Ciencias de la Salud
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Item “Dificultades en el diagnóstico de mielitis transversa”(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2017-04-01) Marín Tabares, Adriana Paola; Dr. Lana Saavedra, Héctor EnriqueThe present clinical case corresponds to a 53 years old male patient whit personal clinical pathologic antecedents of pain and paresthesia of the lower members, he has an surgical treatment antecedents of left saphenectomy during two times. Left inguinal hernioplasty from one year ago. He is attended because he presents a picture of progressive and generalized asthenia of three years of evolution, that seven hours previous to the entrance, he is exasperated provoking difficulty of moving, accompanied of sporadic paresthesia of the lower members. At the moment in the physical exam, he presents TA: 110/60, FC: 61 LPM, FR: 18RPM, SAT O2: 97% AA, T: 36.70C, WEIGTH 68Kg HEIGTH 165 cm, IMC 25 m/kg, the patient is awake, conscious, febrile, hydrated, algid, normocefalic head, without apparent pathology, eyes pupils of 2mm. isochoric, norm reactive to the light and to the accommodation, normal hearing, permeable nostrils, humid oral mucous, normal oropharynx, not painful to the palpation and movement, OA thyroid, preserved thorax expansibility, lungs with vesicular whisper kept without over added noise, heart with cardiac rhythmic noise, without blowing, soft abdomen, depressible, non-painful to the palpation, hrydroaerial noises present, scar of an hernioplasty in the left region, painful lumbar region to the digital pressure at the level of L1-L2, lower members with decreased strength 1/5, tone preserved, tactile sensibility abolished ( sensitive levels until hips region T12-L1, reflexes osteotendinous Rotuliano and Aquileo (hiperreflexia), Babinski negative, Lasegue negative, Neurological exam: Patient orientated in time, space and person, Glasgow 15/15 higher mental functions preserved, cranial pairs preserved. Motor exam: The patient remains in dorsal decubitus, it is not possible to value the progress, the sensibility of higher members preserved, the lower members abolished. Complementary exams: Thyroid profile, Prostatic and Lipidic : Normal Reactive Protein C: negative, Procalcitonin: 0.08, Hematic Biometry: Normal, Antibodies: Normal, Anticardiolipin: 3.9, Anticardiolipin 1GM: 1, Cardiolipin Beta2: 1.6, Antinuclear Antibodies: 0.04, Glucose: 97.70, Urea in serum: 62.4, Creatinine: 0.9, Na 139, K 4.2, Speed of erythrocyte sedimentation: 3, Latex: Negative, VDRL: Not reactive, Cytomegalovirus IGG: > 500.00, IGM: 0.252, Hepatitis C: 0.067, Herpes I-IGG: 44.42, Folic Acid 11.42, Albumin: 3.9 The patient enters to the service of neurology with the diagnostic of paraplegia in study; is not possible to establish a clear diagnostic based on the clinical history data. He stays in observation with therapy for the pain, complex B and physiotherapy. Complementary exams are taken with the purpose of establishing the etiology. After the corresponding exams, the results are within the normal parameters; during the hospitalization he presents favorable clinical evolution and progressive increase in the motor activity of the lower members, showing muscular strength of 3/5 and evident sensibility until S2 and S3. He can stay standing on foot and starts his ambulation; for that reason it is considered as a clinical picture of Transverse Myelitis and it is decided his exit from the hospital with the corresponding pursuit from the part of physiatrist. Until now he has reached a high progress in his motor activity, allowing him walking in short steps without help, but he continues receiving physiotherapy.Item Crisis Convulsivas Asociadas a Síndrome Poliglandular Autoinmune(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-10-01) Bermeo Chango, Silvia Tatiana; Arguello Navarro, Hugo Enrique Dr.Polyglandular autoimmune syndrome (SPA) is a rare disorder characterized by the coexistence of at least two glandular insufficiencies mediated immune mechanisms, together with other diseases not endocrinological it. The objective of this research is to describe the clinical presentation and the flaws in the health system that impede the timely treatment of these patients, this case is a teenage female patient 17 years old with a history of primary adrenal insufficiency and hypothyroidism primary diagnosed since age 7, which required several hospitalizations due to decompensation of the underlying pathology; as family history has consanguinity of parents (first cousins), maternal grandmother with diabetes; twin sister diagnosed with adrenal insufficiency and epilepsy, who dies at age 7 by their condition; gynecological history menarche at age 11 with irregular menstrual cycles every 3-5 months, amenorrhea over 16 years. As usual medication consume prednisone 5 mg QD, levothyroxine 100 ug QD, income family relates my having tingling in the arms, lower limb pain and seizure generalized 24 hours earlier, involuntary movements of upper and lower limbs is observed deviation glance the right, relaxation of sphincters, recover spontaneously, and left with paresthesias in upper limbs, lower limbs muscle pain with spasmodic muscular contraction that prevents full extension; hospitalization tonic clonic seizure new box about 5 minutes, without relaxation of sphincters with spontaneous recovery is observed. In addition to the physical examination Chevostek positive sign, upper limbs, Trossseau positive sign, lower limb muscle strength IV / V, negative Babinsky was found; with these symptoms the patient goes emergency service to Internal Medicine Hospital IESS of Latacunga, where several complementary tests showing change in values electrolyte is conducted, several imagenlógicos studies performed after which the group of diseases presenting is cataloged from childhood to today as autoimmune polyglandular syndrome type I, restoring itself compensator treatment of their endocrinological disorders.