Jorge Eduardo Sarmiento Verdecia - Academia.edu (original) (raw)

Papers by Jorge Eduardo Sarmiento Verdecia

Clinical Infectious Diseases

Medical Mycology Case Reports

Open Forum Infectious Diseases

A 48-year-old man who had returned from Panama 5 weeks prior presented with fever, dysuria, hemat... more A 48-year-old man who had returned from Panama 5 weeks prior presented with fever, dysuria, hematuria, flank pain, and suprapubic pain and was found to have a prostatic abscess. Abscess fluid obtained during transurethral drainage grew Burkholderia pseudomallei. Blood cultures remained negative, and imaging did not show any other visceral abscess. This presentation of primary prostatic melioidosis is extremely rare in this region.

Cureus, 2021

A 42-year-old male with a history of untreated psoriasis and a previous episode of presumed left ... more A 42-year-old male with a history of untreated psoriasis and a previous episode of presumed left knee septic arthritis developed sudden onset of left knee pain, swelling, and a moderate effusion. The pathogen could not be isolated despite extensive inflammation seen in synovial fluid (SF) and synovial tissue biopsy. Whether this is culture-negative septic arthritis or pseudo-septic arthritis is the enigma, given the limited sensitivity of current available SF microbiologic testing. We present a challenging and stimulating case with no current guidelines for an optimal empiric antibiotic regimen or anti-inflammatory therapy.

IDCases, 2021

An 80-year-old patient was admitted for fever, chills, and chest wall pain. He had a past medical... more An 80-year-old patient was admitted for fever, chills, and chest wall pain. He had a past medical history significant for heart failure with a cardiac resynchronization therapy pacemaker implantation. Extensive workup revealed Enterobacter cloacae endocarditis of the pacemaker leads and the mitral valve, a rare etiology with an unidentified source in our patient. He was managed with a rather unconventional method which proved to be successful. This case sheds light on non-HACEK (other than Haemophilus spp., Aggregatibacter actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, or Kingella spp). gram-negative organisms, and particularly E. cloacae, as uncommon causes of endocarditis with elevated mortality, and discusses potential treatment modalities.

Cureus, 2021

Solid organ transplant (SOT) recipients are at increased risk of opportunistic infections due to ... more Solid organ transplant (SOT) recipients are at increased risk of opportunistic infections due to significant Tcell immune dysfunction. The incidence of clinical disseminated histoplasmosis is rare, and its variable clinical presentation and response to therapy make it challenging to treat with resultant high mortality. A high index of clinical suspicion is necessary, especially in non-endemic areas. We report our clinical experience treating a 63-year-old renal transplant patient on immunosuppressive therapy with late-onset acute miliary histoplasmosis initiated on liposomal amphotericin B (L-AmB).

Cureus, 2021

Here, we present the case of a 52-year-old patient who presented with fever, chills, and weight l... more Here, we present the case of a 52-year-old patient who presented with fever, chills, and weight loss. Further workup revealed Bartonella endocarditis of the aortic valve. After six weeks of antibiotics, a follow-up transthoracic echocardiogram showed a decrease in the size of vegetation. Serologic testing based on epidemiologic history should be obtained for the workup of blood culture-negative endocarditis.

Journal of Cardiology Cases, 2021

A 68-year-old woman with a past medical history of chronic obstructive pulmonary disease and squa... more A 68-year-old woman with a past medical history of chronic obstructive pulmonary disease and squamous cell carcinoma of the lung with recent right upper and middle lobectomy was admitted for dyspnea and volume overload. She was diagnosed with right-sided heart failure (RHF) through clinical, laboratory, and echocardiographic means. In the setting of chronic respiratory failure, the recent right lung lobectomy was deemed to be the inciting factor of the RHF. The mechanism by which RHF occurs in this situation is multifactorial, and it is essential to undergo pre-operative risk stratification and post-operative monitoring to avoid emergent events. < Learning objective: New-onset right heart failure can be a detrimental complication of lung resection surgery in patients with chronic respiratory failure. With proper pre-operative risk stratification and its corresponding post-operative monitoring, we can anticipate such occurrences and avoid emergent admissions, enabling better outcomes in a high-risk patient population. >

Cureus, 2020

A 57-year-old African American male was admitted for workup of unintentional weight loss. He was ... more A 57-year-old African American male was admitted for workup of unintentional weight loss. He was found to have an esophageal squamous cell carcinoma. Electrocardiogram (ECG) readings demonstrated deep Q waves in leads V1-V2 with T wave flattening, which raised concern for a septal infarct. Myocardial infarction (MI) was subsequently ruled out through clinical, imaging, and laboratory analysis. The ECG findings were deemed as a pseudo-infarct pattern in the setting of squamous cell carcinoma of the esophagus.

KnE Engineering, 2018

Computational simulation is a powerful tool that allows the experimentation of variants in produc... more Computational simulation is a powerful tool that allows the experimentation of variants in production environments, which made on real scenarios, would entail heavy costs for the company. For this, it is necessary to correctly define the model that represents the actual processes involved. This paper presents the development of a computational simulation model, developed with "Siman" programming language and "Arena" software, based on queuing theory for the processes of milk production process in the Dairy Plant FCP-ESPOCH. We sought to determine the efficiency of the computational model using the scientific method, techniques of descriptive statistics and hypothesis demonstration. The results indicate that the data of the model are similar to the real ones in the processes of Daily Crude Milk Reception and Production Daily Pasteurized Milk, concluding that the computational model is valid for future experimentation.

BMJ Case Reports, 2019

A 61-year-old Caucasian woman presented to the emergency room complaining of left-sided chest pai... more A 61-year-old Caucasian woman presented to the emergency room complaining of left-sided chest pain and altered mentation for 3 days. Her medical history included liver cirrhosis and coronary artery disease. On admission, she was found to have methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia. Due to a decline in mental status, a lumbar puncture was performed and cerebrospinal fluid cultures grew MRSA. She was treated initially with vancomycin. Ceftaroline was later added, due to the high burden of disease and difficulty in clearing her infection. After initiation of ceftaroline, bacteraemia cleared and mental status improved, however, she developed haemolytic anaemia. Ceftaroline was stopped and vancomycin continued. Staphylococcal meningitis is a rare occurrence, estimated at a rate of only 1%–10% of all bacterial meningitis cases. Ceftaroline seems to be a suitable option for disseminated MRSA infection, including MRSA meningitis, when the clinical response to vancomy...

IDCases, 2019

We present here a case of relapsed HIV-related Kaposi Sarcoma (KS), manifesting as a plantar ulce... more We present here a case of relapsed HIV-related Kaposi Sarcoma (KS), manifesting as a plantar ulcer with underlying bone involvement in a patient with well-controlled HIV. Radiographic and magnetic resonance imaging of the patient's right foot showed bone destruction suggestive of osteomyelitis. However, when a bone biopsy was done, this was consistent with KS, without any signs of bone infection. Patient was initially diagnosed with KS four years prior. He was successfully treated at the time with doxorubicin, radiation therapy, and began HIV therapy. At the time of the KS recurrence, his HIV viral load was undetectable and his CD4 count was over 900 cells/uL (CD4 percentage of 42%). Musculoskeletal (MSK) involvement in KS is a rare manifestation of this disease. The argest series of skeletal KS in people living with HIV by Papanastasopoulos at el. showed a prevalence of only 1.1%. The radiological features of MSK-KS are generally lytic osseous lesions, but presentations may differ. Bone biopsy remains the gold standard for diagnosis, as many other infectious and neoplastic processes can mimic MSK-KS radiographically. In the era of highly active antiretroviral therapy, people living with HIV who are diagnosed with MSK-KS appear to have a substantially improved survival rate than previously described.

IDCases, 2019

We present a case of a 42-year-old Caucasian man that came to our facility complaining of dyspnea... more We present a case of a 42-year-old Caucasian man that came to our facility complaining of dyspnea and subjective fevers and was found to have infective endocarditis. His blood cultures initially grew Peptostreptococcus spp and he was started on penicillin and gentamicin. Repeat blood cultures, drawn 48 h later, became positive for Granulicatella adiacens. Vancomycin was added at this point, given reports of growing penicillin resistance of Granulicatella spp. Transthoracic echocardiogram showed multiple vegetations on the aortic, mitral and tricuspid valves. The patient's final antibacterial regimen consisted of intravenous penicillin G 24 million units daily and vancomycin (goal trough of 15-20) for a total of 6 weeks. The first 2 weeks of his regimen also included gentamicin. The patient was not considered for valve replacement surgery given concern for continued use of illicit intravenous drugs. Peptostreptococcus species are anaerobic, non-spore forming, gram-positive cocci, thought to generally have a subacute clinical presentation. Granulicatella genus is nutritionally deficient bacteria which require a supplemented media in order to grow. Both of these bacteria are present in the mouth and gastrointestinal flora. The rate of infective endocarditis from anaerobic species has been reported up to 16%, which includes multiple species. While on nutritionally deficient bacteria are reported to be involved on infective endocarditis in the range of 3-8%. Antimicrobial resistance is on the rise for both of these species, which makes the appropriate choice of antimicrobials quite important.

KnE Engineering, 2018

University requires agility in accordance to the needs arising from technological innovation and ... more University requires agility in accordance to the needs arising from technological innovation and the reform of the regulations that govern higher education, which is why the present project arises to model and implement a web application that allows the entry and visualization of qualifications, and online registration under the academic regulations that govern the Technical University of Cotopaxi. For the development of this web application, Metric V3 methodology was used, with its five stages within the life cycle of software development. Once the application was developed, it was submitted to a usability evaluation with four computer users who issued their assessments respect to ten questions related to the usability principles of Jakob Nielsen. The result was 86.5% favorable of the application for which it was necessary to previously analyze the options of "packaged" software and customized development. Resumen La universidad requiere de agilidad conforme a las necesidades que surgen por la innovación tecnológica y la reforma de las normativas que rigen la educación superior, por ello surge el presente proyecto para modelar e implementar una aplicación web, que permita el ingreso y visualización de calificaciones, y matriculación en línea bajo el reglamento académico que rige a la Universidad Técnica de Cotopaxi. Para el desarrollo de esta aplicación web se utilizó la metodología Métrica V3, con sus cinco etapas dentro del ciclo de vida de desarrollo del software. Una vez el aplicativo fue desarrollado se lo sometió a una evaluación de usabilidad con cuatro usuarios informáticos que emitieron sus valoraciones con respecto a diez preguntas planteadas asociadas a los principios de usabilidad de Jakob Nielsen. El resultado arrojó un 86,5% favorable del aplicativo para el cual fue necesario analizar previamente las opciones de software "empaquetado" y desarrollo a medida.

La simulacion es una poderosa tecnica para la resolucion de problemas al imitar el comportamiento... more La simulacion es una poderosa tecnica para la resolucion de problemas al imitar el comportamiento de los sistemas del mundo real, por lo que es aplicable a un sinnumero de campos como la estadistica, la economia, la fisica, o la industria en donde principalmente se aplica en el desarrollo de un proyecto cientifico orientado a la optimizacion de los procesos de produccion de una linea de fabrica que requiere de un estudio profundo de los parametros, variables, constantes, y procedimientos que intervienen en su funcionamiento. Este documento, presenta un estudio del proceso de produccion de queso de la planta de lacteos FCP-ESPOCH (Facultad de Ciencias Pecuarias – Escuela Superior Politecnica de Chimborazo) a traves de la teoria de colas, con el objetivo de generar un modelo de simulacion computacional que represente lo mas fielmente posible a los procesos de produccion de la planta y se convierta en una herramienta de apoyo a la toma de decisiones y experimentacion de los elementos d...

Clinical Infectious Diseases

Medical Mycology Case Reports

Open Forum Infectious Diseases

A 48-year-old man who had returned from Panama 5 weeks prior presented with fever, dysuria, hemat... more A 48-year-old man who had returned from Panama 5 weeks prior presented with fever, dysuria, hematuria, flank pain, and suprapubic pain and was found to have a prostatic abscess. Abscess fluid obtained during transurethral drainage grew Burkholderia pseudomallei. Blood cultures remained negative, and imaging did not show any other visceral abscess. This presentation of primary prostatic melioidosis is extremely rare in this region.

Cureus, 2021

A 42-year-old male with a history of untreated psoriasis and a previous episode of presumed left ... more A 42-year-old male with a history of untreated psoriasis and a previous episode of presumed left knee septic arthritis developed sudden onset of left knee pain, swelling, and a moderate effusion. The pathogen could not be isolated despite extensive inflammation seen in synovial fluid (SF) and synovial tissue biopsy. Whether this is culture-negative septic arthritis or pseudo-septic arthritis is the enigma, given the limited sensitivity of current available SF microbiologic testing. We present a challenging and stimulating case with no current guidelines for an optimal empiric antibiotic regimen or anti-inflammatory therapy.

IDCases, 2021

An 80-year-old patient was admitted for fever, chills, and chest wall pain. He had a past medical... more An 80-year-old patient was admitted for fever, chills, and chest wall pain. He had a past medical history significant for heart failure with a cardiac resynchronization therapy pacemaker implantation. Extensive workup revealed Enterobacter cloacae endocarditis of the pacemaker leads and the mitral valve, a rare etiology with an unidentified source in our patient. He was managed with a rather unconventional method which proved to be successful. This case sheds light on non-HACEK (other than Haemophilus spp., Aggregatibacter actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, or Kingella spp). gram-negative organisms, and particularly E. cloacae, as uncommon causes of endocarditis with elevated mortality, and discusses potential treatment modalities.

Cureus, 2021

Solid organ transplant (SOT) recipients are at increased risk of opportunistic infections due to ... more Solid organ transplant (SOT) recipients are at increased risk of opportunistic infections due to significant Tcell immune dysfunction. The incidence of clinical disseminated histoplasmosis is rare, and its variable clinical presentation and response to therapy make it challenging to treat with resultant high mortality. A high index of clinical suspicion is necessary, especially in non-endemic areas. We report our clinical experience treating a 63-year-old renal transplant patient on immunosuppressive therapy with late-onset acute miliary histoplasmosis initiated on liposomal amphotericin B (L-AmB).

Cureus, 2021

Here, we present the case of a 52-year-old patient who presented with fever, chills, and weight l... more Here, we present the case of a 52-year-old patient who presented with fever, chills, and weight loss. Further workup revealed Bartonella endocarditis of the aortic valve. After six weeks of antibiotics, a follow-up transthoracic echocardiogram showed a decrease in the size of vegetation. Serologic testing based on epidemiologic history should be obtained for the workup of blood culture-negative endocarditis.

Journal of Cardiology Cases, 2021

A 68-year-old woman with a past medical history of chronic obstructive pulmonary disease and squa... more A 68-year-old woman with a past medical history of chronic obstructive pulmonary disease and squamous cell carcinoma of the lung with recent right upper and middle lobectomy was admitted for dyspnea and volume overload. She was diagnosed with right-sided heart failure (RHF) through clinical, laboratory, and echocardiographic means. In the setting of chronic respiratory failure, the recent right lung lobectomy was deemed to be the inciting factor of the RHF. The mechanism by which RHF occurs in this situation is multifactorial, and it is essential to undergo pre-operative risk stratification and post-operative monitoring to avoid emergent events. < Learning objective: New-onset right heart failure can be a detrimental complication of lung resection surgery in patients with chronic respiratory failure. With proper pre-operative risk stratification and its corresponding post-operative monitoring, we can anticipate such occurrences and avoid emergent admissions, enabling better outcomes in a high-risk patient population. >

Cureus, 2020

A 57-year-old African American male was admitted for workup of unintentional weight loss. He was ... more A 57-year-old African American male was admitted for workup of unintentional weight loss. He was found to have an esophageal squamous cell carcinoma. Electrocardiogram (ECG) readings demonstrated deep Q waves in leads V1-V2 with T wave flattening, which raised concern for a septal infarct. Myocardial infarction (MI) was subsequently ruled out through clinical, imaging, and laboratory analysis. The ECG findings were deemed as a pseudo-infarct pattern in the setting of squamous cell carcinoma of the esophagus.

KnE Engineering, 2018

Computational simulation is a powerful tool that allows the experimentation of variants in produc... more Computational simulation is a powerful tool that allows the experimentation of variants in production environments, which made on real scenarios, would entail heavy costs for the company. For this, it is necessary to correctly define the model that represents the actual processes involved. This paper presents the development of a computational simulation model, developed with "Siman" programming language and "Arena" software, based on queuing theory for the processes of milk production process in the Dairy Plant FCP-ESPOCH. We sought to determine the efficiency of the computational model using the scientific method, techniques of descriptive statistics and hypothesis demonstration. The results indicate that the data of the model are similar to the real ones in the processes of Daily Crude Milk Reception and Production Daily Pasteurized Milk, concluding that the computational model is valid for future experimentation.

BMJ Case Reports, 2019

A 61-year-old Caucasian woman presented to the emergency room complaining of left-sided chest pai... more A 61-year-old Caucasian woman presented to the emergency room complaining of left-sided chest pain and altered mentation for 3 days. Her medical history included liver cirrhosis and coronary artery disease. On admission, she was found to have methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia. Due to a decline in mental status, a lumbar puncture was performed and cerebrospinal fluid cultures grew MRSA. She was treated initially with vancomycin. Ceftaroline was later added, due to the high burden of disease and difficulty in clearing her infection. After initiation of ceftaroline, bacteraemia cleared and mental status improved, however, she developed haemolytic anaemia. Ceftaroline was stopped and vancomycin continued. Staphylococcal meningitis is a rare occurrence, estimated at a rate of only 1%–10% of all bacterial meningitis cases. Ceftaroline seems to be a suitable option for disseminated MRSA infection, including MRSA meningitis, when the clinical response to vancomy...

IDCases, 2019

We present here a case of relapsed HIV-related Kaposi Sarcoma (KS), manifesting as a plantar ulce... more We present here a case of relapsed HIV-related Kaposi Sarcoma (KS), manifesting as a plantar ulcer with underlying bone involvement in a patient with well-controlled HIV. Radiographic and magnetic resonance imaging of the patient's right foot showed bone destruction suggestive of osteomyelitis. However, when a bone biopsy was done, this was consistent with KS, without any signs of bone infection. Patient was initially diagnosed with KS four years prior. He was successfully treated at the time with doxorubicin, radiation therapy, and began HIV therapy. At the time of the KS recurrence, his HIV viral load was undetectable and his CD4 count was over 900 cells/uL (CD4 percentage of 42%). Musculoskeletal (MSK) involvement in KS is a rare manifestation of this disease. The argest series of skeletal KS in people living with HIV by Papanastasopoulos at el. showed a prevalence of only 1.1%. The radiological features of MSK-KS are generally lytic osseous lesions, but presentations may differ. Bone biopsy remains the gold standard for diagnosis, as many other infectious and neoplastic processes can mimic MSK-KS radiographically. In the era of highly active antiretroviral therapy, people living with HIV who are diagnosed with MSK-KS appear to have a substantially improved survival rate than previously described.

IDCases, 2019

We present a case of a 42-year-old Caucasian man that came to our facility complaining of dyspnea... more We present a case of a 42-year-old Caucasian man that came to our facility complaining of dyspnea and subjective fevers and was found to have infective endocarditis. His blood cultures initially grew Peptostreptococcus spp and he was started on penicillin and gentamicin. Repeat blood cultures, drawn 48 h later, became positive for Granulicatella adiacens. Vancomycin was added at this point, given reports of growing penicillin resistance of Granulicatella spp. Transthoracic echocardiogram showed multiple vegetations on the aortic, mitral and tricuspid valves. The patient's final antibacterial regimen consisted of intravenous penicillin G 24 million units daily and vancomycin (goal trough of 15-20) for a total of 6 weeks. The first 2 weeks of his regimen also included gentamicin. The patient was not considered for valve replacement surgery given concern for continued use of illicit intravenous drugs. Peptostreptococcus species are anaerobic, non-spore forming, gram-positive cocci, thought to generally have a subacute clinical presentation. Granulicatella genus is nutritionally deficient bacteria which require a supplemented media in order to grow. Both of these bacteria are present in the mouth and gastrointestinal flora. The rate of infective endocarditis from anaerobic species has been reported up to 16%, which includes multiple species. While on nutritionally deficient bacteria are reported to be involved on infective endocarditis in the range of 3-8%. Antimicrobial resistance is on the rise for both of these species, which makes the appropriate choice of antimicrobials quite important.

KnE Engineering, 2018

University requires agility in accordance to the needs arising from technological innovation and ... more University requires agility in accordance to the needs arising from technological innovation and the reform of the regulations that govern higher education, which is why the present project arises to model and implement a web application that allows the entry and visualization of qualifications, and online registration under the academic regulations that govern the Technical University of Cotopaxi. For the development of this web application, Metric V3 methodology was used, with its five stages within the life cycle of software development. Once the application was developed, it was submitted to a usability evaluation with four computer users who issued their assessments respect to ten questions related to the usability principles of Jakob Nielsen. The result was 86.5% favorable of the application for which it was necessary to previously analyze the options of "packaged" software and customized development. Resumen La universidad requiere de agilidad conforme a las necesidades que surgen por la innovación tecnológica y la reforma de las normativas que rigen la educación superior, por ello surge el presente proyecto para modelar e implementar una aplicación web, que permita el ingreso y visualización de calificaciones, y matriculación en línea bajo el reglamento académico que rige a la Universidad Técnica de Cotopaxi. Para el desarrollo de esta aplicación web se utilizó la metodología Métrica V3, con sus cinco etapas dentro del ciclo de vida de desarrollo del software. Una vez el aplicativo fue desarrollado se lo sometió a una evaluación de usabilidad con cuatro usuarios informáticos que emitieron sus valoraciones con respecto a diez preguntas planteadas asociadas a los principios de usabilidad de Jakob Nielsen. El resultado arrojó un 86,5% favorable del aplicativo para el cual fue necesario analizar previamente las opciones de software "empaquetado" y desarrollo a medida.

La simulacion es una poderosa tecnica para la resolucion de problemas al imitar el comportamiento... more La simulacion es una poderosa tecnica para la resolucion de problemas al imitar el comportamiento de los sistemas del mundo real, por lo que es aplicable a un sinnumero de campos como la estadistica, la economia, la fisica, o la industria en donde principalmente se aplica en el desarrollo de un proyecto cientifico orientado a la optimizacion de los procesos de produccion de una linea de fabrica que requiere de un estudio profundo de los parametros, variables, constantes, y procedimientos que intervienen en su funcionamiento. Este documento, presenta un estudio del proceso de produccion de queso de la planta de lacteos FCP-ESPOCH (Facultad de Ciencias Pecuarias – Escuela Superior Politecnica de Chimborazo) a traves de la teoria de colas, con el objetivo de generar un modelo de simulacion computacional que represente lo mas fielmente posible a los procesos de produccion de la planta y se convierta en una herramienta de apoyo a la toma de decisiones y experimentacion de los elementos d...