Community- acquired pneumonia: a case report

INTRODUCTION Community-acquired pneumonia (CAP) is an acute lower respiratory tract infection in a patient who has acquired the infection in the community. Patients typically present with fever, dyspnea, productive cough and pleuritic chest pain. On physical examination tachypnea, auscultatory rales, increased tactile fremitus and purulent sputum are present. Most common pathogens are Streptococcus pneumoniae, Haemophilus influenza and Moraxella catarrhalis. Streptococcus pneumoniae is the causative organism for up to 2/3 of all CAP. With clinical suspicion of pneumonia full blood count, urea, electrolytes and CRP should be tested. Chest x-ray typically shows lobar infiltrates. Sputum can be microbiologically tested to identify the pathogen. Supportive therapy as well as antibiotic therapy according to national guidelines is advised. CASE PRESENTATION A previously healthy 45-year old male presents to the outpatient department due to fever, cough and malaise for 2 days. On physical examination his vitals are: blood pressure 140/70 mmHg, heart rate 80/min, oxygen saturation 96%, body temperature 38 °C, breathing frequency 24/min. On auscultation rales are heard over the right lower lobe. His laboratory results show leukocytosis with elevated CRP. Chest x-ray is performed and a consolidation is seen in the right lower lobe. He is prescribed amoxicillin 500-1000 mg/8 h per os for 7-10 days. CONCLUSION CAP is one of the most common infectious diseases and is associated with considerable morbidity and mortality, particularly in elderly patients and those with significant comorbidities. The most common pathogen is Streptococcus pneumoniae. Antibiotic therapy is usually started empirically

Reverse arthroplasty - alternative to conventional surgical methods in communitive proximal humerus fracture and severe rotator cuff tear.

INTRODUCTION The reverse shoulder arthroplasty is a type of shoulder replacement in which the normal ball and socket relationship of glenohumeral joint is reversed, creating a more stable joint with a fixed fulcrum. It was developed as a potential solution in response to the cases which could not be managed effectively with a conventional shoulder arthroplasty. The most common post-surgical complication is instability. CASE REPORT This case report includes two patients that had undergone this type of arthroplasty. The first patient was admitted after suffering a comminuted proximal humerus fracture. The second patient suffered a total rotator cuff tear. Both of our patients had severely restricted mobility and pain in the shoulder prior to the procedure and reverse arthroplasty was considered to give the best results. After the surgery they started with physical rehabilitation for several weeks. We noticed considerable improvement in range of motion and reduced pain compared to the condition before the surgery. CONCLUSION Reverse shoulder arthroplasty is utilized in cases in which conventional shoulder replacement surgery would result in poor outcomes and high failure rates. The most common such cases are massive rotator cuff tear, shoulder fractures and failed prior shoulder replacement procedures. Indications continue to expand and the number of prostheses implanted is rapidly growing

Plaque and guttate psoriasis in a child treated with biological therapy

INTRODUCTION Psoriasis is a chronic inflammatory disease, which is predominantly characterized by erythematosquamous lesions. Treatment depends on patient’s age, disease severity and localization, and can extend from topical therapy and phototherapy to systemic treatment with immunosuppressive or biologic drugs. CASE REPORT A 4-year-old girl came to our dermatologic clinic due to erythematosquamous plaques on her scalp, limbs and trunk, which first appeared a few weeks before. Her father was treated for psoriasis with biological therapy. The girl’s skin lesions were also typical for psoriasis, nails and joints were not affected. Therapy with corticosteroid creams and appropriate skin care were advised. She had regular check-ups, where we observed her symptoms worsening. We decided to start immunosuppressant therapy with methotrexate, which greatly improved her skin. After decreasing the doses and discontinuation of systemic treatment after two years, her condition remained stable. She noted occasional partial regressions of the lesions, which were treated with topical corticosteroids and immunomodulators. However, after about a year, a generalized deterioration of the disease was visible, including lesions typical for inverse psoriasis. We prescribed biologic therapy with adalimumab, which she still receives every two weeks along with additional local therapy when needed. The treatment is successful, at her recent check-up the skin lesions were still in regression. CONCLUSION The use of biological therapy for psoriasis in children in Slovenia is rare, however, it is an effective option in case of moderate to severe symptoms, which have not been relieved by other types of treatment

Deep vein thrombosis: a case report

INTRODUCTION Deep vein thrombosis (DVT) is an obstruction of the vein caused by thrombus. It most commonly occurs is the deep veins of the lower extremity. DVT is divided into distal and proximal vein thrombosis. Symptoms of DVT include warmth, swelling, pain and erythema of the involved extremity. Risk factors are old age, pregnancy, synthetic estrogen, trauma, surgery, past DVT, cancer, obesity, immobility and thrombophilia. Wells score evaluates the likelihood of DVT. D-dimer assay should be routinely performed. It has a negative predictive value for GVT. Ultrasound evaluation is recommended for patients with likely DVT according to the Wells score or a positive D-dimer assay. Treat with low molecular weight heparin (LMWH) immediately. Start warfarin simultaneously with LMWH for 3-6 months. CASE PRESENTATION 80-year old female presents to the outpatient department due to a week of right leg swelling with calf tenderness. She denies having any difficulties breathing. Her regular therapy consists of antihypertensive drugs. On physical examination her vitals are: blood pressure 140/80 mmHg, heart rate 80/min, oxygen saturation 98 %, body temperature 36,5 °. Right calf is warm and painful on palpation. Her Wells score is 3. There is no D-dimer assay available in the outpatient department. She is urgently referred to the nearby hospital for further evaluation. CONCLUSION Proximal vein thrombosis is most commonly associated with the development of pulmonary embolism (PE). PE is a medical emergency. Anticoagulant therapy is indicated for patients with DVT, since PE will occur in 50 % of untreated individuals

Case report: Kidney stone disease in emergency care ambulance

Kidney stones can affect any part of urinary tract . It is an urological disorder affecting about 2- 5% of worldwide population, more common in countrys with high standard. It is the most commonly appeared in people between the ages of 18 nad 45 years. The disease affects male more frequently then female. Passing kidney stones is usually painful. A 63-year-old man, diagnosed with previous kidney stones episode, came to our ER office due to severe pain in the right side and back bellow the ribs. The pain was coming in waves and fluctuates in intensity. He also had some pain on urination. He denied fever. In clinical examination he was afebrile, eupnoic, the lung sound were clear, the abdomen was soft but painful on palpation on both sides also palpation of the back was painful. We gave him tramadol 50 mg, ketoprofen 100 mg and tiethyperazine 6,5 mg in 100 mL in saline for pain intravenously. Blood sample did not show infection also urine sample was normal. Naproxen 500 mg two times daily was prescribed. After 2 day she experienced severe pain again, but it was localised in lower abdomen and radiated in groin, he had very painful urination. He visited emergency care office again, we gave him ketoprofen 100 mg, trospium 5 mg and tramadol 5 mg in 100 mL of saline intravenously. It released the pain His urin sample showed an urinary tract infection. His CRP level was 30.We prescribed him Ciprofloksacin 1000 mg daily. In diferential diagnosis of kidney stone disease we always have to think on urinary tract infection, which can also be a complication of the disease

Reconstruction and postoperative physical rehabilitation of noncontact anterior cruciate ligamentum injury from rollerblading

The anterior cruciate ligament functions as a primary restraint to excessive anterior translation and rotation of the tibia on the femur; thus a complete ACL tear normally results in dynamic knee instability or failure to manage quick changes in position. Physical therapy is necessary for optimal rehabilitation whether the treatment is surgical or only conservative. CASE PRESENTATION A 29-year old healthy male presented with 24h-lasting acute pain in the knee after hearing a »pop« while rollerblading. The following morning he was unable to extend the knee fully or bear weight when walking. There was no previous history of knee injury or degenerative joint disease. The physical exam presented mild joint effusion, limitation of range of motion and pain upon palpation. Surgery was performed using a graft from the patellar ligament with the superior part of the patella. After the procedure, he started physical therapy with an emphasis on the range of motion training with the use of continuous passive motion device and weight-bearing exercises. CONCLUSION The knee is one of the joints that are most susceptible to ligament injuries, as it is located in the middle of two large lever arms. The decision for surgical reconstruction versus conservative treatment is an ongoing subject of debate. Surgery is usually the treatment of choice for professional athletes. With the implementation of post-surgical physical therapy, the result is complete recovery with normal knee function and a full range of motion in only 60-80% of cases

Molecular and morphological characterization of Dothiorella species associated with dieback of Ostrya carpinifolia in Slovenia and Italy

Isolates that resemble Dothiorella (Botryosphaeriaceae, Ascomycota) species were isolated from dead twigs, asymptomatic and necrotized bark of European hop hornbeam (Ostrya carpinifolia Scop.), Eurasian smoke tree (Cotinus coggygria Scop.) and common juniper (Juniperus communis L.) growing in western Slovenia and northern Italy. They were identified based on anamorph morphology and phylogenetic analyses of the ITS rDNA and EF-1α sequences, and previously designated as Dothiorella sp. A, B and C. This study has clarified the identity of these species by comparing them with other Dothiorella species known from culture based on gene sequence data, as well as morphological characters of the anamorphs. The phylogenetic results revealed three species, Dothiorella iberica, Dothiorella parva, and a Dothiorella sp. Isolates identified in the phylogenetic analyses as D. parva differed from the original description of this species and are thus described here based on the anamorph morphology. Isolates of D. parva were identified from O. carpinifolia in western Slovenia and northern Italy, and C. coggygria in western Slovenia, and coexist with Dothiorella sp. on O. carpinifolia in northern Italy. Dothiorella iberica was identified on J. communis in western Slovenia, thus expanding the geographic range of this species. This is the first record of D. parva from these hosts and countries. Our results indicate that these Dothiorella species occur widely across the Mediterranean region, and on a variety of hosts

Molecular and morphological characterization of Dothiorella species associated with dieback of Ostrya carpinifolia in Slovenia and Italy

Isolates that resemble Dothiorella (Botryosphaeriaceae, Ascomycota) species were isolated from dead twigs, asymptomatic and necrotized bark of European hop hornbeam (Ostrya carpinifolia Scop.), Eurasian smoke tree (Cotinus coggygria Scop.) and common juniper (Juniperus communis L.) growing in western Slovenia and northern Italy. They were identified based on anamorph morphology and phylogenetic analyses of the ITS rDNA and EF-1α sequences, and previously designated as Dothiorella sp. A, B and C. This study has clarified the identity of these species by comparing them with other Dothiorella species known from culture based on gene sequence data, as well as morphological characters of the anamorphs. The phylogenetic results revealed three species, Dothiorella iberica, Dothiorella parva, and a Dothiorella sp. Isolates identified in the phylogenetic analyses as D. parva differed from the original description of this species and are thus described here based on the anamorph morphology. Isolates of D. parva were identified from O. carpinifolia in western Slovenia and northern Italy, and C. coggygria in western Slovenia, and coexist with Dothiorella sp. on O. carpinifolia in northern Italy. Dothiorella iberica was identified on J. communis in western Slovenia, thus expanding the geographic range of this species. This is the first record of D. parva from these hosts and countries. Our results indicate that these Dothiorella species occur widely across the Mediterranean region, and on a variety of hosts.This study was financed by the Slovenian Research Agency (research program P4-0107) and the Ministry of Agriculture and the Environment of Republic of Slovenia (Public Forestry Service). Molecular and morphological studies were carried out in laboratories of the Forestry and Agricultural Biotechnology Institute (FABI), the University of Pretoria, South Africa and funded by the DST/NRF Centre of Excellence in Tree Health Biotechnology.http://www.fupress.com/pmam2016Forestry and Agricultural Biotechnology Institute (FABI)GeneticsMicrobiology and Plant Patholog