Delayed neuropsychiatric syndrome after carbon monoxide poisoning: inclusion of hyperbaric oxygen therapy in the recovery protocol

The delayed neuropsychiatric syndrome can arise in the period from 4 days to 5 weeks following carbon monoxide poisoning, and is characterized by neuropsychological deficits, which in some cases become chronic. This case report describes an adult female who apparently suffered self-inflicted carbon monoxide poisoning. She was not treated with hyperbaric oxygen and developed delayed sequelae on day 20. The treatment started with 40 sessions of hyperbaric oxygen therapy and subsequently with neuropsychological rehabilitation and physiotherapy. The treatment resulted in a progressive and almost complete physical and psychological recovery as evidenced by neuropsychometric tests and diagnostic imaging performed in the follow-up. Recovery was attributed to hyperbaric oxygen therapy. Although further research is required, we propose hyperbaric oxygen therapy also in the recovery protocol in the treatment of delayed neuropsychiatric syndrome

Pneumococcal sepsis associated with adrenal apoplexy in a young woman with anorexia nervosa

BACKGROUND A crude rate of mortality of 5% has been quoted for anorexia nervosa in recent studies. Nowadays the mechanism of death is unclear and various authors recommend that any anorexia nervosa death be reported and that, where possible, an autopsy be performed. METHODS In this work we present a case of sudden death in anorexia nervosa with unexpected autopsy findings. A 21-years-old woman with long-standing anorexia nervosa, severely underweight with a body mass index of 14.47 kg/m2, has been taken to the Emergency Department in very critical conditions. Despite the attempts of resuscitation, she died shortly afterwards. Therefore an autopsy has been requested in order to clarify the causes of death. RESULTS The clinical picture, laboratory parameters, histology and microbiological investigations were consistent with pneumococcal sepsis associated adrenal apoplexy. CONCLUSIONS The cause of death in anorexia nervosa cannot reliably be established from antemortem clinical features. All anorexia nervosa deaths should be reported together with description of necropsy. This may lead to advances in the knowledge and treatment practices

Deep tissue biopsy vs. superficial swab culture, including microbial loading determination, in the microbiological assessment of Skin and Soft Tissue Infections (SSTIs)

Thirty-two patients affected by SSTIs including DFIs were enrolled between 2013 and 2014. Superficial swab was obtained before and after cleansing with sterile saline, and after ultrasonic debridement; deep tissue biopsy was obtained from ulcer base. Samples were diluted with 1 mL of saline, serial 10-fold dilutions to 10−6 were made and 50 μL of each dilution was plated onto appropriate media. Bacteria were identified by Vitek II system. Microbial load was expressed as CFU/mL. Statistical analysis was performed by χ2. Incidence of Gram positives was higher than Gram negatives (S. aureus and P. aeruginosa being the most frequent); concordance (same bacteria isolated before and after debridement) never exceeded 60%. Ultrasonic debridement significantly reduced bacterial load or even suppressed bacterial growth. While reliability of superficial swab is poor for microbiological diagnosis of SSTIs, swabbing after ultrasonic debridement and biopsy of the ulcer base may be equally reliable