Animais Venenosos em Território Português: Abordagem Clínica de Picadas e Mordeduras

There are many native species of animals with the potential to cause severe disease in Portugal. Of the four clinically relevant snake species, the vipers (Vipera latastei and Vipera seoanei) are the most concerning. They can cause severe disease and require in-hospital management, monitoring and specific treatment, including the administration of anti-snake venom serum. The Malpolon monspessulanus and Macroprotodon brevis snakes cause mostly localized clinical manifestations, which do not require specific treatment. Only a minority of the spider species in Portugal possess chelicerae (mouthparts of the Chelicerata, shaped as either articulated fangs or pincers, which may contain venom or be connected to the venom glands and are used for predation or capture of food) long enough to perforate the human skin. Nevertheless, Latrodectus tredecimguttatus and Loxosceles rufescens spider bites may require specialized treatment in a hospital setting, as well as careful active symptom surveillance. Diversely, the treatment for Scolopendra cingulata and Scolopendra oraniensis centipedes’ bites is merely symptomatic. The only existing scorpion species in Portugal is the Buthus ibericus; its sting typically causes local symptoms with intense pain, and its treatment consists essentially of analgesia. The insects of the Hymenoptera order, such as bees and wasps, have the ability to inject venom into the skin. Most people present only with local or regional inflammatory response, and symptomatic treatment is usually effective. Even so, individuals with hypersensitivity to bee venom may develop anaphylaxis. Several marine species in the Portuguese coast are venomous to humans, including weeverfish (Trachinidae family), stingrays (Dasyatis pastinaca, Taeniura grabata, Myliobatis aquila), red scorpion fish (Scorpaena scrofa), cnidaria (Pelagia noctiluca, Chrysaora hysoscella, Physalia physalis) and bearded fireworm (Hermodice carunculata); treatment is symptomatic. Contact with the larvae or bristles (chitinous structures with locomotor or tactile functions) of Thaumetopoea pityocampa (pine processionary) can cause cutaneous, ocular and, rarely, respiratory reactions; its management is also symptomatic.

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Different diagnostic strategies for different settings

Geriatric Care ◽

10.4081/gc.2021.9538 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Ferdinando Petrazzuoli

Keyword(s):

Primary Care ◽

Watchful Waiting ◽

Severe Disease ◽

Hospital Setting ◽

Symptomatic Treatment ◽

Diagnostic Strategy ◽

Diagnostic Strategies ◽

High Prevalence ◽

Prevalence Estimates ◽

Low Prevalence

Diagnostic strategies should always take into consideration the setting in which they are administered. The predictive value, positive or negative of a clinical sign or diagnostic test has a different weight in family medicine than in the hospital setting. Many tests have not been formally evaluated in primary care; unfortunately, very often low prevalence settings are used to conduct screening in these populations, and often result in unrealistically high prevalence estimates for chronic disease and these results are then used to conclude that General Practitioners are not good at detecting diseases. In primary care, the prevalence and incidence of disease differs from what appears in the hospital setting, and severe disease occurs less frequently in general practice than in hospital because there is no preventive selection. This requires a specific probability-based decision-making process, based by the knowledge of patients and the community. In primary care, the diagnostic strategy should begin with complaints and symptoms and address uncertainty and complexity, using step-by-step strategies, including watchful waiting, presumptive symptomatic treatment, and focusing on low-tech strategies.

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Herpesviruses. Part 2

Ukraïnsʹkij žurnal medicini bìologìï ta sportu ◽

10.26693/jmbs06.02.211 ◽

2021 ◽

Vol 6 (2) ◽

pp. 211-220

Author(s):

R. S. Nazaryan ◽

◽

Yu. V. Fomenko ◽

N. A. Scheblykina ◽

T. A. Kolesova ◽

...

Keyword(s):

Epithelial Cells ◽

Antiviral Treatment ◽

Clinical Manifestations ◽

Specific Treatment ◽

Nucleoside Analogs ◽

Symptomatic Treatment ◽

Reproductive Activity ◽

Herpes Infection ◽

Therapeutic Measures ◽

Accompanying Symptoms

The clinical manifestations of herpes infection depend on the pathogenic properties of the pathogen and on the state of immunity of the infected organism. Herpesviruses type 1-3 are predominantly neurotropic and cause diseases of the nervous system. The reproduction of the virus is carried out in the neurons of the nerve ganglia and epithelial cells, as they have a common ectodermal origin. Herpesviruses type 4, 5 and 8 are predominantly lymphotropic and cause diseases of the immune system. In a latent and persistent state, viruses are found in lymphocytes, monocytes, polymorphonuclear leukocytes, as they exhibit tropism for cells of mesenchymal origin. When the infection is reactivated, the virus is reproduced in cells of ectodermal origin, which leads to characteristic organ lesions. Type 6 and 7 viruses are both neurotropic and lymphotropic. They are capable to infect T-lymphocytes, B-lymphocytes, epithelial cells, endothelial cells, hepatocytes, fibroblasts, glial cells, stem cells, monocytes, macrophages, leukocytes, etc. They are able to promote the reactivation of other viruses, forming mixed forms, which leads to an aggravation of the clinical picture of the disease. Therapy of herpesvirus infections should be scientifically grounded, consistent, gradual, complex and include: specific antiviral treatment; immunotherapy; antibacterial therapy; detoxification therapy; symptomatic treatment and therapeutic measures aimed to eliminate various complications. Antiviral drugs for the treatment of herpes infection are divided into 4 groups: nucleoside analogs; drugs that cause the destruction of viruses located extracellularly; drugs that are active against intracellular viruses; drugs with a double effect. Modern therapy of herpesvirus infections is capable to suppress the reproductive activity of the reactivated virus, modulate the body's immune response, prevent and eliminate various complications of herpes infections, but is unable to affect the latent form of viruses. In the complex therapy of herpes infection, along with the specific treatment methods aimed to destroy the virus and to enhance the body's immunity, it is necessary to apply the entire range of therapeutic measures that help eliminate the accompanying symptoms and complications of diseases caused by herpesviruses

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INTERLEUKIN 6, AN IMPORTANT BIOMARKER OF CYTOKINE STORM IN COVID-19

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i4.1894 ◽

2021 ◽

Vol 5 (4) ◽

Author(s):

Alok Verma ◽

Archana Shrivastava ◽

Divyansh Verma

Keyword(s):

Early Detection ◽

Virus Disease ◽

Severe Disease ◽

Clinical Manifestations ◽

Specific Treatment ◽

Rapid Progression ◽

Cytokine Storm ◽

Corona Virus ◽

Current Scenario ◽

Patients Experience

Background: The Corona virus disease, COVID-19 is characterised by varied clinical course. Most patients experience only mild symptoms and get cured while others develop severe disease with increasing hypoxia ending in acute respiratory failure In current scenario, disease progression mainly relies on clinical manifestations and some investigations. It has been suggested that one of the possible mechanism underlying rapid progression is a Cytokine storm . Objective: The study was aimed to early detection of IL-6 that could help in identifying Cytokine storm and direct patients to specific treatment so as to reduce severity of disease. Material and Methods: This is the study done on patients presented with symptoms of corona virus disease. These patients were examined clinically and investigated according. Result: 321 patients were found positive for Corona virus out of which 206 males & 115 females. Fever (84%) and cough (71.4%)are the most common symptoms. 167 patients had increased IL-6 who presented with severe symptoms These patients were followed up strictly and proper treatment given Out of which maximum patients responded well within 15 days and 27 patients required hospitalisation and were managed Conclusion: Early detection of IL-6 along with clinical assessment of the patient condition could help clinician identifying and treating those most at risk of deterioration Therefore early identification of Cytokine storm and managing hyper inflammation could be a key route to reduce severity and mortality in COVID-19 patients. Keywords: COVID-19, IL-6 , Cytokine storm .

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The novel coronavirus disease (COVID-19) in children with cancer, hematologic malignancies, and severe immunodeficiencies. Results of monocenter study

Pediatric Hematology/Oncology and Immunopathology ◽

10.24287/1726-1708-2021-20-4-89-99 ◽

2021 ◽

Vol 20 (4) ◽

pp. 89-99

Author(s):

G. G. Solopova ◽

E. V. Tsyganova ◽

A. V. Kondrashova ◽

G. N. Gordeeva ◽

E. V. Rozanceva ◽

...

Keyword(s):

Risk Factors ◽

Clinical Symptoms ◽

Severe Disease ◽

Clinical Manifestations ◽

Specific Treatment ◽

Hematologic Malignancies ◽

Underlying Disease ◽

Hematopoietic Stem ◽

Female Ratio ◽

Factors Associated

Data on clinical manifestations of COVID-19 in immunocompromised patients in Russia is lacking, which prompted us to conduct a study to investigate clinical manifestations, risk factors, and outcomes of SARS-CoV-2 infection in children with oncological and hematological diseases treated at the D. Rogachev NMRCPHOI (Center). In this retrospective-prospective, nonrandomized, non-interventional study we enrolled children under 18 years with cancer, hematologic malignancies, and primary immunodeficiencies (PIDs) who underwent treatment at the Center from April 2020 to October 2021. COVID-19 cases were confirmed by polymerase chain reaction testing and classified as asymptomatic, mild, moderate, severe and critical. The study was approved by the Independent Ethics Committee and the Scientific Council of the Center. The study included 89 patients with a median age of 9.7 years and almost equal gender distribution (the male-to-female ratio was 1.1:1). Most patients (74%) were infected in a family claster. The main underlying diseases were: hemoblastoses (43.8%), solid tumors (33.7%), PIDs (14.6%). The most common clinical symptoms were fever (29%) and respiratory symptoms (47%). In 79% of cases, patients were asymptomatic or had mild symptoms; 21% of patients had moderate and severe disease (16% and 5%, accordingly). Risk factors associated with severe COVID-19 included lymphopenia (p < 0.001) and hematopoietic stem cell transplantation (HSCT) (p = 0.002). Full recovery was documented in 84% of the patients, 16% died, however COVID-attributed mortality was 5.5%. The highest mortality was in patients with moderate/severe COVID-19 (47% vs 7%, p < 0.001), in those with progression/ relapse of the underlying disease (36.3% vs 6%, p = 0.02), in children who had received specific therapy within a year before the SARS-CoV-2 diagnosis (21% vs 0%, p = 0.02), among HSCT recipients (31.6% vs 12.1%, p = 0.02), and patients with concomitant infections (33% vs 9.2%, p < 0.01). Factors associated with poor prognosis were moderate or severe COVID-19, relapse/ progression of the underlying disease, specific treatment (HSCT in particular) within 1 year before the SARS-CoV-2 diagnosis, concomitant infections, and lymphopenia. Data obtained in this study can help physicians with management decisions at this population of patients.

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High predatory efficiency and abundance drive expected ecological impacts of a marine invasive fish

Marine Ecology Progress Series ◽

10.3354/meps13251 ◽

2020 ◽

Vol 637 ◽

pp. 195-208 ◽

Cited By ~ 1

Author(s):

EM DeRoy ◽

R Scott ◽

NE Hussey ◽

HJ MacIsaac

Keyword(s):

Invasive Species ◽

Native Species ◽

Ecological Impact ◽

Marine Species ◽

Ecological Impacts ◽

Negative Effects ◽

Marine Predator ◽

Eastern Gulf Of Mexico ◽

Red Grouper ◽

Per Capita

The ecological impacts of invasive species are highly variable and mediated by many factors, including both habitat and population abundance. Lionfish Pterois volitans are an invasive marine species which have high reported detrimental effects on prey populations, but whose effects relative to native predators are currently unknown for the recently colonized eastern Gulf of Mexico. We used functional response (FR) methodology to assess the ecological impact of lionfish relative to 2 functionally similar native species (red grouper Epinephelus morio and graysby grouper Cephalopholis cruentata) foraging in a heterogeneous environment. We then combined the per capita impact of each species with their field abundance to obtain a Relative Impact Potential (RIP). RIP assesses the broader ecological impact of invasive relative to native predators, the magnitude of which predicts community-level negative effects of invasive species. Lionfish FR and overall consumption rate was intermediate to that of red grouper (higher) and graysby grouper (lower). However, lionfish had the highest capture efficiency of all species, which was invariant of habitat. Much higher field abundance of lionfish resulted in high RIPs relative to both grouper species, demonstrating that the ecological impact of lionfish in this region will be driven mainly by high abundance and high predator efficiency rather than per capita effect. Our comparative study is the first empirical assessment of lionfish per capita impact and RIP in this region and is one of few such studies to quantify the FR of a marine predator.

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Multiple Myeloma or Brucellosis: A Case Report

Infectious Disorders - Drug Targets ◽

10.2174/1871526519666190307123047 ◽

2020 ◽

Vol 20 (1) ◽

pp. 102-105 ◽

Cited By ~ 1

Author(s):

Hossein A. Rahdar ◽

Mansoor Kodori ◽

Mohamad R. Salehi ◽

Mahsa Doomanlou ◽

Morteza Karami-Zarandi ◽

...

Keyword(s):

Multiple Myeloma ◽

Brucella Melitensis ◽

Severe Disease ◽

Correct Diagnosis ◽

Clinical Manifestations ◽

Bone Marrow Aspiration ◽

Major Health Problem ◽

Brucella Infection ◽

Wide Range ◽

Parental Treatment

Background: Brucellosis, a major health problem in developing countries, is a multisystem infection with a broad spectrum of clinical manifestations. Hematological complications, ranging from an intravascular coagulopathy to mild homeostasis disorders (such as gammopathy), have been reported in brucella infection. These signs and symptoms may lead to misdiagnosis of brucellosis with other hematological diseases. Case: A 65-year-old male whose occupation was shepherding was referred to our hospital as a known case of multiple myeloma with continuous fever, muscle weakness, and night sweating after taking 2 courses of chemotherapy. The laboratory diagnosis of multiple myeloma had been based on the observation of a high percent of plasma cells in the bone marrow aspiration. At follow- up, the result of patient's fever workup, with 2 sets of blood cultures, was positive for Brucella melitensis. Isolated brucella was confirmed as B. melitensis by 16S rRNA sequencing. Brucellosis serologic test was performed by agglutination test and positive results were obtained. The patient was discharged with the cessation of fever and general improvement after the end of the parental treatment phase of brucella bacteremia. Conclusions: Brucella infection may cause a severe disease, mimicking a primary hematological disease, which could complicate the correct diagnosis. In brucellosis cases, due to the wide range of symptoms, in addition to cultivation and serological methods, molecular methods should also be used to prevent inappropriate diagnosis and additional costs.

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Genetic polymorphism for IFNγ +874T/A in patients with acute toxoplasmosis

Revista da Sociedade Brasileira de Medicina Tropical ◽

10.1590/s0037-86822012000600020 ◽

2012 ◽

Vol 45 (6) ◽

pp. 757-760 ◽

Cited By ~ 11

Author(s):

Elizabeth de Souza Neves ◽

André Luis Land Curi ◽

Maira Cavalcanti de Albuquerque ◽

Cassius Schnel Palhano-Silva ◽

Laura Berriel da Silva ◽

...

Keyword(s):

Single Nucleotide Polymorphism ◽

Case Control Study ◽

Severe Disease ◽

Clinical Manifestations ◽

Nucleotide Polymorphism ◽

Gene Encoding ◽

Single Nucleotide ◽

Duration Of Disease ◽

Acute Toxoplasmosis ◽

Control Study

INTRODUCTION: A single nucleotide polymorphism (SNP) in the gene encoding gamma interferon influences its production and is associated with severity of infectious diseases. This study aimed to evaluate the association of IFNγ+874T/A SNP with duration of disease, morbidity, and development of retinochoroiditis in acute toxoplasmosis. METHODS: A case-control study was conducted among 30 patients and 90 controls. RESULTS: Although statistical associations were not confirmed, A-allele was more common among retinochoroiditis cases and prolonged illness, while T-allele was more frequent in severe disease. CONCLUSIONS: Despite few cases, the results could indicate a relation between IFNγ+874T/A single nucleotide polymorphism and clinical manifestations of toxoplasmosis.

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A New Multiplatform Model for Outpatient Prenatal and Postpartum Care in a Cohort of COVID-19-Affected Obstetric Patients

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18105144 ◽

2021 ◽

Vol 18 (10) ◽

pp. 5144

Author(s):

Mar Muñoz-Chápuli Gutiérrez ◽

Ana Durán-Vila ◽

Javier Ruiz-Labarta ◽

Pilar Payá-Martínez ◽

Pilar Pintado Recarte ◽

...

Keyword(s):

Clinical Manifestations ◽

Specific Treatment ◽

Rt Pcr ◽

Good Adherence ◽

Major Morbidity ◽

Reference Hospital ◽

The Mean ◽

Discharge From Hospital ◽

Over Time

Spain was one of the epicenters of the first wave of the COVID-19 pandemic. We describe in this article the design and results of a new telephone-and-telematic multiplatform model of systematic prenatal and postpartum follow-up for COVID-19-affected women implemented in a tertiary reference hospital in Madrid. We included patients with RT-PCR-confirmed COVID-19 during pregnancy or delivery from 10 March 2020 to 15 December 2020. We had a total of 211 obstetric patients: 148 (70.1%) were tested at the onset of suspicious clinical manifestations and 62 (29.4%) were tested in the context of routine screening. Of all the patients, 60 women (28.4%) were asymptomatic and 97 (46%) presented mild symptoms. Fifty-one women (24.2%) were admitted to our hospital for specific treatment because of moderate or severe symptoms. We had no missed cases and a good adherence. The mean number of calls per patient was 2.3. We performed 55 in-person visits. We analyzed the complexity of our program over time, showing a two-wave-like pattern. One patient was identified as needing hospitalization and we did not record major morbidity. Telemedicine programs are a strong and reproducible tool to reach to pregnant population affected by COVID-19, to assess its symptoms and severity, and to record for pregnancy-related symptoms both in an outpatient regime and after discharge from hospital.

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Outpatient Management of COVID-19 Disease: A Holistic Patient-Centered Proposal Based on the Greek Experience

Journal of Personalized Medicine ◽

10.3390/jpm11080709 ◽

2021 ◽

Vol 11 (8) ◽

pp. 709

Author(s):

Adamantia Liapikou ◽

Eleni Tzortzaki ◽

Georgios Hillas ◽

Miltiadis Markatos ◽

Ilias C. Papanikolaou ◽

...

Keyword(s):

Preventive Measures ◽

Severe Disease ◽

Hospital Setting ◽

Guidance Document ◽

Outpatient Management ◽

Patient Centered ◽

Mild Disease ◽

Novel Coronavirus ◽

Second Wave ◽

Close Contacts

Novel coronavirus disease 2019 (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a worldwide pandemic and affected more than 227 countries or territories, resulting in more than 179 million cases with over 3.890.00 deaths, as of June 25, 2021. The Hellenic Thoracic Society (HTS) during the second wave of COVID-19 pandemic released a guidance document for the management of patients with COVID-19 in the community and in hospital setting. In this review, with guidance the HTS document, we are discussing the outpatient management of COVID-19 patients, including the preventive measures, the patients’ isolation and quarantine criteria of close contacts, the severity and risk stratification, including the decisions for advanced hospitalization, and the disease management at home in patients with mild disease and after hospital discharge for those with more severe disease.

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Clinical Management of Hypertension, Inflammation and Thrombosis in Hospitalized COVID-19 Patients: Impact on Survival and Concerns

Journal of Clinical Medicine ◽

10.3390/jcm10051073 ◽

2021 ◽

Vol 10 (5) ◽

pp. 1073

Author(s):

Patricia Martínez-Botía ◽

Ángel Bernardo ◽

Andrea Acebes-Huerta ◽

Alberto Caro ◽

Blanca Leoz ◽

...

Keyword(s):

Arterial Hypertension ◽

Clinical Management ◽

Cox Regression ◽

Angiotensin Receptor Blockers ◽

Treatment Options ◽

Clinical Manifestations ◽

Specific Treatment ◽

Hospitalized Patients ◽

Thrombosis Prophylaxis ◽

The Impact

The most severe clinical manifestations of the Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), are due to an unbalanced immune response and a pro-thrombotic hemostatic disturbance, with arterial hypertension or diabetes as acknowledged risk factors. While waiting for a specific treatment, the clinical management of hospitalized patients is still a matter of debate, and the effectiveness of treatments to manage clinical manifestations and comorbidities has been questioned. In this study, we aim to assess the impact of the clinical management of arterial hypertension, inflammation and thrombosis on the survival of COVID-19 patients. The Spanish cohorts included in this observational retrospective study are from HM Hospitales (2035 patients) and from Hospital Universitario Central de Asturias (72 patients). Kaplan Meier survival curves, Cox regression and propensity score matching analyses were employed, considering demographic variables, comorbidities and treatment arms (when opportune) as covariates. The management of arterial hypertension with angiotensin-converting enzyme 2 (ACE2) inhibitors or angiotensin receptor blockers is not detrimental, as was initially reported, and neither was the use of non-steroidal anti-inflammatory drugs (NSAIDs). On the contrary, our analysis shows that the use on itself of corticosteroids is not beneficial. Importantly, the management of COVID-19 patients with low molecular weight heparin (LMWH) as an anticoagulant significantly improves the survival of hospitalized patients. These results delineate the current treatment options under debate, supporting the effectiveness of thrombosis prophylaxis on COVID-19 patients as a first-line treatment without the need for compromising the treatment of comorbidities, while suggesting cautiousness when administering corticosteroids.

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