Pneumonitis as A Consequence of (Peg)Interferon-Ribavirin Combination Therapy for Hepatitis C: a Review of the Literature

Combination of peginterferon and ribavirin is the current therapy for chronic hepatitis C infection (HCV). Interstitial pneumonitis is a rare side-effect of HCV therapy and is an important cause of dose reduction or discontinuation, impairing success of antiviral therapy. We performed a review of the literature in order to present diagnostic modalities and possible treatments for pneumonitis and to offer guidelines. We searched for cases where pneumonitis as a side-effect of HCV treatment was documented. First we performed a literature search via PubMed and Web of Science interface and second we searched three drug toxicity databases. We systematically analyzed all case reports with respect to clinical manifestations, type of treatment, and outcome. A literature search revealed 19 articles, containing 25 case descriptions, while we traced 33 cases from the drug toxicity databases. Pneumonitis presented with any of the combination of fever, dyspnea, and cough and can arise with any type of (conventional or pegylated) interferon. Mortality secondary to pneumonitis was seen in 7% of cases, exclusively with peginterferon α-2b. In most cases therapy was discontinued and steroids were started. Interferon-induced pneumonitis during HCV treatment is a severe complication and should be recognized in order to prevent further pulmonary damage and/or death

Cervical intramedullary schwannoma: a case report and review of the literature

Intramedullary schwannomas unrelated with neurofibromatosis are uncommon tumors, but if correctly diagnosed and properly treated they may have a good prognosis

HLA-Driven Convergence of HIV-1 Viral Subtypes B and F Toward the Adaptation to Immune Responses in Human Populations

BACKGROUND: Cytotoxic T-Lymphocyte (CTL) response drives the evolution of HIV-1 at a host-level by selecting HLA-restricted escape mutations. Dissecting the dynamics of these escape mutations at a population-level would help to understand how HLA-mediated selection drives the evolution of HIV-1. METHODOLOGY/PRINCIPAL FINDINGS: We undertook a study of the dynamics of HIV-1 CTL-escape mutations by analyzing through statistical approaches and phylogenetic methods the viral gene gag sequenced in plasma samples collected between the years 1987 and 2006 from 302 drug-naive HIV-positive patients. By applying logistic regression models and after performing correction for multiple test, we identified 22 potential CTL-escape mutations (p-value<0.05; q-value<0.2); 10 of these associations were confirmed in samples biologically independent by a Bayesian Markov Chain Monte-Carlo method. Analyzing their prevalence back in time we found that escape mutations that are the consensus residue in samples collected after 2003 have actually significantly increased in time in one of either B or F subtype until becoming the most frequent residue, while dominating the other viral subtype. Their estimated prevalence in the viral subtype they did not dominate was lower than 30% for the majority of samples collected at the end of the 80's. In addition, when screening the entire viral region, we found that the 75% of positions significantly changing in time (p<0.05) were located within known CTL epitopes. CONCLUSIONS: Across HIV Gag protein, the rise of polymorphisms from independent origin during the last twenty years of epidemic in our setting was related to an association with an HLA allele. The fact that these mutations accumulated in one of either B or F subtypes have also dominated the other subtype shows how this selection might be causing a convergence of viral subtypes to variants which are more likely to evade the immune response of the population where they circulate

Persistent left superior vena cava: Review of the literature, clinical implications, and relevance of alterations in thoracic central venous anatomy as pertaining to the general principles of central venous access device placement and venography in cancer patients

Persistent left superior vena cava (PLSVC) represents the most common congenital venous anomaly of the thoracic systemic venous return, occurring in 0.3% to 0.5% of individuals in the general population, and in up to 12% of individuals with other documented congential heart abnormalities. In this regard, there is very little in the literature that specifically addresses the potential importance of the incidental finding of PLSVC to surgeons, interventional radiologists, and other physicians actively involved in central venous access device placement in cancer patients. In the current review, we have attempted to comprehensively evaluate the available literature regarding PLSVC. Additionally, we have discussed the clinical implications and relevance of such congenital aberrancies, as well as of treatment-induced or disease-induced alterations in the anatomy of the thoracic central venous system, as they pertain to the general principles of successful placement of central venous access devices in cancer patients. Specifically regarding PLSVC, it is critical to recognize its presence during attempted central venous access device placement and to fully characterize the pattern of cardiac venous return (i.e., to the right atrium or to the left atrium) in any patient suspected of PLSVC prior to initiation of use of their central venous access device

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine

[This corrects the article DOI: 10.1186/s13054-016-1208-6.]

Factors associated with admission to the intensive care unit in patients undergoing nephrectomy

Background: At present, there is no known risk factor analysis in patients undergoing nephrectomy secondary to lithiasis that favor their entry into the intensive care unit. There is no consensus in methods that report post-surgical complications. As a consequence, the reported incidence of complications in renal surgery ranges from 2% to 54%, regardless of the surgical approach. Methodology: A total of 58 patients with diagnosis of renal exclusion confirmed by renal scintigraphy, and lithiasis, were submitted to simple nephrectomy by a group of expert surgeons. A total of 58 patients were evaluated. Descriptive statistics were measured for the demographic variables. Inferential statistics were evaluated in quantitative variables using the Student's T test, with a p < 0.005. Chi square test was used for the qualitative variables. Results: When the multivariate analysis was carried out between the variables: age, weight, height, diabetes mellitus, systemic hypertension, smoking, abscess and transfusion, it was not possible to identify correlation between these and the development of complications or admission to the intensive care unit. However, when assessing by logistic regression the relationship between transfusing a patient and developing complications, a positive relationship was found with a p = 0.003, and an OR 13.45 CI [2.4â72]. Patients who suffered complications required a longer stay in the intensive care unit (p = 0.002). Conclusions: It was observed that patients with comorbidities such as hypertension, diabetes mellitus and anemia are more likely to require handling per unit of intensive care, even greater in those requiring transsurgical transfusion. Because there are not enough studies that relate the different risk factors that require intensive care unit management, a risk classification or transsurgical transfusion indications in these patients cannot yet be mentioned. Resumen: Antecedentes: En la actualidad no se conoce un análisis en lo que se refiere a los factores de riesgo en pacientes sometidos a nefrectomía secundario a patología litiásica que favorezcan su ingreso a la unidad de cuidados intensivos. A pesar de que las tazas de complicaciones son utilizadas para comparar el éxito en las distintas técnicas quirúrgicas, no hay un consenso en los métodos que reporten complicaciones post quirúrgicas. Por consecuencia, la incidencia reportada de complicaciones en la cirugía renal va del 2% al 54%, independientemente del abordaje quirúrgico. Metodología: Se incluyeron un total de 58 pacientes con diagnóstico de exclusión renal confirmado mediante gamagrafía renal, y litiasis, sometidos a nefrectomía simple por un grupo de cirujanos expertos. Se realizó medición de estadística descriptiva para las variables demográficas. La estadística inferencial fue evaluada en variables cuantitativas se utilizando la prueba T de Student, con una p < 0.005. Para las variables cualitativas se utilizó prueba de Chi cuadrada. Resultados: Al realizar el análisis multivariado entre las variables: edad, peso, talla, Diabetes Mellitus, Hipertensión Arterial Sistémica, tabaco, presencia de absceso y transfusión no se logró identificar correlación entre estas y el desarrollo de complicaciones o el ingreso a la unidad de cuidados intensivos. Sin embargo, al momento de evaluar mediante regresión logística la relación entre transfundir a un paciente y el desarrollo de complicaciones se encontró relación positiva con una p 0.003, y un OR 13.45 CI [2.4-72]. Los pacientes que sufrieron complicaciones requirieron mayor estancia en la unidad de cuidados intensivos (p = 0.002). Conclusiones: Se observó que en los pacientes en quienes presentan comorbilidades como son hipertensión, Diabetes Mellitus y anemia son más propensos a requerir manejo por unidad de cuidados intensivos siendo aún mayor en los que se requirió de transfusión transquirurgica. Debido a que no se cuentan con suficientes estudios que relacionen los diferentes factores de riesgo que hagan requerir de manejo por unidad de cuidados intensivos no se puede aún hablar de una clasificación de riesgo ni de indicaciones de transfusión transquirurgicas en estos pacientes. Keywords: Nephrectomy, Anemia, Complications, Non-functioning kidney, Intensive care unit, Palabras clave: Nefrectomía, Anemia, Complicaciones, Exclusión renal, Unidad de cuidados intensivo

Manifestaciones extrapulmonares de la infección por SARS-CoV-2

La enfermedad causada por un nuevo coronavirus, que inició en 2019, fue denominada COVID-19 y declarada pandemia el 11 de marzo de 2020 por la Organización Mundial de la Salud. Si bien es cierto que los primeros reportes enfatizaron las manifestaciones respiratorias de esta enfermedad como presentación clínica inicial, poco a poco empezaron a aparecer casos con manifestaciones iniciales distintas, involucrando otros sistemas. En los casos en los que se identificó afectación del sistema nervioso central, los hallazgos más frecuentes fueron mareo, cefalea y alteración del estado de alerta. Respecto al sistema cardiovascular, la elevación de biomarcadores cardiacos y la miocarditis son unos de los hallazgos más frecuentes. Los principales síntomas gastrointestinales descritos hasta el momento son anorexia, náuseas, vómitos, diarrea y dolor o disconfort abdominal. La tromboembolia venosa es una complicación frecuente y un problema de salud pública. Las manifestaciones cutáneas siguen siendo un campo de investigación. Se han identificado exantemas maculopapulares, livedo reticular y gangrena acral, entre otros. El personal sanitario debe estar actualizado sobre los nuevos hallazgos clínicos y las formas de presentación de esta enfermedad solo parcialmente conocida, lo que permitirá hacer diagnósticos más precisos y oportunos, y así impactar en el pronóstico de estos enfermos