Ectopic ACTH secretion and hyperaldosteronism as an unusual paraneoplastic syndrome in a patient with metastatic small cell lung cancer

Small cell lung cancer is usually associated with paraneoplastic syndromes due to hormonal secretion, the most frequent, the syndrome of inappropriate antidiuretic hormone secretion. A case of a hyperaldosteronism and ectopic secretion of adrenocorticotropic hormone associated with small cell lung cancer is presented. A 59-year-old patient was studied for a constitutional syndrome diagnosing a metastatic small cell lung cancer. In the course of the oncological process, he manifests a clinic of hypertension, hypernatremia and hypokalemia. After a hormonal study he is diagnosed with a paraneoplastic hyperaldosteronism that is controlled with antihypertensives and antialdosteronics. The patient finally died due to liver progression of his tumor disease

TVI- Arquitectura y Construcción - AR313 - 202102

Descripción: El curso TVI-Arquitectura y construcción introduce al estudiante en el conocimiento de las necesidades constructivas del proyecto arquitectónico y en la aplicación de los sistema estructurales; en la coordinación de sistemas estructurales para hacer posible que los sótanos de estacionamiento calcen sobre plantas de desarrollo habitacional, que los ductos de instalaciones eléctricas y sanitarias tengan continuidad, etc. Se diseñan pequeños edificios de oficinas, fábricas, centros comerciales, clínicas, complejos deportivos, etc. Propósito: Desarrollar propuestas arquitectónicas cuya concepción involucre la necesidad de pensar en sistemas estructurales adecuados, un correcto dimensionamiento para las necesidades materiales del proyecto (tales como estacionamiento, traslado de muebles, y seguridad) La construcción implica decidir una lógica estructural, por el comportamiento del material, y la expresión arquitectónica en coherencia con el tema ¿organización y funcionamiento- y el lugar. La asignatura contribuye al desarrollo de las competencias específicas de la carrera: Diseño Fundamentado, que corresponde a los criterios NAAB PC2, PC3, PC8, PC5, SC3, SC5, así como, Técnica y Construcción que corresponde a los criterios NAAB SC1, SC4, SC6; ambas en el nivel de logro 2. Tiene como requisito la asignatura de AR309 TV - Arquitectura y Medio Ambient

Global Survey of Outcomes of Neurocritical Care Patients: Analysis of the PRINCE Study Part 2

BACKGROUND: Neurocritical care is devoted to the care of critically ill patients with acute neurological or neurosurgical emergencies. There is limited information regarding epidemiological data, disease characteristics, variability of clinical care, and in-hospital mortality of neurocritically ill patients worldwide. We addressed these issues in the Point PRevalence In Neurocritical CarE (PRINCE) study, a prospective, cross-sectional, observational study. METHODS: We recruited patients from various intensive care units (ICUs) admitted on a pre-specified date, and the investigators recorded specific clinical care activities they performed on the subjects during their first 7 days of admission or discharge (whichever came first) from their ICUs and at hospital discharge. In this manuscript, we analyzed the final data set of the study that included patient admission characteristics, disease type and severity, ICU resources, ICU and hospital length of stay, and in-hospital mortality. We present descriptive statistics to summarize data from the case report form. We tested differences between geographically grouped data using parametric and nonparametric testing as appropriate. We used a multivariable logistic regression model to evaluate factors associated with in-hospital mortality. RESULTS: We analyzed data from 1545 patients admitted to 147 participating sites from 31 countries of which most were from North America (69%, N = 1063). Globally, there was variability in patient characteristics, admission diagnosis, ICU treatment team and resource allocation, and in-hospital mortality. Seventy-three percent of the participating centers were academic, and the most common admitting diagnosis was subarachnoid hemorrhage (13%). The majority of patients were male (59%), a half of whom had at least two comorbidities, and median Glasgow Coma Scale (GCS) of 13. Factors associated with in-hospital mortality included age (OR 1.03; 95% CI, 1.02 to 1.04); lower GCS (OR 1.20; 95% CI, 1.14 to 1.16 for every point reduction in GCS); pupillary reactivity (OR 1.8; 95% CI, 1.09 to 3.23 for bilateral unreactive pupils); admission source (emergency room versus direct admission [OR 2.2; 95% CI, 1.3 to 3.75]; admission from a general ward versus direct admission [OR 5.85; 95% CI, 2.75 to 12.45; and admission from another ICU versus direct admission [OR 3.34; 95% CI, 1.27 to 8.8]); and the absence of a dedicated neurocritical care unit (NCCU) (OR 1.7; 95% CI, 1.04 to 2.47). CONCLUSION: PRINCE is the first study to evaluate care patterns of neurocritical patients worldwide. The data suggest that there is a wide variability in clinical care resources and patient characteristics. Neurological severity of illness and the absence of a dedicated NCCU are independent predictors of in-patient mortality.status: publishe