Comunicaciones y Reportes

Solapamiento de los síndromes de Guillain-Barré y Miller Fisher como complicación inusual de la COVID-19. Presentación de un caso

Sun, 01 Jan 2023 00:00:00 GMT

Solapamiento de los síndromes de Guillain-Barré y Miller Fisher como complicación inusual de la COVID-19. Presentación de un caso Díaz-Guio, D.A.; Salazar-Ospina, M.A.; Salazar-Palacio, C.; Díaz-Gómez, A.S.; Díaz-Guio, Y.; Ricardo-Zapata, A.; Castaño-Osorio, W.; Rodríguez-Morales, A.J. Background: The COVID-19 pandemic has had a devastating impact on the world, mainly during the first year of the pandemic, where strategies such as vaccination were not available. Information on the outcomes of patients admitted to the intensive care unit (ICU) in Colombia is scarce. Our main objective was to characterize critically ill patients with COVID-19 in our region. Methods: We conducted a single-center retrospective observational study in which we included patients with COVID-19 confirmed by RT-PCR who were admitted to the adult ICU between March 18, 2020 and March 18, 2021, in Quindío, Colombia. We identify the clinical and laboratory characteristics at admission, the support used, and their relationship with mortality during ICU hospitalization. Results: Three hundred and fifty-nine patients with a confirmed diagnosis of COVID-19 were admitted, 64% men, mean age was 62.7 years (SD ± 12.3), body mass index 27.9 kg/m2 (±5.8), SOFA score was 7.6 (±3.12), Pa/FiO2 96.2 (±62.3), and lung compliance 30.5 ml/cmH2O (±18.4). Mortality was 60%. The variables with the highest mortality association were obesity OR: 2.38 (95% CI: 1.39–4.09, p: <.001), Glasgow coma scale at admission <12: 17.5, (5.21–58.8, p: <.001), PaFiO2 <100: 5.63, (3.38–9.39, p: <.001), static lung compliance less than 50 ml/cmH2O: 3.54, (3.38–9.39, p: <.001), SOFA score >5: 3.75 (2.19–6.42, p: <0.001), ferritin > 1000: 2.58, (1.66–4.02, p: <.001), C-reactive protein > 5: 2.52 (1.42–4.26, p: <.001), and LDH > 280: 2.71 (1.55–4.74, p: <.001). Patients who required PEEP > 10 cmH2O: 2.34 (1.48–3.70, p: <.001), FiO2 > 60%: 4.01, (2.46–6.53, p: <.001), and ventilation in the prone position. Conclusion: Mortality in the first year of the pandemic in our region was high, mainly associated with obesity, inflammation, altered mental status upon admission, and increased lung elastance.

Rare mutation of the PPOX gene in a patient with Porphyria Variegate: a case report in Peru

Sun, 01 Jan 2023 00:00:00 GMT

Rare mutation of the PPOX gene in a patient with Porphyria Variegate: a case report in Peru Kamimoto-Rodriguez, A.; Caira-Chuquineyra, B.; Fernandez-Guzman, D. Introduction: Variegate porphyria (VP) is a rare disease, resulting from mutation of the protoporphyrinogen oxidase (PPOX) enzyme gene, and it is characterized by cutaneous manifestations and acute neuro-visceral symptoms. Case report: We describe the case of a 21-year-old woman from Peruvian highlands. The patient came to the emergency department for abdominal pain, quadriparesis and reddish urine. The patient also presented the syndrome of inappropriate secretion of antidiuretic hormone (SIADH), motor neuropathy and respiratory failure. These clinical features were diagnosed as consequence of a porphyria crisis. The specific diagnosis was made with an elevated urinary porphobilinogen level (185.7 mg/24hours) and genetic analysis, which showed a rare pathogenic variant of the PPOX gene (nucleotide change: c.78C>A and protein change: p.Cys26*). The patient required intensive care until the administration of specific treatment with hemin. Conclusion: We report a case of VP with a pathogenic variant in the PPOX gene.

Vasculitis cutánea asociada a Ehrlichiosis canina. Reporte de un caso clínico

Sun, 01 Jan 2023 00:00:00 GMT

Vasculitis cutánea asociada a Ehrlichiosis canina. Reporte de un caso clínico Gualan-Cango, M.I.; Ordoñez, A.R.; Venturo-Barriga, R.A.; Aguilar-Galvez, L.F. Canine Ehrlichiosis can trigger cutaneous vasculitis by immunopathogenic mechanisms, as do Rickettsia and Leishmania, among others. Vasculitis refers to inflammation of the blood vessels of the skin resulting in altered blood flow and ischemic necrosis of the skin. The aim of this work was to report the case of a four-year-old male dog, which presented erosive-ulcerative alopecic lesions and some crusty lesions on the head, nasal plane, flexion regions, pinna and tip of the tail. A hemogram was performed, confirming anemia, normocytic normochromic non-regenerative, leukocytes still normal with lymphopenia, and thrombocytopenia. The blood smear showed the presence of basophilic morulae in monocytes, findings compatible with Ehrlichia spp. The patient was treated with Prednisolone 1 milligram·kilogram-1 -mg·kg-1-every 24 hours –h– for 10 days –d-, Pentoxifylline 15 mg every 12 h for 120 d, 500 mg of Doxycycline and 500 mg of Niacinamide every 12 h for 20 d. Two controls (skin lesions) were performed, one at 21 d and the other at 60 d. It is concluded that the treatment was satisfactory, where the patient recovered completely after the treatment administered.

Tricuspid valve dysplasia (Ebstein-like)

Wed, 01 Jan 2020 00:00:00 GMT

Tricuspid valve dysplasia (Ebstein-like) Chambergo-Michilot, D.; Espinoza-Gutiérrez, G.A.; Gómez, J.M.; Tenorio-Quispe, A.M. The Ebstein anomaly is a malformation characterised by the apical displacement of the insertions of the septal valve and the posterior tricuspid valve, displaced tricuspid functional ring, and atrialisation of the right ventricle. Cases have been found during surgery that have complied with these criteria, and have therefore been classified as “Ebstein-like anomalies”. Some of them have been described anatomically as valve dysplasia. The case is presented of a 20 year-old female that presented with dyspnoea Class III of the New York Heart Association, and a stabbing pain in the chest. This was classified as a possible Ebstein anomaly by cardiac ultrasound. However the findings during the surgery were compatible with tricuspid valve dysplasia with dilation of the functional ring. This case highlights the importance of the appropriate use of cardiac ultrasound, as well as the need to carry out prospective studies on Ebstein-like cases.