SN Comprehensive Clinical Medicine最新文献

For better understanding the relationship between stress-related hormone and probable sleep bruxism (SB), we compared the serum level of cortisol in patients with SB and healthy individuals. Thirty-nine patients with self-reported probable SB were compared to 40 age and sex matched healthy volunteers. All participants were examined and assessed using a two‐part questionnaire including Hamilton’s Anxiety Scale (HAM-A) and Perceived Stress Scale (PSS). Morning serum cortisol level was evaluated by chemiluminescent immunoassay. Data were analyzed by SPSS software using Mann–Whitney, Wilcoxon, and paired-sample t test. The mean serum cortisol level in SB group (12.70 ± 4.90 µg/dl) was slightly higher than healthy individuals (11.3 ± 43.42 µg/dl), but the two groups did not show a significant difference (P = 0.184). PSS mean scores were not significantly different, but HAM-A scale was significantly higher in SB group (19.13 ± 8.70) than in healthy individuals (6.80 ± 4.87). Higher anxiety scores could be better correlated with SB than morning serum cortisol levels and stress.

Psoas abscess is the accumulation of fluid around the iliopsoas muscle. Pott’s spine also called spinal tuberculosis occurs due to extra pulmonary tuberculosis. Common clinical manifestations include high grade fever, back pain, weight loss and lump in groin. Condition can be treated by anti-tubercular therapy and sensitive anti-microbials with analgesics for symptomatic relief. Drainage and surgical procedures can be carried out to remove the accumulated fluid based on inter individual severity. In this case study, we report a rare case of psoas abscess with Pott’s spine. A 28-year female presented with complaints of lump pain in groin, abdominal pain, flank pain, fever and weight loss. Medical history showed untreated tuberculosis since 5–6 months. MRI pelvis showed right psoas abscess measuring approximately 7 cm × 6.5 cm × 14 cm while MRI Dorso-lumbar spine showed Pott’s spine. The drainage clearance procedure was performed, and patient was prescribed with anti-tuberculous and anti-microbial drugs during hospitalization. On discharge, patient’s condition was improved. The condition is rare. Pott’s spine, if not diagnosed early, may delay the prognosis and cause psoas abscess, so it must be treated in time to reduce morbidity and mortality. Follow-up is essential to prevent the relapse of extra-pulmonary tuberculosis.

The double aortic arch is an extremely rare vascular malformation that can be a cause of wheezing episodes and dysphagia in a young child. Depending on the extent of airway compression, anaesthesia management varies. Our patient was a 10-month-old boy with recurrent wheezing and choking episodes. The trachea and oesophagus were compressed by the double aortic arch, and the baby was posted for surgical division of the non-dominant aortic arch. The anaesthesia management is often difficult owing to the airway compression. The anaesthesia management varies from maintaining spontaneous breathing during induction and careful selection of an appropriate endotracheal tube based on the tracheal dimensions to requiring tracheal reconstruction procedures to manage the tracheal stenosis. Intraoperative surgical management depends on the identification of the dominant aortic arch from arterial pressure changes of upper and lower limbs and the repair of associated intra-cardiac defects. We report one such case with a successful outcome. Three-dimensional computed tomography images are attached for a clear understanding of the anatomy. Vascular rings are known, but rare causes of wheezing and choking episodes in a child, which requires careful planning of anaesthesia for a good outcome.

Following decongestive therapy in patients with acute heart failure, it has been observed that there is an increase in the QRS amplitude in the bipolar limb leads on the surface electrocardiogram (ECG). We wanted to study this phenomenon to identify any markers of improvements in heart failure. Patients with atrial flutter, atrial fibrillation, implanted permanent pacemaker, acute coronary syndrome and those treated with sodium nitroprusside were excluded. Net fluid loss over the course of diuresis was calculated as fluid lost-fluid administered. All patients had two standard 12-lead ECGs recorded at admission prior to starting diuresis and after conclusion of therapy which was at discharge. There were 59 patients. All were treated with decongestive therapy and observed over a period of 8 ± 3.2 days. The urine output following therapy was similar in both groups of patients. The left ventricular internal diameter in diastole (LVIDd) and left ventricular internal diameter in systole (LVIDs) were less in the group with increase in QRS amplitude (Group 2) compared to the group who did not show change in QRS amplitude (Group 1), 4.4 (pm) 0.8 cm vs 4.9 (pm) 0.8 cm, p = 0.036, and 3.1 (pm) 0.5 cm vs 3.7 (pm) 1.0 cm, p = 0.002. The ratio between the peak velocity blood flow in early (E wave) and late diastole (A wave) in group 2 was 1.2 (pm) 0.7 compared to 1.7 (pm) 1.0 in group 1, p = 0.087. The deceleration time (DT) was higher by 45.2 (pm) 21.5 ms in group 2 compared to group 1 with no change in QRS amplitude, p = 0.04. Following decongestive therapy in a group of patients with heart failure, the QRS amplitude reflected in the limb leads improved significantly from pre-treatment values in the patients with less LV remodelling in terms of LV dilatation and LV diastolic dysfunction.

Epilepsy is a common neurological disorder, characterized by predisposition to generate epileptic seizures. Clinical manifestations are heterogeneous, and neuroimaging plays a crucial role in the diagnosis and management of this condition. Magnetic resonance imaging is the imaging modality of choice to study epilepsy, and numerous advanced techniques have been introduced to study this condition and give new insights into its pathophysiology. The aim of this narrative review is to describe the newest advanced imaging techniques used to study epilepsy.

We present a case of non-hereditary hemorrhagic telangiectasia (HHT) arteriovenous malformation (AVM) epistaxis in a young healthy patient, causing life-threatening bleeding with successful embolization. We report a case of a 33-year-old healthy male with massive epistaxis. A noninvasive intervention failed to treat the bleeding. Following procedure with electronic cauterization was not sufficient. At last, after a multidisciplinary Concilium, diagnostic catheterization of an AVM with embolization was successfully done. The case highlights an unusual AVM that causes epistaxis and a possible collaborative multidisciplinary management.