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BMJ Case Reports Sep 2023, are gram-positive, non-spore forming anaerobic or microaerophilic species. Empyema due to actinomycosis is relatively rare and can be difficult to diagnose as the...
, are gram-positive, non-spore forming anaerobic or microaerophilic species. Empyema due to actinomycosis is relatively rare and can be difficult to diagnose as the presenting symptoms may be indolent and the micro-organism may be difficult to culture. This case report describes a patient presenting with dyspnoea, weight loss and lethargy. The chest radiograph, CT and thoracic ultrasound revealed a left-sided pleural effusion. A chest drain was inserted under ultrasound guidance. The pleural fluid was macroscopically consistent with pus and microbiology showed growth of gram-positive bacilli, as well as the species. The patient was treated with a drainage of the pleural fluid, a prolonged course of antibiotics and made a good recovery. The awareness that the species and the species through their synergistic interaction may cause empyema, may lead to a timely diagnosis and treatment.
Topics: Humans; Actinomycosis; Anti-Bacterial Agents; Chest Tubes; Empyema; Fusobacterium
PubMed: 37714555
DOI: 10.1136/bcr-2022-252867 -
Medicine Jun 2023Orexin, also known as hypocretin, is an excitatory neuropeptide secreted by the hypothalamus. Orexin is divided into orexin-A (OXA) and orexin-B (OXB), which are derived... (Review)
Review
Orexin, also known as hypocretin, is an excitatory neuropeptide secreted by the hypothalamus. Orexin is divided into orexin-A (OXA) and orexin-B (OXB), which are derived from a common precursor secreted by hypothalamic neurons. Orexin acts on orexin receptor-1 (OX1R) and orexin receptor-2 (OX2R). Orexin neurons, as well as receptors, are widely distributed in various regions of the brain as well as in the peripheral system and have a wider range of functions. This paper reviews the latest research results of orexin in the aspects of food intake, sleep, addiction, depression and anxiety. Because orexin has certain physiological functions in many systems, we further explored the possibility of orexin as a new target for the treatment of bulimia, anorexia nervosa, insomnia, lethargy, anxiety and depression. It is precisely because orexin has physiological functions in multiple systems that orexin, as a new target for the treatment of the above diseases, has potential contradictions. For example, it promotes the function of 1 system and may inhibit the function of another system. How to study a new drug, which can not only treat the diseases of this system, but also do not affect other system functions, is what we need to focus on.
Topics: Humans; Orexins; Orexin Receptors; Cognition; Brain; Anxiety
PubMed: 37390267
DOI: 10.1097/MD.0000000000034206 -
Euroasian Journal of... 2023Autoimmune hepatitis (AIH) accounts for cases of chronic liver disease with greater incidence in females than males. It has a bimodal distribution in the age group...
UNLABELLED
Autoimmune hepatitis (AIH) accounts for cases of chronic liver disease with greater incidence in females than males. It has a bimodal distribution in the age group peaking around pubertal periods and later in the fourth to sixth decade of life. It is characterized by continual hepatocellular inflammation and necrosis which bears the potential to progress to fibrosis and cirrhosis. Approximately a third of the patients manifest with features of acute hepatitis while some patients may progress to chronic liver disease with acute liver failure manifesting in the form of jaundice and coagulopathy. Management has long involved administration of corticosteroids alone or in association with other immunosuppressants like azathioprine to achieve long-term remission. Response to therapy is significantly variable as few patients achieve remission while some may relapse, thereby becoming candidates requiring lifelong therapy. It can either present as insidious onset or acute with manifestations ranging broadly from fatigue malaise, lethargy right upper quadrant pain weight loss anorexia, and jaundice, where up to one-third of patients may have progressed to frank cirrhosis at the time of diagnosis. A 62-year female presented with complaints of facial puffiness more around the eyes, associated with profoundly reduced appetite, yellowish discoloration of the skin, conjunctiva since 1 month, and sudden onset generalized itching not associated with fever, joint pains, weight loss, vomiting, loose stools, rash, or bleeding manifestations. She was admitted for further evaluation and workup. Liver function test revealed predominant unconjugated hyperbilirubinemia with direct bilirubin of 0.7 mg/dL and indirect bilirubin of 1.6 mg/day and transaminitis. Further investigations showed significantly elevated immunoglobulin G (IgG) and 1:80 titer of antinuclear antibodies (ANAs). In view of the high suspicion of autoimmune etiologies, the patient was subjected to a liver biopsy that confirmed cirrhosis with moderate interface hepatitis in the background of negative viral serologies and substance abuse history. She was started on a steroid course on a monthly follow-up basis to ensure biochemical remission.
HOW TO CITE THIS ARTICLE
Fatima R, Mohammed V, Fatima A, . Case of Autoimmune Hepatitis. Euroasian J Hepatogastroenterol 2023;13(2):166-168.
PubMed: 38222952
DOI: 10.5005/jp-journals-10018-1413 -
RoFo : Fortschritte Auf Dem Gebiete Der... Apr 2024Patients with Alzheimer's disease (AD) can now be treated with monoclonal antibodies aiming at clearing amyloid plaques from the brain parenchyma. Weeks after initiation...
Patients with Alzheimer's disease (AD) can now be treated with monoclonal antibodies aiming at clearing amyloid plaques from the brain parenchyma. Weeks after initiation of this drug therapy, patients may develop so-called amyloid-related imaging abnormalities (ARIA) on MRI. ARIA comprise vasogenic edema and leptomeningeal effusions (ARIA-E) as well as microbleeds and superficial hemosiderosis (ARIA-H). The prevalence is drug- and dose-dependent (up to 40 % of patients), the apolipoprotein E4 variant and concomitant cerebral amyloid angiopathy (CAA) increase the risk. With regard to MRI characteristics, ARIA strongly resembles the so-called inflammatory subtype of CAA (CAA-ri). While patients with CAA-ri are typically detected due to symptoms such as headaches, lethargy, confusion, and rarely epileptic seizures, around 20 % of ARIA patients show symptoms. Management of ARIA is not yet clearly established. In asymptomatic patients, discontinuation of the drug might be sufficient. KEY POINTS: · Amyloid-related imaging abnormalities (ARIA) occur in around 20 % of patients who are treated with monoclonal antibodies against amyloid β.. · There are 2 types: ARIA-E (edema effusion) und ARIA-H (hemorrhage).. · Depending on the severity, therapy with monoclonal antibodies is either interrupted or finished.. CITATION FORMAT: · Urbach H, Linn J, Hattingen E et al. Imaging of Amyloid-Related Imaging Abnormalities (ARIA). Fortschr Röntgenstr 2024; 196: 363 - 369.
Topics: Humans; Amyloid beta-Peptides; Alzheimer Disease; Cerebral Amyloid Angiopathy; Magnetic Resonance Imaging; Antibodies, Monoclonal; Edema
PubMed: 37995736
DOI: 10.1055/a-2185-8472 -
Veterinary Surgery : VS Nov 2023To report small intestinal herniation through the epiploic foramen in a dog.
OBJECTIVE
To report small intestinal herniation through the epiploic foramen in a dog.
ANIMALS
Nine-year-old male castrated Shih Tzu.
STUDY DESIGN
Case report.
METHODS
The dog presented with an 8-year history of vomiting and regurgitation and acute onset of melena, lethargy, anorexia, anemia, and suspected gastrointestinal mass or obstruction on prereferral imaging. Abnormalities on abdominal radiographs included a large, midcaudal soft tissue structure and cranial displacement and segmental dilation of the small intestine. On abdominal ultrasound, severe gastric dilation, jejunal tortuosity and stacking, and peritoneal effusion were observed. Epiploic herniation of the small intestine and segmental jejunal devitalization was diagnosed on exploratory laparotomy, and the dog underwent hernia reduction, jejunal resection and anastomosis, and nasogastric tube placement.
RESULTS
Severe gastric distention and atony persisted 24 h after surgery, despite medical management. The dog was taken to surgery for decompressive gastrotomy and placement of gastrostomy and nasojejunostomy tubes for postoperative decompression and feeding, respectively. Three days after the original surgery, the dog developed a septic abdomen from anastomotic dehiscence and underwent jejunal resection and anastomosis and peritoneal drain placement. Gastric dysmotility gradually resolved with the administration of motility stimulants, removal of gastric residual volume, and nutritional support via nasojejunostomy tube feedings. Three months after discharge, the dog was clinically normal.
CONCLUSION
Epiploic foramen entrapment should be considered a type of herniation in dogs. Clinical suspicion should be raised in dogs with unresolving regurgitation and vomiting, visceral displacement, and stacking and distension of small intestine.
Topics: Male; Dogs; Animals; Intestine, Small; Jejunum; Gastrostomy; Laparotomy; Vomiting; Intestinal Obstruction; Dog Diseases
PubMed: 37293954
DOI: 10.1111/vsu.13975 -
JAMA Jul 2023
Topics: Child; Humans; Cysts; Liver Diseases; Lung Diseases
PubMed: 37418277
DOI: 10.1001/jama.2023.11834 -
NeoReviews Nov 2023
Topics: Infant, Newborn; Humans; Muscle Hypotonia; Lethargy
PubMed: 37907399
DOI: 10.1542/neo.24-11-e733 -
Archives of Disease in Childhood Nov 2023Adrenal insufficiency (AI) is characterised by lack of cortisol production from the adrenal glands. This can be a primary adrenal disorder or secondary to... (Review)
Review
Emergency and perioperative management of adrenal insufficiency in children and young people: British Society for Paediatric Endocrinology and Diabetes consensus guidance.
Adrenal insufficiency (AI) is characterised by lack of cortisol production from the adrenal glands. This can be a primary adrenal disorder or secondary to adrenocorticotropic hormone deficiency or suppression from exogenous glucocorticoids. Symptoms of AI in children may initially be non-specific and include growth faltering, lethargy, poor feeding, weight loss, abdominal pain, vomiting and lingering illnesses. AI is treated with replacement doses of hydrocortisone. At times of physiological stress such as illness, trauma or surgery, there is an increased requirement for exogenous glucocorticoids, which if untreated can lead to an adrenal crisis and death. There are no unified guidelines for those <18 years old in the UK, leading to substantial variation in the management of AI. This paper sets out guidance for intercurrent illness, medical, dental and surgical procedures to allow timely and appropriate recognition and treatment of AI and adrenal crisis for children and young people.
Topics: Child; Humans; Adolescent; Consensus; Adrenal Insufficiency; Hydrocortisone; Glucocorticoids; Diabetes Mellitus
PubMed: 37045585
DOI: 10.1136/archdischild-2022-325156