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INTRODUCTION: Diabetes and stress hyperglycemia have been related with poorer clinical outcomes in patients infected by SARS-CoV-2 and at risk for severe disease. OBJECTIVE: To evaluate clinical outcomes in three groups of patients (with diabetes, without diabetes and with stress hyperglycemia) with SARS-CoV-2 infection. MATERIALS AND METHODS: A retrospective cohort study was conducted in Cali (Colombia). We included patients 18 years old or older with a diagnosis of SARS-CoV-2 infection, managed in the emergency room, hospitalization, or intensive care unit between March 2020 and December 2021. Immunocompromised patients and pregnant women were excluded. Patients were classified into three groups: without diabetes, with diabetes, and with stress hyperglycemia. A comparison between the groups was performed. RESULTS: A total of 945 patients were included (59.6% without diabetes, 27% with diabetes, and 13.4% with stress hyperglycemia). Fifty-five-point three percent required intensive care unit management, with a higher need in patients with stress hyperglycemia (89.8%) and diabetes (67.1%), with no difference between these groups (p = 0.249). We identified a higher probability of death in the group with stress hyperglycemia versus the one without diabetes (adjusted OR = 8.12; 95% CI: 5.12-12.88; p < 0.01). Frequency of acute respiratory distress syndrome, need for invasive mechanical ventilation, use of vasopressors and inotropes, need for de novo renal replacement therapy, and mortality was higher in patients with metabolic alterations (diabetes and stress hyperglycemia). CONCLUSIONS: Diabetes and stress hyperglycemia were associated with worse clinical outcomes and mortality in patients with COVID-19. These patients should be identified early and considered them high risk at the COVID-19 diagnosis to mitigate adverse outcomes.
Introducción. La diabetes y la hiperglucemia de estrés se han relacionado con peores desenlaces clínicos en pacientes infectados por SARS-CoV-2 y con riesgo de enfermedad grave. Objetivo. Evaluar los resultados clínicos en tres grupos de pacientes (con diabetes, sin diabetes o con hiperglucemia de estrés) con infección por SARS-CoV-2. Materiales y métodos. Se llevó a cabo un estudio retrospectivo de cohorte en Cali (Colombia). Se incluyeron pacientes de 18 años o más, con diagnóstico de infección por SARS-CoV-2 atendidos en urgencias, hospitalización o unidad de cuidados intensivos entre marzo de 2020 y diciembre de 2021. Se excluyeron los pacientes inmunocomprometidos y las mujeres embarazadas. Los pacientes fueron clasificados en tres grupos: sin diabetes, con diabetes y con hiperglucemia de estrés. Se realizó una comparación entre los grupos. Resultados. Se incluyeron 945 pacientes (59,6 % sin diabetes, 27 % con diabetes y 13,4 % con hiperglucemia de estrés). El 55,3 % requirió manejo en la unidad de cuidados intensivos, con mayor necesidad por parte de los pacientes con hiperglucemia de estrés (89,8 %) y diabetes (67,1%), sin diferencia entre estos grupos (p = 0,249). Se observó una mayor probabilidad de muerte en el grupo con hiperglucemia de estrés versus sin diabetes (OR ajustado = 8,12; IC95%: 5,12-12,88; p < 0,01). La frecuencia de síndrome de distrés respiratorio agudo, necesidad de ventilación mecánica invasiva, uso de vasopresores e inotrópicos, necesidad de terapia de reemplazo renal de novo y mortalidad fue mayor en pacientes con alteraciones metabólicas (diabetes e hiperglucemia de estrés). Conclusiones. La diabetes y la hiperglucemia de estrés se asociaron a peores resultados clínicos y mortalidad en pacientes con COVID-19. Estos pacientes deben ser identificados tempranamente y considerados de alto riesgo al momento del diagnóstico de COVID-19 para mitigar los desenlaces adversos.
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COVID-19 , Hiperglicemia , Humanos , COVID-19/complicações , COVID-19/terapia , Estudos Retrospectivos , Hiperglicemia/complicações , Feminino , Masculino , Pessoa de Meia-Idade , Idoso , Diabetes Mellitus/epidemiologia , Adulto , SARS-CoV-2 , Unidades de Terapia Intensiva , Complicações do Diabetes , Síndrome do Desconforto Respiratório/etiologiaRESUMO
INTRODUCTION: Diabetes mellitus is one of the most common diseases worldwide, with a high morbidity and mortality rate. Its prevalence has been increasing, as well as its acute complications, such as hyperglycemic crises. Hyperglycemic crises can present with combined features of diabetic ketoacidosis and hyperosmolar state. However, their implications are not fully understood. OBJECTIVE: To describe the characteristics, outcomes, and complications of the diabetic population with hyperglycemic crises and to value the combined state in the Latin American population. MATERIALS AND METHODS: Retrospective observational study of all hyperglycemic crises treated in the intensive care unit of the Fundación Valle del Lili between January 1, 2015, and December 31, 2020. Descriptive analysis and prevalence ratio estimation for deaths were performed using the robust Poisson regression method. RESULTS: There were 317 patients with confirmed hyperglycemic crises, 43 (13.56%) with diabetic ketoacidosis, 9 (2.83%) in hyperosmolar state, and 265 (83.59%) with combined diabetic ketoacidosis and hyperosmolar state. Infection was the most frequent triggering cause (52.52%). Fatalities due to ketoacidosis occurred in four patients (9.30%) and combined diabetic ketoacidosis/hyperosmolar state in 22 patients (8.30%); no patient had a hyperosmolar state. Mechanical ventilation was associated with death occurrence (adjusted PR = 1.15; 95 % CI 95 = 1.06 - 1.24). CONCLUSIONS: The combined state was the most prevalent presentation of the hyperglycemic crisis, with a mortality rate similar to diabetic ketoacidosis. Invasive mechanical ventilation was associated with a higher occurrence of death.
Introducción. La diabetes mellitus es una de las enfermedades más frecuentes en todo el mundo, con una tasa elevada de morbimortalidad. Su prevalencia ha ido en aumento y, también, sus complicaciones agudas, como las crisis hiperglucémicas. Las crisis hiperglucémicas pueden presentar características combinadas de cetoacidosis diabética y estado hiperosmolar. Aún no se conocen completamente sus implicaciones. Objetivo. Describir las características, los resultados y las complicaciones de la población diabética con crisis hiperglucémicas, y valorar el estado mixto en la población latinoamericana. Materiales y métodos. Se trata de un estudio observacional retrospectivo de pacientes con crisis hiperglucémicas atendidos en la unidad de cuidados intensivos de la Fundación Valle del Lili, entre el 1º de enero de 2015 y el 31 de diciembre de 2020. Se realizó un análisis descriptivo y se estimó la razón de prevalencia para muerte mediante el método de regresión de Poisson. Resultados. Se incluyeron 317 pacientes con crisis hiperglucémica confirmada, 43 (13,56 %) con cetoacidosis diabética, 9 (2,83 %) en estado hiperosmolar y 265 (83,59 %) en estado mixto. La causa desencadenante más frecuente fue la infección (52,52 %). Cuatro pacientes fallecieron por cetoacidosis (9,30 %), 22 (8,30 %), por un estado mixto; ninguno se encontraba en estado hiperosmolar. La asistencia respiratoria mecánica se asoció con la muerte (razón de prevalencia ajustada = 1,15; IC95%: 1,06-1,24). Conclusiones. El estado combinado fue la presentación más prevalente de la crisis hiperglucémica, con una tasa de mortalidad similar a la de la cetoacidosis diabética, y la asistencia respiratoria mecánica invasiva se asoció con una mayor ocurrencia de muerte.
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Cetoacidose Diabética , Hiperglicemia , Humanos , Estudos Retrospectivos , Cetoacidose Diabética/epidemiologia , Cetoacidose Diabética/complicações , América Latina/epidemiologia , Hiperglicemia/epidemiologia , Hiperglicemia/complicações , Masculino , Adulto , Feminino , Pessoa de Meia-Idade , Prevalência , Idoso , Unidades de Terapia Intensiva , Coma Hiperglicêmico Hiperosmolar não Cetótico/epidemiologia , Coma Hiperglicêmico Hiperosmolar não Cetótico/complicaçõesRESUMO
INTRODUCCIÓN: El absceso hepático (AH) es el tipo mas común de abscesos viscerales. Se estima que el perfil epidemiológico de esta enfermedad ha cambiado con el aumento de la resistencia de los microorganismos y el uso de nuevos medicamentos. OBJETIVO: Describir las características demográficas y clínicas de los pacientes hospitalizados con diagnóstico de AH en un hospital universitario del suroccidente colombiano. MÉTODOS: Se realizó un estudio observacional retrospectivo, en la Fundación Valle del Lili, Cali, Colombia. Se incluyeron pacientes mayores de 18 años con diagnóstico de AH hospitalizados entre 2011-2020. RESULTADOS: Se incluyeron 182 pacientes. La mediana de edad fUe 56 años (rango intercuartílico, 45-67) y 62,1% fueron hombres. El microrganismo mas común fue Klebsiella pneumoniae (17,6%). La mayoría requirió drenaje percutáneo (58,2%). El 58,8% tuvo un absceso único y 54,4% fue manejado en cuidados intensivos. El 7,1% de los pacientes falleció. Al comparar los casos que fueron manejados en cuidados intensivos vs. aquellos que no lo fueron, hubo más hepatomegalia (28,3 vs. 11,0%, p = 0,004), derrame pleural derecho (48,5 vs. 28,1%, p = 0,010), cirugía (42,4 vs. 13,4%, p < 0,001), falla terapéutica (22,2 vs. 7,3%, p = 0,007) y muerte (12,1 vs. 1,2%, p = 0,005) en los atendidos en UCI. CONCLUSIÓN: Las Enterobacterales son la principal causa de AH en nuestra población. La mortalidad ha disminuido, pero la hospitalización en cuidados intensivos sigue siendo alta.
BACKGROUND: Liver abscess (LA) is the most common type of visceral abscess. It is estimated that the epidemiological profile of this disease has changed with the increase in resistance and the use of new drugs. AIM: To describe the demographic and clinical characteristics of hospitalized patients with a diagnosis of LA in a university hospital in the southwestern region of Colombia. METHODS: A. retrospective observational study was conducted at Fundación Valle del Lili, Cali, Colombia. Patients older than 18 years with a diagnosis of LA hospitalized between 2011-2020 were included. RESULTS: A total of 182 patients were included. The median age was 56 years (interquartile range, 45-67) and 62.1% were men. The most common microorganism was Klebsiella pneumoniae (17.6%). The majority required percutaneous drainage (58.2%). A 58.8% had a single abscess and 54.4% were treated in ICU. A 7.1% of the patients died. When comparing cases treated in the ICU vs. those who did not, there was more hepatomegaly (28.3 vs. 11.0%, p = 0.004), right pleural effusion (48.5 vs. 28.1%, p = 0.010), surgery (42.4 vs. 13.4%, p < 0.001), therapeutic failure (22.2 vs. 7.3%, p = 0.007) and death (12.1 vs. 1.2%, p = 0.005) in patients treated in ICU. CONCLUSION: Enterobacterales are the main cause of LA in our population. Mortality has decreased, but intensive care hospitalization remains high.
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Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Abscesso Hepático/epidemiologia , Drenagem/métodos , Estudos Retrospectivos , Colômbia , Cuidados Críticos , Hospitais Universitários , Klebsiella pneumoniae , Abscesso Hepático/microbiologia , Abscesso Hepático/mortalidade , Abscesso Hepático/terapia , Antibacterianos/uso terapêuticoRESUMO
Introduction: Stroke is a major cause of morbidity and mortality worldwide, with hemorrhagic stroke being the deadliest form of acute stroke. Therefore, the cause of the event should be determined to direct the associated therapy and take preventive measures. Hyperhomocysteinemia has been described as a rare etiology of stroke. Although hyperhomocysteinemia has been associated with venous thrombotic events, altered endothelial function, and procoagulant states, its clinical role in stroke remains controversial. Case description: We present a case of a 60-year-old male patient with primary autoimmune hypothyroidism who presented with dysarthria, facial paresis, and left upper-limb monoparesis after sexual intercourse. A simple skull computed tomography scan showed hyperintensity in the right basal ganglion, indicating an acute hemorrhagic event. Etiological studies were performed, including ambulatory blood pressure monitoring, cerebral angiography, and transthoracic echocardiogram, which ruled out underlying vascular pathology. During follow-up, vitamin B12 deficiency and hyperhomocysteinemia were detected, without other blood biochemical profile alterations. Supplementation was initiated, and homocysteine levels gradually decreased, without new neurological deficits observed during follow-up. Conclusion: Quantification of homocysteine should be considered in patients with a cerebrovascular disease without apparent cause, as documenting hyperhomocysteinemia and correcting its underlying etiology are essential not only for providing appropriate management but also for preventing future events.
Introducción: el accidente cerebrovascular es una causa importante de morbilidad y mortalidad en todo el mundo, y el accidente cerebrovascular hemorrágico es la forma más mortífera de accidente cerebro- vascular agudo. La determinación de la causa del evento es esencial para dirigir la terapia asociada y poder tomar medidas preventivas. La hiperhomocisteinemia se ha descrito como una etiología poco frecuente de accidente cerebrovascular. Aunque esta se ha asociado con eventos trombóticos venosos, disfunción endotelial alterada y estados procoagulantes, sigue siendo controvertido su papel clínico en el accidente cerebrovascular. Descripción del caso: se presenta el caso de un hombre de 60 años con hipotiroidismo autoinmune primario que presentó disartria, paresia facial y monoparesia del miembro superior izquierdo después de un encuentro sexual. Una simple tomografía computarizada de cráneo mostró hipointensidad en la región del ganglio basal derecho, que indicaba un evento hemorrágico agudo. Se realizaron estudios etiológicos, incluyendo monitorización ambulatoria de la presión arterial, angiografía cerebral y ecocardiograma transtorácico, que descartaron patología vascular subyacente. Durante el seguimiento, se detectó deficiencia de vitamina B12 e hiperhomocisteinemia, sin otras alteraciones en el perfil bioquímico sanguíneo. Se inició la suplementación y los niveles de homocisteína disminuyeron gradualmente, sin observar nuevos déficits neurológicos durante el seguimiento. Conclusión: la cuantificación de homocisteína debe ser considerada en casos de enfermedad cerebrovascular sin causa aparente, dado que documentar la hiperhomocisteinemia y corregir su etiología subyacente es esencial no solo para proporcionar un manejo adecuado, sino también para prevenir eventos futuros.
Introdução: o acidente vascular cerebral (AVC) é uma das principais causas de morbidade e mortalidade em todo o mundo, sendo o AVC hemorrágico a forma mais letal de AVC agudo. A determinação da causa do evento é essencial para direcionar a terapia associada e poder tomar medidas preventivas. A hiperhomocisteinemia tem sido descrita como uma etiologia rara de acidente vascular cerebral. Embora a hiper-homocisteinemia tenha sido associada a eventos trombóticos venosos, disfunção endotelial alterada e estados pró-coagulantes, seu papel clínico no AVC permanece controverso. Descrição do caso: apresentamos o caso de um homem de 60 anos com hipotireoidismo autoimune primário que apresentou disartria, paresia facial e monoparesia do membro superior esquerdo após relação sexual. A tomografia computadorizada de crânio mostrou hipointensidade na região do gânglio da base direito, indicando evento hemorrágico agudo. Foram realizados estudos etiológicos, incluindo monitorização ambulatorial da pressão arterial, angiografia cerebral e ecocardiograma transtorácico, que descartaram patologia vascular subjacente. Durante o acompanhamento, foram detectados deficiência de vitamina B12 e hiper-homocistei- nemia, sem outras alterações no perfil bioquímico sanguíneo. A suplementação foi iniciada e os níveis de homocisteína diminuíram gradualmente, sem novos déficits neurológicos observados durante o acompanhamento. Conclusão: a quantificação da homocisteína deve ser considerada em casos de doença vascular cerebral sem causa aparente, pois documentar a hiper-homocisteinemia e corrigir sua etiologia subjacente é essencial não apenas para fornecer manejo adequado, mas também para prevenir eventos futuros.
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HumanosRESUMO
INTRODUCTION: Continuous subcutaneous insulin infusion (CSII) has emerged as a potential solution for diabetes management during the pandemic, as it reduces the need for in-person visits and allows for remote monitoring of patients. Telemedicine has also become increasingly important in the management of diabetes during the pandemic, as it allows healthcare providers to provide remote consultations and support. Here, we discuss the implications of this approach for diabetes management beyond the pandemic, including the potential for increased access to care and improved patient outcomes. METHODS: We performed a longitudinal observational study between 1 March 2020 and 31 December 2020 to evaluate glycemic parameters in diabetic patients with CSII in a telehealth service. Glycemic parameters were time in range (TIR), time above range, time below range, mean daily glucose, glucose management indicator (GMI), and glycemic variability control. RESULTS: A total of 36 patients were included in the study, with 29 having type 1 diabetes and 6 having type 2 diabetes. The study found that the proportion of patients achieving target glucose variability and GMI remained unchanged during follow-up. However, in patients with type 2 diabetes, the time in target range increased from 70% to 80%, and the time in hyperglycemia decreased from 2% to 0%. CONCLUSIONS: The results of this study suggest that telemedicine is a strategy for maintaining glycemic control in patients using CSII. However, the lack of access to the internet and adequate telemonitoring devices make it difficult to use on a large scale in emerging countries like ours.
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Diabetes Mellitus Tipo 2 , Telemedicina , Humanos , Hipoglicemiantes/uso terapêutico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Glicemia , América Latina , Hemoglobinas Glicadas , Insulina/uso terapêutico , Glucose , HospitaisRESUMO
IgG4-related disease is a recently described disease that can involve various organs and systems. Single organ involvement is the exception to the rule, it is generally a multi-system entity. We present a 36-year-old woman, with no previous pathological history or autoimmune disease, with headache caused by cystic macroadenoma. A transsphenoidal resection was performed and pathology documented areas of fibrosis with a predominantly plasmolymphocytic infíltrate and positive IgG4 staining in more than 20 cells per high-power field, meeting diagnostic criteria for IgG4-related sclerosing disease. Involvement of other organs was ruled out, and the patient improved clinically after management.
La enfermedad relacionada con IgG4 es una entidad recientemente descrita, capaz de involucrar diversos órganos y sistemas. El compromiso de órganos aislados es la excepción a la regla, dado que generalmente se trata de una entidad multisistémica. Se presenta el caso de una mujer de 36 años, sin antecedentes patológicos previos, en quien como causa de cefalea se documenta un macroadenoma quístico llevado a resección transesfenoidal, cuyo resultado de patología documenta zonas de fibrosis con infiltrado de predominio plasmo-linfocitario y la tinción para IgG4 positiva en más de 20 células por campo de alto poder, lo que configura criterios diagnósticos para enfermedad esclerosante relacionada con IgG4; se descartó compromiso de otros órganos y hubo mejoría clínica posterior al manejo.
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Humanos , Feminino , Adulto , Encefalopatias , Imunoglobulina G , Proteínas , Hipofisite , Aminoácidos, Peptídeos e Proteínas , Doenças do Sistema NervosoRESUMO
Neuroblastoma is a solid tumor considered almost exclusively pediatric, with more than 95% of patients diagnosed before 10 years of age, with a mostly benign clinical course and with encouraging survival rates in these age ranges. It occurs rarely in adolescents, and the presentation in young adults or older people is even rarer; consequently, a more severe prognosis and higher mortality rates have been documented within this population. This is also due to a great limitation within the treatment since the chemotherapeutic regimens proposed so far are valid for pediatric patients, with low tolerance to it within the adult population. We present the case of a 24-year-old female patient with catecholamine-secreting neuroblastoma who obtained surgical management, with subsequent local tumor recurrence, with subsequent need for onco-specific and symptomatic management.
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OBJECTIVE: Closed-loop insulin systems represent a technological advance in diabetes management but have rarely been studied in pregnancy. We report a case of a patient with type 1 diabetes mellitus who was previously a user of the Paradigm VEO pump and then migrated to Medtronic 670G. Research Design and Methods. We reviewed the case of a G1P0 patient with type 1 diabetes, treated with the Medtronic 670G system during pregnancy; a comparison with current literature was done. RESULTS: The patient achieved improved glycemic control as measured by time spent in different ranges as follows: <70 mg/dL, 8-4% and 70-180 mg/dL, 83-94%. Secondary outcomes included reduction of stress, anxiety, fear of hypoglycemia, and the psychological burden related to the disease. There were no obstetric or neonatal complications. CONCLUSION: The Medtronic 670G closed-loop system was used safely in a pregnant woman; nevertheless, further research is needed to validate this system in this patient population.
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Artificial intelligence techniques have been positioned in the resolution of problems in various areas of healthcare. Clinical decision support systems developed from this technology have optimized the healthcare of patients with chronic diseases through mobile applications. In this study, several models based on this methodology have been developed to calculate the basal insulin dose in patients with type I diabetes using subcutaneous insulin infusion pumps. Methods. A pilot experimental study was performed with data from 56 patients with type 1 diabetes who used insulin infusion pumps and underwent continuous glucose monitoring. Several models based on artificial intelligence techniques were developed to analyze glycemic patterns based on continuous glucose monitoring and clinical variables in order to estimate the basal insulin dose. We used neural networks (NNs), Bayesian networks (BNs), support vector machines (SVMs), and random forests (RF). We then evaluated the agreement between predicted and actual values using several statistical error measurements: mean absolute error (MAE), mean square error (MSE), root-mean-square error (RMSE), Pearson's correlation coefficient (R), and determination coefficient (R 2). Results. Twenty-four different models were obtained, one for each hour of the day, with each chosen technique. Correlation coefficients obtained with RF, SVMs, NNs, and BNs were 0.9999, 0.9921, 0.0303, and 0.7754, respectively. The error increased between 06:00 and 07:00 and between 13:00 and 17:00. Conclusions. The performance of the RF technique was excellent and got very close to the actual values. Intelligence techniques could be used to predict basal insulin dose. However, it is necessary to explore the validity of the results and select the target population. Models that allow for more accurate levels of prediction should be further explored.
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INTRODUCTION: Diabetes mellitus (DM) is a highly prevalent disease worldwide. It has been associated with an important morbimortality due to its complications and sometimes as a result of adverse events related to treatment. Insulin pump therapy (IPT) is one of the options used to control this disease and reduces one of the most frequent complication associated with treatment: hypoglycemia, which has also a great impact on life quality and clinical status of patients. MATERIALS AND METHODS: A descriptive and retrospective study was performed including patients treated and followed by the department of endocrinology from a high-complexity university hospital in Cali, Colombia, between 2012 and 2017. Patients were on IPT and continuous glucose monitoring (CGM): MiniMed Paradigm® Veo™ Insulin Pump (Medtronic®) and MiniMed 640G Insulin Pump-Enlite™ Sensor (Medtronic®). Presentation of hypoglycemia and variables associated with its development were evaluated. RESULTS: 51 patients were included. The main indication for IPT initiation was the report of hypoglycemic episodes and inappropriate metabolic control. Initiation of IPT was related with a decrease in glycosylated hemoglobin (HbA1c) and also a decrease in severe hypoglycemic events and hospitalization due to hypoglycemia. The risk factors linked with clinically significant hypoglycemia were male gender, and standard deviation of glucose measures calculated by CGM. A diminished glomerular filtration rate (GFR) (<60 mL/min/1.73 m2) was correlated with higher risk of severe hypoglycemia. CONCLUSION: IPT with CGM is a useful strategy in the management of patients with DM; it is associated with a reduction of adverse hypoglycemic events and hospitalizations due to hypoglycemia.
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Diabetes Mellitus/tratamento farmacológico , Controle Glicêmico/estatística & dados numéricos , Hipoglicemia/epidemiologia , Insulina/administração & dosagem , Adulto , Automonitorização da Glicemia , Colômbia/epidemiologia , Diabetes Mellitus/sangue , Diabetes Mellitus/epidemiologia , Feminino , Hemoglobinas Glicadas/análise , Hemoglobinas Glicadas/efeitos dos fármacos , Hemoglobinas Glicadas/metabolismo , Controle Glicêmico/métodos , Controle Glicêmico/normas , Humanos , Hipoglicemia/induzido quimicamente , Insulina/efeitos adversos , Sistemas de Infusão de Insulina , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Estudos RetrospectivosRESUMO
Riedel's thyroiditis is a rare entity consisting of a fibrotic process of the thyroid which can generate gland destruction, infiltration of cervical structures and even airway obstruction. It has been associated with systemic fibrotic disorders, autoimmune diseases, and more recently with spectrum of diseases related to excess of Immunoglobulin G type 4 (IgG4). Two cases of Riedel's thyroiditis by IgG4, confirmed by immunohistochemistry and was managed surgically with favorable results during the follow-up time, are presented. These case descriptions highlight the diagnostic challenge of this disease, describe the response with surgical management, and make a brief update on the subject.
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RESUMEN Existen pocos estudios que describan las complicaciones neuromusculares del hipertiroidismo. Presentamos el caso de una mujer de 36 años con antecedente de enfermedad de Graves en manejo médico, quien presentó compromiso motor y sensitivo progresivo en extremidades inferiores hasta comprometer la marcha. La electromiografía fue compatible con polineuropatía desmielinizante aguda, la resonancia nuclear magnética sugirió síndrome de Guillain-Barré. Se proporcionó manejo con plasmaféresis y se ajustó tratamiento tiroideo presentando mejoría transitoria. Posteriormente presentó deterioro neurológico con debilidad ascendente y compromiso deglutorio; a pesar de inicio de ciclo de inmunoglobulina persistió empeoramiento clínico con requerimiento de soporte ventilatorio; se decidió realizar tiroidectomía, que resultó en mejoría clínica y resolución del cuadro.
ABSTRACT There are few studies that describe the neuromuscular complications of hyperthyroidism. We present the case of a 36-year-old woman with a history of Graves' disease in medical management, who presented motor and sensitive involvement in the lower limbs until compromising gait. Electromyography was compatible with acute demyelinating polyneuropathy, nuclear magnetic resonance suggested Guillain-Barré syndrome. Management with plasmapheresis was indicated, and thyroid therapy was adjusted with transient improvement. Subsequently, she presented neurological deterioration with ascending weakness and swallowing compromise; despite an immunoglobulin cycle regimen, clinical worsening persisted with the requirement of ventilatory support; thyroidectomy was performed resulting in clinical improvement and resolution of the condition.
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Humanos , Feminino , Adulto , Tireoidectomia/métodos , Doença de Graves/complicações , Síndrome de Guillain-Barré/terapia , Síndrome de Guillain-Barré/complicações , Hipertireoidismo/complicaçõesRESUMO
Resumen El hiperaldosteronismo primario es una causa en ascenso de hipertensión arterial, patología que cada día toma mayor importancia por los desenlaces asociados como infarto agudo de miocardio y enfermedad cerebrovascular, entre otras. Se describen diferentes subtipos de hiperaldosteronismo, la hiperplasia unilateral es uno de estos subtipos, siendo una entidad rara. Aquí presentamos un caso de una paciente femenina de 32 años de edad con antecedente de hipertensión arterial, en quien se documentó hipopotasemia, se realizó la relación entre aldosterona plasmática y renina, que estuvo elevada, con aldosterona de 43.9 pg/mL después de test de carga de solución salina, confirmando un hiperaldosteronismo primario, decidiendo adrenalectomía unilateral basada en el muestreo venoso de aldosterona. La patología mostró normalidad sugiriendo hiperplasia. En su seguimiento posoperatorio se logró mejor control de presión arterial y normalización del nivel de aldosterona, se demuestra así que cuando una lateralización de aldosterona es notada por muestreo venoso, la adrenalectomía provee una opción de mejoría. (Acta Med Colomb 2017; 42: 195-197).
Abstract Primary hyperaldosteronism is an increasing cause of arterial hypertension, pathology that is increasingly important due to the associated outcomes such as acute myocardial infarction and cerebrovascular disease, among others. Different subtypes of hyperaldosteronism are described, being one of these unilateral hyperplasia, which is a rare entity. The case of a 32-year-old female patient with a history of arterial hypertension, in whom hypokalemia was documented, is presented. The relationship between plasma aldosterone and renin, which was elevated, was performed with aldosterone of 43.9 pg / mL after a saline load test, confirming a primary hyperaldosteronism. Unilateral adrenalectomy based on venous sampling of aldosterone was decided. The pathology showed normality suggesting hyperplasia. In postoperative follow-up, better control of blood pressure and normalization of the aldosterone level was achieved, thus demonstrating that when aldosterone lateralization is noticed by venous sampling, adrenalectomy provides an option for improvement. (Acta Med Colomb 2017; 42:195-197).
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Humanos , Feminino , Adulto , Hiperaldosteronismo , Transtornos Cerebrovasculares , Adrenalectomia , Hiperplasia , Hipertensão , HipopotassemiaRESUMO
El síndrome DRESS (reacción a medicamentos con eosinofilia y síntomas sistémicos) es una rara y severa reacción de hipersensibilidad, caracterizado por anormalidades hematológicas y compromiso multiorgánico. Se reporta el caso de una mujer de 35 años con síndrome DRESS inducido por minociclina, la paciente desarrolló falla renal, nefritis intersticial severa, requiriendo manejo de soporte con hemodiálisis. La función renal se normalizó después de ocho semanas de tratamiento con corticoesteroides. (Acta Med Colomb 2012; 37: 89-92).
DRESS syndrome (drug reaction with eosinophilia and systemic symptoms) is a rare and severe hypersensitivity reaction characterized by multiorgan involvement and hematological abnormalities. We present the case of a 35 year old woman with minocycline-induced DRESS syndrome. The patient developed severe interstitial nephritis with renal failure, requiring hemodialysis support management. Renal function returned to normal after eight weeks of treatment with corticosteroids. (Acta Med Colomb 2012; 37: 89-92).