Extreme gonococcal susceptibility associated with acquired complement deficiency secondary to hypocomplementemic urticarial vasculitis and systemic lupus erythematosus

Gonococcal infection is rarely associated with septic shock. We describe a recurrent case of septic shock related to disseminated gonococcemia in a patient with systemic lupus erythematosus and hypocomplementemic urticarial vasculitis, and discuss the implication of profound acquired complement deficiency secondary to these auto-immune diseases. This case raises the question of systematic antibioprophylaxis in patients with acquired complement deficiency.     

Más difícil todavía: tratar una glomerulonefritis rápidamente progresiva grave en el seno de una neumonía por COVID-19

We present the case of a male patient with severe SARS-CoV-2 pneumonia, with simultaneous onset of p-ANCA positive rapidly progressive glomerulonephritis. We discuss the different therapeutic possibilities, emphasising the appropriateness of their administration according to the time in the course of the infection.     

Incidence,severity and outcome of central line related complications in pediatric oncology patients; A single center study

BackgroundCentral venous access device (CVAD)-related complications are associated with high morbidity rates. This study was performed to underline the importance of CVAD-complication prevention and treatment.MethodsAn audit of practice of CVAD-related complications in pediatric oncology patients receiving a CVAD between January 2015 and June 2017 was performed. CVADs included were totally implantable venous access ports (TIVAPs), Hickman–Broviac® (HB), nontunneled, and peripherally inserted CVADs.ResultsA total of 201 children, with 307 CVADs, were analyzed. The incidence rates per 1000 CVAD-days for the most common complications were 1.66 for malfunctions, and 1.51 for central line-associated bloodstream infections (CLABSIs). Of all CVADs inserted, 37.1% were removed owing to complications, of which 45.6% were owing to CLABSIs. In 42% of the CLABSIs, the CLABSI could be successfully cured with systemic antibiotic treatment only. Of all included patients, 5.0% were admitted to the intensive care unit owing to CLABSI. The HB-CVAD compared to the TIVAP was a risk factor for CVAD-related complications, CLABSIs and dislocations in particular.ConclusionsThe incidence of CVAD-related complications is high. Research on the prevention and treatment of CVAD-related complications in pediatric oncology patients should be a high priority for all health care professionals.Type of studyPrognosis study (retrospective).Level of evidenceLevel II.     

Lucio phenomenon mimicking antiphospholipid syndrome: The occurrence of antiphospholipid antibodies in a leprosy patient

Lucio phenomenon is an atypical reaction of leprosy, characterized by vasculitic lesions that can mimic antiphospholipid syndrome (APS) clinically. Distinguishing the two can be difficult as antiphospholipid autoantibodies may be present in patients with leprosy. We report on a 32‐year‐old female patient presenting with a sudden onset of fever, hemorrhagic bullae, and skin necrosis on her lower legs. She was treated for APS due to the presence of antiphospholipid antibodies but had an inadequate response. A skin biopsy revealed thrombotic vasculopathy and necrotizing vasculitis associated with aggregation of foam cells in the perivascular area and subcutis, with acid‐fast bacilli in the histiocytes and blood vessel walls. Direct immunofluorescence showed IgM, C3, and fibrinogen deposition in the superficial and deep dermal blood vessels. The pathology confirmed the diagnosis of Lucio phenomenon, and appropriate therapy was given. It is essential to evaluate the patient comprehensively, including clinical, serological, and pathological aspects, to obtain the correct diagnosis.     

Antioxidant imbalance and genotoxicity detected in fish induced by titanium dioxide nanoparticles (NpTiO2) and inorganic lead (PbII)

Titanium dioxide nanoparticles (NpTiO₂) are the most widely-used nanoparticle type and the adsorption of metals such as lead (PbII) onto their surface is a major source of concern to scientists. This study evaluated the effects of the associated exposure to both types of contaminant, i.e., lead (a known genotoxic metal) and NpTiO₂, in a freshwater fish (Astyanax serratus) through intraperitoneal injection for an acute assay of 96 h. The effects of this exposure were evaluated using the comet assay, DNA diffusion assay and piscine micronucleus test, as well as the quantification of antioxidant enzymes (SOD, CAT, and GST) and metallothioneins. Our findings indicate that co-exposure of PbII with NpTiO₂ can provoke ROS imbalances, leading to DNA damage in the blood and liver tissue of A. serratus, as well as modifying erythropoiesis in this species, inducing necrosis and changing the nuclear morphology of the erythrocytes.     

活血化瘀联合温阳生肌法治疗青斑样血管炎临床分析

目的分析青斑样血管炎的临床特征及中医证候特点,提高对本病的诊断及中医辨证水平。方法对12例确诊的青斑样血管炎患者的临床表现、组织病理、中医证候、中医治则、方药、预后进行回顾性分析。结果12例患者中男3例,女9例,年龄15~45岁,平均年龄20.17岁,中医药治疗时间为14~70 d,平均时间为54.60 d。12例患者均为对称皮疹,均伴有疼痛;皮损特点均为红斑、水疱、紫癜、坏死、水肿、溃疡,呈现线状或放射状分布;皮损痊愈后见色素沉着斑或线状象牙白色萎缩性瘢痕。所有患者经过组织病理确诊。12例患者均符合寒凝血瘀证。坏死期选用活血化瘀法,应用桃红四物汤加减;溃疡期选用温阳生肌法,应用自拟方温阳生肌汤加减。局部使用黄连膏换药。12例患者经中医药治疗后皮损均完全消退,溃疡愈合,遗留色素沉着斑及象牙白色萎缩性瘢痕。停药后随访6个月无1例复发。结论活血化瘀联合温阳生肌法为中医治疗青斑样血管炎提供了新的思路,并能明显降低复发率,值得进一步研究。     

基于方剂构成信息的知识发现和关联网络构建挖掘海洋中药海马历代用药经验＊

目的 通过对含海马方剂构成信息进行数据挖掘和知识发现，构建关联网络，分析海马的历代应用情况，挖掘海马用药配伍经验，发现海马潜在功效和主治病症，为海马的临床应用和开发提供依据。方法 以《中医方剂大辞典》《中国药典》《中华医典》等多部著作为方源，收集含有海马的相关方剂，并进行频数分析、关联规则挖掘和关联网络的构建。结果 共筛选有文献记载的含海马方剂154首。从剂型看，大多为散剂，从方剂分布年代来看，海马的应用虽然有很长历史，但是古代应用并不广泛，现代应用较多。通过对配伍药物进行分析发现，与海马配伍频率较高的是“鹿茸”、“熟地黄”、“肉苁蓉”等补益药物。从功效主治方面看，大多数方剂具有“补肾”、“温阳”、“益精”等传统功效外，还具有健脑等功效；主治病症中，除“阳痿”、“癥瘕”、“疔疮”等《中国药典》所记载的疾病之外，还可治疗“虚劳”、“健忘”、“瘿病”、“不寐”、“痹证”、“小便淋沥或不通”等。对其进行关联关系分析发现，海马配伍补肾温阳的效果较为明显，多用于治疗阳痿，且腰痛、虚劳、遗精、健忘、不育等疾病的治疗与补肾关系密切；在治疗癥瘕时，多与醋、樗鸡、干漆、硇砂、斑蝥、水蛭、没药、当归配伍。结论 该研究不仅发现了含海马方剂的常用剂型、分布年代和药物配伍规律，发现了历代医家应用海马的临床经验，还探索了海马的潜在应用价值。海马作为一味海洋中药，具有温、补、托、消等特性，除常用于治疗阳痿外，还可用于治疗腰痛、健忘、瘿病、不寐、痹证等病症，这些研究结果可为拓展海马的临床应用提供理论基础及依据。     

Ischemic stroke in Morocco: Prehospital delay and associated factors

ObjectivesThis study aimed to estimate prehospital delay and to identify the factors associated with the late arrival of patients with ischemic stroke at the Souss Massa Regional Hospital Center in Morocco.Patients and methodsAn observational, prospective, cross-sectional study was conducted from March 2019 to September 2019 in the Souss Massa regional hospital center, which is a public hospital structure. A questionnaire was administered to patients with ischemic stroke and to bystanders (family or others), while clinical and paraclinical data were collected from medical records. Univariate and multivariate logistic regression analyses were used to identify the factors associated with delayed arrival at emergency department.ResultsA total of 197 patients and 197 bystanders who fulfilled the criteria for the study were included. The median time from symptom onset to hospital arrival was 6 hours (IQR, 4–16). Multiple regression analysis showed that illiteracy (OR 38.58; CI_95%: 3.40–437.27), waiting for symptoms to disappear (patient behavior) (OR 11.24; CI_95%: 1.57–80.45), deciding to go directly to the hospital (patient behavior) (OR 0.07; CI_95%: 0.01–0.57), bystander's knowledge that stroke is a disease requiring urgent care within a limited therapeutic window (OR 0.005; CI_95%: 0.00–0.36), and direct admission without reference (OR 0.005; CI_95%: 0.00–0.07), were independently associated with late arrival (> 4.5 hours) of patients with acute ischemic stroke. In addition, illiteracy (OR 24.62; CI_95%: 4.37–138.69), vertigo and disturbance of balance or coordination (OR 0.14; CI_95%: 0.03–0.73), the relative's knowledge that stroke is a disease requiring urgent care and within a limited therapeutic window (OR 0.03; CI_95%: 0.00–0.22), calling for an ambulance (relative's behavior) (OR 0.16; CI_95%: 0.03–0.80), distance between 50 and 100 km (OR 10.16; CI_95%: 1.16–89.33), and direct admission without reference (OR 0.03; CI_95%: 0.00–0.14), were independently associated with late arrival (> 6 hours) of patients with acute ischemic stroke.ConclusionPatient behavior, bystander knowledge and direct admission to the competent hospital for stroke care are modifiable factors potentially useful for reducing onset-to-door time, and thereby increasing the implementation rates of acute stroke therapies.     

The Impact of Emotional Exhaustion on Psychological Factors in Workers with Secondary Traumatic Experiences: A Multi-Group Path Analysis

Objective The objective of the present study was to explore causal pathways to understand how second traumatic experiences could affect the development of emotional exhaustion and psychiatric problems. Methods A total of 582 workers who had jobs vulnerable to secondary traumatic experiences were enrolled for this study. Emotional exhaustion, secondary trauma, resilience, perceived stress, depression, anxiety, and sleep problems were evaluated. A model with pathways from secondary traumatic experience score to depression and anxiety was proposed. The participants were divided into three groups according to the resilience: the low, middle and high resilience group. Results Resilience was a meaningful moderator between secondary traumatic experiences and psychiatric problems. In the path model, the secondary trauma and perceived stress directly and indirectly predicted perceived stress, emotional exhaustion, depression, anxiety, and sleep problems in all three groups. Direct effects of perceived stress on depression and anxiety were the largest in the low resilience group. However, direct effects of secondary trauma on perceived stress and emotional exhaustion were the largest in the high resilience group. Conclusion Understanding the needs of focusing for distinct psychological factors offers a valuable direction for the development of intervention programs to prevent emotional exhaustion among workers with secondary traumatic experiences.