Spinal Cord Stimulation: Viable Therapeutic Option for Postlaminectomy Syndrome in Elderly Patients.

We present a 76-year-old man with chronic back pain refractory to treatment secondary to spinal trauma from a motor vehicle accident 34 years ago. After trauma, multiple interventions were performed due to spinal instability. The patient was diagnosed with the postlaminectomy syndrome. Multimodal analgesia management failed to control our patient's pain, severely affecting our patient and his family's quality of life. For these reasons, a spinal cord stimulator was implanted despite our patient age. After four months, our patient presented with significant improvement in his life quality.

Spinal cord stimulator for neuropathic pain in a patient with severe disability due to transverse myelitis.

Transverse myelitis is an inflammatory disease of the central nervous system that disrupts nerve signals' conduction. The illness is characterised by weakness in the lower limbs accompanied by paresthesia and urinary and bowel incontinence. The most disabling sequel is the onset of chronic neuropathic pain, which can severely limit the patient's independence and negatively affect her quality of life. We present the case of a patient who received a spinal neurostimulator after a failure of conventional medical treatment. Masking pain through paresthesia, a mechanism provided by the device significantly reduces pain perception. The treatment success in our patient represents an advance in pain therapy.

Decreased Mortality in Patients With Severe Bronchospasm Associated With SARS-CoV-2: An Alternative to Invasive Mechanical Ventilation.

The number of patients with acute episodes of severe bronchospasm needing intubation and ventilatory support has increased rapidly during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) coronavirus disease 2019 (COVID-19) pandemic. Although medical consensus upholds the use of ventilatory support in this pathology, its survival benefits remain unclear. To improve the outcomes and survival rates, a bundle of early respiratory therapy with a pharmacological rescue regimen was provided to four patients with bronchospasm secondary to COVID-19. This therapeutic approach successfully delayed the need for invasive mechanical ventilation for 48 hours and decreased the mortality rate in all cases.

Atypical Obstructive Pseudotumors in AIDS as the Initial Manifestation of Gastrointestinal Histoplasmosis.

Histoplasma capsulatum is a dysmorphic fungus distributed worldwide commonly associated with pulmonary histoplasmosis. We report the case of an unusual presentation of gastrointestinal histoplasmosis leading to the obstruction of the intestinal lumen in a 30-year-old female, HIV positive, admitted to the hospital due to chronic abdominal pain and constipation. An initial abdominal CT revealed a mass in the sigmoid colon. A further colonoscopy showed an infiltrating, friable mass obstructing 80% of the lumen staining positive for H. capsulatum. The unspecific nature of the patient's symptoms along with the unusual presentation of the infection raises awareness about the importance of including new pathologies to differential diagnoses when treating AIDS patients.

Perspective from Ecuador, the Second Country with More Confirmed Cases of Coronavirus Disease 2019 in South America: A Review.

To face the pandemic outbreak of a novel coronavirus many countries developed a series of containment methods; however, developing countries in South America had reacted apathetically to this worldwide concern. Ecuador's response to the novel virus Coronavirus Disease 2019 (COVID-19) started on February 26, 2020, one month after the outbreak began in China. As of today, the countries with more confirmed cases in South America are Brazil and Ecuador. Although Brazil has two times the number of cases than Ecuador (Brazil: 700 cases per 100000 people vs. Ecuador: 400 cases per 100000), the huge population difference between the two countries raises concerns about the public health policies implemented by the Ecuadorian government. Even though there is no cure for COVID-19, chloroquine and hydroxychloroquine are promising alternatives. The COVID-19 pandemic outbreak has shown that there is room for improvement in the healthcare systems worldwide and the disastrous results on the fragile often unprepared are those systems in developing countries.

Gastrointestinal Cryptococcosis Associated with Intestinal Lymphangiectasia.

Intestinal lymphangiectasia is a pathological dilation of enteric lymphatic vessels resulting in lymph leakage to the intestinal lumen. This chronic lymph leakage leads to a state of immunosuppression secondary to the loss of humoral and cellular components of the immune system and represents a potential risk factor for opportunistic infections. We report a case of protein-losing enteropathy in a seemingly immunocompetent patient. An intestinal histopathological study revealed the unusual association of lymphangiectasia and intestinal cryptococcosis. Although cryptococcal infection is common in immunocompromised patients, intestinal involvement is rarely reported. We found no reports on the association of intestinal cryptococcosis in patients with lymphangiectasia. This case report is the first to describe intestinal cryptococcosis associated with intestinal lymphangiectasia.

Alveolar Hemorrhage, a Rare and Life-Threatening Complication of Catastrophic Antiphospholipid Syndrome.

Alveolar hemorrhage is the rarest pulmonary complication of catastrophic antiphospholipid syndrome and is associated with high mortality risk. This life-threatening complication results from autoimmune damage to the alveolar blood vessels. Given the limited literature addressing the association of these two pathologies, we report a series of three cases with this complication and then compare our findings with 6 cases reported in the literature.