Segmental Clavicle Fracture in a Polytraumatized Patient: Case Report.

Clavicle fracture represents 5% of the fractures in adults. However, segmental clavicle fractures are infrequent and have been understudied in the current literature. Cases have been reported showing adequate results with both surgical and conservative management, and yet, it has not been possible to reach a consensus regarding diagnosis or management of such condition. A patient with a middle and lateral segmental clavicle fracture is reported, after presenting multiple trauma in a road traffic accident, also suffering trauma to the right hemi body, multiple rib segmental fractures and hemothorax. After stabilization, he was taken to surgery for open reduction and internal fixation of the clavicle using a double plate technique, as it has been rarely described in the literature. The functional result was shown to be adequate and satisfactory in the postoperative follow-up. Despite the limited evidence available on the management of this type of pathology, surgical management is a valid option given the risk of non-union. The foregoing is concluded by the potential harm in patient functionality.

Segmental Clavicle Fracture in a Polytraumatized Patient: Case Report / Fratura segmentar da clavícula em paciente politraumatizado: Relato de caso

Abstract Clavicle fracture represents 5% of the fractures in adults. However, segmental clavicle fractures are infrequent and have been understudied in the current literature. Cases have been reported showing adequate results with both surgical and conservative management, and yet, it has not been possible to reach a consensus regarding diagnosis or management of such condition. A patient with a middle and lateral segmental clavicle fracture is reported, after presenting multiple trauma in a road traffic accident, also suffering trauma to the right hemi body, multiple rib segmental fractures and hemothorax. After stabilization, he was taken to surgery for open reduction and internal fixation of the clavicle using a double plate technique, as it has been rarely described in the literature. The functional result was shown to be adequate and satisfactory in the postoperative follow-up. Despite the limited evidence available on the management of this type of pathology, surgical management is a valid option given the risk of non-union. The foregoing is concluded by the potential harm in patient functionality.

Resumo A fratura de clavícula representa 5% das fraturas em adultos. No entanto, as fraturas segmentares da clavícula são infrequentes e pouco estudadas na literatura atual. Há relatos de casos com bons resultados após o tratamento cirúrgico ou conservador, mas não existe consenso quanto ao diagnóstico ou manejo dessas lesões. Relata-se um paciente com fratura segmentar média e lateral da clavícula após politraumatismo em acidente de trânsito. O paciente também apresentava traumatismo em hemicorpo direito, múltiplas fraturas segmentares da costela e do hemotórax. Após estabilização, ele foi encaminhado à cirurgia para redução aberta e fixação interna da clavícula pela técnica de placa dupla, raramente descrita na literatura. O resultado funcional foi considerado satisfatório e adequado no acompanhamento pós-operatório. Apesar das poucas evidências sobre o manejo desse tipo de patologia, o tratamento cirúrgico é uma opção válida devido ao risco de não união, apesar da possível diminuição da funcionalidade do paciente.

Caso Clínico: Discinesia Ciliar Primaria (Síndrome de Kartagener) / Clinical Case Report: Primary Ciliary Dyskinesia (Kartagener's Syndrom

INTRODUCCIÓN: La discinesia ciliar primaria es un trastorno hereditario autosómico recesivo, que afecta la función de las células ciliadas y se caracteriza por infecciones respiratorias a repetición y afecta tanto al tracto respiratorio superior e inferior, puede asociarse con trastornos de la lateralidad orgánica (síndrome de Kartagener), infertilidad y en algunos casos malformaciones. No existe un tratamiento específico; sin embargo, se tratan las infecciones agudas y se realiza seguimiento de la función pulmonar como en el caso clínico que se presenta a continuación. CASO CLÍNICO: Se trata de una mujer de 28 años, con antecedentes de dextrocardia, sinusitis, otitis, bronquitis y neumonías a repetición, asmática, con rinorrea mucoide crónica, que acudió por cuadro persistente de tos productiva y disnea de moderados esfuerzos. Al examen físico destacó: saturación de 80% con FIO2: 21%, cianosis discreta, ruidos cardiacos audibles en hemitórax derecho con reforzamiento del segundo ruido, estertores difusos y frémito aumentado. En la espirometría se detectó patrón obstructivo ­ restrictivo severo, la tomografía demostró la presencia de sinusitis maxilar y esfenoidal, dextrocardia, bronquiectasias e infiltrados difusos, poliesplenia, hepatomegalia e hígado en herradura. Se diagnosticó de síndrome de Kartagener (por dextrocardia, sinusitis y bronquiectasias). EVOLUCIÓN: Durante la estancia hospitalaria la paciente permaneció sin requerimientos de oxígeno suplementario y afebril. Recibió tratamiento antibiótico, corticoides inhalatorios y salbutamol. Se explicó a la paciente y sus familiares la benignidad de la enfermedad y el requerimiento de controles rigurosos por consulta externa. El diagnóstico definitivo por microscopía electrónica no fue realizado por falta de recursos a nivel local. CONCLUSIÓN: La discinesia ciliar primaria por lo general tiene un curso evolutivo de carácter benigno, al ser una enfermedad poco conocida su diagnóstico es tardío. La discinesia ciliar primaria debe ser considera dentro de los diagnósticos diferenciales de un paciente que presenta infecciones respiratorias a repetición.(au)

BACKGROUND: Primary ciliary dyskinesia is an inherited autosomal recessive disorder, which affects the function of ciliated cells and is characterized by recurrent upper and lower respiratory infections. It may be associated with organic laterality disorders (Kartagener syndrome), infertility and in some cases malformations. There is no specific treatment; however, acute infections management and pulmonary function surveillance is recommended, as presented in the case report. CASE REPORT: 28-year-old woman with a history of dextrocardia, sinusitis, otitis, bronchitis and recurrent pneumonia, asthmatic, with chronic mucoid rhinorrhea and recurrent episodes of productive cough and dyspnea. Physical examination revealed an oxygen saturation of 80% at room air, discrete cyanosis, and audible cardiac sounds in the right hemithorax with reinforcement of the second noise, diffuse rales and increased thrill. Pulmonary function test was positive for a severe obstructive - restrictive pattern, computed tomography revealed the presence of maxillary and sphenoid sinusitis, dextrocardia, bronchiectasis, polysplenia hepatomegaly and horseshoe liver. The diagnosis of Kartagener syndrome was made (due to dextrocardia, sinusitis and bronchiectasis). EVOLUTION: During the hospital stay the patient remained without oxygen requirements, she received antibiotic treatment plus corticosteroids and salbutamol. Patient education was carried out, indicating the benignity of the disease and the requirement of close monitoring. Definitive diagnosis by electron microscopy was not available. CONCLUSION: Primary ciliary dyskinesia usually has a benign course of evolution; being an uncommon disease, diagnosis is usually late. Primary ciliary dyskinesia should be considered within the differential diagnosis of patients with recurrent respiratory infection(au)

Coexistencia de micosis pulmonar mixta en paciente inmunocompetente. Primer re-porte de caso, revisión y actualidad / Mixed pulmonary mycosis coexistence in immuno-competent patient. First case report, review and cur-rent affair

La micosis pulmonar mixta es una entidad muy poco común, aún más en pacientes sin inmunodepresión, a continuación, se exponen los hallazgos epidemiológicos y clínicos que explican la masiva invasión micótica en un estado inmune normal. Resumen del Caso: Se trata de una paciente femenina, adulta, sin antecedentes médicos de importancia, que debuta con cuadro de insuficiencia respiratoria aguda y hemoptisis, la evidencia imagenológica y microbiológica permitió el diagnóstico de aspergilosis pulmonar angio-invasiva coexistente con candidiasis pulmonar; se empleó terapia anti fúngica solucionando así la infección. Conclusión: Una micosis pulmonar mixta depende de la exposición de la fuente de infección y puede coexistir en inmunocompetencia gracias a la acción exfoliativa de los patógenos y los sustratos que el huésped produzca.

Mixed pulmonary mycosis is a very rare entity, even more so in patients without immunosuppression, then the epidemiological and clinical findings explain the massive mycotic invasion in a normal immune state. Case Summary: This case is about a female patient, adult, with medical background, who debuted with acute respiratory failure and hemoptysis, the imaging and microbiological evidence allowed the diagnosis of pulmonary angio-invasive aspergillosis coexisting with pulmonary candidiasis; Antifungal therapy was used to solve the infection Conclusion: A mixed pulmonary mycosis depends on the exposure of the source of infection and can coexist in immunocompetence due to the exfoliative action of the pathogens and the substrates that the host produces.

[Clinical management of child and adolescent psychiatric emergencies in patients with substance abuse disorders]. / Manejo de las urgencias psiquiátricas en población infantojuvenil con consumo de sustancias psicoactivas.

This paper addresses the problem of substance abuse disorders in child and adolescent patients within its frequent psychiatric emergency setting. It describes the clinical features that defne the high complexity of these cases, the current state of knowledge regarding clinical management of child and adolescent psychiatric emergencies in patients with substance abuse disorders, and the available treatment strategies in the metropolitan area of Buenos Aires, Argentina. Finally, this article delves into the existence of a metropolitan addiction treatment network, its community outreach and the obstacles it has to conquer in order to attain the international standards for the treatment of substance abuse disorders.

Evidence of suppression of onchocerciasis transmission in the Venezuelan Amazonian focus.

BACKGROUND: The World Health Organization (WHO) has set goals for onchocerciasis elimination in Latin America by 2015. Most of the six previously endemic countries are attaining this goal by implementing twice a year (and in some foci, quarterly) mass ivermectin (Mectizan®) distribution. Elimination of transmission has been verified in Colombia, Ecuador and Mexico. Challenges remain in the Amazonian focus straddling Venezuela and Brazil, where the disease affects the hard-to-reach Yanomami indigenous population. We provide evidence of suppression of Onchocerca volvulus transmission by Simulium guianense s.l. in 16 previously hyperendemic Yanomami communities in southern Venezuela after 15 years of 6-monthly and 5 years of 3-monthly mass ivermectin treatment. METHODS: Baseline and monitoring and evaluation parasitological, ophthalmological, entomological and serological surveys were conducted in selected sentinel and extra-sentinel communities of the focus throughout the implementation of the programme. RESULTS: From 2010 to 2012-2015, clinico-parasitological surveys indicate a substantial decrease in skin microfilarial prevalence and intensity of infection; accompanied by no evidence (or very low prevalence and intensity) of ocular microfilariae in the examined population. Of a total of 51,341 S. guianense flies tested by PCR none had L3 infection (heads only). Prevalence of infective flies and seasonal transmission potentials in 2012-2013 were, respectively, under 1% and 20 L3/person/transmission season. Serology in children aged 1-10 years demonstrated that although 26 out of 396 (7%) individuals still had Ov-16 antibodies, only 4/218 (2%) seropositives were aged 1-5 years. CONCLUSIONS: We report evidence of recent transmission and morbidity suppression in some communities of the focus representing 75% of the Yanomami population and 70% of all known communities. We conclude that onchocerciasis transmission could be feasibly interrupted in the Venezuelan Amazonian focus.

Evaluacion del ffecto de la magnetoterapia, la lectroterapia y los ejercicios del suelo pelvico como tratamiento rehabilitador en la incotinencia uiinaria / Evaluation of the magnetotherapy effect and the pelvis floor excercises as a rehabilitator treatment in urinary incontinente

La incontinencia urinaria tiene elevada prevalencia, preferentemente en mujeres, afectando la vida personal y social de los enfermos. Evaluamos el impacto del tratamiento rehabilitador del suelo pélvico sobre síntomas y signos de incontinencia en 28 pacientes, 25 mujeres y 3 hombres con edades promedio de 53.9 y 66.6 años En las mujeres predominó la incontinencia asociada a otras patologías del suelo pélvico, seguida por la mixta y en los hombres la secundaria a prostatectomía. Evaluamos la incontinencia al inicio y evolutivamente mediante historia clínica, necesidad de uso de colectores, prueba decompresa y diario miccional. Aplicamosmagnetoterapia en región pélvica, electroterapia estimuladora de musculatura perineal y ejercicios para fortalecimiento muscular pélvico sola o combinada. Once pacientes abandonaron el tratamiento, 53% curaron, 29% tuvieron mejoría notable y 18% mantienen el tratamiento. Concluimos que la rehabilitación del suelo pélvico constituye una terapia útil y definitiva para curar o mejorar la incontinencia urinaria.

The urinary incontinence has high prevalence preferably among women, We evaluated the impact of rehabilitative treatment of pelvic floor in symptoms and signs of incontinence in 28 patients 25 women with age average 53,9 years and 3 masculine with age average 66,6 years. We applied them rehabilitative treatment that included Magnetoteraphy, stimulate electrotherapy to the perineal musculature and pelvic exercises, alone or in combination. Principal results: the urinary incontinence prevailed as diagnosis, in the feminine sex, associated with other pelvic pathologies, followed mixed incontinence and men secundary toprostatectomy. Eleven patients leave treatment, 53% cure, 29% improvement and 18% are still in treatment. We conclude that remarkable improvement the symptoms evidenced benefits of rehabilitative treatment of pelvic floor for urinary incontinente.

Evaluación del efecto de la magnetoterapia, la electroterapia y los ejercicios del suelo pélvico como tratamiento rehabilitador en la incontinencia urinaria / Evaluation of the magnetotherapy effect and the pelvis floor excercises as a rehabilitator treatment in urinary incontinence

La incontinencia urinaria tiene elevada prevalencia, preferentemente en mujeres, afectando la vida personal y social de los enfermos. Evaluamos el impacto del tratamiento rehabilitador del suelo pélvico sobre síntomas y signos de incontinencia en 28 pacientes, 25 mujeres y 3 hombres con edades promedio de 53.9 y 66.6 años En las mujeres predominó la incontinencia asociada a otras patologías del suelo pélvico, seguida por la mixta y en los hombres la secundaria a prostatectomía. Evaluamos la incontinencia al inicio y evolutivamente mediante historia clínica, necesidad de uso de colectores, prueba decompresa y diario miccional. Aplicamos magnetoterapia en región pélvica, electroterapia estimuladora de musculatura perineal y ejercicios para fortalecimiento muscular pélvico sola o combinada. Once pacientes abandonaron el tratamiento, 53 por ciento curaron, 29 por ciento tuvieron mejoría notable y 18 por ciento mantienen el tratamiento. Concluimos que la rehabilitación del suelo pélvico constituye una terapia útil y definitiva para curar o mejorar la incontinencia urinaria(AU)

The urinary incontinence has high prevalence preferably among women, We evaluated the impact of rehabilitative treatment of pelvic floor in symptoms and signs of incontinence in 28 patients 25 women with age average 53,9 years and 3 masculine with age average 66,6 years. We applied them rehabilitative treatment that included Magnetoteraphy, stimulate electrotherapy to the perineal musculature and pelvic exercises, alone or in combination. Principal results: the urinary incontinence prevailed as diagnosis, in the feminine sex, associated with other pelvic pathologies, followed mixed incontinence and men secundary toprostatectomy. Eleven patients leave treatment, 53 percent cure, 29 percent improvement and 18 percent are still in treatment. We conclude that remarkable improvement the symptoms evidenced benefits of rehabilitative treatment of pelvic floor for urinary incontinence(AU)