Insuficiencia cardíaca de novo: Un reto diagnóstico / Di novo heart failure: A diagnostic challenge

Introducción: El término insuficiencia cardíaca de novo hace referencia a pacientes sin diagnóstico previo de dicha enfermedad. La revisión de este tema deviene de un problema real, pues muchos pacientes acuden a la atención secundaria sin diagnóstico previo de insuficiencia cardíaca y además en estadios avanzados. Objetivo: Describir los elementos claves para el diagnóstico precoz de insuficiencia Cardíacas. Métodos: Se llevó a cabo una búsqueda bibliográfica en las siguientes bases de datos: Pubmed, SciELO, ESBCO, Cochrane y BVS, así como en diferentes webs médicas durante tres meses entre febrero de 2021 al 31 de mayo de 2021. Conclusiones: El diagnóstico precoz de insuficiencia cardíaca permitió disminuir el número de pacientes que llegan a la Atención Secundaria sin diagnóstico previo. Existen clasificaciones que identifican estadios tempranos de la enfermedad y la de la ACC/AHA es relevante para lograr este objetivo. En atención primaria esto es un reto si no se emplean pruebas diagnósticas como el ecocardiograma. Es importante la determinación de las concentraciones circulantes del péptido natriurético tipo B (BNP) y del fragmento N-terminal de su protohormona (N-terminal BNP). Este biomarcador debería estar accesible en las consultas ambulatorias para pacientes que presentan sospecha clínica de insuficiencia cardíaca «de novo»(AU)

Introduction: The term di novo heart failure refers to patients without a previous diagnosis of this disease. The review of this issue comes from a real problem, since a group of patients attend secondary care without a previous diagnosis of heart failure and also have in advanced stages. Objective: The objective is to provide a clue that facilitates the early diagnosis of heart failure. Methods: A bibliographic search was carried out in the following databases: Pubmed, SciELO, ESBCO, Cochrane and BVS, as well as in different medical websites for three months (February 1, 2021 to May 31, 2021). Conclusions: The early diagnosis of heart failure will allow us to reduce the number of patients who arrive at Secondary Care without a previous diagnosis. There are classifications that identify early stages of the disease, being in our opinion the ACC / AHA classification the one that should carry the most weight. In primary care this can be a challenge if diagnostic tests such as echocardiography are not used. Dosification of serum levels of type B natriuretic peptide (BNP) and the N-terminal fragment of its protohormone (N-terminal BNP) is very useful. This biomarker should be accessible in outpatient clinics for patients with clinical suspicion of di novo heart failure(AU)

Encefalomielitis tóxica por anestesia espinal. Presentación de un caso / Toxic encefphalomyelitis due to spinal anesthesia. Presentation of a case

RESUMEN: Introducción: Las complicaciones neurológicas como consecuencia de anestesia espinal se han reportado frecuentemente debido al amplio uso de dicha anestesia, la cual puede ocasionar una mielopatía tóxica. Presentación del Caso Paciente de 26 de edad con antecedentes de salud, fue ingresada en el Hospital Clínico Quirúrgico Freyre de Andrade 24 horas después de operada por hemorroides con anestesia espinal (lidocaína hiperbárica). Comienza con ptosis palpebral derecha y dificultad para la marcha. Es egresada y dos días después ingresa en obnubilación y rigidez de nuca con LCR (Líquido Cefalorraquídeo) - positivo y sospecha de meningoencefalitis. Evoluciona en coma sin respuesta satisfactoria a antibióticos durante 14 días. Se constata edema cerebral, trastornos autonómicos, hemiparesia alterna y paraplejía fláccida. Se retira antibiótico y se trata con betametasona parenteral durante dos meses más fisioterapia durante 10 meses. Tuvo mejoría progresiva y recuperación casi total. Todos los estudios microbiológicos fueron normales en suero y líquido cefalorraquídeo Discusión: Se han reportado disímiles lesiones neurológicas por anestesia espinal que incluyen 3 síndromes: meningoencefalitis, lesión de pares craneales y paraparesia(plejía). El caso que presentamos presentó los 3 tipos de lesiones más edema cerebral. Conclusiones: Es infrecuente la asociación de los tres síndromes pues no encontramos caso igual en bases de datos. La resolución con betametasona es un aspecto terapéutico a considerar ante casos similares.

Abstract: Introduction: Neurological complications as a consequence of spinal anesthesia have been frequently reported due to its extensive use, which can cause toxic myelopathy. Case Presentation A 26-years-old patient with a health history was admitted to the Freyre de Andrade Clinical Surgical Hospital 24 hours after surgery for hemorrhoids with spinal anesthesia (hyperbaric lidocaine). It begins with right palpebral ptosis and difficulty walking. She was discharged and two days later she was admitted with drowsiness and stiff neck with positive CSF and suspected meningoencephalitis. She evolves into a coma with no satisfactory response to antibiotics for 14 days. Cerebral edema, autonomic disorders, alternating hemiparesis, and flaccid paraplegia are noted. The antibiotic was withdrawn and she was treated with parenteral betamethasone for two months plus physiotherapy for 10 months. She had progressive improvement and almost total recovery. All serum and cerebrospinal fluid microbiological studies were normal. Discussion: Dissimilar neurological injuries have been reported by spinal anesthesia that include 3 syndromes: meningoencephalitis, cranial nerve injury and paraparesis (plegia). This case had 3 types of lesions plus cerebral edema. Conclusions: The association of the three syndromes is infrequent since we did not find the same case in databases. Resolution with betamethasone is a therapeutic aspect to consider in similar cases

Coma mixedematoso como presentación de hipotiroidismo / Myxedema coma as presentation of hypothyroidism

Resumen Se presenta un caso de una paciente de 69 años de edad y sin antecedentes personales o familiares de patología tiroidea alguna, que asiste con un estado convulsivo de aparición súbita, de hemicuerpo derecho y relajación esfinteriana, asociado, además, a trastornos del estado de conciencia, bradicardia, bradipnea y edema de difícil Godet en miembros inferiores. Los exámenes complementarios mostraron acidosis respiratoria, hiposecreción de T4 y elevación de la hormona estimulante de la tiroides por retroalimentación negativa. Estos resultados corroboraron el diagnóstico presuntivo de coma mixedematoso. Se emprendió el tratamiento hormonal correspondiente con levotiroxina, al cual respondió satisfactoriamente y fue egresada a los 24 días de su ingreso, pendiente de valoración por el especialista de endocrinología.

Abstract We present the case of a 69-year-old female patient with no personal or family history of any thyroid disease, who attends with a convulsive state of sudden onset, right hemibody and sphincter relaxation, also associated with disorders of the state of consciousness, bradycardia, bradypnea and edema of difficult godet in lower limbs. Complementary analyses showed respiratory acidosis, hyposecretion of T4 and elevation of the thyroid stimulating hormone by negative feedback. These results corroborated the presumptive diagnosis of myxedema coma. The corresponding hormonal treatment with levothyroxine was undertaken, to which it responded satisfactorily and was discharged 24 days after admission, pending evaluation by the endocrinology specialist for an outpatient hormone replacement therapy.

[Pectus excavatum y carinatum en el síndrome de Marfan y síndromes similares: prevalencia e impacto clínico pulmonar y cardiovascular].

INTRODUCTION: Pectus excavatum (PE) and carinatum (PC) are common in Marfan syndrome (SM) and similar syndromes (SS). Patients can evolve without symptoms. In some there is depression, social adjustment disorders, pulmonary and cardiovascular symptoms in which there is controversy about their relationship with the structural damage of the thorax. OBJECTIVE: To assess the prevalence of the type of thoracic deformity in patients with MS and SS in a historical and current cohort and to analyze the clinical, pulmonary and cardiovascular impact. METHOD: Prospective study. Subjects who met the Ghent criteria and who had a complete clinical record, an echocardiogram and/or magnetic resonance imaging, computed tomography and respiratory function tests were included. RESULTS: Of a total of 338 patients with MS and SS, 112 cases with thoracic deformity were detected, the prevalence of PE and PC in SM 13.6 and 12.4, respectively, was lower in SS. There is compression and displacement of lung and right cardiac cavities by PE and the correlation between the Haller Index and the increased PASP is 44 (p = 0.009). CONCLUSIONS: The prevalence of PE and PC in SM and SS is high, which impacts on lung function and cardiovascular damage, requires corrective management of the thoracic deformity and not only implies for aesthetic purposes.

INTRODUCCIÓN: El pectus excavatum (PE) y el pectus carinatum (PC) son frecuentes en el síndrome de Marfan (SM) y en síndromes similares (SS). Los pacientes pueden evolucionar sin síntomas. En algunos hay depresión, trastornos de adaptación social, síntomas pulmonares y cardiovasculares, en los cuales hay controversia de su relación con el daño estructural del tórax. OBJETIVO: Evaluar la prevalencia del tipo de deformidad torácica en pacientes con SM y SS en una cohorte histórica y analizar el impacto clínico, pulmonar y cardiovascular. MÉTODO: Estudio prospectivo. Se incluyeron sujetos con criterios de Ghent y características específicas de cada síndrome, con expediente completo, ecocardiograma o resonancia magnética y tomografía computada, y pruebas de función respiratoria. RESULTADOS: De un total de 338 pacientes con SM y SS, se detectaron 112 casos con deformidad torácica. Prevalencia de PE y PC en SM: 13.6 y 12.4; fue menor en SS. Hay compresión y desplazamiento de pulmón y cavidades cardiacas derechas por PE. Hay correlación entre el Índice de Haller y la presión sistólica de la arteria pulmonar incrementada es de 44 (p = 0.009). CONCLUSIONES: La prevalencia de PE y PC en el SM y SS es alta, lo cual impacta en la función pulmonar y cardiovascular, en esas condiciones se requiere del manejo correctivo de la deformidad torácica y el objetivo no es estético.

Comparative study between M. oleifera and aluminum sulfate for water treatment: case study Colombia.

The world has a water deficit, mostly located in developing countries. For example, in Colombia, water deficit is a major concern and it increases in rural areas, where the rate of accessibility to drinking water is of 33.26% in 2005. Since the 1970s, the most used technology for water purification is the conventional physicochemical process. The most common coagulant used in this process is aluminum sulfate (alum). This study focuses on a comparison between Moringa oleifera seeds and alum for water treatment in different natural waters. Results showed that M. oleifera removed 90% turbidity and alum 96% from water samples from the tested natural brook. However, color removal for M. oleifera was 95 and 80.3% for alum. For water-polluted samples, both coagulants have shown high efficiency (100%) in color and turbidity removal. Usage of natural coagulants (i.e., M. oleifera) instead of chemical ones (i.e., alum) are more convenient in rural areas where the economic situation and accessibility of those products are key elements to maintain fresh water treatment standards. Additionally, results demonstrated that high dosages M. oleifera did not affect the optimal value in terms of color and turbidity removal. In rural and developing countries, this is important because it does not require a sophisticated dosing equipment.

Fiebre de origen desconocido. Estudio de 52 casos / Fever of Unknown Origin. A Study of 52 Cases

Fundamento: la fiebre de origen desconocido es un síndrome clínico de alta complejidad diagnóstica. En Cuba solo se han publicado dos estudios clínicos con referencia a este tema, por lo cual resulta importante la compilación de una serie de casos en los que se aplicó un método diagnóstico certero para determinar las causas más frecuentes. Objetivo: describir las causas más frecuentes de fiebre de origen desconocido. Métodos: estudio descriptivo de serie de casos realizado en 52 pacientes ingresados en el Hospital Clínico-Quirúrgico Freyre de Andrade entre los años 2000-2010, con diagnóstico de fiebre de origen desconocido. Se analizaron: edad, sexo, estudios complementarios (variables de investigaciones humorales, microbiológicas, de imagen y biopsias), resultados obtenidos y conducta médica acorde a estos, diagnóstico de cada paciente, tratamiento impuesto y evolución clínica posterior. Resultados: del total de pacientes, 37(71 %) tenían infecciones, nueve con endocarditis infecciosa. Nueve pacientes (16 %) tuvieron neoplasias, siete de ellas hematopoyéticas. En tres pacientes (6 %) se diagnosticó enfermedad inflamatoria no infecciosa. Conclusiones: la primera causa de fiebre de origen desconocido son las infecciones bacterianas principalmente endocarditis infecciosa y tuberculosis. La segunda causa son las neoplasias malignas hematopoyéticas y principalmente el linfoma no Hodgkin.

Background: fever of unknown origin is a clinical syndrome of great diagnostic complexity. Only two clinical studies related to this subject have been published in Cuba, hence it is important the compilation of a series of cases where an accurate diagnostic method was applied to determine its most common causes. Objective: to describe the most frequent causes of fever of unknown origin. Methods: a case-series study of 52 patients admitted to the Freyre de Andrade Clinical-Surgical Hospital with a diagnosis of fever of unknown origin was conducted from 2000 to 2010. The study variables included: age, sex, complementary studies (variables from humoral, microbiological and imaging investigations and biopsies), results obtained and medical management established according to them, diagnosis of each patient, treatment and clinical course. Results: of all patients, 37(71 %) had infections, nine suffered from infectious endocarditis. Nine (16 %) had neoplasms; seven of them were hematopoietic. Three patients (6 %) were diagnosed with non-infectious inflammatory disease. Conclusions: the first cause of fever of unknown origin is bacterial infection, primarily infectious endocarditis and tuberculosis. The second cause is hematopoietic neoplasm and particularly the non-Hodgkin’s lymphoma.

Toward high performance thermoset/carbon nanotube sheet nanocomposites via resistive heating assisted infiltration and cure.

Thermoset/carbon nanotube (CNT) sheet nanocomposites were successfully fabricated by resistive heating assisted infiltration and cure (RHAIC) of the polymer matrix resin. Resistive heating takes advantage of the electrical and thermal conductivity of CNTs to rapidly and uniformly introduce heat into the CNT sheet. Heating the CNT sheet reduces the viscosity of the polymer resin due to localized temperature rise in close proximity to the resin, which enhances resin flow, penetration, and wetting of the CNT reinforcement. Once the resin infusion process is complete, the applied power is increased to raise the temperature of the CNT sheet, which rapidly cures the polymer matrix. Tensile tests were used to evaluate the mechanical properties of the processed thermoset/CNT sheet nanocomposites. The improved wetting and adhesion of the polymer resin to the CNT reinforcement yield significant improvement of thermoset/CNT nanocomposite mechanical properties. The highest specific tensile strength of bismaleimide(BMI)/CNT sheet nanocomposites was obtained to date was 684 MPa/(g/cm(3)), using 4 V (2 A) for resin infiltration, followed by precure at 10 V (6 A) for 10 min and post curing at 240 °C for 6 h in an oven. The highest specific Young's modulus of BMI/CNT sheet nanocomposite was 71 GPa/(g/cm(3)) using resistive heating infiltration at 8.3 V (4.7 A) for 3 min followed by resistive heating cure at 12.5 V (7 A) for 30 min. In both cases, the CNT sheets were stretched and held in tension to prevent relaxation of the aligned CNTs during the course of RHAIC.

Sensibilidad y especificidad de la escala de Alvarado en el diagnóstico de apendicitis aguda comparada con TAC o ultrasonido en las primeras 24 horas de evolución / Sensitivity and specificity of the Alvarado Score in the diagnosis of acute appendicitis as compared with CAT scan and ultrasound during the first 24 hours of evolution

Objetivo: Comparar la sensibilidad y especificidad de la escala de Alvarado en el diagnóstico de apendicitis aguda con la técnica por tomografía axial computada (TAC) y ultrasonido (US). Sede: Hospital Christus Muguerza Alta Especialidad, Monterrey (México). Diseño: Estudio prospectivo, comparativo, observacional y transversal. Análisis estadístico: sensibilidad, especificidad y valores predictivos positivos y negativos. Análisis bayesiano. Pacientes y métodos: Se estudiaron a noventa y nueve pacientes con el diagnóstico clínico sugestivo de apendicitis aguda con menos de 24 horas de evolución y que se sometieron a apendicectomía. Se valoraron clínicamente bajo la escala de Alvarado. A 43 pacientes se les realizó TAC y a 46 US abdominal. Se estableció el valor diagnóstico de la aplicación de la escala por sí sola y se comparó el valor diagnóstico de TAC o US, así como la posibilidad postprueba negativa (PPPN). El estudio histopatológico fue el estándar de oro diagnóstico. Resultados: Noventa y nueve pacientes con evaluación de Alvarado tuvieron una sensibilidad de 73%, especificidad de 57%, valor predictivo (VP) positivo de 91%, VP negativo de 26%, PPPN de 32%. La TAC tuvo una sensibilidad de 92%, especificidad de 0%, VP positivo de 96%, VP negativo de 0%, PPPN de 99%. El US tuvo sensibilidad de 90% especificidad de 50%, VP positivo de 92%, VP negativo de 43% y PPPN de 17%. Conclusión: La escala de Alvarado continúa siendo una buena prueba diagnóstica para el diagnóstico de apendicitis aguda. El ultrasonido es la mejor prueba de imagen diagnóstica adyuvante, ya que cuando indica negatividad para apendicitis, la posibilidad que ésta esté presente es de 17%.

Objective: To compare the sensitivity and specificity of the Alvarado score for the diagnosis of acute appendicitis with that of computed axial tomography (CAT) scan and ultrasound (US). Setting: Christus Muguerza High Specialty Hospital, Monterrey (México). Design: Prospective, comparative, observational, cross sectional study. Statistical analysis: sensitivity, specificity, and positive and negative predictive values. Bayesian analysis. Patients and methods: Ninety-nine patients with clinical diagnosis suggestive of acute appendicitis with less than 24-hour evolution, subjected to appendicectomy. Patients were clinically evaluated with the Alvarado Score, CAT scan was performed in 43 patients, and abdominal US in 46 patients. We established the diagnostic value of the Alvarado Score by itself and compared it with the diagnostic value of CAT scan and US, as well as with the possibility of negative post-test (PNPT). The histopathological study was the diagnostic gold standard. Results: Ninety-nine patients evaluated with the Alvarado score, yielded a sensitivity of 73%, specificity of 57%, positive predictive value (PV) of 91% negative predictive value of 26%, PNPT of 32%. CAT scan had a sensitivity of 92%, specificity of 0%, positive PV of 96%, negative PV of 0%, PNPT of 99%. The US revealed a sensitivity of 90%, specificity of 50%, positive PV of 92%, negative PV of 43%, PNPT of 17%. Conclusion: The Alvarado score continues to be a good diagnostic test for acute appendicitis. US is the best adjuvant imaging test, since when it indicates negativity for appendicitis, the possibility that this is present is of 17%.

Conjunctival metastasis from Kaposi's sarcoma: a case report.

We present one case of Kaposi's sarcoma with conjunctive metastasis. The case describes a 71-years-old white male, who was admitted at hospital by malaise, slight pain on the left eyelid, nodular lesion of the left leg, and enlarge lymph nodes in inguinal regions. The conjunctive neoplasms are rare, and we most frequently can see the pigment ones followed by squamous epithelials and lymphomas. The primary Kaposi's sarcoma (KS) from conjunctiva is a rare tumor and it has increased by AIDS emergence and immunosuppression. The appearance of conjunctival metastasis from KS is a stand out event.