Secuencia Moebius. Análisis retrospectivo de 30 pacientes / Moebius syndrome. A retrospective analysis of 30 patients.

Introducción: La secuencia Moebius se caracteriza por el compromiso congénito de los nervios motor ocular externo y facial, y se puede asociar al compromiso de otros pares craneales y a otros defectos congénitos. Su etiología es multifactorial y no bien definida, actualmente la teoría más aceptada es la disrupción vascular durante el desarrollo del romboencéfalo. Su incidencia exacta se desconoce, pero impresiona estar en aumento y asociada a la exposición prenatal a teratógenos. Objetivos: Analizar las historias clínicas de 30 pacientes con secuencia Moebius y las características de su compromiso ocular. Materiales y métodos: Estudio retrospectivo, transversal, observacional y descriptivo. Se analizaron 30 historias clínicas de pacientes con secuencia Moebius atendidos por vez primera entre el mes de Julio de 1999 y Junio de 2012 por el servicio de Oftalmología del Hospital Garrahan. Resultados: Se estudiaron 30 pacientes 15 de sexo femenino y 15 de sexo masculino, dentro de los antecedentes maternos 7 madres refirieron ingesta de misoprostol y 4 tuvieron metrorragias durante el primer trimestre de embarazo. Todos los pacientes tuvieron compromiso del VII nervio; en 20 pacientes fue bilateral y simétrico; y en los restantes asimétrico. Todos los pacientes tuvieron compromiso del VI nervio bilateral, a algunos de los cuáles se les efectuó cirugía de estrabismo otros están en plan de cirugía y unos pocos no la requirieron por presentar fijación de ambos ojos en posición primaria de la mirada. Conclusión: la secuencia Moebius es una rara patología genética y congénita multifactorial y de compromiso multisistémico que ha visto incrementada su frecuencia desde el uso de ciertos fármacos teratógenos y que obliga a una intervención quirúrgica precoz de neuroortopedistas, oftalmólogos, cirujanos plásticos y control clínico multidisciplinario para brindarles a estos niños las mejores posibilidades de desarrollo funcional y estético reparador (AU)

Introduction: Moebius syndrome is characterized by congenital palsy of the external and facial oculomotpr nerves, and may be associated with involvement of other cranial nerves and congenital defects. The etiology is multifactorial and not well defined. Currently, the most widely accepted theory is a rhombencephalic maldevelopment. The true incidence of Moebius syndrome is unknown, but it seems to be increasing associated with prenatal exposure to teratogenic factors. Objectives: To analyze the clinical charts of 30 patients with Moebius syndrome assessing ocular involvement. Material and methods: A retrospective, cross-sectional, observational study. Thirty clinical charts of patients with Moebius syndrome that were first seen at the Department of Ophthalmology of Hospital Garrahan between July 1999 and June 2012 were assessed. Results: Of the 30 patients 15 were female and 15 male. Maternal history showed seven mothers that received misoprostol and four that had metrorrhagia in the first trimester of pregnancy. All patients had VII cranial nerve involvement; the involvement was bilateral and symmetric in 20 and asymmetric in the remaining patients. All patients had bilateral VI nerve involvement, some of whom underwent surgery for strabismus, others are on the list for surgery, and a few do not require surgery because of fixation of both eyes in primary gaze position. Conclusion: Moebius syndrome is a rare multifactorial genetic and congenital pathology with multisystemic involvement and increased incidence because of the use of teratogenic drugs requiring early surgical intervention by neuroorthopedic and plastic surgeons, and ophthalmologists, and a multidisciplinary follow-up to provide these children with the best possibilities for functional development and aesthetic repair (AU)

Group B streptococcal neonatal infections in Rio Grande do Sul, Brazil.

UNLABELLED: Group B Streptococcus is the most common pathogen found in neonatal sepsis in North America. OBJECTIVES: We describe 15 cases of neonatal infections by Group B Streptococcus (Streptococcus agalactiae) at a Neonatal Intensive Care Unit of a public and teaching hospital. METHODS: We conducted a study at Hospital de Clínicas de Porto Alegre, from January 1st, 1996 to June 30, 1999. Diagnosis of neonatal infection was established according to the findings of Group B Streptococcus in blood culture associated with alterations resembling sepsis on the basis of clinical picture and laboratory findings. RESULTS: Fifteen cases of neonatal infections by Group B Streptococcus were detected. Eleven cases consisted of early-onset sepsis, 2 cases of occult bacteremia and 2 cases of late-onset sepsis. Eight cases had septic shock (53%), 8 cases had pneumonia (53%), and 4 cases had meningitis (27%). Fourteen cases were diagnosed from a positive blood culture, and 1 case from evidence of these bacteria in pulmonary anatomopathological examination. Thirteen cases (87%) were diagnosed before 72 hours of life. We had 3 deaths (20%), and 3 cases of meningitis developing neurological deficits. CONCLUSIONS: Streptococcus Group B is one of the most important pathogens in the etiology of early-onset neonatal sepsis at our hospital, with high mortality and morbidity. However, we do not know the incidence of GBS neonatal infections at other hospitals. More data are needed to establish a basis for trials of different strategies to reduce these infections.

Menopausal experiences and bone density of Mayan women in Yucatan, Mexico.

This cross-sectional study reports on the menopausal transition of Mayan women from Yucatan, Mexico. A total of 228 women completed the study, and 118 women were classified by history as postmenopausal; the others were premenopausal. Demographic information, reproductive history, physical examination, hormone concentrations, radial bone density, food samples, and history of physical activity were obtained. The average age at which menopause occurred by history was 44.3 +/- 4.4 years; this is reflected in the distribution of FSH levels by age. None of the women reported symptoms of hot flashes, and none recalled any history of significant symptoms associated with their menopausal transition. Hormone levels were similar to U.S. reference values with elevated FSH (66.6 +/- 29.1 mIU/ml), low estradiol (9.4 +/- 8.3 pg/ml) and estrone (13.3 +/- 7.8 pg/ml), E1 > E2, and normal levels of testosterone and androstenedione. BMD declined with age, and values were lower than reference values for United States women. Clinical evidence of fracture was not detected by history or physical examination even for those who were 20 years postmenopausal. The endocrine characteristics of menopause among Mayan women in Yucatan are similar to hormonal changes reported for women in the United States, but signs, symptoms, and apparent consequences are different in the two populations.

[Aflatoxins in newly harvested corn in Panama]. / Aflatoxinas en maíz recién cosechado en Panamá.

Mycotoxins are fungal metabolites that may contaminate foods and feeds, resulting at times in important disease in humans and animals. Thirty-six samples of nine varieties of newly harvested corn (4 samples each variety) were analyzed in search of aflatoxins by thin layer chromatography and high pressure liquid chromatography, and also cultured for the presence of Aspergillus flavus. Of the 36 samples studied, one was contaminated with 1290 ppb aflatoxin B1, which is 258x the concentration suggested by WHO, placed at 5 ppb in food for human consumption. Culture of the 36 samples of corn resulted in growth of 55 colonies of A. flavus from all but two (1 and 6) of the 9 varieties. Of the 55 colonies of A. flavus obtained, 15 (27.3%) were toxigenic. Comments are made on the public health implications of these findings.

Aflatoxinas en maíz recién cosechado en Panamá / Aflatoxins in newly harvested corn in Panama

Mycotoxins are fungal metabolites that may contaminate foods and feeds, resulting at times in important disease in humans and animals. Thirty-six samples of nine varieties of newly harvested corn (4 samples each variety) were analyzed in search of aflatoxins by thin layer chromatography and high pressure liquid chromatography, and also cultured for the presence of Aspergillus flavus. Of the 36 samples studied, one was contaminated with 1290 ppb aflatoxin B1, which is 258x the concentration suggested by WHO, placed at 5 ppb in food for human consumption. Culture of the 36 samples of corn resulted in growth of 55 colonies of A. flavus from all but two (1 and 6) of the 9 varieties. Of the 55 colonies of A. flavus obtained, 15 (27.3%) were toxigenic. Comments are made on the public health implications of these findings.

Aislamiento de Cryptococcus neoformans a partir de suelos en Panama / Cryptococcus neoformans isolation from the soil in Panama

Reports of Cryptococcus neoformans isolations from patients in Panama have appeared since 1978, but to our knowledge, thIs is the first report of isolation of this organism from soil samples in the Republic. Of 25 soil samples analyzed, two (25%) yielded the organism on birdseed agar medium. Canavanine-glycine-bromthymol blue medium served to identify the isolates as belonging to C. neorformans var neoformans, and not C. Neoformans var. gattii. Initially, isolates did not have capsules, but upon passage through newborn mice, wide capsules developed. This finding has important public health implications, since non-encapsulated environmental organisms, once in the host, can develop capsules, which significantly contribute to virulence

[Cryptococcus neoformans isolation from the soil in Panama]. / Aislamiento de Cryptococcus neoformans a partir de suelos en Panama.

Reports of Cryptococcus neoformans isolations from patients in Panama have appeared since 1978, but to our knowledge, thIs is the first report of isolation of this organism from soil samples in the Republic. Of 25 soil samples analyzed, two (25%) yielded the organism on birdseed agar medium. Canavanine-glycine-bromthymol blue medium served to identify the isolates as belonging to C. neorformans var neoformans, and not C. Neoformans var. gattii. Initially, isolates did not have capsules, but upon passage through newborn mice, wide capsules developed. This finding has important public health implications, since non-encapsulated environmental organisms, once in the host, can develop capsules, which significantly contribute to virulence.

Characteristics of chief complaints of patients with temporomandibular disorders in a Brazilian population.

A retrospective survey of 894 patients with temporomandibular disorders was conducted in order to analyse the characteristics of chief complaints. The patients presented complaints of pain (82.1%), functional disturbance (12.3%), articular sounds (5.0%) and swelling (0.6%). Unilateral occurrence (66.5%) was more frequent than bilateral. The most frequent location of pain was the temporomandibular joint (TMJ) (82.1%) followed by ear (10.8%), face (2.3%), head (2.3%), mandible (1.0%), neck (0.9%), temporal (0.4%) and frontal (0.1%) areas. Pain in the TMJ occurred in isolation (87.9%) or associated to other locations. The most frequent functional disturbance was limitation of jaw opening (32.1%).

Characteristics of cheif complaints of patients with temporomandibular disorders in a brazilian population / Caracteristicas das reclamações dos pacientes com desordens temporomandibulares da população brasileira

A retrospective survey of 894 patients with temporomandibular disorders was conducted in order to analyse the characteristics of chief complaints. The patients presented complaints of pain (82.1 percent), functional disturbance (12.3 percent) articular sounts (5.0 percent) and swelling (0.6 percent). Unilateral occurrence (66.5 percent) was more frequent than bilateral. The most frequent location of pain was the temporomandibular joint (TMJ) (82.1 percent) followed by ear (10.8 percent), face (2.3 percent), head (2.3 percent), mandible (1.0 percent), nech (0.9 percent), temporal (0,4 percent) and frontal (0.1 percent) areas. Pain in the TMJ occured in isolation (87.9 percent) or associated to other locations. The most frequent functional disturbance was limitation of jaw opening (32.1 percent)

Aspectos éticos de la experimentació animal / Ethical aspects in experimentation with animals

Muchos de los progresos en el campo de la medicina se han logrado gracias a la experimentación con animales. La urología se ha enriquecido mucho, tanto en su vertiente clínica como quirúrgica, de la cirugía experimental.Incluso actualmente, el entrenamiento quirúrgico de las nuevas generaciones de urólogos en técnicas quirúrgicas complejas y de uso poco frecuente requiere del empleo de animales de experimentación. Téngase en cuenta que tan sólo el 1,7 por ciento del total de animales de experimentación se utiliza para la enseñanza y la formación quirúrgica. La inmensa mayoría de ellos se emplea para la investigación de nuevos fármacos, productos o aparatos, o en la investigación básica. Estamos muy lejos de la antigua "vivisección", y nuestra mejor respuesta a la opinión pública, que se encuentra muy sensibilizada por los argumentos- en ocasiones sin fundamento- esgrimidos por las sociedades protectoras de animales, consiste en dar una detallada información de nuestras actividades que, además de cumplir con las normas que al respecto señala la legislación de cada país, se realizan en centros autorizados, dirigidos por personas experimentada, capaces de identificar los signos que pudieran indicar la presencia de dolor o sufrimiento en los animales, con vistas a reducirlo o evitarlo por completo

Aspectos éticos de la experimentació animal / Ethical aspects in experimentation with animals

Muchos de los progresos en el campo de la medicina se han logrado gracias a la experimentación con animales. La urología se ha enriquecido mucho, tanto en su vertiente clínica como quirúrgica, de la cirugía experimental.Incluso actualmente, el entrenamiento quirúrgico de las nuevas generaciones de urólogos en técnicas quirúrgicas complejas y de uso poco frecuente requiere del empleo de animales de experimentación. Téngase en cuenta que tan sólo el 1,7 por ciento del total de animales de experimentación se utiliza para la enseñanza y la formación quirúrgica. La inmensa mayoría de ellos se emplea para la investigación de nuevos fármacos, productos o aparatos, o en la investigación básica. Estamos muy lejos de la antigua "vivisección", y nuestra mejor respuesta a la opinión pública, que se encuentra muy sensibilizada por los argumentos- en ocasiones sin fundamento- esgrimidos por las sociedades protectoras de animales, consiste en dar una detallada información de nuestras actividades que, además de cumplir con las normas que al respecto señala la legislación de cada país, se realizan en centros autorizados, dirigidos por personas experimentada, capaces de identificar los signos que pudieran indicar la presencia de dolor o sufrimiento en los animales, con vistas a reducirlo o evitarlo por completo(AU)

Optimización de la técnica de inmunoelectrotransferencia (western blot) para la confirmación de la infección por el virus de immunodeficiencia humana (VIH) en Panamá / Optimization of the immunoelectrophoresis technic (western blot) for the confirmation of human immunodeficiency virus infection (HIV) in Panama

The purpose of this study is to report the results of the authors' investigation to apply the western blot technique (WB UP-LCS) in the diagnosis of human immunodeficiency virus type 1 (HIV-1) infection. To do this, the authors separated the proteins of the HIV-1 virus by electrophoresis, based on their molecular weight, in poliacilamide gel with SDS (SDS-PAGE) during 3 hours at 200 volts. Then they electrotransferred these proteins to nitrocellulose paper during four hours at 200 milliamperes, with the aid of external cooling. The nitrocellulose strips were evaluated considering the incubation time (1 and 16 hours), two conjugates (human anti IgG with Peroxidase and human anti IgG Biotin plus Streptatividine with Peroxidase) and two dilutions of the patients' sera (1/50 and 1/100). Based on their results the Authors conclude that, in the first place, the optimal conditions for the test include a dilution of 1/100 of the patients serum, incubation of the serum for 16 hours and the use of the conjugate of anti human IgG with Biotin and Streptavidine with Peroxidase; secondary, that the immunologic reactivity against proteins p24 and gp 160/120 is the most important diagnostic criterion for the confirmation of infection with HIV-1 and that they obtained a diagnostic correlation of 100% at a cost which was 5 to 7 times less than that of the commercial system

[Optimization of the immunoelectrophoresis technic (western blot) for the confirmation of human immunodeficiency virus infection (HIV) in Panama]. / Optimización de la técnica de inmunoelectrotransferencia (western blot) para la confirmación de la infección por el virus de immunodeficiencia humana (VIH) en Panamá.

The purpose of this study is to report the results of the authors' investigation to apply the western blot technique (WB UP-LCS) in the diagnosis of human immunodeficiency virus type 1 (HIV-1) infection. To do this, the authors separated the proteins of the HIV-1 virus by electrophoresis, based on their molecular weight, in poliacilamide gel with SDS (SDS-PAGE) during 3 hours at 200 volts. Then they electrotransferred these proteins to nitrocellulose paper during four hours at 200 milliamperes, with the aid of external cooling. The nitrocellulose strips were evaluated considering the incubation time (1 and 16 hours), two conjugates (human anti IgG with Peroxidase and human anti IgG Biotin plus Streptatividine with Peroxidase) and two dilutions of the patients' sera (1/50 and 1/100). Based on their results the Authors conclude that, in the first place, the optimal conditions for the test include a dilution of 1/100 of the patients serum, incubation of the serum for 16 hours and the use of the conjugate of anti human IgG with Biotin and Streptavidine with Peroxidase; secondary, that the immunologic reactivity against proteins p24 and gp 160/120 is the most important diagnostic criterion for the confirmation of infection with HIV-1 and that they obtained a diagnostic correlation of 100% at a cost which was 5 to 7 times less than that of the commercial system.

[The isolation of Schizophyllum commune in Panama]. / Aislamiento de Schizophyllum commune en Panama.

The authors report the isolation of the basidiomycete Schizophyllum commune in two enclosed areas of healthy facilities in the city of Panama. The growth occurred in Sabouraud's agar as a white mycelium which gradually rose above the surface of the culture medium until it became a fan-shaped basidiocarp. This basidiomycete is found in environmental samples, but since there have been reports of its role in pathologic processes it should be included in the etiologic differential diagnosis in some patients and clinical laboratory must identify it and not discard it as a "contaminant".

Aislamiento de Schizophyllum commune en Panama / The isolation of Schizophyllum commune in Panama

The authors report the isolation of the basidiomycete Schizophyllum commune in two enclosed areas of healthy facilities in the city of Panama. The growth occurred in Sabouraud's agar as a white mycelium which gradually rose above the surface of the culture medium until it became a fan-shaped basidiocarp. This basidiomycete is found in environmental samples, but since there have been reports of its role in pathologic processes it should be included in the etiologic differential diagnosis in some patients and clinical laboratory must identify it and not discard it as a [quot]contaminant[quot]

Menopause without symptoms: the endocrinology of menopause among rural Mayan Indians.

OBJECTIVE: Our purpose was to determine the characteristics of menopause among Mayan women who did not have menopausal symptoms. STUDY DESIGN: A cross-sectional study of Mayan women from Chichimila, Mexico, was performed. Demographic information, history and physical examination, hormone concentrations, and radial bone density measurement were obtained. RESULTS: Fifty-two postmenopausal women were compared with 26 premenopausal women. Menopause occurred at 44.3 +/- 4.4 years. None of the women admitted to hot flushes and did not recall significant menopausal symptoms. Hormone levels included elevated follicle-stimulating hormone (66.6 +/- 29 mlU/ml), low estradiol and estrone (9.4 +/- 8.3 and 13.3 +/- 7.8 pg/ml), estrone greater than estradiol levels, normal levels of testosterone and androstenedione (0.17 +/- 0.14 and 0.31 +/- 0.17 ng/ml). Bone mineral density declined with age, but height did not. Clinical evidence of osteoporosis was not detected. CONCLUSIONS: Lack of symptoms during the menopausal transition is not attributable to a difference in endocrinology. Postmenopausal Mayan women are estrogen deprived and experience age-related bone demineralization but do not have a high incidence of osteoporotic fractures.

[Economic impact of nosocomial infections on the Metropolitan Hospital Complex of the Social Security Fund (from January through December, 1987)]. / El impacto económico de las infecciones nosocomiales en el Complejo Hospitalario Metropolitano de la Caja de Seguro Social (enero a diciembre, 1987).

Nosocomial infections increase the morbidity, mortality and cost of hospitalization. The Hospital Infection Committee of the Metropolitan Hospital Complex of the Caja de Seguro Social de Panama studied the problem of nosocomial infections in 1987 and showed that of 29,576 admissions, 820 patients developed 994 nosocomial infections (an annual incidence of 3.69%). This resulted in 5191 additional days of hospitalization, at a conservatively estimated cost of B/ 840,153, and was responsible for 24 deaths. An adequate and efficient program of control of nosocomial infections in recommended.

[Cases of ocular mycosis at the metropolitan hospital complex of the Social Security Fund (1979-88)]. / Casos de Micosis Ocular en el Complejo Hospitalario Metropolitano de la Caja de Seguro Social (1979-88).

Of 277 eye specimens processed during the ten-year period of January, 1979 through December, 1988 in the Social Security Hospital, we isolated fungi 115 times. The fungal isolations were equally distributed between the two sexes, our rainy season months being the most productive with almost 70% of the recoveries. Candida species were identified in 90 (78%) of 115 cultures, C. albicans being the most frequent (46 cultures or 51%) followed by C. parakrusei (19 isolations, 21%). Less frequently obtained organisms were Fusarium (8 times, 7%), Aspergillus (4 cultures) and others, even No cardia brasiliensis in one instance.

[Prevalence of Paracoccidioides brasiliensis infection in Panamanian children. Preliminary report]. / Prevalencia de la infección por Paracoccidioides brasiliensis en niños panameños. Informe preliminar.

The prevalence of Paracoccidioides brasiliensis infection in Panamanian children was demonstrated to be 12.73% (14/110) by skin reactivity to 50 micrograms of yeast derived antigen. Boys were infected more frequently than girls - 1.45:1. The earliest age of infection was 2 years, and a direct relationship was noted between age and frequency of infections (as the children became older, more of them became infected); boys more so than girls. Thirteen of 14 (93%) of the infected juvenile population live in a rural environment.

[Infection caused by Paracoccidioides brasiliensis in people living in Cocle and Veraguas, Republic of Panamá]. / Infección por Paracoccidioides brasiliensis en personas residentes en Coclé y en Veraguas, República de Panamá.

Intradermal application of yeast phase paracoccidioidin antigen obtained by sonication and lysis from the fungus to 111 residents of Veraguas province (68 men and 43 women) and 130 Cocle province residents (57 men and 73 women) elicited a positive reaction in 9.01% (1/111) and 26.15% (34/30) of the Veraguas and Cocle residents respectively. Positive reactions ranged between papules of 5 and 27 mm in diameter, the majority being between 11 and 20 mm. Infection was more frequent in men (1:1.47 for Veraguas and 1:1.28 for Coclé) and in those involved in farming. A prevalence of 21.95% P. brasiliensis infection is demonstrated for the Republic of Panama.