1,720,997 research outputs found
Acute abdomen.
No full textA 63-year-old man presented to us with fever and mild abdominal pain. He had a previous history of chronic active hepatitis B in treatment with entecavir and tenofovir. Clinical and laboratory examinations on blood and ascitic fluid were suggestive of spontaneous bacterial peritonitis. Empirical therapy with piperacillin tazobactam and a prophylactic dose of enoxaparin were administered. After three days from admission he presented an acute abdomen and a platelet count drop of more than 50% of baseline (nadir 60,000/mm3). Nasogastric aspiration, bowel rest and parenteral nutrition commence
Black esophagus
No full textAbstractBlack esophagus is an uncommon clinical entity and its pathogenesis remains unknown. Clinical presentation is usually characterized by the combination of hematemesis and circumferential darkness of the mucosa in the distal esophagus. This case illustrates an atypical presentation of the disease. Despite its rarity, black esophagus should be considered in the differential diagnosis of acute upper gastrointestinal bleeding, especially in patients with predisposing factors
Soluble FcγRIA expressed on monocytes (sCD64): A new serum biomarker of acute kidney injury in patients with suspected infection at emergency department admission
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Septic Shock with multi organ failure due to fluoroquinolones resistant Campylobacter Jejuni
No full textBACKGROUND Campylobacter jejuni infections are typically self-limited, and severe extra-intestinal complications are uncommon. CASE REPORT We report a case of a man with septic shock due to fluoroquinolones resistant Campylobacter jejuni. CONCLUSIONS This manuscript emphasizes the potential lethality of fluorquinolones resistant Campylobacter jejuni bacteremia
Omega-3 Polyunsaturated Fatty Acids: Structural and Functional Effects on the Vascular Wall
Full text linkOmega-3 polyunsaturated fatty acids (n-3 PUFA) consumption is associated with reduced cardiovascular disease risk. Increasing evidence demonstrating a beneficial effect of n-3 PUFA on arterial wall properties is progressively emerging. We reviewed the recent available evidence for the cardiovascular effects of n-3 PUFA focusing on structural and functional properties of the vascular wall. In experimental studies and clinical trials n-3 PUFA have shown the ability to improve arterial hemodynamics by reducing arterial stiffness, thus explaining some of its cardioprotective properties. Recent studies suggest beneficial effects of n-3 PUFA on endothelial activation, which are likely to improve vascular function. Several molecular, cellular, and physiological pathways influenced by n-3 PUFA can affect arterial wall properties and therefore interfere with the atherosclerotic process. Although the relative weight of different physiological and molecular mechanisms and the dose-response on arterial wall properties have yet to be determined, n-3 PUFA have the potential to beneficially impact arterial wall remodeling and cardiovascular outcomes by targeting arterial wall stiffening and endothelial dysfunction
High-protein diet with excess leucine prevents inactivity-induced insulin resistance in women
Full text linkBackground and aims: Muscle inactivity leads to muscle atrophy and insulin resistance. The branched-chain amino acid (BCAA) leucine interacts with the insulin signaling pathway to modulate glucose metabolism. We have tested the ability of a high-protein BCAA-enriched diet to prevent insulin resistance during long-term bed rest (BR). Methods: Stable isotopes were infused to determine glucose and protein kinetics in the postabsorptive state and during a hyperinsulinemic-euglycemic clamp in combination with amino acid infusion (Clamp + AA) before and at the end of 60 days of BR in two groups of healthy, young women receiving eucaloric diets containing 1 g of protein/kg per day (n = 8) or 1.45 g of protein/kg per day enriched with 0.15 g/kg per day of BCAAs (leucine/valine/isoleucine = 2/1/1) (n = 8). Body composition was determined by Dual X-ray Absorptiometry. Results: BR decreased lean body mass by 7.6 ± 0.3 % and 7.2 ± 0.8 % in the groups receiving conventional or high protein-BCAA diets, respectively. Fat mass was unchanged in both groups. At the end of BR, percent changes of insulin-mediated glucose uptake significantly (p = 0.01) decreased in the conventional diet group from 155 ± 23 % to 84 ± 10 % while did not change significantly in the high protein-BCAA diet group from 126 ± 20 % to 141 ± 27 % (BR effect, p = 0.32; BR/diet interaction, p = 0.01; Repeated Measures ANCOVA). In contrast, there were no BR/diet interactions on proteolysis and protein synthesis Clamp + AA changes in the conventional diet and the high protein-BCAA diet groups. Conclusion: A high protein-BCAA enriched diet prevented inactivity-induced insulin resistance in healthy women
Growth Rate of Small Abdominal Aortic Aneurysms and Genetic Polymorphisms of Matrix MetalloProteases-1, -3, and -9
No full textGenetic variants of matrix metalloproteases (MMPs)-1, -3, and -9, together with clinical variables, might predict the growth rate (GR) of abdominal aortic aneurysm (AAA). Genotyping of MMP-1 (1,607 Gþ/G), MMP-3 ( 1,171 6A/5A), and MMP-9 microsatellite (13–26 cytosine–adenosine repeats around -90) from peripheral blood was performed in 137 AAA patients with two AAA diameter measurements (at least 3 months to 1 year apart). When the same technique (either ultrasound or computed tomography) was used for the two measurements, yearly GR was estimated and compared with MMP genotype and clinical features by linear and binary logistic regression. Collectively, 36 patients provided 94 observations, with a median GR of 3 mm/year (interquartile range, 0–5.8); GRs in carriers of MMP-1 polymorphism G/G, G/Gþ, and Gþ/Gþ genotype were 0.3, 3.5, and 4.7mm/year, respectively (p 1⁄4 0.008). In linear logistic regression, the main determinant of GR was growth arrest (GA, i.e., GR 1⁄4 0, occurring in 32 observations, 34%). In turn, GA occurredmainly in G/G MMP-1 genotype (odds ratio, 3.9; 95% confidence interval, 1.6–9.7; p 1⁄4 0.002), while variables accounting for GR > 0 were MMP-1 G þ /Gþ genotype, intake of any antihypertensive drug, and MMP-3 6A/6A genotype. Carriers of none, one, or two/three of these conditions accounted for a GR of 3, 4, and 9 mm/year, respectively (p 1⁄4 0.001). MMP-1 (1,607 Gþ/) variant is associated to differential GR in AAA: homozygous G deletion variant shows higher GA prevalence and lower GR, while carriers of G þ /Gþ MMP-1 genotype, together with intake of antihypertensive drugs, and 6A/6A in MMP-3 present cumulative GR increase
Anti-infective management of infected skin ulcers
Full text linkInfected skin ulcers represent a frequent and intricate clinical challenge, necessitating prompt and comprehensive multidisciplinary interventions to avert complications. Anti-infective therapy constitutes a cornerstone in the therapeutic paradigm. This manuscript delineates our approach to anti-infective management of infected ulcers, encompassing insights into clinical classifications, diagnostic features, examples of early clinical decision-making in anti-infective treatment, comprehensive evaluation of infectious diseases encompassing host clinical considerations and potential interventions, determination of antibiotic therapy duration, methodologies for assessing clinical response, identification of potential causes for lack of clinical response, as well as strategies for outpatient parenteral antibiotic therapy and a diagnostic and therapeutic algorithm
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