Perforazione ileale da febbre tifoide

Typhoid fever continues to be a major public health problem in developing countries and mortality is mainly related to its most frequent complication, namely: intestinal perforation. The paper presents the case of a 12-year-old girl with abdominal pain associated with watery diarrhoea, vomiting, fever and general malaise for two weeks. Typhoid fever was suspected, therefore therapy with ceftriaxone was started. Clinical conditions were worsening, so X-ray of the abdomen was performed with evidence of hydro-aerial levels and ultrasound showing abundant non-homogeneous echogenic material in the pelvic cavity, consistent with purulent ascites. Exploratory laparotomy was performed showing an isolated perforation of the ileus, which was sutured. In the postoperative period, antibiotic therapy was boosted with metronidazole and gentamicin. Due to the wound dehiscence, surgical revision with secondary tension sutures was necessary.

Polyserositis secondary to COVID-19: the diagnostic dilemma

COVID-19 is a novel disease often presenting with a cough, fever or a change in smell or taste. Recently, it has been recognised that COVID-19 may result in multisystemic issues and thus cause atypical symptoms, which can cause diagnostic delay, uncertainty and inaccuracy. A 60-year-old woman presented to the hospital with a 2-day history of mid-thoracic discomfort, intermittent rigours, fevers and general malaise, a few weeks after likely COVID-19 infection. She was admitted and treated for community-acquired pneumonia. However, her symptoms recurred despite multiple courses of antibiotics, which prompted further workup. A combination of a pleural and pericardial effusion was identified, leading to a diagnosis of polyserositis, and a COVID-19 antibody test came back positive. Colchicine was effective at resolving her symptoms, leading to further conviction of a probable postviral polyserositis.

Algunas reflexiones sobre el litigio en el fuero de familia en época de pandemia y los principios que imperan en la materia. / Some reflections on litigation in the law of the familly in time of pandemic and the principles that rule in the matter

El llamado procedimiento familiar exige el cumplimiento efectivo del principio de inmediación procesal y de la intervención dinámica y comprometida del Juez. Como podemos observar en la teoría, estamos de acuerdo en la necesidad de un tribunal de familia presente, visible y acompañante de estos dolorosos procesos que se acentuaron aun en época de pandemia, por la falta de recursos económicos, por el malestar general de la población, por la falta de cooperación de innumerables sectores, es por ello que siempre insta a los encargados de llevar justicia a cada familia a tener actitudes más humanas y sociales, que restrictivas y formales. ABSTRACT: The so-called family procedure requires effective compliance with the principle of procedural immediacy and the dynamic and committed intervention of the Judge. As we can see in theory, we agree on the need for a family court that is present, visible and accompanying these painful processes that were accentuated even in times of pandemic, due to the lack of economic resources, due to the general malaise of the population Due to the lack of cooperation from innumerable sectors, that is why it always urges those in charge of bringing justice to each family to have more humane and social attitudes, rather than restrictive and formal.

Generalised eruptive histiocytosis preceded by systemic symptoms

Generalised eruptive histiocytosis is a rare proliferative disease that typically presents with indolent cutaneous eruptions. We describe the case of a 73-year-old man presenting with diffuse, asymptomatic crops of pink to dusky red papules preceded by general malaise, myalgias, fluctuating fever, chills, and weight loss. Histological evaluation revealed a non-Langerhans cell histiocytic dermal infiltrate with spindle cell features and chronic inflammation, reactive for CD68 and negative for both S100 and CD1a. Malignancy screening was negative. This report aims to highlight a unique presentation of generalised eruptive histiocytosis, emphasise histological findings, and discuss considerations for malignancy screening.

An unusual case of giant cell arteritis

A 73-year-old man presented with unsteadiness and general malaise and later had problems with cognition. This was initially diagnosed as benign paroxysmal positional vertigo, but he was later found to have giant cell arteritis. Neurologists and physicians should be aware that giant cell arteritis can present with encephalopathy rather than the more typical features of headache, jaw pain and visual disturbance.

We Need New Names : A Dirge on Evil

The present article seeks to validate Bulawayo's We Need New Names as a credible alternative to the official national historiography. It attempts to achieve this feat by obtaining answers to two key questions. The first is whether Bulawayo is fair to indict everyone (even perceived victims) for the general malaise that bedevils her nameless dystopian republic. The second question seeks insights on whether the novelist's sex guarantees women some exemption from the finger pointing that Darling otherwise executes with the candor of a death-row judge, albeit in her naive gravity-defying buoyancy. In search for answers to these questions, the researchers first analyze the portrayal of white people in Bulawayo’s unnamed postcolonial state. It then juxtaposes the presentation of the post-independence rulers of the fictional state with that of the suffering masses with the intention to justify, or otherwise, why both perceived victims and culprits are held culpable to the malaise that obtains. Finally, the research examines how women in Africa (and of Africa) are juxtaposed to women in the west. This last part encapsulates problematizing the brand of Darling’s cosmopolitanism as a possible commentary on both the home she abandons and the one she adopts. Since the underlying objective of the study is to test Bulawayo’s We Need New Names as a credible alternative to the metanarrative, parallels are drawn between events and narratives in Bulawayo’s nameless republic and those in the milieu from which her text emerges in its trans-continental settings.

Alternative Pathway Involvement in Protoporphyria Patients Related to Sun Exposure

The homeostasis of tissues in a chronic disease is an essential function of the alternative pathway (AP) of the complement system (CS). However, if not controlled, it may also be detrimental to healthy cells with a consequent aggravation of symptoms. The protoporphyria (PP) is a rare chronic disease that causes phototoxicity in visible light with local skin pain and general malaise. In order to establish if there is a systemic involvement of the CS during sun exposure, we designed a non-invasive method with a serum collection in winter and summer from 19 PP and 13 controls to detect the levels of CS protein: Properdin, Factor H (FH), and C5. Moreover, the global radiation data were collected from the regional agency of environmental protection (ARPA). The results show growing values for every protein in patients with PP, compared to control, in both seasons, in particular in summer compared to winter. To reinforce the evidence, we have estimated the personal exposure of patients based on the global radiation data. The main factors of the AP increased over the season, confirming the involvement of the AP in relation to light exposure. The systemic response could justify the general malaise of patients after long light exposure and can be exploited to elucidate new therapeutic approaches.

Factors associated with readmission to the Emergency Department in a cohort of COVID-19 hospitalized patients

Introduction: The aim of this study was to describe the symptomatology and main factors associated with readmission to the Emergency Department (ED) in COVID-19 patients discharged from hospital during the first wave of the pandemic at the San Cecilio University Hospital, Granada, Spain. Methods: An observational longitudinal study was conducted in a cohort of 441 patients admitted to our hospital with confirmed SARS-CoV-2 polymerase chain reaction (PCR) from 1 March to 15 April 2020. Patients were followed up through medical records 6 months after discharge. Sociodemographic, clinical and symptomatologic variables were collected. Descriptive, bivariate and multivariate logistic regression analyses were performed. Results: The mean age of patients in the cohort was 66.4 years (s = 15.3), with 55.1%men. In-hospital mortality was 18.1%. The presence of persistent symptomatology was high (64.5%), especially respiratory (53.2%), systemic (46.3%) and neurological (31.0%). A total of 75 (20.8%) patients were readmitted to the ED during the 6 months following hospital discharge. The main factors associated with readmission to the ED were polymedication (P = 0.031), living in a care home (P = 0.014), fever (P = 0.047), general malaise (P < 0.001), thoracic pain (P < 0.001), headache (P = 0.012), hematological symptoms (P = 0.011), nephrological symptoms (P = 0.047), depressive symptoms (P = 0.009), syncope or hypotension (P = 0.006) and superinfection (P = 0.018). After multivariate adjustment analysis, thoracic pain (OR: 4.45, 95% CI: 1.88–10.52), general malaise and hematological symptoms (OR: 3.95, 95% CI: 1.12–13.89) remained as risk factors. Conclusions: The presence of persistent symptomatology after hospital discharge in our cohort was common and varied. Polymedication and living in a care home made up the most vulnerable profile of COVID-19 patients for returning to the ED. Thoracic pain, general malaise and hematological symptoms were identified as potential markers of severity, along with others predictors. These findings might be useful for optimizing follow-up strategies. Future studies conducted in other geographical areas are necessary to corroborate our results.

Therapeutic and Vaccine Options for COVID-19: Status after 6 Months of the Disease Outbreak

An outbreak of the coronavirus disease 2019 (COVID-19) caused by an infection of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) occurred in Wuhan, China, in December 2019. This new virus belongs to the group of enveloped RNA beta-coronaviruses. Symptoms may differ in various infected persons, but major presentations include dry cough, nasal congestion, shortness of breath, fever, and general malaise. The disease appears to be more severe in patients above the age of 60 years and those with underlying conditions such as diabetes, cancer, cardiovascular diseases, chronic respiratory disease, and hypertension. There is still no approved vaccine against COVID-19, but more than a hundred are at different stages of development. It is known that the development of new drugs takes a relatively long time, so several known and already-approved drugs are being repurposed for the treatment of this disease. In this review, we explore the therapeutic and vaccine options that are available for COVID-19 6 months after its outbreak. Most noteworthy among the therapeutic options are dexamethasone, remdesivir, Avigan (favipiravir) and convalescent plasma.