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1.
Lancet ; 395(10221): 339-349, 2020 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-32007169

RESUMEN

BACKGROUND: Acute atrial fibrillation is the most common arrythmia treated in the emergency department. Our primary aim was to compare conversion to sinus rhythm between pharmacological cardioversion followed by electrical cardioversion (drug-shock), and electrical cardioversion alone (shock-only). Our secondary aim was to compare the effectiveness of two pad positions for electrical cardioversion. METHODS: We did a partial factorial trial of two protocols for patients with acute atrial fibrillation at 11 academic hospital emergency departments in Canada. We enrolled adult patients with acute atrial fibrillation. Protocol 1 was a randomised, blinded, placebo-controlled comparison of attempted pharmacological cardioversion with intravenous procainamide (15 mg/kg over 30 min) followed by electrical cardioversion if necessary (up to three shocks, each of ≥200 J), and placebo infusion followed by electrical cardioversion. For patients having electrical cardioversion, we used Protocol 2, a randomised, open-label, nested comparison of anteroposterior versus anterolateral pad positions. Patients were randomly assigned (1:1, stratified by study site) for Protocol 1 by on-site research personnel using an online electronic data capture system. Randomisation for Protocol 2 occurred 30 min after drug infusion for patients who had not converted and was stratified by site and Protocol 1 allocation. Patients and all research and emergency department staff were masked to treatment allocation for Protocol 1. The primary outcome was conversion to normal sinus rhythm for at least 30 min at any time after randomisation and up to a point immediately after three shocks. Protocol 1 was analysed by intention to treat and Protocol 2 excluded patients who did not receive electrical cardioversion. This study is registered at ClinicalTrials.gov, number NCT01891058. FINDINGS: Between July 18, 2013, and Oct 17, 2018, we enrolled 396 patients, and none were lost to follow-up. In the drug-shock group (n=204), conversion to sinus rhythm occurred in 196 (96%) patients and in the shock-only group (n=192), conversion occurred in 176 (92%) patients (absolute difference 4%; 95% CI 0-9; p=0·07). The proportion of patients discharged home was 97% (n=198) versus 95% (n=183; p=0·60). 106 (52%) patients in the drug-shock group converted after drug infusion only. No patients had serious adverse events in follow-up. The different pad positions in Protocol 2 (n=244), had similar conversions to sinus rhythm (119 [94%] of 127 in anterolateral group vs 108 [92%] of 117 in anteroposterior group; p=0·68). INTERPRETATION: Both the drug-shock and shock-only strategies were highly effective, rapid, and safe in restoring sinus rhythm for patients in the emergency department with acute atrial fibrillation, avoiding the need for return to hospital. The drug infusion worked for about half of patients and avoided the resource intensive procedural sedation required for electrical cardioversion. We also found no significant difference between the anterolateral and anteroposterior pad positions for electrical cardioversion. Immediate rhythm control for patients in the emergency department with acute atrial fibrillation leads to excellent outcomes. FUNDING: Heart and Stroke Foundation of Canada and the Canadian Institutes of Health Research.


Asunto(s)
Antiarrítmicos/uso terapéutico , Fibrilación Atrial/terapia , Cardioversión Eléctrica , Enfermedad Aguda , Adulto , Anciano , Anciano de 80 o más Años , Protocolos Clínicos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Adulto Joven
3.
Internist (Berl) ; 61(1): 5-12, 2020 Jan.
Artículo en Alemán | MEDLINE | ID: mdl-31912164

RESUMEN

Cough is one of the most frequent causes for consultation in primary care. The diagnostic characteristics in primary care with a broad spectrum of causes and unspecific symptoms are presented using the example of acute and chronic cough. The understanding of the formation of the cough stimulus and the induction by inflammatory, mechanical and chemical triggers as well as the significance of the stimulus threshold of the cough receptor facilitate the comprehension of the various possible causes of cough. The necessary diagnostic procedures are based on the exclusion of warning symptoms that necessitate emergency inpatient treatment, on the duration of symptoms and the spectrum of causes to be expected from them. Ambiguities often remain even with careful basic diagnostics. Watchful waiting and active surveillance can initially be the most sensible approach but should not be misconstrued as carelessness. It necessitates follow-up controls and increased attention especially in patients with a high-risk constellation (e.g. multimorbidity, immune suppression, heart failure) in order to be able to quickly react to the development of treatable aspects or even dangerous courses of disease.


Asunto(s)
Tos/diagnóstico , Servicio de Urgencia en Hospital , Atención Primaria de Salud , Enfermedad Aguda , Enfermedad Crónica , Humanos , Derivación y Consulta , Espera Vigilante
4.
Clin Sci (Lond) ; 134(2): 261-271, 2020 Jan 31.
Artículo en Inglés | MEDLINE | ID: mdl-31922199

RESUMEN

Acute myeloid leukemia (AML) is a malignant disorder of hemopoietic stem cells. AML can escape immunosurveillance of natural killer (NK) by gene mutation, fusions and epigenetic modification. The mechanism of AML immune evasion is not clearly understood. Here we show that CD48 high expression is a favorable prognosis factor that is down-regulated in AML patients, which can help AML evade from NK cell recognition and killing. Furthermore, we demonstrate that CD48 expression is regulated by methylation and that a hypomethylating agent can increase the CD48 expression, which increases the NK cells killing in vitro. Finally, we show that CD48 high expression can reverse the AML immune evasion and activate NK cells function in vivo. The present study suggests that a combination the hypomethylating agent and NK cell infusion could be a new strategy to cure AML.


Asunto(s)
Antígeno CD48/inmunología , Epigénesis Genética/inmunología , Silenciador del Gen/inmunología , Leucemia Mieloide/inmunología , Escape del Tumor/inmunología , Enfermedad Aguda , Animales , Antimetabolitos Antineoplásicos/farmacología , Antígeno CD48/genética , Línea Celular Tumoral , Células Cultivadas , Metilación de ADN/efectos de los fármacos , Metilación de ADN/genética , Metilación de ADN/inmunología , Decitabina/farmacología , Regulación de la Expresión Génica/efectos de los fármacos , Regulación de la Expresión Génica/inmunología , Humanos , Estimación de Kaplan-Meier , Células Asesinas Naturales/inmunología , Células Asesinas Naturales/metabolismo , Leucemia Mieloide/tratamiento farmacológico , Leucemia Mieloide/genética , Masculino , Ratones Endogámicos BALB C , Escape del Tumor/genética , Ensayos Antitumor por Modelo de Xenoinjerto
5.
Mymensingh Med J ; 29(1): 5-15, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31915329

RESUMEN

Acute post-streptococcal glomerulonephritis (APSGN) is the commonest cause of acute glomerulonephritis (AGN), which usually present with gross hematuria, mild edema, oliguria, hypertension and varying degree of renal insufficiency. It is more common among the population of school going age where poverty, overcrowding and poor hygienic conditions are prevailing. This cross sectional observational study was aimed to know the socio-demographic variables, clinical profile and immediate outcome of AGN in hospitalized children and was conducted in the Pediatric department of Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from November 2014 to April 2015. A detailed history was taken from the parents in each case with a written questionnaire. A written consent was also taken from the guardian of the including patients and also permission was taken from the ethical committee of MMCH. Thorough clinical examination and available relevant investigations were done in all patients. Progresses of the patient were monitored by daily clinical examinations and also by investigations. Data were analyzed by statistical package for social science (SPSS) windows version 18. Results were verified by doing standard test for significance. Among total 60 cases male was 58.3% & female was 41.7%. The common age group of presentation was between 7-12 years (73%), peak age of incidence was 7-9 years. Most of them came from low socioeconomic status (83.3%), 63.3% from rural area with average 5-6 member's family size. Most of the parents were illiterate. History of (H/O) skin infection was present in 35(58.3%) patients, 15(25%) had H/O sore throat, 15% did not give any H/O infection before presentation. Average duration of gap between infection and appearance of clinical feature was 7-14 days in 73.40%and 15-21 days was in 45.7% in case of sore throat & skin infection respectively. Almost all (95%) patients presented with puffiness of face, others presented with scanty micturition, gross hematuria, respiratory distress, fever, convulsion and altered sensorium. Edema (75%), hypertension (88.3%), pallor (38%), tachypnea (25%), tachycardia (26.7%) were the important clinical findings. Microscopic hematuria was present among 96.66% patients; low complement level was found in 85% cases. There is significant association between low socioeconomic statuses with more hospital stay. Only one patient died due to heart failure and 98.3% patient had complete recovery. Results of this study conclude that most of the patients came from rural illiterate family with low socioeconomic background. Skin infection is the commonest cause of acute glomerulonephritis. Edema, scanty micturation, hematuria and hypertension are the common mode of presentation. Heart failure and hypertensive encephalopathy are the common complication of AGN. Immediate prognosis of AGN was excellent.


Asunto(s)
Glomerulonefritis/diagnóstico , Tiempo de Internación/estadística & datos numéricos , Enfermedad Aguda , Bangladesh/epidemiología , Niño , Estudios Transversales , Femenino , Glomerulonefritis/epidemiología , Humanos , Incidencia , Masculino , Pediatría , Población Rural , Factores Socioeconómicos
6.
Medicine (Baltimore) ; 99(4): e18899, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31977901

RESUMEN

BACKGROUND: Acute bronchitis (AB) is a common cause of childhood morbidity. Tuina, a kind of Chinese massage, is frequently used for the treatment of AB in children by traditional Chinese medicine doctors. However, there is no relevant systematic review show its effectiveness and safety. The study aims to evaluate the effectiveness and safety of Tuina for children with AB. METHODS: The following electronic databases will be searched from the respective dates of database inception to January 1st, 2020: The Cochrane Library, Web of Science, the World Health Organization International Clinical Trials Registry Platform, Springer, EMBASE, MEDLINE, China National Knowledge Infrastructure, the Chinese Biomedical Literature Database, Wanfang database, the Chinese Scientific Journal Database, and other sources. All published randomized controlled trials and blinded researches that are relevant to the subject of interest only will be contained. Two independent researchers will operate article retrieval, duplication removing, screening, quality evaluation, and data analyses by Review Manager (V.5.3.5). Meta-analyses, subgroup analysis and/or descriptive analysis will be performed based on the included data conditions. RESULTS: High-quality synthesis and/or descriptive analysis of current evidence will be provided from the bronchitis severity score, symptom, and quality-of-life questionnaires, the questionnaire of clinical symptoms of cough and sputum, Patient Satisfaction Scale and adverse reactions. CONCLUSION: This study will provide the evidence of whether Tuina is an effective and safe intervention for children with AB. PROSPERO REGISTRATION NUMBER: CRD42019140667.


Asunto(s)
Bronquitis/terapia , Masaje , Medicina China Tradicional , Enfermedad Aguda , Niño , Humanos , Revisiones Sistemáticas como Asunto
7.
Pneumologie ; 74(1): 46-49, 2020 Jan.
Artículo en Alemán | MEDLINE | ID: mdl-31958870

RESUMEN

In 2017 the German Clinical Guideline for Treating Acute Respiratory Insufficiency with Invasive Ventilation and Extracorporeal Membrane Oxygenation: Evidence-Based Recommendations were released. This article highlights emerging data and new concepts which were introduced since 2017. Among others it summarizes the current progress made in evidence-based recommendations of mechanical ventilation and extracorporeal membrane oxygenation (ECMO). In detail, the new evidence for treating severe ARDS with ECMO, phenotyping of ARDS, early neuromuscular blockade and the application of non-invasive ventilation and high-flow oxygen therapy are discussed.


Asunto(s)
Oxigenación por Membrana Extracorpórea/métodos , Guías de Práctica Clínica como Asunto , Respiración Artificial/métodos , Síndrome de Dificultad Respiratoria del Adulto/terapia , Insuficiencia Respiratoria/diagnóstico , Enfermedad Aguda , Humanos , Pulmón , Síndrome de Dificultad Respiratoria del Adulto/diagnóstico , Insuficiencia Respiratoria/fisiopatología
8.
Vasc Endovascular Surg ; 54(2): 135-140, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31769352

RESUMEN

PURPOSE: Ultrasound-facilitated, catheter-directed, low-dose fibrinolysis (USAT) appears to provide promising results for the management of acute submassive pulmonary embolisms (ASMPEs) at tertiary care centers. This study assessed outcome measures at a community-based hospital systems and compared results to known studies. MATERIALS AND METHODS: This is a single-center, retrospective study assessing clinical outcomes of the EkoSonic Endovascular System intervention for ASMPEs performed by three surgical 3 subspecialties (interventional radiology, interventional cardiology, and vascular surgery) part of a pulmonary embolism response team (PERT). We reviewed 146 PERT activations from June 2013 to December 2017. Eighty-three patients with ASMPEs underwent USAT. RESULTS: Our study showed greater differences (P = .01) between baseline and follow-up pulmonary artery systolic pressures (20.9 ± 9.8 mm Hg [n = 14]) compared to the ULTIMA study (12.3 ± 10 mm Hg [n = 30]). Our length-of-stay measures were shorter (6.1 ± 5.1 [n = 83]; P = .0001) compared to the SEATTLE II study (8.8 ± 5.0 [n = 150]). Preprocedure transthoracic echocardiograms (TTEs) were performed for 54 (65%) of 83 patients. Postprocedure TTEs at 48 hours was performed for 52 (62%) of 83 patients. Use of TTEs before and after intervention did not change outcomes. Intracranial hemorrhage was not observed in our patient population. There was no difference in outcomes between the three subspecialties in our study. CONCLUSIONS: Use of USAT in a community-based hospital PERT has similar outcomes to tertiary care centers. Furthermore, similar outcomes were observed between the three subspecialties suggesting development of a comprehensive care team for management of ASMPEs.


Asunto(s)
Cateterismo Periférico , Fibrinolíticos/administración & dosificación , Hospitales Comunitarios , Embolia Pulmonar/terapia , Terapia Trombolítica/métodos , Terapia por Ultrasonido , Enfermedad Aguda , Adulto , Anciano , Cardiólogos , Cateterismo Periférico/efectos adversos , Femenino , Fibrinolíticos/efectos adversos , Humanos , Infusiones Intraarteriales , Masculino , Michigan , Persona de Mediana Edad , Embolia Pulmonar/diagnóstico por imagen , Embolia Pulmonar/fisiopatología , Radiólogos , Estudios Retrospectivos , Especialización , Cirujanos , Terapia Trombolítica/efectos adversos , Factores de Tiempo , Resultado del Tratamiento , Terapia por Ultrasonido/efectos adversos
9.
Clin Biochem ; 75: 35-39, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31672650

RESUMEN

BACKGROUND: Increased levels of circulating endostatin predicts cardiovascular morbidity and impaired kidney function in the general population. The utility of endostatin as a risk marker for mortality in the emergency department (ED) has not been reported. AIM: Our main aim was to study the association between plasma endostatin and 90-day mortality in an unselected cohort of patients admitted to the ED for acute dyspnea. Design Circulating endostatin was analyzed in plasma from 1710 adults and related to 90-day mortality in Cox proportional hazard models adjusted for age, sex, body mass index, oxygen saturation, respiratory rate, body temperature, C-reactive protein, lactate, creatinine and medical priority according to the Medical Emergency Triage and Treatment System-Adult score (METTS-A). The predictive value of endostatin for mortality was evaluated with receiver operating characteristic (ROC) analysis and compared with the clinical triage scoring system and age. RESULTS: Each one standard deviation increment of endostatin was associated with a HR of 2.12 (95% CI 1.31-3.44 p < 0.01) for 90-day mortality after full adjustment. Levels of endostatin were significantly increased in the group of patients with highest METTS-A (p < 0.001). When tested for the outcome 90-day mortality, the area under the ROC curve (AUC) was 0.616 for METTS-A, 0.701 for endostatin, 0.708 for METTS -A and age and 0.738 for METTS-A, age and levels of endostatin. CONCLUSIONS: In an unselected cohort of patients admitted to the ED with acute dyspnea, endostatin had a string association to 90-day mortality and improved prediction of 90-day mortality in the ED beyond the clinical triage scoring system and age with 3%.


Asunto(s)
Disnea/mortalidad , Endostatinas/sangre , Enfermedad Aguda , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Estudios de Cohortes , Disnea/sangre , Servicio de Urgencia en Hospital , Femenino , Mortalidad Hospitalaria , Humanos , Masculino , Persona de Mediana Edad
11.
Radiol Med ; 125(1): 80-86, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31529401

RESUMEN

OBJECTIVE: To observe the structural changes of gray matter nuclei in patients with acute carbon monoxide intoxication by diffusion tensor imaging (DTI), quantify the degree of deep gray matter damage in the brain by adopting imaging technology and research the characteristics of the damage and its pertinence with memory and cognitive impairment. METHODS: Twenty-five patients with acute carbon monoxide intoxication and 25 healthy volunteers matched in sex and age were examined by routine head MRI and diffusion tensor imaging (DTI). Bilateral hippocampus, dater nucleus, thalamus, amygdala, globus pallidus and putamen were taken as regions of interest. The mean diffusion coefficient (MD), anisotropic fraction (FA) and appearance of deep gray matter nucleus in patients with acute carbon monoxide intoxication were analyzed. It found that the change of diffusion coefficient (ADC) and its clinical correlation with cognitive impairment were generated by carbon monoxide intoxication. RESULTS: Compared with the healthy control group, the FA values of bilateral globus pallidus, hippocampus, dater nucleus and putamen decreased, while the FA values of amygdala and thalamus had no statistical significance; the MD values and ADC values of hippocampus, globus pallidus and putamen increased, while the MD and ADC values of dater nucleus, thalamus and amygdala had no statistical significance, either. CONCLUSION: DTI is capable of sensitively reflecting the damage of gray matter nuclei caused by acute carbon monoxide intoxication and quantifying the degree of hypoxic brain damage in a certain extent, and may be related to cognitive impairment.


Asunto(s)
Traumatismos Difusos del Encéfalo/diagnóstico por imagen , Intoxicación por Monóxido de Carbono/diagnóstico por imagen , Imagen de Difusión Tensora/métodos , Sustancia Gris/diagnóstico por imagen , Enfermedad Aguda , Adulto , Anciano , Amígdala del Cerebelo/diagnóstico por imagen , Anisotropía , Estudios de Casos y Controles , Cognición , Femenino , Globo Pálido/diagnóstico por imagen , Hipocampo/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Pruebas de Estado Mental y Demencia , Persona de Mediana Edad , Giro Parahipocampal/diagnóstico por imagen , Putamen/diagnóstico por imagen , Tálamo/diagnóstico por imagen , Vigilia , Adulto Joven
12.
Biomed Chromatogr ; 34(1): e4699, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31524294

RESUMEN

In this study, we developed and validated two reliable high-performance liquid chromatography (HPLC) methods for the qualitative detection of six oral ß-lactams, which are commonly used in pediatric patients with acute respiratory infections (ARIs). Two distinct reverse-phase chromatographic separations of six ß-lactams were obtained. Four ß-lactams (cefadroxil, cephalexin, cefaclor and cefixime) in urine were separated using a gradient program with a mobile phase consisting of K2 HPO4 buffer (20 mm, pH 2.8) and acetonitrile on a LichroCART 250 × 4.6 mm, Purospher STAR C18 end-capped (5 µm) column. Two remained ß-lactams (amoxicillin and cefuroxime) were analyzed using a gradient elution with the mobile phase containing K2 HPO4 buffer (20 mm, pH 3.0) and acetonitrile on a LichroCart® Purospher Star C8 end-capped column (5 µm, 125 × 4.6 mm). Good linearity within the range of 0.3-30 µg/ml for cefadroxil, cephalexin, cefaclor and cefixime, and 0.2-20 µg/ml for amoxicillin and cefuroxime, was attained. The precisions were <14%. The accuracies ranged from 85.87 to 102.8%. The two validated methods were then applied to determine these six antibiotics in 553 urine samples of pediatric patients with ARIs. As a result, 32.2% were positive with one or more of six tested ß-lactams. Cefixime was the most commonly detected agent, accounting for 9.8% of enrolled patients.


Asunto(s)
Cromatografía Líquida de Alta Presión/métodos , Infecciones del Sistema Respiratorio/tratamiento farmacológico , beta-Lactamas/orina , Enfermedad Aguda , Adolescente , Niño , Preescolar , Cromatografía de Fase Inversa/métodos , Humanos , Lactante , Recién Nacido , Límite de Detección , Modelos Lineales , Uso Excesivo de Medicamentos Recetados , Reproducibilidad de los Resultados , beta-Lactamas/uso terapéutico
13.
Gene ; 728: 144285, 2020 Feb 20.
Artículo en Inglés | MEDLINE | ID: mdl-31838253

RESUMEN

Stroke has serious implications on patients and a huge impact on society. The current treatment regimens with drug for acute cerebral infarction are unsatisfactory. Here, we explore whether the two long non-coding RNA (lncRNA) candidates from preliminary research regulate apoptosis after cerebral infarction, and evaluate the underlying mechanism of action. Bioinformatics analysis of the lncRNA microarray in the preliminary research of our group was performed. Changes in the expression of candidate lncRNAs in SH-SY5Y cells were detected by quantitative polymerase chain reaction (qPCR) after treatment with seven different oxygen and glucose deprivation (OGD) methods. The changes were detected after transfection of cells with six small-interfering RNAs (siRNAs). Cell models were established by OGD after transfection with siRNAs. Cell viability was evaluated with the cell counting kit 8 (CCK8) assay, while TUNEL staining and flow cytometry analysis were performed to determine apoptosis. Changes in the expression and phosphorylation of three proteins were detected by western blotting after the knockdown of NR_120420. Changes in the expression and phosphorylation of P65 protein were detected by western blotting after this cell model was treated with PDTC. Cells were transfected with siNR_120420 and treated with and without PDTC, followed by analysis of cell viability and apoptosis. Bioinformatics analysis revealed that the differentially expressed lncRNAs after acute cerebral infarction were mainly involved in nuclear factor kappa B (NF-κB) and apoptosis. Expression of the two lncRNA candidates in SH-SY5Y cells was the maximum after incubation under the OGD condition for 8 h. The knockdown efficiency was more than 60% for four of the six siRNAs, and knockdown of NR_120420 increased the cell viability and decreased the percentage of TUNEL-positive cells and apoptotic cells. Knockdown of lnc-GCH1-2:3 resulted in none of these effects. Phosphorylation of NF-κB (P65) decreased significantly after the knockdown of NR_120420. Expression and phosphorylation of P65 was significantly reduced after it was treated with PDTC. The inhibitor of NF-κB (PDTC) could abolish the effect of NR_120420 on the regulation of apoptosis in this cell model. Both NR_120420 and lnc-GCH1-2:3 had significant changes in this cell model. Knockdown of NR_120420 inhibited the apoptosis of cells, while NR_120420 knockdown inhibited apoptosis after cerebral infarction by downregulating the phosphorylation of a subunit of NF-κB (P65). This study may provide new idea for improving drug treatment of acute cerebral infarction.


Asunto(s)
Apoptosis , Infarto Cerebral/patología , Glucosa/deficiencia , FN-kappa B/metabolismo , Neuroblastoma/patología , Oxígeno/metabolismo , ARN Largo no Codificante/genética , Enfermedad Aguda , Anciano , Estudios de Casos y Controles , Hipoxia de la Célula , Proliferación Celular , Infarto Cerebral/genética , Infarto Cerebral/metabolismo , Femenino , Humanos , Masculino , Análisis por Micromatrices , FN-kappa B/genética , Neuroblastoma/genética , Neuroblastoma/metabolismo , Fosforilación , Transducción de Señal , Células Tumorales Cultivadas
14.
Ann Hematol ; 99(2): 343-349, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31879790

RESUMEN

Ruxolitinib is a promising option for treating steroid-refractory acute graft-versus-host disease (SR-aGVHD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT). In this study, we describe ruxolitinib treatment for SR-aGVHD in HSCT patients with Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis (EBV-HLH) to evaluate its effectiveness. We evaluated the outcomes of 12 patients who received ruxolitinib for SR-aGVHD between January 2017 and March 2019. Of the 12 patients who received ruxolitinib, 7 patients achieved a complete response (CR), 3 had a partial response (PR), and 2 experienced treatment failure (TF). OS and CR rates were 83.3% and 58.3%, respectively. Moreover, CR was achieved by the six patients who had aGVHD with skin involvement. The mean time of steroid application in the patients who received ruxolitinib was 28.1 days. Median survival after HSCT was 64.6 weeks. The adverse effects of ruxolitinib included grades 3 to 4 neutropenia (n = 7) and grades 3 to 4 thrombocytopenia (n = 6). Cytomegalovirus reactivation was observed in three patients. A high rate of CR and short steroid application time of ruxolitinib as a salvage treatment were observed in HSCT patients with EBV-HLH. Consequently, from this study, it was determined that ruxolitinib is an optimal choice to treat SR-aGVHD in patients with EBV-HLH.


Asunto(s)
Infecciones por Virus de Epstein-Barr , Enfermedad Injerto contra Huésped , Trasplante de Células Madre Hematopoyéticas , Herpesvirus Humano 4 , Linfohistiocitosis Hemofagocítica , Pirazoles/administración & dosificación , Enfermedades de la Piel , Enfermedad Aguda , Adolescente , Adulto , Aloinjertos , Niño , Supervivencia sin Enfermedad , Resistencia a Medicamentos/efectos de los fármacos , Infecciones por Virus de Epstein-Barr/mortalidad , Infecciones por Virus de Epstein-Barr/terapia , Enfermedad Injerto contra Huésped/tratamiento farmacológico , Enfermedad Injerto contra Huésped/mortalidad , Humanos , Linfohistiocitosis Hemofagocítica/mortalidad , Linfohistiocitosis Hemofagocítica/terapia , Masculino , Estudios Retrospectivos , Enfermedades de la Piel/tratamiento farmacológico , Enfermedades de la Piel/mortalidad , Esteroides/administración & dosificación , Tasa de Supervivencia
15.
Vet Parasitol ; 277: 109012, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31884316

RESUMEN

Early in vivo diagnosis of bovine besnoitiosis is crucial for the success of control programmes. However, diagnosis in acutely infected animals is hindered by the low sensitivity of the available serological tools. In this study, a novel ELISA to detect specific anti-Besnoitia besnoiti IgM antibodies was developed. The usefulness of this tool together with an avidity ELISA were studied with a well-coded sera panel from experimentally and naturally infected cattle. First, the kinetics of specific IgM levels were determined in experimentally infected calves during the acute and chronic infection. Next, IgM levels were determined in naturally infected cattle with either acute or chronic infection. Finally, the IgG avidity index was monitored in both experimentally and naturally infected cattle. Specific IgM antibodies were detected prior to specific IgG antibodies (7-19 days vs. 17-26 days post-infection). A prompt IgM response was associated with the end of the febrile stage in experimentally infected calves. Naturally and experimentally infected animals with acute clinical signs tested IgM-positive but IgG-negative, followed by IgG seroconversion 2-3 weeks later. Chronically infected cattle developed both IgM and IgG specific antibodies. Moreover, a progressive increase in the avidity index (AI) was observed in all experimentally infected calves during the course of the experimental trials. However, a low AI coincided with visible tissue cysts. Low avidity values were also detected when naturally infected cattle with acute clinical signs seroconverted, in contrast to a high AI detected in chronically infected cattle. In summary, IgM and avidity ELISAs improved the early in vivo diagnosis of bovine besnoitiosis. IgM-positive but IgG-negative results were indicative of an acute infection, whereas IgG positive results accompanied by low avidity values confirmed a recent infection.


Asunto(s)
Enfermedades de los Bovinos/diagnóstico , Coccidiosis/veterinaria , Enfermedad Aguda , Animales , Anticuerpos Antiprotozoarios/sangre , Bovinos , Coccidiosis/diagnóstico , Ensayo de Inmunoadsorción Enzimática/veterinaria , Inmunoglobulina M/sangre
16.
Vasc Endovascular Surg ; 54(1): 69-74, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31500525

RESUMEN

Acute limb ischemia (ALI) is an abrupt decrease of blood flow to a limb, resulting in a potential threat to that body part. In ALI, which is commonly caused by embolism or traumatic occlusion, symptoms appear quickly due to a lack of collateral blood flow and extension of the thrombus to arterial outflow. In cases with ALI presentation, urgent evaluation and management are necessary. Here, we report 3 cases with ALI due to thromboembolism. Conventional open thromboembolectomy was performed with a femoral artery cutdown and antegrade passage of the embolectomy catheter. Further, distal access was created in the dorsalis pedis artery and/or posterior tibial artery at the ankle level. After the retrograde passage of the guidewire and antegrade insertion of the embolectomy catheter, the embolus was completely removed.


Asunto(s)
Embolectomía , Isquemia/cirugía , Extremidad Inferior/irrigación sanguínea , Trombectomía , Tromboembolia/cirugía , Enfermedad Aguda , Anciano , Anciano de 80 o más Años , Humanos , Isquemia/diagnóstico por imagen , Isquemia/fisiopatología , Masculino , Tromboembolia/diagnóstico por imagen , Tromboembolia/fisiopatología , Resultado del Tratamiento
19.
Radiol Clin North Am ; 58(1): 45-58, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31731902

RESUMEN

Abdominal pain is a common cause for emergency department visits in the United States, and biliary tract disease is the fifth most common cause of hospital admission. Common causes of acute hepatobiliary include gallstones and its associated complications and multiple other hepatobiliary etiologies, including infectious, inflammatory, vascular, and neoplastic causes. Postoperative complications of the biliary tract can result in an acute abdomen. Imaging of the hepatobiliary tree is integral in the diagnostic evaluation of acute hepatobiliary dysfunction, and imaging of the biliary tree requires a multimodality approach utilizing ultrasound, computed tomography, nuclear medicine, and MR imaging.


Asunto(s)
Enfermedades de las Vías Biliares/diagnóstico por imagen , Enfermedades de las Vías Biliares/fisiopatología , Sistema Biliar/diagnóstico por imagen , Sistema Biliar/fisiopatología , Diagnóstico por Imagen/métodos , Enfermedad Aguda , Humanos
20.
Med Clin North Am ; 104(1): 15-24, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31757233

RESUMEN

Urticaria is a common presenting problem to the primary care provider. Acute urticaria lasting less than 6 weeks may be associated with a drug or food allergens. Chronic urticaria lasting more than 6 weeks is often associated without a known underlying cause. Inducible stimuli causing hives should be excluded using specific provocation testing. Treatment follows a standardized algorithmic approach as outlined by the Joint Task Force Practice Parameter and/or International Urticaria guidelines. Patients not responsive to steps 1 or 2 should be referred to an urticaria specialist for further evaluation and treatment. The prognosis and outcome of urticaria is generally very favorable for most patients.


Asunto(s)
Atención Primaria de Salud/métodos , Urticaria/diagnóstico , Enfermedad Aguda , Comités Consultivos/normas , Enfermedad Crónica , Hipersensibilidad a las Drogas/complicaciones , Hipersensibilidad a las Drogas/diagnóstico , Hipersensibilidad a los Alimentos/complicaciones , Hipersensibilidad a los Alimentos/diagnóstico , Humanos , Guías de Práctica Clínica como Asunto , Atención Primaria de Salud/normas , Pronóstico , Derivación y Consulta , Urticaria/etiología
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