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1.
Braz. j. biol ; 83: e244311, 2023. tab, graf
Artigo em Inglês | LILACS-Express | LILACS, VETINDEX | ID: biblio-1285616

RESUMO

Abstract Tuberculosis is a communicable disease with high morbidity and mortality rates in developing countries. The study's primary objective is to compare conventional methods such as acid-fast bacillus (AFB) culture and microscopy with rapid diagnostic methods. The secondary objective is to compare histopathological and microbiological findings in suspected patients with tubercular lymphadenitis. A total of 111 samples (August 2018 to September 2019) of lymph nodes were processed for AFB microscopy, AFB cultures, drug-susceptibility testing (DST), histopathology, and Xpert Mycobacterium Tuberculosis (MTB)/resistance to Rifampin (RIF) assays. Out of 111 lymph node samples, 6 (5.4%) were positive for AFB smear microscopy, 84 (75.6%) were positive for AFB culture, 80 (70.7%) were positive on Gene Xpert, and 102 (91.8%) were indicative of tuberculosis for histopathology studies. Mycobacteria growth indicator tube (MGIT) culture positivity was 84 (75.6%) higher than solid Lowenstein-Jensen (LJ) culture 74 (66.6%). Positive cultures underwent phenotypic DST. Two cases were Multidrug-resistant (MDR) on DST, while three cases were Rifampicin resistant on Gene Xpert. The sensitivity of Genexpert was (62%) against the conventional AFB culture method. The poor performance of conventional lymphadenitis diagnostic methods requires early and accurate diagnostic methodology. Xpert MTB/RIF test can help in the treatment of multidrug-resistant TB cases. Nonetheless, rapid and conventional methods should be used for complete isolation of Mycobacterium tuberculosis.


Resumo A tuberculose é uma doença transmissível com altas taxas de morbimortalidade nos países em desenvolvimento. O objetivo principal do estudo é comparar métodos convencionais, como cultura de bacilo álcool-ácido resistente (BAAR) e microscopia, com métodos de diagnóstico rápido. O objetivo secundário é comparar os achados histopatológicos e microbiológicos em pacientes com suspeita de linfadenite tubercular. Um total de 111 amostras (agosto de 2018 a setembro de 2019) de gânglios linfáticos foi processado ​​para microscopia de AFB, culturas de AFB, teste de susceptibilidade a drogas (DST), histopatologia e Xpert Mycobacterium tuberculosis (MTB)/ensaios de resistência à rifampicina (RIF). Das 111 amostras de linfonodos, 6 (5,4%) foram positivas para baciloscopia de AFB, 84 (75,6%) foram positivas para cultura de AFB, 80 (70,7%) foram positivas para o GeneXpert e 102 (91,8%) foram indicativas de tuberculose para estudos histopatológicos. A positividade da cultura do tubo indicador de crescimento de micobactérias (MGIT) foi 84 (75,6%), maior que a cultura sólida de Lowenstein-Jensen (LJ), 74 (66,6%). As culturas positivas foram submetidas a DST fenotípico. Dois casos eram multirresistentes (MDR) ao DST, enquanto três casos eram resistentes à rifampicina no GeneXpert. A sensibilidade do GeneXpert foi 62% contra o método convencional de cultura AFB. O fraco desempenho dos métodos convencionais de diagnóstico de linfadenite requer metodologia de diagnóstico precoce e precisa. O teste Xpert MTB/RIF pode ajudar no tratamento de casos de tuberculose multirresistente. No entanto, métodos rápidos e convencionais devem ser usados ​​para o isolamento completo do Mycobacterium tuberculosis.

2.
Braz J Biol ; 83: e244311, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34431905

RESUMO

Tuberculosis is a communicable disease with high morbidity and mortality rates in developing countries. The study's primary objective is to compare conventional methods such as acid-fast bacillus (AFB) culture and microscopy with rapid diagnostic methods. The secondary objective is to compare histopathological and microbiological findings in suspected patients with tubercular lymphadenitis. A total of 111 samples (August 2018 to September 2019) of lymph nodes were processed for AFB microscopy, AFB cultures, drug-susceptibility testing (DST), histopathology, and Xpert Mycobacterium Tuberculosis (MTB)/resistance to Rifampin (RIF) assays. Out of 111 lymph node samples, 6 (5.4%) were positive for AFB smear microscopy, 84 (75.6%) were positive for AFB culture, 80 (70.7%) were positive on Gene Xpert, and 102 (91.8%) were indicative of tuberculosis for histopathology studies. Mycobacteria growth indicator tube (MGIT) culture positivity was 84 (75.6%) higher than solid Lowenstein-Jensen (LJ) culture 74 (66.6%). Positive cultures underwent phenotypic DST. Two cases were Multidrug-resistant (MDR) on DST, while three cases were Rifampicin resistant on Gene Xpert. The sensitivity of Genexpert was (62%) against the conventional AFB culture method. The poor performance of conventional lymphadenitis diagnostic methods requires early and accurate diagnostic methodology. Xpert MTB/RIF test can help in the treatment of multidrug-resistant TB cases. Nonetheless, rapid and conventional methods should be used for complete isolation of Mycobacterium tuberculosis.


Assuntos
Mycobacterium tuberculosis , Tuberculose dos Linfonodos , Tuberculose Resistente a Múltiplos Medicamentos , Humanos , Rifampina/farmacologia , Rifampina/uso terapêutico , Tuberculose dos Linfonodos/diagnóstico
3.
Sensors (Basel) ; 21(3)2021 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-33494191

RESUMO

The Department of Transport in the United Kingdom recorded 25,080 motor vehicle fatalities in 2019. This situation stresses the need for an intelligent transport system (ITS) that improves road safety and security by avoiding human errors with the use of autonomous vehicles (AVs). Therefore, this survey discusses the current development of two main components of an ITS: (1) gathering of AVs surrounding data using sensors; and (2) enabling vehicular communication technologies. First, the paper discusses various sensors and their role in AVs. Then, various communication technologies for AVs to facilitate vehicle to everything (V2X) communication are discussed. Based on the transmission range, these technologies are grouped into three main categories: long-range, medium-range and short-range. The short-range group presents the development of Bluetooth, ZigBee and ultra-wide band communication for AVs. The medium-range examines the properties of dedicated short-range communications (DSRC). Finally, the long-range group presents the cellular-vehicle to everything (C-V2X) and 5G-new radio (5G-NR). An important characteristic which differentiates each category and its suitable application is latency. This research presents a comprehensive study of AV technologies and identifies the main advantages, disadvantages, and challenges.

4.
Cureus ; 12(10): e10878, 2020 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-33178530

RESUMO

Sodium-glucose cotransporter-2 (SGLT-2) inhibitors are antihyperglycemic drugs that are currently being recommended as second-line therapy for patients with diabetes mellitus. SGLT-2 Inhibitors function by inhibiting renal cotransporters, which reduces the reabsorption of glucose in the kidney, ultimately decreasing the concentration of glucose in the body. They have gained popularity in recent years due to their protective effects on the heart and kidneys - both organ systems that diabetes mellitus has shown to have a deleterious effect on. However, despite their growing fame, they have been found to increase the risk of euglycemic diabetic ketoacidosis (DKA). Euglycemic DKA is particularly dangerous as there is a chance that it can be missed by clinicians due to glucose levels generally being less than 200 mg/dL. There is an increasing body of literature detailing cases of euglycemic DKA after bariatric surgery. We present a brief review of the literature regarding this important side effect of SGLT-2 inhibitors seen in patients after bariatric surgery.

5.
Cureus ; 12(10): e10745, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-33150097

RESUMO

Acute hepatitis is most often self-resolving and a benign condition that rarely requires any anti-viral drugs. In immunocompromised patients (HIV-infected patients and transplant recipients), the morbidity and mortality associated with cytomegalovirus (CMV) infection have been extensively reported in the medical literature. We are describing a rare case of acute severe cytomegalovirus hepatitis in an immunocompetent host. In immunocompetent individuals, in most cases, it causes a subclinical infection and hence doesn't require an anti-viral agent for treatment. Our patient was unique because it presented with clinically severe hepatitis and was uncharacteristically treated with the use of antiviral medications.

6.
Cureus ; 12(9): e10650, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-33133820

RESUMO

We report a case of encephalitis in a young male patient with severe coronavirus disease 2019 (COVID-19) who initially presented with typical symptoms of fever, dry cough, and shortness of breath but later on developed acute respiratory distress syndrome and required mechanical ventilation. Two days post-extubation, the patient developed new-onset generalized tonic-clonic seizures and confusion. MRI of the brain was done and it showed an abnormal signal in the bilateral medial cortical frontal region. His cerebral spinal fluid (CSF) analysis revealed a characteristic picture of a viral infection with a high white blood cell count and normal glucose and protein levels. After ruling out all common causes of viral encephalitis such as herpes simplex virus (HSV) and based on the review of available literature regarding the neurological manifestations of COVID-19, this case was labeled as acute viral encephalitis secondary to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

7.
Cureus ; 12(10): e11074, 2020 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-33224668

RESUMO

Rheumatoid arthritis-associated interstitial lung disease (RA-ILD) is a rare extraarticular manifestation of the systemic autoimmune disease rheumatoid arthritis. RA-ILD is one of the leading causes of morbidity and mortality in patients with rheumatoid arthritis. It is more commonly seen in patients with risk factors, which include male sex, severe rheumatoid arthritis, and smoking. The presentation depends on the extent of the underlying pathology. Patients can remain asymptomatic for extended periods of time and progressively develop symptoms such as shortness of breath on exertion and a nonproductive cough. The diagnosis is made using a combination of clinical presentation, pulmonary function testing, and imaging. It is difficult for a practitioner to distinguish the presentation of interstitial lung disease from other causes and RA-ILD. However, it is extremely important to differentiate them due to the differences in management. The treatment usually involves a multidisciplinary team guided approach towards treating the underlying rheumatoid arthritis. Asymptomatic patients are managed by observation, while symptomatic patients are managed with glucocorticoids and immunosuppressants. Accurate and early treatment can lead to an improvement in a patient's symptoms and significantly improve their quality of life. We present an interesting case of a female with a long-standing history of rheumatoid arthritis not on any treatment presenting to the ED with exertional shortness of breath, dry cough, and abdominal distension.

8.
Cureus ; 12(8): e10108, 2020 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-33005526

RESUMO

Thyrotoxic periodic paralysis (TPP) is a rare disease of the muscles that presents with painless weakness of the muscles. The patients usually have hypokalemia and hyperthyroidism with elevations in the level of triiodothyronine (T3) and thyroxine (T4). The muscle weakness is usually transient, and the patients in many cases suffer from recurrent episodes of muscle paralysis. This flaccid muscle paralysis predominantly affects the proximal and lower extremities group of muscles more than the distal and upper extremity muscles. This condition is one of the drastic complications of Graves's disease and, unfortunately, may require admission and treatment in the critical care units. It is often not recognized during the initial attack in the American population as the prevalence is very low among the Caucasian population and people from North America. However, while the prevalence is extremely low in the Caucasian population, it is known to be 10 times more common among the Asian population when compared with the Caucasian population. Furthermore, while the diseases of the thyroid gland are more common in females, this rare disease predominantly affects male sex. It is treated by reversing the hypokalemia, which can in itself prove to be fatal if not corrected quickly, and this is followed by treatment to restore the euthyroid state. A literature review on this reversible cause of muscle weakness is very important to better understand this disease.

9.
Cureus ; 12(8): e10058, 2020 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-32999781

RESUMO

Lung cancer is one of the most common cancers diagnosed every year and accounts for a major percentage of cancer incidence and mortality annually, especially in men. Lung adenocarcinoma is a subtype of non-small cell lung cancer (NSCLC), which is the most common type of lung cancer found in smokers and nonsmokers alike. It is known to have diverse CT chest findings ranging from: ground-glass opacities (GGOs) with partially solid nodules, to single or multiple solid nodules that can be either central or peripheral, to thin-walled cystic lesions. Lesions are usually solitary but may be multifocal. Rarely, these lesions can be calcified or demonstrate cavitation, which can make it difficult to distinguish from an infectious disease like tuberculosis, pneumonia, or even fungal infections. Here, we present a case of a 36-year-old Asian male with no significant past medical history, except a 16-pack-year smoking history and recent deployment to Afghanistan, that initially presented with a chief complaint of cough of three-week duration. His CT scan showed innumerable bilateral pulmonary nodules within both lung fields with a miliary type appearance that ultimately turned out to be adenocarcinoma.

10.
Cureus ; 12(9): e10634, 2020 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-33123447

RESUMO

Thyrotoxic periodic paralysis is a clinical condition characterized by muscle weakness in patients with underlying hyperthyroidism. It is usually more commonly seen in patients of Asian origin and has a predisposition for the male population (unlike other thyroid disorders which commonly affect the female population). Findings are more overt in patients who have subclinical hyperthyroidism and there is a risk of them remaining untreated. The symptoms can range from mild muscle weakness to total paralysis. The muscles affected predominantly are the proximal and lower extremities group of muscles. Thyrotoxic muscle paralysis can be precipitated by hyperinsulinemic states such as after heavy meals, physical exertion, obesity, stress, and certain medications like high-dose steroids, antiretrovirals, and interferon therapy. The acute intervention usually revolves around the replenishment of patient's potassium stores followed by maintenance therapy with anti-thyroid medications. We present a case of a Chinese adolescent who presented to us with lower muscle weakness and underlying subclinical hyperthyroidism. It's important for clinicians to be familiar with this disease entity and include it in their differentials whenever a patient with muscle weakness presents. The treatment is simple and can result in rapid improvement of symptoms and should be initiated quickly.

11.
Cureus ; 12(8): e9849, 2020 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-32953356

RESUMO

Myasthenia gravis is an auto-immune disease that results in muscle weakness caused by antibodies released against acetylcholine receptors at the presynaptic membrane. Treatment options include acetylcholinesterase medications that cause a wide range of side-effects by increasing the concentration of acetylcholine at the synaptic cleft. One peculiar side effect seen is the precipitation of myocardial infarction caused by an excess of acetylcholine especially among elderly females. We present an interesting case of an 88-year-old female with a history of lung cancer newly diagnosed with paraneoplastic myasthenia gravis, started on treatment with prednisone 40 mg daily, and pyridostigmine 60 mg every six hours. She initially showed remarkable improvement in symptoms within a few hours, however, one day later, the patient developed sudden onset of chest pain radiating towards her left arm. A 12-lead electrocardiogram (EKG) showed diffuse ST-elevation in anterior leads and cardiac enzymes were found to be elevated. Pyridostigmine was stopped and the patient was started on heparin. The patient underwent cardiac catheterization which showed 50% stenosis in the right coronary artery (RCA) and 70% in the left anterior descending artery (LAD). The patient was monitored in the cardiac care unit (CCU) for 24 hours and later on discharged home on oral prednisone. It is a common practice to start treatment with anti-cholinesterase medications in newly diagnosed patients of myasthenia gravis, however, these medications can precipitate myocardial ischemia by coronary vasogenic spasm or by their arrhythmogenic effect. It is important to be aware of these outcomes while starting patients on these medications.

12.
Artigo em Inglês | MEDLINE | ID: mdl-16124417

RESUMO

We report the identification of mixed Plasmodium infections in four recent patients with malaria clinically refractory to empiric chloroquine therapy using the rapid antigen detection kit, NOW ICT Malaria Pf/Pv. A rapid in vitro immunodiagnostic test, the NOW ICT Malaria Pf/Pv test kit was used for the detection of circulating Plasmodium falciparum (Pf) and Plasmodium vivax (Pv) antigens in whole blood. Peripheral blood microscopy confirmed mixed-species infection in all the cases. Thick and thin peripheral blood films were made and stained with Giemsa stain and examined by both hospital laboratory staff and an experienced parasitologist who was blinded to the results of the rapid malarial antigen tests. Four recent patients (all male; mean age, 24 years) with mixed malarial infection were identified. All the subjects were males working for an oil company in a coastal area of Pakistan, and all had been diagnosed presumptively with malaria based on clinical grounds (without microbiologic confirmation), and were treated empirically with chloroquine without clinical response. Semiquantitative malaria counts via microscopy were as follows: P. vivax, scanty (2 patients) and moderate (2 patients); for P. falciparum--scanty (1 patient), moderate (2 patients), and heavy (1 patient). The present case series, although limited by the small number of patients with proven mixed P. falciparum-P. vivax infection, highlights the usefulness of the rapid antigen test in a highly malarious region of Pakistan where chloroquine resistance is prevalent. Although there was full concordance between the results of blood smear microscopy and rapid antigen testing, these techniques are potentially most useful when there is a discrepancy with microscopy findings. Accurate and rapid diagnosis of parasites, particularly in cases of mixed P. falciparum and P. vivax infection, is of immense importance for individual patient management and in reducing the burden of disease, especially in regions of chloroquine resistance.


Assuntos
Antígenos de Protozoários/sangue , Malária Falciparum/diagnóstico , Malária Vivax/diagnóstico , Plasmodium falciparum/imunologia , Plasmodium vivax/imunologia , Kit de Reagentes para Diagnóstico , Testes Sorológicos/métodos , Adulto , Animais , Antimaláricos/farmacologia , Antimaláricos/uso terapêutico , Corantes Azur , Cloroquina/farmacologia , Cloroquina/uso terapêutico , Cromatografia , Resistência a Medicamentos , Humanos , Malária Falciparum/tratamento farmacológico , Malária Falciparum/parasitologia , Malária Vivax/tratamento farmacológico , Malária Vivax/parasitologia , Masculino , Paquistão , Estudos Retrospectivos
15.
J Emerg Med ; 21(1): 15-20, 2001 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-11399382

RESUMO

Thrombotic thrombocytopenic purpura (TTP) is a rare disease whose incidence is now increasing. We present a case of a 37-year-old man who presented with bilateral flank pain and hematuria, subsequently diagnosed with TTP. Thrombotic thrombocytopenic purpura has classically been characterized by the pentad of fever, microangiopathic hemolytic anemia, neurologic symptoms, renal dysfunction, and thrombocytopenia. The pathogenesis of the disease has been a mystery until recently. We review the current literature regarding the pathophysiology and management of this disorder. Our discussion focuses on the importance of understanding this disease while considering the differential diagnosis of a patient presenting with anemia and thrombocytopenia because the common pitfall of rapidly administering platelets to a patient with TTP may lead to a disastrous outcome.


Assuntos
Dor no Flanco/etiologia , Hematúria/etiologia , Púrpura Trombocitopênica Trombótica/complicações , Adulto , Diagnóstico Diferencial , Emergências , Humanos , Masculino , Troca Plasmática , Plasmaferese , Púrpura Trombocitopênica Idiopática/diagnóstico , Púrpura Trombocitopênica Idiopática/fisiopatologia , Púrpura Trombocitopênica Idiopática/terapia , Púrpura Trombocitopênica Trombótica/diagnóstico , Púrpura Trombocitopênica Trombótica/fisiopatologia , Púrpura Trombocitopênica Trombótica/terapia
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