Jejunal Perforation Due to Histoplasmosis Regarding a Case.

Histoplasmosis is an increasing infection that mainly affects immunocompromised individuals such as patients with HIV/AIDS, with the disseminated form, especially gastrointestinal, being common in this population. The clinical presentation ranges from asymptomatic to symptoms that mimic other abdominal diseases. Jejunal perforation due to histoplasmosis, although rare, has been reported in a few cases, typically in men living with HIV in their fourth decade of life. We present the case of a 34-year-old male, with a history of HIV and colonic histoplasmosis who presented with acute abdominal pain requiring exploratory laparotomy and intestinal resection due to jejunal perforation, with histological confirmation of histoplasmosis in the resected intestinal segment.

Parásitos intestinales y factores de riesgo en escolares de una institución educativa rural de Tunja (Colombia) en el año 2015 / Intestinal parasites and risk factors in schoolchildren of a rural school from Tunja (Colombia) in 2015

Introducción: una de las enfermedades infecciosas más común es el parasitismo intestinal, encontrándose ampliamente distribuido a nivel mundial, especialmente en las personas más vulnerables. Objetivo: determinar la prevalencia de parásitos intestinales y los factores de riesgo en escolares de una institución educativa rural de la ciudad de Tunja (Colombia). Materiales y métodos: se llevó a cabo una investigación de tipo descriptivo transversal, en la cual aceptaron participar 89 niños con previa firma del asentimiento y consentimiento informado por parte de sus padres. Se recolectaron muestras de heces fecales de cada uno de los niños y se les practicó examen coprológico y análisis por medio de la técnica de concentración formol-éter. Los factores de riesgo se evaluaron con la ayuda de una encuesta que contempló preguntas sobre los hábitos higiénico-sanitarios y las características de las viviendas. Resultados: la prevalencia general de parásitos intestinales fue del 74,2%, siendo Entamoeba histolytica/dispar (90,9%), Endolimax nana (66,7%) y Entamoeba coli (60,6%) las especies más frecuentes. Dentro de los factores de riesgo se destacan la medicación en casa, el contacto con animales, la disposición de aguas residuales al aire libre, jugar con tierra y caminar descalzos. No se encontró relación estadísticamente significativa entre los factores de riesgo y el parasitismo intestinal. Conclusiones: la proporción de parásitos intestinales en los escolares estudiados fue alta (74,2%), con predominio de los protozoos y los parásitos no patógenos. Es importante continuar incrementando las actividades educativas encaminadas a prevenir el parasitismo intestinal. (AU)

Introduction: Parasitic intestinal diseases are one of the most predominant among infectious diseases, finding distributed worldwide, especially in most vulnerable people. Objective: To determine the prevalence of intestinal parasites and the risk factors in schoolchildren of rural educational institution from Tunja (Colombia). Materials and methods: A transversal descriptive study has been carried out in 89 schoolchildren that agreed to participate with the prior written informed consent and assent from their parents. Stool samples from each child were collected and coprological test and analysis by formalin-ether concentration technique were conducted. The risk factors were assessed by a survey, which included questions about hygiene habits and housing characteristics. Results: The overall infection of intestinal parasites was 74.2 % being Entamoeba histolytica/dispar (90.9%), followed by Endolimax nana (66.7%), and Entamoeba coli (60.6%) the most frequent species. Risk factors include self-medication, animal contact, outdoor sewage disposing, play with soil, and walking barefoot. It was not found a significant relationship between risk factors and intestinal parasites. Conclusions: The proportion of intestinal parasites in schoolchildren was high (74.2%), with the protozoa and non-pathogenic parasites as most predominant. It is important to continue increasing educational efforts to prevent intestinal parasites. (AU)

Detection of tidal recruitment/overdistension in lung-healthy mechanically ventilated patients under general anesthesia.

BACKGROUND: The volume-dependent single compartment model (VDSCM) has been applied for identification of overdistension in mechanically ventilated patients with acute lung injury. In this observational study we evaluated the use of the VDSCM to identify tidal recruitment/overdistension induced by tidal volume (Vt) and positive end-expiratory pressure (PEEP) in lung-healthy anesthetized subjects. METHODS: Fifteen patients (ASA physical status I-II) undergoing general anesthesia for elective plastic breast reconstruction surgery were mechanically ventilated in volume-controlled ventilation (VCV), with Vt of 8 mL•kg(-1) and PEEP of 0 cm H(2)O. With these settings, ventilatory mode was randomly adjusted in VCV or pressure-controlled ventilation (PCV) and PEEP was sequentially increased from 0 to 5 and 10 cm H(2)O, 5 min per step. Thereafter, PEEP was decreased to 0 cm H(2)O, Vt increased to 10 mL•kg(-1) and, keeping minute ventilation constant, PEEP was similarly increased to 5 and 10 cm H(2)O. Airway pressure and flow were continuously recorded and fitted to the VDSCM with or without considering flow-dependencies. A "distension index" (%E(2)) derived from the VDSCM was used to assess Vt and PEEP-induced recruitment/overdistension. Positive and negative values of %E(2) suggest tidal overdistension or tidal recruitment, respectively. In addition, the linear respiratory system elastance was calculated. Comparisons among variables at each PEEP value, Vt setting, ventilatory mode, and regression model considering or not considering flow-dependencies were performed with the Wilcoxon-sign rank test for paired samples (P < 0.05). Multiple comparisons were corrected with the Bonferroni method. The relative change in the estimated noisy variance was used as an index of the goodness of fit of the models. RESULTS: VDSCM including the flow-dependent parameter significantly improved estimated noisy variance in almost all experimental conditions (11.2 to 71.4, smallest of the lower and highest of the upper 95% confidence intervals). No differences in %E(2) were observed between VCV and PCV, at comparable Vt and PEEP levels, when flow-dependencies were included in the regression model. The negligence of the flow-dependent parameter systematically led to an underestimation of %E(2) in PCV compared to VCV mode (all P < 0.02). At a given Vt, %E(2) was negative at a PEEP of 0 cm H(2)O and significantly increased with PEEP, being almost 0 at a PEEP of 5 cm H(2)O. At a given level of PEEP, %E(2) significantly increased with Vt. CONCLUSIONS: The distension index %E(2), derived from the VDSCM considering flow-dependencies, seems able to identify tidal recruitment/overdistension induced by Vt and PEEP independent of flow waveform in healthy lung-anesthetized patients.