scholarly journals Imported Cases of Cutaneous Leishmaniasis in Cuba, 2017: Role of Human Movement.

2021 ◽  
Author(s):  
Lianet Monzote ◽  
Daniel González ◽  
Orestes Blanco ◽  
Jorge Fraga ◽  
Virginia Capó ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Demographic Data ◽  
Human Movement ◽  
Clinical Samples ◽  
Diagnostic Assays ◽  
Epidemiological Features ◽  
Imported Cases ◽  
Vector Borne

Abstract Background: Leishmaniasis is a vector-borne disease caused by several species from genus Leishmania. An increase in the number of cases related to human movement has been informed in the last years. Due to the increase of suspicious leishmaniasis cases arriving in Cuba during 2017, an general analysis is presented herein. Methods: Clinical samples were collected from 5 patients suspicious of leishmaniasis, received from January to December 2017 at the Institute of Tropical Medicine Pedro Kourí, Cuba. Skin lesion samples were analyzed using different diagnostic assays: direct smear, histological examination, and molecular analysis for species identification. Epidemiological and demographic data were requested from each case and analyzed. Treatment and follow up of patient was also performed.Results: Five cases were confirmed as Leishmania infection according to microscopic observation and molecular methods results. PCR-18S, PCR-N/RFLP and PCR-F/RFLP identified the following species: L. panamensis (2 cases), L. braziliensis (1 case), L.panamensis/L.guyanensis (1 case), L. mexicana complex (1 case). In treated patients, drugs were well tolerated, cure were documented and no relapse have been currently reported (3 years later).Conclusions: Clinical characteristics, demographic data, and epidemiological features of infection for each case evidence the potential risk related with travel to endemic areas of leishmaniasis.

scholarly journals SAT0267 ROLE OF AGGRESSIVE IMMUNOSUPPRESSION ON SUBGLOTTIC STENOSIS IN GRANULOMATOSIS WITH POLYANGIITIS: RETROSPECTIVE ANALYSIS OF A MONOCENTRIC COHORT

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1076.1-1077
Author(s):  
L. Moroni ◽  
L. Giudice ◽  
G. A. Ramirez ◽  
S. Sartorelli ◽  
A. Cariddi ◽  
...  
Keyword(s):  
Medical Treatment ◽  
Clinical Characteristics ◽  
Granulomatosis With Polyangiitis ◽  
Balloon Catheter ◽  
Subglottic Stenosis ◽  
Damage Accrual ◽  
The Mean ◽  
The One

Background:Subglottic stenosis (SGS) is defined as airway narrowing below the vocal cords and is a common and potentially life-threatening manifestation of Granulomatosis with Polyangiitis (GPA), with an estimated prevalence of 16-23% (1). Balloon catheter dilation is effective in GPA-related SGS, but relapses are frequent. Little is known about the role of immunosuppression in this setting.Objectives:to analyse the clinical characteristics of a monocentric GPA cohort, describe phenotype differences among patients with and without SGS and investigate the role of surgical and medical treatments on relapse risk and general outcome.Methods:Biopsy-proven patients with SGS were identified by review of medical charts among a cohort of patients with GPA, classified according to the algorithm of the European Medicine Agency (2). The clinical characteristics of patients with SGS were retrospectively collected over a median follow-up time of 15.9 years and compared to those of patients without SGS.Results:Fourteen patients with SGS-GPA were identified, with a female to male ratio of 1:1 and a prevalence of 29.2% among the cohort. The mean ± SD age at GPA onset was 30.8 ± 14.4 years, with a mean time from GPA diagnosis to SGS onset of 4.7 ± 4.2 years. ANCA were positive in 78.6% (54.0% anti-PR3, 18.1% anti-MPO and 27.9% IFI only). The mean Birmingham Vasculitis Activity Score (BVAS) at onset was 10.0 ± 5.6. The main clinical manifestations associated with SGS were crusty rhinitis (100%), sinusitis (78%), pulmonary disease (72.7%), otitis/mastoiditis (50%), glomerulonephritis (42.9%), orbital pseudotumor (28.6%). Six patients (42.9%) received medical treatment only, other six (42.9%) had one to three balloon dilations and two (14.2%) underwent four or more procedures. Eight patients had no SGS relapse (maximum one dilation) and they all received immunosuppression with rituximab (RTX), cyclophosphamide (CYC) or azathioprine (AZA). All patients who received no immunosuppression, methotrexate (MTX) or mycophenolate (MMF) had at least one relapse. Patients treated with MTX or MMF had a mean relapse-free survival of 13.1 months, which was comparable to the one of patients not receiving medical treatment (40.2 months; p=NS) and shorter than the one of patients receiving CYC or RTX (153.2 months; p=0.032). CYC use also inversely correlated with the number of surgical procedures (r=-0.691, p=0.006). Compared to patients without SGS (31 consecutive patients with at least 4 years of follow-up), patients with SGS-GPA had an earlier disease onset (mean age 30.8 vs 50.4 years; p<0.001), but with lower BVAS (mean 10.0 vs 15.3; p=0.013) and showed a higher prevalence of crusty rhinitis (100% vs 67.7%; p=0.019). No difference was observed in damage accrual over time between the two groups.Conclusion:Subglottic stenosis is highly prevalent in patients with GPA and may define a milder disease subset occurring more frequently in younger patients. MTX and MMF might be insufficient to prevent SGS relapses requiring balloon dilation. Aggressive immunosuppression (CYC or RTX) might have a non-redundant role in this setting and reduce the risk of relapses.References:[1]Quinn KA, et al. Subglottic stenosis and endobronchial disease in granulomatosis with polyangiitis. Rheumatology 2019; 58 (12), 2203-2211.[2]Watts R, et al. Development and validation of a consensus methodology for the classification of the ANCA associated vasculitides and polyarteritis nodosa for epidemiological studies. Ann Rheum Dis 2007; 66: 222-7.Disclosure of Interests:Luca Moroni: None declared, Laura Giudice: None declared, Giuseppe Alvise Ramirez: None declared, Silvia Sartorelli: None declared, adriana cariddi: None declared, Angelo Carretta: None declared, Enrica Bozzolo: None declared, Lorenzo Dagna Grant/research support from: The Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR) received unresctricted research/educational grants from Abbvie, Bristol-Myers Squibb, Celgene, Janssen, Merk Sharp & Dohme, Mundipharma Pharmaceuticals, Novartis, Pfizer, Roche, Sanofi-Genzyme, and SOBI., Consultant of: Prof Lorenzo Dagna received consultation honoraria from Abbvie, Amgen, Biogen, Bristol-Myers Squibb, Celltrion, Novartis, Pfizer, Roche, Sanofi-Genzyme, and SOBI.

Treatment Patterns and Outcomes in Bleb-Related Endophthalmitis: A 9-Year Analysis at a Tertiary Eye Center

2020 ◽  
pp. 247412642095396
Author(s):  
Cason B. Robbins ◽  
Henry L. Feng ◽  
Divakar Gupta ◽  
Sharon Fekrat
Keyword(s):  
Initial Treatment ◽  
Care Center ◽  
Demographic Data ◽  
Tertiary Care ◽  
Light Perception ◽  
Initial Management ◽  
Pars Plana ◽  
Line Loss

Purpose: Clinical presentation, treatment choices, and outcomes in cases of bleb-related endophthalmitis (BRE) at a tertiary care center over a 9-year period are described. Methods: A retrospective review was conducted of patients diagnosed with BRE at Duke Eye Center (Durham, North Carolina) from January 1, 2009 to January 1, 2018, with at least 6 months of follow-up, assessing demographic data, initial management, and visual acuity (VA). Results: Twenty eyes of 20 patients with BRE were identified. Median time from surgery to presentation was 6.53 years. Presenting VA of light perception only was significantly associated with the decision to pursue pars plana vitrectomy (PPV) as initial treatment (odds ratio 59.4, 95% CI, 2.1-1670.8, P = .016). Twelve eyes (60%) had culture-proven infectious endophthalmitis. Eleven eyes (55%) underwent PPV during treatment; 5 eyes underwent PPV on presentation, and 6 eyes underwent PPV after initial presentation. Compared with pre-endophthalmitis VA, 6 eyes that underwent subsequent PPV had greater VA loss at 6 months than cases not undergoing subsequent PPV (Early Treatment Diabetic Retinopathy Study line loss of 14 vs 4 lines, respectively; P = .044). Conclusions: BRE eyes presenting with light-perception VA were more likely to undergo initial PPV; yet many eyes in this study required PPV during treatment. Visual outcomes are often poor in BRE despite intensive management. There was greater VA loss from pre-endophthalmitis VA levels at 6 months in eyes undergoing PPV after initial treatment. Prospective studies are needed to assess the optimal role of PPV in patients with BRE.

Thrombosis associated with ventriculoatrial shunts

2008 ◽  
Vol 2 (4) ◽  
pp. 286-291 ◽  
Author(s):  
Norka Wilkinson ◽  
Sandeep Sood ◽  
Steven D. Ham ◽  
Holly Gilmer-Hill ◽  
Patricia Fleming ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Anticoagulation Therapy ◽  
Treatment Strategies ◽  
Outcome Data ◽  
Single Center Study ◽  
Prophylactic Anticoagulation ◽  
Risk For Thrombosis ◽  
Work Up

Object In this single-center study, the authors examined the clinical characteristics, risk factors, treatment strategies, and outcomes in patients with thrombosis associated with ventriculoatrial (VA) shunts. Methods Inpatient and outpatient charts of patients who underwent treatment and follow-up in the Hematology-Oncology Division at the authors' institution and in whom thrombosis developed secondary to a VA shunt placement were reviewed. A complete thrombophilia work-up was performed in each patient, and these records were also reviewed. Treatment including medical and surgical management was noted and outcome data were recorded. Results Resolution of thrombosis was seen after anticoagulation therapy in all patients; this may be an alternative to surgical therapy. Conclusions Patients with VA shunts represent a unique group at risk for thrombosis. The duration of anticoagulation therapy must be individualized. However, larger studies are needed to evaluate the efficacy of screening for asymptomatic thrombosis and to investigate the role of prophylactic anticoagulation.

scholarly journals Influence factors of death risk among COVID-19 patients in Wuhan, China: a hospital-based case-cohort study

2020 ◽  
Author(s):  
Lin Fu ◽  
Jun Fei ◽  
Hui-Xian Xiang ◽  
Ying Xiang ◽  
Meng-Die Li ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Clinical Characteristics ◽  
Demographic Data ◽  
Influence Factors ◽  
Oxygenation Index ◽  
Prognostic Indicators ◽  
Urea Nitrogen ◽  
Death Risk ◽  
Stratified Analysis

Abstract Background Coronavirus disease 2019 (COVID-19) triggered by infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has been widely pandemic all over the world. The aim of this study was to analyze the influence factors of death risk among 200 COVID-19 patients.Methods Two hundred patients with confirmed SARS-CoV-2 infection were recruited. Demographic data and clinical characteristics were collected from electronic medical records. Biochemical indexes on admission were measured and patient's prognosis was tracked. The association of demographic data, clinical characteristics and biochemical indexes with death risk was analyzed.Results Of 200 COVID-19 patients, 163 (81.5%) had at least one of comorbidities. Among all patients, critical cases accounted for 26.2%. Severe cases were 29.7%. Besides, common cases accounted for 44.1%. At the end of follow-up, 34 (17%) were died on mean 10.9 day after hospitalization. Stratified analysis revealed that older ages, lower oxygenation index and comorbidities elevated death risk of COVID-19 patients. On admission, 85.5% COVID-19 patients were with at least one of extrapulmonary organ injuries. Univariable logistic regression showed that ALT, TBIL, AST, myoglobin and LDH, AST/ALT ratio, creatinine, urea nitrogen and uric acid were positively associated with death risk of COVID-19 patients. Multivariable logistic regression revealed that AST/ALT ratio, urea nitrogen, TBIL and LDH on admission were positively correlated with death risk of COVID-19 patients.Conclusion Older age, lower oxygenation index and comorbidities on admission elevate death risk of COVID-19 patients. AST/ALT ratio, urea nitrogen, TBIL and LDH on admission may be potential prognostic indicators.

scholarly journals The Role of Human Movement in the Transmission of Vector-Borne Pathogens

2009 ◽  
Vol 3 (7) ◽  
pp. e481 ◽  
Author(s):  
Steven T. Stoddard ◽  
Amy C. Morrison ◽  
Gonzalo M. Vazquez-Prokopec ◽  
Valerie Paz Soldan ◽  
Tadeusz J. Kochel ◽  
...  
Keyword(s):  
Human Movement ◽  
Vector Borne

scholarly journals POS1333 ANKLE ARTHRITIS IN JUVENILE IDIOPATHIC ARTHRITIS: DON’T MISS TENOSYNOVITIS. CLINICAL AND SONOGRAPHIC FEATURES OF ANKLE TENOSYNOVITIS IN JIA

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 948.3-949
Author(s):  
S. Pastore ◽  
S. Della Paolera ◽  
A. Zabotti ◽  
A. Tommasini ◽  
A. Taddio
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Clinical Characteristics ◽  
Color Doppler ◽  
Tendon Sheath ◽  
Response To Treatment ◽  
Tibialis Posterior ◽  
Ultrasound Guided ◽  
Sonographic Examination

Background:Tenosynovitis can occur in patients with Juvenile Idiopathic Arthritis (JIA) and may be clinically difficult to distinguish from joint synovitis. The role of musculoskeletal ultrasound (msk-US) is still discussed in the management of JIA but recent studies supported the utility of msk-US especially in detection of tenosynovitis. There is no consensus treatment for tenosynovitis in children with JIA and almost all studies focused on tendon sheath injection with glucocorticoids.Objectives:The aims of the study were: i) to define the prevalence of tenosynovitis of the ankle in JIA patients and ankle swelling; ii) to describe the clinical characteristics of patient with tenosynovitis and to analyze different response to treatment.Methods:We conducted an observational cross-sectional study of a group of patients with JIA followed at the Rheumatology Service of the Maternal and Child Institute “Burlo Garofolo” of Trieste. We enrolled all the patients who reported a swelling of the ankle at least once during the follow-up period and, among these patients, we included only those who underwent msk-US. Based on both clinical and sonographic examination, we identified patients with tenosynovitis and we described their demographical and clinical characteristics as well as the therapeutic approach undertaken in this group of patients.Results:On December 31st 2019, 56 swollen ankles of 48 patients were assessed with msk-US: 22 ankles showed sonographic signs of synovitis (39%), 16 ankles of both synovitis and tenosynovitis (28%), 14 ankles of tenosynovitis only (25%). Overall, tenosynovitis was detected on twenty-seven (56%) out of 48 children with at least a swollen ankle. The majority of patient were females (70%) and the most affected tendon was the tibialis posterior (66%). Twenty-five patients with tenosynovitis (92%) achieved clinical and radiological remission: seven out of 26 patients (26%) treated with methotrexate achieved clinical and radiological remission without the addition of other therapies; fifteen out of seventeen patients (88%) treated with a biological drug responded to the therapy, of which eleven (73%) were in combination therapy with methotrexate.Conclusion:We observed that more than 50% of the patients with a swelling of the ankle presented a tenosynovitis and among these patients about 50% did not show sonographic sign of synovitis. Msk-US was decisive in order to identify tenosynovitis and to characterize ankle swelling in JIA patients. Among patients with tenosynovitis biological therapy alone or in association with immunomodulating therapy showed effectiveness in inducing disease remission.References:[1]Peters SE, Laxer RM et al. Ultrasound-guided steroid tendon sheath injections in juvenile idiopathic arthritis: a 10-year single-center retrospective study. Pediatr Rheumatol Online J. 2017 Apr 11;15(1):22.[2]Lanni S, Bovis F et al. Delineating the Application of Ultrasound in Detecting Synovial Abnormalities of the Subtalar Joint in Juvenile Idiopathic Arthritis. Arthritis Care Res (Hoboken). 2016 Sep;68(9):1346-53.[3]Cimaz R, Giani T et al. What is the real role of ultrasound in the management of juvenile idiopathic arthritis? Ann Rheum Dis. 2020 Apr;79(4):437-439. doi: 10.1136/annrheumdis-2019-216358[4]Lanni S, Marafon DP et al. Comparison between clinical and ultrasound assessment of the ankle region in juvenile idiopathic arthritis. Arthritis Care Res (Hoboken). 2020 Apr 27.[5]Laurell L, Court-Payen M et al. Ultrasonography and color Doppler in juvenile idiopathic arthritis: diagnosis and follow-up of ultrasound-guided steroid injection in the ankle region. A descriptive interventional study. Pediatr Rheumatol Online J. 2011 Jan 29;9(1):4.Disclosure of Interests:None declared

Effect of cannabis consumption on characteristics and evolution of thromboangitis obliterans

VASA ◽  
2021 ◽  
pp. 1-5
Author(s):  
Guillaume Bergère ◽  
Claire Toquet ◽  
Clément Hoffmann ◽  
Luc Bressollette ◽  
Alizée Raimbeau ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Clinical Presentation ◽  
Thromboangiitis Obliterans ◽  
Tobacco Exposure ◽  
Free Survival ◽  
Younger Age ◽  
Arterial Involvement ◽  
Cannabis Consumption

Summary: Background: Thromboangiitis obliterans (TAO) is a distal non atherosclerotic thrombotic vasculitis affecting tobacco smokers. The role of cannabis co-exposure remains controversial. The study aims to assess how cannabis consumption influences clinical presentation and outcome of TAO in tobacco smokers. Patients and methods: TAO patients, according to Papa’s criteria, were included in a retrospective bicentric study between the 1st January 2003 and the 1st march 2020. Clinical characteristics, arterial involvement at TAO diagnosis, vascular event and amputations during follow-up were analyzed according to cannabis consumption. Results: Seventy-three patients with TAO patients were included. Forty-five patients were in Tobacco group (T) and 28 in Tobacco and cannabis group (T&C). Tobacco exposure was less important in T&C group than in T group (19.4±11.3 vs 31.6±16.6 pack-years) (p=0.005) and patients in T&C group were younger at TAO diagnosis than in T group (p=0.008). Patients in T&C group presented more claudication (33.3% vs 8.9%, p=0.01) and less upper limbs resting ischemia (25.9% vs 51.1%, p=0.04) than patients in the T group. No differences were found between groups with regard to arterial distribution. Amputation rate for patients who had at least one major or minor amputation did not differ between T and T&C group (25% vs 14.8%, p=0.38). Conclusions: Cannabis consumption was associated with a younger age of TAO onset. However, it does not affect amputation-free survival, Tobacco exposure is less important in T&C patients; data of this bicentric study suggest that cannabis could be a cofactor of tobacco which accelerates TAO onset.

STUDY TO EVALUATE THE ROLE OF LAPAROSCOPY IN CHRONIC ABDOMINAL PAIN

2021 ◽  
pp. 26-27
Author(s):  
K.Nagarjuna Reddy ◽  
G. Raga Harshitha
Keyword(s):  
Abdominal Pain ◽  
Average Length ◽  
Demographic Data ◽  
Previous History ◽  
Chronic Abdominal Pain ◽  
Main Function ◽  
Therapeutic Role ◽  
History Of

INTRODUCTION : Chronic abdominal pain can be diagnostic challenge. Chronic abdominal pain is a signicant clinical problem that often leads to repeated laparotomies. Laparoscopy has a signicant diagnostic and therapeutic role in patients with chronic abdominal pain. In case of diagnostic uncertainty, laparoscopy may help to avoid unnecessary laparotomy, provide accurate diagnosis and helps to plan surgical treatment. The main function of laparoscopic evaluation is to detect the presence or absence of intra abdominal organic lesion. AIMS AND OBJECTIVES : To determine the diagnostic and therapeutic role of laparoscopy in chronic abdominal pain. MATERIALS AND METHODS : All patients undergoing laparoscopy for chronic abdominal pain were included in the study for a period of 1 year from Nov. 2018 to Oct. 2019 in SHANTIRAM Medical College and General Hospital. The patient's demographic data, length of time with pain, diagnostic studies, intraoperative ndings, interventions and follow-up were determined. INCLUSION CRITERIA: Patients with history of abdominal pain for 3months or more, if physical examination and diagnostic tests are unrevealing. Patients with previous history of abdominal operation are included. RESULTS : A total of 25 patients (19 women and 6 men) with an average age of 34.64yrs underwent diagnostic laparoscopy for the evaluation and treatment of chronic abdominal pain. The average length of time with pain was 32.96 weeks (range 12-96). 2 cases required conversion to an open procedure and no complications occurred. Findings included abdominal Koch's in 9, appendicitis in 8, cholecystitis in 1, cirrhosis in 1; ovarian cyst in 1, bilateral mbrial cyst in 1 and 4 patients had no obvious pathology. 82.6% of patients had pain relief at the time of follow up. CONCLUSION : Laparoscopy has a diagnostic and therapeutic role in patients with chronic pain abdomen

scholarly journals Arbovirus emergence in temperate climates: the case of Córdoba, Argentina, 2009-2018

2019 ◽  
Author(s):  
Michael A. Robert ◽  
Daniela Tatiana Tinunin ◽  
Elisabet Marina Benitez ◽  
Francisco Ludueña-Almeida ◽  
Moory Romero ◽  
...  
Keyword(s):  
Costa Rica ◽  
Dengue Virus ◽  
Dengue Fever ◽  
Disease Transmission ◽  
Human Movement ◽  
Denv Serotypes ◽  
Imported Cases ◽  
The Tropics ◽  
Zika Fever

AbstractThe distribution of arbovirus disease transmission is expanding from the tropics and subtropics into temperate regions worldwide. The aim of this study was to characterize the emergence of arboviruses in the temperate city of Córdoba, Argentina (2009-2018), including dengue virus (DENV) serotypes and origins of imported cases. The first cases of dengue fever were reported in 2009, followed by outbreaks in 2013, 2015, and 2016, each outbreak having greater incidence than the previous. DENV1 was the predominant serotype. Cases were imported from Venezuela, Brazil, Bolivia, Mexico, Costa Rica, and northern Argentina. The first imported cases of chikungunya were reported in 2014 and the first imported and autochthonous of Zika fever in 2016. Regional efforts are needed to strengthen surveillance, due to the key role of human movement in arbovirus introductions.

scholarly journals Clinical characteristics, outcomes and follow-up of COVID-19 infection in cancer patients

2020 ◽  
Author(s):  
Minghao Fang ◽  
Jianmin Ling ◽  
Yanqing Wu ◽  
Zhaohua Wang ◽  
Le Yang
Keyword(s):  
Cancer Survivors ◽  
Cancer Patients ◽  
Clinical Characteristics ◽  
Demographic Data ◽  
Signs And Symptoms ◽  
Rt Pcr ◽  
Cytokine Profiles ◽  
Tnf Α ◽  
Clinical Records

Abstract Purpose: The study is to describe the clinical characteristics, outcomes and follow-up of cancer patients with COVID-19. Methods: Clinical records, demographic data, signs and symptoms, laboratory results, cytokine profiles, chest CT scans, comorbidities, treatments, clinical outcomes, and RT-PCR of SARS-CoV-2 after discharge were retrospectively collected for fifty-six cancer patients with laboratory-confirmed COVID-19 pneumonia who were admitted to Tongji Hospital of Huazhong University of Science and Technology, Wuhan, China, from Feb 1 to Apr 1, 2020. Evidence of cytokine profiles were assessed by testing for the IL1β, IL2R, IL6, IL8, IL10, and TNF - α in the peripheral blood of severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) infected cancer patients. Results: Of 2143 patients with COVID-19, 56 cancer patients were included. The patients were divided into two groups, as cancer survivors, and cancer non-survivors. 12 (21%) patients with lymphopenia (0.5 [0.3-0.7]) had died during hospital stay. In non-survivors, IL2R, IL6, and IL10 were higher. 3(6.8%) cancer survivors with COVID-19 had positive RT-PCR test results again shortly after discharge. Conclusion: The mortality rate of COVID-19 among cancer patients are considerable. Cancer non-survivors are characterized by more severe lymphopenia and a higher levels of cytokines. Recovered cancer survivors still may be virus carriers.

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