Acute febrile illness (AFI) is a morbid condition with a sudden onset of fever with at least seven days of evolution, where no signs or symptoms related to an apparent infection have been identified. In Latin America, a high proportion of disease is typically due to malaria and arboviruses. However, among the infectious etiologies, tick-borne diseases (TBDs) should also be considered, especially in areas where people come into direct contact with these arthropods. This study aims to describe the etiology and epidemiology related to tick-borne agents in patients with AFI and the tick’s natural infection by agents of TBD in the rural tropical Magdalena Medio region in Colombia, and explore the factors associated with the presence of Coxiella burnetii infection. We conduct a cohort study enrolling 271 patients with AFI to detect the bacteria of the genera Anaplasma, Ehrlichia, Coxiella, Rickettsia, Borrelia, and Francisella through molecular techniques, and additionally evaluate the presence of IgG antibodies with commercially available kits. We also conduct tick collection in the patient’s households or workplaces for the molecular screening of the same bacterial genera. Seropositivity to IgG antibodies was obtained for all the bacteria analyzed, with Francisella being the most common at 39.5% (107/271), followed by R. rickettsii at 31.4% (85/271), Ehrlichia at 26.9% (73/271), R. typhi at 15.5% (42/271), Anaplasma at 14.4% (39/271), and Borrelia at 6.6% (18/271). However, these bacteria were not detected by the molecular techniques used. Coxiella burnetii infection was detected in 39.5% of the patients: 49.5% only by phase I and II IgG antibodies, 33.6% only by real-time PCR, and 16.8% had a concordant positive result for both techniques. A total of 191 adult ticks, 111 females and 80 males, were collected and identified as Rhipicephalus sanguineus s.l. and Rhipicephalus microplus. In the 169 adult ticks in which natural infection was evaluated, Ehrlichia spp. was detected in 21.3% (36/169), Coxiella spp. in 11.8% (20/169), and Anaplasma spp. in 4.7% (8/169). In conclusion, we identified the prior exposition to Francisella, Anaplasma, Ehrlichia, Rickettsia, Borrelia, and Coxiella in patients through serological tests. We also detected the infection of C. burnetii using molecular techniques. In the ticks, we identified bacteria of the genera Coxiella, Anaplasma, and Ehrlichia. These results suggest the importance of these zoonotic agents as possible causes of AFI in this region.

Background. Dexmedetomidine (Dex), a selective a 2-adrenergic receptor agonist, has been previously reported to attenuate intrapulmonary shunt during one-lung ventilation (OLV) and to alleviate bronchoconstriction. However, the therapeutic effects of nebulized Dex on pulmonary shunt and lung mechanics during OLV have not been evaluated. Here we determine whether nebulized dexmedetomidine improved pulmonary shunt and lung mechanics in patients undergoing elective thoracic surgery in a prospective randomized controlled clinical trial. Methods. One hundred and twenty-eight patients undergoing elective thoracoscopic surgery were included in this study and randomly divided into four groups: 0.9% saline (Placebo group), 0.5 μg/kg (Dex 0.5 group), 1 μg/kg (Dex 1 group) and 2 μg/kg (Dex 2 group) dexmedetomidine. After bronchial intubation, patients received different nebulized doses of dexmedetomidine (0.5 μg/kg, 1 μg/kg and 2 μg/kg) or 0.9% saline placebo during two-lung ventilation(TLV). OLV was initiated 15 min after bronchial intubation. Anesthesia was maintained with intravenous infusion of cisatracurium and propofol. Bispectral Index values were maintained within 40-50 by adjusting the infusion of propofol in all groups. Arterial blood gas samples and central venous blood gas samples were taken as follows: 15 min after bronchial intubation during two-lung ventilation (TLV 15), after 30 and 60 min of OLV (OLV 30 and OLV 60 , respectively) and 15 min after reinstitution of TLV (ReTLV). Dynamic compliance was also calculated at TLV 15 , OLV 30 , OLV 60 and ReTLV. Results. Dex decreased the requirement of propofol in a dose-dependent manner(P=0.000). Heart rate (HR) and mean arterial pressure (MAP) displayed no significant difference among groups (P=0.397 and 0.863). Compared with placebo group, Dex administered between 0.5 and 2 μg/kg increased partial pressure of oxygen (P a O 2) significantly at OLV 30 and OLV 60 (P=0.000) , however Dex administered between 1 and 2 μg/kg decreased pulmonary shunt fraction (Q s /Q t) at OLV 30 and OLV 60 (P=0.000).

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Los tumores ampulares corresponden a aquellos ubicados en la unión de los segmentos terminales del conducto pancreático y colédoco. Constituyen entre un 1 a 2% de los tumores del tracto digestivo, se caracterizan por su lento crecimiento y por corresponder a los tumores periampulares de mejor pronóstico. Existen varias opciones terapéuticas, una de ellas es, la resección endoscópica. Presentamos el caso clínico de un hombre de 70 años, que consulta por cuadro de ictericia progresiva, coluria, acolia y dolor abdominal. La TC de abdomen es sugerente de neoplasia periampular. En la colangiografía retrógrada endoscópica se constató una lesión proliferativa irregular y friable ubicado en la ampolla de váter, sugerente de ampuloma. Se realiza papilotomía, instalación de endoprótesis biliar y biopsia de papila. La biopsia informa adenocarcinoma de la ampolla de váter. El tratamiento propuesto fue ampulectomía endoscópica. La anatomía patológica de la pieza resecada concluye adenoma velloso con focos de displasia de alto grado y carcinoma intramucoso sin evidencia de invasión de la submucosa. Palabras clave: tumores periampulares, ampulectomía endoscópica.