Paraproteinemic Keratopathy in a Patient With Previous LASIK Procedure Mimicking Lattice Corneal Dystrophy.

PURPOSE: The aim of this study was to report a unique clinical presentation of paraproteinemic keratopathy after a myopic uneventful laser in situ keratomileusis (LASIK) procedure that led to the diagnosis of gammopathy of undetermined significance. METHODS: This was an interventional case report. A 55-year-old woman present with bilateral branching opacities limited to the optical zone of myopic LASIK. The patient's medical history was unremarkable. RESULTS: After ruling out a mutation in TGF-ß1 , a systemic workup was performed, revealing an IgG level of 12.8 mg/dL, lambda-free light chain of 12.8 mg/dL, and M-spike of 0.6 g/dL. Bone marrow aspiration was slightly hypercellular, without evidence of neoplastic infiltration by plasma cells. The patient underwent 3 cycles of systemic chemotherapy, with improvement in best-corrected visual acuity. CONCLUSIONS: Paraproteinemic keratopathy is a rare clinical presentation that may lead to a systemic diagnosis of hematologic malignancy. To the best of our knowledge, this is the first reported case of paraproteinemic keratopathy after LASIK.

Consenso de hemofilia en México / Mexican Consensus in Haemophilia

resumen está disponible en el texto completo

Abstract Hemophilia is a hemorrhagic disorder with a sex-linked inherited pattern, characterized by an inability to amplify coagulation due to a deficiency in coagulation factor VIII (hemophilia A or classic) or factor IX (hemophilia B). Sequencing of the genes involved in hemophilia has provided a description and record of the main mutations, as well as a correlation with the various degrees of severity. Hemorrhagic manifestations are related to levels of circulating factor, mainly affecting the musculoskeletal system and specifically the large joints (knees, ankles and elbows). This document is a review and consensus of the main genetic aspects of hemophilia, from the inheritance pattern to the concept of women carriers, physiopathology and classification of the disorder, the basic and confirmation studies when hemophilia is suspected, the various treatment regimens based on infusion of the deficient coagulation factor as well as innovative factor-free therapies and recommendations for the management of complications associated with treatment (development of inhibitors and/or transfusion transmitted infections) or secondary to articular hemorrhagic events (hemophilic arthropathy). Finally, relevant reviews of clinical and treatment aspects of hemorrhagic pathology charachterized by acquired deficiency of FVIII secondary to neutralized antibodies named acquired hemophilia.

Perfil inmunofenotípico de cáncer de mama de pacientes atendidas en un hospital general de Lima, Perú / Immune phenotypic profile of patients with breast cancer attended at a public hospital in Lima, Peru

RESUMEN La inmunohistoquímica permite clasificar al cáncer de mama en subtipos que tienen relevancia para el tratamiento y pronóstico. En comparación con los marcadores genéticos, la inmunohistoquímica es de costos accesibles, más fácil de realizar y tiene buena correlación con los subtipos moleculares. Objetivo: Describir el perfil inmunohistoquímico de cáncer de mama en pacientes atendidos en un hospital general de Lima, Perú. Material y métodos: Estudio descriptivo, transversal y retrospectivo que incluyó todos los casos de carcinoma invasivo de mama diagnosticados entre el 1 de mayo de 2015 y el 30 de abril del 2017. Se realizó la descripción histopatológica de los casos y se los clasificó de acuerdo con los protocolos actuales en cuatro subtipos. Resultados: Se reportaron 330 casos de cáncer de mama, 71 fueron excluidos, quedando 259 para el estudio. La media de edad fue de 54,64 ± 14,07. La neoplasia se localizó de la mama derecha en la mitad de casos. El 88,03% correspondió al tipo histológico carcinoma invasivo ductal no especial, y el grado histológico fue intermedio en el 53,28% de los casos. El subtipo molecular fue Luminal A en el 40,15% del total, y solo un 11,97% de las muestras fueron HER2/neu positivo no luminal. Conclusiones: Uno de cada cuatro casos de cancer de mama presentó una inmunohistoquímica de Her2/neu positivo, mientras que el subtipo inmunohistoquímico más común de carcinoma de mama invasivo fue Luminal A. De igual forma, el grado histológico se asocia al subtipo inmunohistoquímico.

SUMMARY Immunohistochemistry (IH) allows to classify breast cancer in subtypes that are relevant for treatment and prognosis. Compared to genetic markers, IH is cheaper, easier to perform and has good correlation with molecular subtypes. Objective: To describe the immune phenotypic profile of patients with breast cancer attended at a public hospital in Lima, Peru. Methods: Cross-sectional study that included all cases of invasive breast cancer diagnosed from May 1st 2015 to April 30, 2017. Histopathological description was performed and cases were classified based on current protocols into four subtypes. Results: 330 cases were included; 71 were excluded; 259 were left for analysis. Mean age was 54.64 ± 14.07 years. In half of cases the cancer was located in the right breast. The invasive ductal carcinoma accounted for 88.03% of cases; the intermediate histological degree was found in 53.28% of cases. The molecular subtype Luminal A accounted for 40.15% and only 11.97% were non-luminal HER2/neu positive. Conclusions: One in four cases of breast cancer presented with the IH pattern of HER2/neu positive, while the most common IH subtype was Luminal A. Histological degree was associated with the IH subtype.

Manipulation of cutaneous leishmaniasis lesions: case series in a peruvian hospital. / Manipulación de lesiones en pacientes con leishmaniasis cutánea: serie de casos en un hospital peruano.

In cutaneous leishmaniasis endemic areas it is a common practice for patients to manipulate their lesions with traditional treatments as a first therapeutic option. A case series study was conducted in order to describe the frequency and the variations of the patient manipulation of cutaneous leishmaniasis lesions at the Cayetano Heredia Hospital. The study included 124 patients with cutaneous leishmaniasis. From the patient population it was found that 54% (67/124) manipulated their lesions. Of this, 92.5% (62/67) did so with chemicals, and 43.3% (29/67) with plants. The most frequent local changes reported by patients were increased lesion size in 35.8% (24/67) and increased inflammation in 28.4% (19/67). Manipulation by patients decreased the positivity of the parasitological diagnosis in those patients with ulcerative lesions.

En áreas endémicas de leishmaniasis cutánea es común que los pacientes manipulen sus lesiones con tratamientos tradicionales como primera opción terapéutica. Con el objetivo de describir la frecuencia y los cambios de la manipulación de lesiones de leishmaniasis cutánea de pacientes en el Hospital Cayetano Heredia, se realizó un estudio tipo serie de casos. Se incluyeron 124 pacientes con leishmaniasis cutánea. El 54% (67/124) manipuló sus lesiones; el 92,5% (62/67) lo hizo con productos químicos, y el 43,3% (29/67), con plantas. Los cambios locales más frecuentemente reportados por los pacientes fueron aumento de tamaño de la lesión en el 35,8% (24/67) e incremento de inflamación en el 28,4% (19/67). La manipulación disminuyó la positividad del diagnóstico parasitológico en aquellos pacientes con lesiones ulcerativas.

Infections after hematopoietic cell transplantation are not a burden for mortality at a limited-resource center in a developing country.

BACKGROUND: Hematopoietic cell transplantation (HCT) outcomes, including infectious complications, change between centers and countries. Thus, the aim of this study was to report the incidence of infections and isolated pathogens among recipients of HCT and the association with mortality at a tertiary referral center in Mexico. METHODS: Two hundred and eighty-two patients undergoing autologous or allogeneic HCT between January 2005 and December 2018 at the National Institute of Medical Sciences and Nutricion Salvador Zubiran were included. RESULTS: In autologous HCT (n = 176), within the preengraftment and the early postengraftment, 130 (74%) and 31 (18%) recipients presented infections, respectively. Within the preengraftment, the early postengraftment, and the late postengraftment, 81 (76%), 34 (33%), and 58 (60%) allogeneic HCT recipients presented infections, respectively. Non-relapse mortality (NRM) as a result of infections occurred in 1 (0.6%) and 5 (5%) autologous and allogeneic HCT recipients, respectively. CONCLUSIONS: Our results demonstrated that despite our limited resources, infections were not a significant burden for NRM among HCT recipients. More importantly, the isolation rates were higher than international studies, which could be explained by the existence of a specialized infectious diseases department and laboratory, which we consider key elements for the establishment of an HCT program worldwide.

Manipulación de lesiones en pacientes con leishmaniasis cutánea: serie de casos en un hospital peruano / Manipulation of cutaneous leishmaniasis lesions: case series in a peruvian hospital

RESUMEN En áreas endémicas de leishmaniasis cutánea es común que los pacientes manipulen sus lesiones con tratamientos tradicionales como primera opción terapéutica. Con el objetivo de describir la frecuencia y los cambios de la manipulación de lesiones de leishmaniasis cutánea de pacientes en el Hospital Cayetano Heredia, se realizó un estudio tipo serie de casos. Se incluyeron 124 pacientes con leishmaniasis cutánea. El 54% (67/124) manipuló sus lesiones; el 92,5% (62/67) lo hizo con productos químicos, y el 43,3% (29/67), con plantas. Los cambios locales más frecuentemente reportados por los pacientes fueron aumento de tamaño de la lesión en el 35,8% (24/67) e incremento de inflamación en el 28,4% (19/67). La manipulación disminuyó la positividad del diagnóstico parasitológico en aquellos pacientes con lesiones ulcerativas.

ABSTRACT In cutaneous leishmaniasis endemic areas it is a common practice for patients to manipulate their lesions with traditional treatments as a first therapeutic option. A case series study was conducted in order to describe the frequency and the variations of the patient manipulation of cutaneous leishmaniasis lesions at the Cayetano Heredia Hospital. The study included 124 patients with cutaneous leishmaniasis. From the patient population it was found that 54% (67/124) manipulated their lesions. Of this, 92.5% (62/67) did so with chemicals, and 43.3% (29/67) with plants. The most frequent local changes reported by patients were increased lesion size in 35.8% (24/67) and increased inflammation in 28.4% (19/67). Manipulation by patients decreased the positivity of the parasitological diagnosis in those patients with ulcerative lesions.

Strongyloides stercoralis hyperinfection syndrome: a deeper understanding of a neglected disease.

Strongyloides stercoralis hyperinfection syndrome (SHS) is a life-threatening condition that warrants early detection and management. We describe the pathogenesis, organ-specific clinical manifestations, and risk factors associated to this condition. A comprehensive review of the literature was conducted in PubMed, LILACS, EBSCO and SciELO by using the keywords: "hyperinfection syndrome"; "Strongyloides stercoralis"; "disseminated strongyloidiasis"; "systemic strongyloidiasis", "pathogenesis" and "pathophysiology". Relevant articles on this topic were evaluated and included by consensus. Also, a secondary search of the literature was performed. Articles in English and Spanish language were included. SHS has been described in tropical and sub-tropical regions. However, there is growing evidence of cases detected in developed countries favored by increasing migration and the advance in immunosuppressive therapies for oncologic and inflammatory diseases. SHS is characterized by massive multiplication of larvae, typically in immunocompromised hosts. Clinical manifestations vary according to the organ involved and include diarrhea, intestinal bleeding, alveolar hemorrhages, heart failure, jaundice, bacteremia among others. Despite advances in the understanding of this condition, fatality rates are near 90%. Clinicians should consider SHS in the differential diagnosis of acutely ill patients with multiple organ damage and epidemiological risk factors. Adverse outcomes are common, especially with delayed anti-parasitic treatment.

Efficient Lazy Theta* Path Planning over a Sparse Grid to Explore Large 3D Volumes with a Multirotor UAV.

Exploring large, unknown, and unstructured environments is challenging for Unmanned Aerial Vehicles (UAVs), but they are valuable tools to inspect large structures safely and efficiently. The Lazy Theta* path-planning algorithm is revisited and adapted to generate paths fast enough to be used in real time and outdoors in large 3D scenarios. In real unknown scenarios, a given minimum safety distance to the nearest obstacle or unknown space should be observed, increasing the associated obstacle detection queries, and creating a bottleneck in the path-planning algorithm. We have reduced the dimension of the problem by considering geometrical properties to speed up these computations. On the other hand, we have also applied a non-regular grid representation of the world to increase the performance of the path-planning algorithm. In particular, a sparse resolution grid in the form of an octree is used, organizing the measurements spatially, merging voxels when they are of the same state. Additionally, the number of neighbors is trimmed to match the sparse tree to reduce the number of obstacle detection queries. The development methodology adopted was Test-Driven Development (TDD) and the outcome was evaluated in real outdoors flights with a multirotor UAV. In the results, the performance shows over 90 percent decrease in overall path generation computation time. Furthermore, our approach scales well with the safety distance increases.

Figura del padre en relación a la crianza: pasado, presente y futuro / A figura do pai em matéria de educação: passado, presente e futuro / Figure of the father in relating to the upbringing: past, present and future

La situación actual en el mundo occidental refleja un cambio gradual de la figura del padre en la crianza de su descendencia; según refleja Madeleine Leininger en su teoría, debemos conocer las características de este fenómeno para aplicar cuidados culturalmente congruentes. Basándonos en el concepto de Mercer «los roles no están fijados; por tanto, carece de importancia qué persona se encarga de realizar los distintos roles» (Marriner, 2007) podemos asemejar el vínculo materno-filial al paterno-filial. Proponemos una investigación de corte cualitativo basada en la entrevista en profundidad al objeto de estudio: padres (hombres) noveles; y grupos de discusión a matronas como figura profesional más representativa y que está directamente implicada con la salud reproductiva de la mujer y del cuidado del recién nacido. Así podemos afirmar que la idea de familia típica tal y como es aceptada entra en crisis entorno a los años noventa, emergiendo así la figura de los Nuevos Padres, concepto introducido por Bonino (2003). Nos encontramos con un padre cuya presencia en el cuidado de los hijos tiene una gran importancia en el buen desarrollo de los mismos (Alberdi Escario, 2007). Por tanto debemos trabajar sobre el modelo de Nuevos Padres para definir la implicación de éste en la crianza. La matrona es la profesional más cualificada para servir como agente impulsor de cambio (AU)

A situação atual no Ocidente reflete uma mudança gradual do pai na educação dos seus filhos, como refletido na sua teoria Madeleine Leininger, é preciso conhecer as características deste fenômeno para implementar cuidados culturalmente congruentes. Baseado no conceito de Mercer «papéis não são fixos, então não importa onde a pessoa é responsável por executar os diferentes papéis» (Marriner, 2007) podem imitar a subsidiária maternopaterno-filial. Propomos uma pesquisa qualitativa com base em entrevistas em profundidade a fim de estudar: os pais (homens) novato, e grupos de discussão parteiras profissionais como a figura mais representativa e está diretamente envolvido com a saúde reprodutiva das mulheres e cuidados o recém-nascido. Assim, podemos dizer que a idéia típica família é aceito como está em crise em torno da década de noventa, emerge a figura de os novos pais, um conceito introduzido por Bonino (2003). Encontramos um pai cuja presença no cuidado das crianças é de grande importância no desenvolvimento adequado desses (Alberdi & Escario, 2007). Portanto, devemos trabalhar com o modelo para definir o envolvimento dos pais em Nova elevando-o. A parteira é o profissional mais qualificado para servir como agentes de mudança (AU)

The current situation in the West reflects a gradual change of the father in the upbringing of their offspring, as reflected in its theory Madeleine Leininger, one must know the characteristics of this phenomenon to implement culturally congruent care. Based on the concept of Mercer «roles are not fixed, so no matter which person is responsible for performing the different roles» (Marriner, 2007) can mimic the maternal-paternal-filial subsidiary. We propose a qualitative research based on in-depth interview in order to study: parents (men) novice, and discussion groups professional midwives as the most representative figure and is directly involved with women’s reproductive health and care the newborn. Thus we can say that the typical family idea is accepted as is in crisis around the nineties, there emerges the figure of the new parents, a concept introduced by Bonino (2003). We met a father whose presence in the care of children is of great importance in the proper development of these (Alberdi & Escario, 2007). Therefore we must work on the model to define the New Parent involvement in raising it. The midwife is the professional most qualified to serve as agents of change (AU)

Algunas reflexiones sobre la biografía divulgativa. Los casos de Monlau, Rubio y Giné / No disponible

Este trabajo pretende reflexionar, a partir de los casos de Pedro Felipe Monalu, Federico Rubio y Juan Giné y Partagás, sobre las dificultades, tanto formales como de contenido, que entraña la biografía divulgativa. Los problemas de localización de las fuentes, la falta de estudios previoss, el difícil equilibrio entre individuo y sociedad, la representatividad de los individuos son algunas de las cuestiones que se abordan en este artículo

The current article aims to study the popular nonscholar and its formal and ground difficulties based inthe particular cases of Pedro Felipe Monlau, Federico Rubio and JuanGiné y Partagás. Some of the principal subjects in this work are how to find documents, the scarce of former studies, the difficult balance between people and society and the representative value of biographied people

Clinical course of insular thyroid carcinoma.

BACKGROUND: To present the clinical picture and outcome of poorly differentiated insular-type thyroid carcinoma (ITC) compared with papillary thyroid carcinoma (PTC) in a Mexican population in order to demonstrate their different biological behavior. MATERIAL/METHODS: Retrospective, transversal study comparing ITC (G1) with PTC (G2). Assessed variables were: age, gender, size of tumor, previous history of thyroid disease, and outcome. The recurrence/death risk was established according to the MACIS, De GROOT, and AMES classifications. Statistical analysis was made by means of central tendency measures, the Kaplan-Meier method, Cox-Mantel's log-rank, Student's t, and chi-square tests. RESULTS: Both groups were classified based on a high or low risk for thyroid neoplasms. G1 had 13 patients, tumor volume was 78 cm3, 7 cases presented metastases at the time of admittance, five had antecedents of goiter. Average follow-up time was 23 months. G2 had seventy-one patients, tumor volume was 42 cm3, and follow-up time of 44 months. Kaplan-Meier revealed a lower survival in Group 1 than Group 2, statistically significant by the Cox-Mantel log-rank test. A significant statistical difference existed regarding survival and the presence of metastases: G1 (61%) and G2 (53.8%). No statistical difference was found between tumor size. CONCLUSIONS: ITC is more aggressive than PTC. It occurs in the 6th decade of life, with antecedents of long-standing goiter, and has a high recurrence, metastasis and mortality frequency.

El difícil proceso de creación del Instituto de Vacunación del Estado (1871-1877)

Hasta 1871, España no contó con un organismo estatal encargado de cultivar, difundir y controlar la vacuna antivariólica. En este trabajo se analizan los problemas de creación del Instituto de Vacunación del Estado que sufrió varias refundaciones y remodelaciones entre 1871-1877. Las principales dificultades a las que tuvo que hacer frente fueron de tipo administrativo y técnico (AU)

Pseudoaneurisma postraumático de la arteria vertebral excluído mediante terapia endovascular con preservación de la arteria vertebral / Endovascular treatment for post-traumatic pseudoaneurysm in vertebral artery

Se presenta el caso de un hombre joven, que desarrolló un aneurisma de la arteria vertebral derecha, luedo de sufrir herida con arma cortopunzante en el cuello. Se analiza el procedimiento diagnóstico y se presenta la técnica endovascular utilizada para trombosar el pseudoaneurisma, conservando el vaso nativo

Relación entre la circunferencia braquial y el peso al nacer / Relationship between brachial circunference and birth weight

Para confirmar la relación entre la circunferencia braquial y el peso al nacer se estudiaron 292 recién nacidos entre abril y mayo de 1992 en el Hospital San Rafael de Alajuela. Se demostró una correlación estadísticamente significativa con la circunferencia braquial menor de 9,5 centímetros y peso menor de 2.500 gramos. Igualmente, una circunferencia braquial mayor de 11,5 centímetros se correlaciona con un peso al nacer mayor de 4.000 gramos. Por sencillo, barato y por su validez como predictor del peso al nacer, el método es de gran utilidad en los países pobres, debido a la escasez de recursos en salud, como las balanzas en las maternidades

Análisis de un caso de infección neonatal por Campylobacter sp / Analysis of a case of neonatal infection by Campylobacter sp

Se presenta el primer caso de septicemia en el período neonatal por Campylobacter sp. reportado en Costa Rica; producto de la contaminación ambiental con heces de aves de corral, animales domésticos en general y humanos, así como falta de educación por parte de la madre, sobre los métodos de prevención de infecciones en niños y adultos; atribuido a la poca educación que en salud por parte de los miembros de los equipos humanos encargados de ella. La paciente ingresó al Hospital San Rafaelde Alajuela con un cuadro clínico de enteritis y sepsis por lo que se tomaron los cultivos de rutina correspondientes a estos casos : dos hemocultivos, coprocultivo y líquido cefalorraquídeo. En los hemocultivos se aisló Campylobacter sp. como único agente infeccioso, sin que se necesitaran medios selectivos. A pesar de ser el primer caso de septicemia por Campylobacter que se reporta en Costa Rica en un recién nacido, cabe señalar la importancia que a nivel de salud pública tiene como agente causal de infecciones entéricas.

Escherichia Hermannii Sepsis con infección urinaria y colestasis intrahepatica en un lactante: reporte de un caso / Infection and intrahepatic colesthasis by Escherichia Hermannii in a lactant

Se presenta el primer caso de infección urinaria y colestasis intrahepática por E. hermannii en un lactante, siendo única bacteria aislada. Se demuestra su patogenicidad y debe tratarse con los antibióticos adecuados.