RESUMO
Common presentations of tularemia include pneumonia and ulceroglandular, oropharyngeal, or typhoidal disease. Neuromeningeal involvement is extremely rare. We report a case of a severe rhombencephalitis due to Francisella tularensis. Diagnosis was possible thanks to a very precise interview, and the patient dramatically improved after specific antibiotherapy.
Assuntos
Encefalite/diagnóstico , Encefalite/patologia , Francisella tularensis/isolamento & purificação , Tularemia/diagnóstico , Tularemia/patologia , Antibacterianos/uso terapêutico , Encéfalo/diagnóstico por imagem , Encefalite/tratamento farmacológico , Encefalite/microbiologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Radiografia , Resultado do Tratamento , Tularemia/tratamento farmacológico , Tularemia/microbiologiaRESUMO
OBJECTIVE: The variability of the medical information available on the Internet (MedInfoWeb) raises concern about its quality. There is no data about the quality of MedInfoWeb concerning epidural analgesia for labour (EAL). Our aims were to assess the quality of MedInfoWeb concerning EAL and to study the stability of MedInfoWeb and the ranking of website into search engine (SE) during 1year. STUDY DESIGN: Observational study. MATERIALS AND METHODS: We created our own data form to analyse the firsts 40 Google(®), Alta Vista(®) and Yahoo(®) websites. In 2009 and 2010, two independent assessors assessed the quality of the website structure (structure score noted out of 25) and the quality of medical information (medical score noted out of 30). The global score (noted on 55) was the addition of structure and medical scores. A HONcode labelling was noted. RESULTS: Between 2009 and 2010, the average global (23 vs. 22), structure (11 vs. 11) and medical (12 vs. 12) Scores were stable. The SE's quality was comparable. A SE website's rank was not related to its global score. The labelling HONcode websites were the best (26 vs. 21, P=0.048). The best website in 2009 and 2010 was doctissimo.fr. In 2010, only 58% of the websites were still presents. CONCLUSION: The quality of MedInfoWeb concerning EAL is poor and did not improve between 2009 and 2010. The MedInfoWeb is unstable: 42% of the websites disappeared in 1year. No website or SE is currently able to give reliable medical information concerning EAL.