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1.
BMJ Open ; 11(2): e047216, 2021 02 22.
Artículo en Inglés | MEDLINE | ID: mdl-33619203

RESUMEN

OBJECTIVES: To assess the seroprevalence of anti-SARS-CoV-2 IgG among health careworkers (HCWs) in our university hospital and verify the risk of acquiring the infection according to work area. DESIGN: Cross-sectional study. SETTING: Monocentric, Italian, third-level university hospital. PARTICIPANTS: All the employees of the hospital on a voluntary base, for a total of 4055 participants among 4572 HCWs (88.7%). PRIMARY AND SECONDARY OUTCOME MEASURES: Number of anti-SARS-CoV-2 positive serology according to working area. Association of anti-SARS-CoV-2 positive serology to selected variables (age, gender, country of origin, body mass index, smoking, symptoms and contact with confirmed cases). RESULTS: From 27 April 2020 to 12 June 2020, 4055 HCWs were tested and 309 (7.6%) had a serological positive test. No relevant difference was found between men and women (8.3% vs 7.3%, p=0.3), whereas a higher prevalence was observed among foreign-born workers (27/186, 14.5%, p<0.001), employees younger than 30 (64/668, 9.6%, p=0.02) or older than 60 years (38/383, 9.9%, p=0.02) and among healthcare assistants (40/320, 12.5%, p=0.06). Working as frontline HCWs was not associated with an increased frequency of positive serology (p=0.42). A positive association was found with presence and number of symptoms (p<0.001). The symptoms most frequently associated with a positive serology were taste and smell alterations (OR 4.62, 95% CI: 2.99 to 7.15) and fever (OR 4.37, 95% CI: 3.11 to 6.13). No symptoms were reported in 84/309 (27.2%) HCWs with positive IgG levels. Declared exposure to a suspected/confirmed case was more frequently associated (p<0.001) with positive serology when the contact was a family member (19/94, 20.2%) than a patient or colleague (78/888, 8.8%). CONCLUSIONS: SARS-CoV-2 infection occurred undetected in a large fraction of HCWs and it was not associated with working in COVID-19 frontline areas. Beyond the hospital setting, exposure within the community represents an additional source of infection for HCWs.


Asunto(s)
Anticuerpos Antivirales , Inmunoglobulina G , Personal de Hospital , Adulto , Anticuerpos Antivirales/sangre , /epidemiología , Estudios Transversales , Femenino , Hospitales Universitarios , Humanos , Inmunoglobulina G/sangre , Italia/epidemiología , Masculino , Persona de Mediana Edad , Personal de Hospital/estadística & datos numéricos , Estudios Seroepidemiológicos
2.
Am J Epidemiol ; 190(2): 265-276, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33524118

RESUMEN

Polyunsaturated fatty acids (PUFAs) are critical for brain development and have been linked with neurodevelopmental outcomes. We conducted a population-based case-control study in California to examine the association between PUFAs measured in midpregnancy serum samples and autism spectrum disorder (ASD) in offspring. ASD cases (n = 499) were identified through the California Department of Developmental Services and matched to live-birth population controls (n = 502) on birth month, year (2010 or 2011), and sex. Logistic regression models were used to examine crude and adjusted associations. In secondary analyses, we examined ASD with and without co-occurring intellectual disability (ID; n = 67 and n = 432, respectively) and effect modification by sex and ethnicity. No clear patterns emerged, though there was a modest inverse association with the top quartile of linoleic acid level (highest quartile vs. lowest: adjusted odds ratio = 0.74, 95% confidence interval: 0.49, 1.11; P for trend = 0.10). Lower levels of total and ω-3 PUFAs were associated with ASD with ID (lowest decile of total PUFAs vs. deciles 4-7: adjusted odds ratio = 2.78, 95% confidence interval: 1.13, 6.82) but not ASD without ID. We did not observe evidence of effect modification by the factors examined. These findings do not suggest a strong association between midpregnancy PUFA levels and ASD. In further work, researchers should consider associations with ASD with ID and in other time windows.


Asunto(s)
Trastorno del Espectro Autista/epidemiología , Ácidos Grasos Insaturados/sangre , Discapacidad Intelectual/epidemiología , Segundo Trimestre del Embarazo/sangre , Trastorno del Espectro Autista/etnología , Peso al Nacer , California/epidemiología , Estudios de Casos y Controles , Niño , Preescolar , Femenino , Edad Gestacional , Humanos , Discapacidad Intelectual/etnología , Masculino , Oportunidad Relativa , Embarazo , Factores Sexuales , Factores Socioeconómicos
3.
Am J Epidemiol ; 190(2): 196-206, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33524121

RESUMEN

Gallbladder cancer (GBC) is a highly fatal cancer that can be cured through cholecystectomy if identified early. The presence of gallstones is the primary risk factor for GBC, but few people with gallstones develop GBC. A key question is what drives the development of GBC among persons with gallstones. We initiated the Chile Biliary Longitudinal Study (Chile BiLS) to address this question. From 2016 to 2019, Chile BiLS enrolled 4,726 women aged 50-74 years with ultrasound-detected gallstones from southern-central Chile, accounting for an estimated 36% of eligible women with gallstones in the study area. The median age was 59 years; 25% of the women were Amerindian (Mapuche), 60% were obese, 25% had diabetes, and 6% had cardiovascular disease. Participants will be followed for gallbladder dysplasia or cancer for 6 years. As of April 30, 2020, over 91% of those eligible completed the year 2 follow-up visit. Data being collected include epidemiologic and sociodemographic information, anthropometric measurements, blood pressure, and tooth counts. Biosamples being taken include baseline plasma, buffy coat, red blood cells, serum, blood clot from serum, and PAXgene whole blood (PreAnalytiX GmbH, Hombrechtikon, Switzerland). Complete gallbladder sampling is conducted for most participants undergoing cholecystectomy. The Chile BiLS cohort study will increase our understanding of GBC etiology and could identify potential risk stratification and early detection strategies in high-risk areas.


Asunto(s)
Neoplasias de la Vesícula Biliar/epidemiología , Cálculos Biliares/epidemiología , Anciano , Presión Sanguínea , Pesos y Medidas Corporales , Enfermedades Cardiovasculares/epidemiología , Chile , Diabetes Mellitus/epidemiología , Femenino , Neoplasias de la Vesícula Biliar/diagnóstico por imagen , Neoplasias de la Vesícula Biliar/etnología , Cálculos Biliares/diagnóstico por imagen , Cálculos Biliares/etnología , Humanos , Mediadores de Inflamación/sangre , Estudios Longitudinales , Persona de Mediana Edad , Obesidad/epidemiología , Proyectos de Investigación , Factores de Riesgo , Factores Socioeconómicos , Pérdida de Diente/epidemiología
4.
PLoS Pathog ; 17(2): e1009243, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33524041

RESUMEN

The current pandemic emergence of novel coronavirus disease (COVID-19) poses a relevant threat to global health. SARS-CoV-2 infection is characterized by a wide range of clinical manifestations, ranging from absence of symptoms to severe forms that need intensive care treatment. Here, plasma-EDTA samples of 30 patients compared with age- and sex-matched controls were analyzed via untargeted nuclear magnetic resonance (NMR)-based metabolomics and lipidomics. With the same approach, the effect of tocilizumab administration was evaluated in a subset of patients. Despite the heterogeneity of the clinical symptoms, COVID-19 patients are characterized by common plasma metabolomic and lipidomic signatures (91.7% and 87.5% accuracy, respectively, when compared to controls). Tocilizumab treatment resulted in at least partial reversion of the metabolic alterations due to SARS-CoV-2 infection. In conclusion, NMR-based metabolomic and lipidomic profiling provides novel insights into the pathophysiological mechanism of human response to SARS-CoV-2 infection and to monitor treatment outcomes.


Asunto(s)
Anticuerpos Monoclonales Humanizados/administración & dosificación , Lipidómica , Lípidos/sangre , /metabolismo , /sangre , Femenino , Humanos , Masculino , Resonancia Magnética Nuclear Biomolecular
5.
Cytokine ; 140: 155439, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33524886

RESUMEN

BACKGROUND: Immunodeficiency has pivotal role in the pathogenesis of coronavirus disease 2019 (COVID-19). Several studies have indicated defects in the immune system of COVID-19 patients at different disease stages. Therefore, this study investigated whether alters in immune responses of COVID-19 patients may be considered as predicting factors for disease outcome. METHODS: The percentages of innate and adoptive immune cells in the recovered and dead patients with COVID-19, and healthy subjects were determined by flow cytometry. The levels of pro- and anti-inflammatory cytokines and other immune factors were also measured by enzyme-linked immunosorbent assay. RESULTS: At the first day of hospitalization, the frequencies of CD56dim CD16+ NK cells and CD56bright CD16dim/- NK cells in patients who died during treatment were significantly increased compared to recovered and healthy individuals (P < 0.0001). The recovered and dead patients had a significant increase in monocyte number in comparison with healthy subjects (P < 0.05). No significant change was observed in Th1 cell numbers between the recovered and dead patients while Th2, Th17 cell, and Treg percentages in death cases were significantly lower than healthy control and those recovered, unlike exhausted CD4 + and CD8 + T cells and activated CD4 + T cells (P < 0.0001-0.05). The activated CD8 + T cell was significantly higher in the recovered patients than healthy individuals (P < 0.0001-0.05). IL-1α, IL-1ß, IL-6, and TNF-α levels in patients were significantly increased (P < 0.0001-0.01). However, there were no differences in TNF-α and IL-1ß levels between dead and recovered patients. Unlike TGF-ß1 level, IL-10 was significantly increased in recovered patients (P < 0.05). Lymphocyte numbers in recovered patients were significantly increased compared to dead patients, unlike ESR value (P < 0.001-0.01). CRP value in recovered patients significantly differed from dead patients (P < 0.001). CONCLUSION: Changes in frequencies of some immune cells and levels of some immune factors may be considered as predictors of mortality in COVID-19 patients.


Asunto(s)
/inmunología , Citocinas/inmunología , Sistema Inmunológico/inmunología , Inmunidad/inmunología , Sobrevivientes/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , /virología , Citocinas/sangre , Femenino , Humanos , Sistema Inmunológico/citología , Masculino , Persona de Mediana Edad , Monocitos/inmunología , Tasa de Supervivencia , Linfocitos T/inmunología , Linfocitos T Colaboradores-Inductores/clasificación , Linfocitos T Colaboradores-Inductores/inmunología , Linfocitos T Reguladores/inmunología
6.
Clin Appl Thromb Hemost ; 27: 1076029621992128, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33539188

RESUMEN

Hyperferritinemia is associated with poor outcomes in critically ill patients with sepsis, hemophagocytic lymphohistiocytosis (HLH), macrophage activation syndromes (MAS) and coronavirus disease 19 (COVID-19). Autopsies of hyperferritinemic patients that succumbed to either sepsis, HLH, MAS or COVID-19 have revealed disseminated microvascular thromboses with von Willebrand factor (VWF)-, platelets-, and/or fibrin-rich microthrombi. It is unknown whether high plasma ferritin concentration actively promotes microvascular thrombosis, or merely serves as a prognostic biomarker in these patients. Here, we show that secretion of VWF from human umbilical vein endothelial cells (HUVEC) is significantly enhanced by 100,000 ng/ml of recombinant ferritin heavy chain protein (FHC). Ferritin fraction that was isolated by size exclusion chromatography from the plasma of critically ill HLH patients promoted VWF secretion from HUVEC, compared to similar fraction from non-critically ill control plasma. Furthermore, recombinant FHC moderately suppressed the activity of VWF cleaving metalloprotease ADAMTS-13. These observations suggest that a state of marked hyperferritinemia could promote thrombosis and organ injury by inducing endothelial VWF secretion and reducing the ADAMTS-13 activity.


Asunto(s)
Proteína ADAMTS13/metabolismo , /complicaciones , Ferritinas/metabolismo , /complicaciones , Factor de von Willebrand/metabolismo , Proteína ADAMTS13/antagonistas & inhibidores , Enfermedad Crítica , Ferritinas/sangre , Células Endoteliales de la Vena Umbilical Humana , Humanos , Linfohistiocitosis Hemofagocítica/sangre , Linfohistiocitosis Hemofagocítica/complicaciones , Oxidorreductasas/sangre , Oxidorreductasas/metabolismo , Proteínas Recombinantes/sangre , Proteínas Recombinantes/metabolismo , Trombosis/sangre , Trombosis/etiología
7.
BMJ Case Rep ; 14(2)2021 Feb 05.
Artículo en Inglés | MEDLINE | ID: mdl-33547104

RESUMEN

We observed a rare case of two different digestive paraneoplastic syndromes that improved with the treatment of the neoplasms. The first syndrome was chronic intestinal pseudo-obstruction (CIPO), which is a subtype of paraneoplastic syndromes called a paraneoplastic neurological syndrome (PNS). The second was Stauffer's syndrome, which is a unique paraneoplastic syndrome characterised by non-metastatic intrahepatic cholestasis associated with neoplasms. Here, we report the case of a 55-year-old man who presented with two concurrent paraneoplastic syndromes in the digestive system. The intestinal pseudo-obstruction and elevated biliary enzyme levels improved as the lung cancer responded to chemotherapy. In this case, CIPO as a PNS led to the detection of lung cancer. To our knowledge, this is the first report of Stauffer's syndrome caused by lung adenocarcinoma.


Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Colestasis Intrahepática/etiología , Seudoobstrucción Intestinal/etiología , Neoplasias Pulmonares/tratamiento farmacológico , Síndromes Paraneoplásicos/complicaciones , Biomarcadores/sangre , Colestasis Intrahepática/diagnóstico , Diagnóstico Diferencial , Humanos , Seudoobstrucción Intestinal/diagnóstico , Neoplasias Pulmonares/diagnóstico , Masculino , Persona de Mediana Edad , Síndromes Paraneoplásicos/diagnóstico , Síndrome
8.
BMJ Case Rep ; 14(2)2021 Feb 05.
Artículo en Inglés | MEDLINE | ID: mdl-33547117

RESUMEN

The report describes a patient with cholestatic jaundice who had incidentally detected parathyroid hormone-independent hypercalcaemia. The differential diagnosis for this presentation includes systemic granulomatous and infiltrative disorders, drug-induced liver injury and malignancy. As the initial investigations were non-contributory towards the aetiology, she was given steroids and later plasma exchange for symptomatic treatment. The differentials were revised again in view of no clinical and biochemical response. A repeat fine-needle aspiration cytology of the thyroid nodule (seen on positron emission tomography/CT) revealed papillary carcinoma of the thyroid. The patient underwent total thyroidectomy. There was a complete normalisation of liver function tests and serum calcium, and resolution of pruritus 3 months post surgery. She was retrospectively diagnosed as a case of papillary carcinoma of the thyroid with paraneoplastic manifestations-hypercalcaemia and cholestatic jaundice-which got resolved with treatment of the primary tumour.


Asunto(s)
Hipercalcemia/etiología , Ictericia Obstructiva/etiología , Prurito/etiología , Cáncer Papilar Tiroideo/complicaciones , Cáncer Papilar Tiroideo/cirugía , Adulto , Biomarcadores/sangre , Terapia Combinada , Diagnóstico Diferencial , Femenino , Humanos , Hipercalcemia/terapia , Ictericia Obstructiva/terapia , Prurito/terapia , Cáncer Papilar Tiroideo/diagnóstico por imagen , Tiroidectomía
9.
BMJ Case Rep ; 14(2)2021 Feb 05.
Artículo en Inglés | MEDLINE | ID: mdl-33547118

RESUMEN

We describe the case of an 81-year-old man who presented with unspecific symptoms of desolation and general weakness, which led to a delayed diagnosis of rheumatoid arthritis (RA). The patient had not received any previous treatment as he had not been in contact with medical services for several years prior to hospital admission. This enabled advanced disease manifestations to develop, including peripheral neuropathy with distal paraparesis, lethargy and weight loss. These signs and symptoms were later recognised as extra-articular manifestations of RA and classical features of RA were less pronounced. Following extensive diagnostic testing ruling out other possible causes for the presenting symptoms, an anti-inflammatory therapy with oral glucocorticoids and methotrexate was started.


Asunto(s)
Antirreumáticos/uso terapéutico , Artritis Reumatoide/diagnóstico , Artritis Reumatoide/tratamiento farmacológico , Glucocorticoides/uso terapéutico , Metotrexato/uso terapéutico , Anciano de 80 o más Años , Biomarcadores/sangre , Diagnóstico Tardío , Depresión , Diagnóstico Diferencial , Diagnóstico por Imagen , Humanos , Masculino , Debilidad Muscular
10.
BMJ Case Rep ; 14(2)2021 Feb 05.
Artículo en Inglés | MEDLINE | ID: mdl-33547121

RESUMEN

Renal involvement in mantle cell lymphoma (MCL) is rare. We present the case of a man followed for MCL presented with acute kidney injury and positive antineutrophil cytoplasmic antibody (ANCA) type anti proteinase 3 (PR3). He was treated as for a rapidly progressing glomerulonephritis with cyclophosphamide and methylprednisolone followed by oral prednisone. Renal biopsy revealed diffuse endocapillary proliferation and segmental extracapillary proliferation in four glomeruli. Immunohistochemistry confirmed the renal invasion of lymphomatous cells. He started improving his renal function shortly after starting treatment. The coexistence of renal MCL infiltration, extracapillary proliferation and ANCA positive is exceptional.


Asunto(s)
Glomerulonefritis/etiología , Linfoma de Células del Manto/complicaciones , Anticuerpos Anticitoplasma de Neutrófilos/sangre , Protocolos de Quimioterapia Combinada Antineoplásica , Biomarcadores de Tumor/sangre , Biopsia , Ciclofosfamida , Diagnóstico Diferencial , Doxorrubicina , Glomerulonefritis/tratamiento farmacológico , Glomerulonefritis/patología , Humanos , Linfoma de Células del Manto/tratamiento farmacológico , Linfoma de Células del Manto/patología , Masculino , Persona de Mediana Edad , Prednisona , Rituximab , Vincristina
11.
BMJ Case Rep ; 14(2)2021 Feb 08.
Artículo en Inglés | MEDLINE | ID: mdl-33558377

RESUMEN

A 43-year-old African American man presented with right upper quadrant pain and elevated blood pressure. Investigations revealed elevated lipase, hypercalcaemia and elevated creatinine. CT abdomen with contrast revealed extensive intraabdominal lymphadenopathy with an initial suspicion for a lymphoproliferative malignancy. Patient was managed for acute pancreatitis, with further workup of hypercalcaemia revealing an elevated ACE level. Inguinal lymph node biopsy confirmed a non-caseating granuloma leading to the diagnosis of sarcoidosis.


Asunto(s)
Enfermedades Pancreáticas/diagnóstico , Pancreatitis/etiología , Sarcoidosis/diagnóstico , Lesión Renal Aguda/etiología , Corticoesteroides/uso terapéutico , Adulto , Biopsia , Creatinina/sangre , Diagnóstico Diferencial , Humanos , Hipercalcemia/etiología , Lipasa/sangre , Ganglios Linfáticos/patología , Masculino , Enfermedades Pancreáticas/diagnóstico por imagen , Enfermedades Pancreáticas/tratamiento farmacológico , Sarcoidosis/diagnóstico por imagen , Sarcoidosis/tratamiento farmacológico , Tomografía Computarizada por Rayos X
12.
JAMA ; 325(6): 552-560, 2021 02 09.
Artículo en Inglés | MEDLINE | ID: mdl-33560322

RESUMEN

Importance: The optimal transfusion strategy in patients with acute myocardial infarction and anemia is unclear. Objective: To determine whether a restrictive transfusion strategy would be clinically noninferior to a liberal strategy. Design, Setting, and Participants: Open-label, noninferiority, randomized trial conducted in 35 hospitals in France and Spain including 668 patients with myocardial infarction and hemoglobin level between 7 and 10 g/dL. Enrollment could be considered at any time during the index admission for myocardial infarction. The first participant was enrolled in March 2016 and the last was enrolled in September 2019. The final 30-day follow-up was accrued in November 2019. Interventions: Patients were randomly assigned to undergo a restrictive (transfusion triggered by hemoglobin ≤8; n = 342) or a liberal (transfusion triggered by hemoglobin ≤10 g/dL; n = 324) transfusion strategy. Main Outcomes and Measures: The primary clinical outcome was major adverse cardiovascular events (MACE; composite of all-cause death, stroke, recurrent myocardial infarction, or emergency revascularization prompted by ischemia) at 30 days. Noninferiority required that the upper bound of the 1-sided 97.5% CI for the relative risk of the primary outcome be less than 1.25. The secondary outcomes included the individual components of the primary outcome. Results: Among 668 patients who were randomized, 666 patients (median [interquartile range] age, 77 [69-84] years; 281 [42.2%] women) completed the 30-day follow-up, including 342 in the restrictive transfusion group (122 [35.7%] received transfusion; 342 total units of packed red blood cells transfused) and 324 in the liberal transfusion group (323 [99.7%] received transfusion; 758 total units transfused). At 30 days, MACE occurred in 36 patients (11.0% [95% CI, 7.5%-14.6%]) in the restrictive group and in 45 patients (14.0% [95% CI, 10.0%-17.9%]) in the liberal group (difference, -3.0% [95% CI, -8.4% to 2.4%]). The relative risk of the primary outcome was 0.79 (1-sided 97.5% CI, 0.00-1.19), meeting the prespecified noninferiority criterion. In the restrictive vs liberal group, all-cause death occurred in 5.6% vs 7.7% of patients, recurrent myocardial infarction occurred in 2.1% vs 3.1%, emergency revascularization prompted by ischemia occurred in 1.5% vs 1.9%, and nonfatal ischemic stroke occurred in 0.6% of patients in both groups. Conclusions and Relevance: Among patients with acute myocardial infarction and anemia, a restrictive compared with a liberal transfusion strategy resulted in a noninferior rate of MACE after 30 days. However, the CI included what may be a clinically important harm. Trial Registration: ClinicalTrials.gov Identifier: NCT02648113.


Asunto(s)
Anemia/terapia , Transfusión Sanguínea , Infarto del Miocardio/terapia , Anciano , Anciano de 80 o más Años , Anemia/complicaciones , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/prevención & control , Femenino , Hemoglobinas/análisis , Humanos , Masculino , Infarto del Miocardio/sangre , Infarto del Miocardio/complicaciones
13.
BMJ Case Rep ; 14(2)2021 Feb 09.
Artículo en Inglés | MEDLINE | ID: mdl-33563687

RESUMEN

Pituitary apoplexy (PA) is an endocrine emergency presenting with headache, visual and hormonal disturbances. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is rare after PA. A 64-year-old woman presented with acute frontal headache and nausea with normal neurological examination. Labs included normal sodium and creatinine. Echo showed new-onset congestive heart failure (CHF) and MRI of the brain revealed PA. She had normal cortisol levels and low thyroid stimulating hormone with normal thyroxine (T4) levels. During her hospitalisation, patient developed hyponatraemia. Initially, this was attributed to CHF and she was treated with tolvaptan with normalisation of sodium. One week later, she was readmitted with diarrhoea and hyponatraemia. She was euvolaemic on examination indicating compensated CHF. Despite fluid challenge, patient had no improvement of sodium levels. The diagnosis of SIADH was made. Clinicians should suspect SIADH in patients with hyponatraemia in the setting of PA with normal T4 and cortisol levels.


Asunto(s)
Hiponatremia/diagnóstico , Síndrome de Secreción Inadecuada de ADH/diagnóstico , Apoplejia Hipofisaria/diagnóstico , Biomarcadores/sangre , Diagnóstico Diferencial , Femenino , Humanos , Hiponatremia/terapia , Síndrome de Secreción Inadecuada de ADH/terapia , Imagen por Resonancia Magnética , Persona de Mediana Edad , Apoplejia Hipofisaria/terapia , Síndrome
14.
BMJ Case Rep ; 14(2)2021 Feb 09.
Artículo en Inglés | MEDLINE | ID: mdl-33563688

RESUMEN

We describe a case of a compartment syndrome after transulnar coronary intervention. As far as we are aware of, this is the first report of such a complication after a transulnar approach described in the literature. Compartment syndrome is a very rare but possibly devastating complication of coronary angiography and percutaneous coronary interventions. We retrospectively observed an incidence rate of 0.007% after 13,948 coronary angiographies or 0.013% after 7532 interventions performed through the wrist in our centre in the last 5 years. Rapid recognition and treatment of this rare complication may prevent long-term morbidity and are thus of utmost importance. General measures should be taken to reduce this incidence of this serious complication.


Asunto(s)
Angina de Pecho/terapia , Síndromes Compartimentales/etiología , Síndromes Compartimentales/cirugía , Intervención Coronaria Percutánea/efectos adversos , Arteria Cubital , Angina de Pecho/diagnóstico , Biomarcadores/sangre , Síndromes Compartimentales/diagnóstico por imagen , Diagnóstico Diferencial , Stents Liberadores de Fármacos , Electrocardiografía , Humanos , Masculino , Persona de Mediana Edad , Técnicas de Sutura , Ultrasonografía
15.
BMJ Case Rep ; 14(2)2021 Feb 09.
Artículo en Inglés | MEDLINE | ID: mdl-33563691

RESUMEN

While sporadic inclusion body myositis (sIBM) is the most commonly acquired inflammatory myopathy above 50 years of age, its refractory response to conventional immunosuppressive treatments raises questions about its perplexing pathogenesis. Muscle biopsy typically reveals major histocompatibility complex I antigens and CD8+ T cell endomysial infiltrates invading non-necrotic muscle fibres early in the disease course with rimmed vacuoles, protein aggregates and amyloid inclusions later in the disease. Transactive response DNA-binding protein-43 (TDP-43), a protein implicated in transcriptional repression in neurodegenerative diseases, is also found in sIBM. C5b-9 membrane attack complex, an effector protein involved in the complement cascade of the immune response, is commonly found in dermatomyositis, but has rarely been reported in IBM. We describe a novel case of IBM with simultaneous C5b-9 and TDP-43 staining on quadriceps biopsy, raising the question of a possibility of concurrent immune-mediated inflammatory and myodegenerative pathogenesis.


Asunto(s)
Complejo de Ataque a Membrana del Sistema Complemento/metabolismo , Proteínas de Unión al ADN/metabolismo , Miositis por Cuerpos de Inclusión/diagnóstico , Miositis por Cuerpos de Inclusión/metabolismo , Anciano , Biomarcadores/sangre , Biopsia , Diagnóstico Diferencial , Humanos , Masculino , Coloración y Etiquetado
16.
BMJ Case Rep ; 14(2)2021 Feb 09.
Artículo en Inglés | MEDLINE | ID: mdl-33563692

RESUMEN

An 81-year-old woman, diabetic and hypertensive, presented with nausea and intermittent vomiting. She had dysphagia and loss of appetite for over 6 weeks and significant weight loss over 3 weeks and was admitted in general surgery unit on emergency basis. Investigations revealed dilated stomach and a stone in first part of duodenum, with probable site of obstruction at level of first part of duodenum, secondary to a cholecystoduodenal fistula. With a preoperative diagnosis of Bouveret's syndrome, she underwent laparotomy and subtotal cholecystectomy. Postoperative recovery was delayed due to gastroparesis and delayed gastric emptying which resolved with conservative management. Successful management of this case required a multidisciplinary team approach. Early diagnosis was the key to management. Mode of treatment and management of Bouveret's syndrome should be tailored to suit patient's age, comorbidities and performance status.


Asunto(s)
Cálculos Biliares/complicaciones , Obstrucción de la Salida Gástrica/etiología , Obstrucción de la Salida Gástrica/cirugía , Anciano de 80 o más Años , Biomarcadores/sangre , Colecistectomía , Diagnóstico Diferencial , Diagnóstico Precoz , Femenino , Cálculos Biliares/diagnóstico por imagen , Obstrucción de la Salida Gástrica/diagnóstico por imagen , Humanos , Laparotomía , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/terapia , Síndrome
17.
BMJ Case Rep ; 14(2)2021 Feb 09.
Artículo en Inglés | MEDLINE | ID: mdl-33563693

RESUMEN

A 54 year-old man was admitted after being found on the floor of his home, thought to have been there for approximately 5 days. He was diagnosed with a non-ST elevation myocardial infarction and bilateral cerebral ischaemic infarcts, as well as an acute kidney injury driven by rhabdomyolysis. The following day, bilateral lower limb ischaemia was observed. A full body CT angiogram revealed a complete thromboembolic shower with bilateral arterial occlusion in the lower limbs, bilateral pulmonary emboli, a splenic infarct and mesenteric ischaemia. An echocardiogram revealed a large thrombus in the left ventricle as the likely thromboembolic source. Bilateral lower limb amputations were recommended, commencing a complex discussion regarding the best course of management for this patient. The discussion was multifaceted, owing to the patient's lack of capacity, and input from multiple teams and the patient's relatives was required. Both ethical and clinical challenges arise from this case of a thromboembolic shower.


Asunto(s)
Tromboembolia/diagnóstico por imagen , Tromboembolia/terapia , Amputación , Arteriopatías Oclusivas/diagnóstico por imagen , Arteriopatías Oclusivas/terapia , Biomarcadores/sangre , Infarto Cerebral/diagnóstico por imagen , Infarto Cerebral/terapia , Angiografía por Tomografía Computarizada , Trombosis Coronaria/diagnóstico por imagen , Trombosis Coronaria/terapia , Diagnóstico Diferencial , Ecocardiografía , Electrocardiografía , Humanos , Masculino , Isquemia Mesentérica/diagnóstico por imagen , Isquemia Mesentérica/terapia , Persona de Mediana Edad , Embolia Pulmonar/diagnóstico por imagen , Embolia Pulmonar/terapia , Infarto del Bazo/diagnóstico por imagen , Infarto del Bazo/terapia
18.
BMJ Case Rep ; 14(2)2021 Feb 09.
Artículo en Inglés | MEDLINE | ID: mdl-33563695

RESUMEN

Choledochal cyst and gallbladder duplication are rare congenital anomalies. They typically are surgical problems of infancy or childhood but rarely may present in adults also. Despite high resolution imaging, the differentiation of type II choledochal cyst from gallbladder duplication often causes the diagnostic dilemma; which may result in high risk for intraoperative iatrogenic injury. Operative management of choledochal cyst is the definite treatment because of its malignant potential. A type II choledochal cyst arising from the hepatic hilum presenting as gallbladder duplication on imaging has not been reported earlier in the literature and here we present a case report of the same which was managed successfully.


Asunto(s)
Quiste del Colédoco/diagnóstico por imagen , Quiste del Colédoco/cirugía , Adulto , Biomarcadores/sangre , Pancreatocolangiografía por Resonancia Magnética , Diagnóstico Diferencial , Femenino , Vesícula Biliar/anomalías , Humanos , Ultrasonografía
20.
J Am Osteopath Assoc ; 121(2): 199-210, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33567087

RESUMEN

Context: The true prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), has been difficult to determine due to limited testing, inconsistent symptom severity, and asymptomatic infections. Systematic investigation of the prevalence of SARS-CoV-2 has been limited to urban environments and large academic centers. Limited data on the seroprevalence of SARS-CoV-2 is available for those who live in a rural community setting, leaving rural practitioners to extrapolate the epidemiology of COVID-19 to a nonhomogeneous population. Objective: To determine the seroprevalence of SARS-CoV-2 in a community setting. The secondary objective of this study was to describe the difference in infection rate and reverse transcription polymerase chain reaction (RT-PCR) testing in the same rural community. Methods: A prospective convenience sample of community members and healthcare workers from the Kingman, Arizona area were tested for SARS-CoV-2-specific antibodies using a lateral flow immunoassay with the VITROS Anti-SARS-CoV-2 IgG test (Ortho-Clinical Diagnostics, Inc.) from September 28, 2020 to October 09, 2020. Upon recruitment, participants were asked to complete a demographic survey assessing socioeconomic status, comorbidities, and COVID-19 symptoms in the preceding two months. Following enrollment, a retrospective chart review was completed to determine the percentage of patients who had undergone previous SARS-CoV-RT-PCR testing. Results: A total of 566 participants were included in the final analysis: 380 (67.1%) were women, 186 (32.9%) were men, a majority (458; 80.9%) self-identified as White, and 303 (53.5%) were employed as healthcare professionals. Seroprevalence of SARS-CoV-2 was found to be 8.0% (45 of 566) across the sample and 9.9% (30 of 303) in healthcare workers. No statistical difference in seroprevalence was found between men and women, healthcare workers and other participants, amongst racial groups, by socioeconomic status, by comorbid conditions, or by education level. Among the participants, 108 (19.1%) underwent previous RT-PCR testing. Of the 45 patients who were antibody positive, 27 (60%) had received a previous RT-PCR test, with 20 (44.4%) testing positive for SARS-CoV-2. Participants with symptoms of anosmia/ageusia (p<0.001), chest congestion (p=0.047), fever (p=0.007), and shortness of breath (p=0.002) within the past two months were more likely to have antibodies to SARS-CoV-2. Conclusion: Only 8% of 566 participants in this rural community setting were found to have antibodies for SARS-CoV-2. A large minority (18; 40%) of patients testing seropositive for SARs-CoV-2 had never received a prior test, suggesting that the actual rates of infection are higher than publicly available data suggest. Further large-scale antibody testing is needed to determine the true prevalence of SARS-CoV-2 in the rural setting.


Asunto(s)
Anticuerpos Antivirales/sangre , /inmunología , Adulto , Arizona/epidemiología , Femenino , Personal de Salud , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Estudios Retrospectivos , Población Rural , Estudios Seroepidemiológicos , Factores Socioeconómicos
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