[Usefulness of test strips for early diagnosis of spontaneous bacterial peritonitis in cirrhotic patients with ascites]. / Utilidad de las tiras reactivas para el diagnóstico temprano de peritonitis bacteriana espontánea en pacientes cirróticos con ascitis.

INTRODUCTION: Spontaneous bacterial peritonitis requires an early diagnosis to start antibiotic therapy. The ideal diagnostic study is the cytochemical of ascites fluid, which can be expensive, delayed and of limited availability in primary health care centers. OBJECTIVE: Evaluate the usefulness and diagnostic accuracy of Multistix 10SG test strips for the diagnosis of spontaneous bacterial peritonitis in cirrhotic patients with ascites. MATERIALS AND METHODS: Observational descriptive study of diagnostic test in cirrhotic patients with ascites. The leukocyte count of ascites fluid was determined by the colorimetric scale of the Multistix 10SG test strip and compared with the gold standard for diagnosis (polymorphonuclear ≥ 250 cells / mm³). RESULTS: Of 174 patients with ascites (51.7% women, average age 59 years) 30 were diagnosed with spontaneous bacterial peritonitis. With a grade ++ cut-off point, the test strip had sensitivity 73.3%, specificity 96.5%, positive predictive value 81.4%, negative predictive value 94.5%, positive likelihood ratio 21.2 and negative likelihood ratio of 0.27. CONCLUSIONS: The test strips have adequate specificity and negative predictive value, being a low cost tool, simple use, quick interpretation and easy access, to support the decision not to start an antibiotic in patients with ascites and suspected spontaneous bacterial peritonitis. Due to their low sensitivity they do not replace the cytochemical study as the test of choice for the definitive diagnosis, but it is useful for optimizing the initial approach of these patients.

[Bronchobiliary fistula. Report of a case]. / Fístula biliopleurobronquial: reporte de un caso.

Bronchobiliary fistula (BBF) is an abnormal communication between the biliary tract and the bronchial tree. Is an infrequent condition, usually secondary to a local infectious process or a traumatic event. Bilioptisis is pathognomonic. We present the case of a 37 year old woman with secondary biliary cirrhosis, in list for liver transplantation, with several episodes of cholangitis and carrier of external biliary diverivation, who presented bilioptisis and HIDA scintigraphy with SPECT confirmed BBF. This case was resolved with percutaneous derivation of the biliary tract.

Magnetic Biochar Obtained by Chemical Coprecipitation and Pyrolysis of Corn Cob Residues: Characterization and Methylene Blue Adsorption.

Biochar is a carbonaceous and porous material with limited adsorption capacity, which increases by modifying its surface. Many of the biochars modified with magnetic nanoparticles reported previously were obtained in two steps: first, the biomass was pyrolyzed, and then the modification was performed. In this research, a biochar with Fe3O4 particles was obtained during the pyrolysis process. Corn cob residues were used to obtain the biochar (i.e., BCM) and the magnetic one (i.e., BCMFe). The BCMFe biochar was synthesized by a chemical coprecipitation technique prior to the pyrolysis process. The biochars obtained were characterized to determine their physicochemical, surface, and structural properties. The characterization revealed a porous surface with a 1013.52 m2/g area for BCM and 903.67 m2/g for BCMFe. The pores were uniformly distributed, as observed in SEM images. BCMFe showed Fe3O4 particles on the surface with a spherical shape and a uniform distribution. According to FTIR analysis, the functional groups formed on the surface were aliphatic and carbonyl functional groups. Ash content in the biochar was 4.0% in BCM and 8.0% in BCMFe; the difference corresponded to the presence of inorganic elements. The TGA showed that BCM lost 93.8 wt% while BCMFe was more thermally stable due to the inorganic species on the biochar surface, with a weight loss of 78.6%. Both biochars were tested as adsorbent materials for methylene blue. BCM and BCMFe obtained a maximum adsorption capacity (qm) of 23.17 mg/g and 39.66 mg/g, respectively. The obtained biochars are promising materials for the efficient removal of organic pollutants.

Exposure to Atmospheric Ozone Disruption and Altitude Over 3500 m.a.s.l. are Associated with a Higher Prevalence of Photodermatoses in Pediatric Population of High-Altitude in Peru.

Objective: To determine if exposure to atmospheric ozone disruption and other factors are associated with photodermatoses in the high-altitude pediatric population in Peru. Materials and Methods: A cross-sectional study based on data obtained from studies of dermatological diseases among the population exposed to mine tailings in Peru which included children under the age of 18 in 6 population centers located over 2500 meters above sea level (m.a.s.l). We evaluated the presence of photodermatoses and possible associated factors obtaining the adjusted odds ratio (aOR) and confidence intervals (CI). Results: 594 children below the age of 18 participated in this study, 53.0% girls, the average age was 10.4 ± 4.1 years. 51.3% were exposed to a mini hole in the ozone layer, 60.1% resided at an altitude over 3500 m.a.s.l and 51.9% presented cutaneous manifestations of atopy upon physical examination. The prevalence of photodermatoses was 64.8%, of which the most frequent were actinic prurigo (49.3%), pityriasis alba (18.5%) and actinic cheilitis (4.4%). The multivariate analysis found that residing in a region exposed to the mini hole in the ozone layer (aOR = 4.23; CI 95%: 2.32-7.72) and residing at an altitude over 3500 m.a.s.l (aOR = 2.76; CI 95%: 1.57-4.86) were both independent associated factors to photodermatoses. Conclusion: A high prevalence of photodermatoses exists among the pediatric population living at high-altitude in Peru. Residing in a region exposed to a mini hole in the ozone layer and residing over 3500 m.a.s.l constituted associated factors.

Surface modification of activated carbon cloth with calcium silicate and hydroxyapatite: bioactive composite material.

In this study new compounds consisting of activated carbon cloths (ACC) modified with calcium silicate (CaSiO3) were prepared for hydroxyapatite (HAP) generation. ACC samples were oxidized with 8 M HNO3 at different times (15 min and 2 h), to increase oxygenated functional groups. The CaSiO3 fine powders were prepared by chemical coprecipitation using Ca(NO3)2∙4H2O and Si(OC2H5)4, and 5 M NaOH was used as precipitant. The resulting powders were mixed with ethanol by ultrasound stirring and the previously oxidized activated carbon fibers were placed leaving under stirring for 30 min to allow particle dispersion. Once the formed compounds were dried, the samples were immersed in a simulated body fluid (SBF) solution for 21 days in conical tubes at 36.5 °C to allow the HAP formation on the ACC/CaSiO3 composite surface. The results indicated that the increase in oxidation time improves HAP formation on the surface from ACC/CaSiO3 compounds and this bioactive composite may be a potential material for bone regeneration.

A Brain-Permeable Aminosterol Regulates Cell Membranes to Mitigate the Toxicity of Diverse Pore-Forming Agents.

The molecular composition of the plasma membrane plays a key role in mediating the susceptibility of cells to perturbations induced by toxic molecules. The pharmacological regulation of the properties of the cell membrane has therefore the potential to enhance cellular resilience to a wide variety of chemical and biological compounds. In this study, we investigate the ability of claramine, a blood-brain barrier permeable small molecule in the aminosterol class, to neutralize the toxicity of acute biological threat agents, including melittin from honeybee venom and α-hemolysin from Staphylococcus aureus. Our results show that claramine neutralizes the toxicity of these pore-forming agents by preventing their interactions with cell membranes without perturbing their structures in a detectable manner. We thus demonstrate that the exogenous administration of an aminosterol can tune the properties of lipid membranes and protect cells from diverse biotoxins, including not just misfolded protein oligomers as previously shown but also biological protein-based toxins. Our results indicate that the investigation of regulators of the physicochemical properties of cell membranes offers novel opportunities to develop countermeasures against an extensive set of cytotoxic effects associated with cell membrane disruption.

New Advances in the Determination of Free and Bound Phenolic Compounds of Banana Passion Fruit Pulp (Passiflora tripartita, var. Mollissima (Kunth) L.H. Bailey) and Their In Vitro Antioxidant and Hypoglycemic Capacities.

Banana passion fruit (Passiflora tripartite L.H. Bailey) is a lesser known species of the genus Passiflora. This fruit typically grows in the Andean region of Ecuador and it is locally known as tumbo, taxo or curuba. The juice of this fruit is highly appreciated in South America. Extracts of banana passion fruit were characterized for their content levels of free and bound phenolic compounds by high performance liquid chromatography coupled to high resolution mass spectrometry detector (HPLC-ESI-TOF-MS). A total of 82 polar compounds classified as phenolic acid derivatives, organic acids, benzophenones, flavan-3-ols, flavonols and flavones were detected in the extracts. The total phenolic content was 2356 mg 100 g-1 dry matter, with the bound phenolic fraction representing 37.7% of total amounts. Flavan-3-ols, such as (epi)catechin, (epi)azfelechin and their derivatives, were the main phenolic compounds in the free phenolic fraction; however, phenolic acids represented the most abundant class of bound phenolic extracts. The antioxidant and hypoglycemic capacities reported for banana passion fruit were higher than for other fruits. To our knowledge, this is the first time that bound phenolic compounds have been described in banana passion fruit pulp.

Utilidad de las tiras reactivas para el diagnóstico temprano de peritonitis bacteriana espontánea en pacientes cirróticos con ascitis / Usefulness of test strips for early diagnosis of spontaneous bacterial peritonitis in cirrhotic patients with ascites

Introducción: La peritonitis bacteriana espontánea requiere un diagnóstico temprano para el inicio de antibioticoterapia. El estudio diagnóstico ideal es el citoquímico del líquido ascítico, el cual puede ser costoso, demorado y de disponibilidad limitada en centros primarios de atención en salud. Objetivo: Evaluar la utilidad y precisión diagnóstica de las tiras reactivas Multistix 10SG para el diagnóstico de peritonitis bacteriana espontánea en pacientes cirróticos con ascitis. Materiales y métodos: Estudio observacional descriptivo de prueba diagnóstica en pacientes cirróticos con ascitis. Se determinó el conteo de leucocitos del líquido ascítico por la escala colorimétrica de la tira reactiva Multistix 10SG y se comparó con el gold standard para el diagnóstico (polimorfonucleares ≥ 250 células/mm³). Resultados: De 174 pacientes con ascitis (51,7% mujeres, promedio de edad 59 años) 30 fueron diagnosticados con peritonitis bacteriana espontánea. Con un punto de corte grado ++, la tira reactiva tuvo sensibilidad 73,3%, especificidad 96,5%, valor predictivo positivo 81,4%, valor predictivo negativo 94,5%, razón de probabilidad positiva 21,2 y razón de probabilidad negativa 0,27. Conclusiones: Las tiras reactivas tienen adecuada especificidad y valor predictivo negativo, siendo una herramienta de bajo costo, uso sencillo, rápida interpretación y fácil acceso, para apoyar la decisión de no iniciar antibiótico en pacientes con ascitis y sospecha de peritonitis bacteriana espontánea. Por su baja sensibilidad no reemplazan al estudio citoquímico como prueba de elección para el diagnóstico definitivo, pero si es útil para optimizar el abordaje inicial de estos pacientes.

Introduction: Spontaneous bacterial peritonitis requires an early diagnosis to start antibiotic therapy. The ideal diagnostic study is the cytochemical of ascites fluid, which can be expensive, delayed and of limited availability in primary health care centers. Objective: Evaluate the usefulness and diagnostic accuracy of Multistix 10SG test strips for the diagnosis of spontaneous bacterial peritonitis in cirrhotic patients with ascites. Materials and methods: Observational descriptive study of diagnostic test in cirrhotic patients with ascites. The leukocyte count of ascites fluid was determined by the colorimetric scale of the Multistix 10SG test strip and compared with the gold standard for diagnosis (polymorphonuclear ≥ 250 cells / mm³). Results: Of 174 patients with ascites (51.7% women, average age 59 years) 30 were diagnosed with spontaneous bacterial peritonitis. With a grade ++ cut-off point, the test strip had sensitivity 73.3%, specificity 96.5%, positive predictive value 81.4%, negative predictive value 94.5%, positive likelihood ratio 21.2 and negative likelihood ratio of 0.27. Conclusions: The test strips have adequate specificity and negative predictive value, being a low cost tool, simple use, quick interpretation and easy access, to support the decision not to start an antibiotic in patients with ascites and suspected spontaneous bacterial peritonitis. Due to their low sensitivity they do not replace the cytochemical study as the test of choice for the definitive diagnosis, but it is useful for optimizing the initial approach of these patients.

Guidance on the use of handheld survey meters for radiological triage: time-dependent detector count rates corresponding to 50, 250, and 500 mSV effective dose for adult males and adult females.

In June 2006, the Radiation Studies Branch of the Centers for Disease Control and Prevention held a workshop to explore rapid methods of facilitating radiological triage of large numbers of potentially contaminated individuals following detonation of a radiological dispersal device. Two options were discussed. The first was the use of traditional gamma cameras in nuclear medicine departments operated as makeshift wholebody counters. Guidance on this approach is currently available from the CDC. This approach would be feasible if a manageable number of individuals were involved, transportation to the relevant hospitals was quickly provided, and the medical staff at each facility had been previously trained in this non-traditional use of their radiopharmaceutical imaging devices. If, however,substantially larger numbers of individuals (100's to 1,000's) needed radiological screening, other options must be given to first responders, first receivers, and health physicists providing medical management. In this study, the second option of the workshop was investigated--the use of commercially available portable survey meters (either NaI or GM based) for assessing potential ranges of effective dose (< 50, 50-250, 250-500,and >500 mSv). Two hybrid computational phantoms were used to model an adult male and an adult female subject internally contaminated with 241Am, 60Cs, 137Cs, 131I, or 192Ir following an acute inhalation or ingestion intake. As a function of time following the exposure, the net count rates corresponding to committed effective doses of 50, 250, and 500 mSv were estimated via Monte Carlo radiation transport simulation for each of four different detector types, positions, and screening distances.Measured net count rates can be compared to these values, and an assignment of one of four possible effective dose ranges could be made. The method implicitly assumes that all external contamination has been removed prior to screening and that the measurements be conducted in a low background, and possibly mobile, facility positioned at the triage location. Net count rate data are provided in both tabular and graphical format within a series of eight handbooks available at the CDC website (http://www.bt.cdc.gov/radiation/clinicians/evaluation).

Hybrid computational phantoms representing the reference adult male and adult female: construction and applications for retrospective dosimetry.

Currently, two classes of computational phantoms have been developed for dosimetry calculation: (1) stylized (or mathematical) and (2) voxel (or tomographic) phantoms describing human anatomy through mathematical surface equations and 3D voxel matrices, respectively. Mathematical surface equations in stylized phantoms are flexible, but the resulting anatomy is not as realistic. Voxel phantoms display far better anatomical realism, but they are limited in terms of their ability to alter organ shape, position, and depth, as well as body posture. A new class of computational phantoms called hybrid phantoms takes advantage of the best features of stylized and voxel phantoms-flexibility and anatomical realism, respectively. In the current study, hybrid computational phantoms representing the adult male and female reference anatomy and anthropometry are presented. These phantoms serve as the starting framework for creating patient or worker sculpted whole-body phantoms for retrospective dose reconstruction. Contours of major organs and tissues were converted or segmented from computed tomography images of a 36-y-old Korean volunteer and a 25-y-old U.S. female patient, respectively, with supplemental high-resolution CT images of the cranium. Polygon mesh models for the major organs and tissues were reconstructed and imported into Rhinoceros™ for non-uniform rational B-spline (NURBS) surface modeling. The resulting NURBS/polygon mesh models representing body contour and internal anatomy were matched to anthropometric data and reference organ mass data provided by Centers for Disease Control and Prevention and International Commission on Radiation Protection, respectively. Finally, two hybrid adult male and female phantoms were completed where a total of eight anthropometric data categories were matched to standard values within 4% and organ volumes matched to ICRP data within 1% with the exception of total skin. The hybrid phantoms were voxelized from the NURBS phantoms at resolutions of 0.158 × 0.158 × 0.158 cm and 0.126 × 0.126 × 0.126 cm for the male and female, respectively. To highlight the flexibility of the hybrid phantoms, graphical displays are given of (1) underweight and overweight adult male phantoms, (2) a sitting position for the adult female phantom, and (3) extraction and higher-resolution voxelization of the small intestine for localized dosimetry of mucosal and stem cell layers. These phantoms are used to model radioactively contaminated individuals and to then assess time-dependent detector count rate thresholds corresponding to 50, 250, and 500 mSv effective dose, as might be needed during in-field radiological triage by first responders or first receivers.

Fístula biliopleurobronquial: reporte de un caso / Bronchobiliary fistula: Report of a case

La fístula biliopleurobronquial (FBB) es una comunicación anormal entre la vía biliar y el árbol bronquial. Es una condición infrecuente, generalmente secundaria a un proceso infeccioso local o a un evento traumático. La bilioptisis es patognomónica. Presentamos el caso de una mujer de 37 años con historia de cirrosis biliar secundaria, en lista para trasplante hepático, con múltiples episodios de colangitis previos y usuaria de derivación biliar externa, quien curso con bilioptisis y mediante gammagrafía HIDA con SPECT se confirmó fistula biliopleurobronquial. Éste caso se resolvió con derivación percutánea de la vía biliar

Bronchobiliary fistula (BBF) is an abnormal communication between the biliary tract and the bronchial tree. Is an infrequent condition, usually secondary to a local infectious process or a traumatic event. Bilioptisis is pathognomonic. We present the case of a 37 year old woman with secondary biliary cirrhosis, in list for liver transplantation, with several episodes of cholangitis and carrier of external biliary diverivation, who presented bilioptisis and HIDA scintigraphy with SPECT confirmed BBF. This case was resolved with percutaneous derivation of the biliary tract

The UF family of reference hybrid phantoms for computational radiation dosimetry.

Computational human phantoms are computer models used to obtain dose distributions within the human body exposed to internal or external radiation sources. In addition, they are increasingly used to develop detector efficiencies for in vivo whole-body counters. Two classes of computational human phantoms have been widely utilized for dosimetry calculation: stylized and voxel phantoms that describe human anatomy through mathematical surface equations and 3D voxel matrices, respectively. Stylized phantoms are flexible in that changes to organ position and shape are possible given avoidance of region overlap, while voxel phantoms are typically fixed to a given patient anatomy, yet can be proportionally scaled to match individuals of larger or smaller stature, but of equivalent organ anatomy. Voxel phantoms provide much better anatomical realism as compared to stylized phantoms which are intrinsically limited by mathematical surface equations. To address the drawbacks of these phantoms, hybrid phantoms based on non-uniform rational B-spline (NURBS) surfaces have been introduced wherein anthropomorphic flexibility and anatomic realism are both preserved. Researchers at the University of Florida have introduced a series of hybrid phantoms representing the ICRP Publication 89 reference newborn, 15 year, and adult male and female. In this study, six additional phantoms are added to the UF family of hybrid phantoms-those of the reference 1 year, 5 year and 10 year child. Head and torso CT images of patients whose ages were close to the targeted ages were obtained under approved protocols. Major organs and tissues were segmented from these images using an image processing software, 3D-DOCTOR. NURBS and polygon mesh surfaces were then used to model individual organs and tissues after importing the segmented organ models to the 3D NURBS modeling software, Rhinoceros. The phantoms were matched to four reference datasets: (1) standard anthropometric data, (2) reference organ masses from ICRP Publication 89, (3) reference elemental compositions provided in ICRP 89 as well as ICRU Report 46, and (4) reference data on the alimentary tract organs given in ICRP Publications 89 and 100. Various adjustments and refinements to the organ systems of the previously described newborn, 15 year and adult phantoms are also presented. The UF series of hybrid phantoms retain the non-uniform scalability of stylized phantoms while maintaining the anatomical realism of patient-specific voxel phantoms with respect to organ shape, depth and inter-organ distance. While the final versions of these phantoms are in a voxelized format for radiation transport simulation, their primary format is given as NURBS and polygon mesh surfaces, thus permitting one to sculpt non-reference phantoms using the reference phantoms as an anatomic template.

Skin diseases in the Peruvian Amazonia.

BACKGROUND: Dermatologic diseases vary widely as a result of geographic location and may be influenced by environmental factors. Aim To determine the epidemiology of dermatological diseases in the Peruvian Amazonia. METHODS: Transversal and multicentric study, which were carried out during February of 2006, 2007, and 2008 in three regional hospitals in the Peruvian Amazonia. All new patients who were looking for dermatological consultation were included. Univariate/bivariate analysis, chi square, and multinomial logistic regression were used with a confidence level of 95%. RESULTS: A total of 1602 patients were included. The infectious and parasitic dermatoses were the most prevalent (31.5%). There was a statistically significant association between infections of the skin and subcutaneous tissue in children (P < 0.001). The parasitic dermatoses such as scabiosis, pediculosis, and myiasis were associated with an altitude less than 700 meters above sea level (m.a.s.l.) (P = 0.003, OR = 3.1, CI: 1.5-6.7). On the other hand, radiation-related disorders of the skin and subcutaneous tissue were associated with more than 700 m.a.s.l. (P < 0.01, OR = 2.9, CI: 1.7-4.9). CONCLUSIONS: Infectious dermatological diseases were the most common diagnoses in the Peruvian Amazonia. In addition, radiation-related disorders of the skin should be addressed for people living/traveling in the rainforest area. These findings may assist in the training of general doctors in diagnosis and treatment of the most common dermatoses in tropical areas. Moreover, this study would be helpful for physicians from developed countries when giving medical advice/attention to travelers or immigrants of tropical areas.

Antibodies against desmoglein 1 in healthy subjects in endemic and nonendemic areas of pemphigus foliaceus (fogo selvagem) in Peru.

BACKGROUND: Endemic pemphigus foliaceus or fogo selvagem is an autoimmune skin disease characterized by the presence of subcorneal superficial blisters and antibodies of the immunoglobulin G4 (IgG4) class specific for the desmosomal glycoprotein, desmoglein 1. In Peru, no studies have been published on the seroprevalence of antibodies against desmoglein 1 in healthy subjects from endemic foci. SUBJECTS AND METHODS: This was a cross-sectional study. The sample included 82 healthy subjects, 41 from the Pueblo Libre community, a focus of endemic pemphigus foliaceus, and 41 from a nonendemic urban area in Pucallpa City. Enzyme-linked immunosorbent assay (ELISA) was used to determine the presence of antibodies against desmoglein 1. Samples were processed and tested at the Department of Dermatology and Cutaneous Surgery, School of Medicine, University of Miami, Miami, Florida. RESULTS: It was found that 31.7% of healthy individuals (13 subjects) from the endemic focus had anti-desmoglein 1 antibodies. A statistically significant association was found between the distance from the endemic focus and the presence of antibodies against desmoglein 1 in subjects living within the endemic focus [Mantel-Haenszel odds ratio (OR), 3.34; P = 0.03; 95% confidence interval (CI), 1.06-10.48]. Agriculture as an occupation showed a statistically significant association with the presence of antibodies against desmoglein 1 (Mantel-Haenszel OR, 7.84; P < 0.001; 95% CI, 2.47-24.87). CONCLUSIONS: Antibodies against desmoglein 1 are present in healthy subjects exposed to an endemic focus of pemphigus foliaceus (fogo selvagem). Agriculture is associated with a high risk of development of antibodies against desmoglein 1 in the endemic focus of the Pueblo Libre community.

HIV prevention programs of nongovernmental organizations in Latin America and the Caribbean: the Global AIDS Intervention Network project.

OBJECTIVE: The objective of this paper is to describe HIV prevention programs conducted by nongovernmental organizations (NGO) that are meeting this challenge. METHODS: One NGO undertaking HIV prevention programs was evaluated in each of the 23 countries participating in the Global AIDS Intervention Network (GAIN) Project throughout Latin America and the Caribbean. A two-stage selection process was used: (1) a search in databases and other information sources; (2) identification of NGOs that were best established and most actively engaged in HIV prevention activity. Executive directors were questioned about staffing, budget issues, populations served and barriers faced by these entities. RESULTS: The 23 NGOs conducted 58 direct-service programs and had been conducting HIV prevention activities for a mean of 8 years (SD=4.45; range 1-18 years). Average annual program budget was US $205,393 (range: US $10,000 to US $1,440,000). The NGOs reported a mean of 4.5 full-time employees (range 0-15, SD=4.7). Many relied on volunteers (median=10, mean=51, range 0-700, SD=150) to conduct HIV prevention activities. The NGOs provided prevention services for the general community (82.6%), children and adolescents (34.8%) and men who have sex with men (30.4%). Activities conducted by NGOs included train-the-trainer activities (43.5%) and face-to-face prevention activities (34.8%). Obstacles cited included lack of funding (60.9%) and HIV-related stigma and discrimination (56.5%). CONCLUSION: The strategies used by NGOs to overcome barriers to prevention are a testament to their ingenuity and commitment, and serve as examples for NGOs in other world regions.

Pénfigo foliáceo endémico en tres regiones de la amazonía peruana: enero-diciembre 2004 / Endemic Pemphigus foliaceus in three regions of Peruvian Amazonia: January-December 2004

OBJETIVO: Determinar las características epidemiológicas y clínicas del pénfigo foliáceo endémico(PFE) en tres regiones de la Amazonía Peruana durante el año 2004. MATERIAL Y MÉTODOS: Estudio descriptivo, prospectivo y observacional realizado en tres regiones de la amazonía peruana. Los pacientes con PFE fueron captados en el Hospital de Apoyo de Chachapoyas (Amazonas), Hospital Hermilio Valdizán Medrano (Huánuco), Posta Médica EsSalud Santa Lucía-Uchiza (San Martín), en los centros de salud de cada departamento y mediante búsqueda activa durante Enero y Diciembre del año 2004. El diagnóstico se realizó en base a los criterios epidemiológico, clínico, histopatológico e inmunológico. RESULTADOS: Se captó un total de 10 casos de PFE en los departamentos de Amazonas, Huánuco y San Martín. Se determinó áreas endémicas de PFE en Tingo María, Tournavista y La Unión (Huánuco), Moyobamba (San Martín), Tuemal y Bagua (Amazonas). La mayor frecuencia de pacientes fueron de sexo masculino, menores de 40 años, de forma clínica generalizada con régimen de tratamiento irregular. Se detectó casos en Moyobamba y Tuemal a una altitud de 886 y 1172 msnm respectivamente, con características clínicas similares a la de los casos detectados a altitudes inferiores a 800 msnm. CONCLUSIÓN: De las regiones estudiadas, Huánuco es la que presenta mayor frecuencia de pacientes con PFE mientras que en San Martín y Amazonas la frecuencia es marcadamente inferior. Existen casos de PFE en San Martín y Amazonas a altitudes superiores a los 800 msnm.

OBJECTIVE: To determine clinical and epidemiological characteristics of Endemic Pemphigus Foliaceus (EPF) in three regions of Peruvian Amazon during 2004. MATERIAL AND METHODS: Descriptive, prospective and observational study realized in three regions of Peruvian Amazonia. Patients with EPF were enrolled in Chachapoyas Hospital (Amazonas), Hermilio Valdizan Medrano Hospital (Huanuco), Santa Lucia-Uchiza Essalud Health Station (San Martin), in Health Centers of each department and through active search during January and December of 2004. The diagnosis was realized based to clinical epidemiologic, histopathologic and immunologic features. RESULTS: It was enrolled a total of 10 cases with EPF in departments of Amazonas, Huanuco and San Martin. It was determined endemic areas of EPF in Tingo Maria, Tournavista and La Union (Huanuco), Moyobamba (San Martin), Tuemal and Bagua (Amazonas). The major frequency of patients was male, under of 40 years, generalized clinical form with regimen of irregular treatment. It was detected cases in Moyobamba and Tuemal at a height of 886 and 1172 masl respectively, with clinical characteristics similar to the cases detected at heights under 800 masl. CONCLUSION: Huanuco is area which present major frequency of patients with EPF, while in San Martin and Amazonas, the frequency is extremely lower. There are cases of EPF in San Martin and Amazonas at heights above 800 masl.

Inmunopatología de sujetos sanos de un área endémica para pénfigo foliáceo en Perú: Estudio comparativo con familiares / Immunopathologic characterization of healthy subjects in an endemic area for pemphigus foliaceus: Comparative study with relatives.

Introducción: el pénfigo foliáceo endémico (PFE) ha sido descrito a principios de los años 50 en la selva peruana. En el 2006, Ortega y col. reportaron la presencia de anticuerpos anti-desmogleina 1 en Pueblo Libre, Ucayali. Sin embargo, no existen reportes inmunológicos sobre los familiares de pacientes con PFE en la zona. Objetivos: comparar las características inmunopatológicas de los sujetos sanos de Pueblo Libre (Campo Verde-Ucayali) endémico para pénfigo foliáceo, con familiares sanos de pacientes con PFE y controles sanos de áreas no endémicas. Material y métodos: estudio prospectivo y multicéntrico realizado de junio a agosto del 2006 que incluyó a 41 sujetos sanos de la comunidad de Pueblo Libre, 11 familiares de pacientes con PFE y 20 sujetos sanos de áreas no endémicas de la enfermedad de los que se obtuvo muestras de sangre para la realización del estudio inmunopatológico (ELISA para anticuerpos anti desmogleína 1 y anti desmogleína 3) comparándose las características de cada grupo de investigación. Para fijar los valores de corte se realizó la estandarización del ELISA usando el análisis de características operativas del receptor (ROC). Resultados: en Pueblo Libre se encontró una prevalencia de anticuerpos anti desmogleína 1 de 46,3%. El patrón predominante fue el IgG2 (62,5%) y el IgG1 (56,3%). En el 31,7% se detectó anticuerpos anti-desmogleína 3. Existió alta correlación entre los valores índice de anticuerpos anti desmogleína 1 y anti desmogleína 3 (r=0,76), significativa a un nivel α=0,01. Para los familiares de los pacientes con PFE, el 45,5% fueron positivos para anticuerpos anti-desmogleνna 1 con un patrσn predominante IgG1 (63,6%) e IgG2 (54,5%). Se detectó anticuerpos anti-desmogleína 1 en el 10 % de sujetos sanos de áreas no endémicas; no se detectó anticuerpos anti desmogleína 3 en este grupo. Conclusiones: las personas sanas expuestas a factores ambientales de los focos endémicos de PFE y los familiares de pacientes desarrollan anticuerpos no patogénicos anti desmogleína 1 y 3 con características inmunopatológicas similares.

Introduction: endemic pemphigus foliaceus (PFE) has been described at the beginning of the 50s in the peruvian forest. In 2006,Ortega & col. reported the presence of desmoglein 1 antibodies in Pueblo Libre, Ucayali. Nevertheless, immune reports does not exist on patients’ relatives with PFE in the zone. Objetives: to compare the immunopathologic profiles of healthy subjects from Pueblo Libre (an area in Ucayali, endemic for pemphigus foliaceus), with healthy relatives of patients with endemic pemphigus foliaceus (EPF) and healthy controls from non-endemic areas. Materials and methods: this is a prospective multicentric study performed from June to August 2006. The sample consisted of 41 healthy subjects from the Pueblo Libre community, 11 relatives of EPF patients and 20 healthy subjects from non-endemic areas. Blood samples were obtained for immunopathologic studies (ELISA technique for antibodies against desmoglein-1 and desmoglein- 3). The immunopathologic profiles of each group were compared. Standardization of ELISA was performed using the analysis of receptor operative characteristics (ROC) to find appropriate cut-off values. Results: in Pueblo Libre, the prevalence of antibodies against desmoglein-1 was 46,3%. The predominant pattern was 56,3% for IgG1 and 62,5% for IgG2. Antibodies against desmoglein-3 were found in 31,7% of the sample. A high correlation was found between the index values of antibodies against desmoglein-1 and desmoglein-3. (r=0.76); this is statistically significant, with an alpha = 0,001. The frequency of antibodies against desmoglein-1 was 45,5% in the relatives of EPF patients; the predominant pattern was 63,6% for IgG1 and 54,5% for IgG2. Antibodies against desmoglein-1 were detected in two healthy subjects from non-endemic areas; antibodies against desmoglein-3 were not detected. Conclusion: healthy subjects who are exposed to environmental factors in a focus of endemic pemphigus foliaceus and the relatives of patients with EPF develop non-pathogenic antibodies against desmoglein-1 and -3 with similar immunologic profiles.

Queratosis arsenical en pobladores expuestos a relaves mineros en altura en San Mateo de Huanchor: ¿sinergismo entre arsenicismo y daño actínico crónico? / Arsenical keratosis in a population exposed to mining tailings at high altitude in San Mateo de Huanchor: synergism between arsenicalism and chronic actibic damage?

Objetivo: Determinar la prevalencia de queratosis arsenical en una población de altura (3290 msnm) expuesta a relaves mineros con arsénico y que posean daño actínico crónico. Material y Métodos: Estudio descriptivo, transversal de tipo exploratorio. De Octubre del 2003 a enero 2004, se evaluó pobladores expuestos a relaves mineros del distrito de San Mateo de Huanchor (3290 msnm, Huarochirí, Lima) mediante una visita domiciliaria . A los pacientes con diagnóstico clínico de queratosis arsenical se les realizó biopsia de piel, examen histológico de las lesiones (coloración hematoxilina-eosina) y dosaje de arsénico en orina de 24 horas. Resultados: Se encontró 8 casos de queratosis arsenical en una población de 119 personas expuestas a relaves mineros con daño actínico crónico (tasa de prevalencia de 6,7 casos por 100 habitantes). La edad promedio de los pacientes fue 38,63 más menos 25,90 años y 75 por ciento de casos fueron de sexo masculino. La distribución de las lesiones de queratosis fue en palmas de manos, 3 pobladores; plantas de pie, 2; tórax, 1; muslos, 1; palmoplantar, 1. El 87,5 por ciento presentó multiplicidad de lesiones. El 100 por ciento de los pacientes mostró en el examen histológico hallazgos compatibles con queratosis arsenical. En relación al daño actínico crónico, 100 por ciento de casos presentó dermatitis actínica en región facial; 62,5 por ciento queratosis actínica, y 25 por ciento queilitis actínica. Conclusiones: La queratosis arsenical es una patología frecuente en pobladores del distrito de San Mateo de Huanchor expuestos a relaves mineros en altura. El daño actínico crónico podría tener un efecto sinérgico para el desarrollo de cáncer de piel en las lesiones arsenicales.

Pénfigo foliáceo endémico y pénfigo vulgar en pacientes de edad pediátrica en Ucayali / Pemphigus foliaceus endemicus and pemphigus vulgaris in paediatric patients in Ucayali

Objetivo: Describir las características clínicas y epidemiológicas de pacientes con pénfigo en edad pediátrica en Ucayali, Perú. Métodos: Estudio transversal en el departamento de Ucayali (Perú) entre diciembre del 2002 y noviembre del 2003. La población estuvo constituida por pacientes menores de 16 años de edad con diagnóstico de pénfigo foliáceo endémico (PFE) y pénfigo vulgar (PV), captados en el Hospital Regional de Pucallpa mediante búsqueda activa en las comunidades de Vista Alegre y la comunidad nativa de San Francisco. Se incluyó en el estudio a todo paciente pediátrico que presentó lesiones ampollares, costrosas y/o el signo de Nikolsky. Resultados: Se reclutó un total de 12 casos, 3 con PV y 9 con PFE (fogo selvagem) en pacientes en edad pediátrica. La edad promedio de los pacientes con PFE fue 9,3 años y 11,6 años para PV. En ambos casos el género más afectado fue el masculino. Los casos de PFE procedían de áreas rurales y/o comunidades nativas mientras que los pacientes con PV, el 66,6 por ciento procedía de área urbana. En todos los casos la presentación clínica correspondió a una eritrodermia exfoliativa. La respuesta terapéutica a los corticoides sistémicos fue buena. Conclusiones: El PFE constituye el tipo de pénfigo más frecuente en pacientes pediátricos del departamento de Ucayali, el sexo masculino es el predominante, el grupo etario más afectado está entre los 11 y 15 años. El pénfigo en edad pediátrica responde adecuadamente a la corticoterapia sistémica.

Infección cutánea por citomegalovirus en relación con el mecanismo patogénico del vitíligo generalizado de inicio reciente / Cytomegalovirus skin infection in relation with the initial pathogenic mechanism of early generalized Vitiligo

OBJETIVO: Demostrar la asociación de la infección cutánea por citomegalovirus en pacientes con vitíligo generalizado de inicio reciente. MATERIAL Y METODOS: Estudio de casos y controles realizado de marzo a diciembre del 2003. Se conformaron dos grupos para la investigación: un grupo de 30 pacientes con diagnóstico de vitíligo generalizado de inicio reciente y otro grupo control conformado por 30 sujetos sanos. De todos los pacientes se obtuvo muestras de piel a las que se realizó Reacción en Cadena de la Polimerasa para genoma de citomegalovirus y exámenes histopatológicos con tinciones hematoxilina-eosina. RESULTADOS: Se encontró que 23 pacientes con vitíligo (76.6 por ciento) fueron positivos para genoma de citomegalovirus en Reacción de Cadena de Polimerasa, mientras que sólo siete controles (23.3 por ciento) resultaron positivos. Se encontró diferencia estadística significativa para infección por citomegalovirus en los pacientes con vitíligo versus los controles con un OR = 10,7 (95 por ciento: IC 3,47 - 33,1) (p<0,001). El examen histopatológico para citomegalovirus fue negativo en el grupo de pacientes con vitíligo reciente y los controles. CONCLUSIONES: Existe asociación entre infeccion cutánea por citomegalovirus y vitíligo de inicio reciente en un grupo selecto de pacientes.