Apendicitis aguda de presentación atípica, un reto diagnóstico. Reporte de caso y revisión de la literatura

BACKGROUND: Atypical appendicitis corresponds to approximately 39.3% of all appendicitis cases. Typically located appendicitis begins with acute pain around the belly button, which will later migrate to the right iliac fossa; however, the patient’s condition must be oriented in details that arise from a meticulous anamnesis, considering the patients history and the development of the symptoms. CASE REPORTS: 17-year-old male patient with history of right hepatectomy 15 years ago. He presented with five day evolution continuous abdominal pain, located in the right upper quadrant, nausea, vomiting and fever. Complementary laboratory tests evidenced: leukocytosis, neutrophilia, elevated procalcitonin and CRP. Tomography was suggestive of an inflammatory process in the lower right thoracic region and the right upper quadrant. A diagnostic laparoscopy was performed, it was converted into an exploratory laparotomy, showing purulent fluid in the right parietocolic gutter, adhesions, appendicular plastron in the right sub and retrohepatic region formed by the cecum, distal ileum, omentum and appendix. Retrohepatic appendix with perforation in the middle third, appendicular base and poor quality cecum. An appendectomy, cavity lavage was performed, with placement of a drain. EVOLUTION: During the postoperative period, the patient had a poor clinical evolution, with health care associated pneumonia, in addition to the need for a second surgical intervention due to the formation of a sub-hepatic collection. After 13 days of hospital care, after the second surgical intervention, he presented an adequate recovery and was discharged from the hospital. CONCLUSION: Physicians must have a high clinical suspicion of atypical location appendicitis in the presence of acute abdomen; since a late diagnosis of this cases increases the risk of complications, with perforation and peritonitis and prolonged hospital stay. The first-line treatment for complicated appendicitis is surgical intervention.

Caso Clínico: Resolución quirúrgica de coartación de aorta en un paciente pediátrico

BACKGROUND: Coarctation of the aorta is a congenital heart disease with an incidence of 4 per 10 000 live births, it may or may not be associated with patent ductus arteriosus as well as other malformations. It is usually asymptomatic and diagnosed by its classic signs such as; arterial pressure gradient between extremities, reduced pulses in the lower extremities, arterial hypertension in the upper extremities or, in severe cases, left heart failure. Its resolution can be percutaneous or surgical, depending on the patient’s age and the characteristics of the defect. CASE REPORTS: A 6-year-old male patient, asymptomatic, with suspected aortic coarctation, due to a difference between arterial pressures in the upper and lower limbs, lower limbs with reduced pulses, and a systolic murmur in the aortic focus. An echocardiogram was requested, which reported a bicuspid aortic valve with raphe, mild regurgitation, and coarctation of the aorta; CT angiography showed coarctation of the juxtaductal aorta; cardiac catheterization showed almost no passage of contrast through the defect, so surgical treatment was scheduled. EVOLUTION: Surgical correction was performed by coartectomy with end-to-end anastomosis and closure of the ductus arteriosus. After the intervention, a relevant improvement in the pressure gradient between the extremities was observed. In the postoperative period the patient presented hypertension, that we managed to control, the patient progressed favorably and was discharged after 4 days without antihypertensive treatment. CONCLUSION: Life expectancy in patients who underwent surgery to correct a congenital heart disease is higher than in those who don’t, so timely diagnosis is an important tool to improve life quality and life expectancy.

Reporte de Caso Clínico: Linfangioma quístico de epiplón

BACKGROUND: Mesenteric lymphangioma is a rare, benign congenital cystic tumor of the lym-phatic vessels, which occurs in less than 5% pf the cases at the abdomen. They appear most often during childhood. This tumor should be considered as a differential diagnosis of acute abdomen and other abdominal masses. CASE REPORT: A 6-year-old boy presented with abdominal pain and peritonism. He presented a low-grade fever, a positive rebound sign, as well as leukocytosis and neutrophilia. Ultrasono-graphy showed abundant free fluid in abdomen and pelvis. EVOLUTION: Exploratory laparotomy was performed, finding a cystic mass dependent on the greater omentum, this mass was resected. Histopathology was negative for malignancy and compatible with cystic lymphangioma, immunohistochemistry was positive for D2-40 marker. The patient evolved favorably without surgical complications and without evidence of recurrence up to one year of follow-up. CONCLUSION: Mesenteric cystic lymphangioma can present with symptoms of acute abdomen, it can also have a chronic evolution. Complete resection is the treatment of choice, currently minimally invasive procedures are performed with favorable results. Ultrasound is useful for long-term follow-up.

Beneficios de la actividad física durante un lapso de 16 semanas en pacientes con Enfermedad de Parkinson de la fundación “FUNDAPE”, Marzo–Septiembre 2019

BACKGROUND: Parkinson's disease (PD) is neurodegenerative, explained by the loss of dopaminergic neurons of the substantia nigra, affecting most commonly people over 60 years of age. The aim of this study was to analyze the benefits in both motor and non-motor symptoms, found after a 16-week pro- gram of physical activity in people with this disease who belong to the Parkinson Foundation of Ecuador (FUNDAPE). METHODS: This is a quasi-experimental interventional study, with a sample of 17 patients with Parkin- son’s disease diagnosis that went through a 16 week program of aerobic exercise, to analyze its impact on maximum oxygen consumption, motor skills, balance, cognition, body composition, and presence of depression. For the analysis, Wilconson “t-test” was applied. Confidence interval was 95%, 5% error. RESULTS: The maximum oxygen consumption improved 29.86%. The percentage of fat mass decreased 10.78%. The muscle weight percentage increased 4.58%. Regarding the different evaluated tests, the mean score for UPRDS improved 8.29%; the mean score for Berg Scale test improved 6.25%; regarding Ye- savage Geriatric Depression Scale, the percentage of patients with probable depression decreased from 42.86% to 7.14% in the group with PD of ≤5 years of evolution, and from 66.67% to 33.33% in the group with PD for than 5 years; regarding the Folstein Minimental State of Mind test, we found no benefits. CONCLUSION: This study showed that there are statistically significant benefits resulting from the appli- cation of a 16 week aerobic exercise program in patients with Parkinson’s disease, related to the motor and non-motor symptoms of the disease, body composition, and maximum oxygen consumption. No significant benefits were found in relation to the cognitive impairment associated with the disease. The benefits were greater in patients younger than 60 years of age, and were also greater in patients with less than 5 years of evolution of the disease.

Cardiopatías congénitas, tratamiento quirúrgico y sus complicaciones en población pediátrica del Hospital Vicente Corral Moscoso, 2017- Agosto 2019

BACKGROUND: The heart is the most commonly affected organ by congenital diseases, with and incidence of 0.8 per 100 newborns. Nearly two thirds of all the surgical procedures are now a days performed before the first year of life, improving survival rate and life quality. This study aims to determine the frequency of the surgical interventions performed to treat congenital heart diseases and its complications. METHODS: An observational, descriptive cross sectional study was carried out; with 70 pediatric patients diagnosed and surgically treated for congenital heart diseases. The data was collected from the patient’s medical records using a form. Statistical analysis was performed using SPSS version 15 software. RESULTS: The median age was 1.1 years, 60% of the sample were women. 90% of the heart diseases were non-cyanogenic. The most frequent diagnosis was: persistence of the arterial duct (58.57%), followed by interventricular communication (12.86%). The type of procedures corresponds to the heart disease, thus 58.57% were performed for closure of arterial duct persistence and 12.86% were surgical repairs for closure of interventricular communication. The median stay in the intensive care unit was 4 days and the median stay in general hospitalization room was 5 days. The main complications in this pediatric population undergoing a surgical procedure were: pneumonia (11.4%) and sepsis of unspecified origin (8.6%). CONCLUSION: Treatment for heart diseases were performed at early ages (average age= 2.5±3.2). More than half of the surgical procedures for congenital heart disease were performed to correct the persistence of the ductus arteriosus, the main complication was pneumonia.

Caso Clínico: Meningohidroencefalocele Gigante

BACKGROUND: Encephaloceles are a rare congenital anomaly, affecting 1 in 5 000 live births.A meningohydroencephalocele is the herniation of the meninges, ventricles, and part of the brain through a congenital defect in the skull. The prognosis of newborns depends on several factors. The young age and the associated congenital anomalies in these patients contribute to the diagnostic and treatment challenge. CASE REPORT: Male newborn, born at 37 weeks of gestation, by emergency C-section due to latent labor, presenting a large mass over the parieto-occipital region, with lobed, irregular edges, partially covered by the scalp, and in other areas a purplish red tone. The newborn was no very reactive, had decreased tone, absent crying. EVOLUTION: After specialist’s evaluation, due to the significant defect in the cranial shell and the structural brain abnormalities, the patient was not a candidate for surgical treatment. The newborn was discharged with a reduced life expectancy, to receive care at home. CONCLUSION: giant meningohydroencephalocele is a rare neural tube defect. The management of encephaloceles can be complicated and must be individualized, and will depend on the anatomical structures involved. Although in this case the prognosis was bad, multidisciplinary work is always necessary for proper management.

Estudio Transversal Hispano-Ecuatoriano: Discapacidades derivadas de Ictus cerebral

BACKGROUND: Currently, stroke is one of the main causes of disability in the world. Globally 5 million people acquire permanent disability each year for this cause; up to 30% of affected patients suffer from some type of disability. Early management of the patient can reduce the sequelae derived from the injury. The aim of this study is to find out if there are differences in disabilities derived from strokes, between the cities of Madrid (Spain) and Cuenca (Ecuador), in association with programmed early patient care. METHODS: This is an observational, descriptive, cross-sectional, multicenter study. The sample consisted of 40 patients diagnosed with stroke, 20 from Cuenca, Ecuador, and 20 from Madrid, Spain. Data was obtained from the patient’s medical records. Both groups were compared using Pearson’s Chi-square test (Χ2) for each studied variable. RESULTS: in the Madrid Group 80% of the strokes were ischemic, in the Cuenca Group 90% of the strokes were ischemic, there is not significant association. In both groups the highest percentage of sequelae occurred due to injury of the middle cerebral artery (MCA). There was no significant difference in the percentage of disabilities derived from stroke between the groups, the Madrid Group had a lower rate of derived disabilities (45%), compared to Cuenca Group (76%), but the differences was not significant (p=0.069); however, the association between the death percentage among the groups was statistically significant (p=0.003). CONCLUSION: No significant association was found in terms of etiology, risk factors and clinical characteristics of stroke between the groups. There are no significant differences in the sequelae derived from stroke between the groups, but there is significant difference in terms of death percentage between the groups, with the application of “Código Ictus” type of program.

Hiperplasia Fibrosa Inflamatoria: Reporte de un caso

BACKGROUND: Inflammatory fibrous hyperplasia associated with the use of removable dental prosthesis (IFH) is an adaptive lesion caused by long-term trauma exerted by a poorly adapted removable prosthesis on the oral mucosa, usually in the vestibular sulcus. Its diagnosis and treatment is imperative, due to its potential to cause discomfort to the patient, altering aesthetics, phonectics and chewing. CASE REPORTS: A 41-year-old denture wearer woman was referred due to discomfort in the right lower vestibular sulcus, the clinical examination showed a bilobed enlargement with an invagination where the edge of the prosthesis fits, the patient has worn the prosthesis for 15 years. EVOLUTION: Resection with scalpel (conventional technique) was performed. The histopathological examination reported inflammatory fibrous hyperplasia and a new total removable bimaxillary prosthesis was made for the patient. CONCLUSIONS: HFI is one of the main oral lesions in older adults denture wearers and it causes aesthetic and functional alterations; it is produced by the constant irritation caused by the settlement of the prosthesis borders on the mucovestibular sulcus as a consequence of alveolar resorption. Treatment is meant to eliminate the injury and its etiology; the absence of lesions on the mucosa and the bottom of the sulcus is completely necessary.

Factores predisponentes y métodos de suicidio: Mini-revisión de la actualidad

Suicide is a major global public health problem, especially among young and middle-aged adults. According to the WHO, worldwide, approximately 800 000 people commit suicide every year. Some predisposing factors for suicide are related to the personal sphere and are universal, such as biological conditions or psychiatric pathology, childhood adversities, as well as social and community perspective: housing situation, religion, social integration and support, unemployment, stress. The highest frequencies of occurrence have been found in males and in the age groups between 15 and 25 years, or over 65 years. Regarding suicide methods, there is a predilection for hanging in most countries, and although suicide methods do not differ much from one country to another, it should be considered that they vary according to the access to lethal methods. Men are reported to commit suicide more frequently using violent methods. A greater recognition of the risk factors and suicide methods used is necessary to raise awarenes among the population and prevention.