RESUMO
INTRODUCTION: Adrenal hemorrhage is a classical but rare complication of antiphospholipid syndrome, revealing diagnosis in one third of the cases. Anti-vitamin K therapy is the standard treatment but direct oral anticoagulants are discussed as an alternative. In the latest recommendations, it is advised not to use direct oral anticoagulants in the setting of antiphospholipid syndrome. CASE REPORT: We present a case of bilateral adrenal hemorrhage revealing primary antiphospholipid syndrome with triple positive antibody profile, in a 47-year-old man treated by apixaban for previous venous thromboembolism. CONCLUSION: To our knowledge, it is the first case of adrenal hemorrhage occurring during apixaban treatment in a patient with antiphospholipid syndrome. This case illustrates the inefficacy of direct oral anticoagulants to prevent thrombotic events in antiphospholipid syndrome, in accordance with the latest recommendations.
Assuntos
Doenças das Glândulas Suprarrenais/induzido quimicamente , Síndrome Antifosfolipídica/diagnóstico , Hemorragia/induzido quimicamente , Pirazóis/efeitos adversos , Piridonas/efeitos adversos , Doenças das Glândulas Suprarrenais/diagnóstico , Glândulas Suprarrenais/efeitos dos fármacos , Glândulas Suprarrenais/patologia , Síndrome Antifosfolipídica/complicações , Hemorragia/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Necrose/induzido quimicamente , Necrose/diagnóstico , Pirazóis/uso terapêutico , Piridonas/uso terapêutico , Tromboembolia Venosa/complicações , Tromboembolia Venosa/tratamento farmacológicoAssuntos
Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/diagnóstico , Confusão/etiologia , Linfoma de Células B/complicações , Linfoma de Células B/diagnóstico , Alcoolismo/complicações , Neoplasias Encefálicas/tratamento farmacológico , Glucocorticoides/uso terapêutico , Humanos , Linfoma de Células B/tratamento farmacológico , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fumar/efeitos adversos , Resultado do TratamentoRESUMO
INTRODUCTION: In the elderly, both the presence of a multiple pathology and multiple medication have been shown to be frequent risk factors for adverse drug events. However, a few studies only have included parameters of standardized geriatric assessment for the purpose of identifying other risk factors. Our study compared the parameters of standard geriatric assessment, in the presence or absence of adverse drug events and evaluated the prevalence of adverse drug events in elderly inpatients, the symptoms, and the drugs involved. METHODS: A total of 823 patients were studied during a two-year period. Two groups of patients were identified, according to the presence or absence of an adverse drug event. Eight fields of geriatric assessment were compared: comorbidities, number of drugs, functional status, nutritional status, mobility, mood, neurosensory disorders, and cognition. For patients who experienced an adverse drug event, we also analyzed the drugs involved and the symptoms of the adverse drug events. RESULTS: One hundred and twelve patients (13.6%) aged 82 years+/-7.5 experienced 144 adverse drug events. Significant differences between the two groups were observed in the following: symptoms of depression, problems of mobility, risk of malnutrition (respectively p=0.001, p=0.002, p=0.007), the female sex, number of drugs, number of comorbidities, and the administration of diuretics. Cardiovascular (23.2%), psychotropic (17.9%) and anti-infectious (17%) medicines were the most frequently involved. The symptoms that occurred most frequently were orthostatic hypotension (14.6%), gastrointestinal disorders (12.5%), and neuropsychological (10.4%) disorders. CONCLUSION: Elderly patients with multiple pathology and multiple medication are at high risk for adverse drug events. Other lesser known factors, such as depression, problems of mobility, and malnutrition must be researched, as they are evidence of the underlying the frailty of the elderly population.
Assuntos
Sistemas de Notificação de Reações Adversas a Medicamentos , Envelhecimento , Prescrições de Medicamentos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Avaliação Geriátrica , Hospitalização/estatística & dados numéricos , Sistemas de Notificação de Reações Adversas a Medicamentos/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , França/epidemiologia , Hospitais Universitários , Humanos , Medicina Interna/estatística & dados numéricos , Masculino , Erros de Medicação/estatística & dados numéricos , Prevalência , Estudos Retrospectivos , Fatores de Risco , Distribuição por SexoRESUMO
PURPOSE: High variability has been observed in the estimation of the glomerular filtration rate (GFR) in older patients, according to the formula used and no single formula has been recommended to date. The aim of this study was to quantify the precision and accuracy of the GFR estimated by means of three formulas and the measurement of cystatin C. METHODS: This prospective study was conducted in an acute care geriatric unit. Participants were patients, aged 70 years and over, having a possible 24-hour urine collection. The GFR was estimated using the Cockroft-Gault (CG), the Modification of Diet in Renal Disease (MDRD), and the Creatinine Clearance (Cl-Cr) formulas. The serum level of cystatin C was also measured. RESULTS: Eighty-one patients were included in the study. CG formula underestimated the GFR by a mean difference of 8.65 ml/min, compared with MDRD formula. Cl-Cr underestimated the GFR by a mean difference of 7.56 ml/min, compared with CG formula, and by a mean difference of 16.79 ml/min, compared with the MDRD formula. The degree of discrepancy between CG and Cl-Cr estimates, and between Cl-Cr and MDRD estimates decreased as the estimated GFR approached normal values. MDRD best matched the measurement of cystatin C, followed by CG and Cl-Cr (Kappa coefficient=0.43, 0.22 and 0.16, respectively). CONCLUSION: Our study confirms the high variability of GFR in older patients and particularly in those with abnormal renal function, depending on the formula used. Serum cystatine C level and MDRD formula appear to be the most concordant estimates of GFR in this population.
Assuntos
Taxa de Filtração Glomerular/fisiologia , Pacientes Internados , Urinálise/métodos , Idoso , Idoso de 80 Anos ou mais , Albuminúria/epidemiologia , Creatinina/sangue , Creatinina/urina , Cistatina C , Cistatinas/urina , Humanos , Estudos Prospectivos , Sensibilidade e EspecificidadeRESUMO
Acute lithium intoxication may occur in circumstances causing kidney failure, when using lithium chronically. This situation may lead to neurological symptoms with coma, gastrointestinal disorders with diarrhea, cardiovascular symptoms with hypotension and metabolic symptoms with hypercalcemia. Nephrogenic diabetes insipidus may also develop. We report the case of a 69-year-old woman suffering from unipolar manic-depressive psychosis and treated by lithium for 10 years. This case highlights the need to monitor serum lithium levels in patients on long-term lithium regimens, especially in circumstances involving dehydration.
Assuntos
Transtorno Bipolar/tratamento farmacológico , Diabetes Insípido Nefrogênico/induzido quimicamente , Compostos de Lítio/efeitos adversos , Idoso , Desidratação/induzido quimicamente , Desidratação/etiologia , Feminino , HumanosAssuntos
Aneurisma , Síndrome de Behçet/complicações , Artéria Pulmonar , Corticosteroides/administração & dosagem , Corticosteroides/uso terapêutico , Adulto , Aneurisma/diagnóstico , Aneurisma/diagnóstico por imagem , Aneurisma/tratamento farmacológico , Aneurisma/cirurgia , Angiografia , Azatioprina/administração & dosagem , Azatioprina/uso terapêutico , Síndrome de Behçet/diagnóstico , Diagnóstico Diferencial , Quimioterapia Combinada , Seguimentos , Hemoptise/etiologia , Humanos , Imunossupressores/administração & dosagem , Imunossupressores/uso terapêutico , Masculino , Pneumonectomia , Artéria Pulmonar/diagnóstico por imagem , Radiografia Torácica , Síndrome , Fatores de Tempo , Resultado do TratamentoRESUMO
INTRODUCTION: The term 'primary' osteoporosis refers to osteoporosis that results from the involutional losses associated with aging and, in women, additional losses related to natural menopause. Osteoporosis that is caused or exacerbated by other disorders or medication exposures is referred to as 'secondary' osteoporosis. CURRENT KNOWLEDGE AND KEY POINTS: This article describes the major causes and provides a framework for the diagnostic investigation of patients with suspected of having secondary osteoporosis. There are numerous causes of secondary bone loss, including endocrine disorders, disorders of the gastrointestinal or biliary tract, rheumatic diseases, haematological diseases, immobilization, adverse effects of drug therapy, and a wide miscellaneous group. FUTURE PERSPECTIVES: Secondary osteoporosis is potentially reversible during the treatment of the underlying disease. It must be identified and induce a symptomatic treatment in all cases plus an etiologic treatment when possible.
Assuntos
Medicina Interna , Osteoporose/diagnóstico , Osteoporose/etiologia , Diagnóstico Diferencial , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Doenças do Sistema Endócrino/complicações , Gastroenteropatias/complicações , Doenças Hematológicas/complicações , Humanos , Imobilização , Doenças Reumáticas/complicaçõesRESUMO
PURPOSE: Tuberculosis involving the central nervous system (CNS) is rarely observed in non immuno-compromised hosts. We report herin the various clinical, biological and radiological manifestations observed in 7 patients with CNS tuberculosis. METHODS: Clinical and biological records of 7 patients with CNS tuberculosis were retrospectively studied. All patients had encephalic CT-scan and MRI in the course of the disease. RESULTS: 5 women and 2 men with a mean age of 38.4 years initially initially presented with headache (n = 6), fever (n = 5), meningeal irritation (n = 3), localizing neurological signs (n = 1). Lumbar punction revealed lymphocytic meningitis (n = 6/7). Mycobacterium tuberculosis or bovis was isolated in 3 patients only. Cerebral tomodensitography or magnetic resonance imaging were initially normal in most of cases (n = 4/7), but discovered in the course of disease basilar meningitis (n = 6), hydrocephalus (n = 6), abcess or tuberculoma (n = 4). In all the patients, initiation of the treatment was complicated by clinical and/or biological deterioration, called paradoxal reaction, leading in all cases to glucocorticoid adjunction, with various final results. Indeed, 4 patients developed neurological sequelae. No patient died. CONCLUSION: CNS tuberculosis is a rare disease in non immunocompromised patients whose diagnostic may be difficult due to the absence of specific clinical symptoms, negative initial radiological examination, as well as delayed and often negative bacterial isolation. Paradoxal reaction appeared to be frequent despite specific antibiotherapy and underlines the beneficial effects of addictive corticosteroids.
Assuntos
Imunocompetência , Tuberculose do Sistema Nervoso Central/diagnóstico , Corticosteroides/uso terapêutico , Adulto , Antituberculosos/uso terapêutico , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis/isolamento & purificação , Gravidez , Estudos Retrospectivos , Resultado do Tratamento , Tuberculoma Intracraniano/diagnóstico , Tuberculoma Intracraniano/tratamento farmacológico , Tuberculoma Intracraniano/microbiologia , Tuberculose do Sistema Nervoso Central/tratamento farmacológico , Tuberculose do Sistema Nervoso Central/microbiologia , Tuberculose Meníngea/diagnóstico , Tuberculose Meníngea/tratamento farmacológico , Tuberculose Meníngea/microbiologiaRESUMO
We report a case of fulminant presentation of thrombotic microangiopathy associated with Hodgkin's lymphoma in an HIV-infected patient. After aggressive therapy with antiretroviral drugs, chemotherapy, and plasmatherapy, complete remission of thrombotic microangiopathy and Hodgkin's lymphoma was observed.
Assuntos
Eletrodos Implantados/efeitos adversos , Endocardite Bacteriana/etiologia , Hipotireoidismo/etiologia , Marca-Passo Artificial/efeitos adversos , Embolia Pulmonar/etiologia , Idoso , Tosse/etiologia , Dispneia/etiologia , Ecocardiografia Transesofagiana , Endocardite Bacteriana/diagnóstico , Feminino , Humanos , Hipotireoidismo/sangue , Hipotireoidismo/tratamento farmacológico , Embolia Pulmonar/diagnóstico , Tomografia Computadorizada por Raios XAssuntos
Anabolizantes/efeitos adversos , Discite/etiologia , Infecções por Bactérias Gram-Positivas/etiologia , Propionibacterium acnes , Adulto , Discite/diagnóstico , Discite/terapia , Discotomia , Infecções por Bactérias Gram-Positivas/diagnóstico , Infecções por Bactérias Gram-Positivas/terapia , Humanos , Injeções Intramusculares , Imageamento por Ressonância Magnética , MasculinoRESUMO
INTRODUCTION: Acquired factor V inhibitor is rare and clinical symptoms are quite variable. Bleeding is the leading symptom but some patients are asymptomatic. Several diseases or conditions are associated with factor V inhibitors. Various treatments have been attempted but randomized or prospective trials are not available. EXEGESIS: Here we report three cases of acquired factor V inhibitor. These reports highlight the clinical variability of this disorder. Pathogenesis and therapy with reference to the literature are discussed. CONCLUSION: Factor V inhibitors are rare and associated to several diseases or conditions. Pathogenesis is still unclear except in patients exposed to bovine thrombin. The majority of the cases developed after surgery. In a few cases there is an association to a malignant or autoimmune disease. Plasmapheresis and platelet transfusions might be the best treatment in case of severe bleeding. High-dose intravenous immunoglobulin infusions have been used successfully in some cases and we report here their efficacy in two cases.
Assuntos
Transtornos da Coagulação Sanguínea/etiologia , Fator V/antagonistas & inibidores , Hemorragia/etiologia , Idoso , Feminino , Hemorragia/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Fatores de RiscoAssuntos
Histiocitose de Células não Langerhans/parasitologia , Malária Falciparum/complicações , Idoso , Animais , Ferritinas/deficiência , Histiocitose de Células não Langerhans/complicações , Histiocitose de Células não Langerhans/diagnóstico , Humanos , Hipertrigliceridemia/etiologia , L-Lactato Desidrogenase/sangue , Masculino , Pancitopenia/etiologiaAssuntos
Injúria Renal Aguda/etiologia , Bacteriemia/complicações , Coagulação Intravascular Disseminada/etiologia , Hepatite/etiologia , Rabdomiólise/etiologia , Infecções por Salmonella/complicações , Bacteriemia/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Salmonella/microbiologia , Salmonella enteritidis/isolamento & purificaçãoRESUMO
A screening in vitro of antifungic activity of 24 strains of Basidiomycetes was realized with their culture filtrate. Lycoperdon perlatum Pers. = Pers., Oudemansiella platyphylla (Pers. ex Fr.) Mos., Agrocybe dura (Bolt) Singer have shown an activity against Candida albicans, Candida tropicalis and Aspergillus fumigatus; Pholiota spumosa (Fr.) Singer towards Botrytis cinerea and Lycoperdon perlatum Pers. = Pers. towards Alternaria solani, Botrytis cinerea and Verticillium dahliae. More extensive studies of the kinetics of antifungic substances production from Lycoperdon perlatum Pers. = Pers. were effectued with 2 different media and 2 different seeding technics on the strains which were sensible to the inhibitory character of this Gasteromycete.