A 77-year-old man with arterial hypertension and dyslipidaemia, treated with olmesartan/hydrochlorothiazide and simvastatin, was admitted with a 3-week history of anorexia, nausea, vomiting, profuse diarrhoea and weight loss. He was dehydrated and blood tests showed acute kidney injury. The aetiological study was inconclusive. The patient had a favourable clinical evolution during hospitalization and was discharged. However, after about 10 days at home, he was re-admitted to hospital with the same clinical presentation. It was noticed that olmesartan had not been prescribed during the previous admission but had been restarted on an outpatient basis. Biopsy examination showed duodenal mucosa with villous atrophy and polymorphic inflammatory infiltrate. Antibody testing for coeliac disease was negative. Based on these facts, it was hypothesized that the patient had olmesartan-induced enteropathy, which was subsequently confirmed.
The authors present a case of purulent pericarditis probably secondary to respiratory infection, a rare entity in the antibiotic era. Pericardial fluid analysis identified streptococci and oral anaerobes as the causative agents. A prolonged and complicated diagnostic and therapeutic course, which included a long stay in the intensive care unit, is described, and a review of purulent pericarditis provided. Pericardial effusion, particularly in the setting of concomitant respiratory infection and immunocompromise or other risk factors, should raise the suspicion of bacterial pericarditis and prompt its timely diagnosis and treatment. Purulent pericarditis can be lethal and has potentially severe complications, so adequate antimicrobial therapy and source control are key.
A woman in her early 40s, with a history of excessive alcohol intake, presented with purpuric, ulcerative lesions on the lower limbs. On examination, hirsutism and generalized stiffening and thickening of the skin were noted. Laboratory investigations revealed hyperbilirubinemia, hypergammaglobulinemia and positive anti-smooth muscle antibodies. Histologic examination of the skin was compatible with scleroderma. Histologic examination of the liver was suggestive of autoimmune and alcoholic hepatitis.
Background and objectiveHealthcare-associated ventriculitis and meningitis (HAVM) is frequent in neurocritical patients and associated with significant mortality. Surgery and intracranial devices are usually necessary and may lead to infection. Classical clinical signs and cerebral spinal fluid (CSF) analysis may be unreliable. The purpose of this study was to characterize the prevalence of HAVM, risk factors, and interventions in the neurocritical population admitted in the ICU. MethodsThis was a retrospective single-center analysis of all adult neurocritical patients admitted to an ICU during a three-year period. ResultsA total of 218 neurocritical patients were included. The prevalence of HAVM was 13% and it was found to be associated with mortality. When suspected, it was not possible to exclude HAVM in 30% of the patients. HAVM was significantly associated with surgery, surgical reintervention, and brain devices. Sustained fever was the most frequent clinical sign, and it was significantly associated with unexcluded HAVM. CSF cell count was significantly higher in HAVM, though without microbiological isolation in most of the cases. ConclusionBrain damage, interventions, and devices may significantly alter cerebral homeostasis. Sustained fever is very frequent and may be attributed to several conditions. CSF cell count is useful for the diagnosis of HAVM. HAVM is a clinical challenge in the management of neurocritical patients with important therapeutic and prognostic implications.
Introduction:Helicobacter pylori infection is very prevalent worldwide and is associated with the progression of the gastric carcinogenesis cascade, being one of the main risk factors for the development of gastric carcinoma. Several factors are determinant for the infection and for the development of gastric disease, including environmental factors, host genetic factors and virulence factors of the bacteria. Material and Methods:In this review, we present an overview of the current knowledge on the determinants of the infection and on the recently described molecular mechanisms of Helicobacter pylori adhesion to the gastric mucosa, as well as its possible future therapeutic application. Results:The adhesion of Helicobacter pylori to the gastric epithelium is critical for gastric pathogenesis, allowing bacterial access to nutrients and the action of bacterial virulence factors, promoting recurrence of the infection and the progression of the gastric carcinogenesis pathway. Discussion: Eradication of Helicobacter pylori infection is the best preventive strategy available against gastric cancer, mainly if it is achieved before the development of pre-neoplastic lesions. The increase in antibiotics resistance, together with the eradication failures in some patients, has promoted the development of alternative treatments. Conclusion:The new therapeutic strategies, focused on the molecular mechanism of Helicobacter pylori adhesion, are very promising;however, future studies are needed to evaluate its in vivo efficiency and toxicity.
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