RESUMO
Vibrio parahaemolyticus infection commonly manifests as gastroenteritis, including diarrhea, abdominal pain, nausea, vomiting, and fever. Although uncommon, V. parahaemolyticus has also been associated with wound infection and septic shock. These two manifestations have not been well-reported in medical literature, yet may yield a high risk of death, thus requiring emergent interventions. We present a case of a 42-year-old patient who developed septic shock secondary to a bullous necrotic wound and diarrhea due to V. parahaemolyticus. Multi-organ dysfunction syndrome with extreme cardiac injury developed very early in the course of the disease, prompting ICU admission and management with antibiotics, fluid resuscitation, vasopressors, blood purification, and surgical debridement. The treatment achieved a good clinical outcome. To the best of our knowledge, this is the first case report of V. parahaemolyticus-induced cardiomyopathy. V. parahaemolyticus should be considered as one of the causative agents in patients with sepsis due to cellulitis, particularly in patients with a suggestive history, such as exposure to seawater or eating seafood.
RESUMO
Background: Little is known about the application of the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) in pediatric thyroid nodules. This meta-analysis was aimed to investigate the use of TBSRTC in the pediatric population. Methods: Relevant articles were searched in PubMed and Web of Science. Meta-analysis of proportion and its 95% confidence interval (CI) were computed utilizing the random-effect model. We used subgroup analyses and meta-regression to explore the sources of heterogeneities. Egger's regression test and funnel plot visualization were used to examine publication bias. Results: We included 17 articles comprising of 3687 pediatric thyroid nodules for meta-analyses. TBSRTC outputs including frequency and risk of malignancy (ROM) for the majority of categories were not statistically different from recently published meta-analysis of 145,066 thyroid nodules in adult patients. The resection rate (RR) in the pediatric group was significantly higher in most of the categories compared with published adult data: benign, 23.2% [CI = 18.6-27.9] vs. 13.0% [CI = 9.5-16.5]; atypia of undetermined significance/follicular lesion of undetermined significance, 62.6% [CI = 50.3-74.9] vs. 36.2% [CI = 29.9-42.5]; follicular neoplasm/suspicious for follicular neoplasm, 84.3% [CI = 75.2-93.4] vs. 60.5% [CI = 54.5-66.5]; and suspicious for malignancy, 93.8% [CI = 90.1-97.6] vs. 69.7% [CI = 64.0-75.5]. Conclusion: TBSRTC is a valuable tool to make clinical decisions for pediatric patients with thyroid nodules. Pediatric patients with benign and indeterminate thyroid nodules had a higher RR than adult counterpart, but ROM of these categories in adults and children was not statistically different suggesting a potential risk of overtreatment in pediatric patients. Determining the best treatment guidelines and additional tools for risk stratification must be a top priority to precisely identify the target patient groups for surgical intervention.
