1/17. copper deficiency anemia and nephrosis in zinc-toxicity: a case report.zinc is a ubiquitous element that is essential for normal enzymatic function in multiple metabolic pathways. Chronic excessive zinc ingestion causes severe reversible anemia in humans. In animals, zinc toxicity leads to anemia as well as physiologic and morphologic damage to the pancreas, kidneys, and often, multisystem failure and death. In this case, a young female ingested approximately 2000 mg of zinc gluconate daily for 12 months. She subsequently developed anemia consistent with zinc-induced copper deficiency and severe nephrosis. After cessation of zinc ingestion, her anemia and nephrosis resolved. This case study underscores the importance of an accurate and thorough investigation of nutritional supplements during the history and physical examination. Given the promulgation of zinc for the treatment of skin disorders and the common cold, along with the commercialization of nutritional supplements, unimpeded by regulatory guidelines, it is imperative that primary care physicians be attuned to the potentially dangerous consequences of excessive zinc ingestion.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/17. hyperhomocysteinemia masquerading as pulmonary embolism.We describe a 30-year-old male who presented with acute onset of breathlessness, tachycardia, and palpitations associated with distension of jugular vein and clear lungs on physical examination. The chest X-ray was normal and ECG was showing S1Q3T3 and right ventricular strain pattern. His 2-D echocardiography was showing dilated right atrium, right ventricular dilatation and moderate pulmonary arterial hypertension. He was found to have thrombosis involving left side of deep venous system with normal superficial venous system (Doppler proved). All routine blood investigations for etiology of recurrent DVT were normal except serum homocyteine level, which was significantly raised. Megaloblastic anemia on peripheral smear and hyperhomocysteinemia prompted us to search for its cause, which was subsequently found to be vitamin B12 deficiency. Such an association of megaloblastic anemia due to vitamin B12 deficiency leading to hyperhomocysteinemia and subsequent thrombosis in left venous system presenting as acute pulmonary embolism has not been described earlier in the medical literature.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
3/17. Case of complete recovery of pancytopenia after treatment of hypopituitarism.We describe a 55-year-old woman who presented with pancytopenia with a normocytic and normochromic anemia which was progressive despite conventional treatments such as folic acid, vitamin B6, and oxymetholone. Her physical findings and history of a previous massive postpartum hemorrhage suggested Sheehan's syndrome, and the pituitary hormonal studies revealed panhypopituitarism. After 4 months of thyroxine and glucocorticoid replacement therapy, her pancytopenia and bone marrow hypoplasia recovered completely. pancytopenia is a rare manifestation of a hormonal abnormality, but hematologists need to be aware of panhypopituitarism as a differential diagnosis when women showing features of hypopituitarism present with pancytopenia because it can be reversed with adequate hormone replacement.- - - - - - - - - - ranking = 0.13574009662805keywords = physical (Clic here for more details about this article) |
4/17. Functional ability of patients on dialysis: the critical role of anemia.Maintining hemoglobin (Hb) levels in the range (11 to 12 g/dL) recommended by the National kidney Foundation's kidney Disease Quality Initiative (NKF/KDOQI) has been shown to significantly improve functional ability in patients on dialysis. The combination of partial anemia correction and an individualized exercise program yields additional incremental benefits. nurses fulfill a crucial role in ensuring that appropriate Hb levels are maintained while at the same time encouraging patients to improve their physical conditioning and functional status.- - - - - - - - - - ranking = 0.13574009662805keywords = physical (Clic here for more details about this article) |
5/17. Neonatal effects of breast cancer chemotherapy administered during pregnancy.A human fetus is most susceptible to teratogenic agents during the first trimester of pregnancy. cyclophosphamide and doxorubicin are pregnancy category D agents; however, potential benefits may warrant treatment with these agents during pregnancy under special circumstances. During her first trimester of pregnancy, a 37-year-old Caucasian woman was diagnosed with stage IIB infiltrating ductal carcinoma in situ (breast cancer) that was estrogen and progesterone receptor negative and human epidermal growth factor receptor-2 positive. The patient was treated with doxorubicin and cyclophosphamide in the second and third trimesters and delivered a premature baby boy at 31 weeks' gestation. The neonate was intubated on delivery because of respiratory distress and failure; however, no physical anomalies were observed. He had neutropenia and anemia, quite possibly as a result of his mother's chemotherapy 1 week before delivery. He was prophylactically treated for sepsis, but all cultures were negative. The infant grew and developed normally during his first year of life and remained in good health. An objective causality assessment revealed that it was probable that the infant's adverse events (prematurity, neutropenia, and anemia) were related to his mother's doxorubicin and cyclophosphamide therapy; however, these were the only adverse events potentially linked to in utero exposure to chemotherapy during the second and third trimesters. Due to the special considerations of both mother and infant, optimal treatment for patients with pregnancy-associated breast cancer requires the expert opinion of a multidisciplinary care team.- - - - - - - - - - ranking = 0.13574009662805keywords = physical (Clic here for more details about this article) |
6/17. quality of life in patients on dialysis: benefits of maintaining a hemoglobin of 11 to 12 g/dL.Clinical data have consistently demonstrated that improvements in quality of life (QOL) are associated with hemoglobin (Hb) and hematocrit (Hct) levels maintained in the range recommended by the National kidney Foundation's kidney Disease Outcomes Quality Initiative (NKF-K/DOQI). Hb levels between 11 and 12 g/dL and Hct levels between 33% to 36% yield significant improvements in a wide variety of parameters in the physical, cognitive, and psychological/social domains.- - - - - - - - - - ranking = 0.13574009662805keywords = physical (Clic here for more details about this article) |
7/17. Postural hallucinations? An unusual presentation of anaemia.The case of a 14 year old girl is reported, referred to child psychiatry with tearfulness and possible auditory hallucinations. Closer questioning revealed a history of low energy, sleeping excessively without refreshment, exertional dyspnoea, and poor growth. Psychologically, there was no evidence of low mood or negative cognitions despite the inexplicable tearfulness. Detailed enquiry revealed the "hallucinations" to be "whooshing" noises in her ears precipitated by standing. She was found to have a haemoglobin level of 55 g/l, attributed to a combination of poor diet and menorrhagia.Periodic, anaemic, cerebral hypoxia could be proposed to be the root of most, if not all, of the symptoms, illustrating the importance of marrying physical and psychological history taking with suitable investigations for an eminently treatable condition.- - - - - - - - - - ranking = 0.13574009662805keywords = physical (Clic here for more details about this article) |
8/17. Unruptured left cornual pregnancy: case report.Cornual pregnancy is a rare condition. The morbidity and mortality are directly related to the length of time for diagnosis. The present paper reports a case of unruptured left cornual pregnancy which was diagnosed by the patient's symptom, physical examination and positive urine pregnancy test. ultrasonography confirmed the diagnosis. Left cornual resection was carried out in the present case without immediate or long-term complication.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
9/17. A rare cause of anemia and thrombocytopenia in a newborn: congenital malaria.A newborn with fever and jaundice was referred to our hospital with anemia and thrombocytopenia of unknown origin. The patient's mother suffered from malaria infection during the third trimester of her pregnancy, but she did not accept medical therapy. On physical examination the newborn showed mild splenomegaly and jaundice. Laboratory tests revealed marked anemia with a hemoglobin value of 7.7 g/L and thrombocytopenia with platelet numbers of 17,000/mm3. plasmodium vivax was detected in blood smear. Oral therapy with chloroquine and primaquine was started. This patient is the second case of congenital malaria reported from turkey, and shows that the diagnosis of congenital malaria should be considered in infants with suspected congenital infection who are born to mothers with a history of malarial disease. We emphasize the importance of adequate antenatal medical therapy during pregnancy.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
10/17. Idiopathic pure red cell aplasia: case report with review of literature.Pure red cell aplasia (PRCA) is characterized by near absence of red blood cell precursors in the bone marrow with associated anemia and reticulocytopenia. megakaryocytes and white blood cell precursors remain intact. Acute self-limited PRCA is the most common form. Acquired chronic PRCA is often idiopathic but can be associated with underlying disorders such as thymoma or autoimmune diseases. Congenital PRCA is associated with physical abnormalities. Pure red blood cell aplasia should always be included in the differential diagnosis of chronic unexplained anemia. We report a case of idiopathic pure red blood cell aplasia in an elderly male who has had a chronic anemia with recurrent blood transfusions for about 30 years.- - - - - - - - - - ranking = 0.13574009662805keywords = physical (Clic here for more details about this article) |
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