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Purpose: To analyze binocular vision of individuals aged 18 to 35 years diagnosed with keratoconus, utilizing spectacles and rigid gas-permeable (RGP) contact lenses. Research was led by the Universidad Autónoma de Aguascalientes, México and Fundación Universitaria del Área Andina Pereira, Colombia. Methods: A single center, prospective non-randomized, comparative, interventional, open-label study, in which the differences in binocular vision performance with both spectacles and RGP contact lenses was carried out from December 2018 to December 2019. Sampling was performed according to consecutive cases with keratoconus that met the inclusion criteria until the proposed sample size was reached. Results: Rigid gas-permeable (RGP) contact lenses notably enhanced distance and near visual acuity in keratoconus patients compared to spectacles. Visual alignment analysis shows exophoria at both distances and is slightly higher with RGP contact lenses. The difference was statistically significant (p<0.05), with 82.5 % presenting compensated phoria with spectacles and pnly 42.50% with RGP contact lenses. Stereoscopic vision improved while wearing RGP contact lenses (42.59 %), although accommodation and accommodative flexibility remained within normal ranges. Conclusions: Patients with keratoconus fitted with RGP contact lenses have improved binocular vision skills such as visual acuity, stereopsis, and accommodative flexibility. However, even when the vergence and motor system is decompensated with respect to normal ranges, the range between break and recovery points for both fusional reserves and the near point of convergence (NPC) improves with the use of RGP contact lenses, giving indications of an adaptive condition of the motor system from the medium to the long term.(AU)
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Humanos , Masculino , Femenino , Adolescente , Adulto Joven , Queratocono , Anteojos , Lentes de Contacto , Visión Binocular , Pruebas de Visión , Colombia , México , Oftalmología , Estudios ProspectivosRESUMEN
This study determines the sensitivity and specificity of a screening test to detect perceptual abnormalities and whether there are differences between gender. Vision is a complex process involving visual perception. Any alterations can affect learning, so having a screening test in Spanish that is easy to use and reliable for timely diagnosis will reduce the percentage of visuo-perceptual interference during learning process. A total of 200 subjects participated, aged between 8 and 15 years old, with good visual acuity, and no strabismus, amblyopia, ocular pathology, or neurological damage. The Petrosyan questionnaire (screening test) was employed to identify symptoms associated with perceptual impairment, and a subsequent assessment was conducted to evaluate perceptual abilities. The mean age was 11.5 years (57% male; 44% female). The screening test indicated that 30% of the subjects were suspected of having perceptual alteration, while 24% were diagnosed with a real alteration in perceptual abilities. The sensitivity was 1 and the specificity was 0.92. The Spanish version of the Petrosyan questionnaire has high sensitivity and specificity values and is therefore considered very accurate for identifying the need for a perceptual assessment. There are statistically significant differences in perceptual abilities according to gender. The female group shows more symptomatology and a higher percentage of alteration in perceptual skills.
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Severe acute respiratory syndrome coronavirus 2 has caused a global pandemic, leading to health, economic, and political crisis. The virus triggers the activation of inflammatory reactants including interleukin-6 (IL-6), ferritin, and C-reactive protein (CRP), causing multiorgan damage, particularly affecting the lungs. Tocilizumab, an IL-6 receptor blocker, has the potential to diminish the progression of the disease and reduce organ damage and long-term complications. The aim of this observational retrospective cohort study was to evaluate the efficacy of tocilizumab in decreasing CRP levels in hospitalized coronavirus disease 2019 (COVID-19) patients compared to standard care without the drug. The study included 141 patients during their Hospital Stay (HS), with 100 in the Tocilizumab group and 41 in the non-Tocilizumab group. Clinical information was collected from the electronic clinical record, analyzed using statistical software, and homogenized the CRP levels from the severe group to the levels of the less complicated group at 48 h of hospitalization. The results showed a statistically significant greater decrease in CRP levels in the Tocilizumab group at 48 h after the use of the treatment, with no differences in mortality or length of stay between the groups. In conclusion, tocilizumab accelerates the diminishing of CRP levels compared to standard treatment alone, and its use may have potential benefits in the management of severe COVID-19 patients when used alongside with follow-up quantification of CRP levels reduction.IMPORTANCESevere acute respiratory syndrome coronavirus 2 has caused a global pandemic, leading to health, economic, and political crises. International guidelines for managing coronavirus disease 2019 (COVID-19) give recommendations according to the severity of the disease and the level of oxygen therapy needed. Tocilizumab is an option for the therapeutic management of hospitalized patients with any level of oxygen therapy; IL-6 serum level is the parameter for the follow-up on the efficacy, but it is not available at many hospitals. In this study, we demonstrate that C-reactive protein determination can predict the response to tocilizumab in severe COVID-19, the target patients for treatment with this drug. The use of this affordable and extensively available biomarker supports clinical decisions for the early escalation of the therapy and for the rational use of this drug on those prone to improve with the use of it.
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Anticuerpos Monoclonales Humanizados , Proteína C-Reactiva , Tratamiento Farmacológico de COVID-19 , COVID-19 , Hospitalización , SARS-CoV-2 , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Anticuerpos Monoclonales Humanizados/uso terapéutico , Proteína C-Reactiva/análisis , Proteína C-Reactiva/metabolismo , COVID-19/mortalidad , COVID-19/sangre , Interleucina-6/sangre , Estudios Retrospectivos , SARS-CoV-2/efectos de los fármacosRESUMEN
PURPOSE: To analyze binocular vision of individuals aged 18 to 35 years diagnosed with keratoconus, utilizing spectacles and rigid gas-permeable (RGP) contact lenses. Research was led by the Universidad Autónoma de Aguascalientes, México and Fundación Universitaria del Área Andina Pereira, Colombia. METHODS: A single center, prospective non-randomized, comparative, interventional, open-label study, in which the differences in binocular vision performance with both spectacles and RGP contact lenses was carried out from December 2018 to December 2019. Sampling was performed according to consecutive cases with keratoconus that met the inclusion criteria until the proposed sample size was reached. RESULTS: Rigid gas-permeable (RGP) contact lenses notably enhanced distance and near visual acuity in keratoconus patients compared to spectacles. Visual alignment analysis shows exophoria at both distances and is slightly higher with RGP contact lenses. The difference was statistically significant (p<0.05), with 82.5 % presenting compensated phoria with spectacles and pnly 42.50% with RGP contact lenses. Stereoscopic vision improved while wearing RGP contact lenses (42.59 %), although accommodation and accommodative flexibility remained within normal ranges. CONCLUSIONS: Patients with keratoconus fitted with RGP contact lenses have improved binocular vision skills such as visual acuity, stereopsis, and accommodative flexibility. However, even when the vergence and motor system is decompensated with respect to normal ranges, the range between break and recovery points for both fusional reserves and the near point of convergence (NPC) improves with the use of RGP contact lenses, giving indications of an adaptive condition of the motor system from the medium to the long term.
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Lentes de Contacto , Anteojos , Queratocono , Visión Binocular , Agudeza Visual , Humanos , Queratocono/terapia , Queratocono/fisiopatología , Queratocono/rehabilitación , Adulto , Visión Binocular/fisiología , Agudeza Visual/fisiología , Masculino , Estudios Prospectivos , Adulto Joven , Femenino , AdolescenteRESUMEN
MicroRNAs (miRNAs) and long non-coding RNAs (lncRNAs) are two crucial classes of transcripts that belong to the major group of non-coding RNAs (ncRNAs). These RNA molecules have significant influence over diverse molecular processes due to their crucial role as regulators of gene expression. However, the dysregulated expression of these ncRNAs constitutes a fundamental factor in the etiology and progression of a wide variety of multifaceted human diseases, including kidney diseases. In this context, over the past years, compelling evidence has shown that miRNAs and lncRNAs could be prospective targets for the development of next-generation drugs against kidney diseases as they participate in a number of disease-associated processes, such as podocyte and nephron death, renal fibrosis, inflammation, transition from acute kidney injury to chronic kidney disease, renal vascular changes, sepsis, pyroptosis, and apoptosis. Hence, in this current review, we critically analyze the recent findings concerning the therapeutic inferences of miRNAs and lncRNAs in the pathophysiological context of kidney diseases. Additionally, with the aim of driving advances in the formulation of ncRNA-based drugs tailored for the management of kidney diseases, we discuss some of the key challenges and future prospects that should be addressed in forthcoming investigations.
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MicroARNs , ARN Largo no Codificante , Insuficiencia Renal Crónica , Humanos , MicroARNs/genética , MicroARNs/metabolismo , ARN Largo no Codificante/genética , ARN Largo no Codificante/metabolismo , ARN no Traducido , Insuficiencia Renal Crónica/tratamiento farmacológico , Insuficiencia Renal Crónica/genética , Insuficiencia Renal Crónica/metabolismo , FibrosisRESUMEN
Acanthamoeba griffini is known to cause amoebic keratitis (AK); its main causes are inadequate hygiene when contact lenses are handled and/or its prolonged use at night, as well as the use of contact lenses during underwater activities. The most used treatment for AK is the combination of propamidine isethionate combined with polyhexamethylene biguanide, which disrupts the cytoplasmic membrane, and damages cellular components and respiratory enzymes. We proposed an immunoconjugate treatment obtained from Acanthamoeba immunized rabbit serum combined with propamidine isethionate; the corneas of hamsters inoculated with A. griffini (MYP2004) were treated with the combined, at 1, 2, and 3 weeks. Propamidine isethionate is frequently used for AK treatment, in vivo study we are found IL-1ß and IL-10 expression and caspase 3 activity is significantly increased with respect to the group that was inoculated with the amoeba without receiving any treatment, suggesting that it may be an effect of the toxicity of this drug on the corneal tissue. Application of the immunoconjugate showed enhanced amoebicidal and anti-inflammatory activities, with comparison to propamidine isethionate only. The aim of this study is to evaluate the effect of the immunoconjugate of propamidine isethionate and polyclonal antibodies as a treatment of AK in golden hamsters (Mesocricetus auratus).
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BACKGROUND: Chagas disease (CD) treatment is commonly associated with a high incidence of adverse effects. It is crucial to study and update these adverse effects to improve the existing knowledge of which drugs to use and to clarify the information presented to patients. METHODS: We analyzed the adverse effects of benznidazole in two cohorts of patients: a large retrospective study and a small prospective study. RESULTS: This large retrospective study described the most and least common adverse effects in our area and characterized our Chagas disease population. This prospective study, along with a close follow-up of the treatment, detected more adverse effects and enhanced the patients' perception of the disease and treatment. CONCLUSIONS: This information is important for preventing non-medical-related withdrawals and for removing baseless fears. Better knowledge of patients could help us provide better care.
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Enfermedad de Chagas , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Nitroimidazoles , Tripanocidas , Trypanosoma cruzi , Humanos , Estudios Prospectivos , Estudios Retrospectivos , Enfermedad Crónica , Tripanocidas/efectos adversos , Enfermedad de Chagas/tratamiento farmacológico , Enfermedad de Chagas/epidemiología , Nitroimidazoles/efectos adversosRESUMEN
End-use demand data availability is a catalyst for improving energy efficiency measures and upgrading electricity demand studies. Nevertheless, residential end-use public datasets are limited, and end-use monitoring is costly. The lack of electricity end-use data is even more profound in Latin America, where there are no public end-use datasets as far as the authors are concerned. Hence, we present the Residential Electricity End-use Demand Dataset of Costa Rica (REEDD-CR), containing the results of monitoring 51 Costa Rican households. The data set includes the aggregated and branch circuit measurements for every home with a sample time of 1 min for at least an entire week. The measurements were distributed all around the country. In addition, based on these sub-measurements, REEDD-CR includes a dataset of 197 load signatures composed of seven consumption and demand features for eight high-consuming appliances: refrigerator, stove, dryer, lighting, water heating, air conditioning, microwave, and washing machine. The features included on each load signature are average power, peak power, average daily events, average daily energy, day-use factor, night-use factor, and time of use. The single-appliance measurements used to calculate these load signatures are also part of the dataset. The release of REEDD-CR can serve as a tool for appliance modeling, demand disaggregation testing, feedback for energy demand models, and the overall upgrade of electricity supply and demand simulation studies with realistic and disaggregated data.
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MicroRNAs (miRNAs) are tiny (20-24 nucleotides long), non-coding, highly conserved RNA molecules that play a crucial role within the post-transcriptional regulation of gene expression via sequence-specific mechanisms. Since the miRNA transcriptome is involved in multiple molecular processes needed for cellular homeostasis, its altered expression can trigger the development and progression of several human pathologies. In this context, over the last few years, several relevant studies have demonstrated that dysregulated miRNAs affect a wide range of molecular mechanisms associated with irritable bowel syndrome (IBS), a common gastrointestinal disorder. For instance, abnormal miRNA expression in IBS patients is related to the alteration of intestinal permeability, visceral hyperalgesia, inflammatory pathways, and pain sensitivity. Besides, specific miRNAs are differentially expressed in the different subtypes of IBS, and therefore, they might be used as biomarkers for precise diagnosis of these pathological conditions. Accordingly, miRNAs have noteworthy potential as theragnostic targets for IBS. Hence, in this current review, we present an overview of the recent discoveries regarding the clinical relevance of miRNAs in IBS, which might be useful in the future for the development of miRNA-based drugs against this disorder.
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Síndrome del Colon Irritable , MicroARNs , Humanos , MicroARNs/genética , Síndrome del Colon Irritable/diagnóstico , Síndrome del Colon Irritable/genética , Síndrome del Colon Irritable/complicaciones , Regulación de la Expresión Génica , Umbral del Dolor , HiperalgesiaRESUMEN
ABSTRACT Background: Chagas disease (CD) treatment is commonly associated with a high incidence of adverse effects. It is crucial to study and update these adverse effects to improve the existing knowledge of which drugs to use and to clarify the information presented to patients. Methods: We analyzed the adverse effects of benznidazole in two cohorts of patients: a large retrospective study and a small prospective study. Results: This large retrospective study described the most and least common adverse effects in our area and characterized our Chagas disease population. This prospective study, along with a close follow-up of the treatment, detected more adverse effects and enhanced the patients' perception of the disease and treatment. Conclusions: This information is important for preventing non-medical-related withdrawals and for removing baseless fears. Better knowledge of patients could help us provide better care.
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Multiple comorbidities related to arsenic exposure through drinking water continue to be public problems worldwide, principally in chronically exposed populations, such as those in the Comarca Lagunera (CL), Mexico. In addition, this relationship could be exacerbated by an early life exposure through the placenta and later through breast milk. This study conducted a comparative analysis of arsenic levels in multiple biological samples from pregnant women and their neonates in the CL and the comparison region, Saltillo. Total arsenic levels in placenta, breast milk, blood, and urine were measured in pregnant women and their neonates from rural areas of seven municipalities of the CL using atomic absorption spectrophotometry with hydride generation methodology. The average concentrations of tAs in drinking water were 47.7 µg/L and 0.05 µg/L in the exposed and non-exposed areas, respectively. Mean levels of tAs were 7.80 µg/kg, 77.04 µg/g-Cr, and 4.30 µg/L in placenta, blood, urine, and breast milk, respectively, in mothers, and 107.92 µg/g-Cr in neonates in the exposed group, which were significantly higher than those in the non-exposed area. High levels of urinary arsenic in neonates were maintained 4 days after birth, demonstrating an early arsenic exposure route through the placenta and breast milk. In addition, our study suggested that breastfeeding may reduce arsenic exposure in infants in arsenic-contaminated areas. Further studies are necessary to follow up on comorbidities later in life in neonates and to provide interventions in this region.
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Arsénico , Agua Potable , Lactante , Recién Nacido , Humanos , Femenino , Embarazo , Agua Potable/análisis , Arsénico/análisis , Leche Humana/química , Lactancia Materna , Espectrofotometría Atómica , MéxicoRESUMEN
Background: Osteocalcin plays a role in glucose metabolism in mice, but its relevance in human energetic metabolism is controversial. Its relationship with markers of energetic metabolism in the pediatric population has not been systematically addressed in infants and adolescents. Objective: This study aims to assess the mean differences between tOC, ucOC, and cOC among healthy children and children with type 1 or type 2 diabetes (T1D or T2D) and the correlation of these bone molecules with metabolic markers. Methods: A systematic review and metanalysis were performed following PRISMA criteria to identify relevant observational studies published in English and Spanish using PubMed, Scopus, EBSCO, and Web of Science databases. The risk of bias was assessed using New Castle-Ottawa scale. Effect size measures comprised standardized mean difference (SMD) and Pearson correlations. Heterogeneity and meta-regressions were performed. Results: The 20 studies included were of high quality and comprised 3,000 pediatric patients who underwent tOC, cOC, or ucOC measurements. Among healthy subjects, there was a positive correlation of ucOC with WC and weight, a positive correlation of tOC with FPG, HDL-c, WC, height, and weight, and a negative correlation between tOC and HbA1c. Among diabetic subjects, a negative correlation of ucOC with HbA1c and glycemia in both T1D and T2D was found and a negative correlation between tOC and HbA1c in T1D but not in T2D. The ucOC concentrations were lower in T2D, T1D, and patients with abnormal glucose status than among controls. The serum concentrations of tOC concentrations were lower among T1D than in controls. The patient's age, altitude, and HbA1c influenced the levels of serum tOC. Conclusion: Osteocalcin is involved in energy metabolism in pediatric subjects because it is consistently related to metabolic and anthropometric parameters. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier: CRD42019138283.
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Purpose: This paper aims to evaluate the prevalence of REs in a clinic from Aguascalientes, Mexico by analysing clinical records from the local public health system. Refractive errors (REs) are quite common globally, but no data have been published regarding their frequency in clinics from Mexico. A priori, the frequency of ametropias should be high as admixture ancestry from this region is mainly European and Amerindian, the regions with high prevalence worldwide.MethodsThis cross-sectional study was conducted on 2195 subjects from records of public optometry services during the year 2018. Information obtained included age, gender, sphere, cylinder and axis. The prevalence of myopia, hyperopia and astigmatism was determined by gender and age groups in paediatric and adult patients. Chi-square testing was applied to determine significant differences in prevalence across age groups and gender. A p-value <0.05 was considered significant.ResultsIn subjects under 18 years of age, the prevalence of emmetropia, astigmatism, myopia and hyperopia was 20.1%, 51.1%, 7.0% and 11.8%, respectively. In adults, emmetropia was present at a frequency of 20.1%, while 57.1% presented astigmatism, 12.4% hyperopia and 8.6% presented myopia. A significant association was observed between the presence of REs and age and gender.ConclusionsIn this first report of prevalence of REs from western Mexico, astigmatism was the most prevalent RE in children, adolescents and adults while the least common was myopia. Important differences were found in prevalence in comparison to national and international reports. (AU)
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Humanos , Niño , Adolescente , Adulto , Distribución por Edad , Astigmatismo , Hiperopía , Prevalencia , Salud Pública , Errores de Refracción , Estudios Transversales , México/epidemiología , Visión OcularRESUMEN
Congenital Chagas disease (CCD) has become a global health problem. Historically, the diagnosis of CCD has been carried out using parasitological methods and traditional serological techniques, however, new serological techniques such as chemiluminescent microparticle immunoassays (CMIA) have been developed in the last few years with many advantages compared with traditional serological tests. A total of 75 children born to 72 Latin American Chagas-infected mothers were consecutively enrolled and studied by CMIA and indirect immunofluorescence (IIF) at 0-2, 6, 9, and 12 months of age. At the end of the follow-up, 74 out of 75 children were considered uninfected and one child was diagnosed with CCD. Our study emphasizes the need to carry out serological follow-up on every newborn from a mother with Chagas disease and shows that CMIA assay is a great diagnostic tool as a single serological test at 9 months of age to rule out CCD or to identify possible transmission.
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Anticuerpos Antiprotozoarios/inmunología , Enfermedad de Chagas/diagnóstico , Adulto , Enfermedad de Chagas/congénito , Enfermedad de Chagas/tratamiento farmacológico , Enfermedad de Chagas/inmunología , Femenino , Sangre Fetal/inmunología , Técnica del Anticuerpo Fluorescente Indirecta , Humanos , Inmunoensayo , Lactante , Recién Nacido , Mediciones Luminiscentes , Masculino , Nitroimidazoles/uso terapéutico , Estudios Prospectivos , Sensibilidad y Especificidad , España , Tripanocidas/uso terapéutico , Adulto JovenRESUMEN
PURPOSE: This paper aims to evaluate the prevalence of REs in a clinic from Aguascalientes, Mexico by analysing clinical records from the local public health system. Refractive errors (REs) are quite common globally, but no data have been published regarding their frequency in clinics from Mexico. A priori, the frequency of ametropias should be high as admixture ancestry from this region is mainly European and Amerindian, the regions with high prevalence worldwide. METHODS: This cross-sectional study was conducted on 2195 subjects from records of public optometry services during the year 2018. Information obtained included age, gender, sphere, cylinder and axis. The prevalence of myopia, hyperopia and astigmatism was determined by gender and age groups in paediatric and adult patients. Chi-square testing was applied to determine significant differences in prevalence across age groups and gender. A p-value <0.05 was considered significant. RESULTS: In subjects under 18 years of age, the prevalence of emmetropia, astigmatism, myopia and hyperopia was 20.1%, 51.1%, 7.0% and 11.8%, respectively. In adults, emmetropia was present at a frequency of 20.1%, while 57.1% presented astigmatism, 12.4% hyperopia and 8.6% presented myopia. A significant association was observed between the presence of REs and age and gender. CONCLUSIONS: In this first report of prevalence of REs from western Mexico, astigmatism was the most prevalent RE in children, adolescents and adults while the least common was myopia. Important differences were found in prevalence in comparison to national and international reports.
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Astigmatismo , Hiperopía , Errores de Refracción , Adolescente , Adulto , Distribución por Edad , Niño , Estudios Transversales , Humanos , México/epidemiología , Prevalencia , Salud Pública , Errores de Refracción/epidemiologíaRESUMEN
BACKGROUND: The COVID-19 pandemic had infected more than 3.5M people around the world and more than 250K people died in 187 countries by May 2020. The causal agent of this disease is a coronavirus whose onset of symptoms to death range from 6 to 41 days with a median of 14 days. This period is dependent on several factors such as the presence of comorbidities, age and the efficiency of the innate or adaptive immune responses. METHODS: The effector mechanisms of both types of immune responses depend on the pathogen involved. In the case of a viral infection, the innate immune response may approach the harmful virus through pattern recognition receptors inducing an antiviral state. RESULTS: On the other hand, the adaptive immune response activates antibody production to neutralize or eliminate the virus. Phenolics are plant secondary metabolites with many biological activities for plants and humans against infection. Chemical modification of proteins may enhance their biological properties; thus, a protein of medical interest, for instance, a viral protein can be used as a scaffold to build a biopharmaceutical conjugated or complexated with phenolics exhibiting structural complexity or biological activities to achieve effective phenolic-protein-based therapeutics like vaccine adjuvant complexes, immunogen conjugates, and antiviral conjugates. CONCLUSION: Pharmaceutical biotechnology applies the principles of biotechnology to develop biopharmaceuticals for protein-based therapeutics; such as adjuvants, recombinant proteins, monoclonal antibodies, and antivirals. As neither a vaccine nor a treatment for COVID-19 is currently available, this manuscript focuses on insights from pharmaceutical biotechnology into phenolic biopharmaceuticals against COVID-19.
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COVID-19 , Preparaciones Farmacéuticas , Vacunas , Biotecnología , Humanos , Pandemias , SARS-CoV-2RESUMEN
BACKGROUND: The parasite Entamoeba histolytica is the causal agent of amoebiasis, a worldwide emerging disease. Amebic brain abscess is a form of invasive amebiasis that is both rare and frequently lethal. This condition always begins with the infection of the colon by E. histolytica trophozoites, which subsequently travel through the bloodstream to extraintestinal tissues. CASE PRESENTATION: We report a case of a 71-year-old female who reported an altered state of consciousness, disorientation, sleepiness and memory loss. She had no history of hepatic or intestinal amoebiasis. A preliminary diagnosis of colloidal vesicular phase neurocysticercosis was made based on nuclear magnetic resonance imaging (NMRI). A postsurgery immunofluorescence study was positive for the 140 kDa fibronectin receptor of E. histolytica, although a serum analysis by ELISA was negative for IgG antibodies against this parasite. A specific E. histolytica 128 bp rRNA gene was identified by PCR in biopsy tissue. The final diagnosis was cerebral amoebiasis. The patient underwent neurosurgery to eliminate amoebic abscesses and was then given a regimen of metronidazole, ceftriaxone and dexamethasone for 4 weeks after the neurosurgery. However, a rapid decline in her condition led to death. CONCLUSIONS: The present case of an individual with a rare form of cerebral amoebiasis highlights the importance of performing immunofluorescence, NMRI and PCR if a patient has brain abscess and a poorly defined diagnosis. Moreover, the administration of corticosteroids to such patients can often lead to a rapid decline in their condition.
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Absceso Encefálico/diagnóstico , Absceso Encefálico/parasitología , Infecciones Parasitarias del Sistema Nervioso Central/diagnóstico , Entamebiasis/diagnóstico , Anciano , Animales , Absceso Encefálico/tratamiento farmacológico , Absceso Encefálico/cirugía , Ceftriaxona/administración & dosificación , Infecciones Parasitarias del Sistema Nervioso Central/tratamiento farmacológico , Infecciones Parasitarias del Sistema Nervioso Central/patología , Infecciones Parasitarias del Sistema Nervioso Central/cirugía , Terapia Combinada , ADN Protozoario/análisis , Dexametasona/administración & dosificación , Quimioterapia Combinada , Entamoeba histolytica/genética , Entamoeba histolytica/inmunología , Entamoeba histolytica/aislamiento & purificación , Entamebiasis/tratamiento farmacológico , Entamebiasis/patología , Entamebiasis/cirugía , Resultado Fatal , Femenino , Humanos , Metronidazol/administración & dosificación , Procedimientos Neuroquirúrgicos , Pruebas SerológicasRESUMEN
INTRODUCTION: The coexistence of an enterocutaneous fistula (ECF) with large abdominal wall defects represent one of the most demanding situations seen by a surgeon. Simultaneous treatment of ECF closure with abdominal wall defect closure has been widely debated. Our objective was to determine if the type of abdominal wall closure was associated with fistula recurrence after definitive surgery for ECF. MATERIALS AND METHODS: Consecutive patients submitted to fistula resection with primary anastomosis for ECF closure. Among several variables, total abdominal wall closure (primary independent variable) was assessed as a factor related to the recurrence of the ECF (dependent variable). Univariate and multivariate analyses were performed. RESULTS: One-hundred and fourteen patients were included. Fistula recurred in 39 patients (34%). Total abdominal wall closure was done in 37 patients (32%). ECF recurred in 16% (6 of 37 patients) when abdominal wall closure was performed, compared to 43% (33 of 77 patients) when this was not (p < 0.02). After multivariate analyses, abdominal wall closure was found as a protective factor against recurrence (p < 0.02). Patients with total abdominal wall closure had one-fourth of risk for recurrence compared to patients without it. Other factors associated to recurrence of ECF were multiple fistulas (p < 0.05), intraoperative blood loss >325 mL (p < 0.05) and preoperative C-reactive protein >0.5 mg/dL (p < 0.01). CONCLUSION: Our results suggest that total abdominal wall closure is a protective factor against fistula recurrence after definitive surgery for ECF.
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Pared Abdominal/cirugía , Fístula Intestinal/cirugía , Complicaciones Posoperatorias/cirugía , Adulto , Análisis de Varianza , Anastomosis Quirúrgica , Proteína C-Reactiva/análisis , Femenino , Humanos , Fístula Intestinal/mortalidad , Masculino , Persona de Mediana Edad , Análisis Multivariante , Factores de Riesgo , Prevención SecundariaRESUMEN
In recent decades and because of migration, Chagas disease has become a global public health problem. A significant focus has been placed on pregnant women who can transmit the disease to their offspring. Here, we report four cases of women who did not know that they were pregnant while they were being treated with benznidazole. A diagnosis was established according to serology and Trypanosoma cruzi polymerase chain reaction (PCR)-standardized tests. Treatment was discontinued when pregnancy was confirmed, and a thorough follow-up was carried out. Although each case was different, none of the mothers developed health problems during pregnancy, and their newborns were delivered without any teratogenic effects.