During the COVID-19 pandemic, acute respiratory failure, often associated with acute respiratory distress syndrome, required a broad differential diagnosis that demanded several therapeutic interventions. We present the case of a 41-year-old with COVID-19 who presented pneumothorax and pneumomediastinum. The insertion of a chest tube immediately improved his respiratory distress. Follow-up images revealed the resolution of the pneumothorax and pneumomediastinum. This case emphasizes the potentially lethal complications of spontaneous pneumothorax and pneumomediastinum in COVID-19 patients.

La tasa de filtración glomerular (TFG) es un índice que mide la velocidad a la que se filtra la sangre por minuto en los corpúsculos renales de ambos riñones, y que suele ser alrededor e 125 mL/min en los hombres y 105 mL/min en las mujeres. La  medición  de  la  TFG  se  hace  mediante  la  prueba  de Depuración de Creatinina con recolección de orina de 24 o 2 horas y no es viable en su inmediatez para su valoración en la práctica diaria, por ello se han desarrollado diversas ecuaciones matemáticas que permitan su estimación(1). Durante los últimos años, la TFG ha sido considerada como el mejor índice para evaluar la función renal, siendo muy importante en la atención médica de todo paciente.

Letter to the Editor (without abstract)

Hydatidosis is a parasitic zoonosis caused by Echinococcus, with rural livestock areas the most prevalent. It constitutes a public health problem, with Peru being one of the most affected countries. The granulosus genus is responsible for cystic disease, predominantly affecting the liver and lungs. Disseminated hydatidosis is the simultaneous involvement of multiple organs and, as rare, is a diagnostic challenge. We present the case of a man with disseminated hydatidosis complicated by the rupture of one of the lung cysts, which had been incidentally diagnosed by imaging studies. Due to pulmonary, hepatic, pancreatic and splenic involvement, he received albendazole for 9 uninterrupted months with the disappearance of most of the lesions at the lung, hepatic and splenic levels. Currently, the management of disseminated hydatidosis there is no consensus, although surgery, percutaneous drai...

Introduction: During the COVID-19 pandemic, clinical prediction rules such as the PAWNN score have been developed to estimate mortality risk using only a complete blood count. However, it has not yet been validated in the Peruvian and Latin American population. Material and methods: A validation study was conducted in a retrospective cohort of patients hospitalized with COVID-19 between March and December 2020. Sensitivity, specificity, predictive values, likelihood ratios, and the area under the receiver operating characteristic curve (AUROC) for the PAWNN score were calculated. Results: A total of 1,963 patients were included, with a median age of 58 years; 66.4% were male. The mortality rate was 46.9%. Using a cutoff of 6, sensitivity was 96%, specificity was 16%, and AUROC was 0.71 (95% CI: 0.69–0.73). Conclusion: The PAWNN score does not have adequate diagnostic performance to pre...

Paracoccidioidomycosis is a systemic mycosis, endemic to Latin America, caused by the dimorphicfungus Paracoccidioides spp., mainly acquired through the inhalation of spores present in theenvironment. It predominantly affects males in rural areas due to their frequent exposure tocontaminated soil. Following primary infection, the pathogen has the potential to spread viahematogenous or lymphatic routes, involving various organs and systems. The acute form ofparacoccidioidomycosis impairs peripheral T-cell function and disrupts neutrophil maturation,while the chronic form is characterized by a progressive decline of the cellular immune response,along with increased Th1-cytokine levels. Severe cases may present with hypergammaglobulinemia,reduced phagocytic capacity and immune dysregulation. The most significant risk factors includeprior immunosuppression and infectious comorbidities, such ...

The accidents caused by the larval stages of the Lepidoptera are known as erucism. Accidental contact with caterpillars of the genus Lonomia spp. can trigger hemorrhagic syndromes that in severe cases can lead to acute renal injury and intracranial hemorrhage. We present the case of a 48 year-old male from Peruvian Central Jungle who while was working in the forest comes in contact with a caterpillar, after which he developed an hemorrhagic syndrome characterized by coagulopathy and subarachnoid hemorrhage. The clinical picture resolved satisfactorily after administration of antilonomic serum. The pathophysiological, clinical and laboratory aspects that led to the diagnosis are discussed, as well as the reported effectiveness of treatment.

The accidents caused by the larval stages of the Lepidoptera are known as erucism. Accidental contact with caterpillars of the genus Lonomia spp. can trigger hemorrhagic syndromes that in severe cases can lead to acute renal injury and intracranial hemorrhage. We present the case of a 48 year-old male from Peruvian Central Jungle who while was working in the forest comes in contact with a caterpillar, after which he developed an hemorrhagic syndrome characterized by coagulopathy and subarachnoid hemorrhage. The clinical picture resolved satisfactorily after administration of antilonomic serum. The pathophysiological, clinical and laboratory aspects that led to the diagnosis are discussed, as well as the reported effectiveness of treatment.

A 19-year-old woman who started with respiratory symptoms and later presented subacute symptoms with behavioral and neurological disorder associated with hallucinations, aggressiveness, mutism, epileptic seizures, facial dyskinesias and fever. MRI was normal, EEG recorded delta waves, CSF and serum studies were negative for secondary causes. Treatment was initiated with acyclovir, anticonvulsants and, subsequently, she received methylprednisolone with immunoglobulin without satisfactory response. Treatment with rituximab was started, with a favorable response. The CSF panel was positive for NMDAr. It is important to recognize early the neuropsychiatric manifestations of this pathology for an opportune management having a positive impact on the long term prognosis.

Aunque la tromboembolia pulmonar es frecuente en aquellos pacientes con síndrome antifosfolipidico (SAF), la presentación bilateral no es usual, así como la presentación en adultos mayores. Se presenta el caso de un paciente varón, adulto mayor de 72 años con antecedente de purpura trombocitopénica inmune quien fue hospitalizado con el diagnóstico de tromboembolia pulmonar bilateral. Diecisiete días después del ingreso se realizó el diagnostico de SAF primario y tuvo una buena evolución clínica. Se debe considerar SAF primario en aquellos pacientes con eventos vasculares trombóticos en ausencia de condiciones predisponentes.

Aunque la tromboembolia pulmonar es frecuente en aquellos pacientes con síndrome antifosfolipidico (SAF), la presentación bilateral no es usual, así como la presentación en adultos mayores. Se presenta el caso de un paciente varón, adulto mayor de 72 años con antecedente de purpura trombocitopénica inmune quien fue hospitalizado con el diagnóstico de tromboembolia pulmonar bilateral. Diecisiete días después del ingreso se realizó el diagnostico de SAF primario y tuvo una buena evolución clínica. Se debe considerar SAF primario en aquellos pacientes con eventos vasculares trombóticos en ausencia de condiciones predisponentes.

Objetivo: determinar el efecto de la pronación consciente en la saturación de oxígeno (SaO2) en pacientes hospitalizados por COVID-19. Métodos: estudio de corte transversal analítico. La población estuvo conformada por los pacientes hospitalizados en uno de los pabellones por COVID-19 en el Hospital Nacional Hipólito Unanue durante el periodo junio a agosto del 2020. Se realizó un muestreo por conveniencia de tipo consecutivo de todos los pacientes comprendidos en el periodo de estudio. Se incluyó a pacientes hospitalizados mayores de 18 años, con el diagnóstico de neumonía por COVID-19. Fueron excluidos aquellos con algún grado de encefalopatía, post operados, gestantes, pacientes con inestabilidad hemodinámica. Se comparó la media de saturación arterial de oxígeno (SaO2) basal con la obtenida luego de una y dos horas de pronación. Asimismo, se evaluaron los factores ...

Objective: to determine the effect of conscious pronation on oxygen saturation in patients hospitalized for COVID-19. Methods: the present study was analytical - cross-sectional. The population was made up of patients hospitalized in one of the wards for COVID-19 at the Hospital Nacional Hipólito Unánue during the period June to August 2020. A consecutive convenience sampling of all patients included in the period of study. Hospitalized patients older than 18 years were included, with the diagnosis of COVID-19 by serological and molecular tests.Those with some degree of encephalopathy, post-operated, pregnant, patients with hemodynamic instability were excluded. The mean arterial oxygen saturation (SaO2) baseline was compared with that obtained after one and two hours of pronation. Likewise, the factors associated with the change in saturation were evaluated. Results: of the 198 hospit...

Se presenta el caso de un varón de 32 años de edad, con historia de dolor abdominal, anemia severa y confusión mental. Se le halló anemia ferropénica, hematomas perirrenales bilateral, microaneurismas de las arterias renales, trombosis venosa cerebral. Los estudios inmunológicos fueron positivos para anticuerpos antinucleares, anti Smith, anticoagulante lúpico, anti B2GP1 y anti cardiolipina, Se le trató con pulsos de metilprednisolona, con buena evolución clínica.

The research was funded by FONDECYT through the project Coinfeccion por patogenos respiratorios virales y bacterianos detectados por metodos moleculares en pacientes hospitalizados por COVID-19 y su impacto en la mortalidad y desenlaces desfavorables (Convenio N degrees 044-2020-FONDECYT) and Research Vice-chancellor of Universidad Ricardo Palma.