Revista médica de Chile
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Revista médica de Chile · Jul 2023
Review Case Reports[First Case report of Lawsonella clevelandensis Infection in Latin America and literature review].
Lawsonella clevelandensis is a gram-positive anaerobic bacillus, partially acid-fast, belonging to the order Corynebacteriales and is considered commensal of the skin and oral cavity. In recent years, few cases of infection by this microorganism have been reported, generally in immunosuppressed patients, with the most reported clinical presentation being the generation of abscesses. The isolation of this bacterium is difficult since it does not grow in traditional cultures, so its identification usually requires the use of molecular biology. ⋯ Sequencing of the gene that codes for the 16s RNA of the bacterial ribosome was performed from a urine sample, obtaining a sequence compatible with Lawsonella clevelandensis. After the result, therapy with amoxicillin-clavulanic acid was indicated with resolution of the leukocyturia and negative smear microscopy, and immunosuppression could be indicated without inconvenience. To the authors' knowledge, this is the twelfth case of Lawsonella clevelandensis infection described in the medical literature in the world and the first to report the isolation of the pathogen in urine.
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Revista médica de Chile · Jul 2023
Review[Update in diagnosis and management of Clostridioides difficile].
Clostridioides difficile (C. difficile) is one of the leading causes of infection associated with health care with high morbidity and mortality, especially among hospitalized older adults. The increase in the use of antibiotics has been associated with a higher number of cases and greater virulence. Its clinical presentation ranges from asymptomatic carriers to toxic megacolon. ⋯ Fidaxomicin, fecal microbiota transplant, and new therapies such as monoclonal antibodies have been incorporated into the therapeutic arsenal, with a higher level of evidence. Nevertheless, the severity, patient comorbidity, recurrence risk factors, and the economic cost of each therapeutic option must be considered. This review aims to update the last guidelines proposed by the Chilean Societies of Gastroenterology and Infectious Diseases published in 2016, providing the latest recommendations regarding prevention, diagnosis, and treatment of C. difficile infection.
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Revista médica de Chile · Jul 2023
Review[Endomyocardial biopsy in current practice: Technical Aspects, Indications and complications].
Endomyocardial biopsy (EMB) is an invasive procedure and a diagnostic tool used mainly on the follow-up of post-heart transplant rejection in the past years. Currently, it has an important role in the diagnosis of non-ischemic cardiomyopathies. ⋯ Diagnostic performance has improved with advances in pathology analysis. Its complications risk, close to 1% in high-volume interventional centers, can be justified considering the potential benefit of an accurate diagnosis and prognosis.
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the International Agency for Research on Cancer included the occupational and environmental exposure of firefighters, in the list of carcinogens for humans. ⋯ Identifying associations between firefighters' occupational exposures and cancer risk is a challenging task mainly due to the multifactorial origin of cancer. The best way to reduce exposure is to implement preventative measures.
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Revista médica de Chile · Jul 2023
Case ReportsBeyond the Recommendations of the Clinical Guidelines for Medullary Thyroid Cancer - A Case Report.
Medullary thyroid cancer (MTC) is a rare disease from parafollicular C cells. Calcitonin has been suggested as a screening; its levels are proportional to the tumor size and predictive of metastatic disease. We present a case where an early action was taken with lower cut-off points. ⋯ Surgery was done, and a biopsy confirmed metastases. Conclusions: The clinical guidelines may allow the management of cases; however, they should be used considering each case context. In our patient, if the guidelines had been strictly followed, it would not have been possible to detect liver metastases to achieve a surgical resection with curative intent.