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2.
J Indian Soc Pedod Prev Dent ; 38(3): 319-322, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33004733

RESUMEN

Melanotic neuroectodermal tumor is a rare benign congenital neoplasm involving the head-and-neck region found in infants <1 year of age. The lesion most commonly affects the maxilla. We report the case of a 4-month-old male child with a tumor involving the anterior region of the maxilla along with a brief review of literature, differential diagnosis, and treatment.


Asunto(s)
Tumor Neuroectodérmico Melanótico , Niño , Diagnóstico Diferencial , Humanos , Lactante , Masculino , Maxilar , Tumor Neuroectodérmico Melanótico/diagnóstico , Tumor Neuroectodérmico Melanótico/diagnóstico por imagen , Tumor Neuroectodérmico Melanótico/cirugía
3.
Arch Pathol Lab Med ; 144(10): 1162-1163, 2020 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-33002155
4.
Chron Respir Dis ; 17: 1479973120961843, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33000640

RESUMEN

The spread of the SARS-CoV-2 infection among population has imposed a re-organization of healthcare services, aiming at stratifying patients and dedicating specific areas where patients with suspected COVID-related respiratory disease could receive the necessary health care assistance while waiting for the confirmation of the diagnosis of COVID-19 disease. In this scenario, the pathway defined as a "grey zone" is strongly advocated. We describe the application of rules and pathways in a regional context with low diffusion of the infection among the general population in the attempt to provide the best care to respiratory patients with suspected COVID-19. To date, this process has avoided the worst-case scenario of intra-hospital epidemic outbreak.


Asunto(s)
Infecciones por Coronavirus , Vías Clínicas/tendencias , Control de Infecciones/métodos , Pandemias , Manejo de Atención al Paciente , Neumonía Viral , Enfermedades Respiratorias/diagnóstico , Anciano , Betacoronavirus , Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/terapia , Diagnóstico Diferencial , Femenino , Humanos , Italia/epidemiología , Masculino , Innovación Organizacional , Pandemias/prevención & control , Manejo de Atención al Paciente/organización & administración , Manejo de Atención al Paciente/normas , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Neumonía Viral/terapia , Prevalencia
5.
Tohoku J Exp Med ; 252(2): 109-119, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-33028754

RESUMEN

Coronavirus disease 2019 (COVID-19) is associated with various symptoms and changes in hematological and biochemical variables. However, clinical features, which can differentiate COVID-19 from non-COVID-19, are not clear. We therefore examined the key clinical features of COVID-19 and non-COVID-19 patients. This study included 60 COVID-19 patients and 100 non-COVID-19 patients, diagnosed by PCR, and no significant differences in the age and sex were seen between the two groups. The frequencies of fatigue, loose stool, diarrhea, nasal obstruction, olfactory dysfunction, taste dysfunction, underlying hyperlipidemia, and the prescription of angiotensin II receptor blocker (ARB) were significantly higher in COVID-19 patients than those in non-COVID-19 patients. The counts of leucocytes, neutrophils, lymphocytes, eosinophils, monocytes, and basophils and the levels of chloride and calcium in blood of COVID-19 patients were significantly lower than those of non-COVID-19 patients. The frequencies of atypical lymphocytes and the levels of lactate dehydrogenase (LDH) and potassium were significantly higher in COVID-19 than those in non-COVID-19. The C-reactive protein (CRP) level in COVID-19 patients was significantly lower than that in non-COVID-19 patients, when we compared CRP levels among patients with elevated CRP. This study is the first to indicate that electrolyte levels and the frequency of atypical lymphocytes in COVID-19 are significantly different from those in non-COVID-19. Fatigue, loose stool, diarrhea, nasal obstruction, olfactory dysfunction, and taste dysfunction were the key symptoms of COVID-19. Furthermore, hyperlipidemia and ARB may be risk factors of COVID-19. In conclusion, leucocytes, leucocyte fractions, CRP, LDH, and electrolytes are useful indicators for COVID-19 diagnosis.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Electrólitos/sangre , Linfocitos/virología , Neumonía Viral/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Betacoronavirus , Proteína C-Reactiva/análisis , Niño , Diagnóstico Diferencial , Femenino , Humanos , L-Lactato Deshidrogenasa/sangre , Masculino , Persona de Mediana Edad , Trastornos del Olfato/virología , Pandemias , Reacción en Cadena de la Polimerasa , Estudios Retrospectivos , Evaluación de Síntomas , Trastornos del Gusto/virología , Adulto Joven
6.
Int J Med Sci ; 17(16): 2561-2569, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33029098

RESUMEN

Background: During the outbreak period of COVID-19 pneumonia, cancer patients have been neglected and in greater danger. Furthermore, the differential diagnosis between COVID-19 pneumonia and radiation pneumonitis in cancer patients remains a challenge. This study determined their clinical presentations and radiological features in order to early diagnose and separate COVID-19 pneumonia from radiation pneumonitis patients promptly. Methods and Findings: From January 21, 2020 to February 18, 2020, 112 patients diagnosed with suspected COVID-19 were selected consecutively. A retrospective analysis including all patients' presenting was performed. Four patients from 112 suspected individals were selected, including 2 males and 2 females with a median age of 54 years (range 39-64 years). After repeated pharyngeal swab nucleic acid tests, 1 case was confirmed and 3 cases were excluded from COVID-19 pneumonia. Despite the comparable morphologic characteristics of lung CT imaging, the location, extent, and distribution of lung lesions between COVID-19 pneumonia and radiation pneumonitis differed significantly. Conclusions: Lung CT imaging combined with clinical and laboratory findings can facilitate early diagnosis and appropriate management of COVID-19 pneumonia with a history of malignancy and radiation therapy.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/diagnóstico por imagen , Diagnóstico Diferencial , Neoplasias/radioterapia , Neumonía Viral/diagnóstico por imagen , Neumonitis por Radiación/diagnóstico por imagen , Adulto , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/diagnóstico , Neoplasias Esofágicas/diagnóstico por imagen , Neoplasias Esofágicas/patología , Neoplasias Esofágicas/radioterapia , Femenino , Humanos , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/radioterapia , Masculino , Persona de Mediana Edad , Neoplasias Nasofaríngeas/diagnóstico por imagen , Neoplasias Nasofaríngeas/patología , Neoplasias Nasofaríngeas/radioterapia , Neoplasias/virología , Pandemias , Estudios Retrospectivos , Tomografía Computarizada por Rayos X
7.
Curr Opin Ophthalmol ; 31(6): 521-531, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33009085

RESUMEN

PURPOSE OF REVIEW: Ocular sarcoidosis is one of the most common causes of uveitis worldwide. The diagnosis and treatment of patients with ocular sarcoidosis remains challenging in some cases. It is important for clinicians to keep up to date with new diagnostic and treatment tools for this disease. RECENT FINDINGS: The International Workshop on Ocular Sarcoidosis diagnostic criteria were first proposed in 2009 and revised in 2017. The new criteria contained two parts: ocular presentation and systemic investigation. The diagnostic value of liver enzymes was reduced in the new criteria, whereas the value placed of lymphopenia and the CD4/CD8 ratio in bronchoalveolar lavage fluid were increased. Despite not being included in the criteria, recent studies have also highlighted the diagnostic value of serum soluble interleukin-2 receptors. Recent ophthalmologic imaging also provides useful insights for the differential diagnosis.Many new treatments for ocular sarcoidosis have been developed in recent years. The introduction of biological immunomodulatory agents for uveitis treatment represents a big improvement. Antitumor necrosis factor-alpha antibodies, including adalimumab, have been proven to be effective for treating ocular sarcoidosis. Many studies have also suggested that other biological agents could be effective and well tolerated. Newer intravitreal dexamethasone and fluocinolone implants have been developed. Patients treated with these implants have experienced good and sustained control of their intraocular inflammation. SUMMARY: Diagnosis and treatment options for ocular sarcoidosis have changed over time. However, challenges still exist in some difficult patients. Future studies should focus on finding more sensitive biomarkers and developing more effective immunomodulatory treatments with longer efficacy and less side effects.


Asunto(s)
Oftalmopatías/diagnóstico , Oftalmopatías/tratamiento farmacológico , Sarcoidosis/diagnóstico , Sarcoidosis/tratamiento farmacológico , Biomarcadores/análisis , Diagnóstico Diferencial , Endoftalmitis/diagnóstico , Humanos
8.
Aust J Gen Pract ; 49(10): 656-661, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-33015681

RESUMEN

BACKGROUND: Patients with red eyes frequently present to general practitioners (GPs). Although infrequent, some patients with COVID-19 may present with features typical of viral conjunctivitis. SARS-CoV-2 is expressed at a low rate in tears, which may be a source of infection to GPs caring for patients at high risk of COVID­19. OBJECTIVE: The aims of this article are to outline: 1) ophthalmic complications of SARS-CoV-2 infection, 2) triage and management of patients with potential COVID-19 conjunctivitis, and 3) triage and management of patients with red eyes during the current COVID-19 pandemic. DISCUSSION: It is important that GPs: 1) have a high index of suspicion that patients with apparently typical viral conjunctivitis may have an uncommon presentation of COVID-19 illness, 2) develop appropriate telephone triage systems to reduce patient consultations, and 3) foster relationships with their ophthalmologist and optometrist colleagues who can provide phone advice, guidance on treatment initiation and definitive care when necessary.


Asunto(s)
Betacoronavirus/aislamiento & purificación , Conjuntivitis , Infecciones por Coronavirus , Control de Infecciones , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Pandemias , Neumonía Viral , Triaje/métodos , Comorbilidad , Conjuntivitis/diagnóstico , Conjuntivitis/epidemiología , Conjuntivitis/virología , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/terapia , Diagnóstico Diferencial , Técnicas de Diagnóstico Oftalmológico , Médicos Generales , Humanos , Control de Infecciones/métodos , Control de Infecciones/organización & administración , Exposición Profesional/prevención & control , Neumonía Viral/epidemiología , Neumonía Viral/fisiopatología , Neumonía Viral/terapia , Lágrimas/virología
9.
BMC Pregnancy Childbirth ; 20(1): 587, 2020 Oct 06.
Artículo en Inglés | MEDLINE | ID: mdl-33023500

RESUMEN

BACKGROUND: There are no published cases of tonic-clonic seizures and posterior bilateral blindness during pregnancy and Severe Acute Respiratory Syndrome (SARS) Coronavirus (COV) 2 (SARS-COV-2) infection. We do not just face new and unknown manifestations, but also how different patient groups are affected by SARS-COV-2 infection, such as pregnant women. Coronavirus Disease 2019 (COVID-19), preeclampsia, eclampsia and posterior reversible leukoencephalopathy share endothelium damage and similar pathophysiology. CASE PRESENTATION: A 35-year-old pregnant woman was admitted for tonic-clonic seizures and SARS-COV-2 infection. She had a normal pregnancy control and no other symptoms before tonic-clonic seizures development. After a Caesarean section (C-section) she developed high blood pressure, and we initiated antihypertensive treatment with labetalol, amlodipine and captopril. Few hours later she developed symptoms of cortical blindness that resolved in 72 h with normal brain computed tomography (CT) angiography. CONCLUSION: The authors conclude that SARS COV-2 infection could promote brain endothelial damage and facilitate neurological complications during pregnancy.


Asunto(s)
Antihipertensivos/administración & dosificación , Betacoronavirus/aislamiento & purificación , Ceguera Cortical , Cesárea/métodos , Infecciones por Coronavirus , Eclampsia , Fibrinolíticos/administración & dosificación , Pandemias , Neumonía Viral , Complicaciones Infecciosas del Embarazo , Convulsiones , Adulto , Ceguera Cortical/diagnóstico , Ceguera Cortical/virología , Encéfalo/diagnóstico por imagen , Angiografía por Tomografía Computarizada/métodos , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/fisiopatología , Diagnóstico Diferencial , Eclampsia/diagnóstico , Eclampsia/terapia , Eclampsia/virología , Femenino , Humanos , Examen Neurológico/métodos , Neumonía Viral/diagnóstico , Neumonía Viral/fisiopatología , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/etiología , Complicaciones Infecciosas del Embarazo/fisiopatología , Resultado del Embarazo , Convulsiones/diagnóstico , Convulsiones/etiología , Convulsiones/terapia , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento
10.
Rev Assoc Med Bras (1992) ; 66(9): 1277-1282, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-33027458

RESUMEN

INTRODUCTION: Microcytic anemias are very common in clinical practice, with iron deficiency anemia (IDA) and thalassemia minor (TT) being the most prevalent. Diagnostic confirmation of these clinical entities requires tests involving iron metabolism profile, hemoglobin electrophoresis, and molecular analysis. In this context, several discriminant indices have been proposed to simplify the differential diagnosis between IDA and TM. OBJECTIVE: The aim of this paper was to demonstrate the clinical relevance of the use of discriminant indices in individuals with microcytic anemia to simplify the differential diagnosis between iron deficiency anemia and minor thalassemia. METHODS: A bibliographic and cross-sectional search was performed in the PubMed, SciELO and LILACS databases, using the following descriptors: iron deficiency anemia, thalassemia minor, and differential diagnosis. RESULTS: More than 40 mathematical indices based on erythrocyte parameters have been proposed in the hematological literature in individuals with microcytosis. Green & King indexes (IGK), Ehsani index, and erythrocyte count (RBC) had excellent performances, especially when their efficacy was observed in adults and children. CONCLUSIONS: Confirmatory tests for differential diagnosis between IDA and TM require time-consuming and costly methods. Despite the excellent performances of IGK, Ehsani index, and RBC, none of them presented sufficient sensitivity and specificity to establish a diagnosis. However, they can provide a powerful additional tool for diagnostic simplification between IDA and TM.


Asunto(s)
Anemia Ferropénica , Talasemia beta , Anemia Ferropénica/diagnóstico , Estudios Transversales , Diagnóstico Diferencial , Índices de Eritrocitos , Humanos , Talasemia beta/diagnóstico
11.
Stomatologiia (Mosk) ; 99(5): 92-95, 2020.
Artículo en Ruso | MEDLINE | ID: mdl-33034184

RESUMEN

The article presents a clinical case of an immunohistochemical study of a rare disease: necrotizing sialometaplasia in the hard palate. Due to the complexity of the differential diagnosis between necrotizing sialometaplasia and squamous cell carcinoma, an immunohistochemical method was used with antibodies to proteins Ki-67, P53, P63 and cytokeratins-7 and Immunohistochemical study established low proliferative activity of glandular cells in excretory ducts and metaplastic squamous epithelium for Ki-67 protein, significant expression of protein P63 was detected both in the ductal epithelium nuclei and in metaplastic areas and expression of the mutant protein P53 was approximately absent. Marked expression of cytokeratin-7 in the ducts cells and weak expression in necrotic acini of the glands and metaplastic epithelium was noted. It was shown that cytokeratin-15 homogeneously stains the peripheral zone of metaplastic epithelium, which is characteristic of a benign lesion. Thus, the panel of antibodies to proteins Ki-67, P53 and cytokeratins-7 and 15 allows to verify necrotizing sialometaplasia.


Asunto(s)
Carcinoma de Células Escamosas , Sialometaplasia Necrotizante , Carcinoma de Células Escamosas/diagnóstico , Diagnóstico Diferencial , Epitelio , Humanos , Paladar Duro , Sialometaplasia Necrotizante/diagnóstico
12.
BMJ Case Rep ; 13(10)2020 Oct 04.
Artículo en Inglés | MEDLINE | ID: mdl-33012721

RESUMEN

We present a case of non-convulsive status epilepticus in a 57-year-old woman with a schizoaffective disorder, without an antecedent seizure history, with two possible aetiologies including SARS-CoV-2 infection and clozapine uptitration. We discuss the presentation, investigations, differential diagnosis and management. In particular, we focus on the electroencephalogram (EEG) findings seen in this case and the electroclinical response to antiepileptic medication. We review the literature and discuss the relevance of this case to the SARS-CoV-2 global pandemic. We emphasise the importance of considering possible neurological manifestations of SARS-CoV-2 infection and highlight seizure disorder as one of the possible presentations. In addition, we discuss the possible effects of clozapine on the electroclinical presentation by way of possible seizure induction as well as discuss the possible EEG changes and we highlight that this needs to be kept in mind especially during rapid titration.


Asunto(s)
Antipsicóticos/efectos adversos , Betacoronavirus , Clozapina/efectos adversos , Infecciones por Coronavirus/complicaciones , Neumonía Viral/complicaciones , Trastornos Psicóticos/tratamiento farmacológico , Estado Epiléptico/etiología , Clozapina/uso terapéutico , Diagnóstico Diferencial , Electroencefalografía/métodos , Femenino , Humanos , Persona de Mediana Edad , Pandemias , Estado Epiléptico/fisiopatología
13.
Medicine (Baltimore) ; 99(40): e22583, 2020 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-33019474

RESUMEN

INTRODUCTION: Henoch-Schönlein purpura (HSP) is an extremely rare condition in patients with pulmonary tuberculosis, with only a few reported cases. Compared to patients with typical clinical symptoms, it is difficult to make a definitive diagnosis when HSP presents as an initial manifestation in pulmonary tuberculosis patients. Herein, a case of pulmonary tuberculosis that showed HSP at first was reported, and the related literatures were reviewed. PATIENT CONCERNS: A 24-year-old man presented with palpable purpura on the extremities, accompanied by abdominal pain, bloody stools, and knee pain. DIAGNOSES: The patient was diagnosed with pulmonary tuberculosis based on the results of interferon gamma release assays, purified protein derivative test, and computed tomography. INTERVENTIONS: The patient was treated with vitamin C and chlorpheniramine for 2 weeks, and the above-mentioned symptoms were relieved. However, 3 weeks later, the purpura recurred with high-grade fever and chest pain during the inspiratory phase. The patient was then treated with anti-tuberculosis drugs, and the purpura as well as the high fever disappeared. OUTCOMES: The patient recovered well and remained free of symptoms during the follow-up examination. CONCLUSION: Pulmonary tuberculosis presenting with HSP as an initial manifestation is not common. Therefore, it is difficult to clinically diagnose and treat this disease. When an adult patient shows HSP, it is important to consider the possibility of tuberculosis to avoid misdiagnosis and delayed treatment.


Asunto(s)
Antituberculosos/uso terapéutico , Púrpura de Schoenlein-Henoch/etiología , Tuberculosis Pulmonar/complicaciones , Tuberculosis Pulmonar/tratamiento farmacológico , Dolor Abdominal/diagnóstico , Dolor Abdominal/etiología , Cuidados Posteriores , Ácido Ascórbico/uso terapéutico , Clorfeniramina/uso terapéutico , Diagnóstico Diferencial , Fiebre/diagnóstico , Fiebre/etiología , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiología , Antagonistas de los Receptores Histamínicos H1/uso terapéutico , Humanos , Ensayos de Liberación de Interferón gamma/métodos , Masculino , Púrpura de Schoenlein-Henoch/tratamiento farmacológico , Resultado del Tratamiento , Tuberculina , Tuberculosis Pulmonar/sangre , Tuberculosis Pulmonar/diagnóstico por imagen , Vitaminas/uso terapéutico , Adulto Joven
14.
Medicine (Baltimore) ; 99(40): e22619, 2020 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-33019483

RESUMEN

RATIONALE: Xanthogranuloma of the sellar region is exceedingly rare, and described in only a handful of case reports. Herein, we present a case of xanthogranuloma of the sellar region to improve our knowledge for the diagnosis and management of this unusual disease. PATIENT CONCERNS: A 50-year-old female presented with the symptoms of intermittent vomiting, occasional head discomfort, and diabetes insipidus of 1 month duration. DIAGNOSES: Magnetic resonance imaging showed a large well-defined, vase-like, heterogeneous mass in the sellar region. The lesion showed mixed signal with hierarchical signal presentation. Fluid-fluid level sign can be found within the lesion. The upper part of the lesion was hyperintense, and the lower part was hypointense on both T1-weighted images and T2-weighted images. The lesion showed no enhancement following the intravenous administration of gadolinium. The normal pituitary tissue was not clearly visible. Optic chiasm was compressed and displaced by the lesion. Initial diagnosis of pituitary macroadenoma with hemorrhage in the sellar region was made before surgery. Final diagnosis of sellar xanthogranuloma was confirmed by histopathological examination after surgical resection. INTERVENTIONS: Gross total resection of the lesion was achieved using the microscope through endonasal transsphenoidal approach. OUTCOMES: The patient recovered well with improved binocular vision and no symptom of diabetes insipidus, and was discharged 5 days after operation. LESSONS: Sellar xanthogranuloma should receive diagnostic consideration for the lesion that is a heterogeneously mixed mass with a degree of T1-weighted images hyperintense in the sellar region.


Asunto(s)
Diabetes Insípida/etiología , Granuloma/cirugía , Silla Turca/patología , Xantomatosis/patología , Xantomatosis/cirugía , Diagnóstico Diferencial , Femenino , Gadolinio/administración & dosificación , Granuloma/patología , Cefalea/etiología , Humanos , Imagen por Resonancia Magnética/métodos , Persona de Mediana Edad , Neoplasias Hipofisarias/diagnóstico , Silla Turca/diagnóstico por imagen , Resultado del Tratamiento , Vómitos/etiología
15.
Ann Biol Clin (Paris) ; 78(5): 499-518, 2020 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-33026346

RESUMEN

The French society of clinical biology "Biochemical markers of COVID-19" has set up a working group with the primary aim of reviewing, analyzing and monitoring the evolution of biological prescriptions according to the patient's care path and to look for markers of progression and severity of the disease. This study covers all public and private sectors of medical biology located in metropolitan and overseas France and also extends to the French-speaking world. This article presents the testimonies and data obtained for the "Overseas and French-speaking countries" sub-working group made up of 45 volunteer correspondents, located in 20 regions of the world. In view of the delayed spread of the SARS-CoV-2 virus, the overseas regions and the French-speaking regions have benefited from feedback from the first territories confronted with COVID-19. Thus, the entry of the virus or its spread in epidemic form could be avoided, thanks to the rapid closure of borders. The overseas territories depend very strongly on air and/or sea links with the metropolis or with the neighboring continent. The isolation of these countries is responsible for reagent supply difficulties and has necessitated emergency orders and the establishment of stocks lasting several months, in order to avoid shortages and maintain adequate patient care. In addition, in countries located in tropical or intertropical zones, the diagnosis of COVID-19 is complicated by the presence of various zoonoses (dengue, Zika, malaria, leptospirosis, etc.).


Asunto(s)
Servicios de Laboratorio Clínico , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Salud Global/estadística & datos numéricos , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Medicina del Viajero/organización & administración , Adulto , África/epidemiología , Anciano , Anciano de 80 o más Años , Bélgica/epidemiología , Betacoronavirus/fisiología , Biomarcadores/análisis , Biomarcadores/sangre , Cambodia/epidemiología , Niño , Servicios de Laboratorio Clínico/organización & administración , Servicios de Laboratorio Clínico/estadística & datos numéricos , Trazado de Contacto/métodos , Trazado de Contacto/estadística & datos numéricos , Infecciones por Coronavirus/transmisión , Diagnóstico Diferencial , Femenino , Francia/epidemiología , Hospitalización/estadística & datos numéricos , Humanos , Recién Nacido , Islas/epidemiología , Lenguaje , Laos/epidemiología , Louisiana/epidemiología , Masculino , Personal de Laboratorio Clínico/organización & administración , Personal de Laboratorio Clínico/estadística & datos numéricos , Persona de Mediana Edad , Pandemias , Neumonía Viral/transmisión , Estudios Retrospectivos , Encuestas y Cuestionarios , Análisis de Supervivencia , Medicina del Viajero/métodos , Medicina del Viajero/estadística & datos numéricos , Enfermedad Relacionada con los Viajes , Clima Tropical , Medicina Tropical/métodos , Medicina Tropical/organización & administración , Medicina Tropical/estadística & datos numéricos , Vietnam/epidemiología
16.
BMJ Case Rep ; 13(10)2020 Oct 07.
Artículo en Inglés | MEDLINE | ID: mdl-33028570

RESUMEN

In March 2020, a 74-year-old man affected by end-stage renal disease and on peritoneal dialysis was referred to an emergency room in Modena, Northern Italy, due to fever and respiratory symptoms. After ruling out COVID-19 infection, a diagnosis of chronic obstructive pulmonary disease exacerbation was confirmed and he was thus transferred to the nephrology division. Physical examination and blood tests revealed a positive fluid balance and insufficient correction of the uraemic syndrome, although peritoneal dialysis prescription was maximised. After discussion with the patient and his family, the staff decided to start hybrid dialysis, consisting of once-weekly in-hospital haemodialysis and home peritoneal dialysis for the remaining days. He was discharged at the end of the antibiotic course, after an internal jugular vein central venous catheter placement and the first haemodialysis session. This strategy allowed improvement of depuration parameters and avoidance of frequent access to the hospital, which is crucial in limiting exposure to SARS-CoV-2 in an endemic setting.


Asunto(s)
Infecciones por Coronavirus , Fallo Renal Crónico , Pandemias , Diálisis Peritoneal/métodos , Neumonía Viral , Enfermedad Pulmonar Obstructiva Crónica , Diálisis Renal/métodos , Anciano , Antibacterianos/administración & dosificación , Betacoronavirus , Terapia Combinada/métodos , Terapia Combinada/tendencias , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Diagnóstico Diferencial , Unidades de Hemodiálisis en Hospital , Humanos , Control de Infecciones/métodos , Fallo Renal Crónico/diagnóstico , Fallo Renal Crónico/fisiopatología , Fallo Renal Crónico/terapia , Masculino , Innovación Organizacional , Pandemias/prevención & control , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Brote de los Síntomas
17.
BMJ Case Rep ; 13(10)2020 Oct 07.
Artículo en Inglés | MEDLINE | ID: mdl-33028572

RESUMEN

A 13-year-old boy presented to hospital with 3-day self-limited fever, followed by dry cough, persistent asthenia and impaired general condition of 2 weeks' duration. Blood analyses showed a severe inflammatory status and chest X-ray images were consistent with bilateral COVID-19 pneumonia. He developed an acute respiratory failure that required paediatric intensive care admission and non-invasive ventilation. A targeted COVID-19 treatment was initiated with hydroxicloroquine, corticosteroids, enoxaparine and a single dose of tocilizumab. Repeated serological tests and real-time reverse transcription PCR for SARS-CoV-2 were negative. Other infectious pathogens were also ruled out. Thoracic high resolution CT showed an intense bilateral pulmonary dissemination with lytic vertebral bone lesions. After diagnostic investigations, Ewing's sarcoma with metastatic pulmonary dissemination was diagnosed. Nowadays, in the context of SARS-CoV-2 community pandemic, we cannot forget that COVID-19 clinical presentation is not specific and other entities can mimic its clinical features.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Neoplasias Pulmonares , Nódulos Pulmonares Múltiples , Neumonía Viral/diagnóstico , Sarcoma de Ewing , Tomografía Computarizada por Rayos X/métodos , Adolescente , Protocolos de Quimioterapia Combinada Antineoplásica , Examen de la Médula Ósea/métodos , Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/fisiopatología , Diagnóstico Diferencial , Humanos , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/fisiopatología , Neoplasias Pulmonares/secundario , Masculino , Nódulos Pulmonares Múltiples/diagnóstico por imagen , Nódulos Pulmonares Múltiples/patología , Pandemias , Neumonía Viral/sangre , Neumonía Viral/etiología , Neumonía Viral/fisiopatología , Sarcoma de Ewing/diagnóstico , Sarcoma de Ewing/fisiopatología , Tomografía Computarizada de Emisión de Fotón Único/métodos
18.
Medicine (Baltimore) ; 99(41): e22259, 2020 Oct 09.
Artículo en Inglés | MEDLINE | ID: mdl-33031266

RESUMEN

Drug-induced liver injury (DILI) is difficult in diagnose, criteria used now are mostly based on history review. We tried to evaluate the value of these criteria and histopathology features in DILI to perform a method diagnosing DILI more definitely.We enrolled 458 consecutive hospitalized DILI patients from January 1, 2012 to December 31, 2018, using Roussel-Uclaf Causality Assessment Method (RUCAM), Maria & Victorino scale (M&V), and Digestive Disease Week-Japan criterion (DDW-J) combined with refined pathological scoring system respectively to perform the evaluation.A total of 458 DILI patients were enrolled, the area under receiver operating characteristics (AUROC) of the 3 clinical diagnostic criteria were 0.730 (95% confidence interval [CI]: 0.667-0.793), 0.793 (95% CI: 0.740-0.847), and 0.764 (95% CI: 0.702-0.826) respectively. Three hundred two DILI patients' liver biopsies were included: steatosis in 204 cases (67.5%), cholestasis in 151 cases (50%), cell apoptosis in 139 cases (46%), eosinophil granulocyte infiltration in 131 cases (43.4%), central and/or portal phlebitis in 103 cases (34.1%), iron deposition in 90 cases (29.8%), and pigmented macrophages in 92 cases (30.5%). The AUROC of refined pathological scale combined with 3 criteria were 0.843 (95% CI: 0.747-0.914), 0.907 (95% CI: 0.822-0.960), and 0.881 (95% CI: 0.790-0.942) respectively. In hepatocellular type, the AUROCs were 0.894 (95% CI: 0.787-0.959), 0.960 (95% CI: 0.857-0.994), and 0.940 (95% CI: 0.847-0.985); in cholestatic type, the AUROCs were 0.750 (95% CI: 0.466-0.931), 0.500 (95% CI: 0.239-0.761), and 0.500 (95% CI: 0.239-0.761); in mixed type, the AUROCs were 0.786 (95% CI: 0.524-0.943), 0.869 (95% CI: 0.619-0.981), and 0.762 (95% CI: 0.498 to -0.930).Combined with pathological scale can significantly improve the accuracy of clinical diagnostic criteria, no matter in alone or combined condition, M&V might be more accurate in diagnosing DILI from suspected patients.


Asunto(s)
Enfermedad Hepática Inducida por Sustancias y Drogas/diagnóstico , Biomarcadores/sangre , Biopsia con Aguja , Enfermedad Hepática Inducida por Sustancias y Drogas/patología , Diagnóstico Diferencial , Femenino , Humanos , Inmunohistoquímica , Masculino , Persona de Mediana Edad
19.
Medicine (Baltimore) ; 99(41): e22478, 2020 Oct 09.
Artículo en Inglés | MEDLINE | ID: mdl-33031279

RESUMEN

RATIONALE: Pleomorphic xanthoastrocytoma (PXA) is a rare low-grade glial neoplasm of the central nervous system, which is difficult to distinguish from other neoplastic and non-neoplastic entities. Herein, we report 2 cases of PXA that had been misdiagnosed as an inflammatory granuloma. PATIENT CONCERNS: The first case was a 22-year-old man who originally presented with a generalized seizure 7 years previously. Magnetic resonance imaging (MRI) revealed a lesion in the right parietal lobe, leading to a diagnosis of inflammatory granuloma. The second case was a 43-year-old man who presented with repeated generalized seizures. MRI revealed a nodular lesion in the left temporal lobe. The magnetic resonance spectrum showed elevated Cho and NAA peaks and a decreased Cr peak. An inflammatory granuloma was suspected. DIAGNOSIS: After surgical treatment, histopathological examination revealed PXA. INTERVENTIONS: In the first case, after 10 months of anti-inflammatory treatment, the lesion was significantly reduced in size. During the following 7 years, the patient experienced generalized seizures 3 to 4 times annually. To control intractable epilepsy, the lesion was resected. In the second case, conservative treatment provided no benefit, and then the lesion was resected. OUTCOMES: In the first case, during a follow-up period of 14 months, the patient was seizure-free with no tumor recurrence. In the second case, after a 6 months of follow-up, the patient remained seizure-free with no tumor recurrence. LESSONS: The preoperative differential diagnosis of PXA is challenging due to the nonspecific symptoms and imaging manifestations. Considering the potential risk of malignant transformation of PXA, early surgery should be highlighted, and gross total resection is associated with a favorable prognosis.


Asunto(s)
Astrocitoma/diagnóstico por imagen , Neoplasias Encefálicas/diagnóstico por imagen , Granuloma/diagnóstico por imagen , Adulto , Astrocitoma/patología , Astrocitoma/cirugía , Neoplasias Encefálicas/patología , Neoplasias Encefálicas/cirugía , Cerebro , Diagnóstico Diferencial , Errores Diagnósticos , Humanos , Imagen por Resonancia Magnética , Masculino , Convulsiones/etiología , Adulto Joven
20.
Medicine (Baltimore) ; 99(41): e22580, 2020 Oct 09.
Artículo en Inglés | MEDLINE | ID: mdl-33031307

RESUMEN

RATIONALE: Mycobacterium tuberculosis (TB) remains a serious threat in developing countries. Primary isolated hepatic tuberculosis is extremely rare. Because of its non-specific imaging features, noninvasive preoperative imaging diagnosis of isolated hepatic tuberculoma remains challenging. PATIENT CONCERNS: A 48-year-old man was admitted to our hospital due for suspected liver neoplasm during health examination. DIAGNOSES: The tests for blood, liver function, and tumor markers were within normal range. Preoperative ultrasonography (US) showed a hypoechoic lesion with a longitudinal diameter of 2.5 cm in segment six of liver. It exhibited early arterial phase hyperenhancement and late arterial phase rapid washout in contrast-enhanced US. It demonstrated hyperintensity in T2-weighted magnetic resonance imaging and partly restricted diffusion in diffusion-weighted imaging. For this nodule, the preoperative diagnosis was small hepatocellular carcinoma (HCC). INTERVENTIONS: Laparoscopic hepatectomy was performed. Intraoperative extensive adhesion in the abdominal cavity and liver was found. The lesion had undergone expansive growth. OUTCOMES: Microscopically, a granuloma with some necrosis was detected. With both acid-fast staining and TB fragment polymerase chain reaction showing positive results, TB was the final histology diagnosis. After surgery, the patient declined any anti-TB medication. During the follow-up, he had no symptoms. In the sixth month after surgery, he underwent an upper abdominal US. It showed no lesions in the liver. LESSONS: Because of non-specific imaging findings and non-specific symptoms, a diagnosis of isolated hepatic TB is difficult to make, especially for small lesions. A diagnosis of HCC should be made cautiously when small isolated lesions in the liver are encountered, especially in patients without a history of hepatitis and with negative tumor markers.


Asunto(s)
Tuberculosis Hepática/diagnóstico por imagen , Tuberculosis Hepática/cirugía , Carcinoma Hepatocelular/diagnóstico por imagen , Medios de Contraste , Diagnóstico Diferencial , Hepatectomía , Humanos , Neoplasias Hepáticas/diagnóstico por imagen , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Ultrasonografía
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