ABSTRACT
Cardiovascular surgery in Panama has depended on constant contributions and support from other developed countries. Although cardiac surgery has reached important milestones, cardiac surgery training is still evolving. Here, we provide a look into both the development and training of cardiac surgery in the Republic of Panama and the importance of international training.
Subject(s)
Cardiac Surgical Procedures , Humans , Treatment Outcome , PanamaABSTRACT
<b>Background and Objective:</b> Forage production in the tropics is generally asymmetrically distributed. Hence the need to use more complex models, especially when multiple comparisons are made and there are very large deviations from normality. The objective of this research is to fit a Generalized Additive Model for Location, Scale and Shape (GAMLSS) model on accumulated dry matter data from <i>Brachiaria brizantha</i> using a model selection algorithm. <b>Materials and Methods:</b> A Box-Cox Power Exponential (BCPE) distribution was adjusted on the dry matter from <i>Brachiaria brizantha</i> data implementing GAMLSS in R (programming language). The accumulated dry matter data for <i>B. brizantha</i> were obtained from a study carried out on a farm in the state of Portuguesa, Venezuela. The explanatory covariate x was the interval between cuts (21, 28, 35 and 42 days). <b>Results:</b> The dependent variable (dry matter) exhibited both skewness and kurtosis. GAMLSS allowed flexible modeling of both the distribution of the dry matter yield from <i>B. brizantha</i> and the dependence of all the parameters of the distribution on intervals between cuttings. For the dry matter yield from <i>B. brizantha</i>, which exhibited skewness and leptokurtosis, the BCPE distribution, provided the best fit. <b>Conclusion:</b> The interval between cuttings showed an effect that is reflected in the average yield of dry matter from <i>B. brizantha</i>. The interval between cuts affected the skewness and the kurtosis of the distribution.
Subject(s)
Algorithms , Brachiaria/growth & development , Geographic Mapping , Agriculture/methods , Humans , VenezuelaABSTRACT
Objective: To provide real world observational data about glucose control, the burden of diabetes, comorbidities, and cardiovascular risk factors among patients initiating second-line therapy in Latin America (LA). Methods: This report is a cross-sectional analysis of the LA cohort of the DISCOVER study, describing the regional prevalence of microvascular and macrovascular complications in Mexico, Costa Rica, Panama, Colombia, Argentina, and Brazil. Results: One thousand six hundred and sixteen patients were included in 69 investigational sites. Hemoglobin A1c was >7% (42 mmol/mol) in 81.3% of subjects. Macrovascular complications were reported by 13.8% of the subjects. Microvascular conditions were reported in 15.2% of the subjects. The prevalence of hypertension and of hyperlipidemia was 55.5% and 45.9%, respectively. Blood pressure, total cholesterol, and low-density lipoprotein were out of target levels in 38.5%, 51.2%, and 81.7% of the patients, respectively. Overweight or obesity was reported in 83.8% of the cases. Conclusion: Our study shows that patients with type 2 diabetes in LA are not reaching their glucose, lipids, blood pressure, and weight targets. The prevalence of microvascular (15.2%), macrovascular (13.8%), and uncontrolled comorbidities in patients at an early stage of the disease (initiating a second-line therapy) highlights the need for more aggressive risk factor screening as well as treatment in LA. Abbreviations: CV = cardiovascular; CVD = cardiovascular disease; DM = diabetes mellitus; HbA1c = hemoglobin A1c; LA = Latin America/Latin American; LDL = low density cholesterol; T2DM = type 2 diabetes mellitus.
Subject(s)
Cardiovascular Diseases , Diabetes Mellitus, Type 2 , Cardiovascular Diseases/complications , Cross-Sectional Studies , Diabetes Mellitus, Type 2/complications , Humans , Latin America , Prevalence , Risk FactorsABSTRACT
PURPOSE: To report surgical outcomes in a series of cases with symptomatic vitreomacular traction that met MIVI-TRUST (Microplasmin for intravitreous injection-traction release without surgical treatment) criteria for ocriplasmin use who underwent primary 25-gauge vitrectomy. MATERIALS AND METHODS: A single-center retrospective chart review study was performed in patients who underwent primary 25-gauge vitrectomy for symptomatic vitreomacular traction (VTM) from January 2013 through January 2016. Pre- and postoperative visual acuity (measured by the early treatment diabetic retinopathy acuity test), and posterior hyaloid focal attachment to the macula (demonstrated by high-definition optical coherence tomography) were analyzed. In addition, intra- and postoperative complications were obtained from medical records. RESULTS: Fifteen consecutive cases of symptomatic VMT traction that underwent primary 25-gauge vitrectomy were included. All met the MIVI-TRUST criteria for ocriplasmin use. In all cases, VMT resolution, macular hole closure, and improvement in best corrected visual acuity (BCVA) were observed. Mean visual acuity improved from 56.53 ± 16.04 letters at baseline to 73.13 ± 7.46 letters at 24 weeks of follow-up. The mean BCVA improvement from baseline was 16.60 letters (range 6-44), which was statistically significant (P < 0.0001). Ten of fifteen patients (66.6%) showed significant improvement of their BCVA to 20/40 or better (70 or more in ETDRS visual acuity test). No significant intra- or postoperative complications were documented. CONCLUSIONS: Primary 25-gauge pars plana vitrectomy in eyes with symptomatic vitreomacular traction is able to efficiently resolve VMT and macular holes, improving vision in candidates for intravitreal injection of ocriplasmin. This well-tolerated surgical procedure may be a reliable and predictable alternative for resolving VMT pathology.
Subject(s)
Eye Diseases/surgery , Fibrinolysin/administration & dosage , Fibrinolytic Agents/administration & dosage , Peptide Fragments/administration & dosage , Retinal Perforations/surgery , Vitrectomy/methods , Vitreous Body/surgery , Aged , Combined Modality Therapy , Eye Diseases/diagnostic imaging , Eye Diseases/physiopathology , Female , Humans , Intravitreal Injections , Male , Microsurgery , Middle Aged , Retinal Perforations/diagnostic imaging , Retinal Perforations/physiopathology , Retrospective Studies , Tomography, Optical Coherence , Visual Acuity/physiology , Vitreous Body/diagnostic imaging , Vitreous Body/physiopathologyABSTRACT
A 39-year-old woman with autosomal dominant polycystic kidney disease (ADPKD) presented with acromegaly and a pituitary macroadenoma. There was a family history of this renal disorder. She had undergone surgery for pituitary adenoma 6 years prior. Physical examination disclosed bitemporal hemianopsia and elevation of both basal growth hormone (GH) 106 ng/mL (normal 0-5) and insulin-like growth factor (IGF-1) 811 ng/mL (normal 48-255) blood levels. A magnetic resonance imaging scan disclosed a 3.0 cm sellar and suprasellar mass with both optic chiasm compression and left cavernous sinus invasion. Pathologic, cytogenetic, molecular and in silico analysis was undertaken. Histologic, immunohistochemical and ultrastructural studies of the lesion disclosed a sparsely granulated somatotroph adenoma. Standard chromosome analysis on the blood sample showed no abnormality. Sequence analysis of the coding regions of PKD1 and PKD2 employing DNA from both peripheral leukocytes and the tumor revealed the most common PKD1 mutation, 5014_5015delAG. Analysis of the entire SSTR5 gene disclosed the variant c.142C>A (p.L48M, rs4988483) in the heterozygous state in both blood and tumor, while no pathogenic mutations were noted in the MEN1, AIP, p27Kip1 and SSTR2 genes. To our knowledge, this is the fourth reported case of a GH-producing pituitary adenoma associated with ADPKD, but the first subjected to extensive morphological, ultrastructural, cytogenetic and molecular studies. The physical proximity of the PKD1 and SSTR5 genes on chromosome 16 suggests a causal relationship between ADPKD and somatotroph adenoma.
Subject(s)
Acromegaly/complications , Acromegaly/genetics , Growth Hormone-Secreting Pituitary Adenoma/complications , Growth Hormone-Secreting Pituitary Adenoma/genetics , Pituitary Neoplasms/complications , Polycystic Kidney, Autosomal Dominant/complications , Polycystic Kidney, Autosomal Dominant/genetics , Receptors, Somatostatin/genetics , TRPP Cation Channels/genetics , Acromegaly/pathology , Adenoma/complications , Adenoma/genetics , Adult , Base Sequence , Female , Humans , Pituitary Gland/pathology , Pituitary Neoplasms/genetics , Pituitary Neoplasms/pathology , Polymorphism, GeneticABSTRACT
Introducción: Nuevo Pevas, centro poblado con diez años de creación situado en el distrito de Pevas, Loreto, presentó en febrero del 2000 un brote epidémico de malaria. Objetivo: describir las características del brote de malaria en la localidad de Nuevo Pevas y el desarrollo de las acciones dirigidas a su control. Material y Métodos: reportado y verificado el brote, un equipo de intervención desarrolló actividades integrales de control de brote. Resultados: sobre 2 000 habitantes, se muestreó al 98.7% de la población, leyendo 1 974 láminas. Se detectó y trató 231 casos de malaria, 185 por P. falciparum y 46 por P. vivax. Diez casos de malaria grave/complicada ameritaron hospitalización entre los que no se registraron fallecidos. La tasa de incidencia del periodo de intervención fue de 115.5 por 1 000 habitantes. Se reportaron tres fallecimientos poco antes de que el equipo inicie sus actividades a plenitud. Durante la intervención no hubo defunciones. Discusión: la intervención fue rápida, integral y efectiva. Se trabajaron las dos acciones que doctrinariamente tiene el Programa de control de malaria, la búsqueda activa de casos y el tratamiento y acciones de control vectorial. Conclusiones: es probable que de no haber actuado con prontitud la morbi-mortalidad hubiera sido mayor. Se trata de una población migrante, con poco tiempo en el área, sin historia de residencia en zona endémica, por lo tanto ninguna inmunidad relativa contra malaria.
Introduction: In February 2000 an outbreak of malaria ocurred in Nuevo Pevas, a town with ten years of establishment situated in the district of Pevas, Loreto. Objective: To describe the characteristics of the outbreak of malaria in the village of Nuevo Pevas and the actions developped for its control. Methods: Once the outbreak was reported and verified an intervention team carried out comprehensive control of the outbreak. Results: Over 2 000 habitants we performed 1 974 blood smears (98.7% of population), detecting and treating 231 cases of malaria, 185 by P.falciparum and 46 by P. vivax. Ten cases of severe malaria merit hospitalization but none of them died. The incidence rate of the intervention period was 115.5 per 1 000. Three deaths were reported shortly before the team starts full activities. During the intervention there were no deaths. Discussion: the intervention was prompt, thorough and effective. The two actions the team worked were doctrinaire for Malaria control program, such as active case finding and treatment and vector control activities. Conclusions: it is likely that of not having acted promptly morbidity and mortality were higher. This is a migrant population, with little time in the area, with no history of residence in an endemic area, therefore no immunity against malaria on.
Subject(s)
Humans , Male , Female , Communicable Disease Control , Epidemics/prevention & control , Malaria/epidemiology , Malaria/prevention & control , PeruABSTRACT
El objetivo de esta investigación fue comparar la influencia de los suplementos en los medios de maduración oocitaria y su posterior fertilización. Los suplementos probados fueron el suero fetal bovino (SFB), el suero de vaca en estro (SVE), el suero de neonato precalostral (SNP) y el suero de yegua en estro (SYE). Los oocitos se obtuvieron de ovarios de vacas de abasto público. Los ovarios fueron transportados hasta el laboratorio en solución salina a una temperatura de 37 °C ; después se lavaron durante cinco minutos en hipoclorito y en solución de NaCI 0,9 por ciento y posteriormente fueron aspirados. Los oocitos encontrados se depositaron en los medios de maduración que contenían 108 oocitos por cada tratamiento. Una vez madurados, los oocitos fueron depositados en medio de fecundación por un periodo de 18 horas, al cabo de las cuales se llevaron al medio de maduración de embriones (PBS+ SFB 10 por ciento). Al sexto día, se hizo el respectivo conteo con ayuda del microscopio. Con la aplicación de la prueba estadística de CHI2 se pudo comprobar la diferencia significativa entre los diferentes sueros en la maduración y fertilización de los oocitos...
Subject(s)
Cattle , Cattle , Oocytes , Serum , FertilizationABSTRACT
El trabajo plantea y explica una serie de problemas existentes en las autorizaciones que la Superintendencia de Telecomunicaciones otorga para prestar el Servicio de Estación Espacial en territorio Boliviano, basado en el marco normativo vigente en nuestro país
Subject(s)
TelecommunicationsABSTRACT
La púrpura fulminans (PF) es una enfermedad cutánea purpúrica aguda asociada a un síndrome de coagulación intravascular diseminada (CID). Sus causas conocidas incluyen infecciones virales y bacterianas así como trombofilias. Es sabido que durante el embarazo existen alteraciones en los mecanismos hemostáticos; sin embargo, no se ha demostrado que estos fenómenos por sí solos ayuden al desarrollo de la PF.Se describe el caso de una mujer de 22 años, quien tuvo PF en circunstancias inusuales tales como el desarrollo de su cuadro durante el embarazo y el origen probable en una infección por E. coli. Se presentan los hallazgos clínicos, las intervenciones médicas y quirúrgicas y el desenlace. La paciente sobrevivió pero hubo necesidad de amputarle las falanges distales de tres artejos del pie izquierdo.
PF is a serious cutaneous purpuric disease, associated with an intravascular disseminated coagulation syndrome. Among its known causes, besides those of thrombophilia, are viral and bacterial infections, mostly Neisseria meningitidis. During pregnancy there are alterations in the hemostatic mechanism. However, by themselves, they have not been shown to lead to PF. The case of a 22-year-old woman who developed PF during pregnancy, presumably due to her Escherichia coli urinary tract infection, is presented including clinical, paraclinical, therapeutic and surgical aspects. She recovered but suffered amputation of the distant phalanges of three toes in the left foot
