Medicina
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Case Reports
[Sertraline. Adverse effects due to the superposition of serotonic and malignant neuroleptic syndromes].
A 57 year-old man chronically treated with 50 mg daily of sertraline was admitted to the emergency room with mental status changes, rigidity, seizure activity and autonomic instability. He was rapidly transferred to the Intensive Care Unit. Laboratory determinations revealed increases in serum enzymes, prevailing creatine phosphokinase with a peak level by the third day of 35,000 Ui/L. ⋯ Supportive care included discontinuation of sertraline and lorazepam administration. Mental status, and rigidity returned to baseline within 60 hours. Differential diagnosis between the neuroleptic malignant syndrome and the serotonin syndrome could not be determined accurately because of the striking overlap of signs and symptoms of both syndromes.
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The administration of high volumes of fluids during resuscitation of critically ill patients follows the recommendations of experts' committees that postulate volume expansion to correct deficits that may be associated with certain conditions (sepsis, trauma, surgery, etc), not primarily characterized by hypovolemia. These recommendations suggest that optimizing cardiac output may avoid occult deficit in tissue oxygen delivery and consumption that could lead to multisystem organic failure and death. The lack of benefit in the morbidity and mortality rates of patients with treatments directed to reach supranormal values of oxygen delivery, attempts against this hypothesis, since it fails to correct the primary hemodynamic dysfunction (arterial vasodilatación) and generates fluid overload. The probable mechanisms linked with the avidity to retain water and sodium by critically ill patients are reviewed and the use of restricted protocols that preserve fluid balance is encouraged to potentially improve outcome.
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Fifty three patients (pts) received an allogeneic hematopoietic transplant using peripheral blood progenitor cells (PBPC). Diagnosis were acute myeloid leukemia (AML) in 16 pts, acute lymphoblastic leukemia (ALL) in 15, chronic myeloid leukemia (CML) in first chronic phase in 12, aplastic anemia in 4, myelodysplasia in 3 and Hodgkin's disease, major thalasemia and Hunter's syndrome in one each. Mean age was 20 years-old (2-55), 28 males and 25 females. ⋯ Forty three pts were evaluable for chronic GVHD with a mean follow-up of 18 months (4-39). Chronic GVHD was observed in 26.4% by day +240, only 2 pts developed severe cGVHD. The present experience demonstrates an acceptable incidence for cGVHD; however, taking into account recent reports showing an increase of this complication, it seems reasonable not to perform this procedure for non-malignant diseases in which graft versus malignancy effect is not to be expected.
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Human poisoning by Lepidoptera (butterflies, caterpillars and moths) has been known to physicians since old times. In the last few years, several factors have been causative of a great number of contacts between different stages of these insects and humans, occasionally with epidemic features. Species of medical interest in Argentina are those related to Megalopygidae, Saturniidae, Hemileucidae, Arctiidae, Notodentidae and Eucliedae families. ⋯ In the past two years, there have been some cases of poisoning by Lonomia obliqua in Misiones, in the North East of Argentina on the border with Southern Brazil. This presents a potential risk, taking into account the poor knowledge regarding this insect and its venom in Argentina. This brief actualization gives some biochemical, clinical and epidemiologic tools towards understanding human Lepidopterism, an uncommon medical problem in this country.
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Our objective was to determine delirium incidence and risk factors in a cohort of elderly inpatients. We randomly selected 149 patients, aged 65 years or older, from admission to general wards, without evidence of delirium. They were evaluated daily with the Confusion Assessment Method, an instrument validated for the diagnosis of delirium. ⋯ We conclude that delirium in our setting is very frequent and has negative effects on resource utilization and mortality in elderly inpatients. Its association with the severity of the disease seems interesting. Appropriate prospective identification of patients at risk for delirium may allow the implementation of preventive strategies in order to minimize the impact of this complication.