Exclusión renal por endometriosis profunda ureteral: a propósito de un caso / Renal exclusion due to deep infiltrating ureteral endometriosis: a case report

INTRODUCCIÓN: La endometriosis ureteral es una afección rara que afecta al 0.01-1,7% de las mujeres con endometriosis. Hasta un 30% cursa de forma asintomática y un 11,5-14,7% pueden evolucionar con falla renal. La falta de diagnóstico de la enfermedad puede terminar en una uropatía obstructiva y falla renal irreversible. Se presenta el caso de una paciente con afectación grave de la función renal secundaria a endometriosis profunda con compromiso ureteral. CASO CLÍNICO: Mujer de 35 años con endometriosis que consultó por exacerbación de los síntomas. En su estudio destaca, en la resonancia magnética, el hallazgo de endometriosis pélvica profunda y compromiso endometriósico intrínseco del uréter distal derecho, provocando una acentuada hidroureteronefrosis. El cintigrama renal demuestra acentuado compromiso de la función renal derecha, con una función relativa del 7%. Se realizaron nefrectomía total derecha y resección de enfermedad pélvica profunda laparoscópica, sin incidentes. CONCLUSIONES: La endometriosis ureteral representa un desafío diagnóstico y terapéutico. El manejo multidisciplinario entre radiólogos, ginecólogos y urólogos, mediante el diseño de una estrategia quirúrgica individualizada, es imprescindible para definir el tratamiento óptimo de estas pacientes.

INTRODUCTION: Ureteral endometriosis is a rare entity that affects 0.01-1,7% of women with endometriosis. Up to 30% of the patients are asymptomatic and 11.5-14.7% will develop renal failure. Misdiagnosis can lead to obstructive uropathy and permanent renal failure. We present the case of a patient with severe compromise of renal function secondary to deep infiltrating endometriosis with ureteral involvement. CASE REPORT: A 35-year-old woman with endometriosis presented with exacerbation of symptoms. Magnetic resonance showed deep pelvic endometriosis and intrinsic endometriotic involvement of the right distal ureter, causing a marked hydroureteronephrosis. Renal scintigram showed a severe compromise of the right renal function, with a relative function of 7%. Through laparoscopy a total right nephrectomy and resection of deep infiltrating endometriosis was performed. The patient had a satisfactory recovery in the postoperative period. CONCLUSIONS: Ureteral endometriosis presents a diagnostic and therapeutical challenge. Joint multidisciplinary management between radiologists, gynecologists and urologists through the design of an individualized surgical strategy is essential to define the optimal treatment for these patients.

Oral findings and its association with prenatal and perinatal factors in newborns / 소아과

PURPOSE: This study aimed to determine the frequency of abnormalities in the newborn oral cavity and to evaluate the association with prenatal and perinatal factors. METHODS: This cross-sectional study evaluated 2,216 newborns. Oral findings were assessed in the first 24 hours of life using visual examination. Sex, weight, length, gestational age, and medical disorders at birth were recorded. Maternal demographic and medical information was also obtained. RESULTS: The most common oral findings were Bohn’s nodules, Epstein’s pearls, and dental lamina cysts. Other intraoral findings included odontogenic cysts, ankyloglossia, and natal teeth, among others. In logistic regression analyses, folic acid consumption during pregnancy was significantly associated with Bohn’s nodules (odds ratio [OR], 1.79; 95% confidence interval [CI], 1.23–2.55; P=0.002), Epstein’s pearls (OR, 1.63; 95% CI, 1.14–2.33; P=0.007), and dental lamina cysts (OR, 1.45; 95% CI, 1.02–2.05; P=0.038). Moreover, preterm births were negatively associated with prevalence of Bohn’s nodules (OR, 0.63; 95% CI, 0.50–0.80; P≤0.0001). Comparison between newborns with and without oral inclusion cysts showed that maternal folic acid and iron intake were significantly different (P < 0.05). CONCLUSION: Maternal folic acid and iron intake were associated with the prevalence of oral inclusion cysts.

Skin problems in children under five years old at a rural hospital in Southern Ethiopia

Objective To examine the prevalence of cutaneous disorders in children under 5 years old who attended a rural hospital in Southern Ethiopia. Methods A prospective cross-sectional study was conducted from January 26 to February 20, 2015 in children under 5 years old who attended Gambo Rural Hospital in West Arsi of the Oromia Region, Ethiopia. Results A total of 324 children were included (59.6% male) whose median age was 16.4 months. In total, 147 children [45.4%; 95% confidence interval (CI): 40.0%–50.8%] under 5 years had a skin problem, of which 101 (68.7%) consulted for that reason. The other 46 (31.3%) consulted for a general health problem and the dermatological condition was a secondary finding during the physical exploration. In 93 children (28.7%; 95% CI: 20%–33.8%), it was the main disease, and in 54 children (16.5%; 95% CI: 13.0%–21.1%) it was concomitant with other diseases. The most common dermatological disease was scabies (n = 44, 13.6%; 95% CI: 10.3%–17.7%). Impetigo was diagnosed in 32 children (9.9%; 95% CI: 7.1%–13.3%), of which 23 (71.9%) had complicated impetigo. Nineteen children (5.9%; 95% CI: 3.8%–9.0%) had eczema, 10 (3.1%) had eczema associated to other conditions. The following most frequent skin problems were tinea (n = 9; 2.8%), infected wound and ulcer (n = 7; 2.2%), and burns (n = 6; 1.9%). Conclusions Skin problems, mainly scabies, impetigo, and eczema were common in young children attended at a rural hospital in Southern Ethiopia. Children under 5 years should be examined thoroughly to rule out skin diseases, especially scabies.

Screening for tuberculosis in family and household contacts in a rural area in Ethiopia over a 20-month period

The purpose of this study is to describe the experience of the completion of the Tuberculosis [TB] Contact Screening Logbook [TB-CSL]. The TB-CSL was retrospectively analyzed from July 2007 until June 2012. During the study period, 122 patients were included in the TB-CSL; however, 17 [13.9%] patients with TB were written in the TB-CSL, but without registering any contacts. Of the 105 TB patients with contacts registered, the family and household contacts were finally performed in 68 index TB patients [55.7% of TB patients]. These 68 index TB cases had 299 family and household contacts; the median contact per patient was 4.4 [+/- 1.9]. Of the 299 contacts, 160 [53.5%] were screened. The median of those screened per patient was 2.3 [+/- 1.9]. Of the 160 family and household contacts screened, 34 [31.3%] of them were children

Management and transference of patients diagnosed with tuberculosis in a rural hospital in southern Ethiopia

Treatment of new tuberculosis [TB] cases in Directly Observed Treatment Short Course [DOTS] programmes is believed to be the most valuable strategy for TB control. The aim of this study is to describe the experience of diagnosed cases of TB in a district hospital situated in a rural zone of Ethiopia and of "transferred out" TB cases from the hospital to their local health facilities using the DOTS programme spanning a period of 8 years. Data collection was obtained by using a TB register book in a rural district hospital from 2004 to 2011. The collected information included the type of TB, age, HIV status, and treatment outcomes using standardized definitions; 6459 patients with all forms of TB were diagnosed. Twenty-eight percent were smear-positive pulmonary TB [PTB] cases, 28.97% were smear-negative PTB cases, and 42.8% were extra-pulmonary TB [EPTB]. The global "transferred out" rate was 78.5% [5073/6459]; the "transferred out" rate after diagnosis at hospital and before starting DOTS was 72.6% [4689/6459], and after finishing the intensive phase and admission was 21.8% [385/1770]. The proportion of total cases "transferred out" in smear-negative PTB cases [70.2%] was less than smear-positive PTB cases [79.2%] [odd ratio [OR]: 0.81; 95% confidence interval [CI]: 0.76-0.87] and was higher in EPTB cases [83.3%] [OR: 1.15; 95% CI: 1.05-1.19]. The percentage of "transferred out" after hospital admission was higher in HIV-positive cases [16.8%] than in HIV-negative cases [8.5%] [OR: 2.13; 95% CI: 1.28-3.53]. In conclusion, district hospitals are still important facilities for the diagnosis of TB cases, particularly EPTB

Mammary, testicular and adnexal tuberculosis diagnosed by histology in a rural hospital in Southern Ethiopia

This study describes the experience of mammary, testicle and adnexal tuberculosis [TB] diagnosed by histological characteristics in a rural district hospital in Southern Ethiopia over a period of 7 years. During the same period, a total of 5589 TB cases were diagnosed. Fourteen cases of breast TB with a prevalence of 0.25% [95% confidence interval [CI]: 0.14-0.43], 8 cases of testicular TB [prevalence 0.14, [95% CI: 0.06-0.29]] and two ovarian TB [prevalence: 0.035 [95% CI: 0.001-0.15]]. The breast, testes and adnexal TB may mimic other conditions. Proper diagnosis is encouraged because the disease is curable with anti-TB drugs.