[Coinfection of dengue and leptospirosis in a girl from the peruvian amazon]. / Coinfección por dengue y leptospirosis en una niña de la amazonía peruana.

We report the case of a 10 year old girl, born and raised in the city of Iquitos in Peru who presented with headache, fever, chills, musculoskeletal pain, mild epigastric pain, epistaxis and hematemesis. On physical examination, the patient was afebrile and in good general condition. Serological tests confirmed infection of dengue and leptospirosis. The patient received intravenous hydration with sodium chloride 0.9% and penicillin G sodium, achieving a favorable clinical course such that she was discharged a few days after admission to the hospital. Although these diseases are common in the Peruvian Amazon, the simultaneous presence of both in the pediatric population is little documented; therefore, a good clinical history and laboratory tests are important for diagnosis and treatment.

Coinfección por dengue y leptospirosis en una niña de la Amazonía Peruana / Coinfection of dengue and leptospirosis in a girl from the Peruvian Amazon

Se reporta el caso de una niña de 10 años, natural y procedente de la ciudad de Iquitos en Perú que presentó cefalea, fiebre, escalofríos, dolor osteomuscular, leve dolor en epigastrio, epistaxis y hematemesis. Al examen físico la paciente se encontraba afebril y en regular estado general. Por medio de pruebas serológicas se confirmó la infección por dengue y leptospirosis. La paciente recibió hidratación endovenosa con cloruro de sodio al 0,9% y penicilina G sódica, logrando una evolución clínica favorable por lo que fue dada de alta a los pocos días de su ingreso al hospital. Aunque estas dos enfermedades son comunes en la Amazonía peruana, la presencia simultánea de ambas en la población pediátrica es poco documentada; por ello, una buena historia clínica y exámenes de laboratorio son importantes para el diagnóstico y tratamiento oportuno.

We report the case of a 10 year old girl, born and raised in the city of Iquitos in Peru who presented with headache, fever, chills, musculoskeletal pain, mild epigastric pain, epistaxis and hematemesis. On physical examination, the patient was afebrile and in good general condition. Serological tests confirmed infection of dengue and leptospirosis. The patient received intravenous hydration with sodium chloride 0.9% and penicillin G sodium, achieving a favorable clinical course such that she was discharged a few days after admission to the hospital. Although these diseases are common in the Peruvian Amazon, the simultaneous presence of both in the pediatric population is little documented; therefore, a good clinical history and laboratory tests are important for diagnosis and treatment.

Melanoma anal amelanótico: reporte de caso / Anorectal amelanotic melanoma: a case report

Se presenta el caso de un paciente de 60 años de edad que presenta dolor y sensación de cuerpo extraño enla región anal, asociado a deposiciones con restos de sangre. Al tacto rectal se palpó una lesión indurada enla cara anterior del conducto anal. En la colonoscopía se evidenció una lesión proliferante elevada, pigmentada“negruzca”, de aproximadamente 2 cm de diámetro, compatible con neoplasia maligna de canal anal. Se procedió a una biopsia e inmunohistoquímica, que dio como resultado el S-100 positivo y HMB-45 negativo.Una tomografía helicoidal multicorte toraco-abdomino-pélvico descartó tumoraciones y adenomegalias metastásicas. El paciente fue sometido a una resección local parcial transanal de la tumoración pigmentada.El resultado histopatológico posquirúrgico confirmó el diagnóstico de melanoma maligno anal amelanótico(MMAA); el S-100 fue positivo; el Melan-A, positivo débil, y el KI-67, positivo. El paciente presentó una evolución favorable y fue dado de alta a los tres días de la cirugía.

We present the case of a 60 year old patient suffering pain and the sensation of a foreign body in the analregion associated with traces of blood in stools. Digital rectal exam (DRE) revealed a hardened lesion locatedon the wall of the anal canal. Colonoscopy revealed a raised proliferating lesion with a blackish color which was about 2 inches in diameter. This was compatible with an anal canal malignancy. We proceeded to a biopsy and immunohistochemistry study which tested positive for S-100 and negative for HMB-45. A multislicehelical chest, abdominal and pelvic CAT scan ruled out metastatic tumors and lymphadenopathy. The patient underwent local transanal excision of the partially pigmented tumor. Post- surgical histopathological results confi rmed the diagnosis of malignant anal amelanotic melanoma positive for S-100. The sample tested weakly positive for Melan-A and positive for KI-67. The favorable outcome of the procedure led to the patient’sdischarge 3 days after surgery.

Factors associated with anti-tuberculosis medication adverse effects: a case-control study in Lima, Peru.

BACKGROUND: Long-term exposure to anti-tuberculosis medication increases risk of adverse drug reactions and toxicity. The objective of this investigation was to determine factors associated with anti-tuberculosis adverse drug reactions in Lima, Peru, with special emphasis on MDR-TB medication, HIV infection, diabetes, age and tobacco use. METHODOLOGY AND RESULTS: A case-control study was performed using information from Peruvian TB Programme. A case was defined as having reported an anti-TB adverse drug reaction during 2005-2010 with appropriate notification on clinical records. Controls were defined as not having reported a side effect, receiving anti-TB therapy during the same time that the case had appeared. Crude, and age- and sex-adjusted models were calculated using odds ratios (OR) and 95% confidence intervals (95%CI). A multivariable model was created to look for independent factors associated with side effect from anti-TB therapy. A total of 720 patients (144 cases and 576 controls) were analyzed. In our multivariable model, age, especially those over 40 years (OR = 3.93; 95%CI: 1.65-9.35), overweight/obesity (OR = 2.13; 95%CI: 1.17-3.89), anemia (OR = 2.10; IC95%: 1.13-3.92), MDR-TB medication (OR = 11.1; 95%CI: 6.29-19.6), and smoking (OR = 2.00; 95%CI: 1.03-3.87) were independently associated with adverse drug reactions. CONCLUSIONS: Old age, anemia, MDR-TB medication, overweight/obesity status, and smoking history are independent risk factors associated with anti-tuberculosis adverse drug reactions. Patients with these risk factors should be monitored during the anti-TB therapy. A comprehensive clinical history and additional medical exams, including hematocrit and HIV-ELISA, might be useful to identify these patients.