RESUMEN
Lung transplantation can improve the survival of patients with severe chronic pulmonary disorders. However, the short- and long-term risk of infections can increase morbidity and mortality rates. A non-systematic review was performed to provide the most updated information on pathogen, host, and environment-related factors associated with the occurrence of bacterial, fungal, and viral infections as well as the most appropriate therapeutic options. Bacterial infections account for about 50% of all infectious diseases in lung transplanted patients, while viruses represent the second cause of infection accounting for one third of all infections. Almost 10% of patients develop invasive fungal infections during the first year after lung transplant. Pre-transplantation comorbidities, disruption of physical barriers during the surgery, and exposure to nosocomial pathogens during the hospital stay are directly associated with the occurrence of life-threatening infections. Empiric antimicrobial treatment after the assessment of individual risk factors, local epidemiology of drug-resistant pathogens and possible drug-drug interactions can improve the clinical outcomes.
RESUMEN
SETTING: Early diagnosis of latent tuberculous infection (LTBI) should be pursued in healthcare workers (HCWs). While HCWs in hospitals are screened for LTBI, HCWs in outpatient settings are usually not. In 2017, in Italy, a tuberculosis (TB) infected paediatrician working in an outpatient vaccination service infected 15 adults and nine children. The investigation involved 2490 children and 151 adults. Among children, nine were tuberculin skin test-positive, and four developed active TB. Among 123 adult contacts with longer exposure, seven were interferon-gamma release assay (IGRA) positive and none had active TB. Among 28 close contacts, eight had a positive IGRA, and three had pulmonary TB. The total outbreak cost 1 017 903.OBJECTIVE: To compare the outbreak cost with those of potential screening programme strategies.RESULTS: Regular screening of paediatric outpatient HCWs would have cost between 2592 and 11 373. Extending the screening to all outpatient HCWs (caring for adults and children) would have cost between 66 384 and 155 043. Investigating only close contacts would have cost 42 857.CONCLUSION: Each of these screening strategies would have been cost-effective compared with the outbreak investigation occurring in real life with a cut-off of 474 for the maximum number of tested outpatient HCWs needed for the screening strategy to be cost-saving.
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Personal de Salud , Tuberculosis Latente/diagnóstico , Tamizaje Masivo/métodos , Tuberculosis Pulmonar/diagnóstico , Adulto , Niño , Análisis Costo-Beneficio , Brotes de Enfermedades , Humanos , Ensayos de Liberación de Interferón gamma , Italia , Tuberculosis Latente/epidemiología , Tamizaje Masivo/economía , Pacientes Ambulatorios , Prueba de Tuberculina , Tuberculosis Pulmonar/epidemiologíaRESUMEN
One hundred and one patients suffering from chronic daily headache (CDH) and medication overuse were treated, in an in-patient setting, with abrupt discontinuation of the medication overused, intravenous hydrating, and intravenous administration of benzodiazepines and ademetionine. The mean time to CDH resolution was 8.8 days. The in-patient withdrawal protocol used was effective, safe and well tolerated. There was a trend for a shorter time to CDH resolution in patients who overused triptans (P=0.062). There was no correlation between time to CDH resolution and either the type of initial primary headache or duration of medication abuse, whereas time to CDH resolution was related to daily drug intake (P=0.01). In multiple regression analysis, daily drug intake, age and type of medication overused were independent predictors of time to CDH resolution. At 3-months' follow-up, no patient had relapsed and was again overusing symptomatic medications.
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Analgésicos/efectos adversos , Analgésicos/farmacocinética , Cefaleas Secundarias/inducido químicamente , Factores de Edad , Benzodiazepinas/uso terapéutico , Femenino , Cefalea/tratamiento farmacológico , Cefaleas Secundarias/tratamiento farmacológico , Hospitalización , Humanos , Inactivación Metabólica , Masculino , S-Adenosilmetionina/uso terapéutico , Factores de TiempoRESUMEN
To the best of our knowledge, persistent visual symptoms, lasting months or years without evidence of infarction, a rare complication of migraine with aura, has been reported in only 20 patients. We report the case of a 43-year-old woman with a 31-year history of migraine with typical visual aura. At presentation, she experienced a visual aura in her right hemifield followed by a pulsating headache. The visual symptoms persisted. There were no abnormal findings on neurological and ophthalmological examinations, EEG, visual evoked potentials (VEPs), brain computed tomography and magnetic resonance imaging (MRI). Both brain single photon emission computed tomography (SPECT) and brain perfusion MRI revealed decreased left fronto-parieto-occipital and right occipital blood perfusion. A perfusion MRI, performed 7 months after symptom onset and almost complete extinction of symptoms, was normal. As previously reported, we demonstrated a cortical hypoperfusion by SPECT in a case of persistent visual aura. For the first time this finding was confirmed by perfusion MRI.
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Infarto Cerebral/diagnóstico , Imagen por Resonancia Magnética/métodos , Migraña con Aura/diagnóstico , Tomografía Computarizada de Emisión de Fotón Único/métodos , Adulto , Infarto Cerebral/fisiopatología , Femenino , Humanos , Migraña con Aura/fisiopatologíaRESUMEN
Recent data indicate that patients with vascular dementia (VaD) show a cholinergic deficit. Having obtained good results in a previous study comparing rivastigmine, an inhibitor of acetylcholinesterase (AChE) and butyrylcholine-sterase (BuChE), vs. aspirin, we aimed to compare the efficacy and tolerability of rivastigmine vs. aspirin plus nimodipine. Patients with a diagnosis of dementia and probable VaD received rivastigmine 3-6 mg/day (n = 32) or aspirin plus nimodipine (n = 32) in an open study for 16 months. Patients treated with rivastigmine showed superior benefits, compared with those receiving aspirin plus nimodipine, in attention, executive function, instrumental activities of daily living, and behavioural and psychotic disturbances. Side-effects in both groups were tolerable and there were no study withdrawals. The benefits observed with rivastigmine may reflect its inhibitory effects on AChE and BuChE, and the drug's affinity for frontal brain areas.
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Aspirina/uso terapéutico , Carbamatos/uso terapéutico , Inhibidores de la Colinesterasa/uso terapéutico , Demencia Vascular/tratamiento farmacológico , Nimodipina/uso terapéutico , Fenilcarbamatos , Vasodilatadores/uso terapéutico , Anciano , Anciano de 80 o más Años , Trastornos del Conocimiento/etiología , Quimioterapia Combinada , Femenino , Humanos , Masculino , Trastornos Psicóticos/etiología , Rivastigmina , Resultado del TratamientoRESUMEN
We studied seven patients with corticobasal degeneration (CBD) from a clinical and imaging perspective. We describe the main morphological features of CBD and, using functional MRI, try to define the possible role of the parietal lobe in simple and complex learned motor sequences. We showed decreased activation of the parietal lobe contralateral to the more affected arm, when movements, simple or complex, are performed with that hand. Moreover we found that functional imaging can demonstrate parietal and motor cortex dysfunction before structural, and even single-photon emission computed tomography changes become evident.
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Enfermedades de los Ganglios Basales/diagnóstico , Corteza Cerebral/patología , Imagen por Resonancia Magnética , Enfermedades Neurodegenerativas/diagnóstico , Tomografía Computarizada de Emisión de Fotón Único , Anciano , Enfermedades de los Ganglios Basales/fisiopatología , Enfermedades de los Ganglios Basales/psicología , Corteza Cerebral/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Neurodegenerativas/fisiopatología , Enfermedades Neurodegenerativas/psicología , Pruebas Neuropsicológicas , Lóbulo Parietal/patología , Lóbulo Parietal/fisiopatología , Escalas de WechslerRESUMEN
Glossopharyngeal neuralgia causes intermittent, lancinanting pain, involving the posterior tongue and pharynx, with radiation to deep ear structures. There are different pharmacological therapies which are tried to treat the neuralgia: carbamazepin, phenytoin, diazepam, amytriptyline, phenobarbital, ketamine, and baclofen; there are also surgical treatment proposed in order to cure the neuralgia such as vascular decompression or electrical stimulation of the motor cortex controlateral to the pain area. We report a single case of a patient with glossopharyngeal neuralgia treated with Gabapentin, the first described, who was followed up for four years, who respond completely to the therapy and did not complain from side effects, reducing even the reminiscence of pain during the second cluster of crisis.
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Acetatos/uso terapéutico , Aminas , Analgésicos/uso terapéutico , Ácidos Ciclohexanocarboxílicos , Enfermedades del Nervio Glosofaríngeo/tratamiento farmacológico , Enfermedades del Nervio Glosofaríngeo/fisiopatología , Nervio Glosofaríngeo/efectos de los fármacos , Ácido gamma-Aminobutírico , Analgésicos Opioides/uso terapéutico , Anticonvulsivantes/efectos adversos , Carbamazepina/efectos adversos , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Quimioterapia Combinada , Femenino , Estudios de Seguimiento , Gabapentina , Nervio Glosofaríngeo/patología , Nervio Glosofaríngeo/fisiopatología , Enfermedades del Nervio Glosofaríngeo/etiología , Humanos , Persona de Mediana Edad , Tramadol/uso terapéutico , Resultado del TratamientoRESUMEN
The spatial arrangement of neuronal sources for digit movement is non somatotopic, and is structured as extensively arranged through different regional cortex. We have functionally examined the cerebro-cortical activation during simple and complex motor sequences, before and after learning sessions, in healthy volunteers, both considering left- and right-dominant hand use, and left non dominant hand use, skillfulness and educational level. We discuss the results with a review on the topic.
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Corteza Cerebral/fisiología , Lateralidad Funcional/fisiología , Imagen por Resonancia Magnética , Destreza Motora/fisiología , Música , Adulto , Condicionamiento Psicológico/fisiología , Femenino , Humanos , Masculino , Movimiento/fisiologíaAsunto(s)
Acetatos/uso terapéutico , Enfermedad de Alzheimer/tratamiento farmacológico , Enfermedad de Alzheimer/psicología , Aminas , Ácidos Ciclohexanocarboxílicos , Agonistas de Aminoácidos Excitadores/uso terapéutico , Ácido gamma-Aminobutírico , Anciano , Conducta/efectos de los fármacos , Femenino , Gabapentina , Humanos , MasculinoRESUMEN
We describe a patient in whom motor neuron disease and frontal dementia showed concomitant development. This patient underwent a detailed and sequential neurolinguistic assessment, which indicated an alteration in language planning, language comprehension, and morphosyntactic operations. He showed also attention deficit, abstract reasoning disturbances, and prosopoagnosia which became worse during the year follow-up. We suggest that a more specific and sensitive neurolinguistic and neuropsychological test battery must be used to detect and study the entire disruption of cognitive processes in frontal dementia related to motor neuron disease.
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Trastornos del Conocimiento/diagnóstico , Trastornos del Conocimiento/etiología , Demencia/fisiopatología , Lóbulo Frontal/fisiopatología , Enfermedad de la Neurona Motora/complicaciones , Enfermedad de la Neurona Motora/fisiopatología , Atrofia/diagnóstico por imagen , Atrofia/patología , Lóbulo Frontal/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Enfermedad de la Neurona Motora/diagnóstico , Pruebas Neuropsicológicas , Tomografía Computarizada por Rayos XAsunto(s)
Demencia/etiología , Deficiencia de Vitamina B 12/complicaciones , Anciano , Humanos , MasculinoAsunto(s)
Apraxias/diagnóstico , Apraxias/fisiopatología , Escritura , Anciano , Humanos , MasculinoRESUMEN
The use of the mother tongue relies on implicit memory procedures that are mainly controlled by subcortical structures. A second language depends on the integrity of the explicit memory system, largely subserved by cortical areas. Therefore, bilinguals can be considered as neurolinguistic models which contribute to the understanding of how the cortical and subcortical language systems communicate while maintaining independent functions. We describe a patient who developed an impairment of the mother tongue after an infarct of the caudate. During follow-up, a dramatic improvement of the mother tongue accompanied by worsening of the second language became evident after the extension of the ischemic lesion to the cortex.