Trauma resulting in rare avulsion-type renal injury and lobe migration: An uncommon case report.

In this case report, we discuss a rare incident of avulsion-type renal injury in a 24-year-old male with no significant medical history. The injury occurred during a traffic accident, where he was involved in a direct impact collision between a motorcycle and a vehicle, leading to altered corticomedullary differentiation in the right kidney, a retroperitoneal hematoma, and free fluid in the cavity. The patient underwent successful emergency abdominal surgery, which involved the removal of the damaged kidney due to the severity of the injury. During his postoperative recovery in the ICU, he received extensive care, including sedation, mechanical ventilation, and vasopressor support. Ultimately, he made a successful recovery and was discharged after rehabilitation. This case highlights the complexities involved in managing patients with renal injuries resulting from high-energy impact accidents. It emphasizes the importance of a multidisciplinary approach in treatment, the challenges associated with deciding on surgical intervention, and the significance of rehabilitation in patient recovery. The uniqueness of this case, characterized by its distinct mechanism of injury and the severity of the trauma, contributes to our broader understanding of renal trauma management in the field of trauma medicine. It underscores the need for personalized patient care strategies and emphasizes the effectiveness of surgical interventions in severe cases of renal trauma.

Surfactant therapy using vibrating-mesh nebulizers in adults with COVID-19-induced ARDS: A case series.

Coronavirus adult respiratory distress syndrome, characterized by decreased surfactant due to lysis of type II pneumocytes and hyaline membrane formation, contributes to severe hypoxemia. The administration of surfactant via high-flow nasal cannula (HFNC) may positively affect lung structure and function in this context. In this study, we report on five clinical cases, encompassing patients aged 40-60 years of both sexes, who tested positive for coronavirus disease 2019 via real-time polymerase chain reaction and exhibited significant pulmonary compromise with elevated inflammatory biomarkers. These patients were treated with aerosol therapy using surfactant delivered through vibrating-mesh nebulizers alongside HFNC. Of these patients, four demonstrated positive responses to the treatment, suggesting that aerosol therapy with surfactant through vibrating-mesh nebulizers could be a viable rescue therapy in adults receiving HFNC oxygen therapy for hypoxemic respiratory failure caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Unfortunately, one patient had a negative outcome and succumbed. The findings from these cases indicate that the use of aerosol therapy with vibrating-mesh nebulizers as rescue therapy might offer an alternative approach for managing adults with hypoxemic respiratory failure due to SARS-CoV-2, as evidenced by the positive outcomes in four out of the five cases presented.

An Unusual Case of Severe Pneumonia Caused Due Candida Tropicalis With a Favorable Clinical Response to Antifungals in a Nonimmunocompromised Patient From the Community.

Severe pneumonia due to Candida tropicalis infection mainly occurs in immunosuppressed patients or those currently receiving broad-spectrum antibiotics. Herein, we report a case of severe pneumonia caused due to C tropicalis in an elderly patient. A 72-year-old man with a previous history of hypertension, ischemic stroke, and facial paralysis sequelae treated with the botulinic toxin, was admitted to the hospital for dyspnea. Severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) infection was negative. Computed tomography of the chest revealed bilateral consolidation with left predominance. A bronchoalveolar lavage sample was sent to molecular biology, but no microorganisms were detected using a FilmArray respiratory panel. However, mamanocandidas test for candida was 166 pg/mL (positive), and fungal structures were identified by the MALDI-TOF Biotyper mass spectrometry and attributed to C tropicalis. Antifungal therapy was started using caspofungin 75 mg as the initial dose followed by 50 mg daily. After 10 days of treatment, ventilatory weaning was achieved. By day 14, the patient was decannulated from the tracheostomy. Oral antifungal treatment with voriconazole was continued, and he was discharged from intensive care in good clinical condition. Severe pneumonia due to C tropicalis might occur in specific cases, especially in those patients with risk factors, and must thus be considered when approaching such cases.

A 71-Year-Old Man From Ecuador With a History of Type 2 Diabetes Mellitus and Severe COVID-19 Pneumonia and Lung Cavitation Associated With Triple Infection With Trichosporon Asahii, Klebsiella Pneumoniae, and Pseudomonas Aeruginosa.

Unvaccinated patients with comorbidities that impair the immune function, such as type 2 diabetes mellitus, are more likely to develop severe COVID-19. The COVID-19-associated acute respiratory distress syndrome has raised new concerns in intensive care units globally owing to the presence of secondary fungal infections. We report the case of a 71-year-old man from Ecuador with a history of type 2 diabetes mellitus, severe COVID-19 pneumonia, and lung cavitation associated with triple infections with Trichosporon asahii, Klebsiella pneumoniae, and Pseudomonas aeruginosa. The patient with a history of high blood pressure and type 2 diabetes was admitted to our hospital from a private care center with a diagnosis of COVID-19-associated acute respiratory distress syndrome. On arrival, the patient presented with signs of hypoxemic respiratory failure. During his stay at another hospital, he had received tocilizumab and corticosteroid therapy. Therefore, intubation was performed and mechanical ventilation was initiated. The patient developed a septic shock and renal failure with a glomerular filtration rate of 27.5 mL/min/1.73 m2; therefore, two hemodiafiltration sessions were started. The bronchoalveolar lavage revealed erythematous lesions in the bronchial tree and abundant purulent secretions and erosions in the bronchial mucosa, with a cavitary lesion in the right bronchial tree. The bronchoalveolar lavage samples were used to isolate Trichosporon asahii, Klebsiella pneumoniae, and Pseudomonas aeruginosa carbapenemase class A. Matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF) Biotyper mass spectrometry and polymerase chain reaction (PCR) molecular identification were performed. This case report suggested that patients with severe COVID-19 pneumonia, with or without comorbidities, are more susceptible to opportunistic infections.

Mendelson's Syndrome: Chemical Pneumonitis After Pesticide Intake.

BACKGROUND Mendelson's syndrome consists of pulmonary aspiration of acidic gastric contents that results in acute lung injury (chemical pneumonitis). CASE REPORT We present the case of a 15-year-old girl who was admitted to the Emergency Department 1 h after ingestion of an organophosphate pesticide. The patient had abundant emesis of aqueous, transparent content, accompanied by drowsiness and moderate sialorrhea. We observed drooling and foaming at the mouth and tachycardia, and her oxygen saturation dropped to 75%, requiring immediate invasive ventilation. Computed tomography (CT) revealed opacities in both lung bases, while bronchoscopy evidenced burn lesions along the airway. A bronchoalveolar lavage (BAL) was performed and microbiological results were negative. Following the BAL, the patient showed a satisfactory evolution and full recovery. CONCLUSIONS This case report describes chemical pneumonitis due to pulmonary aspiration of sterile gastric contents following ingestion of a pesticide. We discuss the importance of timely diagnosis, the characteristic burn lesions found in bronchoscopy, and the role of bronchoalveolar lavage, which most likely allowed for a rapid recovery with favorable results.

Early Pulmonary Metastasis After a Surgical Resection of Glioblastoma Multiforme. A Case Report.

BACKGROUND Glioblastoma multiforme is one of the most aggressive types of tumors that affect the central nervous system. It has an extremely high morbidity and mortality rate despite immediate treatment and advances in chemotherapy, radiotherapy, and surgery. In the natural history of the disease, extracranial metastases of glioblastoma multiforme are a rare complication that can be localized in the lungs, bone, liver, and lymph nodes. CASE REPORT A 66-year-old male presented with pulmonary metastasis after the surgical resection of a primary glioblastoma multiforme tumor. Seventeen days after surgery while in the intensive care unit, the patient had leukocytosis with a predominance of neutrophils. An exploratory bronchoscopy evidenced a white lesion that prevented the visualization of the bronchus. Consequently, a sample was taken for pathological study that demonstrated pulmonary metastasis due to glioblastoma multiforme. CONCLUSIONS Surgical resection of the tumor can precipitate the appearance of extracranial metastases, especially pulmonary metastases.

Azygos Vein Aneurysm with Thrombosis and Aspergillus fumigatus Diagnosed Using Bronchoscopy: Case Report.

BACKGROUND The venous system of the posterior thoracic wall merges into a single trunk called the azygos vein, located in the posterior mediastinum, before draining into the superior vena cava. An aneurysm in the azygos vein is extremely rare. Such aneurysms are discovered as incidental radiology findings or while investigating a mediastinal mass. Visualization via bronchoscopy is atypical. CASE REPORT An 86-year-old female patient presented to the Emergency Department with a 5-day complaint of dyspnea and chest pain. She was admitted because of worsening condition leading to respiratory failure and paresthesias. She underwent endotracheal intubation and invasive mechanical ventilatory support. A chest X-ray showed a thickened mediastinum, tortuous thoracic aorta, and bilateral perihilar infiltrate with right predominance. Bronchoscopy revealed bleeding along the right bronchus and a blue protrusion coated with white material at the entrance of the main right bronchus. A pulmonary computed tomography angiography confirmed the presence of an azygos vein dilatation. Culture of bronchoalveolar lavage revealed Aspergillus fumigatus. CONCLUSIONS Bronchoscopy as a diagnostic method allows clinicians to verify the state and permeability of the airways during investigation of azygos vein aneurysms, which are rare entities but should be considered in the differential diagnosis of mediastinal masses and may be complicated by fungal pathogens such as Aspergillus fumigatus mostly in immunocompromised patients.

Bronchial Visualization of Tetanic Contractions: A Case Report.

BACKGROUND Tetanus is a potentially fatal infectious disease which, during its evolution, creates multiple complications, usually requiring intensive management and care. CASE REPORT We present a clinical case of a 59-year-old male patient with generalized tetanus admitted to the intensive care unit. Flexible bronchoscopy revealed contraction of the bronchial demonstrating that tetany existed at the respiratory level, which rarely becomes evident. The clinical manifestations included trismus, facial paralysis, neck stiffness, and compromised respiratory function. The patient presented a state of respiratory failure that required invasive mechanical ventilation which was evaluated by bronchoscopy and that showed spasms of the bronchial musculature. The patient presented generalized tetanus in which the bronchial affectation was evaluated by bronchoscopy in the intensive care unit. In developed countries, the anti-tetanus toxoid vaccine has ostensibly decreased its incidence, while it is endemic in developing countries, and although there are measures such as vaccination that try to reduce its incidence, in Ecuador there is an increase in incidences. In this patient case, contraction of the bronchial rings was observed, demonstrating that tetany existed at the respiratory level, which rarely becomes evident. CONCLUSIONS Although muscular contractions are widespread, this clinical case evidences bronchial spams reported and visualized by bronchoscopy.

Volume-assured pressure support mode plus pirfenidone as resuscitation therapy in patients with exacerbation of idiopathic pulmonary fibrosis.

INTRODUCTION: Treatment among advanced stage idiopathic pulmonary fibrosis is quite challenging, especially considering that no major evidence has been released about it. This case report demonstrates and discusses the benefit of non-invasive mechanical ventilation in volume-assured pressure support (AVAPS) mode plus pirfenidone based on the relief of apatient'ssymptoms in combination with high-resolution computed tomography (HRCT) evidence. MATERIAL AND METHODS: An 83-year-old female patient with multiple hospital admissions within a six-month period initially presented with cardiac symptoms which were later attributed to apossible exacerbation of her primary diagnosis, idiopathic pulmonary fibrosis. CONCLUSION: The addition of non-invasive mechanical ventilation in AVAPS mode plus pirfenidone can improve the survival rates even in patients with current exacerbations of acute respiratory failure due to idiopathic pulmonary fibrosis.

Preparation and Characterization of Bio-Based PLA/PBAT and Cinnamon Essential Oil Polymer Fibers and Life-Cycle Assessment from Hydrolytic Degradation.

Nowadays, the need to reduce the dependence on fuel products and to achieve a sustainable development is of special importance due to environmental concerns. Therefore, new alternatives must be sought. In this work, extruded fibers from poly (lactic acid) (PLA) and poly (butylene adipate-co-terephthalate) (PBAT) added with cinnamon essential oil (CEO) were prepared and characterized, and the hydrolytic degradation was assessed. A two-phase system was observed with spherical particles of PBAT embedded in the PLA matrix. The thermal analysis showed partial miscibility between PLA and PBAT. Mechanically, Young's modulus decreased and the elongation at break increased with the incorporation of PBAT and CEO into the blends. The variation in weight loss for the fibers was below 5% during the period of hydrolytic degradation studied with the most important changes at 37 °C and pH 8.50. From microscopy, the formation of cracks in the fiber surface was evidenced, especially for PLA fibers in alkaline medium at 37 °C. This study shows the importance of the variables that influence the performance of polyester-cinnamon essential oil-based fibers in agro-industrial applications for horticultural product preservation.

Treatment of postnatal depression in low-income mothers in primary-care clinics in Santiago, Chile: a randomised controlled trial.

BACKGROUND: The optimum way to improve the recognition and treatment of postnatal depression in developing countries is uncertain. We compared the effectiveness of a multicomponent intervention with usual care to treat postnatal depression in low-income mothers in primary-care clinics in Santiago, Chile. METHODS: 230 mothers with major depression attending postnatal clinics were randomly allocated to either a multicomponent intervention (n=114) or usual care (n=116). The multicomponent intervention involved a psychoeducational group, treatment adherence support, and pharmacotherapy if needed. Usual care included all services normally available in the clinics, including antidepressant drugs, brief psychotherapeutic interventions, medical consultations, or external referral for specialty treatment. The primary outcome measure was the Edinburgh postnatal depression scale (EPDS) score at 3 and 6 months after randomisation. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00518830. FINDINGS: 208 (90%) of women randomly assigned to treatment groups completed assessments. The crude mean EPDS score was lower for the multicomponent intervention group than for the usual care group at 3 months (8.5 [95% CI 7.2-9.7] vs 12.8 [11.3-14.1]). Although these differences between groups decreased by 6 months, EPDS score remained better in multicomponent intervention group than in usual care group (10.9 [9.6-12.2] vs 12.5 [11.1-13.8]). The adjusted difference in mean EPDS between the two groups at 3 months was -4.5 (95% CI -6.3 to -2.7; p<0.0001). The decrease in the number of women taking antidepressants after 3 months was greater in the intervention group than in the usual care group (multicomponent intervention from 60/101 [59%; 95% CI 49-69%] to 38/106 [36%; 27-46%]; usual care from 18/108 [17%; 10-25%] to 11/102 [11%; 6-19%]). INTERPRETATION: Our findings suggest that low-income mothers with depression and who have newly born children could be effectively helped, even in low-income settings, through multicomponent interventions. Further refinements to this intervention are needed to ensure treatment compliance after the acute phase.

[A randomized trial of pharmacotherapy with telephone monitoring to improve treatment of depression in primary care in Santiago, Chile]. / Un ensayo clínico aleatorizado de farmacoterapia con monitorización telefónica para mejorar el tratamiento de la depresión en la atención primaria en Santiago, Chile.

BACKGROUND: Depression is a public health problem, due to its high prevalence and its associated disability. AIM: To compare a pharmacological intervention for depression controlled by phone from a central level (TM) and the usual treatment (TH) in a randomized clinical trial. MATERIAL AND METHODS: Three hundred and forty five women, aged 22 to 59 years were studied. They were randomly assigned to receive the usual therapy or a pharmacological intervention with periodical telephone contacts with medical collaboration personnel, to reinforce compliance with treatment and educate about the disease. Women were blindly evaluated at 3 and 6 months with the Hamilton depression rating score (HDRS) and the SF-36 to assess depressive symptoms and quality of life, respectively. RESULTS: In both evaluations, improvement was significantly greater in the TM group than the TH group. At 3 months, improvement was higher in the TM group in the subscales of physical function, pain, general health, energy, emotional role, mental health and standardized physical and psychic scales of SF-36. At 6 months, this significant difference in favour of TM was maintained for energy, mental health and the standardized psychic scale. CONCLUSIONS: A telephone reinforcement improves the outcomes of treatments for depression.

[Psychopathology and social functioning among offspring of depressed women]. / Cómo es la salud mental de los hijos de madres deprimidas consultantes a servicios de atención primaria?

BACKGROUND: Offspring of depressive parents have two times more risk of developing a depression, other psychiatric diseases or a poor social functioning. AIM: To assess psychopathology and social functioning among offspring of currently depressed mothers. MATERIAL AND METHODS: We enrolled 290 depressed mother-child pairs in five primary-care clinics in Santiago. A two-stage screening process to identify female primary-care patients with current major depressive illness with children aged 6-16 years, was used. AH eligible and consenting patients were asked to complete the general health questionnaire (GHQ-12). Those scoring 5 or more were invited to participate in a baseline assessment. The final sample consisted of 290 mother-child pairs. Patients with a current DSM-IV diagnosis of major depression were eligible unless they had current psychotic symptoms, imminent suicide risk, history of mania, or current alcohol abuse. Child psychopathology was assessed with the Child Behavior Checklist (CBCL), a highly reliable and widely used parent-rated checklist to assess competencies and behavioural and emotional problems in children 4 to 18 years of age. RESULTS: Fifty percent (95% confidence interval (CI): 43.9-55.7) of children had overall CBCL psychopathology scores in clinical range. Internalizing symptoms were more prevalent than externalizing symptoms (62.2% [9596CI: 56.3-67.8] and 35.7% [9596CI: 30.2-41.5]. CONCLUSIONS: A large proportion of children of depressed poor mothers attending primary care clinics in Chile, had psychopathological symptom scores in the clinical range, with a predominance of internalizing symptoms. These results are similar to those previously reported in the United States of America.

Molecular description and similarity relationships among native germplasm potatoes (Solanum tuberosum ssp. tuberosum L.) using morphological data and AFLP markers

Chile is considered to be a sub-center of origin for the cultivated potato, with native and introduced genetic material coexisting in the country. Thus, the different varieties present in Chiloe Island are characterized by a rich diversity of forms, sizes, colours and phenological characteristics. In the present work, the level of polymorphism and the genetic relationship were studied by means of molecular markers using the amplified fragment length polymorphism (AFLP) technique and twenty-seven morphological characters. Twenty varieties of potatoes from the Chiloe Island were analyzed. The commercial variety Desirée and one specie from the Etuberosa series, Solanum fernandezianum, collected in the Juan Fernandez Island were included as controls. A similarity tree-diagram was made, based on all the AFLP bands generated in the range between 65 and 290 base pairs. With these tools, it was possible to identify molecular differences and similarities that might be associated with important morphological traits such as the predominant forms of the tuber, flower colour and resistance to disease.

Common mental disorders and the built environment in Santiago, Chile.

BACKGROUND: There is growing research interest in the influence of the built environment on mental disorders. AIMS: To estimate the variation in the prevalence of common mental disorders attributable to individuals and the built environment of geographical sectors where they live. METHOD: A sample of 3870 adults (response rate 90%) clustered in 248 geographical sectors participated in a household cross-sectional survey in Santiago, Chile. Independently rated contextual measures of the built environment were obtained. The Clinical Interview Schedule was used to estimate the prevalence of common mental disorders. RESULTS: There was a significant association between the quality of the built environment of small geographical sectors and the presence of common mental disorders among its residents. The better the quality of the built environment, the lower the scores for psychiatric symptoms; however, only a small proportion of the variation in common mental disorder existed at sector level, after adjusting for individual factors. CONCLUSIONS: Findings from our study, using a contextual assessment of the quality of the built environment and multilevel modelling in the analysis, suggest these associations may be more marked in non-Western settings with more homogeneous geographical sectors.

Un ensayo clínico aleatorizado de farmacoterapia con monitorización telefónica para mejorar el tratamiento de la depresión en la atención primaria en Santiago, Chile / A randomized trial of pharmacotherapy with telephone monitoring to improve treatment of depression in primary care in Santiago, Chile

Background: Depression is a public health problem, due to its high prevalence and its associated disability. Aim: To compare a pharmacological intervention for depression controlled by phone from a central level (TM) and the usual treatment (TH) in a randomized clinical trial. Material and methods: Three hundred and forty five women, aged 22 to 59 years were studied. They were randomly assigned to receive the usual therapy or a pharmacological intervention with periodical telephone contacts with medical collaboration personnel, to reinforce compliance with treatment and educate about the disease. Women were blindly evaluated at 3 and 6 months with the Hamilton depression rating score (HDRS) and the SF-36 to assess depressive symptoms and quality of life, respectively. Results: In both evaluations, improvement was significantly greater in the TM group than the TH group. At 3 months, improvement was higher in the TM group in the subscales of physical function, pain, general health, energy, emotional role, mental health and standardized physical and psychic scales of SF-36. At 6 months, this significant difference in favour of TM was maintained for energy, mental health and the standardized psychic scale. Conclusions: A telephone reinforcement improves the outcomes of treatments for depression.

[Quality of life of women depressed in the post-partum period]. / Calidad de vida de mujeres deprimidas en el posparto.

BACKGROUND: Depression is common among women, specially during breeding. AIM: To characterize post-partum depression in a group of women attending a primary health care clinic and its relationship to quality of life. MATERIAL AND METHODS: The sample included women meeting criteria for Major Depression, with a child of up to 11 months old. Exclusion criteria included the presence of psychosis, history of mania, alcohol abuse, illegal drug use, high suicide risk, and receiving mental health care in the last three months. Structured interviews used were the Edinburgh postpartum depression scale (EPDS), Mini International Neuropsychiatric Interview (MINI), Medical Outcomes Study Questionnaire (SF-36) and questions about incapacity and health care use. RESULTS: The sample included 159 women with a median age of 27 years (range: 16-43 years). Thirty three percent were married, 30.8% lived in common law marriage, 9.4% were divorced, and 26.4% were single. Most (89.3%) were housewives, 31% were students, and 6.9% were employed. The average score on the EPDS was 17 points (S.D. 4.2). The average SF-36 somatic score was 42.7 points (S.D. 8.2), and the emotional score was 30.3 (D.S. 0.3). The relation between the average score on the EPDS and the somatic and emotional scores was statistically significant (p=0.000-0.006). CONCLUSIONS: Most women were mildly to moderately depressed. Their depression was associated with a marked impairment of activities of daily living. These findings add to the evidence suggesting that depression is associated with marked disability cultures, even when the depression is mild to moderate.