RESUMEN
Hemostatic powders (HP) are increasingly used to address limitations in conventional endoscopic techniques for gastrointestinal bleeding. HP is a relatively recent addition to the arsenal of hemostatic endoscopic procedures (HEPs) for gastrointestinal bleeding (GIB) due to benign and malignant lesions, which all life-threatening conditions. HP acts as a mechanical barrier and/or promotes platelet activation and coagulation cascade. Malignancy causes comprise 1-5% of all non-variceal upper gastrointestinal bleeding (NVUGIB). UI-EWD (NexPowder) is composed of oxidized dextran and succinic anhydride, which is converted to an adhesive hydrogel upon contact with moisture. The resulting hydrogel cross-links within itself and with adjacent tissue to create a mechanical barrier to promote hemostasis. As it does not require clot formation to achieve hemostasis, UI-EWD does not require active bleeding. This provides it a potential role in prophylaxis, such as post-procedure or following primary hemostasis achieved with conventional endoscopic techniques. While UI-EWD is the newest development in hemostatic powders for clinical use, initial results are promising. We report the case of a 51-year-old male with epidermoid esophageal stenosing carcinoma recently diagnosed and locally advanced. Started treatment concurrent chemotherapy and radiotherapy, being necessary a nasogastric tube for parenteral nutrition. Our patient came to the emergency unit due to hematemesis which came from a pressure ulcer with active bleeding shown in gastroscopy exploration, withdrawing the tube and spraying onto the surface of the bleeding site UI-EWD until the bleeding lesion was completely covered with the powder, doing successful hemostasis confirmed by hemostasis until 5 minutes after the endoscopic treatment. HP is highly effective in patients with NVUGIB when used either in combination with or as rescue therapy. Rapid development of hemostatic powders and growing clinical expertise has established these agents as a valuable strategy in gastrointestinal bleeding.
RESUMEN
Infectious diseases are extremely important in the global health landscape, specifically dengue and its severe forms. Clinical characterization is very variable due to the wide spectrum of manifestations the virus induces. Dengue is a viral infection caused by the dengue virus and is transmitted to humans by mosquitos of the Aedes family. Dengue is the most important arthropod-borne disease and if symptoms occur, could appear suddenly, characterized by biphasic fever, headache, retroocular pain, pain in various parts of the body, prostration and rash. It has also been described that the Dengue virus can also cause liver dysfunction that could vary from mild injury to severe hepatocyte injury, commonly in tropical and subtropical climates. We report the case of a 24-year-old female who came to the emergency room due to fever and myalgia, in the context of a recent trip to Cuba. Physical examination included positive tourniquet test and laboratory findings showed anaemia and thrombocytopenia, as well as elevated transaminase levels. Serologic tests for dengue virus are requested and a positive result of specific antibodies-IgM classified the patient as presumptive being necessary to confirm authorities the outbreak and explain the patient it requires a close monitoring. Abdominal ultrasound showed mild splenomegaly. Because of progressive analytical normalization, the patient asked for outpatient care.
RESUMEN
In recent years, the development of immunotherapy has been stablished with monoclonals antibodies against control immune molecules in T lymphocytes, tumor cells and other cells, which block lymphocyte activation and suppress immune response. These molecules are Cytotoxic T-Lymphocyte Antigen 4 (CTLA-4) and Programmed Death-ligand 1 (PD-1). Despite clinical benefits, these therapies are not exempt from side effects known as immune-related adverse events (irAEs). We report the case of a 68-year-old female with stage IIIB epidermoid lung cancer diagnosed in 2017.