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1.
Monaldi Arch Chest Dis ; 90(4)2020 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-33305554

RESUMO

Coronavirus Disease-2019 (COVID-19) is the worst worldwide pandemic with more than 12,000,000 cases and 560,000 deaths until 14th July 2020. Men were more infected by COVID-19 than women, and male subjects with underlying conditions, including diabetes, hypertension, and cardiovascular diseases developed a severe form of the affection, with increased mortality rate. Many factors can contribute to the disparity in disease outcomes, such as hormone-specific reaction and activity of X-linked genes, which modulate the innate and adaptive immune response to virus infection. Until now, only the Remdesivir was approved by FDA (Food Drug Administration) for COVID-19 treatment, although several clinical trials are ongoing worldwide also on other drugs. In this review, we analyzed published studies on several drugs (chloroquine or hydroxychloroquine, remdesivir, favipiravir, lopinavir-ritonavir in combination, tocilizumab, plasma, and immunoglobulins) with some efficacy to COVID-19 in humans, and evaluated if there were a gender analysis of the available data. In our opinion, it is essential to report data about COVID-19 disaggregated by sex, age, and race, because the knowledge of gender differences is fundamental to identify effective and customized treatments to reduce hospitalizations, admissions to intensive care units, and mortality.

2.
Artigo em Inglês | MEDLINE | ID: mdl-33103404

RESUMO

INTRODUCTION: The American Society for Gastrointestinal Endoscopy (ASGE) has produced numerous algorithms for the management of gastrointestinal bleeding (GIB) in which endoscopy plays a major role. The aim of this Systematic Review was to evaluate the diagnostic accuracy of computerized tomography (CT) angiography in detecting non-variceal gastrointestinal bleeding (NVGIB). METHODS: Studies were identified on PubMed, Web of Science and Scopus databases from 2009 to 2019. The search performed included the following terms: "digestive" and "bleeding" as well as "acute bleeding gastrointestinal" or "acute bleeding digestive". Studies were included if enrolled adult patients and included measures of diagnostic accuracy (sensibility and specificity) of CT angiography in detecting GIB. Studies on variceal bleeding were excluded. First, a bivariate diagnostic randomeffects meta-analysis was fitted through REML (Restricted maximum likelihood approach) method, with the estimation of pooled sensitivity, specificity and SROC curve. Then, an univariate model was fitted for the 11 studies, with the estimation of pooled Diagnostic Odds Ratio and Cochrane's Q for heterogeneity. RESULTS: Eleven studies were eligible for inclusion criteria and so included in the analysis. The pooled sensitivity is 85% [75%, 92%], the pooled specificity 93% [89%, 96%]. The pooled DOR is 94.35 [37.91, 234.82]. Q for heterogeneity is not significant (p=0.377). CONCLUSIONS: CT angiography showed a good sensibility and specificity in detecting NVGIB. Therefore, it would be useful to consider CT angiography use also in the suspicion of NVGIB, especially when endoscopy is not immediately available and there are signs and symptoms of bleeding in progress.

3.
Clin Nephrol ; 2020 Oct 19.
Artigo em Inglês | MEDLINE | ID: mdl-33074095

RESUMO

Acute kidney injury (AKI) occurs in 3.2 - 9.6% of hospital admissions and in 2.1 - 22.1% of prevalent intensive care unit patients, worldwide. There is a sexual dimorphism in the AKI evolution with implications of sex hormones, endothelin etc. We provide a mini-review on the gender-related differences in the AKI evolution.

4.
Int J Mol Sci ; 21(20)2020 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-33076256

RESUMO

(1) Background: Circulating micro-RNAs (miRNAs) modulate the expression of molecules in diabetes. We evaluated the expression of serum miRNA-195-5p and -451a in diabetic patients with ischemic stroke and correlated them with two markers of brain tissue integrity. (2) Methods: Seventy-eight subjects with acute ischemic stroke (AIS) or transient ischemic attack (TIA) (40 with diabetes) were enrolled. Serum miRNA levels, brain-derived neurotrophic factor (BDNF) and vascular endothelial growth factor A (VEGF-A) were assessed at admission and 24 and 72 h after a post-ischemic stroke, and were compared to 20 controls. (3) Results: Both circulating miRNAs were two-fold up-regulated in diabetic AIS and TIA patients compared to non-diabetics. Their levels progressively decreased at 24 and 72 h in both AIS and TIA patients. Interestingly, in the non-diabetic TIA group, both circulating miRNAs, although higher than the controls, tended to achieve a complete decay after 72 h. Furthermore, miRNA-195-5p and miRNA-451a levels inversely correlated with both BDNF and VEGF-A serum levels. (4) Conclusions: These data show a different profile of both micro-RNAs in diabetic versus non-diabetic patients after acute ischemic stroke, suggesting their pivotal role in cerebrovascular ischemic attack.

5.
J Clin Med ; 9(9)2020 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-32962242

RESUMO

Sarcoidosis is a granulomatous disorder of unknown etiology characterized by noncaseating granulomas virtually in every organ and tissue. This finding represents the most important diagnostic clue to reach a correct definition of sarcoidosis, although the biopsy is invasive and has several risk procedures. Several efforts are made to suspect the diagnosis of sarcoidosis by combining noninvasive elements, in particular from imaging, though these findings are often nonspecific and reflect the wide multifactorial pathogenesis. Every effort should be made to obtain a detailed radiological picture that, if associated with a suggestive clinical picture, could avoid the need of biopsy in some specific cases. In this narrative review, we aim to describe main computed tomography (CT) features of pulmonary and abdominal sarcoidosis, by reporting strengths and limits of this technique, in particular for the identification of extrapulmonary, isolated disease.

7.
Intern Emerg Med ; 15(2): 327-331, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32040830

RESUMO

The aim of this systematic review was to assess AKI (acute kidney injury) in adult patients, treated with vancomycin (V) + piperacillin/tazobactam (PT) compared to V monotherapy. Studies were found in Pubmed, Web of Science and Scopus databases. Articles not in English, pediatric studies and case reports were excluded. A study is eligible for inclusion if the adjusted Odds ratio (aOR) for AKI in V + PT compared to V monotherapy groups, could be extracted or determined from available data. Six retrospective cohort studies were eligible for inclusion criteria and so they were included in the analysis. All studies separately showed a significant higher risk of developing AKI (OR > 1, p < 0.05) in V + PT group compared to V monotherapy group. Considering the methodological difference of included studies, a random effect model was preferred. The model showed a pooled significant higher risk of developing AKI [OR 2.77 (95% CI 1.94, 3.96), p < 0.0001] in V + PT group compared to V group. Association of V and PT appears to be associated with a greater risk of AKI compared to V in monotherapy. These results may serve as the impetus for further evaluation into true mechanisms behind this additive nephrotoxic effect and its potential implications on mortality.


Assuntos
Lesão Renal Aguda/etiologia , Quimioterapia Combinada/normas , Piperacilina/efeitos adversos , Tazobactam/efeitos adversos , Vancomicina/efeitos adversos , Adulto , Antibacterianos/efeitos adversos , Antibacterianos/uso terapêutico , Quimioterapia Combinada/efeitos adversos , Humanos , Piperacilina/uso terapêutico , Tazobactam/uso terapêutico , Vancomicina/uso terapêutico
8.
Intern Emerg Med ; 15(2): 251-256, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31302849

RESUMO

Atrial fibrillation (AF) is a frequent pathology in Internal Medicine departments. The aim of our study was to identify the risk factors associated with the development of new-onset AF during hospitalization and to evaluate its outcome as in-hospital mortality. We conducted a retrospective case-control study on a cohort of 14,179 patients admitted to an internal medicine department. We included in the study the patients who did not have an anamnestic history of AF, who presented a sinus rhythm at the time of admission and who developed a new-onset AF during hospitalization. For each of these cases, two controls were enrolled who were not affected by AF. The patients included in the study were 588, including 196 cases and 392 controls. Patients who developed AF during hospitalization had significantly more comorbidity than controls. The most frequent causes for hospitalization were sepsis, significantly higher in the case group. From the results of the multivariate analysis, the factors related independently to the development of AF were the presence of a number of comorbidities ≥ 3 (OR = 1.52; p = 0.017), sepsis as a reason of hospitalization (OR = 2, 16; p = 0.001) and glycemic value at the admission ≥ 130 mg/dL (OR = 1.44; p = 0.047). Both the length of hospital stay and in-hospital mortality were higher in the group of patients who developed AF, with a statistically significant difference compared to controls (p < 0.001).


Assuntos
Fibrilação Atrial/complicações , Quartos de Pacientes/estatística & dados numéricos , Resultado do Tratamento , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/mortalidade , Estudos de Casos e Controles , Comorbidade/tendências , Ecocardiografia/métodos , Feminino , Mortalidade Hospitalar/tendências , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Quartos de Pacientes/organização & administração , Quartos de Pacientes/normas , Curva ROC , Estudos Retrospectivos , Fatores de Risco
9.
Pharmacogenomics J ; 20(3): 451-461, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31801992

RESUMO

We assessed the predictive accuracy of the Warfarin Pharmacogenetics Consortium (IWPC) algorithm in a prospective cohort of 376 high-risk elderly patients (≥65 years) who required new treatment with warfarin for either medical (non valvular atrial fibrillation) or surgical conditions (heart valve replacement), had ≥1 comorbid conditions, and regularly used ≥2 other drugs. Follow-up visits were performed according to clinical practice and lasted for a maximum of 1 year. Two hundred and eighty-three (75%) patients achieved a stable maintenance dose. Warfarin maintenance doses were low on average (median 20.3 mg/week, interquartile range, 14.1-27.7 mg/week) and were substantially overestimated by the IWPC algorithm. Overall the percentage of patients whose predicted dose of warfarin was within 20% of the actual stable dose was equal to 37.5%, (95% CI 32.0-43.3%). IWPC algorithm explained only 31% of the actual warfarin dose variability. Modifications of the IWPC algorithm are needed in high-risk elderly people.

10.
Artigo em Inglês | MEDLINE | ID: mdl-33383855

RESUMO

Parkinson's disease has been found to significantly affect health-related quality of life. The gender differences of the health-related quality of life of subjects with Parkinson's disease have been observed in a number of studies. These differences have been reported in terms of the age at onset, clinical manifestations, and response to therapy. In general, women with Parkinson's disease showed more positive disease outcomes with regard to emotion processing, non-motor symptoms, and cognitive functions, although women report more Parkinson's disease-related clinical manifestations. Female gender predicted poor physical functioning and socioemotional health-related quality of life, while male gender predicted the cognitive domain of health-related quality of life. Some studies reported gender differences in the association between health-related quality of life and non-motor symptoms. Depression and fatigue were the main causes of poorer health-related quality of life in women, even in the early stages of Parkinson's disease. The aim of this review was to collect the best available evidence on gender differences in the development of Parkinson's disease symptoms and health-related quality of life.


Assuntos
Doença de Parkinson , Qualidade de Vida , Fatores Sexuais , Atividades Cotidianas , Depressão , Fadiga , Feminino , Humanos , Masculino , Doença de Parkinson/epidemiologia
11.
12.
J Clin Med ; 8(2)2019 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-30678250

RESUMO

We have evaluated circulating miRNAs (-195-5p and -451a) in subjects with acute ischemic stroke (AIS) and in patients with transient ischemic attack (TIA). In this study, 18 subjects with AIS and 18 patients with TIA were enrolled and examined at admission (T0) and at 24 h and 48 h after admission, and compared to 20 controls (C). At T0, circulating miRNA-195-5p and -451a were significantly upregulated in both AIS and TIA patients, compared to C. We also observed a progressive reduction of circulating miRNA levels at 24 h and 48 h in both AIS and TIA patients. Hypoxia inducible factor 1alpha (HIF-1α) serum level was significantly increased at T0, in both AIS and TIA patients, in comparison to C (both p < 0.01 vs. C) and it decreased in both AIS and TIA patients at 24 h and at 48 h, in comparison to T0 (both p < 0.01 vs. T0). Vascular endothelial growth factor (VEGF) serum level was significantly decreased at T0, in both AIS and TIA patients, if compared to C (both p < 0.01 vs. C) and increased, in both AIS and TIA patients, at 24 h and 48 h, if compared to T0 (both p < 0.01 vs. T0). The elevated expression of miRNA-195-5p and miRNA-451a significantly decreased over time at 24 h and 48 h, and it is associated with decreased HIF-α levels and increased VEGF serum levels. These data may suggest a role for this miRNAs as biomarker in the pathogenesis and prognosis of AIS patients and for the first time also in TIA patients.

13.
Emerg (Tehran) ; 6(1): e52, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30584568

RESUMO

Introduction: Early detection is crucial for prompt management of acute kidney injury (AKI) patients in emergency department (ED). This study aimed to investigate the usefulness of hyperchloremic metabolic acidosis (HCMA) levels in this regard. Methods: In this retrospective observational study, > 18 years old critically ill patients presenting to ED of Marcianise Hospital, Italy, were divided into non-AKI and AKI group according to KDIGO guideline. The level of HCMA ((arterial pH x bicarbonate)/chloride) was compared between groups and correlation of HCMA with estimated glomerular filtration rate (e-GFR) in ARF patients was evaluated. Results: 134 patients with the mean age of 76.5 ± 3.1 years were enrolled (64 non-AKI and 70 AKI; 64% female). Two groups were similar regarding mean age (p = 0.251), sex (p = 0.091), APACHII score (p = 0.215), Charlson Comorbidity Index (p= 0.187), and body mass index (p = 0.129). The mean HCMA level was 1.98 ± 0.09 in the non-AKI group and 1.56 ± 0.07 in the AKI group (p=0.039). There was a positive correlation between HCMA and e-GFR levels in AKI group (r: 0.467, p=0.0092). Conclusions: If confirmed and validated in a future study, ABG derived formula for HCMA may be a useful tool for early detection of AKI patients in emergency department.

14.
Am J Emerg Med ; 35(11): 1691-1694, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28600073

RESUMO

STUDY OBJECTIVE: We investigated the serum sodium correction rate on length of hospitalization and survival rate, in severe chronic hyponatremic patients at the Emergency Department (ED). DESIGN: An observational study using clinical chart review. SETTING: The ED of the University Hospital of Marcianise, Caserta, Italy with approximately 30,000 patients visits a year. TYPE OF PARTICIPANTS: We reviewed sixty-seven patients with severe hyponatremia subdivided in 2 subgroups: group A consisting of 35 patients with serum sodium correction rate<0.3mmol/h and group B consisting of 32 patients with serum sodium correction rate between <0.5 and ≥0.3mmol/h. INTERVENTION: Emergency patients were evaluated for serum sodium correction rate for hyponatremia by clinical chart review. MEASUREMENTS AND MAIN RESULTS: Severe hyponatremia was defined as a serum sodium level<120mmol/l. Mean serum sodium correction rate of hyponatremia was of 0.17±0.09% in group A and 0.41±0.05% in group B (p<0.001 vs group A). The length of hospital stay was 10.7±3.7days for group A, and it was significantly decreased to 3.8±0.4days for group B (p<0.005 vs group A). In addition we observed that correction rate of hyponatremia in group A was associated with a significantly lower survival rate (25%) in comparison to group B (60%) (p<0.001 vs group A). CONCLUSION: We observed that serum sodium correction rate ≥0.3 and <0.5mmol/h was associated with a shorter length of hospital stay and a major survival rate.


Assuntos
Hidratação/métodos , Hiponatremia/terapia , Tempo de Internação , Solução Salina Hipertônica/uso terapêutico , Idoso , Serviço Hospitalar de Emergência , Feminino , Humanos , Hiponatremia/mortalidade , Itália , Masculino , Estudos Retrospectivos , Taxa de Sobrevida , Fatores de Tempo , Resultado do Tratamento
15.
Am J Emerg Med ; 35(5): 749-752, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28131601

RESUMO

STUDY OBJECTIVE: We investigated seasonal prevalence of hyponatremia in the emergency department (ED). DESIGN: A cross-sectional study using clinical chart review. SETTING: University Hospital ED, with approximately 28 000 patient visits a year. TYPE OF PARTICIPANTS: We reviewed 15 049 patients, subdivided in 2 groups: the adult group consisting of 9822 patients aged between 18 and 64years old and the elderly group consisting of 5227 patients aged over 65years presenting to the ED between January 1st, 2014 and December 31st, 2015. INTERVENTION: Emergency patients were evaluated for the presence of hyponatremia by clinical chart review. MEASUREMENTS AND MAIN RESULTS: Hyponatremia was defined as a serum sodium level<135mmol/l. Mean monthly prevalence of hyponatremia was of 3.74±0.5% in the adult group and it was significantly increased to 10.3±0.7% in the elderly group (p<0.05 vs adults). During the summer, hyponatremia prevalence was of 4.14±0.2% in adult and markedly increased to 12.52±0.7% (zenith) in elderly patients (p<0.01 vs adult group; p<0.05 vs other seasons in elderly group). In the elderly group, we reported a significant correlation between weather temperature and hyponatremia prevalence (r: 0.491; p<0.05). CONCLUSION: We observed a major influence of climate on the prevalence of hyponatremia in the elderly in the ED. Decline in renal function, salt loss, reduced salt intake and increased water ingestion could all contribute to developing hyponatremia in elderly patients during the summer. These data could be useful for emergency physicians to prevent hot weather-induced hyponatremia in the elderly.


Assuntos
Serviços Médicos de Emergência , Hospitalização/estatística & dados numéricos , Temperatura Alta/efeitos adversos , Hiponatremia/epidemiologia , Estações do Ano , Adolescente , Adulto , Fatores Etários , Estudos Transversais , Diuréticos/efeitos adversos , Serviços Médicos de Emergência/estatística & dados numéricos , Feminino , Humanos , Hiponatremia/prevenção & controle , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Adulto Jovem
16.
Am J Emerg Med ; 34(10): 1923-1926, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27475041

RESUMO

OBJECTIVE: The objective of the study is to investigate the prevalence of electrolyte imbalance (EI) in the emergency department (ED) with systemic diseases in different decades of life. METHODS: We enrolled patients admitted to the ED. The population study included 7941 patients, subdivided in 3 groups: young group (Y), middle-aged group (MA), and elderly group (E). RESULTS: We observed EI in 13.7% of the whole population. Hyponatremia (hNa+) is the most frequent EI (44%) followed by hypokalemia (hK+) (39%), hyperkalemia (HK+) (13%), and hypernatremia (HNa+) (4.4%). In the Y group, the EI occurred in 7.1% of all patients (P< .05 vs MA and E), whereas in the MA group, they were shown in 11.5% of patients and in the E group in 22% of all patients group (P< .05 vs MA and Y). In the Y group, gastrointestinal diseases are the most frequently associated disease (24.6%; P< .05 vs MA and E). In the MA group, the most frequently associated disease was a current cardiovascular disease (29.7%; P< .05 vs Y and E). In the E group, the frequently associated diseases are cardiovascular (22.8%; P< .05 vs Y) and lung diseases (16.7%; P< .05 vs MA and Y). CONCLUSIONS: In our study, 13.7% of all patients showed an EI, and only 2% of cases were alone without any associated systemic disease. Most EIs are associated to other systemic diseases. The present data also depict different age-related and disease-associated prevalence patterns of EI, thus highlighting a complex clinical scenario.


Assuntos
Serviço Hospitalar de Emergência , Desequilíbrio Hidroeletrolítico/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/epidemiologia , Estudos Transversais , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Gastroenteropatias/complicações , Gastroenteropatias/epidemiologia , Humanos , Hipernatremia/complicações , Hipernatremia/epidemiologia , Hipopotassemia/complicações , Hipopotassemia/epidemiologia , Hiponatremia/complicações , Hiponatremia/epidemiologia , Pneumopatias/complicações , Pneumopatias/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Desequilíbrio Hidroeletrolítico/complicações , Adulto Jovem
17.
Am J Emerg Med ; 34(1): 113.e1-2, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26189055

RESUMO

Our patient is a 42-year-old woman with muscle paralysis, muscle weakness, and fever. On admission, a neurologic examination showed proximal and distal weakness in the leg. Serum creatine phosphokinase and serum myoglobin level were markedly increased (5600 UI/L and 5197 UI/L, respectively). There was no sign of renal failure. Nerve conduction study was negative. Serologic studies for virus titers showed the antibody immunoglobulin M cytomegalovirus. Muscle weakness and its paralysis, fever, and serum creatine kinase level gradually improved after the administration of methylprednisolone intravenous. Cytomegalovirus infection was thought to have played a central role in this case, leading to an acute but reversible peripheral muscle paralysis.


Assuntos
Rabdomiólise/diagnóstico , Doença Aguda , Adulto , Diagnóstico Diferencial , Feminino , Glucocorticoides/uso terapêutico , Humanos , Metilprednisolona/uso terapêutico , Rabdomiólise/tratamento farmacológico
18.
Nutrition ; 30(9): 1045-9, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24993749

RESUMO

OBJECTIVES: The aim of this study was to determine the long-term effects of a moderate protein diet (MPD) on renal function, low-grade inflammation, and oxidative stress in older adults with type 2 diabetes, which to date are unclear. METHODS: Seventy-four older adults with type 2 diabetes and chronic kidney disease (stage G3b-G4) were enrolled in the study. During the 4-wk baseline period (T0), all patients were asked to follow a normal protein diet regimen, providing 1.1 g/kg daily. Successively, all patients were asked to follow an MPD, for 36 mo, providing 0.7 g/kg daily, for only 6 d/wk. Patients who refused to follow an MPD treatment were included in the control (NPD [normal protein diet] group). During the 36 mo of the study, creatinine clearance, blood urea nitrogen, proteinuria, blood pressure, glycated hemoglobin (Hb)A1c, fat-free mass, low-grade inflammation (interleukin-6 and C-reactive protein) were evaluated monthly and oxidative stress (urinary 8-epiprostaglandin [Epi-PG]F2α) was evaluated every 3 mo. RESULTS: During T0, mean creatinine clearance, proteinuria, blood urea nitrogen, blood pressure, HbA1c, fat free mass, low-grade inflammation, and oxidative stress were similar in both groups. After 36 mo, a significant reduction in decline of renal function was observed in the MPD group but not in controls (2.4 ± 0.2 versus 5.7 ± 0.5 mL·min·y, respectively; P < 0.05 versus control). Similarly, a significant reduction in proteinuria, serum interleukin-6, serum C-reactive protein, and urinary 8-Epi-PGF2α excretion, was observed in the MPD group (P < 0.05 versus NPD). CONCLUSION: In older adults with type 2 diabetes, long-term effects of an MPD regimen are associated with a significant decline of renal function, proteinuria, low-grade inflammation, and oxidative stress without a change in fat-free mass.


Assuntos
Diabetes Mellitus Tipo 2 , Nefropatias Diabéticas , Dieta , Proteínas na Dieta/administração & dosagem , Inflamação , Rim/efeitos dos fármacos , Insuficiência Renal Crônica , Idoso , Proteína C-Reativa/metabolismo , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Nefropatias Diabéticas/sangue , Nefropatias Diabéticas/etiologia , Dieta com Restrição de Proteínas , Proteínas na Dieta/efeitos adversos , Dinoprosta/análogos & derivados , Dinoprosta/sangue , Feminino , Humanos , Inflamação/sangue , Inflamação/etiologia , Interleucina-6/sangue , Rim/fisiopatologia , Masculino , Estresse Oxidativo/efeitos dos fármacos , Cooperação do Paciente , Proteinúria/etiologia , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/etiologia , Fatores de Tempo
20.
Am J Emerg Med ; 32(6): 691.e1-2, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24468126

RESUMO

Tetanus is a major worldwide health problem, and its global incidence has been estimated to be approximately 1 million cases per year. In particular, tetanus is more frequent in the elderly as compared with adults. We report a case of an octogenarian who presented with dysphagia and tremors as the only clinical symptoms. During hospitalization, the patient's clinical conditions worsened rapidly, and, although in absence of the classic clinical presentation (trisma, nuchal rigidity, and opisthotonus), a diagnosis of tetanus was suspected. Thus, the patient underwent a tetanus immunoglobulin immunization and antibiotic therapy with excellent clinical recovery.


Assuntos
Transtornos de Deglutição/etiologia , Tétano/complicações , Doença Aguda , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Humanos , Lacerações/complicações , Lacerações/microbiologia , Traumatismos da Perna/complicações , Traumatismos da Perna/microbiologia , Masculino , Tétano/diagnóstico , Tétano/tratamento farmacológico , Toxoide Tetânico/uso terapêutico
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