La ventilación mecánica invasiva como estrategia terapéutica no está exenta de complicaciones. Es imperativo tener parámetros de ventilación protectiva en aquellos pacientes que están sometidos a ello. OBJETIVO: Demostrar si la potencia mecánica como parámetro ventilatorio tiene validez pronóstica de mortalidad en pacientes críticos con ventilación mecánica invasiva prolongada. MATERIAL Y MÉTODO: Se realizó un estudio transversal analítico de pacientes críticos en ventilación mecánica invasiva prolongada debido a Síndrome de Distrés Respiratorio Agudo por COVID-19 que ingresaron a la Unidad de Cuidados Intensivos del Hospital Regional Docente de Trujillo durante el periodo de marzo 2020 a mayo del 2021. RESULTADOS: La potencia mecánica, como parámetro ventilatorio, se asocia a mortalidad (RPa 1.061; IC 95% 1.037-1.085; p=0.00) al igual que la presión plateau y sie...

Objective: To determine the usefulness of lactate as a prognostic factor of death in severe sepsis. Setting: Hospital Regional Docente de Trujillo. La Libertad. Perú. Material and Methods: A case control study nested in a cohort. We studied a total of 82 adult patients with severe sepsis during the period from June 2012 to April 2013 in whom we determined the usefulness of the lactate level by calculating the Positive and Negative Likelihood Ratio, Relative Risk, Positive and Negative Predictive Value, Sensibility and Specificity. The exposed cohort was constituted by those patients who presented a lactate > 2 mmol/l and the unexposed cohort by those with lactate < 2 mmol/l. Results: Overall mortality was of 54.9 % of the patients, being 92.7% in the group of cases and 17.1% in the group of controls respectively. We found a Sensitivity of 84.4% (CI: 72.7 - 96.1), a Specificity of ...

INTRODUCCION: El trauma craneoencefálico severo es una patología frecuente, conlleva una morbimortalidad no despreciable. La hipernatremia podría considerarse un factor asociado a mal pronóstico con el fin de optimizar la terapéutica en el grupo de pacientes de alto riesgo. OBJETIVO: Determinar si la hipernatremia es un factor pronóstico de mortalidad en pacientes con trauma craneoencefálico en un hospital público que es centro de referencia local en trauma. MATERIAL Y MÉTODO: Se realizó muestreo no probabilístico de pacientes con trauma encefalocraneano severo, adultos, ambos sexos de la Unidad de Cuidados Intensivos del Hospital Regional Docente de Trujillo en el periodo del 2015–2018. RESULTADOS: La mortalidad en el grupo con y sin hipernatremia fue de 38% y 6% respectivamente (p=0,001). La diferencia de medias de la natremia entre el grupo con y sin mortalidad fue de 21,...

Galería Fotográfica (sin resumen)

Galería Fotográfica (sin resumen)

Mujer de 38 años con lesión eritematosa migratoria en cara y tronco superior de larga, evolución. Antecedente de ingestión de pescado crudo. Se halló incremento de IgE sérica y eosinofilia absoluta. La biopsia demostró dermatitis y paniculitis eosinofílica más sección de un parásito compatible con Gnatostoma spp. Se trató con ivermectina lográndose la curación.

Paciente con hemoptisis a repetición sincrónica con el periodo menstrual. La radiografía y tomografía de tórax fueron normales. La fibrobroncoscopía solo mostró sangrado proveniente del lóbulo superior derecho, de donde se tomaron muestras de biopsia, lavado y cepillado broncoalveolar. El estudio histológico mostró tejido endometrial compatible con endometriosis pulmonar parenquimal. Se trató con un agonista de GnRH (danazol), con control de la hemoptisis. Seis meses más tarde, la paciente se encontraba asintomática.

Mujer de 38 años con lesión eritematosa migratoria en cara y tronco superior de larga, evolución. Antecedente de ingestión de pescado crudo. Se halló incremento de IgE sérica y eosinofilia absoluta. La biopsia demostró dermatitis y paniculitis eosinofílica más sección de un parásito compatible con Gnatostoma spp. Se trató con ivermectina lográndose la curación.

Paciente con hemoptisis a repetición sincrónica con el periodo menstrual. La radiografía y tomografía de tórax fueron normales. La fibrobroncoscopía solo mostró sangrado proveniente del lóbulo superior derecho, de donde se tomaron muestras de biopsia, lavado y cepillado broncoalveolar. El estudio histológico mostró tejido endometrial compatible con endometriosis pulmonar parenquimal. Se trató con un agonista de GnRH (danazol), con control de la hemoptisis. Seis meses más tarde, la paciente se encontraba asintomática.

Objetive: To determine the validity of the diameter of the optic nerve sheath by ultrasound for the diagnosis of intracranial hypertension in patients with severe traumatic brain injury. Material and methods: A diagnostic test study was carried out in 43 patients with suspected intracranial hypertension secondary to severe traumatic brain injury, who fulfilled the diagnostic criteria according to the "Clinical Decision Rule" based on clinical and tomographic findings, then were made measurements of the optic nerve sheath by ultrasound at the Regional Teaching Hospital of Trujillo between May 2019 -January 2020. Results: From a total of 43 patients, when processing the data using the ROC curve, a cut point of the diameter of the optic nerve sheath of 6.05 mm was obtained, equivalent to intracranial hypertension, with an area under the curve (AUC) of 0.776 (P = 0.004); sensitivity, specifi...

Objective: To demonstrate that the PANC 3 score is useful as a predictor of severity in patients with acute pancreatitis. Materials and methods: Retrospective, observational study of diagnostic test type carried out in the Gastroenterology service in the Hospital Regional Docente de Trujillo which included a total of 160 patients with acute pancreatitis. Sensitivity, specificity, PPV and NPV of the PANC 3 score were calculated. Results: The PANC 3 score showed a sensitivity of 73.08%, a specificity of 100%, a positive predictive value of 100% and a negative predictive value of 95.04%. Pleural effusion proved to be the best parameter predicting severity in patients with acute pancreatitis, with a sensitivity of 88.46% and a specificity of 89.55%. The male genre is associated with severe acute pancreatitis. Conclusions: The PANC 3 score can be used as a predictor of severity in pati...

Objetive. To describe the clinical-epidemiological characteristics in patients with a confirmed diagnosis of COVID-19 from the Viru Health Network from March to May 2020. Material and Methods: Study with a quantitative approach and descriptive observational design with secondary data. The population made up of patients diagnosed positive for COVID-19 with molecular and serological tests. The documentation technique was applied. The established instrument, based on the COVID-19 clinical epidemiological investigation card used during the clinical consultation. Sociodemographic variables, antecedents and clinical manifestations were identified. The data was processed using dynamic tables in Excel and SPSS 26.0 software. Results: 67.7% of COVID-19 cases were found in the Virú Health Network in the adult and elderly life stages. Prevalence of male patients (57.4%) compared to female (42.6%)....

Introduction. We live in a globalized world that is kept connected through the internet. Determining the veracity of the information we receive is difficult, even more so in that related to health. The internet is one of the most popular sources for the search for health-related information and this behavior increases in the context of epidemiological outbreaks. In the context of the current pandemic, an increase in anxiety about health issues has been found, the main concern being being infected by SARS-CoV-2. Search strategy: A search was carried out in the PubMed database of all articles published up to June 30, 2020. The search for terms included the keywords suggested by the controlled vocabulary Medical Subjects Headings (MeSH) and connectors. Cyberchondria, COVID-19 and Mental Health: The role of the media is crucial, because it could induce anxiety in the population. Cyberchondri...

Introduction. The severe acute respiratory syndrome type 2 coronavirus infection (SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19) has significantly transformed the way hospital medicine is practiced in these last 4 months. Currently, there are a large number of patients who are admitted to health facilities by emergency presenting respiratory failure that rapidly evolves to the critical state of the disease, requiring in some cases admission to the intensive care unit (ICU) and the provision of ventilation invasive mechanics (IMV). Different strategies and methods have been carried out for the management of patients with SARS CoV 2 infection, one of them and with greater relevance is the prone position (PD), used to improve oxygenation levels in patients with syndrome of acute respiratory distress (ARDS). The PD position improves oxygenation levels, decreasing the gravitation...

Introduction: Vascular disorders are frequent in Down Syndrome (SD); however, it is unclear whether such patients are at increased risk for venous thromboembolic events, making this association rare. Clinical case: We report the case of a 27-year-old female patient with DS who presented a large central embolus in the pulmonary artery and its middle lobular branch on the right side; likewise, a thrombus in the femoral artery that almost completely blocked its diameter, whose presentation is asymptomatic; being diagnosed by CT Angiography and Doppler ultrasound accordingly. Enoxaparin and Warfarin were given as treatment, having a favorable evolution. Conclusion: Much attention should be paid to the correlation between venous thromboembolic disease and Down syndrome, and a wide effort should be made in its prevention, detection and treatment.

Introduction: The aim of this study was to synthesize the evidence on the causes of sudden cardiac death (SCD) associated with hypokalemia in individuals ≥15 to <65 years of age without structural heart disease. Case report. We reported a case and collected SCD cases following the PECO strategy. We conducted a bibliographic search of the literature published up to November 30, 2021. We included 25 cases. The mean age was 33.8 ± 2.4 years. Of the total cases, 60% were male and 60% corresponded to acquired etiologies. Thyrotoxicosis was the etiology of 8% of cases. The QTc interval was prolonged in 90% of the cases in which it could be recorded. Sixty percent of cases occurred out of hospital. Only 24% of episodes resulted in death. Conclusions. Thyrotoxicosis is a rare cause of hypokalemic sudden cardiac arrest (SCA). Hypokalemic SCA seems to be associated with better clinical resul...

Introducción. Los sarcomas retroperitoneales son tumores raros, con una presentación clínica dada por síntomas compresivos poco específicos. Reporte de Caso: Reportamos un caso de un varón de 69 años con historia de lumbociatalgia e incremento en el volumen del miembro inferior izquierdo hasta llegar a la incapacidad para deambular, se le realizó una Tomografía Abdominal Con Contraste donde se halló una gran tumoración dependiente del músculo psoas iliaco izquierdo que se extendía hasta la pelvis, la cual fue sometida a biopsia encontrándose un Liposarcoma de psoas de alta celularidad. Conclusiones: Los sarcomas son tumores raros originados del tejido mesequenquimal, la gran mayoría de estos tienen síntomas y signos inespecíficos siendo diagnosticados de forma tardía y a pesar del manejo quirúrgico el pronóstico es pobre.

Introduction. Retroperitoneal sarcomas are rare tumors, with a clinical presentation given by poorly specific compression symptoms. Case Report: We report a case of a 69-year-old man with a history of lumbociatalgia and an increase in the volume of the left lower limb until he was unable to wander, he underwent a Contrast Abdominal Tomography where a large tumor dependent on the left iliac psoas muscle was found, that extended to the pelvis, which was biopsied, finding a highly cellular psoas Liposarcoma. Conclusions: Sarcomas are rare tumors originating from the mesequenchymal tissue, the vast majority of them have nonspecific symptoms and signs, being diagnosed late and despite the surgical management of the prognosis is poor.

Objective: Determine the risk factors for multidrug-resistant Pseudomonas aeruginosa infection in patients with pneumonia associated with mechanical ventilation in the intensive care unit. Material and Methods: An observational, analytical, retrospective, case-control study was carried out in which 84 medical records of patients aged ≥ 18 years with a diagnosis of ventilator-associated pneumonia were selected by simple randomization at the Alta Complejidad Hospital Virgen de la Puerta (HACVP) and Hospital Belén de Trujillo (HBT) during the period from January-2014 to December-2019. In the data analysis, the Chi-square test was used to determine the statistical significance of association in the study variables. Results: Age, use of prior broad-spectrum antibiotic therapy, use of urinary catheter, time of urinary catheter use, and postoperative abdominal surgery were significantly asso...

Las manifestaciones extra intestinales en pacientes con Enfermedad Inflamatoria Intestinal (EII) se presentan en un 25% de los casos, de éstas, las manifestaciones vasculares son raras y representan entre el 1% al 8%, las más importantes son la trombosis venosa profunda (TVP) y la embolia pulmonar (EP), representan una causa relevante de morbilidad y mortalidad, además de un mayor riesgo de recurrencia de TVP. Por lo que el reconocimiento y la prevención de estas complicaciones son importantes. No hay consenso aún sobre profilaxis primaria ni secundaria para evitar recurrencias en este tipo de pacientes. Reportamos el caso de un paciente varón de 52 años de edad quien ingresa con cuadro de TVP en vena poplítea izquierda al momento del diagnóstico de Colitis Ulcerativa y durante un episodio de exacerbación severa (Índice de Truelove: 16 puntos). El ecodoppler mostró la presenc...