RESUMO
Thiamine-responsive megaloblastic anaemia (TRMA) is a syndrome associated with megaloblastic anaemia, diabetes mellitus and sensorineural deafness, due to mutations in the SLC19A2gene, which codes for a thiamine carrier protein. Oral thiamine supplementation is the main treatment. We report the case of a 19-year-old man known for TRMA, who presented in the emergency department with bicytopenia (haemoglobin 5,4 g/dL, thrombocytes 38×109/L) revealed by dyspnea and chest pain. Investigations excluded bleeding, hemolysis, coagulopathy and iron deficiencies. A recent infection and an acute coronary syndrome have also been eliminated. We later found out that thiamine treatment had been discontinued three months before, due to general confinement in Tunisia during the COVID-19 pandemic. Parenteral administration of 100 mg of thiamine daily resulted in the recovery of haematopoiesis within three weeks.
Assuntos
Anemia Megaloblástica/sangue , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Diabetes Mellitus/sangue , Perda Auditiva Neurossensorial/sangue , Pandemias , Pneumonia Viral/epidemiologia , Deficiência de Tiamina/congênito , Trombocitopenia/etiologia , Síndrome Coronariana Aguda/diagnóstico , Anemia Megaloblástica/tratamento farmacológico , Anemia Megaloblástica/fisiopatologia , COVID-19 , Dor no Peito/etiologia , Diabetes Mellitus/tratamento farmacológico , Diabetes Mellitus/fisiopatologia , Diagnóstico Diferencial , Hemoglobinas Glicadas/análise , Acessibilidade aos Serviços de Saúde , Perda Auditiva Neurossensorial/tratamento farmacológico , Perda Auditiva Neurossensorial/fisiopatologia , Hemoglobinas/análise , Humanos , Masculino , Derrame Pericárdico/diagnóstico por imagem , Derrame Pericárdico/etiologia , Recidiva , SARS-CoV-2 , Tiamina/provisão & distribuição , Tiamina/uso terapêutico , Deficiência de Tiamina/sangue , Deficiência de Tiamina/tratamento farmacológico , Deficiência de Tiamina/fisiopatologia , Tunísia , Adulto JovemRESUMO
Thiamine-responsive megaloblastic anaemia (TRMA) is a syndrome associated with megaloblastic anaemia, diabetes mellitus and sensorineural deafness, due to mutations in the SLC19A2 gene, which codes for a thiamine carrier protein. Oral thiamine supplementation is the main treatment. We report the case of a 19-year-old man known for TRMA, who presented in the emergency department with bicytopenia (haemoglobin 5,4 g/dL, thrombocytes 38×109/L) revealed by dyspnea and chest pain. Investigations excluded bleeding, hemolysis, coagulopathy and iron deficiencies. A recent infection and an acute coronary syndrome have also been eliminated. We later found out that thiamine treatment had been discontinued three months before, due to general confinement in Tunisia during the COVID-19 pandemic. Parenteral administration of 100 mg of thiamine daily resulted in the recovery of haematopoiesis within three weeks
Assuntos
COVID-19 , Adulto , Anemia Megaloblástica , TunísiaRESUMO
BACKGROUND: Smoking cessation should be a priority for smokers, especially coronary patients. AIM: To study the place and effectiveness of acupuncture in smoking cessation in coronary patients. METHODS: We conducted a prospective open-label study of 25 coronary smokers treated by acupuncture over a 10-month period, from June 2017 to March 2018. A 2-session protocol acupuncture weekly for three to five weeks, with a positive response. In order to evaluate the effectiveness of acupuncture, a questionnaire was completed by the doctor during the treatment, at three and six months after the end of the sessions. Positive response was defined by total cessation of smoking. RESULTS: The average age of our patients was 55.5 years (33 to 77 years). The sex ratio of our population was 1.5 with a male predominance. All our patients had a coronary history. The average cigarette consumption was 22.7 pack-years on average. The results of our study showed that acupuncture allows the withdrawal of 5 smokers (20%) from the first session. After the fifth session, 60% of our patients stopped smoking. At the end of the treatment, 17 smokers (70%) stopped smoking completely. At 3 and 6 months of treatment, we observed a stabilization of smoking cessation and decrease rates. CONCLUSION: Smoking cessation is difficult to obtain whatever the therapeutic method used, which encourages us to strengthen preventive measures.