Nasal cartilage destruction associated to cutaneous histoplasmosis in AIDS.

BACKGROUND: Systemic histoplasmosis is a disease of high morbidity and mortality in immunocompromised patients. Patients with AIDS get the infection through inhalation of spores, triggering a primary lung infection with a subsequent hematogenous spread to multiple organs, including the skin. Tissue necrosis have been documented in cutaneous histoplasmosis with multiple clinical manifestations that mimic other diseases. CASE PRESENTATION: We report the case of nasal cartilage destruction associated to cutaneous histoplasmosis in AIDS. A 24-year-old man, resident in Ecuadorian coast, with a history of HIV for 7 years without any treatment. In the last 3 months, he has been presenting a molluscum-like lesions on his nasal bridge with subsequent dissemination to the trunk and extremities. He was admitted to the emergency department for dyspnoea, cough, and malaise. Due to his respiratory failure, he was admitted to the intensive care unit (ICU) with mechanical ventilation. Physical examination reveals a crusted surface ulcer that involves the nose and cheeks, associated with erythematous papules, some with a crusted surface which are spread to the face, trunk, and upper limbs. The patient has a specific skin involvement with a butterfly-like ulcer appearance and destruction of the upper and lower lateral cartilage of the nose. At admission CD4 cell count was 11/mm3 with a HIV viral load of 322,908 copies. Mycological cultures identified Histoplasma capsulatum. A treatment with highly active antiretroviral therapy (HAART) was stablished, associated with liposomal amphotericin B at a dose of 3 mg/kg/day and itraconazole 200 mg twice a day for 12 months. CONCLUSIONS: Cutaneous histoplasmosis is a rare manifestation of pulmonary histoplasmosis in patients with AIDS. The cutaneous manifestations included papules, nodules, plaques, and ulcers. A histology examination is required to rule out other fungal or parasitic infections. Treatment includes highly active antiretroviral therapy (HAART), amphotericin B liposomal and itraconazole, the latest for at least 12 months.

[Single-center Experience of Endovascular Abdominal Aortic Aneurysm Treatment in Patients with Hostile Neck Anatomy versus Favorable Anatomy]. / Experiencia unicéntrica del tratamiento endovascular de aneurisma aórtico abdominal en pacientes con anatomía del cuello hostil versus anatomía favorable.

BACKGROUND: Endovascular aneurysm repair (EVAR) generally is not recommend for patients with unfavorable neck anatomy. This study examines the short-term results according to the characteristics of the proximal aortic neck treated with EVAR. METHODS: Between December 2010 and January 2013, 21 patients were treated with EVAR. Patients were classified as those with favorable neck anatomy (FNA) and hostile neck anatomy (HNA). The parameters for HNA were considered as one or more of the following criteria: neck length < 15 mm, angle > 60°, diameter > 28 mm, ≥ 50% of thrombus in the proximal neck circumference, inverted tapered neck. Clinical and demographic characteristics were compared within the short-term (30 days). RESULTS: A total of 47.7% of the stents were placed in FNA. Perioperative complications were vascular injury and bleeding, which occurred at the same frequency in both groups, and postoperative complications were acute renal failure and pulmonary complications in both groups. The mortality rate was 0% FNA vs. 20% ANA. Intraoperative type I endoleaks occurred in FNA in one case (9%) and HNA in two cases (20%). The cuffs were used in the FNA endoleak and in a HNA case and the other case was treated by angioplasty over dilatation subsequently presenting early endoleak. CONCLUSIONS: Patients presenting a hostile neck are at increased risk of complications related to endoleaks and second interventions, so close monitoring of these patients should be maintained. However, no incidence of open surgical conversion, rupture, or death related to aortic aneurysm was seen. This being so, it is possible to treat these patients with challenging aortic characteristics. Increased vigilance in these patients should be considered.

Fabrication and histological evaluation of a self-setting granular cement using calcium sulfate hemihydrate granules with different pore distribution.

Granular type of bone substitutes is currently used in the field of dentistry to restore alveolar bone defects. However, the migration of the granules from the implantation site is still an unresolved issue. In this study, the feasibility to fabricate self-setting calcium sulfate hemihydrate (CSH) granules using different ranges of loading pressure: CSH(0), CSH(50), CSH(100), and CSH(150) was investigated with the hypothesis that CSH granules with reduced microporosity can inhibit the rapid dissolution rate of the calcium sulfate dihydrate (CSD) set blocks and induce bone regeneration. After 4 weeks of implantation, the granules were mostly replaced with new bone although no significant differences were observed. Nevertheless, the granules demonstrated the ability to set within the bone defect. It is therefore concluded that the setting ability of calcium sulfate can contribute to address the issue of migration of the granules and provide a useful guide for designing setting bone substitutes.

Mycetoma in Ecuador.

BACKGROUND: Previous studies on the distribution of mycetoma globally have failed to identify Ecuador as an endemic country. METHODS: We present data on 35 cases of mycetoma in Ecuador between 1955 and 2021: 5 cases from our experience and 30 cases from the literature. RESULTS: Eight cases of eumycetoma (23%) and 27 cases of actinomycetoma (77%) were diagnosed. Most cases originated from the coastal region of Ecuador. CONCLUSIONS: For the first time in an English-language publication, this communication confirms the presence of mycetoma in Ecuador, securing Ecuador's position on the global mycetoma map.

Successful treatment of mucosal neuromas by radiofrequency ablation in a patient with multiple endocrine neoplasia type 2B.

This is the first report of mucosal neuromas being treated successfully with radiofrequency ablation in a patient with multiple endocrine neoplasia type 2B.

Advances in Clinical Research in Ecuador.

Ecuador is undergoing a process of clinical research development and strengthening. At the turn of the century, Ecuador experienced a favorable transition period of economic stability, which enabled advances in the health system and improvements in population welfare indicators. During this period, Ecuador created an institutional infrastructure to support the implementation and development of research projects. In turn, Ecuador created institutions, including the National Agency for Health Regulation, Control, and Surveillance (Agencia Nacional de Regulación, Control y Vigilancia Sanitaria [ARCSA]), and regulations establishing clinical trial (CT) design, conduct, recording, and reporting parameters, whose compliance ensures the protection of the rights of research subjects and requires compliance with Good Clinical Practice (GCP). Ecuador has favorable conditions for fostering the development of clinical research. The regulation of CTs is a process undergoing consistent changes toward harmonization with international standards and quality assurance.

Seroprevalence and risk factors for Trypanosoma cruzi infection in the Amazon region of Ecuador.

Trypanosoma cruzi infection in the Ecuadorian Amazon region has recently been reported. A seroepidemiologic survey conducted in four provinces in this region indicates a seroprevalence rate of 2.4% among the 6,866 samples collected in 162 communities. Among children < OR = 10 years of age, 1.2% were seropositive. Risk factors for T. cruzi seropositivity were having been born and remaining in the Ecuadorian Amazon provinces, age, living in a house with a thatch roof and open or mixed wall construction, recognizing the vector insects, and reporting being bitten by a triatomine bug. These data suggest active transmission of Chagas' disease in the Ecuadorian Amazon region is associated with poor housing conditions, and highlight the need for further studies aimed at understanding the biology of the insect vectors, reservoir species, and the clinical impact of T. cruzi infection as the basis for future educational and control programs in this region.

A new estuarine species, Nereis garwoodi (Polychaeta: Nereididae), from Bahía Chetumal, Mexican Caribbean coast.

Nereis garwoodi n. sp. is described on the basis of eight syntype specimens (six atokous and two heteronereis) collected in Bahía Chetumal, Mexican Caribbean coast, and the variability in the paragnath numbers in the pharynx is established using 180 specimens; paragnath numbers are I:10(SD = 1.9); II:30 (SD = 2.6); III:41 (SD = 5.2); IV:29 (SD = 3.5), V:1, VI:4, VII-VIII: > 30. Its eyes are big and its longest tentacular cirri reaches setiger 11. A revised key to species of Nereis recorded from the Grand Caribbean Sea is included.

Hipoplasia dérmica focal / Focal Dermal Hypoplasia

El síndrome de Goltz llamado también hipoplasia dérmica focal es una rara dermatosis que fue definida por primera vez por Goltz en el año 1962. Se la considera una genodermatosis de presentación esporádica (95% de los pacientes) aunque se han reportado casos de transmisión familiar. Compromete estructuras derivadas del mesodermo y ectodermo con predominio en el sexo femenino acompañada de herencia dominante ligada al cromosoma X. La mutación en el gen PORCN (locus Xp11.23) es letal en la mayoría de varones. La importancia de su publicación radica en su baja frecuencia y las manifestaciones clínicas características que ayudan al establecer el diagnóstico.

Goltz syndrome, also called focal dermal hypoplasia, is a rare dermatosis that was first defined by Goltz in 1962. It is considered a genodermatosis with sporadic presentation (95% of patients) although familiar aggregation has been reported. It compromises mesodermal and ectodermal structures, most frequently in female patients, its inheritance mode is dominant X linked. The mutation in the PORCN gene (locus Xp11.23) is lethal in the majority of males. The importance of its publication lies in its low frequency and clinical characteristic that helps in establishing the correct diagnosis.

Serologic evidence of flavivirus infection in bats in the Yucatan Peninsula of Mexico.

We captured 140 bats of seven species in Merida City in the Yucatan Peninsula of Mexico in 2010. Serum was collected from each bat and assayed by plaque reduction neutralization test (PRNT) using six flaviviruses: West Nile virus, St. Louis encephalitis virus, and dengue viruses 1-4. Flavivirus-specific antibodies were detected in 26 bats (19%). The antibody-positive bats belonged to three species: the Pallas's long-tongued bat (Glossophaga soricina), Jamaican fruit bat (Artibeus jamaicensis), and great fruit-eating bat (Artibeus lituratus), and their flavivirus antibody prevalences were 33%, 24%, and 9%, respectively. The PRNT titers were usually highest for dengue virus 2 or dengue virus 4, but none of the titers exceeded 80. These data could indicate that most of the antibody-positive bats had been infected with dengue virus. However, because all titers were low, it is possible that the bats had been infected with another (perhaps unrecognized) flavivirus not included in the PRNT analysis, possibly a virus more closely related to dengue virus than to other flaviviruses. Each serum sample was assayed for flavivirus RNA by reverse transcription PCR, but all were negative.

Susceptibilidad antibiótica de Helicobacter pylori: un estudio de prevalencia en pacientes con dispepsia en Quito, Ecuador / Susceptibility of Helicobacter Pylori to Antibiotics: a Study of Prevalence in Patients with Dyspepsia in Quito, Ecuador

Resumen Introducción: el Helicobacter pylori se asocia con patologías gastrointestinales, el incremento en la resistencia a los antibióticos utilizados para su erradicación es alarmante a nivel mundial. En este estudio se determinó la susceptibilidad a 5 antibióticos utilizados en la terapia de erradicación de H. pylori aislado de una población adulta con dispepsia recurrente en Quito, Ecuador. Materiales y métodos : previa aceptación del consentimiento informado, se tomaron biopsias de cuerpo y fondo gástrico de 210 pacientes con dispepsia y mediante cultivo se recuperaron los aislados de H. pylori identificado mediante pruebas bioquímicas. La susceptibilidad al metronidazol, claritromicina, amoxicilina, tetraciclina y levofloxacina se realizó por concentración mínima inhibitoria (CMI). Todos los cultivos se correlacionaron con el estudio histopatológico. Resultados: se recuperaron 89 aislados de H. pylori. Se obtuvo un kappa de 0,9 entre el cultivo y el estudio histopatológico. El porcentaje de cepas con resistencia antibiótica fue: metronidazol (63%), claritromicina (66%), amoxicilina (43%), tetraciclina (36%) y levofloxacina (54%). Conclusión: estos hallazgos demuestran la alta resistencia a los antibióticos usados para la erradicación de H. pylori, varios factores como el consumo indiscriminado de antibióticos, terapia previa, entre otros podrían estar involucrados.

Abstract Introduction: Worldwide, helicobacter pylori is associated with gastrointestinal pathologies, but increasing resistance to antibiotics used for its eradication is causing alarm. This study determined susceptibility of H. pylori to five antibiotics used in eradication therapy in an adult population with recurrent dyspepsia in Quito, Ecuador. Materials and methods: After patients provided informed consent, biopsies were taken from the gastric corpus and fundus of 210 patients with dyspepsia. H. pylori isolates identified by biochemical tests were recovered from cultures of biopsy samples. Minimal inhibitory concentrations (MIC) of metronidazole, clarithromycin, amoxicillin, tetracycline and levofloxacin were tested to indicate susceptibility. All cultures were correlated with the histopathological study. Results: H. pylori isolates were recovered from 89 cultures. A kappa of 0.9 was obtained between the culture and the histopathological study. The percentage of strains with antibiotic resistance were 63% for metronidazole, 66% for clarithromycin, 43% for amoxicillin, 36% for tetracycline and 54% for levofloxacin. Conclusion: These findings demonstrate high levels of resistance to the antibiotics used for eradication of H. pylori. Several factors including indiscriminate consumption of antibiotics and previous therapy may be involved.

Prevalence of anti-Taenia solium antibodies in sera from outpatients in an Andean region of Ecuador

Sera from 9,254 individuals that presented at one of three outpatient clinics in Quito, Ecuador were assayed by indirect hemagglutination for the presence of antibodies reactive with antigens from Taenia solium cysts. Immunoblot anlysis of 81 selected sera with IHA titers ranging from 0 to 1,028 showed that a titer of maior ou igual a 32 was suggestive of exposure to the parasite. Nine percent (9 por cento) of the 9,254 patients had titers of 32 or greater. Of 3,503 sera from one clinic, which included sera from food handlers undergoing yearly physicals, 390 (11 por cento) were positive. In addition, a correlation with age was seen in some, but not all, populations. In situations where age-related effects were noted, the highest incidence was seen in the youngest (0-20 years) and in the oldest (51-60 years) group. Thus, a resurgence of infection after a period of lower prevalence may be developing. Overall, this study shows that cysticercosis is relatively common and potentially a serious health problem in this region.

Ultrasonografía del tracto gastrointestinal / Ultrasonography of the gastrointestinal tract

Se presenta la experiencia obtenida mediante la exploración ultrasonográfica como procedimiento diagnóstico inicial de las lesiones neoplásicas, inflamatorias y obstructivas del tracto gastrointestinal en 31 pacientes evaluados prospectivamente y en quienes los exámenes complementarios posteriores permitieron establecer una patología específica. Se establecen los patrones sonográficos de aquellas lesiones cuya etiología fue luego corroborada por estudios complementarios. En veintiocho, los hallazgos fueron suficientes para orientar o afirmar la existencia de lesiones, distribuídas así: 14 neoplasias (13 malignas y 1 benigna), 6 procesos inflamatorios (3 de intestino grueso y 3 apendicitis aguda), 8 procesos obstructivos (5 de origen gástrico, 1 duodenal y 2 de intestino delgado). Hubo 3 errores diagnósticos. La rapidez del método, su no invasividad, la posibilidad de repetirlo cuantas veces sea necesario y poder observar la respuesta y evolución del tratamiento indicado, hacen que sea útil para orientar y en algunos casos para establecer el diagnóstico de lesiones del tubo digestivo

A new estuarine species, Nereis garwoodi (Polychaeta: Nereididae), from Bahía Chetumal, Mexican Caribbean coast

Nereis garwoodi n. sp. is described on the basis of eight syntype specimens (six atokous and two heteronereis) collected in Bahía Chetumal, Mexican Caribbean coast, and the variability in the paragnath numbers in the pharynx is established using 180 specimens; paragnath numbers are I:10(SD = 1.9); II:30 (SD = 2.6); III:41 (SD = 5.2); IV:29 (SD = 3.5), V:1, VI:4, VII-VIII: > 30. Its eyes are big and its longest tentacular cirri reaches setiger 11. A revised key to species of Nereis recorded from the Grand Caribbean Sea is included.