RESUMEN
Tuberculosis used to be uncommon in the developed countries but seems to be still on rampant in developing countries. However, there seems to be an increasing occurrence in the developed countries too mainly due to low living conditions, increased migration, HIV immune-compromisation and inappropriate use of antitubercular drugs. Lymphatic tuberculosis is the second commonest extrapulmonary location of tuberculosis followed by genitourinary, bone and joint, miliary, meningeal and abdominal. Abdominal tuberculosis represents nearly 11%-16% of all extrapulmonary tuberculosis locations. Furthermore, abdominal tuberculosis co-exists with pulmonary tuberculosis in 10%-30% of patients. Abdominal tuberculosis remains difficult to diagnose due to non-specific symptoms, variable anatomical locations and lack of specific sensitive diagnostic tools. Diagnosis can be rarely suspected, especially in cases of isolated abdominal tuberculosis without clinical or radiological findings. We present a rare case of a patient with pulmonary tuberculosis combined with intra-abdominal lymphatic tuberculosis causing small intestine volvulus.
RESUMEN
BACKGROUND: Saksenaea vasiformis is one of the numerous fungi of the Order Mucorales. Rapid progression and invasion of neighboring tissues are the most characteristic features of S. vasiformis mucormycosis. AIM: The objective of this review is the management of this type of infections. METHODS: Case report and literature review. RESULTS: A 62-year old woman, without a history of immunocompromisation, developed a localized cutaneous infection at her right thigh. No trauma, skin laceration or insect bite was reported at the side of infection. The initial treatment was surgical debridements and intravenous administration of amphotericin B/posaconazole. In order to avoid the further rapid progression of the infection and save her life, it was decided to proceed to amputation of the patient's right leg. This is the first case of S. vasiformis cutaneous infection in an immunocompetent patient, in Greece. CONCLUSION: Early diagnosis of S. vasiformis mucormycosis is of paramount importance. Clinical suspicion, based on the rapid progression of the infection and on the medical history of the patient, is sufficient to start antifungal treatment. Broad, aggressive, and repeated surgical debridement of the infection site together with systemic antifungal agents administration is the key point for successful treatment.
Asunto(s)
Dermatomicosis/diagnóstico , Dermatomicosis/patología , Mucorales/aislamiento & purificación , Mucormicosis/diagnóstico , Mucormicosis/patología , Muslo/patología , Administración Intravenosa , Anfotericina B/administración & dosificación , Amputación Quirúrgica , Antifúngicos/administración & dosificación , Desbridamiento , Dermatomicosis/terapia , Femenino , Grecia , Humanos , Persona de Mediana Edad , Mucormicosis/terapia , Triazoles/administración & dosificaciónRESUMEN
The aim of this study was to compare the efficacy of dabigatran 110âmg twice daily and acenocoumarol in patients with atrial fibrillation discharged after ischemic stroke. We prospectively studied 436 consecutive patients who were discharged after acute ischemic stroke (39.2% males, age 78.6â±â6.7 years). Approximately 1 year after discharge, the functional status was assessed with the modified Rankin scale (mRS). Adverse outcome was defined as mRS between 2 and 6. The occurrence of ischemic stroke, myocardial infarction (MI) and death during the 1-year follow-up was also recorded. At discharge, 142 patients had atrial fibrillation. Acenocoumarol and dabigatran 110âmg twice daily were prescribed to 52.1 and 6.3% of these patients, respectively. At 1 year after discharge, there was a trend for patients treated with acenocoumarol to have lower mRS than patients prescribed dabigatran (2.3â±â2.4 and 4.1â±â2.2, respectively; Pâ=â0.060). Adverse outcome rates and the incidence of stroke during follow-up did not differ between the two groups. The incidence of MI was almost three times higher in patients prescribed dabigatran than in those prescribed acenocoumarol, but this difference did not reach significance (11.1 and 4.0%, respectively; Pâ=â0.254). The incidence of cardiovascular death was also almost three times higher in the former, but again this difference was not significant (33.3 and 12.2%, respectively; Pâ=â0.237). In real-world patients with acute ischemic stroke, dabigatran 110âmg twice daily is as effective as acenocoumarol in preventing stroke but appears to be associated with worse long-term functional outcome and higher incidence of MI.
Asunto(s)
Acenocumarol/administración & dosificación , Antitrombinas/administración & dosificación , Dabigatrán/administración & dosificación , Acenocumarol/efectos adversos , Anciano , Anciano de 80 o más Años , Antitrombinas/efectos adversos , Fibrilación Atrial/complicaciones , Fibrilación Atrial/tratamiento farmacológico , Fibrilación Atrial/mortalidad , Fibrilación Atrial/patología , Isquemia Encefálica/complicaciones , Isquemia Encefálica/tratamiento farmacológico , Isquemia Encefálica/mortalidad , Isquemia Encefálica/patología , Dabigatrán/efectos adversos , Esquema de Medicación , Femenino , Humanos , Masculino , Infarto del Miocardio/inducido químicamente , Infarto del Miocardio/tratamiento farmacológico , Infarto del Miocardio/mortalidad , Infarto del Miocardio/patología , Alta del Paciente , Estudios Prospectivos , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/tratamiento farmacológico , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/patología , Análisis de Supervivencia , Trombosis/complicaciones , Trombosis/mortalidad , Trombosis/patología , Trombosis/prevención & controlRESUMEN
BACKGROUND AND AIMS: There are no studies that compared the effects of different intensities of statin treatment on the long-term outcome of patients with recent ischemic stroke. We aimed to evaluate these effects. METHODS: We prospectively studied 436 consecutive patients who were discharged after acute ischemic stroke (39.2% males, age 78.6 ± 6.7 years). Statin treatment was categorized in equipotent doses of atorvastatin. One year after discharge, the functional status was assessed with the modified Rankin scale (mRS). Adverse outcome was defined as mRS between 2 and 6. The occurrence of ischemic stroke, myocardial infarction and death was recorded. RESULT: Adverse outcome rates were lower in patients treated with atorvastatin 20 mg/day or more potent doses of statins than in patients treated with atorvastatin 10 mg/day (63.5, 38.2 and 48.2%, respectively; p = 0.004). In binary logistic regression analysis, independent predictors of adverse outcome were the mRS at discharge (relative risk (RR) 2.33, 95% confidence interval (CI) 1.77-3.07, p < 0.001) whereas more aggressive treatment with statins independently predicted favorable outcome (atorvastatin 20 vs. 10 mg/day, RR 0.30, 95% CI 0.11-0.87, p = 0.026; atorvastatin 40 mg/day or more potent dose of statins vs. atorvastatin 10 mg/day, RR 1.66, 95% CI 0.62-4.44, p = NS). The incidence of cardiovascular events and all-cause mortality showed a trend for being lower in patients treated with atorvastatin 40-80 mg/day or rosuvastatin 10-40 mg/day than in those treated with less potent doses of statins. CONCLUSION: More aggressive statin treatment improves the long-term functional outcome of patients with acute ischemic stroke more than less aggressive treatment.