Sistema Regional de Información
en línea para Revistas Científicas de América Latina,
el Caribe, España y Portugal

Takayasu arteritis is a vasculitis which affects women mainly between the 2nd and 3rd decade of life. Currently, the tools that are the most important to diagnose Takayasu arteritis are computed tomography (CT), magnetic resonance angiography (MRA), and ultrasound. This report presents the case of a patient with a chronic history of asthenia, hypertension that was never studied by a secondary cause, febrile sensation of nocturnal predominance, lipothymias, and blurred vision. She is later diagnosed with Takayasu's Disease. The different imaging techniques to make the diagnosis are described and interpreted in this report.

Diabetic bullosis is a spontaneous, non-inflammatory vesiculobullous disease seen in patients with diabetes mellitus type 1 and type 2. We present the case of a 97 years old woman with poor controlled diabetes mellitus 2 who reported a subit appearence in both legs of two non-painfull, non-pruriginous, non-erithematous blisters with clear content. After a detailed anamnesis and physical examination, the diagnosis of diabetic bullosis was made.

HIV infection is highly prevalent worldwide. Renal disorders, both acute and chronic, are more common in patients with HIV than in the general population, being present in up to 30% of these patients. Patients with HIV infection can develop various glomerular, vascular, tubulointerstitial and obstructive nephropathies related in some cases to the virus itself, to the drugs administered or to the coinfections they present. Given this, it is important to determine the prevalence of nephropathy in patients with HIV in the health center. Objective: to determine the prevalence of patients with nephropathy in the HIV carrier population treated at the RACG Hospital. Population: patients in the infectology department Rafael Ángel Calderón Guardia Hospital. Methods: observational, retrospective study. A prevalence of 20% patients with chronic kidney disease of KDIGO 2 or more stages is documented; 2.5% of the population presented significant proteinuria unrelated to viral load or CD4 count. It is necessary to improve the control for the prevention and / or diagnosis of nephropathy in the patient with HIV in the infectology department of H. R. A. C. G.

The Structural Objective Clinical Evaluation (OSCE) is an evaluative tool in clinical and practical aspects that are sometimes not taken in the written test in the clinical courses of the medicine career. Gynecology course (ME 4013 group 01) incorporated an OSCE experience in both semesters of 2018, three procedure stations were use (PAP, long-term contraception placement) and two decision-making (contraceptive choice and complication management). The students valued this activity as positive: "There is a real interaction with the patient and allows to make dynamic decisions regarding the patient management". Aspects to improve were found: the balanced distribution of the stations of the procedures and the reasoning, as well as the clarity of the instructions during the test. The OSCE is a tool that can enrich the already known evaluative method

Chronic kidney disease is a prevalent and high mortality entity, which is underdiagnosed due to global registration problems, among its complications is the bone mineral disorder which favors vascular calcifications and cardiovascular risk in this population. The use of mimetic calcium generates adequate control of secondary hyperparathyroidism in nephropathic patients on dialysis, especially when joint management is carried out with other drugs for the control of bone mineral disorder; and, it achieves a reduction in cardiovascular risk.

Bipolar disorder is a chronic disorder characterized by unusual intense mood shifts ranging from mania to depression. It affects an important percentage of the world population, and to women in their reproductive years. In pregnancy, it has deleterious effects on the fetus development, and it represents a big risk for the mother: self-injury, drugs abuse and suicide. Diagnosis is the most challenging step in management, because it determines the treatment plan, which is completly different than other psiquiatric disorder plan.  Common drug classes used in pregnancy are lithium, atypical antipsychotics and lamotrigine. The purpose of this article is to inform about this mental illness, the risks of non-medication and the challenges involved in the treatment.

Serotonin syndrome is a potentially lethal adverse drug reaction that results from the therapeutic use of some drug, intentional overdose or involuntary drug interactions. Therefore, the syndrome is a predictable consequence of excess serotonergic agonism of central nervous system and of peripheral nervous system. This serotonin excess produces a spectrum of findings and clinical manifestations range from mild to severe symptoms that threaten the lives of patients. It is extremely important to recognize the syndrome for early diagnosis and the most appropriate approach, as it has significant impact on prognosis. In this document we review the most important aspects of the syndrome, its diagnosis and treatment.

Medical students usually perceive neurosciences as one of the most complicated medical specialties to learn. They consider the subject as complex and have difficulties understanding the theory which in turn impedes the application of what they have learned. The term “neurophobia” describes the fear of neuroscience and clinical neurology that medical students develop with the subsequent incapacity to apply their basic sciences knowledge to clinical practice. This eventually produces a paralysis of thought at the moment of action. In Costa Rica there is a great deficit of neurologists, therefore primary care physicians must have appropriate neurological knowledge in order to provide a satisfactory approach to patients with common neurological disorders.

Brugada Syndrome is an inherited condition whose diagnosis is based on a electrocardiographic pattern, which is associated with a risk of ventricular fibrillation and sudden death. The literature mentions that the causal mechanism may be related to an abnormal repolarization of the right ventricle related to sodium channel dysfunction. The latest evidence points to an important genetic role in up to a third of patients. The treatment is complex especially in asymptomatic patients, but the trend is the use of an implantable defibrillator. The following is an electrocardiographic case of Sindrome de Brugada, from which its characteristic pattern and clinical importance will be described.

Mesoamerican Nephropathy refers to Chronic Kidney Disease of unknown etiology not associated with traditional risk factors, endemic in Central America. The main associated factor is the strenuous physical activity under heat stress realized by the young men dedicated to agriculture. Recent investigations have highlighted an inflammatory factor as part of the disease ethiopathogenesis. The population with high risk for Mesoamerican Nephropathy also presents an elevated risk of Acute Kidney Injury that will not be diagnosed and that will progress into Chronic Kidney Disease.