Características y resultados de pacientes COVID-19 tratados con ventilación mecánica invasiva en Hospital San Juan de Dios. Marzo-junio 2020

Background: The overall mortality of patients with COVID-19 admitted to intensive care units is approximately 40%. Aim: To describe the characteristics of a cohort of patients with COVID-19 who required invasive mechanical ventilation due to severe hypoxemic acute respiratory failure at a general hospital in Santiago, Chile. Material and Methods: Review of medical records and follow up for 28 days of patients with COVID-19 confirmed by polymerase chain reaction who required invasive mechanical ventilation and who were admitted to the intensive care unit from March 24 to June 7, 2020. Results: Data from 152 patients aged 58 (interquartile range (IQR) 47-65 years (66% men) was analyzed. As of July 5, 36 (24%) had died, 75 (49%) were discharged, 10 (7%) were still on invasive mechanical ventilation, 11 (7%) remained with tracheostomy but without invasive mechanical ventilation, and 20 (13%) were hospitalized in a basic unit. The median time on invasive mechanical ventilation among extubated patients was 14 days (IQR 10-21) and 121 (80%) were in the prone position. Patients who died were older, had a higher frequency of diabetes mellitus and a higher driving pressure at 7 days than those discharged alive from the intensive care unit. Conclusions: In this study mortality was lower than that reported in the first international studies, probably due to the selection of younger patients and greater knowledge of the disease.

Effect of intrabronchial platelet rich plasma on the exercise-induced pulmonary hemorrhage endoscopic score in thoroughbred racehorses using furosemide: a preliminary study / [Efeito da instilação intrabronquial de plasma rico em plaquetas no escore endoscópico da hemorragia pulmonar induzida por exercício em cavalos Puro-Sangue Inglês de corrida e usuários de furosemida: um estudo preliminar]

The high prevalence of exercise-induced pulmonary hemorrhage (EIPH) in athletic horses constitutes to be a challenge to the racing industry and a source of major concern to animal welfare. Both experimental and clinical evidence indicate that the use of autologous platelet-rich plasma (PRP) is a promising effector of repair in a variety of pulmonary conditions. The present study evaluated the effect of intrabronchial instillation of PRP on EIPH endoscopic scores from 37 Thoroughbred racehorses. Inclusion criteria were for animals to be EIPH-positive in, at least, two consecutive post-exercise endoscopic exams and to receive 250mg of furosemide IV four hours before racing. Animals were randomly assigned into 3 groups: placebo, control, and PRP instillation. All 37 Thoroughbred racehorses included had EIPH endoscopic scores pre- and post- treatment compared by statistical analysis. The bleeding score from the group receiving PRP was significantly lower than in the control and placebo groups. No adverse effects were observed in any animal during or after the experiment. It was possible to conclude that the intrabronchial instillation of autologous PRP was effective in reducing EIPH scores in racehorses receiving furosemide and that this bioproduct can be considered as a promising coadjuvant in controlling EIPH in athletic horses.(AU)

A alta prevalência de hemorragia pulmonar induzida por exercício (HPIE) em cavalos atletas é um desafio de longa data para a indústria de corridas, além de figurar como grande preocupação sobre o bem-estar animal. As evidências experimentais e clínicas indicam que o uso do plasma rico em plaquetas (PRP) de fonte autógena é promissor na terapêutica de diversas lesões pulmonares. O presente estudo objetivou avaliar as mudanças após corrida no escore endoscópico de HPIE de 37 cavalos Puro-Sangue Inglês que receberam instilação intrabronquial de PRP autólogo. Os animais selecionados eram HPIE-positivos em, ao menos, dois exames endoscópicos consecutivos e recebiam 250mg de furosemida IV administrado quatro horas antes de cada corrida. Na comparação dos escores endoscópicos pré e pós-tratamento, verificou-se que o escore de HPIE do grupo tratado com PRP foi significantemente menor que o dos grupos controle e placebo. Nenhum efeito adverso foi observado nos animais durante ou após o experimento. Concluiu-se que a instilação intrabronquial de PRP autólogo foi efetiva na redução do escore de HPIE de cavalos de corrida usuários de furosemida e que este bioproduto pode ser considerado uma alternativa promissora no controle de HPIE em cavalos atletas.(AU)

Diagnóstico diferencial de la fibrosis pulmonar idiopática / Differential diagnosis of idiopathic pulmonary fibrosis

Para el diagnóstico certero de fibrosis pulmonar idiopática (FPI) es de vital importancia la presencia de un patrón tomográfico definitivo de neumonía intersticial usual (NIU), en un contexto clínico adecuado. El interrogatorio dirigido, el uso de cuestionarios validados, una evaluación reumatológica acuciosa y exámenes complementarios son importantes para descartar causas secundarias de fibrosis pulmonar como neumonitis por hipersensibilidad (NHS), enfermedades del tejido conectivo (ETC), toxicidad por drogas y algunas neumoconiosis que pueden imitar el patrón radiológico y muchas veces dificultar un diagnóstico adecuado de FPI.

For the accurate diagnosis of idiopathic pulmonary fibrosis (IPF), the presence of a definitive tomographic pattern of usual interstitial pneumonia (UIP) is of vital importance, in an appropriate clinical context. Targeted interrogation, the use of valid questionnaires, an acute rheumatologic evaluation and complementary examinations are important to rule out secondary causes such as hypersensitivity pneumonitis (HP), connective tissue diseases (CTD), drug toxicity and some pneumoconiosis that can mimic the radiological pattern and often hinder a clear diagnosis of IPF.

Leiomioma retroperitoneal: reporte de un caso / Retroperitoneal leiomyoma: report of a case

Introducción: El mioma retroperitoneal es un tumor de músculo liso con baja incidencia, de etiología variada, siendo lo más frecuente debido a una larga exposición a estrógenos. Presentación del caso: Mujer de 52 años, con antecedentes de diabetes mellitus tipo 1 e hipotiroidismo, consultó por irregularidad menstrual de 1 año de evolución. Al examen físico destacó una masa abdominal palpable y al tacto rectal abombamiento del fondo de saco posterior. Una ecografía transvaginal mostró una lesión sólida retro-uterina de 90x67x79mm por lo que se planteó como hipótesis diagnóstica un tumor pélvico, sin poder descartar origen anexial. Exámenes de laboratorio resultaron normales con marcadores tumorales negativos. Durante el intraoperatorio se identificaron anexos sanos y una masa retroperitoneal por lo que se decidió realizar tumerectomía y anexectomía izquierda por riesgo de bridas. La biopsia resultó compatible con neurilemoma, pero mediante inmunohistoquímica se confirmó diagnóstico de leiomioma. Cursó postoperatorio en buenas condiciones. Discusión: El leiomioma retroperitoneal es un diagnóstico diferencial de tumor retroperitoneal, a pesar de su baja incidencia y menor frecuencia que una tumoración maligna. Sus presentaciones clínicas más frecuentes son como masa abdominal palpable, distensión abdominal o asintomática. Actualmente ningún examen de laboratorio o imagenológico, ha demostrado una alta precisión para discriminar entre un tumor maligno y uno benigno, por lo cual, su confirmación sigue dependiendo de la biopsia excisional. La probabilidad de recurrencia es baja, sin embargo, si esta se presenta, puede deberse a un tumor maligno, por lo que es recomendable un adecuado seguimiento clínico e imagenológico de estas pacientes.

Introduction: The retroperitoneal myoma is a smooth muscle tumor with a low incidence, of varied etiology, being the most frequent due to a long estrogen exposure. Case report: Woman, 52 years old, with a history of diabetes mellitus type 1 and hypothyroidism who consulted for menstrual irregularity of 1 year of evolution. The physical examination revealed a palpable abdominal mass and rectal touch of the posterior recumbent sac. A transvaginal ultrasound showed a solid retro-uterine lesion of 90x67x79mm, so it was diagnosed a pelvic tumor, without being able to rule out adnexal origin. Laboratory tests were normal with negative tumor markers. During the intraoperative period, were identified healthy appendages and a retroperitoneal mass, so it was decided to perform tumerectomy and left annexectomy for the risk of flanges. The biopsy was compatible with neurilemoma, but by means of immunohistochemistry a diagnosis of leiomyoma was confirmed. Came postoperative in good condition. Discussion: Retroperitoneal leiomyoma is a differential diagnosis of retroperitoneal tumor, despite its low incidence and less frequent than a malignant tumor. Its most frequent clinical presentations are palpable abdominal mass, abdominal distension or asymptomatic. At present, no laboratory or imaging examination has shown a high precision to discriminate between a malignant tumor and a benign one, so that its confirmation still depends on the excisional biopsy. The probability of recurrence is low, however, if it is present, it may be due to a malignant tumor, which is why it is advisable to have adequate clinical and imaging follow-up of these patients

¿Qué hay de nuevo en el síndrome de ovario poliquístico? / What’s new in polycystic ovary syndrome

Polycystic ovary syndrome is recognized as a risk factor for the development of type 2 diabetes and metabolic syndrome. The prevalence of the condition is 6 to 10 percent in different populations. Its etiology is not well known and there are genetic and epigenetic phenomena involved. Due to its association with insulin resistance, it has been incorporated as another component of Reaven plurimetabolic syndrome. Therefore polycystic ovary syndrome evolved from an ovarian disease to a multisystem disorder and it must be considered a public health problem.

Tumores pardos múltiples en un paciente con hiperparatiroidismo primario / Multiple brown tumors in primary hyperparathyroidism: report of one case

Brown tumors are an uncommon manifestation of primary and secondary hyperparathyroidism. We report a 38 years old male consulting for generalized bone pain and prostration caused by multiple osteolytic lesions. Diagnostic work up disclosed a primary hyperparathyroidism secondary to a right parathyroid adenoma. The patient was subjected to a parathyroidectomy. After one year of follow up, symptoms have decreased considerably, laboratory parameters are normal and bone lesions are disappearing.

Clinical and epidemiological aspects of canine parvovirus (CPV) enteritis in the State of Rio de Janeiro: 1995 - 2004

This paper relates the clinical and epidemiological aspects of canine parvovirus infection (CPV) in the State of Rio de Janeiro from April 1995 to March 2004. A total of 341 fecal samples were collected from up to 6-months-old puppies with gastroenteritis. The diagnosis of CPV infection was confirmed by hemagglutination/ hemagglutination inhibition tests, enzyme immunoassay, virus isolation in cell culture or polymerase chain reaction. One hundred and fifty-seven samples (46 percent) were positive for CPV. No correlation among sex, breed or age and the occurrence of CPV infection was observed. The classical signs of parvoviral enteritis (anorexia, lethargy, vomiting and hemorrhagic fluid diarrhea) were observed in 70 percent of CPV-positive and in 60 percent of CPV-negative puppies. Although CPV could be detected throughout the studied period, its occurrence was significantly higher from June to September and November to December. These results show that CPV is still circulating in the State of Rio de Janeiro.

Este trabalho relata os aspectos clínicos e epidemiológicos da infecção pelo CPV no Estado do Rio de Janeiro, no período de abril de 1995 a março de 2004. Coletaram-se 341 amostras fecais de cães com até seis meses de idade que apresentavam gastrenterite. O diagnóstico da infecção pelo CPV foi confirmado através dos testes de hemaglutinação/inibição da hemaglutinação, ensaio imunoenzimático, isolamento viral em cultura de células ou reação em cadeia pela polimerase. Cento e cinqüenta e sete amostras (46 por cento) foram consideradas positivas para CPV. Não foi observada correlação entre sexo, raça ou idade e a ocorrência da infecção por CPV. Os sinais clínicos clássicos de parvovirose (vômito, anorexia, apatia e diarréia líquida hemorrágica) foram observados em 70 por cento dos animais positivos e 60 por cento dos animais negativos para CPV. O CPV foi detectado ao longo do período estudado, entretanto observou-se um aumento do número de casos positivos nos períodos de junho a setembro e novembro a dezembro. Estes resultados mostram que o CPV ainda circula no Estado do Rio de Janeiro.

Pulmonary tuberculosis: evaluation of interferon-gamma levels as an immunological healing marker based on the response to the Bacillus Calmette-Guerin

Tuberculosis (TB) is a disease caused by Mycobacterium tuberculosis whose interaction with the host may lead to a cell-mediated protective immune response. The presence of interferon-gamma is related to this response. With the purpose of understanding the immunological mechanisms involved in this protection, the lymphoproliferative response, IFN-gamma and other cytokines like interleukin (IL-5, IL-10), and tumor necrosis factor alpha (TNF-alfa) were evaluated before and after the use of anti-TB drugs on 30 patients with active TB disease, 24 healthy household contacts of active TB patients, with positive purified protein derivative (PPD) skin tests (induration > 10 mm), and 34 asymptomatic individuals with negative PPD skin test results (induration < 5 mm). The positive lymphoproliferative response among peripheral blood mononuclear cells of patients showed high levels of IFN-gamma, TNF-alfa, and IL-10. No significant levels of IL-5 were detected. After treatment with rifampicina, isoniazida, and pirazinamida, only the levels of IFN-gamma increased significantly (p < 0.01). These results highlight the need for further evaluation of IFN-gamma production as a healing prognostic of patients treated.

Case report: spontaneous rupture of the spleen due to dengue fever

Spontaneous rupture of the spleen has been described in cases of hematologic, neoplasic and infectious diseases, or resulting from pancreatitis. We report a rare case of spontaneous splenic rupture, and favorable evolution after splenectomy, in a patient with dengue fever, which occurred during the last outbreak of dengue fever in Brazil.

Attitudes toward breastfeeding working mothers

This investigation assesses attitudes towards breastfeeding working mothers, employees' knowledge of their legal rights and employees' views of the new amendment of Law 427 in Puerto Rico. The sample consists of 36 men and 64 women (N = 101) employed in different institutions of the San Juan metropolitan area. Participants completed the Attitude Scale toward working breastfeeding mothers. The scale's consistency is substantiated by an item-total reliability coefficient yielding r (92) = .70, p < .05. Results show that employed Puerto Ricans may support breastfeeding working mothers. However, many individuals are not aware of the laws that protect a breastfeeding working mother and how extracting milk may help productivity instead of impairing it.

Mutations in the rpoB gene of rifampicin-resistant Mycobacterium tuberculosis strains isolated in Brazil and France

We evaluated the mutations in a 193bp of the rpoB gene by automated sequencing of rifampicin (RMP)-resistant and susceptible Mycobacterium tuberculosis strains isolated from Brazil (25 strains) and France (37 strains). In RMP-resistant strains, mutations were identified in 100 percent (16/16) from France and 89 percent (16/18) from Brazil. No mutation was detected in the 28 RMP-susceptible strains. Among RMP-resistant or RMP-susceptible strains deletion was observed. A double point mutation which had not been reported before was detected in one strain from France. Among French resistant strains mutations were found in codons 531 (31.2 percent), 526, 513 and 533 (18.7 percent each). In Brazilian strains the most common mutations were in codons 531 (72.2 percent), 526 (11.1 percent) and 513 (5.5 percent). The heterogeneity found in French strains may be related to the fact that most of those strains were from African or Asian patients

Trombofilia y embarazo / Thrombophilia and pregnancy

Las trombofilias corresponden a desordenes del sistema hemostático que predisponen a fenómenos trombóticos. Los factores de riesgo de presentar trombosis durante el embarazo están incrementados. Estudios recientes demuestran que pacientes portadoras de trombofilia tiene una alta probabilidad de presentar complicaciones durante la gestación: preeclampsia severa, retardo del crecimiento intrauterino, desprendimiento prematuro de placenta normoinserta y mortinatos. Todo esto estaría vinculado a fenómenos trombóticos de los vasos placentarios

Detection of cytomegalovirus infections by PCR in renal transplant patients

Cytomegalovirus (CMV) is the single most important infectious agent affecting recipients of organ transplants. To evaluate the incidence and the clinical importance of CMV infection in renal transplants in Brazil, 37 patients submitted to renal allograft transplants were tested periodically for the presence of cytomegalovirus DNA in urine using the polymerase chain reaction (PCR), and for the presence of IgM and IgG antibodies against CMV by enzyme-linked immunosorbent assay (ELISA) and indirect immunofluorescence (IIF). The PCR-amplified products were detected by gel electrophoresis and confirmed by dot-blot hybridization with oligonucleotide probes. Thirty-two of the 37 patients (86.4 percent) were positive by at least one of the three methods. In six patients, PCR was the only test which detected the probable CMV infection. Ten patients had a positive result by PCR before transplantation. In general, the diagnosis was achieved earlier by PCR than by serologic tests. Active infection occurred more frequently during the first four months after transplantation. Sixteen of the 32 patients (50 percent) with active CMV infection presented clinical symptoms consistent with CMV infection. Five patients without evidence of active CMV infection by the three tests had only minor clinical manifestations during follow-up. Our results indicate that PCR is a highly sensitive procedure for the early detection of CMV infection and that CMV infection in renal transplant patients is a frequent problem in Brazil

Vulvovaginites: Aspectos Dietéticos e Bioquímicos / Biochemical and Nutritional Aspects of Vulvovaginitis

A vulvovaginite, expressäo de diversas patologias que acometem o trato genital inferior feminino, é conhecida desde Hipócrates e Soranus como importante manifestaçäo de distúrbios potencialmente graves para a saúde genital e sistêmica das mulheres. Vários trabalhos já enfocaram com muita ênfase, os aspectos microbiológicos destas doenças, porém pouca coisa tem sido feita em funçäo dos fatores coadjuvantes que poderiam favorecer ou dificultar a instalaçäo das mesmas. Neste artigo säo enfocados os aspéctos bioquímicos e nutricionais do conteúdo vaginal fisiológico, dando uma descriçäo dos achados mais frequentes, bem como as possíveis interaçöes com a microflora. Os mecanismos de proteçäo ou de facilitaçäo do corrimento vaginal säo apontados, estressando a importância dos aminoácidos e imunoglobinas, secretadas principalmente a nível local. O conhecimento de tais aspectos, pode servir como chave importante para o ginecologista estabelecer uma correlaçäo entre os achados clínicos e laboratoriais e conseqüentemente elucidar a açäo fisiopatogênica em determinados casos, base fundamental para o perfeito diagnóstico e tratamento

Avaliaçäo de modificaçöes na rotina laboratorial do líquido pleural no rendimento diagnóstico de tuberculose pleural / Evaluation of laboratory routine of pleural fluid in diagnostic yield for pleural tuberculosis

Foi comparado o rendimento diagnóstico de tuberculose obtido em estudo propesctivo do líquido pleural de 80 pacientes e em análise retrospectiva de 105 prontuários médicos. Na série prospectiva foi introduzido o controle de qualidade, quando atençäo especial foi dada à colheita, transporte e processamento (precedido ou näo de descontaminaçäo) do líquido pleural. Na série retrospectiva utilizou-se a rotina do Serviço de Bacteriologia da Tuberculose, que consistia em descontaminaçäo de todos os materiais. Na abordagem prospectiva, 97 por cento dos pacientes tiveram seu diagnóstico confirmado. Este foi obtido histopatologicamente em 87 por cento e bacteriologicamente em 56 por cento dos casos. No estudo retrospectivo, a confirmaçäo diagnóstica ocorreu em 94 por cento dos casos. Na série prospectiva, a sensibilidade da cultura no líquido pleural näo precedida de descontaminaçäo (36 por cento) foi superior àquela observada no material submetido a descontaminaçäo (29 por cento) (p = 0,02). O rendimento da cultura do líquido pleural submetido a descontaminaçäo foi de 29 por cento e o oservado no exame bacteriológico do fragmento pleural, de 42 por cento (p < 0,02). Entretanto, na ausência de descontaminaçäo, o rendimento bacteriológico do líquido pleural (36 por cento) e o do fragmento pleural (42 por cento) foram semelhantes (p = 0,22). O controle de qualidade introduzido na série prospectiva aumentou o rendimento da cultura do líquido pleural de 26 por cento para 29 por cento.

Vaginose bacteriana: experiência com o tiafenicol / Bacterial vaginosis: experience with thiamphenicol; \"Clue Cell\"

O objetivo deste trablho foi avaliar a eficácia do tiafenicol no tratamento da vaginose bacteriana. Foram estudadas 31 pacientes portadoras de vaginose bacteriana, cujo diagnóstico presuntivo foi confirmado através do isolamento de Gardneella vaginalis no conteúdo vaginal. Realizou-se também cultura para germes aeróbios, anaeróbios, Chlamydia trachomatis, Neisseria gonorrhoeae e Mobiluncus sp. As pacientes e seus parceiros sexuais foram tratados com tiafenicol, na dosagem de 2,5 g VO (dose única, ao dia, durante dois dias). As avaliaçÆes realizadas no 7§ e 28§ dias após o tratamento demonstraram cura clínica em 29 (93,5 por cento) casos. A cultura para Gardnerella vaginalis foi positiva em dois (6,5 por cento) casos no 7§ dia e em três (9,7 por cento) casos no 28§ dia. Os germes anaeróbios foram isolados em um (3,2 por cento) caso no 7§ dia e em dois (6,5 por cento) casos no 28§ dia. A cultura para Mobiluncus sp foi positiva em seis (19,3 por cento) casos antes do tratamento e negativa em todos após omesmo. Concluem os autores que otiafenicol mostrou-se eficaz para otratamento da vaginose bacteriana

Donated organs as a source of cytomegalovirus (CMV) in renal transplant patients

Two patients receiving the same cadaver kidney graft were investigated prospectively for cytomegalovirus (CMV) infection using the polymerase chain reaction (PCR) and serologic tests (ELISA and IFI). The data indicate that a strain of CMV was probably transmitted from the same donor to both kidney recipients including one who was seropositive for CMV

Alteraçöes do humor relacionadas às variaçöes hormonais: II. Síndrome pré-menstrual / Humor changes related to hormonal variations: II. Premenstrual syndrome

Os autores apresentam revisäo sobre o termo Síndrome Pré-Menstrual (SPM) e questöes relativas ao seu diagnóstico diferencial com outras patologias clínicas e distúrbios do humor. Correlacionam as ligaçöes entre açäo dos esteróides sexuais, opióides, prostaglandians e secotonina no cérebro e as alteraçöes do humor na SPM e sugerem de forma crítica manejo clínico da SPM.

Alteraçöes do humor relacionadas às variaçöes hormonais: I. Menopausa / Humor changes related to hormonal variations: I. Menopause

A abordagem do climaterio tornou-se um dilema do seculo 20. A menopausa, por si, nao tem efeito negativo sobre a saude mental. A morbidade psiquiatrica e mais frequente na peri-menopausa. Fatores familiares e socio-culturais sao mais importantes na etiologia da desordem mental, do que as mudantas fisiologicas. Os psicofarmacos deverao ser utilizados naquelas mulheres menopausadas, com ansiedade ou depressao, que nao respondem a terapia de repositao hormonal.

Rapid identification of beta-globin structural mutations by sequencing the mRNA from peripheral blood reticulocytes

A simple and rapid method for the molecular detection of beta-globin structural mutations is described using a reverse transcription-polymerase chain reaction of reticulocyte mRNA and direct sequencing of the product. The amplified segment (employing a sense primer 5'-ATTTGCTTCTGACACAACTGT-3', located at position + 1 with respect to the Cap site and an antisense primer 5'-TCCAGATGCTCAAGGCCCTTC-3', located at position + 1772 with respect to the Cap site) encompasses the cDNA sequence including the three globin exons. Employing this method we were able to characterize two hemoglobin structural variants: Hb S (beta 6 (A3) Glu-Val: GAG-GTG) and Hb Porto Alegre (beta 9 (A6) Ser-Cys: TCT-TGT). The approach described in this paper should be very useful to detect hemoglobin structural variants because the RNA extraction is simple, rapid and does not require cesium chloride, guanidinium and proteinase K. In addition, the direct sequencing of the RT-PCR product permits the screening of the entire globin genes with only two reactions