South Health and Policy (Journal)
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Wünderlich syndrome. Report of two cases with different presentation modalities
No full textCase reports: Case 1 is a male patient who presented with left lumbar pain and wanders to the emergency department. Case 2: a female patient is brought to the emergency department in hypovolemic shock. In both cases, it was decided to perform urgent surgical treatment to correct the hemorrhage due to the progressive deterioration of hemodynamics, the subsequent evolution was favorable.Relevance: Wünderlich syndrome is characterized by retropritoneal hemorrhage localized at the renal or perirenal level, which occurs sudden onset. Implications: The available evidence on this pathology is scarce because it is a little suspected medical emergency.Conclusion: Wünderlich syndrome presents relatively frequently in emergency departments and represents a diagnostic-therapeutic challenge
Diagnostic utility of transthoracic ultrasound in chest trauma versus chest radiography
No full textThe general objective: To determine the diagnostic utility of transthoracic ultrasound in comparison with chest x-ray in patients with thoracic trauma in the surgical emergency of the Central Hospital of Maracay during the period 2023-2024. Materials and Methods: A quantitative research was carried out under the clinical-epidemiological modality of descriptive, non-experimental, observational, prospective and longitudinal type. The study population consisted of 32 patients over 10 years of age, of both sexes, with chest pain and diagnosed with thoracic trauma. Results: The average age of the patients was 38.15 years (±15.27), with a male predominance (84.38%). Most of the patients came from the state of Aragua (71.88%). The most common clinical manifestations were chest pain (100%) and dyspnea (43.75%). The leading causes of trauma included motorcycle-vehicle collisions (25%) and vehicle-to-vehicle collisions (9.38%). Transthoracic ultrasound detected pneumothorax in 28.13% of cases and pleural effusion in 18.75%, with sensitivities and specificities higher than those of chest x-ray. In addition, a high concordance was found in the detection of rib fractures and interstitial patterns. Conclusion: The study demonstrates that transthoracic ultrasound is an effective and superior diagnostic tool compared to chest x-ray for the detection of pulmonary pathologies in patients with thoracic trauma. Its routine implementation in surgical emergencies can significantly improve the diagnosis and management of these injuries, reducing morbidity and mortality. It is recommended that medical personnel be trained in the use of transthoracic ultrasound and consider its integration into trauma management protocols in emergencies
Iron Deficiency Without Anemia: A Neglected Clinical Syndrome in Internal Medicine Practice
No full textIron deficiency without anemia was identified as an underestimated condition in clinical practice, despite its high prevalence and impact on quality of life. Although iron has historically been linked solely to hemoglobin production, multiple studies have shown that this mineral is essential for mitochondrial, muscular, immunological, and neurological functions. Thus, patients with normal hemoglobin levels but low iron stores presented symptoms such as chronic fatigue, mild dyspnea, headaches, restless legs syndrome, tachycardia, and mild cognitive disorders.This condition was observed more frequently in young women, people with chronic inflammatory diseases, heart failure, or older adults. In these individuals, ferritin was found to be reduced or functionally inactive, making timely diagnosis difficult due to the absence of obvious anemia. The traditional approach in internal medicine, which focused only on hemoglobin, ignored this deficiency, limiting the use of effective treatments such as oral or intravenous iron supplementation.In countries such as Cuba, the need to update clinical guidelines to consider this condition as a separate entity was recognized. It was proposed to routinely include ferritin and transferrin saturation measurements in patients with nonspecific symptoms, especially in women of childbearing age and people with inflammatory comorbidities. Recognizing this deficiency led to significant diagnostic improvement and an opportunity to alleviate the functional and emotional burden on patients, highlighting the importance of modern, comprehensive, and evidence-based internal medicine
Two patients diagnosed with hereditary angioedema in Pinar del Río
No full textIntroduction: hereditary angioedema (HAE) is a rare autosomal dominant disease that can be fatal if not treated promptly. It is caused by a deficiency in the synthesis of the inhibitory complement C1.
Objective: to describe The clinical presentation, diagnosis, and treatment of two patients with hereditary angioedema in Pinar del Río.
Methods: two patients are reported with a definitive diagnosis of hereditary angioedema treated at the Pepe Portilla Pediatric Hospital from November 2011 to January 2023. The following are included: Classification, family tree, personal and family history, description, laboratory diagnosis, evolution, and treatment of the disease.
Results: the patients presented recurrent episodes of edema in various regions of the body, both spontaneously and due to trauma, affecting the gastrointestinal mucosa with vomiting and diarrhea. Laboratory tests showed a severe decrease in C4 levels. Both received preventive treatment with danazol. Berinert was used in severe attacks in the patient with hereditary angioedema type I. One case showed an absence of family history, suggesting a new mutation; while the other had a family history, demonstrating an autosomal dominant pattern and milder symptoms
A case report: Spetzler Martin grade III arteriovenous malformation
No full textArteriovenous malformations are defined as an abnormal connection between the arteries that supply the brain tissue and the drainage veins forming a communication through a network of vessels in the brain tissue.It is presented by congenital errors in vascular morphogenesis caused by failures. Barrera (2018). This article describes a case of a 14-year-old patient with no apparent pathological history who presented with a generalized headache of a pulsatile nature without amelioration, for a period of 6 months of evolution
Transitions theory as a framework for rehabilitation nursing for people with tracheostomy during ventilatory weaning in intensive care
No full textIntroduction: Ventilatory weaning involves moving from invasive mechanical ventilation to spontaneous ventilation. In people with tracheostomies, this process causes physical vulnerabilities (reduced respiratory function, risk of infections), psychological vulnerabilities (anxiety due to the inability to vocalize) and social vulnerabilities (isolation in the ICU, interruption of roles).Objective: To analyze the role of rehabilitation nursing care in promoting ventilatory weaning in tracheostomized individuals, through the lens of Meleis’ Transitions Theory.Methods: Theoretical review based on Meleis\u27 Transitions Theory and recent studies, integrating evidence on the vulnerability of the person with a tracheostomy, in the process of weaning, respiratory rehabilitation strategies, mobilization, emotional support and health education. Results: The Transitions Theory guides the rehabilitation nurse towards a personalized assessment of the physical, cognitive, social and cultural conditions of the person with a tracheostomy; education adapted to the level of literacy, with respiratory exercise training; early mobilization and functional training to reduce atrophy and strengthen respiratory muscles; psychosocial and family support, promoting adequate communication, the presence of family members and coping strategies; monitoring of transition indicators, allowing dynamic adjustments to the rehabilitation nursing care plan.Conclusions: The application of the Transitions Theory enables rehabilitation nurses to plan and implement interventions centered on the person with a tracheostomy and their family, valuing vulnerability as an expression of quality of life. By monitoring process and outcome indicators, nurses anticipate barriers, strengthen trust and promote coping strategies, helping to make ventilator weaning a healthy and transformative transition
Between stigma and access: obstacles to HIV testing
No full textThe text addressed the late diagnosis of the Human Immunodeficiency Virus (HIV) as a persistent problem at a global level, despite scientific advances in its treatment. It analysed how various psychosocial and structural factors influenced the low demand for testing, such as low risk perception, social stigma, mistrust of the health system, limited access to services and lack of adequate information. It was explained that these barriers not only affected individual health, but also compromised the prevention and control of the epidemic. Finally, it was proposed that the HIV test be integrated into routine medical check-ups as a strategy to reduce stigmatisation and improve access to timely diagnosis
Umbilical cord stem cells as regenerative therapy: advances in the treatment of type I diabetes
No full textType I diabetes mellitus was presented as an autoimmune disease that destroyed the β cells of the pancreas, generating an insulin deficit and metabolic complications. Although traditional insulin treatment was necessary, it failed to stop the progression of the disease. Regenerative medicine offered new alternatives, including the use of stem cells derived from the umbilical cord. These cells showed an ability to differentiate into pancreatic cells and modulate the immune system, which helped to improve glycaemic control and reduce dependence on exogenous insulin. Clinical studies confirmed that this therapy was safe, well-tolerated and ethically acceptable, making it a promising alternative in the treatment of T1D
Evaluation of Health-Related Quality of Life in Villa Piletones: A Public Health Approach
No full textThe study addressed Health-Related Quality of Life (HRQoL) as an essential component in the evaluation of the physical, mental and social well-being of the population. It focused on the community of Villa Piletones, with the aim of diagnosing its health situation and guiding public policies. Through the use of the EQ-5D instrument, inequalities were identified and useful data was generated to compare regional contexts. It was highlighted how socioeconomic, environmental and lifestyle factors influenced the perception of health. The research allowed to consolidate HRQOL as a valid tool for designing strategies to improve community health
Impact of self-medication on chronic daily headache
No full textIntroduction: Chronic daily headache is a frequent condition in the general population. A high percentage of patients have an abusive consumption of analgesics that makes the headache worse and may also carry the risk of multiple pathologies produced by these drugs. It is defined as the presence of headache continuously or almost continuously for at least 15 days a month, for a period of at least three months.Material and methods: This work was carried out through a detailed search of medical articles and clinical trials published between 2010 and 2023.Results: The precise pathophysiological mechanisms that lead to the development of headache due to analgesic abuse are largely unknown, however, multiple factors may be involved, including genetic predisposition, sensitization within the trigeminal system, abnormal processing of cortical pain and decreased anti-nociceptive activity of the supraspinal structures.Conclusion: NSAIDs are the first step in the pharmacological treatment of headaches and chronic use of these drugs can cause a paradoxical worsening of the headache and the development of analgesic-induced headache, which is currently the most prevalent secondary headache worldwide