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.

Time-series analysis of ambient PM2.5 and cardiorespiratory emergency room visits in Lima, Peru during 2010-2016.

INTRODUCTION: There have been no time-series studies of air pollution in Peru. Here we evaluate the effect of ambient PM2.5 on emergency room (ER) visits in Lima. METHODS: We estimated daily PM2.5 levels at a 1 km2 resolution during 2010-2016 using ground measurements, satellite data, and chemical transport model simulations. Population-weighted average daily PM2.5 levels were calculated for each district in Lima (n = 40), and assigned to patients based on residence. ER visits for respiratory and circulatory diseases were gathered from nine large public hospitals. Poisson regression was used to estimate the rate ratio for daily ER visits with change in daily PM2.5, controlling for meteorology, time trends, and district. RESULTS: For each interquartile range (IQR) increase in PM2.5, respiratory disease ER visits increased 4% (95% CI: 0-5%), stroke visits 10% (3-18%), and ischemic heart disease visits (adults, 18-64 years) 11% (-1, 24%). Districts with higher poverty showed significantly stronger associations of PM2.5 and respiratory disease ER visits than districts with lower poverty. Effects were diminished 24-42% using Lima-wide instead of district-specific PM2.5 levels. CONCLUSIONS: Short-term exposure to ambient PM2.5 is associated with increases in ER visits in Lima for respiratory diseases and stroke, and among middle-aged adults, ischemic heart disease.

Fibrodisplasia osificante progresiva en pediatría: a propósito de un caso clínico / Fibrodysplasia ossificans progressiva in pediatrics: a case report

Introducción: La Fibrodisplasia osificante progresiva es una enfermedad congénita autosómica dominante poco frecuente, caracterizada por malformaciones esqueléticas y osificación heterotópica progresiva e invalidante. Caso clínico: Niño de 11 años consulta por múltiples lesiones osificadas en tronco y región cervical con importante limitación en su movilidad. En el examen físico destaca un ortejo mayor corto. Estudio genético muestra mutación del gen ACVR1. Recibe tratamiento con periodos cortos de corticosteroides posterior a traumas y previo a procedimientos, asociado a un manejo multidisciplinario. Revisión de la literatura: A la fecha el principal tratamiento es la prevención de los brotes de osificación y el uso de corticosteroides o antiinflamatorios cuando los brotes ya se iniciaron. Están en curso ensayos clínicos con bifosfonatos y anticuerpos anti-activina A. Conclusión: En la actualidad no existe un tratamiento específico, sin embargo, un diagnóstico precoz, la prevención de brotes y nuevas terapias podrían mejorar el pronóstico de los pacientes.

ntroduction: Fibrodysplasia ossificans progressiva is a rare autosomal dominant congenital disease characterized by skeletal malformations and progressive disabling heterotopic ossification. Clinical case: An 11-year-old boy consulted with multiple ossified lesions in the trunk and cervical regions associated with significant limitation in mobility. On physical examination, the big toe is short. Genetic study shows ACVR1 gene mutation. He received treatment with short corticosteroid periods after traumas and prior to clinical procedures, as well as a multidisciplinary management.Literature review: To date the main treatment is the prevention of ossification flare-ups and the use of corticosteroids or anti-inflammatories when they have already started. Clinical trials are ongoing with bisphosphonates and anti-activin A antibodies.Conclusion: There is currently no specific treatment, however, early diagnosis, prevention of flare-ups and new therapies could improve the prognosis of patients.

Variations in AXIN2 predict risk and prognosis of colorectal cancer.

OBJECTIVE: Colorectal cancer (CRC) and hypodontia are frequent and different diseases with common genes are involved in their etiology. The objective of this study was to identify the association between AXIN2 rs2240308 with hypodontia and CRC. PATIENTS AND METHODS: This study consisted of 50 individuals with hypodontia, 50 individuals with CRC, and 155 healthy individuals from Colombia. SNP genotyping assays of rs2240308 were performed and family history of cancer in individuals with hypodontia was documented. In silico analysis was implemented to define the genomic profile of the AXIN2 gene associated with CRC. Multivariate analysis, chi square, odd ratio tests, and R software were used for statistical analysis. RESULTS: AXIN2 rs2240308 showed association with CRC (OR = 5.4 CI: 2.7-10.4; p < 0.001) and with other familial cancer in individuals with hypodontia (p < 0.005 OR = 1.75, 95% CI: 1.22-6.91). In silico analysis showed that variations in AXIN2 found in CRC patients, were more frequently in earlier stages of tumor and patients who carry variations in the AXIN2 gene have a worse prognosis (p < 0.05). The association between AXIN2 rs2240308 with hypodontia was not significant. CONCLUSIONS: These results suggest that AXIN2 rs2240308 polymorphism is associated with CRC and AXIN2 could be a risk marker for predisposition and prognosis of CRC.

Urinary tract infections in inpatients: that challenge.

Urinary tract infection (UTI) is one of the major nosocomial infections. In more than 80% of cases it is related to the use of urological devices, especially linked to the misuse of urinary catheters. Empirical treatment should be based on local epidemiology, severity criteria and risk of multiresistant bacteria. This review shows the most important aspects of nosocomial UTI, as well as the recommendations for correct treatment adjustment; both empirical and definitive, that is the great challenge to avoid multiresistance, as well as to avoid unnecessary treatments.

Influenza A and B co-infection: a case-control study and review of the literature.

Influenza virus infection remains a major cause of morbidity and mortality during winter seasons. Bacterial and virus co-infection is a commonly described situation in these patients. However, data on co-infection by influenza A and B viruses are lacking. In this study, we present the cases of co-infection by influenza A and B viruses during the winter season of 2014-2015 in our institution. We analyzed 2759 samples from 2111 patients and found that 625 samples corresponding to 609 patients were positive for influenza A or B virus. A total of 371 patients had influenza A, 228 had influenza B, and 10 (1.6 %) had influenza A and B virus detection in the same sample. The median age of co-infected patients was 78.6 years, and only one of the co-infected patients died because of the infection. Comparison with a control group of mono-infected patients revealed that co-infection was significantly associated with nosocomial acquisition [odds ratio (OR) = 4.5, 95 % confidence interval (CI) = 1.05-19.25, p = 0.042]. However, co-infection was not associated with worse outcome, previous underlying condition, or vaccination status. Multivariate analysis revealed that co-infection was not an independent risk factor for death and that no single risk factor could predict co-infection.

[Dietetic supplements for weight reduction: medical and ethical dilemmas]. / Suplementos dietéticos para reducir de peso: dilemas médicos y éticos.

Obesity is an important public health problem. Dietetic supplements are commonly used by obese patients who are not aware of the effectiveness or potential harms of these products. The aim of this paper is to discuss the ethical dilemma associated with the use of these supplements. The principles of autonomy, beneficence and justice are involved. Obesity as a chronic disease, requires qualified medical care. Obese individuals should be aware of their disease and voluntarily agree to receive professional care.

Contribución de la neuropsicología al diagnóstico de enfermedades neuropsiquiátricas / Neuropsychology's contribution in diagnosing neuropsychiatric disorders

La neuropsicología se ha posicionado como un recurso esencial para la mayoría de las unidades de neurología, neurocirugía, psiquiatría y neurorrehabilitación, que atienden tanto a niños, adultos y adultos mayores, que padecen alteraciones del sistema nervioso central. El desafío de la neuropsicología es contribuir al proceso diagnóstico y al manejo de estos pacientes a partir de la evaluación de procesos cognitivos como atención, memoria, percepción, funciones ejecutivas, considerando sus manifestaciones conductuales y emocionales, toda vez que para la mayoría de las alteraciones neuropsiquiátricas no se cuenta con marcadores biológicos u otras técnicas que precisen el diagnóstico. Las alteraciones neuropsicológicas son manifestaciones comunes y, en algunos casos, centrales en varias de las patologías más prevalentes en neurología y psiquiatría. Este artículo presenta la definición, ámbito, objetivos y herramientas de la neuropsicología, y entrega una breve caracterización de algunos de los trastornos neuropsiquiátricos más relevantes, desde esta perspectiva.

Neuropsychology has positioned itself as an essential resource for most modern centers of neurology, neurosurgery, psychiatry and neurorehabilitation for children, adults and seniors suffering from central nervous system disorders. Its challenge is to help in the diagnosis and management of these patients through the evaluation of cognitive processes, such as: Attention, memory, perception, executive functions; taking into account behavioral and emotional expressions - since most neuropsychiatric disorders have no biological markers; and we have no other techniques that provide accurate diagnoses. Neuropsychological disturbances are common, and in some cases, the main clinical manifestation in these disorders. This paper discusses the definition, scope, objectives, and tools of neuropsychology. It also provides a brief description of some relevant neuropsychiatric disorders through this perspective.

Prevalencia del sindrome metabolico en niños y adolescentes chilenos con historia familiar de enfermedades cronicas no transmisibles

La historia familiar (HF) de Enfermedades Crónicas no Transmisibles (ECNT), aumentaría el riesgo de síndrome metabólico (SM). En Chile, el SM afecta al 27% de niños con sobrepeso, y la hiperglicemia de ayuno (HA) es el trastorno menos prevalente (4.0%). El objetivo fue estudiar la prevalencia del SM y de los factores de riesgo cardiovascular (FRCV) en niños con sobrepeso e HF de ECNT analizando su asociación con el número de parientes afectados y con la historia parental (HP). En 183 niños con IMC ≥p85 de 11,8 ± 1,8 años (86 varones) e HF (padres y/o abuelos) de ECNT, se evaluó el z IMC (CDC / NCHS), el perímetro de cintura, la presión arterial, la glicemia, la insulina, los triglicéridos y el colesterol-HDL. El SM y los FRCV fueron diagnosticados por el criterio de Cook y la insulinoresistencia (IR) por el HOMA-IR. Se utilizaron Chi², ANOVA, t Student y Willcoxon. La HF de DM2, hipertensión arterial y dislipidemia fue de 81,4 %, 88,0 % y 71,6 % respectivamente. La prevalencia del SM fue de 46,5%, asociándose a la magnitud del sobrepeso y a la HP de ECNT. La prevalencia de hipertrigliceridemia y de hiperglicemia de ayuno fueron de 54,6% y 31,4% respectivamente. No hubo asociación entre el número de parientes con HF y el perfil cardiovascular y metabólico del niño. Se concluye, que la HF de ECNT, se asocia a una mayor prevalencia del SM, de dislipidemia y de hiperglicemia de ayuno que la observada en población general de niños con sobrepeso.

Metabolic syndrome prevalence in Chilean children and adolescent with family history of chronic noncommunicable diseases. . Family history (FH+) of non transmisible chronic diseases (NTCD) increase MetS risk. In Chile, the MetS affects 27% of overweight children, and fasting hyperglycemia is very low prevalent (4,0%). The objective was to study the prevalence of MetS and the cardiovascular risk factors (CVRF) in overweight children with a family background of NTCD and analyze its association with the number of relatives witth NTCD and with parental history (PH). In 183 overweight children (BMI ≥p85) mean age 11,8 ± 1,8 (86 males) with a FH+ (parental or grandparental) of NTCD, were assessed the BMI z (CDC / NCHS), waist circumference, blood arterial pressure, fasting Glucose and Insulin (RIA), triglycerides, HDL chol. The MetS and the CVRF were diagnosed using the Cook phenotype and the insulin resistance (IR) through the HOMA-IR. Chi², ANOVA, t Student and Willcoxon test were performed. The frequency of FH+ of DM2, hypertension and dyslipidemia were 81,4 %, 88,0 % and 71,6 % respectively. The MeTS prevalence was 46,5 % associated to overweight magnitude an parental history of NTCD. The prevalence of hypertriglyceridemia was 54,6%, while fasting hyperglycemia affected 31,4% of the sample. There was no association between number of relatives with NTCD and CV risk profile. We conclude that in overweight children with FH+ of NTCD, the prevalence of MetS, dyslipidemia and fasting hyperglycemia are significantly higher, than those observed in the general population of obese children.

Estrategia salud en tu casa: redefinición de la atención primaria de la salud en la comuna de Curarrehue / Strategy health at your home: redefining primary health care in the rural Municipality of Curarrehue, Chile

Con el propósito de volver a la integralidad de la APS, la comuna de Curarrehue desde el año 2010 está impulsando la estrategia “Salud en tu Casa”, la cual es una herramienta que apunta hacia el desarrollo local donde, a través del trabajo transdisciplinario, fundamentado en la intersectorialidad, el trabajo comunitario y el aumento del capital social, ha puesto en el eje del sistema de salud la promoción y la prevención de manera real y en su amplio sentido, fundamentado en el abordaje de los determinantes sociales de la salud. Se expone el proceso que ha llevado adelante el equipo de salud local de Curarrehue en la tarea de reorientar la APS de la comuna desde el enfoque de determinantes sociales de la salud.

Since 2010, Curarrehue, a small town in the south of Chile, is driving an strategy called “Health at Home” in order to return to the comprehensive model of Primary Health Care. This is a tool aimed at local development through transdisciplinary work, intersectorial action, community work and increased social capital. Its axis has been health promotion and prevention based on addressing the social determinants of health. The process that has been driven by the local health team of Curarrehue in the task of reorienting the Primary Health Care in view of the social determinants of health, is here presented.

A field studies and modeling approach to develop organochlorine pesticide and PCB total maximum daily load calculations: case study for Echo Park Lake, Los Angeles, CA.

Echo Park Lake is a small lake in Los Angeles, CA listed on the USA Clean Water Act Section 303(d) list of impaired water bodies for elevated levels of organochlorine pesticides (OCPs) and polychlorinated biphenyls (PCBs) in fish tissue. A lake water and sediment sampling program was completed to support the development of total maximum daily loads (TMDL) to address the lake impairment. The field data indicated quantifiable levels of OCPs and PCBs in the sediments, but lake water data were all below detection levels. The field sediment data obtained may explain the contaminant levels in fish tissue using appropriate sediment-water partitioning coefficients and bioaccumulation factors. A partition-equilibrium fugacity model of the whole lake system was used to interpret the field data and indicated that half of the total mass of the pollutants in the system are in the sediments and the other half is in soil; therefore, soil erosion could be a significant pollutant transport mode into the lake. Modeling also indicated that developing and quantifying the TMDL depends significantly on the analytical detection level for the pollutants in field samples and on the choice of octanol-water partitioning coefficient and bioaccumulation factors for the model.

¿Contribuye la nutrición enteral precoz a disminuir las complicaciones de la gastrectomía radical por cáncer gástrico? / Does contribute early enteral nutrition to decrease the complications of radical gastrectomy for gastric cancer?

OBJETIVO: Evaluar si la administración de nutrición enteral precoz en el post operatorio de los pacientes gastrectomizados por cáncer gástrico contribuye a disminuir la frecuencia de complicaciones post operatorias. MATERIALES Y MÉTODOS: Se realizó un estudio de casos y controles con 120 pacientes, 60 con complicaciones post-operatorias (casos) y 60 pacientes sin complicaciones postoperatorias (controles), pareados por edad y sexo. RESULTADOS: El análisis univariado, encontró que albúmina (p=0.03), hematocrito (p=0.004), nutrición enteral precoz (p<0.01), estadío del cáncer gástrico (p=0.013) se comportaron como variables asociadas al desarrollo de complicaciones post-operatorias; sin embargo, en el análisis múltivariado, sólo la nutrición enteral precoz (p=0.014), nivel de hematocrito (0.019) y estadio anatomopatológico (0.013) mostraron asociación estadística significativa. CONCLUSIONES: La nutrición enteral precoz administrada por sonda nasoenteral en el post-operatorio inmediato, junto con el nivel de hematocrito y estadio anátomo-patológico de la enfermedad, se asociaron estadísticamente a la disminución de las complicaciones postoperatorias, en pacientes sometidos a cirugía radical, por cáncer gástrico.

OBJECTIVE: To evaluate whether the administration of early enteral nutrition in postoperative gastrectomized patients due gastric cancer helps to reduce the frequency of postoperative complications. MATERIALS AND METHODS: A case-control study with 120 patients, 60 with postoperative complications (cases) and 60 patients without post operative complications (controls) matched for age and sex. RESULTS: The uni-variable analysis found that albumin (p=0.03), hematocrit (p=0.004), early enteral nutrition (p<0.01), stage of gastric cancer (p=0.013), behaved as variables associated with the development of postoperative complications. However, in this multivariable analysis, only early enteral nutrition (p=0.014), hematocrit (0.019) and pathological stage (0.013), showed statistically significant association. CONCLUSIONS: The early enteral nutrition administered by nasoenteral tube in the immediate postoperative period, with the hematocrit level and the anatomopathological disease stage is associated with statistically decreased postoperative complications in patients undergoing radical surgery for gastric cancer.

Complicaciones postoperatorias en la herniorrafia ambulatoria con malla: estudio comparativo de la tasa de infección del sitio operatorio con y sin profilaxis antibiótica / Antibiotic prophylaxis in mesh inguinal herniorrhapy

The use of antibiotic prophylaxis has been questioned in the inguinal herniorrhaphy with mesh. The aim of this paper is to give account of the efficiency of antibiotic prophylaxis (AP) in the prevention of wound infection in the elective inguinal herniorrhaphy with mesh under local anaesthesia in an ambulatory basis. In the present observacional analytic study, 955 patients were operated upon with a mesh technique during a 10 year period, .in the CRS Hernia Centre in Santiago. In the first group of 250 patients, lgr Cefazolin® was administered iv one hour before the operation, in the second group of 710 patients no antibiotics were used. Demographic variables, associated diseases, the length of surgery were comparable in both groups. The same team of surgeons work in both groups. Wound infection was defined as the presence of pus in the surgical wound associated with a positive bacterial culture. The rate of wound infections was 1.05 percent of the first and 0.35 percent of the second group. This difference was no significant (p < 0.08). The isolated germ was a Staphylo-coccus aureus in all cases. The treatment was ambulatory in all cases. The rate of haematoma and funiculo-testicular fluxion were low. We conclude that the rate of wound infection in mesh herniorrhaphies is low and that the antibiotic prophylaxis does not improve these results. Its routine use in these patients is not justified.

Introducción: El uso de la profilaxis antibiótica en la cirugía hemiaria con malla es controversial. El propósito del presente estudio es establecer la efectividad de la profilaxis antibiótica (PA) en la prevención de la infección del sitio operatorio (ISO) en la herniorrafía con malla efectuada en forma ambulatoria con anestesia local. Material y Método: El estudio observacional analítico se realizó dentro del Programa de Cirugía Ambulatoria del CRS Cordillera, en dos grupos consecutivos de pacientes, el primero que se sometió a PA mediante lgr de Cefazolina® intravenosa, inmediatamente antes del procedimiento quirúrgico, y el segundo en el que se prescindió de ella. Los controles postoperatorios se efectuaron al 7º y 30º día por un cirujano del grupo. Se diagnosticó ISO con la presencia de exudado purulento, con cultivo bacteriano positivo. Resultados: El estudio se efectuó en 955 pacientes operados entre 1998 y 2008. En el primer grupo, constituido por 245 pacientes se usó PA, en el segundo grupo de 710 pacientes se prescindió de ella. Las variables demográficas, antecedentes mórbidos y la duración del acto quirúrgico fueron comparables en ambos grupos. Se registraron 2 casos de infección en el primer grupo (1,05 por ciento) y dos en el segundo (0,35). Esta diferencia no fue significativa. El germen aislado fue en todos los casos el estafilococo dorado. Conclusiones: La tasa ISO en la hemiorrafia inguinal electiva ambulatoria con malla es baja y no se modificó con el uso de PA. Su empleo indiscriminado no aparece justificado en estos pacientes.

Stability and comparative analysis of AOT/water/isooctane reverse micelle system using dynamic light scattering and molecular dynamics.

We use molecular dynamics (MD) and dynamic light scattering (DLS) measurements to analyze the size of reverse micellar structures in the AOT-water-isooctane system at different water-to-surfactant ratios at ambient temperature and pressure. We find good qualitative agreement for the size and morphology behavior of the reverse micelle structures between molecular dynamics calculations and DLS measurements; however, the average values for the reverse micelle size distributions are systematically larger for the DLS measurements. The latter tends to capture the average hydrodynamic size of the structures based on self-diffusion rather than the average physical size as measured in MD simulations, explaining the systematic deviations observed. The combination of MD with DLS allows a better interpretation of the experimental results, in particular for conditions where the structures are nonspherical, commonly observed at lower water-to-surfactant ratios. We also present and analyze the effect of zirconyl chloride on the micellar size distributions in this system. These type of salts are common for reverse micellar synthesis processes. We find that zirconyl chloride affects significantly the size distributions.

[Original and abbreviated Zarit caregiver burden scales. Validation in Chile]. / Validación en Chile de la Escala de Sobrecarga del Cuidador de Zarit en sus versiones original y abreviada.

BACKGROUND: Six percent of the Chilean population has a disability requiring assistance with daily-living-activities and 69% of these individuals are cared by direct family members. The latter are at risk of developing caregiver burden. Zarit scales are used to assess the severity of caregiver burden. AIM: To validate the original and abbreviated Zarit scales for caregiver burden. MATERIAL AND METHODS: Two groups of interviewers applied the original and abbreviated Zarit scales, along with a single subjective indicator for burden and surveys for depression, to 32 caregivers from an outpatient clinic in Melipilla, Chile. In 22 subjects, the instruments were applied again, four months later RESULTS: Both Zarit scales showed high correlation with the subjective indicator for burden and with depression (r =0.51 and 0.67, respectively), supporting its construct validity. The abbreviated scale had a high correlation with the original scale (r =0.92), supporting its criterion validity. It had a 100 % sensitivity 77.7%, specificity 86.6% positive predictive value and 100% negative predictive value to discriminate severe caregiver burden, using the original scale as standard. Both instruments showed high internal consistency (Cronbach alpha =0.84 and 0.87, respectively), inter-observer reliability (intraclass correlation coefficient =0.81 and 0.86, respectively) and stability reliability (Kappa test-retest =0.91 and 0.93, respectively). CONCLUSIONS: Both original and abbreviated Zarit burden scales are valid to assess caregiver's burden in a Chilean context. The abbreviate scale Szeged particularly useful for primary care.