Folia medica
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Review Case Reports
Severe throat pain in patients with negative oropharyngeal examination: four case reports and overview of the literature.
Throat pain is one of the most frequent complaints prompting patient visits to healthcare professionals. Primary care physicians being the first contact point are frequently encountered with symptoms such as sore throat and odynophagia. ⋯ This case series highlights the necessity for a high level of suspicion on the part of the primary care physicians when facing patients complaining of severe throat pain since their symptoms may indicate conditions such as supraglottitis, lingual tonsillitis or pemphigus vulgaris. A careful clinical examination, including an indirect laryngoscopy, is required especially when the initial oropharyngeal examination is normal.
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Salivary alpha-amylase is a useful biomarker that can be used in assessing human psychobiological and social behavioural processes. Studying it opens up possibilities for the creation of novel concepts concerning the interaction of biological and social processes and their impact on health and behaviour. ⋯ The adapted version of the State-Trait Anxiety Inventory score (STAI) created by Spielberger is appropriate for assessment of stress-related anxiety in young individuals. Salivary alpha-amylase may be used as a biomarker for objective evaluation of the psychosomatic state of individuals in a stressful environment. The combination of psychological test and objective indicator such as salivary alpha-amylase is an excellent tool for objective evaluation of individual's state in stressful environment. Similar tests may be used in assessment of patients' behaviours at dental treatment that may be considered a stressor in most patients.
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Review
Ventilator-associated pneumonias in children (I)--diagnostic criteria, etiology and pathogenesis.
Ventilator-associated pneumonias have been estimated to be the second most common nosocomial infections among children treated in intensive care units. They occur in mechanically ventilated patients through intubation tube or tracheostomy, the inflammation usually involving the lung parenchyma. The ventilator-associated pneumonia is associated with a longer antibiotic treatment, greater duration of mechanical ventilation (MV) and higher mortality rates in children. ⋯ The disease etiology is associated with the typical causes of nosocomial infections in this age: P. aeruginosa, E. coli and K. pneumoniae. The pathogenesis of the condition is inadequately studied but the aspiration of gastric contents and immune deficiency are proven risk factors. Two mechanisms have a major role in the development of the disease--micro-aspiration of gastric contents and colonization of the lower airways with pathogens.
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Spontaneous spinal epidural hematoma is a rare disorder. We present a case of a 55-year-old man who was awakened by severe pain in the neck and shoulders and inability to move his arms and legs. He was admitted to the clinic as an emergency. His physical status showed no abnormalities. The local status presented with roughly expressed cervical vertebral syndrome. Neurological examination found quadriplegia of acute onset. Distal parahypesthesia with sensory level at the nipples was found. The patient suffered urine retention. Laboratory blood tests showed no coagulation disorder. Spiral computed tomography of the cervical region was performed. The CT image revealed a muff-shaped acute epidural hematoma around the cervical dural membrane with lower thickness on the right side and levels from C2 to C4. Emergency right-sided hemilaminectomy of C3 vertebra was performed. A hard blood clot forming acute epidural hematoma was removed. The patient recovered completely for ten days after the surgery. ⋯ In sudden occurrence of neck pain associated with neurological deficit in the arms spontaneous cervical epidural hematoma should be suspected. Spiral scanner and magnetic resonance are imaging techniques of choice in these patients. The favorable outcome of the disease depends on the prompt diagnosis and emergency removal of the hematoma.
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Comparative Study
Optical coherence tomography for the detection of early macular edema in diabetic patients with retinopathy.
To compare the retinal thickness measurements with spectral-domain optical coherence tomography (OCT) in healthy subjects with those of type 2 diabetes patients with or without diabetic retinopathy (DR) and with no clinical evidence of diabetic macular edema (DME). ⋯ In the present study, mean retinal thickness was greater in diabetic patients (with and without DR) than in healthy subjects. Patients with DR had thicker retinas than patients without DR. Spectral-domain OCT seemed to be useful for the detection of early DME in patients with retinopathy and no clinical evidence of macular edema. Patients with early DME should have a closer follow-up