RESUMO
In-house assays for the diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by quantitative reverse-transcription polymerase chain reaction (qRT-PCR), are feasible alternatives, particularly in developing countries. Cycle threshold (Ct ) values obtained by qRT-PCR were compared with clinical and laboratory data from saliva of inpatients with COVID-19 and asymptomatic health workers (AHW) were studied. Saliva specimens from 58 inpatients confirmed by qRT-PCR for SARS-CoV-2 using nasopharyngeal specimens, and 105 AHW were studied by qRT-PCR using three sets of primers for the N (N1, N2, and N3) gene of SARS-CoV-2, according to the CDC Diagnostic Panel protocol, showing a positivity of 88% for inpatients and 8% for AHW. Bivariate analysis revealed an association between Ct < 38.0 values for N2 and mechanical ventilation assistance among patients (p = .013). In addition, values of aspartate-transaminase, lactate dehydrogenase, and ferritin showed significant correlations with Ct values of N1 and N3 genes in inpatients. Therefore, our results show that Ct values correlate with some relevant clinical data for inpatients with COVID-19.
Assuntos
Teste de Ácido Nucleico para COVID-19/estatística & dados numéricos , COVID-19/diagnóstico , Pessoal de Saúde/estatística & dados numéricos , Pacientes Internados/estatística & dados numéricos , Adulto , Idoso , Infecções Assintomáticas , Biomarcadores/sangue , Proteínas do Nucleocapsídeo de Coronavírus/genética , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fosfoproteínas/genética , SARS-CoV-2/genética , SARS-CoV-2/isolamento & purificação , Saliva/virologia , Índice de Gravidade de DoençaRESUMO
A Mexican 24-year-old male patient was referred to our hospital due to increased left retroauricular volume with skin fistulisation, resembling an infection by the uncommon worm Lagochilascaris minor. The patient was submitted to lateral skull base surgery. No adult worms or eggs were observed during light and scanning electron microscopy analysis, as well as by histopathologic examination of the small piece of removed tissue, only L3 stage larvae of Lagochilascaris spp. were identified. Polymerase chain reaction-sequencing assays were performed using primers for the mitochondrial 12S and the nuclear 18S rDNA gene. DNA of some L minor adults, previously identified, were used as control. The molecular analysis identified the worm as L minor. According to previous reports, lagochilascariasis is a complicated infection that requires an interdisciplinary management by different clinical specialists. This is the first time that 12S and 18S rDNA genes are reported as molecular markers for diagnosis of L minor.
Assuntos
Infecções por Ascaridida/diagnóstico , Ascaridoidea/isolamento & purificação , DNA de Helmintos/análise , Animais , Infecções por Ascaridida/parasitologia , Ascaridoidea/ultraestrutura , DNA Ribossômico/análise , Humanos , Masculino , México , Microscopia Eletrônica de Varredura , Reação em Cadeia da Polimerase , Adulto JovemRESUMO
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.
Assuntos
Neoplasias dos Nervos Cranianos/complicações , Doenças do Nervo Facial/complicações , Processo Mastoide/inervação , Neurilemoma/complicações , Neoplasias Parotídeas/complicações , Membrana Timpânica/inervação , Adulto , Neoplasias dos Nervos Cranianos/patologia , Neoplasias dos Nervos Cranianos/cirurgia , Doenças do Nervo Facial/patologia , Doenças do Nervo Facial/cirurgia , Paralisia Facial/etiologia , Paralisia Facial/cirurgia , Feminino , Perda Auditiva Condutiva/etiologia , Humanos , Masculino , Neurilemoma/patologia , Neurilemoma/cirurgia , Glândula Parótida/inervação , Neoplasias Parotídeas/patologia , Neoplasias Parotídeas/cirurgia , Estudos Retrospectivos , Zumbido/etiologia , Adulto JovemRESUMO
La Stenotrophomonas maltophilia es una bacteria oportunista que causa diversos tipos de infecciones asociadas con la atención sanitaria en pacientes debilitados, especialmente en aquellos que han recibido antimicrobianos de amplio espectro. La Stenotrophomonas maltophilia se posiciona hoy en día como un patógeno nosocomial de ámbito general, el cual se añade a otros multirresistentes como Staphylococcus aureus, Acinetobacter spp. y Pseudomonas aeruginosa. Presentamos este caso dado que es el primero que encontramos en nuestro servicio (el cual simula una infección recurrente por micobacterias) y con el objetivo de demostrar el protocolo utilizado para el diagnóstico y tratamiento. Este germen se reporta con poca frecuencia y todos los pacientes son inmunosuprimidos o con tratamiento antibiótico prolongado. Este agente infeccioso se debe considerar e incluir entre los diagnósticos diferenciales de conglomerados ganglionares abscedados. En pacientes con inmunosupresión sospechada o conocida es necesario descartar la presencia de microorganismos oportunistas, para poder proporcionarle un diagnóstico adecuado y un tratamiento específico.
Stenotrophomonas maltophilia is an opportunistic bacterium that can cause various types of infections associated with health care in debilitated patients, especially those who have previously received broad-spectrum antimicrobials. Stenotrophomonas maltophilia is positioned today as a nosocomial pathogen of general scope, such as adding other multiresistant Staphylococcus aureus, Acinetobacter spp. and Pseudomonas aeruginosa.We present this case because it is the first thing we find in our service (wich simulates a recurrent mycobacterial infection) and with the aim of demonstrating the protocol used in diagnosis and treatment. This germ is infrequently reported and all patients are immunosuppressed or with prolonged antibiotic treatment. This infectious agent should be considered and included in the differential diagnosis of lymph node abscessed conglomerates. In patients with suspected or known immunosuppression is necessary to rule out opportunistic organisms, to provide a proper diagnosis and specific treatment.
Assuntos
Humanos , Stenotrophomonas maltophilia , Hospedeiro Imunocomprometido , LinfonodosRESUMO
Most paranasal sinus mucoceles are unilateral and affect one or at most two contiguous sinuses. We describe the case of a 44-year-old woman with bilateral maxillary sinus mucoceles who presented clinically with left malar pain, right-sided swelling, and proptosis of the right eye. The diagnostic workup included computed tomography and magnetic resonance imaging. In addition, because of the atypical bilateral presentation, we analyzed mucosal sinonasal tissue samples by electron microscopy. Microscopic analysis revealed an absence of one of the microtubule doublets in three of the outer doublets of the axoneme, thereby establishing a diagnosis of isolated ciliary dysfunction. To the best of our knowledge, ciliary dysfunction as a cause of bilateral mucoceles has not been previously reported in the literature. The patient underwent successful surgery for removal of the mucoceles, and she exhibited no evidence of recurrence at the 18-month follow-up. When a diagnosis of bilateral mucocele formation is made, we suggest that ciliary dysfunction be considered in the differential diagnosis and that electron microscopy of the sinonasal mucosa be performed in the workup.
Assuntos
Microtúbulos/ultraestrutura , Mucocele/etiologia , Mucosa Nasal/ultraestrutura , Doenças dos Seios Paranasais/etiologia , Adulto , Cílios/ultraestrutura , Feminino , Humanos , Mucosa Nasal/citologiaRESUMO
Los paragangliomas son las neoplasias vasculares benignas más comunes del cuello. Surgen de células paragangliónicas extraadrenales derivadas de la cresta neural. El 90% se presentan en el tejido adrenal y 10% en tejidos extraadrenales de los cuales el 85% son abdominales, 12% torácicos y 3% en cabeza y cuello. El sitio más común de presentación es el cuerpo carotídeo, seguido por yugulotimpánicos y vagales. Otros sitios infrecuentes incluyen laringe, cavidad nasal, órbita, tráquea, cuerpo aórtico y mediastino. Se presentan los casos de dos pacientes con paragangliomas laríngeos en quienes se realizó faringotomía lateral y laringofisura, para connotar la importancia de tener presentes los diagnósticos diferenciales ante el hallazgo de una masa supraglótica y plantear un flujograma diagnóstico y terapéutico. Aunque con ambos abordajes se logra la remoción completa, son comunes las complicaciones postoperatorias; la faringotomía lateral es técnicamente más difícil y las complicaciones potenciales son más serias que con laringofisura.
Paragangliomas are the most common type of benign vascular tumors of the neck. Extraadrenal paraganglionicas arise from cells derived from the neural crest. 90% occur in the adrenal tissue and 10% in extra-adrenal tissues of which 85% are abdominal, thoracic 12% and 3% in head and neck. The most common site is the carotid body, followed by yugulotimpánicos and vagal. Other rare sites include the larynx, nasal cavity, orbit, trachea, mediastinum and aortic body. We present the cases of two patients with laryngeal paragangliomas who underwent to pharyngotomy and laryngofi ssure; in order to connote the importance of differential diagnoses present before a fi nding of a supraglottic mass and pose diagnostic and therapeutic fl owchart. Although both approaches allows the complete removal of the mass; postoperative complications are common; pharyngotomy approach is technically more diffi cult and potential complications are more serious than laryngofi ssure.
Assuntos
Humanos , Paraganglioma , Neoplasias de Cabeça e Pescoço , LaringeRESUMO
Mucormycosis is a lethal opportunistic fungal infection, described mostly in immunocompromised patients. A comparative cohort study was conducted to compare the evolution of the study group patients with rhino-orbital mucormycosis, in which a therapeutic protocol was instituted, in which the pterygomaxillary fossa is systematically surgically approached and orbital exenteration is performed or not based on the spreading of the infection to the orbital apex or the orbital fissure, with a historical group where these criteria were not applied. Fifteen cases were included, eight in historic group A and seven in the study group B. Medical treatment was provided with control of the underlying disease (amphotericin B and low molecular weight heparin) as well as surgical treatment with extensive debridement including endoscopic ethmoidectomy and exploration of the pterygomaxillary fossa, also performing orbital exenteration only in patients who presented orbital apex syndrome in group B. In group A, there was a mortality rate of 50%, in group B all patients were clinical cured; however, the two patients with hematologic diseases died of complications not related to the fungal infection. With the standardization of a diagnostic and therapeutic protocol, good results in healing and survival of patients can be obtained.
Assuntos
Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Mucormicose/terapia , Doenças Nasais/terapia , Doenças Orbitárias/terapia , Doenças dos Seios Paranasais/terapia , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Hospedeiro Imunocomprometido , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tempo para o Tratamento , Adulto JovemRESUMO
BACKGROUND: Myopericytoma is a perivascular tumor of the skin and subcutaneous tissue of the extremities, it is a rare finding in the head and neck, and even rarer is its deep location. METHODS: A 38-year-old woman presented with a slowly growing mass at the right carotid triangle. Contrast-enhanced CT scan revealed a moderately enhancing mass. At surgery, the tumor was firmly attached to the common carotid artery, making it necessary to excise a small portion of the vessel wall. RESULTS: The histopathologic report was myopericytoma. The postoperative course was uneventful, without tumor recurrence. CONCLUSION: The very few deep located myopericytomas at the head and neck region show a predilection to appear near the great neck vessels with a possibility to require vascular repair, or at the parotid space where they can be multicentric. © 2016 Wiley Periodicals, Inc. Head Neck 38: E2479-E2482, 2016.
Assuntos
Artéria Carótida Primitiva/patologia , Neoplasias de Cabeça e Pescoço/patologia , Hemangiopericitoma/patologia , Hemangiopericitoma/cirurgia , Pescoço/patologia , Adulto , Meios de Contraste , Feminino , Seguimentos , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Neoplasias de Cabeça e Pescoço/cirurgia , Hemangiopericitoma/diagnóstico por imagem , Humanos , Biópsia Guiada por Imagem/métodos , Imuno-Histoquímica , Pescoço/cirurgia , Doenças Raras , Medição de Risco , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoRESUMO
We describe the surgery and reconstruction employed with a sternocleidomastoid myocutaneous flap for the treatment of a heterotopic glioma in a 2-year-old boy with incomplete palatal fissure who presented with dysphagia and snoring, in whom a lateral pharyngeal wall mass obstructing 60% of the airway was noted. Heterotopic gliomas are uncommonly reported in the parapharyngeal space and should be included in the differential diagnosis at this location in children. Parapharyngeal tumors present difficult diagnostic and management challenges; head and neck surgeons must be prepared not only for the resection but also for the reconstruction of these rare lesions.
Assuntos
Coristoma/cirurgia , Fissura Palatina/cirurgia , Glioma/cirurgia , Neoplasias Faríngeas/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Retalhos Cirúrgicos/cirurgia , Pré-Escolar , Coristoma/diagnóstico , Fissura Palatina/complicações , Humanos , Masculino , Músculo Esquelético/cirurgia , Neoplasias Faríngeas/complicações , Faringe/patologia , Tomografia Computadorizada por Raios XRESUMO
INTRODUCTION: The Swine Origin A H1N1 Influenza Virus (SOIV) pandemic emerged in April 2009 affecting people and health-care systems worldwide. This study examined the differences among the early clinical features presented in confirmed SOIV cases, those who tested negative for SOIV infection, fatalities, and hospitalized cases. METHODOLOGY: We reviewed 1,024 initial medical records of patients presenting with acute respiratory symptoms who attended the respiratory emergency room of a general hospital in Mexico and had a confirmatory test for influenza AH1N1 by RT-PCR from April to December 2009. RESULTS: Out of 1,024 cases, 457 (44%) were men with a mean age of 31±17 years; however, of these, SOIV confirmed cases were younger (26±8, p=0.000). SOIV infection was confirmed in 36% of the patients. Most (%?) cases presented mild infection, 20% of the patients required hospitalization, and 0.09% patients died. Asthma was more frequent in confirmed cases (p=0.028). Presence of COPD, systemic arterial hypertension, and diabetes mellitus was significant in confirmed hospitalized cases. Pulmonary rales, wheezing, and sudden symptom onset were more frequent and statistically significant in confirmed patients. Influenza-like illness was more frequent in confirmed cases (p=0.049). CONCLUSIONS: This study presents one of the largest series of the new SOIV infection confirmed by RT-PCR reported. This infection is frequently mild and affects mainly young adults. Sudden symptoms onset, pulmonary rales, and wheezing are early features of this infection. Asthma, COPD, systemic arterial hypertension, and diabetes mellitus should be identified to identify potentially severe and fatal cases. ILI helps distinguish SOIV infection.