Browsing by Autor "Edwin Cruz Choquetopa"

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Bilateral Subdural Empyema, secondary to odontogenic infectious process. Case Report
(2024) Edwin Cruz Choquetopa; Jhossmar Cristians Auza-Santiváñez; Mildred Ericka Kubatz La Madrid; Blas Apaza-Huanca; Yenifer Zelaya-Espinoza; Maribel Zambrana-Mejia; F Salazar; Osman Arteaga Iriarte
Introduction: Subdural empyema (ESD) is a collection of pus between the dura mater and arachnoid, and constitutes a medical emergency due to its rapid progression and high mortality rate. Although ENT infections are the main causes, odontogenic infections can also lead to ESD. Early diagnosis, intravenous antibiotic therapy and surgical intervention are essential to reduce mortality.Clinical case: A 32-year-old male patient presented with a month-long picture of swelling and pain on the left side of the face, recently aggravated by fever, headache, vomiting and generalised tonic-clonic convulsions. He had a history of alcoholism and recurrent dental infections. Imaging revealed a bilateral subdural empyema with left-sided predominance. Urgent antibiotic treatment was initiated, followed by bilateral craniotomy and drainage of purulent material. In addition, a brain abscess and a subgaleal haematoma were managed. Cultures identified Streptococcus viridans and coagulase-negative Staphylococcus, with good response to targeted therapy. The patient progressed favourably and was discharged in good condition.Conclusions: In regions like Bolivia, the prevalence of odontogenic infections due to cultural and economic factors increases the risk of severe complications such as SDE. A multidisciplinary approach, including early diagnosis, broad-spectrum antibiotics, and surgical intervention, is essential to improve outcomes and reduce mortality in these patients
Detection and evaluation of vascular calcifications using Duplex Doppler ultrasound, in patients with Chronic Kidney Disease at the Centro Integral Hemodialisis y Trasplantes S.R.L. in Tarija Bolivia
(2024) Jhossmar Cristians Auza-Santiváñez; Jose Luis Diaz-Guerrero; Blas Apaza-Huanca; Elier Carrera González; Jorge Márquez-Molina; R. Sarmiento; Edwin Cruz Choquetopa
Introduction: Chronic Kidney Disease represents a systemic pathology with important consequences on patient survival, mainly through the development of vascular calcifications. Early detection of these calcifications is crucial for the assessment of cardiovascular risk and timely therapeutic management. The present study aims to evaluate the usefulness of Duplex Doppler ultrasound in the detection and evaluation of vascular calcifications in patients with CKD.Methods: Study design. Descriptive observational, which was carried out at the Centro Integral Hemodialisis y Trasplantes S.R.L. in Tarija, Bolivia. The research universe was 60 patients with Chronic Kidney Disease, who undergo hemodialysis at the Center, the sample was 32 patients, selected according to inclusion and exclusion criteria. Exclusion Criteria: Any patient who does not meet the inclusion criteria. Inclusion Criteria: Patients with CKD who undergo Hemodialysis at Centro Integral Hemodialisis y Trasplantes S.R.L.Results: Table 1 shows that, of 32 patients, the predominant age group is 61 to 70 years. The presence of chronic diseases is evident in patients with CKD, with arterial hypertension and type II diabetes mellitus being the most frequent. Table 3 shows that of the total number of patients in the study population, 75% had a mild vascular calcification score (0-25 points), 21.87% had a moderate vascular calcification score (26-39 points), and only 3.12% had a severe score (40-63 points).Conclusions: Duplex Doppler ultrasound is a noninvasive, safe and effective technique for the evaluation of vascular calcifications in patients with chronic kidney disease. Its ability to detect subtle changes in arterial morphology allows for early diagnosis and better management of cardiovascular risk. The presence of vascular calcifications in patients with CKD increases cardiovascular risk
Early prediction of acute kidney injury in neurocritical patients: relevance of renal resistance index and intrarenal venous Doppler as diagnostic tools
(2023) Jorge Márquez-Molina; Jhossmar Cristians Auza-Santiváñez; Edwin Cruz Choquetopa; José Bernardo Antezana-Muñoz; Osman Arteaga Iriarte; Helen Fernández Burgoa
Introduction: Implementing renal POCUS in critical care is a valuable tool complementing the physical examination of critical patients. As it is noninvasive, accessible, innocuous, and economical, it makes it possible to assess, at the bedside of patients, renal perfusion via ultrasound measurements such as the renal resistance index (RRI) and intrarenal venous Doppler (IRVD), which are considered early predictors of the acute renal lesion. Goals: Determine the relationship between the renal resistance index (RRI) and the degree of acute renal lesion according to KDIGO in neurocritical patients. Correlate the alterations to intrarenal venous Doppler (IRVD) flow with the degree of the acute renal lesion, according to KDIGO. Methods: An observational, analytical, prospective, longitudinal study was carried out in an ICU with an influx of neurocritical patients. Forty-three (43) patients participated. Their renal resistance index (RRI) and intrarenal venous Doppler (IRVD) were measured upon admission, 72 hours later, and 7 days after admission. Which of these tools better predicts acute renal lesions according to KDIGO was assessed. Results: In the study with 43 critical patients, no significant correlation was found between the RRI value and the acute renal lesion, according to KDIGO. On the contrary, a significant relation was found between intrarenal venous Doppler (IRVD) upon admission, 72 hours later, and 7 days after admission with the acute renal lesion according to KDIGO, with a value of r: 43=0.95 (P=0.54); 0.49 (P=0.001); 0.58 (P=0.000). When analyzing via the classification tree, it was determined that the variables better predicting the risk of suffering from an acute renal lesion before its occurrence are the measurement of intrarenal venous Doppler (IRVD) 7 days after admission and the value of the accumulated water balance. Conclusions: There is a positive and significant correlation between intrarenal venous Doppler (IRVD) and the acute renal lesion. Intrarenal venous Doppler (IRVD) and the accumulated water balance better predict the risk of suffering from an acute renal lesion in critical patients. In contrast, the renal resistance index (RRI) was unrelated to the acute renal lesion in the studied population
Extubation based on predictive scales in the management of neurocritical patients: Narrative review and update
(2025) Jhossmar Cristians Auza-Santiváñez; Edwin Cruz Choquetopa; José Bernardo Antezana-Muñoz; Osman Arteaga Iriarte; Sara Milca Robles-Nina; Blas Apaza-Huanca; Rodrigo Stalin Torrico-Araúz; David Oliver Aguirre-Soliz
Introduction: Invasive mechanical ventilation (IMV) is essential in neurocritical patients to ensure oxygenation, control ventilation and prevent secondary brain damage, although its prolonged use is associated with complications such as ventilator-associated pneumonia (VAP) and increased mortality. Extubation in this population faces failure rates of up to 40%, highlighting the need for specific strategies. Methodology: A narrative review was conducted based on original articles, case series and open access systematic reviews, consulted in SciELO, LILACS, Scopus, PubMed-Medline, Google Scholar and ClinicalKey. DeCS descriptors and Boolean operators were used, excluding letters to the editor and conference proceedings to prioritise quality evidence. Development: Extubation in neurocritical patients is compromised by neurological (altered level of consciousness, reflex dysfunction), respiratory (secretions, weak cough) and systemic (prolonged IMV) factors. Scales such as VISAGE, AIRWAY SCORE and ENIO integrate key variables to predict success, although they lack universal validation. Tracheostomy reduces duration of IMV, but not VAPV or mortality, while physiotherapy shows unconfirmed potential. Conclusion: Predictive scales offer valuable tools, but their standardisation is limited. Level of consciousness does not consistently predict success, prioritising airway protection. Prospective studies are needed to develop specific protocols and improve outcomes in neurocritical patients.
Utility of POCUS in estimating blood volume in neurocritical patients with hyponatremia, in the Polyvalent Intensive Care Unit of the Viedma Clinical Hospital
(2024) Edwin Cruz Choquetopa; Jhossmar Cristians Auza-Santiváñez; José Bernardo Antezana-Muñoz; Jorge Márquez-Molina; F Salazar; Osman Arteaga Iriarte; Daniel Victor Arraya Borges; Eloy Paycho Anagua
Introduction: Hyponatremia is one of the most common hydroelectrolytic disorders in patients with neurocritical pathology. Estimating blood volume in critically ill patients with hyponatremia is a challenge, and this is where point-of-care ultrasound (POCUS) becomes relevant.Methods: An observational, analytical, prospective, and longitudinal study was conducted in an ICU with a high influx of neurocritical patients. Thirty-one neurocritical patients who developed acute hyponatremia participated. They were evaluated clinically, analytically, and underwent ultrasound measurements at the bedside of the patients. It was determined which of the variables (clinical, analytical, and ultrasound) achieved the greatest sensitivity and specificity when determining blood volume. Results: More than half developed hyponatremia during their stay in the ICU, the predominant gender was male with more than 61% and more than 77% had a diagnosis of head trauma. The ROC curve was able to show that the ultrasound variables presented a sensitivity of 93% and specificity of 94% with an area under the curve (AUC) of 0.93. And of these (ITV, GC, Echo-pulmonary, VEXUS and IVC indices) were the ones that best predict blood volume. In our survival analysis (Kaplan Meier) we found a mean survival of 37.5 days (36.4 - 38.49) in the group (Hypovolemic = CPS), compared to a mean survival of 27.7 days (25.4 - 29.9) in the group (Normo-hypervolemic = SIADH) (CI 95% P: 0.078), which expresses higher mortality in those neurocritical patients who developed acute hyponatremia (Normo-hypervolemic = CPS).Conclusions:More than half of the neurocritical patients developed hyponatremia during their stay in the ICU, the mean age of the patients was 44 for the hypovolemic group and 35 for the normo-hypervolemic group, the predominant gender was male and most had a diagnosis of head trauma. POCUS (LUS, VEXUS, FoCUS) showed higher sensitivity and specificity in predicting blood volume in neurocritical patients with acute hyponatremia. The time to resolution of hyponatremia after starting treatment was a median of 3 days in the hypovolemic group, in contrast to the normo-hypervolemic group, which required more time, and no cases of overcorrection were reported in either group. Neurocritical patients with acute hyponatremia (Hypovolemic = CPS) would have more days of survival compared to neurocritical patients with acute hyponatremia (Normo-hypervolemic = SIADH)