Acta clinica Croatica
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Acta clinica Croatica · Nov 2023
Review Case ReportsALTERNATING HYPOTHYROIDISM AND HYPERTHYROIDISM IN AN ADOLESCENT BOY - DO WE ALWAYS UNDERSTAND WHAT DRIVES THE SWITCH?
Alternating hypothyroidism and hyperthyroidism is a rare phenomenon, especially among pediatric patients. It is usually related to simultaneous, unbalanced presence of stimulating and blocking thyroid stimulating hormone receptor antibodies (TRAbs). Herein we describe thyroid stimulating hormone (TSH) and thyroid hormone fluctuations in an adolescent boy with negative TRAbs. ⋯ Due to a mild clinical presentation, most of the time he did not require any medication. This case contributes to the spectrum of alternating hypothyroidism and hyperthyroidism in the pediatric age and raises the question of mechanisms involved in fluctuating thyroid function. Therapeutic decisions should be individualized and guided by clinical manifestations and thyroid function tests, irrespective of the underlying pathophysiology.
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Acta clinica Croatica · Nov 2023
ReviewORBITAL BLOWOUT FRACTURES: A RETROSPECTIVE STUDY WITH LITERATURE REVIEW.
Blowout fractures of the orbit are relatively common injuries of the viscerocranium. However, there is still no general consensus on the optimal timing and method of treatment. ⋯ In other words, of our 91 patients, those admitted to our department in the first 48 hours from the injury had a more than 4 times lower rate of complications, likely due to early recognition of the injury with early intravenous antibiotic and corticosteroid administration, multidisciplinary treatment, and early recognition of candidates for emergency and early surgical treatment. The results of our study show the importance of treating blowout fractures in a tertiary care facility with expertise on the subject.
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Acta clinica Croatica · Nov 2023
ReviewTHE ROLE OF INTERFERON-GAMMA RELEASE ASSAYS IN DIAGNOSIS OF LATENT TUBERCULOSIS INFECTION IN CHILDREN.
Despite numerous published papers, diagnosis of latent tuberculosis infection (LTBI) in children is still an undefined area. The importance of this topic lies in the fact that one third of the world's population is infected with Mycobacterium (M.) tuberculosis. The majority of infected individuals are LTBI cases which make a reservoir for future active tuberculosis (TB) patients. ⋯ Nevertheless, in the diagnosis of LTBI in children, TST still has some advantages. However, generations of IGRAs have brought many diagnostic advantages that are emphasized in this review. In a difficult procedure of diagnosing LTBI in children, performance of IGRA could be the key factor in making decision whether to use preventive therapy or not.
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Acta clinica Croatica · Nov 2023
Case ReportsACUTE PAINFUL THYROIDITIS AND THYROTOXICOSIS AFTER PCI - A CASE STUDY.
Destructive thyroiditis is a self-limited disease characterized by acute release of preformed thyroid hormones. We present a patient with extremely rare acute painful thyroiditis after percutaneous coronary intervention (PCI) in acute myocardial infarction without ST-elevation. ⋯ Because of the increasing number of patients referred to cardiac catheterization, invasive cardiologists should be aware of the potentially serious thyroid dysfunction that can result from iodinated contrast use. The aim of our paper is, in the light of the patient presented, to discuss the pathophysiology, clinical presentations, therapy and potential preventive measures in patients that develop thyroid dysfunction after PCI.
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Acta clinica Croatica · Nov 2023
Case ReportsISOLATED ABDUCENS NERVE PALSY AFTER LUMBAR PUNCTURE - A CASE REPORT.
Isolated abducens nerve palsy following lumbar puncture is a rare complication. In scientific literature, it has been mostly described after performing spinal anesthesia in anesthesiology literature rather than in neurological literature. Isolated abducens nerve palsy usually occurs from one to three weeks after performing lumbar puncture and it is important to connect it with this procedure and exclude other possible etiologies. ⋯ We also planned to treat the patient with epidural blood patch, which is usually successful when performed as soon as the diagnosis is established. Unfortunately, our patient refused diagnostic and therapeutic proposal, so it was impossible to know final outcome. In conclusion, we want to highlight these complications, especially to young doctors and specialists who might see it rarely.