Women living in Latin American countries bear a disproportionate burden of cervical cancer, a condition caused by infection with the human papillomavirus (HPV). We performed a study in Santa Elena, Guayas (currently Santa Elena Province), Ecuador, to determine how often HPV could be detected in women attending a private cancer screening clinic. Participants underwent a Pap test, and vaginal and cervical swabs were performed for HPV testing by the polymerase chain reaction (PCR). Each participant completed a verbally administered survey. The mean age of 302 participants was 37.7 years (range 18 to 78 years). The majority of cervical and vaginal specimens contained sufficient DNA to perform PCR. Overall, 24.2% of the participants had either a cervical or vaginal swab that tested positive for HPV. In general, there was a good correlation between the HPV types detected in the cervical and vaginal swabs from the participants, but vaginal swabs were more likely to contain HPV DNA than were cervical swabs. The high-risk HPV types 16, 52, 58, and 59 and the low-risk HPV types 62, 71, 72, and 83 were the most frequently detected HPV types. The number of lifetime sexual partners was positively associated with detection of any HPV type, detection of oncogenic HPV, and abnormal Pap smears. Further studies are needed to determine if these results are representative of all Ecuadorian women and to determine if cervical cancers in Ecuadorian women are caused by the same HPV types found in the swab specimens obtained in this study.

RESUMENLa enfermedad de Wilson es una enfermedad hereditaria de tipo autosómico recesivo del metabolismo del cobre; produce toxicidad por la acumulación de este. La anemia hemolítica en la enfermedad de Wilson ocurre hasta en un 17% en algún momento de la enfermedad; sin embargo, es inusual como presentación inicial. Se expone un caso de enfermedad de Wilson en un niño de 11 años con anemia hemolítica, prueba de Coombs negativa y elevación de enzimas hepáticas. Se realizó un fondo de ojo, que mostró anillos de Kayser-Fleischer, junto con niveles bajos de ceruloplasmina y elevación en la excreción del cobre urinario. El paciente se trató con D-penicilamina y piridoxina. Palabras clave: enfermedad de Wilson, anemia hemolítica, prueba de Coombs. ABSTRACTWilson disease is an autosomal recessive disorder of the copper`s hepatic metabolism; it results in toxicity due to accumulation of the mineral. The hemolytic anemia is present in 17% at some point of the disease, although it is a rare initial clinical presentation. Case report: 11 years old boy who presented with negative Coombs hemolytic anemia and elevation of liver enzymes. The possibility of Wilson disease was considered, which was confirmed with the finding of a Kayser-Fleischer ring in the eye exam. He also had a low ceruloplasmin level in plasma and a high urinary copper excretion. He was treated with D-penicillamine and pyridoxine.

“Desde 1984 estudios comprobaron que la hidroxiurea aumentaba los niveles de hemoglobina fetal y del volumen corpuscular medio, por esta razón a partir de 1998 fue el primer fármaco aprobado para el tratamiento en la drepanocitosis. El objetivo de este estudio fue describir la respuesta y complicaciones de los pacientes drepanocíticos en tratamiento con hidroxiurea en el Hospital Nacional de Niños.” Para ello los autores realizaron un estudio transversal retrospectivo en el que estudiaron 30 pacientes y les compararon parámetros hematológicos antes y después del uso de hidroxiurea. Concluyen los autores que “el uso de hidroxiurea en los pacientes drepanocíticos se asoció a una reducción en el número de hospitalizaciones por crisis vasoclusivas, al mismo tiempo se redujo el número de transfusiones anuales, sin efectos secundarios y sin comprometer la velocidad de crecimiento de los pacientes.”

Leishmaniasis is a protozoan disease caused by the parasite Leishmania. It is most common in developing countries. Its clinical presentation varies depending on several factors such as patient’s immunity. Cutaneous leishmaniasis is one of the main types of leishmaniasis, it is known to be a great mimicker. When seen in immunodeficient populations, such as patients with acute lymphoblastic leukemia, it may present more aggressively and its diagnosis is challenging. We present a case of a five-year-old male with a history of acute lymphoblastic leukemia undergoing chemotherapy who developed papules evolving into ulcerated nodules on his left lower extremity. An initial smear for leishmaniasis was negative, the disease evolved and spread in an ascending fashion, while efforts were made finding a diagnosis. One-month later the smear was repeated and positive for leishmaniasis. Subsequently, therapy with Meglumine antimoniate was prescribed. The lesions healed with atrophic scarring without complications. Cutaneous leishmaniasis diagnostic methods are not standardized, limitations such as interpreter’s expertise and patient’s immunity state may play a role in delaying the diagnosis.

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