Presentación de casos clínicos RESUMENSe denomina tuberculosis cutánea a la enfermedad cutánea infecciosa crónica ocasionada por el Mycobacterium tuberculosis. Es poco frecuente y particularmente difícil de diagnosticar. Su incidencia, según la bibliografía, oscila entre el 1,5 y el 4% de todas las formas de tuberculosis extrapulmonares. Las formas clínicas dependen de la vía de llegada del bacilo a la piel, del estado inmunológico del paciente y del medio ambiente. Se presenta un caso de tuberculosis cutánea en un niño con lesiones dermatológicas crónicas, de evolución tórpida, sin respuesta a los tratamientos instituidos; la biopsia de piel mostró granulomas caseosos. El objetivo es describir un paciente con una presentación clínica infrecuente de esta enfermedad, destacar la importancia de su reconocimiento y tratamiento precoz, y evitar así la aparición de complicaciones y secuelas. Palabras clave: Mycobacterium tuberculosis, úlcera cutánea, tuberculosis cutánea.
AbStRActCutaneous tuberculosis is a chronic infectious disease caused by Mycobacterium tuberculosis. It is not very frequent and particularly difficult to diagnose. It incidence ranges between 1.5 and 4% of all extrapulmonary tuberculosis, according to bibliography. The clinic presentations depend on the arrival via of the bacillus to the skin, the patient´s immune state and the environment. We show a cutaneous tuberculosis on a child with chronic dermatologic lesions, with torpid evolution, without response to treatments; the skin biopsy showed caseous granulomas. The aim is to show a patient with an infrequent clinic presentation of this disease, to emphasize the importance of an early recognition and treatment, avoiding the appearance of complications and sequels.
Introduction: Sepsis is one of the leading causes of mortality in patients with hematologic malignancies. Our aim is evaluate the impact of multimodal strategy on sepsis bundle compliance and in-hospital mortality in patients with hematologic malignancies.
Methods:We conducted a quasi-experimental study that included patients with hematologic malignancies and sepsis or septic shock, between January 1, 2017 and August 31, 2020. The study comprised two phases: phase 1, survey of sepsis and sepsis shock cases and reformulation of the sepsis team and sepsis bundle; phase 2, staff training, monthly meetings of the sepsis team and feedback for care teams. The followup of patients was for 30 days, during hospitalization, or until death. Data were analyzed with descriptive and inferential statistics, with a 95% significance interval. And the tests considered a 5% significance level.
Results: A total of 329 (42.5%) patients were included. The proportion of sepsis was 241 (73.3%) and septic shock 88 (26.7%). We observed an increase in the 3h-bundle compliance in the phase 2 (86.8%), compared to the phase 1 (71.3%), with p=0.001. The in-hospital mortality was lower in the 2nd phase (38.2%), compared to the first phase (51.5%), with p=0.024. These results were mainly observed in cases of sepsis identified in the wards.
Conclusions:The multimodal strategy had an impact on increasing the rate of compliance to the sepsis bundle. In-hospital mortality significantly reduced in the intervention phase of the study.
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