Acute infectious pancreatitis due to Salmonella typhi: Case report and literature review.

Salmonella typhi remains an endemic disease in Madagascar. Acute pancreatitis remains a rare complication of S. typhi colitis. We presented the case of a 27-year-old male, admitted to febrile diarrhea, vomiting, and severe abdominal pain. Blood work-up revealed elevated plasma lipase level. Abdominal CT scan showed acute pancreatitis without necrosis. Blood and stool culture positivity for S. typhi. Patient was diagnosed as acute pancreatitis caused by S. typhi. The outcome was favorable under symptomatic medical treatment (rehydration and analgesic) combined with adapted antibiotic therapy. Acute pancreatitis is a possible complication of Salmonella infections. The presence of severe abdominal pain and febrile diarrhea should draw clinicians' attention to possible Salmonella acute pancreatitis.

Clinical mortality risk factors of variceal upper gastrointestinal bleeding in a Malagasy surgical intensive care unit.

BACKGROUND: Variceal upper gastrointestinal bleeding is a dreadful complication of portal hypertension with a significant morbidity and mortality. Different prognostic scores can be used. However, in the local context of Madagascar, the completion of paraclinical investigations can be delayed by the limited financial means of patients. Hence, determining clinical mortality risk factors of variceal upper gastrointestinal bleeding could be interesting. The aim of the study was to evaluate the clinical mortality risk factors of variceal gastrointestinal bleeding (VUGIB). METHOD: An observational, cohort retrospective study was conducted over an 8-year period (2010-2017), at the surgical intensive care unit of the J.R. Andrianavalona University Hospital, Antananarivo, in patients admitted for VUGIB confirmed by upper gastrointestinal endoscopy and whose clinical examination was performed at admission. The primary endpoint was intensive care unit (ICU) mortality. Univariate analysis and multivariate logistic regression analysis were performed to identify risk factors for ICU mortality, with OR defining odds ratio. A p value <0.05 was considered significant. RESULTS: 1920 patients were admitted for gastrointestinal bleeding of any digestive causes; the source of bleeding was variceal in 269 patients (14%). The predominantly male population (sex ratio = 2.5), aged 47.1 ± 13.7 years was mostly American Society of Anesthesiologists (ASA) 1 classification (58.4%). In 56.5% of patients, the gastrointestinal bleeding had not occurred before. The mortality rate was 16.0%. Three major clinical factors of mortality were identified: previous endoscopic band variceal ligation (OR = 12.57 [2.18-72.58], p = 0.005), tachycardia >120 bpm (OR = 2.91 [1.04-8.14], p = 0.041), and ascites (OR = 3.80 [1.85-7.81], p < 0.001). CONCLUSION: Upper gastrointestinal bleeding may be life-threatening. The mortality scores are certainly useful; however, the identification of clinical factors is interesting in countries like Madagascar, pending the results of paraclinical investigations.

[Normal values in self-blood pressure measurement in relation to the presence of target organ disease. Data from the VAMPAHICA study]. / Valores de normalidad de la automedida de la presión arterial en relación con la presencia de lesión en los órganos diana. Datos del estudio VAMPAHICA.

BACKGROUND AND OBJECTIVE: International guides of hypertension (HT) recommend self-blood -pressure-measurement (SBPM) values higher than 135/85 mmHg to determine isolated clinical hypertension (ICH). This paper suggests a lower cut-off. PATIENTS AND METHOD: This prospective, protocol-based study included 378 patients, 250 new hypertensive patients without previous treatment. Both SBPM and ambulatory blood pressure monitoring (ABPM) were measured in all patients. Risk factors and target organ disease (TOD) were evaluated by electrocardiography, renal function, microalbuminuria and retinography. RESULTS: With a 135/85 mmHg ICH cut-off, only differences in serum creatinine levels (78.67 ICH vs 83.98 micromol/l sustained HT -SHT-; p = 0.03), grade I/II fundus oculi (FO) lesions (44.7 vs 62.8%; p = 0.009) and any FO lesions (48.2 vs 67.4%; p = 0.005) were found. With a ICH cut-off of 130/80 mmHg, a lower risk of grade III/IV FO lesions was found (RR = 0.59; 90% confidence interval [CI], 0.36-0.96; p = 0.06). Any TOD risk was related to SHT with a 130/85 mmHg cut-off (RR = 12.04; 90% CI, 1.03-140.28; p = 0.09). CONCLUSIONS: Taking a 135/85 mmHg ICH cut-off, no differences in TOD between ICH and SHT were found. Taking a 130 mmHg ICH systolic blood pressure (SBP) cut-off, those who are below 130 mmHg have a lower risk of grade III/IV FO lesions. Those who are above this value have a higher TOD risk. Looking at TOD risk, we should consider a < 130 mmHg SBP cut-off for ICH diagnosis.

Valores de normalidad de la automedida de la presión arterial en relación con la presencia de lesión en los órganos diana. Datos del estudio VAMPAHICA / Normal values in self-blood pressure measurement in relation to the presence of target organ disease. Data from the VAMPAHICA study

Fundamento y objetivo: Las guías internacionales de hipertensión arterial (HTA) recomiendan valores de automedida de la presión arterial (AMPA) con un punto de corte de 135/85 mmHg para diagnosticar hipertensión clínica aislada (HCA). En este artículo se defiende un punto de corte inferior. Pacientes y método: Estudio prospectivo protocolizado con 378 pacientes que incluyó a 250 hipertensos de nuevo diagnóstico sin tratamiento. Se efectuó AMPA y monitorización de la presión arterial a todos los pacientes. Se evaluaron los factores de riesgo y la lesión en órganos diana (LOD) mediante electrocardiograma, función renal, microalbuminuria y retinografía. Resultados: El punto de corte de 135/85 mmHg sólo muestra diferencias en los valores de creatinina sérica (78,67 en HCA frente a 83,98 mmol/l en HTA mantenida [HTAM]; p = 0,03), en las lesiones grado I/II del fondo de ojo (FO) (el 44,7 frente al 62,8%; p = 0,009) y en la presencia de cualquier lesión en el FO (el 48,2 frente al 67,4%; p = 0,005). Con menor significación estadística, el menor riesgo de lesiones grado III/IV en el FO se observó en los HCA, con un punto de corte de 130/80 mmHg (riesgo relativo [RR] = 0,59; intervalo de confianza [IC] del 90%, 0,36-0,96; p = 0,06). El mayor riesgo de cualquier LOD se observó en los pacientes con HTAM con un punto de corte de 130/85 mmHg (RR = 12,04; IC del 90%, 1,03-140,28; p = 0,09). Conclusiones: El punto de corte de 135/85 mmHg no muestra diferencias en la presencia de LOD entre pacientes con HCA y HTAM. Para un punto de corte de 130 mmHg de presión arterial sistólica, aquellos por debajo de 130 mmHg presentan menor riesgo de lesiones grado III/IV en el FO. Aquellos por encima de 130 mmHg presentan mayor riesgo de cualquier LOD. Si se define la HCA por la probabilidad de presentar LOD, cabe plantearse un punto de corte de AMPA inferior a 130 mmHg de presión arterial sistólica

Background and objective: International guides of hypertension (HT) recommend self-blood -pressure-measurement (SBPM) values higher than 135/85 mmHg to determine isolated clinical hypertension (ICH). This paper suggests a lower cut-off. Patients and method: This prospective, protocol-based study included 378 patients, 250 new hypertensive patients without previous treatment. Both SBPM and ambulatory blood pressure monitoring (ABPM) were measured in all patients. Risk factors and target organ disease (TOD) were evaluated by electrocardiography, renal function, microalbuminuria and retinography. Results: With a 135/85 mmHg ICH cut-off, only differences in serum creatinine levels (78.67 ICH vs 83.98 mmol/l sustained HT ­SHT­; p = 0.03), grade I/II fundus oculi (FO) lesions (44.7 vs 62.8%; p = 0.009) and any FO lesions (48.2 vs 67.4%; p = 0.005) were found. With a ICH cut-off of 130/80 mmHg, a lower risk of grade III/IV FO lesions was found (RR = 0.59; 90% confidence interval [CI], 0.36-0.96; p = 0.06). Any TOD risk was related to SHT with a 130/85 mmHg cut-off (RR = 12.04; 90% CI, 1.03-140.28; p = 0.09). Conclusions: Taking a 135/85 mmHg ICH cut-off, no differences in TOD between ICH and SHT were found. Taking a 130 mmHg ICH systolic blood pressure (SBP) cut-off, those who are below 130 mmHg have a lower risk of grade III/IV FO lesions. Those who are above this value have a higher TOD risk. Looking at TOD risk, we should consider a < 130 mmHg SBP cut-off for ICH diagnosis

[Appraisal of self-measurement of blood pressure in the diagnosis of isolated clinical hypertension. VAMPAHICA study]. / Valoración de la automedida de la presión arterial en el diagnóstico de la hipertensión clínica aislada. Estudio VAMPAHICA.

INTRODUCTION: There are no existing studies that appraise cardiovascular morbidity-mortality in patients diagnosed with isolated clinical hypertension (HCA) through self-measurement of blood pressure (AMPA). OBJECTIVE: To find the prognostic value of AMPA for diagnosing HCA, by means of assessment of cardiovascular morbidity-mortality in clinical and out-patient measurement (MAPA) of blood pressure. METHOD: Prospective study with 3 cohorts: 1) hypertense patients; 2) patients with HCA, and 3) patients with normal blood pressure. All patients seen at 14 primary care centres with newly diagnosed essential hypertension will be included. AMPA will distinguish who has HCA. One in every four patients will have a MAPA. In parallel, a cohort of people with normal pressure will be selected. The follow-up period will be 3 years. We calculate that the sample needed will be 1400 people. The main measurements will be the prevalence of lesions in the target organ and mortality due to cardiovascular disease in the 3 cohorts. The prevalence of HCA will also be worked out. DISCUSSION: If the AMPA technique is shown to be as valid as MAPA, then it can be used to diagnose HCA, which would be beneficial because of its accessibility, lower cost and greater comfort for patients.

Valoración de la automedida de la presión arterial en el diagnóstico de la hipertensión clínica aislada. Estudio VAMPAHICA / Appraisal of self-measurement of blood pressure in the diagnosis of isolated clinical hypertension. VAMPAHICA study

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Ocular anomalies of individuals with mental illness and dual diagnosis.

BACKGROUND: Oculo-visual findings commonly associated with persons diagnosed as having mental illness and/or dual diagnosis (i.e. mental illness with mental retardation) have not been fully investigated. This study determines the most common eye and vision anomalies associated with these disorders and discusses the similarities and differences between these two unique populations. METHODS: Data were obtained by the random selection of 88 patient records from the Illinois Eye Institute/Easter Seal Society of Metropolitan Chicago Eye Care and Treatment Program (Illinois College of Optometry). Results from the most recent oculo-visual evaluation were reviewed. Commonly accepted methods of assessing the eyes and vision of patients with disabilities were used. RESULTS: Individuals with mental illness frequently exhibited uncorrected refractive error, strabismus, blepharitis, pigmentary retinopathy, and cataracts. Those with mental retardation and mental illness (dual diagnosis) demonstrated similar findings with the exception of cataracts. A statistically significant amount of compound astigmatism was seen in those with mental illness. CONCLUSIONS: Many of the ocular anomalies found among the mentally ill and those with dual diagnosis were common to both groups but occurred with different frequencies. Appropriate spectacle correction and individually designed therapy programs should play an important role in the developmental and intellectual habilitation of these patients.

[Non-leukemic disease of the central nervous system in children with acute lymphoblastic leukemia. I. Somnolence syndrome (author's transl)]. / Cerebrale Komplikationen der Leukämiebehandlung. I. Das Apathiesyndrom.

Prophylactic irradiation of the skull and intrathecal application of methotrexate has proven to be highly effective in preventing central nervous system disease in acute lymphoblastic leukemia or non-Hodgkin-lymphoma. Prophylactic treatment may be complicated by a somnolence syndrome occuring 4--8 weaks after the end of irradiation. The main features of this clinical entity are somnolence, lethargy, dullness, anorexia, headache, and vomiting. EEG frequently displays a distinct slowing of activity. All symptoms are reversible after 3--49 days. The syndrome clearly is consequence of skull irradiation. Its metabolic basis probably is transient disturbance of myelinization.

Plasma levels and symptom complaints in patients maintained on daily dosage of methadone hydrochloride.

Plasma methadone levels, symptom complaints, and urine tests for illicit opiate use were followed weekly in 17 patients on a methadone maintenance program. There were very large differences between patients in the plasma level established at a given dosage, implying large differences in the rate of methadone metabolism. Despite virtually constant daily dosage, the plasma methadone levels fluctuated greatly from week to week and from day to day in individual patients. With rate exceptions there was no relationship between plasma methadone level and symptom complaints or between weekly chamges in plasma methadone level and changes in symptom complaints. Except possible to identify the ocassional patient with unusually low plasam methadone levels, the determination of methadone levels is not likely to be or practical value in methadone programs.