Carcinomatosis meníngea, un desafío diagnóstico. Reporte de caso

We present the case of a 66-year-old male patient, hypertensive, with diffuse gastric adenocarcinoma stage IV and malignant tumor of right orbit. The patient consulted for loss of consciousness and incoherent language. Physical examination revealed meningeal signs. Lumbar puncture showed elevated opening pressure, pleocytosis, hypoglycaemia, hyperproteinorrachia, high lactate, with negative microbiological examination. These clinical data and CSF analysis initially determined acute meningitis. However, the neurological service proposed as a diagnostic impression meningeal carcinomatosis, which required three lumbar punctures to confirm it. Meningeal carcinomatosis is a differential diagnosis that must be considered in a patient with tumoral pathology and meningeal signs. Clinical suspicion, cytochemical findings, and cytology by CSF cyto-centrifuge are important.Se presenta el caso de un paciente masculino de 66 años, hipertenso, con adenocarcinoma gástrico difuso estadio IV y tumor maligno de órbita derecha, que consultó por cuadro de pérdida de conciencia y lenguaje incoherente. Al examen físico se encontraron signos meníngeos y la punción lumbar mostró presión de apertura elevada, pleocitosis, hipoglucorraquia, hiperproteinorraquia, lactato alto, con examen microbiológico negativo; estos datos clínicos y el análisis de LCR determinaron inicialmente el diagnóstico de meningitis aguda. Sin embargo, el servicio de neurología propuso como impresión diagnóstica carcinomatosis meníngea, la cual requirió tres punciones lumbares para confirmarla. La carcinomatosis meníngea es un diagnóstico diferencial que debe plantearse en un paciente con patología tumoral y signos meníngeos. Es importante la sospecha clínica, los hallazgos en el citoquímico y la citología por cito-centrífuga de líquido cefalorraquídeo

Meningeal carcinomatosis. Case report

We present the case of a 66-year-old male patient, hypertensive, with diffuse gastric adenocarcinoma stage IV and malignant tumor of right orbit. The patient consulted for loss of consciousness and incoherent language. Physical examination revealed meningeal signs. Lumbar puncture showed elevated opening pressure, pleocytosis, hypoglycaemia, hyperproteinorrachia, high lactate, with negative microbiological examination. These clinical data and CSF analysis initially determined acute meningitis. However, the neurological service proposed as a diagnostic impression meningeal carcinomatosis, which required three lumbar punctures to confirm it. Meningeal carcinomatosis is a differential diagnosis that must be considered in a patient with tumoral pathology and meningeal signs. Clinical suspicion, cytochemical findings, and cytology by CSF cyto-centrifuge are important

Masa en tránsito en el ventrículo derecho: ¿tumor vs trombo?

Echodense images in the RV have a wide spectrum of diagnoses, the main ones being tumors or thrombi. We present the case of a 31-year-old woman in whom an echodense mass in transit in RV suggestive of thrombus was incidentally diagnosed. Venous thromboembolic disease was ruled-out. Cardiac MRI confirmed the echocardiographic diagnosi. The surgery showed new over old thrombus, and she received indefinite oral anticoagulation. This case shows how the multimodal imaging allows the accurate assessment of RV masses. The thrombus in the RV forces the clinician to rule out associated diseases.Las imágenes ecodensas en el VD tienen un amplio espectro de diagnósticos, los principales son tumores o trombos. Se presenta el caso de una mujer de 31 años en la que se diagnostica de forma incidental una masa ecodensa en tránsito en VD sugestiva de trombo. Se ampliaron estudios descartando enfermedad tromboembólica venosa. La resonancia cardíaca confirmó el diagnóstico ecocardiográfico, fue llevada a resección quirúrgica evidenciando trombo antiguo más nuevo y recibió anticoagulación oral indefinida. Este caso muestra como la imagen multimodal permite valorar de forma precisa las masas del VD. El trombo en el VD obliga al clínico descartar enfermedades asociadas

Staphylococcus aureus endocarditis of the tricuspid valve after septic abortion: Case report and literature review

We report a case of a female patient, 22 years old, with a diagnosis of tricuspid valve endocarditis by S. aureus following septic abortion. The diagnosis was established by the Duke University criteria and it was confirmed by the echocardiographic findings

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Control of blood pressure and cardiovascular outcomes in type 2 diabetes

High blood pressure in patients with diabetes mellitus results in a significant increase in the risk of cardiovascular events and mortality. The current evidence regarding the impact of intervention on blood pressure levels (in accordance with a specific threshold) is not particularly robust. Blood pressure control is more difficult to achieve in patients with diabetes than in non-diabetic patients, and requires using combination therapy in most patients. Different management guidelines recommend initiating pharmacological therapy with values >140/90 mm/Hg; however, an optimal cut point for this population has not been established. Based on the available evidence, it appears that blood pressure targets will probably have to be lower than <140/90mmHg, and that values approaching 130/80mmHg should be recommended. Initial treatment of hypertension in diabetes should include drug classes demonstrated to reduce cardiovascular events; i.e., angiotensin converting-enzyme inhibitors, angiotensin receptor blockers, diuretics, or dihydropyridine calcium channel blockers. The start of therapy must be individualized in accordance with the patient's baseline characteristics, and factors such as associated comorbidities, race, and age, inter alia

Riesgo cardiovascular en artritis reumatoidea: revisión narrativa

Rheumatoid arthritis (RA) is a chronic autoimmune disease with an especially articular involvement that is associated with an exponential increase in cardiovascular risk (CVR). Disease activity can be measured with clinimetric scores, such as Disease Activity Score 28 (DAS 28), and CVR with scales such as Framingham and SCORE, available as an electronic application for mobile devices. Adequate disease control decreases CVR. Achieving this goal requires the very important participation of the first level health centers, for whom this review presents a practical approach on specific aspects of RA treatment and CVR approach.La artritis reumatoide (AR) es una enfermedad autoinmune crónica con compromiso especialmente articular que se relaciona con un aumento exponencial del riesgo cardiovascular (RCV). La actividad de la enfermedad se puede medir con escalas clinimétricas, como el Disease Activity Score 28 (DAS 28) y el RCV con escalas como la de Framingham y SCORE, disponibles como aplicación electrónica para dispositivos móviles. El adecuado control de la enfermedad disminuye el RCV; lograr este objetivo requiere la participación importante de los centros de salud de primer nivel, para quienes se presenta en esta revisión una aproximación práctica sobre aspectos concretos de tratamiento de la AR y enfoque del RCV

Síndrome de Tako-Tsubo: Reporte de caso clínico y revisión de la literatura.

We report a case of 73 year old female patient with a diagnosis of Tako-Tsubo syndrome (Transient left ventricular apical dysfunction) secondary to a stressful event. The diagnosis is confirmed by the Mayo Clinic criteria, emphasizing in the clinical, electrocardiographic, echocardiographic and angiographic findings. We review the literature.Se reporta el caso de paciente femenina de 73 años con diagnóstico de síndrome de Tako-Tsubo (Síndrome de disfunción ventricular izquierda apical transitoria) secundario a un evento estresante. Se confirma el diagnóstico por medio de los criterios de la Clínica de Mayo, enfatizando en los datos clínicos, electrocardiográficos, ecocardiográficos y angiográficos. Se revisa la literatura

Tako-Tsubo syndrome: Case report

We report a case of 73 year old female patient with a diagnosis of Tako-Tsubo syndrome (Transient left ventricular apical dysfunction) secondary to a stressful event. The diagnosis is confirmed by the Mayo Clinic criteria, emphasizing in the clinical, electrocardiographic, echocardiographic and angiographic findings. We review the literature

Cardiovascular risk in rheumatoid arthritis: a narrative review

Rheumatoid arthritis (RA) is a chronic autoimmune disease with an especially articular involvement that is associated with an exponential increase in cardiovascular risk (CVR). Disease activity can be measured with clinimetric scores, such as Disease Activity Score 28 (DAS 28), and CVR with scales such as Framingham and SCORE, available as an electronic application for mobile devices. Adequate disease control decreases CVR. Achieving this goal requires the very important participation of the first level health centers, for whom this review presents a practical approach on specific aspects of RA treatment and CVR approach