Secuencia Moebius. Análisis retrospectivo de 30 pacientes / Moebius syndrome. A retrospective analysis of 30 patients.

Introducción: La secuencia Moebius se caracteriza por el compromiso congénito de los nervios motor ocular externo y facial, y se puede asociar al compromiso de otros pares craneales y a otros defectos congénitos. Su etiología es multifactorial y no bien definida, actualmente la teoría más aceptada es la disrupción vascular durante el desarrollo del romboencéfalo. Su incidencia exacta se desconoce, pero impresiona estar en aumento y asociada a la exposición prenatal a teratógenos. Objetivos: Analizar las historias clínicas de 30 pacientes con secuencia Moebius y las características de su compromiso ocular. Materiales y métodos: Estudio retrospectivo, transversal, observacional y descriptivo. Se analizaron 30 historias clínicas de pacientes con secuencia Moebius atendidos por vez primera entre el mes de Julio de 1999 y Junio de 2012 por el servicio de Oftalmología del Hospital Garrahan. Resultados: Se estudiaron 30 pacientes 15 de sexo femenino y 15 de sexo masculino, dentro de los antecedentes maternos 7 madres refirieron ingesta de misoprostol y 4 tuvieron metrorragias durante el primer trimestre de embarazo. Todos los pacientes tuvieron compromiso del VII nervio; en 20 pacientes fue bilateral y simétrico; y en los restantes asimétrico. Todos los pacientes tuvieron compromiso del VI nervio bilateral, a algunos de los cuáles se les efectuó cirugía de estrabismo otros están en plan de cirugía y unos pocos no la requirieron por presentar fijación de ambos ojos en posición primaria de la mirada. Conclusión: la secuencia Moebius es una rara patología genética y congénita multifactorial y de compromiso multisistémico que ha visto incrementada su frecuencia desde el uso de ciertos fármacos teratógenos y que obliga a una intervención quirúrgica precoz de neuroortopedistas, oftalmólogos, cirujanos plásticos y control clínico multidisciplinario para brindarles a estos niños las mejores posibilidades de desarrollo funcional y estético reparador (AU)

Introduction: Moebius syndrome is characterized by congenital palsy of the external and facial oculomotpr nerves, and may be associated with involvement of other cranial nerves and congenital defects. The etiology is multifactorial and not well defined. Currently, the most widely accepted theory is a rhombencephalic maldevelopment. The true incidence of Moebius syndrome is unknown, but it seems to be increasing associated with prenatal exposure to teratogenic factors. Objectives: To analyze the clinical charts of 30 patients with Moebius syndrome assessing ocular involvement. Material and methods: A retrospective, cross-sectional, observational study. Thirty clinical charts of patients with Moebius syndrome that were first seen at the Department of Ophthalmology of Hospital Garrahan between July 1999 and June 2012 were assessed. Results: Of the 30 patients 15 were female and 15 male. Maternal history showed seven mothers that received misoprostol and four that had metrorrhagia in the first trimester of pregnancy. All patients had VII cranial nerve involvement; the involvement was bilateral and symmetric in 20 and asymmetric in the remaining patients. All patients had bilateral VI nerve involvement, some of whom underwent surgery for strabismus, others are on the list for surgery, and a few do not require surgery because of fixation of both eyes in primary gaze position. Conclusion: Moebius syndrome is a rare multifactorial genetic and congenital pathology with multisystemic involvement and increased incidence because of the use of teratogenic drugs requiring early surgical intervention by neuroorthopedic and plastic surgeons, and ophthalmologists, and a multidisciplinary follow-up to provide these children with the best possibilities for functional development and aesthetic repair (AU)

Aflatoxinas en maíz recién cosechado en Panamá / Aflatoxins in newly harvested corn in Panama

Mycotoxins are fungal metabolites that may contaminate foods and feeds, resulting at times in important disease in humans and animals. Thirty-six samples of nine varieties of newly harvested corn (4 samples each variety) were analyzed in search of aflatoxins by thin layer chromatography and high pressure liquid chromatography, and also cultured for the presence of Aspergillus flavus. Of the 36 samples studied, one was contaminated with 1290 ppb aflatoxin B1, which is 258x the concentration suggested by WHO, placed at 5 ppb in food for human consumption. Culture of the 36 samples of corn resulted in growth of 55 colonies of A. flavus from all but two (1 and 6) of the 9 varieties. Of the 55 colonies of A. flavus obtained, 15 (27.3%) were toxigenic. Comments are made on the public health implications of these findings.

Aislamiento de Cryptococcus neoformans a partir de suelos en Panama / Cryptococcus neoformans isolation from the soil in Panama

Reports of Cryptococcus neoformans isolations from patients in Panama have appeared since 1978, but to our knowledge, thIs is the first report of isolation of this organism from soil samples in the Republic. Of 25 soil samples analyzed, two (25%) yielded the organism on birdseed agar medium. Canavanine-glycine-bromthymol blue medium served to identify the isolates as belonging to C. neorformans var neoformans, and not C. Neoformans var. gattii. Initially, isolates did not have capsules, but upon passage through newborn mice, wide capsules developed. This finding has important public health implications, since non-encapsulated environmental organisms, once in the host, can develop capsules, which significantly contribute to virulence

Aspectos éticos de la experimentació animal / Ethical aspects in experimentation with animals

Muchos de los progresos en el campo de la medicina se han logrado gracias a la experimentación con animales. La urología se ha enriquecido mucho, tanto en su vertiente clínica como quirúrgica, de la cirugía experimental.Incluso actualmente, el entrenamiento quirúrgico de las nuevas generaciones de urólogos en técnicas quirúrgicas complejas y de uso poco frecuente requiere del empleo de animales de experimentación. Téngase en cuenta que tan sólo el 1,7 por ciento del total de animales de experimentación se utiliza para la enseñanza y la formación quirúrgica. La inmensa mayoría de ellos se emplea para la investigación de nuevos fármacos, productos o aparatos, o en la investigación básica. Estamos muy lejos de la antigua "vivisección", y nuestra mejor respuesta a la opinión pública, que se encuentra muy sensibilizada por los argumentos- en ocasiones sin fundamento- esgrimidos por las sociedades protectoras de animales, consiste en dar una detallada información de nuestras actividades que, además de cumplir con las normas que al respecto señala la legislación de cada país, se realizan en centros autorizados, dirigidos por personas experimentada, capaces de identificar los signos que pudieran indicar la presencia de dolor o sufrimiento en los animales, con vistas a reducirlo o evitarlo por completo

Optimización de la técnica de inmunoelectrotransferencia (western blot) para la confirmación de la infección por el virus de immunodeficiencia humana (VIH) en Panamá / Optimization of the immunoelectrophoresis technic (western blot) for the confirmation of human immunodeficiency virus infection (HIV) in Panama

The purpose of this study is to report the results of the authors' investigation to apply the western blot technique (WB UP-LCS) in the diagnosis of human immunodeficiency virus type 1 (HIV-1) infection. To do this, the authors separated the proteins of the HIV-1 virus by electrophoresis, based on their molecular weight, in poliacilamide gel with SDS (SDS-PAGE) during 3 hours at 200 volts. Then they electrotransferred these proteins to nitrocellulose paper during four hours at 200 milliamperes, with the aid of external cooling. The nitrocellulose strips were evaluated considering the incubation time (1 and 16 hours), two conjugates (human anti IgG with Peroxidase and human anti IgG Biotin plus Streptatividine with Peroxidase) and two dilutions of the patients' sera (1/50 and 1/100). Based on their results the Authors conclude that, in the first place, the optimal conditions for the test include a dilution of 1/100 of the patients serum, incubation of the serum for 16 hours and the use of the conjugate of anti human IgG with Biotin and Streptavidine with Peroxidase; secondary, that the immunologic reactivity against proteins p24 and gp 160/120 is the most important diagnostic criterion for the confirmation of infection with HIV-1 and that they obtained a diagnostic correlation of 100% at a cost which was 5 to 7 times less than that of the commercial system

Aislamiento de Schizophyllum commune en Panama / The isolation of Schizophyllum commune in Panama

The authors report the isolation of the basidiomycete Schizophyllum commune in two enclosed areas of healthy facilities in the city of Panama. The growth occurred in Sabouraud's agar as a white mycelium which gradually rose above the surface of the culture medium until it became a fan-shaped basidiocarp. This basidiomycete is found in environmental samples, but since there have been reports of its role in pathologic processes it should be included in the etiologic differential diagnosis in some patients and clinical laboratory must identify it and not discard it as a [quot]contaminant[quot]