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1.
Medicine (Baltimore) ; 99(28): e20827, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664076

RESUMO

RATIONALE: Cystic lymphangioma (CL) is a rare benign tumor resulting from a failure of the lymphatic system development. It may occur at any age but it is more frequent during childhood. Its clinical presentation and location are various but abdominal CL are uncommon. Among those, mesenteric presentation is the most frequent form whereas CL of the retroperitoneum are particularly rare. PATIENT CONCERNS: Herein, we report the case of a 17-years-old patient with no medical history who presented with right-upper quadrant (RUQ) pain, but no other symptom. Physical examination showed tenderness of the RUQ without distension. Lab tests were unremarkable. DIAGNOSIS: Abdominal computed tomography (CT) highlighted a retroperitoneal cystic mass potentially infiltrating the mesenterium, raising suspicion of a CL of the retroperitoneum. Diagnosis of CL was confirmed by histological analyses. INTERVENTION: Patient underwent an exploratory laparoscopy that infirmed infiltration of the mesenterium and allowed for resection. OUTCOMES: Postoperative course was uneventful and there is no evidence of recurrence after 14 months of follow-up. LESSONS: Although CL essentially occur in children, pediatric retroperitoneal CL is a rare finding, with only 21 cases identified in the literature.In summary, CL are benign tumors rarely located in the retroperitoneum. Despite performant imaging technologies, preoperative diagnosis is challenging. Whenever possible, laparoscopic resection should be the treatment of choice. Herein, we report the largest CL pediatric case laparoscopically resected, and the first review of the literature on the topic.


Assuntos
Dor Abdominal/etiologia , Linfangioma Cístico/cirurgia , Mesentério/patologia , Neoplasias Retroperitoneais/cirurgia , Espaço Retroperitoneal/patologia , Adolescente , Assistência ao Convalescente , Criança , Pré-Escolar , Feminino , Humanos , Laparoscopia/métodos , Masculino , Mesentério/diagnóstico por imagem , Mesentério/cirurgia , Espaço Retroperitoneal/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
2.
Medicine (Baltimore) ; 99(28): e20829, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664077

RESUMO

INTRODUCTION: Anabolic steroids are widely administered to patients with aplastic anemia (AA) and are associated with numerous medical complications. To assist with future diagnoses, we report about a young boy with multiple hepatocellular adenomas (HAs) induced by long-term use of anabolic androgenic steroids (AAS) for AA and present a related literature review. PATIENT CONCERN: A 15-year-old boy who was diagnosed with AA in 2011 had been treated with stanozolol (6 mg per day) and ciclosporin A (120-150 mg per day) for almost 4 years. He presented with epigastric pain and fever, and abdominal computed tomography showed a lesion of heterogenous density measuring 13.5 × 13.0 × 8.0 cm in the left hepatic lobe, which was initially misdiagnosed as a liver abscess. DIAGNOSIS: The patient went into hemorrhagic shock twice after invasive manipulation that aimed at diagnosis and was finally diagnosed with HA using fine needle aspiration. INTERVENTIONS: The patient discontinued AAS and only reserved ciclosporin A for AA treatment. OUTCOMES: Follow-up abdominal computed tomography performed 4 years after AAS discontinuation showed obvious regression of the hepatic lesions. CONCLUSION: It is of great importance for hematologists to completely understand that the long-term use of AAS may cause HA, which carries a great risk of hemorrhage and malignant transformation.


Assuntos
Adenoma de Células Hepáticas/induzido quimicamente , Anemia Aplástica/complicações , Neoplasias Hepáticas/patologia , Estanozolol/efeitos adversos , Congêneres da Testosterona/efeitos adversos , Dor Abdominal/etiologia , Adenoma de Células Hepáticas/patologia , Adolescente , Adulto , Assistência ao Convalescente , Idoso , Anemia Aplástica/tratamento farmacológico , Biópsia por Agulha Fina/métodos , Ciclosporina/uso terapêutico , Erros de Diagnóstico , Feminino , Febre/etiologia , Humanos , Imunossupressores/uso terapêutico , Abscesso Hepático/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Choque Hemorrágico/diagnóstico , Choque Hemorrágico/etiologia , Estanozolol/uso terapêutico , Congêneres da Testosterona/uso terapêutico , Tomografia Computadorizada por Raios X/métodos
3.
Medicine (Baltimore) ; 99(28): e21175, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664157

RESUMO

To analyze the clinical characteristics of intestinal tuberculosis (ITB), pay attention to the diagnostic value of endoscopy and mucosal biopsy, improve the recognition of atypical manifestations of ITB under endoscopy, and reduce misdiagnosis and missed diagnosis.The clinical data of 10 patients who were hospitalized in Changzhou second people's Hospital and finally diagnosed as ITB from January 1, 2015 to present were analyzed retrospectively. The basic information, medical history, clinical manifestations and computed tomography (CT), endoscopy of the patients was analyzed retrospectively. The results of pathological examination were analyzed and sorted out.Among the 10 patients, the ratio of male to female was 7:3, 10 (100%) had abdominal pain, 3 (30%) had diarrhea and 2 (20%) had bloody stool. The positive rate of tuberculosis T cell test was 75% (6/8), the diagnostic rate of chest high resolution CT was 60%, and the abnormal rate of abdominal high-resolution CT was 66.7% (6/9). Colonoscopy showed that the lesions mainly involved ileocecum (70%) and ascending colon (60%). Most of the lesions were intestinal stenosis (60%) and circular ulcer (50%). In a few cases, cold abscess (20%) and scar diverticulum (10%). Most of the pathological manifestations were granuloma formation and multinucleated giant cells (60%). The detection rate of caseous granuloma was 20%.The general condition and clinical manifestations of patients with ITB are not specific. Endoscopy and mucosal biopsy are of great significance for its diagnosis. The clinical manifestations and endoscopy of some patients showed atypical signs. Therefore, the combination of multi-disciplinary team models and the enhancement of clinician's recognition of the characteristics of endoscopic examination of ITB can improve us the diagnosis level of ITB.


Assuntos
Dor Abdominal/diagnóstico , Endoscopia Gastrointestinal , Gastroenterite/diagnóstico , Tuberculose Gastrointestinal/diagnóstico , Dor Abdominal/microbiologia , Adolescente , Adulto , Idoso , Biópsia , Diagnóstico Diferencial , Erros de Diagnóstico , Feminino , Gastroenterite/microbiologia , Humanos , Intestino Delgado/microbiologia , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Adulto Jovem
5.
Medicine (Baltimore) ; 99(27): e21111, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629744

RESUMO

RATIONALE: Intermittent combined pancreaticobiliary obstruction may lead to multiple episodes of ascending cholangitis and pancreatitis, usually due to choledocholithiasis or periampullary mass. However, one of the rare causes is periampullary or juxtapapillary duodenal diverticulum. Although duodenal diverticula are relatively common in the general population, the overwhelming majority are asymptomatic. Duodenal diverticula can cause combined pancreaticobiliary obstruction through multiple mechanisms such as stasis-induced primary choledocholithiasis, stasis-induced intradiverticular enterolith, or longstanding diverticulitis, causing stenosing fibrosing papillitis or a combination of more than one of these mechanisms. Herein, I report a case of Lemmel syndrome due to a combination of multiple mechanisms and review the available literature on the epidemiology, pathogenesis, clinical presentation, diagnostic work-up, and management of juxtapapillary duodenal diverticulum. PATIENT CONCERNS: Multiple episodes of abdominal pain, jaundice, anorexia, fever, and significant unintentional weight loss. DIAGNOSES AND INTERVENTIONS: Primary choledocholithiasis, recurrent ascending cholangitis, recurrent acute pancreatitis, and pancreatic atrophy due to giant juxtapapillary duodenal diverticulum, with unsuccessful endoscopic retrograde cholangiopancreatography that was completely resolved after open transduodenal sphincteroplasty and septoplasty, transampullary and transcystic common bile duct exploration and stone extraction, and duodenal diverticular inversion. OUTCOME: Complete resolution of combined pancreaticobiliary obstruction without recurrence for 2 years after surgery. LESSONS: Surgeons should be aware of such rare syndromes to avoid misdiagnosis and delayed or inappropriate management. Furthermore, they should understand the different available operative options for cases that are refractory to endoscopic approach.


Assuntos
Colangite/complicações , Divertículo/complicações , Icterícia/etiologia , Pancreatite/complicações , Dor Abdominal/etiologia , Atrofia , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Coledocolitíase/complicações , Colestase/etiologia , Colestase/patologia , Diverticulite/complicações , Divertículo/patologia , Divertículo/cirurgia , Neoplasias Duodenais/patologia , Feminino , Humanos , Indonésia/etnologia , Pancreatopatias/patologia , Recidiva , Esfincterotomia Transduodenal/métodos , Resultado do Tratamento , Adulto Jovem
6.
Rev Invest Clin ; 72(3): 165-177, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32584326

RESUMO

Background: Regional information regarding the characteristics of patients with coronavirus disease (COVID)-19 is needed for a better understanding of the pandemic. Objective: The objective of the study to describe the clinical features of COVID-19 patients diagnosed in a tertiary-care center in Mexico City and to assess differences according to the treatment setting (ambulatory vs. hospital) and to the need of intensive care (IC). Methods: We conducted a prospective cohort, including consecutive patients with COVID-19 from February 26, 2020 to April 11, 2020. Results: We identified 309 patients (140 inpatients and 169 outpatients). The median age was 43 years (interquartile range, 33-54), 59.2% men, and 18.6% healthcare workers (12.3% from our center). The median body mass index (BMI) was 29.00 kg/m2 and 39.6% had obesity. Compared to outpatients, inpatients were older, had comorbidities, cough, and dyspnea more frequently. Twenty-nine (20.7%) inpatients required treatment in the IC unit (ICU). History of diabetes (type 1 or 2) and abdominal pain were more common in ICU patients compared to non-ICU patients. ICU patients had higher BMIs, higher respiratory rates, and lower room-air capillary oxygen saturations. ICU patients showed a more severe inflammatory response as assessed by white blood cell count, neutrophil and platelet count, C-reactive protein, ferritin, procalcitonin, and albumin levels. By the end of the study period, 65 inpatients had been discharged because of improvement, 70 continued hospitalized, and five had died. Conclusions: Patients with comorbidities, either middle-age obese or elderly complaining of fever, cough, or dyspnea, were more likely to be admitted. At admission, patients with diabetes, high BMI, and clinical or laboratory findings consistent with a severe inflammatory state were more likely to require IC.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Dor Abdominal/epidemiologia , Adulto , Idoso , Assistência Ambulatorial , Biomarcadores/sangue , Índice de Massa Corporal , Comorbidade , Infecções por Coronavirus/complicações , Infecções por Coronavirus/terapia , Cuidados Críticos , Dispneia/etiologia , Feminino , Gastroenteropatias/epidemiologia , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , México , Pessoa de Meia-Idade , Obesidade/epidemiologia , Pacientes Ambulatoriais/estatística & dados numéricos , Pneumonia Viral/complicações , Pneumonia Viral/terapia , Índice de Gravidade de Doença , Centros de Atenção Terciária/estatística & dados numéricos , Resultado do Tratamento
7.
Medicine (Baltimore) ; 99(26): e20896, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590800

RESUMO

INTRODUCTION: Metastatic neuroblastoma (NB) is an aggressive malignancy with a poor prognosis. Many patients present with relapsed high-risk NB after undergoing first-line treatment, and there is no standard therapy available in this setting. PATIENT CONCERNS: The present study aimed to present the cases of 2 patients with recurrent high-risk NB. DIAGNOSIS: Two children with International Neuroblastoma Stage System stage 4 high-risk NB chemotherapy. The disease recurrent after finishing the treatment. INTERVENTIONS: Both patients (34 months old and 41 months old) experienced recurrence, received second-line treatment, and then received maintenance treatment using apatinib plus retinoic acid. The apatinib (10 mg/kg per day) and retinoic acid (160 mg/m per day) were administered on alternating 2-week cycles, which was continued for 1 year. OUTCOMES: The 2 patients had achieved complete response by the 1-year follow-up after starting apatinib plus retinoic acid, and did not experience any adverse drug reactions. CONCLUSION: The outcomes from these cases suggest that apatinib plus isotretinoin might be an option for maintenance therapy in patients with recurrent high-risk NB.


Assuntos
Neuroblastoma/complicações , Neuroblastoma/tratamento farmacológico , Piridinas/uso terapêutico , Tretinoína/uso terapêutico , Dor Abdominal/etiologia , Antineoplásicos/uso terapêutico , Pré-Escolar , Tratamento Farmacológico/métodos , Tratamento Farmacológico/normas , Humanos , Masculino , Metástase Neoplásica/tratamento farmacológico , Metástase Neoplásica/fisiopatologia , Neuroblastoma/fisiopatologia , Recidiva
8.
Medicine (Baltimore) ; 99(26): e20811, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590766

RESUMO

RATIONALE: Catastrophic antiphospholipid syndrome (CAPS) is a rare, life-threatening condition of antiphospholipid syndrome (APS). Treatment and management of CAPS remain challenging and the mortality rate is approximately 50% among cases. We describe a successfully treated case of a CAPS patient who had undergone massive bowel resection due to obstruction of superior mesenteric artery. PATIENT CONCERNS: A 40-year-old male patient was admitted to our hospital with acute abdominal pain, melena, and a history of deep vein thrombosis in both legs for over 10 years, there was no previous diagnosis of APS. DIAGNOSIS: The patient was diagnosed as CAPS with bowel necrosis due to obstruction of superior mesenteric artery based on the presence of antiphospholipid antibodies, computed tomography scan, and histopathological examination. INTERVENTIONS: Emergency surgery was performed to remove approximately 6 meters of the necrotic small intestine, of which the length of the remaining small intestine was 40 cm from the duodenum and 80 cm from the ileocaecal valve. Anticoagulants were prescribed with low molecular weight heparin. After discharging, APS was managed with direct oral anticoagulants (DOACs) for secondary thromboprophylaxis because the patient was unable to reach target International Normalized Ratio (INR) with vitamin K antagonists (VKAs). OUTCOMES: During 24 months of follow-up until now, the patient did not develop new thrombosis or relapse CAPS and his state remained stable. LESSONS: While VKAs is amongst the most important and fundamental treatment, physicians should be aware that VKAs are absorbed via the small intestine. For CAPS cases who had undergone massive bowel resection, DOACs is a reasonable alternative which has been found to be as safe and effective as VKAs in terms of thrombosis prevention.


Assuntos
Anticoagulantes/uso terapêutico , Síndrome Antifosfolipídica/tratamento farmacológico , Dor Abdominal/etiologia , Administração Oral , Adulto , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Masculino , Melena/etiologia , Trombose/tratamento farmacológico , Trombose/prevenção & controle , Tomografia Computadorizada por Raios X/métodos
9.
BMJ Case Rep ; 13(6)2020 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-32546557

RESUMO

A 33-year-old man presented repeatedly with severe abdominal pain and diarrhoea. Renal colic was suspected, and he was admitted for pain management. Questioning elicited an additional history of sore throat and mild, dry cough. Inflammatory markers were mildly raised (C reactive protein (CRP) 40 mg/L). Initial nasopharyngeal swabs were negative for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) by PCR. CT of the kidneys, ureters and bladder (CT KUB) was normal; however, CT of the thorax showed multifocal bilateral peripheral areas of consolidation consistent with COVID-19 infection. He developed respiratory compromise and was transferred to the intensive care unit (ICU). Sputum was positive for SARS-CoV-2 by PCR, and culture grew Yersinia enterocolitica He recovered following supportive management and treatment with piperacillin-tazobactam.


Assuntos
Dor Abdominal , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus , Pulmão/diagnóstico por imagem , Pandemias , Combinação Piperacilina e Tazobactam/administração & dosagem , Pneumonia Viral , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Adulto , Antibacterianos/administração & dosagem , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Cuidados Críticos/métodos , Diagnóstico Diferencial , Diarreia/diagnóstico , Diarreia/etiologia , Humanos , Masculino , Pneumonia Viral/diagnóstico , Pneumonia Viral/etiologia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Escarro/microbiologia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Yersinia enterocolitica/isolamento & purificação
10.
Clin Radiol ; 75(8): 592-598, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32546365

RESUMO

AIM: To evaluate the diagnostic utility of additional whole-chest computed tomography (CT) in identifying otherwise unheralded COVID-19 lung disease as part of an acute abdominal pain CT imaging pathway in response to the COVID-19 pandemic. MATERIALS AND METHODS: Consecutive patients (n=172) who underwent additional whole-chest CT via a COVID-19 acute abdominal pain CT imaging pathway between 27 March and 3 May 2020 were evaluated in this retrospective single-centre study. Chest CT examinations were graded as non-COVID-19, indeterminate for, or classic/probable for COVID-19. CT examinations in the latter two categories were further divided into one of three anatomical distributions (lung base, limited chest [below carina], whole chest [above carina]) based on location of findings. Reverse transcriptase-polymerase chain reaction (RT-PCR) results and clinical features of COVID-19 were assessed to determine if COVID-19 was clinically suspected at the time of CT referral. RESULTS: Twenty-seven of the 172 (15.7%) patients had CT features potentially indicative of COVID-19 pneumonia, 6/27 (3.5%) demonstrating a classic/probable pattern and 21/27 (12.2%) demonstrating an indeterminate pattern. After correlation with clinical features and RT-PCR 8/172 (4.7%) were defined as COVID-19 positive, of which only 1/172 (0.6%) was clinically unsuspected of COVID-19 at the time of CT referral. All COVID-19 positive cases could be identified on review of the lung base alone. CONCLUSION: Whole-chest CT as part of an acute abdominal pain CT imaging pathway has a very low diagnostic yield for our cohort of patients. All COVID-19-positive patients in our cohort were identified on review of the lung bases on the abdominal CT and this offers an alternative imaging approach in this patient group.


Assuntos
Dor Abdominal/etiologia , Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico por imagem , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico por imagem , Radiografia Torácica/métodos , Tomografia Computadorizada por Raios X/métodos , Doença Aguda , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Estudos Retrospectivos
12.
J Pak Med Assoc ; 70(Suppl 3)(5): S98-S100, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32515381

RESUMO

The current pandemic coronavirus disease (COVID-19) is an ongoing healthcare crisis. While COVID- 19 typically presents as fever and respiratory illness, almost 50% of the patients also have associated digestive symptoms which vary from abdominal pain to diarrhoea and indigestion. Literature review of association of COVID- 19 with digestive symptoms was done using Google search and the results are presented herein.


Assuntos
Dor Abdominal , Betacoronavirus , Infecções por Coronavirus , Diarreia , Pandemias , Pneumonia Viral , Dor Abdominal/epidemiologia , Dor Abdominal/virologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Diarreia/epidemiologia , Diarreia/virologia , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão
13.
Medicine (Baltimore) ; 99(22): e20316, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32481403

RESUMO

Stomachache is not only disease name of Traditional Chinese medicine (TCM) but also the clinical symptom. It is a common and multiple diseases. TCM has its particular advantage in clinical treatment of stomachache. Syndrome differentiation is an important concept in TCM practice. The therapeutic process is virtually a nonlinear mapping process from clinical symptom to syndrome diagnosis with processing and seeking rules from mass data. Artificial neutral network has strong learning ability for nonlinear relationship. Artificial neutral network has been widely used to TCM area where the multiple factors, multilevel, nonlinear problem accompanied by a large number of optimization exist.We present an original experimental method to apply the improved third-order convergence LM algorithm to intelligent syndrome differentiation for the first time, and compare the predicted ability of Levenberg-Marquardt (LM) algorithm and the improved third-order convergence LM algorithm in syndrome differentiation.In this study, 2436 cases of stomachache electronic medical data from hospital information system, and then the real world data were normalized and standardized. Afterwards, LM algorithm and the improved third-order convergence LM algorithm were used to build the Back Propagation (BP) neural network model for intelligent syndrome differentiation of stomachache on Matlab, respectively. Finally, the differentiation performance of the 2 models was tested and analyzed.The testing results showed that the improved third-order convergence LM algorithm model has better average prediction and diagnosis accuracy, especially in predicting "liver-stomach disharmony" and "stomach yang deficiency", is above 95%.By effectively using the self-learning and auto-update ability of the BP neural network, the intelligent syndrome differentiation model of TCM can fully approach the real side of syndrome differentiation, and shows excellent predicted ability of syndrome differentiation.


Assuntos
Dor Abdominal/diagnóstico , Medicina Tradicional Chinesa/métodos , Redes Neurais de Computação , Gastropatias/diagnóstico , Dor Abdominal/fisiopatologia , Algoritmos , Diagnóstico Diferencial , Humanos , Gastropatias/fisiopatologia
14.
J Card Surg ; 35(7): 1736-1739, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32497341

RESUMO

The impact of the coronavirus disease 2019 (COVID-19) pandemic in New York City (NYC) is dramatic. COVID-19 cases surged, hospitals expanded to meet capacity, and NYC remains the global epicenter of this pandemic. During this unprecedented time, a young woman with known Marfan syndrome presented with an acute complicated type B aortic dissection to our Aortic Center. Using the provisional extension to induce a complete attachment technique, we treated this patient and quickly discharged her the next day to decrease the risk of COVID-19 infection. Her progress was monitored using frequent phone calls and one office visit at two weeks.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Infecções por Coronavirus/epidemiologia , Procedimentos Endovasculares/métodos , Pneumonia Viral/epidemiologia , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Doença Aguda , Adulto , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/etiologia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/etiologia , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Infecções por Coronavirus/diagnóstico , Infecção Hospitalar/prevenção & controle , Feminino , Seguimentos , Humanos , Tempo de Internação , Angiografia por Ressonância Magnética/métodos , Síndrome de Marfan/complicações , Síndrome de Marfan/diagnóstico , Cidade de Nova Iorque , Pandemias , Pneumonia Viral/diagnóstico , Índice de Gravidade de Doença , Resultado do Tratamento
15.
Praxis (Bern 1994) ; 109(8): 652-657, 2020.
Artigo em Alemão | MEDLINE | ID: mdl-32517594

RESUMO

CME Sonography 91: Differential Diagnosis of Lower Abdominal Pain Abstract. Pain in the lower abdomen is a frequent reason for further imaging clarification by sonography. The most frequent causes are appendicitis and diverticulitis, in addition to ureteral stones, ovarian and tubal pathology as well as various hernias. Appendicitis has a characteristic clinical presentation and can be diagnosed by CT or ultrasound. In children, the differential diagnosis is that of mesenteric lymphadenitis. Diverticulitis, often right-sided, can also be reliably diagnosed with CT or ultrasound. Not to be forgotten is the left-sided diverticulitis, which occurs more frequently in Asian persons. Appendicitis epiploica should be recognized to avoid unnecessary operations. The iliopsoas syndrome, which is diagnosed by sonopalpation, often remains undetected.


Assuntos
Dor Abdominal , Apendicite , Diverticulite , Dor Abdominal/diagnóstico por imagem , Apendicite/diagnóstico por imagem , Criança , Diagnóstico Diferencial , Diverticulite/diagnóstico por imagem , Humanos , Ultrassonografia
18.
Ned Tijdschr Geneeskd ; 1642020 Apr 02.
Artigo em Holandês | MEDLINE | ID: mdl-32392009

RESUMO

OBJECTIVE: To describe disease presentation and clinical characteristics of patients with COVID-19 presenting to the Emergency Department (ED) of Bernhoven hospital in Uden, the Netherlands. DESIGN: Prospective, descriptive study. METHOD: The registry focused on atypical symptoms and co-infections. We hypothesized that patients older than 70 years more often have atypical symptoms. The number of co-infections is unknown. Therefore, we prospectively registered medical history, duration of symptoms, symptoms, temperature, lab results and co-infections of patients with confirmed COVID-19 in the period March 4-16th. RESULTS: The clinical characteristics of 107 patients were registered. The average age was 71 years and 41% was female. The median duration of symptoms was 5 days. 19% of patients had not been referred to pulmonary or internal medicine. Symptoms were fever (78%), respiratory complaints (78%), chest pain (28%), abdominal pain (13%), and diarrhea (34%). In 54% of the COVID-19 patients at the ED, the temperature was ≥ 38,0°C, CRP ≥ 50 in 51%, leucocytosis in 12% and elevated LD in 61%. Of 31 patients 24 (77%) had an absolute lymphopenia. Co-infections were seen in 16% of patients. The mortality in the ED was 2% and ICU-admission 5%. On March 25th, 2020 the overall mortality was 22% and ICU-admission 15%. CONCLUSION: We have seen patients with a very serious disease resulting in a high mortality and ICU-admission. Over 35% of patient did not have the typical symptoms of fever and respiratory complaints; atypical symptoms like chest pain, abdominal pain and diarrhea are frequently seen. There is no difference between patients over and under 70 years. COVID-19 patients can present with atypical symptoms, co-infections and distributed over various medical specialties.


Assuntos
Betacoronavirus , Infecções por Coronavirus/diagnóstico , Serviço Hospitalar de Emergência/estatística & dados numéricos , Pneumonia Viral/diagnóstico , Dor Abdominal/diagnóstico , Adulto , Idoso , Dor no Peito/diagnóstico , Comorbidade , Infecções por Coronavirus/epidemiologia , Feminino , Febre/diagnóstico , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Pandemias , Pneumonia Viral/epidemiologia , Estudos Prospectivos , Sistema de Registros/estatística & dados numéricos
19.
BMC Infect Dis ; 20(1): 327, 2020 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-32380974

RESUMO

BACKGROUND: Tularemia, a re-emerging, potential life threatening infectious disease, can present itself with nonspecific clinical symptoms including fever, chills and malaise. Taking a detailed history of exposure and a highly raised index of clinical suspicion are necessary to take the appropriate diagnostic and therapeutic steps in this setting. Here, a case report of typhoid tularaemia is presented. CASE PRESENTATION: A 53-year old male forester and farmer with protracted fever, abdominal pain, diarrhoea and loss of weight, who experienced productive cough and a pulmonary infiltrate later in the course of disease, was admitted for further investigation. Tularaemia was suspected only owing to history and confirmed by serologic testing more than three weeks after the beginning of the symptoms. The initial antibiotic therapy with ceftriaxone/doxycycline was switched to ciprofloxacin, resulting in the resolution of fever and symptoms. CONCLUSION: Tularaemia has to be considered as a differential diagnosis in febrile patients, even more in cases with protracted fever. Since tularaemia is expanding geographically, involving more animal hosts and causing larger outbreaks, clinicians have to be aware of this potentially fatal disease.


Assuntos
Febre/microbiologia , Tularemia/diagnóstico , Tularemia/etiologia , Dor Abdominal/diagnóstico , Dor Abdominal/tratamento farmacológico , Antibacterianos/uso terapêutico , Peso Corporal , Ceftriaxona/uso terapêutico , Ciprofloxacino/uso terapêutico , Tosse/tratamento farmacológico , Tosse/microbiologia , Diagnóstico Diferencial , Diarreia/tratamento farmacológico , Diarreia/microbiologia , Doxiciclina/uso terapêutico , Fazendeiros , Francisella tularensis/patogenicidade , Humanos , Masculino , Pessoa de Meia-Idade , Testes Sorológicos , Tularemia/tratamento farmacológico
20.
Artigo em Inglês | MEDLINE | ID: mdl-32457035

RESUMO

BACKGROUND: The COVID-19 epidemic has affected over 2.6 million people across 210 countries. Recent studies have shown that patients with COVID-19 experience relevant gastrointestinal (GI) symptoms. We aimed to perform a systematic review and meta-analysis on the GI symptoms of COVID-19. METHODS: A literature search was conducted via electronic databases, including PubMed, Embase, Scopus, and Google Scholar, from inception until 20 March 2020. Data were extracted from relevant studies. A systematic review of GI symptoms and a meta-analysis comparing symptoms in severe and non-severe patients was performed using RevMan V.5.3. RESULTS: Pooled data from 2477 patients with a reverse transcription-PCR-positive COVID-19 infection across 17 studies were analysed. Our study revealed that diarrhoea (7.8%) followed by nausea and/or vomiting (5.5 %) were the most common GI symptoms. We performed a meta-analysis comparing the odds of having GI symptoms in severe versus non-severe COVID-19-positive patients. 4 studies for nausea and/or vomiting, 5 studies for diarrhoea and 3 studies for abdominal pain were used for the analyses. There was no significant difference in the incidence of diarrhoea (OR=1.32, 95% CI 0.8 to 2.18, Z=1.07, p=0.28, I2=17%) or nausea and/or vomiting (OR=0.96, 95% CI 0.42 to 2.19, Z=0.10, p=0.92, I2=55%) between either group. However, there was seven times higher odds of having abdominal pain in patients with severe illness when compared with non-severe patients (OR=7.17, 95% CI 1.95 to 26.34, Z=2.97, p=0.003, I2=0%). CONCLUSION: Our study has reiterated that GI symptoms are an important clinical feature of COVID-19. Patients with severe disease are more likely to have abdominal pain as compared with patients with non-severe disease.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Gastroenteropatias/virologia , Pneumonia Viral/complicações , Dor Abdominal/virologia , Diarreia/virologia , Humanos , Náusea/virologia , Pandemias , Vômito/virologia
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