Near-fatal asthma as clinical manifestation in onset diabetic patient: Case report / Asma casi fatal como manifestación clínica en paciente diabética debut: Reporte de caso

Near-fatal asthma (NFA) is defined as the most severe form of asthma characterized by a refractory asthma attack with an arterial carbon dioxide tension (PaCO2) greater than 45 mmHg and altered consciousness, requiring mechanical ventilation. We reported the case of 40-year-old female patient, obese and asthmatic with irregular treatment who presented dyspnea accompanied by severe oppressive chest pain and loss of consciousness, with generalized cyanosis and severe shortness of breath, for which she underwent emergency endotracheal intubation and mechanical ventilation. Laboratory tests show decompensated respiratory acidosis, glycemia of 258 mg / dl and HbA1C of 7.94%; her diagnosing diabetes mellitus. Asthmatic patients with type 2 diabetes mellitus who have irregular treatment for both diseases are at increased risk of manifesting near-fatal asthma.

El asma casi fatal (ACF) se define como la forma más severa de asma que se caracteriza por una crisis asmática refractaria con una presión parcial de dióxido de carbono (PaCO2) mayor a 45 mmHg y alteración de la conciencia que requiere ventilación mecánica. Presentamos a una paciente femenina de 40 años, obesa y asmática con tratamiento irregular que acude por disnea acompañada de dolor torácico tipo opresivo de intensidad severa y pérdida de la conciencia, con cianosis generalizada y dificultad intensa para respirar por lo que se le realiza intubación endotraqueal de emergencia y ventilación mecánica. En los exámenes de laboratorio se encuentra acidosis respiratoria descompensada, glicemia de 258 mg/dl y HbA1C de 7.94%; diagnosticándole diabetes mellitus. Los pacientes asmáticos con diabetes mellitus tipo 2 que tienen un tratamiento irregular para ambas enfermedades presentan mayor riesgo de manifestar un asma casi fatal.

A dosimetric analysis of incidental radiation to the internal mammary nodes with a three-field chest wall technique

@#<p style="text-align: justify;"><strong>Objectives:</strong> The authors' aim was to conduct a dosimetric analysis of the incidental radiation dose to the internal mammary node (IMN) region using a three-field chest wall technique (TFCWT).</p><p style="text-align: justify;"><strong>Methods:</strong> This retrospective study utilized 3D-conformal radiotherapy plans of 50 postmastectomy patients (25 left-sided and 25 rightsided). All plans used the TFCWT, composed of narrowed tangents matched medially to an AP electron field, and prescribed a total dose of 50 Gy in 28 fractions. The IMNs were not intentionally treated in all included plans.</p><p style="text-align: justify;"><strong>Results:</strong> The mean dose to the IMN-planning target volume (IMN-PTV) was 45.1 Gy (26.4 - 55.6, SD 6.5). Minimum doses received by 95% and 90% of the IMN-PTV were 29.3 Gy (8 - 49, SD 10.0) and 34.0 Gy (10.0 - 52.0, SD 8.6), respectively. The percent volume of IMN-PTV receiving 100%, 95%, 90%, and 80% were 47.4% (3 - 94, SD 21.6), 55.6% (6 - 97, SD 22.4), 61.92% (7 - 98, SD 22.2), and 72.61% (18-100, SD 20.2), respectively. The average ipsilateral lung V20 Gy (with supraclavicular fields) was 25.0% (16 - 29, SD 3.4), and the average heart mean dose was 2.5 Gy (0.5 - 7.9, SD 1.58).</p><p style="text-align: justify;"><strong>Conclusion:</strong> Although the results suggest increased IMN radiation doses with the TFCWT when compared historically to standard tangents, the incidental doses are comparatively less than that traditionally prescribed to the IMNs in high-risk patients. It is unknown whether this incidental IMN dose confers any clinical benefit.</p>

Household Cost of Antenatal Care and Delivery Services in a Rural Community of Kaduna State; Northwestern Nigeria

Maternal mortality remains a leading cause of death among women of reproductive age. While Nigeria has only two percent of the global population; it contributes 10 to the global maternal mortality burden. Antenatal care (ANC) reduces the incidence of maternal mortality. However; financial capability affects access to antenatal care. Thus; the rural poor are at a higher risk of maternal mortality. Materials and Methods: A cross-sectional descriptive study involving 135 women (pregnant women and those who are 6 weeks postpartum). Structured interviewer-administered questionnaires were used for data collection. Data analysis was carried out using statistical package for social sciences software (version 17). Results: The average amount spent on booking and initial laboratory investigations were N77 (half a dollar) and N316 ($2); respectively. Per ANC visit; average amount spent on drugs and transportation were N229 ($1.5) and N139 ($0.9) respectively. For delivery; the average amount spent was N1500 ($9.6). On an average; ANC plus delivery cost about N3;365.00 ($22). There was a statistically significant association between husband's income and ANC attendance (X 2 = 2.451; df = 2; P = 0.048). Conclusion: Cost of Antenatal care and delivery services were not catastrophic but were a barrier to accessing antenatal care and facility-based delivery services in the study area. ANC attendance was associated with the income of household heads. Pro-poor policies and actions are needed to address this problem; as it will go a long way in reducing maternal mortality in this part of the country

Subconjunctival injection of bevacizumab for treatment of pterygium

@#Objectives This study determined the biologic effect and safety of subconjunctival administration of bevacizumab in patients with primary and recurrent pterygium. Methods We conducted an off-label, multiple-dosing, interventional case series involving 15 patients with primary and recurrent pterygium. They received subconjunctival bevacizumab (1.25 mg) every 2 weeks for 10 weeks. Pterygium vascularity and thickness were graded (1 for atrophic, 2 for intermediate, and 3 for fleshy) by 3 masked observers. The size of the pterygium (measured by surface area in cm2) was recorded from baseline to 16 weeks postinjection. Treatment-related complications and adverse events were reported. The main outcome measures were changes in pterygium size, vascularity, thickness, and treatment safety. Results There was no statistically significant difference in the mean surface area of the pterygia at different intervals (p > 0.05). The mean surface area was 1.22 ± 0.19 cm2 at baseline, 1.22 ± 0.18 cm2 and 1.22 ± 0.17 cm2 at 10 and 16 weeks postinjection respectively. There was a significant difference in the mean pteygium grading by the 3 masked observers at different intervals (p < 0.01). At baseline, there were 11 patients (73.3%) with grade 2 pterygium and 4 (26.7%) with grade 3. At 1.5 months postinjection, there were 5 (33.3%) with grade 1 pterygium, 7 (46.7%) with grade 2, and 3 (20%) with grade 3. The 5 patients with grade 1 pterygium at the end of the study period had a baseline pterygium grading of 2. Snellen visual acuity, refraction, intraocular pressure, and blood pressure remained stable. No serious ocular or systemic side effects were observed. Conclusion Subconjunctival injection of 1.25 mg of bevacizumab given every 2 weeks for 10 weeks resulted in no significant change in size of the pterygium. However, local application of bevacizumab showed promise in inducing regression in pterygium vascularity and thickness. Further evaluation of bevacizumab for the treatment of pterygia is warranted.

Modified Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) as a screening test for dementia for Thai elderly.

A potential test for early detection of dementia in the elderly is the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), which is based on information from the informant for the elderly about the changes of the elderly in everyday cognitive functioning associated with dementia. The present study aimed to modify and assess the reliability and validity of the modified IQCODE consisting of 32 items. The study consisted of two methods of assessing dementia: DSMIV diagnosis carried out by clinicians, and informants responding to the IQCODE. The subjects were 200 pairs of elderly subjects and their informants who visited the Geriatric Clinic, Ramathibodi Hospital. The optimal cutoff score on the modified IQCODE was 3.42, with 90% sensitivity and 95% specificity. The positive predictive values, negative predictive values, and accuracy were 0.94, 0.90, and 0.92, respectively. The IQCODE items had high internal consistency. The IQCODE associated with the elderly person's age, but not with their gender and educational level; nor were they associated with the demographic characteristics of the informant. Therefore, the IQCODE could be used as an alternative screening test for dementia in Thailand with acceptable sensitivity and specificity. This tool may be useful for dementia screening in the community and the geriatric clinic for early detection of disease.

Antibiotic use and overuse for appendicectomy in Antigua and Barbuda

The use of antibiotics for appendicectomy in Antigua and Barbuda, from January 1998 to December 1999, was examined with respect to current Surgical Infection Society guidelines from developed countries. There were 143 cases of appendicectomy performed at Holberton Hospital. The mean patient age and standard deviation (SD) was 28.1 +/- 15.8 years, 57female. Pathology showed inflammed appendix only in 56, peri-appendiceal abscess/perforation in 17, [quot ]fibrosed[quot ] appendix in 10and normal appendix in 17. Postoperative infection (wound infection, fever > three days) was seen in 7/24 (29) of cases with peri-appendiceal abscess/perforation and 2/119 (1.7) of the other cases. A subset of 88 cases had antibiotic use reviewed: 3/88 (3.4) were given no antibiotics, 7/88 (8) were given one antibiotic, 5/88 (5.7) were given two antibiotics, 72/88 (81.8) were given three antibiotics and 1/88 (1.1) was given four antibiotics. Parenteral antibiotics were given a mean and SD of 5.39 +/- 1.94 days followed by oral antibiotics in 18/88 (20.5) cases. Those with appendiceal abscess/perforation were treated parenterally for mean and SD of 6.56 +/- 2.35 days, not significantly different from others. Most frequent antibiotics used were gentamicin, metronidazole and ampicillin/penicillin/cloxacillin/cephradine (81.8). The Surgical Infection Society recommends starting prophylactic antibiotics before surgery, using appropriate spectrum agents for less than 24 hours if not contaminated and less than five days if infected. It may be possible to safely reduce antibiotic use for appendicectomy in Antigua and Barbuda.

Se examinó el uso de los antibióticos en apendicectomías en Antigua y Barbuda, en el período comprendido de enero de 1998 a diciembre de 1999, sobre la base de las guías actuales de la Sociedad de Infecciones Quirúrgicas de los países desarrollados. Un total de 143 casos de apendicectomía fueron atendidos en el Hospital Holberton. La edad media de los pacientes y la desviación estándar (DE) fue 28.1 + 15.8 años, 57% mujeres. La patología mostró apéndice inflamado sólo en el 56% de los casos, absceso periapendicular/perforación en 17%, apéndice "fibroso"en el 10% y apéndice normal en el 17%. Se vio infección postoperatoria (infección de heridas, fiebre>tres días) en 7/24 (29%) de los casos con absceso periapendicular/perforación y 2/119 (1.7%) de los otros casos. A un subconjunto de 88 casos se le revisó el uso de antibióticos: a 3/88 (3.4%) no se les dio antibióticos, 7/88 (8%) recibieron un antibiótico, 5/88 (5.7%) recibieron dos antibiótico, 72/88 (81.8%) recibieron tres antibióticos, y 1/88 (1.1%) recibió cuatro antibióticos. Se suministraron antibióticos parenterales para una media y DE equivalente a 5.39 ± 1.94 días, seguidos de antibióticos orales en 18/88 (20.5%) casos. Los pacientes con absceso apendicular/perforación fueron tratados parenteralmente para una media y DE equivalente a 6.56 + 2.35 días, sin diferencia significativa con respecto a los otros. Los antibióticos más frecuentes fueron la gentamicina, el metronidazol, y la ampicilina/ penicilina/ cloxacilina/ cefradina (81.8%). La Sociedad de Infecciones Quirúrgicas recomienda que se comience con antibióticos profilácticos antes de la cirugía, usando agentes de espectro apropiado durantes menos de 24 horas si no hay contaminación y menos de 5 días si hay infección. El uso de antibióticos en la apendicectomía puede reducirse sin peligro en Antigua.

Frosted-branch angiitis

OBJECTIVE: To report a case of frosted-branch angiitis. METHOD: This is a case report of frosted-branch angiitis seen at the University of the Philippines-Philippine General Hospital. RESULTS: A 42 year-old male presented with progressive blurring of vision of the left eye. Indirect funduscopy showed dilated retinal veins with perivascular sheathing, giving the appearance of frosted-branches of a tree. CONCLUSION: Frosted-branch angiitis is a rare form of retinal vasculitis with various etiologies. Despite the severe retinal appearance, the prognosis is usually good, with rapid recovery of visual acuity after prompt steroid treatment.