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Meningoencephalitis due to Listeria monocytogenes in a Young Immunocompetent Patient: Case Report with Literature Review

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Advances in Infectious Diseases 2024年第1期14卷 213-219页

作者： Janette Alejandra Gamiño Gutierrez Gustavo Adolfo Hernández Valdez Arleth Anahí Montaño Gómez Jorge Morales Rojas Graciela Gaddy Robles Martinez Anahi Herrera Ruelas Alin Kaori Ferreyra Gudiño Jocelin Celeste Jurado Cardona Jimena Jexabeth Ibáñez Núñez Anahí Fierros Ramos Departmento de Neurocirugia Hospital Civil de Guadalajara Fray Antonio Alcalde Guadalajara México Departamento de Medicina Interna ISSSTE Tepic General Hospital APP Tepic México

Meningoencephalitis secondary to Listeria monocytogenes (L. monocytogenes) mainly affects newborns, the elderly and immunocompromised people;there are extremely rare cases in which said infection occurs in immunocompetent individuals. We present the case of a young adult patient without immunocompromise, who developed meningoencephalitis due to L. monocytogenes;This case is exceptional, since it occurred in an individual outside the classic age group, in addition to not having risk factors, which is why it should be considered an atypical causal agent.

关键词： Meningitis Encephalitis Rhombencephalitis Listeria monocytogenes Immunocompetent

Portal Venous Thrombosis and Splenic Hemangioma, Secondary to Acute Pancreatitis: Case Report

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Open Journal of Gastroenterology 2024年第1期14卷 11-17页

作者： Gustavo Adolfo Hernández Valdez Harvey Yair Zamora Veliz Estefany Gilberty Mendoza Verdin Quitzia Mayanim Rentería Fonseca Itzel Velázquez Viniegra Janette Alejandra Gamiño Gutierrez Diana Rita Velázquez Jimenez Florencio Favian Andrade Luis Fernando Baez Bustos Jorge Morales Rojas María Jacqueline Martínez Tejeda Graciela Gaddy Robles Martínez Juan antonio Contreras Escamilla Departamento de Medicina Interna ISSSTE Tepic General Hospital APP Tepic Nayarit México General Surgery Department ISSSTE Tepic General Hospital APP Tepic Nayarit México hospital civil fray antonio alcalde Guadalajara Jalisco México

We present an unusual case of portal vein thrombosis with a splanchnic hemangioma secondary to acute biliary pancreatitis. We report a 45-year-old patient, who has systemic arterial hypertension in treatment, was admitted for abdominal pain in the epigastrium, with irradiation to the right hypochondrium, accompanied by nausea and vomiting of 10 occasions of bile content, physical examination with pain in the right hypochondrium, Murphy positive. We have laboratory studies with a lipase of 788, so a diagnosis of pancreatitis is made with an etiology to be determined. The laboratories suggestive of acute biliary pancreatitis (lipase 788.71);an imaging study was subsequently performed (ultrasonography) with the result of stone in the common bile duct. A laparoscopy was performed with relative improvement, so he was discharged and returned 20 days after surgery due to abdominal pain of the same intensity in the left hypochondrium. Ending his hospitalization with a splenectomy for splenic hemangioma with portal vein thrombosis.

关键词： Pancreatitis Esplenic Hemangioma Esplenectomy Portal Vein Thrombosis Surgery

Pancreatic cancer,autoimmune or chronic pancreatitis,beyond tissue diagnosis:Collateral imaging and clinical characteristics may differentiate them

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World Journal of Gastrointestinal Oncology 2023年第6期15卷 925-942页

作者： Ana I Tornel-Avelar Jose antonio Velarde Ruiz-Velasco Mario Pelaez-Luna Department of Gastroenterology Hospital Civil of Guadalajara“Fray Antonio Alcalde”Guadalajara 44340JaliscoMexico Research Division School of Medicine/Department of Gastroenterology Universidad Nacional Autonoma de México/National Institute of Medical Sciences and Nutrition“Salvador Zubiran”Tlalpan 14000Mexico CityMexico

Pancreatic ductal adenocarcinoma(PDAC)is one of the most lethal malignancies and is developing into the 2nd leading cause of cancer-related death.Often,the clinical and radiological presentation of PDAC may be mirrored by other inflammatory pancreatic masses,such as autoimmune pancreatitis(AIP)and massforming chronic pancreatitis(MFCP),making its diagnosis challenging.Differentiating AIP and MFCP from PDAC is vital due to significant therapeutic and prognostic implications.Current diagnostic criteria and tools allow the precise differentiation of benign from malignant masses;however,the diagnostic accuracy is imperfect.Major pancreatic resections have been performed in AIP cases under initial suspicion of PDAC after a diagnostic approach failed to provide an accurate diagnosis.It is not unusual that after a thorough diagnostic evaluation,the clinician is confronted with a pancreatic mass with uncertain diagnosis.In those cases,a re-evaluation must be entertained,preferably by an experienced multispecialty team including radiologists,pathologists,gastroenterologists,and surgeons,looking for disease-specific clinical,imaging,and histological hallmarks or collateral evidence that could favor a specific diagnosis.Our aim is to describe current diagnostic limitations that hinder our ability to reach an accurate diagnosis among AIP,PDAC,and MFCP and to highlight those disease-specific clinical,radiological,serological,and histological characteristics that could support the presence of any of these three disorders when facing a pancreatic mass with uncertain diagnosis after an initial diagnostic approach has been unsuccessful.

关键词： Pancreas cancer Chronic pancreatitis Autoimmune pancreatitis Pancreas mass Endoscopic ultrasound Diagnosis

High Frequency of Antiviral Resistance Mutations in HBV Genotypes A2 and H: Multidrug Resistance Strains in Mexico

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Journal of Clinical and Translational Hepatology 2023年第5期11卷 1023-1034页

作者： Alexis Jose-Abrego Sonia Roman João Renato Rebello Pinho Michele Soares Gomes-Gouvêa Arturo Panduro Department of Genomic Medicine in Hepatology Civil Hospital of Guadalajara“Fray Antonio Alcalde”GuadalajaraJaliscoMexico Health Sciences Center University of GuadalajaraGuadalajaraJaliscoMexico LIM07 Department of GastroenterologyUniversity of São PauloSão PauloBrazil hospital Israelita Albert Einstein São PauloBrazil

Background and Aims:Lamivudine(3TC),telbivudine(LdT),entecavir(ETV),adefovir(ADF),and tenofovir(TFV)are drugs used to treat hepatitis B virus(HBV)infection,but specific mutations allow some viruses to become resistant to antiviral drugs or to acquire immune escape capacities.These mutations have not been thoroughly investigated in Mexico.This study aimed to estimate the prevalence of HBV antiviral resistance and escape mutations.Methods:This cross-sectional study analyzed 158 samples.HBV DNA was extracted,amplified,and sequenced in serum samples using the spin column method,PCR assay,and Sanger’s sequencing,respectively.HBV genotypes were determined,and HBV mutations were tested using the Geno2pheno tool.Results:Overall,68.4%(108/158)of HBV patients were infected with genotype H,followed by G(11.4%,18/158),A2(10.8%,17/158),F1b(6.9.0%,11/158),D(1.9%,3/158),and E(0.6%,1/158),and 5.1%(8/158)had evidence of recombination.The prevalence of resistance mutations was 8.2%(13/158)and the most common combined mutation was rt180M+rt204V.Notably,we found the combinations rt180M+rt204V+rt173L(n=2)and rt180M+rt204V+rt202G(n=1)that confer multidrug resistance to 3TC,LdT,and ETV.Resistance mutations were found in genotypes A2(11.8%,2/17),and H(10.2%,11/108),and escape mutations were detected in HBV genotypes A2(11.8%,2/17),H(10.2%,11/108),F1b(9.1%,1/11)and G(5.6%,1/18).Conclusions:The highest prevalence of antiviral resistance mutations or escape mutations was detected in HBV genotypes A2 and H.The earliest cases of HBV multidrug resistance were detected in Mexico.

关键词： Hepatitis B virus Drug resistance mutations Multidrug resistance strain Immune escape

Genes, emotions and gut microbiota:The next frontier for the gastroenterologist

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World Journal of Gastroenterology 2017年第17期23卷 3030-3042页

作者： Arturo Panduro Ingrid Rivera-Iniguez Maricruz Sepulveda-Villegas Sonia Roman Department of Molecular Biology in Medicine Civil Hospital of Guadalajara“Fray Antonio Alcalde” Health Sciences Center University of Guadalajara

Most medical specialties including the field of gastroenterology are mainly aimed at treating diseases rather than preventing them. Genomic medicine studies the health/disease process based on the interaction of the human genes with the environment. The gastrointestinal(GI) system is an ideal model to analyze the interaction between our genes, emotions and the gut microbiota. Based on the current knowledge, this mini-review aims to provide an integrated synopsis of this interaction to achieve a better understanding of the GI disorders related to bad eating habits and stress-related disease. Since human beings are the result of an evolutionary process, many biological processes such as instincts, emotions and behavior are interconnected to guarantee survival. Nourishment is a physiological need triggered by the instinct of survival to satisfy the body's energy demands. The brain-gut axis comprises a tightly connected neuralneuroendocrine circuitry between the hunger-satiety center, the dopaminergic reward system involved in the pleasure of eating and the gut microbiota that regulates which food we eat and emotions. However, genetic variations and the consumption of high-sugar and high-fat diets have overridden this energy/pleasure neurocircuitry to the point of addiction of several foodstuffs. Consequently, a gut dysbiosis generates inflammation and a negative emotional state may lead to chronic diseases. Balancing this altered processes to regain health may involve personalized-medicine and genome-based strategies. Thus, an integrated approach based on the understanding of the gene-emotions-gut microbiota interaction is the next frontier that awaits the gastroenterologist to prevent and treat GI disorders associated with obesity and negative emotions.

关键词：基因情感大脑报酬系统内脏 microbiota 胃肠的疾病个性化的药基于染色体的营养 Nutrigenetics 食物决策肥胖

Hepatitis C virus clearance and less liver damage in patients with high cholesterol, low-density lipoprotein cholesterol and APOE ε4 allele

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World Journal of Gastroenterology 2019年第38期25卷 5826-5837页

作者： Karina Gonzalez-Aldaco Sonia Roman Rafael Torres-Valadez Claudia Ojeda-Granados Luis A Torres-Reyes Arturo Panduro Department of Molecular Biology in Medicine Civil Hospital of Guadalajara "Fray Antonio Alcalde" and Health Sciences Center University of Guadalajara

BACKGROUND Cholesterol is related to improvements in the rate of sustained virological response and a robust immune response against the hepatitis C virus(HCV).APOE gene polymorphisms regulate cholesterol levels modifying the course of the HCV infection.The relationship between cholesterol,APOE alleles,and the outcome of HCV infection has not been evaluated in the admixed population of Mexico.AIM To investigate the role of APOE-ε2,-ε3,and-ε4 alleles and the metabolic profile in the outcome of HCV infection.METHODS A total of 299 treatment-na?ve HCV patients were included in this retrospective study.Patients were stratified in chronic hepatitis C(CHC)(n=206)and spontaneous clearance(SC)(n=93).A clinical record was registered.Biochemical tests were assessed by dry chemistry assay.APOE genotypes were determined using a Real-Time polymerase chain reaction assay.RESULTS Total cholesterol,low-density lipoprotein cholesterol(LDL-c),triglycerides,and hypercholesterolemia were higher in SC than CHC patients as well as the frequency of the APOEε4 allele(12.4%vs 7.3%).SC patients were overweight(54.8%).Theε4 allele was associated with SC(OR=0.55,95%CI:0.31-0.98,P=0.042)and mild fibrosis(F1-F2)in CHC patients(OR 0.091,95%CI 0.01-0.75,P=0.020).LDL-c≥101.5 mg/dL(OR=0.20,95%CI:0.10-0.41,P<0.001)and BMI≥26.6 kg/m2(OR=0.37,95%CI:0.18-0.76,P<0.001)were associated with SC status;while ALT≥50.5 IU/L was negatively associated(OR=5.67,95%CI:2.69-11.97,P<0.001).CONCLUSION In SC patients,the APOEε4 allele and LDL-c conferred a protective effect in the course of the HCV infection in the context of excess body weight.

关键词： Liver damage Body mass index Spontaneous hepatitis C virus clearance Low-density lipoprotein Cholesterol

Differential distribution of gene polymorphisms associated with hypercholesterolemia,hypertriglyceridemia,and hypoalphalipoproteinemia among Native American and Mestizo Mexicans

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World Journal of Hepatology 2022年第7期14卷 1408-1420页

作者： Rafael Torres-Valadez Sonia Roman Claudia Ojeda-Granados Karina Gonzalez-Aldaco Arturo Panduro Department of Genomic Medicine in Hepatology Civil Hospital of Guadalajara Fray Antonio Alcalde/Health Sciences CenterUniversity of GuadalajaraGuadalajaraJalisco 44280Mexico Unidad Especializada en Investigación Desarrollo e Innovación en Medicina Genómica Centro Nayarita de Innovación y Transferencia de TecnologíaUniversidad Autónoma de NayaritUnidad Académica de Salud IntegralTepicNayarit 63173Mexico

BACKGROUND Dyslipidemias are metabolic abnormalities associated with chronic diseases caused by genetic and environmental factors.The Mexican population displays regional differences according to ethnicity with an impact on the type of dyslipidemia.AIM To define the main dyslipidemias,the frequency of lipid-related risk alleles,and their association with hyperlipidemic states among different ethnic groups in West Mexico.METHODS In a retrospective study,1324 adults were selected to compare dyslipidemias and lipid-related gene polymorphisms.Demographic,clinical,and laboratory data were collected.A subgroup of 196 normal weight subjects without impaired glucose was selected for the association analyses.Genotyping was determined by allelic discrimination assay.RESULTS Hypercholesterolemia was the most prevalent dyslipidemia(42.3%).The frequency of the risk alleles associated with hypoalphalipoproteinemia(ABCA1)and hypercholesterolemia(APOE,LDLR)was higher in the Native Americans(P=0.047).In contrast,the Mestizos with European ancestry showed a higher frequency of the risk alleles for hypertriglyceridemia(APOE2,MTTP)(P=0.045).In normal weight Mestizo subjects,the APOB TT and LDLR GG genotypes were associated risk factors for hypercholesterolemia(OR=5.33,95%CI:1.537-18.502,P=0.008 and OR=3.90,95%CI:1.042-14.583,P=0.043,respectively),and displayed an increase in low-density lipoprotein cholesterol levels(APOB:β=40.39,95%CI:14.415-66.366,P=0.004;LDLR:β=20.77,95%CI:5.763-35.784,P=0.007).CONCLUSION Gene polymorphisms and dyslipidemias showed a differential distribution.Regional primary health care strategies are required to mitigate their prevalence considering the genetic and environmental features which could have important implications for personalized medicine within the new era of precision medicine.

关键词： Dyslipidemia Ethnicity Genes Obesity Lipids Liver disease Diet

HBV endemicity in Mexico is associated with HBV genotypes H and G

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World Journal of Gastroenterology 2013年第33期19卷 5446-5453页

作者： Sonia Roman Arturo Panduro Department of Molecular Biology in Medicine Civil Hospital of Guadalajara"Fray Antonio Alcalde"and Health Sciences CenterUniversity of Guadalajara

Hepatitis B virus(HBV)genotypes have distinct genetic and geographic diversity and may be associated with specific clinical characteristics,progression,severity of disease and antiviral response.Herein,we provide an updated overview of the endemicity of HBV genotypes H and G in Mexico.HBV genotype H is predominant among the Mexican population,but not in Central America.Its geographic distribution is related to a typical endemicity among the Mexicans which is characterized by a low hepatitis B surface antigen seroprevalence,apparently due to a rapid resolution of the infection,low viral loads and a high prevalence of occult B infection.During chronic infections,genotype H is detected in mixtures with other HBV genotypes and associated with other co-morbidities,such as obesity,alcoholism and co-infection with hepatitis C virus or human immunodeficiency virus.Hepatocellular carcinoma prevalence is low.Thus,antiviral therapy may differ significantly from the standard guidelines established worldwide.The high prevalence of HBV genotype G in the Americas,especially among the Mexican population,raises new questions regarding its geographic origin that will require further investigation.

关键词： Hepatitis B virus genotypes Hepatitis B virus genotype H Hepatitis B virus genotype G Molecular epidemiology Mexico Antiviral therapy Severity of liver disease Clinical outcome

Need of righteous attitudes towards eradication of hepatitis C virus infection in Latin America

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World Journal of Gastroenterology 2016年第22期22卷 5137-5142页

作者： Arturo Panduro Sonia Roman Department of Molecular Biology in Medicine Civil Hospital of Guadalajara "Fray Antonio Alcalde" Health Sciences Center University of Guadalajara

Over the last few years, we have expanded our knowledge on numerous facets of the hepatitis C virus(HCV). Beginning with its discovery and viral life cycle, its impact on health, the development of liver disease and currently, effective antiviral treatments. The latter point has become of great interest throughout the developed world, where the possible eradication of HCV through specific strategies to reach all HCV-infected people has been announced. However, this scenario is very different in the countries of Latin America(LA), in which < 2% of infected patients requiring treatment have access to HCV medications. It has been estimated that at least ten million Latin Americans may be infected with HCV. Despite the numbers, viral hepatitis does not seem to be considered a health problem in this region of the world. This reality poses a challenge for politicians and governments of these countries, as well as to the pharmaceutical industry, the medical practitioners, and academics in LA. In this editorial, we state the need for alterations in the attitudes of the integral players involved in this situation. A recognition shift could help to create preventive strategies of viral hepatitis and to advocate for accessibility to new HCV treatments.

关键词： Low-income Antiviral agents Public health Medical societies Drug industry