Molecular and Clinical Aspects of Chronic Manifestations in Chagas Disease: A State-of-the-Art Review

Chronic manifestations of Chagas disease present as disabling and life-threatening conditions affecting mainly the cardiovascular and gastrointestinal systems. Although meaningful research has outlined the different molecular mechanisms underlying Trypanosoma cruzi’s infection and the host-parasite interactions that follow, prompt diagnosis and treatment remain a challenge, particularly in developing countries and also in those where the disease is considered non-endemic. This review intends to present an up-to-date review of the parasite’s life cycle, genetic diversity, virulence factors, and infective mechanisms, as well as the epidemiology, clinical presentation, diagnosis, and treatment options of the main chronic complications of Chagas disease.

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Vascular Dysfunction in Preeclampsia

Cells ◽

10.3390/cells10113055 ◽

2021 ◽

Vol 10 (11) ◽

pp. 3055

Author(s):

Megan A. Opichka ◽

Matthew W. Rappelt ◽

David D. Gutterman ◽

Justin L. Grobe ◽

Jennifer J. McIntosh

Keyword(s):

Oxidative Stress ◽

Molecular Mechanisms ◽

Vascular Dysfunction ◽

Treatment Options ◽

Cardiovascular Disorder ◽

Endothelial Damage ◽

Spiral Artery ◽

Mitochondrial Stress ◽

Inflammatory State ◽

Life Threatening

Preeclampsia is a life-threatening pregnancy-associated cardiovascular disorder characterized by hypertension and proteinuria at 20 weeks of gestation. Though its exact underlying cause is not precisely defined and likely heterogenous, a plethora of research indicates that in some women with preeclampsia, both maternal and placental vascular dysfunction plays a role in the pathogenesis and can persist into the postpartum period. Potential abnormalities include impaired placentation, incomplete spiral artery remodeling, and endothelial damage, which are further propagated by immune factors, mitochondrial stress, and an imbalance of pro- and antiangiogenic substances. While the field has progressed, current gaps in knowledge include detailed initial molecular mechanisms and effective treatment options. Newfound evidence indicates that vasopressin is an early mediator and biomarker of the disorder, and promising future therapeutic avenues include mitigating mitochondrial dysfunction, excess oxidative stress, and the resulting inflammatory state. In this review, we provide a detailed overview of vascular defects present during preeclampsia and connect well-established notions to newer discoveries at the molecular, cellular, and whole-organism levels.

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Intraventricular Tension Pneumocephalus as a Complication of Paranasal Sinus Surgery

Neurosurgery ◽

10.1227/00006123-198105000-00011 ◽

1981 ◽

Vol 8 (5) ◽

pp. 574-576 ◽

Cited By ~ 31

Author(s):

Dudley H. Davis ◽

Edward R. Laws ◽

Thomas J. McDonald ◽

John R. Salassa ◽

Lawrence H. Phillips

Keyword(s):

Intracranial Pressure ◽

Paranasal Sinus ◽

Diagnosis And Treatment ◽

Sinus Surgery ◽

Tension Pneumocephalus ◽

Paranasal Sinus Surgery ◽

Life Threatening ◽

Prompt Diagnosis

Abstract A case of intraventricular tension pneumocephalus occurring as a complication of paranasal sinus surgery is presented. The pathophysiology of tension pneumocephalus is discussed and emphasis is placed on the potentially life-threatening increase in intracranial pressure that occurs. Tension pneumocephalus requires prompt diagnosis and treatment.

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Impacted denture in the oesophagus: review of the literature and its management

BMJ Case Reports ◽

10.1136/bcr-2019-229655 ◽

2019 ◽

Vol 12 (10) ◽

pp. e229655

Author(s):

Zahir Mughal ◽

Alexander Rowan Charlton ◽

Raghav Dwivedi ◽

Basavaiah Natesh

Keyword(s):

Foreign Body ◽

Clinical Assessment ◽

Treatment Options ◽

Oesophageal Perforation ◽

Review Of The Literature ◽

Common Cause ◽

Life Threatening ◽

Foreign Body Impaction ◽

Acute Dysphagia ◽

Prompt Diagnosis

Foreign body impaction in the oesophagus is a common cause of acute dysphagia. Oesophageal impaction of sharp objects such as dentures can be life threatening due to the risk of oesophageal perforation. This condition requires urgent treatment, and therefore prompt diagnosis and management is vital to avoid complications. Diagnosing oesophageal foreign body can be challenging due to its poor localising symptoms. We describe a case of an impacted denture in which considerable delays to treatment were encountered, and discuss the pitfalls and lessons learnt. This case and review of the literature draw attention to clinical assessment, investigation and treatment options for oesophageal foreign body impaction.

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Ureteroarterial Fistula from Ureteral Stump: A Challenging Case

Case Reports in Urology ◽

10.1155/2014/514625 ◽

2014 ◽

Vol 2014 ◽

pp. 1-3

Author(s):

Pietro Pozzilli ◽

Massimo Lenti ◽

Stefano Mosca ◽

Elisabetta Nunzi ◽

Luigi Mearini

Keyword(s):

Rare Condition ◽

Diagnosis And Treatment ◽

Endovascular Stent ◽

Difficult Diagnosis ◽

Ureteroarterial Fistula ◽

Threatening Condition ◽

Life Threatening ◽

Endovascular Stent Placement ◽

Prompt Diagnosis ◽

Ureteral Occlusion

Ureteroarterial fistula (UAF) is a relatively rare condition with about 150 cases reported in the literature. Since it is a potentially life-threatening condition, a prompt diagnosis and treatment are crucial. We present here a rare, challenging case of UAF diagnosed after left nephrectomy, thus involving the ureteral stump. The difficult diagnosis and treatment by contemporary use of endovascular stent placement and ureteral occlusion by mean of metallic coils and Onyx injection are discussed.

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Intensive care management of status epilepticus

Journal of Neuroanaesthesiology and Critical Care ◽

10.4103/2348-0548.182344 ◽

2016 ◽

Vol 03 (02) ◽

pp. 083-095

Author(s):

Nidhi Gupta

Keyword(s):

Status Epilepticus ◽

Treatment Options ◽

Altered Mental Status ◽

Success Rates ◽

Airway Protection ◽

Life Threatening ◽

Underlying Causes ◽

High Index Of Suspicion ◽

Prompt Diagnosis ◽

Deep Brain

AbstractStatus epilepticus (SE) is a life-threatening neurological emergency that requires prompt diagnosis and treatment. SE may be classified into convulsive and non-convulsive types, based on the presence of rhythmic jerking of the extremities. Clinically, tonic-clonic convulsive SE (CSE) is divided into four subsequent stages: Early, established, refractory and super-refractory. Initial elements of resuscitation include airway protection, haemodynamic resuscitation and seizure control. Further treatment should then be guided by the diagnostic workup. Rapid treatment of early SE is achieved with intravenous (IV) lorazepam or intramuscular midazolam. In established SE, IV antiepileptic drugs (AEDs) (phenytoin/fosphenytoin, valproate, levetiracetam, phenobarbital) are most commonly used, but there is no Class I evidence for choosing one over the other. Considered overall, cumulative data from the literature are consistent with valproate and levetiracetam, being a safe and effective therapeutic alternative to phenobarbital and phenytoin for treatment of established SE. Refractory SE (RSE) and super-RSE are treated with anaesthetic medications (propofol, midazolam, thiopental/pentobarbital, ketamine), non-anaesthetic drugs (lidocaine, magnesium, pyridoxine), AEDs (levetiracetam, lacosamide, topiramate, lacosamide, pregabalin, gabapentin) and other cause-directed treatments with low success rates. Potential non-pharmacologic interventions to be considered in super-RSE include hypothermia, electroconvulsive therapy, ketogenic diet, immunomodulatory treatments, emergency resective epilepsy surgery, cerebrospinal fluid drainage and vagal nerve or deep brain stimulation or transcranial magnetic stimulation. Diagnosis of non-CSE requires continuous electroencephalography and involves a high index of suspicion in all patients with an altered mental status of unclear cause or with a prolonged postictal state. Treatment options include addressing underlying causes and aggressive pharmacologic interventions with a benzodiazepine, phenytoin and valproate.

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A Practical Guide to the Management of Diabetic Ketoacidosis in Adults

Acute Medicine Journal ◽

10.52964/amja.0008 ◽

2002 ◽

Vol 1 (2) ◽

pp. 35-39

Author(s):

Alison Evans ◽

◽

Martin Taylor ◽

Keyword(s):

Diabetic Ketoacidosis ◽

Diagnosis And Treatment ◽

Medical Emergency ◽

Adherence To Guidelines ◽

Practical Advice ◽

Practical Guide ◽

Life Threatening ◽

Prompt Diagnosis ◽

Doctors And Nurses

Diabetic ketoacidosis is a life-threatening medical emergency which requires prompt diagnosis and treatment. Understanding the mechanism by which lack of insulin causes dehydration and acidosis is helpful in managing this condition. Numerous guidelines exist to improve management but adherence to guidelines is often poor. This guide aims to provide practical advice for the doctors and nurses involved in the immediate management of these patients.

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Early Diagnosis and Successful Treatment of Idiopathic Autoimmune Factor XIII Deficiency Complicated by Intracerebral Hemorrhage

Blood ◽

10.1182/blood.v120.21.4634.4634 ◽

2012 ◽

Vol 120 (21) ◽

pp. 4634-4634

Author(s):

Mihoko Takai ◽

Naoko Hosono ◽

Shinji Kishi ◽

Takahiro Yamauchi ◽

Yoshimasa Urasaki ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Immunosuppressive Therapy ◽

Diagnosis And Treatment ◽

Bleeding Tendency ◽

Open Drainage ◽

Life Threatening ◽

History Of ◽

Prompt Diagnosis ◽

Fxiii Activity ◽

Fxiii Deficiency

Abstract Abstract 4634 Summary: Autoimmune factor XIII (FXIII) deficiency is an extremely rare bleeding disorder that can be life-threatening without prompt diagnosis and treatment. Many clinicians, even experienced hematologists, are unaware of this critical disorder. The causes and mechanisms of autoimmune FXIII deficiency remain unclear, but patients should be given top priority in receiving FXIII concentrate and immunosuppressive drugs when this is suspected to avoid fatal hemorrhage. We report the first Japanese case of autoimmune FXIII deficiency presenting as acute intracerebral hemorrhage. The clinical manifestations allowed prompt diagnosis and effective treatment in the form of emergency open drainage and infusion of FXIII concentrates combined with prednisolone therapy, leading to success in saving the life of this patient. Case: A 68-year-old man was hospitalized in another department of our hospital with abdominal pain and diffuse purpura of the abdominal skin in the absence of any history of trauma. He did not have a family history of bleeding tendency. Since he had been receiving low-dose aspirin because of a previous stroke, he received a transfusion of red cell concentrate and was discharged after cessation of aspirin. Two weeks later, he was taken to an emergency room with left hemiplegia. Computed tomography (CT) revealed an intracerebral hemorrhage measuring 4 cm in diameter. Sixteen hours after hospitalization, emergency open drainage was performed because of decreased levels of consciousness due to an expanding intracerebral hemorrhage measuring 7 cm with midline shift. Bleeding was controlled during the operation and CT showed no evidence of further bleeding after surgery. However, on postoperative day 2, subcutaneous bleeding spontaneously developed on the patient's head. Platelet counts and coagulation tests were normal, and other tests showed no evidence of factor VIII, factor IX or von Willebrand factor deficiencies. Given the lack of evidence of other autoimmune disorders or family history of bleeding tendency, we suspected idiopathic autoimmune FXIII deficiency and immediately initiated administration of FXIII concentrate. After treatment with FXIII concentrate, subcutaneous bleeding on the head was arrested and level of consciousness had recovered at all. 3 days after it was confirmed that FXIII activity was as low as 11%, and was not corrected by normal plasma at 1:1 in the cross-mixing test, suggesting the presence of anti-FXIII inhibitor and corroborating our clinical diagnosis. Based on the detection of anti-FXIII A autoantibodies in dot blot assay, we immediately started immunosuppressive therapy using prednisolone at 1 mg/kg combined with FXIII concentrate. Three weeks later, inhibition of FXIII activity was partly improved. FXIII activity was 36%, and 1:1 cross-mixing test was corrected, indicating that immunosuppressive therapy with prednisolone was proving successful. Four weeks later, his surgical wound had healed and FXIII concentration injection was discontinued. Prednisolone tapering was started, and after 8 weeks, with prednisolone tapered to 35 mg, FXIII activity was elevated to 53%. This was not yet sufficient, but anti-FXIII A subunit autoantibodies had disappeared completely, first as free-form antibody and then as bound/complexed antibody. Successful results were achieved in response to short-term treatment. In fact, in some of the 28 cases reported from Japan, anti-FXIII inhibitors were continued despite immunosuppressive therapy for a few years. The next target was to stop prednisolone therapy, because the major causes of death in patients with autoimmune FXIII deficiency is bleeding or infection. Why and when the patient developed autoantibodies remains unclear, as he had no evidence of other autoimmune disorders. This report describes a remarkably successful case in which early diagnosis and treatment of autoimmune FXIII deficiency achieved good outcomes for a case complicated by intracerebral hemorrhage. All clinicians should consider the possibility of this rare disease when they encounter patients who present with life-threatening bleeding and normal coagulation tests are inconclusive. Prompt diagnosis and treatment are crucial in saving the life of the patient. Disclosures: No relevant conflicts of interest to declare.

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Clinical aspects and antenatal diagnosis of invasive placenta: a review of ten-years’ experience of a multi-profile hospital in Lithuania

Acta medica Lituanica ◽

10.6001/actamedica.v24i3.3552 ◽

2017 ◽

Vol 24 (3) ◽

pp. 176-187 ◽

Cited By ~ 1

Author(s):

Jelena Volochovič ◽

Diana Ramašauskaitė ◽

Ramunė Šimkevičiūtė

Keyword(s):

Treatment Options ◽

University Hospital ◽

Clinical Aspects ◽

Tertiary Level ◽

Optimal Care ◽

Mother And Child ◽

Internal Iliac ◽

Invasive Placenta ◽

Life Threatening ◽

Vilnius University

Background. Invasive placenta is a rare obstetrical pathology that is life-threatening to mother and child. It is important to diagnose this pathology as early as possible and to plan further optimal care of patients in order to minimize life-threatening complications. The aim of this study was to analyze the frequency of cases of invasive placenta, the peculiarities of their clinical manifestation in women who gave birth from 2006 to 2015, to evaluate diagnostic and treatment options of this pathology, and to review their changes when the level of services provided by the institution changes. Materials and methods. A retrospective study was performed of the ten-year period of 2006 to 2015. The study consisted of examining the data of medical records of a group of 14 women. Results. The incidence of invasive placenta at the secondary level hospital was 1/2170 births, 1:934 births at the tertiary level. There were only three patients (21.4%) diagnosed with invasive placenta during pregnancy at Vilnius University Hospital Santaros Klinikos Obstetrics and Gynaecology Centre. Before the surgery, pre-occlusive balloons were ushered into the internal iliac artery and inflated to reduce bleeding after the newborn delivery. The amount of blood loss in the whole group ranged from 1000 to 6500 ml (avg. 3130.7 ml). Radical treatment was given to eleven patients. Conclusion. Invasive placenta is a life-threatening condition. Tertiary-level hospitals have a greater capacity for antenatal diagnostics. Timely diagnosis of placental invasion and evaluation of the level of the myometrium damage before delivery is instrumental in planning patient care and preparing for delivery and operation.

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The Chaos of Triage: A Model for Early Exclusion of Cardiac Injury in Chest Gunshot Wound Patients

10.21203/rs.3.rs-668325/v1 ◽

2021 ◽

Author(s):

Chih-Yuan Fu ◽

Francesco Bajani ◽

Ghulam H Saadat ◽

Matt Kaminsky ◽

Andrew Dennis ◽

...

Keyword(s):

Logistic Regression ◽

Prediction Model ◽

External Validation ◽

Cardiac Injury ◽

Diagnosis And Treatment ◽

Multivariate Logistic Regression ◽

Heart Injuries ◽

Life Threatening ◽

Heart Injury ◽

Prompt Diagnosis

Abstract IntroductionHeart injury caused by thoracic gunshot wounds (GSW) is especially life-threatening and require prompt diagnosis and treatment. Heart injury is especially life-threatening and requires prompt diagnosis and treatment. During the pre-hospital phase and initial triage in the emergency department (ED), early recognition of a patient with heart GSW is difficult but important. The purpose of this study was to evaluate the predictability of heart injury in patients with chest GSWs. MethodsThe National Trauma Data Bank was queried for patients with chest GSW treated at all US trauma centres from July 1, 2009, to June 30, 2016. Patients with and without heart injuries (ICD-9: 861.00-03, 861.10-13) were compared and analyzed. Multivariate logistic regression was performed to evaluate independent factors of heart injury which could be obtained during the pre-hospital or triage phase only. Step-backward selection was used to establish a model for such patients. We used the receiver operating characteristic (ROC) curve to test the accuracy of this model and Youden’s J statistic to find the cutoff value of sensitivity/specificity. Level 1 trauma registry data from Stroger Hospital of Cook County (July 1, 2016, to June 30, 2017) was used for external validation of this prediction model.Results47,044 patients with chest GSW were evaluated in the ED and 8.6% of them had heart injuries. The mortality rates of patients without cardiac injury versus those with cardiac injury were 9.0% (3864/42997) and 21.7% (879/4047) respectively. Patients with heart injuries were significantly younger (28.4 vs. 29.3, p<0.001), had lower SBP (34.7 vs. 103.8 mmHg, p<0.001), had lower GCS (5.1 vs. 11.2, p<0.001) and a higher probability of apnea (58.3% vs. 14.7%, p<0.001), higher rate of pulselessness (59.9% vs. 12.0%, p<0.001), and more self-inflicted injuries (9.7% vs. 8.5%, p<0.001) than patients without heart injuries. The cutoff values of SBP and GCS for prediction of heart injury were 61mmHg (AUC: 0.783) and 5.5 (AUC: 0.768) respectively. Integration of six independent factors (age, SBP, GCS, apnea, lack of pulse and suicide intent) with multivariate logistic regression showed an AUC: 0.823 and specificity of 88.8% in the heart injury prediction model. External validation with the local database showed 95.6% specificity.ConclusionEarly diagnosis of heart injury is important in the management of patients with chest GSWs. Our model has high specificity and can be beneficial for early triage of cardiac injury in patients with GSW to the chest.

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Ureteroarterial Fistula: A Diagnosis Which Is Not Always Black and White

Case Reports in Urology ◽

10.1155/2021/8165991 ◽

2021 ◽

Vol 2021 ◽

pp. 1-4

Author(s):

A. Haffar ◽

T. Trump ◽

A. A. Elbakry ◽

K. McCluskey ◽

M. W. Salkini ◽

...

Keyword(s):

Multidisciplinary Team ◽

Diagnosis And Treatment ◽

Imaging Modalities ◽

Gross Hematuria ◽

Advanced Imaging ◽

Black And White ◽

Threatening Condition ◽

Life Threatening ◽

High Index Of Suspicion ◽

Prompt Diagnosis

Ureteroiliac artery fistulas are a rare, life-threatening condition that requires a high index of suspicion for prompt diagnosis. Presurgical diagnosis is challenging as this condition can lie hidden despite advanced imaging modalities. We present two cases of patients presenting with gross hematuria and exsanguination in the setting of a ureteroiliac artery fistula. These cases highlight the difficulties in timely diagnosis and treatment in a multidisciplinary team.

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