Hyperbaric oxygen therapy as an adjunctive treatment for COVID-19-associated mucormycosis: a report of two cases. / Oxigenoterapia hiperbárica como tratamiento complementario en mucormicosis asociada con la COVID-19: a propósito de dos casos.

OBJECTIVE.: We present the first two cases reported in Peru of the use of adjuvant hyperbaric oxygen therapy (HBOT) in patients with COVID-19-associated mucormycosis (CAM). The first case is a 41-year-old woman, with pain in the left side of the face and palatine region with purulent rhinorrhea for a month. Only an oroantral fistula was found during physical examination. The second case is a 35-year-old male, with decreased left visual acuity and palatal pain with a fistula, draining purulent secretion for four months. Both patients have history of diabetes, had moderate COVID-19 four months prior to admission, and received corticosteroid therapy for this diagnosis. Tomographic evaluation of both patients showed involvement of the maxillary sinus and surrounding bone tissue; both received diagnostic and therapeutic nasal endoscopy for debridement. Histological analysis showed that the samples were compatible with mucormycosis. The patients underwent debridement and were treated with amphotericin B deoxycholate; however, they presented torpid evolution. Then, HBOT was added and the patients showed an evident improvement after four weeks of treatment with subsequent controls without the presence of mucormycosis. We highlight the favorable evolution of these patients while receiving HBOT as treatment for a disease with high morbimortality, which emerged during the pandemic.

Oxigenoterapia hiperbárica como tratamiento complementario en mucormicosis asociada a COVID-19: a propósito de dos casos / Hyperbaric oxygen therapy as an adjunctive treatment for COVID-19-associated mucormycosis: a report of two cases

Reportamos los dos primeros casos, en Perú, sobre el uso del tratamiento con oxigeno hiperbárico coadyuvante (TOHC) en pacientes con mucormicosis asociado a COVID-19 (MAC). El primer caso es una mujer de 41 años, con dolor en hemicara y región palatina izquierdas con rinorrea purulenta de un mes de evolución. Al examen físico, solo evidencia fístula oroantral. El segundo caso se trata de un varón de 35 años, con disminución de agudeza visual izquierda y dolor palatino con fístula que drena secreción purulenta de cuatro meses de evolución. Ambos pacientes tienen el antecedente de diabetes, tuvieron COVID-19 moderado cuatro meses antes del ingreso, y recibieron corticoterapia por este diagnóstico. Ambos pacientes tuvieron una evaluación tomográfica que mostró compromiso del seno maxilar y tejido óseo circundante, con endoscopia nasal diagnóstica y terapéutica para desbridamiento. Se obtuvieron muestras compatibles con mucormicosis en estudio histológico. Los pacientes fueron tratados con limpieza quirúrgica y anfotericina B desoxicolato, sin embargo, presentaron evoluciones tórpidas. Por lo tanto, se adicionó la TOHC y mostraron una mejoría evidente tras cuatro semanas de tratamiento con controles subsiguientes sin presencia de mucormicosis. Resaltamos la evolución de estos pacientes con TOHC, en una enfermedad con importante morbimortalidad, que ha sido emergente durante la pandemia.

We present the first two cases reported in Peru of the use of adjuvant hyperbaric oxygen therapy (HBOT) in patients with COVID-19-associated mucormycosis (CAM). The first case is a 41-year-old woman, with pain in the left side of the face and palatine region with purulent rhinorrhea for a month. Only an oroantral fistula was found during physical examination. The second case is a 35-year-old male, with decreased left visual acuity and palatal pain with a fistula, draining purulent secretion for four months. Both patients have history of diabetes, had moderate COVID-19 four months prior to admission, and received corticosteroid therapy for this diagnosis. Tomographic evaluation of both patients showed involvement of the maxillary sinus and surrounding bone tissue; both received diagnostic and therapeutic nasal endoscopy for debridement. Histological analysis showed that the samples were compatible with mucormycosis. The patients underwent debridement and were treated with amphotericin B deoxycholate; however, they presented torpid evolution. Then, HBOT was added and the patients showed an evident improvement after four weeks of treatment with subsequent controls without the presence of mucormycosis. We highlight the favorable evolution of these patients while receiving HBOT as treatment for a disease with high morbimortality, which emerged during the pandemic.

Evaluación clínico-flujométrica en exacerbaciones agudas de asma bronquial, tratados con fenoterol, en un Servicio de Emergencia, en adultos / Clinical-flowmetry evaluation in the acute exacerbations of bronchial asthma, treated with fenoterol, Emergency Service, in adults

Problema: "¿Cuáles son los cambios clínico-flujométricos observados en pacientes con exacerbaciones agudas de asma bronquial leve, moderado y severo, con nebulización convencional en el servicio de emergencia del Hospital Nacional Arzobispo Loayza?". Objetivo: determinar los cambios en la función pulmonar medida con PEF y cambios clínicos en exacerbaciones agudas leves, moderadas o severas del asma bronquial en adultos sometidos a nebulización convencional. Metodología: Es un estudio descriptivo, observacional, prospectivo, realizado en emergencia del Hospital Nacional Arzobispo Loayza; se evaluó 136 pacientes mayores de 18 años con exacerbación aguda leve, moderada y severa de asma bronquial, nebulizados con fenoterol, con un IC de 95 por ciento, z de 1.96, potencia de 80 por ciento (para una muestra de131 pacientes); se excluyeron enfermedades respiratorias y cardiacas crónicas y asma casi fatal, etc. Se midió la variación del PEF, la mejoría clínica, estancia en la sala de emergencia, requerimiento de hospitalización y recaídas. Se estimó las frecuencias absolutas y relativas de cada variable y en algunos casos se sometió a pruebas de significación estadística para determinar las diferencias. La información se presenta en cuadros y gráficos. Resultados: Se reclutó 136 pacientes asmáticos, 108 mujeres, y 28 varones, 56 casos leves (41.2 por ciento), 60 casos moderados (44.1 por ciento) y 20 severos (14.7 por ciento); la edad promedio de los casos fue de 36.3 años, siendo de 50.6 años en el grupo de mayor severidad. Todos usaban beta agonistas como broncodilatador, y más de la mitad (55.9 por ciento) usaba corticoides en cualquiera de sus formas, el 35 por ciento usaba corticoides vía oral en sus crisis. La mayoría (64.7 por ciento) esperaba más de 1 día de inicio de la crisis para atenderse, todos los grupos tuvieron variación de la frecuencia cardiaca tras la nebulización siendo el de mayor taquicardia en el grupo de severo. No se registraron casos de...

Problem: "What are the clinical-flowmetry changes observed in patients with acute exacerbations of mild, moderate and severe bronchial asthma, with conventional nebulization in the emergency service of the National Hospital Arzobispo Loayza?” Objective: To determine changes in pulmonary function measured by PEF and clinical changes in mild, moderate or severe acute exacerbations of asthma in adults undergoing conventional nebulization. Methodology: A descriptive, observational, prospective study, conducted in emergency at National Hospital Arzobispo Loayza; 136 patients over 18 with mild, moderate and severe acute exacerbation of bronchial asthma, nebulized with fenoterol, with 95 per cent Cl, z 1.96, power of 80 per cent (for a sample of 131 patients) was evaluated; chronic respiratory and heart diseases and near-fatal asthma were excluded, etc. PEF variation, clinical improvement, stay in the emergency room, hospitalization requirement and relapse was measured. Absolute and relative to each variable and in some cases subjected to tests to determine statistical significance of differences was estimated frequencies. The information is presented in tables and graphs. Results: 136 asthmatic patients, 108 women and 28 men, 56 mild cases (41.2 per cent), moderate 60 cases (44.1 per cent) and 20 severe (14.7 per cent) were enrolled; the average age of the cases was 36.3 years, with 50.6 years in the group of greater severity. All beta agonists used as a bronchodilator, and more than half (55.9 per cent) used steroids in any form, 35 per cent used oral corticosteroids in their crisis. Most (64.7 per cent) waited more than 1 day of onset of the crisis to be addressed, all groups had variation in heart rate after nebulization tachycardia being the most severe in the group. No cases of fatal or near-fatal asthma were recorded. The stand by time and stay for treatment was variable, being the most severe cases prolonged length of stay, and the members of the SIS. A...

Miopatía autoinmune necrotizante / Necrotizing autoimmune myositis

Mujer de 21 años, procedente de Camisea, Cusco, con dos semanas de debilidad muscular progresiva que llego inclusive a la falla ventilatoria, elevación extrema de crantina sérica total, patrón miopático en la electromiografía y con presencia de necrosis masiva sin infiltrado inflamatorio en la biopsia muscular. La pciente mejoró clínica y por los estudios de laboratorio con el tratamiento inmunosupresor.

A 21 year-old woman, from Camisea, Cusco, with two weeks of progressive muscle weakness that came even to ventilatory failure, extreme elevation of total serum creatine phosphokinase (CPK) a myopathic pattern in electromyography and presence of massive necrosis without inflammatory infiltrate in the muscle biopsy. The patient improved the clinical and laboratory parameters with immunosuppressive treatment.