Neumonía por Pneumocystis Jirovecii en paciente adolescente inmunosuprimido no VIH positivo: Un reporte de caso / Pneumocystis Jirovecii pneumonia in a non-HIV immunosuppressed adolescent patient: A case report

Resumen La neumonía en el paciente inmunocomprometido es un reto diagnóstico al cual el clínico se enfrenta cada vez con más frecuencia , al momento de hablar de infiltrados en vidrio esmerilado es menester tener siempre en cuenta la posibilidad de neumonía por Pneumocystis Jirovecii, que por mucho tiempo se pensó como una enfermedad propia del huésped inmunosuprimido con VIH, a través del tiempo se ha manifestado en pacientes con trasplantes de órgano sólido y de precursores hematopoyéticos, asociado a autoinmunidad, al uso crónico de corticoesteroides y más recientemente al uso de terapia biológicas. La descripción de esta enfermedad y sus métodos diagnósticos en huéspedes inmunosuprimidos no VIH no es del todo claro, sabemos que el tratamiento de elección en estos casos es el trimetropin-sulfametoxazol (TMP-SMX) el cual no cuenta con evidencia de alta calidad al momento de plantear una dosis ni un tiempo de duración establecidos. Presentamos el caso de un paciente con diagnóstico de glomerulonefritis por enfermedad de cambios mínimos corticodependiente y quien desarrolló neumonía por Pneumocystis Jirovecii confirmada por histopatología quien recibió tratamiento y tuvo un desenlace positivo.

Abstract The pneumonia in the immunocompromised patient is a diagnostic challenge that the clinician faces more and more frequently, every time we talk about ground glass infiltrates it is necessary to always take into account the possibility of pneumonia due to Neumocystis Jirovecii, which for a long time was thought as a disease of the immunosuppressed host with HIV, but that across the time it has manifested itself in patients with solid organ transplants and hematopoietic precursors, associated with autoimmunity, the chronic use of corticosteroids and more recently the use of biological therapy. The description of this disease and the diagnostic methods in non-HIV immunosuppressed hosts is not entirely clear, we know that the treatment of choice in these cases is trimethropin-sulfamethoxazole (TMP-SMX), which does not have high-quality evidence at the time of a dose or a time of established duration. We present the case of a patient diagnosed with glomerulonephritis due to corticodependent minimal change disease and who suffers from pneumocystis Jirovecii pneumonia confirmed by histopathology, which received treatment and had a positive outcome

The devil is coming: Feeding behavior of juvenile Munk's devil rays (Mobula munkiana) in very shallow waters of Punta Descartes, Costa Rica

Introduction: Identifying critical habitats for vulnerable elasmobranch species is crucial for effective conservation measures. The Munk's devil ray (Mobula munkiana) is endemic to the Eastern Pacific, but yet little is known about its biology, ecology, and habitat use. As filter feeders, it is assumed that this species concentrates at high-productive upwelling regions, such as the Costa Rican Dome. Like many elasmobranchs, its populations are highly depleted and require urgent information to inform better conservation measures. Objective: The study was conducted to gain information on a unique behavior observed in juvenile M. munkiana, so further information can be provided on early life stages of this vulnerable species. Methods: From June to September 2017 and in August 2018, the feeding behavior of juvenile Mobula munkiana was observed in two shallow bays located at Punta Descartes, North Pacific Costa Rica. Individuals were captured using a non-lethal method to obtain data on size, weight, and sex distribution. Plankton samples (n = 100) were taken at both bays throughout the months to infer diet composition. Results: Munk's devil rays showed a repetitive swimming movement parallel to the beach, feeding exclusively in the shallow breaking zone of the low tide waves at depth <50cm. A total of 12 M. munkiana (11 live and one found dead) indicated a juvenile feeding aggregation ranging from 490 - 610mm in disk width and 1400 - 2300gr in weight. The sex ratio (males to females) was 3:1. Zooplankton of the order Mysidacae was found in the highest abundance in the breaking zone. Conclusions: The specific behavior and seasonal occurrence of juvenile Munk's devil rays in this area seem to be driven by prey abundance. More research is needed to conclude the presence of reproductive adults at deeper depths and the year-round habitat use of Punta Descartes. The area is threatened by unsustainable development and requires realistic management strategies to guarantee the survival of vulnerable species and their critical habitats.

Introducción: La identificación de hábitats críticos para especies vulnerables de elasmobranquios es crucial para tomar medidas de conservación efectivas. La manta diablo o raya de Munk (Mobula munkiana) es endémica del Pacífico Oriental y se sabe poco sobre su biología, ecología y uso de hábitat. Como filtradores, se asume que se concentran en regiones de afloramiento con alta productividad; sus poblaciones se consideran en disminución y requieren información urgente para fundamentar medidas de conservación. Objetivo: El estudio se realizó para obtener información sobre un comportamiento de alimentación observado en juveniles de M. munkiana, con el fin de proporcionar más información sobre las primeras etapas de vida de esta especie considerada vulnerable a la extinción. Métodos: De junio a setiembre de 2017 y en agosto de 2018, se observó el comportamiento de alimentación de los juveniles de M. munkiana en dos bahías poco profundas de Punta Descartes, en el Pacífico norte de Costa Rica. Los individuos fueron capturados utilizando un método no letal para obtener datos sobre el tamaño, peso y sexo. Se tomaron 100 muestras de plancton en las bahías para inferir la composición de la dieta. Resultados: Las rayas mostraron un comportamiento de natación repetitivo paralelo a la playa, alimentándose exclusivamente en la zona de rompimiento de las olas en marea baja, a menos de 50 cm de profundidad. Un total de 12 rayas M. munkiana (11 vivas y una encontrada muerta) indicaron una agregación de juveniles para alimentarse. Los anchos de disco variaron de 490 a 610 mm y el peso entre 1400 a 2300 g. La proporción sexual (machos: hembras) fue de 3:1. En la zona donde rompían las olas se encontró principalmente el orden Mysidaceae. Conclusiones: El comportamiento específico y la ocurrencia estacional de M. munkiana en la zona de estudio parecen estar impulsados por la abundancia de presas. Se necesita más investigación para concluir la presencia de adultos reproductivos a mayor profundidad y sobre el uso de hábitat en los alrededores de Punta Descartes durante todo el año. Esta área se encuentra amenazada por un desarrollo insostenible y requiere estrategias de manejo realistas para garantizar la supervivencia de especies vulnerables y sus hábitats críticos.

Diversity of white spot patterns in the eagle ray Aetobatus laticeps (Myliobatiformes: Aetobatidae) in the north Pacific coast of Costa Rica

Introduction: The Pacific white-spotted eagle ray Aetobatus laticeps, has recently separated from the Atlantic A. narinari based on both morphological and genetic evidence. This species is characterized by a dark body with numerous white spots all over its dorsal side. Considering the type, shape, number, and distribution of these natural markings as potential identifiers at the individual level, we studied the variation in the spot patterns. Objective: Describe and compare the white spot pattern (type and distribution) of individuals and evaluate their potential use as identifiers at the individual level. Methods: We analyzed 54 videos (105 subsequent extracted photos) and 19 photographic records that were taken at different sites along the Pacific coast of northern Costa Rica. Results: Seventeen distinctive types of white spots were identified across the entire dorsal side of the rays. Significant differences between each major body section (pectoral fins, back, head, and pelvic fins) were found in the type and frequency of white spots. The type 'single spot' was commonly distributed across the entire dorsal side, and the spot pattern on the pelvic fins was informative to identify 72 individuals. Conclusions: The analysis of the type, shape, and distribution of white spots in A. laticeps determined several combinations of white spot patterns that be used for further taxonomic description and provide potential identification of the individual for future population studies along with its distribution.

Introducción: La raya águila de manchas blancas del Pacífico, Aetobatus laticeps, se ha separado recientemente de A. narinari del Atlántico basándose en pruebas tanto morfológicas como genéticas. Esta especie se caracteriza por un cuerpo oscuro con numerosas manchas blancas en toda su parte dorsal. Considerando el tipo, la forma, el número y la distribución de estas marcas naturales como identificadores potenciales a nivel individual, estudiamos la variación en los patrones de manchas. Objetivo: Describir y comparar el patrón de manchas blancas (tipo y distribución) de individuos y evaluar su uso potencial como identificadores a nivel individual en especímenes recapturados. Métodos: Analizamos 54 videos (con 105 fotografías extraídas posteriormente) y 19 registros fotográficos que fueron tomados en diferentes sitios a lo largo de la costa pacífica del norte de Costa Rica. Resultados: Se identificaron diecisiete tipos distintivos de manchas blancas en todo el lado dorsal de los radios. Se encontraron diferencias significativas entre cada sección principal del cuerpo (aletas pectorales, espalda, cabeza y aletas pélvicas) en el tipo y frecuencia de manchas blancas. El tipo 'punto único' se distribuyó comúnmente en todo el lado dorsal, y el patrón de puntos en las aletas pélvicas fue informativo para identificar 72 individuos. Conclusiones: El análisis del tipo, la forma y la distribución de las manchas blancas en A. laticeps determinó varias combinaciones de patrones de manchas blancas que se utilizarán para una descripción taxonómica adicional y brindan una identificación potencial del individuo para futuros estudios de población a lo largo de su distribución.

Embarazo ectópico en cicatriz de cesárea: reporte de caso y revisión de la literatura. Hospital Simón Bolívar subred norte Bogotá, Colombia / Ectopic pregnancy in cesarean section scar: case report and literature review. Hospital Simón Bolívar Subred Norte, Bogota, Colombia / Gravidez ectópica em cicatriz de cesárea: relato de caso e revisão da literatura. Hospital Simón Bolívar, subrede norte Bogotá, Colômbia

Resumen: El embarazo ectópico se define como la Implantación del saco gestaclonal fuera del útero y representa el 3 % de todos los embarazos. La ubicación anatómica más frecuente es en la trompa uterina, en donde se presenta en un 95 %, dejando así un 5 % a otras localizaciones como el ovario, la cavidad abdominal, cervlcouterina y cicatriz uterina previa. El caso es relevante por su baja prevalencia y por los hallazgos ecográficos, las posibles opciones terapéuticas para la paciente y los hallazgos intraoperatorios. Se realizó una revisión de la literatura, utilizando bases de datos como PubMed, Medline y Science Direct, con el fin de evaluar y analizar el estado del arte de esta condición patológica. Presentamos el caso de una paciente con un embarazo de 7 semanas localizado a nivel ístmico cervical por ecografía, inicialmente tratada de manera conservadora con Metotrexato (MTX) sistémico, sin respuesta al tratamiento, por lo cual requirió intervención quirúrgica y preservación de la fertilidad. Se realiza una revisión actualizada del tema con los diferentes enfoques terapéuticos.

Abstract: Ectopic pregnancy is defined as the implantation of the gestational sac outside the uterus and it represents 3% of all pregnancies. The most frequent anatomical location is in the uterine tube, where it occurs in 95% of the cases, thus leaving 5% to other locations such as the ovary, the abdominal cavity, the cervix and a previous uterine scar. The case is relevant because of its low prevalence and because of the ultrasound findings, the possible therapeutic options for the patient, and the intraoperative findings. A literature review was carried out, using databases such as PubMed, Medline and Science Direct, in order to evaluate and analyze the state of the art of this pathological condition. Here, we present the case of a patient with a 7-week pregnancy located at the cervical isthmus level by ultrasound, initially treated conservatively with systemic Methotrexate (MTX), with no response to the treatment, and therefore she required surgical intervention and preservation of fertility. An updated review of the subject is carried out with the different therapeutic approaches.

Resumo: A gravidez ectópica é definida como a Implantação do saco gestaclonal fora do útero e representa 3 % de todas as gestações. A localização anatómica mais frequente é na trompa uterina, onde é apresentada em 95 %, deixando assim 5 % a outras localizações, como ovário, cavidade abdominal, cervicouterina e cicatriz uterina prévia. O caso é relevante por sua baixa prevalência e pelos achados ecográficos, as possíveis opções terapêuticas para a paciente e os achados intraope-ratórios. Foi realizada uma revisão da literatura com a utilização de bases de dados como PubMed, Medline e Science Direct, a fim de avaliar e analisar o estado da arte dessa condição patológica. Apresentamos o caso de uma paciente com uma gravidez de sete semanas localizada no nível Istmo cervical por ecografia, inicialmente tratada de maneira conservadora com metotrexato (MTX) sistémico, sem resposta ao tratamento, razão pela qual requiriu intervenção cirúrgica e preservação da fertilidade. Foi realizada uma revisão atualizada do tema com diferentes abordagens terapêuticas.

The prevalence of CYP2D6 Gene Polymorphisms among Filipinos and their use as biomarkers for lung cancer risk

Objectives@#The highly polymorphic nature of the CYP2D6 gene and its central role in the metabolism of commonly used drugs make it an ideal candidate for pharmacogenetic screening. This study aims to determine the prevalence of CYP2D6 polymorphisms among Filipinos and their association to lung cancer. @*Method@#Forty seven single nucleotide polymorphisms (SNPs) of the CYP2D6 gene were genotyped from DNA samples of 115 cases with lung cancer and age- and sex-matched 115 controls. @*Results@#Results show that 18 out of 47 polymorphisms have significant genotypic variability (>1% for at least 2 genotypes). No variant is associated with lung cancer. However, rs1135840, rs16947 and rs28360521, were found to be highly variable among Filipinos. @*Conclusion@#This study demonstrated that CYP2D6 polymorphisms are present among Filipinos, which, although not found to be associated with lung cancer, can be useful biomarkers for future pharmacogenetic studies. The SNP rs16947 is found to be associated with cancer and timolol-induced bradycardia; the SNP rs1135840, on the other hand, is only shown to be linked with cancer. The genetic variant rs28360521 is known to be associated with low-dose aspirin-induced lower gastrointestinal bleeding.

Necesidad de tratamiento periodontal e higiene oral en pacientes Garantías Explícitas en Salud de 60 años de Punta Arenas / Periodontal treatment need and oral hygiene in 60 year-old Explicit Health Guarantees (GES) patients from Punta Arenas

Objetivo Determinar la necesidad de tratamiento periodontal e higiene oral en adultos pertenecientes al programa de Garantías Explícitas en Salud (GES) de 60 años de Punta Arenas. Material y métodos Estudio observacional descriptivo transversal en el cual se seleccionaron 153 pacientes de 60 años de edad, de la ciudad de Punta Arenas, región de Magallanes y Antártica Chilena, pertenecientes al programa GES de los centros de salud municipalizados a través de una muestra aleatoria simple, representativa de cada establecimiento. Los pacientes fueron evaluados por un examinador previamente calibrado (K = 0,84) en un examen clínico visual para determinar la necesidad de tratamiento periodontal a través del Periodontal Screening and Recording (PSR) y el índice de higiene oral según O’Leary. Los datos fueron transferidos a una hoja de cálculo Microsoft Excel y analizados estadísticamente. Resultados La totalidad de los adultos mayores examinados necesitó tratamiento periodontal. Con respecto al índice de higiene oral un 98,69% de los pacientes presentó higiene deficiente. Conclusión La totalidad de los adultos mayores beneficiarios del GES 60 años presentan necesidad de tratamiento periodontal, además de observarse índices muy bajos de higiene oral, lo que muestra que la población no posee una condición favorable de salud oral.

Objective To determine the need for periodontal treatment and oral hygiene in sixty- year-old adults belonging to the GES (Explicit Health Guarantees) program in Punta Arenas. Material and methods A cross-sectional observational study was conducted in which 153 sixty-year-old GES patients were selected from municipal health centres in Punta Arenas, Magallanes and Chilean Antarctica. A simple random sample was used to select participants from each establishment. Patients were evaluated by a previously calibrated examiner (K = 0.84) through a visual clinical examination to determine the need for periodontal treatment through the Periodontal Screening and Recording (PSR), and the level of Oral Hygiene (O’Leary). Data were transferred to a Microsoft Excel worksheet and statistically analysed. Results All of the older adults needed periodontal treatment. Almost all (98.69%) of patients showed deficient oral hygiene. Conclusion All the 60-year-old GES patients in Punta Arenas have a need for periodontal treatment; all of them demonstrated extremely low indexes of oral hygiene, thus showing that this population does not have favourable oral health.

Prevalence of patients with cleft lip and palate who were treated at the San Borja Arriarán Clinical Hospital in Santiago Chile, within the AUGE Healthcare Plan / Prevalencia de pacientes con fisuras labio palatinas tratadas en el Hospital San Borja Arriarán en Santiago de Chile, en el marco del Plan Auge

Cleft lip and palate (CLP) are congenital defects caused by faulty fusion of the embryonic processes that participate in the formation of oral and nasal cavities, this leads to a number of functional, social and psychological alterations. The incidence is estimated at 1/700 live birth, resulting in a high cost to the public health system. In 2005 these malformations were incorporated in the Regime of Explicit Health Guarantees (Garantías Explícitas en Salud ­ GES), also known as Plan AUGE, a health program developed in Chile, that has been conceived and implemented to guarantee access, quality, protection and recovery for certain pathologies. To determine which clefts are more prevalent in patients who were treated in the Hospital and compare these results are consistent with international literature, along with which gender is more affected and their association with other syndromes. Medical records of 169 patients with CLP were reviewed. Their gender, type of cleft according to its anatomical classification and their association with other syndromes were recorded. Ten percent of the CLP were associated with syndromes, there being a higher prevalence among male infants (56.8%) than females (43.2%). Incidence of cleft lip, with or without cleft palate, was higher than the incidence of isolated cleft palate. CLP has a heterogeneous distribution. This creates the need to know, which clefts are more prevalent in our patients and to compare with other results.

Las Fisuras Labio Palatinas (FLP) son defectos congénitos causados por una mala fusión de los procesos embrionarios que participan en la formación de las cavidades oral y nasal, que generan una seria de alteraciones funcionales, sociales y pscicológicas. La incidencia de las FLP se estima en 1/700 nacidos vivos, lo que genera un importante gasto a nivel de salud pública. En el 2005 éstas malformaciones fueron incorporadas al "Régimen de Garantías Explícitas en Salud (GES)", también conocido como Plan AUGE, éste es un programa de salud concebido y creado para garantizar el acceso, calidad, protección y recuperación de ciertas patologías. Determinar que fisuras con más prevalentes en pacientes que han sido tratados en el Hospital y comparar estos resultados con la literatura internacional, además determinar que género se ve más afectado y si existe asociación con síndromes. Se revisaron las fichas clínicas de 169 pacientes con FLP. Registrándose el género, el tipo FLP de acuerdo a su clasificación anatómica y la asociación con otros síndromes. Resultados: 10% de las FLP presentaban otro síndrome asociado. Hay una mayor incidencia en el género masculino (56,8%) que en el femenino (43.2%). Las fisuras de labio, con o sin compromiso del paladar, son más frecuentes que las fisuras labiales aisladas. Las FLP tienen una distribución heterogénea. Esto crea la necesidad de conocer que fisuras son más prevalentes en nuestros pacientes con el objetivo de compararlos con otros resultados.

A six-month assessment of medical news reporting in leading local newspaper in the Philippines: Is it based on good evidence?

BACKGROUND: Evidence-Based Medicine (EBM) has brought about a paradigm shift in medical practice. However, evidence in peer-reviewed medical journals is inaccessible to a lay person for whom the newspaper is the most accessible source of information. This study aims to determine if medical news articles (MNAs) in leading local newspapers in the Philippines are based on good evidence. OBJECTIVES: To characterize MNAs based on: (1) references cited and their level of evidence as appraised by authors and two independent EBM experts; (2) use of clinical outcomes; (3) mention of treatment beneft and potential harm in measurable terms; (4) mention of cost of treatment; and (5) disclosure of pharmaceutical industry support. METHODS: MNAs on non-surgical prevention and treatment of adult diseases from January to June 2002 in three leading local Philippine newspapers were appraised. MNAs on diagnosis, pediatric and surgical treatments, multiple treatment modalities, columns were excluded. References were assessed independently by two EBM experts; diferences were resolved by consensus. RESULTS: The fve conditions most frequently reported on were: diabetes, coronary heart disease, cancer, arthritis and hypertension. Of 113 MNAs, 94 (83%) cited references4 were medical journal articles, 34 (63%) of which were based on good quality evidence. Out of the 94 MNAs, 51 (54%) reported clinical endpoints, 31 (33%) quantifed beneft, 21 (22%) cited potential harm, 22 (23%) disclosed industry support, and 4 (4%) mentioned cost of treatment. None of the MNA authors mentioned critically appraising their references. CONCLUSION: The 113 MNAs published in three leading local newspapers in the Philippines during the six-month period showed shortcomings in providing information to beneft the public. EBM awareness among journalists and studies covering a longer period and a broader line of the print media are recommended.