Primary Tuberculosis of the Pharynx in an HIV Context: A Case Report

Pharyngeal tuberculosis without pulmonary involvement is very rare and may be confused with malignant lesions. We present a 45-year-old female patient with a history of HIV presenting with a history of cough, sore throat, and oral ulcers with chronic use of antibiotics. The evolution would indicate a probable malignant tumor, but the biopsy was consistent with Pharyngeal TB. The patient initiated anti-tuberculosis therapy and demonstrated improved conditions and remission of ulcers. In the context of HIV, this treatment could be a major contributor to the underdiagnosis of the disease and may lead to alternative diagnoses. Therefore, it is vital to consider this condition in patients who do not respond to antibiotics.

Case series of complicated bronchopulmonary lophomoniasis. Differential diagnosis of tuberculosis?

Pulmonary lophomoniasis is a rare and life-threatening disease, most commonly reported across Asian and Latin American countries. Here, we have reported two cases of pulmonary lophomoniasis presenting with atypical manifestations. Case #1 represents a 19-year-old male patient with clinical characteristics suggestive of tuberculosis, presenting with hemoptysis and receiving antituberculosis treatment. Case #2 represents a 69-year-old man with post-tuberculosis pulmonary disease with cystic bronchiectasis presenting with polymicrobial co-infection. Based on our case experience, lophomoniasis should be considered in patients with pneumonia who do not respond to antibiotic treatment, and the corresponding epidemiological factors should be carefully considered in addition to bronchoscopy for precise diagnosis.

Stroke imaging modality for endovascular therapy in the extended window: systematic review and meta-analysis

BACKGROUND

In anterior circulation large vessel occlusion (LVO) in the extended time window, the guidelines recommend advanced imaging (ADVI) to select patients for endovascular therapy (EVT). However, questions remain regarding its availability and applicability in the real world. It is unclear whether an approach to the extended window EVT that does not use ADVI would be equivalent.

METHODS

In April 2022, a literature search was performed to identified randomized controlled trials (RCT) and observational studies describing 90-day outcomes. We performed a meta-analysis of the proportion of aggregate using a random effect to estimate rates of functional independence, defined as modified Rankin Scale (mRS) score ≤2 at 90 days, mean mRS, mortality and symptomatic intracranial hemorrhage (sICH) stratified by imaging modality.

RESULTS

Four RCTs and 28 observational studies were included. The pooled proportion of functional independence among patients selected by ADVI was 44% (95% CI 39% to 48%; I2=80%) and 48% (95% CI 41% to 55%; I2=75%) with non-contrast CT/CT angiography (NCCT/CTA) (p=0.36). Mean mRS with ADVI was 2.88 (95% CI 2.36 to 3.41; I2=0.0%) and 2.79 (95% CI 2.31 to 3.27; I2=0.0%) with NCCT (p=0.79). Mortality in patients selected by ADVI was 13% (95% CI 10% to 17%; I2=81%) and 16% (95% CI 12% to 22%; I2=69%) with NCCT (p=0.29). sICH with ADVI was 4% (95% CI 3% to 7%; I2=73%) and 6% with NCCT/CTA (95% CI 4% to 8%; I2=6%, p=0.27).

CONCLUSIONS

Our study suggests that, in anterior circulation LVO, the rates of functional independence may be similar when patients are selected using ADVI or NCCT for EVT in the extended time window. A simplified triage protocol does not seem to increase mortality or sICH. PROTOCOL REGISTRATION NUMBER: (PROSPERO ID: CRD42021236092).

Primary headache disorders in Latin America and the Caribbean: A meta-analysis of population-based studies

BACKGROUND

In this manuscript, we aim to systematically estimate the pooled prevalence and incidence of primary headaches and its subtypes (migraine, tension-type headache, and chronic headaches) in Latin America and the Caribbean, describing its epidemiological profile and associated factors.

METHODS

We systematically searched PubMed/MEDLINE, Scopus, and LILACS (From conception to March 2021), for populational studies reporting the epidemiology of primary headaches and their associated factors in Latin America and the Caribbean. The data extraction was conducted independently. We performed random-effect model meta-analysis of prevalence (overall primary headaches and by subtypes) and associated factors, assessed potential sources of heterogeneity, the risk of bias, publication bias, and the evidence certainty (GRADE methodology).

RESULTS

We included 32 populational studies (38 subpopulations, n = 63,813). The prevalence of primary headaches was 41.4% (95% CI 31.1-52.2%; n = 54,357), 15% for migraine (95% CI 12.0-18.3; n = 53,658 individuals), 20.6% for tension-type headache (95% CI 12.4-30.2; n = 25,840), and 6% for chronic headaches (95% CI 3.3-9.6; n = 21,720), with high between-study heterogeneity. No incidence data was found. Female sex, white ethnicity, high BMI, comorbid mental health disorders, and low-back pain were associated with higher prevalence of primary headaches. The prevalence was less in rural areas.

CONCLUSION

In Latin America and the Caribbean, primary headaches are highly prevalent affecting young females disproportionally. The prevalence of chronic headaches is higher than in other systematic global and regional estimations. The presence of comorbidities as modifiable risk factors should encourage their integration as targets for community-based preventive and therapeutic interventions.

PROTOCOL REGISTRATION NUMBER

CRD42018105116.

Adaptation and altitude sickness: A 40-year bibliometric analysis and collaborative networks

Introduction

We analyze the scientific production and collaboration networks of studies based on adaptation and altitude diseases in the period 1980-2020.

Methods

The publications were extracted from journals indexed in Scopus. The bibliometric analysis was used to analyze the scientific production, including the number of annual publications, the documents, and the characteristics of the publications. With the VOSviewer software, the analysis of collaborative networks, productivity of the countries, as well as the analysis of the co-occurrence of keywords were visualized.

Results

15,240 documents were registered, of which 3,985 documents were analyzed. A significant trend was observed in the number of publications (R ²: 0.9847; P: < 0.001), with annual growth of 4.6%. The largest number of publications were original articles (77.8%), these published more frequently in the journal "Altitude Medicine and Biology". The largest number of countries were from Europe and Asia; however, the largest collaboration network was with the United States. Of the countries with high altitudes, China and Peru ranked first in scientific productivity. The research priorities were on the adaptation mechanism (37.1%), mainly anoxia and respiratory function. Acute mountain sickness (18.4%) and pulmonary edema (14.7%) were the most reported diseases. Of the top 10 institutions, "University of Colorado" and "Universidad Peruana Cayetano Heredia" contributed more than 100 publications.

Conclusions

Scientific production on adaptation and altitude illnesses continues to grow. The United States and United Kingdom present collaborative networks with high-altitude countries. The research is aimed at studying the mechanisms of adaptation to altitude and acute mountain sickness.

Greater occipital nerve block for chronic migraine patients: A meta-analysis

INTRODUCTION

Greater occipital nerve block (GONB) is a minimally invasive procedure frequently used in patients with chronic migraine (CM); however, the quality of the evidence supporting its use is still unknown. Therefore, we aimed to conduct a systematic review, meta-analysis and quality assessment of GONB local anaesthetics combined or not with corticosteroids to prevent CM.

METHODS

We searched Medline, Scopus and Web of Science up to October 2020. We included randomized control trials (RCT) and observational studies assessing GONB without language restrictions. Two researchers selected the studies, extracted the data and evaluated the risk of bias independently. The primary outcomes measured to assess efficacy were the change from baseline in the intensity and frequency of headache in the intervention group compared to placebo at a onetime point. We performed a meta-analysis with random effect models, and we evaluated random errors with trial sequential analysis (TSA). We assessed the risk of bias (ROB) with the ROB2 tool and the certainty of the evidence with GRADE.

RESULTS

We identified 2864 studies in the databases and included three RCTs for quantitative synthesis. Most ROB assessments were 'high risk' or 'some concerns'. GONB reduced the intensity of headaches at the end of the first month (MD: -1.35, 95% CI: -2.12 to -0.59) and the second month (MD: -2.10, CI 95%: -2.94 to -1.26) as well as the frequency of headaches (first month: MD: -4.45 days, 95% CI: -6.56 to -2.34 days; second month: MD: -5.49, 95% CI -8.94 to -2.03 days). Corticosteroids did not show a significant decrease in the frequency of headaches during the first month of treatment (MD: -1.1 days, 95% CI: -4.1 to 1.8, p = .45). Included trials reported similar adverse events between groups. The exploratory TSA showed inconclusive results. Overall, the quality of the evidence was very low because of the substantial risk of bias and imprecision.

CONCLUSION

The limited evidence available shows that GONB with local anaesthetics could reduce headache frequency and intensity compared to placebo, while adding corticosteroids did not show additional benefits. GONB was safe with a similar number of minor adverse events. However, our confidence in these estimates is very low since the evidence is based on a few trials, with a small sample size and a significant risk of bias. In addition, the exploratory TSA was inconclusive, so we need larger and specific trials.

Producción científica en insuficiencia cardiaca en Perú: un estudio bibliométrico

Objetivo:

Analizar la producción científica peruana sobre insuficiencia cardiaca (IC) en el periodo 2000-2020.

Material y métodos:

Se realizó un estudio observacional bibliométrico en la base de datos de Scopus y Scielo de documentos publicados sobre IC por algún autor con filiación peruana entre los años 2000 y 2020. Se analizaron de manera descriptiva las variables de producción científica, número de publicaciones anuales, documentos, características de las publicaciones e instituciones. Se analizaron las redes colaborativas, construyéndose una red de nodos utilizando el software VOSViewer v1.6.5.

Resultados:

Se encontró 236 publicaciones en Scopus y 55 en Scielo. El mayor número de documentos fueron artículos originales seguido de artículos de revisión. The Lancet y la Revista Peruana de Medicina Experimental y Salud Pública fueron las que tuvieron el mayor número de publicaciones. Se registraron 31 países que tuvieron al menos cinco documentos publicados con un autor del Perú. La colaboración científica fue principalmente con EE.UU. y a nivel regional con Argentina. Se publicaron 55 documentos con solo autores peruanos.

Conclusiones:

La producción científica en IC de autores peruanos se encuentra en crecimiento exponencial. Y es la Universidad Peruana Cayetano Heredia/Crónicas la institución peruana con más publicaciones sobre esta.

Drug reaction with eosinophilia and systemic symptoms (DRESS) induced by phenytoin re-exposure: case report and systematic review

Introduction: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is an adverse and severe skin reaction due to patients' susceptibility to medications, including phenytoin. The objective was to explore the characteristics of patients with DRESS secondary to phenytoin through a systematic review.Methods: We describe a case of DRESS syndrome secondary to phenytoin in a patient with previous exposure to this drug. A systematic literature review of cases of phenytoin-induced DRESS syndrome was conducted in PubMed/Medline, Scopus and Web of Science until May 2019.Results: 37 articles describing 40 cases of DRESS syndrome were selected. Mean age of onset was 33 years, without gender difference. Symptoms started between two and 90 days (mean ± 23 days). Liver and respiratory tract were most frequently involved, and eosinophilia was a common feature, it was presented with an average value of 9.7%. A discussion of the case and qualitative synthesis of the evidence reported in the literature were made.Conclusion: Patients and presentation characteristics will mostly be presented according to the criteria used by RegiSCAR. It is recommended to consider adequate monitoring of adverse reactions to antiepileptic drugs such as DRESS syndrome, given its severity and high lethality.

Systematic review of warfarin-induced skin necrosis case reports and secondary analysis of factors associated with mortality

OBJECTIVE

Warfarin-induced skin necrosis (WSN) is a rare (0.0.1%-0.1%) and severe adverse reaction. The clinical characteristics of this reaction and its mortality rate have not been explored in a large population. Therefore, we present the case of a Peruvian patient who developed WSN and perform a systematic review of case reports of WSN.

METHODS

A systematic search was performed using the Pubmed/Medline, Scopus, Web of Science and Embase databases. Patient clinical data were collected and extracted from every case report. Furthermore, we analysed the factors associated with mortality because of WSN using the Poisson regression model with robust variations, obtaining risk ratios (RR) and their respective confidence intervals (95% CI).

RESULTS

We identified 90 case reports that included a total of 111 patients with WSN (mean age 52.5 years), 20.72% of whom died of complications because of WSN. Being male (RR: 2.87; 95% CI 1.21-6.83) and having three or more affected regions (RR: 6.81; 95% CI 2.62-17.74) were associated with an increased risk of death caused by WSN.

CONCLUSION

This systematic review identified 90 case reports of WSN with three or more affected body regions. Male sex was associated with an increased risk of death. Further studies are needed to analyse and confirm these results.

Is Surfer's myelopathy an acute hyperextension-induced myelopathy? A systematic synthesis of case studies and proposed diagnostic criteria

BACKGROUND

Surfer's myelopathy is a rare complication of spinal hyperextension originally described in novice surfers. However, reports from patients practicing different activities had risen.

AIM

To systematically synthesize the epidemiological and clinical evidence on acute hyperextension-induced myelopathy ("Surfer's myelopathy") and propose new diagnostic criteria.

METHODS

We systematically searched four databases for all observational and case studies on the topic. We performed a narrative synthesis to propose diagnostic criteria and tested the criteria retrospectively on the included cases. A case report is also presented.

RESULTS

Forty-two articles reporting 104 cases (median age 19 years, slightly male predominance) were included. All cases reported a nontraumatic hyperextension event (58% after surfing). All of the cases presented pain of hyperacute onset. The most frequent clinical feature was bladder or bowel dysfunction (84%). The thoracic region was the most frequently affected (87%) with longitudinal involvement until the conus (67%). At discharge or follow-up, 52% partially recovered. We propose five diagnostic criteria with three levels of certainty (definite, probable, and possible): (1) nontraumatic spine hyperextension activity (in individuals with no pre-existent spinal disease); (2) hyperacute onset (with acute pain onset); (3) spinal cord injury clinic (motor, sensory, or autonomic deficit); (4) MRI findings with central spinal cord abnormalities (multiple segments); and (5) no other alternative diagnosis. We identified 88% definite and 12% probable/possible cases.

CONCLUSION

The acute hyperextension-induced myelopathy could occur not only during surfing but also during other activities. Therefore, increased awareness and education among sports communities and general physicians are needed.

Costs Related to Frontotemporal Dementia in Latin America: A Scoping Review of Economic Health Studies

Introduction: Frontotemporal dementia (FTD) is a complex syndrome characterized by changes in behavior, language, executive control, and motor symptoms. Its annual economic burden per patient in developed countries has been classified as considerable, amounting to US$119,654 per patient, almost double the patient costs reported for Alzheimer's disease. However, there is little information regarding cost-of-illness (COI) for FTD in Latin-America (LA). Aim: To describe the costs related to FTD in LA. Methods: We included COI studies on FTD conducted in LA published in English, Spanish, or Portuguese from inception to September 2020. We carried out a systematic search in Pubmed/Medline, Scopus, Web of Science, Scielo, Cochrane, and gray literature. For quality assessment, we used a COI assessment tool available in the literature. All costs were reported in USD for 1 year and adjusted for inflation. Results: We included three studies from Argentina, Brazil, and Peru. Direct costs (DCs) included medication (from US$959.20 to US$ 4,279.20), health care costs (from US$ 2,275.80 to US$7,856.16), and caregiver costs (from US$9,634.00 to US$28,730.28). Indirect costs (ICs) amounted to US$43,076.88. Conclusions: In LA countries, the reporting of costs related to FTD continues to be oriented toward DCs. They remain lower than in developed countries, possibly due to the limited health budget allocated. Only one Brazilian report analyzed ICs, representing the highest percentage of the total costs. Therefore, studies on the COI of this disease in LA are essential, focusing on both out-of-pocket spending and the potential economic loss to patients' homes and families.

Scoping Review of Clinical Practice Guidelines for the Early Management of Stroke with Focus on Endovascular Treatment

BACKGROUND

Stroke represents one of the major causes of death and long-term disability worldwide and, even when new treatment strategies have been identified, there is a need of quality clinical practice guidelines (CPGs) to guide and improve acute stroke care. We aim to describe the characteristics and assess the quality of CPGs in endovascular treatment for acute ischemic stroke due to anterior-circulation large-vessel occlusion.

METHODS

We conducted a scoping review of CPGs that assessed stroke management. We searched the following databases: PubMed, TripDatabase, Scopus, and Google Scholar to identify CPGs published or updated in the last 3 years and used Appraisal of Guidelines Research and Evaluation II to assess the quality of the guidelines.

RESULTS

We found a total of 9 CPGs published or updated between 2018 and 2020, from which only one third had adequate methodologic rigor. Guidelines presented pitfalls related to evidence search, assessment, and methods used to reach the recommendations. All the CPGs considered a 24-hour extended window of treatment and the CPGs considered the use of similar imaging techniques to diagnose and explore the extent of the stroke. However, there were variations regarding the selection criteria for thrombectomy.

CONCLUSIONS

The quality of the CPGs varied widely, which issues around the identification and assessment of the evidence used to reach recommendations. Despite this, the recommendations regarding the use of thrombectomy were similar across the CPGs. Readers need to carefully assess the methodologic rigor of CPGs before applying them to their clinical practice.

Prevalence and incidence of epilepsy in Latin America and the Caribbean: A systematic review and meta-analysis of population-based studies

OBJECTIVE

This study was undertaken to perform an updated systematic review and meta-analysis to estimate the pooled prevalence and incidence of epilepsy in Latin America and the Caribbean (LAC), describing trends over time, and exploring potential clinical and epidemiological factors explaining the heterogeneity in the region.

METHODS

Observational studies assessing the incidence or prevalence of epilepsy in LAC countries up to March 2020 were systematically reviewed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Meta-analyses and cumulative analyses were performed using random-effects models. We assessed between-study heterogeneity with sensitivity, subgroup, and meta-regression analyses. Moreover, the quality of the included studies and the certainty of evidence were evaluated using the GRADE (grading of recommendation, assessment, development, and evaluation) approach.

RESULTS

Overall, 40 studies (from 42 records) were included, 37 for prevalence analyses and six for incidence (312 387 inhabitants; 410 178 person-years). The lifetime prevalence was 14.09 per 1000 inhabitants (95% confidence interval [CI] = 11.72-16.67), for active epilepsy prevalence was 9.06 per 1000 individuals (95% CI = 6.94-11.44), and the incidence rate was 1.11 per 1000 person-years (95% CI = .65-1.70). These high estimates have been constant in the region since 1990. However, substantial statistical heterogeneity between studies and publication bias were found. The overall certainty of evidence was low. Methodological aspects (sample size) and countries' epidemiological characteristics such as access to sanitation services and child and adult mortality rates explained the high heterogeneity. Finally, the prevalence of epilepsy associated with neurocysticercosis (NCC) in the general population was high, and the proportion of NCC diagnosis among people living with epilepsy was 17.37%.

SIGNIFICANCE

The epilepsy prevalence and incidence in LAC are higher than worldwide estimates, being constant since 1990 and strongly influenced by NCC. We identified high between-study heterogeneity and significant methodological limitations (e.g., heterogeneous definitions, lack of longitudinal studies). The region needs upgraded research using standardized definitions and diagnostic methods, and urgent action against preventable causes.

Latin American Research on Bariatric Surgery: a Bibliometric Study

We performed a bibliometric analysis of Latin American documents published between 1984 to 2019 in Scopus-indexed journals. A total of 1856 documents were analyzed. The annual scientific production was 64 documents per year, with an annual increase rate of 15.9%. The countries with the highest scientific production on BS were Brazil (64.7%) and Chile (14.5%). Most of the publications were original (76.6%) and review articles (11.9%). The journal with the highest publication record was "Obesity Surgery" (25.8%). The extra-regional collaboration was mainly with the USA. In conclusion, Latin American scientific production on BS has shown a significant increase in recent years. However, more participation is needed, fostering intra-regional collaboration and involving universities and health institutions in BS research.

Atypical lymphangioma and hyperkeratosis in a patient with morbid obesity

Lymphangioma is a rare and understudied pathology that is usually detected in the first decade of life, and its appearance in adults is rare. This report details a 51-year-old man with morbid obesity who presented, for the last eight months, multiple asymmetric tumor lesions with extension to the scrotal region. The diagnosis of circumscribed lymphangioma with associated infection was confirmed. This case report demonstrates an unusual presentation of the characteristics of the lymphangioma that are seldom described in the literature.

[Poverty and its influence on risk and family damage in a district of Lima, Peru: results by sector analysis and Primary Health Care]

OBJECTIVE

Poverty generates negative effects on health, education, and family environment. Sectoral analysis through its components enables to identify the risk groups and damage in the families. The objective of this work is to determine the state of poverty and its influence on the risk and family damage in the district of Villa Maria del Triunfo (VMT), Lima, Peru.

MATERIALS AND METHODS

Ecological study that used the database of the health facility of the VMT district, in which the family risk and the socioeconomic level of 450 families in 7 sectors are evaluated between the years 2015 to June 2017.

RESULTS

More than three-quarters of the families are poor (77.9%). The most prevalent damages were malnutrition and mental health. The most frequent family risk factors were family violence, with the absence of breastfeeding in infants, adolescent pregnancy, and old age. It was found that poverty was associated with family risk (P=.019, OR: 1.84, 95% CI: 1.07-3.23), and damage risk (P<.001, OR: 2.29; 95% CI: 1.32-3.92).

CONCLUSION

The level of poverty is high. This condition was associated with increased risk and family damage, especially for malnutrition and mental health problems. Interventions should be carried out in families, especially among the poor, and decisive measures should be made on the social factors determining ill-health.

Factors associated with depression in patients with Parkinson's disease A multicenter study in Lima, Peru

The diagnosis and treatment of depression in patients with Parkinson's disease (PD) is inadequate, often contributing to a reduced quality of life, rapid disease progression, higher cognitive impairment, and an increased burden of care for family members of patients with PD.

OBJECTIVE

To determine the factors associated with depression in PD and to examine the frequency of depressive symptoms among patients with PD.

METHODS

This study was an observational, analytical, multicenter study of a cross-sectional cohort, conducted between July 2016 and May 2017. PD patients were recruited from neurology clinics in Lima, Peru. All statistical analyses were performed using descriptive statistics. Bivariate and multivariate logistic regression analyses were calculated using STATA.

RESULTS

Out of 124 patients (average age: 68.7 years; 58% males) included in the study 60.5% (75/124) presented with symptoms of depression; only 20% (25/124) received antidepressants. Factors associated with depression in PD included: unemployment, falls, freezing of gait, involuntary movements micrographia, stooped posture, hyposmia, movement disorders in sleep, rapid disease progression, and the use of MAOIs. Furthermore, statistically significant differences were found in disease duration, UPDRS and MMSE scores, Hoehn and Yahr (HY) stage, and length of time taking L-dopa between PD patients with and without depressive symptoms.

CONCLUSION

Factors associated with depressive symptoms in patients with PD were hyposmia, rapid progression of the disease, the use of L-dopa, and use of MAOIs. The frequency of depressive symptoms in patients with PD is high; early diagnosis and prompt treatment are needed to improve their quality of life and the family environment.

[Cavernoma complicated with biliopatia secondary to type 1 Gaucher disease: report of a Peruvian case]

Gaucher disease is an autosomal recessive lysosomal storage disorder characterized by deficiency of beta-glucosidase that would lead to the accumulation of glucosylceramide mainly in cells of the mononuclear phagocytic system causing systemic effectations. We present a patient of twenty years who is suffering from chronic pain in the left hypochondrium with episodes of bleeding for 3 years and sensation of thermal rise, physical examination revealed jaundice and massive splenomegaly, without neurological involvement. Severe osteoporosis, pancytopenia, and the presence of portal vein thrombosis with cavernomatous transformation complicated by portal biliopathy simulating a klatskin tumor, marrow and enzymatic studies were compatible with Gaucher disease, were shown as unexpected findings. he received treatment with imiglucerase, following up. It is a rare case, of great interest, heterogeneity in its clinical manifestations and unpublished by its complication, constituting a challenge to reach its diagnosis of this orphan disease.