Fever of unknown origin: A 12-year case series in Colombia.

BACKGROUND: Fever of unknown origin (FUO) is a diagnostic challenge with highly heterogeneous causes. Its etiology can change according to the studied regions, and the chance of reaching a diagnosis depends on available resources. The aim of this study is to describe the clinical characteristics, etiology and the usefulness of diagnostic aids in cases of FUO managed over 12 years in a Colombian reference center. METHODOLOGY: Single-institution retrospective case series. All cases of FUO between 2006 and 2017 were identified with the help of an electronic medical record search software. Cases of adults with fever for more than three weeks who remained undiagnosed after three days of hospitalization are described. RESULTS: Of 1,009 cases evaluated, 112 cases met the inclusion criteria (median age 43 years, 66% men). The etiologies identified were infectious (31.2%), inflammatory (20.5%), neoplastic (14.3%), and miscellaneous (2.7%) diseases. 31.2% remained without etiological diagnosis. The most frequent conditions were tuberculosis (17%), Hodgkin's lymphoma (7.1%), systemic lupus erythematosus (6.3%), disseminated histoplasmosis, and adult Still's disease. Contrast tomography and biopsies were the studies that most frequently supported or confirmed the final diagnosis. CONCLUSIONS: This series of contemporary Latin American cases suggests that the categories of FUO etiologies are similar to those reported in studies from developed countries, with tuberculosis being the most frequent cause in our setting. Our results highlight the importance of tomography-guided invasive studies in the diagnostic approach to FUO.

Dispositivos para generación de discurso y fundamentos conceptuales del trabajo infantil / Mechanisms for the generation of discourses and fundamental concepts of child work / Dispositivos para geração de discurso e fundamentos conceituais do trabalho infantil

En este avance de investigación proponemos una metodología para el trabajo con niños y niñas, basada en dos dispositivos para la generación de discurso por medio de la actividad lúdica: un dispositivo destinado a la identificación de las dinámicas relacionales en el contexto de la familia, y otro orientado al reconocimiento de las formas en que se reproducen estas dinámicas en el entorno escolar. Igualmente presentamos las categorías analíticas que han servido para definir la situación de la infancia trabajadora, a partir de la identificación de temas centrales en el discurso de revistas especializadas sobre el tema, desplegando estas categorías como los fundamentos hermenéuticos que permitirán identificar a los niños y niñas como actores sociales productivos, y como ciudadanos y ciudadanas con derechos y deberes que demandan ser respetados.

This in-progress research study proposes a methodology for child work, based on two mechanisms for the generation of discourses through ludic activities. The first aims to identify relational dynamics in the family context; the second has the objective of recognizing the ways in which these dynamics are developed in the school environment. This article also presents the analytical categories that have been used to define the situation of the working children, based on the identification of the main topics used in literature from specialized journals. These categories are deployed as hermeneutical principles that will allow for the identification of children as social and productive actors and as citizens with rights and duties that demand to be respected.

Esta investigação propõe uma metodologia para o trabalho com a infância, baseada em dois dispositivos pra geração de discurso por meio da atividade lúdica. Um destinado à identificação das dinâmicas relacionais no contexto da família, outro em relação ao reconhecimento das formas em que se reproduzem estas dinâmicas no âmbito da escola. Igualmente se apresentam as categorias analíticas que servem pra definir a situação da infância trabalhadora, a partir de identificação dos temas centrais no discurso de visitas especializadas no tema, despregando estas categorias como fundamentos hermenêuticos que permitam identificar aos infantes como atores sociais produtivos e como cidadãos com direitos e deveres que pedem ser respeitados.

Tos ferina neonatal, una enfermedad emergente / Newborn pertussis: a re-emergent disease

La tos ferina es una enfermedad del tracto respiratorio superior que ha incrementado últimamente su incidencia. Se ha demostrado que los adultos son la principal fuente de transmisión para los niños susceptibles. En la actualidad, la enfermedad afecta con más frecuencia a los niños menores de 3 meses, entre los cuales, los menores de 1 mes tienen mayor riesgo de complicaciones y letalidad. Se presenta un caso autóctono de una recién nacida de 16 días con episodios de tos quintosa, cianosante y emetizante, cuadro hemático que evidencia leucocitosis y linfocitosis, que se originó en un área donde está implementada, como política de salud pública, la vacunación para tos ferina en niños. La paciente tuvo una evolución tórpida complicada con convulsiones y necesidad de ventilación mecánica. Se identificó en la paciente Bordetella pertussis por inmunofluorescencia, reacción en cadena de la polimerasa y cultivo. Se hace una breve revisión de la literatura, haciendo énfasis en el panorama actual de la vacunación en neonatos.

Neonatal pertussis is an upper respiratory tract infection whose incidence has recently increased. Adults have been demonstrated to be the main source for neonatal infection, accounting for the rising rates of disease in this later population group. Currently, the disease affects chiefly infants under three months of age, among which, those younger than one moth have the highest rates of complication and death. Here we present an indigenous case of a 16 days old newborn that arose in an area where pertussis vaccination during the first months of life is the rule and very few cases had been documented throughout the last years. The patient presented whooping cough with cyanosis and emesis episodes, whose complete blood count showed markedly and increasingly high leukocytosis and lymphocytosis. Her clinical course complicated with seizures and required mechanical ventilation. B. pertussis was demonstrated by means of immunofluorescence, polymerase chain reaction and culture. A brief literature review is made with emphasis on current landmarks on pertussis vaccination.

Disfagia lusoria: Reporte de un caso y revisión de literatura / Dysphagia lusoria: A case report and review of the literature

La compresión extrínseca del esófago por estructuras vasculares es una causa poco frecuente de disfagia; sin embargo, su diagnóstico es de gran importancia para ofrecer un adecuado manejo y disminuir la repercusión sobre la calidad de vida de los pacientes. Se presenta un caso ilustrativo de disfagia lusoria y posteriormente una revisión sobre su etiología, enfoque diagnóstico y manejo.

Extrinsic esophagus compression produced by vascular structures is a rare cause of dysphagia. Nevertheless, its diagnosis is critical to allow an appropriate management and to lower the impact on the patients’ quality of life. Here, an illustrative case of dysphagia lusoria is presented followed by a review of its etiology, diagnosis approach and its treatment.