RESUMO
The COVID-19 pandemic and its impact on health systems had a significant effect on the management of inflammatory diseases in the long term and myopathies could be signs of COVID-19, making it difficult to diagnose the cause and effect relationship. An unvaccinated 62-year-old female patient followed for polymyositis was tested positive for COVID-19 on polymerase chain reaction (PCR) of nasopharyngeal swab revealed by dyspnea and rhinorrhea with fever and pulmonary involvement of 75%. She had an enlarged left ventricle with complete left branch block, inaugural diabetes mellitus with ketosis, kidney dysfunction, and inflammatory syndrome. Despite the early initiation of invasive ventilation in combination with the national protocol against covid-19, the patient died on day 4 of care. The best management should anticipate comorbidities and the evolutionary profile would guide the continuation of the treatment. Polymyositis like other rheumatic diseases was associated with a very high risk of developing a severe form of COVID-19. The combination of elder age and comorbidities led to a severe form of COVID-19 and therefore to a poor prognosis. The article aimed to show the severity of the association of covid-19 with polymyositis at the comorbid stage.
RESUMO
The COVID-19 pandemic has had a great impact on chronic diseases, including epilepsy. The imbalance of antiepileptic drugs in case of intercurrent infection with COVID-19 leads to worsening seizures. A 71-year-old man, followed for post-traumatic epilepsy for 30 years, was stabilized with phenobarbital and topiramate. He presented generalized tonic-clonic epileptic seizures without meningitis. He improved well on midazolam combined with the usual treatment before the diagnosis and worsening of the covid-19. The severity of the lung damage led to hypoxia, recurrence of seizures, and poor prognosis. The association between covid-19 and epilepsy remains pejorative despite management. An epileptic seizure should always be considered as a possible manifestation of COVID-19. The article aimed to establish the relationship between covid-19 and the risk of worsening seizures and to demonstrate the severity of the association between covid-19 and epilepsy in elderly patients.
Assuntos
Toxidermias/complicações , Eosinofilia/complicações , Síndrome do Desconforto Respiratório/diagnóstico , Corticosteroides/uso terapêutico , Adulto , Antibacterianos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Baclofeno/efeitos adversos , Toxidermias/patologia , Feminino , Agonistas GABAérgicos/efeitos adversos , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Staphylococcus aureus Resistente à Meticilina , Penicilina G/efeitos adversos , Síndrome do Desconforto Respiratório/complicações , Pele/patologia , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/tratamento farmacológico , Síndrome , Vancomicina/uso terapêuticoAssuntos
Cateterismo Periférico/efeitos adversos , Artéria Femoral , Isquemia/etiologia , Perna (Membro)/irrigação sanguínea , Trombose/complicações , Trombose/etiologia , Adolescente , Humanos , Masculino , Monitorização Fisiológica , Intoxicação por Organofosfatos , Fluxo Sanguíneo Regional/fisiologia , Fatores de RiscoAssuntos
Leishmaniose Visceral/complicações , Sepse/complicações , Antiprotozoários/uso terapêutico , Ecocardiografia , Humanos , Imunocompetência , Leishmania infantum , Leishmaniose Visceral/tratamento farmacológico , Leishmaniose Visceral/parasitologia , Masculino , Meglumina/uso terapêutico , Antimoniato de Meglumina , Pessoa de Meia-Idade , Compostos Organometálicos/uso terapêuticoRESUMO
Meningitis caused by Acinetobacter baumannii is rare and are mostly hospital acquired after neurosurgical procedure. We report a case of a 40-year old man was admitted to the intensive care unit due to subarachnoid haemorrhage. Our patient developed a ventriculitis due to A.baumannii treated successfully with sulbactam IV and intrathecal amikacin.
Assuntos
Adulto , Humanos , Masculino , Acinetobacter baumannii , Infecções por Acinetobacter/tratamento farmacológico , Amicacina/administração & dosagem , Antibacterianos/administração & dosagem , Meningites Bacterianas/tratamento farmacológico , Sulbactam/administração & dosagem , Infecções por Acinetobacter/etiologia , Craniotomia/efeitos adversos , Evolução Fatal , Injeções Espinhais , Meningites Bacterianas/etiologia , Hemorragia Subaracnóidea/cirurgiaAssuntos
Infecções por Acinetobacter/tratamento farmacológico , Acinetobacter baumannii/efeitos dos fármacos , Amicacina/administração & dosagem , Colistina/administração & dosagem , Infecção Hospitalar/tratamento farmacológico , Hidrocefalia/cirurgia , Meningites Bacterianas/tratamento farmacológico , Infecção da Ferida Cirúrgica/tratamento farmacológico , Ventriculostomia , Infecções por Acinetobacter/complicações , Acinetobacter baumannii/isolamento & purificação , Idoso , Amicacina/uso terapêutico , Isquemia Encefálica/complicações , Colistina/uso terapêutico , Infecção Hospitalar/microbiologia , Farmacorresistência Bacteriana Múltipla , Quimioterapia Combinada , Evolução Fatal , Humanos , Hidrocefalia/etiologia , Injeções Espinhais , Masculino , Meningites Bacterianas/complicações , Meningites Bacterianas/microbiologia , Infecções por Pseudomonas/complicações , Choque Séptico/complicações , Infecção da Ferida Cirúrgica/microbiologiaRESUMO
Meningitis caused by Acinetobacter baumannii is rare and are mostly hospital acquired after neurosurgical procedure. We report a case of a 40-year old man was admitted to the intensive care unit due to subarachnoid haemorrhage. Our patient developed a ventriculitis due to A.baumannii treated successfully with sulbactam IV and intrathecal amikacin.
Assuntos
Infecções por Acinetobacter/tratamento farmacológico , Acinetobacter baumannii , Amicacina/administração & dosagem , Antibacterianos/administração & dosagem , Meningites Bacterianas/tratamento farmacológico , Sulbactam/administração & dosagem , Infecções por Acinetobacter/etiologia , Adulto , Craniotomia/efeitos adversos , Evolução Fatal , Humanos , Injeções Espinhais , Masculino , Meningites Bacterianas/etiologia , Hemorragia Subaracnóidea/cirurgiaRESUMO
The extra cellular volume is strictly proportional to the amount of sodium present in the body. Its clinical evaluation on dialysis (through clinical story, weight and blood pressure changes) often needs probing for dry weight by reducing progressively the post dialysis weight down to the point where hypotension regularly occurs. Common critics addressed to the clinical assessment of dry weight include lack of sensitivity, of objectivity and of repeatability. But non clinical methods are far from perfect. They are non invasive, but they are poorly sensitive and reproducible (except for bio impedance, but in very strictly equal operational conditions). Most of them (natriuretic peptides, inferior vena cava echography, on-line volemia) measure exclusively the plasma volume but not the extra cellular volume. Besides, they increase dialysis complexity and cost. None of them is so far validated for dialysis. The accurate and absolute value of extra cellular volume is useless in clinical daily practice. What is needed is a simple fast evaluation of the actual extra cellular volume relative to its ideal level (dry weight). The clinical method based on two very simple, costless objective measurements, weight and blood pressure, allows for fulfilling the goal, the continuous adjustment of extra cellular volume and blood pressure normalization.
Assuntos
Espaço Extracelular/química , Falência Renal Crônica/terapia , Diálise Peritoneal , Diálise Renal , Sódio/análise , Impedância Elétrica , Humanos , Falência Renal Crônica/fisiopatologia , Peptídeos Natriuréticos/análise , Sensibilidade e EspecificidadeRESUMO
Low salt diet for dialysis patients was recommended at the very beginning of dialysis treatment. It was issued from Kempner and Guyton studies who have established the relationship between salt, hypertension, and the role of the kidney in sodium balance. This recommendation vanished from dialysis literature during the seventies and eighties and is currently on the way back. Salt intake has been evaluated in a small number of patients, found between 8.3 to 14.1 gram/day. Interventional studies for salt intake restriction have been efficient to reduce high blood pressure and decrease the interdialytic weight gain. In our unit, salt restriction is systematically prescribed to chronic kidney failure patients. We have evaluated from food recall or 3-day questionnaires the salt intake in 91 hemodialysis patients during the year 2005. Daily salt intake, not including salt added during cooking, was found at 3.8 g/day. This intake is correlated to interdialytic weight gain, water and phosphate intakes, and to BMI. Then a significant reduction in salt intake is possible in dialysis patients. This result may be obtained by the fruitful collaboration involving nurses, dietitians and the nephrologists.
Assuntos
Dieta Hipossódica , Diálise Renal , Sódio/metabolismo , Idoso , Idoso de 80 Anos ou mais , Nefropatias Diabéticas/metabolismo , Nefropatias Diabéticas/terapia , Feminino , Humanos , Rim/fisiopatologia , Falência Renal Crônica/metabolismo , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos TestesRESUMO
Although the efficacy and the health benefits of sodium restriction are clear, such restrictions continue to be met with the greatest reluctance, most particularly--as underscored by the historian Bergier in his hypothesis--because profoundly symbolic values are unfailingly related to salt. This brief report summarizes several historical aspects of salt's role as a substance participating in religious rites and linguistic contexts where its past role can still be seen today. It broaches the important question of "salt hunger" of the vital role of salt in past times, a costly substance because it was indispensable, and the basis of a tax (the salt tax) which underlay the French Revolution.
Assuntos
Dieta Hipossódica , Sódio/fisiologia , Paladar , Humanos , PolíticaAssuntos
Colchicum/intoxicação , Adulto , Feminino , Humanos , Intoxicação/diagnóstico , Intoxicação/terapiaAssuntos
Hiperparatireoidismo Secundário/sangue , Naftalenos/uso terapêutico , Diálise Renal , Idoso , Fosfatase Alcalina/sangue , Biomarcadores/sangue , Osso e Ossos/metabolismo , Cinacalcete , Feminino , Humanos , Hiperparatireoidismo Secundário/tratamento farmacológico , Masculino , Hormônio Paratireóideo/sangue , Fatores de TempoAssuntos
Tinturas para Cabelo/intoxicação , Miocardite/induzido quimicamente , Fenilenodiaminas/intoxicação , Suicídio , Troponina I/sangue , Adulto , Biomarcadores , Feminino , Humanos , Miocardite/sangue , Miocardite/mortalidade , Estudos Retrospectivos , Rabdomiólise/sangue , Rabdomiólise/induzido quimicamente , Choque Cardiogênico/etiologia , Choque Cardiogênico/mortalidadeRESUMO
Acute organophosphate poisoning, whether accidental or suicidal, is frequent in developing countries and produces significant morbidity and mortality. Organophosphates inhibit cholinesterase activity at the neuromuscular junction and cause extensive muscle paralysis, particularly for respiratory function. Poisonings evolve in three stages: cholinesterase crisis, intermediate syndrome and delayed neuropathy. Electrophysiological aspects have been poorly studied. We report the case of a 25-year-old woman admitted to intensive care unit with muscarinic signs and respiratory failure after attempted suicidal organophosphate poisoning. Cholinesterase activity was low and the electrophysiological study disclosed the characteristic aspect of intermediate syndrome. The patient died due to septic complications. This syndrome is exceptional with a poorly understood pathophysiology. The electrophysiological study is essential for diagnosis.
Assuntos
Inibidores da Colinesterase/intoxicação , Intoxicação por Organofosfatos , Adulto , Colinesterases/sangue , Estimulação Elétrica , Eletrodiagnóstico , Eletrofisiologia , Evolução Fatal , Feminino , Humanos , Nervo Mediano/fisiologia , Sepse/etiologia , Tentativa de SuicídioRESUMO
INTRODUCTION: Acute organophosphate (OP) intoxications, accidental or voluntary, are responsible for a high mortality. They cause extensive muscular paralysis by acetyl cholinesterase activity inhibition at the neuromuscular junction level. AIM: To underline the rarity and the characteristic electrophysiological pattern during cholinergic crisis. OBSERVATION: A 28-year-old woman was admitted to the medical intensive care unit for Malathion acute intoxication with signs of glandular hypersecretion, complicated tetraparesis, and respiratory distress. The cholinesterase activity was 17%. The electroneuromyography showed multiple motor responses to the same stimulation, which is characteristic of the cholinergic crisis. Other electrophysiological parameters, in particular low-frequency repetitive stimulations, were normal. The evolution was favourable after symptomatic treatment and respiratory assistance. DISCUSSION AND CONCLUSIONS: Organophosphate intoxications evolve in three phases: acute cholinergic crisis, intermediate syndrome, and delayed neuropathy. While the electrophysiological aspects of delayed neuropathy are best characterized, those of crisis and intermediate syndrome remain very little studied. The persistence of acetylcholine in the synaptic slit would explain the multiple motor responses to single stimulation during the crisis.