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Cryoagglutinin autoimmune hemolytic anemia secondary to Mycoplasma pneumoniae infection in patient with pernicious anemia: A case report
(Medwave Estudios Limitada, 2025-09-17)
Leslie Gricel Cuzco Macias
;
Ashley Carolina Cuzco Macias
;
Daniel Simancas-Racines
;
PARISE VASCO, JUAN MARCOS
This report describes the rare case of a patient with autoimmune hemolytic anemia due to cryoagglutinins secondary to Mycoplasma pneumoniae infection, coexisting with pernicious anemia. A 56-year-old man presented with a ten-day history of cough and mucocutaneous pallor. Laboratory studies revealed megaloblastic anemia with low vitamin B12 levels, positive antibodies against intrinsic factor and parietal cells, as well as hemolysis parameters and a positive direct Coombs test for complement (C3d) with cryoagglutinins active at low temperatures. M. pneumoniae infection was confirmed by indirect immunofluorescence for IgM and IgG. Intramuscular B complex supplementation and doxycycline were administered for 14 days, improving hemoglobin and other hematological parameters within four weeks. This case highlights the diagnostic complexity in patients with rare hemolytic anemias in the context of atypical infections and underscores the importance of a multidisciplinary approach for their diagnosis and appropriate treatment. The coexistence of cryoagglutinin-mediated autoimmune hemolytic anemia and pernicious anemia poses diagnostic and therapeutic challenges that are relevant to clinical practice.
Scopus© Citations 1
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Orthopedic Management of a Class III Malocclusion With Deep Anterior Crossbite and Transverse Discrepancy: A Case Report
(Wiley, 2025-10-11)
César Sebastián Arcos-López
;
Marco González
;
VILLARREAL ORTEGA, BYRON MARCELO
;
PARISE VASCO, JUAN MARCOS
;
Nihat Kılıç
Class III malocclusion is a dentoskeletal condition characterized by altered relationships between bones, teeth, and muscular structures. Sagittal and transversal maxillary deficiency is one of the most common patterns, negatively affecting facial esthetics and the psychosocial well‐being of the patient. This case report describes an 11‐year‐old male patient with Class III skeletal malocclusion, a deep anterior crossbite, and a transverse discrepancy. Orthodontic treatment was performed with a mini‐implant assisted rapid palatal expansion (MARPE 2S), anchored in the maxilla with two mini‐implants, combined with four additional components: two for a face mask and two for the Ertty Gap III protocol, as well as a lip bumper with flanges for 5/16 heavy intermaxillary elastics in Class III mechanics for 24 h a day, attached to a soldered lingual arch. The combination of these orthopedic devices synergistically improved expansion and anteroposterior changes, resulting in significant functional, esthetic, and psychological improvements for the patient.
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Effects of Preoperative Exercise Interventions in Patients Undergoing Metabolic and Bariatric Surgery: A Systematic Review and Meta-Analysis
(MDPI AG, 2025-09-01)
SIMANCAS RACINES, DANIEL ALEJANDRO
;
PARISE VASCO, JUAN MARCOS
;
ANGAMARCA IGUAGO, JAIME WLADIMIR
;
Ashley Carolina Cuzco Macias
;
Carlos Soria
Background: Obesity affects over one billion people globally. Bariatric surgery is the most effective long-term intervention for severe obesity. However, postoperative outcomes can vary considerably, with such factors as baseline fitness and cardiorespiratory reserve influencing surgical outcomes. This systematic review aimed to evaluate the effects of preoperative exercise or physical activity, compared to standard care or no intervention, on preoperative fitness parameters and perioperative surgical outcomes in adults with obesity undergoing metabolic and bariatric surgery. Methods: A systematic review was conducted in accordance with the recommendations of the Cochrane Handbook and the PRISMA guidelines. Randomized controlled trials, non-randomized controlled trials, and cohort studies with control groups evaluating preoperative exercise interventions were included. Two independent reviewers conducted study selection, data extraction, and risk of bias assessment using Cochrane tools. Meta-analyses were performed using random effects models, with standardized mean differences calculated for continuous outcomes. Evidence certainty was assessed using the GRADE approach. Results: A total of 15 studies, including 1378 participants, were identified for qualitative synthesis, with 12 contributing data for quantitative meta-analysis. Preoperative exercise interventions significantly improved six-minute walk test distance (SMD 2.01; 95% CI: 0.51 to 3.50; p = 0.009) and VO2 peak (SMD 1.02; 95% CI: 0.52 to 1.51; p < 0.0001). BMI reduction was significant (SMD −0.96; 95% CI: −1.75 to −0.16; p = 0.02), while weight change was not statistically significant (SMD −0.81; 95% CI: −1.72 to 0.09; p = 0.08). One study reported a reduction in hospital length of stay of 0.64 days (95% CI: −0.86 to −0.42; p < 0.00001). Evidence certainty was rated as very low to low across all outcomes. Conclusions: Preoperative exercise interventions have been shown to significantly improve cardiorespiratory fitness in bariatric surgery candidates, with large effect sizes for functional capacity measures. Despite the low certainty of the evidence, these findings suggest that supervised exercise programs should be incorporated into the preoperative care of bariatric surgery patients.
Scopus© Citations 1
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Association Between Dental Caries, Dental Biofilm, and Body Mass Index in Indigenous Children from Two Regions of Ecuador: A Cross-Sectional Study
(Ovid Technologies (Wolters Kluwer Health), 2025-07)
Ana del Carmen Armas Vega
;
María Cristina Rockenbach Binz Ordóñez
;
Esteban Torracchi-Carrasco
;
Eleonor Vélez León
;
PARISE VASCO, JUAN MARCOS
Aim:To assess caries prevalence and its association with dental biofilm presence and body mass index (BMI) in children. Materials and Methods: In this cross-sectional study, 88 children aged 2–12 years were examined. The presence of dental caries was evaluated using the International Caries Detection and Assessment System (ICDAS) II criteria, with caries prevalence and index (dmft/DMFT) calculated based on established codes equivalent to World Health Organization standards (ICDAS II E-G/4–6). Dental biofilm was assessed using a standardized index, and nutritional status was determined by calculating BMI. To analyze the relationships between caries experience (dmft and DMFT) and the independent variables of weight, height, BMI, and dental biofilm index, a multiple linear regression analysis was performed using SPSS v25.0. Results: A high prevalence of dental caries was observed in the study population. For primary teeth, caries prevalence (ICDAS 2–6) ranged from 15.9% to 52.3%, with a mean of approximately two affected teeth per child. In permanent teeth, the prevalence for initial caries lesions (ICDAS II code 2) reached 75%, with an average of three affected teeth per child. A statistically significant correlation was identified between BMI, dental biofilm index, and the DMFT score. Notably, a child's weight demonstrated a moderate negative impact on their DMFT score, explaining 45% of the variance (η² = 0.45). Conclusion: The findings reveal a high burden of dental caries among children in the surveyed rural Ecuadorian communities. The significant association between a lower BMI and a higher caries index, alongside the influence of dental biofilm, underscores the intricate relationship between nutritional status, oral hygiene, and oral health. These results highlight the need for integrated public health interventions that address both malnutrition and oral hygiene to mitigate the high prevalence of dental caries in this and similar populations.
Scopus© Citations 3
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Preventing and Managing Pre- and Postoperative Micronutrient Deficiencies: A Vital Component of Long-Term Success in Bariatric Surgery
(MDPI AG, 2025-02-20)
REYTOR GONZÁLEZ, CLAUDIA MARÍA
;
Evelyn Frias-Toral
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NUÑEZ VASQUEZ, CRISTINA ELIZABETH
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PARISE VASCO, JUAN MARCOS
;
Raynier Zambrano-Villacres
Bariatric surgery (BS) is an effective treatment for severe obesity and its related comorbidities, such as type 2 diabetes and hypertension. However, the anatomical and physiological changes associated with these procedures significantly increase the risk of preoperative and postoperative micronutrient deficiencies, which can lead to severe complications such as anemia, osteoporosis, and neurological disorders. This narrative review examines the prevalence and clinical implications of micronutrient deficiencies in BS patients, as well as evidence-based strategies for their prevention and management. The most common deficiencies include iron, vitamin B12, folate, calcium, vitamin D, and fat-soluble vitamins (A, E, and K). Procedures with a hypoabsorptive component, such as Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion with duodenal switch (BPD/DS), pose higher risks of deficiencies compared to restrictive procedures like sleeve gastrectomy (SG). Effective strategies involve the preoperative correction of deficiencies, continuous monitoring, and tailored supplementation. However, long-term adherence to supplementation tends to decrease over time, influenced by behavioral and socioeconomic factors. Hence, preventing and managing micronutrient deficiencies are crucial for the long-term success of BS. While current guidelines provide valuable recommendations, many are based on low-certainty evidence, underscoring the need for more robust studies. A multidisciplinary approach, combined with innovative strategies, such as telemedicine, can enhance adherence and achieve sustainable clinical outcomes.
Scopus© Citations 43
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Interleukin-receptor antagonist and tumour necrosis factor inhibitors for the primary and secondary prevention of atherosclerotic cardiovascular diseases
(Wiley, 2024-09-19)
MARTI CARVAJAL, ARTURO JOSE
;
Mario A Gemmato-Valecillos
;
Diana Monge Martín
;
Mark Dayer
;
Eduardo Alegría-Barrero
Background: Atherosclerotic cardiovascular disease (ACVD) is worsened by chronic inflammatory diseases. Interleukin receptor antagonists (IL-RAs) and tumour necrosis factor-alpha (TNF) inhibitors have been studied to see if they can prevent cardiovascular events. Objectives: The purpose of this study was to assess the clinical benefits and harms of IL-RAs and TNF inhibitors in the primary and secondary prevention of ACVD. Search methods: The Cochrane Heart Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE (including In-Process & Other Non-Indexed Citations), Ovid Embase, EBSCO CINAHL plus, and clinical trial registries for ongoing and unpublished studies were searched in February 2024. The reference lists of relevant studies, reviews, meta-analyses and health technology reports were searched to identify additional studies. No limitations on language, date of publication or study type were set. Selection criteria: RCTs that recruited people with and without pre-existing ACVD, comparing IL-RAs or TNF inhibitors versus placebo or usual care, were selected. The primary outcomes considered were all-cause mortality, myocardial infarction, unstable angina, and adverse events. Data collection and analysis: Two or more review authors, working independently at each step, selected studies, extracted data, assessed the risk of bias and used GRADE to judge the certainty of evidence. Main results: We included 58 RCTs (22,053 participants; 21,308 analysed), comparing medication efficacy with placebo or usual care. Thirty-four trials focused on primary prevention and 24 on secondary prevention. The interventions included IL-1 RAs (anakinra, canakinumab), IL-6 RA (tocilizumab), TNF-inhibitors (etanercept, infliximab) compared with placebo or usual care. The certainty of evidence was low to very low due to biases and imprecision; all trials had a high risk of bias. Primary prevention: IL-1 RAs  The evidence is very uncertain about the effects of the intervention on all-cause mortality(RR 0.33, 95% CI 0.01 to 7.58, 1 trial), myocardial infarction (RR 0.71, 95% CI 0.04 to 12.48, I² = 39%, 2 trials), unstable angina (RR 0.24, 95% CI 0.03 to 2.11, I² = 0%, 2 trials), stroke (RR 2.42, 95% CI 0.12 to 50.15; 1 trial), adverse events (RR 0.85, 95% CI 0.59 to 1.22, I² = 54%, 3 trials), or infection (rate ratio 0.84, 95% 0.55 to 1.29, I² = 0%, 4 trials). Evidence is very uncertain about whether anakinra and cankinumab may reduce heart failure (RR 0.21, 95% CI 0.05 to 0.94, I² = 0%, 3 trials). Peripheral vascular disease (PVD) was not reported as an outcome. IL-6 RAs The evidence is very uncertain about the effects of the intervention on all-cause mortality (RR 0.68, 95% CI 0.12 to 3.74, I² = 30%, 3 trials), myocardial infarction (RR 0.27, 95% CI 0.04 to1.68, I² = 0%, 3 trials), heart failure (RR 1.02, 95% CI 0.11 to 9.63, I² = 0%, 2 trials), PVD (RR 2.94, 95% CI 0.12 to 71.47, 1 trial), stroke (RR 0.34, 95% CI 0.01 to 8.14, 1 trial), or any infection (rate ratio 1.10, 95% CI: 0.88 to 1.37, I2 = 18%, 5 trials). Adverse events may increase (RR 1.13, 95% CI 1.04 to 1.23, I² = 33%, 5 trials). No trial assessed unstable angina. TNF inhibitors The evidence is very uncertain about the effects of the intervention on all-cause mortality (RR 1.78, 95% CI 0.63 to 4.99, I² = 10%, 3 trials), myocardial infarction (RR 2.61, 95% CI 0.11 to 62.26, 1 trial), stroke (RR 0.46, 95% CI 0.08 to 2.80, I² = 0%; 3 trials), heart failure (RR 0.85, 95% CI 0.06 to 12.76, 1 trial). Adverse events may increase (RR 1.13, 95% CI 1.01 to 1.25, I² = 51%, 13 trials). No trial assessed unstable angina or PVD. Secondary prevention: IL-1 RAs The evidence is very uncertain about the effects of the intervention on all-cause mortality (RR 0.94, 95% CI 0.84 to 1.06, I² = 0%, 8 trials), unstable angina (RR 0.88, 95% CI 0.65 to 1.19, I² = 0%, 3 trials), PVD (RR 0.85, 95% CI 0.19 to 3.73, I² = 38%, 3 trials), stroke (RR 0.94, 95% CI 0.74 to 1.2, I² = 0%; 7 trials), heart failure (RR 0.91, 95% 0.5 to 1.65, I² = 0%; 7 trials), or adverse events (RR 0.92, 95% CI 0.78 to 1.09, I² = 3%, 4 trials). There may be little to no difference between the groups in myocardial infarction (RR 0.88, 95% CI 0.0.75 to 1.04, I² = 0%, 6 trials). IL6-RAs The evidence is very uncertain about the effects of the intervention on all-cause mortality (RR 1.09, 95% CI 0.61 to 1.96, I² = 0%, 2 trials), myocardial infarction (RR 0.46, 95% CI 0.07 to 3.04, I² = 45%, 3 trials), unstable angina (RR 0.33, 95% CI 0.01 to 8.02, 1 trial), stroke (RR 1.03, 95% CI 0.07 to 16.25, 1 trial), adverse events (RR 0.89, 95% CI 0.76 to 1.05, I² = 0%, 2 trials), or any infection (rate ratio 0.66, 95% CI 0.32 to 1.36, I² = 0%, 4 trials). No trial assessed PVD or heart failure. TNF inhibitors The evidence is very uncertain about the effect of the intervention on all-cause mortality (RR 1.16, 95% CI 0.69 to 1.95, I² = 47%, 5 trials), heart failure (RR 0.92, 95% 0.75 to 1.14, I² = 0%, 4 trials), or adverse events (RR 1.15, 95% CI 0.84 to 1.56, I² = 32%, 2 trials). No trial assessed myocardial infarction, unstable angina, PVD or stroke. Adverse events may be underestimated and benefits inflated due to inadequate reporting. Authors' conclusions: This Cochrane review assessed the benefits and harms of using interleukin-receptor antagonists and tumour necrosis factor inhibitors for primary and secondary prevention of atherosclerotic diseases compared with placebo or usual care. However, the evidence for the predetermined outcomes was deemed low or very low certainty, so there is still a need to determine whether these interventions provide clinical benefits or cause harm from this perspective. In summary, the different biases and imprecision in the included studies limit their external validity and represent a limitation to determining the effectiveness of the intervention for both primary and secondary prevention of ACVD.
Scopus© Citations 4

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