病例29-2024:47岁男性，意识错乱、肾衰竭

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病例29-2024:47岁男性，意识错乱、肾衰竭

病例29-2024:47岁男性，意识错乱、肾衰竭

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测试京东医生

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11人

以下内容来源于 NEJM 。

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文章病例29-2024:47岁男性，意识错乱、肾衰竭

以下内容来源于 NEJM 。

测试京东医生

主任医师

北京大学医院

文章夜间艾菲尔铁塔征

以下内容来源于 NEJM 。 A 50-year-old man presented with a 1-year history of progressive headaches and nausea. On physical examination, neck stiffness and dysmetria in both arms on finger-to-nose testing were noted. Results of a lumbar puncture revealed an opening pressure of 31 cm of water (reference range, 7 to 20), and cerebrospinal fluid studies were notable for elevations in the protein level and immunoglobulin index. Subsequent contrast-enhanced, T1-phase magnetic resonance imaging (MRI) of the head showed thickened dura with central hypointensity and peripheral enhancement at the posterior falx and cerebellar tentorium — a finding known as Eiffel-by-night sign (coronal view). Eiffel-by-night sign is thought to represent active inflammation of chronic pachymeningitis and may be seen in the context of inflammatory, autoimmune, neoplastic, or vascular conditions. A dural biopsy showed a lymphoplasmacytic infiltrate with IgG4-positive plasma cells. The serum IgG4 level was elevated. Whole-body imaging showed no other organ involvement. A diagnosis of IgG4-related hypertrophic pachymeningitis was made. Treatment was initiated with methylprednisolone pulse therapy for 5 days and was then transitioned to a slowly tapering dose of oral glucocorticoids. At a 2-month follow-up visit, a repeat MRI of the head showed improvement, and at 6 months, the patient’s headache had abated. A maintenance dose of a glucocorticoid was continued.

测试京东医生

主任医师

北京大学医院

文章对一家纽约社区医院扩大C auris入院筛查方案的实用性分析

以下内容来源于PubMed。 Abstract Background: Candida auris (C auris) is an emerging global infectious disease threat, and screening practices for identification of C auris are inconsistent across healthcare facilities. This study describes the utility of expanding a C auris admission screening protocol at an acute care hospital to screen all patients presenting from any skilled nursing facility. Methods: A retrospective review identified all patients screened on admission for C auris from January 2022 through September 2023. Patients were identified for risk potential, and those deemed high risk were placed on transmission-based precautions while awaiting culture results. Results: Of the 591 patients screened, 14 cases were identified (2.4%). Nine cases presented with tracheostomies or were ventilator-dependent and classified as high risk. Five cases were considered low risk at the time of screening. Eight of these newly identified cases would not be screened under the prior criteria. Discussion: This study's findings support prior studies that patients with tracheostomies or were ventilator-dependent have greater risk for C auris colonization. Adopting an expanded admission screening program has allowed the hospital to detect more cases earlier to prevent nosocomial transmissions. Conclusions: Healthcare facilities should consider initiating or expanding admission screening programs for C auris based on community prevalence rates of C auris. Keywords: Colonization; Emerging Diseases; Implementation Science; Screening; Skilled Nursing Facilities; Surveillance.

测试京东医生

主任医师

北京大学医院

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