RESUMO
Staphylococcus aureus bacteremia is a substantial cause of childhood disease and death, but few studies have described its epidemiology in developing countries. Using a population-based surveillance system for pneumonia, sepsis, and meningitis, we estimated S. aureus bacteremia incidence and the case-fatality ratio in children <5 years of age in 2 regions in the eastern part of The Gambia during 2008-2015. Among 33,060 children with suspected pneumonia, sepsis, or meningitis, we performed blood culture for 27,851; of 1,130 patients with bacteremia, 198 (17.5%) were positive for S. aureus. S. aureus bacteremia incidence was 78 (95% CI 67-91) cases/100,000 person-years in children <5 years of age and 2,080 (95% CI 1,621-2,627) cases/100,000 person-years in neonates. Incidence did not change after introduction of the pneumococcal conjugate vaccine. The case-fatality ratio was 14.1% (95% CI 9.6%-19.8%). Interventions are needed to reduce the S. aureus bacteremia burden in The Gambia, particularly among neonates.
Assuntos
Bacteriemia , População Rural , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus , Pré-Escolar , Gerenciamento Clínico , Feminino , Gâmbia/epidemiologia , História do Século XXI , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Vacinas Pneumocócicas/administração & dosagem , Vacinas Pneumocócicas/imunologia , Vigilância da População , Fatores de Risco , Infecções Estafilocócicas/história , Infecções Estafilocócicas/prevenção & controleRESUMO
BACKGROUND: Central venous access in cancer patients is often challenging. A history of access is common. Appropriate indications for venous imaging studies are not clearly defined. METHODS: This study was a retrospective analysis of selective use of preoperative venous duplex ultrasound and intraoperative venography in 248 consecutive cancer patients undergoing central venous access placement. RESULTS: Ninety patients had a history of central venous access placement. Eleven had a history of deep venous thrombosis of an upper extremity or central vein. One hundred three underwent preoperative ultrasound. Previous central venous access placement was not associated with an abnormal preoperative ultrasound; however, previous central venous access with deep venous thrombosis was (P =.014). Thirty patients underwent intraoperative venography, of which 18 also had preoperative ultrasound. Fifty percent of patients with an abnormal intraoperative venogram had no abnormal findings on preoperative ultrasound. CONCLUSIONS: Routine preoperative ultrasound is unnecessary. We advocate the selective use of preoperative ultrasound in those with a history of central venous access associated with deep venous thrombosis. We advocate the use of intraoperative venography when there is difficulty advancing the guidewire or catheter or when preoperative ultrasound is negative despite a history of central venous access with deep venous thrombosis.
Assuntos
Cateterismo Venoso Central/métodos , Ultrassonografia Doppler Dupla/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Reações Falso-Positivas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Flebografia/métodos , Valor Preditivo dos Testes , Cuidados Pré-Operatórios , Estudos Retrospectivos , Fatores de Risco , Trombose Venosa/diagnóstico por imagemRESUMO
Glucagonomas are rare tumors. They are predominantly located in the body or tail of the pancreas and display a constellation of signs and symptoms referred to as glucagonoma syndrome. The term necrolytic migratory erythema is used to characterize the distinctive rash associated with this syndrome. This report describes a classic presentation consisting of dermatitis, glossitis, stomatitis, angular cheilitis, anemia, and weight loss that was associated with the finding of a pancreatic mass and a markedly elevated plasma glucagon level. After pancreatic resection, the patient had complete resolution of the rash and normalization of plasma glucagon.
