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Dengue Infection Causing Acute Kidney Injury 登革感染引起急性肾损伤
Pub Date : 2016-06-27 DOI: 10.4172/2329-9088.1000211
R. Naqvi
Objective: We aim to report patients coming to this tertiary care center, developing acute kidney injury (AKI) after Dengue infection. Methods: An observational study of patients identified as having AKI after Dengue infection. AKI was defined according to RIFLE criteria with sudden rise in creatinine or decline in urine output or both. All patients had normal size non obstructed kidneys on ultrasonography, with no previous co morbid. Dengue was diagnosed on detection of dengue-specific IgM capture antibody or a four-fold or greater increase of dengue-specific IgG capture antibody by ELISA. Results: From January 2000 – December 2014, total 3525 patients with AKI registered at this institution, of these 43 (1.21%) developed AKI in association with dengue infection. Average age of patients was 34.65 ± 14.50 (range 16-90 years) with 31 male and 12 female. Jaundice and oligo-anuria were most common associated symptoms with fever. Renal replacement therapy required in 31 (72.09%) patients. Complete recovery was seen in 37 (86%), while 6 (14%) died during acute phase of illness. Age, jaundice, thrombocytopenia and shock were the factors significantly associated with high mortality. Conclusion: AKI though less reported, remains dreaded complication of dengue virus infection. With involvement of liver, circulatory system and prolonged thrombocytopenia mortality is high.
目的:我们的目的是报告在登革热感染后出现急性肾损伤(AKI)的患者来到这个三级保健中心。方法:对登革热感染后AKI患者进行观察性研究。AKI是根据RIFLE标准定义的,伴有肌酐突然升高或尿量下降或两者兼而有之。所有患者超声检查显示肾脏大小正常,无梗阻,既往无合并症。通过ELISA检测登革热特异性IgM捕获抗体或登革热特异性IgG捕获抗体增加4倍或更多,诊断为登革热。结果:2000年1月至2014年12月,该机构共登记了3525例AKI患者,其中43例(1.21%)发生与登革热感染相关的AKI。患者平均年龄34.65±14.50岁(16 ~ 90岁),其中男性31例,女性12例。黄疸和少尿是发烧最常见的相关症状。31例(72.09%)患者需要肾脏替代治疗。37例(86%)患者完全康复,6例(14%)患者在疾病急性期死亡。年龄、黄疸、血小板减少和休克是与高死亡率显著相关的因素。结论:AKI虽然报道较少,但仍是登革热病毒感染的可怕并发症。累及肝脏、循环系统和延长的血小板减少死亡率高。
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引用次数: 9
Developing a Simple Proof of Concept Clinical Decision-Making Tool for Predicting Surgical Outcomes after Obstetric Fistula Repair in a Developing Country 开发一种简单的概念验证临床决策工具,用于预测发展中国家产科瘘修复后的手术结果
Pub Date : 2016-05-20 DOI: 10.4172/2329-9088.1000209
B. T. Sambo, C. Missikpode, K. Salifou, A. Hodonou, E. Mensah, Alex, re Allodé, Christian Johnson, A. Saftlas, Robert B. Wallace
Introduction: Obstetric fistula is a serious injury resulting from obstructed labor causing significant maternal morbidity in women in developing countries. In order to maximize probability of successful surgical repair, it is important to identify women at-risk for poor surgical outcomes so that they can be given appropriate care. The goal of this study is to explore additional factors associated with fistula repair outcomes, as well as determine whether statistical modeling can be used to create a clinical decision-making tool for predicting a successful repair. Methods: Medical records for 82 patients surgically treated for obstetric fistula in Benin were retrospectively reviewed to collect demographic and clinical information related to their condition and procedure. Individuals were grouped into 3 main outcomes: successful closure with continence, successful closure with residual incontinence, and failed repair. A backwards stepwise selection methodology and logistic regression were used to select factors and examine their associations with the surgical outcomes. Structural equation modelling was used to develop a prediction tool for successful repair. Results: Location of fistula (vesicovaginal, vesicouterine, ureteroalvaginal, ureterouterine, and rectovaginal) (OR=7.6 (2.39, 24.36)), being married (OR=3.45 (1.09, 10.90)), parity of 1 to 3 (OR=2.99 (0.94, 9.49)), duration of fistula less than 10 years (OR=2.07 (0.88, 8.25)), and no previous repair attempt (OR=2.40 (0.79, 7.25)) were found to favor a successful closure with continence. We developed a prediction tool to sort women with obstetric fistula into 5 different categories based on probability of success. Our model suggests that marital status affects successful repair through a mediating factor not yet identified. Conclusion: This study classified fistulous women into clinically relevant categories based on the probability of a successful repair. The results from the present study may inspire further research on identifying fistulas with poor prospect of success, which might benefit from more specialized care.
产科瘘是一种由难产引起的严重损伤,在发展中国家的妇女中造成了严重的孕产妇发病率。为了最大限度地提高手术修复的成功率,重要的是要确定有不良手术结果风险的妇女,以便给予适当的护理。本研究的目的是探索与瘘管修复结果相关的其他因素,以及确定统计模型是否可以用于创建预测成功修复的临床决策工具。方法:回顾性分析贝宁82例手术治疗产科瘘患者的医疗记录,收集与其病情和手术相关的人口统计学和临床信息。个体分为3个主要结果:成功封闭尿失禁,成功封闭残余尿失禁和修复失败。采用逆向逐步选择方法和逻辑回归来选择因素并检查其与手术结果的关系。利用结构方程模型开发了成功修复的预测工具。结果:瘘管的位置(膀胱阴道、膀胱外腔、输尿管阴道、输尿管外腔和直肠阴道)(OR=7.6(2.39, 24.36))、已婚(OR=3.45(1.09, 10.90))、胎次为1 ~ 3 (OR=2.99(0.94, 9.49))、瘘管持续时间小于10年(OR=2.07(0.88, 8.25))、既往无修补尝试(OR=2.40(0.79, 7.25))均有利于成功闭锁。我们开发了一种预测工具,根据成功率将产科瘘妇女分为5个不同的类别。我们的模型表明,婚姻状况通过一个尚未确定的中介因素影响成功修复。结论:本研究根据成功修复的可能性将瘘女性分为临床相关的类别。本研究的结果可能会启发进一步的研究,以确定成功前景不佳的瘘管,这可能会受益于更专业的护理。
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引用次数: 4
Morbidity Profile, Healthcare Utilization and Associated out of Pocket Expenditure on Health among Elderly Population of Lucknow District, Northern India 印度北部勒克瑙地区老年人口的发病率概况、医疗保健利用和相关的自付医疗费用
Pub Date : 2016-05-16 DOI: 10.4172/2329-9088.1000210
S. Singh, P. Pavan, Ey
Objective: To study and assess the morbidities occurring in an elderly person, the pattern of their healthcare utilization and the expenditure they incur during the process of receiving treatment. Methods: A cross-sectional study was carried out involving 404 elderly participants from both the urban and rural parts of Lucknow. The elderly participants were interviewed with the help of a pretested questionnaire.The data was collected on morbidity profile, healthcare utilization and associated expenditure by elderly. Results: Most common single chronic disease entity was hypertension (20.5%), and the most common group of morbidities were dental (18.8%), orthopedics (17.3%) and cardiovascular (11.8%) in that order. The proportion of those utilizing Inpatient care, out-patient care, Outpatient dental care, AYUSH care and self-medication was 32.9%, 62.9%, 20.7%, 36.4% and 35.6% respectively. Total mean out of pocket expenditure on health among participants from the urban and rural area was INR 7842.25 (SD 9067.97) and INR 6034.82 (SD 9566.45) respectively. Conclusion: The out of pocket expenditure among the elderly was much higher than per capita health expenditure of the country.
目的:研究和评价某老年人在接受治疗过程中的发病率、医疗保健利用模式和费用支出情况。方法:对来自勒克瑙城市和农村地区的404名老年人进行横断面研究。老年参与者在预先测试的问卷的帮助下接受采访。收集老年人发病情况、医疗保健利用和相关支出的数据。结果:高血压是最常见的单一慢性疾病(20.5%),其次是牙科(18.8%)、骨科(17.3%)和心血管(11.8%)。利用住院护理、门诊护理、门诊牙科护理、AYUSH护理和自我药疗的比例分别为32.9%、62.9%、20.7%、36.4%和35.6%。来自城市和农村地区的参与者在医疗方面的平均自付费用总额分别为7842.25印度卢比(SD 9067.97)和6034.82印度卢比(SD 9566.45)。结论:我国老年人自费医疗费用远高于人均医疗费用。
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引用次数: 5
Genitourinary Hydatid Disease: A Review 泌尿生殖系统包虫病:综述
Pub Date : 2016-04-12 DOI: 10.4172/2329-9088.1000208
S. Siddappa, V. Karthikeyan
Parasitism means a temporary or permanent reciprocal association between two species, where one species depends upon another for its existence. The most important parasitic diseases involving the genitourinary system in humans are helminthic, where schistosomiasis is the commonest followed by hydatid disease (HD) and filariasis [1]. HD is a parasitic infestation, caused by tape worms of the genus Echinococcus, that usually involves the liver and lungs, although no organ is spared [2,3]. The varied presentations and complications of HD present routine surgical problems in endemic areas, although HD of the urinary tract is uncommon, comprising 2–4% of all cases [3]. This article reviews the epidemiology, etiopathogenesis, clinical features and presentations, medical and surgical treatment of genitourinary and pelvic echinococcosis with special reference to individual organs. In addition our own experience at our hospital in the last 4 years that we treated 4 cases of hydatid cysts of which 3 were renal HD and one was primary pelvic HD.
寄生是指两个物种之间暂时或永久的相互联系,其中一个物种依赖另一个物种生存。涉及人类泌尿生殖系统的最重要的寄生虫病是寄生虫病,其中最常见的是血吸虫病,其次是包虫病(HD)和丝虫病。HD是一种寄生虫感染,由棘球绦虫属的带状蠕虫引起,通常累及肝脏和肺部,但没有器官能幸免[2,3]。HD的各种表现和并发症是流行地区的常规手术问题,尽管尿路HD并不常见,占所有病例的2-4%。本文综述了泌尿生殖系统和盆腔包虫病的流行病学、发病机制、临床特点、临床表现、内科和外科治疗,并特别提到了个体器官。此外,根据我们在我院过去4年的经验,我们治疗了4例包虫病,其中3例是肾脏HD, 1例是原发性盆腔HD。
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引用次数: 10
A Traumatic Splenic Rupture: Dreaded Complication of Splenomegaly 外伤性脾破裂:脾肿大的可怕并发症
Pub Date : 2016-01-01 DOI: 10.4172/2329-9088.1000162
J. Shiber, E. Fontane, David Prisk
We discuss the causes of splenomegaly and the underlying abnormalities leading to the most feared complication of a traumatic splenic rupture. A case discussion is included.
我们讨论脾肿大的原因和潜在的异常导致外伤性脾破裂最可怕的并发症。包括一个案例讨论。
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引用次数: 3
Bilateral Anterior Shoulder Dislocations due to Seizure 癫痫引起的双侧前肩脱位
Pub Date : 2016-01-01 DOI: 10.4172/2329-9088.1000160
J. Shiber, Jesus A Diaz, Kamal I. Bohsali
Volume 2 • Issue 1 • 1000160 Trop Med Surg ISSN: 2329-9088 TPMS, an open access journal A 33 year-old man presented to the emergency department (ED) after intentional overdose of prescription drugs with concomitant cocaine and alcohol abuse. During assessment, he had a witnessed generalized tonic-clonic seizure that terminated after intravenous lorazepam administration. He was admitted to the Intermediate Care Unit for ongoing close monitoring due to persistently altered mental status. When more alert the following day he complained of bilateral shoulder pain with markedly restricted range of movement. An initial screening chest radiograph demonstrated bilateral anterior shoulder dislocations with an associated fracture of the left greater tuberosity (Figure 1). On further discussion a history of multiple bilateral shoulder dislocations with minimal force was elicited. He was reviewed by the orthopedic service that elected to perform closed reduction under general anesthesia and he was placed in bilateral shoulder immobilizers for 2 weeks. Operative repair was recommended.
一名33岁男子在故意过量服用处方药并同时滥用可卡因和酒精后,被送往急诊室(ED)。在评估期间,他有全身性强直阵挛发作,静脉注射劳拉西泮后终止。由于精神状态持续改变,他被送入中级护理病房接受持续密切监测。第二天更加清醒时,他主诉双侧肩痛,活动范围明显受限。初步筛查胸片显示双侧肩关节前脱位并伴有左侧大结节骨折(图1)。在进一步的讨论中,我们发现了多发双侧肩关节脱位的历史。矫形科对患者进行了复查,选择在全身麻醉下进行闭合复位,并将患者放置在双侧肩部固定器上2周。建议手术修复。
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引用次数: 2
Lingual Angioedema due to ACE-Inhibitor ace抑制剂所致舌血管性水肿
Pub Date : 2016-01-01 DOI: 10.4172/2329-9088.1000161
J. Shiber
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引用次数: 5
Supra-Infected Hepatic and Renal Amebic Abscesses-A Case Report 超感染肝、肾阿米巴脓肿1例报告
Pub Date : 2016-01-01 DOI: 10.4172/2329-9088.1000158
Manizate Fotini, C. Martin, Hameer Muneer, C. Roger
We describe the case of a 69-year-old man referred from a nursing home facility for acute severe anemia. On presentation, the patient complained of fever, chills, and abdominal pain. Physical exam was significant for a fever of 103.8 F, pale conjunctivae, rales over the right lung base and direct tenderness to palpation overlying the right upper quadrant. Laboratory analysis revealed a normocytic normochromic anemia of 6.7 g/dL, leukocytosis of 17.2 K/μL, elevated creatinine and hepatic function panel with a urinalysis remarkable for turbid cloudy appearing urine, positive for leucocyte esterase and white blood cells. Abdominal Ultrasonography (US) and computed tomography (CT) of the abdomen and pelvis with contrast revealed a 9.2 cm in maximal diameter low-density collection in the posterior aspect of the right lobe of the liver contiguous with a 7.2 cm maximal diameter multi-loculated collection of the superior pole of the right kidney. CT guided drainage of the liver revealed anchovy paste like material and positive cultures for proteus mirabilis species were obtained from both the hepatic and renal foci. Serum entamoeba antibody testing for IgG was positive and intravenous metronidazole with oral iodoquinol was started. Ultimately the patient’s clinical status improved and he was subsequently discharged
我们描述的情况下,一个69岁的男子转介从养老院设施急性严重贫血。病人就诊时主诉发热、寒战和腹痛。体格检查表现为发热103.8华氏度,结膜苍白,右肺底部有啰音,右上腹触诊直接压痛。实验室分析显示:正常细胞性贫血6.7 g/dL,白细胞增多17.2 K/μL,肌酐和肝功能升高,尿样呈浑浊样,白细胞酯酶和白细胞阳性。腹部超声(US)和腹部及骨盆CT (CT)造影显示肝右叶后侧有一个最大直径9.2 cm的低密度病灶,与右肾上极一个最大直径7.2 cm的多定位病灶相邻。在CT引导下行肝脏引流,肝脏和肾脏病灶均可见凤尾鱼膏样物质和奇迹变形杆菌阳性培养物。血清内阿米巴抗体检测IgG阳性,开始静脉注射甲硝唑并口服碘喹诺。最终患者的临床状况好转,随后出院
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引用次数: 0
Effect of Thyroxine on Mosquito Larvae during Winter Months in Dengue Prone Regions of India 甲状腺素对印度登革热易发地区冬季蚊幼虫的影响
Pub Date : 2016-01-01 DOI: 10.4172/2329-9088.1000159
S. Kannan
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引用次数: 5
Comparison between Post-tonsillectomy Bleeding of Three Different Techniques in Children 儿童扁桃体切除术后三种手术方法出血的比较
Pub Date : 2015-12-23 DOI: 10.4172/2329-9088.1000202
Abdullah Alzuwayed, M. Qattan
Introduction: Post-tonsillectomy bleeding remains the most serious complication of tonsillectomy. The rate of post tonsillectomy bleeding varies with different technique. The common used techniques are the bipolar, monopolar and cold. Methods: This was a retrospective case series study based on chart review of children under 14 years who underwent tonsillectomy during the period between January 2010 to December 2011 at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia – ENT department. The charts of all the patients were reviewed by the student and the data form filled for included patients for the age, gender, indications for tonsillectomy, previous surgery, medications, admission type, technique used which are the bipolar, monopolar and cold technique and complications. Results: Out of 60 patients reviewed, post tonsillectomy bleeding was reported in 16 (27%). Indications for tonsillectomy were six indications and most common one was recurrent adenotonsillitis in 27 (46%). Intraoprative bleeding was 8 cases (13%) which was the most common type of bleeding and there was no significant difference in post tonsillectomy bleeding between the three techniques (p=0.62). Conclusion: The result showed that there was no significant difference in post tonsillectomy bleeding between the three techniques.
扁桃体切除术后出血仍然是扁桃体切除术最严重的并发症。扁桃体切除术后出血的发生率随手术方法的不同而不同。常用的技术是双极,单极和冷。方法:对2010年1月至2011年12月在沙特阿拉伯利雅得阿卜杜勒阿齐兹国王医疗城(KAMC)耳鼻喉科接受扁桃体切除术的14岁以下儿童进行回顾性病例系列研究。学生查看了所有患者的表格,并填写了患者的年龄、性别、扁桃体切除术指征、既往手术、药物、入院类型、使用的技术(双极、单极和冷技术)和并发症。结果:在回顾的60例患者中,有16例(27%)扁桃体切除术后出血。扁桃体切除术的指征有6种,最常见的指征是复发性腺扁桃体炎,27例(46%)。术中出血8例(13%)是最常见的出血类型,三种技术在扁桃体切除术后出血方面差异无统计学意义(p=0.62)。结论:三种方法在扁桃体切除术后出血发生率上无显著差异。
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引用次数: 1
期刊
Tropical medicine & surgery
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