Evolución de los serotipos causantes de enfermedad neumocócica invasiva aislados durante 2008-2022 en un Hospital Público Madrileño de nivel dos, en relación con su inclusión en diferentes vacunas conjugadas / Evolution of the serotypes causing invasive pneumococcal disease along 2008-2022 in a Level 2 Public Hospital of the Madrid Region, in relation to their inclusion in different conjugate vaccines

Introducción. El uso de vacunas conjugadas frente a Streptococcus pneumoniae ocasiona cambios en la epidemio logía de la Enfermedad Neumocócica Invasiva (ENI). El objetivo de este estudio fue analizar la evolución de los serotipos de S. pneumoniae aislados en el Hospital Universitario de Getafe entre 2008 y 2022. Material y métodos. Se estudiaron 313 cepas de S. pneu moniae. El serotipado se realizó mediante el test de aglutina ción por látex (Pneumotest-latex) y la reacción de Quellung. Además, se determinó la concentración mínima inhibitoria (CMI) frente a penicilina, eritromicina y levofloxacino por el método de gradiente de concentración (E-test) según los cri terios de corte EUCAST. Resultados. Los serotipos más frecuentes en todo el pe riodo de estudio fueron 8, 3, 19A, 1, 11A y 22F correspondien do con el 46,6 % de los aislados. Durante los años 2008-2012, los serotipos 3, 1, 19A, 7F, 6C y 11A supusieron en conjunto el 53,6% de los aislamientos. Entre 2013 y 2017 los serotipos 3, 8, 12F, 19A, 22F y 19F representaron el 51% de los aislados. Entre 2018-2022 los serotipos 8, 3, 11A, 15A, 4 y 6C incluyeron al 55,5% de los casos. En total, 5 cepas (1,6%) se mostraron resistentes a penicilina, 64 (20,4%) resistentes a eritromicina y 11 (3,5%) resistentes a levofloxacino. Los niveles de CMI50 y CMI90 frente a los tres antibióticos se mantuvieron estables a lo largo del tiempo. Conclusiones. El uso de vacunas conjugadas condicionó un descenso de los serotipos cubiertos junto con un aumento de los no vacunales. Los patrones de sensibilidad a eritromicina y levofloxacino se mantuvieron relativamente estables. La re sistencia a penicilina fue muy baja, no encontrándose este tipo de cepas resistentes en el último periodo de estudio (AU)

Introduction. The use of conjugate vaccines against Streptococcus pneumoniae originates changes in the invasive pneumococcal disease (IPD). The aim of this study was to in vestigate the evolution of S. pneumoniae serotypes isolated in the Hospital Universitario de Getafe between 2008 and 2022. Material and Methods. 313 of S. pneumoniae strains were studied. Serotyping was carried out by latex agglutina tion (Pneumotest-latex) and the Quellung reaction. In addi tion, the minimal inhibitory concentration (MIC) was deter mined against penicillin, erythromycin and levofloxacin by the concentration gradient method (E-test) according the EUCAST breakpoints. Results. The most frequent serotypes throughout the study period were 8, 3, 19A, 1, 11A and 22F corresponding to 46.6% of the isolates. Along 2008-2012 the serotypes 3, 1, 19A, 7F, 6C and 11A represented altogether 53.6% of the isolates. Between 2013 and 2017 the serotypes 3, 8, 12F, 19A, 22F and 19F grouped 51% of the isolates. During 2018-2022 the serotypes 8, 3, 11A, 15A, 4 and 6C included the 55.5% of the cases. In total 5 strains (1.6%) were penicillin resistant, 64 (20.4%) erythromycin resistant and 11 (3.5%) levofloxacin re sistant. The MIC50 and MIC90 levels maintained stables along the time. Conclusion. The conjugate vaccines use with different se rotype coverage conditioned a decrease of the vaccine-includ ed and an increase of non-covered. Despite these changes, the global antimicrobial susceptibility patterns to erythromycin and levofloxacin maintained relatively stables. The resistance a penicillin was low, not finding this type of resistant strains in the last study period (AU)

Maternal Factors Associated with Non-Exclusive Breastfeeding in Haitian Immigrant Women in Southern Chile.

There is limited knowledge concerning factors that affect non-exclusive breastfeeding (NEBF) practices in immigrant populations, especially in Latin America. The objective of the present study was to determine the association between maternal factors and the prevalence of NEBF in Haitian immigrant women in southern Chile. This was an analytical cross-sectional study. The probabilistic sample consisted of 173 Haitian women who gave informed consent. Sociodemographic and dietary-nutritional information was collected from all participants. Bivariate (χ2) and multivariate (logistic regression) inferential statistics were applied. All analyses were performed with the STATA 16.0 statistical software, and the significance level was established as α < 0.05. The prevalence of EBF at 6 mo was 54.3%. Maternal factors associated with a lower prevalence of EBF were not having permanent residency (OR: 2.34, CI: 2.18−2.83), residency <12 months (OR: 2.23, CI: 2.09−2.78), limited knowledge of breastfeeding (OR: 1.96; CI: 1.81−2.27), and low educational attainment (OR: 1.78; CI: 1.61−2.11). The protective factors were employment (OR: 0.36, CI: 0.28−0.40), access to basic services (OR: 0.32; CI: 0.22−0.48), and Spanish proficiency (OR: 0.29; CI: 0.20−0.51). Haitian immigrant women without legal residency, recently arrived, with low educational attainment, and poor knowledge of breastfeeding have more risk of not providing exclusive breastfeeding. Targeted interventions for mothers with these risk factors may help improve EBF rates.

Evaluation of the Chagas VirClia® and Chagas TESA VirClia® for the Diagnosis of Trypanosoma cruzi Infection.

Chagas disease (CD), caused by the protozoan Trypanosoma cruzi, is an important problem of public health even in regions where it is not endemic. Spain ranks second worldwide in terms of imported cases of T. cruzi infection in the chronic phase. The diagnosis in this stage is made via the detection of antibodies against T. cruzi. Therefore, we aimed to evaluate the sensitivity and specificity of two fully automated chemiluminescence immunoassays, Chagas VirClia® (CHR), which uses a mixture of recombinant antigens, and Chagas TESA VirClia® (TESA), the first chemiluminescence assay based on excretion-secretion antigens of trypomastigotes, both designed in monotest format. A retrospective case-control study was performed using 105 well-characterized samples: 49 from patients with CD, 22 from uninfected individuals, and 32 from patients with other pathologies. Sensitivity was 98% for CHR and 92% for TESA. In contrast, the specificity in both was 100%. Cross-reactivity was observed in leishmaniasis (2/10). CHR meets the criteria to become a tool for serological screening, while TESA has the potential for confirmation and cross-reaction discrimination. The monotest format allows its application in laboratories with a small number of samples. The high specificity of both assays is useful in areas where leishmaniasis is endemic.

Early detection of gastric cancer using global, genome-wide and IRF4, ELMO1, CLIP4 and MSC DNA methylation in endoscopic biopsies.

Clinically useful molecular tools to triage gastric cancer patients are not currently available. We aimed to develop a molecular tool to predict gastric cancer risk in endoscopy-driven biopsies obtained from high-risk gastric cancer clinics in low resource settings.We discovered and validated a DNA methylation biomarker panel in endoscopic samples obtained from 362 patients seen between 2004 and 2009 in three high-risk gastric cancer clinics in Lima, Perú, and validated it in 306 samples from the Cancer Genome Atlas project ("TCGA"). Global, epigenome wide and gene-specific DNA methylation analyses were used in a Phase I Biomarker Development Trial to identify a continuous biomarker panel that combines a Global DNA Methylation Index (GDMI) and promoter DNA methylation levels of IRF4, ELMO1, CLIP4 and MSC.We observed an inverse association between the GDMI and histological progression to gastric cancer, when comparing gastritis patients without metaplasia (mean = 5.74, 95% CI, 4.97-6.50), gastritis patients with metaplasia (mean = 4.81, 95% CI, 3.77-5.84), and gastric cancer cases (mean = 3.38, 95% CI, 2.82-3.94), respectively (p < 0.0001). Promoter methylation of IRF4 (p < 0.0001), ELMO1 (p < 0.0001), CLIP4 (p < 0.0001), and MSC (p < 0.0001), is also associated with increasing severity from gastritis with no metaplasia to gastritis with metaplasia and gastric cancer.Our findings suggest that IRF4, ELMO1, CLIP4 and MSC promoter methylation coupled with a GDMI>4 are useful molecular tools for gastric cancer risk stratification in endoscopic biopsies.

Cuticular extracts from Acromis sparsa (Coleoptera: Cassidinae) mediate arrestment behavior of the commensal canestriniid mite Grandiella rugosita.

Astigmatid mites in the family Canestriniidae are often closely associated with tortoise leaf beetles (Chrysomelidae: Cassidinae). For example, the survival of the commensal canestriniid mite Grandiella rugosita depends on dispersal to the cassidine beetle Acromis sparsa. Here, we tested whether the beetle cuticle provides chemical cues for host recognition for G. rugosita. In two-choice assays with cuticular extracts from A. sparsa and the co-occurring, non-host cassidine Chelymorpha alternans offered simultaneously, mites clearly preferred the area treated with extract from their host. In no-choice assays, G. rugosita spent three times longer and moved three times slower on host cuticular extracts compared to non-host extracts and the solvent control. Analyses of the chemical composition of cuticular extracts from males and females of A. sparsa and C. alternans revealed complex mixtures of mainly methyl branched hydrocarbons, which clearly separated both species in a principal component analysis. We found no qualitative difference between males and females of either species, but in C. alternans quantitative differences between males and females were detected. Our results demonstrate that G. rugosita is able to discriminate between cuticular extracts from its host A. sparsa and the non-host C. alternans. The components eliciting the observed arrestment behavior remain to be determined.

Socioeconomic and nutritional factors account for the association of gastric cancer with Amerindian ancestry in a Latin American admixed population.

Gastric cancer is one of the most lethal types of cancer and its incidence varies worldwide, with the Andean region of South America showing high incidence rates. We evaluated the genetic structure of the population from Lima (Peru) and performed a case-control genetic association study to test the contribution of African, European, or Native American ancestry to risk for gastric cancer, controlling for the effect of non-genetic factors. A wide set of socioeconomic, dietary, and clinic information was collected for each participant in the study and ancestry was estimated based on 103 ancestry informative markers. Although the urban population from Lima is usually considered as mestizo (i.e., admixed from Africans, Europeans, and Native Americans), we observed a high fraction of Native American ancestry (78.4% for the cases and 74.6% for the controls) and a very low African ancestry (<5%). We determined that higher Native American individual ancestry is associated with gastric cancer, but socioeconomic factors associated both with gastric cancer and Native American ethnicity account for this association. Therefore, the high incidence of gastric cancer in Peru does not seem to be related to susceptibility alleles common in this population. Instead, our result suggests a predominant role for ethnic-associated socioeconomic factors and disparities in access to health services. Since Native Americans are a neglected group in genomic studies, we suggest that the population from Lima and other large cities from Western South America with high Native American ancestry background may be convenient targets for epidemiological studies focused on this ethnic group.

Enfermedad granulomatosa crónica: a propósito de un caso / Chronic granulomatous disease: a case report

La enfermedad granulomatosa crónica es una enfermedad hereditaria rara producida por un defecto en el metabolismo de oxidación de las células fagocíticas, que afecta la capacidad microbicida y da como resultado una tendencia a presentar infecciones recurrentes por hongos y bacterias en la piel y en las superficies epiteliales. Se presenta un caso clínico.

The allometry of CNS size and consequences of miniaturization in orb-weaving and cleptoparasitic spiders.

Allometric studies of the gross neuroanatomy of adults from nine species of spiders from six web-weaving families (Orbicularia), and nymphs from six of these species, show that very small spiders resemble other small animals in having disproportionately larger central nervous systems (CNSs) relative to body mass when compared with large-bodied forms. Small spiderlings and minute adult spiders have similar relative CNS volumes. The relatively large CNS of a very small spider occupies up to 78% of the cephalothorax volume. The CNSs of very small spiders extend into their coxae, occupying as much as 26% of the profile area of the coxae of an Anapisona simoni spiderling (body mass < 0.005 mg). Such modifications occur both in species with minute adults, and in tiny spiderlings of species with large-bodied adults. In at least one such species, Leucauge mariana, the CNS of the spiderling extends into a prominent ventral bulge of the sternum. Tiny spiders also have reduced neuronal cell body diameters. The adults of nearly all orbicularian spiders weave prey capture webs, as do the spiderlings, beginning with second instar nymphs. Comparable allometric relations occur in adults of both orb-weaving and cleptoparasitic species, indicating that this behavioral difference is not reflected in differences in gross CNS allometry.

Interleukin-1 beta single-nucleotide polymorphism's C allele is associated with elevated risk of gastric cancer in Helicobacter pylori-infected Peruvians.

Particular alleles of the interleukin-1B (IL-1B) gene have been correlated with increased risk of atrophic gastritis and gastric cancer in the populations of East Asia and Europe. No such data exist from Peru, a developing country with a population genotypically different from others studied and with a high prevalence of Helicobacter pylori infection and gastric cancer. We conducted a case-control study comparing 334 hospitalized patients with atrophic gastritis or gastric cancer with 158 nonatrophic gastritis patients (controls). Conditional logistic regression analysis revealed that an increased risk of atrophic gastritis (odds ratio, 5.60) and gastric cancer (odds ratio, 2.36) was associated with the IL-1B-511 C allele. Our study is the first to establish this allele as a risk for these conditions. Given the high prevalence of H. pylori and recurrence rate after treatment, IL-1B-511 single-nucleotide polymorphism analysis may identify those individuals who would benefit most from robust H. pylori eradication efforts in Peru.

Melanoma lentiginoso acral: una variante de melanoma maligno de especial interés en Colombia / Acral lentiginous melanoma: a variant of malignant melanoma of special interest in Colombia

El melanoma lentiginoso acral (MLA) es una variante rápidamente progresiva del melanoma maligno (MM). Constituye el 5-10% de los MM y se presenta con mayor frecuencia en pacientes de raza negra, asiáticos y latinoamericanos. En Colombia, la frecuencia de MM se encuentra en aumento y el MLA es una de las variantes más comunes (14,7% de todos los melanomas). La edad promedio de presentación es de 58 años, con una tasa de supervivencia menor para las personas de raza negra, asociada al diagnóstico tardío. EL MLA se localiza en las plantas, palmas y regiones subungueales y en su etiopatología se ha descrito la presencia de mutaciones en varios genes: 9p21 p16: (67%), 11q13 (CCND1) (47%), 22q11-q13 (40%) y 5p15 (20%). El diagnóstico de MLA se ha fundamentado clásicamente en la histopatología; sin embargo, otros métodos como la dermatoscopia, la evaluación del ganglio centinela y la detección de alteraciones en las proteínas del ciclo celular pueden contribuir al diagnóstico precoz y a mejorar el pronóstico tanto del MLA como del MM en general.

Acral lentiginous melanoma (ALM) is a rapidly progressive variant of malignant melanoma (MM). It constitutes 5-10% of all cases of MM and its prevalence is higher in blacks, Asians and Latin Americans. In Colombia, the incidence of MM is increasing and ALM is one of its most common variants (14.7% of all melanoma cases). The mean age at presentation of the disease is 58 years, and the survival rate is lower in black people, partly due to delayed diagnoses. ALM is located in the soles, palms and subungual regions. Mutations in several genes have been described in the pathogenesis of ALM, namely: 9p21 (p16: 67%), 11q13 (CCND1) (47%), 22q11-q13 (40%) and 5p15 (20%). The diagnosis of ALM has been traditionally based on histopathology; however, other diagnostic tools such as dermoscopy, evaluation of the sentinel lymph node and detection of alterations in proteins that control the cell cycle, may contribute to earlier diagnoses and, consequently, improve the prognosis of both ALM and MM.

Edad óptima para el despistaje endoscópico de cáncer gástrico en pacientes con dispepsia sin síntomas de alarma / Age optimal for endoscopic screening for gastric cancer in patients with dyspepsia symptoms without alarm

Objetivo: Determinar la edad óptima de despistaje de cáncer gástrico en pacientes con dispepsia sin síntomas de alarma. MÉTODO: Estudio analítico, descriptivo y retrospectivo (2001-2005). Se analizó 285 casos de pacientes con dispepsia y cáncer gástrico en el Hospital Nacional Arzobispo Loayza, calculándose la frecuencia acumulativa por edad y grupo etáreo, así como también por estudio de percentiles, para determinar la edad óptima de despistaje endoscópico. Ambos grupos, con y sin signos de alarma fueron analizados con frecuencias relativas y absolutas, Chi-cuadrado y test de Student según la variable categórica o contínua respectivamente. Se consideró valores significativos de p<0.05. RESULTADOS: De 32,388 endoscopías realizadas en pacientes por motivo de dispepsia, se encontró 285 casos confirmados de cáncer gástrico, 45 de ellos sin signos de alarma. No hubo diferencia en la frecuencia acumulativa <35 y <40 años, con una pérdida de casos de cáncer gástrico de 0.29 y 0.30 por 1000 endoscopías, respectivamente. Al tomarse 40 años como edad óptima de despistaje, se perderían 4 casos (8.9 por ciento, aproximadamente 1 caso por año), de los cuales uno sería cáncer gástrico precoz. El percentil 5 fue 30.3 años y el 10 fue 39,4 años. Si se hubiera tomado una edad de 45 años se habrían perdido 6 casos (15 por ciento) y 12 (27 por ciento), si la edad se elevaba a 55 años. No hubo diferencia estadísticamente significativa entre el sexo, edad y duración de la dispepsia. Por el contrario, sí existió relación con el tipo de dispepsia (ulcerosa), tipo de lesión, localización, histología y el estadío del cáncer gástrico para ambos grupos. CONCLUSIÓN: Se recomienda que la edad óptima para el despistaje endoscópico de cáncer gástrico en pacientes con dispepsia sin síntomas de alarma, sea a partir de los 40 años de edad para ambos sexos.

Objective: To determine the optimal age for screening endoscopy on patients withdyspepsia without alarm symptoms to avoid missing gastric cancer. Methods: A Cross sectional study was performed (2001-2005). 285 cases of patientswith dyspepsia and gastric cancer were found at Arzobispo Loayza National Hospital. Cumulative age frequencies and percentiles were used to determine the optimal age for screening endoscopy. Both groups, with and without alarm symptoms were comparedusing the chi-square test for categorical data. Continuous data was expressed as mean (SD) and was compared with the t- test. Significant values of p were specified as mayor 0.05. Results: A total of 32,388 upper endoscopic procedures in dyspeptic patients were performed and 285 cases of gastric cancer were diagnosed, 45 cases of them not featuring any alarm symptoms were found. There were no differences in cumulative frequency between the mayor 35 and mayor 40 years old, with a frequency of 0.29 and 0.20 per 1000 endoscopies, respectively. If the age of 40 had been taken as the optimal age for screening, 4 cases of gastric cancer (8.9 per cent) would have been missed (one case per year approximately),one case would have been an early gastric cancer. The 5th percentile was 30.3 years old and the 10th was 39.4. If the age of 45 had been taken as the optimal age for screening, 6 (15 per cent) cases of gastric cancer would have been missed and 12 (27 per cent) cases if the age was 55 years old. There was no statistical difference between gender, age and duration of dyspepsia. On the other hand, relations between type of dyspepsia (ulcerative), type of lesion, position, histology and stage of gastric cancer for both groups were found. Conclusion: It´s recommended that the optimal age for endoscopic screening for gastric cancer in dyspeptic patients without alarm symptoms for both genders, should be over 40 years old.

[Viral Hepatitis A over imposed on chronic hepatic damage due to tamoxifen: report of a case]. / Hepatitis viral A sobreimpuesta a injuria hepática crónica por tamoxifeno.

A case of Hepatitis A is reported in a patient prescribed tamoxifen after surgery for breast cancer and taking tamoxifen 20 mg/day for two and a half years. Documented is the indirect development of Hepatitis A and tamoxifen-induced hepatic damage.

[Optimal age for gastric cancer screening in patients with dyspepsia without alarm symptoms]. / Edad óptima para el despistaje endoscópico de cáncer gástrico en pacientes con dispepsia sin síntomas de alarma.

OBJECTIVE: To determine the optimal age for screening endoscopy on patients with dyspepsia without alarm symptoms to avoid missing gastric cancer. METHODS: A Cross sectional study was performed (2001-2005). 285 cases of patients with dyspepsia and gastric cancer were found at Arzobispo Loayza National Hospital. Cumulative age frequencies and percentiles were used to determine the optimal age for screening endoscopy. Both groups, with and without alarm symptoms were compared using the chi-square test for categorical data. Continuous data was expressed as mean (SD) and was compared with the t- test. Significant values of p were specified as <0.05. RESULTS: A total of 32,388 upper endoscopic procedures in dyspeptic patients were performed and 285 cases of gastric cancer were diagnosed, 45 cases of them not featuring any alarm symptoms were found. There were no differences in cumulative frequency between the <35 and <40 years old, with a frequency of 0.29 and 0.20 per 1000 endoscopies, respectively. If the age of 40 had been taken as the optimal age for screening, 4 cases of gastric cancer (8.9%) would have been missed (one case per year approximately), one case would have been an early gastric cancer. The 5th percentile was 30.3 years old and the 10th was 39.4. If the age of 45 had been taken as the optimal age for screening, 6 (15%) cases of gastric cancer would have been missed and 12 (27%) cases if the age was 55 years old. There was no statistical difference between gender, age and duration of dyspepsia. On the other hand, relations between type of dyspepsia (ulcerative), type of lesion, position, histology and stage of gastric cancer for both groups were found. CONCLUSION: It's recommended that the optimal age for endoscopic screening for gastric cancer in dyspeptic patients without alarm symptoms for both genders, should be over 40 years old.

Soda consumption and overweight status of 2-year-old mexican-american children in california.

OBJECTIVE: The prevalence of overweight in United States children, 2 to 5 years old, has increased 2-fold since 1975, with the highest prevalence in Mexican Americans. The objective of this study was to determine the association between current soda consumption and overweight in 2-year-old Mexican-American children. RESEARCH METHODS AND PROCEDURES: The Center for the Health Assessment of Mothers and Children of Salinas study is a longitudinal study of the health of low-income Latino pregnant women and their children living in the Salinas Valley, CA. Six hundred pregnant women were enrolled (October 1999 to October 2000), and their children were followed until 2 years of age. This cross-sectional analysis includes the 354 children who completed the 2-year follow-up interview. Standing height (centimeters) and weight (grams) were measured at 2 years. Overweight was defined as > or =95th percentile of the sex-specific BMI for each child's age. RESULTS: Fifty-five (15.5%) children were overweight. Over half (56%) reported consuming any soda in the last week. After covariate adjustment, compared with no soda consumption, <1 soda/d was not related to overweight (adjusted odds ratio, 0.97; 95% confidence interval, 0.47, 1.99), but > or =1 soda/d was significantly associated with overweight (adjusted odds ratio, 3.39; 95% confidence interval, 1.43, 8.07), and the test for trend was significant (p = 0.02). DISCUSSION: At 2 years of age, the prevalence of overweight among the Center for the Health Assessment of Mothers and Children of Salinas cohort is higher than the national prevalence estimate for Mexican-American 2- to 5-year-old children and is significantly associated with current soda consumption. Interventions to reduce consumption of soda in young Mexican-American children should be considered.

[Colestasic toxic hepatitis caused by terbinafine: case report]. / Hepatitis tóxica colestásica por terbinafina: reporte de caso.

Trichophytic onychomycosis of the feet represents an important and serious medical problem. Until recent years, there was not cure for this unpleasant pathology. It is only at the beginning of the 50s, especially at the onset of the antimycotic systemic therapy that a cure is available offering high rate of clinical and mycological therapy. The purpose of this report is to better inform on the undesirable side-effects of antimycotic agents which are currently so largely disseminated. The case of a young patient is presented who was enjoying good health and who after 6 weeks of starting therapy with terbinafine on a doses of 1 pill of 250 mg a day, to treat a trichophytic onychomycosis in both feet, developed severe symptoms of toxic colostatic hepatitis duly corroborated after pertinent testing. Patient had a full recovery after a few months of having interrupted her therapy, apparently without any sequel. The literature in this regard has been revised and a close monitoring of the hepatic function is recommended prior and during treatment with this drug. The need to continue research to find an ideal antimycotic still not found is also recommended.

Hepatitis tóxica colestásica por terbinafina: reporte de caso / Colestasica toxic hepatitis by terbinafine: case report

Las onicomicosis tricofíticas de los pies representan un importante y serio problema médico. Hasta años recientes, no se contaba con una terapia que ofreciera curación para esta desagradable patología. Recién a partir de los años 50, sobre todo con el advenimiento de la terapia sistémica antimicótica, se puede ofrecer un elevado porcentaje de curaciones clínico-micológicas. Con el propósito de contribuir al mejor conocimiento de los efectos indeseables de estos agentes antimicóticos, actualmente tan difundidos, presentamos el caso de una paciente joven y gozando de buena salud que, 6 semanas después de iniciada la terapia con terbinafina oral a dosis terapéuticas, 1 comprimido de 250 mg por día, para tratar una onicomicosis tricofítica universal de ambos pies, desarrolló un cuadro sintomático severo de hepatitis tóxica colestásica, comprobado por las pruebas pertinentes, que, afortunadamente, remitió hasta su recuperación, varios meses después de interrumpida la terapia, sin dejar, aparentemente, secuelas. Se revisa la literatura al respecto y se llama la atención de la necesidad de controlar previamente y durante el tratamiento con esta droga la función hepática y se señala la necesidad de continuar con las investigaciones hasta el hallazgo de un antimicótico ideal, todavía no logrado.

Trichophytic onychomycosis of the feet represents an important and serious medical problem. Until recent years, there was not cure for this unpleasant pathology. It is only at the beginning ofthe 50s, especially at the onset of the antimycotic systemic therapy that a cure is available offering high rate of clinical and mycological therapy. The purpose of this report is to better inform on the undesirable side-effects of antimycotic agents which are currently so largely disseminated. The case of a young patient is presented who was enjoying good health and who after 6 weeks of starting therapy with terbinafine on a dosis of 1 pill of 250 mg a day, to treat a trichophytic onychomycosis in both feet, developed severe symptoms of toxic colostatic hepatitis duly corroborated after pertinent testing. Patient had a full recovery after a few months of having interrupted her therapy, apparently without any sequel. The literature in this regard has been revised and a close monitoring of the hepatic function isrecommended prior and during treatment with this drug. The need to continue research to find an ideal antimycotic still not found is also recommended.

[CLINICAL AND IMMUNOLOGICL PROFILE IN 22 PATIENTS WITH PRIMARY BILIARY CIRRHOSIS] / Perfil clínico e inmunológico en 22 pacientes con diagnóstico histopatológico de cirrosis biliar primaria.

The primary biliary cirrhosis (PBC) is a no frequent entity in our country. Its diagnosis is based on clinical features, cholestasic pattern in liver function tests and the presence of antimitochondrial antibody in 90% of cases and other auto-antibodies in the serum, all this information is supported by characteristic hepatic histopathologic data. Also some clinical variants have been described that has suggested different denominations such as Overlap Syndrome, associated to autoimmune hepatitis and autoimmune colangitis, known by its persistent negativity of the antimitochondrials antibodies.The present study reports the clinical, biochemical and immunological findings of 22 patients with histopathologic diagnosis of PBC observed between 1994 and 1999, in Arzobispo Loayza Hospital and private offices, in Lima, Per .Results shown a cholestatic pattern in 100% of patients, jaundice in 95%, pruritus in 86%, hyperpigmentation of skin in 40.9%, hepatomegaly in 36.9% splenomegaly in 37.3% and xantelasma in 36%; alkaline phospatase was increased between 5 and 30 times the normal values in all patients, oxalacetic and piruvic transaminases were increased more than twice the normal values in 95% and 90%, respectively and hypercholesterolemia in 89% of patients; the antimitochondrial antibodies were positive in 64%, antinuclear antibodies in 32% and anti smooth muscle in 18%; 7 patients present associated autoimmune diseases, 4 with sicca syndrome, 2 with vitilige and 1 with hemolitic anemia. Three patients were classified as primary biliary cirrhosis, associated to autoimmune hepatitis; 4 patients died during the follow up and six patients were treated with ursodeoxicholic acid for more than six months.We can conclude that the profile found is a cholestasic pattern with jaundice in the majority of patients, low positivity of mitochondrial antibodies; there was no difference between AMA positive and negative patients, and in the third part of patients it was observed an associated immune disease and in three cases there was evidence of association with autoimmune hepatitis (Overlap Syndrome). Finally, the treatment with ursodeoxicolic acid improves some biochemical parameters, but apparently, they do not survival improve.

[PREGNANCY AND HEPATITIS CIRRHOSIS] / Cirrosis Hepática y Gestación.

We report a case of a pregnant woman of 33 years old, suffering from hepatic cirrhosis by Hepatitis B with splenomegaly and portal hypertension, the 40 weeks pregnancy ended succesfully with a newborn weighting 2,900 g born by vaginal delivery.

[MYCOBACTERIUM AVIUM INTRACELLULAR DUODENITIS IN AN AIDS PATIENTS] / Duodenitis por Mycobacterium avium intracelular en un paciente con síndrome de inmunodeficiencia adquirida(SIDA).

Mycobacterium avium Intracellulare is a significant pathogen in immunocompromised patients.We present a male patient, 37 years old, HIV(positive) since 1998 with clinical history of chronic diarrhea and weigth loss. On December 1999 he was seen on the Gastroenterology service of Arzobispo Loayza Hospital. He was found to have esophageal candidiasis and Mycobacterium avium Intracellular in his duodenum.The epidemiological, clinical, endoscopy and pathological features are reviewed in this special way of presentation, the association between AIDS and MAI.