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Parechovirus A (PeV-A, Parechovirus, Picornaviridae) are human pathogens associated with mild to severe gastrointestinal and respiratory diseases in young children. While several studies have investigated the association of PeV-A with human disease, little is known about its epidemiology or detection in Latin America. Between the years 2014 and 2015, a total of 200 samples were collected from Panamanian pediatric patients aged < 16 years old exhibiting symptoms associated with respiratory (n = 64), gastrointestinal (n = 68), or neurological (n = 68) diseases. These samples were gathered from patients who had previously received negative diagnoses for the main respiratory viruses, rotavirus, and neurological viruses like herpes virus, enterovirus, and cytomegalovirus. The presence of PeV-A was analyzed by real time RT-PCR.Eight positive PeV-A infections (4.0%, 95% CI: 1.7 to 7.7) were detected: two in respiratory samples (3.0%, 95% CI: 0.3 to 10.8), five in gastrointestinal samples (7.3%, 95% CI: 2.4 to 16.3), and one in cerebrospinal fluid (1.5%, 95% CI: 1.4 to 7.9). The study provides evidence of PeV-A circulation in Panama and the data collectively, remarked on the importance of considering PeV-A in the Panamanian pediatric diagnostic landscape, especially when conventional testing for more common viruses yields negative results.
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Infecciones por Enterovirus , Enterovirus , Parechovirus , Infecciones por Picornaviridae , Picornaviridae , Humanos , Niño , Lactante , Preescolar , Adolescente , Parechovirus/genética , Infecciones por Picornaviridae/diagnóstico , Infecciones por Picornaviridae/epidemiología , Infecciones por Enterovirus/diagnóstico , Infecciones por Enterovirus/epidemiología , Picornaviridae/genéticaRESUMEN
BACKGROUND: Identifying the most highly cited papers in a given field can help researchers and professionals understand the milestones and research areas that are generating the most impact. This study aimed to identify and describe the 50 most frequently cited manuscripts on cysticercosis and neurocysticercosis. METHODS: We identified the 50 most cited papers (articles and reviews) on cysticercosis and neurocysticercosis from the MEDLINE database and indexed in Web of Science-Core Collection, analyzing their bibliographic and content characteristics. RESULTS: The most cited documents comprised 29 (58%) original articles and 21 (42%) reviews, the bulk of which were narrative reviews (nâ =â 17), with a negligible presence of other types of reviews with high-level scientific evidence. Six journals published 42% of the articles. In addition to the USA, Mexico and Peru were prominent countries of origin among leading researchers. The main research topics were the central nervous system and epilepsy on the one hand, and diagnostic and therapeutic approaches on the other. CONCLUSION: Our findings shed light on the dissemination of knowledge about cysticercosis and neurocysticercosis in recent decades, identifying the most highly cited contributions that have driven research in the field.
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Factor de Impacto de la Revista , Neurocisticercosis , Humanos , Neurocisticercosis/complicaciones , Publicaciones , Conocimiento , MéxicoRESUMEN
Background: Rhinocerebral mucormycosis is a rare, life-threatening fungal infection that affects the sinuses, nasal passages, and brain. Its management remains challenging owing to high mortality rates. Combination antifungal therapy is an area of ongoing research aimed at improving outcomes. We aimed to describe the clinical management and outcomes of patients with rhinocerebral mucormycosis who were treated with antifungal combination therapy. Methods: This retrospective case series included 10 patients diagnosed with rhinocerebral mucormycosis at two academic medical centers between January 2008 and July 2023 who received initial antifungal therapy with liposomal amphotericin B (L-AmB), alone or in combination, within 24 h of diagnosis. Clinical data were extracted from the medical records. Results: Most patients were males (70 %) with uncontrolled diabetes (71.4 %). L-AmB was used as the initial therapy in all patients, either as monotherapy (n = 4) or combination therapy (n = 6), followed by posaconazole maintenance. The combinations included L-AmB with posaconazole (n = 4), L-AmB with micafungin (n = 3), or both (n = 3). The overall mortality rate was 50 %. Survivors had high morbidity, with median 31-day hospitalizations and 50 % readmission rate. Conclusions: Despite aggressive management, rhinocerebral mucormycosis has high mortality and morbidity rates. While combination antifungal therapy aims to improve cure rates, our case series showed higher mortality rates than monotherapy. Additional research is warranted to optimize management approaches for this devastating infection.
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ABSTRACT Myiasis is a temporary infection of the skin or other organs with fly larvae.1 The larvae develop into boil-like lesions. Creeping sensations and pain are usually described by patients. Following the maturation of the larvae, spontaneous exiting and healing is experienced. Herein we present a case of a traveler returning from Central African Republic. She does not recall insect bites. She never took off her clothing for recreational bathing, nor did she visit any rural areas. The lesions appeared on unexposed skin. The specific diagnosis was performed by morphologic characterization of the larvae, resulting in Cordylobia anthropophaga, the dominant form of myiasis in Africa. To our knowledge, this is the first reported case of C. anthropophaga in Latin America.
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Humanos , Animales , Femenino , Persona de Mediana Edad , Dípteros , Enfermedad Relacionada con los Viajes , Larva/anatomía & histología , Miasis/parasitología , Panamá , República CentroafricanaRESUMEN
Abstract Background: Treatment of sickle cell anemia is a challenging task and despite the well understood genetic and biochemical pathway of sickle hemoglobin, current therapy continues to be limited to the symptomatic treatment of pain, supplemental oxygen, antibiotics, red blood cell transfusions and hydroxyurea. SANGUINATE is a carbon monoxide releasing molecule and oxygen transfer agent under clinical development for the treatment of sickle cell anemia and comorbidities. Methods: An open-label randomized Phase Ib study was performed in adult sickle cell anemia patients. Two dose levels of SANGUINATE were compared to hydroxyurea in 24 homozygotes for Hb SS. Twelve subjects received either a low dose (160 mg/kg) of SANGUINATE or 15 mg/kg hydroxyurea. Another 12 subjects received either a high dose (320 mg/kg) of SANGUINATE or 15 mg/kg hydroxyurea. The primary endpoint was the safety of SANGUINATE versus hydroxyurea in sickle cell anemia patients. Secondary endpoints included determination of the plasma pharmacokinetics and assessment of hematologic measurements. Results: Musculoskeletal related adverse events were the most common. Transient troponin I levels increased in three patients, one of whom had an increase in tricuspid regurgitant velocity; however, no clinical signs were noted. Following an assessment of vital signs, tricuspid regurgitant velocity, electrocardiogram, serum biochemistry, hematology, urinalysis, and analysis of reported adverse events, SANGUINATE was found to be safe in stable sickle cell anemia patients. Conclusions: The clinical trial met its primary objective of demonstrating an acceptable safety profile for SANGUINATE in patients with sickle cell anemia. This trial established the safety of SANGUINATE at both dose levels and permitted its advance to Phase II trials.
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Humanos , Masculino , Femenino , Adulto , Comorbilidad , Ensayo Clínico Controlado Aleatorio , Anemia de Células Falciformes/terapiaRESUMEN
Traditional mosquito control strategies rely heavily on the use of chemical insecticides. However, concerns about the efficiency of traditional control methods, environmental impact and emerging pesticide resistance have highlighted the necessity for developing innovative tools for mosquito control. Some novel strategies, including release of insects carrying a dominant lethal gene (RIDL®), rely on the sustained release of modified male mosquitoes and therefore benefit from a thorough understanding of the biology of the male of the species. In this report we present the results of a mark-release-recapture study aimed at: (i) establishing the survival in the field of laboratory-reared, wild-type male Aedes aegypti and (b) estimating the size of the local adult Ae. aegypti population. The study took place in Panama, a country where recent increases in the incidence and severity of dengue cases have prompted health authorities to evaluate alternative strategies for vector control. Results suggest a life expectancy of 2.3 days for released male mosquitoes (confidence interval: 1.78-2.86). Overall, the male mosquito population was estimated at 58 males/ha (range 12-81 males/ha), which can be extrapolated to an average of 0.64 pupae/person for the study area. The practical implications of these results are discussed.
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Animales , Masculino , Aedes/fisiología , Dengue/prevención & control , Insectos Vectores/fisiología , Control de Mosquitos/métodos , Distribución Animal , Colorantes Fluorescentes , Esperanza de Vida , Panamá , Pupa/fisiología , Razón de Masculinidad , Análisis de SupervivenciaRESUMEN
Objetivo: Revisar el manejo terapéutico, según el tipo de lesiones, ubicación de acuerdo a la clasificación de Strasberg's Bismuth, y según el momento en que se realiza el diagnóstico. Métodos: Se presentan 5 casos con lesiones iatrogénicas de la vía biliar, en un total de 411 colecistectomías en el Hospital José María Benítez, desde enero 2008 a octubre 2013, en las cuales se realizó tratamiento quirúrgico y/o endoscópico según el caso. Estudio descriptivo y retrospectivo. Resultados: De los 5 pacientes, presentados 4 pertenecen al Hospital José María Benítez y uno fue referido de otro centro asistencial, total de 411 colecistectomías, abiertas 310, laparoscópicas 101. La incidencia en colecistectomía abierta 0,97% (3/309) y en colecistectomía por laparoscopia 0,99% (1/101). La resolución se realizó en 4 casos con tratamiento quirúrgico y en 1 caso con tratamiento endoscópico, esfinterotomía más stent biliar. Evolución post-operatoria sin complicaciones. Conclusión: Las lesiones iatrogénicas de la vía biliar principal son situaciones clínicas complejas con importante morbilidad,generando complicaciones agudas o crónicas afectando severa-mente la calidad de vida en el mejor de los casos, en su gran mayoría se producen durante colecistectomías y se considera que son el resultado de una identificación incorrecta de los elementos del triángulo de Calot. Una vez que se presentan se requiere de un abordaje integral y de un equipo entrenado multidisciplinario entre cirujanos, radiólogos, y endoscopistas(AU)
Objective: To review the therapeutic, depending on the typeof injury management, location according to the classification of Strasberg's - Bismuth, and according to the moment in which the diagnosis is made. Methods: Five cases with iatrogenic injuries of the biliary tract, of 411 cholecystectomies in the Hospital José María Benítez since January 2008 to October 2013, which was carried out surgical or endoscopic treatment according to the case are presented. It's a descriptive and retrospective study.Results: Of the 5 patients presented, 4 belong to the Hospital José María Benítez and one was referred to other healthcare, total 411 cholecystectomies: open 310, laparoscopic 101. The incidence in open cholecystectomy 0.97% (3/309) and laparoscopic 0.99% (1/101). The resolution was carried out in 4 cases with surgical treatment and in 1 case with endoscopic treatment, sphincterotomy plus biliary stent. Postoperative evolution was without complications. Conclusion: The main bile duct iatrogenic injuries are complex clinical situations with significant morbidity, generating acute or chronic complications, severely affecting the quality of life in the best of cases, the vast majority occur during cholecystectomies andit is considered to be the result of an incorrect identification of the elements of Calot's triangle. Once presented, requires a comprehensive approach and a trained multidisciplinary team between surgeons, radiologists, and endoscopists(AU)
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Humanos , Masculino , Femenino , Adulto , Anciano , Conductos Biliares , Colecistectomía , Colecistectomía Laparoscópica , Diagnóstico , Cuidados Posoperatorios , Morbilidad , Laparoscopía , Cirujanos , HospitalesRESUMEN
Objetivo. Investigar la prevalencia de farmacorresistencia transmitida del VIH en adultos en Panamá mediante un estudio del umbral modificado de la Organización Mundial de la Salud (OMS) e investigar las tasas de resistencia inicial en lactantesseropositivos para el VIH en Panamá.Métodos. En el Instituto Conmemorativo Gorgas, en 47 adultos seropositivos al VIH se efectuó la genotipificación de las mutaciones asociadas con la farmacorresistencia transmitida en los genes de la transcriptasa inversa y la proteasa del VIH-1, según las directrices del estudio umbral de la OMS, modificadas para incluir a las personas ≤ 26 años de edad. Las tasas de prevalencia de las mutaciones farmacorresistentes contra tres clases de fármacos antirretroviral inhibidores de la transcriptasa inversaanálogos de nucleósidos, inhibidores de la transcriptasa inversa no análogos de nucleósidos e inhibidores de la proteasa se clasificaron en bajas (< 5,0%), moderadas (5,0%15,0%) o altas (> 15,0%). También se llevó a cabo genotipificación y se calcularonlas tasas de prevalencia de las mutaciones causantes de farmacorresistencia en 25 lactantes.Resultados. En los adultos de Panamá la farmacorresistencia transmitida fue moderada: 6 de 47 adultos seropositivos para el VIH presentaron una o más mutacionesasociadas con farmacorresistencia transmitida. Las mutaciones farmacorresitentes de transmisión horizontal fueron moderadas para los inhibidores de la transcriptasainversa análogos de nucleósidos y los inhibidores de la transcriptasa inversa no análogos de nucleósidos, y bajas para los inhibidores de la proteasa. En Panamá la transmisiónvertical del VIH ha disminuido en el período 20022007, pero la prevalenciade la farmacorresistencia del VIH transmitida por vía vertical es moderada (12,0%) y está surgiendo como un problema debido a la cobertura antirretroviral incompletadurante el embarazo...
Objective. To investigate the prevalence of transmitted drug-resistant HIV among adults in Panama by using a modified World Health Organization Threshold Survey (WHO-TS) and to investigate rates of initial resistance among HIV-positive infants in Panama.Methods. At the Gorgas Memorial Institute, 47 HIV-positive adults were genotyped for mutations associated with transmitted drug resistance (TDR) in the reverse transcriptase andprotease genes of HIV-1, according to WHO-TS guidelines, modified to include patients ≤ 26 years old. Prevalence rates for drug-resistance mutations against three classes of antiretroviraldrugsnucleoside analog reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), and protease inhibitorswere calculated as low (< 5.0%), moderate (5.0%15.0%), and high (> 15.0%). Twenty-five infant patients were also genotyped and prevalence rates for drug-resistance mutations were calculated. Results. TDR among Panamanian adults was moderate: 6 of 47 HIV-positive adultsshowed one or more mutations associated with TDR. Horizontal TDR mutations were moderate for NRTIs and NNRTIs and low for protease inhibitors. Vertical transmission of HIV inPanama has decreased for 20022007, but vertical HIV TDR prevalence is moderate (12.0%) and is emerging as a problem due to incomplete antiretroviral coverage in pregnancy. Conclusions. The prevalence of HIV TDR indicated by this study, combined with knownrates of HIV infection in Panama, suggests more extensive surveys are needed to identify risk factors associated with transmission of HIV drug resistance. Specific WHO-TS guidelines for monitoring vertical transmission of drug-resistant HIV should be established.
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Adolescente , Adulto , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Embarazo , Adulto Joven , VIH-1 , Fármacos Anti-VIH/farmacología , Farmacorresistencia Viral , VIH-1 , Fármacos Anti-VIH/uso terapéutico , Farmacorresistencia Viral/genética , Genes pol , Genotipo , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Infecciones por VIH/transmisión , Infecciones por VIH/virología , Inhibidores de la Proteasa del VIH/farmacología , Inhibidores de la Proteasa del VIH/uso terapéutico , Proteasa del VIH/genética , Transcriptasa Inversa del VIH/genética , Transmisión Vertical de Enfermedad Infecciosa , Panamá/epidemiología , Complicaciones Infecciosas del Embarazo/virología , Prevalencia , Inhibidores de la Transcriptasa Inversa/farmacología , Inhibidores de la Transcriptasa Inversa/uso terapéuticoRESUMEN
Los paragangliomas funcionantes de mediastino son tumores raros del sistema paraganglionar. Nosotros reportamos un caso de una mujer de 22 años de edad, con antecedente de hipertensión arterial diagnosticada a los 18 años. En los estudios realizados se constató una excreción urinaria de ácido vainillin mandelico aumentada, en la radiografía del tórax y RMN - resonancia magnética nuclear - se detectó una masa localizada en mediastino posterior. En la toracotomía se halló una lesión tumoral de 7,5 x 4 cm que fue resecada. El examen histológico confirmó el diagnóstico de paraganglioma
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Adulto , Femenino , Células Cromafines , Mediastino , Paraganglios Cromafines , Paraganglioma , Cirugía GeneralRESUMEN
Durante el período de enero de 1997 a septiembre de 1998 se estudiaron 22 pacientes hospitalizados con manifestaciones clínicas de dolor, aumento de volumen de los tejidos blandos, fiebre, flogosis, disfagia y trismus. A todos se les realizó una tomografía computada (TC) para determinar la extensión del proceso infeccioso, alteraciones de los tejidos adyacentes, presencia de celulitis y áreas de licuefacción. Se correlacionaron los aspectos clínicos con los hallazgos observados tomográficamente y cómo influyeron éstos en el manejo posterior
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Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Dolor/diagnóstico , Infecciones de los Tejidos Blandos/diagnóstico , Infecciones de los Tejidos Blandos/etiología , Cuello/patología , Diagnóstico Diferencial , Tomografía Computarizada por Rayos X/métodos , Tomografía Computarizada por Rayos XRESUMEN
Introducción: Los pacientes con malignidades hematológicas, debido a la alteración de sus sistemas de defensa, son más susceptibles a infecciones y tienen mayores riesgos de sufrir bacteriemias originadas por infecciones locales o un foco infeccioso no evidente. Esto agregado a terapias invasivas, aumenta los riesgos de bacteriemia. Metodología: La población en estudio consiste de 24 casos de pacientes con malignidades hematológicas de fondo, y que fueron hospitalizados en el Servicio de Hematología del CHAAM entre las fechas 1-1-94 al 31-12-96. Además, que hayan presentado un episodio bacterémico ya sea a su ingreso o durante sus hospitalizaciones. Este episodio debe constar en el libro de hemocultivos de la CHAAM y en el expediente médico. Resultados: El promedio de edad de la población fue de 50 años. La LMA fue la patología más frecuente (42 por ciento). El 50 (por ciento) de la población estaba severamente leucopénica (CGB<500). Las bacterias más frecuentes en el estudio fueron la E. coli (29 por ciento) y Staph. coagulasa negativa (17 por ciento). El 58 (por ciento) de los casos fueron nosocomiales. Discusión: La bacteriemia por E. coli se presentó principalmente en pacientes mayores de 60 años. Se observó un cambio en las bacterias predominantes en 1996 vs 1994, pues E. coli pasó de 42 (por ciento) a 16 (por ciento) y P. eruginosa y Acinetobacter baumani pasaron ambos de 0 (por ciento) a 25 (por ciento), siendo probablemente la consecuencia del uso de antibióticos de amplio espectro como profilaxis, ya que la A. baumani mostró poca sensibilidad a gran parte de este tipo de antibióticos