The role of gastrointestinal endoscopy in Kaposi sarcoma / El papel de la endoscopia gastrointestinal en el sarcoma de Kaposi

We are writing to make endoscopists aware of the paramount of a prompt diagnosis of gastrointestinal Kaposi sarcoma (GI-KS). Patients with GI involvement have a two to five times higher risk of death and will benefit from chemotherapy to improve their survival. However, current evidence found that one out of three patients might have a false negative result even with HHV-8 since other entities such as gastrointestinal stromal tumors, angiosarcoma, and lymphoma shared macroscopic and histopathological characteristics. These cause a delay in treatment and significantly worsen the prognosis. We observed a trend for a positive diagnosis from ulcers and nodules. To our knowledge, this is the largest cohort of patients with GI-KS in the world. Our study suggests that in cases where a complete immunochemistry panel for KS is not available, HHV-8 remains as a bare minimum. However, other gastrointestinal lesions shared histopathological characteristics. Therefore, we suggest taking biopsies from nodular and ulcer-type lesions to increase the probability to establish a histopathological diagnosis.(AU)

The role of gastrointestinal endoscopy in Kaposi sarcoma.

We are writing to make endoscopists aware of the paramount of a prompt diagnosis of gastrointestinal Kaposi sarcoma (GI-KS). Patients with GI involvement have a two to five times higher risk of death and will benefit from chemotherapy to improve their survival. However, current evidence found that one out of three patients might have a false negative result even with HHV-8 since other entities such as gastrointestinal stromal tumors, angiosarcoma, and lymphoma shared macroscopic and histopathological characteristics. These cause a delay in treatment and significantly worsen the prognosis. We observed a trend for a positive diagnosis from ulcers and nodules. To our knowledge, this is the largest cohort of patients with GI-KS in the world. Our study suggests that in cases where a complete immunochemistry panel for KS is not available, HHV-8 remains as a bare minimum. However, other gastrointestinal lesions shared histopathological characteristics. Therefore, we suggest taking biopsies from nodular and ulcer-type lesions to increase the probability to establish a histopathological diagnosis.

Spatial and spatiotemporal clustering of the COVID-19 pandemic in Ecuador / Aglomeración espacial y espaciotemporal de la pandemia por COVID-19 en Ecuador

Abstract Introduction: In Ecuador, the first COVID-19 case, the disease caused by the SARS-CoV-2 virus, was officially reported on February 29, 2020. As of April 2, the officially confirmed numbers of COVID-19 cases and deaths from it were 3 163 and 120, respectively, that is, a mortality rate of 3.8%. Objective: To identify spatial and spatiotemporal clusters of COVID-19 cases officially confirmed in Ecuador. Materials and methods: Case series study. An analysis of all COVID-19 cases officially confirmed in Ecuador from March 13, 2020 to April 2, 2020 was performed. Relative Risk (RR) of COVID-19 contagion was determined using the discrete Poisson distribution model in the SaTScan software. Clusters were generated using purely spatial and spatiotemporal scan statistics. Significance of each cluster was obtained through 999 iterations using the Monte Carlo simulation, obtaining the most probable random model. Results: As of April 2, spatiotemporal clustering allowed identifying two clusters in Ecuador, a main cluster in the Guayas province (area: 15 430 km2; population: 3.6 million inhabitants; RR: 7.08; p<0.000001; calculated annual incidence 1700 cases / 100 000 people) and a secondary cluster in the Pichincha province (area: 88 904 km2; population: 7.1 million; RR: 0.38; p<0.000001; calculated annual incidence 737 cases / 100 000 people.) Conclusions: The implementation of COVID-19 mitigation strategies should be focused on areas of high transmission risk; therefore, spatial, and spatiotemporal clustering with SaTScan can be extremely useful for the early detection and surveillance of COVID-19 outbreaks.

Resumen Introducción. En Ecuador el primer caso de COVID-19, la enfermedad causada por el virus SARS-CoV-2, fue reportado oficialmente el 29 de febrero del 2020, y para el 2 de abril, las cifras oficiales de casos confirmados y de muertes ascendían a 3 163 y 120, respectivamente, con una tasa de mortalidad del 3.8% Objetivo. Identificar aglomerados espaciales y espaciotemporales de los casos de COVID-19 confirmados oficialmente en Ecuador. Materiales y métodos. Estudio de series de casos. Se analizaron todos los casos de COVID-19 confirmados oficialmente en Ecuador entre el 13 de marzo y el 2 de abril de 2020. El riesgo relativo (RR) de contagio se determinó en el programa SaTScan de acuerdo con el modelo de probabilidad discreta de Poisson, las aglomeraciones espaciales y espaciotemporales se detectaron con la estadística de rastreo espacial y la significancia estadística de cada aglomerado se determinó mediante 999 iteraciones usando la simulación Monte Carlo, obteniéndose el modelo aleatorio más probable. Resultados. Al 2 de abril, mediante la aglomeración espaciotemporal, fue posible identificar dos aglomerados en Ecuador, uno principal centrado en la provincia de Guayas (superficie: 15 430 km2, población: 3,6 millones de habitantes, RR: 7.08; p<0.000001 e incidencia anual calculada: 1 700 casos/100 000 habitantes) y uno secundario centrado en la provincia de Pichincha (superficie: 88 904 km2, población: 7.1 millones de habitantes, RR: 0.38, p<0.000001 e incidencia anual calculada: 737 casos/100 000 habitantes). Conclusiones. La implementación de las estrategias de mitigación del COVID-19 se debe enfocar en áreas de alto riesgo de transmisión; por tanto, los datos sobre aglomerados espaciales y espaciotemporales obtenidos con el programa SatScan pueden ser de gran utilidad en la detección temprana y vigilancia sanitaria de focos de COVID-19.

Illicit drug use research in Latin America: epidemiology service use, and HIV.

The purpose of this article is to review the research status of illicit drug use and its data sources in Latin America, with particular attention to the research that has been produced in the past 15 years in epidemiology of illicit drug use services utilization, and relationship between HIV and drug use. This article complements the series of articles that are published in this same volume which examine drug abuse research (epidemiology, prevention, and treatment) and HIV prevention in Latinos residing in the United States. This review resulted from extensive international and national searches using the following databases: Current Contents Connect, Social and Behavioral Sciences; EBSCO; EMBASE(R) Psychiatry; Evidence Based Medicine (through OVID); Medline, Neurosciences, PsychINFO, Pubmed, BIREME/PAHO/WHO--Virtual Health Library, and SciELO. Papers selected for further review included those published in Spanish, English, and Portuguese in peer-reviewed journals. From the evidence reviewed, it was found that the published research literature is heavily concentrated on descriptive epidemiologic surveys, providing primarily prevalence rates and general information on associated factors. Evidence on patterns of service delivery and HIV prevention and treatment is limited. The cumulative scope of this research clearly indicates variability in quantity and quality of research across Latin American nations and the need for greater uniformity in data collection elements, methodologies, and the creation of international collaborative research networks.