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[PMID]: 29514339
[Au] Autor:Boyd K; Harrison JM; Kavanaugh MJ
[Ad] Address:Internal Medicine Department, Naval Medical Center, 620 John Paul Jones Circle, Portsmouth, VA 23708.
[Ti] Title:False-Positive Monospot in a Returning Traveler with Dengue Fever.
[So] Source:Mil Med;183(3-4):e235-e236, 2018 Mar 01.
[Is] ISSN:1930-613X
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:The heterophile antibody (Monospot), initial test of choice for Epstein-Barr virus (EBV)-associated infectious mononucleosis, is both sensitive (70-92%) and specific (96-100%). False positives have been demonstrated in cases of viral hepatitis, human immunodeficiency virus, leukemia, lymphoma, pancreatic cancer, systemic lupus erythematosus, and rubella. We present a case of a 46-yr-old male who developed fever, chills, headaches, myalgia, fatigue, and photophobia 1 d after returning from the Philippines. He demonstrated a mild transaminitis and significant thrombocytopenia (12,000 cells/µL). His initial evaluation revealed a positive heterophile antibody test. Without a classic EBV presentation, a fever in returning traveler evaluation was instituted resulting in a positive dengue test by direct fluorescence IgM (8.82 IU) and IgG (7.13 IU), respectively. Both his EBV DNA polymerase chain reaction and IgM by viral capsid antigen were negative. Dengue, an RNA flavivirus, and the dengue antibody have demonstrated cross-reactivity with other flaviviruses including Japanese encephalitis virus, yellow fever virus, West Nile virus, and St. Louis encephalitis. However, EBV is a double-helix DNA herpesvirus and structurally very different. To our knowledge, this is the first reported case of cross-reactivity between dengue and EBV that describes a potential false positive for the heterophile antibody test.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180307
[Lr] Last revision date:180307
[St] Status:In-Data-Review
[do] DOI:10.1093/milmed/usx046

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[PMID]: 29513698
[Au] Autor:Anderson KB; Simasathien S; Watanaveeradej V; Weg AL; Ellison DW; Suwanpakdee D; Klungthong C; Phonpakobsin T; Kerdpanich P; Phiboonbanakit D; Gibbons RV; Fernandez S; Macareo LR; Yoon IK; Jarman RG
[Ad] Address:Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand.
[Ti] Title:Clinical and laboratory predictors of influenza infection among individuals with influenza-like illness presenting to an urban Thai hospital over a five-year period.
[So] Source:PLoS One;13(3):e0193050, 2018.
[Is] ISSN:1932-6203
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Early diagnosis of influenza infection maximizes the effectiveness of antiviral medicines. Here, we assess the ability for clinical characteristics and rapid influenza tests to predict PCR-confirmed influenza infection in a sentinel, cross-sectional study for influenza-like illness (ILI) in Thailand. Participants meeting criteria for acute ILI (fever > 38°C and cough or sore throat) were recruited from inpatient and outpatient departments in Bangkok, Thailand, from 2009-2014. The primary endpoint for the study was the occurrence of virologically-confirmed influenza infection (based upon detection of viral RNA by RT-PCR) among individuals presenting for care with ILI. Nasal and throat swabs were tested by rapid influenza test (QuickVue) and by RT-PCR. Vaccine effectiveness (VE) was calculated using the case test-negative method. Classification and Regression Tree (CART) analysis was used to predict influenza RT-PCR positivity based upon symptoms reported. We enrolled 4572 individuals with ILI; 32.7% had detectable influenza RNA by RT-PCR. Influenza cases were attributable to influenza B (38.6%), A(H1N1)pdm09 (35.1%), and A(H3N2) (26.3%) viruses. VE was highest against influenza A(H1N1)pdm09 virus and among adults. The most important symptoms for predicting influenza PCR-positivity among patients with ILI were cough, runny nose, chills, and body aches. The accuracy of the CART predictive model was 72.8%, with an NPV of 78.1% and a PPV of 59.7%. During epidemic periods, PPV improved to 68.5%. The PPV of the QuickVue assay relative to RT-PCR was 93.0% overall, with peak performance during epidemic periods and in the absence of oseltamivir treatment. Clinical criteria demonstrated poor predictive capability outside of epidemic periods while rapid tests were reasonably accurate and may provide an acceptable alternative to RT-PCR testing in resource-limited areas.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180307
[Lr] Last revision date:180307
[St] Status:In-Data-Review
[do] DOI:10.1371/journal.pone.0193050

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[PMID]: 29279030
[Au] Autor:Arellano K; Mosley JC; Moore DC
[Ad] Address:1 Department of Pharmacy, Southeast Health, Cape Girardeau, MO, USA.
[Ti] Title:Case Report of Ipilimumab-Induced Diffuse, Nonnecrotizing Granulomatous Lymphadenitis and Granulomatous Vasculitis.
[So] Source:J Pharm Pract;31(2):227-229, 2018 Apr.
[Is] ISSN:1531-1937
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Ipilimumab is indicated for the treatment of melanoma in both the metastatic and adjuvant setting. Ipilimumab inhibits cytotoxic T-lymphocyte antigen 4, leading to the augmentation of T-cell activity and an antitumor immune system response. The side effect profile of ipilimumab consists of autoimmune-like events such as dermatitis, colitis, and thyroiditis. These immune-related adverse events can be serious, often resulting in the need for systemic immunosuppression with corticosteroids. We present a case of diffuse, nonnecrotizing granulomatous lymphadenitis and granulomatous vasculitis in a heavily pretreated patient with metastatic melanoma. After completion of 4 cycles of ipilimumab for the treatment of metastatic melanoma, our patient complained of increasing fatigue, drenching night sweats, and chills. Imaging revealed diffuse adenopathy involving several lymph nodes. Biopsy was positive for nonnecrotizing granulomatous lymphadenitis and granulomatous vasculitis. High-dose prednisone was initiated and tapered gradually over 6 weeks, resulting in complete resolution of the granulomatous disease.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:In-Process
[do] DOI:10.1177/0897190017699762

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[PMID]: 29509613
[Au] Autor:Premkumar A; Godfrey W; Gottschalk MB; Boden SD
[Ad] Address:Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY.
[Ti] Title:Red Flags for Low Back Pain Are Not Always Really Red: A Prospective Evaluation of the Clinical Utility of Commonly Used Screening Questions for Low Back Pain.
[So] Source:J Bone Joint Surg Am;100(5):368-374, 2018 Mar 07.
[Is] ISSN:1535-1386
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Low back pain has a high prevalence and morbidity, and is a source of substantial health-care spending. Numerous published guidelines support the use of so-called red flag questions to screen for serious pathology in patients with low back pain. This paper examines the effectiveness of red flag questions as a screening tool for patients presenting with low back pain to a multidisciplinary academic spine center. METHODS: We conducted a retrospective review of the cases of 9,940 patients with a chief complaint of low back pain. The patients completed a questionnaire that included several red flag questions during their first physician visit. Diagnostic data for the same clinical episode were collected from medical records and were corroborated with imaging reports. Patients who were diagnosed as having a vertebral fracture, malignancy, infection, or cauda equina syndrome were classified as having a red flag diagnosis. RESULTS: Specific individual red flags and combinations of red flags were associated with an increased probability of underlying serious spinal pathology, e.g., recent trauma and an age of >50 years were associated with vertebral fracture. The presence or absence of other red flags, such as night pain, was unrelated to any particular diagnosis. For instance, for patients with no recent history of infection and no fever, chills, or sweating, the presence of night pain was a false-positive finding for infection >96% of the time. In general, the absence of red flag responses did not meaningfully decrease the likelihood of a red flag diagnosis; 64% of patients with spinal malignancy had no associated red flags. CONCLUSIONS: While a positive response to a red flag question may indicate the presence of serious disease, a negative response to 1 or 2 red flag questions does not meaningfully decrease the likelihood of a red flag diagnosis. Clinicians should use caution when utilizing red flag questions as screening tools.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180306
[Lr] Last revision date:180306
[St] Status:In-Data-Review
[do] DOI:10.2106/JBJS.17.00134

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[PMID]: 29500125
[Au] Autor:Khan R; Ali A
[Ad] Address:Division of Hematology, Oncology and Blood & Bone Marrow Transplant Unit, University of Iowa Hospitals and Clinics, Iowa City, IA, USA. Electronic address: rafiullah@uiowa.edu.
[Ti] Title:Non-traumatic splenic rupture in a patient with human granulocytic anaplasmosis and focused review of the literature.
[So] Source:Ticks Tick Borne Dis;, 2018 Feb 22.
[Is] ISSN:1877-9603
[Cp] Country of publication:Netherlands
[La] Language:eng
[Ab] Abstract:We report a rare case of a 53-year-old man with no significant past medical history who reported multiple tick bites within a 2-month period. The patient reported not "feeling well" for the 2 ½ weeks. He complained of generalized body aches, pains, and chills. He did not report nausea, vomiting, or yellowish discoloration of the eyes or skin. He presented to the emergency room with syncope preceded by severe abdominal pain. Upon presentation, he was pale and hypotensive. He had not experienced any trauma. Computed tomography revealed a splenic rupture, hemoperitoneum, and active extravasation of contrast material. The estimated amount of hemoperitoneum was 1.5 liters of blood. Subsequently, an infectious disease work-up revealed a positive Anaplasma phagocytophilum polymerase reaction in blood. The patient was aggressively resuscitated, and a splenectomy was performed followed by doxycycline therapy. He successfully recovered.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180303
[Lr] Last revision date:180303
[St] Status:Publisher

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[PMID]: 29355731
[Au] Autor:Huang S; Zhang L; Yao L; Li J; Chen H; Ni Q; Pan C; Jin L
[Ad] Address:Department of Infectious Disease, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.
[Ti] Title:Human babesiosis in Southeast China: A case report.
[So] Source:Int J Infect Dis;68:36-38, 2018 Jan 29.
[Is] ISSN:1878-3511
[Cp] Country of publication:Canada
[La] Language:eng
[Ab] Abstract:A 60-year-old female patient living in Southeast China presented with persistent fever, chills, night sweats, fatigue, and dizziness of 12-day duration. Blood tests showed neutropenia, thrombocytopenia, and active hemolytic anemia, with elevated C-reactive protein. Broad-spectrum antibiotics were administered for a possible diagnosis of sepsis, without any response. Malaria was initially diagnosed after visualizing intraerythrocytic ring-shaped parasites in bone marrow and blood smears. The patient resided in an area of unstable endemicity for Plasmodium falciparum. Blood samples were sent to the Centers for Disease Control and Prevention and a definitive diagnosis of human babesiosis was made using Babesia microti-specific PCR. Chloroquine phosphate and clindamycin were started and the patient became normothermic. However, due to the intolerable adverse effects of the antibiotics, intravenous azithromycin was given as an alternative. The patient recovered from fever and hemolysis, and repeated peripheral blood smears showed hemoparasite clearance. Cases of human babesiosis are rarely reported and probably under-diagnosed in China; therefore, improving our understanding of this disease as a newly emerging public health threat is imperative.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1801
[Cu] Class update date: 180226
[Lr] Last revision date:180226
[St] Status:Publisher

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[PMID]: 28449653
[Au] Autor:Diawara I; Zerouali K; Elmdaghri N; Abid A
[Ad] Address:Laboratoire de Microbiologie, Faculté de Médecine et de Pharmacie, Hassan II University of Casablanca, B.P 5696, Casablanca, Morocco. diawaraidris@gmail.com.
[Ti] Title:A case report of parapneumonic pleural effusion caused by Streptococcus pneumoniae serotype 19A in a child immunized with 13-valent conjugate pneumococcal vaccine.
[So] Source:BMC Pediatr;17(1):114, 2017 Apr 27.
[Is] ISSN:1471-2431
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:BACKGROUND: Simple parapneumonic effusion is a pleural effusion associated with lung infection (i.e., pneumonia). Streptococcus pneumoniae remains the most common pathogen causing parapneumonic effusions. In Morocco, the pneumococcal conjugate vaccine 13-valent (PCV13) was introduced in the national immunization program in October 2010 in 2 + 1 schedule for prevention of pneumococcal disease, and replaced by the PCV10 in July 2012 in the same schedule. We report a case of parapneumonic pleural effusions caused by S. pneumoniae serotype 19A in a child immunized with 3 doses of PCV13. CASE PRESENTATION: This is a 2.5 years old previously healthy Moroccan female, fully vaccinated by PCV13 and immunocompetent, admitted to a private medical clinic with a six months history of persistent asthma. On arrival (7 February 2015), she was febrile to 40.3 °C with a brutal flu syndrome, chills, dry cough and serous rhinitis, for which she received symptomatic treatment. A biological assessment was done that confirmed the clinical diagnosis of flu. Seven days after, she presented a progressive deterioration of its general condition and the onset of severe abdominal pain. She was hospitalized and a second biological assessment, computed tomography scans and chest radiography were done that confirmed a diagnosis of a pneumococcal parapneumonia with abscess of the left lower lobe with encysted empyema. Microbiological analysis of the pleural fluid showed a S. pneumoniae serotype 19A with susceptibility intermediate to penicillin. The patient was treated by antibiotics including amoxicillin, cefixime ceftriaxone and vancomycin. CONCLUSIONS: We reported a case of parapneumonic pleural effusions caused by a vaccine serotype pneumococcal 19A occurring in an immunocompetent child immunized with 3 doses of PCV13.
[Mh] MeSH terms primary: Pleural Effusion/microbiology
Pneumococcal Vaccines
Pneumonia, Pneumococcal/microbiology
Serogroup
Streptococcus pneumoniae/immunology
[Mh] MeSH terms secundary: Child, Preschool
Female
Humans
Pleural Effusion/diagnosis
Pneumonia, Pneumococcal/diagnosis
Pneumonia, Pneumococcal/prevention & control
Streptococcus pneumoniae/isolation & purification
[Pt] Publication type:CASE REPORTS; JOURNAL ARTICLE
[Nm] Name of substance:0 (13-valent pneumococcal vaccine); 0 (Pneumococcal Vaccines)
[Em] Entry month:1802
[Cu] Class update date: 180223
[Lr] Last revision date:180223
[Js] Journal subset:IM
[Da] Date of entry for processing:170429
[St] Status:MEDLINE
[do] DOI:10.1186/s12887-017-0872-2

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[PMID]: 29443771
[Au] Autor:Yanagiya M; Matsumoto J; Nagano M; Kusakabe M; Matsumoto Y; Furukawa R; Ohara S; Usui K
[Ad] Address:Department of General Thoracic Surgery, NTT Medical Center Tokyo.
[Ti] Title:Endoscopic bronchial occlusion for postoperative persistent bronchopleural fistula with computed tomography fluoroscopy guidance and virtual bronchoscopic navigation: A case report.
[So] Source:Medicine (Baltimore);97(7):e9921, 2018 Feb.
[Is] ISSN:1536-5964
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:RATIONALE: The development of postoperative bronchopleural fistula (BPF) remains a challenge in thoracic surgery. We herein report a case of BPF successfully treated with endoscopic bronchial occlusion under computed tomography (CT) fluoroscopy and virtual bronchoscopic navigation (VBN). PATIENT CONCERNS: A 63-year-old man underwent right upper lobectomy with concomitant S6a subsegmentectomy for lung adenocarcinoma. On postoperative day 24, he complained of shaking chills with high fever. DIAGNOSES: BPF with subsequent pneumonia and empyema. INTERVENTIONS: Despite aggressive surgical interventions for the BPF, air leakage persisted postoperatively. On days 26 and 34 after the final operation, endobronchial occlusions were performed under CT fluoroscopy and VBN. OUTCOMES: The air leaks greatly decreased and the patient was discharged. LESSONS: CT fluoroscopy and VBN can be useful techniques for endobronchial occlusion in the treatment of BPF.
[Mh] MeSH terms primary: Bronchial Fistula/therapy
Bronchoscopy/methods
Fluoroscopy
Pleural Diseases/therapy
Postoperative Complications/therapy
Tomography, X-Ray Computed
[Mh] MeSH terms secundary: Adenocarcinoma/surgery
Bronchial Fistula/diagnostic imaging
Bronchial Fistula/etiology
Empyema/etiology
Humans
Lung Neoplasms/surgery
Male
Middle Aged
Pleural Diseases/diagnostic imaging
Pleural Diseases/etiology
Pneumonectomy/adverse effects
Pneumonia/etiology
Postoperative Complications/diagnostic imaging
[Pt] Publication type:CASE REPORTS; JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180220
[Lr] Last revision date:180220
[Js] Journal subset:AIM; IM
[Da] Date of entry for processing:180215
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009921

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[PMID]: 29324816
[Au] Autor:Park JH; Cho SJ; White SK; Cox-Ganser JM
[Ad] Address:Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, United States of America.
[Ti] Title:Changes in respiratory and non-respiratory symptoms in occupants of a large office building over a period of moisture damage remediation attempts.
[So] Source:PLoS One;13(1):e0191165, 2018.
[Is] ISSN:1932-6203
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:There is limited information on the natural history of building occupants' health in relation to attempts to remediate moisture damage. We examined changes in respiratory and non-respiratory symptoms in 1,175 office building occupants over seven years with multiple remediation attempts. During each of four surveys, we categorized participants using a severity score: 0 = asymptomatic; 1 = mild, symptomatic in the last 12 months, but not frequently in the last 4 weeks; 2 = severe, symptomatic at least once weekly in the last 4 weeks. Building-related symptoms were defined as improving away from the building. We used random intercept models adjusted for demographics, smoking, building tenure, and microbial exposures to estimate temporal changes in the odds of building-related symptoms or severity scores independent of the effect of microbial exposures. Trend analyses of combined mild/severe symptoms showed no changes in the odds of respiratory symptoms but significant improvement in non-respiratory symptoms over time. Separate analyses showed increases in the odds of severe respiratory symptoms (odds ratio/year = 1.15‒1.16, p-values<0.05) and severity scores (0.02/year, p-values<0.05) for wheezing and shortness of breath on exertion, due to worsening of participants in the mild symptom group. For non-respiratory symptoms, we found no changes in the odds of severe symptoms but improvement in severity scores (-0.04‒-0.01/year, p-values<0.05) and the odds for mild fever and chills, excessive fatigue, headache, and throat symptoms (0.65-0.79/year, p-values<0.05). Our study suggests that after the onset of respiratory and severe non-respiratory symptoms associated with dampness/mold, remediation efforts might not be effective in improving occupants' health.
[Mh] MeSH terms primary: Environmental Restoration and Remediation
Humidity/adverse effects
Humidity/prevention & control
Occupational Exposure/adverse effects
Occupational Exposure/prevention & control
Occupational Health
Respiratory Tract Diseases/etiology
Respiratory Tract Diseases/prevention & control
[Mh] MeSH terms secundary: Adult
Air Microbiology
Air Pollution, Indoor/adverse effects
Air Pollution, Indoor/prevention & control
Asthma/epidemiology
Asthma/etiology
Asthma/prevention & control
Cross-Sectional Studies
Female
Humans
Linear Models
Male
Middle Aged
Occupational Health/trends
Odds Ratio
Prevalence
Respiratory Sounds/etiology
Respiratory Tract Diseases/epidemiology
Surveys and Questionnaires
Time Factors
[Pt] Publication type:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Entry month:1802
[Cu] Class update date: 180220
[Lr] Last revision date:180220
[Js] Journal subset:IM
[Da] Date of entry for processing:180112
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0191165

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[PMID]: 29458082
[Au] Autor:Su A; Lief L; Berlin D; Cooper Z; Ouyang D; Holmes J; Maciejewski R; Maciejewski PK; Prigerson HG
[Ad] Address:Center for Research on End-Of-Life Care, Weill Cornell Medicine, New York, NY 10065, USA; Department of Medicine, Weill Cornell Medicine, New York, NY 10065, USA.
[Ti] Title:Beyond Pain: Nurses' Assessment of Patient Suffering, Dignity, and Dying in the Intensive Care Unit.
[So] Source:J Pain Symptom Manage;, 2018 Feb 16.
[Is] ISSN:1873-6513
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:CONTEXT: Deaths in the Intensive Care Unit (ICU) are increasingly common in the United States, yet little is known about patients' experiences at the end-of-life in the ICU. OBJECTIVES: The objective of this study was to determine nurse assessment of symptoms experienced, and care received by ICU patients in their final week, and their associations with nurse-perceived suffering and dignity. METHODS: From September 2015 to March 2017, nurses who cared for 200 ICU patients who died were interviewed about physical and psychosocial dimensions of patients' experiences. Medical chart abstraction was used to document baseline patient characteristics and care. RESULTS: The patient sample was 61% male, 70.2% white, and on average 66.9 (SD=15.1) years old. Nurses reported 40.9% of patients suffered severely and 33.1% experienced severe loss of dignity. The most common symptoms perceived to contribute to suffering and loss of dignity included: trouble breathing (44.0%), edema (41.9%), and loss of control of limbs (36.1%). Most (n=9) remained significantly (p<0.05) associated with suffering, after adjusting for physical pain, including fever/chills, fatigue, and edema. CONCLUSIONS: Dying ICU patients are perceived by nurses to experience extreme indignities and suffer beyond physical pain. Attention to symptoms such as dyspnea and edema may improve the quality of death in the ICU.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180219
[Lr] Last revision date:180219
[St] Status:Publisher


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