Mucormicosis bronquial, un hallazgo inusual en la broncoscopia / Bronchial mucormycosis, an unusual finding on bronchoscopy

La mucormicosis es una infección causada por hongos oportunistas pertenecientes al orden de los mucorales. Desde la aparición de la pandemia por SARS-CoV-2 se han emitido alertas sobre el incremento en la presentación de esta infección. La presentación de mucormicosis traqueo-bronquial representa el 37% de la afectación pulmonar. A continuación, se desarrolla el caso clínico de una pa-ciente diabética con neumonía severa por SARS-CoV-2, con evolución desfavorable, quien es llevada a broncoscopia, encontrando pseudomembranas blanquecinas que obs-truían la luz del bronquio fuente izquierdo, confirmándose histopatológicamente la presencia de mucorales. Se realiza reporte del presente caso para reconocer la apa-rición de infecciones fúngicas en pacientes que presen-tan diabetes mal controlada e infección por SARS-CoV-2 que tienen una evolución tórpida. La presencia de seudo membranas blancas puede ser un signo de alarma para tener este tipo de infecciones dentro de las posibilidades diagnósticas

Mucormycosis is an infection caused by opportunistic fungi belonging to the order Mucorales. Since the SARS CoV 2 pandemic, warnings have been issued about the increase in the presentation of this infection. The presentation of tracheobronchial mucormycosis represents 37% of pulmonary involvement.We present the clinical case of a diabetic patient with severe pneumonia due to SARS VOC 2, with unfavorable evolution, who was taken to bronchoscopy and found whitish pseudomembranes obstructing the lumen of the left main bronchus, confirming histopathologically the presence of mucormycosis.A report of the present case is made to recognize the appearance of fungal infections in patients with poorly controlled diabetes and SARSe COV 2 infection, who have a torpid evolution. The presence of white pseudomembranes should be an alarm sign to have this type of infections within the diagnostic possibilities

Anesthetic Challenges Posed by Heavy Kratom Users.

Kratom is a herbal and natural dietary supplement from Southeast Asia that is gaining popularity in the United States. Its leaves contain multiple psychoactive chemicals that stimulate opioid, alpha-2, and serotonergic receptors. Kratom is used as a stimulant and in the treatment of anxiety, pain, and opioid withdrawal. In most states, kratom can be purchased legally and is sold at smoke shops, gas stations, and online. To date, only limited data is available on the impact of habitual kratom use on patients undergoing anesthesia. The following case report highlights multiple anesthetic challenges posed by a heavy kratom user.

El riesgo de parasitismo por Angiostrongylus cantonensis: una problemática reemergente en Cuba / The risk of parasitism by Angiostrongylus cantonensis: a re-emerging problem in Cuba / O risco de parasitismo devido a Angiostrongylus cantonensis: um problema reemergente em Cuba

RESUMEN Introducción: El riesgo de parasitismo por Angiostrongylus cantonensis transmitido por el caracol gigante africano es una problemática reemergente en Cuba. Objetivo: Sistematizar contenidos esenciales relacionados con el caracol gigante africano y el parásito Angiostrongylus cantonensis, el riesgo de meningitis eosinofílica y su manejo. Método: En el Hospital General Docente "Dr. Agostinho Neto", entre septiembre y diciembre de 2019 se hizo una revisión narrativa sobre el tema a través de una búsqueda en bases de datos electrónicas (Biblioteca Virtual en Salud): LILACS, PubMed, SciELO, RedALyC, Scopus, Cochrane. Resultados: La información se estructuró en caracterización del caracol gigante africano y el riesgo de infección por Angiostrongylus cantonensis en Cuba, patogénesis y epidemiologia de la angiostrongylosis, y diagnóstico y tratamiento de la meningitis eosinofílica por este nemátodo. Se identificaron controversias sobre los criterios diagnósticos, el protocolo de actuación para su prevención y rehabilitación, y la carencia de un instrumento para estratificar el riesgo de esta infección. Conclusiones: Se sistematizaron contenidos esenciales sobre el caracol gigante africano, lo que posibilita la preparación de los profesionales para incrementar la percepción del riesgo de infección por Angiostrongylus cantonensis en la población.

ABSTRACT Introduction: The risk of parasitism by Angiostrongylus cantonensis transmitted by the giant African land snail, Lissachatina fulica is a re-emerging problem in Cuba. Objective: Systematize essential contents related to the giant African land snail and the parasite Angiostrongylus cantonensis, the risk of eosinophilic meningitis and its management. Method: A narrative review was made on the subject in the Teaching General Hospital "Dr. Agostinho Neto", between September and December 2019 through a search in electronic databases (Virtual Health Library): LILACS, PubMed, SciELO, RedALyC, Scopus, Cochrane. Results: The information was structured in the characterization of the African giant land snail and the risk of infection by Angiostrongylus cantonensis in Cuba, pathogenesis and epidemiology of angiostrongylosis, and diagnosis and treatment of eosinophilic meningitis by this nematode. Controversies were identified regarding the diagnostic criteria, the protocol of action for its prevention and rehabilitation, and the lack of an instrument to stratify the risk of this infection. Conclusions: Essential content on the giant African land snail was systematized, enabling the preparation of professionals to increase the perception of the risk of infection by Angiostrongylus cantonensis in the population.

RESUMO Introdução: O risco de parasitismo causado por Angiostrongylus cantonensis transmitido pelo caracol gigante africano é um problema reemergente em Cuba. Objetivo: Sistematizar conteúdos essenciais relacionados ao caracol gigante africano e ao parasita Angiostrongylus cantonensis, ao risco de meningite eosinofílica e seu manejo. Método: No Hospital Geral de Ensino "Dr. Agostinho Neto", entre setembro e dezembro de 2019, foi realizada uma revisão narrativa do assunto através de uma busca em bases de dados eletrônicas (Biblioteca Virtual em Saúde): LILACS, PubMed, SciELO, RedALyC, Scopus, Cochrane. Resultados: As informações foram estruturadas na caracterização do caracol gigante africano e no risco de infecção por Angiostrongylus cantonensis em Cuba, patogênese e epidemiologia da angiostrongilose, diagnóstico e tratamento da meningite eosinofílica por esse nematóide. Foram identificadas controvérsias sobre os critérios diagnósticos, o protocolo de ação para sua prevenção e reabilitação e a falta de um instrumento para estratificar o risco dessa infecção. Conclusões: Foram sistematizados conteúdos essenciais sobre o caracol gigante africano, o que possibilita a preparação de profissionais para aumentar a percepção do risco de infecção por Angiostrongylus cantonensis na população.

Hipertensión intraabdominal y síndrome compartimental abdominal en el paciente grave / Intra-abdominal hypertension and abdominal compartment syndrome in the severe patient / Hipertensão intra-abdominal e síndrome do compartimento abdominal no paciente grave

RESUMEN Introducción: La hipertensión intraabdominal y el síndrome compartimental abdominal implican un grave pronóstico. Objetivo: Sistematizar contenidos esenciales relacionados con el diagnóstico y el tratamiento de estas emergencias médicas. Método: En la Facultad de Ciencias Médicas Guantánamo, entre enero y julio de 2019 se hizo una revisión narrativa sobre el tema a través de una búsqueda en bases de datos electrónicas (Biblioteca Virtual en Salud): LILACS, PubMed, SciELO, ClinicalKey, REDALYC, Scopus, Cochrane. Resultados: Se localizaron 125 documentos, y se eligieron 25 relevantes para el objetivo de la revisión. La información se estructuró en los siguientes aspectos: definición, fisiopatología, etiología, diagnóstico y tratamiento. Conclusiones: Se elaboró un referente teórico útil a estudiantes y médicos generales para prepararse sobre el tema. Se identificaron controversias sobre la efectividad del uso de fármacos sedantes, analgésicos, procinéticos, albúmina y diuréticos, la terapia de reemplazo renal y la descompresión gástrica y colónica para el tratamiento médico, el impacto de los tratamientos quirúrgicos en la supervivencia de pacientes y el efecto de la comorbilidad del paciente, la enfermedad causal, la ventana temporal diagnóstico-tratamiento en los resultados terapéuticos de estas emergencias médicas.

ABSTRACT Introduction: Intra-abdominal hypertension and abdominal compartment syndrome imply a serious prognosis. Objective: Systematize essential contents related to the diagnosis and treatment of these medical emergencies. Method: In the Faculty of Medical Sciences Guantanamo, between January and July 2019, a narrative review on the subject was made through a search in electronic databases (Virtual Health Library): LILACS, PubMed, SciELO, ClinicalKey, REDALYC, Scopus, Cochrane. Results: 125 documents were located, and 25 relevant for the purpose of the review were chosen. The information was structured in the following aspects: definition, pathophysiology, etiology, diagnosis and treatment. Conclusions: A useful theoretical reference to students and general practitioners was prepared to prepare on the subject. Controversies were identified about the effectiveness of the use of sedative, analgesic, prokinetic, albumin and diuretic drugs, renal replacement therapy and gastric and colonic decompression for medical treatment, the impact of surgical treatments on patient survival and the effect of the patient's comorbidity, the causative disease, the diagnostic-treatment time window in the therapeutic results of these medical emergencies.

RESUMO Introdução: Hipertensão intra-abdominal e síndrome do compartimento abdominal implicam um prognóstico sério. Objetivo: Sistematizar conteúdos essenciais relacionados ao diagnóstico e tratamento dessas emergências médicas. Método: Na Faculdade de Ciências Médicas de Guantánamo, entre janeiro e julho de 2019, foi realizada uma revisão narrativa sobre o assunto, através de uma busca em bases de dados eletrônicas (Biblioteca Virtual em Saúde): LILACS, PubMed, SciELO, ClinicalKey, REDALYC, Scopus, Cochrane. Resultados: Foram localizados 125 documentos e escolhidos 25 relevantes para a finalidade da revisão. As informações foram estruturadas nos seguintes aspectos: definição, fisiopatologia, etiologia, diagnóstico e tratamento. Conclusões: Foi preparado um referencial teórico útil para estudantes e médicos de clínica geral para se preparar sobre o assunto. Foram identificadas controvérsias sobre a eficácia do uso de medicamentos sedativos, analgésicos, procinéticos, albumina e diuréticos, terapia de reposição renal e descompressão gástrica e colônica para tratamento médico, o impacto dos tratamentos cirúrgicos na sobrevida dos pacientes e o efeito da comorbidade do paciente, da doença causadora, da janela do tempo de diagnóstico e tratamento nos resultados terapêuticos dessas emergências médicas.

Autocuidado de la salud diabetológica en adultos mayores del Policlínico Docente Marcio Manduley Murillo, La Habana 2018 / Autocuidado da saúde do diabético em idosos da Policlínica de Ensino Marcio Manduley Murillo, Havana 2018 / Self-care of diabetic health in older adults of the Teaching Polyclinic Marcio Manduley Murillo, Havana 2018

Introducción: la educación del paciente con diabetes mellitus en función del autocuidado de su salud es una exigencia social. Objetivo: diseñar una intervención educativa dirigida a elevar la preparación para el autocuidado de la salud diabetológica de pacientes adultos mayores dispensarizados en el consultorio No. 4 del Policlínico Docente Marcio Manduley Murillo, municipio Centro Habana, La Habana. Método: se realizó un estudio descriptivo, prospectivo, transversal y de intervención educativa. Se estudiaron las siguientes variables: edad, sexo, estado civil, escolaridad, tipo de diabetes, tiempo evolución, control metabólico y complicaciones de esta enfermedad. Se exploró el nivel de preparación de los pacientes para el autocuidado de la salud diabetológica. Se diseñó, aplicó y validó una intervención educativa dirigida a su preparación para el autocuidado de la salud diabetológica. Resultados: fue más común que los pacientes tuvieran 65 a 69 años de edad (48,6 por ciento), fueran mujeres (59,8 por ciento), divorciados (25,0 por ciento), con un nivel escolar de secundaria básica (40,3 por ciento), diabetes mellitus tipo II (90,4 por ciento) de más de 15 años de evolución (40,3 por ciento). El 72,2 por ciento tenía descontrol de la enfermedad y el 52,2 por ciento evidencias de daño de órganos dianas. Solo el 16,7 por ciento tenía un adecuado nivel de preparación respecto al tema diabetes mellitus, que mejoró hasta un 93,0 por ciento luego de aplicar una intervención educativa. Conclusiones: se manifestó la necesidad de educar a los pacientes sobre el tema y la viabilidad de la intervención educativa diseñada para el logro de esta finalidad(AU)

Introduction: the education of patients with diabetes mellitus based on self-care of their health is a social requirement. Objective: design an educational intervention aimed at raising the preparation for self-care of diabetological health of elderly patients dispensed in the office No. 4 of the Teaching Polyclinic Marcio Manduley Murillo, Centro Habana Municipality, Havana. Method: a descriptive, prospective, crosssectional and educational intervention study was carried out. The following variables were studied: age, sex, marital status, schooling, type of diabetes, evolution time, metabolic control and complications of this disease. The level of preparation of patients for self-care of diabetes health was explored. An educational intervention aimed at its preparation for self-care of diabetological health was designed, applied and validated. Results: it was more common for patients to be 65 to 69 years old (48.6 percent), were women (59.8 percent), divorced (25.0 percent), with a basic secondary school level (40.3 percent), type II diabetes mellitus (90.4 percent) over 15 years of evolution (40.3 percent). 72.2 percent had uncontrolled disease and 52.2 ercent evidence of target organ damage. Only 16.7percent had an adequate level of preparation regarding diabetes mellitus, which improved up to 93.0 percent after applying an educational intervention. Conclusions: the need to educate patients about the topic and the viability of the educational intervention designed to achieve this purpose was expressed(AU)

Introdução: a educação de pacientes com diabetes mellitus com base no autocuidado de sua Saúde é uma necesidade social. Objetivo: elaborar uma intervenção educacional com o objetivo de elevar a preparação para o autocuidado da saúde diabetológica de pacientes idosos dispensados no consultório nº 4 da Policlínica de Ensino Marcio Manduley Murillo, município de Centro Habana, Havana. Método: estudo descritivo, prospectivo, transversal e educacional. Foram estudadas as seguintes variáveis: idade, sexo, estado civil, escolaridade, tipo de diabetes, tempo de evolução, controle metabólico e complicações desta doença. O nível de preparação dos pacientes para o autocuidado da saúde do diabetes foi explorado. Foi projetada, aplicada e validada uma intervenção educativa voltada à sua preparação para o autocuidado da saúde diabetológica. Resultados: os pacientes com idade entre 65 e 69 anos (48,6 por cento) eram mais comuns: mulheres (59,8 por cento), divorciadas (25,0 por cento), com ensino médio básico (40,3 por cento), diabetes mellitus tipo II (90,4 por cento) ao longo de 15 anos de evolução (40,3 por cento). 72,2 por cento tinham doença não controlada e 52,2 por cento evidenciam danos nos órgãos-alvo. Apenas 16,7 por cento apresentaram nível adequado de preparo para diabetes mellitus, que aumentou para 93,0 por cento após a aplicação de uma intervenção educativa. Conclusões: expressou-se a necessidade de educar os pacientes sobre o tema e a viabilidade da intervenção educacional projetada para atingir esse objetivo(AU)

Drug reaction with eosinophilia and systemic symptoms (DRESS) and multiple organ dysfunction syndrome (MODS): one more reason for a new effective treatment against leishmaniasis.

INTRODUCTION: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe drug-induced reaction associated with eosinophilia and systemic manifestations. Anticonvulsants, sulfonamides, and antivirals are the most related and described drugs in DRESS syndrome. METHODS AND CASE: We present a case of severe multiple organ dysfunction syndrome (MODS) with the risk of death associated with DRESS syndrome due to antileishmanial pentavalent antimonial drug and its simultaneous toxicity. Consequently, a comprehensive review of the main clinical problems and comparative discussion of both clinical conditions was made. DISCUSSION: The overlap of DRESS syndrome and antileishmanial pentavalent antimonial drug toxicity can be life-threatening. Both conditions represent a true clinical, diagnostic, and therapeutic challenge. We exposed specific clinical and laboratory results with rare occurrence. CONCLUSION: Any physician and dermatologists should keep in mind the broad spectrum of clinical manifestations and laboratory findings associated with the use of pentavalent antimonial drugs. The clinical suspicion, an early diagnosis, and aggressive treatment are essential to prevent complications and death.

Significado de la enfermedad, experiencias y expectativas de pacientes con mielofibrosis / Meaning of illness, experiences and expectations of patients with myelofibrosis

Fundamentos: La mielofibrosis es una enfermedad rara que afecta personas adultas especialmente sobre la cual no se encuentran estudios que investiguen el sentir del padecimiento en los pacientes o que aborden lo que ha representado esta enfermedad en la vida El trabajo buscó determinar el significado, las experiencias y las implicaciones que la mielofibrosis tiene en pacientes colombianos. Métodos: Estudio cualitativo de 10 pacientes con mielo fibrosis. Muestreo teórico intencionado. Técnica: entrevista a profundidad realizada por psicóloga clínica con cuestionario semiestructurado diseñado por los investigadores. Entre diciembre 2013 - enero 2014. Análisis de contenido con apoyo del software Atlas ti. Versión 7, licencia educativa multiusuario. Resultados: 7 hombres, 3 mujeres con edades entre 19-80 de varias regiones del país, con diagnostico entre 1-17 años. Edad mediana 63.5 años. Cinco con diagnóstico inicial de anemia, leucemia o hepatomegalia. Ninguno conocía previamente la enfermedad. Atribuyen la causa: cocinar con leña, manipulación de materiales en su trabajo, vida agitada sin buena alimentación o razones divinas. El padecimiento de mielofibrosis cambio las concepciones sobre la vida, sus expectativas, hábitos y costumbres. Tienen la convicción de vivir con apoyo del sistema de salud. La familia, la religión y los médicos se convierten en su apoyo. Conclusiones No conocían sobre enfermedad. Manifiestan emociones y sentimientos de incredulidad, angustia, tristeza, miedo entre otros y es la familia, la creencia en Dios y la cercanía y comprensión del médico la mejor red de apoyo. Su expectativa frente a la enfermedad es de esperanza

Background: Myelofibrosis is a rare disease on which no studies about the suffering of patients who have it have been conducted. this work seeks to determine the significance, the experiences and the implications that Myelofibrosis has in Colombian patients. Methods: This is a qualitative study method directed to Myelofibrosis diagnosed patients where theoretical intentional samples were collected. To such end, 10 interviews were conducted between December 2013 and January 2014 by a Clinical Psychologist with semi-structured questionnaires carefully designed by the researchers. The content analysis was developed with Atlas.ti® software support, multi-user educative license, version 7. Results: 7 male and 3 female patients between 19-80 years old from various regions of the country were enrolled whose illness had been diagnosed within the 1 and 17 years from the onset of symptoms. Five of the patients had an initial diagnosis of Anemia, Leukemia or Hepatomegaly. None of them knew about their disease previously. They attributed the cause to such symptoms to factors like cooking with firewood, the handling of materials at their work, busy life with poor eating habits or to spiritual reasons. Suffering from the illness has substantially changed the patients’ conceptions about life and therefore their expectations, habits, and customs. They have the conviction to continue living with the support of the health system and to overcome the disease. Family, religion, and doctors become their support. Conclusions: They did not know anything about the illness previous to the diagnosis. However, they express emotions and feelings of disbelief, anger, sadness, and fear among others and it is the family, the belief in God and the closeness and understanding of their doctors which constitutes their main support network. Hope is the only expectation he has towards the disease

Divertículo de Meckel en el adulto mayor: una causa de sangrado digestivo: Revisión de la literatura y reporte de un caso / Meckel's divericulum in the senior adult patient: a primary cause of gastrointestinal bleeding. Literature review and case report

El divertículo de Meckel es la anormalidad congénita más frecuente del tubo digestivo, que afecta, aproximadamente, al 2 % de la población. Se produce por una alteración en el cierre del conducto onfalomesentérico, por lo general, en la quinta semana de vida intrauterina. Aunque usualmente es asintomático, puede manifestarse por una de las siguientes complicaciones: sangrado gastrointestinal, obstrucción intestinal, inflamación y perforación, enfermedad tumoral y encarcelación en una hernia inguinal (hernia de Littre). Tiene incidencia de complicaciones a largo plazo, de 4,2 %, la cual disminuye con la edad. El tratamiento del divertículo de Meckel sintomático siempre es quirúrgico y existe controversia respecto a su resección cuando es un hallazgo incidental. El divertículo de Meckel es una causa infrecuente de sangrado gastrointestinal con hematoquecia, usualmente en la población pediátrica. En los adultos, la complicación más frecuente es la obstrucción intestinal causada por intususcepción, vólvulos o estenosis. Se presenta el caso de una paciente adulta mayor con sangrado gastrointestinal, como complicación de un divertículo de Meckel.

Meckel's diverticulum is the most common congenital malformation of the gastrointestinal tract, affecting approximately 2% of the population. It is a consequence of the inadequate closure of the viteline duct during the fifth week of gestational life. It is usually asymptomatic; however, gastrointestinal bleeding, intestinal obstruction, inflammation, perforation, neoplastic pathology or hernia incarceration (Littre's hernia) may complicate it. It has a of 4.2% rate life-long risk of complications, rate that decreases with age. The treatment for a symptomatic Meckel's diverticulum is surgical. There is controversy about the surgical management incidentally detected Meckel's diverticulum. Meckel's diverticulum is an uncommon cause of gastrointestinal bleeding, usually affecting the pediatric population. In the adult population, the most frequent complication is intestinal obstruction caused by intussusception, volvulus or intestinal stenosis. In this article, we present a clinical case of an elder patient with gastrointestinal bleeding caused by a Meckel's diverticulum.

Hydrophobic carboxy-terminal residues dramatically reduce protein levels in the haloarchaeon Haloferax volcanii.

Proteolysis is important not only to cell physiology but also to the successful development of biocatalysts. While a wide-variety of signals are known to trigger protein degradation in bacteria and eukaryotes, these mechanisms are poorly understood in archaea, known for their ability to withstand harsh conditions. Here we present a systematic study in which single C-terminal amino acid residues were added to a reporter protein and shown to influence its levels in an archaeal cell. All 20 amino acid residues were examined for their impact on protein levels, using the reporter protein soluble modified red-shifted GFP (smRS-GFP) expressed in the haloarchaeon Haloferax volcanii as a model system. Addition of hydrophobic residues, including Leu, Cys, Met, Phe, Ala, Tyr, Ile and Val, gave the most pronounced reduction in smRS-GFP levels compared with the addition of either neutral or charged hydrophilic residues. In contrast to the altered protein levels, the C-terminal alterations had no influence on smRS-GFP-specific transcript levels, thus revealing that the effect is post-transcriptional.

New cytotoxic indolic metabolites from a marine Streptomyces.

Three new cytotoxic 3,6-disubstituted indoles (1-3) were isolated from the mycelium of a strain identified as Streptomyces sp. (BL-49-58-005), which was separated from a Mexican marine invertebrate, and their structures established by analysis of NMR and mass spectral data. GI(50) values for 1 and 2 in cytotoxic bioassays against a panel of 14 different tumor cell lines were estimated at micromolar range, while compound 3 showed no activity in the same assays.

IB-00208, a new cytotoxic polycyclic xanthone produced by a marine-derived Actinomadura. I. Isolation of the strain, taxonomy and biological activites.

A new compound, IB-00208, has been isolated from the fermentation broth of an actinomycete isolated from a marine environment. The strain was identified as Actinomadura sp. by its chemical and phylogenetic characteristics. The compound shows cytotoxic activity on tumor cell lines and bactericidal activity against gram-positive bacteria.

Opciones terapéuticas en el tromboembolismo pulmonar: ¿Anticoagulación? ¿Trombolisis? ¿Filtros?: Primera comunicación nacional de la colocación de filtros de Greenfield / Therapeutic options in pulmonary thromboembolism: anticoagulation? thrombolysis? filters? filters?: first national report of Greenfiel filters use

Se discuten cinco casos de embolia pulmonar establecida y en cada caso se identificaron: 1. los factores de riesgo trombótico, 2 la existencia de contraindicaciones (absolutas o relativas) para el uso de la terapéutica anticoagulante y trombolítica, 3. la presentación clínica de los episodios embólicos y la evidencia (clínica o instrumental) de trombosis venosa profunda concomitante, 4. la metodología terapéutica utilizada, tratando de adecuarla a las necesidades de los pacientes (anticoagulación; trombolisis; o interrupción al flujo de la vena cava inferior). Esto condujo a los autores a la indicación de interrupción de la vena cava inferior mediante filtros de Greenfield 12F (la primera comunicación nacional de dos casos)