Plant Waste-Based Bioadditive as an Antioxidant Agent and Rheological Modifier of Bitumen.

In recent times, circular economy initiatives in addition to the need for sustainable biomaterials have brought about several attempts at the eco-friendly, eco-sustainable and cost-effective production of asphalt pavements. It is an increasingly common practice in the asphalt industry to improve road pavement performance using additives to enhance the physico-chemical properties of bitumen, which performs the role of the binder in the asphalt mix. This paper evaluated the potential of a bio-based additive derived from olive leaf residue as a modifier and antioxidant agent for bitumen. Samples of neat, aged and doped aged bitumen were analyzed. In this study, the two bio-based additives were characterized in terms of phenol, chlorophyll, lignin and cellulose content, which was correlated with the mechanical properties of the tested samples. The mechanical properties of the neat, modified, aged and unaged samples were evaluated via Dynamic Shear Rheology. The bio-based additives proved to be promising and can improve the properties of bitumen binder and the performance of asphalt pavements in general.

Starch/PVOH aqueous solutions: a chemical-physical characterization.

This work investigates the relationship between the structure and physicochemical properties of three different starches in starch/polyvinyl alcohol aqueous solutions. For this purpose, accurate nuclear magnetic resonance (NMR) analyses were performed to determine the role that the starch structure plays in the formation of binder solutions. Moreover, a dynamic shear rheometer (DSR) was used to investigate the mechanical properties of the solutions and correlate them with the structure of each starch. Complete characterization of the analysed starches and the starch/PVOH solutions was also carried out through light scattering measurements. Furthermore, by crossing the data coming from NMR and light scattering with those coming from rheology, the best solution was identified. Finally, to confirm the interaction mechanism between starch and PVOH, thermogravimetric analysis and an NMR study, using 1H and 13C NMR spectra, were carried out on the film obtained from the best solution. The analyses carried out showed that PVOH has a stabilizing effect on starch/PVOH solutions, and the starch with the greatest branching degree is the one that forms a more structured network.

Triacylglycerol Composition and Chemical-Physical Properties of Cocoa Butter and Its Derivatives: NMR, DSC, X-ray, Rheological Investigation.

In recent years, the food industry has become increasingly involved in researching vegetable fats and oils with appropriate mechanical properties (ease of transport, processing, and storage) and a specific lipidic composition to ensure healthy products for consumers. The chemical-physical behavior of these matrices depends on their composition in terms of single fatty acids (FA). However, as we demonstrate in this work, these properties, as well as the absorption, digestion and uptake in humans of specific FAs, are also largely determined by their regiosomerism within the TriAcylGlycerols (TAG) moieties (sn-1,2,3 positions). The goal of this work is to study for the first time vegetable fats obtained directly from a sample of natural cocoa butter (CB) through a process that manipulates the distribution of FAs but not their nature. Even if the initial percentage of each FA in the mixture remains the same, CB derivatives seem to show improved chemical-physical features. In order to understand which factors account for their physical and chemical characteristics, and to check whether or not the obtained new matrices could be considered as valid alternatives to other vegetable fats (e.g., palm oil (PO)), we carried out an experimental investigation at both the macroscopic and molecular level including: (i) Differential Scanning Calorimetry (DSC) analyses to examine thermal features; (ii) rheological testing to explore mechanical properties; (iii) powder X-ray diffraction (PXRD) to evaluate the solid-state phases of the obtained fats; and (iv) 1H and 13C Nuclear Magnetic Resonance (NMR, 1D and 2D) spectroscopy to rapidly analyze fatty acid composition including regioisomeric distribution on the glycerol backbone. These last results open up the possibility of using NMR spectroscopy as an alternative to the chromatographic techniques routinely employed for the investigation of similar matrices.

Solitary Extrapleural Fibrous Tumor in Salivary Glands: Our Experience-Case Series and Literature Review.

(1) Background: Extrapleural solitary fibrous tumors (ESFTs) are rare oncological entities occurring in the head and neck, and even more so in the salivary glands. The clinical presentation and histologic features are usually unspecific, resulting in frequent misclassification. As an unusual tumor, ESTFs have an unpredictable clinical behavior. (2) Methods: We present two clinical cases referred to our Maxillofacial Surgery Unit for the onset of a symptomless mass involving, in one case, the parotid gland, and in the other case, the sublingual gland. (3) Results: Solitary fibrous tumors could be considered as neoplasms with intermediate biological behavior that are not entirely predictable on the basis of morphological features, as these are mostly still unknown. However, a few histologic, immunohistochemical, and imaging features, such as a hypodense signal at the T1 sequence in an MRI, or positivity for CD34, bcl2, and CD99, and the NAB2-STATS6 fusion gene, could be useful for an early differential diagnosis of ESTFs. (4) Conclusions: All patients were alive at follow-up with no evidence of disease. Surgical management should always be considered as the first choice for oncological radicality, and clinical behavior should always be defined with the help of the study of radiological and anatomopathological features.

NMR Spectroscopy Applied to the Metabolic Analysis of Natural Extracts of Cannabis sativa.

Cannabis sativa is a herbaceous multiple-use species commonly employed to produce fiber, oil, and medicine. It is now becoming popular for the high nutritional properties of its seed oil and for the pharmacological activity of its cannabinoid fraction in inflorescences. The present study aims to apply nuclear magnetic resonance (NMR) spectroscopy to provide useful qualitative and quantitative information on the chemical composition of seed and flower Cannabis extracts obtained by ultra-sound-assisted extraction, and to evaluate NMR as an alternative to the official procedure for the quantification of cannabinoids. The estimation of the optimal ω-6/ω-3 ratio from the 1H NMR spectrum for the seed extracts of the Futura 75 variety and the quantitative results from the 1H and 13C NMR spectra for the inflorescence extracts of the Tiborszallasi and Kompolti varieties demonstrate that NMR technology represents a good alternative to classical chromatography, supplying sufficiently precise, sensitive, rapid, and informative data without any sample pre-treatment. In addition, different extraction procedures were tested and evaluated to compare the elaboration of spectral data with the principal component analysis (PCA) statistical method and the quantitative NMR results: the extracts obtained with higher polarity solvents (acetone or ethanol) were poor in psychotropic agents (THC < LOD) but had an appreciable percentage of both cannabinoids and triacylgliceroles (TAGs). These bioactive-rich extracts could be used in the food and pharmaceutical industries, opening new pathways for the production of functional foods and supplements.

Pseudoobstrucción colónica aguda (Sindrome de Ogilvie) posterior a una nefrectomía radical: Reporte de caso / Acute Colonic Pseudo-Obstruction (Ogilvie'S Syndrome) After Radical Nephrectomy: Case Report

El Sindrome de Ogilvie se caracteriza por una dilatación masiva del colon y una clínica sugestiva de obstrucción intestinal mecánica, sin causa orgánica. Presentamos un caso de dilatación aguda idiopática del colon secundaria a una cirugía abdominal. El objetivo de este reporte fue la descripción de una patología urológica inusual que puede pasarse por alto o tratarse como un íleo adinámico y, la revisión de la literatura relacionada con la definición, factores de riesgos, etiología, fisiopatología y el tratamiento de la misma. Paciente masculino de 61 años con antecedente de nefrectomía radical izquierda por tumor renal que, a las 48hs del alta hospitalaria, consultó por presentar distensión abdominal aguda. Se solicitó una radiografía abdominal y una tomografía computada que evidenciaba importante dilatación intestinal y un diámetro cecal mayor a 12cm. Se practicó una laparotomía exploradora de urgencia constatándose dilatación colónica del colon transverso y ascendente con un cambio de diámetro a nivel del ángulo esplénico, sin causa osbtructiva. Finalmente, se realizó colostomía en asa. A los 6 meses de seguimiento, la videocolonoscopía no mostró lesiones endoluminales concluyendo en un Sindrome de Ogilvie secundario a la nefrectomía. Finalmente, se efectuó reconstrucción del tránsito con buena evolución posterior. En nuestro caso, el Sindrome de Ogilvie fue una complicación postoperatoria y como fallaron las terapias conservadoras iniciales instauradas, este reporte provee una modalidad de tratamiento alternativo. Si se reconoce temprano y se trata adecuadamente, la pseudoobstrucción se resolverá en la mayoría de los pacientes y la tasa de mortalidad posterior será menor.

Ogilvie's Syndrome is characterized by massive dilation of the colon and symptoms suggestive of mechanical intestinal obstruction, without organic cause. We present a case of acute idiopathic dilation of the colon secondary to abdominal surgery. The aim of this case report was the presentation of an unusual pathology that can be overlooked or treated as adynamic ileus and the review of the literature addressing the definition, risk factors, etiology, pathophysiology and treatment of it. A 61-year-old male patient with a history of a left radical nephrectomy due to a renal tumor. At 48hs after from his hospital discharge, he consulted for presenting acute abdominal distension. An abdominal radiograph and a computed tomography scan showed evidence of dilated loops of bowel with caecal diameter more than 12 cm. An emergency laparotomy was performed with an evidence of ascending and transverse colon distension with diameter change at a splenic angle level, it showed no apparent cause. The surgical procedure ends with a loop transverse colostomy. At 6 months of follow up, the colonoscopy control did not show endoluminal injuries, we can infer a secondary Ogilviés syndrome to nephrectomy. Finally, the patient received a restoring intestinal and showed good progress. In our case, Ogilviés syndrome was a postoperative complication and as the initial conservative therapies implemented failed, this report provides an alternative treatment modality. If recognized early and treated appropriately, pseudo-obstruction will resolve in most patients and the subsequent mortality rate will be minor.

Análisis comparativo de las pautas del consejo de organizaciones internacionales de ciencias médicas (CIOMS)2016. (Parte 3 de 3) / Comparative analysis of the standards of the council of international organizations of medical sciences (CIOMS)2016. (Part 3 of 3)

El este tercer trabajo se presenta el análisis comparativo de las últimas pautas de CIOMS 2016, realizado por estudiantes de la VI Cohorte de la Maestría en Bioética como parte de la evaluación de la asignatura Bioética e Investigación. En estas pautas se abordan de forma novedosa temas tan importantes como la investigación en grupos vulnerables, en situaciones de desastre y brotes de enfermedades de orden natural o creadas por el hombre e investigaciones con conglomerados, así como la compensación por daños, manejo de datos cuando se utiliza el entorno virtual y herramientas digitales y el conflicto de interés, lo cual proporcionará a los investigadores un aporte en su formación y una rápida adaptación a la nueva propuesta CIOMS(AU)

In this third work, the comparative analysis of the latest CIOMS 2016 guidelines, carried out by students of the VI Cohort of the Master in Bioethics, as part of the evaluation of the subject Bioethics and Research is presented. These guidelines deal in a novel way with important issues such as research in vulnerable groups in situations of disaster and outbreaks of natural or man-made diseases and investigations with clusters, as well as compensation for damages, data management when the virtual environment and digital tools and the conflict of interest are used, which will provide researchers with a contribution in their training and a rapid adaptation to the new CIOMS proposal(AU)

Glioblastoma: Prognostic Factors and Predictive Response to Radio and Chemotherapy.

Glioblastoma multiforme (GBM) is characterized by poor prognosis despite an aggressive therapeutic strategy. In recent years, many advances have been achieved in the field of glioblastoma biology. Here we try to summarize the main clinical and biological factors impacting clinical prognostication and therapy of GBM patients. From that standpoint, hopefully, in the near future, personalized therapies will be available.

Oral Manifestations Associated to Paracoccidioidomicosis and Histoplasmosis

Objective: To determine the frequency and clinical forms of oral manifestations associated to Paracoccidioidomycosis (PCM) and Histoplasmosis. Material and Methods: 481 medical records of outpatients referred to the Medical Mycology Department were reviewed since 2009 to 2016. Data were analyzed using descriptive statistical methods. Results: 47 (9.77%) cases had oral manifestations, 29 (61.70%) were associated to PCM and 18 (38.29%) to histoplasmosis. For PCM, male-female ratio was 8:1 and 1:1 for histoplasmosis. The average age for PCM was 48 years old and 53 for histoplasmosis. All the PCM patients had more than 1 oral structure affected: 44.82% were gingival lesions and 27.58% palate. In patients with histoplasmosis, 6 (33.33%) were lesions affecting palate and 6 (33.33%) involving tongue. For both entities, painful ulcers and granulomatous-like lesions were the most prevalent clinical forms; however, we observed a wide range of other oral manifestations. Regarding PCM patient's comorbidities, 3 (10.34%) cases had HIV/AIDS, 8 (27.58%) histoplasmosis and 2 (6.89%) carcinomas. Whereas the comorbidities of patients with histoplasmosis, 2 (11.11%) had HIV/AIDS and 1 (5.55%) had carcinoma. Conclusion: In endemic countries for both mycoses, dentists must be aware of patients with mouth lesions, take advantage of epidemiologic clues that suggest risk factors and be acquainted with all the current diagnostic tests in order to make a quick diagnosis and treatment in highly suspicious cases.

Presentaciones atípicas de histoplasmosis: anemia hemolítica. Descripción de un caso y revisión de la literatura / Atypical presentations of histoplasmosis: hemolytic anemia. Case report and literature review

La histoplasmosis es una enfermedad granulomatosa, producida por Histoplasma capsulatum. Causa un amplio espectro de manifestaciones clínicas, la más frecuente es la pulmonar. En algunos casos se presentan formas diseminadas, con afectación de uno o múltiples órganos, con características atípicas, difíciles de reconocer. Reporte del caso: Se presenta el caso de un paciente masculino de 70 años de edad, procedente de Barinas, quien trabajó en una granja de gallinas, con diagnóstico de histoplasmosis y anemia hemolítica, las cuales se resolvieron con tratamiento antifúngico. Conclusiones: En Venezuela, zona endémica para esta micosis, el médico está obligado a tener un alto índice de sospecha acerca de la misma, teniendo en cuenta factores como la edad y la epidemiología. A la luz de nuestros conocimientos, es el tercer caso reportado.

Histoplasmosis is a granulomatous disease, produced by Histoplasma capsulatum. This fungus causes a wide range of clinical manifestations; the most common is the pulmonary form. In some cases, atypical presentations are described. Case report: a 70 year old male patient, from Barinas, Venezuela, who worked in a chicken farm, with diagnosis of histoplasmosis and hemolytic anemia is described. The patient improved with antifungal treatment. Conclusions: in Venezuela, an endemic area for this mycosis, clinicians must have a high suspicion index for this disease, taking into account risk factors, such as age and epidemiology. To our knowledge, this is the third case report in the literature.

Presentaciones atípicas de histoplasmosis / Atypical presentations of histoplasmosis

La histoplasmosis es una enfermedad granulomatosa, producida por Histoplasma capsulatum. Causa un amplio espectro de manifestaciones clínicas, la más frecuente es la pulmonar. En algunos casos se presentan formas diseminadas con afectación de uno o múltiples órganos, de características atípicas difíciles de reconocer. La patogenia de esta enfermedad es igual a la de tuberculosis y se ha descrito coinfección. Se reportan tres casos de histoplasmosis de presentación infrecuente: ancianos, coinfección con micobacterias, localizaciones atípicas y revisión de la literatura. El primer caso fue el de un paciente de 19 años de edad con absceso cerebral. El segundo y tercer caso correspondieron a personas mayores de 60 años, con coinfección por Histoplasma capsulatum y Mycobacterium sp, de presentación articular y enfermedad ginecológica, respectivamente. En Venezuela, zona endémica para esta micosis, el médico está obligado a tener un alto índice de sospecha acerca de la misma, teniendo en cuenta factores como la edad y la epidemiología. (Acta Med Colomb 2015; 40: 254-259).

Histoplasmosis is a granulomatous disease caused by Histoplasma capsulatum. It causes a wide spectrum of clinical manifestations, being the pulmonary the most common one. In some cases disseminated forms with involvement of one or multiple organs are manifested with atypical characteristics difficult to recognize. The pathogenesis of this disease is equal to that of TB and co-infection has been described. Three cases of infrequent presentation of histoplasmosis: elderly, co-infection with mycobacteria, atypical presentations and review of the literature are presented. The first case involved a 19-year-old with cerebral abscess. The second and third cases were for people over 60, co-infected with Histoplasma capsulatum and Mycobacterium sp, with joint involvement and gynecological disease, respectively. In Venezuela, endemic area for histoplasmosis, the doctor is required to have a high index of suspicion about this entity, taking into account factors such as age and epidemiology. (Acta Med Colomb 2015; 40: 254-259).

Concordancia entre los métodos del diagnóstico micológico de la paracoccidioidomicosis / Concordance between methods of mycological diagnosis of paracoccidioidomycosis

La paracoccidioidomicosis (PCM) es una enfermedad crónica, sistémica, granulomatosa, endémica en nuestro país, producida por un hongo dimorfo denominado Paracoccidioides brasiliensis. Existen numerosas técnicas para realizar el diagnóstico de esta entidad. Nos planteamos la posibilidad de realizar un estudio para determinar la concordancia que pudiese existir entre las diferentes técnicas que se utilizan para el diagnóstico de la PCM. Se realizó un registro de historias clínicas. Se evaluaron 251 historias clínicas de pacientes con diagnóstico de PCM, de la consulta externa de la Sección de Micología Médica “Dr. Dante Borelli” del IMT-UCV, entre los años 2000 y 2010. Se determinó la concordancia entre los métodos diagnósticos por medio del análisis de concordancia de atributos para datos binarios. Entre el examen directo y el cultivo, no hubo acuerdo. Entre la serología y el examen directo, se encontró que hubo equivalencia, así como entre el cultivo y la serología. No se pudo calcular correlación alguna con la histopatología, ya que no hubo datos negativos, en vista de que todas las muestras procesadas fueron positivas. El diagnóstico de la PCM se basa en la identificación y el aislamiento del hongo. Es obligatoria la realización del examen directo en fresco de toda muestra clínica. Nuestro estudio de muestra que deben realizarse todos los métodos que estén al alcance (examen directo en fresco, cultivo, serología, histopatología) a fin de aumentar la probabilidad de llegar a un diagnóstico certero de esta patología

Paracoccidioidomycosis (PCM) is a chronic, granulomatous disease, endemic in our country, produced by a dimorphic fungus, Paracoccidioides brasiliensis. Several techniques are used for the diagnosis. A study was performed to determine the agreement that could exist between the different techniques, used for the diagnosis of PCM. Clinical records of patients with diagnosis of PCM was made. 251 clinical records were reviewed, from the Sección de Micología Médica “Dr. Dante Borelli”, IMT- UCV, between 2000 and 2010. The agreement between the methods was determined by means of the analysis of agreement of attributes for binary data. Between direct examination and culture, there was no agreement. Between serology and direct examination, there was equivalence, as well as between culture and serology. Correlation could not be calculated with histopathology, since there were no negative data, due to the fact that all the processed samples were positive. The diagnosis of the PCM is based on the identification and isolation of the fungus. Direct examination is mandatory in all clinical samples. Our study demonstrates that all the methods must be performed (direct examination, culture, serology, histopathology) in order to increase the probability of reaching an accurate diagnosis

Epidemiology of sporotrichosis in Venezuela.

BACKGROUND: Sporotrichosis is one of the most common subcutaneous mycoses in Venezuela. It is a granulomatous chronic infection with cutaneous or subcutaneous tissue lesions. Regional lymphatic involvement may be present; extracutaneous disease is rare. The causal fungus Sporothrix schenckii has been isolated from soil, vegetation, and animals on numerous occasions and in many localities throughout the world. The aim of this study is to describe clinical and epidemiological features of cases of sporotrichosis observed in Venezuela and review of the literature. PATIENTS AND METHODS: We included the demographic data, clinical features, diagnostic methods, treatment, and follow-up of patients with sporotrichosis from 1963 to 2009, diagnosed at the Department of Medical Mycology. RESULTS: One-hundred and thirty-three sporotrichosis cases were diagnosed. Most patients were under the age of 30 years (66.15%). In 61.6% of them, the mode of transmission was not identified. The predominant clinical form in this population was lymphocutaneous (63.15%). Direct microscopic diagnosis was performed in 123 cases, and 57.9% yielded positive results for asteroid body. CONCLUSIONS: Sporotrichosis is an endemic subcutaneous mycosis in Venezuela. There are no reports to this date of disseminated forms of the disease, even amongst patients with acquired immunodeficiency syndrome. Direct microscopic examination of wet mount slides with saline solution or distilled water in the search for asteroid bodies is paramount. Saturated sodium and potassium iodine solutions continue to be extremely efficacious and affordable to most of our patients, therefore our treatment of choice.

Concordancia entre el exámen directo en fresco y tres métodos de laboratorio para el diagnóstico de la paracoccidioidomicosis / Concordance between direct fresh examination and three laboratory methods for the diagnosis of paracoccidioidomycosis

La paracoccidioidomicosis (PCM) es una enfermedad crónica, sistémica, granulomatosa, restringida a la América Latina .En nuestro país, es una de las micosis endémicas más importantes. Es producida por un hongo dimorfo denominado Paracoccidioides brasiliensis. En el presente trabajo se realizo un estudio retrospectivo de los pacientes con PCM, proveniente de la consulta externa de la Sección de Micología Médica "Dr. Dante Borelli" del Instituto de Medicina Tropical de la Universidad Central de Venezuela, en el lapso comprendido entre 2000-2010 con la finalidad de evaluar la consistencia diagnóstica del examen directo en fresco, el cultivo, la serología, y la histopatología. Se encontró que no hubo correlación entre los métodos o que esta fue muy baja; en tal sentido se recomienda que para el diagnóstico adecuado de la PCM es necesario utilizar los métodos en conjunto y que un resultado negativo de cualquiera de los métodos, no descarta la enfermedad, mientras que un resultado positivo lleva al diagnóstico de la misma

Paracoccidioidomycosis (PCM) is a chronic, systemic, granulomatous disease, restricted to Latin America. In our country, it is one of the most important endemic mycosis. It is produced by a dimorphic fungus named Paracoccidioides brasiliensis. In the present study, a retrospective of PCM patients was carried out, at the Section of Micología Médica "Dr. Dante Borelli", Instituto de Medicina Tropical, Universidad Central de Venezuela, between 2000-2010, with the purpose of evaluating the consistency of direct examination, related to other methods: culture, serology, and histopathology. We found that there was no correlation between the methods or that this was very low; in this regard it is recommended that for the proper diagnosis of PCM the use of all methods is required and that a negative test result does not rule out the disease, while a positive result by any of them leads to the diagnosis, taking into account the potential of each of the methods.

Paracoccidioidomicosis: clínica, epidemiología y tratamiento / Paracoccidioidomicosis: clinical considerations, epidemiology and treatment

Objetivo: caracterizar desde el punto de vista clínico, epidemiológico y de tratamiento, los pacientes con diagnóstico de paracoccidioidomicosis evaluados en la Consulta Externa de la Sección de Micología Médica del IMT-UCV y procedentes de otros hospitales del área de la Gran Caracas, cuyas muestras fueron procesadas en dicha Sección, entre los años 2001-2011. Métodos: estudio descriptivo de registros, donde se tomaron en cuenta las historias de los pacientes con diagnóstico de paracoccidioidomicosis. Resultados: la relación hombre:mujer obtenida fue de 6,5:1, sólo el 29,16% de los pacientes tenían ocupaciones agrícolas. Los síntomas más frecuentes fueron tos (50%) y pérdida de peso (45,06%) y los signos más comunes fueron lesiones en orofaringe (53,6%) y adenopatías (27,2%). 7,65% cursaron concomitantemente con infección por VIH/SIDA, 5,61% con tuberculosis y 6,63% con histoplasmosis. En cuanto al diagnóstico, el examen directo fue positivo en 87,5% de los casos, el cultivo en el 62,90% y la serología en el 88,46%. La mortalidad general fue de 4,11%. Discusión: La paracoccidioidomicosis es una enfermedad que puede ocurrir en pacientes inmunocompetentes e inmunocomprometidos; tiende a observarse ahora con mayor frecuencia en los pacientes con SIDA. El número de casos entre los pacientes del sexo femenino ha aumentado. La investigación acerca del lugar de origen, de la procedencia y la ocupación del paciente es importante a la hora de plantearse el diagnóstico. Esto debe ser tomado en consideración en un país endémico como el nuestro. Su diagnóstico es relativamente fácil en manos de personal entrenado.

Objective: to characterize from the clinical, epidemiological and treatment viewpoints, patients diagnosed with paracoccidioidomycosis and evaluated in the outpatient clinic of the Medical Mycology Section, at the IMT-UCV and from other hospitals in the greater Caracas area, whose samples were processed in this section between 2001-2011. Methods: descriptive study of records, taking into account the histories of patients diagnosed with paracoccidioidomicosis. Results: the male:female ratio obtained was 6.5:1; only 29.16% of the patients had agricultural occupations. The most common symptoms were cough (50%) and weight loss (45.06%), and the most common signs were oropharyngeal lesions (53.6%) and adenopathy (27.2%). Concomitantly, 7.65% had HIV/AIDS infection, 5.61% tuberculosis and 6.63% histoplasmosis. In terms of diagnosis, the direct exam was positive in 87.5% of cases, the culture in 62.90% and serology in 88.46%. Overall mortality was 4.11%. Discussion: paracoccidioidomycosis is a disease that can occur in immunocompetent and immunocompromised patients; currently, it tends to appear more frequently in patients with AIDS. The number of cases among female patients has increased. Research about the place of birth, the origin and the occupation of the patient is important when considering the diagnosis; this should be taken into consideration in an endemic country like Venezuela. Its diagnosis is relatively easy in the hands of trained personnel.

Detección e identificación de Candida dubliniensis por métodos fenotípicos en estomatitis sub-protésica: reporte de un caso / Detection and identification of methods for phenotypic Candida dubliniensis in denture stomatitis: report of case

La Estomatitis Sub-Protésica es una afección comúnmente observada en sujetos portadores de prótesis dentales removibles. Son numerosos los reportes publicados en los que se asocia esta patología con la presencia de hongos del Género Candida, y particularmente con Candida albicans. No obstante, algunas cepas identificadas como C. albicans, pudieran no tratarse en realidad de este microorganismo sino de Candida dubliniensis, más aún si se toma en cuenta que ambas especies producen clamidoconidias. Es por ello que resulta necesario comparar distintos métodos fenotípicos que permitan diferenciar en buena medida a ambas especies. En este artículo se describe el caso de una paciente portadora de prótesis removible superior con diagnóstico clínico de Estomatitis Sub-Protésica, a quien se le tomó muestras del paladar afectado y de la prótesis implicada. Se emplearon diferentes métodos fenotípicos de identificación diferencial de ambas especies, entre estos: CHROMagar Candida, Agar tabaco, Agar Pal´s, Agar Tween 80, medio de tomate y zanahoria y de Agar Sabouraud con NaCl al 6,5% (P/V). También se realizaron la pruebas de termotolerancia a 45ºC, aglutinación en latex, así como la identificación a través del sistema ID 32C (bioMerieux). Una vez empleados los métodos antes mencionados, la especie encontrada en el paladar de la paciente fue C. dubliniensis, en tanto que la que se halló en la prótesis fue C. albicans, siendo esta la primera vez que se detecta e identifica en nuestro país a C.dubliniensis en pacientes que presentan esta patología bucal.

Denture stomatitis is a condition commonly observed in subjects with removable dentures. There are numerous reports published in which this disease is associated with the presence of fungi of the genus Candida, particularly Candida albicans. However, some strains identified as C. albicans, may not actually be this organism but Candida dubliniensis, especially if one takes into account that both species produce clamidoconidias. That is why it is necessary to compare different phenotypic methods to differentiate largely to both species. This article describes the case of a patient with upper removable prosthesis with a clinical diagnosis of Denture Stomatitis, whom he took samples of the palate is affected and the prosthesis involved. Different methods were used phenotypic differential identification of both species, among them: CHROMagar Candida Agar snuff, Pal's Agar, Tween 80 Agar, tomato and carrot medium, and Sabouraud Agar with 6.5% NaCl (P / V ). Also thermotolerance tests performed at 45 ° C, latex agglutination, and identification by ID 32C system (bioMerieux) were used. Once employed the above methods, the species found in the mouth of the patient was C. dubliniensis, whereas that was found in the prosthesis was C. albicans, marking the first time it is detected and identified in our country C.dubliniensis in patients with this oral pathology.

Acute disseminated encephalomyelitis presenting as fever of unknown origin: case report.

BACKGROUND: Fever of unknown origin (FUO) can be defined as a body temperature higher than 38.3°C on several occasions over more than 3 weeks, the diagnosis of which remains uncertain after 1 week of evaluation. Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disease of the central nervous system with a wide range of clinical manifestations. The highest incidence of ADEM is observed during childhood and it usually occurs following a viral or bacterial infection or, more rarely, following a vaccination, or without a preceding cause. CASE PRESENTATION: Here, we describe an atypical case of ADEM that initially manifested as several weeks of FUO in a fifteen years old boy. CONCLUSIONS: This case report suggests a new possible syndromic association between ADEM and FUO, which should be considered in the clinical examination of patients with FUO, especially in the presence of also modest neurologic or neuropsychiatric symptoms.

Estudio de Infecciones diseminadas por candida en pacientes con neutropenia febril asociada a enfermedades hemato-oncológicas / Study disseminated Candida infections in patients with febrile neutropenia associated with hemato-oncological diseases

Mundialmente, en las últimas dos décadas se ha observado un incremento en la frecuencia de las infecciones micóticas diseminadas, con alta morbi-mortalidad, particularmente importante en las infecciones por Candida. El objetivo es determinar la frecuencia de candidiasis diseminada, en pacientes con enfermedades hemato-oncológicas o aplasia medular que ingresaron a los servicios de medicina interna del hospital universitario de caracas, con fiebre y neutropenia, entre enero y septiembre de 2010, realizándose evaluación exhaustiva y tomándose muestras de sangre, además de otras muestras en caso de presencia de lesiones, para el diagnóstico micológico. Se evaluaron 48 pacientes en el período del estudio, diagnósticandose 21 casos (43,75%) de micosis diseminadas, catalogadas como infecciones probadas en 13 y probables en 8 casos. De las infecciones probadas 8 (38%) correspondieron a infecciones por Candida: en uno se aisló Candida albicans y en 7, Candida no albicans: 2 pacientes con candida tropicalis, 2 con candida glabatra y uno con candida guillermondii. Dos cepas fueron informadas como candida spp, y 5 por otros hongos. Las infecciones micóticas diseminadas contribuyen sustancialmente a la morbimortalidad de los pacientes con neutropenia, por lo tanto es fundamental la sospecha y diagnóstico temprano de estas entidades en los pacientes con cáncer de origen hematológico y aplasia medular.

Wordwide, there has been an increase in the incidence of disseminated fungal diseases during the last two decades, with high morbidity and mortality particularly importante in Candida infections. To determine the frequency of disseminated candidiasis in patients with hemato-oncological diseases or bone marrow aplasia and febrile neutropenia. A descriptive, prospective and analytical study was conducted. Patients with hemato-oncological diseases or bone marrow aplasia who were hospitalized at the internal medicine service of the hospital universitrio de caracas, with fever and neutropenia, between january and september, 2010 were included, making torough assessment and taking blook samples as well as other clinical specimen when other lesions were present, for mycological diagnosis. During the study period, 48 patients were evaluated. Twenty one cases were diagnosed (43.75%) as disseminated fungal disease. They were classified as proven in 13 cases and probable in 8. From the proven diseases, 8 (38%) corresponded to Candida infections: in one, Candida albicans was isolated and in 7, Candida non-albicans: 2 patients with Candida tropicalis were found, 2 with Candida glabrata and one with Candida guillermondii. Two were reported as Candida spp. In 5 patients other fungi were found. Dissemiated fungal infections substantially contribute to morbidity and mortality in neutropenic patients. For this reason, awareness and early diagnosis of this disease are crucial are crucial in patients with hematological cancer and bone marrow aplasis.

Estudio de casos de paracoccidioidomicosis infantil diagnosticados en el área de la Gran Caracas Venezuela / Study paracoccidioidomycosis diagnosed cases of childhood in the area of Greater Caracas Venezuela

La paracoccidioidomicosis pocas veces afecta niños y no es de denuncia obligatoria. Su verdadero impacto en la población infantil es desconocido. El objetivo fue determinar en número de casos de paracoccidioidomicosis infantil diagnosticados en centros de salud de la Gran Caracas, en niños con edades entre 0-15 años. Se evaluaron historias de niños con paracoccidioidomicosis, provenientes de hospitales de la Gran Caracas. Se revisaron 420 historias con diagnóstico de paracoccidioidomicosis, de las cuales 33 (7,9%) fueron niños menores de 15 años, siendo la media de edad 7,97 años. El género masculino predominó (69,7%), la razón masculino-femenino fue 1,5:1 en niños con edades de 0-7 años y 5,5:1 entre 8-15 años. La mayoría procedían del estado Miranda, 11 (35,5%) seguido del Distrito Capital 9 (29,1%). En 26 casos se clasificó la enfermedad, encontrando que 24 (92,3%) desarrollaron la forma aguda. Las principales manifestaciones clínicas precisadas en 25 historias fueron: fiebre 18 (72%) adenomegalias 16 (64%), hepatomegalia 12 (48,0%) y esplenomegalia 11 (44%). De 24 casos que tenían datos de laboratorio se observó que la eosinofilia y la anemia fueron los principales hallazgos. El diagnóstico micológico se realizó por serología en 24 (72,7%) casos, biopsia 11 (45,8%), examen directo 3 (12,5%) y cultivo 1 (4,2%). La paracoccidioidomicosis infantil es una entidad infrecuente, la cual se observa en 7,9% de los casos. Las manifestaciones más frecuentes son fiebre, adenomegalias y hepatoesplenomegalia. El diagnóstico de la paracoccidioidomicosis aguda infantil, siempre debe ser considerado en niños con edades de 0-15 años, en Venezuela.

Paracoccidioidomycosis rarely affects children, and it is not a notifiable disease. Its real impact in the child population is unknown. The aim of the study was to determine the number of paracoccidioidomycosis cases diagnosed in various health centers in Great Caracas, in children between 0-15 years. We reviewed 420 records with diagnosis of paracoccidioidomycosis from Hospital of Caracas. 33 (7,9%) were from children less than 15 years old. Age average 7,97 years. Male gender accounted for 69.7%, with a male: female relation of 1.5:1 in children between 0-7 years and 5,5:1 between 8-15 years. Most of the patients 11 (35,5%) came from Miranda state, followed bu Distrito Capital 9 (29,1%). In 26 patients the disease could be classified, from which 24 (92,3%) developed the acute form. Clinical manifestations, recorded in 25 cases were: fever 18 (72%), enlarged lymph nodes 16 (64%), hepatomegaly 12 (48,0%) and splenomegaly 11 (44%). From 24 cases in which laboratory data was recorded, eosinophilia and anemia were the most relevent findings. Mycological diagnosis was performed by serology in 24 (72,7%) cases, biopsy 11 (45,8%), direct examination 3 (12,5%) and culture 1 (4,2%). Child paracoccidioidomycosis is a rare disease, observed in 7, )% of cases. Most relevant clinical manifestations are fever, enlarged lymph nodes and hepatosplenomegaly. Acute paracoccidioidomycosis must be considered as a possible diagnosis in children between 0-15 years, in endemic countries such as Venezuela.