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3.
Chiropr Man Therap ; 27: 58, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31827766

RESUMO

Background: The one-month prevalence of back pain in children and adolescents has been reported at 33, 28 and 48% at ages 9, 13 and 15 respectively. There are many suspected risk factors and triggers of back pain in young people. Objective: The purpose of this scoping review was to identify potential risk factors and potential triggers for back pain in young people. The purpose of part I was to identify potential risk factors for incident and episodic back pain in young people. Part II included all eligible studies with unclear or mixed types of back pain. Methods: Due to the vast number of studies on "risk factors" for back pain, a two-part scoping review of the literature was chosen as the best way to summarise the evidence. We adhered to the PRISMA-ScR guideline for scoping reviews. General potential risk factors and triggers for back pain in children and young adults (≤ 24 years) were included, incorporating physical, environmental, and/or physiological factors. A search was conducted using PubMed and Cochrane databases from inception to September 2018, limited to the English language. Within part I, and because of their importance, only the results of the studies that investigated risk factors of incident back pain and back pain episodes are presented. Results: The search identified 7356 articles, of which 91 articles were eligible for this scoping review. The majority of the eligible articles had an unclear definition of back pain (results presented in scoping review part II). There were 7 inception cohort studies included and 1 cohort study that met the criteria for part I. The most consistent risk factors for incident and episodic back pain are female sex and older age. Conclusion: Due to inconsistent ways of reporting on the type of back pain, no definitive risk factor for back pain has been identified. In general, females often report more symptoms, also for other diseases, and older age is not a useful risk factor as it merely indicates that the onset may not be in childhood. Clearly, the time has come to study the causes of back pain from different angles.


Assuntos
Dor nas Costas/epidemiologia , Saúde da Criança/estatística & dados numéricos , Estudos de Coortes , Humanos , Fatores Desencadeantes , Fatores de Risco , Adulto Jovem
4.
Chiropr Man Therap ; 27: 61, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31827768

RESUMO

Background: Back pain is a global problem in terms of disability and financially, with a large burden both to the individual and to society. Back pain was previously believed to be uncommon in children. However, there is a growing body of evidence that this is not the case. Objective: Part I of this scoping review studied risk factors of incident and episodic back pain. In this part II we aimed to identify all risk factors and triggers with unclear or mixed type back pain in young people and to identify any gaps in the literature. Methods: A scoping review design was selected to summarise the evidence, as there are many studies on "risk factors" for back pain. The scoping review followed the PRISMSA-ScR guidelines. We considered all studies that tested potential risk factors and triggers for thoracic and/or lumbar spine pain, in children, adolescents, and young adults (≤ 24 years). PubMed and Cochrane databases were searched from inception to September 2018, to identify relevant English language articles. The results regarding potential risk factors were separated into temporal precursors and bidirectional risk factors and the studies were classified by study design. Results: Our comprehensive search strategy identified 7356 articles, of which 83 articles were considered eligible for this review (part II). There were 53 cross-sectional studies and 30 cohort studies. Potential risk factors for back pain were: female sex, older age, later pubertal status, positive family history of back pain, increased growth, and a history of back pain, most of which are temporal precursor variables. There was limited research for the illness factors, spinal posture, and muscle endurance in the development of back pain. Conclusion: Many of the included studies approached risk factors in similar ways and found factors that were associated with back pain but were not obvious risk factors as causality was uncertain. Future research should be more rigorous and innovative in the way that risk factors are considered. This could be through statistical approaches including cumulative exposures, or longitudinal approaches including multi-trajectory methods. Additionally, data on proposed risk factors should be collected before the onset of back pain.


Assuntos
Dor nas Costas/epidemiologia , Dor nas Costas/etiologia , Saúde da Criança , Estudos de Coortes , Estudos Transversais , Humanos , Fatores Desencadeantes , Fatores de Risco , Adulto Jovem
5.
BMJ Case Rep ; 12(12)2019 Dec 05.
Artigo em Inglês | MEDLINE | ID: mdl-31811105

RESUMO

We describe the case of a 25-year-old parturient who presented sudden onset and short-lived severe headache caused by reversible cerebral vasoconstriction syndrome (RCVS) during an emergency caesarean section. The syndrome was triggered by phenylephrine administered intravenously to correct arterial hypotension following spinal anaesthesia. RCVS is a clinical and radiological syndrome attributed to transient disturbance in the control of cerebral arterial tone resulting in vasospasms. The syndrome can be precipitated by several triggers, including vasoactive drugs, often used during spinal anaesthesia, illicit drugs, pregnancy and postpartum state. Diagnosis and management can be challenging during pregnancy, peripartum or post partum, since many medications commonly used during these periods must be avoided to prevent triggering RCVS. The aim of this report is to raise the awareness, particularly for anaesthesiologists and obstetricians, of this rare and potentially serious syndrome. We discuss diagnosis, triggers, pathogenesis, clinical course and complications, as well as coordinated multidisciplinary management plans.


Assuntos
Transtornos Cerebrovasculares/diagnóstico , Hipertensão/diagnóstico , Complicações Intraoperatórias/diagnóstico , Fenilefrina/efeitos adversos , Vasoconstritores/efeitos adversos , Vasoespasmo Intracraniano/diagnóstico , Adulto , Raquianestesia/efeitos adversos , Transtornos Cerebrovasculares/induzido quimicamente , Transtornos Cerebrovasculares/complicações , Transtornos Cerebrovasculares/diagnóstico por imagem , Cesárea , Diagnóstico Diferencial , Feminino , Cefaleia/etiologia , Humanos , Hipertensão/induzido quimicamente , Hipertensão/complicações , Hipertensão/diagnóstico por imagem , Complicações Intraoperatórias/induzido quimicamente , Fenilefrina/administração & dosagem , Fatores Desencadeantes , Gravidez , Vasoconstritores/administração & dosagem , Vasoespasmo Intracraniano/induzido quimicamente , Vasoespasmo Intracraniano/complicações , Vasoespasmo Intracraniano/diagnóstico por imagem
6.
PLoS One ; 14(12): e0226402, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31841545

RESUMO

Recent advances on the environmental determinants of Kawasaki Disease have pointed to the important role of the atmospheric transport of a still unknown agent potentially triggering the disease. The hypothesis arose from an innovative methodology combining expertise in climate dynamics, the analysis of ocean and atmosphere data, the use of dispersion models and the search for biological agents in air samples. The approach offered a new perspective to reveal the identity of the potential trigger, but at the same time, it increased the level of complexity, which could potentially lead to the misinterpretation of the mechanisms. Some years after it was originally formulated, we here provide a brief clarification on the approach and limits of the methodology in order to prevent an eventual misuse of our research ideas and theory, so that further research can better focus on the knowledge gaps that still remain open.


Assuntos
Clima , Meio Ambiente , Síndrome de Linfonodos Mucocutâneos/etiologia , Atmosfera , Canadá/epidemiologia , Monitoramento Ambiental , Geografia , Humanos , Incidência , Japão/epidemiologia , Síndrome de Linfonodos Mucocutâneos/epidemiologia , Nova Zelândia/epidemiologia , Fatores Desencadeantes , Fatores de Risco , Estações do Ano , Estados Unidos/epidemiologia , Vento
7.
BMC Neurol ; 19(1): 281, 2019 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-31718587

RESUMO

BACKGROUND: Myasthenia gravis associated takotsubo syndrome is a rare condition. This study aimed to explore its typical presentation, investigations and treatment through a systematic review of previously reported cases. METHODS: Databases and reference lists of the selected articles were searched for case reports on Myasthenia gravis associated takotsubo syndrome. CARE guidelines were used for the quality assessment of the selected articles. RESULTS: Sixteen cases were selected out of 580 search results. Western Pacific, American and European regions contributed to 88% of the cases. Females were most affected (81%). Features of both myasthenia gravis and takotsubo syndrome were the common clinical presentations. All cases had a myasthenic crisis. Half of the cases had no prior diagnosis of myasthenia gravis. Pyridostigmine and prednisolone were useful for myasthenia gravis while dobutamine was most commonly used for takotsubo syndrome. All cases survived except four (25%). CONCLUSIONS: Myasthenia gravis associated takotsubo syndrome via a myasthenic crisis is rare but life-threatening. Therefore, predisposition due to emotional and physical triggers needs to be avoided for its prevention. The rare entity should be suspected even in patients without a prior diagnosis of Myasthenia gravis.


Assuntos
Miastenia Gravis/complicações , Cardiomiopatia de Takotsubo/complicações , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Desencadeantes
8.
Arch Gynecol Obstet ; 300(6): 1613-1619, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31656970

RESUMO

PURPOSE: To investigate the precipitating factors of heart failure (HF) and to investigate the maternal and neonatal outcomes in pregnant women with HF. METHODS: We reviewed the medical records of pregnant women with HF who were treated at West China Second University Hospital between September 2012 and September 2017. We recorded baseline characteristics, onset and treatment of HF, comorbidities, modes of delivery, and maternal and fetal mortality and morbidity. Chi-square tests or Fisher's exact tests were used to explore the comorbidities in different subgroups. RESULTS: Seventy pregnant women with HF were identified. The most common pregnancy-specific conditions were severe preeclampsia (36/70, 51.43%) and multiple pregnancies (16/70, 22.86%). The most common nonpregnancy-specific conditions were lung infections (34/70, 48.57%) and cardiac problems (25/70, 35.71%). Sixty patients (85.71%) developed HF during pregnancy. Sixty-seven pregnancies (95.71%) ended in cesarean section. Three maternal deaths (4.29%) from HF were recorded. Of the 87 fetuses, three fetuses (3.45%) ended in miscarriages and stillbirth occurred in 5.75% of fetuses. The mean birth weight of a neonate was 2174.49 ± 609.57 (817-3430) g. There were eight neonatal deaths (8/79, 10.13%). The incidence of lung infection (P = 0.031) or cardiac problems (P = 0.044) differs between patients with NYHA classes II and patients with NYHA classes III/IV. The incidence of lung infection (P = 0.006) was also different in patients with prenatal HF and patients with postpartum HF. CONCLUSION: Peripartum HF is associated with high maternal and neonatal morbidity and mortality. Hypertensive disorders in pregnancy, lung infections, and cardiac problems are most common precipitating factors of HF in pregnancy.


Assuntos
Insuficiência Cardíaca/etiologia , Complicações na Gravidez/etiologia , Adolescente , Adulto , Peso ao Nascer , Feminino , Humanos , Recém-Nascido , Fatores Desencadeantes , Gravidez , Estudos Retrospectivos , Centros de Atenção Terciária , Fatores de Tempo , Adulto Jovem
9.
BMJ Case Rep ; 12(9)2019 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-31540920

RESUMO

Takotsubo cardiomyopathy is a left ventricular dysfunction that typically occurs after sudden intense emotional or physical stress and mimics myocardial infarction. We describe a case of a 60-year-old woman that presented to the emergency department with chest pain after she attended a wedding and ate a large amount of wasabi, assuming it to be an avocado. To the best of our knowledge, this is the first report of takotsubo cardiomyopathy triggered by wasabi consumption.


Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Dor no Peito/induzido quimicamente , Antagonistas de Receptores de Mineralocorticoides/uso terapêutico , Cardiomiopatia de Takotsubo/induzido quimicamente , Wasabia/efeitos adversos , Dor no Peito/diagnóstico por imagem , Angiografia Coronária , Ecocardiografia , Feminino , Humanos , Pessoa de Meia-Idade , Fatores Desencadeantes , Cardiomiopatia de Takotsubo/diagnóstico por imagem , Cardiomiopatia de Takotsubo/tratamento farmacológico , Cardiomiopatia de Takotsubo/fisiopatologia , Resultado do Tratamento , Wasabia/química
10.
J Neurol ; 266(12): 3065-3075, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31520105

RESUMO

INTRODUCTION: Predisposing and precipitating factors for delirium are well known; however, their interaction and impact on delirium in neurological patients remains largely unknown. Therefore, those factors were evaluated in hospitalized patients with neurological disorders. METHODS: In this prospective cohort study, 1487 neurological patients were included, 356 patients with delirium and 1131 without delirium. Relevant neurological- and medical-related clusters were assessed with multiple regression analyses, prediction models, and cluster analysis evaluating their association with delirium. RESULTS: The 1-year incidence of delirium in this cohort was 23.9%. Delirium developed in 31% of patients with stroke, in 39.5% with epilepsy, and in 58.4% with ICH. The most relevant predisposing factors were substance-use disorders (OR 4.24, 2.28-7.78, p < 0.001), advanced age (OR 3.44, CI 2.40-4.92, p < 0.001), and neurodegenerative disorders (OR 2.58, CI 1.47-4.54, p = 0.001). The most relevant precipitating factors were meningitis (OR 21.52, CI 1.22-379.83, p = 0.036), acute renal failure (OR 10.01, CI 1.13-88.73, p = 0.039), and intracranial hemorrhage (OR 3.62, CI 2.08-6.30, p < 0.001). Delirious patients were hospitalized 6 days longer, had higher in-hospital mortality, and were discharged more often to nursing homes and rehabilitation. Best predictor for delirium was the coexistence of advanced age with epilepsy (58.3%, p < 0.001), while patients aged < 65 years without epilepsy and stroke rarely developed delirium (5.1%, p < 0.001). CONCLUSIONS: Delirium is common in elder neurological patients and associated with worse outcome. Primary cerebral conditions most frequently precipitate delirium in neurology. Neurologists are advised to monitor symptoms of delirium in the presence of risk factors to enable both timely diagnostic work-up and management of delirium.


Assuntos
Lesão Renal Aguda/epidemiologia , Delírio/epidemiologia , Delírio/etiologia , Epilepsia/epidemiologia , Hemorragias Intracranianas/epidemiologia , Meningite/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Fatores Etários , Idoso , Análise por Conglomerados , Comorbidade , Suscetibilidade a Doenças , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Neurodegenerativas/epidemiologia , Fatores Desencadeantes , Estudos Prospectivos , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
11.
PLoS One ; 14(8): e0221329, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31430332

RESUMO

INTRODUCTION: Precipitating factors that contribute to the severity of exertional heat stroke (EHS) are unclear. The purpose of this study was to determine the effect of prior illness (PI) on EHS severity. METHODS: We performed a retrospective clinical record review of 179 documented cases of EHS at the Marine Corps Base in Quantico, Virginia. RESULTS: Approximately 30% of EHS cases had a medically documented PI. Anthropometrics (height, weight, body mass index) and commonly associated risk factors for EHS (age, number of days in training, wet bulb globe temperature, sleep patterns) did not differ between PI and no illness (NI) groups. PI patients presented with higher maximal rectal core temperatures (40.6 ± 1.0°C vs. 40.3 ± 1.2°C; P = 0.0419), and elevated pulse rates (118.1 ± 16.7 bpm vs. 110.5 ± 24.2 bpm; P = 0.0397). At the point of care, biomarker values were similar between PI and NI groups, with the exception of a trend toward elevated monocytes in those with PI (7.9 ± 2.9% vs 6.7± 2.7%; P = 0.0521). Rate and duration of cooling were similar between PI and NI patients. CONCLUSION: This study indicates that PI has a minimal effect on the patient presentation, severity and treatment outcome of EHS. The results of this study have important implications for military, civilian, and occupational populations who are at risk for EHS.


Assuntos
Golpe de Calor/diagnóstico , Hipotermia Induzida , Índice de Gravidade de Doença , Adulto , Feminino , Golpe de Calor/etiologia , Golpe de Calor/terapia , Temperatura Alta/efeitos adversos , Humanos , Masculino , Militares , Fatores Desencadeantes , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Virginia , Adulto Jovem
12.
Eur Heart J Acute Cardiovasc Care ; 8(7): 667-680, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31436133

RESUMO

BACKGROUND: The aim of this study was to describe the prevalence and prognostic value of the most common triggering factors in acute heart failure. METHODS: Patients with acute heart failure from 41 Spanish emergency departments were recruited consecutively in three time periods between 2011 and 2016. Precipitating factors were classified as: (a) unrecognized; (b) infection; (c) atrial fibrillation; (d) anaemia; (e) hypertension; (f) acute coronary syndrome; (g) non-adherence; and (h) two or more precipitant factors. Unadjusted and adjusted logistic regression models were used to assess the association between 30-day mortality and each precipitant factor. The risk of dying was further evaluated by week intervals over the 30-day follow-up to assess the period of higher vulnerability for each precipitant factor. RESULTS: Approximately 69% of our 9999 patients presented with a triggering factor and 1002 died within the first 30 days (10.0%). The most prevalent factors were infection and atrial fibrillation. After adjusting for 11 known predictors, acute coronary syndrome was associated with higher 30-day mortality (odds ratio (OR) 1.87; 95% confidence interval (CI) 1.02-3.42), whereas atrial fibrillation (OR 0.75; 95% CI 0.56-0.94) and hypertension (OR 0.34; 95% CI 0.21-0.55) were significantly associated with better outcomes when compared to patients without precipitant. Patients with infection, anaemia and non-compliance were not at higher risk of dying within 30 days. These findings were consistent across gender and age groups. The 30-day mortality time pattern varied between and within precipitant factors. CONCLUSIONS: Precipitant factors in acute heart failure patients are prevalent and have a prognostic value regardless of the patient's gender and age. They can be managed with specific treatments and can sometimes be prevented.


Assuntos
Insuficiência Cardíaca/mortalidade , Sistema de Registros , Medição de Risco/métodos , Doença Aguda , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Mortalidade Hospitalar/tendências , Humanos , Masculino , Fatores Desencadeantes , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Espanha/epidemiologia , Taxa de Sobrevida/tendências
13.
Diabetes Metab Syndr ; 13(4): 2357-2360, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31405643

RESUMO

BACKGROUND: We aimed to retrospectively investigate the clinical and biochemical profile of Diabetic ketoacidosis (DKA) patients and various precipitating and prognostic factors. METHODS: This was a hospital-based retrospective observational study, conducted in a tertiary care hospital in north India, from March 2014 to March 2017. RESULTS: Among 50 patients who satisfied the study criteria, 10 (20%) had DKA as their first presentation. Most common symptoms were nausea and vomiting (74%). Noncompliance was the major precipitating cause in 26 cases (52%) followed by infections in 18 cases (36%). The mean value of blood sugar at presentation was 406.8 ±â€¯130.4 mg/dl with serum ketone 5.38 ±â€¯1.56 mmol/l and mean pH 7.128 ±â€¯0.157 with severe DKA in 14 (28%) patients. Mean duration of hospital stay was 8.2.±5.0 days, and low hemoglobin (p = 0.019) and high pulse rate (p = 0.025) were independent predictors of a longer stay. CONCLUSION: With intensive care, mortality did not occur; however, non-compliance remained the most common precipitating cause of DKA followed by infections.


Assuntos
Biomarcadores/sangue , Cetoacidose Diabética/diagnóstico , Tempo de Internação/estatística & dados numéricos , Cooperação do Paciente , Fatores Desencadeantes , Adolescente , Adulto , Idoso , Cetoacidose Diabética/sangue , Cetoacidose Diabética/etiologia , Feminino , Seguimentos , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Centros de Atenção Terciária , Adulto Jovem
14.
BMJ Case Rep ; 12(7)2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31352387

RESUMO

Takotsubo cardiomyopathy (TTC) is most commonly characterised by transient apical ballooning in response to physical or emotional stress without significant coronary artery disease (CAD). Various physical and emotional factors can trigger TTC. We report a case of hypothermia-induced biventricular TTC in an 84-year-old man admitted with a core body temperature of 29.8°C, followed by quick recovery of systolic function and resolution of wall motion abnormality after discharge. TTC should be suspected in hypothermic patients presenting with evidence of new onset heart failure and be added to the expanding list of factors triggering TTC. Similar to TTC induced by various other factors, hypothermia-induced TTC also carries a favourable prognosis with relatively quick recovery of wall motion abnormalities.


Assuntos
Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Temperatura Baixa/efeitos adversos , Hipotermia/complicações , Cardiomiopatia de Takotsubo/etiologia , Idoso de 80 Anos ou mais , Hidratação , Humanos , Hipotermia/fisiopatologia , Hipotermia/terapia , Masculino , Fatores Desencadeantes , Reaquecimento , Cardiomiopatia de Takotsubo/fisiopatologia , Cardiomiopatia de Takotsubo/terapia , Resultado do Tratamento
16.
BMC Pulm Med ; 19(1): 110, 2019 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-31221118

RESUMO

BACKGROUND: Acute respiratory distress syndrome (ARDS) is a life-threatening disease; however, its treatment has not yet been fully established. The progression of ARDS is considered to be mediated by altered intercellular communication between immune and structural cells in the lung. One of several factors involved in intercellular communication is the extracellular vesicle (EV). They act as carriers of functional content such as RNA molecules, proteins, and lipids and deliver cargo from donor to recipient cells. EVs have been reported to regulate the nucleotide-binding oligomerization like receptor 3 (NLRP3) inflammasome. This has been identified as the cellular machinery responsible for activating inflammatory processes, a key component responsible for the pathogenesis of ARDS. METHODS: Here, we provide comprehensive genetic analysis of microRNAs (miRNAs) in EVs, demonstrating increased expression of the miRNA-466 family in the bronchoalveolar lavage fluid of a mouse ARDS model. RESULTS: Transfection of bone marrow-derived macrophages (BMDMs) with miRNA-466 g and 466 m-5p resulted in increased interleukin-1 beta (IL-1ß) release after LPS and ATP treatment, which is an established in vitro model of NLRP3 inflammasome activation. Moreover, LPS-induced pro-IL-1ß expression was accelerated by miRNA-466 g and 466 m-5p in BMDMs. CONCLUSIONS: These findings imply that miRNA-466 family molecules are secreted via EVs into the airways in an ARDS model, and this exacerbates inflammation through the NLRP3 inflammasome. Our results suggest that the NLRP3 inflammasome pathway, regulated by extracellular vesicle miRNA, could act as a therapeutic target for ARDS.


Assuntos
Vesículas Extracelulares/metabolismo , Inflamassomos/metabolismo , MicroRNAs/metabolismo , Síndrome do Desconforto Respiratório do Adulto/metabolismo , Animais , Líquido da Lavagem Broncoalveolar/química , Modelos Animais de Doenças , Inflamação/metabolismo , Interleucina-1beta/metabolismo , Lipopolissacarídeos , Macrófagos/efeitos dos fármacos , Macrófagos/metabolismo , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Proteína 3 que Contém Domínio de Pirina da Família NLR/metabolismo , Fatores Desencadeantes , Síndrome do Desconforto Respiratório do Adulto/induzido quimicamente
17.
Acta Neurochir (Wien) ; 161(7): 1307-1315, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31106393

RESUMO

BACKGROUND: Delirium is the most common neuropsychiatric presentation during hospitalization. In neurosurgery, studies on predisposing and precipitating risk factors for the development of delirium are rare but required for the individual risk estimation. METHODS: Prospective cohort study in a tertiary university center. In total, 949 neurosurgical patients, 307 with and 642 without delirium, were included. Demographic factors, neurosurgery-related, neurological, and medical clusters were tested as predictors of delirium in multiple logistic regression analyses. RESULTS: The incidence of delirium in this cohort of neurosurgical patients was 32.4%. Compared to patients without delirium, those with delirium were significantly older, more cognitively and neurologically impaired, transferred from hospitals and nursing homes, admitted as emergencies, longer hospitalized (16.2 vs. 9.5 days; p < 0.001), in greater need of intensive care management, and more frequently transferred to rehabilitation. Predisposing factors of delirium were stroke (OR 5.45, CI 2.12-14.0, p < 0.001), cardiac insufficiency (OR 4.59, CI 1.09-19.26, p = 0.038), cerebral neoplasm (OR 1.53, CI 0.92-2.54, p = 0.019), and age ≥ 65 years (OR 1.47, CI 1.03-2.09, p = 0.030). Precipitating factors of delirium were acute cerebral injury (OR 3.91, CI 2.24-6.83, p < 0.001), hydrocephalus (OR 3.10, CI 1.98-4.87, p < 0.001), and intracranial hemorrhage (OR 1.90, CI 1.23-2.94, p = 0.004). CONCLUSIONS: Delirium in acute neurosurgical patients was associated with longer hospitalization. Whereas common etiologies of delirium like infections and dementia, did not predict delirium, pre-existing neurovascular and traumatic diseases, as well as surgery-related events seem important risk factors contributing to delirium in neurosurgery.


Assuntos
Neoplasias Encefálicas/complicações , Delírio/etiologia , Hidrocefalia/complicações , Procedimentos Neurocirúrgicos/efeitos adversos , Acidente Vascular Cerebral/complicações , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Delírio/epidemiologia , Feminino , Hospitalização , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fatores Desencadeantes , Estudos Prospectivos , Fatores de Risco
18.
Clin Drug Investig ; 39(7): 683-690, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31065934

RESUMO

BACKGROUND AND OBJECTIVE: As of December 2017, 20 diabetic ketosis (DK)/diabetic ketoacidosis (DKA) cases associated with sodium-glucose co-transporter 2 inhibitors (SGLT2i) had been reported to the Health Sciences Authority (HSA), Singapore. We aimed to provide a detailed analysis of the profile of these cases. METHODS: As part of the emerging safety issue monitoring, the HSA followed up on SGLT2i-associated DK/DKA cases with the reporters to obtain the missing and/or supplementary information. Descriptive statistics were employed to summarise the data collected, while the Mann-Whitney test was employed to evaluate the differences between typical and euglycaemic DKA cases as well as between genders. RESULTS: All cases led to hospitalisation but were non-fatal. Where reported, the majority (71-85%) of DK/DKA cases occurred within 180 days of SGLT2i therapy initiation and involved female patients and/or patients with long-standing type 2 diabetes mellitus (T2DM). Apart from the difference in blood glucose levels, no differences in the profile between the typical and euglycaemic DKA cases were noted. Known precipitating factors were identified in all cases. Acute illnesses, particularly infections and abscesses, were the most commonly reported precipitating factors, followed by insulin dose reduction/cessation. CONCLUSIONS: Based on the profile of the reported cases, it is imperative to maintain clinical vigilance for DK/DKA, especially during the first 6 months of SGLT2i treatment and more so in female patients and/or patients with long-standing T2DM. Prompt evaluation and management of underlying precipitating factors is also important to assess and mitigate the risk of developing DK/DKA during treatment with SGLT2i.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Cetoacidose Diabética/etiologia , Inibidores do Transportador 2 de Sódio-Glicose/farmacologia , Adulto , Glicemia/análise , Feminino , Humanos , Insulina/uso terapêutico , Cetose , Masculino , Pessoa de Meia-Idade , Fatores Desencadeantes , Singapura , Adulto Jovem
19.
Am J Clin Dermatol ; 20(5): 669-682, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31119650

RESUMO

Eruptive melanocytic nevi (EMN) is a phenomenon characterized by the sudden onset of nevi. Our objective was to compile all published reports of EMN to identify possible precipitating factors and to evaluate the clinical appearance and course. We conducted a systematic bibliographic search and selected 93 articles, representing 179 patients with EMN. The suspected causes were skin and other diseases (50%); immunosuppressive agents, chemotherapy or melanotan (41%); and miscellaneous, including idiopathic (9%). The clinical manifestations could largely be divided into two categories: EMN associated with skin diseases were frequently few in number (fewer than ten nevi), large, and localized to the site of previous skin disease, whereas those due to other causes presented most often with multiple small widespread nevi. In general, EMN seem to persist unchanged after their appearance, but development over several years or fading has also been reported. Overall, 16% of the cases had at least one histologically confirmed dysplastic nevus. Five cases of associated melanoma were reported. We conclude that the clinical appearance of EMN may differ according to the suggested triggering factor. Based on the clinical distinction, we propose a new subclassification of EMN: (1) widespread eruptive nevi (WEN), with numerous small nevi, triggered by, for example, drugs and internal diseases, and (2) Köbner-like eruptive nevi, often with big and few nevi, associated with skin diseases and most often localized at the site of previous skin disease/trauma. The nature of the data precluded assessment of risk of malignant transformation.


Assuntos
Síndrome do Nevo Displásico/epidemiologia , Nevo Pigmentado/epidemiologia , Neoplasias Cutâneas/epidemiologia , Síndrome do Nevo Displásico/diagnóstico , Síndrome do Nevo Displásico/etiologia , Humanos , Imunossupressores/efeitos adversos , Nevo Pigmentado/diagnóstico , Nevo Pigmentado/etiologia , Peptídeos Cíclicos/efeitos adversos , Fatores Desencadeantes , Medição de Risco , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/etiologia , alfa-MSH/efeitos adversos , alfa-MSH/análogos & derivados
20.
BMJ Case Rep ; 12(4)2019 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-31023735

RESUMO

Tetralogy of Fallot (TOF) is the most common form of cyanotic congenital heart disease beyond the age of 3 months. Complete heart block (CHB) is rare but a serious sequalae post-repair of TOF. We present a case of an 18-month-old child who developed late CHB after around 1 year of the corrective surgery of the congenital anomaly. On the regular follow-up visit, the patient assessment was unremarkable. However, there was bradycardia, 55 beats/min. The ECG showed complete atrioventricular dissociation. Echocardiogram was done and demonstrated severe tricuspid regurgitation (TR). The patient required a permanent pacemaker and he is currently well. We are presenting this case as a late unexpected CHB, with a possibility of progressive right-side dilatation as a contributing factor to CHB due to severe TR.


Assuntos
Bloqueio Atrioventricular/etiologia , Bloqueio Atrioventricular/cirurgia , Tetralogia de Fallot/complicações , Assistência ao Convalescente , Bloqueio Atrioventricular/fisiopatologia , Bloqueio Atrioventricular/terapia , Ecocardiografia/métodos , Eletrocardiografia , Humanos , Lactente , Masculino , Marca-Passo Artificial , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/cirurgia , Fatores Desencadeantes , Tetralogia de Fallot/diagnóstico , Tetralogia de Fallot/cirurgia , Resultado do Tratamento , Insuficiência da Valva Tricúspide/complicações , Insuficiência da Valva Tricúspide/diagnóstico por imagem
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