Pulmonary and central nervous system nocardiosis: Alcoholism as an immunocompromising factor / Nocardiosis pulmonar y del sistema nervioso central: el alcoholismo como factor de inmunocompromiso

Nocardiosis is a disease with worldwide distribution. It is usually found in tropical areas and mainly affects immunocompromised patients, however, there are also cases where its infection has been reported in immunocompetent patients. This pathology is caused by bacteria known as Nocardia spp., which are gram-positive microorganisms and environmental saprophytes, and although exposure to Nocardia spp. is almost universal, only a small fraction of exposed people develops the disease. We present the case of a 47-year-old man, with no evidence of immunosuppression, from a rural area of Boyacá, who was admitted due to intense and intermittent headache accompanied by paresthesia and, finally, a decrease in consciousness. A brain magnetic resonance was performed and evidenced a fronto-temporo- occipital space-occupying lesion in the cortico-subcortical region with a compressive effect and displacement of the ventricular system cavities. It was suspected at first a neoplastic lesion or a brain abscess. The lesion was surgically resected, and its culture showed Nocardia africana/nova. In later studies a possible primary pulmonary focus was evidenced. Alcoholism was the only risk factor documented. The patient completed 6 weeks of hospital antibiotic treatment with favorable clinical and radiological evolution and was discharged with a 1-year plan of outpatient antibiotic therapy. Although Nocardia spp. mainly affects immunocompromised patients, evidence shows that this microorganism can also be a threat to individuals without traditional immunosuppression risk factors.

La nocardiosis es una enfermedad de distribución mundial; de forma habitual se encuentra en zonas tropicales y afecta principalmente a pacientes inmunocomprometidos, sin embargo, también existen casos reportados de infección en personas inmunocompetentes. Esta infección es causada por actinomicetos del género Nocardia spp. que son bacterias Gram positivas, saprófitos ambientales. Aunque la exposición a Nocardia spp. es casi universal, solo una pequeña fracción de las personas expuestas desarrollan la enfermedad. Se presenta el caso de un hombre de 47 años, sin dato de inmunosupresión, procedente de un área rural de Boyacá, que consultó por un cuadro clínico de cefalea intensa e intermitente, con parestesias y, finalmente, alteración del estado de conciencia. Se practicó una resonancia magnética cerebral, en la que se evidenció una lesión que ocupaba espacio de localización córtico-subcortical en la región fronto-témporo-parietal izquierda, con efecto compresivo y desplazamiento de las cavidades del sistema ventricular. Se sospechó, inicialmente, una lesión neoplásica o un absceso cerebral. El paciente fue sometido a una resección quirúrgica, y el cultivo de la lesión documentó Nocardia africana/nova; en estudios posteriores, se evidenció un posible foco pulmonar primario. Como único factor de riesgo en el paciente, se documentó alcoholismo. Completó seis semanas de tratamiento antibiótico intrahospitalario con evolución clínica y radiológica, y egresó con plan de un año de terapia antibiótica ambulatoria. Aunque la enfermedad por Nocardia spp. afecta principalmente a pacientes inmunocomprometidos, la "evidencia" clínica demuestra que este microorganismo también puede ser una amenaza para individuos sin los factores de riesgo tradicionales para inmunosupresión.

Nocardiosis pulmonar y del sistema nervioso central: el alcoholismo como factor de inmunocompromiso / Pulmonary and central nervous system nocardiosis: Alcoholism as an immunocompromising factor

La nocardiosis es una enfermedad de distribución mundial; de forma habitual se encuentra en zonas tropicales y afecta principalmente a pacientes inmunocomprometidos, sin embargo, también existen casos reportados de infección en personas inmunocompetentes. Esta infección es causada por actinomicetos del género Nocardia spp. que son bacterias Gram positivas, saprófitos ambientales. Aunque la exposición a Nocardia spp. es casi universal, solo una pequeña fracción de las personas expuestas desarrollan la enfermedad. Se presenta el caso de un hombre de 47 años, sin dato de inmunosupresión, procedente de un área rural de Boyacá, que consultó por un cuadro clínico de cefalea intensa e intermitente, con parestesias y, finalmente, alteración del estado de conciencia. Se practicó una resonancia magnética cerebral, en la que se evidenció una lesión que ocupaba espacio de localización córtico-subcortical en la región fronto-témporo-parietal izquierda, con efecto compresivo y desplazamiento de las cavidades del sistema ventricular. Se sospechó, inicialmente, una lesión neoplásica o un absceso cerebral. El paciente fue sometido a una resección quirúrgica, y el cultivo de la lesión documentó Nocardia africana/nova; en estudios posteriores, se evidenció un posible foco pulmonar primario. Como único factor de riesgo en el paciente, se documentó alcoholismo. Completó seis semanas de tratamiento antibiótico intrahospitalario con evolución clínica y radiológica, y egresó con plan de un año de terapia antibiótica ambulatoria. Aunque la enfermedad por Nocardia spp. afecta principalmente a pacientes inmunocomprometidos, la "evidencia" clínica demuestra que este microorganismo también puede ser una amenaza para individuos sin los factores de riesgo tradicionales para inmunosupresión.

Nocardiosis is a disease with worldwide distribution. It is usually found in tropical areas and mainly affects immunocompromised patients, however, there are also cases where its infection has been reported in immunocompetent patients. This pathology is caused by bacteria known as Nocardia spp., which are gram-positive microorganisms and environmental saprophytes, and although exposure to Nocardia spp. is almost universal, only a small fraction of exposed people develops the disease. We present the case of a 47-year-old man, with no evidence of immunosuppression, from a rural area of Boyacá, who was admitted due to intense and intermittent headache accompanied by paresthesia and, finally, a decrease in consciousness. A brain magnetic resonance was performed and evidenced a fronto-temporo- occipital space-occupying lesion in the cortico-subcortical region with a compressive effect and displacement of the ventricular system cavities. It was suspected at first a neoplastic lesion or a brain abscess. The lesion was surgically resected, and its culture showed Nocardia africana/nova. In later studies a possible primary pulmonary focus was evidenced. Alcoholism was the only risk factor documented. The patient completed 6 weeks of hospital antibiotic treatment with favorable clinical and radiological evolution and was discharged with a 1-year plan of outpatient antibiotic therapy. Although Nocardia spp. mainly affects immunocompromised patients, evidence shows that this microorganism can also be a threat to individuals without traditional immunosuppression risk factors.

Knowledge, Attitudes, and Practices on Rocky Mountain Spotted Fever among Physicians in a Highly Endemic Region-Mexicali, Mexico.

Rocky Mountain spotted fever (RMSF) is a potentially fatal tickborne disease caused by the bacterium, Rickettsia rickettsii and transmitted primarily by the brown dog tick (Rhipicephalus sanguineus) in the southwestern United States and Mexico. RMSF can be rapidly fatal if not treated early with doxycycline, making healthcare worker awareness and education critical to reduce morbidity and mortality. During 2008-2019, Mexicali experienced a RMSF epidemic with 779 confirmed cases, and an 11-year case-fatality rate of 18% (N = 140). A cross-sectional study was conducted with 290 physicians and physicians-in-training across 12 medical facilities in Mexicali. They were asked to complete a 23-item questionnaire to assess knowledge, attitudes, and practices for clinical, epidemiologic, and preventive aspects of RMSF. Half of participants were female, the largest age group was aged 25 to 44 (47%), and median time in practice was 6 years (interquartile rate: 1-21.5). Less than half (48%) surveyed were confident where diagnostic testing could be performed, and two-thirds did not regularly order serology (67%) or molecular diagnostic (66%) tests for RMSF when a patient presented with fever. Sixty-four percent knew doxycycline as first-line treatment of children < 8 years with suspected RMSF. When comparing healthcare workers with < 6 years of experience to those with ≥ 6 years, more experience was associated with greater confidence in where to have diagnostic testing performed (prevalence odds ratio [prevalence odds ratios [pOR]] = 2.3; P = 0.004), and frequency of ordering laboratory tests (serology, pOR = 3.3; P = 0.002; polymerase chain reaction, pOR = 3.9; P = 0.001). Continued education, including information on diagnostic testing is key to reducing morbidity and mortality from RMSF.

Does episiotomy protect against injury of the levator ani muscle in normal vaginal delivery?

AIMS: To investigate whether episiotomy is associated with avulsion of the levator ani in its pubic insertion after normal vaginal delivery. METHODS: This is an observational study at a tertiary obstetric unit recruited 194 primiparous women who had normal vaginal delivery with or without episiotomy. All women underwent translabial 4D ultrasound scanning after delivery. Tomographic ultrasound imaging was used to diagnose levator avulsion. Lesions were recorded as unilateral or bilateral. The investigators were blinded to all clinical data. The influence of other variables associated with delivery such as maternal age, body mass index, gestational age, birth weight, fetal head circumference, and use of epidural anesthesia was recorded and their relation with avulsion was also studied. RESULTS: Avulsion was identified in eleven (10.9%) of the 101 women with episiotomy and in fourteen (15.1%) of the 93 women without. The difference was not statistically significant (P = 0.401). Other variables showed no influence on the prevalence of avulsion. CONCLUSIONS: Episiotomy does not appear to be associated with injury to the levator ani muscle in its pubic insertion in normal vaginal delivery.

The efficacy of acupuncture and decompression splints in the treatment of temporomandibular joint pain-dysfunction syndrome

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The efficacy of acupuncture and decompression splints in the treatment of temporomandibular joint pain-dysfunction syndrome.

OBJECTIVES: The goal of the present study was to evaluate the results of applying acupuncture or occlusal decompression splints in the treatment of patients diagnosed with the temporomandibular joint pain-dysfunction syndrome. DESIGN OF THE STUDY: We conducted a randomized clinical trial including 20 patients to whom the mentioned treatments were applied. Results were evaluated through an analogue pain scale, measurements of mouth opening and jaw lateral deviation in millimetres, and assessment of sensitivity to pressure on different points: preauricular, masseter muscle, temporal muscle and trapezius. Parameters were evaluated before and 30 days after the treatment. For standardized pressure, we used a pressure algometer. RESULTS: Patients treated with decompression splints showed reductions in subjective pain and pain upon pressure on temporal, masseter and trapezius muscles, as well as increased mouth opening after the treatment. Patients treated with acupuncture showed pain reduction in the short term and improvements in all of the evaluated para-meters (stronger pressure was required to produce pain; mouth opening was improved). CONCLUSION: Acupuncture was an effective complement and/or an acceptable alternative to decompression splints in the treatment of myofascial pain and temporomandibular joint pain-dysfunction syndrome.

Hemostatic properties of Venezuelan Bothrops snake venoms with special reference to Bothrops isabelae venom.

In Venezuela, Bothrops snakes are responsible for more than 80% of all recorded snakebites. This study focuses on the biological and hemostatic characteristics of Bothrops isabelae venom along with its comparative characteristics with two other closely related Bothrops venoms, Bothrops atrox and Bothrops colombiensis. Electrophoretic profiles of crude B. isabelae venom showed protein bands between 14 and 100 kDa with the majority in the range of 14-31 kDa. The molecular exclusion chromatographic profile of this venom contains five fractions (F1-F5). Amidolytic activity evaluation evidenced strong thrombin-like followed by kallikrein-like activities in crude venom and in fractions F1 and F2. The fibrinogenolytic activity of B. isabelae venom at a ratio of 100:1 (fibrinogen/venom) induced a degradation of A alpha and B beta chains at 15 min and 2 h, respectively. At a ratio of 100:10, a total degradation of A alpha and B beta chains at 5 min and of gamma chains at 24 h was apparent. This current study evidences one of rarely reported for Bothrops venoms, which resembles the physiologic effect of plasmin. B. isabelae venom as well as F2 and F3 fractions, contain fibrinolytic activity on fibrin plate of 36, 23.5 and 9.45 mm(2)/microg, respectively using 25 microg of protein. Crude venom and F1 fraction showed gelatinolytic activity. Comparative analysis amongst Venezuelan bothropoid venoms, evidenced that the LD(50) of B. isabelae (5.9 mg/kg) was similar to B. atrox-Puerto Ayacucho 1 (6.1 mg/kg) and B. colombiensis-Caucagua (5.8 mg/kg). B. isabelae venom showed minor hemorrhagic activity, whereas B. atrox-Parguasa (Bolivar state) was the most hemorrhagic. In this study, a relative high thrombin-like activity was observed in B. colombiensis venoms (502-568 mUA/min/mg), and a relative high factor Xa-like activity was found in B. atrox venoms (126-294 mUA/min/mg). Fibrinolytic activity evaluated with 10 microg protein, showed that B. isabelae venom contained higher specific activity (50 mm(2)/microg) than B. colombiensis and B. atrox venoms, which should encourage the isolation of these fibrinolytic molecules to improve the quality of immunotherapy.

Amplio espectro de la enfermedad vascular hepática en imágenes / Ample spectrum of vascular hepatic disease

La enfermedad vascular hepática (EVH)constituye un amplio espectro de entidades de baja prevalencia, pero con manifestaciones clínicas diversas que pueden llevar a la muerte. Una detección temprana y un tratamiento oportuno cambian el pronóstico. De ahí que las imágenes diagnósticas desempeñen un papel fundamental; sin embargo, hay que tener en cuenta el amplio diagnóstico diferencial. La tomografía computarizada de abdomen es una de las herramientas más útiles para el diagnóstico, sin olvidar otros métodos de imagen, como el ultrasonido Doppler y la resonancia magnética. La EVH puede clasificarse según la repercusión que se pueda derivar de ella, por lo que en términos prácticos puede dividirse en alteraciones venosas, portales, arteriales, sinusoidales y otras. El objetivo de esta revisión es describir la presentación más frecuente de la EVH y sus principales hallazgos y diagnósticos diferenciales, al tiempo que se reconoce su correlación con los mecanismos fisiopatológicos.

Hepatic vascular diseases (HVD) are a broad spectrum of entities of low prevalence but with different clinical manifestations that may even lead to death. Its early detection and timely treatment may change the prognosis. Diagnostic imaging plays a key role and imaging findings may be typical.However, in most cases, radiologists must take into account a wide range of differential diagnosis. Computed tomography (CT) of the abdomen is one of the most useful tools for the diagnosis of HVD taking also into account the value of other imaging methods such as Doppler Ultrasound andMagnetic Resonance Imaging (MRI).HVD can be classified according to the compromised vascular structure and can be divided into venous, portal, arterial, sinusoidal and others disorders. The objective of this review is to describe the most common presentation HVD . The major imaging findings and differential diagnosis recognizingits correlation with the pathophysiological mechanisms.

The LEC rat: a useful model for studying liver carcinogenesis related to oxidative stress and inflammation.

Growing evidence indicates oxidative stress as a mechanism of several diseases including cancer. Oxidative stress can be defined as the imbalance between cellular oxidant species production and antioxidant capability shifted towards the former. Lipid peroxidation is one of the processes that takes place during oxidative stress. Lipid peroxidation products, such as malondialdehyde (MDA) and 4-hydroxy-2-nonenal (HNE), are closely related to carcinogenesis as they are potent mutagens and they have been suggested as modulators of signal pathways related to proliferation and apoptosis, two processes implicated in cancer development. Mechanisms by which oxidative stress leads to tumor formation are still under investigation. The need of suitable in vivo models that could reflect that inflammation-related human carcinogenesis is evident. In this regard, the mutant strain Long Evans Cinnamon-like (LEC) rat provides a promising model for investigation of the relationship between hepatitis induced by oxidative stress and hepatocarcinogenesis because it has been demonstrated to develop spontaneous liver tumor formation related to copper accumulation and oxidative stress. In this review, the findings regarding oxidative stress and its relation with liver pathologies in LEC rats are discussed; we focus on the mechanisms proposed for HNE carcinogenesis.

Utilidad diagnóstica del CD10, BCL-6 y desmina en el linfoma T angioinmunoblástico. Estudio inmunohistoquímico de 7 casos / Diagnostic utility of CD10, BCL-6 and desmin, in Angioimmunoblastic T-cell lymphoma. Immunohistochemical study of 7 cases

Antecentes: El Linfoma T Angioinmunoblástico es un linfoma T periférico que representa solo el 1-2% de los Linfomas no Hodgkin. Este linfoma tiene características clínicas y patológicas particulares que lo sitúan dentro del grupo de linfomas agresivos y de mal pronóstico. Estudios recientes han demostrado diversos hallazgos inmunofenotípicos y genéticos que pueden ser de utilidad en el diagnóstico de esta entidad. El objetivo de este estudio es investigar si la expresión de CD10, BCL-6 y la expansión de las células dendríticas es constante y por consecuencia útil en el diagnóstico de LTA. Material y métodos: Se estudiaron siete casos de Linfoma T Angioinmunoblástico, obtenidos del departamento de Patología del American British Cowdray Medical Center en la Ciudad de México. Se realizaron tinciones con H&E y tinción retículo de Gordon-Sweet e inmunohistoquímica con CD20, CD3, CD10, Bcl-6, Desmina y queratina de amplio espectro. Resultados: Todos los casos mostraron expresión aberrante de CD10 y Bcl-6, así como también la expansión de la red de células dendríticas foliculares y en tres casos además aumento de células reticulares fibroblásticas desmina/citoqueratina positivas. Conclusiones: La proliferación de las células dendríticas foliculares y de células reticulares fibroblásticas desmina/citoqueratina positivas, así como la expresión aberrante de CD10 y Bcl-6 son características constantes en el Linfoma T Angioinmunoblástico. Estos hallazgos inmunohistoquímicos son útiles en al diagnóstico de LTA (AU)

Introduction: Angioimmunoblastic T-cell lymphoma (ATL) is a peripheral T-cell lymphoma representing only 1- 2% of non-Hodgkin’s lymphomas. Clinical course of ATL is aggressive and its prognosis is poor. Recent studies have identified useful immunohistochemical and genetic features in the diagnosis of this entity. The aim of this study was to investigate the expression of CD10, BCL-6 and dendritic cells expansion in ATL. Patients and methods: Seven cases of ATL retrieved form the files of the Department of Pathology of the American British Cowdray Medical Center in Mexico City were studied. Sections were stained with H&E and Gordon-Sweet for reticular fibers. Immunohistochemistry for CD20, CD3, CD10, BCL-6, desmin and wide spectrum cytokeratins was done. Results: All cases showed aberrant expression for CD10 and BCl-6. In all cases expansion of follicular dendritic cells was found. An increase in number of desmin/cytokeratin positive reticulum cells was also found in three patients. Conclusions: Dendritic follicular cells and desmin positive/cytokeratin positive reticular cells proliferation, as well as aberrant expression of CD10 and BCl-6 are constant characteristics of ATL. These findings are useful immunophenotypical features in the diagnosis of ALT (AU)

[Human infections by black yeasts of genus Exophiala]. / Infecciones humanas por levaduras negras del género Exophiala.

Clinical and laboratory aspects of the infections caused by Exophiala species are reviewed with regard to its epidemiology, diagnosis and treatment. Exophiala is a genus of dematiaceous hyphomycetes whose taxonomy and nomenclature undergo constant revision. Exophiala species are widely distributed in nature, and they are uncommon human pathogens. In recent years it appears to have increased its frequency as a cause of human infections, mainly in immunocompromised patients. They have been associated with phaeohyphomycosis, chromoblastomycosis, eumycotic mycetoma and disseminated infection. The procedures recommended for diagnosis consist of detection of fungal elements in tissue and growth of the organism in culture. Identification is mostly based upon microscopic observation of morphological characteristics and conidiogenesis, combined with the evaluation of physiological tests and nitrate and carbohydrate assimilations. Antifungal agents such as amphotericin B, itraconazole and voriconazole showed in vitro activity to most of the Exophiala species of clinical interest. The therapeutic recommendations are mainly deduced from the observation of single cases.