Alveolar Proteinosis Secondary to M. tuberculosis, in a Patient with Transient CD4 Lymphocytopenia Due to Cryptococcus neoformans Infection: First Case in the Literature

Transient CD4 lymphocytopenia is defined as the transitory presence of CD4+ T lymphocyte fewer than 300 cells/mm3 or less than 20% of T cells without HIV infection. It can occur due to multiple causes; however, it is rare for it to occur due to opportunistic infections. Few cases have been described in the literature where antimicrobial treatment normalizes the CD4 count, being more frequent in Mycobacterium tuberculosis infections. To date, this phenomenon has not been described in Cryptococcus neoformans infections. This would be the first reported case according to our knowledge, of a patient who normalizes CD4 count after antifungal treatment, later developing alveolar proteinosis due to M. Tuberculosis

Effects of supplementary oxygen on obese patients with hypercapnia at 2 600 metros of altitude

Introduction: Supplementary oxygen on a high flow in obese patients with elevated PaCO2, carries the risk of worsening hypercapnia in patients at sea level. Nevertheless, at an altitude over 2 500 meters over sea level, is unknown the response to supplementary oxygen. Method: Randomized crossover clinical trial in subjects with BMI ≥ 30 kg/m2 and initial arterial blood gases with a PCO2 over 35 mmHg without supplementary oxygen, currently living for over a month at a height over 2 500 meters over sea level. Two tests were performed with supplementary oxygen of 28 % and 50 % to evaluate the PaCO2 on arterial blood gases

Efectos del oxígeno suplementario en pacientes obesos con hipercapnia a 2 600 metros de altitud

7 páginasSupplementary oxygen on a high flow in obese patients with elevated PaCO2 , carries the risk of worsening hypercapnia in patients at sea level. Nevertheless, at a altitude over 2 500 meters over sea level, is unknown the response to supplementary oxygen. Method: Randomized crossover clinical trial in subjects with BMI ≥ 30 kg/m2 and initial arterial blood gases with a PCO2 over 35 mmHg without supplementary oxygen, currently living for over a month at a height over 2 500 meters over sea level. Two tests were performed with supplementary oxygen of 28 % and 50 % to evaluate the PaCO2 on arterial blood gases. Results: 44 subjects were analyzed. The mean age, women and BMI was 57.36 ± 13.8 years, 59.1 %, 38.38 ± 6.31 kg/m2 , respectively. With supplemental oxygen at 28 % and 50 %, there was a -0.011 decrease in arterial pH (P = 0.003), an increase of 1 mmHg in PaCO2 (P = 0.039), 16.6 mmHg in PaO2 (P = 0.001) 0.007 mmHg at the HCO3 (P = 0.795) and SO2 levels of 1.62 % (P = 0.029). Conclusion: Supplementary oxygen at 28 and 50 % in obese patients with PaCO2 greatest that 35 mmHg on heights over 2500 meters worsen hypercapnia on 1.00 mmHg.Oxígeno suplementario a alto flujo. en pacientes obesos con PaCO2 elevada , lleva el riesgo de empeoramiento de la hipercapnia en pacientes al nivel del mar. Sin embargo, a una altitud de más de 2 500 metros sobre nivel del mar, se desconoce la respuesta a la suplementación oxígeno. Método: ensayo clínico cruzado, aleatorizado en sujetos con IMC ≥ 30 kg/m2 y arterial inicial gases en sangre con una PCO2 más de 35 mmHg sin oxígeno suplementario, viviendo actualmente más de un mes a una altura superior a 2 500 metros sobre el nivel del mar. Se realizaron dos pruebas con oxígeno suplementario de 28 % y 50 % para evaluar la PaCO2 en sangre arterial gases. Resultados: Se analizaron 44 sujetos. El significado edad, mujeres e IMC fue de 57,36 ± 13,8 años, 59,1 %, 38,38 ± 6,31kg/m2 , respectivamente. Con suplementario oxígeno al 28 % y 50 %, hubo una disminución de -0,011 en el pH arterial (P = 0,003), un aumento de 1 mmHg en PaCO2 (P = 0,039), 16,6 mmHg en PaO2 (P = 0,001) 0,007 mmHg en el HCO3 (P = 0,795) y niveles de SO2 de 1,62 % (P = 0,029). Conclusión: suplementaria oxígeno al 28 y 50 % en pacientes obesos con PaCO2 mayor que 35 mmHg en alturas superiores a 2500 metros empeorar la hipercapnia en 1,00 mmHg

<i>Pandoraea pnomenusa</i> Superinfection in a Patient with SARS-CoV-2 Pneumonia: First Case in the Literature

Pandoraea pnomenusa is a Gram-negative bacterium of the Pandoraea genus and is mainly associated with the colonization of structurally abnormal airways. During the COVID-19 pandemic, many microorganisms have been associated with coinfection and superinfection in SARS-CoV-2 pneumonia, but so far, no coinfection or superinfection by P. pnomenusa has been reported. We present the first case describing this association in a previously healthy patient. Clinical manifestations, treatment, and outcomes are shown

High altitude pulmonary edema at 2640 m altitude associated with an acute Rhinovirus infection. First case in the literature

High altitude pulmonary edema (HAPE) is a multifactorial condition that may occur after ascent of high altitudes, especially in genetic predisposed individuals. Diagnosis is challenging and could lead to potentially lethal complications such as acute respiratory distress syndrome (ARDS). We present one of the few reported cases of HAPE below 3000 m of altitude, and the first to our knowledge to present with a concomitant acute Rhinovirus infection, precipitating and complicating the diagnosis and clinical course. Clinical manifestations, treatment, and outcomes are shown below

Alveolar Proteinosis Secondary to <i>M. tuberculosis</i>, in a Patient with Transient CD4 Lymphocytopenia Due to <i>Cryptococcus neoformans</i> Infection: First Case in the Literature

Transient CD4 lymphocytopenia is defined as the transitory presence of CD4+ T lymphocyte fewer than 300 cells/mm3 or less than 20% of T cells without HIV infection. It can occur due to multiple causes; however, it is rare for it to occur due to opportunistic infections. Few cases have been described in the literature where antimicrobial treatment normalizes the CD4 count, being more frequent in Mycobacterium tuberculosis infections. To date, this phenomenon has not been described in Cryptococcus neoformans infections. This would be the first reported case according to our knowledge, of a patient who normalizes CD4 count after antifungal treatment, later developing alveolar proteinosis due to M. Tuberculosis.</i

Human Genetic Host Factors and Its Role in the Pathogenesis of Chikungunya Virus Infection

11 páginasChikungunya virus (CHIKV) is an alphavirus from the Togaviridae family that causes acute arthropathy in humans. It is an arthropod-borne virus transmitted initially by the Aedes (Ae) aegypti and after 2006's epidemic in La Reunion by Ae albopictus due to an adaptive mutation of alanine for valine in the position 226 of the E1 glycoprotein genome (A226V). The first isolated cases of CHIKV were reported in Tanzania, however since its arrival to the Western Hemisphere in 2013, the infection became a pandemic. After a mosquito bite from an infected viremic patient the virus replicates eliciting viremia, fever, rash, myalgia, arthralgia, and arthritis. After the acute phase, CHIKV infection can progress to a chronic stage where rheumatic symptoms can last for several months to years. Although there is a great number of studies on the pathogenesis of CHIKV infection not only in humans but also in animal models, there still gaps in the proper understanding of the disease. To this date, it is unknown why a percentage of patients do not develop clinical symptoms despite having been exposed to the virus and developing an adaptive immune response. Also, controversy stills exist on the pathogenesis of chronic joint symptoms. It is known that host immune response to an infectious disease is reflected on patient's symptoms. At the same time, it is now well-established that host genetic variation is an important component of the varied onset, severity, and outcome of infectious disease. It is essential to understand the interaction between the aetiological agent and the host to know the chronic sequelae of the disease. The present review summarizes the current findings on human host genetics and its relationship with immune response in CHIKV infection

Opioides para el manejo de la disnea en pacientes con insuficiencia cardiaca: Revisión sistemática de la literatura

8 páginasIntroduction: Heart failure is a chronic, progressive, prevalent disease, with a high impact on health systems and on the quality of life of patients and families. Dyspnea is a common symptom and management with opioids has been proposed. Objective: To conduct a systematic review of the literature pertaining to the use of opioids for the management of dyspnea in patients with stable chronic heart failure, functional class New York Heart Association (NYHA) II, III, or IV. Materials and methods: A systematic review was conducted in the MEDLINE, Embase, Cochrane, OVID, LILACS, and PROSPERO databases of articles published in 5 languages between January 1, 1995 and July 31, 2018. Studies describing the administration of any type of opioid for the management of dyspnea in patients with stable chronic heart failure NYHA II, III, or IV were included. Results: Four clinical trials were obtained for the final analysis with a total number of 70 patients, describing opioid administration for the management of dyspnea in patients with stable chronic heart failure, NYHA II, III, or IV. Conclusion: In adult patients with compensated chronic heart failure under optimum treatment, there is low-quality evidence that shows benefit with the use of opioids for the management of dyspnea. For a stronger recommendation, controlled, randomized studies with a larger number of subjects are required

Sobrevida en una cohorte con diagnóstico de tuberculosis en Colombia

7 páginasBackground: Tuberculosis is a chronic infectious pathology whose incidence is high in developing countries, however, information and studies that analyze mortality and long-term survival are limited. Methodology: retrospective cohort study, in patients with a diagnosis of tuberculosis older than 18 years, admission was consecutive until completing the study period. Survival and mortality were analyzed using the Kaplan-Meier estimator by the log Rank test. Results: 329 subjects were admitted, mortality at 30 days was 11.9% and at one year 24.6%, pulmonary tuberculosis was the most frequent type with 70.2%. Physical examination findings related to mortality were cachexia (p<0.001) and extremity edema (p<0.001). Overall survival was 87.2% at 30 days and 72.9% at one year. In patients with pulmonary tuberculosis, survival was 85.8% at 30 days and 72.8% at one year. Conclusion: The one-year survival rate in patients hospitalized for tuberculosis is low, advanced age, malnutrition, PaO2/FiO2 less than 300, c-reactive protein greater than 45 mg/dL, cerebrovascular disease and peripheral vascular disease were variables that were associated with higher mortalityIntroducción: La tuberculosis es una patología infecciosa crónica cuya incidencia es elevada en países en vía de desarrollo, sin embargo, es limitada la información y los estudios que analizan la mortalidad y sobrevida a largo plazo. Metodología: estudio de cohorte retrospectivo, en pacientes con diagnóstico de tuberculosis mayores de 18 años, el ingreso fue de manera consecutiva hasta completar el periodo de estudio. Se analizó la sobrevida y mortalidad a través del estimador Kaplan – Meier por la prueba de log Rank. Resultados: ingresaron 329 sujetos, la mortalidad a los 30 días fue de 11,9% y al año del 24,6%, la tuberculosis pulmonar fue el tipo más frecuente con en el 70,2%. Los hallazgos al examen físico relacionados con mortalidad fueron la caquexia (p<0,001) y el edema en extremidades (p<0,001). La sobrevida general fue del 87,2% a los 30 días y del 72,9% al año. En los pacientes con tuberculosis pulmonar la sobrevida fue del 85,8% a los 30 días y del 72,8% al año. Conclusión: La tasa de sobrevida a un año en pacientes hospitalizados por tuberculosis es baja, la edad avanzada, desnutrición, PaO2/FiO2 menor de 300, proteína c reactiva mayor de 45 mg/dL, enfermedad cerebrovascular y enfermedad vascular periférica fueron variables que se asociaron con una mayor mortalidad

Demographic and clinical characteristics of chikungunya patients from six Colombian cities, 2014–2015

AbstractIn 2014, the chikungunya virus reached Colombia for the first time, resulting in a nationwide epidemic. The objective of this study was to describe the demographics and clinical characteristics of suspected chikungunya cases. Chikungunya infection was confirmed by enzyme-linked immunosorbent assay and 548 patients where included in the study. Of these patients, 295 were positive for antibodies against chikungunya (53.8%), and 27.6% (151/295) were symptomatic for chikungunya infection, with a symptomatic:asymptomatic ratio of 1.04:1. Factors associated with infection included low income and low socio-economic strata (odds ratio [OR]: 1.8; 95% confidence interval [CI]: 1.0–3.2, p = 0.003 and OR: 2.1; CI: 1.3–3.4, p = 0.002, respectively). Confirmed symptomatic cases were associated with symmetric arthritis (OR: 11.7; CI: 6.0–23.0, p < 0.001) of ankles (OR: 8.5; CI: 3.5–20.9, p < 0.001), hands (OR: 8.5; CI: 3.5–20.9, p < 0.001), feet (OR: 6.5; CI: 2.8–15.3, p < 0.001), and wrists (OR: 17.3; CI: 2.3–130.5, p < 0.001). Our study showed that poverty is associated with chikungunya infection. Public health strategies to prevent and control chikungunya should focus on poorer communities that are more vulnerable to infection. The rate of asymptomatic infections among confirmed cases was 48.8%. However, those with symptoms displayed a characteristic rheumatic clinical picture, which could help differentiate chikungunya infection from other endemic viral diseases