Background Achalasia is an autoimmune disease whose probable causal agent is a neurotropic virus that chronically infects the myenteric plexus of the esophagus and induces the disease in a genetically susceptible host. The association between achalasia and coronaviruses has not been reported. Aims To evaluate the presence of the SARS‐CoV‐2 virus, the ACE2 expression, the tissue architecture, and immune response in the lower esophageal sphincter muscle (LESm) of achalasia patients who posteriorly had SARS‐CoV‐2 (achalasia‐COVID‐19) infection before laparoscopic Heller myotomy (LHM) and compare the findings with type II achalasia patients and transplant donors (controls) without COVID‐19. Methods The LESm of 7 achalasia‐COVID‐19 patients (diagnosed by PCR), ten achalasia patients, and ten controls without COVID‐19 were included. The presence of the virus was evaluated by in situ PCR and immunohistochemistry. ACE2 receptor expression and effector CD4 T cell and regulatory subsets were determined by immunohistochemistry. Key Results Coronavirus was detected in 6/7 patients‐COVID‐19. The SARS‐CoV‐2 was undetectable in the LESm of the achalasia patients and controls. ACE2 receptor was expressed in all the patients and controls. One patient developed achalasia type II post‐COVID‐19. The percentage of Th22/Th17/Th1/pDCreg was higher in achalasia and achalasia‐COVID‐19 pre‐HLM vs. controls. The Th2/Treg/Breg cell percentages were higher only in achalasia vs. controls. Conclusion & Inferences SARS‐CoV2 and its receptor expression in the LESm of achalasia patients who posteriorly had COVID‐19 but not in the controls suggests that it could affect the myenteric plexus. Unlike achalasia, patients‐COVID‐19 have an imbalance between effector CD4 T cells and the regulatory mechanisms.
Introduction: Previous studies have suggested that achalasia is an autoimmune disease whose probable causal agent is a neurotropic virus that chronically infects the myenteric plexus of the esophagus and, in a genetically susceptible host, induces the disease. The association between achalasia and coronaviruses has not been reported in the literature. Objective: To evaluate the presence of the SARS-CoV-2 virus, the ACE2 expression, the tissue architecture, and immune response in the lower esophageal sphincter (LES) muscle of patients with achalasia who had SARS-CoV-2 infection before laparoscopic Heller myotomy (LHM) and compare the findings with patients with type II achalasia and transplant donors (controls) without COVID-19. Material and Methods: The LES muscle of 7 patients with achalasia who had SARS-CoV-2 infection before LHM (diagnosed by PCR), ten patients with achalasia, and ten transplant donors (controls) without COVID-19 were included. The presence of the virus was evaluated by in situ PCR and immunohistochemistry. ACE2 receptor expression and CD4 T cell and regulatory subsets were determined by immunohistochemistry. Results: All patients had type II achalasia. Coronavirus was detected in 6/7 patients who had COVID-19. The SARS-CoV-2 was undetectable in the LES muscle of the achalasia patients and transplant donors (controls). The ACE2 receptor was expressed in all the patients and controls. One patient developed achalasia type II post-COVID-19. The percentage of Th22, Th17, Th1, and pDCreg was higher in achalasia and achalasia-COVID-19 pre-HLM vs. transplant donors. The Th2, Treg, and Breg cell percentages were higher only in achalasia vs. transplant donors. Conclusion: The presence of the SARS-CoV2 and its receptor in the LES muscle of patients with type II achalasia who had COVID-19 pre-LHM but not in the controls suggests that it could affect the myenteric plexus. Unlike patients with achalasia, patients who had COVID-19 have an imbalance between effector CD4 T cells and the regulatory mechanisms.
Neumología y Cirugía de TóraxAnálisis epidemiológico de la mortalidad por enfermedad pulmonar obstructiva crónica en el estado de Yucatán en 2017 Epidemiological analysis of chronic obstructive pulmonary disease mortality in the state of Yucatan in 2017
Diving as a method of fishing is used worldwide in small-scale fisheries. However, one of the main causes of morbidity and mortality among fishermen is decompression sickness (DCS). We report the case of a 46-year-old male fisherman diver who presented with chronic inguinal pain that radiated to the lower left limb. Living and working in a fishing port in Yucatan, he had a prior history of DCS. A diagnosis of avascular necrosis in the left femoral head secondary to DCS was made via analysis of clinical and radiological findings. The necrosis was surgically resolved by a total hip arthroplasty. Dysbaric osteonecrosis is a more probable diagnosis. In this region fishermen undergo significant decompression stress in their daily fishing efforts. Further studies regarding prevalence of dysbaric osteonecrosis among small-scale fisheries divers are needed. In a community where DCS is endemic and has become an epidemic, as of late, the perception of this health risk remains low. Furthermore, training and decompression technique are lacking among the fishing communities.
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