Fara Russo, Anna Vitiello, Maria Carolina Russo, Alfonso Riccio, Camillo Candurro
New evidence suggests that Sars-CoV2 infection during pregnancy may result in complications such as hypertension, nephropathy, thrombocytopenia, and liver damage. A pre-eclampsia-like syndrome has also been proposed in pregnant women with severe SARS-CoV-2 infection, which meets the pre-eclampsia criteria but resolves without delivery, with improvement in respiratory symptoms. 31-year-old, second pregnancy, in Emergency Room for PROM (premature rupture of membranes), has Sars-CoV2 infection and has not been vaccinated. Normal examinations and mild hypertension were present upon admission, but no treatment was administered. Vaginal Leukocytic Delivery 12 hours after admission, newborn Apgar score 9/10, weight 3.250 kg. At 20 hours after delivery, epigastric pain VAS 8-9 for 20 minutes, systolic/diastolic hypertension peak, increase in transaminases, LDH, ALP, Bilirubin, Dimer, platelet and fibrinogen drop. Neurological and respiratory objectivity were negative, and renal indices were within normal limits, so nifedipine 30mgx2/day + methyldopa 500 mgx2/day was started. Abdominal ultrasound revealed a thin perihepatic fluid stratum. A prophilaxis of dexamethasone 12mg twice a day and magnesium sulfate was introduced. At 32 hours after delivery, the laboratory detected an increase in transaminases, LDH, and worsening of thrombocytopenia. The patient is always eupnoic, and the diuresis is adequate. Blood tests improved gradually after 56 hours postpartum. Methyldopa and steroids are escalating. On day 7, discharge with normalized platelet and bilirubin counts and a decreasing trend in transaminases, LDH, and PAL. At the one-week follow-up, liver enzymes and coagulation were completely normal, and blood pressure was well controlled with methyldopa. We conclude that the simultaneous presence of the two diseases could have had a synergistic or opportunistic effect, resulting in severe clinical manifestations via interaction with the Renin-Angiotensin-Aldosterone system.
{"title":"COVID-19 in pregnant women: description of a possible case of COVID-19-linked HELLP-like syndrome","authors":"Fara Russo, Anna Vitiello, Maria Carolina Russo, Alfonso Riccio, Camillo Candurro","doi":"10.4081/amsa.2024.39","DOIUrl":"https://doi.org/10.4081/amsa.2024.39","url":null,"abstract":"New evidence suggests that Sars-CoV2 infection during pregnancy may result in complications such as hypertension, nephropathy, thrombocytopenia, and liver damage. A pre-eclampsia-like syndrome has also been proposed in pregnant women with severe SARS-CoV-2 infection, which meets the pre-eclampsia criteria but resolves without delivery, with improvement in respiratory symptoms. 31-year-old, second pregnancy, in Emergency Room for PROM (premature rupture of membranes), has Sars-CoV2 infection and has not been vaccinated. Normal examinations and mild hypertension were present upon admission, but no treatment was administered. Vaginal Leukocytic Delivery 12 hours after admission, newborn Apgar score 9/10, weight 3.250 kg. At 20 hours after delivery, epigastric pain VAS 8-9 for 20 minutes, systolic/diastolic hypertension peak, increase in transaminases, LDH, ALP, Bilirubin, Dimer, platelet and fibrinogen drop. Neurological and respiratory objectivity were negative, and renal indices were within normal limits, so nifedipine 30mgx2/day + methyldopa 500 mgx2/day was started. Abdominal ultrasound revealed a thin perihepatic fluid stratum. A prophilaxis of dexamethasone 12mg twice a day and magnesium sulfate was introduced. At 32 hours after delivery, the laboratory detected an increase in transaminases, LDH, and worsening of thrombocytopenia. The patient is always eupnoic, and the diuresis is adequate. Blood tests improved gradually after 56 hours postpartum. Methyldopa and steroids are escalating. On day 7, discharge with normalized platelet and bilirubin counts and a decreasing trend in transaminases, LDH, and PAL. At the one-week follow-up, liver enzymes and coagulation were completely normal, and blood pressure was well controlled with methyldopa. We conclude that the simultaneous presence of the two diseases could have had a synergistic or opportunistic effect, resulting in severe clinical manifestations via interaction with the Renin-Angiotensin-Aldosterone system.","PeriodicalId":486793,"journal":{"name":"Acute Care Medicine Surgery and Anesthesia","volume":"2 15","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140381910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
F. Coletta, Simone Esposito, Giovanna Di Maiolo, Filomena Lo Chiatto, Mariarosaria Cuomo, Giovanna Paola De Marco, Pasqualina Amitrano, Crescenzo Sala, Antonio Tomasello, Romolo Villani
Loxosceles rufescens, also known as “violin spider” due to its characteristic appearance, is a medium-sized spider species that can potentially pose a threat to humans. For this study, patients who presented to our hospital’s Poison Control Center between January 1, 2022, and December 31, 2022, and met the following inclusion criteria were included: Suspicion of a violin spider bite, as evaluated by our center. Our protocol involves an initial local treatment, which includes local washing with copious water and disinfection, along with the application of chlorotetracycline hydrochloride. Systemic therapy utilizes Amoxicillin and Clavulanic Acid as the first-line medication. The primary endpoints of this study are the timing and effectiveness of the treatment for cutaneous lesions. Demographic and anamnestic information regarding age, gender, and timelines was summarized using descriptive methods. Our study’s results indicate that erythema and pain are the most frequent symptoms. Loxoscelism is highly concentrated in the Western hemisphere and is considered the only proven arachnological cause of dermo-necrosis. In recent years, there has been an increase in diagnoses.
{"title":"Loxosceles rufescens: single-institutional epidemiology, diagnosis and treatment","authors":"F. Coletta, Simone Esposito, Giovanna Di Maiolo, Filomena Lo Chiatto, Mariarosaria Cuomo, Giovanna Paola De Marco, Pasqualina Amitrano, Crescenzo Sala, Antonio Tomasello, Romolo Villani","doi":"10.4081/amsa.2024.38","DOIUrl":"https://doi.org/10.4081/amsa.2024.38","url":null,"abstract":"Loxosceles rufescens, also known as “violin spider” due to its characteristic appearance, is a medium-sized spider species that can potentially pose a threat to humans. For this study, patients who presented to our hospital’s Poison Control Center between January 1, 2022, and December 31, 2022, and met the following inclusion criteria were included: Suspicion of a violin spider bite, as evaluated by our center. Our protocol involves an initial local treatment, which includes local washing with copious water and disinfection, along with the application of chlorotetracycline hydrochloride. Systemic therapy utilizes Amoxicillin and Clavulanic Acid as the first-line medication. The primary endpoints of this study are the timing and effectiveness of the treatment for cutaneous lesions. Demographic and anamnestic information regarding age, gender, and timelines was summarized using descriptive methods. Our study’s results indicate that erythema and pain are the most frequent symptoms. Loxoscelism is highly concentrated in the Western hemisphere and is considered the only proven arachnological cause of dermo-necrosis. In recent years, there has been an increase in diagnoses.","PeriodicalId":486793,"journal":{"name":"Acute Care Medicine Surgery and Anesthesia","volume":"38 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139608915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ovarian hyperstimulation syndrome (OHSS) is a well-known complication of assisted reproduction. The hyperstimulated ovaries release vasoactive substances that can increase capillary permeability, resulting in volume shift to the extravascular space and leading to hypovolemia, ascites and, in complicated cases, pleural and pericardial effusions, kidney and liver failure, shock. Point Of Care UltraSound (POCUS) can help the emergency physician to detect many of these complications, as well as guide their treatment. In this case report we present a patient at low risk for OHSS who recently underwent a successful in vitro fertilization, coming to the emergency department with an unusual complication of OHSS (an isolated pleural effusion), that has been safely and promptly diagnosed and treated in the emergency room with the help of POCUS, without any unnecessary exposition to ionizing radiations.
{"title":"Dealing with specialist pathology: an unusual case of ovarian hyperstimulation syndrome managed in the emergency department with point of care ultrasound","authors":"Roberto Lazzari, Mariona Condom Siñol","doi":"10.4081/amsa.2023.31","DOIUrl":"https://doi.org/10.4081/amsa.2023.31","url":null,"abstract":"Ovarian hyperstimulation syndrome (OHSS) is a well-known complication of assisted reproduction. The hyperstimulated ovaries release vasoactive substances that can increase capillary permeability, resulting in volume shift to the extravascular space and leading to hypovolemia, ascites and, in complicated cases, pleural and pericardial effusions, kidney and liver failure, shock. Point Of Care UltraSound (POCUS) can help the emergency physician to detect many of these complications, as well as guide their treatment. In this case report we present a patient at low risk for OHSS who recently underwent a successful in vitro fertilization, coming to the emergency department with an unusual complication of OHSS (an isolated pleural effusion), that has been safely and promptly diagnosed and treated in the emergency room with the help of POCUS, without any unnecessary exposition to ionizing radiations.","PeriodicalId":486793,"journal":{"name":"Acute Care Medicine Surgery and Anesthesia","volume":"51 24","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138952472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Melissa Nardecchia, Carlo Vallicelli, Mauro Stefano, Vanni Agnoletti, Luca Ansaloni, Paola Fugazzola, Federico Coccolini, Marco Vaira, Massimo Sartelli, Fausto Catena
Malignant bowel obstruction caused by peritoneal carcinomatosis is a common complication that affects a large proportion of gastrointestinal and ovarian oncology patients and predicts poor longterm survival. The management strategy for these patients includes a variety of medical therapies and surgical options; however, how to choose the best treatment strategy remains a mystery. The purpose of this narrative review was to summarize the most recent evidence on multimodal malignant bowel obstruction treatment and determine whether or not progress had been made. We should work to establish consensus guidelines, where possible, to ensure that this unique patient group receives the appropriate treatment or compassionate care during this often terminal event.
{"title":"Current need for guidelines in emergency surgery in peritoneal carcinomatosis","authors":"Melissa Nardecchia, Carlo Vallicelli, Mauro Stefano, Vanni Agnoletti, Luca Ansaloni, Paola Fugazzola, Federico Coccolini, Marco Vaira, Massimo Sartelli, Fausto Catena","doi":"10.4081/amsa.2023.27","DOIUrl":"https://doi.org/10.4081/amsa.2023.27","url":null,"abstract":"Malignant bowel obstruction caused by peritoneal carcinomatosis is a common complication that affects a large proportion of gastrointestinal and ovarian oncology patients and predicts poor longterm survival. The management strategy for these patients includes a variety of medical therapies and surgical options; however, how to choose the best treatment strategy remains a mystery. The purpose of this narrative review was to summarize the most recent evidence on multimodal malignant bowel obstruction treatment and determine whether or not progress had been made. We should work to establish consensus guidelines, where possible, to ensure that this unique patient group receives the appropriate treatment or compassionate care during this often terminal event.","PeriodicalId":486793,"journal":{"name":"Acute Care Medicine Surgery and Anesthesia","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135895110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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