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1.
Indian J Tuberc ; 69(1): 113-119, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-35074143

RESUMEN

Cutaneous tuberculosis classically presents as Lupus vulgaris, scrofuloderma, tuberculosis verrucose cutis and tubercular abscess. Hypersensitivity reaction to the bacilli leads to Lichen scrofulosorum and papulonecrotic tuberculids. At the same time, it can have myriad of clinical presentations, many of which are still undescribed. It is important to regularly update ourselves with these unusual manifestations so as to ensure early treatment and reduction of overall morbidity. In this case series tuberculosis manifesting as rapidly progressing diffuse facial granulomas, sporotrichoid tuberculosis, tuberculosis mimicking squamous cell carcinoma, scrofuloderma as tubercular ulcer, lupus vulgaris with nasal septal perforation, lupus vulgaris resembling furuncle, psoriasis, dermatitis and BT Hansen are described in immunocompetent individuals. These cases highlight the importance of recognition of atypical forms of cutaneous tuberculosis to minimize scarring and dissemination of bacilli.


Asunto(s)
Carcinoma de Células Escamosas , Lupus Vulgar , Tuberculosis Cutánea , Humanos , Lupus Vulgar/diagnóstico , Lupus Vulgar/tratamiento farmacológico , Tuberculosis Cutánea/diagnóstico , Tuberculosis Cutánea/tratamiento farmacológico
3.
Artículo en Inglés | MEDLINE | ID: mdl-34909659

RESUMEN

In this study novel derivatives of 1,2,4-triazole pyridine coupled with Schiff base were obtained in altered aromatic aldehyde and 4-((5-(pyridin-3-yl)-4H-1,2,4-triazol-3-ylthio)methyl)benzenamine reactions. Thin layer chromatography and melting point determination were employed to verify the purity of hybrid derivatives. The structures of the hybrid derivatives were interpreted using methods comprising infrared, nuclear magnetic resonance, and mass spectroscopy. The in vitro anti-microbial properties and minimum inhibitory concentration were determined with Gram-positive and Gram-negative bacteria. Among the derivatives produced, two derivatives comprising (Z)-2-((4-((5-(pyridine-3-yl)-4H-1,2,4-triazol-3-ylthio)methyl)phenylimino)methyl)phenoland (Z)-2-methoxy-5-((4-((5-(pyridine-3-yl)-4H-1,2,4-triazol-3- ylthio)methyl)phenylimino)methyl)phenol obtained promising results as antibacterial agents. After synthesizing different derivatives, docking studies were performed and the scores range from -10.3154 to -12.962 â€‹kcal/mol.

4.
Kathmandu Univ Med J (KUMJ) ; 19(73): 17-21, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34812152

RESUMEN

Background Determination of Amniotic Fluid Index (AFI) is an important component of antepartum assessment of all normal pregnancies. Objective To compare the obstetric interventions and neonatal outcomes in term pregnancies with borderline Amniotic Fluid Index versus normal Amniotic Fluid Index. Method This hospital based prospective study was conducted at Tribhuwan University Teaching Hospital over 1 year between 2017 and 2018 in 128 women having uncomplicated term pregnancy admitted in labor ward. Of the 128 women, 64 women had borderline Amniotic Fluid Index (5.1-8 cm) and 64 normal AFI (8.1 - 24 cm). Parameters studied were induction of labor, cesarean section, instrumental delivery, intrapartum abnormal fetal heart rate, meconium staining of liquor, APGAR score at 5 and 7 minutes, birth weight, neonatal intensive care unit (NICU) admission and neonatal death. Data was analyzed using software OpenEpi. Result Statistically significant difference in result was obtained in the two groups in terms of rate of induction of labor (73.4% vs 35.9%, p = 0.0001, OR = 4.9), rate of cesarean section (42.1% vs 28 .1%, p = 0.04, OR = 1.8), tachypnea (50% vs 11.1%, p = 0.01) and low birth weight (9.1% vs 4.5%, p = 0.04). No statistical significance was found in meconium staining of liquor (33% vs 38.3%, p = 0.3) and APGAR score of <7 at 5 minutes (3.1% vs 1.5%, p = 0.06). There were no neonatal intensive care unit admissions and neonatal mortality in any of the babies. Conclusion Detection of amniotic fluid volume at term is important for timely maternal interventions to improve the overall fetal outcome.


Asunto(s)
Líquido Amniótico , Cesárea , Parto Obstétrico , Femenino , Humanos , Recién Nacido , Embarazo , Resultado del Embarazo , Estudios Prospectivos
5.
Br J Surg ; 108(9): 1104, 2021 09 27.
Artículo en Inglés | MEDLINE | ID: mdl-34160031
6.
BJA Educ ; 21(7): 270-277, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-34178384
7.
Ann R Coll Surg Engl ; 103(3): 191-196, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33645271

RESUMEN

INTRODUCTION: Squamous cell carcinoma is the most common variant of anal malignancy. Certain disease-related factors have been established in determining survival. These include tumour size, differentiation and nodal involvement. Other factors such as HIV status, human papillomavirus infection, smoking and socioeconomic disparity may have important roles, however few data are available on the UK population. We aim to correlate social deprivation and survival of anal cancer patients at a tertiary centre. MATERIALS AND METHODS: All consecutive cases diagnosed with anal squamous cell carcinoma and treated as per local protocol between July 2010 and April 2017 were included. The pathological and demographical details were collected from a prospectively maintained database. Socioeconomic deprivation was defined for each postcode using the Index of Multiple Deprivation decile compiled by local governments in England. Survival was estimated using Kaplan-Meier analysis and Cox regression was used to investigate the effect of different factors on overall survival. RESULTS: A total of 129 patients with anal squamous cell carcinoma over a median follow-up of 43 months were included. Overall survival for the entire patient cohort was 87.7% (95% confidence interval, CI, 82.0-93.7%), 75.5% (95% CI 67.5-84.5%) and 68.9% (95% CI 59.7-79.6%) at one year, three years and five years, respectively. On multivariate analysis, Index of Multiple Deprivation and income do not significantly influence overall survival (p = 0.79, hazard ratio, HR, 1.07; 95% CI 0.61-1.63), (p = 0.99, HR=1.00; 95% CI 0.61-1.63), respectively. Increased risk of death was observed for male sex (p = 0.02, HR=2.80; 95% CI 1.02-5.50) and larger tumour size (p = 0.01, HR=1.64; 95% CI 1.12-2.41). CONCLUSION: In contrast to US studies, there is little difference in survival between the least deprived and most deprived groups. We attribute this to equal access to intensity-modulated radiation therapy-based chemoradiotherapy. Thus, a highly effective treatment made available to all mitigates any survival difference between socioeconomic groups.


Asunto(s)
Neoplasias del Ano/mortalidad , Carcinoma de Células Escamosas/mortalidad , Estatus Económico , Clase Social , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias del Ano/patología , Neoplasias del Ano/terapia , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/terapia , Quimioradioterapia , Estudios de Cohortes , Femenino , Humanos , Renta , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Modelos de Riesgos Proporcionales , Radioterapia de Intensidad Modulada , Características de la Residencia , Factores Sexuales , Tasa de Supervivencia , Carga Tumoral , Reino Unido
8.
Toxicol Lett ; 341: 59-67, 2021 May 01.
Artículo en Inglés | MEDLINE | ID: mdl-33548342

RESUMEN

Toxicological risk assessment of medical devices requires genotoxicity assessment as per ISO 10993, Part 3, which is designed to address gene mutations, clastogenicity and/or aneugenicity endpoints. 'Site of contact genotoxicity' is a potential genotoxic risk especially for medical implants, that is currently not addressed in biocompatibility standards. We therefore performed initial validation study on the use of alkaline single cell gel electrophoresis (comet assay) for detecting 'site of contact genotoxicity' of medical devices, using test items made of acrylic implants impregnated with ethyl methanesulphonate (EMS). Comet assay detected increased DNA migration at the site of implantation, but not in the liver. The same implants also failed to show any genotoxicity potentials, when tested on the standard test battery using Salmonella/microsome and chromosome aberration assays. The study suggested that some medical implants can cause 'site of contact genotoxicity', without producing systemic genotoxicity. In conclusion, comet assay will add new dimension to safety assessment of medical devices, and this assay can be added to the battery of genetic toxicology tests for evaluating biocompatibility of medical implants.


Asunto(s)
Resinas Acrílicas/química , Ensayo Cometa/métodos , Metanosulfonato de Etilo/toxicidad , Ensayo de Materiales , Prótesis e Implantes , Animales , Metanosulfonato de Etilo/administración & dosificación , Metanosulfonato de Etilo/química , Hepatocitos/efectos de los fármacos , Ratas , Ratas Wistar , Agua
9.
Sci Rep ; 11(1): 2055, 2021 01 21.
Artículo en Inglés | MEDLINE | ID: mdl-33479392

RESUMEN

The repeatability and reproducibility of radiomic features extracted from CT scans need to be investigated to evaluate the temporal stability of imaging features with respect to a controlled scenario (test-retest), as well as their dependence on acquisition parameters such as slice thickness, or tube current. Only robust and stable features should be used in prognostication/prediction models to improve generalizability across multiple institutions. In this study, we investigated the repeatability and reproducibility of radiomic features with respect to three different scanners, variable slice thickness, tube current, and use of intravenous (IV) contrast medium, combining phantom studies and human subjects with non-small cell lung cancer. In all, half of the radiomic features showed good repeatability (ICC > 0.9) independent of scanner model. Within acquisition protocols, changes in slice thickness was associated with poorer reproducibility compared to the use of IV contrast. Broad feature classes exhibit different behaviors, with only few features appearing to be the most stable. 108 features presented both good repeatability and reproducibility in all the experiments, most of them being wavelet and Laplacian of Gaussian features.


Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas/diagnóstico , Procesamiento de Imagen Asistido por Computador , Aprendizaje Automático , Tomografía Computarizada por Rayos X , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Pulmón de Células no Pequeñas/diagnóstico por imagen , Carcinoma de Pulmón de Células no Pequeñas/patología , Estudios de Cohortes , Simulación por Computador , Femenino , Humanos , Imagen por Resonancia Magnética/normas , Masculino , Persona de Mediana Edad , Fantasmas de Imagen/normas , Reproducibilidad de los Resultados
10.
J Clin Tuberc Other Mycobact Dis ; 22: 100207, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33364444

RESUMEN

BACKGROUND: Globally, Tuberculosis (TB) is one of the top 10 causes of death. In Nepal, poverty and malnutrition aggravate the burden of TB. To identify Mycobacterium tuberculosis sputum is the best sample to identify the bacterium which is helpful for diagnosis. The aim of this study is to identify the situation, burden and challenges of pulmonary tuberculosis in low-middle income country like Nepal. METHOD: A retrospective-audit with reliable-secondary-data of one year was collected (n = 4131). Descriptive-analysis was performed using frequency, percentage and analytical using chi-square-test. Level of significance was set at p < 0.05. Ethical Approval was obtained from IRC-PAHS. RESULT: The prevalence of notified/suspected cases was highest among the patients having >60 years of age 1344(32.54%) and least among the patients with ≤15 years of age 239(5.79%). The male had 1.67 times more smear-positive pulmonary TB cases. Among the AFB-positive cases, smear 3+ was seen in most of the cases 69(38.54%) followed by smear 1+ and smear 2+ in 56(31.28%) and 54(30.16%) respectively. CONCLUSION: The prevalence of smear-positive pulmonary TB case is higher in male. Smear 3+ is seen in most of the followed by smear 1+ and smear 2+. The Burden of Pulmonary TB is more among adult and old-age-people and its control is a challenge for developing and low-middle income countries like Nepal.

12.
SAR QSAR Environ Res ; 31(11): 869-881, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33100034

RESUMEN

Ligand-based pharmacophore modelling and virtual screening along with in vitro screening were performed as a rational strategy for the identification of novel compounds as apoptosis inducers and anticancer agents from the chemical database. Known apoptosis inducers were selected from the literature for generation of pharmacophore models, which were subjected to validation using Receiver operating characteristic (ROC) and Günere-Henry (GH) scoring methods. Based on highest fitness score of 4680.61, ROC value of 0.872 and GH score of 0.758, pharmacophore model-2 was selected as the best model. Model-2 as 3D search query was searched against the IBS database to find novel compounds as hits. Three hits were selected with a QFIT value more than 82 for in vitro screening as apoptosis inducers and anticancer agents. In vitro anticancer activity was performed using resazurin cell variability assay, and apoptosis inducing activity was determined using caspase-3 activation and annexin-FITC assays. One of the retrieved hit, STOCK5S-44056 demonstrated IC50 value of 23.56 µM in cell variability assay, and had EC50 value of 26.95 µM in caspase-3 activation assay. STOCK5S-44056 also indicated late stage induction of apoptosis in annexin assay. The results of in vitro activity revealed that STOCK5S-44056 has a potential to become anticancer agents.


Asunto(s)
Antineoplásicos/química , Apoptosis/efectos de los fármacos , Diseño de Fármacos , Relación Estructura-Actividad Cuantitativa , Animales , Bases de Datos de Compuestos Químicos , Humanos , Ligandos , Modelos Moleculares
13.
AJNR Am J Neuroradiol ; 41(10): 1825-1832, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-33023913

RESUMEN

BACKGROUND AND PURPOSE: A new transtentorial venous system consisting of medial, intermediate, and lateral tentorial veins, connecting infra- and supratentorial compartments, was recently shown in 2 cadaver dissections and 2 patient scans. We sought to characterize the venous patterns within the tentorium and their relation to measures of skull development in a cohort of healthy adults. MATERIALS AND METHODS: We retrospectively reviewed tentorial venous anatomy of the head using CTA/CTV performed for routine care or research purposes in 238 patients. Included studies had adequate contrast opacification of venous structures and a section thickness of ≤2 mm; we excluded cases with space-occupying lesions and vascular pathologies. Tentorial angle, dural sinus configurations, and measures of skull base development were assessed as predictors of tentorial venous anatomy variation via Cramér V association, the binary encoded Pearson correlation, and nearest-point algorithm with the Euclidean distance metric for clustering. RESULTS: Tentorial vein development was related to the ringed configuration of the tentorial sinuses (P < .005). There were 3 configurations. Groups 1A and 1B (n = 50/238) had ringed configuration, while group 2 did not (n = 188/238). Group 1A (n = 38/50) had a medialized ringed configuration, and group 1B had a lateralized ringed configuration (n = 12/50). Measurements of skull base development were predictive of these groups. The ringed configuration of group 1 was related to the presence of a split confluens, which correlated with a decreased internal auditory canal-petroclival fissure angle. Configuration 1A was related to the degree of petrous apex pneumatization (P value = .010). CONCLUSIONS: Variations in the transtentorial venous system directly correlate with cranial development.


Asunto(s)
Senos Craneales/anatomía & histología , Duramadre/irrigación sanguínea , Cadáver , Humanos
14.
Kathmandu Univ Med J (KUMJ) ; 18(71): 275-278, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-34158436

RESUMEN

Background Ultrasonography is the easily available, cheap and reliable method for evaluation of ovaries. Ovarian volume is the major factor in the diagnosis of various ovarian pathologies and confusing discrepancies are found in the literature. Objective To determine the ovarian volume among individuals attending outpatient department in tertiary level hospital. Method Descriptive cross sectional study design was used; 305 patients of 16-60 years attending general outpatient department in the Tribhuvan University Teaching Hospital, Kathmandu, Nepal were included. Ovarian volume was calculated by using transabdominal ultrasonography. Data was collected in the predesigned proforma and analyzed using statistical package for the social sciences software. Result The study showed mean total ovarian volume 5.95 ± 2.44 cc (centimeter cube) with mean right ovarian volume 5.94 ± 2.70 cc and mean left ovarian volume 6.05 ± 2.79 cc. Significant decrease in ovarian volume with age was observed. Height and weight did not show significant correlation with ovarian volumes and no significant variation seen in the volumes of right and left ovaries. Periovulatory ovaries show significantly higher volumes on right side than luteal phase. Similarly, significantly higher volume of left ovary seen in mixed ethnic group than mongoloid group. Conclusion Measurement of ovarian volume is important for evaluation and management of ovarian disorders. Ultrasonography which is readily available, simple and cost effective is better suited for our environment than other imaging modality. Values of ovarian volume from this study may provide a baseline of normal ovarian volume in our community.


Asunto(s)
Pacientes Ambulatorios , Ovario , Adulto , Estudios Transversales , Femenino , Hospitales de Enseñanza , Humanos , Nepal , Ovario/diagnóstico por imagen , Ultrasonografía , Universidades
15.
Mem Cognit ; 48(1): 16-31, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31385241

RESUMEN

Cognitive control, which allows for the selection and monitoring of goal-relevant behavior, is dynamically upregulated on the basis of moment-to-moment cognitive demands. One route by which these demands are registered by cognitive control systems is via the detection of response conflict. Yet working memory (WM) demands may similarly signal dynamic adjustments in cognitive control. In a delayed-recognition WM task, Jha and Kiyonaga (Journal of Experimental Psychology: Learning, Memory, & Cognition, 36(4), 1036-1042, 2010) demonstrated dynamic adjustments in cognitive control via manipulations of mnemonic load and delay-spanning cognitive interference. In the present study, we aimed to extend prior work by investigating whether affective interference may similarly upregulate cognitive control. In Experiment 1, participants (N = 89) completed a delayed-recognition WM task in which mnemonic load (memory load of one vs. two items) and delay-spanning affective interference (neutral vs. negative distractors) were manipulated in a factorial design. Consistent with Jha and Kiyonaga, the present results revealed that mnemonic load led to dynamic adjustments in cognitive control, as reflected by greater performance on trials preceded by high than by low load. In addition, we observed that affective interference could trigger dynamic adjustments in cognitive control, as evinced by higher performance on trials preceded by negative than by neutral distractors. These findings were subsequently confirmed in Experiment 2, which was a pre-registered replication study (N = 100). Thus, these results suggest that in addition to dynamic adjustments as a function of mnemonic load, affective interference, similar to cognitive interference (Jha & Kiyonaga Journal of Experimental Psychology: Learning, Memory, & Cognition, 36(4), 1036-1042, 2010), may trigger dynamic adjustments in cognitive control during a WM task.


Asunto(s)
Afecto/fisiología , Atención/fisiología , Función Ejecutiva/fisiología , Memoria a Corto Plazo/fisiología , Reconocimiento en Psicología/fisiología , Análisis y Desempeño de Tareas , Adulto , Femenino , Humanos , Masculino , Adulto Joven
17.
Sci Rep ; 9(1): 14469, 2019 10 09.
Artículo en Inglés | MEDLINE | ID: mdl-31597949

RESUMEN

Scaffolds and implants in orthopaedics and regenerative dentistry usually fail because of bacterial infections. A promising solution would be the development of biomaterials with both significant regenerative potential and enhanced antibacterial activity. Working towards this direction, fluorapatite was synthesised and doped with Sr2+ and Ce3+ ions in order to tailor its properties. After experiments with four common bacteria (i.e. E. Coli, S. Aureus, B. Subtilis, B. Cereus), it was found that the undoped and the Ce3+ doped fluorapatites present better antibacterial response than the Sr2+ doped material. The synthesised minerals were incorporated into chitosan scaffolds and tested with Dental Pulp Stem Cells (DPSCs) to check their regenerative potential. As was expected, the scaffolds containing Sr2+-doped fluorapatite, presented high osteoconductivity leading to the differentiation of the DPSCs into osteoblasts. Similar results were obtained for the Ce3+-doped material, since both the concentration of osteocalcin and the RUNX2 gene expression were considerably higher than that for the un-doped mineral. Overall, it was shown that doping with Ce3+ retains the good antibacterial profile of fluorapatite and enhances its regenerative potential, which makes it a promising option for dealing with conditions where healing of hard tissues is compromised by bacterial contamination.


Asunto(s)
Antibacterianos/administración & dosificación , Periimplantitis/tratamiento farmacológico , Apatitas/química , Materiales Biocompatibles/química , Diferenciación Celular , Células Cultivadas , Cesio/química , Quitosano/química , Pulpa Dental/citología , Humanos , Ensayo de Materiales , Microscopía Electrónica de Rastreo , Osteoblastos/citología , Periimplantitis/patología , Periimplantitis/fisiopatología , Endodoncia Regenerativa/métodos , Células Madre/citología , Estroncio/química , Andamios del Tejido/química
18.
Phys Med Biol ; 64(18): 185007, 2019 09 18.
Artículo en Inglés | MEDLINE | ID: mdl-31470417

RESUMEN

Imaging systems are often modeled as continuous-to-discrete mappings that map the object (i.e. a function of continuous variables such as space, time, energy, wavelength, etc) to a finite set of measurements. When it comes to reconstruction, some discretized version of the object is almost always assumed, leading to a discrete-to-discrete representation of the imaging system. In this paper, we discuss a method for single-photon emission computed tomography (SPECT) imaging that avoids discrete representations of the object or the imaging system, thus allowing reconstruction on an arbitrarily fine set of points.


Asunto(s)
Imagenología Tridimensional/métodos , Algoritmos , Fantasmas de Imagen , Tomografía Computarizada de Emisión de Fotón Único
19.
Orphanet J Rare Dis ; 14(1): 181, 2019 07 22.
Artículo en Inglés | MEDLINE | ID: mdl-31331350

RESUMEN

BACKGROUND: Phenylketonuria (PKU) is an inherited deficiency in the enzyme phenylalanine hydroxylase (PAH), which, when poorly-managed, is associated with clinical features including deficient growth, microcephaly, seizures, and intellectual impairment. The management of PKU should start as soon as possible after diagnosis to prevent irreversible damage and be maintained throughout life. The aim of this study was to assess the burden of illness in PKU patients in general and in PKU patients born before and after the introduction of newborn screening in Germany. METHODS: This retrospective matched cohort analysis used the Institut für angewandte Gesundheitsforschung Berlin (InGef) research database containing anonymized healthcare claims of approximately 4 million covered lives. PKU patients were compared with matched controls from the general population within the same database (1:10 ratio via direct, exact matching on age and gender without replacement). PKU patients were included if they were aged ≥18 years on 01/01/15 and were continuously enrolled from 01/01/10 to 31/12/15. The 50 most commonly reported comorbidities and 50 most commonly prescribed medications in the PKU population were analyzed. Differences between groups were tested using 95% confidence interval (CI) of prevalence ratio (PR) values. RESULTS: The analysis included 377 adult PKU patients (< 5 of which were receiving sapropterin dihydrochloride) and 3,770 matched controls. Of the 50 most common comorbidities in the PKU population, those with a statistically significant PR > 1.5 vs controls included major depressive disorders (PR = 2.3), chronic ischemic heart disease (PR = 1.7), asthma (PR = 1.7), dizziness and giddiness (PR = 1.8), unspecified diabetes mellitus (PR = 1.7), infectious gastroenteritis and colitis (PR = 1.7), and reaction to severe stress and adjustment disorders (PR = 1.6). The most commonly prescribed Anatomical Therapeutic Chemical (ATC) subcodes among PKU patients (vs the control population) are for systemic antibacterials (34.7% vs 32.8%), anti-inflammatory and antirheumatic (29.4% vs 27.5%), renin-angiotensin agents (30.0% vs 27.0%), acid-related disorders (29.4% vs 20.2%), and beta-blockers (24.9% vs 19.9%). CONCLUSION: The overall clinical burden on patients with PKU is exacerbated by a significantly higher risk of numerous comorbidities and hence, prescribing of the requisite medication, both for recognized (e.g. major depressive disorders) and more unexpected comorbidities (e.g. ischemic heart disease).


Asunto(s)
Seguro de Salud , Fenilcetonurias/patología , Adolescente , Adulto , Estudios de Cohortes , Femenino , Alemania , Humanos , Masculino , Estudios Retrospectivos , Adulto Joven
20.
Clin Exp Dermatol ; 44(2): 123-129, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-29808607

RESUMEN

Mycetoma caused by either filamentous fungi (eumycotic) or bacteria (actinomycotic) has recently been recognized by the World Health Organization as a neglected tropical disease. Although mycetoma is preventable and treatable, especially in the early stages, it carries high morbidity and a huge socioeconomic burden. Skin and subcutaneous tissue is affected, with a classic presentation of hard woody swellings, discharging sinuses and presence of grains (containing the causative organism). Variants with swelling without sinuses have also been described. Left untreated it may involve underlying bone and muscle, leading to permanent disability. Common actinomycotic species include Streptomyces somaliensis, Actinomadura madurae, Actinomadura pelletieri, Nocardia brasiliensis and Nocardia asteroides, while Madurella mycetomatis, Madurella grisea, Pseudoallescheria boydii and Leptosphaeria senegalensis are common eumycotic agents. Men are more commonly affected than women, and the leg is the most frequently affected site. Diagnosis in suspected lesions is made with the help of grain examination, microscopy, imaging (radiography, ultrasonography, magnetic resonance imaging) and culture, and more recently by molecular methods such as PCR and molecular sequencing. Molecular sequencing for both fungi and bacteria is important for rapid and correct diagnosis, especially in culture-negative cases. Treatment is long, more successful in actinomycetoma than eumycetoma, and may require a holistic approach comprising antimicrobials, surgery and rehabilitation. Mycetoma can be prevented by simple measures such as wearing protective garments and shoes, especially in rural areas and during outdoor activities.


Asunto(s)
Micetoma/microbiología , Actinomyces , Antibacterianos/uso terapéutico , Antifúngicos/uso terapéutico , Humanos , Micetoma/diagnóstico , Micetoma/tratamiento farmacológico , Micetoma/patología , Piel/microbiología , Piel/patología
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