Atypical bacterial infections of the central nervous system transmitted by ticks: An unknown threat.

Infections of the central nervous system caused by atypical bacteria are becoming more common. Borrelia burgdorferi and Rickettsia conorii are microorganisms transmitted by ticks; infection with these bacteria result in a wide spectrum of manifestations on imaging. In areas where these tick-borne microorganisms are endemic, including Spain, these infections must be included in the differential diagnosis of patients with a variety of systemic and neurologic symptoms. The clinical presentation of these infections is nonspecific, and CT is normally the initial imaging technique, although MRI is more sensitive to early changes. On MRI, these infections can manifest as small lesions in the deep supratentorial white matter that are hyperintense on T2-weighted/FLAIR sequences. It is fundamental to know the imaging characteristics of the different atypical bacterial infections and their differential diagnoses. Good history taking combined with complementary tests (blood tests and CSF analysis) and the neuroimaging findings can help reach the right diagnosis and enable appropriate treatment, thereby preventing possible neurological sequelae.

Valoración del seguimiento de las guías clínicas en la exacerbación de la enfermedad pulmonar obstructiva crónica (EPOC) en el servicio de urgencias / Assessment of adherence to practice guidelines for managing exacerbation of chronic obstructive pulmonary disease in the emergency department

Se describe la experiencia clínica en cuanto al grado de cumplimiento de las guías clínicas en pacientes con enfermedad pulmonar obstructiva crónica (EPOC) atendidos en un servicio de urgencias hospitalario (SUH). Se han revisado las historias de 352 pacientes atendidos por EPOC durante un periodo de 1 año. Se ha observado que la presión arterial se registró en el 92% de los casos, la frecuencia cardiaca en el 74,7%, la frecuencia respiratoria en el 71,9%, la saturación arterial de oxígeno en el 88,4%, la presencia de disnea en reposo en el 25,3% y el uso de musculatura accesoria en el13,4%. De los casos en los que pudo valorarse la antibioticoterapia, ésta se administró sin indicación en el 78,2%, y sólo 117 de los 215 pacientes con criterios de gravedad recibieron corticoides sistémicos (54%). En conclusión, se constata un cumplimiento bajo en la valoración de ítems necesarios para la aplicación de guías clínicas en la EPOC por lo que es necesario buscar herramientas para la mejora en el seguimiento de las recomendaciones de las vías clínicas. (AU)

This study aimed to describe clinical practice in terms of the degree of adherence to practice guidelines for managing chronic obstructive pulmonary disease (COPD) in a hospital emergency department. We reviewed the records of 352patients with COPD treated over a period of 1 year. Blood pressure was recorded in 92% of the cases, heart rate in74.7%, respiratory frequency in 71.9%, arterial blood oxygen saturation in 88.4%, the presence of breathlessness at rest in 25.3%, and accessory muscle recruitment in 13.4%. In cases for which it was possible to assess antibiotic therapy, these drugs were administered without adherence to guideline indications in 78.2%, and only 117 of the 215 patients (54%) with serious exacerbation received systemic corticosteroids. We conclude that the records reveal low adherence to recommendations for recording the signs required to apply practice guidelines for the management of COPD. It is therefore necessary to find tools that improve adherence to the recommended clinical pathways (AU)

Cutaneous mucormycosis: report of five cases and review of the literature.

Mucormycosis is a highly aggressive fungal infection caused by Zygomycetes, from the order of Mucorales. This infection commonly presents an aggressive and rapid course and typically affects immunocompromised patients. Mucormycosis can manifest in different clinical patterns and locations. Although the correct diagnosis is often difficult, an early identification is essential for patient survival. Several clinical forms of mucormycosis are recognised. Cutaneous mucormycosis is less common than other clinical forms, but potentially lethal if treatment is not rapid. Tissue examination by histopathology and culture confirms the fungal infection. Standard treatment includes antifungal therapies associated with surgical debridement. We report five different cases of cutaneous mucormycosis treated in our institution and the management carried out in each case.

Dolor abdominal en paciente tratado con acenocumarol. Un caso de hematoma intramural espontáneo de intestino delgado / Abdominal ain in a patient using acenocoumarol. A case of spontaneous intramural samll-bowel hematoma

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