Recurrent hemoperitoneum due to aneurysm of the left hepatic artery. Even "Ockham's razor" can fail

The infection of Klebsiella variicola constituted a high morbility and mortality disease in the most of its guest. It is tended to be associated with a septic shock which required an intensive treatment most of the times. The pathological mechanisms are not well-defined. A correlation has been made between this clinical case and one likely pathogenicity factor, which could explain these rates. We present the case of a male patient who presented to the emergency department with a septic shock. The patient eventually developed an hemoperitoneum by the aneurysm of the left hepatic artery which is very unusual.

Rhabdomyoma of the parapharyngeal space

Rhabdomyoma is a benign tumor that comes from skeletal tissue, it is classified as cardiac and extracardiac according to the location. Extracardiac rhabdomyomas most frequently originate in the head and neck at the larynx and pharynx, being the parapharyngeal space an exceptional location. We present the clinical case of an 86-year-old man asymptomatic patient with a laterocervical mass with years of evolution, that has increased its size progressively, with dysphagia and dyspnea on exertion in the last years. CT and MRI were requested, which provided dimensions, location at the parapharyngeal space, as well as signs of benignity. The FNA results indicated that it was a mesenchymal tumor. After cervicotomy and histological study, the diagnosis of parapharyngeal space rhabdomyoma was confirmed. We conducted a bibliographic review of this extremely rare benign tumor at the head and neck level.

For which reasons are newborns brought to the emergency department?

Objectives: Compare what sanitary and socio-demographic factors present the newborns that were attended in the hospital emergency room in regard to the newborns who don’t visit the hospital during their first month of life. Methods: A retrospective observational case-control study was performed, considering as cases those neonates who were brought to the hospital emergency department during their first month of life, matched with control of their same sex and age, born in the hospital but that hadn’t visited the emergency room. Results: 15.15% of the newborns were brought to the hospital emergency department during the year of the study. The main risk factors associated with the visits to the emergency room were: Unemployment, self-employment, and the mother’s younger age. The main reasons why the newborns were brought were: Phisiological phenomena of the newborn (17.4%), upper respiratory infection (13.4%), and colic or crying (12.8%). Conclusions: Newborns can manifest a wide variety of symptoms and signs that, due to their non-specificity, generate anxiety in their parents and can generate numerous visits to the emergency services, with a higher probability of hospitalization due to their young age and the physician’s caution, rather than due to severity of the illness.

Has the kidney survival improved in the IgA glomerulopathy in the last three decades?

Aim: To have the knowledge of the incidence, clinical, analytical and histological presentations, the kidney survival mean and the contribution of treatments to it. Methods: A descriptive, observational and transversal study over 156 patients who were diagnosed of primary IgA glomerulonephritis between 1994 and 2018 in the Nephrology department of Reina Sofía Hospital in Córdoba. Variables were analysed globally and compared between group 1 (G1) 1994-2002, group 2 (G2) 2002-2010 and group 3 (G3) 2010-2018. Results: Annual incidence 8,4 cases/million, 69,2% men, age mean 35,4±15,2 years old, serum creatinine mean 1,7±1,2 mg./dl., proteinuria mean 1,9±2,4 g./24h., macroscopic hematuria 41,4%, arterial hypertension 61,5%, ACEI/IIARA 87,5% and corticosteroids 33,7%. Kidney biopsy, mesangial proliferation 71,1%, sclerosis 49,2%, severe fibrosis 27,1%. The kidney survival at 10 and 20 years was 80,6% and 77,3%, respectively. GROUPS. The annual incidence increased in G3 (9,9 cases/million VS 6,9 cases/million G1), higher age mean (39,4±16,5 years old VS 31,5±14,9 years old G1, p=0,011), lower macroscopic hematuria (27,5% VS 58,8% G1, p=0,021) and worse prognosis histological characteristics, S1 (59,6% VS 25% G1, p=0,005) y F2 (21,7% VS 20% G1, p=0,016). The kidney survival at 8 years was identical in three groups (p=0,16). Conclusion: The incidence of biopsies with IgA nephropathy in Cordoba was increased between 2010 and 2018, with older patients, lower macroscopic hematuria and worse prognosis histological characteristics. Treatments and kidney survival at 8 years have not varied in three groups, making a different therapeutic approach necessary in order to improve the prognosis of the disease.

Suggestive changes of human papillomavirus infection in students at a public university

Introduction: Sexually transmitted infections are a global public health problem. Objective: to analyze the results of cervical-vaginal cytologies with suggestive changes of Human Papillomavirus infection in students of the Faculty of Health Sciences of the University of Carabobo, who was attended the gynecology consultation of the Ambulatory “Nuestra Seora de la Luz” in 2016-2017. Method: descriptive, cross-sectional study. Population consisting of all students of the Faculty of Health Sciences who was attended the Gynecology Consultation at the Ambulatory mentioned above during the period under study. Non-probabilistic and intentional sample, inclusion criteria: age, acceptance to belong to the study by signing informed consent, and not suffering pathologies at the time of sampling or being pregnant. The collection of the information was carried out through the interview and subsequent cytological examination, and the cytological study was expressed according to the BETHESDA 2001 system. The sample for cervical-vaginal cytology was performed according to standard procedure. Results: average age of 21.43-2.47 years, 40.2% belonging to the low mean stratum, 9.2% smokers, sexarquia in ages 18-20 years in 52.6% of cases, 70% with 2 or 3 pairs. As for the cytology result, 9.2% was suggestive for Human Papillomavirus infection, while with the BETHESDA 2001 System, in the epithelial cell abnormalities section, 63.6% showed low-grade Human Papillomavirus -associated. Conclusions: in the sample, the suggestive changes to Human Papillomavirus infection, was higher than that found in other countries, whereas most interviewees presented risk factors to contract it, so emphasis on education is recommended conducting annual cytology to the at-risk population.

Antonio Chamorro Daza (1903-2003): Scientific production during the first years of exile (1937-1945)

Objetives: The main aim of our work is to highlight the importance of Chamorro’s discoveries in the fields of endocrinology, gynaecology, reproduction and oncology. Methods: Evaluation of the bibliometric impact of Chamorro’s work using Google Scholar, PubMed, Scopus and Gallica. Results: Between 1937 and 1945 Chamorro carried out important research work, the results of which provided valuable discoveries about the activity of the main endocrine glands. Discussion: To achieve our objective, Google Scholar has been the most profitable metasearch engine from a practical point of view, having recognized almost all of the articles published by Chamorro, although having ignored some of them it could be thought that the overall impact of this author is higher than that which has been found. Conclusions: These findings were reflected in the most prestigious journals and widely disseminated in U.S. research institutions, amongst others. In Spain, however, they were ignored. Maybe it’s time to spread it.

Psoas abscess. Percutaneous resolution

Description of the case of a patient who goes to the emergency service of one General Hospital Zone of the Instituto Mexicano del Seguro Social, I.M.S.S. with a left abdominal-inguinal pain and fever of one month of evolution. The study of the case, gets tomographic evidence of a left psoas abscess of large dimensions is obtained with laboratory tests compatible with systemic inflammatory response. Percutaneous drainage was performed in the emergency service to continue his hospital stay later, with gradual improvement until his discharge. Few cases are reported of this pathology and much less of those that can be resolved in this way so little invasive.