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[PMID]:29465591
[Au] Autor:Wang H; Lu SC; He L; Dong JH
[Ad] Endereço:Department of Hepatobiliary Surgery, The General Hospital of the People's Liberation army.
[Ti] Título:A study on risk factors and diagnostic efficiency of posthepatectomy liver failure in the nonobstructive jaundice.
[So] Source:Medicine (Baltimore);97(8):e9963, 2018 Feb.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Liver failure remains as the most common complication and cause of death after hepatectomy, and continues to be a challenge for doctors.t test and χ test were used for single factor analysis of data-related variables, then results were introduced into the model to undergo the multiple factors logistic regression analysis. Pearson correlation analysis was performed for related postoperative indexes, and a diagnostic evaluation was performed using the receiver operating characteristic (ROC) of postoperative indexes.Differences in age, body mass index (BMI), portal vein hypertension, bile duct cancer, total bilirubin, alkaline phosphatase (ALP), gamma-glutamyl transpeptidase (GGT), operation time, cumulative portal vein occlusion time, intraoperative blood volume, residual liver volume (RLV)/entire live rvolume, ascites volume at postoperative day (POD)3, supplemental albumin amount at POD3, hospitalization time after operation, and the prothrombin activity (PTA) were statistically significant. Furthermore, there were significant differences in total bilirubin and the supplemental albumin amount at POD3. ROC analysis of the average PTA, albumin amounts, ascites volume at POD3, and their combined diagnosis were performed, which had diagnostic value for postoperative liver failure (area under the curve (AUC): 0.895, AUC: 0.798, AUC: 0.775, and AUC: 0.903).Preoperative total bilirubin level and the supplemental albumin amount at POD3 were independent risk factors. PTA can be used as the index of postoperative liver failure, and the combined diagnosis of the indexes can improve the early prediction of postoperative liver failure.
[Mh] Termos MeSH primário: Hepatectomia/efeitos adversos
Icterícia/sangue
Falência Hepática/etiologia
Complicações Pós-Operatórias
[Mh] Termos MeSH secundário: Adolescente
Adulto
Fatores Etários
Idoso
Idoso de 80 Anos ou mais
Área Sob a Curva
Ascite/etiologia
Bilirrubina/sangue
Índice de Massa Corporal
Distribuição de Qui-Quadrado
Criança
Pré-Escolar
Feminino
Seres Humanos
Hipertensão Portal/complicações
Hipertensão Portal/cirurgia
Lactente
Icterícia/cirurgia
Testes de Função Hepática
Neoplasias Hepáticas/complicações
Neoplasias Hepáticas/cirurgia
Modelos Logísticos
Masculino
Meia-Idade
Duração da Cirurgia
Período Pós-Operatório
Valor Preditivo dos Testes
Período Pré-Operatório
Tempo de Protrombina
Curva ROC
Estudos Retrospectivos
Fatores de Risco
Albumina Sérica/análise
Adulto Jovem
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Serum Albumin); RFM9X3LJ49 (Bilirubin)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180302
[Lr] Data última revisão:
180302
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180222
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009963


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[PMID]:28471111
[Au] Autor:Hao SR; Geng SC; Fan LX; Chen JJ; Zhang Q; Li LJ
[Ad] Endereço:State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China.
[Ti] Título:Intelligent diagnosis of jaundice with dynamic uncertain causality graph model.
[So] Source:J Zhejiang Univ Sci B;18(5):393-401, 2017 May.
[Is] ISSN:1862-1783
[Cp] País de publicação:China
[La] Idioma:eng
[Ab] Resumo:Jaundice is a common and complex clinical symptom potentially occurring in hepatology, general surgery, pediatrics, infectious diseases, gynecology, and obstetrics, and it is fairly difficult to distinguish the cause of jaundice in clinical practice, especially for general practitioners in less developed regions. With collaboration between physicians and artificial intelligence engineers, a comprehensive knowledge base relevant to jaundice was created based on demographic information, symptoms, physical signs, laboratory tests, imaging diagnosis, medical histories, and risk factors. Then a diagnostic modeling and reasoning system using the dynamic uncertain causality graph was proposed. A modularized modeling scheme was presented to reduce the complexity of model construction, providing multiple perspectives and arbitrary granularity for disease causality representations. A "chaining" inference algorithm and weighted logic operation mechanism were employed to guarantee the exactness and efficiency of diagnostic reasoning under situations of incomplete and uncertain information. Moreover, the causal interactions among diseases and symptoms intuitively demonstrated the reasoning process in a graphical manner. Verification was performed using 203 randomly pooled clinical cases, and the accuracy was 99.01% and 84.73%, respectively, with or without laboratory tests in the model. The solutions were more explicable and convincing than common methods such as Bayesian Networks, further increasing the objectivity of clinical decision-making. The promising results indicated that our model could be potentially used in intelligent diagnosis and help decrease public health expenditure.
[Mh] Termos MeSH primário: Algoritmos
Gráficos por Computador
Diagnóstico por Computador/métodos
Icterícia/diagnóstico
Aprendizado de Máquina
Modelos Estatísticos
[Mh] Termos MeSH secundário: Teorema de Bayes
Causalidade
Simulação por Computador
Sistemas de Apoio a Decisões Clínicas
Seres Humanos
Icterícia/epidemiologia
Prevalência
Reprodutibilidade dos Testes
Sensibilidade e Especificidade
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180226
[Lr] Data última revisão:
180226
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE
[do] DOI:10.1631/jzus.B1600273


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[PMID]:29381966
[Au] Autor:Liu MX; Wen XY; Leung YK; Zheng YJ; Jin MS; Jin QL; Niu JQ
[Ad] Endereço:Department of Hepatology, The First Hospital of Jilin University.
[Ti] Título:Hemolytic anemia in alcoholic liver disease: Zieve syndrome: A case report and literature review.
[So] Source:Medicine (Baltimore);96(47):e8742, 2017 Nov.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Zieve syndrome, a rarely reported disease resulting from alcohol abuse, consists of a triad of symptoms: hemolytic anemia, cholestatic jaundice, and transient hyperlipidemia. It is largely under-recognized and under-reported, possibly because of unawareness of the condition by physicians. Here, we report a case of Zieve syndrome managed at the Jilin University First Bethune Hospital. PATIENT CONCERNS: A 30-year-old Chinese woman presented with a 4-month history of fatigue, yellowish discoloration of the eyes, and tea-colored urine. She had been a heavy drinker for 2 years prior to onset of the disease with an average daily alcohol intake of 60 g/d and more than 80 g/d for the previous 6 months. DIAGNOSIS: The diagnosis of Zieve syndrome was confirmed based on hemolysis and cholestatic jaundice secondary to alcoholic liver disease and heavy drinking. Bone marrow biopsy and liver biopsy both supported the diagnosis. INTERVENTIONS: We treated her with abstinence from alcohol and supportive therapy. OUTCOMES: The patient was discharged 14 days after admission with an improvement in symptoms, which continued to subside during the 2-month follow-up period. LESSONS: Doctors confronted with hemolysis in a patient with alcoholic liver disease should be aware of the under-reported Zieve syndrome. Recognition of this syndrome could help doctors avoid unnecessary invasive procedures and emphasize the importance of alcohol abstinence as the mainstay of management. Glucocorticoids may not be useful in treating hemolytic anemia in Zieve syndrome.
[Mh] Termos MeSH primário: Anemia Hemolítica/complicações
Hepatopatias Alcoólicas/complicações
[Mh] Termos MeSH secundário: Adulto
Feminino
Seres Humanos
Hiperlipidemias/etiologia
Icterícia/etiologia
Síndrome
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180220
[Lr] Data última revisão:
180220
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008742


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[PMID]:29310402
[Au] Autor:Ye Z; Ye S; Zhou D; Zheng S; Wang W
[Ad] Endereço:Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital.
[Ti] Título:A rare variation of celiac trunk and hepatic artery complicating pancreaticoduodenectomy: A case report and literature review.
[So] Source:Medicine (Baltimore);96(48):e8969, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Anatomical variations of the celiac trunk and the hepatic artery are of considerable importance in hepatopancreatobiliary surgery, liver transplants, and radiological abdominal interventions. PATIENT CONCERNS: Here, we report a 57-year-old man with 2 weeks of painless progressive jaundice. Preoperative imaging and cytology brush results suggested an ampullary tumor and common hepatic artery anomaly (CTA) was reported. The patient underwent pancreaticoduodenectomy (PD). Intraoperatively, the CHA and gastroduodenal artery (GDA) were abnormal. The CHA emerged from the superior mesenteric artery (SMA). Computer tomography angiography (CTA) was performed postoperatively; surprisingly, the left gastric artery (LGA) and splenic artery (SA) arising from the anterior wall of the abdominal aorta replaced the normal structure of the celiac trunk, and an accessory left hepatic artery (LHA) emerged from the LGA. DIAGNOSES: The patient was diagnosed with cholangiocarcinoma and accompanying extremely rare variation of celiac trunk and hepatic artery. INTERVENTIONS AND OUTCOMES: The patient underwent PD and had an uneventful postoperative evolution. There was no recurrence of the tumor and with normal liver function during the 10-month follow-up. INTERVENTIONS: The patient underwent PD and had an uneventful postoperative evolution. OUTCOMES: There was no recurrence of the tumor and with normal liver function during the 10-month follow-up. LESSONS: Surgeons must keep in mind that arterial variation may be present in the vascular structures intraoperatively, even if it was not revealed in preoperative imaging. The preoperative identification of arterial variation and its relationship with the tumor is necessary to avoid intraoperative vascular injury and complications after surgery.
[Mh] Termos MeSH primário: Variação Anatômica
Neoplasias dos Ductos Biliares/cirurgia
Artéria Celíaca
Colangiocarcinoma/cirurgia
Artéria Hepática
Pancreaticoduodenectomia
[Mh] Termos MeSH secundário: Neoplasias dos Ductos Biliares/complicações
Neoplasias dos Ductos Biliares/diagnóstico por imagem
Artéria Celíaca/diagnóstico por imagem
Artéria Celíaca/cirurgia
Colangiocarcinoma/complicações
Colangiocarcinoma/diagnóstico por imagem
Diagnóstico Diferencial
Artéria Hepática/diagnóstico por imagem
Artéria Hepática/cirurgia
Seres Humanos
Icterícia/diagnóstico por imagem
Icterícia/etiologia
Icterícia/cirurgia
Masculino
Meia-Idade
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180116
[Lr] Data última revisão:
180116
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180110
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008969


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[PMID]:29188946
[Au] Autor:Saarnio J; Kylänpää L; Koskela R
[Ti] Título:A jaundiced patient at the emergency department.
[So] Source:Duodecim;132(18):1693-8, 2016.
[Is] ISSN:0012-7183
[Cp] País de publicação:Finland
[La] Idioma:eng
[Ab] Resumo:Jaundice is a common cause for seeking medical attention at an emergency department. The doctor on call should be able to recognize patients whose jaundice requires emergency investigations and treatment in specialized care. Most patients can be treated electively on an urgent referral. Ultrasound scan of the liver will in most cases clarify whether a liver disease or a biliary tract obstruction is in question, and whether the patient should be referred to an internist or a surgeon.
[Mh] Termos MeSH primário: Serviço Hospitalar de Emergência
Icterícia/diagnóstico
Encaminhamento e Consulta
[Mh] Termos MeSH secundário: Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180108
[Lr] Data última revisão:
180108
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171201
[St] Status:MEDLINE


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[PMID]:29176816
[Au] Autor:Spina A; Lenglet A; Beversluis D; de Jong M; Vernier L; Spencer C; Andayi F; Kamau C; Vollmer S; Hogema B; Irwin A; Ngueremi Yary R; Mahamat Ali A; Moussa A; Alfani P; Sang S
[Ad] Endereço:Médecins Sans Frontières, Operational Center Amsterdam (OCA), Ndjamena, Chad.
[Ti] Título:A large outbreak of Hepatitis E virus genotype 1 infection in an urban setting in Chad likely linked to household level transmission factors, 2016-2017.
[So] Source:PLoS One;12(11):e0188240, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: In September 2016, three acutely jaundiced (AJS) pregnant women were admitted to Am Timan Hospital, eastern Chad. We described the outbreak and conducted a case test-negative study to identify risk factors for this genotype of HEV in an acute outbreak setting. METHODS: Active case finding using a community based surveillance network identified suspected AJS cases. Pregnant or visibly ill AJS cases presenting at hospital were tested with Assure® IgM HEV rapid diagnostic tests (RDTs) and some with Polymerase Chain Reaction (PCR) in Amsterdam; confirmed cases were RDT-positive and controls were RDT-negative. All answered questions around: demographics, household makeup, area of residence, handwashing practices, water collection behaviour and clinical presentation. We calculated unadjusted odds ratios (ORs) and 95% confidence intervals (95% CI). RESULTS: Between September and April 2017, 1443 AJS cases (1293 confirmed) were detected in the town(attack rate: 2%; estimated 65,000 population). PCR testing confirmed HEV genotype 1e. HEV RDTs were used for 250 AJS cases; 100 (40%) were confirmed. Risk factors for HEV infection, included: having at least two children under the age of 5 years (OR 2.1, 95%CI 1.1-4.3), having another household member with jaundice (OR 2.4, 95%CI 0.90-6.3) and, with borderline significance, living in the neighbourhoods of Riad (OR 3.8, 95%CI 1.0-1.8) or Ridina (OR 3.3, 95%CI 1.0-12.6). Cases were more likely to present with vomiting (OR 3.2, 9%CI 1.4-7.9) than controls; possibly due to selection bias. Cases were non-significantly less likely to report always washing hands before meals compared with controls (OR 0.33, 95%CI 0.1-1.1). DISCUSSION: Our study suggests household factors and area of residence (possibly linked to access to water and sanitation) play a role in HEV transmission; which could inform future outbreak responses. Ongoing sero-prevalence studies will elucidate more aspects of transmission dynamics of this virus with genotype 1e.
[Mh] Termos MeSH primário: Cidades/estatística & dados numéricos
Surtos de Doenças/estatística & dados numéricos
Características da Família
Vírus da Hepatite E/genética
Hepatite E/epidemiologia
Hepatite E/transmissão
[Mh] Termos MeSH secundário: Adolescente
Adulto
Chade/epidemiologia
Criança
Pré-Escolar
Feminino
Geografia
Seres Humanos
Lactente
Recém-Nascido
Icterícia/epidemiologia
Masculino
Fatores de Risco
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171219
[Lr] Data última revisão:
171219
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171128
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0188240


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[PMID]:28953442
[Au] Autor:Bhattacharyya RP; Flores EJ; Azar MM
[Ad] Endereço:From the Department of Medicine, Division of Infectious Disease (R.P.B.), and the Departments of Radiology (E.J.F.) and Pathology (M.M.A.), Massachusetts General Hospital, and the Departments of Medicine (R.P.B.), Radiology (E.J.F.), and Pathology (M.M.A.), Harvard Medical School - both in Boston.
[Ti] Título:Case 30-2017. A 65-Year-Old Woman with Altered Mental Status, Bacteremia, and Acute Liver Failure.
[So] Source:N Engl J Med;377(13):1274-1282, 2017 Sep 28.
[Is] ISSN:1533-4406
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Bacteriemia/diagnóstico
Infecções por Campylobacter/diagnóstico
Campylobacter jejuni/isolamento & purificação
Hepatite Autoimune/complicações
Falência Hepática Aguda/etiologia
[Mh] Termos MeSH secundário: Idoso
Bacteriemia/complicações
Hemocultura
Infecções por Campylobacter/complicações
Delírio/etiologia
Diagnóstico Diferencial
Evolução Fatal
Feminino
Insuficiência Cardíaca/etiologia
Hepatite Autoimune/tratamento farmacológico
Seres Humanos
Hospedeiro Imunocomprometido
Icterícia/etiologia
Testes de Função Hepática
Pulmão/diagnóstico por imagem
Radiografia
[Pt] Tipo de publicação:CASE REPORTS; CLINICAL CONFERENCE; JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171016
[Lr] Data última revisão:
171016
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170928
[St] Status:MEDLINE
[do] DOI:10.1056/NEJMcpc1706100


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[PMID]:28670851
[Au] Autor:Haider N; Khan MSU; Hossain MB; Sazzad HMS; Rahman MZ; Ahmed F; Zeidner NS
[Ad] Endereço:International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh.
[Ti] Título:Serological evidence of hepatitis E virus infection in pigs and jaundice among pig handlers in Bangladesh.
[So] Source:Zoonoses Public Health;64(7):572-577, 2017 Nov.
[Is] ISSN:1863-2378
[Cp] País de publicação:Germany
[La] Idioma:eng
[Ab] Resumo:Hepatitis E virus (HEV) is the most common cause of viral hepatitis in humans. Pigs may act as a reservoir of HEV, and pig handlers were frequently identified with a higher prevalence of antibodies to HEV. The objectives of this study were to identify evidence of HEV infection in pigs and compare the history of jaundice between pig handlers and people not exposed to pigs and pork. Blood and faecal samples were collected from 100 pigs derived from three slaughterhouses in the Gazipur district of Bangladesh from January to June, 2011. We also interviewed 200 pig handlers and 250 non-exposed people who did not eat pork or handled pigs in the past 2 years. We tested the pig sera for HEV-specific antibodies using a competitive ELISA and pig faecal samples for HEV RNA using real-time RT-PCR. Of 100 pig sera, 82% (n = 82) had detectable antibody against HEV. Of the 200 pig handlers, 28% (56/200) demonstrated jaundice within the past 2 years, whereas only 17% (43/250) of controls had a history of jaundice (p < .05). Compared to non-exposed people, those who slaughtered pigs (31% versus 15%, p < .001), reared pigs (37% versus 20%, p < .001), butchered pigs (35% versus 19%, p < .001) or involved in pork transportation (28% versus 13%, p < .001) were more likely to be affected with jaundice in the preceding 2 years. In multivariate logistic regression analysis, exposure to pigs (odds ratio [OR]: 2.2, 95% CI: 1.2-3.9) and age (OR: 0.97, 95% CI: 0.95-0.99) was significantly associated with jaundice in the past 2 years. Pigs in Bangladesh demonstrated evidence of HEV infection, and a history of jaundice was significantly more frequent in pig handlers. Identifying and genotyping HEV in pigs and pig handlers may provide further evidence of the pig's role in zoonotic HEV transmission in Bangladesh.
[Mh] Termos MeSH primário: Hepatite E/veterinária
Icterícia/etiologia
Exposição Ocupacional
Doenças dos Suínos/virologia
[Mh] Termos MeSH secundário: Matadouros
Animais
Bangladesh/epidemiologia
Fazendeiros
Feminino
Hepatite E/transmissão
Hepatite E/virologia
Seres Humanos
Icterícia/epidemiologia
Masculino
Estudos Soroepidemiológicos
Testes Sorológicos
Suínos
Doenças dos Suínos/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171109
[Lr] Data última revisão:
171109
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170704
[St] Status:MEDLINE
[do] DOI:10.1111/zph.12372


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[PMID]:28582440
[Au] Autor:Abongomera C; Ritmeijer K; Vogt F; Buyze J; Mekonnen Z; Admassu H; Colebunders R; Mohammed R; Lynen L; Diro E; van Griensven J
[Ad] Endereço:Médecins Sans Frontières, Abdurafi, Ethiopia.
[Ti] Título:Development and external validation of a clinical prognostic score for death in visceral leishmaniasis patients in a high HIV co-infection burden area in Ethiopia.
[So] Source:PLoS One;12(6):e0178996, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: In Ethiopia, case fatality rates among subgroups of visceral leishmaniasis (VL) patients are high. A clinical prognostic score for death in VL patients could contribute to optimal management and reduction of these case fatality rates. We aimed to identify predictors of death from VL, and to develop and externally validate a clinical prognostic score for death in VL patients, in a high HIV co-infection burden area in Ethiopia. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a retrospective cohort study in north west Ethiopia. Predictors with an adjusted likelihood ratio ≥1.5 or ≤0.67 were retained to calculate the predictor score. The derivation cohort consisted of 1686 VL patients treated at an upgraded health center and the external validation cohort consisted of 404 VL patients treated in hospital. There were 99 deaths in the derivation cohort and 53 deaths in the external validation cohort. The predictors of death were: age >40 years (score +1); HIV seropositive (score +1); HIV seronegative (score -1); hemoglobin ≤6.5 g/dl (score +1); bleeding (score +1); jaundice (score +1); edema (score +1); ascites (score +2) and tuberculosis (score +1). The total predictor score per patient ranged from -1 to +5. A score of -1, indicated a low risk of death (1.0%), a score of 0 an intermediate risk of death (3.8%) and a score of +1 to +5, a high risk of death (10.4-85.7%). The area under the receiver operating characteristic curve was 0.83 (95% confidence interval: 0.79-0.87) in derivation, and 0.78 (95% confidence interval: 0.72-0.83) in external validation. CONCLUSIONS/SIGNIFICANCE: The overall performance of the score was good. The score can enable the early detection of VL cases at high risk of death, which can inform operational, clinical management guidelines, and VL program management. Implementation of focused strategies could contribute to optimal management and reduction of the case fatality rates.
[Mh] Termos MeSH primário: Infecções por HIV/mortalidade
Leishmaniose Visceral/mortalidade
[Mh] Termos MeSH secundário: Adolescente
Adulto
Área Sob a Curva
Ascite/diagnóstico
Ascite/patologia
Criança
Pré-Escolar
Coinfecção
Etiópia
Feminino
Infecções por HIV/diagnóstico
Infecções por HIV/parasitologia
Infecções por HIV/patologia
Hemoglobinas/metabolismo
Hemorragia/diagnóstico
Hemorragia/patologia
Seres Humanos
Icterícia/diagnóstico
Icterícia/patologia
Leishmaniose Visceral/diagnóstico
Leishmaniose Visceral/parasitologia
Leishmaniose Visceral/patologia
Masculino
Meia-Idade
Prognóstico
Projetos de Pesquisa
Estudos Retrospectivos
Fatores de Risco
Análise de Sobrevida
Tuberculose Pulmonar/diagnóstico
Tuberculose Pulmonar/patologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; VALIDATION STUDIES
[Nm] Nome de substância:
0 (Hemoglobins)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170919
[Lr] Data última revisão:
170919
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170606
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0178996


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[PMID]:28527874
[Au] Autor:Connor-Schuler R; Khan A; Goyal N; Zimny E
[Ad] Endereço:Henry Ford Hospital, Detroit, MI, USA. Electronic address: rconnor1@hfhs.org.
[Ti] Título:Pressor support during a Jarisch Herxheimer reaction after initiation of treatment for Weil's disease.
[So] Source:Am J Emerg Med;35(8):1211.e3-1211.e4, 2017 Aug.
[Is] ISSN:1532-8171
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:We present a case of Weil's disease complicated by a Jarisch-Herxheimer reaction (JHR) after initiation of antibiotics while in the emergency department requiring invasive monitoring and vasopressor support. The case is followed by a brief review of the JHR which is rarely observed with treatment of leptospirosis. A healthy 28-year-old female who recently returned from the Caribbean presented to the emergency department with flu-like symptoms. The patient appeared jaundiced with conjunctival suffusion and was ultimately treated with the appropriate antibiotics for leptospirosis in the ED. She decompensated subsequently, requiring supplemental oxygen, central and arterial line placement, and vasopressor support with norepinephrine. Although rarely encountered and not well reported throughout the literature, initiation of antibiotics can cause a JHR reaction given that Leptospira interrogans is a spirochete. This JHR may be self-limited and of short duration, or it can be prolonged and severe, requiring invasive therapies such as central line placement for vasopressor support and intubation. It is suggested that patients started on antibiotics for leptospirosis/Weil's disease should be monitored in the emergency department for a short duration prior to discharge or transfer to a regular medical floor for observation given the possibility for decompensation.
[Mh] Termos MeSH primário: Antibacterianos/efeitos adversos
Icterícia/microbiologia
Leptospira interrogans/isolamento & purificação
Norepinefrina/administração & dosagem
Vasoconstritores/administração & dosagem
Doença de Weil/diagnóstico
[Mh] Termos MeSH secundário: Adulto
Antibacterianos/administração & dosagem
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico
Feminino
Seres Humanos
Icterícia/etiologia
Fatores de Risco
Viagem
Resultado do Tratamento
Doença de Weil/tratamento farmacológico
Doença de Weil/fisiopatologia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Bacterial Agents); 0 (Vasoconstrictor Agents); X4W3ENH1CV (Norepinephrine)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171004
[Lr] Data última revisão:
171004
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170522
[St] Status:MEDLINE



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