A nationwide epidemiological and geodemographic analysis of lymphatic filariasis in Ecuador: a neglected and often forgotten disease in Ecuador.

Introduction: Lymphatic filariasis (LF) is a neglected parasitic disease transmitted by mosquitoes and affecting the lymphatic system. The aim of this study was to analyze the epidemiological and sociodemographic characteristics of patients with LF during the last 11 years of available data in Ecuador. Methods: A 11-year nationwide analysis of hospital admission and in-hospital mortality based on the National Institute of Statistics and Census (INEC) data was conducted in Ecuador from 2011 to 2021. The International Classification of Diseases 10th Revision (ICD-10) code for filariasis (ICD: B74) was used to retrieve information on severe LF as a proxy for incidence among 221 Ecuadorian cities. Results: A total of 26 hospital admissions and 3 deaths due to LF were registered. The highest mortality rate was found in populations over 80 years. Men accounted for 62.5% (n = 17) of total number of cases with an average incidence rate of 1.7 cases per/1,000,000, while females accounted for 34.6% (n = 9), representing 1 case per/1,000,000 woman. Cities located at lower altitude (459/1,000,000) reported higher incidence rates than those located at higher altitudes (7.4/1,000,000). Conclusion: This is the first study on LF in Ecuador. Although, Ecuador is not considered endemic for LF, we found evidence of the presence of this disease in recent years. The implementation and improvement of an adequate integrated epidemiological surveillance system will allow early identification of cases and therefore their respective treatment.

Relationship between near infrared spectroscopy and intra-compartmental pressures.

BACKGROUND: Near infrared spectroscopy (NIRS) has been suggested as a possible means for detecting perfusion deficits in patients with acute compartment syndrome (ACS). STUDY OBJECTIVES: To longitudinally examine NIRS in an ACS model to determine its responsiveness to decreasing perfusion pressure. METHODS: A NIRS sensor pad was placed under a tourniquet over the anterior compartment in the mid-tibia region on 20 volunteers. Initial perfusion pressures and NIRS values were recorded. The tourniquet pressure was sequentially raised by 10 mm Hg in 10-min intervals until systolic pressure was surpassed. NIRS values and perfusion pressure were determined at the end of each 10-min interval. RESULTS: There was no change in mean NIRS values from the initial baseline until 30 mm Hg of perfusion pressure was reached. Additionally, a statistically significant drop in mean NIRS values was observed as perfusion pressures dropped from 10 mm Hg to 0 mm Hg, and again with subsequent decreases of 10 mm Hg perfusion pressure until systolic pressure was surpassed. CONCLUSIONS: These results coincide with previously published studies using alternative methods of measuring blood flow or perfusion. NIRS values were responsive to decreasing perfusion pressures over a longitudinal period of time in an ACS model. These results suggest that NIRS may be useful for continuous, non-invasive monitoring of patients for whom ACS is a concern. Additional studies on traumatized patients are required.

Correlation between muscle oxygenation and compartment pressures in acute compartment syndrome of the leg.

BACKGROUND: Near-infrared spectroscopy estimates soft-tissue oxygenation approximately 2 to 3 cm below the skin. The purpose of the present study was to evaluate muscle oxygenation in the setting of an acute compartment syndrome of the leg and to determine if near-infrared spectroscopy is capable of detecting perfusion deficits. METHODS: Fourteen patients with unilateral lower extremity trauma were enrolled after the diagnosis of an acute compartment syndrome was made clinically and confirmed with intracompartmental pressure measurements. Lower extremity muscle compartments were evaluated with near-infrared spectroscopy, and near-infrared spectroscopy values of the uninjured, contralateral leg of each patient were used as internal reference values. The compartment perfusion gradient was calculated as the diastolic blood pressure minus the intracompartmental pressure. RESULTS: Intracompartmental pressures ranged from 21 to 176 mm Hg (mean, 79 mm Hg) and exceeded 30 mm Hg in all compartments but two (both in the same patient). Thirty-eight compartments had a perfusion gradient of < or = 10 mm Hg (indicating ischemia). Among ischemic compartments, near-infrared spectroscopy values in the anterior, lateral, deep posterior, and superficial posterior compartments of the injured limbs were decreased by an average 10.1%, 10.1%, 9.4%, and 16.3% in comparison with the corresponding compartments of the uninjured leg. Differences in near-infrared spectroscopy values (the near-infrared spectroscopy value for the injured leg minus the near-infrared spectroscopy value for the uninjured leg) were positively correlated with compartment perfusion gradient within each compartment (r = 0.82, 0.65, 0.67, and 0.62, for the anterior, lateral, deep posterior, and superficial posterior compartments, respectively; p < 0.05 for all). CONCLUSIONS: Normalized near-infrared spectroscopy values decrease significantly with decreasing lower limb perfusion pressures. Near-infrared spectroscopy may be capable of differentiating between injured patients with and without an acute compartment syndrome.

Near-infrared spectroscopy in lower extremity trauma.

BACKGROUND: Near-infrared spectroscopy measures the percentage of hemoglobin oxygen saturation in the microcirculation of tissue up to 3 cm below the skin. The purpose of this study was to describe the measurable response of normal tissue oxygenation in the leg after acute trauma with use of this technique. METHODS: Twenty-six patients with acute unilateral tibial fractures and twenty-five uninjured volunteer control subjects were enrolled. Near-infrared spectroscopy measurements were obtained for both legs in all four compartments: anterior, lateral, deep posterior, and superficial posterior. The twenty-six injured legs were compared with twenty-five uninjured legs (randomly selected) of the volunteer control group, with the contralateral limb in each patient serving as an internal control. RESULTS: The mean tissue oxygenation for each compartment in the injured legs was 69% (anterior), 70% (lateral), 74% (deep posterior), and 70% (superficial posterior). In the control (uninjured) legs, the average tissue oxygenation percentage in each compartment was 54%, 55%, 60%, and 57%, respectively. Repeated-measures analysis revealed that near-infrared spectroscopy values averaged 15.4 percentage points (95% confidence interval, 12.2 to 18.6 percentage points) higher for injured legs than for uninjured legs, controlling for the value of the contralateral limb (p < 0.0001). CONCLUSIONS: Tibial fracture produces a predictable increase in tissue oxygenation as measured by near-infrared spectroscopy. The corresponding compartment of the contralateral leg can provide strong utility as an internal control value when evaluating the hyperemic response to injury.

Cholestasis, sclerosing cholangitis, and liver transplantation in Langerhans cell Histiocytosis.

OBJECTIVE: To analyze features and outcomes of cholestasis, sclerosing cholangitis (SC), and liver transplantation (LTx) in patients with Langerhans cell Histiocytosis (LCH) between October 1987 and June 1999. STUDY DESIGN: Of 182 cases with LCH, 36 had hepatic involvement and 12 of those presented with cholestasis. These 12 were the focus of our study. Their median age was 23 months (range: 3-36). Hepatomegaly or hepatosplenomegaly was found in 11 of the 12; elevations of alkaline phosphatase, transaminases, gamma glutamyl transpeptidase (GGT), and less frequently direct bilirubin were detected. Sonography, liver biopsy, and cholangiography were consistent with the diagnosis of SC in 11 patients. None of the biopsies revealed Langerhans cells (LC). Frequently associated lesions of skin, bone, and ear were noted. Early patients were treated with Vinblastine/prednisone for 8 weeks, later patients with the LCH I and LCH II protocols of the Histiocyte Society (HS). RESULTS: Median follow-up was 28 months (range: 10-86). Three patients improved and remained without signs of progressive SC at 27, 32, and 86 months. Nine had progressive liver sequelae resistant to chemotherapy. Of these nine, five received LTx, three died before LTx with progressive SC, and one awaits LTx. Three LTx patients survive without disease reactivation 14, 25, and 37 months post-transplant. Two patients died less than one month after LTx, due to renal failure and sepsis in the first patient and bowel volvulus with perforation followed by sepsis in the second one. CONCLUSIONS: SC is a frequent and usually progressive sequela of multisystem LCH in our institution. LTx has become the treatment of choice for the majority of patients and should be considered early in cases with severe hepatic involvement.