Carrion´s disease is an endemic disease in Peru caused by Bartonella bacilliformis presenting with an acute or hemolytic form and a chronic verrucous form with asymptomatic bacteremia. The acute form is usually serious and is associated with high morbidity and mortality. We report the case of a case of a young pregnant woman from Yungay, Ancash who presented with the acute form complicated with multi organ failure and acute respiratory distress syndrome needing mechanical ventilation and dying.

Klebsiella pneumoniae (Kp) is a member of the Enterobacteriaceae family, it is an opportunistic pathogen that affects immunosuppressed individuals. K1 and K2 strains are hyper mucous that is considered an hypervirulent factor. We report a case of a female patient who developed a hepatic abscess, bacteremia and meningoencephalitis due to an hypervirulent Kp strain requiring mechanical ventilation, vasopressors, antibiotic treatment and percutaneous drainage of the liver abscess in the intensive care unit at Hospital Cayetano Heredia. The patient survived and was discharge from the hospital. This case illustrates the presence of an hypervirulent Kp strain in Peru.

Objectives: To describe clinical, epidemiological, mechanical ventilation (MV) parameters and to determine overall mortality and that related to MV parameters in patients with acute respiratory distress syndrome (ARDS) in an ICU in Lima, Peru. Methods: A retrospective cohort including 133 patients with ARDS due to Covid-19 requiring MV in the Hospital Cayetano Heredia’s ICU was built from March to November 2020. Results: Males accounted for 75% of the cohort; 68% had no comorbidities; 97% has severe ARDS and 82% received extended 72h prone MV. Overall mortality was 38%; bivariate analysis found that alive patients had lower plateau pressure 27±1 cm H20 vs. 30±1 cm H20 (p=0.007), lower driving pressure 15±4 vs. 17±5 (p=0.008), higher static lung compliance 32±1 vs. 28±1 ml/cm H20 (p=0.01) and higher Pa02/Fi02 ratio 194±86 mm Hg vs. 157±66 mm Hg (p=0.01) than patients who died. P...

Pain is a sign of illness and a common complain that bring patients to a health care facility. It is classified in acute or chronic pain, nociceptive or neuropathic, and according to conduction velocity, fast or slowly. C and Aδ- fibers respond to stimuli and produce the experience of pain, this defines them as nociceptors. Central pathways of pain include: nociceptors respond to stimuli and produce the experience of pain when they are electrically stimulated (Transduction); axons of nociceptors enter the spinal cord via the dorsal root, where Glutamate are Substance P are released, spinal neurons send their axons to the contralateral thalamus (Transmission); the perceived intensity of pain can be modulated by brain circuits (Modulation). Pain inhibition is achieved by calcium channel blockage and open potassium channel by endogenous and exogenous opioids, due hyperpolarization of the c...

Objetivo: Determinar las características clínicas y epidemiológicas de los pacientes con intoxicación inducida e intencional, atendidos en un hospital general. Material y métodos: Se incluyeron pacientes con intoxicación inducida e intencional; de ambos sexos, mayores de 14 años. La información se obtuvo de la historia clínica de ingreso, entrevista personal, test de Hamilton y evaluación toxicológica en orina en los intoxicados inducidos. Resultados: De marzo a diciembre del 2006 hubo 45 pacientes con intoxicación inducida y 382 pacientes con intoxicación intencional, de estos últimos se tuvo información completa en 104. Los pacientes con intoxicación inducida en comparación a los intoxicados intencionales fueron varones (p=0,001); de mayor edad (31,62 ± 9,38 vs 26,85 ± 12,18 años) (p=0,011), mayor nivel de instrucción (p=0,04), empleados (p=0,01) y mayor nivel soci...

Introduction: Shoshin Beriberi is a disease generated by thiamine deficiency and is characterized by acute fulminant cardiac dysfunction (1). Objective: To highlight cardiogenic shock and hyperlactacidemia in a patient with shoshin beriberi in an intensive care unit of a general hospital. Material and method: The information was taken from the electronic medical history of the intensive care unit (ICU) of the Cayetano Heredia National Hospital (HNCH) and from laboratory and image records. Case: 22-year-old female patient, with a history of anorexia nervosa, multisystem tuberculosis (TBC); with abdominal pain, vomiting, oral intolerance, prolonged fasting, received total parenteral nutrition (TPN) without thiamine intake and with hospitalization for 40 days on the general floor; Admission to the ICU in cardiogenic shock and hyperlactacidemia with serum lactate 13.8 mmol/L. With sepsis rul...

El tromboembolismo pulmonar (TEP) masivo, es un evento vascular agudo caracterizado por choque obstructivo, con mortalidad alta. El objetivo del reporte fue resaltar la terapia de trombólisis con guía ecocardiográfica en un paciente con tromboembolismo pulmonar (TEP) masivo y arresto cardiopulmonar. Se presenta el caso de un varón de 48 años de edad, con fractura expuesta de tibia izquierda no operada, hospitalizado sin uso de heparina profiláctica, quién cursó con disnea súbita, dolor torácico y arresto cardiopulmonar dos veces, el primero en hospitalización general, y el segundo al ingreso a la unidad de cuidados intensivos (UCI). Post retorno de la circulación espontanea cursó con hipotensión, taquicardia, hipoxemia, Glasgow 4 puntos; en el electrocardiograma se encontró taquicardia sinusal, patrón S1Q3T3, bloqueo completo de rama derecha; en la ecocardiografía relaci...

Pain is a sign of illness and a common complain that bring patients to a health care facility. It is classified in acute or chronic pain, nociceptive or neuropathic, and according to conduction velocity, fast or slowly. C and Aδ- fibers respond to stimuli and produce the experience of pain, this defines them as nociceptors. Central pathways of pain include: nociceptors respond to stimuli and produce the experience of pain when they are electrically stimulated (Transduction); axons of nociceptors enter the spinal cord via the dorsal root, where Glutamate are Substance P are released, spinal neurons send their axons to the contralateral thalamus (Transmission); the perceived intensity of pain can be modulated by brain circuits (Modulation). Pain inhibition is achieved by calcium channel blockage and open potassium channel by endogenous and exogenous opioids, due hyperpolarization of the c...

SARS-CoV-2 is an RNA virus that can manifest clinically with pneumonia, neurologic, myocardial and renal involvement as well as with hematologic and multiple organ failure and death. We report the case of a male patient admitted to the ICU severe acute respiratory distress associated to SARS-CoV-2 infection who required mechanical ventilation with pronation and vasopressors. He developed acute kidney injury with reddish urine and serum levels of CK in 17,179 UI/ml consistent with SARS-CoV-2 associated rhabdomyolysis. The patient underwent hemodialysis with complete recovery and subsequent discharge from the ICU.

Objective: To estimate mortality rates associated with hydroxichloroquine and azithromycin use in Covid-19 patients undergoing mechanical ventilation in an intensive care unit in Lima. Material and methods: This is a retrospective analytical cohort. One hundred and five patients with Covid-19 undergoing invasive mechanical ventilation who were admitted with a diagnosis of acute respiratory insufficiency to the intensive care unit of Cayetano Heredia Hospital in Lima during 2020. Results: The overall mortality rate was 38%. Most patients (79%) were male, their mean age was 50 ± 13 years, two thirds (65%) did not have comorbidities; APACHE II and SOFA scores were 12 ± 6 points and 5 ± 3 points, respectively. Thirty percent of all patients received hydroxichloroquine, 32% received azithromycin, and 32% received both drugs. Mortality was significantly higher in those patients who received...

Objetivos: Estimar la mortalidad relacionada a hidroxicloroquina y azitromicina en pacientes con COVID-19 en ventilación mecánica de una unidad de cuidados intensivos. Material y métodos: Cohorte analítica retrospectiva. Se incluyeron 105 pacientes con COVID-19 en ventilación mecánica invasiva que ingresaron con el diagnóstico de Insuficiencia Respiratoria Aguda a la unidad de cuidados intensivos del Hospital Cayetano Heredia durante el año 2020. Resultados: La mortalidad global fue 38%; el 79% fueron varones, la edad media fue 50±13 años, el 65% no tuvo comorbilidades; al ingreso la puntuación en la escala APACHE II fue 12±6 puntos y en la escala SOFA 5±3 puntos; el 30% recibió hidroxicloroquina, el 32% azitromicina y 32% la combinación de los mismos. La mortalidad fue significativamente mayor en pacientes que recibieron hidroxicloroquina (p=0.00), azitromicina (p=0.03), ...

Objective: To estimate mortality rates associated with hydroxichloroquine and azithromycin use in Covid-19 patients undergoing mechanical ventilation in an intensive care unit in Lima. Material and methods: This is a retrospective analytical cohort. One hundred and five patients with Covid-19 undergoing invasive mechanical ventilation who were admitted with a diagnosis of acute respiratory insufficiency to the intensive care unit of Cayetano Heredia Hospital in Lima during 2020. Results: The overall mortality rate was 38%. Most patients (79%) were male, their mean age was 50 ± 13 years, two thirds (65%) did not have comorbidities; APACHE II and SOFA scores were 12 ± 6 points and 5 ± 3 points, respectively. Thirty percent of all patients received hydroxichloroquine, 32% received azithromycin, and 32% received both drugs. Mortality was significantly higher in those patients who received...

La dapsona es una sulfona utilizada en una variedad de enfermedades dermatológicas que incluye el pénfigo, la metahemoglobinemia es un síndrome clínico potencialmente mortal debido a la disminución del aporte de oxígeno desde la sangre hacia los tejidos; la metahemoglobinemia adquirida es la forma más frecuente y es un conocido efecto adverso del uso de dapsona. Describimos el caso de un varón con pénfigo foliáceo y tratamiento reciente con dapsona, que presentó cianosis, disnea y choque circulatorio ante concentraciones elevadas de metahemoglobina(21%); el tratamiento inicial incluyó oxigenoterapia, soporte ventilatorio invasivo, hemodinámico y administración de azul de metileno intravenoso, ante la ausencia de respuesta clínica se realizó exanguinotransfusión como terapia de segunda línea con respuesta óptima, el nivel sérico de metahemoglobina fue 2,3% tres h...

Objetivos: Estimar la mortalidad global, la mortalidad relacionada a los tipos de destete de pacientes en ventilación mecánica y describir los factores relacionados al fracaso del destete en una unidad de cuidados intensivos. Material y métodos: Estudio observacional, descriptivo. Se incluyeron 147 pacientes sometidos a destete de ventilación mecánica invasiva que ingresaron con el diagnóstico de Insuficiencia Respiratoria Aguda a la unidad de cuidados intensivos del Hospital Cayetano Heredia durante el año 2014. Resultados: La mortalidad global de los pacientes sometidos a destete de ventilación mecánica fue 27%, se observó mayor mortalidad en el grupo destete prolongado 42%, seguido por destete difícil 29% y destete simple 15% (p=0,039);  la mortalidad global incrementó conforme aumentó la estancia en la unidad de cuidados intensivos y los días en ventilación mecán...

Objective: To report on mortality and therapeutic interventions of patients with severe COVID-19 on mechanical ventilation in an intensive care unit (ICU). Methods: A retrospective cohort study of 105 patients with severe COVID-19 admitted to the ICU with respiratory failure needing mechanical ventilation from march to October 2020 was carried-out. Results: overall mortality of patients on mechanical ventilation was 38%; 79% were males: mean age was 49.8 ± 13 years; 65% did not have comorbidities; APACHE II score was 12±6; and the SOFA score was 5±3. Patients presented with lymphopenia, high serum levels of ferritin, lactic dehydrogenase and C-reactive protein. Thirty percent received hydroxychloroquine, 32% received azithromycin, 47% ceftriaxone and 27% received hydroxychloroquine plus azithromycin. Mortality was significantly higher in males (p=0,004), with high APACHE II (p=0.005) ...

Objetivos: Determinar la frecuencia de microorganismos y el patrón de susceptibilidad antimicrobiana en aislamientos de cultivos de secreción endotraqueal en la unidad de cuidados intensivos de un hospital nacional de Lima. Material y métodos: Estudio observacional, descriptivo. Se incluyeron 195 cultivos positivos de secreción endotraqueal de pacientes en ventilación mecánica durante el periodo enero a diciembre del 2016. Resultados: Acinetobacter sp. fue la bacteria más frecuentemente aislada (28%) seguido por Pseudomonas aeruginosa (22%) y Klebsiella pneumoniae (14%), Los aislamientos con Acinetobacter sp. presentaron una elevada resistencia a antibióticos carbapenémicos (meropenem 90% eimipenem 88%). Conclusiones: Se identificó una elevada frecuencia de Acinetobacter sp. En cultivos de secreción traqueal en la unidad de cuidados intensivos, con un patrón de multirresisten...

Objetivo. Determinar las características clínicas de los pacientes condiagnóstico de influenza A (H1N1). Material y Métodos. Se realizó un estudio descriptivo y retrospectivo en los pacientes hospitalizados con sospecha de infección por influenza A (H1N1) en el Servicio de Emergencia del Hospital Nacional Cayetano Heredia (HNCH) de Lima, de mayo a agosto de 2009. La información se tomó de las historias clínicas de los pacientes a su ingreso y se incluyó a pacientes mayores de 14 años con RT-PCR (reacción en cadena de polimerasa en tiempo real) por hisopado nasofaríngeo positivos parainfluenza A (H1N1). Resultados. De 92 pacientes hospitalizados por sospecha de infección por influenza A (H1N1), 62 fueron positivos. De estos, 40 pacientes fueron varones, la edad promedio fue 35,29 ± 16,8 años, el tiempo promedio de enfermedad y dehospitalización fueron 5,8 ±3,8 y 7,7 ± 5...

Objetivo. Determinar las características clínicas de los pacientes condiagnóstico de influenza A (H1N1). Material y Métodos. Se realizó un estudio descriptivo y retrospectivo en los pacientes hospitalizados con sospecha de infección por influenza A (H1N1) en el Servicio de Emergencia del Hospital Nacional Cayetano Heredia (HNCH) de Lima, de mayo a agosto de 2009. La información se tomó de las historias clínicas de los pacientes a su ingreso y se incluyó a pacientes mayores de 14 años con RT-PCR (reacción en cadena de polimerasa en tiempo real) por hisopado nasofaríngeo positivos parainfluenza A (H1N1). Resultados. De 92 pacientes hospitalizados por sospecha de infección por influenza A (H1N1), 62 fueron positivos. De estos, 40 pacientes fueron varones, la edad promedio fue 35,29 ± 16,8 años, el tiempo promedio de enfermedad y dehospitalización fueron 5,8 ±3,8 y 7,7 ± 5...

Introduction: noninvasive mechanical ventilation is a technique with a fan interface - patient through a nasal or facial mask. This reduces the morbidity associated with conventional mechanical ventilation associated with endotracheal intubation and sedation of the patient relaxation. Objectives: To assess morbidity and mortality of patients undergoing non-invasive mechanical ventilation (NIMV), in the General Intensive Care Unit (GICU) of Hospital Nacional Cayetano Heredia (HNCH) from June 2007 to May 2008. Material and method: We obtained data from the GICU files from June 2007 to May 2008. We recorded physiological values when beginning and finishing NIMV and we defined success and failure when using NIMV. Results: During the one-year study, 30 patients required NIMV, their average age was 49.7± 2 years, and 63.3 per cent were women. When NIMV was started, APACHE II sc...

Introduction: noninvasive mechanical ventilation is a technique with a fan interface - patient through a nasal or facial mask. This reduces the morbidity associated with conventional mechanical ventilation associated with endotracheal intubation and sedation of the patient relaxation. Objectives: To assess morbidity and mortality of patients undergoing non-invasive mechanical ventilation (NIMV), in the General Intensive Care Unit (GICU) of Hospital Nacional Cayetano Heredia (HNCH) from June 2007 to May 2008. Material and method: We obtained data from the GICU files from June 2007 to May 2008. We recorded physiological values when beginning and finishing NIMV and we defined success and failure when using NIMV. Results: During the one-year study, 30 patients required NIMV, their average age was 49.7± 2 years, and 63.3 per cent were women. When NIMV was started, APACHE II sc...