Reducing costs of referrals for non-neonatal circumcision in Florida Medicaid population.

INTRODUCTION: Florida Medicaid will only cover a non-neonatal circumcision if it meets the specified Medicaid medical indications or the patient is 3 years or older and has failed a 6-week trial of topical steroid therapy (TST). Referral of children who do not meet guideline criteria results in unnecessary costs. OBJECTIVE: We sought to evaluate the cost savings if the initial evaluation and management were performed by the primary care provider (PCP) with referral to a pediatric urologist of only those males meeting the guidelines. STUDY DESIGN: An institutional review board-approved retrospective chart review of all male pediatric patients ≥3 years of age presenting for phimosis/circumcision from September 2016 to September 2019 at our institution was performed. Data extracted included (1) presence of phimosis, (2) presence of medical indication for circumcision on presentation, (3) circumcision performed without meeting criteria, (4) use of topical steroid therapy prior to referral. The population was stratified into 2 groups based on whether criteria were met at the time of referral. Those with a defined medical indication on presentation were excluded from cost analysis. Cost savings were based on costs incurred for PCP visit(s) versus initial referral to a urologist using estimated Medicaid reimbursement rates. RESULTS: Of the 763 males, 76.1% (581) did not meet Medicaid criteria for circumcision on presentation. Of these, 67 had a retractable foreskin with no medical indication, 514 had phimosis with no documented topical steroid therapy (TST) failure. A savings of $95,704.16 would have been incurred if the PCP initiated the evaluation and management and referred only those who met the criteria (Table 2). DISCUSSION: These savings would only be feasible if there were proper education of PCPs in the evaluation of phimosis and the role of TST. Limitations are assuming cost savings in the setting of well-educated pediatricians for clinical exam and believing they are aware of and comply with the guidelines. CONCLUSIONS: Education of PCPs on the role of TST in phimosis and current Medicaid guidelines may reduce unnecessary office visits, health care costs, and family burden. The most impactful method to reduce the cost of non-neonatal circumcision would be for states that do not currently cover neonatal circumcision to acknowledge affirmative policies from the American Academy of Pediatrics regarding circumcision and realize the cost savings associated with providing coverage for neonatal circumcision and reducing significantly the number of more expensive non-neonatal circumcisions.

Identificando las trayectorias de cambio terapéutico en psicoterapia breve en pacientes chilenos / Identifying trajectories of therapeutic change in brief psychotherapy in Chilean outpatients

Antecedentes: identificar subgrupos de pacientes que demuestren diferentes trayectorias de cambio terapéutico durante psicoterapia en contextos realistas es relevante para el desarrollo de procesos terapéuticos personalizados y efectivos. Objetivos: El presente estudio tuvo como objetivos (a) identificar trayectorias de cambios terapéutico en pacientes chilenos (b) explorar variables que puedan predecir la probabilidad de pertenecer a ciertas trayectorias y (c) examinar si estas diferentes trayectorias desembocan en distintos resultados terapéuticos. Método: se llevaron a cabo análisis de modelos de crecimientos mixto (Growth Mixture Modeling - GMM) y regresiones logísticas multinominales en una muestra de 400 pacientes chilenos recibiendo psicoterapia en un centro de salud mental privado. Resultados: se identificaron tres trayectorias de cambio terapéutico (a) disfunción inicial moderada con leve deterioro, (b) disfunción inicial leve con cambio favorable y (c) disfunción inicial severa con rápido cambio favorable. La edad de los pacientes fue considerada un factor predictor de trayectoria significativa, sugiriendo una peor prognosis para pacientes de mayor edad. Además, todas las trayectorias fueron predictoras del resultado terapéutico. Conclusiones: estos resultados pueden ser utilizados para desarrollar intervenciones enfocadas en el paciente, basadas en las trayectorias de cambio que exhiban.

Background: Identifying subgroups of patients that may show distinct trajectories of change during psychotherapy in realistic settings is relevant for the development of personalized therapeutic processes. Aims: The present study sought to (a) identify trajectories of change in Chilean patients; (b) explore variables that may predict the likelihood of belonging to certain trajectories; and (c) examine whether these different trajectories result in differences in treatment outcomes. Method: Growth mixture modeling (GMM) and multinomial logistic regression analysis were carried out on the data of 400 patients receiving psychotherapy at a private outpatient clinic in Chile. Results: Three trajectories of change were identified: (a) moderate initial dysfunction with slight deterioration, (b) mild initial dysfunction with favorable change, and (c) high initial dysfunction with rapid favorable change. Patient's age was found to be a significant predictor of trajectory assigned, suggesting a poorer prognosis for older patients. Moreover, the trajectories were significant predictors of treatment outcome. Conclusions: These results can be used to develop patient-specific therapeutic interventions based on the trajectories they exhibit.

Significant heterogeneity in the diagnosis and long-term management of Wilson disease: Results from a large multicenter Spanish study.

There is uncertainty regarding Wilson's disease (WD) management. OBJECTIVES: To assess, in a multicenter Spanish retrospective cohort study, whether the approach to WD is homogeneous among centers. METHODS: Data on WD patients followed at 32 Spanish hospitals were collected. RESULTS: 153 cases, 58% men, 20.6 years at diagnosis, 69.1% hepatic presentation, were followed for 15.5 years. Discordant results in non-invasive laboratory parameters were present in 39.8%. Intrahepatic copper concentration was pathologic in 82.4%. Genetic testing was only done in 56.6% with positive results in 83.9%. A definite WD diagnosis (Leipzig score ≥4) was retrospectively confirmed in 92.5% of cases. Chelating agents were standard initial therapy (75.2%) with frequent modifications (57%), particularly to maintenance zinc. Enzyme normalization was not achieved by one third, most commonly in the setting of poor compliance, lack of genetic mutations and/or presence of cardiometabolic risk factors. Although not statistically significant, there were trends for sex differences in number of diagnosed cases, age at diagnosis and biochemical response. CONCLUSIONS: Significant heterogeneity in diagnosis and management of WD patients emerges from this multicenter study that includes both small and large reference centers. The incorporation of genetic testing will likely improve diagnosis. Sex differences need to be further explored.

aVR: la derivada olvidada / aVR: the forgotten lead

Resumen La derivada aVR es frecuentemente olvidada al interpretar un electrocardiograma. Esto se explica en gran medida debido a que no aporta información específica sobre el ventrículo izquierdo. Sin embargo, tiene gran utilidad en términos tanto de diagnóstico como de pronóstico en múltiples condiciones clínicas, como el síndrome coronario agudo, la pericarditis, la disección aórtica, la intoxicación por antidepresivos tricíclicos, las arritmias y múltiples trastornos de la conducción cardiaca. El objetivo de este artículo es resaltar la importancia clínica de esta derivada y así incentivar su evaluación sistemática en la práctica clínica.

Abstract aVR lead is a frequently forgotten derivative when interpreting an electrocardiogram. This may be largely explained by the fact that it does not provide specific information on the left ventricle. However, it is very useful in terms of both, diagnosis and prognosis, of different clinical entities such as acute coronary syndrome, pericarditis, aortic dissection, tricyclic antidepressants intoxication, arrhythmias and multiple cardiac conduction disorders. The main purpose of this article is to highlight the clinical importance of aVR lead and thus encourage its use in clinical practice.

[Colistin resistance in carbapenem-resistant Klebsiella pneumoniae isolates from a pediatric hospital from Corrientes, Argentina]. / Resistencia a colistina en aislados de Klebsiella pneumoniae resistente a carbapenémicos en un hospital pediátrico de Corrientes.

BACKGROUND: There is an increase of carbapenem-resistant Klebsiella pneumoniae (CRKP) infections in the pediatric population and epidemiological data are limited. AIM: To calculate the frequency of CRKP in pediatric patients, to determine the in vitro activity of colistin and to detect the presence of mcr-1 gene in said isolates. METHODS: 220 isolates of K. pneumoniae were studied in a pediatric hospital between January 2018 and December 2019. Antimicrobial susceptibility was determined by microdilution in broth according to guidelines of CLSI and EUCAST. The genes blaKPC, blaNDM, blaIMP, blaVIM, blaOXA-48 and mcr-1 were detected by polymerase chain reaction (PCR). RESULTS: 9.5% (n: 21) of the isolates were characterized as CRKP, where was observed a resistance to colistin of 47.6% (10/21) with values of MIC50 of 2 µg/mL and MIC90 of ≥ 4 µg/mL. In 100% of CRKP strains the blaKPC gene was detected and the mcr-1 gene was not found. The resistance profile to other antimicrobials was as follow: gentamicin 100% (n: 21), trimethoprim/sulfamethoxazole 100% (n: 21), ciprofloxacin 100% (n: 21), amikacin 19% (n: 4). All of the isolates were sensitive to ceftazidime/avibactam and tigecycline. CONCLUSION: This study demonstrates a significant value of resistance to colistin in pediatric patients compared to other last line antimicrobial such as ceftazidime/avibactam and tigecycline.

Resistencia a colistina en aislados de Klebsiella pneumoniae resistente a carbapenémicos en un hospital pediátrico de Corrientes / Colistin resistance in carbapenem-resistant Klebsiella pneumoniae isolates from a pediatric hospital from Corrientes, Argentina

INTRODUCCIÓN: Existe un incremento de las infecciones por Klebsiella pneumoniae resistente a carbapenémicos (KPRC) en la población pediátrica y los datos epidemiológicos son limitados. OBJETIVOS: Conocer la frecuencia de KPRC en pacientes pediátricos, determinar la actividad in vitro de colistina y detectar el gen mcr-1 en dichos aislados. MATERIALES Y MÉTODOS: Se estudiaron 220 aislados de K. pneumoniae en un hospital pediátrico durante los años 2018 y 2019. La susceptibilidad antimicrobiana se determinó por microdilución en caldo según CLSI y EUCAST. Los genes blaKPC, blaNDM, blaIMP, blaVIM, blaOXA-48 y mcr-1 se analizaron mediante reacción de polimerasa en cadena (RPC). RESULTADOS: El 9,5% (n: 21) de los aislados fueron caracterizados como KPRC, donde se observó una resistencia a colistina de 47,6% (10/21) con valores de CIM50 de 2 μg/mL y CIM90 de > 4 μg/mL. En todos los aislados de KPRC se caracterizó el gen blaKPC y no se detectó el gen mcr-1. El perfil de resistencia observado en otros antimicrobianos fue el siguiente: gentamicina 100% (n: 21), ciprofloxacina 100% (n: 21), cotrimoxazol 100% (n: 21) y amikacina 19% (n: 4). Se observó 100% de sensibilidad a tigeciclina y ceftazidima/avibactam. CONCLUSIÓN: Este estudio demuestra un valor significativo de la resistencia a colistina en comparación a ceftazidima/avibactam y tigeciclina.

BACKGROUND: There is an increase of carbapenem-resistant Klebsiella pneumoniae (CRKP) infections in the pediatric population and epidemiological data are limited. Aim: To calculate the frequency of CRKP in pediatric patients, to determine the in vitro activity of colistin and to detect the presence of mcr-1 gene in said isolates. METHODS: 220 isolates of K. pneumoniae were studied in a pediatric hospital between January 2018 and December 2019. Antimicrobial susceptibility was determined by microdilution in broth according to guidelines of CLSI and EUCAST. The genes blaKPC, blaNDM, blaIMP, blaVIM, blaOXA-48 and mcr-1 were detected by polymerase chain reaction (PCR). RESULTS: 9.5% (n: 21) of the isolates were characterized as CRKP, where was observed a resistance to colistin of 47.6% (10/21) with values of MIC50 of 2 μg/mL and MIC90 of ≥ 4 μg/mL. In 100% of CRKP strains the blaKPC gene was detected and the mcr-1 gene was not found. The resistance profile to other antimicrobials was as follow: gentamicin 100% (n: 21), trimethoprim/sulfamethoxazole 100% (n: 21), ciprofloxacin 100% (n: 21), amikacin 19% (n: 4). All of the isolates were sensitive to ceftazidime/avibactam and tigecycline. CONCLUSION: This study demonstrates a significant value of resistance to colistin in pediatric patients compared to other last line antimicrobial such as ceftazidime/avibactam and tigecycline.

Impact of Florida Medicaid guidelines on frequency and cost of delayed circumcision at Nemours Children's hospital.

INTRODUCTION: In 2003, Florida Medicaid discontinued coverage of routine neonatal circumcision (NC) resulting in an increase in nonneonatal circumcisions. Florida Medicaid is one of 16 state healthcare plans that do not cover NC. Florida Medicaid covers male circumcision in a child ≥3 years for a defined medical indication or persistent phimosis refractory to topical steroid therapy (TST). We sought to assess the economic impact of the evaluation and management of phimosis/circumcision in Florida Medicaid males ≥3 years treated at Nemours Children's Hospital. STUDY DESIGN: We performed an IRB approved retrospective chart review of all male Florida Medicaid patients ≥3 years seen at NCH for phimosis/circumcision from Sept. 2016-Sept. 2019. Data extracted included demographics, age at presentation, prior treatment with TST, response to TST, and surgical interventions. The patients were stratified into three management groups. Total costs for each group were based upon estimated Medicaid reimbursement rates. Data were analyzed using descriptive analysis on SPSS. RESULTS: Seven hundred and sixty-three males were evaluated. Age at presentation ranged from 3 to 17 years and 59% of patients were 3-6 years at initial presentation. Three hundred and forty patients underwent circumcision. The total estimated cost of care for all patients was $1,345,533.90. This compares to an estimated cost of $171,675 if all individuals underwent NC at 2020 costs. CONCLUSIONS: The total estimated cost associated with the evaluation and management of 763 patients ≥3 years for phimosis/circumcision was 7.8 times the estimated cost of NC for all these patients and likely is an underestimation of the true difference in cost as we did not account for additional visits outside of the initial consultation and follow-up, post-operative visits outside of the global period, emergency room visits, and returns to operating room. Of the circumcisions performed, only 18.5% met Florida Medicaid defined medical indications. Success rates for TST range from 53.8 to 95% in the literature, however, our success rate was 34.3%. The reason for the variation in response rate between our results and the literature may reflect that caretakers desiring circumcision may be less compliant with TST use. Only 6.6% of patients had a documented failure of TST prior to initial presentation. Further education of PCPs on current Medicaid/MCG guidelines for the evaluation and management of phimosis, as well as PCP adoption of TST, could reduce the number of unnecessary office visits, healthcare costs, and family burden.

Preferencias de atención a la discapacidad en una muestra de pacientes hospitalizados / Disability care preferences in a sample of hospitalized patients

ANTECEDENTES: En Chile, el 16 % de la población son mayores de 60 años; de ellos el 25 % tiene algún grado de dependencia funcional y el 10 % dependencia severa. En este contexto, una de las problemáticas de los equipos de salud es la definición de objetivos de cuidado cuando el paciente no los puede manifestar, decisión que podría facilitarse definiendo directrices anticipadas. MATERIAL Y MÉTODOS: Estudio transversal, descriptivo. Incluyó pacientes de 40-60 años que recibieron atención entre septiembre-octubre de 2017 en el Hospital San José, ubicado en Santiago de Chile. Se aplicó una encuesta sobre el conocimiento de riesgo de dependencia funcional y sus voluntades anticipadas. RESULTADOS: 150 pacientes, edad media 51,4 años, 56 % son solteros/divorciados, promedio 1,2 hijos y escolaridad media 46 %. Las patologías más prevalentes fueron hipertensión arterial del 50 % y diabetes del 30 %. El 40 % tenía autopercepción de salud regular. El 50 % refirió conocer sus patologías crónicas y riesgo de dependencia asociado. Respecto a las preferencias anticipadas en el hipotético caso de dependencia severa en el futuro, el 60 % escogería un familiar como cuidador, el 72 % preferiría vivir en domicilio propio y el 55,3 % rechazaría reanimación en caso de parada cardiorrespiratoria. No se encontró correlación estadística entre escolaridad y conocimiento de estado de salud, riesgo de dependencia asociado a sus enfermedades ni tampoco con la decisión de recibir reanimación en caso de parada cardiorrespiratoria. CONCLUSIONES: De nuestra muestra podemos interpretar que existe una brecha respecto a lo que significa envejecimiento satisfactorio, manejo adecuado de patologías crónicas potencialmente invalidantes y elaboración de directrices anticipadas por quienes las padecen

BACKGROUND: In Chile, 16 % of the population are over the age of 60; of these, 25 % have some degree of functional dependence and 10 % have severe dependence. In this context, one of the problems of health teams is the definition of objectives of care when the patient cannot express them, a decision that could facilitate defining directives. MATERIAL AND METHODS: A cross-sectional, descriptive study. It included patients aged 40-60 years who received care between September and October of 2017 at San José Hospital, Santiago de Chile. A survey on the knowledge of their functional dependence risk was administered, covering their advance preferences. RESULTS: A total of 150 patients participated with an average age of 51.4 years; 56 % were single/divorced. They had 1.2 children on average, and a mean level of schooling of 46 %. The most prevalent diseases were hypertension (50 %) and diabetes (30 %). Forty percent perceived their health status as fair; 50 % claimed to be aware of their chronic diseases and their associated risk of dependence. Regarding the advance preferences, in the hypothetical situation of severe dependence, 60 % would choose a relative as caregiver, 72 % would prefer to live in their own home, and 55.3 % rejected resuscitation in case of cardiac arrest. There was no statistical correlation between schooling and awareness of health status, risk of dependence associated with their illnesses, or the decision to receive resuscitation in case of cardiac arrest. CONCLUSIONS: From our sample we may interpret that there is a gap regarding the meaning of successful aging, correct management of potentially invalidating chronic diseases, and preparation of advance directives by those who suffer from them

A new DNA-based model for finite field arithmetic.

A Galois field G F ( p n ) with p ≥ 2 a prime number and n ≥ 1 is a mathematical structure widely used in Cryptography and Error Correcting Codes Theory. In this paper, we propose a novel DNA-based model for arithmetic over G F ( p n ) . Our model has three main advantages over other previously described models. First, it has a flexible implementation in the laboratory that allows the realization arithmetic calculations in parallel for p ≥ 2 , while the tile assembly and the sticker models are limited to p = 2 . Second, the proposed model is less prone to error, because it is grounded on conventional Polymerase Chain Reaction (PCR) amplification and gel electrophoresis techniques. Hence, the problems associated to models such as tile-assembly and stickers, that arise when using more complex molecular techniques, such as hybridization and denaturation, are avoided. Third, it is simple to implement and requires 50 ng/µL per DNA double fragment used to develop the calculations, since the only feature of interest is the size of the DNA double strand fragments. The efficiency of our model has execution times of order O ( 1 ) and O ( n ) , for the addition and multiplication over G F ( p n ) , respectively. Furthermore, this paper provides one of the few experimental evidences of arithmetic calculations for molecular computing and validates the technical applicability of the proposed model to perform arithmetic operations over G F ( p n ) .

Imaging biomarkers for steatohepatitis and fibrosis detection in non-alcoholic fatty liver disease.

There is a need, in NAFLD management, to develop non-invasive methods to detect steatohepatitis (NASH) and to predict advanced fibrosis stages. We evaluated a tool based on optical analysis of liver magnetic resonance images (MRI) as biomarkers for NASH and fibrosis detection by investigating patients with biopsy-proven NAFLD who underwent magnetic resonance (MR) protocols using 1.5T General Electric (GE) or Philips devices. Two imaging biomarkers (NASHMRI and FibroMRI) were developed, standardised and validated using area under the receiver operating characteristic curve (AUROC) analysis. The results indicated NASHMRI diagnostic accuracy for steatohepatitis detection was 0.83 (95% CI: 0.73-0.93) and FibroMRI diagnostic accuracy for significant fibrosis determination was 0.85 (95% CI: 0.77-0.94). These findings were independent of the MR system used. We conclude that optical analysis of MRI has high potential to define non-invasive imaging biomarkers for the detection of steatohepatitis (NASHMRI) and the prediction of significant fibrosis (FibroMRI) in NAFLD patients.

Hypothyroidism in a five-year-old boy with rhabdomyolysis and recent history of cardiac tamponade: a case report.

INTRODUCTION: Cardiac tamponade is a rare manifestation of hypothyroidism, and a less rare cause of pericardial effusion. The accumulation of the pericardial fluid is gradual, and often does not compromise cardiac hemodynamic function. There is a relationship between the severity and chronicity of the disease with the presence of pericardial effusion. There are few cases describing associated pericardial tamponade published in the literature. When a tamponade occurs, a concomitant provocative factor such as a viral pericarditis may be related. Our patient's case appears to be the youngest patient described so far. CASE PRESENTATION: We report the case of a previously healthy five-year-old Hispanic (non-indigenous) boy who developed rhabdomyolysis with a history of a recent pericardial effusion and tamponade two months before that required the placement of a percutaneous pericardial drainage. Pericardial effusion was considered to be viral. Later on readmission, clinical primary hypothyroidism was diagnosed and thought to be associated with the previous cardiac tamponade. He developed rhabdomyolysis, which was considered to be autoimmune and was treated with steroids. The level of creatine phosphate kinase and creatine kinase MB fraction returned to within the reference rangeone week after our patient was started on steroids and three weeks after he was started on thyroid hormones. CONCLUSIONS: Physicians should consider hypothyroidism as a differential diagnosis in patients with pericardial effusion. Pericardial effusion may progress and cause a cardiac tamponade with hemodynamic instability. The fact that our patient did not have any manifestations of hypothyroidism might have delayed diagnosis.

Tumor esofágico de células granulares: descripción de un tumor benigno poco frecuente / Granular cell tumor of the esophagus: description of an infrequent benign tumor

ResumenEl tumor de células granulares (TCG) es un tumor infrecuente descrito en 1926 por Abrikossoff. El 6% de estos tumores se encuentran en el tracto gastrointestinal siendo el esófago el lugar de mayor incidencia. El comportamiento suele ser benigno por lo que la mayoría de los TCG esofágicos son asintomáticos descubriéndose de forma casual en la realización de una gastroscopia. En el examen endoscópico aparece como una lesión polipoide o sésil, de aspecto submucoso, bien delimitada, recubierta de mucosa normal de color amarillento y con un aumento de su consistencia. La ecoendoscopia ha mejorado notablemente la evaluación de estas lesiones siendo actualmente la mucosectomía endoscópica el tratamiento de elección con una baja tasa de complicaciones. El estudio histológico de la pieza de resección evidencia características propias como la positividad para la proteína S-100. Presentamos 2 nuevos casos de TCG en esófago recientemente diagnosticados y se comentan los aspectos más relevantes de esta infrecuente enfermedad (AU)

Granular cell tumors (GCT) are infrequent tumors first described by Abrikossoff in 1926. Gastrointestinal involvement occurs in about 6% of GCT, the esophagus being the most frequent location. These tumors are usually benign and asymptomatic and are usually found incidentally when an upper gastrointestinal endoscopy is carried out for another reason, showing an isolated polyp or sessile submucosal nodule, covered by intact yellowish mucosa and with firm consistency. Endoscopic ultrasonography has significantly improved the diagnosis of these lesions. Nowadays endoscopic mucosectomy is the treatment of choice of esophageal GCT with a low frequency of complications. Histologic analysis of the surgical specimen shows specific characteristics such as positivity for S-100 protein. We present two new cases of esophageal GCT that were diagnosed recently and discuss the most relevant features of this infrequent disease (AU)

[Granular cell tumor of the esophagus: description of an infrequent benign tumor]. / Tumor esofágico de células granulares: descripción de un tumor benigno poco frecuente.

Granular cell tumors (GCT) are infrequent tumors first described by Abrikossoff in 1926. Gastrointestinal involvement occurs in about 6% of GCT, the esophagus being the most frequent location. These tumors are usually benign and asymptomatic and are usually found incidentally when an upper gastrointestinal endoscopy is carried out for another reason, showing an isolated polyp or sessile submucosal nodule, covered by intact yellowish mucosa and with firm consistency. Endoscopic ultrasonography has significantly improved the diagnosis of these lesions. Nowadays endoscopic mucosectomy is the treatment of choice of esophageal GCT with a low frequency of complications. Histologic analysis of the surgical specimen shows specific characteristics such as positivity for S-100 protein. We present two new cases of esophageal GCT that were diagnosed recently and discuss the most relevant features of this infrequent disease.

Toxoplasmosis y Embarazo / Toxoplasmosis and Pregnancy

Los autores presentan sus observaciones en el manejo de la serología a Toxoplasma, empleando la hemoglutinación indirecta en 7.969 embarazadas y reportan 4.296 (53.91 por ciento ) de gestantes con serología positiva. La frecuencia de los títulos fue: inferiores a 1:1.024 a 1:4.096 en 941 (21.90 por ciento ) y mayores de 1:4.096 en 140 (3.26 por ciento ). La mayoría (83.04 por ciento ) de las embarazadas y 79.88 por ciento de las positivas con edades entre 21 a 35 años. La prevalencia de Toxoplasmosis reciente fue de 7.20 por ciento (127/1.638) de ellas, el 84.25 por ciento con edades entre 21 a 35 años y edad gestacional: menor de 16 semanas: 50.40 por ciento , entre 17 y 28 semanas: 39.37 por ciento y el 10.23 por ciento restante mayor de 28 semanas; la mayor frecuencia (47.25 por ciento ) de títulos fue entre 1:1.024 a 1:4.096. La evolución serológica en los casos recientes mostró ascenso en 55.04 por ciento , estabilidad en 25.69 por ciento y descenso en 19.27 por ciento . Toxoplasmosis latente se diagnóstico en el 92.80 por ciento de los casos y la evolución mostró ascenso en sólo 15.21 por ciento . En 56 madres con Toxoplasmosis reciente hubo 2 (3.57 por ciento ) casos de transmisión congénita y ninguno en 368 casos de infección latente. Recibido 01-09-92 Aceptado 30-11-92

Tratamiento y evolución de la toxoplasmosis ganglionar / Treatment and evolution of the lymphadenopatic toxoplasmosis

Se presenta la experiencia clínica y terapéutica en setenta y siete (77) casos de linfadenopatía toxoplasmósica. Se demuestra la independencia entre el tratamiento y la evolución clínica y serológica en pacientes con la forma no febril de la toxoplasmosis ganglionar. Se concluye que el tratamiento específico sólo está indicado en los pacientes febriles

Incidencia de miasis en pacientes de consulta externa / Ocurrence of myaisis in ambulatory patients

Se reportan doce casos humanos de Miasis: cutánea (8), nasal (2), ocular (1) y vaginal (1). Las larvas causantes de miasis secundarias fueron identificadas como pertenecientes a Callitroga americana (10) y Dermatobia sp (2)

Efecto terapeutico de praziquantel sobre Hymenolepis nana / Therapeutic effect of praziquantel on Hymenolepis nana

Treinta pacientes a quienes se les diagnosticó parasitismo por Hymenolepis nana, fueron tratados con Praziquantel a la dosis de 25 mgrs/Kg.p. por vía oral en una sola toma, repetida diez días después de la primera cura, sin que ninguno de ellos reportara manifestaciones de intolerancia al medicamento. Los pacientes estudiados poseían edades comprendidas entre dos y treinta y cuatro años. Catorce (46.67%) eran del sexo masculino y diez y seis (53,33%) del sexo femenino. El diagnóstico parasitológico se realizó por examen coproparasitoscópico directo y por concentración evidenciando la presencia de huevos de Hymenolepis nana. De los treinta pacientes, veintiseis (86.67%) reportaron al interrogatorio las siguientes manifestaciones clínicas: dolor abdominal 20 casos (66.66%), Sídrome Diarréico 8 casos (26,66%), Anorexia 5 casos (16.66%) Náuseas 1 caso (13,33%) y pérdida de peso 1 caso (13,33%) cuatro pacientes (13,33%) y pérdida de peso de 1 caso (13,33%) cuatro pacientes (13,33%) eran asintomáticos. La efectividad terapéutica del Praziquantel sobre Hymenolepis nana valorada por la desaparición de huevos de parásito en heces, utilizando las mismas técnicas empleadas para hacer el diagnóstico, fue de 96,67% (29 casos) catorce días después del tratamiento. Los autores concluyen que dada la eficacia y la facilidad de administración, el Praziquantel constituye el medicamento de elección para el tratamiento de Hymenolepis nana

Relación entre aborto y serologia positiva para toxoplasma / Relationship between miscarriages and positive serology for toxoplasmosis

Conocida la alta prevalencia de serología positiva para Toxoplasma entre las mujeres embarazadas en nuestro medio, los autores realizan un estudio estadístico para tratar de establecer la relación que pueda existir entre Toxoplasmosis y aborto (interrupciónm espontánea del embarazo durante el primer trimestre). Se utilizó la reacción de hemaglutinación indirecta para investigación de anticuerpos séricos en 2.068 mujeres de las cuales 1.223 (59,14%) eran gestantes y 845 (40,86%) habían abortado. En las embarazadas las serología resultó positiva en 498 (40,72%) y negativa en 725 (59,28%). En las abortadoras fueron positivas 359 (42.49%) y negativas 486 (57,51%). La aplicación de la prueba de independencia Chi cuadrado con un nivel de significación de 0,05, demostró independencia entre aborto e infección por Toxoplasma gondii