Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.972
Filtrar
2.
Ulus Travma Acil Cerrahi Derg ; 28(7): 1031-1034, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35775669

RESUMO

Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract and may cause serious complications such as intestinal obstruction, gastrointestinal hemorrhage, or inflammation with/without perforation, which can present with non-spe-cific symptoms and signs. We report on the case of a 2.5-year-old boy admitted to our emergency department in poor condition, with compatible signs of decompensated hypovolemic shock. This case finally resulted in intestinal volvulus and internal hernia, a very rare combination of two complications of MD, as determined in the operating room.


Assuntos
Hérnia Abdominal , Obstrução Intestinal , Volvo Intestinal , Divertículo Ileal , Choque , Criança , Pré-Escolar , Hérnia Abdominal/complicações , Humanos , Obstrução Intestinal/complicações , Volvo Intestinal/complicações , Volvo Intestinal/cirurgia , Masculino , Divertículo Ileal/complicações , Divertículo Ileal/diagnóstico , Divertículo Ileal/cirurgia , Choque/etiologia
3.
Can Vet J ; 63(7): 711-714, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35784770

RESUMO

A 6-year-old neutered male golden retriever mix dog was presented for investigation of acute restlessness, increased respiratory effort, non-productive retching, and anorexia. Initial abdominal radiography revealed marked gastric dilation with a normal gastric shape and position, along with mineralized granular material in the pyloric region, consistent with a pyloric outflow obstruction secondary to suspected sand impaction. The dog was stabilized with gastric trocharization and medical management with intravenous fluids, antiemetics, polyethylene glycol via a nasogastric tube, and analgesia was initiated. The dog developed aspiration pneumonia during hospitalization and became oxygen-dependent. There was no significant improvement of clinical status despite 72 h of medical management, and surgical intervention was subsequently recommended. Exploratory laparotomy revealed a counterclockwise gastric dilatation and volvulus. The stomach was repositioned into normal anatomic position and an incisional gastropexy was performed. The dog was maintained in the intensive care unit for 4 d postoperatively. Currently, 3 mo postoperatively, the dog is healthy without recurrence of clinical signs. Key clinical message: Counterclockwise gastric dilatation and volvulus is a rare condition in veterinary medicine; however, it should be considered in a patient with acute gastric distension and signs of pyloric outflow obstruction when characteristic radiological signs of clockwise gastric dilatation and volvulus are absent, and there is radiological evidence of persistent gastric foreign material despite medical management. Misdiagnosis of counterclockwise gastric dilatation and volvulus can delay definitive surgical intervention and lead to higher morbidity and mortality.


Dilatation gastrique dans le sens inverse des aiguilles d'une montre et volvulus chez un chien. Un chien golden retriever mâle castré âgé de 6 ans a été présenté pour évaluation à la suite d'agitation aiguë, d'un effort respiratoire accru, des haut-le-coeur non productifs et d'anorexie. La radiographie abdominale initiale a révélé une dilatation gastrique marquée avec une forme et une position gastrique normales, ainsi qu'un matériau granulaire minéralisé dans la région pylorique, compatible avec une suspicion d'obstruction de l'écoulement pylorique secondaire à une impaction par du sable. Le chien a été stabilisé avec une trocarisation gastrique et une prise en charge médicale avec des fluides intraveineux, des antiémétiques, du polyéthylène glycol via une sonde nasogastrique, et une analgésie a été initiée. Le chien a développé une pneumonie par aspiration pendant l'hospitalisation et est devenu dépendant de l'oxygène. Il n'y a pas eu d'amélioration significative de l'état clinique malgré 72 h de prise en charge médicale et une intervention chirurgicale a été recommandée. La laparotomie exploratrice a révélé une dilatation gastrique dans le sens inverse des aiguilles d'une montre et un volvulus. L'estomac a été repositionné en position anatomique normale et une gastropexie incisionnelle a été réalisée. Le chien a été maintenu en unité de soins intensifs pendant 4 jours après l'opération. Actuellement, 3 mois après l'opération, le chien est en bonne santé sans récidive des signes cliniques.Message clinique clé :La dilatation dans le sens inverse des aiguilles d'une montre et le volvulus gastriques sont une affection rare en médecine vétérinaire; cependant, cela doit être envisagé chez un patient présentant une distension gastrique aiguë et des signes d'obstruction de l'écoulement pylorique en l'absence de signes radiologiques caractéristiques de dilatation gastrique dans le sens des aiguilles d'une montre et de volvulus, et en cas de preuve radiologique de corps étranger gastrique persistant malgré la prise en charge médicale. Un diagnostic erroné de dilatation gastrique dans le sens inverse des aiguilles d'une montre et de volvulus peut retarder l'intervention chirurgicale définitive et entraîner une morbidité et une mortalité plus élevées.(Traduit par Dr Serge Messier).


Assuntos
Doenças do Cão , Dilatação Gástrica , Gastropexia , Volvo Intestinal , Volvo Gástrico , Animais , Doenças do Cão/diagnóstico por imagem , Doenças do Cão/cirurgia , Cães , Dilatação Gástrica/complicações , Dilatação Gástrica/cirurgia , Dilatação Gástrica/veterinária , Gastropexia/veterinária , Volvo Intestinal/complicações , Volvo Intestinal/veterinária , Masculino , Volvo Gástrico/complicações , Volvo Gástrico/cirurgia , Volvo Gástrico/veterinária
4.
PLoS Negl Trop Dis ; 16(7): e0010620, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35849615

RESUMO

BACKGROUND: Onchocerciasis is a neglected tropical filarial disease transmitted by the bites of blackflies, causing blindness and severe skin lesions. The change in focus for onchocerciasis management from control to elimination requires thorough mapping of pre-control endemicity to identify areas requiring interventions and to monitor progress. Onchocerca volvulus nodule prevalence in sub-Saharan Africa is spatially continuous and heterogeneous, and highly endemic areas may contribute to transmission in areas of low endemicity or vice-versa. Ethiopia is one such onchocerciasis-endemic country with heterogeneous O. volvulus nodule prevalence, and many districts are still unmapped despite their potential for onchocerciasis transmission. METHODOLOGY/PRINCIPLE FINDINGS: A Bayesian geostatistical model was fitted for retrospective pre-intervention nodule prevalence data collected from 916 unique sites and 35,077 people across Ethiopia. We used multiple environmental, socio-demographic, and climate variables to estimate the pre-intervention prevalence of O. volvulus nodules across Ethiopia and to explore their relationship with prevalence. Prevalence was high in southern and northwestern Ethiopia and low in Ethiopia's central and eastern parts. Distance to the nearest river (RR: 0.9850, 95% BCI: 0.9751-0.995), precipitation seasonality (RR: 0.9837, 95% BCI: 0.9681-0.9995), and flow accumulation (RR: 0.9586, 95% BCI: 0.9321-0.9816) were negatively associated with O. volvulus nodule prevalence, while soil moisture (RR: 1.0218, 95% BCI: 1.0135-1.0302) was positively associated. The model estimated the number of pre-intervention cases of O. volvulus nodules in Ethiopia to be around 6.48 million (95% BCI: 3.53-13.04 million). CONCLUSIONS/SIGNIFICANCE: Nodule prevalence distribution was correlated with habitat suitability for vector breeding and associated biting behavior. The modeled pre-intervention prevalence can be used as a guide for determining priorities for elimination mapping in regions of Ethiopia that are currently unmapped, most of which have comparatively low infection prevalence.


Assuntos
Volvo Intestinal , Onchocerca volvulus , Oncocercose , Animais , Teorema de Bayes , Etiópia/epidemiologia , Humanos , Ivermectina , Onchocerca , Oncocercose/epidemiologia , Oncocercose/prevenção & controle , Prevalência , Estudos Retrospectivos
5.
Medicine (Baltimore) ; 101(30): e29670, 2022 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-35905251

RESUMO

RATIONALE: Midgut malrotation is a rare congenital abnormality resulting from failure of complete intestinal rotation and subsequent fixation during early fetal development. There appeared to be no obvious symptoms in most patients, and a few patients may exhibit symptoms similar to hyperemesis gravidarum, such as nausea and vomiting. Here, we present a case of midgut malrotation presenting as hyperemesis gravidarum. PATIENT CONCERNS: A 27-year-old woman with an intrauterine pregnancy of 27 + 6 weeks complained of severe nausea and vomiting for 2 weeks. DIAGNOSIS: Magnetic resonance imaging showed obvious dilatation in the proximal part of the duodenum and gastric cavity and the absence of a duodenal path dorsal to the superior mesenteric artery, which was diagnosed as midgut malrotation. INTERVENTIONS: Considering that the patient's vital signs were stable, without manifestation of peritonitis or the risks of surgery to the fetus, conservative treatment was adopted. Unfortunately, the fetus developed severe hydrocephalus at 32 weeks. The patient and her family decided to abandon the fetus, and a mid-trimester-induced abortion was performed. OUTCOMES: The related symptoms completely disappeared after delivery, and the relevant examination after discharge also confirmed the presence of midgut malrotation without gastrointestinal discomfort within 1 year after delivery. LESSONS: Midgut malrotation can be considered as a differential diagnosis of hyperemesis gravidarum. Conservative treatment under close monitoring is desirable in pregnant women diagnosed with midgut malrotation.


Assuntos
Anormalidades do Sistema Digestório , Hiperêmese Gravídica , Volvo Intestinal , Adulto , Anormalidades do Sistema Digestório/complicações , Anormalidades do Sistema Digestório/diagnóstico , Anormalidades do Sistema Digestório/cirurgia , Feminino , Humanos , Hiperêmese Gravídica/complicações , Hiperêmese Gravídica/diagnóstico , Volvo Intestinal/complicações , Volvo Intestinal/diagnóstico , Volvo Intestinal/cirurgia , Náusea/etiologia , Gravidez
6.
Rev. colomb. cir ; 37(3): 518-524, junio 14, 2022. fig
Artigo em Espanhol | LILACS | ID: biblio-1378849

RESUMO

Introducción. La esclerosis sistémica es una enfermedad del colágeno de etiología autoinmune, con manifestaciones gastrointestinales hasta en un 90 % de los pacientes. Aunque es infrecuente, se han descrito algunos casos de vólvulos colónicos, pero es extremadamente rara la presentación de vólvulo cecal y del colon sigmoide en un mismo paciente. Caso clínico.Paciente femenina de 65 años, con antecedente de esclerosis sistémica, quien consultó a urgencias por dolor y distensión abdominal, asociados a emesis, con ausencia de flatos y deposiciones. Por imágenes sugestivas de obstrucción intestinal con zona de transición en el colon sigmoide se indicó laparotomía exploratoria, con hallazgo de vólvulo del sigmoide. Posteriormente reingresó por sintomatología similar, con imágenes sugestivas de vólvulo cecal. Se realizó hemicolectomía derecha con ileostomía y posterior cierre de ileostomía en misma hospitalización. Discusión. El vólvulo del colon sigmoide y ciego en un mismo paciente es una condición muy infrecuente. Existen pocos casos reportados en la literatura. Conclusión. La resección del segmento colónico afectado es el estándar de manejo quirúrgico.


Introduction. Systemic sclerosis is a collagen disease of autoimmune etiology, with gastrointestinal manifestations in up to 90% of patients. Although infrequent, some cases of colonic volvulus have been described, but the presentation of cecal and sigmoid colon volvulus in the same patient is extremely rarely. Clinical case. A 65-year-old female patient, with a history of systemic sclerosis, who consulted the emergency room due to abdominal pain and distension, associated with emesis and absence of flatus and stools. Due to images suggestive of intestinal obstruction with a transition zone in the sigmoid colon, an exploratory laparotomy was indicated, with the finding of a sigmoid volvulus. She was later readmitted for similar symptoms, with images suggestive of cecal volvulus. Right hemicolectomy was performed with ileostomy and subsequent closure of the ileostomy in the same hospitalization. Discussion. Volvulus of the sigmoid and cecum in the same patient is a very rare condition. There are few cases reported in the literature. Conclusion. Resection of the affected colonic segment is the standard of care management.


Assuntos
Humanos , Escleroderma Sistêmico , Volvo Intestinal , Colo Sigmoide , Ceco , Colectomia , Obstrução Intestinal
8.
Acta Crystallogr F Struct Biol Commun ; 78(Pt 6): 232-240, 2022 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-35647680

RESUMO

Superoxide dismutases (SODs) are metalloproteins that are responsible for the dismutation of superoxide anion radicals. SODs are consequently protective against oxidative damage to cellular components. Among other protective mechanisms, the filarial parasite Onchocerca volvulus has a well developed defense system to scavenge toxic free radicals using SODs during migration and sojourning of the microfilariae and adult worms in the human body. O. volvulus is responsible for the neglected disease onchocerciasis or `river blindness'. In the present study, an extracellular Cu/Zn-SOD from O. volvulus (OvEC-SOD) was cloned, purified and crystallized to obtain structural insight into an attractive drug target with the potential to combat onchocerciasis. The recombinant OvEC-SOD forms a dimer and the protein structure was solved and refined to 1.55 Šresolution by X-ray crystallography. Interestingly, a sulfate ion supports the coordination of the conserved copper ion. The overall protein shape was verified by small-angle X-ray scattering. The enzyme shows a different surface charge distribution and different termini when compared with the homologous human SOD. A distinct hydrophobic cleft to which both protomers of the dimer contribute was utilized for a docking approach with compounds that have previously been identified as SOD inhibitors to highlight the potential for individual structure-based drug development.


Assuntos
Volvo Intestinal , Onchocerca volvulus , Oncocercose , Parasitos , Animais , Cristalografia por Raios X , Desenvolvimento de Medicamentos , Onchocerca volvulus/genética , Onchocerca volvulus/metabolismo , Parasitos/metabolismo , Superóxido Dismutase/química
11.
PLoS Negl Trop Dis ; 16(5): e0010340, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35503786

RESUMO

BACKGROUND: Annual mass drug administrations (MDA) of ivermectin will strongly reduce Onchocerca volvulus microfilariae (mf) in the skin and in the onchocerciasis patients' eyes. Ivermectin treatment will also affect the expression of immunity in patients, such that activated immune defenses may help control and contribute to clearance of mf of O. volvulus. Longitudinal surveys are a prerequisite to determining the impact of ivermectin on the status of anti-parasite immunity, notably in risk zones where parasite transmission and active O. volvulus infections persist. METHODOLOGY/PRINCIPAL FINDINGS: Onchocerciasis patients were treated annually with ivermectin and their Onchocerca volvulus antigen (OvAg) specific IgG and cellular responses were investigated before and at 30 years post initial ivermectin treatment (30yPT). Repeated annual ivermectin treatments eliminated persisting O. volvulus microfilariae (mf) from the skin of patients and abrogated patent infections. The OvAg-specific IgG1 and IgG4 responses were diminished at 30yPT to the levels observed in endemic controls. Prior to starting ivermectin treatment, OvAg-induced cellular productions of IL-10, IFN-γ, CCL13, CCL17 and CCL18 were low in patients, and at 30yPT, cellular cytokine and chemokine responses increased to the levels observed in endemic controls. In contrast, mitogen(PHA)- induced IL-10, IFN-γ, CCL17 and CCL18 cellular production was diminished. This divergent response profile thus revealed increased parasite antigen-specific but reduced polyclonal cellular responsiveness in patients. The transmission of O. volvulus continued at the patients' location in the Mô river basin in central Togo 2018 and 2019 when 0.58% and 0.45%, respectively, of Simulium damnosum s.l. vector blackflies carried O. volvulus infections. CONCLUSIONS/SIGNIFICANCE: Repeated annual ivermectin treatment of onchocerciasis patients durably inhibited their patent O. volvulus infections despite ongoing low-level parasite transmission in the study area. Repeated MDA with ivermectin affects the expression of immunity in patients. O. volvulus parasite-specific antibody levels diminished to levels seen in infection-free endemic controls. With low antibody levels, antibody-dependent cellular cytotoxic responses against tissue-dwelling O. volvulus larvae will weaken. O. volvulus antigen inducible cytokine and chemokine production increased in treated mf-negative patients, while their innate responsiveness to mitogen declined. Such lower innate responsiveness in elderly patients could contribute to reduced adaptive immune responses to parasite infections and vaccines. On the other hand, increased specific cellular chemokine responses in mf-negative onchocerciasis patients could reflect effector cell activation against tissue invasive larval stages of O. volvulus. The annual Simulium damnosum s.l. biting rate observed in the Mô river basin was similar to levels prior to initiation of MDA with ivermectin, and the positive rtPCR results reported here confirm ongoing O. volvulus transmission.


Assuntos
Volvo Intestinal , Onchocerca volvulus , Oncocercose , Parasitos , Simuliidae , Idoso , Animais , Citocinas , Humanos , Imunoglobulina G , Interleucina-10 , Ivermectina/uso terapêutico , Microfilárias , Mitógenos/uso terapêutico , Onchocerca , Simuliidae/parasitologia , Togo/epidemiologia
12.
Ulus Travma Acil Cerrahi Derg ; 28(3): 281-284, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35485550

RESUMO

BACKGROUND: Sigmoid volvulus (SV), the wrapping of the sigmoid colon around itself, is a rare intestinal obstruction form world-wide. For this reason, the physiopathology of SV, particularly the precipitating factors, are not clearly identified. The aim of this study is to evaluate the precipitating factors in SV. METHODS: The clinical records of consecutive 416 patients with SV were reviewed prospectively from January 1986 to July 2020. As a control, the records of consecutive 100 patients with non-volvulus intestinal obstruction were reviewed prospectively in the past 24 months. The premorbid symptoms including acute diarrhea, sudden and excessive body motions, overeating after a prolonged starvation, coughing spell, and labor was evaluated. RESULTS: Among the premorbid symptoms, 1-5-day interval of diarrhea (42 patients, 10.1%, p<0.05), harvesting activation (35 patients, 8.4%, p<0.05), and overeating after Ramadan fasting (31 patients, 7.5%, p<0.05) were found to be statistically significant precipitating factors in SV. CONCLUSION: Although there are few studies about the precipitating factors of SV in the literature, increased bowel motility, excessive body motions, and overeating following a prolonged starvation look like the precipitating factors in the development of SV.


Assuntos
Obstrução Intestinal , Volvo Intestinal , Doenças do Colo Sigmoide , Diarreia , Humanos , Hiperfagia , Obstrução Intestinal/cirurgia , Volvo Intestinal/diagnóstico , Volvo Intestinal/etiologia , Volvo Intestinal/patologia , Doenças do Colo Sigmoide/diagnóstico , Doenças do Colo Sigmoide/etiologia , Doenças do Colo Sigmoide/cirurgia
13.
Ulus Travma Acil Cerrahi Derg ; 28(3): 249-253, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35485572

RESUMO

BACKGROUND: We aimed to present cecum pathologies which are the cause of acute abdomen. METHODS: Between January 2015 and June 2019, patients that were operated with the diagnosis of acute abdomen and patients with the primary cecum pathologies were evaluated retrospectively. RESULTS: There were eight patients, five males and three females. The mean age was 7.2±2.9 years. Complaints were abdominal pain and vomiting in all patients. Physical examination was consistent with acute abdomen. In the imaging studies, the preliminary diagnosis was considered as two patients had acute appendicitis, two had invagination (one due to Meckel diverticulum and one with mesenteric cyst), two had ileus, one had perforated appendicitis, and one had cecum diverticulum. In surgery, five patients had cecum mass, one had cecum diverticulitis, one had cecum volvulus, and one had inflamed necrotic cecum. All patients underwent cecum resection and ileocolonic anastomosis. Histopathologic examination was resulted as Burkitt's lymphoma in three patients, cecum diverticulum in two, duplication of cecum in one, tuberculosis of cecum in one, and gangrenous necrosis due to volvulus in one patient. The mean follow-up period was 25 months (2 months-4 years). Follow-up was uneventful. CONCLUSION: Primary cecum pathologies are very rare. This leads to lack of standardization in treatment planning. Considering the patients with malignancy in the series, ileocolonic anastomosis with cecum resection is an adequate and appropriate treatment option in children with primary cecum pathology.


Assuntos
Abdome Agudo , Apendicite , Volvo Intestinal , Divertículo Ileal , Abdome Agudo/etiologia , Abdome Agudo/cirurgia , Apendicite/diagnóstico , Ceco/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Volvo Intestinal/diagnóstico , Volvo Intestinal/diagnóstico por imagem , Masculino , Divertículo Ileal/diagnóstico , Divertículo Ileal/diagnóstico por imagem , Estudos Retrospectivos
14.
Clin Imaging ; 87: 11-27, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35468341

RESUMO

Twisting of the abdominal organs usually leads to acute abdomen, and a timely diagnosis is critical to salvage organ viability. Early diagnosis and prompt intervention are essential to avoid complications of ischemia and gangrene. Volvulus/torsion of the abdominal and pelvic organs present with non-specific clinical symptoms such as acute severe abdominal or pelvic pain generally necessitating imaging diagnosis. Since the timely critical diagnosis is necessary, emergency radiologists need to be well versed with the pertinent imaging findings of this acute surgical condition.


Assuntos
Abdome Agudo , Volvo Intestinal , Abdome , Abdome Agudo/diagnóstico por imagem , Abdome Agudo/etiologia , Diagnóstico por Imagem/métodos , Humanos , Volvo Intestinal/diagnóstico por imagem , Anormalidade Torcional/cirurgia
15.
BMC Pediatr ; 22(1): 192, 2022 04 11.
Artigo em Inglês | MEDLINE | ID: mdl-35410162

RESUMO

BACKGROUND: In neonatal patients with necrotizing enterocolitis (NEC) the inflammatory response is mediated by a plurality of different proteins. The proteins olfactomedin 4 (OLFM4) and lysozyme (LYZ) are part of the intestinal mucosal defense and especially OLFM4 has rarely been evaluated in neonatal gastrointestinal diseases. The aim of this study was to analyze whether expression levels of both proteins of innate immunity, OLFM4 and lysozyme, were increased during NEC in neonates. METHODS: Intestinal tissues of patients with NEC were examined with immunohistochemical staining of formalin-fixed and paraffin-embedded sections of resected tissue using antibodies against OLFM4 and lysozyme. Staining-positive tissues were semi-quantitatively scored from 0 (no staining), 1 (weak staining), 2 (moderate staining) to 3 (highly intense staining) by two individual investigators. Intestinal tissue of infants with volvulus was used as a control as other intestinal tissue without major inflammation was not available. RESULTS: Both applied antibodies against OLFM4 showed different staining patterns with higher staining intensity of the antibody OLFM4 (D1E4M). OLFM4 (median score of the antibody OLFM4 (D1E4M): 3.0) and lysozyme (median score: 3.0) are highly expressed in intestinal and immune cells during NEC. Expression of OLFM4 and lysozyme in the control samples with volvulus was observable but significantly lower (median score of the antibody OLFM4 (D1E4M): 1.25; median score of the antibody against LYZ: 2.0; p = 0.033 and p = 0.037, respectively). CONCLUSIONS: Both proteins, OLFM4 and lysozyme, may play a role in the pathogenesis of NEC in neonatal patients, but the exact mechanisms of OLFM4 and lysozyme function and their role in immunological responses have not yet been resolved in detail. These observations add new insights as basis for further large-scale population research.


Assuntos
Enterocolite Necrosante , Doenças Fetais , Doenças do Recém-Nascido , Volvo Intestinal , Enterocolite Necrosante/etiologia , Fator Estimulador de Colônias de Granulócitos , Humanos , Lactente , Recém-Nascido , Mucosa Intestinal/metabolismo , Volvo Intestinal/complicações , Muramidase , Proteínas
17.
PLoS Negl Trop Dis ; 16(4): e0010079, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35476631

RESUMO

BACKGROUND: Our study in CDTI-naïve areas in Nord Kivu and Ituri (Democratic Republic of the Congo, DRC), Lofa County (Liberia) and Nkwanta district (Ghana) showed that a single 8 mg moxidectin dose reduced skin microfilariae density (microfilariae/mg skin, SmfD) better and for longer than a single 150µg/kg ivermectin dose. We now analysed efficacy by study area and pre-treatment SmfD (intensity of infection, IoI). METHODOLOGY/PRINCIPAL FINDINGS: Four and three IoI categories were defined for across-study and by-study area analyses, respectively. We used a general linear model to analyse SmfD 1, 6, 12 and 18 months post-treatment, a logistic model to determine the odds of undetectable SmfD from month 1 to month 6 (UD1-6), month 12 (UD1-12) and month 18 (UD1-18), and descriptive statistics to quantitate inter-interindividual response differences. Twelve months post-treatment, treatment differences (difference in adjusted geometric mean SmfD after moxidectin and ivermectin in percentage of the adjusted geometric mean SmfD after ivermectin treatment) were 92.9%, 90.1%, 86.8% and 84.5% in Nord Kivu, Ituri, Lofa and Nkwanta, and 74.1%, 84.2%, 90.0% and 95.4% for participants with SmfD 10-20, ≥20-<50, ≥50-<80, ≥80, respectively. Ivermectin's efficacy was lower in Ituri and Nkwanta than Nord Kivu and Lofa (p≤0.002) and moxidectin's efficacy lower in Nkwanta than Nord Kivu, Ituri and Lofa (p<0.006). Odds ratios for UD1-6, UD1-12 or UD1-18 after moxidectin versus ivermectin treatment exceeded 7.0. Suboptimal response (SmfD 12 months post-treatment >40% of pre-treatment SmfD) occurred in 0%, 0.3%, 1.6% and 3.9% of moxidectin and 12.1%, 23.7%, 10.8% and 28.0% of ivermectin treated participants in Nord Kivu, Ituri, Lofa and Nkwanta, respectively. CONCLUSIONS/SIGNIFICANCE: The benefit of moxidectin vs ivermectin treatment increased with pre-treatment IoI. The possibility that parasite populations in different areas have different drug susceptibility without prior ivermectin selection pressure needs to be considered and further investigated. CLINICAL TRIAL REGISTRATION: Registered on 14 November 2008 in Clinicaltrials.gov (ID: NCT00790998).


Assuntos
Volvo Intestinal , Oncocercose , Animais , República Democrática do Congo/epidemiologia , Gana , Humanos , Ivermectina/farmacologia , Ivermectina/uso terapêutico , Libéria , Macrolídeos , Microfilárias , Oncocercose/tratamento farmacológico
18.
Front Cell Infect Microbiol ; 12: 869039, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35444961

RESUMO

Human onchocerciasis is a devastating neglected tropical disease caused by infection of the filarial nematode Onchocerca volvulus. The infection can cause irreversible visual impairment or blindness and stigmatizing dermatitis. More than 32 million people were estimated to be infected with O. volvulus in Africa, and 385,000 suffered from blindness. Even though the implementation of mass drug administration (MDA) with ivermectin has reduced the global prevalence of onchocerciasis, O. volvulus infection remains challenging to control because MDA with ivermectin cannot be implemented in endemic areas co-endemic with loiasis due to the risk of severe adverse events. There is also emerging drug resistance to ivermectin that further complicates the elimination of onchocerciasis. Thus, the development of a vaccine that would induce protective immunity and reduce infection burden is essential. Efforts to develop prophylactic and/or therapeutic vaccines for onchocerciasis have been explored since the late 1980s by many researchers and entities, and here we summarize the recent advances made in the development of vaccines against the infection of O. volvulus and onchocerciasis.


Assuntos
Volvo Intestinal , Oncocercose , Vacinas , Animais , Cegueira/induzido quimicamente , Cegueira/tratamento farmacológico , Bovinos , Humanos , Volvo Intestinal/induzido quimicamente , Ivermectina/farmacologia , Ivermectina/uso terapêutico , Onchocerca , Oncocercose/tratamento farmacológico , Oncocercose/prevenção & controle , Oncocercose/veterinária
19.
Am Surg ; 88(8): 1922-1924, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35392679

RESUMO

Cecal volvulus can be a rare and challenging diagnosis. We report a 47-year-old female who presented to the hospital and was diagnosed with acute appendicitis based on workup and clinical exam. The patient underwent laparoscopic appendectomy where the appendix was localized after extensive ascending colon mobilization. The patient's post-operative course was complicated by cecal volvulus requiring a right hemicolectomy. There have been several other reported cases of cecal volvulus following laparoscopic appendectomy, both of which also involved considerable cecal mobilization. More data are necessary to determine whether this clinical course could have been prevented with more limited mobilization or with cecopexy at initial surgery. A mobilized cecum may benefit from early surgical intervention to prevent future volvulus or a chronic mobile cecum syndrome. Cecal volvulus should be considered in the case of worsening abdominal pain or obstruction following laparoscopic appendectomy, given the consequences that can result if symptoms are overlooked.


Assuntos
Apêndice , Doenças do Ceco , Volvo Intestinal , Laparoscopia , Apendicectomia/efeitos adversos , Doenças do Ceco/diagnóstico , Doenças do Ceco/etiologia , Doenças do Ceco/cirurgia , Colo , Feminino , Humanos , Volvo Intestinal/complicações , Volvo Intestinal/cirurgia , Laparoscopia/efeitos adversos , Pessoa de Meia-Idade
20.
BMC Pediatr ; 22(1): 110, 2022 02 28.
Artigo em Inglês | MEDLINE | ID: mdl-35227232

RESUMO

BACKGROUND: Pancreaticobiliary maljunction is a congenital anatomical abnorma l junction of the pancreatic duct and bile duct into a common channel outside the duodenal wall. Pancreas divisum is also a congenital anatomical abnormality characterized by unfused pancreatic ducts. Intestinal malrotation is caused by the failure of bowel rotation and fixation. We reported an optimal surgical intervention for the rare case of pancreaticobiliary maljunction and pancreas divisum accompanied intestinal malrotation. CASE PRESENTATION: A 2-year-old female presented with fever and jaundice. Abdominal ultrasound showed dilated common bile duct and intrahepatic bile ducts; MRCP showed pancreaticobiliary maljunction, pancreas divisum, and dilated biliary system; Abdominal contrast-enhanced CT showed a reversed relationship between the superior mesenteric artery and the superior mesenteric vein. An operation of laparoscopic resection of the extrahepatic bile duct, Roux-en-Y hepaticojejunostomy, and Ladd's procedure was performed after the inflammation of the biliary system was treated. The post-operative follow-up period was uneventful. CONCLUSIONS: The management of pancreas divisum can be conservative. We present an optimal pattern of Roux-en-Y hepaticojejunostomy to deal with pancreaticobiliary maljunction associated with intestinal malrotation.


Assuntos
Má Junção Pancreaticobiliar , Pré-Escolar , Colangiopancreatografia Retrógrada Endoscópica/métodos , Ducto Colédoco/anormalidades , Ducto Colédoco/diagnóstico por imagem , Ducto Colédoco/cirurgia , Anormalidades do Sistema Digestório , Feminino , Humanos , Volvo Intestinal , Pâncreas/anormalidades , Pâncreas/diagnóstico por imagem , Pâncreas/cirurgia , Ductos Pancreáticos/anormalidades , Ductos Pancreáticos/diagnóstico por imagem , Ductos Pancreáticos/cirurgia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...