Bilateral Ramsay Hunt syndrome in a diabetic patient

BACKGROUND: Herpes zoster oticus accounts for about 10% cases of facial palsy, which is usually unilateral and complete and full recovery occurs in only about 20% of untreated patients. Bilateral herpes zoster oticus can sometime occur in immunocompromised patients, though incidence is very rare. CASE PRESENTATION: Diabetic male, 57 year old presented to us with bilateral facial palsy due to herpes zoster oticus. Patient was having bilateral mild to moderate sensorineural hearing loss. Patient was treated with appropriate metabolic control, anti-inflammatory drugs and intravenous acyclovir. Due to uncontrolled diabetes, glucocorticoids were not used in this patient. Significant improvement in hearing status and facial nerve functions were seen in this patient. CONCLUSIONS: Herpes zoster causes severe infections in diabetic patients and can be a cause of bilateral facial palsy and bilateral Ramsay Hunt syndrome. Herpes zoster in diabetic patients should be treated with appropriate metabolic control, NSAIDS and intravenous acyclovir, which we feel should be started at the earliest. Glucocorticoids should be avoided in diabetic patients

Protocol for German trial of Acyclovir and corticosteroids in Herpes-simplex-virus-encephalitis (GACHE): a multicenter, multinational, randomized, double-blind, placebo-controlled German, Austrian and Dutch trial [ISRCTN45122933]

Background The treatment of Herpes-simplex-virus-encephalitis (HSVE) remains a major unsolved problem in Neurology. Current gold standard for therapy is acyclovir, a drug that inhibits viral replication. Despite antiviral treatment, mortality remains up to 15%, less than 20% of patients are able to go back to work, and the majority of patients suffer from severe disability. This is a discouraging, unsatisfactory situation for treating physicians, the disabled patients and their families, and constitutes an enormous burden to the public health services. The information obtained from experimental animal research and from recent retrospective clinical observations, indicates that a substantial benefit in outcome can be expected in patients with HSVE who are treated with adjuvant dexamethasone. But currently there is no available evidence to support the routine use of adjuvant corticosteroid treatment in HSVE. A randomized multicenter trial is the only useful instrument to address this question. Design GACHE is a multicenter, randomized, double-blind, placebo-controlled, parallel group clinical trial of treatment with acyclovir and adjuvant dexamethasone, as compared with acyclovir and placebo in adults with HSVE. The statistical design will be that of a 3-stage-group sequential trial with potential sample size adaptation in the last stage. Conclusion 372 patients with proven HSVE (positive HSV-DNA-PCR), aged 18 up to 85 years; with focal neurological signs no longer than 5 days prior to admission, and who give informed consent will be recruited from Departments of Neurology of academic medical centers in Germany, Austria and The Netherlands. Sample size will potentially be extended after the second interim analysis up to a maximum of 450 patients. Trial Registration Current Controlled Trials ISRCTN4512293

Herpes simplex virus encephalitis in pregnancy - a case report and review of reported patients in the literature

BACKGROUND: Herpes simplex virus (HSV) encephalitis is the most common sporadic cause of encephalitis with significant morbidity and mortality that is drastically reduced by early antiviral treatment. CASE PRESENTATION: We report a 37 year old woman, 33 weeks pregnant, who presented with seizures due to proven HSV-1 encephalitis, and who had had a previous episode of probable viral encephalitis aged 14 years. She was successfully treated with aciclovir on both occasions and, in the latter, went on to deliver a healthy infant. This case is compared with 17 cases of HSV encephalitis in pregnancy in the literature identifying a predominance in the late 2nd and 3rd trimesters, perhaps in part due to immunological changes in pregnancy. The clinical presentation is also compared with non-pregnant patients with HSV encephalitis in the largest prospective UK and European studies. We also present practical advice on management from recent national guidelines. CONCLUSION: When pregnant women present with new seizures, headache, impaired consciousness or altered behaviour urgent investigation is required to identify common diagnoses, such as eclampsia, venous sinus thrombosis and metabolic disturbances. Nevertheless, viral encephalitis is a very treatable cause of this presentation with potentially serious complications if missed, and may be more common in latter stages of pregnancy. Encephalitis should not be discounted if the patient is afebrile, has a normal Glasgow coma score, or the cerebrospinal fluid white cell count is only slightly elevated, as these features are well recognised in viral encephalitis

Analyse des variations de l'état de santé d'aidants familiaux de patients en hospitalisation à domicile pour soins paliatifs

Beaucoup de personnes souhaiteraient passer leurs derniers instants chez eux. Cela nécessite l'investissement de leurs proches, particulièrement l'aidant familial principal dont le rôle est essentiel mais entrainant des conséquences sur sa santé. L'hospitalisation à domicile (HAD) est une alternative à l'hospitalisation conventionnelle. L'objectif principal de cette étude était de détenniner la variation de la santé des aidants familiaux de patients en HAD pour soins palliatifs. L'objectif secondaire était de rechercher un lien entre la variation de la santé des aidants et les composantes objectives et subjectives de leur fardeau. Entre décembre 2011 et août 2013, les aidants de patients admis en soins pallüitifs dans les HAD de l' APARD participaient à un entretien initial puis répondaient à un questionnaire post-HAD afin d'évaluer les éventuels problèmes de santé survenus pendant l'HAD. Le critère de jugement principal était la survenue d'un événement psychique et/ou physique. Les critères de jugement secondaires étaient le fardeau objectif (participation aux soins) et le fardeau subjectif (vécu de son rôle). Panni les 20 aidants analysés, 75% (IC95%[56-94]) rapportaient au moins un événement physique et 30% (IC95%[14,1-55,9)) au moins un événement psychique. La variation de la santé psychique était corrélée au fardeau subjectif (p=0,002 ; t= 0,66 IC95%[0,31 ;0,85]). Cette étude confirme une variation non négligeable de l'état de santé des aidants familiaux de patients en soins palliatifs même dans le cadre d'une HAD. Un travail sur l'évaluation systématique de leur santé et sur l'utilisation du fardeau subjectif pour la prise en charge constituerait une piste intéressanteMONTPELLIER-BU Médecine UPM (341722108) / SudocMONTPELLIER-BU Médecine (341722104) / SudocSudocFranceF

Etude rétrospective sur la sortie précoce de prématuré d'un service de néonatologie en 2000

PARIS13-BU Serge Lebovici (930082101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Epidémiologie microbienne des pneumopathies infectieuses du sujet âgé fragile

MONTPELLIER-BU Médecine UPM (341722108) / SudocPARIS-BIUM (751062103) / SudocMONTPELLIER-BU Médecine (341722104) / SudocSudocFranceF