Reumatismo tuberculoso «enfermedad de Poncet». Reporte de caso

ResumenAntecedentesLas muertes por tuberculosis a nivel mundial han superado los 2,5 millones de casos por año. La enfermedad de Poncet es una forma poco frecuente de tuberculosis, caracterizada por un cuadro de poliartritis.Caso clínicoVarón de 24 años de edad, quien presentó rigidez matinal, artralgias, artritis bilateral simétrica de interfalángicas proximales, carpos, rodillas, tobillos, hombros y adenomegalias a nivel cervical, submandibular, supraclavicular izquierda, axilar e inguinal, sin fiebre. Resultados de laboratorio: velocidad de sedimentación globular 44mm/hora, proteína C reactiva 4.35, niveles de complemento C3 y C4 normales, factor reumatoide y anticuerpos anti-péptido C citrulinado negativos, anticuerpos antinucleares positivos con patrón moteado fino 1:320 y citoplásmico 1:160; anticuerpos anti-Smith, anti-ADN de doble cadena, antígeno A de síndrome de Sjogren's y antígeno B de síndrome de Sjogren's negativos. Reporte histológico del tejido ganglionar cervical con lesiones granulomatosas compatibles con tuberculosis. Se descartaron artritis reumatoide y lupus eritematoso sistémico. Se inició tratamiento antifímico remitiendo el cuadro clínico. Se concluyó el diagnóstico de enfermedad de Poncet.ConclusiónEl diagnóstico diferencial entre tuberculosis y enfermedades articulares inflamatorias de etiología autoimune es un reto clínico.AbstractBackgroundDeaths due to tuberculosis have reached 2.5 million cases per year worldwide. Poncet's disease is an infrequent form of tuberculosis characterised by a clinical picture of polyarthritis.Clinical caseA 24-year-old male presented with morning stiffness, arthralgias, bilateral symmetric arthritis of the proximal interphalangeal joints, wrists, knees, ankles, and shoulders, and adenomegalies at the cervical, submandibular, left supraclavicular, axillary and inguinal levels, without fever. Laboratory results were as follows: ESR 44mm/h, C-reactive protein 4.35, normal levels of complement C3 and C4, negative rheumatoid factor and anticyclic citrullinated peptide antibodies, positive antinuclear antibodies with fine speckled pattern (1:320) and cytoplasm (1:160) pattern and negative anti-Smith, -double-stranded DNA, Sjogren's syndrome-antigen A and Sjogren's syndrome-antigen B. Histological report of cervical node tissue revealed granulomatous lesions compatible with tuberculosis. Rheumatoid arthritis and systemic lupus erythematosus were ruled out. Anti-tuberculosis agents were initiated that resolved the clinical picture. Diagnosis of Poncet's disease was confirmed.ConclusionThe differential diagnosis between tuberculosis and autoimmune inflammatory joint diseases is a clinical challenge

Experiencia de la escuela itinerante de derechos humanos para las mujeres de la Ciudad de México, 2016 a 2018

La Constitución Política de México menciona que todas y todos tenemos derechos a educación, trabajo digno, a servicios de salud y más, la población femenina es del 51.4% en la República Mexicana; las mujeres representamos el 52.6% (4,687,003) del total de población de la Ciudad de México, siendo el 62.8% de mujeres que tienen 15 años y más de lo anterior el 95.8% son alfabetas y se tiene sin instrucción en primaria un 6.8%, secundaria y medio superior un 18.7% y de superior y el 16.1 % a nivel superior. Por lo anterior se generó la escuela itinerante de derechos humanos para las mujeres de la Ciudad de México, teniendo como objetivo explicar los derechos humanos y de las mujeres para que tomen conciencia de que existen herramientas jurídicas que las respaldan por ser mujeres. El presente trabajo se realizó en las 16 delegaciones ahora alcaldías, el primer año fueron 8 sedes con 10 talleres de diversos temas como derechos humanos, de la mujer, sobre su cuerpo, derechos económicos, principalmente, el segundo año fueron 10 sedes con 10 talleres se actualizaron las pláticas sobre derechos humanos, de mujeres, se agrego comunicación digital y la relación equidad de género y medio ambiente, para el último año se compactaron a 8 sedes con 8 diferentes talleres teniendo la base los derechos humanos y de la mujer. Se obtuvo que el primer año asistieron aproximadamente 150 participantes capacitándose por mes en cada cede un total de 1,500 mujeres al año, en 2017 fueron 2,000 mujeres capacitas y en el 2018 fueron 2,580 capacitadas, observándose un aumento proporcional del interés de las mujeres por los diferentes talleres, las participantes fueron desde amas de casa, estudiantes y profesionistas, de 15 años y más

Prospective study of urinary tract infection surveillance after kidney transplantation

<p>Abstract</p> <p>Background</p> <p>Urinary tract infection (UTI) remains one of the main complications after kidney transplantation and it has serious consequences.</p> <p>Methods</p> <p>Fifty-two patients with kidney transplantation were evaluated for UTI at 3-145 days (mean 40.0 days) after surgery.. Forty-two received a graft from a live donor and 10 from a deceased donor. There were 22 female and 30 male patients, aged 11-47 years. Microscopic examinations, leukocyte esterase stick, and urinary culture were performed every third day and weekly after hospitalization. A positive culture was consider when patients presented bacterial counts up to 10⁵ counts.</p> <p>Results</p> <p>UTI developed in 19/52 (37%) patients at 3-75 days (mean 19.5 days after transplantation. Recurrent infection was observed in 7/52 (13.4%) patients at days 17-65. UTI was more frequent in patients who received deceased grafts compared with live grafts (7/10, 70% <it>vs</it>. 12/42, 28%; p < 0.007). Female patients were more susceptible than male (11/22, 50% <it>vs</it>. 8/22, 36.35%; p < 0.042). Five-year survival rate was 94.5% (49/52 patients). Kidney Graft exit update is 47/52 (90.2%), and there were no significant differences between graft rejection and UTI (p = 0.2518). Isolated bacteria were <it>Escherichia coli </it>(31.5%), <it>Candida albicans </it>(21.0%) and <it>Enterococcus </it>spp. (10.5%), followed by <it>Pseudomonas aeruginosa, Klebsiella pneumoniae, Morganella </it><it>morganii, Enterobacter cloacae </it>and <it>Micrococcus </it>spp. Secondary infections were produced by (7/19, 36.8%). <it>Enterococcus </it>spp. (57%), <it>E. coli </it>(28%) and <it>Micrococcus </it>spp. (14.2%). Antibiotic resistance was 22% for ciprofloxacin and 33% for ampicillin. Therapeutic alternatives were aztreonam, trimethoprim-sulfamethoxazole, netilmicin and fosfomycin.</p> <p>Conclusions</p> <p>Surveillance of UTI for the first 3 months is a good option for improving quality of life of kidney transplantation patients and the exit of graft function especially for female patients and those receiving deceased grafts. Antibiograms provided a good therapeutic alternative to patients who presented with UTIs after receiving a kidney allograft.</p

Clinical Predictors of Hyperperfusion Syndrome Following Carotid Stenting: Results From a National Prospective Multicenter Study

[Objectives] The aim of the HISPANIAS (HyperperfusIon Syndrome Post-carotid ANgIoplasty And Stenting) study was to define CHS rates and develop a clinical predictive model for cerebral hyperperfusion syndrome (CHS) after carotid artery stenting (CAS).[Background] CHS is a severe complication following CAS. The presence of clinical manifestations is estimated on the basis of retrospective reviews and is still uncertain.[Methods] The HISPANIAS study was a national prospective multicenter study with 14 recruiting hospitals. CHS was classified as mild (headache only) and moderate-severe (seizure, impaired level of consciousness, or development of focal neurological signs).[Results] A total of 757 CAS procedures were performed. CHS occurred in 22 (2.9%) patients, in which 16 (2.1%) had moderate-severe CHS and 6 (0.8%) had mild CHS (only headache). The rate of hemorrhages was 0.7% and was associated with high mortality (20%). Pre-operative predictors of moderate-severe CHS in multivariate analysis were female sex (odds ratio [OR]: 3.24; 95% confidence interval [CI]: 1.11 to 9.47; p = 0.03), older patients (OR: 1.09; 95% CI: 1.01 to 1.17; p = 0.02), left carotid artery treated (OR: 4.13; 95% CI: 1.11 to 15.40; p = 0.03), and chronic renal failure (OR: 6.29; 95% CI: 1.75 to 22.57; p = 0.005). The area under the curve of this clinical and radiological model was 0.86 (95% CI: 0.81 to 0.92; p = 0.001).[Conclusions] The rate of CHS in the HISPANIAS study was 2.9%, with moderate-severe CHS of 2.1%. CHS was independently associated with female sex, older age, history of chronic kidney disease, and a treated left carotid artery. Although further investigations are needed, the authors propose a model to identify high-risk patients and develop strategies to decrease CHS morbidity and mortality in the future.This study was supported by a Spanish grant from the Instituto de Salud Carlos III (ISCIII-FIS IP14/00971, 2014–2017). The ITRIBIS project has the registration number REGPOT-2013-1. Cooperative Cerebrovascular Disease Research Network (INVICTUS+) (RD16/0019/0015). Dr. Mancha is supported by a Río Hortega contract (CM16/00015). Abbott and Grifols have partial financial supported the conduction of the HISPANIAS project but had no role in the design of the study, interpretation of the data, or manuscript approval.Peer reviewe

COVID-19 outbreaks in a transmission control scenario: challenges posed by social and leisure activities, and for workers in vulnerable conditions, Spain, early summer 2020

Severe acute respiratory syndrome coronavirus 2 community-wide transmission declined in Spain by early May 2020, being replaced by outbreaks and sporadic cases. From mid-June to 2 August, excluding single household outbreaks, 673 outbreaks were notified nationally, 551 active (>6,200 cases) at the time. More than half of these outbreaks and cases coincided with: (i) social (family/friends’ gatherings or leisure venues) and (ii) occupational (mainly involving workers in vulnerable conditions) settings. Control measures were accordingly applied

5to. Congreso Internacional de Ciencia, Tecnología e Innovación para la Sociedad. Memoria académica

El V Congreso Internacional de Ciencia, Tecnología e Innovación para la Sociedad, CITIS 2019, realizado del 6 al 8 de febrero de 2019 y organizado por la Universidad Politécnica Salesiana, ofreció a la comunidad académica nacional e internacional una plataforma de comunicación unificada, dirigida a cubrir los problemas teóricos y prácticos de mayor impacto en la sociedad moderna desde la ingeniería. En esta edición, dedicada a los 25 años de vida de la UPS, los ejes temáticos estuvieron relacionados con la aplicación de la ciencia, el desarrollo tecnológico y la innovación en cinco pilares fundamentales de nuestra sociedad: la industria, la movilidad, la sostenibilidad ambiental, la información y las telecomunicaciones. El comité científico estuvo conformado formado por 48 investigadores procedentes de diez países: España, Reino Unido, Italia, Bélgica, México, Venezuela, Colombia, Brasil, Estados Unidos y Ecuador. Fueron recibidas un centenar de contribuciones, de las cuales 39 fueron aprobadas en forma de ponencias y 15 en formato poster. Estas contribuciones fueron presentadas de forma oral ante toda la comunidad académica que se dio cita en el Congreso, quienes desde el aula magna, el auditorio y la sala de usos múltiples de la Universidad Politécnica Salesiana, cumplieron respetuosamente la responsabilidad de representar a toda la sociedad en la revisión, aceptación y validación del conocimiento nuevo que fue presentado en cada exposición por los investigadores. Paralelo a las sesiones técnicas, el Congreso contó con espacios de presentación de posters científicos y cinco workshops en temáticas de vanguardia que cautivaron la atención de nuestros docentes y estudiantes. También en el marco del evento se impartieron un total de ocho conferencias magistrales en temas tan actuales como la gestión del conocimiento en la universidad-ecosistema, los retos y oportunidades de la industria 4.0, los avances de la investigación básica y aplicada en mecatrónica para el estudio de robots de nueva generación, la optimización en ingeniería con técnicas multi-objetivo, el desarrollo de las redes avanzadas en Latinoamérica y los mundos, la contaminación del aire debido al tránsito vehicular, el radón y los riesgos que representa este gas radiactivo para la salud humana, entre otros

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Elementos bioéticos para formular un instrumento de evaluación de los protocolos de investigaciónElementos bioéticos para formular un instrumento de evaluación de los protocolos de investigación

Tesis (Maestría en Bioética), Instituto Politécnico Nacional, SEPI, ESM, 2009, 1 archivo PDF, (145 páginas). tesis.ipn.m

The Value of Transcranial Doppler Sonography in Hyperperfusion Syndrome after Carotid Artery Stenting: A Nationwide Prospective Study

This study was supported by a Spanish grant from the Instituto de Salud Carlos III (ISCIII-FIS IP14/00971,2014-2017). The ITRIBIS project (Improving Translational Research Potential at the Institute of Biomedicine of Seville) has the registration number REGPOT-2013-1. Cooperative Cerebrovascular Disease Research Network (INVICTUS+)(RD16/0019/0015). Fernando Mancha is supported by a Rio Hortega contract. Francisco Moniche is PI of PI15/01197 and PI18/01414 grants. This study was partially funded by Abbott (Chicago, IL, USA) and Grifols (Barcelona, Spain) but had no role in the design of the study, interpretation of the data or manuscript approval