-
Revue Medicale de Liege Oct 2023We here describe the case of a post-menopausal woman presenting with a recent vertebral fracture and cortical osteopenia on bone dual energy X-ray absorptiometry. Based...
We here describe the case of a post-menopausal woman presenting with a recent vertebral fracture and cortical osteopenia on bone dual energy X-ray absorptiometry. Based on this case, we will discuss the definition and diagnosis of osteoporosis as well as the indications to treat, which go beyond the densitometric-based definition of osteoporosis. We will also address the osteoporosis screening recommendations, and the blood workup required before treatment initiation. The choice of the treatment, its duration and the non-pharmacological measures will be discussed in another article.
Topics: Female; Humans; Bone Density; Osteoporosis; Absorptiometry, Photon; Bone Diseases, Metabolic
PubMed: 37830325
DOI: No ID Found -
Cureus Feb 2023The diagnosis of infective endocarditis is challenging because it has a variable clinical presentation and nonspecific symptoms and can present in different forms,...
The diagnosis of infective endocarditis is challenging because it has a variable clinical presentation and nonspecific symptoms and can present in different forms, especially when an unusual etiological agent is involved. We present the case of a female in her 70s admitted to the hospital with a medical history of bicytopenia, severe aortic stenosis, and rheumatoid arthritis. She had several consultations during which she presented with asthenia and general malaise. A septic screen test was performed that would determine that was present in a blood culture (BC), which was not valued. About three months later, she was hospitalized. In the first 24 hours of admission, the septic screen test was repeated and was isolated in BC. Splenic infarctions and transthoracic echocardiography suggested probable endocarditis, which was confirmed with transesophageal echocardiography. She underwent surgical intervention to remove the perivalvular abscess and replace the aortic prosthesis.
PubMed: 36879704
DOI: 10.7759/cureus.34529 -
BMJ Case Reports Oct 2023A woman in her 50s presented with a 4-day history of left knee pain, erythema, swelling as well as malaise and rigours 1 month after undergoing a left knee meniscectomy....
A woman in her 50s presented with a 4-day history of left knee pain, erythema, swelling as well as malaise and rigours 1 month after undergoing a left knee meniscectomy. She was diagnosed with left native knee septic arthritis and underwent arthroscopic irrigation and debridement of the knee; cultures from synovial tissue grew spp are soil-dwelling and livestock-dwelling bacteria which occasionally cause disease in immunocompromised hosts. Infection in immunocompetent hosts is rare, and septic arthritis secondary to has not been reported previously.
Topics: Female; Humans; Debridement; Arthroscopy; Rhodococcus; Arthritis, Infectious
PubMed: 37802590
DOI: 10.1136/bcr-2023-256864 -
Australian Journal of General Practice Dec 2022Cooking and heating with gas is common in Australian homes and is a risk factor for several important health problems; however, there is little awareness of these risks...
BACKGROUND
Cooking and heating with gas is common in Australian homes and is a risk factor for several important health problems; however, there is little awareness of these risks among doctors or the public. Gas stove use is estimated to cause 12% of childhood asthma in Australia.
OBJECTIVE
The aim of this article is to help general practitioners identify when gas combustion products such as nitrogen dioxide might be contributing to asthma in children and adults and to alert them to the risks of carbon monoxide (CO) poisoning, which can be hard to diagnose.
DISCUSSION
There are excellent alternatives to the use of gas in domestic appliances and some simple behavioural changes that can reduce exposure in situations where appliances cannot yet be removed. CO poisoning can be insidious. Mild exposure can cause headache, nausea, vomiting, dizziness, malaise and confusion, so it can be mistaken for common conditions such as influenza or gastroenteritis. The COMA mnemonic is clinically useful. Increased awareness of these issues can provide patients with safer and healthier living environments.
Topics: Adult; Child; Humans; Australia; Nausea; Vomiting; Dizziness; Asthma
PubMed: 36451320
DOI: 10.31128/AJGP-08-22-6535 -
Ocular Immunology and Inflammation Sep 2023Endogenous endophthalmitis (EE) is an uncommon but potentially devastating ocular infection involving the inner layers of the eye. The global incidence of EE is on the...
Endogenous endophthalmitis (EE) is an uncommon but potentially devastating ocular infection involving the inner layers of the eye. The global incidence of EE is on the rise. Common ocular signs and symptoms associated with EE include conjunctival injection, ocular pain, and reduced visual acuity. On clinical examination, a history of prior or coexisting systemic infections, symptoms (e.g., fever, malaise), and localizing features may be noted. Clinical diagnosis is often challenging, resulting in critical delays that contribute to a poor prognosis. Blood cultures and ocular fluid samples can aid in conforming causative pathogen(s), after which empirical antibiotic therapy, both systemic and intravitreal, should be instated. The use of steroids to suppress inflammation remains controversial. Surgical options include pars plana vitrectomy. Overall prognosis varies depending on host and pathogen factors, and early diagnosis and initiation of appropriate treatment are crucial.
Topics: Humans; Vitreous Body; Retrospective Studies; Endophthalmitis; Vitrectomy; Eye Infections, Fungal; Anti-Bacterial Agents
PubMed: 36306406
DOI: 10.1080/09273948.2022.2126863 -
Maedica Jun 2020Pyrexia of unknown origin represents a diagnostic challenge in the daily practice. Clinical features are often subtle or inadequate to recognize the etiology of...
Pyrexia of unknown origin represents a diagnostic challenge in the daily practice. Clinical features are often subtle or inadequate to recognize the etiology of prolonged fever. Endocrine etiology of pyrexia of unknown origin is not common. Here we present a case of an elderly female seeking medical advice from her general practitioner due to a four-week history of moderate fever, malaise and loss of appetite. Initial outpatient diagnostic workup was negative. During repeated examination a slight enlargement of thyroid gland was noticed. Thyroid function tests revealed a very low level of thyroid stimulated hormone along with elevated free T4 suggesting subacute thyroiditis. Low dose administration of corticosteroids led to clinical improvement and fever remission. Physicians involved must be aware about this unusual presentation of thyroiditis and include the condition in the differential diagnosis of prolonged unexplained fever. In the absence of clinical signs and symptoms, an abnormal thyroid function test may prevent from unnecessary investigations and inefficient hospital admission.
PubMed: 32952694
DOI: 10.26574/maedica.2020.15.2.266 -
Frontiers in Allergy 2022Urticaria is a mast cell-dependent disease, characterized by the presence of wheals, angioedema, or both in the absence of systemic symptoms. It is a common disease... (Review)
Review
Urticaria is a mast cell-dependent disease, characterized by the presence of wheals, angioedema, or both in the absence of systemic symptoms. It is a common disease worldwide, with an important health burden especially in chronic situations, that last more than 6 weeks. Although urticaria is usually a straightforward diagnosis, some diseases presenting with urticarial lesions must be excluded, particularly urticarial vasculitis and auto-inflammatory syndromes. In these settings additional atypical features are often present (long-lasting lesions, bruising, fever, malaise, arthralgia), allowing the clinician to suspect a diagnosis other than urticaria. The authors propose an approach based on these atypical features, the presence or absence of systemic symptoms and on skin histopathology as well as some blood parameters.
PubMed: 36238930
DOI: 10.3389/falgy.2022.808543 -
Emergency Medicine Clinics of North... Feb 2021Weakness has a broad differential diagnosis. A paradigm for organizing possibilities is to consider what part of the nervous system is involved, ranging from brain,... (Review)
Review
Weakness has a broad differential diagnosis. A paradigm for organizing possibilities is to consider what part of the nervous system is involved, ranging from brain, spinal cord, nerve roots, and peripheral nerves to the neuromuscular junction. The clinician can consider internal versus external causes. Some neurologic conditions have subtle presentations yet carry a risk of short-term decompensation if not recognized. It is helpful to consider whether an emergency department presentation of weakness is a new disease process or represents an exacerbation of an established condition. Emergency presentations of weakness are challenging, and one must carefully consider potential serious causes.
Topics: Acute Disease; Diagnosis, Differential; Emergency Service, Hospital; Humans; Muscle Weakness
PubMed: 33218656
DOI: 10.1016/j.emc.2020.09.010 -
Healthcare (Basel, Switzerland) Jul 2020A current problem regarding Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is the large proportion of doctors that are either not trained or refuse to...
A current problem regarding Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is the large proportion of doctors that are either not trained or refuse to recognize ME/CFS as a genuine clinical entity, and as a result do not diagnose it. An additional problem is that most of the clinical and research studies currently available on ME are focused on patients who are ambulant and able to attend clinics and there is very limited data on patients who are very severe (housebound or bedbound), despite the fact that they constitute an estimated 25% of all ME/CFS cases. This author has personal experience of managing and advising on numerous cases of severe paediatric ME, and offers a series of case reports of individual cases as a means of illustrating various points regarding clinical presentation, together with general principles of appropriate management.
PubMed: 32674263
DOI: 10.3390/healthcare8030211