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Enterococci spp. are Gram-positive bacteria that cause mild to severe infections, many associated with the oral cavity, such as periapical infections and healthcare-associated infections (HAIs). Many of these infections become serious diseases that are difficult to resolve, specifically when multidrug-resistant (MDR) strains cause them. In recent years, the number of MDR strains of Enterococcus spp. has increased significantly. This increased prevalence of MDR strains produces significant pressure to generate more antimicrobial therapies, but there is a decline in the production of new antibiotics, driving the development of complementary therapies, such as photodynamic therapy (PDT). PDT combines a photosensitizer agent (PS), light, and oxygen to cause photooxidative stress in bacterial cells. PDT can eradicate Enterococcus spp. contaminations, improve the classic cleaning processes, and eradicate the bacteria in dental pieces. PDT's effectiveness can be improved with nanoparticles that function as carriers. Our work aims to describe the advances in PDT against Enterococcus spp. as a complement to antibiotic therapy, focusing on infections by Enterococcus faecium and Enterococcus faecalis, dental hygiene, and using nanoparticles to improve the antimicrobial effect. A systematic bibliographic search without a meta-analysis was conducted on various databases, using inclusion and exclusion criteria to identify the most relevant research. Of the 193 non-redundant articles found, 65 were selected for a systematic review, from which a summary table was created and a manual description was made. Photodynamic therapy for treating E. faecium and E. faecalis is a widely studied area, with promising results concerning bactericidal effectiveness and reductions in biofilm formation, particularly in regard to dental hygiene. Because most of the studies were conducted in vitro or ex vivo, the results indicated that there were not sufficient data to initiate clinical trials for safety and efficacy studies on humans.

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We present a multiscale stochastic analysis of foreign exchange rates using the H-theory formalism, which provides a hierarchical intermittency model for the information cascade in the currency market. We examine the distributions of returns and volatilities for the three most traded currency pairs: euro-U.S. dollar, U.S. dollar-Japanese yen, and British pound-U.S. dollar. We find that these markets have a hierarchy of timescales, with larger markets exhibiting more hierarchy levels. We provide a theoretical framework for understanding why the number of levels in the information cascade increases with market size, in analogy with similar behavior for the energy cascade in turbulence as a function of Reynolds number. We briefly argue that using turbulence-like models for financial markets can also provide valuable insights for developing efficient algorithmic trading strategies.

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Mucormycosis is an invasive opportunistic fungal infection with high mortality, mainly detected in people with COVID-19, especially those with underlying diseases such as diabetes mellitus. Mucormycosis prevalence is 0.005 to 1.7 cases per million inhabitants, and it has been increasing in countries like India and Pakistan. This mycosis can affect different organs, and clinical manifestations reflect the transmission mechanism. Frequent forms are rhino-orbital-cerebral and pulmonary. This disease should be suspected in patients with necrotic injuries on mucous membranes or skin. We present a case of a patient with diabetes mellitus and diagnosed with oral mucormycosis associated with COVID-19.

La mucormicosis es una infección fúngica oportunista e invasiva, con una elevada tasa de mortalidad. Se ha detectado principalmente en pacientes con COVID-19, especialmente en personas con enfermedades concomitantes como la diabetes mellitus. La prevalencia de las mucormicosis es de 0,005 a 1,7 casos por millón de habitantes y ha ido en aumento en países como India y Pakistán; puede afectar diferentes órganos y su forma clínica refleja el mecanismo de transmisión. Entre las formas frecuentes están la rino-orbital-cerebral y la pulmonar, por ello, debe sospecharse mucormicosis en los pacientes con lesiones necróticas en mucosas o piel. Se presenta el caso de un paciente con antecedentes de diabetes mellitus que fue diagnosticado con mucormicosis oral asociada a la COVID-19.

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BACKGROUND: Disparities in the timely diagnosis and care of cancer patients, particularly concerning geographical, racial/ethnic, and economic factors, remain a global health challenge. This study explores the multifaceted interplay between socioeconomic status, health literacy, and specific patient perceptions regarding care access and treatment options that impact cancer care in Uruguay. METHODS: Using the Cancer Health Literacy Test, Spanish Version (CHLT-30-DKspa), and a highly comprehensive questionnaire, we dissected the factors influencing the pathway to diagnosis and route of cancer care. This was done to identify delays by analyzing diverse socioeconomic and sex subgroups across multiple healthcare settings. RESULTS: Patients with lower income took longer to get an appointment after showing symptoms (p = 0.02) and longer to get a diagnosis after having an appointment (p = 0.037). Race/ethnicity also had a significant impact on the length of time from symptoms to first appointment (p =0.019), whereas employment status had a significant impact on patients being susceptible to diagnostic delays beyond the advocated 14-day window (p = 0.02). Higher educational levels were positively associated with increased cancer health literacy scores (p = 0.043), revealing the potential to mitigate delays through health literacy-boosting initiatives. Women had significantly higher self-reported symptom duration before seeking an intervention (p = 0.022). We also found many other significant factors effecting treatment delays and cancer health literacy. CONCLUSIONS: While affirming the global pertinence of socioeconomic- and literacy-focused interventions in enhancing cancer care, the findings underscore a complex, gendered, and perceptually influenced healthcare navigation journey. The results highlight the urgent necessity for strategically crafted, globally relevant interventions that transcend equitable access to integrate literacy, gender sensitivity, and patient-perception alignments in pursuit of optimized global cancer care outcomes.

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This study examined the impact of green advertising and eco-labels on the attitudes and environmental awareness of millennials purchasing eco-friendly products in shopping centers across Ecuador. The research utilized a quantitative, correlational, cross-sectional methodology with 430 millennials participating. A 20-item survey was administered face-to-face at shopping centers in Quito and Guayaquil, Ecuador. The validity of the research model was established through Confirmatory Factor Analysis (CFA) and Structural Equation Modeling (SEM), employing SPSS 20 and AMOS 24 for statistical evaluations. Findings reveal that green advertising significantly shapes environmental attitudes (ß: 0.245) and awareness (ß: 0.110), as well as directly influences the purchasing behavior (ß: 0.154) towards green products. While eco-labels do not exert a direct effect on purchasing behavior (ß: 0.128), they significantly inform attitudes (ß: 0.406) and ecological awareness (ß: 0.277) of millennials who purchase organic products. This paper is among the pioneering research to delineate the correlation between green advertising elements and the purchasing patterns of green products among millennials in a developing nation. It concludes that marketing strategies centered on green advertising and eco-labels do affect millennials' attitudes and environmental consciousness, but only advertising has a direct impact on purchasing behaviors, contrary to eco-labels. The research bears social significance as it affirms that millennials are attentive to environmental issues and are actively engaged in promoting sustainability.

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Background: Color-coded duplex sonography (CCDS) is a widely proposed noninvasive diagnostic tool in microsurgery. CCDS has been applied to lower extremity salvage cases to define appropriate blood flow velocity criteria for achieving arterial success in diabetic foot and complex microsurgery cases. This study aimed to compare the success ratio of free flaps when using CCDS versus cases where CCDS was not used. Methods: We included complex microsurgery cases from 2019 to 2021. These cases were subsequently categorized into two groups: group A consisted of cases where CCDS parameters were applied, whereas group B comprised cases where CCDS was not performed at all. Results: The study encompassed 14 cases (11 men and three women). The age range varied from 23 to 62 years, with an average age of 42. Using CCDS analysis and planning demonstrated improved outcomes in comparison with cases where CCDS was not performed, albeit without statistical significance (P = 0.064). Conclusions: The application of CCDS proves to be beneficial in the realm of microsurgery. Although not achieving statistical significance, our data imply that CCDS utilization holds promise for enhancing microsurgical procedures.

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The particle size distribution (PSD) in emulsion polymerization (EP) has been modeled in the past using either the pseudo bulk (PB) or the 0-1/0-1-2 approaches. There is some controversy on the proper type of model to be used to simulate the experimental PSDs, which are apparently broader than the theoretical ones. Additionally, the numerical technique employed to solve the model equations, involving hyperbolic partial differential equations (PDEs) with moving and possibly steep fronts, has to be precise and robust, which is not a trivial matter. A deterministic kinetic model for the PSD evolution of ab initio EP of vinyl monomers was developed to investigate these issues. The model considers three phases, micellar nucleation, and particles that can contain n≥0 radicals. Finite volume (FV) and weighted-residual methods are used to solve the system of PDEs and compared; their limitations are also identified. The model was validated by comparing predictions with data of monomer conversion and PSD for the batch emulsion homopolymerization of styrene (Sty) and methyl methacrylate (MMA) using sodium dodecyl sulfate (SDS)/potassium persulfate (KPS) at 60 °C, as well as the copolymerization of Sty-MMA (50/50; mol/mol) at 50 and 60 °C. It is concluded that the PB model has a structural problem when attempting to adequately represent PSDs with steep fronts, so its use is discouraged. On the other hand, there is no generalized evidence of the need to add a stochastic term to enhance the PSD prediction of EP deterministic models.

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Concern about green practices by companies and people has grown exponentially worldwide, considering them as a key element sustaining the development of competitive advantages. Given the present competitive, dynamic, and turbulent supermarket environment, managing environmental practices is essential for their survival. This study has two objectives: First, studying the relationship between green practices and customer satisfaction and, second, analyzing the impact of green practices and satisfaction on loyalty, word-of-mouth, and willingness to pay more via a quantitative study on a convenience sample of 458 customers from different Chilean supermarkets. Partial least square regression was used to analyze data. Results show the importance of green practices for developing satisfaction and different customer behaviors such as loyalty, word-of-mouth, and willingness to pay more. In addition, results prove satisfaction's positive impact on loyalty, word-of-mouth, and willingness to pay more. Those results also provide empirical evidence about the effects of green practices on the supermarket industry and, in this way, their advancement toward more sustainable management.

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Multidrug-resistant bacteria, such as ESBL producing-Klebsiella pneumoniae, have increased substantially, encouraging the development of complementary therapies such as photodynamic inactivation (PDI). PDI uses photosensitizer (PS) compounds that kill bacteria using light to produce reactive oxygen species. We test Ru-based PS to inhibit K. pneumoniae and advance in the characterization of the mode of action. The PDI activity of PSRu-L2, and PSRu-L3, was determined by serial micro dilutions exposing K. pneumoniae to 0.612 J/cm 2 of light dose. PS interaction with cefotaxime was determined on a collection of 118 clinical isolates of K. pneumoniae. To characterize the mode of action of PDI, the bacterial response to oxidative stress was measured by RT-qPCR. Also, the cytotoxicity on mammalian cells was assessed by trypan blue exclusion. Over clinical isolates, the compounds are bactericidal, at doses of 8 µg/mL PSRu-L2 and 4 µg/mL PSRu-L3, inhibit bacterial growth by 3 log10 (>99.9%) with a lethality of 30 min. A remarkable synergistic effect of the PSRu-L2 and PSRu-L3 compounds with cefotaxime increased the bactericidal effect in a subpopulation of 66 ESBL-clinical isolates to > 6 log10 with an FIC-value of 0.16 and 0.17, respectively. The bacterial transcription response suggests that the mode of action occurs through Type II oxidative stress. The upregulation of the extracytoplasmic virulence factors mrkD, magA, and rmpA accompanied this response. Also, the compounds show little or no toxicity in vitro on HEp-2 and HEK293T cells. Through the type II effect, PSs compounds are bactericidal, synergistic on K. pneumoniae, and have low cytotoxicity in mammals.

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Background: Simultaneous pancreas-kidney transplantation (SPKT) is a complex and demanding procedure with a considerable risk of morbidity and mortality. Advances in surgical techniques and organ preservation have introduced changes in care protocols. Two cohorts of patients receiving SPKT with two different protocols were compared to determine overall survival and pancreatic and renal graft failure-free survival. Methods: This retrospective observational study was conducted in two cohorts of SPKT recipient patients that underwent surgery between 2001 and 2021. Outcomes were compared in transplant patients between 2001 and 2011 (cohort 1; initial protocol) and 2012-2021 (cohort 2; improved protocol). In addition to the temporality, the cohorts were defined by a protocolization of technical aspects and medical management in cohort 2 (improved protocol), compared to a wide variability in the procedures carried out in cohort 1 (initial protocol). Overall survival and pancreatic and renal graft failure-free survival were the primary outcomes. These outcomes were determined using Kaplan-Meier survival analysis and the log-rank test. Results: Fifty-five SPKT were performed during the study period: 32 in cohort 1 and 23 in cohort 2. In the survival analysis, an average of 2546 days (95% CI: 1902-3190) was found in cohort 1, while in cohort 2, it was 2540 days (95% CI: 2100-3204) (p > 0.05). Pancreatic graft failure-free survival had an average of 1705 days (95% CI: 1037-2373) in cohort 1, lower than the average in cohort 2 (2337 days; 95% CI: 1887-2788) (p = 0.016). Similarly, renal graft failure-free survival had an average of 2167 days (95% CI: 1485-2849) in cohort 1, lower than the average in cohort 2 (2583 days; 95% CI: 2159-3006) (p = 0.017). Conclusions: This analysis indicates that pancreatic and renal graft failure-free survival associated with SPKT decreased significantly in cohort 2, with results related to improvements in the treatment protocol implemented in that cohort.

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The aims of this study were (1) to describe and examine differences in change of direction (COD) performance and the magnitude of asymmetries in para-footballers with cerebral palsy (CP) and controls and (2) to evaluate the association between COD outcomes and linear sprint performance. Twenty-eight international para-footballers with CP and thirty-nine non-impaired football players (control group) participated in this study. All participants completed a 10-m sprint and two attempts of the 505 COD test with the dominant and non-dominant leg. The COD deficit was calculated using the difference between the 505 test and the 10-m sprint time, while the asymmetry index was determined by comparing each leg's completion time and COD deficit. Players across groups showed interlimb asymmetries between the dominant and non-dominant legs in COD outcomes and deficit (p < 0.05, dg = -0.40 to -1.46), although these asymmetries imbalance were not significantly different between the sexes with and without impairment. Males with CP exhibited a faster directional COD speed and a shorter COD deficit than their female counterparts (p < 0.01, dg = -1.68 to -2.53). Similarly, the control group had faster scores than the CP groups of the same sex (p < 0.05, dg = 0.53 to 3.78). Lastly, the female CP group and male control groups showed a significant association between sprint and the COD deficit in the dominant leg (p < 0.05, r = -0.58 to 0.65). Therefore, the use of directional dominance, the COD deficit, and asymmetry outcomes could be helpful for classification purposes to assess the impact of the impairment on sport-specific activity testing according to sex.

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BACKGROUND: The main functions of the endotracheal tube (ETT) cuff are to prevent aspiration and to allow pressurization of the respiratory system. For this purpose, it is essential to maintain adequate pressure inside the cuff, thus reducing the risks for the patient. It is regularly checked using a manometer and is considered the best alternative. The objective of this study was to evaluate the cuff pressure behavior of different ETTs during the simulation of an inflation maneuver using different manometers. METHODS: A bench study was performed. Four brands of 8-mm internal diameter single lumen with a Murphy eye ETT with cuff and 3 different brands of manometers were used. In addition, a pulmonary mechanics monitor was connected to the inside of the cuff through the body of the distal end of the ETT. RESULTS: A total of 528 measurements were made on the 4 ETTs. During the complete procedure (connection and disconnection), there was a significant pressure drop of 7 ± 1.4 cm H2O from the initial pressure (Pinitial) (P < .001), of which 6 ± 1.4 cm H2O was lost during connection (difference between Pinitial and Pconnection). The Preconnection value was 19.1 ± 1.6 cm H2O, showing a significant total pressure drop of 11 ± 1.6 cm H2O (difference between Pinitial and Preconnection) (P < .001). The Pfinal mean was 29.6 ± 1.3 cm H2O. Significant differences were found between manometers according to the time of measurement. A similar phenomenon was evidenced when analyzing different ETTs. CONCLUSIONS: Significant pressure changes occur secondary to ETT cuff measurement, which has important implications for patient safety.

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Leptocarpha rivularis is a native South American plant used ancestrally by Mapuche people to treat gastrointestinal ailments. L. rivularis flower extracts are rich in molecules with therapeutic potential, including the sesquiterpene lactone leptocarpin, which displays cytotoxic effects against various cancer types in vitro. However, the combination of active molecules in these extracts could offer a hitherto unexplored potential for targeting cancer. In this study, we investigated the effect of L. rivularis flower extracts on the proliferation, survival, and spread parameters of gastric cancer cells in vitro. Gastric cancer (AGS and MKN-45) and normal immortalized (GES-1) cell lines were treated with different concentrations of L. rivularis flower extracts (DCM, Hex, EtOAc, and EtOH) and we determined the changes in proliferation (MTS assay, cell cycle analysis), cell viability/cytotoxicity (trypan blue exclusion assay, DEVDase activity, mitochondrial membrane potential MMP, and clonogenic ability), senescence (ß-galactosidase activity) and spread potential (invasion and migration assays using the Boyden chamber approach) in all these cells. The results showed that the DCM, EtOAc, and Hex extracts display a selective antitumoral effect in gastric cancer cells by affecting all the cancer parameters tested. These findings reveal an attractive antitumoral potential of L. rivularis flower extracts by targeting several acquired capabilities of cancer cells.

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The interest in the Coordinative Chain Transfer Polymerization (CCTP) of a family of naturally occurring hydrocarbon monomers, namely terpenes, for the production of high-performance rubbers is increasing year by year. In this work, the synthesis of poly(ß-myrcene) via CCTP is introduced, using neodymium versatate (NdV3), diisobutylaluminum hydrade (DIBAH) as the catalytic system and dimethyldichlorosilane (Me2SiCl2) as the activator. A bimodal distribution in the GPC signal reveals the presence of two populations at low conversions, attributable to dormants (arising from reversible chain transfer reactions) and dead chains (arising from termination and irreversible chain transfer reactions); a unimodal distribution is generated at medium and high conversions, corresponding to the dominant species, the dormant chains. Additionally, a mathematical kinetic model was developed based on the Method of Moments to study a set of selected experiments: ([ß-myrcene]0:[NdV3]0:[DIBAH]0:[Me2SiCl2]0 = 660:1:2:1, 885:1:2:1, and 533:1:2:1). In order to estimate the kinetic rate constant of the systems, a minimization of the sum of squared errors (SSE) between the model predicted values and the experimental measurements was carried out, resulting in an excellent fit. A set of the Arrhenius parameters were estimated for the ratio [ß-myrcene]0:[NdV3]0:[DIBAH]0:[Me2SiCl2]0 = 660:1:2:1 in a temperature range between 50 to 70 °C. While the end-group functionality (EGF) was predominantly preserved as the ratio [ß-myrcene]0:[NdV3]0 was decreased, higher catalytic activity was obtained with a high ratio.

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We offer a new perspective on the problem of characterizing mesoscopic fluctuations in the interplateau regions of the integer quantum Hall transition. We found that longitudinal and transverse conductance fluctuations, generated by varying the external magnetic field within a microscopic model, are multifractal and lead to distributions of conductance increments (magnetoconductance) with heavy tails (intermittency) and signatures of a hierarchical structure (cascade) in the corresponding stochastic process, akin to Kolmogorov's theory of fluid turbulence. We confirm this picture by interpreting the stochastic process of the conductance increments in the framework of H theory, which is a continuous-time stochastic approach that incorporates the basic features of Kolmogorov's theory. The multifractal analysis of the conductance "time series," combined with the H-theory formalism, provides strong support for the overall characterization of mesoscopic fluctuations in the quantum Hall transition as a multifractal stochastic phenomenon with multiscale hierarchy, intermittency, and cascade effects.

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INTRODUCTION: Neoplastic degeneration is an uncommon but extremely serious complication of pilonidal sinus (PS) disease. We pretend to determine the factors that influence in the prognosis of the neoplastic disease assessing clinical features and histological findings. MATERIALS AND METHODS: We retrospectively studied the patients diagnosed of malignization of PS in our institution from 2000 to 2019. RESULTS: Seven male patients with a mean age at diagnosis of 64.8 years old were collected. Average time between the initial symptoms of PS disease and the tumor diagnosis was 33.7 years. The patients presenting an ulcerative pattern in the primary tumor showed in all the cases perineural invasion, local deep structures infiltration, and neoplastic dissemination to the regional lymph nodes. All these patients died in an average time of 7 months. On the other hand, patients with exophytic patterns in the primary tumor did not present local invasion or regional nodes affectation. All the cases survive with an average follow-up of 70.5 months. CONCLUSIONS: Ulcerated lesions clearly show a worse prognosis than tumors with exophytic morphology. Factors as perineural infiltration, local deep structures infiltration, or regional lymph node involvement dramatically decrease survival rates.

OBJETIVO: La cancerificación es una complicación infrecuente pero grave de la enfermedad por sinus pilonidal. Intentaremos determinar los factores que influyen en el pronóstico de la enfermedad neoplásica basándonos en hallazgos clínicos e histopatológicos. MATERIAL Y MÉTODOS: retrospectivamente se revisan pacientes diagnosticados de malignización de sinus pilonidal en nuestra institución del 2000 a 2019. RESULTADOS: fueron recopilados los casos de siete varones con una media de edad al diagnóstico de 64.8 años. El promedio entre el inicio de los síntomas de sinus pilonidal y el diagnóstico del tumor fue de 33.7 años. Los pacientes con un patrón ulcerativo en el tumor primario presentaron todos invasión perineural, infiltración de estructuras profundas y diseminación a linfáticos regionales. Todos estos pacientes fallecieron en una media de 7 meses. Por el contrario, los pacientes que mostraban un patrón exofítico, no presentaron invasión local o afectación de los linfáticos regionales. Todos estos casos sobrevivieron, con una media de seguimiento de 70.5 meses. CONCLUSIONES: tumores primarios ulcerativos claramente presentan un peor pronóstico que los casos de morfología exofítica. Factores como la infiltración perineural, la invasión local de estructuras profundas o la afectación de los ganglios linfáticos regionales van ligados a una disminución dramática en la supervivencia.

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Random lasers (RLs) are remarkable experimental platforms to advance the understanding of complex systems phenomena, such as the replica-symmetry-breaking (RSB) spin glass phase, dynamics modes correlations, and turbulence. Here we study these three phenomena jointly in a Nd:YAG based RL synthesized for the first time using a spray pyrolysis method. We propose a couple of modified Pearson correlation coefficients that are simultaneously sensitive to the emergence and fading out of photonic intermittency turbulent-like effects, dynamics evolution of modes correlations, and onset of RSB behavior. Our results show how intertwined these phenomena are in RLs, and suggest that they might share some common underlying mechanisms, possibly approached in future theoretical models under a unified treatment.

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Introducción: en el presente reporte de caso se presenta una urgencia endocrinológica, el coma mixedematoso. Se considera una descompensación del hipotiroidismo y su mortalidad es alta alcanzando hasta 52% en algunas series de casos. Puede desencadenarse por múltiples factores y su presentación clínica es muy variada ya que comprende la afección de diversos sistemas. Presentación del caso: se presenta el caso de una paciente femenina de 42 años de edad que consultó al servicio de urgencias del Hospital de San José de Bogotá con sospecha inicial de una de falla cardiaca descompensada, sin embargo, cursó con pobre mejoría ante el manejo instaurado, por lo cual se realizaron estudios de extensión en donde se encontró una función tiroidea deprimida. Discusión y conclusiones: en este momento se consideró que la paciente padecía un coma mixedematoso, se instauró manejo con dosis altas de levotiroxina oral con lo cual evolucionó de manera favorable y se logró dar de alta a los pocos días.

Introduction: herein we present an endocrine emergency, myxedema coma, which is a form of decompensated hypothyroidism, whose mortality may be as high as 52% as evidenced in some case series. It may be triggered by multiplefactors and has varied clinical presentations for it affects diverse organ systems. Case presentation:we present the case of a 42-year-old female who presented to the emergency department of Hospital de San José in Bogotá with clinical suspicion of decompensated heart failure upon admission, however, her response was poor to the treatment she received. Extension studies were performed which showed low thyroid function. Discussion and conclusions: at this point the patient was diagnosed with myxedema coma, and was started on high doses of oral levothyroxine, with which she evolved favorably and was discharged a few days later.

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