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      "title": "ERECCIÓN INVOLUNTARIA Y FRECUENTEMENTE DOLOROSA",
      "body": "ERECCIÓN INVOLUNTARIA Y FRECUENTEMENTE DOLOROSA\n#\n<div class=\"text-justify\">\nEste post que hoy comparto hago mención sobre un tema que a pesar de no ser común, suele suceder en emergencias hospitalarias y muchas personas no conocen o no tienen una información adecuada, espero que pueda ser de su agrado e interés.\n </div>\n\n#\n[Fuente](https://thoughtcatalog.files.wordpress.com/2016/03/shutterstock_323723567.jpg?w=1024&h=740&resize=1024,740&quality=95&strip=all&crop=1) \nhttps://thoughtcatalog.files.wordpress.com/2016/03/shutterstock_323723567.jpg?w=1024&h=740&resize=1024,740&quality=95&strip=all&crop=1\n<div class=\"text-justify\">\n\n#\nLos hombres en diferentes edades comienzan a experimentar una o varias erecciones peneana al día, entiéndase por erección el endurecimiento y levantamiento del pene; esto es un evento neurovascular, lo que quiere decir que tiene influencia psicológica y hormonal.  \n#\n\n¿Qué sucede cuando esto ocurre involuntariamente? ¿Por qué sucede que luego de terminada una relación sexual, el pene no se relaja? ¿Por qué puede ocurrir frecuentemente con dolor y en ocasiones cursar sin dolor? \n<div>\n\n<center>\n#\n[Fuente](http://www.comocrecerelpene.guia-salud.com/wp-content/uploads/2017/02/sistema-reproductor-masculino.png)\nhttp://www.comocrecerelpene.guia-salud.com/wp-content/uploads/2017/02/sistema-reproductor-masculino.png\n#\n\n\n\n\n# PRIAPISMO.\n#\n\n[Fuente](https://periodicosalud.com/wp-content/uploads/2017/07/Priapismo-%E2%80%93-Que-es-definici%C3%B3n-causas-s%C3%ADntomas-tratamiento.jpg)\nhttps://periodicosalud.com/wp-content/uploads/2017/07/Priapismo-%E2%80%93-Que-es-definici%C3%B3n-causas-s%C3%ADntomas-tratamiento.jpg\n#\n</center>\n<div class=\"text-justify\">\n\nSe define priapismo como Erección peneana con una duración igual o superior a cuatro horas en privación de estímulo sexual o después de que este ha culminado.  \n#\nCLASIFICACIÓN: \n#\n•\tPrimario o segundario \n•\tDe alto flujo (no isquémico)\n•\tDe bajo flujo (isquémico) el cual se asocia a mayor disfunción eréctil.\n#\nETIOLOGÍA\n# \n- Priapismo de alto flujo: anemia falciforme, fístula traumática e idiopática.\n#\n- Priapismo de bajo flujo: anemia falciforme, malignidad hematológica, carcinoma renal o de vejiga, idiopáticas, carcinoma de próstata, lesión medular, carcinoma de cuerpos cavernosos, medicamentos (drogas ilegales).\n#\nPRIAPISMO DE ALTO FLUJO\n#\nHace referencia cuando en flujo arterial es continuo y excesivo hacia los espacios lacunares de los cuerpos cavernosos, casi siempre ocurre por una fístula arterial-lacunar por laceración violenta de la arteria cavernosa debido a un mecanismo traumático. No hay estasis venosa, hipercapnia o acidosis, debido a que la entrega de oxihemoglobina a los tejidos no se encuentra impedida. No es dolorosa. Se trata de una ERECCIÓN PARCIAL, NO DOLOROSA. \n#\nPRIAPISMO DE BAJO FLUJO \n#\nEs más común, tiene un gran potencial para provocar fibrosis y disfunción eréctil permanente (57 % después de 48 horas) existen, relajación anormal del musculo liso cavernoso lo que conlleva a la veno-oclusión, a diferencia del priapismo de alto flujo, la no llegada de la oxihemoglobina provoca acidosis, hipercapnia e isquemia sostenida. Se trata de una ERECCIÓN AGUDA, RIGIDA Y EXTREMADAMENTE DOLOROSA. \n#\nDIAGNÓSTICO: \n#\nAnamnesis y evaluación clínica; paraclínicos y hemodinámica de la sangre peneana; presión parcial de oxígeno (PO2) <30mmhg, presión parcial de dióxido de carbono (PCO2) >60mmhg, pH ≤ 7.25 (priapismo de bajo flujo).\n#\nTRATAMIENTO\n#\nPriapismo de Alto Flujo: Manejo Quirúrgico:  arteriografía \n#\nPriapismo de bajo flujo:\n#\nManejo médico:\n* Reconocer algún tipo de etiología subyacente\n* Aspiración de los cuerpos cavernosos con jeringa hepanizada con infusión salina normal para liberar coágulo. \n* Instalación intracavernosa de un agente vasoconstrictor (epinefrina 2ml).\n#\nManejo quirúrgico:\n* conectar cuerpos cavernosos con el glande. \n#\n   \nReferencia\n#\n http://www.medigraphic.com/pdfs/revmedcoscen/rmc-2013/rmc133s.pdf\n#\nhttp://scielo.isciii.es/pdf/urol/v63n8/03.pdf\n#\n\n </div>",
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      "body": "<center>\n\n# ERECCIÓN INVOLUNTARIA Y FRECUENTEMENTE DOLOROSA.\n# \n[Fuente](https://thoughtcatalog.files.wordpress.com/2016/03/shutterstock_323723567.jpg?w=1024&h=740&resize=1024,740&quality=95&strip=all&crop=1)\nhttps://thoughtcatalog.files.wordpress.com/2016/03/shutterstock_323723567.jpg?w=1024&h=740&resize=1024,740&quality=95&strip=all&crop=1\n#\nEste post que hoy comparto hago mención sobre un tema que a pesar de no ser común en la emergencia hospitalaria suele presentarse, muchas personas no conocen o no tienen una información adecuada, espero que pueda ser de su agrado e interés.\n#\n\n[Fuente](http://www.noticiassalud.com/wp-content/uploads/2012/07/Priapismo.jpg)\nhttp://www.noticiassalud.com/wp-content/uploads/2012/07/Priapismo.jpg\n#\n\n<div class=\"text-justify\">\nLos hombres en diferentes edades comienzan a experimentar una o varias erecciones peneana al día, entiéndase por erección en el endurecimiento y levantamiento del pene; esto es un evento neurovascular, lo que quiere decir que tiene influencia psicológica y hormonal.  \n¿Qué sucede cuando esto ocurre involuntariamente? ¿Por qué sucede que luego de terminada una relación sexual, el pene no se relaja? ¿Por qué puede ocurrir frecuentemente con dolor y en ocasiones cursar sin dolor? \n\n\n#\n[Fuente](https://truelibido.com/wp-content/uploads/2017/03/erection-2.png.pagespeed.ce.iRtMZNVi7O.png) \nhttps://truelibido.com/wp-content/uploads/2017/03/erection-2.png.pagespeed.ce.iRtMZNVi7O.png\n#\nPRIAPISMO.\n#\n[Fuente](https://periodicosalud.com/wp-content/uploads/2017/07/Priapismo-%E2%80%93-Que-es-definici%C3%B3n-causas-s%C3%ADntomas-tratamiento.jpg)\nhttps://periodicosalud.com/wp-content/uploads/2017/07/Priapismo-%E2%80%93-Que-es-definici%C3%B3n-causas-s%C3%ADntomas-tratamiento.jpg\n#\nSe define priapismo como Erección peneana con una duración igual o superior a cuatro horas en privación de estímulo sexual o después de que este ha culminado.\n#\nSe clasifican: \n•\tPrimario o segundario \n•\tDe alto flujo (no isquémico)\n•\tDe bajo flujo (isquémico) el cual se asocia a mayor disfunción eréctil.\n#\nEtiología \nPriapismo de alto flujo: anemia falciforme, fistula traumática e idiopática.\nPriapismo de bajo flujo: anemia falciforme, malignidad hematológica, carcinoma renal o de vejiga, idiopáticas, carcinoma de próstata, lesión medular, carcinoma de cuerpos cavernosos, medicamentos (drogas ilegales).\n#\nPRIAPISMO DE ALTO FLUJO\n#\nHace referencia cuando en flujo arterial es continuo y excesivo hacia los espacios lacunares de los cuerpos cavernosos, casi siempre ocurre por una fistula arterial-lacunar por laceración violenta de la arteria cavernosa debido a un mecanismo traumático. No hay estasis venosa, hipercapnia o acidosis, debido a que la entrega de oxihemoglobina a los tejidos no se encuentra impedida. No es dolorosa. Se trata de una ERECCIÓN PARCIAL, NO DOLOROSA.\n#\nPRIAPISMO DE BAJO FLUJO.\n# \nEs más común, tiene un gran potencial para provocar fibrosis y disfunción eréctil permanente (57 % después de 48 horas) existen, relajación anormal del musculo liso cavernoso lo que conlleva a la venooclusion, a diferencia del priapismo de alto flujo, la no llegada de la oxihemoglobina provoca acidosis, hipercapnia e isquemia sostenida. Se trata de una ERECCION AGUDA, RIGIDA Y EXTREMADAMENTE DOLOROSA. \n#\nDiagnostico: \nAnamnesis y evaluación clínica; paraclínicos y hemodinámica de la sangre peneana; presión de oxigeno (PO2) <30mmhg, presión parcial de dióxido de carbono (PCO2) >60mmhg, pH ≤ 7.25 (priapismo de bajo flujo).\n#\nTratamiento \n#\nPriapismo de Alto Flujo: manejo expectante \nManejo quirúrgico de Priapismo de alto flujo: arteriografía \n#\nManejo medico en priapismo de bajo flujo:\n * Reconocer algún tipo de etiología subyacente.\n * Aspiración de los cuerpos cavernosos con jeringa hepanizada con infusión salina normal para liberar coagulo. \n * Instalación intracavernosa de un agente vasoconstrictor (epinefrina 2ml).\n\nManejo quirúrgico de priapismo de bajo flujo: conectar cuerpos cavernosos con el glande. \n  \n </div>\n\n\nReferencia\n\n\nhttp://scielo.isciii.es/pdf/urol/v63n8/03.pdf\n#\n#\nhttp://www.medigraphic.com/pdfs/revmedcoscen/rmc-2013/rmc133s.pdf\n\n#",
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      "title": "YELLOW FEVER",
      "body": "# YELLOW FEVER\n\n<center>\n\n[Source](http://clinicadelviajero.com.mx/wp-content/uploads/2015/04/Fiebre-Amarilla-CAPV-540x280.jpg)\n http://clinicadelviajero.com.mx/wp-content/uploads/2015/04/Fiebre-Amarilla-CAPV-540x280.jpg\n\n#\n\n<div class=\"text-justify\">\n\nIt is an acute viral disease transmitted by the bite of a mosquito, which must be previously infected. It is a virus belonging to the family Flaviviridae, genus Flavivirus.\n\n#\n\nIt occurs in tropical and subtropical areas of South America and Africa, it has NOT been described in Asia.\n\n#\n\n </div>\n\n[Source](https://2.bp.blogspot.com/-377xZqHQ6vs/WIDM2fCd90I/AAAAAAAAXOo/QBy8LYv420MYC5gxeyvy69uJEdKO_dC9QCLcB/s640/tw-fiebre-amarilla-mapa.jpg) \nhttps://2.bp.blogspot.com/-377xZqHQ6vs/WIDM2fCd90I/AAAAAAAAXOo/QBy8LYv420MYC5gxeyvy69uJEdKO_dC9QCLcB/s640/tw-fiebre-amarilla-mapa.jpg\n\n# \n\n<div class=\"text-justify\">\n\nThe virus will be transmitted from one host to another by the bite of a hematophagous arthropod. These vectors, when feeding on a viremic host, ingest the infecting virus and after a period of incubation in the insect, this is endowed with the capacity to transmit the disease to other animals or susceptible persons. Yellow fever is a zoonosis of the apes.\n\n#\n\nThere are 2 transmission cycles: jungle and urban.\n\n•\t• Jungle cycle: the virus circulates among primates, NOT in humans. The main vectors in America are mosquitoes of the genus Haemagogus (in Venezuela the most important vectors are: H. splendens, H. equinus, H. capricornae and H. leucocelaneus) and Sabethes, while in Africa they belong to the genus Aedes. In both continents, the reservoir is the monkey.\n\n\n#\n\n•\t• Urban cycle: circulation of the virus in susceptible humans. It is transmitted by the bite of the Aedes aegypti mosquito. This cycle begins when a person who has acquired the infection in the forest moves during the phase in which the virus circulates in their blood (viremia) to urban centers with high density of Aedes aegypti, where it is stung by said vector, which In turn, it will transmit the virus to another susceptible person, thus establishing the start of transmission in the urban environment.\n\n\n </div>\n\n#\n\n[Source](https://1.bp.blogspot.com/-1Juk9U7MuTk/WJWDmQJISfI/AAAAAAAAAuU/K9mXBCRfh18TC47lGTt64RWkK_oW0BvawCLcB/s1600/Mapa.jpg) https://1.bp.blogspot.com/-1Juk9U7MuTk/WJWDmQJISfI/AAAAAAAAAuU/K9mXBCRfh18TC47lGTt64RWkK_oW0BvawCLcB/s1600/Mapa.jpg\n\n#\n\n<div class=\"text-justify\">\n\n\nPeriod of transmission: Few days before the onset of fever and during the initial 3-5 days of the disease.\n\nIn Venezuela there are 3 natural foci of yellow fever:\n\n1. The focus of Guayana: Located in the Bolívar state, among the populations included in this focus are Upata, El Palmar, Guasipati, El Callao, Tumeremo and El Dorado. Another focus of importance in this area is the Carona River.\n\n\n#\n\n2. Focus of Lake Maracaibo: constituted by the jungle areas surrounding Lake Maracaibo and extending north and south to the foothills of the Andean mountain range of Trujillo, Mérida and Táchira states and west to the foothills of the Sierra de Perijá.\n\n#\n\n3. The focus of San Camilo: It covers the Piedmont of Apure, Barinas, Mérida and Táchira states, in the basins of the Capara, Uribante, Nula and Sarare rivers.\n\n# \n\nPATHOGENESIS\n\n#\nAfter the inculcation period, a period of approximately 24 hours elapses during which the virus can not be detected, after this period of eclipse, the liver becomes the main target.\n\n#\n\nBetween 72 - 96 hours:\n\n#\n\n•\tNecrotic and acidophilic changes are observed in the Kupffer cells, followed by changes in the hepatocytes (apoptosis) and the bodies of Councilman are produced.\n•\tThe mediozonal region of the hepatic lobule is affected and the cells in the vena cava are respected.\n\n#\nBetween 96 - 120 hours: the changes reach their fullness.\n\n#\n\n•\tNumerous bodies of Councilman are found and the necrosis of the middle zone is accentuated.\n •\tIntranuclear inclusions (Torres bodies) can be visualized.\n•\tMarked adipose metamorphosis of the cytoplasm.\n\n#\n\nLiver damage is direct and inflammation is minimal.\n\n#\n\nIn the Yellow Fever, a hemorrhagic diathesis is characteristic, due to the decrease of the synthesis and/or increase in the consumption of the coagulation factors.\n\n#\n\nRenal involvement is due to hypoperfusion and acute tubular necrosis, which generates proteinuria and renal failure. While encephalopathy may be due to cerebral edema, metabolic alterations, hypoperfusion or direct involvement by the virus.\n\n\n#\n\nCLINICAL MANIFESTATIONS\n\n#\n\nIt can occur as a nonspecific febrile condition (abortive form) or with all the classic symptoms in the most severe cases. 1/20 presents a clinical picture with jaundice. \n\n#\n\nIn forms with defined clinical manifestations, the incubation period lasts 3 - 7 days. The disease begins with the so-called \"period of infection\", followed by a \"period of remission\" and in 12-25% of cases after remission, the \"period of intoxication\" appears\n#\n\n1.\tPeriod of infection (viraemic phase):\n• Elevated fever - sudden onset\n• Chill\n• A headache\n• Myalgia\n• Low back pain\n• Nausea\n• Conjunctival injection\n• Severe decay.\n• Faget sign (slow pulse in relation to temperature)\n\n#\n\n2.\tRemission period:\n\n#\n\n•\tFever and most symptoms disappear.\n•\tIn the abortive form of the disease, it is normal for it to get here and it follows a rapid recovery.\n\n\n#\n\n3.\tPeriod of intoxication (the virus is NOT present and antibodies appear):\n#\nIn 12-25% of cases, after a remission of one or 2 days, this second clinical phase may appear. This is characterized by:\n• Fever\n• Abdominal pain\n• Black or brown vomit, is classic.\n• Jaundice (50% of the cases that present it are fatal)\n• Hemorrhages (mainly in the skin, mucosa and digestive tract)\n• Other important findings: oliguria, hypotension, and alt. of consciousness (delirium, stupor or coma)\nIn the terminal phase the patient can present:\n• Shock\n• Cheyne-Stokes breathing and hypothermia.\n• Hypothermia\nWeakness in convalescence can last for weeks.\n#\n\nComplications:\n• Pneumonia\n• Sepsis\n• Late deaths, even weeks after having recovered from the acute disease and this is due to the development of myocardial damage, arrhythmias, renal failure.\n• Suppurative mumps.\n\n </div>\n\n\n[Source](https://thumb9.shutterstock.com/display_pic_with_logo/3565355/412075486/stock-vector-yellow-fever-symptoms-three-stages-412075486.jpg) \nhttps://thumb9.shutterstock.com/display_pic_with_logo/3565355/412075486/stock-vector-yellow-fever-symptoms-three-stages-412075486.jpg\n\n#\nDIAGNOSIS\n\nLaboratory findings: prognostic value\n• Leukopenia (absolute neutropenia and lymphopenia)\n• Thrombocytopenia\n• Proteinuria\n• Increase in urea, creatinine, and direct bilirubin.\n• The increase of ALT - AST (> 1000) - It correlates directly with the severity. They rise during the 2nd and 3rd day, reach their maximum 2-5 days later and in patients who survive rapidly decline between 10 - 14 days.\n• Prolongation of TP - TPT\n• Decrease in factors II, V, VII, IX, and X\n• ECG shows sinus bradycardia.\n\nSerology:\nELISA test\n• Detection of specific IgM or increase in total antibodies -IgM, hemagglutination inhibitory (HI), complement fixation (CF) or neutralizing (N) - antibodies in 2 samples (acute phase and convalescence).\nor IgM, Hemagglutination inhibitors, and Neutralizers appear between 5 - 7 days\no FC between 7 - 14 days\n\nViral isolation: (First 5 days of fever)\nBy inoculation of mosquito cells and detection of viral antigen in infected cells by immunofluorescence.\n\nTREATMENT\nNo existen antivirales efectivos para esta enfermedad.\n\nSymptomatic\n• Paracetamol (a headache and fever)\n• Cimetidine or Ranitidine + antacids (↓ risk of gastrointestinal bleeding)\n\nSupportive therapy\nIn the period of intoxication to help the patient survive, although not always effective.\n\n#\n\n# References:\n\n#\n\n* http://www.msal.gob.ar/images/stories/bes/graficos/0000000064cnt-01-guia-fiebre-amarilla.pdf\n\n#\n\n*  http://tesis.luz.edu.ve/tde_arquivos/161/TDE-2012-03-02T10:47:47Z-2553/Publico/garcia_marcano_virlena_del_pilar.pdf\n\n#",
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