Browsing by Autor "P. Ussetti Gil"

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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.
Immune thrombocytopenia a key piece of the puzzle for the diagnosis of atypical systemic lupus erythematosus in critically ill patients. Case report
(2025) P. Ussetti Gil; Felipe Verscheure Peralta; Jhossmar Cristians Auza-Santiváñez; Mariela Marpartida Vildoso; Eduardo Ustarez; Jovanna Baptista; F. Gavilán Carrasco; Felipe Vanegas
Introduction: immune thrombocytopenia (ITP) is an autoimmune disorder characterized by autoantibody-mediated destruction of platelets, resulting in low platelet count and increased risk of bleeding, and may be an initial manifestation of systemic lupus erythematosus (SLE), especially in patients with findings suggestive of autoimmunity.Clinical Case: a 52-year-old male presented with fever, hematuria, generalized petechiae (including mucous membranes), myalgia, mucosal bleeding, oliguria progressive to anuria, and severe arterial hypertension. Initial studies revealed severe anemia, severe thrombocytopenia, and acute kidney injury, which led to his admission to the Intensive Care Unit (ICU). Complementary studies showed positive ANA, low complement (C3, C4), and positive anti-Ro, while anti-dsDNA antibodies, ANCA, and markers of antiphospholipid syndrome were negative. Imaging revealed pulmonary edema with mild alveolar hemorrhage and renal ultrasound findings consistent with active lupus nephritis. These findings raised the possibility that severe thrombocytopenia was a prelude to SLE. After initial treatment refractory, the patient was escalated to rituximab, with a favorable response without complications, which allowed discharge from the ICU.Conclusions: this case highlights the importance of considering SLE in patients with refractory thrombocytopenia without apparent cause, even in men, and underlines the need for a multidisciplinary approach for timely diagnosis and treatment, thus preventing serious complications.
Immune thrombocytopenia a key piece of the puzzle for the diagnosis of atypical systemic lupus erythematosus in critically ill patients. Case report
(2025) P. Ussetti Gil; Felipe Verscheure Peralta; Jhossmar Cristians Auza-Santiváñez; Mariela Marpartida Vildoso; Eduardo Ustarez; Jovanna Baptista; F. Gavilán Carrasco; Freddy Ednildon Bautista-Vanegas
Introduction: immune thrombocytopenia (ITP) is an autoimmune disorder characterized by autoantibody-mediated destruction of platelets, resulting in low platelet count and increased risk of bleeding, and may be an initial manifestation of systemic lupus erythematosus (SLE), especially in patients with findings suggestive of autoimmunity.Clinical Case: a 52-year-old male presented with fever, hematuria, generalized petechiae (including mucous membranes), myalgia, mucosal bleeding, oliguria progressive to anuria, and severe arterial hypertension. Initial studies revealed severe anemia, severe thrombocytopenia, and acute kidney injury, which led to his admission to the Intensive Care Unit (ICU). Complementary studies showed positive ANA, low complement (C3, C4), and positive anti-Ro, while anti-dsDNA antibodies, ANCA, and markers of antiphospholipid syndrome were negative. Imaging revealed pulmonary edema with mild alveolar hemorrhage and renal ultrasound findings consistent with active lupus nephritis. These findings raised the possibility that severe thrombocytopenia was a prelude to SLE. After initial treatment refractory, the patient was escalated to rituximab, with a favorable response without complications, which allowed discharge from the ICU.Conclusions: this case highlights the importance of considering SLE in patients with refractory thrombocytopenia without apparent cause, even in men, and underlines the need for a multidisciplinary approach for timely diagnosis and treatment, thus preventing serious complications.
Mountain sickness: physiological challenges, diagnosis and treatment
(2025) Jhossmar Cristians Auza-Santiváñez; P. Ussetti Gil; Mildred Ericka Kubatz La Madrid; Ingrid Neysa Cabezas-Soliz; Jorge Márquez-Molina; Yamila Cruz Cruz; Dilma Villca-Villca; R. Sarmiento
INTRODUCTION. The first descriptions of altitude sickness were made in (1540-1600). Nowadays, different cities in the world are at high altitude, for example Qinghai-Tibetan Plateau in China occupies an area of almost 2.5 million inhabitants km2, with an average elevation of over 4,500 m. Altitude sickness should be a major concern for anyone who normally resides at sea level. METHOD. 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. RESULTS AND DISCUSSION. The partial pressure of arterial oxygen (PaO2 ) decreases with altitude, which produces progressive tissue hypoxia. The normal compensatory response to hypobaric hypoxia is called acclimatization. Its main characteristic is increased ventilation. The ability to acclimatize varies widely among individuals and depends on many factors, including the degree of hypoxic stress (rate of ascent, altitude reached), the intrinsic ability of the individual to compensate for the decrease in PaO2, and extrinsic factors. Progressive ascent produces greater hypoxic stress, requiring greater degrees of physiological and behavioral adaptations to preserve function. The more rapid the ascent and the higher the altitude, the greater the stress. Below 1500 m, symptoms of high altitude illness are generally not manifest. From approximately 1500 to 2500 m, symptoms are generally mild, if experienced at all. From approximately 2500 m, mild to moderate symptoms become quite common among unacclimatized visitors after a rapid ascent. As a general rule, people who normally reside below 1500 m should avoid an abrupt ascent to altitudes above 2800 m for sleeping. Sedative-hypnotics should be avoided during acclimatization. Abstinence from alcohol is safest
Neurological complications in patients with Human Immunodeficiency Virus infection at the Japanese Hospital in Santa Cruz, Bolivia
(2025) Carmen Julia Salvatierra-Rocha; Jhossmar Cristians Auza-Santiváñez; Alejandro Peralta Landívar; Carlos Lá Fuente Zerain; Mildred Ericka Kubatz La Madrid; Yamila Cruz Cruz; P. Ussetti Gil; Marco Antonio Gumucio Villarroel; Dulce María Hernández Vázquez
Introduction: Neurological involvement is common among patients with Human Immunodeficiency Virus (HIV) infection. Between 40 and 60% will develop symptomatic neurological complications with high morbidity and mortality at some point. Objective: To analyze the clinical-epidemiological characteristics of patients with HIV infection who develop neurological complications at the Japanese Hospital of Santa Cruz de la Sierra in the period between March 2019 and February 2022.Methods: Observational, descriptive, prospective, cross-sectional study. Universe and Sample: Patients admitted through the Emergency Service of the Japanese Hospital with a confirmed diagnosis of Human Immunodeficiency Virus Disease during the period between March 2019 and February 2022Results and discussion: A total of 42 patients were evaluated, the majority of whom were men and had a younger average age. For both sexes, the majority of patients reported having a source of employment. Regarding sexual orientation, almost all women reported being heterosexual, while men were more variable, with the majority being bisexual. Three clinical syndromes were identified at admission. The frequency of focal syndrome was dominant in women, but was not significantly different from the others. In men, meningeal syndrome and focal syndrome were the dominant ones, significantly exceeding non-focal syndrome. Ten neurological complications were identified, cerebral toxoplasmosis was the most frequent, followed by cerebral cryptococcosis and meningeal tuberculosis. Considering all patients in general, their typical hospital stay was 11 days with a range between 2 and 56 days. Of the 42 patients evaluated, it was only possible to measure the CD4 status for 27.Conclusions: The young male population with employment in the city of Santa Cruz with aberrant sexual behavior was the most affected. Focal syndrome was the most frequent form of presentation, in the form of cerebral toxoplasmosis. Severely low levels of immunosuppression were found in the study population. Hospital stay is variable and is longer in cases of focal syndrome and meningeal syndrome. We consider it important to continue the present study, which will allow us to increase the sample size.