Journal articles: 'Severe complicanze'

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Caputo, N., M. Hamam, R. Scatolini, G. Giordano, and E. Ciorba. "Ruolo delle lesioni carotidee tandem nell'incidenza dell'ictus perioperatorio e nella recidiva dell'ictus." Rivista di Neuroradiologia 9, no. 1 (February 1996): 53–58. http://dx.doi.org/10.1177/197140099600900106.

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Gli autori riferiscono i risultati relativi ad uno studio effettuato su una casistica di 45 pazienti vascolari sintomatici, sottoposti ad intervento di TEA carotideo e controllati clinicamente per 5 anni con lo scopo di verificare se la presenza di lesioni ateromasiche intracraniche associate a quelle delle biforcazioni carotidee era in grado di condizionare l'incidenza dell'ictus perioperatorio o della recidiva dell'ictus. Sugli 85 assi carotidei valutati angiograficamente in fase preoperatoria 53 erano portatori di lesioni tandem; 55 assi carotidei sono stati operati e 30 non sono stati operati; dei casi operati 7 hanno presentato complicanze neurologiche (un solo caso aveva lesioni tandem) e 7 complicanze non neurologiche (5 avevano lesioni tandem). Gli autori concludono che le lesioni tandem non influenzano l'incidenza dell'ictus perioperatorio o della recidiva dell'ictus nei pazienti operati. Severe stenosing atheromatous lesions in the intracranial vessels constitute a significant perioperative risk factor and are commonly considered a major exclusion criterion for carotid endarterectomy.

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Tison, Tiziana, Piero Marson, and Giustina De Silvestro. "Lo scambio eritrocitario." Giornale di Clinica Nefrologica e Dialisi 25, no. 4_suppl (July 23, 2013): S27—S29. http://dx.doi.org/10.33393/gcnd.2013.1086.

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Lo scambio eritrocitario è una procedura in cui, utilizzando un separatore cellulare, si rimuovono i globuli rossi anomali del paziente, che vengono rimpiazzati con globuli rossi di un donatore volontario. Lo scambio eritrocitario può essere effettuato sia utilizzando accessi venosi periferici che un catetere venoso centrale. Dal momento che spesso si tratta di pazienti pediatrici è importante valutare attentamente le indicazioni ed è necessario considerare alcuni aspetti particolari della procedura aferetica. Lo scambio eritrocitario è indicato in caso di complicanze severe della drepanocitosi, quali l'ictus e l'acute chest syndrome, e nel caso di alcune infezioni quali la malaria e la babesiosi, in cui si verifica, ad opera dei parassiti, un danno eritrocitario.

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SAPONARO, G., G. GASPARINI, D. CERVELLI, L. DALL’ASTA, G. D’AMATO, M. FORCIONE, S. PELO, and A. MORO. "Il lembo libero osteoperiosteo di Fibula come opzione ricostruttiva preprotesica nelle atrofie severe e nei difetti post oncologici dei mascellari." Acta Otorhinolaryngologica Italica 35, no. 6 (December 2015): 394–99. http://dx.doi.org/10.14639/0392-100x-763.

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Il gold standard nella ricostruzione dei mascellari nelle atrofie severe, siano esse di natura idiopatica o iatrogena, come nei casi di chirurgia resettiva oncologica, deve essere incentrato verso tecniche di ricostruzione immediata che consentano un veloce recupero funzionale ed estetico. I pazienti considerati in questo studio sono stati trattati durante un periodo di 5 anni (2010-2014) con ricostruzione immediata del deficit dei mascellari, eseguito per mezzo di lembo libero di fibula osteo-periosteo. Sono stati pertanto selezionati 14 pazienti sottoposti a ricostruzione con tale tecnica, senza riportare complicanze a medio e lungo termine. Il principale vantaggio di questo tipo di ricostruzione va ricercato nella formazione di gengiva cheratinizzata sovrastante il lembo libero che consente la migliori condizione possibile per una ricostruzione implantoprotesica. L’unico svantaggio di questa tecnica è da imputare alla necessità di lasciare che la ferita chirurgica intraorale guarisca per seconda intenzione in modo da promuovere la formazione di gengiva cheratinizzata dai bordi della ferita stessa, per tale ragione però il pazente necessita di un rigido follow up per il primo mese dopo l’intervento. Lo scopo di questo lavoro è valutare l’efficacia di tale tecnica nelle ricostruzioni ossee dei mascellari.

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Scavuzzo, A., A. Granata, A. Saita, and F. Fiorini. "Complicanze della nefrolitotrissia percutanea." Giornale di Clinica Nefrologica e Dialisi 23, no. 2 (January 24, 2018): 38–43. http://dx.doi.org/10.33393/gcnd.2011.1436.

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L'obiettivo di questo studio è descrivere “step-by-step” la nefrolitotrissia percutanea e le sue complicanze. A tale proposito sono stati valutati i casi di calcolosi renale da noi trattati con nefrolitotrissia percutanea (PCNL) dal 2001 al 2010 ed è stata al contempo rivista la letteratura circa l'incidenza e il management delle complicanze legate a tale procedura. La percentuale globale di complicanze registrate durante e dopo le PCNL possono raggiungere anche l'83% dei casi e comprendono ematomi (7,2%), trasfusioni (11,2%-17,5%) e febbre (21,0%-32,0%). Molte di queste complicazioni, se riconosciute precocemente, possono essere gestite con trattamenti conservativi o mininvasivi. Le complicanze maggiori sono rare (setticemia (0,3–0,4%), lesioni intestinali (0,2–0,8%), lesioni pleuriche (0,0–3,1%)). Le co-morbilità (insufficienza renale, diabete mellito, obesità severa, malattie polmonari) sembrano incrementare il rischio di complicanze. Nella nostra casistica la percentuale complessiva di complicanze è stata pari al 26%, molte delle quali si sono risolte senza sequele. In conclusione, la PCNL rappresenta una metodica sicura e con basso rischio di complicanze specifiche specie se a seguito di un'accurata selezione e preparazione dei pazienti, tecnica appropriata e attento follow-up nel post-operatorio al fine di assicurare tempestivo intervento se/quando necessario.

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Ianache, Irina, and Cristiana Oprea. "COMPLICAŢIE NEUROLOGICĂ SEVERĂ LA O TÂNĂRĂ CU INFECŢIE HIV." Romanian Journal of Infectious Diseases 19, no. 4 (December 31, 2016): 266–72. http://dx.doi.org/10.37897/rjid.2016.4.11.

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Introducere: Managementul pacienţilor cu infecţie HIV şi sindrom inflamator de reconstituţie imună (IRIS) reprezintă încă o provocare, în special la pacienţii cu infecţii oportuniste cerebrale. Prezentare de caz: Prezentăm cazul unei tinere în vârstă de 26 de ani, diagnosticată cu infecţie HIV într-un serviciu de hematologie şi internată în clinică noastră cu anemie severă, anxietate şi depresie. Probele biologice la internare au evidenţiat o anemie importantă, imunodepresie severă (CD4+ 63/mm3) şi o viremie HIV crescută (6,25 log10 copii/mL). După o lună de la iniţierea terapiei antiretrovirale cu schemă lamivudina 3TC, tenofovir (TDF) şi raltegravir (RAL), s-a observat o creştere importantă a imunităţii celulare (limfocite CD4+ 192/mm3) şi o scădere semnificativă a încărcăturii virale HIV la 1.5 log10 copii/mL. Evoluţia clinică a fost dificilă, pacienta prezentând multiple episoade de convulsii tonico-clonice generalizate, halucinaţii auditive şi instalând hemipareză dreaptă. Examenul LCR a evidenţiat 2 celule/mmc, proteinorahie normală (0,42 g/l), ARN- HIV de 82 copii/mL iar culturile bacteriene şi fungice nu au fost crescute. Examenul IRM cerebral a evidenţiat leziuni hiperintense în secvenţele T2 şi FLAIR, hipointense în T1, localizate în ariile fronto-temporale, în emisferul cerebelos drept şi în punte. Deşi PCR ADN-JC a fost pozitiv în LCR, sugerând diagnosticul de leucoencefalopatie multifocală progresivă (PML), aspectul neuro-imagistic atipic şi simptomatologia psihiatrică asociată au făcut iniţial dificilă stabilirea diagnosticului. Starea generală s-a agravat treptat în special prin accentuarea simptomatologiei psihiatrice şi neurologice (tremor sever, hipotonie axială, slăbiciune musculară generalizată, insomnie şi anxietate marcată). Progresia semnificativă a leziunilor în substanţa albă subcorticală cu priză de contrast, în contextul ameliorării statusului imunologic, a scăderii importante a viremiei HIV şi a prezenţei ADN-JC în LCR, au orientat diagnosticul spre IRIS-PML. Pacienta a primit corticoterapie în doze mari, tratament antipsihotic şi a continuat terapia antiretrovirală, cu evoluţie clinică treptat favorabilă, cu ameliorarea treptată a simptomatologiei neuropsihice. Concluzii: Diagnosticul afecţiunii neurologice a fost dificil în special din cauza debutului atipic, a prezenţei concomitente a simptomelor psihice şi a aspectului neuro-imagistic necaracteristic.

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Rajendram, Rajkumar, Arif Hussain, Naveed Mahmood, and Gabriele Via. "Dynamic right-to-left interatrial shunt may complicate severe COVID-19." BMJ Case Reports 14, no. 10 (October 2021): e245301. http://dx.doi.org/10.1136/bcr-2021-245301.

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Right-to-left (RTL) interatrial shunt (IAS) may complicate select cases of COVID-19 pneumonia. We describe the use of serial imaging to monitor shunt in critically ill patients. A 52-year-old man presented with COVID-19 pneumonia. Hypoxia worsened despite maximal medical therapy and non-invasive ventilation. On day 8, saline microbubble contrast-enhanced transthoracic echocardiography revealed a patent foramen ovale (PFO) with RTLIAS. Invasive ventilation was initiated the next day. The course was complicated by intermittent severe desaturation without worsening aeration or haemodynamic instability, so PFO closure was considered. However, on day 12, saline microbubble contrast-enhanced transoesophageal echocardiography excluded RTLIAS. The patient was extubated on day 27 and discharged home 12 days later. Thus, RTLIAS may be dynamic and changes can be detected and monitored by serial imaging. Bedside echocardiography with saline microbubble contrast, a simple, minimally invasive bedside test, may be useful in the management of patients with severe hypoxia.

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Foresman, Ryan N., and Christopher W. Connors. "Severe Pulmonary Hypertension and Right Ventricular Failure Complicate a Total Abdominal Hysterectomy." Seminars in Cardiothoracic and Vascular Anesthesia 15, no. 4 (October 24, 2011): 179–82. http://dx.doi.org/10.1177/1089253211424223.

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Objective: The 2007 American College of Cardiology/American Heart Association guidelines report that no significant studies have been conducted assessing the perioperative risk of pulmonary hypertension in noncardiac surgery. However, the presence of right ventricular failure has been well documented to have poor prognostic implications. The presence of pulmonary hypertension and right ventricular failure present unique perioperative challenges. These include maintenance of adequate cardiac function, acid–base management, intraoperative monitoring, and postoperative pain management. Case report: The authors report the case of a patient with severe pulmonary hypertension who underwent an open total abdominal hysterectomy. The case was complicated by known right ventricular failure, severe portal hypertension, obstructive sleep apnea, extensive smoking history, and systemic anticoagulation therapy. The patient was not a candidate for postoperative neuraxial analgesia because of the timing and dose of systemic anticoagulation. Two-dimensional transesophageal echocardiography was used for real-time visualization and intraoperative cardiac monitoring. The patient was transferred to the intensive care unit for careful titration of opioids and slow ventilator wean to extubation. The postoperative course proceeded without significant morbidity or mortality. Clinical challenges: ( a) Preoperative assessment of pulmonary hypertension, ( b) postoperative pain control, ( c) cardiovascular stability, and ( d) intraoperative monitoring. Conclusions: This case illustrates the unique challenges associated with pulmonary hypertension and right ventricular failure in the setting of noncardiac surgery. This case also demonstrates that continuous, real-time data provided by transesophageal echocardiography can be used to successfully manage a complicated patient with pulmonary hypertension.

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Barbera, V., G. Barbera, G. Otranto, R. Faiola, C. Feliziani, A. Villani, and A. Santoboni. "Calcifilassi peniena: una rara complicanza in corso di emodialisi." Giornale di Clinica Nefrologica e Dialisi 24, no. 1 (January 24, 2018): 9–12. http://dx.doi.org/10.33393/gcnd.2012.1106.

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La calcifilassi rappresenta una condizione clinica severa ed assai grave che si manifesta prevalentemente - ma non esclusivamente - in pazienti affetti da malattia renale cronica (CKD) sottoposti a terapia sostitutiva. Colpisce circa 1′1– 4% della popolazione dialitica (1, 2) e presenta una mortalità assai elevata (60–80%) (3). È caratterizzata clinicamente dalla presenza di ulcerazioni ischemiche a carico della cute e da necrosi conseguente allo sviluppo di calcificazioni distrofiche delle arteriole sottocutanee. L'interessamento penieno è assai raro ed in letteratura ne sono riportate - fino ad oggi - circa 40 segnalazioni. A tale proposito viene descritto il caso di un paziente di 50 anni, seguito presso la nostra UOC che sviluppò tale grave e, purtroppo fatale, complicanza clinica.

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Hardeman, A., A. Finley, and M. Huntwork. "M303 LANGUAGE BARRIERS COMPLICATE FOOD ALLERGY TESTING IN CASES OF SEVERE ATOPIC DERMATITIS." Annals of Allergy, Asthma & Immunology 127, no. 5 (November 2021): S125—S126. http://dx.doi.org/10.1016/j.anai.2021.08.402.

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Carvalho, Joana, Rita Moinho, Patricia Macao, and Guiomar Oliveira. "When snakebites complicate: a paediatric case with shock and compartment syndrome." BMJ Case Reports 14, no. 2 (February 2021): e240206. http://dx.doi.org/10.1136/bcr-2020-240206.

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We report the case of an 11-year-old boy brought to our emergency department 2 hours after a viper bite to his right hand. He suffered severe pain and rapidly progressive swelling with signs of haemodynamic compromise in keeping with distributive shock. The oedema progressed from his right wrist upwards to his forearm and upper arm with compartment syndrome ultimately resulting. He underwent fasciotomy of the right upper limb and antivenom serum was given. The patient required vasopressors for 48 hours and a total of nine surgical interventions were necessary. In the event of a snakebite, it is essential to promptly recognise the signs of severity, complications and indications for the administration of antivenom serum. We intend to highlight this rare shock aetiology and the need for emergency management if severe clinical signs are present. Early administration of antivenom serum is essential and it should be available in all emergency departments.

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Marras, L. C., T. P. Kalaparambath, S. E. Black, and D. W. Rowed. "Severe Tension Pneumocephalus Complicating Frontal Sinus Osteoma." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 25, no. 1 (February 1998): 79–81. http://dx.doi.org/10.1017/s0317167100033540.

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ABSTRACT:Background:Tension pneumocephalus, the accumulation of intracranial gas under pressure, is a rare but potentially life-threatening condition which can complicate craniofacial surgery, trauma, or cranial tumor. It presents as an acute or subacute expanding mass lesion.Case Report:We present a case of a 40-year-old male who developed tension pneumocephalus as a consequence of a previously detected but untreated frontal sinus osteoma. Despite prompt decompression and repair of the fistulous connection between the sinus and the intracranial compartment, the patient suffered permanent frontal lobe damage with significant neurocognitive sequelae and seizures.Conclusions:This case illustrates that tension pneumocephalus can be a dangerous entity with potential for early mortality and long-term morbidity. We recommend, therefore, early treatment and close follow up of destructive lesions involving the posterior frontal sinus wall.

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Fakhouri, Eddie W., Stephen J. Peterson, Janish Kothari, Ragin Alex, Joseph I. Shapiro, and Nader G. Abraham. "Genetic Polymorphisms Complicate COVID-19 Therapy: Pivotal Role of HO-1 in Cytokine Storm." Antioxidants 9, no. 7 (July 18, 2020): 636. http://dx.doi.org/10.3390/antiox9070636.

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Coronaviruses are very large RNA viruses that originate in animal reservoirs and include severe acute respiratory distress syndrome (SARS) and Middle East respiratory syndrome (MERS) and other inconsequential coronaviruses from human reservoirs like the common cold. SARS-CoV-2, the virus that causes COVID-19 and is believed to originate from bat, quickly spread into a global pandemic. This RNA virus has a special affinity for porphyrins. It invades the cell at the angiotensin converting enzyme-2 (ACE-2) receptor and binds to hemoproteins, resulting in a severe systemic inflammatory response, particularly in high ACE-2 organs like the lungs, heart, and kidney, resulting in systemic disease. The inflammatory response manifested by increased cytokine levels and reactive oxygen species results in inhibition of heme oxygenase (HO-1), with a subsequent loss of cytoprotection. This has been seen in other viral illness like human immunodeficiency virus (HIV), Ebola, and SARS/MERS. There are a number of medications that have been tried with some showing early clinical promise. This illness disproportionately affects patients with obesity, a chronic inflammatory disease with a baseline excess of cytokines. The majority of the medications used in the treatment of COVID-19 are metabolized by cytochrome P450 (CYP) enzymes, primarily CYP2D6. This is further complicated by genetic polymorphisms of CYP2D6, HO-1, ACE, and ACE-2. There is a potential role for HO-1 upregulation to treat/prevent cytokine storm. Current therapy must focus on antivirals and heme oxygenase upregulation. Vaccine development will be the only magic bullet.

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Ceccato, Adrian, Marta Camprubí-Rimblas, Elena Campaña-Duel, Aina Areny-Balagueró, Luis Morales-Quinteros, and Antonio Artigas. "Anticoagulant Treatment in Severe ARDS COVID-19 Patients." Journal of Clinical Medicine 11, no. 10 (May 10, 2022): 2695. http://dx.doi.org/10.3390/jcm11102695.

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Patients with COVID-19 may complicate their evolution with thromboembolic events. Incidence of thromboembolic complications are high and also, patients with the critically-ill disease showed evidence of microthrombi and microangiopathy in the lung probably due to endothelial damage by directly and indirectly injured endothelial and epithelial cells. Pulmonary embolism, deep venous thrombosis and arterial embolism were reported in patients with COVID-19, and several analytical abnormal coagulation parameters have been described as well. D-dimer, longer coagulation times and lower platelet counts have been associated with poor outcomes. The use of anticoagulation or high doses of prophylactic heparin is controversial. Despite the use of anticoagulation or high prophylactic dose of heparin have been associated with better outcomes in observational studies, only in patients with non-critically ill disease benefits for anticoagulation was observed. In critically-ill patient, anticoagulation was not associated with better outcomes. Other measures such as antiplatelet therapy, fibrinolytic therapy or nebulized anticoagulants are being studied in ongoing clinical trials.

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Patel, Roshan, and Rohit Malliwal. "Severe hyponatraemia and autonomic dysreflexia in a quadriplegic person." BMJ Case Reports 12, no. 6 (June 2019): e228209. http://dx.doi.org/10.1136/bcr-2018-228209.

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Spinal cord injury (SCI) is associated with a range of secondary health issues. Altered neurological function can complicate diagnosis, which may have serious consequences. Here we present the case of a tetraplegic person presenting with confusion and bradycardia. Initial testing revealed severe hyponatraemia (sodium 96 mmol/L) and ST elevation associated with labile blood pressure. Delayed further investigation identified sigmoid volvulus—endoscopic decompression led to resolution of haemodynamic lability and a diagnosis of autonomic dysreflexia. Low mood and poor documentation in the community were found to contribute to poor compliance with an established bowel management plan. Inpatient care involved electrolyte correction and establishment of regular bowel motions. The patient was discharged at baseline neurology with psychological support. This case highlights poor awareness of the secondary health issues affecting those with SCI and the complex relationship between mental and physical health.

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D'Arena, Giovanni, Giuseppe Pietrantuono, Emilio Buccino, Giancarlo Pacifico, and Pellegrino Musto. "Fournier's Gangrene Complicating Hematologic Malignancies: Literature Review and Treatment Suggestions." Mediterranean Journal of Hematology and Infectious Diseases 5, no. 1 (November 4, 2013): e2013067. http://dx.doi.org/10.4084/mjhid.2013.067.

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Fournier’s gangrene (FG) is a rare but severe necrotizing fasciitis of the external genitalia that may complicate the clinical course of hematologic malignancies and sometimes may be the first sign of the disease. The clinical course of FG is very aggressive and the mortality is still high despite the improvement in its management. Early recognition of FG and prompt appropriate treatment with surgical debridement and administration of antibiotics are the cornerstone of the management of this very severe disease.

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Hoy, Michael, Kate Flavin, and Venkat Prasad. "A complex obstetric case." Journal of the Intensive Care Society 18, no. 3 (April 3, 2017): 239–43. http://dx.doi.org/10.1177/1751143717700910.

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A 33-year-old primigravida presented with severe sepsis, severe pre-eclampsia, peripartum cardiomyopathy and the haemolysis, elevated liver enzymes and low platelets syndrome manifesting over the course of 24 h causing a diagnostic conundrum and a difficult sequence of physiological problems to overcome. We describe a previously unreported sequence of events involving a pre-eclamptic, septic parturient to improve anaesthetic and intensive care physician awareness of confounding factors that complicate assessment and management of these patients.

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Eyer-Silva, Walter A., Jorge Francisco C. Pinto, Juçara Árabe, and Carlos Alberto Morais-de-Sá. "Paradoxical reaction to the treatment of tuberculosis uncovering previously silent meningeal disease." Revista da Sociedade Brasileira de Medicina Tropical 35, no. 1 (February 2002): 59–61. http://dx.doi.org/10.1590/s0037-86822002000100011.

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The development of paradoxical clinical worsening following initiation of tuberculosis treatment may complicate the clinical course of both HIV-infected and uninfected patients. We report a severe manifestation of the so called paradoxical reaction to the treatment of tuberculosis that unmasked previously silent meningeal disease in a 34-year-old HIV-infected male patient.

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Braunthal, Stephanie, and Andrei Brateanu. "Hypertension in pregnancy: Pathophysiology and treatment." SAGE Open Medicine 7 (January 2019): 205031211984370. http://dx.doi.org/10.1177/2050312119843700.

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Hypertensive disorders of pregnancy, an umbrella term that includes preexisting and gestational hypertension, preeclampsia, and eclampsia, complicate up to 10% of pregnancies and represent a significant cause of maternal and perinatal morbidity and mortality. Despite the differences in guidelines, there appears to be consensus that severe hypertension and non-severe hypertension with evidence of end-organ damage need to be controlled; yet the ideal target ranges below 160/110 mmHg remain a source of debate. This review outlines the definition, pathophysiology, goals of therapy, and treatment agents used in hypertensive disorders of pregnancy.

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Chacko, Anita R., Peter H. Zwart, Randy J. Read, Eleanor J. Dodson, C. D. Rao, and Kaza Suguna. "Severe diffraction anisotropy, rotational pseudosymmetry and twinning complicate the refinement of a pentameric coiled-coil structure of NSP4 of rotavirus." Acta Crystallographica Section D Biological Crystallography 68, no. 11 (October 18, 2012): 1541–48. http://dx.doi.org/10.1107/s090744491203836x.

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The crystal structure of the region spanning residues 95–146 of the rotavirus nonstructural protein NSP4 from the asymptomatic human strain ST3 was determined at a resolution of 2.5 Å. Severe diffraction anisotropy, rotational pseudosymmetry and twinning complicated the refinement of this structure. A systematic explanation confirming the crystal pathologies and describing how the structure was successfully refined is given in this report.

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Kalimuddin, Shirin, Yii Ean Teh, Liang En Wee, Shay Paintal, Ram Sasisekharan, Jenny G. Low, Sujata K. Sheth, and Eng Eong Ooi. "Chronic sequelae complicate convalescence from both dengue and acute viral respiratory illness." PLOS Neglected Tropical Diseases 16, no. 8 (August 18, 2022): e0010724. http://dx.doi.org/10.1371/journal.pntd.0010724.

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Long Covid has raised awareness of the potentially disabling chronic sequelae that afflicts patients after acute viral infection. Similar syndromes of post-infectious sequelae have also been observed after other viral infections such as dengue, but their true prevalence and functional impact remain poorly defined. We prospectively enrolled 209 patients with acute dengue (n = 48; one with severe dengue) and other acute viral respiratory infections (ARI) (n = 161), and followed them up for chronic sequelae up to one year post-enrolment, prior to the onset of the Covid-19 pandemic. Baseline demographics and co-morbidities were balanced between both groups except for gender, with more males in the dengue cohort (63% vs 29%, p<0.001). Except for the first visit, data on symptoms were collected remotely using a purpose-built mobile phone application. Mental health outcomes were evaluated using the validated SF-12v2 Health Survey. Almost all patients (95.8% of dengue and 94.4% of ARI patients) experienced at least one symptom of fatigue, somnolence, headache, concentration impairment or memory impairment within the first week of enrolment. Amongst patients with at least 3-months of follow-up, 18.0% in the dengue cohort and 14.6% in the ARI cohort experienced persistent symptoms. The median month-3 SF-12v2 Mental Component Summary Score was lower in patients who remained symptomatic at 3 months and beyond, compared to those whose symptoms fully resolved (47.7 vs. 56.0, p<0.001), indicating that patients who self-reported persistence of symptoms also experienced functionally worse mental health. No statistically significant difference in age, gender distribution or hospitalisation status was observed between those with and without chronic sequelae. Our findings reveal an under-appreciated burden of post-infection chronic sequelae in dengue and ARI patients. They call for studies to define the pathophysiology of this condition, and determine the efficacy of both vaccines as well as antiviral drugs in preventing such sequelae.

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Hollen, Chris, Jessica Rice, Michelle Park, and Vijayshree Yadav. "Rituximab for treatment of refractory multiple sclerosis relapses during pregnancy." Multiple Sclerosis Journal 27, no. 10 (April 30, 2021): 1620–23. http://dx.doi.org/10.1177/1352458521998937.

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Case Summary: While multiple sclerosis (MS) disease activity declines during pregnancy, there are situations where MS relapses in pregnant women do occur. Mild relapses may be managed with close observation, but severe refractory relapses may require more aggressive management. We describe two cases of rituximab used for severe, refractory multiple sclerosis relapses during pregnancy. Rituximab did not appear to complicate either pregnancy and there were no further relapses for either women. Rituximab should not be overlooked in rare refractory cases, such as the rebound relapses sometimes seen following the discontinuation of lymphocyte-sequestering disease-modifying therapies.

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Zakynthinos, E., T. Vassilakopoulos, P. Kaltsas, E. Malagari, Z. Daniil, C. Roussos, and S. G. Zakynthinos. "Pulmonary hypertension, interstitial lung fibrosis, and lung iron deposition in thalassaemia major." Thorax 56, no. 9 (September 1, 2001): 737–39. http://dx.doi.org/10.1136/thx.56.9.737.

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Although restrictive lung disease is the predominant abnormality of pulmonary function in patients with thalassaemia major (TM), its aetiology and its association with pulmonary hypertension (PH) detected in some patients with TM remains unknown. We report a patient with TM, iron overload, frequent pulmonary infections, and progressive severe precapillary PH over the previous 5 years. A severe restrictive pattern and interstitial lung fibrosis were revealed by pulmonary function tests and high resolution computed tomography, respectively. This presentation suggests that interstitial fibrosis may complicate lung involvement in TM and can significantly contribute to the development of PH.

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Andaev, E. I., R. V. Adelshin, and S. V. Balakhonov. "Severe Fever with Thrombocytopenic Syndrome: Current Epidemiological Situation." Epidemiology and Vaccinal Prevention 20, no. 4 (September 4, 2021): 114–22. http://dx.doi.org/10.31631/2073-3046-2021-20-4-114-122.

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Relevance. Severe fever with thrombocytopenia syndrome is a viral disease characterized by acute fever, accompanied by progressive thrombocytopenia, leucopenia. The mortality is up to 30%. The disease was first identified in 2009 in rural areas of central China, Hubei and Henan. The causative agent of the disease is a new Severe Fever with Thrombocytopenia Syndrome Virus (SFTSV). The SFTSV is mainly transmitted through tick bites, especially Haemaphysalis longicornis which is the dominant tick species in East Asia.The aim of the review is to analyze relevant information about Severe Fever with Thrombocytopenia Syndrome, including the molecular genetics features of the pathogen, clinical manifestations, geographical distribution, epidemiological features, as well as the possibility of drift and spread of infection in the Russian Federation.Conclusions. SFTS is a serious health threat as it relates to new and re-emerging infections. The further spread of SFTS in China may complicate the epidemiological situation in the country. SFTSV may have a much wider global distribution in Southeast Asia than is currently known. The risk of H. longicornis ticks spreading is predicted in the north-east United States, New Zealand, parts of Australia and several Pacific islands. The presence of the H. longicornis in the Primorsky Territory on the Far East indicates a possible risk of the natural focus formation in the event of the introduction of the pathogen.

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Cofoian-Amet, Zela, Cristina Mitu, Elena Rosianu, Ayghiul Mujdaba-Elmi, and Bogdan O. Popescu. "Advanced atherosclerosis and stroke in a young patient with cutaneous lymphoma." Romanian Journal of Neurology 13, no. 2 (June 30, 2014): 72–74. http://dx.doi.org/10.37897/rjn.2014.2.5.

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Atherosclerosis might begin in childhood with the development of fatty streaks. However, the advanced lesions of atherosclerosis, which complicate with ischemic events, are frequent rather in the elderly. We report here a case of early severe and symptomatic atheromatosis of large cervical vessels, in a young patient with some risk factors and strong familial history of vascular disease who was diagnosed with Sezary syndrome.

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Valero, Nereida Josefina, Lisbeth Georgina Polanco Peláez, and Marcos Jacob Sacan Arriola. "LINFOHISTIOCITOSIS HEMOFAGOCÍTICA ASOCIADA AL DENGUE GRAVE." Enfermería Investiga 6, no. 4 (July 3, 2021): 65. http://dx.doi.org/10.31243/ei.uta.v6i4.1207.2021.

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La linfohistiocitosis hemofagocítica (LHH) es una enfermedad que afecta al sistema inmunitario, a través de la activación macrofágica descontrolada, con falla en las funciones de las células asesinas natural killer (NK) y los linfocitos T citotóxicos. El dengue es la arbovirosis de mayor impacto en salud pública, que se presenta en áreas tropicales del mundo. El objetivo de esta investigación fue analizar la asociación de la linfohistiocitosis hemofagocítica a la severidad del dengue, síntomas y diagnóstico. Se aplicó una metodología con diseño documental con revisión sistemática de la bibliografía en las bases de datos científicas y buscadores PubMed, Medline, Scielo, Elsevier y Google Académico, utilizando las palabras clave: síndrome hemofagocítico, linfohistiocitosis hemofagocítica, virus dengue, dengue grave, natural killer e inflamación. Se seleccionaron 85 artículos bajo criterios de inclusión y exclusión, tanto en inglés como en español, publicados entre los años 2010-2021. El síndrome hemofagocítico es el responsable de los síntomas que en determinado momento prolongan o complican el dengue grave, se caracteriza por una activación inmune patológica, con signos y síntomas de inflamación excesiva, donde sus principales manifestaciones clínicas son fiebre, citopenias, esplenomegalias, hemofagocitosis, hipertrigliceridemia e hipofibrinogenemia, teniendo encuentra que el problema principal en esta patología es el diagnóstico oportuno, dado que su presentación generalmente esta enmascarada por la enfermedad viral que usualmente se convierte en el desencadenante, y la persistencia o progresión de los síntomas suele ser pasada por alto. La LHH asociada al dengue se encuentra descrita como una forma inusual y grave, lo que da como resultado una tormenta de citocinas liberadas durante la enfermedad. La asociación entre ambas entidades causa manifestaciones clínicas amplias que pueden iniciar desde lo menos grave hasta lo hemorrágico, el cuadro febril, dolor abdominal y dificultad respiratoria, entre otras manifestaciones clínicas, resaltan, lo cual debe orientar al diagnóstico oportuno y evitar la muerte del paciente. Palabras clave: síndrome hemofagocítico linfohistiocitosis, virus dengue, dengue grave, dengue severo, natural killer. ABSTRACT Hemophagocytic lymphohistiocytosis (HHL) is a disease that affects the immune system, through uncontrolled macrophage activation, with failure of natural killer (NK) cells and cytotoxic T lymphocytes. Dengue is the arbovirus with the greatest impact on public health, occurring in tropical areas of the world. The objective of this research was to analyze the association of hemophagocytic lymphohistiocytosis with the severity of dengue, symptoms and diagnosis. A documentary design methodology was applied with a systematic review of the bibliography in the scientific databases and search engines PubMed, Medline, Scielo, Elsevier and Google Scholar, using the key words: hemophagocytic syndrome, hemophagocytic lymphohistiocytosis, dengue virus, severe dengue, natural killer and inflammation. 85 articles were selected under inclusion and exclusion criteria, both in English and Spanish, published between 2010-2021. Hemophagocytic syndrome is responsible for the symptoms that at a certain time prolong or complicate severe dengue, it is characterized by pathological immune activation, with signs and symptoms of excessive inflammation, where its main clinical manifestations are fever, cytopenias, splenomegaly, hemophagocytosis, hypertriglyceridemia and hypofibrinogenemia, having found that the main problem in this pathology is timely diagnosis, since its presentation is generally masked by the viral disease that usually becomes the trigger, and the persistence or progression of symptoms is often overlooked. Dengue-associated LHH is described as an unusual and severe form, resulting in a storm of cytokines released during the disease. The association between both entities causes wide clinical manifestations that can start from the less severe to the hemorrhagic, the feverish picture, abdominal pain and respiratory distress, among other clinical manifestations, they highlight, which should guide the timely diagnosis and avoid the death of the patient. Keywords: hemophagocytic lymphohistiocytosis syndrome, dengue virus, severe dengue, severe dengue, natural killer.

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Askin, Cyrus Ashraf, Jerome Craig Edelson, Guy Smith Dooley, and Amy Nicole Stratton. "UnMASking the diagnosis: Acute severe necrotizing pancreatitis in the setting of systemic lupus erythematosus complicated by macrophage activation syndrome." Case Reports in Internal Medicine 5, no. 4 (August 13, 2018): 1. http://dx.doi.org/10.5430/crim.v5n4p1.

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Systemic lupus erythematosus (SLE) is a common rheumatologic condition with known GI involvement. Acute pancreatitis (AP) is a rare GI complication of SLE and is typically associated with increased disease activity. Macrophage activation syndrome (MAS) is an unusual, hyper-inflammatory response to a rheumatologic stimulus characterized by hyperferritinemia, pancytopenia, thermal dysregulation and multi-organ dysfunction. MAS, more commonly seen in children, has been reported to complicate both adult onset SLE and AP. We present a case of necrotizing AP secondary to an SLE flare complicated by MAS in an adult patient successfully treated with anakinra.

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Cherniy, V. I. "The modern concept of intensive therapy of coagulopathy, which is complicate polytrauma and shock." Клінічна та профілактична медицина 2, no. 8 (August 22, 2019): 4–15. http://dx.doi.org/10.31612/2616-4868.2(8).2019.01.

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The statute presents the fourth edition (The European guideline on management of major bleeding and coagulopathy following trauma: fourth edition, 2016) of European recommendations on the treatment of severe blood loss and coagulopathy caused by injury. More than 50% of all trauma patients with a fatal outcome die within 24 hours after injury. After hospitalization in a third of patients with trauma, the bleeding is coagulopathic. They significantly increase the risk of multiple organ failure and death compared with patients with similar trauma in the absence of coagulopathy. Early acute coagulopathy associated with traumatic injury is multifactorial: 1) hemorrhage induced shock; 2) tissue damage with the release of tissue thromboplastin and the development of thrombinemia; 3) activation of anticoagulant and fibrinolytic systems. The severity of coagulation disorders is determined by the influence of environmental factors, metabolic disorders (acidosis, hypothermia, tissue hypoperfusion and consumption coagulopathy) and therapeutic strategy. Coagulopathies can be associated with trauma to the brain, liver, and patient's individual characteristics, which include age, heredity, comorbidities, and medication, especially oral anticoagulants. Coagulation monitoring (internationally normalized ratio (INR) and APTT), characterizes only the beginning of the 2nd phase of blood coagulation, and represents the generation of only the first 4% of thrombin. Therefore, the performance of a normal coagulogram may be normal, although the general condition of the blood coagulation system is pathological. Late diagnosis of traumatic coagulopathy may affect the outcome. A new concept of reanimation of patients with massive bleeding has been presented, the immediate introduction of coagulation components (RBC, native plasma and platelets in a 1: 1: 1 ratio), tranexamic acid, fresh frozen plasma, fibrinogen concentrate, desmopressin, prothrombin complex concentrate, recombinant activated coagulation factor VII (rFVIIa). Currently, the issue of using fresh whole blood for resuscitation in case of injury and massive blood loss is relevant.

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Mamun, SM AA, Zafor Iqbal, Arif Mahmood, and Sania Ahsan. "Post-COVID19 Lung Fibrosis: An Worrying Experience of COVID19 Survivors." Bangladesh Journal of Medicine 33, no. 1 (December 6, 2021): 114–19. http://dx.doi.org/10.3329/bjm.v33i1.56801.

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Patients recovering from confirmed COVID19 particularly moderate to severe disease, those treated in HDU / ICU support with high flow nasal cannula & Mechanical ventilation ,experienced different symptoms ranging from tiredness, fatigue to severe exertional dyspnea. High resolution CT scan of Chest of these such patients showed persistent radiological abnormalities simulating progressive fibrotic lung disease. Lung function including CO transfer factor revealed moderate to severe reduction. In case of patients recovered from moderate to severe COVID19 pneumonia, lung fibrosis is a big problem and it is one of the most worrying long-term complications. Lung fibrosis was documented in previous Severe Acute Respiratory Syndrome & Middle east Respiratory Syndrome pathology, and current observational studies suggests that pulmonary fibrosis could also complicate infection by SARSCOV2. The objective of our study was to set up a criteria of patients who are at risk to develop such serious complication, thus giving a chance for early detection of post-COVID19 lung fibrosis and thus preventing such disabling complication by proper andearly intervention . Bangladesh J Medicine July 2022; 33(1) : 114-119

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Volpi, Sara, Jason M. Ali, Alishah Suleman, and Rahim Nadeem Ahmed. "Pneumomediastinum in COVID-19 patients: a case series of a rare complication." European Journal of Cardio-Thoracic Surgery 58, no. 3 (August 5, 2020): 646–47. http://dx.doi.org/10.1093/ejcts/ezaa222.

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Abstract Pneumomediastinum is a rare clinical finding, but one which can be the source of significant concern for clinicians. By presenting 3 such cases, we highlight that pneumomediastinum can complicate the course of a severe coronavirus disease 2019 infection but emphasize that conservative management is the first-line method of treatment, with gradual resorption of the air from the tissues. It is important to be alert to the development of pneumothorax, which will require drainage.

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Adjei Boachie, Joseph, and Eduardo Smith-Singares. "Sampson’s Artery Hemorrhage after Inguinal Hernia Repair: Second Case Reported." Case Reports in Surgery 2016 (2016): 1–2. http://dx.doi.org/10.1155/2016/2534037.

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Sampson artery is normally obliterated in postembryonic development. In rare cases it can remain patent and complicate a routine outpatient herniorrhaphy when severed. This is the second reported case in the available English literature of hemoperitoneum due to bleeding from a patent Sampson’s artery following an open inguinal hernia repair.

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Roberson, Megan, and Austin Smith. "Cerebral Malaria in a Patient with Recent Travel to the Congo Presenting with Delirium: A Case Report." Clinical Practice and Cases in Emergency Medicine 4, no. 4 (October 19, 2020): 533–36. http://dx.doi.org/10.5811/cpcem.2020.8.47995.

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Introduction: Cerebral malaria, a syndrome of altered consciousness, is a rare and severe neurologic complication resulting from Plasmodium falciparum.1 Historically, cerebral malaria has been seen more frequently in children rather than adults. To complicate the diagnosis, cerebral malaria has few specific symptoms and neurologic findings can vary with each case. Case Report: We describe a case of a 61-year-old male who returned from the Democratic Republic of Congo and presented to the emergency department with dehydration, fatigue, and intermittent confusion. He was ultimately diagnosed with cerebral malaria caused by P. falciparum. Conclusion: Even with close monitoring and appropriate treatment, cerebral malaria carries a severe risk of long-term neurocognitive deficits and a high mortality rate.

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Kim, Seunghoon, Youngbin Lym, and Ki-Jung Kim. "Developing Crash Severity Model Handling Class Imbalance and Implementing Ordered Nature: Focusing on Elderly Drivers." International Journal of Environmental Research and Public Health 18, no. 4 (February 18, 2021): 1966. http://dx.doi.org/10.3390/ijerph18041966.

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Along with the rapid demographic change, there has been increased attention to the risk of vehicle crashes relative to older drivers. Due to senior involvement and their physical vulnerability, it is crucial to develop models that accurately predict the severity of senior-involved crashes. However, the challenge is how to cope with an imbalanced severity class distribution and the ordered nature of crash severities, as these can complicate the classification of the severity of crashes. In that regard, this study investigates the influence of implementing ordinal nature and handling imbalanced class distribution on the prediction performance. Using vehicle crash data in Ohio, U.S., as an example, the eight machine learning classifiers (logistic and ordered logistic regressions and random forest and ordered random forest with or without handling imbalanced classes) are suggested and then compared with their respective performances. The analysis outcomes show that balancing strategy enhances performance in predicting severe crashes. In contrast, the effects of implementing ordinal nature vary across models. Specifically, the ordered random forest classifier without balancing appears to be superior in terms of overall prediction accuracy, and the ordered random forest with balancing outperforms others in predicting severer crashes.

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Mahajan, Kunal, Virender Katyal, Suvrat Arya, and Meha Shrama. "Antiphospholipid Syndrome in a Pregnant Female Presenting with Severe Thrombocytopenia and Bleeding." Case Reports in Medicine 2015 (2015): 1–3. http://dx.doi.org/10.1155/2015/234878.

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The antiphospholipid antibody syndrome (APS) is defined by the persistent presence of antiphospholipid antibodies in patients with recurrent venous or arterial thromboembolism or pregnancy morbidity. Antithrombotic therapy is the mainstay of treatment given the high risk of recurrent thromboembolism that characterizes this condition. Despite the prothrombotic nature of APS, thrombocytopenia is present in a proportion of patients, which can complicate management and limit the use of antithrombotic therapy. The mechanism of APS-associated thrombocytopenia is multifactorial and its relation to thrombotic risk is poorly characterized. The presence of thrombocytopenia does not appear to reduce thrombotic risk in patients with APS, who can develop thromboembolic complications necessitating antithrombotic treatment. In these cases, treatment of the thrombocytopenia may be necessary to facilitate administration of antithrombotic agents. We present such a pregnant lady with history of recurrent pregnancy losses who presented with severe thrombocytopenia and bleeding manifestations, who was subsequently diagnosed to have antiphospholipid antibody syndrome. She was initially managed with steroids and when her platelet counts improved, antithrombotic therapy was started. She delivered an uneventful and successful pregnancy outcome without any complications during follow-up.

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Radwińska, Justyna, Anna Domosławska, Andrzej Pomianowski, Katarzyna Żarczyńska, and Andrzej Jurczak. "Implications of Blood Coagulation and Fibrinolytic Disorders in Severe Endometritis-Pyometra Complex in Bitches." Bulletin of the Veterinary Institute in Pulawy 56, no. 3 (September 1, 2012): 293–97. http://dx.doi.org/10.2478/v10213-012-0053-x.

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Abstract Twenty bitches with acute endometritis-pyometra complex (EPC) and 20 clinically healthy bitches were examined. The following coagulation parameters were determined in haemostatic evaluations: prothrombin time (PT), activated partial thromboplastin time (aPTT), thrombin time (TT), fibrinogen concentrations (FBG), D-dimer concentrations (D-D), antithrombin activity (AT), and blood platelet counts (PLT). Morphological and biochemical blood parameters were also analysed. Examinations of animals affected by EPC revealed blood coagulation and fibrinolytic disorders, and the noted results (PT 13.7 ±1.06 s, aPTT 23.4 ±1.04 s, TT 15.6 ±0.68 s, FBG 2.2 g/L, D-D 785.4 ±103.05 μg/L, AT 111.1 ±13.51%, PLT 169.30 ±126.31 103/μL) point to a high risk of disseminated intravascular coagulation. The findings indicate that the coagulation parameters of bitches affected by EPC should be analysed before treatment as the noted disorder can significantly complicate therapy and ovariohysterectomy, and endanger the patients' life.

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Sormunen-Harju, Heidi, Krista Sarvas, Niina Matikainen, Nanna Sarvilinna, and E. Kalevi Laitinen. "Adrenal infarction in a healthy pregnant woman." Obstetric Medicine 9, no. 2 (April 15, 2016): 90–92. http://dx.doi.org/10.1177/1753495x15627959.

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Adrenal infarction is a very rare event but occasionally seen in hypercoagulable states. We present a case of a 31-year-old woman at 38 weeks of gestation who developed a severe upper abdominal pain and unilateral adrenal infarction due to thrombosis of the adrenal vein. The only thrombogenic factor found was pregnancy. The case highlights that adrenal infarction may complicate a normal pregnancy and should be included in the differential diagnosis of the acute abdomen in pregnancy.

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Hidayati, Eka Laksmi, Maulana Rosyady, Henny Adriani Puspitasari, Meilania Saraswati, Angela Grace, and Cahyani Gita Ambarsari. "Plasma exchange and hemodialysis for severe manifestations of multiple wasp stings in a child." Journal of Renal Injury Prevention 9, no. 3 (May 14, 2020): e27-e27. http://dx.doi.org/10.34172/jrip.2020.27.

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Wasp stings occur frequently in developing countries and often lead to fatal outcomes due to the effects of wasp venom. Hemolysis and rhabdomyolysis often complicate wasp stings and result in acute kidney injury (AKI). We report a case of multiple wasp stings leading to AKI and multiple organ dysfunction syndrome (MODS) in a 9-year-old Indonesian girl. Kidney biopsy revealed acute tubular necrosis and acute interstitial nephritis. Despite delayed admission, she recovered in 33 days after 3 days of intravenous steroid administration, eight sessions of intermittent hemodialysis, and two sessions of plasma exchange (PE). Complete recovery of kidney function, indicated by normal diuresis, normal estimated glomerular filtration rate, and negative albuminuria, was reached within 12 weeks. This case showed that immediate admission following multiple wasp stings (particularly >10 stings) to initiate early dialysis is important to promptly remove toxins and preserve kidney function. The case also showed that PE can be beneficial in cases of hemolysis and rhabdomyolysis complicated by MODS.

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Norouzi, Mahnaz, Shaghayegh Norouzi, Alistaire Ruggiero, Mohammad S. Khan, Stephen Myers, Kylie Kavanagh, and Ravichandra Vemuri. "Type-2 Diabetes as a Risk Factor for Severe COVID-19 Infection." Microorganisms 9, no. 6 (June 3, 2021): 1211. http://dx.doi.org/10.3390/microorganisms9061211.

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The current outbreak caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), termed coronavirus disease 2019 (COVID-19), has generated a notable challenge for diabetic patients. Overall, people with diabetes have a higher risk of developing different infectious diseases and demonstrate increased mortality. Type 2 diabetes mellitus (T2DM) is a significant risk factor for COVID-19 progression and its severity, poor prognosis, and increased mortality. How diabetes contributes to COVID-19 severity is unclear; however, it may be correlated with the effects of hyperglycemia on systemic inflammatory responses and immune system dysfunction. Using the envelope spike glycoprotein SARS-CoV-2, COVID-19 binds to angiotensin-converting enzyme 2 (ACE2) receptors, a key protein expressed in metabolic organs and tissues such as pancreatic islets. Therefore, it has been suggested that diabetic patients are more susceptible to severe SARS-CoV-2 infections, as glucose metabolism impairments complicate the pathophysiology of COVID-19 disease in these patients. In this review, we provide insight into the COVID-19 disease complications relevant to diabetes and try to focus on the present data and growing concepts surrounding SARS-CoV-2 infections in T2DM patients.

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Alkoht, Asaad, Ibrahem Hanafi, and Basheer Khalil. "Macrophage Activation Syndrome: A Report of Two Cases and a Literature Review." Case Reports in Rheumatology 2017 (2017): 1–5. http://dx.doi.org/10.1155/2017/5304180.

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Macrophage activation syndrome (MAS) is a severe, potentially fatal condition that may complicate autoimmune diseases, and it belongs to hemophagocytic lymphohistiocytosis (HLH) disorders. MAS occurs in adults and children. However, it is rare in juvenile systemic lupus erythematosus (jSLE), and it is extremely rare to be the initial presentation of jSLE. Here, we report two patients with juvenile SLE who initially presented with MAS. One of the two patients is 4 years old. This is the youngest reported patient to our knowledge.

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Recchia, Andreaserena, Marco Cascella, Sabrina Altamura, Felice Borrelli, Nazario De Nittis, Elisabetta Dibenedetto, Maria Labonia, Giovanna Pavone, and Alfredo Del Gaudio. "Early Diagnosis and Antibiotic Treatment Combined with Multicomponent Hemodynamic Support for Addressing a Severe Case of Lemierre’s Syndrome." Antibiotics 10, no. 12 (December 14, 2021): 1526. http://dx.doi.org/10.3390/antibiotics10121526.

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A 20-year-old man was admitted to the intensive care unit for septic shock due to Lemierre’s syndrome. It is a rare syndrome that manifests as an upper respiratory infection, although systemic involvement, severe coagulopathy, and multi-organ failure can dangerously complicate the clinical picture. In this syndrome, sepsis-related neuroendocrine dysregulation and microcirculation impairment can have a rapid deleterious progression. Consequently, proper diagnosis, early source control, and appropriate antibiotics administration are mandatory to improve the prognosis. The intensive treatment is aimed at limiting organ damage through hemodynamic optimization. Remarkably, in septic shock due to Lemierre’s syndrome, hemodynamic optimization can be achieved through the synergic effect of norepinephrine, argipressin, and hydrocortisone.

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van Beek-Peeters, Judith J. A. M., Jop B. L. van der Meer, Miriam C. Faes, Annemarie J. B. M. de Vos, Martijn W. A. van Geldorp, Ben J. L. Van den Branden, Ruth E. Pel-Littel, Nardo J. M. van der Meer, and Mirella M. N. Minkman. "Professionals’ views on shared decision-making in severe aortic stenosis." Heart 108, no. 7 (December 24, 2021): 558–64. http://dx.doi.org/10.1136/heartjnl-2021-320194.

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ObjectiveTo provide insight into professionals’ perceptions of and experiences with shared decision-making (SDM) in the treatment of symptomatic patients with severe aortic stenosis (AS).MethodsA semistructured interview study was performed in the heart centres of academic and large teaching hospitals in the Netherlands between June and December 2020. Cardiothoracic surgeons, interventional cardiologists, nurse practitioners and physician assistants (n=21) involved in the decision-making process for treatment of severe AS were interviewed. An inductive thematic analysis was used to identify, analyse and report patterns in the data.ResultsFour primary themes were generated: (1) the concept of SDM, (2) knowledge, (3) communication and interaction, and (4) implementation of SDM. Not all respondents considered patient participation as an element of SDM. They experienced a discrepancy between patients’ wishes and treatment options. Respondents explained that not knowing patient preferences for health improvement hinders SDM and complicating patient characteristics for patient participation were perceived. A shared responsibility for improving SDM was suggested for patients and all professionals involved in the decision-making process for severe AS.ConclusionsProfessionals struggle to make highly complex treatment decisions part of SDM and to embed patients’ expectations of treatment and patients’ preferences. Additionally, organisational constraints complicate the SDM process. To ensure sustainable high-quality care, professionals should increase their awareness of patient participation in SDM, and collaboration in the pathway for decision-making in severe AS is required to support the documentation and availability of information according to the principles of SDM.

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Schmidt, Stephan, and Thomas Schulten. "Severe rebound after cessation of fingolimod treated with ocrelizumab with coincidental transient aggravation: report of two cases." Therapeutic Advances in Neurological Disorders 12 (January 2019): 175628641984681. http://dx.doi.org/10.1177/1756286419846818.

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Background: Fingolimod (FTY), an oral treatment for patients with relapsing-remitting multiple sclerosis (RRMS), has been associated with a significant rebound of disease activity after cessation of therapy. Methods: We present the clinical and radiological findings of two patients with severe rebound after FTY withdrawal, which was further aggravated by the initiation of treatment with the B cell-depleting monoclonal antibody, ocrelizumab. Results: Both patients exhibited significant Expanded Disability Status Scale progression after administration of ocrelizumab despite immune reconstitution more than 3 months after FTY withdrawal. Conclusions: Although the observed effect may be coincidental, ocrelizumab may complicate recovery of rebound after cessation of FTY. Further studies are warranted to better understand and predict the clinical and immunological consequences of sequential immunosuppressive and immunomodulatory treatments in patients with highly active RRMS.

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Trikalinos, Nikolaos A., Hyun Kim, Amir Iravani, Lauren Henke, and Anitha Vijayan. "Severe metabolic acidosis and hyperkalemia after peptide receptor radionuclide therapy. A case report, review of the literature and proposed treatment algorithm." Journal of Onco-Nephrology 5, no. 2 (June 2021): 122–28. http://dx.doi.org/10.1177/23993693211019762.

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Peptide receptor radionuclide therapy (PRRT) has been increasingly used in the treatment of patients with well-differentiated neuroendocrine neoplasms (WD-NENs), but electrolyte abnormalities during prophylactic aminoacid (AA) infusion can complicate its administration. We describe a case of AA-induced acidosis and hyperkalemia associated with PRRT. We tailored an oral and intravenous sodium bicarbonate regimen for pre-emptive treatment prior to subsequent PRRT session, thereby preventing hospitalization. We provide a relevant review of the literature and our treatment algorithm, that can serve as a point of reference in treatment of this life-threatening complication of PRRT.

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Salikhov, I. G., E. I. Bogdanov, and A. T. Zabbarova. "Cerebral vasculitis: clinical features and diagnostic principles." Neurology Bulletin XXXIII, no. 3-4 (September 15, 2001): 71–77. http://dx.doi.org/10.17816/nb80866.

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Cerebral vasculitis (CV) is a severe, potentially disabling disease that usually develops in the presence of rheumatic, infectious, medicinal, or malignant diseases. In rare cases, isolated (primary) vasculitis of the central nervous system (CNS) is observed [17, 33]. The complex pathogenesis, polymorphism of clinical manifestations, and the absence in most cases of reliable non-invasive diagnostic criteria for CV complicate early diagnosis and treatment. In this regard, it seems relevant to analyze the features of clinical manifestations and diagnostic capabilities in cerebrovascular pathology caused by vasculitis.

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Canzi, P., A. Pecci, M. Manfrin, E. Rebecchi, C. Zaninetti, V. Bozzi, and M. Benazzo. "ACTA OTORHINOLARYNGOLOGICA ITALICA." Acta Otorhinolaryngologica Italica 36, no. 5 (October 2016): 415–20. http://dx.doi.org/10.14639/0392-100x-702.

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La malattia MYH9-correlata è una rara sindrome genetica caratterizzata da piastrinopenia congenita associata al rischio di sviluppare, durante linfanzia o letà adulta, ipoacusia neurosensoriale, nefropatia e cataratta presenile ad andamento evolutivo. Furono inclusi in uno studio retrospettivo tutti i casi con sordità da severa a profonda arruolati consecutivamente nel Registro Italiano dei pazienti affetti da malattia MYH9-correlata. La popolazione esaminata coinvolse 147 pazienti Italiani con malattia MYH9-correlata: lipoacusia fu identificata nel 52% dei casi e solo 4 pazienti (6%) presentarono un quadro di sordità da severa a profonda alletà media di 33 anni. In tutti i 4 pazienti, la sordità fu associata ad un lieve sanguinamento spontaneo e in 3 pazienti fu accompagnata da un coinvolgimento renale. Limpianto cocleare fu eseguito in 3 casi, con beneficio, in assenza di complicanze maggiori. La diagnosi di malattia MYH9-correlata fu eseguita circa 28 anni dopo la prima manifestazione clinica della malattia che non fu mai sospettata da un otorinolaringoiatra. Saranno discussi gli aspetti clinici e diagnostici di 4 pazienti con sordità da severa a profonda affetti da malattia MYH)-correlata, focalizzando anche le implicazioni terapeutiche.

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Jurkonis, Mantas, Indrė Tamulienė, Rimantė Čerkauskienė, Arijanda Neverauskienė, Rytis Žilevičius, and Gražina Kleinotienė. "FEBRILINĖS NEUTROPENIJOS GYDYMO STANDARTAI PEDIATRIJOJE." Medicinos teorija ir praktika 21, no. 2.1 (March 10, 2015): 131–36. http://dx.doi.org/10.15591/mtp.2015.019.

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Managing cancer patients with fever and neutropenia must be considered as a medical emergency since any delay in initiating appropriate empirical antibacterial therapy may result in high rates of mortality and morbidity. Emerging antibacterial resistance in bacterial pathogens infecting febrile neutropenic patients complicates management, and choosing the type of empirical antimicrobial therapy has become a challenge. To further complicate the decision process, not all neutropenic patients are in the same category of susceptibility to develop severe infection. This review gives a brief overview of current antimicrobial regiment strategy in febrile neutropenic cancer patients.

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Hussain, Azhar, Alia Noorani, Ranjit Deshpande, Lindsay John, Max Baghai, Olaf Wendler, Donald Whitaker, and Habib Khan. "Management of pneumothorax in mechanically ventilated COVID-19 patients: early experience." Interactive CardioVascular and Thoracic Surgery 31, no. 4 (August 31, 2020): 540–43. http://dx.doi.org/10.1093/icvts/ivaa129.

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Abstract A significant proportion of patients infected with the novel coronavirus, now termed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), require intensive care admission and subsequent mechanical ventilation. Pneumothorax, a potential fatal complication of mechanical ventilation, can further complicate the management of COVID-19 patients, whilst chest drain insertion may increase the risk of transmission of attending staff. We present a case series and a suggested best-practice protocol for how to manage and treat pneumothoraces in COVID-19 patients in an intensive care unit setting.

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Дручинин, Denis Druchinin, Миляев, and Andrey Milyaev. "Automated system as a tool to improve the quality of tillage with forest disk tools." Forestry Engineering Journal 4, no. 1 (April 21, 2014): 158–62. http://dx.doi.org/10.12737/3362.

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The advantages and disadvantages of disk tillage in severe operating conditions of forestry are examined. Various methods proposed by scientists to eliminate the problems of weak deepens capacity of working bodies of tillage equipment of this type and their fragile progress at a given depth of processing are described. These proposed solutions make heavier disc tools, which leads to an increase in dynamic loads on the working bodies and to increased fuel consumption of mounted tractor. Developed special devices complicate the design of disk tillage equipment and their production.

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Umlauf, Julian, Stefanie Eilenberger, and Oliver Spring. "Successful Treatment of a Patient with COVID-19-Induced Severe ARDS, Pneumothorax, and Pneumomediastinum with Awake vv-ECMO Implantation." Case Reports in Critical Care 2022 (August 10, 2022): 1–4. http://dx.doi.org/10.1155/2022/6559385.

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Management of acute respiratory distress syndrome (ARDS) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is still a challenge for the staff on intensive-care units (ICU’s) around the world. Many of these patients are treated with invasive ventilation. Sometimes, the occurrence of pneumothorax and/or pneumomediastinum can complicate the course of the disease because initiation of invasive ventilation might be fatal in those patients. Venovenous extracorporal membrane oxygenation (vv-ECMO) is increasingly used to prevent patients with severe ARDS from hypoxia. However, clear recommendations for or against the initiation of vv-ECMO in awake patients are currently lacking. We present the case of a 42-year-old patient with COVID-19-associated severe ARDS, pneumothorax, and pneumomediastinum. To preserve sufficient oxygenation and to avoid invasive ventilation, we implanted a vv-ECMO while the patient was awake. The patient recovered and was discharged home 41 days after transfer to our hospital. We therefore suggest that awake implantation of vv-ECMO might be useful in a subgroup of patients with severe ARDS caused by SARS-CoV-2. However, further evidence is needed to verify our hypothesis.

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Lebedev, O. I., A. V. Surov, T. Yu Matnenko, S. Zh Kabuldinova, O. V. Kutuzov, and E. M. Naumenko. "Severe diseases of the anterior segment of the eye accompanied by somatic pathology and COVID-19: clinical cases under the pandemic." Russian Ophthalmological Journal 15, no. 2 (Прил) (June 16, 2022): 129–37. http://dx.doi.org/10.21516/2072-0076-2022-15-2-supplement-129-137.

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The article presents three clinical cases of severe pathologies of the anterior segment of the eye, which developed in patients with serious concomitant somatic diseases and COVID-19 under the pandemic. Our observations show that the SARS-CoV-2 virus can contribute to the onset of severe keratitis and keratouveitis, characterized by a long torpid course, relapses, and a poorly predicted outcome. In patients with coronavirus and severe somatic pathology, these diseases have atypical symptoms that complicate the diagnosis, are resistant to treatment, and require an extended period of convalescence. This can be explained by pronounced vascular inflammatory reactions, a possible invasion of eye tissue by viral particles, disruption of tear production, a decrease in local immune defense factors of the eye and systemic immunity, and a violation of the hemato-ophthalmic barrier. Local and general drug treatment brought weakly positive changes. The course of the disease took an undulating character. The description of the clinical cases reflects the polymorphism of symptoms and the multiorganic character of damages associated with COVID-19.

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Prokopakis, E. P., I. M. Vlastos, B. J. Ferguson, G. Scadding, H. Kawauchi, C. Georgalas, N. Papadopoulos, and P. W. Hellings. "SCUAD and chronic rhinosinusitis. Reinforcing hypothesis driven research in difficult cases." Rhinology journal 52, no. 1 (March 1, 2014): 3–8. http://dx.doi.org/10.4193/rhino13.049.

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Background: Our objective is to present recent research findings on recalcitrant chronic rhinosinusitis (CRS) in relation to "Severe Chronic Upper Airway Disease" (SCUAD). Methodology: Literature review using Medline and Em base databases (search terms 'chronic rhinosinusitis'; "chronic sinusitis" or"Severe Chronic Upper Airway Disease") limited to articles published in the English language. Results: Complex pathophysiological mechanisms characterize various forms of chronic rhinitis and rhinosinusitis (CRS), where inflammation persists in spite of adequate medical treatment. In these cases, a multifactorial etiology often underlies the development of sino-nasal inflammation. The interaction between chronic upper and lower airway inflammation via neurogenic and systemic pathways may complicate the therapy of these patients, and lead to insufficient symptom control. Conclusion: The recently introduced definition of "Severe Chronic Upper Airway Disease" (SCUAD) increases awareness of those patients with persistent inflammation and symptoms despite guideline-driven pharmacologic treatment. The concept of SCUAD may prove helpful in directing research towards clarifying the definition, diagnosis and pathophysiology of rhinitis and rhinosinusitis, their limits and overlap. In this review, a hypothesis on SCUAD immunopathology is also presented.

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Journal articles on the topic 'Severe complicanze'

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