Resumen: La encefalopatía hepática consiste en la disfunción o deterioro cerebral, consecuente a afecciones como insuficiencia hepática e hipertensión portal, en el ámbito médico es catalogada como una grave complicación clínica asociada al daño hepático severo. Se llevó a cabo un estudio cualitativo de revisión sistemática aplicando la declaración PRISMA 2020, en donde se utilizó los documentos disponibles en las diferentes bases de datos y con la aplicación de los operadores booleanos para su búsqueda. De los documentos seleccionados se pudieron obtener 840 referencias de información en una primera búsqueda en las bases de datos y 8 registros de datos. Finalmente, para la investigación se consiguió un total de 16 fuentes bibliográficas. La encefalopatía hepática se compone de un síndrome neuro-psiquiátrico que incluye deterioro psicomotor y/o sensitivo, desorientación, incoordinación, alteración de la memoria, confusión, somnolencia, estupor y coma, existen diversas herramientas para el diagnóstico desde el primer nivel de atención, una de las principales es la anamnesis y la exploración física del paciente donde se espera encontrar hallazgos cognitivos y neuromusculares relacionados a la enfermedad hepática grave, entre los estudios complementarios se emplea principalmente exámenes de laboratorio, Criterios de West Haven, prueba psicométrica, prueba neurofisiológica y estudios de neuroimagen como resonancia magnética.

Resumo: A encefalopatia hepática consiste na disfunção ou deterioração cerebral, consequente a condições como a insuficiência hepática e a hipertensão portal, e é classificada no domínio médico como uma complicação clínica grave associada a lesões hepáticas graves. Foi efectuado um estudo de revisão sistemática qualitativa aplicando a declaração PRISMA 2020, utilizando os documentos disponíveis nas diferentes bases de dados e operadores booleanos para a pesquisa. A partir dos documentos selecionados, foi possível obter 840 referências de informação numa primeira pesquisa nas bases de dados e 8 registros de dados. Por fim, obteve-se um total de 16 fontes bibliográficas para a investigação. A encefalopatia hepática é uma síndrome neuropsiquiátrica que inclui comprometimento psicomotor e/ou sensorial, desorientação, incoordenação, comprometimento da memória, confusão, sonolência, estupor e coma, e existem várias ferramentas para o diagnóstico no primeiro nível de cuidados, Um dos principais instrumentos é a anamnese e o exame físico do doente, onde se esperam encontrar achados cognitivos e neuromusculares relacionados com a doença hepática grave. Os estudos complementares incluem testes laboratoriais, os critérios de West Haven, testes psicométricos, testes neurofisiológicos e estudos de neuroimagem, como a ressonância magnética.

Abstract: Hepatic encephalopathy consists of brain dysfunction or deterioration, consequent to conditions such as hepatic insufficiency and portal hypertension, and in the medical field it is cataloged as a serious clinical complication associated with severe liver damage. A qualitative study of systematic review was carried out applying the PRISMA 2020 statement, using the documents available in the different databases and Boolean operators for the search. From the selected documents it was possible to obtain 840 references of information in a first search in the databases and 8 data records. Finally, a total of 16 bibliographic sources were obtained for the research. Hepatic encephalopathy is composed of a neuropsychiatric syndrome that includes psychomotor and/or sensory impairment, disorientation, incoordination, memory alteration, confusion, somnolence, stupor and coma, there are several tools for diagnosis from the first level of care, One of the main ones is the anamnesis and physical examination of the patient where it is expected to find cognitive and neuromuscular findings related to severe liver disease, among the complementary studies are mainly used laboratory tests, West Haven Criteria, psychometric test, neurophysiological test and neuroimaging studies such as magnetic resonance imaging.

Abstract Background: Acute pulmonary embolism (PE) is a significant cause of morbimortality. Epidemiological data in Portugal are limited, potentially leading to underdiagnosis. Catheter-directed therapy (CDT) is a promising alternative treatment, particularly for high-risk patients. Objectives: To evaluate the impact of CDT on intermediate-high-risk and high-risk acute PE. Methods: This is a retrospective single-centre study conducted from 2019 to 2023 in Portugal. Data included patient demographics, clinical presentation, procedural characteristics, and outcomes. Comparisons before and after the procedure were carried out, using two-sided paired Student´s T-test or McNemar´s test. P-value < 0.05 was considered statistically significant. Results: Among the 21 patients included in this study, the mean age was 62.5 (±16.8) years and 57% (n = 12) were female. Bilateral PE was predominant (n=18, 86%), with fifteen patients (75%) classified as high-risk PE and five (25%) as intermediate-high-risk PE. Overweight (n = 12, 57%), hypertension (n = 9, 45%), dyslipidaemia (n = 8, 40%), immobility (n = 4, 20%), and active cancer (n=3, 14%) were prevalent comorbidities. The median Charlson Comorbidity Index score was 3.5 (IQR 1.2–4.0). Two-thirds (n = 10, 67%) of the patients with high-risk PE exhibited contraindications to systemic fibrinolysis, while one-third (n = 5, 33%) had previously undergone failed thrombolysis. CDT improved hemodynamic parameters, significantly reducing the right ventricular (RV) dysfunction after the procedure (72.2% vs 23.5%, p=0.008). There was a low incidence of bleeding complications, with only one patient (5%) experiencing life-threatening haemorrhage. Despite these improvements, in-hospital mortality remained high (n = 5, 24%). No deaths occurred within three months post-discharge. Conclusions: Despite being in its early stages, CDT showed encouraging results in improving hemodynamic and clinical parameters in intermediate-high-risk and high-risk acute PE patients. Larger trials are warranted to further evaluate its efficacy and establish its role in treatment protocols. Background (PE morbimortality limited underdiagnosis Catheterdirected Catheter directed (CDT highrisk risk Objectives intermediatehighrisk intermediate Methods singlecentre single centre 201 202 demographics presentation characteristics outcomes out twosided two sided Students Student s Ttest T test McNemars McNemar Pvalue P value 005 0 05 0.0 Results 2 625 62 5 62. ±16.8 168 16 8 (±16.8 57 n 12 female n=18, n18 18 (n=18 86%, 86 86% , 86%) 75% 75 (75% 25% 25 (25% 57%, 57%) 9 45%, 45 45% 45%) 40%, 40 40% 40%) 4 20%, 20 20% 20%) n=3, n3 3 (n=3 14% 14 comorbidities 35 3. IQR 1.2–4.0. 1240 1.2–4.0 . 1 1.2–4.0) Twothirds Two thirds 10 67% 67 fibrinolysis onethird third 33% 33 thrombolysis RV (RV 72.2% 722 72 (72.2 235 23 23.5% p=0.008. p0008 p p=0.008 008 p=0.008) complications 5% (5% lifethreatening life threatening haemorrhage improvements inhospital hospital 24%. 24 24% 24%) postdischarge. postdischarge post discharge. discharge post-discharge Conclusions stages protocols 00 0. 6 ±16. (±16. n=18 n1 (n=1 7 (75 (25 n=3 (n= 124 1.2–4. 72.2 (72. 23.5 p000 p=0.00 (5 ±16 (±16 n=1 (7 (2 n= 1.2–4 72. (72 23. p00 p=0.0 ( ±1 (±1 1.2– p0 p=0. ± (± 1.2 p=0 1. p=

ABSTRACT Severe acute respiratory syndrome coronavirus 2 is the causative agent of COVID-19. In the week of March 21 to 27, 2021 an increase of 8% in cases was confirmed in Cuba. The Cuban Ministry of Public Health decided to approve the health intervention with the SOBERANA vaccine candidates to be administered to the staff working in health institutions. The objectives were to describe the vaccination coverage achieved with the SOBERANA heterologous scheme and the progression of the disease in the vaccinated subjects. This is a descriptive, prospective study. We perceived 884 subjects that fulfilled the criteria to be included. The subjects were followed up by the researchers of the sentinel site during the application of the scheme and 5 months after its conclusion. Adequate vaccination coverage was achieved for the heterologous scheme of three doses of SOBERANA. The most frequent comorbidities inside the group of workers who fell ill of COVID-19, 14 days after of completing the heterologous scheme were: high blood pressure, asthma, type 2 diabetes mellitus and ischemic heart disease. The bigger proportion of sick persons corresponded to those who worked in the high-risk red zone, followed by those who worked in the green zone and in the professional group, and lastly non-professional non-technical workers. Disease progression to severe and critical forms was not described in vaccinated workers. Symptoms and more frequent signs in the sick persons were fever, cough, asthenia and anorexia. Adequate vaccination coverage was achieved; the progression of the disease to severe or critical forms was aborted despite the high occupational exposure of the staff and chronic comorbidities.

RESUMEN El coronavirus de tipo 2 del síndrome respiratorio agudo severo es el agente causal de la COVID-19. En la semana del 21 al 27 de marzo de 2021 se confirmó en Cuba un incremento del 8% de los casos. El Ministerio de Salud Pública de Cuba decidió aprobar la intervención sanitaria con los candidatos vacunales SOBERANA para ser administrados al personal que laboraba en instituciones de salud. Los objetivos del presente trabajo son describir las coberturas de vacunación alcanzadas con el esquema heterólogo de SOBERANA y la progresión de la enfermedad en los sujetos vacunados con el mismo. Se trata de un estudio descriptivo, prospectivo. Se captaron 884 sujetos que cumplieron los criterios para ser incluidos. Los sujetos fueron seguidos por los investigadores del sitio centinela durante la aplicación del esquema y 5 meses después de concluido. Se lograron adecuadas coberturas de vacunación para el esquema heterólogo de tres dosis de SOBERANA. Las comorbilidades más frecuentes en el grupo de trabajadores que enfermó de COVID-19 después de 14 días de culminado el esquema heterólogo fueron: hipertensión arterial, asma, diabetes mellitus tipo 2 y cardiopatía isquémica. La mayor proporción de enfermos correspondió a los que trabajaron durante la pandemia en zona roja con alto riesgo, seguido de los que trabajaron en zona verde y en el grupo de los profesionales y, por último, los trabajadores no profesionales no técnicos. No se describió progresión de la enfermedad hacia las formas graves y críticas en los trabajadores vacunados. Los síntomas y signos más frecuentes en el grupo de enfermos fueron fiebre, tos, astenia y anorexia. Se lograron adecuadas coberturas vacunales llegando a ser abortada la progresión de la enfermedad a formas graves o críticas a pesar de la alta exposición laboral del personal y la existencia de comorbilidades crónicas.

ABSTRACT Allergic rhinitis has been increasing in Latin American countries, leading to a growing population of patients who need medical treatment for this respiratory condition. Its similarity to COVID-19 in terms of symptoms and the possibility of concurrence with it, make allergic rhinitis of particular interest to health systems. The countries of Latin America and the Caribbean have been particularly vulnerable due to multiple challenges, including high poverty rates, limited access to medical care and limitations in the provision of basic health services, as well as the absence of guidelines of treatment for allergic rhinitis in a pandemic situation. With the aim of to provide essential management for multidisciplinary teams in Latin America and the Caribbean regarding the evaluation and treatment of allergic rhinitis during the COVID-19 pandemic, published scientific literature on the treatment of allergic rhinitis and COVID-19 was reviewed, and the opinion of leading professionals from scientific societies in the region was considered. The different measures to avoid infections and the different treatment strategies were analyzed, with an emphasis on intranasal therapy and treatment with allergy vaccines. A position statement was formulated with the intention of maintaining continuity of medical service in the context of a pandemic and minimizing the spread, infection and complication associated with severe acute respiratory syndrome coronavirus 2 in patients undergoing or starting treatment for allergic rhinitis.

RESUMEN La rinitis alérgica ha ido en aumento en los países latinoamericanos, dando lugar a una creciente población de pacientes que necesitan tratamiento médico para esta afección respiratoria. Su similitud con la COVID-19 en cuanto a síntomas y la posibilidad de concurrencia con esta, hacen que la rinitis alérgica sea de particular interés para los sistemas de salud. Los países de América Latina y el Caribe han sido particularmente vulnerables por múltiples desafíos, entre estos, las altas tasas de pobreza, el acceso limitado a la atención médica y las limitaciones en la prestación de servicios básicos de salud, así como la ausencia de guías de tratamiento para la rinitis alérgica en situación de pandemia. Con el objetivo de proporcionar orientación esencial para los equipos multidisciplinarios de América Latina y el Caribe con respecto a la evaluación y el tratamiento de la rinitis alérgica durante la pandemia de COVID-19, se revisó literatura científica publicada sobre tratamiento de la rinitis alérgica y COVID-19, y se consideró la opinión de profesionales líderes de sociedades científicas de la región. Se analizaron las diferentes medidas para evitar contagios, y las diferentes estrategias de tratamiento con énfasis en la terapia intranasal y el tratamiento con vacunas contra la alergia. Se formuló una declaración de posicionamiento con la intención de mantener la continuidad del servicio médico en el contexto de una pandemia y minimizar la propagación, infección y complicación asociada con el coronavirus tipo 2 del síndrome respiratorio agudo severo en pacientes con seguimiento o comenzando tratamiento para la rinitis alérgica.

Resumen El sistema respiratorio es el principalmente afecto en la infección por SARS-CoV-2, produciendo el síndrome respiratorio agudo severo como principal complicación en COVID-19, además los pacientes con enfermedad severa desarrollan insuficiencia multiorgánica; entre estos destacamos el sistema nervioso, por su potencial neurotropismo. Los datos clínicos recientes revelan que los pacientes pueden manifestar síntomas como anosmia, disgeusia, deterioro de conciencia, cefalea, convulsiones y enfermedad cerebrovascular (ECV), incluida la hemorragia cerebral y el accidente cerebrovascular isquémico. Se describen dos pacientes varones físicamente activos con infección complicada por SARS-CoV-2 sin comorbilidades significativas para el desarrollo de hemorragia intracraneal, ni antecedentes de traumatismo craneoencefálico o malformaciones anatómicas documentadas. Ambos ingresaron por el área de emergencia y en su estancia en UCI desarrollaron hemorragia intracraneal diagnosticada por tomografía computarizada. Los hallazgos paraclínicos en los dos casos fueron compatibles con un estado protrombótico, como posibles etiologías del sangrado en ambos pacientes.

Abstract The respiratory system is mainly affected by the SARS-CoV-2 infection, producing a severe acute respiratory syndrome known as COVID-19 (Coronavirus disease 2019), patients with severe disease usually develop multiorgan failure; among these we can focus on the nervous system, due to its potential neurotropism. Recent clinical data reveal that patients may manifest symptoms such as anosmia, dysgeusia, impaired consciousness, headache, seizures, and cerebrovascular disease (CVD). We describe two physically active male patients with complicated SARS-CoV-2 infection without significant comorbidities related to the development of intracranial hemorrhage, nor a history of head trauma or documented anatomic malformations. Both were admitted by the emergency department and during their stay in the ICU they developed intracranial hemorrhage diagnosed by computed tomography. The paraclinical findings in the two cases were compatible with a prothrombotic state as possible etiologies of bleeding in both.

RESUMO Esta revisão teve como objetivo abranger a maioria das publicações existentes até agora, que relatam os efeitos oftalmológicos da doença COVID-19, causadas pelo novo coronavírus ou síndrome respiratória aguda grave 2 (SARS-CoV-2). Realizamos uma pesquisa pubmed/medline até 28/02/2021, na qual revisamos as seguintes publicações em inglês: cartas ao editor, casos clínicos, revisões de literatura e estudos clínicos. O campo de busca incluiu tanto o resumo quanto o título da publicação. Conjuntivite viral, conjuntivite imuno-mediada, paralisia oculomotor (POM) e uveíte foram encontradas como afeções oculares causadas pelo COVID 19. A possibilidade de retinopatia é levantada. Os oftalmologistas apresentam um risco considerável de contrair o COVID-19 devido ao contato próximo com o paciente, exposição a lágrimas e secreções oculares, bem como o uso de equipamentos e aparelhos suscetíveis à contaminação.

ABSTRACT This review was intended to cover of the existing publications up to the moment which inform about the ophthalmological affectations of the COVID-19 disease, caused by the new coronavirus or severe acute respiratory syndrome 2 (SARS-CoV-2). It was carried out a search in PubMed/Medline until 28/02/2021, the following publications in English were revised: letters to the editor, clinical cases, bibliographic review and clinical studies. In the search field was included both, the abstract and the title of the publication. As ocular affectations produced by the covid-19 were found the viral conjunctivitis, immune-mediated conjunctivitis, oculomotors paralysis (POM) and uveitis. The possibility of retinopathy is raised. Ophthalmologists are at considerable risk of contracting the COVID-19 due to close contact with the patient, exposure to tears and ocular secretions, as well as the use of equipment and devices capable of get contaminated.

RESUMEN En esta revisión se pretendió abarcar la mayoría de las publicaciones existentes hasta el momento, que informan sobre las afectaciones oftalmológicas de la enfermedad COVID-19, causada por el nuevo coronavirus o síndrome respiratorio agudo severo 2 (SARS-CoV-2). Se realizó una búsqueda en Pubmed/Medline hasta el 28/02/2021, en la que se revisaron las siguientes publicaciones en inglés: cartas al editor, casos clínicos, revisiones bibliográficas y estudios clínicos. En el campo de búsqueda se incluyó tanto el resumen (abstract) como el título de la publicación. Se encontraron como afectaciones oculares producidas por la COVID 19 la conjuntivitis viral, una conjuntivitis inmunomediada, parálisis oculomotoras (POM) y uveítis. Se plantea la posibilidad de retinopatía. Los oftalmólogos presentamos un riesgo considerable de contraer la COVID-19 debido a al contacto estrecho con el paciente, exposición a las lágrimas y secreciones oculares, así como al uso de equipos y aparatos susceptibles de contaminarse.

Resumo As tomografias de tórax geralmente incluem o abdome superior, o que implica a avaliação das estruturas abdominais superiores. Nosso objetivo é resumir os achados incidentais mais comuns do abdome superior que não requerem imagem ou tratamento adicional em pacientes submetidos a tomografia computadorizada de tórax sem contraste para investigar sintomas ou doenças torácicas. Achados incidentais comuns do fígado, vesícula biliar, baço, glândulas adrenais, rins, retroperitônio e alterações que podem mimetizar lesões nesses órgãos serão revisados. O radiologista torácico deve estar ciente de tais achados e relatar quando nenhuma investigação adicional for necessária, para evitar excesso de exames, especialmente com radiação ionizante, proteger os pacientes de intervenções médicas e de preocupações.

Abstract Chest scans usually include the upper abdomen, leading radiologists to evaluate the upper abdominal structures. The aim of this article is to summarize the most common incidental upper abdominal findings that do not require further imaging or management in patients undergoing unenhanced computed tomography of the chest for the investigation of thoracic symptoms or diseases. We review common incidental findings of the liver, gallbladder, spleen, adrenal glands, kidney, and retroperitoneum, as well as findings that mimic other lesions. Thoracic radiologists should be aware of such typical findings and report when no further investigation is needed, thus avoiding unnecessary imaging examinations, protecting patients from additional medical interventions, and allaying patient concerns.

Resumen El consumo de sustancias psicoactivas es un problema de salud pública mundial, y la cocaína ocupa un lugar destacado, en cuanto a frecuencia de consumo, asociada con la necesidad de utilizar servicios médicos de urgencia por las complicaciones derivadas de sobredosis e intoxicación por exposición a esta. Los efectos clínicos están plenamente caracterizados, pero dentro de ellos no se ha identificado de manera clara y común la presencia de broncoespasmo. Entre los factores de riesgo, se encuentra la exposición por vía inhalatoria y la comorbilidad del paciente, entre las cuales el asma representa la gran mayoría de los casos. Es importante identificar dicha complicación cuando una persona ha estado en contacto con esta sustancia, por lo que se presenta un caso en el cual el paciente desarrolló un broncoespasmo severo con requerimiento de ventilación mecánica.

Abstract The consumption of psychoactive substances represents today in our country and worldwide a public health problem. Among these, cocaine occupies an important place, in terms of frequency of consumption, associated with the need to use emergency medical services due to complications derived from intoxication and overdose with exposure to it. The clinical effects are fully characterized, but bronchospasm is not clearly and commonly identified within these. Among the risk factors for its generation, we find inhalation exposure and patient comorbidity, among which asthma accounts for the most cases. For this reason, it is essential to identify said complications associated with contact with this substance. We present a case in which the patient develops severe bronchospasm with a requirement for mechanical ventilation.

Resumo Objetivo: Avaliar a concordância interobservador entre radiologistas para os critérios atuais da Fleischner Society para categorias diagnósticas de pneumonia intersticial usual (PIU) em tomografia computadorizada (TC). Materiais e Métodos: Cinco observadores categorizaram independentemente as imagens de TC de 44 pacientes com doença pulmonar intersticial que foram submetidos a biópsia pulmonar empregando as últimas categorias de diagnóstico da Sociedade Fleischner para UIP. Também foram avaliadas presença, extensão e distribuição dos achados de imagem mais relevantes, bem como a confiança no diagnóstico mais provável e em até três hipóteses diagnósticas. Resultados: Houve concordância moderada a alta para as categorias diagnósticas entre os observadores (κ = 0,59-0,61). A concordância interobservador para a pontuação binária foi alta (κ = 0,77-0,79), enquanto para a presença de faveolamento foi considerada de alta a muito alta (κ = 0,81-0,96). Houve concordância em uma das três hipóteses diagnósticas em apenas 36,4% dos casos. Baixa concordância foi encontrada para o diagnóstico mais provável (κ = 0,19-0,21). Conclusão: A concordância entre observadores para os critérios atuais de TC da Fleischner Society para UIP foi moderada a alta entre observadores com diferentes níveis de experiência. Houve baixa concordância nas hipóteses diagnósticas e quanto ao grau de confiança no diagnóstico primário.

Abstract Objective: To assess interobserver agreement among radiologists regarding the current Fleischner Society diagnostic criteria for usual interstitial pneumonia (UIP) patterns on computed tomography (CT). Materials and Methods: Using the Fleischner Society criteria for UIP CT patterns, five raters, working independently, categorized the high-resolution CT (HRCT) scans of 44 patients with interstitial lung disease who underwent lung biopsy. The raters also evaluated the presence, extent, and distribution of the most relevant imaging findings, as well as indicating their level of confidence in the most likely diagnosis and in up to three diagnostic hypotheses. Results: There was moderate to substantial interobserver agreement regarding the UIP patterns on HRCT—kappa statistic (κ) = 0.59-0.61. Interobserver agreement for the binary scores was substantial (κ = 0.77-0.79), whereas that for the presence of honeycombing was almost perfect (κ = 0.81-0.96). There was agreement regarding at least one of the three diagnostic hypotheses in only 36.4% of the cases. For the level of confidence in the most likely diagnosis, there was only slight to fair agreement (κ = 0.19-0.21). Conclusion: Interobserver agreement regarding the current Fleischner Society CT criteria for UIP was moderate to substantial among raters with varying levels of experience. There was only slight to fair agreement regarding the diagnostic hypotheses and for the level of confidence in the most likely diagnosis.

ABSTRACT Wiski, a male mongrel dog (Pekingese breed) of four-year-old male, arrived for consultation. He presented paraplegia and signs of acute spinal pain. The initial protocol was to treat the emergency with fluid therapy, pain management and blood pressure control. Neurological examination revealed upper motor neuron signs in the pelvic limbs, compromised proprioception and urinary function, severe pain at the thoracolumbar junction with a reduced panniculus reflex. Imaging studies (X-ray and CT) confirmed a Hansen type I disc herniation between the thirteenth thoracic vertebra and the first lumbar vertebra. A conventional approach for hemilaminectomy was carried out between T13 and L1 intervertebral levels. A first exploratory pediculectomy was performed on the left side of L1 vertebral pedicle, which revealed disc material in the cranial portion; hence a second pediculectomy was started at T13. Both pediculectomies were joined by hemilaminectomy. Disc material was removed from the vertebral canal and washed with saline solution to finish the synthesis of the muscular planes, thoracolumbar fasciae, subcutaneous tissue, and skin. Postoperative period involved total restriction of movement, antibiotherapy and anti-inflammatory and analgesic therapy. Urinary retention, associated to upper motor neuron signs, was treated with Diazepam exclusively during the first days. During the first 14 days, the animal showed no evidence of pain, sepsis or surgical complications. At 23 postoperative days, the animal recovered the motor activity of its pelvic limbs.

RESUMEN A consulta llega Wiski, un canino mestizo de pequinés, macho de cuatro años de edad con paraplejia y signos de dolor espinal agudo. La conducta inicial fue atender la urgencia mediante terapia de fluidos, manejo del dolor y control de la presión sanguínea. El examen neurológico evidenció signos de motoneurona superior en los miembros pélvicos, compromiso en la propiocepción y en la función urinaria, dolor severo en la unión toracolumbar con una reducción del reflejo panicular. Los estudios imagenológicos (RX y TAC) confirmaron una Hernia discal Hansen tipo I entre la décimo tercera vértebra torácica y la primera lumbar. Se realizó un abordaje convencional para hemilaminectomía entre T13 y L1. Se realizó una primera pediculectomía exploratoria en el lado izquierdo del pedículo vertebral de L1, que evidenció material discal en la porción craneal, por lo que se inició una segunda pediculectomía en T13. Ambas pediculectomías se unieron mediante hemilaminectomía. Se retiró el material discal del canal vertebral y se realizó lavado del mismo con solución salina para terminar con la síntesis de los planos musculares, fascias toracolumbares, tejido subcutáneo y piel. El posoperatorio implicó la restricción total del movimiento, antibioterapia, terapia antinflamatoria y analgésica. La retención urinaria, asociada a los signos de motoneurona superior, se trató solo con Diazepan los primeros días. Durante los primeros 14 días, el paciente no presentó evidencias de dolor, sepsis o complicaciones quirúrgicas y, a los 23 días posoperatorios, el paciente recuperó la actividad motora de sus miembros pélvicos.

ABSTRACT Introduction: Coronavirus disease 2019 (Covid-19) is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). In addition to direct tissue invasion, SARS-CoV-2 can also elicit an exaggerated host immune response, often leading to a cytokine storm, significantly contributing to multi-organ dysfunction. Autoimmune diseases are characterized by a pro-inflammatory state, accelerated atherosclerosis and an increased incidence of vascular complications, which is why there is a high risk of complications in the presence of SARS-CoV-2 in these patients. Altered immune system regulation, increased metabolic demand, and procoagulant activity likely explain part of the increased risk of adverse outcomes in people with Covid-19-related atherosclerotic disease. Objective: To update the knowledge of health personnel in the management of these diseases. Method: We reviewed articles in PubMed, SciELO and Google Scholar with a controlled vocabulary strategy, from December 2019 to November 2020. We selected a total of 50 articles. Findings: The high production of autoantibodies, whether secondary to rheumatic disease or due to intercurrent infection, may be involved in the development of endothelial dysfunction, the progression and rupture of the atherosclerotic plaque. Discussion: It has been shown that these autoimmune chronic diseases are associated with high cardiovascular morbidity and mortality, so the doctor of these times must be able to recognize these patients.

RESUMEN Introducción: La enfermedad por el coronavirus 2019 (COVID-19) es causada por el síndrome respiratorio agudo severo coronavirus-2 (SARS-CoV-2). Además de la invasión tisular directa, el SARS-CoV-2 también puede provocar una respuesta inmune exagerada del huésped, que con frecuencia conduce a una tormenta de citocinas, que contribuye, significativamente, a la disfunción multiorgánica. Las enfermedades autoinmunes se caracterizan por un estado proinflamatorio, aterosclerosis acelerada e incremento de la incidencia de complicaciones vasculares por lo que en estos pacientes existe un alto riesgo de complicaciones ante la presencia del SARS-CoV-2. La alteración en la regulación del sistema inmunológico, el aumento de la demanda metabólica y la actividad procoagulante probablemente explican parte del mayor riesgo de resultados adversos en las personas con enfermedad aterosclerótica relacionada con la COVID-19. Objetivo: Actualizar los conocimientos del personal de salud en el manejo de estas enfermedades. Método: Se realizó una búsqueda de artículos en PubMed, SciELO y Google Scholar con estrategia de vocabulario controlado, de diciembre 2019 a noviembre 2020. Se seleccionaron un total de 50 artículos. Desarrollo: La elevada producción de autoanticuerpos ya sea secundaria a la enfermedad reumática o por una infección intercurrente, puede estar implicada en el desarrollo de la disfunción endotelial, la progresión y la ruptura de la placa aterosclerótica. Conclusiones: Se ha demostrado que estas enfermedades crónicas autoinmunitarias se asocian a una elevada morbimortalidad cardiovascular por lo que el médico de estos tiempos tiene que ser capaz de reconocer estos pacientes.

Abstract The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes the disease COVID-19, represents one of the most deleterious health emergencies of the last two decades; of which there are still innumerable unknowns about the course and handling of atypical presentations. Therefore, it is important to publish clinical cases of interest in a special population, such as kidney transplant recipients, who may have a greater risk of contracting the disease due to their immunosuppression and frequent contact with the medical care system. Co-infection with other respiratory viruses is not uncommon in the transplanted population with COVID-19, and the association with opportunistic germs such as Mycobacteria, Cytomegalovirus, Pneumocystis jirovecii and fungi, such as Cryptococcus neoformans, is unknown, yet it is possible that this association could worsen the severity of the systemic and pulmonary involvement. We present the case of a 45-year-old deceased-donor kidney transplant recipient man who was admitted to the emergency service; he presented acute respiratory difficulty syndrome (ARDS) and ventilatory failure due to infection by SARS-CoV-2. It was also confirmed that he had systemic infection by Cryptococcus neoformans without compromise of the central nervous system. It was necessary to use invasive mechanical ventilation, glucocorticoid, liposomal amphotericin B; he died 12 days after admission.

Resumen La infección por el síndrome respiratorio agudo severo por coronavirus 2 (SARS-CoV-2), causante de la enfermedad COVID-19, representa una de las emergencias sanitarias más deletéreas de las últimas dos décadas; de la que aún existen innumerables incógnitas acerca del curso y manejo de presentaciones atípicas. Por lo anterior, resulta importante publicar casos clínicos de interés en población especial como lo son los pacientes receptores de trasplante renal, quienes pueden tener un mayor riesgo de contraer la enfermedad dado su estado de inmunosupresión, así como por el contacto frecuente con el sistema de atención médica. La coinfección con otros virus respiratorios no es infrecuente en población trasplantada con COVID-19, y la asociación con gérmenes oportunistas como Micobacterias, Citomegalovirus, Pneumocystis jirovecii y hongos, tal como el Cryptococcus neoformans es desconocida, pero es posible que dicha asociación pudiese empeorar la severidad del compromiso sistémico y pulmonar. Se presenta el caso de un hombre de 45 años, con antecedentes de trasplante renal de donante cadavérico, que ingresó al servicio de urgencias del Hospital de San José; el presentó síndrome de dificultad respiratoria aguda (SDRA) y falla ventilatoria por infección por SARS-CoV-2. Además, se confirmó infección sistémica por Cryptococcus neoformans sin compromiso del sistema nervioso central. Se inició manejo con ventilación mecánica invasiva, glucocorticoide, anfotericina B liposomal; fallece a los 12 días de su ingreso.

ABSTRACT Introduction: COVID-19 is the disease caused by the SARS-CoV-2 virus. Though most patients present mild or moderate symptoms, 5% develop severe respiratory syndrome. Awareness of the dynamics of the immune response to SARS-CoV-2 infection is essential for the appropriate management of patients. Objective: Describe the essential elements of the dynamics of the immune response to SARS-CoV-2 infection. Methods: A review was conducted of updated literature contained in bibliographic databases. A total 40 publications were consulted. An analysis was performed of the quality and reliability of the papers selected. Data analysis and integration: In the initial stage of the immune response to SARS-CoV-2 there is a predominance of innate defense mechanisms aimed at eliminating the virus and preventing the progress of the disease toward severity. If the immune system fails to eradicate the virus, immune dysregulation will occur and considerable damage will result from tissue inflammation. Immunotherapy should focus on stimulating the first (protective) stage and delete the second. An appropriate immune response is vital in the combat against coronavirus infections. Conclusions: The dynamics of the antiviral response in SARS-CoV-2 patients are essential elements conditioning the severity of the disease. Occurrence of the cytokine storm resulting from immune dysregulation has been cited as the primary cause of the severe respiratory syndrome developing in these patients. Better knowledge about the immunopathogenic mechanisms involved is indispensable to develop highly efficient drugs.

RESUMEN Introducción. La COVID-19 es la enfermedad causada por el virus SARS-CoV-2. Aunque la mayoría de los pacientes presentan síntomas leves o moderados, un 5 % desarrolla un síndrome respiratorio severo. Conocer la dinámica de la respuesta inmune en la infección por SARS-CoV-2 es esencial para el manejo adecuado de los pacientes. Objetivo. Describir los elementos esenciales de la dinámica de la respuesta inmune a la infección por SARS-CoV-2. Métodos: Se realizó una revisión de la literatura actualizada en bases de datos bibliográficas. Se consultaron 40 publicaciones. Se analizó la calidad y fiabilidad de los artículos seleccionados. Análisis e integración de la información: Durante los momentos iniciales de la respuesta inmune al SARS-CoV-2 predominan mecanismos innatos de defensa encaminados a eliminar el virus e impedir el avance de la enfermedad hacia la severidad. Si el sistema inmune no logra erradicar el virus ocurre una desregulación inmune que produce un daño importante por inflamación tisular. La inmunoterapia debe enfocarse en estimular la primera etapa (protectora) y suprimir la segunda. Una respuesta inmune adecuada es vital en el enfrentamiento a las infecciones por coronavirus. Conclusiones. La dinámica de la respuesta antiviral en los infectados por SARS-CoV-2 es uno de los elementos esenciales que condicionan la severidad de la enfermedad. La aparición de la tormenta de citocinas, producto de una desregulación inmune, se ha presentado como causa primaria del síndrome respiratorio severo observado en estos pacientes. Un mayor conocimiento de los mecanismos inmunopatogénicos es imprescindible para el desarrollo de medicamentos con alta eficacia.