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Ton MD, Phuong DV, Tho PQ, Dung NT, Tuan TA, Thien NT. Management of ruptured aneurysmal subarachnoid hemorrhage with multiple basilar trunk aneurysms using a flow-diverter stent: A case report. Radiol Case Rep 2024; 19:2629-2632. [PMID: 38645949 PMCID: PMC11026529 DOI: 10.1016/j.radcr.2024.03.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/10/2024] [Accepted: 03/13/2024] [Indexed: 04/23/2024] Open
Abstract
Ruptured aneurysmal subarachnoid hemorrhage associated with multiple basilar trunk aneurysms represents a rare clinical condition. Endovascular intervention stands as the preferred therapeutic approach. We present the case of a 35-year-old patient with subarachnoid hemorrhage and three consecutive basilar trunk aneurysms. Utilizing a flow-diverter stent, we achieved simultaneous occlusion of all 3 aneurysms, performed 2 hours post dual antiplatelet therapy (comprising salicylic acid 300 mg and ticagrelor 180 mg). Sustained resistance to clopidogrel necessitated the subsequent 3 months, followed by single antiplatelet therapy. At the 1-month follow-up, the patient demonstrated a favorable clinical course, devoid of cerebral infarction, and evidenced unobstructed stent patency upon brain magnetic resonance imaging.
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Affiliation(s)
- Mai D. Ton
- Stroke Center, Bach Mai Hospital, 78 Giai Phong Street, Dong Da District, Hanoi, Vietnam
- Hanoi Medical University, No 1, Ton That Tung Street, Dong Da District, Hanoi, Vietnam
- VNU University of Medicine and Pharmacy; 144 Xuan Thuy Street, Cau Giay District, Hanoi, Vietnam
| | - Dao V. Phuong
- Stroke Center, Bach Mai Hospital, 78 Giai Phong Street, Dong Da District, Hanoi, Vietnam
- Hanoi Medical University, No 1, Ton That Tung Street, Dong Da District, Hanoi, Vietnam
- VNU University of Medicine and Pharmacy; 144 Xuan Thuy Street, Cau Giay District, Hanoi, Vietnam
| | - Pham Q. Tho
- Stroke Center, Bach Mai Hospital, 78 Giai Phong Street, Dong Da District, Hanoi, Vietnam
| | - Nguyen T. Dung
- Stroke Center, Bach Mai Hospital, 78 Giai Phong Street, Dong Da District, Hanoi, Vietnam
- Hanoi Medical University, No 1, Ton That Tung Street, Dong Da District, Hanoi, Vietnam
- VNU University of Medicine and Pharmacy; 144 Xuan Thuy Street, Cau Giay District, Hanoi, Vietnam
| | - Tran A. Tuan
- Stroke Center, Bach Mai Hospital, 78 Giai Phong Street, Dong Da District, Hanoi, Vietnam
- VNU University of Medicine and Pharmacy; 144 Xuan Thuy Street, Cau Giay District, Hanoi, Vietnam
- Radiology Center, Bach Mai Hospital, 78 Giai Phong Street, Dong Da District, Hanoi, Vietnam
| | - Nguyen T. Thien
- Radiology Center, Bach Mai Hospital, 78 Giai Phong Street, Dong Da District, Hanoi, Vietnam
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Addo-Yobo E, Anh DD, El-Sayed HF, Fox LM, Fox MP, MacLeod W, Saha S, Tuan TA, Thea DM, Qazi S. Outpatient treatment of children with severe pneumonia with oral amoxicillin in four countries: the MASS study. Trop Med Int Health 2011; 16:995-1006. [PMID: 21545381 DOI: 10.1111/j.1365-3156.2011.02787.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE A recent randomized clinical trial demonstrated home-based treatment of WHO-defined severe pneumonia with oral amoxicillin was equivalent to hospital-based therapy and parenteral antibiotics. We aimed to determine whether this finding is generalizable across four countries. METHODS Multicentre observational study in Bangladesh, Egypt, Ghana and Vietnam between November 2005 and May 2008. Children aged 3-59 months with WHO-defined severe pneumonia were enrolled at participating health centres and managed at home with oral amoxicillin (80-90 mg/kg per day) for 5 days. Children were followed up at home on days 1, 2, 3 and 6 and at a facility on day 14 to look for cumulative treatment failure through day 6 and relapse between days 6 and 14. RESULTS Of 6582 children screened, 873 were included, of whom 823 had an outcome ascertained. There was substantial variation in presenting characteristics by site. Bangladesh and Ghana had fever (97%) as a more common symptom than Egypt (74%) and Vietnam (66%), while in Vietnam, audible wheeze was more common (49%) than at other sites (range 2-16%). Treatment failure by day 6 was 9.2% (95% CI: 7.3-11.2%) across all sites, varying from 6.4% (95% CI: 3.1-9.8%) in Ghana to 13.2% (95% CI: 8.4-18.0%) in Vietnam; 2.7% (95% CI: 1.5-3.9%) of the 733 children well on day 6 relapsed by day 14. The most common causes of treatment failure were persistence of lower chest wall indrawing (LCI) at day 6 (3.8%; 95% CI: 2.6-5.2%), abnormally sleepy or difficult to wake (1.3%; 95% CI: 0.7-2.3%) and central cyanosis (1.3%; 95% CI: 0.7-2.3%). All children survived and only one adverse drug reaction occurred. Treatment failure was more frequent in young infants and those presenting with rapid respiratory rates. CONCLUSIONS Clinical treatment failure and adverse event rates among children with severe pneumonia treated at home with oral amoxicillin did not substantially differ across geographic areas. Thus, home-based therapy of severe pneumonia can be applied to a wide variety of settings.
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Affiliation(s)
- Emmanuel Addo-Yobo
- Komfo Anokye Teaching Hospital, University of Science and Technology, Kumasi, Ghana
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Patel A, Mamtani M, Hibberd PL, Tuan TA, Jeena P, Chisaka N, Hassan M, Maulen-Radovan I, Thea DM, Qazi S, Kulkarni H. Value of chest radiography in predicting treatment response in children aged 3-59 months with severe pneumonia. Int J Tuberc Lung Dis 2008; 12:1320-1326. [PMID: 18926044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
SETTING International multicentric study at nine tertiary care centres. OBJECTIVE The World Health Organization (WHO) currently does not recommend chest radiographs (CXRs) for routine management of pneumonia. We evaluated the use of CXR for the prediction of treatment failure in children with severe pneumonia. DESIGN We used WHO vaccine trials radiographic assessment, clinical and nasopharyngeal microbiological data from 1121 3-59-month-old children recruited using the WHO definition of severe pneumonia in the Amoxicillin Penicillin Pneumonia International Study (APPIS). Using Poisson regression, we estimated the relative risk of developing clinical treatment failure and predictive preventive benefit of the CXR and examined the concordance of the CXR findings with the nasopharyngeal microbiological data. RESULTS A CXR with 'significant pathology' (defined by the WHO algorithm as end-point consolidation, pleural fluid and other infiltrates) was associated with a high risk of treatment failure, especially in children who received penicillin as compared to oral amoxicillin. Significant pathology was also associated with nasopharyngeal isolation of penicillin-resistant Streptococcus pneumoniae. Children with a normal CXR had a reduced risk of clinical treatment failure. CONCLUSIONS CXR with significant pathology independently and additively predicts clinical treatment failure. If CXR and the WHO tool are available, they can be used in the management of severe pneumonia.
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Affiliation(s)
- A Patel
- Lata Medical Research Foundation, Nagpur, India
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