Bowel angina: Henoch-Schonleinpurpura in adult patient based on clinical approach: a case report

The GI involvement of Henoch-Schonlein purpura (HSP) has often been described as self-limiting, with no long term morbidity.GI manifestation is higher in adult patient. HSP is an autoimmune disorder characterized by the deposition of IgA immune complexes in the wall of small to medium size arteries. We present a 41-year-old patient with GI involvement (Bowel angina) in HSP case admitted at Wangaya Regional Hospital Denpasar. The case are treated by steroid and symptomatictreatment. Diagnosis is established through a clinical approach with EULAR criteria. The patient recovered with supportive treatment and had a favourableclinical outcome.

Características clínico-epidemiológicas de los pacientes ingresados en el Hospital "Amalia Simoni" durante la pandemia Covid-19 / Clinical-epidemiologic characteristics of the patients admitted in the Hospital "Amalia Simoni" during the Covid-19 pandemics

RESUMEN Introducción: desde los finales del año pasado en Wuhan, se informó de una neumonía de etiología desconocida, que llevó a la Organización Mundial de la Salud a declarar la infección por SARS-CoV-2, como una emergencia sanitaria denominándola como enfermedad por coronavirus 2019 (COVID-19). En Cuba se confeccionó un programa de enfrentamiento, en el cual la atención hospitalaria, siguió un riguroso protocolo de atención a pacientes positivos de la COVID-19, en áreas de cuidados mínimos, intensivos o progresivos. Objetivo: caracterizar clínica/epidemiológica pacientes positivos de la COVID-19, ingresados en el Hospital "Amalia Simoni". Materiales y métodos: se realizó un estudio descriptivo, transversal de 1 066 ingresos en el Hospital "Amalia Simoni", de marzo-mayo del 2020. Se revisaron historias clínicas y se obtuvo: edad, sexo, procedencia, sintomatología, comorbilidades y evolución epidemiológica. Datos que se evaluaron mediante estadísticas descriptivas. Resultados: se halló un predominio de edad media, sin diferencias de sexo, predominaron los casos de la ciudad de Camagüey y de los municipios con mayor urbanización. Prevalecieron la tos y la fiebre, además de la mitad de los casos sin comorbilidades, con solo un pequeño porcentaje de casos confirmados. Conclusiones: con un enfoque basado en la medicina preventiva en los casos estudiados, predominó la edad media, de procedencia de áreas urbanizadas con mayor población y aglomeraciones sociales. Se destacó que el ingreso precoz, basada en la pesquisa de la Atención Primaria logró disminuir los casos confirmados a un pequeño porcentaje, al igual que los graves y un solo fallecido (AU).

ABSTRACT Introduction: from the end of the last year in Wuhan, China, it was informed an unknown etiology pneumonia leading the World Health Organization to declare the infection with SARS-CoV-2 a sanitary emergency naming it coronavirus disease 2019 (Covid-19). A confrontation program was elaborated in Cuba, in which hospital care followed a rigorous protocol to take care to Covid-19-positive patients in areas of minimal, intensive and progressive care. Objective: to clinically/epidemiologically characterize Covid-19-positive patients admitted in the Hospital "Amalia Simoni". Materials and methods: a cross-sectional, descriptive study was carried out in 1 066 patients admitted in the Hospital "Amalia Simoni" in the period March-May 2020. Clinical records were reviewed and data gathered were age, sex, origin, symptomatology, co-morbidities and epidemiological evolution, data obtained through descriptive statistics. Results: it was found the predominance of medium age, without sex differences; the cases of patients from the city of Camaguey and from the municipalities with biggest urbanization predominated. Cough and fever prevailed; half of cases did not have comorbidities, and only a little percent of cases was confirmed. Conclusions: with an approach based in preventive medicine, medium age, and provenance from urban areas with bigger population and social concentrations predominated in the studied cases. It was showed that precocious admission, based on the Primary Health Care screening, succeeded in diminish confirmed cases to a little percent, as diminished the seriously ill ones; only one patient died (AU).

Benign neonatal sleep myoclonus in a child

Benign neonatal sleep myoclonus (BNSM), is a disorder generally mistaken for seizures during the newborn period. Benign neonatal sleep myoclonus is featured by myoclonic "lightninglike" jerks of the extremities that exclusively occur during sleep; it is not associated with epilepsy that occur only during sleep and cease abruptly when the child is agitated. This case reported was a 50 days-old baby boy with a history suggestive of abnormal movements for limbs noted over the preceding 7 days. Diagnosis of BNSM in infant based on history taking, clinical manifestation, and with no electroencephalographic changes. BNSM is usually not associated with any other neurologic impairment and spontaneously subsides within the first year of life. Its importance lies in the differential diagnosis with the epileptic, especially myoclonic, seizures of infancy. BNSM can be misinterpreting for neonatal seizures or even neonatal status epilepticus, the recognition of benign sleep myoclonus of infancy is imperative to elude unnecessary diagnostic studies and treatments.

Early switch/early discharge opportunities for hospitalized patients with methicillin-resistant Staphylococcus aureus complicated skin and soft tissue infections in Brazil

ABSTRACT Background: Early antibiotic switch and early discharge protocols have not been widely studied in Latin America. Our objective was to describe real-world treatment patterns, resource use, and estimate opportunities for early switch from intravenous to oral antibiotics and early discharge for patients hospitalized with methicillin-resistant Staphylococcus aureus complicated skin and soft-tissue infections. Materials/methods: This retrospective medical chart review recruited 72 physicians from Brazil to collect data from patients hospitalized with documented methicillin-resistant Staphylococcus aureus complicated skin and soft tissue infections between May 2013 and May 2015, and discharged alive by June 2015. Data collected included clinical characteristics and outcomes, hospital length of stay, methicillin-resistant Staphylococcus aureus-targeted intravenous and oral antibiotic use, and early switch and early discharge eligibility using literature-based and expert-validated criteria. Results: A total of 199 patient charts were reviewed, of which 196 (98.5%) were prescribed methicillin-resistant Staphylococcus aureus -active therapy. Only four patients were switched from intravenous to oral antibiotics while hospitalized. The mean length of methicillin-resistant Staphylococcus aureus-active treatment was 14.7 (standard deviation, 10.1) days, with 14.6 (standard deviation, 10.1) total days of intravenous therapy. The mean length of hospital stay was 22.2 (standard deviation, 23.0) days. The most frequent initial methicillin-resistant Staphylococcus aureus-active therapies were intravenous vancomycin (58.2%), intravenous clindamycin (19.9%), and intravenous daptomycin (6.6%). Thirty-one patients (15.6%) were discharged with methicillin-resistant Staphylococcus aureus -active antibiotics of which 80.6% received oral antibiotics. Sixty-two patients (31.2%) met early switch criteria and potentially could have discontinued intravenous therapy 6.8 (standard deviation, 7.8) days sooner, and 65 patients (32.7%) met early discharge criteria and potentially could have been discharged 5.3 (standard deviation, 7.0) days sooner. Conclusions: Only 2% of patients were switched from intravenous to oral antibiotics in our study while almost one-third were early switch eligible. Additionally, one-third of hospitalized patients with methicillin-resistant Staphylococcus aureus complicated skin and soft tissue infections were early discharge eligible indicating opportunity for reducing intravenous therapy and days of hospital stay. These results provide insight into possible benefits of implementation of early switch/early discharge protocols in Brazil.

Extracorporeal membrane oxygenation - An anesthesiologist's perspective - Part II: Clinical and technical consideration.

Although the concept of extracorporeal membrane oxygenation (ECMO) has remained unchanged, component technology has evolved considerably over the past three decades. Presently the clinical conditions requiring ECMO support have been updated with input from the outcome data of patient registries. Modern circuit configuration has become less cumbersome, safer, and more efficient. Technological advances now allow prolonged support with fewer complications compared to the past eras and facilitate transition to a single bedside caregiver model, similar to hemofiltration or ventricular-assist devices. The clinical considerations and indicators for placing the patient on ECMO, the various circuit configurations, clinical and technical issues, and management aspects are considered in this article.

Diagnosis of Bacterial Vaginosis with Relation to Isolation of Gardnerella vaginalis

Among 104 patients who visited a local clinic with increased, bad-smelling vaginal discharge, twenty-nine women (27.9%) were found to have bacterial vaginosis (BV) according to the Amsel's composite clinical criteria (homogeneous thin gray discharge, positive amine test, vaginal pH over 4.5, positivity of clue cell by Gram stain). The specificity, sensitivity and positive and negative predictive values of the Amsel's composite clinical criteria were estimated in relation to the G. vaginalis isolation rate. Fifty-two strains of G. vaginalis (50%) were isolated from vaginal swabs taken from 104 patients. The sensitivities of clue cells and G. vaginalis isolation were both 96.6% (28) in the 29 BV patients. The specificities of clue cells and the presence of G. vaginalis were 85.3% and 68.0%, respectively. But the sensitivity, specificity, and positive and negative predictive values of the combination of clue cells and morphotype of G. vaginalis were 93.1%, 92.0%, 81.8% and 97.2%, respectively. The sensitivity, specificity and positive and negative predictive values of amine test were 89.7%, 98.7%, 96.2% and 94.9% in the 29 BV patients. Among 52 strains of G. vaginalis, 34 strains (87.2%) were isolated from the 39 clue cell positive samples and the remaining 18 (27.7%) from the 65 clue cell negative cases. Twenty-four strains (92.3%) were isolated from 26 amine test positive samples and the remaining 28 (35.9%) from 78 amine test negative cases. According to these results, it seems that the amine test is a useful test for the diagnosis of BV. However, we propose the combination criteria of clue cells and G. vaginalis morphotype in vaginal discharge should give more objective results than the amine test for the diagnosis of BV. The sensitivity and specificity of vaginal pH over 4.5 were 86.2% and 57.3%, and those of homogeneous discharge 93.1% and 65.3%, respectively. These two criteria were not as specific as clue cells and amine test for the diagnosis of BV. These results suggest that BV could be diagnosed more simply and precisely with the finding of clue cells spotted with Gram variable polymorphic bacteria by means of Gram stain of vaginal wall swabs.

Practical Criteria for Prediction of Responses to Chemotherapy in 90 patients with Acute Leukemias / 第三军医大学学报

Five clinical criteria, including the size of the liver, spleen, and lymph nodes, tenderness over the sternum, and hemorrhagic tendency, the white cell and platelet counts, the bone marrow picture, and the marrow blast decrease index (MBDI) were studied in 90 patients with acute leukemia prior to and after chemotherapy to predict the therapeutic effects.It is concluded that in the 4th week after the commencement of chemotherapy, if there is amelioration of the 5 clinical criteria, steady increase of platelets or with a rebounding peak, improvement of the bone marrow proliferation, and MBDI over 41%, it is an indication that there will be a remission of the disease. If, on the contrary, the 5 criteria shows no amelioration, the white count exceeds 50?109/L, the platelet count decreases markedly, bone marrow proliferation demonstrates no improvement, and MBDI is below 40%, then the possibility to have remission is very little.This method for the prediction the therapeutic responses in leukemic patients is simple, practical, and reliable. The comprehensive analysis of the 9 items cai exercise the function of mutual compensation and render the prediction more precise