Rhino-Orbital mucormycosis in an immunocompetent pediatric patient with hyperglycemia of the hospitalized patient.

INTRODUCTION: Acute invasive rhino-orbital mucormycosis usually affects diabetic or neutropenic patients, and only exceptionally develops in immunocompetent adults and children. METHODOLOGY: A 12-years-old immunocompetent female, presented with complicated rhinosinusitis with a subperiosteal orbital abscess, without improvement after initial medical and surgical management, the patient also developed hyperglycemia of the hospitalized patient that represented a challenging and potentially lethal clinical scenario. RESULTS: Diagnosed with an unsuspected rhino-orbital mucormycosis by direct microscopy and PCR, she survived after amphotericin B and surgical treatment. CONCLUSIONS: In cases with torpid clinical evolution, even in apparently immunocompetent patients, appropriate multidisciplinary workup must be performed to rule out opportunistic etiologies including mucormycosis to improve survival.

High heterogeneity, mixed infections and new genotypes in human congenital toxoplasmosis cases in the mega-metropolis of Central Mexico.

Mexico presents high prevalence of Toxoplasma gondii infection, including the congenital form, but there are few data about the genetic diversity of the parasite, so we attempted parasite isolation and genotyping in nine mother/children pairs with congenital toxoplasmosis (CT), living in the Valley of Mexico, who were part of a 30 cases cohort that started 12 years ago. They were recruited through research projects which included pre- and postnatal screening of congenital infections or directly CT, and cases referred to INP for management because they had clinical abnormalities. Genotyping was performed by PCR-RFLP of SAG1, SAG2, SAG3, BTUB GRA6, c22-8, c29-2, L358, PK1 and Apico markers, followed by sequencing. Sixty seven percent of samples were typed for the SAG3 locus, 39% for Apico and 33% for BTUB, while Alt. SAG2, GRA6 and c29-2 types could be labelled in less cases. Type I alleles predominated, followed by II and III. We isolated the first strain obtained from humans in Mexico and found three genotypes not previously found in the world. The presence of ToxoDB#10 clonal type was documented in one pair, as well as mixed infections in five mothers. No relation of genotype or parasite load with clinical signs was found. In conclusion, we encountered great genetic diversity and mixed T. gondii infections among mother/children pairs with congenital toxoplasmosis in the mega-metropolis of the Valley of Mexico.

Immunoglobulin Concentrations in Plasma and Saliva During the Neonatal Period.

BACKGROUND: Screening for infectious diseases in newborns using immunoglobulin (Ig)A-, IgM-, and IgE-specific antibodies is expensive and impractical. To determine if total levels of these Igs can be used for screening purposes, thus simplifying the process, their basic levels in the 1(st) month of extrauterine life need to be determined. Additionally, the ability to simplify screening by using saliva also needs to be determined. The aim of this study was to determine IgA, IgM, and IgE concentrations in plasma and saliva in newborns, correlation between the samples, and relationship between Ig levels and newborn age. METHODS: We enrolled 53 apparently healthy newborns, paired samples of plasma and saliva were collected, and total IgA, IgM, and IgE concentrations determined by capture enzyme-linked immunosorbent assay. The correlation between plasma and saliva values was calculated by Spearman's rank correlation coefficient and the IgA, IgM, and IgE distributions were analyzed by the Shapiro-Wilk test. We also determined the level of each Ig concentration according to age. RESULTS: IgA and IgM levels in plasma and IgA levels in saliva increased significantly during 1(st) month of life, especially in the 2(nd) week and 3(rd) week, with a good correlation of IgA between plasma and saliva. IgE levels in both plasma and saliva and IgM levels in saliva were very low or absent. CONCLUSION: These results suggest that Igs in saliva could be good biomarkers for newborn screening programs during the 1(st) week of life. This study established reference values for Igs according to age in the neonatal period.

Vesícula biliar a la izquierda del ligamento falciforme en ausencia de situs inversus: 'sinistraposición' / Gall bladder located to the left of the falciform ligament without situs inversus: "sinistraposition"

La vesícula biliar ubicada a la izquierda del ligamento falciforme, en ausencia de situs inversus, también denominada 'sinistraposición', es una rara anomalía anatómica. Aunque es poco frecuente, se considera importante que todo cirujano se familiarice con este hallazgo, ya que la cirugía puede convertirse en un verdadero desafío técnico. En varios informes de casos, se ha documentado el manejo seguro de la 'sinistraposición' cuando es hallada de forma incidental durante una colecistectomía laparoscópica convencional. Así pues, este procedimiento puede practicarse de forma segura, aunque la lesión de la vía biliar no es inusual, dado que la asociación de estos casos a anomalías del árbol biliar y de la vena porta intrahepática no es despreciable. En el presente artículo se presenta el caso de un paciente con colelitiasis sintomática y ecografías que no reportaron la posición anómala de la vesícula biliar. Fue sometido a colecistectomía laparoscópica programada, en la cual se encontró una vesícula biliar ubicada en el segmento III del hígado, aparentemente no asociada a otras alteraciones biliares extrahepáticas. El procedimiento se realizó por vía laparoscópica multipuerto, sin complicaciones para el paciente, quien hasta el momento se encuentra asintomático.

The gallbladder located to the left of the falciform ligament in absence of situs inversus, called sinistraposition, is a rare anatomic anomaly. Although infrequent, it is important that surgeons become familiar with this finding, for surgery can become a real technical challenge. Several case reports have documented the safe handling of sinistraposition when found incidentally during conventional laparoscopic cholecystectomy. We report the case of patient with asymptomatic cholecystectomy and ultrasound echography that did not report the anomalous location of the gallbladder. Elective laparoscopic cholecystectomy was performed, encountering a gallbladder located in the segment III of the liver, with no apparent associated extrahepatic biliary anomalies. The procedure was carried out by a multiport approach, without complications, and so far the patient is asymptomatic.