Uso del ecocardiograma transtorácico para evaluar la función cardiaca en pacientes con cetoacidosis diabética

La cetoacidosis diabética (CAD) es una complicación grave de la diabetes mellitus (DM). El estrés sistémico, la inflamación y las alteraciones en el equilibro acido-base presentes tienen el potencial de causar daño cardiovascular. El objetivo de nuestro estudio es, evaluar con el uso de ecocardiografía la función y estructura cardíaca durante y posterior a un episodio de CAD. Materiales y métodos. Se realizó un ecocardiograma transtorácico con medición de diámetro, grosor de las paredes y masa del ventrículo izquierdo (VI), además de evaluación de la función diastólica, volúmenes auriculares y función del VI determinada por fracción de eyección (FEVI) y deformación longitudinal global (DLG) (esta última permite detectar defectos sutiles en la función), durante las primeras horas del cuadro de CAD. Se determinaron los niveles de troponina I ultrasensible de manera inicial. El ecocardiograma transtorácico fue repetido posterior a la resolución del cuadro de CAD para comparar los hallazgos durante y posterior al cuadro. Resultados. Un total de 20 sujetos fueron incluidos en el análisis final. La media de edad fue de 33±13.6 años, 70% eran mujeres y 70% tenían DM tipo 1, 75% de los cuadros de CAD fueron severos, el resto moderados. Encontramos que el tiempo de contracción isovolumétrica y tiempo de eyección del VI se encontraban significativamente acortados durante la CAD y se prolongaban tras la resolución (47.6±9.9 vs. 62.2±14.1, p = <0.001) y (218.6±37.9 vs. 265.06±34.7, p = <0.001), respectivamente. Así mismo el tiempo de relajación isovolumétrica se encontraba acortado y se prolongaba tras la resolución (41.72±8.29 vs. 59.32±17.98, p = < 0.001). Los diámetros y volúmenes del VI aumentaron significativamente tras la resolución del cuadro. No hubo diferencias en la FEVI ni DLG, 25% de los pacientes tenían deterioro de la función ventricular por DLG. Además, 20% presentaron elevación de la troponina ultrasensible, 75% de estos con deterioro de la DLG. Se encontró relación de la elevación de troponina y el deterioro de la DLG tanto durante como posterior a la resolución de la CAD. Conclusiones. La CAD se asocia con cambios en la función y estructura cardíaca que parecen en su mayoría transitorios, reflejan un estado de hipercontractilidad del miocardio y mejoran al resolverse el cuadro. Algunos pacientes presentan evidencia de daño miocárdico por elevación de troponina y parámetros de función ventricular

A case of round pneumonia due to Enterobacter hormaechei: the need for a standardized diagnosis and treatment approach in adults

Round pneumonia is an unusual radiological manifestation of a bacterial lung infection. We present the case of an elderly male patient who arrived at the emergency room with a productive cough and exertional dyspnea. His chest x-ray and CT showed a round opacity and air bronchograms in the right upper lobe. Taken together, the patient’s symptoms and images strongly suggest a pulmonary infection. Empirical antibiotic therapy with ceftriaxone and clarithromycin was started. The sputum culture was positive for Enterobacter hormaechei and the bacterium was sensitive to levofloxacin; therefore, the antibiotic therapy was changed. Despite the treatment, the patient progressed to respiratory failure and septic shock, dying six days after admission. Although round pneumonia is uncommon, it is a potentially curable disease and clinicians should always consider it in their differential diagnosis

Tumor of the epididymis: an uncommon presentation of disseminated coccidioidomycosis

Coccidioidomycosis is an endemic disease of arid regions in the Western hemisphere. Its clinical presentation varies from asymptomatic nodules on chest x-rays to disseminated disease. We present the case of a 48-year-old man with a hard and heterogeneous tumor in the posterior aspect of the right testis. Color flow doppler testicular ultrasonography was performed and two nodular masses in the tail of the right epididymis were identified. An epididymectomy was performed and histopathological examination revealed coccidioidomycosis. After diagnosis, the patient was successfully treated with fluconazol

Tumor of the epididymis: an uncommon presentation of disseminated coccidioidomycosis

ABSTRACT Coccidioidomycosis is an endemic disease of arid regions in the Western hemisphere. Its clinical presentation varies from asymptomatic nodules on chest x-rays to disseminated disease. We present the case of a 48-year-old man with a hard and heterogeneous tumor in the posterior aspect of the right testis. Color flow doppler testicular ultrasonography was performed and two nodular masses in the tail of the right epididymis were identified. An epididymectomy was performed and histopathological examination revealed coccidioidomycosis. After diagnosis, the patient was successfully treated with fluconazol

Pseudomyocardial Infarction in a Patient with Severe Diabetic Ketoacidosis and Mild Hyperkalemia

A 48-year-old male with a prior diagnosis of diabetes mellitus presented to the emergency department with malaise and nausea. On work-up, he was found with hyperglycemia and high anion gap metabolic acidosis, with a blood pH<6.94. A diagnosis of severe diabetic ketoacidosis was established; serum electrolyte analysis showed mild hyperkalemia. On work-up, a 12-lead electrocardiogram was obtained, and it showed an ST-segment elevation on anterior leads that completely resolved with diabetic ketoacidosis treatment. ST-segment elevation myocardial infarction can be a precipitant factor for diabetic ketoacidosis, and evaluation of diabetic patients with suspected myocardial infarction can be challenging since they can present with atypical or little symptoms. Hyperkalemia, which usually accompanies diabetic ketoacidosis, can cause electrocardiographic alterations that are well described, but ST-segment elevation is uncommon. A pseudomyocardial infarction pattern has been described in patients with diabetic ketoacidosis; of note, most of these patients presented severe hyperkalemia. We believe this is of great importance for clinicians because they must be able to recognize those patients that present with electrocardiographic abnormalities secondary to the metabolic alterations and those that can be experiencing actual ongoing ischemia, in order to establish an appropriate and prompt treatment