Muscular Cysticercosis: An Incidental Finding in the Developed World.

CASE: We present a case of muscular cysticercosis incidentally diagnosed in a patient admitted for a femoral neck fracture and submitted to total hip arthroplasty. CONCLUSION: Human cysticercosis is a parasitic infection representing a major health concern in developing countries. The clinical features are variable and depend on the anatomic location, cyst burden, cysticerci stage, and host inflammatory response. Diagnosis is commonly incidental, and prompt pattern recognition is key to diagnosis, adequate referral, and treatment. This is one of the first reports of hip arthroplasty in a patient with a history of parasitic infection (without the need for directed pathogen treatment).

Azole-resistant Candida albicans Spondylodiscitis After Bariatric Surgery: A Case Report.

CASE: We present a case of azole and partial caspofungin-resistant Candida albicans spondylodiscitis, after bariatric surgery with bowel perforation. Treatment included debridement and several months of anidulafungin, complemented with antibacterial therapy because of relapse for bacterial superinfection. After treatment, the infection did not recur clinically or radiologically during one and half years follow-up. CONCLUSION: Although C. albicans spondylodiscitis is rare, fungi should be suspected as a causative agent. Adequate history, imaging and laboratory testing, and medical and surgical treatment should be performed to successfully eradicate the infection and resolve potential neurological deficits.

[Trauma scores in the management of politrauma patients: which one and what for?]. / Trauma scores na avaliação de politraumatizados: quais e para quê?

BACKGROUND: The improvement rescue and transport of politrauma patients (PTP) increases the number of patients admitted to the Emergency departments in very severe conditions. The early prediction of later complications and bad outcomes is paramount for a good strategy. The aim of this study was to evaluate the severity of PTP in the Trauma Room (TR) of a Level 1 Hospital, using the ISS, RTS, TRISS scores and define variables associated with bad outcomes, namely ICU admission (ICU), ARDS, MODS and Death. MATERIAL/METHODS: Prospective study with data collection of demographic, clinical, laboratory and imaging parameters of all PTP admitted to the TR. The ISS was calculated by the Abbreviated Injury Scale, RTS and TRISS by Trauma.org site formulas. Statistical analysis was performed in SPSS. RESULTS: 278 patients were admitted in TR after Manchester screening during 6 months: 244 (185 men, 59 women) were studied, average age 39,32±19.32 years. Hospital admission- 157 patients (ICU-46, Intermediate Care Unit-29, Surgery Services-82) and 85 discharged. Submitted to Surgery-75. Scores: ISS-13,58±19,32, RTS-7,30±1,01; TRISS-92,42±15,85; Glasgow Coma Score (GCS)-13,00±3,61.Severe complications: ARDS-8%; SIRS-40%; MODS-18%; Death-14%. DISCUSSION: There is statistical correlation between Surgery Type: ICU and MODS; GCS, ISS, RTS, TRISS: ICU, ARDS, MODS and Death. Multivariate analysis shows that Surgery Type, GCS and TRISS predict ICU admission (ROC-0,884); TRISS predicts ARDS (ROC-0,844); TRISS predicts MODS (ROC-0,876); TRISS and age predicts Death (ROC-0,887). CONCLUSIONS: This study confirms scores validity in PTP assessment, as they are able to predict severe complications. TRISS seems to be the best score for prediction of bad outcomes.