Tromboembolismo pulmonar asociado a COVID-19 en paciente con síndrome de May-Thurner / COVID-19-associated Pulmonary Thromboembolism in a Patient with May-Thurner Syndrome

Introducción: El síndrome de May-Thurner es una enfermedad cuya prevalencia real es desconocida. Suele ser asintomática y las manifestaciones clínicas aparecen en el contexto de las complicaciones asociadas a la enfermedad. La aproximación diagnóstica se realiza por medio de imágenes, donde se identifican alteraciones patognomónicas que permiten descartar diagnósticos diferenciales. Se ha demostrado que la COVID-19 genera un estado protrombótico, que en contexto del síndrome de May-Thurner puede derivar en complicaciones tromboembólicas. Objetivo: Comparar la clínica y la posible relación de la enfermedad tromboembólica venosa en el curso de la COVID-19 en pacientes con SMT. Caso clínico: Mujer de 24 años, secretaria de profesión y residente en Bucaramanga. Presentó un cuadro clínico de 20 días de evolución que inició con rinorrea hialina, tos ocasional y mialgias; cinco días después manifestó fiebre no cuantificada y tos con expectoración hemoptoica. Conclusiones: Dentro de la fisiopatología de la infección por SARS-CoV-2 se desarrollan mecanismos procoagulantes, lo cual incrementa el riesgo de eventos trombóticos en pacientes con o sin factores de riesgo(AU)

Introduction: May-Thurner syndrome is a disease whose actual prevalence is unknown. It is usually asymptomatic and clinical manifestations appear in the context of complications associated with the disease. The diagnostic approach is performed by imaging, where pathognomonic alterations are identified to rule out differential diagnoses. It has been demonstrated that COVID-19 generates a prothrombotic state, which particularly in patients with May-Thurner syndrome would lead to thromboembolic complications. Objective: To compare the clinical and possible relationship of venous thromboembolic disease in the course of COVID-19 in patients with May-Thurner syndrome. Clinical case: 24-year-old woman, secretary by profession and resident in Bucaramanga, Colombia. She presented a clinical picture of 20 days of evolution that began with hyaline rhinorrhea, occasional cough and myalgias; five days later she manifested unquantified fever and cough with hemoptotic expectoration. Conclusions: Within the pathophysiology of SARS-CoV-2 infection, procoagulant mechanisms develop, which increases the risk of thrombotic events in patients with or without risk factors(AU)

Neuroleptic malignant syndrome associated with atypical antipsychotics: A case report.

INTRODUCTION: Neuroleptic malignant syndrome (NMS) is uncommon, with an incidence of 0.01%-3.23%, and is associated with the use of drugs that intervene with dopamine, causing hyperthermia, muscular rigidity, confusion, autonomic instability and death. CASE REPORT: A 35-year-old man with a history of catatonia, refractory epilepsy and functional impairment, required frequent changes in his anticonvulsant and antipsychotic treatment, due to adverse effects. During 2019, in the month of July, clozapine was changed to amisulpride, in September he developed fever, muscle stiffness, stupor, diaphoresis and tachypnea over a two-week period; paraclinical tests showed elevated creatine phosphokinase (CPK) and leukocytosis, so NMS was considered. The antipsychotic was withdrawn and he was treated with bromocriptine and biperiden, with a good response. Ten days after discharge, he began treatment with olanzapine, which generated a similar episode to the one described in December, with subsequent management and resolution. DISCUSSION: The diagnosis is based on the use of drugs that alter dopamine levels, plus altered state of consciousness, fever, autonomic instability and paraclinical tests showing leukocytosis and elevated CPK. Differential diagnoses must be ruled out. Early diagnosis generally leads to total remission, although some patients will suffer complications, long-term sequelae or recurrences. The recurrence in this case derived from the early reintroduction of the neuroleptic after the first episode. Treatment should be individualised according to severity to avoid mortality. CONCLUSIONS: Atypical antipsychotics are rarely suspected of generating NMS. Moreover, the time to reintroduction after an episode must also be taken into account.

Características de pacientes con exacerbación aguda grave de enfermedad pulmonar obstructiva crónica que requirieron ventilación mecánica invasiva en un hospital de Santander durante 2014-2020

Introducción: la enfermedad pulmonar obstructiva crónica es una limitación del flujo de aire por anomalías alveolares. En una exacerbación aguda, la ventilación mecánica no invasiva es la primera línea en el manejo, sin embargo, existen ciertos factores de riesgo que hacen más probable el uso de ventilación mecánica invasiva en estos pacientes, que no están apropiadamente descritos en la literatura científica y que pueden guiar hacia una elección de soporte ventilatorio apropiado. Objetivo: describir los factores que se asociaron con mayor necesidad de ventilación mecánica no invasiva en una cohorte de pacientes hospitalizados con exacerbación aguda de la enfermedad pulmonar obstructiva crónica. Métodos: estudio observacional analítico de corte transversal, con muestreo no probabilístico que incluye todos los pacientes que consultaron a urgencias y fueron hospitalizados por exacerbación aguda de la enfermedad pulmonar obstructiva crónica en un hospital de tercer nivel de Santander, Colombia, durante el período 2014-2020. Resultados: fueron incluidos 81 pacientes, 36 requirieron ventilación mecánica no invasiva y 12 ventilación mecánica invasiva; 25 % de los pacientes con ventilación mecánica no invasiva fallaron a la terapia inicial y demandaron el uso de ventilación mecánica invasiva. Las comorbilidades más frecuentes fueron hipertensión arterial (70,3 %) y cardiopatía (49,38 %); 70 % había tenido exposición al tabaquismo como fumador directo. Conclusiones: el uso de ventilación mecánica invasiva estuvo relacionado de forma estadísticamente significativa en pacientes con perfil de disnea severa, acidosis por parámetros gasométricos, escalamiento antibiótico, uso de corticoides intravenosos, requerimiento de unidad de cuidado intensivo, infecciones asociadas al cuidado de la salud y estancia hospitalaria prolongada.

Introduction: Chronic obstructive pulmonary disease is airflow limitation due to alveolar abnormalities. In an acute exa- cerbation, non-invasive mechanical ventilation is the first line of management, however, there are certain risk factors that make the use of invasive mechanical ventilation more likely in these patients, which are not adequately described in the scientific literature and that can guide towards a choice of appropriate ventilatory support. Objective: To describe the factors that were associated with an increased need for invasive mechanical ventilation in a cohort of hospitalized patients with an acute exacerbation of chronic obstructive pulmonary disease. Methods: Cross-sectional analytical observational study, with non-probabilistic sampling including all patients who consulted the emergency room and were hospitalized for acute exacerbation of chronic obstructive pulmonary disease in a tertiary care hospital in Santander-Colombia during the period 2014-2020. Results: 81 patients were included, 36 required non-invasive mechanical ventilation and 12 invasive me- chanical ventilation. 25 % of the patients with non-invasive mechanical ventilation failed the initial therapy and demanded the use of invasive mechanical ventilation. The most frequent comorbidities were arterial hypertension (70.3 %) and heart disease (49.38 %). 70 % had been exposed to smoking as direct smokers. Conclusions: The use of invasive mechanical ven- tilation was associated in a statistically significant way in patients with a profile of: severe dyspnea, acidosis by gasometric parameters, antibiotic escalation, use of intravenous corticosteroids, intensive care unit requirement, infections associa- ted with health care and prolonged hospital stay.

Síndrome neuroléptico maligno asociado a antipsicóticos atípicos: a propósito de un caso

Introducción: El síndrome neuroléptico maligno (SNM) es infrecuente, con una incidencia del 0,01 al 3,23%, y tiene relación con el consumo de fármacos que interfieren con la dopamina; genera hipertermia, rigidez muscular, confusión, inestabilidad autonómica y la muerte. Caso clínico: Un varón de 35 arios, con antecedentes de catatonía, epilepsia refractaria y deterioro funcional, en tratamiento anticonvulsivo y antipsicótico, requirió cambio frecuente por efectos adversos de este. En julio de 2019 se cambió la clozapina por amisulprida; en septiembre se inicia un cuadro de 2 semanas de fiebre, rigidez muscular, estupor, diaforesis y taquipnea; los paraclínicos mostraron aumento de la creatininasa (CK) y leucocitosis, por lo que se consideró SNM. Se retiró el antipsicótico y se trató con bromocriptina y biperideno, que obtuvieron buena respuesta. A los 10 días del egreso, se inició tratamiento con olanzapina, que generó en diciembre un cuadro clínico similar al descrito, con posterior tratamiento y resolución. Discusión: El diagnóstico se basa en la toma de fármacos que alteren la dopamina, más alteración del estado de conciencia, fiebre e inestabilidad autonómica, junto con paraclínicos como leucocitosis y elevación de la CK. Se debe descartar diagnósticos diferenciales. El diagnóstico temprano generalmente lleva a la remisión total; algunos tendrán complicaciones, secuelas a largo plazo o recidivas. La recurrencia en este caso derivó de la reintroducción temprana del neuroléptico después del primer episodio. El tratamiento se debe individualizar según la gravedad para evitar la muerte. Conclusiones: Rara vez se sospecha que los antipsicóticos atípicos generen SNM; a su vez se debe tener en cuenta el tiempo a la reintroducción después de un episodio.

Introduction: Neuroleptic malignant syndrome (NMS) is uncommon, with an incidence of 0.01% to 3.23%, and is associated with the use of drugs that intervene with dopamine, causing hyperthermia, muscular rigidity, confusion, autonomic instability and death. Case report: A 35-year-old man with a history of catatonia, refractory epilepsy and functional impairment, required frequent changes in his anticonvulsant and antipsychotic treatment, due to adverse effects. During 2019, in the month of July, clozapine was changed to amisul-pride, in September he developed fever, muscle stiffness, stupor, diaphoresis and tachypnea over a two-week period; paraclinical tests showed elevated creatine phosphokinase (CPK) and leukocytosis, so NMS was considered. The antipsychotic was withdrawn and he was treated with bromocriptine and biperiden, with a good response. Ten days after discharge, he began treatment with olanzapine, which generated a similar episode to the one described in December, with subsequent management and resolution. Discussion: The diagnosis is based on the use of drugs that alter dopamine levels, plus altered state of consciousness, fever, autonomic instability and paraclinical tests showing leukocy-tosis and elevated CPK. Differential diagnosis must be ruled out. Early diagnosis generally leads to total remission, although some patients will suffer complications, long-term sequelae or recurrences. The recurrence in this case derived from the early reintroduction of the neuroleptic after the first episode. Treatment should be individualised according to severity to avoid mortality. Conclusions: Atypical antipsychotics are rarely suspected of generating NMS. Moreover, the time to reintroduction after an episode must also be taken into account.

Caracterización y fisiopatología del Sars-Cov-2, Revisión de la literatura actual / Characterization and pathophysiology of sars-cov-2, actual literature review

RESUMEN La enfermedad por coronavirus 2019 (COVID-19) es causada por un nuevo betacoronavirus conocido como síndrome respiratorio agudo severo coronavirus-2 (SARS-CoV-2). Para el 22 de junio del 2021, el número de casos confirmados en todo el mundo había superado los 178 millones, con más de 3 millones de muertes. La fisiopatología de la COVID-19 a partir de la infección por SARS-CoV-2 no está del todo dilucidada. En el presente artículo se exponen los hallazgos encontrados después de la búsqueda en la literatura científica realizada en la base de datos PubMed entre octubre de 2020 y abril de 2021 en la cual se incluyeron 71 artículos, con el objetivo de la revisión fisiopatológica completa, detallada y actualizada del SARS-CoV-2, abordando temas como la caracterización y ciclo de vida del virus, el mecanismo de transmisión, la cinética viral y la respuesta inmune, junto con la dinámica fisiopatológica de la infección. MÉD.UIS.2021;34(2): 61-75.

ABSTRACT Coronavirus disease 2019 (COVID-19) is caused by a new betacoronavirus named as Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). On June 22nd, 2021, the number of confirmed cases worldwide exceeded 178 million, resulting in more than 3 million deaths. The pathophysiology of COVID-19 from the infection of SARS-CoV-2 is not entirely elucidated. This review presents the findings after the research in the scientific literature carried out in the PubMed database between October 2020 and April 2021, in which 71 articles were included, with the aim of a complete, detailed and updated pathophysiological review of SARS-CoV-2, addressing issues such as the characterization and life cycle of the virus, the transmission mechanism, viral kinetics and immune response, along with the pathophysiological dynamics of the infection. MÉD.UIS.2021;34(2): 61-75.

Neuroleptic Malignant Syndrome Associated with Atypical Antipsychotics: A Case Report. / Síndrome neuroléptico maligno asociado a antipsicóticos atípicos: a propósito de un caso.

INTRODUCTION: Neuroleptic malignant syndrome (NMS) is uncommon, with an incidence of 0.01% to 3.23%, and is associated with the use of drugs that intervene with dopamine, causing hyperthermia, muscular rigidity, confusion, autonomic instability and death. CASE REPORT: A 35-year-old man with a history of catatonia, refractory epilepsy and functional impairment, required frequent changes in his anticonvulsant and antipsychotic treatment, due to adverse effects. During 2019, in the month of July, clozapine was changed to amisulpride, in September he developed fever, muscle stiffness, stupor, diaphoresis and tachypnea over a two-week period; paraclinical tests showed elevated creatine phosphokinase (CPK) and leukocytosis, so NMS was considered. The antipsychotic was withdrawn and he was treated with bromocriptine and biperiden, with a good response. Ten days after discharge, he began treatment with olanzapine, which generated a similar episode to the one described in December, with subsequent management and resolution. DISCUSSION: The diagnosis is based on the use of drugs that alter dopamine levels, plus altered state of consciousness, fever, autonomic instability and paraclinical tests showing leukocytosis and elevated CPK. Differential diagnosis must be ruled out. Early diagnosis generally leads to total remission, although some patients will suffer complications, long-term sequelae or recurrences. The recurrence in this case derived from the early reintroduction of the neuroleptic after the first episode. Treatment should be individualised according to severity to avoid mortality. CONCLUSIONS: Atypical antipsychotics are rarely suspected of generating NMS. Moreover, the time to reintroduction after an episode must also be taken into account.

Vasculitis inusual asociada a anticuerpos anticitoplasma de neutrófilos / Unusual vasculitis associated with antineutrophil cytoplasmic antibodies

Introducción: Las vasculitis asociadas a autoanticuerpos citoplasmáticos de neutrófilos son afecciones infrecuentes con una incidencia reportada de 46 a 184 casos por millón de personas y aparecen, generalmente, en edades tardías de la vida. Objetivo: Describir los hallazgos de una paciente en la que se diagnosticó vasculitis pauciinmune tipo poliangeítis microscópica tardíamente. Caso clínico: Se presenta el caso de una paciente de 60 años con antecedente de enfermedad renal crónica y compromiso respiratorio manifestado por disnea, tos productiva, malestar general y fiebre. En las imágenes se evidenció bronquiectasias y en los exámenes de laboratorio factor reumatoideo alto, autoanticuerpos citoplasmáticos antineutrófilos perinucleares positivos, anticuerpos antinucleares negativos y hemosiderófagos en el lavado broncoalveolar. Se instauró manejo con corticoides sistémicos con franca mejoría clínica. Sin embargo, una malformación arteriovenosa que originó una hemorragia en la fosa posterior, le ocasionó la muerte. Conclusiones: El diagnóstico de las vasculitis es complejo y depende en gran medida del criterio clínico, por lo que el médico debe estar presto a la interpretación de las manifestaciones clínicas y de los hallazgos paraclínicos(AU)

Introduction: Vasculitis associated with neutrophil cytoplasmic autoantibodies are infrequent conditions with a reported incidence of 46 to 184 cases per million people and it generally appears late in life. Objective: To describe the findings of a patient in whom microscopic polyangiitis-type pauciimmune vasculitis was late diagnosed. Clinical case report: We report a case of a 60-year-old patient with history of chronic kidney disease and respiratory compromise exhibited by dyspnea, productive cough, general malaise and fever. The images showed bronchiectasis and laboratory tests revealed high rheumatoid factor, positive perinuclear antineutrophil cytoplasmic autoantibodies, negative antinuclear antibodies, and bronchoalveolar lavage exposed hemosiderophages. Management with systemic corticosteroids was established with clear clinical improvement. However, an arteriovenous malformation that caused a hemorrhage in the posterior fossa caused his death. Conclusions: The diagnosis of vasculitis is complex and depends largely on clinical criteria, so physicians must be ready to interpret the clinical manifestations and paraclinical findings(AU)