Referral pattern of leptospirosis cases during a large urban epidemic of dengue.

During heavy seasonal rainfall in 1996, concurrent epidemics of dengue and leptospirosis occurred in an urban center in northeastern Brazil. We interviewed 110 cases of leptospirosis hospitalized a median of seven days after the onset of illness to evaluate the impact of the dengue epidemic on the triage of suspected leptospirosis from ambulatory clinics to the infectious disease reference hospital. Within the first three days of illness, 46 (42%) cases sought their first medical evaluation, and 28 (61% of 46) received a diagnosis of dengue. Dengue diagnoses were associated with a median of five days delay in referral to the infectious disease hospital. Patients who reported initial diagnoses of dengue were more likely than other patients to have required admission to the intensive care unit (odds ratio [OR] 2.7, 95% confidence interval [CI] 0.8–9.5) and to have died during hospitalization (OR 5.1, 95% CI 0.8–55.0). These findings indicate that diagnostic confusion between the early symptoms of leptospirosis and dengue may have contributed to the high mortality observed during the leptospirosis epidemi

Referral pattern of leptospirosis cases during a large urban epidemic of dengue.

Submitted by Ana Maria Fiscina Sampaio ([email protected]) on 2014-05-02T15:58:51Z No. of bitstreams: 1 Flannery B Referral pattern....pdf: 69522 bytes, checksum: 8388a12b44c4c68eeb813fe4a617ac6e (MD5)Made available in DSpace on 2014-05-02T15:58:51Z (GMT). No. of bitstreams: 1 Flannery B Referral pattern....pdf: 69522 bytes, checksum: 8388a12b44c4c68eeb813fe4a617ac6e (MD5) Previous issue date: 2001School of Public Health. University of California. Warren Hall. Berkeley, CAHospital Couto Maia. Secretary of Health for the State of Bahia. Salvador, BA, BrasilFundação Oswaldo Cruz. Centro de Pesquisa Gonçalo Moniz. Salvador, BA, BrasilFundação Oswaldo Cruz. Centro de Pesquisa Gonçalo Moniz. Salvador, BA, BrasilFundação Oswaldo Cruz. Centro de Pesquisa Gonçalo Moniz. Salvador, BA, BrasilFundação Oswaldo Cruz. Centro de Pesquisa Gonçalo Moniz. Salvador, BA, BrasilHospital Couto Maia. Secretary of Health for the State of Bahia. Salvador, BA, BrasilSchool of Public Health. University of California. Warren Hall. Berkeley, CAFundação Oswaldo Cruz. Centro de Pesquisa Gonçalo Moniz. Salvador, BA, BrasilFundação Oswaldo Cruz. Centro de Pesquisa Gonçalo Moniz. Salvador, BA, Brasil / Weill Medical College of Cornell University. New York, NYDuring heavy seasonal rainfall in 1996, concurrent epidemics of dengue and leptospirosis occurred in an urban center in northeastern Brazil. We interviewed 110 cases of leptospirosis hospitalized a median of seven days after the onset of illness to evaluate the impact of the dengue epidemic on the triage of suspected leptospirosis from ambulatory clinics to the infectious disease reference hospital. Within the first three days of illness, 46 (42%) cases sought their first medical evaluation, and 28 (61% of 46) received a diagnosis of dengue. Dengue diagnoses were associated with a median of five days delay in referral to the infectious disease hospital. Patients who reported initial diagnoses of dengue were more likely than other patients to have required admission to the intensive care unit (odds ratio [OR] 2.7, 95% confidence interval [CI] 0.8–9.5) and to have died during hospitalization (OR 5.1, 95% CI 0.8–55.0). These findings indicate that diagnostic confusion between the early symptoms of leptospirosis and dengue may have contributed to the high mortality observed during the leptospirosis epidemi

MIOEPITELIOMA DE PARTES MOLES DO RETO: RELATO DE CASO

Annotated in handwritten ink: To Genl. Robert Anderson with the compliments of J.E. Hilgard, Assist. U.S. Coast Survey.; Relief shown by hachures.; General map of eastern Virginia showing cities and towns, roads, rivers, and relief by hachures. The map is overprinted in red to indicate railroads and concentric circles centered on Richmond. Circles are at intervals of ten miles.; In his report to the Superintendent of the Coast survey dated November 1, 1862, Nicholson notes that "In addition to the printing of our charts proper, a map representing the seat of war in Virginia was, at the suggestion of the Superintendent, compiled by myself during the past year, and printed in colors, partly as an experiment in that class of work, and partly to meet the popular demand for information on the movements of our armies. This map has met with unexpected success, and has been much called for, and copies quite freely distributed; but, in order to cover the expenses of its getting up and printing, a number of copies have been placed in the hands of our sale agents, the proceeds of which have more than covered expenses; in all, some five thousand five hundred copies have been printed, over twenty-five hundred sold, and nearly three thousand copies gratuitously distributed." (Report of the Superintendent of the Coast Survey, showing the Progress of the Survey during the Year 1862 (Washington: Government Printing Office, 1864). p. 151.).; This is the first of seven issues in the Library of Congress published in 1862. Distinguishing characteristics include the depiction of the "Blairsville Branch" railroad, the "Manassas Gap R.R." extending to Harrisonburg, Virginia, and the "Delaware R.R." on the Eastern Shore extending to Seaford.; Description derived from published bibliography.1:887,04

Profile of Crohn’s Disease Patients Who Underwent Anorectal Examination under Anesthesia

Abstract Introduction Crohn’s disease (CD) is an inflammatory bowel disease, and in ∼ 30% of cases it is associated with perianal manifestations. To identify the extent of the damage and to implement an appropriate treatment, anorectal examination under anesthesia (EUA) is fundamental. Objective To describe the profile of patients who underwent anorectal EUA in university and private hospitals in the state of Bahia, Brazil. Methodology A retrospective, descriptive study with 46 patients who underwent anorectal EUA between March, 2016 and November, 2019. Results A total of 62 anorectal EUAs were performed in 46 patients. With an average age of 36.8 years, the female gender was predominant (52.2%) among these patients. Anal fistulas were the most frequent findings (83.8%), and in most cases they were treated with a seton placement (69.4%). The main recommended surgical indication was a proper evaluation and identification of perianal disease, followed by drainage of the abscess and therefore immunobiological therapy (59.6%). Conclusion In the present study, the profile of CD patients was similar to those found in the literature, with a high rate of complex anal fistulas. Additional studies are still necessary to further comprehend and treat this particular and debilitating manifestation of the disease.</jats:p

Variables associated with progression of moderate-to-severe Crohn’s disease

Objective Determine the variables associated with hospitalisations in patients with Crohn’s disease and those associated with surgery, intestinal resection, hospital readmission, need for multiple operations and immunobiological agent use.Design A cross-sectional study was conducted from 2019 to 2021, using two centres for inflammatory bowel diseases in the Brazilian Public Health System.Results This study included 220 patients. Only perianal disease was associated with hospitalisation (31.6% vs 13.0%, p=0.012). Stricturing or penetrating behaviour (35.8% vs 12.6%, p&lt;0.001) and perianal disease (45.9% vs 9.9%, p&lt;0.001) were associated with surgery. Ileal or ileocolonic location (80.0% vs 46.5%, p=0.044) and stricturing or penetrating behaviour (68.0% vs 11.2%, p&lt;0.001) were associated with intestinal resection. Steroids use at first Crohn’s disease occurrence and postoperative complications were associated with hospital readmission and need for multiple operations, respectively. Age below 40 years at diagnosis (81.3% vs 62.0%, p=0.004), upper gastrointestinal tract involvement (21.8% vs 10.3%, p=0.040) and perianal disease (35.9% vs 16.3%, p&lt;0.001) were associated with immunobiological agent use.Conclusion Perianal disease and stricturing or penetrating behaviour were associated with more than one significant outcome. Other variables related to Crohn’s disease progression were age below 40 years at diagnosis, an ileal or ileocolonic disease localisation, an upper gastrointestinal tract involvement, the use of steroids at the first Crohn’s disease occurrence and history of postoperative complications. These findings are similar to those in the countries with a high prevalence of Crohn’s disease