A retrospective study of clinical and epidemiological characteristics of snakebite in Napo Province, Ecuadorian Amazon.

BACKGROUND: Snakebite envenoming remains a relevant public health problem in tropical and subtropical countries. In Ecuador, this is particularly true in an area of great diversity like the Amazon region. Nevertheless, there is scarce information about epidemiological and clinical characteristics of these accidents in this area. METHODS: This was a descriptive and retrospective study of snakebite cases treated at a tertiary hospital in the Napo Province, Ecuadorian Amazon, from 2015 to 2019. We collected sociodemographic and snakebite-related information, clinical aspects and the use of antivenom and antibiotics from medical records. RESULTS: Information from 133 snakebite accidents was reviewed in this time period. Reports of snakebite envenoming decreased over the years. In total, 67% of those bitten were from nearby indigenous communities, which were the most affected groups. When a species was identified, Bothrops atrox was responsible for the highest number of cases registered. Local clinical manifestations were more frequent than systemic signs, in keeping with the typical effects produced by bothropic venoms. Additionally, data showed that more antivenom vials were given than those suggested by the protocol of the Ecuadorian Ministry of Health, in proportion to the grade of severity. Finally, we identified a low incidence of adverse reactions with antivenom administration, as well as a frequent use of antibiotics. CONCLUSIONS: The profile of snakebite accidents in the Napo Province is very similar to that described for other localities in the Amazon region of Ecuador and neighboring countries, with its challenges and limitations. Such aspects underlie the importance of establishing a robust and science-based public health program to respond to this frequent, but neglected, tropical disease.

Bothrops atrox from Ecuadorian Amazon: Initial analyses of venoms from individuals.

Bothrops atrox is the most clinically relevant snake species within the Amazon region, which includes Ecuadorian territories. It comprises a large distribution, which could contribute to the genetic and venomic variation identified in the species. The high variability and protein isoform diversity of its venom are of medical interest, since it can influence the clinical manifestations caused by envenomation and its treatment. However, in Ecuador there is insufficient information on the diversity of venomic phenotypes, even of relevant species such as B. atrox. Here, we characterized the biochemical and toxicological profiles of the venom of six B. atrox individuals from the Ecuadorian Amazon. Differences in catalytic activities of toxins, elution profiles in liquid chromatography, electrophoretic patterns, and toxic effects among the analyzed samples were identified. Nonetheless, in the preclinical testing of antivenom, two samples from Mera (Pastaza) required a higher dose to achieve total neutralization of lethality and hemorrhage. Taken together, these data highlight the importance of analyzing individual venoms in studies focused on the outcomes of envenoming.

Assessing the stability of historical and desiccated snake venoms from a medically important Ecuadorian collection.

Bothrops asper and Bothrops atrox are important venomous snakes from Ecuador responsible for the most of ophidic accidents, which in the past were treated with a national polyvant antivenom. For years, the venom pools were collected and stored at room temperature in a laboratory. Taking into account the controversial ability of desiccated samples to retain their biological effects and enzymatic activities, we investigated the biochemical and toxicological properties of venoms after years of storage. The proteomic profiles of historical venoms analyzed by high-performance liquid chromatography and electrophoresis are very similar. The fresh batches of venom were more lethal than those stored for years, just as the initial and current LD50 values of these samples changed. Significant differences were showed in the myotoxic and hemorrhagic activity of some venom pools, while no significant statistical differences were found for the edema activity. The enzymatic assays revealed a variation in proteolytic activity on azocasein and phospholipase A2 activity, and low differences were reported for thrombin-like serine protease activity. The maintenance of the proteomic profile and certain toxicological activities convert this venom library in a valuable source for research purposes. Nonetheless, the significative reduction of toxicological activities, such as hemorrhagic activity not feasible using these samples for the antivenom production.

Mastitis granulomatosa idiopática: características demográficas, clínicas e imagenológicas en una serie de casos / Idiopathic granulomatous mastitis: demographic, clinical and imaging characteristics of a series of cases

Resumen: OBJETIVO: Realizar una caracterización demográfica, clínica e imagenológica de una serie de casos de mastitis granulomatosa idiopática. MATERIALES Y MÉTODOS: Estudio observacional, retrospectivo y transversal de una serie de casos de pacientes con diagnóstico de mastitis granulomatosa idiopática atendidas en el Hospital Universitario Dr. José Eleuterio González, Monterrey, NL, entre enero 2015 y diciembre 2019. Criterio de inclusión: pacientes mayores de 18 años con diagnóstico histológico de mastitis granulomatosa idiopática en ausencia de un agente etiológico específico. Criterios de exclusión: pacientes con cuadro de mastitis relacionado con una patología específica o con algún antecedente de traumatismo-laceración reciente en la mama. Variables de estudio: información demográfica (edad, escolaridad, estado civil, etc.), proceso-método diagnóstico, hallazgos por imagen y tratamientos indicados. RESULTADOS: Se incluyeron 20 pacientes con edad promedio de 32 años, 17 en edad fértil, y el resto en la posmenopausia. Las 20 pacientes tuvieron, al menos, 1 embarazo de término sumado a un periodo variable de lactancia. 19 tenían enfermedad unilateral, la mayoría en la mama izquierda (60%). El hallazgo principal al establecer el diagnóstico: en 20 una tumoración, 15 de 20 eritema y 11 mastalgia. El reporte radiológico mediante BIRADS fue de IVA en 12, IVB en 6 y 1 tanto para II y III. En todas las pacientes se comprobó el diagnóstico con estudio histopatológico. Doce recibieron tratamiento inicial con prednisona, 7 con antibióticos y AINES y un caso con escisión quirúrgica. CONCLUSIONES: La mastitis granulomatosa idiopática es una enfermedad rara de prevalencia aún desconocida, con un comportamiento benigno de tipo inflamatorio crónico, cuya patogenia permanece aún desconocida. Al ser una enfermedad con un diagnóstico por exclusión, obliga al estudio histopatológico para establecer el diagnóstico definitivo, idealmente mediante la toma de una biopsia con Tru-cut. Aunque se han planteado varias alternativas terapéuticas, en la actualidad no existe un protocolo universal que justifique un tratamiento en forma generalizada. La resección de la lesión con márgenes amplios asociada o no con corticoides orales, sigue siendo el tratamiento más indicado.

Abstract: OBJECTIVE: To perform a demographic, clinical and imaging characterization of a series of cases of idiopathic granulomatous mastitis. MATERIALS AND METHODS: Observational, retrospective and cross-sectional study of a series of cases of patients diagnosed with idiopathic granulomatous mastitis, at Hospital Universitario "Dr. José Eleuterio González in Monterrey, Mexico between January 2015 and December 2019. The study comprised all patients older than 18 years old who had histological diagnosis of idiopathic granulomatous mastitis in the absence of a specific agent. Patients with mastitis related to a specific pathology or with a history of recent breast trauma/laceration were excluded. Variables to determine are demographic information (age, education, marital status, etc.), diagnostic process/method, imaging findings and treatment. RESULTS: 20 patients with an average age of 32 years were included, 17 of childbearing age, and the rest at menopause. All patients had at least one full-term pregnancy and a variable lactation period. 19 presented the disease unilaterally, 60% in the left breast. Clinical presentation: 20 presented tumor, 15 erythema and 11 mastalgia. Imaging: BIRADS IVA in 12, IVB in 6 , III in 1 and II in 1. Diagnostic confirmation was performed in all patients by histopathological study. 12 received initial treatment with prednisone, 7 with antibiotics and NSAIDs, and one case with surgical excision. CONCLUSIONS: Idiopathic granulomatous mastitis is a rare benign and chronic inflammatory disease of unknown prevalence and pathogenesis. It mainly affects women of reproductive age. Imaging studies usually report nonspecific findings. It requires histopathological study to establish a definitive diagnosis, as it is a disease with diagnosis by exclusion, ideally by taking a Tru-cut biopsy. Although several therapeutic alternatives have been proposed, currently there is no universal protocol for treatment, however, resection of the lesion with wide margins associated or not with oral corticosteroids prevails as the most widely used treatment nowadays.

Harnessing snake venom phospholipases A2 to novel approaches for overcoming antibiotic resistance.

The emergence of antibiotic resistance drives an essential race against time to reveal new molecular structures capable of addressing this alarming global health problem. Snake venoms are natural catalogs of multifunctional toxins and privileged frameworks, which serve as potential templates for the inspiration of novel treatment strategies for combating antibiotic resistant bacteria. Phospholipases A2 (PLA2 s) are one of the main classes of antibacterial biomolecules, with recognized therapeutic value, found in these valuable secretions. Recently, a number of biomimetic oligopeptides based on small fragments of primary structure from PLA2 toxins has emerged as a meaningful opportunity to overcome multidrug-resistant clinical isolates. Thus, this review will highlight the biochemical and structural properties of antibacterial PLA2 s and peptides thereof, as well as their possible molecular mechanisms of action and key roles in development of effective therapeutic strategies. Chemical strategies possibly useful to convert antibacterial peptides from PLA2 s to efficient drugs will be equally addressed.

Agenesia del sacro / Sacro agenesis

Dentro del espectro de displasia caudal o síndrome de regresión caudal se encuentra la agenesia del sacro. El espectro de malformaciones de la masa celular caudal incluye las lumbosacras, las anorrectales y las urogenitales, así como anormalidades de miembros inferiores. Su presentación puede incluir una o más de las siguientes: Fusión de los miembros inferiores (sirenomielia), Agenesia lumbosacra, Atresia anal, Genitales anormales, Aplasia renal, Hipoplasia pulmonar. Puede asociarse con el síndrome de Potter. Su incidencia está aumentada en hijos de madres diabéticas. Las anormalidades espinales pueden ir desde la agenesia parcial del sacro hasta la agenesia total de las vértebras lumbosacras

Estudio de la siringomielia por resonancia magnética

La contribución que la Resonancia Magnética ofrece al estudio, diagnóstico y seguimiento de las cavidades intramedulares (siringo-hidromielia) ha sucitado en nosotros el deseo de publicar los cuatro primeros casos recolectados en un período de seis meses a partir de diciembre de 1988, cuando por primera vez se implantó en Colombia la técnica de Resonancia Magnética. Se realiza además una revisión sobre el tema

Microcalcificación y meningioma

Se presenta el caso de un meningioma psamomatoso en un paciente adolescente con sus hallazgos clínicos, radiológicos y de patología. Su rar presentación en menores de 20 años y la buena correlación entre las imágenes y la patología lo califican como un caso representativo

Discos intervertebrales lumbares extruidos / Extruded lumbar disks

La discolisis percutanea con colagenasa produce resultados altamente satisfactorios en pacientes con discos lumbares protruidos, pero no actua cuando el disco esta extruido, caso en el cual esta indicada la excision quirurgica del tejido herniado. Con el objeto de establecer este diagnostico diferencial se hizo el estudio retrospectivo de las historias clinicas y las mielografias de los archivos del Instituto Neurologico de Colombia. El cuadro clinico clasico de dolor lombociatico continuo producico por el disco extruido no aliviado con reposo en cama, con signos de compresion radicular fue observado en 10 a 30 casos seleccionados de discos extruidos. En 19 enfermos la mielografia fue concluyente. Al combinar los hallazgos clinicos y mielograficos se pudo establecer el diagnostico con certeza en solo dos terceras partes de los casos. En esta serie no se utilizo la discografia, procedimiento que podria ser adicionado para incrementar nuestra capacidad de distinguir los discos lumbares extruidos de los protruidos.