scholarly journals Frequency of Migraine as a Chief Complaint in Otolaryngology Outpatient Practice

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Omar Sabra ◽  
Maria Muhammad Ali ◽  
Maha Al Zayer ◽  
Saleh Altuwaijri
Keyword(s):  
International Headache Society ◽  
Nasal Congestion ◽  
Chief Complaint ◽  
Male Ratio ◽  
Chief Complaints ◽  
History Of ◽  
Ihs Criteria ◽  
Migraine Group ◽  
Outpatient Practice ◽  
Atypical Presentations

Objective.To identify the frequency of typical (headache and dizziness) and common atypical (ear fullness, pressure, pain, tinnitus, facial fullness, and nasal congestion) migraine symptoms as chief complaints among patients presenting to otolaryngology clinic.Methods.This is a descriptive study of prospectively collected data from a general otolaryngology practice. Typical migraine presentations were diagnosed by applying international headache society (IHS) criteria for migraine headache and Neuhauser’s criteria for migrainous vertigo. Atypical otologic and rhinologic migraine symptoms were diagnosed using individualized criteria. Charts were reviewed at 6-month interval from the first presentation.Results.Out of 1002 consecutive patients, 10.8% presented with “migrainous chief complaint.” All migrainous chief complaint patients had a history of headache but not all of them presented with headache. Corrected female to male ratio in the migraine group was 3 to 1; age distributions were significantly different between the migraine and nonmigraine groups by applyingt-test. Out of the atypical complaints, 86% of the patients had a history of concomitant typical presentation.Conclusion. Actual diagnostic criteria for migraine do not satisfy the diversity of its presentation. Investigating the history of migraine is enough to diagnose most atypical presentations. Sound knowledge about migraine seems essential for any ENT practitioner.

scholarly journals Modified Lothrop (Draf III) procedure for the treatment of a recurrent orbitofrontal cholesterol granuloma: A case report

2020 ◽  
Vol 8 ◽  
pp. 2050313X2090780
Author(s):  
Hidenori Yokoi ◽  
Hidetaka Yamanaka ◽  
Yuma Matsumoto ◽  
Michitsugu Kawada ◽  
Masachika Fujiwara ◽  
...  
Keyword(s):  
Nasal Congestion ◽  
Sinus Surgery ◽  
Resected Specimen ◽  
Histopathological Analysis ◽  
Cholesterol Granuloma ◽  
Chief Complaints ◽  
History Of ◽  
The Right ◽  
Ethmoid Sinuses ◽  
Draf Iii

Orbitofrontal cholesterol granuloma is a rare occurrence. Here, we present a case involving a 64-year-old man with a recurrent orbitofrontal cholesterol granuloma treated by the Modified Lothrop (Draf III) procedure. The patient, who had a history of trauma and previous sinus surgery, presented with chief complaints of nasal congestion, olfactory impairment, and diplopia. We suspected chronic sinusitis; computed tomography showed a soft-tissue shadow extending from the bilateral frontal sinuses to the ethmoid sinuses, with a cyst in the right orbitofrontal region. We performed endoscopic surgery for removal of the mass, and histopathological analysis of the resected specimen confirmed a diagnosis of cholesterol granuloma. The lesion recurred 2 months later, and we performed revision surgery using the Modified Lothrop or Draf III procedure. The patient showed no relapse at the 5-year follow-up. These findings suggest that the Draf III procedure is an effective surgical treatment for cholesterol granulomas.

scholarly journals Atypical presentation of COVID-19; an observational retrospective study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Maryam Haghighi-Morad ◽  
Ilad Alavi Darazam ◽  
Hooman Bahrami-Moltagh ◽  
Maryam Amerifar ◽  
Nasim Zamani ◽  
...  
Keyword(s):  
Invasive Mechanical Ventilation ◽  
False Negative ◽  
Signs And Symptoms ◽  
Final Diagnosis ◽  
Chief Complaint ◽  
Presenting Symptoms ◽  
Care Workers ◽  
Chief Complaints ◽  
Atypical Presentations ◽  
Substances Of Abuse

Abstract Background COVID-19 infection may present with atypical signs and symptoms and false negative polymerase chain reaction (PCR) tests predisposing healthy people and health care workers to infection. The aim of the current study is to evaluate the features of atypical presentations in COVID-19 infection in a referral center in Tehran, Iran. Methods Hospital database of inpatients admitted to Loghman Hakim hospital between February 20th and May 11th, 2020 was reviewed and all patients with final diagnosis of COVID-19 infection were evaluated for their presenting symptoms. Patients with chief complaints of “fever”, “dyspnea”, and/or “cough” as typical presentations of COVID-19 were excluded and those with other clinical presentations were included. Results Nineteen patients were included with a mean age of 51 ± 19 years, of whom, 17 were males (89%). Median [IQR] Glasgow coma scale (GCS) was 14 [13, 15]. Almost 10 had referred with chief complaint of methanol poisoning and overdose on substances of abuse. Only 8 cases (42%) had positive COVID-19 test. Nine (47%) needed invasive mechanical ventilation, of whom, two had positive COVID-19 test results (p = ns). Eight patients (42%) died with three of them having positive PCRs. Conclusions In patients referring to emergency departments with chief complaint of poisoning (especially poisonings that can result in dyspnea including substances of abuse and toxic alcohols), gastrointestinal, and constitutional respiratory symptoms, attention should be given not to miss possible cases of COVID-19.

scholarly journals Food and migraine in adolescents

2011 ◽  
Vol 51 (4) ◽  
pp. 223
Author(s):  
Magda Bouhairet ◽  
Muhammad Ali ◽  
Bistok Saing ◽  
Johannes Harlan Saing ◽  
Yazid Dimyati
Keyword(s):  
Family History ◽  
International Headache Society ◽  
Ice Cream ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Migraine Headaches ◽  
Frequent Relapses ◽  
History Of ◽  
Ihs Criteria ◽  
Instant Noodles

Background Migraine headaches are a common problem worldwide, especially in adolescents. They are usually chronic, with frequent relapses. Therefore, any dietary risk factor for headaches has important implications on migraineurs. However, the association between migraine and diet needs to be examined further.Objective To investigate the association between diet and migraine in adolescents.Methods We conducted a cross-sectional study in August to September 2009 on 13 - 18 year old adolescents in a senior high school in Medan, North Sumatera. We included subjects diagnosed with migraine, according to the International Headache Society (IHS) criteria. Ninety participants completed the questionnaire. Foods we observed for a link to migraine included milk, chocolate, ice cream, cheese, bread, instant noodles, meatballs, chili sauce, sweetener, yoghurt, pizza, and other foods and beverages.Results Of the 90 participants with migraines, there were more females (61.1%) than males. There were statistically significant associations between migraine and triggering foods (P = 0.045, 95% CI 0.59 to 0.79) as well as between migraine and family history of migraine (P = 0.043, 95% CI 0.46 to 0.66). Stress (P = 0.164), menstruation (P = 0.369), and sound or light (P= 0.577) had no significant association with migraine. A wide variety of foods and beverages were implicated as migraine precipitants. The most common were chili sauce (75.8%), ice cream (71.0%), milk (67.7%), instant noodles (67.7%), chocolate (61.3%), peanuts (59.7%), cheese (54.8%) and meatballs (54.8%).Conclusion Food and family history have a significant association with the occurrence of migraine in adolescents. 

An audit and insights from clinical exome sequencing in psychiatry: genotype-phenotype correlation

2020 ◽  
Author(s):  
Jayant Mahadevan ◽  
Reeteka Sud ◽  
Ravi Kumar Nadella ◽  
Vani P ◽  
Anand G Subramaniam ◽  
...  
Keyword(s):  
Exome Sequencing ◽  
Psychiatric Symptoms ◽  
Pathogenic Variant ◽  
Clinical Exome Sequencing ◽  
Mapt Gene ◽  
Nf1 Gene ◽  
Novel Variant ◽  
History Of ◽  
Atypical Presentations ◽  
Minor Physical Anomalies

BACKGROUND:Psychiatric syndromes have polymorphic symptomatology, and are known to be heritable. Psychiatric symptoms (and even syndromes) often occur as part of the clinical presentation in rare Mendelian syndromes. Clinical exome sequencing reports may help with refining diagnosis and influence treatment decisions, in addition to providing a window into the biology of brain and behaviour. We describe a clinical audit of 12 individuals who sought treatment at our hospital, and for whom targeted sequencing was ordered. Three cases are discussed in detail to demonstrate correlations between genotype and phenotype in the clinic.METHODS:Targeted Next-Generation Sequencing (NGS) was done using Clinical Exome Panel (TruSight One, Illumina) covering coding exons and flanking intronic sequences of 4811 genes associated with known inherited diseases. Variants detected were classified according to the American College for Medical Genetics (ACMG) recommendation for standards of interpretation and reporting of sequence variations.RESULTS:Ten out of twelve cases had at least one pathogenic variant. In one of these cases, we detected a known pathogenic variant in MAPT gene in a suspected FTD case, which helped us to confirm the diagnosis. In another case, we detected a novel variant predicted to be deleterious in NF1 gene. Identification of this mutation suggested a change in treatment for the patient, that was of benefit. The same patient also harboured a novel variant in the TRIO gene. This gene may be involved in biological processes that underlie the patient’s psychiatric illness.CONCLUSIONS:The cases discussed here exemplify different scenarios under which targeted exome sequencing can find meaningful application in the clinic: confirming diagnosis (MAPT variant), or modifying treatment (NF1). We suggest that clinical exome sequencing can be a helpful addition to a clinician’s toolkit when there are expediting factors to consider— such as early-onset, strong family history of mental illness, complex/atypical presentations and minor physical anomalies or neurocutaneous markers.

Migraine without aura and migrainous disorder in children; International Headache Society (IHS) and revised IHS criteria

Cephalalgia ◽  
2000 ◽  
Vol 20 (7) ◽  
pp. 617-620 ◽  
Author(s):  
A Cano ◽  
E Palomeras ◽  
S Alfonso ◽  
D Ortega ◽  
P Sanz ◽  
...  
Keyword(s):  
Migraine Without Aura ◽  
International Headache Society ◽  
Ihs Criteria

scholarly journals 451. Evaluation of Exposure History in Healthcare Personnel with Coronavirus 2019 Disease

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S293-S293
Author(s):  
Sandra Silva ◽  
Thriveen Mana ◽  
Davinder Bhullar ◽  
Beatrice Tabor ◽  
Curtis Donskey
Keyword(s):  
High Risk ◽  
Risk Exposure ◽  
Healthcare Personnel ◽  
Administrative Personnel ◽  
Asymptomatic Carriage ◽  
Moderate Disease ◽  
Control And Prevention ◽  
History Of ◽  
Exposure History ◽  
Atypical Presentations

Abstract Background During the Coronavirus Disease 2019 (COVID-19) pandemic, many healthcare personnel (HCP) have developed COVID-19. However, there is uncertainty regarding whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was acquired at work versus in the community. Methods We conducted a cohort study to examine exposure history of personnel with COVID-19 infection or asymptomatic carriage in a VA healthcare system. High-risk exposures were classified based Centers for Disease Control and Prevention criteria. Results Of 578 personnel tested, 49 (8%) had nasopharyngeal swabs with positive PCR results, including 45 (92%) with and 4 (8%) without COVID-19 symptoms. Of the 49 cases, 21 (43%) had a documented high-risk exposure at work, including 14 exposures to COVID-19 patients and 7 exposures to colonized or infected personnel. Exposures to infected patients most often were a result of delays in recognition of COVID-19 due to atypical presentations. Exposures to personnel with COVID-19 most often involved activities such as meals when facemasks were not worn. Most cases occurred among nurses (26, 53%) and administrative personnel (10, 20%); only 3 physicians developed COVID-19. No cases occurred in personnel working on COVID-19 wards. All personnel had mild or moderate disease. Conclusion Forty-three percent of healthcare personnel with COVID-19 had prior high-risk exposures at work. Improved detection of patients with atypical presentations and efforts to reduce high-risk contacts among personnel may reduce the risk for acquisition of SARS-CoV-2. Disclosures All Authors: No reported disclosures

A Useful Diagnostic Method for Drug-induced Pneumonitis

1994 ◽  
Vol 22 (03n04) ◽  
pp. 329-336 ◽  
Author(s):  
Akira Kawasaki ◽  
Yutaka Mizushima ◽  
Hitoshi Kunitani ◽  
Masanobu Kitagawa ◽  
Masashi Kobayashi
Keyword(s):  
Bronchoalveolar Lavage Fluid ◽  
Challenge Test ◽  
Lavage Fluid ◽  
Peripheral Blood Lymphocytes ◽  
Lymphocyte Stimulation Test ◽  
Drug Induced ◽  
Chief Complaints ◽  
History Of ◽  
Chest X Ray

A 51 year-old male was admitted to our hospital with chief complaints of fever, dry cough and dyspnea. Chest X -ray films and his history of taking Chinese medicine for liver dysfunction were suggestive of drug-induced pneumonitis. Lymphocyte stimulation test (LST) to causative Chinese medical drugs of Sho-saiko-to and Dai-saiko-to was negative with peripheral blood lymphocytes (PBL), but was positive with Iymphocytes from bronchoalveolar lavage fluid (BALF). In vivo challenge test for Sho-saiko-to was positive. The LST with BALF-lymphocytes proved to be very useful in making a diagnosis of drug-induced pneumonitis.

Streptococcus salivarius endogenous endophthalmitis

2021 ◽  
Vol 14 (2) ◽  
pp. e239299
Author(s):  
Carl-Joe Mehanna ◽  
Lea Kallassi ◽  
Ahmad M Mansour ◽  
Rola N Hamam
Keyword(s):  
Opportunistic Infections ◽  
External Source ◽  
Endogenous Endophthalmitis ◽  
Streptococcus Salivarius ◽  
Source Of Infection ◽  
Transcatheter Aortic Valve ◽  
History Of ◽  
Atypical Presentations ◽  
High Index Of Suspicion ◽  
Valve Implantation

We describe a case of endogenous endophthalmitis in an elderly man caused by Streptococcus salivarius. An 88-year-old male patient with diabetes with iron deficiency anaemia and history of transcatheter aortic valve implantation presented with an insidious clinical picture of atraumatic endophthalmitis. No internal or external source could be identified. Diagnostic and therapeutic vitrectomy revealed papillomacular abscess and vitreous fluids grew S. salivarius. Despite lack of an identifiable source of infection, a high index of suspicion for atypical presentations is required in patients with multiple comorbidities that could weaken their immune system towards opportunistic infections. Early detection, microbiological evaluation and prompt treatment are critical to avoid disastrous outcomes. While S. salivarius has been implicated in cases of exogenous endophthalmitis, this is the first reported case of endogenous endophthalmitis due to S. salivarius.

scholarly journals Pseudoaneurisma Arteri Brakialis Pasca Kateterisasi Laporan Kasus

e-CliniC ◽  
2019 ◽  
Vol 7 (1) ◽  
Author(s):  
Natalia Ch. Polii ◽  
Janry A. Pangemanan ◽  
Agnes L. Panda ◽  
Ira Posangi
Keyword(s):  
Brachial Artery ◽  
Colour Doppler ◽  
Ultrasound Guided ◽  
Compression Technique ◽  
Artery Pseudoaneurysm ◽  
Neck Size ◽  
Chief Complaints ◽  
Pulsed Wave Doppler ◽  
History Of ◽  
The Right

Abstract: Post-catheterization PSA occurs at the site of arterial puncture followed by incomplete hemostasis. We reported a 63-year-old male visited the emergency department of Prof Dr. R. D. Kandou Hospital with chief complaints of swelling and severe pain on the right arm, occured 6 days prior to the ER visit. His right arm looked darker and felt colder than the counterpart, felt numb, and was hard to move due to pain. Three months ago, the patient had a history of percutaneous transluminal coronary angiography through brachial artery access. Examination of the right upper extremity revealed hematoma at brachial artery puncture site, edema at 1/3 distal of the brachial region, cold acral areas, strong right brachial artery pulses, yet small radial ones. Vascular Doppler examination showed a superficial hematoma above the brachial artery and a PSA pouch of 1.23 x 1.67 cm with a small neck (<0.5 cm). Colour Doppler displayed a “yin and yang” flow at pouch, while pulsed-wave Doppler showed a “to and fro” wave through the neck. Patient was diagnosed as iatrogenic brachial artery pseudoaneurysm and managed with ultrasound-guided compression technique followed by continuous compression with elastic bandage. This technique was selected due to the PSA size less than 3 cm yet symptomatic, small neck size (<1 cm), and no size progression. Patient discharged after the PSA pouch and neck shrinked. On 6 months follow-up, neither neck nor pseudoaneurysm pouch were found.Keywords: pseudoaneurysm, ultrasound-guided compression Abstrak: PSA pasca kateterisasi terjadi pada arteri yang dipungsi tetapi tidak terjadi hemostasis sempurna. Kami melaporkan seorang laki-laki berusia 63 tahun datang di Instalasi Rawat Darurat Medik RSUP Prof. Dr. R. D. Kandou dengan keluhan utama bengkak dan nyeri hebat pada lengan kanan sejak 6 hari SMRS dan memberat pada satu hari terakhir. Tangan kanan tampak lebih gelap dibandingkan tangan kiri, teraba dingin, terasa kebas dan sulit digerakkan karena nyeri. Tiga bulan sebelumnya pasien dilakukan tindakan intervensi koroner perkutan. Pada pemeriksaan ekstremitas atas kanan tampak hematoma di daerah pungksi, edema setinggi 1/3 distal regio brachialis sampai ujung jari, akral teraba dingin, pulsasi arteri brakialis teraba kuat tetapi arteri radialis teraba kecil. Pemeriksaan Doppler vascular mendapatkan gambaran hematoma superfisial dari arteri brakialis dan tampak kantong PSA berukuran 1,23x1,67 cm dengan neck berukuran kecil (<0,5 cm) Pada colour Doppler didapatkan aliran pada kantong pseudoaneurisma seperti gambaran yin dan yang. Pada pulsed-wave Doppler di saluran PSA (neck) didapatkan gelombang “to and fro”. Berdasarkan anamnesis, pemeriksaan fisik dan penunjang pasien ini didiagnosis dengan PSA arteri brakialis iatrogenik (pasca kateterisasi). Penanganan dengan ultrasound-guided compression dan dilanjutkan dengan kompresi kontinu dengan bebat elastik. Pemilihan teknik kompresi ini berdasarkan pada ukuran kantong <3 cm namun bergejala, ukuran neck kecil <1cm serta tidak didapatkan pembesaran progresif. Pasien dipulangkan setelah kantong maupun neck PSA tampak mengecil, dan 6 bulan setelahnya tidak lagi terlihat neck maupun kantong PSA.Kata kunci: pseudoaneurisma, ultrasound-guided compression

scholarly journals The natural history of community-acquired common colds symptoms assessed over 4-years

2015 ◽  
Vol 53 (1) ◽  
pp. 81-88
Author(s):  
Theodore J. Witek ◽  
David L. Ramsey ◽  
Andrew N. Carr ◽  
Donald K. Riker
Keyword(s):  
Sore Throat ◽  
Common Cold ◽  
Nasal Congestion ◽  
Runny Nose ◽  
Symptom Evaluation ◽  
Symptom Frequency ◽  
Bothersome Symptom ◽  
History Of ◽  
The Common ◽  
Pain Symptoms

Background: The common cold is the most frequently experienced infection among humans, but limited data exist to characterize the onset, duration, severity and intersection of symptoms in community-acquired colds. A more complete understanding of the symptom frequency and burden in naturally occurring colds is needed. Methodology: We characterized common cold symptoms from 226 cold episodes experienced by 104 male or female subjects. Subjects were enrolled in the work environment in an attempt to start symptom evaluation (frequency and severity) at the earliest sign of their cold. We also assessed the symptom that had the greatest impact on the subject by asking them to identify their single most bothersome symptom. Results: Symptom reporting started within 24 hours of cold onset for most subjects. Sore throat was a harbinger of the illness but was accompanied by multiple symptoms, including nasal congestion, runny nose and headache. Cough was not usually the most frequent symptom, but was present throughout the cold, becoming most bothersome later in the cold. Nasal congestion, pain (eg, sore throat, headache, muscle pains) or feverishness and secretory symptoms (eg, runny nose, sneezing), and even cough, were simultaneously experienced with high incidence over the first 4 days of illness. The single most bothersome symptom was sore throat on day 1, followed by nasal congestion on days 2-5 and cough on days 6 and 7. Conclusion: There is substantial overlap in the appearance of common cold symptoms over the first several days of the common cold. Nasal congestion, secretory and pain symptoms frequently occur together, with cough being somewhat less prominent, but quite bothersome when present. These data establish the typical symptomatology of a common cold and provide a foundation for the rational treatment of cold symptoms typically experienced by cold sufferers.

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