ABSTRACT
A 63-year-old male with coronavirus disease 2019 (COVID-19) pneumonia presented to the emergency department, supplementary oxygen is delivered via nasal cannula, and invasive ventilation was not needed; there was significant pneumoperitoneum on radiologic control. After a meticulous examination of the thoracic tomography, there were some linear air collections adjacent to the bronchovascular sheaths, indicative of the Macklin effect, without abdominal alterations, and the patient remained stable; therefore, we did not perform a surgical procedure, and the pneumoperitoneum reabsorbed spontaneously on radiologic control. The pulmonary origin of pneumoperitoneum is unusual and is associated with mechanical ventilation and alveolar leak; the air leak with subsequent dissection into other anatomical spaces is called the Macklin effect. It is essential to have this mechanism in mind because most of these patients respond well to conservative treatment. When studying primary pneumoperitoneum, the cause should be studied carefully to discard visceral perforation, tracheal or esophageal rupture.
ABSTRACT
BACKGROUND: Anaphylaxis is a life-threating hypersensitivity reaction. Epinephrine underuse in patients with anaphylaxis could lead to poor outcomes. There is evidence that the epinephrine use in such patients could be as low as 8%. OBJECTIVE: To assess the percentage of physicians who know that epinephrine is the first-line treatment in anaphylaxis. The secondary objective was to assess knowledge gaps regarding anaphylaxis diagnosis and treatment that could lead to epinephrine underuse. METHODS: We performed an online survey for physicians in Mexico City, using a 10-item questionnaire assessing anaphylaxis knowledge. We obtained measures of central tendency for statistical analysis, such as frequency, 95% confidence interval, as well as the chi-square test for comparing the groups. RESULTS: A total of 196 surveys were considered for analysis. Of all the participants, 96.44% were able to correctly diagnose an anaphylaxis case with cutaneous, respiratory, and cardiovascular symptoms. Fifty-two percent correctly diagnosed anaphylaxis without cutaneous symptoms. The 72.4% of the respondents chose epinephrine as the first-line treatment, 42.3% correctly answered that there is no absolute contraindication to giving epinephrine, and 20.9% ignored whether there was any contraindication for its use. Only 38.3% of participants answered that during discharge they would prescribe an autoinjector. Regarding the administration route, 63.4% answered that the first dose of epinephrine is applied intramuscularly and 50% of the participants chose the correct dose of epinephrine. Only 2.6% of the participants answered all 10 questions correctly. CONCLUSION: There is still some difficulty recognizing anaphylaxis without cutaneous symptoms. Even though two-thirds of physicians identified that epinephrine is the treatment of choice, only 49.5% would have used intramuscular epinephrine as first-line treatment. We found a low percentage of epinephrine ampule prescription and knowledge of the correct dose. These findings can account for epinephrine underuse when dealing with anaphylaxis in the real clinical practice.
ABSTRACT
Food allergy is an immune reaction that occurs frequently at a pediatric age; its prevalence is higher in industrialized countries, affecting 8% of the population in average. The most frequently involved foods are: milk, chicken eggs, soy, peanuts, fish, wheat, seafood, and dried fruits. Food allergies can be divided into three groups: IgE-mediated, non-IgE-mediated, and mixed food allergy. The symptoms will depend on the immunological mechanisms and they can be divided into immediate or delayed symptoms; immediate symptoms appear during the first two hours after the intake, and delayed symptoms appear after the second hour and up to 72 hours. The diagnosis of food allergies requires the medical history of the patient, a physical examination, and laboratory tests; a misdiagnosis can lead to unnecessary elimination diets. The gold standard is the double-blind, placebo-controlled oral food challenge. The main treatment is food restriction, in which the entailed nutritional and psychological implications must be taken into account. Another treatment option is oral immunotherapy, which is recommended for patients who cannot carry out an elimination diet due to its significant impact on the quality of life.
La alergia alimentaria es una reacción inmunológica que se presenta de forma frecuente en la edad pediátrica; su prevalencia es mayor en los países industrializados y en promedio afecta a 8 % de la población. Los alimentos más frecuentemente involucrados son leche, huevo, soya, cacahuate, pescado, trigo, mariscos y frutos secos. La alergia alimentaria se puede dividir en tres grupos: alergia alimentaria mediada por inmunoglobulina E, no mediada por inmunoglobulina E y mixta. Los síntomas dependerán de los mecanismos inmunológicos y se pueden dividir en inmediatos o tardíos; los inmediatos se presentan en las primeras dos horas de la ingesta y los tardíos posterior a la segunda hora y hasta 72 horas. Para el diagnóstico se debe obtener la historia clínica, realizar exploración física y exámenes de laboratorio; un diagnóstico erróneo puede llevar a dietas de eliminación innecesarias. El estándar de oro es el reto oral doble ciego controlado con placebo. El tratamiento principal es la restricción del alimento, en la cual se debe tener en cuenta las implicaciones nutricionales y psicológicas que conlleva. Otro tratamiento es la inmunoterapia oral, que se recomienda en quienes no pueden llevar a cabo dieta de eliminación por la importante afectación de la calidad de vida.
