This document presents a case study of a 36-year-old man admitted to the hospital with fever, abdominal pain, and lack of appetite. Initial tests showed jaundice and liver abnormalities. Further evaluation found a liver abscess. The patient was treated but had a similar prior illness in Malaysia. Tests identified the cause as melioidosis, a tropical disease caused by the bacterium Burkholderia pseudomallei. The patient received long-term antibiotic treatment and follow-up showed the infection had resolved. The presentation discusses the epidemiology, pathogenesis, diagnosis and treatment of melioidosis.
Mixed cryoglobulinemia & HEV infectionSamir Haffar
1) Mixed cryoglobulinemia has been reported related to chronic hepatitis E virus (HEV) infection, with 9 documented cases described.
2) All cases involved immunosuppressed patients who developed chronic HEV genotype 3 infection.
3) Treatment with antiviral therapy such as pegylated interferon or ribavirin led to viral clearance and resolution of cryoglobulinemia in reported cases.
A 35-year-old male patient with HIV was admitted with complaints of painful swelling in his right lower limb. Doppler imaging showed deep vein thrombosis in the right leg. The patient had no other risk factors for DVT. He was treated with anticoagulation therapy and his symptoms improved. Deep vein thrombosis is more common in HIV-infected individuals due to factors causing a hypercoagulable state induced by the virus. The report examines the case of DVT in an HIV-positive patient without other risk factors.
A 76-year-old man with multiple medical problems was admitted to the hospital with fever, low white blood cell count, and lung infiltrates for over 5 weeks, and testing showed diffuse lung opacities and inflammation; a lung biopsy found granulomatous inflammation and he was started on tuberculosis treatment, but his condition worsened with continued fevers, hemoptysis, and hypoxemia. His past medical history included several cardiovascular and pulmonary conditions, as well as transitional cell carcinoma of the bladder treated with BCG therapy 7 months prior.
This document discusses an approach to aquatic skin infections. It presents a case of a 45-year-old male with liver disease who developed severe leg pain and swelling after consuming raw oysters. He was diagnosed with Vibrio vulnificus infection based on blood and wound cultures. V. vulnificus is found in coastal waters and can cause serious soft tissue infections or sepsis, especially in individuals with liver disease or iron overload. Prompt treatment with antibiotics is needed but prognosis remains poor, with fatality rates over 50% for septicemia.
This document discusses coagulopathy and thrombosis in COVID-19 patients. It reviews a case where a clot-busting drug improved a patient's condition, suggesting blood clots play a bigger role in the disease than previously thought. Autopsies show COVID patients' lungs and other organs choked with microclots. The virus may directly infect blood vessels, impairing blood flow regulation and promoting clotting. Routine monitoring of coagulation markers and use of preventative doses of anticoagulants are recommended for COVID patients.
The document discusses anticoagulation in COVID-19 patients. It notes that COVID-19 infection can cause a cytokine storm and increased risk of thrombosis. Studies have shown that 1/3 of hospitalized COVID-19 patients develop thrombotic complications. Several guidelines recommend prophylactic anticoagulation for hospitalized COVID-19 patients to reduce the risk of thromboembolism and lower mortality. Early initiation of prophylactic anticoagulation is associated with a 27% reduced risk of death within 30 days. The document discusses diagnostic tests for coagulopathy in COVID-19 patients and potential radiological findings of thromboembolic complications.
The document summarizes a study on severe sepsis and septic shock patients admitted to a medical ICU in Turkey between 2007-2014. The key findings are:
1) 33.1% of ICU patients were admitted with severe sepsis or septic shock, with an overall mortality rate of 48.3%.
2) The most common infection source was respiratory (45.5%) and the most frequent isolated organism was E. coli (23%).
3) While the frequency of sepsis varied over the 8-year period, mortality rates in the ICU and hospital did not significantly change over time.
Mixed cryoglobulinemia & HEV infectionSamir Haffar
1) Mixed cryoglobulinemia has been reported related to chronic hepatitis E virus (HEV) infection, with 9 documented cases described.
2) All cases involved immunosuppressed patients who developed chronic HEV genotype 3 infection.
3) Treatment with antiviral therapy such as pegylated interferon or ribavirin led to viral clearance and resolution of cryoglobulinemia in reported cases.
A 35-year-old male patient with HIV was admitted with complaints of painful swelling in his right lower limb. Doppler imaging showed deep vein thrombosis in the right leg. The patient had no other risk factors for DVT. He was treated with anticoagulation therapy and his symptoms improved. Deep vein thrombosis is more common in HIV-infected individuals due to factors causing a hypercoagulable state induced by the virus. The report examines the case of DVT in an HIV-positive patient without other risk factors.
A 76-year-old man with multiple medical problems was admitted to the hospital with fever, low white blood cell count, and lung infiltrates for over 5 weeks, and testing showed diffuse lung opacities and inflammation; a lung biopsy found granulomatous inflammation and he was started on tuberculosis treatment, but his condition worsened with continued fevers, hemoptysis, and hypoxemia. His past medical history included several cardiovascular and pulmonary conditions, as well as transitional cell carcinoma of the bladder treated with BCG therapy 7 months prior.
This document discusses an approach to aquatic skin infections. It presents a case of a 45-year-old male with liver disease who developed severe leg pain and swelling after consuming raw oysters. He was diagnosed with Vibrio vulnificus infection based on blood and wound cultures. V. vulnificus is found in coastal waters and can cause serious soft tissue infections or sepsis, especially in individuals with liver disease or iron overload. Prompt treatment with antibiotics is needed but prognosis remains poor, with fatality rates over 50% for septicemia.
This document discusses coagulopathy and thrombosis in COVID-19 patients. It reviews a case where a clot-busting drug improved a patient's condition, suggesting blood clots play a bigger role in the disease than previously thought. Autopsies show COVID patients' lungs and other organs choked with microclots. The virus may directly infect blood vessels, impairing blood flow regulation and promoting clotting. Routine monitoring of coagulation markers and use of preventative doses of anticoagulants are recommended for COVID patients.
The document discusses anticoagulation in COVID-19 patients. It notes that COVID-19 infection can cause a cytokine storm and increased risk of thrombosis. Studies have shown that 1/3 of hospitalized COVID-19 patients develop thrombotic complications. Several guidelines recommend prophylactic anticoagulation for hospitalized COVID-19 patients to reduce the risk of thromboembolism and lower mortality. Early initiation of prophylactic anticoagulation is associated with a 27% reduced risk of death within 30 days. The document discusses diagnostic tests for coagulopathy in COVID-19 patients and potential radiological findings of thromboembolic complications.
The document summarizes a study on severe sepsis and septic shock patients admitted to a medical ICU in Turkey between 2007-2014. The key findings are:
1) 33.1% of ICU patients were admitted with severe sepsis or septic shock, with an overall mortality rate of 48.3%.
2) The most common infection source was respiratory (45.5%) and the most frequent isolated organism was E. coli (23%).
3) While the frequency of sepsis varied over the 8-year period, mortality rates in the ICU and hospital did not significantly change over time.
A 58-year-old woman was admitted with COVID-19 symptoms and developed cardiogenic and septic shock. An echocardiogram showed findings consistent with takotsubo cardiomyopathy - also known as stress cardiomyopathy - with left ventricular dysfunction. Her left ventricular function improved over the next few days, supporting the diagnosis of reversible acute stress cardiomyopathy secondary to COVID-19. This is the first reported case of takotsubo cardiomyopathy associated with COVID-19 in the United States.
The document discusses shock and sepsis. It defines shock as a clinical condition characterized by a fast pulse rate and low blood pressure. The main types of shock discussed are hypovolemic, cardiogenic, septic, anaphylactic, and neurogenic. Sepsis is defined as a life-threatening organ dysfunction caused by the body's response to an infection. As sepsis progresses it can lead to septic shock, which is associated with high mortality. The stages of shock and signs and symptoms of early and late sepsis are also summarized.
This document discusses coronary artery disease in HIV patients. It covers the relative magnitude of cardiovascular disease among HIV patients, current data on the association between HIV and coronary artery disease, known risk factors and how they may be modulated by HIV diagnosis, screening and prevention recommendations, and areas for future research. Key points include increased rates of myocardial infarction and atherosclerosis in HIV patients, traditional and HIV-specific risk factors, screening tools and their limitations, effects of antiretroviral therapy on risk, and lifestyle and medical interventions for prevention.
Central Nervous System Histoplasmosis Related to Bioprosthetic Endocarditisasclepiuspdfs
Endocarditis caused by Histoplasma capsulatum is a rare occurrence. Involvement of the central nervous system by Histoplasma is also relatively uncommon. This paper reports a case of a 62-year-old woman with a past medical history significant for a myocardial infarct 5 years prior which necessitated coronary artery bypass graft surgery, prosthetic aortic valve replacement 4 years prior, and sarcoidosis, diagnosed 1 year prior, which was treated with methotrexate. She presented with fevers, generalized weakness, night sweats, and chest and throat pain. An echocardiogram done as part of her evaluation showed a vegetation on her prosthetic aortic valve. H. capsulatum was identified on blood cultures, and she was started on antibiotics. She expired shortly thereafter. At autopsy, a diagnosis of Histoplasma endocarditis was confirmed with evidence of embolic disease involving kidneys and digits of the hand. Hilar lymph nodes showed evidence of the fungus. Examination of the brain showed multiple widespread microscopic foci of macrophages, lymphocytes, and microglial cells with associated Histoplasma organisms, highlighted on Gomori methenamine silver staining. This paper will discuss central nervous system involvement by Histoplasma.
Dengue Fever-Related Cardiac manifestation in Ibn-Sina Hospital Mukalla, Hadh...asclepiuspdfs
This document summarizes a study on cardiac manifestations in patients hospitalized with dengue fever in Mukalla, Yemen. The study found that the most common cardiac manifestations were sinus tachycardia (39.4% of patients) and hypotension (18.37% of patients). Other less common findings included pulmonary congestion, bradycardia, and pericardial effusion. There was a close correlation between the severity of cardiac manifestations and the severity of dengue based on WHO classifications, with more severe cardiac issues seen in those with severe dengue. The most common causes of death in the study (10 patients) were refractory shock and other complications associated with severe dengue disease.
1. HIV was first described in 1981 and is caused by HIV-1 and HIV-2 viruses which deplete CD4 lymphocytes. As of 2000, 58 million people were infected globally and 21.8 million had died.
2. Cardiac manifestations are common in HIV/AIDS patients, occurring in 28-73% of patients. Prior to antiretroviral therapy, cardiac disease was usually only detected at autopsy.
3. Guidelines recommend regular echocardiograms to monitor cardiac dysfunction in HIV patients, with increased frequency if abnormalities are detected. Endocarditis prevalence is increased in HIV patients.
Cardiomyopathy in HIV patients has been shown to progress faster than idiopathic Dilated Cardiomyopathy in the HIV negative population. It is therefore important to recognize this condition early in this population and manage it appropriately. Studies need to be done to validate the current therapy for cardiomyopathy in this population since it is still unclear that LV dysfunction in this population responds in a similar fashion as in HIV negative patients with Dilated Cardiomyopathy
This document discusses biomarkers in scleroderma and their potential uses. It defines biomarkers as measurable indicators of biological processes related to health and disease. Biomarkers could help predict disease progression and treatment response. The document reviews potential biomarkers related to skin involvement, lung fibrosis, renal disease, and pulmonary arterial hypertension in scleroderma. It highlights how biomarkers may help identify patients at high risk of organ complications who could benefit from early treatment or clinical trial enrollment.
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.
- HIVAN (HIV-associated nephropathy) is a type of kidney disease seen in some individuals with HIV. It was first described in 1984 and by 1999 it became the third leading cause of end-stage kidney disease.
- Pathologically it is characterized by collapsing focal segmental glomerulosclerosis, tubular microcystic dilation, and tubulointerstitial inflammation. On immunofluorescence there are deposits of IgM, C3 and less commonly C1 in collapsed segments.
- The incidence of HIVAN ranges from 3.9 to 11.2 cases per 1,000 person-years. Risk factors include older age, female sex, diabetes, hypertension, intravenous drug use,
This document provides a summary of key information about primary care approaches to treating HIV patients, including:
1) It discusses the history and epidemiology of HIV, modes of transmission, clinical presentations to different specialists, treatment with HAART, and baseline evaluations prior to treatment initiation.
2) Primary care providers should offer ART to patients with CD4 counts <200 or symptoms, consider treatment for counts 200-350, and can defer for asymptomatic patients with counts >350 and low viral loads.
3) When initiating ART, providers should evaluate readiness, ensure adherence, perform baseline testing, and select preferred first-line regimens consisting of 2 NRTIs combined with an NNRTI or PI.
This document provides an overview of kidney disorders associated with HIV infection. It discusses acute kidney injury in HIV patients, which is more common than in the general population. It also reviews electrolyte disturbances, medication toxicity from antiretrovirals and other HIV drugs, and thrombotic microangiopathy associated with HIV. The document focuses in depth on HIV-associated nephropathy (HIVAN), immune complex glomerulonephritis, and hepatitis C co-infection in HIV patients. It provides details on the pathogenesis, epidemiology, clinical presentation, pathology, diagnosis and treatment of these important kidney conditions seen in individuals living with HIV.
Perspective of Cardiac Troponin and Membrane Potential in People Living with ...asclepiuspdfs
Background: Hypertension is an event in which the force of the blood against the artery walls is too high leading to severe health complications and increases the risk of heart disease, stroke, and sometimes death. Aim: This study was carried out to determine the levels of cardiac troponin 1 and membrane potential in hypertensive subjects in Owerri, Imo state. Materials and Methods: A total of 120 subjects within the age 30–70 years were recruited for this study. The study consists of 60 subjects who were diagnosed of hypertension and 60 were apparently healthy individuals who served as controls subjects of the same age bracket. The levels of cardiac troponin 1 and membrane potential were analyzed using enzyme-linked immunosorbent assay technique. Data were assessed using SPSS version 20, the mean value with P ˂ 0.05 was considered statistically significant. Results: The result revealed that the levels of cardiac troponin 1 in hypertension were significantly increased when compared with control subjects while the levels of membrane potential were significantly decreased when compared to control at P < 0.05. Conclusion: The increased serum level of cardiac troponin 1 and decreased membrane potential in hypertensive subjects may contribute some risk factors in patients with hypertension.
Cross talk between covid-19 and ischemic strokeafnaanqureshi1
This document discusses the relationship between COVID-19 and ischemic stroke. It notes that SARS-CoV-2 binds to ACE2 receptors, decreasing ACE2 activity and increasing angiotensin II levels, which can increase risks of hypertension, diabetes, and ischemic stroke. Studies have found elevated inflammatory cytokines and chemokines in COVID-19 patients that may damage the blood-brain barrier and increase stroke risk. There is also evidence that the neurological and pulmonary systems interact immunologically, so stroke may increase susceptibility to pulmonary infections like COVID-19. The document examines the involvement of the renin-angiotensin system and inflammatory responses in both conditions.
This document summarizes the types and causes of kidney disease associated with HIV infection. It discusses HIV-associated nephropathy (HIVAN) in particular, which predominantly affects black populations and involves both glomerular and tubular kidney damage. The pathogenesis of HIVAN involves direct infection of kidney cells by HIV. Treatment focuses on antiretroviral therapy and ACE inhibitors, with corticosteroids and immunosuppressants also being investigated.
1) Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. It is a major healthcare problem with high mortality rates, especially septic shock which has mortality rates of 50-60%.
2) The new Sepsis-3 definition defines sepsis as a life-threatening organ dysfunction caused by a dysregulated host response to infection represented by an increase of two or more points in the SOFA score.
3) Early goal-directed therapy (EGDT) is a protocol-based approach for initial resuscitation of sepsis patients. It aims to achieve specific goals for central venous pressure, mean arterial pressure, ScvO2, and other parameters within 6 hours and
This document discusses HIV and its impact on the kidneys. It includes information from a nephrologist and clinical studies showing:
1) HIV can cause kidney disease, most notably HIV-associated nephropathy (HIVAN), which disproportionately affects African Americans.
2) Early studies from the pre-HAART era in the 1980s-1990s showed high rates of kidney disease and failure in people with HIV.
3) Later studies from the HAART era in the 2000s found lower rates of new kidney disease but higher overall prevalence, suggesting antiretroviral drugs may be improving outcomes for some but also contributing to kidney issues over the long term.
A 23-year old female presents with a rash, bruising, nosebleeds, and heavy menstruation. Her physical exam and labs reveal an isolated thrombocytopenia. Her peripheral smear shows decreased platelet numbers and slightly larger platelets, suggesting early release from the bone marrow in response to peripheral destruction. Further history and testing are needed to determine the cause of the thrombocytopenia.
- Management of lower GI bleeding (LGIB) requires identifying high-risk patients, optimizing medical management, and performing endoscopy within 24 hours for diagnosis and treatment.
- For ongoing or recurrent LGIB after endoscopy, angiography may be considered to locate the bleeding site.
- Coordinated care between emergency department, ICU, GI specialists, and interventional radiology is important to optimize outcomes for patients with LGIB.
Sinus Bradicardia on grade II dengue hemorragic fever.pptxSyahrulAdzim
This case report describes a 37-year-old man diagnosed with Grade II dengue hemorrhagic fever who presented with sinus bradycardia. Laboratory tests confirmed dengue infection and showed thrombocytopenia and elevated liver enzymes. Chest X-ray found left pleural effusion. The patient was treated conservatively with IV fluids, antiemetics, and analgesics. Dengue virus can cause myocardial inflammation and arrhythmias like bradycardia through direct viral invasion or immune mediated mechanisms. This case emphasizes that bradycardia is a common finding in dengue that results from the cardiac effects of the viral infection.
A 58-year-old woman was admitted with COVID-19 symptoms and developed cardiogenic and septic shock. An echocardiogram showed findings consistent with takotsubo cardiomyopathy - also known as stress cardiomyopathy - with left ventricular dysfunction. Her left ventricular function improved over the next few days, supporting the diagnosis of reversible acute stress cardiomyopathy secondary to COVID-19. This is the first reported case of takotsubo cardiomyopathy associated with COVID-19 in the United States.
The document discusses shock and sepsis. It defines shock as a clinical condition characterized by a fast pulse rate and low blood pressure. The main types of shock discussed are hypovolemic, cardiogenic, septic, anaphylactic, and neurogenic. Sepsis is defined as a life-threatening organ dysfunction caused by the body's response to an infection. As sepsis progresses it can lead to septic shock, which is associated with high mortality. The stages of shock and signs and symptoms of early and late sepsis are also summarized.
This document discusses coronary artery disease in HIV patients. It covers the relative magnitude of cardiovascular disease among HIV patients, current data on the association between HIV and coronary artery disease, known risk factors and how they may be modulated by HIV diagnosis, screening and prevention recommendations, and areas for future research. Key points include increased rates of myocardial infarction and atherosclerosis in HIV patients, traditional and HIV-specific risk factors, screening tools and their limitations, effects of antiretroviral therapy on risk, and lifestyle and medical interventions for prevention.
Central Nervous System Histoplasmosis Related to Bioprosthetic Endocarditisasclepiuspdfs
Endocarditis caused by Histoplasma capsulatum is a rare occurrence. Involvement of the central nervous system by Histoplasma is also relatively uncommon. This paper reports a case of a 62-year-old woman with a past medical history significant for a myocardial infarct 5 years prior which necessitated coronary artery bypass graft surgery, prosthetic aortic valve replacement 4 years prior, and sarcoidosis, diagnosed 1 year prior, which was treated with methotrexate. She presented with fevers, generalized weakness, night sweats, and chest and throat pain. An echocardiogram done as part of her evaluation showed a vegetation on her prosthetic aortic valve. H. capsulatum was identified on blood cultures, and she was started on antibiotics. She expired shortly thereafter. At autopsy, a diagnosis of Histoplasma endocarditis was confirmed with evidence of embolic disease involving kidneys and digits of the hand. Hilar lymph nodes showed evidence of the fungus. Examination of the brain showed multiple widespread microscopic foci of macrophages, lymphocytes, and microglial cells with associated Histoplasma organisms, highlighted on Gomori methenamine silver staining. This paper will discuss central nervous system involvement by Histoplasma.
Dengue Fever-Related Cardiac manifestation in Ibn-Sina Hospital Mukalla, Hadh...asclepiuspdfs
This document summarizes a study on cardiac manifestations in patients hospitalized with dengue fever in Mukalla, Yemen. The study found that the most common cardiac manifestations were sinus tachycardia (39.4% of patients) and hypotension (18.37% of patients). Other less common findings included pulmonary congestion, bradycardia, and pericardial effusion. There was a close correlation between the severity of cardiac manifestations and the severity of dengue based on WHO classifications, with more severe cardiac issues seen in those with severe dengue. The most common causes of death in the study (10 patients) were refractory shock and other complications associated with severe dengue disease.
1. HIV was first described in 1981 and is caused by HIV-1 and HIV-2 viruses which deplete CD4 lymphocytes. As of 2000, 58 million people were infected globally and 21.8 million had died.
2. Cardiac manifestations are common in HIV/AIDS patients, occurring in 28-73% of patients. Prior to antiretroviral therapy, cardiac disease was usually only detected at autopsy.
3. Guidelines recommend regular echocardiograms to monitor cardiac dysfunction in HIV patients, with increased frequency if abnormalities are detected. Endocarditis prevalence is increased in HIV patients.
Cardiomyopathy in HIV patients has been shown to progress faster than idiopathic Dilated Cardiomyopathy in the HIV negative population. It is therefore important to recognize this condition early in this population and manage it appropriately. Studies need to be done to validate the current therapy for cardiomyopathy in this population since it is still unclear that LV dysfunction in this population responds in a similar fashion as in HIV negative patients with Dilated Cardiomyopathy
This document discusses biomarkers in scleroderma and their potential uses. It defines biomarkers as measurable indicators of biological processes related to health and disease. Biomarkers could help predict disease progression and treatment response. The document reviews potential biomarkers related to skin involvement, lung fibrosis, renal disease, and pulmonary arterial hypertension in scleroderma. It highlights how biomarkers may help identify patients at high risk of organ complications who could benefit from early treatment or clinical trial enrollment.
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.
- HIVAN (HIV-associated nephropathy) is a type of kidney disease seen in some individuals with HIV. It was first described in 1984 and by 1999 it became the third leading cause of end-stage kidney disease.
- Pathologically it is characterized by collapsing focal segmental glomerulosclerosis, tubular microcystic dilation, and tubulointerstitial inflammation. On immunofluorescence there are deposits of IgM, C3 and less commonly C1 in collapsed segments.
- The incidence of HIVAN ranges from 3.9 to 11.2 cases per 1,000 person-years. Risk factors include older age, female sex, diabetes, hypertension, intravenous drug use,
This document provides a summary of key information about primary care approaches to treating HIV patients, including:
1) It discusses the history and epidemiology of HIV, modes of transmission, clinical presentations to different specialists, treatment with HAART, and baseline evaluations prior to treatment initiation.
2) Primary care providers should offer ART to patients with CD4 counts <200 or symptoms, consider treatment for counts 200-350, and can defer for asymptomatic patients with counts >350 and low viral loads.
3) When initiating ART, providers should evaluate readiness, ensure adherence, perform baseline testing, and select preferred first-line regimens consisting of 2 NRTIs combined with an NNRTI or PI.
This document provides an overview of kidney disorders associated with HIV infection. It discusses acute kidney injury in HIV patients, which is more common than in the general population. It also reviews electrolyte disturbances, medication toxicity from antiretrovirals and other HIV drugs, and thrombotic microangiopathy associated with HIV. The document focuses in depth on HIV-associated nephropathy (HIVAN), immune complex glomerulonephritis, and hepatitis C co-infection in HIV patients. It provides details on the pathogenesis, epidemiology, clinical presentation, pathology, diagnosis and treatment of these important kidney conditions seen in individuals living with HIV.
Perspective of Cardiac Troponin and Membrane Potential in People Living with ...asclepiuspdfs
Background: Hypertension is an event in which the force of the blood against the artery walls is too high leading to severe health complications and increases the risk of heart disease, stroke, and sometimes death. Aim: This study was carried out to determine the levels of cardiac troponin 1 and membrane potential in hypertensive subjects in Owerri, Imo state. Materials and Methods: A total of 120 subjects within the age 30–70 years were recruited for this study. The study consists of 60 subjects who were diagnosed of hypertension and 60 were apparently healthy individuals who served as controls subjects of the same age bracket. The levels of cardiac troponin 1 and membrane potential were analyzed using enzyme-linked immunosorbent assay technique. Data were assessed using SPSS version 20, the mean value with P ˂ 0.05 was considered statistically significant. Results: The result revealed that the levels of cardiac troponin 1 in hypertension were significantly increased when compared with control subjects while the levels of membrane potential were significantly decreased when compared to control at P < 0.05. Conclusion: The increased serum level of cardiac troponin 1 and decreased membrane potential in hypertensive subjects may contribute some risk factors in patients with hypertension.
Cross talk between covid-19 and ischemic strokeafnaanqureshi1
This document discusses the relationship between COVID-19 and ischemic stroke. It notes that SARS-CoV-2 binds to ACE2 receptors, decreasing ACE2 activity and increasing angiotensin II levels, which can increase risks of hypertension, diabetes, and ischemic stroke. Studies have found elevated inflammatory cytokines and chemokines in COVID-19 patients that may damage the blood-brain barrier and increase stroke risk. There is also evidence that the neurological and pulmonary systems interact immunologically, so stroke may increase susceptibility to pulmonary infections like COVID-19. The document examines the involvement of the renin-angiotensin system and inflammatory responses in both conditions.
This document summarizes the types and causes of kidney disease associated with HIV infection. It discusses HIV-associated nephropathy (HIVAN) in particular, which predominantly affects black populations and involves both glomerular and tubular kidney damage. The pathogenesis of HIVAN involves direct infection of kidney cells by HIV. Treatment focuses on antiretroviral therapy and ACE inhibitors, with corticosteroids and immunosuppressants also being investigated.
1) Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. It is a major healthcare problem with high mortality rates, especially septic shock which has mortality rates of 50-60%.
2) The new Sepsis-3 definition defines sepsis as a life-threatening organ dysfunction caused by a dysregulated host response to infection represented by an increase of two or more points in the SOFA score.
3) Early goal-directed therapy (EGDT) is a protocol-based approach for initial resuscitation of sepsis patients. It aims to achieve specific goals for central venous pressure, mean arterial pressure, ScvO2, and other parameters within 6 hours and
This document discusses HIV and its impact on the kidneys. It includes information from a nephrologist and clinical studies showing:
1) HIV can cause kidney disease, most notably HIV-associated nephropathy (HIVAN), which disproportionately affects African Americans.
2) Early studies from the pre-HAART era in the 1980s-1990s showed high rates of kidney disease and failure in people with HIV.
3) Later studies from the HAART era in the 2000s found lower rates of new kidney disease but higher overall prevalence, suggesting antiretroviral drugs may be improving outcomes for some but also contributing to kidney issues over the long term.
A 23-year old female presents with a rash, bruising, nosebleeds, and heavy menstruation. Her physical exam and labs reveal an isolated thrombocytopenia. Her peripheral smear shows decreased platelet numbers and slightly larger platelets, suggesting early release from the bone marrow in response to peripheral destruction. Further history and testing are needed to determine the cause of the thrombocytopenia.
- Management of lower GI bleeding (LGIB) requires identifying high-risk patients, optimizing medical management, and performing endoscopy within 24 hours for diagnosis and treatment.
- For ongoing or recurrent LGIB after endoscopy, angiography may be considered to locate the bleeding site.
- Coordinated care between emergency department, ICU, GI specialists, and interventional radiology is important to optimize outcomes for patients with LGIB.
Sinus Bradicardia on grade II dengue hemorragic fever.pptxSyahrulAdzim
This case report describes a 37-year-old man diagnosed with Grade II dengue hemorrhagic fever who presented with sinus bradycardia. Laboratory tests confirmed dengue infection and showed thrombocytopenia and elevated liver enzymes. Chest X-ray found left pleural effusion. The patient was treated conservatively with IV fluids, antiemetics, and analgesics. Dengue virus can cause myocardial inflammation and arrhythmias like bradycardia through direct viral invasion or immune mediated mechanisms. This case emphasizes that bradycardia is a common finding in dengue that results from the cardiac effects of the viral infection.
CHORIOCARCINOMA case & presntn-Dr.Mohammad.ashraful aminMohammad Asif
This document presents a case study of a 27-year-old female patient named Shila Rani who presented with symptoms of amenorrhea for 6 weeks, vomiting for 12 days, chest tightness for 12 days, and fever and weakness for 12 days. On examination, she appeared ill with respiratory distress. Tests revealed mild anemia, elevated white blood cell count and beta-HCG levels, suggestive of an ectopic pregnancy in the left ovary with metastasis to the lungs. She was diagnosed with choriocarcinoma and referred to an oncologist for chemotherapy with methotrexate.
Ulcerative colitis is a type of inflammatory bowel disease that causes long-lasting inflammation and ulcers in the lining of the large intestine. It commonly involves the rectum and may extend in a proximal and continuous fashion to involve other parts of the colon. Diagnosis involves colonoscopy, biopsy, and lab tests. Treatment depends on severity and may include medications to reduce inflammation, immunosuppressants, corticosteroids, or surgery to remove all or part of the colon. Complications can include toxic megacolon, colonic perforation, hemorrhage, strictures, and colon cancer with long-standing disease. Prognosis is generally good with treatment, though some patients may eventually require surgery.
Septic shock, updated presentation, including latest guidelines from Intensive care societies and how to approach to the diagnosis with few notes about Early Goal Directed Therapy and role of steroids
This case discusses a renal transplant recipient with a history of familial Mediterranean fever who presented with persistent fever, diarrhea, abdominal pain, and neurological symptoms. Initial workup ruled out infection as a cause. The patient's symptoms correlated with higher cyclosporine levels. Literature suggests there may be a pharmacokinetic interaction between cyclosporine and colchicine that increases free drug concentrations, potentially leading to toxicity. Reducing the cyclosporine dose addressed the patient's symptoms.
The document provides information about renal biopsies, including their definition, history, indications, contraindications, preparation, procedure, post-procedure care, complications, and discharge/follow-up. A renal biopsy is a procedure that obtains kidney tissue, typically using a needle, to help diagnose kidney diseases. It has become safer since the 1950s with the development of needle biopsies and imaging guidance. Key indications include unexplained kidney issues like proteinuria or injuries. Risks include bleeding, but most complications are minor and self-limiting. Patients are monitored after the procedure and advised on follow-up care.
A case of an ovarian tumour pre-operatively thought to be malignant, which was per-operatively diagnosed as benign and later confirmed as a mucinous cystadenoma.
Ob-Gyn Department, BIRDEM-2 General Hospital, Shegunbagicha, Dhaka, Bangladesh
The first document describes two emergency cases seen at the hospital on October 6th, 2022. The first case involves a 37-year-old man brought to the emergency department for worsening lethargy and abdominal pain. On examination, he appears weak with low blood pressure and pale conjunctiva. The second case involves a 3-year-old girl brought to the emergency department for intermittent abdominal pain and vomiting blood. On examination, she appears weak with a palpable mass in her right lower abdomen. The tutor leads a discussion on identifying and discussing the problems in these cases chronologically while considering all possible diagnoses. References are also provided for some laboratory results.
case presentation Dr. Neveen Nabeeh >>> 14 Annunal Meeting of Nephrology Dep...Ahmed Albeyaly
A 35-year-old female presented with a painful rash, fever, decreased urine output, and weakness for one month. Examination found purpuric lesions and splenomegaly. Labs showed kidney injury, low platelets, and cryoglobulins. A skin biopsy found leukocytoclastic vasculitis. She was diagnosed with mixed cryoglobulinemia and kidney involvement. She received treatments including plasmapheresis, steroids, cyclophosphamide, and antivirals.
This case presentation describes a 27-year-old female who presented with decreased urine output, swelling of the face and feet, anorexia, and vomiting two days after a cesarean section. Laboratory investigations revealed thrombocytopenia, microangiopathic hemolytic anemia, and acute kidney injury. A renal biopsy showed features of thrombotic microangiopathy. She was diagnosed with postpartum atypical hemolytic uremic syndrome (aHUS). Treatment included plasma exchange, hemodialysis as needed, and supportive care. Her clinical parameters improved with treatment and she was discharged after three weeks.
This document summarizes a presentation on Clostridium difficile infection (CDI). The objectives are to identify risk factors for CDI, explain diagnosis and management, compare current practices to guidelines, and discuss prevention. It then presents a case report of an elderly male patient with chronic diarrhea possibly related to antibiotic use. His symptoms improved with metronidazole and vancomycin treatment over 10 days per guidelines. The discussion covers CDI epidemiology, pathogenesis, risk factors, treatment options including the potential need for dual therapy, and issues like antibiotic resistance.
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3. (1) High grade fever for 15 days.
(2) Right upper abdominal pain for same duration.
(3) Lack of appetite , nausea, vomiting for same
duration.
The temperature was 104°F, Blood pressure 120/70 mm
Hg, and heart rate 100 beats per minute, Jaundice (++),
Hyperaesthesia present over right hypochondriac
region, mild dull aching upper abdominal pain and
tenderness over the back. The other physical
examinations were normal.
In the winter of 2016, a 36-year-old man admitted in our hospital
through emergency department with the complaints of
5. The presumed diagnosis was Liver
abscess with DM.
The patient was treated with Intravenous fluids,
Injectable Ondansetron, Ceftazidime,
Metronidazole, Omeprazole, Tiemonium
Methylsulphate ,Short and long acting Insulin.
7. In the next morning, we got some additional laboratory data
obtained last evening
(1) Serum electrolytes Na+ 131, K+ 4.9, Cl- 93.2 mmol/l
(2) Creatinine 1.1 g/dl ( 0.6 to 1.3 )g/dl
(3) ALT (SGPT) 24 U/l (normal range, up to 40 IU/l),
(4) AST 19 U/l (normal range, 8 – 41 IU/l)
(5) Bilirubin 2.7 mg /dl (0.2 – 1.1 mg/dl)
(6) Alkaline Phosphatase 222.47 IU/lL( 30-120 IU/L)
(7) Serum Amylase 59 U/L ( 0- 130U/L) , Lipase 110 U/L
(0-160U/L)
8. • Hospital admission ?
• What would be the
possibilities?
1. Hepatitis- Alcohol/Viral/
Idiosyncratic drug
reaction.
2. Malaria
9. The next second morning we had review of the case.
Fever ( 102°F) and abdominal pain was slightly
subsided. There was no vomiting in last 24 hrs.
He reported no alcohol use, drug abuse, blood
transfusion, physical contact or travelling to
malaria endemic zone .
The blood pressure was 120/85 mm Hg.
10. (1) Hb level 8.5 g/dl, WBC count 12,000/cumm with 70%
neutrophils and, platelet count 3,30,000/cumm of blood.
(2) HBsAg (0.050) Negative.
(3) Anti HCV (0.061) Negative.
(4) Total bilirubin level 2.0 mg/dl
(5) Prothombin time of patient 20.4 sec and control 13.0. INR
1.56
(6)FBS 8.6 mmol/l, 2HABF 10 mmol/l
(7) ICT Malaria – Negative. Blood for MP – Not detected.
(8) CXR- Normal
11. USG of whole abdomen shows one irregular
hypoechoic lesion ( 6.8x 3.6 cm) in right lobe.
No ascites or pleural effusion is seen.
Comment: SOL in right lobe of liver.
13. During further evaluation, patient reveals some past history
Which he didn’t mentioned earlier…..
He had a similar kind of illness while he was working
abroad (Malaysia) 6 months back. For that he got
admitted in the hospital there and they did several
investigations and gave him injectable medications.
But he failed to show any related documents except
one paper.
(1) He was febrile.( 102°F)
(2) His blood pressure was 130/80mm Hg.
(3) The remainder of his physical examination was
normal.
14. (1) AFP 1.90 ng/ml ( < 8.5 )
(2) CEA 9.33 ng/ml ( Up to non smoker 5, smoker 10 )
(3) CA- 19-9 = 29.21 U/ml ( <40.0 )
(4) CRP 20, (< 6)
(5) Video Colonoscopy - Normal rectum and colon at
colonoscopy
(6) Blood for C/S – No growth.
(8) CT Scan of Upper Abdomen
a) Mild Hepatomegaly, b) Multiple indistinct hypodense SOL.
17. In recalling the precise moment and investigations
from Malaysia
(1) USG of Whole Abdomen – Partially liquefied
liver abscess at segment VII and VIII, measuring
8.9 (AP) x 4.9 cm (W). (26/6/2016)
(2) USG of whole Abdomen- Partially liquefied
liver abscess involving segment VII and VIII 10.9x
5.7 cm. A new irregular hypoechoic lesion in the
spleen likely splenic abscess.( 08/07/2016)
Melioidosis serology IgM : Positive (1: 320)
18. • What should be the next Plan?
How should we approach the case?
19. Next plan and approaches ……….
Consultation given to the Surgery department
Surgery Department examined the patient, Gave
advice to transfuse one unit whole blood after proper
grouping, crossmatching and adviced some
investigations…….
USG of whole abdomen (Review) – Liver normal in
size, Two mixed hypoechoic cystic masses, measuring
about vol. 49cc , seen in the anterior superior aspect
of right lobe of liver.
Spleen – Few tiny cysts noted.
Impression – (1) Liver abscess. (2) Tiny splenic cysts.
20. USG guided Catheter drainage done under
L/A…….
23. History
• 1912, Alfred Whitmore
• Burma
• Organism isolated
in humans
− Glanders-like disease
− No equine exposure
− Colony growth differed
from glanders
− “Whitmore” disease Alfred Whitmore 1876-1941
Center for Food Security and Public Health
Io
• The name melioidosis is derived from Greek word ‘melis’
meaning a distemper of asses with suffixes ‘oid’meaning similar
to and ‘osis’ meaning a condition that is, a condition similar to
glanders.
24. History
• 1913, Malaysia
• Stanton and Fletcher
• “Distemper-like”
outbreak in animals
• Pioneered serological
tests
Ambrose
Thomas
Stanton
Center for Food Security and Public Health Io
William
Fletcher
25. History
• 1948-1954, Indo-China
− Over 100 French soldiers
• 1973, Vietnam
− Over 300 American soldiers
− “Vietnamese time bomb”
Infections reoccurred after latent period
− Military dogs in Vietnam also affected
Fever, myalgia, dermal abscesses
Center for Food Security and Public Health
Io
26. History
Center for Food Security and Public Health
Io
• 1970’s, France
− Numerous horses and zoo
animals affected
− Melioidosis in temperate climates
• 1989
− Effective antibiotic treatment
• Thailand had reported the highest number of cases, with an estimated 2000
to 3000 cases of melioidosis each year.
27. Epidemiology
• Melioidosis is predominately a disease of tropical
climates.
• It is endemic in Southeast Asia, northern Australia and
Brazil.
• Northeast Thailand has the highest incidence of
melioidosis.
• Septicemic meliodosis has high mortality, 87% in
Thailand, 75% in East Malaysia, 39% in Singapore and
19% inAustralia.
• Localised melioidosis has lower mortality.
(Mustafa, Murtaza, et al. "Clinical manifestations, diagnosis, and treatment of
Melioidosis." IOSR Journal of Pharmacy 5(2015): 13-19).
29. In 1964, melioidosis was reported in a
foreign sailor who was travelling through
Bangladesh [7]. However, the first case of
melioidosis in Bangladesh was diagnosed
in a native Bangladeshi infant in
1988 [8]. Later on several cases of
melioidosis were reported up to 2014 [9].
Melioidosis presenting as septic arthritis
in Bengali men in East London
Article · October 1999 with 3
ReadsDOI:10.1093/rheumatology/38.10.
1029a
Burkholderia
pseudomallei: Its
Detection in Soil and
Seroprevalence in
Bangladesh
Article · January 2016
with 81 ReadsDOI:
10.1371/journal.pntd.000
4301
Disseminated
Meliodosis presenting
as septic shock: an
endemic disease of
Bangladesh
Article · February 2015
with 9 Reads
30. Melioidosis in Bangladesh
• 22 cases were identified, among them 19 were
published in different journals and 3 local cases
are yet to be published
Retrospective analysis of
meliodosis (1988-2015)
• 21 were diabetic and 18 were male. 16 cases
were classified as endemic while 6 cases were
reported as returning travelers from Bangladesh.
Results
• Lung involvement (8, 36.3%) and organ abscess (6,
27.2%).
Common Organ
involvement
• 14 cases responded to
ceftazidime/imipenem/meropenum
combination of doxycycline and trimethoprim-
sulfamethoxazole or amoxicillin-clavulanic acid.
In 3 cases treatment was not mentioned and 5
patients died despite of treatment.
Treatment Outcome
Uddin K.N., Afroze S.R., Rahim M.A., Barai L., Haq J.A.
BIRDEM General Hospital and Ibrahim Medical
College, Dhaka, Bangladesh
33. • Successfully abscess drained and pus sent for culture at
BIRDEM Hospital
BIRDEM – Growth of Burkholderia pseudomallei.
Aztreonam S
Ceftazidime S
Ciprofloxacin S
Co-Ttimoxazole S
Imipenem S
Tazobactum + Pipercillin S
Tetracycline S
35. Final Diagnosis
• Melioidosis
• Rx
• Inj. Ceftazidime (2gm) i/v 8 hrly.
For 21 days, followed by Cap. Doxycycline
200 mg with Tab. Co-trimoxazole (S –
1600mg plus T- 320mg) for 12 weeks.
36. • Follow up of the patient after
complete the treatment…….
CBC
• Hb 9.6gm/dl,
WBC- 6.7 K/ʯl,
Neutrophil –
29.0%.
Bilirubin,
SGPT, CRP
• Bilirubin 0.61
mg/dl
• SGPT 32 U/l
• CRP < 6
USG of Whole
abdomen
• Normal
findings.
40. Mode of Transmission
1. Inhalation
2. Ingestion
3. Inoculation
4. breast milk
5. perinatal
6.human to human uncommon
41. Clinical manifestations
A shows cutaneous melioidosis in a healthy host.
B shows lung abscesses on the chest radiograph of a patient with acute melioidosis
pneumonia.
C shows the corresponding computed tomographic (CT) scan.
D shows the skin manifestations in a fatal case of disseminated melioidosis.
E shows splenic abscesses on an abdominal CT scan.
F shows aspirated pus in a patient with prostatic and periprostatic abscesses, and
G shows the abscesses on a CT scan from the patient.
43. Clinical manifestation
• Pulmonary infection
• Skin ulceration
• Lymphadenopathy
• Manifestations are exacerbated long after the exposure;
hence called as Vietnam time bomb disease.
44. Laboratory diagnosis
• Sample collection
1. Sputum
2. BAL
3. Blood or bone marrow
4. Urine and a
5. Throat swab
6. Pus and
7. Wound swab
8. Skin lesions
9. Rectal swab
45. Gram stain
• Gram stain:
• B. pseudomallei is a
Gram-negative bacillus.
• Measures about 2–5 μm in
length and 0.4–0.8 μm in
diameter.
• It frequently does not
show bipolar-staining on
Gram stain, but it is often
pleomorphic and usually
stains slightly unevenly.
46. Culture
• B. pseudomallei is not fastidious and grows on a
large variety of culture media (blood
agar, Chocolate agar, MacConkey agar, etc.).
• Ashdown's medium may be used for selective
isolation.
• Cultures typically become positive in 24 to 48 hours
47. Colony morphology:
• Smooth, creamy, white colonies on BA at 24 hrs
• Some may be mucoid or become dry and wrinkled
at 48 - 72 hrs
• Pink colonies on MA agar at 24 - 48 hrs or colorless
colonies at 48 hrs
48. Selective medium (Ashdown medium)
• Contains crystal violet and gentamicin as selective
agents.
• It is also enriched with 4% glycerol, which is
required by some strains of B. pseudomallei to
grow.
• It usually produces flat wrinkled purple colonies.
• Colonies will also exhibit an earthy odor.
• The colony appears irregular-edge, rough and pale
purple.
49. Biochemical test
• Catalase = Positive
• Oxidase = Positive
• Indole = Negative
• Motility = Positive
• Triple Sugar Iron (TSI) = K/NC
• Colistin/Polymyxin B = Resistant (no zone)
52. Serology
• Strains of B.
pseudomallei are
identified serologically
by agglutination tests,
rapid slide or tube
agglutination
• Recently ELISA based
on monoclonal antitoxin
is avialble for rapid
diagnosis in endemic
areas of melioidosis.
53. Latex agglutination test
• Initial screening of suspected colonies from any agar medium
is undertaken by latex agglutination using latex particles
coated with antibodies specific for the 200-kDa
exopolysaccharide of B. pseudomallei.
Method:
• Pipette 10 μl of control and test latex onto a glass slide
• Note: Controls do not have to be tested with every sample but
should be run in tandem on each testing day.
• Using a toothpick, touch the suspected colony and emulsify
the colony in the test latex.
• Rotate the samples to mix to allow the reaction to occur.
54. Interpretation:
• Agglutination (positive) may be rapid or may take
up to 20 secs.
• Observe for at least 2 mins before declaring the
status of the sample as positive or negative.
55. • Indirect hemaggultination test (IHA).
• Various enzyme-linked immunosorbent assays
(ELISA),and other serological assays are also
available.
• PCR (polymerase chain reaction) which has also
been evaluated to detect B. pseudomallei genome in
pus, sputum, and other specimens.
57. Treatment
• B. pseudomallei is intrinsically resistant to many
antibiotics, including aminoglycosides and early
betalactams (penicillin, ampicillin, first and second
generation cephalosporins, gentamicin, tobramycin,
and streotomycin).