Pulmonary tuberculosis: a common diagnosis at INER

A 24 year old woman who presented at INER (Instituto Nacional de Enfermedades Respiratorias) at Mexico City complaining of shortness of breath, weight loss, and chronic cough. This image shows a classic radiographic appearance of pulmonary tuberculosis. An heterogeneous image with alveolar filling pattern and homogeneous opacity are observed at the right apex. Elevation of right hemidiaphragm due to atelectasia is also shown.

Gerardo Morales-Mora

technorati tags: Tb, Pulmonary tuberculosis, tuberculosis, INER, clinical cases, medical images, unbounded medicine

Horrible: Child abuse

Another case of Child abuse was shown today on TV news.

It seems that we can’t stop this and some parents preffer to remain in silence rather than to speak out loud about this impunity.

I think it is time to recognize this cases and report them to the authorities. So today’s matter is to know the facts about child abuse & neglect.

Also know as child maltreatment it is a group of comission, omission and lack of actions, that result in morbidiy and/or mortality.

It is every agression or omission of intentional nature, indoor or outdoor, against child(s), before or after the birth that affects their bio-psycho-social integrity. This actions can be from an individual, a group of people (society), an institution taking advantage of their physical and/or intelectual superiority.

There is a triad of child abuse:

  1. Child: Often a non-accepted (desired) kid, malformation, chronic or acute diseases.
  2. Agressor: Often a parent or caretaker, alcoholic or drug abuse problem, background of abuse.
  3. Triggers: Unemployment, marital disfunction, social and economic problems.

It’s importance: 2,900,000 cases / year on U.S.A of wich 33% is physical abuse. Second leading cause of death in child less than 5 years old.

Burn by iron Circular burn


You should always suspect child abuse when:

Clinical aspects on child: Non-correlated history given by parents, small height, poor hygiene, previous lesions, malnutrition, non-desired/non-accepted child, incomplete vaccination schedule.

Clinical aspects on child’s family: Delayed medical attention, abuse background, step-mother/father, alcoholism, ask for medical attencion by someone else outside the central group of family.

It is required a multidisciplinary team: Primary care Physician, Pediatrician, Social work, Mental Health, Lawyer, Voluntaries.

The action of preventive mesures should include all levels of society: International organizations, Federal instances, Local community (church, school, friends, pediatrician, etc), Child’s family and Child.

Who where ever you are do: Let’s stop this.


Jon Mikel Iñarritu, M.D.

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You should never take this chest x-ray

To take this chest x-ray is a common error for those without experience.

Tension-type pneumothorax

The diagnosis of Tension-type pneumothorax is a clinical one. That is because it’s a real emergency (inmediately life-threatening), that should be identified on primary survey.

Basis of Diagnosis:

  • Hyperresonance of affected hemithorax
  • Decreased or absence of breath sounds
  • Tracheal deviation to the other side of pneumothorax is
  • Respiratory distress
  • Hypotension
  • Tachypnea
  • Hypoxia
  • Distended neck veins (this could be absent if your patient is hypovolemic.

Mechanism: The air enters to the pleural space (a virtual one) and cannot escape, then the intrapleural pressure increases and the lung becomes collapsed with secondary shift of the mediastinal contents to the opposite side.

Treatment: Needle decompression (thoracostomy) with large-bore needle in the second intercostal space in the midclavicular line to convert the tension pneumothorax into a simple pneumothorax. This simple procedure can save your patient’s life.

Be aware, explore your patient, establish a diagnosis and give a prompt and proper treatment.


Jon Mikel Iñarritu, M.D.

technorati tags: tension-type pneumothorax, tension pneumothorax, CXR, chest x-ray, x-ray, xray, pneumothorax, thoracostomy, unbounded medicine