Early Detection of Refractive Errors by Photorefraction at School Age.

Early detection and treatment of refractive defects during school age are essential to avoid irreversible future vision loss and potential school problems. Previously, vision screening of preschool children used methods based on subjective visual acuity; however, technologies such as photorefraction have promoted the detection of refractive errors quickly and easily. In this study, 1347 children from 10 schools in Madrid aged 4 to 12 years participated in a program of early detection of visual problems, which consisted of visual screening composed of anamnesis and photorefraction with a PlusOptix A12R. The prevalence of refractive errors was analyzed in terms of spherical equivalent, cylinder and its orientation, and potential cases of development of high myopia or amblyopia. Hyperopia predominates in the early years, but the number of myopic subjects is higher than that of hyperopic subjects from the age of ten onwards. At all ages, the predominant orientation of astigmatism was with-the-rule. On average, 80% of the myopic subjects were uncorrected. Potential high myopia increased with age, from 4 to 21% of the measured population. Potential amblyopia cases decreased across age groups, from 19 to 13.7%. There is a need to raise awareness of the importance of vision screening at school age to address vision problems.

Eye movements as a predictor of preference for progressive power lenses.

The purpose of this study is to determine if there is any correlation between the characteristics of the user's eye movements (EMs) and the preference of the user when wearing different Progressive power lenses (PPLs) distributions. An eye-tracker system with a sample rate of 120Hz and temporal resolution of 8.3ms (Tobii-X3-120) was used to register EMs of 38 PPL users when reading in a computer screen with 2 types of PPLs (PPLsoft and PPL-hard). Number of fixations, complete fixation time, fixation duration mean, saccade duration mean, saccade distance mean, and number of regressions were analyzed for 6 different regions of the computer screen. A statistically significant difference was observed between the characteristics of the user's EMs and the user's PPL subjective preference (p < 0.05*). Subjects that preferred the PPL-hard presented significantly lower complete fixation time, lower fixation duration mean and lower number of regressions than those subjects indicating a preference for the PPL-soft. Results of this study suggest that eye-tracking systems can be used as PPL design recommendation systems according to the user EMs performance.

Infectious Endocarditis Caused by Pseudomona aeruginosa on Bicuspid Aortic Valve.

We report the case of a 53-year-old man with psoriatic arthritis, suffering from a malignant and recidivant myoepithelioma in his right axilla and arm, and undergoing two surgeries, with the last one being performed a month prior to actual admission. After the last surgery, he was admitted to hospital with fever without a source. After physical examination, laboratory tests, blood cultures and transthoracic and transesophageal echocardiography, he was diagnosed with infectious endocarditis (IE) on a bicuspid aortic valve (BAV) caused by Pseudomona aeruginosa (PA). Antibiogram-guided antibiotic therapy with meropenem and tobramicin was initiated. However, in the presence of repetitive spleen infarctions and a large vegetation, 12 days after admission, a bioprosthesis aortic valve implantation was performed. The postsurgical evolution was favorable and prolonged antibiotic course with meropenem and tobramicin was completed. The pathological anatomy and the native valve cultured confirmed an IE caused by PA. Gram-negative non-HACEK IE cases are infrequent, accounting for 1.8% of the total IE cases. PA is the second most frequent bacillus in this group, causing endocarditis more prevalently when associated with healthcare procedures rather than injectable drug use. No prior case study has identified IE caused by PA related to a BAV in the last years.

Role of Exercise Testing and Speckle Tracking Echocardiography in Paradoxical Severe Aortic Stenosis.

Introduction The clinical behavior and prognosis of patients with asymptomatic paradoxical low-gradient aortic stenosis (PLGAS) still remain controversial. Some authors consider PLGAS as an echocardiographically poorly quantified moderate AS (MAS). We aimed to investigate the clinical behavior of PLGAS by comparing it with that of asymptomatic high-gradient aortic stenosis (HG-AS) and MAS using transthoracic echocardiography (TTE) with speckle tracking imaging (STI) and cardiopulmonary exercise testing (CPET). The hypothesis of our study is, unlike that described by other authors, to demonstrate the existence of clinical and echocardiographic differences between PLGAS and MAS. Methods A cohort of 113 patients was included and categorized into three groups according to AS type: MAS (n=63), HG-AS (n=29), and PLGAS (n=21). Patients' clinical data were obtained. Patients underwent 2D TTE with STI and CPET. Results There were no significant differences in the clinical variables between the three AS groups. In the multivariate multinomial logistic regression analysis, with PLGAS being the reference category, the most powerful variable for establishing a difference with HG-AS was the left ventricular mass (LVM) indexed by body-surface area (odds ratio [OR]=1.04, confidence interval (CI)=1.01-1.06, p<0.05). The MAS group showed less abnormal CPET (OR=0.198, CI=0.06-0.69, p<0.05), and higher left ventricle global longitudinal strain rate (GLSR) (OR=0.003, CI=0.00-0.35, p<0.05) than the PLGAS group. Conclusions TTE with STI and CPET established the clear differences between patients with asymptomatic PLGAS and those with asymptomatic MAS, as well as the similarities between patients with PLGAS and those with HG-AS. Our data identify PLGAS as a completely different entity from MAS.

Seroprevalencia de toxoplasmosis en pacientes femeninos que asisten a la red ambulatoria del municipio Francisco Linares Alcántara, Maracay, estado Aragua, Venezuela / Seroprevalence of toxoplasmosis in female patients attending the outpatient network of the municipality Francisco Linares Alcántara, Maracay, Aragua state, Venezuela

Toxoplasmosis es la enfermedad parasitaria causada por Toxoplasma gondii, protozoario intracelular obligatorio de la subclase Coccidia. La infección en humanos ocurre accidentalmente por diferentes mecanismos de transmisión: oral, congénita, transfusiones sanguíneas, trasplantes de órganos y accidentes de laboratorio. En Venezuela, se ha reportado que 60% de la población aparentemente sana presenta la infección. Tomando en cuenta su prevalencia se determinó la seroprevalencia de toxoplasmosis en pacientes femeninos con edades de 14-44 años de la red ambulatoria Municipio Francisco Linares Alcántara, Maracay, Edo. Aragua, Venezuela, implementándose como métodos diagnóstico el Ensayo Inmunoenzimático (ELISA) y Hemaglutinación Indirecta (HAI) en 90 pacientes, obteniendo como resultado por el método ELISA, una seroprevalencia 61% donde 98% presentó anticuerpos tipo IgG y 2% anticuerpos tipo IgM. Por el método HAI se encontró una seroprevalencia del 41%, donde 100% mostraron anticuerpos tipo IgG. Por medio de la prueba de ji cuadrado aplicada con un nivel de significancia de 95% y considerando un valor de p ≤0,05 no se identificaron asociaciones estadísticamente significativas entre los factores de riesgo y adquirir la infección. Sin embargo, el grupo con mayor frecuencia de anticuerpos anti-T. gondii estuvo representado por edades >34 años, demostrando con ello que el riesgo de adquirir la infección, aumenta con la edad.

Toxoplasmosis is a parasitic disease caused by Toxoplasma gondii. The infection in human occurs accidentally by different transmission mechanisms: oral, congenital, blood transfusions, organ transplants and from laboratory accidents. In Venezuela, it has been reported that 60% of the population apparently healthy have the infection. Taking into account its prevalence was determined the seroprevalence of toxoplasmosis in female patients aged 14-44 years of the outpatient network Municipality Francisco Linares Alcántara, Maracay, State Aragua, Venezuela, implemented as methods of diagnosis the enzyme-linked immunosorbent assay (ELISA) and Indirect Hemagglutination (HAI) in 90 patients. Obtaining as a result of the ELISA method, a seroprevalence 61% where 98% presented antibodies IgG and IgM antibodies 2%, by the HAI method, was found 41% where 100% showed IgG antibodies. By means of the chi-square test with a significance level of 95% and a p value ≤0.005, we identified no statistically significant associations between risk factors and infection. However the group with the highest frequency of antibodies anti-T. gondii was represented by ages >34 years, proving that the risk of acquiring the infection increases with age.

Prevalence, incidence, and remission rates of urinary incontinence in women attended in gynecological practice.

AIMS: To assess the prevalence of urinary incontinence (UI) in a cohort of women attended in primary care gynecological and estimate the incidence and remission rates of UI symptoms at 1 year. METHODS: We performed a multicenter prospective cohort study of women attending eight primary care gynecological practices. Consecutive women attended for gynecological issues different from UI were invited to participate in the study by answering the International Consultation on Incontinence questionnaire-Short Form (ICIQ-UI-SF). Patients receiving treatment for UI, during pregnant, and postpartum were excluded. All women with UI symptoms (ICIQ-UI-SF > 0) wishing treatment were studied and treated following routine clinical practice. All women were invited to answer the same questionnaire by phone 1 year after inclusion. RESULTS: A total of 2,840 women answered the questionnaire; 1,188 (41.8%) had UI symptoms (ICIQ-UI-SF > 0). Accordingly, nearly half (44.9%) had mild UI symptoms. Treatment was requested by only 551/1,188 incontinent women (46.38%), being related to the severity of UI. At 1 year, 2,443 patients/2,840 (86.0%) were found and again responded to the ICIQ-UI-SF. At 1 year the incidence of UI was 5.3% (77 new cases of UI out of 1,652 with the initial ICIQ-UI-SF = 0) while the remission rate of UI among untreated women was 27.9% (144 with ICIQ-UI-SF = 0). CONCLUSIONS: Almost one half of women attended in primary care general gynecology practices have UI symptoms, with less than 50% requesting treatment. In these women, UI is a dynamic process with an incidence of 5.3% and a remission rate of 27.9% at 1 year. Neurourol. Urodynam. 36:1081-1085, 2017. © 2016 Wiley Periodicals, Inc.

Immunocapture of circulating Schistosoma mansoni cathepsin B antigen (Sm31) by anti-Sm31 polyclonal antibodies.

Adult Schistosoma mansoni parasites have the capacity to degrade ingested host hemoglobin and other host plasma proteins by using a series of gut proteolytic enzymes, including cathepsin B; this enzyme is released to the host intravascular environment during regurgitations of adult worms. Cathepsin B becomes thus a circulating parasite component that has been shown to be specifically recognized as the Sm31 antigen by antibodies present in most S. mansoni infected patients. Taking advantage of this immunological property, we attempted here to immunocapture Sm31 from sera of infected patients using specific polyclonal rabbit antibodies raised against a highly enriched preparation of Sm31 and detect its intrinsic proteolytic activity using a previously described solid-phase procedure called Cysteine Protease Immuno Assay (CPIA). To produce highly specific anti-Sm31/cathepsin B antibodies, cathepsin B (Sm31 or SmCB) was enriched more than 3000-folds from an adult worm preparation using a series of conventional biochemical steps including ion exchange and affinity chromatography. Anti-cathepsin B antibodies were generated by immunizing rabbits with the enriched cathepsin B fraction; these antibodies recognized a band of Mr.~31 kDa in Western-blot (WB) analysis of this fraction and were able to capture, in a modified CPIA procedure, Sm31/SmCB present in sera from infected Venezuelan patients living in low endemic areas for schistosomiasis. CPIA showed 100% sensitivity and 100% specificity; representing a new diagnostic tool to detect circulating Sm31 antigen in actual infections.

Improving paclitaxel delivery: in vitro and in vivo characterization of PEGylated polyphosphoester-based nanocarriers.

Nanomaterials have great potential to offer effective treatment against devastating diseases by providing sustained release of high concentrations of therapeutic agents locally, especially when the route of administration allows for direct access to the diseased tissues. Biodegradable polyphosphoester-based polymeric micelles and shell cross-linked knedel-like nanoparticles (SCKs) have been designed from amphiphilic block-graft terpolymers, PEBP-b-PBYP-g-PEG, which effectively incorporate high concentrations of paclitaxel (PTX). Well-dispersed nanoparticles physically loaded with PTX were prepared, exhibiting desirable physiochemical characteristics. Encapsulation of 10 wt% PTX, into either micelles or SCKs, allowed for aqueous suspension of PTX at concentrations up to 4.8 mg/mL, as compared to <2.0 µg/mL for the aqueous solubility of the drug alone. Drug release studies indicated that PTX released from these nanostructures was defined through a structure-function relationship, whereby the half-life of sustained PTX release was doubled through cross-linking of the micellar structure to form SCKs. In vitro, physically loaded micellar and SCK nanotherapeutics demonstrated IC50 values against osteosarcoma cell lines, known to metastasize to the lungs (CCH-OS-O and SJSA), similar to the pharmaceutical Taxol formulation. Evaluation of these materials in vivo has provided an understanding of the effects of nanoparticle structure-function relationships on intratracheal delivery and related biodistribution and pharmacokinetics. Overall, we have demonstrated the potential of these novel nanotherapeutics toward future sustained release treatments via administration directly to the sites of lung metastases of osteosarcoma.

Effect of total mixed ration composition and daily grazing pattern on milk production, composition and fatty acids profile of dairy cows.

The possibilities of using high quality pastures in conjunction with total mixed ration (TMR) during the grazing season have been examined. An experiment with sixteen Holstein cows blocked and randomly assigned to four treatments in a factorial arrangement was conducted in order to evaluate the influence of grazing time of day (day or night) and type of silage (maize or Italian ryegrass) included in the TMR of dairy cows grazing 12 h daily on milk yield, composition and fatty acid profile. The silage type had no effect on the dry matter intake, milk yield and fat and protein proportions. However, cows grazing during the night ate more grass than cows grazing during the day (8·53 vs. 5·65 kg DM/d; P<0·05). No differences were seen between grazing-time with respect to milk production, fat and protein contents. However, the proportion of polyunsaturated fatty acid was higher in milk of dairy cows grazing at night-time than grazing at day-time, especially 18:2n-6 (2·37 vs. 2·12 g/100 g FA respectively, P<0·05) and 18:2cis9trans11 (2·08 vs. 1·74 g/100 g FA respectively, P<0·05).

Enfoque bioético y social de la infección por el Virus de Inmunodeficiencia Humana / Bioethics and social approach of the Acquired Immunodeficiency Syndrome

Las personas portadoras o enfermas del virus de inmunodeficiencia humana han experimentado consecuencias devastadoras en el plano personal, familiar y social desde la aparición de los primeros casos. El objetivo del presente trabajo es analizar el cumplimiento de los principios bioéticos, así como la repercusión derivada de las implicaciones éticas del actuar profesional con estos pacientes, lo cual demuestra la necesidad de vencer los tabúes y la discriminación que han sido objeto desde los inicios de la epidemia(AU)

Persons who are carrier of the Acquired Immunodeficiency Syndrome or persons who are sick have experienced destructive consequences in the personal, familiar and social spheres since the appearance of the first cases. The objective of this work is to analyze the fulfilment of the bioethical principles, as well as the repercussion derived from the ethics dilemma of the professional behaviour with these patients, what demonstrate the necessity of overcoming taboos and the discrimination they have suffered from since the beginnings of the disease(AU)

Enfoque bioético y social de la infección por el Virus de Inmunodeficiencia Humana / Bioethics and social approach of the Acquired Immunodeficiency Syndrome

Las personas portadoras o enfermas del virus de inmunodeficiencia humana han experimentado consecuencias devastadoras en el plano personal, familiar y social desde la aparición de los primeros casos. El objetivo del presente trabajo es analizar el cumplimiento de los principios bioéticos, así como la repercusión derivada de las implicaciones éticas del actuar profesional con estos pacientes, lo cual demuestra la necesidad de vencer los tabúes y la discriminación que han sido objeto desde los inicios de la epidemia.

Persons who are carrier of the Acquired Immunodeficiency Syndrome or persons who are sick have experienced destructive consequences in the personal, familiar and social spheres since the appearance of the first cases. The objective of this work is to analyze the fulfilment of the bioethical principles, as well as the repercussion derived from the ethics dilemma of the professional behaviour with these patients, what demonstrate the necessity of overcoming taboos and the discrimination they have suffered from since the beginnings of the disease.

Adenocarcinoma renal injertado en riñón poliquístico. Presentación de un caso / Renal adenocarcinoma implanted in kidney polycystic. Case presentation

Introducción: el carcinoma de células renales representa entre 90-95 por ciento de los tumores malignos que afectan el riñón, siendo infrecuente su observación asociado a la enfermedad renal poliquística autosómica del adulto.Objetivo: mostrar la asociación de adenocarcinoma renal en una paciente con nefropatía poliquística del adulto de diagnóstico en edad avanzada con escasas manifestaciones clínicas y humorales. Presentación del caso: se presenta el caso clínico de una paciente de 65 años con antecedentes de poliquistosis renal que consulta por aumento de volumen del abdomen constatándose nefromegalia gigante. Se presentan los datos clínicos, humorales, imagenológicos e histológicos que permitieron su diagnóstico. Conclusiones: aunque infrecuente, debe considerarse la posibilidad de adenocarcinoma renal de células claras asociado al riñón poliquístico(AU)

Introduction: the renal cells carcinoma represents between 90-95 percent of the malignant tumors that affect the kidney being infrequent its observation associated with the autosomal polycystic kidney disease of the adult. Objetive: to show the association of renal adenocarcinoma in a patient with polycystic nephropathy of the adult of late presentation and with scarce clinical and humoral manifestations. Case Presentation: there appears the clinical case of a 65-year-old feminine patient with precedents of kidney polycystic that it consults of increase of volume of the abdomen being stated nefromegalia giant. The clinical information appears, humoral, imagenoly and histological that allowed its diagnosis. Conclusions: although infrequently should be consider the diagnostic possibility of clear cell renal adenocarcinoma associated to polycystic kidney(AU)

Adenocarcinoma renal injertado en riñón poliquístico. Presentación de un caso / Renal adenocarcinoma implanted in kidney polycystic. Case presentation

Introducción: el carcinoma de células renales representa entre 90-95 % de los tumores malignos que afectan el riñón, siendo infrecuente su observación asociado a la enfermedad renal poliquística autosómica del adulto. Objetivo: mostrar la asociación de adenocarcinoma renal en una paciente con nefropatía poliquística del adulto de diagnóstico en edad avanzada con escasas manifestaciones clínicas y humorales. Presentación del caso: se presenta el caso clínico de una paciente de 65 años con antecedentes de poliquistosis renal que consulta por aumento de volumen del abdomen constatándose nefromegalia gigante. Se presentan los datos clínicos, humorales, imagenológicos e histológicos que permitieron su diagnóstico. Conclusiones: aunque infrecuente, debe considerarse la posibilidad de adenocarcinoma renal de células claras asociado al riñón poliquístico.

Introduction: the renal cells carcinoma represents between 90-95 % of the malignant tumors that affect the kidney being infrequent its observation associated with the autosomal polycystic kidney disease of the adult. Objetive: to show the association of renal adenocarcinoma in a patient with polycystic nephropathy of the adult of late presentation and with scarce clinical and humoral manifestations. Case Presentation: there appears the clinical case of a 65-year-old feminine patient with precedents of kidney polycystic that it consults of increase of volume of the abdomen being stated nefromegalia giant. The clinical information appears, humoral, imagenoly and histological that allowed its diagnosis. Conclusions: although infrequently should be consider the diagnostic possibility of clear cell renal adenocarcinoma associated to polycystic kidney.

Advancing in the management of chronic kidney disease: the results of implementing a quick resolution consultation.

BACKGROUND: Currently, chronic kidney disease (CKD) is understood as global important public health problem, a situation that requires a new approach. OBJECTIVES: To show the results obtained after implementing a quick resolution consultation for CKD management. METHODS: Results were analysed during 6 month time period. RESULTS: A total of 9.61% of received proposals were referred to primary care without in-person visits. In addition, 28.05% of patients were initially evaluated through high resolution clinics and 62.33% were directly referred to other clinics. From the initial 28.05% mentioned, once evaluated, treatment adjusted and informed about the disease, 70% were referred over to primary care for monitoring and the remaining 30% were given specialist appointments. As a consequence, 70.65% of patients were selected for monitoring by nephrology from all proposals received, and 29.35% for primary care monitoring. We observed a significant decrease in the delay until the first medical appointment. CONCLUSIONS: Quick resolution consultations demonstrated to be an efficient tool for CKD management. Its implementation allowed both low consumption of health care resources, selected patients with high risk of progressive cardiovascular disease for long term monitoring, and offered not only an initial evaluation and adjustment of treatment with information provided to those who would be monitored by primary care, but also diminished primary care delays significantly.

The effect of depression on physician-patient communication among Hispanic end-stage renal disease patients.

End-stage renal disease is associated with increased level of depression. Depression is associated with a reduction in the ability of people to effectively communicate in interpersonal settings. The interaction between end-stage renal disease patients and their physicians has important implications for the course of the treatment of this disease; however, there is limited research examining the influence of depression on general patient-physician communication. This study examines the association between depression and physician-patient communication in a sample of Hispanic end-stage renal disease patients. Participating patients filled out the Beck Depression Inventory and self-reported their feelings about meeting with physicians. Patients then met with a physician, and a nurse practitioner observed the interaction. Results indicate that depression was negatively associated with patients' self-reported perceptions of their readiness for the appointment (r =-.20) and with self-reported communication efficacy (r =-.19). Moreover, the nurse practitioner rated patients with depression as being significantly less likely (a) to ask for clarification (r =-.40), (b) to be engaged in the conversation (r =-.46), and (c) to be forthcoming with the physician (r =-.37). Results of this study have significant implications for communication between physicians and end-stage renal disease patients and for the influence of depression on patient-physician communication.

Avanzando en el manejo de la enfermedad renal crónica: resultados de la implantación de una consulta de rápida resolución / Advancing in the management of chronic kidney disease: the results of implementing a quick resolution consultation

Antecedentes: La enfermedad renal crónica (ERC) se entiende actualmente como un importante problema de salud pública global, que requiere una nueva aproximación. Objetivos: Mostrar los resultados de la implantación de una consulta de rápida resolución para el manejo de la ERC. Métodos: Se han analizado de manera retrospectiva los resultados obtenidos durante un período de seis meses, entre septiembre de 2011 y febrero de 2012. Las variables estudiadas han sido la edad de los pacientes, el origen de las propuestas, la causa de las remisiones, el destino inicial dado a estas y el destino final de los pacientes. Resultados: Un 9,61 % de las propuestas recibidas se ha remitido a Atención Primaria sin consulta presencial. Un 28,05 % de los pacientes han sido evaluados inicialmente en la consulta de alta resolución y un 62,33 % se ha citado directamente para el resto de las consultas. Del 28,05 % inicial, tras el proceso de evaluación, ajuste e información acerca de la enfermedad un 70 % ha sido remitido nuevamente a Primaria para seguimiento, y el otro 30 % se ha citado para su seguimiento en consultas. Por tanto, del total de propuestas se ha seleccionado un 70,65 % de pacientes para seguimiento por Nefrología y un 29,35 % para seguimiento por Atención Primaria. Por otro lado, se ha disminuido la demora para primeras visitas a menos de la mitad. Conclusiones: La consulta de alta resolución se ha mostrado como un instrumento eficiente en el manejo de la ERC. Su implantación ha permitido, consumiendo un mínimo de los recursos asistenciales, seleccionar para seguimiento a largo plazo a aquellos pacientes de mayor riesgo de progresión y cardiovascular pero ofreciendo también una evaluación inicial, ajuste de tratamiento e información a los que serán seguidos por Atención Primaria, y disminuir la demora en primeras visitas de manera significativa (AU)

Background: Currently, chronic kidney disease (CKD) is understood as global important public health problem, a situation which requires a new approach. Objectives: To show the results obtained after implementing a quick resolution consultation for CKD management. Methods: Results were analysed during 6 month time period. Results: A total of 9.61% of received proposals were referred to primary care without in-person visits. In addition, 28.05% of patients were initially evaluated through high resolution consults and 62.33% were directly referred to other consults. From the initial 28.05% mentioned, once evaluated, treatment adjusted and informed about the disease, 70% were referred over to primary care for monitoring and the remaining 30% were given specialist appointments. As a consequence, 70.65% of patients were selected for monitoring by nephrology from all proposals received, and 29.35% for primary care monitoring. We observed a significant decrease in the delay until the first medical appointment. Conclusions: Quick resolution consultations demonstrated to be an efficient tool for CKD management. Its implementation allowed both low consumption of health care resources, selected patients with high risk of progression cardiovascular disease for long term monitoring, and offered not only an initial evaluation and adjustment of treatment with information provided to those who would be monitored by primary care, but also diminished primary care delays significantly (AU)

Tumor de pancoast presentación de un caso / Pancoast´s tumor case presentation

Introducción: El Tumor de Pancoast se produce por crecimiento local de un tumor del vértice pulmonar que penetra fácilmente en el canal neural y destruye las raíces nerviosas octava cervical y primera y segunda torácicas. Su causa más frecuente es el cáncer de pulmón.Objetivo: Al presentar este caso, nuestro objetivo es mostrar de forma ilustrativa una de las formas neurológicas de presentación del cáncer de pulmón y señalar una vez más cómo este tipo de paciente casi siempre acude por Ortopedia y rara vez por Neumología o Medicina Interna. Presentación del caso: Se presentó una paciente que aquejó primeramente dolor en hombro derecho, acude al ortopédico y al reumatólogo, este último al verle las manos (uñas en vidrio de reloj y dedos hipocráticos), la remite a Neumología, se realiza radiografía de tórax, se ingresa en Medicina Interna, donde se le practica una serie de estudios, incluida cirugía de mínimo acceso por el Grupo de Tórax. Conclusiones: El estudio histológico corroboró el diagnóstico de carcinoma bronquial epidermoide, así como demostró cómo estos casos entran por Ortopedia, lo cual atrasa el accionar médico. Motivación: Tuvimos a bien presentar este caso, que ilustra cómo los pacientes con esta patología, en muchas ocasiones, entran por Ortopedia, lo cual demora el diagnóstico y, por ende, la conducta(AU)

Introduction: Pancoast tumor refers to a tumor located in the vertex of the lung. It can easily penetrate the neural channel destroying the eight cervical and first and second thoracic nervous roots. The most frequent cause of this tumor is lung cancer. Objective: To present this case, we wants to show a neurological presentation form of lung cancer and demostrate again that this type of patient often not consult in Neumology or Internal Medicine inicially. Case presentation: Female patient complaining of pain in the right shoulder was seen in the orthopedic and rheumatology office. On Physical exam the rheumatologists detects watch glass nails and Hippocratic fingers and refers the patient to the pneumatological department. A decrease in the breath sounds of the right vertex was detected. An x-ray of the thorax was taken and the patient was admitted in the internal medicine ward. Studies carried out included minimal access thoracic surgery. Conclusions: Histologically the diagnosis was an epidermoid bronchial carcinoma, also demostrate that this type of patient often not consult in Neumology or Internal Medicine inicially. Motivation: This case shows how often patients with this pathology consult by orthopedic, retarding diagnosis and the treatment(AU)

Tumor de pancoast presentación de un caso / Pancoast´s tumor case presentation

Introducción: El Tumor de Pancoast se produce por crecimiento local de un tumor del vértice pulmonar que penetra fácilmente en el canal neural y destruye las raíces nerviosas octava cervical y primera y segunda torácicas. Su causa más frecuente es el cáncer de pulmón. Objetivo: Al presentar este caso, nuestro objetivo es mostrar de forma ilustrativa una de las formas neurológicas de presentación del cáncer de pulmón y señalar una vez más cómo este tipo de paciente casi siempre acude por Ortopedia y rara vez por Neumología o Medicina Interna. Presentación del caso: Se presentó una paciente que aquejó primeramente dolor en hombro derecho, acude al ortopédico y al reumatólogo, este último al verle las manos (uñas en vidrio de reloj y dedos hipocráticos), la remite a Neumología, se realiza radiografía de tórax, se ingresa en Medicina Interna, donde se le practica una serie de estudios, incluida cirugía de mínimo acceso por el Grupo de Tórax. Conclusiones: El estudio histológico corroboró el diagnóstico de carcinoma bronquial epidermoide, así como demostró cómo estos casos entran por Ortopedia, lo cual atrasa el accionar médico. Motivación: Tuvimos a bien presentar este caso, que ilustra cómo los pacientes con esta patología, en muchas ocasiones, entran por Ortopedia, lo cual demora el diagnóstico y, por ende, la conducta.

Introduction: Pancoast tumor refers to a tumor located in the vertex of the lung. It can easily penetrate the neural channel destroying the eight cervical and first and second thoracic nervous roots. The most frequent cause of this tumor is lung cancer. Objective: To present this case, we wants to show a neurological presentation form of lung cancer and demostrate again that this type of patient often not consult in Neumology or Internal Medicine inicially. Case presentation: Female patient complaining of pain in the right shoulder was seen in the orthopedic and rheumatology office. On Physical exam the rheumatologists detects watch glass nails and Hippocratic fingers and refers the patient to the pneumatological department. A decrease in the breath sounds of the right vertex was detected. An x-ray of the thorax was taken and the patient was admitted in the internal medicine ward. Studies carried out included minimal access thoracic surgery. Conclusions: Histologically the diagnosis was an epidermoid bronchial carcinoma, also demostrate that this type of patient often not consult in Neumology or Internal Medicine inicially. Motivation: This case shows how often patients with this pathology consult by orthopedic, retarding diagnosis and the treatment.