post-procedure pelvis MRI as well as UFE images and reports were reviewed for all patients. Results: One patient (1.5 %) was found to have amenorrhea out of the 67 patients we were able to contact. She was 52 years old at the time of UFE and had irregular period. Menstruation did not resume following UFE along with menopausal symptoms including night sweats, mood swings and irritability, likely due to premature ovarian failure (POF). The rest of patients had normal resumption of menses. Conclusion: The incidence of amenorrhea is less than what’s reported in the literature could be due to advances in UFE since its introduction as a treatment for uterine fibroids, likely due to advances in image quality, tans-catheter embolization equipments/techniques and embolic material used in UFE.

Penerapan Fisioterapi Dada dan Batuk Efektif Terhadap Ketidakefektifan Bersihan Jalan Nafas Pada Pasien Tuberculosis Paru

Pulmonary tuberculosis is a chronic bacterial infection by the bacillus Myobacterium tuberculosis. This disease causes the patient to cough with phlegm or coghing up blood, shortness of breath, chest pain, night sweats and decreased appetite. The purpose of this scientific paper is ti describe nursing care for pulmonary tuberculosis patients with ineffective airway clearance problems. This research uses a descriptive case study method with the subject of two pulmonary tuberculosis patients who experience ineffective airway clearance problems in Pelutan Pemalang Village. The chest physiotherapy and effetive coughing actions were carried out for three days, twice a day, morning and evening. The results showed that the effective chest physiotherapy and coughing were able to overcome the ineffectiveness of airway clearance. Therefore, it can be concluded that the effective chest and cough physiotherapy is considered effective against ineffective airway clearance in pulmonary tuberculosis patients. For this reason, nurses are expected to be able to provide effective chest and cough physiotherapy therapy to help overcome the ineffectiveness of airway clearance in pulmonary tuberculosis patients.Keywords: Effective Cough and Chest Physiotherapy, Ineffective Airway Clearing AbstrakTuberculosis paru merupakan penyakit infeksi bakteri menahun yang disebabkan oleh basil myobacterium tuberculosis. Penyakit ini menyebabkan pasien batuk disertai dahak atau batuk berdarah, sesak nafas, nyeri pada daerah dada, keringat pada malam hari dan penurunan nafsu makan. Tujuan dari Karya Tulis Ilmiah ini untuk menggambarkan asuhan keperawatan pada pasien tuberculosis paru dengan masalah ketidakefektifan bersihan jalan nafas. Rancangan Karya Tulis Ilmiah ini menggunakan metode studi kasus deskriptif dengan subjek dua pasien tuberculosis paru yang mengalami masalah ketidakefektifan bersihan jalan nafas di Kelurahan Pelutan Pemalang, dilakukan tindakan fisioterapi dada dan batuk efektif dilakukan selama tiga hari dikerjakan dua kali sehari pagi dan sore. Hasil pemberian fisioterapi dada dan batuk efektif berhasil mampu mengatasi ketidakefektifan bersihan jalan nafas. Kesimpulan : fisioterapi dada dan batuk efektif dinilai efektif terhadap ketidakefektifan bersihan jalan nafas pada pasien tuberculosis paru. Untuk itu diharapkan perawat dapat memberikan terapi fisioterapi dada dan batuk efektif untuk membantu mengatasi ketidakefektifan bersihan jalan nafas pada pasien tuberculosis paru.Kata kunci: Fisioterapi Dada dan Batuk Efektif, Ketidakefektifan Bersihan Jalan Nafas

A RARE CASE OF ROSAI-DORFMAN DISEASE IN HYPOTHYROIDISM PATIENT A DIAGNOSTIC COEXISTENCE

Rosai-Dorfman disease (RDD) is a rare, benign, and predominantly nodal disease that most commonly presents as bilateral, painless cervical lymphadenopathy; although inguinal, axillary, mediastinal, and hilar lymphadenopathy has also been reported. Apart from nodal involvement, RDD has extra nodal manifestations involving bone, soft tissue, and liver as well as constitutional symptoms of fever, night sweats, and weight loss, which make it reasonable to rule out the infectious, autoimmune, and malignant conditions as the differential diagnosis.

Clinical Predictors of Lung Function in Patients Recovering from Mild COVID-19

Background: There are few studies have assessed lung function in Hispanic subjects recovering from mild COVID-19. Therefore, we examined the prevalence of impaired pulmonary diffusing capacity for carbon monoxide (DLCO) as defined by values below the lower limit of normal (< LLN, < 5th percentile) in Hispanics recovering from mild COVID-19. We also examined the prevalence of a restrictive spirometric pattern as defined by the ratio of forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) being ≥ LLN with the FVC being < LLN. Finally, we wanted to examine factors that cause the prevalence of an impaired DLCO to vary between studies.Methods: In this observational study, adult patients (n = 146) with mild COVID-19 were recruited from a Long-term follow-up COVID-19 clinic in Yucatan, Mexico between March, and August 2021. Spirometry, DLCO, and self-reported signs/symptoms were recorded 34 ± 4 days after diagnosis. Results: At post-evaluation, 20% and 30% patients recovering from COVID-19 were classified as having a restrictive spirometric pattern and impaired DLCO, respectively; 13% had both. The most prevalent reported symptoms were fatigue (73%), persistent cough (43%), shortness of breath (42%) and a blocked/runny nose (36%). Increased age, a blocked/runny nose, excessive night sweats, and a restrictive spirometric pattern increased probability of having an impaired DLCO. The proportion of patients with previous mild COVID-19 who had impaired DLCO increased by 12% when the definition of impaired DLCO was < 80% predicted instead of < LLN. Having severe (compared to mild) COVID-19 increased the percentage of those with impaired DLCO by 20%. Conclusions: One-third of patients with mild COVID-19 have impaired DLCO thirty-four days post-diagnosis. One-fifth of patients have a restrictive spirometric pattern. The criteria that define impaired DLCO and the severity of COVID-19 disease affects the proportion of those with impaired DLCO at follow-up.