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Evidence Based Digoxin Therapeutic Monitoring - A Lower and Narrower Therapeutic Range
Get PDFCardiac glycosides have been used for congestive heart failure and certain cardiac arrhythmias for more than 200 years. Despite introducing a variety of new classes of drugs for the management of heart failure, specifically angiotensin-converting enzyme (ACE) inhibitors, b-adrenergic antagonists (blockers), and the aldosterone antagonist spironolactone, digoxin continues to have an important role in long-term outpatient management. However, a narrow margin exists between therapeutic and toxic doses of digoxin, resulting in a high incidence of digoxin toxicity in clinical practice.
A wide variety of placebo-controlled clinical trials have unequivocally shown that treatment with digoxin can improve symptoms, quality of life, and exercise tolerance in patients with mild, moderate, or severe heart failure. The clinical relevance of digoxin therapeutic monitoring is also proved but the SDC (Serum Digoxin Concentrations) required for optimal clinical efficacy and acceptable toxicity remains controversial. In the last years, international guidelines recommend 1.2 ng/mL as an acceptable high level.
In this bibliographic synthesis, we aim to collect pertinent information from the MedLine database about an exposure-effect relationship to assess the evidence level scientific of new digoxin therapeutic monitoring
Cellulitis Developing After Intramuscular Metamizole Injection
Get PDFIf the suitable technique is not used in intramuscular injection applications and the injection area is not detected correctly, complications may be observed. Our patient was given intramuscular Metamizole in his house and then he had cellulitis with necrosis area. Following an antibiotic treatment, tissue defect was primarily covered with gluteal muscle skin flap. Cellulitis development after metamizole injection is not common still potential side effects should be considered before prescription
Holt-Oram Syndrome: a Simple Diagnosis that Is Often Delayed
Get PDFBackground: Holt-Oram syndrome is uncommon. It is characterized by heart disease and skeletal abnormalities of the hands and arms (upper limbs). This condition is inherited in an autosomal dominant pattern, which means one copy of the altered gene in each cell is sufficient to cause the disorder. The most common problem is an atrial septal defect and upper limb musculoskeletal deformities. These morphological characteristics should suggest a cardiac abnormality that is usually silent.Case presentation: We report isolated cases with this syndrome. Tow patients with skeletal anomalies have been survived 11 and 29 years with their congenital cardiac defects without being diagnosed despite their obvious upper limb deformities. In the two cases, the diagnosis of Holt-Oram syndrome was delayed and the cardiac defects have been revealed at the stage of surgery. We will discuss the variables of musculoskeletal abnormalities and their association with cardiac morphological defects.Conclusion: Holt-Oram syndrome is a rare inherited clinical disorder. The cardiac defects should be suspected in the presence of congenital upper limb abnormalities
Paradoxical Reactions During Antituberculosis Therapy - A Single-Center Prospective Analysis
Get PDFBackground: Paradoxical reactions during anti-TB treatment represent a real challenge to pneumo-phthisiologists and require a high index of suspicion. It has been suggested that this reaction during appropriate treatment is common and severe in HIV-negative individuals. Our objective was to determine the frequency of paradoxical reactions and their associated features. Method: A prospective study was undertaken in a population of HIV-TB+ patients to determine the frequency of paradoxical reactions and their associated features. Results: Paradoxical reactions occurred in 1.5% of all our hospital’s TB patients. Conclusion: Paradoxical reactions during anti-TB treatment is common in HIV-uninfected individuals and must be considered after careful exclusion of medication non-adherence, other infections, development of resistance, and other similar conditions
Ashy Dermatosis : A Case of Cinderella
Get PDFWe report the case of a 20-years old female, who presented anasymptomatic grayish macules affecting the neck, trunk, and roots of legs (Panel A). Histopathologic examination showed increased dermal melanophages (Panel B) and vacuolization of the basal cell layer (Panel C), evoking an ashy dermatosis (AD). The paraclinical assessment didn't find any related disease. Multiple therapies were proposed such as corticosteroids and phototherapy. Evolution was marked by the extension of lesions in members at five years of follow-up.AD was first described by Ramírez. He called the patients «Los cenicientos». The Spanish term cenicienta means Cinderella, because of this folklore character's close association with ashes from sitting at home alone by the fireplace. Most cases present gray–brown macules which are commonly found on the face, arms, neck, and trunk. Histopathologic findings are nonspecific and include vacuolization of the basal layer, pigmentary incontinence, and perivascular inflammatory infiltrate. The etiology of AD is unknown. Some authors reported associations with ammonium nitrate, whipworm infestation, and HIV seroconversions. Many treatments was proposed such as corticosteroids, dapsone, clofazimine and phototherapy, but the results are not satisfactory. Such as basic research on the pathogenesis and treatment of hypermelanosis continuous, we look for more answers to the questions raised by this case
Bilateral Acetabular Fracture. Two Case Reports with Literature Review
No full textBilateral acetabular fractures represent a challenge, even for experienced Orthopedic surgeons. We present two patients who had an isolated acetabular bilateral fracture, following a violent trauma caused by a traffic accident, which was treated in our department. The treatment strategy is planned by a team of surgeons. After a proper preoperative preparation and using a surgical treatment by postero-lateral Moore and Kocher-Langenbeck approach with internal fixation. Our clinical and radiological results were very satisfying
Head and Neck Sarcomas - Our Experience at a Tertiary Care Center in Rabat, Morocco
Get PDFIntroduction: Head and neck sarcomas are rare, malignant, and very heterogeneous tumors. The difficulty to manage these sarcomas requires the intervention of a multidisciplinary team to improve the prognosis. The aim of our study is to report our series (epidemiological, histological, and progressive characteristics) and evaluate our treatment results.Patients and methods: This is a retrospective study on 42 cases of head and neck sarcomas, assembled at ENT and Maxillofacial Surgery department in the University Hospital of Rabat, for a period of 5 years (2010-2015). All sarcomas were confirmed by histological examination with immunohistochemical study.Results: There were 29 men and 13 women. The average age of our patients was 35.5 years (extremes of age: 13 and 70 years). All patients received a CT scan with MRI scan in 21 cases. A remote extension assessment showed lung metastases in 8 cases. The most frequently found histological type was synovial sarcoma, which was noted in 13 patients (30.9%) followed by osteosarcoma (21.2%). The osteosarcoma treatment was curative in 19 cases, based on surgery with radiotherapy. Total remission was noted in twelve patients.Conclusion: Head and neck sarcomas are rare and very aggressive cancers with a poor prognosis. The treatment approach combines surgery and chemoradiation. However, in the absence of adequate and effective treatment protocols, it is necessary to establish a surgical indication in time to ensure excision as complete as possible
Pulmonary Tuberculosis and Diabetes Mellitus Profile
Get PDFBackground: About 95% of patients with tuberculosis (TB) and 70% of patients with diabetes mellitus (DM) live in low and middle-income countries. As a result, DM and TB are increasingly occurring together. The risk of tuberculosis is two to five times greater in patients with diabetes. The purpose of this study is to analyze the characteristics of pulmonary tuberculosis in patients with diabetes and to evaluate the impact of tuberculosis on diabetes control.Patients and Methods: This is a retrospective study of 80 patients with confirmed pulmonary tuberculosis, comparing 30 patients with diabetes with 50 without diabetes.Results: Diabetes was more frequent in older patients with tuberculosis and in male patients. 63,3% had type 2 diabetes. Tuberculosis symptoms did not differ between the two groups. Involvement of basal segments of the lower lobes and cavitation occurred more frequently in patients with diabetes, but this difference was not significant. The time for conversion to negative of sputum culture was longer in control patients (44,1 ± 20,2 days) than in case (36 ± 18.3) (p = 0.08).Conclusion: Tuberculosis is frequently associated with diabetes mainly in low-income countries. The problem with this association could be accentuated in the future
Syphilis in Colonial Morocco - The Case of Bousbir
Get PDFSyphilis is a venereal disease. Morocco has witnessed syphilis since the fifteenth century and the treatment of this disease remained archaic until the Protectorate was established.With the establishment of the colonial system in Morocco, the phenomenon of prostitution spread. Protectorate authorities designated a particular place in Casablanca for such activity that developed: Bousbir district. The authorities’ efforts failed to regulate and organize such activity because of the development of clandestine prostitution in relation to urban growth and the increase of employed, poor, and downgraded urban population, especially among women who practice prostitution, and due to lack of a real social policy of the Protectorate concerning the policy of land-use planning or control that were a priority.
Tuberculosis of the Parotid Gland in Children - A Report of 4 Cases
Get PDFTuberculosis is a chronic granulomatous infection caused by Mycobacterium tuberculosis or bovis that can affect all organs. However being located in the salivary glands is rare, affecting mainly adults between 20 and 50 years, although a few cases were described in children. We reported a series of 4 children with parotid TB diagnosed and treated at the ENT department of the hospital of specialties of Rabat.The average age was 9.25 years and the sex ratio M/F was 1. All children were admitted for parotid swelling evolving over an average period of 6 months which fistulized afterward, a child had also facial paralysis. Histological analysis of the fine-needle aspiration or the sample taken from the fistula confirmed the diagnosis of tuberculosis with the presence of giant cell granuloma with caseous necrosis. All children received anti-bacillary treatment for 6 months and showed good evolution.Although being rare, parotid TB in children remains a condition to be considered at the occurrence of any chronic parotid swelling, especially in endemic countries