RESUMO
We report on a case of endocarditis attributable to Cardiobacterium hominis in a 31-year-old man who presented with acute-onset, left-sided hemiparesthesia. Magnetic resonance imaging of the brain showed acute infarctions in 2 areas of the right cerebral cortex, and a transesophageal echocardiogram revealed vegetation in a previously unrecognized bicuspid aortic valve. The patient completed a 6-week course of ceftriaxone and aspirin, with resolution of the vegetation and neurological complications. Our literature review of C. hominis endocarditis suggests that aortic-valve involvement is associated with high stroke and valve-surgery rates. Favorable outcomes and treatment success are evident with either penicillin or ceftriaxone, in combination with (if indicated) valve surgery in patients with neurological complications.
Assuntos
Cardiobacterium , Infarto Cerebral/diagnóstico , Endocardite Bacteriana/diagnóstico , Infecções por Bactérias Gram-Negativas/diagnóstico , Embolia Intracraniana/diagnóstico , Infecções Oportunistas/diagnóstico , Tendão do Calcâneo , Adulto , Anti-Inflamatórios/efeitos adversos , Anti-Inflamatórios/uso terapêutico , Anti-Inflamatórios não Esteroides/efeitos adversos , Anti-Inflamatórios não Esteroides/uso terapêutico , Angiografia Cerebral , Doença de Crohn/tratamento farmacológico , Ecocardiografia Transesofagiana , Humanos , Angiografia por Ressonância Magnética , Masculino , Mesalamina/efeitos adversos , Mesalamina/uso terapêutico , Prednisona/efeitos adversos , Prednisona/uso terapêutico , Tendinopatia/tratamento farmacológicoRESUMO
Exenatide is a new injectable medication for the treatment of hyperglycemia in type 2 diabetes. Due to limited information of exenatide use in Asians and Pacific Islanders (API), we retrospectively reviewed API patients' responses to exenatide treatment and compared the efficacy and safety of treatment to Caucasian patients. A total of 92 patients (70 API, 21 Caucasians, and 1 Hispanic) with type 2 diabetes were treated with exenatide. In all patients, there was a significant decrease in A1c level, BMI, and weight after 6 months of exenatide treatment (A1c from 8.63 +/- 1.46 to 8.23 +/- 1.46; P = 0.03, BMI from 34.54 +/- 7.07 to 32.14 +/- 6.41; P < 0.01, and weight from 215.24 +/- 52.04 to 202.50 +/- 49.90; P < 0.01 at 95% CI, N = 51). However, differences in mean change of A1c level, BMI, and weight between API and Caucasian patients were not observed at 3 and 6 months of treatment. Side effects and discontinuation of exenatide treatment between API and Caucasian patients were similar. In conclusion, exenatide is an effective anti-hyperglycemic agent in API patients with responses similar to that observed for Caucasian patients.