Beyond digestive pathology: endoscopic study in systemic disease.

A 77-year-old male patient with heart disease, kidney disease under study, and quiescent multiple myeloma. He presented a 2 years history of weight loss and digestive symptoms. In the endoscopic study, multiple gastric ulcers were observed, whose histological study ruled out the initial suspicion. The patient died a month later from refractory shock.

Teneurin-3 regulates the generation of non-image-forming visual circuitry and responsiveness to light in the suprachiasmatic nucleus.

Visual system function depends upon the elaboration of precise connections between retinal ganglion cell (RGC) axons and their central targets in the brain. Though some progress has been made in defining the molecules that regulate RGC connectivity required for the assembly and function of image-forming circuitry, surprisingly little is known about factors required for intrinsically photosensitive RGCs (ipRGCs) to target a principal component of the non-image-forming circuitry: the suprachiasmatic nucleus (SCN). Furthermore, the molecules required for forming circuits critical for circadian behaviors within the SCN are not known. We observe here that the adhesion molecule teneurin-3 (Tenm3) is highly expressed in vasoactive intestinal peptide (VIP) neurons located in the core region of the SCN. Since Tenm3 is required for other aspects of mammalian visual system development, we investigate roles for Tenm3 in regulating ipRGC-SCN connectivity and function. Our results show that Tenm3 negatively regulates association between VIP and arginine vasopressin (AVP) neurons within the SCN and is essential for M1 ipRGC axon innervation to the SCN. Specifically, in Tenm3-/- mice, we find a reduction in ventro-medial innervation to the SCN. Despite this reduction, Tenm3-/- mice have higher sensitivity to light and faster re-entrainment to phase advances, probably due to the increased association between VIP and AVP neurons. These data show that Tenm3 plays key roles in elaborating non-image-forming visual system circuitry and that it influences murine responses to phase-advancing light stimuli.

Human Papillomavirus Prevalence and Associated Factors in Indigenous Women in Ecuador: A Cross-Sectional Analytical Study.

Cervical cancer (CC) is the second leading cause of death from malignancy in women in Ecuador. Human papillomavirus (HPV) is the main causative agent of CC. Although several studies have been conducted on HPV detection in Ecuador, there are limited data on indigenous women. This cross-sectional study aimed to analyze the prevalence of HPV and associated factors in women from the indigenous communities of Quilloac, Saraguro and Sevilla Don Bosco. The study included 396 sexually active women belonging to the aforementioned ethnicities. A validated questionnaire was used to collect socio-demographic data, and real-time Polymerase Chain Reaction (PCR) tests were used to detect HPV and other sexually transmitted infections (STIs). These communities are located in the southern region of Ecuador and face geographical and cultural barriers to accessing health services. The results showed that 28.35% of women tested positive for both types of HPV, 23.48% for high-risk (HR) HPV, and 10.35% for low-risk (LR) HPV. Statistically significant associations were found between HR HPV and having more than three sexual partners (OR 1.99, CI 1.03-3.85) and Chlamydia trachomatis infection (OR 2.54, CI 1.08-5.99). This study suggests that HPV infection and other sexually transmitted pathogens are common among indigenous women, highlighting the need for control measures and timely diagnosis in this population.

Myiasis in a Neglected Elderly: Urgent Action Needed in South America.

Background: Myiasis is an infestation by fly larvae. Some species exclusively affect humans, contaminating wounds, mucous membranes, and other tissues. It is a disease with marked socioeconomic connotations. Case Presentation: The current case involves a 95-year-old woman, an inhabitant of the Andean region of Ecuador with a history of resection of basal cell carcinoma in the left zygomatic region and a diagnosis of chronic leukemia. The surgical wound was secondarily infested with Cochliomyia hominivorax fly larvae and the patient was readmitted to the hospital to treat this complication. A marked clinical improvement was observed after surgical debridement, removal of larvae and administration of ivermectin and antibiotics. Conclusion: The determinants of this infestation were advanced age, neglect, and destitution in a patient with an open wound on the face after resection of a basal cell carcinoma. This case illustrates the appalling reality of the marginalized and excluded population of South America. Also of concern is the expansion of myiasis-producing fly populations to areas outside their natural humid and warm habitat. South American governments are called upon to act jointly and effectively against this ominous disease.

Choledochoduodenostomy with LAMS (Hot-Axios type) for malignant obstructive jaundice - An increasingly used technique.

An 82-year-old woman who presented with obstructive jaundice and constitutional syndrome was diagnosed with pancreatic adenocarcinoma. Palliative management was decided with endoscopic ultrasound drainage as it was impossible to perform ERCP due to anatomical alterations, a consequence of the neoplastic lesion.

Occlusal polygon area of the molars in six Colombian ethnic groups / Área del polígono oclusal de molares en seis grupos étnicos de Colombia

SUMMARY: Descriptive observational cross-sectional study to determine the AOP of the second molars (55, 65, 75, 85) and the first permanent molars (16, 26, 36 and 46) in 459 study models corresponding to six ethnic groups in Colombia, Embera indigenous of Alto Baudó (Chocó), Caucasoid mestizos of Cali (Valle del Cauca), African descent of Cali (Valle del Cauca), Misak indigenous of Silvia (Cauca), Nasa indigenous of Morales (Cauca), and indigenous of Leticia (Amazonas). There were no significant differences of AOP among the six ethnic groups except when compared to the Amazon Indians with African descent of Cali, Embera indigenous and Nasa indigenous. There was no sexual dimorphism except tooth 65 for all ethnic groups. There was bilateral symmetry except between teeth 16 and 26. The distance matrix showed that Caucasoid mestizos of Cali were grouped with microdont populations, Amazon indigenous, Embera indigenous, Misak indigenous and Nasa indigenous, and African descendants of Cali were grouped with mesodont populations. The Embera and Amazon indigenous had the highest values of OAP associated with the relative isolation and less mestizaje. Overall, there was no sexual dimorphism or bilateral asymmetry. This study coincides with the different theories about reducing the size of the teeth as evolutionary characteristic of hominids.

RESUMEN: Estudio observacional descriptivo de corte transversal en el que se determinó el APO de los segundos molars deciduos (55, 65, 75, 85) y de los primeros molares permanentes (16, 26, 36, 46) en 459 modelos de estudio correspondientes a seis grupos étnicos de Colombia: Indígenas embera del Alto Baudó (Chocó), mestizos caucasoides de Cali (Valle del Cauca), afrodescendientes de Cali (Valle del Cauca), indígenas misak de Silvia (Cauca), indígenas nasa de Morales (Cauca) e indígenas de Leticia (Amazonas). No se encontraron diferencias significativas en el APO de los seis grupos étnicos, excepto entre indígenas del Amazonas y de afrodescendientes de Cali, e indígenas embera e indígenas nasa. No se evidenció dimorfismo exual en ninguno de los seis grupos. Hubo simetría bilateral, excepto entre los dientes 16 y 26. La matriz de distancias demostró que los mestizos caucasoides de Cali se agrupan con poblaciones microdontes, indígenas del amazonas, indígenas embera, indígenas misak e indígenas nasa; mientras que los afrodescendientes de Cali se agrupan con poblaciones mesodentes. Los indígenas embera y del Amazonas presentaron altos valores del APO, asociado a su aislamiento relativo y bajo mestizaje. En términos generales, no hubo dimorfismo sexual ni asimetría bilateral. Los resultados de este estudio concuerdan con diferentes teorías sobre la reducción del tamaño dental como una característica evolutiva de los himínidos.

Lenvatinib in severe hypoglycemia associated with hepatocellular carcinoma.

We present the case of a 24-year-old male with multicentric hepatocellular carcinoma (HCC) over HBV-related compensated liver cirrhosis, on treatment with sorafenib and tenofovir. He had multiple admissions in recent months for severe hypoglycemia episodes with neurological symptoms.

Estudio de confirmación diagnóstica de esclerosis lateral amiotrófica, del hospital clínico Herminda Martín, entre los años 2006 y 2018 / Study of the time of diagnostic confirmation and survival of amyotrophic lateral sclerosis, from the hospital clinico Herminda Martín, between 2006 and 2018

ANTECEDENTES: Esclerosis lateral amiotrófica (ELA), enfermedad neurodegenerativa que afecta motoneuronas superiores e inferiores. Con un tiempo promedio de confirmación diagnóstica de 15,6 meses y una supervivencia a 3 años del diagnóstico del 50%. Existe escaso conocimiento de sintomatología inicial, produciendo retraso diagnóstico. OBJETIVOS: Determinar el tiempo de confirmación diagnóstica en pacientes con ELA, del HCHM entre 2006-2018, Identificar síntomas iniciales, determinar tiempo de supervivencia global y por sexo. MÉTODOS: Estudio longitudinal descriptivo analítico del tiempo de diagnóstico; síntomas primarios: i)trastornos motores; ii)trastornos de lenguaje y/o deglución; iii) ambos; y supervivencia de pacientes con ELA del HCHM entre 2006-2018. RESULTADOS: Entre 2016-2018 se diagnosticaron 19 pacientes con ELA, 47% mujeres (9) y 53% hombres (10); edad promedio al diagnóstico de 61,44 y 59,30, respectivamente. El tiempo de confirmación diagnóstica en mujeres fue 17,56 (ES ± 0,71) semanas y en hombres 34,80 (ES ± 0,68) semanas. En mujeres la frecuencia de diagnósticos primarios: 78% trastornos motores; 11% trastornos de lenguaje y/o deglución; 11% ambos, en hombres: 30% trastornos motores; 20% trastornos de lenguaje y/o deglución; 50% ambos. La media de supervivencia global fue 6,5 años. CONCLUSIONES: Existe diferencia significativa entre síntomas iniciales y según sexo, con predominio motor en mujeres y mixto en hombres. No existen diferencias significativas en tiempos diagnósticos ni supervivencia en ambos grupos, se destaca que sobrevivió el 50% de mujeres a los 7,2 años y 50% de hombres a los 6,3 años. No se diferencia un perfil clínico inicial.

BACKGROUND: Amyotrophic lateral sclerosis (ALS), neurodegenerative disease that affects the upper and lower motor neurons. With an average diagnostic confirmation time of 15,6 months and a 3-year survival from diagnosis of 50%. There is poor knowledge of initial symptoms, causing diagnostic delay. OBJECTIVES: To determine the diagnostic confirmation time in patients with ALS of HCHM between 2006-2018, Identify initial symptoms, determine overall survival time and by sex. METHODS: Descriptive analytical longitudinal study of diagnosis time; primary symptoms: i) motor disorders; ii) language and / or swallowing disorders; and iii) both; and survival of patients with ALS from HCHM between 2006-2018. RESULTS: Between 2016-2018, 19 patients with ALS were diagnosed, 47% women (9) and 53% men (10); average age at diagnosis of 61.44 and 59.30, respectively. The diagnostic confirmation time in women was 17.56 (ES ± 0.71) weeks and in men 34.80 (ES ± 0.68) weeks. In women, the frequency of primary diagnoses: 78% motor disorders; 11% language and / or swallowing disorders; 11% both, in men: 30% motor disorders; 20% language and / or swallowing disorders; 50% both. The mean overall survival was 6.5 years. CONCLUSIONS: There is a significant difference between initial symptoms and according to sex, with motor predominance in women and mixed in men. There are no significant differences in diagnostic times or survival in both groups, it is emphasized that 50% of women survived at 7.2 years and 50% of men at 6.3 years. An initial clinical profile is not differentiated.

Prophylactic perioperative antibiotic use in endoscopic sinus surgery: a systematic review and meta-analysis.

CONTEXT: Perioperative antibiotics are widely used to improve the outcomes of endoscopic sinus surgery. OBJECTIVE: The aim of this study was to summarize the evidence on the effect of perioperative antibiotic prophylaxis on outcomes of endoscopic sinus surgery. DATA SOURCES AND REVIEW METHODS: We searched electronic databases from inception through May 2011 for any relevant clinical trials or observational studies. Two reviewers working independently extracted study characteristics, quality, and the outcomes of interest. Random-effects meta-analysis was used to pool the relative risks (RRs) and the standardized mean differences (SMDs) across trials. RESULTS: We found 4 eligible trials with varying quality, of which 3 were included in the quantitative analysis. Antibiotic prophylaxis was associated with a nonsignificant reduction in the incidence of infections (relative risk, 0.76; 95% confidence interval [CI], 0.64 to 1.09), symptoms scores (SMD, -0.04; 95% CI, -0.46 to 0.38), and endoscopic scores (SMD, -0.09; 95% CI, 0.30 to 0.13). The heterogeneity associated with the analysis was significant only for the outcome of change in symptoms score (I-squared values, 0%, 70%, and 0% for the 3 outcomes, respectively). CONCLUSIONS: Trial data available to date are unable to demonstrate a statistically significant reduction in infection, symptom scores, or endoscopic scores to support the routine use of postoperative prophylactic antibiotics following endoscopic sinus surgery. Our analysis was limited by the number of published trials related to this topic.

Isolation and molecular identification of Leishmania ( Viannia ) peruviana from naturally infected Lutzomyia peruensis (Diptera: Psychodidae) in the Peruvian Andes

Leishmania (Viannia) peruviana was isolated from 1/75 Lutzomyia peruensis captured during May 2006 in an endemic cutaneous leishmaniasis region of the Peruvian Andes (Chaute, Huarochiri, Lima, Peru). Sand fly gut with promastigotes was inoculated into a hamster and the remaining body was fixed in ethanol. L. (Viannia) sp. was determined by polymerase chain reaction (PCR), and Leishmania species through molecular genotyping by PCR-restriction fragment length polymorphism analyses targeting the genes cpb and hsp70, resulting L. (V.) peruviana. The infected sand fly appeared 15 days after the rains finished, time expected and useful real time data for interventions when transmission is occurring.

Conocimiento de los odontólogos que laboran en las IPS de Medellín acerca del Sistema Integral de Información en Salud / Knowledge of the comprehensive health information system by dentists who work in Health Service Institutions in Medellín

El SIIS (Sistema Integral de Información en Salud) es un conjunto de componentes que procesan, almacenan, distribuyen información, sobre la salud de los usuarios de un servicio de salud; sirve para planear, hacer, verificar y controlar, tomar decisiones y proponer nuevas estrategias para el mejoramiento continuo de la organización. Se realizó un estudio descriptivo para evaluar el conocimiento de los odontólogos que laboran en diferentes IPS sobre el sistema de información, la importancia del diligenciamiento de los RIPS, capacitación recibida, realimentación, grado de dificultad y motivación por el correcto diligenciamiento. Se entrevistaron 140 odontólogos de cinco IPS públicas y privadas de Medellín. El 99 por ciento de los entrevistados manifestaron darle importancia al Sistema de información por que se conoce el perfil epidemiológico. El 69 por ciento tiene conocimiento sobre las RIPS, pero no identifican que significa dicha sigla; el 56.8 por ciento manifiesta haber recibido capacitación y el 84.6 por ciento informaron no recibir retroalimentación de los datos recolectados. Los odontólogos manifiestan que la mayor dificultad para recolectar los datos es el tiempo y la poca motivación por parte de la empresa en la que laboran. A pesar de identificar la importancia del SIIS, en términos del conocimiento de la situación de la salud oral de la población afiliada y beneficiaria, existe desmotivación por no recibir suficiente retroalimentación puesto que son ellos en el nivel operativo quienes están mas directamente relacionados con la situación de salud enfermedad de la población. Informan también no tener tiempo disponible para diligenciar los registros, por que consideran que tienen muchas actividades que realizar en su jornada laboral, además de la atención al usuario. La formación de los profesionales deben insistir con mayor profundidad en la importancia del sistema de información como herramienta gerencial y administrativa...