Cost-utility analysis of a palliative care program in Colombia.

BACKGROUND: The economic assessment of health care models in palliative care promotes their global development. The purpose of the study is to assess the cost-effectiveness of a palliative care program (named Contigo) with that of conventional care from the perspective of a health benefit plan administrator company, Sanitas, in Colombia. METHODS: The incremental cost-utility ratio (ICUR) and the incremental net monetary benefit (INMB) were estimated using micro-costing in a retrospective, analytical cross-sectional study on the care of terminally ill patients enrolled in a palliative care program. A 6-month time horizon prior to death was used. The EQ-5D-3 L questionnaire (EQ-5D-3 L) and the McGill Quality of Life Questionnaire (MQOL) were used to measure the quality of life. RESULTS: The study included 43 patients managed within the program and 16 patients who received conventional medical management. The program was less expensive than the conventional practice (difference of 1,924.35 US dollars (USD), P = 0.18). When compared to the last 15 days, there is a higher perception of quality of life, which yielded 0.25 in the EQ-5D-3 L (p < 0.01) and 1.55 in the MQOL (P < 0.01). The ICUR was negative and the INMB was positive. CONCLUSION: Because the Contigo program reduces costs while improving quality of life, it is considered to be net cost-saving and a model with value in health care. Greater availability of palliative care programs, such as Contigo, in Colombia can help reduce existing gaps in access to universal palliative care health coverage, resulting in more cost-effective care.

DNA Damage in Bat Blood Leukocytes Using a Chromatin Dispersion Test (CDT): Biomarker of Environmental Genotoxicity.

Environmental pollutants produce adverse effects on organisms and ecosystems. Biomonitoring and biomarkers offer a reasonable approach to make these assessments. Induced genetic changes can be using as a biomarker in organisms that react to a given compound in the ecosystem. Monitoring environmental genotoxicity necessitates the choice of model animals known as "sentinels or biological monitors" and the suitability of validated tests for DNA damage evaluation. We aimed to estimate the DNA damage produced by thermal stress in the leukocytes of the Mexican free-tailed bat (Tadarida brasiliensis). The DNA damage in bat leukocytes exposed to different temperatures (35 °C, 45 °C, and 55 °C) was evaluated by the adapted chromatin dispersion test (CDT) and the results were confirmed by the alkaline comet test. The CDT permitted a clear representation of leukocytes with fragmented DNA and of nonfragmented DNA. In addition, we detected nuclear anomalies in relation to cell death cellular swelling, nuclear fragmentation, and chromatin lysis. The alkaline comet assay revealed that the halos of diffuse chromatin include fragmented DNA. The assay of the method employing the CDT is well established, precise, and cost-effective for the routine quantitative analysis of DNA damage on the effect of the leukocytes of bats exposed to thermal stress. This could also apply as a sensitive screening tool for the evaluation of genotoxicity in environmental protection programs.

Metal Contents in Feathers from Birds (Rhynchopsitta terrisi, and Columba livia) with Different Ecological Niches.

The metal contaminants can be utilized as an ecological tool to analyze niche partition in birds. As environmental contamination biological indicators, essential (Zn, Cu, and Cr) and non-essential (Pb and Cd) metals in the flight feathers of the Maroon-fronted Parrot and Pigeon with different ecological niches were assessed. The feathers of the parrot were gathered at a national park (Parque Nacional Cumbres de Monterrey) and the feathers of pigeons were collected at an urban site, that is, the city of Monterrey, Mexico. An atomic absorption spectrophotometer was used to establish the concentration of metals in the feathers. Zn, Cu, Cr, Pb, and Cd were detected in the two studied samples. The results obtained in this study exhibited an increase in metal concentrations in pigeon feathers with respect to parrot feathers. In conclusion, employing parrot and pigeon feathers comprises an important tool to track trace-metal occurrence in the environment and metal accumulation in birds. This information is crucial to possess in order to minimize exposure to essential metals in species of wild birds with different ecological niches.

Thermal stress induces pyknosis in pigeon erythrocytes: digital image analysis.

Pyknosis or hypercondensation of chromatin is informative in the understanding of nucleosomal packing in translationally inactive chromatin and in the compression of cell death. However, mechanisms that result in the formation of avian erythrocytes with variant nuclear morphology are poorly understood.Purpose: In this work, we evaluated pyknosis in pigeon erythrocytes treated with thermal stress using Digital Image Analysis (DIA).Materials and methods: Pigeon erythrocytes were treated at thermal stress (33 °C, 43 °C, and 53 °C), and nuclear modifications were analyzed by DIA.Results: Our results showed that thermal stress induced DNA condensation. Based on DNA fluorescent staining and compaction, four subclasses with progressively more pyknotic nuclei each could be distinguished. Alkaline comet assay showed that the presence of pyknotic nuclei was associated with the DNA fragmentation typical of apoptosis. DIA analysis showed a decrease of nuclear area and a significant increase of fluorescence intensity with respect to non-pyknotic nucleus. Additionally we observed nuclear dissolution events associated with swell and loose membrane integrity.Conclusion: These findings can contribute to the evaluation of health and metabolic status in diagnostic cytology, especially in neoplastic conditions and infection by microorganisms.

Evaluation of the genotoxic effect of heavy metals in pigeons from urban and rural habitat in Monterrey, Mexico, using the chromatin dispersion assay.

PURPOSE: Evaluate genotoxic effect of heavy metals on Pigeon Erythrocytes (PE) from urban and rural habitat (outside of the city) in Monterrey, Mexico, using the chromatin dispersion assay. MATERIALS AND METHODS: We quantified metals concentrations (Cd, Hg, Cu and Pb) in tail feathers of 22 pigeons from an urban and a rural site in northeastern Mexico. DNA damage in peripheral blood erythrocytes was measured by chromatin dispersion assay in 13 pigeon living in urban habitat and in nine living in rural habitat as the control. MicroNucleus (MN) test was used to confirm levels of DNA damage. RESULTS: Birds in urban habitat had highest concentrations in feathers for all the metallic elements analysed with respect to birds in rural habitat. Concentrations of Cu and Hg showed a significant increase (p < 0.05). Our results showed a significant increase of DNA damage in urban-habitat pigeons compared with that of pigeons in rural area. These results were confirmed by a MN test. CONCLUSIONS: Our preliminary findings demonstrate that PE examination via chromatin dispersion assay is a reliable, precise and inexpensive morphological bioassay for evaluating environmental genotoxicity associated with heavy metals. Further studies for evaluating the individual participation of contaminants in DNA damage are needed.

Detection of DNA damage in pigeon erythrocytes using a chromatin dispersion assay.

The monitoring of environmental genotoxicity requires the selection of model organisms as 'sentinels' as well as the development of sensitive and reliable tests for the assessment of DNA damage. The aims of this study were to quantify genomic DNA strand breakage in the erythrocytes of Columba livia induced by thermal stress using the modified chromatin dispersion test and to validate the results by alkaline comet assay and DNA breakage detection-fluorescence in situ hybridization (DBD-FISH). The chromatin dispersion test allowed for clear visualization of erythrocyte cells with DNA damage and of cells with no DNA damage. DNA damage increased significantly with increase in temperature. Additionally, we observed nuclear abnormalities associated with apoptosis, such as karyorrhexis (nuclear disintegration) and karyolysis (nuclear dissolution). These results were validated by alkaline comet assay and DBD-FISH. In conclusion, this procedure is a reliable, precise, and inexpensive morphological bioassay for routine quantitative analysis of DNA breakage in pigeon erythrocytes induced by thermal stress. This method could also be useful as a practical screening tool for genotoxicity testing in environmental care.

Reward devaluation disrupts latent inhibition in fear conditioning.

Three experiments explored the link between reward shifts and latent inhibition (LI). Using consummatory procedures, rewards were either downshifted from 32% to 4% sucrose (Experiments 1-2), or upshifted from 4% to 32% sucrose (Experiment 3). In both cases, appropriate unshifted controls were also included. LI was implemented in terms of fear conditioning involving a single tone-shock pairing after extensive tone-only preexposure. Nonpreexposed controls were also included. Experiment 1 demonstrated a typical LI effect (i.e., disruption of fear conditioning after preexposure to the tone) in animals previously exposed only to 4% sucrose. However, the LI effect was eliminated by preexposure to a 32%-to-4% sucrose devaluation. Experiment 2 replicated this effect when the LI protocol was administered immediately after the reward devaluation event. However, LI was restored when preexposure was administered after a 60-min retention interval. Finally, Experiment 3 showed that a reward upshift did not affect LI. These results point to a significant role of negative emotion related to reward devaluation in the enhancement of stimulus processing despite extensive nonreinforced preexposure experience.

Predictive validity of body fat percentage by bioimpedance compared with deuterium oxide dilution in Costa Rican schoolchildren.

OBJECTIVE: The purpose of this study was to verify the validity of body fat percentage (BF%) by bioelectrical impedance analysis (BIA) in a sample of Costa Rican schoolchildren. METHODS: The sample consisted of 52 male (mean age 8.1 ± 0.9 years) and 49 female (mean age 7.5 ± 1.0 years) schoolchildren. Deuterium oxide dilution was the reference method used as the "gold standard" to determine the fat mass (FM) expressed as BF%. Linear regression analyses and paired sample t-tests were used to test the association and mean differences between BIA and deuterium oxide dilution BF%. Concordance between BIA and deuterium oxide dilution BF% was determined by Lin's concordance correlation coefficient. Measurement of agreement between the two methods was analyzed using the Bland-Altman procedure. RESULTS: Significant associations between BIA and deuterium oxide dilution BF% were found in males (R = 0.97, R2 = 0.95, P < .0001) and in females (R = 0.98, R2 = .96, P < .0001). The measurements of BF% (mean ± SD) were not significantly different between males (BIA 31.1 ± 7.6% vs. deuterium oxide dilution 31.0 ± 7.4%) and females (BIA 25.9 ± 7.9% vs. deuterium oxide dilution 26.3 ± 7.8%) by t-test. Lin's concordance correlation coefficient identified an almost perfect strength of agreement between males and females. Bland-Altman plots showed that the Bodystat measured similar BF% compared to the deuterium oxide dilution in both males and females. CONCLUSIONS: BIA Bodystat presented high agreement with BF% measured by deuterium oxide dilution; therefore BIA Bodystat is recommended for estimating BF% in Costa Rican schoolchildren.

[Assessment of moral competence of physicians]. / Índice C en médicos de dos centros hospitalarios chilenos según el test de competencia moral de Lind.

BACKGROUND: Moral competence (MC) in physicians is fundamental, given the increasing complexity of medicine. The "Moral Competence Test" (MCT © Lind) evaluates this feature and its indicator is the C Index (CI). AIM: To explore moral competence and its associated factors among physicians working in Chile. MATERIAL AND METHODS: The MCT was answered by 236 physicians from two medical centers who voluntarily participated in the study. Besides the test, participants completed an encrypted form giving information about gender, years in practice and post-graduate studies. RESULTS: The average CI value of the participants was 20,9. Post-graduate studies had a significant positive influence on CI. There was a significant decrease in CI, between 16 and 20 years of professional exercise. Gender and the area of post-graduate studies did not have a significant influence. CONCLUSIONS: The studied physicians showed a wide range of CI which was positively affected by the postgraduate studies performed. The years of professional practice had a negative influence. Expanding training opportunities during professional practice could have a positive effect on CM as measured by CI.

Evaluation of environmental genotoxicity by comet assay in Columba livia.

The concentrations of recognized or suspected genotoxic and carcinogenic agents found in the air of large cities and, in particular, developing countries, have raised concerns about the potential for chronic health effects in the populations exposed to them. The biomonitoring of environmental genotoxicity requires the selection of representative organisms as "sentinels," as well as the development of suitable and sensitive assays, such as those aimed at assessing DNA damage. The aim of this study was to evaluate DNA damage levels in erythrocytes from Columba livia living in the metropolitan area of Monterrey, Mexico, compared with control animals via comet assay, and to confirm the results via Micronuclei test (MN) and DNA breakage detection-fluorescence in situ hybridization (DBD-FISH). Our results showed a significant increase in DNA migration in animals from the area assayed compared with that observed in control animals sampled in non-contaminated areas. These results were confirmed by MN test and DBD-FISH. In conclusion, these observations confirm that the examination of erythrocytes from Columba livia via alkaline comet assay provides a sensitive and reliable end point for the detection of environmental genotoxicants.

Highly Stable Double-Stranded DNA Containing Sequential Silver(I)-Mediated 7-Deazaadenine/Thymine Watson-Crick Base Pairs.

The oligonucleotide d(TX)9 , which consists of an octadecamer sequence with alternating non-canonical 7-deazaadenine (X) and canonical thymine (T) as the nucleobases, was synthesized and shown to hybridize into double-stranded DNA through the formation of hydrogen-bonded Watson-Crick base pairs. dsDNA with metal-mediated base pairs was then obtained by selectively replacing W-C hydrogen bonds by coordination bonds to central silver(I) ions. The oligonucleotide I adopts a duplex structure in the absence of Ag(+) ions, and its stability is significantly enhanced in the presence of Ag(+) ions while its double-helix structure is retained. Temperature-dependent UV spectroscopy, circular dichroism spectroscopy, and ESI mass spectrometry were used to confirm the selective formation of the silver(I)-mediated base pairs. This strategy could become useful for preparing stable metallo-DNA-based nanostructures.

Psychiatric Features of Children with Chronic Functional Constipation: Focusing on Individuals with Autism Spectrum Disorder.

PURPOSE: The present study aimed to assess the psychiatric characteristics of children with chronic functional constipation using the Aberrant Behavior Checklist-Japanese version and the Pervasive Developmental Disorders/Autism Society Japan Rating Scale, and to examine the frequency of autism spectrum disorder in children with chronic functional constipation. We also investigated differences in treatment duration between children with and without autism spectrum disorder. METHODS: Treatment outcomes were examined retrospectively for 55 participants (chronic functional constipation group: n = 30, mean age 3.4 years; control group: n = 25, mean age, 4.5 years). The association between chronic functional constipation and autism spectrum disorder was evaluated using multivariable logistic regression analysis. RESULTS: The mean Aberrant Behavior Checklist score and frequency of individuals with autism spectrum disorder were significantly higher in the chronic functional constipation group. After adjusting for age and sex, chronic functional constipation was significantly associated with autism spectrum disorder. In the chronic functional constipation group, the frequency of onset was significantly higher in children with autism spectrum disorder under 1 year of age. When treated, the mean duration of constipation was significantly longer in children with autism spectrum disorder. CONCLUSION: Pediatricians, pediatric surgeons, and child psychiatrists should work closely to ensure appropriate treatment of chronic functional constipation in children with autism spectrum disorder.

[Food habits and winter diet of Charadrius melodus (Charadriiformes: Charadriidae) in Boca Ciega, Tamaulipas, Mexico]. / Hábitos alimenticios y dieta invernal de Charadrius melodus (Charadriiformes: Charadriidae) en Boca Ciega, Tamaulipas, México.

The Piping Plover (Charadrius melodus) is a migratory endangered species that arrives, along with a great number of other winter migratory birds, to Boca Ciega every year. In spite of the importance of this ecosystem, these species, are threatened by the current habitat change caused by the dredging activities in the area. With the aim to generate new information about the importance of this area during winter, we studied C melodus activities during the winter season in Laguna Madre, from December 2009 to March 2010. Our objectives were: 1) determine the importance of the area during winter, 2) describe C. melodus ethology, feeding substrate preferences and food items, 3) to analyze and describe the sympatric diversity associated with C melodus. A total of ninety nine individuals were observed during the monitoring. The Cochran and Kendall test showed a high significance of the species with the substrate and signs tests using a binomial distribution that indicated a high preference for algal type of substrate. The highest activity recorded for this species during this winter season was feeding. The principal food items found in sediments were larvae of Diptera: Chironomidae and Ephydridae. The sympatric species of C. melodus were two families of Charadriiforms: Scolopacidae (nine species) and Charadriidae (two species). We concluded that this is an important area for feeding, protection and rest sites for this species, and its protection and management is recommended.

Upper Extremity Trauma in Costa Rica - Evaluating Epidemiology and Identifying Opportunities.

Background: Traffic accidents and musculoskeletal injuries represent a major cause of morbidity and mortality in Costa Rica. To inform capacity building efforts, we conducted a survey study of hand and upper extremity (UE) fellowship-trained surgeons in Costa Rica to evaluate the epidemiology, complications, and challenges in care of UE trauma. Methods: Aiming to capture all hand and UE trained surgeons in Costa Rica, we compiled a list of nine surgeons and sent a survey in Spanish using Qualtrics. Assessment questions were developed to understand the burden, complications, practice patterns, challenges, and capacity associated with care of UE trauma. Questions were designed to focus on opportunities for future investigation. Questions were translated and adapted by two bilingual speakers. Data were reported descriptively and open-ended responses were analyzed using content analysis. Results: Nine (100%) surgeons completed the survey. Distal radius fractures, hand and finger fractures, and tendon injuries are the most frequently noted conditions. Stiffness and infection are the most common complications. About 29% of patients are unable to get necessary therapy and 13% do not return for follow-up care with monetary, distance, and transportation limitations being the greatest challenges. Conclusions: The burden of UE trauma in Costa Rica is high. Identifying common conditions, complications, challenges, and capacity allows for a tailored approach to partnership and capacity building (e.g. directing capacity building and/or research infrastructure toward distal radius fractures). These insights represent opportunities to inform community-driven care improvement and research initiatives, such as Delphi consensus approaches to identify priorities or the development of outcome measurement systems.

Sulfur nanocomposites with insecticidal effect for the control of Bactericera cockerelli.

The purpose of this research was to synthesize nanocomposites consisting of sulfur nanoparticles coated with eucalyptus and rosemary essential oils to determine the insecticidal effect in the control of nymphs of paratrioza (Bactericera cockerelli (Sulc) (Hemiptera: Triozidae)) in potato crops. A solution of thiosulfate was reduced to elemental sulfur, and the sulfur nanoparticles were coated with eucalyptus and rosemary essential oils with the three concentrations of 0.25%, 0.5%, and 0.75%. The samples were characterized by UV-visible spectroscopy, energy-dispersive X-ray spectroscopy, transmission electron microscopy, and scanning electron microscopy. The insecticidal efficacy of the nanocomposites was evaluated in the entomology laboratory 24, 48, and 72 h after application. Furthermore, efficacy was compared to the commercial insecticide thiamethoxam (0.25%) and a control. The results show that eucalyptus nanocomposites with oil concentrations of 0.25%, 0.5%, and 0.75% and rosemary nanocomposites with an oil concentration of 0.5% have an insecticidal efficacy of 100% for the control of insect nymphs 24 h after application. The insecticidal efficacy of rosemary nanocomposites with oil concentrations of 0.25% and 0.75% increases over time and reaches 100% at 24 and 72 h, respectively. The synthesized nanocomposites are more effective in controlling nymphs of paratrioza than the commercial insecticide thiamethoxam; thus, they could be used for the development of new insecticides.

Removal of synaptic Ca²+-permeable AMPA receptors during sleep.

There is accumulating evidence that sleep contributes to memory formation and learning, but the underlying cellular mechanisms are incompletely understood. To investigate the impact of sleep on excitatory synaptic transmission, we obtained whole-cell patch-clamp recordings from layer V pyramidal neurons in acute slices of somatosensory cortex of juvenile rats (postnatal days 21-25). In animals after the dark period, philanthotoxin 74 (PhTx)-sensitive calcium-permeable AMPA receptors (CP-AMPARs) accounted for ∼25% of total EPSP size, and current-voltage (I-V) relationships of the underlying EPSCs showed inward rectification. In contrast, in similar experiments after the light period, EPSPs were PhTx insensitive with linear I-V characteristics, indicating that CP-AMPARs were less abundant. Combined EEG and EMG recordings confirmed that slow-wave sleep-associated delta wave power peaked at the onset of the more quiescent, lights-on phase of the cycle. Subsequently, we show that burst firing, a characteristic action potential discharge mode of layer V pyramidal neurons during slow-wave sleep has a dual impact on synaptic AMPA receptor composition: repetitive burst firing without synaptic stimulation eliminated CP-AMPARs by activating serine/threonine phosphatases. Additionally, repetitive burst-firing paired with EPSPs led to input-specific long-term depression (LTD), affecting Ca(2+) impermeable AMPARs via protein kinase C signaling. In agreement with two parallel mechanisms, simple bursts were ineffective after the light period but paired bursts induced robust LTD. In contrast, incremental LTD was generated by both conditioning protocols after the dark cycle. Together, our results demonstrate qualitative changes at neocortical glutamatergic synapses that can be induced by discharge patterns characteristic of non-rapid eye movement sleep.

Description of a novel technique for ultrasound-based planning for gynaecological 3D brachytherapy and comparison between plans of this technique and 2D with fluoroscopy.

With the purpose of implementing a way to obtain volumes from ultrasound axial images, a novel method for 3D gynaecologic brachytherapy was assessed, with a 3D-printed attachment for a commercial stepper (for prostate brachytherapy). It allowed the acquisition of a transabdominal axial image series by ultrasound; these images were uploaded to a treatment planning system where high-risk clinical tumour volume (HR-CTV) and risk organs were contoured. A dose administration plan was developed with orthogonal X-ray images (0° and 270° incidences), using International Commission on Radiation Units and Measurements (ICRU) 38 points. The same plan was applied in the ultrasound images' sequence and their respective volumes; differences were noted. In the 20 cases analysed, with a given point A dose, its corresponding dose delivered to 90% of HR-CTV percentage was highly variable (mean = 104.2, SD = 26.01). There is a significant variation of this percentage when point A falls outside the HR-CTV than when it falls inside (p < 0.00001). There is a significant correlation in terms of the bladder point dose ICRU 38 and the Maximum dose to 2cc of organ or target volume (D2cc) bladder (p = 0.021); however, there is no such correlation when we relate the rectum point dose ICRU 38 to the D2cc rectum (p = 0.327). There was a negative correlation between HR-CTV and D2cc bladder and D2cc rectum; both were statistically significant. There were significant differences comparing ICRU points and dose to prescription and organ at risk volumes, pointing out that there is room for optimisation of plans using the latter technique. So, it is proposed to further test this image modality and compare it to other imaging techniques that allow the creation of volumes, such as computed tomography or magnetic resonance imaging.

Psychological pain and opioid receptors: Reward downshift is disrupted when tested in a context signaling morphine.

A sucrose downshift causes a temporary suppression of consumption accompanied by psychological pain, a negative emotion triggered by reward loss. When administered systemically before downshift sessions, opioid agonists reduce and opioid antagonists enhance such behavioral suppression. However, little is known about the effects of signals of opioid drugs on behavior during a reward downshift episode. Research showed that morphine administration can induce a direct effect (e.g., hypoalgesia) followed by a compensatory effect (e.g., hyperalgesia). Therefore, a signal for morphine could elicit either a direct or a compensatory effect. Male Wistar rats were exposed to ten 5-min sessions of access to 32% sucrose in context A, followed by three sessions of access to 4% sucrose in context B. In parallel, animals received pairings between context B and morphine (5 mg/kg, sc) occurring each day immediately after sucrose sessions (contexts were counterbalanced). Control conditions included a saline control (no morphine injected), an unpaired control (morphine injected after exposure to B) tested in A (Experiment 1), and an unpaired control tested in B (Experiment 2). In both experiments, behavioral suppression induced by the 32-to-4% sucrose downshift was attenuated when the downshift occurred in a context previously paired with morphine. These data are consistent with the hypothesis that reward downshift is accompanied by an emotion of negative valence that can be counteracted by the conditioned release of endogenous opioids triggered by signals of morphine, much like it is attenuated by systemic morphine administration. Alternative hypotheses are also discussed.

[Primary ciliary dyskinesia in children. Role of electron microscopy in countries with medium economic resources]. / Discinesia ciliar primaria en niños. Rol de la microscopia electrónica en países de medianos recursos económicos.

Primary ciliary dyskinesia (PCD) is a rare genetic disease that produces functional and structural de fects in the cilia. In Peru, no cases of this disease have been reported in the pediatric population. OBJECTIVE: To describe the clinical, radiological and ciliary ultrastructure characteristics in children with PCD, in a country with medium economic resources. CLINICAL CASE: We report 5 patients with PCD treated at the Instituto Nacional de Salud del Niño-Breña (Peru). Age range 1 to 5 years (median 3 years). Three patients were male. The most frequent clinical manifestations were chronic wet cough, rhonchi, coarse crackles, recurrent bronchial obstructive syndrome, and recurrent pneumonia. All patients had atelectasis, three had bronchiectasis, and two had dextrocardia with situs inversus. Two patients had undergone lobectomy. Other causes of recurrent pneumonias were ruled out with im munodeficiency study, chlorine test and pulmonary aspiration The electron microscopy showed ab sence of the inner arm of dynein as the most frequent pattern. All patients received treatment with antibiotics, nebulization with hypertonic saline, and respiratory physiotherapy with good adherence. CONCLUSION: In medium incomes countries, electron microscopy associated with clinical and radio logical characteristics plays an important role in the early diagnosis of this disease. This is the first Peruvian report that contributes to the casuistry and epidemiology of this rare pathology.

[Surfactant protein C dysfunction in pediatric patients: Clinical Case]. / Disfunción de la proteína surfactante C en pacientes pediátricos: Caso Clínico.

Pulmonary surfactant dysfunction disorders are caused by genetic defects that alter pulmonary surfactant metabolism. They are rare disorders and cause significant morbidity and mortality in the neonatal and pediatric populations. OBJECTIVE: To describe the clinical, histopathological, and ultrastructural findings of the lamellar body that suggest surfactant protein C (SP-C) dysfunction, where confirmatory genetic studies are not available. CLINICAL CASE: We report three pediatric cases of pul monary surfactant dysfunction disorders from a pediatric hospital in Peru. Video-assisted lung biop sy was performed in all cases. Ultrastructural studies of the lamellar body were compatible with type- C pulmonary surfactant dysfunction. The treatment used was methylprednisolone pulses monthly for six months, then every two months, varying the duration according to the clinical evolution. They also received daily hydroxychloroquine and azithromycin three times a week. Clinical evaluations, eye fundus, echocardiogram, electrocardiogram, and biochemistry were performed periodically. At follow-up, there was a good response to treatment and no adverse effects were observed. One case died despite the therapies received. CONCLUSIONS: In 3 patients with type-C surfactant dysfunction, treatment with corticosteroids, hydroxychloroquine, and azithromycin was successful in 2 of them. This is one of the first case series reported in Peru that contributes to the study of these diseases, es pecially in low- and medium-income countries.