ABSTRACT
Pneumomediastinum is a rare complication of substance use, likely due to a Valsalva maneuver after drug inhalation. There are no previously documented associations between pneumomediastinum and opioid use. A 30-year-old man with a history of recent heroin and fentanyl inhalation presented to the emergency department in respiratory distress requiring intubation. His course was complicated by pneumomediastinum which subsequently developed tension physiology. He required emergent surgical decompression with a "blowhole incision" to his anterior chest. Although a rare complication of polysubstance use, pneumomediastinum can progress to tension physiology, requiring prompt diagnosis and management.
Subject(s)
Heroin Dependence , Mediastinal Emphysema , Administration, Inhalation , Adult , Dyspnea/complications , Fentanyl , Humans , Male , Mediastinal Emphysema/chemically induced , Mediastinal Emphysema/diagnostic imaging , Valsalva ManeuverABSTRACT
BACKGROUND: Eagle syndrome is an uncommon condition, characterized by alteration in the stylomastoid process and sometimes a complete calcification of the stylohyoid ligament. OBJECTIVE: To report the relevance of a timely diagnosis and treatment options. CASE REPORT: 53-year-old female, present symptoms, characterized by occipital headache and neck pain and dysphagia with one-year evolution, through studies Imaging and clinical, the diagnosis of eagle syndrome was obtained, which is treated by surgical transoral approach. CONCLUSIONS: Eagle syndrome consists of nonspecific clinical signs, so it is important to understand the diagnostic evaluation, and the variety of treatment options.
ANTECEDENTES: El síndrome de Eagle es una condición poco común caracterizada por una alteración en la apófisis estilomastoides o una calcificación completa del ligamento estilohioideo. OBJETIVO: Reportar la relevancia de un diagnóstico oportuno y las opciones de tratamiento. CASO CLÍNICO: Mujer de 53 años con síntomas de cefalea occipital, dolor cervical y disfagia con 1 año de evolución. Por medio de imagenología y la clínica se establece el diagnóstico de síndrome de Eagle, que fue tratado con un abordaje transoral. CONCLUSIONES: El síndrome de Eagle consta de signos clínicos inespecíficos, por lo que es importante comprender la evaluación diagnóstica y la variedad de opciones de tratamiento.
Subject(s)
Ossification, Heterotopic , Tomography, X-Ray Computed , Female , Humans , Middle Aged , Neck Pain/etiology , Ossification, Heterotopic/diagnosis , Ossification, Heterotopic/surgery , Temporal Bone/abnormalities , Temporal Bone/diagnostic imaging , Temporal Bone/surgeryABSTRACT
BACKGROUND: Mucormycosis is a rare, invasive disease associated with high mortality rates, produced by opportunistic pathogens related to the Mucorales order and characterised by a diverse range of clinical forms; acute rhino-orbital-cerebral and pulmonary symptoms are the most reported ones. OBJECTIVES: To report the experience of mucormycosis observed in a tertiary-care hospital in Mexico for 35 years. METHODS: This was a retrospective, descriptive and observational study on mucormycosis at a tertiary-care hospital in Mexico from January 1985 to December 2019. Demographic and clinical data and mycological and histopathological records were selected. RESULTS: Two hundred fourteen proven cases of mucormycosis for 35 years at a tertiary-care hospital in Mexico were included. Most of the cases were male patients with a median age of 45 years. The two most associated underlying diseases were diabetes mellitus (76.6%) and haematologic malignancy (15.4%). The three primary clinical forms were as follows: rhino-orbito-cerebral (75.9%), cutaneous (8.41%) and pulmonary (7.47%) mucormycosis. The most isolated agents were Rhizopus arrhizus (58.4%) and Lichtheimia corymbifera (12.3%). The overall therapeutic response was 58.5%, and the best response was observed with amphotericin B deoxycholate and surgical debridement. CONCLUSION: Mucormycosis is an emerging disease, and its incidence has increased at our hospital over the years. In this study, the rhino-cerebral clinical type was the most frequent in patients with uncontrolled diabetes; the main aetiological agent was R. arrhizus. Early diagnosis, control of the underlying disease and prompt management may increase the survival rate.
Subject(s)
Mucormycosis/epidemiology , Mucormycosis/mortality , Tertiary Care Centers/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , Amphotericin B/therapeutic use , Antifungal Agents/therapeutic use , Child , Child, Preschool , Deoxycholic Acid/therapeutic use , Drug Combinations , Female , Humans , Infant , Infant, Newborn , Male , Medical Records , Mexico/epidemiology , Middle Aged , Mucorales/genetics , Mucorales/pathogenicity , Mucormycosis/drug therapy , Retrospective Studies , Time Factors , Young AdultABSTRACT
SARS-CoV-2, the virus responsible for COVID-19, causes widespread damage in the lungs in the setting of an overzealous immune response whose origin remains unclear. We present a scalable, propagable, personalized, cost-effective adult stem cell-derived human lung organoid model that is complete with both proximal and distal airway epithelia. Monolayers derived from adult lung organoids (ALOs), primary airway cells, or hiPSC-derived alveolar type-II (AT2) pneumocytes were infected with SARS-CoV-2 to create in vitro lung models of COVID-19. Infected ALO-monolayers best recapitulated the transcriptomic signatures in diverse cohorts of COVID-19 patient-derived respiratory samples. The airway (proximal) cells were critical for sustained viral infection, whereas distal alveolar differentiation (AT2[->]AT1) was critical for mounting the overzealous host immune response in fatal disease; ALO monolayers with well-mixed proximodistal airway components recapitulated both. Findings validate a human lung model of COVID-19, which can be immediately utilized to investigate COVID-19 pathogenesis and vet new therapies and vaccines. GRAPHIC ABSTRACT O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=176 SRC="FIGDIR/small/344002v4_ufig1.gif" ALT="Figure 1"> View larger version (52K): org.highwire.dtl.DTLVardef@1d1507aorg.highwire.dtl.DTLVardef@faa17forg.highwire.dtl.DTLVardef@80ceb1org.highwire.dtl.DTLVardef@81d61c_HPS_FORMAT_FIGEXP M_FIG C_FIG HIGHLIGHTSO_LIHuman lung organoids with mixed proximodistal epithelia are created C_LIO_LIProximal airway cells are critical for viral infectivity C_LIO_LIDistal alveolar cells are important for emulating host response C_LIO_LIBoth are required for the overzealous response in severe COVID-19 C_LI IN BRIEFAn integrated stem cell-based disease modeling and computational approach demonstrate how both proximal airway epithelium is critical for SARS-CoV-2 infectivity, but distal differentiation of alveolar pneumocytes is critical for simulating the overzealous host response in fatal COVID-19.
ABSTRACT
No disponible
Subject(s)
Humans , Male , Adult , Carcinoma, Merkel Cell/diagnosis , Carcinoma, Merkel Cell/therapy , Ethmoid Sinus/pathology , Ethmoid Sinus , Paranasal Sinus Neoplasms/diagnosis , Paranasal Sinus Neoplasms/therapy , Immunohistochemistry/methods , ImmunohistochemistryABSTRACT
El síndrome de Immunodeficiencia Adquirida (SIDA) es de particular interés para el Otorrinolaringólogo y Cirujano de Cabeza y Cuello porque se ha estimado que entre el 40 por ciento y 80 por ciento de los pacientes con esta enfermedad presentan sintomatología o manifestaciones físicas en el área de la cabeza y el cuello. Por ello, revisamos 318 expedientes de pacientes con diagnóstico clínico, epidemiológico y serológico de SIDA vistos en el Hospital General de México entre mayo de 1993 y diciembre de 1994. Encontramos patología en cabeza y cuello en 169 (54.14 por ciento); de estos, 113 fueron del sexo masculino y 56 del sexo femenino. La cavidad oral presento patología en 87 de los pacientes (51.48 por ciento), orofaringe en 34 (20.12 por ciento), Nariz y senos paranasales en 26 (15.38 por ciento), piel de cabeza y cuello en 8 (4.73 por ciento), oído medio 7(4.14 por ciento), oído externo 4(2.37 por ciento, laringe 1 (0.59 por ciento) y un absceso lateral de cuello (0.59 por ciento)
Subject(s)
Adolescent , Adult , Middle Aged , Humans , Male , Female , AIDS-Related Opportunistic Infections/etiology , Otorhinolaryngologic Diseases/etiology , Mouth Diseases/etiology , Nose Diseases/etiology , Risk Factors , Acquired Immunodeficiency Syndrome/complicationsABSTRACT
Avaliou-se a PCR no diagnostico laboratorial de infeccao por Mycobacterium spp. utilizando diversas amostras clinicas. Classificou-se os grupos segundo criterios clinicos, radiologicos e epidemiologicos em: infeccao comprovada, altamente provavel, os grupos controle negativo com infeccao por outras bacterias, e controle negativo sem infeccao. Padronizou-se o tratamento de amostras e extracao de DNA nos diversos fluidos biologicos. A amplificacao do DNA foi realizada em duas etapas: a primeira utilizou-se iniciadores especificos para o Genero Mycobacterium e a segunda utilizou-se iniciadores especie especificos para o complexo M. tuberculosis e M. avium. A PCR apresentou cem por cento de positividade para o grupo controle positivo, o grupo de estudo com alta probabilidade de infeccao apresentou cultura e baciloscopia de 43,6 32,1 por cento de positividade respectivamente, a PCR a presentou 88,5 por cento de positividade. O grupo provavel teve positividade na cultura e baciloscopia de 21,05 e 16,8 por cento respectivamente, e a PCR foi de 61,5 por cento. Nenhum caso de falso positivo foi encontrado nos grupos controles negativos. Conclui-se que o metodo de PCR e efetivo, reprodutivel, sendo aplicavel na rotina laboratorial
Subject(s)
Humans , Gene Amplification/methods , Mycobacterium Infections/diagnosis , Mycobacterium/isolation & purification , Polymerase Chain Reaction , Tuberculosis, Pulmonary/diagnosisABSTRACT
Pneumocystis carinii es un patógeno oportunista frecuentemente involucrado en neumonitis en pacientes con síndrome de inmunodeficiencia adquirida(SIDA). En general, las manifestaciones estrapulmonares por P. carinii son raras y generalmente son asociadas a enfermedad sistemica grave, otros cuadros de inmunodeficiencia, enfermedades malignas o supresión inmune. Se presenta el caso de un paciente masculino portador del síndrome de inmunodeficiencia adquirida, con un cuadro de otitis media por Pneumocystis carinii, con otalgia severa, otorrea e hipoacusia conductiva. Se hace una revisión de la bibliografía sobre esta rara patología
