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1.
Rev. colomb. cir ; 36(3): 471-480, 20210000. tab, fig
Article in Spanish | LILACS | ID: biblio-1254297

ABSTRACT

Introducción. En el paciente con pancreatitis aguda severa, la presencia de necrosis infectada y falla multiorgánica se asocian con una mortalidad del 20-40 %. La tomografía computarizada con contraste intravenoso y la clasificación del Consenso de Atlanta 2012 son importantes herramientas de diagnóstico para el tratamiento oportuno. En esta investigación, se analizó la relación del índice de severidad tomográfico y los cambios morfológicos locales según dicha clasificación, con la estancia hospitalaria, intervención, infección y mortalidad de los pacientes. Métodos. Estudio de cohorte retrospectiva realizado entre los años 2015 y 2019, donde se incluyeron pacientes mayores de 15 años con pancreatitis aguda severa diagnosticado por tomografía computarizada con contraste, y se evaluó el índice de severidad tomográfico y los cambios morfológicos según la clasificación de Atlanta 2012, en relación con los desenlaces clínicos de los pacientes. Resultados. Se incluyeron 56 pacientes, en el 82,1 % (n=46) de los casos la causa fue litiásica. La falla orgánica fue principalmente pulmonar 53,6 % (n=30) y cardiovascular 55,4 % (n=31). Según la tomografía, se clasificó como severa (7-10 puntos) en el 91,1 % (n=51) de los pacientes. En pacientes con necrosis amurallada infectada la estancia hospitalaria media fue mayor (78,5 días); en todos los pacientes con pancreatitis severa se encontró infección y fueron sometidos a algún tipo de intervención. La mortalidad fue menor del 10 % (n=5).Discusión. El índice de severidad tomográfica para la categorización de severo se correlacionó en un 90 % con pancreatitis aguda severa. Una tomografía de control a la cuarta semana podría identificar complicaciones tardías para un manejo precoz


Introduction. In patients with severe acute pancreatitis, the presence of infected necrosis and multiple organ failure are associated with a mortality of 20-40%. Computed tomography with intravenous contrast and the 2012 Atlanta Consensus classification are important diagnostic tools for timely treatment. In this research, the relationship between the tomographic severity index and the local morphological changes according to that classification, with the hospital stay, intervention, infection and mortality of the patients was analyzed.Methods. Retrospective cohort study carried out between the years 2015 and 2019, which included patients older than 15 years with severe acute pancreatitis diagnosed by contrast computed tomography, the tomographic severity index and morphological changes according to the Atlanta 2012 classification were evaluated, in relationship with the clinical outcomes of the patients. Results. Fifty-six patients were included, in 82.1% (n=46) of the cases the cause was lithiasis. Organ failure was mainly pulmonary 53.6% (n=30) and cardiovascular 55.4% (n=31). According to the tomography, it was classified as severe (7-10) in 91.1% (n=51) of the patients. In patients with infected walled necrosis, the mean hospital stay was longer (78.5 days); infection was found in all patients with severe pancreatitis and they underwent some type of intervention. Mortality was less than 10% (n=5).Discussion. The tomographic severity index for the categorization of severity is 90% correlated with severe acute pancreatitis. A control tomography at the fourth week could identify late complications for early management


Subject(s)
Humans , Pancreatitis , Severity of Illness Index , Infections , Tomography , Mortality , Intraoperative Complications , Necrosis
2.
Arch. argent. pediatr ; 119(1): e80-e83, feb. 2021. tab, ilus
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1147283

ABSTRACT

La intoxicación por mordedura de serpiente es un problema de salud pública global. En la población pediátrica, la intoxicación por mordedura de serpiente presenta características diferentes que en los pacientes adultos. La Bungarus multicinctus es una especie de elápido sumamente venenoso. Las presentaciones clínicas documentadas después de la intoxicación por mordedura de Bungarus multicinctus son reacciones locales mínimas, insuficiencia respiratoria, dolor generalizado e hiponatremia potencialmente mortal. Presentamos el caso de una intoxicación por mordedura de Bungarus multicinctus en una niña con manifestaciones clínicas atípicas, incluidas necrosis tisular grave y trombocitopenia con coagulopatía.


Snakebite envenoming is a global public health problem. The pediatric population poisoned by snakebite envenoming has different features than adult patients. Bungarus multicinctus is a highly venomous species of the elapid snake. The documented clinical presentations following Bungarus multicinctus envenoming are minimal local reactions, respiratory failure, general pain, and life-threatening hyponatremia. We present an uncommon case of Bungarus multicinctus envenomation in a girl with unusual clinical findings, including severe tissue necrosis and thrombocytopenia with coagulopathy.


Subject(s)
Humans , Female , Child , Snake Bites , Necrosis , Poisoning , Thrombocytopenia , Blood Coagulation Disorders , China , Bungarus
3.
Pesqui. vet. bras ; 41: e06988, 2021. ilus
Article in English | ID: biblio-1351274

ABSTRACT

In this study, an outbreak of spontaneous poisoning by Dodonaea viscosa (D. viscosa) in a herd of dairy cattle in the municipality of Capão do Leão, Rio Grande do Sul, was investigated. Three deaths occurred in a batch of 16 Jersey cattle, aged between three and four years, kept in a native field. The clinical signs observed were apathy, decreased production, and anorexia, with death occurring within approximately 48 h after the onset of signs. The three cattle were necropsied, and tissue samples were sent for histopathological examination. Necropsy findings included serosanguineous fluid in the abdominal cavity, intestines with congested serosa, and marked mesenteric edema. The mucosa of the abomasum of two of the animals was hemorrhagic with bloody content, and among the ruminal content of a bovine, leaves with morphological characteristics compatible with D. viscosa were observed. The livers of the three animals were enlarged, with accentuation of the lobular pattern. Histologically, centrilobular coagulation necrosis with congestion and hemorrhage was observed in the liver. Vacuolization and degeneration of hepatocytes were observed in the mid-zonal and periportal regions. The diagnosis of poisoning by D. viscosa leaves was based on epidemiological data, necropsy findings, and histopathological alterations. The presence of the plant in the rumen and in the grazing site of the affected cattle was essential for the diagnosis.(AU)


Neste trabalho, é descrito um surto de intoxicação espontânea por Dodonaea viscosa (D. viscosa) ocorrido em um rebanho de bovinos leiteiros, no município de Capão do Leão, no Rio Grande do Sul. Ocorreram três mortes em um lote de 16 bovinos da raça Jersey com idades entre três e quatro anos, mantidos em campo nativo. Os sinais clínicos observados foram apatia, queda na produção e anorexia, com morte em aproximadamente 48 horas após o início dos sinais. Os três bovinos foram necropsiados, e amostras de tecidos foram encaminhadas para exame histopatológico. Os achados de necropsia incluíam líquido serossanguinolento na cavidade abdominal, intestinos com serosas congestas e marcado edema de mesentério. A mucosa do abomaso de dois animais apresentava-se hemorrágica com conteúdo sanguinolento e, em meio ao conteúdo ruminal de um bovino foram observadas folhas com caracteres morfológicos compatíveis com D. viscosa. O fígado dos três animais estava aumentado, com acentuação do padrão lobular. Histologicamente no fígado havia necrose de coagulação centrolobular com congestão e hemorragia. Nas regiões médio-zonal e periportal observou-se vacuolização e degeneração dos hepatócitos. O diagnóstico de intoxicação pelas folhas D. viscosa foi baseado nos dados epidemiológicos, nos achados de necropsia e nas alterações histopatológicas. A presença da planta no rúmen e no local de pastoreio dos bovinos afetados foi fundamental para o diagnóstico.(AU)


Subject(s)
Animals , Cattle , Poisoning , Blood Coagulation , Hepatocytes , Sapindaceae , Fluconazole , Necrosis
4.
Pesqui. vet. bras ; 41: e06935, 2021. ilus
Article in English | ID: biblio-1346696

ABSTRACT

This study describes the epidemiological, clinical, and pathological aspects of spontaneous and experimental poisoning by nitroxinil at 34% concentration in goats. The outbreak occurred on a farm in the municipality of Prata, Paraíba state. Nitroxinil was administered to a herd of 120 goats, of which 18 presented with anorexia, vocalization, abdominal distension, weakness, staggering, and falls. Necropsy of three goats revealed that the main lesion was acute liver injury. Histologically the liver showed centrilobular necrosis associated with hemorrhage and hepatocyte degeneration. In the kidneys, tubular nephrosis with granular cylinder formations was observed. The lungs showed multifocal to coalescent areas of moderate interalveolar edema and vascular congestion. Experimental poisoning was carried out in two goats, with the same medication and doses administered on the farm. The experimental goats showed clinical signs and macroscopic and histological changes similar to the spontaneously poisoned goats. The diagnosis of nitroxinil poisoning was made based on epidemiological, clinical, and pathological data, and confirmed by experimental poisoning. The administration of nitroxinil in high doses, associated with high ambient temperature and physical exercises, can cause poisoning with high lethality in goats.(AU)


Este estudo descreve os aspectos epidemiológicos, clínicos e patológicos da intoxicação espontânea e experimental por nitroxinil na concentração de 34% em caprinos. O surto ocorreu em uma fazenda no município de Prata, Paraíba. Nitroxinil foi administrado a um rebanho de 120 cabras, das quais 18 apresentavam anorexia, vocalização, distensão abdominal, fraqueza, cambaleando e quedas. A necropsia de três cabras revelou que a lesão principal era uma lesão hepática aguda. Histologicamente, o fígado apresentava necrose centrolobular associada a hemorragia e degeneração de hepatócitos. Nos rins, nefrose tubular com formações de cilindro granular foi observada. Os pulmões apresentavam áreas multifocais a coalescentes de edema interalveolar moderado e congestão vascular. A intoxicação experimental foi realizada em duas cabras, com a mesma medicação e doses administradas na fazenda. As cabras experimentais apresentaram sinais clínicos e alterações macroscópicas e histológicas semelhantes às cabras intoxicadas espontaneamente. O diagnóstico de intoxicação por nitroxinil foi feito com base em dados epidemiológicos, clínicos e patológicos, e confirmado por intoxicação experimental. A administração de nitroxinil em altas doses, associada à alta temperatura ambiente e exercícios físicos, pode causar intoxicação com alta letalidade em caprinos.(AU)


Subject(s)
Animals , Poisoning , Goats , Hepatocytes , Kidney , Anthelmintics , Necrosis , Nitroxinil
5.
REVISA (Online) ; 10(2): 224-228, 2021.
Article in Portuguese | LILACS | ID: biblio-1178421

ABSTRACT

Objetivo: Relatar a assistência de enfermagem diante do caso de um adolescente com diagnóstico de Necrólise Epidérmica Tóxica (NET) internado em uma Unidade de Terapia Intensiva de Queimados. Método: Trata-se de um relato de caso sobre as intervenções de enfermagem realizadas em um adolescente com diagnóstico de NET, internado por um mês em 2020 na Unidade de Terapia Intensiva de Queimados de Goiás. As informações foram coletadas do prontuário do paciente. Resultados: Apresentamos práticas clínicas para auxiliar no manejo de pacientes com NET. O caso apresentado teve um desfecho positivo. Conclusão: Os cuidados de enfermagem são essenciais para o prognóstico positivo do paciente. Nesse caso, a enfermagem atuava principalmente no cuidado de feridas, administração de medicamentos, laserterapia e vigilância para prevenção de infecções


Objective: To report nursing care facing a case of an adolescent diagnosed with Toxic Epidermal Necrolysis (TEN) hospitalized in a Burns Intensive Care Unit. Method: This is a case report on the nursing interventions performed on a teenager diagnosed with TEN, who was hospitalized for a month in 2020 at the Burn Intensive Care Unit in the state of Goiás. The information was collected from the patient's medical record. Results: We present clinical practices to assist the management of patients with TEN. The case presented had a positive outcome. Conclusion: Nursing care is essential for the positive prognosis of the patient. In this case, nursing acted mainly in wound care, medication administration, laser therapy and surveillance to prevent infections


Objetivo: Informar los cuidados de enfermería en el caso de un adolescente diagnosticado de Necrólisis Epidérmica Tóxica (TNE) ingresado en una Unidad de Cuidados Intensivos por Quemados. Método: Se trata de un relato de caso sobre las intervenciones de enfermería prestadas a un adolescente diagnosticado de TNE, hospitalizado durante un mes en 2020 en la Unidad de Cuidados Intensivos Quemados de Goiás, información obtenida de la história clínica del paciente. Resultados: Presentamos prácticas clínicas para ayudar en el manejo de pacientes con TNE. El caso presentado tuvo un resultado positivo. Conclusión: El cuidado de enfermería es fundamental para el pronóstico positivo del paciente. En este caso, la enfermería trabajó principalmente en el cuidado de heridas, administración de medicamentos, terapia con láser y vigilancia para prevenir infecciones.


Subject(s)
Humans , Skin , Necrosis , Nursing Care , Wounds and Injuries , Burns , Adolescent , Toxicity , Lasers
6.
Autops. Case Rep ; 11: e2021284, 2021. graf
Article in English | LILACS | ID: biblio-1249014

ABSTRACT

Acute esophageal necrosis (AEN), also known as "black esophagus," is an entity characterized by the circumferential black appearance of esophageal mucosa, usually associated with hypoperfusion and gastric outlet obstruction. This entity has a reported prevalence of up to 0.2%, affecting predominantly elderly men with multiple comorbidities. Most cases resolve with conservative treatment with no need of surgical intervention. However, the overall prognosis is poor, with mortality reaching one-third of cases due to the patient's underlying illness. In this article we present three cases of patients with AEN.


Subject(s)
Humans , Male , Middle Aged , Aged , Aged, 80 and over , Esophageal Diseases/pathology , Necrosis , Endoscopy, Gastrointestinal , Gastrointestinal Hemorrhage
7.
Rev. colomb. gastroenterol ; 35(4): 533-536, dic. 2020. graf
Article in Spanish | LILACS | ID: biblio-1156336

ABSTRACT

Resumen La esofagitis necrotizante aguda es una entidad poco común que afecta sobre todo a ancianos. La presentación clínica más común es hemorragia digestiva alta. El pronóstico depende de las enfermedades de base con una mortalidad de hasta el 50 %. Se presenta el caso de un varón de 77 años con historia de una semana de melena, 3 episodios de hematemesis y epigastralgia. La endoscopia digestiva alta reveló una mucosa con necrosis en parches y fibrina en el esófago medio y distal. La biopsia de esófago fue compatible con necrosis de mucosa.


Abstract Acute necrotizing esophagitis is a rare entity that affects mainly elderly patients. The most common clinical presentation is upper gastrointestinal bleeding. The prognosis depends on the underlying diseases, with a mortality of up to 50%. This is the case of a 77-year-old male patient who presented with melena, three episodes of hematemesis, and epigastric pain for a week. Upper endoscopy revealed mucosa with spotty necrosis and fibrin in the middle and distal esophagus. Esophageal biopsy was compatible with mucosal necrosis.


Subject(s)
Humans , Male , Aged , Esophagus , Hemorrhage , Hematemesis , Melena , Mucous Membrane , Necrosis
8.
Electron. j. biotechnol ; 48: 95-100, nov. 2020. ilus, tab
Article in English | LILACS | ID: biblio-1254838

ABSTRACT

BACKGROUND: An efficient regeneration protocol is a priority for the successful application of plant biotechnology. Grape nodal explants were used to develop a micropropagation protocol for Thompson Seedless and Taify cvs. Explants were cultured on MS medium supplemented with Kinetin or benzylaminopurine (BA) and indolebutyric acid (IBA). RESULTS: For both cultivars, axillary buds were grown, only, on a medium enriched with kinetin, moreover, shoot tip necrosis and callus formation were observed on Thompson Seedless cv. cultures grown on a medium with BA. Supplementing the growth medium with 100 mM (boron) B and 2.5 mM (calcium) Ca successfully help overcome these phenomena. The highest regenerated shoot numbers (14 and 6.2 explant 1 ) for Taify and Thompson Seedless cvs., respectively, were on media supplemented with 13.2 mM BA + 4.9 mM IBA and BA 13.2 mM + 5.8 mM IBA, respectively. Moreover, these media supported the developing shoots to have the heaviest dry weights (1.46 and 0.72 mg explant 1 ) for Taify and Thompson Seedless cvs., respectively. Thompson Seedless cv. regenerated shoot numbers and their dry weights were significantly increased by increasing the MS medium PO4 concentration. However, these two parameters were significantly decreased for Taify cv. Developing shoots were elongated and rooted on MS medium enriched with 4.9 mM, IBA 100 mM B and 2.5 mM Ca. Plantlets were acclimatized and successfully transferred to the greenhouse conditions. CONCLUSIONS: A novel promising protocol for Thomson Seedless and Taify cvs. micropropagation using single nodes has been developed.


Subject(s)
Phosphates/chemistry , Boron/chemistry , Calcium/chemistry , Vitis/growth & development , Regeneration , Biotechnology , Plant Shoots , Necrosis/prevention & control
9.
Rev. bras. ortop ; 55(5): 543-550, Sept.-Oct. 2020. graf
Article in English | LILACS | ID: biblio-1144202

ABSTRACT

Abstract Objective The aim of the present study was to determine the effect of combined zoledronic acid and alendronate therapy on bone edema and knee pain in cases of spontaneous osteonecrosis of the knee. We report our experience with this treatment. Methods A retrospective case series of 11 patients with spontaneous osteonecrosis of the knee confirmed by magnetic resonance image (MRI). The patients were treated with a single dose of 5 mg of intravenous zoledronic acid combined with 35 mg twice a week of oral alendronate, for 16 weeks. The visual analogue scale scores were noted before the beginning of the therapy, at 8 weeks, and at 16 weeks of follow-up. The size of the bone marrow edema adjacent to the lesion was measured on T2-weighted MRI coronal images at the beginning of the therapy and at 16 weeks. Results The average visual analogue scale score at 0 weeks was of 7.72, and of 0.81 at 16 weeks of therapy; the difference was statistically significant (p= 0.03). The mean bone marrow involvement at 0 weeks was of 80%, which reduced to 11.81% at 16 weeks of therapy. This change was statistically significant (p= 0.03). Conclusion Our data shows that the combination therapy causes early pain relief and reduction of the bone edema, and it is safe, effective and well-tolerated for a painful disease entity like spontaneous osteonecrosis of the knee.


Resumo Objetivo Determinar o efeito do tratamento combinado de ácido zoledrônico e alendronato no edema ósseo e na dor no joelho em casos de osteonecrose espontânea do joelho. A experiência dos autores com este tratamento é relatada. Métodos Série de casos retrospectiva, incluindo 11 pacientes com osteonecrose espontânea do joelho confirmada por ressonância magnética. Os pacientes foram tratados com uma dose intravenosa única de 5 mg de ácido zoledrônico combinada com 35 mg de alendronato oral, 2 vezes por semana, por 16 semanas. Os escores da escala visual analógica foram aferidos antes do começo do tratamento, em 8 semanas e em 16 semanas de acompanhamento. O tamanho do edema da medula óssea adjacente à lesão foi medido em imagens de ressonância magnética coronal ponderadas em T2 no início do tratamento e em 16 semanas. Resultados O escore médio da escala visual analógica em 0 semanas foi de 7,72, contra 0,81 em 16 semanas de tratamento, uma diferença estatisticamente significativa (p= 0,03). O envolvimento médio da medula óssea em 0 semanas foi de 80%, e foi reduzido para 11,81% em 16 semanas de tratamento, uma diferença também estatisticamente significativa (p= 0,03). Conclusão Os dados mostram que a terapia combinada proporciona alívio da dor inicial e redução do edema ósseo, sendo segura, eficaz e bem tolerada em uma enfermidade dolorosa como a osteonecrose espontânea do joelho.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Osteoarthritis , Pain , Bone and Bones , Bone Marrow , Magnetic Resonance Spectroscopy , Combined Modality Therapy , Alendronate , Diphosphonates , Dosage , Visual Analog Scale , Zoledronic Acid , Knee Joint , Necrosis
10.
Rev. cuba. med. mil ; 49(3): e456, jul.-set. 2020. fig
Article in Spanish | LILACS, CUMED | ID: biblio-1144486

ABSTRACT

Introducción: La aspergilosis es una infección micótica oportunista que se presenta fundamentalmente en pacientes inmunodeprimidos y su principal fuente de transmisión lo constituyen las esporas presentes en el aire de salones de operaciones y unidades de cuidados intensivos. Objetivo: Presentar un caso de una micosis pulmonar masiva por una variante angioinvasiva de Aspergillus. Caso clínico: Se presenta un paciente con aspergilosis pulmonar grave, diagnosticada después de la resección de un tumor mediastinal. Se describen las características de la primera intervención, la evolución postoperatoria que condujo a la segunda, se muestran las imágenes tomográficas, quirúrgicas, microbiológicas y anátomo-patológicas que permitieron definir el diagnóstico. Conclusiones: La posibilidad de una micosis pulmonar debe tenerse en cuenta, aun cuando sea una afección rara y de manejo difícil, en pacientes inmunodeprimidos, con condensación pulmonar rebelde al tratamiento(AU)


Introduction: Aspergillosis is an opportunistic fungal infection that occurs mainly in immunosuppressed patients and its main source of transmission is the spores present in the air of operating rooms and intensive care units. Objective: To present a case of a massive pulmonary mycosis due to an angioinvasive variant of Aspergillus. Clinical case: A patient with severe pulmonary aspergillosis, diagnosed after resection of a mediastinal tumor, is presented. The characteristics of the first intervention are described, the postoperative evolution that led to the second one, the tomographic, surgical, microbiological and anatomo-pathological images that allowed to define the diagnosis are shown. Conclusions: The possibility of a pulmonary mycosis should be taken into account, even when it is a rare and difficult-to-handle condition, in immunocompromised patients, with pulmonary condensation that is rebellious to treatment. Aspergillosis is an opportunistic fungal infection that occurs mainly in immunosuppressed patients and its main source of transmission is the spores present in the air of operating rooms and intensive care units(AU)


Subject(s)
Humans , Male , Adult , Pulmonary Aspergillosis/drug therapy , Mycoses , Necrosis/diagnostic imaging , Teratocarcinoma/surgery , Teratocarcinoma/therapy , Invasive Pulmonary Aspergillosis/complications , Lung/pathology
11.
Rev. bras. cir. cardiovasc ; 35(4): 580-483, July-Aug. 2020. tab, graf
Article in English | LILACS, SES-SP | ID: biblio-1137294

ABSTRACT

Abstract Constrictive pericarditis is a disease where loss of pericardial elasticity and restriction of filling of the cardiac chambers occurs. It is most often seen as an associated symptom of heart failure. Pericardiectomy provides effective treatment for patients with symptomatic constrictive pericarditis, although high rates of morbidity and mortality are related to the procedure. We present a case with extensive calcification, massive caseous necrosis and an important impairment of right ventricular function successfully operated in our institution.


Subject(s)
Humans , Pericarditis, Constrictive/surgery , Pericarditis, Constrictive/etiology , Pericarditis, Constrictive/diagnostic imaging , Vascular Calcification/complications , Heart Failure , Pericardium/surgery , Pericardium/diagnostic imaging , Pericardiectomy , Necrosis
12.
Medicina (B.Aires) ; 80(5): 523-530, ago. 2020. graf
Article in Spanish | LILACS | ID: biblio-1287206

ABSTRACT

Resumen El ataque de pie diabético tiene una presentación aguda y grave que representa una amenaza para la conservación del miembro afectado e incluso para la vida del paciente. Es un término que surge por la necesidad de facilitar la identificación de aquellos pacientes que requieren intervención urgente, dándole un sentido de urgencia y gravedad, reforzando el concepto de que "tiempo es tejido". Se han identificado tres situaciones en las cuales urge este tipo de intervención: el ataque de pie diabético infectado, donde el pie se presenta con una infección grave y con rápida progresión de necrosis que requiere internación, un desbridamiento rápido de tejido desvitalizado, drenaje de colecciones y tratamiento antibiótico; el ataque de pie diabético isquémico que implica isquemia progresiva y evolutiva y requiere revascularización urgente, y la neuroartropatía de Charcot en fase aguda que demanda rápida identificación y descarga. El reconocimiento oportuno de dichas presentaciones es fundamental para iniciar un tratamiento adecuado y mejorar la evolución de los pacientes. En la presente revisión, se realiza una descripción de la fisiopatología, presentación clínica, tratamiento y evolución de los tres tipos de ataque de pie diabético.


Abstract Diabetic foot attack has an acute and severe presentation that threatens the affected limb and the patient´s life. It is a term that arises from the need to identify those patients that require urgent intervention; it conveys a sense of urgency and severity, reminding the term of "time is tissue". The classic presentation is that of a severe infected foot with rapidly progressive necrosis that requires urgent surgery to debride all necrotic tissue and purulent collections, providing an adequate antibiotic treatment. Ischemic diabetic foot attack that demands urgent revascularization and the acute Charcot neuroarthropathy for which primacy is given to diagnostic confirmation and off-loading are also considered atypical presentations of diabetic foot attack. The aim of identifying these diabetic foot presentations is to promote rapid intervention to provide adequate and effective treatment, avoiding the most feared complication which is the limb amputation. In the present review, a description of the pathophysiology, clinical presentation, treatment and evolution of the three types of diabetic foot attack is made.


Subject(s)
Humans , Diabetic Foot/therapy , Diabetes Mellitus , Treatment Outcome , Diabetic Foot/diagnosis , Foot , Amputation , Necrosis
13.
Arch. argent. pediatr ; 118(3): e292-e295, jun. 2020. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1116975

ABSTRACT

La entidad llamada tick-borne lymphadenopathy, también conocida como dermacentor-borne necrosis eritema lymphadenopathy, se incluye dentro del diagnóstico diferencial de enfermedades transmitidas por garrapatas, que han aumentado considerablemente en los últimos años debido a una mayor observación clínica-epidemiológica y mejoría diagnóstica. Es una zoonosis causada por Rickettsia slovaca y transmitida por la picadura de la garrapata Dermacentor marginatus. Los pacientes afectados tienen una escara necrótica rodeada de un halo eritematoso en el cuero cabelludo y adenopatías regionales dolorosas. Se presenta a un varón de siete años que mostró, tras la extracción de una garrapata, una escara necrótica en el cuero cabelludo, con adenopatías y febrícula. La reacción en cadena de la polimerasa y el cultivo de la lesión confirmaron la presencia de Rickettsia slovaca. El paciente recibió azitromicina oral con buena respuesta. En Atención Primaria, es importante el seguimiento de las picaduras de garrapatas para detectar posibles enfermedades transmitidas por estas.


The entity called tick-borne lymphadenopathy, also known as dermacentor-borne necrosis eritema lymphadenopathy, is included in the differential diagnosis of diseases transmitted by ticks, which have increased considerably in recent years due to greater clinical-epidemiological observation and diagnostic improvement. It is a zoonosis caused by Rickettsia slovaca and transmitted by the bite of the Dermacentor marginatus tick. Affected patients have a necrotic eschar surrounded by an erythematous halo in the scalp, as well as painful regional lymphadenopathy. Linfadenopatía transmitida por garrapata. Un caso pediátrico de rickettsiosis en atención primaria Lymphadenopathy transmitted by tick. A pediatric case of rickettsiosis in primary care We present a seven-year-old male who shows, after the extraction of a tick, a necrotic eschar on the scalp, accompanied by lymphadenopathy and low-grade fever. The study of polymerase chain reaction and culture of the lesion confirm the presence of Rickettsia slovaca. The patient received oral azithromycin with a good response. In Primary Care, it is important to monitor the tick bites, to detect possible diseases transmitted by them.


Subject(s)
Humans , Male , Child , Tick Bites , Spotted Fever Group Rickettsiosis , Ticks , Zoonoses , Azithromycin/therapeutic use , Pressure Ulcer , Lymphadenopathy , Necrosis
14.
J. oral res. (Impresa) ; 9(2): 86-92, abr. 30, 2020. ilus, tab
Article in English | LILACS | ID: biblio-1151843

ABSTRACT

Introduction: Lichen planus is one of the most common oral mucosal lesions. Transforming growth factor-ß (TGF- ß) has a marked effect on epithelial­mesenchymal transition and immune cells function. Vascular Endothelial Growth Factor (VEGF) is a key regulator of vasculogenesis and angiogenesis. Tumor necrosis factor-α (TNF-α) mediates T-lymphocyte homing and apoptosis of epithelial cells. Objetive: The present study was conducted in order to compare the expression of serum and salivary TGF- ß, VEGF, TNF-α between OLP patients and control individuals to investigate if saliva can be used as an alternative to serum for diagnostic purposes and for monitoring disease. Materials and Methods: 23 OLP patients and 23 control individuals were included to evaluate serum and salivary TGF-ß, VEGF, TNF-α using ELISA kits. Five milliliters of venous blood was collected and unstimulated saliva was collected by the spitting method. Results: Serum and salivary levels of TGF- ß, VEGF, TNF-α are higher in OLP patients compared to normal controls. Mean difference is higher in saliva than serum. Moreover, there was a significant difference in serum and salivary VEGF and TNF-α between symptomatic and asymptomatic groups. Conclusions: Saliva can be a used as a substitute for serum to evaluate levels of the assessed biomarkers.


Introducción: El liquen plano oral es una de las lesiones de la mucosa oral más comunes. El factor de crecimiento transformante ß (TGF-ß) tiene un efecto marcado sobre la transición epitelial-mesenquimal y la función de las células inmunes. El factor de crecimiento endotelial vascular (VEGF) es un regulador clave de la vasculogénesis y la angiogénesis. El factor de necrosis tumoral α (TNF-α) media la localización de los linfocitos T y la apoptosis de las células epiteliales. Objetivo: El presente estudio se realizó con el fin de comparar la expresión en suero y saliva de TGF-ß, VEGF, TNF-α entre pacientes con OLP y personas de control para investigar si la saliva se puede utilizar como alternativa al suero para fines de diagnóstico y monitoreo de la enfermedad. Material y Métodos: Se incluyeron 23 pacientes con OLP y 23 individuos control para evaluar los niéveles en suero y en saliva de TGF- ß, VEGF, TNF-α utilizando kits ELISA. Se recogieron cinco mililitros de sangre venosa y se recogió saliva no estimulada por el método de escupir. Resultado: Los niveles séricos y salivales de TGF-ß, VEGF, TNF-α son más altos en pacientes con OLP en comparación con los controles normales. La diferencia media es mayor en saliva que en suero. Además, hubo una diferencia significativa de VEGF y TNF-α en suero y saliva entre los grupos sintomáticos y asintomáticos. Conclusion: La saliva puede usarse como un sustituto del suero para evaluar los niveles de los biomarcadores estudiados


Subject(s)
Humans , Male , Female , Saliva/metabolism , Transforming Growth Factor beta , Tumor Necrosis Factor-alpha , Lichen Planus, Oral/diagnosis , Serum/metabolism , Vascular Endothelial Growth Factor A , Egypt , Mouth Mucosa , Necrosis
15.
Rev. argent. dermatol ; 101(1): 61-70, mar. 2020. graf
Article in Spanish | LILACS | ID: biblio-1125807

ABSTRACT

Resumen La calcifilaxis es una enfermedad poco frecuente, aunque presenta una elevada tasa de mortalidad debido sobre todo a complicaciones como sepsis o gangrena. Generalmente se asocia a insuficiencia renal severa. Se define como la calcificación de la capa media de vasos de pequeño y mediano tamaño de la dermis y tejido celular subcutáneo. Clínicamente se manifiesta como un síndrome de livedoracemosa que progresa a púrpura retiforme y necrosis cutánea. La primera línea de tratamiento es el tiosulfato sódico.


Abstract Calciphylaxis is a rare disease, although it has a high mortality rate due mainly to complications such as sepsis or gangrene. It is usually associated with severe renal failure. It is defined as the calcification of the middle layer of small and medium-sized vessels of the dermis and subcutaneous cellular tissue. Clinically it manifests as a livedoracemosa syndrome that progresses to retinal purpura and cutaneous necrosis. The first line of treatment is sodium thiosulfate.


Subject(s)
Humans , Male , Middle Aged , Calciphylaxis/diagnosis , Calciphylaxis/therapy , Sepsis/prevention & control , Calciphylaxis/mortality , Diagnosis, Differential , Necrosis/complications
16.
Rev. argent. dermatol ; 101(1): 1-10, mar. 2020. graf
Article in Spanish | LILACS | ID: biblio-1092404

ABSTRACT

RESUMEN El embolismo por cristales de colesterol (ECC) es una complicación de la enfermedad arterioesclerótica en la que el desprendimiento de fragmentos de placa de ateroma, principalmente de grandes arterias, provoca oclusión de pequeños vasos. Esta entidad, también llamada ateroembolia o síndrome de los dedos del pie azules, es más frecuente en pacientes de edad avanzada y después de procedimientos invasivos intravasculares. Se manifiesta con cianosis, livedo reticularis, necrosis y úlceras asociado a manifestaciones renales y gastrointestinales. Se presenta un paciente trasplantado renal y portador de fístula arteriovenosa trombosada izquierda con ateroembolia localizada en mano homolateral.


ABSTRACT The cholesterol crystal embolism (ECC) is a complication of arteriosclerotic disease in which the detachment of fragments of atheromatous plaque mainly from large arteries, causes occlusion of small vessels. This entity, also called atheroembolism or blue toe syndrome, is more common in elderly patients and after intravascular invasive procedures. It manifests with cyanosis, livedo reticularis, necrosis and ulcers associated with renal and gastrointestinal manifestations. We present a renal transplant patient with a left thrombosed arteriovenous fistula with atheroembolism located in homolateral hand.


Subject(s)
Humans , Male , Middle Aged , Cholesterol/adverse effects , Arteriovenous Fistula/complications , Embolism, Cholesterol/physiopathology , Upper Extremity/blood supply , Skin Manifestations , Embolism, Cholesterol/diagnosis , Renal Insufficiency/complications , Ischemia/complications , Necrosis/complications
17.
Autops. Case Rep ; 10(1): 2019136, Jan.-Mar. 2020. ilus
Article in English | LILACS | ID: biblio-1087661

ABSTRACT

Acute esophageal necrosis (AEN) also known as "black esophagus" or "acute necrotizing esophagus" is a rare entity characterized by striking endoscopic findings of circumferential black coloring of the esophagus. AEN most frequently seen in the distal esophagus and can extend proximally along the entire esophagus. Characteristically, the circumferential black mucosa stops abruptly at the EGJ. AEN tends to present as acute upper gastrointestinal bleeding, though other symptoms including dysphagia and epigastric pain have been described. The etiology of AEN is multifactorial including a combination of ischemic insult, mucosal barrier defect, and a backflow injury of gastric secretions. Described is a case of AEN in a patient with history of uncontrolled diabetes who presented with an atypical chest pain mimicking acute coronary syndrome with negative subsequent cardiovascular workup.


Subject(s)
Humans , Male , Aged, 80 and over , Esophageal Diseases/diagnosis , Acute Coronary Syndrome/diagnosis , Chest Pain , Necrosis
18.
Electron. j. biotechnol ; 44: 14-18, Mar. 2020. ilus, graf
Article in English | LILACS | ID: biblio-1087629

ABSTRACT

BACKGROUND: Although bioactive metabolites capable of causing oxidative photo-necrosis in plant tissues have been identified in fungi, little is known about this type of mechanism in bacteria. These metabolites act as photosensitizers that generate reactive oxygen species (ROS) capable of causing damage to cells. In addition, these metabolites can pass into an energetically excited state when they receive some luminous stimulus, a condition in which they interact with other molecules present in the environment, such as molecular oxygen (O2), also known as triplet oxygen (3 O2), generating ROS. RESULTS: The suspension of the bacterial culture of Pseudomonas cedrina was shown to produce foliar necrosis in papaya leaves (Carica papaya L.) only in the presence of sunlight, which is evidence of photosensitizing mechanisms that generate singlet oxygen (1 O2). From the chemical study of extracts obtained from this bacteria, 3-(4-(2-carboxipropyl) phenyl) but-2-enoic acid (1) was isolated. This compound, in the presence of light and triplet oxygen (3 O2), was able to oxidize ergosterol to its peroxide, since it acted as a photosensitizer producing 1 O2, with which it was corroborated that a photosensitization reaction occurs, mechanism by which this bacterium could prove to cause oxidative foliar photo-necrosis. CONCLUSIONS: P. cedrina was able to induce oxidative foliar photo-necrosis because of its potential ability to produce photosensitizing metabolites that generate singlet oxygen in the plants it colonizes. Based on the above, it can be proposed that some bacteria can cause oxidative foliar photo-necrosis as an important mechanism in the pathogenesis of host species.


Subject(s)
Plant Diseases/microbiology , Pseudomonas/physiology , Carica/microbiology , Singlet Oxygen/metabolism , Pseudomonas/metabolism , Acids , Reactive Oxygen Species , Plant Leaves/microbiology , Photooxidation , Light , Necrosis
19.
J. venom. anim. toxins incl. trop. dis ; 26: e20200043, 2020. tab
Article in English | ID: biblio-1135129

ABSTRACT

Trimeresurus stejnegeri stejnegeri bite induces tissue swelling, pain, thrombocytopenia, rhabdomyolysis, and acute renal failure. However, the incidence of coagulopathy, factors associated with wound necrosis, and the appropriate management of this condition have not been well characterized yet. Materials: This study included patients bitten by T. s. stejnegeri that were admitted to the study hospitals from 2001 to 2016. Patient characteristics, laboratory data, and management approaches were compared in victims with and without wound necrosis. Results: A total of 185 patients were evaluated: three patients (1.6%) were asymptomatic; whereas tissue swelling and pain, local ecchymosis, wound necrosis, coagulopathy, thrombocytopenia, rhabdomyolysis, and renal impairment were present in 182, 53, 13, 15, 10, 1, and 3 patients, respectively. One patient died from coagulopathy and hemorrhagic shock. Antivenom was administered to all envenomed patients at a median time of 1.8 h after the bite. The median total dose of antivenom was five vials. Chi-square analysis showed that bitten fingers, using cold packs during first aid, presence of bullae or blisters, lymphangitis or lymphadenitis, local numbness and suspected infection to be significantly associated with wound necrosis. After adjustment using a multivariate logistic regression model, only cold packs as first aid, bulla or blister formation, and wound infection remained significant. Conclusions: The main effects of T. s. stejnegeri envenomation are tissue swelling, pain, and local ecchymosis. We do not recommend the use of cold packs during first aid to reduce wound pain, as this may be a risk factor for wound necrosis. In addition, patients with bulla or blister formation should be carefully examined for subsequent wound necrosis. Antiplatelet use may worsen systemic bleeding. No severe rhabdomyolysis or renal failure was observed in this large case series, we therefore considered that they were not prominent effects of T. s. stejnegeri bite.(AU)


Subject(s)
Animals , Thrombocytopenia , Bites and Stings , Antivenins , Risk Factors , Trimeresurus , Crotalid Venoms , Necrosis , Wounds and Injuries
20.
Article in English | WPRIM | ID: wpr-811069

ABSTRACT

PURPOSE: Different characteristics of airway microbiome in asthmatics may lead to differential immune responses, which in turn cause eosinophilic or neutrophilic airway inflammation. However, the relationships among these factors have yet to be fully elucidated.METHODS: Microbes in induced sputum samples were subjected to sequence analysis of 16S rRNA. Airway inflammatory phenotypes were defined as neutrophils (>60%) and eosinophils (>3%), and inflammation endotypes were defined by levels of T helper (Th) 1 (interferon-γ), Th2 (interleukin [IL]-5 and IL-13), Th-17 (IL-17), and innate Th2 (IL-25, IL-33, and thymic stromal lymphopoietin) cytokines, inflammasomes (IL-1β), epithelial activation markers (granulocyte-macrophage colony-stimulating factor and IL-8), and Inflammation (IL-6 and tumor necrosis factor-α) cytokines in sputum supernatants was assessed by enzyme-linked immunosorbent assay.RESULTS: The numbers of operational taxonomic units were significantly higher in the mixed (n = 21) and neutrophilic (n = 23) inflammation groups than in the paucigranulocytic inflammation group (n = 19; p < 0.05). At the species level, Granulicatella adiacens, Streptococcus parasanguinis, Streptococcus pneumoniae, Veillonella rogosae, Haemophilus parainfluenzae, and Neisseria perflava levels were significantly higher in the eosinophilic inflammation group (n = 20), whereas JYGU_s levels were significantly higher in the neutrophilic inflammation group compared to the other subtypes (P < 0.05). Additionally, IL-5 and IL-13 concentrations were correlated with the percentage of eosinophils (P < 0.05) and IL-13 levels were positively correlated with the read counts of Porphyromonas pasteri and V. rogosae (P < 0.05). IL-1β concentrations were correlated with the percentage of neutrophils (P < 0.05). had a tendency to be positively correlated with the read count of JYGU_s (P = 0.095), and was negatively correlated with that of S. pneumoniae (P < 0.05).CONCLUSIONS: Difference of microbial patterns in airways may induce distinctive endotypes of asthma, which is responsible for the neutrophilic or eosinophilic inflammation in asthma.


Subject(s)
Asthma , Colony-Stimulating Factors , Cytokines , Enzyme-Linked Immunosorbent Assay , Eosinophils , Haemophilus parainfluenzae , Inflammasomes , Inflammation , Interleukin-13 , Interleukin-33 , Interleukin-5 , Microbiota , Necrosis , Neisseria , Neutrophils , Phenotype , Pneumonia , Porphyromonas , Sequence Analysis , Sputum , Streptococcus , Streptococcus pneumoniae , Veillonella
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