No abstract

Q fever is a worldwide zoonosis caused by Coxiella burnetii. Looking to the duration of the disease, Q fever may be divided into acute and chronic forms. In humans, acute C. burnetii is often asymptomatic or mistaken for an influenza-like illness or atypical pneumonia. On the other hand, chronic Q fever is characterized by a spontaneous evolution lasting for > 6 months and a high level of IgG antibodies titre, generally determined by the indirect fluorescence antibody (IFA). However, other clinical manifestations may be observed, including hepatic, neurologic, dermatologic, and cardiac disturbs. Teha last one includes pericarditis, which has been observed in 1% of patients affected by C. burnetii infection. However, this incidence is probably underestimated. In fact, over 80% of acute as well as recurrent pericarditis remains aetiologically unexplained.We describe a case of a 36-year-old man reporting progressive onset of dyspnea, chest pain and dysthermia sensation. Ambulatory treatment was unsatisfactory developing a severe respiratory failure recquiring his admission in the Critical Care Department. Blood test showed discrete leukocytosis with left deviation and increased reactive protein C levels. Thoracic computed tomography (CT) showed a 22mm pericardial effusion with a bilateral pleural effusion more marked in the left lung area. Microbiological as well as serological studies showed positive IgM titers to C. Burnetii. Doxycycline treatment was initiated with postive results.

The presence of a foreign body in the airway is a potentially life-threatening clinical condition that requires urgent medical attention. We present a case of a 12-year-old boy who presented in the emergency room with a history of an episode of choking after aspiration of a foreign body, followed by severe respiratory distress and subcutaneous emphysema. Chest radiography revealed hyperinflation data, pneumothorax, and subcutaneous emphysema data. The flexible bronchoscope examination showed the presence of an inorganic foreign body impacted on the carina with tracheal lesions and laryngeal edema. It was necessary to perform a tracheostomy for its definitive extraction. The gold standard in the treatment of foreign body aspiration is bronchoscopy; although, in children, the technique adopted continues to be controversial, flexible bronchoscopy can be effective and very useful.

Spontaneous rupture of the spleen is a rare clinical condition that usually presents as a complication of a background pathology and can become a life-threatening condition if it is not diagnosed in time. We present the case of a 15-year-old girl with abdominal pain and clinical data of hypovolemic shock. The simple tomographic study revealed deformation of the splenic architecture and hemoperitoneum. Surgery demonstrated splenic rupture with ptosis spleen and intraperitoneal free blood. The anatomopathological examination showed the presence of splenomegaly and findings suggestive of peliosis. It also highlights the known causes related to spontaneous splenic rupture.

No abstract

The purpose of this review is to summarize the management of upper gastrointestinal bleeding (UGIB). This entity has an annual incidence of 48 to 160 cases per 100,000 adults, with a mortality rate of 10% to 14%. Classically, UGIB is divided in non-variceal hemorrhage and variceal hemorrhage, being more frequently observed the first one (80%-90%). The initial management includes investigate about the form of presentation, color and characteristics of the hemorrhage, the age of the patient, presence of coagulopathy, disease or cardiovascular risk factors, use of nonsteroidal anti-inflammatory drugs (NSAIDs), antiaggregants or anticoagulants, previous episodes of hemorrhage, endoscopy, alcohol intake, etc. However, this process must not delay the initiation of hemodynamic resuscitation in patients with patients with ongoing bleeding. To stratify these patients, risk scores including Blatchford score and Rockall score are developed.Diagnosis is realized through endscopy, which allows definitive treatment. This treatment is improved providing pre-endoscopy as well as post-endoscopy therapy, including proton pump inhibitor (PPI) therapy. In variceal hemorrhage, if endoscopy therapy fails, balloon tamponade or transjugular intrahepatic portosystemic shunt (TIPSS) are indicated.The purpose of this review is to summarize the initial management of acute UGIB, especially in the Emergency Department.

Focal nodular hyperplasia (FNH) is considered the second most frequent benign liver tumor with a low prevalence, with a broad predominance in the female population. Most cases are asymptomatic and are often discovered incidentally. Diagnostic imaging through MRI, CT, and ultrasound can be achieved in up to 80% of cases. In some cases, a histopathological study may be necessary, especially in view of the diagnostic uncertainty and suspicion of malignancy. To date, the management of these lesions remains controversial, conservative management is recommended for asymptomatic or small lesions, relegating surgical treatment only in cases of symptomatic lesions or uncertain behavior.

Background and Objectives: Chronic Kidney Disease of uncertain or non-traditional etiology (CKDnT) is a form of chronic kidney disease of undetermined etiology (CKDu) and is not associated with traditional risk factors. The aim of this study was to investigate the association of polymorphisms rs2070744, 4b/a and rs1799983 of the NOS3 gene with CKDnT in Mexican patients. Materials and Methods: We included 105 patients with CKDnT and 90 controls. Genotyping was performed by PCR-RFLP’s, genotypic and allelic frequencies were determined and compared between the two groups using χ2 analysis, and differences were expressed as odd ratios with 95% confidence intervals (CI). Values of p < 0.05 were considered statistically significant. Results: Overall, 80% of patients were male. The rs1799983 polymorphism in NOS3 was found to be associated with CKDnT in the Mexican population (p = 0.006) (OR = 0.397; 95% CI, 0.192–0.817) under a dominant model. The genotype frequency was significantly different between the CKDnT and control groups (χ2 = 8.298, p = 0.016). Conclusions: The results of this study indicate that there is an association between the rs2070744 polymorphism and CKDnT in the Mexican population. This polymorphism can play an important role in the pathophysiology of CKDnT whenever there is previous endothelial dysfunction.