RESUMEN
Paracoccidioidomycosis (PCM) is an endemic systemic infection in several countries of Latin America. The few registered cases in Mexico most likely do not reflect the real frequency. Disseminate the epidemiological and clinical data of unreported cases of PCM in Mexico from 1972 until 2012 is the aim of this work. Epidemiological and clinical information of non-published cases of PCM was requested from the principal mycological diagnosis centres in Mexico. A total of 93 cases were received. The infection was found predominantly in men (95.7%), peasants (88.5%) and individual between 31 and 60 years of age. Most of the cases were found in tropical areas of the Gulf of Mexico (54.84%) and the Pacific littoral (20.3%). The main sites of dissemination were the oral mucosa (39.38%) and skin (34.05%). The most effective treatments were itraconazole alone and the combination of itraconazole with sulfamethoxazole-trimethoprim. PCM is a subdiagnosed pathology in Mexico. Therefore, adequate training is necessary to determine the current status of this mycosis.
Asunto(s)
Paracoccidioidomicosis/epidemiología , Paracoccidioidomicosis/patología , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Antifúngicos/uso terapéutico , Niño , Femenino , Humanos , Itraconazol/uso terapéutico , Masculino , México/epidemiología , Persona de Mediana Edad , Mucosa Bucal/microbiología , Exposición Profesional , Paracoccidioidomicosis/tratamiento farmacológico , Factores Sexuales , Piel/microbiología , Topografía Médica , Combinación Trimetoprim y Sulfametoxazol/uso terapéutico , Adulto JovenRESUMEN
UNLABELLED: Mycetoma is one of the most frequent chronic subcutaneous infections in many tropical and subtropical regions. OBJECTIVE: To update the epidemiological data of mycetoma cases in Mexico. METHOD: A survey in the main mycological diagnosis centers in this country was performed. Each mycologist was requested for number of diagnosed mycetoma cases, age, sex, occupation, geographic origin, type of mycetoma, and etiological agents. RESULTS: Until 2012, we have registered 3,933 cases in the last 54 years. Sex distribution corresponds to 75.6% for men and 24.4% for women. In 75.72% is present in adults between 16-50 years old. The predominant work group of patients is farmers (58.41%) followed by housewives (21.79%). Most of patients come from Jalisco, Morelos, Nuevo Leon, Guerrero, Veracruz and Michoacan states. The most affected body areas are limbs (60.29%) and trunk (19.76%). Actinomycetoma has a frequency of 96.52%, and the commonest etiological agent is Nocardia brasiliensis (65.58%). Eumycetoma (3.48%) is mainly caused by Madurella grisea (28.47%) and M. mycetomatis (26.28%). CONCLUSIONS: Mycetoma is an under-diagnosed pathology representing a health problem in rural regions and must be attended with more interest by the health institutions.
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Micetoma/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , México/epidemiología , Persona de Mediana Edad , Adulto JovenRESUMEN
BACKGROUND: The outcome and interpretation of intra-synovial diagnostic analgesia of the distal interphalangeal joint (DIPJ) and the navicular bursa (NB) remain in dispute, and no objective studies have been carried out to establish the percentage of improvement over time from these two analgesia techniques. OBJECTIVES: To investigate the qualitative and time-dependent outcome of DIPJ-A and NB-A in naturally occurring forelimb lameness. STUDY DESIGN: Case series. METHODS: Twenty-three clinical cases with forelimb lameness were evaluated objectively using a body mounted inertial sensor system (BMIS). Lameness was localised to the foot with a palmar digital nerve block and/or an abaxial sesamoidean nerve block on day 1, and analgesia of the DIPJ (DIPJ-A) and NB (NB-A) were performed on days 2 and 3. Improvement following perineural analgesia was measured after 10 min and intra-synovial blocks after 2-, 5- and 10-min. Horses with at least 70% improvement measured objectively after diagnostic analgesia were included in the study. RESULTS: There was no significant association between improvement following perineural analgesia and the DIPJ-A and NB-A. The mean improvement in the lameness differed between DIPJ-A and NB-A at 2 min (p < 0.001) and at 5 min (p = 0.04), and it was no longer observed after 10 min (p = 0.06). A positive NB-A produced a high degree of improvement that remained stable, whereas the DIPJ-A improved over time. MAIN LIMITATIONS: Perineural and intra-synovial analgesia were performed without contrast medium to assess the diffusion of mepivacaine. CONCLUSIONS: Our results suggest that perineural analgesia is not reliable enough to differentiate pain originating from DIPJ and NB. Early evaluation of the DIPJ-A and NB-A can determine the origin of the pain. An improvement following NB-A was constant over time, but an improvement following DIPJ-A varied by up to 10 min.
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Analgesia , Enfermedades de los Caballos , Animales , Caballos , Cojera Animal/diagnóstico , Cojera Animal/tratamiento farmacológico , Inyecciones Intraarticulares/veterinaria , Dolor/veterinaria , Analgesia/veterinaria , Miembro Anterior , Enfermedades de los Caballos/diagnóstico , Enfermedades de los Caballos/tratamiento farmacológicoRESUMEN
OBJECTIVE: To determine the proximal diffusion distance of radiopaque contrast medium and mepivacaine/methylene blue solution and incidence of inadvertent intrasynovial and intravascular injections of modified sesamoid nerve block (MASB) when compared with traditional plantar nerve analgesia techniques of the equine distal hind limb. SAMPLE: Ex vivo model: 18 hind limbs; and in vivo model: 5 horses in a crossover study. METHODS: In the ex vivo model, a mepivacaine/methylene blue solution was used to compare the diffusion distance between MASB, basisesamoid block (BSB), and traditional low plantar block (TLPB). Ten minutes after injection, skin was dissected and proximal diffusion distance of the dye patch was measured. In the in vivo model, both hind limbs were injected with radiopaque contrast medium with either MASB or TLPB. Ten minutes after injection, a radiograph was acquired and the proximal diffusion of the contrast medium patch was measured. RESULTS: In the ex vivo model, solution proximal diffusion distance for MASB was significantly longer than BSB (P < .050) and significantly shorter than TLPB (P < .050). Both techniques reached the proximal aspect of DFTS similarly (P = .289), and no difference in the incidence of intrasynovial or intravascular injections was observed (P = .292). In the in vivo model, contrast medium proximal diffusion of MASB was significantly shorter than TLPB (P < .050). The proportion of injections that diffused subcutaneously to the proximal aspect of the proximal pouch of the DFTS was not significantly different between techniques (P = .136). No difference in the incidence of DFTS intrasynovial or intravascular injections was observed (P = .305). CLINICAL RELEVANCE: MASB presented significantly more proximal diffusion than BSB and less proximal diffusion than TLPB, consistently reached the proximal aspect of DFTS, and presented a very low risk of intrasynovial and intravascular injections.
Asunto(s)
Mepivacaína , Bloqueo Nervioso , Caballos , Animales , Mepivacaína/farmacología , Estudios Cruzados , Azul de Metileno , Medios de Contraste/farmacología , Bloqueo Nervioso/veterinaria , Anestésicos Locales/farmacologíaRESUMEN
The diagnosis of fungal Neglected Tropical Diseases (NTD) is primarily based on initial visual recognition of a suspected case followed by confirmatory laboratory testing, which is often limited to specialized facilities. Although molecular and serodiagnostic tools have advanced, a substantial gap remains between the desirable and the practical in endemic settings. To explore this issue further, we conducted a survey of subject matter experts on the optimal diagnostic methods sufficient to initiate treatment in well-equipped versus basic healthcare settings, as well as optimal sampling methods, for three fungal NTDs: mycetoma, chromoblastomycosis, and sporotrichosis. A survey of 23 centres found consensus on the key role of semi-invasive sampling methods such as biopsy diagnosis as compared with swabs or impression smears, and on the importance of histopathology, direct microscopy, and culture for mycetoma and chromoblastomycosis confirmation in well-equipped laboratories. In basic healthcare settings, direct microscopy combined with clinical signs were reported to be the most useful diagnostic indicators to prompt referral for treatment. The survey identified that the diagnosis of sporotrichosis is the most problematic with poor sensitivity across the most widely available laboratory tests except fungal culture, highlighting the need to improve mycological diagnostic capacity and to develop innovative diagnostic solutions. Fungal microscopy and culture are now recognized as WHO essential diagnostic tests and better training in their application will help improve the situation. For mycetoma and sporotrichosis, in particular, advances in identifying specific marker antigens or genomic sequences may pave the way for new laboratory-based or point-of-care tests, although this is a formidable task given the large number of different organisms that can cause fungal NTDs.
RESUMEN
The uncontrolled sale of topical corticosteroids has become an important risk factor for the development of iatrogenic Cushing syndrome in children, especially in countries where medications are sold over the counter. This is exacerbated by the lack of information for both the patients and pharmacists. This report documents a series of eight cases of iatrogenic Cushing syndrome secondary to an inappropriate use of topical steroids, due to a misdiagnosis of scabies.
RESUMEN
BACKGROUND: Mycetomas are frequent subcutaneous mycoses with typical clinical characteristics such as sinuses, blood-stained, serous, or purulent exudates as well as local swelling. Even though the most commonly affected areas are the lower limbs, we report four cases affecting the neck and midback regions, of which three were young females. We draw attention to the importance of early identification of these cases for prevention and specific treatment in order to avoid severe consequences or irreversible complications such as quadriplegia. OBJECTIVE: To document the occurrence of cervical spine and middle dorsal thoracic mycetomas, as well as their severity, clinical manifestations, and secondary complications. MATERIAL AND METHODS: This was an observational and descriptive study in which we reviewed cases with neck and middle dorsal thoracic mycetomas diagnosed at the Acapulco General Hospital of Guerrero State, Mexico. We describe the cases including the mechanism of inoculation, neurological symptoms, and severity. CONCLUSIONS: We describe three cases initially diagnosed clinically as cervical mycetomas and one in the middle dorsal thoracic region. All the cases were diagnosed at the Acapulco General Hospital of Guerrero State in Mexico.
Asunto(s)
Micetoma/diagnóstico , Micetoma/tratamiento farmacológico , Nocardiosis/complicaciones , Adolescente , Adulto , Dorso , Femenino , Humanos , Masculino , México , Micetoma/microbiología , Cuello , Adulto JovenRESUMEN
BACKGROUND: Adipose tissue is a promising source of mesenchymal stromal cells (MSCs) for the treatment of tendon disease. The goal of this study was to assess the effect of a single intralesional implantation of adipose tissue-derived mesenchymal stromal cells (AT-MSCs) on artificial lesions in equine superficial digital flexor tendons (SDFTs). METHODS: During this randomized, controlled, blinded experimental study, either autologous cultured AT-MSCs suspended in autologous inactivated serum (AT-MSC-serum) or autologous inactivated serum (serum) were injected intralesionally 2 weeks after surgical creation of centrally located SDFT lesions in both forelimbs of nine horses. Healing was assessed clinically and with ultrasound (standard B-mode and ultrasound tissue characterization) at regular intervals over 24 weeks. After euthanasia of the horses the SDFTs were examined histologically, biochemically and by means of biomechanical testing. RESULTS: AT-MSC implantation did not substantially influence clinical and ultrasonographic parameters. Histology, biochemical and biomechanical characteristics of the repair tissue did not differ significantly between treatment modalities after 24 weeks. Compared with macroscopically normal tendon tissue, the content of the mature collagen crosslink hydroxylysylpyridinoline did not differ after AT-MSC-serum treatment (p = 0.074) while it was significantly lower (p = 0.027) in lesions treated with serum alone. Stress at failure (p = 0.048) and the modulus of elasticity (p = 0.001) were significantly lower after AT-MSC-serum treatment than in normal tendon tissue. CONCLUSIONS: The effect of a single intralesional injection of cultured AT-MSCs suspended in autologous inactivated serum was not superior to treatment of surgically created SDFT lesions with autologous inactivated serum alone in a surgical model of tendinopathy over an observation period of 22 weeks. AT-MSC treatment might have a positive influence on collagen crosslinking of remodelling scar tissue. Controlled long-term studies including naturally occurring tendinopathies are necessary to verify the effects of AT-MSCs on tendon disease.
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Tejido Adiposo/citología , Enfermedades de los Caballos/terapia , Trasplante de Células Madre Mesenquimatosas , Células Madre Mesenquimatosas/citología , Tendinopatía/terapia , Tendinopatía/veterinaria , Aminoácidos/análisis , Animales , Colágeno/análisis , Modelos Animales de Enfermedad , Módulo de Elasticidad , Enfermedades de los Caballos/patología , Caballos , Inyecciones Intralesiones , Estrés Mecánico , Tendinopatía/patología , Factores de Tiempo , Trasplante Autólogo , UltrasonografíaRESUMEN
BACKGROUND: Simple nephrectomy is the procedure of choice in the treatment of excluded kidneys. The purpose of this study was to describe and compare surgical results in open simple retroperitoneal nephrectomies in patients with and without nephrostomy. METHODOLOGY: 58 patients were analyzed. The demographic parameters of patients with nephrostomy were compared to patients without nephrostomy (age, gender, weight, lithium localization, transoperative variables (surgical time, transoperative bleeding) and postoperative variables (need for intensive care, need for transfusion, surgical wound infection and hospital stay days) RESULTS: Statistically significant differences were found for the variables of operative bleeding (p=0.0442), surgical time (p=0.0093), hospital stay days (p=0.0040), and transfusion requirements (p=0.0170). There were no differences in the need for intensive care (p=0.6314), transoperative complications (p=0.7414) and surgical wound infection (p=0.2762). CONCLUSIONS: The presence of a nephrostomy catheter in patients undergoing open simple nephrectomy leads to an increased risk of morbidity, with increased bleeding, surgical time, need for transfusion, and hospital stay days.
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Nefrectomía , Nefrolitiasis/cirugía , Nefrotomía , Ureterolitiasis/cirugía , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nefrectomía/métodosRESUMEN
Las infecciones supurativas del riñón y del espacio perinefrítico son poco comunes, sin embargo, se asocian a una morbimortalidad elevada, afectando a ambos sexos por igual excepto los casos de absceso cortical que es 3 veces más común en el hombre que en la mujer. La incidencia se incrementa con la edad y habitualmente se asocia a uropatía obstructiva. Los abscesos renales representan 0,2% de todos los abscesos intraabdominales, de los cuales el 10% de los abscesos corticales rompen a través de la cápsula formando un absceso perinefrítico, el cual es difícil de manejar y conlleva un peor pronóstico, con una alta mortalidad a pesar de tratamiento quirúrgico oportuno
Supurative infections of the kidney and perinephritic space are rare, however, are associated with high morbidity and mortality, affecting both sexes equally except for cases of cortical abscess which is 3 times more common in men than in women. The incidence increases with age and is usually associated with obstructive uropathy. Renal abscesses represent 0.2% of all abscesses. intraabdominal, of which 10% of cortical abscesses break through the capsule forming a Perinephritic abscess, which is difficult to manage and leads to a worse prognosis, with high mortality despite prompt surgical treatment.
Asunto(s)
Litiasis , Insuficiencia Renal , Infecciones , NefrectomíaRESUMEN
Skin diseases have a very high frequency either in developed as well as in undeveloped countries. Guerrero, Chiapas, and Oaxaca are the most impoverished states in Mexico, where 24% of the population lacks basic health care, and only 15% are estimated to have access to specialists. Community Dermatology program was founded in 1991 with the intention of improving the dermatological health of remote, marginalized inhabitants of the state of Guerrero. The program consists of a two-day visit to a pre-selected community; the first day includes a basic dermatology training course for local providers, and day 2 is a "Jornada",which means a day of free medical consultation and treatment. Pityriasis albus Cloasma, vitiligo, and acne continue to be the most frequent diagnosed primary disorders, as in rural areas occupational obligations include prolonged sun exposure. The experience and success of Community Dermatology over the last 20 years has demonstrated that this model of healthcare delivery and instruction is economically feasible, provides practical and quantifiable benefits for the communities served, and could be emulated by other disciplines within medicine.
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Medicina Comunitaria/educación , Dermatología/educación , Atención Primaria de Salud , Enfermedades de la Piel/diagnóstico , Enfermedades de la Piel/terapia , Adolescente , Adulto , Niño , Femenino , Humanos , Masculino , Medicina , México , Marginación Social , Adulto JovenRESUMEN
Eumycetoma is caused by different fungi. Madurella mycetomatis, Madurella grisae, and Scedosporium apiospermum are the most common causative agents. This disease is more frequent on the lower extremities but can also be present in other areas. The diagnosis is made by direct microscopic examination and histologic study, which should show hyphae and vesicles characteristic of the fungi. Etiologic identification of the species of the fungus is sometimes difficult by culture and biopsy specimen; in these cases, molecular techniques can help to identify the infecting organism. Treatment has been with amphotericin B, which is now seldom used due to its side effects and limited success. The best therapeutic choice is surgical removal of the lesion, followed by medical treatment. This includes antifungals such as the azoles, ketoconazole and itraconazole; in resistant cases, posaconazole and voriconazole are currently recommended. In particular, the combination of terbinafine and itraconazole can elicit a good result in some cases.
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Antifúngicos/uso terapéutico , Micetoma/tratamiento farmacológico , Farmacorresistencia Fúngica Múltiple/efectos de los fármacos , Humanos , Micetoma/etiología , Micetoma/cirugíaRESUMEN
Programs that have been devised to improve the lot of patients with skin disease, or disease presenting with skin signs and symptoms, in resource-poor regions have focused mainly on education and training or community-oriented control measures. However, both have in common an objective of managing disease at population level. Training has been delivered in different ways both by direct teaching for varying periods of time or by web-based and electronic communication; control measures have been less in evidence and there is a great need for more support from funding agencies. Despite this, there is now a growing number of successful initiatives in health improvement for skin conditions that cover many parts of the world. This report describes many of these schemes as an example of what can be done to help patients.
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Medicina Comunitaria/economía , Medicina Comunitaria/educación , Alfabetización en Salud/economía , Enfermedades de la Piel/tratamiento farmacológico , Países en Desarrollo/economía , Necesidades y Demandas de Servicios de Salud/economía , Humanos , Pobreza , Salud Pública/economía , Salud Pública/educación , Enfermedades de la Piel/diagnóstico , Enfermedades de la Piel/epidemiología , TelemedicinaRESUMEN
BACKGROUND: Actinomycetoma is a chronic infection resulting from aerobic Actinomycetes. The major agents are Nocardia brasiliensis, Actinomadura madurae, and Streptomyces somaliensis. The most frequent topographies are the lower and upper limbs. The prognosis of this disease is determined by several factors, such as etiologic agent, clinical topography, and depth of disease (degree of involvement, visceral, and bone affection). The purpose of this paper was to present our experience with actinomycetoma of the perianal region. METHODS: This study comprises 20 cases of perianal actinomycetoma, all of which were clinically and microbiologically proven by direct examinations, cultures, and biopsies. Clinical responses to the two principal treatment regimes used [combination of trimethoprim-sulfamethoxazole (TMS/SMX) and diaminodiphenylsulfone (DDS) or amikacine plus TMS/SMX] are reported. RESULTS: Most of the cases were male (17/20, 85%), the mean age was 42.1 years, and the farmers predominated (90%). The principal etiologic agent isolated was N. brasiliensis (85%). CONCLUSIONS: Perianal actinomycetoma is a rare entity. Differential diagnosis with anal sinuses, hydroadenitis, and cutaneous tuberculosis must be made in endemic areas by performing mycologic tests and biopsies. Treatment depends on the etiologic agent involved and the patient's condition.
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Infecciones por Actinomycetales/microbiología , Infecciones por Actinomycetales/patología , Enfermedades Cutáneas Bacterianas/microbiología , Enfermedades Cutáneas Bacterianas/patología , Infecciones por Actinomycetales/tratamiento farmacológico , Adulto , Anciano , Enfermedades de los Trabajadores Agrícolas/microbiología , Enfermedades de los Trabajadores Agrícolas/patología , Antibacterianos/uso terapéutico , Antiinfecciosos/uso terapéutico , Nalgas/microbiología , Nalgas/patología , Dapsona/uso terapéutico , Quimioterapia Combinada , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Cutáneas Bacterianas/tratamiento farmacológico , Estreptomicina/uso terapéutico , Combinación Trimetoprim y Sulfametoxazol/uso terapéuticoRESUMEN
La literatura internacional reporta diferentes protocolos de aislamiento y cultivo para las células madre de origen adiposo, ADSC. Aunque una gran parte de los protocolos de aislamientos son efectivos, se ha podido determinar que en la mayoría de los casos en que se utilizan los protocolos de cultivo planteados se dan crecimientos celulares muy pobres. En esta investigación se montaron las células en botellas de cultivo de 25 cm2 en cuatro medios diferentes: Medio Amniomax (GIBCO) (medio 1); Medio Ham´s F10 suplementado con 10 por ciento SFB, 1 por ciento antibiótico y ajustado para tener 2mm de L-Glutamina (medio 2); Medio Ham´s F10 suplementado con 10 por ciento SFB, 1 por ciento de antibióticos y ajustado para alcanzar 4mm de L-Glutamina (medio 3) y Medio Ham´s F10 suplementado con 20 por ciento de Suero Autólogo (SA), 1 por ciento de antibióticos y ajustado para alcanzar 4mm de L-Glutamina (medio 4). Después de realizado este experimento se logró determinar que con el medio 1 se obtenían crecimientos celulares marcadamente más rápidos que con los otros medios, consiguiéndose niveles confluentes en un lapso de 9 días (aproximadamente 6 millones de ADSC).
International literature reports different protocols for the isolation and cultive of adipose stem cells (ADSC). Although majority of the isolation protocols are effective, it has been determined that in most of the cases in which these cultive protocols are used, the cell growth rates are poor. Being the stem cells one promising therapeutic option, the group experimented with different cultive media to improve the times of cultive. In this investigation, the cell pellet was planted in a 25 cm2 cultive bottle in four different media: Amniomax Media (GIBCO) (medium 1); Hams F10 Media supplemented with 10% SFB, 1% antibiotic and adjusted to 2mm de L-Glutamina (medio 2); Hams F10 Media supplemented with 10% SFB, 1% antibiotic and adjusted to 4mm de L-Glutamina (medium 3) and Hams F10 supplemented with 20% of autologous serum (SA), 1% antibiotic and adjusted to 4mm de L-Glutamina (medium 4). This experiment determines that medium 1 stimulates faster growth rates than the others, obtaining confluent levels in 9 days (approximately 6 million ADSC).
Asunto(s)
Tejido Adiposo , Técnicas de Laboratorio Clínico , Guías como Asunto , Células MadreRESUMEN
Se revisan algunos conceptos del mixedema pretibial y se presenta el caso de una mujer con vitíligo de 65 años de edad, con enfermedad de Graves-Basedow, que se acompañó de mixedema pretibial del tipo trifoedema y de la variedad nodular múltiple de Gottron
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Humanos , Anciano , Femenino , Dermatosis de la Pierna , Mixedema , Enfermedad de GravesRESUMEN
Se presenta una alternativa para la obtención de los campos de radiación necesarios para la aplicación de la técnica de bandas móviles en la irradiación del abdomen en el caso particular de emplearse irradiadores de C060 Chisobalt o Chisostat. Los campos obtenidos son de 3,6 y 9 cm de ancho por 18,20 y 22 cm de largo, a la distancia fuente (superficie de 80 cm). Se adjuntan los valores de calibración de las escalas de los colimadores y las curvas de isodosis en el plano principal del haz para su uso en la planificación del tratamiento
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Radioterapia/métodos , Neoplasias Abdominales/radioterapiaRESUMEN
Se ralizó un estudio a 65 pacientes con diagnóstico de hemorragia subaracnoidea (HSA) secundaria a ruptura de aneurisma cerebral de 1§ de febrero de 1991 al 31 de agosto de 1992, siguiendo por sies meses a 55 pacientes, 35 mujeres y 20 hombres. Por escala de Hunt y Hess (HH) para HSA, se situó a 23 en grado I, ocho en grado II, 19 en grado III y cinco en grado IV, por angiografía cerebral se demostró vasoespasmo en 14 y por tomografía computarizada cerebral se corroboró resangrado en diez. El intervalo entre la sintomatología la cirugía fue de seis a 136 días, promediando 21. Obteniendo en 34 pacientes buena recuperación, 12 deshabilitados y nueve defunciones. Se concluye que el diagnóstico y manejo tempranos disminuyen la morbimortalidad; aumentando ésta en los días cuatro a 13 después del sangrado, en los grados III y IV de HH, ante resangrado y vasoespasmo