Blastoma pleuropulmonar: reporte de un caso / Pleuropulmonary blastoma: case report

El blastoma pleuropulmonar corresponde a una neoplasia primaria de pulmón, exclusiva de la edad pediátrica, poco frecuente y de características agresivas. La edad de diagnóstico varía entre 1 mes y 12 años. No se identifica una distinción de sexos. Se localiza en la pleura o el pulmón. Suele presentarse como dificultad respiratoria, con o sin neumotórax, dolor torácico y fiebre, por lo que es mal diagnosticada como neumonía. Radiológicamente, suele hallarse una masa de gran tamaño cercana a la pleura en la base pulmonar derecha sin broncograma aéreo. Cuenta con tres tipos histológicos: tipo I (quístico), tipo II (mixto), tipo III (sólido). Su tratamiento incluye resección y quimioterapia multimodal. El tipo I tiene un pronóstico favorable, pero los tipos II y III tienen mal pronóstico. Se presenta un caso de blastoma pleuropulmonar en una niña de 2 años, con énfasis en su diagnóstico clínico-radiológico.

Pleuropulmonary Blastoma corresponds to a malignant primary lung disorder, exclusive of pediatric age, infrequent and of aggressive characteristics. Age on diagnosis is 1 month-12 years. Rates per sex are equal. It can be found inside pleura or lungs. Respiratory distress associated or not with pneumothorax, chest pain and fever are classical clinical signs. These symptoms could be misdiagnosed as pneumonia. Radiologically, a large mass near the pleura at the base of the right lung without air bronchogram is its most common form. It has three histological types: type I (cystic), type II (mixed) and type III (solid). Its treatment requires tumor excision and multimodal chemotherapy. Pleuropulmonary Blastoma type I has good prognosis; type II and III variants have lower survival. We report a 2-year-old girl, pointing to the clinical-radiological diagnosis.

[Pleuropulmonary blastoma: case report]. / Blastoma pleuropulmonar: reporte de un caso.

Pleuropulmonary Blastoma corresponds to a malignant primary lung disorder, exclusive of pediatric age, infrequent and of aggressive characteristics. Age on diagnosis is 1 month-12 years. Rates per sex are equal. It can be found inside pleura or lungs. Respiratory distress associated or not with pneumothorax, chest pain and fever are classical clinical signs. These symptoms could be misdiagnosed as pneumonia. Radiologically, a large mass near the pleura at the base of the right lung without air bronchogram is its most common form. It has three histological types: type I (cystic), type II (mixed) and type III (solid). Its treatment requires tumor excision and multimodal chemotherapy. Pleuropulmonary Blastoma type I has good prognosis; type II and III variants have lower survival. We report a 2-year-old girl, pointing to the clinicalradiological diagnosis.

El blastoma pleuropulmonar corresponde a una neoplasia primaria de pulmón, exclusiva de la edad pediátrica, poco frecuente y de características agresivas. La edad de diagnóstico varía entre 1 mes y 12 años. No se identifica una distinción de sexos. Se localiza en la pleura o el pulmón. Suele presentarse como dificultad respiratoria, con o sin neumotórax, dolor torácico y fiebre, por lo que es mal diagnosticada como neumonía. Radiológicamente, suele hallarse una masa de gran tamaño cercana a la pleura en la base pulmonar derecha sin broncograma aéreo. Cuenta con tres tipos histológicos: tipo I (quístico), tipo II (mixto), tipo III (sólido). Su tratamiento incluye resección y quimioterapia multimodal. El tipo I tiene un pronóstico favorable, pero los tipos II y III tienen mal pronóstico. Se presenta un caso de blastoma pleuropulmonar en una niña de 2 años, con énfasis en su diagnóstico clínico-radiológico.

Melatonin, minocycline and ascorbic acid reduce oxidative stress and viral titers and increase survival rate in experimental Venezuelan equine encephalitis.

Venezuelan equine encephalitis (VEE) virus causes an acute central nervous system infection in human and animals. Melatonin (MLT), minocycline (MIN) and ascorbic acid (AA) have been shown to have antiviral activities in experimental infections; however, the mechanisms involved are poorly studied. Therefore, the aim of this study was to determine the effects of those compounds on the viral titers, NO production and lipid peroxidation in the brain of mice and neuroblastoma cultures infected by VEE virus. Infected mouse (10 LD50) were treated with MLT (500 µg/kg bw), MIN (50mg/kg bw) or AA (50mg/kg bw). Infected neuroblastoma cultures (MOI: 1); MLT: 0.5, 1, 5mM, MIN: 0.1, 0.2, 2 µM or AA: 25, 50, 75 µM. Brains were obtained at days 1, 3 and 5. In addition, survival rate of infected treated mice was also analyzed. Viral replication was determined by the plaque formation technique. NO and lipid peroxidation were measured by Griess׳ reaction and thiobarbituric acid assay respectively. Increased viral replication, NO production and lipid peroxidation were observed in both, infected brain and neuroblastoma cell cultures compared with uninfected controls. Those effects were diminished by the studied treatments. In addition, increased survival rate (50%) in treated infected animals compared with untreated infected mice (0%) was found. MLT, MIN and AA have an antiviral effect involving their anti-oxidant properties, and suggesting a potential use of these compounds for human VEE virus infection.

Aplicabilidad del examen clínico objetivo estructurado en la evaluación de las competencias clínicas de los internos de medicina en la rotación de pediatría, Hospital Nacional Dos de Mayo - 2006 / Applicability of the objective structured clínical examination (OSCE) in assessing clinical competence of medical interns in the pediatric rotation of the National Hospital Dos de Mayo in 2006

Objetivo: Determinar la aplicabilidad del Examen Clínico Objetivo Estructurado (ECOE) en la evaluación de las competencias clínicas de los internos de medicina en la rotación de pediatría del Hospital Nacional Dos de mayo en el año 2006. Metodología: Estudio cuasi-experimental. 77 Internos de medicina que rotaron en el servicio de pediatría del Hospital Nacional Dos de Mayo en el año 2006 fueron evaluados mediante un ECOE constituido por 11 estaciones de 7 minutos cada una, que comprendieron: 04 para evaluación del desempeño, 05 para medir el juicio clínico y 02 para resolución de problemas. El ECOE fue aplicado trimestralmente en, la evaluación sumativa de las competencias clínicas al término de cada rotación. Resultados: Con el nivel de "Competentes" calificaron: Menos del 25 por ciento de internos en las estaciones de desempeño, 50-80 por ciento en las estaciones de juicio clínico, y 41 por ciento en las estaciones para resolución de problemas. En la calificación global del ECOE el 87.3 por ciento obtuvo el nivel de "En proceso". En la encuesta realizada a los internos, el 92.3 por ciento opinó que el ECOE era un examen interesante. Conclusiones: El ECOE es una metodología aplicable para la evaluación de las competencias clínicas de los internos de medicina- en la rotación de pediatría porque ha permitido emitir juicios de valor acerca del nivel de logro de las mismas y porque es un formato ha flexible que puede ser adaptado a nuestra realidad y a las competencias clínicas que se quieran evaluar.

General Objective: To determine the applicability of the Objective Structured Clínical Examination (OSCE) in assessing clinical competence of medical interns in the pediatric rotation of the "Dos de Mayo" National Hospital in 2006. Methods: Quasi-Experimental study. 77 medical interns who rotated in the pediatric ward of the "Dos de Mayo" National Hospital in 2006, were assessed by an OSCE made up of 11 stations seven minutes each, which íncluded: 04 for performance evaluation, 05 for measuring the clínical judgment and 02 for troubleshooting. The OSCE was applíed quarterly in the summatíve evaluation of clínical skills at the end of each rotation. Results: The level of "proficient" rated: Less than 25 per cent of medical interns in the performance stations, 50-80 per cent in the clinical judgment stations, and 41 per cent at the troubleshooting stations. At the OSCE global rating, 87.3 per cent of interns achieved "In Process" level. In the survey administered to medical interns, 92.3 per cent felt that the OSCE was an interesting test. Conclusions: The OSCE is an applícable methodology for assessing the clínical competence of medical interns in pediatrics rotation because it has allowed to make value judgments about the level of achievement of these and because it is a flexible format that can be adapted to our reality and clinical competencies to be evaluated.

Bacterias enteropatógenas en la comunidad étnica añu de la Laguna de Sinamaica, Estado Zulia, Venezuela / Enteropathogenic bacteria in the añu ethnic community from Laguna de Sinamaica, Zulia State, Venezuela

Los estudios poblacionales sobre prevalencia de enteropatógenos bacterianos son escasos, particularmente en comunidades indígenas. En el presente estudio se investigó la prevalencia de bacterias enteropatógenas en muestras de materia fecal correspondientes a 378 individuos de la etnia añu, de diferente edad y género, residentes en la Laguna de Sinamaica, estado Zulia. Se realizó el cultivo bacteriológico convencional, excluyendo las categorías diarreogénicas de Escherichia coli. Se obtuvieron 71 cultivos positivos (18,8%), con predominio de las infecciones por un solo agente (58 casos, 81,7%), aunque también se detectaron asociaciones entre dos o tres especies (15,5% y 2,8%, respectivamente). En total se aislaron 86 cepas bacterianas, cuya distribución fue la siguiente: Aeromonas spp.: 34 aislamientos (39,5%), Vibrio spp.: 27 (31,4%), Shigella spp.: 11 (12,8%), Campylobacter spp.: 9 (10,5%), Plesiomonas shigelloides: 3 (3,5%) y Salmonella enterica: 2 (2,3%). V. parahaemolyticus resultó la especie predominante (15/86; 17,4%). El riesgo de infección por bacterias enteropatógenas resultó 2,6 veces superior para niños lactantes y preescolares (p < 0,01). La mayoría de los individuos participantes negó presentar sintomatología gastrointestinal. Los resultados demuestran una alta prevalencia de enteropatógenos bacterianos entre la población añu estudiada, con una distribución mayoritaria de las especies que habitualmente forman parte de la microbiota normal de las aguas.

Population studies on prevalence of enteropathogenic bacteria are few, especially in indigenous communities. In the present study we investigated the prevalence of enteropathogenic bacteria in feces samples corresponding to 378 individuals from the añu ethnic community with various ages and gender, living at the Laguna de Sinamaica, Zulia State. A conventional bacteriological culture was done, excluding Escherichia coli diarrheogenic categories. Seventy one positive cultures were obtained (18.8%) with predominance of single agent infections (58 cases, 81.7%), even though associations between two or three species were also detected (15.5% and 2.8% respectively). A total of 86 bacterial strains were isolated, with the following distribution: Aeromonas spp, 34 (39.5%) isolates; Vibrio spp, 27 (31.4%); Shigella spp, 11 (12.8%); Campylobacter spp, 9 (10.5%); Plesiomonas shigelloides, 3 (3.5); and Salmonella enterica, 2.3%). V. parahaemolyticus turned out to be the predominant species (15/86, 17.4%). The enteropathogenic bacterial infection risk was 2.6 higher for lactating and preschool children (p< 0.01). Most of the participating individuals denied presence of gastrointestinal symptoms. The results showed a high prevalence of bacterial enteropathogens in the añu population studied, with a mayor distribution of the species which habitually are part of normal water microbiology.

Experimental induction of salt-sensitive hypertension is associated with lymphocyte proliferative response to HSP70.

Renal tubulointerstitial inflammation is a constant feature of experimental models of hypertension and likely plays a role in the pathogenesis of salt-sensitive hypertension. We have previously raised the possibility that the immune cell infiltration is driven by a low grade autoimmune reactivity directed to or facilitated by renal heat shock protein over expression. The present studies were done to gain insight on possible cell-mediated immune mechanisms in experimental hypertension by determining the renal expression of HSP70 and the proliferation index of T lymphocytes cultured with HSP70. We studied male Sprague-Dawley rats with inhibition of nitric oxide (NO) synthase (n=6), protein overload (PO) proteinuria (n=7) and short-term angiotensin II (Ang II) infusion (n=5), and their corresponding control groups. Each model was associated with 2 to 4 fold increase (P<0.05-0.001) in renal HSP70 expression. T cells isolated from the spleens demonstrated a significant two- to nine-fold response compared to controls (P<0.05 or lower for each comparison) when cultured with HSP70. These studies suggest that autoimmunity to stress proteins is involved in the sustained low-grade inflammatory infiltration that occurs in the tubulointerstitial areas of the hypertensive kidney.