Pub Date : 2019-10-31DOI: 10.46619/joccr.2019.2-1048
Moustaide K, A. N, Gallouj S, Mernissi Fz
Clear cell acanthoma is an uncommon type of benign epithelial tumor. Typically, it is a solitary lesion found on the lower limbs. It presents as a nodule or small plaque with slow and well-defined growth. Diagnosis used to be clinical and histopathological, but the advent of dermoscopy has led to an increase in diagnostic accuracy. We describe a case in which dermoscopy proved highly useful for diagnosis of the lesion.
{"title":"Dermoscopic features of Clear Cell Acanthoma: A Case Report and Review of the Literature","authors":"Moustaide K, A. N, Gallouj S, Mernissi Fz","doi":"10.46619/joccr.2019.2-1048","DOIUrl":"https://doi.org/10.46619/joccr.2019.2-1048","url":null,"abstract":"Clear cell acanthoma is an uncommon type of benign epithelial tumor. Typically, it is a solitary lesion found on the lower limbs. It presents as a nodule or small plaque with slow and well-defined growth. Diagnosis used to be clinical and histopathological, but the advent of dermoscopy has led to an increase in diagnostic accuracy. We describe a case in which dermoscopy proved highly useful for diagnosis of the lesion.","PeriodicalId":73665,"journal":{"name":"Journal of clinical cases & reports","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85279966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-31DOI: 10.46619/joccr.2019.2-1050
Bittmann S, Villalon G, Weissenstein A, Luchter E
The abuse of benzodiazepines by pregnant women can cause intoxication in the neonate. Benzodiazepines can diffuse readily across the placenta to the fetus because of their high lipid solubility. After the sixth month of pregnancy, the loss of the cytotrophoblasts from the placenta further facilitates the transport of benzodiazepines across the placenta. They may persist for at least a week in pharmacologically active concentrations after administration of high dosages to the mother. We report about a floppy, drowsy and pulmonary impaired newborn delivered in the 36th week of gestation. The mother was a regular user of clorazepate, a long-acting benzodiazepine during pregnancy.
{"title":"Benzodiazepine Intoxication in a Neonate by Maternal Use in Pregnancy","authors":"Bittmann S, Villalon G, Weissenstein A, Luchter E","doi":"10.46619/joccr.2019.2-1050","DOIUrl":"https://doi.org/10.46619/joccr.2019.2-1050","url":null,"abstract":"The abuse of benzodiazepines by pregnant women can cause intoxication in the neonate. Benzodiazepines can diffuse readily across the placenta to the fetus because of their high lipid solubility. After the sixth month of pregnancy, the loss of the cytotrophoblasts from the placenta further facilitates the transport of benzodiazepines across the placenta. They may persist for at least a week in pharmacologically active concentrations after administration of high dosages to the mother. We report about a floppy, drowsy and pulmonary impaired newborn delivered in the 36th week of gestation. The mother was a regular user of clorazepate, a long-acting benzodiazepine during pregnancy.","PeriodicalId":73665,"journal":{"name":"Journal of clinical cases & reports","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76973084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-30DOI: 10.46619/joccr.2019.2-1043
Ahuja Varun
Artificial intelligence (AI) is a branch of computer science that deals with the development of algorithms that seek to simulate human intelligence. The phrase “artificial intelligence” was likely coined during a conference at Dartmouth College in 1956. The earliest work of medical AI dates back to the early 1970s. Over years, AI has found implications in various fields. In this article, we summarize its applications in drug discovery and medicine.
{"title":"Artificial Intelligence (AI) in Drug Discovery and Medicine","authors":"Ahuja Varun","doi":"10.46619/joccr.2019.2-1043","DOIUrl":"https://doi.org/10.46619/joccr.2019.2-1043","url":null,"abstract":"Artificial intelligence (AI) is a branch of computer science that deals with the development of algorithms that seek to simulate human intelligence. The phrase “artificial intelligence” was likely coined during a conference at Dartmouth College in 1956. The earliest work of medical AI dates back to the early 1970s. Over years, AI has found implications in various fields. In this article, we summarize its applications in drug discovery and medicine.","PeriodicalId":73665,"journal":{"name":"Journal of clinical cases & reports","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86670373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-30DOI: 10.46619/joccr.2019.2-1045
Begum Rabea, Anwar Mohammad
Background: Knee Osteoarthritis is the most common joint disorder and one of the leading causes of disability. The main symptoms associated with osteoarthritis are pain, discomfort, limitation of activity and reduced participation. Physiotherapy management is evidence-based treatment approach that have short-term and long-term effect on reducing pain, improve muscle strength and function. Aim: The aim of this study was to find out evidence-based physiotherapy in patient with knee osteoarthritis through three tract reasoning on reducing pain, improve muscle strength and function. Method: A case-based study was conducted. The three tract reasoning: procedural, interactive and conditional were used during diagnosis and in management of knee osteoarthritis. Results: The patient respond well in physiotherapy treatment. The swelling was 100% reduced, reduced pain in VAS from 8/10 to 1/10, improved muscle strength by oxford muscle grading scale by grade V, weight bearing is more (90%) and only 25% remain limitation in functionally from 69%. Conclusion: Knee osteoarthritis is frequent musculoskeletal condition that affect person’s activities and restricted the participation. Using clinical reasoning physiotherapist diagnosed and managed the symptoms. After receiving physiotherapy treatment improved the patient’s status of health.
背景:膝骨关节炎是最常见的关节疾病，也是致残的主要原因之一。与骨关节炎相关的主要症状是疼痛、不适、活动受限和参与减少。物理治疗管理是一种循证治疗方法，对减轻疼痛、改善肌肉力量和功能有短期和长期的效果。目的:通过三道推理，探讨循证物理治疗对膝关节骨性关节炎患者减轻疼痛、改善肌力和功能的作用。方法:采用个案研究方法。在膝关节骨关节炎的诊断和治疗中应用程序性、互动性和条件性三道推理。结果:患者对物理治疗反应良好。肿胀减轻100%，VAS评分从8/10降至1/10，根据牛津肌肉分级量表(oxford muscle grading scale by grade V)，肌肉力量得到改善，负重增加(90%)，功能限制从69%降至25%。结论:膝关节骨性关节炎是一种影响人的活动，限制其参与的常见肌肉骨骼疾病。物理治疗师运用临床推理对症状进行诊断和处理。接受物理治疗后，患者的健康状况得到改善。
{"title":"Physiotherapy Management in Patient with Knee Osteoarthritis through Three Tract Reasoning: A Case Report","authors":"Begum Rabea, Anwar Mohammad","doi":"10.46619/joccr.2019.2-1045","DOIUrl":"https://doi.org/10.46619/joccr.2019.2-1045","url":null,"abstract":"Background: Knee Osteoarthritis is the most common joint disorder and one of the leading causes of disability. The main symptoms associated with osteoarthritis are pain, discomfort, limitation of activity and reduced participation. Physiotherapy management is evidence-based treatment approach that have short-term and long-term effect on reducing pain, improve muscle strength and function. Aim: The aim of this study was to find out evidence-based physiotherapy in patient with knee osteoarthritis through three tract reasoning on reducing pain, improve muscle strength and function. Method: A case-based study was conducted. The three tract reasoning: procedural, interactive and conditional were used during diagnosis and in management of knee osteoarthritis. Results: The patient respond well in physiotherapy treatment. The swelling was 100% reduced, reduced pain in VAS from 8/10 to 1/10, improved muscle strength by oxford muscle grading scale by grade V, weight bearing is more (90%) and only 25% remain limitation in functionally from 69%. Conclusion: Knee osteoarthritis is frequent musculoskeletal condition that affect person’s activities and restricted the participation. Using clinical reasoning physiotherapist diagnosed and managed the symptoms. After receiving physiotherapy treatment improved the patient’s status of health.","PeriodicalId":73665,"journal":{"name":"Journal of clinical cases & reports","volume":"257 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79119926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-30DOI: 10.46619/joccr.2019.2-1042
A. Emmanuel, A. U. Akpan, Ohwonigho Collins Adjekuko, E. Obeagu
Background/Objectives: Erythrocyte indices constitute important parameters useful in clinical care of children. Analysis of erythrocyte indices for children in IDP (Internally Displaced People) camps in Adamawa State like in most states in Nigeria was not fully studied. Therefore, this study aims to analyze the erythrocyte indices of children in Fufore IDP camp in Yola. Materials and Methods: This study enrolled 297 children (137 females and 160 males) in the camp with age range of 12 to 61 months old and 201 apparently healthy school children as control group. 3ml of blood were collected from children and transferred into K3-EDTA vacutainer tubes. Full blood count was determined within four hours of blood collection using the Sysmex XP300 hematological analyzer. Results: Mean erythrocyte count of subjects and control was 3.1 ± 0.7 X109/l and 4.3 ± 0.7 X109/l respectively at P<0.05 and red cell distribution width (RDW) of subjects was 16.9% while that of control was 13.5%. Hemoglobin level of subject and control was 9.7 ± 1.1 g/dl and 12.4 ± 1.3 g/dl respectively. The mean Pack Cell Volume (PCV) of subjects was 32.7 ± 0.3% while the PCV of control group was 37.0 ± 0.2%. The Mean Cell Volume (MCV) of subject and control group was 74.8 ± 0.6 fl and 81 ± 0.5 fl respectively while Mean Cell Hemoglobin (MCH) of the control and subject group was 26.9 ± 0.9 pg and 27 ± 0.4 pg respectively at P<0.05. Conclusion: Children in IDP camp had lower RBC count, PCV, MCV, Hemoglobin values and higher RDW value than the control group at P<0.05. Hence microcytic and iron deficiency anemia was observed among children in Fufore IDP camp in Yola.
{"title":"Analysis of Erythrocyte Indices of Children in Internally Displaced People Camp of Yola, Northeast Nigeria","authors":"A. Emmanuel, A. U. Akpan, Ohwonigho Collins Adjekuko, E. Obeagu","doi":"10.46619/joccr.2019.2-1042","DOIUrl":"https://doi.org/10.46619/joccr.2019.2-1042","url":null,"abstract":"Background/Objectives: Erythrocyte indices constitute important parameters useful in clinical care of children. Analysis of erythrocyte indices for children in IDP (Internally Displaced People) camps in Adamawa State like in most states in Nigeria was not fully studied. Therefore, this study aims to analyze the erythrocyte indices of children in Fufore IDP camp in Yola. Materials and Methods: This study enrolled 297 children (137 females and 160 males) in the camp with age range of 12 to 61 months old and 201 apparently healthy school children as control group. 3ml of blood were collected from children and transferred into K3-EDTA vacutainer tubes. Full blood count was determined within four hours of blood collection using the Sysmex XP300 hematological analyzer. Results: Mean erythrocyte count of subjects and control was 3.1 ± 0.7 X109/l and 4.3 ± 0.7 X109/l respectively at P<0.05 and red cell distribution width (RDW) of subjects was 16.9% while that of control was 13.5%. Hemoglobin level of subject and control was 9.7 ± 1.1 g/dl and 12.4 ± 1.3 g/dl respectively. The mean Pack Cell Volume (PCV) of subjects was 32.7 ± 0.3% while the PCV of control group was 37.0 ± 0.2%. The Mean Cell Volume (MCV) of subject and control group was 74.8 ± 0.6 fl and 81 ± 0.5 fl respectively while Mean Cell Hemoglobin (MCH) of the control and subject group was 26.9 ± 0.9 pg and 27 ± 0.4 pg respectively at P<0.05. Conclusion: Children in IDP camp had lower RBC count, PCV, MCV, Hemoglobin values and higher RDW value than the control group at P<0.05. Hence microcytic and iron deficiency anemia was observed among children in Fufore IDP camp in Yola.","PeriodicalId":73665,"journal":{"name":"Journal of clinical cases & reports","volume":"60 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79333175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-30DOI: 10.46619/joccr.2019.2-1040
Jose Carvalho Ramos Alexandre
With the spread of yoga, meditation, and other Eastern spiritual practices in Western countries, clinical cases of “physio kundalini syndrome” have begun to emerge. In this article I presented a case that, despite having common elements with a psychotic disorder, can be considered a typical clinical case of awakening of kundalini, since the patient was apparently able to solve his health problems without any medical intervention and says he is perfectly integrated into the community.
{"title":"Physio Kundalini Syndrome: A Case Report","authors":"Jose Carvalho Ramos Alexandre","doi":"10.46619/joccr.2019.2-1040","DOIUrl":"https://doi.org/10.46619/joccr.2019.2-1040","url":null,"abstract":"With the spread of yoga, meditation, and other Eastern spiritual practices in Western countries, clinical cases of “physio kundalini syndrome” have begun to emerge. In this article I presented a case that, despite having common elements with a psychotic disorder, can be considered a typical clinical case of awakening of kundalini, since the patient was apparently able to solve his health problems without any medical intervention and says he is perfectly integrated into the community.","PeriodicalId":73665,"journal":{"name":"Journal of clinical cases & reports","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75071694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-30DOI: 10.46619/joccr.2019.2-1039
Shamima Nur Nusrat, Hasan Bin Rakib Kabirul
A 21-year-old lady who is previously diagnosed as a case of Schizophrenia, 4 years back, with positive symptoms such as delusion, hallucination. She has prescribed with risperidone 4 mg and she is compliant to drug. Currently she is on full remission for 1 year. She is under treatment with Risperidon, 4 mg. This lady has some complaints of obsessions such as aggressive impulses and pathological doubt which is followed by some compulsions such as avoidance and checking rituals for last 3 years. She has complained of having some experiences such as doing something embarrassing and these experiences are truly intrusive, unwanted and senseless to her. This currently remitted Schizophrenic patient has good insight now. She has a marked improvement in her daily activities as well as sociability.
{"title":"A Case Report of Obsessive-Compulsive Disorder and Complete Remission of Schizophrenia","authors":"Shamima Nur Nusrat, Hasan Bin Rakib Kabirul","doi":"10.46619/joccr.2019.2-1039","DOIUrl":"https://doi.org/10.46619/joccr.2019.2-1039","url":null,"abstract":"A 21-year-old lady who is previously diagnosed as a case of Schizophrenia, 4 years back, with positive symptoms such as delusion, hallucination. She has prescribed with risperidone 4 mg and she is compliant to drug. Currently she is on full remission for 1 year. She is under treatment with Risperidon, 4 mg. This lady has some complaints of obsessions such as aggressive impulses and pathological doubt which is followed by some compulsions such as avoidance and checking rituals for last 3 years. She has complained of having some experiences such as doing something embarrassing and these experiences are truly intrusive, unwanted and senseless to her. This currently remitted Schizophrenic patient has good insight now. She has a marked improvement in her daily activities as well as sociability.","PeriodicalId":73665,"journal":{"name":"Journal of clinical cases & reports","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80531979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-30DOI: 10.46619/joccr.2019.2-1034
Imran Muhammad
Early neurological deterioration is a well-established complication of an acute ischaemic stroke, however late deterioration is an uncommon finding and could be very challenging to diagnose and treat in timely manner. I report a case of an 82-year-old male who had suffered a stroke 28 years earlier and was functionally performing very well afterwards and living independently. This patient was presented to Worcestershire Hospital with signs and symptoms consistent with Urinary Tract Infection diagnosis. He was treated with Trimethoprim and his clinical condition improved significantly. While awaiting for his social rehab he suddenly developed dysphonia and dysphagia, along with mixed upper and lower motor neuron lesion signs consistent with a posterior circulation stroke. He was investigated extensively and MRI spine ruled out any spinal cord compression however MRI head revealed old infarcts in left parietal lobe, cerebellar region and thalamic area (no acute changes). Surprisingly MRI head also shown global atrophic change with significant atrophy of midbrain in comparison to the pons (Hummingbird sign) which rose suspicion of progressive supranuclear palsy. Initially patient was treated for acute stroke as per stroke team advice however patient was later reviewed by neurologist who explained that symptoms were attributed due to neurological decompensation of chronic infarcts (left parietal, thalamic, cerebellar) exacerbated by acute infection. Progressive Supranuclear Palsy was also excluded based on sudden onset of symptoms as compared to gradual onset of actual disease. His neurological symptoms improved slowly, but the dysphagia and dysphonia persisted. The risk of aspiration pre-empted the insertion of a percutaneous endoscopic gastrostomy (PEG) for feeding before he was discharged for rehabilitation.
{"title":"Neurological Decompensation of an Old Ischaemic Stroke following Infection","authors":"Imran Muhammad","doi":"10.46619/joccr.2019.2-1034","DOIUrl":"https://doi.org/10.46619/joccr.2019.2-1034","url":null,"abstract":"Early neurological deterioration is a well-established complication of an acute ischaemic stroke, however late deterioration is an uncommon finding and could be very challenging to diagnose and treat in timely manner. I report a case of an 82-year-old male who had suffered a stroke 28 years earlier and was functionally performing very well afterwards and living independently. This patient was presented to Worcestershire Hospital with signs and symptoms consistent with Urinary Tract Infection diagnosis. He was treated with Trimethoprim and his clinical condition improved significantly. While awaiting for his social rehab he suddenly developed dysphonia and dysphagia, along with mixed upper and lower motor neuron lesion signs consistent with a posterior circulation stroke. He was investigated extensively and MRI spine ruled out any spinal cord compression however MRI head revealed old infarcts in left parietal lobe, cerebellar region and thalamic area (no acute changes). Surprisingly MRI head also shown global atrophic change with significant atrophy of midbrain in comparison to the pons (Hummingbird sign) which rose suspicion of progressive supranuclear palsy. Initially patient was treated for acute stroke as per stroke team advice however patient was later reviewed by neurologist who explained that symptoms were attributed due to neurological decompensation of chronic infarcts (left parietal, thalamic, cerebellar) exacerbated by acute infection. Progressive Supranuclear Palsy was also excluded based on sudden onset of symptoms as compared to gradual onset of actual disease. His neurological symptoms improved slowly, but the dysphagia and dysphonia persisted. The risk of aspiration pre-empted the insertion of a percutaneous endoscopic gastrostomy (PEG) for feeding before he was discharged for rehabilitation.","PeriodicalId":73665,"journal":{"name":"Journal of clinical cases & reports","volume":"54 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87605002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-30DOI: 10.46619/joccr.2019.2-1037
L. Daniel, Landis Michael, Trieu Becca
While typically a disease of younger men, seminomas do occasionally occur beyond the age of 70. There is less clarity on the treatment for men in this age range. Herein we describe a case of a man in his 80s with aggressive disease, review available literature, and highlight the challenges of treatment men in this age range.
{"title":"Seminomas in the Elderly: A Rare Situation but a Challenging Problem","authors":"L. Daniel, Landis Michael, Trieu Becca","doi":"10.46619/joccr.2019.2-1037","DOIUrl":"https://doi.org/10.46619/joccr.2019.2-1037","url":null,"abstract":"While typically a disease of younger men, seminomas do occasionally occur beyond the age of 70. There is less clarity on the treatment for men in this age range. Herein we describe a case of a man in his 80s with aggressive disease, review available literature, and highlight the challenges of treatment men in this age range.","PeriodicalId":73665,"journal":{"name":"Journal of clinical cases & reports","volume":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90197454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-30DOI: 10.46619/joccr.2019.2-1038
N. Haia, F. Nakhoul, Nasser Susan, M. Jerdev, Zaid Said Abo, S. Soboh, N. Boshra, N. Wael
Background and Objective: Urinary tract infection is the most common bacterial infection in the pediatric population.The upper urinary tract infection involves the kidney parenchyma and may cause scarring and permanent damage that will proceed to cause hypertension and decreased kidney function. Almost third of cases will relapse following the first infection in one year. There are different imaging techniques that can help to detect children at risk for future infections, kidney scarring or other systemic complications. The Ultrasonography of bladder and kidneys: is a relatively cheap, non-invasive and fast test that enables to find children with anatomical anomalies that can be corrected to avoid future infections or complications. Also, this test does not pose the risk of radiation exposure. Voiding cystourethrogram: is the test of choice to establish the presence of vesicoureteral reflux that is a major risk factor for future infections and scaring. This test has a radiation exposure risk, it is invasive and relatively complex to perform. DMSA scintigraphy test: may be performed to determine acute pyelonephritis or to investigate kidney scarring. This test has a greater radiation exposure risk. But it cannot distinguish between dysplasia of a kidney or scarring. With the development and improvement of the imaging capabilities of Doppler ultrasonography, we can measure the Resistive Index, which is a sonographic value to assess the kidney function. The normal value of the resistive index is 0.6 and the normal upper limit is 0.7. The increase in this value is related to kidney artery stenosis, extreme hypertension, infants, and intrinsic kidney disease. Importance: In this work, we want to measure if the Resistive Index can predict kidney scarring. Participants: We followed after 71 cases of kids from 0 to 11 years old that was admitted to our hospital Baruch Padeh Medical Center, Poriya, in the diagnosis of Urinary tract infection.71 children participated in the full evaluation. 56 children were under 2 years of age, 8 were aged 2 to 4 years, and 7 were over 5 years or older; 18 were males and 53 were females. Design: The diagnosis was made on the base of clinical presentation, laboratory blood analysis, urinary analysis, and urinary cultures. We measured the Resistive index in all of these patients. And they did the ordinary US of kidney parenchyma, the DMSA study and a cystography by the accepted protocols of our department. Settings: All patients underwent Doppler within 72 hours of hospitalization. Before our conclusions, we divided the patients in the study by their age. Main outcome: In the first group under 2 years old, we found a moderate correlation between the RI and DMSA study. And there was a strong correlation between RI and cystography .In the second group above 4 years, we found a strong correlation between RI both to DMSA and cystography. Results: In all the age groups we examined there is a strong correlation between RI and po
{"title":"Resistive Index (RI) in Febrile Urinary Tract Infection: New Predictive Value","authors":"N. Haia, F. Nakhoul, Nasser Susan, M. Jerdev, Zaid Said Abo, S. Soboh, N. Boshra, N. Wael","doi":"10.46619/joccr.2019.2-1038","DOIUrl":"https://doi.org/10.46619/joccr.2019.2-1038","url":null,"abstract":"Background and Objective: Urinary tract infection is the most common bacterial infection in the pediatric population.The upper urinary tract infection involves the kidney parenchyma and may cause scarring and permanent damage that will proceed to cause hypertension and decreased kidney function. Almost third of cases will relapse following the first infection in one year. There are different imaging techniques that can help to detect children at risk for future infections, kidney scarring or other systemic complications. The Ultrasonography of bladder and kidneys: is a relatively cheap, non-invasive and fast test that enables to find children with anatomical anomalies that can be corrected to avoid future infections or complications. Also, this test does not pose the risk of radiation exposure. Voiding cystourethrogram: is the test of choice to establish the presence of vesicoureteral reflux that is a major risk factor for future infections and scaring. This test has a radiation exposure risk, it is invasive and relatively complex to perform. DMSA scintigraphy test: may be performed to determine acute pyelonephritis or to investigate kidney scarring. This test has a greater radiation exposure risk. But it cannot distinguish between dysplasia of a kidney or scarring. With the development and improvement of the imaging capabilities of Doppler ultrasonography, we can measure the Resistive Index, which is a sonographic value to assess the kidney function. The normal value of the resistive index is 0.6 and the normal upper limit is 0.7. The increase in this value is related to kidney artery stenosis, extreme hypertension, infants, and intrinsic kidney disease. Importance: In this work, we want to measure if the Resistive Index can predict kidney scarring. Participants: We followed after 71 cases of kids from 0 to 11 years old that was admitted to our hospital Baruch Padeh Medical Center, Poriya, in the diagnosis of Urinary tract infection.71 children participated in the full evaluation. 56 children were under 2 years of age, 8 were aged 2 to 4 years, and 7 were over 5 years or older; 18 were males and 53 were females. Design: The diagnosis was made on the base of clinical presentation, laboratory blood analysis, urinary analysis, and urinary cultures. We measured the Resistive index in all of these patients. And they did the ordinary US of kidney parenchyma, the DMSA study and a cystography by the accepted protocols of our department. Settings: All patients underwent Doppler within 72 hours of hospitalization. Before our conclusions, we divided the patients in the study by their age. Main outcome: In the first group under 2 years old, we found a moderate correlation between the RI and DMSA study. And there was a strong correlation between RI and cystography .In the second group above 4 years, we found a strong correlation between RI both to DMSA and cystography. Results: In all the age groups we examined there is a strong correlation between RI and po","PeriodicalId":73665,"journal":{"name":"Journal of clinical cases & reports","volume":"227 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80158654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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