Serie de Casos Retrospectiva de las Características Clínicas, del Manejo y Resultados de los Pacientes con COVID-19 en hospitales privados de la región metropolitana en la República de Panamá

Introducción: El 9 de marzo de 2020 se confirma el primer caso de COVID-19 en la República de Panamá. Según el reporte #46 de Panamá emitido por la OPS el 26 de enero de 2021, Panamá es el segundo país de las Américas con más alta incidencia después de Estados Unidos. Métodos: El diseño del estudio es observacional retrospectivo. En este estudio participaron 140 pacientes de 3 instituciones privadas localizadas en el área metropolitana de la República de Panamá. Resultados: De la muestra, 65.71% eran hombres y 34.29% eran mujeres, 72 (51.43%) pacientes fueron hospitalizados. La edad media fue de 48.39 años. El 49% de los pacientes presentaron antecedentes personales patológicos, el más común fue hipertensión arterial (63.27%). Los síntomas más frecuentes encontramos fiebre (71.43%), tos (61.43%), fatiga (50.71%) y disnea (32.86%). Del total de pacientes, 55.71% recibió tratamiento intrahospitalario, 11.51% fue admitido a UCI, 9.29% sufrió complicaciones y las más frecuente fue falla respiratoria (61.54%). De los medicamentos utilizados en ese periodo de tiempo lo más comúnmente usado fue la hidroxicloroquina (91.03%) y la azitromicina (84.62%). Conclusiones: Se encontraron resultados similares a estudios descriptivos realizados en distintos países con modelos similares al nuestro.   (provisto por Infomedic International)

Introduction: The first case of COVID-19 in the Republic of Panama was confirmed on March 9 2020. In the Panama #46 report issued by PAHO on January 26, 2021, Panama was the second country in the Americas with the highest incidence of COVID-19 after the United States. Methods: The design of the study is a retrospective observational study of 140 patients from 3 private hospitals located in the metropolitan area of the Republic of Panama. Results: Of the sample, 65.71% were men and 34.29% were women, 72 (51.43%) patients were hospitalized. The median age was 48.39 years. 49% of the patients presented a pathological personal history, the most common was arterial hypertension (63.27%).  Of the sample, 65.71% were men and 34.29% were women, 72 (51.43%) patients were hospitalized. The average age was 48.39 years. 49% of patients had a pathological personal history where high blood pressure was the most frequent (63.27%). The most common symptoms were fever (71.43%), cough (61.43%), fatigue (50.71%) and dyspnea (32.86%). Of the total number of patients, 55.71% received in-hospital treatment, 11.51% were admitted to the ICU, 9.29% suffered complications, the most frequent was respiratory failure (61.54%). Of the drugs used in that time period, the most commonly used were hydroxychloroquine (91.03%) and azithromycin (84.62%). Conclusions: Similar results were found to descriptive studies carried out in different countries with models similar to ours. (provided by Infomedic International)

2011 Portuguese recommendations for the use of biological therapies in patients with psoriatic arthritis.

OBJECTIVE: To develop recommendations for the treatment of psoriatic arthritis (PsA) with biological therapies, endorsed by the Portuguese Society of Rheumatology. METHODS: These treatment recommendations were formulated by Portuguese rheumatologists based on literature evidence and consensus opinion. A draft of the recommendations was first circulated to all Portuguese rheumatologists and their suggestions were incorporated in the draft. At a national meeting the recommendations were discussed and all attending rheumatologists voted on the level of agreement for each recommendation. A second draft was again circulated before publication. RESULTS: A consensus was achieved regarding the initiation, assessment of response and switching biological therapies in patients with PsA. Specific recommendations were developed for several disease domains: peripheral arthritis, axial disease, enthesitis and dactylitis. CONCLUSION: These recommendations may be used for guidance in deciding which patients with PsA should be treated with biological therapies. They cover a rapidly evolving area of therapeutic intervention. As more evidence becomes available and more biological therapies are licensed, these recommendations will have to be updated.

Portuguese guidelines for the use of biological agents in rheumatoid arthritis - October 2011 update.

The authors present the revised version of the Portuguese Society of Rheumatology (SPR) guidelines for the treatment of Rheumatoid Arthritis (RA) with biological therapies. In these guidelines the criteria for introduction and maintenance of biological agents are discussed as well as the contraindications and procedures in the case of nonresponders. Biological treatment (with a tumour necrosis factor antagonist, abatacept or tocilizumab) should be considered in RA patients with a disease activity score 28 (DAS 28) equal to or greater than 3.2 despite treatment with at least 20mg-weekly-dose of methotrexate (MTX) for at least 3 months or, if such treatment is not possible, after 3 months of other conventional disease modifying drug or combination therapy. A DAS 28 score between 2.6 and 3.2 with a significant functional or radiological deterioration under treatment with conventional regimens could also constitute an indication for biological treatment. The treatment goal should be remission or, if that is not achievable, at least a low disease activity, defined by a DAS28 lower than 3.2, without significative functional or radiological worsening. The response criteria, at the end of the first 3 months of treatment, are a decrease of at least 0.6 in the DAS28 score. After 6 months of treatment res­ponse criteria is defined as a decrease greater than 1.2 in the DAS28 score. Non-responders, in accordance to the Rheumatologist's clinical opinion, should try a switch to another biological agent (tumour necrosis factor antagonist, abatacept, rituximab or tocilizumab).

Portuguese guidelines for the use of biological agents in rheumatoid arthritis - March 2010 update.

The authors present the revised version of the Portuguese Society of Rheumatology (SPR) guidelines for the treatment of rheumatoid arthritis (RA) with biological therapies. In these guidelines the criteria for introduction and maintenance of biological agents are discussed as well as the contraindications and procedures in the case of non-responders. Biological treatment should be considered in RA patients with a disease activity score 28 (DAS 28) superior to 3.2 despite treatment with 20mg/week of methotrexate (MTX) for at least 3 months or, if such treatment is not possible, after 6 months of other conventional disease modifying drug or combination therapy. A DAS 28 score between 2.6 and 3.2 with a significant functional or radiological deterioration under treatment with conventional regimens could also constitute an indication for biological treatment. The treatment goal should be remission or, if that is not achievable, at least a low disease activity, characterized by a DAS28 lower than 3.2, without significative functional or radiological worsening. The response criteria, at the end of the first 3 months of treatment, are a decrease of 0.6 in the DAS28 score. After 6 months of treatment response criteria is defined as a decrease of more than 1.2 in the DAS28 score. Non-responders, in accordance to the Rheumatologist's clinical opinion, should try a switch to another biological agent (tumour necrosis factor antagonist, abatacept, rituximab or tocilizumab).

Massive hemorrhage in hemangioblastomas Literature review.

Massive hemorrhage is a very uncommon event among hemangioblastomas. Forty-four cases have been reported before this review. Thorough analysis of all reported cases on literature was accomplished. The majority presented as parenchymatous or subarachnoid bleedings. Subarachnoid hemorrhage was only associated with spinal hemangioblastomas, while parenchymatous bleedings were more, but not only, originated from cranial instances. Ventricular hemorrhage from a hemangioblastoma was exceptional, with only two previous cases bleeding directly into the ventricular compartment. To our knowledge, the illustrative case is the first one of pure tetraventricular hemorrhage from a hemangioblastoma. When hemangioblastoma bleeding occurs, it is usually the very first clinical presentation of a previously undetected tumor. Solid type, large size, and spinal-radicular locations are more frequently related to hemorrhage. Hemorrhage following hemangioblastoma embolization and the association of this tumor with other bleeding lesions, such as arteriovenous malformations and aneurysms, is also discussed.

Polyarticular arthritis secondary to Mycobacterium bovis infection: an unusual clinical presentation.

We describe a 37-year-old Mexican man with incapacitating polyarticular arthritis secondary to Mycobacterium bovis infection. A dermatologist diagnosed psoriasis two years before admission. One year later due to symmetric ankle and knee arthritis, he was treated with three doses of etanercept. The arthritis extended to the carpus and metacarpophalangeal joints. Multifocal dactylitis and a left ankle periarticular abscess were documented. Concomitantly he developed fever, cough, and adenopathies. Ankle MRI showed osteomyelitis of the calcaneous with a posterior abscess. A CT-body scan documented mild pleural effusion that corresponded to an exudate. An ankle aspiration yielded a caseous fluid with acid-fast bacilli. Knee and ankle synovial biopsies documented a granulomatous synovitis. A lymph node biopsy showed granulomas with caseous necrosis. After 1 month, Mycobacterium bovis was isolated from these tissues. Antituberculous regimen was started with satisfactory response. Although largely eradicated, bovine tuberculosis still occurs. Nevertheless, the clinical presentation as polyarthritis is very uncommon and represents a diagnostic challenge.

Shunt-related craniocerebral disproportion: treatment with cranial vault expanding procedures.

Two patients with intracranial arachnoid cysts, one with myelomeningocele-hydrocephalus and the other with a subdural fluid collection, were given a cerebrospinal (CSF) extracranial shunt. All four patients developed features of CSF overdrainage following shunting and were treated by cranial vault expanding procedures. Before undergoing decompressive craniotomy, the patients were treated by a variety of procedures, including changing of obstructed ventricular catheters (n=4), insertion or upgrading of programmable valves (n=3), and foramen magnum decompression (n=1). Clinical manifestations of these four patients were attributed to craniocerebral disproportion caused by chronic and progressive skull changes due to dampening of the CSF pulse pressure, which is necessary for maintaining normal cranial growth. On the basis of our previous experience with expanding craniotomies in cases of minimal forms of craniosynostosis, we treated these patients with bilateral parietal craniotomies, with satisfactory results. In conclusion, biparietal decompressive craniotomy constitutes a useful and safe procedure for relieving the clinical manifestations of some CSF overdrainage syndromes, especially in cases with slit-ventricle syndrome and craniocerebral disproportion that prove to be refractory to simpler management procedures.