The Diagnosis of Fungal Neglected Tropical Diseases (Fungal NTDs) and the Role of Investigation and Laboratory Tests: An Expert Consensus Report.

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.

Relevancia del antecedente de absceso perirrenal en pacientes sometidos a nefrectomía simple retroperitoneal / Relevance of Perirenal Abscess in Patients undergoing Retroperitoneal Simple Nephrectomy

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.

Effect of single intralesional treatment of surgically induced equine superficial digital flexor tendon core lesions with adipose-derived mesenchymal stromal cells: a controlled experimental trial.

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.

Paracoccidioidomycosis in Mexico: clinical and epidemiological data from 93 new cases (1972-2012).

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.

Eumycetoma.

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.

Comparación de diferentes protocolos para el cultivo de células madre mesenquimales de origen adiposo / Comparison of different protocols for the cultive of mesenchymal stem cells of adipose origin

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); Ham’s F10 Media supplemented with 10% SFB, 1% antibiotic and adjusted to 2mm de L-Glutamina (medio 2); Ham’s F10 Media supplemented with 10% SFB, 1% antibiotic and adjusted to 4mm de L-Glutamina (medium 3) and Ham’s 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).

Experiencia en el tratamiento de hemorragia subaracnoidea secundaria a ruptura de aneurisma intracraneal en el Centro Médico del Noreste / Experience in the treatment of subarachnoideal hemorrhage followin rupture of an intracranial aneurism at the Centro Medico del Noreste

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

Mixedema pretibial: estudio de un caso / Pretibial mixedema: study of a case

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

Una alternativa para la aplicación de la técnica de bandas móviles de equipos chisostat y chisobalt / An alternative for the application of the technique of mobile bands in chisostat and chisobalt equipments

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