Case Report: Primary Cutaneous Histoplasmosis in an Immunocompetent Patient After Cosmetic Injection of Platelet-Rich Plasma Treated with Trimethoprim-Sulfamethoxazole.

BACKGROUND Histoplasmosis is typically associated with immunocompromised individuals, but cases in immunocompetent patients are rare. Primary cutaneous histoplasmosis (PCH) is a challenging diagnosis due to its clinical polymorphism and can mimic other infectious and non-infectious diseases. Previous cases of PCH have been reported in immunocompetent patients with underlying medical conditions or trauma history. So far there have been no reports of PCH after platelet-rich plasma (PRP) application due to inadequate hygiene measures in an immunocompetent host. CASE REPORT This case report presents a rare occurrence of PCH following a cosmetic procedure (PRP injection) in an immunocompetent patient. The patient developed nodule-like lesions at the application sites, which progressed to ulceration with purulent discharge. Initially, atypical mycobacterial infection was suspected, and empirical antibiotic therapy was initiated. Complementary tests were performed, ruling out immunosuppression and systemic pathogens. The patient showed complete resolution of the lesions after one month of atypical treatment with trimethoprim-sulfamethoxazole (TMP/SMX). Pathological examination confirmed the diagnosis of PCH with intracytoplasmic inclusions of Histoplasma sp. CONCLUSIONS This case highlights the importance of considering histoplasmosis as a diagnostic possibility, especially in hyperendemic areas like Venezuela. Direct inoculation of Histoplasma sp. after aesthetic procedures without proper hygiene measures can lead to pathological lesions, even in immunocompetent individuals. TMP/SMX can be considered as an alternative treatment option in the absence of the first-line medication. Further exploration of this treatment approach may benefit patients with similar clinical conditions or when ideal treatment options are unavailable.

Epidemiologic Behavior and Estimation of an Optimal Cut-Off Point for Homeostasis Model Assessment-2 Insulin Resistance: A Report from a Venezuelan Population.

Background. Mathematical models such as Homeostasis Model Assessment have gained popularity in the evaluation of insulin resistance (IR). The purpose of this study was to estimate the optimal cut-off point for Homeostasis Model Assessment-2 Insulin Resistance (HOMA2-IR) in an adult population of Maracaibo, Venezuela. Methods. Descriptive, cross-sectional study with randomized, multistaged sampling included 2,026 adult individuals. IR was evaluated through HOMA2-IR calculation in 602 metabolically healthy individuals. For cut-off point estimation, two approaches were applied: HOMA2-IR percentile distribution and construction of ROC curves using sensitivity and specificity for selection. Results. HOMA2-IR arithmetic mean for the general population was 2.21 ± 1.42, with 2.18 ± 1.37 for women and 2.23 ± 1.47 for men (P = 0.466). When calculating HOMA2-IR for the healthy reference population, the resulting p75 was 2.00. Using ROC curves, the selected cut-off point was 1.95, with an area under the curve of 0.801, sensibility of 75.3%, and specificity of 72.8%. Conclusions. We propose an optimal cut-off point of 2.00 for HOMA2-IR, offering high sensitivity and specificity, sufficient for proper assessment of IR in the adult population of our city, Maracaibo. The determination of population-specific cut-off points is needed to evaluate risk for public health problems, such as obesity and metabolic syndrome.

[Nephroprotection from calcium channels blocking agents: a contribution to their probable mechanism of action]. / El efecto de nefroprotección de los calcio-antagonistas: una contribución al conocimiento de su probable mecanismo.

The prevalence and incidence of end-stage renal disease have progressively increased in the last 20 years and, both Hypertension (HT) and Diabetes Mellitus (DM) are the two most important causes of such a condition. Haemodynamic and metabolic perturbations contribute to the development and progression of renal disease and both HT and DM are key factors in the nephropathy. Blood pressure reduction alone is insufficient for maximal renal protection, hence the need for the knowledge of additional mechanisms for nephroprotection in order to establish preventive measures. To contribute to the knowledge of the nephroprotective mechanism of the calcium channel blocking agents (CB) of the dihydropiridine group, this prospective, experimental, longitudinal, and placebo-controlled clinical trial was performed in 55 non-diabetic normotensive and hypertensive adults receiving 3 CB drugs at antihypertensive doses and as monodoses. There were 3 groups. A: Normotensive (n = 25) receiving a single dose of Nitrendipine 20 mg; B: Type I and II hypertensive (n = 15) receiving Nifedipine for 12 weeks; and C: Type I and II hypertensive (n = 15) receiving Amlodipine 5 mg/day, for one week. Together with clinical and hemodynamic responses, biochemical parameters such as renal vasoactive hormones renin, prostaglandins and kallikreins, nitric oxide and cGMP were measured. The antihypertensive effect of CB drugs was confirmed and there was a significant increase in urinary kallikreins excretion related to an increase in nitric oxide. It is concluded that the nephroprotective effect of CB may be due to their capacity to increase urinary kallikreins which in turn, releases nitric oxide production. It is recommended to continue this research with larger number of hypertensive and diabetic patients with nephropathy and longer clinical trials.

El efecto de nefroprotección de los calcio-antagonistas: una contribución al conocimiento de su probable mecanismo / Nephroprotection from calcium channels blocking agents: a contribution to their probable mechanism of action

La prevalencia e incidencia de la Insuficiencia Renal Crónica (IRC) han ido aumentando progresivamente en los últimos 20 años, y tanto la Hipertensión Arterial (HTA) como la Diabetes Mellitus (DM) son las dos causas más importantes de ambas situaciones. Los cambios hemodinámicos y metabólicos contribuyen en el desarrollo y progresión de la enfermedad renal en ambas HTA y DM, que son factores claves en la nefropatía. La reducción de la presión arterial sola no es suficiente para una máxima protección renal, de allí la necesidad del conocimiento de un mecanismo adicional para la nefroprotección para establecer medidas preventivas. A manera de contribuir al conocimiento de tal mecanismo nefroprotector de las drogas calcio-antagonistas (CA) del grupo dihidropiridinas se realizó este estudio prospectivo, experimental y longitudinal controlado con placebo en 55 adultos normotensos e hipertensos no-diabéticos que recibieron 3 drogas antihipertensivas CA a monodosis matutinas. Se dividieron en 3 grupos. Grupo A (n = 25): Control, normotensos, que recibieron dosis única de 20 mg de Nitrendipina (NIT). Grupo B (n = 15): Hipertensos tipos I y II que recibieron dosis de 20 mg de Nifedipina (NIF) por 12 semanas y Grupo C (n = 15): Hipertensos tipo I y II que recibieron monodosis de Amlodipina (AML) de 5 mg/d durante 1 semana. En conjunto con las respuestas clínica y hemodinámica, se analizaron parámetros bioquímicos como hormonas vasoactivas renales renina, prostaglandinas, calicreínas y óxido nítrico y también cGMP. El efecto antihipertensivo de los CA se confirmó, y hubo un aumento significativo de la excreción urinaria de calicreínas relacionado con el aumento del óxido nítrico.

Denervação acetabular cranial e dorsal no tratamento da displasia coxofemoral em cães: 360 dias de evolução de 97 casos / Cranial and dorsal acetabular denervation technique in treatment of hip dysplasia in dogs: 360 days evaluation of 97 cases

Realizou-se a pesquisa com o intuito de avaliar os resultados clínicos da denervação acetabular cranial e dorsal por curetagem em cães com displasia coxofemoral. Foram estudados, para tanto, 97 cães, sem predileção racial ou sexual, de 1-7 anos de idade, com diagnóstico clínico e radiográfico de displasia coxofemoral. Para avaliação dos resultados da técnica cirúrgica, de curetagem das fibras nervosas do periósteo acetabular cranial e dorsal, exames clínicos foram realizados no momento pré-operatório (exame inicial), e pós-operatório, nos dias dois, sete, 14, 21, 30, 60, 180 e 360. Todos os animais foram avaliados quanto à claudicação, dor à movimentação e toque, grau de atrofia muscular, sensibilidade dolorosa ao teste de Ortolani, e qualidade de vida. A denervação reduziu a claudicação, e dor à movimentação e toque à partir de dois dias de pós-operatório, reduziu atrofia muscular aos 60 dias pós-operatórios, e melhorou a qualidade de vida dos pacientes tratados, sob a ótica dos proprietários e veterinários aos 360 dias de pós-operatório. A dener-vação acetabular dorsal é técnica factível no tratamento da dor conseqüente à displasia coxofemoral em cães, com decréscimo significativo desta após dois dias da intervenção cirúrgica, aumenta qualidade de vida e proporciona maior atividade aos pacientes com proprietários satisfeitos quanto aos resultados do procedimento. A técnica cirúrgica deve incluir a curetagem das fibras nervosas do periósteo acetabular tanto da região cranial quanto dorsal.

The aim was to evaluate the clinical results of cranial and dorsal acetabular denervation using curettage in dysplastic dogs. Ninty seven dogs without distinction of breed and sex, 1 to 7 years of age, were analyzed for diagnosis and treatment of hip dysplasia, based on physical examination, clinical signs and radiographic findings. For evaluation of results of the surgical denervation technique, clinical examinations were performed preoperatively (initial exam) and postoperatively at days 2, 7, 14, 21, 30, 60 180 and 360. All animals were evaluated for lameness, pain to movement and touch, muscular atrophy degree, pain sensivity to Ortolani's test and assessment of life quality. The surgical denervation procedure decreases lameness, pain to movement and touch after 2 days of procedure, decreases muscular atrophy after 60 days of procedure, and improves quality of life from the owner's and veterinarian's point of view even after 1 year of the treatment. Dorsal acetabular denervation is a feasible surgical technique in treatment of pain secondary to hip dysplasia in dogs, with significant decrease of pain after 2 days of treatment, improvement of quality of life, decrease of lameness, and consequently joyful animals and owners extremely satisfied with the results obtained by the proposed treatment. The surgical technique must include the curettage of nerve fibers from the cranial-dorsal and dorsal region of the acetabular periosteum.