ABSTRACT
BACKGROUND: The use of non-invasive positive pressure ventilation (NIPPV) in COVID-19 patients with hypoxaemia is still under debate. The aim was to evaluate the efficacy of NIPPV (CPAP, HELMET-CPAP or NIV) in COVID-19 patients treated in the dedicated COVID-19 Intermediate Care Unit of Coimbra Hospital and University Centre, Portugal, and to assess factors associated with NIPPV failure. METHODS: Patients admitted from December 1st 2020 to February 28th 2021, treated with NIPPV due to COVID-19 were included. Failure was defined as orotracheal intubation (OTI) or death during hospital stay. Factors associated with NIPPV failure were included in a univariate binary logistic regression analysis; those with a significance level of p < 0.001 entered a multivariate logistic regression model. RESULTS: A total of 163 patients were included, 64.4% were males (n = 105). The median age was 66 years (IQR 56-75). NIPPV failure was observed in 66 (40.5%) patients, 26 (39.4%) were intubated and 40 (60.6%) died during their hospital stay. The highest CRP (OR 1.164; 95%CI 1.036-1.308) and morphine use (OR 24.771; 95%CI 1.809-339.241) were identified as predictors of failure after applying multivariate logistic regression. Adherence to prone positioning (OR 0.109; 95%CI 0.017-0.700) and a higher value of the lowest platelet count during hospital stay (OR 0.977; 95%CI 0.960-0.994) were associated with a favorable outcome. CONCLUSIONS: NIPPV was successful in over half of patients. Highest CRP during hospital stay and morphine use were predictors of failure. Adherence to prone positioning and a higher value of the lowest platelet count during hospital stay were associated with a favourable outcome.
Subject(s)
Chylothorax , Diet Therapy/methods , Liver Cirrhosis, Alcoholic , Thoracentesis/methods , Triglycerides/metabolism , Aged , Chylothorax/diagnosis , Chylothorax/etiology , Chylothorax/metabolism , Chylothorax/therapy , Humans , Liver Cirrhosis, Alcoholic/complications , Liver Cirrhosis, Alcoholic/therapy , Male , Treatment OutcomeABSTRACT
Acute intermittent porphyria (AIP) is a rare condition, a metabolic disorder of the haem biosynthesis. An acute crisis of AIP can present as a combination of symptoms, such as abdominal pain, autonomic dysfunction, hyponatremia, muscle weakness and neurological symptoms in the absence of others obvious causes. We report the case of a 53-year-old woman, who was previously diagnosed with AIP 5 weeks after therapeutic suspension has developed an acute disease exacerbation. During hospitalisation, further exacerbation has occurred after analgesia with metamizole. Glucose and hemin infusions resulted in slow improvement. Physical rehabilitation was crucial to peripheral polyneuropathy recovery. Taking into account the porphyrinogenic effect described for metamizole, this drug might have triggered the second attack. Clinical history was sufficient to suspect the diagnosis and to start the treatment immediately, preventing important sequelae.
Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Dipyrone/adverse effects , Muscle Weakness/drug therapy , Pain Management/methods , Porphyria, Acute Intermittent/drug therapy , Abdominal Pain , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Dipyrone/administration & dosage , Disease Progression , Female , Glucose/administration & dosage , Hemin/administration & dosage , Humans , Hyponatremia , Infusions, Parenteral , Middle Aged , Muscle Weakness/physiopathology , Porphyria, Acute Intermittent/diagnosis , Porphyria, Acute Intermittent/physiopathology , Treatment OutcomeSubject(s)
Neurilemmoma/diagnostic imaging , Sacrum/diagnostic imaging , Spinal Neoplasms/diagnostic imaging , Humans , Imaging, Three-Dimensional , Magnetic Resonance Imaging , Male , Neoplasm Invasiveness , Neurilemmoma/surgery , Positron Emission Tomography Computed Tomography , Sacrum/surgery , Spinal Neoplasms/surgery , Young AdultABSTRACT
Although foreign body ingestion is a common occurrence, perforation and penetration of the gastrointestinal tract is unusual and the development of a hepatic abscess is even more rare. The authors describe two cases of fish bone perforation of the gastrointestinal tract with hepatic perforation and abscess formation, from distinctive age groups and varying presentation, although both developed septic shock. The lack of history of ingestion of foreign bodies, non-specificity of both clinical presentation and complementary examinations all play a role in delaying the diagnosis and therefore in the prognosis itself.
Embora a ingestão de corpo estranho seja uma situação relativamente comum, a perfuração e penetração do trato gastrointestinal é pouco frequente e a formação de um abcesso hepático é ainda mais rara. Os autores descrevem dois casos de perfuração do trato gastrointestinal por espinha de peixe com formação de abcesso hepático, pertencentes a grupos etários distintos e com diferente apresentação clínica, embora ambos tenham desenvolvido choque séptico. A ausência de história de ingestão de corpo estranho, a inespecificidade dos resultados dos exames complementares e das manifestações clínicas contribuem para um atraso no diagnóstico e, também por isso, influenciam o próprio prognóstico.
