Although the “triglyceride paradox” states that hypertriglyceridemia is less frequent in Blacks and the risk of pancreatitis increases with severe hypertriglyceridemia, we herein report on a case of moderate hypertr...Although the “triglyceride paradox” states that hypertriglyceridemia is less frequent in Blacks and the risk of pancreatitis increases with severe hypertriglyceridemia, we herein report on a case of moderate hypertriglyceridemia revealed by an acute chest syndrome and a milky appearance serum in a 47-year-old type 2 diabetes black patient with prior history of recurrent acute pancreatitis. In addition to insulin therapy and coronary angioplasty, the combination of a statin and a fibrate resulted two months later in a substantial improvement in triglyceride levels and a normal serum appearance.展开更多
Acute chest syndrome (ACS) is a serious pulmonary complication of sickle cell disease. It is estimated to be responsible for a quarter of deaths in the pediatric sickle cell population. In Senegal, there are not enoug...Acute chest syndrome (ACS) is a serious pulmonary complication of sickle cell disease. It is estimated to be responsible for a quarter of deaths in the pediatric sickle cell population. In Senegal, there are not enough pediatric studies in this area. The objective of our study was to determine the epidemiological, diagnostic and evolutionary characteristics of ATS at the Albert Royer National Children’s Hospital (CHNEAR) in Dakar. This was a retrospective study in patients hospitalized at CHNEAR for ATS from January 1, 2021 to March 31, 2022. We included patients hospitalized and diagnosed with ATS. We had collected 102 patients, i.e. a hospital incidence of 2.96%. The average age of the children was 9 years old;the sex ratio was 1.04. The main symptoms on admission were hypoxemia (97.06%), chest pain (77.45%), dyspnea (77.45%) and fever (65.69%). 52.94% of patients had an associated vaso-occlusive crisis (VOC). The chest x-ray was abnormal in 92 patients, a rate of 90.20% and showed images of pneumonia (71%);bronchitis (17.65%) and pleurisy (0.98%). None of the children benefited from a pulmonary ultrasound. The treatment associated with analgesics (100%), broad-spectrum antibiotics (100%), oxygen therapy (100%), hydration (95.09%), transfusion (73.53%), non-ventilation invasive (6.86%), intubation (2.94%) and beta 2 mimetics (12.75%). No patient benefited from incentive spirometry. Almost all of the patients 95.10% (n = 97) had a favorable clinical evolution. However, five children (4.90%) had an unfavorable outcome including one case of complication such as stroke (0.98%) and four (4) cases of death. The average hospital stay was 8 days. ATS is common in children with sickle cell disease in Senegal and its etiologies seem to be dominated by infectious causes in our context.展开更多
Background: Sickle cell anemia is caused by a mutation in the beta globin gene, resulting in the production of sickle hemoglobin, which is less soluble than normal hemoglobin. The main disease features are related to ...Background: Sickle cell anemia is caused by a mutation in the beta globin gene, resulting in the production of sickle hemoglobin, which is less soluble than normal hemoglobin. The main disease features are related to hemolytic anemia and blood vessels occlusion, causing ischemia and infracts. Acute chest syndrome is one of its most dangerous manifestations, and may cause severe hypoxemia and acute respiratory failure. Conservative management is often successful, but in rare cases the syndrome may be refractory. Extracorporeal membrane oxygenation (ECMO) support may be life-saving in these extreme situations. Case Report: A 31-year-old male admitted to the intensive care unit (ICU) in our hospital due to acute chest syndrome and massive aspiration. Due to extreme hypoxemia and severe acute respiratory distress syndrome, veno-venous ECMO support was initiated with rapid improvement in both oxygenation and hemodynamic status. The patient was weaned of ECMO after 7 days. He was discharged 4 weeks later. Although initiation of ECMO in sickle cell patients is uncommon, in selected refractory cases it may be life-saving. Conclusion: Although initiation of ECMO therapy in sickle cell anemia patients is uncommon, and may be even controversial, in selected refractory cases it may be life-saving.展开更多
文摘Although the “triglyceride paradox” states that hypertriglyceridemia is less frequent in Blacks and the risk of pancreatitis increases with severe hypertriglyceridemia, we herein report on a case of moderate hypertriglyceridemia revealed by an acute chest syndrome and a milky appearance serum in a 47-year-old type 2 diabetes black patient with prior history of recurrent acute pancreatitis. In addition to insulin therapy and coronary angioplasty, the combination of a statin and a fibrate resulted two months later in a substantial improvement in triglyceride levels and a normal serum appearance.
文摘Acute chest syndrome (ACS) is a serious pulmonary complication of sickle cell disease. It is estimated to be responsible for a quarter of deaths in the pediatric sickle cell population. In Senegal, there are not enough pediatric studies in this area. The objective of our study was to determine the epidemiological, diagnostic and evolutionary characteristics of ATS at the Albert Royer National Children’s Hospital (CHNEAR) in Dakar. This was a retrospective study in patients hospitalized at CHNEAR for ATS from January 1, 2021 to March 31, 2022. We included patients hospitalized and diagnosed with ATS. We had collected 102 patients, i.e. a hospital incidence of 2.96%. The average age of the children was 9 years old;the sex ratio was 1.04. The main symptoms on admission were hypoxemia (97.06%), chest pain (77.45%), dyspnea (77.45%) and fever (65.69%). 52.94% of patients had an associated vaso-occlusive crisis (VOC). The chest x-ray was abnormal in 92 patients, a rate of 90.20% and showed images of pneumonia (71%);bronchitis (17.65%) and pleurisy (0.98%). None of the children benefited from a pulmonary ultrasound. The treatment associated with analgesics (100%), broad-spectrum antibiotics (100%), oxygen therapy (100%), hydration (95.09%), transfusion (73.53%), non-ventilation invasive (6.86%), intubation (2.94%) and beta 2 mimetics (12.75%). No patient benefited from incentive spirometry. Almost all of the patients 95.10% (n = 97) had a favorable clinical evolution. However, five children (4.90%) had an unfavorable outcome including one case of complication such as stroke (0.98%) and four (4) cases of death. The average hospital stay was 8 days. ATS is common in children with sickle cell disease in Senegal and its etiologies seem to be dominated by infectious causes in our context.
文摘Background: Sickle cell anemia is caused by a mutation in the beta globin gene, resulting in the production of sickle hemoglobin, which is less soluble than normal hemoglobin. The main disease features are related to hemolytic anemia and blood vessels occlusion, causing ischemia and infracts. Acute chest syndrome is one of its most dangerous manifestations, and may cause severe hypoxemia and acute respiratory failure. Conservative management is often successful, but in rare cases the syndrome may be refractory. Extracorporeal membrane oxygenation (ECMO) support may be life-saving in these extreme situations. Case Report: A 31-year-old male admitted to the intensive care unit (ICU) in our hospital due to acute chest syndrome and massive aspiration. Due to extreme hypoxemia and severe acute respiratory distress syndrome, veno-venous ECMO support was initiated with rapid improvement in both oxygenation and hemodynamic status. The patient was weaned of ECMO after 7 days. He was discharged 4 weeks later. Although initiation of ECMO in sickle cell patients is uncommon, in selected refractory cases it may be life-saving. Conclusion: Although initiation of ECMO therapy in sickle cell anemia patients is uncommon, and may be even controversial, in selected refractory cases it may be life-saving.
