Flexible Endoscopic Evaluation of Swallowing (FEES) provides direct visualization of the pharynx and larynx immediately before and after a swallow in a patient with dysphagia. Dysphagia is the difficulty in swallowing solid or liquid food. It is a symptom of an underlying disease like tetanus and myasthenia gravis. This case report showed the important role of FEES in patients with dysphagia due to tetanus followed by myasthenia gravis as its complication. A 58-year-old man had complaints of severe difficulty in swallowing followed by complaints of fever and whole body seizures, which supported the diagnosis of tetanus. In the course of the disease, symptoms and the results of supporting examinations indicated the presence of myasthenia gravis. Comprehensive management had done with colleagues in internal medicine, neurology and medical rehabilitation. That condition improved and the complaints disappeared after one month. It can be concluded that FEES played an important role in diagnosing dysphagia. It could identify the modification of food consistencies and therapeutic maneuvers to prevent an aspiration for a patient with dysphagia as the early symptom of tetanus which caused neurotransmitter damage that broke muscle nerve junctions. It is also one of the predisposing factors for autoimmune conditions in myasthenia gravis. Correct diagnosis and comprehensive management give a better improvement for the disease.
Thromboembolic events are a common and important cause of morbidity and mortality in cancer patients that require early diagnosis and treatment. Reports have suggested that chemotherapeutic agents may contribute to this risk. In this case report, a 60-year-old male patient on chemotherapy (dacarbazine and doxorubicin) for leiomyosarcoma with no previous history of thromboembolism developed left carotid artery thrombosis 3 days after the first cycle of chemotherapy. A low molecular weight heparin was started for a possible cerebrovascular accident-related thrombosis. In the second cycle, he developed right femoral vein thrombosis only 2 days after initiating the chemotherapy. The chemotherapy protocol was changed and the patient did not develop any thrombosis during the 1-year follow-up. In the literature, no thrombotic complications have previously been reported due to either dacarbazine or doxorubicin. In conclusion, elderly patients on chemotherapy should be carefully monitored for thromboembolic complications and, in case of thrombosis, the chemotherapy protocol should be changed.
Juice of dates (Phoenix dactylifera) is widely used to reduce the risk of spontaneous bleeding by shorting the bleeding time, for example on hemorrhargic fever and the consequence of consuming drugs (e.g. aspirin, anti coagulant, anti cancer, diuretic, etc). This study aimed to investigate the effect of dates juice on the bleeding time of male Wistar strain rats that induced by aspirin. This study was experimental research with post test only control group design. In this study, 10 male Wistar strain rats were randomly divided into 2 groups. The first group (positive control) were only treated by aspirin and the second group (treatment group) were treated by aspirin and palm dates juice. Mean of the bleeding time in first group was 42,6 + 11,5 seconds and in second group was 28,0 + 3,0 seconds. Distribution of data was normal but not homogenous, so that data was analyzed by non parametric statistic test Mann-Whitney. The result showed that there was significant difference between the first and the second group. This study concluded that juice of dates affects the bleeding time of male Wistar strain rats that induced by aspirin.
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