An Atypical Case of Taravana Syndrome in a Breath-Hold Underwater Fishing Champion: A Case Report

Dysbaric accidents are usually referred to compressed air-supplied diving. Nonetheless, some cases of decompression illness are known to have occurred among breath-hold (BH) divers also, and they are reported in the medical literature. A male BH diver ((à years old), underwater *shing champion, presented neurological disorders as dizziness, sensory numbness, blurred vision, and le+ frontoparietal pain a+er many dives to a $à–$( meters sea water depth with short surface intervals. Symptoms spontaneously regressed and the patient came back home. )e following morning, pain and neurological impairment occurred again and the diver went by himself to the hospital where he had a generalized tonic-clonic seizure and lost consciousness. A magnetic resonance imaging of the brain disclofsed a cortical T -weighted hypointense area in the temporal region corresponding to infarction with partial hemorrhage. An early hyperbaric oxygen therapy led to prompt resolution of neurological *ndings. All clinical and imaging characteristics were referable to the Taravana diving syndrome, induced by repetitive prolonged deep BH dives. )e reappearance of neurological signs a+er an uncommon ! -hour symptom-free interval may suggest an atypical case of Taravana syndrome

A perioperative uncontrollable bleeding in an elderly patient with acquired hemophilia A: a case report

Acquired hemophilia A should be taken into account in the differential diagnosis of perioperative bleeding in patients without any apparent reason for activated partial thromboplastin time prolongation

A review of analytical methods for the determination of four new phosphodiesterase type 5 inhibitors in biological samples and pharmaceutical preparations

The introduction of oral phosphodiesterase type 5 inhibitor therapy in 1998 revolutionized the treatment of erectile dysfunction. Erectile dysfunction is the most common sexual problem in men. It often has a profound effect on intimate relationships and quality of life. The analysis of pharmaceuticals is an important part of the drug development process as well as for routine analysis and quality control of commercial formulations. Whereas the determination of sildenafil citrate, vardenafil and tadalafil are well documented by a variety of methods, there are few publications about the determination of udenafil, lodenafil carbonate, mirodenafil and avanafil. The paper presents a brief review of the action mechanism, adverse effects, pharmacokinetics and the most recent analytical methods that can determine drug concentration in biological matrices and pharmaceutical formulations of these four drugs.A introdução da terapia oral com inibidores da fosfodiesterase tipo 5, em 1998, revolucionou o tratamento da disfunção erétil. A disfunção erétil é o problema sexual mais comum em homens. Muitas vezes tem um efeito profundo nas relações íntimas e na qualidade de vida. A análise de produtos farmacêuticos é uma parte importante do processo de desenvolvimento de fármacos, bem como para a análise de rotina e controle de qualidade das formulações comerciais. Enquanto a determinação do citrato de sildenafila, vardenafila e tadalafila está bem documentada por uma variedade de métodos, existem poucas publicações sobre a determinação de udenafila, carbonato de lodenafila, mirodenafila e avanafila. O artigo apresenta uma breve revisão do mecanismo de ação, efeitos adversos, farmacocinética e os mais recentes métodos analíticos, que podem determinar a concentração do fármaco em matrizes biológicas e formulações farmacêuticas destes quatro fármacos

An Atypical Case of Taravana Syndrome in Mediterraneo

Dysbaric accidents are usually referred to compressed air-supplied diving. Nonetheless, diving accidents are known to have occurred among breath-hold divers also and some cases are reported in medical literature. A male professional breath hold diver (57 year old) presented neurological disorders as dizziness, sensory numbness, blurred vision and left phronto-parietal pain after many dives to a 30-35 meters seawater depth. He went home after the regression of the symptoms and runned 8 Km the following morning. Pain, sensory numbness and dizziness occurred after running. He went by himself to the hospital where he had a grand mal seizure and lost consciousness. A magnetic resonance imaging of the brain disclosed one cortical T1- weighted hypointensity in temporal region corresponding to infarction with partial hemorrhage. All clinical and radiological manifestations were likely to be referred to the very rare Taravana diving syndrome induced by repetitive prolonged deep breath-hold dives. The reappearance of signs after 17-hour free time make it thought as an atypical case

K. PNEUMONIAE E A. BAUMANNII PRODUTTORI DI CARBAPENEMASE. INCIDENZA, FATTORI DI RISCHIO ED IMPATTO SULL’OUTCOME

Obiettivo. L’incidenza di infezioni da Klebsiella pneumoniae (KP) produttori di carbapenemase e Acinetobacter bauman- nii (AB) resistente al carbapenemico è aumentata negli ultimi anni determinando limitazioni di opzioni di trattamento. Il presente studio è stato intrapreso per determinare la preva- lenza di KP e AB resistenti ai carbapenemici e la loro influen- za sull’outcome. Materiali e metodi. Nel periodo di 13 mesi preso in considera- zione, sono stati isolati 69 colture di KP e AB, da pazienti rico- verati per più di 72 ore, presso la Unità di Terapia Intensiva Polivalente del Policlinico “P. Giaccone” di Palermo. La pro- duzione di beta-lattamasi a spettro esteso è stata testata mediante double disk synergy test (DDST) e E test. È stata inoltre saggiata la co-resistenza a fluorochinoloni, aminoglicosi- di, carbapenemici, colistina e tigeciclina con metodo della dif- fusione su piastra. I fattori di rischio sono stati valutati come variabili relativi ai giorni di degenza (LOS) e all’outcome.Risultati. Delle 69 colture isolate, 39 (25 KP e 14 AB) erano produttori di ESBL ma sensibili al carbapenemico, mentre 30 (11 KP e 19 AB) erano resistenti al carbapenemico. Di questi 8 sono state ottenute dal mini-BAL, 6 dal sangue, 5 da essu- dati e 11 dalle urine. Tutti sono risultati resistenti agli antibio- tici testati tranne colistina e tigeciclina. Il tempo di degenza in ospedaliera >9 giorni è risultato un fattore di rischio significa- tivo (p=0,006), così come la precedente esposizione a terapia antibiotica ad ampio spettro (p=0,026). Inoltre il tempo di antibioticoterapia inappropriata, dall’esordio dei sintomi allo switch della terapia >5 giorni, è risultato fattore di rischio molto significativo sull’outcome (p=0,001) Discussione e conclusioni. L’alta prevalenza di KP e AB pro- duttori di carbapenemasi, è associata ad un aumento signifi- cativo della degenza ospedaliera, della morbilità e delle spese ospedaliere. Il tempo di antibioticoterapia inadeguato è forte- mente associato ad un outcome peggiore. Questo deve far porre l’accento su strategie di intervento per controllare e prevenire la loro diffusione e a sviluppare tecniche diagnosti- che il più precoci possibili