Cerebrospinal fluid shunting for the management of cryptococcal meningitis: a scoping review

Objective: This scoping review aimed to describe studies that evaluate the management of cryptococcal meningitis (CM) using cerebrospinal fluid (CSF) shunts, types of shunts used, and clinically relevant patient outcomes. Methods: We searched in the following databases: PubMed, Web of Science/Core collection, Embase, the Cochrane Library, and clinicaltrials.gov on 1 April 2022. We included two-arm and one-arm cohort studies that evaluated clinically relevant patient outcomes. Case reports were used to describe the type of CSF shunts used and the rationale behind its selection. The selection and extraction processes were independently performed by two authors. Results: This study included 20 cohort studies and 26 case reports. Only seven cohort studies compared two groups. Ventriculoperitoneal shunt was the most commonly used type of shunt (82.1%). The main indications for placing a shunt were persistently high opening pressure (57.1%) and persisting neurological symptoms or deterioration (54.3%). Cohort studies suggest that patients with shunt showed improvement in some outcomes such as neurological symptoms and hospital stay length. The most common shunt complications were post-operative fever (1–35.6%) and shunt obstruction (7–16%). Conclusion: CSF shunts may improve some clinically relevant outcomes in patients with CM, but the evidence is very uncertain.Revisión por pare

Asociación entre anemia intrahospitalaria y estancia hospitalaria en niños de 1 mes a 5 años en un hospital de Lima, Perú en el año 2018

La anemia ha sido declarada como uno de los principales problemas de salud pública a nivel mundial, sobretodo en el grupo etario de niños menores de 5 años. El desarrollo de esta entidad durante la hospitalización se conoce como anemia intrahospitalaria (AIH). La AIH tiene una alta prevalencia tanto en Estados Unidos como Latinoamérica, sobre todo en el grupo etario de escolares y preescolares, además se asocia con resultados adversos como aumento de la mortalidad, mayor probabilidad de recaídas en el primer mes y aumento del tiempo de estancia hospitalaria. Este último llega a asociarse con múltiples efectos adversos como infecciones nosocomiales que afectan la recuperación del paciente. Por ello, el objetivo de nuestro estudio es estimar la asociación entre la presencia de anemia intrahospitalaria y el tiempo de estancia hospitalaria en niños de 1 mes a 5 años en el hospital María Auxiliadora durante el año 2018. Es un estudio observacional de tipo cohorte retrospectiva en el Hospital María Auxiliadora (HMA) del departamento de Lima. El HMA es un hospital III-1 ubicado en el distrito de San Juan de Miraflores. Se revisarán 220 historias clínicas (HC) de pacientes de 1 mes a 5 años, elegidas por conveniencia, del servicio de Pediatría del año 2018. Posteriormente, se realizará un análisis multivariado donde se calculará el riesgo relativo (RR) por medio del modelo de regresión lineal

Association between functional outcomes and time since injury in trauma survivors: Exploratory Analysis of the CRASH-2 trial

Introducción: Actualmente, los traumatismos son considerados la sexta causa de mortalidad y la quinta causa de discapacidad en todos los grupos etarios. Uno de los factores más importantes en la supervivencia de un paciente traumatizado es el tiempo de injuria. Objetivo: Estimar la asociación entre el tiempo de injuria y el nivel de estatus funcional al alta en pacientes adultos con trauma enrolados en el ensayo CRASH-2 durante los años 2005-2010. Métodos: Estudio de tipo cohorte retrospectiva que corresponde a un análisis secundario de la base de datos del ensayo experimental CRASH-2. Se calculó el riesgo relativo (RR) del tiempo de injuria que se define como el intervalo de tiempo que inicia desde el momento del accidente hasta la el arribo al hospital y estatus funcional mediante un modelo lineal generalizado de la familia Poisson, link log con varianza robusta con un intervalo de confianza al 95% ajustado por edad, sexo, tipo de injuria, accidente cerebro vascular (ACV), traumatismo encéfalo craneano (TEC) y eventos vasooclusivos. Resultados: Se analizó la información de 16,950 pacientes para este estudio. El 66.97% de los pacientes tuvieron un tiempo no prolongado (≤ 3 horas) y el 76.77% presentaron un estatus funcional independiente al alta. Encontramos que los pacientes que tuvieron un tiempo de injuria prolongado tienen un 11.00% más riesgo de presentar un estatus funcional dependiente en comparación a los pacientes con tiempo de injuria no prolongado. Conclusión: Nuestro estudio apoya el rápido transporte de pacientes con trauma ante la relación entre un tiempo de injuria prolongado y el desarrollo de un estatus funcional dependiente.Introduction: Currently, trauma is considered the sixth global cause of mortality and fifth cause of disability in all age groups. . One of the most important factors in the survival of an injured patient is the injury time. Objective: To estimate the association between injury time and functional status at discharge in adult trauma patients enrolled in the CRASH-2 trial during the years 2005-2010. Methods: Retrospective cohort study corresponding to a secondary analysis of the CRASH-2 experimental trial database. The relative risk (RR) of time of injury (defined as the time interval from the time of the injury to hospital arrival) and functional status was calculated using a generalized linear model of the Poisson family, link log with robust variance with a 95% confidence interval adjusted for age, sex, type of injury, stroke, traumatic brain injury (TBI) and vaso-oclusive events. Results: Data from 16,950 patients were analyzed for this study. The 66.97% of the patients had a non-prolonged injury time (≤ 3 hours) and 76.77% presented an independent functional status at discharge. We found that patients who had a prolonged injury time had a 11.00% higher risk of presenting a dependent functional status compared to patients with a non-prolonged injury time. Other factors associated with dependent functional status are age, type of injury, stroke, TBI, among others. Conclusions: Our study concludes that a prolonged injury time increases the risk of developing a dependent functional status and due to this result, we encourage the rapid transportation of trauma patients to reduce the risk of dependent functional status.Tesi

Lemierre-like syndrome after soft tissue infection due to methicillin-resistant Staphylococcus aureus: A case report and literature review

Background: The growing threat from pre-extensively drug-resistant tuberculosis (pre-XDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) poses a major public health concern in Latin America and the Caribbean (LAC). Therefore, this study aimed to summarize the available evidence on the prevalence of pre-XDR-TB and XDR-TB among patients with multidrug-resistant tuberculosis in LAC. Methods: A systematic review was conducted in the following databases on June 3, 2023: PubMed, Scopus, Ovid Medline, Web of Science, Scielo and LILACS. We estimated pooled proportions using a random effects model (Dersimonian and Laird). The 95% confidence intervals (95% CI) were calculated using the binomial exact method (Clopper-Pearson Method). Subgroup (by time period and country) and sensitivity analyses were performed. Results: Twenty-nine studies were eligible for qualitative synthesis and 27 for meta-analysis (n = 15,565). The pooled prevalence of XDR-TB in the study participants was 5% (95% CI: 3%-6%), while that of pre-XDR-TB was 10% (95% CI 7%-14%). Cuba (6%, 95% CI 0%-17%) and Peru (6%, 95% CI 5%-7%) had the highest pooled prevalence of XDR-TB. Regarding pre-XDR-TB, Brazil (16%, 95% CI 11%-22%) and Peru (13%, 95% CI: 9%-16%) showed the highest prevalence. Conclusions: The pooled prevalence of pre-XDR-TB and XDR-TB in LAC was 10% and 5%, respectively. Governments should strengthen drug-resistance surveillance and TB programs.Revisión por pare

sj-docx-2-tai-10.1177_20499361241228666 – Supplemental material for Cerebrospinal fluid shunting for the management of cryptococcal meningitis: a scoping review

Supplemental material, sj-docx-2-tai-10.1177_20499361241228666 for Cerebrospinal fluid shunting for the management of cryptococcal meningitis: a scoping review by Gonzalo Cornejo-Venegas, Xosse Carreras, Andrea S. Salcedo, David R. Soriano-Moreno, Jorge L. Salinas and Jorge Alave in Therapeutic Advances in Infectious Disease</p

sj-docx-1-tai-10.1177_20499361241228666 – Supplemental material for Cerebrospinal fluid shunting for the management of cryptococcal meningitis: a scoping review

Supplemental material, sj-docx-1-tai-10.1177_20499361241228666 for Cerebrospinal fluid shunting for the management of cryptococcal meningitis: a scoping review by Gonzalo Cornejo-Venegas, Xosse Carreras, Andrea S. Salcedo, David R. Soriano-Moreno, Jorge L. Salinas and Jorge Alave in Therapeutic Advances in Infectious Disease</p

Mycotic aneurysms due to Trichosporon asahii in a patient with ulcerative colitis under immunosuppression

Yeast fungi of the genus Trichosporon spp. can colonize the gastrointestinal tract in humans. In recent decades, the pathogenic role of Trichosporon asahii has been increasingly acknowledged especially in the setting of neutropenic patients with hematological malignancies. However, non-neutropenic patients who are immunosuppressed for other reasons are also at risk of developing invasive forms of this mycosis. We present the case of a 62-year-old male, with a history of ulcerative colitis under immunosuppressive treatment and previous exposure to antibiotics for various bacterial infections, who was admitted to the emergency department with a mycotic aneurysm of the abdominal aorta and left common iliac secondary to T. asahii infection. A multidisciplinary approach of the case (both early medical and surgical interventions) allowed the patient’s favorable outcome. The patient was followed for more than two years with no evidence of relapse. We postulate that the diagnosis of invasive Trichosporonosis should be considered in patients with inflammatory bowel disease (IBD) under immunosuppressive treatment and with prior exposure to antibiotics