Subretinal abscess due to Candida tropicalis in a patient with acute myeloid leukaemia: Case report.

A 54-year-old female patient with a history of acute myeloid leukaemia and receiving maintenance chemotherapy had a systemic relapse. She also had candidaemia caused by Candida tropicalis. Her blood cultures were negative after receiving antifungal treatment. Later, she had an ophthalmological assessment as part of the protocol, without ocular discomfort. In the fundoscopic examination, a whitish chorioretinal lesion was found in the left eye in relation to subretinal abscess, which correlated with retinal angiography and optical coherence tomography. The patient was treated with systemic antifungals with a favourable resolution of the lesion.

Absceso subretinal por Candida tropicalis en un paciente con leucemia mieloide: reporte de caso / Subretinal abscess due to Candida tropicalis in a patient with acute myeloid leukaemia: case report

Paciente mujer de 54 años con historia de leucemia mieloide aguda, bajo quimioterapia de mantenimiento, cursa con recaída sistémica y candidemia por Candida tropicalis (C. tropicalis), tratada con antifúngico, con respuesta favorable es referida a oftalmológica como parte de protocolo. El examen fundoscópico en ojo izquierdo halló una lesión blanquecina, coriorretiniana en el cuadrante súpero temporal. Los exámenes de angiografía retinal y tomografía de coherencia óptica correlacionaron con absceso subretinal. La paciente fue tratada con antifúngicos sistémicos con resolución favorable de la lesión. Los abscesos subretinianos son una rara manifestación intraocular por C. tropicalis, este organismo es potencial agente causal de afección ocular en presencia de antecedente sistémico de inmunosupresión y factores de riesgo asociados.

A 54-year-old female patient with a history of acute myeloid leukaemia and receiving maintenance chemotherapy had a systemic relapse. She also had candidaemia caused by Candida tropicalis. Her blood cultures were negative after receiving antifungal treatment. Later, she had an ophthalmological assessment as part of the protocol, without ocular discomfort. In the fundoscopic examination, a whitish chorioretinal lesion was found in the left eye in relation to subretinal abscess, which correlated with retinal angiography and optical coherence tomography. The patient was treated with systemic antifungals with a favourable resolution of the lesion.

Subretinal abscess due to Candida tropicalis in a patient with acute myeloid leukaemia: case report. / Absceso subretinal por Candida tropicalis en un paciente con leucemia mieloide: reporte de caso.

A 54-year-old female patient with a history of acute myeloid leukaemia and receiving maintenance chemotherapy had a systemic relapse. She also had candidaemia caused by Candida tropicalis. Her blood cultures were negative after receiving antifungal treatment. Later, she had an ophthalmological assessment as part of the protocol, without ocular discomfort. In the fundoscopic examination, a whitish chorioretinal lesion was found in the left eye in relation to subretinal abscess, which correlated with retinal angiography and optical coherence tomography. The patient was treated with systemic antifungals with a favourable resolution of the lesion.

Orbital metastasis diagnosed by ultrasound-guided fine-needle aspiration biopsy: Case report of unknown primary site. / Metástasis de la órbita diagnosticada por biopsia por aspiración con aguja fina guiada por ultrasonido: reporte de caso de sitio primario desconocido.

Twenty five percent of orbital metastasis is usually of unknown primary origin and it requires histopathological and immunohistochemical confirmation. The fine-needle aspiration biopsy of the orbit is an alternative procedure to conventional orbitotomy. The case is presented of a 60 year-old woman with a right orbit tumour mass and neoplastic lesions in her brain and cranium. As an incidental finding, she had a thrombus in her left atrium, and so an orbitotomy procedure was ruled out. An ultrasound-guided fine-needle aspiration biopsy was performed instead with rapid on-site evaluation of biopsy samples. These showed malignant cells of a lung adenocarcinoma, which was confirmed with immunohistochemistry and chest diagnostic images. In conclusion, biopsy samples obtained by fine-needle aspiration biopsy, together with cytopathological and immunohistological analysis, enabled orbital metastasis to be identified in the case described, and showed that fine-needle aspiration biopsy is a safe, effective, and minimally invasive alternative.

Interferon alpha-2a as alternative treatment for conjunctival squamous cell carcinoma. / Interferón alfa-2a como tratamiento alternativo para el carcinoma conjuntival de células escamosas.

CASE REPORT: A 35 year-old male patient with a history of HIV infection characterized by progressive tumour growth in bulbar conjunctiva of the left eye, corresponding to conjunctival squamous cell carcinoma that responded to treatment with interferon alpha-2a. DISCUSSION: Interferon alpha-2b has been used at conjunctival level as a topical immunomodulator treatment, with complete remission of epithelial neoplasms being observed. However, there have not been any previous publications on the use of interferon alpha-2a, which differs from interferon alpha-2b in a single amino acid, for the treatment of conjunctival squamous cell carcinoma.

Weekly iron supplementation is as effective as 5 day per week iron supplementation in Bolivian school children living at high altitude.

OBJECTIVE: To compare the efficacy of a daily and a weekly iron supplementation on the hematological status of anemic children living at high altitude. DESIGN: Double blind iron supplementation trial including a placebo control group. SETTING: A socioeconomically disadvantaged district of La Paz, Bolivia (altitude of 4000 m). SUBJECTS: Anemic (hemoglobin concentration < or = 144 g/L), 3.3-8.3 y old children of both sexes. INTERVENTION: Children received a placebo (n = 57) or a dose of 3-4 mg of elemental iron per kg body weight (FeSO4 tablets) 1 d per week (n = 58) or 5 d per week (n = 58) for 16 weeks. RESULTS: Hemoglobin and zinc erythrocyte protoporphyrin concentrations improved significantly in supplemented groups but not in the placebo group. Changes in hemoglobin during the study were not significantly different between supplemented groups (weekly group: 15.2 +/- 6.9 g/L and daily group: 18.6 +/- 11.1 g/L) but were different from the placebo group (0.5 +/- 7.1 g/L, P < 0.001). At the end of the supplementation period, the hemoglobin distribution was Gaussian, and similar in both supplemented groups. Adjusting for the initial hemoglobin concentration, final hemoglobin and its changes were similar in both supplemented groups. CONCLUSION: Weekly iron supplementation is as efficacious as daily iron supplementation in improving iron status and correcting moderate iron deficiency anemia in Bolivian school children living at high altitude. SPONSORSHIP: Program supported in part by ORSTROM, the French Ministry of Foreign Affairs and the National Secretary's Office of Health, Bolivia.

Definition and prevalence of anemia in Bolivian women of childbearing age living at high altitudes: the effect of iron-folate supplementation.

This paper discusses the effect that high altitudes have on iron metabolism and summarizes the results of an iron-folate supplementation trial. The two main objectives of the trial were to determine hemoglobin cut-off values for the diagnosis of anemia in Bolivian women of childbearing age living at high altitudes, and to estimate the prevalence of anemia in this population. The study showed that nutritional anemia is an important public health problem in such populations and that many methods of assessing it lead to an underestimation of prevalence. The cut-off values defined through this study, one of the few iron supplementation trials conducted at high altitudes, confirm the need to establish revised hemoglobin values for the diagnosis of anemia in populations living at high altitudes.

Effect of altitude and socioeconomic status on VO2max and anaerobic power in prepubertal Bolivian girls.

The aim of this work was to evaluate the effects of high altitude and low socioeconomic status (SES) on aerobic and anaerobic power in 11-yr-old Bolivian girls. At both high (3,600 m) and low (420 m) altitudes, low-SES groups of girls were compared to similarly aged, high-SES girls. At low altitude, low-SES girls were also compared with younger high-SES girls with the same anthropometric characteristics. Anthropometric data were similar between high-SES and low-SES girls at both altitudes, but low-SES girls showed a 9-mo growth delay. Maximal O2 uptake was significantly lower for low-SES girls at both altitudes. Values did not differ when expressed relative to body weight at high altitude for high-SES vs. low-SES girls (37.6 +/- 1.2 vs. 39.3 +/- 1.0 ml.min-1.kg body wt-1), but a difference persisted at low altitude between high- and low-SES girls (37.5 +/- 1.0 vs. 34.7 +/- 0.7 ml.min-1.kg body wt-1). Anaerobic power (Pmax, force-velocity test; Pwing, Wingate test) was reduced for low-SES girls at both altitudes, whatever the mode of expression. For a given SES, the relative anaerobic performances were lower at low altitude. At low altitude, low-SES girls developed lower anaerobic power than did younger high-SES girls with similar anthropometric characteristics. In conclusion, at both altitudes, the reduction of anaerobic performances observed in girls of low SES could not be totally explained by anthropometric factors. Structural and/or functional muscle alterations are suggested. Moreover, at low altitude, tropical and other factors may have contributed to differences in performance between low- and high-SES girls.

Circulating proteins and iron status in blood as indicators of the nutritional status of 10- to 12-year-old Bolivian boys.

The purpose of the present study was to evaluate the nutritional status of children based on anthropometric measurements, biochemical indicators of protein energy malnutrition as well as hematological variables. The subjects were 93 10- to 12-year-old Bolivian boys: 12 HAHSES, 28 HALSES, 36 LALSES, and 17 LALSES (see Introduction to this Supplement). The overall nutritional status of the boys was evaluated by anthropometric indicators (weight for age [W/A], height for age [H bd, and weight for height [W/H]). The biochemical indicators included proteins total, albumin, prealbumin, orosomucoid and protein C-reactive (for MPE) as well as hematocrit (Ht), hemoglobin (Hb), serum iron, serum ferritin, and transferrin saturation (TS). The prevalence of growth retardation of LSES boys at HA as well as at LA was found to be high when the 3rd percentile was used as the cutoff point. The corresponding prealbumin levels were found to be lower in LSES than in HSES boys at both altitudes. The study shows that LSES boys at both altitudes have significantly lower prealbumin levels than HSES boys. The socioeconomic factor seems to be more critical for the nutritional status of prepubertal boys than altitude. The study also shows that all the boys had hematological parameters within normal range. The HA boys of both SES had higher hemoglobin concentration and hematocrits than the LA boys, a fact that is explained by high-altitude hypoxia. The hematological data do not provide evidence of malnutrition among the boys.

Haematology and erythrocyte metabolism in man at high altitude: an Aymara-Quechua comparison.

In the course of haematological and biological investigations among Aymara and Quechua populations in Bolivia, an anthropological study of the erythrocytary respiratory function was carried out on the two groups at two altitudes: 3,600 m and 450 m. A difference in the intensity of the biological variations of the two populations is observed at high altitude. In the Quechuas, as in any lowland native, the adaptative phenomena are totally and quickly reversible. In the Aymaras, we detected the existence of more marked haematological and biochemical characters: moderate polycythemia, hyperhaemoglobinemia, microcytosis, metabolical hyperactivity with accumulation of 2-3 di-phosphoglycerate and ATP, and methaemoglobinemia with a drop in the activity of the methaemoglobin reductases. The Aymaras preserve some of those characters (methaemoglobinemia excepted) when they settle in lowlands.

[Double-blind study on the action of almitrine in patients with polycythemia of high altitude]. / Etude en double insu de l'effet de l'almitrine sur les malades porteurs de polyglobulie pathologique d'altitude.

Chronic polycythaemia in people living at high altitude is associated with hypoxaemia due to a marked reduction in hypoxic and hypercapnic drives. The effect of almitrine, a chemoreceptor stimulant, was evaluated in 40 patients, with haematocrit values over 57%, living in La Pa2 (3,600-4,000 m). Two studies were carried out. The aim of the first was to assess the ventilatory response, and the increase in PaO2 due to almitrine in a double blind, placebo controlled protocol including 40 patients (mean haematocrit 66.8%). Almitrine was given orally at a dose of 3 mg X kg-1. Variance analysis showed that three hours later there was a significant increase in PaO2 (+0.46 kPa), pH and respiratory frequency, with a significant reduction in PaCO2 (-0.4 kPa). The increase in ventilation (+17%) was not significant. The aim of the second study was to assess the effect of almitrine on the polycythaemia. It was given orally at a dose of 1.5 mg X kg-1 X day-1 to twelve patients over a four week period. Blood gases, ventilation (VE), oxygen consumption (VO2), carbon dioxide, production (VCO2) and haematocrit were measured every week. There was a slight but significant reduction in haematocrit (-3.5%). PaO2 and all the other measured parameters (VE, PaCO2, pH, VO2 VCO2) remained constant. The reduction in haematocrit was not therefore due to an increase in diurnal PaO2 but is perhaps due to the improvement in pulmonary ventilation during sleep.