Eyelash Loss: An Unusual Manifestation of Uncontrolled Hypothyroidism.

Hypothyroidism commonly presents with dermatological and hair-related symptoms, although the loss of eyelashes and eyebrows is considered uncommon in clinical practice. Here, we present a case of milphosis secondary to uncontrolled hypothyroidism. A 24-year-old female with a history of hypothyroidism following total thyroidectomy and poor medication adherence presented with significant eyelash loss, accompanied by symptoms of dysphonia, bradyphrenia, bradylalia, constipation, pronounced fatigue, and drowsiness. Physical examination revealed periorbital edema and extensive eyelash loss affecting the upper eyelids. Laboratory analysis demonstrated a markedly elevated thyroid-stimulating hormone (TSH) level of 240.8 µIU/mL (normal range 0.38 to 5.33 µIU/L), confirming severe uncontrolled hypothyroidism. Levothyroxine treatment was reintroduced, leading to complete resolution of periorbital edema and regrowth of eyelashes after 12 weeks, coinciding with improvement in TSH levels. This clinical case adds to the limited literature on madarosis and milphosis as manifestations of hypothyroidism, emphasizing the importance of clinician awareness regarding their potential presentation in the context of the disease. Understanding these manifestations and their differential diagnoses is crucial for ensuring prompt and accurate diagnosis and treatment.

Effect of mercury in the influx and efflux of nutrients in the microalga Desmodesmus armatus.

Anthropogenic activities such as mining and the metallurgical industry are the main sources of mercury contamination. Mercury is one of the most serious environmental problems in the world. This study aimed to investigate, using experimental kinetic data, the effect of different inorganic mercury (Hg2+) concentrations on the response of microalga Desmodesmus armatus stress. Cell growth, nutrients uptake and mercury ions from the extracellular medium, and oxygen production were determined. A Compartment Structured Model allowed elucidating the phenomena of transmembrane transport, including influx and efflux of nutrients, metal ions and bioadsorption of metal ions on the cell wall, which are difficult to determine experimentally. This model was able to explain two tolerance mechanisms against mercury, the first one was the adsorption of Hg2+ions onto the cell wall and the second was the efflux of mercury ions. The model predicted a competition between internalization and adsorption with a maximum tolerable concentration of 5.29 mg/L of HgCl2. The kinetic data and the model showed that mercury causes physiological changes in the cell, which allow the microalga to adapt to these new conditions to counteract the toxic effects. For this reason, D. armatus can be considered as a Hg-tolerant microalga. This tolerance capacity is associated with the activation of the efflux as a detoxification mechanism that facilitates the maintenance of the osmotic balance for all the modeled chemical species. Furthermore, the accumulation of mercury in the cell membrane suggests the presence of thiol groups associated with its internalization, leading to the conclusion that metabolically active tolerance mechanisms are dominant over passive ones.

Lesiones metastásicas a glándula tiroides. Una serie de casos / Metastatic lesions to the thyroid gland. Case series

Las lesiones metastásicas representan hasta un 3 % de los tumores malignos de la glándula tiroides. La mayoría de los casos se originan de tumores de células renales y de pulmón. El abordaje diagnóstico implica una alta sospecha clínica en pacientes con primarios conocidos, sin embargo, puede ser la manifestación inicial de una enfermedad maligna extensa no diagnosticada hasta en un 20 % a 40 % de los pacientes. La biopsia por aguja fina ha demostrado buen rendimiento para el diagnóstico de los nódulos metastásicos. El pronóstico y la opción del tratamiento quirúrgico dependen del control local del primario y del estado de la enfermedad sistémica asociada, por lo tanto, debe ser individualizado. Por lo general, hasta un 80 % de los pacientes con compromiso de la tiroides tienen enfermedad metastásica multiorgánica, y la intención del tratamiento quirúrgico es con fines paliativos para prevenir las complicaciones derivadas de la extensión local de la enfermedad a las estructuras del tracto aerodigestivo superior en el cuello. Se presenta a continuación, una serie de seis casos de pacientes con lesiones metastásicas a glándula tiroides con primarios en riñón, mama y de melanomas

Metastatic lesions represent up to 3% of malignant tumors of the thyroid gland. Most cases originate from lung and renal cell tumors. The diagnostic approach implies a high clinical suspicion in patients with known primaries, however, it can be the initial manifestation of an extensive undiagnosed malignant disease in up to 20% to 40% of patients. Fine-needle biopsy has shown good performance for the diagnosis of metastatic nodules. The prognosis and the option of surgical treatment depend on the local control of the primary condition and the state of the associated systemic disease, therefore it must be individualized. In general, up to 80% of patients with thyroid involvement have multi-organ metastatic disease and surgical treatment is intended to be palliative to prevent complications resulting from local extension of the disease to structures of the upper aerodigestive tract in the neck. A case series of six patients with metastatic lesions to the thyroid gland with primaries in the kidney, breast and melanomas is presented below

Eficacia y tolerabilidad de Nitazoxanida para parasitismo intestinal en escolares atendidos en el Centro de Salud de la Universidad del Quindío / Efficacy and tolerability of Nitazoxanide for intestinal parasitism in schoolchildren treated at the Health Center of the University of Quindío

Resumen Objetivo: Describir la efectividad del tratamiento antiparasitario intestinal brindado a niños de cuatro a nueve años atendidos en el centro de Salud de la Universidad del Quindío entre Julio de 2017 a marzo de 2018. Materiales y métodos: Estudio observacional prospectivo. Se extrajeron datos de historias clínicas de pacientes con rango de edad de 4 a 9 años, quienes consultaron en el Centro de Salud de la Universidad del Quindío y se diagnosticaron mediante coprológico con blastocistosis o giardiasis. Se seleccionaron las historias cuyo tratamiento fuese Nitazoxanida y tuviesen un coprológico control postratamiento. Se presentan estadísticas descriptivas; porcentaje de eficacia y tolerabilidad. Resultados: De 15 niños tratados con Nitazoxanida, respondieron al tratamiento 10, en quienes no se hallaron parásitos en el coprológico control. Con una eficacia del 83,3% (IC95% 60 - 100) en blastocistosis, 57,1% (IC95% 32 - 82%) en giardiasis. Conclusión: Se evidenciaron resultados porcentuales similares a los reportados en la literatura, siendo más eficaz en blastocisotisis que en giardiasis.

Abstract Objective: To describe the effectiveness of the intestinal antiparasitic treatment given to children ranging between 4 and 9 years old that were attended in the Health Center of the University of Quindío in the period of July 2017 and March 2018. Materials and methods: Prospective observational study. Data were extracted from medical records of patients with an age range of 4 to 9 years, who consulted at the Health Center of the University of Quindío and were diagnosed through coprological tests with Blastocystis and Giardiasis. The clinical records were selected by whose treatment was done with Nitazoxanide or Albendazole with coprological results of post-treatment check-up. Descriptive statistics are presented along with percentage of efficacy and tolerability. Results: From 15 children treated with Nitazoxanide, 10 responded to the treatment, who presented no parasites in the coprological check-up. The remaining population presented some type of parasitic infection (n = 5). With an efficiency of 83,3% (IC95% 32 - 82%) in blastocystis, and 57,1% (IC95% 32 - 82%) in giardiasis. Conclusion: Percentage results similar to those reported in the literature were evidenced, being more effective in blastocystis than in giardiasis.

Candidatus Rickettsia senegalensis in Cat Fleas (Siphonaptera: Pulicidae) Collected from Dogs and Cats in Cauca, Colombia.

Rickettsia typhi and Rickettsia felis (Rickettsiales: Rickettsiaceae) are flea-transmitted pathogens. They are important causes of acute febrile illness throughout the world. We, therefore, sought to identify the rickettsial species present in the fleas of dogs and cats in the department of Cauca, Colombia. In this study, we collected 1,242 fleas from 132 dogs and 43 fleas from 11 cats. All fleas were morphologically identified as Ctenocephalides felis (Bouché) adults and organized in pools for DNA extraction (234 pools from dogs and 11 from cats). The gltA gene from rickettsiae was targeted for screening amplification using conventional PCR. In total, 144 of the 245 pools (58.7%) were positive. The positive samples were then processed for the amplification of the 17kDa antigen gene (144/144; 100% positive) and sca5 gene (140/144; 97.2% positive). In addition, restriction enzyme length polymorphism analysis using NlaIV on the amplified product of the sca5 gene demonstrated several organisms: 21/140 (15%) were R. felis, 118/140 (84.3%) were Rickettsia asemboensis, and 1/140 (0.7%) were Candidatus Rickettsia senegalensis. Subsequent sequencing confirmed Candidatus Rickettsia senegalensis in C. felis collected from dogs the first reported from Colombia.

Descripción de la experiencia en pacientes diagnosticados con insulinoma. Estudio multicéntrico en Medellín, Colombia / Description of the experience with patients with insulinoma diagnosis. Multicentric study in Medellín, Colombia

RESUMEN Objetivo: describir la experiencia de los pacientes con insulinoma, diagnosticados y tratados entre los años 2002 y 2017 en tres hospitales de la ciudad de Medellín, Colombia. Métodos: estudio descriptivo y retrospectivo de pacientes con criterios bioquímicos para hipoglucemia hiperinsulínica y confirmación histopatológica de insulinoma. Resultados: se estudiaron 19 casos, 10 eran mujeres (52,6 %), la edad media al diagnóstico fue 43 años (D.E 15,5). Hubo cuatro casos de insulinoma multifocal (21,1 %), tres asociados con NEM-1 (15,8 %) y dos malignos (10,6 %). Todos presentaron hipoglucemia en ayunas y 63,2 % posprandial. En la prueba de ayuno, el nadir de glucemia sucedió antes de 48 horas en todos los casos, en promedio 9 horas (D.E 8,0). El diagnóstico bioquímico fue realizado con hipoglucemia e insulina elevada en todos los casos, aunque el péptido C fue reportado en nueve pacientes (47,3 %) y las sulfonilureas en dos (11,1 %). La localización preoperatoria se hizo por imágenes en 12 individuos (68,5 %) y las pruebas invasivas fueron necesarias en seis (31,5 %). Las pruebas diagnósticas fueron positivas en un 83 % para resonancia, 50 % para ecografía endoscópica y prueba de estímulo intraarterial con calcio y 100 % para ecografía intraoperatoria. La cirugía se realizó en 18 casos (94,7 %). La mortalidad (15,8 %) fue derivada de complicaciones en el posoperatorio temprano; la curación se logró en todos los casos. Conclusiones: el insulinoma en nuestro medio tiene características demográficas y clínicas similares a otras series. Existen limitaciones locales para el acceso a los estudios bioquímicos y en el rendimiento diagnóstico de las pruebas de localización.

SUMMARY Objective: The objective of the study was to describe the characteristics of patients with insulinoma in three hospitals in Medellín, Colombia, between 2002 and 2017. Methods: A retrospective analysis of patients with hyperinsulinemic hypoglycemia and histologic confirmation of insulinoma was conducted. Results: A total of 19 cases were identified. Ten women (52.6 %) and 9 males (47.4 %). The mean age at diagnosis was 43 years (S.D: 15.5). Four cases had multifocal insulinoma (21.1%), 3 cases were secondary to multiple endocrine neoplasia type 1 (15.8 %), and 2 of them were malignant (10.6 %). All patients presented fasting hypo-glycemia, and 63.2% presented post-prandial hypoglycemia. Glucose nadir in the fasting test occurred in the first 48 hours in all cases, with a mean time to hypoglycemia of 9 hours (S.D 8.0). The biochemical diagnosis was done with increased insulin in the presence of hypoglycemia. C-peptide was done in 9 patients (47.3 %), and sulfonylureas in 2 cases (11.1 %). Preoperative localization was done by imaging in 12 cases (68.5 %), and invasive tests were required in 6 cases (31.5 %). Localization tests were positive as follows: magnetic resonance imaging in 83%, endoscopic ultrasound in 50%, selective intra-arterial calcium injection in 50 %, and intraoperative ultrasound in 100%. Eighteen patients (94. 7%) underwent surgery. Mortality (15.8 %) was secondary to early post-operative complications. Conclusions: The characteristics of patients with insulinoma in Medellín are similar to other series. However, there are important local limitations for proper biochemical testing and imaging localization. This is the largest study in our country.

Consumo de estatinas y asociación con la elevación en los niveles de creatina fosfoquinasa / Statin use and association with elevated levels of creatine phosphokinase

Introducción: las estatinas son medicamentos hipolipemiantes asociados con miotoxicidad como efecto adverso. Objetivo: determinar la asociación entre el uso de estatinas y la elevación de la creatinafosfoquinasa. Materiales y métodos: se realizó un estudio transversal en pacientes consecutivos que asistieron al Laboratorio Clínico Hematológico (Medellín, Colombia) para la determinación del perfil lipídico. Se incluyeron 661 pacientes, 329 en el grupo de estatinas y 332 en el de no estatinas.A todos se les midieron los niveles séricos de creatina fosfoquinasa y se consideraron como elevados los niveles superiores a 170 mg/dL. Se estableció un nivel de significancia menor de 0,05. Resultados: se registró mayor proporción de pacientes con creatina fosfoquinasa elevada en el grupo con consumo de estatinas (64,9% frente a 47% en el grupo de no estatinas; razón de disparidad: 2,01; intervalo de confianza del 95%: 1,21-3,32; p= 0,0085). No se encontró asociación entre la elevación de la creatina fosfoquinasa y la presencia de dolor (razón de disparidad: 0,78; intervalo de confianza del 95%: 0,40-1,50; p= 0,5615), fatiga (razón de disparidad: 0,85; intervalo de confianza del 95%: 0,45-1,61; p= 0,7385) y debilidad muscular (razón de disparidad: 1,46; intervalo de confianzadel 95%: 0,68-3,12; p= 0,4333); aunque el grupo de estatinas presentó mayor frecuencia de dolor (razón de disparidad: 2,96), fatiga (razón de disparidad: 1,98) y debilidad muscular (razón de disparidad: 4,19). Conclusiones: el consumo de estatinas se relaciona con síntomas musculares y elevación de creatina fosfoquinasa, sin relación entre la elevación de creatina fosfoquinasa y la presencia de síntomas musculares.

Introduction: statins are a class of lipid-lowering medications associated with the adverse effect of myotoxicity. Objetive: To determine the association between statin use and creatine phosphokinase elevation. Materials and methods: A cross-sectional study, involving consecutive patients attending in the clinical laboratory Laboratorio Clinico Hematologico (Medellin, Colombia) for a serum lipid profile test was performance. A total of 661 patients were included, 329 belonged to the statin group and 332 to the non-statin group. All patients were tested for serum creatine phosphokinase and were considered elevated the serum levels higher than 170 mg/dL. The threshold for significance was set as p-value less than 0.05. Results: Creatine phosphokinase levels were more elevated in the statin group (64.9% versus 47% in non-statin group; odds ratio: 2.01; 95% confidence interval: 1.21-3.32, p= 0.0085). No association was found between the degree of creatine phosphokinase elevation and the presence of muscular pain (odds ratio: 0.78; 95% confidence interval: 95%, 0.40-1.50, p= 0.5615), fatigue (odds ratio: 0.85; 95% confidence interval: 0.45-1.61, p= 0.7385) or muscle weakness (odds ratio: 1.46; 95% confidence interval: 0.68-3.12, p= 0.4333). However, the statin group exhibited greater frequency of muscle pain (odds ratio: 2.96), fatigue (odds ratio: 1.98) and muscle weakness (odds ratio: 4.19). Conclusions: statin use is associated with a higher frequency of muscular symptoms and higher creatine phosphokinase levels, with no relationship between creatine phosphokinase elevation and the presence of muscle symptoms.