Disseminated Cerebral and Intradural Extramedullary Spinal Nocardiosis in an Immunocompetent Patient

Disseminated nocardiosis of the central nervous system (CNS) has been rarely reported, especially in the immunocompetent patient. We report a case of cerebral and cervical intradural extramedullary nocardiosis likely to have been the result of disseminated spread from a pulmonary infective focus. Attempts at tissue biopsy and culture of the initial cerebral and pulmonary lesions both failed to yield the diagnosis. Interval development of a symptomatic intradural extramedullary cervical lesion resulted in open biopsy and an eventual diagnosis of nocardiosis was made. We highlight the diagnostic dilemma and rarity of spinal nocardial dissemination in an immunocompetent individual.

Chylous Ascites in Systemic Lupus Erythematosus (SLE) Patients

The gastrointestinal system is commonly implicated in Systemic Lupus Erythematosus (SLE). Ascites, produced by several mechanisms has been reported as a systemic manifestation of lupus, but only rarely as an initial presentation of the disease. Its appearance is often insidious and without abdominal pain. Chylous ascites (such as chyle in the peritoneal cavity) has seldom been reported in SLE. We describe a case of chylous ascites in an SLE patient, reviewing the other published cases, its pathophysiology and its management.

Fresh Frozen Plasma in Hereditary Angioedema Crisis: To Give or Not To Give?

Objectives: Fresh frozen plasma (FFP) has been used in angioedema crises, however there is a risk of aggravating the symptoms as well as transmitting infections. In this report, the authors emphasize the dangers of this therapy. Materials and methods: A 25-year-old woman with hereditary angioedema (HAE) was treated with FFP after which her symptoms escalated. Results: Administration of purified C1-inhibitor (C1-INH) resulted in relief of her symptoms. Conclusions: FFP is to be avoided in a HAE crisis. Newer therapies for angioedema are preferred.

Just Another Pelvic Mass?

Objectives: To describe the case of a patient presenting with weight loss and a pelvic mass. Materials and methods: We performed an advanced search in MEDLINE using the key words "wasting syndrome", "actinomycosis" and "pelvic mass". Results: A 63-year-old woman had a well-delimited and tender pelvic mass and was found to be anaemic. Before scans were performed, clinicians considered malignancy and other diagnoses. Conclusion: Actinomycosis is a chronic infection that usually affects the abdomen. Because of the lack of specificity of clinical and radiological findings, a multidisciplinary approach is the keypoint for making an accurate diagnosis.

Gastric and Peritoneal Involvement of Human Herpes Virus 8 Related Kaposi Sarcoma in a Patient with Acquired Immunodeficiency Syndrome

Kaposi's sarcoma (KS) is one of the most frequent neoplastic diseases in patients infected with human immunodeficiency virus (HIV). The authors report the case of a 40-year-old male with ascites, peripheral edema and peritoneal carcinomatosis secondary to a gastric KS related to human herpes virus type 8 (HHV-8). The patient had severe immunodeficiency, with a TCD4+ count of 86 cells/µl and newly diagnosed acquired immunodeficiency syndrome. His clinical condition rapidly deteriorated, with multiorgan failure, and he died without the possibility of initiating antiretroviral therapy or chemotherapy. To the authors’ knowledge, carcinomatosis is a rare feature in KS.

Magnetic Theory and Applications in the Naples Bay (Southern Tyrrhenian Sea, Italy): Magnetic Anomaly Fields and Relationships with Morpho-Structural Lineaments

Magnetic theory and application to a complex volcanic area located in Southern Italy are here discussed showing the example of the Gulf of Naples, located at Southern Italy Tyrrhenian margin. A magnetic anomaly map of the Gulf of Naples has been constructed aimed at highlighting new knowledge on geophysics and volcanology of this area of the Eastern Tyrrhenian margin, characterized by a complex geophysical setting, strongly depending on sea bottom topography. The theoretical aspects of marine magnetometry and multibeam bathymetry have been discussed. Magnetic data processing included the correction of the data for the diurnal variation, the correction of the data for the offset and the leveling of the data as a function of the correction at the cross-points of the navigation lines. Multibeam and single-beam bathymetric data processing has been considered. Magnetic anomaly fields in the Naples Bay have been discussed through a detailed geological interpretation and correlated with main morpho-structural features recognized through morphobathymetric interpretation. Details of magnetic anomalies have been selected, represented and correlated with significant seismic profiles, recorded on the same navigation lines of magnetometry. They include the continental shelf offshore the Somma-Vesuvius volcanic complex, the outer shelf of the Gulf of Pozzuoli offshore the Phlegrean Fields volcanic complex, the relict volcanic banks of Pentapalummo, Nisida and Miseno, the Gaia volcanic bank on the Naples slope, the western slope of the Dohrn canyon, the Magnaghi canyon’s head and the magnetic anomalies among the Ischia and Procida islands.

Fever, Hemiparesis and Hyponatraemia in a 63-year-old. HIV, another Great Masquerader?

The authors describe the unusual case of a 63-year-old patient who was referred with fever and lethargy, and was found to be hyponatraemic. The patient subsequently developed hemiparesis, and neuroradiology showed several space-occupying brain lesions. The cause was later identified as cerebral toxoplasmosis in undiagnosed Acquired Immunodeficiency Syndrome (AIDS).

Nutraceutics, Frailty and Polypharmacy in the Oldest Old

Malnutrition and nutritional problems are common in older adults. Multiple chronic disease, inflammation, cognitive and functional impairment, geriatric syndromes (including delirium, falls or chronic pain) and drug use (i.e. polypharmacy, adverse drug reactions) may play a role in the onset of malnutrition and nutritional problems.

Addressing Inpatient Admissions and Readmissions Due to Adverse Drug Reactions in the Oldest Old

Adverse drugs reactions (ADRs) in the older population are a major healthcare problem resulting in significant morbidity, healthcare consumption and high costs.

STOPP/START Criteria and Their Role as a Clinical Tool in Routine Practice

Screening Tool of Older Persons’ Prescriptions (STOPP)/Screening Tool to Alert to Right Treatment (START) criteria was first published in 2008, primarily as an alternative set of explicit criteria for potentially inappropriate medications (PIMs) to Beers criteria.

A Comprehensive Protocol to Mitigate Inappropriate Medication in the Elderly

The percentage of elderly population is increasing and it is estimated that by 2050 30% of the population in developed countries will be over 65. Elderly often have multiple chronic diseases that require multiple medications.

Improving Drug Prescription in Elderly Diabetic Patients

Nowadays, there is no doubt that there is a good epidemic of ageing with the inversion of the population pyramid. There is no doubt either about the current epidemic of obesity and bad nutritional habits that have resulted in an increase of diabetic patients in the world. And the union of these epidemics has led to an increase of diabetes (DM) in the elderly.

The STRIPassistant: a Digital Tool to Optimize Polypharmacy

The Structured Tool to Reduce Inappropriate Prescribing (STRIP) is a method to perform a medication review. Part of this method is the pharmaceutical analysis that is digitalized into the STRIPassistant (demo: www.ephor.eu). The effectiveness and time-efficiency of the STRIPassistant will be presented.

Inappropriate Drug Prescribing in Older Adults: How to Reduce It?

Because older patients are more vulnerable to adverse drug-related events, there is a need to ensure appropriate pharmacotherapy in these patients. Screening to identify older patients at risk of drug-related problems (DRP) and adverse drug reactions (ADR) is the first critical step within a multistep approach to geriatric pharmacotherapy.

Hepcidin and Ferritin Levels in Fever of Unknown Origin: Is There a New Biomarker?

Background and objectives: Significantly elevated serum ferritin levels are associated with both iron overload and some inflammatory conditions. Hepcidin is a protein that interferes with iron absorption in inflammatory states and acts as an acute-phase reactant. Materials and methods: Here we report the case a 33-year-old patient who presented with high fever, skin lesions and arthralgia lasting for 2 weeks. His ferritin level was 13,800 µg/l and his hepcidin level was 61 ng/dl. Results: The final diagnosis was adult onset Still's disease. The condition evolved satisfactorily with steroid treatment, but after several weeks the patient presented with an unexpected recurrence. Conclusions: Hepcidin is a good inflammatory marker that could be useful in the differential diagnosis of hyperferritinaemia.