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Pulmonary Artery Pseudoaneurysm: A Post-Covid Complication. J Ayub Med Coll Abbottabad 2023; 35:327-330. [PMID: 37422832 DOI: 10.55519/jamc-02-10521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
We present a case report of a potentially lethal post-COVID complication. A 65-year-old male presented with shortness of breath and fever with chills. He had recently recovered from COVID pneumonia. Contrast enhanced CT scan chest gave the suspicion of pulmonary pseudoaneurysm. CT aortogram revealed a well-defined rounded mass in the right lung mainly occupying the lower lobe of the right lung. Angiography through the right common femoral vein was performed and it confirmed a huge pseudoaneurysm arising from the posteromedial branch of the right descending interlobar artery. As the artery was not found suitable for endovascular embolization, the patient was referred to a thoracic surgeon.
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Predictive symptoms for COVID-19 in the community: REACT-1 study of over 1 million people. PLoS Med 2021; 18:e1003777. [PMID: 34582457 PMCID: PMC8478234 DOI: 10.1371/journal.pmed.1003777] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 08/20/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Rapid detection, isolation, and contact tracing of community COVID-19 cases are essential measures to limit the community spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We aimed to identify a parsimonious set of symptoms that jointly predict COVID-19 and investigated whether predictive symptoms differ between the B.1.1.7 (Alpha) lineage (predominating as of April 2021 in the US, UK, and elsewhere) and wild type. METHODS AND FINDINGS We obtained throat and nose swabs with valid SARS-CoV-2 PCR test results from 1,147,370 volunteers aged 5 years and above (6,450 positive cases) in the REal-time Assessment of Community Transmission-1 (REACT-1) study. This study involved repeated community-based random surveys of prevalence in England (study rounds 2 to 8, June 2020 to January 2021, response rates 22%-27%). Participants were asked about symptoms occurring in the week prior to testing. Viral genome sequencing was carried out for PCR-positive samples with N-gene cycle threshold value < 34 (N = 1,079) in round 8 (January 2021). In univariate analysis, all 26 surveyed symptoms were associated with PCR positivity compared with non-symptomatic people. Stability selection (1,000 penalized logistic regression models with 50% subsampling) among people reporting at least 1 symptom identified 7 symptoms as jointly and positively predictive of PCR positivity in rounds 2-7 (June to December 2020): loss or change of sense of smell, loss or change of sense of taste, fever, new persistent cough, chills, appetite loss, and muscle aches. The resulting model (rounds 2-7) predicted PCR positivity in round 8 with area under the curve (AUC) of 0.77. The same 7 symptoms were selected as jointly predictive of B.1.1.7 infection in round 8, although when comparing B.1.1.7 with wild type, new persistent cough and sore throat were more predictive of B.1.1.7 infection while loss or change of sense of smell was more predictive of the wild type. The main limitations of our study are (i) potential participation bias despite random sampling of named individuals from the National Health Service register and weighting designed to achieve a representative sample of the population of England and (ii) the necessary reliance on self-reported symptoms, which may be prone to recall bias and may therefore lead to biased estimates of symptom prevalence in England. CONCLUSIONS Where testing capacity is limited, it is important to use tests in the most efficient way possible. We identified a set of 7 symptoms that, when considered together, maximize detection of COVID-19 in the community, including infection with the B.1.1.7 lineage.
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Subcutaneous injection of mRNA vaccines against severe acute respiratory syndrome coronavirus 2: an option for severe bleeding disorders or anticoagulated patients? Blood Coagul Fibrinolysis 2021; 32:423-424. [PMID: 34397451 PMCID: PMC8373386 DOI: 10.1097/mbc.0000000000001048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 04/30/2021] [Indexed: 11/26/2022]
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Improving Patient Experience During the COVID-19 Pandemic: One Family's Reflections. J Hosp Med 2020; 15:760-762. [PMID: 33231540 DOI: 10.12788/jhm.3509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 07/25/2020] [Indexed: 11/20/2022]
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Procalcitonin in hemodialysis patients presenting with fever or chills to the emergency department. Intern Emerg Med 2020; 15:257-262. [PMID: 31352654 DOI: 10.1007/s11739-019-02156-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 07/17/2019] [Indexed: 01/23/2023]
Abstract
We sought to assess the role of procalcitonin in discriminating severe bacterial infections requiring antibiotic treatment from non-bacterial causes of fever or chills in chronic dialysis patients. Chronic hemodialysis patients who were admitted to the emergency room due to fever and/or chills were recruited to the study. The presence or absence of bacterial infection was defined after recruitment conclusion by an infectious disease specialist who was blinded to procalcitonin results. Procalcitonin levels were compared between infected and non-infected patients. Out of 54 patients recruited, 22 (41%) patients eventually diagnosed with infection. Mean (± SD) procalcitonin values were 4.3 (± 5.5) ng/ml among cases, 1.0 (± 2.0) ng/ml among controls with no infection (p = 0.02). A cutoff PCT value of 1 ng/ml or higher had 77% sensitivity and 59% specificity for the diagnosis of severe infection. Procalcitonin cannot usefully identify hemodialysis patient with bacterial infection.
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Emphysematous liver abscess with hepatic portal venous gas. Intern Emerg Med 2019; 14:1335-1336. [PMID: 31485818 DOI: 10.1007/s11739-019-02184-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 08/22/2019] [Indexed: 10/26/2022]
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45-year-old woman • fever and chills • diffuse abdominal pain • shortness of breath • Dx? THE JOURNAL OF FAMILY PRACTICE 2019; 68:E8-E9. [PMID: 31725140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Fever and chills. Diffuse abdominal pain. Shortness of breath.
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Immunophenotypical Characterization of a Brazilian POIS (Post-Orgasmic Illness Syndrome) Patient: Adding More Pieces to Puzzle. JOURNAL OF SEX & MARITAL THERAPY 2019; 46:227-233. [PMID: 31612795 DOI: 10.1080/0092623x.2019.1677835] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Post-orgasmic illness syndrome (POIS) is a rare condition characterized by post-ejaculatory symptoms. Here is reported the first Brazilian POIS patient. Immunological investigation did not confirm the previous hypothesis of a hypersensitivity reaction. Cell immunophenotyping comparing healthy individuals produced evidence of abnormalities not associated to clinical manifestations. The patient was submitted to specific immunotherapy with transient clinical response and was referred to a psychologist but did not demonstrate clinical improvement of symptoms. Therefore, etiology of POIS remains unclear.
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Past is Prologue. J Hosp Med 2019; 14:501-505. [PMID: 31251159 DOI: 10.12788/jhm.3224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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63-Year-Old Man With Fever, Chills, and Myalgias. Mayo Clin Proc 2019; 94:882-886. [PMID: 30935707 DOI: 10.1016/j.mayocp.2018.08.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 07/28/2018] [Accepted: 08/02/2018] [Indexed: 11/24/2022]
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Spectrum of complications in chronic kidney disease patients undergoing maintenance hemodialysis: An experience of a tertiary care center in Nepal. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2019; 30:208-214. [PMID: 30804283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
The burden of chronic kidney disease (CKD) is increasing worldwide. Renal replacement therapy is the lifesaving treatment modality in end-stage renal disease. Among various renal replacement modalities, hemodialysis (HD) is widely preferred one. Intradialytic complications are common and mostly inevitable. This study was conducted to determine pattern of intradialytic complications and its associated factors. This is a cross-sectional study conducted for six months duration among all CKD patients who were undergoing maintenance HD in B. P. Koirala Institute of Health Sciences, Dharan, Nepal. Of 228 patients, most were male 141 (61.8%) with median age 50 years (22-77). In this study, diabetic nephropathy (38.2%) was the most common etiology of CKD. Among 228 patients, complications were noted in 133 (58.3%) patients. Common complications were chills and rigor (44.3%), backache (30.7%), and hypotension (27.2%) in the study patients. Intradialytic complications were significantly associated with increasing age (P <0.001) and irregular HD (P <0.001). The common complications among CKD patient undergoing maintenance HD were chills, backache, and hypotension. Increasing age and irregular HD were significantly associated with intradialytic complications.
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Case 26-2018: A 48-Year-Old Man with Fever, Chills, Myalgias, and Rash. N Engl J Med 2018; 379:775-785. [PMID: 30134139 DOI: 10.1056/nejmcpc1807494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Pseudomonas stutzeri prosthetic valve endocarditis: A case report and review of the literature. J Infect Public Health 2018; 12:434-437. [PMID: 30049610 DOI: 10.1016/j.jiph.2018.07.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 07/01/2018] [Accepted: 07/05/2018] [Indexed: 11/19/2022] Open
Abstract
We report a case of Pseudomonas stutzeri endocarditis in Lebanon. The patient had a recent history of prosthetic aortic valve replacement and presented to the emergency department with fever and chills. Transesophageal echocardiography confirmed the presence of a vegetation on the prosthetic valve and blood cultures yielded P. stutzeri. The patient was treated with surgery and antibiotics but deteriorated and passed away four days after admission. To our knowledge, this is the fifth case of P. stutzeri endocarditis reported in the literature, and the first case with early presentation and mortality.
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Neurological Complications in a Polynesian Traveler with Dengue. HAWAI'I JOURNAL OF MEDICINE & PUBLIC HEALTH : A JOURNAL OF ASIA PACIFIC MEDICINE & PUBLIC HEALTH 2017; 76:275-278. [PMID: 29018589 PMCID: PMC5630466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In recent times, there has been an increased focus on mosquito-borne Flaviviruses, in particular dengue and Zika. With the reappearance of dengue in Hawai'i and the mainland United States (US), clinicians should be aware of both the common presentations of dengue, as well as other less common complications associated with the disease. Dengue can result in neurologic disorders such as encephalopathy, encephalitis, immune-mediated syndromes, neuromuscular dysfunction, and neuro-ophthalmologic disorders. We present an interesting case of dengue that initially presented with classic symptoms (arthropathy, biphasic fever, and rash) and subsequently developed into a neurologic movement disorder with muscle tightening and twitching of the face, chest, and extremities. We review and update the epidemiology, biology, the clinical presentations including the neurologic complications associated with dengue, as well as their management and areas of future study in this field.
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Chills During Hemodialysis: Prediction and Prevalence of Bacterial Infections - A Retrospective Cohort Study. Am J Med 2017; 130:477-481. [PMID: 27993572 DOI: 10.1016/j.amjmed.2016.11.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 10/27/2016] [Accepted: 11/08/2016] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Chills are a complication of patients undergoing hemodialysis. The rate of infection among hemodialysis patients presenting with chills is not well established, and empirical broad-spectrum antibiotics are usually the rule. METHODS We performed a retrospective study aiming to assess the rates of infection and bacteremia in hemodialysis patients presenting with chills. We evaluated risk factors for infection and bacteremia and tested a prediction model for infection. RESULTS Overall, 269 hemodialysis patients with a first episode of chills were included. Ninety patients (33.5%) had bacteremia and 162 (60.2%) had an infection. Risk factors for bacteremia in multivariate analysis included fever (odds ratio [OR] 1.6; 95% confidence interval [CI], 1.1-2.3; P = .009) and vascular catheter as dialysis access (OR 6.2; 95% CI, 3.2-12.0, P <.001). Leukocytosis was an additional risk factor in multivariate analysis for any type of infection (OR 1.265; 95% CI, 1.113-1.438; P <.001). Using a prediction model to evaluate patients without obvious source of infection, we found that patients with fistula or graft as their access, without fever, abnormal leukocytes, or hypoalbuminemia, had a low rate (1/17, 6%) of bacteremia. CONCLUSIONS Hemodialysis patients presenting with chills during dialysis, with or without fever, have high rates (∼60%) of infection. Patients with no obvious source of infection, with fistula or graft as access, presenting without fever, leukocytosis, or hypoalbuminemia have low risk for bacteremia and may be investigated without prompt antibiotic treatment. All other patients should receive antibiotic coverage immediately following a chills episode.
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Pyogenic Liver Abscess: A Retrospective Study of 105 Cases in an Emergency Department from East China. J Emerg Med 2016; 52:409-416. [PMID: 27765437 DOI: 10.1016/j.jemermed.2016.09.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 09/09/2016] [Accepted: 09/15/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND Pyogenic liver abscesses have become common in emergency departments (EDs) in recent years in Shanghai, China due to a variety of risk factors contributory to the disease. OBJECTIVE To review our experience in managing pyogenic liver abscesses to aid in the current management of this complex condition. METHODS This retrospective study was conducted to collect and analyze information from adult patients diagnosed with liver hepatic abscesses who were admitted to Ren Ji Hospital during the period from January 1, 2010 to December 31, 2015. The demographic data, etiology, underlying diseases, clinical presentation, imaging features, laboratory examinations, microbiological tests, treatment, and clinical outcomes were analyzed. RESULTS The data of a total 105 patients were retrospectively analyzed. The mean age of the patients was 62.0 ± 13.5 years. The etiology was predominantly hepatobiliary disease (43/105, 40.1%) or diabetes mellitus (42/105, 40.0%). During hospitalization, 12 patients (11.4%) with septic shock required intensive care. One patient died, yielding a 0.9% fatality rate. In addition to empiric antimicrobial therapy, 66/105 (62.9%) patients underwent ultrasound-guided percutaneous drainage of the liver abscess at diagnosis. Only 3 patients required surgical intervention. Bacterial culture of pyogenic fluids revealed 25 positive results of 66 cases (37.9%). Among them, Klebsiella pneumoniae was the primary pathogen detected in 15 cases (60.0%). CONCLUSIONS Pyogenic liver abscesses have become common in EDs in Shanghai, China. The early recognition of the disease, prompt use of empirical antimicrobial therapy, initiation of drainage in the appropriate patients, and controlling the underlying conditions were crucial for preventing severe sepsis and improving the outcome.
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Clinical Case of the Month:A 54 Year-Old Woman With Fever and Chills of Four-Days Duration. THE JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY : OFFICIAL ORGAN OF THE LOUISIANA STATE MEDICAL SOCIETY 2016; 168:143-145. [PMID: 27598899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A 54 year-old woman with diabetes mellitus type two and end-stage renal disease on hemodialysis presented to the emergency department with a four day history of generalized malaise, fever, and chills. Her symptoms were also associated with occasional dyspnea without a cough. She reported intermittent chronic diarrhea with hemodialysis which was currently unchanged. On the day of admission, she could not tolerate hemodialysis due to her symptoms. Over the past year she admitted to night sweats and a 40 pound weight loss. She denied having palpitations, chest pain, hemoptysis, lymph node swelling, sick contacts, or recent travel. The remainder of the review of systems was negative.
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CASE RECORDS of the MASSACHUSETTS GENERAL HOSPITAL. Case 24-2015. A 28-Year-Old Pregnant Woman with Fever, Chills, Headache, and Fatigue. N Engl J Med 2015. [PMID: 26222563 DOI: 10.1056/nejmcpc1501763] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Histiocytic necrotising lymphadenitis (Kikuchi-Fujimoto disease) of axillary lymph nodes. BMJ Case Rep 2015; 2015:bcr2014203776. [PMID: 25564582 PMCID: PMC4289788 DOI: 10.1136/bcr-2014-203776] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2014] [Indexed: 01/14/2023] Open
Abstract
Kikuchi-Fujimoto disease (KFD) or histiocytic necrotising lymphadenitis is a rare entity, occurring most commonly in young Asian adults. KFD is characterised by fever with tender lymph node enlargement. The cervical group of lymph nodes is most commonly involved, and the diagnosis is conclusively made by lymph node biopsy and histopathology. KFD is a self-limiting condition, which usually resolves over 1-4 months. Symptomatic treatment with antipyretics and/or non-steroidal anti-inflammatory drugs is recommended. Here we describe an uncommon presentation of KFD in a young woman in which only the axillary lymph nodes were enlarged.
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[Lesions of the vulva, fever, chills. You can expect to make this diagnosis more frequently again. Primary syphilis]. MMW Fortschr Med 2013; 155:5. [PMID: 23951635 DOI: 10.1007/s15006-013-0672-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
CONTEXT Clinicians order blood cultures liberally among patients in whom bacteremia is suspected, though a small proportion of blood cultures yield true-positive results. Ordering blood cultures inappropriately may be both wasteful and harmful. OBJECTIVE To review the accuracy of easily obtained clinical and laboratory findings to inform the decision to obtain blood cultures in suspected bacteremia. DATA SOURCES AND STUDY SELECTION A MEDLINE and EMBASE search (inception to April 2012) yielded 35 studies that met inclusion criteria for evaluating the accuracy of clinical variables for bacteremia in adult immunocompetent patients, representing 4566 bacteremia and 25,946 negative blood culture episodes. DATA EXTRACTION Data were extracted to determine the prevalence and likelihood ratios (LRs) of findings for bacteremia. DATA SYNTHESIS The pretest probability of bacteremia varies depending on the clinical context, from low (eg, cellulitis: 2%) to high (eg, septic shock: 69%). Elevated temperatures alone do not accurately predict bacteremia (for ≥38°C [>100.3°F], LR, 1.9 [95% CI, 1.4-2.4]; for ≥38.5°C [>101.2°F], LR, 1.4 [95% CI, 1.1-2.0]), nor does isolated leukocytosis (LR, <1.7). The severity of chills graded on an ordinal scale (shaking chills, LR, 4.7; 95% CI, 3.0-7.2) may be more useful. Both the systemic inflammatory response syndrome (SIRS) and a multivariable decision rule with major and minor criteria are sensitive (but not specific) predictors of bacteremia (SIRS, negative LR, 0.09 [95% CI, 0.03-0.26]; decision rule, negative LR, 0.08 [95% CI, 0.04-0.17]). CONCLUSIONS Blood cultures should not be ordered for adult patients with isolated fever or leukocytosis without considering the pretest probability. SIRS and the decision rule may be helpful in identifying patients who do not need blood cultures. These conclusions do not apply to immunocompromised patients or when endocarditis is suspected.
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Recurrent Saccharomyces cerevisiae fungemia in an otherwise healthy patient. THE ISRAEL MEDICAL ASSOCIATION JOURNAL : IMAJ 2011; 13:575-576. [PMID: 21991722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Comparison of the effects of anesthesia with isoflurane and total intravenous anesthesia on the intensity of body temperature reduction during anesthesia and incidence of postoperative chills. ACTA MEDICA IRANICA 2011; 49:425-432. [PMID: 21960073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
This study compared the effects of anesthesia with isoflurane and TIVA (total intravenous anesthesia) on the intensity of body temperature reduction during anesthesia and incidence of chills after lumbar disc surgery. The study was done as a single blinded randomized clinical trial. From 60 patients who underwent lumbar disc surgery, 30 subjects were placed in isoflurane group and 30 in the TIVA group. Maintenance of anesthesia was done with isoflurane (MAC=0.8-1) and N(2)O 50% in isoflurane group and in TIVA group with propofol at the dose of 100-150 mg /kg body weight /minute and remifentanil at the dose of 2.0 mg /kg body weight/minute. Chills rate was recorded in recovery room. Changes in body temperature, body surface temperature, systolic blood pressure, diastolic blood pressure and heart rate showed no significant difference between the two groups before and after induction and at different times during the operation (P<0.05). Chill rate was not significantly different between the two groups (P<0.05). It seems that TIVA (remifentanil at the dose of 2.0 µg/kg body weight/minute in combination with propofol at the dose of 100-150 µg/kg body weight/minute) and 0.81 MAC isoflurane-N(2)O 50% can be used as a safe method of anesthesia in patients with good tolerance lumbar back disc surgery without hypothermia, chills and considerable hemodynamic changes.
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Avoiding sore throat morbidity and mortality: when is it not "just a sore throat?". Am Fam Physician 2011; 83:26-28. [PMID: 21888123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Sero-epidemiological investigation of an outbreak of fever in rural area of Rohtak. THE JOURNAL OF COMMUNICABLE DISEASES 2010; 42:77-79. [PMID: 22468557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Assessment of pain after elective abortion relating to the use of misoprostol for dilatation of the cervix. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2010; 32:244-53. [PMID: 20500969 DOI: 10.1016/s1701-2163(16)34451-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Our objective was to compare the use of misoprostol to that of laminaria tents for dilatation of the cervix before a surgical elective abortion (EAB) during the first trimester, with regard to the pain caused (1) during insertion, for both methods, (2) immediately before the EAB, and (3) one hour after the procedure. METHODS One hundred two women were recruited at Clinique de planification des naissances du Centre hospitalier universitaire de Québec, CHUL pavilion, between March 1, 2006 and March 1, 2007, for a tracking study. Fifty-three women were given 400 microg of misoprostol intravaginally, three to four hours before the EAB, and a laminaria tent was inserted in 49 women, 16 to 24 hours before the EAB. A visual analog scale was used to determine the pain score. RESULTS One hour after EAB, severe pain was reported in 6% of the participants who were given misoprostol. The pain score post-EAB was 3.8 times higher in women who were given misoprostol than in those who had a laminaria tent inserted (P = 0.004). The pain score during insertion of the dilatation method was 33 times higher with the laminaria tent than with misoprostol (P < 0. 001), and 30% of women who had a laminaria tent inserted felt severe pain. CONCLUSION While misoprostol may increase pain after EAB in a small percentage of women, it remains an efficient, easy to use, low-cost method for dilating the cervix before an EAB. It is one of the options that may be offered to women when a pre-EAB dilatation of the cervix is required, after discussing its benefits and disadvantages with them.
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Abstract
We investigated the effect of subcutaneous anti-D IgG as platelet enhancing therapy in children with idiopathic thrombocytopenic purpura (ITP). Twenty-three children were treated with subcutaneous anti-D 50 microg/kg. The median platelet count increased from 7 x 10(9) to 31 x 10(9)/L on day 3 (P < 0.01). The median decline in hemoglobin was 1.3 g/dl. Two children experienced minor fever and chills within 24 hr of treatment. Pain at the injection site was common but self-limiting with no effect on activity level. These results suggest subcutaneous anti-D IgG 50 microg/kg as an effective and well-tolerated treatment option in childhood ITP.
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Atypical histopathology in bowel-associated dermatosis-arthritis syndrome: A case report. Dermatol Online J 2009; 15:3. [PMID: 19379647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Bowel-associated dermatosis-arthritis syndrome (BADAS) is characterized by a prodrome of fever, chills, and flu-like symptoms with subsequent skin eruptions, myalgias, and polyarthralgias. The syndrome was initially described following jejunoileal bypass surgery for weight loss. Histopathology of the skin lesions present in BADAS is described in the literature as identical to that of Sweet syndrome. We present a patient whose clinical history and physical exam were consistent with the diagnosis of BADAS. Dermatopathology in this case demonstrated a large subcorneal pustule without a significant dermal neutrophilic infiltrate. The histologic differential included subcorneal pustular dermatosis, bullous impetigo, or IgA pemphigus. The histology in BADAS may not necessarily be identical to Sweet syndrome, and the clinical picture alone plays an important role in diagnosis. The correct diagnosis of BADAS prevents a myriad of laboratory tests and allows for more effective symptom management in this chronic condition.
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An outbreak of high fever and chills, increased blood pressure, and pruritus in a hemodialysis unit [corrected]. IRANIAN JOURNAL OF KIDNEY DISEASES 2008; 2:167-168. [PMID: 19377233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Clinical problem-solving. A stitch in time--a 64-year-old man with a history of coronary artery disease and peripheral vascular disease was admitted to the hospital with a several-month history of fevers, chills, and fatigue. N Engl J Med 2007; 357:1029-34. [PMID: 17804848 DOI: 10.1056/nejmcps062601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
OBJECTIVE To examine the differences between biomedical and Japanese women's concepts of vasomotor symptoms and the relationships between the symptom of chilliness (hieshō) and menopause status, other vasomotor symptoms, and environmental factors such as soy isoflavone intake and exposure in Japan. DESIGN Participants were healthy Japanese women, aged 45 to 55, living in Kyoto and Fukushima prefectures, divided into menopausal groups based on menstrual patterns. Women recalled 82 general health symptoms during the previous 2 weeks and collected finger-prick dried blood spots and matched 24-hour dietary records, which were analyzed, respectively, for isoflavone concentration by high-performance liquid chromatography coulometric electrode array detection and for soy isoflavone intake using a Japanese phytochemical database. RESULTS An examination of kōnenki (Japanese for climacteric) symptoms suggests that chilliness (hieshō), which was reported by 29.3% of participants compared with a range of 3.0% to 22.1% for hot flushes, constitutes an important vasomotor symptom. Chilliness prevalence differed significantly between premenopausal and other menopausal status groups, with positive correlations with other estrogen-influenced sexual-vasomotor symptoms and negative correlations with isoflavone concentrations. Negative correlations with soy isoflavone intake were also found for sweating, although not for nobose and hoteri (two Japanese terms for hot flush). CONCLUSIONS Chilliness seems to be a more important vasomotor symptom than hot flushes and sweats in Japanese women and may reflect differing thermoregulatory physiology, possibly influenced by dietary soy.
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Surgical challenge in cholecystectomy: xanthogranulomatous cholecystitis. THE TURKISH JOURNAL OF GASTROENTEROLOGY : THE OFFICIAL JOURNAL OF TURKISH SOCIETY OF GASTROENTEROLOGY 2007; 18:131-2. [PMID: 17602366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
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Abstract
BACKGROUND Anthrax vaccine was licensed in 1970 and is used to protect individuals exposed to biological warfare and those who may come in contact with Bacillus anthracis in infected animals or in laboratory settings. The current adsorbed anthrax vaccine is regarded as effective and safe. Adverse effects reported include fever, chills, myalgia, arthralgia, and nausea. Four cases of rheumatoid arthritis (RA) temporally related to anthrax vaccine have been reported. As the number of administered doses increases, a better understanding of its adverse events profile will be forthcoming. OBJECTIVE To describe another patient with RA temporally related to anthrax vaccination. METHODS A 42-year-old man developed bilateral knee stiffness and pain in all the proximal interphalangeal joints 5 days after receiving the first dose of anthrax vaccine. He reported chills, fever, and joint and neck pain, with a tender nodule at the injection site after dose 2. Hours after receiving dose 3 he experienced fever, chills, nausea, vomiting, and neck, hand, and shoulder pain. The vaccination series was terminated after the third dose. RESULTS Physical examination revealed moderate swelling and tenderness of his bilateral proximal interphalangeal joints. His complete blood cell count was normal; rheumatoid factor level, 198 IU/mL; erythrocyte sedimentation rate, 53 mm/h; antinuclear antibodies, negative; C-reactive protein level, 2.7 mg/L; and anti-cyclic citrullinated peptide antibody level, 168 EU. Radiographs revealed mild degenerative changes in his hands and knees bilaterally. CONCLUSIONS This case represents a fifth patient with RA temporally related to anthrax vaccine.
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A Phase 1 Clinical Study of Intravenous Administration of PV701, an Oncolytic Virus, Using Two-Step Desensitization. Clin Cancer Res 2006; 12:2555-62. [PMID: 16638865 DOI: 10.1158/1078-0432.ccr-05-2038] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE In a previous phase 1 study, adverse events, especially flu-like symptoms, were observed mainly following the first i.v. bolus dose of PV701, an oncolytic Newcastle disease virus. Desensitization to adverse events of subsequent doses occurred, allowing a 10-fold increase in the maximum tolerated dose for these doses. Although one-step desensitization (a single desensitizing dose with higher subsequent doses) addressed the tolerability of high repeat doses, additional testing was required to further improve tolerability of the initial dose. This study tested the hypothesis that two-step desensitization, using two dose increments before high repeat doses, would be well tolerated. EXPERIMENTAL DESIGN Sixteen adults with incurable solid tumors were enrolled. Cycles consisted of six PV701 doses over 2 weeks followed by a 1-week rest. Doses 1 to 2 were 1 and 12 x 10(9) plaque-forming units (pfu)/m(2), respectively, whereas doses 3 to 6 were escalated by cohort from 24 to 120 x 10(9) pfu/m(2). RESULTS No dose-limiting toxicities were observed, permitting dose escalation through cohort 4 (1, 12, 120, 120, 120, 120 x 10(9) pfu/m(2)). Mild flu-like symptoms were common following the first infusion, diminished with repeated dosing, and were less pronounced than those seen previously. Tumor regression was observed in a patient with anal carcinoma who enrolled with stable disease following palliative radiotherapy. Four patients with clearly progressing cancer before enrollment had disease stabilization of >/=6 months. CONCLUSIONS This novel two-step desensitization improved patient tolerability compared with the previous regimen. Toxicities were predictable and manageable. PV701, the first oncolytic virus to enter phase 1 i.v. testing, continues to show single-agent activity, warranting planned phase 2 trials.
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Time tells the tale. Am J Med 2005; 118:840-2. [PMID: 16084175 DOI: 10.1016/j.amjmed.2005.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2004] [Indexed: 12/01/2022]
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Abstract
OBJECTIVE Our objective was to define the spectrum and possible predictors of symptoms that occur in patients after percutaneous radiofrequency ablation of hepatic tumors. SUBJECTS AND METHODS We performed 50 consecutive percutaneous radiofrequency ablation sessions on 39 patients with a total of 89 liver tumors. All patients had pre- and postablation laboratory studies and CT or MRI scans. After treatment, patients were followed for 3 weeks with a standardized questionnaire to assess for postablation symptoms. Comparisons of the presence or absence of symptoms were made for the laboratory test values, liver volumes, and pre- and postablation tumor volumes. RESULTS Postablation symptoms occurred in 14 of 39 (36%) patients after 17 of 50 (34%) ablation sessions. Symptoms consisted of fever (16/17), malaise (12/17), chills (6/17), delayed pain (5/17), and nausea (2/17). On average, the symptoms presented 3 days after ablation and lasted 5 days. Statistically significant (p < 0.01) predictors of symptoms were tumor volumes > 50 cm3 (4.5 cm diameter), ablated tissue volumes > 150 cm3 (6.5 cm diameter), a difference between preablation tumor volume and the volume of tissue ablated > 125 cm3, or postablation aspartate aminotransferase levels > 350 IU/L. CONCLUSION Approximately one third of patients undergoing percutaneous radiofrequency ablation of hepatic tumors develop delayed, transient flulike symptoms that can be treated conservatively and are significantly related to the volume of tissue ablated. Familiarity with this postablation syndrome should facilitate appropriate management of affected patients.
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Identification of typhoid fever and paratyphoid fever cases at presentation in outpatient clinics in Jakarta, Indonesia. Trans R Soc Trop Med Hyg 2005; 99:440-50. [PMID: 15837356 DOI: 10.1016/j.trstmh.2004.09.012] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2004] [Revised: 09/13/2004] [Accepted: 09/22/2004] [Indexed: 11/21/2022] Open
Abstract
In Jakarta, Indonesia, over 80% of patients with typhoid fever or paratyphoid fever are treated in outpatient settings. In a community-based prospective passive surveillance study, we identified 59 typhoid, 23 paratyphoid fever and 259 non-enteric fever outpatients, all blood culture-confirmed. We compared their symptoms with the aim of developing a clinical prediction rule that may help direct empirical antibiotic treatment to cases with suspected (para)typhoid fever, rather than all febrile patients, or refer patients for additional diagnostic tests. Paratyphoid fever (Salmonella paratyphi A) could not be distinguished clinically from typhoid fever. Decisions on empirical antibiotic treatment and advice on hygiene measures in patients with suspected (para)typhoid fever should take into account chills and absence of cough in the first week of fever and delirium in the second week of illness. This prediction rule increases the likelihood of (para)typhoid fever from 1:10 in the first week to, at most, 2:3 in the second week of a febrile illness. However, we were not able to propose a robust clinical prediction rule that could be used as absolute screening method for decisions on additional diagnostic tests, because of the low sensitivity of presenting symptoms in (para)typhoid fever.
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Abstract
We evaluated the predictive value of chills, bacteraemia and endotoxaemia for in-hospital mortality and survival at 5-10 years long-term follow-up in a prospective cohort of 'early sepsis' patients presenting with fever resulting from community-acquired pneumonia or pyelonephritis. Febrile patients with chills had bacteraemia more often (RR 3.1, 95% CI 1.8-5.4) than those without chills. Neither chills nor bacteraemia were significantly related to in-hospital mortality, but patients with endotoxaemia had a higher in-hospital mortality rate than those without endotoxaemia. Patients with chills had a significantly higher survival rate at long-term follow-up than those without chills on admission: the estimated risk of dying was 0.644 (95% CI 0.43-0.95, P = 0.029) for an individual with chills, compared to a person without chills, adjusting for the other factors [age cohort, underlying disease and the pro-inflammatory response in the blood, i.e. tumour necrosis factor-alpha (TNF-alpha) and blood leucocyte number, as scored on hospital admission] in the Cox proportional hazards model. Chills may characterize a patient subpopulation that upon pulmonary and urinary tract infection is able to raise a more rapid and/or efficient host response.
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Abstract
African tick bite fever (ATBF) is an infectious disease commonly observed in travelers to sub-Saharan Africa. Because the presentation of the disease is often not specific, ATBF is frequently not diagnosed or confused with Mediterranean spotted fever. We present the case of a 63-year-old woman with typical history and symptoms. The diagnosis of ATBF was serologically confirmed by immunofluoroscence. ATBF is an important differential diagnosis of fever in patients returning from sub-Saharan Africa.
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Abstract
Health care providers in the areas where histoplasmosis is not endemic can benefit greatly from understanding the clinical presentation, diagnosis and management of disseminated histoplasmosis as patients from the endemic areas may travel to and require medical attention in areas of low disease prevalence. Use of effective diagnostic tools such as Histoplasma antigen detection can aid in providing timely and appropriate therapy.
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A thirty-six-year-old male with fever, chills, and weight loss. NEW JERSEY MEDICINE : THE JOURNAL OF THE MEDICAL SOCIETY OF NEW JERSEY 2004; 101:11-5. [PMID: 15373142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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Not just gastroenteritis: Thyroid storm unmasked. Emerg Med Australas 2004; 16:247-9. [PMID: 15228472 DOI: 10.1111/j.1742-6723.2004.00575.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Establishing the diagnosis of thyroid storm is difficult in the ED, especially where there is no antecedent history of thyroid disease or clinical clues like goitre, exophthalmos or altered mentation, yet early recognition and treatment are essential in reducing mortality and morbidity from this endocrine emergency. We present a case where suspected infective gastroenteritis in a newly diagnosed diabetic masked the major symptomatology of thyroid storm, and review the diagnosis and management of thyrotoxic crisis.
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[Evaluation of adherence to the regulations for declaration of notification of transfusion reactions with fever and chills. A study of the Association Inter-Régionale du Sud-Est d'Hémovigilance (AIRSEH)]. Transfus Clin Biol 2003; 10:324-30. [PMID: 14572548 DOI: 10.1016/s1246-7820(03)00103-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Febrile non-hemolytic transfusion reactions (FNHTR) are the most frequently reported acute adverse effects of blood products, and should be notified within 48 h according to the hemovigilance regulation. In order to study the conformity of these notifications and to search for factors associated with non-conformity, we retrospectively studied all FNHTR notified by voluntary centers of the AIRSEH group from 1st September 1994 to 31st December 1999. Seven hundred and sixty-one FNHTR were registered by 10 centers, most of them were benign (grade 1); 67.8% were non-conform. The non-conformity was associated with the number of biological investigations performed (median number, respectively, 4.24 and 2.94--P = 0.038--in non-conform and conform notifications--P = 0.038) in univariate analysis. Using a logistic regression model, center and severity were the only two factors significantly associated with non-conformity. Different center practices, and in particular the interface between the hospital and the blood bank, may be responsible for the effect center. Moreover, the non-conformity concerns first of all benign FNHTR. A stronger separation between alert and epidemiological surveillance is proposed in order to improve the notifications' conformity.
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