RESUMEN
OBJECTIVE: The objective of our study was to evaluate the impact of the lockdown period on the glycemic balance in patients with GDM. METHODS: A retrospective study in one center (Lille, France) compared two periods: the COVID-19 lockdown of 18 March 2020 to 7 May 2020 versus the same period during 2019. Glucose targets were defined by a capillary fasting glucose target < 5.1mmol/L and/or a 2-hour postprandial capillary glucose < 6.6 mmol/L. GDM control was defined as: good (< 20% of the glycemic values were not within the target range), acceptable (20 to 40% of the glycemic values were not within the target range) or poor (> 40% of the glycemic values were not within the target range). RESULTS: Two hundred twenty-nine patients were included in 2019 and 222 in 2020. The same mean number of capillary blood sugar tests was performed by the two groups. Postprandial blood sugar was significantly less well controlled in 2020, with a lower rate of good control (61.6% vs 69.4%) and higher rates of acceptable (24.7% vs 21.8%) and poor control (13.7% and 8.7%) (p < 0.05). Use of insulin therapy was significantly higher in 2020 compared with 2019 (47.7% and 36.2%, respectively; p < 0.05). CONCLUSION: Diabetes control was lower during the COVID-19 pandemic lockdown, even if follow-up was not impacted. This may be explained by reduced physical activity, modified dietary habits and anxiety during this period.
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COVID-19 , Diabetes Gestacional/epidemiología , Adulto , Glucemia/análisis , Femenino , Humanos , Pandemias , Distanciamiento Físico , Embarazo , Estudios RetrospectivosRESUMEN
INTRODUCTION: Bickerstaff brainstem encephalitis is characterized by the occurrence of ataxia, ophthalmoplegia, motor weakness with areflexia and central nervous system symptoms, with drowsiness, pyramidal syndrome and sensorial symptoms. Diagnosis is based on MR findings and GQ1b antibodies. Treatment is not well known. OBSERVATION: We report a patient aged 39 years native of Laos who presented weakness, loss of reflexes, and drowsiness. Brain MR showed hyperintense signals in the brain stem. GQ1b antibodies were positive. The course was characterized by decrease of the weakness, normalization of MR and negativity of GQ1b antibodies. DISCUSSION: This observation underlines common features of Bickerstaff brainstem encephalitis, Miller Fisher syndrome and Guillain Barre syndrome. A favorable course and GQ1b antibodies are shared by these syndromes.
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Autoanticuerpos/sangre , Autoantígenos/inmunología , Ceguera/etiología , Coma/etiología , Enfermedades Autoinmunes Desmielinizantes SNC/diagnóstico , Encefalitis/diagnóstico , Gangliósidos/inmunología , Cuadriplejía/etiología , Corticoesteroides/uso terapéutico , Autoanticuerpos/inmunología , Tronco Encefálico/patología , Terapia Combinada , Enfermedades Autoinmunes Desmielinizantes SNC/complicaciones , Enfermedades Autoinmunes Desmielinizantes SNC/inmunología , Enfermedades Autoinmunes Desmielinizantes SNC/terapia , Electroencefalografía , Encefalitis/complicaciones , Encefalitis/inmunología , Encefalitis/terapia , Femenino , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Atrofia Óptica/etiología , Plasmaféresis , Reflejo Anormal , SíndromeRESUMEN
Pneumocystis carinii (PC) pneumonia was reported with increased frequency in patients presenting with acquired immunodeficiency syndrome (AIDS) or in patients receiving immunosuppressive chemotherapy for hemopathies. Extrapulmonary dissemination of PC is rare. In this study, three patients had PC infection of the bone marrow. Two of them presented with malignant lymphoma that had apparent immunosuppression, and the third patient presented with AIDS. In all three cases, such an infection was observed before or concomittantly with PC pneumonia. A bone marrow biopsy, bone marrow aspirate, or both can be useful, readily available tools for the diagnosis of a PC infection and especially its dissemination in patients with malignant lymphoma after intensive treatment or in patients with AIDS. The appreciation of such a dissemination may have some implications in the treatment of PC infection.
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Síndrome de Inmunodeficiencia Adquirida/complicaciones , Enfermedades de la Médula Ósea/microbiología , Linfoma/complicaciones , Micosis/etiología , Pneumocystis/aislamiento & purificación , Adulto , Anciano , Biopsia , Enfermedades de la Médula Ósea/etiología , Neoplasias Encefálicas/complicaciones , Femenino , Enfermedad de Hodgkin/complicaciones , Humanos , Tolerancia Inmunológica , MasculinoRESUMEN
Serial studies of the plasma protein C-protein S system were performed during the clinical course of a pregnant woman with meningococcaemia who recovered under therapy. The patient had limited purpura fulminans skin lesions and hereditary C4b-binding protein deficiency was suspected. This diagnosis was confirmed in the patient 1 year after delivery and also by family studies. During the meningococcaemia, an initial mild and transient acquired protein C deficiency was seen but no protein S deficiency was observed despite consumption of the latter protein. As C4b-binding protein partial deficiency is associated with high free protein S and protein S activity, this may have protected against acquired protein S deficiency during meningococcaemia.
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Proteínas Portadoras/metabolismo , Proteínas Inactivadoras de Complemento , Glicoproteínas , Meningitis Meningocócica/etiología , Proteína S/análisis , Adulto , Niño , Femenino , Humanos , Masculino , Meningitis Meningocócica/tratamiento farmacológico , Embarazo , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Complicaciones Infecciosas del Embarazo/etiología , Púrpura/complicacionesRESUMEN
The authors report two cases of arteriovenous fistula due to spontaneous rupture of an aortic or iliac aneurysm into the iliocaval venous axis. This is a rare complication of atheromatous aneurysm (less than 4% of ruptured aneurysms), often difficult to diagnose as the clinical presentation may be obscure. Although aortography is the reference diagnostic investigation, color Doppler ultrasonography enabled visualisation of the arteriovenous communication and provided an accurate diagnosis in one recent case. Treatment of these aortocaval fistulae is always surgical. The prognosis and immediate operative mortality depend mainly on the presence of an associated retroperitoneal rupture.
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Aneurisma/complicaciones , Fístula Arteriovenosa/etiología , Arteria Ilíaca , Vena Ilíaca , Anciano , Anciano de 80 o más Años , Aneurisma de la Aorta/complicaciones , Aortografía , Fístula Arteriovenosa/diagnóstico por imagen , Ecocardiografía Doppler , Humanos , Masculino , Tomografía Computarizada por Rayos X , Vena Cava InferiorRESUMEN
INTRODUCTION: We report three cases of neurotoxicity in patients with renal failure, treated with Zelitrex (valacyclovir). EXEGESIS: The patients are two women and a man, aged 76 +/- 4.6 years, who presented acute mental confusion during a treatment with valacyclovir. In two cases, the patients previously had altered renal function and were under peritoneal dialysis. In the last case, the patient had simultaneous neurotoxicity and acute renal failure. After the discontinuation of the drug, the outcome was favourable in all cases. CONCLUSION: Our cases focus attention on the possible neurotoxicity of valacyclovir, which is an amino acid ester prodrug of acyclovir, rapidly and almost completely hydrolysed to acyclovir prior to systemic exposure. The bioavailability of valacyclovir is 54% compared to approximately 20% for oral acyclovir and may account for unexpected overdoses, which may lead to serious neurological toxicity.
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Aciclovir/análogos & derivados , Aciclovir/efectos adversos , Trastornos Mentales/inducido químicamente , Profármacos/efectos adversos , Valina/análogos & derivados , Valina/efectos adversos , Aciclovir/farmacocinética , Anciano , Anciano de 80 o más Años , Disponibilidad Biológica , Sobredosis de Droga , Femenino , Humanos , Masculino , Profármacos/farmacocinética , Insuficiencia Renal/tratamiento farmacológico , Valaciclovir , Valina/farmacocinéticaRESUMEN
BACKGROUND: The cardiac output (CO) is classically measured in intensive care unit patients. pulse contour (PC) method allows monitoring of CO. OBJECTIVE: The aim of the present study was to assess the ability of PC to assess the fluid responsiveness defined as an increase in CO more than or equal to 15% after 500 mL hydroxyethyl starch over 20 minutes. PATIENTS AND METHODS: In this observational prospective study, patients in shock in whom a PC method was inserted were included. CO was measure using the PC and thermodilution methods before and after a fluid challenge indicated by the physician. The correlation coefficient was measured, the diagram of Bland and Altman was built and the percentage of error (Critchley and Critchley method) was calculated. The ability of PC to diagnose fluid responsiveness was assessed using a receiver operating characteristics (ROC) curve. RESULTS: Sixty-two fluid challenges were performed in 37 included patients. After fluid challenge, r(2) was 0.05 (P<0.01), the bias between PC and thermodilution was 0.3 ± 1.2L/min and the percentage of error was 36%. The area of the ROC curve was 0.601 [0.468-0.723]. CONCLUSION: In ICU patients with shock, PC cannot replace thermodilution to diagnose fluid responsiveness.
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Gasto Cardíaco , Pulso Arterial , Termodilución , Anciano , Femenino , Humanos , Derivados de Hidroxietil Almidón , Masculino , Estudios Prospectivos , Reproducibilidad de los ResultadosRESUMEN
BACKGROUND: Classic mortality prediction models in intensive care units (ICUs) are based on clinical scores, which do not contain any coagulation test (SAPS-II or SOFA scores). OBJECTIVES: To determine whether coagulation tests can improve mortality prediction in patients with septic shock. PATIENTS AND METHODS: One hundred fifty-eight consecutive patients with septic shock entering our institution's ICU were investigated on the first day of admission, and deaths were registered during the first month. RESULTS: Among all the coagulation tests performed, only the fibrinogen (Fg) plasma level, together with the SAPS-II score and the age, were included in our simplified mortality score [area under the receiver operating curve (AUC) 0.927, standard deviation (SD) 0.030], which was more efficient than SAPS-II and SOFA scores themselves in predicting first-week mortality, its optimized cut-off having a very high negative predictive value (NPV) [0.989; 95% confidence interval (CI) 0.967-1.000)]. A simplified score predicting first-month mortality, containing the prothrombin ratio and the antithrombin activity values in addition to the age, the hemoglobin concentration, and the SAPS-II and SOFA scores (AUC 0.889, SD 0.026), was found to be superior to the SAPS-II and SOFA scores, the optimized cut-off value having a high NPV (0.952; 95% CI 0.888-1.000). CONCLUSIONS: In patients admitted to an ICU with septic shock, some initial coagulation test values can help identify those who will survive in the first week and then in the first month.
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Pruebas de Coagulación Sanguínea , Fibrinógeno/análisis , Índice de Severidad de la Enfermedad , Choque Séptico/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Área Bajo la Curva , Recuento de Células Sanguíneas , Factores de Coagulación Sanguínea/análisis , Terapia Combinada , Comorbilidad , Coagulación Intravascular Diseminada/sangre , Coagulación Intravascular Diseminada/etiología , Coagulación Intravascular Diseminada/mortalidad , Femenino , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Estudios de Seguimiento , Francia/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Insuficiencia Multiorgánica/sangre , Insuficiencia Multiorgánica/etiología , Insuficiencia Multiorgánica/mortalidad , Valor Predictivo de las Pruebas , Curva ROC , Choque Séptico/sangre , Choque Séptico/terapia , Análisis de SupervivenciaRESUMEN
Pneumocystis carinii is observed in the bone marrow of two adults immuno-compromised; the initial diseases are on the one hand a Hodgkin's disease, on the other hand a malignant lymphoma for immunocytoma type, which necessitate heavy and invalidating treatments. A Pneumocystis carinii pneumonia with respiratory distress seems to have carrying away two patients death. Eventually pathogenic part of the parasite in the bone marrow localization.
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Médula Ósea/parasitología , Enfermedad de Hodgkin/inmunología , Linfoma/inmunología , Pneumocystis/aislamiento & purificación , Neumonía por Pneumocystis/etiología , Adulto , Anciano , Femenino , Humanos , Tolerancia Inmunológica , MasculinoRESUMEN
Isolated acquired factor VII deficiency is uncommon. We report 11 cases of acquired factor VII deficiency associated with severe systemic sepsis. All patients initially displayed a heterozygous-like factor VII deficiency confirmed by both clotting and amidolytic assays, associated with low factor VII antigen levels, and increased haemostasis markers (D-dimers, prothrombin fragments 1.2, thrombin-antithrombin complexes). After sepsis recovery, normal factor VII levels were evidenced. Isolated factor VII consumption or proteolytic degradation by leucocyte proteases can be evoked, but the mechanism of acquired factor VII deficiency during sepsis remains to be elucidated. The knowledge of this syndrome should avoid false diagnosis of congenital factor VII deficiency.
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Deficiencia del Factor VII/complicaciones , Sepsis/complicaciones , Adulto , Diagnóstico Diferencial , Deficiencia del Factor VII/diagnóstico , Femenino , Hemostasis , Humanos , Masculino , Persona de Mediana Edad , Sepsis/sangre , Sepsis/diagnósticoRESUMEN
In a prospective, randomized study we compared cefotaxime (C) with tobramycin plus cefazolin (C + T) in the treatment of Enterobacterial septicemia. Twenty-five patients received C and twenty two C + T. There are 8 treatment failures, in C + T group, 3 in C group. We observed 5 adverse effects, 2 in the C group (1 reversible collapse and 1 Pseudomonas aeruginosa superinfection) and 3 in the C + T group (acute renal failures). We conclude that C may be more effective and less toxic than cefazolin plus tobramycin for patients with Enterobacterial septicemia.