Medicina
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Chronic subdural hematoma (cSDH) is an increasingly prevalent condition, particularly among elderly population and is associated with elevated morbidity. The pathophysiology of cSDH involves proliferation of dural edge cells, fibroblasts, and release of vascular angiogenic factors leading to angiogenesis of a vascularized neomembrane perfused by the middle meningeal artery (MMA). MMA embolization is a technique that can be employed as treatment in conjunction with surgery or as a standalone therapy. ⋯ After discharge, no patient required a new surgical intervention. MMA embolization is impressive to be a safe and an option to treat cSDH. We present our experience in six patients in a hospital in Argentina.
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Observational Study
[Meningeal cryptococcosis in patients living with HIV. Experience in intensive care].
Meningeal cryptococcosis (MC) is a frequent cause of meningoencephalitis in people living with HIV (PLHIV), leading to substantial morbidity (20-55%). Clinical characteristics, lethality and adverse prognostic factors in PLHIV with MC admitted to intensive care units (ICUs) are described. ⋯ The results indicate that altered functional and nutritional status, a PLHIV prognostic score ≥ 8 points, requiring MV and suffering sepsis on admission to the ICU are more frequent in deceased patients, and they could therefore serve as independent variables to predict a higher risk of mortality.
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The relationship between bullous pemphigoid (BP) and neoplasms has been debated in the medical literature. Although numerous case reports have described the coexistence of BP with various neoplasms, case-control studies have yielded conflicting results. We present the case of a male patient who developed BP shortly after being diagnosed with mycosis fungoides (MF). ⋯ The association between cutaneous T-cell lymphoma and autoimmune blistering disease is rare, although similar cases have been reported, some associated with phototherapy. In this case, the onset of BP after sun exposure suggests a potential connection. The coexistence of BP and MF remains controversial, and this case highlights the importance of considering autoimmune blistering diseases in patients with oncohematological neoplasms.
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Observational Study
[Molecular diagnosis of bacteriaemia: benefits of using the FilmArray® BCID2 sepsis panel in a third level hospital].
Delay in initiating appropriate antimicrobial therapy prolongs hospitalization, increases in-hospital mortality, and raises economic costs. Currently, the identification and susceptibility testing of bacteria in positive blood cultures require a considerable amount of time. The objective of this study was to assess the impact of the BCID2 FilmArray® (FA) panel on the timing of appropriate antimicrobial therapy and potential antimicrobial costs. ⋯ The implementation of FA facilitated a faster administration of appropriate antimicrobial therapy, leading to a reduction in the duration of broadspectrum empirical antimicrobial therapy and subsequent economic savings.
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Case Reports
[Minimally invasive treatment of infected pancreatic necrosis in a patient with lupic pancreatitis].
Acute pancreatitis (AP) is one of the most common gastrointestinal diseases that requires hospital admission in our environment, where early medical treatment and a staggered approach sequence significantly reduces morbidity and mortality. Pancreatic necrosis is associated with a death rate of 8 to 39% and is practically always an indication for intervention. This condition as a manifestation of systemic lupus erythematosus (SLE) is rare and its frequency is less than 5%. The objectives of this case are to show the success of the minimally invasive approach, highlighting the benefits, such as a decrease in pain and infection at the surgical site, resulting in an improvement in quality of life; and the other hand, lupus should be highlighted as a rare cause of acute pancreatitis.