Esofagitis eosinofílica de tórpida evolución / Eosinophilic esophagitis with torpid evolution

Introducción: La esofagitis eosinofílica es una enfermedad inmunomediada, crónica y progresiva, combinando disfunción esofágica e infiltrado eosinofílico exclusivo del esófago. Tanto su diagnóstico como su respuesta a los tratamientos requieren de evaluación histológica mediante endoscopias repetidas. Caso clínico. Varón de 11 años con disfagia para sólidos de años de evolución con empeoramiento en los últimos meses; angustia ante las ingestas con estancamiento ponderal; vómitos en impactaciones alimentarias; pirosis postprandial. Antecedentes patológicos: broncoespasmos de repetición y sensibilización a Alternaria. Exploración física: signos de hipotrofia pondero-estatural (somatometría: alrededor de –2 desviaciones estándares; Carrascosa 2017). Pruebas complementarias: analítica general sin alteraciones significativas incluyendo inmunoglobulinas E específicas alimentarias; prick test sensibilización a neumoalérgenos; gastroscopia mucosa esofágica edematosa, estrías longitudinales y exudados blanquecinos, mucosa gástrica signos de gastritis, mucosa duodenal normal; histología con un máximo 35 eosinófilos por campos de gran aumento y gastritis crónica leve-moderada con infección por Helicobacter pylori. Tratamiento y evolución: inducción a la remisión con inhibidores bomba de protones a dosis altas con buena respuesta clínica y macroscópica (parcial histológica), reduciendo a dosis de mantenimiento; ante recaída macroscópica (no histológica) se cambia a dieta exenta de leche y gluten sin respuesta; segundo intento de remisión con inhibidores sin éxito; finalmente se pautan corticoides deglutidos con buena respuesta tanto macroscópica como histológica; pendiente control con dosis de mantenimiento, asintomático. Comentarios. Como se aprecia en nuestro caso, esta enfermedad conlleva un difícil manejo ante la afectación parcheada de la mucosa y la discordancia clínico-histológica, lo que complica la interpretación de sus resultados.(AU)

Introduction: Eosinophilic esophagitis is an immunemediated, chronic and progressive disease, combining esophageal dysfunction and eosinophilic infiltrate exclusive to the esophagus. Both its diagnosis and its response to treatments require histological evaluation through repeated endoscopies. Case report. 11-year-old male with dysphagia for solids of years of evolution with worsening in recent months; anxiety before eating with weight stagnation; vomiting in food impactions; postprandial heartburn. Pathological history: repeated bronchospasms and sensitization to Alternaria. Physical examination: signs of weight-height hypotrophy (somatometry: around –2 standard deviations; Carrascosa 2017). Complementary tests: general blood test without significant alterations including food-specific immunoglobulins E; prick test sensitization to pneumoallergens; gastroscopy edematous esophageal mucosa, longitudinal furrows and whitish exudates, gastric mucosa signs of gastritis, normal duodenal mucosa; histology with a maximum of 35 eosinophils per high-power fields and mild-moderate chronic gastritis with Helicobacter pylori infection. Treatment and evolution: induction of remission with high-dose proton pump inhibitors with good clinical and macroscopic response (partial histological), reducing to maintenance doses; In the event of a macroscopic (non-histological) relapse, a diet free of milk and gluten is started without response; second attempt at remission with inhibitors without success; finally, swallowed corticosteroids are prescribed with good macroscopic and histological response; pending control with maintenance dose, asymptomatic. Discussion. Like our case shows, this disease has a difficult management due to patchy involvement of the mucosa and clinical-histological discordance, which complicates the interpretation of its results.(AU)

Severe mucosal leishmaniasis with torpid and fatal evolution.

Mucosal leishmaniasis is a clinical condition that is difficult to diagnose and treat and usually precedes a cutaneous leishmaniasis condition with a long latency period as observed in our study of a patient who experienced a torpid evolution in 9 months, caused by having had cutaneous leishmaniasis on the neck without therapeutic treatment, although with ulcer closure 18 years earlier, incomplete treatment with antimonials and amphotericin B, with the destruction of the eyeball, a large area of necrosis on the face and nasal bone exposure. Additionally, the patient had chronic anemia (9.4 g/dl), lymphopenia and neutrophilia (lymphocytes 13.1%, neutrophils 84.4%), and co-infections by fungi (yeasts and hyphae) and Gram-negative bacteria (multidrug-resistant Proteus mirabilis and Escherichia coli) leading to sepsis and subsequent death of the patient.

Similar hibernation physiology in bats across broad geographic ranges.

Species with broad geographic ranges may experience varied environmental conditions throughout their range leading to local adaptation. Variation among populations reflects potential adaptability or plasticity, with implications for populations impacted by disease, climate change, and other anthropogenic influences. However, behavior may counteract divergent selection among populations. We studied intraspecific variation in hibernation physiology of Myotis lucifugus (little brown myotis) and Corynorhinus townsendii (Townsend's big-eared bat), two species of bats with large geographic ranges. We studied M. lucifugus at three hibernacula which spanned a latitudinal gradient of 1500 km, and C. townsendii from 6 hibernacula spread across 1200 km latitude and 1200 km longitude. We found no difference in torpid metabolic rate among populations of either species, nor was there a difference in the effect of ambient temperature among sites. Evaporative water loss was similar among populations of both species, with the exception of one C. townsendii pairwise site difference and one M. lucifugus site that differed from the others. We suggest the general lack of geographic variation is a consequence of behavioral microhabitat selection. As volant animals, bats can travel relatively long distances in search of preferred microclimates for hibernation. Despite dramatic macroclimate differences among populations, hibernating bats are able to find preferred microclimate conditions within their range, resulting in similar selection pressures among populations spread across wide geographic ranges.

Síndrome hemofagocítico secundario a infección por virus del dengue / Hemophagocytic syndrome secondary to dengue virus infection

Introducción: El síndrome hemofagocítico se presenta como un cuadro clínico grave, provocado por una respuesta inadecuada del sistema inmunológico a un desencadenante infeccioso, neoplásico, reumatológico o metabólico, que origina una reacción inflamatoria no controlada; presenta una incidencia baja pero la letalidad sin el manejo adecuado es muy elevada. Objetivo: Destacar la importancia de diagnóstico oportuno del síndrome hemofagocítico en pacientes con dengue que presentan evolución tórpida. Presentación del caso: Paciente de 7 años de edad, con dengue grave dado por shock, hepatomegalia con elevación de transaminasas, con mala evolución clínica, quien cumple criterios de Síndrome hemofagocítico. Recibió manejo con inmunomoduladores con evolución satisfactoria. Conclusiones: Es importante considerar el Síndrome hemofagocítico como causa ante enfermedades con evolución tórpida a pesar de tener un manejo médico correcto(AU)

Introduction: Hemophagocytic syndrome is a severe clinical picture with an uncontrolled inflammatory reaction caused by an inadequate immune system response to an infectious, neoplastic, rheumatological, or metabolic trigger. The syndrome has low incidence but high fatality when the management is not adequate. Objective: To highlight the importance of a prompt diagnosis of hemophagocytic syndrome in patients with dengue who present a torpid evolution. Case presentation: Seven-year-old patient with severe dengue caused by shock, hepatomegaly with elevated transaminase levels and poor clinical evolution who meets hemophagocytic syndrome criteria. The patient had satisfactory progression after receiving immunomodulatory treatment. Conclusions: Hemophagocytic syndrome must be considered as a cause of pathologies in dengue patients with torpid evolution, even when correct medical management is made(AU)

[Treatment of torpid trophic ulcers in patients of the older age group.]

Chronic ulcers or non-healing ulcers are more common in the elderly (20 out of 1 000 people), whose age is closer to 80 years. The application of the principles of regenerative medicine, actively developing, in the treatment of such diseases, is based on the use of both autologous blood derivatives and autologous mononuclear cells. Objective: to evaluate the effectiveness of the use of plasma enriched with platelets in the treatment of torpid ulcers of the lower extremities in patients of the older age group. A prospective, randomized clinical trial was conducted in 80 patients. According to preliminary calculations, it has been shown that the combination of traditional treatment with the introduction of plasma enriched with platelets leads to accelerated healing of ulcers.

Prosthetic joint infection by Bordetella holmesii: Case report and a review of the literature.

INTRODUCTION: Bordetella holmesii is a Gram-negative coccobacillus involved in different infections mostly described in case reports. Prosthetic joint infections in relation to this pathogen are rare. Here, we present the third case of B. holmesii in a patient without anatomical or functional spleen dysfunction. CASE REPORT: The patient was a 62-year-old female with a total knee prosthesis implanted in 1997 that required multiple replacements of the femoral component due to aseptic loosening in the past years. The patient was admitted to our hospital for an elective replacement surgery due to new radiological signs of loosening. B. holmesii was isolated from synovial fluid obtained during surgery. The identification was performed by matrix-assisted laser desorption ionization-time of flight mass spectrometry and confirmed by 16S rRNA gene amplification and sequencing. Antibiotic treatment was started but 14 days after surgery the patient presented pain and joint effusion. An arthrocentesis was performed and synovial fluid culture was positive again for B. holmesii. Surgical debridement including polyethylene replacement was performed and antibiotic treatment was continued for 3 months. After a 2-year follow-up period, the patient remained asymptomatic and physical examination showed normal function of the prosthesis. CONCLUSION: B. holmesii is an uncommon cause of bone and joint infections. This case indicates that this microorganism is a potential pathogen of prosthetic or native arthritis, and it should be considered when cultures are negative and in cases presenting torpid evolution.

De-Extinction.

De-extinction projects for species such as the woolly mammoth and passenger pigeon have greatly stimulated public and scientific interest, producing a large body of literature and much debate. To date, there has been little consistency in descriptions of de-extinction technologies and purposes. In 2016, a special committee of the International Union for the Conservation of Nature (IUCN) published a set of guidelines for de-extinction practice, establishing the first detailed description of de-extinction; yet incoherencies in published literature persist. There are even several problems with the IUCN definition. Here I present a comprehensive definition of de-extinction practice and rationale that expounds and reconciles the biological and ecological inconsistencies in the IUCN definition. This new definition brings together the practices of reintroduction and ecological replacement with de-extinction efforts that employ breeding strategies to recover unique extinct phenotypes into a single "de-extinction" discipline. An accurate understanding of de-extinction and biotechnology segregates the restoration of certain species into a new classification of endangerment, removing them from the purview of de-extinction and into the arena of species' recovery. I term these species as "evolutionarily torpid species"; a term to apply to species falsely considered extinct, which in fact persist in the form of cryopreserved tissues and cultured cells. For the first time in published literature, all currently active de-extinction breeding programs are reviewed and their progress presented. Lastly, I review and scrutinize various topics pertaining to de-extinction in light of the growing body of peer-reviewed literature published since de-extinction breeding programs gained public attention in 2013.

[The sanitation of staphylococcus bacteria carrying: new possibilities and perspectives.]

The study was carried out to investigate possibility of applying biologically active substances - interferon inductors - for increasing effectiveness of prevention and treatment of torpid forms of infectious process, staphylococcus bacteria carrying in particular, considering effectiveness of their effect on biological characteristics of Staphylococcus aureus. The data are obtained concerning character of effect of pharmaceuticals on persistent characteristics of staphylococcus. These results can be applied in selection of new perspective preparations for sanitation of staphylococcus bacteria carrying.