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1.
Acta Neurol Taiwan ; 31(1): 36-40, 2022 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-34988952

RESUMO

PURPOSE: Posterior reversible encephalopathy syndrome (PRES) displayed various acute neurological symptoms. PRES is a rare presentation of hypercalcemia. Here we present a case with ectopic secretion of parathyroid hormone from neuroendocrine carcinoma of the endometrium presenting as hypercalcemia-related PRES. CASE REPORT: A 67-year-old woman presented with acute generalized tonic-clonic seizure followed by post-ictal confusion and neuropsychiatric behaviors. The diagnosis is PRES. Investigations showed uterine cervical region with multiple liver metastasis complicated with hypercalcemia, elevated intact parathyroid hormone. Further pathology concluded as a poorly differentiated adenocarcinoma of the endometrium with neuroendocrine differentiation and immunoreactive for PTH. The patient's neurologic manifestations had resolved. Serum free calcium level and intact-PTH had declined after first course of definitive chemoradiation. CONCLUSION: Immunostaining of the tumor tissue can be used to estimate the ectopic PTH production within the tumor cells. Early detection and appropriate clinical treatment hold the potential to improve the prognosis of refractory hypercalcemia and hypercalcemia related PRES. Keyword: Posterior reversible encephalopathy syndrome; hypercalcemia; intact-parathyroid hormone; parathyroid hormone-related peptide; neuroendocrine carcinoma of endometrium.


Assuntos
Carcinoma Neuroendócrino , Hipercalcemia , Síndrome da Leucoencefalopatia Posterior , Idoso , Carcinoma Neuroendócrino/complicações , Endométrio , Feminino , Humanos , Hipercalcemia/etiologia , Hormônio Paratireóideo
2.
BMC Surg ; 22(1): 6, 2022 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-34996410

RESUMO

BACKGROUND: Ingestion of fish bones leading to gastric perforation and inducing abscess formation in the caudate lobe of the liver is very rare. CASE PRESENTATION: A 67-year-old man presented to our hospital with a 2-day history of subxiphoid pain. There were no specific symptoms other than pain. Laboratory tests showed only an increase in the number and percentage of neutrophils. Contrast-enhanced Computerized tomography (CT) of the abdomen showed two linear dense opacities in the gastric cardia, one of which penetrated the stomach and was adjacent to the caudate lobe of the liver, with inflammatory changes in the caudate lobe. We finally diagnosed his condition as a caudate lobe abscess secondary to intestinal perforation caused by a fishbone based on the history and imaging findings. The patient underwent 3D laparoscopic partial caudate lobectomy, incision and drainage of the liver abscess, and fishbone removal. The procedure was successful and we removed the fishbone from the liver. The patient was discharged on the 9th postoperative day without other complications. CONCLUSIONS: Liver abscess caused by foreign bodies requires multidisciplinary treatment. Especially when located in the caudate lobe, we must detect and remove the cause of the abscess as early as possible. Foreign bodies that perforate the gastrointestinal tract can penetrate to the liver and cause abscess formation, as in this case. When exploring the etiology of liver abscesses, we should investigate the general condition, including the whole gastrointestinal tract.


Assuntos
Corpos Estranhos , Migração de Corpo Estranho , Laparoscopia , Abscesso Hepático , Idoso , Animais , Corpos Estranhos/complicações , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/cirurgia , Migração de Corpo Estranho/complicações , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/cirurgia , Humanos , Abscesso Hepático/diagnóstico por imagem , Abscesso Hepático/etiologia , Abscesso Hepático/cirurgia , Masculino
3.
BMC Surg ; 22(1): 5, 2022 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-34996411

RESUMO

BACKGROUND: The frequency of gallstones is higher in patients who have undergone gastrectomy than in the general population. While there have been some studies of gallstone formation after open gastrectomy, there are few reports of gallstones after laparoscopic gastrectomy (LG). Therefore, this study aimed to evaluate the incidence of gallstones after LG. METHODS: We retrospectively reviewed the records of 184 patients who underwent LG between January 2011 and May 2016 at Saiseikai Utsunomiya Hospital. After gastrectomy, abdominal ultrasonography was generally performed every 6 months for 5 years. Patients who underwent cholecystectomy before LG, underwent simultaneous cholecystectomy, and did not undergo abdominal ultrasonography, with an observation period of < 24 months, were excluded from the study. Finally, 90 patients were analyzed. Laparoscopic cholecystectomy was performed whenever biliary complications occurred. Patient characteristics were compared using the two-tailed Fisher's exact test or Chi-square test. In addition, the risk factors for postoperative gallstones were analyzed using logistic regression analysis. RESULTS: Among the 90 patients included in this study, 60 were men (78%), and the mean age was 65.5 years. Laparoscopic total gastrectomy was performed for 15 patients and laparoscopic distal gastrectomy for 75 patients. D2 lymph node dissection was performed for 8 patients (9%), whereas 68 patients underwent LG with Roux-en-Y reconstruction (76%). Gallstones were detected after LG in 27 of the 90 (30%) patients. Multivariate analysis identified Roux-en-Y reconstruction and male sex as significant risk factors of gallstones after gastrectomy. The incidence of gallstones was significantly higher (53%) in male patients who underwent Roux-en-Y reconstruction. Symptomatic gallstones after laparoscopic cholecystectomy were found in 6 cases (6/27, 22%), and all patients underwent laparoscopic cholecystectomy. CONCLUSION: Roux-en-Y reconstruction and male sex were identified as significant risk factors for gallstones after LG.


Assuntos
Cálculos Biliares , Laparoscopia , Neoplasias Gástricas , Idoso , Cálculos Biliares/diagnóstico por imagem , Cálculos Biliares/epidemiologia , Cálculos Biliares/etiologia , Gastrectomia/efeitos adversos , Humanos , Laparoscopia/efeitos adversos , Masculino , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Neoplasias Gástricas/epidemiologia , Neoplasias Gástricas/cirurgia
4.
World J Surg Oncol ; 20(1): 8, 2022 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-34996471

RESUMO

BACKGROUND: Malignant peripheral nerve sheath tumor (MPNST) is a rare soft tissue sarcoma mainly treated via surgical resection. Herein, we report a case of MPNST wherein a massive tumor thrombus extended to the major veins and heart. CASE PRESENTATION: A 39-year-old female with a history of neurofibromatosis type 1 developed MPNST from the right radial nerve. In addition to adjuvant chemotherapy, she underwent wide tumor resection and concomitant radial nerve resection, followed by postoperative radiotherapy. Histological evaluation revealed marked venous invasion. The 2-year follow-up CT revealed an asymptomatic recurrent tumor thrombus extending from the right subclavian vein to the heart. An urgent life-saving operation was performed to ligate the base of the right subclavian vein and remove the entire intravenous thrombus that extended to the right ventricle. The remaining tumor in the right subclavian vein increased in size 3 months after thrombectomy. After confirming the absence of any metastatic lesions, the patient underwent extended forequarter amputation to achieve surgical remission. One year later, a new metastasis to the right diaphragm was safely resected. The patient remains alive without any evidence of disease 2 years after the extended forequarter amputation. CONCLUSIONS: In cases of a previous history of microscopic venous invasion, recurrence can occur as a massive tumor thrombus that extends to the great vessels.


Assuntos
Neurofibromatose 1 , Neurofibrossarcoma , Neoplasias de Tecidos Moles , Trombose , Adulto , Feminino , Humanos , Recidiva Local de Neoplasia/cirurgia , Trombose/etiologia , Trombose/cirurgia
5.
Rev Alerg Mex ; 69 Suppl 1: s24-s30, 2022.
Artigo em Espanhol | MEDLINE | ID: mdl-34998307

RESUMO

Air pollution, climate change, and the decrease of biological diversity are major threats to human health. In the past decades, an increase in allergic diseases, including asthma and rhinoconjunctivitis, has been observed. Up to 40 % of the world population may have an allergic disease, which represents a significant impact on the quality of life of those who suffer from it, and environmental pollution is one of the causes of its presentation. Air pollution causes significant morbidity and mortality in patients with inflammatory airway diseases such as allergic rhinitis, chronic rhinosinusitis, asthma, and chronic obstructive pulmonary disease. Oxidative stress in patients with respiratory diseases can induce eosinophilic inflammation in the airways, increase atopic allergic sensitization, and rise susceptibility to infections. Climate change has influenced exposure to extramural allergens and it is associated with exacerbations of respiratory diseases in the upper and lower airway. The interaction of indoor and outdoor environmental exposure and host factors can affect the development and progression of lifelong allergic diseases. The decrease of exposure to air pollutants has been associated with a favorable response in respiratory health, which is why it is necessary to implement measures that contribute to an improvement in air quality.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Asma , Rinite Alérgica , Poluentes Atmosféricos/efeitos adversos , Poluição do Ar/efeitos adversos , Alérgenos , Asma/epidemiologia , Asma/etiologia , Humanos , Qualidade de Vida , Rinite Alérgica/epidemiologia , Rinite Alérgica/etiologia
6.
Rev Alerg Mex ; 69 Suppl 1: s31-s37, 2022.
Artigo em Espanhol | MEDLINE | ID: mdl-34998308

RESUMO

This allergy is a hypersensitivity reaction that is triggered by contact with latex. Symptoms vary depending on factors such as route, frequency, and exposure dose, as well as individual susceptibility. The clinical manifestations can be localized at the site of contact with latex or generalized. Exposure can occur directly as a result of contact with the skin and mucous membranes, that is by touching or being touched by objects with latex, or by inhaling (breathing) particles from objects with latex. Contact can also be indirect; for example, by ingesting food that has been handled by a worker wearing latex gloves or by having contact with a person who has been blowing up balloons. The diagnosis of latex allergy is made based on the patient's medical history and on what has been reported in the interrogation, and it is complemented with in vivo studies (such as skin tests and provocation tests) or in vitro studies (determination of specific IgE). The fundamental pillar in the treatment of latex allergy is the education of the patient to achieve the avoidance of products made with this material or the contact and intake of food that has had contact with latex. In view of the foregoing, latex allergy has a great medical and social relevance due to all the safety measures that the patient must take.


Assuntos
Hipersensibilidade ao Látex , Humanos , Hipersensibilidade ao Látex/diagnóstico , Hipersensibilidade ao Látex/epidemiologia , Hipersensibilidade ao Látex/etiologia , Testes Cutâneos
7.
Rev Alerg Mex ; 69 Suppl 1: s69-s80, 2022.
Artigo em Espanhol | MEDLINE | ID: mdl-34998312

RESUMO

Chronic spontaneous urticaria is a condition that persists for more than six weeks, it occurs in the absence of an identifiable triggering factor and from the pathogenic activation of mast cells and basophils. The possibility of autoimmune etiology in up to 40 % of patients is presented, followed by subclinical infections and psychological factors. Two main mechanisms of the pathogenesis of chronic urticaria have been proposed: the former is the dysregulation of intracellular signaling pathways within mast cells and basophils, which leads to defects in the traffic or function of these cells. The latter is the development of autoantibodies against FcεRIα or IgE, in both mast cells and basophils. Numerous autoimmune diseases such as systemic lupus erythematosus, polymyositis, dermatomyositis, and rheumatoid arthritis have been associated with chronic urticaria; however, autoimmune thyroid disease deserves a special mention. A higher prevalence of antithyroid antibodies has been found, regardless of thyroid function (euthyroidism, hypo and hyperthyroidism) in patients with chronic spontaneous urticaria. Several infections have been linked to chronic urticaria. The best evidence is for Helicobacter pylori infection. Finally, stress is associated with the onset of the disease through the activation of the sympathetic and adrenomedullary system and the hypothalamic-pituitary- adrenal axis. Diagnosis may vary in different regions of the world, but the common feature is the completion of a thorough medical history.


Assuntos
Doenças Autoimunes , Urticária Crônica , Infecções por Helicobacter , Helicobacter pylori , Urticária , Autoanticorpos , Doenças Autoimunes/epidemiologia , Autoimunidade , Doença Crônica , Humanos , Imunoglobulina E , Receptores de IgE , Urticária/epidemiologia , Urticária/etiologia
8.
Rev Alerg Mex ; 69 Suppl 1: s81-s93, 2022.
Artigo em Espanhol | MEDLINE | ID: mdl-34998313

RESUMO

Betalactams are the most widely used antimicrobials for their safety and efficacy. These include the penicillins, cephalosporins, carbapenems, and monobactams. Penicillin allergy ranks first in relation to drug allergy. 10 to 20 % of the population is labeled as allergic to it, often wrongly. Cross reaction is reported in 2 to 5 % between penicillins and cephalosporin. There is no cross reaction between penicillins and aztreonam, but there is with ceftazidime. All the mechanisms of the Gell and Coombs classification are included in the pathophysiology of hypersensitivity reactions to penicillin. Stratification according to risk allows us to take the most objective behavior to label the patient as allergic to. In the natural history of penicillin allergy, 80-90 % of patients lose this sensitivity by 10 years. If necessary, the patient can undergo a desensitization protocol. The immuno-allergist is a key piece in the selection of the patient, the elaboration of the challenge and desensitization protocols, in a controlled environment.


Assuntos
Hipersensibilidade a Drogas , Penicilinas , Antibacterianos/efeitos adversos , Carbapenêmicos , Cefalosporinas/efeitos adversos , Reações Cruzadas , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/epidemiologia , Hipersensibilidade a Drogas/etiologia , Humanos , Penicilinas/efeitos adversos , Testes Cutâneos
9.
Orv Hetil ; 163(2): 43-51, 2022 01 09.
Artigo em Húngaro | MEDLINE | ID: mdl-34999570

RESUMO

Összefoglaló. A malignus daganatok és a stroke együttesen gyakran fordulnak elo a stroke tradicionális rizikófaktoraival (magas vérnyomás, hyperlipidaemia, cukorbetegség, elhízás, dohányzás) rendelkezo betegekben. Az elmúlt évtized kutatási eredményei alátámasztották, hogy a rosszindulatú daganatban szenvedo betegekben szignifikánsan nagyobb a stroke kockázata. A malignus daganatokhoz társuló stroke a leggyakrabban a malignus daganat diagnózisát követo fél-egy év során jelentkezik. A kapcsolat a másik irányban is létezik: stroke-betegek követése során malignus daganat szignifikánsan gyakrabban jelent meg, mint a stroke-mentes kontrollcsoportban. A daganatot a leginkább a stroke utáni elso hat hónapban diagnosztizálják. A korábban nem ismert rosszindulatú daganat idonként az akut stroke kezelése során derül ki. Ismeretlen eredetu stroke (cryptogen stroke) hátterében rosszindulatú tumorhoz társuló hiperkoagulabilitás is feltételezheto. A háttérben a leggyakrabban tüdorák áll, ezt az emlocarcinoma és a melanoma követi. Jelenleg nincs ajánlás a felismert malignus daganatok esetében a stroke primer prevenciójára. A malignus tumor mellett jelentkezo akut ischaemiás stroke kezelésére a rekombináns szöveti plazminogénaktivátorral történo intravénás thrombolysis alkalmazható a várható túlélés és a vérzésveszély mérlegelésével; a mechanikus thrombectomia alkalmazásáról kevés az adat, irányelvszintu ajánlások még nincsenek. A másodlagos stroke-prevencióra a kis molekulasúlyú heparinnal történo antikoagulálást javasolják. Jelenleg még nem ismerjük pontos részleteiben a daganat által okozott hiperkoaguláció mechanizmusát, ezért még nem ismert, hogy mi a legjobb módszer tumoros betegeknél a stroke megelozésére. Nincsenek jól definiált ajánlások arra sem, hogy milyen esetekben lenne indokolt tumorkeresés cryptogen stroke-os betegekben. Orv Hetil. 2022; 163(2): 43-51. Summary. Cancer and stroke occur in similar patient populations, and they have similar traditional risk factors (hypertension, hyperlipidemia, obesity, diabetes, and smoking), therefore, it is beneficial to study the relationship between cancer and stroke. Patients diagnosed with cancer have an increased incidence of acute ischemic cerebral events within the first 6 months up to a year post diagnosis. The reverse relationship is also true for patients diagnosed with stroke and then cancer. Interestingly, patients may have a stroke as their first indication to an underlying developing cancer and will most often be diagnosed with cancer sometime within six months to a year after the cerebral incident. When cancer is diagnosed immediately after a cryptogenic stroke (unknown etiology), the stroke may be a result of cancer-associated hypercoagulability. The most common malignancies observed in the cancer-stroke patients are lung, breast and melanoma. Currently, there are no pharmacologic recommendations for primary stroke prevention in cancer patients. For acute ischemic stroke, life expectancy and the potential for hemorrhagic complications should be considered when deciding on thrombolytic treatment. Only a few case series have been reported on mechanical thrombectomy in malignancies, and there are no guideline recommendations yet. Secondary prevention is advised through low molecular weight heparin. Understanding cancer-associated hypercoagulability and the ways we can prevent the combined effects of cancer and stroke is a crucial gap that requires further studies. Additionally, guides to aid in the recognition of underlying malignancy in patients suffering from cryptogenic stroke need to be established. Orv Hetil. 2022; 163(2): 43-51.


Assuntos
Isquemia Encefálica , AVC Isquêmico , Neoplasias , Acidente Vascular Cerebral , Humanos , Incidência , Neoplasias/complicações , Neoplasias/diagnóstico , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia
11.
Scand J Trauma Resusc Emerg Med ; 30(1): 3, 2022 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-35016708

RESUMO

BACKGROUND: Posttraumatic stress disorder (PTSD) has been shown to be elevated among first responders (Emergency Medical Services, fire service, police force) compared to the general population. Examining the prevalence of mental health issues in a work force with an elevated occupational risk is fundamental towards ensuring their wellbeing and implementing safeguard measures. The goal of this study is therefore to report the prevalence of depression, anxiety, posttraumatic development, and PTSD in Norwegian ambulance personnel. METHODS: This study is a cross-sectional, anonymous, web-based survey (Questback®), performed among operative personnel employed in the Emergency Medical Services in the Regional Health Trust of Central Norway between 18. February and 9. April 2021. The study was sent to 1052 eligible participants. Questions reported demographic data, a traumatic events exposure index, Patient Health Questionnaire-9 (Depression), Generalized Anxiety Disorder-7 scale, Posttraumatic symptom scale (PTSD) and Posttraumatic change scale. RESULTS: The response rate in this study was 45.5% (n = 479/1052). The mean age of respondents was 37.1 years (std. 11.1) and 52.8% (n = 253) were male. Of the respondents, 80.6% (n = 386) were married or had a partner, and 91.6% (n = 439) reported having access to a peer support programme, with 34.9% (n = 167) reporting that they had utilized peer support. In this study, 5% (n = 24) showed a prevalence of manifest posttraumatic stress disorder symptoms, while 8.6% (n = 41) reported moderate to severe depression and 2.9% (n = 14) presented moderate to severe symptoms of general anxiety. Of the respondents, 77.2% (n = 370) reported personal growth because of their work experiences. CONCLUSIONS: This study indicates that Norwegian ambulance personnel report a prevalence of posttraumatic stress symptoms and depression, which is slightly higher for men, and lower for the female proportion in this study, when compared to an adult Norwegian population. The vast majority of respondents reported personal growth because of their work experience, and both the degree of peer support and having a partner seem to influence levels of posttraumatic stress and -development.


Assuntos
Transtornos de Estresse Pós-Traumáticos , Adulto , Ambulâncias , Ansiedade , Estudos Transversais , Depressão/epidemiologia , Depressão/etiologia , Feminino , Humanos , Masculino , Saúde Mental , Prevalência , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/etiologia
12.
J Med Case Rep ; 16(1): 22, 2022 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-35016725

RESUMO

BACKGROUND: Tumor-induced osteomalacia is a rare, acquired paraneoplastic syndrome, including hypophosphatemia, high serum alkaline phosphatase, reduced active vitamin D, suboptimal bone mineral density, bone pain, fragility fractures, and muscle weakness. CASE PRESENTATION: We report a case of 74-year-old male of mixed ancestry with hypophosphatemia resistant to treatment despite optimal compliance, associated with profound reduction of bone mineral density and multiple nontraumatic fractures, including bilateral rib fractures, lower-thoracic (T11, T12) vertebrae, and two fractures involving the surgical and anatomical neck of the right humerus. We discuss an approach to identifying the underlying cause of hypophosphatemia associated with fragility fractures, and options for management of this rare condition. CONCLUSION: Although rare, tumor-induced osteomalacia can be diagnosed if a logical stepwise approach is implemented. Surgery could be curative if the tumor is properly located and is resectable.


Assuntos
Hipofosfatemia , Neoplasias de Tecido Conjuntivo , Osteomalacia , Síndromes Paraneoplásicas , Idoso , Fatores de Crescimento de Fibroblastos , Humanos , Hipofosfatemia/etiologia , Masculino , Neoplasias de Tecido Conjuntivo/complicações , Neoplasias de Tecido Conjuntivo/diagnóstico por imagem , Neoplasias de Tecido Conjuntivo/cirurgia , Osteomalacia/diagnóstico por imagem , Osteomalacia/etiologia , Síndromes Paraneoplásicas/etiologia
13.
Compend Contin Educ Dent ; 43(1): e5-e8, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35019665

RESUMO

This study evaluated the effect of alloplastic bone grafts in osseous defects following surgical removal of horizontally impacted third molars by comparing the periodontal measures distal to the second molar in grafted and nongrafted third molar extraction sites. Materials and Methods: A double-blind, randomized, controlled clinical trial was designed on subjects with bilateral horizontally impacted mandibular third molars. Grafting consisting of alloplasts at the third molar extraction sites was compared with nongrafted sites. This study assessed 54 randomized sites in 27 patients who were selected using a split-mouth design. The predictor variable included the change in pocket depth distal to the mandibular second molar and associated dentin hypersensitivity around the second molar, assessed preoperatively and at 3 and 6 months after third molar surgery. The data regarding pocket depth reduction was statistically analyzed using paired t-test. The data concerning reduction in dentin hypersensitivity was statistically analyzed using chi-square test. Results: Six months after third molar surgery, mean pocket depth distal to mandibular second molar decreased significantly at the grafted sites compared to the nongrafted sites. The reduction in dentin hypersensitivity of mandibular second molar was statistically significant for the grafted sites at 6 months, compared to the nongrafted sites.


Assuntos
Sensibilidade da Dentina , Dente Impactado , Sensibilidade da Dentina/etiologia , Humanos , Mandíbula/cirurgia , Dente Serotino/cirurgia , Extração Dentária , Dente Impactado/cirurgia
14.
A A Pract ; 16(1): e01556, 2022 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-35020604

RESUMO

Autonomic dysreflexia occurs after a spinal cord injury usually at the level of T6 or above, and its hallmark feature is exaggerated autonomic response to noxious stimuli resulting in uncontrolled hypertensive episodes with reflexive bradycardia that can be fatal if not controlled. We present a case highlighting regional anesthetic techniques, including peripheral nerve blocks, to ameliorate the symptoms of autonomic dysreflexia triggered by hip fractures in a 57-year-old woman with an old C5-C6 spinal cord injury before definitive hip surgery. The regional techniques described provide anesthesiologists with a simple strategy to potentially mitigate a life-threatening situation.


Assuntos
Anestesia por Condução , Disreflexia Autonômica , Fraturas do Quadril , Hipertensão , Traumatismos da Medula Espinal , Disreflexia Autonômica/etiologia , Feminino , Fraturas do Quadril/cirurgia , Humanos , Pessoa de Meia-Idade
15.
BMC Gastroenterol ; 22(1): 20, 2022 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-35021995

RESUMO

BACKGROUND: Emerging evidence suggests that cardiometabolic index (CMI) is closely related to diabetes, hypertension, stroke, cardiovascular disease, and kidney disease, which implies that CMI has the value as an indicator of metabolic diseases. However, data on the relationships between CMI and non-alcoholic fatty liver disease (NAFLD) risks have not been reported. This study is designed to examine the association between CMI and NAFLD in the general population. METHODS: The current study included 14,251 subjects whose CMI was the product of triglyceride/high-density lipoprotein cholesterol ratio and waist-to-height ratio. Linear regression was used to analyze the correlation between baseline information and CMI, logistic regression was used to study the relationship between CMI and NAFLD, and subgroup analysis was used to explore potential high-risk groups. RESULTS: After adjusted for potential confounding factors, higher CMI was independently associated with NAFLD, in which every additional standard deviation (SD) of CMI increased the risk of NAFLD by 28% (OR 1.28 per SD increase, 95% CI 1.19-1.37, P for trend < 0.0001). There were also significant differences in CMI-related NAFLD risk among different ages and genders, in which the CMI-related NAFLD risk in young people was significantly higher than that in other age groups (OR = 2.63 per SD increase for young people, OR = 1.38 per SD increase for young and middle-aged people, OR = 1.18 per SD increase for middle-aged and elderly people; OR = 1.14 per SD increase for elderly people, P for interaction = 0.0010), and the CMI-related NAFLD risk in women was significantly higher than that in men (OR = 1.58 per SD increase for women, OR = 1.26 per SD increase for men, P for interaction = 0.0045). CONCLUSIONS: Current studies have found that after excluding potential confounding factors, higher CMI in the general population is independently associated with NAFLD risk.


Assuntos
Doenças Cardiovasculares , Hepatopatia Gordurosa não Alcoólica , Adolescente , Idoso , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , HDL-Colesterol , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Fatores de Risco , Triglicerídeos
16.
Nihon Shokakibyo Gakkai Zasshi ; 119(1): 47-52, 2022.
Artigo em Japonês | MEDLINE | ID: mdl-35022370

RESUMO

A man in his 70s visited our hospital for abdominal pain. Upon admission, abdominal computed tomography findings suggested a duodenal diverticular perforation. Upper gastrointestinal endoscopy revealed an incarcerated enterolith in the periampullary diverticulum. We achieved conservative management by inserting an endoscopic nasobiliary drainage tube into the duodenal diverticulum to aid drainage. The patient was discharged without serious complications 35 days after admission. We report a case of duodenal diverticular perforation with an incarcerated enterolith managed conservatively using endoscopic therapy.


Assuntos
Divertículo , Duodenopatias , Úlcera Duodenal , Perfuração Intestinal , Divertículo/complicações , Divertículo/diagnóstico por imagem , Divertículo/cirurgia , Drenagem , Duodenopatias/diagnóstico por imagem , Duodenopatias/etiologia , Duodenopatias/cirurgia , Humanos , Perfuração Intestinal/diagnóstico por imagem , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Masculino
17.
Nihon Shokakibyo Gakkai Zasshi ; 119(1): 61-65, 2022.
Artigo em Japonês | MEDLINE | ID: mdl-35022372

RESUMO

This is the case of a 40-year-old, 34-week pregnant woman, who had bloody stools and abdominal pain from 20 weeks gestation. She presented to our department as she noted an exacerbation in her abdominal pain, and was admitted. Sonography and magnetic resonance imaging displayed a mass with an appearance consistent with intussusception, hence intussusception was diagnosed. The patient underwent a cesarean section and concurrent partial colectomy, which showed that she had a colon cancer. There were no postoperative complications. Colon cancer as a complication of pregnancy is rare. We encountered a case of a patient with colorectal cancer that caused intussusception in the latter half of pregnancy, and report it here with a review of the literature.


Assuntos
Neoplasias do Colo , Intussuscepção , Adulto , Cesárea , Colectomia , Neoplasias do Colo/complicações , Neoplasias do Colo/diagnóstico por imagem , Neoplasias do Colo/cirurgia , Feminino , Humanos , Intussuscepção/diagnóstico por imagem , Intussuscepção/etiologia , Intussuscepção/cirurgia , Gravidez , Ultrassonografia
18.
J Int Med Res ; 50(1): 3000605211067688, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34986677

RESUMO

OBJECTIVE: To begin to understand how to prevent deep vein thrombosis (DVT) after an innovative operation termed intracorporeal laparoscopic reconstruction of detenial sigmoid neobladder, we explored the factors that influence DVT following surgery, with the aim of constructing a model for predicting DVT occurrence. METHODS: This retrospective study included 151 bladder cancer patients who underwent intracorporeal laparoscopic reconstruction of detenial sigmoid neobladder. Data describing general clinical characteristics and other common parameters were collected and analyzed. Thereafter, we generated model evaluation curves and finally cross-validated their extrapolations. RESULTS: Age and body mass index were risk factors for DVT, whereas postoperative use of hemostatic agents and postoperative passive muscle massage were significant protective factors. Model evaluation curves showed that the model had high accuracy and little bias. Cross-validation affirmed the accuracy of our model. CONCLUSION: The prediction model constructed herein was highly accurate and had little bias; thus, it can be used to predict the likelihood of developing DVT after surgery.


Assuntos
Laparoscopia , Neoplasias da Bexiga Urinária , Trombose Venosa , Humanos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Fatores de Risco , Neoplasias da Bexiga Urinária/cirurgia , Trombose Venosa/etiologia , Trombose Venosa/prevenção & controle
19.
Int J Surg ; 97: 106206, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34990833

RESUMO

BACKGROUND: Considerable controversies exist regarding the severity of skeletal muscle wasting (SMW) during neoadjuvant therapy (NAT) and its impact on therapeutic outcomes in patients with esophageal or esophagogastric junction cancer (EC/EGJC). This systematic review and meta-analysis aimed to resolve these issues. Particularly, the prognostic value of SMW during NAT was compared to pre-NAT and pre-surgery sarcopenia status. METHODS: We searched PubMed, Embase, and Cochrane Library databases through October 13th, 2021 to identify cohort studies focusing on SMW during NAT and therapeutic outcomes in EC/EGJC patients. Both neoadjuvant chemotherapy and neoadjuvant chemoradiotherapy were studied. A meta-analysis was conducted to quantify SMW and increased sarcopenia during NAT. Therapeutic outcomes include perioperative morbidities and survival profiles. A separate meta-analysis investigating the impacts of pre-NAT/pre-surgery sarcopenia on therapeutic outcomes was synchronously performed. RESULTS: Twenty-five studies with 2706 participants were included in this review. The pooled SMW during NAT were -2.47 cm2/m2 in skeletal muscle index and -0.23 cm2/m2 in psoas muscle index, with wasting proportion reaching 4.44%. The pooled prevalence rate of sarcopenia increased from 53.1% before NAT to 65.8% before surgery. Neoadjuvant chemoradiotherapy, advanced age, and being male were identified as risk factors for severe SMW during NAT. Notably, severe SMW during NAT showed a greater hazard ratio (HR) than pre-NAT and pre-surgery sarcopenia in predicting overall survival (HR 1.92, P < 0.001; HR 1.17, P = 0.036; and HR 1.28, P = 0.011, respectively) and recurrence-free survival (HR 1.51, P = 0.002; HR 1.27, P = 0.008; and HR 1.38, P = 0.006, respectively). However, severe SMW during NAT was not significantly associated with perioperative morbidities. CONCLUSIONS: SMW during NAT is a novel prognosticator that is different from sarcopenia for poor survival in EC/EGJC patients. Interventions aiming at maintaining skeletal muscle during NAT are anticipated to promote therapeutic outcomes.


Assuntos
Neoplasias Esofágicas , Sarcopenia , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/terapia , Junção Esofagogástrica , Humanos , Masculino , Músculo Esquelético/patologia , Terapia Neoadjuvante , Prognóstico , Músculos Psoas , Sarcopenia/etiologia , Taxa de Sobrevida
20.
JAMA Netw Open ; 5(1): e2142210, 2022 01 04.
Artigo em Inglês | MEDLINE | ID: mdl-34994793

RESUMO

Importance: A surge of COVID-19 occurred from March to June 2021, in New Delhi, India, linked to the B.1.617.2 (Delta) variant of SARS-CoV-2. COVID-19 vaccines were rolled out for health care workers (HCWs) starting in January 2021. Objective: To assess the incidence density of reinfection among a cohort of HCWs and estimate the effectiveness of the inactivated whole virion vaccine BBV152 against reinfection. Design, Setting, and Participants: This was a retrospective cohort study among HCWs working at a tertiary care center in New Delhi, India. Exposures: Vaccination with 0, 1, or 2 doses of BBV152. Main Outcomes and Measures: The HCWs were categorized as fully vaccinated (with 2 doses and ≥15 days after the second dose), partially vaccinated (with 1 dose or 2 doses with <15 days after the second dose), or unvaccinated. The incidence density of COVID-19 reinfection per 100 person-years was computed, and events from March 3, 2020, to June 18, 2021, were included for analysis. Unadjusted and adjusted hazard ratios (HRs) were estimated using a Cox proportional hazards model. Estimated vaccine effectiveness (1 - adjusted HR) was reported. Results: Among 15 244 HCWs who participated in the study, 4978 (32.7%) were diagnosed with COVID-19. The mean (SD) age was 36.6 (10.3) years, and 55.0% were male. The reinfection incidence density was 7.26 (95% CI: 6.09-8.66) per 100 person-years (124 HCWs [2.5%], total person follow-up period of 1696 person-years as time at risk). Fully vaccinated HCWs had lower risk of reinfection (HR, 0.14 [95% CI, 0.08-0.23]), symptomatic reinfection (HR, 0.13 [95% CI, 0.07-0.24]), and asymptomatic reinfection (HR, 0.16 [95% CI, 0.05-0.53]) compared with unvaccinated HCWs. Accordingly, among the 3 vaccine categories, reinfection was observed in 60 of 472 (12.7%) of unvaccinated (incidence density, 18.05 per 100 person-years; 95% CI, 14.02-23.25), 39 of 356 (11.0%) of partially vaccinated (incidence density 15.62 per 100 person-years; 95% CI, 11.42-21.38), and 17 of 1089 (1.6%) fully vaccinated (incidence density 2.18 per 100 person-years; 95% CI, 1.35-3.51) HCWs. The estimated effectiveness of BBV152 against reinfection was 86% (95% CI, 77%-92%); symptomatic reinfection, 87% (95% CI, 76%-93%); and asymptomatic reinfection, 84% (95% CI, 47%-95%) among fully vaccinated HCWs. Partial vaccination was not associated with reduced risk of reinfection. Conclusions and Relevance: These findings suggest that BBV152 was associated with protection against both symptomatic and asymptomatic reinfection in HCWs after a complete vaccination schedule, when the predominant circulating variant was B.1.617.2.


Assuntos
COVID-19/epidemiologia , Pessoal de Saúde , Reinfecção , SARS-CoV-2 , Adulto , COVID-19/etiologia , COVID-19/prevenção & controle , Vacinas contra COVID-19/administração & dosagem , Estudos de Coortes , Feminino , Humanos , Imunogenicidade da Vacina , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Centros de Atenção Terciária , Vacinas de Produtos Inativados/administração & dosagem , Vírion/imunologia , Adulto Jovem
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