Oscar Giovanny Iglesias Jiménez

Objective: we present a case of Vogt-Koyanagi-Harada syndrome in a young patient with no relevant past medical history. Case: a 23-year-old female patient who presented with a one-month progressive visual acuity loss. Right eye fundus examination revealed serous retinal detachment with a subtotal focal area of transparent sub-retinal fluid, macular involvement, and a whitish nasal temporal sub-retinal lesion. Left eye fundus examination, revealed funnel-shaped total anterior retinal detachment without proliferative vitreoretinopathy. Discussion and conclusions: a significant alteration in cerebrospinal fluid was evidenced in addition to abovesaid findings. Vogt-Koyanagi-Harada syndrome was diagnosed. Treatment based on systemic corticosteroids was administered, achieving improvement in symptoms. Given Vogt-Koyanagi-Harada syndrome´s difficult diagnosis and infrequent presentation, proper knowledge of the disease is essential for ensuring an adequate approach and an appropriate treatment for these patients.

In sickle cell disease (SCD), fluid intake is decisive because dehydration increases the polymerization of HbS and the appearance of vaso-occlusive crisis (VOC). The use of hydroxyurea (HU) in SCD has shown an increase in survival and reduction of complications. Objectives: Compare the daily fluid intake and the use of HU independently in a population with FD with scientific recommendations, determine therapeutic compliance and difference between sexes. Methods: Cross-sectional and analytical study. Results: Men had higher fluid intake by a difference of about 0.5 L compared to women, p= 0.003. 16% of the sample ingested more than 3 liters per day. 78.5% of the sample had HU indicated and 42.2% of women and 25.8% of men used it, p= 0.09. The average fluid intake was 1.92 L/day, 1.5 liters lower than the intake recommendation for PE, p<0.05. The average dose of 14.86 mg/kg/day of the 35 patients with HU showed no statistical difference compared to the standard recommended starting dose, p= 0.88. Conclusions: Daily fluid intake was sub-optimal and constituted 54.8% of the recommended requirements. It was determined that there was underuse of HU due to lack of indication. Low fluid intake or the use of HU had no association with factors such as age, gender, education, and living area. Sex differences show a higher frequency of acute chest syndrome (ACS) and HU use in the female population with SCD, findings opposite to what has been documented in other cohorts.

Sickle cell disease (SCD) comprises a group of hereditary disorders with heterogeneous clinical expression and multiple complications of a vascular and hemolytic nature. Priapism represents a urological emergency that requires early surgical intervention to reduce erectile dysfunction. Objectives: Report five cases of SCD treated for priapism at the ESE University Hospital of Cartagena (ESEHUC), and highlight the sociodemographic, clinical and laboratory characteristics that were associated with erectile dysfunction. Methods: Hospital case series. Results: Five cases of priapism were recorded with a median calculated for age of 33 years, BMI: 23 kg/m2, three cases belonged to the homozygous subtype, one double heterozygous, and one sickle cell trait. The average hospital admission was considered late, being greater than 48 hours of evolution of priapism and urological surgical management was chosen in all of them. Three cases presented sexual dysfunction, one was classified as severe. Conclusions: Cases with subclinical forms and low-risk genotypes may face greater priapism, with a risk of complications with an impact on sexual life. We insist on educating patients about: early consultation, and lifestyles that reduce the risk of priapism.

Introduction: Pericardial effusion is a rare complication of hypothyroidism; its progression to tamponade is frequently underdiagnosed due to low clinical suspicion, causing delays in treatment and fatal complications. The only possible etiology was manifest hypothyroidism with myxedematous manifestations, with ultrasound suggestive of chronic autoimmune thyroiditis and positive antithyroid antibodies, with clinical stabilization after the pericardial window and further improvement with thyroid hormone replacement.Objective: Identify patients with electrocardiographic signs of tamponade, such as electrical alternation, low voltage, added to bradycardia, and a chest X-ray with cardiomegaly, which allows us to think of hypothyroidism as an underlying etiology.Case presentation: A 41-year-old male patient was admitted due to edematous syndrome and dyspnea, with clinical and laboratory findings suggestive of massive pericardial effusion and signs of cardiac tamponade. He was treated with pericardial drainage and levothyroxine.Discussion: The causes of dyspnea in the patient who visits the emergency room are innumerable. The anamnesis and the semiological findings during the clinical evaluation are the starting point for its study. . Concerning hypothyroidism and dyspnea of cardiac origin, this has support based on which various physiopathological aspects converge.Conclusions: The identification of individuals with risk factors for PH, its diagnosis, and treatments that have a positive impact on the reduction of symptoms and complications. Introducción: el derrame pericárdico es una complicación poco frecuente del hipotiroidismo; su evolución al taponamiento suele ser subdiagnosticado debido a la baja sospecha clínica causando demora en el tratamiento y complicaciones fatales. Objetivo: identificar pacientes con signos de electrocardiográficos de taponamiento como: alternancia eléctrica, bajo voltaje, sumado a bradicardia, y una radiografía de tórax con cardiomegalia, lo que permite pensar en hipotiroidismo como etiología subyacente. Presentación del caso: paciente masculino de 41 años quien ingresó por síndrome edematoso y disnea, con hallazgos clínicos y paraclínicos sugestivos de derrame pericárdicos masivo y signos de taponamiento cardiaco, manejado con drenaje pericárdico y levotiroxina. Discusión: las causas de la disnea en el paciente que consulta a urgencias son innumerables. La anamnesis y los hallazgos semiológicos durante le evaluación clínica son el punto de partida para su estudio. Con relación al hipotiroidismo y la disnea de origen cardiaco, esta tiene un sustento en cuya base confluyen varios aspectos fisiopatológicos. Conclusión: la identificación de individuos con factores de riesgo para HP, su diagnóstico y tratamiento impactan positivamente en la reducción de síntomas y complicaciones.