Determinación de rangos de BCTx y N-MID Osteocalcina y asociación con Osteoporosis en mujeres chilenas posmenopáusicas

Introducción: La densitometría ósea (DO) tiene alta especificidad para el diagnóstico de osteoporosis, pero sensibilidad bajo lo óptimo para estimar el riesgo de fracturas. Éste, se puede calcular por algoritmos de predictores, y se ha propuesto incluir los marcadores óseos (MO), pero la magnitud de su asociación es incierta. El MO recomendado para medir resorción ósea es Beta-Cross Laps (B-CTx), y uno de formación ósea es la osteocalcina. Objetivos: 1) Establecer rangos de B-CTx y N-MID osteocalcina (N-MID) en mujeres posmenopáusicas (MPM), y comparar los niveles entre grupos: 1) Control sano y 2) Con DO alterada. Material y Métodos: Se reclutaron MPM, con DO del último año. Se realizó encuesta de factores de riesgo de fracturas y medición de MO. Se excluyeron MPM con causa secundaria para compromiso del recambio óseo. Resultados: 117 MPM (57 control, 60 DO alterada), 18 % osteoporosis, comparables. Los rangos de B-CTx y N-MID fueron 0,41 ± 0,18 [IC95% 0,37- 0,45] y 22,76 ± 7,73 [IC95% 21,29-24,24] ng/mL. Los niveles promedios de B-CTx y N-MID fueron más altos en grupo con DO alterada (0,46 ± 0,19 y 24,29 ± 8,04 ng/mL). Se encontró correlación moderada entre ambos MO, pero débil con DO alterada. Conclusiones: Se determinaron por primera vez rangos de B-CTx y N-MID en MPM chilenas, corroborando la similitud a otros países. Se encontraron valores discretamente más elevados de MO en grupo DO alterada, probablemente atribuible a causas secundarias no reportadas. Estos MO podrían constituir una herramienta complementaria a la DO y FRAX en la evaluación ósea.

Introduction: Bone densitometry (BD) has high specificity in the osteoporosis diagnosis but suboptimal sensitivity to estimate fracture risk. It was proposed that bone turnover markers (BTM) could be included in the osteoporosis risk algorithm, although the extent of its association is unknown. One recommended BTM to assess bone resorption is Beta-Cross Laps (B-CTx), while a BTM to assess bone formation is osteocalcin. Aims: To establish BCTx and N-MID osteocalcin (N-MID) ranges in postmenopausal women (PM) and compare BTM levels in two groups: control and with abnormal BD. Methods: PM with BD within the last year were recruited. A questionnaire of risk factors for fractures was applied, and BTM was measured. Volunteers with diseases that would affect bone remodeling were excluded. Results: 117 PM (57 control and 60 with abnormal BD) were recruited. 18% had osteoporosis, and the groups were comparable. The ranges for B-CTx and N-MID were 0.41 ± 0.18 [IC95% 0.37-0.45] and 22.76 ± 7.73 [IC95% 21.29-24.24] ng/mL. The mean levels of B-CTx and N-MID were higher in the group with abnormal BD (0.46 ± 0.19 and 24.29 ± 8.04 ng/mL). A moderate correlation between both BTM was found, but it was weak with abnormal BD. Conclusions: B-CTx and N-MID ranges were assessed for the first time in Chilean PM, similar to values found in other countries. Slightly higher values of BTM were found in the group with abnormal BD, which the presence of omitted secondary causes could explain. These BTM could be a complementary tool to BD and FRAX in bone evaluation.

[Determination of reference values of CTx and NMID-Osteocalcin and their association with osteoporosis in postmenopausal chilean women]. / Determinación de rangos de BCTx y N-MID Osteocalcina y asociación con Osteoporosis en mujeres chilenas posmenopáusicas.

INTRODUCTION: Bone densitometry (BD) has high specificity in the osteoporosis diagnosis but suboptimal sensitivity to estimate fracture risk. It was proposed that bone turnover markers (BTM) could be included in the osteoporosis risk algorithm, although the extent of its association is unknown. One recommended BTM to assess bone resorption is Beta-Cross Laps (B-CTx), while a BTM to assess bone formation is osteocalcin. AIMS: To establish BCTx and N-MID osteocalcin (N-MID) ranges in postmenopausal women (PM) and compare BTM levels in two groups: control and with abnormal BD. METHODS: PM with BD within the last year were recruited. A questionnaire of risk factors for fractures was applied, and BTM was measured. Volunteers with diseases that would affect bone remodeling were excluded. RESULTS: 117 PM (57 control and 60 with abnormal BD) were recruited. 18% had osteoporosis, and the groups were comparable. The ranges for B-CTx and N-MID were 0.41 ± 0.18 [IC95% 0.37-0.45] and 22.76 ± 7.73 [IC95% 21.29-24.24] ng/mL. The mean levels of B-CTx and N-MID were higher in the group with abnormal BD (0.46 ± 0.19 and 24.29 ± 8.04 ng/mL). A moderate correlation between both BTM was found, but it was weak with abnormal BD. CONCLUSIONS: B-CTx and N-MID ranges were assessed for the first time in Chilean PM, similar to values found in other countries. Slightly higher values of BTM were found in the group with abnormal BD, which the presence of omitted secondary causes could explain. These BTM could be a complementary tool to BD and FRAX in bone evaluation.

Treatment of Bolivian Leishmania braziliensis Cutaneous and Mucosal Leishmaniasis.

Although infection with Leishmania braziliensis is perhaps the key reason to treat New World cutaneous leishmaniasis (CL) and mucosal leishmaniasis (ML), the total literature contains relatively few reported cases. With the aim of supplementing the meager clinical information available, we searched the records of Jorochito (Dermatology) Hospital, Bolivia, for the years 1999-2020 and identified treatment records for 1,696 naive CL patients and 355 naive ML patients. Because follow-up was poor for this real-world treatment experience in the developing world, only 255 CL patients (15%) and 114 ML patients (32%) attended follow-up at Hospital. We therefore engaged in an Active Search for "lost" patients, located a further 542 CL patients (32%) and 142 ML patients (44%), thus eventually accomplished follow up on 697 CL patients (41%) and 256 ML patients (72%). Granular adverse event data derived from hospital records is listed for the 902 CL and 86 ML patients administered Glucantime intramuscularly, the 401 CL and 202 ML patients administered Glucantime intravenously, and the 163 CL and 89 ML patients administered miltefosine orally. Efficacy was obtained from hospital records for patients seen at hospital and from patient recall communicated by telephone for the patients found in the Active Search. The overall CL cure rate was 508 of 697 CL patients (73%) with follow-up: intramuscular Glucantime-196/293 (67%); intravenous Glucantime-90/126 (71%); intralesional Glucantime-34/54 (63%); oral miltefosine-52/69 (75%). The overall ML cure rate was 161 of 256 ML patients (63%) with follow-up: intramuscular Glucantime-26/48 (54%); intravenous Glucantime-66/104 (63%); intravenous amphotericin B deoxycholate-19/35 (54%); oral miltefosine-50/71 (70%). We offer this extensive adverse event and efficacy experience as useful guides for clinicians presented with a L. braziliensis infection. The cure rates also illustrate the quandary of New World CL and ML chemotherapy: sufficiently high to be useful but nevertheless needing augmentation with new agents.

Venous Thromboembolism in Patients with Cancer Receiving Specialist Palliative Care.

CONTEXT: The prevalence of venous thromboembolism (VTE) in patients with cancer is particularly high at disease progression and during relapse. Patients cared for in specialized palliative care units (SPCU) are rarely included in VTE studies. Objective: We sought to study the prevalence, clinical characteristics, and survival of individuals with VTE in an SPCU setting. METHODS: We retrospectively included 2707 consecutive individuals with active cancer managed at a SPCU. Data were summarized using descriptive statistics and frequency for categorical variables. Overall survival was estimated by Kaplan-Meier and comparisons by log-rank test. Thrombotic events were confirmed by imaging. RESULTS: We studied 1984(73.3%) women and 723 (26.7%) men. The overall prevalence of thrombosis was 22.2% with only 6.2% occurring after initiating SPCU care, and was higher in women (24.6% vs 15.8%), particularly with gynecological tumors (cervical: 30.5%, ovarian: 29.2%). Median survival was slightly longer for patients without VTE (80 days [IQR21-334] and 69 days [IQR 25-235]; p = 0.03). CONCLUSIONS: Prevalence of VTE was high and varied by tumor origin. VTE may impact survival. Though median survival is short, some patients are followed over months, suggesting that in the absence of high bleeding risk, treatment for thrombosis in an attempt to decrease the morbidity of re-thrombosis should be considered. On the other hand, few patients developed symptomatic VTE during SPCU care, making generalized primary prophylaxis probably unwarranted. Customizing anticoagulation for the risk of hemorrhage and physical performance is essential.

Case Report: Mini-endoscopic combined intrarenal surgery in an en-bloc kidney transplant.

BACKGROUND: Overall incidence of stones in kidney transplant recipients is 1%. En-bloc kidney transplant is a rare anatomical condition in which kidney stones treatment can be extremely difficult to treat. As far as we know, no cases of staghorn calculi in en-bloc kidney transplant have been published so far. CASE PRESENTATION: A 27-year-old woman presented to the Emergency Department because of asthenia, adynamia and weight loss associated with lower urinary tract symptoms and subfebrile temperature. Ten years before, she had undergone an en-bloc kidney transplant because of end-stage renal disease secondary to perinatal asphyxia syndrome. One kidney was implanted capo-volta in the right iliac fossa and the other one in the right flank. NCCT scan showed incomplete staghorn calculi in the iliac fossa transplanted kidney. Besides, severe dilation of the native and the right flank transplanted kidney, due to two ureteral stones of 6 and 7 mm impacted in the uretero-ureteral anastomosis, was found. After hospital admission and under ceftriaxone prophylaxis, an attempt to perform primary RIRS following our COVID protocol was carried out. Nevertheless, we ended up placing a JJ stent because once the guidewire passed through the ureteral stones, purulent material came out from the ureteral orifice. She stayed 9 days in-hospital for management of postobstructive polyuria and was discharged with oral antibiotics. Three weeks afterward, we removed the stent and performed flexible ureteroscopy and holmium laser lithotripsy of the ureteral stones. In the same procedure, we performed Mini-ECIRS (21 French) previous ultrasound-guided upper pole puncture. Postoperative NCCT scan showed neither residual fragments nor operative complications. CONCLUSION: This is the first clinical case reporting Mini-ECIRS in a patient with an en-bloc kidney transplant. This endourological approach seems to be a feasible, safe and effective approach to treat stones in this anatomically challenging condition.

[Mucinous cystadenoma of the ileocecal valve. Uncommon intestinal tumor in a oneyear-old boy. Case report]. / Cistoadenoma mucinoso de la vá lvula ileocecal: tumoración intestinal infrecuente en un niñ o de 1 añ o. Reporte de caso.

Mucinous cystadenoma is usually found in the ovary, pancreas and appendix but its presentation in the intestine is extremely rare. In this case report we present an infant with partial intestinal occlusion due to a mucinous cystadenoma of the ileocecal valve. We performed an excision of the terminal ileum, ileocecal valve, cecum and appendix, followed by ileocolic anastomosis. The patient did well after the procedure and recovered uneventfully. To our knowledge, this is the first case report of this tumor in this location.

Cistoadenoma mucinoso de la válvula ileocecal: tumoración intestinal infrecuente en un niño de 1 año. Reporte de caso / Mucinous cystadenoma of the ileocecal valve. Uncommon intestinal tumor in a oneyear-old boy. Case report

RESUMEN El cistoadenoma mucinoso se encuentra usualmente en el ovario, páncreas y el apéndice, pero su presentación en el intestino es extremadamente rara. En este reporte de caso, presentamos a un niño con obstrucción parcial intestinal debido a un cistoadenoma mucinoso en la válvula ileocecal. En la cirugía se retiró el íleo terminal, válvula ileocecal, ciego y apéndice, seguido de anastomosis ileocecal. El paciente evolucionó favorablemente en el postoperatorio y se recuperó sin contratiempos. A nuestro entender, este es el primer reporte de presentación de este tumor en dicha localización.

ABSTRACT Mucinous cystadenoma is usually found in the ovary, pancreas and appendix but its presentation in the intestine is extremely rare. In this case report we present an infant with partial intestinal occlusion due to a mucinous cystadenoma of the ileocecal valve. We performed an excision of the terminal ileum, ileocecal valve, cecum and appendix, followed by ileocolic anastomosis. The patient did well after the procedure and recovered uneventfully. To our knowledge, this is the first case report of this tumor in this location.

Mass Drug Administration of Triclabendazole for Fasciola Hepatica in Bolivia.

Human infection with Fasciola hepatica leads to obstruction of the common bile duct by adult worms and disease characterized by biliary colic, epigastric pain, and nausea. Recommended treatment is a single dose of triclabendazole (TCBZ) (10 mg/kg). Because in the 1990s the Bolivian Altiplano bordering Lake Titicaca was thought to have the highest prevalence of human fascioliasis worldwide, the Bolivian Ministry of Health instituted TCBZ mass drug administration (MDA). From 2008 to 2016 (excepting 2015), one dose of 250 mg was administered, usually in September/October, to each resident of highly endemic regions willing to participate. This is apparently the first reported use of MDA for Fasciola. The proportion of persons in key regions receiving TCBZ MDA was 87% in 2016. In 2017, we resurveyed key regions, and found that the MDA program had been dramatically successful. Whereas Fasciola prevalence was reported as 26.9% in Huacullani/Tiahuanaco and 12.6% in Batallas in 1999, there was 0.7% prevalence in Huacullani/Tiahuanaco and 1% in Batallas in 2017. However, lessons from schistosomiasis control efforts suggest that for sustained control of Fasciola infection, Fasciola MDA needs to be maintained and coupled with measures to control infection in the intermediary snail and in the animal hosts of F. hepatica.

Baseline serum albumin and other common clinical markers are prognostic factors in colorectal carcinoma: A retrospective cohort study.

The aim of the present study was to define the prognostic role of baseline serum albumin (BSA) in colorectal cancer (CRC) across tumor-node-metastasis (TNM) stages and other well defined prognostic factors. Many prognostic models in medicine employ BSA to define or refine treatments in very specific settings; in CRC, BSA has been found to be a prognostic factor as well. A retrospective cohort study of consecutive patients with CRC demonstrated by biopsy, who attended a cancer center during a 7-year period. Multivariate analysis was utilized to define prognostic factors associated with overall survival (OS) employing the Cox model. In this retrospective cohort study, 1465 patients were included; 46.6% were females and 53.4% males (mean age, 59.1 years). Mean BSA was inversely correlated with TNM stages. By multivariate analysis, it was an independent explanatory variable. TNM stages, "R" classification, age, lymphocyte count, neutrophil/platelet ratio, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, postoperative morbidity, and BSA were independently associated with OS. Morbidities, surgery type, chemotherapy, and radiotherapy were considered confounders after adjusting by TNM stages. BSA is a significant and independent prognostic factor in patients with CRC, and its effect is maintained across TNM strata and other well known clinical prognostic factors. It can be easily used in prognostic models and should be employed to stratify prognosis in therapeutic randomized clinical trials.

Implementation of malaria dynamic models in municipality level early warning systems in Colombia. Part I: description of study sites.

As part of the Integrated National Adaptation Pilot project and the Integrated Surveillance and Control System, the Colombian National Institute of Health is working on the design and implementation of a Malaria Early Warning System framework, supported by seasonal climate forecasting capabilities, weather and environmental monitoring, and malaria statistical and dynamic models. In this report, we provide an overview of the local ecoepidemiologic settings where four malaria process-based mathematical models are currently being implemented at a municipal level. The description includes general characteristics, malaria situation (predominant type of infection, malaria-positive cases data, malaria incidence, and seasonality), entomologic conditions (primary and secondary vectors, mosquito densities, and feeding frequencies), climatic conditions (climatology and long-term trends), key drivers of epidemic outbreaks, and non-climatic factors (populations at risk, control campaigns, and socioeconomic conditions). Selected pilot sites exhibit different ecoepidemiologic settings that must be taken into account in the development of the integrated surveillance and control system.

Health care-associated infections in hematology-oncology patients with neutropenia: a method of surveillance.

We present a prospective method of surveillance of health care-associated infection in hematology-oncology inpatients with neutropenia. Incidence rates were calculated on the basis of the number of hospitalized patients, the duration of hospital stay (in days), the number of days of neutropenia, and (in cases of central line-associated blood stream infection) the number of central line-days. We detected 11.4 and 66.4 episodes of febrile neutropenia per 1,000 hospital-days and per 1,000 days of neutropenia, respectively. The incidence of central line-associated blood stream infection was 2.6 per 1,000 central line-days. Gram-negative bacteria were the most prevalent pathogens. Efforts should be made to monitor infection rates on hematology-oncology wards.

Implantes dentales en osteogénesis imperfecta. Niños con huesos de cristal: algo más que un caso clínico / Dental implants in osteogenesis imperfecta. Children with crystal bones: more than a clinical case

La osteogénesis imperfecta, también llamada enfermedad de los niños con huesos de cirstal, es una enfermedad genética. La misma se caracteriza porque los huesos se rompen tras un mínimo traumatismo e incluso sin causa. Su incidencia es alta. Puede no sercongénita. Se debe a la insuficiente y/o defectuosa formación del colágeno tipo I, que constituye el 85 a 90 por ciento del hueso. En tipos severos causa la muerte al nacer. Ha sido contraindicada la colocación de implantes. Este caso clínico de implantes fue exitoso en un Tipo moderado (IV) y se realizó a pedido del paciente, luego de explicársele la falta de antecedentesen la bibliografía y la contraindicación teórica.

Implantes dentales en osteogénesis imperfecta. Niños con huesos de cristal: algo más que un caso clínico / Dental implants in osteogenesis imperfecta. Children with crystal bones: more than a clinical case

La osteogénesis imperfecta, también llamada enfermedad de los niños con huesos de cirstal, es una enfermedad genética. La misma se caracteriza porque los huesos se rompen tras un mínimo traumatismo e incluso sin causa. Su incidencia es alta. Puede no sercongénita. Se debe a la insuficiente y/o defectuosa formación del colágeno tipo I, que constituye el 85 a 90 por ciento del hueso. En tipos severos causa la muerte al nacer. Ha sido contraindicada la colocación de implantes. Este caso clínico de implantes fue exitoso en un Tipo moderado (IV) y se realizó a pedido del paciente, luego de explicársele la falta de antecedentesen la bibliografía y la contraindicación teórica.(AU)

Consensus on criteria for potential areas for wolf reintroduction in Mexico.

Given the conflict with human interests that in many cases results in the extirpation of large carnivores, acceptance of their reintroduction is a considerable challenge. By the 1980s Mexican wolves (Canis lupus) were extinct in the wild. In 1998 a population was reintroduced in the Blue Range Mountains of New Mexico (U.S.A.). Efforts to reintroduce the species in Mexico have been ongoing since the late 1980s. Four teams working independently identified 6 areas in northern Mexico in the historic range of Mexican wolves, where reintroductions could potentially be successful. Each team used different methods and criteria to identify the areas, which makes it difficult to prioritize among these areas. Therefore, members of the different teams worked together to devise criteria for use in identifying priority areas. They identified areas with high, intermediate, and low potential levels of conflict between wolves and humans. Areas with low potential conflict had larger buffers (i.e., distance from human settlement to areas suitable for wolves) around human settlements than high- and intermediate-conflict areas and thus were thought most appropriate for the first reintroduction. High-conflict areas contained habitat associated with wolf presence, but were closer to human activity. The first reintroduction of Mexican wolves to Mexico occurred in October 2011 in one of the identified low-conflict areas. The identification of suitable areas for reintroduction represents a crucial step in the process toward the restoration of large carnivores. Choice of the first reintroduction area can determine whether the reintroduction is successful or fails. A failure may preclude future reintroduction efforts in a region or country.

Frequency of antinuclear antibodies in mestizo Mexican children with morphea.

Morphea is a disease that affects connective tissue and microvessels. Its pathogenesis is unknown, but several autoimmune factors participate. Our objective was to determine the frequency of antinuclear antibodies (ANAs) in pediatric patients with morphea and to establish their relation with the clinical variants and disease activity. A cross-sectional study was carried out from January 1999 to January 2008 in patients with morphea seen at the Instituto Dermatologico de Jalisco. ANAs were determined through an indirect immunoflourescent method, and the immunospecificity was done with a double immunodiffusion technique in agarose gel. A total of 34 children were included in the study, 74% of the female gender. Plaque morphea was the most common variant, present in 44% of the cases, followed by linear morphea in 38%, and generalized morphea in 18%. ANAs were positive in 29%, with homogenous immunoflourescense as the most frequent pattern (70%). Of the ANA-positive patients, 83% had generalized morphea, and in 70% of the cases the disease were considered as active. The frequency of ANA-positive children with morphea was 29%, and seems to be related to more extensive disease. No previous studies exist on this topic in the mestizo Mexican population.

Histoplasmosis localizada del sistema nervioso central en un niño inmunocompetente / Central nervous system localized histoplasmosis in an immunocompetent child

Introducción. La histoplasmosis localizada del sistema nervioso en una forma rara de presentación de estamicosis sistémica. Se puede manifestar clínicamente como una meningitis crónica, lesiones focales encefálicas ode la médula espinal, ataques cerebrovasculares y encefalitis. Caso clínico. Se presenta el caso de un niño inmunocompentente con histoplasmosis localizada del sistema nervioso central. Su cuadro clínico neurológico fue de evolución crónica y presentó varios déficits neurológicos focales. Las imágenes diagnósticas evidenciaron múltiples masas del tallo cerebral y de la médula espinal cervical. Las pruebas inmunológicas demostraron anticuerpos anti Histoplasma. El paciente mejoró con el tratamiento secuencial de anfotericina B y fluconazol. Conclusiones. A pesar de su rareza, la histoplasmosis del sistema nervioso debe estar en el diagnóstico diferencial de las masas múltiples del encéfalo y médula espinal en un paciente residente en área endémica, las pruebas inmunológicas son útiles como herramienta diagnóstica y el tratamiento antimicótico puede llevar a la curación.

Introduction. Localized central nervous system histoplasmosis is a rare clinical form of this systemic mycosis. It could be presented as chronic meningitis, focal encephalic or spinal cord lesions, stroke syndromes and encephalitis.Clinical case. We present a case of an immunocompetent child with localized histoplasmosis of the central nervous system. The neurological case had a chronic evolution and presented several focal neurological deficits. Magnetic resonance imaging showed multiple masses of the brainstem and the cervical spinal cord. Immunologicaltests showed antibodies anti-Histoplasma capsulatum. The clinical condition of the patient improved with the sequential treatment with amphotericin B and fluconazole.Conclusions. In spite of the rare presentation, central nervous system histoplasmosis should be considered inthe differential diagnosis of multiple brain and spinal cord lesions in a patient resident in an endemic area. Immunological tests are useful as a diagnostic tool and the antifungal treatment could lead to cure.

Ca-ATPase activity of human red cell ghosts: preeclampsia, lipid peroxidation and MgSO4.

The increased level of lipid peroxidation of red blood cells during preeclampsia is considered to be responsible for the diminished Ca-ATPase activity in these cells. The level of lipid peroxidation and the Ca-ATPase activity of red blood cells from preeclamptic women, return to their normal values after in vivo and in vitro treatment with MgSO4 for 24 h. In order to evaluate whether or not cell intactness is essential for these changes, we used either intact red blood cells or red cell ghosts from normotensive pregnant women. The intact red blood cells were treated with Fenton's reagent and then incubated with 4 mM MgSO4. The red cells ghosts were irradiated with UV light and afterwards incubated with MgSO4 at 4 degrees C. Lipid peroxidation and Ca-ATPase activity were determined for all the preparations. Both, Fenton's reagent and UV irradiation increased the level of lipid peroxidation and diminished the Ca-ATPase activity of the red cell membranes. Incubation of the cells treated with Fenton's reagent, or the ghosts irradiated with UV, with 4 mM MgSO4, returned Ca-ATPase activity and lipid peroxidation levels to normal values. The presence of MgSO4 blocked the effects in the ghosts of UV irradiation. MgSO4 seems to better protect the red cell membrane against lipid peroxidation than other SO4= and Cl- salts. These results indicate that the changes in the lipid peroxidation of the red cell ghosts and their Ca-ATPase activity are a result of changes to the cell membranes.

Carcinoma lobulillar in situ dentro de un fibroadenoma mamario: reporte de dos casos / Situ lobular carcinoma within a fibroadenoma breast: report of two cases

Un carcinoma originado en un fibroadenoma es poco frecuente. El propósito de este reporte es incrementar el conocimiento de esta entidad y disminuir la práctica de diagnósticos con examinación macroscópica del tumor. Nosotros presentamos dos casos de Carcinoma In Situ Lobular originado en un Fibroadenoma beningno.

A carcinoma arising within a Fibroadenoma in an unusual ocurrence. The purpose of this report is to increase to awareness of this entity and to reduce the practica of rendering a diagnosis on gross examination of the tumor. We present two case of an in Situ Lobular Carcinoma within an benign fibroadenoma.

Randomized, double-blind, placebo-controlled study of Malarone for malaria prophylaxis in non-immune Colombian soldiers.

Malarone was compared with placebo in a double-blind, randomized, placebo-controlled trial of prophylaxis of malaria in predominately Plasmodium vivax areas of Colombia. The study population consisted of 180 completely non-immune Colombian soldiers, male, average age 19 years, and average weight 63 kg. Twenty-four subjects were considered unevaluable because of compliance issues, including one Malarone subject (with no detectable drug levels) who became infected with P. vivax. Of the 97 evaluable subjects who received Malarone (250 mg atovaquone plus 100 mg proguanil hydrochloride) daily from 1 day before entering the endemic area to 7 days after leaving the endemic area, none became parasitemic. Of the 46 evaluable placebo subjects, 11 became infected with P. vivax and 2 became infected with Plasmodium falciparum. The protective efficacy of Malarone for all malaria and for P. vivax malaria was 100% (LL 95% CI = 63%) and 100% (LL 95% CI = 58%), respectively, and was 96% if the one case with undetectable blood levels was included. Malarone has high protective efficacy for P. vivax in Colombia.