Browsing by Autor "Eloy Paycho Anagua"

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Current perspectives in the diagnosis and management of bacterial meningitis. Literature review and update
(2025) Jhossmar Cristians Auza-Santiváñez; Blas Apaza-Huanca; C. Roman; P. Ussetti Gil; José Bernardo Antezana-Muñoz; Freddy Ednildon Bautista-Vanegas; Jorge Márquez-Molina; Mildred Ericka Kubatz La Madrid; Eloy Paycho Anagua
Introduction: Bacterial meningitis is a serious and potentially fatal disease that has represented a significant challenge to medicine since its identification in the 19th century. Despite advances in antimicrobial treatment, it remains a major cause of morbidity and mortality worldwide. This review aims to update current perspectives on the diagnosis and management of bacterial meningitis, focusing on its pathogenesis, clinical manifestations, diagnostic methods, and therapeutic strategies. Methods: A search for information was carried out in the period August-December 2024 in the SciELO, LILACS, Scopus, PubMed-MedLine databases, the Google Scholar search engine, as well as in the ClinicalKeys services. For the recovery of information, an advanced search strategy was used and the terms “meningitis or bacterial meningitis” were used, as well as their translations into the English language. To combine the terms, Boolean operators were used, with search formulas according to the syntax requested by each database. Furthermore, in order to achieve a review based on the best possible evidence, only studies of the type case series, original articles or systematic reviews were selected. Results and discussion: Bacterial meningitis develops when pathogens overcome the host's defense mechanisms, colonizing mucous membranes, invading the bloodstream and penetrating the subarachnoid space. The main pathogens include Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae. The most common clinical manifestations are fever, headache, stiff neck and altered mental status. Diagnosis is based on analysis of cerebrospinal fluid (CSF), which shows pleocytosis, increased protein and decreased glucose. Empirical treatment includes antibiotics such as cefotaxime, ceftriaxone and vancomycin, together with dexamethasone as adjuvant therapy to reduce inflammation. Conclusions: Bacterial meningitis is a serious infection of the central nervous system, a medical emergency whose mortality and sequelae can be reduced with timely diagnosis and treatment. The key is to start treatment immediately and without delay. Prevention is the cornerstone of its control. Only through multidisciplinary management, which could include an expert infectious disease specialist, an intensive care physician, a specialized nurse and adequate laboratory equipment, can the impact of this devastating disease be mitigated.
Usefulness of ultrasound in the diagnosis of lumbricoid ascaris. Case Report and Literature Review
(2024) Ismael Vargas Gallego; Jhossmar Cristians Auza-Santiváñez; Ariel Sosa Remón; Eloy Paycho Anagua; Marco Antonio Gumucio Villarroel; R. Sarmiento; Mildred Ericka Kubatz La Madrid
Introduction. The World Health Organization (WHO) points out that more than a third of the world's population is infected by one or more parasites. Ascariasis is the most prevalent parasitic disease in the world, with approximately 664 million people infested. Clinical case. A 22-year-old female patient enters the emergency department with general malaise, with worsening symptoms in recent days, intense abdominal pain, associated with nausea and uncontrollable vomiting. She also reports non-elimination of gas and absence of bowel movements. . An emergency ultrasound is requested, it reports the stomach with the presence of a linear, tubular echogenic image that moves in different directions. Discussion. The widespread use of ultrasound in Emergency Departments for the diagnosis of acute abdomen, as well as in the laboratory, allowed us to reach the presumptive diagnosis of temporary biliary obstruction due to A. lumbricoides, in addition, the presence of jaundice, direct hyperbilirubinemia and discrete elevation gamma-glutamyltransferase (GGT); findings that could direct the exploration of the bile duct during the surgical procedure. Conclusions. The importance of the clinical case lies in the use of abdominal ultrasound as a diagnostic method for Ascaris Lumbricoides. The use of ultrasound in emergency services is essential in the presence of an acute abdomen, and in any patient who presents acute biliary symptoms, always think about this pathology
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)