The study aimed to test the inflammation hypothesis in antiphospholipid syndrome (APS) by assessing biochemical markers of inflammation and platelet activation. Forty one patients with APS were compared to 40 controls. High-sensitivity C-reactive protein (hs-CRP) (as inflammatory biomarker), P-selectin and soluble CD40L (sCD40L) (as platelet activation markers) were measured by ELISA at enrolment and after 12 months follow-up. Serum hs-CRP, P-selectin and sCD40L levels were significantly higher in patients with APS compared to controls. P-selectin was significantly higher in APS patients with recurrent or acute thrombosis compared to APS patients with no recurrent thrombotic events. Serum hs-CRP and anticardiolipin antibodies (aCL) and were independent predictors of thrombosis in APS. In conclusion, persistent increased hs-CRP titres demonstrated low-grade inflammation in APS. Serum biomarkers as aCL and hs-CRP were independent thrombotic cumulative risk predictors in patients with APS.
Myasthenia gravis (MG) is a chronic autoimmune neuromuscular disease affecting the neuromuscular junction and causes weakness in the skeletal muscles. The acetylcholine receptor is usually attacked in skeletal muscles, but other components of neuromuscular junction, such as muscle-specific receptor tyrosine kinase, may be affected. MG can be life-threatening when the respiratory muscles are involved. The first symptom in about 2 out of 3 cases is the damage of the extrinsic eye muscles. The condition is treatable, so an early recognition is needed. Although there have been reports of associations between psychosis and myasthenia gravis it is unclear if psychotic symptoms in MG are an integral part of the various manifestations of this disease, or are due to another co-occurring distinct disorder. Sometimes psychotic episodes could disguise the simptoms of myastenia gravis, and delay the diagnosis.
We present a case of type I negative pressure pulmonary edema in a healthy 17-year-old boy who underwent an emergent appendectomy under general anesthesia. The particularity of our case revolves around the administration of meperidine for perioperative shivering, along with other anesthetic risk factors, which may have served as the trigger of type I negative pressure pulmonary edema.We present the pathophysiological mechanisms, the formulation of clinical and paraclinical diagnosis and the principles of intensive care therapy. This was the first such case experienced in our practice, with a remarkable learning opportunity.Negative pressure pulmonary edema (NPPE) is an acute, potentially life threatening, uncommon perioperative pathological entity. Two clinical types have been described: type I NPPE, associated with acute airway obstruction, and type II NPPE, associated with chronic partial upper airway obstruction. An early differential diagnosis between various pulmonary edema conditions in critically ill patients and a prompt recognition of high risk of acute morbidity are crucial in certain circumstances. We present a case of type I NPPE in a healthy 17-year-old boy who underwent an emergent appendectomy under general anesthesia. The particularity of our case revolves around the administration of meperidine, along with other anesthetic risk factors, which may have served as the trigger of NPPE. Experimental part Study case presentationA 17-year-old male patient without medical history presented with acute appendicitis. After evaluation in the emergency department, he was admitted for emergency appendectomy. His preoperative physical examination and laboratory tests were within normal limits except for neutrophilic leukocytosis.Physical status: height (H) = 1.60 m; weight (W) = 50 kg; body mass index (BMI) = 19.53 kg/m 2 ; airway assessment by Mallampati classification of oral opening -Mallampati I.Cardiovascular status: blood pressure (BP) = 117/59 mmHg; heart rate (HR) = 75 bpm; heart auscultationnormal.Respiratory status: chest auscultation was clear bilaterally, without murmurs. His baseline pulse oximetry arterial blood oxygen saturation (SpO 2 ) was 99% on room air, with a fraction of inspired oxygen (FiO 2 ) of 0.21. * email: claudiagavris@yahoo.com, Phone: +40723791322; vlader2000@yahoo.com, Phone: +40723271972 Laboratory blood investigations: hemoglobin (Hgb) = 15.2 g/L; hematocrit (Hct) = 42%; leukocytes (L) = 9,450/ µL (neutrophils = 90%); platelets (PLT) = 221,000/µL; activated partial prothrombine time (aPTT) = 24.4 s; international normalized ratio (INR) = 1.09; serum proteins = 71 g/L; fibrinogen = 3.22 g/L; C-reactive protein (CRP) = 11.3 mg/L; glycemia = 110 mg/dL; serum Na + = 135 mmol/L; serum K + = 4.1 mmol/L; serum Cl -= 98,5 mmol/ L; serum total calcium = 9.43 mg/dL; serum Mg + = 1.81 mg/dL; aspartate aminotrasferase (AST) = 20 U/L; alanine aminotransferase (ALT) = 18 U/L; lactate dehidrogenase (LDH) = 374 U/L; blood urea nitrogen (BUN) = 33.3 mg/ dL; creatinine = 1.06 mg/dL.The patient w...
The use of long-acting injectable antipsychotics (LAIs) is considered to be an important treatment option, especially in early stages of schizophrenia. The aim of this study was to evaluate the efficacy, safety and sustained remission in schizophrenia patients treated with three of the available LAIs substances: olanzapine pamoate, risperidone microspheres and aripiprazole monohydrate. A retrospective chart review study evaluating the efficacy of LAIs compared to oral antispychotics during a five years period was performed. Of the 102 patients included in the study, 52 (50.9%) continued LAIs: olanzapine pamoate (n = 20, 38.4%), risperidone microsphere (n = 22, 42.3%), aripiprazole monohydrate (n = 10, 19.3%). In the LAIs group the number of relapses was smaller than in the oral antipsychotics group (12 vs. 23, P [ 0.05) as well as the number of admissions (15 vs. 30, P [ 0.05). In conclusion, relapse in schizophrenia is strongly related to nonadherence. LAIs prescription overall was underutilized despite their efficacy. Future randomized studies are needed to evaluate the long term efficacy of LAIs compared to oral treatment.
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