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Emphysematous pyelonephritis (EPN) is a severe disease of the renal system in which gas formed by facultative anaerobe microorganisms accumulates, being Escherichia coli the most representative causative agent. A series of conditions foster its development including uncontrolled diabetes mellitus, diabetic nephropathy and obstructive uropathy. Abdominal CT scan continues to be the gold standard for diagnosis. Currently, nephrectomy is avoided as much as possible, and more conservative treatments are given. Mortality is still as high as 21 % despite new therapeutic options, all of which are mostly surgical. The rarest cases are those classified as grade IV, which affect both kidneys; these are considered the most lethal of the clinical presentations and they are also of particular interest, since a multidisciplinary team must be in charge of treatment. Herein, we present the case of an elderly woman with chronic diseases and a presentation of massive emphysematous pyelonephritis concurrent with emphysematous cystitis and pneumoperitoneum, who required bilateral radical nephrectomy despite efforts of preserving at least one of the kidneys.
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Introducción: La fractura diafisaria de húmero es frecuente y, en la actualidad, se privilegia el tratamiento quirúrgico. La consolidación en mala rotación puede causar un deterioro de la función y artrosis a largo plazo. Con las técnicas mínimamente invasivas, es difícil manejar la rotación intraoperatoria al no tener una visión directa de la reducción fracturaria. Objetivo: Describir criterios radiográficos para la reducción rotatoria en las fracturas diafisarias de húmero. Materiales y métodos: Estudio retrospectivo de radiografías de húmero comparando criterios radiográficos del húmero distal entre radiografías con rotación interna (sin retroversión proximal) y rotación externa (con retroversión fisiológica). Criterios estudiados: sobreproyección del epicóndilo lateral por sobre el capitellum >50%, esclerosis del borde inferior de la fosa olecraneana, esclerosis del borde lateral de la fosa olecraneana y asimetría de la fosa olecraneana. Resultados: El 97% de las 200 radiografías estudiadas cumplió con los criterios de inclusión y exclusión. Sobreproyección del epicóndilo por sobre el capitellum: 83,3% de los casos; esclerosis del borde inferior de la fosa olecraneana: 30%, esclerosis del borde lateral de la fosa olecraneana: 86,6% y asimetría: 80% de ellas. Todos los criterios con significancia estadística (p <0,001). Al analizar los tres signos positivos en conjunto, la sensibilidad fue del 70% y la especificidad, del 98%; valor predictivo positivo 95,5% y valor predictivo negativo 84,5%. Conclusiones: La rotación humeral correcta es difícil de reproducir en las cirugías mínimamente invasivas, en pacientes con una fractura diafisaria. Describimos cuatro criterios radiográficos que permiten inferir una correcta rotación humeral. Nivel de Evidencia: III
Introduction: Humeral shaft fractures are frequent and surgical treatment is currently favored. Consolidation in malrotation is a complication that can lead to impaired function and long-term osteoarthritis. In minimally invasive techniques, it is difficult to manage intraoperative rotation as there is no direct view of the fracture reduction. Objective: To describe radiological criteria for rotational reduction in humeral shaft fractures. Materials and methods: Retrospective study of humerus radiographs comparing radiological criteria of the distal humerus between radiographs with internal rotation (without proximal retroversion) and radiographs with external rotation (with physiological retroversion). Criteria studied: Overprojection of the lateral epicondyle over the capitellum of more than 50%; sclerosis of the lower border of the olecranon fossa (OF); sclerosis of the lateral border of the OF and asymmetry of the OF. Results: 200 radiographs were studied; 97% met the inclusion and exclusion criteria. Overprojection of the epicondyle over the capitellum was found in 83.3% of the cases. Sclerosis of the inferior border of the OF in 30%, sclerosis of the lateral border of the OF in 86.6%, and asymmetry of OF in 80%. All criteria with statistically significant (p<0.001). When analyzing the 3 positive signs, we found a sensitivity of 70% and a specificity of 98%. The positive predictive value was 95.5% and the negative predictive value was 84.5%. Conclusions: Correct humeral rotation is difficult to reproduce when performing minimally invasive surgeries in patients with a diaphyseal fracture. We describe 4 radiological criteria that allow inferring a correct humeral rotation. Level of Evidence: III
Assuntos
Radiografia , Diáfises , Fixação Intramedular de Fraturas , Fraturas do Úmero/cirurgiaRESUMO
OBJECTIVE: To evaluate the duration of protection of pentavaent rotavirus vaccine (RV5) against rotavirus hospitalizations in Nicaragua, a developing country in Central America. METHODS: We conducted a case-control study at 4 hospitals from 2007 through 2010, including 1016 children hospitalized with laboratory-confirmed rotavirus diarrhea, 4930 controls with nonrotavirus diarrhea (ie, "test-negative"), and 5627 controls without diarrhea. All cases and controls were aged ≥ 6 months and born after August 2006. Outcomes included odds of antecedent vaccination between case-patients and controls, and effectiveness of vaccination (1 - adjusted odds ratio [OR] × 100). Duration of protection was assessed by comparing effectiveness among children aged <1 year compared with ≥ 1 year. RESULTS: Indicators of socioeconomic conditions and nonrotavirus vaccination (oral polio vaccine and diphtheria/tetanus/pertussis/hepatitis A/hepatitis B) for test-negative controls were more comparable to the rotavirus case-patients than nondiarrhea controls. RV5 vaccination was associated with a significantly lower risk of rotavirus hospitalization by using test-negative controls (OR: 0.55; 95% confidence interval [CI]: 0.41-0.74) and nondiarrhea controls (OR: 0.30; 95% CI: 0.22-0.40). Risk of rotavirus hospitalization was twofold lower among RV5 vaccinated children aged <1 year (OR: 0.36; 95% CI: 0.22-0.57) compared with RV5 vaccinated children aged ≥ 1 year (OR: 0.70; 95% CI: 0.47-1.05). CONCLUSIONS: RV5 provided good protection against severe rotavirus disease in Nicaragua during the first year of life, when most severe and fatal rotavirus disease in developing countries occurs. However, the decline in protection with age warrants monitoring of disease among older children and consideration of a booster dose evaluation at the end of infancy.
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Anticorpos Antivirais/sangue , Países em Desenvolvimento , Diarreia Infantil/imunologia , Diarreia Infantil/prevenção & controle , Infecções por Rotavirus/imunologia , Infecções por Rotavirus/prevenção & controle , Vacinas contra Rotavirus/imunologia , Rotavirus/imunologia , Estudos de Casos e Controles , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Imunização Secundária , Lactente , Masculino , Nicarágua , Razão de Chances , Vigilância da População , Resultado do Tratamento , Vacinas Atenuadas/imunologiaRESUMO
Se realizaron 105 estudios de eco estrés con dobutamina en el periodo de agosto 2008 a septiembre del 2010 en el Centro Médico Diagnóstico de Alta Tecnología José Martí, de la ciudad de Barcelona, estado Anzoátegui, Venezuela, de la misión médica cubana. De los 105 pacientes estudiados 70 (66 porciento) eran del sexo masculino y 35 (34 porciento) del sexo femenino, de estos pacientes 88 (83 porciento) acudieron por presentar dolor precordial, y 17 pacientes (16 por ciento) para diagnóstico de viabilidad. De los 105 estudios realizados, 32 (30.5 por ciento) resultaron positivos, y 73 (69.5 porciento) fueron negativos. De los 32 casos positivos, 25 (78.2 porciento) fueron del sexo masculino y 7 (21.8 porciento) del sexo femenino. Resultaron positivos 18 pacientes con prueba de esfuerzo negativa
It was carried out 105 dobutamine stress echo study in the period from August 2008 to September 2010 at the Diagnostic Medical Center of High Technology José Martí from Barcelona City, Anzoátegui State, Venezuela, in the Cuban medical mission. From 105 patients studied, 70 (66 percent) were male and 35 (34 percent) were female; 88 (83 percent) of these patients presented chest pain and 17 patients (16 percent) went for viability diagnosis. From the 105 studies, 32 (30.5 percent) were positive, and 73 (69.5 percent) were negative. From the 32 positive cases, 25 (78.2 percent) were male and 7 (21.8 percent) female. 18 patients resulted positive with negative stress test
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Humanos , Masculino , Feminino , Ecocardiografia sob Estresse/métodos , Isquemia Miocárdica/diagnósticoRESUMO
BACKGROUND: In 2006, Merck & Co., Inc., partnered with the Nicaraguan Ministry of Health to demonstrate the public health impact of routine universal vaccination by delivering more than 1.3 million doses of the oral, pentavalent rotavirus vaccine (RV5) in a 3-year period. METHODS: A matched case-control study evaluated the effectiveness of RV5 in reducing the risk for severe wild-type rotavirus gastroenteritis (RGE) resulting in hospitalizations and emergency department visits among children who completed the recommended 3-dose regimen as part of the routine national vaccine program. Cases were identified from 6 hospitals from February 2007 to October 2009 and were age-matched with hospital controls and community controls. Vaccine effectiveness was calculated using conditional logistic regression. RESULTS: Three hundred RGE cases eligible for analysis were matched to 792 hospital and 851 community controls. Vaccine coverage of RV5 in the community reached 92%. Vaccine effectiveness during 2 years of follow-up against severe disease in children receiving 3 doses of RV5 was 87% (95% confidence interval [CI], 74-93) for community controls, 64% (95% CI, 44-78) for hospital controls, and 76% (95% CI, 63-84) when the groups were combined. For the combined groups, vaccine effectiveness was 85% (95% CI, 66-93) among children <12 months old at the time of RGE onset. CONCLUSIONS: The Merck-Nicaragua Rotavirus Vaccine Partnership promoted rapid and widespread uptake of a novel vaccine in a developing country. Vaccine effectiveness was greatest for children younger than 12 months of age who were at the highest risk for severe rotavirus disease.
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Infecções Comunitárias Adquiridas/prevenção & controle , Gastroenterite/prevenção & controle , Infecções por Rotavirus/prevenção & controle , Vacinas contra Rotavirus/administração & dosagem , Vacinação , Estudos de Casos e Controles , Criança , Pré-Escolar , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/imunologia , Infecções Comunitárias Adquiridas/virologia , Países em Desenvolvimento , Indústria Farmacêutica/economia , Indústria Farmacêutica/organização & administração , Feminino , Seguimentos , Gastroenterite/epidemiologia , Gastroenterite/imunologia , Gastroenterite/virologia , Humanos , Lactente , Modelos Logísticos , Masculino , Nicarágua/epidemiologia , Saúde Pública , Parcerias Público-Privadas/economia , Parcerias Público-Privadas/organização & administração , Infecções por Rotavirus/epidemiologia , Infecções por Rotavirus/imunologia , Infecções por Rotavirus/virologia , Vacinas contra Rotavirus/imunologia , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
Se conoce como Pseudohermafroditismo o estado intersexual a las entidades en las que el aspecto de los genitales externos es ambiguo o está en desacuerdo con el sexo cromosómico gonadal o genético y, puede tener etiologías diversas. La exposición continua a estrógenos o a andrógenos puede inducir dismorfismo femenino así como el desarrollo de tumor es benignos y o malignos en los órganos blancos. Se presenta el caso de una joven de 15 años con virilización, que acude a consulta médica por presentar tumor de crecimiento progresivo en abdomen. La presencia de genitales ambiguos desde su nacimiento no había sido motivo de consulta previa. El diagnóstico, hallazgos, manejo y seguimiento en cuatro meses son descritos, así como la revisión del tema