An Acute Infection due to Hepatitis E in the Context of a Patient with Rituximab and Methotrexate Therapy.

Background: This report presents the influence of immunosuppression by new rheumatological therapies on hepatitis E virus infection in a 54-year-old male patient with an anti-synthetase syndrome and treatment with methotrexate and rituximab. Case description: The patient arrived at the Emergency Department with epigastric pain, vomiting and dark urine. Initial examination revealed signs of inflammation and hepatic dysfunction. Subsequent laboratory tests and imaging confirmed acute hepatitis E infection in the context of recent initiation of rituximab therapy. Despite initial suspicion of pancreatitis, subsequent investigations ruled out pancreatic involvement. Treatment with ribavirin, along with supportive measures, led to significant clinical improvement with resolution of jaundice, ascites, and oedema. Conclusions: This case underscores the importance of considering hepatitis E in patients with autoimmune conditions, especially when initiating immunosuppressive therapies, a situation that is not well described in scientific literature and is increasingly common, necessitating proper recognition. LEARNING POINTS: Suspect hepatitis E virus infection in the presence of persistent liver failure of unknown cause.Recognise immunosuppression as a cause of increased risk of hepatitis E infection.Take into account the repercussions of immunosuppressive therapy such as rituximab regarding hepatitis E infections in immunocompromised patients.

Ensayo clínico comparando propofol versus propofol más midazolam en endoscopia diagnóstica en pacientes de bajo riesgo anestésico / A clinical trial comparing propofol versus propofol plus midazolam in diagnostic endoscopy of patients with a low anesthetic risk

Antecedentes y objetivos: propofol y midazolam son dos de los fármacos más utilizados en la endoscopia digestiva alta (EDA). El objetivo del estudio fue evaluar dos protocolos de sedación utilizando estos fármacos en pacientes sometidos a una EDA en términos de seguridad, eficiencia, calidad de la exploración y aceptación del paciente. Pacientes y métodos: estudio prospectivo, randomizado y a doble ciego, en el que se incluyó a 83 pacientes de 18-80 años, de bajo riesgo anestésico (ASA I-II) sometidos a EDA diagnóstica, aleatorizados a recibir propofol más placebo (grupo A) o midazolam más propofol (grupo B). Resultados: en el grupo A, 42 pacientes recibieron un bolo de placebo (suero salino) y propofol en bolos de 20 mg hasta una media de 115 mg; en el grupo B, 41 pacientes recibieron 3 mg de midazolam y bolos de 20 mg de propofol hasta una media 83 mg. No hubo diferencias significativas en los efectos adversos en ambos grupos y los que se presentaron se trataron de forma conservadora. Los pacientes en el grupo B (midazolam más propofol) alcanzaron de forma más rápida la sedación deseada sin variar el tiempo global de la exploración. La calidad en la evaluación endoscópica fue similar en ambos grupos y los pacientes se sintieron igualmente satisfechos con ambos regímenes de sedación. Conclusiones: la sedación con midazolam más propofol no afecta al tiempo global de la exploración, utiliza menos dosis de propofol, es tan segura como la administración del propofol en monoterapia, proporciona igual calidad de exploración y similar aceptación por los pacientes

Background and objectives: propofol and midazolam are two of the most commonly used sedatives in upper gastrointestinal endoscopy (UGE). The objective of this study was to evaluate these two sedation regimens administered to patients who underwent an UGE with regard to security, efficiency, quality of exploration and patient response. Patients and methods: a prospective, randomized and double-blind study was performed which included 83 patients between 18 and 80 years of age of a low anesthetic risk (ASA - American Society of Anesthesiologists- I-II) who underwent a diagnostic UGE. Patients were randomized to receive sedation with either placebo plus propofol (group A) or midazolam plus propofol (group B). Results: in group A, 42 patients received a placebo bolus (saline solution) and on average up to 115 mg of propofol in boluses of 20 mg. In group B, 41 patients received 3 mg of midazolam and an average of up to 83 mg of propofol in boluses of 20 mg. There were no significant differences in the adverse effects observed in either group and all adverse events were treated conservatively. The patients in group B (midazolam plus propofol) entered the desired sedated state more quickly with no variation in the overall time of the exploration. The quality of the endoscopic evaluation was similar in both groups and the patients were equally satisfied regardless of the sedatives they received. Conclusions: the use of midazolam plus propofol as a sedative does not affect the overall exploration time, a lower dose of propofol can be used and it is as safe as administering propofol as a monotherapy while providing the same level of both exploration quality and patient approval

A clinical trial comparing propofol versus propofol plus midazolam in diagnostic endoscopy of patients with a low anesthetic risk.

BACKGROUND AND OBJECTIVES: propofol and midazolam are two of the most commonly used sedatives in upper gastrointestinal endoscopy (UGE). The objective of this study was to evaluate these two sedation regimens administered to patients who underwent an UGE with regard to security, efficiency, quality of exploration and patient response. PATIENTS AND METHODS: a prospective, randomized and double-blind study was performed which included 83 patients between 18 and 80 years of age of a low anesthetic risk (ASA - American Society of Anesthesiologists- I-II) who underwent a diagnostic UGE. Patients were randomized to receive sedation with either placebo plus propofol (group A) or midazolam plus propofol (group B). RESULTS: in group A, 42 patients received a placebo bolus (saline solution) and on average up to 115 mg of propofol in boluses of 20 mg. In group B, 41 patients received 3 mg of midazolam and an average of up to 83 mg of propofol in boluses of 20 mg. There were no significant differences in the adverse effects observed in either group and all adverse events were treated conservatively. The patients in group B (midazolam plus propofol) entered the desired sedated state more quickly with no variation in the overall time of the exploration. The quality of the endoscopic evaluation was similar in both groups and the patients were equally satisfied regardless of the sedatives they received. CONCLUSIONS: the use of midazolam plus propofol as a sedative does not affect the overall exploration time, a lower dose of propofol can be used and it is as safe as administering propofol as a monotherapy while providing the same level of both exploration quality and patient approval.

Aneurisma intraparotídeo de vena comunicante posterior / Intraparotid aneurysm of the posterior communicating vein

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[Tuberculous arthritis of the temporomandibular joint caused by Mycobacterium bovis. A diagnostic conundrum]. / Artritis temporomandibular por Mycobacterium bovis. Un problema diagnóstico.

Infrequent variants of extrapulmonary tuberculosis pose a challenging public health problem because of the delay in their diagnosis and treatment. Joint involvement is usually encountered in major joints (hip, elbow, knee and ankle). Tuberculous involvement of the temporomandibular joint is extremely uncommon but must be considered in patients with pain, inflammation or joint stiffness not resolved with conventional treatment.

Artritis temporomandibular por Mycobacterium bovis. Un problema diagnóstico / Tuberculous arthritis of the temporomandibular joint caused by Mycobacterium bovis. A diagnostic conundrum

Las variantes infrecuentes de tuberculosis extrapulmonar son un reto de salud pública por abocar a un retraso diagnóstico-terapéutico. Las formas articulares se localizan en las grandes articulaciones (cadera, rodilla, codo, tobillo). La afectación temporomandibular es extremadamente infrecuente, pero debe ser considerada ante todo dolor, inflamación o rigidez articular que no se resuelva con tratamientos convencionales y, por tanto, ser investigada (AU)

Infrequent variants of extrapulmonary tuberculosis pose a challenging public health problem because of the delay in their diagnosis and treatment. Joint involvement is usually encountered in major joints (hip, elbow, knee and ankle). Tuberculous involvement of the temporomandibular joint is extremely uncommon but must be considered in patients with pain, inflammation or joint stiffness not resolved with conventional treatment (AU)

[Clinical study on head and neck tulareamia]. / Estudio clínico de la tularemia en cabeza y cuello.

OBJECTIVE: To perform a clinical description of head and neck tularaemia, collating the therapeutic strategies used and the most significant variables that seem to influence its evolution. MATERIAL AND METHODS: A retrospective descriptive study was performed on the series diagnosed in 2007 with involvement of the head and neck areas. For the definition of clinical cases, the recommendations of the Spanish National Centre for Epidemiological Surveillance, the European Union Network for the Surveillance and Control of Communicable Diseases and the U.S. Center for Disease Control and Prevention were followed. Basic statistics, stage, treatment carried out and evolution were noted. A descriptive statistical study as well as an analysis of the influencing variables in the clinical course of the disease and possible management are provided. RESULTS AND CONCLUSIONS: 27 patients were studied. The clinical profile of the patient type is a middle-aged individual from rural areas, with a 1:1 male/female ratio, asymptomatic but affected by growing laterocervical lymphadenopathies, often appearing in summer, and notable on palpation, without any demonstrable entranceway. However, the profile is subject to variable patterns. The suspected diagnosis was confirmed on the basis of serological determinations (93 %). Two groups were observed: one formed by those with less evident clinical manifestations and an early ganglionar stage that mostly evolved well with specific antibiotic therapy, and another one with major clinical manifestations or advanced stage in which surgical procedures were required although subsequent evolution was good. In areas of high incidence, in summer, it is a disease to be considered in the differential diagnosis of lymphadenopathy syndromes.

Estudio clínico de la tularemia en cabeza y cuello / Clinical study on head and neck tulareamia

Objetivo. Realizar una descripción clínica de la tularemia en cabeza y cuello, recoger las estrategias terapéuticas empleadas y las variables más significativas que influyen en su evolución. Material y métodos. Se realizó un estudio retrospectivo y descriptivo de nuestra serie de 2007, en la que se demostró afectación de algún área definida como otorrinolaringológica. Para la definición de caso clínico, se siguieron las recomendaciones de la Red Nacional de Vigilancia Epidemiológica, la Red de Vigilancia Epidemiológica y Control de las Enfermedades Transmisibles de la Unión Europea y en el Centro para el Control de Enfermedades de Estados Unidos. Se recogieron las variables estadísticas básicas, el estadio de enfermedad y el tratamiento realizado, así como su evolución. Se realizó un estudio estadístico descriptivo de nuestra serie y de las variables que influyeron en el curso clínico de la enfermedad y su posible tratamiento. Resultados y conclusiones. Se estudió a 27 pacientes. El paciente tipo presenta una proporción de mujer: varón de 1:1, de edad media, procedente generalmente del ámbito rural, asintomático, pero afectado de adenopatías laterocervicales de crecimiento progresivo evolucionadas, de aparición estival y sensibles a la palpación, sin puerta de entrada evidente. No obstante, el perfil está sujeto a múltiples variaciones. El diagnóstico de sospecha se confirmó mediante estudio serológico (93 %). Se demostraron dos grupos: uno con manifestaciones clínicas menores y estadio temprano, que evolucionaron bien con tratamiento antibiótico específico, y otro con estadio más avanzado en el que fueron precisos gestos intervencionistas, aunque la evolución posterior fue buena. En áreas de alta incidencia, en verano, es una enfermedad a tener muy en cuenta en el diagnóstico diferencial de síndromes adenopáticos (AU)

Objective: To perform a clinical description of head and neck tularaemia, collating the therapeutic strategies used and the most significant variables that seem to influence its evolution. Material and methods: A retrospective descriptive study was performed on the series diagnosed in 2007 with involvement of the head and neck areas. For the definition of clinical cases, the recommendations of the Spanish National Centre for Epidemiological Surveillance, the European Union Network for the Surveillance and Control of Communicable Diseases and the U.S. Center for Disease Control and Prevention were followed. Basic statistics, stage, treatment carried out and evolution were noted. A descriptive statistical study as well as an analysis of the influencing variables in the clinical course of the disease and possible management are provided.Results and conclusions: 27 patients were studied. The clinical profile of the patient type is amiddle-aged individual from rural areas, with a 1:1 male/female ratio, asymptomatic but affected by growing laterocervical lymphadenopathies, often appearing in summer, and notable on palpation, without any demonstrable entranceway. However, the profile is subject to variable patterns. The suspected diagnosis was confirmed on the basis of serological determinations (93 %). Two groups were observed: one formed by those with less evident clinical manifestations and an early ganglionar stage that mostly evolved well with specific antibiotic therapy, and another one with major clinical manifestations or advanced stage in which surgical procedures were required although subsequent evolution was good. In areas of high incidence, in summer, it is a disease to be considered in the differential diagnosis of lymphadenopathy syndromes (AU)

Quiste tirogloso basilingual: causa infrecuente de disfagia y disnea / Basilingual thyroglossal cyst: an infrequent cause of Dysphagia and dyspnoea

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