ABSTRACT
El uso diagnóstico y terapéutico de la broncoscopia flexible (BF) ha tenido una gran evolución desde que Gustav Killian realizó en 1897 la primera endoscopia traqueal para extraer un cuerpo extraño1. Con el pasar de los años se ha demostrado que es un procedimiento seguro2 con una mortalidad escasa (< 0.1%) siendo sus complicaciones infrecuentes y derivadas principalmente del tipo de técnica, de las propias comorbilidades del paciente y de la sedación3. Dentro de las complicaciones infrecuentes podemos mencionar el neumomediastino y el neumoperitoneo que generalmente se deben a la presencia de una ruptura gástrica. Presentamos el caso de un paciente de 58 años que 15 días tras la realización de una BF, presenta el hallazgo incidental de un neumoperitoneo asintomático sin evidencia de lesión gástrica (AU)
The diagnostic and therapeutic use of flexible bronchoscopy has evolved greatly since Gustav Killian performed the first tracheal endoscopy in 1897 to remove a foreign body. Over the years it has been shown that it is a safe procedure with low mortality (< 0.1%), with a small rate of complications which are mainly due to the type of technique, the patients own comorbidities and sedation. Among the infrequent complications we can mention pneumomediastinum and pneumoperitoneum, which are generally due to the presence of a gastric rupture. We present the case of a 58-year-old patient who, 15 days after performing a flexible bronchoscopy, presented an incidental asymptomatic pneumoperitoneum with no evidence of gastric lesion (AU)
Subject(s)
Humans , Male , Middle Aged , Pneumoperitoneum/etiology , Bronchoscopy/adverse effects , Bronchoscopy/methods , Pneumoperitoneum/diagnostic imagingABSTRACT
La infección por el nuevo coronavirus (SARS-CoV2) tuvo un tratamiento debatido debido a la incógnita sobre su patogenia,que con el pasar del tiempo se aclaró evidenciándose un componente inflamatorio, siendo la corticoterapia una opciónterapéutica. En pacientes con corticoides es primordial conocer las posibles reacciones colaterales por su efecto inmuno-supresor. Presentamos el caso de un varón de origen ecuatoriano, de 48 años, que tras infección por SARS-CoV-2 tratadacon corticoides presentó exantema serpiginoso que tras serología para Strongyloides stercoralis se confirmó el diagnósticode larva currens.(AU)
The infection by the new coronavirus (SARS-CoV-2) had in its beginnings a debated treatment, due to the unknown aboutits pathogenesis, which with the passage of time was clarified evidencing an inflammatory component. Corticosteroid the-rapy showed as a therapeutic option. In patients with corticosteroids it is essential to know the possible side reactions dueto their immunosuppressive effect. We present the case of a 48-year-old male from Ecuador, who after infection by SARS-CoV-2 treated with corticosteroids, suffering as a complication the appearance of a serpiginous rash in the lumbar region.Due to its migratory history, serology for Strongyloides stercoralis, the diagnosis of currens larva was confirmed.(AU)
Subject(s)
Humans , Male , Middle Aged , Pandemics , Severe acute respiratory syndrome-related coronavirus , Coronavirus Infections/epidemiology , Strongyloides stercoralis , Inpatients , Physical Examination , Communicable Diseases , Respiratory Tract DiseasesABSTRACT
The Hernansky-Pudlak syndrome (HPS) is a rare genetic disorder. We report three cases from a family of 12 siblings, with six albinos, of whom four and the father had pulmonary fibrosis (PF). Case 1 was admitted to our hospital due to increasing dyspnoea and history of gynaecological bleeding. Pulmonary function test showed a restrictive airflow pattern, high-resolution computed tomographic scan demonstrated interstitial lung disease (ILD), and platelet aggregation was compromised with a reduced number of platelet dense bodies. The family history revealed endogamy and 11 members with suspected HPS. One of the albino sisters and the father had passed away with unidentified ILD, an albino brother died 14 years earlier, his autopsy had shown collections of ceroid pigments in the lungs, consistent with HPS, and another brother was followed up at our hospital for ILD and compromised platelet aggregation. This family probably has the highest number of members affected by HPS in Spain.
ABSTRACT
Introduction: Non-invasive respiratory therapies (NRT) were widely used in the first wave of the COVID-19 pandemic in different settings, depending on availability. The objective of our study was to present 90-day survival and associated factors in patients treated with NRT in a tertiary hospital without an Intermediate Respiratory Care Unit. The secondary objective was to compare the outcomes of the different therapies. Methods: Observational study of patients treated with NRT outside of an intensive care or intermediate respiratory care unit setting, diagnosed with COVID-19 and acute respiratory distress syndrome by radiological criteria and SpO2/FiO2 ratio. A multivariate logistic regression model was developed to determine independently associated variables, and the outcomes of high flow nasal cannula and continuous positive airway pressure were compared. Results: In total, 107 patients were treated and 85 (79.4%) survived at 90 days. Before starting NRT, the mean SpO2/FiO2 ratio was 119.8 ± 59.4. A higher SOFA score was significantly associated with mortality (OR 2,09; 95% CI 1.34-3.27), while self-pronation was a protective factor (OR 0.23; 95% CI 0.06-0.91). High flow nasal cannula was used in 63 subjects (58.9%), and continuous positive airway pressure in 41 (38.3%), with no differences between them. Conclusion: Approximately 4 out of 5 patients treated with NRT survived to 90 days, and no significant differences were found between high flow nasal cannula and continuous positive airway pressure.
