scholarly journals An Unusual Presentation of Lyme Neuroborreliosis

2015 ◽  
Vol 14 (1) ◽  
pp. 32-35
Author(s):  
Laura Kitto ◽  
◽  
Chris McKenna ◽  
Keyword(s):  
Back Pain ◽  
Incidental Finding ◽  
Lyme Neuroborreliosis ◽  
Common Symptom ◽  
Functional Diagnosis ◽  
Acute Medical Unit ◽  
History Of ◽  
Severe Back Pain ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired

Back pain is a common symptom among patients presenting to the acute medical unit. We describe the case of a 55-year-old man with a brief history of fatigue and severe back pain, unresponsive to escalating doses of opiate analgesia. Blood tests and imaging studies were unremarkable and a functional diagnosis was considered. Several weeks into his admission he developed a lower motor neurone facial nerve palsy. He was treated with antibiotics for an incidental finding of a hospital-acquired pneumonia on imaging, which remarkably led to the resolution of his facial palsy and allowed a dramatic reduction in analgesia. This triggered further investigations; identifying Lyme neuroborreliosis as the cause of his symptoms.

scholarly journals Addition of the combination of sims technique and semi-fowler positioning to cardiorespiratory exercises in patients with myasthenia gravis: case report

2021 ◽  
Vol 9 (8) ◽  
pp. 2459
Author(s):  
Putu Ayu Meka Raini ◽  
Luh Putu Ratna Sundari ◽  
Ni Kadek Yuni Fridayani
Keyword(s):  
Myasthenia Gravis ◽  
Respiratory Muscle ◽  
Autoimmune Disorder ◽  
Active Range Of Motion ◽  
Postural Drainage ◽  
History Of ◽  
Hospital Acquired Pneumonia ◽  
Respiratory Training ◽  
Hospital Acquired ◽  
Increased Activity

Myasthenia gravis (MG) is an autoimmune disorder characterized by fluctuating muscle fatigue, worsening with increased activity, and improving at rest. Physiotherapy plays a role in reducing symptoms such as shortness of breath, respiratory muscle weakness, and airway obstruction due to decrease the sputum in the lung lobes and prevent of the exacerbation. Respiratory training and postural drainage techniques are part of intervention that given by physiotherapy for patients diagnosed with MG and had symptoms hospital acquired pneumonia (HAP). A male, 28 years old patient diagnosed with HAP and had history of MG hospitalized a month with dyspnoea and disable to do activity daily living. Physiotherapy treatment that given to the patient from 18th July 2018 till 28th July 2018 are respiratory training included breathing exercise, cough exercise, shoulder expansion, Active Range of motion (ROM) exercise, stretching of respiratory muscle and home program exercise that helped by nurse and caregiver. Patient had medical treatment from all medical team by pulmonologist, neurologist and nurse too. Combined this new technique postural drainage and all physiotherapy programs showed significant in patient such as dyspnoea decreased. 

Images in anesthesiology: three safe, simple, and inexpensive methods to administer the sphenopalatine ganglion block

2020 ◽  
Vol 45 (11) ◽  
pp. 880-882
Author(s):  
Danielle Levin ◽  
Shaul Cohen
Keyword(s):  
Back Pain ◽  
Dural Puncture ◽  
Sphenopalatine Ganglion ◽  
Ganglion Block ◽  
Tension Headaches ◽  
History Of ◽  
Sphenopalatine Ganglion Block ◽  
Severe Back Pain

The sphenopalatine ganglion (SPG) block is a simple and valuable technique that was discovered over a century ago, but, unfortunately, very few anesthesiology providers are familiar with this block. After some of our recent publications, physicians from different countries have reached out to us requesting more specifics on how we perform our version of the block. In this report, we provide a brief history of the block and demonstrate our three effective, simple, readily available, and inexpensive methodologies with images. We are proud to share that our three SPG block techniques have so far effectively relieved patients of chronic migraines, acute migraines, tension headaches, moderate-to-severe back pain, and post-dural puncture headaches.

scholarly journals Adrenal Incidentaloma In Patient with Bilateral Nephrolithiasis and Infectef Right Kidney Cyst

2020 ◽  
Vol 1 (2) ◽  
pp. 31
Author(s):  
Kholidatul Husna ◽  
Hermina Novida
Keyword(s):  
Left Kidney ◽  
Malignant Lesion ◽  
Adrenal Incidentaloma ◽  
Signs And Symptoms ◽  
Kidney Cyst ◽  
Abdominal Ct Scan ◽  
Suprarenal Mass ◽  
History Of ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired

Adrenal incidentaloma (AI) is a rare case, with a prevalence of 3-7% in the general population. We report a case of a 66 year old female, presented with the history of bilateral flank pain. The patient was performed urologic evaluation due to suspicion of right perirenal abscess and left kidney tumor, and from abdominal CT scan it was found suprarenal mass. There were no signs and symptoms of hormonal hyperfunction. Radiological evaluation in the patient showed the present of malignant lesion. Therefore, adrenalectomy was planned. Before undergoing adrenalectomy, the patient had passed away 6 days after first surgery (right pyelolitotomy and unroofing cyst), with septic shock suspected as cause of death due to hospital-acquired pneumonia.

scholarly journals Diagnosing Spinal Gout: A Rare Case of Back Pain and Fever

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Andres Cordova Sanchez ◽  
Maneesh Bisen ◽  
Farzam Khokhar ◽  
Adriana May ◽  
Jihad Ben Gabr
Keyword(s):  
Back Pain ◽  
Vertebral Osteomyelitis ◽  
Axial Skeleton ◽  
Definitive Diagnosis ◽  
Pathological Examination ◽  
Imaging Findings ◽  
Monosodium Urate ◽  
High Prevalence ◽  
History Of ◽  
Severe Back Pain

Gout is a common inflammatory arthritis that has a high prevalence worldwide. It is characterized by monosodium urate deposition, usually affecting the joints and soft tissue of the lower extremities. Urate deposition in the axial skeleton resulting in spinal gout is rare. However, it seems to be more prevalent than usually thought, largely because it is underdiagnosed. Imaging findings are, for the most part, nonspecific and often mimic infectious etiologies. Definitive diagnosis requires pathological examination. Thus, it can be easily missed. We present a 41-year-old male with a seven-year history of untreated gout who came in with severe back pain, fevers, and radiculopathy. He was initially diagnosed with vertebral osteomyelitis. However, after a biopsy, spinal gout was confirmed. Spinal gout can be misdiagnosed as vertebral osteomyelitis given the similarities in presentation and imaging findings. This case report highlights the importance of keeping spinal gout as a differential of vertebral osteomyelitis, especially in patients with long-standing or uncontrolled gout with tophi.

Aberrant right subclavian artery – a rare congenital anatomical variation causing dysphagia lusoria

VASA ◽  
2020 ◽  
pp. 1-4
Author(s):  
Foivos Irakleidis ◽  
Jonathon Kyriakides ◽  
Daryll Baker
Keyword(s):  
Subclavian Artery ◽  
Incidental Finding ◽  
Anatomical Variation ◽  
Later Life ◽  
Aberrant Right Subclavian Artery ◽  
Barium Swallow ◽  
Common Symptom ◽  
Dysphagia Lusoria ◽  
Anatomical Anomaly ◽  
History Of

Summary: An aberrant right subclavian artery (ARSA) is a rare anatomical variation of the aortic arch. Although an incidental finding and asymptomatic in the majority of individuals, an ARSA can cause troubling symptoms during both childhood and in later life. In adulthood, the most common symptom is dysphagia, where the condition is named dysphagia lusoria. In other rare cases it can cause shortness of breath, chronic cough and hoarseness of voice amongst others. We present a case of a 65-year-old female patient who was diagnosed with dysphagia lusoria following a barium swallow examination to investigate a 10-year history of dysphagia. She was further investigated with other imaging modalities to establish her diagnosis. The dysphagia was not progressive, nor did it result in malnutrition, and hence the patient was managed conservatively. There is currently no established guideline to classify the severity of symptoms or radiological findings of this anatomical anomaly. Our case reiterates the importance of such protocols, in order to be able to avoid the risks of an unnecessary surgical procedure, whilst being sure to prevent the undertreatment of affected individuals.

Hospital Acquired Pneumonia

2016 ◽  
Author(s):  
Joshua Lupton
Keyword(s):  
The Elderly ◽  
Chronic Obstructive ◽  
Microbial Infection ◽  
Term Care ◽  
Obstructive Pulmonary Disease ◽  
Increased Risk ◽  
History Of ◽  
Hospital Acquired Pneumonia ◽  
Pulmonary Parenchyma ◽  
Hospital Acquired

Pneumonia consists of inflammation of the pulmonary parenchyma, typically resulting from a microbial infection. Hospital-acquired pneumonia (HAP) occurs in (typically elderly) patients in long-term care facilities, with regular IV therapy, with immunosuppression, or with a history of recent treatment at a hospital. It is associated with high mortality. The majority HAP patients present with some constellation of cough, fever, sputum production, and pleuritic chest pain. Patients with chronic obstructive pulmonary disease (COPD) and cystic fibrosis are at increased risk for pneumonia. The Infectious Disease Society of America requires infiltrates on chest x-ray or other imaging for the diagnosis of pneumonia. For hospitalized patients, empiric antimicrobial therapy for HAP should be given as soon as pneumonia is highly suspected. There is currently a vaccine available against Streptococcus pneumonia that all patients should be offered before discharge from the hospital. The elderly are already more susceptible to HAP due to decreased mobility and increased comorbidities.

Giant hiatus hernia presenting as a chronic cough masking a sinister diagnosis

2020 ◽  
Vol 13 (12) ◽  
pp. e235802
Author(s):  
Navin Mukundu Nagesh ◽  
Dixon Osilli ◽  
David Khoo
Keyword(s):  
Ct Scan ◽  
Hiatus Hernia ◽  
Incidental Finding ◽  
Polypoid Lesion ◽  
Cardiac Complications ◽  
Lifestyle Modifications ◽  
Invasive Adenocarcinoma ◽  
Hospital Acquired Infection ◽  
History Of ◽  
Hospital Acquired

We present a case of an 82-year-old gentleman with an 18-month history of productive cough. Urgent CT scan of the thorax revealed type 1 hiatus hernia (HH). The patient was managed conservatively with lifestyle modifications to help his reflux symptomology. The patient subsequently presented with acute shortness of breath and vomiting. Repeat CT scan reported a giant incarcerated HH (15 cm). Endoscopy revealed an incidental finding of a 3 cm polypoid lesion in the oesophagus at the level of the carina and histology of biopsies reported an invasive adenocarcinoma. During admission, the patient unfortunately had a hospital acquired infection and cardiac complications which prevented surgical intervention. Patients with suspected HH should be investigated thoroughly with imaging studies including chest X-ray, CT or MRI alongside oesophageal manometry and gastroscopy. Endoscopic evaluation is particularly important as these patients are at higher risk of Barrett’s oesophagus and invasive malignancy.

Severe Back Pain and a History of Tuberculosis

2000 ◽  
Vol 35 (4) ◽  
pp. 45-48
Author(s):  
David S. Bromet ◽  
Amy Pope-Harman ◽  
Thomas P. Archer ◽  
Ernest L Mazzaferri
Keyword(s):  
Back Pain ◽  
History Of ◽  
Severe Back Pain

scholarly journals Liver Cirrhosis and Diabetes Mellitus Are Risk Factors forStaphylococcus aureusInfection in Patients with Healthcare-Associated or Hospital-Acquired Pneumonia

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Huang-Pin Wu ◽  
Chien-Ming Chu ◽  
Chun-Yao Lin ◽  
Chung-Chieh Yu ◽  
Chung-Ching Hua ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Liver Cirrhosis ◽  
Empiric Antibiotic Therapy ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
History Of ◽  
Hospital Acquired Pneumonia ◽  
Healthcare Associated ◽  
Hospital Acquired

Background.The risk factors forStaphylococcus aureus(S. aureus) pneumonia are not fully identified. The aim of this work was to find out the clinical characteristics associated withS. aureusinfection in patients with healthcare-associated pneumonia (HCAP) and hospital-acquired pneumonia (HAP), which may be applicable for more appropriate selection of empiric antibiotic therapy.Methods.From July 2007 to June 2010, patients who were admitted to the intensive care unit with severe HCAP/HAP and severe sepsis were enrolled in this study. Lower respiratory tract sample was semiquantitatively cultured. Initial broad-spectrum antibiotics were chosen by Taiwan or American guidelines for pneumonia management. Standard bundle therapies were provided to all patients according to the guidelines of the Surviving Sepsis Campaign.Results.The most frequently isolated pathogens werePseudomonas aeruginosa,S. aureus,Acinetobacter baumannii,Klebsiella pneumoniae, andEscherichia coli. Patients with positive isolation ofS. aureusin culture had significantly higher history of liver cirrhosis and diabetes mellitus, with odds ratios of 3.098 and 1.899, respectively. TheS. aureuspneumonia was not correlated with history of chronic obstructive pulmonary disease, hypertension, and hemodialysis.Conclusion.Liver cirrhosis and diabetes mellitus may be risk factors forS. aureusinfection in patients with severe HCAP or HAP.

A Rare Case of Spinal Leprosy Mimicking Spinal Tuberculosis

2019 ◽  
pp. 33
Author(s):  
K Thuraikumar ◽  
V Naveen ◽  
Mustaqim A ◽  
Arieff AA ◽  
K Shri ◽  
...  
Keyword(s):  
Back Pain ◽  
Soft Tissue ◽  
Histopathological Examination ◽  
Posterior Instrumentation ◽  
Spinal Tuberculosis ◽  
Previous History ◽  
Skin Lesions ◽  
Titanium Implants ◽  
Paravertebral Abscess ◽  
History Of

Introduction: Spinal tuberculosis is the most common manifestation of extrapulmonar y tuberculosis. A combination of leprosy and tuberculosis is a rare entity.Case report: A 44-year-old male patient working as a laborer presented to our hospital with complaints of severe back pain and swelling over the back, difficulty in walking, associated with constitutional symptoms. On admission, he was febrile and had leukocytosis. Initial spine X-ray showed end plate destruction and increase in soft tissue shadow at the level of T8-T9. CT spine revealed thoracic paravertebral collection extending from T7 to T9 levels, suggest ive of tuberculous spondylitis with cold abscess. Patient refused a transpedicular biopsy and was started on anti-tubercular therapy. Two weeks after commencement of treatment, he developed worsening back pain and weakness of the lower extremities. MRI spine showed a paravertebral abscess and posterior soft tissue edema involving level of T7 to T11. Patient underwent a posterior decompression, debridement and posterior instrumentation. He was discharged well, there was improvement of his lower limb power. Upon clinic review, he complained of multiple hyperpigmented, painless, nonpruritic skin lesions over the trunk and back. No previous history of eczema, psoriasis and Tinea corporis. Given the history of allergy, initial impression was hypersensitivity reaction towards the titanium implants, and he was started on anti-histamines. However, there was no improvements seen. Histopathological examination of skin lesions revealed presence of granuloma within the dermis layer, composed of epitheloid, histiocytes, lymphocytes and plasma cells. Wade-Fite stain for Mycobacterium leprae is positive. Slit skin smear shows multibacillary leprosy. Patient was started on multidrug therapy (rifampicin, clofazimine and dapsone) for 1 year. He has recovered well.International Journal of Human and Health Sciences Supplementary Issue: 2019 Page: 33

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