Atencion Primaria Practica最新文献

Context

Currently, infection by the SARS-CoV-2 virus predominantly generates a respiratory infection, which can lead to acute and late complications, as well as mild or severe sequelae. A complication that has been evidenced is the state of hypercoagulability, such as pulmonary thromboembolism (PE) or deep vein thrombosis (DVT).

Clinical case

We present the case of a patient with a recent history of COVID-19 infection who consulted for dyspnea and pain in the left hemithorax, complementary images were taken showing a large cavern at the right pulmonary base and an electrocardiogram suggestive of pulmonary thromboembolism, a CT scan was taken with protocol for PET that confirms it and smear microscopies that report positive for pulmonary tuberculosis coinfection.

Discussion and conclusions

The formation of prothrombotic phenomena by COVID-19 has become a frequent complication, however, the coinfection of tuberculosis and COVID-19 is rare, this is due to a process of amplification of the deregulated immune response called «cytokine storm», which activates latent and hidden infections, in addition the use of immunosuppressive drugs in COVID-19 can lead to an expression of tuberculosis.

Tuberculosis infection should be suspected in an endemic environment together with persistence of symptoms after the resolution of the viral infection, symptomatic cases before the acute viral process or in cases of atypical radiographic findings; in these cases, HIV infection or infection should be ruled out. another bacterial coinfection.

Odontoid fractures in older adults are not uncommon and are usually due to falls from their height. The availability of imaging test makes this type of fracture more diagnosed. According to the Anderson and D'Alonso classifications, they are divided into three types of fractures, being type II the most frequent in older adults due to the degenerative changes. The choice of the kind of treatment, surgical or not, is crucial due to the instability of the axis and the high mortality that they can entail.

We present the case of a 36-year-old female patient with a history of recent infection by COVID 19 with mild symptoms who started with bullous dermal lesions that evolved into ulcers with necrotic background without improvement with antihistamines and topical corticosteroids, a skin biopsy was taken which reported leukocytoclastic vasculitis, it is considered secondary to recent infection by COVID 19, for which medical management is given with subsequent improvement.

Cerebral toxoplasmosis is an infection produced by an opportunistic organism, which in the case of immunocompetent people can be asymptomatic or produce mild symptoms, however in the immunocompromised population can generate severe symptoms and even death as a final outcome, it is necessary to have a diagnostic suspicion and provide appropriate management to avoid complications, sequelae and/or death. This case report seeks to promote the importance of clinical suspicion, diagnosis and timely treatment.

Context

OSI Debagoiena Integrated Healthcare Organization is composed of a hospital and 4 Primary Care Units (PCU) with an area of influence of 67,000 inhabitants.

Local problem

The use of antibiotics was reviewed in patients with antibiotic prophylaxis in urinary tract infection (ITU): Nitrofurantoin, fosfomycin trometamol, calcium fosfomycin, cotrimoxazole and cefuroxima axethyl and various incidences regarding dosage, duration and adequacy were found.

Methods

From the Oracle Business Intelligence (OBI) database, the list of patients meeting the recurrent UTI criteria and, on the other hand, patients with antibiotics in prophylactic doses were obtained.

Interventions

A descriptive statistical analysis was carried out which was analyzed and included in a report on the status of use of ITU prophylaxis.

Sessions were held at each PCU and another general session at the hospital to show the results.

Results

In the Organization, with this criterion, 382 patients were detected, and of these, 12 were active prophylaxis in March 2019 (330 women, 52 men).

In addition, an antibiotic and chronic and “on-demand” prescription search was conducted and many more patients with antibiotic prophylaxis were found to exist.

The sessions clarify concepts around antibiotics that can be used in ITU prophylaxis, posology, duration, etc. Qualitatively, on-demand requirements with packaging limitation have increased significantly.

Conclusions

Consensus measures were collected in a protocol for the use of prophylaxis of UTI at the Organization level agreed between Primary care, Infection Commission and Urology.

We present the case of a patient with long-term right hemithorax pain managed as rotator cuff syndrome who underwent a chest X-ray with a report of an ill-defined image in the right upper hemithorax and later a chest CT scan with a mass of neoplastic appearance described in the right upper lobe that was later confirmed as malignant with histological diagnosis.