Introduction and purpose: Acute pharyngitis and tonsillitis is the most common reason why people want to visit their primary care physician. Viruses are the most common cause of acute pharyngitis and acute tonsillitis in children and adults. The patient complains about pain with sudden onset and throat irritation, pain on swallowing, fever and headache, and in children also abdominal pain, nausea and vomiting. Brief description of the state of knowledge: Most acute tonsillopharyngitis is due to rhinoviruses (35%), influenza (30%), RSV and parainfluenza. Bacteria causes 30% of the infections and S. pyogenes is the most common cause. Viral infections are seasonal. S.pyogenes infection is most often in winter and early spring. Changes in the pharyngeal mucosa look similar in both bacterial and viral etiologies. Because of that, scales have been developed to assess the probability of a bacterial infection. The most used is Centor / McIsaac scale. The gold standard of diagnostics is throat swab culture. In the treatment of streptococcal pharyngitis and tonsillitis, penicillins are used as first-line treatment. Antibiotic treatment reduces infectivity, lowers the risk of rheumatic fever and made symptoms disappear two days earlier. Tonsillectomy does not reduce the number of recurrent pharyngitis and tonsillitis, therefore it cannot be recommended. Conclusion: Acute tonsillopharyngitis can result in many complications, the most serious of them is rheumatic fever. Therefore, it is very important to properly diagnose and use antibiotic therapy when necessary.
Introduction and purpose: Kawasaki disease is an acute, self-limited vasculitis of medium arteries, and it affects children under 5 years old. It can lead to coronary artery aneurysms. Brief description of the state of knowledge: Pathogenesis of Kawasaki disease is unclear. The diagnosis is based on the clinical findings. The characteristic symptoms are polymorphous skin rashes, conjunctivitis, erythema, dryness, cracking and bleeding of the lips, erythema and swelling of palms and soles and cervical lymphadenopathy. Kawasaki disease is defined as a fever for 5 days accompanied by 4 or more of the diagnostic symptoms described above. The classic diagnosis is based on the exclusion of other diseases too. The diagnosis of incomplete Kawasaki disease is suggested if less than 4 main clinical features are found. It is the most common cause of acquired heart disease in children. Kawasaki disease can lead to coronary artery aneurysm, myocarditis and pericarditis so it is very important to treat this illness correctly. Basic treatment is a single infusion of intravenous immunoglobulin and high-dose aspirin. Recurrent Kawasaki disease (persistent fever after first line treatment with IVIG and aspirin) requires the same treatment as used for the first episode. Corticosteroids and immune-modulating therapies can be used as second and third line options. Quick recognition and early treatment result in a reduction of coronary artery abnormalities. Conclusion: This article reviews basic informations, history, epidemiology, pathophysiology, clinical presentation, diagnostic criteria, complications and treatment of Kawasaki disease.
Introduction and purpose: Sarcoidosis is a chronic, multi-system inflammatory disorder of unknown etiology. Due to the varied clinical picture of patients, the diagnosis of the disease is complicated, especially when the heart is affected.The aim of this article is to review the available diagnostic tools used for the diagnosis, evaluation and monitoring of patients with suspected cardiac sarcoidosis. Description of the state of knowledge: Sarcoidosis may affect any organ, but in particular lungs, skin, lymph nodes, eyes, liver and spleen. The most common manifestations are persistent cough, skin changes, visual disturbances, peripheral lymphadenopathy, fatigue and incidental abnormal chest radiograph. Cardiac sarcoidosis, occurring in about 5% of patients, is clinically significant with a wide range of symptoms including conduction abnormalities, ventricular arrhythmias, heart failure and sudden death. The diagnosis of cardiac sarcoidosis is challenging and often requires a combined approach using clinical data and advanced imaging. Invasive and non-invasive diagnostic tests are helpful in assessing the severity of heart involvement, with non-invasive tests becoming increasingly important, due to low sensitivity (30%) and high complication rate of endomyocardial biopsy for the diagnosis of cardiac sarcoidosis. Summary: Sarcoidosis significantly increases the mortality of patients and furthermore causes impaired quality of life and disability. Attempts to accurately assess the development of disease provide a more comprehensive and personalized care for patients. Especially cardiac sarcoidosis, as a potentially life-threatening localization, requires early diagnosis and appropriate treatment.
Introduction and purpose: Ruptured intracranial aneurysm causes a life-threatening subarachnoid hemorrhage, which is characterized by a high percentage of disability and mortality. As of today, we have two main treatments for this condition: microsurgical clipping and endovascular coil embolization. The aim of the study was to evaluate both treatment modalities, assess their limitations and compare them in terms of mortality, postoperative condition/complications and long-term patient’s condition Materials and methods: This study was based on the analysis of medical databases’ analysis. Results: Four randomized controlled trials, one guideline and one meta-analysis were reviewed. The results did not significantly differ between the studies. They proved that endovascular coiling technique showed fewer poor outcomes, deaths or dependency, one year after the treatment. These differences decreased in the following years. The microsurgical clipping was more effective at total obliteration of the aneurysm but was not related to better quality of life for those patients. Both techniques also did not differ in terms of the patients’ distant long-term neuropsychological state. Conclusion: Endovascular coiling embolization is still a rapidly developing technique that may be the main treatment modality in the future. However, at this point, both treatments have advantages and limitations. It is crucial to assess every patient individually.
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