Use of the polymerase chain reaction for diagnosing bovine tuberculosis in Panama.

In addition to causing large losses to the cattle industry, Mycobacterium bovis, the causative agent for bovine tuberculosis, is a serious public health issue because it can potentially infect humans. Diagnosis based on isolation and identification of the bacillus is tedious and may take weeks. The diagnosis of M. bovis by polymerase chain reaction (PCR), using species-specific primers, is fast, highly sensitive and of great value in epidemiological studies. In this study, deoxyribonucleic acid (DNA) was extracted from 60 nasal mucus samples collected from three different farms, all located in an area where M. bovis is endemic. Two farms tested negative for an antibody response to the M. tuberculosis purified protein derivative (PPD) antigen, whereas the other farm gave a positive result. The amplified fragment of DNA was 460 base pairs with a sequence similar to that previously reported. Only 5% of the samples from the third farm tested positive for the presence of antibodies against PPD, whereas 65% of samples (from all three farms) gave a positive result when PCR was used. Thus, the authors suggest the use of the PCR species-specific primers test to support the programme against bovine tuberculosis in Panama.

Real-time polymerase chain reaction diagnosis of leishmaniasis in Panama from both fresh and frozen tissue.

Skin biopsies stored in ethanol from 49 patients with suspected cutaneous leishmaniasis (CL) were tested in a real-time polymerase chain reaction (PCR) assay and compared with conventional diagnostic methods. With clinical diagnosis as the gold standard, PCR had a sensitivity of 96% (47/49) vs. 61% (30/49) for histopathology and 33% (16/49) for culture. In addition, DNA was extracted from 70 frozen smears of lesions from suspected cases of CL and tested with the same assay. In these samples, the PCR had a sensitivity of 61% (43/70) vs. 56% (39/70) for histopathology and 41% (29/70) for culture. In this study, real-time PCR offered a rapid diagnosis with an enhanced sensitivity over conventional methods. Although the yield of PCR diagnosis was lower when testing frozen smears, the assay still outperformed existing diagnostic modalities.

[Dengue in Panama, 1993]. / Dengue en Panamá, 1993.

Up to 1993, Panama was the only country in Central America where the autochthonous transmission of dengue virus had been detected without experimenting an explosive epidemic despite being reinfected with the Aedes aegypti mosquito since 1985. The characteristics of this first outbreak reported on November 19, 1993, are described in this paper. It is shown that even when there is a Program for the Surveillance and Control of Dengue, which considers low levels of Aedes aegypti infection and a system for the early detection of the virus, the epidemics appear if the community does not take an active part as it happened in 1994, 1995, and 1996. The 14 cases reported were located in an area under the responsibility of the Health Center in San Isidro, Belisario Porras, Special District of San Miguelito, in Panama City (13 cases in 4 blocks of the sector of Santa Librada and 1 case in San Isidro Valley). 3 patients were under 15 and 8 over 36, the other 3 were between 15 and 24.9 were females. The dengue type 2 virus was isolated in 3 patients. The presence of IgM and IgG antibodies to dengue was demonstrated in 11 patients, whereas in 8 over 20 it was observed a secondary type answer. According to the clinical picture, the epidemic was classified as dengue fever. The seroepidemiological survey carried out in the sector of Santa Librada and its surroundings 5 months after the appearance of the symptoms in the first case showed a prevalence of antibodies to dengue of 5.7% (46/802), mainly among individuals over 44. These results confirmed that the outbreak was geographically limited.

[Re-emergence of dengue in Panama]. / Reemergencia del dengue en Panama.

The dengue surveillance system in Panama during the 1994 and 1995 epidemics shows the following results: In 1994 we registered 793 dengue cases and a year after 3,083 dengue cases, with three dengue haemorrhagic cases (one death). To estimate the accumulated incidence rates in 1994-1995 period, we consolidated the cases. The highest risk of dengue and the highest dengue haemorrhagic propension were observed in: West Panama (709.49 per 100,000 persons), Los Santos (405.74 per 100,000 persons), Herrera (337.62 per 100,000), Metropolitana (126.98 per 100,000) and San Miguelito (125.10 per 100,000 persons).

Reemergencia del dengue en Panama / Re-emergence of dengue in Panama

The dengue surveillance system in Panama during the 1994 and 1995 epidemics shows the following results: In 1994 we registered 793 dengue cases and a year after 3,083 dengue cases, with three dengue haemorrhagic cases (one death). To estimate the accumulated incidence rates in 1994-1995 period, we consolidated the cases. The highest risk of dengue and the highest dengue haemorrhagic propension were observed in: West Panama (709.49 per 100,000 persons), Los Santos (405.74 per 100,000 persons), Herrera (337.62 per 100,000), Metropolitana (126.98 per 100,000) and San Miguelito (125.10 per 100,000 persons)

Laparoscopy in the evaluation of the intrathoracic abdomen after penetrating injury.

Penetrating trauma to the intrathoracic abdomen is a difficult clinical problem, especially with reference to the detection of diaphragmatic injuries. A retrospective analysis of 657 laparotomies for penetrating abdominal trauma at our institution revealed 78 laparotomies with negative results. The majority (44.8%) were for wounds in the lower chest and upper abdomen. The role of laparoscopy in evaluating these difficult areas was studied in 40 (34 stab wounds and 6 gunshot injuries) patients. Fifteen stab wounds and five gunshot wounds were nonpenetrating. Laparoscopy revealed eight clinically unsuspected diaphragmatic lacerations in seven patients. Twenty patients had hemoperitoneum. Five patients with omental bleeding and abdominal wall bleeding and four with nonbleeding liver lacerations underwent nontherapeutic laparotomies. One patient with a nonbleeding liver laceration was observed successfully without laparotomy. Ten of the 20 patients with hemoperitoneum had therapeutic laparotomies. The incidence of diaphragmatic lesions discovered by laparoscopy in this series was comparable with that reported after a mandatory laparotomy for thoracoabdominal wounds. It is concluded that laparoscopy is an excellent modality for the evaluation of the intrathoracic abdomen and the diaphragm.

[The cholera epidemic in Panama 1991]. / Epidemia de cólera en Panama, 1991.

The authors studied the epidemiology of the outbreak of cholera (due to Vibrio cholerae 01, Inabe serotype) which occurred in Panama in 1991, during which 1179 probable cases were reported, with 292 hospitalizations, 29 deaths and 51 confirmed cases. There was an average of 24.7% hospitalizations and a 2.5% mortality. The epidemic involved 21 of 24 "corregimientos' in Darién, 2 of 4 in San Blas, 5 of 15 in Panama East, 3 of 40 in Colón and one of 19 in the metropolitan area of Panama City. The incidence of infected patients was seen in infants less than 1 year old and in children 1 to 4 years of age. Taking into account the population in each 'corregimiento', it can be said that less than 1% of the population was infected, but that in San Blas, where few communities have aqueduct and latrines, 10% of the population was infected.