Clinical factors associated with peripherally inserted central catheters (PICC) related bloodstream infections: a single centre retrospective cohort.

BACKGROUND: Despite their spread in daily practice, few data is available on clinical factors associated with peripherally inserted central catheter (PICC)-related bloodstream infections (PR-BSI). We aimed to assess the PR-BSI incidence, microbiology, and factors associated with PR-BSI with a focus on clinical symptoms. METHODS: We conducted a retrospective cohort study in a French university hospital. We screened all PICC insertions performed from April 1st, 2018, to April 1st, 2019, and included PICC insertions in adult patients. We assessed the PR-BSI incidence, the factors associated with PR-BSI using a Cox model, and negative and positive predictive values (NPVs and PPVs) of each clinical sign for PR-BSI. RESULTS: Of the 901 PICCs inserted in 783 patients (38,320 catheters days), 214 PICCs (24%) presented with a complication. The most prevalent complication was PR-BSI (1.9 per 1000 catheter days; 8.1% of inserted PICCs ). Enterobacterales (N = 27, 37%) and coagulase negative Staphylococci (N = 24, 33%), were the main microorganisms responsible for PR-BSI. Factors independently associated with occurrence of PR-BSI were fever (hazard ratio 13.21, 95% confidence interval 6.00-29.11, p < 0.001) and chills (HR 3.66, 95%CI 1.92-6.99, p < 0.001). All clinical signs and a duration of PICC maintenance ≥ 28 days, had a low PPVs (≤ 67.1%) but high NPVs (≥ 92.5%) for PR-BSI. CONCLUSIONS: Monitoring of clinical signs, especially fever and chills, with caution and limitation of device maintenance duration, could improve PICC management.

Effect Evaluation of Dexmedetomidine Intravenous Anesthesia on Postoperative Agitation in Patients with Craniocerebral Injury by Magnetic Resonance Imaging Based on Sparse Reconstruction Algorithm.

The effect of dexmedetomidine on postoperative agitation of patients with craniocerebral injury was investigated based on magnetic resonance imaging (MRI) with the sparse reconstruction algorithm. Sixty patients with craniocerebral injury who underwent tracheal intubation and craniotomy hematoma removal under general anesthesia in hospital were selected as the research objects. Patients were randomly and averagely divided into the normal saline group (group A) and the dexmedetomidine (DEX) group (group B). DEX was added to patients in group A during anesthesia. Other operations in group B were the same as those in group A, where DEX needed to be used was replaced by an equal amount of the normal saline. All patients received the MRI examination, and the images were processed by using the sparse reconstruction algorithm. After the surgery, some indexes, such as hemodynamics (mean arterial pressure (MAP) and hear rate (HR)), the Riker sedation agitation score, the Ramsay sedation score, and the visual analogue scale (VAS) score were recorded and compared. The results showed that the MRI image quality processed by sparse reconstruction algorithm was observably improved. After reconstruction, the sharpness of the image was significantly improved, and the distinction between lesions and tissues was also increased. The Riker sedation agitation score and the incidence of agitation in group A were greatly lower than those in group B (16% VS 76%, P < 0.05). The Ramsay sedation score of group A was manifestly higher than that of group B. The cases of postoperative nausea, vomiting, chills, delirium, and bradycardia in group A were 2, 1, 1, 0, and 1, respectively. The cases of postoperative nausea, vomiting, chills, delirium, and bradycardia in group B were 3, 9, 6, 5, and 0, respectively. The cases of chills and delirium in group A were observably less than those in group B (P < 0.05). In conclusion, based on the sparse reconstruction algorithm, the MRI technology and DEX had high adoption value in preventing postoperative agitation of patients with craniocerebral injury. Compared with group B, the hemodynamics of patients in group A was more stable.

Diagnóstico tardío de lepra lepromatosa. A propósito de un caso / No disponible

La lepra es una enfermedad infecciosa crónica, que afecta piel y nervios periféricos, la mucosa de las vías respiratorias superiores y también los ojos, además de algunas otras estructuras, ocurre en personas de cualquier edad y de ambos sexos causadas por el Mycobacterium leprae. El diagnóstico precoz reviste gran importancia ya que cura al enfermo, interrumpe la cadena de transmisión y evita las discapacidades. Presentamos un paciente masculino de 46 años de edad, trabajador agrícola sin antecedentes epidemiológicos conocidos y sin percepción del riesgo de la enfermedad que ingresa en el hospital municipal de Florida con fiebre, dolores articulares y lesiones en piel, diagnosticándose una lepra lepromatosa, discapacidad grado 2 según clasificación de la OMS dado por la deformidad de manos y pies, la pérdida de la estructura y la rigidez, constituyendo un diagnóstico tardío

Leprosy is an infectious disease with a chronic evolution that affects skin, peripheral nerves, upper respiratory tract and other structures. It appears in individuals of any age or sex and its etiological agent is Mycobacterium leprae. An early diagnosis is essential for preventing incapacities and interrupting the chain of transmission. We present a case of a 46 year old male, field worker, with a previous clinical history and no reception of the risk of illness. He entered the general hospital in Florida with fever, joint pains and skin lesions and was diagnosed of lepromatous leprosy, with grade 2 disabilities according to the WHO classification of the hand, feet and eye deformities, all the cause of a late diagnosis

Abscesos hepáticos / Hepatic abscesses

No disponible

Can cycles of chills and fever resolve bipolar disorder mania?

Treatment resistance is common in populations of patients with bipolar disorder stressing the need for new therapeutic strategies. Favourable effects of fever on mental disease have been noted throughout history. Today there is increasing evidence that immunological processes are involved in the pathophysiology of mental disorders. We present a case in which a patient with treatment resistant bipolar disorder mania seemingly recovered as a result of recurrent fever. This indicates that artificial fever might become a last resort therapy for treatment resistant mania.

Psychometric scores and persistence of irritable bowel after Campylobacter concisus infection.

OBJECTIVE: Gastroenteritis with Campylobacter concisus is an emerging infection, but the risk of irritable bowel syndrome (IBS) following it is unknown. MATERIAL AND METHODS: In a prospective, community-based study of gastroenteritis with C. concisus and C. jejuni/coli, we invited adult patients to participate in a questionnaire study, including IBS symptoms and psychometric scores, at baseline and at 6 months. We estimated adjusted RR (RRadj) (for age, sex and comorbidity) for IBS as the primary outcome. RESULTS: The development of IBS symptoms at 6 months was reported in 26/106 (25%) patients with C. concisus infection, and in 30/162 (19%) of C. jejuni/coli patients. The baseline predictors for IBS in C. concisus infection were high anxiety scores (RRadj 2.0; 95% CI 1.1-3.6, p<0.05), chills (RRadj 1.9; 95% CI 1.0-3.6, p<0.05), headache (RRadj 2.5; 95% CI 1.1-6.0, p<0.05), dizziness (RRadj 2.6; 95% CI 1.2-5.8, p<0.05) and muscle ache (RRadj 3.6; 95% CI 1.4-8.9, p<0.01). For all Campylobacter patients (n=268), we confirmed previous reports of anxiety (RRadj 2.0; 95% CI 1.3-3.1), depression (RRadj 2.3; 95% CI 1.3-4.0) and high somatization scores (RRadj 3.0; 95% CI 1.5-6.0) as predictors for post-infectious IBS (PI-IBS). CONCLUSIONS: Gastroenteritis with C. concisus carries a 25% risk of IBS at 6-month follow-up. The risk factors for IBS are chills, headache, dizziness and muscle ache in the acute stage, as well as preexisting high psychometric scores for anxiety. Our findings suggest that psychological factors play a role in the development of PI-IBS.

Fascitis necrotizante causada por Vibrio vulnificus / Necrotising fasciitis caused by Vibrio vulnificus

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Dantrolene sodium for the treatment of aldesleukin-induced rigors in a melanoma patient.

OBJECTIVE: To report the case of a 58-year-old male with melanoma who developed aldesleukin-induced rigors and was successfully treated with intravenous dantrolene sodium 20 mg and provide a review of the literature discussing other agents that have been used to treat drug-induced rigors. CASE SUMMARY: A 58-year-old male was treated with 720,000 IU/kg of aldesleukin every 8 hours as part of his antimelanoma therapy. The patient developed rigors after aldesleukin administration and was successfully treated with 25 mg of meperidine. Later, he experienced renal dysfunction that was also linked to aldesleukin therapy and developed normeperidine-induced neurotoxicity requiring discontinuation of meperidine therapy. The rigors were treated with intravenous dantrolene sodium 20 mg every 4 hours, with complete resolution of symptoms. DISCUSSION: Several antineoplastic agents can cause rigors; many of these agents can also lead to renal failure. Several agents have been investigated for their use in the management of rigors but can cause adverse effects or are unsuitable in the setting of renal insufficiency or failure. Although meperidine remains the mainstay for the treatment and prevention of rigors, it can be associated with neurotoxicity in some patients, particularly those with impaired renal function. Given that dantrolene has been shown to be effective against rigors, it may be a useful alternative for patients who can not tolerate meperidine. Drugs with a more favorable adverse effect profile that are not eliminated through the kidneys are needed. CONCLUSIONS: In the oncology setting, severe rigors can result in the interruption of a patient's cancer therapy, which can increase the risk of treatment failure. Dantrolene may be a useful alternative for patients experiencing rigors who can not tolerate meperidine.

Piercing oral: una amenaza para la salud periodontal / Oral piercing: a threat for periodontal health

La colocación de piercing oral es hoy en día muy frecuente en la población por una cuestión de moda. Las complicaciones que puede ocasionar esta práctica son numerosas y cada vez más frecuentes debido principalmente a que se lleva a cabo por personal no sanitario, el cual carece de conocimientos médicos y anatómicos, y a que el portador del piercing no es informado adecuadamente sobre las complicaciones y los posibles riesgos que puede acarrear esta práctica en la salud oral (AU)

Nowadays oral piercings are commonplace due to their rise in fashion. Complications that can arise from this practice are numerous and increasingly more frequent, principally due to the fact that they are carried out by non-healthcare workers who lack medical and anatomy training. Due to this, the wearer is not adequately informed about the complications and possible risks to their oral health (AU)

Síndrome general, como presentación de un absceso pulmonar por Streptococcus pneumoniae / Toxic syndrome, like debut of lung abscess dur to Streptococcus pneumoniae

No disponible

No disponible

Muckle-Wells syndrome: report of six cases with hyperpigmented sclerodermoid skin lesions.

Muckle-Wells syndrome (MWS) is a rare syndrome, characterized by chronic recurrent urticaria, often combined with fever, chills, rigors, malaise, and arthralgia. Progressive sensorineural deafness, and, in approximately one third of the patients, amyloidosis of the kidneys as well as of other organs may occur. It was first described in 1962 by Muckle and Wells. Herein we describe six cases of MWS showing, in addition to the classic features of MWS, unique skin lesions that to the best of our knowledge have not been described before in association with MWS.

The degree of chills for risk of bacteremia in acute febrile illness.

PURPOSE: Patients with acute febrile illness may experience different degrees of chills. To evaluate the different degrees of chills in predicting risk of bacteremia in patients with acute febrile illness, we performed a single-center prospective observational study. METHODS: We enrolled consecutive adult patients with acute febrile illness presenting to our emergency department. We defined mild chills as cold-feeling equivalent such as the need of an outer jacket; moderate chills as the need for a thick blanket; and shaking chills as whole-body shaking even under a thick blanket. We estimated risk ratios of the different degrees of chills for bacteremia using multivariable adjusted Poisson regression. RESULTS: Of a total 526 patients, 40 patients (7.6%) had bacteremia. There were 65 patients (12.4%) with shaking chills, 100 (19%) with moderate chills, and 105 (20%) with mild chills. By comparing patients with no chills, the risk ratios of bacteremia were 12.1 (95% confidence interval [CI] 4.1-36.2) for shaking chills, 4.1 (95% CI 1.6-10.7) for moderate chills, and 1.8 (95% CI 0.9-3.3) for mild chills. Shaking chills showed a specificity of 90.3% (95% CI 89.2-91.5) and positive likelihood ratio of 4.65 (95% CI 2.95-6.86). The absence of chills showed a sensitivity of 87.5% (95% CI 74.4-94.5) and negative likelihood ratio of 0.24 (95% CI 0.11-0.51). CONCLUSION: Evaluation of the degree of chills is important for estimating risk of bacteremia in patients with acute febrile illness. The more severe degree of chills suggests the higher risk of bacteremia.