Hallazgos bucales en pacientes COVID-19 / Oral Findings in Patients With COVID-19

El propósito de este trabajo fue caracterizar las alteraciones orales en un grupo de pacientes COVID-19. Para ello se evaluaron 55 pacientes hospitalizados, confirmados COVID-19 en distintos estadios de severidad. Previo consentimiento informado, se examinó la cavidad oral y se registraron los hallazgos clínicos. El grupo de estudio estuvo conformado por 25 mujeres (45,5%) y 30 varones (54,5%), con edades comprendidas entre uno y 89 años. Un 40% de los pacientes mostraron alguna lesión bucal. Las lesiones más comunes fueron candidiasis y ulceraciones (7 pacientes cada uno) y en 2 pacientes se observó enantema. También se encontraron alteraciones de la normalidad como glositis migratoria y varicosidades linguales. Asimismo, se registraron alteraciones del gusto, xerostomía y dolor/ardor bucal en el 60, 27,3 y 36,4%, respectivamente. En los pacientes COVID-19 se observaron con frecuencia alteraciones y lesiones en la mucosa bucal. Finalmente, la disgeusia y el dolor y/o el ardor oral fueron los síntomas comunes en estos pacientes (AU)

The aim of this study was to describe oral lesions in a group of patients with COVID-19. We recruited 55 patients, 25 women (45.5%) and 30 men (54.5%), aged between 1 and 89 years with confirmed COVID-19 at different stages of severity. After obtaining informed consent, we examined their mouths and recorded clinical findings. Forty percent of the patients had at least 1 oral lesion. The most common lesions were candidiasis and ulcers (7 patients each); 2 patients had enanthems. Geographic tongue and caviar tongue were also observed. Altered taste, dry mouth, and painful/burning mouth were noted in 60%, 27.3%, and 36.4% of patients, respectively. Oral mucosal alterations and lesions were prevalent in this series of COVID-19 patients. Altered taste and a painful/burning mouth were common symptoms (AU)

[Translated article] Oral Findings in Patients With COVID-19 / Hallazgos bucales en pacientes COVID-19

The aim of this study was to describe oral lesions in a group of patients with COVID-19. We recruited 55 patients, 25 women (45.5%) and 30 men (54.5%), aged between 1 and 89 years with confirmed COVID-19 at different stages of severity. After obtaining informed consent, we examined their mouths and recorded clinical findings. Forty percent of the patients had at least 1 oral lesion. The most common lesions were candidiasis and ulcers (7 patients each); 2 patients had enanthems. Geographic tongue and caviar tongue were also observed. Altered taste, dry mouth, and painful/burning mouth were noted in 60%, 27.3%, and 36.4% of patients, respectively. Oral mucosal alterations and lesions were prevalent in this series of COVID-19 patients. Altered taste and a painful/burning mouth were common symptoms (AU)

El propósito de este trabajo fue caracterizar las alteraciones orales en un grupo de pacientes COVID-19. Para ello se evaluaron 55 pacientes hospitalizados, confirmados COVID-19 en distintos estadios de severidad. Previo consentimiento informado, se examinó la cavidad oral y se registraron los hallazgos clínicos. El grupo de estudio estuvo conformado por 25 mujeres (45,5%) y 30 varones (54,5%), con edades comprendidas entre uno y 89 años. Un 40% de los pacientes mostraron alguna lesión bucal. Las lesiones más comunes fueron candidiasis y ulceraciones (7 pacientes cada uno) y en 2 pacientes se observó enantema. También se encontraron alteraciones de la normalidad como glositis migratoria y varicosidades linguales. Asimismo, se registraron alteraciones del gusto, xerostomía y dolor/ardor bucal en el 60, 27,3 y 36,4%, respectivamente. En los pacientes COVID-19 se observaron con frecuencia alteraciones y lesiones en la mucosa bucal. Finalmente, la disgeusia y el dolor y/o el ardor oral fueron los síntomas comunes en estos pacientes (AU)

[Oral Findings in Patients With COVID-19]. / Hallazgos bucales en pacientes COVID-19.

The aim of this study was to describe oral lesions in a group of patients with COVID-19. We recruited 55 patients, 25 women (45.5%) and 30 men (54.5%), aged between 1 and 89 years with confirmed COVID-19 at different stages of severity. After obtaining informed consent, we examined their mouths and recorded clinical findings. Forty percent of the patients had at least 1 oral lesion. The most common lesions were candidiasis and ulcers (7 patients each); 2 patients had enanthems. Geographic tongue and caviar tongue were also observed. Altered taste, dry mouth, and painful/burning mouth were noted in 60%, 27.3%, and 36.4% of patients, respectively. Oral mucosal alterations and lesions were prevalent in this series of COVID-19 patients. Altered taste and a painful/burning mouth were common symptoms.

Oral Findings in Patients With COVID-19.

The aim of this study was to describe oral lesions in a group of patients with COVID-19. We recruited 55 patients, 25 women (45.5%) and 30 men (54.5%), aged between 1 and 89 years with confirmed COVID-19 at different stages of severity. After obtaining informed consent, we examined their mouths and recorded clinical findings. Forty percent of the patients had at least 1 oral lesion. The most common lesions were candidiasis and ulcers (7 patients each); 2 patients had enanthems. Geographic tongue and caviar tongue were also observed. Altered taste, dry mouth, and painful/burning mouth were noted in 60%, 27.3%, and 36.4% of patients, respectively. Oral mucosal alterations and lesions were prevalent in this series of COVID-19 patients. Altered taste and a painful/burning mouth were common symptoms.

El propósito de este trabajo fue caracterizar las alteraciones orales en un grupo de pacientes COVID-19. Para ello se evaluaron 55 pacientes hospitalizados, confirmados COVID-19 en distintos estadios de severidad. Previo consentimiento informado, se examinó la cavidad oral y se registraron los hallazgos clínicos. El grupo de estudio estuvo conformado por 25 mujeres (45,5%) y 30 hombres (54,5%), con edades comprendidas entre 1 y 89 años. Un 40% de los pacientes mostraron alguna lesión bucal. Las lesiones más comunes fueron candidiasis y ulceraciones (7 pacientes cada uno) y en dos pacientes se observó enantema. También se encontraron alteraciones de la normalidad como glositis migratoria y varicosidades linguales. Asimismo, se registraron alteraciones del gusto, xerostomía y dolor/ardor bucal en el 60%, 27,3% y 36,4% respectivamente. En los pacientes COVID-19 se observaron con frecuencia alteraciones y lesiones en la mucosa bucal. Finalmente, la disgeusia y el dolor y/o el ardor oral fueron síntomas comunes en estos pacientes.

Melanoma mucoso nasal: una enfermedad impredecible / Mucosal melanoma of the nasal cavity: an unpredictable disease

RESUMEN El melanoma mucoso maligno es un tumor neuroectodérmico de menos del 5% de las neoplasias nasosinusales. Es un tumor de mal pronóstico clásicamente su promedio de supervivencia a cinco años es cercano al 28% y 17,5% a diez años, siendo aún peor cuando existe metástasis en cuello. Se presentan a continuación dos casos de melanoma mucoso en cavidad nasal y senos paranasales, el primero mujer 58 años con melanoma septal llevada a septotomía abierta más quimioterapia y radioterapia adyuvante, con recurrencia en cuello submaxilar derecho tratada con vaciamiento supraomohioideo actualmente sin recurrencia; el segundo hombre de 40 años con antecedente de resección melanoma septal quien presenta nuevo melanoma región etmoidal izquierda luego de su primera cirugía y es llevado a resección endoscópica transnasal sin tratamiento adyuvante por decisión del paciente.

ABSTRACT Sinonasal mucosal melanoma is a neuroectodermic tumor account less 5% of nasosinusal tumors. It has a poor prognosis with a five-year average survival near 28% and 17.5% to 10 years; if neck metastasis is even worst. Here we present two clinical cases. First one a woman 58 years old with septal melanoma who receives an open septectomy with chemotherapy and radiotherapy with submaxillary recurrence treated with supraomohyoid neck dissection. The second case, a man 40 years old with previous septal melanoma surgery who has an ethmoid sinus recurrence and receives transnasal endoscopic surgery without adjuvant therapy by patient desire.

Physical properties of films based on pectin and babassu coconut mesocarp.

The objective of this research was to study the physical properties, water sorption, thermal and structure of films made from citrus pectin (CP), babassu coconut mesocarp (BCM) and glycerol (G). Seventeen formulations were prepared according to a central compound rotational design combining different proportions of the materials and evaluating the films produced according to their moisture contents, solubility, thicknesses and water vapor permeability. The results showed a direct relationship between the composition of the film and each physical property, providing films with unique mechanical characteristics and barrier properties. In the second phase, the films were reformulated, maintaining the proportions of CP and BCM constant and altering the G content. The results showed films with permeable structures, thus favoring the use of high drying temperatures (up to 70 °C) for the confection of films, without altering their physical and structural properties.

Developing Sustainable Cancer Education Programs: Training Public Health Students to Deliver Cancer 101 in Puerto Rico.

The use of promotores to educate Hispanic communities about different health topics has been proven successful, albeit with limitations in program sustainability. The goal of this study was to develop a sustainable train-the-trainer model to train graduate public health (PH) students to disseminate cancer education among communities in Puerto Rico (PR). Graduate students (n = 32) from Ponce Health Sciences University's (PHSU) PH program participated in a 2-day Cáncer 101 training, where they learned how to deliver nine cancer modules to the community. Cancer knowledge was assessed before and after the training via 54 items measuring discussed concepts. Participants also assessed the training's effectiveness by completing a training evaluation informed by social cognitive theory (SCT) constructs of self-efficacy, outcome expectations, facilitation, and observational learning. Participants were mainly female (78.1 %), 26.7 ± 3.9 years old, and enrolled in a Masters-level program (81.3 %). Participants reported an average 11.38-point increase in cancer knowledge after attending the training [t(31) = 14.88, p < .001]. Participants also evaluated the training favorably upon completion, reporting satisfactory comments in the open-ended responses and high scores on measured SCT constructs. The Cáncer 101 training program effectively prepared students to deliver cancer education to local communities. Training graduate PH students to educate communities about health issues is an innovative, and potentially sustainable, way to reach underserved populations.

Tumor fibroso solitario de la glándula tiroides con extensión intratorácica / Solitary fibrous tumor of the thyroid gland with intrathoracic extension

El tumor fibroso solitario (TFS) es una neoplasia mesenquimal de células fusiformes infrecuente descrita inicialmente en la pleura pero con localización reconocida en otros sitios. El TFS de la glándula tiroides (TFST) es aun más raro. Se describe el caso de una mujer de 65 años de edad, con masa cervical de crecimiento progresivo, a tal punto que ya la masa se hacía notable en parte inferior de su cuello, siendo este el único síntoma narrado. La paciente presentaba una gran masa tiroidea en el lóbulo derecho con extensión intratorácica. Se practicó hemitiroidectomia derecha (paciente tenia historia previa de resección del lóbulo tiroideo izquierdo por lesión benigna) Total, además de toracotomía endoscópica por la extensión de la masa la cual en la tomografía contrastada, se originaba en el lóbulo tiroideo derecho y descendía paralelo a la columna dorsal desplazando a la tráquea y el esófago. La patología reportó un tumor de 15 centímetros, con células fusiformes y patrón de crecimiento hemangiopericítico sin pleomorfismo, atipia, mitosis o necrosis. Luego de practicar diferentes estudios y marcadores tumorales, de todos estudios fueron positivos CD34, Bcl2, CD99 y vimentina. Se diagnosticó tumor fibroso solitario de glándula tiroides. El nervio vago derecho fue lesionado en la cirugía, actualmente está en terapia de voz. Al momento actual casi seis meses luego de su cirugía, no se documenta recidiva tumoral.

Solitary fibrous tumor (SFT) is a rare mesenchymal neoplasm initially described as spindle cells in the pleura but recognized location elsewhere. The TFS thyroid gland (TFST) even infrequent. A case of a 65 years old woman with progressive growth of a right cervical mass without associated symptoms described other than cosmesis is described . The patient had a thyroid mass in the right lobe with intrathoracic extension. A right Hemi thyroidectomy and thoracotomy for the extent of the mass was performed. Pathology reported a 15 cm tumor with spindle cell and growth pattern hemangiopericitic without pleomorphism, atypia, mitosis or necrosis. Immunohistochemistry was positive for CD34, Bcl-2, CD99 and vimentin, making the diagnosis of solitary fibrous tumor of thyroid gland. The patient's right Vagus nerve was injured intraoperatively and she is currently under voice therapy. Currently now, almost six months after her surgery she is free of disease.

When a Common Language Is Not Enough: Transcreating Cancer 101 for Communities in Puerto Rico.

In Puerto Rico (PR), cancer is the leading cause of death. Previous research has identified the need for cancer education in PR. Using culturally adapted cancer curricula to train local health educators may effectively increase cancer education and reduce health disparities. This article describes the three-phase process used to transcreate the Cancer 101 curriculum to train Master of Public Health (MPH) students to educate PR communities. First, an expert panel collaboratively reviewed the curriculum for content, legibility, utility, and colloquialisms. Recommendations included incorporating local references and resources, replacing words and examples with culturally relevant topics, and updating objectives and evaluation items. Subsequent focus groups with 10 MPH students assessed the adaptation's strengths, weaknesses, and utility for future trainees. Participants were satisfied with the curriculum's overall adaptation, ease of use, and listed resources; further improvements were suggested for all modules. Final expert panel revisions highlighted minor feedback, with the final curriculum containing nine transcreated modules. The transcreation process identified the need for changes to content and cultural translation. Changes were culturally and literacy-level appropriate, represented PR's social context, and were tailored for future trainees to successfully deliver cancer education. Findings highlight the importance of adapting Spanish educational materials across Hispanic sub-groups.

Molecular identification of Coccidioides immitis in formalin-fixed, paraffin-embedded (FFPE) tissues from a Colombian patient.

Coccidioides immitis and C. posadasii are the etiologic agents of coccidioidomycosis, an endemic fungal disease of the Americas. In Colombia, this mycosis is uncommon, and only five cases, two of them imported, have been documented.By means of DNA sequencing, C. immitis was identified in formalin-fixed, paraffin-embedded archival tissues samples from the 5th Colombian patient diagnosed in 1997. The patient was born in Pinto, Department of Magdalena, and had never visited other geographic regions, a reason to consider that the mycosis had been acquired locally.This species is primarily found in California although it has been occasionally reported in other geographic areas such as Mexico and Brazil. This is the first indigenous report of C. immitis-associated coccidioidomycosis in a Colombian patient.

Distribution and evolution of het gene homologs in the basidiomycota.

In filamentous fungi a system known as somatic incompatibility (SI) governs self/non-self recognition. SI is controlled by a regulatory signaling network involving proteins encoded at the het (heterokaryon incompatible) loci. Despite the wide occurrence of SI, the molecular identity and structure of only a small number of het genes and their products have been characterized in the model fungi Neurospora crassa and Podospora anserina. Our aim was to identify and study the distribution and evolution of putative het gene homologs in the Basidiomycota. For this purpose we used the information available for the model fungi to identify homologs of het genes in other fungi, especially the Basidiomycota. Putative het-c, het-c2 and un-24 homologs, as well as sequences containing the NACHT, HET or WD40 domains present in the het-e, het-r, het-6 and het-d genes were identified in certain members of the Ascomycota and Basidiomycota. The widespread phylogenetic distribution of certain het genes may reflect the fact that the encoded proteins are involved in fundamental cellular processes other than SI. Although homologs of het-S were previously known only from the Sordariomycetes (Ascomycota), we also identified a putative homolog of this gene in Gymnopus luxurians (Basidiomycota, class Agaricomycetes). Furthermore, with the exception of un-24, all of the putative het genes identified occurred mostly in a multi-copy fashion, some with lineage and species-specific expansions. Overall our results indicated that gene duplication followed by gene loss and/or gene family expansion, as well as multiple events of domain fusion and shuffling played an important role in the evolution of het gene homologs of Basidiomycota and other filamentous fungi.

Struma ovarii con un foco de micro-carcinoma papilar variante folicular de tiroides: reporte de caso y revisión de la literatura / Struma ovarii with follicular variant of papillary thyroid carcinoma: report of one case

Struma ovarii is an ovarian teratoma composed mainly of thyroid tissue, which can occasionally develop a malignant thyroid tumor. We report a 61 years old female consulting for a metrorrhagia in whom an ovarian cyst was discovered. The patient was subjected to a hysterectomy and bilateral oophorectomy. The pathological study of the surgical piece revealed a focus of papillary thyroid carcinoma, follicular variety in a right struma ovarii. Three months after surgery, an abdominal CAT scan did not show any abnormality.

Efecto de la neutralización y adición de edulcorante en las propiedades fisicoquímicas, microbiológicas y sensoriales del arequipe de leche de búfala / Neutralization and addition of sweetening effect in physicochemical, microbiological and sensory properties of buffalo milk arequipe

La leche de búfala, debido a su composición, especialmente en carbohidratos, presenta una aptitud favorable para la elaboración de arequipe. Su rendimiento en productos lácteos es 40% superior al de la leche bovina. Esta investigación evalúa la variación de dos niveles de neutralización (0.09 y 0.10 % ácido láctico) y tres porcentajes de edulcorantes (25% sacarosa; 22% sacarosa y 30% azúcar invertido; 20% sacarosa y 30% azúcar invertido), en la elaboración del arequipe de leche de búfala. Al tratamiento seleccionado por los jueces mediante la prueba de medición de grado de satisfacción se le determina: contenidos de sólidos totales, humedad, cenizas, proteína, grasa, viscosidad, color, mesófilos, coliformes totales, coliformes fecales,mohos y levaduras y Staphylococcus coagulasa positivo. Se almacena a temperatura ambiente y se le practica análisis microbiológico (mohos y levaduras), organoléptico (arenosidad) y fisicoquímico (sólidos totales y humedad) en intervalos de diez días durante sesenta días. El tratamiento seleccionado, con un nivel de confianza del 95%, es el de 0.10% acido láctico, 20% sacarosa y 30% azúcar invertido. El arequipe presenta contenidos de sólidos totales, humedad, cenizas, proteína y grasa de 77.90 ± 0.04%; 22.10 ± 0.04%; 1.76 ± 0.09%; 9.85 ± 0.37% y 7.95 ± 0.41% respectivamente; un comportamiento seudoplástico y tixotrópico. El arequipe elaborado, de acuerdo con los análisis microbiológicos, cumple la Norma Técnica ColombianaNTC 3757 de 1996 y conserva sus características microbiológicas, organolépticas y fisicoquímicas hasta eldía cincuenta.

Biopsia aspiracion con aguja fina en el diagnostico de quiste de paratiroides / Biopsy aspiration with fine needle in the diagnosis of cyst of paratiroides

Los quistes de paratiroides constituyen solamente del 1 al 5 por ciento de los quistes cervicales. Fueron descritos por primera vez por Sandstrom en 1880 y Goris en 1906 realizó la primera resección de la cual se tenga conocimiento. Desde esta descripción a la fecha, sólo se han reportado aproximadamente 250 casos en la literatura, se presenta el caso de una mujer de 25 años de edad con lesión paratraqueal derecha que consultó a Dinámica IPS para realizar biopsia aspiración con aguja fina guiada por ecografía saliendo líquido transparente que informó 300 pg/dL de paratohormona (valor 10-69 pg/dL). Se presenta el caso de un quiste de paratiroides diagnosticado por biopsia aspiración con aguja fina

Comparacion entre la tecnica de capilaridad y la biopsia aspiracion con aguja fina (BACAF) en nodulos de tiroides / Comparison between capillary technique and fine-needle aspiration biopsy (BACAF) in thyroid nodules

La biopsia aspiración con aguja fina de tiroides es el examen de elección en los nódulos tiroideos. Se realizó un estudio en el cual se comparó la técnica de capilaridad con la biopsia por aspiración con aguja fina (BACAF) en lesiones de tiroides.Se efectuaron en total 50 biopsias de tiroides. Sc encontró que los resultados de los extendidos citológicos preparados para cada método fueron comparables en calidad, cantidad y rendimiento diagnóstico. Las dos técnicas tuvieron una adecuada eficacia diagnóstica. Se concluyó que la capilaridad es un excelente método diagnóstico y combinado con el bacaf mejora la sensibilidad diagnóstica.

The thyroid Fine-Needle Aspiration Biopsy is the test of choice for thyroid nodules. We carried out a study to compare the Capillarity technique versus Fine-Needle Aspiration Biopsy (FNAB) in thyroid lesions. We performed 50 thyroid biopsies. We found that the results of the cytology smears prepared for cach technique were comparable in qualit, amount and diagnostic reward. Both techniques had an adequate diagnostic efficacy. We concluded that capillarity, is an excellent diagnostic method and combined with FNAB improves the diagnostic sensitivity.

Tumor de células granulares en el tracto gastrointestinal / Granular cells tumor in the gastrointestinal tract

Los tumores de células granulares son lesiones ubicuas en el tracto gastrointestinal, raras y asintomáticas, y generalmente son un hallazgo incidental a la endoscopia alta o baja. En el tracto gastrointestinal se ubican más frecuentemente en el esófago, colon y recto, estómago, apéndice, intestino delgado o tracto biliopancreático. Este artículo describe tres pacientes con cuatro tumores de células granulares en recto, esófago (2 lesiones) y apéndice. Se hace especial énfasis en su origen neural, su comportamiento benigno que justifica las resecciones endoscópicas o quirúrgicas limitadas y la necesidad de un seguimiento por la posibilidad, aunque poca, de transformación maligna

Neurofibromatosis: presentacion de un caso / Neurofibromatoses: a case report

Se presenta un caso de neurofibromatosis en un paciente de 70 años de edad, natural de Lituania, residente en Medellín, con múltiples tumores cutáneos en la cara, de 25 años de evolución. Al examen físico, presenta manchas café con leche y efélides intertriginosas que sugieren el diagnóstico, el cual es confirmado con estudio histopatológico de la lesión.

A case of neurofibromatoses is presented in a 70 years old patient, who was borned in Lituania, resident in Medellín (Colombia), and had multiple cutaneous tumoral lesions of 25 years ofevolution in face. At physical examination we founded coffee au lait spots and intertriginous freekles that suggest the diagnosis, wich was confirmed by histopatologic studies.

Bezoares: reporte de dos casos y revision de la literetura / Bezoars: report of two cases and review of the literature

Los bezoares son cuerpos extraños, conglomerados de pelo, fibras vegetales, medicamentos y otras sustancias en el tracto gastrointestinal de los humanos y ciertos animales, predominando en la niñez y en las mujeres; usualmente está asociado a desórdenes de la conducta; en adultos, son encontrados frecuentemente después de cirugía gástrica. Se describen dos casos clínicos y se revisa la literatura.

Bewars are foreign bodies, conglomerates of hair, vegetable fibers, medicaments and other substances in the gastrointestinal tract of humans and certain animals, predominant in childhood, in women, usually associated to behavioral disorders, in adults, are frequently encountered after a gastric surgery. We describe two clinical cases and review literature.

Improvement of the synthesis of diphenylmethyl 7beta-(o-hydroxy)benzylideneamino-3-hydroxymethyl-3-cephem-4-carboxylate.

The title product (I) is synthesized currently from 7-aminocephalosporanic acid, and diphenyldiazomethane (DDM) is used as a protective reagent of the acid function for further reactions. When DDM was prepared from benzophenone hydrazone by reaction with chloramine T, it was resulted impure by p-toluenesulfonamide, formed as side product, which cannot be removed during the final purification step carried out according to the literature procedure. Two simple methods are proposed here to obtain I with the suitable degree of purity necessary for a drug.

Snakebites and ethnobotany in the northwest region of Colombia: Part I: traditional use of plants.

In Antioquia and Chocó, traditional healers attend 60% of snakebites. With the aim to produce an inventory of the plants used by the healers to treat snakebites and to document the methods of preparation, administration, the dosage, number of patients treated throughout their years of practice with treatment results, 20 healers with experience in Bothrops, Porthidium and Bothriechis envenomations were interviewed between August, 1996 and November, 1998. They belong to nine black and three indigenous rural communities located near the towns of Bojayá, Vigía del Fuerte, Unguía (Atrato river valley), Nuquí and Bahía Solano (Pacific coast). Based on field interviews, 101 species of plants were identified as used to treat snakebites. The part used of each plant varies according to the species. Sixty plants are used in the form of drinks prepared by infusion, decoction or maceration; 78 as external baths on the affected extremity; 11 for steam application and 39 for poultices; the latter is used mainly when the bite is complicated by local necrosis. In mild and moderate envenomations, they generally use a mixture of three plants, while in severe cases they mix from five to 12, a handful of each one. Treatment is generally performed for 1-3 days, when the patient reacts positively. They reported to have treated 454 patients during their years of experience, 20 of them (4.4%) died. With the guidance of the healers, 77 species of plants were collected and photographed. These plants belong to 41 families, of which Piperaceae (13 species), Araceae (six species), Asteraceae (five species) and Gesneriaceae (three species) have the highest number of species.