Histoplasmosis en pacientes con infección por VIH en Paraguay: Casuística del Laboratorio Central del Ministerio de Salud Pública en el período 1993-2017

Resumen Introducción: La histoplasmosis es una micosis sistémica en pacientes inmunodeprimidos y su epidemiología es desconocida en el país. Objetivo: Describir los datos demográficos y clínicos de pacientes con infección por VIH (IpVIH) e histoplasmosis diagnosticadas en el Laboratorio Central de Salud Pública, Asunción-Paraguay. Pacientes yMétodos: Estudio retrospectivo y transversal de pacientes con muestras positivas a Histoplasma capsulatum diagnosticados en el período 1993-2017. Resultados: Fueron diagnosticados 162 pacientes con IpVIH e histoplasmosis. El origen de los pacientes en orden de prevalencia fue: la capital Asunción, Central, Cordillera y San Pedro. La relación hombre/mujer fue 4:1 y la edad media 34,1 ± 7,7 años con un rango de 18 a 61 años. La fiebre, las lesiones en piel y las úlceras en mucosa fueron los síntomas y manifestaciones más frecuentes. Los métodos para diagnósticos más utilizados fueron las escarificaciones de piel, úlceras muco-cutáneas y las punciones de médula ósea. Conclusión: Por ser el primer reporte nacional de histoplasmosis en pacientes con IpVIH, consideramos este trabajo relevante para la base de otros estudios de micosis profunda.

Abstract Background: Histoplasmosis is a systemic mycosis in immunosuppressed patients and its epidemiology is unknown in the country. Aim: To describe the demographic and clinical data of patients with HIV infection and histoplasmosis diagnosed in the Central Public Health Laboratory, Asunción-Paraguay. Methods: Retrospective and cross-sectional study of patients with Histoplasma capsulatum positive samples diagnosed in the period 1993-2017. Results: 162 patients with HIV infection were diagnosed as histoplasmosis. The origin of the patients in order of prevalence were the capital Asunción, Central, Cordillera and San Pedro departments. The male/female ratio was 4: 1 and the mean age was 34.1 ± 7.7 years with a range of18 to 61 years. Fever, skin lesions and mucosal ulcers were the most frequent symptoms and manifestations. The most widely used diagnostic methods were scarification of skin, mucocutaneous ulcers and bone marrow punctures. Conclusion: As it is the first national report of histoplasmosis in patients with HIV infection, we consider this work relevant for the basis of other studies of deep mycosis.

Análisis morfométrico e índices corporales del capitán de la sabana / Morphometric analysis and body indexes of the catfish (Eremophilus mutisii)

RESUMEN Con el objetivo de caracterizar la morfometría e índices corporales de Eremophilus mutisii, se usaron treinta y tres peces (27 hembras y 6 machos) provenientes del río Bogotá, específicamente de la región de Suesca. La relación de aspecto de la aleta caudal se determinó mediante el software de análisis de imágenes ImageJ®. Se calculó el índice gonadosomático, hepatosomático y rendimiento en canal para cada pez. Para el análisis de los datos se usaron correlaciones, regresiones y técnicas de análisis multivariado (análisis discriminante canónico). Como resultado del estudio se encontró que el sexo no afecta la forma del cuerpo de los peces. La relación entre la longitud y el peso se ajustó para cada sexo. La relación de aspecto de la aleta caudal presentó un promedio de 1,57 lo que sugiere que la especie presenta hábito sedentario o de natación lenta. El índice gonadosomático de las hembras en maduración (media: 14,43%, rango: 8,84% a 23,22%) aumentó en función del peso corporal y fue mayor que el de los machos (media: 5,32%, rango: 2,31% a 8,29%). Por lo tanto, el rendimiento de la carcasa fue menor en las hembras en maduración. La media del índice hepatosomático para hembras fue 0,86% (rango: 0,43% a 1,88%) y para machos fue 0,63% (rango: 0,39% a 1,09%). En conclusión, Eremophilus mutisii es una especie sedentaria y las hembras se caracterizarán por presentar mayor índice gonadosomático y menor rendimiento en carcasa que los machos.

ABSTRACT With the aim of characterizing the morphometry and body indexes of Eremophilus mutisii, thirty-three fishes (27 females and 6 males) coming from the Bogotá river, specifically of the Suesca region, were used. The aspect ratio of the caudal fin was determined with the aid of the image analysis software ImageJ®. Gonadosomatic and hepatosomatic indexes and carcass yield were determined for each fish. Correlation, regression and multivariate (canonical discriminant analysis) techniques were used for data analysis. Results indicated that sex does not affect the body shape of the fishes. The relationship between length and weight was fitted for each sex. The average aspect ratio of the caudal fin was 1.57, which suggests that the species has sedentary habits or slow swimming. The gonadosomatic index of the maturing females (mean: 14.43 %; range: 8.84 % to 23.22 %) increased as a function of body weight and was greater than in males (mean: 5.32 %; range: 2.31 % to 8.29 %). Therefore, the carcass yield was lower in maturing females than in males. The mean of the hepatosomatic index for females was 0.86 % (range: 0.43 % to 1.88 %) and for males was 0.63 % (range: 0.39 % to 1.09 %). As a conclusion, Eremophilus mutisii is a sedentary fish species, and females exhibit greater gonadosomatic index and lower carcass yield than males.

Efecto de los antagonistas de aldosterona en nefropatía diabética: revisión sistemática de la literatura / Systematic review of the effect of aldosterone antagonists on urinary albumin excretion in diabetic nephropathy

The beneficial effect angiotensin converting enzyme inhibitors (ACEI) and angiotensin II receptor antagonists (ARA) for diabetic nephropathy can be hampered by the phenomenon of aldosterone escape. Aldosterone antagonists such as espironolactone or epleronone could potentiate the effects of ACEI and ARA and avoid the later problem. We performed a systematic search of the literature on the effects of aldosterone antagonists on diabetic nephropathy. We searched for clinical trials and follow up studies measuring the effects of aldosterone antagonists on urinary albumin excretion among patients with diabetic nephropathy. We retrieved 1345 papers on the subject and 10 were selected for analysis. Among these, spironolactone was more effective than comparing drugs to achieve a reduction in urinary albumin excretion of approximately 30 to 40 percent. On the other hand epleronone was not superior to comparing drugs. All studies reported a modest reduction in glomerular filtration rate and an increase in serum potassium levels. In conclusion, spironolactone in doses of 25 to 100 mg/day reduces urinary albumin excretion but reduces also glomerular filtration rate and increases serum potassium levels.

Caracterización fisicoquímica de la variedad castilla del lulo (Solanum quitoense Lam) en seis estados de maduración / Physicochemical characterization of the lulo (Solanum quitoense Lam) castilla variety in six ripening stages

Background: Lulo (Solanum quitoense Lam) is considered a fruit with a high potential for exportation due to its exotic aroma, its bittersweet taste and the bright green color of its pulp. As a climacteric fruit is harvested when the fruit has reached full development, and 75% of the ripening is apparent by its characteristic yellow color with some small green points. However, this parameter is not enough to decide the right time for the crop, due to the irregularity of the fruits, especially for selling purposes in international markets, hence studies have been conducted to establish the changes during ripening and postharvest. Objectives: The aim of this work was to determine the relationship between color measurement and the other physicochemical parameters in the six ripening stages of lulo Castilla variety, in order to define the optimal harvesting time. Methods: Three fruits were studied for each stage, and were analyzed in the fresh state: ° Brix, pH, titratable acidity and color changes in the cortex, according to CIELab system. Results: The ranges obtained for the six evaluated stages were: ° Brix: 4.2 - 10.3, pH: 3.67 - 3.90, acidity: 2.63 - 3.00 and color (ΔE): 0 - 53. We found that the epicarp of the fruit varies from green to yellow intense, indicating the maturity for consumption. Total soluble solids increased with fruit maturation and the tritatable acidity decreased reaching a minimum values at stage 3, which was considered optimum for harvesting. The pH increased in stage 5 due to the drop of vacuolar H+ ion concentration. Conclusion: By measuring color parameters, 3 ripening stages were defined: green (0, 1, 2); semi ripe (3, 4) and ripe (5).

Efecto del procesamiento de la dieta sobre el desempeño productivo de tilapia nilótica (Oreochromis niloticus var. chitralada)en un ciclo comercial de producción / Effect of feed proccesing on the productive performance of nile tilapia (Oreochromis niloticus var. chitralada) in a commercial production cycle

Este estudio evaluó el efecto del procesamiento de alimento (extruido frente a peletizado)sobre el desempeño productivo de tilapia nilótica durante un ciclo comercial de producción. Se utilizaron 504 alevinos reversados que fueron alimentados con un sistema de alimentación por fases (alevinaje, crecimiento 1, crecimiento 2 y finalización)con niveles de proteína cruda para cada fase de 43,10%, 36,40%, 31,50% y 28,65%respectivamente. Las dietas fueron procesadas (extruidas o peletizadas) en micro extrusora para laboratorio Exteec® (Exteec máquinas, Brasil). El análisis de los indicadores acumulados mostró que el proceso de extrusión generó un mayor crecimiento y una mayor eficiencia en el uso de alimento hasta la fase de crecimiento 2 (P<0,05). En la fase de finalización los desempeños fueron similares entre los tipos de procesamiento, respuesta que podría estar asociada con una mayor densidad en términos de biomasa alcanzada por el grupo alimentado con alimento extruido generando así que el desempeño global del ciclo no presentara diferencias entre los tratamientos.

The purpose of this study was to evaluate the effect of feed proccesing (extruded vspelleted) on productive performance of Nile tilapia in a commercial production cycle. Sex-reversed fry (504) Nile tilapia were fed a four–phase diet (fry, growth 1, growth 2 yfinishing) with 43.10%, 36.40%, 31.50% and 28.65% of crude protein, respectively. The diets were processed (extruded or pelleted) in a micro laboratory extruder Exteec®(Exteec machines, Brazil). The extrusion produced higher growth and feed efficiencyuntil the “growth 2” phase (P<0.05). During the finishing phase the productive performances were similar between feed processing methods. This result should be dueto the higher carrying capacity achievement for extruded group and also genered that acumulative cycle performance didn’t have significant differences between treatments.

Retention and penetration of a conventional resin-based sealant and a photochromatic flowable composite resin placed on occlusal pits and fissures.

This study compares the retention and penetration of a conventional resin-based sealant (Fluroshield) and a photochromatic flowable composite resin (Tetric Flow Chroma) placed on occlusal pits and fissures and submitted to thermal or chemical cycling regimens. Penetration assessment--ten premolars were sealed with each material, isolated (except for the sealed surface) and immersed in 0.2% Rhodamine B. The teeth were serially sectioned in a mesiodistal direction. The images of the sections were digitized and analyzed (ImageLab). The distance between the most superficial and the deepest points on the occlusal central groove was calculated to determine the groove's total depth. The length of the central groove filled with the sealant was divided by its total depth to obtain the percentage of sealing of the occlusal groove. Retention assessment--30 premolars were sealed, their occlusal surfaces were photographed and the area occupied by the sealing materials was demarcated (ImageLab). The teeth were submitted to different treatments: thermocycled, stored in artificial saliva and immersed in acetic acid and saliva (10 cycles/day protocol for 30 days). New photographs were taken to assess the final area occupied by the materials. The difference between the final and initial area was calculated to obtain the material loss. The data was analyzed (two-way ANOVA and Tukey's test P<0.05). Both materials presented similar penetration of the occlusal central groove. After thermal and chemical cycling, the materials did not differ with respect to retention, except for immersion in acetic acid. In this case, Tetric Flow Chroma presented greater retention than Fluoroshield.

Osteogenic sarcoma of bone: a review of 158 cases admitted to the National Orthopedic Hospital

A discussion of the clinical, radiological, and pathological aspects of osteogenic sarcoma has been presentedA review of 158 cases of osteogenic sarcoma admitted to the National Orthopedic Hospital has been made. There is a predominance of male cases over the females. The age incidence in which this neoplasm is frequently found is between 10 and 25 years. The most common site of location is the lower half of the femur and upper third of the tibia, followed by the upper half of the humerusPain and swelling are the most frequent symptoms observed. The average duration of the illness before the patient is seen is 4 months. Regardless of the type of surgery, the outcome is always fatal. Of the fifty-five cases that had been followed up only 5 reached the 5-year survival period. One of them reached the ten-year survival period. Of the 50 patients that had been followed and died, 42 died of respiratory failure due to widespread metastases. Four died of operative shock, two of post-operative complication and two of exsanguination. (Summary)

Esophageal motility disorders in Mexican patioents with Duchenne's muscular dystrophy

Objetive: Myopathies are entities tahat mainly involve strieted muscle. In Duchenne's muscular dystrophy (DMD) there have been reported smooth muscle alterations in the pre-oral phase of swallowing, in gastric emptying, and pseudoobstruction. Nevertheless, esophageal motility alterations are not concluding. The objetive of this work was to determine if there are motor esophageal alterations is this patients, and if this alterations are related to the clinical manifestations of disease. Study design: nine consecutive patients with DMD (mean age 8, range 6-11 years; males) were evaluated, comparing clinical and manometric findings. Results: esophageal manometry alterations were found in all patients, mainly simultaneous non-peristaltic waves (60.86 percent) of diminished amplitude, in both striated and smooth muscle. Seventy seven percent presented with upper and lower gastrointestinal symptoms (dysphagia, regurgitation, epigastric pain, constipation, and distention). No correlation was found between esophageal motility alterations and gastrointestinal symptoms, nor with the clinical stage of disease in accordance to Brook (r=0.27). Conclusion: these results show that patients with DMD present esophageal motor disorders in both striated and smooth muscle, as well as upper and lower gastrointestinal symptoms. Specialized motility studies, could yield a better understanding of disease, and, possibly with adequate treatment, provide for a better quality of life in children with DMD.

El bloqueo del ganglio estrellado y la atropina no afectan los cambios electrocardiograficos de la hemorragia subaracnoidea. / Stellate ganglion blockade and atropine do not affect the electrocardiographic changes of subarachnoid hemorrhage

Se informan dos pacientes con hemorragia subaracnoidea (HSA) aguda que tuvieron anormalidades llamativas de repolarizacion ventricular. El bloqueo bilateral del ganglio estrellado la administracion de atropina intravenosa y, en un paciente el propranolol intravenoso no cambiaron la morfologia de las ondas T ni el intervalo QT prolongado. Este estudio sugiere que los cambios de repolarizacion vistos en algunos pacientes con HSA son causados por anormalidades estructurales en el musculo ventricular, y que no son reflejo de un trastorno electrofisiologico inducido por la asimetria en el tono simpatico

Desarrollo de una bebida lactea a base de leche descremada, grasa lactea, solidos de arroz y grasa de palma. / Development of a milk-base beverage from skim, milk fat, rice starch and palm oil

Una bebida nutritiva a base de leche, disponible en las formas fluida y en polvo de solubilidad instantanea por CITA para ser utilizada en el mercado oficial. La formula contiene leche descremada fresca, grasa lactea, grasa vegetal y almidon de arroz modificado por hidrolisis enzimatica

El sistema de informacion en nutricion de Costa Rica. / Nutrition information system in Costa Rica

El Sistema de Informacion en Nutricion (SIN), es un sistema de informacion interinstituciona, cuyo montaje ha implicado la integracion de componentes fisicos, humanos y de procedimientos de diversas entidades publicas para recolectar, almacenar, procesar y analizar conjuntos de datos en forma periodica. El objetivo de este sistema es generar el conocimiento necesario para alimentar permanentemente el proceso de toma de decisiones, en sectores especificos de la accion de gobierno; su vigencia esta sujeta a la existencia de un proceso radical de toma de decisiones