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Osler-Weber-Rendu Syndrome with Severe Hepatic Manifestations: A Rare Clinical Case
Get PDFRendu-Osler-Weber syndrome is a rare inherited syndrome with autosomal dominant transmission characterized by systemic arteriovenous malformations (AVMs) with multi-organ involvement. Its incidence is 1–2/100,000 and it is predominant in females (the male/female ratio varies from 1:2 to 1:4.5).Clinical manifestations and complications are related to recurrent bleeding and, in some cases, the development of end-organ failure. Management is mostly supportive care and it is essential to promote control of the disease as much as possible and screen eventual complications. We describe the case of a 67-year-old male patient with Rendu-Osler-Weber syndrome admitted to the emergency department with decompensated heart failure due to acute anaemia because of severe epistaxis. During hospitalization, the patient progressed to acute-on-chronic liver failure with hepatic encephalopathy and an abdominal computed tomography scan showed multiple hepatic AVMs considered to be the cause of the chronic liver disease
Violenza sessuale e femminicidio: un profilo criminale
Get PDFTracciare il profilo di un autore di reato avvalendosi di documentazione tratta da relazione di perizia diviene particolarmente importante al fine di sottoporre a verifica le ipotesi teoriche e le considerazioni clinico-forensi che sottostanno alla sua redazione.
Il caso che qui si propone è quello di un autore di violenza sessuale nonché di tentato femminicidio, sospettato altresì di altro femminicidio, in quest’ultimo caso purtroppo portato a compimento
Takotsubo Cardiomyopathy Due to Combined Use of Phentermine and Lisdexamfetamine
Get PDFObjectives: This is the first case report of iatrogenic Takotsubo syndrome (TS) due to a combination of lisdexamfetamine and phentermine.Background: TS is characterized by transient acute ballooning of the left ventricular wall. Typically, it occurs in extremely stressed post-menopausal women, however a few iatrogenic causes have been described recently.Results: A 55-year old woman prescribed lisdexamfetamine and phentermine, presented with acute substernal chest pain. Acute coronary syndrome was excluded. The echocardiogram was diagnostic of TS, and she recovered spontaneously, with supportive care.Conclusion: Caution with the use of sympathomimetic medications in post-menopausal women appears warrante
Contrast-Induced Rhabdomyolysis Occurring after ERCP in a Patient with Pancreatic Cancer: A Case Report
Get PDFObjective: We present a patient with pancreatic cancer who developed weakness, acute renal failure and significantly raised creatine kinase levels post-ERCP and who was assessed as having contrast-induced rhabdomyolysis.Results: The patient underwent haemofiltration and ultimately succumbed to his condition.Conclusion: Rhabdomyolysis is a potentially life-threatening condition which occurs because of damage to skeletal muscle, with release of myoglobin and electrolytes into the circulation. The mortality rate is 59% in severe cases, despite appropriate treatmen
COVID Blindness: Delayed Diagnosis of Aseptic Meningitis in the COVID-19 Era
Get PDFDiagnostic errors are a serious problem in healthcare. The diagnostic process is highly susceptible to cognitive bias and the current COVID-19 pandemic may cause normally accurate healthcare workers to make incorrect decisions. We report a case of aseptic meningitis that required five healthcare visits before it was correctly diagnosed. This case highlights the risk of anchoring bias and the importance of carefully assessing diagnostic processes during the COVID-19 pandemic
Sentenze appalti : rassegna sistematica e ragionata di Giurisprudenza in tema di appalti e contratti pubblici
No full textQuesto progetto editoriale nasce con l’intento di fornire un supporto di orientamento
concreto e affidabile, in grado di affiancare l’attività di tutti i soggetti che operano a
vario titolo nell’area appalti e contratti pubblici: RUP, consulenti e professionisti
tecnici e legali, dirigenti, funzionari e addetti degli uffici gare di enti, pubbliche
amministrazioni e operatori economici.
È allo scopo raccolta in modo sistematico e ordinato la più rilevante giurisprudenza
amministrativa in tema di appalti e contratti pubblici, emessa sulla base del quadro
normativo vigente.
La materia è suddivisa in 113 “punti della giurisprudenza”, in ciascuno dei quali - a
seguito di un accurato lavoro di selezione - confluiscono le massime e i principi di
diritto maggiormente significativi e rappresentativi degli orientamenti più autorevoli
e accreditati.
Ciascuna sentenza è corredata degli eventuali precedenti, dei possibili orientamenti
contrastanti e dei pertinenti riferimenti normativi.
Per ogni tema è altresì fornito un sintetico inquadramento giuridico, che ne illustra il
perimetro normativo.
Il dettagliato indice fornisce al lettore un agile strumento di ricerca e consultazione,
con lo scopo di consentire un rapido ed efficace reperimento delle pronunce
giurisprudenziali più adatte alla circostanza di interesse
Governing Future Challenges in Mediterranean Protected Areas
Get PDFThe book presents current Governance and
Management Systems of Protected Areas,
assessing their appropriateness to face future
challenges, providing reciprocal benefits to
local communities and environment. Eight
articles reflect the main threats accelerating
negative impacts on marine ecosystems such as
climate change, invasive alien species, marine
litter, tourism. How can marine and terrestrial
Protected Areas such as Biosphere Reserves,
Natural and Cultural World Heritage sites,
Natura 2000 areas, National and Regional
Parks, and marine observatories increase their
response mechanisms? Considerations for new
paradigms related to the protection of the
marine environment are presented and experts
discuss recommendations for the transformation
of the Governance and Management Systems
Recurrent Klebsiella pneumoniae Infection Causing Transcatheter Aortic Valve Implantation (TAVI)-Related Endocarditis
Get PDFThe authors report the case of an 86-year-old woman presenting with recurrent Klebsiella pneumoniae bacteraemia. She had severe aortic stenosis submitted to a recent transcatheter aortic valve implantation (TAVI). Initially, Klebsiella pneumoniae bacteraemia from a urinary source was diagnosed . Following another 4 episodes of bacteraemia with the same agent, the source was ultimately found to be a periprosthetic abscess. Considering the patient’s unsuitability for surgery, a decision was made for life-long antimicrobial therapy. This approach has been successful in preventing recurrences or complications. Endocarditis is one of the most severe complications seen following TAVI, often carrying a poor prognosis. Even though Klebsiella spp. are common pathogens for healthcare-associated infections among the elderly, they are seldom the causative agent for endocarditis. Being the first reported case of TAVI-related Klebsiella endocarditis, it was successfully managed using a medical approach
Fever During Anti-integrin Therapy: New Immunodeficiency
Get PDFBackground: The causes of inflammatory bowel disease (IBD) have not yet been clearly elucidated, but it is known that genetic susceptibility, altered gut microbiota and environmental factors are all involved, and that a combination of these factors causes an inappropriate immune response, resulting in impaired intestinal barrier function. With regard to the treatment of IBD, the use of conventional immunosuppressive drugs has been complemented by more specific therapeutic agents, including biological drugs. Systemic immune suppression is a risk factor for cytomegalovirus (CMV) infection, which is associated with considerable morbidity and mortality in immunocompromised hosts.
Case Report: A 33-year-old male patient was admitted to our medical unit complaining of a 10-day history of fever, fatigue and headache. He had been suffering from ulcerative colitis and primary sclerosing cholangitis for five years and was currently being treated with azathioprine and vedolizumab. In the past he had already taken infliximab, adalimumab and golimumab without any clinical response. After the exclusion of systemic infectious diseases, his serology was consistent with a primary CMV infection. This was successfully treated with intravenous ganciclovir therapy.
Conclusion: Vedolizumab is an anti-integrin biological agent approved for IBD treatment. Its gut-selective mechanism of action would appear to increase its safety profile, however data on this are still limited. Moreover, it should always be remembered that IBD patients have an increased risk of CMV infection, both primary and reactivation, because of their concurrent immunosuppression
Not All ENT Granulomas Are Wegener’s – Keep Tuberculosis in Mind
Get PDFMycobacterium tuberculosis affects the middle ear in rare cases and is a challenging diagnosis. In this case, we present a 57-year-old patient diagnosed with anti-neutrophil cytoplasmic antibody (ANCA)-negative granulomatosis with polyangiitis (GPA) following a biopsy result of nasal granulomas, who was immediately started on immunosuppressive treatment. Years later, she developed progressive hypoacusis. Magnetic resonance imaging (MRI) revealed an extensive mass in the tympanic cavity extending to the mastoid. A biopsy of the mass was positive for Mycobacterium tuberculosis. Immunosuppressants were weaned and the patient was started on anti-tuberculous therapy with resolution of the complaints and findings. Tuberculous infections are difficult to diagnose and frequently mimic other illnesses, but in our case, we believe that an indolent tuberculous process was present from the beginning and evolved under immunosuppressive therapy