Ifosfamide-induced nephrotoxicity in oncological patients.

INTRODUCTION: Ifosfamide is an alkylating chemotherapeutic agent used in the treatment of various neoplasms. Its main adverse effects include renal damage. AREAS COVERED: A comprehensive review was conducted, including 100 articles from the Scielo, Scopus, and EMBASE databases. Ifosfamide-induced nephrotoxicity is attributed to its toxic metabolites, such as acrolein and chloroacetaldehyde, which cause mitochondrial damage and oxidative stress in renal tubular cells. Literature review found a 29-year average age with no gender predominance and a mortality of 13%. Currently, no fully effective strategy exists for preventing ifosfamide-induced nephrotoxicity; however, hydration, forced diuresis, and other interventions are employed to limit renal damage. Long-term renal function monitoring is essential for patients treated with ifosfamide. EXPERT OPINION: Ifosfamide remains essential in neoplasm treatment, but nephrotoxicity, often compounded by coadministered drugs, poses diagnostic challenges. Preventive strategies are lacking, necessitating further research. Identifying timely risk factors can mitigate renal damage, and a multidisciplinary approach manages established nephrotoxicity. Emerging therapies may reduce ifosfamide induced nephrotoxicity.

Ifosfamide is a type of chemotherapy used to treat different types of cancers. However, one of its main side effects is kidney damage. Researchers reviewed 100 articles from medical databases to understand how ifosfamide affects the kidneys. The kidney damage is caused by harmful substances produced when ifosfamide is broken down in the body. These substances can harm the cells in the kidneys. Studies have shown that 13% of the patients treated with ifosfamide can die. Currently, there is no perfect way to prevent kidney damage from ifosfamide, but doctors try to protect the kidneys by giving patients plenty of fluids and using other treatments, so it's important for patients who receive ifosfamide to have their kidney function checked regularly. Although ifosfamide is effective against cancer, its potential kidney side effects should be carefully considered by doctors when deciding on the best treatment for each patient.

A 25-Year-Old Woman with a High-Risk Large and Occlusive Pulmonary Embolism, Later Diagnosed with Primary Antiphospholipid Syndrome and Hyperhomocysteinemia: A Case Report.

BACKGROUND High-risk pulmonary embolism (PE) occurs when the pulmonary circulation is suddenly occluded by a thrombus and is a life-threatening medical emergency. In young and otherwise healthy individuals, there may be undiagnosed underlying risk factors for PE that require investigation. This report presents the case of a 25-year-old woman admitted as an emergency with a high-risk large and occlusive PE, later diagnosed with primary antiphospholipid syndrome (APS) and hyperhomocysteinemia. CASE REPORT A 25-year-old woman presented with sudden-onset dyspnea after elective cholecystectomy. One year earlier, the patient had lower limb deep vein thrombosis without an identified predisposing cause, and she received anticoagulation for 6 months. On physical examination, she had right leg edema. Laboratory tests revealed elevated levels of troponin, pro-B-type natriuretic peptide, and D-dimer. Computed tomography pulmonary angiography (CTPA) demonstrated a large and occlusive PE, and an echocardiogram showed right ventricular dysfunction. Successful thrombolysis was performed with alteplase. On repeat CTPA, a significant reduction in filling defects in the pulmonary vasculature was observed. The patient evolved uneventfully and was discharged home on a vitamin K antagonist. Due to unprovoked recurrent thrombotic events, suspicion of underlying thrombophilia was raised, and hypercoagulability studies confirmed primary APS and hyperhomocysteinemia. CONCLUSIONS This report presents the case of a life-threatening high-risk PE in a previously healthy young woman and highlights the importance of emergency management followed by investigation and treatment of underlying risk factors for venous thromboembolism, including APS and hyperhomocysteinemia.

Küpers clinical prediction score in a case series of primary aldosteronism

Background: Primary aldosteronism is a disorder due to excessive aldosterone production in the presence of low renin levels. It is an underdiagnosed pathology despite its simple screening. Establishing the unilateral or bilateral location represents the greatest diagnostic challenge and is crucial to define the therapeutic approach. Adrenal venous catheterization (AVC) is the best test to establish the location, but it is invasive and expensive. New predictive markers of laterality are being developed. Case series presentation: We present a case series of 8 patients diagnosed with primary aldosteronism due to arterial hypertension with hypokalaemia, elevated aldosterone-renin ratio and compatible computed tomography. 4 patients underwent adrenal venous catheterization. Conclusion: In patients who underwent catheterization as well as in those who did not, the Küpers score adequately predicted lateralization in 75% of cases and it could be a useful tool to discriminate unilateral from bilateral aldosteronism.

Introducción: El hiperaldosteronismo primario es un desorden debido a una producción excesiva de aldosterona en presencia de niveles bajos de renina. Es una patología infradiagnosticada a pesar de su simple tamizaje. Definir la localización unilateral o bilateral representa el más importante desafío diagnóstico y es crucial para el abordaje terapéutico. El cateterismo venoso adrenal (CVA) es la mejor prueba para establecer la localización, pero es invasivo y costoso. Nuevos marcadores predictivos de unilateralidad se encuentran en desarrollo. Presentación de serie de casos: Presentamos una serie de casos de 8 pacientes diagnosticados con hiperaldosteronismo primario debido a hipertensión arterial con hipocalemia, radio aldosterona-renina elevado y tomografía compatible. 4 pacientes fueron sometidos a cateterismo venoso adrenal. Conclusión: Tanto en los pacientes que fueron sometidos a cateterismo venoso adrenal como en los que no, el score de Küpers predijo adecuadamente la lateralidad en 75% de los casos y puede ser una herramienta útil para diferenciar el hiperaldosteronismo unilateral del bilateral.

Diagnosis and management of small bowel neuroendocrine tumors: A state-of-the-art.

This review provides an update on the epidemiology, pathophysiology, symptoms, diagnosis and treatment of neuroendocrine neoplasms (NENs) of the small bowel (SB). These NENs are defined as a group of neoplasms deriving from neuroendocrine cells. NENs are currently the most common primary tumors of the SB, mainly involving the ileum, making the SB the most frequently affected part of the gastrointestinal tract. SB NENs by definition are located between the ligament of Treitz and the ileocecal valve. They are characterized by small size and induce an extensive fibrotic reaction in the small intestine including the mesentery, resulting in narrowing or twisting of the intestine. Clinical manifestations of bowel functionality are related to the precise location of the primary tumor. The majority of them are non-functional NENs and generally asymptomatic; in an advanced stage, NENs present symptoms of mass effect by non-specific abdominal pain or carcinoid syndrome which appears in patients with liver metastasis (around 10%). The main manifestations of the carcinoid syndrome are facial flushing (94%), diarrhea (78%), abdominal cramps (50%), heart valve disease (50%), telangiectasia (25%), wheezing (15%) and edema (19%). Diagnosis is made by imaging or biochemical tests, and the order of request will depend on the initial diagnostic hypothesis, while confirmation will always be histological. All patients with a localized SB NEN with or without near metastasis in the mesentery are recommended for curative resection. Locoregional and distant spread may be susceptible to several therapeutic strategies, such as chemotherapy, somatostatin analogs and palliative resection.

Peritonitis Due to Appendicitis Related to Mercury Sequestration: An Unusual Peruvian Case Report.

Elemental mercury ingestion caused by folk practices is rare and usually harmless. Nevertheless, some complications related to mercury ingestion have been reported such as appendicitis related to mercury sequestration and poisoning leading to systemic toxicity. Patients usually present with nausea, vomiting, and abdominal tenderness. Mercury sequestration in the appendix depends on its anatomy and mercury physical properties, both of which may lead to appendicitis, resulting in subsequent peritonitis leading to multiple and severe surgical complications. A 26-year-old Peruvian man complaining of vomiting and abdominal pain after ingestion of elemental mercury as part of a folk practice presented to the emergency department. Physical exam was remarkable for rigid abdomen and diffuse rebound sign. A clinical diagnosis of peritonitis was made. The patient was taken to the operating room where an open appendectomy and peritoneal lavage were performed. On gross inspection, a silver foreign body within the perforated appendix was seen by the surgical team. The patient developed multiple surgical complications leading to multiple organ failure and death. Clinicians should be aware that mercury ingestion is usually benign. However, severe complications may develop. Early surgical and medical intervention should be initiated promptly to achieve better outcomes. We present the first case of peritonitis due to appendicitis related to mercury sequestration in the appendix.

Acromegalia por macroadenoma hipofisiario en paciente con síndrome de McCune-Albright. Reporte de caso y revisión de la literatura / Acromegaly due to pituitary macroadenoma in a patient with McCune-Albright syndrome. Case report and literature overview

Introducción: El síndrome de McCune-Albright (SMA) es una enfermedad rara caracterizada por la triada: manchas cutáneas de color café con leche, displasia fibrosa poliostótica y pubertad precoz. Puede afectar a diversos ejes hormonales, entre ellos el de la hormona de crecimiento (GH), pudiendo asociarse a acromegalia. Reporte de caso: describimos el caso de una mujer de 44 años, con pubertad precoz periférica, hemorragia uterina anormal, crecimiento de manos y pies, prognatismo, prominencia frontal, manchas café con leche y tumoraciones pétreas en cara y antebrazos. Resultados: Apoyados con exámenes laboratoriales y de imágenes, se llegaron a los diagnósticos de acromegalia, hipogonadismo hipogonadotropo y síndrome de McCune-Albright. La paciente fue sometida a tratamiento quirúrgico con persistencia de enfermedad clínica y laboratorial. Conclusión: El diagnóstico y tratamiento oportunos de la acromegalia y sus complicaciones brindará un mejor pronóstico a los pacientes con SMA.

Background: McCune-Albright syndrome (MAS) is a rare disease characterized by the triad: café-au-lait skin spots, polyostotic fibrous dysplasia, and precocious puberty. It can affect various hormonal axes, including growth hormone (GH), and may be associated with acromegaly. We describe the case Case report:of a 44-year-old woman with peripheral precocious puberty, abnormal uterinebleeding, growthof thehands and feet, prognathism, frontal prominence, café-au-lait spots, and stony tumorsonthefaceandforearms.Supportedby Results:laboratory and imaging tests, the diagnoses of acromegaly, hypogonadotropic hypogonadism and McCune-Albright syndrome were reached. The patient underwent surgical treatment with persistence of clinical and laboratory disease. Conclusion: Timely diagnosis and treatment of acromegaly and its complications will provide a better prognosis for patients with MAS

Complicaciones de la obesidad en niños y adolescentes durante la pandemia de COVID-19: Una revisión narrativa / Complicaciones de la obesidad en niños y adolescentes durante la pandemia de COVID-19: Una revisión narrativa

Introducción: La obesidad en niños y adolescentes ha aumentado exponencialmente en todo el mundo. Asimismo, la pandemia del coronavirus (COVID-19) ha conducido a una mayor tasa de obesidad pediátrica. El exceso de tejido adiposo genera una desregulación de hormonas como adiponectina, ghrelina y leptina, entre otras. Las alteraciones metabólicas pueden ocasionar enfermedad cardiovascular, dislipidemias, hipertensión arterial, diabetes mellitus tipo 2, enfermedad del hígado graso no alcohólico, trastornos del sueño y mayor riesgo de COVID-19 severo. La obesidad tiene diferentes enfoques terapéuticos, como programas conductuales de pérdida de peso, tratamientos farmacológicos y procedimientos quirúrgicos. De esta manera, el diagnóstico y el tratamiento oportuno es importante para disminuir la mortalidad asociada a la obesidad en la población pediátrica.

Introduction: Obesity in children and adolescents has increased exponentially worldwide. Likewise, the coronavirus pandemic (COVID-19) has led to a higher rate of pediatric obesity. Excess adipose tissue leads to dysregulation of hormones such as adiponectin, ghrelin and leptin, among others. Metabolic alterations can lead to cardiovascular disease, dyslipidemias, arterial hypertension, type 2 diabetes mellitus, non-alcoholic fatty liver disease, sleep disorders and increased risk of severe COVID-19. Obesity has different therapeutic approaches, such as behavioral weight loss programs, pharmacological treatments and surgical procedures. Thus, timely diagnosis and treatment is important to decrease obesity-associated mortality in the pediatric population.

Complications of obesity in children and adolescents during covid-19 pandemic: A narrative review

Obesity in children and adolescents has increased exponentially around the world. Furthermore, the COVID-19 pandemic has led to a higher pediatric obesity rate. The excess adipose tissue generates a dysregulation of adiponectin, ghrelin, and leptin, among others. Metabolic alterations can develop cardiovascular disease, dyslipidemias, arterial hypertension, type 2 diabetes mellitus, nonalcoholic fatty liver disease, sleep disorders, and higher risk of COVID-19 severity. Obesity has different therapeutic approaches such as behavioral weight loss programs, pharmacologic treatments, and surgical procedures. Therefore, timely diagnosis and treatment are important to decrease the mortality in obesity among pediatric population.

La obesidad en niños y adolescentes ha aumentado exponencialmente en todo el mundo. Asimismo, la pandemia del coronavirus (COVID-19) ha conducido a una mayor tasa de obesidad pediátrica. El exceso de tejido adiposo genera una desregulación de hormonas como adiponectina, ghrelina y leptina, entre otras. Las alteraciones metabólicas pueden ocasionar enfermedad cardiovascular, dislipidemias, hipertensión arterial, diabetes mellitus tipo 2, enfermedad del hígado graso no alcohólico, trastornos del sueño y mayor riesgo de COVID-19 severo. La obesidad tiene diferentes enfoques terapéuticos, como programas conductuales de pérdida de peso, tratamientos farmacológicos y procedimientos quirúrgicos. De esta manera, el diagnóstico y el tratamiento oportuno es importante para disminuir la mortalidad asociada a la obesidad en la población pediátrica.