Association between bacterial resistance profile and the development of intra-abdominal abscesses in pediatric patients with perforated appendicitis: cohort study.

PURPOSE: The objective of this study was to determine the association between the presence of a microorganism resistant to the antibiotic used in empirical therapy and the development of intra-abdominal abscesses in children with perforated appendicitis. METHODS: A prospective cohort study was conducted in patients under 18 years of age who underwent laparoscopic appendectomy between November 1, 2019, and September 30, 2020, in whom perforated appendicitis was documented intraoperatively. Peritoneal fluid samples were taken for bacteria culture purposes, and clinical and microbiological data were collected from all patients. RESULTS: A total of 232 patients were included in the study. The most isolated microorganisms were Escherichia coli (80.14%) and Pseudomonas aeruginosa (7.45%). In addition, 5.31% of E. coli isolates were classified as ESBL-producing organisms. No association was found between a germ resistant to empiric antimicrobial therapy and the development of a postoperative intra-abdominal abscess. Multivariate analysis showed that being a high-risk patient on admission (OR 2.89 (p = 0.01)) was associated with the development of intra-abdominal abscesses postoperatively. CONCLUSION: E. coli was the most commonly isolated microorganism, with a low rate of ESBL-producing isolates. No association between resistance and risk of postoperative intra-abdominal abscess was found. However, it was identified that being a high-risk patient on admission was associated with this complication. TYPE OF STUDY: Prognosis study. LEVEL OF EVIDENCE: Level I.

Buerger's disease with cerebral involvement in a middle-aged woman with diabetes mellitus. a case report

Introduction: Buerger's disease (BD) generally affects men, young people, and smokers, but it can also affect women. Its incidence is rare in Latin America. Case report: A 40-year-old Colombian woman, active smoker and user of psychoactive substances, attended the emergency department of a tertiary care center due to symptoms of 3 days consisting of retraction of the corner of the mouth, drooling, and involuntary tongue movements. The patient, who had a history of uncontrolled diabetes and recent acute ischemia of the right upper limb due to acute thrombosis, required surgical management and subsequent use of oral anticoagulation. She later developed necrotic changes in the distal phalanges of the right hand that required ablative therapy. Since age, sex and limb involvement were not typical for BD, collagenosis, vasculitis or thrombophilia were ruled out, but after excluding these disorders, BD with atypical features was considered. The patient was discharged with oral anticoagulation, aspirin, combined analgesia, physiotherapy, and recommendation for smoking cessation. Conclusions: Age, sex, smoking and comorbidities such as diabetes are risk factors for BD. Imaging and histopathology are the gold standard for the definitive diagnosis of this entity. Multidisciplinary management, lifestyle changes, smoking cessation, pain control, good wound healing and social support are key aspects for better clinical outcomes in patients with BD.

Introducción. La enfermedad de Buerger (EB) afecta generalmente a hombres, jóvenes y fumadores, y aunque también puede afectar a mujeres, su incidencia es rara en Latinoamérica. Presentación del caso. Mujer colombiana de 40 años, fumadora activa y consumidora de sustancias psicoactivas, quien acudió al servicio de urgencias de una institución de tercer nivel por síntomas de 3 días de evolución consistentes en retracción de la comisura bucal, babeo y movimientos involuntarios de la lengua. La paciente, que tenía antecedente de diabetes no controlada y reciente isquemia aguda de miembro superior derecho por trombosis aguda, requirió manejo intervencionista y subsecuente uso de anticoagulación oral. Posteriormente, desarrolló cambios necróticos en falanges distales de mano derecha y requirió terapia ablativa. Dado que la edad, el género y la afectación de las extremidades no eran típicos para EB, se procedió a descartar colagenosis, vasculitis o trombofilia, pero tras excluir estas patologías se consideró EB con características atípicas. La paciente fue dada de alta con anticoagulación oral, aspirina, analgesia combinada, fisioterapia y recomendación de suspender el consumo de tabaco. Conclusiones. La edad, el género, el tabaquismo y las comorbilidades como diabetes son factores de riesgo para EB. La imagenología e histopatología son estándar de oro en el diagnóstico definitivo de esta entidad. El manejo multidisciplinario, los cambios en el estilo de vida, la cesación del tabaquismo, el control del dolor, la buena cicatrización de heridas y el apoyo social son aspectos importantes para obtener mejores resultados clínicos en pacientes con EB.

Alveolar Proteinosis Secondary to M. tuberculosis, in a Patient with Transient CD4 Lymphocytopenia Due to Cryptococcus neoformans Infection: First Case in the Literature.

Transient CD4 lymphocytopenia is defined as the transitory presence of CD4+ T lymphocyte fewer than 300 cells/mm3 or less than 20% of T cells without HIV infection. It can occur due to multiple causes; however, it is rare for it to occur due to opportunistic infections. Few cases have been described in the literature where antimicrobial treatment normalizes the CD4 count, being more frequent in Mycobacterium tuberculosis infections. To date, this phenomenon has not been described in Cryptococcus neoformans infections. This would be the first reported case according to our knowledge, of a patient who normalizes CD4 count after antifungal treatment, later developing alveolar proteinosis due to M. Tuberculosis.

The effect of intravenous insulin, apheresis and oral lipid-lowering agents on non-fasting hypertriglyceridemia and associated pancreatitis.

OBJECTIVES: There is evidence that increasing severity of hypertriglyceridemia increases the risk of acute pancreatitis. There is a debate about superiority of treatment methods and previous works have specifically called for direct comparison between IV insulin and apheresis techniques. Identify patient characteristics predictive of lipid-lowering therapy selection in a large community hospital for treatment of hypertriglyceridemia; evaluate for a concentration-dependent relationship between hypertriglyceridemia severity and risk of acute pancreatitis; assess for differences in clinical outcomes between patients treated with IV insulin versus apheresis. METHODS: Single center, retrospective cohort study including patients with hypertriglyceridemia between January 2007 and December 2016. Main measures included frequency of pancreatitis, choice of lipid-lowering therapy, and clinical comparisons of diet, oral lipid-lowering agents, IV insulin, and apheresis. RESULTS: Initial serum triglyceride level and disease acuity was higher among patients in insulin and apheresis groups. Neither triglyceride level, Charlson comorbidity index, age, BISAP score, nor initial CRP predicted use of IV insulin versus apheresis. Prevalence of pancreatitis increased with higher triglyceride level, reaching 48% with triglycerides >2000 md/dL (p < 0.001). There was a significant decrease in serum triglycerides at each time interval (p < 0.05) in patients treated with IV insulin and apheresis, but no difference in clearance rate between the two. Length of stay did not differ between IV insulin and apheresis. CONCLUSION: The presence of pancreatitis, hyperglycemia, and hypertriglyceridemia severity influenced selection of therapies like IV insulin and apheresis. We found no superiority of either IV insulin or apheresis in the treatment of severe hypertriglyceridemia among patients hospitalized for pancreatitis.

Erector Spinae Plane Block for Surgery of the Posterior Thoracic Wall in a Pediatric Patient.

OBJECTIVE: Historically, regional anesthesia for surgery on the posterior thoracic wall has been limited to neuraxial and paravertebral nerve blocks. The erector spinae plane (ESP) block is a novel technique that anesthetizes the dorsal rami of the spinal nerves innervating the posterior thoracic wall. We report the use of the ESP block for this clinical application in a pediatric patient. CASE REPORT: A healthy 3-year-old girl was scheduled for resection of a giant paraspinal lipoma extending over the T4-T7 dermatomes. She received a preoperative single-shot ESP block at the level of the T1 transverse process; this level was chosen to avoid the lipoma and cover the planned surgical incision over the T2-T8 dermatomes. Hemodynamic stability and excellent pain control perioperatively were obtained with minimal anesthetic requirements and no systemic analgesics apart from fentanyl administered for induction of anesthesia. Return to normal function (ambulation, feeding, and communication) was achieved within 2 hours after surgery. A pain score of 0 on the FLACC (Face, Legs, Activity, Cry, Consolability) scale was maintained until discharge from the hospital 4 hours after the surgery. First analgesic use was 18 hours after hospital discharge. No complications were reported. CONCLUSIONS: The ESP block is an effective option for surgery on the posterior thoracic wall. The opioid- and anesthetic-sparing effects exhibited in this case facilitated rapid postoperative recovery and early discharge.

[Maxillofacial fractures and associated factors in Campeche Mexico, Instituto Mexicano del Seguro Social medical insurance policyholders. Retrospective analysis 1994-1999]. / Fracturas maxilofaciales y factores asociados en derechohabientes del IMSS Campeche, México, análisis retrospectivo 1994-1999.

OBJECTIVE: To determine prevalence, distribution, and associated factors of maxillofacial fractures (MFs) among third-party insurance plan patients. METHOD: A cross-sectional and descriptive study with data of patients from Oral and Maxilofacial Surgery Department (January 1994 to December-1999) at the Instituto Mexicano del Seguro Social in Campeche, Mexico, was carried out. Daily registries, surgical programming lists' and charts of 1,611 patients were used to determine presence of MFs, age, sex, and status of the insured. Analysis was made in STATA 7 using X2. Odds ratio (OR) with confidence intervals to 95% were calculated (1C95%). RESULTS: The prevalence of MFs was 9.4%. The age average was 31.04+/-15.49 years old. The major percentage of MFs were dentoalveolar fractures (26.3%), followed by mandibular angle (20.4%) and mandibular body (13.2%). Being a male was strongly associated with presence of MFs (OR=6.1; 1C95% 4.08, 9.12). The groups of age with greater association to MFs were those of 41-50 (RM=3.30 1C95% 1.57, 6.96) and those of 31-40 (RM=2.87 1C95% 1.53, 5.55). The workers category displayed a superior association (RM=6.25 1C95% 3.21, 13.56) to the other groups of the insured category. CONCLUSIONS: The epidemiologic characteristics of MFs were similar to those reported in the specialized literature. Appearing mainly in men and intermediate age groups ages. The patterns of fractures in the studied patients were different according to the age group to which they belonged.

Fracturas maxilofaciales y factores asociados en derechohabientes del IMSS Campeche, México: Análisis retrospectivo 1994-1999 / Maxilofacial Fractures and Associated Factors in Campeche Mexico, Instituto Mexicano del Seguro Social Medical Insurance Policyholders: Retropsective Analysis 1994-1999

Objetivo: determinar la prevalencia y distribución de fracturas maxilofaciales (FMs) en derechohabientes del Instituto Mexicano del Seguro Social (IMSS) Campeche. Material y métodos: estudio transversal con datos de pacientes atendidos en el departamento de Cirugía Oral y Maxilofacial (enero-1994 a diciembre-1999) del IMSS Campeche. Se utilizaron registros diarios, libretas de programación quirúrgica y expedientes de 1611 pacientes para determinar la presencia de FMs la edad, el sexo y la calidad del asegurado. FI análisis se realizó en STATA 7 utilizando X². Se calcularon razones de momios (RM) con intervalos de confianza al 95% (1C95%). Resultados: la prevalencia de FMs fue de 9.4%. la media de edad fue de 31.04 ± 15.49 años. El mayor porcentaje de FMs fueron las Dentó alveolares (26.3%), seguida de las del ángulo mandibular (20.4%) y de las del cuerpo mandibular (13.2%). El sexo masculino estuvo fuertemente asociado a la presencia de FMs (RM=6.1; 1C95% 4.08,9.12). los grupos de edad con mayor asociación a FMs fueron los de 41-50 (RM=3.30 1C95% 1.57, 6.96) y el de 31-40 (RM=2.871C95%1.53, 5.55). los trabajadores presentaron una asociación superior (RM=6.25 1C95% 3.21,13.56) a los otros grupos de asegurados. Conclusiones: las características epidemiológicas de FMs fueron similares a las reportadas en la literatura especializada. Se observó principalmente en hombres y en los grupos de edad intermedia. los patrones de fracturas en los pacientes estudiados fueron diferentes según el grupo de edad al que pertenecían.

Objective: To determine prevalence, distribution, and associated factors of maxillofacial fractures (MFs) among third-party insurance plan patients. Method: A cross-sectional and descriptive study with data of patients from Oral and Maxilofacial Surgery Department (January 1994 to December-1999) at the Instituto Mexicano del Seguro Social in Campeche, Mexico, was carried out. Daily registries, surgical programming lists' and charts off 611 patients were used to determine presence of MFs, age, sex, and status of the insured. Analysis was made in STATA 7 using X². Odds ratio (OR) with confidence intervals to 95% were calculated (1C9 5%). Results: The prevalence of MFs was 9.4%. The age average was 31.04 +15.49 years old. The major percentage of MFs were dentoalveolar fractures (26.3%), followed by mandibular angle (20.4%) and mandibular body (13.2%). Being a male was strongly associated with presence of MFs (OR=6. 1; 1C95% 4.08, 9.12). The groups of age with greater association to MFs were those of 41-50 (RM-3.30 1C 95% 1.57, 6.96) and those of 31-40 (RM=2.87 1C95% 1.53,5.55). The workers-category displayed a superior association (RM=6.251C 95% 3.21, 13.56) to the other groups of the insured category. Conclusions: The epidemiologic characteristics of MFs were similar to those reported in the specialized literature. Appearing mainly in men and intermediate age groups ages. The patterns of fractures in the studied patients were different according to the age group to which they belonged.

Fracturas mandibulares: estudio en una unidad de cirugía oral y maxilofacial del IMSS / Mandibular fractures: a study at an Oral and Maxillofacial Unit from the IMSS

Objetivo: describir la frecuencia y distribución de fracturas mandibular (Fmd) en una unidad de cirugía oral y maxilofacial del IMSS Campeche. Material y métodos: se realizó un estudio transversal en pacientes remitidos entre enero 94 y diciembre 99. Los datos fueron obtenidos de registros diarios. Las variables fueron: presencia de Fmd, edad, sexo, tipo de aseguramiento, año y tipo de bloqueo anestésico utilizado. El análisis estadístico se llevó a cabo en STATA 7 utilizando pruebas no paramétricas. Resultados: seencontraron 88 Fmd, con una myor frecuencia entre hombres que en mujeres (61.7 por ciento vs 43.7 por ciento)(p=0.068). Más del 75 por ciento de los casos se presentaron en pacientes <- 40 años. El grupo de edad con mayor porcentaje (73.7 por ciento) de Fmd fueron los de 31-40 años (p=0.000). Los que presentaron la mayor frecuencia de Fmd fueron la categoría de "trabajadores" (67 por ciento)(p=0.000). Las fracturas más comunes fueron las de ángulo (35.2 por ciento) y las de cuerpo mandibular (22.7 por ciento). Conclusiones: las características encontradas en esta muestra autoseleccionada fueron similares a las reportadas en la literatura especializada internacional, presentándose principalmente en hombres y en edades intermedias. Los patrones de fractura fueron diferentes según el grupo de edad al que pertenecían