Colangiopatía hipertensiva portal por transformación portal cavernomatosa de origen no cirrótica: a propósito de un caso

La colangiopatía portal hace referencia a anomalías colangiográficas que se producen en pacientes con cavernomatosis portal, siendo progresiva, cursando con enfermedad biliar sintomática y anomalías graves de las vías biliares. Y, representa una complicación infrecuente de la hipertensión portal. Se describe el caso de un hombre de 53 años, con historia de larga data de hipertensión portal nocirrótica y cavernomatosis portal, quien presentó un episodio de enfermedad biliar obstructiva sintomática, y en estudios se documentó tejido fibrótico de extensión periportal ascendente con compresión extrínseca del colédoco distal y dilatación de la vía biliar extra e intrahepática. Por lo que se procedió a colangiopancreatografía retrógrada endoscópica, realizándose tratamiento paliativo, con papilotomía pequeña y colocación de endoprótesis biliar plástica, siendo exitoso por ausencia de complicaciones procedimentales, y mejoría clínica y parámetros bioquímicos. Finalmente, recibiendo de alta con indicación de seguimiento prioritario para recambios periódicos de endoprótesis biliares, y valoración por hepatología. La colangiopatía portal es una entidad rara que debe sospecharse en sujetos con hipertensión portal de origen no-cirrótico, con hallazgos imagenológicos de estenosis, angulaciones o dilataciones segmentarias, su tratamiento debe ser individualizado, y la terapia endoscópica es de elección en enfermedad biliar sintomática.

Portal cholangiopathy refers to cholangiographic abnormalities occurring in patients with portal cavernomatosis, being progressive, presenting with symptomatic biliary disease and severe biliary tract abnormalities. And, it represents an infrequent complication of portal hypertension. We describe the case of a 53-year-old man with a long history of non-cirrhotic portal hypertension and portal cavernomatosis, who presented an episode of symptomatic obstructive biliary disease, and studies documented fibrotic tissue of ascending periportal extension with extrinsic compression of the distal common bile duct and dilatation of the extra and intrahepatic biliary tract. Therefore, endoscopic retrograde cholangiopancreatography was performed, and palliative treatment with small papillotomy and placement of a plastic biliary endoprosthesis was successful due to the absence of procedural complications, and clinical improvement and biochemical parameters. Finally, the patient was discharged with indication of priority follow-up for periodic replacement of biliary stents, and evaluation by hepatology. Portal cholangiopathy is a rare entity that should be suspected in subjects with portal hypertension of non-cirrhotic origin, with imaging findings of stenosis, angulations or segmental dilatations, its treatment should be individualized, and endoscopic therapy is of choice in symptomatic biliary disease.

[Hypertensive portal cholangiopathy due to portal cavernomatous transformation of non-cirrhotic origin: a case report]. / Colangiopatía hipertensiva portal por transformación portal cavernomatosa de origen no cirrótica: a propósito de un caso.

Portal cholangiopathy refers to cholangiographic abnormalities occurring in patients with portal cavernomatosis, being progressive, presenting with symptomatic biliary disease and severe biliary tract abnormalities. And, it represents an infrequent complication of portal hypertension. We describe the case of a 53-year-old man with a long history of non-cirrhotic portal hypertension and portal cavernomatosis, who presented an episode of symptomatic obstructive biliary disease, and studies documented fibrotic tissue of ascending periportal extension with extrinsic compression of the distal common bile duct and dilatation of the extra and intrahepatic biliary tract. Therefore, endoscopic retrograde cholangiopancreatography was performed, and palliative treatment with small papillotomy and placement of a plastic biliary endoprosthesis was successful due to the absence of procedural complications, and clinical improvement and biochemical parameters. Finally, the patient was discharged with indication of priority follow-up for periodic replacement of biliary stents, and evaluation by hepatology. Portal cholangiopathy is a rare entity that should be suspected in subjects with portal hypertension of non-cirrhotic origin, with imaging findings of stenosis, angulations or segmental dilatations, its treatment should be individualized, and endoscopic therapy is of choice in symptomatic biliary disease.

Variables hemodinámicas cardíacas y desenlaces postrasplante hepático en un centro de referencia de trasplantes en Colombia a 2600 metros sobre el nivel del mar / Cardiac hemodynamic variables and post-liver transplant outcomes in a transplant referral center in Colombia at 2,600 meters above sea level

Resumen Introducción: la valoración hemodinámica mediante ecocardiografía Doppler tiene importancia en la identificación de alteraciones sistólicas/diastólicas como predictor de desenlaces en el postrasplante hepático desde alteraciones cardiovasculares hasta disfunción del injerto y mortalidad. Métodos: estudio de cohorte retrospectivo. Paciente con trasplante hepático en el hospital LaCardio, en Bogotá, Colombia entre enero de 2005 y julio de 2021. Análisis de variables sociodemográficas, comorbilidades, ecocardiografía y variables intraoperatorias con desenlaces primarios como disfunción temprana del injerto, lesión renal aguda (LRA) y mortalidad durante el seguimiento. Se realizó un árbol de clasificación y regresión (CART). Resultados: se analizaron a 397 pacientes, el 54,4% eran hombres, y el 71% tenía algún grado de disfunción diastólica, hipertrofia ventricular izquierda (30,9%) con presencia de disfunción del injerto en el 8% y LRA en el 21%, y una mortalidad del 15% durante el seguimiento del estudio. En el modelo CART para desenlaces de mortalidad y disfunción del injerto se relacionó con la presencia de índice de masa corporal (IMC) < 19 o la combinación de IMC entre 19 y < 24 con diálisis. Conclusión: las variables ecocardiográficas, la sarcopenia y la LRA o requerimiento de terapia de reemplazo renal se relacionan con desenlaces de mortalidad y disfunción del injerto.

Abstract Introduction: Hemodynamic assessment by Doppler echocardiography is essential in identifying systolic/diastolic changes as a predictor of outcomes in post-liver transplantation, from cardiovascular changes to graft dysfunction and mortality. Materials and methods: Retrospective cohort study. Patient with a liver transplant at the LaCardio hospital in Bogotá, Colombia, between January 2005 and July 2021. Analysis of sociodemographic variables, comorbidities, echocardiography, and intraoperative variables with primary outcomes such as early graft dysfunction, acute kidney injury (AKI), and mortality during follow-up. A classification and regression tree (CART) was performed. Results: 397 patients were analyzed; 54.4% were men, 71% had some degree of diastolic dysfunction and left ventricular hypertrophy (30.9%) with graft dysfunction in 8% and AKI in 21%, and a mortality of 15% during the study follow-up. In the CART model, mortality and graft dysfunction outcomes were related to a body mass index (BMI) < 19 or a combination of BMI between 19 and < 24 with dialysis. Conclusion: Echocardiographic variables, sarcopenia, AKI, or the requirement for renal replacement therapy are related to mortality and graft dysfunction outcomes.

Assessing the Nationwide COVID-19 Risk in Mexico through the Lens of Comorbidity by an XGBoost-Based Logistic Regression Model.

The outbreak of the new COVID-19 disease is a serious health problem that has affected a large part of the world population, especially older adults and people who suffer from a previous comorbidity. In this work, we proposed a classifier model that allows for deciding whether or not a patient might suffer from the COVID-19 disease, considering spatio-temporal variables, physical characteristics of the patients and the presence of previous diseases. We used XGBoost to maximize the likelihood function of the multivariate logistic regression model. The estimated and observed values of percentage occurrence of cases were very similar, and indicated that the proposed model was suitable to predict new cases (AUC = 0.75). The main results revealed that patients without comorbidities are less likely to be COVID-19 positive, unlike people with diabetes, obesity and pneumonia. The distribution function by age group showed that, during the first and second wave of COVID-19, young people aged ≤20 were the least affected by the pandemic, while the most affected were people between 20 and 40 years, followed by adults older than 40 years. In the case of the third and fourth wave, there was an increased risk for young individuals (under 20 years), while older adults over 40 years decreased their chances of infection. Estimates of positive COVID cases with both the XGBoost-LR model and the multivariate logistic regression model were used to create maps to visualize the spatial distribution of positive cases across the country. Spatial analysis was carried out to determine, through the data, the main geographical areas where a greater number of positive cases occurred. The results showed that the areas most affected by COVID-19 were in the central and northern regions of Mexico.

Enfermedad gonocócica diseminada: Reporte de caso

Introducción: La infección por Neisseria gonorrhoeae (NG) es la segunda causa enfermedad de transmisión sexual (ETS), con una incidencia en aumento, altas tasas de resistencia antibiótica y con su mayor presentación a nivel genital. Su presentación con bacteriemia es menor del 3 %, con limitante en su diagnóstico por su bajo rendimiento. Por lo anterior reportamos el caso. Presentación caso: Hombre de 60 años con antecedente de diabetes mellitus, quien ingresa por cuadro poliarticular con sinovitis, asociado a un síndrome febril, sin otro hallazgo al examen físico. Se documenta bacteriemia por NG, con nexo temporal con relación sexual previa. Se indica tratamiento antibiótico según antibiograma con profilaxis a pareja. Paciente egresa sin ninguna complicación. Conclusión : La diseminación hemática por NG es una condición rara, con síntomas iniciales muy inespecíficos, con bajo rendimiento de pruebas diagnósticas en esta condición, por lo cual requiere alta sospecha clínica y cobra gran importancia una historia clínica muy detallada. Como en nuestro caso, los síntomas inespecíficos condicionaron a descartar otras condiciones hasta el aislamiento en hemocultivos lleva a diagnósticos definitivo. Es un caso con presentación clínica inusual.

Introduction: Infection by Neisseria gonorrhoeae (NG) is the second cause of sexually transmitted disease (ETS), with an increasing incidence, high rates of antibiotic resistance and with its greatest presentation at the genital level. Its presentation with bacteriemia is less than 3%, limiting its diagnosis due to its low performance. Therefore, we report the case. Case presentation: 60-year-old man with a history of diabetes mellitus, who was admitted due to polyarticular symptoms with synovitis, associated with a febrile syndrome, with no other finding on physical examination. Bacteremia due to Neisseria gonorrhoeae is documented, with a temporal link with previous sexual intercourse. Antibiotic treatment is indicated according to antibiogram with partner prophylaxis. Patient is discharged without any complications. Conclusion: Hematic dissemination by NG is a rare condition, with very non-specific initial symptoms, with low performance of diagnostic tests in this condition, which requires high clinical suspicion, and a very detailed clinical history is of great importance. As in our case, nonspecific symptoms led to ruling out other conditions until isolation in blood cultures leads to a definitive diagnosis. It is a case with unusual clinical presentation

Anca-positive vasculitis with full-house nephropathy, an unusual association: a case report and review of literature / Vasculite ANCA-positivo com nefropatia full-house, uma associação incomum: um relato de caso e revisão de literatura

Abstract Rapidly progressive glomerulonephritis is a medical emergency, with mortality around 20%. It is characterized by crescent glomerulonephritis and progressive loss of kidney function, hematuria, and proteinuria. Its classification is given by immunofluorescence detection of antibodies against glomerular basement membrane (Anti-MBG), immunocomplexes, or pauci-immune pattern. Its etiology should be based on clinical findings, immunological profile, age, sex, and histopathological characteristics. We present a case of a 27-year-old woman with symptoms consistent with rapidly progressive glomerulonephritis and biopsy findings of a full-house kidney nephropathy, with an early fatal outcome. An association of low incidence, as it is a case with a full-house pattern, and an autoimmune profile for negative systemic lupus erythematosus makes this a rare case. ANCA-associated vasculitis with full-house kidney disease was diagnosed, an unusual condition with up to 3% presentation and few reports in the literature, highlighting the importance of its reporting and contribution to the literature.

Resumo A glomerulonefrite rapidamente progressiva é uma emergência médica, com mortalidade em torno de 20%. É caracterizada por glomerulonefrite com crescentes e perda progressiva da função renal, hematúria e proteinúria. Sua classificação é dada pela detecção na imunofluorescência de anticorpos anti-membrana basal glomerular (Anti-MBG), imunocomplexos, ou padrão pauci-imune. Sua etiologia deve ser baseada em resultados clínicos, perfil imunológico, idade, sexo e características histopatológicas. Apresentamos o caso de uma mulher de 27 anos de idade com sintomas consistentes com uma glomerulonefrite rapidamente progressiva e achados de biópsia de uma nefropatia com padrão full-house que evoluiu com desfecho fatal precoce. A associação de um padrão full-house, que possui uma baixa incidência, com um perfil autoimune para lúpus eritematoso sistêmico negativo torna este um caso raro. Foi diagnosticado vasculite associada ao ANCA com doença renal com padrão full-house. Por se tratar de uma condição incomum com até 3% de apresentação e poucos registros na literatura, destacamos a importância de seu relato e sua contribuição para a literatura.

Sarcoma de la vena pulmonar / Sarcoma of the pulmonary vein

Resumen Los sarcomas son neoplasias primarias, cuya ubicación es rara en grandes vasos y excepcional en las venas pulmonares. Los dos tipos más frecuentes en las venas pulmonares son el leiomiosarcoma y el fibrosarcoma, con una distribución alrededor de la cuarta a la quinta décadas de vida, un pronóstico de 23 meses y 60% de metástasis al momento del diagnóstico. La presentación clínica es inespecífica ya que simula situaciones como embolia pulmonar, falla cardiaca descompensada y masa en la aurícula izquierda. Para su diagnóstico se cuenta con diferentes herramientas, como la ecocardiografía, la tomografía computarizada, la angiografía coronaria, la resonancia magnética y la tomografía por emisión de positrones (PET TC). El tratamiento incluye resección quirúrgica radical, manejo adyuvante con quimioterapia y radioterapia, e incluso, en casos seleccionados, trasplante de corazón. Se presenta el caso de una paciente con diagnóstico inicial de embolia pulmonar, con un episodio de edema pulmonar secundario a masa en la aurícula izquierda y extensión de un sarcoma de vena pulmonar derecha, con desenlace fatal. Se aporta a la literatura con el caso y la revisión de tema.

Abstract Sarcomas are primary neoplasms, whose location is rare in large vessels and in the pulmonary veins is exceptional. The two most frequent types in the pulmonary vein are leiomyosarcoma and fibrosarcoma, distribution around 4 and 5 decades of life, with a prognosis of 23 months and 60% metastasis at the time of diagnosis. The clinical presentation is nonspecific simulating situations such as pulmonary embolism, decompensated heart failure and mass in the left atrium. Different tools are available for its diagnosis, like echocardiography, computed tomography, coronary angiography, magnetic resonance imaging and PET CT. Treatment includes radical surgical resection, adjuvant therapy with chemotherapy, and radiation therapy, even heart transplantation in selected cases. It is presented the case of a patient with an initial diagnosis of pulmonary embolism, with an episode of pulmonary edema secondary to a mass in the left atrium, extension of a sarcoma of the right pulmonary vein, with a fatal outcome. We contributed to the literature with the case and review of theme.

Hematogenous dissemination mediastinitis: case report / Mediastinitis de diseminación hematogena: Reporte de un caso

Abstract Background: Acute mediastinitis is the inflammation of the connective tissue and fat surrounding the mediastinal structures. It is a high-mortality entity and its most frequent causes include sternotomy infections from cardiovascular surgery, esophageal perforation and extension of head and neck infections. Isolated cases of acute mediastinitis from hematogenous spread are described in the literature. Case presentation: 58 year-old man, with history of gouty arthritis managed with steroids, diagnosed with acute mediastinitis by S. aureus, secondary to septic arthritis of the ankle, managed with drainage of mediastinal collections by thoracoscopy and antibiotic therapy, with satisfactory evolution. Conclusions: In patients with acute mediastinitis, hematogenous dissemination should be considered when the etiologies most frequently associated with the entity are ruled out. Early surgical treatment derived from a multidisciplinary diagnostic approach improves the prognosis of these patients.

Resumen Antecedentes: la mediastinitis aguda es la inflamación del tejido conectivo y la grasa que rodea las estructuras mediastínicas. Es una entidad de alta mortalidad y sus causas más frecuentes incluyen infecciones de la esternotomia de la cirugía cardiovascular, perforación esofágica y extensión de infecciones de cabeza y cuello. Casos aislados de mediastinitis aguda por diseminación hematógena se describen en la literatura. Caso: Hombre de 58 años, con antecedente de artritis gotosa manejado con esteroides, diagnosticado de mediastinitis aguda por S. aureus, secundaria a artritis séptica de tobillo, manejada con drenaje de colecciones mediastínicas por toracoscopia y antibioterapia, con evolución satisfactoria. Conclusiones: En pacientes con mediastinitis aguda, se puede considerar la diseminación hematógena cuando las etiologías más frecuentemente asociadas a la entidad están descartados. El tratamiento quirúrgico precoz derivado de un abordaje diagnóstico multidisciplinar mejora el pronóstico de estos pacientes.

Design of a Low-Power Embedded System Based on a SoC-FPGA and the Honeybee Search Algorithm for Real-Time Video Tracking.

Video tracking involves detecting previously designated objects of interest within a sequence of image frames. It can be applied in robotics, unmanned vehicles, and automation, among other fields of interest. Video tracking is still regarded as an open problem due to a number of obstacles that still need to be overcome, including the need for high precision and real-time results, as well as portability and low-power demands. This work presents the design, implementation and assessment of a low-power embedded system based on an SoC-FPGA platform and the honeybee search algorithm (HSA) for real-time video tracking. HSA is a meta-heuristic that combines evolutionary computing and swarm intelligence techniques. Our findings demonstrated that the combination of SoC-FPGA and HSA reduced the consumption of computational resources, allowing real-time multiprocessing without a reduction in precision, and with the advantage of lower power consumption, which enabled portability. A starker difference was observed when measuring the power consumption. The proposed SoC-FPGA system consumed about 5 Watts, whereas the CPU-GPU system required more than 200 Watts. A general recommendation obtained from this research is to use SoC-FPGA over CPU-GPU to work with meta-heuristics in computer vision applications when an embedded solution is required.

Actinomyces y síndrome de Kartagener: Reporte de caso y revisión de la literatura / Actinomyces and Kartagener syndrome: Case report and literature review

RESUMEN El síndrome de Kartagener, el cual hace parte del subgrupo de las discinesias ciliares primarias predispone a infecciones respiratorias recurrentes del tracto respiratorio por Haemophilus influenzae, Staphylococcus aureus y Streptococcus pneumoniae. Se describe a continuación el caso de un paciente con diagnóstico de síndrome de Kartagener en quien se documentó colonización por Pseudomonas fluorescens y neumonía con empiema asociado por Actinomyces spp, una asociación poco frecuente en la literatura.

ABSTRACT Kartagener syndrome, which is part of the subgroup of the primary ciliary dyskinesias, predisposes to recurrent respiratory tract infections due to Haemophilus influenzae, Staphylococcus aureus and Streptococcus pneumoniae. The case of a patient with a diagnosis of Kartagener syndrome in whom colonization by Pseudomonas fluorescens and pneumonia complicated with empyema by Actinomyces spp is a rare association in the literature, which is described below.

Neumonía por Raoultella planticola en paciente con COVID-19 crítico / Raoultella planticola pneumonia in a patient with critical COVID-19

RESUMEN Raoultella Planticola es una bacteria que se ha descrito recientemente en la literatura como patógeno emergente de infecciones urinarias, abdominales y pulmonares. A continuación, se presenta el caso de un paciente de 63 años con antecedente de sobrepeso y dislipidemia hospitalizado en contexto de neumonía por SARS CoV2 quien presenta sobreinfección por R. Planticola y E. Aerogenes. Recibió manejo con Cefepime por 7 días con adecuada evolución clínica.

ABSTRACT Raoultella planticola is a bacterium that has been recently described in the literature as an emerging pathogen that causes urinary, abdominal, and lung infections. We present the case of a 63-year-old overweight and with dyslipidemia that was hospitalized because of a SARS-CoV-2 infection. He developed R. planticola and E. aerogenes superinfections. He was treated with cefepime for seven days, and he recovered uneventfully.

Anca-positive vasculitis with full-house nephropathy, an unusual association: a case report and review of literature.

Rapidly progressive glomerulonephritis is a medical emergency, with mortality around 20%. It is characterized by crescent glomerulonephritis and progressive loss of kidney function, hematuria, and proteinuria. Its classification is given by immunofluorescence detection of antibodies against glomerular basement membrane (Anti-MBG), immunocomplexes, or pauci-immune pattern. Its etiology should be based on clinical findings, immunological profile, age, sex, and histopathological characteristics. We present a case of a 27-year-old woman with symptoms consistent with rapidly progressive glomerulonephritis and biopsy findings of a full-house kidney nephropathy, with an early fatal outcome. An association of low incidence, as it is a case with a full-house pattern, and an autoimmune profile for negative systemic lupus erythematosus makes this a rare case. ANCA-associated vasculitis with full-house kidney disease was diagnosed, an unusual condition with up to 3% presentation and few reports in the literature, highlighting the importance of its reporting and contribution to the literature.

Síndrome de Hamman - rich: Reporte de caso / Hamman-Rich Syndrome: case report

Resumen La neumonía intersticial aguda, también conocida como síndrome de Hamman-Rich, se caracteriza por la presencia de insuficiencia respiratoria aguda, hallazgo imagenológico de infiltrados difusos bilaterales del parénquima pulmonar y daño alveolar difuso en histopatología pulmonar. Es una patología con una mortalidad mayor al 50% debido a la falta de una terapia específica más allá del manejo sintomático y soporte ventilatorio. Se expone el caso de un paciente masculino de 56 años quien se presenta con síntomas respiratorios inespecíficos, deterioro progresivo de la oxigenación y hallazgo de opacidades en vidrio esmerilado difusas bilaterales. Además, biopsia pulmonar en la que se evidencia daño alveolar difuso en fase fibroproliferativa en quien se descarta proceso infeccioso, enfermedades autoinmunes y toxicidad medicamentosa, por lo que se hace el diagnóstico. Recibió manejo con pulsos de metilprednisolona con recuperación completa del cuadro. MÉD.UIS.2021;34(3): 103-8.

Abstract Acute interstitial pneumonitis, also known as Hamman Rich syndrome, characterised by acute respiratory failure, bilateral lung infiltrates on radiographs and diffuse alveolar damage (DAD) on lung histopathology, is an exclusion diagnosis which requires a complete study of other possible etiologies of DAD. It is a pathology with a mortality greater than 50% due to not having a specific therapy beyond symptomatic management and ventilatory support. We present a case of a 56 year old male with respiratory symptoms, who has progressive worsening oxygen levels and bilateral ground glass opacities on chest images. Lung biopsy with diffuse alveolar damage, infection, autoimmune diseases, and drug adverse reaction were ruled out. Managed with mechanical ventilation and high dose systemic corticoids with complete recovery. MÉD.UIS.2021;34(3): 103-8.

Neumonía por coinfección de Aspergillus fumigatus y Pneumocystis jirovecii en un paciente no VIH: Reporte de caso / Pneumonia due to Aspergillus fumigatus and Pneumocystis jirovecii coinfection in a non-HIV- infected patient: Case report

RESUMEN La aspergilosis pulmonar invasiva es una enfermedad presente principalmente en pacientes inmunocomprometidos con alta carga de mortalidad. La neumonía por Pneumocystis jirovecii es una infección oportunista potencialmente mortal que afecta a pacientes inmunocomprometidos por diversas etiologías. La coinfección por estos patógenos en pacientes inmunocompetentes es inusual. Reportamos un caso de un paciente sin las causas tradicionales de inmunocompromiso en el desarrollo de una neumonía en coinfección por Aspergillus fumigatus y Pneumocystis jirovecii.

ABSTRACT Invasive pulmonary aspergillosis is a condition that mainly occurs in immunosuppressed patients, and it has a high mortality rate. Pneumonia caused by Pneumocystis jirovecii is a potentially lethal opportunistic infection affecting immunosuppressed patients with different etiology. Coinfection by Aspergillus and P. jirovecii in immunocompetent patients is unusual. We report a case of a patient with no common causes of immunosuppression who developed pneumonia coinfection caused by Aspergillus fumigatus and Pneumocystis jirovecii.

Síndrome de Sweet por tuberculosis peritoneal: reporte de caso / Sweet's Syndrome due to peritoneal tuberculosis: Case report

Resumen La tuberculosis (TBC) peritoneal es una entidad poco frecuente y representa un 25 %-50 % de los casos de tuberculosis abdominal, y 0,1 %-0,7 % de todos los casos de tuberculosis. La mortalidad alcanza un 35 % cuando hay un retraso en el tratamiento, y un 73 % en pacientes con cirrosis. Además, tiene un gran espectro clínico, por lo que su diagnóstico diferencial abarca a nivel clínico patologías como cirrosis, malignidad, síndrome nefrótico, desnutrición; a nivel imagenológico enfermedad metastásica peritoneal, carcinomatosis de origen gástrico, pancreático, vesical, ovárico, colónico y enfermedades infecciosas como actinomicosis, coccidioidomicosis, histoplasmosis o micobacterias no tuberculosas. El diagnóstico se apoya inicialmente con química sanguínea, función hepática y renal, ultrasonido, tomografía computarizada (TC), paracentesis con citoquímico de líquido peritoneal, medición de adenosina-desaminasa (ADA) y reacción en cadena de polimerasa (PCR); no obstante, la laparoscopia con biopsia peritoneal y confirmación patológica o microbiológica siguen siendo el estándar de oro. Se han descrito casos de falsos negativos de la prueba ADA en situaciones de inmunosupresión o uso de antituberculosos. Se ha planteado el seguimiento de la actividad de la enfermedad midiendo los niveles de antígeno del cáncer 125 (CA-125). A continuación, presentamos un caso inusual de un paciente con TBC peritoneal con un síndrome de Sweet secundario, en quien inicialmente el reporte para ADA fue negativo, posiblemente debido a la administración de meropenem y en quien, además, se hizo el seguimiento de la actividad de la enfermedad con CA-125. Son muy excepcionales los reportes de falsos negativos de ADA y Sweet secundario a tuberculosis, por lo cual aportamos a la literatura con el reporte de nuestro caso.

Abstract Peritoneal tuberculosis is a rare disease that accounts for 25-50% of abdominal tuberculosis cases and 0.1-0.7% of all cases of tuberculosis. Mortality is 35% when treatment is delayed, and 73% in patients with cirrhosis. It also has a wide clinical spectrum, so its differential diagnosis covers conditions such as cirrhosis, malignancy, nephrotic syndrome, and malnutrition. Moreover, imaging studies may reveal peritoneal metastases; carcinomatosis of gastric, pancreatic, bladder, ovarian, colonic origin; and infectious diseases such as actinomycosis, coccidioidomycosis, histoplasmosis or non-tuberculous mycobacteria. Diagnosis is initially supported by blood chemistry, liver and renal function tests, ultrasound, CT scans, paracentesis with peritoneal fluid cytochemistry, and ADA and PCR measurement. The gold standard is laparoscopy with peritoneal biopsy and pathological or microbiological confirmation. Cases of false negatives of the ADA test have been described in immunosuppression or use of antituberculosis drugs. Monitoring of disease activity by measuring CA-125 levels has been considered. The following is the report of an unusual case of peritoneal TB with secondary Sweet's syndrome, in which the ADA report was initially negative, possibly due to meropenem administration, and in whom disease activity was monitored through Ca125. False negative reports of ADA and Sweet's secondary to TB are very rare, so this case contributes to the literature on these conditions.

Características clínicas y sociodemográficas de una población adulta con tumores neuroendocrinos

Introducción: Los tumores neuroendocrinos representan un grupo de neoplasias de baja incidencia que derivan de células neuroendocrinas distribuidas en todo el cuerpo en especial sistema respiratorio y gastrointestinal. Objetivo: Determinar las características clínicas y sociodemográficas de una población adulta con padecimiento de tumores neuroendocrinos. Materiales y métodos: Estudio descriptivo transversal, se evaluaron 91 historias clínicas con diagnóstico de tumores neuroendocrinos confirmados por patología entre los años 2013 a 2020. Análisis realizado en Microsoft Excel 2013 y EpiInfo 7.2. Resultados: La media de edad fue 60 años, con predominio en hombres (57%). Los principales antecedentes fueron el tabaquismo (35%), hipertensión arterial (22%) y EPOC (9%). Los principales síntomas fueron el dolor abdominal (43%), pérdida de peso (31%) y tos (26%). Según el origen, fueron más frecuentes los de intestino anterior (75%), predominando los de tracto respiratorio (39,5%). En el 21,9%, el origen fue desconocido. Teniendo en cuenta la clasificación 2019 de la OMS, predominaron los carcinomas neuroendocrinos (56%), de los cuales el más frecuente fue el carcinoma de células pequeñas. Entre los bien diferenciados (44%), fueron más frecuentes los de bajo grado (58%) seguido grado intermedio (24%) y bajo grado (17%). Las metástasis se registraron en 37% de los casos con afectación principalmente hepática (49%), ganglios (21%) y sistema nervioso central (9%). La muerte se presentó en el 24% de los casos. Conclusiones: Los resultados del presente estudio concuerdan con lo reportado a nivel mundial, resaltando el predominio de los tumores de origen pulmonar, como también clínica semejante según los órganos afectados.

Introduction: Neuroendocrine tumors represent a group of low-incidence neoplasms derived from neuroendocrine cells distributed throughout the body, especially the respiratory and gastrointestinal systems. Objective: To determine the clinical and sociodemographic characteristics of an adult population with neuroendocrine tumors. Materials and methods: In a descriptive cross-sectional study, 91 medical records with a diagnosis of neuroendocrine tumors confirmed by pathology were evaluated between the years 2013 and 2020. Analysis carried out in Microsoft Excel 2013 and EpiInfo 7.2. Results: The mean age was 60 years, with a predominance in men (57%). The main antecedents were smoking (35%), arterial hypertension (22%), and COPD (9%). The main symptoms were abdominal pain (43%), weight loss (31%), and cough (26%). According to the origin, those of the foregut were more frequent (75%), predominantly those of the respiratory tract (39.5%). In 21.9%, the origin was unknown. Taking into account 2019 WHO classification, neuroendocrine carcinomas predominated (56%), of which the most frequent was small cell carcinoma. Among the well-differentiated (44%), low-grade (58%) followed by intermediate grade (24%) and low-grade (17%). Metastases were registered in 37% of the cases with mainly liver involvement (49%), lymph nodes (21%), and central nervous system (9%). Death occurred in 24% of cases. Conclusions: The results of the present study coincide with those reported worldwide, highlighting the predominance of tumors of pulmonary origin, as well as similar clinical symptoms according to the affected organs

Quiste mesentérico gigante: reporte de caso / Giant mesenteric cyst. Case report

Resumen El quiste mesentérico es una patología intraabdominal poco frecuente, en su mayoría benigna. El tratamiento casi siempre es quirúrgico y consiste en la resección del quiste y de los órganos involucrados siempre que sea posible con el fin de reducir la tasa de recurrencia. Se presenta el caso de un paciente de 38 años con dolor abdominal inespecífico y diagnóstico ecográfico de masa retroperitoneal zona II izquierda gigante. Los estudios de extensión incluyeron tomografía axial computarizada, resonancia magnética y endoscopia de vías digestivas altas, cuyos hallazgos informaron una lesión quística gigante. Se realizó resección quirúrgica de la lesión por vía abierta, con diagnóstico histopatológico de quiste mesentérico.

Abstract A mesenteric cyst is a rare, mostly benign, intra-abdominal tumor. Treatment is almost always surgical and consists of removing the cyst and involved organs whenever possible to prevent recurrence. The following is the case of a 38-year-old patient with nonspecific abdominal pain and an ultrasound diagnosis of a giant retroperitoneal mass in the left medial paracolic gutter. The following imaging studies were performed: computed tomography, magnetic resonance, and endoscopy, finding a giant cystic lesion. An exploratory laparotomy was performed to remove the mass, and a histopathology report confirmed the diagnosis of mesenteric cyst.

Hiperamonemia como causa de diálisis no renal / Hyperammonemia as a cause of non-renal dialysis

Resumen La hiperamonemia es una condición frecuente en pacientes cirróticos y en el contexto de una causa no cirrótica se relaciona con aumento en la producción de amonio o alteración en su eliminación. La presentación clínica de esta condición es inespecífica: va desde alteración del comportamiento hasta estado de coma, siendo una de las causas de diálisis no renal por determinados valores o refractariedad a manejo médico. Se presenta el caso de una mujer de 35 años, quien ingresó al servicio de urgencias con alteración del estado de conciencia, niveles de amonio elevados y masa hipervascular en hígado. Los estudios de aminoácidos limitantes del ciclo de la urea y ácido orótico urinario fueron normales y la biopsia de la lesión hepática reportó carcinoma hepático fibrolamelar, al cual se atribuyó la presencia de shunt portosistémico que causaba la hiperamonemia. Se indicó diálisis por persistencia de elevaciones de amonio y poca respuesta al tratamiento médico. Dada la evolución de la paciente, fue necesario reiniciar la terapia reemplazo renal por reaparición de estado encefalopático al suspender la misma. Esta terapia se mantuvo hasta el trasplante hepático que se realizó como tratamiento del carcinoma, con posterior estabilización de niveles de amonio y suspensión de la diálisis.

Abstract Hyperammonemia is a common condition in cirrhotic patients. In the context of a non-cirrhotic cause, this is related to the increase in its production of ammonium or alteration in its elimination. The clinical presentation is nonspecific, from the alteration of the behavior to the coma, being one of the causes of non-renal dialysis due to certain values or refractoriness to medical management. The case of a 35-year-old woman is presented, who is admitted to the emergency department with altered state of consciousness, elevated ammonium levels and hypervascular mass in the liver. Biopsy of the liver lesion reports fibrolamellar liver carcinoma. The presence of a portosystemic shunt that causes hyperammonemia is attributed to this pathology. Dialysis is indicated by persistence of ammonium elevations with little response to medical treatment. In its evolution, it required a restart of renal replacement due to a reappearance of the encephalopathic state when it was suspended. This therapy is maintained until liver transplantation performed as a carcinoma treatment, with subsequent stabilization of ammonium levels and dialysis suspension.

Tuberculosis ileocecal: a propósito de un caso / Ileocecal tuberculosis: A case report

Resumen La tuberculosis es una enfermedad de importancia en la salud pública a nivel mundial, con una alta incidencia a nivel del territorio colombiano. Principalmente, afecta el parénquima pulmonar; sin embargo, en un porcentaje elevado de casos se diagnostica en su forma extrapulmonar y el tracto gastrointestinal es uno de los sitios más frecuentes. Así mismo, la región ileocecal y el íleon terminal son las regiones con más predilección por la bacteria Mycobaterium tuberculosis. Las manifestaciones en esta rara presentación de la enfermedad están dadas por dolor abdominal y sensación de masa principalmente, lesiones ulcerosas en la mucosa intestinal y hallazgos histológicos correspondientes a granulomas caseificantes de gran tamaño y de morfología confluente, que se diferencian de otras entidades como la enfermedad de Crohn. La búsqueda de la enfermedad dentro del tracto gastrointestinal se realiza con ayuda de métodos invasivos como la colonoscopia y de ayudas diagnósticas de laboratorio como cultivos, tinciones o reacción en cadena de la polimerasa (PCR). Dada la complejidad en el diagnóstico de esta forma de tuberculosis, el conocimiento y la manera en que se aborda un paciente con un cuadro sugestivo de esta enfermedad son factores importantes para establecer el manejo terapéutico oportuno. Se comparte un caso inusual de tuberculosis ileocecal como manifestación de síndrome febril prolongado con desenlace fatal.

Abstract Tuberculosis is a disease of public health importance worldwide with a high incidence in Colombia. It mainly affects the lung parenchyma. However, in a large number of cases, it is diagnosed in its extrapulmonary form, with the gastrointestinal tract being one of the most frequent sites. Mycobacterium tuberculosis has a strong predilection for the ileocecal region and the terminal ileum. Manifestations of this rare form of the disease are abdominal pain and mass sensation mainly, as well as ulcerative lesions in the intestinal mucosa and histological findings corresponding to large caseating granulomas of confluent morphology, which distinguish it from other entities such as Crohn's disease. Invasive procedures, such as colonoscopy, and diagnostic laboratory aids, such as cultures, stains, and PCR, are used to find the disease in the gastrointestinal tract. Given the difficulty of diagnosing this type of tuberculosis, knowledge and how a patient with symptoms suggestive of the disease is approached are critical factors for establishing timely treatment. The following is an unusual case of ileocecal TB as a manifestation of prolonged febrile illness with a fatal outcome.

Experimental Methodology for the Separation Materials in the Recycling Process of Silicon Photovoltaic Panels.

As the use of photovoltaic installations becomes extensive, it is necessary to look for recycling processes that mitigate the environmental impact of damaged or end-of-life photovoltaic panels. There is no single path for recycling silicon panels, some works focus on recovering the reusable silicon wafers, others recover the silicon and metals contained in the panel. In the last few years, silicon solar cells are thinner, and it becomes more difficult to separate them from the glass, so the trend is towards the recovery of silicon. In this paper, we investigate the experimental conditions to delaminate and recovery silicon in the recycling process, using a combination of mechanical, thermal, and chemical methods. The conditions of thermal treatment to remove the ethylene-vinyl acetate (EVA) layer were optimized to 30 min at 650 °C in the furnace. To separate silicon and metals, the composition of HF/HNO3 solution and the immersion time were adjusted considering environmental aspects and cost. Under the selected conditions, panels from different manufacturers were tested, obtaining similar yields of recovered silicon but differences in the metal concentrations.