Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 11 de 11
Filtrar
1.
Cureus ; 14(12): e32759, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36686079

RESUMO

Nocardia species are aerobic, gram-positive, filamentous bacteria. Infection occurs either through inhalation leading to pulmonary symptoms or inoculation presenting with skin findings. Hematogenous dissemination, although uncommon, is possible and can lead to central nervous system involvement. Nocardia brain abscess is a rare manifestation that comprises 2% of all brain abscess etiologies, mostly occurring in immunocompromised patients. Establishing a diagnosis is often difficult, especially due to its rare occurrence and the fact that it can mimic other etiologies on brain imaging including necrotic tumors. High mortality rates have been reported due to delays in establishing a diagnosis and a lack of precise treatment guidelines.

2.
Am J Emerg Med ; 44: 415-418, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-32402500

RESUMO

BACKGROUND: Front-loaded diazepam is used to rapidly control agitation in patients with severe alcohol withdrawal syndrome (AWS). Our institution began using front-loaded lorazepam in August 2017 secondary to a nation-wide shortage of intravenous (IV) diazepam. Currently, there are no studies comparing lorazepam to diazepam for frontloading in severe AWS. METHOD: Retrospective cohort study of all adults presenting to the emergency department with a diagnosis of AWS and prescribed the institution's alcohol withdrawal agitated delirium protocol 8 months pre and post shortage of IV diazepam were eligible inclusion for the study. Of these, 106 patients were front-loaded with diazepam and 70 patients were front-loaded with lorazepam. RESULTS: There was no difference in the mean change in Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised scores 24 h pre and post front-loading in the two groups (-13.9 ± -8.08 vs. -13.1 ± -8.91, p = 0.534). Patients who received front-loaded lorazepam had an increased incidence of ICU-delirium (positive for the Confusion Assessment Method in the ICU: 75% with lorazepam vs. 52.6% with diazepam, p = 0.009) and a higher risk of over-sedation, but this did not reach statistical significance (Richmond Agitation-Sedation Scale score < -1: 32.1% with lorazepam vs. 18.2% with diazepam, p = 0.063). CONCLUSION: Front-loaded lorazepam was similar to front-loaded diazepam in controlling AWS symptoms. Lorazepam's delayed onset of action should be considered when determining how quickly repeat doses are administered to avoid the potential for adverse drug events.


Assuntos
Delirium por Abstinência Alcoólica/tratamento farmacológico , Diazepam/uso terapêutico , Hipnóticos e Sedativos/uso terapêutico , Lorazepam/uso terapêutico , Biomarcadores/análise , Diazepam/administração & dosagem , Serviço Hospitalar de Emergência , Feminino , Humanos , Hipnóticos e Sedativos/administração & dosagem , Lorazepam/administração & dosagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sinais Vitais
3.
Pharmacotherapy ; 39(9): 881-888, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31278761

RESUMO

STUDY OBJECTIVE: Gabapentin has been proved to be beneficial in promoting abstinence, decreasing alcohol cravings, and improving mood and sleep quality when given at higher doses; however, data are limited regarding the efficacy and safety of using high-dose gabapentin as part of the treatment of alcohol withdrawal syndrome (AWS). The aim of this study was to evaluate the impact of high-dose gabapentin on benzodiazepine requirements, alcohol withdrawal symptoms, and hospital length of stay in patients hospitalized with AWS. DESIGN: Retrospective cohort study. SETTING: Large academic medical center. PATIENTS: All adults presenting to the emergency department between January 2015 and April 2018 with a diagnosis of severe AWS (Clinical Institute Withdrawal Assessment for Alcohol Scale, Revised [CIWA-Ar] score ≥ 15) and prescribed the institution's alcohol withdrawal agitated delirium protocol were eligible for inclusion in the study. Of these, 50 patients who received high-dose gabapentin (≥ 1800 mg/day) in the first 48 hours of hospital admission (treatment group) were propensity score-matched to 50 patients who did not receive gabapentin (control group). MEASUREMENTS AND MAIN RESULTS: Patients who received high-dose gabapentin required a significantly lower overall amount of benzodiazepines (mean ± SD 109.5 ± 53.4 mg vs 88.5 ± 35.6 mg [lorazepam equivalents], p=0.023) and had a significantly lower mean CIWA-Ar score (10.1 ± 4.7 vs 7.7 ± 3.9, p=0.010) and maximum CIWA-Ar score (16.0 ± 7.0 vs 12.6 ± 6.1, p=0.016) on day 3 of hospitalization. The high-dose gabapentin regimen was well tolerated, without an increased risk of oversedation, compared with the control group (Richmond Agitation-Sedation Scale score < -1: 34% in the treatment group vs 20% in the control group, p=0.115). Patients receiving high-dose gabapentin had a shorter length of hospital stay (7.4 ± 4.0 days vs 6.0 ± 2.6 days, p=0.034) and increased likelihood of being discharged home (66% vs 88%, p=0.009) compared with the control group. CONCLUSION: Early initiation of high-dose gabapentin was associated with a significant reduction in benzodiazepine exposure, faster stabilization of alcohol withdrawal-related symptoms, and shorter hospital length of stay. Future studies evaluating gabapentin's effect on long-term safety and hospital readmission are warranted.


Assuntos
Benzodiazepinas/uso terapêutico , Etanol/efeitos adversos , Gabapentina/uso terapêutico , Tempo de Internação/estatística & dados numéricos , Síndrome de Abstinência a Substâncias/tratamento farmacológico , Centros Médicos Acadêmicos , Adulto , Delirium por Abstinência Alcoólica/tratamento farmacológico , Benzodiazepinas/administração & dosagem , Relação Dose-Resposta a Droga , Feminino , Gabapentina/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Estudos Retrospectivos
4.
Am J Emerg Med ; 36(11): 1993-1997, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29530360

RESUMO

BACKGROUND: Urinary tract infections (UTIs) are one of the most common reasons women seek treatment in the emergency department (ED). The biomarker procalcitonin (PCT) has gained popularity over the last decade to improve the diagnosis of bacterial infections and reduce unnecessary exposure to antibiotics. PCT has been extensively studied in patients with pneumonia and sepsis and may have additional role in UTI. METHODS: A retrospective study of patients who presented to the ED in which a urinalysis test and a PCT level was obtained within the first 24h of presentation. Signs and symptoms of UTI and urine cultures were reviewed to determine a positive diagnosis of UTI. The area under the receiver operating curve was used to calculate the test characteristics of PCT. Different breakpoints were analyzed to determine which PCT level corresponded to the highest sensitivity and specificity. RESULTS: 293 patients were included in this single center, retrospective study. The AUC of PCT to predict UTI was 0.717; 95% CI: 0.643-0.791 (p<0.001). A PCT threshold of 0.25ng/ml corresponded to the best combination of sensitivity (67%) and specificity (63%), with a positive predictive value and negative predictive value of 26% and 91%, respectively. CONCLUSIONS: A PCT threshold <0.25ng/ml was a strong predictor of the absence of UTI. The high negative predictive value of PCT may be useful as an adjunct to urinalysis results to rule out UTI and facilitate noninitiation or earlier discontinuation of empiric antibiotics.


Assuntos
Pró-Calcitonina/metabolismo , Infecções Urinárias/diagnóstico , Idoso , Área Sob a Curva , Biomarcadores/metabolismo , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Estudos Retrospectivos , Sensibilidade e Especificidade , Urinálise
5.
Conn Med ; 81(2): 95-98, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29738153

RESUMO

Levamisole is used as an agent to increase the total weight of street cocaine. We report the case of a 28-year-old female who presented with multiple painful, ulcerating lesions. She tested positive for cocaine and levamisole. Her skin lesions improved with abstinence from cocaine. Patients with levamisole-induced toxicity most often present with skin manifestations or joint pain. Leukopenia, neutropenia, and agranulocytosis are common lab abnormalities seen in these patients. Complete resolution of the skin lesions are observed approximatelythree weeks after abstinence. Patients known to use street drugs, who present with unexplained skin rash, neutropenia, and multiple immunological abnormalities, should be tested for both cocaine and levamisole. Urine toxicology screen is positive for cocaine approximately 72 hours after ingestion. Levamisole requires specialized testing that is not readily available commercially andis positive forless than 48 hours after exposure.


Assuntos
Transtornos Relacionados ao Uso de Cocaína/complicações , Cocaína Crack/efeitos adversos , Fármacos Dermatológicos/efeitos adversos , Exantema/induzido quimicamente , Levamisol/efeitos adversos , Adulto , Combinação de Medicamentos , Contaminação de Medicamentos , Exantema/patologia , Feminino , Humanos , Retirada de Medicamento Baseada em Segurança/métodos , Pele/patologia
6.
Med Clin North Am ; 100(5): 1047-56, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27542424

RESUMO

Occult gastrointestinal bleeding is not visible and may present with a positive fecal occult blood test or iron deficiency anemia. Obscure bleeding can be overt or occult, with no source identified despite an appropriate diagnostic workup. A stepwise approach to this evaluation after negative upper and lower endoscopy has been shown to be cost effective. This includes repeat endoscopies if warranted, followed by video capsule endoscopy (VCE) if no obstruction is present. If the VCE is positive then specific endoscopic intervention may be possible. If negative, patients may undergo either repeat testing or watchful waiting with iron supplements.


Assuntos
Anemia Ferropriva/etiologia , Endoscopia Gastrointestinal , Hemorragia Gastrointestinal/etiologia , Sangue Oculto , Endoscopia Gastrointestinal/métodos , Hemorragia Gastrointestinal/complicações , Hemorragia Gastrointestinal/fisiopatologia , Humanos , Anamnese , Exame Físico
7.
Conn Med ; 80(5): 297-300, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-27328579

RESUMO

A 43-year-old male with a history of bioprosthetic aortic valve replacement and tricuspid valve annuloplasty presented with vertigo and was found to have an acute infarct in the left superior cerebellum, as well as a left-middle cerebral artery mycotic aneurysm. Blood cultures grew Cardiobacterium hominis and bioprosthetic aortic valve vegetation was found on transthoracic echocardiogram.


Assuntos
Aneurisma Infectado/microbiologia , Bioprótese , Cardiobacterium , Ceftriaxona/administração & dosagem , Infarto Cerebral , Endocardite Bacteriana/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Implante de Prótese de Valva Cardíaca/efeitos adversos , Próteses Valvulares Cardíacas , Aneurisma Intracraniano/microbiologia , Complicações Pós-Operatórias , Adulto , Aneurisma Infectado/diagnóstico por imagem , Antibacterianos/administração & dosagem , Valva Aórtica/cirurgia , Doença da Válvula Aórtica Bicúspide , Bioprótese/efeitos adversos , Bioprótese/microbiologia , Cardiobacterium/efeitos dos fármacos , Cardiobacterium/isolamento & purificação , Infarto Cerebral/diagnóstico , Infarto Cerebral/etiologia , Infarto Cerebral/fisiopatologia , Infarto Cerebral/terapia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/diagnóstico , Infecções por Bactérias Gram-Negativas/complicações , Infecções por Bactérias Gram-Negativas/diagnóstico , Cardiopatias Congênitas/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Próteses Valvulares Cardíacas/efeitos adversos , Próteses Valvulares Cardíacas/microbiologia , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Masculino , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
8.
Conn Med ; 80(3): 143-5, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27169296

RESUMO

UNLABELLED: Penicillin encephalopathy is a rare, potentially reversible phenomenon of drug-induced neurotoxicity. CASE: A 65-year-old female with a history of HIV was admitted with a three-day history of worsening headache, confusion, and lethargy. On examination she was awake but confused. Cerebrospinal fluid (CSF) and serum venereal disease research laboratory (VDRL) test returned positive and the patient was started on intravenous penicillin G with probenecid. On the second day of therapy, she developed myoclonic jerking, consistent with penicillin neurotoxicity. Repeat labs also showed new onset renal failure. Penicillin and probenecid therapy were stopped with a resolution of symptoms. Subsequently, therapy without probenecid was reinstituted uneventfully. DISCUSSION: Herein, we describe a female who developed penicillin neurotoxicity after initiation of intravenous penicillin therapy with probenecid for neurosyphilis. It is important that penicillin-induced toxicity be considered if characteristic myoclonic movements accompany encephalopathy. The presence of coexistent renal compromise should heighten the vigilance of clinicians.


Assuntos
Encefalopatias/induzido quimicamente , Neurossífilis , Penicilina G , Probenecid , Adjuvantes Farmacêuticos/administração & dosagem , Adjuvantes Farmacêuticos/efeitos adversos , Idoso , Antibacterianos/administração & dosagem , Antibacterianos/efeitos adversos , Encefalopatias/prevenção & controle , Feminino , Infecções por HIV/complicações , Humanos , Neurossífilis/complicações , Neurossífilis/diagnóstico , Neurossífilis/tratamento farmacológico , Neurossífilis/fisiopatologia , Penicilina G/administração & dosagem , Penicilina G/efeitos adversos , Probenecid/administração & dosagem , Probenecid/efeitos adversos , Insuficiência Renal/induzido quimicamente , Sorodiagnóstico da Sífilis/métodos , Resultado do Tratamento
9.
Conn Med ; 80(9): 543-547, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-29772140

RESUMO

Aggregatibacter aphrophilus is an uncommon cause of vertebral infections and its complications are infrequently seen. We believe ours is the first reported case of scrotal abscess as a complication of vertebral osteomyelitis. We have also reviewed nine cases with complications similar to this report. Epidural abscess is the most commonly found complication, having been reported in six patients, followed closely by psoas abscess, which was seen in five patients. All except one patient underwent surgical drainage, with all patients showing complete resolution of infection.


Assuntos
Infecções por Pasteurellaceae/diagnóstico , Abscesso do Psoas/microbiologia , Espaço Retroperitoneal/microbiologia , Hidrocele Testicular/microbiologia , Adulto , Aggregatibacter aphrophilus/isolamento & purificação , Epididimite/microbiologia , Humanos , Masculino , Osteomielite/complicações , Osteomielite/microbiologia
10.
Conn Med ; 78(1): 37-9, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24600780

RESUMO

INTRODUCTION: Acetaminophen is known for its toxic effects onhepatic cells. Moreover, acetaminophen toxicity in the setting of hepatic failure has also been associatedwith dysfunction and failure of other organ systems, including the pancreas. Drug-induced pancreatitis (DIP) is rare and has been associated with acetaminophen. CASE: A 19-year-old female presents with a one-week history of abdominal pain associated with nausea, vomiting, and headache. One day earlier she was discharged from an outside hospital where she was admitted for fulminant hepatic failure secondary to acetaminophen toxicity. She had no other complaints and denied consuming alcohol or taking any medications. An examination showed epigastric tenderness. Labs obtained on admission revealed abnormal but improving liver function tests with worsening amylase and lipase. A computed tomography scan on day three of admission revealed what appeared to be a large pancreatic pseudocyst. A magnetic resonance cholangiopancreatographyconfirmed the diagnosis. DISCUSSION: Here we present the case of a young female with a delayed onset acetaminophen-induced pancreatitis. Although DIP is rare, acetaminophen should be recognized as a cause of acute pancreatitis. In addition, itis important for physicians to recognize the increased incidence of pancreatic pseudocyst amongst patients under age 20 with history of DIP, and include pseudocyst in the differential and workup for those presenting with recurrent abdominal pain.


Assuntos
Acetaminofen/efeitos adversos , Analgésicos não Narcóticos/efeitos adversos , Pseudocisto Pancreático/induzido quimicamente , Doença Aguda , Adulto , Feminino , Humanos , Testes de Função Hepática , Pseudocisto Pancreático/diagnóstico , Pancreatite/induzido quimicamente , Pancreatite/diagnóstico
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...