Pulmonary embolism during pregnancy: How to avoid computed tomographic pulmonary angiography?

Pregnancy and the postpartum period are well-established risk factors for venous thromboembolism (VTE). Computed tomographic pulmonary angiography (CTPA) remains the gold standard in the diagnosis of pulmonary embolism (PE), but exposure to teratogenic factors should be avoided in pregnant women. A few years ago the YEARS algorithm was developed, primarily to determine the need for CTPA

Look under the sheets – a case report of diabetic foot

     Diabetic foot is a long-term complication of diabetes mellitus that results directly from peripheral arterial disease or sensory neuropathy affecting the feet in diabetes mellitus. Diabetic foot is rare, but potentially lethal complication associated with the diabetes. The management of diabetic foot infections requires assessing the microbial etiology, attentive wound management, good nutrition, antimicrobial therapy and glycemic control. In several clinical circumstances, surgical resection is preferable.     A 65-year-old patient with 2-month necrosis of the second toe of the left foot and recurrent fever is presented. Diabetic foot developed. Citrobacter koseri was isolated from bone cultures. Intravenous treatment with amoxicillin + clavulanic acid and metronidazole was administered for 2 weeks and the wound was poorly recovered. After a surgical consultation, the patient was qualified for the amputation of the second toe of the left foot

Cystic Fibrosis - Related Diabetes

Cystic fibrosis (CF) is life-shortening autosomal recessive disease, caused by mutations in the cystic fibrosis transmembrane conductance regulator protein. The most common of CF complications is cystic fibrosis-related diabetes (CFRD). The pathophysiology of CFRD is complex. The best test for screening and diagnosis of CFRD is the oral glucose tolerance test (OGTT). Insulin therapy is a treatment of choice in CFDR pharmacotherapy. An inseparable element of CFRD therapy is also physical activity and diet

Neuroleptic malignant syndrome – a case report

Neuroleptic malignant syndrome (NMS) is rare, but potentially lethal complication associated with the use of neuroleptic agents. NMS is most often observed after high-potency first-generation neuroleptic agents. NMS is characterised by a distinctive clinical syndrome including: hyperthermia, muscular rigidity, mental status change, autonomic disability. The most common laboratory finding is elevated serum CK. The management of patients with NMS demands aggressive care and discontinuing of the causative agent. A 49-year-old patient with recurrent depressive disorders is presented. NMS developed following the increase in haloperidol dose and concomitant use of olanzapine. The treatment with bromocriptine and lorazepam resulted in a prompt recovery

Hyperkalemia - a review article

Introduction: Potassium is critical cation in physiological functions. Hyperkalemia is a common electrolyte disorder, defined as potassium level above 5,5 mmol/L. Knowledge of the basic rules of hyperkalemia management is crucial to every doctor. Purpose: Systemic review of causes, symptoms and treatment of hyperkalemia. Material and methods: Standard criteria were used to review the literature data. The search of articles in the PubMed database was carried out. Description of the state of knowledge: The causes of hyperkalemia are different and mostly result from impaired urinary potassium excretion due to acute or chronic kidney disease. The symptoms of hyperkalemia vary and usually affect skeletal muscles, myocardium and central nervous system. Treatment of hyperkalemia depends on the presence or absence of symptoms, the severity of potassium elevation and the cause of hyperkalemia. Therefore, management with the patient with hyperkalemia includes careful interview, evaluation of clinical symptoms, ECG and searching for possible causes of disorders. Summary: Hyperkalemia requires urgent therapeutic intervention. In each case of elevated potassium concentration ECG should be performed and the obtained laboratory result should be verified. The crucial point in hyperkalemia treatment is the shift of potassium to the cells and simultaneously the removal of potassium from the body

Sodium-glucose co-transporter 2 inhibitors – a review article

Antihyperglycemic interventions have centered on increasing insulin availability, improving insulin sensitivity or restoring β-cell activity to normalize plasma glucose levels in patients with type 2 diabetes mellitus. An alternative strategy is to enhance urinary glucose excretion by targeting renal sodium-glucose co-transporters (SGLTs). Sodium-glucose co-transporter 2 (SGLT2) inhibitors reduce blood glucose by increasing urinary glucose excretion and present a valuable therapeutic option for the treatment of type 2 diabetes. Presently, clinically available SGLT2 inhibitors include canagliflozin, dapagliflozin and empagliflozin

Cervical tubercular lymphadenitis accompanying with pulmonary tuberculosis – a case report

Tuberculosis (TB) is still one of the major public health problems worldwide. TB is an infectious disease caused by Mycobacterium tuberculosis. It typically affects the lungs (pulmonary tuberculosis), but may also occur in other sites (extrapulmonary tuberculosis). Cervical tubercular lymphadenitis is one of the most common localizations of extrapulmonary tuberculosis [1,2]. We present a case of a 57-year old man with a history of 3-month weakness and swollen, bilaterally inflamed cervical lymph nodes. Cervical tubercular lymphadenitis accompanying with pulmonary tuberculosis was diagnosed. Moreover, we carry out the differential diagnosis of the cervical lymphadenopathy

Acute hypersensitivity pneumonitis associated with mushroom worker’s lung – a case report

Hypersensitivity pneumonitis (HP), also known as extrinsic allergic alveolitis is a non-IgE mediated allergic reaction to inhalation of an allergen. There are more than 200 allergens known to cause this condition, but the list of antigens responsible for the development of HP is constantly expanded. Dangerous agents are usually inhaled at the workplace, so we may distinguish the following patients at risk of HP: farmers, pigeon breeders, mushroom workers, cheese employees or even malt workers. Mushroom worker's lung (MWL) has been described in workers exposed to mushroom spores or to inhaled antigens from compost (mostly thermophilic actinomycetes)

The correlation of mutations and expressions of genes within the PI3K/Akt/mTOR pathway in breast cancer : a preliminary study

There is an urgent need to seek new molecular biomarkers helpful in diagnosing and treating breast cancer. In this elaboration, we performed a molecular analysis of mutations and expression of genes within the PI3K/Akt/mTOR pathway in patients with ductal breast cancer of various malignancy levels. We recognized significant correlations between the expression levels of the studied genes. We also performed a bioinformatics analysis of the data available on the international database TCGA and compared them with our own research. Studies on mutations and expression of genes were conducted using High-Resolution Melt PCR (HRM-PCR), Allele-Specific-quantitative PCR (ASP-qPCR), Real-Time PCR molecular methods in a group of women with ductal breast cancer. Bioinformatics analysis was carried out using web source Ualcan and bc-GenExMiner. In the studied group of women, it was observed that the prevalence of mutations in the studied PIK3CA and AKT1 genes was 29.63%. It was stated that the average expression level of the PIK3CA, PIK3R1, PTEN genes in the group of breast cancer patients is lower in comparison to the control group, while the average expression level of the AKT1 and mTOR genes in the studied group was higher in comparison to the control group. It was also indicated that in the group of patients with mutations in the area of the PIK3CA and AKT1 genes, the PIK3CA gene expression level is statistically significantly lower than in the group without mutations. According to our knowledge, we demonstrate, for the first time, that there is a very strong positive correlation between the levels of AKT1 and mTOR gene expression in the case of patients with mutations and without mutations

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