Overcoming obstacles in Panama to starting a renal biopsy program in a rural area during the COVID-19 pandemic.

Due to the many implemented restrictions, the SARS-CoV-2 pandemic has rendered some tasks more difficult, for instance, the evaluation of outpatients. Panama's tertiary care hospital for kidney biopsy referral was transformed into a COVID-only hospital in order to assist the large number of COVID-19 patients. In order to face the impossibility of following patients with nephrotic or nephritic syndrome, a biopsy program was implemented in a southern province in Panama. Thirty kidney biopsies were carried out over a 1-year period. This experience shows that kidney biopsy programs, that are usually run only in large referral centers, can also be implemented in small nephrology centers, allowing to obtain accurate diagnoses and to guide correct treatment.

Lesions missed on prostate biopsies in cases sent in for consultation.

BACKGROUND: There are no reports on how often lesions are missed on prostate needle biopsies. METHODS: Over a 10-month period, 8/99 to 5/00, 3,251 prostate biopsy cases were seen in consultation. RESULTS: We identified 87 (2.7%) patients with missed lesions (n = 9 academic hospitals; n = 44 community hospitals; n = 34 commercial labs). Overall, 119 lesions were missed in 87 patients. Missed lesions were as follows: small atypical glands suspicious for cancer (41 lesions in 35 patients), prostatic adenocarcinoma (39 cancers in 32 patients), high grade prostatic intraepithelial neoplasia (HGPIN) (34 lesions in 30 patients), and HGPIN with adjacent small atypical glands (five lesions in five patients)--some men with more than one type of missed lesion. Detection of the missed lesions would have resulted in either: a definite change in care in 15 of 3,251 (0.5%) patients or a possible change in care (bilateral cancer vs. unilateral cancer; HGPIN vs. atypical) in 17 (0.5%) patients. In 21 (24%) of the cases, the slides were seen by at least two pathologists prior to consultation at our hospital. CONCLUSIONS: Although the number of prostate biopsies with missed lesions in a consult-based population of prostate biopsies appears relatively high (2.7%), the detection of the missed lesions would have only effected a definite change in care in 0.5% of all patients or a possible change in care in another 0.5% of patients. Our data underestimates missed lesions, as the entire specimen was not submitted for review in 41% of cases. Although our incidence of missed lesions gives some indication as to the magnitude of the problem, it cannot be equated with the risk of missing lesions in unselected cases.

Eficacia, seguridad y tolerancia de la Azitromicina en el tratamiento de pacientes con faringitis agudas / Efficacy, security and tolerance of Azitromicina in acute pharyingitis patients treatment

Se evaluaron 25 pacientes adultos con infección faríngea aguda, los que fueron tratados con un nuevo antibiótico del grupo de los macrólidos, la azitromicina en única dosis oral de 500 mg. durante tres días consecutivos. Resultaron catorce pacientes del sexo masculino y 11 del sexo femenino con edades de 17 a 67 años. Previo al tratamiento se les practicó cultivo faríngeo, identificando 14 pacientes (56%) positivos por Estreptococo Beta hemolítico del grupo A, 5 pacientes (20%) con Estafilococos coagulasa positivo, 2 casos (8%) positivos por Klebsiella pneumoniae y un caso de cada uno de los siguientes agentes: Estafilococos coagulasa negativo, Estreptococo Alfa hemolítico, Diplococo pneumoniae y Escherichia coli. Los síntomas más frecuentes y severos encontrados además de la fiebre y disfagia fueron irritabilidad, hiperemia y malestar general. Estas molestias practicamente desaparecieron en el control de los 5 días post-tratamiento y en su totalidad estaban ausentes en los controles de los 12 y 21-28 días post-tratamiento. El control bacteriológico post-tratamiento indica que todos los veintitrés (92%) pacientes positivos por agentes patógenos durante el pre-tratamiento fueron negativos en este control. En el grupo estudiado no se presentaron efectos secundarios ni siquiera del aparato digestivo, tan frecuente con estos tratamientos. Los autores concluyen que este macrólido, la azitromicina, del grupo azálido es clínica y bacteriológicamente eficaz y seguro para el tratamiento de faringitis agudas, con el beneficio adicional de su fácil régimen de dosificación lo que garantiza cumplimiento de la terapia total.