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1.
Lancet Haematol ; 8(5): e334-e343, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33894169

RESUMEN

BACKGROUND: There are no approved treatments for vaso-occlusive crises in sickle cell disease. Sevuparin is a novel non-anticoagulant low molecular weight heparinoid, with anti-adhesive properties. In this study, we tested whether sevuparin could shorten vaso-occlusive crisis duration in hospitalised patients with sickle cell disease. METHODS: We did a multicentre, double-blinded, placebo-controlled, phase 2 study in 16 public access clinical hospitals in the Netherlands, Lebanon, Turkey, Bahrain, Oman, Saudi Arabia, and Jamaica. Patients aged 12-50 years with a diagnosis of sickle cell disease (types HbSS, HbSC, HbSß0-thalassaemia, or HbSß+-thalassaemia) on a stable dose of hydroxyurea, hospitalised with vaso-occlusive crisis for parenteral opioid analgesia with a projected stay of more than 48 h were included in the study. Patients were randomly assigned (1:1) using a computer-generated randomisation scheme to receive sevuparin (18 mg/kg per day) or placebo (NaCl, 0·9% solution) intravenously for 2-7 days until vaso-occlusive crisis resolution. All individuals involved in the trial were masked to treatment allocation. The analysis was done in the intention-to-treat population. The primary endpoint was time to vaso-occlusive crisis resolution defined as freedom from parenteral opioid use (in preceding 6-10 h); and readiness for discharge as judged by the patient or physician. The trial is registered with ClinicalTrials.gov, NCT02515838. FINDINGS: Between Oct 7, 2015, and Feb 10, 2019, 144 patients were randomly assigned and administered sevuparin (n=69) or placebo (n=75). The median age was 22·2 years (range 12·2-33·6), 104 (72%) 144 were adults (18 years or older), and 90 (63%) were male and 54 (37%) were female. The intention-to-treat analysis for the primary endpoint showed no significant difference in median time to vaso-occlusive crisis resolution between the sevuparin and placebo groups (100·4 h [95% CI 85·5-116·8]) vs 86·4 h [70·6-95·1]; hazard ratio 0·89 [0·6-1·3]; p=0·55). Serious adverse events occurred in 16 (22%) of 68 patients in the sevuparin group and in 21 (22%) of patients in the placebo group. The most frequent treatment-emergent adverse events were pyrexia (17 [25%] in the sevuparin group vs 17 [22%] in the placebo group), constipation (12 [18%] vs 17 [22%]), and decreased haemoglobin (18 [26%] vs 9 [12%]). There were no deaths in the sevuparin group and there was one (1%) death in the placebo group after a hyper-haemolytic episode due to alloimmunisation. INTERPRETATION: This result, as well as the results seen in other clinical studies of inhibitors of adhesion in sickle cell disease, suggest that selectin-mediated adhesion might be important in the initiation, but not maintenance of vaso-occlusion, indicating that strategies to treat vaso-occlusive crises differ from strategies to prevent this complication. FUNDING: Modus Therapeutics.


Asunto(s)
Dolor Agudo/tratamiento farmacológico , Anemia de Células Falciformes/patología , Heparina/análogos & derivados , Dolor Agudo/complicaciones , Adolescente , Adulto , Anemia de Células Falciformes/complicaciones , Niño , Femenino , Fiebre/etiología , Hemoglobinas/análisis , Heparina/efectos adversos , Heparina/uso terapéutico , Humanos , Masculino , Tiempo de Tromboplastina Parcial , Efecto Placebo , Modelos de Riesgos Proporcionales , Resultado del Tratamiento , Adulto Joven
5.
Acta Med Indones ; 53(1): 82-85, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33818410

RESUMEN

Although typically patients with coronavirus disease-19 (COVID-19) have pulmonary symptoms atypical cases can occasionally present with extra-pulmonary symptoms. We report an interesting case of COVID-19 female patient presenting with combination of central nervous system disorder and acute myocardial infarct as initial manifestation. Multiorgan involvement in COVID-19 might lead to multiple atypical presentation which could be overlooked by the physician.


Asunto(s)
Síndrome Coronario Agudo , Encefalitis , /aislamiento & purificación , Síndrome Coronario Agudo/sangre , Síndrome Coronario Agudo/etiología , Síndrome Coronario Agudo/fisiopatología , Síndrome Coronario Agudo/terapia , Adulto , /diagnóstico , /fisiopatología , /métodos , Deterioro Clínico , Coma/diagnóstico , Coma/etiología , Electrocardiografía/métodos , Encefalitis/sangre , Encefalitis/etiología , Encefalitis/fisiopatología , Encefalitis/terapia , Resultado Fatal , Femenino , Fiebre/diagnóstico , Fiebre/etiología , Humanos , Respiración Artificial/métodos
6.
Medicine (Baltimore) ; 100(14): e25360, 2021 Apr 09.
Artículo en Inglés | MEDLINE | ID: mdl-33832116

RESUMEN

INTRODUCTION: Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer, and most patients in China are diagnosed at the intermediate or later stages, which is not suitable for the first line therapies. Transarterial chemoembolization (TACE) is a commonly selected therapeutic option for intermediate and later stage HCC in China, but patients often suffer from postembolization syndrome (PES), manifesting as fever, liver area pain, nausea, vomiting, paralyzed intestinal obstruction, and abdominal pain after TACE. We try to conduct a double blinded, randomized, placebo-controlled clinical trial to observe whether Chaihu Guizhi decoction (CGD), a classic traditional Chinese formula, could prophylactically alleviate the incidence of PES in HCC patients after TACE. METHODS: Patients will be randomly assigned sequentially in a 1:1 ratio by using preformed randomization envelopes. After TACE procedures, patients in the treatment group will be administrated with Chinese herbal formula CGD, and patients in the control group with CGD simulations, twice a day, continuously for 7 days. The outcomes are the incidence of PES hospitalization and, complications. SPSS version 22 (IBM, Chicago, IL) will be used for the data, and a P < .05 will be considered statistically significant. CONCLUSIONS: The findings will explore the prophylactic effect of CGD in alleviating the incidence of PES following TACE in HCC patients. TRIAL REGISTRATION: OSF Registration number: DOI 10.17605/OSF.IO/FKRSN.


Asunto(s)
Quimioembolización Terapéutica/efectos adversos , Quimioembolización Terapéutica/métodos , Medicamentos Herbarios Chinos/administración & dosificación , Fiebre/prevención & control , Neoplasias Hepáticas/terapia , Náusea/prevención & control , Vómitos/prevención & control , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Método Doble Ciego , Medicamentos Herbarios Chinos/efectos adversos , Femenino , Fiebre/etiología , Humanos , Masculino , Persona de Mediana Edad , Náusea/etiología , Proyectos de Investigación , Síndrome , Vómitos/etiología , Adulto Joven
7.
Orv Hetil ; 162(16): 602-607, 2021 04 07.
Artículo en Húngaro | MEDLINE | ID: mdl-33830937

RESUMEN

Összefoglaló. Újabb megfigyelések szerint a SARS-CoV-2-fertozést követoen gyermekekben a paediatric inflammatory multisystem syndrome (PIMS) elnevezésu, sokkállapottal szövodött Kawasaki-megbetegedéshez hasonlító, többszervi elégtelenségnek megfelelo tünetegyüttes alakulhat ki. A gyermekek többségében ilyenkor a direkt víruskimutatás már sikertelen, azonban a SARS-CoV-2 ellen képzodött antitest igazolhatja a diagnózist. Dolgozatunk célja az egyik elso hazai eset ismertetése. Egy 15 éves fiú került gyermek intenzív osztályos felvételre több napon át észlelt magas láz, kesztyu-, zokniszeru exanthema, conjunctivitis, többszervi elégtelenség, szeptikus sokk tüneteivel, akut gyulladásra utaló laboratóriumi eltérésekkel és diffúz hasi panaszokkal. Felvételét megelozoen néhány héttel SARS-CoV-2-fertozésen esett át. Felvételekor a direkt víruskimutatás sikertelen volt, ám a SARS-CoV-2 elleni antitest vizsgálata pozitív lett. Komplex intenzív terápia mellett állapota stabilizálódott. Az irodalmi ajánlásoknak megfeleloen immunglobulin-, acetilszalicilsav- és szteroidkezelésben részesítettük, melynek hatására állapota maradványtünetek nélkül rendezodött. A növekvo esetszámú gyermekkori SARS-CoV-2-fertozés mellett egyre gyakrabban várható a SARS-CoV-2-fertozést követo, a Kawasaki-betegség tüneteire emlékezteto PIMS kialakulása. Gyermekekben súlyos szeptikus állapot és többszervi elégtelenség esetén gondolni kell a PIMS lehetoségére, mely esetenként intenzív osztályos ellátást és célzott terápiát igényel. Legjobb tudomásunk szerint a leírásra került beteg a Magyarországon diagnosztizált egyik legkorábbi eset. Orv Hetil. 2021; 162(16): 602-607. Summary. Recently following SARS-CoV-2 infection, a new, multisystem disease (paediatric inflammatory multisystem syndrome, PIMS) with fever was recognized in children with shock and multiorgan failure. On of the first Hungarian cases will be described. A 15-year-old boy was admitted to the Paediatric Intensive Care Unit with persistent high fever, diffuse abdominal pain, septic shock, multiple organ failure, gloves- and socks-shaped cutan exanthema, conjunctivitis and laboratory signs of inflammation. Some weeks preceding his admission, symptoms of mild SARS-CoV-2 infection were revealed. At admission, the SARS-CoV-2 PCR and antigen tests were negative, however, the presence of IgG antibody was shown. Following complex supportive intensive care along with internationally recommended immunoglobulin, aspirin and steroid treatment, the patient was completely cured without any sequalae. In children after SARS-CoV-2 infection, PIMS could occur mimicking Kawasaki syndrome. At this time, in children virus PCR or antigen tests are usually negative already, but the presence of SARS-CoV-2 antibody could prove the preceding disease. Due to the increasing number of SARS-CoV-2 infections, the occurrence of post-SARS-CoV-2 PIMS in childhood is expected to increase. For paediatric patients, in case of severe septic state and multiple organ failure, PIMS should be also considered, which may require intensive care and targeted therapy. As far as we know, the described case is one of the earliest cases of PIMS in Hungary. Orv Hetil. 2021; 162(16): 602-607.


Asunto(s)
Dolor Abdominal/etiología , Fiebre/etiología , Inmunoglobulina G/sangre , Síndrome de Respuesta Inflamatoria Sistémica , Adolescente , /virología , Conjuntivitis/virología , Exantema/virología , Hospitalización , Humanos , Hungría , Inflamación/virología , Unidades de Cuidado Intensivo Pediátrico , Masculino , Insuficiencia Multiorgánica/virología , Choque Séptico/virología , Síndrome de Respuesta Inflamatoria Sistémica/sangre , Síndrome de Respuesta Inflamatoria Sistémica/virología
8.
BMJ Open ; 11(3): e044853, 2021 03 31.
Artículo en Inglés | MEDLINE | ID: mdl-33789854

RESUMEN

OBJECTIVES: One major goal of the emergency department (ED) is to decide, whether patients need to be hospitalised or can be sent home safely. We aim at providing criteria for these decisions without knowing the SARS-CoV-2 test result in suspected cases. SETTING: Tertiary emergency medicine. PARTICIPANTS: All patients were treated at the ED of the Charité during the pandemic peak and underwent SARS-CoV-2 testing. Patients with positive test results were characterised in detail and underwent a 14-day-follow-up. PRIMARY AND SECONDARY OUTCOME MEASURES: Logistic regression and classification and regression tree (CART) analyses were performed to identify predictors (primary endpoint), which confirm safe discharge. The clinical endpoint was all-cause mortality or need for mechanical ventilation during index stay or after readmission. RESULTS: The primary test population of suspected COVID-19 consisted of n=1255 cases, 45.2% were women (n=567). Of these, n=110 tested positive for SARS-CoV-2 (8.8%). The median age of SARS-CoV-2-positive cases was 45 years (IQR: 33-66 years), whereas the median age of the group tested negative for SARS-CoV-2 was 42 years (IQR: 30-60 years) (p=0.096). 43.6% were directly admitted to hospital care.CART analysis identified the variables oxygen saturation (<95%), dyspnoea and history of cardiovascular (CV) disease to distinguish between high and low-risk groups. If all three variables were negative, most patients were discharged from ED, and the incidence of the clinical endpoint was 0%. The validation cohort confirmed the safety of discharge using these variables and revealed an incidence of the clinical endpoint from 14.3% in patients with CV disease, 9.4% in patients with dyspnoea and 18.2% in patients with O2 satuaration below 95%. CONCLUSIONS: Based on easily available variables like dyspnoea, oxygen saturation, history of CV disease, approximately 25% of patients subsequently confirmed with COVID-19 can be identified for safe discharge. TRIAL REGISTRATION NUMBER: DRKS00023117.


Asunto(s)
/epidemiología , Toma de Decisiones , Servicio de Urgencia en Hospital/estadística & datos numéricos , Adulto , Anciano , /terapia , /estadística & datos numéricos , Estudios de Cohortes , Tos/etiología , Disnea/etiología , Servicio de Urgencia en Hospital/organización & administración , Femenino , Fiebre/etiología , Alemania/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Respiración Artificial/estadística & datos numéricos
9.
BMC Infect Dis ; 21(1): 368, 2021 Apr 19.
Artículo en Inglés | MEDLINE | ID: mdl-33874899

RESUMEN

BACKGROUND: Kawasaki disease (KD) as an acute, systemic vasculitis is the leading cause of acquired heart disease in children under the age of 5 years. METHODS: A 10-year cross-sectional retrospective study was designed to assess 190 Iranian children with KD during 2008-2018. Demographic data, clinical and laboratory manifestations from the onset of symptoms to diagnosis, clinical signs and symptoms, and subsequent treatments were evaluated to predict hospitalization stay, complications, and response to treatment. RESULTS: Children with KD had a male-to-female ratio of 1.18:1 and an average age of 36 months. There was an insignificantly more incidence of KD in cold seasons. The most frequent symptoms were fever (92.6%), oral mucus membrane changes (75.8%), bilateral bulbar conjunctival injection (73.7%), polymorphous skin rash (73.2%), peripheral extremity changes (63.7%), and cervical lymphadenopathy (60.0%). The rate of gastrointestinal, cardiac, joint, and hepatic complications was determined to be 38.4, 27.9, 6.8, and 4.2%, respectively. 89.5% of patients received intravenous immunoglobulin (IVIG) plus aspirin as the first line of treatment, while, 16.3% of them needed an extra second line of treatment. Significantly low serum sodium levels and high platelet counts were detected in KD patients with cardiac complications. Cardiac complications often were more encountered in patients who did not respond to the first line of treatment. Higher platelet count, lower serum sodium amount, and C-reactive protein (CRP) level were significantly associated with a need for an additive second line of treatment. A significant relationship between hospitalization stay and hemoglobin level was found. CONCLUSION: As most of the clinical manifestations and complications were following other reports released over the past few years, such data can be confidently used to diagnose KD in Iran. Seasonal incidence and a positive history of recent infection in a notable number of patients may provide clues to understand possible etiologies of KD. Laboratory markers can successfully contribute to health practitioners with the clinical judgment of the need for additional treatments, possible complications, and hospitalization duration.


Asunto(s)
Enfermedades Gastrointestinales/complicaciones , Inmunoglobulinas Intravenosas/uso terapéutico , Síndrome Mucocutáneo Linfonodular/diagnóstico , Proteína C-Reactiva/análisis , Niño , Preescolar , Aneurisma Coronario/etiología , Estudios Transversales , Exantema/etiología , Femenino , Fiebre/etiología , Cardiopatías/complicaciones , Humanos , Incidencia , Lactante , Irán/epidemiología , Masculino , Síndrome Mucocutáneo Linfonodular/complicaciones , Síndrome Mucocutáneo Linfonodular/tratamiento farmacológico , Síndrome Mucocutáneo Linfonodular/epidemiología , Recuento de Plaquetas , Estudios Retrospectivos
11.
BMJ Case Rep ; 14(3)2021 Mar 10.
Artículo en Inglés | MEDLINE | ID: mdl-33692072

RESUMEN

Neonatal herpes simplex virus (HSV) infection is rare, with an estimated incidence of 3.58 per 100 000 live births in the UK and should be suspected in any newborn with fever and bacterial culture-negative sepsis. We describe a case of a previously well full-term male neonate who presented with persistent fever and elevated ferritin level that was carried out during the era of the COVID-19 pandemic as part of SARS-CoV-2 panel investigations. Despite the initial negative HSV serology, HSV-1 PCR from a scalp lesion returned positive. He made a full recovery after acyclovir therapy. This case highlights the importance of maintaining a high clinical index of suspicion of HSV infection in any febrile neonate even with absence of maternal history and negative serology, particularly if associated with hyperferritinaemia. We also address the challenge of interpreting inflammatory biomarkers' results for SARS-CoV-2 infection in neonates.


Asunto(s)
/epidemiología , Ferritinas/sangre , Fiebre/etiología , Herpes Simple/diagnóstico , Complicaciones Infecciosas del Embarazo/diagnóstico , Aciclovir/uso terapéutico , Antivirales/uso terapéutico , Femenino , Herpes Simple/complicaciones , Herpes Simple/tratamiento farmacológico , Herpesvirus Humano 1/aislamiento & purificación , Humanos , Recién Nacido , Masculino , Pandemias , Reacción en Cadena de la Polimerasa , Embarazo , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Resultado del Tratamiento
12.
PLoS One ; 16(3): e0248920, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33765050

RESUMEN

BACKGROUND: Tests are scarce resources, especially in low and middle-income countries, and the optimization of testing programs during a pandemic is critical for the effectiveness of the disease control. Hence, we aim to use the combination of symptoms to build a predictive model as a screening tool to identify people and areas with a higher risk of SARS-CoV-2 infection to be prioritized for testing. MATERIALS AND METHODS: We performed a retrospective analysis of individuals registered in "Dados do Bem," a Brazilian app-based symptom tracker. We applied machine learning techniques and provided a SARS-CoV-2 infection risk map of Rio de Janeiro city. RESULTS: From April 28 to July 16, 2020, 337,435 individuals registered their symptoms through the app. Of these, 49,721 participants were tested for SARS-CoV-2 infection, being 5,888 (11.8%) positive. Among self-reported symptoms, loss of smell (OR[95%CI]: 4.6 [4.4-4.9]), fever (2.6 [2.5-2.8]), and shortness of breath (2.1 [1.6-2.7]) were independently associated with SARS-CoV-2 infection. Our final model obtained a competitive performance, with only 7% of false-negative users predicted as negatives (NPV = 0.93). The model was incorporated by the "Dados do Bem" app aiming to prioritize users for testing. We developed an external validation in the city of Rio de Janeiro. We found that the proportion of positive results increased significantly from 14.9% (before using our model) to 18.1% (after the model). CONCLUSIONS: Our results showed that the combination of symptoms might predict SARS-Cov-2 infection and, therefore, can be used as a tool by decision-makers to refine testing and disease control strategies.


Asunto(s)
/diagnóstico , Aprendizaje Automático , Adulto , Brasil , /virología , Disnea/etiología , Reacciones Falso Negativas , Reacciones Falso Positivas , Femenino , Fiebre/etiología , Humanos , Masculino , Persona de Mediana Edad , Aplicaciones Móviles , Sistema de Registros , Estudios Retrospectivos , Riesgo , Autoinforme
13.
Artículo en Inglés | MEDLINE | ID: mdl-33787738

RESUMEN

We report a rare case of an infective endocarditis by Aerococcus spp in a bioprosthetic aortic valve following a prostate biopsy, in an asymptomatic adult with no additional risk factor for prostate cancer, excepting for age. The diagnosis was based on the presence of vegetations on the bioprosthesis seen on the echocardiogram, positive blood cultures and fever, and a favorable clinical outcome following the treatment with ceftriaxone and gentamicin.


Asunto(s)
Aerococcus/aislamiento & purificación , Ceftriaxona/uso terapéutico , Endocarditis/tratamiento farmacológico , Fiebre/etiología , Gentamicinas/uso terapéutico , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Próstata/patología , Anciano , Biopsia , Ecocardiografía , Endocarditis/diagnóstico , Endocarditis/microbiología , Femenino , Infecciones por Bacterias Grampositivas/sangre , Infecciones por Bacterias Grampositivas/diagnóstico , Humanos , Masculino , ARN Ribosómico 16S , Resultado del Tratamiento
14.
Medicine (Baltimore) ; 100(12): e25259, 2021 Mar 26.
Artículo en Inglés | MEDLINE | ID: mdl-33761723

RESUMEN

RATIONALE: Although single organ vasculitis (SOV) is a rare occurrence and it is difficult to diagnose, its possibility as a cause of fever of unknown origin (FUO) must be considered. Recently, the usefulness of 18F-fluorodeoxyglucose positron emission tomography computed tomography (FDG PET/CT) in the diagnosis of unknown fevers due to vasculitis, especially in cases of small and medium-sized vasculitis, has begun to be pointed out. PATIENT CONCERNS: We report the case of an 84-year-old woman with persisting fever for more than 2 weeks. She had no accompanying symptoms, other than fever, and the physical examination, echocardiography, and contrast-enhanced CT did not reveal any diagnostic clue. DIAGNOSES: The FDG PET/CT revealed positive uptakes of FDG in the left breast, with a standardized uptake value (SUV) of 2.9. The biopsy specimen of the left breast lesion revealed rupture of the elastic plate and evidence of fibrinoid necrosis of arteries, leading to the diagnosis of polyarteritis (PAN). Further angiographic examination and additional imaging did not reveal the presence of other lesions. Therefore, the diagnosis was established as a PAN-SOV of the left breast. INTERVENTIONS: This patient has improved with follow-up only. OUTCOMES: There has been no evidence of a relapse of PAN over a 5-year follow-up period. LESSONS: SOV presenting with unspecific local symptoms is difficult to diagnose based on the medical history and clinical examination. Our findings show that early "Combination of PET-CT and biopsy" can be a powerful diagnostic tool in patients with FUO for whom diagnosis of the underlying cause is difficult despite appropriate clinical examination.


Asunto(s)
Biopsia/métodos , Mama , Arterias Mamarias , Poliarteritis Nudosa , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Anciano de 80 o más Años , Mama/irrigación sanguínea , Mama/diagnóstico por imagen , Diagnóstico Diferencial , Femenino , Fiebre/diagnóstico , Fiebre/etiología , Fluorodesoxiglucosa F18/farmacología , Humanos , Arterias Mamarias/diagnóstico por imagen , Arterias Mamarias/patología , Poliarteritis Nudosa/diagnóstico , Poliarteritis Nudosa/fisiopatología , Radiofármacos/farmacología
15.
Medicine (Baltimore) ; 100(13): e24053, 2021 Apr 02.
Artículo en Inglés | MEDLINE | ID: mdl-33787568

RESUMEN

RATIONALE: Neurogenic fever is a non-infectious source of fever in a patient with brain injury, especially hypothalamic injury. We report on a stroke patient with neurogenic fever due to injury of hypothalamus, demonstrated by using diffusion tensor imaging (DTI). PATIENT CONCERNS: A 28-year-old male patient was admitted to the rehabilitation department of university hospital at 30 months after onset. Brain MRI showed leukomalactic lesions in hypothalamus, bilateral medial temporal lobe, and bilateral basal ganglia. He showed intermittent high body temperature (maximum:39.5°C, range:38.5-39.2°C), but did not show any infection signs upon physical examination or after assessing his white blood cell count and inflammatory enzyme levels such as erythrocyte sedimentation rate and C-reactive protein. In addition, 8 age-matched normal (control) subjects (4 male, mean age: 26.6 years, range: 21-29years) were enrolled in the study. DIAGNOSIS: Intraventricular hemorrhage and intracerebral hemorrhage in the left basal ganglia. INTERVENTIONS: He underwent extraventricular drainage and ventriculoperitoneal shunting for hydrocephalus. OUTCOMES: DTI was performed at 30 months after onset, fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were obtained for hypothalamus. The FA and ADC values of patient were lower and higher, respectively, by more than two standard deviations from control values. Injury of hypothalamus was demonstrated in a stroke patient with neurogenic fever. LESSIONS: Our results suggest that evaluation of hypothalamus using DTI would be helpful in patients show unexplained fever following brain injury.


Asunto(s)
Hemorragia Cerebral/complicaciones , Fiebre/etiología , Hipotálamo/lesiones , Accidente Cerebrovascular/complicaciones , Adulto , Hemorragia Cerebral/diagnóstico por imagen , Imagen de Difusión Tensora , Fiebre/diagnóstico por imagen , Humanos , Hipotálamo/diagnóstico por imagen , Masculino , Accidente Cerebrovascular/diagnóstico por imagen
16.
Medicine (Baltimore) ; 100(13): e25182, 2021 Apr 02.
Artículo en Inglés | MEDLINE | ID: mdl-33787599

RESUMEN

ABSTRACT: We aimed to evaluate the risk factors of febrile urinary tract infection (UTI) following retrograde intrarenal surgery (RIRS) for treating renal stones.We retrospectively reviewed the data of patients with 10 - 30 mm kidney stones who underwent RIRS from January 2014 to July 2017. Evaluation included age, gender, body mass index, stone size, stone location, and operative time. All surgeries were performed by a single surgeon and ureteral stenting was not done prior surgery. The risk factors of febrile UTI after RIRS were assessed by univariate and multivariate logistic regression analysis.A total of 150 patients were included in the present study, and 17 patients (11.3%) had febrile UTI after RIRS. Mean patient age was 56.64 ±â€Š13.91 years, and both genders were evenly distributed. Mean stone size was 14.16 ±â€Š5.89 mm. and mean operation time was 74.50 ±â€Š42.56 minutes. According to univariate analysis, preoperative pyuria was associated with postoperative febrile UTI. Multivariate logistic regression analysis showed that preoperative pyuria was the only independent risk factor of infectious complications after RIRS (odds ratios 8.311, 95% confidence intervals 1.759 - 39.275, P = .008). Age, gender, body mass index, comorbidity, preoperative bacteriuria, presence of hydronephrosis, renal stone characteristics, and operative time were not associated with febrile UTI after RIRS.Preoperative pyuria was the only risk factor of infectious complications following RIRS. Therefore, careful management after RIRS is necessary especially when preoperative urinalysis shows pyuria.


Asunto(s)
Fiebre/etiología , Cálculos Renales/cirugía , Nefrotomía/efectos adversos , Complicaciones Posoperatorias/etiología , Piuria/complicaciones , Infecciones Urinarias/etiología , Adulto , Anciano , Femenino , Humanos , Cálculos Renales/orina , Modelos Logísticos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Tempo Operativo , Periodo Preoperatorio , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento
17.
J Trop Pediatr ; 67(1)2021 01 29.
Artículo en Inglés | MEDLINE | ID: mdl-33787904

RESUMEN

LAY SUMMARY: Clinical and laboratory parameters of multisystem inflammatory syndrome in children (MIS-C) mimic Kawasaki disease (KD). KD has been described in association with dengue, scrub typhus and leptospirosis. However, MIS-C with concomitant infection has rarely been reported in literature. A 14-year-old-girl presented with fever and rash with history of redness of eyes, lips and tongue. Investigations showed anemia, lymphopenia, thrombocytosis with elevated erythrocyte sedimentation rate, C-reactive protein, pro-brain natriuretic peptide, Interleukin-6, ferritin and d-dimer. Scrub typhus immunoglobulin M was positive. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin G (IgG) level was also elevated. A diagnosis of MIS-C with concomitant scrub typhus was proffered. Child received azithromycin, intravenous immunoglobulin and methylprednisolone. After an afebrile period of 2.5 days, child developed unremitting fever and rash. Repeat investigations showed anemia, worsening lymphopenia, thrombocytopenia, transaminitis, hypertriglyceridemia, hyperferritinemia and hypofibrinogenemia which were consistent with a diagnosis of macrophage activation syndrome (MAS). KD, MIS-C and MAS represent three distinct phenotypes of hyperinflammation seen in children during coronavirus disease pandemic. Several tropical infections may mimic or coexist with MIS-C which can be a diagnostic challenge for the treating physician. Identification of coexistence or differentiation between the two conditions is important in countries with high incidence of tropical infections to guide appropriate investigations and treatment.


Asunto(s)
/complicaciones , Síndrome de Activación Macrofágica/diagnóstico , Tifus por Ácaros/diagnóstico , Síndrome de Respuesta Inflamatoria Sistémica , Adolescente , Azitromicina/uso terapéutico , Biomarcadores/sangre , /diagnóstico , Niño , Femenino , Fiebre/etiología , Humanos , Inmunoglobulina G/sangre , Inmunoglobulinas Intravenosas/uso terapéutico , Síndrome de Activación Macrofágica/complicaciones , Síndrome de Activación Macrofágica/tratamiento farmacológico , Síndrome de Activación Macrofágica/inmunología , Metilprednisolona/administración & dosificación , Metilprednisolona/uso terapéutico , Pandemias , Tifus por Ácaros/complicaciones , Tifus por Ácaros/tratamiento farmacológico , Síndrome de Respuesta Inflamatoria Sistémica/sangre , Síndrome de Respuesta Inflamatoria Sistémica/diagnóstico , Síndrome de Respuesta Inflamatoria Sistémica/tratamiento farmacológico , Síndrome de Respuesta Inflamatoria Sistémica/inmunología
18.
Ned Tijdschr Geneeskd ; 1652021 02 04.
Artículo en Holandés | MEDLINE | ID: mdl-33651513

RESUMEN

We present a 30-year-old male, an 82-year-old male and a 71-year-old female who presented with fever, cough and dyspnea during de COVID-19 pandemic. Chest CT showed a ground-glass opacification and/or crazy paving. In all of these patients the PCR for SARS-CoV-2 was negative, but the COVID-19 pandemic caused a delay in diagnosis and treatment of these patients with big consequences for these patients. We show the risk of being fixated on COVID-19, the need for a careful examination respecting the medical history of the patient. Don't conclude too quickly on a CORADS-4 or 5, but do additional tests and consult other specialists when the PCR for SARS-CoV-2 is negative.


Asunto(s)
/métodos , Diagnóstico Tardío , Pulmón/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Adulto , Anciano , /fisiopatología , Toma de Decisiones Clínicas , Tos/diagnóstico , Tos/etiología , Diagnóstico Tardío/efectos adversos , Diagnóstico Tardío/prevención & control , Diagnóstico Diferencial , Disnea/diagnóstico , Disnea/etiología , Femenino , Fiebre/diagnóstico , Fiebre/etiología , Humanos , Masculino
19.
PLoS One ; 16(3): e0248009, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33724987

RESUMEN

INTRODUCTION: Since the start of the pandemic, millions of people have been infected, with thousands of deaths. Many foci worldwide have been identified in retirement nursing homes, with a high number of deaths. Our study aims were to evaluate the spread of SARS-CoV-2 in the retirement nursing homes, the predictors to develop symptoms, and death. METHODS AND FINDINGS: We conducted a retrospective study enrolling all people living in retirement nursing homes (PLRNH), where at least one SARS-CoV-2 infected person was present. Medical and clinical data were collected. Variables were compared with Student's t-test or Pearson chi-square test as appropriate. Uni- and multivariate analyses were conducted to evaluate variables' influence on infection and symptoms development. Cox proportional-hazards model was used to evaluate 30 days mortality predictors, considering death as the dependent variable. We enrolled 382 subjects. The mean age was 81.15±10.97 years, and males were 140(36.7%). At the multivariate analysis, mental disorders, malignancies, and angiotensin II receptor blockers were predictors of SARS-CoV-2 infection while having a neurological syndrome was associated with a lower risk. Only half of the people with SARS-CoV-2 infection developed symptoms. Chronic obstructive pulmonary disease and neurological syndrome were correlated with an increased risk of developing SARS-CoV-2 related symptoms. Fifty-six (21.2%) people with SARS-CoV-2 infection died; of these, 53 died in the first 30 days after the swab's positivity. Significant factors associated with 30-days mortality were male gender, hypokinetic disease, and the presence of fever and dyspnea. Patients' autonomy and early heparin treatment were related to lower mortality risk. CONCLUSIONS: We evidenced factors associated with infection's risk and death in a setting with high mortality such as retirement nursing homes, that should be carefully considered in the management of PLRNH.


Asunto(s)
/patología , Anciano , Anciano de 80 o más Años , Antagonistas de Receptores de Angiotensina/administración & dosificación , /mortalidad , Disnea/etiología , Femenino , Fiebre/etiología , Heparina de Bajo-Peso-Molecular/uso terapéutico , Humanos , Masculino , Trastornos Mentales/complicaciones , Trastornos Mentales/patología , Neoplasias/complicaciones , Neoplasias/patología , Casas de Salud , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales , Tasa de Supervivencia
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