Abstract Current diagnostic workup of patients with suspected acute pulmonary embolism (PE) usually starts with the assessment of clinical pretest probability, using clinical prediction rules and plasma D-dimer measurement. Although an accurate diagnosis of acute pulmonary embolism (PE) in patients is thus of crucial importance, the diagnostic management of suspected PE is still challenging. A 60-year-old man with chest pain and expectoration of blood was admitted to the Department of Cardiology, General Hospital in Cuprija, Serbia. After physical examination and laboratory analyses, the diagnosis of Right side pleuropne monia and acute pulmonary embolism was established. Clinically, patient was hemodynamically stable, auscultative slightly weaker respiratory sound right basal, without pretibial edema. Laboratory: C-reactive protein (CRP) 132.9 mg/L, Leukocytes (Le) 18.9x109/L, Erythrocytes (Er) 3.23x1012/L, Haemoglobin (Hgb) 113 g/L, Platelets (Plt) 79x109/L, D-dimer 35.2. On the third day after admission, D-dimer was increased and platelet count was decreased (Plt up to 62x109/L). According to Wells’ rules, score was 2.5 (without symptoms on admission), a normal clinical finding with clinical manifestation of hemoptysis and chest pain, which represents the intermediate level of clinical probability of PE. After the recidive of PE, Wells’ score was 6.5. In summary, this study suggests that Wells’ score, based on a patient’s risk for pulmonary embolism, is a valuable guidance for decision-making in combination with knowledge and experience of clinicians. Clinicians should use validated clinical prediction rules to estimate pretest probability in patients in whom acute PE is being consiered.
Leukemia is a neoplastic disorder of the blood forming tissues, primarily affecting leukocytes. This is heterogeneous group of diseases, which occurs from a neoplastic proliferation in the bone marrow. The replacement of normal bone marrow elements by leukemic cells causes decreased production of erythrocytes, normal white blood cells and platelets. The clinical result is anemia with weakness, fatigue, pallor of skin and mucosal membranes; thrombocytopenia with associated bleeding tendencies and leucopenia resulting in increased susceptibility to infection. Leukemia is of special interest to the dentists because he is frequently the first person to whom the patient turns for treatment. Dental procedures such as oral surgery, periodontal treatment, or even prophylaxis that produced trauma to the tissue may aggravate the situation and give rise to exacerbations of acute symptoms, which can result in death. Primarily, oral clinical manifestations may be consisting of gingivitis, gingival hyperplasia, hemorrhage, petechiae, erosion ulceration and necrosis of the gingiva and mucosa. The aim of this article is to evaluate the oral signs and symptoms of leukemia and present a clinical case, 59-old female with oral and extra-oral manifestation, as an initial signs of the disease.
'White coat' hypertension is a transitory increase of the blood pressure in children and adults that is manifested in the presence of the medical doctor. The disorder is predominantly manifested in children whereas in adults appears to be significantly rare. It is considered that 20% of hypertension cases in children have white coat hypertension. The exact cause of white coat hypertension has remained established. Possible etiological factors are the following: heredity, psychological stress, type of a personality. The disorder is of usually mild clinical manifestations. The disorder has a tendency to evolve into sustained hypertension. The complications of the disorder can be presented as 'target organ damage'. Gold standard for diagnosis is 24/h ambulatory blood pressure monitoring. Drug therapy is usually unnecessary because, instead, the monitoring is advised over a longer period for timely diagnosis of persistent hypertension, which should be actively treated.
Abstract Prevalence of cognitive disorders is high in maintenance hemodialysis patients. Montreal cognitive assessment (MoCA) is used for detecting and evaluation of cognitive disorder degree in this patient population. In examined patient population, only 5 (12.5%) of them had normal cognitive function (MoCA ≥26). Mild cognitive impairment (MoCA 18-26) was found in 65.9% (29) patients, while moderate cognitive disorder (MoCA 10-17) was detected in 6 (21.6%) patients. Major cognitive disorder wasn’t detected in examined population. Statistically significant correlation was not established between laboratory parameters and overall MoCA score. Statistically significant correlation, however, was established between MoCA item that evaluates space and time orientation and intermediate secondary hyperparathyroidism and space and time orientation and severe secondary hyperparathyroidism. Hemodynamic instability during hemodialysis and silent ischemia of the brain are increasing risk of appearance of cognitive disorders in maintenance hemodialysis patients.
Abstract Prevalence of cognitive disorders is high in maintenance hemodialysis patients. Montreal cognitive assessment (MoCA) is used for detecting and evaluation of cognitive disorder degree in this patient population. In examined patient population, only 5 (12.5%) of them had normal cognitive function (MoCA ≥26). Mild cognitive impairment (MoCA 18-26) was found in 65.9% (29) patients, while moderate cognitive disorder (MoCA 10-17) was detected in 6 (21.6%) patients. Major cognitive disorder wasn’t detected in examined population. Statistically signifi cant correlation was not established between laboratory parameters and overall MoCA score. Statistically signifi cant correlation, however, was established between MoCA item that evaluates space and time orientation and intermediate secondary hyperparathyroidism and space and time orientation and severe secondary hyperparathyroidism. Hemodynamic instability during hemodialysis and silent ischemia of the brain are increasing risk of appearance of cognitive disorders in maintenance hemodialysis patients.