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INTRODUCTION: Identifying effective drugs for Coronavirus disease 2019 (COVID-19) is urgently needed. An efficient approach is to evaluate whether existing approved drugs have anti-SARS-CoV-2 effects. The antiviral properties of lithium salts have been studied for many years. Their anti-inflammatory and immune-potentiating effects result from the inhibition of glycogen synthase kinase-3. AIMS: To obtain pre-clinical evidence on the safety and therapeutic effects of lithium salts in the treatment of COVID-19. RESULTS: Six different concentrations of lithium, ranging 2-12 mmol/L, were evaluated. Lithium inhibited the replication of SARS-CoV-2 virus in a dose-dependent manner with an IC50 value of 4 mmol/L. Lithium-treated wells showed a significantly higher percentage of monolayer conservation than viral control, particularly at concentrations higher than 6 mmol/L, verified through microscopic observation, the neutral red assay, and the determination of N protein in the supernatants of treated wells. Hamsters treated with lithium showed less intense disease with fewer signs. No lithium-related mortality or overt signs of toxicity were observed during the experiment. A trend of decreasing viral load in nasopharyngeal swabs and lungs was observed in treated hamsters compared to controls. CONCLUSIONS: These results provide pre-clinical evidence of the antiviral and immunotherapeutic effects of lithium against SARS-CoV-2, which supports an advance to clinical trials on COVID-19's patients.
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Tratamento Farmacológico da COVID-19 , Animais , Antivirais/farmacologia , Antivirais/uso terapêutico , Cricetinae , Humanos , Lítio , SARS-CoV-2 , SaisRESUMO
OBJECTIVES: To describe the past 20 years' correction modalities for keratoconus and their visual outcomes and possible complications. METHODS: A review of the published literature related to the visual outcomes and possible complications in the context of keratoconus management using nonsurgical procedures for the last 20 years (glasses and contact lenses) was performed. Original articles that reported the outcome of any correction modalities of keratoconus management were reviewed. RESULTS: The most nonsurgical procedure used on keratoconus management is the contact lens fitting. Soft contact lenses and soft toric contact lenses, rigid gas-permeable contact lenses, piggyback contact lens system, hybrid contact lenses, and scleral and corneoscleral contact lenses form the contemporary range of available lens types for keratoconus management with contact lenses. All of them try to restore the vision, improve the quality of life, and delay surgical procedures in patients with this disease. Complications are derived from the intolerance of using contact lens, and the use of each depends on keratoconus severity. CONCLUSIONS: In the context of nonsurgical procedures, the use of contact lenses for the management of keratoconic patients represents a good alternative to restore vision and improve the quality of live in this population.
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We revised 7988 laparoscopies over twenty years. Three hundred and ninety three were urgent laparoscopies: 325 patients with acute spontaneous abdomen and 68 acute traumatic abdomen. Emergency laparoscopy is made in patients with, both spontaneous and traumatic acute abdomen, when diagnosis is not made in 8 hours with the usual clinical and imaging methods. Acute diffuse peritonitis was the commonest finding in the first group (21%) and splenic rupture in the traumatic group (34%). There were two severe complications (0.5%): pulmonary oedema in a patient with myocardial disease and a respiratory failure in a old patient, which were resolved. We had two deaths related to laparoscopic diagnosis: massive mesenteric thrombosis and fecal peritonitis. There are few contraindications and tolerance is very good. This study shows a sensitivity of 98%, a specificity of 90%, a predictive positive value greater than 98% and a negative predictive value of 100%. In summary, the present study demonstrates that emergency laparoscopy is a effective diagnostic method in acute abdominal pain of uncertain aetiology.
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Abdome Agudo/diagnóstico , Traumatismos Abdominais/diagnóstico , Laparoscopia , Abdome Agudo/etiologia , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Diagnóstico Diferencial , Emergências , Endometriose/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cistos Ovarianos/complicações , Cistos Ovarianos/diagnóstico , Neoplasias Ovarianas/complicações , Neoplasias Ovarianas/diagnóstico , Gravidez , Gravidez Ectópica/diagnóstico , Salpingite/diagnósticoRESUMO
We reviewed 46 cases of Crohn's disease diagnosed during the period between 1978-1988, with the intention to analyse the age, sex, presentation, evolution, complications and diagnosis. The majority of patients were women, with a mean age of 39. In the last years we have seen an increment in our number of cases. The mean time to diagnosis was about 3.5 years. The main symptoms were abdominal pain, diarrhoea and loss of weight. The complications was of 40% in colonic disease and 75% when the affection was in ileum and colon. During the evolution 4 patients died, 2 of them from their Crohn's disease. One patient had a colonic carcinoma. In 15% of the cases there was a previous appendectomy. The most frequent radiological findings were in the small intestine: lack of haustration and cobblestone appearance. In the colon: lack of haustration and ulceration. The most frequent endoscopical findings were ulcers and a cobblestone appearance.
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Doença de Crohn/epidemiologia , Adolescente , Adulto , Idoso , Doença de Crohn/complicações , Feminino , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Espanha/epidemiologiaRESUMO
Hemangiomas are de most frequent benign liver tumours. Their clinical relevance is small but they can cause to the patient and/or the physician a great worry because can be indistinguishable from hepatic malignances. From 1991 to 1994 five patients with liver hemangiomas were diagnosed by laparoscopy after a erroneous and/or contradictory interpretation by various imaging techniques. In four cases hemangiomas resembled metastatic carcinoma of the liver, and in the other patient hemangioma was interpreted as focal nodular hyperplasia. Diagnosis and treatment are discussed.
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Hemangioma/diagnóstico , Laparoscopia , Neoplasias Hepáticas/diagnóstico , Carcinoma/diagnóstico , Diagnóstico Diferencial , Erros de Diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Wegener's granulomatosis is a necrotizing granulomatous vasculitis often characterized by involvement of the upper respiratory tract, lungs and kidney, although any organic system can be affected. We present the case of a female patient with Wegener's granulomatosis diagnosed by biopsy of the kidney, and severe gastrointestinal bleeding with fatal course. Endoscopic findings of the colon and the histopathology of the biopsy are discussed.
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Gastroenteropatias/etiologia , Granulomatose com Poliangiite/complicações , Doença Aguda , Biópsia , Feminino , Gastroenteropatias/patologia , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/patologia , Granulomatose com Poliangiite/patologia , Humanos , Rim/patologia , Pessoa de Meia-IdadeRESUMO
Local hepatic tuberculosis without active pulmonary or miliary tuberculosis is an uncommon diagnosis. Even less common is the finding of a nodular form of local hepatic tuberculosis. There is a growing incidence of the disease related to human immunodeficiency virus. The authors report a case of pseudotumoral hepatic tuberculosis in a patient without AIDS, manifesting as prolonged fever, diagnosed previously as metastatic liver. Imaging studies of the liver and laparoscopic findings suggested metastatic disease. The correct diagnosis was made by histology of biopsies obtained in laparoscopy, which is an easy and cheap method, with less morbidity and mortality than surgical intervention. The case report illustrates the difficulty in reaching the correct diagnosis, most often confused with carcinoma of the liver, primary or metastatic. A greater awareness of this rare clinical entity may prevent needless surgical intervention since the majority of patients respond well to antituberculous chemotherapy.
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Laparoscopia , Neoplasias Hepáticas/diagnóstico , Tuberculose Hepática/diagnóstico , Idoso , Biópsia , Diagnóstico Diferencial , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Masculino , Tomografia Computadorizada por Raios X , Tuberculose Hepática/diagnóstico por imagem , Tuberculose Hepática/patologiaRESUMO
INTRODUCTION: Horner syndrome (HS) involves an injury affecting the ocular sympathetic nerve, which gives rise to myosis, palpebral ptosis and enophthalmos, and is accompanied by hemifacial anhidrosis in its complete forms. Its extension means that its involvement can occur in different structures and as a result of different medical and surgical processes. CASE REPORT: We describe the case of two patients who developed a subacute form of HS without involvement of the sweating process and which was not accompanied by any other clinical features affecting the orbit, neck, brain, spinal cord or of a radicular nature. Both of them had been submitted to thoracoplasty as therapy for tuberculosis over 30 years earlier. The complementary studies that were conducted did not reveal involvement of the ocular sympathetic nerve anywhere other than in the pleura. CONCLUSIONS: The lesion would have been produced in the endothoracic fascia, where the cervical sympathetic chain is closely related to the apical pleura, and the physiopathological mechanism would be fibrosis of the aforementioned structures. Many reports have been published that describe the onset of HS as an acute complication following thoracic surgery, but its late development is infrequent.
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Síndrome de Horner/diagnóstico , Complicações Pós-Operatórias , Toracoplastia/métodos , Idoso , Feminino , Síndrome de Horner/diagnóstico por imagem , Síndrome de Horner/tratamento farmacológico , Humanos , Masculino , Fatores de Tempo , Tomografia Computadorizada por Raios XRESUMO
INTRODUCTION: Central retinal vein thrombosis (CRVT) is a multifactorial disease and known risk factors include high blood pressure, diabetes mellitus, hypercholesterolemia and primary open-angle glaucoma. Yet in patients below the age of 60, a state of hyperviscosity and hypercoagulability in the absence of other vascular risk factors are important factors, as is hyperhomocysteinemia, an independent risk factor for venous thromboses. Homocysteine is an essential amino acid produced by the transmethylation of methionine. It can be remethylated using enzymes that require folate and cobalamin to re-form methionine or to catabolize for cystathionine beta-synthetase, which is dependent on pyridoxine to form cysteine. Hyperhomocysteinemia can give rise to a dysfunction in the endothelium of the vessel, with a proliferation of vascular smooth muscle and prothrombotic homostatic changes. CASE REPORT: A male, aged 33, with no vascular risk factors except cigarette smoking who presented a sharp drop in visual acuity in the right eye. An ophthalmological examination revealed the presence of CRVT, which was confirmed by fluorescein angiography. The results of all analytical and imaging studies conducted while the patient was in hospital were negative. Later analytical monitoring showed a moderate increase in homocysteine. CONCLUSION: From a survey of the literature we have found an important relation between CRVT and hyperhomocysteinemia, which has been noted as a potential risk factor and which requires therapy.
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Hiper-Homocisteinemia/complicações , Oclusão da Veia Retiniana/etiologia , Doenças Vasculares/etiologia , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Retina/patologia , Oclusão da Veia Retiniana/patologia , Fatores de Risco , Doenças Vasculares/patologiaRESUMO
We reviewed 96 cases of ulcerative colitis diagnosed during the period between 1970 and 1988, with the intention of analysing the presentation, complications, evolution and diagnosis aspects. The most frequent presentation symptoms were mucoid and bloody diarrhea (91.3%) and abdominal pain (84%), isolated rectal bleeding being predominated in distal type. The frequency of complications were 17.14%. X-ray findings were the lack of haustration and ulcers, the rate of normal barium enema being of 27.27% (without double contrast). Rectum was not affected in 6.8%. The endoscopy showed an edematous and congestive mucosa, ulcer with normal barium enema. The most significant anatomopathological findings were the lymphoplasmocyte and polynuclear infiltration of the proper lamina and epithelial ulcer, with a lack of cripta and absence of metaplasia of Paneth's cells. In our area, we have to use colonoscopy to diagnose the disease, because the double contrast barium enema is not performed as a routine. Only a few (5) of our patients needed surgical treatment.
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Colite Ulcerativa/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Colite Ulcerativa/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Espanha/epidemiologiaRESUMO
Eosinophilic gastroenteritis is an unusual entity that is rarely found in daily clinical practise. Its aetiology is unknown and diagnosis can be made microscopically with evidence of massive eosinophilic infiltration in patients with chronic gastrointestinal symptoms, excluding entities that may cause such findings (parasitic infestation, medical therapy, inflammatory bowel disease, and so on). Allergic processes are usually associated and these normally respond well to steroids. We present our last year's experience of four women with eosinophilic gastroenteritis with an extraordinary atypical clinical onset. Two of the women presented with an acute abdomen and two with isolated colonic involvement. The management of acute abdomen avoiding surgery and a complete response with azathioprine are the outstanding variables that make our recent cases of special interest. Demographic variables were similar to others reported from our medium, with the exception of a higher incidence of women. Our cases suggest the wide spectrum of clinical presentations and show the high suspicion index needed for a diagnosis that is made by pathologists.
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Eosinofilia/diagnóstico , Gastroenterite/diagnóstico , Abdome Agudo/etiologia , Adulto , Colo/patologia , Feminino , Gastroenterite/complicações , Gastroenterite/epidemiologia , Humanos , Pessoa de Meia-IdadeRESUMO
Pneumonia due to Listeria monocytogenes is extremely uncommon. We report the case of an 87-year-old woman with no underlying immunosuppressive disease who presented with listerial pneumonia. Cutaneous anergy and a decrease in total lymphocyte count in this elderly woman could predispose her to listerial infection.
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Listeria monocytogenes , Pneumonia Bacteriana/microbiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
An epidemiological study of inflammatory bowel disease in the Province of Granada, Spain, was conducted between 1979 and 1988. Altogether, 257 cases were identified: 167 ulcerative colitis, 79 Crohn's disease, and 11 indeterminate colitis. The mean incidence of ulcerative colitis in the 10 year period was 2/10(5) and 0.9/10(5) for Crohn's disease. This is the first epidemiological study in Spain of the incidence of ulcerative colitis and corroborates the results of an earlier population based study on the incidence of Crohn's disease in Spain.