Faculty of Medicine
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Item type:Publication, Osteoarticular involvement in childhood brucellosis: experience with 133 cases in an endemic region(Wolters Kluwer/Lippincott, 2013-08); ; ; Aim: To describe the main clinical and laboratory characteristics, frequency and distribution of osteoarticular involvement, therapeutic options and outcome in children with osteoarticular brucellosis. Methods: This descriptive study includes 133 pediatric patients with osteoarticular brucellosis who were treated at the University Clinic for Infectious Diseases and Febrile Conditions in Skopje, Republic of Macedonia, during the period between 1989 and 2011. Brucellosis was presumptively diagnosed on the basis of clinical signs and confirmed by the detection of specific antibodies at significant titers. Results: The median age of patients was 9 years (range, 2-14 years) and 63.9% were males. Family history of brucellosis was present in 54.1%. The dominant clinical symptoms were arthralgia and fever in 77.4% and 73.7%, respectively, and the dominant sign was hepatomegaly in 73.7% of patients. The main laboratory abnormalities were elevated C-reactive protein (81.0%) and circulating immunocomplexes (80.7%). In 71.4% of patients, the osteoarticular involvement was monoarticular. Hip arthritis was present in 49.6%, followed by the knee in 30.1%. Various therapeutic regimens with a duration of 6 weeks were used. In 87 patients during a follow-up of at least 6 months, relapse occurred in 13.8%. Conclusions: Osteoarticular involvement is frequent in children with brucellosis. It is most often manifested with monoarthritis of the large weight-bearing joints. Brucellosis should be included in the differential diagnosis of childhood arthritis in endemic countries, especially in the presence of family history, contact with infected animals or ingestion of unpasteurized food products, fever and hepatomegaly. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, ПРИКАЗ НА СЛУЧАЈ: ТРЕТМАН СО ЕМБОЛИЗАЦИЈА НА ХЕМАТОМ ВО ПРАВИОТ СТОМАЧЕН МУСКУЛ КАЈ ПАЦИЕНТ СО КОВИД-19 A CASE REPORT: EMBOLIZATION TREATMENT OF RECTUS SHEATH HEMATOMA IN A COVID-19 PATIENT(Македонско лекарско друштво = Macedonian Medical Association, 2022-10); ; Introduction. In this case report we present a patient with COVID-19 pneumonia and rectus sheath hematoma (RSH) treated with embolization. Methods. A 63-year-old man positive for SARS-CoV- 2 presented with cough, fever and dyspnea to our Clinic. The patient was admitted and treated with oxygen, antibiotics, corticosteroid, anticoagulant and oral antiplatelet therapy. Thirteen days after admission the patient had severe abdominal pain, the CT scan confirmed left rectus sheath hematoma and he underwent a CT angiography with embolization of the left inferior epigastric artery. Ten days after embolization the patient recovered completely and was discharged. Result. SARS-CoV-2 infection is associated with coagulopathy, hence the anticoagulant therapy. The main side effect of anticoagulant therapy is an increased risk of bleeding. A rare complication of anticoagulant therapy is rectus sheath hematoma. The treatment is usually conservative with intravenous fluids, pain medication, discontinuation of anticoagulant therapy, and blood transfusion in cases of severe anemia. The computed tomography is the most common method to establish or confirm the diagnosis. Еmbolization of bleeding vessels can be performed in large RSH with hemodynamic instability and/or with evidence of active bleeding. Conclusion. Inpatient treatment of COVID-19 pneumonia includes anticoagulant agents, but clinicians must carefully monitor their possible side effects and suspect a rectus sheath hematoma in patients with abdominal pain and palpable mass. Those with clinically relevant rectus sheath hematoma that do not respond to supportive care can be successfully treated using embolization, thus avoiding invasive surgical approach. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Osteoarticular Involvement in Childhood Brucellosis(Wolters Kluwer/Lippincott, 2013-08); ; ;