Introducción: Candida spp. Es la principal causa de fungemia, cuya incidencia ha aumentado en los últimos años. Existen datos locales insuficientes sobre este tipo de infecciones. Materiales y métodos: Este fue un estudio observacional retrospectivo de 44 pacientes diagnosticados con candidiasis invasiva hospitalizados en la Fundación Valle del Lili, el cual es un centro de cuarto nivel afiliado a la Universidad Icesi en el Suroccidente Colombiano, entre los años 2012 a 2017. Resultados: Se identificaron 44 pacientes con candidiasis invasiva, 27 de ellos mujeres (61%). La mediana de edad fue de 56 años (36 – 70). Más del 50% tenían una enfermedad crónica subyacente, uso de antibióticos (84%), catéter venoso central (80%), ventilación mecánica (68%) y nutrición enteral (66%) El 80% requirió manejo en unidad de cuidados intensivos (UCI) donde debutaron con sepsis (68%) y falla respiratoria (61%). En el 90% de los casos se aisló alguna especie de Candida spp. A partir de hemocultivo y sólo al 22% se le realizó prueba de sensibilidad. El tratamiento de elección fue con fluconazol (80%), asociado a caspofungina (70%). La tasa de mortalidad fue del 49%, con una mediana de 33 (22-49,5) días desde el ingreso hasta el fallecimiento. C. albicans fue el principal microorganismo aislado. La resistencia a azoles en especies no albicans existe en nuestro medio. Conclusión: La candidiasis se presenta como candidemia asociada a infección bacteriana concomitante, que cobra mayor importancia en el contexto del paciente inmunosuprimido asociado a elevadas tasas de mortalidad.
Introduction: Insulinomas are rare pancreatic neuroendocrine tumors derived from beta cells responsible for insulin secretion. These tumors are typically manifested by hypoglycemia signs and symptoms, which might be non-specific leading to a delay in the diagnosis. The present study describes the experience in the approach of patients with insulinoma at Fundación Valle del Lili, Cali, Colombia.Case Presentation: A retrospective search of patients with the diagnosis of insulinoma within the database of the pathology service was performed between March 2002 and February 2017. Parameters such as the lesion size and localization, the immunohistochemistry findings, the serum levels of glucose, the insulin and C-peptide levels, the presence of metastasis, and the development of diabetes after surgery were evaluated. A total of nine patients with a diagnosis of insulinoma were enrolled in the study. The cohort comprised of seven men and two women, aged 30–50 years. Whipple triad was present in seven patients. The most common symptom was hypoglycemia-related syncope. All patients underwent surgical resection of the tumor with subsequent resolution of the symptoms. Only one patient was diagnosed with diabetes in the postoperative period.Conclusion: In the last 15 years, only nine cases of insulinoma were detected at the Fundación Valle del Lili, which is consistent with the low incidence of the disease. A higher frequency of the disease is noted in men, unlike that in the literature. However, other clinical and pathological features from large studies are in agreement with the current data. Nevertheless, continual experience in the management and identification of these cases is essential as common clinical manifestations may not be observed.
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