1,720,962 research outputs found
Hyper-IgD syndrome and other hereditary periodic fever syndromes
No full textHereditary periodic fever syndromes are a group of systemic disorders characterized by recurrent attacks of systemic inflammation (autoinflammation) without infectious or autoimmune cause. The hyper-IgD syndrome (HIDS) is a rare autosomal recessive inflammatory disorder characterized by recurrent fever, increased serum IgD (normal value < 100 U/ml) and generalized inflammation (lymphadenopathy, arthralgias/arthritis, abdominal complaints, skin rash, and headache). The attacks persist during the entire life although frequency and severity tend to diminish with age. HIDS is caused by specific mutations in the gene encoding mevalonate kinase, resulting in depressed enzymatic activity. At present the therapy for the syndrome is only supportive. Other than HIDS, other hereditary systemic inflammatory disorders have been described: the Familial Mediterranean Fever, the tumour necrosis factor receptor associated periodic syndrome (TRAPS), a disease related to the mutations of one of the TNF receptors, the Familial Cold Urticaria and the Muckle-Wells syndrome. The differential diagnosis with other causes of periodic fever is crucial for assessing appropriate management and treatment
Il test di tolleranza ad anestetici locali: nostra esperienza su 434 pazienti.
No full textIntroduzione
L’allergia agli anestetici locali (AL) di tipo amidico è estremamente rara. Ciononostante il problema di identificare i pazienti a rischio di reazioni allergiche agli AL esiste, considerato il numero elevato di anestesie locali eseguite e la prevalenza non trascurabile delle relative reazione avverse.
Obiettivi
Valutare l’utilità del test abbreviato di tolleranza ad AL eseguito nel nostro centro allergologico in pazienti con reazioni avverse ad altri farmaci (gruppo 1) o ad AL (gruppo 2) o senza reazioni avverse nell’anamnesi (gruppo 3).
Metodi
Il test di tolleranza è stato eseguito su 434 pazienti consecutivi (321 di sesso femminile) con mepivacaina 3%, lidocaina (2%), prilocaina (5%) o bupivacaina (0.25%), senza vasocostrittori e conservanti. Il nostro protocollo consisteva di un “prick test” (alla diluizione 1:1, seguito da una intradermoreazione (1:100) e poi da due iniezioni sottocutanee (1:10 e 1:1).
L’analisi statistica è stata eseguita con il test del chi-quadrato.
Risultati.
50 pazienti presentavano test cutanei positivi: all’intradermoreazione 45 (10.3%) nei quali il test è stato portato a termine senza reazioni avverse; al prick test 3 (0.6%) e alla iniezione sottocutanea 2 (0.4%) (1 con dispnea ed edema dell’ugola e 1 con orticaria), che sono stati avviati ad ulteriore test di tolleranza con AL alternativo giunto alla fine senza eventi avversi. Il test del chi-quadrato non ha messo in evidenza differenze tra i gruppi.
Conclusioni
Tutti i test di tolleranza hanno identificato l’AL che non ha dato reazioni avverse nell’uso clinico (entro le due settimane successive). Il nostro protocollo pertanto ha dimostrato di essere sicuro ed efficace. Poiché numerosi test intradermici sono risultati falsamente positivi, suggeriamo di abbreviare ulteriormente questo protocollo omettendo il test intradermico
Le pollinosi emergenti
No full textL'allergia è una patologia cronica, diffusa in tutto il mondoche riguarda persone di ogni età. Diversi studi riportano un incremento della prevalenza delle sindromi allergiche soprattutto nel mondo occidentale. Di qui la necessità di porre attenzione all'andamento di pollinosi emergenti, le piante implicatee la loro distribuzione geografic
Takotsubo Cardiomyopathy and Acute Infectious Diseases: A Mini-Review of Case Reports.
No full textTakotsubo cardiomyopathy (TTC), also defined as "stress cardiomyopathy," is characterized by a systolic dysfunction localized in the apical and medial left ventricles. Takotsubo cardiomyopathy is more prevalent in females and it is usually related to an event triggered by physical or emotional stress. We systematically explored PubMed and Embase medical information source to identify case reports showing association between infection and TTC. For each kind of infection, we collected a set of data, including pathogen, site of infection, clinical outcome, patient age and sex, and author and year of publication. We found 26 articles dealing with 27 case reports (74% women). The mean age was 61.4 ± 13.7 years and bacterial infections were more frequent (n = 23, 85.2%). In 14 cases, there was a culture-based definition of the bacterial strain: gram+ in 8 cases (57.1%) and gram- in 6 cases (42.9%). Clinical outcome was always favorable
Color-coding triage and allergic reactions in an Italian ED.
No full textEmergency Department (ED) crowding is an international public health problem. Moreover, it is associated with prolonged stay and increased risk of adverse drug events (ADEs). Adverse drug reactions (ADRs) account for 3-6% of all hospital admissions, and occur in 10-15% of hospitalized patiens. An ADE should be differentiated from ADR, the latter including harm related to medication errors and drug/food medications. Only few studies have focused prevalence and incidence of drug allergy in hospital-based populations. We were interested to drug allergy, defined as an immunologically-mediated drug hypersensitivity reaction, characterized by either IgE or non-IgE mediated mechanism. In particular, we aimed to focus on drug allergies referring to the ED and requiring hospitalization, to evaluate type and prevalence, and relationships between initial triage assessment and hospital lenght of stay (LOS). This study was conducted, between January and December 2009, at the Emergency Department of St. Anna Hospital of Ferrara, a 863-bed tertiary care teaching hospital, with a yearly patient flow in the ED of approximately 76 000. Allergic reactions were defined as erythema, exanthema, urticaria and angioedema. Age, sex, triage assessment colour code, history, body temperature, drugs involved, LOS, and therapy were evaluated. Descriptive analysis and chi-square test were performed, and triage assessment represented the grouping variable. Multivariate analysis was not performed due to the limited sample size. Out of 75 966 patients arrived to the ED in the year 2009, 2842 (3.7%) were admitted to the ED ward. Of these, 58 (2%) presented a drug-related allergic reaction. Mean age was 58±5 years (range 18-88), 62% were female. Comorbilities included metabolic, heart, bone, infectious, gastric, vascular, neurologic, renal, and bowel diseases; 14% had a history of cancer. Allergic reactions were due to several kind of medications: anti-infective, anti-inflammatory, endocrine, cardiovascular, antineoplastic, and other. Triage assessment showed colour code green in 26% of cases, yellow in 55% and red in 19%. LOS was 6-12 hours in 19% of cases, between 12 hours and 3 days in 41%, and >3 days in 40%. Therapy at first evaluation included antihistaminics, steroids, non-steroidal-anti-inflammatory drugs, plasma expanders, and oxygen. Triage assessment colour code red was associated with history of heart disease, lung disease and vascular disease, whereas only allergic reactions defined as urticaria were related to the green code. The red code was significantly associated with longer LOS >3 days. Allergic reactions are very frequent among ED attenders: national data in the USA estimated incidence of ADRs as 2.4 visits x 1000 population. Of these, 33.5% were drug allergies, and 11.3% required hospitalization. Although triage represents a highly useful tool to prioritize patients’s care in EDs, very limited data relating triage assessment colour code for allergic reactions are available. The importance of a correct triage is important, since it has been shown that ED patients presenting with ADEs incurred great health services utilization and costs of hospital care. To the best of our knowledge, this is the first study evaluating the relationship between triage colour code, clinical features, and LOS in subjects with allergic reactions presenting to the ED. Patients’ age was younger compared with previous reports, and LOS exceeded 3 days in more than 40% of cases, with a good correspondence with the triage colour code assigned upon ED arrival. EDs could represent optimal settings for research, and support important translational knowledge
May allergic syndrome represent valid trigger for Tako-tsubo cardiomyopathy? A systematic review of reported cases.
No full textIntroduction: Anaphylactic reaction represent a not uncommon life-threatening emergency. The allergic syndrome may involve multiple target organs, including skin, respiratory, gastrointestinal, and cardiovascular systems. Tako-Tsubo cardiomyopathy (TTC) is a reversible clinical condition mimicking an acute myocardial infarction (AMI). Typical presentation involves chest pain and/or dyspnea, transient ST-segment elevation on the electrocardiogram (ECG), with modest increase in cardiac troponin. Multifactorial pathophysiologic mechanisms are likely to be involved, but the most accepted pathogenic hypothesis indicates abrupt elevation of circulating catecholamine, triggered by emotional and/or physical stress. The aim of this review was to evaluate if anaphylaxis may represent a stressful valid trigger for TTC.
Methods: We systematically explored the most important medical information sources, to identify the different triggering causes. The following keywords were searching: takotsubo cardiomyopathy, stress-induced cardiomyopathy, apical ballooning syndrome in combination with allergic reaction, anaphylactic shock, and anaphylaxis. We also collected a set of data, including author, year of publication, patients' sex and age, triggers of allergic reaction and outcome.
Results: Out of a total of 1958 articles found (1443 with the precise MeSH term: Takotsubo cardiomyopathy, we found 26 case reports. The mean age was 47.7 ± 19.2 years, and the great majority of patients were women (76.9%). Drug reactions were reported in 22 patients (84.6%), of whom 10 (45.5%) were treated with therapeutic doses of epinephrine, 5 (22.7%) with general anesthetics, and 3 (13.6%) with antibiotics. Anaphylactic reaction due to intravenous contrast media for computer tomography has been reported only in two cases. Clinical outcome was favorable in most cases, with only 1 fatal event described.
Conclusions: TTC may be associated with anaphylactic reactions, mainly due to epinephrine administration during allergic reaction, as results in approximately 45% of reported cases. Thus, allergic reactions may be fully considered a potential trigger of TTC, with a mechanism including both production of inflammatory cytokines and adrenaline treatment
The crucial factor of hospital readmissions: a retrospective cohort study of patients evaluated in the emergency department and admitted to the department of medicine of a general hospital in Italy.
No full textBackground
Early hospital readmissions, defined as rehospitalization within 30 days from a previous discharge, represent an economic and social burden for public health management. As data about early readmission in Italy are scarce, we aimed to relate the phenomenon of 30-day readmission to factors identified at the time of emergency department (ED) visits in subjects admitted to medical wards of a general hospital in Italy.
Methods
We performed a retrospective 30-month observational study, evaluating all patients admitted to the Department of Medicine of the Hospital of Ferrara, Italy. Our study compared early and late readmission: patients were evaluated on the basis of the ED admission diagnosis and classified differently on the basis of a concordant or discordant readmission diagnosis in respect to the diagnosis of a first hospitalization.
Results
Out of 13,237 patients admitted during the study period, 3,631 (27.4%) were readmitted; of those, 656 were 30-day rehospitalizations (5% of total admissions). Early rehospitalization occurred 12 days (median) later than previous discharge. The most frequent causes of rehospitalization were cardiovascular disease (CVD) in 29.3% and pulmonary disease (PD) in 29.7% of cases. Patients admitted with the same diagnosis were younger, had lower length of stay (LOS) and higher prevalence of CVD, PD and cancer. Age, CVD and PD were independently associated with 30-day readmission with concordant diagnosis and kidney disease with 30-day rehospitalization with a discordant diagnosis.
Conclusions
Comorbid patients are at higher risk for 30-day readmission. Reduction of LOS, especially in elderly subjects, could increase early rehospitalization rates
The dilemma of diagnosing fever of unknown origin: large arteries vasculitis revealed by 18F-FDG PET/CT imaging. A case report
No full textFever of unknown origin (FUO) is an uncommon disease, and its underlying etiology may include a number causes, i.e., infections, malignancies, autoimmune conditions. Diagnosis is often a difficult task, and usually physician spend time and money in order to define the etiology of FUO. We report a case of patient who presented with FUO and headache, and positron emission tomography (PET) with 2-deoxy-2-[fluorine-18] fluoro-D-glucose (18F-FDG) allowed to reveal the presence of a large vessel vasculitis. 18F-FDG PET may represent an useful tool in patients with FUO, since it can early depict an hypermetabolic activity due to inflammation and so help to achieve a final diagnosis in some cases of FUO
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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