Large Pneumoperitoneum After Gastrostomy Placement in a Patient With Amyotrophic Lateral Sclerosis.

We present a 67-year-old male with amyotrophic lateral sclerosis (ALS) who developed left lower lobe atelectasis and respiratory failure caused by a large pneumoperitoneum after gastrostomy placement. The patient was successfully managed with paracentesis, postural measures, and continued application of noninvasive positive pressure ventilation (NIPPV). There is no clear evidence that links the use of NIPPV with an increased risk of pneumoperitoneum. The evacuation of air from the peritoneal cavity may help improve the respiratory mechanics in patients with diaphragmatic weakness such as the one presented.

Multi-drug resistant tuberculosis, ten years later. / Tuberculosis multirresistentediez años después.

Drug-resistant tuberculosis, especially those with resistance to rifampicin (RR-TB), has become one of the main obstacles to achieving the dream of eradicating tuberculosis. Furthermore, it is necessary to combine three or four different drugs in the attempt to cure TB, however, unfortunately, there are few available that can be considered genuinely effective. Fortunately, the notable worldwide increase in RR-TB in recent years has led to the investment of resources in the development of new drugs for TB, and other drugs investigated for other diseases have been successfully tested on TB. This has resulted in a clear change in the clinical management of these patients over the last 3-4 years, and it is now easier to design therapeutic regimens and achieve higher success rates. All these changes are updated in this review.