Case Report: Total Nephrectomy for Renal Hydatidosis.

Cystic echinococcosis, known as hydatidosis, is a parasitic zoonosis caused by the larvae of Echinococcus granulosus. Renal hydatidosis is a very rare condition, representing 1% to 2% of cases. We present an 18-year-old patient who, after suffering a trauma, experienced severe lower back pain and persistent gross hematuria disproportionate to the trauma. Ultrasonography and tomography revealed cystic images compatible with right renal hydatidosis and hemoperitoneum. In addition, rapid clinical deterioration was observed with decreased hematocrit, leading to lumpectomy with abundant cysts inside and outside the right kidney, without viable parenchyma. Therefore, a total nephrectomy was performed. The patient was discharged with albendazole treatment. Pathological anatomic analysis confirmed the diagnosis of hydatidosis. Surgery remains the best therapeutic option. The use of ultrasonography improves the early detection of zoonosis, especially in pediatric patients, and favors the use of more conservative therapeutic techniques.

Cough dynamics in adults receiving tuberculosis treatment.

Cough is a characteristic symptom of tuberculosis, is the main cause of transmission, and is used to assess treatment response. We aimed to identify the best measure of cough severity and characterize changes during initial tuberculosis therapy. We conducted a prospective cohort of recently diagnosed ambulatory adult patients with pulmonary tuberculosis in two tertiary hospitals in Lima, Peru. Pre-treatment and five times during the first two months of treatment, a vibrometer was used to capture 4-hour recordings of involuntary cough. A total of 358 recordings from 69 participants were analyzed using a computer algorithm. Total time spent coughing (seconds per hour) was a better predictor of microbiologic indicators of disease severity and treatment response than the frequency of cough episodes or cough power. Patients with prior tuberculosis tended to cough more than patients without prior tuberculosis, and patients with tuberculosis and diabetes coughed more than patients without diabetes co-morbidity. Cough characteristics were similar regardless of HIV co-infection and for drug-susceptible versus drug-resistant tuberculosis. Tuberculosis treatment response may be meaningfully assessed by objectively monitoring the time spent coughing. This measure demonstrated that cough was increased in patients with TB recurrence or co-morbid diabetes, but not because of drug resistance or HIV co-infection.

A Propósito De Un Caso De Demencia Frontotemporal - Variante conductual, Con Síntomas Amnésicos E Imágenes Cerebrales Tipo Alzheimer / About a case of Frontotemporal Dementia - behavioral variant, with amnesic symptoms and Alzheimer type cerebral images: report of a case

Resumen La Demencia frontotemporal - variable conductual (DFT-vc), es una importante causa de discapacidad en adultos menores de 65 años. Se postula como una enfermedad neurológica con manifestaciones predominantemente psiquiátricas y, por tanto, constituye un frecuente diagnóstico diferencial ante patologías psiquiátricas de inicio no temprano. Aunque tradicionalmente se consideraba entre sus criterios diagnósticos a la ausencia de deterioro de la memoria -como en la Enfermedad de Alzheimer (EA)-, diversos estudios registran hasta un 15% de prevalencia de casos con franco deterioro mnésico, igualmente las neuroimágenes de uno y otro cuadro demencial pueden tener un traslape. Actualmente la presencia de "síndromes de fenocopia" -cuadros clínicos semejantes a DFT-vc pero sin deterioro cognitivo- y casos de EA con síntomas de desinhibición y conductuales, tornan más complejo el diagnóstico clínico y sugieren la insuficiencia de los criterios establecidos para el diagnóstico y la necesaria adopción de criterios paraclínicos. Con ese fin presentamos un caso ilustrativo de DFT-vc con deterioro de la memoria, y revisamos la bibliografía pertinente.

Frontotemporal dementia - behavioral variant (FTD-bv), is an important cause of disability in adults under 65 years of age. It is postulated as a neurological disease with predominantly psychiatric manifestations and, therefore, constitutes a frequent differential diagnosis in psychiatric pathologies of not early onset. Although traditionally the absence of memory impairment was considered among its diagnostic criteria - as opposed to Alzheimer'a disease (AD) -, several studies have found until 15% of prevalence of cases with frank mnemonic deterioration, as well as neuroimaging of one and the other can have overlap. Currently, the presence of "phenocopy syndromes" - clinical pictures similar to FTD-bv but without cognitive impairment- and cases of AD with disinhibition and behavioral symptoms, make the clinical diagnosis more complex and suggest the insufficiency of the established diagnostic criteria and the necessary adoption of paraclinical criteria. To this purpose, we present an illustrative case of FTD-bv with memory impairment and Alzheimer-like neuroimages, and we review the pertinent bibliography.

Validation of the RUDAS in Patients With a Middle-Level Education in Lima, Peru.

OBJECTIVES: To assess the psychometric properties of the Peruvian version of the Rowland Universal Dementia Assessment Scale (RUDAS-PE) to discriminate controls from patients with mild cognitive impairment (MCI) and early dementia (ED) in a population with a mid-level education. METHODS: A total of 133 patients from a memory clinic were administered the RUDAS-PE, INECO Frontal Screening, Addenbrooke's Cognitive Examination, and Mini-Mental State Examination. Results were compared against a neuropsychological evaluation (gold standard). Validity measures, internal consistency, and concurrent validity were calculated. RESULTS: Cronbach's α was 0.68; Pearson's ratio was 0.79 (P < .01). The area under the receiver-operating characteristics curve of the RUDAS to discriminate between ED and MCI was 89.0% (optimal cutoff at <21), whereas between MCI and controls, it was 99.0% (optimal cutoff at <24). CONCLUSIONS: The RUDAS-PE has acceptable psychometric properties performing well in its ability to discriminate controls from patients with MCI and ED.

Knowledge, attitudes and practices related to tuberculosis in pharmacy workers in a cross-sectional survey in El Agustino, Peru.

INTRODUCTION: Although the worldwide incidence of tuberculosis (TB) is slowly decreasing, annual infection rates in Peru remain among the highest in the Americas. Pharmacies could play an important role in facilitating early detection of TB. However, the awareness, expertise and cooperation of pharmacy workers is fundamental. This study explored the TB-related knowledge, attitudes and practices of pharmacy workers in a district with one of the highest incidences of TB in Peru. METHODS: This cross-sectional study applied a questionnaire that was administered face to face using smartphones with one pharmacy worker at each of 45 randomly selected pharmacies in the El Agustino district of Lima, Peru. RESULTS: Participants were primarily female (78%) and had an average age of 31.3 years old (range 18-57 years old). Only 11% of participants were pharmacists with complete university training. The pharmacy workers' knowledge was adequate; however, workers had important knowledge gaps and myths regarding prevention of TB transmission. Most pharmacy workers (77%) reported they would send a client with a history of cough for more than two weeks to a healthcare center, while 23% reported they would offer them antitussive medication or antibiotics. Almost all workers reported talking with clients about diseases and reported respiratory symptoms as one of the most common causes for consultation (60%). Most participants expressed interest in learning more about TB and expanding their involvement in the fight against TB in their community. CONCLUSION: Pharmacy workers have adequate knowledge about TB. However, we identified gaps in knowledge with respect to prevention of TB transmission. Pharmacy workers commonly see patients with respiratory symptoms and some offer recommendations, including for treatment. Pharmacy workers are willing to learn more and contribute to TB control and could be a valuable asset in the control and prevention of TB in Peru. To achieve this integration of pharmacy workers into TB control and prevention, more research is needed.

Evaluación de la apatía en la enfermedad de Parkinson y escalas disponibles para su medición en la investigación neuropsiquiátrica y la práctica clínica / Evaluation of apathy in Parkinson's disease and available scales for its measurement in neuropsychiatric research and clinical practice

La evaluación de la apatía en patología neuro-psiquiátrica es muy importante en la investigación y en la práctica clínica. Muchas veces sus síntomas son sub-diagnosticados o diagnosticados como depresión y otras condiciones. La presente revisión aborda las escalas más utilizadas las últimas décadas para la valoración de apatía y ofrece recomendaciones y apreciaciones generales sobre su uso y utilidad basada en la bibliografía disponible. Al margen de las diferencias entre escalas la tarea de estandarizar el diagnóstico de apatía en la práctica clínica y la investigación nacionales una necesidad que no debe postergarse al contar con herramientas suficientes y adecuadas a la fecha que han evolucionado desde la definición de Marin hasta la escala Dimensional Apathy Scale (DAS). Se sugiere estudios que validen y adapten culturalmente estas herramientas a nuestro entorno poblacional y pongan en práctica la medición cuantitativa de la apatía en la consulta clínica

The evaluation of apathy in neuropsychiatric pathology is very important in research and in clinical practice. Many times their symptoms are underdiagnosed as part of depression and other conditions. The present review addresses the scales most used in recent decades for the assessment of apathy and offers recommendations and general assessments of their use and utility based on the available literature. Apart from the differences between scales, the task of standardizing the diagnosis of apathy in clinical practice and national research is a need that should not be postponed by having sufficient and appropriate tools to date that have evolved from the definition of Marin to the Dimensional Apathy Scale (DAS). It is suggested that studies validate and culturally adapt these tools to our population environment and put into practice the quantitative measurement of apathy in the clinical environment.

[Cystoisospora belli infection in HIV patients: Analysis of cases with different clinical evolution]. / Infección por Cystoisospora belli en pacientes con VIH: análisis de casos con diferente evolución clínica.

INTRODUCTION: Cystoisospora belli infection is one of the most important causes of watery diarrhea in patients with HIV and causes high rates of morbidity and mortality. METHODS: A retrospective study was conducted in patients with HIV and diarrhea by C. belli. Clinical and laboratory characteristics were collected by analyzing clinical records. RESULTS: Four had recurrent diarrhea despite receiving secondary prophylaxis with cotrimoxazole and specific treatment, two of which had a good viral and immunological response to highly active antiretroviral therapy (HAART) at the time of diagnosis and antiparasitic treatment. While the remaining three did not receive prophylaxis, neither did HAART (two of them), but they responded well to treatment. CONCLUSIONS: C. belli is an important cause of diarrhea in HIV patients on HAART and prophylaxis, being able to have different clinical evolution. We suggest that persistent infection may be due to drug failure by intrinsic or extrinsic to the parasite causes, or to defects in restoration of the intestinal immune system, or both.

Infección por Cystoisospora belli en pacientes con VIH: análisis de casos con diferente evolución clínica / Cystoisospora belli infection in HIV patients: analysis of cases with different clinical evolution

Resumen Introducción: La infección por Cystoisospora belli es una de las causas más frecuentes de diarrea acuosa en pacientes con infección por VIH y ocasiona altas tasas de morbilidad y mortalidad. Métodos: Se realizó un estudio retrospectivo en pacientes infectados con VIH y diarrea por C. belli. Características clínicas y de laboratorio fueron recolectadas mediante el análisis de historias clínicas. Resultados: Se identificaron siete casos. Cuatro presentaron diarrea recurrente a pesar de recibir profilaxis secundaria con cotrimoxazol y tratamiento específico, dos de los cuales tuvieron buena respuesta viral e inmunológica al tratamiento anti-retroviral de gran actividad (TARGA) al momento del diagnóstico y tratamiento antiparasitario. Mientras que, los tres restantes no recibían profilaxis, tampoco TARGA (dos de ellos), pero respondieron bien al tratamiento. Conclusiones: C. belli es causa importante de diarrea en pacientes VIH con TARGA y profilaxis, pudiendo tener distinta evolución clínica. Sugerimos que la infección persistente puede ser debido al fallo farmacológico por causas intrínsecas o extrínsecas al parásito, o a defectos en la restauración del sistema inmune intestinal, o ambos.

Introduction: Cystoisospora belli infection is one of the most important causes of watery diarrhea in patients with HIV and causes high rates of morbidity and mortality. Methods: A retrospective study was conducted in patients with HIV and diarrhea by C. belli. Clinical and laboratory characteristics were collected by analyzing clinical records. Results: Four had recurrent diarrhea despite receiving secondary prophylaxis with cotrimoxazole and specific treatment, two of which had a good viral and immunological response to highly active antiretroviral therapy (HAART) at the time of diagnosis and antiparasitic treatment. While the remaining three did not receive prophylaxis, neither did HAART (two of them), but they responded well to treatment. Conclusions: C. belli is an important cause of diarrhea in HIV patients on HAART and prophylaxis, being able to have different clinical evolution. We suggest that persistent infection may be due to drug failure by intrinsic or extrinsic to the parasite causes, or to defects in restoration of the intestinal immune system, or both.

[Atrioventricular canal defect, single atrium and tricuspid atresia as part of a case of Ellis-Van Creveld syndrome]. / Defecto del canal auriculoventricular, aurícula única y atresia tricuspídea como parte de un caso de síndrome de Ellis-Van Creveld.

Ellis-Van Creveld Syndrome or chondrectodermal dysplasia is produced by an autosomal recessive inheritance secondary to mutation in the short arm of chromosome 4. The syndrome affects multiple organs. It is described as a clinical tetrad that involves chondrodysplasia, ectodermal dysplasia, polydactyly and congenital heart defects. It is only known from reports and case series. We present a three months old male, without relevant family history, who presented chondrodysplasia, upper lip merged to palate, bilateral sinpolydactyly in the hands, developmental dysplasia of the hip, narrow chest with short ribs, and heart defects. This case is the first report of EVC in Peruvian literature.

Defecto del canal auriculoventricular, aurícula única y atresia tricuspídea como parte de un caso de síndrome de Ellis-Van Creveld / Atrioventricular canal defect, single atrium and tricuspid atresia as part of a case of Ellis-Van Creveld syndrome

El síndrome de Ellis-Van Creveld (SEVC) o displasia condroectodérmica se debe a una mutación de transmisión autosómica recesiva en el brazo corto del cromosoma 4 y afecta múltiples órganos. Descrito como una tétrada clásica de condrodisplasia, displasia ectodérmica, polidactilia y defectos cardíacos congénitos, sólo se conoce a partir de informes y series de casos. Se describe el caso de un varón de 3 meses, sin antecedentes familiares de importancia, que presentó un cuadro de condrodisplasia, labio superior fusionado al paladar, simpolidactilia posaxial bilateral en las manos, displasia del desarrollo de las caderas, tórax estrecho con costillas cortas y compromiso cardíaco. El presente caso sería la primera comunicación del SEVC en el Perú.

Ellis-Van Creveld Syndrome or chondrectodermal dysplasia is produced by an autosomal recessive inheritance secondary to mutation in the short arm of chromosome 4. The syndrome affects multiple organs. It is described as a clinical tetrad that involves chondrodysplasia, ectodermal dysplasia, polydactyly and congenital heart defects. It is only known from reports and case series. We present a three months old male, without relevant family history, who presented chondrodysplasia, upper lip merged to palate, bilateral sinpolydactyly in the hands, developmental dysplasia of the hip, narrow chest with short ribs, and heart defects. This case is the first report of EVC in Peruvian literature.

[Use of medicinal plants among people attending two reference hospitals in Cuzco, Peru]. / Empleo de plantas medicinales en usuarios de dos hospitales referenciales del Cusco, Perú.

In order to determine the frequency and characteristics of the use of medicinal plants in patients from two third-level hospitals in the city of Cusco, a cross-sectional study was conducted between August and September 2011. For data collection, an instrument was built and validated through experts' judgment. The sample included 250 people selected in a non-probabilistic way. 83.2 and 75.3% informed having had used medicinal plants sometime during their lives and in the last month, respectively; additionally, 85.7 indicated that they wished their doctor would have prescribed them medicinal plants. Their most frequent uses include digestive problems (62.4%) as well as urinary (42.4%) and respiratory problems (40.4%). We conclude that the use of medicinal plants is widely spread among users of two hospitals in the city of Cusco. Utilization patterns show that patients wished the physicians of the health system prescribed medicinal plants in their consults.

Empleo de plantas medicinales en usuarios de dos hospitales referenciales del Cusco, Perú / Use of medicinal plants among people attending two reference hospitals in Cusco, Peru

Con el fin de determinar la frecuencia de empleo de plantas medicinales y describir las características de su uso en pacientes de dos hospitales referenciales de la ciudad de Cusco, se realizó un estudio transversal entre agosto y septiembre de 2011. Para el recojo de datos se construyó un instrumento, validado por juicio de expertos. El tamaño de la muestra fue de 250 personas seleccionadas no probabilísticamente. El 83,2 y 75,3% informaron haber empleado plantas medicinales alguna vez en su vida y en el último mes, respectivamente; además, el 85,7 señaló que desearía que su médico le recete plantas medicinales. Sus usos más frecuentes son para problemas digestivos (62,4%); urinarios (42,4%), y respiratorios (40,4%). Se concluye que el empleo de plantas medicinales se encuentra bastante difundido entre los usuarios de dos hospitales referenciales de la ciudad de Cusco. Los patrones de empleo revelan que los pacientes desean que los médicos del sistema de salud prescriban plantas medicinales en su acto médico.

In order to determine the frequency and characteristics of the use of medicinal plants in patients from two third-level hospitals in the city of Cusco, a cross-sectional study was conducted between August and September 2011. For data collection, an instrument was built and validated through experts’ judgment. The sample included 250 people selected in a non-probabilistic way. 83.2 and 75.3% informed having had used medicinal plants sometime during their lives and in the last month, respectively; additionally, 85.7 indicated that they wished their doctor would have prescribed them medicinal plants. Their most frequent uses include digestive problems (62.4%) as well as urinary (42.4%) and respiratory problems (40.4%). We conclude that the use of medicinal plants is widely spread among users of two hospitals in the city of Cusco. Utilization patterns show that patients wished the physicians of the health system prescribed medicinal plants in their consults.

[Oral blastomycosis, laryngeal papillomatosis and esophageal tuberculosis]. / Blastomicosis oral, papilomatosis laríngea y tuberculosis esofágica.

Esophageal involvement is an extremely rare complication of tuberculosis even in countries with high prevalence of infection. We report the case of a 57 year-old hiv-seronegative patient with simultaneous diagnoses of oral blastomycosis and laryngeal papillomatosis. Both were confirmed by anatomopathological analysis. The esophageal biopsy revealed granulomatous esophagitis with necrosis and ziehl-neelsen stain showed acid-fast alcohol resistant bacilli suggestive of tuberculosis. The patient's history included pulmonary tuberculosis twice and previous abandonment of therapy. Thus, it was necessary to use oral itraconazole combined with second-line anti-tuberculosis drugs administered through a gastrostomy tube. The clinical development was favorable.

Blastomicosis oral, papilomatosis laríngea y tuberculosis esofágica / Oral blastomycosis, laryngeal papillomatosis and esophageal tuberculosis

El compromiso esofágico es una complicación infrecuente de la tuberculosis incluso en países con alta prevalencia de infección. Se presenta el caso de un paciente de 57 años no seropositivo al virus de inmunodeficiencia humana (VIH), con diagnóstico simultáneo de blastomicosis en cavidad oral y papilomatosis laríngea, ambas confirmadas por anatomía patológica. La biopsia de esófago reveló esofagitis granulomatosa con necrosis; la tinción de Ziehl-Neelsen mostró bacilos ácido-alcohol resistente, sugerentes de tuberculosis. El antecedente de tuberculosis pulmonar en dos oportunidades y abandono de tratamiento determinó el inicio de tratamiento antituberculoso de segunda línea a través de un tubo de gastrostomía, más itraconazol vía oral. La evolución fue favorable.

Esophageal involvement is an extremely rare complication of tuberculosis even in countries with high prevalence of infection. We report the case of a 57 year-old hiv-seronegative patient with simultaneous diagnoses of oral blastomycosis and laryngeal papillomatosis. Both were confirmed by anatomopathological analysis. The esophageal biopsy revealed granulomatous esophagitis with necrosis and ziehl-neelsen stain showed acid-fast alcohol resistant bacilli suggestive of tuberculosis. The patient’s history included pulmonary tuberculosis twice and previous abandonment of therapy. Thus, it was necessary to use oral itraconazole combined with second-line anti-tuberculosis drugs administered through a gastrostomy tube. The clinical development was favorable.

[Chromomycosis: report of a disabling case]. / Cromomicosis: reporte de un caso incapacitante.

Chromomycosis is a deep subcutaneous mycosis caused by different dymorphic fungi species that normally live in vegetal debris. We report the case of a 51 year-old patient that six years previous to the evaluation worked making roof tiles in Madre de Dios, Peru; where he presented an initial papular lesion in a leg, which continued expanding until the 4 limbs were affected with disabling verrucous lesions. Fumagoid cells were found in the skin biopsy. The patient was hospitalized and received topical cleaning, antibiotics and terbinafine. He was discharged two months later with clinical improvement.

Cromomicosis: reporte de un caso incapacitante / Chromomycosis: report of a disabling case

La cromomicosis es una micosis profunda subcutánea producida por hongos dimórficos que de forma habitual habitan en restos vegetales. Se presenta el caso de un paciente de 51 años que seis años antes del ingreso se dedicaba a la fabricación de tejas en Madre de Dios, Perú; donde sufrió una lesión inicial papular en una pierna la cual se extendió hasta comprometer los cuatro miembros, con lesiones verrucosas que lo llevaron a la discapacidad. Se observaron cuerpos fumagoides en la biopsia de piel. El paciente fue hospitalizado y recibió curaciones tópicas, antibioticoterapia y terbinafina. Fue dado de alta al cabo de dos meses con mejoría clínica.

Chromomycosis is a deep subcutaneous mycosis caused by different dymorphic fungi species that normally live in vegetal debris. We report the case of a 51 year-old patient that six years previous to the evaluation worked making roof tiles in Madre de Dios, Peru; where he presented an initial papular lesion in a leg, which continued expanding until the 4 limbs were affected with disabling verrucous lesions. Fumagoid cells were found in the skin biopsy. The patient was hospitalized and received topical cleaning, antibiotics and terbinafine. He was discharged two months later with clinical improvement.