Hemotórax masivo: una rarísima complicación de la trombólisis de la embolia pulmonar

Massive haemothorax secondary to thrombolysis during the treatment of pulmonary embolism (PE) is an exceptional and poorly documented in the literature event. We talk about massive haemothorax when the amount of extravasated fluid in pleura exceeds 1,500 mL, which is a serious haemodynamic compromise. Spontaneous haemothorax is a rare entity whose most common causes are ruptured arteriovenous malformations, tumors, coagulation disorders or secondary to anticoagulant therapy. We present a case of massive spontaneous haemothorax secondary to systemic thrombolytic treatment in a patient with pulmonary embolism.El hemotórax masivo (HM) secundario a trombólisis durante el tratamiento de la embolia pulmonar (EP) es un evento excepcional y escasamente documentado en la literatura. Se habla de HM cuando la cantidad de líquido extravasado en pleura supera los 1.500 mL, lo que supone un grave compromiso hemodinámico. El hemotórax espontáneo es una entidad poco frecuente cuyas causas más comunes son la rotura de malformaciones arteriovenosas, neoplasias, desórdenes de la coagulación o secundario a tratamiento anticoagulante. Se presenta un caso de hemotórax espontáneo masivo secundario al tratamiento trombolítico sistémico en una paciente con embolia pulmonar

Rivaroxaban Monotherapy in Patients with Pulmonary Embolism: Off-Label vs. Labeled Therapy

Oral anticoagulants; Rivaroxaban; Venpus thromboembolismAnticoagulantes orales; Rivaroxaban; Tromboembolismo de venpusAnticoagulants orals; Rivaroxaban; Tromboembolisme de venpusBackground: The use of rivaroxaban in clinical practice often deviates from manufacturer prescribing information. No studies have demonstrated an association between this practice and improved outcomes. Methods: We used the RIETE registry to assess the clinical characteristics of patients with pulmonary embolism (PE) who received off-label rivaroxaban, and to compare their 3-month outcomes with those receiving the labeled therapy. The patients were classified into four subgroups: (1) labeled therapy; (2) delayed start; (3) low doses and (4) both conditions. Results: From May 2013 to May 2022, 2490 patients with PE received rivaroxaban: labeled therapy—1485 (58.6%); delayed start—808 (32.5%); low doses—143 (5.7%); both conditions—54 (2.2%). Patients with a delayed start were more likely to present with syncope, hypotension, raised troponin levels and more severe abnormalities on the echocardiogram than those on labeled therapy. Patients receiving low doses were most likely to have cancer, recent bleeding, anemia, thrombocytopenia or renal insufficiency. During the first 3 months, 3 patients developed PE recurrence, 4 had deep-vein thrombosis, 11 had major bleeding and 16 died. The rates of major bleeding (11 vs. 0; p < 0.001) or death (15 vs. 1; OR: 22.5; 95% CI: 2.97–170.5) were higher in patients receiving off-label rivaroxaban than in those on labeled therapy, with no differences in VTE recurrence (OR: 1.11; 95% CI: 0.25–6.57). Conclusions: In patients with severe PE, the start of rivaroxaban administration was often delayed. In those at increased risk for bleeding, it was often prescribed at low doses. Both subgroups had a worse outcome than those on labeled rivaroxaban

Una lumbalgia atípica con una causa infrecuente: espondilodiscitis por neumococo

We describe the case of a 13-year-old male with no history of interest with intermittent fever and 4-week low back pain who was finally diagnosed as having pneumococcal spondylodiscitis. To emphasize the importance of this communication, due to the few cases described in the literature of this form of invasive pneumococcal disease, and also because of their involvement in a young patient with no underlying chronic pathology, since pneumococcal spondylodiscitis usually affects patients with age over 50 years and with significant comorbidity (immunosuppression, asplenia, diabetes, alcohol consumption, etc.).Describimos el caso de un varón de 13 años sin ningún antecedente de interés con un cuadro de fiebre intermitente y dolor lumbar de 4 semanas de evolución que fue finalmente diagnosticado de espondilodiscitis neumocócica. Resaltar la importancia de esta comunicación, por los escasos casos descritos en la literatura de esta forma de enfermedad neumocócica invasiva, y también por su afectación en un paciente joven y sin patología crónica de base, ya que la espondilodiscitis neumocócica suele afectar a pacientes con edad superior a 50 años y con comorbilidad importante (inmunosupresión, asplenia, diabetes, consumo de alcohol, etc.)

Síndrome de cascanueces como causa poco frecuente de dolor abdominal y hematuria en mujeres jóvenes. A propósito de dos casos

The nutcracker syndrome is a pathology characterized by compression of the left renal vein, between the superior mesenteric artery and the abdominal aorta, sometimes being difficult to diagnose and complex treatment. It usually affects young women and is manifested mainly by abdominal pain and hematuria, causing many visits to the emergency services and specialists until the final diagnosis. We present two very illustrative cases of young women who after multiple consultations were finally diagnosed with nutcracker syndrome.El síndrome de cascanueces es una patología que se caracteriza por la compresión de la vena renal izquierda, entre la arteria mesentérica superior y la aorta abdominal, siendo en ocasiones de difícil diagnóstico y de trata- miento complejo. Suele afectar a mujeres jóvenes y se manifiesta principalmente por dolor abdominal y hematuria, ocasionando multitud de visitas a los servicios de Urgencias y especialistas hasta llegar al diagnóstico final. Presentamos dos casos muy ilustrativos de mujeres jóvenes que, tras múltiples consultas, finalmente fueron diagnosticadas de síndrome de cascanueces

Miositis necrotizante autoinmune y dermatomiositis por estatinas: un diagnóstico diferencial complejo

Treatment with statins can induce muscle toxicity relatively frequently. With a lower incidence, statins can lead to an autoimmune necrotizing myopathy or dermatomyositis, myopathies which can potentially be severe with clinical, analytical and histological features. We present the case of a middle-aged woman who, after starting treatment with atorvastatin, presents an inflammatory myopathy, difficult to fit into a subtype, with skin lesions suggestive of dermatomyositis, however, histologically compatible with a necrotizing myopathy caused by statins.El tratamiento con estatinas puede inducir toxicidad muscular con relativa frecuencia. Con una menor incidencia, también puede provocar una miopatía necrotizante autoinmune o una dermatomiositis, miopatías potencialmente graves con una presentación clínica, analítica e histológica características. El diagnóstico diferencial entre ambas patologías no siembre es fácil. Se expone el caso de una mujer de edad media que, tras iniciar tratamiento con atorvastatina, presenta un cuadro inequívoco de miopatía inflamatoria, pero difícil de encuadrar en un subtipo, con lesiones cutáneas a favor de dermatomiositis, sin embargo, histológicamente compatible con una miopatía necrotizante por estatinas

Comparison of seven prognostic tools to identify low-risk pulmonary embolism in patients aged <50 years

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Search for dark matter produced in association with bottom or top quarks in √s = 13 TeV pp collisions with the ATLAS detector

A search for weakly interacting massive particle dark matter produced in association with bottom or top quarks is presented. Final states containing third-generation quarks and miss- ing transverse momentum are considered. The analysis uses 36.1 fb−1 of proton–proton collision data recorded by the ATLAS experiment at √s = 13 TeV in 2015 and 2016. No significant excess of events above the estimated backgrounds is observed. The results are in- terpreted in the framework of simplified models of spin-0 dark-matter mediators. For colour- neutral spin-0 mediators produced in association with top quarks and decaying into a pair of dark-matter particles, mediator masses below 50 GeV are excluded assuming a dark-matter candidate mass of 1 GeV and unitary couplings. For scalar and pseudoscalar mediators produced in association with bottom quarks, the search sets limits on the production cross- section of 300 times the predicted rate for mediators with masses between 10 and 50 GeV and assuming a dark-matter mass of 1 GeV and unitary coupling. Constraints on colour- charged scalar simplified models are also presented. Assuming a dark-matter particle mass of 35 GeV, mediator particles with mass below 1.1 TeV are excluded for couplings yielding a dark-matter relic density consistent with measurements

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to &lt;90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], &gt;300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of &lt;15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P&lt;0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P&lt;0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years