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1.
BMC Cardiovasc Disord ; 24(1): 239, 2024 May 07.
Artículo en Inglés | MEDLINE | ID: mdl-38714966

RESUMEN

OBJECTIVE: Cerebral malperfusion (CM) is a common comorbidity in acute type A aortic dissection (ATAAD), which is associated with high mortality and poor neurological prognosis. This meta-analysis investigated the surgical strategy of ATAAD patients with CM, aiming to compare the difference in therapeutic effectiveness between the central repair-first and the early reperfusion-first according to clinical outcomes. METHODS: The meta-analysis and systematic review was conducted based on studies sourced from the PubMed, Embase, and Cochrane literature database, in which cases of ATAAD with CM underwent surgical repair were included. Data for baseline characteristics, mortality, survival were extracted, and risk ratio (RR) values and the pooled mortality were calculated. RESULTS: A total of 17 retrospective studies were analyzed, including 1010 cases of ATAAD with CM underwent surgical repair. The pooled early mortality in early reperfusion group was lower (8.1%; CI, 0.02 to 0.168) than that in the central repair group (16.2%; CI, 0.115 to 0.216). The pooled long-term mortality was 7.9% in the early reperfusion cohort and 17.4% the central repair-first cohort, without a statistically significant heterogeneity (I [2] = 51.271%; p = 0.056). The mean time of symptom-onset-to-the-operation-room in all the reports was 8.87 ± 12.3 h. CONCLUSION: This meta-analysis suggested that early reperfusion-first may achieved better outcomes compared to central repair-first in ATAAD patients complicated with CM to some extent. Early operation and early restoration of cerebral perfusion may reduce the occurrence of some neurological complications. TRIAL REGISTRATION: The meta-analysis was registered in the International Prospective Register of Systematic Reviews database (No. CRD CRD42023475629) on Nov. 8th, 2023.


Asunto(s)
Aneurisma de la Aorta , Disección Aórtica , Circulación Cerebrovascular , Humanos , Disección Aórtica/cirugía , Disección Aórtica/mortalidad , Disección Aórtica/complicaciones , Disección Aórtica/fisiopatología , Disección Aórtica/diagnóstico por imagen , Resultado del Tratamiento , Factores de Riesgo , Factores de Tiempo , Aneurisma de la Aorta/cirugía , Aneurisma de la Aorta/mortalidad , Aneurisma de la Aorta/complicaciones , Aneurisma de la Aorta/fisiopatología , Aneurisma de la Aorta/diagnóstico por imagen , Femenino , Masculino , Persona de Mediana Edad , Anciano , Enfermedad Aguda , Trastornos Cerebrovasculares/cirugía , Trastornos Cerebrovasculares/etiología , Trastornos Cerebrovasculares/mortalidad , Trastornos Cerebrovasculares/diagnóstico , Trastornos Cerebrovasculares/fisiopatología , Adulto , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/mortalidad , Medición de Riesgo , Reperfusión , Tiempo de Tratamiento
2.
Tex Heart Inst J ; 51(1)2024 May 08.
Artículo en Inglés | MEDLINE | ID: mdl-38715399

RESUMEN

Acute transient contrast-induced neurologic deficit is an uncommon condition triggered by the administration of intra-arterial contrast during angiography. It can present with encephalopathy, cortical blindness, seizures, or focal deficits. This report describes a patient who presented with severe neurologic deficits after percutaneous coronary intervention, with complete symptom resolution within 72 hours.


Asunto(s)
Medios de Contraste , Angiografía Coronaria , Intervención Coronaria Percutánea , Humanos , Intervención Coronaria Percutánea/efectos adversos , Intervención Coronaria Percutánea/métodos , Medios de Contraste/efectos adversos , Masculino , Anciano , Enfermedad Aguda , Persona de Mediana Edad
3.
Medicine (Baltimore) ; 103(19): e38035, 2024 May 10.
Artículo en Inglés | MEDLINE | ID: mdl-38728451

RESUMEN

OBJECTIVE: The objective of this meta-analysis is to evaluate the diagnostic performance of acoustic radiation force impulse (ARFI) in acute pancreatitis (AP) patients. METHODS: PubMed, Web of Science, Embase, Wanfang, Chinese Biological Medicine databases, and Chinese Biomedical Literature Service System were searched for relevant studies to explore the potential diagnostic performance of ARFI in AP from inception to November 2023. STATA 14.0 was used to analyze the standardized mean difference (SMD) with 95% confidence interval (CI), pooled sensitivity, specificity, area under the curve, meta-regression analysis, sensitivity analysis, and publication bias. RESULTS: Nine studies, involving 533 AP patients and 585 healthy controls, were included. AP patients had significantly higher ARFI levels than healthy controls (SMD: 3.13, 95% CI: 1.88-4.39, P = .001). The area under the curve of ARFI for diagnosing AP was 0.99 (95% CI: 0.98-1.00), with 98% sensitivity and 94% specificity. Meta-regression identified the study region and study period as the sources of heterogeneity. Sensitivity analysis showed that the exclusion of any single study did not materially alter the overall combined effect. No evidence of publication bias was observed in the included studies. CONCLUSION: This meta-analysis demonstrated that ARFI exerted satisfactory diagnostic performance in AP.


Asunto(s)
Diagnóstico por Imagen de Elasticidad , Pancreatitis , Sensibilidad y Especificidad , Humanos , Pancreatitis/diagnóstico , Pancreatitis/diagnóstico por imagen , Diagnóstico por Imagen de Elasticidad/métodos , Enfermedad Aguda
4.
J Cardiothorac Surg ; 19(1): 286, 2024 May 11.
Artículo en Inglés | MEDLINE | ID: mdl-38734628

RESUMEN

Acute type A aortic dissection is a severe cardiovascular disease characterized by rapid onset and high mortality. Traditionally, urgent open aortic repair is performed after admission to prevent aortic rupture and death. However, when combined with malperfusion syndrome, the low perfusion of the superior mesenteric artery can further lead to intestinal necrosis, significantly impacting the surgery's prognosis and potentially resulting in adverse consequences, bringing. This presents great significant challenges in treatment. Based on recent domestic and international research literature, this paper reviews the mechanism, current treatment approaches, and selection of surgical methods for poor organ perfusion caused by acute type A aortic dissection. The literature review findings suggest that central aortic repair can be employed for the treatment of acute type A aortic dissection with inadequate perfusion of the superior mesenteric artery. The superior mesenteric artery can be windowed and (/or) stented, followed by delayed aortic repair. Priority should be given to revascularization of the superior mesenteric artery, followed by central aortic repair. During central aortic repair, direct blood perfusion should be performed on the distal true lumen of the superior mesenteric artery, leading to resulting in favorable therapeutic outcomes. The research results indicate that even after surgical aortic repair, intestinal ischemic necrosis may still occur. In such cases, prompt laparotomy and necessary necrotic bowel resection are crucial for saving the patient's life.


Asunto(s)
Disección Aórtica , Arteria Mesentérica Superior , Necrosis , Humanos , Disección Aórtica/cirugía , Disección Aórtica/complicaciones , Arteria Mesentérica Superior/cirugía , Intestinos/irrigación sanguínea , Intestinos/cirugía , Isquemia Mesentérica/cirugía , Isquemia/cirugía , Aneurisma de la Aorta/cirugía , Aneurisma de la Aorta/complicaciones , Enfermedad Aguda
5.
BMC Med Res Methodol ; 24(1): 112, 2024 May 11.
Artículo en Inglés | MEDLINE | ID: mdl-38734644

RESUMEN

Orphan diseases, exemplified by T-cell prolymphocytic leukemia, present inherent challenges due to limited data availability and complexities in effective care. This study delves into harnessing the potential of machine learning to enhance care strategies for orphan diseases, specifically focusing on allogeneic hematopoietic cell transplantation (allo-HCT) in T-cell prolymphocytic leukemia. The investigation evaluates how varying numbers of variables impact model performance, considering the rarity of the disease. Utilizing data from the Center for International Blood and Marrow Transplant Research, the study scrutinizes outcomes following allo-HCT for T-cell prolymphocytic leukemia. Diverse machine learning models were developed to forecast acute graft-versus-host disease (aGvHD) occurrence and its distinct grades post-allo-HCT. Assessment of model performance relied on balanced accuracy, F1 score, and ROC AUC metrics. The findings highlight the Linear Discriminant Analysis (LDA) classifier achieving the highest testing balanced accuracy of 0.58 in predicting aGvHD. However, challenges arose in its performance during multi-class classification tasks. While affirming the potential of machine learning in enhancing care for orphan diseases, the study underscores the impact of limited data and disease rarity on model performance.


Asunto(s)
Enfermedad Injerto contra Huésped , Trasplante de Células Madre Hematopoyéticas , Leucemia Prolinfocítica de Células T , Aprendizaje Automático , Trasplante Homólogo , Enfermedad Injerto contra Huésped/diagnóstico , Enfermedad Injerto contra Huésped/etiología , Humanos , Trasplante de Células Madre Hematopoyéticas/métodos , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Trasplante Homólogo/métodos , Leucemia Prolinfocítica de Células T/terapia , Leucemia Prolinfocítica de Células T/diagnóstico , Masculino , Persona de Mediana Edad , Femenino , Adulto , Enfermedad Aguda
6.
J Med Life ; 17(1): 123-125, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-38737669

RESUMEN

Primary segmental omental torsion (PSOT) is a very rare cause of acute abdominal pain, and it may often imitate the clinical picture of acute appendicitis. In instances of acute abdominal pain without anorexia, nausea, and vomiting, omental torsion should be included in the differential diagnosis. Any misdiagnosis may lead to major complications such as intraabdominal abscesses and adhesions. A 63-year-old overweight man with a body mass index (BMI) of 41 Kg/m2 presented to the emergency department on a remote island with acute abdominal pain. His medical history included type 2 diabetes mellitus managed with insulin, essential hypertension, osteoarthritis, and no previous abdominal operations. He reported a sharp pain originating in the epigastrium and the right hypochondrium that started five days prior. Physical examination revealed rebound tenderness and guarding across the abdomen with a positive McBurney sign. However, the patient did not report vomiting and was not nauseous. Vital signs were as follows: blood pressure 116/56 mmHg, heart rate 98 beats/min, respiratory rate 19 breaths/min, and a temperature of 38.2 0C. Laboratory results showed a white blood cell count of 10.6, neutrophils of 8.11, C-reactive protein (CRP) 74 mg/l, haemoglobin11.6 g/dl, and hematocrit 36.9%. Due to the absence of a radiographer at the hospital during that period, no imaging investigations were conducted. Diagnostic laparoscopy demonstrated diffused hemoperitoneum and necrotic mass at the site of the hepatic flexure. Initially suspected to be an advanced colon cancer, the decision was made to proceed with open surgery. The necrotic segment of the omentum was found at the right superior point of attachment of the omentum to the hepatic flexure. Consequently, the necrotic segment of the omentum was resected. A thorough investigation of the abdominal cavity did not detect any other abnormalities or pathologies. The patient recovered uneventfully and was transferred to the surgical ward. Torsion of the omentum is a very rare cause of acute abdominal pain. This case highlights the necessity of considering PSOT in the differential diagnosis of acute abdominal pain, especially in cases where symptoms are suggestive of appendicitis but diagnostic findings are negative.


Asunto(s)
Apendicitis , Epiplón , Anomalía Torsional , Humanos , Apendicitis/diagnóstico , Apendicitis/cirugía , Epiplón/patología , Masculino , Persona de Mediana Edad , Diagnóstico Diferencial , Anomalía Torsional/diagnóstico , Anomalía Torsional/cirugía , Anomalía Torsional/diagnóstico por imagen , Dolor Abdominal/etiología , Enfermedad Aguda
9.
Exp Clin Transplant ; 22(4): 307-310, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38742322

RESUMEN

Posttransplant lymphoproliferative disorder is a life-threatening complication after solid-organ transplants. In adults, recipients of heart transplants have the highest risk, whereas renal transplant recipients have the lowest risk among all solid-organ transplants. The most common site for posttransplant lymphoproliferative disorders are gastrointestinal tract followed by the graft itself. Airway involvement in posttransplant lymphoproliferative disorder is rarely encountered. We report a case of a 26-year-old renal allograft recipient who presented to the emergency room with airway obstruction necessitating an emergency tracheostomy. Imaging revealed a left tonsillar mass extending into the nasopharynx and retropharyngeal space causing complete oropharyngeal occlusion. Endoscopic biopsy from nasopharyngeal mass showed a diffuse large B-cell lymphoma and was Ebstein-Barr virus positive. Reduction in immunosuppression and treatment with posttransplant lymphoproliferative disorder-1 risk-stratified approach resulted in complete remission.


Asunto(s)
Obstrucción de las Vías Aéreas , Inmunosupresores , Trasplante de Riñón , Linfoma de Células B Grandes Difuso , Humanos , Trasplante de Riñón/efectos adversos , Adulto , Resultado del Tratamiento , Obstrucción de las Vías Aéreas/etiología , Obstrucción de las Vías Aéreas/virología , Obstrucción de las Vías Aéreas/diagnóstico , Inmunosupresores/efectos adversos , Masculino , Linfoma de Células B Grandes Difuso/virología , Enfermedad Aguda , Biopsia , Infecciones por Virus de Epstein-Barr/diagnóstico , Infecciones por Virus de Epstein-Barr/virología , Infecciones por Virus de Epstein-Barr/complicaciones , Infecciones por Virus de Epstein-Barr/inmunología , Traqueostomía/efectos adversos , Inducción de Remisión , Huésped Inmunocomprometido , Neoplasias Nasofaríngeas/virología , Neoplasias Nasofaríngeas/cirugía , Neoplasias Nasofaríngeas/diagnóstico
10.
J Med Ultrason (2001) ; 51(2): 355-362, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38700562

RESUMEN

PURPOSE: Panoramic ultrasound is one of the recently introduced ultrasound evaluation techniques. We herein examined the relationship between the cross-sectional area of the rectus femoris muscle on panoramic ultrasound and its volume based on the gold standard computed tomography (CT) evaluation. METHODS: This was a single-center prospective observational study. A panoramic ultrasound assessment of the cross-sectional area of the rectus femoris muscle and a simple CT evaluation of its volume were performed on days 1 and 7 of hospitalization. Physical functions were assessed at discharge. RESULTS: Twenty patients were examined. The rate of change in the cross-sectional area of the rectus femoris muscle on panoramic ultrasound correlated with that in its volume on CT (correlation coefficient 0.59, p = 0.0061). In addition, a correlation was observed between the absolute value for the rectus femoris muscle cross-sectional area on panoramic ultrasound and physical functions at discharge. Rectus femoris muscle distances did not correlate with either. CONCLUSION: In the acute phase of critical illness, the cross-sectional area of the rectus femoris muscle on panoramic images correlated with its volume on CT and, thus, it is a valid method for assessing muscle mass.


Asunto(s)
Enfermedad Crítica , Músculo Cuádriceps , Ultrasonografía , Humanos , Estudios Prospectivos , Masculino , Femenino , Ultrasonografía/métodos , Persona de Mediana Edad , Anciano , Músculo Cuádriceps/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Adulto , Anciano de 80 o más Años , Enfermedad Aguda
11.
Cochrane Database Syst Rev ; 5: CD015306, 2024 May 13.
Artículo en Inglés | MEDLINE | ID: mdl-38738639

RESUMEN

BACKGROUND: According to global prevalence analysis studies, acute upper respiratory tract infections (URTIs) are the most common acute infectious disease in children, especially in preschool children. Acute URTIs lead to an economic burden on families and society. Vitamin A refers to the fat-soluble compound all-trans-retinol and also represents retinol and its active metabolites. Vitamin A interacts with both the innate immune system and the adaptive immune system and improves the host's defences against infections. Correlation studies show that serum retinol deficiency was associated with a higher risk of respiratory tract infections. Therefore, vitamin A supplementation may be important in preventing acute URTIs. OBJECTIVES: To assess the effectiveness and safety of vitamin A supplements for preventing acute upper respiratory tract infections in children up to seven years of age. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, the Chinese Biomedical Literature Database, and two trial registration platforms to 8 June 2023. We also checked the reference lists of all primary studies and reviewed relevant systematic reviews and trials for additional references. We imposed no language or publication restrictions. SELECTION CRITERIA: We included randomised controlled trials (RCTs), which evaluated the role of vitamin A supplementation in the prevention of acute URTIs in children up to seven years of age. DATA COLLECTION AND ANALYSIS: We used the standard methodological procedures expected by Cochrane. MAIN RESULTS: We included six studies (27,351 participants). Four studies were RCTs and two were cluster-RCTs. The included studies were all conducted in lower-middle-income countries (two in India, two in South Africa, one in Ecuador, and one in Haiti). Three studies included healthy children who had no vitamin A deficiency, one study included children born to HIV-infected women, one study included low-birthweight neonates, and one study included children in areas with a high local prevalence of malnutrition and xerophthalmia. In two studies, vitamin E was a co-treatment administered in addition to vitamin A. We judged the included studies to be at either a high or unclear risk of bias for random sequence generation, incomplete outcome data, and blinding. Primary outcomes Six studies reported the incidence of acute URTIs during the study period. Five studies reported the number of acute URTIs over a period of time, but there was population heterogeneity and the results were presented in different forms, therefore only three studies were meta-analysed. We are uncertain of the effect of vitamin A supplementation on the number of acute URTIs over two weeks (risk ratio (RR) 1.00, 95% confidence interval (CI) 0.92 to 1.09; I2 = 44%; 3 studies, 22,668 participants; low-certainty evidence). Two studies reported the proportion of participants with an acute URTI. We are uncertain of the effect of vitamin A supplementation on the proportion of participants with an acute URTI (2 studies, 15,535 participants; low-certainty evidence). Only one study (116 participants) reported adverse events. No infant in either the placebo or vitamin A group was found to have feeding difficulties (failure to feed or vomiting), a bulging fontanelle, or neurological signs before or after vitamin A administration (very low-certainty evidence). Secondary outcomes Two studies (296 participants) reported the severity of subjective symptoms, presented by the mean duration of acute URTI. Vitamin A may have little to no effect on the mean duration of acute URTI (very low-certainty evidence). AUTHORS' CONCLUSIONS: The evidence for the use of vitamin A supplementation to prevent acute URTI is uncertain, because population, dose and duration of interventions, and outcomes vary between studies. From generally very low- to low-certainty evidence, we found that there may be no benefit in the use of vitamin A supplementation to prevent acute URTI in children up to seven years of age. More RCTs are needed to strengthen the current evidence. Future research should report over longer time frames using validated tools and consistent reporting, and ensure adequate power calculations, to allow for easier synthesis of data. Finally, it is important to assess vitamin A supplementation for preschool children with vitamin A deficiency.


Asunto(s)
Suplementos Dietéticos , Ensayos Clínicos Controlados Aleatorios como Asunto , Infecciones del Sistema Respiratorio , Vitamina A , Vitaminas , Humanos , Vitamina A/administración & dosificación , Infecciones del Sistema Respiratorio/prevención & control , Preescolar , Lactante , Enfermedad Aguda , Niño , Vitaminas/administración & dosificación , Deficiencia de Vitamina A/prevención & control , Administración Oral , Sesgo
12.
FP Essent ; 540: 24-29, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38767886

RESUMEN

Gastroenteritis is inflammation of the stomach and intestines; colitis is inflammation of the colon. Viruses are the most common cause, followed by bacteria and parasites. Incidence of the various infections varies by age, sex, location, and vaccine availability; vaccination has reduced rotavirus infections by as much as 90% in children. Postinfectious complications include irritable bowel syndrome (IBS) and lactose intolerance. Approximately 9% of patients with acute gastroenteritis or colitis develop postinfectious IBS, which accounts for more than 50% of all IBS cases. The diagnostic approach to gastroenteritis and colitis varies with symptom severity. Microbial studies are not needed with mild symptoms that resolve within a week, but longer-lasting or more severe symptoms (including bloody stool) warrant microbial studies. In addition, recent antibiotic exposure should prompt testing for Clostridioides difficile. Multiplex antimicrobial testing is preferred; stool cultures and microscopic stool examinations are no longer first-line tests. Management depends on severity. Patients with mild or moderate symptoms are treated with oral hydration if tolerated; nasogastric or intravenous hydration are used for those with more severe illness. In addition, antiemetic, antimotility, and/or antisecretory drugs can be used for symptom control. Antimicrobial therapy is indicated for C difficile infections, travel-related diarrhea, other bacterial infections with severe symptoms, and parasitic infections.


Asunto(s)
Colitis , Gastroenteritis , Humanos , Gastroenteritis/diagnóstico , Colitis/diagnóstico , Enfermedad Aguda , Antibacterianos/uso terapéutico , Síndrome del Colon Irritable/diagnóstico , Síndrome del Colon Irritable/terapia
13.
FP Essent ; 540: 30-41, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38767887

RESUMEN

Acute pancreatitis is among the most common gastrointestinal disorders requiring hospitalization. The main causes are gallstones and alcohol use. Patients typically present with upper abdominal pain radiating to the back, worse with eating, plus nausea and vomiting. Diagnosis requires meeting two of three criteria: upper abdominal pain, an elevated serum lipase or amylase level greater than 3 times the normal limit, and imaging findings consistent with pancreatitis. After pancreatitis is diagnosed, the Atlanta classification and identification of the systemic inflammatory response syndrome can identify patients at high risk of complications. Management includes fluid resuscitation and hydration maintenance, pain control that may require opioids, and early feeding. Feeding recommendations have changed and "nothing by mouth" is no longer recommended. Rather, oral feeding should be initiated, as tolerated, within the first 24 hours. If it is not tolerated, enteral feeding via nasogastric or nasojejunal tubes should be initiated. Antibiotics are indicated only with radiologically confirmed infection or systemic infection symptoms. Surgical or endoscopic interventions are needed for biliary pancreatitis or obstructive pancreatitis with cholangitis. One in five patients will have recurrent episodes of pancreatitis; alcohol and smoking are major risk factors. Some develop chronic pancreatitis, associated with chronic pain plus pancreatic dysfunction, including endocrine failure (insulin insufficiency) and/or exocrine failure that requires long-term vitamin supplementation.


Asunto(s)
Pancreatitis , Humanos , Pancreatitis/terapia , Pancreatitis/diagnóstico , Pancreatitis/etiología , Factores de Riesgo , Nutrición Enteral/métodos , Enfermedad Aguda , Fluidoterapia/métodos , Antibacterianos/uso terapéutico , Dolor Abdominal/terapia , Dolor Abdominal/etiología
14.
J Tradit Chin Med ; 44(3): 586-594, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38767644

RESUMEN

OBJECTIVE: To determine the effectiveness of pediatric Tuina (PT) in preventing recurrent acute respiratory tract infections (ARTIs) in children. METHODS: This is a retrospective cohort study based on the electronic medical records of children with recurrent ARTIs in 2016. Children were divided into a PT group or a non-PT group, according to whether they had received PT or not in 2016. The primary outcome was the number of ARTI episodes in 2017 and 2018. The secondary outcomes were the number of ARTIs leading to outpatient department visits and outpatient antibiotic prescriptions due to ARTIs in the same time period. Negative binomial regressions were used to detect the association between PT and the outcomes. RESULTS: A total of 2303 children were included in the analysis, including 94 in the PT group and 2209 in the non-PT group. Children who received PT six or more times in 2016 had fewer episodes of ARTIs in 2017 [incidence rate ratio (IRR): 0.59, 95% confidence interval (CI) (0.42-0.84)] and 2018 [IRR: 0.58, 95% CI (0.36-0.94)] and fewer outpatient department visits due to ARTIs in 2017 [IRR: 0.56, 95% CI (0.38-0.83)] than children who had not received PT in 2016. There was no significant difference in the number of outpatient antibiotic prescriptions between the two groups. CONCLUSIONS: Receiving PT six or more times within one year is associated with a decrease in recurrent ARTIs in children in the following two years. Randomized controlled trials are needed for effect evaluation prior to establishing PT as a method for preventing recurrent ARTIs among children.


Asunto(s)
Infecciones del Sistema Respiratorio , Humanos , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Infecciones del Sistema Respiratorio/epidemiología , Estudios Retrospectivos , Masculino , Femenino , Preescolar , Niño , China/epidemiología , Lactante , Medicamentos Herbarios Chinos/uso terapéutico , Medicamentos Herbarios Chinos/administración & dosificación , Recurrencia , Adolescente , Enfermedad Aguda
16.
J Med Invest ; 71(1.2): 158-161, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38735713

RESUMEN

We investigated impact of persistent malperfusion syndrome (MPS) following central repair of acute type A aortic dissection (ATAAD) on outcomes. Thirty patients who underwent central repair for ATAAD with MPS were included. Patients were divided into two groups:23 patients without MPS following central repair (No-MPS group) and 7 with MPS (Persistent-MPS group). The mean age was 66.8±9.6 and 59.4±13.4 years in the No-MPS and Persistent-MPS groups, respectively (P=0.176). Preoperative MPS included the left coronary artery (n=3), brain (n=3), abdomen (n=7), and extremities (n=11) in the No-MPS group. In the Persistent-MPS group, the right coronary (n=1), brain (n=2), abdomen (n=3), and extremities (n=5) were observed. In the No-MPS group, one patient died of extensive cerebral infarction (4.3%). In the Persistent-MPS group, 2 patients died of sepsis and multi-organ failure, respectively (28.6%) (P=0.061). The Persistent-MPS group had more patients requiring hemodialysis than the No-MPS group (P=0.009). Three patients underwent intestinal resection due to persistent MPS (P<0.001). Persistent MPS following central repair for ATAAD significantly contributed to outcomes. J. Med. Invest. 71 : 158-161, February, 2024.


Asunto(s)
Disección Aórtica , Humanos , Disección Aórtica/cirugía , Masculino , Persona de Mediana Edad , Femenino , Anciano , Enfermedad Aguda , Complicaciones Posoperatorias/etiología , Resultado del Tratamiento , Síndrome , Estudios Retrospectivos , Aneurisma de la Aorta/cirugía
17.
J Assoc Physicians India ; 72(1): 96-98, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-38736081

RESUMEN

Acute pancreatitis is seen in patients with human immunodeficiency virus (HIV) as a result of antiretroviral drug therapy and hypertriglyceridemia. Thrombotic complications are known in patients of HIV as a result of endothelial dysfunction, and right-sided infective endocarditis (IE) is seen in HIV patients mostly due to intravenous (IV) drug abuse. However, the occurrence of acute pancreatitis with sepsis, IE, and bilateral thromboembolism in the same patient is rare. Here, we report this case of a treatment-naive nondrug abuser HIV patient with acute pancreatitis in sepsis, IE, and bilateral pulmonary thromboembolism who recovered completely with treatment.


Asunto(s)
Infecciones por VIH , Embolia Pulmonar , Sepsis , Humanos , Embolia Pulmonar/etiología , Embolia Pulmonar/diagnóstico , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Sepsis/complicaciones , Sepsis/diagnóstico , Masculino , Pancreatitis/diagnóstico , Pancreatitis/complicaciones , Pancreatitis/etiología , Adulto , Enfermedad Aguda , Endocarditis/complicaciones , Endocarditis/diagnóstico , Anticoagulantes/uso terapéutico
18.
Isr Med Assoc J ; 26(5): 299-303, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38736345

RESUMEN

BACKGROUND: Group A Streptococcus (GAS) is the predominant bacterial pathogen of pharyngitis in children. However, distinguishing GAS from viral pharyngitis is sometimes difficult. Unnecessary antibiotic use contributes to unwanted side effects, such as allergic reactions and diarrhea. It also may increase antibiotic resistance. OBJECTIVES: To evaluate the effect of a machine learning algorithm on the clinical evaluation of bacterial pharyngitis in children. METHODS: We assessed 54 children aged 2-17 years who presented to a primary healthcare clinic with a sore throat and fever over 38°C from 1 November 2021 to 30 April 2022. All children were tested with a streptococcal rapid antigen detection test (RADT). If negative, a throat culture was performed. Children with a positive RADT or throat culture were considered GAS-positive and treated antibiotically for 10 days, as per guidelines. Children with negative RADT tests throat cultures were considered positive for viral pharyngitis. The children were allocated into two groups: Group A streptococcal pharyngitis (GAS-P) (n=36) and viral pharyngitis (n=18). All patients underwent a McIsaac score evaluation. A linear support vector machine algorithm was used for classification. RESULTS: The machine learning algorithm resulted in a positive predictive value of 80.6 % (27 of 36) for GAS-P infection. The false discovery rates for GAS-P infection were 19.4 % (7 of 36). CONCLUSIONS: Applying the machine-learning strategy resulted in a high positive predictive value for the detection of streptococcal pharyngitis and can contribute as a medical decision aid in the diagnosis and treatment of GAS-P.


Asunto(s)
Aprendizaje Automático , Faringitis , Infecciones Estreptocócicas , Streptococcus pyogenes , Humanos , Faringitis/microbiología , Faringitis/diagnóstico , Niño , Proyectos Piloto , Infecciones Estreptocócicas/diagnóstico , Infecciones Estreptocócicas/tratamiento farmacológico , Preescolar , Masculino , Femenino , Streptococcus pyogenes/aislamiento & purificación , Adolescente , Sistemas de Apoyo a Decisiones Clínicas , Antibacterianos/uso terapéutico , Antibacterianos/administración & dosificación , Enfermedad Aguda , Diagnóstico Diferencial , Algoritmos
20.
Acta Cir Bras ; 39: e391824, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38716957

RESUMEN

PURPOSE: Reflux esophagitis is a condition characterized by inflammation and irritation of the esophagus, resulting from the backflow of stomach acid and other gastric contents into the esophagus. Columbianadin is a coumarin derivative that exhibits anti-inflammatory and antioxidant effects. In this study, we tried to scrutinize the protective effect of Columbianadin against acute reflux esophagitis in rats. METHODS: RAW 264.7 cells were utilized to assess cell viability and measure the production of inflammatory parameters. The rats received anesthesia, and reflux esophagitis was induced via ligation of pylorus and fore stomach and corpus junction. Rats received the oral administration of Columbianadin (25, 50 and 100 mg/kg) and omeprazole (20 mg/kg). The gastric secretion volume, acidity, and pH were measured. Additionally, the levels of oxidative stress parameters, cytokines, and inflammatory markers were determined. At the end of the study, mRNA expression was assessed. RESULTS: Columbianadin remarkably suppressed the cell viability and production of tumor necrosis factor-α (TNF-α), interleukin (IL)-1ß, IL-6, cyclooxygenase-2 (COX-2), inducible nitric oxide synthase (iNOS), and prostaglandin (PGE2). Columbianadin treatment remarkably suppressed the secretion of gastric volume, total acidity and enhanced the pH level in the stomach. Columbianadin remarkably altered the level of hydrogen peroxidase, free iron, calcium, and plasma scavenging activity, sulfhydryl group; oxidative stress parameters like malonaldehyde, glutathione, superoxide dismutase, catalase, glutathione peroxidase; inflammatory cytokines viz., TNF-α, IL-6, IL-1ß, IL-10, IL-17, and monocyte chemoattractant protein-1; inflammatory parameters including PGE2, iNOS, COX-2, and nuclear kappa B factor (NF-κB). Columbianadin remarkably (P < 0.001) suppressed the mRNA expression TNF-α, IL-6, IL-1ß and plasminogen activator inhibitor-1. CONCLUSIONS: Columbianadin demonstrated a protective effect against acute reflux esophagitis via NF-κB pathway.


Asunto(s)
Esofagitis Péptica , FN-kappa B , Estrés Oxidativo , Animales , Esofagitis Péptica/tratamiento farmacológico , FN-kappa B/metabolismo , FN-kappa B/efectos de los fármacos , Masculino , Ratas , Estrés Oxidativo/efectos de los fármacos , Citocinas/metabolismo , Modelos Animales de Enfermedad , Supervivencia Celular/efectos de los fármacos , Enfermedad Aguda , Células RAW 264.7 , Ratones , Ratas Wistar , Transducción de Señal/efectos de los fármacos , Antioxidantes/farmacología , Antioxidantes/uso terapéutico , Antiinflamatorios/farmacología , Antiinflamatorios/uso terapéutico
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