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The Occurrence of Hemosinus after The Occurrence of Hemosinus after Continuous Positive Airway Pressure Treatment in Four Patients: A Case Report
No full textWe have reported series of four patients with respiratory failure and acidosis due to exacerbation of Chronic Obstructive Pulmonary Disease (COPD), hospitalized to University Hospital of Catania where they were treated with the Continuous Positive Airway Pressure (CPAP) and according to the literature, this treatment can generate high pressures in the nasal and paranasal sinus, so it can induce complications as rhinosinusitis, pneumosinusitis, pneumosinus, bones deformities, and according to our experience hemosinus; this is a rare condition and actually is not present in the scientific literature. We have collected a series of four cases of hemosinus after CPAP treatment occurred in a short period, about six months. The patient histories didn't show acute/sub-acute trauma or coagulation disorder in anamnesis before the hospital recovery. A CT brain study and coagulation factors assessment were performed in all patients. Our result confirmed the literature about effects of CPAP treatment in the coagulation state and identifies a new complication for patients undergoing this therapy
A Case of Bullous Pemphigoid with Hypothyroidism Caused by Hypopituitarism
No full textAbstract: A case of bullous pemphigoid with hypothyroidism caused by hypopituitarism is reported. The patient had a history of brain infarction six years ago. Over three months, tense vesico-bullous eruptions developed on her whole body. Histopathology revealed subepidermal blisters with dense eosinophil infilitrations. A direct immunofluorescent study found deposition of IgG and C3c components in the basement membrane zone. A blood examination showed greatly elevated titer of BP 180 antibody. Based on clinical, histopathological and laboratory findings, the patient was diagnosed as bullous pemphigoid. In our examination of endocrine functions, reduced levels of ACTH, TSH, FT3, FT4 and aldosterone were found, suggesting hypothyroidism caused by hypopituitarism. After the patient was treated by corticosteroid pulse therapy (methylpredonisolone 500mg/d with tapering), the lesions improved. Neurological examination showed lacuna infarction in the brain. We reported a case with bullous pemphigoid with hypothyrodism caused by hypopituitarism
A Viral Exanthem with Several Consecutive Eruptions and Signs of Gianotti-Crosti Syndrome
No full textWe report a case of unusual presentation of a viral exanthem in a 17-month-old girl. The child had signs of Gianotti-Crosti syndrome (GCS)--the long-lasting papular eruption on her extremities and face with non-typical for GCS rash extension to the trunk, enlarged posterior cervical and submandibular lymph nodes, and anicteric hepatitis. Serum polymerase chain reaction (PCR) detected human herpesvirus type 6 (HHV-6) in accord with the exanthem in this child
Efficacy of Interventions for Sexually Abused Children – A Literature Review and Meta-Analysis of Treatment of Post Traumatic Stress Symptoms
No full textBackground: Child sexual abuse is a significant risk factor for psychopathology. Earlier reviews indicate that psychosocial interventions may be effective for some symptoms, but a comprehensive picture is still lacking. Moreover, the rapid increase of research requires evaluations to be updated. The present systematic review aims at describing the research on intervention efficacy among sexually abused children, and analyses their effect in decreasing the post traumatic stress symptoms (PTSS).Methods: The qualitative literature review offers the overview of recent interventions among sexually abused children. It describes the quality of evidence as well as the modality (group vs. individual, family vs. child only) and targeting (universal, selective, indicated) of the interventions. To evaluate the efficacy of interventions, the meta-analysis is applied.Results: The results revealed 23 relevant studies with total of 31 intervention conditions published between 2000 and 2013. The meta-analysis showed that when intervention groups were compared to control groups with no treatment at all, interventions showed a large power of positive changes in PTSS. However, when cognitive behavioral therapy (CBT) groups were compared to control groups which received some other intervention, there was no difference in PTSS changes among experimental and control groups.Conclusions: Results suggest that psychosocial interventions with sexually abused children are beneficial but it is still not clear, which are the most effective methods. The results also highlight the consequences of methodological decisions when conducting meta-analysis. However, because of some limitations of the study, the results of this review should be regarded as tentative and suggestive and further elaboration of the constantly growing evidence is needed
Does Larger Dose of Steroid Improve the Outcome of Intra-Articular Hip Injection?
No full textIntroduction: Intra-articular hip injection has been used to treat arthritic hip pain for decades. However there is no standardised recommended does and there has been variability amongst surgeons.Objective: We aimed to determine if larger dose of steroid injected improved the duration of pain relief.Patients and Method: We retrospectively reviewed, two matched groups of patients treated with variable doses of triamcinolone hip injection; Group A with 40mg and Group B with 80mg. The duration of pain relief after hip injection was recorded in days, weeks or months for patients in each group.Results: In Group A, 7 patients had no pain relief at all from the hip injection, 13 for only days (less than a week), 15 patients for weeks (up to 4 weeks) and 25 patients had complete pain relief till the time of follow-up at 3 months. Similarly in group B, 6 patients had no pain relief at all from hip injection, 14 for days, 18 patients for weeks and 22 patients for 3 months. The duration of pain relief from the hip injection for both Group A (6.2weeks) and B (6.1weeks) was similar with an overall average pain relief of 6.15weeks.Conclusion: 40mg of steroid had same duration of pain relief compared to 80mg of steroid for treating primary hip osteoarthritis
Cancer Risk Factors in SLE: Multivariate Regression Analysis in 16,409 Patients
No full textBackground: We assessed factors associated with cancer risk in systemic lupus erythematosus (SLE), relative to the general population, using a large international multi-centre clinical cohort (30 centres, 16,409 patients).Methods: Cancers were ascertained by registry linkage. We used Poisson hierarchical regression to assess for potential independent effects of sex, race/ethnicity, age group, SLE duration, and calendar-year period on the standardized incidence ratios (SIR; ratio of cancers observed to expected). The hierarchical model allowed for differences in effects across countries. The primary regression analyses were done using the overall cancer SIRs; in secondary analyses we focused on hematological cancer SIRs.Results: In adjusted analyses, we demonstrated lower SIR estimates for overall cancer risk, in black versus white SLE patients, in SLE patients of older versus younger age, and for patients with SLE duration of 5 years or more (versus lower duration). Female sex and calendar year were not clearly associated. Regarding hematological cancers specifically, SLE duration of 5 years or more again appeared to be associated with lower SIR estimates.Conclusion: Cancer risk in SLE is increased relative to the general population; this is particularly true for patients of white race/ethnicity, younger age, and of shorter SLE duration
Further Study of “Care Partnershipsâ€: The Rheumatology Perspective
No full textObjective: We have previously described rheumatology ‘care partnerships’ from the perspective of Quebec family doctors. Our current objective was to describe the perceptions of rheumatologists regarding rheumatology ‘care partnerships’.Methods: Practicing Quebec adult rheumatologists (N=100) were mailed a questionnaire, asking them to rate, on a 5-point scale, factors of importance regarding their relationship with family physicians. A factor was considered to be ranked as high importance to the rheumatologist, if the factor was scored as >4.Results: Of the 100 rheumatologists contacted, 56 completed the survey. All but one of the respondents (n=55) ranked communication and information exchange, as being of high importance. Clear and appropriate balance of responsibilities was also considered very important by most respondents (n=47, 84%) as was appropriateness of referrals from the family physicians (n=42, 75%). Personal knowledge of the family physician (n=19, 34%) and physical proximity to the family physician (n=7, 13%) were less frequently ranked as important to rheumatologists.Conclusion: Along with our previous work, these results confirm that rheumatologists and family doctors share similar values when it comes to rheumatology “care partnershipsâ€. Further study of how to optimize relationships between family physicians and specialists would be of interest
What Everybody is Doing but No One is Talking About: Use of Complementary and Alternative Medicine in the ANCA Associated Vasculitis Population
No full textThe use and impact of complementary and alternative medicine (CAM) for anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV) has not been reported. AAV patients seeking care at our center inquired about CAM, prompting a formal study. Study objectives were to discern how many AAV patients used CAM and its perceived helpfulness in disease management.Methods: AAV patients completed a CAM questionnaire between July 2011 and May 2012. Patients were 18 years or older and had biopsy proven and/or clinical evidence of AAV. Medical record abstraction supplemented data. Classification detailed CAM type including “Mind†or “Mind-Bodyâ€. Perceived helpfulness of CAM was assessed as “veryâ€, “somewhat†or “not at all/don’t knowâ€.Results: A total of 107 patients participated and were a mean age of 53 (range: 18-85), 62% female; 48% proteinase 3 (PR3)-ANCA, 44% myeloperoxidase (MPO)-ANCA and 8% ANCA-negative. Top organs involved included kidney (87%), joints (55%), lung (53%) and upper respiratory (53%).At least one type of CAM treatment or self-help practice was reported by 81% of study participants, with the most frequent being prayer (64%), exercise (27%) and massage therapy (19%). Mind-based practices were used by 28% (excluding prayer) and Mind-Body practices by 14%. Most practices were used to improve wellbeing, and Mind and Mind-Body were deemed very helpful by 83% and 87% respectively. Only 24% of study participants discussed CAM with their physician.Conclusion: CAM practices were commonly used to improve well-being and found to be beneficial among AAV patients, but more open discussion is needed about CAM between physicians and patients
Potential Therapeutic Benefits of Aloe barbadensis in Treatment of Rheumatoid Arthritis
No full textRheumatoid arthritis (RA) is an autoimmune disease characterized with a chronic, systemic inflammation which primarily affects synovial joints. A significant percentage of the world population including notably the aged groups suffers from such a disabling and painful condition that can result in substantial loss of normal functioning and mobility, if not adequately treated. Natural products have always been a potential source of alternative therapy and lead compounds for various diseases. A good number of anti-inflammatory or immunomodulatory plant extracts (and phytochemicals thereof) seem to exist whilst several of them have been specially studied in the context of RA. One potential example in this regard includes Aloe barbadensis. Over 75 active components have already been identified in Aloe barbadensis leaf gels and some of them have been implicated as immunomodulatory compounds and as such beneficial against RA, based on animal studies. This paper aims at critically reviewing the evidence of beneficial role as well as possible mechanism of such action of Aloe barbadensis preparations in RA and related complications
A Novel Approach to a Case of Stent Embolization during a Primary PCI
No full textA 60 year old smoker male presented with acute anterior ST elevation Myocardial Infarction (STEMI) and underwent primary percutaneous coronary intervention (PCI). Thrombus aspiration to a totally occluded proximal LAD (Left Anterior Descending artery)/D1 (first diagonal branch) revealed complex bifurcation disease. PCI complicated by unexpected stent embolization to first obtuse marginal (OM1) branch. After successful revascularization to the D1 branch, different approaches initially failed to retrieve the embolised stent in the OM1 branch. Finally the stent was successfully retrieved using a Filter Wire catheter. To our knowledge this is the first case to retrieve an embolised stent using the filter wire