Medicina Clinica Practica最新文献

A 17-year-old male patient is admitted with an acute episode of dengue fever, during its course presents prolonged fever associated with multiple intrabdominal abscesses (hepatic, splenic). A search for other causes was performed, yielding negative results. The fever spontaneously resolved after 30 days of illness, along with the inflammatory markers. A follow-up imaging at 30 days showed the absence of lesions in the liver and a significant decrease in the abscesses in the spleen. A review is conducted on prolonged dengue associated with intrabdominal complications.

Introduction

Obesity is a disease that has become a major public health concern. The objective of this research was to analyze the changes in the quality of life and in clinical, physiological, and anthropometric parameters in patients with obesity, belonging to a multidisciplinary program for weight loss.

Materials and methods

Observational retrospective cohort study that included obese patients in a multidisciplinary program. The comparison of quantitative variables at admission and discharge from the program was performed with the Wilcoxon signed rank test, while the qualitative variables were compared with the McNemar test. Statistical analysis was performed in the STATA V.15 program.

Results

323 patients were analyzed; it was shown that the median weight decreased 4.4 kg (p < 0.001). Adherence to physical activity increased from 30% (n = 97) to 90% (n = 289) (p < 0.001). Similarly, the median VO2 max increased from 23.6 (IQR 19.7-30.4) on admission to 32.9 (IQR 27.8-38) on discharge. Regarding quality of life, self-care was one of the dimensions with the greatest impact during the program, with a decrease in the report of extreme difficulties from 17.7% to 0.3%. Likewise, the visual analogue scale (VAS) increased the median from 50 (RIC 50-70) to 80 (RIC 70-90) (p < 0.001).

Conclusion

The multidisciplinary approach to obesity offers a comprehensive approach to the patient, impacting not only physical, but also psychological and emotional aspects of the problem, improving her quality of life.

Background

Snakebites are one of the most important health issues globally that cause morbidity, discomfort, and even death. This study aimed to evaluate the clinical features of snakebite in patients referred to Razi Hospital in Ghaemshahr city.

Methods

In this descriptive, cross-sectional study, 325 snakebite patients admitted to Razi Hospital in Qaemshahr city between the years 2014 and 2019 were studied. All information was extracted from patients' medical records. SPSS software version 25 was used to analyze the data.

Results

Patients ranged in age from 9 to 71 years with a mean of 36.6 ± 10.7 years. 238 cases (73.2%) were male and 87 cases (26.8%) were female. The highest frequency of bites with 162 cases (49.8%) was related to the lower extremities and summer with 122 cases (37.5%) had the highest frequency of bites. The highest frequency of local symptoms was related to bruising (17.8%), erythema (16.9%), and pain (15.7%), and the highest frequency of systemic symptoms were related to weakness (24%), and sweating (14.2%). For 88.2% of cases, antivenom was used. 33.8% of the patients received antibiotics, mostly ciprofloxacin + clindamycin.

Conclusion

The results obtained in this study showed that common local complications in patients included bruising, erythema, and edema and systemic complications such as weakness, subcutaneous bleeding, and sweating. Antivenom was used for most of the cases and no deaths were reported. Also, unscientific actions such as incision and suction are still performed in cases that require more awareness and training.

Objective

To determine if the neutrophil-lymphocyte index is a factor associated with mortality in patients with severe traumatic brain injury. In order to establish a rapid marker of unfavorable evolution and adverse outcomes in these patients.

Material and methods

The clinical history of 238 patients with severe traumatic brain injury treated in the Intensive Care Unit of the Trujillo Regional Teaching Hospital during the period 2016-2022 was reviewed.

Results

The neutrophil-lymphocyte index did not show a significant association with mortality (HRc 1.97 95% CI 0.82-4.72) (p > 0.5). The bivariate and multivariate analysis where the intervention of other variables was associated, determined that anisocoria increased the risk of death by 4 times (HRc 4.1; IC95%; 1.86-9.04) (p < 0.001), shock increased the risk of death by 6 times. Death (HRc 6.64; 95%; CI 2.49-17.73) (p < 0.001), and hypernatremia doubled the risk of death (HRc 2.24; 95%; CI 1.005-4.82) (p < 0.04).

Conclusions

It was found that anisocoria, shock, hospital stay and Glasgow coma scale at admission are independent predictors of mortality.

Here we present a case of silicosis in a patient dedicated to tunneling for more than 40 years. Respiratory function test revealed a restrictive pattern with moderately reduced diffusion. Imaging tests revealed a pattern of usual interstitial lung disease with calcified bilateral mediastinal lymph nodes. Given the work history, the findings were suggestive of crystalline silica inhalation pneumoconiosis. The interest of this case lies in the fact that, although related to earthworks, the clinical and iconographic pattern is similar to the one described in mining industry patients.

Introduction

Spontaneous dissection of cervical arteries represents only 2% of all strokes, but represents approximately 10-25% of strokes in youth. Its etiology is sometimes a diagnostic challenge.

Objective

To describe a case of sequential bilateral carotid dissection with a late recurrence suggestive of underlying arteriopathy.

Patients and methods

A 54-year-old woman with acute left carotid dissection with acute/subacute ischemic lesions due to arterial-arterial embolism that progressed as a transient ischemic attack and compressive symptoms with clinical expression of ipsilateral Horner syndrome, which in the study showed a previous right carotid dissection with an organized intraluminal thrombus. She had presented headache and pupillary anisocoria 8 months earlier which were solved spontaneusly. A described extension study was carried out in which an antiphospholipid syndrome was revealed, being confirmed by a history of recurrent abortions.

Conclusions

Sequential dissection with late recurrence seems to be more related to underlying pathologies likewise arteriopathy or to systemic diseases such as antiphospholipid syndrome, which is why extensive screening for underlying pathology is required.

Objective

Stroke is acknowledged as a devastating complication post coronary artery bypass grafting surgery (CABG), that may reduce the quality of life and increase mortality. The incidence of post-CABG stroke results in more hospital mortality, longer times of hospital stays, and raises the costs of hospital and rehabilitative support. Having knowledge about risk factors of stroke after CABG could help to define the best approach to reduce post-CABG strokes.

Materials and methods

In this study, we reviewed the risk factors associated with stroke after CABG and the strategies for reducing the risk of stroke.

Result

According to the evaluation of this study, the incidence rate of stroke after CABG was between 1.2% and 4.2%. The most prevalent risk factors for stroke after CABG are advanced age, previous stroke, atrial fibrillation, carotid artery disease, and diabetes mellitus.

Conclusion

Moreover, off-pump coronary artery bypass graft and epiaortic ultrasonography have a positive effect on reducing the incidence of stroke post-CABG.