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A 20-year-old man presented to the emergency department with a sore throat and general malaise for 2 days. On evaluation, an incidental bifurcated uvula was noted without any acute oropharyngeal abnormalities ([figure 1][1]). He reported the bifurcated uvula was likely congenital as his parents

Background- Chronic pancreatitis is the primary life-threatening nutritional & metabolic condition of gastrointestinal system that becomes a significant threat to the children's growth and induces educational loss due to recurrent hospitalization. Its mortality rate in childhood is up to 10 %. Malnutrition is one of the primary causes of pancreatitis in children. Modern science provides various types of medical and surgical therapies for Chronic pancreatitis, but it is realized that more research is needed for its management satisfactorily. Aim - To study the efficacy of Ayurvedic management of chronic pancreatitis induced due to Malnutrition in an adolescent girl. Material & Methods- It is a single case study of 12 years old teenage girl who was presented herself predominantly with pain in the epi-gastric region (recurrent attacks-especially after intake of the fatty or heavy meal), tenderness in the epi-gastric area, loss of appetite, fever on and off, general malaise, loss of weight, constipation (intermittent), anxious & uncomfortable mental irritation since one & half month. After taking conservative treatment from modern science for one & a half months, she did not get satisfactory relief & therefore; she was advised to under ERCP. However, the patient & her relative was not willing to undergo the same, that’s they approached Panchakarma OPD. After examination, she was advised for Shodhana(Panchtikta & Guduchyadi Niruha Vasti) & Shaman Chikitsa(Amruttotara Kashayam, Arogyavardhini Vati, Kumariasava; Dhanvantara Kashayam, Avipattikar Churna), Panchatikta Ghrita with Vasant Kusumakar Rasa- 10tab+Guduchi Satva- 20gm + Shatavari Churna- 15gm+ Ashwagandha Choorna-15 gm with honey. Observation & Results- After 16 months of regular treatment, the patient has become entirely symptom-free & to date, there was no need for hospitalization. There was no educational loss due to ill-health. Discussion:-Utilizing the basic concepts of Ayurveda(Nidanpanchaka), Jirna Jwarahara, Yakrutottejak, Pramehaghna, or pancreatic-protective, Mrudu Virechak, Bruhana (Shamana & Bruhana Snehapana), Rasayana Chikitsa was planned in this case which showed the promising result. Conclusion- Ayurvedic management with Shodhana & Shamana Chikitsa based on the fundamentals of Ayurveda is effective in Chronic pancreatitis induced due to Malnutrition in children, which may become a ray of hope for pediatric patients.

SARS CoV-2 se transmite principalmente a través de la vía aérea. La media del tiempo desde la exposición hasta la presentación de la sintomatología es de 5 días. Los pacientes infectados pueden permanecer asintomáticos o tener un amplio espectro de manifestaciones como: fiebre, tos seca y malestar general. Aproximadamente, el 20% de pacientes con la COVID-19 requiere hospitalización (10% en área general, el 5% requiere cuidados intermedios y el 5% restante ingresa a cuidados intensivos debido a su estado de gravedad). Los exámenes de laboratorio y radiológicos muestran anomalías de común presentación, pero inespecíficas. El diagnóstico es a través de la prueba de reacción en cadena de polimerasa de transcripción inversa cuando detecta SARS CoV-2. El objetivo de la revisión que se presenta es sintetizar elementos importantes relacionados con la fisiolopatología, manifestaciones clínicas y diagnóstico de la COVID-19.

A 77-year-old man with ischemic cardiomyopathy, severely reduced left ventricular function, and biventricular defibrillator for primary prevention received catheter ablation for multiple ventricular tachycardia despite amiodarone treatment. A few weeks later, the patient presented with unspecific symptoms such as general malaise and nausea.

Bone sarcoidosis is usually considered a rare manifestation of multisystemic sarcoidosis. With the growing use of more sensitive imaging techniques, such as 18F-FDG PET, the detection rate of bone involvement seems to be increasing. We describe the case of a woman presenting with fatigue and general malaise having multiple bone lesions on 18F-FDG PET. A broad range of differential diagnoses was considered, including malignancy, infections, metabolic diseases and primary bone tumours, which may have delayed the diagnosis. Diagnostic work-up eventually led to an anatomopathological diagnosis of bone sarcoidosis. Immunosuppressive therapy is often necessary since sarcoid bone lesions - even asymptomatic - generally appear in more extensive forms of the disease with other organ involvement.

Se presenta el caso de un paciente de 45 años que inicio con tos no productiva, malestar general y disnea progresiva, confirmándose el diagnostico COVID-19 severo con respuesta favorable al tratamiento. En la evolución clínica presentó lesiones tipo papulovesicular pruriginosas que se resolvieron de forma espontánea en el transcurso de las semanas.

A man in his 60s visited a clinic with chief complaints of a fever and general malaise. Suspecting a liver abscess in the left lobe with infiltration into the subcutaneous fat tissue under the rectus abdominis muscle based on computed tomography findings, we performed fine-needle aspiration. An amoebic liver abscess was diagnosed. Remission was achieved by the oral administration of metronidazole alone without placement of a drainage tube. The results obtained in this case suggest that the first line of treatment should be a non-invasive approach with oral administration alone. Invasive intervention should then be considered depending on subsequent progress.

Liver disease in adult horses is commonly identified during investigation of non-specific clinical signs such as general malaise, lethargy or weight loss. In some cases, disease may be advanced and irreversible by the time a diagnosis is reached. Serum biochemistry and tests of liver function form an important part of diagnosing liver disease but provide limited information regarding aetiology, severity and prognosis. Liver biopsy is recommended in the majority of cases to confirm the presence of disease, to guide therapeutics and to provide information regarding prognosis.

Background: Gastrointestinal helminth infections (GHIs) are health problems worldwide. People withGHIs can develop gastrointestinal symptoms, general malaise and weakness, malnutrition, and impairedgrowth and physical development.This study was performed to determine the current prevalence ofGHIs in epidemic areas in northeast Thailand.

A 79‐year‐old woman presented with fever and general malaise. Examination revealed hepatic injury, thrombocytopenia, skin lesions, and regional lymphadenopathy; severe fever with thrombocytopenia syndrome (SFTS) was diagnosed using polymerase chain reaction. The patient developed impaired consciousness that worsened after 4 days. Magnetic resonance imaging of the head revealed a subdural hematoma in the occipital region with an uncertain onset time. As SFTS rarely causes intracranial hemorrhage, the associated risk factors are unknown. Clinicians may overlook potential intracranial hemorrhage in stuporous SFTS patients., We described a rare severe fever with thrombocytopenia (SFTS) case with subdural hematoma. As in this case, there is a possibility that a small amount of intracranial hemorrhage combined with SFTS may be overlooked.

Hypersensitivity pneumonitis (HP) sometimes develops in people working in specific environments. We herein report a case of occupation-related HP in a citrus farmer in Japan. A 66-year-old man developed a fever, dyspnea, and general malaise in March after working near a trash dump filled with moldy tangerines. He presented with leukocytosis, bilateral lung opacities on chest radiographs, and intra-alveolar and interstitial lymphocytic inflammation with fibrotic change on a lung biopsy. His symptoms disappeared after admission and recurred on a revisit to the workplace. Fungal culture and a mycobiome analysis using next-generation sequencing suggested an association with exposure to Penicillium digitatum.

The ability to appreciate an unusual comment or minor abnormality can lead people to the correct diagnosis. General malaise and debility, breathlessness, cyanosis and difficulty with particular movements or an abnormal gait are much more obvious during exercise. The full history of the main complaint or complaints must be recorded in detail, with precise dates. It is important to get right back to the beginning of the problem. When a patient complains of indigestion, for example, it is sensible, after recording the history of the indigestion, to move on at this point to other questions about the alimentary system. Patients are rarely able to make useful guesses at the amount of blood vomited up, and the addition of gastric juice makes questions on the volume of blood vomited of little value. Cardiac pain typically begins in the midline behind the sternum, but may occasionally be experienced in the epigastrium.

Among the symptoms of COVID-19 fever, general malaise, pain and aches, myalgia, fatigue, and headache can affect the quality of life of patients, even after the end of the acute phase of the infection and can be long lasting. The current treatment of these symptoms, also because COVID-19 patients have been asked not to use non-steroidal anti-inflammatory drugs (NSAIDs), in particular ibuprofen are often unsatisfactory. Among the above mentioned symptoms malaise and fatigue seem the most difficult to treat. In this case report we describe the use of kratom (Mitragyna speciosa) by a patient with confirmed COVID-19 infection. What we observed was a fast and sustained relieve of the above mentioned symptoms.

Background Estimating the cumulative prevalence of SARS-COV-2 will help to understand the epidemic, contagion, and immunity to COVID-19 in vulnerable populations. The objective is to determine the extent of infection in the general population and the cumulative incidence by age group. Methods It was carried out with a longitudinal analytical study, in the population of the Lambayeque region, located in the north of Peru. The selection was carried out in multistages (districts, area, household, and finally choosing the interviewee within the house). Seroprevalence was estimated as a positive result of the rapid test whether it was positive IgM or positive IgG. An adjustment was made for the sampling weights used. Results The seroprevalence found in the region was 29.5%. Young people between 21 and 50 years old presented the highest seroprevalence frequencies. A total of 25.4% were asymptomatic. The most frequent complaint was dysgeusia and dysosmia (85.3% and 83.6%). Dysosmia (PR = 1.69), chest pain (PR = 1.49), back pain (PR = 1.45), cough (PR = 1.44), fever (PR = 1.41), general malaise (PR = 1.27) were associated factors with the higher the frequency of seropositivity for SARS-CoV-2. Reporting of complete isolation at home decreased the frequency of positivity (PR = 0.80), however, reporting having ARI contact (PR = 1.60), having contact with a confirmed case (PR = 1.51), and going to market (PR = 1.26) increased the frequency of positivity for SARS-CoV-2. Conclusion These results suggest that Lambayeque is the region with the highest seroprevalence in the world, well above Spain, the United States and similar to a study in India.

A 29-year-old man presented in late summer with a painful great toe on his left foot. The lesion developed within a couple of days starting from redness to swelling and vesiculation. The pain increased causing problems with walking. There was no fever or general malaise. On examination no lymphangitis was evident. His medical history was unremarkable. He had no medical drugs.

A 27-year-old man bearing an erythropoietic protoporphyria (EPP)-associated ferrochelatase (FECH) mutation was admitted to our hospital for general malaise and marked elevation of the serum levels of hepatobiliary enzymes and bilirubin. Initial treatment with plasma exchange did not reduce the blood protoporphyrin or serum liver enzyme levels, so phlebotomy was started. Surprisingly, weekly phlebotomy normalized the serum levels of liver enzymes, accompanied by a marked reduction in the blood protoporphyrin levels. The clinical course of this case strongly suggests that phlebotomy may be a suitable treatment option for EPP-related hepatopathy.

espanolResumen Introduccion La brucelosis es una zoonosis reemergente ampliamente distribuida en el planeta. Produce una alta morbilidad y perdidas sociosanitarias muy cuantiosas en los paises en los que es endemica. Etiopatogenia Producida por coco-bacilos Gram negativos del genero Brucella, del cual existen diferentes especies con hospedadores y patogenicidad propias. B. melitensis, B. abortus y B. suis son las especies mas frecuentes y B. melitensis la mas patogena en seres humanos. Capaz de eludir mecanismos de la respuesta inmune, la infeccion por Brucella tiene tendencia a producir cuadros prolongados, recaidas y complicaciones focales. Espectro clinico y diagnostico Habitualmente la brucelosis se manifiesta como un cuadro febril sin focalidad aparente, de comienzo agudo o subagudo acompanado de escalofrios, sudoracion profusa, artromialgias y malestar general. Aproximadamente, un tercio de los pacientes desarrollara una complicacion focal a lo largo del curso evolutivo de la enfermedad. Por lo inespecifico de su espectro clinico, siempre debe intentarse el diagnostico microbiologico, bien mediante el aislamiento del microorganismo, para lo cual la muestra mas rentable es el hemocultivo, o mediante la demostracion de anticuerpos especificos a titulos significativos o seroconversion. Tratamiento El tratamiento mas eficaz es doxiciclina 100 mg por via oral cada 12 horas durante 6 semanas, junto a estreptomicina las primeras 2 semanas. Aunque algo menos efectiva, por su comodidad, doxiciclina junto con rifampicina 600-900 mg/dia, ambas durante seis semanas, es una buena alternativa. El tratamiento de las complicaciones focales difiere segun la localizacion y gravedad del caso. EnglishIntroduction Brucellosis is a re-emerging zoonosis that is widely distributed around the globe. It causes high morbidity and very substantial social and health losses in the countries in which it is endemic. Aetiopathogenesis Caused by Gram-negative coccobacilli of the Brucella genus, of which there are different species with their own hosts and pathogenicity. B. melitensis, B. abortus and B. suis are the most common species and B. melitensis is the most pathogenic in human beings. Capable of eluding immune response mechanisms, Brucella infection tends to cause prolonged symptoms, relapses and focal complications. Clinical spectrum and diagnosis Brucellosis routinely manifests with a fever of no apparent focus of infection, of acute or subacute onset accompanied by chills, profuse sweating, arthromyalgia and general malaise. Approximately a third of patients will develop a focal complication as the disease progresses. Because its clinical spectrum is so non-specific, microbiological diagnosis must always be attempted, either by isolating the microorganism, haemoculture is the most cost-effective method, or by demonstrating specific antibodies at significant titres or seroconversion. Treatment The most effective treatment is doxycycline p.o. 100 mg every 12 hours for 6 weeks, combined with streptomycin for the first 2 weeks. And for convenience, although somewhat less effective, doxycycline combined with rifampicin 600-900 mg/day, also for six weeks, is a good alternative. The treatment of focal complications varies according to their location and severity.

COVID-19 is a novel disease often presenting with a cough, fever or a change in smell or taste. Recently, it has been recognised that COVID-19 may result in multisystemic issues and thus cause atypical symptoms, which can cause diagnostic delay, uncertainty and inaccuracy. A 60-year-old woman presented to the hospital with a 2-day history of mid-thoracic discomfort, intermittent rigours, fevers and general malaise, a few weeks after likely COVID-19 infection. She was admitted and treated for community-acquired pneumonia. However, her symptoms recurred despite multiple courses of antibiotics, which prompted further workup. A combination of a pleural and pericardial effusion was identified, leading to a diagnosis of polyserositis, and a COVID-19 antibody test came back positive. Colchicine was effective at resolving her symptoms, leading to further conviction of a probable postviral polyserositis.

We reported a case of Penicillium marneffei infection in a 56-year-old man who was being treated for rheumatoid arthritis (RA) since the year 2009 and had no history of corticosteroid treatment. In January 2012, he visited Thailand where he developed fever, general malaise and dyspnea. He immediately returned to Japan and was admitted to our hospital on the same day. On admission, the patient presented with dyspnea (pO2, 96 mmHg) while receiving oxygen (10 L/min) via a reservoir mask; liver enzyme, C-reactive protein (16.2 mg/dL) and β-d-glucan (42.2 pg/mL) levels were also elevated. Thoracoabdominal computed tomography showed diffuse micronodules in both lungs and hepatosplenomegaly. Round-to-oval, yeast-like fungi with central septum, phagocytosis and granuloma formation were observed in the liver and alveolar tissues. The patient was diagnosed with disseminated P. marneffei infection. Treatment with amphotericin B and micafungin was started, and the patient’s general condition improved. Voricon...

Standard chemoradiotherapy (CRT) for local advanced rectal cancer (LARC) rarely induce rectal perforation. Here we report a rare case of rectal perforation in a patient with LARC in the midst of preoperative CRT. A 56-year-old male was conveyed to our hospital exhibiting general malaise. Colonoscopy and imaging tests resulted in a clinical diagnosis of LARC with direct invasion to adjacent organs and regional lymphadenopathy. Preoperative 5-fluorouracil-based CRT was started. At 25 d after the start of CRT, the patient developed a typical fever. Computed tomography revealed rectal perforation, and he underwent emergency sigmoid colostomy. At 12 d after the surgery, the remaining CRT was completed according to the original plan. The histopathological findings after radical operation revealed a wide field of tumor necrosis and fibrosis without lymph node metastasis. We share this case as important evidence for the treatment of LARC perforation in the midst of preoperative CRT.

Leukemia is one of the most common oncological disorders found in the first decade of life. It is characterized by the excessive production of non-functional immature lymphocytic cells, called blasts, which invade the bloodstream causing fatal consequences. Unless timely treated, it is a deadly, severe condition. Its more common manifestations are the following: generalized paleness, spontaneous hemorrhaging, vascular lesions such as bruises and petechiae, general malaise, weight loss, and specific stomatological manifestations such as oral mucosa paleness, leukocyte infiltrate gingivorrhageor apparition of petechiae in some locations of the mouth. The present article documents the case of a five year old girl, diagnosed with B-cell precursor acute lymphoblastic leukemia. The child was subjected to oral rehabilitation under general anesthesia due to the fact that she exhibited multiple infectious foci in her teeth which contraindicated initiation of chemotherapy treatment.

Resumen En diciembre del 2019, se reportaron casos de neumonía de origen desconocido en Wuhan, China. Se confirmó que se trataba de un nuevo coronavirus llamado SARS-Cov-2 que podía causar enfermedad pulmonar a la que llamaron COVID19. El primer niño en América fue reportado por el CDC el 2 de marzo del 2020. El Dengue recientemente ha tenido nuevas altas en países de América, Asia y África, en los que es altamente prevalente, situación preocupante ya que se ha descrito reactividad cruzada serológica entre pacientes con COVID19. Ambas enfermedades comparten síntomas clínicos similares, resultando en diagnósticos erróneos. Este caso corresponde al primer infante documentado no solo en Guatemala sino a nivel mundial con reacción cruzada en la prueba serológica de Dengue DENV IgG e IgM y enfermo de COVID19. Se trata de un paciente masculino de 9 años, quien debuto con fiebre de 40°C, malestar generalizado y erupción eritematosa, el médico de cabecera realiza una prueba rápida Dengue DENV IgM siendo detectable por lo que de tratamiento para el Dengue clásico; a los días el paciente deteriora estado de saludo siendo necesario cuidados intensivos se traslada al Hospital Regional de Occidente, donde inicia con tos no productiva, destaca en el interrogatorio que abuelo y madre padecieron de COVID 19 hace unas semanas; se realiza una RT-PCR Sars-CoV-2 la cual es positiva, por lo que se trata al niño como COVID19 y no como Dengue con evolución satisfactoria.

We experienced a case of HER2-positive male breast cancer with a poor prognosis. A 64-year-old man visited our hospital due to general malaise, a left breast mass, and neck edema. The patient was diagnosed with HER2-positive breast cancer after needle histology.

Generalized pustular psoriasis (GPP) is a chronic, systemic inflammatory disease accompanied by high fever and general malaise. Diffuse erythema and swelling of the extremities occur, with multiple sterile pustules all over the body in GPP patients. GPP often relapses over the lifetime and can be life-threatening. Recent discoveries of the underlying molecular genetic basis of many cases of this disorder have provided major advances to clinicians and researchers towards an understanding of the pathomechanism of GPP. However, the therapeutic management of GPP still faces many challenges and much uncertainty, and an evidence-based review summarizing the available clinical data on the management of this heterogeneous disease is needed. The present review addresses challenges regarding the precise clinical diagnosis and evaluation of clinical symptoms in GPP. In addition, we update and briefly summarize the current understanding of molecular pathomechanisms behind GPP as an autoinflammatory keratinization disease. Recent publications have clarified the genetic backgrounds of patients with GPP and ethnic differences in predisposing factors. Although there are ethnic differences in the prevalences of these pathogenic alleles, from recent reports, at most 60.5% (IL36RN), 5.9% (CARD14), and 10.8% (AP1S3) of GPP patients have the mutations/variations of these genes. All the reported biologics studied seemed effective and relatively well tolerated. Although it is difficult to evaluate therapeutic efficacy from studies on just a few cases, recent findings suggest that biologics can be a useful, powerful tool for controlling skin and systemic inflammation in GPP and for improving the quality of life of GPP patients., ファイル公開：2021/04/01

Myelomatous pleural effusion (MPE) is a rare complication in patients suffering from multiple myeloma (MM). Dyspnea is the predominant symptom in the clinical presentation. Poor prognosis and aggressive MM behavior have been linked to this condition. We describe a case of MPE in an undiagnosed MM patient who presented with respiratory discomfort and general malaise.

Background Isolated adrenocorticotropic hormone deficiency is one kind of hypopituitarism and is triggered by various diseases including autoimmune disorder and/or autoimmune hypophysitis. Adrenocorticotropic hormone deficiency brings out various serious symptoms such as severe hypoglycemia, hypotensive shock, and disturbance of consciousness. Case presentation Here we report a case of 65-year-old Japanese man who developed idiopathic and isolated adrenocorticotropic hormone deficiency. He had continued epigastric comfort without any symptom of hypoglycemia or any autoimmune abnormality. Since he continued to complain of mild epigastric discomfort and general malaise, he was misdiagnosed as having functional dyspepsia and a depression state and took medicine for them for several months. Infection markers and several antibodies which we examined were all negative. An abdominal computed tomography scan showed no mass in adrenal tissue; contrast magnetic resonance imaging of his brain showed that pituitary size was within normal range, and pituitary gland deep dyeing delay and/or deeply stained deficit were not observed. However, in a corticotropin-releasing hormone load test, response of adrenocorticotropic hormone and cortisol was poor after corticotropin-releasing hormone loading, and in growth hormone-releasing peptide 2 load test, adrenocorticotropic hormone response was poor, suggesting the presence of adrenocorticotropic hormone deficiency. Therefore, we started treatment with hydrocortisone, and his various symptoms were soon mitigated. Conclusions We should bear in mind the possibility of adrenocorticotropic hormone deficiency even when patients complain of epigastric discomfort or general malaise alone.

Generalised eruptive histiocytosis is a rare proliferative disease that typically presents with indolent cutaneous eruptions. We describe the case of a 73-year-old man presenting with diffuse, asymptomatic crops of pink to dusky red papules preceded by general malaise, myalgias, fluctuating fever, chills, and weight loss. Histological evaluation revealed a non-Langerhans cell histiocytic dermal infiltrate with spindle cell features and chronic inflammation, reactive for CD68 and negative for both S100 and CD1a. Malignancy screening was negative. This report aims to highlight a unique presentation of generalised eruptive histiocytosis, emphasise histological findings, and discuss considerations for malignancy screening.

Herbal extracts are often used by the folk medicinal practitioners, rural peoples of Bangladesh for the treatments of various ailments for the primary health care. Now-a-days its uses are going more frequent with an established scientific literature. Low cost nutritive wafer biscuits made of ayurvedic or herbal extracts such as shatavari, ashwagandha and yastimadhu powder was developed and evaluated for its chemical composition for nutritive parameters. Brief microbiological studies were also planned to evaluate the shelf life and safety of the product. Finally a sensory evaluation was conducted to ascertain its overall acceptability amongst the population. It was shown that newly developed wafer biscuits were rich in carbohydrate (65%), energy and fat (24% fat). The results indicate that newly formulated biscuits were surprising high in protein (8.20%), dietary fiber (1.5%) and widely accepted by the consumers mainly due to its low cost and health benefits with respect to sensory qualities, high nutritive values . The results also indicated that the newly formulated biscuits were high in self-life ranking and it was agreed that this type of initiative could more effective for growing children as well as in certain therapeutic conditions when general malaise dominates the diseases and such type of fortified foods can be industrially launched as a social business.J. Environ. Sci. & Natural Resources, 9(1): 17-21 2016

Catheter-related bloodstream infections (CRBSIs) commonly arise from a parenteral nutrition catheter hub. A target for a Nutrition Support Team is to have a CRBSI rate of less than 1 per 1000. The diagnosis of CRBSI is suspected clinically by a temperature shortly after setting up a feed, general malaise or raised blood inflammatory markers. It is confirmed by qualitative and quantitative blood cultures from the catheter and peripherally. Treatment of inpatients may involve central venous catheter removal and antibiotics for patients needing short-term parenteral nutrition, but catheter salvage is generally recommended for patients needing long-term parenteral nutrition, where appropriate.

Brucellosis is one of the most common contagious and communicable zoonotic diseases with high rates of morbidity and lifetime sterility. There has been a momentous increase over the recent years in intra/interspecific infection rates, due to poor management and limited resources, especially in developing countries. Abortion in the last trimester is a predominant sign, followed by reduced milk yield and high temperature in cattle, while in humans it is characterized by undulant fever, general malaise, and arthritis. While the clinical picture of brucellosis in humans and cattle is not clear and often misleading with the classical serological diagnosis, efforts have been made to overcome the limitations of current serological assays through the development of PCR-based diagnosis. Due to its complex nature, brucellosis remains a serious threat to public health and livestock in developing countries. In this review, we summarized the recent literature, significant advancements, and challenges in the treatment and vaccination against brucellosis, with a special focus on developing countries.

A 93-year-old patient came to our observation for general malaise, sensory obnubilation, aphasia and dysphagia. He had arterial hypertension in drug treatment. At the first medical contact, the bod...

A 66-year-old gentleman was admitted to hospital with a history of general malaise for 5 months. His symptoms worsened 2 weeks prior to presentation. He experienced swinging pyrexia, night sweats and shortness of breath on exertion. Initial evaluation did not reveal any source of infection. Subsequent investigation revealed infection with vegetation affecting the intra-cardiac leads of cardiac resynchronization therapy device (CRT-D). The patient was treated with prolonged intravenous antibiotics and removal of the device and indwelling leads. The patient made a full recovery and a new device was implanted.

Patient: Male, 62 Final Diagnosis: POEMS syndrome Symptoms: General malaise • pretibial edemas • weight loss Medication: — Clinical Procedure: Autologous hematopoietic stem cell transplantation Specialty: Hematology Objective: Rare disease Background: POEMS syndrome is a rare systemic pathology of paraneoplastic origin that is associated with plasma cell dyscrasia. It is characterized by the presence of sensorimotor polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, skin changes, and other systemic manifestations. The pathogenesis of the syndrome is unknown but over-production of vascular endothelial growth factor is probably responsible for most of the more characteristic symptoms. There is no standard treatment for POEMS syndrome and no randomized controlled clinical trials of treatment exist in the available literature. High-dose melphalan with autologous hematopoietic stem cell transplantation should be considered for younger patients with widespread osteosclerotic lesions, and for patients with rapidly progressive neuropathy. Case Report: This is the case of a 62-year-old Caucasian man who was admitted to our center presenting pretibial edema accompanied by significant weight loss and difficulty walking. POEMS criteria were present and an immunofixation test confirmed the presence of a monoclonal plasmaproliferative disorder. After autologous hematopoietic stem cell transplantation, the monoclonal component disappeared and the patient’s clinical status improved markedly. Conclusions: Autologous hematopoietic stem cell transplantation following high-dose melphalan is an effective therapy for younger patients with widespread osteosclerotic lesions in POEMS syndrome.

Background: Herbal medications are used worldwide for a variety of diseases and conditions. Patients often elect not to disclose their herbal use history, or health care practitioners fail to enquire about specific alternative therapy. The aim of this study was to assess the conditions most frequently self-treated with herbal remedies by patients visiting a tertiary hospital in Garankuwa, South Africa.Methods: Patients attending an out-patient’s clinic at the Dr George Mukhari Academic Hospital were given a questionnaire regarding their use of herbal remedies for various reasons. Assessment was done on past, current, and possible future use of herbal interventions. These interventions were categorised into acute medical conditions, chronic ailments, and cultural uses.Results: Respiratory tract infections were most frequently treated (34%). Other highly ranked uses included protection from evil spirits (32%) and for HIV/AIDS (29%). Digestive ailments (27%), hypertension (18%), and general malaise (17%) acc...

We conducted an open-label study in which food containing Agaricus brasiliensis KA21 was consumed continuously for 12 weeks. A questionnaire for subjective evaluation of the efficacy of this food (hereafter, subjective evaluation questionnaire) revealed significant improvements compared with before its intake; there were improvements in the scores of the amounts of hair loss and gray hair, fatigue and general malaise, eye strain, shoulder stiffness, coldness of extremities, difficulty staying awake during the day, and ease of getting out of bed. These findings suggest that intake of food containing A. brasiliensis KA21 results in the above-mentioned subjectively evaluated improvements, and the possibility that A. brasiliensis KA21 improves the body's immunity. Moreover, no issues regarding the safety of the test food were found.

Bronchiectasis is an umbrella term for patients with a chronic inflammatory lung disease characterised radiologically, by the permanent dilation of bronchi, and clinically, by persistent cough, sputum production, recurrent respiratory tract infections and general malaise [1]. Data across multiple healthcare systems suggest that the prevalence of bronchiectasis is increasing [2–4]. Whether this represents a real increase in disease burden, perhaps in relation to improved longevity of the population and the chronic nature of the diseases that cause bronchiectasis, or is an ascertainment bias due to increased pick-up rates in an era when improved sensitivity high-resolution computed tomography (HRCT) scans are routinely being performed is difficult to determine.

A 62 year-old woman with rheumatoid arthritis (RA) presented with general malaise, shortness of breath, and productive cough. She had had RA for 4 years and had been treated with methotrexate (MTX)...

Decompression sickness (DCS) in humans is associated with reductions in ambient pressure that occur during diving, aviation, or certain manned spaceflight operations. Its signs and symptoms can include, but are not limited to, joint pain, radiating abdominal pain, paresthesia, dyspnea, general malaise, cognitive dysfunction, cardiopulmonary dysfunction, and death. Probabilistic models of DCS allow the probability of DCS incidence and time of occurrence during or after a given hyperbaric or hypobaric exposure to be predicted based on how the gas contents or gas bubble volumes vary in hypothetical tissue compartments during the exposure. These models are calibrated using data containing the pressure and respired gas histories of actual exposures, some of which resulted in DCS, some of which did not, and others in which the diagnosis of DCS was not clear. The latter are referred to as marginal DCS cases. In earlier works, a marginal DCS event was typically weighted as 0.1, with a full DCS event being weighted as 1.0, and a non-event being weighted as 0.0. Recent work has shown that marginal DCS events should be weighted as 0.0 when calibrating gas content models. We confirm this indication in the present work by showing that such models have improved performance when calibrated to data with marginal DCS events coded as non-events. Further, we investigate the ramifications of derating marginal events on model-prescribed air diving no-stop limits.

A woman aged 80 years was admitted under the general physicians with a 2-week history of general malaise. She was referred to dermatology for an opinion on a rash which had been present for 6 months. Examination revealed an erythematous, keratotic and papular rash below her breasts (figure 1), in both axillae (figure 2), upper abdomen and lower back. The rash was asymptomatic. The patient …

Benznidazole, drug of choice for Chagas disease (CD), has been associated with a high incidence of adverse reactions that can become serious, necessitating discontinuation of the drug. We describe the case of a Bolivian patient living in Spain for 9 years, who, following treatment with benznidazole for CD in indeterminate chronic phase, presented with fever, skin lesions, digestive symptoms, general malaise, and laboratory abnormalities. After the discontinuation of benznidazole and, the intake of antihistamines and systemic corticosteroids, the patient presented a complete resolution of the symptoms. Optimization of dose strategies and development of more effective, and better-tolerated drugs is advisable.

This report describes two cases of retroperitoneal abscesses in female western lowland gorillas (Gorilla gorilla gorilla). Clinical symptoms included perivulvar discharge, lameness, hindlimb paresis, and general malaise. Retroperitoneal abscesses should be considered as part of a complete differential list in female gorillas with similar clinical signs.

Background Although bacillus Calmette-Guerin (BCG) has proven highly effective in non–muscle-invasive bladder cancer (NMIBC), but it can cause severe local and systemic side effects. Objectives The objective was to determine whether reducing the dose or duration of BCG was associated with fewer side effects. Efficacy comparisons of one-third dose versus full dose BCG given for 1 yr versus 3 yr have previously been published. Design, setting, and participants After transurethral resection, patients with intermediate- and high-risk NMIBC without carcinoma in situ were randomised to one-third dose or full dose BCG and 1 yr or 3 yr of maintenance. Outcome measurements and statistical analysis Local and systemic side effects were recorded at every instillation and divided into three time periods: during induction, during the first year after induction, and during the second and third years of maintenance. Results and limitations Of the 1316 patients who started BCG, 826 (62.8%) reported local side effects, 403 (30.6%) reported systemic side effects, and 914 (69.5%) reported local or systemic side effects. The percentage of patients with at least one side effect was similar in the four treatment arms ( p =0.41), both overall and in the different time periods. The most frequent local and systemic side effects were chemical cystitis in 460 (35.0%) patients and general malaise in 204 patients (15.5%); 103 patients (7.8%) stopped treatment because of side effects. No significant difference was seen between treatment groups ( p =0.74). In the 653 patients randomised to 3 yr of BCG, 35 (5.4%) stopped during the first year, and 21 (3.2%) stopped in the second or third year. Conclusions No significant differences in side effects were detected according to dose or duration of BCG treatment in the four arms. Side effects requiring stoppage of treatment were seen more frequently in the first year, so not all patients are able to receive the 1–3 yr of treatment recommended in current guidelines. This study was registered at ClinicalTrials.gov with identifier NCT00002990 (http://clinicaltrials.gov/ct2/show/record/NCT00002990).

A case of a patient with bilateral endophthalmitis and vertebral infection is presented here. The case presented with fever, general malaise, reduced vision and back pain for at least two weeks. Diagnosis was established by positive blood cultures together with ophthalmology review and radiological findings. Streptococcus dysgalactiae subspecies equisimilis was isolated from blood cultures. This case demonstrates the risks for older patients of developing invasive disease upon exposure to Streptococcus dysgalactiae, even if underlying diseases are absent.

A 53-year-old woman presented to a hospital with a history of general malaise, significant weight loss and chest discomfort for 6 months. She had no significant past medical history. Her initial investigations revealed elevated inflammatory markers, normocytic anaemia, mildly increased cardiac

Infective endocarditis (IE) can be the first presentation of a silent patent ductus arteriosus (PDA). PDA IE vegetations usually accumulate at the pulmonary end of the PDA and shower septic emboli to the lungs. A 66-year-old female presented with 3 weeks of general malaise, fever and night sweats

58-year-old lady presented to the Emergency Department with a two-day history of shortness of breath and confusion, on a background of one week’s history of general malaise, vomiting, fevers and chills. Her past medical history was unremarkable except for a large, benign goitre. Systemic enquiry revealed no symptoms to suggest a focus of infection.

Case 1: A 55 year-old lady presented with diffuse oedematous erythema infiltrated with numerous small non-follicular pustules. This initially appeared over her face and axillae but subsequently spread to involve much of her torso and proximal limbs. There was associated fever and general malaise. Laboratory investigations also demonstrated an accompanying neutrophilia. Five days previously she had started oral flucloxacillin for a recurrent facial cyst.Case 2: A 48 year-old lady presented with multiple [...]

A 28-year-old woman presented with a 2-week history of fever, night sweats, and general malaise. At presentation, she had haemoptysis, shortness of breath, acute kidney injury, and elevated inflammatory markers. She had a history of intravenous drug use and recent hospitalization 4 months ago with Staphylococcus aureus tricuspid valve endocarditis treated conservatively with …