Prevalence and subtype distribution of Blastocystis sp. infecting children from a rural community in Panama.

Blastocystis sp. is a commonly reported intestinal parasite with a worldwide distribution. Phylogenetic analyses describe at least 17 subtypes for this parasite, and nine of them have been found in humans. However, the prevalence and some epidemiological characteristics of this parasitic infection in rural communities are not well known. The objective of this cross-sectional study was to evaluate the prevalence, subtypes, and epidemiological factors related to Blastocystis sp. Infection in children from of a small rural community in the central area of Panama. For this, 66 fecal samples from children (1 to 12 years old), were initially analyzed for the presence of parasites by a formalin-ethyl acetate/concentration method. Molecular detection and identification of Blastocystis sp. subtypes were carried out by amplification and sequencing of a partial fragment of the small-subunit ribosomal RNA gene. Using data from a questionnaire, analyses of epidemiological conditions potentially associated with Blastocystis sp. transmission were also conducted. Microscopic diagnostics showed that 33.3% (22/66) of the analyzed samples presented entero-parasites. Among them, Blastocystis sp. was the most prevalent, with 21.2% (14/66), followed by the E. histolytica/dispar/moshkovskii complex 4.5% (3/66), Giardia lamblia 1.5% (1/66) and Strongyloides stercoralis 1.5% (1/66). PCR-based analyses detected a prevalence of Blastocystis sp. infection of 74.2% (49/66) in apparently healthy children. Phylogenetic analysis revealed two different subtypes of this parasite: ST1 with 42.2% (28/66) infected, and ST3 with 31.8% (21/66) infected. In addition, recent diarrhea was significantly associated with Blastocystis sp. infection. None of the other risk factors evaluated was statistically associated with infection. These results highlight the need to further investigate clinical, epidemiological, and genetic characteristics of Blastocystis sp. infections in this community.

[Utilisation of first-line antibiotics six years after a multifaceted intervention]. / Uso de antibióticos de primera línea 6 años después de una intervención multifacética.

OBJECTIVE: No study has evaluated the impact of a multifaceted intervention on the quality of the antibiotics prescribed more than 5 years later. METHODS: A total of 210 general practitioners (GP) from eight different regions of Spain were asked to participate in two registrations of respiratory tract infections (RTI) in 2008, before, and in 2009, just after a multifaceted intervention including prescriber feedback, clinical guidelines, training sessions focused on appropriate antibiotic prescribing, workshop on rapid tests and provision of these tests in the GP consultation. They were all again invited to participate in a similar registration in 2015. A new group of clinicians from the same areas who had never participated in antimicrobial stewardship courses were also invited to participate and acted as controls. RESULTS: The 121 GPs who continued the study (57.6%) and the 117 control GPs registered 22,407 RTIs. The antibiotic most commonly prescribed was amoxicillin and clavulanic acid, prescribed in 1,801 cases (8.1% of the total), followed by amoxicillin (1,372 prescriptions, 6.2%), being lower among GPs just after the intervention. The third leading antibiotic among GPs just after the intervention was penicillin V (127 cases, 3.3%) whereas macrolides ranked third in the other three groups of GPs. CONCLUSIONS: The use of first-line antibiotic for RTIs wanes over time after an intervention, but their utilisation is still significantly greater among intervened clinicians six years later compared to GPs who have never been exposed to any antimicrobial stewardship programmes.

Tumoración cutánea pulsátil supraclavicular / Pulsatile Supraclavicular Skin Tumor

No disponible

El patrón de discordancia motilidad-perfusión en la gated-SPECT de reposo sugiere necrosis no transmural en la resonancia magnética cardiaca / Motion-perfusion mismatch-pattern on rest-gated SPECT suggests non-transmural necrosis on cardiac magnetic resonance

No disponible

Tumor filodes maligno: a propósito de un caso y revisión de la literatura / Malignant phyllodes tumor: Apropos of a case and a review of the literature

El tumor filodes de la mama es una neoplasia poco frecuente, representando menos del 1% de todos los tumores de mama. Su diagnóstico definitivo es anatomopatológico, siendo característicamente de estirpe fibroepitelial. Tiene una alta tendencia a la recidiva local (20%) y, aunque poco frecuente, se ha descrito su capacidad metastatizante en otros órganos. El tratamiento es quirúrgico con la extirpación amplia y con márgenes libres. Presentamos el caso de una paciente que desarrolló este tumor y que progresó la enfermedad con afectación pulmonar

Phyllodes tumor of the breast is a rare neoplasm, representing less than 1% of all breast tumors. The definitive diagnosis of these fibroepithelial tumors is histologic. Local recurrence occurs in 20% of cases. Although uncommon, these tumors can metastasize to other organs. Treatment is surgical with wide excision and disease-free margins. We present the case of a patient with phyllodes tumor who developed lung involvement

La enfermedad de Paget de la mama en nuestra área: revisión 1998-2012 / Paget disease of the breast in our setting: review 1998-2012

La enfermedad de Paget de la mama es una entidad poco frecuente y de buen pronóstico. El tratamiento clásico ha sido la mastectomía, pero es posible una cirugía conservadora de la mama, y hoy en día debe valorarse como primera opción siempre y cuando se aseguren márgenes libres con un resultado estético aceptable. Las pruebas de imagen son fundamentales para descartar un carcinoma subyacente y de cara a la planificación de una cirugía conservadora, así como para el futuro seguimiento de estas pacientes

Paget disease of the breast is a relatively rare entity with a favourable prognosis. Form any years, the gold standard treatment has been mastectomy. However, breast-conserving surgery is now feasible and should be evaluated as the first-line option whenever negative margins with acceptable cosmetic results can be achieved. Imaging techniques are essential to exclude an underlying carcinoma and play an important role in selecting candidates for breast-conserving treatment and in follow-up

Domestic dog health worsens with socio-economic deprivation of their home communities.

Dogs play an important role in infectious disease transmission as reservoir hosts of many zoonotic and wildlife pathogens. Nevertheless, unlike wildlife species involved in the life cycle of pathogens, whose health status might be a direct reflection of their fitness and competitive abilities, dog health condition could be sensitive to socio-economic factors impacting the well-being of their owners. Here, we compare several dog health indicators in three rural communities of Panama with different degrees of socio-economic deprivation. From a total of 78 individuals, we collected blood and fecal samples, and assessed their body condition. With the blood samples, we performed routine hematologic evaluation (complete blood counts) and measured cytokine levels (Interferon-γ and Interleukin-10) through enzyme-linked immunosorbent assays. With the fecal samples we diagnosed helminthiases. Dogs were also serologically tested for exposure to Trypanosoma cruzi and canine distemper virus, and molecular tests were done to assess T. cruzi infection status. We found significant differences between dog health measurements, pathogen prevalence, parasite richness, and economic status of the human communities where the dogs lived. We found dogs that were less healthy, more likely to be infected with zoonotic pathogens, and more likely to be seropositive to canine distemper virus in the communities with lower economic status. This study concludes that isolated communities of lower economic status in Panama may have less healthy dogs that could become major reservoirs in the transmission of diseases to humans and sympatric wildlife.

Tamoxifeno y tumoraciones anexiales complejas en paciente trasplantada renal con carcinoma in situ de mama / Tamofixen and complex adnexal cysts in a renal transplant recipient with in situ carcinoma of the breast

El tamoxifeno es un modulador selectivo de los receptores estrogénicos, utilizado con la intención de reducir las tasas de recurrencia y mortalidad de pacientes con cáncer de mama y receptores hormonales positivos. A nivel de ovario y endometrio actúa como agonista estrogénico por lo que no está exento de efectos secundarios. Presentamos un caso clínico de una paciente con cáncer de mama, premenopáusica hasta el inicio del tratamiento, que desarrolló tumoraciones anexiales complejas que obligaron a indicar una laparoscopia diagnóstica y a descartar un nuevo proceso oncológico a nivel de ambos ovarios. La paciente, además, presentaba como antecedentes un trasplante renal por nefropatía y tratamiento inmunosupresor. Hemos revisado la bibliografía al respecto valorando las posibles asociaciones entre dichos procesos (AU)

Tamoxifen is a selective modulator of estrogen receptors and is used to reduce recurrence and mortality rates in breast cancer patients with positive hormone receptors. This drug acts as an estrogen receptor agonist in the ovaries and endometrium and can produce some adverse effects. We report the case of a breast cancer patient, who was premenopausal until the beginning of the treatment and who developed bilateral complex adnexal cysts, requiring a diagnostic laparoscopy to exclude a new oncologic process in the ovaries. The patient had previously received a kidney transplant for nephropathy and immunosuppressive therapy. We review the literature on the topic and evaluate the possible associations between these processes (AU)

Tumoraciones mesenquimales de músculo liso de potencial maligno incierto (STUMP): revisión de un caso clínico / No disponible

Las tumoraciones mesenquimales de músculo liso uterino de potencial de malignidad incierta son hallazgos poco frecuentes en la clínica habitual. La Organización Mundial de la Salud los definió como aquellos tumores uterinos de músculo liso que no podían ser histológicamente clasificados como benignos o malignos. Presentamos un caso clínico de una mujer de 41años, que consultó por aumento del perímetro abdominal y dolor en la región abdominal. Se solicitaron pruebas de imagen, que pusieron de manifiesto la presencia de una gran masa abdominal (20cm). Ante tales hallazgos, se realizó exéresis quirúrgica de la tumoración y posterior histerectomía. El estudio anatomopatológico reveló el diagnóstico de tumoración muscular lisa de bajo grado de malignidad de potencial maligno incierto. Actualmente, la paciente se encuentra asintomática. Conclusión Las tumoraciones mesenquimales de músculo liso uterino de potencial de malignidad incierta son poco frecuentes. Su diagnóstico anatomopatológico es complicado y por ello varios estudios exponen técnicas de inmunohistoquímica que ayudan a esclarecer el diagnóstico definitivo. Algunos autores los clasifican según sus características histológicas, basándose en éstas para establecer el comportamiento y pronóstico de estos tumores. El tratamiento quirúrgico de elección no está definido y el seguimiento ha de ser estrecho por el riesgo de recurrencia existente (AU)

Uterine smooth muscle tumors of uncertain malignant potential (STUMP) are rare findings in routine clinical practice. STUMP are defined by The World Health Organization astumors that cannot be histologically diagnosed as benign or malignant. We present the case of a 41-year-old woman who consulted for abdominal distension and pain. Imaging tests showed the presence of a large abdominal mass (20 cm). The mass was surgically excised followed by hysterectomy. The histopathological diagnosis was uterine STUMP of low grade malignancy. The patient is currently asymptomatic. Conclusion: STUMP are rare. Pathological diagnosis is difficult and several studies describe immunohistochemical techniques that could help to confirm the final diagnosis. Some authors classify these tumors by their histological features, which are then used to establish their behavior and prognosis. The surgical treatment of choice has not been defined and close follow-up must be performed due to the risk of recurrence (AU)

La tomografía computarizada cardiaca en la afección valvular / Cardiac computed tomography for valve disease

La afección valvular cardiaca y la enfermedad coronaria son muy prevalentes en la población general y frecuentemente coinciden en el mismo paciente. La tomografía computarizada (TC) cardiaca permite descartar la enfermedad coronaria antes de la cirugía valvular de forma no invasiva y evitar potencialmente un 66-75% de las coronariografías invasivas. La misma prueba aporta abundante información anatómica y funcional complementaria a la ecocardiografía, que permite caracterizar la etiología de las valvulopatías, así como su repercusión en el corazón y la aorta y, en el caso de las válvulas izquierdas, cuantificar su gravedad. En este trabajo se describe la anatomía valvular cardiaca y los requisitos técnicos de la TC cardiaca para el estudio valvular, para profundizar posteriormente en el valor de la coronariografía prequirúrgica y la caracterización morfofuncional de la afección valvular mediante TC, haciendo hincapié en las válvulas izquierdas (AU)

In this article, we describe the anatomy of the heart valves and the technical requisites of cardiac CT for the study of the valves. We go on to explore the usefulness of CT in the preoperative study of the coronary arteries and in the morphological and functional characterization of valve disease, with special emphasis on the valves of the left side of the heart. Heart valve disease and coronary heart disease are very prevalent in the general population and often coincide in the same patient. Cardiac computed tomography (CT) makes it possible to noninvasively rule out coronary disease before valve surgery and to potentially avoid invasive heart catheterization in 66% to 75% of patients. The same imaging test provides abundant anatomic and functional information that complements the information from echocardiography, making it possible to characterize the etiology of the valve disease and its repercussions on the heart and aorta, as well as to quantify the severity of disease affecting the valves of the left side of the heart (AU)

Cardiac computed tomography for valve disease.

Heart valve disease and coronary heart disease are very prevalent in the general population and often coincide in the same patient. Cardiac computed tomography (CT) makes it possible to noninvasively rule out coronary disease before valve surgery and to potentially avoid invasive heart catheterization in 66% to 75% of patients. The same imaging test provides abundant anatomic and functional information that complements the information from echocardiography, making it possible to characterize the etiology of the valve disease and its repercussions on the heart and aorta, as well as to quantify the severity of disease affecting the valves of the left side of the heart. In this article, we describe the anatomy of the heart valves and the technical requisites of cardiac CT for the study of the valves. We go on to explore the usefulness of CT in the preoperative study of the coronary arteries and in the morphological and functional characterization of valve disease, with special emphasis on the valves of the left side of the heart.

Leiomiomatosis benigna metastatizante: a propósito de un caso / Benign metastasizing leiomyomatosis: apropos of a case

Se presenta el caso de una paciente con neumotórax bilaterales de repetición secundarios a una leiomiomatosis benigna metastatizante. Se intentó el control de su enfermedad con tratamiento médico, siendo necesario proceder a tratamiento radical mediante histerectomía más doble anexectomía ante la escasa respuesta a los procedimientos conservadores (AU)

We report the case of a patient with recurrent bilateral pneumothorax secondary to benign metastasizing leiomyomatosis. Medical treatment was administered but surgery with hysterectomy plus double annexectomy was required due to the lack of response to conservative procedures (AU)

Consideraciones y algunas recomendaciones para escribir un artículo científico en una revista biomédica

"Un manuscrito que se envía a publicación en una revista biomédica, al igual que una ponencia en un congreso o el informe final de un proyecto, corresponde a una forma de informar los resultados de un proceso de investigación científica. ¿Para qué sirve un artículo científico? Cuando se redacta en forma apropiada, un artículo nosotorga valiosa información referente a lo que se hizo, por qué se hizo, cómo se hizo, qué resultó de lo que se hizo y qué significa lo que se hizo (...)" (AU)

Prevalence of trypanosome infections in dogs from Chagas disease endemic regions in Panama, Central America.

The prevalence of canine trypanosomosis was investigated in two Chagas disease endemic rural communities located in the central region of Panama. Serologic tests for Trypanosoma cruzi infection revealed a prevalence of 11.1%. Hemocultures coupled with PCR analysis demonstrated a Trypanosoma rangeli infection rate of 5.1%. An overall trypanosome infection index of 16.2% (16/99) was detected in this canine population. One dog had a mixed infection of T. cruzi and T. rangeli. Six of the trypanosome-infected dogs belong to people who were diagnosed of Chagas disease. We conclude that dogs from this rural area of Panama are frequently infected with trypanosomes transmitted by the sylvatic vector, Rhodnius pallescens, and suggest that dogs are important in the peridomestic transmission cycle of trypanosomes as reservoirs and hosts. The epidemiological implications of these findings are discussed.