ABSTRACT
La tuberculose est un facteur de risque de maladies thromboemboliques. Nous rapportons le cas d'une fille de dix ans qui a présenté un premier épisode de thrombose veineuse profonde découverte devant une douleur du membre pelvien droit avec Ådème et impotence fonctionnelle, confirmée par un échodoppler des vaisseaux de la cuisse. Lors de la recherche de la cause, la tuberculose pulmonaire a été diagnostiquée selon les critères de l'Union Internationale Contre la Tuberculose et les Maladies Respiratoires. La patiente a été mise sous des antituberculeux associés à l'héparine de bas poids moléculaire relayée par l'anti vitamine K. L'évolution a été favorable. Il conviendrait en l'absence de diagnostic microbiologique de la tuberculose dans les pays à ressources limitées, d'évoquer une tuberculose devant toute thrombose veineuse profonde associée à une pneumonie
Subject(s)
Antitubercular Agents , Central African Republic , Pediatrics , Tuberculosis/therapy , Venous Thrombosis/diagnosis , Venous Thrombosis/etiologyABSTRACT
AIM: The aim of this study was to investigate the accuracy of a critical pathway in the early stratification and management of patients with chest pain and suspected acute coronary syndrome (ACS) in the Emergency Department (ED). METHODS: An observational study was performed enrolling all patients with non-traumatic chest pain and suspected ACS who presented during a one-year period in the ED, where a critical pathway with five-level risk stratification, based on risk factors, characteristics of pain and ECG, was implemented. Patients were prospectively evaluated for rates of death, unstable angina, myocardial infarction or revascularization procedure occurring during admission or in the 30 days following discharge from the ED. Receiver-Operating Characteristics (ROC) curve was used to measure the accuracy of the stratification method. RESULTS: Overall, 1813 patients were enrolled: 475 patients (26.1%, 95% CI: 24.0-28.1 ) were admitted and 1338 (73.8%, 95% CI: 71.7-75.8) were discharged. Main outcomes occurred in 233 (49.9%, 95% CI: 47.5-52.2) of patients admitted and in 6 (0.4%, 95% CI: 0.06-0.7) of those discharged. The risk stratification system showed a good accuracy with an AUC-ROC curve of 0.90 (95% CI: 0.88-0.93). A total of 1541 (85%) patients were managed according to critical pathway. Adverse events were significantly fewer in patients discharged according to pathway criteria than in those who were not (0.27% vs. 1.37%, difference: 1.1% CI 95%: 0.06-2.1), without significant increase of inappropriate admissions. CONCLUSION: A critical pathway, based on clinical and ECG features, is a safe and accurate tool to stratify and manage the patients with non-traumatic chest pain and suspected ACS in the ED.
Subject(s)
Acute Coronary Syndrome/diagnosis , Chest Pain/etiology , Critical Pathways/standards , Myocardial Infarction/diagnosis , Acute Coronary Syndrome/physiopathology , Adult , Aged , Angina, Unstable/diagnosis , Area Under Curve , Biomarkers/blood , Chest Pain/physiopathology , Chest Pain/therapy , Coronary Artery Disease/diagnosis , Coronary Artery Disease/therapy , Diagnosis, Differential , Electrocardiography , Emergency Service, Hospital , Female , Hospitalization/statistics & numerical data , Humans , Male , Middle Aged , Myocardial Infarction/therapy , Myocardial Revascularization/methods , Myocardial Revascularization/statistics & numerical data , ROC Curve , Risk FactorsABSTRACT
Pasteurellosis is a zoonosis often caused by cat or dog bites or scratches, or by direct exposure to their secretions. Pasteurella multocida is the main pathogen involved in infections through domestic animal bites; generally a local infection characterized by its particular virulence with consequent rapid onset. Serious infection has also been reported in persons affected by comorbidity without domestic animal bite injuries. Here we report the case of a woman with lower limb exudating vesicular skin ulcers affected by liver cirrhosis, bilateral knee arthritis, septicemia with positive blood culture and synovial fluid culture for Pasteurella multocida. The etiology of Pasteurella multocida must be borne in mind in cases of sepsis in immunodeficient individuals, such as the cirrhotic patient, as well as exposure to domestic animals.
