Browsing by Autor "C. Roman"

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Atypical rash, a diagnostic challenge in clinical practice: A Case Report from Bolivia
(2025) C. Roman; Jhossmar Cristians Auza-Santiváñez; Paola Nielsen Fuentes Luzcuber; L. Castedo; Mildred Ericka Kubatz La Madrid; Sara Milca Robles-Nina; Carmen Julia Salvatierra Rocha; Jorge Márquez-Molina
Hand-foot-and-mouth disease, commonly caused by Coxsackievirus A16, can manifest in atypical and severe forms associated with the CVA6 serotype, termed "eczema coxsackium," which may mimic serious pathologies. This report describes the case of a 10-year-old boy with a diffuse maculopapular rash, targetoid and bullous lesions, and systemic compromise, initially diagnosed as erythema multiforme major. The discussion focuses on the differential diagnostic challenge with eczema herpeticum, highlighting that despite the alarming clinical presentation, etiological confirmation via PCR for CVA6 was crucial to rule out other infections, discontinue unnecessary acyclovir, and focus treatment on supportive care, leading to a favorable outcome. In conclusion, eczema coxsackium due to CVA6 should be considered in severe vesiculobullous rashes, with PCR being essential for an accurate diagnosis and proper management, as its prognosis is generally benign.
Chapter 8. Hypophosphatemia in Emergency Care
(2025) Alberto Martín Díaz-Seminario; Jhossmar Cristians Auza-Santiváñez; C. Roman
INTRODUCCINEn este captulo se estudiarn los trastornos del fosforo, localizado principalmente en el esqueleto (80 %).Este es regulado por el tracto gastrointestinal segn su aporte, el rin y la PTH.Los requerimientos diarios oscilan entre 0,2-0,5 mmol/Kg, 7-10 mmol/1000 Kcal.Sus funciones son variadas; es sustrato para la formacin de ATP, constituyente de los fosfolpidos de la membrana celular, regulacin del calcio intracelular, influye en algunas reacciones enzimticas, interviene en la regulacin de la capacidad de la Hb para transportar oxgeno.La hipofosfatemia se define como una concentracin srica de fsforo inferior al rango normal para la edad (inferior a 2,5 mg/dl (0,81 mmol/l) en adultos).La hipofosfatemia puede ser inducida por una disminucin de la absorcin intestinal neta, un aumento de la excrecin urinaria de fosfato o un desplazamiento agudo de fosfato extracelular hacia las clulas.Los hallazgos clnicos de hipofosfatemia grave incluyen sntomas neurolgicos (convulsiones ), cardacos (arritmias, miocardiopata ), renales (necrosis tubular aguda ) y musculoesquelticos (debilidad muscular , rabdomilisis ), as como insuficiencia respiratoria aguda.La tabla 8.1 muestra las principales causas de hipofosfatemia.
Current perspectives in the diagnosis and management of bacterial meningitis. Literature review and update
(2025) Jhossmar Cristians Auza-Santiváñez; Blas Apaza-Huanca; C. Roman; P. Ussetti Gil; José Bernardo Antezana-Muñoz; Freddy Ednildon Bautista-Vanegas; Jorge Márquez-Molina; Mildred Ericka Kubatz La Madrid; Eloy Paycho Anagua
Introduction: Bacterial meningitis is a serious and potentially fatal disease that has represented a significant challenge to medicine since its identification in the 19th century. Despite advances in antimicrobial treatment, it remains a major cause of morbidity and mortality worldwide. This review aims to update current perspectives on the diagnosis and management of bacterial meningitis, focusing on its pathogenesis, clinical manifestations, diagnostic methods, and therapeutic strategies. Methods: A search for information was carried out in the period August-December 2024 in the SciELO, LILACS, Scopus, PubMed-MedLine databases, the Google Scholar search engine, as well as in the ClinicalKeys services. For the recovery of information, an advanced search strategy was used and the terms “meningitis or bacterial meningitis” were used, as well as their translations into the English language. To combine the terms, Boolean operators were used, with search formulas according to the syntax requested by each database. Furthermore, in order to achieve a review based on the best possible evidence, only studies of the type case series, original articles or systematic reviews were selected. Results and discussion: Bacterial meningitis develops when pathogens overcome the host's defense mechanisms, colonizing mucous membranes, invading the bloodstream and penetrating the subarachnoid space. The main pathogens include Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae. The most common clinical manifestations are fever, headache, stiff neck and altered mental status. Diagnosis is based on analysis of cerebrospinal fluid (CSF), which shows pleocytosis, increased protein and decreased glucose. Empirical treatment includes antibiotics such as cefotaxime, ceftriaxone and vancomycin, together with dexamethasone as adjuvant therapy to reduce inflammation. Conclusions: Bacterial meningitis is a serious infection of the central nervous system, a medical emergency whose mortality and sequelae can be reduced with timely diagnosis and treatment. The key is to start treatment immediately and without delay. Prevention is the cornerstone of its control. Only through multidisciplinary management, which could include an expert infectious disease specialist, an intensive care physician, a specialized nurse and adequate laboratory equipment, can the impact of this devastating disease be mitigated.
Evidence-based pediatric podiatry: literature review and update
(2025) Freddy Ednildon Bautista-Vanegas; Magaly Zurita Villazón; Marlon Carbonell González; Jhossmar Cristians Auza-Santiváñez; Abigail Jazmin Arce-Santivañez; Camila Tassoula Egüez-Pereira; Daniel Ramiro Elías Vallejos-Rejas; C. Roman; Ingrid Neysa Cabezas-Soliz; Liliana Heydi Suarez Laime
Introduction: Pediatric podiatry has become established as an essential discipline in the comprehensive approach to the developing child. Alterations in the morphology and functionality of the children's foot, such as flexible flatfoot, are frequent reasons for consultation and require careful evaluation based on scientific evidence. Objective: This narrative review aims to analyze the evolution of knowledge on the anatomy and physiology of the children's foot, identify the prevalent podiatric conditions in childhood, review the main therapeutic interventions available and update the role of the podiatrist in the current clinical context. Methods. A search for information was carried out in the period May - July 2025, in the databases SciELO, Scopus, PubMed / MedLine, the Google Scholar search engine, Cochrane Library, as well as in the Clinical Keys services. Only those studies of the type systematic reviews, meta-analyses, randomized controlled trials (RCTs), controlled clinical trials (CCTs), observational studies and cross-sectional designs were selected. Results: Evidence shows that most cases of flexible flatfoot in childhood are physiological and do not require treatment, except in the presence of symptoms. Foot orthoses, functional re-education exercises, and appropriate footwear have proven effective in selected cases. In particular, intrinsic muscle strengthening programs have shown improvements in the plantar arch and gait. Current clinical practice remains variable, making ongoing training and the adoption of standardized protocols crucial. Conclusions: Timely, individualized, and evidence-guided intervention can prevent long-term musculoskeletal complications, improve locomotor function, and contribute to a better quality of life in childhood. The role of the pediatric podiatrist should be integrated into the multidisciplinary team for a comprehensive approach to child development.
Measles: A Comprehensive Review of the Virus and Its Public Health Implications
(2025) C. Roman; Jhossmar Cristians Auza-Santiváñez; Cleotilde U. Torres; Freddy Ednildon Bautista-Vanegas; Daniel Ramiro Elías Vallejos-Rejas; Henrry Temis Quisbert-Vasquez; José Bernardo Antezana-Muñoz; Giovanni Callizaya Macedo; Mildred Ericka Kubatz La Madrid
Historically, measles has been an infectious disease responsible for significant morbidity and mortality worldwide. Global vaccination efforts have had a transformative impact, with measles immunization estimated to have prevented more than 60 million deaths globally between 2000 and 2023. Despite these successes, the global goal of measles elimination by 2030, outlined in the Measles and Rubella Strategic Framework 2021-2030, is now under considerable threat due to the recent re-emergence of the disease. Addressing the measles crisis is not only about containing this specific virus, but also about strengthening the fundamental resilience of public health systems worldwide to prepare for and mitigate a broader spectrum of infectious disease threats. This narrative review article aims to provide a comprehensive analysis of the global re-emergence of measles. Clinical and epidemiological trends will be detailed, key factors contributing to this resurgence will be identified, and public health implications will be examined. An analysis of the situation in Bolivia will be included, offering localized perspectives on the challenges and responses. Finally, the article will conclude with strategic recommendations for public health interventions and future preparedness.
Paracoccidioidomycosis in a 16-year-old adolescent patient. A case report from Bolivia
(2025) C. Roman; Jhossmar Cristians Auza-Santiváñez; Daniel Ramiro Elías Vallejos-Rejas; D. Padilla; Marlon Carbonell González; Jose Luis Diaz-Guerrero; L. Castedo; J. Triana
Introduction: Paracoccidioidomycosis (PCM) is the most common systemic mycosis in Latin America. Case: A 16-year-old female patient from Bolivia presented with a 6-month history of ulcerative nasal lesions and cervical lymphadenopathy. Initial histopathology suggested tuberculosis with a positive Ziehl-Neelsen stain. Direct KOH examination revealed characteristic "steering wheel" yeasts of Paracoccidioides brasiliensis. Antituberculosis treatment was discontinued and itraconazole was started with a favorable response. Discussion: Juvenile paracoccidioidomycosis represents a significant diagnostic challenge due to its variable clinical presentation and its ability to mimic other more prevalent pathologies such as tuberculosis and lymphoproliferative syndromes. This case illustrates the importance of maintaining a high index of clinical suspicion in adolescent patients from endemic areas who present with lymphadenopathy and mucocutaneous lesions, especially when tuberculosis studies are negative. A broad differential diagnosis is important, as is the need for specific complementary testing in the event of clinical discrepancies. Direct mycological examination is crucial as a rapid and definitive diagnostic method for paracoccidioidomycosis.
Ramsay Hunt Syndrome in a Pediatric Patient with Atypical Presentation: Case Report
(2025) C. Roman; Paola Nielsen Fuentes Luzcuber; Jhossmar Cristians Auza-Santiváñez; Carmen Julia Salvatierra Rocha; Edson Grover Sañez Liendo; Henrry Temis Quisbert Vasquez; Mildred Ericka Kubatz La Madrid; Benito Aguirre-Cruz; Delly Espejo-Alanoca
The case of a preschooler with Ramsay Hunt Syndrome (RHS) is reported, an infrequent pediatric neurological condition caused by the reactivation of the varicella-zoster virus, whose atypical manifestation represented a diagnostic challenge. The patient, a 3-year and 4-month-old male, presented with vesicular lesions on the forehead and periorbital region, without the classic auricular rash, which led to a delayed diagnosis. Once RHS with bacterial superinfection was confirmed, acyclovir, prednisone, and antibiotics were administered, achieving a favorable evolution. The atypical presentation highlights the diagnostic challenges in children and the risk of delayed management. Therefore, it is crucial to maintain a high index of suspicion for RHS in pediatrics, even with unusual presentations, to ensure early treatment and prevent severe long-term complications.