Neumonía intersticial aguda por micosis pulmonar. Presentación de caso clínico.

Introduction: Interstitial pneumonia is an acute and rapidly progressive lung disease that often leads to respiratory failure and respiratory distress syndrome. Pulmonary mycosis is an infection that can behave like a chronic lung disease or an invasive fungal infection, mainly in immunocompromised patients. Objective: the general objective is to report a clinical case of a patient with acute interstitial pneumonia due to pulmonary mycosis, treated in the intensive care unit, as well as to describe its diagnosis, treatment and evolution. Materials and methods: A descriptive study was carried out; With presentation of a clinical case, relevant aspects of acute interstitial pneumonia due to pulmonary mycosis, authorization was requested from the teaching and research department of the Teodoro Maldonado Carbo hospital, for the review of the clinical history, images, and data publication. Clinical case: the case of a 41-year-old male patient with acquired immunodeficiency syndrome is presented, who was admitted to the intensive care unit due to neurological deterioration and who developed pulmonary sepsis due to Candida tropicalis, hemodynamically unstable with outcome not favorable. Discussion: Pulmonary fungal infections are associated with high morbidity and mortality. The risk factors that favor the presence of invasive pulmonary mycosis are: structural lung damage, immunological compromise such as immunodeficiency, patients in critical condition and with haematological tumors, the latter group being the most at risk.  Conclusion: Candida tropicalis is a fungus rarely reported as a cause of pneumonia. The importance of the case presented lies in the fact that this was the causative agent of infection, evidencing invasive candidiasis, characteristic of biofilm-forming candida species, having a more serious course than other species, since its diagnosis and treatment in due time they are vital.La neumonía intersticial es una enfermedad pulmonar aguda y rápidamente progresiva que a menudo conduce a insuficiencia respiratoria y síndrome de dificultad respiratoria. La micosis pulmonar es una infección que se puede comportar como una enfermedad pulmonar crónica o una infección fúngica invasiva, principalmente en pacientes inmunodeprimidos. Objetivo: el objetivo general es realizar el reporte de un caso clínico, de un paciente con neumonía intersticial aguda por micosis pulmonar, atendido en la unidad de cuidados intensivos, así como describir su diagnóstico, tratamiento y evolución. Materiales y métodos: Se realizó un estudio descriptivo; con presentación de caso clínico, aspectos relevantes sobre neumonía intersticial aguda por micosis pulmonar, se solicitó autorización al departamento de docencia e investigación del hospital Teodoro Maldonado Carbo, para la revisión de historia clínica, imágenes y publicación de datos. Caso clínico: se presenta el caso de un paciente masculino de 41 años de edad con síndrome de inmunodeficiencia adquirida,  que ingresó a la unidad de cuidados intensivos, por  deterioro neurológico y   que desarrollo sepsis de foco pulmonar,  por Cándida tropicalis,  Hemodinámicamente inestable con desenlace no favorable. Discusión: Las infecciones pulmonares por hongos, se asocian con una morbilidad y mortalidad elevada. Los factores de riesgo que favorecen la presencia de micosis pulmonar invasiva son: daño pulmonar estructural, compromiso inmunológico como inmunodeficiencia, pacientes en estado crítico y con tumores hematológicos, siendo este último grupo los de mayor riesgo. Conclusión: La Cándida tropicalis es un hongo poco reportado como causa de  neumonía. La importancia del caso presentado radica en que, ésta, fue el agente causal de infección, evidenciándose candidiasis invasiva, característico de especies de cándidas formadoras de biopelículas, teniendo un curso más grave que otras especies, por cuanto su diagnóstico y tratamiento en el debido tiempo son vitales

Insuficiencia respiratoria aguda, hipoxemia refractaria y ventilación mecánica. Una revisión sistemática.

Acute respiratory distress syndrome (ARDS) or also known as respiratory distress, is an interruption of homeostasis at the alveolar level that can promote: hypoventilation, deterioration of diffusion, shunt and mismatch between ventilation - perfusion or a combination of both. Refractory hypoxemia is defined as a partial blood oxygen pressure measured by blood gas (PaO2) 60 mmHg or a divided oxygen blood pressure ratio for the oxygen inspiratory fraction, PaO2/FiO2 or (PAFI) 100. Mechanical ventilation is a necessary life support measure in the treatment of severe acute respiratory failure. General Objective: To determine the ventilatory management of patients with acute respiratory failure and refractory hypoxemia. Specific objectives: To evaluate the use of ECMO in refractory hypoxemia 2) To determine the usefulness of non-invasive mechanical ventilation, oxygen therapy and adjuvant therapy. METHODS: a systematic review of the literature according to the PRISMA 2020 declaration was carried out with articles from the last 5 years in the vast majority. Databases such as academic Google, Pubmed, IntechOpen, Mendeley, ScienceDirect, journals: JAMA, BMJ, critical care, NEJM, respiratory care were consulted: randomized studies, multicenter studies, clinical cases, review articles, meta-analysis, systematic review, guidelines, observational, descriptive, retrospective studies and consensus documents on the topics: acute respiratory failure, refractory hypoxemia and mechanical ventilation. RESULTS: Position in a prone position is of great importance during distress, as is support with extracorporeal circulation membrane, neuromuscular block and corticosteroids in the treatment of ARDS. As for the ventilatory strategies in this group of patients, intubation is the first step, via translaringea and connection to invasive mechanical ventilation, after which, we can apply the following strategies to improve oxygenation: Use of low Vt in volume-controlled ventilatory modes, low plateau pressures <30 in controlled modes that minimize barotrauma and low FiO2, to prevent oxygen-free radical-related injuries. Current evidence supports use of tidal volume (Vt) lower 6 ml/kg. DISCUSSION: Mechanical ventilatory management of the critical patient with acute respiratory failure presenting refractory hypoxemia includes evaluating oxygenation by PaO2/FiO2. the primary objective is to achieve adequate airway pressure values, apply low Vt, maintain an adequate plateau pressure and measure the conduction pressure to titrate the PEEP at the lowest possible value. Pronation is vital to improve oxygenation and airway pressures. The results of this research showed that, there is benefit of mechanical ventilation with the use of ECMO in this group of patients, in addition, it was determined that high flow oxygen therapy only decreases hypoxemia before intubation, without altering mortality. Dexamethasone, if it provides benefit, as adjuvant therapy in the treatment of acute respiratory failure, with refractory hypoxemiaIntroducción: El síndrome de dificultad respiratoria aguda (SDRA) o también conocido como distress respiratorio, es una interrupción del homeostasis a nivel alveolar que puede promover: hipoventilación, deterioro de la difusión, derivación y desajuste entre la ventilación - perfusión o una combinación de ambas

Embarazo ectópico cervical. Presentación de caso clínico

Cervical pregnancy is the rarest form of ectopic pregnancy, in which the embryo implants and grows within the endocervical canal, like all ectopic pregnancies, can rupture acutely and are the main cause of maternal death in the first trimester of pregnancy, so early recognition and accurate location have significant clinical implications on morbidity and mortality in pregnant women. The aim of this study was to describe a clinical case of cervical ectopic pregnancy, successfully managed with conservative surgical treatment. Relevant aspects about this pathological clinical condition and the importance of timely diagnosis and treatment are described. Informed consent was requested from the patient. Authorization was obtained from the Department of Teaching and Research, allowing the review of clinical history and images for the publication of the case. The present study concludes that cervical ectopic pregnancy is a rare pathological condition with a very high mortality rate if not diagnosed and treated in time. Its management will depend on the hemodynamic state of the patient and her desire to preserve fertilityEl embarazo cervical, es la forma más rara de embarazo ectópico, en la cual el embrión se implanta y crece dentro del canal endocervical, al igual que todos los embarazos ectópicos, pueden romperse de forma aguda y son la principal causa de muerte materna en el primer trimestre del embarazo, por lo que, el reconocimiento precoz y la localización precisa tienen implicaciones clínicas significativas sobre la morbimortalidad en la gestante. El objetivo de este trabajo fue describir un caso clínico de embarazo ectópico cervical, manejado exitosamente con tratamiento quirúrgico conservador. Se describen aspectos relevantes sobre esta condición clínica patológica y la importancia del diagnóstico y tratamiento oportuno.  Se solicitó el consentimiento informado a la paciente. Se obtuvo la autorización del Departamento de docencia e investigación, permitiendo la revisión de historia clínica e imágenes para la publicación del caso. En el presente trabajo se concluye que el embarazo ectópico cervical, es una condición patológica rara y con una tasa de mortalidad muy alta si no se diagnostica y trata a tiempo. Su manejo va a depender del estado hemodinámico de la paciente y de su deseo de preservación de la fertilida

Determination of heavy metals at the electrochemically reduced graphene oxide mercury film electrode (ERGO-HgF-PGE) using adsorptive stripping voltammetry

>Magister Scientiae - MScThis work reports the use of a pencil graphite electrode (PGE) as inexpensive and sensitive electrochemical sensing platform fabricated by using electrochemically reduced graphene oxide (ERGO) in conjunction with an in-situ plated thin mercury film. For the first time the ERGOHgF-PGE sensor is proposed for simultaneous detection of cadmium (Cd2+), copper (Cu2+), lead (Pb2+) and zinc (Zn2+) using N-Nitroso-N-phenylhydroxylamine (cupferron) as complexing agent by square-wave adsorptive cathodic stripping voltammetry (SW-AdCSV). The technique is based on the adsorption of cupferron- metal ion complexes onto the surface of the ERGO-HgFPGE at 0.1 V for 60 s carried out in 0.1 M acetate buffer solution (pH 4.6). The synthesized graphene oxide (GO) and graphene nanosheets (GNs) were characterized using different analytical techniques such as FT-IR which confirms the presence of oxygen moieties embedded in the graphitic structure and further demonstrated by UV-Vis, validating the synthesis of GO202

The prevalence and risk factors associated with Iron, vitamin B12 and folate deficiencies in pregnant women: A cross-sectional study in Mbeya, Tanzania.

Maternal nutrition is an important forecaster of infant's and mother's health status in most developing countries. This study aimed at assessing the prevalence and associated risk factors of iron, vitamin B12, and folate deficiencies among pregnant women in Mbeya Tanzania. A cross-sectional study using a cluster randomized sampling was conducted among 420 pregnant women. A structured questionnaire was used to collect socio-demographic and dietary assessment. Body iron store was assessed using serum ferritin measured by immunoturbidimetric assays using a Roche Cobas 400+ biochemistry analyzer. Serum folate was measured by folate microbiological assay, while serum vitamin B12 was measured by immunochemiluminescence assay using a Roche Cobas e411 immunoassay analyzer. Multivariate analysis was performed using Poisson regression. The prevalence of iron, folate, and vitamin B12 deficiencies among pregnant women in Mbeya was 37.8%, 24.0%, and 9.7% respectively. Higher odds of iron deficiency were seen in pregnant women aged 20-24 years older [Adjusted OR = 1.20 (95%CI 1.03, 1.35)], not employed [Adjusted OR = 3.0(95%CI 1.03-1.77)] and, not received iron/folic acid supplementation [Adjusted OR = 1.11 (95%CI 1.003-1.23)]. Pregnant women with highest and middle socio-economic statuses had lower odds of vitamin B12 deficiency [Adjusted OR = 0.83 (95%CI 0.76-0.92)] and [Adjusted OR = 0.89 (95%CI 0.81-0.98)] respectively. Pregnant women who were not employed, not received iron and folic acid supplement during pregnancy and, not consumed edible vegetable cooking oil had significant higher odds of serum folate deficiency [Adjusted OR = 3.0 (95%CI 1.58-5.68)], [Adjusted OR = 1.53 (95%CI 1.21-1.93)] and, [Adjusted OR = 2.77 (1.03-7.44)] respectively. This study confirms that iron, folate and vitamin B12 deficiencies are still a major challenge among pregnant women in Tanzania. We recommend for public health interventions for the provision of vitamin B12 along with iron and folic acid supplementations, especially in pregnant women belong to low socio-economic status and limited knowledge of healthy diet