Comparación de pruebas moleculares para el diagnóstico de Leishmania spp. en lesiones cutáneas con baja carga parasitaria

Introducción: La leishmaniasis cutánea (LC) es un problema grave de salud pública en Panamá. El diagnóstico de esta parasitosis ha sido siempre desafiante, no sólo debido a su similitud con otras infecciones dérmicas, sino también a características particulares de las lesiones, como cargas parasitarias bajas. ​Materiales y Métodos: En este estudio, se evaluaron mediante cuatro métodos moleculares, 235 muestras de ADN procedentes de lesiones con frotis negativos por LC obtenidas durante el período 2015-2019. Resultados: Los resultados señalan que las sensibilidades encontradas fueron de 75.6% (IC 0.6234-0.8709) para la PCR kDNA-Género específico, de 66.7% (IC 0.5359-0.776) para la PCR Hsp70-Género específico y de 77.6% (IC 0.645-0.8949) para la qPCR 18S ribosomal. Todas las pruebas obtuvieron un valor predictivo positivo de 100%, mientras que el valor predictivo negativo más alto fue con la qPCR (80.58%) y el más bajo con el PCR Hsp70-Género específico (73.2%). En cuanto a la precisión de diagnóstico se obtuvo un rango mayor del 82% en todas las pruebas evaluadas. Conclusión: Este estudio confirma la buena sensibilidad de la PCR kDNA-Viannia para el análisis de lesiones de LC con baja carga parasitaria. Esta metodología es relativamente fácil de estandarizar, por lo que se recomienda su uso en laboratorios clínicos regionales de Panamá. Aun cuando la qPCR 18S ribosomal presentó una sensibilidad relativamente menor, el uso de esta metodología debe ser también considerada por su facilidad de uso, menor tiempo de ejecución y capacidad de cuantificación. (provisto por Infomedic International)

Introduction: Cutaneous leishmaniasis (CL) is a serious public health problem in Panama. The diagnosis of this parasitosis has always been challenging, not only because of its similarity to other dermal infections, but also because of characteristics of the lesions, such as low parasite loads. Materials and Methods: In this study, 235 DNA samples from smear-negative lesions by LC obtained during the period 2015-2019 were evaluated by four molecular methods. Results: The results indicate that the sensitivities found were 75.6% (CI 0.6234-0.8709) for kDNA-Gene-specific PCR, 66.7% (CI 0.5359-0.776) for Hsp70-Gene-specific PCR and 77.6% (CI 0.645-0.8949) for 18S ribosomal qPCR. All tests obtained a positive predictive value of 100%, while the highest negative predictive value was with qPCR (80.58%) and the lowest with Hsp70-Gene-specific PCR (73.2%). In terms of diagnostic accuracy, a range greater than 82% was obtained in all the tests evaluated. Conclusion: This study confirms the good sensitivity of kDNA-Viannia PCR for the analysis of LC lesions with low parasite load. This methodology is relatively easy to standardize, so it is recommended for use in regional clinical laboratories in Panama. Although 18S ribosomal qPCR showed a relatively lower sensitivity, the use of this methodology should also be considered because of its ease of use, shorter execution time and quantification capacity. (provided by Infomedic International)

Variables de medición del desempeño para la toma de decisiones en organizaciones deportivas: una revisión sistemática de literatura

R E S U M E N En el campo de estudio de la gestión organizacional, la medición del desempeño es de gran relevancia, ya que mide la capacidad de las organizaciones para cumplir sus objetivos. De esta forma, las directivas de la empresa pueden analizar desde diferentes niveles su gestión en relación con los procesos, objetivos, recursos, estrategias y cultura. Sin embargo, las organizaciones deportivas cuentan con diferentes públicos de interés, así como diversos tipos de análisis de acuerdo con su estructura y comportamiento organizacional, lo cual genera disparidad en los procesos de verificación y control asociados a la medición del desempeño para el logro de los objetivos organizacionales. Es por esto por lo que se hace necesario generar conocimiento en esta área. Esta investigación tiene como objetivo identificar variables de medición del desempeño aplicables a las organizaciones deportivas, que contribuya al fortalecimiento de la toma de decisiones. La metodología utilizada fue una revisión sistemática de literatura, posteriormente un análisis a través del software NVivo. Como resultado principal, se encontró el hallazgo de siete principales variables de medición del desempeño aplicables a las organizaciones deportivas: la creatividad, la innovación, la productividad, la eficiencia, la eficacia, la competitividad y la rentabilidad.

In the field of study of organizational management, performance measurement is of great relevance, since it measures the capacity of organizations to meet their objectives. In this way company directors can analyze their management from different levels in relation to processes, objectives, resources, strategies and culture. However; sports organizations have different publics of interest, as well as various types of analysis according to their structure and organizational behavior; which generates disparity in the verification and control processes associated with performance measurement for the achievement of objectives. organizational goals. This is why it is necessary to generate knowledge in this area. This research aims to identify performance measurement variables applicable to sports organizations, which contributes to the strengthening of decision-making. The methodology used was a systematic literature review, followed by an analysis using the NVivo software. As a main result, the finding of seven main performance measurement variables applicable to sports organizations was found: creativity innovation, productivity, efficiency effectiveness, competitiveness and profitability.

No campo da gestão organizacional, a medição do desempenho é de grande relevância, pois mede a capacidade das organizações de atingir seus objetivos. Desta forma, a administração da empresa pode analisar sua gestão em diferentes níveis em relação a processos, objetivos, recursos, estratégias e cultura. Entretanto, as organizações esportivas têm diferentes públicos de interesse e diferentes tipos de análise de acordo com sua estrutura e comportamento organizacional, o que gera disparidade nos processos de verificação e controle associados à medição de desempenho para a realização dos objetivos organizacionais. É por isso que é necessário gerar conhecimento nesta área. Esta pesquisa visa identificar variáveis de medição de desempenho aplicáveis às organizações esportivas que contribuem para fortalecer a tomada de decisões. A metodologia utilizada foi uma revisão sistemática da literatura, seguida por uma análise utilizando o software NVivo. O principal resultado foi a descoberta de sete variáveis principais de medição de desempenho aplicáveis às organizações esportivas: criatividade, inovação, produtividade, eficiência, eficácia, competitividade e lucratividade.

Colitis amebiana fulminante con desenlace fatal en un paciente con probable infección por SARS-CoV-2 / Fulminant amebic colitis with fatal outcome in a patient with probable SARS-CoV-2 infection

RESUMEN Se reporta el caso de un varón de 62 años quien presentó tos y dolor abdominal por dos semanas, con hallazgos tomográficos pulmonares compatibles con probable infección por SARS-CoV-2, que recibió tempranamente corticoterapia a dosis altas y de manera ambulatoria. El paciente presentó evolución tórpida, fue hospitalizado y falleció en el posoperatorio inmediato por un cuadro de abdomen agudo quirúrgico. El estudio anatomopatológico mostró estructuras parasitarias con características compatibles con amebas, como causa de una colitis aguda fulminante complicada, con perforación múltiple y peritonitis aguda. La colitis aguda fulminante por amebiasis intestinal en el contexto de un paciente con probable COVID-19 no había sido reportada en el Perú. Resulta importante resaltar la presentación fulminante con desenlace fatal de esta infección parasitaria prevalente en nuestro medio, en el contexto del uso de corticoides ante una probable infección pulmonar por COVID-19.

ABSTRACT We report the case of a 62-year-old male with cough and abdominal pain for two weeks, associated with pulmonary tomographic findings compatible with probable infection by SARS-CoV-2, and who received high doses of early corticotherapy as an outpatient. The patient showed clinical deterioration, was hospitalized and died in the immediate postoperative period due to acute surgical abdomen. The anatomopathological study showed parasitic structures with characteristics compatible with amebae, which was pointed to as the cause of a complicated acute fulminant colitis, with multiple perforations and acute peritonitis. Acute fulminant colitis due to intestinal amebiasis in the context of a patient with probable COVID-19 had not been previously reported in Peru. It is important to highlight the fulminant presentation with fatal outcome of this prevalent parasitic infection, in the context of corticosteroids use in a probable SARS-CoV-2 pulmonary infection.

Evaluation of cytochrome b sequence to identify Leishmania species and variants: the case of Panama

BACKGROUND The genetic heterogeneity of Leishmania parasites is a major factor responsible for the wide variety of Leishmania-associated manifestations. Consequently, understanding the genetic make-up of Leishmania species using suitable molecular markers is an important component of realising local and regional scale disease risk. The cytochrome b (cytb) is frequently used to type New World Leishmania species. However, its potential to discriminate Leishmania species and variants requires further evaluation. OBJECTIVES To explore the capacity of cytb gene to identify New World Leishmania species and variants and to develop an approach able to type local Leishmania species and variants. METHODS We retrieved 360 partial and complete Leishmania cytb gene sequences publicly available in GenBank database to study all single nucleotide polymorphisms (SNPs) across the cytb gene that differentiate New World Leishmania species. This information was used to develop an approach based upon the polymorphisms found in a DNA segment of 948bp. We also compared the typing results found with this technique with the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) profiling obtained using HSP70 gene as target. One hundred Panamanian isolates were used to both typed Leishmania species and assess local genetic variability. FINDINGS We found complete agreement between our cytb approach and the PCR-RFLP profiling method based on HSP70 for Leishmania species identification. Ninety-two isolates were identified as L. panamensis, although other Viannia species were found circulating at a lower frequency. Three L. panamensis haplotypes were identified in Panamanian provinces. We also provide an initial report of L. guyanensis haplotypes circulating in Panama. MAIN CONCLUSIONS Cytb gene sequence encompasses key main SNPs that aid to identify Leishmania species. The cytb approach developed with this information was able to identify and assess genetic variability of local Leishmania species found in this study.

Oral Manifestations Associated to Paracoccidioidomicosis and Histoplasmosis

Objective: To determine the frequency and clinical forms of oral manifestations associated to Paracoccidioidomycosis (PCM) and Histoplasmosis. Material and Methods: 481 medical records of outpatients referred to the Medical Mycology Department were reviewed since 2009 to 2016. Data were analyzed using descriptive statistical methods. Results: 47 (9.77%) cases had oral manifestations, 29 (61.70%) were associated to PCM and 18 (38.29%) to histoplasmosis. For PCM, male-female ratio was 8:1 and 1:1 for histoplasmosis. The average age for PCM was 48 years old and 53 for histoplasmosis. All the PCM patients had more than 1 oral structure affected: 44.82% were gingival lesions and 27.58% palate. In patients with histoplasmosis, 6 (33.33%) were lesions affecting palate and 6 (33.33%) involving tongue. For both entities, painful ulcers and granulomatous-like lesions were the most prevalent clinical forms; however, we observed a wide range of other oral manifestations. Regarding PCM patient's comorbidities, 3 (10.34%) cases had HIV/AIDS, 8 (27.58%) histoplasmosis and 2 (6.89%) carcinomas. Whereas the comorbidities of patients with histoplasmosis, 2 (11.11%) had HIV/AIDS and 1 (5.55%) had carcinoma. Conclusion: In endemic countries for both mycoses, dentists must be aware of patients with mouth lesions, take advantage of epidemiologic clues that suggest risk factors and be acquainted with all the current diagnostic tests in order to make a quick diagnosis and treatment in highly suspicious cases.

Presentaciones atípicas de histoplasmosis: anemia hemolítica. Descripción de un caso y revisión de la literatura / Atypical presentations of histoplasmosis: hemolytic anemia. Case report and literature review

La histoplasmosis es una enfermedad granulomatosa, producida por Histoplasma capsulatum. Causa un amplio espectro de manifestaciones clínicas, la más frecuente es la pulmonar. En algunos casos se presentan formas diseminadas, con afectación de uno o múltiples órganos, con características atípicas, difíciles de reconocer. Reporte del caso: Se presenta el caso de un paciente masculino de 70 años de edad, procedente de Barinas, quien trabajó en una granja de gallinas, con diagnóstico de histoplasmosis y anemia hemolítica, las cuales se resolvieron con tratamiento antifúngico. Conclusiones: En Venezuela, zona endémica para esta micosis, el médico está obligado a tener un alto índice de sospecha acerca de la misma, teniendo en cuenta factores como la edad y la epidemiología. A la luz de nuestros conocimientos, es el tercer caso reportado.

Histoplasmosis is a granulomatous disease, produced by Histoplasma capsulatum. This fungus causes a wide range of clinical manifestations; the most common is the pulmonary form. In some cases, atypical presentations are described. Case report: a 70 year old male patient, from Barinas, Venezuela, who worked in a chicken farm, with diagnosis of histoplasmosis and hemolytic anemia is described. The patient improved with antifungal treatment. Conclusions: in Venezuela, an endemic area for this mycosis, clinicians must have a high suspicion index for this disease, taking into account risk factors, such as age and epidemiology. To our knowledge, this is the third case report in the literature.

Risk factors associated with Trypanosoma cruziexposure in domestic dogs from a rural community in Panama

Chagas disease, caused by Trypanosoma cruziinfection, is a zoonosis of humans, wild and domestic mammals, including dogs. In Panama, the main T. cruzivector is Rhodnius pallescens, a triatomine bug whose main natural habitat is the royal palm, Attalea butyracea. In this paper, we present results from three T. cruziserological tests (immunochromatographic dipstick, indirect immunofluorescence and ELISA) performed in 51 dogs from 24 houses in Trinidad de Las Minas, western Panama. We found that nine dogs were seropositive (17.6% prevalence). Dogs were 1.6 times more likely to become T. cruziseropositive with each year of age and 11.6 times if royal palms where present in the peridomiciliary area of the dog’s household or its two nearest neighbours. Mouse-baited-adhesive traps were employed to evaluate 12 peridomestic royal palms. All palms were found infested with R. pallescenswith an average of 25.50 triatomines captured per palm. Of 35 adult bugs analysed, 88.6% showed protozoa flagellates in their intestinal contents. In addition, dogs were five times more likely to be infected by the presence of an additional domestic animal species in the dog’s peridomiciliary environment. Our results suggest that interventions focused on royal palms might reduce the exposure to T. cruzi infection.

Concordancia entre los métodos del diagnóstico micológico de la paracoccidioidomicosis / Concordance between methods of mycological diagnosis of paracoccidioidomycosis

La paracoccidioidomicosis (PCM) es una enfermedad crónica, sistémica, granulomatosa, endémica en nuestro país, producida por un hongo dimorfo denominado Paracoccidioides brasiliensis. Existen numerosas técnicas para realizar el diagnóstico de esta entidad. Nos planteamos la posibilidad de realizar un estudio para determinar la concordancia que pudiese existir entre las diferentes técnicas que se utilizan para el diagnóstico de la PCM. Se realizó un registro de historias clínicas. Se evaluaron 251 historias clínicas de pacientes con diagnóstico de PCM, de la consulta externa de la Sección de Micología Médica “Dr. Dante Borelli” del IMT-UCV, entre los años 2000 y 2010. Se determinó la concordancia entre los métodos diagnósticos por medio del análisis de concordancia de atributos para datos binarios. Entre el examen directo y el cultivo, no hubo acuerdo. Entre la serología y el examen directo, se encontró que hubo equivalencia, así como entre el cultivo y la serología. No se pudo calcular correlación alguna con la histopatología, ya que no hubo datos negativos, en vista de que todas las muestras procesadas fueron positivas. El diagnóstico de la PCM se basa en la identificación y el aislamiento del hongo. Es obligatoria la realización del examen directo en fresco de toda muestra clínica. Nuestro estudio de muestra que deben realizarse todos los métodos que estén al alcance (examen directo en fresco, cultivo, serología, histopatología) a fin de aumentar la probabilidad de llegar a un diagnóstico certero de esta patología

Paracoccidioidomycosis (PCM) is a chronic, granulomatous disease, endemic in our country, produced by a dimorphic fungus, Paracoccidioides brasiliensis. Several techniques are used for the diagnosis. A study was performed to determine the agreement that could exist between the different techniques, used for the diagnosis of PCM. Clinical records of patients with diagnosis of PCM was made. 251 clinical records were reviewed, from the Sección de Micología Médica “Dr. Dante Borelli”, IMT- UCV, between 2000 and 2010. The agreement between the methods was determined by means of the analysis of agreement of attributes for binary data. Between direct examination and culture, there was no agreement. Between serology and direct examination, there was equivalence, as well as between culture and serology. Correlation could not be calculated with histopathology, since there were no negative data, due to the fact that all the processed samples were positive. The diagnosis of the PCM is based on the identification and isolation of the fungus. Direct examination is mandatory in all clinical samples. Our study demonstrates that all the methods must be performed (direct examination, culture, serology, histopathology) in order to increase the probability of reaching an accurate diagnosis

Conocimientos y factores de riesgo relacionados con la enfermedad de Chagas en dos comunidades panameñas donde Rhodnius pallescens es el vector principal / Knowledge and risk factors related to Chagas´ disease in two Panamanian communities where Rhodnius pallescens is the main vector

Introducción. La implementación de los programas de vigilancia, prevención y control de la enfermedad de Chagas requiere una aproximación integral. La sostenibilidad de los programas depende de la participación comunitaria amparada en un conocimiento básico del problema. Objetivo. Evaluar los conocimientos de los entrevistados que facilitan o limitan la vigilancia, prevención y control de la enfermedad de Chagas en dos comunidades endémicas de Panamá donde Rhodnius pallescens es el vector principal. Materiales y métodos. Mediante un cuestionario se evaluaron los conocimientos y los factores de riesgo relacionados con la enfermedad de Chagas en 201 personas mayores de 10 años de las comunidades endémicas de Las Pavas y Lagartera Grande, ubicadas en la ribera oeste del Canal de Panamá. Con ayuda de los moradores también se evaluó la presencia de chinches triatominos en 93 viviendas a lo largo de un año. Resultados. De las personas entrevistadas, 69,2 % (139/201) tenía pocos o muy pocos conocimientos sobre la enfermedad de Chagas y 93 % (187/201) estaba expuesto a factores de riesgo moderados o altos. Se capturaron chinches triatominos en 20,4 % (19/93) de las viviendas evaluadas, de los cuales, el 86,8 % (66/76) era R. pallescens. Se encontró asociación significativa entre la presencia de chinches dentro de las viviendas y las viviendas catalogadas como precarias (p<0,01). Conclusión. A pesar de que en estas dos comunidades se han desarrollado programas de educación sanitaria, es necesario reforzar los conocimientos básicos sobre la enfermedad de Chagas antes de establecer medidas de prevención y vigilancia que involucren la participación activa de sus habitantes.

Introduction: The implementation of surveillance, control and prevention measures for Chagas´ disease requires an integrated approach. The sustainability of programs depends on community participation supported on a basic understanding of the problem. Objective: To evaluate the knowledge of people interviewed which facilitates or limits the surveillance, prevention and control of Chagas´ disease in two endemic Panamanian communities where Rhodnius pallescens is the main vector. Materials and methods: A questionnaire assessed the knowledge and risk factors related to Chagas´ disease in 201 people over 10 years of age from the endemic communities of Las Pavas and Lagartera Grande located on the western shore of Panama Canal. Additionally, with the help of the residents, the presence of triatomine bugs in 93 dwellings was evaluated during a year. Results: Of those interviewed, 69.2% (139/201) had poor or very poor knowledge about Chagas´ disease. Nearly 93% (187/201) was exposed to moderate or high risk factors. Triatomine bugs were collected in 20.4% (19/93) of the evaluated homes; 80% (66/76) of them were R. pallescens . Significant association was found between the presence of triatomines inside the houses and precarious housing (p<0.01). Conclusion: Despite having been exposed to health education-related programs, it is necessary to strengthen the basic knowledge about Chagas´ disease in the two communities before establishing prevention and surveillance measures which involve active participation of its inhabitants.

Evaluación de diversos métodos fenotípicos para la diferenciación entre Candida dubliniensis y Candida albicans / Evaluation of diverse phenotypic methods for differenting between Candida dubliniensis and Candida albicans

Candida albicans y Candida dubliniensis presentan una estrecha relación filogenética. La similitud de estas especies puede hacer que en un laboratorio microbiológico se identifique en forma errónea C. dubliniensis como C. albicans. El objetivo de esta investigación fue evaluar diversos métodos fenotípicos para la diferenciación entre Candida dubliniensis y Candida albicans. Se utilizaron 6 cepas control de C. dubliniensis y una de C. albicans, provenientes de colecciones reconocidas y sometidas a genotipificación. También se utilizaron 70 aislados identificados como posibles C. albicans utilizando el medio CHROMagar Candida y el medio de bilis agar Feo. Los métodos evaluados fueron: agar Sabouraud dextrosa a 45°C, agar Sabouraud con NaCl al 6,5%, agar Tween 80, agar tabaco, agar Pal’s, agar tomate-zanahoria y aglutinación con partículas de látex (Bichro-Dubli Fumouze®). Encontramos que las técnicas más confiables para realizar la diferenciación fenotípica entre estas dos especies fueron: el agar tomate-zanahoria, el agar Pal’s, el agar tabaco y la aglutinación con partículas de látex (Bichro-Dubli Fumouze®). Además en este estudio, de los 70 aislados considerados como C. albicans, encontramos 1 (1.4%) posible Candida dubliniensis. Sin embargo, las pruebas de biología molecular son las más adecuadas para el diagnóstico certero de estas dos especies.

Candida albicans and Candida dubliniensis have a close phylogenetic relationship. The similarity between these species can cause a microbiology laboratory to identify C. dubliniensis erroneously as C. albicans. The objective of this research was to evaluate diverse phenotypic methods for differentiating between Candida dubliniensis and Candida albicans. Six control strains of C. dubliniensis and one of C. albicans from recognized collections were used and submitted to genotypification. Also, 70 isolates were used, identified as possible C. albicans utilizing CHROMagar Candida and bilis agar Feo mediums. The methods evaluated were: Sabouraud dextrosa agar at 45°C, Sabouraud agar with NaCl at 6.5%, Tween 80 agar, tobacco agar, Pal’s agar, tomato-carrot agar and agglutination with latex particles (Bichro-Dubli Fumouze®). It was found that the most reliable techniques for performing phenotype differentiation between these two species were tomato-carrot agar, Pal’s agar, tobacco agar and agglutination with latex particles (Bichro-Dubli Fumouze®). Of the 70 isolates considered to be C. albicans, one (1.4%) possible Candida dubliniensis was found. Nevertheless, molecular biology tests are the most appropriate means for achieving an accurate diagnosis of these two species.

Evaluación de la susceptibilidad a glicopéptidos en cepas de Staphylococcus aureus resistentes a oxacilina / Evaluation of susceptibility to glycopeptides in oxacillin resistant Staphylococcus aureus strains

Candida albicans y Candida dubliniensis presentan una estrecha relación filogenética. La similitud de estas especies puede hacer que en un laboratorio microbiológico se identifique en forma errónea C. dubliniensis como C. albicans. El objetivo de esta investigación fue evaluar diversos métodos fenotípicos para la diferenciación entre Candida dubliniensis y Candida albicans. Se utilizaron 6 cepas control de C. dubliniensis y una de C. albicans, provenientes de colecciones reconocidas y sometidas a genotipificación. También se utilizaron 70 aislados identificados como posibles C. albicans utilizando el medio CHROMagar Candida y el medio de bilis agar Feo. Los métodos evaluados fueron: agar Sabouraud dextrosa a 45°C, agar Sabouraud con NaCl al 6,5%, agar Tween 80, agar tabaco, agar Pal’s, agar tomate-zanahoria y aglutinación con partículas de látex (Bichro-Dubli Fumouze®). Encontramos que las técnicas más confiables para realizar la diferenciación fenotípica entre estas dos especies fueron: el agar tomate-zanahoria, el agar Pal’s, el agar tabaco y la aglutinación con partículas de látex (Bichro-Dubli Fumouze®). Además en este estudio, de los 70 aislados considerados como C. albicans, encontramos 1 (1.4%) posible Candida dubliniensis. Sin embargo, las pruebas de biología molecular son las más adecuadas para el diagnóstico certero de estas dos especies.

Candida albicans and Candida dubliniensis have a close phylogenetic relationship. The similarity between these species can cause a microbiology laboratory to identify C. dubliniensis erroneously as C. albicans. The objective of this research was to evaluate diverse phenotypic methods for differentiating between Candida dubliniensis and Candida albicans. Six control strains of C. dubliniensis and one of C. albicans from recognized collections were used and submitted to genotypification. Also, 70 isolates were used, identified as possible C. albicans utilizing CHROMagar Candida and bilis agar Feo mediums. The methods evaluated were: Sabouraud dextrosa agar at 45°C, Sabouraud agar with NaCl at 6.5%, Tween 80 agar, tobacco agar, Pal’s agar, tomato-carrot agar and agglutination with latex particles (Bichro-Dubli Fumouze®). It was found that the most reliable techniques for performing phenotype differentiation between these two species were tomato-carrot agar, Pal’s agar, tobacco agar and agglutination with latex particles (Bichro-Dubli Fumouze®). Of the 70 isolates considered to be C. albicans, one (1.4%) possible Candida dubliniensis was found. Nevertheless, molecular biology tests are the most appropriate means for achieving an accurate diagnosis of these two species.

Detección e identificación de Candida dubliniensis por métodos fenotípicos en estomatitis sub-protésica: reporte de un caso / Detection and identification of methods for phenotypic Candida dubliniensis in denture stomatitis: report of case

La Estomatitis Sub-Protésica es una afección comúnmente observada en sujetos portadores de prótesis dentales removibles. Son numerosos los reportes publicados en los que se asocia esta patología con la presencia de hongos del Género Candida, y particularmente con Candida albicans. No obstante, algunas cepas identificadas como C. albicans, pudieran no tratarse en realidad de este microorganismo sino de Candida dubliniensis, más aún si se toma en cuenta que ambas especies producen clamidoconidias. Es por ello que resulta necesario comparar distintos métodos fenotípicos que permitan diferenciar en buena medida a ambas especies. En este artículo se describe el caso de una paciente portadora de prótesis removible superior con diagnóstico clínico de Estomatitis Sub-Protésica, a quien se le tomó muestras del paladar afectado y de la prótesis implicada. Se emplearon diferentes métodos fenotípicos de identificación diferencial de ambas especies, entre estos: CHROMagar Candida, Agar tabaco, Agar Pal´s, Agar Tween 80, medio de tomate y zanahoria y de Agar Sabouraud con NaCl al 6,5% (P/V). También se realizaron la pruebas de termotolerancia a 45ºC, aglutinación en latex, así como la identificación a través del sistema ID 32C (bioMerieux). Una vez empleados los métodos antes mencionados, la especie encontrada en el paladar de la paciente fue C. dubliniensis, en tanto que la que se halló en la prótesis fue C. albicans, siendo esta la primera vez que se detecta e identifica en nuestro país a C.dubliniensis en pacientes que presentan esta patología bucal.

Denture stomatitis is a condition commonly observed in subjects with removable dentures. There are numerous reports published in which this disease is associated with the presence of fungi of the genus Candida, particularly Candida albicans. However, some strains identified as C. albicans, may not actually be this organism but Candida dubliniensis, especially if one takes into account that both species produce clamidoconidias. That is why it is necessary to compare different phenotypic methods to differentiate largely to both species. This article describes the case of a patient with upper removable prosthesis with a clinical diagnosis of Denture Stomatitis, whom he took samples of the palate is affected and the prosthesis involved. Different methods were used phenotypic differential identification of both species, among them: CHROMagar Candida Agar snuff, Pal's Agar, Tween 80 Agar, tomato and carrot medium, and Sabouraud Agar with 6.5% NaCl (P / V ). Also thermotolerance tests performed at 45 ° C, latex agglutination, and identification by ID 32C system (bioMerieux) were used. Once employed the above methods, the species found in the mouth of the patient was C. dubliniensis, whereas that was found in the prosthesis was C. albicans, marking the first time it is detected and identified in our country C.dubliniensis in patients with this oral pathology.

Evaluación de la incapacidad laboral respiratoria / Assessment of disability occupational respiratory

La incapacidad laboral respiratoria o invalidez se produce cuando hay limitación para el desempeño adecuado de las tareas laborales.5 La disfunción o menoscabo se refiere a la pérdida de la función, cuya cuantificación debe realizarla de manera objetiva el médico neumólogo, fundamentarse con pruebas diagnósticas estandarizadas, y determinar la gravedad de la enfermedad, así como su repercusión en las actividades cotidianas. El dictamen de la incapacidad laboral resultante, compete a la Comisión Médica Calificadora de Incapacidad.

Occupational respiratory disability occurs when the worker is unable to successfully perform work tasks. Impairment refers to loss of function whichmeasurement must be objectively made by the pulmonologist, based on standardized tests to determine the severity of disease and its impact on daily activities. The occupational disability certification must be made by the Qualifying Medical Disability Committee.

Feeding sources and trypanosome infection index of Rhodnius pallescens in a Chagas disease endemic area of Amador County, Panama

The sylvatic triatomine Rhodnius pallescens is considered to be the most important and widespread vector of Trypanosoma cruzi and Trypanosoma rangeli in Panama. However, its behavior and biological characteristics have only been partially investigated. Thus, to achieve sustainable and efficient control over Chagas disease in Panama, a better understanding of the ecology and biology of R. pallescens is essential. In this study we evaluated R. pallescens host feeding sources using a dot-blot assay, and the trypanosome infection index by PCR analysis in a Chagas disease endemic area of central Panama. It was found that in peridomestic palm trees, 20.3 percent of the examined bugs had fed on opossums (Didelphis marsupialis). However, we observed an increased anthropophagy (25.4 percent) for those bugs collected inside houses. Considering the domestic and peridomestic habitats as a whole, the proportion of collected R. pallescens infected with trypanosomes was 87.4 percent. In the two habitats the predominant infection was with T. cruzi (80-90 percent). Between 47-51 percent of the analyzed triatomines were infected with T. rangeli. Mixed infections (40-51 percent) were also detected. These findings provide a better basis for the implementation of a rational control and surveillance program for Chagas disease in regions where R. pallescens is endemic.

O triatomíneo silvestre Rhodnius pallescens é considerado o mais importante vetor do Trypanosoma cruzi e Trypanosoma rangeli no Panamá. Entretanto, seu comportamento e características biológicas são pouco estudados. Para controlar a doença de Chagas no Panamá é necessário melhorar a compreensão dos aspectos eco-biológicos do R. pallescens. Neste estudo, investigaram-se as fontes de alimentação de R. pallescens usando dot-blot e o índice de infecção por Trypanosoma por metodologia molecular, em área endêmica da doença de Chagas na região central do Panamá. Foi observado que 20,3 por cento dos barbeiros coletados em palmeiras peridomésticas se alimentavam de gambás (Didelphis marsupialis). Contudo, barbeiros coletados dentro das residências apresentaram antropofagia aumentada (25,4 por cento). Considerando o ambiente doméstico e peridoméstico juntos, o percentual de R. pallescens infectados com Trypanosoma foi de 87,4 por cento. Nos ambientes doméstico e peridoméstico, a infecção por T. cruzi foi de 80,4 por cento e 90 por cento; a infecção por T. rangeli foi de 47 por cento e 51 por cento, respectivamente. Observou-se infecção mista em 43 por cento dos triatomíneos coletados em ambiente doméstico e em 51 por cento dos triatomíneos peridomésticos. Estes achados fornecem embasamento para a implementação de um controle adequado e um programa de vigilância para a doença de Chagas em regiões onde o R. pallescens é endêmico.