1
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Samad M, Dallevet CA, Tandjaoui-Lambiotte Y, Bourgarit A, Jaquet P. Spectacular Improvement of Paradoxical Reaction in Tuberculosis after Tumor Necrosis Factor-Alpha Antagonist Therapy. Cureus 2023; 15:e50596. [PMID: 38222121 PMCID: PMC10788139 DOI: 10.7759/cureus.50596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2023] [Indexed: 01/16/2024] Open
Abstract
We report the case of a 42-year-old immunocompetent Indian patient presenting with miliary tuberculosis complicated by respiratory failure requiring intubation. Conventional quadritherapy was initiated for wild-type Mycobacterium tuberculosis. On day 29 of antibiotic treatment, persistent fever and neurological deterioration prompted the diagnosis of multiple brain and medullary tuberculomas, some surrounded by edema. Laboratory investigations ruled out meningitis and subtherapeutic drug concentrations. To enhance cerebrospinal fluid penetration, ethambutol was replaced with levofloxacin on day 30, and rifampicin doses were increased to 30 mg/kg. Dexamethasone was introduced on day 30 to address the paradoxical response to antituberculosis therapy, but neurological deterioration persisted, leading to hemiparesis and coma, with concurrent development of acute respiratory distress syndrome. As salvage therapy, an anti-tumor necrosis factor agent, infliximab (IFX), was administered on day 40. Rapid clinical improvement was observed, marked by awakening and subsequent weaning from respiratory ventilation just eight days after the first IFX infusion. The patient was discharged from the intensive care unit 10 days post-IFX initiation, with steroids discontinued one month after IFX introduction. Both antituberculosis treatment and IFX infusions (seven in total) were maintained for one year. Clinical and radiological evaluation at one year demonstrated complete clinical and radiological recovery.
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Affiliation(s)
- Myriam Samad
- Pulmonology & Infectious Diseases Department, Delafontaine Hospital, Saint-Denis, FRA
| | | | | | - Anne Bourgarit
- Internal Medicine, Jean Verdier Hospital AP-HP, Bondy, FRA
| | - Pierre Jaquet
- Intensive Care Unit, Delafontaine Hospital, Saint-Denis, FRA
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2
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Monteiro M, Domingos R, Rocha S, Miranda I. Granulomatosis With Polyangiitis: The Complexity of Clinical Manifestations, Therapeutic Challenges, and Complications of a Severe Multisystemic Case. Cureus 2023; 15:e47031. [PMID: 37965407 PMCID: PMC10642917 DOI: 10.7759/cureus.47031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2023] [Indexed: 11/16/2023] Open
Abstract
We report a case of a 34-year-old male with severe multisystemic involvement (including the testis, musculoskeletal system, skin, upper respiratory tract, ocular system, peripheral nerves, abdomen, and kidney) due to granulomatosis with polyangiitis (GPA) and a high proteinase 3 (PR3)-antineutrophil cytoplasmic antibodies (PR3ANCA) titer. A renal biopsy showed pauci-immune glomerulonephritis (GN). Systemic corticotherapy combined with cyclophosphamide was chosen for induction therapy. During the induction phase, clinical deterioration occurred in the form of severe alveolar hemorrhage, leading to admission to the intensive care unit (ICU). Influenza A (H1N1) was detected in the respiratory tract. Furthermore, blood sampling revealed an invasive Klebsiella pneumoniae infection that persisted despite multiple antibiotic regimens. A CT scan showed splenic vascular compromise, assumed to be the primary source of the infection, with sustained improvement after splenectomy. Maintenance therapy included a tapering dose of corticotherapy for 36 months and azathioprine 100mg daily for five years, which achieved full and sustained remission. The patient has been in full remission for nine years, with mild renal sequelae, including proteinuria and secondary hypertension.
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Affiliation(s)
| | | | - Sara Rocha
- Internal Medicine, Hospital Pedro Hispano, Porto, PRT
| | - Inês Miranda
- Internal Medicine, Hospital Egas Moniz, Lisbon, PRT
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3
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Muacevic A, Adler JR, Baptista JP, Martins P. Corticosteroid Therapy in Severe Cases of Pneumonia Caused by SARS-CoV-2. Cureus 2022; 14:e33076. [PMID: 36721548 PMCID: PMC9883672 DOI: 10.7759/cureus.33076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2022] [Indexed: 12/31/2022] Open
Abstract
We present a case of severe pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a 63-year-old woman needing venous oxygenation by an extracorporeal membrane. Given the difficult clinical resolution with persistent inflammatory parameters, treatment with corticosteroids (methylprednisolone) was prescribed. The clinical evolution observed, namely the improvement of respiratory and imaging parameters, reiterates the recommendations of corticosteroids for moderate to severe disease.
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4
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Conte AB, Alaoui FZF, Jayi S, Chaara H, Melhouf MA. [Idiopathic granulomatous mastitis associated with erythema nodosum: a case report]. Pan Afr Med J 2022; 43:196. [PMID: 36942131 PMCID: PMC10024551 DOI: 10.11604/pamj.2022.43.196.26754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 08/02/2022] [Indexed: 12/23/2022] Open
Abstract
Idiopathic granulomatous mastitis (IMD) is a chronic benign inflammatory disease of the breast which can mimic breast cancer. It is more common in young women of childbearing age and poses a challenge in diagnosis of inflammatory breast tumor. We report the case of a 26-year-old female patient who presented with inflammatory breast. Clinical examination showed apyretic patient with edematized and painless irregular smooth mass in the left breast measuring 4 cm surmounted by crusts and multiples fistulizing scars discharging pus by applying pressure, with mobile ipsilateral axillary adenopathy. The remainder of the physical examination showed inflammatory erythematous patches on both legs. A mammogram plus breast ultrasound was performed followed by biopsy that objectified fibrous mastopathy. Lumpectomy was performed due to the persistence of symptoms. Anatomopathological examination objectified granulomatous mastitis. Etiological research didn't identify a clear cause. Corticotherapy associated with antibiotic therapy was started with complete regression of symptoms after two months.
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Affiliation(s)
- Alpha Boubacar Conte
- Université Sidi Mohamed Ben Abdellah, Service de Gynécologie-Obstétrique II, Centre Hospitalier Universitaire Hassan II de Fès, Fès, Maroc
- Corresponding author: Alpha Boubacar Conte, Université Sidi Mohamed Ben Abdellah, Service de Gynécologie-Obstétrique II, Centre Hospitalier Universitaire Hassan II de Fès, Fès, Maroc.
| | - Fatima Zohra Fdili Alaoui
- Université Sidi Mohamed Ben Abdellah, Service de Gynécologie-Obstétrique II, Centre Hospitalier Universitaire Hassan II de Fès, Fès, Maroc
| | - Sofia Jayi
- Université Sidi Mohamed Ben Abdellah, Service de Gynécologie-Obstétrique II, Centre Hospitalier Universitaire Hassan II de Fès, Fès, Maroc
| | - Hikmat Chaara
- Université Sidi Mohamed Ben Abdellah, Service de Gynécologie-Obstétrique II, Centre Hospitalier Universitaire Hassan II de Fès, Fès, Maroc
| | - Moulay Abdelilah Melhouf
- Université Sidi Mohamed Ben Abdellah, Service de Gynécologie-Obstétrique II, Centre Hospitalier Universitaire Hassan II de Fès, Fès, Maroc
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5
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Onisâi M, Vlădăreanu AM, Iordan I, Bumbea H, Găman M, Ciufu C, Voican I, Cîșleanu D, Vasile D, Marinescu C, Nicolescu A, Spînu A, Nistor R, Alexandru A. Primary, secondary or less frequent causes of immune thrombocytopenia: A case report. Exp Ther Med 2021; 22:1096. [PMID: 34504550 DOI: 10.3892/etm.2021.10530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 03/31/2021] [Indexed: 01/16/2023] Open
Abstract
Primary immune thrombocytopenia (ITP) is characterized by isolated low platelet count and it is a diagnosis of exclusion, contrasting to secondary ITP. Therefore, a positive diagnosis is difficult and requires extensive investigation. Some of the underlying conditions that are associated with ITP are lymphoproliferative disorders and infections, especially viral ones. In the present study, the case of a patient diagnosed with diffuse large B-cell lymphoma, who received chemotherapy and autologous hematopoietic stem cell transplantation is presented. After a complete remission of four years, the patient presented with sudden intense hemorrhagic syndrome and severely decreased platelet count. The most frequent causes of secondary ITP were excluded, including lymphoma relapse, and intravenous corticosteroids were started. However, shortly after hospital admission, the patient developed neuro-psychiatric anomalies, fever and pancytopenia, and West-Nile encephalitis was diagnosed. Although the initial development was favorable, he started to complain of progressive severe muscle weakness and eventually succumbed to infectious complications in the setting of prolonged hospitalization, corticotherapy, and immobilization.
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Affiliation(s)
- Minodora Onisâi
- Hematology Clinic, Emergency University Hospital, 050098 Bucharest, Romania.,Department of Hematology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Ana-Maria Vlădăreanu
- Hematology Clinic, Emergency University Hospital, 050098 Bucharest, Romania.,Department of Hematology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Iuliana Iordan
- Hematology Clinic, Emergency University Hospital, 050098 Bucharest, Romania.,Department of Hematology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Horia Bumbea
- Hematology Clinic, Emergency University Hospital, 050098 Bucharest, Romania.,Department of Hematology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Mihaela Găman
- Hematology Clinic, Emergency University Hospital, 050098 Bucharest, Romania.,Department of Hematology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Cristina Ciufu
- Hematology Clinic, Emergency University Hospital, 050098 Bucharest, Romania.,Department of Hematology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Irina Voican
- Hematology Clinic, Emergency University Hospital, 050098 Bucharest, Romania
| | - Diana Cîșleanu
- Hematology Clinic, Emergency University Hospital, 050098 Bucharest, Romania.,Department of Hematology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Daniela Vasile
- Hematology Clinic, Emergency University Hospital, 050098 Bucharest, Romania.,Department of Hematology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Cristina Marinescu
- Hematology Clinic, Emergency University Hospital, 050098 Bucharest, Romania.,Department of Hematology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Anca Nicolescu
- Hematology Clinic, Emergency University Hospital, 050098 Bucharest, Romania
| | - Andreea Spînu
- Hematology Clinic, Emergency University Hospital, 050098 Bucharest, Romania.,Department of Hematology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Raluca Nistor
- Neurology Clinic, Emergency University Hospital, 050098 Bucharest, Romania.,Department of Neurology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Adrian Alexandru
- Department of Plastic Reconstructive Surgery, Emergency University Hospital, 050098 Bucharest, Romania.,Department of Plastic Surgery, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
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6
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Badulescu OV, Popescu D, Ciocoiu M, Rezus C. Immune thrombocytopenia, severe hematological consequence in a patient with COVID-19: A case report. Exp Ther Med 2021; 22:1043. [PMID: 34373729 DOI: 10.3892/etm.2021.10475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 06/29/2021] [Indexed: 01/08/2023] Open
Abstract
Since the first appearance of coronavirus disease 2019 (COVID-19), multiple studies have focused on this novel coronavirus. Within a few months, the clinical and paraclinical manifestations and the mechanisms by which these changes are induced were elaborated. Clinically, the virus mainly causes the common cold, but can also result in severe or fatal pneumonia/acute respiratory syndrome. Regarding the biological changes, similar to any other virus, it can lead to a reduced lymphocyte count. The second most common change is represented by a reduced thrombocyte count. Furthermore, most patients have blood clotting abnormalities, inflammatory syndrome, raised D-dimer and lactate dehydrogenase levels. Detection of immune thrombocytopenia in asymptomatic patients who tested positive for COVID-19 justifies the need to perform differential diagnosis and testing for COVID-19. Typically, patients with severe forms of COVID-19 develop mild thrombocytopenia, while severe thrombocytopenia is rarely reported. The aim of this case report was to present the situation in which one asymptomatic patient who tested positive for COVID-19 developed severe immune thrombocytopenia.
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Affiliation(s)
- Oana-Viola Badulescu
- Department of Pathophysiology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Diana Popescu
- Department of Internal Medicine, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Manuela Ciocoiu
- Department of Pathophysiology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ciprian Rezus
- Department of Internal Medicine, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
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7
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Boccara D, Serror K, Chatelain S, Chaouat M, Mimoun M, Azoulay L. A new therapeutic protocol for the treatment of keloid scars: a retrospective study. J Wound Care 2021; 30:184-190. [PMID: 33729847 DOI: 10.12968/jowc.2021.30.3.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE There are few means to treat large keloid scars, as exeresis-even if partial-impedes direct closure without tension in the absence of a flap or a skin graft. This study evaluates the efficacy, indications for use and limitations of a new therapeutic protocol, combining an extralesional keloid excision left to heal by secondary intention with a paraffin dressing and glucocorticoid ointment, followed by monthly intrascar injections of corticosteroids upon full re-epithelialisation. METHOD A retrospective study of patients treated for keloid scars by using the new therapeutic protocol. Scars were categorised as either healed or recurring. Their recurrence was scored according to the changes in functional signs and the scar volume. RESULTS A total of 36 scars were studied. The mean follow-up was 14.1 months. Healing occurred in a mean of 6.8 weeks. The mean surface area was 21.6cm2. Healing rate was 30.5%. Scar volume was improved in 60% of recurrent cases and functional signs in 56%. Based on adherence with the corticotherapy, two patient groups could be discerned. For patients in the 'adherent' group, the healing rate was 40%, and scar volume was improved in 75% of recurrent cases and the functional signs in 83% of cases. CONCLUSIONS The healing rate in this study was close to that reported in the literature. Excision-healing by secondary intention could therefore be offered to patients for whom adherence is uncertain. The protocol in this study offers a straightforward, fast, accessible solution that does not appear to entail any risk of additional keloids. It could potentially offer a treatment option in case of failure of other treatments, large keloid scars or scalp keloids.
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Affiliation(s)
- David Boccara
- Saint-Louis Hospital, 1 avenue Claude Vellefaux, 75010 Paris, France
| | - Kevin Serror
- Saint-Louis Hospital, 1 avenue Claude Vellefaux, 75010 Paris, France
| | - Sarah Chatelain
- Saint-Louis Hospital, 1 avenue Claude Vellefaux, 75010 Paris, France
| | - Marc Chaouat
- Saint-Louis Hospital, 1 avenue Claude Vellefaux, 75010 Paris, France
| | - Maurice Mimoun
- Saint-Louis Hospital, 1 avenue Claude Vellefaux, 75010 Paris, France
| | - Laura Azoulay
- Saint-Louis Hospital, 1 avenue Claude Vellefaux, 75010 Paris, France
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8
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Crisan-Dabija R, Burlacu A. Thrombotic Events in COVID-19: Inquires About the Deleterious Procoagulant Effect of Corticosteroid Therapy. Clin Appl Thromb Hemost 2021; 27:10760296211020139. [PMID: 34018412 PMCID: PMC8142227 DOI: 10.1177/10760296211020139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Radu Crisan-Dabija
- Grigore T. Popa' University of Medicine and Pharmacy, Iasi, Romania.,Pulmonology Department, Clinic of Pulmonary Diseases, Iasi, Romania
| | - Alexandru Burlacu
- Grigore T. Popa' University of Medicine and Pharmacy, Iasi, Romania.,Department of Interventional Cardiology, Cardiovascular Diseases Institute, Iasi, Romania
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9
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Sima A, Vlad A, Timar B, Cotoi L, Sima L, Vlad M, Timar R. INSULIN AUTOIMMUNE SYNDROME IN A YOUNG CAUCASIAN WOMAN. Acta Endocrinol (Buchar) 2021; 17:248-250. [PMID: 34925575 PMCID: PMC8665236 DOI: 10.4183/aeb.2021.248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
A young Caucasian woman presents several episodes of severe fasting hypoglycemia. Fasting lab tests revealed: glycemia 28 mg/dL, insulinemia 143.3 µU/mL, insulin antibodies above 100 U/mL, leading to the diagnosis of insulin autoimmune syndrome. Due to lack of clinical improvement after 2 months, prednisone was started at 0.5 mg/kg/day, and then tapered by 5 mg every 5 days. Three weeks after discontinuing corticotherapy, the patient had no more severe fasting hypoglycemia, but occasionally postprandial mild hypoglycemia. Fasting lab tests showed: glycemia 83 mg/dL, insulinemia 58.6 µU/mL. At 5 hours during oral glucose tolerance test glycemia was 33 mg/dL, insulinemia 152.9 µU/mL.
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Affiliation(s)
- A. Sima
- “Victor Babeș” University of Medicine and Pharmacy Timișoara, Diabetes, Nutrition and Metabolic Diseases, Department of Internal Medicine II, Timișoara, Romania
- Centre for Studies in Preventive Medicine, Timișoara, Romania
| | - A.R. Vlad
- “Victor Babeș” University of Medicine and Pharmacy Timișoara, Diabetes, Nutrition and Metabolic Diseases, Department of Internal Medicine II, Timișoara, Romania
- Centre for Molecular Research in Nephrology and Vascular Disease, Timișoara, Romania
| | - B. Timar
- “Victor Babeș” University of Medicine and Pharmacy Timișoara, Diabetes, Nutrition and Metabolic Diseases, Department of Internal Medicine II, Timișoara, Romania
- Centre for Molecular Research in Nephrology and Vascular Disease, Timișoara, Romania
| | - L. Cotoi
- “Victor Babeș” University of Medicine and Pharmacy Timișoara, Romania
- “Pius Brinzeu” County Emergency Hospital Timișoara – Endocrinology Department, Timișoara, Romania
| | - L. Sima
- “Victor Babeș” University of Medicine and Pharmacy Timișoara, Department of Surgery I – Surgical Semiology I, Timișoara, Romania
| | - M. Vlad
- Centre for Molecular Research in Nephrology and Vascular Disease, Timișoara, Romania
- “Victor Babes” University of Medicine and Pharmacy Timișoara, Department of Internal Medicine II – Endocrinology, Timișoara, Romania
| | - R. Timar
- “Victor Babeș” University of Medicine and Pharmacy Timișoara, Diabetes, Nutrition and Metabolic Diseases, Department of Internal Medicine II, Timișoara, Romania
- Centre for Molecular Research in Nephrology and Vascular Disease, Timișoara, Romania
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10
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Landouré G, Yalcouyé A, Touré S, Coulibaly T, Makadji M, Guinto CO. [A rare case of Horton's disease without inflammatory syndrome in the Department of Neurology of the Teaching Hospital of Point G, Bamako, Mali]. Mali Med 2021; 36:79-80. [PMID: 38200722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
Horton's disease is the most common inflammatory disease of the vessels after the age of 50 years. We report here the caseof a 64-year-old male, who presented a chronic frontal headache resistant to usual analgesics. Physical examination found pain on bitemporal pressure, a slight induration of temporal arteries and a bilateral decreased temporal pulse. Biological inflammatory testing was normal. However, Doppler ultrasound revealed bilateral intimal infiltration of the temporal artery, supporting the diagnosis of Horton's disease. Put on corticoids, headaches were completely resolved.
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Affiliation(s)
- Guida Landouré
- Service de Neurologie, CHU Point G, Bamako, Mali
- Faculté de Médecine et d'Odontostomatologie, USTTB, Bamako, Mali
| | | | - Sidi Touré
- Service de Rhumatologie, CHU du Point G, Bamako, Mali
| | - Thomas Coulibaly
- Service de Neurologie, CHU Point G, Bamako, Mali
- Faculté de Médecine et d'Odontostomatologie, USTTB, Bamako, Mali
| | | | - Cheick O Guinto
- Service de Neurologie, CHU Point G, Bamako, Mali
- Faculté de Médecine et d'Odontostomatologie, USTTB, Bamako, Mali
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11
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Popescu IA, Statescu L, Vata D, Porumb-Andrese E, Patrascu AI, Grajdeanu IA, Solovastru LG. Pemphigus vulgaris - approach and management. Exp Ther Med 2019; 18:5056-5060. [PMID: 31819769 PMCID: PMC6895778 DOI: 10.3892/etm.2019.7964] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 08/06/2019] [Indexed: 12/26/2022] Open
Abstract
The place of pemphigus vulgaris (PV) among autoimmune bullous dermatoses is well known. In pemphigus, IgG autoantibodies are directed against desmogleins 1 and 3, which are part of the cadherin family of cell-cell adhesion molecules. These structures are responsible for maintaining the intercellular adherence in stratified squamous epithelia, such as the skin and oral mucosa. The incidence of autoimmune bullous dermatoses is steadily increasing, being associated with a high degree of morbidity. The pathophysiology of these dermatoses is very well understood, complemented by recent genetic studies. The gold standard for the diagnosis of pemphigus vulgaris is the detection of autoantibodies or complement component 3 by direct immunofluorescence microscopy of a perilesional biopsy. Early diagnosis and initiation of treatment are necessary in order to achieve a favorable prognosis. Although the first line of treatment is corticotherapy, there are no clear guidelines on dosing regimens, and long-term adverse effects are important. Corticosteroid-sparing adjuvant therapies have been employed in the treatment of PV, aiming to reduce the necessary cumulative dose of corticosteroids. In addition, therapies with anti-CD20 antibodies are used, but antigen-specific immune suppression-based treatments represent the future.
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Affiliation(s)
- Ioana Adriana Popescu
- Department of Dermatology, 'Grigore T. Popa' University of Medicine and Pharmacy, Faculty of Medicine, 700115 Iasi, Romania
| | - Laura Statescu
- Department of Dermatology, 'Grigore T. Popa' University of Medicine and Pharmacy, Faculty of Medicine, 700115 Iasi, Romania.,Dermatology Clinic, 'St. Spiridon' County Emergency Clinical Hospital, 700111 Iasi, Romania
| | - Dan Vata
- Department of Dermatology, 'Grigore T. Popa' University of Medicine and Pharmacy, Faculty of Medicine, 700115 Iasi, Romania.,Dermatology Clinic, 'St. Spiridon' County Emergency Clinical Hospital, 700111 Iasi, Romania
| | - Elena Porumb-Andrese
- Department of Dermatology, 'Grigore T. Popa' University of Medicine and Pharmacy, Faculty of Medicine, 700115 Iasi, Romania.,Dermatology Clinic, 'St. Spiridon' County Emergency Clinical Hospital, 700111 Iasi, Romania
| | - Adriana Ionela Patrascu
- Department of Dermatology, 'Grigore T. Popa' University of Medicine and Pharmacy, Faculty of Medicine, 700115 Iasi, Romania.,Dermatology Clinic, 'St. Spiridon' County Emergency Clinical Hospital, 700111 Iasi, Romania
| | - Ioana-Alina Grajdeanu
- Department of Dermatology, 'Grigore T. Popa' University of Medicine and Pharmacy, Faculty of Medicine, 700115 Iasi, Romania
| | - Laura Gheuca Solovastru
- Department of Dermatology, 'Grigore T. Popa' University of Medicine and Pharmacy, Faculty of Medicine, 700115 Iasi, Romania.,Dermatology Clinic, 'St. Spiridon' County Emergency Clinical Hospital, 700111 Iasi, Romania
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12
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Abstract
Giant cell arteritis (GCA) is associated with an increased risk of cardio- or cerebro-vascular death. The stroke rate in patients with GCA varies between 2.7 and 7.4%. The etiological diagnosis may be challenging between atherosclerotic stroke and stroke related to GCA. Case of an old woman who had ischemic stroke and concomitant diagnosis of GCA and brain imaging characteristics.
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Affiliation(s)
- Flora Ketz
- Gériatrie aiguë polyvalente, GH Pitié-Salpêtrière - Charles-Foix (AP-HP), site Charles-Foix, 7, avenue de la République, 94200 Ivry-sur-Seine, France; UFR de médecine, université Paris-6, université Paris-Sorbonne, 91-105, boulevard de l'Hôpital, 75013 Paris, France.
| | - Alexandra Monti
- Gériatrie aiguë polyvalente, GH Pitié-Salpêtrière - Charles-Foix (AP-HP), site Charles-Foix, 7, avenue de la République, 94200 Ivry-sur-Seine, France
| | - Athanasia Velentza
- Gériatrie aiguë polyvalente, GH Pitié-Salpêtrière - Charles-Foix (AP-HP), site Charles-Foix, 7, avenue de la République, 94200 Ivry-sur-Seine, France
| | - Alice Breining
- Gériatrie aiguë polyvalente, GH Pitié-Salpêtrière - Charles-Foix (AP-HP), site Charles-Foix, 7, avenue de la République, 94200 Ivry-sur-Seine, France
| | - Anne Léger
- Unité de soins intensifs neurovasculaires, GH Pitié-Salpêtrière - Charles-Foix (AP-HP), site Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Éric Pautas
- Gériatrie aiguë polyvalente, GH Pitié-Salpêtrière - Charles-Foix (AP-HP), site Charles-Foix, 7, avenue de la République, 94200 Ivry-sur-Seine, France; UFR de médecine, université Paris-6, université Paris-Sorbonne, 91-105, boulevard de l'Hôpital, 75013 Paris, France
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13
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Zulfiqar AA, Niazi R, Pennaforte JL, Andres E. [Late-onset rheumatoid arthritis: clinical, biological, and therapeutic features About a retrospective study]. Geriatr Psychol Neuropsychiatr Vieil 2019; 17:51-62. [PMID: 30907366 DOI: 10.1684/pnv.2018.0766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Rheumatoid arthritis (RA) is the most common chronic inflammatory rheumatism in adults. The objective of our study was to analyze the clinical, biological and therapeutic characteristics in subjects over 60 years old. PATIENTS AND METHODS We performed a retrospective, monocentric, descriptive study on medical records consultations. The data collection concerned subjects over 60 years of age who had been diagnosed with "rheumatoid arthritis" in the rheumatology and internal medicine departments of CHU Reims over a period stretching from 2010 to 2015. RESULTS Thirty-two patients were included in our study for this period. The mean age of diagnosis was 66.6 years, for a median age of 67.5 years (min: 60 years, max: 88 years). There were 22 female (69%) and 10 male (31%) patients, with a sex ratio H/F of 2.2. The mean duration of symptom progression before diagnosis was 33.2 months. What dominates our series is the inaugural involvement of the interphalangeal proximal, wrists, shoulders and metacarpophalangeal for the vast majority of cases. Oral corticosteroids were used in 27 patients and were the only treatment in 3 patients. Methotrexate (MTX) was introduced in 27 patients. Nine patients received biotherapy: it was tocilizumab (Roactemra®) for 5 patients, adalimumab (Humira®) for 2 patients, abatacept (Orencia®) for 2 patients, etanercept (Enbrel®) for 2 patients, golimumab (Simponi®) for 1 patient and infliximab (Remicade®) for one patient. In our series, 7 patients are over 75 years old at the time of diagnosis of RA. CONCLUSION The rheumatoid arthritis of the elderly remains a common condition and constitutes a diagnostic and therapeutic challenge. Because of the co-morbidities, the clinician's perception of the patient's overall condition and the inaccuracies in the use of certain molecules in these patients, under-treatment may, on the contrary, weaken a patient whose remission will be postponed. This was not the case in our series, with a methodical use of methotrexate as well as effective dose biotherapies.
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Pirvulescu RA, Popa CA, Romanitan MO, Obretin D, Iancu R, Vasile D. Necrotizing retinitis of multifactorial etiology. Rom J Ophthalmol 2018; 61:49-53. [PMID: 29450371 PMCID: PMC5710053 DOI: 10.22336/rjo.2017.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction. We present the case of a 73-year-old woman with osteoporosis, who presented to the emergency room with a sudden vision loss and ocular pain in the right eye, which appeared two days before. The patient mentioned loss of appetite, weight loss for three months and low fever for two weeks. Materials and methods. Among the ophthalmological findings, the most important were panuveitis, and large confluent necrotic areas in the peripheral retina. The patient was diagnosed with RE Panuveitis and acute necrotizing retinitis. Results. Blood exams showed leukocytosis and monocytosis, thrombocytosis and anemia. Further investigations showed high levels of Cytomegalovirus (CMV) anti IgG and Herpes Simplex (HS) type 1 virus anti IgM, urinary infection, and secondary hepatic cytolysis. The CT and MRI of the thorax and abdomen showed no sign of neoplastic disease, and no explanation for the CMV infection was found. The patient received general corticotherapy and antiviral therapy, and, after one month, RE BCVA was 20/ 30. Particularity of the case. Acute necrotizing retinitis in an old patient with CMV and HSV type 1, associated with secondary hepatic cytolysis, without any other immunosuppressive disease and very good outcome.
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Affiliation(s)
- Ruxandra Angela Pirvulescu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Ophthalmology Clinic, University Emergency Hospital, Bucharest, Romania
| | - Cherecheanu Alina Popa
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Ophthalmology Clinic, University Emergency Hospital, Bucharest, Romania
| | - Mihaela Oana Romanitan
- Department for Clinical Research, Karolinska Institute, Sodersjukhuset, Stockholm, Sweden
| | - Dana Obretin
- Infectious Diseases Department, "Dr. Victor Babes" Clinical Hospital ", Bucharest, Romania
| | - Raluca Iancu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Ophthalmology Clinic, University Emergency Hospital, Bucharest, Romania
| | - Danut Vasile
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Surgery 1 Clinic, University Emergency Hospital, Bucharest, Romania
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Abstract
RATIONALE According to the World Health Organization reports, adult-onset hearing loss is the 15th leading cause of burden of disease, and is projected to move up to 7th by the year 2030, especially in high-income countries. Sudden sensorineural hearing loss is considered by otologists as a true otologic emergency. The current standard treatment for sudden hearing loss is a tapered course of oral high-dose corticosteroids. The described clinical case points to the validity of undertaking early hyperbaric oxygenation (HBO) therapy together with corticosteroids for full recovery of adult onset idiopathic sudden sensorineural hearing loss. PATIENT CONCERNS A 44-year-old woman complained of an abrupt hearing deterioration in the left ear with the sensation of aural fullness and loud tinnitus presented for 48 hours. The patient was admitted to the Department of Otolaryngology of Public Hospital for diagnosis and treatment. DIAGNOSES The patient was diagnosed with unilateral sudden idiopathic sensorineural hearing loss, assessed by measuring the tonal audiograms. INTERVENTIONS The patient received treatment including oral high-dose corticosteroids combined with HBO protocol including 15 daily 1-hour exposures to 100% oxygen at 2.5 atmosphere absolute. OUTCOMES A pharmacotherapy combined with early HBO resulted in full recovery of hearing. LESSONS Early implementation of HBO to the pharmacotherapy in sudden sensorineural hearing loss may lead to full recovery of hearing. There is a need for systematic research to establish guidelines for optimal number of HBO sessions in relation to the timeframe from hearing loss symptoms onset to implementation of HBO therapy.
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Zulfiqar AA, Fouqué A, Sui Seng X, Kadri N, Doucet J. [Horton disease in the elderly patient]. Soins Gerontol 2017; 22:42-44. [PMID: 28224964 DOI: 10.1016/j.sger.2016.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Horton disease is difficult to diagnose in the elderly, due to the non-specificity of clinical signs. When evoked in the case of recent headaches, laboratory tests must be carried out to look for signs of inflammation.
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Affiliation(s)
- Abrar-Ahmad Zulfiqar
- Département de médecine interne, gériatrie, thérapeutique, CHU de Rouen, Hôpital Saint-Julien, 76104 Le Petit-Quevilly, France.
| | - Audrey Fouqué
- Département de médecine interne, gériatrie, thérapeutique, CHU de Rouen, Hôpital Saint-Julien, 76104 Le Petit-Quevilly, France
| | - Xavier Sui Seng
- Département de médecine interne, gériatrie, thérapeutique, CHU de Rouen, Hôpital Saint-Julien, 76104 Le Petit-Quevilly, France
| | - Nadir Kadri
- Département de médecine interne, gériatrie, thérapeutique, CHU de Rouen, Hôpital Saint-Julien, 76104 Le Petit-Quevilly, France
| | - Jean Doucet
- Département de médecine interne, gériatrie, thérapeutique, CHU de Rouen, Hôpital Saint-Julien, 76104 Le Petit-Quevilly, France
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Boubaker K, Mahfoudhi M, Abderrahim E, Ben Abdallah T, Kheder A. [Pregnancy and kidney transplantation: report of 10 cases]. Pan Afr Med J 2015; 20:292. [PMID: 26161215 PMCID: PMC4483364 DOI: 10.11604/pamj.2015.20.292.4510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 05/10/2014] [Indexed: 11/13/2022] Open
Abstract
La grossesse chez les patientes transplantées rénales est à risque de complications maternelles mais surtout fœtales. Le risque de survenue de rejet aigue ou chronique inhérent à la grossesse est faible. L'objectif de notre étude était de rapporter les grossesses survenues chez nos transplantées rénales, leurs aspects évolutifs et une revue de la littérature. L’âge moyen des patientes au moment de la transplantation rénale était de 28,5 ans. Le traitement immunosuppresseur d'entretien a associé une corticothérapie, l'azathioprine et/ou la ciclosporine A. Le délai moyen entre la transplantation rénale et la découverte de la grossesse était de 6,5 ans. L’âge moyen au moment de la conception était de 33,8 ans. Il n'ya pas eu de modifications du traitement immunosuppresseur au cours de la grossesse. La créatininémie moyenne au cours de la grossesse était stable à 104,8 µmol/l avec une créatininémie supérieure à 150 µmol/l dans 2 cas. Les complications maternelles au cours de la grossesse étaient une hypertension artérielle gravidique dans 3 cas, une protéinurie dans 3 cas, une ascension de la créatininémie au 7ème mois dans 2 cas, une cholestase hépatique gravidique dans 2 cas et une hyperuricémie dans 4 cas. Une prématurité était observée dans 3 cas en rapport avec une rupture prématurée des membranes, des contractions utérines sur utérus cicatriciel et des signes de prééclampsie dans le troisième cas. Après l'accouchement, Une hypertension artérielle était observée chez 3 patientes. On n'a pas noté de rejet aigu chez nos patientes. La créatininémie moyenne était de 195,3 µmol/l (74- 553 µmol/l). Le développement statural et psychomoteur était normal pour 9 enfants. La bonne évolution des grossesses chez les patientes transplantées rénales une planification et un suivi régulier.
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Affiliation(s)
- Karima Boubaker
- Service de Médecine Interne A, Hôpital Charles Nicolle, Tunis, Tunisie
| | - Madiha Mahfoudhi
- Service de Médecine Interne A, Hôpital Charles Nicolle, Tunis, Tunisie
| | | | | | - Adel Kheder
- Service de Médecine Interne A, Hôpital Charles Nicolle, Tunis, Tunisie
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Chebbi W, Jerbi S. [Systemic sarcoidosis: rare cause of adrenal calcification]. Pan Afr Med J 2014; 18:170. [PMID: 25422688 PMCID: PMC4239449 DOI: 10.11604/pamj.2014.18.170.4769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 06/19/2014] [Indexed: 11/11/2022] Open
Affiliation(s)
- Wafa Chebbi
- Service de Médecine Interne, CHU Taher Sfar Mahdia, 5100 Mahdia, Tunisie
| | - Saida Jerbi
- Service de Radiologie, CHU Taher Sfar Mahdia, 5100 Mahdia, Tunisie
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Oudaina W, Assini K, El Ouardi M, Tligui H. [Severe macrophage activation syndrome following visceral leishmaniasis in a child]. Med Sante Trop 2014; 24:221-3. [PMID: 24876180 DOI: 10.1684/mst.2014.0335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Visceral leishmaniasis (VL) is a parasitic disease that is a public health problem in Morocco and is one of the frequent infectious causes of macrophage activation syndrome (MAS). The combination of clinical and laboratory criteria, even very unspecific, make it possible to diagnose MAS, but a definitive diagnosis requires cytological examination. Rapid treatment is essential. The outcome was favorable.
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Abstract
La compression médullaire d'origine métastatique est une complication neurologique fréquente du cancer. C'est une urgence diagnostique et thérapeutique qui nécessite une prise en charge rapide et efficace. L'imagerie par résonnance magnétique (IRM) constitue l'examen de choix pour l'exploration de l'ensemble de la moelle. La prise en charge thérapeutique doit être multidisciplinaire incluant la corticothérapie, la radiothérapie et la chirurgie.
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Affiliation(s)
- Touria Bouhafa
- Service de Radiothérapie, CHU Hassan II de FES, Faculté de Médecine et de Pharmacie de Fès, Fès, Maroc
| | - Abderrahman Elmazghi
- Service de Radiothérapie, CHU Hassan II de FES, Faculté de Médecine et de Pharmacie de Fès, Fès, Maroc
| | - Ouafae Masbah
- Service de Radiothérapie, CHU Hassan II de FES, Faculté de Médecine et de Pharmacie de Fès, Fès, Maroc
| | - Khalid Hassouni
- Service de Radiothérapie, CHU Hassan II de FES, Faculté de Médecine et de Pharmacie de Fès, Fès, Maroc
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Abstract
We report the case of a 43 year old man who presented recurrent left abducens palsy. His medical history included arterial hypertension, ischemic cardiomiopathy, dyslipidemia, rhinitis, maxillary sinusitis. Physical examination revealed a overweight patient, horizontal gaze diplopia, left nerve VI paresis, mild left retro-orbital pain. The orbital MRI also didn’t offer new information: mild external edema on the left eye, with normal tendon aspect, no thickening or enhancement of the muscle belly and also normal aspect of the bony orbit. Recurrent palsy of EOMs can be caused in rare cases by ocular myositis.
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Nicolescu A, Vladareanu AM, Voican I, Onisai M, Vladareanu R. Therapeutic Options for Immune Thrombocytopenia (ITP) During Pregnancy. Maedica (Bucur) 2013; 8:182-188. [PMID: 24371483 PMCID: PMC3865128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Accepted: 06/11/2013] [Indexed: 06/03/2023]
Abstract
The incidence of ITP during pregnancy is low. When ITP is suspected it is necessary to perform an extended set of clinical and biological investigations in order to determine the etiology of thrombocytopenia, as the diagnosis of ITP is a process of exclusion, because there is no sensitive and specific diagnostic test so far. The treatment for ITP during pregnancy represents a challenge, being necessary in the cases selected according to the obstetrical indications, to the degree of maternal thrombocytopenia and to the extent of the hemorrhagic syndrome, as well as according to the adverse reactions of the treatment on the mother and fetus.
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Affiliation(s)
- Anca Nicolescu
- Emergency University Hospital, Department of Hematology, Bucarest, Romania
| | | | - Irina Voican
- Emergency University Hospital, Department of Hematology, Bucarest, Romania
| | - Minodora Onisai
- Emergency University Hospital, Department of Hematology, Bucarest, Romania
| | - Radu Vladareanu
- Elias Emergency University Hospital, Department of Obstetrics-Gynecology, Bucharest, Romania
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Berti-Couto SA, Vasconcelos ACU, Iglesias JE, Figueiredo MAZ, Salum FG, Cherubini K. Diabetes mellitus and corticotherapy as risk factors for alendronate-related osteonecrosis of the jaws: a study in Wistar rats. Head Neck 2013; 36:84-93. [PMID: 23649954 DOI: 10.1002/hed.23260] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2013] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate the influence of diabetes and corticotherapy on the development of osteonecrosis of the jaws associated with sodium alendronate. METHODS Rats were allocated into 4 groups of 11 animals each, representing different treatments: (1) alendronate; (2) alendronate and corticotherapy; (3) alendronate and diabetes; and (4) control. Tooth extractions were performed in all animals, and histological analysis was performed by hematoxylin and eosin staining and immunohistochemistry using anti-bone morphogenetic protein (BMP)-4 and anti-matrix metalloproteinase (MMP)-13 antibodies. RESULTS On hematoxylin and eosin analysis, proportions of inflammatory infiltrate, microbial colonies, and osteonecrosis were significantly greater in the diabetes group. BMP-4 expression in connective tissue was higher in the corticosteroid group than the alendronate group. There were no significant differences between the other groups. MMP-13 expression did not differ between the groups analyzed. CONCLUSION Diabetes but not corticotherapy is associated with jaw osteonecrosis in rats undergoing alendronate therapy and subjected to tooth extractions.
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Affiliation(s)
- Soraya A Berti-Couto
- Dental College, Pontifical Catholic University of Rio Grande do Sul, Hospital São Lucas, Porto Alegre, RS, Brazil
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L'espérance S, Vincent F, Gaudreault M, Ouellet JA, Li M, Tosikyan A, Goulet S. Treatment of metastatic spinal cord compression: cepo review and clinical recommendations. ACTA ACUST UNITED AC 2013; 19:e478-90. [PMID: 23300371 DOI: 10.3747/co.19.1128] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Metastatic spinal cord compression (mscc) is an oncologic emergency that, unless diagnosed early and treated appropriately, can lead to permanent neurologic impairment. After an analysis of relevant studies evaluating the effectiveness of various treatment modalities, the Comité de l'évolution des pratiques en oncologie (cepo) made recommendations on mscc management. METHOD A review of the scientific literature published up to February 2011 considered only phase ii and iii trials that included assessment of neurologic function. A total of 26 studies were identified. RECOMMENDATIONS Considering the evidence available to date, cepo recommends that cancer patients with mscc be treated by a specialized multidisciplinary team.dexamethasone 16 mg daily be administered to symptomatic patients as soon as mscc is diagnosed or suspected.high-loading-dose corticosteroids be avoided.histopathologic diagnosis and scores from scales evaluating prognosis and spinal instability be considered before treatment.corticosteroids and chemotherapy with radiotherapy be offered to patients with spinal cord compression caused by myeloma, lymphoma, or germ cell tumour without sign of spinal instability or compression by bone fragment.short-course radiotherapy be administered to patients with spinal cord compression and short life expectancy.long-course radiotherapy be administered to patients with inoperable spinal cord compression and good life expectancy.decompressive surgery followed by long-course radiotherapy be offered to appropriate symptomatic mscc patients (including spinal instability, displacement of vertebral fragment); andpatients considered for surgery have a life expectancy of at least 3-6 months.
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Affiliation(s)
- S L'espérance
- Comité de l'évolution des pratiques en oncologie, Quebec City, QC
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Lubala TK, Mutombo AM, Munkana AN, Manika MM. [Pulmonary tuberculosis revealed by thrombocytopenic purpura in children - about a clinical case observed in the pediatric ward of the University Hospital of Lubumbashi]. Pan Afr Med J 2012; 12:75. [PMID: 23077696 PMCID: PMC3473961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Accepted: 03/04/2012] [Indexed: 11/04/2022] Open
Abstract
Nous rapportons le cas d'un enfant de 7 ans, de sexe masculin ayant présenté un purpura thrombopénique avec épistaxis, hématémèse, otorragies et pétéchies généralisées. Durant la même hospitalisation, nous avons mis en évidence une tuberculose pulmonaire documentée par la présence de bacilles acido-alcoolo résistants à l'examen des crachats. Nous avons observé une majoration du taux de plaquettes en une semaine de corticothérapie intraveineuse à haute dose, avant l'instauration d'une poly chimiothérapie antituberculeuse. Nous rappelons également la controverse que suscite la prise en charge de cette association rarement rapportée.
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Affiliation(s)
- Toni Kasole Lubala
- Cliniques Universitaires De Lubumbashi, Département De Pédiatrie BP 1825, Lubumbashi, RDC,Corresponding author: Toni Kasole Lubala, Cliniques Universitaires De Lubumbashi, Département De Pédiatrie BP 1825, Lubumbashi, RDC
| | | | - Arthur Ndundula Munkana
- Cliniques Universitaires De Lubumbashi, Service D'Imagerie Médicale BP 1825, Lubumbashi, RDC
| | - Michel Muteya Manika
- Cliniques Universitaires De Lubumbashi, Service Immuno-Hematologie Et Transfusion BP 1825, Lubumbashi, RDC
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Laprise C, Sladek R, Ponton A, Bernier MC, Hudson TJ, Laviolette M. Functional classes of bronchial mucosa genes that are differentially expressed in asthma. BMC Genomics 2004; 5:21. [PMID: 15038835 PMCID: PMC400730 DOI: 10.1186/1471-2164-5-21] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2003] [Accepted: 03/23/2004] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Asthma pathogenesis and susceptibility involves a complex interplay between genetic and environmental factors. Their interaction modulates the airway inflammation and remodelling processes that are present even in mild asthma and governs the appearance and severity of symptoms of airway hyperresponsiveness. While asthma is felt to develop as the result of interaction among many different genes and signalling pathways, only a few genes have been linked to an increased risk of developing this condition. RESULTS We report the results of expression microarray studies using tissue obtained from bronchial biopsies of healthy controls and of subjects with allergic asthma, both before and following inhaled corticotherapy. We identified 79 genes that show significant differences in expression (following Bonferroni cutoff using p < 6.6 x 10(-6) to correct for multiple testing) in asthmatics compared to controls at significance levels. These included 21 genes previously implicated in asthma, such as NOS2A and GPX3, as well as new potential candidates, such as ALOX15, CTSC and CX3CR1. The expression levels of one third of these transcripts were partially or completely corrected following inhaled corticosteroid therapy. CONCLUSION The study shows that bronchial biopsies obtained from healthy and asthmatic subjects display distinct expression profiles. These differences provide a global view of physiopathologic processes active in the asthmatic lung and may provide invaluable help to clarify the natural history of asthma.
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Affiliation(s)
- Catherine Laprise
- Université du Québec à Chicoutimi, Department of Fundamental Sciences, Chicoutimi, Canada
| | - Robert Sladek
- McGill University and Genome Quebec Innovation Centre, Montreal, Canada
- Departments of Medicine and Human Genetics, McGill University, Montreal, Canada
| | - André Ponton
- McGill University and Genome Quebec Innovation Centre, Montreal, Canada
| | - Marie-Claude Bernier
- Unité de recherche en pneumologie, Centre de recherche de l'Hôpital Laval, Institut universitaire de cardiologie et pneumologie de l'Université Laval, Québec, Canada
| | - Thomas J Hudson
- McGill University and Genome Quebec Innovation Centre, Montreal, Canada
- Departments of Medicine and Human Genetics, McGill University, Montreal, Canada
| | - Michel Laviolette
- Unité de recherche en pneumologie, Centre de recherche de l'Hôpital Laval, Institut universitaire de cardiologie et pneumologie de l'Université Laval, Québec, Canada
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