Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.851.699
Filtrar
1.
Psychiatr Pol ; 58(1): 201-212, 2024 Feb 28.
Artigo em Inglês, Polonês | MEDLINE | ID: mdl-38852189

RESUMO

Eidetic images are a relatively rare phenomenon in the practice of a psychiatrist. They are described in the category of perception disorders as images or memories which, thanks to their plasticity, vividness and detail, are very similar to the currently experienced sensory perceptions. However, it should be remembered that their occurrence is not associated with any mental disorders, and they are also observed in some healthy people. This paper presents a case report of a patient with complaints about "voiced," plastic images - the course of his psychiatric hospitalization and the psychological diagnostics carried out at that time. The authors point out the difficulties in differentiating, first of all, with auditory pseudo-hallucinations and make an attempt at psychopathological classification of the patient's symptoms. The discussion on possible disease mechanisms of this phenomenon is based on reports as well as research on the phenomenon of imagination and eidetic perceptions, and the aim of this study is to draw the attention of diagnosticians to the category of psychological phenomena with an eidetic character, which may allow them to avoid incorrect recognition of them as an element of psychotic disorders of perception.


Assuntos
Alucinações , Humanos , Masculino , Adulto , Alucinações/diagnóstico , Alucinações/psicologia , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/psicologia
4.
Chest ; 165(6): e169-e172, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38852973

RESUMO

CASE PRESENTATION: A 36-year-old male with no significant medical history presented to the ED with progressive left-sided neck and facial pain for the last 7 days. The patient also reported subjective fevers, chills, difficulty opening his mouth, and anorexia for the last 1 week. He denied cough, chest pain or tightness, shortness of breath, skin rashes, dysphagia, or odynophagia. He reported use of two to three 59.15 mL beers daily for the last 20 years. There was no recent travel or sick contact exposure. He did not report any TB exposure, IV drug use, or recent sexual encounters.


Assuntos
Dispneia , Cervicalgia , Humanos , Masculino , Adulto , Dispneia/etiologia , Dispneia/diagnóstico , Cervicalgia/etiologia , Cervicalgia/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Diagnóstico Diferencial
6.
Chest ; 165(6): e163-e167, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38852972

RESUMO

This novel report presents the first known case, to our knowledge, of a 16-year-old male patient who experienced intraventricular thrombosis and pulmonary embolism after a Nuss procedure for pectus excavatum, attributed to chronic bar displacement. Two years after the operation, the patient experienced post-exercise cough and hemoptysis, which led to his admission. Imaging revealed pulmonary embolism, thrombosis in the right ventricular outflow tract, and lung infiltrative lesions. We hypothesize that the chronic bar displacement led to its embedment in the right ventricle, resulting in thrombus formation, which subsequently contributed to partial pulmonary embolism. Surgery revealed the bars' intrusion into the right ventricle and lung. This case highlights the risk of severe complications from bar displacement in the Nuss procedure, which necessitates long-term follow-up evaluation, caution against strenuous activities after surgery, and use of thoracoscopic guidance during bar implantation and removal. It underscores the importance of vigilant evaluation for late-stage complications in patients with respiratory distress or thrombosis after a Nuss procedure.


Assuntos
Tórax em Funil , Embolia Pulmonar , Trombose , Humanos , Embolia Pulmonar/etiologia , Embolia Pulmonar/diagnóstico , Masculino , Adolescente , Tórax em Funil/cirurgia , Trombose/etiologia , Trombose/diagnóstico por imagem , Trombose/diagnóstico , Ventrículos do Coração/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/diagnóstico , Tomografia Computadorizada por Raios X
7.
Chest ; 165(6): e173-e176, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38852974

RESUMO

CASE PRESENTATION: A 30-year-old White woman with presumed rheumatoid arthritis accompanied by CT scan evidence of eosinophilic pneumonitis was referred to the ED by her rheumatologist for an investigation of the progression of dyspnea. Approximately 6 months before, the patient reported experiencing diffuse interphalangeal arthralgias (both proximal and distal) that affected the wrists, knees, and feet. These symptoms were accompanied by Modified Medical Research Council scale grade 2 dyspnea. During the initial assessment, the patient exhibited slight pallor and had no indications of inflammatory activity in the joints. Furthermore, the cardiovascular physical examination and the auto-antibody laboratory profile yielded normal results. However, a wrist ultrasound scan revealed evidence of active synovitis; a chest CT scan displayed multifocal bilateral ground-glass opacities and mild thickening of the interlobular septa. These findings suggested the presence of eosinophilic disease or an acute interstitial process related to collagen vascular disease. Consequently, the patient's treatment commenced with a weekly dose of methotrexate (10 mg). Despite the intervention, 2 months later, the patient returned, reporting persistent arthralgia and a worsening of dyspnea, now classified as Modified Medical Research Council scale grade 3. Subsequently, the rheumatologist referred her to the ED for further assessment. During the initial emergency evaluation, the patient experienced a syncope episode accompanied by orthostatic prodromal symptoms that included dizziness, nausea, and malaise.


Assuntos
Artralgia , Dispneia , Síncope , Humanos , Feminino , Adulto , Dispneia/etiologia , Dispneia/diagnóstico , Síncope/etiologia , Síncope/diagnóstico , Artralgia/etiologia , Artralgia/diagnóstico , Tomografia Computadorizada por Raios X , Diagnóstico Diferencial
10.
Can J Cardiol ; 40(6): 953-968, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38852985

RESUMO

Myocardial infarction with no obstructive coronary artery disease (MINOCA) represents 6%-15% of all acute coronary syndromes, and women are disproportionately represented. MINOCA is an encompassing preliminary diagnosis, and emerging evidence supports a more expansive comprehensive diagnostic and therapeutic clinical approach. The current clinical practice update summarizes the latest evidence regarding the epidemiology, clinical presentation, and diagnostic evaluation of MINOCA. A cascaded approach to diagnostic workup is outlined for clinicians, for noninvasive and invasive diagnostic pathways, depending on clinical setting and local availability of diagnostic modalities. Evidence concerning the nonpharmacological and pharmacological treatment of MINOCA are presented and summarized according to underlying cause of MINOCA, with practical tips on the basis of expert opinion, outlining a real-life, evidence-based, comprehensive approach to management of this challenging condition.


Assuntos
Infarto do Miocárdio , Saúde da Mulher , Humanos , Feminino , Canadá/epidemiologia , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/terapia , Infarto do Miocárdio/epidemiologia , Sociedades Médicas , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/terapia
11.
Nihon Shokakibyo Gakkai Zasshi ; 121(6): 489-496, 2024.
Artigo em Japonês | MEDLINE | ID: mdl-38853018

RESUMO

A 66-year-old male patient with a thyroid and nasopharyngeal cancer history visited our hospital because of a positive fecal occult blood test. Total colonoscopy detected sessile or subpedunculated polyps in the ascending colon, sigmoid colon, and rectum. These polyps were endoscopically resected, and the rectal polyp was pathologically diagnosed as adenocarcinoma in adenoma and the others as adenomas. Additionally, multiple sessile lesions were revealed in the sigmoid colon and rectum. A complete gastrointestinal tract examination revealed multiple foci of glycogenic acanthosis in the esophagus, multiple sessile lesions in the stomach, multiple sessile lesions, clubbings (rod-shaped lesions), and venous malformations in the small bowel. Mucocutaneous examination indicated hemangiomas on the body trunk, patchy pigmentation on the glans penis, and keratotic papules in the inguinal region. The National Comprehensive Cancer Network diagnostic criteria for Cowden syndrome were used in this case. The patient met four major and two minor criteria;thus, Cowden syndrome was diagnosed. Moreover, the patient was had phosphatase and tensin homolog deleted on chromosome 10 gene mutation. This is the first reported case of metachronal triple cancers in a male patient with Cowden syndrome, and our results indicate the importance of cancer surveillance.


Assuntos
Síndrome do Hamartoma Múltiplo , Humanos , Masculino , Idoso , Síndrome do Hamartoma Múltiplo/complicações , Segunda Neoplasia Primária/patologia , Neoplasias Primárias Múltiplas , Adenocarcinoma/diagnóstico
13.
Recenti Prog Med ; 115(6): 271-275, 2024 Jun.
Artigo em Italiano | MEDLINE | ID: mdl-38853729

RESUMO

The excessive, often unconfirmed suspicions of beta-lactam allergy affect up to 10% of the general population, improperly denying a significant percentage of individuals the opportunity to be treated with first-line antibiotics, forcing clinicians to resort to second-line choices that are not always equally effective, safe, and contribute to the increase in antibiotic resistance. Pediatricians and general practitioners can play a crucial role in recognizing and addressing weak suspicions of beta-lactam allergy, actively participating in removing the "label" of being allergic. The article, based on Who AWaRe Manual recommendations, presents current evidence on the issue with practical guidance to promote accurate interpretation and management of an overestimated problem that does not encourage a culture of optimal and prudent antibiotic use.


Assuntos
Antibacterianos , Hipersensibilidade a Drogas , beta-Lactamas , Humanos , beta-Lactamas/efeitos adversos , Antibacterianos/efeitos adversos , Antibacterianos/administração & dosagem , Hipersensibilidade a Drogas/etiologia , Hipersensibilidade a Drogas/diagnóstico , Clínicos Gerais , Guias de Prática Clínica como Assunto , Padrões de Prática Médica , Farmacorresistência Bacteriana , Medicina Geral , Papel do Médico , Pediatras , Resistência Microbiana a Medicamentos , Antibióticos beta Lactam
16.
Health Informatics J ; 30(2): 14604582241259322, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38855877

RESUMO

Patients with rare diseases commonly suffer from severe symptoms as well as chronic and sometimes life-threatening effects. Not only the rarity of the diseases but also the poor documentation of rare diseases often leads to an immense delay in diagnosis. One of the main problems here is the inadequate coding with common classifications such as the International Statistical Classification of Diseases and Related Health Problems. Instead, the ORPHAcode enables precise naming of the diseases. So far, just few approaches report in detail how the technical implementation of the ORPHAcode is done in clinical practice and for research. We present a concept and implementation of storing and mapping of ORPHAcodes. The Transition Database for Rare Diseases contains all the information of the Orphanet catalog and serves as the basis for documentation in the clinical information system as well as for monitoring Key Performance Indicators for rare diseases at the hospital. The five-step process (especially using open source tools and the DataVault 2.0 logic) for set-up the Transition Database allows the approach to be adapted to local conditions as well as to be extended for additional terminologies and ontologies.


Assuntos
Bases de Dados Factuais , Documentação , Doenças Raras , Doenças Raras/classificação , Doenças Raras/diagnóstico , Humanos , Documentação/métodos , Documentação/normas , Classificação Internacional de Doenças/tendências , Classificação Internacional de Doenças/normas
17.
Eur Rev Med Pharmacol Sci ; 28(10): 3513-3522, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38856126

RESUMO

OBJECTIVE: In our study, we analyzed the efficacy and safety data of patients with systemic lupus erythematosus (SLE) after switching to biosimilar rituximab (RTX). PATIENTS AND METHODS: Twenty-two patients who switched to RTX were included in the study. Efficacy data were analyzed using the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) score, and safety data were analyzed using the frequency of side effects. RESULTS: The mean treatment duration of originator RTX was 35.6 ± 23.0 months, and the median treatment duration of biosimilar RTX was 17 months. The SLEDAI-2K score, approximately three months after the first dose of biosimilar RTX, was significantly lower (p = 0.027). A statistically significant difference was found between the SLEDAI-2K score assessed at the follow-up visit three months after the last dose of originator RTX and the SLEDAI-2K score obtained approximately three months after the first dose of biosimilar RTX (p = 0.011) and the calculated median SLEDAI-2K score was significantly lower than the SLEDAI-2K score assessed after administration of originator RTX. The side effect frequency that developed during the treatment of originator RTX was 15.3 per 100 patient-years. The most common side effect was infection, which was 15.3 per 100 patient-years. The most frequent infection was urinary tract infection. The side effect frequency during treatment of biosimilar RTX was 39 per 100 patient-years, and the most frequent infection was pneumonia. CONCLUSIONS: In our study, SLEDAI-2K scores demonstrated that no efficacy loss was experienced after switching to CT-P10 molecule, which is a biosimilar RTX. It was observed that switching to biosimilar RTX did not decrease treatment efficacy in the patient group diagnosed with SLE and biosimilar RTX was found to be safe.


Assuntos
Medicamentos Biossimilares , Lúpus Eritematoso Sistêmico , Rituximab , Humanos , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Lúpus Eritematoso Sistêmico/diagnóstico , Rituximab/efeitos adversos , Rituximab/administração & dosagem , Rituximab/uso terapêutico , Medicamentos Biossimilares/administração & dosagem , Medicamentos Biossimilares/efeitos adversos , Medicamentos Biossimilares/uso terapêutico , Estudos Retrospectivos , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Resultado do Tratamento , Substituição de Medicamentos , Anticorpos Monoclonais Murinos
18.
Eur Rev Med Pharmacol Sci ; 28(10): 3683-3696, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38856144

RESUMO

OBJECTIVE: Monocyte count and red cell distribution width (RDW) have shown prognostic potential in patients with fibrotic lung diseases. Their kinetics and prognostic usefulness of peripheral blood indices in patients with interstitial lung diseases (ILDs) undergoing surgical lung biopsy for diagnostic reasons have not been studied. PATIENTS AND METHODS: We retrospectively included consecutive patients with ILD who underwent surgical lung biopsy for diagnostic purposes Between 07/11/2019 and 11/10/2022. RESULTS: Fifty-five (n=55) patients were included in the study. Median age was 65.0 years (95% CI: 63.0 to 66.0). Postoperative peripheral blood monocyte count on Day 1 was significantly higher compared to preoperative, perioperative, and postoperative values on Day 90 (repeated measures ANOVA, p<0.0001). Patients in the high postoperative monocyte count group had significantly increased length of postoperative hospital stay [Mann-Whitney test, p=0.007] and significantly lower Forced Vital Capacity (FVC)% predicted 3 months after surgery [Mann-Whitney test, p=0.029] compared to patients in the low postoperative monocyte count group. Postoperative RDW on Day 90 was significantly higher compared to preoperative, perioperative and postoperative-Day 1 RDW (repeated measures ANOVA, p=0.008, p=0.006, p<0.0001, respectively). Patients in the high postoperative RDW group did not have increased hospital stay (Mann-Whitney test, p=0.49) or decreased FVC% predicted at 3 months compared to patients in the low postoperative RDW group (Mann-Whitney test, p=0.91). CONCLUSIONS: Peripheral blood monocyte count could be a prognostic biomarker for patients with ILDs undergoing diagnostic surgical lung biopsies. RDW does not seem to represent an acute phase biomarker but seems to increase over time following disease progression. Larger studies are urgently required.


Assuntos
Doenças Pulmonares Intersticiais , Monócitos , Humanos , Idoso , Feminino , Masculino , Pessoa de Meia-Idade , Monócitos/patologia , Doenças Pulmonares Intersticiais/sangue , Doenças Pulmonares Intersticiais/diagnóstico , Doenças Pulmonares Intersticiais/cirurgia , Doenças Pulmonares Intersticiais/patologia , Estudos Retrospectivos , Contagem de Leucócitos , Biópsia , Pulmão/patologia , Pulmão/cirurgia , Tempo de Internação , Índices de Eritrócitos , Período Pós-Operatório
19.
J Vis Exp ; (207)2024 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-38856199

RESUMO

Gram-negative (GN) sepsis is a medical emergency where management in resource-limited settings relies on conventional microbiological culture techniques providing results in 3-4 days. Recognizing this delay in turnaround time (TAT), both EUCAST and CLSI have developed protocols for determining AST results directly from positively flagged automated blood culture bottles (+aBCs). EUCAST rapid AST (RAST) protocol was first introduced in 2018, where zone diameter breakpoints for four common etiological agents of GN sepsis, i.e., Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii complex can be reported. However, those clinical laboratories that have implemented this method in their routine workflow rely on mass spectrometry-based microbial identification, which is not easily available, thus precluding its implementation in resource-limited settings. To circumvent it, we evaluated a direct inoculum protocol (DIP) using a commercial automated microbial identification and antimicrobial susceptibility testing system (aMIAST) to enable early microbial identification within 8 h of positive flagging of aBC. We evaluated this protocol from January to October 2023 to identify the four RAST reportable GN (RR-GN) in the positively flagged aBC. The microbial identification results in DIP were compared with the standard inoculum preparation protocol (SIP) in aMIAST. Of 204 +aBCs with monomorphic GN (+naBC), one of the 4 RR-GN was identified in 105 +naBCs by SIP (E. coli: 50, K. pneumoniae: 20, P. aeruginosa: 9 and A. baumannii complex: 26). Of these, 94% (98/105) were correctly identified by DIP whereas major error and very major error rates were 6% (7/105) and 1.7% (4/240), respectively. When DIP for microbial identification is done using the EUCAST RAST method, provisional clinical reports can be provided within 24 h of receiving the sample. This approach has the potential to significantly reduce the TAT, enabling early institution of appropriate antimicrobial therapy.


Assuntos
Testes de Sensibilidade Microbiana , Humanos , Testes de Sensibilidade Microbiana/métodos , Sepse/microbiologia , Sepse/diagnóstico , Técnicas Bacteriológicas/métodos
20.
Parasitol Res ; 123(6): 238, 2024 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-38856772

RESUMO

Zoonotic cutaneous leishmaniasis (ZCL) is a neglected tropical disease caused by Leishmania (L.) major. This zoonosis is characterized by a broad-spectrum clinical polymorphism and may be underestimated and poorly treated since it is a simulator of various dermatoses. The aim of our study was to analyze the clinical polymorphism of patients with ZCL. A total of 142 patients with confirmed CL based on the microscopic examination of skin lesion biopsies were included in this study. Molecular typing of Leishmania species revealed that all patients were infected with L. major. In total, 14 clinical forms were observed. Six were typical and eight were atypical. The typical ZCL forms are grouped as follows: papular (26.76%), ulcero-crusted (26.05%), ulcerated (13.38%), impetiginous (9.86%), nodular (9.15%), and papulo-nodular (5.63%) lesions. In atypical ZCL forms, we described erythematous (2.81%), erysipeloid (1.4%), sporotrichoid, (1.4%), keratotic (0.7%) lupoid (0.7%), lichenoid (0.7%), psoriasiform (0.7%), and zosteriform (0.7%) lesions. Here, the lichenoid and the keratotic forms caused by L. major were reported for the first time in Tunisia. These findings will help physicians to be aware of the unusual lesions of ZCL that could be confused with other dermatological diseases. For this reason, it will be necessary to improve the diagnosis of CL especially in endemic areas. Such large clinical polymorphism caused by L. major may be the result of a complex association between the vector microbiota, the parasite, and the host immune state, and further studies should be carried out in order to reveal the mechanisms involved in clinical polymorphism of ZCL.


Assuntos
Leishmaniose Cutânea , Zoonoses , Leishmaniose Cutânea/diagnóstico , Leishmaniose Cutânea/parasitologia , Humanos , Masculino , Feminino , Adulto , Zoonoses/parasitologia , Zoonoses/diagnóstico , Pessoa de Meia-Idade , Animais , Adolescente , Adulto Jovem , Criança , Leishmania major/genética , Leishmania major/isolamento & purificação , Idoso , Pele/parasitologia , Pele/patologia , Pré-Escolar
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...