Srp Ark Celok Lek
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Beta-hemolytic group A streptococcus (Streptococcus pyogenes) is the most common bacterial agent associated with the upper respiratory tract infections in humans. The most frequently group A streptococcus-associated disease is pharyngitis. Males and females are equally affected by group A streptococcus. ⋯ Overall congruence of rapid test and culture was 94%. Test is easy to perform and it is recommended as the first diagnostic test for management of children with streptococcal pharyngitis. In children with negative test, but with characteristics highly suggestive of streptococcal infection, throat culture should be performed.
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The management of idiopathic nephrotic syndrome (INS) in children includes immunosuppressive and symptomatic treatment. The response to corticosteroid therapy is the best prognostic marker of the disease. The majority of children with INS (about 85%) are steroid-sensitive as they normalize proteinuria within 4 weeks of daily, oral prednisone administration. ⋯ At present, there is no consensus on therapeutic regimen for steroid-resistant patients. The following immunosuppressive drugs have been used with varying success: cyclosporine, intravenous methyl prednisone pulses alone or combined with or followed by alkylating agents, plasma-exchange, and angiotensin-converting enzyme (ACE) inhibitors. Symptomatic treatment includes: 1) dietary regimen with normal protein intake and salt restriction, 2) calcium and vitamin D are prescribed with steroids, 3) diuretics should be used in case of severe edema, 4) infusion of albumin in case of severe hypovolemia, 5) treatment of hypertension, 6) anticoagulant therapy, and 7) prophylactic antibiotics in high-risk patients.
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Abdominal aortic aneurysm can be repaired by elective procedure while asymptomatic, or immediately when it is complicated--mostly due to rupture. Treating abdominal aneurysm electively, before it becomes urgent, has medical and economical reason. Today, the first month mortality after elective operations of the abdominal aorta aneurysm is less than 3%; on the other hand, significant mortality (25%-70%) has been recorded in patients operated immediately because of rupture of the abdominal aneurysm. In addition, the costs of elective surgical treatment are significantly lower. ⋯ It is interesting that endarterectomy, myocardial revascularization or malignancy after repair of the abdominal aneurysm (ruptured or non-ruptured) had no effect on long-term survival.
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Clinical Trial
[Evaluation of the long term effect of mitoxantrone on neurological disability in patients with active multiple sclerosis].
Several in vivo and in vitro studies showed that mitoxantrone (MTX), a novel anthracendione antineoplastic agent, had an immunomodulatory effect that suppressed humoral immunity, reduced T-cell numbers, lessened helper activity, enhanced suppressor function and had some positive effect on acute and chronic experimental allergic encephalomyelitis in rats. Up to now, several trials of therapy with MTX have been performed in patients with multiple sclerosis (MS). MTX has been recently shown to reduce disease activity, as expressed by reducing relapse rate and decreasing new, active MRI lesions, in a selected group of patients with active relapsing-remitting (RR) MS. ⋯ Cardiotoxicity was not registered. Our findings further support the notion that mitoxantrone reduces neurological disability in active relapsing and secondary progressive multiple sclerosis patients. However, follow-up suggests that this effect slowly subsides after discontinuation of therapy, implying the need for prolongation of such treatment (up to 120 mg/m2) for a period as long as possible.
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Subarachnoidal hemorrhage (SAH) is the fourth most common intracranial cause of death. Approximately 50 to 85 percent of non-traumatic SAH is caused by rupture of congenital berry aneurysm. Symptoms of rupture are typically sudden and without any heralds. In most SAH cases, the vasospasm following the rupture is the most probable cause of death. In forensic pathology, an isolated SAH episode after minor head trauma should be considered dubious, and as mode of death. ⋯ Sometimes, it is not possible to detect the exact localization of the ruptured berry aneurysm: the rupture may destroy the aneurysm completely. In such case, an autopsy should rule out other possible sources of intracranial bleeding, such as vascular malformations, intraventricular spreading of intracerebral hematomas, neoplasia, hematological disorders, etc.