Diagnosis of Celiac Disease after Starting Antitubercular Medication: A Case Report

We present the case of a young patient from Argentina living in a rural area without any relevant medical history. He consulted the emergency department after blunt chest trauma, and during trauma studies, images compatible with pulmonary tuberculosis were found, a diagnosis made incidentally. After starting treatment, he exhibited gastrointestinal symptoms such as diarrhea, abdominal pain, and weight loss, which were initially considered an adverse effect of treatment with rifampin/isoniazid/pyrazinamide/ethambutol (RHZE). Upon completing the first phase of treatment and suspending the medication, the symptoms improved, and the bacilloscopies were negative. Subsequently, the severity of the symptoms drew attention. Additional paraclinical tests were performed with malabsorptive diarrhea results, considering the patient's origin and the fact that his diet included products that he grew himself without prior exposure to gluten. Celiac disease is suspected, and antibodies and biopsy results compatible with this entity were obtained. When reviewing the association of symptom onset with the RHZE/pyridoxine treatment, we found these medications may have wheat-based excipients, which explains the worsening of symptoms, not due to the gastrointestinal adverse effects of the antibiotic but its excipients. Finally, the case was analyzed, tuberculosis was ruled out, and treatment was suspended, refocusing the therapeutic effort on recovering the patient's nutritional status. Subsequently, no other hospital admissions were recorded, and he remained respiratorily asymptomatic, with weight gain and nutritional recovery.

Se presenta el caso de un paciente joven, proveniente de Argentina y residente de un área rural, sin ningún antecedente médico a resaltar. Consultó al servicio de urgencias después de un trauma cerrado de tórax y durante los estudios de trauma se encontraron imágenes compatibles con tuberculosis pulmonar, diagnóstico realizado de manera incidental. Luego del inicio de tratamiento presentó síntomas gastrointestinales dados por diarrea, dolor abdominal y pérdida de peso, lo que inicialmente se consideró un efecto adverso al tratamiento con rifampicina/isoniazida/pirazinamida/etambutol (RHZE). Al completar la primera fase del tratamiento y suspender la medicación mejoraron los síntomas, además de que las baciloscopias fueron negativas. Posteriormente, llamó la atención la gravedad de los síntomas, por lo que se realizaron paraclínicos adicionales con resultados a favor de diarrea malabsortiva; teniendo en cuenta la procedencia del paciente y el hecho de que basaba su dieta en productos que él mismo cultivaba, sin haber exposición previa al gluten. Se sospecha enfermedad celíaca, y se obtuvieron anticuerpos y resultados en la biopsia compatibles con esta entidad. Al revisar la asociación de inicio de síntomas con el uso de tratamiento de RHZE/piridoxina, se observa que estos medicamentos pueden tener excipientes a base de trigo, lo que explica el empeoramiento de los síntomas, no por efectos adversos gastrointestinales del antibiótico sino por sus excipientes. Finalmente, se analizó el caso, se descartó tuberculosis y se suspendió el tratamiento, redirigiendo el esfuerzo terapéutico hacia la recuperación del estado nutricional del paciente. Posteriormente, no se registran otros ingresos hospitalarios, continúa asintomático respiratorio, con ganancia de peso y recuperación nutricional.

Signo de Luftsichel / Luftsichel sign

Paciente de 73 años con antecedente de silicosis pulmonar, que consultó por cuadro clínico compatible con neumonía. Las imágenes mostraron opacidades nodulares pequeñas de predominio apical relacionadas con silicosis y consolidación basal derecha compatible con neumonía. También se evidenció en la radiografía de tórax PA una opacidad parahiliar izquierda relacionada con atelectasia del lóbulo superior izquierdo y una imagen radiolúcida adyacente al cayado aórtico, medial al lóbulo colapsado. Esta alteración corresponde al signo de Luftsichel. Luftsichel es una palabra derivada del alemán, compuesta por luft(aire) y sichel(hoz). Este signo ha sido descrito en atelectasia de lóbulos superiores, particularmente en atelectasia del lóbulo superior izquierdo. Corresponde al segmento apical del lóbulo inferior izquierdo sobreinsuflado e interpuesto entre el mediastino (cayado aórtico) y el lóbulo colapsado.Teniendo en cuenta la dificultad para definir la atelectasia del lóbulo superior izquierdo en la radiografía de tórax, la identificación del signo de Luftsichel puede ser de utilidad para el diagnóstico de esta alteración.

Diversity of protease-producing marine bacteria from sub-antarctic environments.

From seawater and the intestines of benthonic organisms collected from the Beagle Channel, Argentina, 230 marine bacteria were isolated. Cultivable bacteria were characterized and classified as psychrotolerant, whereas few isolates were psychrophiles. These isolates were capable of producing proteases at 4 and 15 °C under neutral (pH 7.0), alkaline (pH 10.0) and acidic (pH 4.5) conditions on different media, revealing 62, 33 and 22% producers at cold and 84, 47 and 33% producers at low temperatures, respectively. More protease-producing strains (67%) were detected when isolated from benthic invertebrates as compared to seawater (33%), with protease production under neutral conditions resulting in milk protein hydrolysis halos between 27 and 30 ± 2 mm in diameter. Using sterile 0.22 µm membrane filters, 29 isolates exhibiting extracellular protease activity were detected. These were grouped into six operational taxonomic units by restriction analysis and identified based on 16S rDNA as γ-proteobacteria of the genera Pseudoalteromonas, Pseudomonas, Shewanella, Alteromonas, Aeromonas, and Serratia. Plasmids were found to be harbored by eight strains, mainly within the isolates from benthonic organisms.

[Acute cystitis in women with type 2 diabetes. Three antimicrobial schemes]. / Cistitis aguda en mujeres con diabetes mellitus tipo 2. Comparación de tres esquemas antimicrobianos.

OBJECTIVE: To compare the effectiveness and secondary effects of trimethoprim-sulfamethoxazole (TMP-SMX), ciprofloxacin, and nitrofurantoin in women with type 2 diabetes mellitus (DM2) and acute community-acquired cystitis. METHODS: A randomized single blind clinical trial was conducted in the family medicine clinic No. 91 of Instituto Mexicano del Seguro Social in Coacalco, Mexico. The study included women with DM2 and acute cystitis who were randomly allocated to one of the following schemes: TMP-SMX (160/800 mg every 12 h), ciprofloxacin (500 mg every 12 h) or nitrofurantoin (100 mg every 6 h) for 10 days. RESULTS: Sixty-one patients fulfilled the inclusion criteria. Bacteriologic eradication at the end of the treatment was observed in 18/23 (78 %) of patients treated with ciprofloxacin; 14/18 (78%) of patients treated with nitrofurantoin; and 9/20 (45 %) of patients treated with TMP-SMX (p = .036). The difference between nitrofurantoin and TMP-SMX, as well as between ciprofloxacin with TMPSMX, was 33 % for both (95 % confidence interval = 4 %, 62 %, and 5 %, 61 % , respectively). The most frequently isolated bacterium was Escherichia coli (75 %), The in vitro resistance rate to TMP-SMX was 76 %, to ciprofloxacin 17 % and to nitrofurantoin 13 % (p = 0.05). The main adverse effects were slight to moderate headache, nausea, and pyrosis in the three groups. CONCLUSIONS: ciprofloxacin and nitrofurantoin were more effective than TMP-SMX for the treatment of community-acquired acute cystitis in Mexican women with DM2. This is probably due to differences in the resistance rates and is probably not specific for diabetic patients; All three antimicrobials were safe.

Utilidad de la medición del ángulo rectoanal. Metodología y valores normales en México / Use of rectoanal angle measurement. Methodology and normal values in Mexico

Se efectuaron mediciones radiológicas y manométricas de la función rectoanal en 17 pacientes y nueve sujetos normales. Las mujeres multíparas mostraron correlación lineal inversa entre los valores del ángulo rectoanal y la presión en reposo del canal anal (r=0.8, p=0.01) y el grado de descenso perineal fue mayor en los pacientes de con el síndrome de úlcera rectal solitaria comparado con los controles (-1.5 vs -0.01+-0.3 cm, p=0.03). En conclusión, estos hallazgos evidencían la importancia del ángulo rectoanal el cual como factor determinante de la continencia anal debe ser incluido en la evaluación de los pacientes con alteraciones del piso pélvico (AU)._