Dolor retroesternal y fiebre con síntomas catarrales; un caso de mediastinitis por Haemophilus influenzae

The case that happens intends to emphasize a potentially fatal pathology. The delay in the diagnosis of this entity potentially influences both the management and the prognosis. A 38-year-old male with no history goes to the Emergency Department for fever, high catarrhal symptoms and retrosternal chest pain. He was stable but febrile and the analytical revealed elevation of acute phase reactants. A CT scan was requested under suspicion of mediastinitis that confirmed the diagnosis. Antibiotic therapy was initiated and an expectant attitude was taken. The precocity of the diagnosis allowed a conservative treatment.El caso que acontece pretende enfatizar en una patología potencialmente mortal. La demora en el diagnóstico de esta entidad influye tanto en el manejo como en el pronóstico. Un varón de 38 años sin antecedentes acudió al Servicio de Urgencias por fiebre, síntomas catarrales altos y dolor torácico retroesternal. Se encontraba estable, pero febril, y la analítica reveló elevación de reactantes de fase aguda. Se solicitó TAC, bajo la sospecha de mediastinitis, que confirmó el diagnóstico. Se inició antibioterapia y se tomó una actitud expectante. La precocidad del diagnóstico permitió un tratamiento conservador

Esófago negro: una complicación infrecuente pero potencialmente mortal

We present the case of an 84-year-old man with a high burden of vascular disease who, in the context of a situation of low output due to an intercurrent infectious process, the patient had an epigastric abdominal pain and upper gastrointestinal bleeding. The endoscopic study revealed the typical image of ‘black esophagus’, corresponding to acute esophageal necrosis. We review here the etiopathogenesis and the main treatment and prognostic implications of this rare but potentially fatal entity.Exponemos el caso de un varón de 84 años con alta carga de enfermedad vascular que, en contexto de una situación de bajo gasto por proceso infeccioso intercurrente, presentaba dolor abdominal epigástrico y hemorragia digestiva alta. El estudio endoscópico reveló la imagen típica de «esófago negro», correspondiente a la necrosis esofágica aguda. En este caso revisamos la etiopatogenia y las principales implicaciones de tratamiento y pronósticas de esta rara pero potencialmente mortal entidad.

Usefulness of Serial Multiorgan Point-of-Care Ultrasound in Acute Heart Failure: Results from a Prospective Observational Cohort.

Background and Objectives: Acute heart failure (AHF) is a common disease and a cause of high morbidity and mortality, constituting a major health problem. The main purpose of this study was to determine the impact of multiorgan ultrasound in identifying pulmonary hypertension (PH), a major prognostic factor in patients admitted due to AHF, and assess whether there are significant changes in the venous excess ultrasonography (VE US) score or femoral vein Doppler at discharge. Materials and Methods: Patients were evaluated with a standard protocol of lung ultrasound, echocardiography, inferior vena cava (IVC) and hepatic, portal, intra-renal and femoral vein Doppler flow patterns at admission and on the day of discharge. Results: Thirty patients were enrolled during November 2021. The mean age was seventy-nine years (Standard Deviation–SD 13.4). Seven patients (23.3%) had a worsening renal function during hospitalization. Regarding ultrasound findings, VE US score was calculated at admission and at discharge, unexpectedly remaining unchanged or even worsened (21 patients, 70.0%). The area under the curve for the lung score was 83.9% (p = 0.008), obtaining a cutoff value of 10 that showed a sensitivity of 82.6% and a specificity of 71.4% in the identification of intermediate and high PH. It was possible to monitor significant changes between both exams on the lung score (16.5 vs. 9.3; p < 0.001), improvement in the hepatic vein Doppler pattern (2.4 vs. 2.1; p = 0.002), improvement in portal vein Doppler pattern (1.7 vs. 1.4; p = 0.023), without significant changes in the intra-renal vein Doppler pattern (1.70 vs. 1.57; p = 0.293), VE US score (1.3 vs. 1.1; p = 0.501), femoral vein Doppler pattern (2.4 vs. 2.1; p = 0.161) and IVC collapsibility (2.0 vs. 2.1; p = 0.420). Conclusions: Our study results suggest that performing serial multiorgan Point-of-Care ultrasound can help us to better identify high and intermediate probability of PH patients with AHF. Currently proposed multi-organ, venous Doppler scanning protocols, such as the VE US score, should be further studied before expanding its use in AHF patients.post-print2977 K

Varón de 57 años con edema penoescrotal

This case emphasizes that highlights the clinical history. We present the case of a 57-year-old man with rapidly developing soft tissue edema in the penis and scrotum. Withdrawal of the causative medication allowed an adequate evolution.Este caso que acontece pretende enfatizar en una patología infrecuente que pone de relevancia la gran importancia de la historia clínica. Presentamos el caso de un varón de 57 años con edema de partes blandas en pene y escroto de rápida instauración. La retirada de la medicación causante permitió una adecuada evolución

Inter-Rater Variability in the Evaluation of Lung Ultrasound in Videos Acquired from COVID-19 Patients

12 páginas, 7 figuras, 1 tablaLung ultrasound (LUS) allows for the detection of a series of manifestations of COVID-19, such as B-lines and consolidations. The objective of this work was to study the inter-rater reliability (IRR) when detecting signs associated with COVID-19 in the LUS, as well as the performance of the test in a longitudinal or transverse orientation. Thirty-three physicians with advanced experience in LUS independently evaluated ultrasound videos previously acquired using the ULTRACOV system on 20 patients with confirmed COVID-19. For each patient, 24 videos of 3 s were acquired (using 12 positions with the probe in longitudinal and transverse orientations). The physicians had no information about the patients or other previous evaluations. The score assigned to each acquisition followed the convention applied in previous studies. A substantial IRR was found in the cases of normal LUS (κ = 0.74), with only a fair IRR for the presence of individual B-lines (κ = 0.36) and for confluent B-lines occupying 50% (κ = 0.50). No statistically significant differences between the longitudinal and transverse scans were found. The IRR for LUS of COVID-19 patients may benefit from more standardized clinical protocols.This research was partially funded by CDTI (Spanish acronym: Centre for Industrial Tech- nological Development), funding number COI-20201153. Partially supported by the Google Cloud Research Credits program with the funding number GCP19980904, by the project RTI2018-099118- A-I00 founded by MCIU/AEI/FEDER UE and by the European Commission–NextGenerationEU, through CSIC’s Global Health Platform (PTI Salud Global)

Varón de 28 años senegalés con fiebre e imposibilidad para la deambulación

This case presents an exceptional pathology whose delay in treatment can generate long-term sequelae. Likewise, the treatment has peculiarities that should be known. A 28-year-old Senegalese man with phlogotic findings in the left sacroiliac and positive sacroiliac provocation maneuvers accompanied by fever and increased acute phase reactants. Early treatment, in our case, allowed a favorable evolution.El caso que acontece pretende enfatizar en una patología excepcional cuya demora en el tratamiento puede generar secuelas a largo plazo. Así mismo el tratamiento tiene peculiaridades que conviene conocer. Presentamos el caso de un varón senegalés de 28 años con datos flogóticos en la sacroiliaca izquierda y maniobras de provocación sacroilíacas positivas acompañado de fiebre y aumento de reactantes de fase aguda. El tratamiento precoz en nuestro caso permitió una evolución favorable.

Usefulness of Systemic Venous Ultrasound Protocols in the Prognosis of Heart Failure Patients: Results from a Prospective Multicentric Study

Mortality and re-admission rates for decompensated acute heart failure (AHF) is increasing overall and risk stratification might be challenging. We sought to evaluate the prognostic role of systemic venous ultrasonography in patients hospitalized for AHF. We prospectively recruited 74 AHF patients with a NT-proBNP level above 500 pg/mL. Then, multi-organ ultrasound assessments (lung, inferior vena cava (IVC), pulsed-wave Doppler (PW-Doppler) of hepatic, portal, intra-renal and femoral veins) were performed at admission, discharge, and follow-up (for 90 days). We also calculated the Venous Excess Ultrasound System (VExUS), a new score of systemic congestion based on IVC dilatation and pulsed-wave Doppler morphology of hepatic, portal and intra-renal veins. An intra-renal monophasic pattern (area under the curve (AUC) 0.923, sensitivity (Sn) 90%, specificity (Sp) 81%, positive predictive value (PPV) 43%, and negative predictive value (NPV) 98%), a portal pulsatility > 50% (AUC 0.749, Sn 80%, Sp 69%, PPV 30%, NPV 96%) and a VExUS score of 3 corresponding to severe congestion (AUC 0.885, Sn 80%, Sp 75%, PPV 33%, and NPV 96%) predicted death during hospitalization. An IVC above 2 cm (AUC 0.758, Sn 93.l% and Sp 58.3) and the presence of an intra-renal monophasic pattern (AUC 0. 834, sensitivity 0.917, specificity 67.4%) in the follow-up visit predicted AHF-related re-admission. Additional scans during hospitalization or the calculation of a VExUS score probably adds unnecessary complexity to the assessment of AHF patients. In conclusion, VExUS score does not contribute to the guidance of therapy or the prediction of complications, compared with the presence of an IVC greater than 2 cm, a venous monophasic intra-renal pattern or a pulsatility > 50% of the portal vein in AHF patients. Early and multidisciplinary follow-up visits remain necessary for the improvement of the prognosis of this highly prevalent disease

Usefulness of Serial Multiorgan Point-of-Care Ultrasound in Acute Heart Failure: Results from a Prospective Observational Cohort

Background and Objectives: Acute heart failure (AHF) is a common disease and a cause of high morbidity and mortality, constituting a major health problem. The main purpose of this study was to determine the impact of multiorgan ultrasound in identifying pulmonary hypertension (PH), a major prognostic factor in patients admitted due to AHF, and assess whether there are significant changes in the venous excess ultrasonography (VE &times; US) score or femoral vein Doppler at discharge. Materials and Methods: Patients were evaluated with a standard protocol of lung ultrasound, echocardiography, inferior vena cava (IVC) and hepatic, portal, intra-renal and femoral vein Doppler flow patterns at admission and on the day of discharge. Results: Thirty patients were enrolled during November 2021. The mean age was seventy-nine years (Standard Deviation&ndash;SD 13.4). Seven patients (23.3%) had a worsening renal function during hospitalization. Regarding ultrasound findings, VE &times; US score was calculated at admission and at discharge, unexpectedly remaining unchanged or even worsened (21 patients, 70.0%). The area under the curve for the lung score was 83.9% (p = 0.008), obtaining a cutoff value of 10 that showed a sensitivity of 82.6% and a specificity of 71.4% in the identification of intermediate and high PH. It was possible to monitor significant changes between both exams on the lung score (16.5 vs. 9.3; p &lt; 0.001), improvement in the hepatic vein Doppler pattern (2.4 vs. 2.1; p = 0.002), improvement in portal vein Doppler pattern (1.7 vs. 1.4; p = 0.023), without significant changes in the intra-renal vein Doppler pattern (1.70 vs. 1.57; p = 0.293), VE &times; US score (1.3 vs. 1.1; p = 0.501), femoral vein Doppler pattern (2.4 vs. 2.1; p = 0.161) and IVC collapsibility (2.0 vs. 2.1; p = 0.420). Conclusions: Our study results suggest that performing serial multiorgan Point-of-Care ultrasound can help us to better identify high and intermediate probability of PH patients with AHF. Currently proposed multi-organ, venous Doppler scanning protocols, such as the VE &times; US score, should be further studied before expanding its use in AHF patients

The L-Alpha-Lysophosphatidylinositol/G Protein-Coupled Receptor 55 System Induces the Development of Nonalcoholic Steatosis and Steatohepatitis

Background and Aims G protein-coupled receptor (GPR) 55 is a putative cannabinoid receptor, and l-alpha-lysophosphatidylinositol (LPI) is its only known endogenous ligand. Although GPR55 has been linked to energy homeostasis in different organs, its specific role in lipid metabolism in the liver and its contribution to the pathophysiology of nonalcoholic fatty liver disease (NAFLD) remains unknown. Approach and Results We measured (1) GPR55 expression in the liver of patients with NAFLD compared with individuals without obesity and without liver disease, as well as animal models with steatosis and nonalcoholic steatohepatitis (NASH), and (2) the effects of LPI and genetic disruption of GPR55 in mice, human hepatocytes, and human hepatic stellate cells. Notably, we found that circulating LPI and liver expression of GPR55 were up-regulated in patients with NASH. LPI induced adenosine monophosphate-activated protein kinase activation of acetyl-coenzyme A carboxylase (ACC) and increased lipid content in human hepatocytes and in the liver of treated mice by inducing de novo lipogenesis and decreasing beta-oxidation. The inhibition of GPR55 and ACC alpha blocked the effects of LPI, and the in vivo knockdown of GPR55 was sufficient to improve liver damage in mice fed a high-fat diet and in mice fed a methionine-choline-deficient diet. Finally, LPI promoted the initiation of hepatic stellate cell activation by stimulating GPR55 and activation of ACC. Conclusions The LPI/GPR55 system plays a role in the development of NAFLD and NASH by activating ACC.Supported by grants from the Fondo Europeo de Desarrollo Regional (FEDER)/Ministerio de Ciencia, Innovacion y Universidades (MCIU)/Agencia Estatal de Investigacion (AEI) (C.D.: BFU2017-87721; M.L.: RTI2018-101840-B-I00; R.N.: BFU2015-70664R; A.G.-R.: PI16/00823; C.G.-M.: PI17/00535), Xunta de Galicia (M.L.: 2015-CP079 and 2016-PG068; R.N.: 2015-CP080 and 2016-PG057), Fundacion Banco Bilbao Vizcaya Argentaria (BBVA; to R.N.), Fundacion Atresmedia (M.L. and R.N.), European Foundation for the Study of Diabetes (R. N.), and Fundacion Francisco Cobos (A.G.-R.). MCIU/AEI/FEDER, European Union, (RTI2018-095134-B-100 to P.A.) provided aid to support the research groups of Sistema Universitario Vasco (IT971-16 to P. A). MCIU provided SAF2017-87301-R and RTI2018-096759-1-100, which were integrated into the Plan Estatal de Investigacion Cientifica y Tecnica e Innovacion and were cofinanced with FEDER (to M.L.M.-C. and T.C. D. respectively), and La Caixa Foundation Program and 2018 Fundacion BBVA Grants for Scientific Research Teams (to M.L.M.-C.). The research leading to these results has also received funding from the European Community's H2020 Framework Programme under the following grant: European Research Council Synergy Grant 2019-WATCH-810331 to R.N. Centro de Investigacion Biomedica en Red (CIBER) de Fisiopatologia de la Obesidad y Nutricion and CIBER de Enfermedades Hepaticas y Digestivas are initiatives of the Instituto de Salud Carlos III (ISCIII) of Spain, which is supported by FEDER funds, Gilead Sciences International Research Scholars Program in Liver Disease (to MVR), PI16/01548 (to MM) and the Red de Trastornos Adictivos-RTA (RD16/0017/0023). This article was partially supported by grants from the Fondo Nacional de Desarrollo Cientifico y Tecnologico grants 1191145 (to M.A.), 1200227 to JPA and 1191183 (to F. B.) and by the Comision Nacional de Investigacion Cientifica y Tecnologica (CONICYT, AFB170005, CARE Chile UC, Basal Centre for Excellence in Science and Technology; to M.A.). We thank MINECO for the Severo Ochoa Excellence Accreditation provided to the Center for Cooperative Research in Biosciences (SEV-2016-0644)

Inter-Rater Variability in the Evaluation of Lung Ultrasound in Videos Acquired from COVID-19 Patients

Lung ultrasound (LUS) allows for the detection of a series of manifestations of COVID-19, such as B-lines and consolidations. The objective of this work was to study the inter-rater reliability (IRR) when detecting signs associated with COVID-19 in the LUS, as well as the performance of the test in a longitudinal or transverse orientation. Thirty-three physicians with advanced experience in LUS independently evaluated ultrasound videos previously acquired using the ULTRACOV system on 20 patients with confirmed COVID-19. For each patient, 24 videos of 3 s were acquired (using 12 positions with the probe in longitudinal and transverse orientations). The physicians had no information about the patients or other previous evaluations. The score assigned to each acquisition followed the convention applied in previous studies. A substantial IRR was found in the cases of normal LUS (&kappa; = 0.74), with only a fair IRR for the presence of individual B-lines (&kappa; = 0.36) and for confluent B-lines occupying &lt; 50% (&kappa; = 0.26) and a moderate IRR in consolidations and B-lines &gt; 50% (&kappa; = 0.50). No statistically significant differences between the longitudinal and transverse scans were found. The IRR for LUS of COVID-19 patients may benefit from more standardized clinical protocols