Search

Background: Ifosfamide-induced Fanconi syndrome is a relatively infrequent complication that generally occurs in young patients with a high cumulative dose of ifosfamide; and is commonly characterized by glycosuria, proteinuria, electrolyte abnormalities, and a normal anion gap metabolic acidosis., Case Presentation: In this study, we present the case of a 16-year-old male patient with of osteosarcoma of the right femur with pulmonary metastasis, who received ifosfamide as part of chemotherapy 1 year and 2 months ago and required hospitalization for cellulitis. During inpatient management, he presented with hypokalemia, hypophosphatemia, polyuria, glycosuria, and proteinuria, by which he was diagnosed with Fanconi syndrome and nephrogenic diabetes insipidus, induced by ifosfamide. Management was focused on the control of the internal environment and use of potassium supplements and potassium-sparing diuretics., Conclusion: Patients receiving ifosfamide should be periodically monitored for kidney function and internal environment to detect any potential complications. It is thus important to carefully observe the cumulative dose of ifosfamide to prevent its associated nephrotoxicity, since its appearance can impoverish the prognosis in patients with neoplasms. Therefore, physicians should always be aware about the possibility of nephrotoxicity development., (© The Author(s).)

Thyroid hormones, mainly triiodothyronine, have genomic and non-genomic effects on cardiomyocytes related to the contractile function of the heart. Thyrotoxicosis, which is the set of signs and symptoms derived from the excess of circulating thyroid hormones, leads to increased cardiac output and decreased systemic vascular resistance, increasing the volume of circulating blood and causing systolic hypertension. In addition, the shortening of the refractory period of cardiomyocytes produces sinus tachycardia and atrial fibrillation. This leads to heart failure. Approximately 1% of patients with thyrotoxicosis develop thyrotoxic cardiomyopathy, a rare but potentially fatal form of dilated cardiomyopathy. Thyrotoxic cardiomyopathy represents a diagnosis of exclusion, and prompt identification is crucial as it is a reversible cause of heart failure, and heart function can be recovered after achieving a euthyroid state using antithyroid drugs. Radioactive iodine therapy and surgery are not the best initial therapeutic approach. Moreover, it is important to manage cardiovascular symptoms, for which beta blockers are the first-line therapeutic option., Competing Interests: Disclosures: Juan Eduardo Quiroz-Aldave, María del Carmen Durand-Vásquez, Carlos Jhonatan Lobato-Jeri, Juan-Manuel Muñoz-Moreno, Diana Carolina Deutz Gómez Condori, Sofía Pilar Ildefonso-Najarro, Felipe Contreras-Yametti, Francisca Zavaleta-Gutiérrez, Luis Concepción-Urteaga and Marcio José Concepción-Zavaleta have no financial or non-financial relationships or activities to declare in relation to this article., (© Touch Medical Media 2023.)

Lipschütz ulcer is a non-sexually transmitted genital lesion of unknown etiology, which presents as a painful vulvar ulcer. Lipschütz ulcers have been described in most continents. This is the first case reported in Peru and South America. We present the case of a 33-year-old female patient with a Lipschütz ulcer after being vaccinated with the second dose of the AstraZeneca COVID-19 vaccine. She reported having had only one sexual partner in her lifetime. Laboratory results were negative for herpes simplex 2, Cytomegalovirus, Toxoplasma gondii, Epstein-Barr virus, and syphilis. The patient received symptomatic treatment. Ten days after the onset, the patient was significantly better during follow-up. This case report displays a potential adverse effect of the AstraZeneca COVID-19 vaccine as a Lipschütz ulcer triggered by the host humoral immune response. However, further research is needed to establish the causal relationship between these two., Competing Interests: The authors have completed the ICMJE conflict of interest statement and declare that they received no funding for the completion of this article; they have no financial relationships with organizations that may have an interest in the article published in the last three years, and they have no other relationships or activities that could influence the publication of the article. The forms can be requested by contacting the corresponding author., (This work is licensed under a Creative Commons Attribution 4.0 International License.)

Background: A sedentary lifestyle and an unhealthy diet have considerably increased the incidence of diabetes mellitus worldwide in recent decades, which has generated a high rate of associated chronic complications., Methods: A narrative review was performed in MEDLINE, EMBASES and SciELO databases, including 162 articles., Results: Diabetic neuropathy (DN) is the most common of these complications, mainly producing two types of involvement: sensorimotor neuropathy, whose most common form is symmetric distal polyneuropathy, and autonomic neuropathies, affecting the cardiovascular, gastrointestinal, and urogenital system. Although hyperglycemia is the main metabolic alteration involved in its genesis, the presents of obesity, dyslipidemia, arterial hypertension, and smoking, play an additional role in its appearance. In the pathophysiology, three main phenomena stand out: oxidative stress, the formation of advanced glycosylation end-products, and microvasculature damage. Diagnosis is clinical, and it is recommended to use a 10 g monofilament and a 128 Hz tuning fork as screening tools. Glycemic control and non-pharmacological interventions constitute the mainstay of DN treatment, although there are currently investigations in antioxidant therapies, in addition to pain management., Conclusions: Diabetes mellitus causes damage to peripheral nerves, being the most common form of this, distal symmetric polyneuropathy. Control of glycemia and comorbidities contribute to prevent, postpone, and reduce its severity. Pharmacological interventions are intended to relieve pain., Competing Interests: None to declare

Abdominal pregnancy is defined as one that occurs outside of the uterus and fallopian tubes in the abdominal cavity. We present the case of a 30-year-old Peruvian female patient from Lima with a surgical history of exploratory laparotomy due to tubal ectopic pregnancy and appendectomy without further relevant personal or family histories. She attended the emergency room of a social security hospital in Peru with a referral from a district hospital and a diagnosis of abdominal pregnancy at 14 weeks of gestational age without previous prenatal controls. Symptomatology at hospital admission was colic-type abdominal pain in the hypogastrium without vaginal bleeding, fluid loss or fever. During hospitalization, she underwent an exploratory laparotomy with embolization of the uterine artery, left salpingectomy, and removal of the abdominal ectopic pregnancy. The evolution was favorable after the surgery, and she was discharged. Without further complications, she continues her controls at the obstetrics and gynecology outpatient service without complications., Competing Interests: The authors have completed the ICMJE conflict of interest statement and declare that they received no funding for the completion of this article; they have no financial relationships with organizations that may have an interest in the article published in the last three years, and they have no other relationships or activities that could influence the publication of the article. The forms can be requested by contacting the corresponding author., (This work is licensed under a Creative Commons Attribution 4.0 International License.)