Medicina
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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.
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Case Reports
[Subacute ataxia associated with cerebellar ataxia, neuropathy and vestibular areflexia (CANVAS)].
Cerebellar ataxia, neuropathy, and vestibular areflexia syndrome (CANVAS) is a late onset neurodegenerative disorder. Its genetic basis has recently been identified in the gene encoding a subunit of the Replication Factor C (RFC1). We present the case of a 62-year-old woman who experienced a history of a biphasic presentation of imbalance and gait disorders, with rapid onset of symptoms followed by slow and progressive neurological deterioration. ⋯ Subsequently, vestibular function tests identified severe bilateral vestibulopathy. This led to considering CANVAS among the diagnoses, which was ultimately confirmed through genetic testing (biallelic expansion of the pentanucleotide AAGGG in the RFC1 gene). This case highlights the importance of this new described genetic disease and its subacute presentation variant, emphasizing the relevance of objective vestibular function tests in idiopathic ataxias to achieve proper diagnosis and eventual genetic counseling for offspring.
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Observational Study
[Cardiovascular risk factors of medical specialists in Argentina].
The objective was to analyze the prevalence of classic CVRFs in specialist doctors and establish if there are differences by sex, age and specialty. ⋯ Specialist physicians have a high prevalence of modifiable CRFs, which are also associated with AHF, present in more than half of the physicians. The prevalence is higher in men, intensivists and those over 60 years of age.
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We present the case of a 35-year-old male patient, sandblaster for eight years, recently diagnosed with pulmonary tuberculosis and systemic sclerosis, who was admitted with dyspnea and poor general condition. Chest X-ray showed a grade I pneumothorax, and on the chest tomography he presented confluent hyperdense masses associated with a pattern of non- specific interstitial pneumonia (NSIP), findings compatible with complicated silicosis. Due to the advanced clinical stage, neither invasive diagnostic test nor pulmonary function test could be performed. ⋯ The patient eventually died under palliative care. Silica inhalation is the cause of silicosis, but it is also implicated in the development of systemic sclerosis (Erasmus syndrome) and although they share a common risk factor, it is rare to find both diseases coexisting. We present the case of a young patient in whom both diseases presented aggressively, with the aim of highlighting the importance of actively searching for expositional diseases and associated conditions.
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Mushrooms containing amatoxins generate the highest number of fatal mycete poisonings on the planet. These toxins are produced not only by Amanita species, such as the well-known Amanita phalloides, but also by other genera, including Lepiota. In this work we report the treatment of a 51-year-old male patient weighing 79 kg who was referred to the hospital after 36 h of ingesting mushrooms. ⋯ The patient was discharged 11 days after admission. This case highlights the importance of obtaining a correct and sufficient anamnesis on fungi, enabling rapid analysis of them, and initiation of timely treatment for intoxication. Once again, the importance of having Toxicological Information and Advice Centers (CIAT) with experience and knowledge of micetisms is demonstrated.