Mediterranean spotted fever (MSF) caused by Rickettsia conorii has become a significant health risk for suffering people and international travelers. In the past, overlooked as a serious disease, at present it is known that MSF was wrongly considered a benign condition. In this report, we present a set of clinical features and laboratory parameters in 55 patients (19 fatalities and 36 survivors) with malignant forms of the disease. The purpose of the study was to outline the prognostic factors of the fatal outcome in patients with malignant MSF. Based on our data, the main prediction factors for mortality in malignant MSF patients were: advanced age, delayed hospital admission, severe concomitant diseases, and failure to start or to complete appropriate antibiotic treatment. Laboratory prognostic factors in fatalities were: leukocytosis with a marked shift to the left; extremely high serum urea and creatinine levels; low levels of fibrinogen and prolongation of thrombin time. The most frequently involved organ systems of malignant cases were: central nervous system 100%, liver 92.72%, kidneys 60%, lungs 58.18%, myocardium 30.9%, and gastrointestinal tract 23.63%. The conducted histopathological investigations revealed lethal complications: encephalitis, brain edema, acute respiratory distress syndrome, non-cardiogenic lung swelling, acute myocarditis, gastrointestinal bleeding, hemorrhagicnecrotizing pancreatitis and acute renal failure.
Characteristic and outcomes of patients with ptb requiring icu careEArl Copina
This document summarizes a study of 58 patients with active pulmonary tuberculosis who required admission to an intensive care unit. The mean age was 48 years and 37.9% required mechanical ventilation. The in-hospital mortality rate was 25.9% with a mean survival of 53.6 days for those who died. Factors independently associated with increased mortality included acute renal failure, need for mechanical ventilation, chronic pancreatitis, sepsis, acute respiratory distress syndrome, and hospital-acquired pneumonia. The study identified risk factors for high mortality rates in tuberculosis patients requiring intensive care.
This study characterized dengue infections in Pakistan by analyzing hematological and serological markers in 154 suspected dengue cases and 146 control patients with other febrile illnesses. NS1 antigen was detected in 55% of dengue cases, IgM antibodies in 30%, and both in 15%. Control groups primarily had malaria (71%) and enteric fever (20%). Hematological markers (platelet count, hematocrit, WBC) measured before and after treatment showed significant differences for platelet count and hematocrit but not WBC count between the groups. Analysis of clinical symptoms and serological/hematological markers helps diagnose dengue, assess prognosis, and inform prevention efforts to reduce morbidity, mortality and spread of the disease.
This document summarizes a study of 82 patients with pneumonia who were treated as outpatients and re-evaluated after 14 days in an emergency department in Spain. The average age was 49 years old, and most patients had mild symptoms. Bacteria were detected in 29% of cases, most commonly Streptococcus pneumoniae and Mycoplasma pneumoniae. All patients recovered without deaths, though two needed further hospital consultation. The study concludes that outpatient treatment can be effective for mildly ill pneumonia patients when monitored in the emergency department.
Renin - Angiotensin - Aldosterone System Inhibitors in Patients with Covid-19Valentina Corona
This document summarizes the current understanding of how medications that inhibit the renin-angiotensin-aldosterone system (RAAS), such as ACE inhibitors and angiotensin receptor blockers (ARBs), may impact COVID-19. It notes that while animal studies have found mixed results on how these drugs affect ACE2 levels, human studies provide little evidence they increase ACE2. It also raises the possibility that ACE2 may be beneficial rather than harmful for lung injury in COVID-19. The document concludes more research is needed to understand the complex interactions between SARS-CoV-2 and the RAAS system in humans before making recommendations about RAAS inhibitor use in COVID-19 patients.
This document discusses cytokine storm syndrome in patients with COVID-19. It defines cytokine storm as an uncontrolled release of inflammatory cytokines that can lead to organ damage. COVID-19 is proposed to progress through four stages, with stage II involving an excessive immune response and cytokine release. Cytokine storm is associated with acute respiratory distress syndrome and multi-organ failure in COVID-19 patients. The document outlines treatments for cytokine storm including immunomodulators, anticoagulants, antivirals, and extracorporeal therapies.
1) Diabetes is identified as a risk factor for worse outcomes from COVID-19 based on studies from China. Mortality was 10% in COVID-19 patients with diabetes versus 2.5% for non-diabetic patients.
2) People with diabetes have an increased risk of severe COVID-19 infection due to defects in innate immunity from hyperglycemia and an increased inflammatory response.
3) The interaction between the SARS-CoV-2 virus and the renin-angiotensin-aldosterone system, which regulates blood pressure and fluid balance, may help explain the link between diabetes, hypertension, and increased COVID-19 severity. The virus relies on binding to ACE2 receptors to infect
This study examined 36 kidney transplant recipients who tested positive for COVID-19 at Montefiore Medical Center. The recipients had a median age of 60, most had hypertension, diabetes or a history of smoking. Initial symptoms often included fever but less so than the general population with COVID-19. Hospitalization was required for 78% of recipients. Mortality was high, with 28% of recipients dying within a median follow-up of 21 days, compared to 1-5% of the general population. Recipients had lower T-cell counts and more rapid disease progression than the general population with COVID-19.
Characteristic and outcomes of patients with ptb requiring icu careEArl Copina
This document summarizes a study of 58 patients with active pulmonary tuberculosis who required admission to an intensive care unit. The mean age was 48 years and 37.9% required mechanical ventilation. The in-hospital mortality rate was 25.9% with a mean survival of 53.6 days for those who died. Factors independently associated with increased mortality included acute renal failure, need for mechanical ventilation, chronic pancreatitis, sepsis, acute respiratory distress syndrome, and hospital-acquired pneumonia. The study identified risk factors for high mortality rates in tuberculosis patients requiring intensive care.
This study characterized dengue infections in Pakistan by analyzing hematological and serological markers in 154 suspected dengue cases and 146 control patients with other febrile illnesses. NS1 antigen was detected in 55% of dengue cases, IgM antibodies in 30%, and both in 15%. Control groups primarily had malaria (71%) and enteric fever (20%). Hematological markers (platelet count, hematocrit, WBC) measured before and after treatment showed significant differences for platelet count and hematocrit but not WBC count between the groups. Analysis of clinical symptoms and serological/hematological markers helps diagnose dengue, assess prognosis, and inform prevention efforts to reduce morbidity, mortality and spread of the disease.
This document summarizes a study of 82 patients with pneumonia who were treated as outpatients and re-evaluated after 14 days in an emergency department in Spain. The average age was 49 years old, and most patients had mild symptoms. Bacteria were detected in 29% of cases, most commonly Streptococcus pneumoniae and Mycoplasma pneumoniae. All patients recovered without deaths, though two needed further hospital consultation. The study concludes that outpatient treatment can be effective for mildly ill pneumonia patients when monitored in the emergency department.
Renin - Angiotensin - Aldosterone System Inhibitors in Patients with Covid-19Valentina Corona
This document summarizes the current understanding of how medications that inhibit the renin-angiotensin-aldosterone system (RAAS), such as ACE inhibitors and angiotensin receptor blockers (ARBs), may impact COVID-19. It notes that while animal studies have found mixed results on how these drugs affect ACE2 levels, human studies provide little evidence they increase ACE2. It also raises the possibility that ACE2 may be beneficial rather than harmful for lung injury in COVID-19. The document concludes more research is needed to understand the complex interactions between SARS-CoV-2 and the RAAS system in humans before making recommendations about RAAS inhibitor use in COVID-19 patients.
This document discusses cytokine storm syndrome in patients with COVID-19. It defines cytokine storm as an uncontrolled release of inflammatory cytokines that can lead to organ damage. COVID-19 is proposed to progress through four stages, with stage II involving an excessive immune response and cytokine release. Cytokine storm is associated with acute respiratory distress syndrome and multi-organ failure in COVID-19 patients. The document outlines treatments for cytokine storm including immunomodulators, anticoagulants, antivirals, and extracorporeal therapies.
1) Diabetes is identified as a risk factor for worse outcomes from COVID-19 based on studies from China. Mortality was 10% in COVID-19 patients with diabetes versus 2.5% for non-diabetic patients.
2) People with diabetes have an increased risk of severe COVID-19 infection due to defects in innate immunity from hyperglycemia and an increased inflammatory response.
3) The interaction between the SARS-CoV-2 virus and the renin-angiotensin-aldosterone system, which regulates blood pressure and fluid balance, may help explain the link between diabetes, hypertension, and increased COVID-19 severity. The virus relies on binding to ACE2 receptors to infect
This study examined 36 kidney transplant recipients who tested positive for COVID-19 at Montefiore Medical Center. The recipients had a median age of 60, most had hypertension, diabetes or a history of smoking. Initial symptoms often included fever but less so than the general population with COVID-19. Hospitalization was required for 78% of recipients. Mortality was high, with 28% of recipients dying within a median follow-up of 21 days, compared to 1-5% of the general population. Recipients had lower T-cell counts and more rapid disease progression than the general population with COVID-19.
This document summarizes a study comparing clinical characteristics and risk factors for severe COVID-19 in 167 hospitalized patients in Anhui, China. The key findings were:
1) 17.9% of patients had severe disease. Older age, comorbidities like diabetes, lower oxygen saturation, lower lymphocyte and CD4 counts, and higher levels of CRP, LDH and IL-6 were associated with more severe disease.
2) Independent risk factors for severe disease identified through logistic regression were lower oxygen saturation and lower CD4 cell count.
3) All patients recovered and were discharged without deaths, though severe cases required treatments like mechanical ventilation, glucocorticoids and immunoglobulins
Serum Procalcitonin as a marker of infection in chronic kidney disease patien...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Outcome of 16 years of hemodialysis infection controlJAFAR ALSAID
The study analyzed the outcomes of a tight infection control protocol over 16 years in a hemodialysis unit. The protocol was successful in limiting hemodialysis-related bloodstream infections and admissions. Specifically:
- The rate of hemodialysis-related bloodstream infections was 0.003 per 100 patient months, far below the international reported rate of 0.75-4.4 infections per 100 patient months.
- The admission rate for hemodialysis-related bloodstream infections was 0.4 per 1000 patient years, much lower than the international rate of 108 admissions per 1000 patient years.
- Only 12 patients experienced hemodialysis-related bloodstream infections over nearly 19 years and
newly diagnosed diabetes in patients with mild COVID19Dr-Ajay Tripathi
This study analyzed 1020 patients with mild to moderate COVID-19 infections and found that 210 (20.6%) had newly diagnosed diabetes based on blood glucose or HbA1c levels. Nearly all (90.4%) of these 210 patients had an HbA1c of 6.5% or higher, suggesting they likely had previously undiagnosed diabetes. The study aims to determine if COVID-19 infection itself increases the risk of diabetes.
The document summarizes the link between hypertension (HTN) and COVID-19. It finds that approximately 22.5% of COVID-19 patients have HTN, making it the most common comorbidity. Patients with HTN who contract COVID-19 have a higher risk of severe outcomes like intensive care unit admission and death. The document also discusses how the renin-angiotensin-aldosterone system, which HTN medications target, may impact the interaction of the COVID-19 virus with the body. Specifically, angiotensin-converting enzyme 2 is utilized by the COVID-19 virus to enter cells and HTN medications like ACE inhibitors may alter ACE2 expression levels.
Guía práctica de Hepatitis C 2011
Journal of Hepatology
EASL (European Association for the study of the Liver)
MEDICINA CORDOBA WEB
www.plan93.com
www.medicinacordoba.com.ar
Evaluation of Cardiac Complications in Pateint Undergoing COVID 19 Treatment:...DrHeena tiwari
This study evaluated cardiac complications in 45 COVID-19 patients admitted to the intensive care unit. Electrocardiography and Holter monitoring found various arrhythmias in patients, with atrial fibrillation, premature ventricular contraction, and tachycardia being most common. The mortality rate of arrhythmias in COVID-19 patients was 17.77%. Although arrhythmias are not very frequent in COVID-19, they can be fatal and have a high mortality rate. Early detection of arrhythmias can help prevent deaths.
Clinical presentation and outcomes of HIV positive patients with diagnosis of...Oscar Malpartida-Tabuchi
This document summarizes a study on tuberculosis (TB) in HIV-positive patients at a hospital in Lima, Peru in 2014. It finds that:
- 22 HIV+ patients were diagnosed with TB, most were male with low CD4 counts. Extra-pulmonary TB was most common.
- 21 cases were microbiologically confirmed, with high rates of drug resistance including 30% MDR and 5% XDR.
- Outcomes differed by HIV treatment group: no mortality in groups receiving HIV drugs >6 months or <6 months, but 18.2% mortality in group not receiving HIV drugs.
This document summarizes evidence on the risks of COVID-19 for people with diabetes and considerations for managing diabetes during the pandemic. It finds that people with diabetes appear to be at increased risk of severe COVID-19 outcomes. Higher BMI and poorer long-term glucose control are linked to worse COVID-19 outcomes. The pandemic also poses indirect risks to diabetes management through disruptions to healthcare, diet, exercise and increased stress. Countries have adopted strategies like telehealth and educational materials to support diabetes care during this time. More evidence is still needed on reducing infection risk and optimal self-management for people with diabetes during the pandemic.
This document discusses various experimental models used to test potential anti-arthritic agents, including adjuvant arthritis in rats, terpentine oil-induced edema, and formaldehyde-induced arthritis. Adjuvant arthritis is induced in rats by injecting complete Freund's adjuvant or synthetic adjuvants and results in hind paw swelling that can be monitored over time. Terpentine oil injected into rat knee joints causes acute, non-immunological edema assessed by measuring joint diameter changes. Formaldehyde injections into rat paws induce chronic, non-immunological arthritis evaluated by paw diameter increases over 10 days. These preclinical models are used to screen anti-arthritic drugs.
Treatment for severe acute respiratory distress syndrome from covid 19Valentina Corona
The document discusses treatment recommendations for patients experiencing severe acute respiratory distress syndrome (ARDS) from COVID-19. It provides guidance on use of extracorporeal membrane oxygenation (ECMO) and other evidence-based options for managing hypoxemia and respiratory failure in COVID-19 patients, including high-flow nasal oxygen, mechanical ventilation strategies, prone positioning, neuromuscular blockade, inhaled nitric oxide, fluid management, and antibiotics. It acknowledges challenges in scaling up ECMO globally and emphasizes optimizing other established treatment protocols.
Γρηγόριος Γεροτζιάφας, Health Innovation Conference 2021Starttech Ventures
Ομιλία – Παρουσίαση:“Artificial intelligence and personalised medicine for patients at high risk of severe COVID-19”
Γρηγόριος Γεροτζιάφας, Καθηγητής Αιματολογίας, Ιατρική σχολή της Σορβόνης, Υπεύθυνος, Τμήμα Θρόμβωσης, Νοσοκομείο Tenon, Παρίσι & Διευθυντής, Ερευνητική Ομάδα Καρκίνος και Θρόμβωση INSERM U938
PCR Assay Turned Positive in 25 Discharged COVID-19 PatientsValentina Corona
1) The study found that 14.5% (25/172) of discharged COVID-19 patients in China later tested positive again for the virus based on RT-PCR testing after being discharged from the hospital.
2) These patients met criteria for discharge but tested positive again within 2-13 days without worsening symptoms.
3) The study suggests that more than two negative RT-PCR tests separated by 48 hours or combining RT-PCR tests with antibody and other immunological markers may be needed to confirm viral clearance before discharge.
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This document discusses stroke in HIV infection. It begins by providing background on HIV/AIDS classifications and prevalence statistics. It then describes the CDC classification system for HIV infection and lists conditions under categories B and C. It discusses the epidemiology of stroke in HIV patients, noting rates vary from 0.5-5% in studies. Potential causes of ischemic and hemorrhagic stroke are outlined. Treatment focuses on underlying infections or disorders. While HAART reduced some complications, protease inhibitors may increase atherosclerosis risk. In conclusion, strokes in HIV patients tend to occur in severe immunosuppression and various infectious etiologies can cause ischemic or hemorrhagic strokes.
Study of clinical and etiological profile of community acquired pneumonia in ...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
The document describes a study on the effectiveness of tocilizumab in treating severe COVID-19 patients. 20 severe or critical COVID-19 patients were given tocilizumab in addition to routine therapy. Within days of treatment, patients saw improved symptoms, reduced oxygen needs, and absorption of lung lesions on CT scans. Inflammatory markers decreased and 19 of the 20 patients were discharged within about two weeks. The study provides evidence that tocilizumab is an effective treatment for severe COVID-19 patients by reducing the cytokine storm.
Robótica é o estudo e uso de robôs, combinando engenharia, ciência da computação e inteligência artificial. A história da robótica inclui mitos antigos, Leonardo da Vinci e o primeiro robô industrial na década de 1950. Robôs são classificados de acordo com sua função e nível de autonomia.
An Analogical Study of the Narrative Techniques Used In the Film Paradesi (20...inventionjournals
Narrations in films have always taken the primary place. Understanding the narrative culture of a medium becomes the prime motive of the narrator while working on adaptations. There is a strong connection between the verbal and visual representation is sequence, since literary and filmic signs are apprehended consecutively through time. The success and acceptability of a film is based on the narration style and techniques. This is very much true in Tamil cinema narrative patterns. While trying to adapt the story from a medium the director of the film Bala, has focused on trying to maintain the narrative syntax of the original, but has also closely followed the semantics of visual design. The Tamil film Paradesi is an adaptation of the Tamil translation Yerium Panikkadu of the novel ‘Red Tea’, which was has been an inspiration for the director.
Este estudio evaluó los niveles de actividad física en 146 estudiantes universitarios en Venezuela utilizando el Cuestionario Internacional de Actividad Física. Se encontró que el patrón de actividad física alta fue el más prevalente (48.6%), seguido por la actividad física moderada (35.6%). La actividad física en el tiempo de ocio registró los menores valores. Los autores concluyen que se deben diseñar programas para aumentar la actividad física en el tiempo de ocio con el fin de mejorar la
This document summarizes a study comparing clinical characteristics and risk factors for severe COVID-19 in 167 hospitalized patients in Anhui, China. The key findings were:
1) 17.9% of patients had severe disease. Older age, comorbidities like diabetes, lower oxygen saturation, lower lymphocyte and CD4 counts, and higher levels of CRP, LDH and IL-6 were associated with more severe disease.
2) Independent risk factors for severe disease identified through logistic regression were lower oxygen saturation and lower CD4 cell count.
3) All patients recovered and were discharged without deaths, though severe cases required treatments like mechanical ventilation, glucocorticoids and immunoglobulins
Serum Procalcitonin as a marker of infection in chronic kidney disease patien...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Outcome of 16 years of hemodialysis infection controlJAFAR ALSAID
The study analyzed the outcomes of a tight infection control protocol over 16 years in a hemodialysis unit. The protocol was successful in limiting hemodialysis-related bloodstream infections and admissions. Specifically:
- The rate of hemodialysis-related bloodstream infections was 0.003 per 100 patient months, far below the international reported rate of 0.75-4.4 infections per 100 patient months.
- The admission rate for hemodialysis-related bloodstream infections was 0.4 per 1000 patient years, much lower than the international rate of 108 admissions per 1000 patient years.
- Only 12 patients experienced hemodialysis-related bloodstream infections over nearly 19 years and
newly diagnosed diabetes in patients with mild COVID19Dr-Ajay Tripathi
This study analyzed 1020 patients with mild to moderate COVID-19 infections and found that 210 (20.6%) had newly diagnosed diabetes based on blood glucose or HbA1c levels. Nearly all (90.4%) of these 210 patients had an HbA1c of 6.5% or higher, suggesting they likely had previously undiagnosed diabetes. The study aims to determine if COVID-19 infection itself increases the risk of diabetes.
The document summarizes the link between hypertension (HTN) and COVID-19. It finds that approximately 22.5% of COVID-19 patients have HTN, making it the most common comorbidity. Patients with HTN who contract COVID-19 have a higher risk of severe outcomes like intensive care unit admission and death. The document also discusses how the renin-angiotensin-aldosterone system, which HTN medications target, may impact the interaction of the COVID-19 virus with the body. Specifically, angiotensin-converting enzyme 2 is utilized by the COVID-19 virus to enter cells and HTN medications like ACE inhibitors may alter ACE2 expression levels.
Guía práctica de Hepatitis C 2011
Journal of Hepatology
EASL (European Association for the study of the Liver)
MEDICINA CORDOBA WEB
www.plan93.com
www.medicinacordoba.com.ar
Evaluation of Cardiac Complications in Pateint Undergoing COVID 19 Treatment:...DrHeena tiwari
This study evaluated cardiac complications in 45 COVID-19 patients admitted to the intensive care unit. Electrocardiography and Holter monitoring found various arrhythmias in patients, with atrial fibrillation, premature ventricular contraction, and tachycardia being most common. The mortality rate of arrhythmias in COVID-19 patients was 17.77%. Although arrhythmias are not very frequent in COVID-19, they can be fatal and have a high mortality rate. Early detection of arrhythmias can help prevent deaths.
Clinical presentation and outcomes of HIV positive patients with diagnosis of...Oscar Malpartida-Tabuchi
This document summarizes a study on tuberculosis (TB) in HIV-positive patients at a hospital in Lima, Peru in 2014. It finds that:
- 22 HIV+ patients were diagnosed with TB, most were male with low CD4 counts. Extra-pulmonary TB was most common.
- 21 cases were microbiologically confirmed, with high rates of drug resistance including 30% MDR and 5% XDR.
- Outcomes differed by HIV treatment group: no mortality in groups receiving HIV drugs >6 months or <6 months, but 18.2% mortality in group not receiving HIV drugs.
This document summarizes evidence on the risks of COVID-19 for people with diabetes and considerations for managing diabetes during the pandemic. It finds that people with diabetes appear to be at increased risk of severe COVID-19 outcomes. Higher BMI and poorer long-term glucose control are linked to worse COVID-19 outcomes. The pandemic also poses indirect risks to diabetes management through disruptions to healthcare, diet, exercise and increased stress. Countries have adopted strategies like telehealth and educational materials to support diabetes care during this time. More evidence is still needed on reducing infection risk and optimal self-management for people with diabetes during the pandemic.
This document discusses various experimental models used to test potential anti-arthritic agents, including adjuvant arthritis in rats, terpentine oil-induced edema, and formaldehyde-induced arthritis. Adjuvant arthritis is induced in rats by injecting complete Freund's adjuvant or synthetic adjuvants and results in hind paw swelling that can be monitored over time. Terpentine oil injected into rat knee joints causes acute, non-immunological edema assessed by measuring joint diameter changes. Formaldehyde injections into rat paws induce chronic, non-immunological arthritis evaluated by paw diameter increases over 10 days. These preclinical models are used to screen anti-arthritic drugs.
Treatment for severe acute respiratory distress syndrome from covid 19Valentina Corona
The document discusses treatment recommendations for patients experiencing severe acute respiratory distress syndrome (ARDS) from COVID-19. It provides guidance on use of extracorporeal membrane oxygenation (ECMO) and other evidence-based options for managing hypoxemia and respiratory failure in COVID-19 patients, including high-flow nasal oxygen, mechanical ventilation strategies, prone positioning, neuromuscular blockade, inhaled nitric oxide, fluid management, and antibiotics. It acknowledges challenges in scaling up ECMO globally and emphasizes optimizing other established treatment protocols.
Γρηγόριος Γεροτζιάφας, Health Innovation Conference 2021Starttech Ventures
Ομιλία – Παρουσίαση:“Artificial intelligence and personalised medicine for patients at high risk of severe COVID-19”
Γρηγόριος Γεροτζιάφας, Καθηγητής Αιματολογίας, Ιατρική σχολή της Σορβόνης, Υπεύθυνος, Τμήμα Θρόμβωσης, Νοσοκομείο Tenon, Παρίσι & Διευθυντής, Ερευνητική Ομάδα Καρκίνος και Θρόμβωση INSERM U938
PCR Assay Turned Positive in 25 Discharged COVID-19 PatientsValentina Corona
1) The study found that 14.5% (25/172) of discharged COVID-19 patients in China later tested positive again for the virus based on RT-PCR testing after being discharged from the hospital.
2) These patients met criteria for discharge but tested positive again within 2-13 days without worsening symptoms.
3) The study suggests that more than two negative RT-PCR tests separated by 48 hours or combining RT-PCR tests with antibody and other immunological markers may be needed to confirm viral clearance before discharge.
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This document discusses stroke in HIV infection. It begins by providing background on HIV/AIDS classifications and prevalence statistics. It then describes the CDC classification system for HIV infection and lists conditions under categories B and C. It discusses the epidemiology of stroke in HIV patients, noting rates vary from 0.5-5% in studies. Potential causes of ischemic and hemorrhagic stroke are outlined. Treatment focuses on underlying infections or disorders. While HAART reduced some complications, protease inhibitors may increase atherosclerosis risk. In conclusion, strokes in HIV patients tend to occur in severe immunosuppression and various infectious etiologies can cause ischemic or hemorrhagic strokes.
Study of clinical and etiological profile of community acquired pneumonia in ...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
The document describes a study on the effectiveness of tocilizumab in treating severe COVID-19 patients. 20 severe or critical COVID-19 patients were given tocilizumab in addition to routine therapy. Within days of treatment, patients saw improved symptoms, reduced oxygen needs, and absorption of lung lesions on CT scans. Inflammatory markers decreased and 19 of the 20 patients were discharged within about two weeks. The study provides evidence that tocilizumab is an effective treatment for severe COVID-19 patients by reducing the cytokine storm.
Robótica é o estudo e uso de robôs, combinando engenharia, ciência da computação e inteligência artificial. A história da robótica inclui mitos antigos, Leonardo da Vinci e o primeiro robô industrial na década de 1950. Robôs são classificados de acordo com sua função e nível de autonomia.
An Analogical Study of the Narrative Techniques Used In the Film Paradesi (20...inventionjournals
Narrations in films have always taken the primary place. Understanding the narrative culture of a medium becomes the prime motive of the narrator while working on adaptations. There is a strong connection between the verbal and visual representation is sequence, since literary and filmic signs are apprehended consecutively through time. The success and acceptability of a film is based on the narration style and techniques. This is very much true in Tamil cinema narrative patterns. While trying to adapt the story from a medium the director of the film Bala, has focused on trying to maintain the narrative syntax of the original, but has also closely followed the semantics of visual design. The Tamil film Paradesi is an adaptation of the Tamil translation Yerium Panikkadu of the novel ‘Red Tea’, which was has been an inspiration for the director.
Este estudio evaluó los niveles de actividad física en 146 estudiantes universitarios en Venezuela utilizando el Cuestionario Internacional de Actividad Física. Se encontró que el patrón de actividad física alta fue el más prevalente (48.6%), seguido por la actividad física moderada (35.6%). La actividad física en el tiempo de ocio registró los menores valores. Los autores concluyen que se deben diseñar programas para aumentar la actividad física en el tiempo de ocio con el fin de mejorar la
CULTURA DE LA INVERSIÓN, AHORRO Y SOSTENIBILIDADLina Naranjo
Este documento discute temas financieros como la inversión, el ahorro y la sostenibilidad desde diferentes perspectivas. Explica que al obtener una deuda como un préstamo se reducen los ingresos para pagarla, pero que una inversión sabia del préstamo puede generar ganancias a largo plazo. También analiza por qué algunas personas malgastan dinero a pesar de tener ingresos altos, y las dificultades que enfrentan otras para que les alcance el sueldo debido al alto costo de vida. El documento con
Towards Indian Agricultural Information: A Need Based Information Flow Modelinventionjournals
Information is crucial for agriculture and rural development. ICT based services in agriculture is gaining importance day by day. Paper proposes to study the nature of agricultural information its uniqueness and problems of handling and organization. Agri informatics and use of different web portals for agriculture also discussed. Paper also highlighted the ICAR and IARIs contribution towards development of NARS (National Agricultural Research System) and models showing Information flow and strategic plan for organization of agricultural information. Some recommendations for proper organization and dissemination of agricultural information have been made to reach grass root level with desired agricultural information.
The Moral Questions on the Religious Basis for Terrorisminventionjournals
Terrorism has been informed and propelled by many factors such as tribal, political, religious and many other factors but experience has shown that religious factor has been a key factor for terrorism; sometimes, it is used to champion other courses which may be political or tribal. Religious terrorism is the justifiability of terror acts on the ground that such an act is sanctioned by a deity; thus, adherents are called to even kill in order to defend their faith. Religious motivated terrorism (e. g., Joshua conquest of the Canaanites in the Old Testament, ISIS terrorist attacks, Al Qaeda, Hezbollah in Lebanon, Boko-Haram in Nigeria etc.) is said to be the deadliest of all other kinds of terrorism. Looking at the religious basis for terrorism, one is poised to raise some moral questions such as: are there ethical justifications for religious terrorism? Is religion the bedrock for morality or vice versa? Since God has reason for all His actions, can He ever sanction the killing of His creatures for His delight? What is the moral undertone of martyrdom? Etc. This research considers these questions and more thereby unveiling a possible moral condemnation of religious basis for terrorism.
Este documento proporciona información sobre la banda de rock estadounidense Aerosmith, incluyendo sus miembros antiguos y actuales, su discografía que data desde 1973 hasta la actualidad, y una lista de las giras que han realizado desde la década de 1970.
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Abstract
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Keywords:Pulmonary fungal disease; pathogen; imaging manifestation; Underlying disease; Clinical analysis; Chinese
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invasive mold disease, invasive aspergillosis, diabetes mellitus.
1. INTRODUCTION
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Clinical and Laboratory Prognostic Factors in Malignant form of Mediterranean Spotted Fever
1. International Journal of Pharmaceutical Science Invention
ISSN (Online): 2319 – 6718, ISSN (Print): 2319 – 670X
www.ijpsi.org Volume 5 Issue 4 ‖ July 2016 ‖ PP.01- 06
www.ijpsi.org 1 | P a g e
Clinical and Laboratory Prognostic Factors in Malignant form of
Mediterranean Spotted Fever
Baltadzhiev I1
, Popivanova N1
, Zaprianov Z2
1
Department of Infectious Diseases, Parasitology and Tropical Medicine, Faculty of Medicine, Medical
University, Plovdiv, Bulgaria;
2
Department of Clinical Pathology, Faculty of Medicine, Medical University, Plovdiv, Bulgaria
ABSTRACT: Mediterranean spotted fever (MSF) caused by Rickettsia conorii has become a significant health
risk for suffering people and international travelers. In the past, overlooked as a serious disease, at present it is
known that MSF was wrongly considered a benign condition. In this report, we present a set of clinical features
and laboratory parameters in 55 patients (19 fatalities and 36 survivors) with malignant forms of the disease.
The purpose of the study was to outline the prognostic factors of the fatal outcome in patients with malignant
MSF. Based on our data, the main prediction factors for mortality in malignant MSF patients were: advanced
age, delayed hospital admission, severe concomitant diseases, and failure to start or to complete appropriate
antibiotic treatment. Laboratory prognostic factors in fatalities were: leukocytosis with a marked shift to the
left; extremely high serum urea and creatinine levels; low levels of fibrinogen and prolongation of thrombin
time. The most frequently involved organ systems of malignant cases were: central nervous system 100%, liver
92.72%, kidneys 60%, lungs 58.18%, myocardium 30.9%, and gastrointestinal tract 23.63%. The conducted
histopathological investigations revealed lethal complications: encephalitis, brain edema, acute respiratory
distress syndrome, non-cardiogenic lung swelling, acute myocarditis, gastrointestinal bleeding, hemorrhagic-
necrotizing pancreatitis and acute renal failure.
Keywords: Mediterranean spotted fever, malignant forms, prognostic factors
I. Introduction
Mediterranean spotted fever (MSF), known as „Marseilles fever‖ or „Boutonneuse fever‖ is a
rickettsial disease endemic for the countries along the Mediterranean coast (South Europe and North Africa).
However, a growing number of cases are reported from Central and Eastern Europe [1, 2]. As a result of
globalization and growing tourism, imported cases of MSF are reported in many non-endemic countries and
regions. Molecular instruments as PCR and sequencing have identified the responsible for the disease rickettsial
agent Rickettsia conorii subsp. conorii, strain Malish Seven [1]. The main epidemiological feature of MSF is the
transmission of rickettsiae to humans in the endemic regions by the bite of the brown dog tick Rhipicephalus
sanguineus during the favorable for tick’s biology spring-summer season. Another important epidemiological
determinant is the human contact with tick'
s intermediate hosts - domestic and stray dogs [3, 4]. The main
clinical signs and symptoms of MSF are: skin eschar (black spot or tache noire) at the site of the tick bite, fever
and flu-like manifestations as headache, adynamia, anorexia, myalgia, etc., emerging 3-5 days before the onset
of papular or maculopapular rash over the trunk and extremities, involving the hands and feet.
Known in Europe since the beginning of the twentieth century, MSF has long been considered a benign
disease. In the early 1980s, D.Raoult reported a patient with a fatal outcome due to MSF and used the term
«malignant» for the most severe forms of the disease [5]. In 1980s and 1990s, the disease was particularly
common in many European countries, and severe, ―malignant‖ including lethal cases have been observed. The
mortality rate reached 54.5% in hospitalized patients with neurological manifestations and multiorgan
involvement [6]. Currently it is known that MSF is, at least as severe as Rocky Mountain spotted fever (RMSF).
In Bulgaria MSF was described in 1948 and for over two decades (1948-1972) had presented as a mild to
moderate disease without registered mortality [7]. Following a 20 year pause, during which the disease was
considered eliminated, it reemerged in the early 1990s and rapidly affected thousands of people in the endemic
regions. During this ―second wave‖ various forms of the disease were observed, and very severe, actually
"malignant" forms were reported, some of them even fatal. In one of our investigations (which included 549
patients in the largest endemic region of Bulgaria – the city of Plovdiv and the neighboring areas with a
population of approximately 700 000 inhabitants), the MSF incidence rate was 11.88 per 100 000 individuals.
The cases were defined as mild - 226 (41.16%), moderate - 180 (32.79%), severe - 88 (16.03%) and malignant -
55 (10.02%) [3]. The grading was based on the establishment of a set of clinical and laboratory criteria [8].
Lethality rate in all treated patients was 3.46%, and mortality in malignant forms reached 34.54%.
2. Clinical and laboratory prognostic factors in malignant form of Mediterranean spotted fever
www.ijpsi.org 2 | P a g e
II. Aims & Objectives
The purpose of this study was to determine the clinical and laboratory prognostic factors contributing to
the fatal outcome in patients with malignant MSF.
III. Patients and Methods
Fifty five patients (30 men and 25 women) with malignant forms of MSF were involved in the study.
They were divided in two groups: Group I comprised 19 fatalities with mean age 59.55±4.09 years; Group II
comprised 36 survivors with mean age 47.22±5.81 years (Mean±SEM), p>0.05). MSF was proven by the
indirect immunofluorescent assay (IFA), with at least a fourfold increase in the antibody titer to a specific
R.conorii antigen (IFA test Rickettsia conori—Spot IF, BioMerieux, Marcy L’Etoile, France). IgG titres of ≥128
and ⁄or IgM titres of >64 were considered indicative of acute infection [9]. Diagnostic laboratory confirmation
by IFA was performed at the Referent Laboratory of the Military Medical Academy in Sofia, Bulgaria. In
addition to the serological confirmation of MSF, our patients fulfilled the clinical and epidemiological scoring
criteria for Mediterranean spotted fever diagnosis, adopted by the members of the European Network for
Surveillance of Tick-Borne Diseases [9].
Inclusion criteria: patients had to meet our criteria for a malignant form of MSF. The criteria have
been published elsewhere [8] and are as follows: extremely severe toxic-infection syndrome, temperature ≥
40°С, chills, severe headache, nausea, vomiting, typhoid mental condition, stupor, coma; abundant
maculopapular and/or haemorrhagic rash, presence of clinically apparent lesions in more than one organ
system (pneumonitis, jaundice, acute renal failure, gastrointestinal hemorrhage, myocarditis, CNS damage);
platelet count of ≤ 50×109
/l or <100×109
/l; serum sodium of ≤ 130 mmol/l; ALT/AST levels increased at least 5
times the baseline; hypocalcemia, hypoalbuminemia, hypoxemia. The presence of at least two clinical
syndromes and two laboratory criteria of the above mentioned, defines the MSF form as malignant. The IgM
titre >1:64 to R.conorii antigen and/or the fourfold titre elevation within 2 weeks was considered indicative of
recent infection.
Exclusion criteria: patients with preceding and/or accompanying end-stage co-morbidities, which
might result in, or contribute to the fatal outcome; glucose-6-phosphate dehydrogenase (G6PD) deficiency;
history of treatment with antibiotics potentially active against Rickettsia species prior to hospitalization.
Statistics: Data were analyzed using statistical software SPSS version 15 (SPSS Inc., Chicago, IL).
Fisher’s exact test was used to differentiate between the lethal and survival cases of malignant MSF for: age,
gender, time from disease onset to hospital admission, pre-morbid conditions, signs and symptoms, etc.
Independent simple t-test was used to compare the mean values of the laboratory parameters between the lethal
and survival cases of malignant MSF. P<0.05 (two tailed) was considered statistically significant.
IV. Results and Discussion
A number of studies have reported severe/malignant MSF and complications [5, 6, 10, 11, 12, 13, 15,
16]. In order to simplify and standardize the definition of MSF forms in severity, we developed a classification
of MSF clinical forms and proposed a scheme to determine the severity of the disease. The proposed scheme was
based on a set of criteria, defining severity [8]. In our research, malignant forms of MSF were defined as "Forms
with multi-organ involvement (malignant)".
Regarding the laboratory parameters, most of the patients with malignant forms of MSF had anemia -
43(78.18%), leukocytosis - 37(67.27%) with a shift to the left - 34(61.81%), thrombocytopenia - 48(87.27%),
and hypofibrinogenemia - 28(50.90%); prothrombin time (PT) was prolonged only in 9(16.36%) out of all
patients, whereas thrombin time (TT) and activated partial thromboplastin time (APTT) were extended in
31(56.36%) of them. In a large proportion of patients hyperbilirubinemia was noted 35(63.63%), and nearly all
had elevated ALT and/or AST serum levels 51(92.72%). In more than half of the patients - 31(56.36%) the total
protein levels were below normal values. The same referred to patients with elevated levels of blood urea
nitrogen and creatinine 33(60.00%). Nearly all patients had decreased albumin 52(94.54%), sodium 49(89.09%)
and calcium 49(88.09%) serum levels.
It was interesting to compare the mean levels of the laboratory parameters between the deceased and
survivors from malignant MSF in order to assess their relative weight in the disease outcome (Table 1).
Deceased patients had significantly higher leukocyte count with a shift to the left and higher serum levels of
blood urea nitrogen and creatinine. Compared to survivors, they had significantly lower values of fibrinogen and
larger prolongation of TT. In the mean values of the remaining laboratory parameters, no significant differences
were found between the deceased and surviving patients. Yet, thrombocytopenia was more pronounced in fatal
cases, irrespective of the fact that the difference was not statistically significant.
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Table 1 Laboratory parameters of patients with malignant forms of Mediterranean spotted fever
Laboratory
parameters
MSF malignant forms
death n=19
MSF malignant forms
survivor n=36
Statistic
Mean±SEM Mean±SEM P S/NS*
Hb g/l 102.77±11.14 114.11±7.35 >0.05 NS
Er x1012
/l 3.22±0.27 3.64±0.23 >0.05 NS
Leuk x109
/l 19.03±3.05 11.33±1.31 <0.05 S
Bands % 21.33±3.06 11.44±2.21 <0.05 S
Segs % 62.22±2.04 60.77±2.76 >0.05 NS
PLTx109
/l 60.22±10.72 86.88±14.56 >0.05 NS
Fibrinogen g/l 1.67±0.28 2.75±0.30 <0.05 S
PT % 74.33±2.00 77.53±4.44 >0.05 NS
ТТsec 24.88±1.50 20.40±1.13 <0.05 S
AТТТsec 36.90±3.25 35.66±1.92 >0.05 NS
Bilirubin Тmol/l 47.04±12.30 64.61±15.74 >0.05 NS
ALT U/l 188.33±56.75 213.88±39.78 >0.05 NS
AST U/l 270.88±74.96 199.77±37.97 >0.05 NS
Total protein g/l 60.55±5.09 59.38±4.21 >0.05 NS
Albumin g/l 27.66±1.69 28.54±4.07 >0.05 NS
UreТmmol/l 38.00±5.85 20.34±5.41 <0.05 S
Creatinine mmol/l 520.33±108.3 226.77±73.35 <0.05 S
Na mmol/l 128.00±2.94 132.77±1.16 >0.05 NS
Ca mmol/l 1.77±0.09 1.65±0.18 >0.05 NS
Legend: Hb – Hemoglobin; Er - Erythrocytes; Leuk – Leukocytes; Segs - Segmented Neutrophils; PLT - platelets;
PT- prothrombin time; TT- thrombine time; AРТТ - Activated partial thromboplastin time; ALT – alanine
aminotransferase; AST - aspartate aminotransferase; Bilirubin micromoles per litre (μmol/l);
* S/NS = significant/not significant
Some epidemiological features and main clinical signs and symptoms of our MSF' patients are
presented in Table 2. All patients had a sudden onset with fever, chills, myalgia, headache, and other flu-like
symptoms. In all patients, three to four days after the onset of symptoms, a specific maculopapular rash
developed, typically starting on the trunk and spreading out to the extremities. It involved the hands and feet in
49 patients (89.09%). Forty one (74.5%) patients presented with tache noire, and conjunctiva was the likely port
of entry in 4 cases. Cracks on fingers, incurred in the process of tick removal from pet dogs were the site of
penetration in 10 cases.
The study was focused on the presence and prevalence rates of certain clinical and/or epidemiological
characteristics in patients with fatal outcomes, compared to survivors from malignant MSF. It was found out
that: age over 45 years, delayed hospital admission (longer than 6 days after the onset of symptoms), presence of
pre-morbid underlying conditions as alcohol abuse, diabetes mellitus and hypertension, as well as failure to start
or to complete appropriate antibiotic treatment were risk factors for fatalities. Regarding the main clinical signs
and symptoms, none was prevalent in patients with malignant MSF from group I compared to patients from
group II. Involved organ systems and main characteristic symptoms and signs (comparatively between the two
groups) are shown in Table 2.
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Тable 2 Clinical and epidemiological features and main clinical symptoms in patients with malignant
forms of Mediterranean spotted fever. Comparative assessment of parameters in fatalities (group I) and
survivors (group II) in malignant forms of Mediterranean spotted fever.
Parameters MSF
total
Тases
N=55
MSF
lethal
Тases
N=19
Group I
MSF
survivors
N=36
Group II
Fisher's exact test
N % N % N % P Odds ratio 95% CI
Age >45 years 33 60.0 17 89.47 16 44.44 =0.001 10.625 2.13-52.95
More than 6 days to
hospital admission
29 52.7 17 89.47 12 33.33 <0.0001 17.00 3.36 -86.00
Pre-morbid
underlying conditions*
17 30.9 15 78.94 2 5.55 <0.0001 63.75 10.5 -386.93
Failure to start or complete
appropriate treatment
15 27.27 11 57.89 4 11.11 =0.0004 11.00 2.76 -43.82
Temperature over 390
Т 53 96.4 19 100.00 34 94.44 =0.53 2.826 0.13 - 61.95
Tache noire 41 74.5 17 89.47 24 66.66 =0.103 4.250 0.84 - 21.50
Hemorrhagic rash 47 85.45 16 84.21 30 83.33 =0.70 1.70 0.31 - 9.38
Myalgia/arthralgia 50 90.90 19 100.00 31 86.11 =0.15 6.810 0.35 –130.15
Headache 52 94.54 19 100.00 33 91.66 =0.543 4.075 0.199 –83.16
Vomiting 44 80.00 18 94.73 26 72.22 =0.18 3.269 0.63 – 16.80
Abdominal pain 30 54.54 9 47.36 21 58.33 =0.57 0.6429 0.21 – 1.96
CNS involvement: 55 100.00
Mental confusion –
―Typhus state‖
49 89.09 19 100.00 30 83.33 = 0.08 8.311 0.44 –156.09
Delirium/seizures/
stupor/coma
24 43.63 12 63.15 12 33.33 = 0.04 3.429 1.07 – 10.95
Pulmonary involvement: 32 58.18
Interstitial pneumonia 29 52.72 13 68.42 16 44.44 = 0.15 2.708 0.84 – 8.72
ARDS* 3 5.45 3 15.78 0 0.00 = 0.03 15.485 0.75 –317.44
Hard violation of the
acid-base balance
17 30.90 13 68.42 4 11.11 <0.0001 17.333 4.19 - 71.73
Myocardial involvement: 17 30.90
ECG abnormalities 16 29.09 8 42.10 8 22.22 = 0.21 2.545 0.76 – 8.48
Myocarditis** 17 30.90 13 68.42 4 11.11 < 0.0001 17.333 4.19 –71.72
Hepatic involvement: 51 92.72
ALT/AST increased levels 51 92.72 16 84.21 35 97.22 = 0.11 0.152 0.014 – 1.58
Jaundice 35 63.63 11 57.89 24 66.66 = 0.58 0.687 0.22 – 2.16
Digestive tract involvement: 13 23.63
Gastrointestinal bleeding 8 14.54 6 31.57 2 5.55 = 0.01 7.845 1.40 – 43.97
Pancreatic involvement 5 9.09 4 21.05 1 2.77 = 0.04 9.333 0.96 – 90.68
Renal involvement: 33 60.00
Very high urea and
creatinine levels
33 60.00 17 89.47 16 44.44 =0.001 10.025 2.13 – 52.95
Acute renal failure 30 54.54 16 84.21 14 38.88 =0.001 8.381 2.05 – 34.11
Legend:
CI -Confidence interval; MSF – Mediterranean spotted fever; *ARDS – acute respiratory distress syndrome;
5. Clinical and laboratory prognostic factors in malignant form of Mediterranean spotted fever
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** Myocarditis - according to clinical setting and/or histological data;
CNS involvement is the acknowledged hallmark of malignant forms of MSF [10, 11, 12, 13]. Altered
mental status of variable degree was present in all of our patients, ranging from cognitive slowing and
somnolence to apathy or confusion – termed by classical authors as «Status typhosus ". The latter was equally
present in the fatality group similarly to MSF survivor group. Typhoid mental condition is likely to progress to
more severe CNS deterioration as delirium, stupor and coma, indicative of meningoencephalitis and/or brain
edema. These symptoms were significantly more frequent in the deceased patients, compared to survivors and
consequently appeared as risk factors for patients with malignant MSF.
Pulmonary involvement, presenting as interstitial pneumonia, was often seen in MSF patients [14] It
was present in 29(52.72%) of our malignant forms of MSF, without statistical difference between the two
studied groups. Acute respiratory distress syndrome (ARDS) however was present only in the group of lethality
and appeared as one of the most important risk factors for death [15, 16].
Myocarditis is an uncommon, however severe occurrence in MSF, and only few cases have been
reported in the literature [17, 18]. Myocardial involvement was found in about one third of the patients with
malignant form of MSF. Myocarditis, diagnosed clinically and instrumentally, as well as based on histology
proved to be a risk factor for mortality as it appeared several times more frequently in deceased than in survivors
from malignant MSF.
Several studies have stated a high frequency of liver functional impairment in the course of MSF [19].
Based on increased ALT and AST activity, complicity of the liver occurred in almost all patients, and jaundice -
in more than half of them. However, both findings showed no prevalence in deceased patients compared to
survivors from malignant MSF.
Hemorrhages in the gastrointestinal tract are serious, although considered uncommon complication of
vasculitic changes in malignant forms of MSF [20, 21, 22]. Gastrointestinal bleeding was a real risk factor for
fatal outcome in our patients. Severe pancreatic damage (histological data in 4 deceased patients) and clinically
suspected in only one of the survivors, was also a serious risk factor for death in malignant MSF.
Involvement of the kidneys was found in approximately 60% of the patients with malignant MSF. It
presented with a significant increase in the serum urea and creatinine levels. Acute renal failure (ARF) was
demonstrated at approximately the same rate. Both conditions were nearly twice as common in deceased
compared to surviving patients and presented real risk factors for the lethal outcome in the most severe forms of
MSF, the so-called malignant forms [23, 24].
V. CONCLUSION
Long time overlooked as a serious disease, at present, it is known that MSF had a false benign reputation.
In this report we managed to identify the prognostic factors for mortality or survival in malignant forms of MSF.
This approach is justified as the diagnosis in such cases is frequently a problem, resulting in delayed treatment.
Early diagnosis and appropriate antibiotic treatment may reduce the risk of complications.
Conflict of Interests: There is no conflict of interests regarding the publication of this paper
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