Diaz Reyes, Nelson Fidel

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fideldiaz@upeu.edu.pe

ORCID

0000-0002-7833-2852

Scopus Author ID

57651853900

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Data Resource Profile: Harmonized health survey data for 240 cities across 11 countries in Latin America: the SALURBAL project
(2024-12-16)
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Mariana Lazo
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Ana Ortigoza
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D. Alex Quistberg
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Brisa N. Sánchez
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Tuberculosis presenting with necrotic retroperitoneal lymphadenopathy in an immunocompetent patient: A case report and literature review
(2025-12-07)
Andrea S. Salcedo
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Xossé Carreras
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Takaaki Kobayashi
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Background: Extrapulmonary tuberculosis (EPTB) accounts for 15-20 % of TB, but necrotic retroperitoneal lymphadenopathy is exceptionally rare, particularly in immunocompetent hosts. Case presentation: . Chest CT demonstrated additional necrotic mediastinal nodes without parenchymal disease. Standard therapy (2HRZE/4HR) was initiated; due to partial radiologic response at six months, isoniazid-rifampicin was extended to complete ten months, achieving full clinical and imaging resolution. Literature review: A structured search identified seven additional immunocompetent adults with necrotic retroperitoneal lymphadenopathy. Abdominal pain predominated; CT consistently showed multiple necrotic nodes. Final diagnoses were tuberculosis (3/7), high-grade B-cell lymphoma (2/7), Kikuchi-Fujimoto disease (1/7), and metastatic esophageal carcinoma (1/7). All cases required tissue confirmation. Conclusions: Necrotic retroperitoneal lymphadenopathy is an uncommon manifestation of TB that can mimic malignancy. In patients from TB-endemic settings, TB should remain high in the differential when CT demonstrates necrotic retroperitoneal nodes. Early image-guided biopsy with mycobacterial testing is decisive. Drug-susceptible disease generally responds to standard six-month therapy, although extended treatment may be warranted for delayed radiologic response.
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Opsoclonus-Myoclonus Syndrome Possibly Associated With Mumps Infection
(2022-10-01)
Ana Laura Salazar
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Takaaki Kobayashi
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Andrea S. Salcedo
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Xossé Carreras
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Jorge Salinas
Opsoclonus-myoclonus syndrome (OMS) is an infrequent yet serious neurologic entity related to neoplastic, infectious, toxic, and metabolic diseases. In recent years, OMS associated with multiple infections have been reported. In contrast to neoplastic and autoimmune etiologies, OMS from infectious diseases occurs in younger patients and has a favorable outcome. Though the data are limited, the use of corticosteroids and immunotherapy remain the treatments of choice for the management of OMS symptoms. We present a patient case of OMS possibility associated with mumps virus in an immunocompetent young adult who was successfully treated with steroids.
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Super refractory status epilepticus as an atypical presentation of Hashimoto’s encephalopathy
(2026-03-16)
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Fred Fernández
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Luciana Chacon Hermoza
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Danny M. Barrientos-Iman
Hashimoto's encephalopathy (HE), also known as steroid responsive encephalopathy associated with autoimmune thyroiditis (SREAT), is a rare autoimmune disorder characterized by neuropsychiatric manifestations and a favorable response to corticosteroids. Seizures occur in nearly half of patients; however, super refractory status epilepticus (SRSE) is an uncommon initial presentation. We describe a young adult woman with Hashimoto's thyroiditis who developed SRSE after a brief prodrome of headache, confusion, and paranoia. Extensive infectious, metabolic, and autoimmune workup was negative, but anti-thyroid peroxidase and anti-thyroglobulin antibodies were markedly elevated. Brain MRI showed nonspecific subcortical T2/FLAIR hyperintensities. The patient was diagnosed with HE and treated with high dose intravenous methylprednisolone followed by intravenous immunoglobulin, resulting in full neurological recovery and sustained seizure freedom at three-month follow up. This case illustrates the importance of considering HE in patients with unexplained SRSE, as prompt recognition and immunotherapy can be lifesaving.
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Cardiac hydatidosis mimicking ischemic heart disease: A case report
(2026-01-01)
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Cherie Quiroz Cortegana
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Luis Iván Gordillo Velásquez
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Jaime Cáceres Pizarro
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, is a zoonotic disease with cardiac involvement reported in less than 2 % of cases but associated with significant clinical challenges. We describe a 44-year-old woman from Peru who presented with exertional chest pain and T-wave inversions on electrocardiography. Imaging revealed a large multiloculated cystic mass with peripheral calcifications in the left ventricular wall, and Western Blot serology confirmed CE. The patient underwent surgical excision under cardiopulmonary bypass, followed by albendazole therapy. Histopathology confirmed a non-viable hydatid cyst. Postoperative recovery was uneventful, and she remained asymptomatic at 16-month follow-up. This case underscores the importance of considering cardiac hydatidosis in endemic regions when evaluating patients with angina-like symptoms in the presence of a cystic cardiac mass on imaging. Public awareness, improved medical education, and ongoing research are crucial to better managing this condition.
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Lemierre-like syndrome after soft tissue infection due to methicillin-resistant Staphylococcus aureus: A case report and literature review
(2024-02-16)
Xossé Carreras
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Andrea S. Salcedo
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Linda Ponce-Rosas
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Jose Armando Gonzales Zamora
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RATIONALE: Lemierre-like syndrome (LLS) is characterized by bacteremia, septic thrombophlebitis of the internal jugular vein, and metastatic abscesses. In contrast to classic Lemierre syndrome, sources of infection are not related to oropharyngeal infections, as are frequent soft tissue infections. In recent years, Staphylococcus aureus has been identified as an emergent pathogen that causes this syndrome. The mortality rate of LLS caused by this pathogen is approximately 16%. Timely diagnosis, antibiotic treatment, and infection control are the cornerstones to treat LLS. Anticoagulant therapy as adjuvant treatment remains controversial. PATIENT CONCERNS: A 31-year-old woman from California, United States (US), was admitted to the emergency room with a history of 2 days of fever and severe throbbing pain in the left cervical region. Thorax and neck CT tomography revealed confluent cavities suggestive of septic embolism in the lungs and a filiform thrombus in the lumen of the left internal jugular vein, with moderate swelling of the soft and muscular tissues. Methicillin-resistant Staphylococcus aureus (MRSA) was isolated from the blood culture. DIAGNOSIS: The thrombus in the internal jugular vein associated with cellulitis in the neck and multiple cavitary lesions in the lungs support the diagnosis of LLS caused by MRSA with septic embolization. INTERVENTIONS: During treatment, the patient received vancomycin IV for 25 days and returned to the US with linezolid orally. In addition, assisted video-thoracoscopy and bilateral mini-thoracotomy with pleural decortication were performed for infectious source control, where 1700cc of purulent pleural fluid was drained. OUTCOMES: The patient was discharged with optimal evolution. LESSONS: LLS should be suspected in patients with skin and soft tissue infections who develop thrombosis or metastatic infections. MRSA infections should be considered in patients from areas where this pathogen is prevalent.
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Opsoclonus-Myoclonus Syndrome Possibly Associated with Mumps Infection
(2022-01-01)
Ana Laura Salazar
;
Takaaki Kobayashi
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Andrea S. Salcedo
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Xossé Carreras
;
Jorge Salinas
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Suicides among adults in Paraguay: An 18-year national exploratory study (2004–2022)
(2023-04-27)
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Iván Barrios
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Osvaldo Melgarejo
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Juan Edgar Tullo-Gómez
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Noelia Ruíz Diáz
BACKGROUND: The number of suicides has been increasing worldwide, year after year, becoming the fourth leading cause of death among young people between 15 and 29 years of age. AIM: In this study, we explored the frequency and characteristics of suicides among the adult general population in Paraguay between 2004 and 2022, considering that suicide attempts and suicidal risk/ideation are frequent and relevant issues in the consultation activity, even if epidemiological evidence on the national rates of suicide is scarce. METHODS: In this observational, descriptive, and exploratory study, official records of all deaths by suicide were reviewed and information analyzed. In addition, an attempt was made to predict the number of suicides in the next 5 years according to a mathematical modeling. RESULTS: In the 18-year period, 5,527 suicides of adults were recorded. Patients' mean age was 36.8 ± 17 years old. A 76.77% of them were males, 77.44% were from an urban area and 25.98% from the Greater Asunción and Central Department of Paraguay. The most frequently used method of suicide was intentional self-inflicted injury by hanging, strangulation, or suffocation (all 67.6%). The expected number of national suicides in the following years from 2023 to 2027 will range between 462 and 530. Limitations include the lack of information regarding diagnoses and personal history in the suicide reports as well as the possibility of underreporting of national suicide cases. CONCLUSION: Our results represent the first large national epidemiological report of suicides in Paraguay and may be of interest for mental health professionals and health authorities in order to reduce the suicide mortality rate within the country.
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Natural Killer T (NKT) Cells and Periodontitis: Potential Regulatory Role of NKT10 Cells
(2021-01-01)
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Emilio A. Cafferata
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Nicolás Díaz
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M.A. Peña
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Luis González
Natural killer T (NKT) cells constitute a unique subset of T lymphocytes characterized by specifically interacting with antigenic glycolipids conjugated to the CD1d receptor on antigen-presenting cells. Functionally, NKT cells are capable of performing either effector or suppressor immune responses, depending on their production of proinflammatory or anti-inflammatory cytokines, respectively. Effector NKT cells are subdivided into three subsets, termed NKT1, NKT2, and NKT17, based on the cytokines they produce and their similarity to the cytokine profile produced by Th1, Th2, and Th17 lymphocytes, respectively. Recently, a new subgroup of NKT cells termed NKT10 has been described, which cooperates and interacts with other immune cells to promote immunoregulatory responses. Although the tissue-specific functions of NKT cells have not been fully elucidated, their activity has been associated with the pathogenesis of different inflammatory diseases with immunopathogenic similarities to periodontitis, including osteolytic pathologies such as rheumatoid arthritis and osteoporosis. In the present review, we revise and discuss the pathogenic characteristics of NKT cells in these diseases and their role in the pathogenesis of periodontitis; particularly, we analyze the potential regulatory role of the IL-10-producing NKT10 cells.
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Rhino-Orbital-Cerebral Mucormycosis in a Post-COVID-19 Patient from Peru
(2022-03-15)
Linda Ponce-Rosas
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Jose Armando Gonzales Zamora
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Oliver Alarco-Cadillo
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Mucormycosis has been reported increasingly in patients affected by COVID-19, especially in India where the first cases were described. In Latin America, there is limited information about this association, mainly coming from Brazil, Mexico, and Peru. Herein, we report the case of a 66-year-old female that presented with rhino-orbital-cerebral mucormycosis, diabetic ketoacidosis, and COVID-19. The patient had the compromise of all the sinuses, orbital invasion, and intracranial extension. Isavuconazole was promptly initiated because amphotericin B was not available. She had a single open surgical debridement of necrotic tissues at the beginning of the diagnosis then multiple manual sessions to clear the residual or recurrent disease during approximately 5 months. Isavuconazole was effective and well-tolerated for 10 months without side effects. We highlight the importance of considering mucormycosis in post-COVID-19 patients with uncontrolled diabetes. The report emphasizes the favorable outcome of isavuconazole as an alternative therapy.

Diaz Reyes, Nelson Fidel

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