Near-fatal asthma as clinical manifestation in onset diabetic patient: Case report / Asma casi fatal como manifestación clínica en paciente diabética debut: Reporte de caso

Near-fatal asthma (NFA) is defined as the most severe form of asthma characterized by a refractory asthma attack with an arterial carbon dioxide tension (PaCO2) greater than 45 mmHg and altered consciousness, requiring mechanical ventilation. We reported the case of 40-year-old female patient, obese and asthmatic with irregular treatment who presented dyspnea accompanied by severe oppressive chest pain and loss of consciousness, with generalized cyanosis and severe shortness of breath, for which she underwent emergency endotracheal intubation and mechanical ventilation. Laboratory tests show decompensated respiratory acidosis, glycemia of 258 mg / dl and HbA1C of 7.94%; her diagnosing diabetes mellitus. Asthmatic patients with type 2 diabetes mellitus who have irregular treatment for both diseases are at increased risk of manifesting near-fatal asthma.

El asma casi fatal (ACF) se define como la forma más severa de asma que se caracteriza por una crisis asmática refractaria con una presión parcial de dióxido de carbono (PaCO2) mayor a 45 mmHg y alteración de la conciencia que requiere ventilación mecánica. Presentamos a una paciente femenina de 40 años, obesa y asmática con tratamiento irregular que acude por disnea acompañada de dolor torácico tipo opresivo de intensidad severa y pérdida de la conciencia, con cianosis generalizada y dificultad intensa para respirar por lo que se le realiza intubación endotraqueal de emergencia y ventilación mecánica. En los exámenes de laboratorio se encuentra acidosis respiratoria descompensada, glicemia de 258 mg/dl y HbA1C de 7.94%; diagnosticándole diabetes mellitus. Los pacientes asmáticos con diabetes mellitus tipo 2 que tienen un tratamiento irregular para ambas enfermedades presentan mayor riesgo de manifestar un asma casi fatal.

Prevalence of Cryptococcal Antigen and Outcomes in People With Human Immunodeficiency Virus in Honduras: A Cohort Study.

BACKGROUND: Cryptococcal meningitis is a major cause of death among people with human immunodeficiency virus (PWH). Cryptococcal antigen (CrAg) testing of asymptomatic patients is an important public health measure to reduce mortality in high-incidence areas. However, limited data exist on CrAg prevalence in Central America. METHODS: We conducted a prospective cohort study at the 2 largest human immunodeficiency virus (HIV) clinics and hospitals in Honduras. Cryptococcal antigen in serum and cerebrospinal fluid was performed in individuals with HIV who had CD4 ≤100 cells/mm3 between 2017 and 2018. After CrAg testing, individuals were observed for 12 months to assess mortality using adjusted Cox proportional hazard models. RESULTS: A total of 220 PWH were tested for CrAg, 12.7% (n = 28) of which tested positive. Cryptococcal antigen prevalence was higher among hospitalized individuals in 40% (n = 10 of 25) of the cases. The proportion (35.8%) of individuals taking antiretroviral therapy was significantly (P < .01) lower among those who tested positive for CrAg. Overall mortality among the cohort was 11.4% (n = 25 of 220) by 12 months. Cryptococcal antigen-positive cases were at a significantly higher risk of death (adjusted hazard ratio, 2.69; 95% confidence interval, 1.07-6.84) compared with CrAg-negative participants. CONCLUSIONS: Cryptococcal antigen prevalence in Honduras was high among PWH. Moreover, individuals who tested positive for CrAg testing were at a higher risk of death. Systemic CrAg of PWH with a CD4 ≤100 cells/mm3 should be routinely performed in Central America.

Dímero D como factor pronóstico de gravedad en pacientes COVID-19 / D-dimer as a prognostic factor of severity in COVID-19 patients

Carta al editor (sin resumen)

Letter to the editor (without abstract)

[Postsurgical delirium complicated with sepsis. Dexmedetomidine versus midazolam]. / Delirio posquirúrgico complicado con sepsis. Dexmedetomidina contra midazolam.

OBJECTIVE: to determine which drug dexmedetomidine or midazolam produces greater delirium in septic patients. METHODS: observational, analytical, comparative, prospective and longitudinal in 59 postsurgical patients both sexes, with mechanical ventilation (MV), sepsis, and sedation with dexmedetomidine or midazolam complicated with sepsis was done. We evaluated age, severity of sepsis with SOFA and APACHE. Complications associated with delirium were registered. The "t" Student test and χ(2) were used. RESULTS: Midazolam group, 33 patients, mean age 49.75 ± 19.48 years, SOFA 15.81 ± 7.48 points and APACHE 7.51 ± 5.41, delirium was present in 29 patients, days of MV 15.86 ± 14.12, reintubation rate 24 %, ICU stay 16.41 ± 14.41, hospital stay 28.58 ± 19.91 days and death rate 34.5 %. Dexmedetomidine group: 26 patients, mean age 49.57 ± 13.76 years, in SOFA 13.34 ± 7.66 points and 6.23 ± 4.51 in APACHE scale, delirium in 11 patients, days of MV 17.9 ± 12.53 and reintubation in 45.5 %, ICU days 14.36 ± 9.25, hospital stay 22.63 ± 14.87 and death in 36.4 %. CONCLUSIONS: delirium was increased in complicated post-surgical patients with sepsis, mechanical ventilation and midazolam.