Fluctuating facial asymmetry and visual perceptive background during a tissue diagnostic histopathological

Background. Fluctuating facial asymmetry (FFA) is accentuated throughout life and has perceptual psychological implications; tissue diagnosis shows interindividual differences at first glance, for example, in the number of fixations, but no reports are available regarding the visual perceptual background in relation to individuals with less or more FFA during the tissue diagnostic task. Materials and methods. In medical students, including 13 men (SD = 19.4 years) and 8 women (SD = 18.1 years), FFA was determined as follows: n = 9 FFA. The entire population performed tissue diagnostic analysis of normal skin and skin with squamous cell carcinoma pathology from digital images to establish the duration and number of fixations and the total time taken for diagnosis. Results. Individuals with > FFA show significant differences in the visual perceptual background during diagnostic analysis of normal and pathological skin, which are magnified by the fixation duration and the number of fixations when the tissue diagnosis is pathological. Conclusion. Compared to those with lower FFA, medical students with greater FFA performing tissue diagnosis of pathological tissue have visual perceptual backgrounds characterized by less time spent in each fixation but with more fixations

Liver abscess due to Granulicatella adiacens in an immunocompetent patient: A case report

Los abscesos hepáticos piógenos por Granulicatella adiacens son infecciones asociadas a una alta mortalidad, principalmente en pacientes inmunocomprometidos. Los principales microorganismos asociados a los abscesos hepáticos son Klebsiella pneumoniae, Escherichia coli o polimicrobianos. Sin embargo, los informes de casos que describen la infección hepática por G. adiacens son limitados. Presentamos el caso de un paciente adulto inmunocompetente que presentó 15 días de evolución consistente en picos febriles cuantificados asociados a astenia, adinamia, escalofríos, ictericia y coluria. El examen clínico inicial reveló tinte ictérico generalizado sin presencia de dolor abdominal y presión arterial con tendencia a la hipotensión. Se sospechó neoplasia biliopancreática confluente, colangitis secundaria y sepsis de origen biliar, iniciándose reanimación con líquidos y antibioterapia, se tomaron hemocultivos y estudios diagnósticos complementarios. Ultrasonido hepatobiliar con evidencia de absceso de 73 x 62 mm en segmento IV, vía biliar y páncreas dentro de límites normales. Se realizaron múltiples pruebas moleculares de detección de microorganismos (FilmArray), identificando a G. adiacens como el principal patógeno. El paciente completó manejo antibiótico con ciprofloxacino, vancomicina y metronidazol en buenas condiciones y fue dado de alta con éxito. Este es el primer absceso hepático piogénico reportado causado por G. adiacens en un paciente inmunocompetente, donde el diagnóstico microbiológico temprano en conjunto con el tratamiento antibiótico dirigido y el drenaje percutáneo de la lesión fueron determinantes en los resultados clínicos.Pyogenic liver abscesses due to Granulicatella adiacens are infections associated with high mortality, mainly in immunocompromised patients. The main microorganisms associated with liver abscesses are Klebsiella pneumoniae, Escherichia coli, or polymicrobial. However, case reports describing liver infection by Granulicatella adiacens are limited. We present the case of an immunocompetent adult patient who presented 15 days of evolution consisting of quantified fever peaks associated with asthenia, adynamia, chills, jaundice and coluria. The initial clinical examination revealed generalized icteric tint without the presence of abdominal pain and blood pressure with a tendency to hypotension. Biliopancreatic confluent neoplasia, secondary cholangitis and sepsis of biliary origin were suspected, initiating fluid resuscitation and antibiotic therapy, blood cultures and complementary diagnostic studies were taken. Hepatobiliary ultrasound with evidence of abscess of 73 x 62 mm in segment IV, bile duct and pancreas within normal limits. In order to better characterize the lesion evidenced in the liver, a contrast-enhanced computed tomography of the abdomen was performed. The patient completed antibiotic management with ciprofloxacin, vancomycin, and metronidazole in good condition and was successfully discharged. This is the first pyogenic liver abscesses reported caused by Granulicatella adiacens in an immunocompetent patient, where early microbiological diagnosis in conjunction with targeted antibiotic treatment and percutaneous drainage of the lesion was decisive in the clinical outcomes

Bullous pemphigoid of idiopathic origin

Introduction: Bullous pemphigoid is a subepidermal autoimmune bullous vesicular dermatosis associated with the formation of autoantibodies that confirm autoantigens in the basement membrane area. Immunomodulatory treatment with corticosteroids is the first line in the control of the disease. Objective: To present the clinical case of a patient diagnosed with a bullous pemphigoid of idiopathic origin. Clinical case: 81-year-old male patient with blistering lesions that are painful on palpation with serohematic content, varied in size, regular borders and a generalized erythematous base; that the initial evaluation suggests a diagnosis of bullous pemphigoid and active bacterial infection of the skin. Laboratory tests and diagnostic images are requested, infectious, autoimmune or associated neoplastic etiologies are ruled out, treatment with intravenous corticosteroids is started with adequate clinical evolution. Finally, no diseases associated with the patient's blistering lesions were identified. Conclusion: Bullous pemphigoid is a rare entity, with a high mortality rate if a late diagnosis and treatment is performed. Recognizing the main manifestations and clinical variants of this disease allows for a timely diagnostic and therapeutic approach, the latter based on the control of the inflammatory response against the skin and other organs

Neumoperitoneo secundario a neumatosis intestinal masiva: un reporte de caso

Introducción. La neumatosis intestinal se define como la presencia de quistes aéreos en la pared del tracto digestivo, a nivel submucoso o subseroso, que comprometen principalmente el intestino delgado. Las manifestaciones clínicas son inespecíficas y los hallazgos imagenológicos son fundamentales en el enfoque diagnóstico. El manejo puede ser médico o quirúrgico, dependiendo del compromiso intestinal y las complicaciones asociadas. Caso clínico. Hombre de 78 años, que ingresó por cuadro de dolor abdominal crónico, con hallazgos imagenológicos de neumoperitoneo. Al ser llevado a intervención quirúrgica se encontró neumatosis intestinal masiva del íleon, requiriendo resección intestinal. Resultado. El paciente presentó una evolución postoperatoria satisfactoria y fue dado de alta, sin complicaciones. Conclusión. La neumatosis intestinal es una enfermedad poco frecuente, que se presenta principalmente en hombres. La sospecha diagnóstica se confirma con imágenes tomográficas. Los pacientes candidatos para el manejo médico deben presentar causas con curso benigno, sin compromiso hemodinámico ni complicaciones. El manejo quirúrgico se reserva para pacientes con abdomen agudo o signos de sepsis

De curandis hominum morbis : an 18th century prescription for stroke management by volatile alkali in the new Kingdom of Granada

boticarios, barberos, médicos y protomédicos, es consecuencia de la experiencia de individuos anónimos de las poblaciones locales, que fueron capaces de percibir directamente en la naturaleza elementos útiles a la terapia, así como de la existencia de principios activos no validados, o bien de efectos placebo. Objetivo: Presentar y analizar desde la perspectiva de la medicina moderna, una receta médica del siglo XVIII en el Nuevo Reino de Granada, en la cual se prescribe el álkali volátil para disminuir síntomas generados por afecciones del sistema musculoesquelético. Desarrollo: En el periodo Colonial, pese a la carencia de estudios o evidencia que respaldara, se utilizaban términos como fármacos, con una dosificación establecida e indicaciones. Se presenta y analiza a la luz de la medicina moderna una receta mÈdica del siglo XVIII para el tratamiento de la apoplexia con efectos benéficos al aumentar el flujo sanguÌneo al cerebro y la disponibilidad de oxÌgeno asÌ mismo aumentando el metabolismo neuronal. El amoníaco puede inducir hiperexcitabilidad neuronal, bloqueo de la actividad de la glutaminasa, reducir la descomposición de glutamina en glutamato y amonÌaco en las terminaciones nerviosas, sin embargo, dosis elevadas podrÌan llegar a producir muerte celular o fallo respiratorio. Conclusiones: El advenimiento de nuevas tecnologías ha permitido avances en el diagnóstico, prevención y tratamiento de múltiples enfermedades. En este contexto, los tratamientos del pasado se han visto relegados a curiosidades históricas. El legado terapéutico colonial conservado en los archivos locales permite viajar al pasado para intentar comprender racionalmente los medicamentos de nuestros predecesores. Existe evidencia cientÌfica que respalda la efectividad del alkali volátil para diversas enfermedades, entre estas la apoplejía. No obstante, una descripción vaga o ausente de la posología, signos, síntomas y comorbilidades, dificulta analizar la eficacia de este tratamiento histórico.The use of medicinal plants and mineral resources in the New Kingdom of Granada in colonial times by apothecaries, barbers, doctors and protomedics, is a consequence of the experience of anonymous individuals from the local populations, who were able to perceive directly in nature elements useful to the therapy, as well as the existence of non-validated active principles, or even placebo effects. Objective: To present and analyze from the perspective of modern medicine, a medical prescription from the 18th century in the New Kingdom of Granada. In which volatile alkali is prescribed to reduce symptoms generated by conditions of the musculoskeletal system. AIM: In the Colonial period, despite the lack of studies or evidence to support, terms were used as drugs, with an established dosage and indications. An 18th century medical prescription for the treatment of stroke is presented and analyzed in the light of modern medicine beneficial effects by increasing blood flow to the brain and the availability of oxygen also increasing neuronal metabolism. Ammonia can induce neuronal hyperexcitability, block glutaminase activity, reduce glutamine breakdown in glutamate and ammonia in nerve endings, however, high doses could lead to cell death or respiratory failure. Conclusions: The advent of new technologies has enabled advances in the diagnosis, prevention and treatment of multiple diseases. In this context, past treatments have been relegated to historical curiosities. The colonial therapeutic legacy preserved in the local archives allows us to travel to the past and try to rationally understand the medicines of our predecessors. There is scientific evidence supporting the effectiveness of volatile alkali for various diseases, including stroke. However, a vague or even absent description of dosage, signs, symptoms and comorbidities, makes it difficult to analyze the effectiveness of this historical treatment.N/

Cardiopulmonary exercise test of Colombian military with war thoracic trauma

Introduction: There are few publications related to cardiopulmonary stress tests in soldiers wounded in combat, and the various complications cause war trauma. Objective: To describe the cardiopulmonary variables in patients with war thoracic trauma submitted to stress tests. Methods: A descriptive study was carried out between 2010 and 2016, at the Hospital Militar Central de Bogotá, D.C., Colombia. The study population consisted of 27 patients with a history of war-derived thoracic trauma, who were submitted to cardiopulmonary stress tests. The variables of age, sex, symptoms, oxygen consumption, cardiopulmonary variables measured by spirometry, type of surgery, trauma and weapon were explored. Results: A total of 27 participants were included. Mean oxygen consumption peak ml / min was 2 891,8 (SD: 621,86), oxygen consumption peak mL/kg/min 43,25 (DS: 9,72), forced vital capacity pre-bronchodilator (L) 4,5 (DS: 1, 3) and post-bronchodilator (L) 4,3 (DS: 1,01). Exploratory analysis found significant differences among those who had a high velocity firearm wounds against other types of weapons. Conclusions: In patients with a history of trauma, peak oxygen consumption ml / min, peak oxygen mL/kg/min and forced vital capacity is lower than in the healthy population; Apparently, the type of high-velocity firearm wound has a greater effect on these variables evaluated by cardiopulmonary stress tests

Sleep apnea in patients with primary chronic headache

Introduction. Sleep apnea syndrome (SAS) can accompany patients with chronic primary headache (CPH), being a frequent cause of persistence of symptoms in these patients, however, the data studying this disorder in patients with CPH are still limited. Objective. To determine the frequency of SAS in patients with CPH. Methods. A retrospective cohort was analyzed in patients with a diagnosis of CPH in a third level hospital. CPH was diagnosed according to the criteria of the International Headache Society and SAS with a polysomnographic record with an apnea-hypopnea index (AHI) >5/h, the frequency of SAS was determined among the total number of patients with AHI >5/h over the total number of patients undergoing polysomnography. Results. A total of 114 subjects were included, where the SAS in CPH was 83.3%, of which 56.8% were men and 60% older than 50 years; 89% of the population had a body mass index (BMI) greater than 27 kg/m2. Fatigue and sleepiness during the day were the most frequent symptoms, reported in 89.5% of the population with SAS compared to 47.4% of the population without a diagnosis of SAS. Conclusion. Sleep apnea is a frequent condition in patients with CPH undergoing polysomnography, mainly overweight men over 50 years of age. The main associated symptoms are fatigue and sleepiness

Linfoma de células T/natural killer extranodal de tipo nasal enmascarado en una sinusopatía

Introducción: El linfoma de células T citotóxico/natural killer extranodal de tipo nasal es poco frecuente, pero con alta tasa de mortalidad. Las manifestaciones clínicas de la enfermedad pueden simular una infección de senos paranasales. Objetivo: Presentar las manifestaciones clínicas de un paciente de 34 años de edad con diagnóstico de linfoma de células T citotóxico/ natural killer extranodal de tipo nasal. Caso clínico: Se presenta un paciente masculino de 34 años de edad con rinorrea verdosa fétida recurrente y obstrucción en fosa nasal derecha. En la evaluación inicial sugiere sinusitis crónica, sin embargo, debido al empeoramiento de las manifestaciones clínicas se realiza una tomografía computarizada que muestra lesiones sugestivas de infiltración neoplásica, una biopsia de la lesión confirma el diagnóstico de linfoma de células T/natural killer extranodal de tipo nasal. Conclusiones: Los linfomas de células T citotóxico/natural killer extranodal de tipo nasal son considerados neoplasias poco frecuentes, caracterizadas por el patrón rápidamente progresivo con afectación ósea; en su etapa inicial presenta manifestaciones clínicas similares a una sinusitis. La tomografía computarizada y la histopatología, son indispensables en el diagnóstico de la enfermedad

Comparison of performances between risk scores for predicting mortality at 30 days in patients with community acquired pneumonia

Background: Risk scores facilitate the assessment of mortality risk in patients with community-acquired pneumonia (CAP). Despite their utilities, there is a scarcity of evidence comparing the various RS simultaneously. This study aims to evaluate and compare multiple risk scores reported in the literature for predicting 30-day mortality in adult patients with CAP. Methods: A retrospective cohort study on patients diagnosed with CAP was conducted across two hospitals in Colombia. The areas under receiver operating characteristic curves (ROC-curves) were calculated for the outcome of survival or death at 30 days using the scores obtained for each of the analyzed questionnaires. Results: A total of 7454 potentially eligible patients were included, with 4350 in the final analysis, of whom 15.2% (662/4350) died within 30 days. The average age was 65.4 years (SD: 21.31), and 59.5% (2563/4350) were male. Chronic kidney disease was 3.7% (9.2% vs. 5.5%; p < 0.001) (OR: 1.85) higher in subjects who died compared to those who survived. Among the patients who died, 33.2% (220/662) presented septic shock compared to 7.3% (271/3688) of the patients who survived (p < 0.001). The best performances at 30 days were shown by the following scores: PSI, SMART-COP and CURB 65 scores with the areas under ROC-curves of 0.83 (95% CI: 0.8–0.85), 0.75 (95% CI: 0.66–0.83), and 0.73 (95% CI: 0.71–0.76), respectively. The RS with the lowest performance was SIRS with the area under ROC-curve of 0.53 (95% CI: 0.51–0.56). Conclusion: The PSI, SMART-COP and CURB 65, demonstrated the best diagnostic performances for predicting 30-day mortality in patients diagnosed with CAP. The burden of comorbidities and complications associated with CAP was higher in patients who died

Performance of risk scores in predicting mortality at 3, 6, and 12 months in patients diagnosed with community-acquired pneumonia

Background: Risk scores (RS) evaluate the likelihood of short-term mortality in patients diagnosed with community-acquired pneumonia (CAP). However, there is a scarcity of evidence to determine the risk of long-term mortality. This article aims to compare the effectiveness of 16 scores in predicting mortality at three, six, and twelve months in adult patients with CAP. Methods: A retrospective cohort study on individuals diagnosed with CAP was conducted across two hospitals in Colombia. Receiver Operating Characteristic (ROC) curves were constructed at 3, 6, and 12 months to assess the predictive ability of death for the following scoring systems: CURB-65, CRB-65, SCAP, CORB, ADROP, NEWS, Pneumonia Shock, REA-ICU, PSI, SMART-COP, SMRT-CO, SOAR, qSOFA, SIRS, CAPSI, and Charlson Comorbidity Index (CCI). Results: A total of 3688 patients were included in the final analysis. Mortality at 3, 6, and 12 months was 5.2%, 8.3%, and 16.3% respectively. At 3 months, PSI, CCI, and CRB-65 scores showed ROC curves of 0.74 (95% CI: 0.71–0.77), 0.71 (95% CI: 0.67–0.74), and 0.70 (95% CI: 0.66–0.74). At 6 months, PSI and CCI scores showed performances of 0.74 (95% CI: 0.72–0.77) and 0.72 (95% CI: 0.69–0.74), respectively. Finally at 12 months, all evaluated scores showed poor discriminatory capacity, including PSI, which decreased from acceptable to poor with an ROC curve of 0.64 (95% CI: 0.61–0.66). Conclusion: When predicting mortality in patients with CAP, at 3 months, PSI, CCI, and CRB-65 showed acceptable predictive performances. At 6 months, only PSI and CCI maintained acceptable levels of accuracy. For the 12-month period, all evaluated scores exhibited very limited discriminatory ability, ranging from poor to almost negligible