Hospital Fernández

One of the challenges in managing patients with hantavirus infection is accurately identifying individuals who are at risk of developing severe disease. Prompt identification of these patients can facilitate critical decisions, such as early referral to an intensive care unit. The identified prognostic factors could be of utility in guiding medical care to enhance the management of hantavirus infection. To identify and evaluate prognostic factors associated with mortality in hantavirus infection. We conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses-reported systematic review following Cochrane guidance adapted for prognosis. We searched PubMed/MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), Biblioteca Virtual de Saúde or Lilac and EMBASE, from 1 January 1993 to 2 October 2025. We included studies evaluating individual prognostic factors or risk assessment models of New World hantavirus infections, with no restrictions on study design, publication status or language. When feasible, we conducted meta-analyses for prognostic factors using the inverse variance-based method with random effect model. We assessed the certainty of the evidence using the Grading of Recommendations Assessment, Development and Evaluation approach. We included 25 studies with a total of 7284 participants. We identified the following prognostic factors for which we found moderate to high certainty that are associated with increased mortality: age over 18 years, female sex, rural residence, elevated creatinine levels, increased haematocrit, signs of bleeding and the presence of infiltrates on chest radiographs. Our systematic review identified prognostic factors for mortality in patients with New World hantavirus infection. These factors can inform clinicians in making more informed management decisions. Furthermore, our findings lay the groundwork for the future development of a clinical prognostic model, potentially enhancing patient care and outcomes. CRD42021225823.

This report describes the rare case of a patient with autoimmune hemolytic anemia due to cryoagglutinins secondary to Mycoplasma pneumoniae infection, coexisting with pernicious anemia. A 56-year-old man presented with a ten-day history of cough and mucocutaneous pallor. Laboratory studies revealed megaloblastic anemia with low vitamin B12 levels, positive antibodies against intrinsic factor and parietal cells, as well as hemolysis parameters and a positive direct Coombs test for complement (C3d) with cryoagglutinins active at low temperatures. M. pneumoniae infection was confirmed by indirect immunofluorescence for IgM and IgG. Intramuscular B complex supplementation and doxycycline were administered for 14 days, improving hemoglobin and other hematological parameters within four weeks. This case highlights the diagnostic complexity in patients with rare hemolytic anemias in the context of atypical infections and underscores the importance of a multidisciplinary approach for their diagnosis and appropriate treatment. The coexistence of cryoagglutinin-mediated autoimmune hemolytic anemia and pernicious anemia poses diagnostic and therapeutic challenges that are relevant to clinical practice.

IntroducciónLa endometriosis infiltrante profunda (EIP) es una forma severa de endometriosis que afecta al 1–2% de las mujeres en edad reproductiva. Se caracteriza por la presencia de tejido endometrial que penetra 5 mm o más por debajo del peritoneo, y suele estar asociada a dolor pélvico severo e infertilidad. Frecuentemente, se manifiesta como un nódulo único mayor a 1 cm, y en un 5–12% de los casos compromete el intestino, principalmente el recto y el colon sigmoides (90%) (1). Hasta el 80% de las mujeres infértiles presentan algún grado de endometriosis (2,3). En casos seleccionados, el tratamiento quirúrgico puede mejorar significativamente la fertilidad: un tercio logra un embarazo en el primer año, y dos tercios dentro de los tres años posteriores a la intervención (4,5). Descripción del caso Paciente de 25 años, con antecedente de quistectomía ovárica laparoscópica por quistes hemorrágicos, en búsqueda de embarazo, consulta por dispareunia y dolor pélvico crónico en fosa ilíaca izquierda, refractario a anticonceptivos orales, que se intensifica con la defecación. Al examen físico, se palpa un nódulo doloroso en el fondo de saco de Douglas al tacto bimanual. Dado que la videocolonoscopía fue incompleta por angulación en unión rectosigmoidea, se complementó con colonoscopía virtual, que mostró dicho estrechamiento, con signos de inflamación local y sin otras lesiones proximales. La resonancia magnética de pelvis confirmó endometriomas bilaterales, hematosalpinx y tejido fibroso retrocervical con componente quístico-hemorrágico que infiltraba ambos ligamentos uterosacros, fórnix vaginal posterior y recto, comprometiendo un 40% de la circunferencia rectal en al menos dos segmentos. También se observó engrosamiento fibroso del peritoneo vesicouterino. Se realizó un abordaje laparoscópico utilizando un movilizador uterino para la adecuada exposición del compartimento posterior, que mejoró al abordar los endometriomas primero. Se identificaron y lateralizaron ambos uréteres para evitar lesionarlos durante la disección de los nódulos endometriósicos rectovaginales. Se resecaron los ligamentos uterosacros, se ingresó al espacio rectovaginal, se liberó el recto y se restableció la anatomía, lo que permitió evaluar el compromiso colorrectal y definir la conducta quirúrgica. Ante dos lesiones con compromiso transmural, se indicó resección segmentaria sin conservación de órgano. Se efectuó anastomosis término-terminal mecánica, preservando el mesorrecto. La paciente evolucionó favorablemente, con alta al cuarto día. ConclusiónDeterminar el grado de compromiso colorrectal es clave para definir el tratamiento: cirugías no resectivas (afeitado y/o resección discoidea de recto) o con resección de órgano. Esta última está indicada ante lesiones multifocales o afectación de más del 50% de la circunferencia, como en este caso. Es un procedimiento seguro por vía laparoscópica y, al tratarse de una enfermedad benigna, se puede conservar el mesorrecto. La mayoría de las pacientes experimentan mejoría significativa del dolor y calidad de vida, con bajas tasas de recurrencia.

<p>A series of spatial cable-stayed footbridges designed by the Carlos Fernández Casado (CFC) firm are examined to explore how pylon positioning, deck curvature, and cable arrangement influence structural behaviour and spatial configuration. The selected projects are analysed in terms of their geometric layouts and force-balancing strategies. Among them, the Santullano Footbridge—one of the firm’s most recent designs— introduces an innovative approach by eliminating anchoring cables through optimized pylon placement. Parametric analysis is employed to achieve structural equilibrium despite geometric asymmetry. The findings highlight how genuine explorations of structural efficiency can enhance visual expressiveness, improve performance and reduce maintenance in modern pedestrian bridge practice.</p>

Although levodopa remains the gold standard treatment for Parkinson's disease (PD), its chronic use is associated with levodopa-induced dyskinesia (LID), a motor complication that impacts prognosis, quality of life, and treatment costs. Most known LID-associated factors have been identified in European-descendant populations. To describe the epidemiology of LID in Latin American and Caribbean (LATAM) countries and assess the relevance of known and novel LID-associated factors in this population. We conducted a cross-sectional study using data from the Latin American Research consortium on the Genetics of Parkinson's Disease (LARGE-PD). We included PD patients with information on LID status and levodopa use from eight LATAM countries. LID prevalence was calculated overall and by country. Countries were compared on demographic and clinical variables. Logistic regression was used to identify associations with LID. A total of 3,695 PD patients (58.8% male) were included. Overall LID prevalence was 25.4% [95% CI: 24.06-26.87], ranging from 9.3% in Colombia to 45.1% in Puerto Rico. Prevalence increased progressively with longer disease duration. Country comparisons showed that not all known LID-associated factors explained prevalence differences. In logistic regression, fast disease progression was significantly associated with LID (OR: 1.55, 95%CI: 1.16-2.07), while sex was not (OR: 1.02, 95%CI: 0.87-1.18). This is the largest study on LID epidemiology in LATAM. While some known risk factors remain relevant, others, like sex, do not, underscoring the need for population-specific studies. Future work should integrate environmental, clinical, and genetic data to better understand LID mechanisms.