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Kampala, Uganda

Martinez M.,Pulmonology Unit | Rochat I.,University of Geneva | Corbelli R.,University of Geneva | Tissieres P.,University of Geneva | And 2 more authors.
Pediatric Critical Care Medicine | Year: 2011

Objective: To report early blood exchange transfusion in malignant pertussis and a favorable clinical outcome. Setting: A pediatric intensive care unit in a tertiary hospital in Geneva, Switzerland. Design: A descriptive case report. Patient: An 8-wk-old girl was diagnosed with malignant pertussis (extreme leukocytosis, seizures, pneumonia, and secondary severe hypoxic respiratory failure associated with pulmonary hypertension). After administration of a one-volume blood exchange transfusion, a rapid decrease in white blood cell count (from 119,000/mm to 36,500/mm) was observed and followed by clinical improvement and favorable outcome despite the initial presence of all described risk factors associated with a high mortality. Conclusion: The use of exchange blood transfusion early in the course of the disease might help to prevent a fatal outcome of malignant pertussis. Copyright © 2011 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

Zanotti R.,Section of Hematology | Lombardo C.,Allergy Unit | Passalacqua G.,University of Genoa | Caimmi C.,Section of Rheumatology | And 13 more authors.
Journal of Allergy and Clinical Immunology | Year: 2015

Background: Systemic mastocytosis is a clonal mast cell (MC) disease that can lead to potentially fatal anaphylactic reactions caused by excessive MC mediator release. The prevalence of mastocytosis in patients with Hymenoptera venom allergy is high, and thus the disease should be suspected in patients with severe reactions caused by Hymenoptera stings and increased serum basal tryptase (SBT) levels. Objective: We sought to evaluate the presence of clonal MC disorders in patients seen at our mastocytosis center with Hymenoptera sting-induced anaphylaxis, documented hypotension, absence of urticaria pigmentosa, and normal SBT levels. Methods: Twenty-two patients with Hymenoptera sting- induced anaphylaxis, without skin lesions, and with tryptase levels of less than 11.4 ng/mL underwent bone marrow evaluation. Bone mineral density was assessed in those patients with ascertained mastocytosis. Results: In 16 of 22 patients, a diagnosis of indolent mastocytosis could be established, and 1 patient had a monoclonal MC activation syndrome. Patients with mastocytosis had higher SBT levels (P =.03) but only rarely had angioedema/urticaria associated with hypotension (P =.004). Conclusions: The absence of urticaria or angioedema in severe reactions to Hymenoptera stings with hypotension might represent the most relevant factor in identifying patients with mastocytosis, regardless of their serum tryptase levels. © 2015 American Academy of Allergy, Asthma & Immunology.

Pinto C.,Medical Oncology Unit | Novello S.,University of Turin | Torri V.,Mario Negri Institute for Pharmacological Research | Ardizzoni A.,University of Parma | And 15 more authors.
Cancer Treatment Reviews | Year: 2013

Malignant pleural mesothelioma (MPM) is a relevant public health issue. A large amount of data indicate a relationship between mesothelioma and asbestos exposure. MPM incidence has considerably and constantly increased over the past two decades in industrialized countries and is expected to peak in 2010-2020. In Italy, the standardized incidence rate in 2008 was 3.6 and 1.3 per 100,000 in men and women respectively, with wide differences from one region to another. The approach to this disease remains difficult and complex in terms of pathogenic mechanism, diagnosis, staging and treatment thus an optimal strategy has not yet been clearly defined. The Second Italian Multidisciplinary Consensus Conference on Malignant Pleural Mesothelioma was held in Turin (Italy) on November 24-25, 2011: recommendations on MPM management for public health institutions, clinicians and patients are presented in this report. © 2012 Elsevier Ltd.

Carbonelli C.,Pulmonology Unit | Prati F.,Infectious Diseases Unit | Carretto E.,Clinical Microbiology Laboratory | Cavazza A.,Pathology Unit | And 2 more authors.
Thorax | Year: 2013

Pulmonary involvement due to Nocardia is generally associated with cell-mediated immunosuppressive conditions and risk factors like HIV infection, lymphoproliferative diseases, diabetes and steroid therapy. Pulmonary alveolar proteinosis (PAP) is a well-known risk factor for Nocardia infection and is usually easily detectable on a high-resolution CT scan as ground-glass opacities with geographical distribution, crazy paving pattern and varying amounts of pulmonary consolidation. Pulmonary nocardiosis should be considered in apparently immunocompetent patients who present with PAP and a suspected opportunistic infection. We report a case of pulmonary nocardiosis occurring in a patient with radiologically inapparent PAP. The serendipitous finding of PAP on transbronchial biopsy further increased the likelihood of a Nocardia infection, subsequently confirmed by a surgical biopsy.

Kibirige D.,St Raphael of St Francis Hospital Nsambya | Ssekitoleko R.,Makerere University | Ssekitoleko R.,Infectious Diseases Unit | Mutebi E.,Makerere University | And 3 more authors.
BMC Infectious Diseases | Year: 2013

Background: There is a documented increase of diabetes mellitus in Sub Saharan Africa, a region where tuberculosis is highly endemic. Currently, diabetes mellitus is one of the recognised risk factors of tuberculosis. No study has reported the magnitude of diabetes mellitus among tuberculosis patients in Uganda, one of the countries with a high burden of tuberculosis. Methods: This was a cross-sectional study conducted among 260 consenting adult patients with a confirmed diagnosis of tuberculosis admitted on the pulmonology wards of Mulago national referral and teaching hospital in Kampala, Uganda to determine the prevalence of diabetes mellitus and associated clinical factors. Laboratory findings as well as the socio-demographic and clinical data collected using a validated questionnaire was obtained. Point of care random blood sugar (RBS) testing was performed on all the patients prior to initiation of anti tuberculosis treatment. Diabetes mellitus was diagnosed if the RBS level was ≥ 200mg/dl in the presence of the classical symptoms of diabetes mellitus. Results: The prevalence of diabetes mellitus among the admitted patients with tuberculosis was 8.5%. Only 5 (1.9%) patients with TB had a known diagnosis of diabetes mellitus at enrolment. Majority of the study participants with TB-DM co-infection had type 2 diabetes mellitus (n=20, 90.9%). At bivariate analysis, raised mean ALT concentrations of ≥80 U/L were associated with DM (OR-6.1, 95% CI 1.4-26.36, p=0.032) and paradoxically, HIV co-infection was protective of DM (OR-0.32, 95% CI 0.13-0.79, P=0.016). The relationship between DM and HIV as well as that with ALT remained statistically significant at multivariate analysis (HIV: OR- 0.17 95%CI 0.06-0.51, p=0.002 and ALT: OR-11.42 95%CI 2.15-60.59, p=0.004).Conclusion: This study demonstrates that diabetes mellitus is common among hospitalized tuberculosis patients in Uganda. The significant clinical predictors associated with diabetes mellitus among tuberculosis patients were HIV co-infection and raised mean serum alanine transaminase concentrations. © 2013 Kibirige et al; licensee BioMed Central Ltd.

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