Tympanic-mastoid and parotid schwannomas of the facial nerve: clinical presentation related to the anatomic site of origin.

Objective: To describe the clinical presentation of the facial nerve schwannomas according to the anatomical site of origin. Method: A retrospective study in which the clinical presentation, diagnostic protocol and treatment of facial nerve tumors in adults was evaluated. Results: We found 6 cases, 4 cases of tympanic-mastoid location at the spectrum of its possible clinical presentation: from symptomatic cases with facial paralysis, to an asymptomatic case in the tympanic portion found as intraoperative finding; and also found two cases located at the parotid gland, one with complete facial paralysis and one without facial palsy. Conclusions: For the diagnosis of intratemporal and parotid schwannomas of the facial nerve, a high clinical suspicion is required given its heterogeneous presentation; its clinical course depends on the segment of origin and expansion: more frequently asymptomatic at the tympanic horizontal portion and symptomatic at the mastoid vertical portion. These tumors must be assessed with imaging studies, incisional biopsy is not recommended. The treatment is surgical resection in symptomatic patients with facial paralysis greater than grade III of House-Brackmann, with immediate reconstruction of the nerve.

Objetivo: Describir la presentación clínica de los schwannomas del nervio facial de acuerdo con el sitio anatómico de origen. Método: Se realizó un estudio retrospectivo en el que se evaluó la presentación clínica, el protocolo diagnóstico y el tratamiento de tumores del nervio facial en adultos. Resultados: Se encontraron seis casos, cuatro de ellos de localización tímpano-mastoidea en los extremos de su posible presentación clínica: desde casos sintomáticos con parálisis facial, hasta un caso asintomático de la porción timpánica encontrado como hallazgo transoperatorio; y se encontraron dos casos de localización parotídea, uno con parálisis facial completa y otro sin parálisis facial. Conclusiones: Para el diagnóstico de tumores intratemporales y parotídeos del nervio facial se requiere una elevada sospecha clínica dado lo heterogéneo de su presentación; su curso clínico depende del segmento de origen y de su extensión: más frecuentemente son asintomáticos los de la porción timpánica y son sintomáticos los de la porción mastoidea. Estos tumores deben evaluarse con estudios de imagen; no se recomienda realizar biopsia incisional. El tratamiento es la resección quirúrgica en los casos sintomáticos con parálisis facial de grado IV o mayor de House-Brackmann, con reconstrucción inmediata del nervio.

DNA Barcoding as a Diagnostic Tool of a Rare Human Parasitosis: The First Case of Lagochilascaris minor in Quintana Roo, Mexico.

Recently, DNA barcoding based on the mitochondrial gene cytochrome c oxidase subunit 1 (COI) has become a widespread tool to identify animals. Its use with parasites of humans has been limited with some groups of nematodes where the amplification of this gene has been difficult. In this study, we present the first COI barcode sequence of a rare parasite from tropical regions, Lagochilascaris minor, which parasitized a human host from Quintana Roo, southern Yucatán Peninsula, Mexico. Destruction of the mastoid apophysis in the lateral sinus and cerebellar involvement were observed at the site of infection. After a radical mastoidectomy and a treatment with 200 mg oral albendazole for 63 days, the patient completely recovered. Lagochilascaris minor was identified based on the ratio between length of spicules and ejaculatory duct, shape of eggs, and host, as well as comparison with its congeners. The mode of infection is unknown, although it could be after direct exposure to eggs or consumption of uncooked wild meat. Morphology of adults is demonstrated using scanning electron microscopy, and high-quality sequences of COI barcode are presented from amplifications using semi-degenerate primers designed for micro-crustaceans. DNA barcoding proved to be a reliable identification method for L. minor. A comparison of the sequences for this species with 81 ascaridoids obtained from the Barcode of Life Database places it in a unique clade most closely related to Baylisascaris procyonis. Future diagnosis of larval and adult stages of L. minor using DNA barcoding will allow the recognition of its infection parameters, transmission, and precise epidemiology. Reports of lagochilascarosis in the Yucatán Peninsula have been occurred over the last decade, suggesting it is an emerging zoonotic disease in the region.

Noma and Noma-like disease in HIV/AIDS patients, a comorbid interaction: A systematic review.

INTRODUCTION: Noma is an opportunistic polymicrobial infection that cause necrosis of the mouth and face, with high morbidity and mortality, predominantly affecting malnourished children and persons with debilitating diseases. Cases of noma-like disease in adults, although rare, have been increasingly reported in HIV/AIDS patients particularly in developing countries but also in more developed countries. METHODOLOGY: A systematic review of the literature to assess the occurrence and clinical impact of noma and noma-like disease in HIV/AIDS patients was performed on PubMed, Virtual Health Library, Cochrane Library and Google Scholar using the keywords "HIV"[ All Fields] AND "Noma"[All Fields] in December 2016 (years includead for the search: 1985 to 2016). RESULTS: Twenty-four published studies were identified that document the occurrence of noma or noma-like disease in a total of 133 HIV/AIDS children and adult patients in the last 22 years. Although HIV infection is not the principal risk factor for noma, in some regions may play a substantial role in its pathogenesis. The mortality rate for noma-like disease in HIV/AIDS patients was 54.3%, compared to the 15% mortality rate of treated noma patients without HIV/AIDS. Most of the cases have never been on antiretroviral therapy, and their HIV infection was discovered because of the noma-like disease. CONCLUSIONS: The syndemic interaction between HIV/AIDS and noma-like disease adversely impacts the severity of the disease and the mortality rate. Noma-like disease, although not yet considered a specific or frequent disease associated with HIV infection, should be considered as an opportunistic infection for AIDS.

Surgical Treatment for Recurrent Benign Paroxysmal Positional Vertigo.

Introduction Benign paroxysmal positional vertigo is a generally benign condition that responds to repositioning maneuvers and frequently resolves spontaneously. However, for some patients it can become a disabling condition in which surgery must be considered. Two different surgical techniques exist, singular neurectomy and posterior semicircular canal occlusion. Objective The objective of this study is to review the current status of singular nerve section and posterior semicircular canal occlusion as treatments for intractable benign paroxysmal positional vertigo, and to determine if there are published data available that favors one over the other. Data Sources MEDLINE and OLDMEDLINE databases of the National Library of Medicine. Data Synthesis Four studies regarding singular neurectomy and 14 reports on semicircular canal occlusion were analyzed. Both techniques are reported to provide similar symptomatic benefit, with low risk of hearing loss and balance impairment. However, anatomical and clinical studies of singular neurectomy show it to be a more challenging technique, and considering that it is indicated in a very small number of cases, it may be difficult to master. Conclusions Both singular neurectomy and semicircular canal occlusion can be safe and effective in those few patients that require surgery for intractable positional vertigo. Although semicircular canal occlusion requires a postauricular transmastoid approach, it is ultimately easier to learn and perform adequately, and thus may be considered the best alternative.

Pruebas de despistaje auditivo en adultos / Hearing loss screening tests for adults

Introducción: La detección temprana de hipoacusia ha sido ampliamente estudiada en recién nacidos gracias a las nuevas tecnologías en pruebas diagnósticas y tratamiento; existen protocolos bien establecidos de despistaje universal en esta población. Sin embargo, en adultos, el despistaje auditivo es un tema que también cobra importancia debido al aumento en la esperanza de vida, al cambio en la pirámide poblacional mexicana, que se estima que en los siguientes 50 años se transformará hacia una forma rectangular (con un aumento en la prevalencia de presbiacusia), y al establecimiento de programas de protección social en salud como el Seguro Popular. No se cuenta con investigaciones mexicanas sobre despistaje auditivo en adultos. El objetivo de este trabajo es evaluar una prueba de emisión tonal y un cuestionario como estrategias de despistaje en adultos. Métodos: Se tomó una muestra de 500 personas sin antecedente de patología otológica en la consulta externa de un hospital general. Se realizó otoscopia, 2 pruebas de despistaje auditivo (emisión tonal y cuestionario) y audiometría a todos los sujetos. Resultados: El cuestionario es una prueba sensible pero poco específica, mientras que la prueba de emisión de tono fue menos sensible pero más específica con tasa mayor de exactitud. La mejor estrategia resultó la combinación de ambas pruebas que alcanzó una exactitud del 90%. Conclusiones: Se propone como la mejor estrategia de despistaje en adultos un cuestionario y una prueba de emisión tonal que garantiza de forma rápida, sin necesidad de entrenamiento especial, una evaluación completa del estado de audición en lo objetivo y subjetivo (AU)

Introduction: The early detection of hearing loss has been studied widely in newborns due to the emerging technologies for diagnosis and treatment. There are detailed protocols for this goal. Nonetheless, hearing loss screening in adults has become more important lately with the increase of the life expectancy, an expected change in the Mexican population pyramid towards a rectangular shape in the next 50 years (with increased hearing loss prevalence) and the creation of public policies for social security such as the «Seguro Popular». There are no Mexican studies about hearing loss screening in adults. The aim of this work was to assess a tone emission and a questionnaire as screening tools for hearing loss in adults. Methods: A sample size of 500 individuals without otology pathology from the outpatient clinics at a general hospital. An otoscopy, 2 screening tests (tone emission and questionnaire) and tonal audiometry were performed on all subjects. Results: The questionnaire turned out to be a sensitive test but with low specificity, while the tone emission was less sensitive but more specific with a higher rate of precision. In this study, the best result was achieved by a combined strategy using the two tests above, with a precision of 90%. Conclusions: The best screening strategy proposed by this study for hearing loss in adults is a questionnaire and tone emission test, which guarantees complete hearing assessment in objective and subjective manners, performed quickly and without special training (AU)

Hearing loss screening tests for adults.

INTRODUCTION: The early detection of hearing loss has been studied widely in newborns due to the emerging technologies for diagnosis and treatment. There are detailed protocols for this goal. Nonetheless, hearing loss screening in adults has become more important lately with the increase of the life expectancy, an expected change in the Mexican population pyramid towards a rectangular shape in the next 50 years (with increased hearing loss prevalence) and the creation of public policies for social security such as the "Seguro Popular". There are no Mexican studies about hearing loss screening in adults. The aim of this work was to assess a tone emission and a questionnaire as screening tools for hearing loss in adults. METHODS: A sample size of 500 individuals without otology pathology from the outpatient clinics at a general hospital. An otoscopy, 2 screening tests (tone emission and questionnaire) and tonal audiometry were performed on all subjects. RESULTS: The questionnaire turned out to be a sensitive test but with low specificity, while the tone emission was less sensitive but more specific with a higher rate of precision. In this study, the best result was achieved by a combined strategy using the two tests above, with a precision of 90%. CONCLUSIONS: The best screening strategy proposed by this study for hearing loss in adults is a questionnaire and tone emission test, which guarantees complete hearing assessment in objective and subjective manners, performed quickly and without special training.