RESUMO
BACKGROUND: The aim is to assess the prognostic value of total T3, total T4, and thyroid-stimulating hormone among critically ill patients admitted to the medical intensive care unit (ICU) in association with mortality and its correlation with the acute physiology and chronic health evaluation II (APACHE II) score. METHODS: : Our prospective observational study consists of 257 patients without known thyroid diseases admitted to the medical ICU. The baseline characteristics of the patients were recorded, including the APACHE II score and thyroid hormone levels at ICU admission. Based on the primary outcome of mortality, we analyzed the data by appropriate statistical methods. A P < 0.05 was considered significant. RESULTS: Of the 257 patients included in the study, 47 (18.28%) succumbed to their illnesses. A significant difference in T3 levels (P < 0.001), T4 levels (P < 0.001), and APACHE II score (P < 0.001) was found between the survivors and the nonsurvivors. There was negative correlation observed between T3 and APACHE II score (r = -0.448, P < 0.001) and T4 and APACHE II score (r = -0.221, P ≤ 0.001). Multivariate logistic regression analysis determined T3 to be the only independent predictor of ICU mortality among thyroid hormones. The area under the curve (AUC) for T3 (0.811 ± 0.04) was almost equal to that of the APACHE II score (0.858 ± 0.029). The duration of ICU stay and hospital stay in patients with low T3 was significantly higher compared to patients with normal T3. CONCLUSION: Serum T3 is a good indicator for predicting mortality and morbidity among critically ill patients.
RESUMO
COVID-19 is caused by the novel SARS-CoV-2 and is a potentially fatal disease that is of great global public health concern. In addition to respiratory symptoms, neurological manifestations have been associated with COVID-19. This is attributed to the neurotropic nature of coronaviruses. The authors present a case of Bell's palsy associated with COVID-19 in a term primigravida.
Assuntos
Paralisia de Bell , COVID-19 , Paralisia Facial , Síndrome de Guillain-Barré/diagnóstico , Prednisolona/administração & dosagem , Complicações Infecciosas na Gravidez , Acidente Vascular Cerebral/diagnóstico , Valaciclovir/administração & dosagem , Adulto , Anti-Inflamatórios/administração & dosagem , Antivirais/administração & dosagem , Paralisia de Bell/etiologia , Paralisia de Bell/fisiopatologia , Paralisia de Bell/terapia , COVID-19/complicações , COVID-19/fisiopatologia , COVID-19/terapia , Diagnóstico Diferencial , Paralisia Facial/diagnóstico , Paralisia Facial/fisiopatologia , Paralisia Facial/terapia , Paralisia Facial/virologia , Feminino , Humanos , Exame Neurológico/métodos , Modalidades de Fisioterapia , Gravidez , Complicações Infecciosas na Gravidez/fisiopatologia , Complicações Infecciosas na Gravidez/terapia , Resultado do TratamentoRESUMO
Synovial sarcomas are deep-seated, genetically distinct, malignant neoplasms seen in young adults, with a male preponderance. They have unusual clinical and pathological presentation and mimic many other sarcomas and carcinomas, making the diagnosis quite challenging. Although four variants are identified, occurrence in the hand is extremely rare and leads to significant morbidity. There is a high incidence of local recurrence and distant metastasis within the first 2 years. We report the case of an elderly woman with monophasic spindle cell synovial sarcoma who presented with painless swelling in her palm and underwent local excision of the neoplasm. At 2-year follow-up, she remains totally asymptomatic with normal function of the hand. We also attempt to give an overview about monophasic spindle cell synovial sarcoma with the differentials, which would help surgeons in prompt diagnosis and appropriate management.
Assuntos
Mãos , Sarcoma Sinovial/cirurgia , Neoplasias de Tecidos Moles/cirurgia , Feminino , Humanos , Imageamento por Ressonância Magnética , Margens de Excisão , Pessoa de Meia-Idade , Sarcoma Sinovial/diagnóstico por imagem , Sarcoma Sinovial/patologia , Neoplasias de Tecidos Moles/diagnóstico por imagem , Neoplasias de Tecidos Moles/patologiaRESUMO
Dengue infection can cause various effects on the central and peripheral nervous systems. Direct neurotropism and immunological mechanisms are responsible for most such neurological manifestations. We present the case of a 64-year-old woman with rapidly progressive dementia with seizures following dengue infection.
Assuntos
Demência/etiologia , Dengue/complicações , Convulsões/etiologia , Demência/tratamento farmacológico , Demência/fisiopatologia , Vírus da Dengue/fisiologia , Dexametasona/uso terapêutico , Feminino , Humanos , Pessoa de Meia-Idade , Convulsões/tratamento farmacológico , Convulsões/fisiopatologia , Resultado do TratamentoRESUMO
Invasive aspergillosis is a highly lethal opportunistic infection that poses a significant threat to immunocompromised patients. With studies suggesting that the incidence of this disease is increasing, and mortality rates remain high, early diagnosis and treatment are very important to improve patient survival. We present the case of a 33-year-old immunocompetent woman who presented with a history of cough and severe breathlessness, and was diagnosed to have invasive aspergillosis. This case emphasises the importance of maintaining a high index of suspicion and also of remembering that invasive aspergillosis is no longer only a disease of immunocompromised individuals. In addition, this case tells us that aspergillosis is one of the new emerging infections in intensive care units.