Current trends in Internal Medicine最新文献

{"title":"What an Internist Need to Know About Hyponatremia?","authors":"G. Decaux","doi":"10.29011/2638-003x.100056","DOIUrl":"https://doi.org/10.29011/2638-003x.100056","url":null,"abstract":"In the ICU, the prevalence of hyponatremia (< 135 mEq/l) is around 15%, and 4.5% have a SNa lower than 125 mEq/l [1]. Outside the hospital for patients aged more than 65 y.o. the prevalence is 4.3% (for SNa < 135 mEq/l) and 0.14% have a SNa lower than 126 mEq/l [2,3]. In virtually all common conditions, the presence of hyponatremia is associate with increased morbidity and mortality, regardless the levels of hyponatremia (for a review, see Ref. [3]).","PeriodicalId":431682,"journal":{"name":"Current trends in Internal Medicine","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129984100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determinants of Adherence to Antiretroviral Treatment Among HIV-Infected Patients at the Departmental Teaching Hospital of Oueme-Plateau","authors":"FA Wanvoegbe, Azon-Kouanou","doi":"10.29011/2638-003x.100054","DOIUrl":"https://doi.org/10.29011/2638-003x.100054","url":null,"abstract":"Objective: To determine factors associated with adherence to antiretroviral treatment among people living with HIV (PLHIV) coming to the Departmental Teaching Hospital of Oueme-Plateau (CHUD-OP). Methods: This was a descriptive and analytical cross-sectional study conducted from 01 July to 01 October, 2017. The study population was HIV-infected persons under antiretroviral treatment and followed in the internal medicine department of CHUDOP. The Center for Adherence Support Evaluation (CASE) questionnaire, commonly known as the CASE Adherence Index, was used to assess adherence. Results: A total of 266 patients were included in this study. The mean, minimum, and maximum age of the patients were, respectively, 39.6 (± 10.3), 19, and 69 with a predominance of the 30 to 50 year-old age group (63.5%). The study population was predominantly female (203 or 76.3%), with a sex ratio of 0.31. Among the 266 respondents, 186 (69.9%) had a good adherence score (>10) to the ARV treatment against 80 (30.1%) who had a poor adherence score. Factors associated with adherence to ART were: absence of adverse events (p=0.001); initial clinical stage (p=0.031); high level of education (p=0.026); sharing of HIV status with family (p=0.034) and spouse (p<0.001); circumstances of HIV discovery (p=0.003); number of tablets per day ≤ 3 (p=0.001). Adherence to ART was also associated with CD4 count ≥ 500 cells/mm3 (p<0.001) and viral load at the time of the survey, undetectable (p < 0.001) testifying to the benefit of this treatment adherence. Conclusion: It is advisable to insist on reinforcing therapeutic education and psychosocial care for patients on ARV treatment. Current Trends in Internal Medicine Wanvoegbe FA, et al. Curr Trends Intern Med 5: 154. www.doi.org/10.29011/2638-003X.100054 www.gavinpublishers.com","PeriodicalId":431682,"journal":{"name":"Current trends in Internal Medicine","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126914674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tissue Doppler Imaging of Left Atrial Appendage Predicts Successful Cardioversion in Patients with Atrial Fibrillation","authors":"P. Kostakou, E. Tryfou, V. Kostopoulos, Marianna, Stamatelatou, C. Mihas, D. Damaskos, Elias, M. Tsougos, C. Olympios, N. Kouris","doi":"10.29011/2638-003x.100053","DOIUrl":"https://doi.org/10.29011/2638-003x.100053","url":null,"abstract":"Aims: Restoration of sinus rhythm in patients with Atrial Fibrillation (AF) prevents from thromboembolic events, decreases the risk for cardiomyopathy and improves quality of life. This study aimed to determine whether Tissue Doppler Imaging (TDI) during Transesophageal Echo (TEE) could predict successful electrical Cardioversion (CV) of AF lasting more than 48 hours but less than 6 months. Materials and Methods: One hundred patients, 74 men and 26 women of mean age 64.7±9.8 years old with non-valvular AF were included. Pulse Wave (PW) Doppler velocities as well as TDI velocities of the medial and lateral walls of the Left Atrial Appendage (LAA) were recorded during TEE before cardioversion. Synchronized electrical cardioversion was occurred within 12 hours after TEE using 100-200 Joules. We also evaluated LA size and the global strain of LAA. Results: Sinus rhythm restoration was succeeded in 80% of patients and maintained until discharge, 48 hours later. TDI velocities > 8cm/s were correlated with successful cardioversion (sensitivity 70% and specificity 63%) and were more predictive compared to PW Doppler velocities of > 40cm/s. TDI recordings at the medial LAA wall were more accurate, with less artefacts and better positioning of the sample volume. Global longitudinal strain was not significantly correlated with CV outcome. Conclusion: Our results indicate that TDI velocities of the LAA walls more than 8cm/s could be used as a cut-off value predicting successful cardioversion of AF. Current Trends in Internal Medicine Kostakou PM, et al. Curr Trends Intern Med 5: 153. www.doi.org/10.29011/2638-003X.100053 www.gavinpublishers.com","PeriodicalId":431682,"journal":{"name":"Current trends in Internal Medicine","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125428257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Granulomatosis with Polyangiitis (Wegener’s) Masquerading as Non-Resolving Pneumonia","authors":"Ganesh Kalyanasundaram, Poh Yong Tan, Nilesh H Pawar, A. Taha","doi":"10.29011/2638-003x.100017","DOIUrl":"https://doi.org/10.29011/2638-003x.100017","url":null,"abstract":"Non-resolving pneumonia (NRP) includes those cases of presumed pneumonia that progress, resolve slowly, or fail to achieve complete resolution despite appropriate treatment [1]. Granulomatosis with Polyangiitis (GPA), previously known as Wegener’s granulomatosis is a multi-system disorder characterized by systemic necrotizing vasculitis which most commonly affects the small and medium vessels of the upper and lower respiratory tract and the kidneys [2,3]. Diagnosis of GPA requires a high index of suspicion, as the initial presentation is usually nonspecific, and most patients are usually diagnosed around 3-12 months from the onset of symptoms [4]. We present a case of a patient with nonresolving pneumonia who was eventually diagnosed with GPA.","PeriodicalId":431682,"journal":{"name":"Current trends in Internal Medicine","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129358033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MRSA Pneumonia: Linezolid versus Vancomycin; A Factual Treatment Choice is Emerging","authors":"L. C. Clark, Nicholas A Kerna, O. Tulp","doi":"10.29011/2638-003X.100016","DOIUrl":"https://doi.org/10.29011/2638-003X.100016","url":null,"abstract":"Currently, in the medical community, there is debate concerning the most effective antibiotic treatment for pneumonia secondary to Methicillin-resistant Staphylococcus aureus (MRSA). There is evidence of emerging resistant strains of gram-positive bacteria associated with vancomycin resistance, such as Vancomycin-resistant Enterococcus (VRE). It has been suggested that the minimum inhibitory concentrations (MICs) of vancomycin are increasing, necessitating a higher dose of vancomycin to be effective. This suggests that strains of MRSA are becoming resistant or evolving [1]. Another relatively new antibiotic, linezolid (Zyvox), has been introduced into the market with the labelled use for treating MRSA pneumonia. Many clinicians have posited that linezolid is superior to vancomycin in enhanced lung tissue penetration and decreased difficulties in achieving appropriate drug levels as linezolid levels do not need to be monitored [2]. The debate continues as studies conclude that neither drug is superior to the other regarding mortality; however, linezolid is associated with fewer morbidities, higher clinical cure rates, and better microbiological cure rates. These ancillary findings and other considerations could position linezolid as the treatment of choice in many MRSA pneumonia clinical scenarios.","PeriodicalId":431682,"journal":{"name":"Current trends in Internal Medicine","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130453959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healing One Acute Pancreatitis Patient with the Duodenal Perforation Caused by a Nutritional Tube Misplacement","authors":"Wei-Li Yu, Yun Sun, Xiang Yang, Zhonghua Lu","doi":"10.29011/2638-003X.100015","DOIUrl":"https://doi.org/10.29011/2638-003X.100015","url":null,"abstract":"Enteral nutrition support of Acute Pancreatitis (AP) patients via a Nasojejunal Feeding Tube (NJT) is a conventional and rational treatment. The nutritional tube placement accurately is of vital important. Generally, complications of NJT placement are uncommon. A 47-year-old female AP patient was admitted to our ICU. An abdominal X-ray showed that an NJT was in the duodenum drop. And there was an abnormal air pattern in the end of the NJT. A CT scan revealed the retroperitoneal air in the end of the NJT as well as the injection of pan shadow meglumine contrast through gastric tube leakage into jejunum, suggesting a duodenal perforation. Therefore, we placed a new jejunum nutrition tube under gastroscope. One month later CT scan showed that there was no leakage into the original considered duodenal perforation through oral contrast agent. One week later the je - junum nutrition tube was pulled out.","PeriodicalId":431682,"journal":{"name":"Current trends in Internal Medicine","volume":"113 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117285771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Progressive Multifocal Leukoencephalopathy - Immune Reconstitution Inflammatory Syndrome (PML-IRIS) In a HIV Positive Male with Steroidal Support and Antiretroviral Therapy with Greater CNS Penetration-Effectiveness Score (CPE): A Case","authors":"R. Abraham, A. Anand, Ramakrishna Prasad, B. Rao, Praneeth Pillala","doi":"10.29011/2638-003X.100013","DOIUrl":"https://doi.org/10.29011/2638-003X.100013","url":null,"abstract":"Introduction: We present a case of Progressive Multifocal Leukoencephalopathy (PML) associated with Immune Reconstitution Inflammatory Syndrome (IRIS) in a male aged 47 year diagnosed with AIDS and a CD4 count of 44/μL who was treated with steroidal support and antiretroviral therapy with greater CNS penetration-effectiveness score (CPE). Case Presentation: A 47-year-old male diagnosed with HIV-1 with AIDS who was started on antiretroviral therapy (ART) presented with confusion, disorientation and inability to walk 10 days after ART initiation with Tenofovir, Emtricitabine, and Efavirenz. History revealed progressive fatigue and weakness. On examination, he was hypotonic with slurring of speech. PML was diagnosed based on MRI and positive JC virus PCR in CSF. This posed a clinical dilemma as to whether this was PML alone or PML-IRIS. Management and outcome: Based on clinical judgment, PML-IRIS was diagnosed. Prednisolone was added to help reduce inflammation. On account of better CNS penetration, Tenofovir, Emtritabine, and Efavirenz was switched to Zidovudine. Lamivudine and Efavirenz. Over a period of three months he made rapid progress and completely regained consciousness, orientation with coherent speech. He was able to walk without support and is now preparing to return to work as a civil engineer. Discussion: 1.1. Distinguishing between PML and PML-IRIS can be challenging. It is important nonetheless since management differs. This case report is among the first from India to highlight this entity and its clinical management. We strongly believe that in our patient early initiation of corticosteroids resulted in dramatic improvement. Once initiated steroids probably need to be continued for 6-8 weeks. Citation: Abraham RR, Anand AK, Prasad R, Rao BC, Pillala P (2018) Management of Progressive Multifocal Leukoencephalopathy Immune Reconstitution Inflammatory Syndrome (PML-IRIS) In a HIV Positive Male with Steroidal Support and Antiretroviral Therapy with Greater CNS Penetration-Effectiveness Score (CPE): A Case Report. Curr Trends Intern Med 2: 113. DOI: 10.29011/2638-003X.100013 2 Volume 2; Issue 03","PeriodicalId":431682,"journal":{"name":"Current trends in Internal Medicine","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126608815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Status of Central and Peripheral Hemodynamics Among Elderly Patients with Heart Failure and Stable Left Ventricular Systolic Function Treated with 3D - Antiviral Therapy of Chronic Viral Hepatitis C (HCV)","authors":"I. Nikitin, I. Baykova, A. M. Alieva, V. A. Kislyakov, L. M. Gogova, V. M. Volynkina, E. Reznik, L. Y. Ilchenko, Ilya Germano","doi":"10.29011/2638-003X.100010","DOIUrl":"https://doi.org/10.29011/2638-003X.100010","url":null,"abstract":"Results of HCV antiviral therapy with Direct Antiviral Agents (DAAs) (Viekira Pak) among elderly patients with heart failure are observed in the article. The evaluated group of patients was traditionally out of therapy scope in interferon + ribavirin era. We assessed safety, compliance and efficacy of HCV Genotype 1 antiviral therapy with Viekira Pak in the targeted population group as well as the status of central and peripheral hemodynamics during the course of therapy and follow-up period.","PeriodicalId":431682,"journal":{"name":"Current trends in Internal Medicine","volume":"127 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123448510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19 Comorbidity Interplayers: Diabetes and Atherogenic Dyslipidemia","authors":"A. Saldanha, A. P. Chacra, L. Rabelo, R. D. S. Filho, A. Margeotto, A. Gasparoto, T. Martinez","doi":"10.29011/2638-003x.100038","DOIUrl":"https://doi.org/10.29011/2638-003x.100038","url":null,"abstract":"Diabetes mellitus is considered an important independent risk factor for coronary artery disease. Atherosclerosis is the most frequent cause of premature death in this group of patients, doubling the risk of coronary disease, tripling the risk of stroke and quadrupling the possibility of peripheral vascular insufficiency symptomatic. Coronavirus (COVID-19) diagnosed patients can do worse when comorbidities are associates. In this paper we present two of them and their interplay that can act addingly to worsen COVID-19 outcome. The two factors can interplay in this role are diabetes and hyperlipidemia. Metabolic syndrome can be a possible precursor of type 2 diabetes: the prevalence of dyslipidemia in patients with type 2 diabetes mellitus is 75%. The components of dyslipidemia in type 2 diabetes mellitus are characterized by quantitative, qualitative and kinetic alterations, all contributing to the risk of cardiovascular disease, the main cause of mortality in this population, mainly related to insulin resistance. Relatively normal cholesterol “hides” an atherogenic lipid profile, with increased intermediate density lipoproteins, small and dense LDL lipoproteins, and small, dense and dysfunctional HDLs. Lipid-lowering drugs for LDL-c have the best documented risk reduction with HMGCoAredutase inhibitors: (statins). Other medications are: inhibitors of intestinal cholesterol absorption (Ezetimibe, Cholestyramine and Cholesevelam), nicotinic acid, fibrates (Gemfibrozil, Phenofibrate and Pemafibrate), omega 3 fatty acids (docosaexaenoic acid and eicosapentaenoic acid) plus new drugs such as and PCSK9 inhibitors. Lifestyle changes, which include the elaboration of an adequate diet, regular practice of physical exercises and control of the common state of anxiety in a large number of patients, should be the first step in the diabetic dyslipidemia therapeutic approach. Unnecessary to emphasize that prior to the institution of lipid therapy, adequate blood glucose control should be achieved.","PeriodicalId":431682,"journal":{"name":"Current trends in Internal Medicine","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123882799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mycobacterium Malmoense Infection in A Previously Healthy Patient Living in A Low-Incidence Country","authors":"Alameeri Amel, Moloney Eddie","doi":"10.29011/2638-003x.100037","DOIUrl":"https://doi.org/10.29011/2638-003x.100037","url":null,"abstract":"Mycobacterium malmoense infection is a bacterium naturally found in the environment, such as in wet soil, house dust and water. It is a slow-growing mycobacterium that was first isolated in 1977. This species presents unique challenges for diagnosis and treatment and continues to cause considerable morbidity and mortality if inadequately treated. The following case report describes a pulmonary manifestation caused by M. malmoense in a previously healthy Irish woman.","PeriodicalId":431682,"journal":{"name":"Current trends in Internal Medicine","volume":"35 8","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120929412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}