Mortalidad por COVID-19 y diagnóstico tardío en las primeras etapas de la pandemia en Bolívar-Colombia / Mortality from COVID-19 and late diagnosis in the early stages of the pandemic in Bolívar-Colombia

Introducción: Los pacientes fallecidos por COVID-19 al inicio de la pandemia evidencian características clínico-epidemiológicas particulares y su identificación, lo mismo que los aspectos asociados a su diagnóstico son fundamentales para la implementación de estrategias en salud pública que permitan la protección sanitaria de los grupos más vulnerables. Objetivo: Determinar las características clínico epidemiológicas de los pacientes fallecidos por COVID-19 y su asociación con el diagnóstico tardío en las primeras etapas de la pandemia en el departamento de Bolívar-Colombia. Materiales y Métodos: Estudio descriptivo de corte transversal con una muestra de 51 pacientes fallecidos por COVID-19; se calculó la frecuencia relativa de los factores de riesgo clínico epidemiológicos de estos pacientes y se realizó un análisis bivariado para evidenciar la asociación con la posibilidad de ser diagnosticado después de la muerte, usando la razón de disparidad (OR) con su intervalo de confianza Resultados: El 47,2 por ciento de los diagnósticos se hicieron después de la muerte; el promedio entre el inicio de los síntomas y la muerte fue aproximadamente 13 días, en los que se evidencia como comorbilidades importantes las enfermedades cardíacas (58,5 por ciento) y la hipertensión (35,8 por ciento). La asociación con el diagnóstico después de la muerte se relaciona con los casos notificados en abril y mayo (p=0,03), ser mayor de 80 años (p=0,03) y tener malnutrición (p=0,04). Conclusión: En el contexto del departamento de Bolívar se observan fallas en el diagnóstico oportuno de algunos grupos poblacionales vulnerables y a los pacientes con enfermedades cardíacas se debe prestar atención para evitar la alta mortalidad(AU)

Introduction: Patients who died from COVID-19 at the beginning of the pandemic show particular clinical-epidemiological characteristics and their identification as well as the aspects associated with the diagnosis are fundamental for the implementation of public health strategies that allow the sanitary protection of the most vulnerable groups. Objective: To determine the clinical-epidemiological characteristics of patients who died from COVID-19 and its association with late diagnosis in the early stages of the pandemic in the department of Bolívar-Colombia. Material and Methods: Descriptive cross-sectional study with a sample of 51 patients who died from COVID-19; the relative frequency of the clinical-epidemiological risk factors of these patients was calculated and a bivariate analysis was performed to show the association with the possibility of being diagnosed after death, using the disparity ratio (OR) with its confidence interval. Results: The 47,2 percent of the diagnoses were made after death; the average between the onset of symptoms and death was approximately 13 days, in which heart disease (58,5 percent) and hypertension (35,8 percent) were evidenced as important comorbidities. The association with diagnosis after death is related to the cases reported in April and May (p = 0.03), being older than 80 years (p = 0.03) and having malnutrition (p = 0.04). Conclusion: In the context of the department of Bolívar, failures are observed in the timely diagnosis of some vulnerable population groups, thus special attention should be paid to patients with heart disease to avoid high mortality(AU)

Hypertrophic cardiomyopathy masked by pericarditis

Hypertrophic cardiomyopathy used to be regarded as a rare untreatable cause of sudden death in young male athletes. This report is the case of a middle-aged female patient with hereditary hypertrophic cardiomyopathy masked by superimposed pericarditis and revealed by autopsy. This case report illustrates how co-morbidity can hide a crucial diagnosis. This case report also illustrates the value of autopsy disclosing a familial disease that is increasingly recognized and dramatically more treatable than a few decades ago. Sudden death due to hypertrophic cardiomyopathy has become preventable, if the diagnosis is made soon enough. The lessons for patient care from this case include the importance of not missing the diagnosis of hypertrophic cardiomyopathy in female patients.

Seguridad del tratamiento con Surfacen® en recién nacidos pretérminos con síndrome de dificultad respiratoria / Safety of the treatment with Surfacen® in preterm newborns with syndrome of respiratory difficulty

Introducción: Varias han sido las publicaciones sobre Surfacen®, pero ninguna ha comparado la seguridad del producto entre su uso temprano y tardío. Objetivo: Comprobar las características de los eventos adversos en ambas formas de administración del producto. Métodos: Se realizó un estudio analítico observacional, no controlado, multicentro, nacional, desde 2007 al 2013. La muestra fue de 484 recién nacidos en los que se comprobaron los eventos adversos ocurridos por Surfacen® administrado de manera temprana y tardía. Las variables estudiadas fueron de caracterización general y de caracterización de los eventos adversos. Resultados: El grupo al que se le administró el surfactante de manera tardía tuvo mayor incidencia de eventos adversos que los tratados de manera temprana (277 vs 268). El porcentaje de pacientes con estos eventos fue mayor en los tratados de manera tardía (63,7 vs 41,3 por ciento). El rescate tardío tuvo 2,5 veces más riesgo de presentar la hemorragia peri- e intraventricular (10,4 vs 4,0 por ciento), mayor riesgo de presentar las diferentes formas de bloqueo aéreo, tres veces más riesgo de displasia broncopulmonar (8,8 vs 2,6 por ciento) y 6 veces más riesgo de presentar desaturación de oxígeno, que el rescate temprano. Conclusiones: El tratamiento con Surfacen®, tanto en su forma de rescate temprano como tardío presenta los mismos eventos adversos que otros surfactantes utilizados y el tratamiento de rescate temprano tiene menos riesgo de presentar eventos adversos como son la hemorragia intraventricular, el bloqueo aéreo, displasia broncopulmonar y desaturación de oxígeno, por lo que su administración es segura(AU)

Introduction: There have been several publications on SURFACEN®, but none has compared the safety of this product in the early and late uses of it. Objective: To check the characteristics of adverse events in both ways of administering the product. Methods: It was carried out an analytic, observational, non- controlled, national multicentric study from 2007 to 2013. The sample consisted of 484 newborns in whom were checked the adverse events occurred in the early and late ways by administered SURFACEN®. The studied variables were of general characterization and of characterization of the adverse events. Results: The group to which the surfactant was administered in a late way had more incidences of adverse events than the ones treated earlier (277 vs 268). The percentage of patients with these events was higher in the ones treated in a late way (63.7 vs 41.3 percent). The late rescue had 2.5 times more risk of presenting peri- and intra-ventricular hemorrhage (10.4 vs 4.0 percent), higher risk of presenting the different forms of air block, three times more risk of bronchopulmonary dysplasia (8.8 vs 2.6 percent), and six times more risk of presenting oxygen desaturation. Conclusions: As much in the way of early rescue as in the late one, the treatment with SURFACEN® presents the same adverse events that other used surfactants; and the early rescue's treatment has less risk of presenting adverse events or intraventricular hemorrhage, air block, bronchopulmonary dysplasia and oxygen desaturation, that is why its administration is safe(AU)

Factores que influyen en la demora diagnóstica de la neoplasia de pulmón en egresados vivos / Factors that influence the diagnostic delay of lung neoplasia in patients discharged alive

Introducción: el cáncer de pulmón es el tumor maligno más frecuente en el mundo, en Cuba es la segunda causa de muerte, su pronóstico depende de diferentes factores entre ellos el intervalo entre el primer síntoma y el inicio del tratamiento. Objetivo: determinar los factores que influyen en la demora en el diagnóstico de los pacientes con neoplasia de pulmón. Métodos: se realizó un estudio descriptivo, retrospectivo y longitudinal de los pacientes egresados vivos con diagnóstico de neoplasia de pulmón en el Hospital Militar Dr. Carlos J. Finlay en el período comprendido entre enero 2016 a enero 2017. Resultados: la neoplasia de pulmón fue más frecuente en mayores de 50 años, del sexo masculino y con estrecha relación con el hábito de fumar, la falta de aire fue el principal síntoma por el que acudieron los pacientes después de un mes de inicio de la sintomatología. La estadía hospitalaria fue superior a los 20 días y se realizó el diagnóstico histológico en pocos pacientes. Conclusiones: la demora en el diagnóstico de la neoplasia de pulmón influye en su supervivencia, pues no se les puede realizar un tratamiento oncoespecífico(AU)

Introduction: lung cancer is the most frequent malignant tumor in the world, in Cuba it is the second cause of death, its prognosis depends on different factors including the interval between the first symptom and the start of treatment. Objective: to determine the factors that influence the delay in the diagnosis of patients with lung neoplasia. Methods: a descriptive, retrospective and longitudinal study of live patients with diagnosis of lung neoplasm was performed at the Military Hospital Dr. Carlos J. Finlay in the period from January 2016 to January 2017. Results: lung neoplasia was more frequent in men over 50 years of age, and with a close relationship with smoking, lack of air was the main symptom for which patients came after a month of onset of smoking symptomatology. The hospital stay was longer than 20 days and the histological diagnosis was made in a few patients. Conclusions: the delay in the diagnosis of lung neoplasia influences their survival, since they cannot be treated onco-specific(AU)

Gelatinous transformation of bone marrow: rare or underdiagnosed?

Gelatinous transformation of the bone marrow (GTBM) is a rare hematologic entity, which was first described by Paul Michael in 1930. GTBM is mostly associated with caloric intake/anorexia nervosa, although it also has been described accompanying other pathologic conditions, such as malignancy, systemic lupus erythematosus and HIV infections. Even though the diagnostic features of the hematopoietic tissue, such as hypoplasia, adipose cell atrophy, and deposition of a gelatinous substance in the bone marrow (which stains with Alcian blue at pH 2.5) are quite specific, the underlying pathogenic mechanisms remain poorly understood. Considering the evidence of reversibility­notably in cases of malnutrition and anorexia­this entity should be kept high on cards as a possible differential diagnosis of patients presenting with cytopenias and associated weight loss or starvation, especially in developing countries with nutritionally deprived populations. On an extensive review of the literature aimed at comprehensively addressing the evolution of the GTBM from the past century until now, we conclude that the lack of clinical suspicion and awareness regarding this pathologic entity has led to misdiagnosis and delayed diagnosis.

Phosphaturic mesenchymal tumor (PMT): exceptionally rare disease, yet crucial not to miss

Phosphaturic mesenchymal tumors (PMTs) are very rare tumors which are frequently associated with Tumor Induced Osteomalacia (TIO), a paraneoplastic syndrome that manifests as renal phosphate wasting. The tumor cells produce a peptide hormone-like substance known as fibroblast growth factor 23 (FGF23), a physiologic regulator of phosphate levels. FGF23 decreases proximal tubule reabsorption of phosphates and inhibits 1-α-hydroxylase, which reduces levels of 1-α, 25-dihydroxyvitamine D3. Thus, overexpression of FGF23 by the tumor cells leads to increased excretion of phosphate in the urine, mobilization of calcium and phosphate from bones, and the reduction of osteoblastic activity, ultimately resulting in widespread osteomalacia. Patients typically present with gradual muscular weakness and diffuse bone pain from pathologic fractures. The diagnosis is often delayed due to the non-specific nature of the symptoms and lack of clinical suspicion. While serum phosphorus and FGF23 testing can assist in making a clinical diagnosis of PMT, the responsible tumor is often difficult to locate. The pathologic diagnosis is often missed due to the rarity of PMTs and histologic overlap with other mesenchymal neoplasms. While patients can experience severe disabilities without treatment, excision is typically curative and results in a dramatic reversal of symptoms. Histologically, PMT has a variable appearance and can resemble other low grade mesenchymal tumors. Even though very few cases of PMT have been reported in the world literature, it is very important to consider this diagnosis in all patients with hypophosphatemic osteomalacia. Here we present a patient who suffered for almost 5 years without a diagnosis. Ultimately, the PMT was located on a 68Ga-DOTA TATE PET/CT scan and subsequently confirmed by histologic and immunohistologic study. Interestingly, strong positivity for FGFR1 by IHC might be related to the recently described FN1-FGFR1 fusion. Upon surgical removal, the patient's phosphate and FGF23 levels returned to normal and the patient's symptoms resolved.

An Appropriate Lower Respiratory Tract Specimen Is Essential for Diagnosis of Middle East Respiratory Syndrome (MERS)

No abstract available.