Diaz Reyes, Nelson Fidel

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Diaz Reyes, Nelson Fidel
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fideldiaz@upeu.edu.pe
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    Acute appendicitis in intestinal malrotation. Case report.
    (2020-09-11)
    Richard Jeremy Febres-Ramos
    ;
    Nelson Diaz  
    Intestinal malrotation is a congenital abnormality of the embryological rotation of the intestine, it is estimated that more than 90% of patients with intestinal malrotation will be presented in the first 12 months of life. The clinical presentation in adults is manifested in a progressive way that usually occurs during the postprandial period, presenting: intermittent vomiting, abdominal pain, weight loss, chronic diarrhea, peritonitis, food intolerance, among Another. Treatment will depend on presentation, either acute or chronic, requiring emergency laparotomy to determine the cause. There is a case of acute surgical abdomen for acute appendicitis in a 27-year-old patient with intestinal malrotation, with initial clinical presentation of severe abdominal pain, diarrhea, positive lumbar percussion fist, which finally reached a Proper resolution and a good prognosis.
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    Opsoclonus-Myoclonus Syndrome Possibly Associated With Mumps Infection
    (2022-10-01)
    Ana Laura Salazar
    ;
    Takaaki Kobayashi
    ;
    Andrea S. Salcedo
    ;
    Xossé Carreras
    ;
    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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    [Recent traumatic lesions in cases of family violence].
    (2012-03)
    Pacheco, José  
    ;
    Díaz, Noelia
    ;
    de La Cruz, Nancy
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    Conservative Treatment of HAV‐Associated Acalculous Acute Cholecystitis in an Adult: A Case Report
    (2025-01-01)
    Sebastian A. Medina-Ramírez
    ;
    Camila A. Arones-Santayana
    ;
    Eduardo Carcausto
    ;
    Nelson Diaz  
    Hepatitis A virus (HAV) is a viral infection that can present with a wide range of clinical manifestations, including rare complications such as acute acalculous cholecystitis (AAC). We present the case of a 31-year-old woman who arrived at the emergency department with severe epigastric pain, fever, early satiety, nausea, and vomiting. Physical examination revealed a positive Murphy's sign, hepatomegaly, and epigastric tenderness, suggesting obstructive acute cholecystitis. Imaging studies showed reactive changes in the gallbladder and mild dilation of the intrahepatic bile ducts. Laboratory tests indicated elevated bilirubin levels and a cholestatic pattern with markedly increased transaminases. Magnetic resonance cholangiopancreatography confirmed AAC and ruled out biliary obstruction. Positive serology for Hepatitis A led to the definitive diagnosis of AAC secondary to Hepatitis A. Treatment focused on supportive care with intravenous hydration and symptomatic management, avoiding antibiotics due to the self-limiting nature of the viral infection. The patient showed a favorable clinical course, with a progressive decrease in gallbladder diameter and normalization of liver parameters. This case highlights the importance of considering rare viral infections as a cause of AAC and demonstrates that a conservative approach can be effective in managing this condition. This case underscores the importance of considering viral etiologies, particularly HAV, in the differential diagnosis of AAC in adults. It further demonstrates that, in carefully selected patients, conservative management can be both safe and effective, thereby avoiding unnecessary antibiotic use or surgical intervention in the context of a self-limiting viral infection.
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    Suicides among adults in Paraguay: An 18-year national exploratory study (2004–2022)
    (2023-04-27)
    Júlio Torales  
    ;
    Iván Barrios
    ;
    Osvaldo Melgarejo
    ;
    Juan Edgar Tullo-Gómez
    ;
    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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    Rhino-Orbital-Cerebral Mucormycosis in a Post-COVID-19 Patient from Peru
    (2022-03-15)
    Linda Ponce-Rosas
    ;
    Jose Armando Gonzales Zamora
    ;
    Nelson Diaz  
    ;
    Oliver Alarco-Cadillo
    ;
    Jorge Alave  
    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.
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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
    ;
    Andrea S. Salcedo
    ;
    Linda Ponce-Rosas
    ;
    Jose Armando Gonzales Zamora
    ;
    Nelson Diaz  
    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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    Natural Killer T (NKT) Cells and Periodontitis: Potential Regulatory Role of NKT10 Cells
    (2021-01-01)
    Samanta Melgar‐Rodríguez  
    ;
    Emilio A. Cafferata
    ;
    Nicolás Díaz
    ;
    M.A. Peña
    ;
    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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    Case Report: Neurobrucellosis Presenting as Malignancy
    (2024-06-11)
    Andrea S. Salcedo
    ;
    Xossé Carreras
    ;
    Takaaki Kobayashi
    ;
    Jorge Salinas
    ;
    Sara Muñoz
    Neurobrucellosis, caused by Brucella species, is a zoonotic infection that may involve the central nervous system. Although uncommon, it can manifest as a solitary intracranial mass. We report a case of neurobrucellosis in a 25-year-old woman from Peru who presented with headache, weight loss, and right-side hemiparesis and paresthesia. A contrast-enhanced magnetic resonance imaging scan revealed an intracerebral mass in the left temporal lobe. Serum testing subsequently were positive. Brain biopsy demonstrated non-necrotizing granulomas without malignant cells. Neurobrucellosis should be considered in the differential diagnosis of brain space occupying lesions in endemic countries.
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