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

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

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

Tinea capitis profunda with secondary bacterial infection

Tinea capitis is a mycotic infection of the scalp, which primarily affects children. It is caused by different infectious agents, in Slovenia most common being Microsporum canis

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

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