The challenging diagnosis of overlapping oral primary/secondary syphilis with nonreactive serology.

The prevalence of oral syphilis, known as "the great imitator" because of its diagnostic complexity and varied clinical manifestations, is increasing worldwide, particularly in people living with HIV (PLWH), who could present false-negative serological results. Although some studies have described the variable presentation of oral syphilis in the context of HIV infection, the difficulty in distinguishing between the primary and secondary stages, clinically and histopathologically, underscores the need to describe atypical cases. We report the case of a 28-year-old HIV-positive man presenting with a 3-month history of painless white/red ulcerated lesion on the soft palate. Physical examination revealed an ulcerated lesion with local signs of inflammation. Initial biopsy revealed a nonspecific inflammatory process and immunohistochemistry (IHC) using anti-Treponema pallidum antibodies showed negative results. The results of serological tests for syphilis (Venereal Disease Research Laboratory and fluorescent treponemal antibody-absorption test) were negative on repeated occasions. Nonetheless, polymerase chain reaction (PCR) assay and subsequent IHC for T. pallidum showed positive results, confirming the diagnosis of oral syphilis. This case illustrates that the diagnosis of oral syphilis is challenging in the absence of serological evidence, and specific tests such as PCR and IHC are useful complementary diagnostic tools.

[Patients with solid organ transplantation and skin cancer: determination of risk factors with emphasis in photoexposure and immunosuppressive regimen. Experience in a third level hospital]. / Pacientes con trasplante de órgano sólido y cáncer de piel: determinación de factores de riesgo con énfasis en la fotoexposición y el esquema inmunosupresor. Experiencia de un hospital de tercer nivel.

BACKGROUND: Non-melanoma skin cancer (NMSC) is the most common malignancy in transplant patients. The incidence of basal cell carcinoma (BCC) is 10 times greater than in the general population, while squamous cell carcinoma (SCC) is 100 times greater. The relationship between the BCC and SCC reverses and increases according to the degree of immunosuppression and sun exposure. One way to predict the risk of NMSC should be based on factors such as: total sun burden factor (TSB). OBJECTIVE: To determine the influence of various risk factors in the development of NMSC and its relation to the type and duration of immunosuppressive treatment, type of transplant, and TSB. METHODS: We worked with a fledgling historical cohort in which patients with kidney or liver transplant were identified and recorded if they developed some form of skin cancer. To study the factors associated with NMSC, we resorted to the strategy of a case-control study. Dermatological examination was performed and a questionnaire of risk factors made in both groups. RESULTS: Of the 140 patients enrolled, 51 were women and 89 men, 120 were renal transplant recipients and 20 liver transplants. Of patients who developed NMSC, 100% were renal transplant recipients. The median age was 48.5 years. Most cancer patients worked outdoors. A total of 78 lesions were found in 40 NMSC patients, 59 (76%) of them were SCC, and 19 (24%) BCC; 45% of all skin cancer patients had more than one injury. The worst affected areas were those photoexposed: 60% head and neck, trunk and upper extremities 18% 50%. In 30% of patients (12/40) 22 new tumors were identified (SCC 18 and BCC 4). No lesions were identified for melanoma. In multivariate logistic regression analysis, statistically significant features were: type-based immunosuppressive regimen of cyclosporine A, azathioprine and prednisone (OR: 59.7; 95% CI: 10.2-348), TSB > 10 (OR: 19; 95% CI: 3-120) and duration of use of immunosuppressive therapy (OR: 1.06; 95% CI: 0.9-1.1). The mean time from transplantation to first dermatological assessment was six years (+5.4). Of the patients, 93% had not regularly used sunscreen before and after transplantation. CONCLUSIONS: The dermatological assessment is convenient and easy to perform. Primary prevention, close monitoring, diagnosis, and treatment of skin lesions are essential components of a comprehensive program for the evaluation of transplant recipients, the purpose of which is to reduce the incidence and morbidity associated with cancer.

[Flouroquinolone activity in clinical isolates of Streptococcus pneumoniae with different susceptibility to penicilline: an epidemiological study in five cities of Mexico]. / Actividad de las fluoroquinolonas en aislamientos clínicos de Streptococcus pneumoniae con diferente susceptibilidad a la penicilina: estudio epidemiológico en cinco ciudades de la República Mexicana.

OBJECTIVE: Determine the susceptibility to five fluoroquinolones and cross-resistance of pneumococcusclinical isolates with different penicillin susceptibilities gathered in a community-based study. DESIGN: Cross-sectional survey. MATERIALS: Two hundred and thirty one (231) isolates were obtained from respiratory secretions or blood specimens from 231 patients with acquired acute respiratory infection or bacteremia. OUTCOME MEASURES: In vitro susceptibility to penicillin (PEN), ciprofloxacin (CIP), levofloxacin (LEV), gatifioxacin (GAT), moxifloxacin (MOX) and gemifioxacin (GEM) was determined with minimal inhibitory concentration (MIC) using the E test. RESULTS: 42% of the isolates showed decreased susceptibility to PEN. The lowest antibiotic concentration that inhibited 90% of the isolates was 3 microg/ml (for CIP), 1 microg/ml (for LEV), 0.25 microg/ml (for GAT), 0.125 microg/ml (for MOX) and 0.032 microg/ml (for GEM). Median MIC for LEV, GAT, MOX and GEM increased with decreasing susceptibility to CIP. Susceptibility to CIP was similar between penicillin-susceptible and penicillin-resistant pneumococci. CONCLUSION: Third and fourth generation fluoroquinolones showed very high inhibitory activity, higher than that for CIP, for both penicillin-susceptible and penicillin-resistant pneumococci. We noted cross-resistance among fluoroquinolones.

Actividad de las fluoroquinolonas en aislamientos clínicos de Streptococcus pneumoniae con diferente susceptibilidad a la penicilina: Estudio epidemiológico en cinco ciudades de la República Mexicana / Flouroquinolone activity in clinical isolates of Streptococcus pneumoniae with different susceptibility to penicilline: An epidemiological study in five cities of Mexico

Objetivo: Determinar el grado de sensibilidad a cinco fluoroquinolonas, y la resistencia cruzada, en aislados clínicos de neumococo con diferente susceptibilidad a la penicilina Diseño: Estudio transversal Lugar: Los aislamientos de Streptococcus pneumoniae (Sp) se obtuvieron en cinco centros de atención médica y en un laboratorio de referencia de cinco ciudades de la República Mexicana, durante febrero de 1999 a mayo del 2000. Material: 231 aislamientos de Sp obtenidos de muestras de secreción de la vía aérea o sangre, de 231 pacientes con infección respiratoria aguda o bacteriemia adquiridas en la comunidad. Mediciones: Se midió la susceptibilidad in vitro a penicilina (PEN), ciprofloxacina (CIP), levofloxacina (LEV), gatifloxacina (GAT), moxifloxacina (MOX) y gemifloxacina (GEM) mediante la determinación de la concentración mínima inhibitoria (CMI) con la prueba E. Resultados: 42% de los aislamientos mostraron susceptibilidad disminuida a la PEN. La mínima concentración del antibiótico que logró inhibir al 90% de los aislamientos fue de 3 µg/ml (para la CIP), 1 Hg/ml (para la LEV), 0.25ng/ml (para la GAT), 0.125 µg/ml (para la MOX) y 0.032 µg/ml (para la GEM). La mediana de la CMI para la LEV (GAT, MOX y GEM) se incrementó proporcionalmente a la disminución de la sensibilidad del neumococo a la CIP. La susceptibilidad a la CIP fue semejante entre los aislamientos sensibles y resistentes a la PEN. Conclusión: las fluoroquinolonas de tercera y cuarta generación mostraron tener buena actividad inhibitoria del neumococo, incluyendo a las cepas resistentes a la PEN, siendo mayor que la de CIP. Se documentó resistencia cruzada entre las fluoroquinolonas.

Objective: Determine the susceptibility to five fluoroquinolones and cross resistance of pneumococcus clinical isolates with different penicillin susceptibilities gathered in a community based study . Design: Cross sectional survey. Materials: Two hundred and thirty one (231) isolates were obtained from respiratory secretions or blood specimensfrom 231 patients with acquired acute respiratory infection or bacteremia. Outcome measures: In vitro susceptibility to penicillin (PEN), ciprofloxacin (CIP), levofloxacin (LEV), gatifloxacin (GAT), moxifloxacin (MOX) and gemifloxacin (GEM) was determined with minimal inhibitory concentration (MIC) using the E test. Results: 42% of the isolates showed decreased susceptibility to PEN. The lowest antibiotic concentration that inhibited 90% of the isolates was 3 Hg/ml (for CIP), 1 µg/ml (forLEV), 0.25 µg/ml (for GAT), 0.125 µg/ml (for MOX) and 0.032 µg/ml (for GEM). Median MIC for LEV, GAT, MOX and GEM increased with decreasing susceptibility to CIP. Susceptibility to CIP was similar between penicillin susceptible and penicillin resistant pneumococci. Conclusion: Third and fourth generation fluoroquinolones showed very high inhibitory activity, higher than that for CIP, for both penicillin susceptible and penicillin resistant pneumococci. We noted cross resistance among fluoroquinolones.

Uso de bebidas y alimentos en el hogar durante la diarrea aguda del niño: estudio etnográfico en una zona rural mexicana / Use of solutions and foods at home during episodes of acute childhood diarrhea: an athnographic study conducted in a rural mexican area

Con el objeto de explorar algunas creencias acerca de la enfermedad diarreica en el niño así como el uso de bebidas de elaboración casera y hábitos de alimentación durante la enfermedad se aplicó un cuestionario estructurado a través de una entrevista personal a 142 madres campesinas. La mayoría de las entrevistadas respondió que acostumbraba dar algún tipo de té (90%) o una bebida de arroz (77%) a su niño con diarrea. Sólo el 18%mencionó el uso de sobres de hidratación oral. Sesenta y tres porciento dijo restringir ciertos alimentos en particular y 25%sometió a ayuno total, usualmente por más de 24 horas, al niño con diarrea. En vista del uso extendido y del propósito perseguido por la madre al dar atole de arroz se justifica el evaluar la eficacia clínica de esta bebida en la prevención de la deshidratación, así como el promover una dieta basada en alimentos disponibles localmente y aceptados culturalmente para el manejo domiciliario del niño con diarrea aguda

Memorias del V curso internacional: avances en enfermedad diarreica y desequilibrio hidroeletrolitico / Memories of the V international course: advances in diarrheic disease and hydroelectrolitical unbalance

No obastante que el uso de la terapia de hidratación ha mostrado su eficacia para prevenir la deshidratación, para reponer los líquidos perdidos y para mantener el adecuado balance hídrico mientras la diarrea persiste, la OMS y otras instituciones de salud han favorecido el uso de bebidas o soluciones basadas en preparaciones caseras que han mostrado ser útiles en el tratamiento de las diarreas y han sido aceptadas por las madres, esto a ocurrido particularmente en zonas rurales donde hay una alta ocurrencia de estos casos. Una de estas preparaciones es la "solución de hidratación a base de harina de arroz" con electrolitos, la cual ha sido utilizada con éxito en varios estudios. el presente trabajo es un estudio de niños menores que presentaron deshidratación secundaria provocada por diarrea aguda. Agrupados en grupo control tratados a base de solución hidratante oral y, grupo de estudio tratados con solución hidratante a base de harina de arroz. La respuesta a este ultimo tratamiento fue significativamente favorable. Sin embargo, la recomendación es que la solución a base de harina de arroz solo debe ser empleada en el hogar en las etapas iniciales de la diarrea aguda, sólo en caso de no disponer de la solución hidratante oral; no debe intentarse sustituir a ésta