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1.
Bol. méd. postgrado ; 36(2): 37-42, dic.2020. tab
Artículo en Español | LILACS, LIVECS | ID: biblio-1117898

RESUMEN

Con el objetivo de determinar el nivel de conocimiento que poseen las madres sobre los signos de alarma de las infecciones respiratorias agudas (IRA) en niños menores de 5 años que asistieron al Servicio Desconcentrado Hospital Universitario Pediátrico Dr. Agustín Zubillaga durante el mes de noviembre 2019, se realizó un estudio descriptivo transversal con 37 madres las cuales se caracterizaron por un promedio de edad de 29,2 ± 7,3 años, solteras (43,2%), con secundaria completa (27%) y empleadas (40,5%). El promedio de edad de los pacientes fue de 15,3 ± 6,2 meses, con predominio del sexo masculino (54%); durante el último año, 45,9% registraron entre 2-3 episodios de IRA. Sobre el nivel de conocimiento global de las madres en relación a los signos de alarma de las IRA se evidenció que en el 56,7% de las madres el nivel era regular. El nivel de conocimiento para las causas de las IRA fue insuficiente en el 48,6% de los casos. En relación a los signos de alarma de IRA identificadas por parte de las madres fueron, en orden de frecuencia, dificultad para respirar (91,8%), fiebre (81%), rechazo al alimento (78,3%) y respiración ruidosa (75,6%). En conclusión, es evidente que la mayoría de las madres conoce los principales signos de alarma de las IRA sin embargo se deben establecer estrategias de intervención destinadas a mejorar su conocimiento con el fin de que las madres reconozcan tempranamente los signos de alarma y por ende busquen atención en el momento oportuno(AU)


With the objective of determining the level of knowledge that mothers have about warning signs of acute respiratory infections (ARI) in children under 5 years of age who attended the Servicio Desconcentrado Hospital Universitario Pediátrico Dr. Agustín Zubillaga (November, 2019), a cross-sectional descriptive study was carried out with 37 mothers with an average age of 29.2 ± 7.3 years, 43.2% were single, with completed secondary school (27%) and employed (40.5%). Average age of patients was 15.3 ± 6.2 months with male predominance (54%); during the previous year, 45.9% had between 2-3 episodes of ARI. Level of knowledge of mothers about global warning signs of ARI was regular in 56.76% of cases. Regarding causes of ARI, level of knowledge was insufficient in 48.6% of mothers. Warning signs of ARI identified by the mothers were, in order of frequency, difficulty in breathing (91.8%), fever (81%), food rejection (78.3%) and loud breathing loud (75.6%). In conclusion, it is clear that most mothers know the main warning signs of ARI however intervention strategies should be established to improve knowledge in order for mothers to recognize early warning signs and therefore seek attention in a timely manner(AU)


Asunto(s)
Humanos , Femenino , Enfermedades Respiratorias , Infecciones del Sistema Respiratorio/diagnóstico , Signos y Síntomas , Hospitales Pediátricos , Pediatría , Enfermedad Aguda , Fiebre
2.
Acute Med ; 19(4): 235-239, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33215177

RESUMEN

BACKGROUND: Influenza B is considered to cause milder illness compared to influenza A. There has been no known association between influenza B and acute pancreatitis. CASE REPORT: We present a case of an influenza B infection complicated with acute pancreatitis. Furthermore, the biochemical markers that are used to diagnose pancreatitis were normal in this case. DISCUSSION: We present the case that Influenza B can present with severity compared to this of Influenza A. We review the literature on infectious causes and diagnostic criteria for acute pancreatitis and on acute pancreatitis with normal pancreatic enzymes. CONCLUSION: Influenza B can rarely cause acute pancreatitis. The absence of biochemical confirmation should not exclude the diagnosis of pancreatitis in the appropriate clinical setting.


Asunto(s)
Infecciones , Pancreatitis , Enfermedad Aguda , Biomarcadores , Humanos , Pancreatitis/diagnóstico , Pancreatitis/etiología
3.
World J Gastroenterol ; 26(40): 6270-6278, 2020 Oct 28.
Artículo en Inglés | MEDLINE | ID: mdl-33177799

RESUMEN

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, mostly causing respiratory symptoms, is also known to affect the gastrointestinal tract. Several case reports hypothesize that SARS-CoV-2 could be an etiological factor in acute pancreatitis (AP). AIM: To assess all the available evidence in the literature relating to coronavirus disease 2019 (COVID-19) and AP. METHODS: We performed a systematic review of the available literature on the topic. The systematic search was conducted on 15 May 2020 on MEDLINE, EMBASE, CENTRAL, Web of Science and Scopus with a search key using the terms "amylase," "lipase," "pancr*," "COVID-19" and synonyms. Due to the low quality and poor comparability of the studies, a meta-analysis was not performed. RESULTS: Six case reports and two retrospective cohorts were included, containing data on eleven COVID-19 patients with AP. Five patients had AP according to the Atlanta classification. Other publications did not provide sufficient information on the diagnostic criteria. Most cases were considered SARS-CoV-2-induced, while several established etiological factors were not investigated. We were able to identify other possible causes in most of them. CONCLUSION: We strongly highlight the need for adherence to the guidelines during a diagnostic and etiological workup, which could alter therapy.


Asunto(s)
Betacoronavirus/aislamiento & purificación , Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus/diagnóstico , Pancreatitis/virología , Neumonía Viral/diagnóstico , Enfermedad Aguda , Técnicas de Laboratorio Clínico/normas , Infecciones por Coronavirus/complicaciones , Adhesión a Directriz , Humanos , Pandemias , Neumonía Viral/complicaciones , Guías de Práctica Clínica como Asunto
4.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 32(10): 1273-1276, 2020 Oct.
Artículo en Chino | MEDLINE | ID: mdl-33198880

RESUMEN

Chronic obstructive pulmonary disease (COPD) has a high incidence, and leads to irreversible lung dysfunction. Preventing COPD acute exacerbation (AECOPD) and delaying the progression of the disease are the focus of treatment. However, there is still a lack of precise and effective preventive measures. A significant feature of AECOPD is the high incidence in winter. The traditional concept is that cold air in winter can be accompanied by increased virus replication, environmental pollution, and reduced air humidity. Various confounding factors intertwine to promote the occurrence of AECOPD, and the impact of low temperature itself has been neglected. In recent years, with the development of molecular biology, more and more studies have found that abnormal secretion of airway mucin can lead to obstruction of mucus clearance, increase the chance of infection, and participate in the development of COPD. Low temperature can affect mucin secretion through various mechanisms. This article summarizes the particularity of COPD airway temperature and the related ways of low temperature leading to mucin changes. It draws people's attention to low temperature in order to carry out basic research and provide new intervention methods for predicting and preventing the occurrence of AECOPD.


Asunto(s)
Enfermedad Pulmonar Obstructiva Crónica , Enfermedad Aguda , Progresión de la Enfermedad , Humanos , Mucinas , Temperatura
5.
Medicine (Baltimore) ; 99(45): e23031, 2020 Nov 06.
Artículo en Inglés | MEDLINE | ID: mdl-33157953

RESUMEN

RATIONALE: The evidence for outpatient pulmonary embolism (PE) management apart from hospitalization is expanding. The availability and ease of direct oral anticoagulants have facilitated this transition. The literature, however, is sparse on the topic of comprehensive management of pulmonary embolism in the primary care clinic setting. As such, the role of the primary care physician in the complete diagnosis, risk stratification for outpatient eligibility, and initiation of treatment is unclear. CASE PRESENTATIONS: Case 1: A 33-year-old man with known heterozygous Factor V Leiden mutation and a remote history of deep vein thrombosis presented to his primary care physician's office with 2 days of mild pleuritic chest pain and a dry cough after a recent transcontinental flight. Case 2: A 48-year-old man with a complex medical history including recent transverse myelitis presented to his primary care family physician with dyspnea and pleuritic chest pain for 6 days. DIAGNOSIS: Case 1: Computed tomographic pulmonary angiography that same afternoon showed multiple bilateral segmental and subsegmental emboli as well as several small pulmonary infarcts. Case 2: The patient's D-dimer was elevated at 1148 ng/mL. His physician ordered a computed tomographic pulmonary angiography, performed that evening, which showed segmental and subsegmental PE. INTERVENTIONS: Both patients were contacted by their respective physicians shortly after their diagnoses and, in shared decision-making, opted for treatment at home with 5 days of enoxaparin followed by dabigatran. OUTCOMES: Neither patient developed recurrence nor complications in the subsequent 3 months. LESSONS: These cases, stratified as low risk using the American College of Chest Physicians criteria and the PE Severity Index, are among the first in the literature to illustrate comprehensive primary care-based outpatient PE management. Care was provided within an integrated delivery system with ready, timely access to laboratory, advanced radiology, and allied health services. This report sets the stage for investigating the public health implications of comprehensive primary care-based PE management, including cost-savings as well as enhanced patient follow-up and patient satisfaction.


Asunto(s)
Dolor en el Pecho/etiología , Disnea/etiología , Transferencia de Pacientes/métodos , Médicos de Atención Primaria/normas , Embolia Pulmonar/tratamiento farmacológico , Enfermedad Aguda , Adulto , Atención Ambulatoria , Anticoagulantes/uso terapéutico , Antitrombinas/uso terapéutico , Dolor en el Pecho/diagnóstico , Angiografía por Tomografía Computarizada/métodos , Dabigatrán/uso terapéutico , Toma de Decisiones Conjunta , Disnea/diagnóstico , Enoxaparina/uso terapéutico , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Mielitis Transversa/complicaciones , Mielitis Transversa/diagnóstico , Transferencia de Pacientes/estadística & datos numéricos , Médicos de Atención Primaria/estadística & datos numéricos , Embolia Pulmonar/diagnóstico por imagen , Medición de Riesgo , Resultado del Tratamiento , Trombosis de la Vena/complicaciones , Trombosis de la Vena/diagnóstico
6.
Trials ; 21(1): 934, 2020 Nov 19.
Artículo en Inglés | MEDLINE | ID: mdl-33213529

RESUMEN

OBJECTIVES: Zilucoplan (complement C5 inhibitor) has profound effects on inhibiting acute lung injury post COVID-19, and can promote lung repair mechanisms that lead to improvement in lung oxygenation parameters. The purpose of this study is to investigate the efficacy and safety of Zilucoplan in improving oxygenation and short- and long-term outcome of COVID-19 patients with acute hypoxic respiratory failure. TRIAL DESIGN: This is a phase 2 academic, prospective, 2:1 randomized, open-label, multi-center interventional study. PARTICIPANTS: Adult patients (≥18y old) will be recruited at specialized COVID-19 units and ICUs at 9 Belgian hospitals. The main eligibility criteria are as follows: 1) Inclusion criteria: a. Recent (≥6 days and ≤16 days) SARS-CoV-2 infection. b. Chest CT scan showing bilateral infiltrates within the last 2 days prior to randomisation. c. Acute hypoxia (defined as PaO2/FiO2 below 350 mmHg or SpO2 below 93% on minimal 2 L/min supplemental oxygen). d. Signs of cytokine release syndrome characterized by either high serum ferritin, or high D-dimers, or high LDH or deep lymphopenia or a combination of those. 2) Exclusion criteria: e. Mechanical ventilation for more than 24 hours prior to randomisation. f. Active bacterial or fungal infection. g. History of meningococcal disease (due to the known high predisposition to invasive, often recurrent meningococcal infections of individuals deficient in components of the alternative and terminal complement pathways). INTERVENTION AND COMPARATOR: Patients in the experimental arm will receive daily 32,4 mg Zilucoplan subcutaneously and a daily IV infusion of 2g of the antibiotic ceftriaxone for 14 days (or until hospital discharge, whichever comes first) in addition to standard of care. These patients will receive additional prophylactic antibiotics until 14 days after the last Zilucoplan dose: hospitalized patients will receive a daily IV infusion of 2g of ceftriaxone, discharged patients will switch to daily 500 mg of oral ciprofloxacin. The control group will receive standard of care and a daily IV infusion of 2g of ceftriaxone for 1 week (or until hospital discharge, whichever comes first), to control for the effects of antibiotics on the clinical course of COVID-19. MAIN OUTCOMES: The primary endpoint is the improvement of oxygenation as measured by mean and/or median change from pre-treatment (day 1) to post-treatment (day 6 and 15 or at discharge, whichever comes first) in PaO2/FiO2 ratio, P(A-a)O2 gradient and a/A PO2 ratio. (PAO2= Partial alveolar pressure of oxygen, PaO2=partial arterial pressure of oxygen, FiO2=Fraction of inspired oxygen). RANDOMISATION: Patients will be randomized in a 2:1 ratio (Zilucoplan: control). Randomization will be done using an Interactive Web Response System (REDCap). BLINDING (MASKING): In this open-label trial neither participants, caregivers, nor those assessing the outcomes will be blinded to group assignment. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): A total of 81 patients will be enrolled: 54 patients will be randomized to the experimental arm and 27 patients to the control arm. TRIAL STATUS: ZILU-COV protocol Version 4.0 (June 10 2020). Participant recruitment started on June 23 2020 and is ongoing. Given the uncertainty of the pandemic, it is difficult to predict the anticipated end date. TRIAL REGISTRATION: The trial was registered on Clinical Trials.gov on May 11th, 2020 (ClinicalTrials.gov Identifier: NCT04382755 ) and on EudraCT (Identifier: 2020-002130-33 ). FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.


Asunto(s)
Complemento C5/antagonistas & inhibidores , Infecciones por Coronavirus/complicaciones , Hipoxia/tratamiento farmacológico , Neumonía Viral/complicaciones , Insuficiencia Respiratoria/tratamiento farmacológico , Enfermedad Aguda , Adulto , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Bélgica/epidemiología , Betacoronavirus/aislamiento & purificación , Estudios de Casos y Controles , Ceftriaxona/administración & dosificación , Ceftriaxona/uso terapéutico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/virología , Síndrome de Liberación de Citoquinas/sangre , Síndrome de Liberación de Citoquinas/tratamiento farmacológico , Quimioterapia Combinada , Humanos , Infusiones Intravenosas , Inyecciones Subcutáneas , Oxígeno/sangre , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/fisiopatología , Neumonía Viral/virología , Estudios Prospectivos , Seguridad , Resultado del Tratamiento
7.
Trials ; 21(1): 940, 2020 Nov 23.
Artículo en Inglés | MEDLINE | ID: mdl-33225990

RESUMEN

OBJECTIVES: To assess the effect of prone positioning therapy on intubation rate in awake patients with COVID-19 and acute respiratory failure. TRIAL DESIGN: This is a two-center parallel group, superiority, randomized (1:1 allocation ratio) controlled trial. PARTICIPANTS: All patients admitted to the Hospital Civil de Guadalajara and Hospital General de Occidente in Mexico for COVID-19 associated acute respiratory failure and in need of supplementary oxygen through high-flow nasal cannula are screened for eligibility. INCLUSION CRITERIA: all adult patients admitted to the COVID-19 unit who test positive for COVID-19 by PCR-test and in need for oxygen are eligible for inclusion. Randomization starts upon identification of requirement of a fraction of inspired oxygen ≥30% for an oxygen capillary saturation of ≥90% Exclusion criteria: less than 18 years-old, pregnancy, patients with immediate need of invasive mechanical ventilation (altered mental status, fatigue), vasopressor requirement to maintain median arterial pressure >65 mmHg, contraindications for prone positioning therapy (recent abdominal or thoracic surgery or trauma, facial, pelvic or spine fracture, untreated pneumothorax, do-not-resuscitate or do-not-intubate order, refusal or inability of the patient to enroll in the study. INTERVENTION AND COMPARATOR: Patients of the intervention group will be asked to remain in a prone position throughout the day as long as possible, with breaks according to tolerance. Pillows will be offered for maximizing comfort at chest, pelvis and knees. Monitoring of vital signs will not be suspended. Inspired fraction of oxygen will be titrated to maintain a capillary saturation of 92%-95%. For patients in the control group, prone positioning will be allowed as a rescue therapy. Staff intensivists will monitor the patient's status in both groups on a 24/7 basis. All other treatment will be unchanged and left to the attending physicians. MAIN OUTCOMES: Endotracheal intubation rate for mechanical ventilation at 28 days. RANDOMISATION: Patients will be randomly allocated to either prone positioning or control group at 1:1 ratio. Such randomization will be computer generated and stratified by center with permuted blocks and length of 4. BLINDING (MASKING): Due to logistical reasons, only principal investigators and the data analyst will be blinded to group assignment. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): With an intubation rate of 60% according to recent reports from some American centers, and assuming a decrease to 40% to be clinically relevant, we calculated a total of 96 patients per group, for a beta error of 0.2, and alpha of 0.5. Therefore, we plan to recruit 200 patients, accounting for minimal losses to follow up, with 100 non-intubated patients in the prone position group and a 100 in the control group. TRIAL STATUS: The local registration number is 048-20, with the protocol version number 2.0. The date of approval is 3rd May 2020. Recruitment started on 3rd May and is expected to end in December 2020. TRIAL REGISTRATION: The protocol was retrospectively registered under the title: "Prone Positioning in Non-intubated Patients With COVID-19 Associated Acute Respiratory Failure. The PRO-CARF trial" in ClinicalTrials.gov with the registration number: NCT04477655. Registered on 20 July 2020. FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines (Additional file 2).


Asunto(s)
Infecciones por Coronavirus/complicaciones , Intubación Intratraqueal/instrumentación , Oxígeno/uso terapéutico , Neumonía Viral/complicaciones , Posición Prona/fisiología , Insuficiencia Respiratoria/etiología , Enfermedad Aguda , Adulto , Betacoronavirus/genética , Cánula/efectos adversos , Cánula/provisión & distribución , Estudios de Casos y Controles , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/virología , Femenino , Hospitalización , Humanos , Intubación Intratraqueal/estadística & datos numéricos , Masculino , México/epidemiología , Oxígeno/administración & dosificación , Oxígeno/sangre , Oxígeno/provisión & distribución , Pandemias , Posicionamiento del Paciente/métodos , Neumonía Viral/epidemiología , Neumonía Viral/virología , Insuficiencia Respiratoria/fisiopatología , Insuficiencia Respiratoria/terapia
8.
Saudi Med J ; 41(11): 1204-1210, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33130840

RESUMEN

OBJECTIVES: To evaluate acute cardiac injury in COVID-19 patients and its association with adverse outcomes including mortality in the United Arab Emirates (UAE) population. METHODS: A retrospective study conducted between February and June 2020 in Dubai, UAE, for all laboratory-confirmed Coronavirus disease-19 patients. Demographic, clinical, laboratory, radiological, and clinical outcomes were compared between patients with and without acute cardiac injury. RESULTS: During the study period, 203 patients were included, of which, 44 (21.7%) had evidence of acute cardiac injury. Compared with patients without acute cardiac injury, patients with acute cardiac injury were: older, had more shortness of breath, diabetes, hypertension, and more bilateral airspace shadowing on admission chest radiography. These patients also had a higher neutrophil count, C-reactive protein, procalcitonin, ferritin, D-dimers and lactate dehydrogenase but lower lymphocyte count. Regarding outcomes, these patients had higher intensive care admissions; a higher rate of complications including acute kidney and liver injury, acidosis, septic shock, acute respiratory distress syndrome, needed more mechanical ventilation, and had a significantly higher risk of death. CONCLUSION: Acute cardiac injury is common among Coronavirus disease-19 patients. These patients present with higher comorbidities, have high inflammatory markers and have greater risk for in-hospital multi-organ damage, need for mechanical ventilation, and death. Prompt full assessment and intervention are recommended.


Asunto(s)
Causas de Muerte , Infecciones por Coronavirus/epidemiología , Lesiones Cardíacas/epidemiología , Mortalidad Hospitalaria/tendencias , Pandemias/estadística & datos numéricos , Neumonía Viral/epidemiología , Enfermedad Aguda , Adulto , Anciano , Estudios de Cohortes , Comorbilidad , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/terapia , Femenino , Lesiones Cardíacas/diagnóstico , Hospitalización/estadística & datos numéricos , Hospitales Urbanos , Humanos , Masculino , Persona de Mediana Edad , Pandemias/prevención & control , Neumonía Viral/diagnóstico , Neumonía Viral/terapia , Estudios Retrospectivos , Arabia Saudita/epidemiología , Índice de Severidad de la Enfermedad , Tasa de Supervivencia
9.
Bone Joint J ; 102-B(11): 1475-1483, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33135447

RESUMEN

AIMS: The aim of this study was to determine the current incidence and epidemiology of humeral diaphyseal fractures. The secondary aim was to explore variation in patient and injury characteristics by fracture location within the humeral diaphysis. METHODS: Over ten years (2008 to 2017), all adult patients (aged ≥ 16 years) sustaining an acute fracture of the humeral diaphysis managed at the study centre were retrospectively identified from a trauma database. Patient age, sex, medical/social background, injury mechanism, fracture classification, and associated injuries were recorded and analyzed. RESULTS: A total of 900 fractures (typical 88.9%, n = 800/900; pathological 8.3%, n = 75/900; periprosthetic 2.8%, n = 25/900) were identified in 898 patients (mean age 57 years (16 to 97), 55.5% (n = 498/898) female). Overall fracture incidence was 12.6/100,000/year. For patients with a typical fracture (n = 798, mean age 56 years (16 to 96), 55.1% (n = 440/798) female), there was a bimodal distribution in men and unimodal distribution in older women (Type G). A fall from standing was the most common injury mechanism (72.6%, n = 581/800). The majority of fractures involved the middle-third of the diaphysis (47.6%, n = 381/800) followed by the proximal- (30.5%, n = 244/800) and distal-thirds (n = 175/800, 21.9%). In all, 18 injuries (2.3%) were open and a radial nerve palsy occurred in 6.7% (n = 53/795). Fractures involving the proximal- and middle-thirds were more likely to occur in older (p < 0.001), female patients (p < 0.001) with comorbidities (p < 0.001) after a fall from standing (p < 0.001). Proximal-third fractures were also more likely to occur in patients with alcohol excess (p = 0.003) and to be classified as AO-Orthopaedic Trauma Association type B or C injuries (p < 0.001). CONCLUSION: This study updates the incidence and epidemiology of humeral diaphyseal fractures. Important differences in patient and injury characteristics were observed based upon fracture location. Injuries involving the proximal- and middle-thirds of the humeral diaphysis should be considered as fragility fractures. Cite this article: Bone Joint J 2020;102-B(11):1475-1483.


Asunto(s)
Diáfisis/lesiones , Fracturas del Húmero/epidemiología , Húmero/lesiones , Fracturas Osteoporóticas/epidemiología , Enfermedad Aguda , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Bases de Datos Factuales , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Reino Unido/epidemiología , Adulto Joven
10.
Kyobu Geka ; 73(10): 783-788, 2020 Sep.
Artículo en Japonés | MEDLINE | ID: mdl-33130766

RESUMEN

Mesenteric malperfusion is reported as a complication associated with acute aortic dissection(AAD) in 3~5% cases, and one of the adverse risk factors for survival. The mortality rate associated with malperfusion due to AAD is higher than that without malperfusion. To improve the clinical outcome, it is important to address the mesenteric malperfusion appropriately. Mesenteric malperfusion remains a diagnostic challenge. Abdominal pain is the most common symptom, but a nonspecific of acute mesenteric ischemia. Computed tomography(CT) including CT angiography is the gold standard in the diagnosis of aortic dissection and the mesenteric malperfusion. No single serum marker, including lactate, is reliable enough to diagnosis mesenteric ischemia. The optimal treatment for mesenteric malperfusion due to AAD is to restore blood flow to the ischemic area as early as possible, while minimizing the risk of thoracic aortic rupture. Those patients with malperfusion but no significant organ ischemia should be treated with immediate surgical repair. Those patients with malperfusion and significant organ ischemia and hemodynamically stable should be treated with mesenteric reperfusion, followed by surgical repair. The management of mesenteric malperfusion associated with AAD requires a tailored approach to improve outcomes. After successful restoration of mesenteric perfusion, patients should be monitored closely, and the bowel should be inspected when there is doubt regarding its viability.


Asunto(s)
Aneurisma Disecante , Aneurisma de la Aorta , Procedimientos Endovasculares , Isquemia Mesentérica , Enfermedad Aguda , Aneurisma Disecante/complicaciones , Aneurisma Disecante/diagnóstico por imagen , Aneurisma Disecante/cirugía , Aneurisma de la Aorta/complicaciones , Aneurisma de la Aorta/diagnóstico por imagen , Aneurisma de la Aorta/cirugía , Humanos , Isquemia/etiología , Isquemia/cirugía , Isquemia Mesentérica/diagnóstico por imagen , Isquemia Mesentérica/cirugía , Resultado del Tratamiento
11.
Wiad Lek ; 73(9 cz. 2): 1973-1976, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33148843

RESUMEN

OBJECTIVE: The aim: To evaluate the effectiveness of the proposed method of surgical treatment of patients with acute purulent cholangitis. PATIENTS AND METHODS: Materials and methods: The research is based on the analysis of the treatment results in 104 patients with acute purulent cholangitis. The volume of surgical interventions on the biliary tract in patients was as follows: endoscopic papillosphincterotomy (EPST) + naso-biliary drainage; EPST + laparoscopic cholecystectomy; cholecystectomy + choledocholithotomy + drainage of the common bile duct. RESULTS: Results: The APACHE-2 scale assessment for patients in the control group was 12,80 ± 1,73, with the SOFA scale - 4,32 ± 0,31 points. Accordingly, the assessment for patients in the main group with the APACHE-2 scale is 11.76 ± 0.81, with the SOFA scale - 4.33 ± 0.79 points. The results obtained in both the control and the main group indicate that the physiological reactions of the organism to the disease, treatment, development of organ dysfunction are reflected in the integrated severity assessment scales. CONCLUSION: Conclusion: The performed analysis of clinical and laboratory results of treatment in both groups established the high efficiency of the proposed treatment method in patients with acute purulent cholangitis, which promotes the more rapid medical and social rehabilitation in this category of patients.


Asunto(s)
Colangitis , Cálculos Biliares , Enfermedad Aguda , Colangitis/cirugía , Colecistectomía , Drenaje , Cálculos Biliares/cirugía , Ingeniería Genética , Humanos
12.
Vestn Otorinolaringol ; 85(5): 40-43, 2020.
Artículo en Ruso | MEDLINE | ID: mdl-33140932

RESUMEN

The purpose of the study was to summarize data on modern antibiotic therapy for acute sinusitis, the role and place of topical antibacterial drugs, in particular Fluimucil-Antibiotic, in modern treatment strategies for this disease. METHODS: Search in the PUBMED electronic database (articles and related abstracts) for the keywords «acute sinusitis", «antibiotics¼, «thiamphenicol glycinate acetylcysteine¼ «biofilm¼, «respiratory tract infection¼, «N-acetylcysteine¼. RESULTS: The published research results indicate the high antibacterial activity of the Fluimucil-Antibiotic, in particular, for the topical drug use in the form of inhalations, applications, irrigation, and instillations. The published research results indicate a wide spectrum of antimicrobial action of Fluimucil-Antibiotic, its ability to destroy biofilms and prevent their formation, good pharmacokinetics, safety, which makes it possible to consider it as a potential treatment option for acute sinusitis in everyday practice.


Asunto(s)
Infecciones del Sistema Respiratorio , Sinusitis , Acetilcisteína , Enfermedad Aguda , Antibacterianos/uso terapéutico , Combinación de Medicamentos , Humanos , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Sinusitis/tratamiento farmacológico
13.
Medicine (Baltimore) ; 99(41): e22482, 2020 Oct 09.
Artículo en Inglés | MEDLINE | ID: mdl-33031280

RESUMEN

RATIONALE: Acute pancreatitis (AP) is one of the most common diseases of gastroenterological emergency with a highly variable clinical course and the incidence being on the rise in recent years. Posttraumatic diaphragmatic hernia is an uncommon disease and may manifest immediately or several years after the incident. Delayed presentation of traumatic diaphragmatic hernia associated with AP is relatively rare. PATIENT CONCERNS: A 26-year-old male with history of left chest knife injury 10 years ago, had AP due to delayed traumatic diaphragmatic hernia 5 days after Dragon Boat Race. DIAGNOSES: Thoracoabdominal computerized tomography detected left diaphragmatic hernia with pancreatic head displacement. Emergency surgery confirmed the diagnosis. INTERVENTIONS: Emergency surgery to reduce and repair the hernia. OUTCOMES: The patient was discharged from the hospital on the sixth postoperative day and no recurrence of pancreatitis during follow-up. LESSONS: For patients without obvious etiology of AP, clinicians should be highly vigilant and inquire the history in detail. For patients with trauma, the relevant examination should be improved, and the pancreatitis caused by traumatic diaphragmatic hernia should be treated with emergency operation immediately.


Asunto(s)
Hernia Diafragmática Traumática/complicaciones , Pancreatitis/etiología , Enfermedad Aguda , Adulto , Hernia Diafragmática Traumática/diagnóstico por imagen , Hernia Diafragmática Traumática/cirugía , Humanos , Masculino , Factores de Tiempo , Tomografía Computarizada por Rayos X , Heridas Punzantes/complicaciones
14.
J Investig Med High Impact Case Rep ; 8: 2324709620966475, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33054445

RESUMEN

Severe acute respiratory syndrome coronavirus-2 infection (SARS-CoV-2), commonly known as COVID-19 (coronavirus disease-2019), began in the Wuhan District of Hubei Province, China. It is regarded as one of the worst pandemics, which has consumed both human lives and the world economy. COVID-19 infection mainly affects the lungs triggering severe hypoxemic respiratory failure, also providing a nidus for superimposed bacterial and fungal infections. We report the case of a 73-year-old male who presented with progressive dyspnea; diagnosed with SARS-CoV-2-related severe acute respiratory distress syndrome and complicated with lung cavitations growing Aspergillus sp. COVID-19, to our knowledge, has rarely been associated with subacute invasive pulmonary aspergillosis with aspergillomas. Subacute invasive pulmonary aspergillosis as a superimposed infection in patients with SARS-CoV-2 is a rare entity. By reporting this case, we would like to make the readers aware of this association.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/complicaciones , Aspergilosis Pulmonar Invasiva/etiología , Neumonía Viral/complicaciones , Enfermedad Aguda , Anciano , Antifúngicos/uso terapéutico , Aspergillus/aislamiento & purificación , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Diagnóstico Diferencial , Humanos , Aspergilosis Pulmonar Invasiva/diagnóstico , Aspergilosis Pulmonar Invasiva/tratamiento farmacológico , Masculino , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Radiografía Torácica , Tomografía Computarizada por Rayos X
15.
Acta Gastroenterol Belg ; 83(3): 413-417, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33094588

RESUMEN

BACKGROUND AND AIM: Acute pancreatitis (AP) is a life- threatening condition across all age groups. In this study, it was aimed to investigate the severity of the disease and associated mortality in the geriatric population. METHODOLOGY: This single-center, prospective study elderly (≥65 years of age) and younger (18-65 years of age) total 147 patients with AP are enrolled To diagnose and asses the severity of AP Atlanta classification was used. Baseline and 12-months follow-up data included Ranson, Imrie, BISAP, APACHE-II, SOFA, Modified Marshall, Balthazar, and Computed Tomography Severity Index (CTSI) as prognostic tools. RESULTS: 6 (15%) patiens in elderly and 5 (6,7%) patients in non elderly group had modarete-severe AP . Patients were followed up 1 year and during this time no systemic complications were seen , 8 (20%) patients in elderly group and 10 (13,6%) patients in younger group had local complications. 1 patients in elderly and 2 patients in non elderly group had acute necrotic collection whereas 1 patient developed walled of necrosis in non elderly group. The elderly patients with any of the following index characteristics would not be expected to have a mild disease course: Imrie score ≥ 3, BISAP score ≥ 3, APACHE-II ≥ 11, CRP ≥ 195 mg/dl. CONCLUSIONS: AP caused a prolonged hospitalization in the elderly compared to younger patients but its severity and clinical outcomes were not different in the two groups.


Asunto(s)
Pancreatitis , Enfermedad Aguda , Adolescente , Adulto , Anciano , Humanos , Persona de Mediana Edad , Pancreatitis/diagnóstico , Pronóstico , Estudios Prospectivos , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Adulto Joven
16.
Transl Psychiatry ; 10(1): 348, 2020 10 13.
Artículo en Inglés | MEDLINE | ID: mdl-33051440

RESUMEN

To study the acute psychological effects of Coronavirus Disease 2019 (COVID-19) outbreak among healthcare workers (HCWs) in China, a cross-sectional survey was conducted among HCWs during the early period of COVID-19 outbreak. The acute psychological effects including symptoms of depression, anxiety, and post-traumatic stress disorder (PTSD) were assessed using the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder (GAD-7) questionnaire, and the Impact of Event Scale-Revised (IES-R). The prevalence of depression, anxiety, and PTSD was estimated at 15.0%, 27.1%, and 9.8%, respectively. Having an intermediate technical title, working at the frontline, receiving insufficient training for protection, and lacking confidence in protection measures were significantly associated with increased risk for depression and anxiety. Being a nurse, having an intermediate technical title, working at the frontline, and lacking confidence in protection measures were risk factors for PTSD. Meanwhile, not worrying about infection was a protective factor for developing depression, anxiety, and PTSD. Psychological interventions should be implemented among HCWs during the COVID-19 outbreak to reduce acute psychological effects and prevent long-term psychological comorbidities. Meanwhile, HCWs should be well trained and well protected before their frontline exposure.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/psicología , Personal de Salud/psicología , Personal de Salud/estadística & datos numéricos , Trastornos Mentales/epidemiología , Trastornos Mentales/psicología , Neumonía Viral/psicología , Enfermedad Aguda , Adulto , China/epidemiología , Estudios Transversales , Femenino , Encuestas Epidemiológicas/métodos , Encuestas Epidemiológicas/estadística & datos numéricos , Humanos , Masculino , Pandemias
17.
Transl Psychiatry ; 10(1): 355, 2020 10 19.
Artículo en Inglés | MEDLINE | ID: mdl-33077738

RESUMEN

This study examined the neuropsychiatric sequelae of acutely ill patients with coronavirus disease 2019 (COVID-19) infection who received treatment in hospital isolation wards during the COVID-19 pandemic. Ten COVID-19 patients who received treatment in various hospitals in Chongqing, China; 10 age- and gender-matched psychiatric patients; and 10 healthy control participants residing in the same city were recruited. All participants completed a survey that collected information on demographic data, physical symptoms in the past 14 days and psychological parameters. Face-to-face interviews with COVID-19 patients were also performed using semi-structured questions. Among the COVID-19 patients, 40% had abnormal findings on the chest computed topography scan, 20% had dysosmia, 10% had dysgeusia, and 80% had repeated positivity on COVID-19 reverse-transcription polymerase chain reaction testing. COVID-19 and psychiatric patients were significantly more worried about their health than healthy controls (p = 0.019). A greater proportion of COVID-19 patients experienced impulsivity (p = 0.016) and insomnia (p = 0.039) than psychiatric patients and healthy controls. COVID-19 patients reported a higher psychological impact of the outbreak than psychiatric patients and healthy controls, with half of them having clinically significant symptoms of posttraumatic stress disorder. COVID-19 and psychiatric patients had higher levels of depression, anxiety and stress than healthy controls. Three themes emerged from the interviews with COVID-19 patients: (i) The emotions experienced by patients after COVID-19 infection (i.e., shock, fear, despair, hope, and boredom); (ii) the external factors that affected patients' mood (i.e., discrimination, medical expenses, care by healthcare workers); and (iii) coping and self-help behavior (i.e., distraction, problem-solving and online support). The future direction in COVID-19 management involves the development of a holistic inpatient service to promote immune and psychological resilience.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/psicología , Pacientes Internos/psicología , Neumonía Viral/psicología , Cuarentena/psicología , Enfermedad Aguda , Adulto , China , Estudios de Evaluación como Asunto , Femenino , Humanos , Pacientes Internos/estadística & datos numéricos , Masculino , Pandemias , Cuarentena/métodos , Cuarentena/estadística & datos numéricos
18.
BMC Pulm Med ; 20(1): 275, 2020 Oct 22.
Artículo en Inglés | MEDLINE | ID: mdl-33092563

RESUMEN

BACKGROUND: Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is an ongoing pandemic that profoundly challenges healthcare systems all over the world. Fever, cough and fatigue are the most commonly reported clinical symptoms. CASE PRESENTATION: A 58-year-old man presented at the emergency department with acute onset haemoptysis. On the fifth day after admission, he developed massive haemoptysis. Computed tomography (CT) angiography of the chest revealed alveolar haemorrhage, more prominent in the left lung. Flexible bronchoscopy confirmed bleeding from the left upper lobe, confirmed by a bronchial arteriography, which was successfully embolized. Nasopharyngeal swabs (NPS) tested for SARS-CoV-2 using real-time polymerase chain reaction (RT-PCR) repeatedly returned negative. Surprisingly, SARS-CoV-2 was eventually detected in bronchoalveolar lavage (BAL) fluid. CONCLUSIONS: Life-threatening haemoptysis is an unusual presentation of COVID-19, reflecting alveolar bleeding as a rare but possible complication. This case emphasises the added value of bronchoscopy with BAL in the diagnostic work-up in case of high clinical suspicion and negative serial NPS in patients presenting with severe symptoms.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/diagnóstico , Hemoptisis/virología , Neumonía Viral/complicaciones , Neumonía Viral/diagnóstico , Enfermedad Aguda , Betacoronavirus , Líquido del Lavado Bronquioalveolar/virología , Broncoscopía , Angiografía por Tomografía Computarizada , Hemoptisis/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Nasofaringe/virología , Pandemias
19.
Adv Clin Exp Med ; 29(10): 1231-1236, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-33125196

RESUMEN

Non-infectious uveitis (NIU) is a serious sight-threatening condition whose pathogenesis is often autoimmune in nature. It may manifest in any age group, though adults aged 20-50 are the group most often affected. It causes 5-10% of visual impairment worldwide. The epidemiology of some specific uveitis diseases varies worldwide, because they are influenced by genetic, environmental and socioeconomic factors. It can occur only in the eye or as a symptom of a systemic condition. The most common cause of NIU is HLA-B-27-associated anterior uveitis (4-32%). The standard treatment for NIU is a local, topical and systemic steroid therapy in combination with immunomodulatory therapy. However, recently, a new drug - adalimumab, which is a tumor necrosis factor α (TNF-α) inhibitor - was approved by FDA in the treatment of NIU and is increasingly used to treat various conditions. Adalimumab has been proven in many studies to be safe and effective in the treatment of NIU associated with diverse systemic diseases.


Asunto(s)
Uveítis , Enfermedad Aguda , Adalimumab/uso terapéutico , Humanos , Factor de Necrosis Tumoral alfa , Uveítis/tratamiento farmacológico
20.
BMC Infect Dis ; 20(1): 768, 2020 Oct 17.
Artículo en Inglés | MEDLINE | ID: mdl-33069216

RESUMEN

BACKGROUND: Cytomegalovirus (CMV) is a double stranded DNA virus and ubiquitous in nature. Association of Guillain-Barre syndrome (GBS) and CMV is well known but CMV acute myositis is a rare condition. Restriction of movements of limbs due to severe pain in myositis may obscure the diagnosis of GBS and this may easily miss. CASE PRESENTATION: Here we describe a 29-year-old male presenting with pain and swelling of bilateral lower limbs which progressed rapidly with increasing serum creatine kinase levels with positive IgM CMV antibodies. In view of no improvement in clinical condition, patient was further evaluated and found to have concurrent GBS. He was treated with plasmapheresis and improved. CONCLUSION: Cytomegalovirus infection presenting as acute myositis is a uncommon and further association with GBS is a rare occurrence.


Asunto(s)
Infecciones por Citomegalovirus/complicaciones , Infecciones por Citomegalovirus/diagnóstico , Citomegalovirus/inmunología , Síndrome de Guillain-Barré/complicaciones , Síndrome de Guillain-Barré/diagnóstico , Miositis/complicaciones , Miositis/diagnóstico , Enfermedad Aguda , Adulto , Anticuerpos Antivirales/sangre , Infecciones por Citomegalovirus/terapia , Errores Diagnósticos , Síndrome de Guillain-Barré/terapia , Humanos , Inmunoglobulina M/sangre , Masculino , Miositis/terapia , Miositis/virología , Dolor , Plasmaféresis , Resultado del Tratamiento
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