Subject(s)
Bacteremia/diagnosis , COVID-19/complications , Candidemia/diagnosis , Cross Infection/diagnosis , Intensive Care Units/statistics & numerical data , Bacteremia/microbiology , COVID-19/physiopathology , Candidemia/microbiology , Critical Illness , Cross Infection/microbiology , Female , Humans , Male , Middle AgedABSTRACT
The authors report a diamniotic dichorionic twin pregnancy after in vitro fertilization (IVF) in mid-second trimester. The dead fetuses were delivered by cesarean section at the 20th week of gestation. The authors discuss management aspects and review of the literature.
Subject(s)
Diseases in Twins , Fertilization in Vitro , Fetal Death/diagnosis , Pregnancy, Twin , Twins, Dizygotic , Female , Fetal Death/surgery , Gestational Age , Humans , Hysterotomy , Middle Aged , PregnancyABSTRACT
Jeune's Syndrome or asphyxiating thoracic dystrophy (ATD) is a rare autosomal recessive skeletal dysplasia syndrome characterized by a small and narrow chest, short extremities, and often polydactyly associated with multiple organ manifestations. The severity of complications ranges from mild to lethal. This is a report of two cases of ATD diagnosed in successive pregnancies of a nonconsanguineous couple. The contribution of sonography in prenatal diagnosis of the syndrome is highlighted.
Subject(s)
Ellis-Van Creveld Syndrome/diagnostic imaging , Female , Humans , Male , Pregnancy , Recurrence , Ultrasonography, Prenatal , Young AdultABSTRACT
BACKGROUND: The ductus venosus is a short vessel, present in the newborn infant on the dorsal surface of the liver, connecting the portal and umbilical circulation with the inferior vena cava. Agenesis of the duct is a rare anomaly. CASE: A 28-year-old woman was referred to our department for the first trimester ultrasound evaluation. Detailed scanning revealed agenesis of the duct. Fetal echocardiography showed cardiac disproportion at the level of the ventricles. CONCLUSION: Agenesis of the duct can be related to either cardiac or congenital abnormalities.
Subject(s)
Fetal Heart/diagnostic imaging , Fetus/blood supply , Portal Vein/embryology , Ultrasonography, Prenatal , Umbilical Veins/embryology , Vena Cava, Inferior/embryology , Adult , Female , Gestational Age , Humans , Infant, Newborn , Portal Vein/abnormalities , Portal Vein/diagnostic imaging , Pregnancy , Umbilical Veins/abnormalities , Umbilical Veins/diagnostic imaging , Vena Cava, Inferior/abnormalities , Vena Cava, Inferior/diagnostic imagingABSTRACT
In acute respiratory distress syndrome (ARDS), recruitment sessions of high-frequency oscillation (HFO) and tracheal gas insufflation (TGI) with short-lasting recruitment manoeuvres (RMs) may improve oxygenation and enable reduction of subsequent conventional mechanical ventilation (CMV) pressures. We determined the effect of adding HFO-TGI sessions to lung-protective CMV on early/severe ARDS outcome. We conducted a prospective clinical trial, subdivided into a first single-centre period and a second two-centre period. We enrolled 125 (first period, n = 54) patients with arterial oxygen tension (P(a,O(2)))/inspiratory oxygen fraction (F(I,O(2))) of <150 mmHg for >12 consecutive hours at an end-expiratory pressure of ≥ 8 cmH(2)O. Patients were randomly assigned to an HFO-TGI group (receiving HFO-TGI sessions with RMs, interspersed with lung-protective CMV; n = 61) or CMV group (receiving lung-protective CMV and RMs; n = 64). The primary outcome was survival to hospital discharge. Pre-enrolment ventilation duration was variable. During days 1-10 post-randomisation, P(a,O(2))/F(I,O(2))), oxygenation index, plateau pressure and respiratory compliance were improved in the HFO-TGI group versus the CMV group (p < 0.001 for group × time). Within days 1-60, the HFO-TGI group had more ventilator-free days versus the CMV group (median (interquartile range) 31.0 (0.0-42.0) versus 0.0 (0.0-23.0) days; p < 0.001), and more days without respiratory, circulatory, renal, coagulation and liver failure (p ≤ 0.003). Survival to hospital discharge was higher in the HFO-TGI group versus the CMV group (38 (62.3%) out of 61 versus 23 (35.9%) out of 64 subjects; p = 0.004). Intermittent recruitment with HFO-TGI and RMs may improve survival in early/severe ARDS.
Subject(s)
High-Frequency Ventilation/methods , Insufflation/methods , Respiratory Distress Syndrome/therapy , Adult , Aged , Female , High-Frequency Ventilation/instrumentation , Humans , Insufflation/instrumentation , Intubation, Intratracheal , Male , Middle Aged , Oxygen/blood , Respiratory Distress Syndrome/mortality , Survival , Treatment OutcomeABSTRACT
A 55-year-old HIV-infected patient on antiretroviral treatment with Ritonavir-boosted Tipranavir as part of HAART developed intracranial haemorrhage during the acute phase of cryptococcal meningitis. CT scan and MRI confirmed the intracranial haemorrhage. Positive cryptococcal antigen and cultures of both blood and CSF confirmed the diagnosis of meningitis caused by Cryptococcus neoformans. There was no evidence of any bleeding disorder, use of aspirin or antiplatelet agents. The patient was treated with Liposomal Amphotericin B for cryptococcal meningitis. No special treatment was needed for the intracranial haemorrhage, but Tipranavir was discontinued and replaced by Kaletra and Saquinavir. Intracranial haemorrhage could be related to Tipranavir and cryptococcal meningitis was a predisposing factor. Headache stopped 3 days after starting antifungal treatment. To the best of our knowledge, this is the first reported case of intracranial haemorrhage related to Tipranavir treatment after the end of the "RESIST" studies and the only one related to meningitis.
Subject(s)
AIDS-Related Opportunistic Infections/complications , Anti-HIV Agents/adverse effects , HIV Infections/complications , Intracranial Hemorrhages/chemically induced , Meningitis, Cryptococcal/complications , Pyridines/adverse effects , Pyrones/adverse effects , AIDS-Related Opportunistic Infections/microbiology , Causality , Cryptococcus neoformans/isolation & purification , HIV Infections/drug therapy , HIV Infections/virology , HIV Protease Inhibitors/adverse effects , HIV-1 , Humans , Intracranial Hemorrhages/diagnostic imaging , Magnetic Resonance Imaging , Male , Meningitis, Cryptococcal/microbiology , Middle Aged , Sulfonamides , Tomography, X-Ray ComputedSubject(s)
Diabetes Mellitus, Type 1/drug therapy , Insulin Infusion Systems , Physician's Role , Physicians, Family , Adult , Continuity of Patient Care , Diabetes Mellitus, Type 1/epidemiology , Female , Greece/epidemiology , Humans , Male , Rural Population , Statistics, Nonparametric , Treatment OutcomeABSTRACT
Stroke represents a leading cause of morbidity and mortality especially among the elderly people, and therefore the need for effective preventive strategies is imperative. The value of physical activity for stroke prevention is not as well established as for other cardiovascular diseases. Despite some conflicting results, the majority of published studies have demonstrated a negative association between physical activity and stroke risk. In this article, we provide a concise overview of the epidemiological studies that investigate this association as well as a comprehensive analysis of the most relevant underlying pathophysiological mechanisms.
