Management of Extrapulmonary Nontuberculous Mycobacterial Infections

2018 ◽  
Vol 39 (03) ◽  
pp. 399-410 ◽  
Author(s):  
Michael Holt ◽  
Shannon Kasperbauer
Keyword(s):  
Surgical Intervention ◽  
Treatment Approach ◽  
Positive Outcome ◽  
Clinical Suspicion ◽  
Multiple Drug ◽  
Therapy Outcomes ◽  
Tissue Samples ◽  
Multiple Drug Therapy ◽  
High Degree ◽  
Microbiologic Diagnosis

AbstractExtrapulmonary disease occurs in a minority of nontuberculous mycobacterial (NTM) infections. The pattern of disease tends to be multifocal in immunocompromised individuals and localized in the immunocompetent. There is increasing recognition of disseminated Mycobacterium chimaera infection, as a complication of cardiac surgery, and focal infections due to rapidly growing mycobacteria. Microbiologic diagnosis requires detection of NTM in blood or tissue samples by microscopy, culture, or molecular methods. Management of extrapulmonary NTM infection requires prolonged, targeted multiple-drug therapy and, in some cases, aggressive surgical intervention. The optimal treatment approach is often unknown. Despite combined medical and surgical therapy, outcomes may be poor. A high degree of clinical suspicion and early diagnosis are required to maximize chances of a positive outcome.

scholarly journals A Case Report of Tubercular Constrictive Pericarditis

2015 ◽  
Vol 10 (1) ◽  
pp. 42-44
Author(s):  
Rajib Kumar Basak ◽  
Md Aftabuddin ◽  
Asit Baran Adhikary ◽  
Omar Sadeque Khan ◽  
Khan Mohammad Amanur Rahman
Keyword(s):  
Pulmonary Tuberculosis ◽  
Constrictive Pericarditis ◽  
Endemic Area ◽  
Surgical Intervention ◽  
Histopathological Examination ◽  
Late Presentation ◽  
Clinical Suspicion ◽  
Exertional Dyspnea ◽  
Nonspecific Sign ◽  
High Degree

Diagnosis of Constrictive pericarditis is sometimes become difficult because that requires a high degree of clinical suspicion due to nonspecific sign and symptoms. But in endemic area like our country the presentation of tubercular constrictive pericarditis is common. Here we report a case of 28 year Bangladeshi male with tubercular constrictive pericarditis presenting with progressive exertional dyspnea, ankle edema, puffyness of face, dry nonproductive caugh. After physical examination and investigation, the patient was diagnosed as constrictive pericarditis. Patient was previously diagnosed as a tubercular patient and still now on antitubercular cat-1 chemotherapy. So finally diagnosis becomes tubercular constrictive pericarditis. After improvement of the symptoms with medical treatment, the definitive surgical intervention, pericardiectomy done. Then removed pericardial tissue was sent for histopathological examination and histopathological report confirmed the diagnosis of tubercular pericarditis. This case is a late presentation of extrapulmonary manifestation of pulmonary tuberculosis, which is present as a consequence or, complication of pulmonary tuberculosis. So, early diagnosis and treatment is very much important in this case to prevent late consequence like tubercular constrictive pericarditis.University Heart Journal Vol. 10, No. 1, January 2014; 42-44

scholarly journals Euglycemic Diabetic Ketoacidosis after a Single Dose of Empagliflozin in a Patient with Pancreatitis

2021 ◽  
Vol 11 (2) ◽  
pp. 216-218
Author(s):  
Marta Brandão Calçada ◽  
Luís Fernandes ◽  
Rita Soares Costa ◽  
Sara Montezinho ◽  
Filipa Martins Duarte ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Diabetic Ketoacidosis ◽  
Drug Class ◽  
Clinical Suspicion ◽  
Laboratory Findings ◽  
Sodium Glucose Cotransporter ◽  
History Of ◽  
High Degree ◽  
Euglycemic Diabetic Ketoacidosis

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are the most recently approved drug class for the treatment of type 2 diabetes mellitus (T2D). Although they are largely well-tolerated, their intake has been associated with euglycemic diabetic ketoacidosis (DKA) in some rare cases. We report the case of a 70-year-old male with type 2 diabetes and no history of DKA, who started therapy with empagliflozin one day before presenting with acute pancreatitis and laboratory findings consistent with euglycemic DKA. SGLT2i can induce euglycemic DKA from the first dose. Given the atypical presentation, a high degree of clinical suspicion is required to recognize this complication.

scholarly journals Chronic Constrictive Pericarditis

2013 ◽  
Vol 2013 ◽  
pp. 1-4
Author(s):  
Hossein Doustkami ◽  
Afshin Hooshyar ◽  
Nasrollah Maleki ◽  
Zahra Tavosi ◽  
Iraj Feizi
Keyword(s):  
Cardiac Catheterization ◽  
Constrictive Pericarditis ◽  
Gold Standard ◽  
Elevated Serum ◽  
Disease Process ◽  
Clinical Suspicion ◽  
Rare Clinical Entity ◽  
Good Recovery ◽  
Prompt Treatment ◽  
High Degree

Constrictive pericarditis (CP) is a rare clinical entity that can pose diagnostic problems. The diagnosis of CP requires a high degree of clinical suspicion. The gold standard for diagnosis is cardiac catheterization with analysis of intracavitary pressure curves, which are high and, in end diastole, equal in all chambers. We present a patient with unexplained dyspnea, recurrent right-side pleural effusion, and ascites. Analysis of the ascitic fluid revealed a high protein content and an elevated serum-ascites gradient. Echocardiography, computed tomography, and cardiac catheterization revealed the diagnosis of CP. He underwent complete pericardiectomy and to date has made a good recovery. The diagnosis of CP is often neglected by admitting physicians, who usually attribute the symptoms to another disease process. This case exemplifies the difficulty in diagnosing this condition, as well as the investigation required, and provides a discussion of the benefit and outcomes of prompt treatment.

Sonographic Discovery of Segmental Testicular Infarction

2021 ◽  
pp. 875647932110649
Author(s):  
Kelly Pham
Keyword(s):  
Conservative Treatment ◽  
Testicular Torsion ◽  
Treatment Process ◽  
Surgical Intervention ◽  
Treatment Approach ◽  
Accurate Diagnosis ◽  
Sonographic Diagnosis ◽  
Testicular Infarction ◽  
Segmental Testicular Infarction

The prevalence of segmental testicular infarction is extremely uncommon and very few cases have been reported in literature. Clinical and sonographic presentation of this condition can mimic testicular neoplasms or testicular torsion. Therefore, accurate diagnosis of segmental testicular infarction is imperative in the treatment process. This case study presents the sonographic diagnosis of testicular infarction in a 49-year-old man who reported mild testicular tenderness. A conservative treatment approach was used, saving the patient unnecessary surgical intervention.

scholarly journals Classification and applying pharmacovigilance principles to study adverse drug reaction and its management

2017 ◽  
Vol 6 (11) ◽  
pp. 2537
Author(s):  
Srihitha Pendota ◽  
Sre Akshaya Kalyani Surabhineni ◽  
Abhinay Sharma Katnapally ◽  
Dharanija Porandla ◽  
Sandeep Kumar Beemreddy
Keyword(s):  
Adverse Drug Reaction ◽  
Drug Reaction ◽  
Causality Assessment ◽  
Causal Relation ◽  
Drug Event ◽  
Multiple Drug ◽  
Different Types ◽  
Multiple Drug Therapy ◽  
Assessment Scales ◽  
Reason For Admission

Adverse drug reaction (ADR) is an unwanted, undesirable effect of medication resulting in mild to severe effect on the patient. This review explains definitions of ADR and it differentiation with adverse drug event, medication error. ADRs may cause increased length of stay or initial reason for admission and are major cause of morbidity and mortality worldwide. Risk factors for ADR occurrence include age, gender, patients with multiple diseases and multiple drug therapy (polypharmacy). ADRs are classified into different types based on the mechanism and onset of reaction. The causal relation between suspected drug and reaction can be assessed by using causality assessment scales. The severity and preventability of ADR can be assessed by severity assessment scale and preventability scale respectively. Clinical Pharmacists play an important role in monitoring and management of ADRs.

scholarly journals A rare case of pancreaticopleural fistula patient presented in surgery OPD

2020 ◽  
Vol 11 (SPL4) ◽  
pp. 1329-1332
Author(s):  
Sajika Dighe ◽  
Raju Shinde ◽  
Sangita Shinde ◽  
Mohit Gupte
Keyword(s):  
Chronic Pancreatitis ◽  
Pleural Fluid ◽  
Pleural Cavity ◽  
Surgical Intervention ◽  
Fluid Collection ◽  
Clinical Suspicion ◽  
Treatment Modalities ◽  
Chest Drain ◽  
High Level

Pancreatico-pleural fistula is rare and infrequent complication of commonly occurring chronic pancreatitis leading to an extra-peritoneal abnormal connection between the pancreatic system and pleural cavity. Diagnosis needs high-level clinical suspicion to avoid delay in the diagnosis as the patient presents with respiratory distress rather than any abdominal symptom and produces large quantities of pleural fluid intractable of pleural tapping or chest drain. Diagnosis of the fistula is clicked by elevated pleural fluid amylase. Various imaging options are available with their unique importance like CECT, ERCP and MRCP. In a low resource, setup CECT becomes a useful modality to delineate the pancreatic parenchymal changes, pancreatic duct anatomy and fluid collection, thus aid in the diagnosis. Treatment modalities depending on structural anatomy of the duct and parenchymal destruction are either Medical, Conservative and Surgical. Here our patient presented with massive left sided pleural effusion resistant to surgical intervention secondary to chronic pancreatitis in a 28-year man later diagnosed as Pancreatico-pleural fistula on CECT. The patient underwent distal pancreatectomy with splenectomy with decortication of the lung with excision of PPF. The patient now is continuous follow-up for chronic pancreatitis and is symptom-free from last 2 years.

Hepatotoxicity Associated With Acetaminophen Usage in Patients Receiving Multiple Drug Therapy for Tuberculosis

CHEST Journal ◽  
1994 ◽  
Vol 105 (2) ◽  
pp. 408-411 ◽  
Author(s):  
Charles M. Nolan ◽  
Robert E. Sandblom ◽  
Kenneth E. Thummel ◽  
John T Slattery ◽  
Sidney D. Nelson
Keyword(s):  
Drug Therapy ◽  
Multiple Drug ◽  
Multiple Drug Therapy

Toxic Effects of Anticonvulsants: General Principles

PEDIATRICS ◽  
1974 ◽  
Vol 53 (4) ◽  
pp. 551-557
Author(s):  
H. Hooshmand
Keyword(s):  
Drug Interaction ◽  
Side Effects ◽  
Toxic Effects ◽  
Multiple Drug ◽  
Severe Ataxia ◽  
Multiple Drug Therapy ◽  
Toxic Potential ◽  
Therapeutic Doses ◽  
Relationship Of ◽  
The Relationship

Any drug, regardless of how benign and well tolerated, is potentially toxic. The toxicity may be due to (1) dosage; (2) the size of the patient; (3) drug interaction; (4) drug specificity for the disease; (5) the nature of the disease for which the drug is used; and (6) the mode and frequency of medication. DOSE OF ANTICONVULSANT Dose of anficonvulsant is very important (Table I). Any anticonvulsant in higher than therapeutic doses has toxic potential. It is well known that anticonvulsants in large enough doses can act as convulsants. This is especially true for diphenylhydantoin, benzodiazepines, and lidocaine. THE SIZE OF THE PATIENT The size of the patient should be considered in dosage. It is safer and more accurate to adjust dosage to body surface than to weight (Table I). As the child grows, there may be a need to gradually increase the dose of anticonvulsants if seizure control is poor, or if the serum level of the anticonvulsant starts to decline. DRUG INTERACTION The relationship. of multiple drug therapy and its toxic effects on the brain is quite complicated, and many forms of toxicity can result. Toxicity may be the result of a combination of pharmacologically similar drugs. Such a combination may enhance the side effects of drowsiness and ataxia. The patient may suffer from these side effects without attaining therapeutic levels of individual anticonvulsants in the blood. In other words, a combination of drugs such as phenobarbital and primidone may result in severe ataxia and drowsiness.

scholarly journals Immune function at diagnosis in relation to responses to therapy in acute lymphocytic leukemia of childhood

Blood ◽  
1976 ◽  
Vol 47 (6) ◽  
pp. 1011-1021 ◽  
Author(s):  
DG Jose ◽  
H Ekert ◽  
J Colebatch ◽  
K Waters ◽  
F Wilson ◽  
...  
Keyword(s):  
Acute Lymphocytic Leukemia ◽  
Cranial Irradiation ◽  
Prophylactic Cranial Irradiation ◽  
Lymphocytic Leukemia ◽  
Lymphoid Cells ◽  
Multiple Drug ◽  
First Remission ◽  
Immune Capacity ◽  
Multiple Drug Therapy

Abstract Tests of immune capacity were performed on blood from 49 children with newly diagnosed, untreated acute lymphocytic leukemia, and relation to prognosis was determined. Patients were treated with multiple-drug therapy and prophylactic cranial irradiation. Median follow-up time was 16 mo (range 10--37 mo). Principal unfavorable findings at diagnosis were absolute numbers of T lymphoid cells outside the range 850-- 2500/mul blood, absence of whole blood responses to phytohemagglutinin in vitro, a low titer of complexed antibody, and the presence in serum of free leukemic blast cell membrane antigen. Fourteen patients showed two or more unfavorable findings at diagnosis. Eleven of these have died. Four of the remaining 35 patients have died. A shorter duration of first remission was found among patients with abnormal numbers of T cells at diagnosis. The findings suggest that the immunologic capacity of the patient at diagnosis is an important determinant in responses to therapy.

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