Disseminated paracoccidioidomycosis associated with lymph node tuberculosis in a non immunocompromised child.

The association of paracoccidioidomycosis (PCM) and tuberculosis (TB) produces an uncommon hyperinflammatory syndrome, causing multiorgan dysfunction. TB associated PCM is a rare condition, but it is fatal if not treated. Herein, we present a immunocompetent child who is admitted for fever and painful lymphadenopathy, with evidence of acid-alcohol-resistant bacillus (AARB) in cervical lymph node biopsy, antituberculous treatment was started with partial clinical improvement and is given discharge from hospital. At 3 weeks, he was readmitted by fever, weight loss, dyspnea and a greater number of adenopathies, in the new biopsy multiple yeasts were found compatible with PCM, our patient responded well to the combination of antituberculosis therapy(ATT), corticosteroid, and amphotericin B deoxycholate, presenting clinical improvement and subsequently continued with itraconazole.

Exceso de grasa visceral asociado a severidad de COVID-19, cuantificado por bioimpedancia / Excess visceral fat associated with severity of COVID-19 quantified by bioimpedance

Hay dos tipos principales de tejido adiposo; el subcutáneo, que es menos activo metabólicamente, y el tejido adiposo visceral, que secreta constantemente citocinas inflamatorias y está relacionado a enfermedades metabólicas y cardiovasculares. Nuestro objetivo fue identificar la asociación entre el exceso de grasa visceral y la severidad de enfermedad en pacientes con COVID-19. Se realizó un estudio observacional analítico que incluyó a pacientes con COVID-19 admitidos al Hospital Carrión de Huancayo, Perú. Se utilizó la balanza de bioimpedancia para cuantificar la composición corporal, la variable dependiente fue la severidad de enfermedad. Se utilizó el análisis de regresión logística para determinar la asociación de la grasa visceral y otros parámetros antropométricos con severidad de enfermedad. Se analizaron a 120 personas con COVID-19, la edad promedio fue 50 años, el sexo masculino fue 60%. De acuerdo a los valores de la composición corporal emitidos por el equipo de bioimpedancia: La grasa visceral > 15Kg (OR 7,31; p = 0,001); la grasa corporal total > 35% (OR 5,58; p = 0,009) y el exceso de peso > 20Kg (OR 6,96; p = 0,011) fueron los parámetros asociados a enfermedad severa por COVID-19. La relación positiva entre el perímetro abdominal y la cantidad de grasa visceral fue significativo (p = 0,01). En la composición corporal, el exceso de grasa visceral es el mayor parámetro asociado a enfermedad severa por COVID-19(AU)

There are two main types of adipose tissue; the subcutaneous, which is less metabolically active, and the visceral adipose tissue, which constantly secretes inflammatory cytokines and is related to metabolic and cardiovascular diseases. Our objetive was to identify the association between the excess of visceral fat and disease severity in COVID-19 patients. An analytical observational study was carried out which included patients with COVID-19 admitted to the Carrión Hospital in Huancayo, Peru. The bioimpedance balance was used to quantify the body composition; the dependent variable was the severity of the disease. A logistic regression analysis was used to determine the association of visceral fat and other anthropometric parameters with the severity of the disease. Out of 120 people with COVID-19 were analyzed, the average age was 50 years, the male sex was 60%. According to the body composition values issued by the bioimpedance team: Visceral fat> 15Kg (OR 7.31; p = 0.001); Total body fat> 35% (OR 5.58; p = 0.009) and excess weight> 20Kg (OR 6.96; p = 0.011) were the parameters associated with severe disease due to COVID-19. The positive relationship between abdominal circumference and the amount of visceral fat was significant (p = 0.01). In body composition, excess visceral fat is the main parameter associated with severe COVID-19 disease(AU)

Sexual Behavior of Men Who Have Sex with Men and Its Relationship to Sexually Transmitted Infections during an Outbreak of the Human Monkeypox Virus.

BACKGROUND: There is a high frequency of monkeypox (MPOX) and sexually transmitted infections (STIs) in men who have sex with men (MSM). AIM: To identify the sexual behavior of MSM during the MPOX infection period. METHODS: We conducted an observational study of cases and controls were carried out. RESULTS: A total of 171 participants were considered, two heterosexual male controls (MSW) were included for each case of MSM with a consecutive selection of people who attended the STI prevention and control center from January to July 2022. The results revealed that the mean number of sexual partners reported in the last year was higher in cases (4.2) compared to controls 1.9 (p < 0.05). The related conditions for MSM to acquire some type of STI were sexual intercourse under the influence of alcohol (OR 2.42; 95% CI: 1.11-3.96), forgetting to use a protection method (condom) (OR 3.16; 95%: 1.73-7.48) and sexual intercourse with casual couples (OR 1.4; 95% CI: 1.01-2.16). CONCLUSION: Our findings demonstrated a link between the sexual behavior of men who have sex with men and the high prevalence of sexually transmitted infections during the human monkeypox virus outbreak.

Comparación clínica y laboratorial de la fiebre amarilla severa versus dengue grave en Perú / Clinical and laboratory differences between severe yellow fever and severe dengue in emergency patients

En los centros de Emergencia con poco apoyo de laboratorio, es difícil diferenciar a los pacientes con dengue grave y fiebre amarilla severa. El objetivo fue comparar el perfil clínico y de laboratorio de los pacientes con dengue grave y fiebre amarilla severa en Urgencias. Se realizó un estudio observacional retrospectivo de pacientes con diagnóstico confirmado de dengue y fiebre amarilla en el período 2018 a 2020 atendidos en la Unidad de Emergencia del Hospital Carrión, Huancayo-Perú. Se evaluaron un total de 35 pacientes, 11 pacientes (31,4%) fueron diagnosticados con fiebre amarilla severa y 24 pacientes (68,5%) con dengue grave. La media de los resultados de laboratorio con fiebre amarilla severa fueron bilirrubina indirecta 4,7 ml/dL, aspartato transaminasa 4463 UI/L, transaminasa aminotransferasa 4329 UI/L, creatinina 4,9 mg/dl. En pacientes con dengue grave el hematocrito promedio fue 51,8, hemoglobina 17,6 g/dl, plaquetas 24 × 103/mm. En pacientes con síndrome ictérico-febril la presencia de bradicardia, bilirrubina indirecta elevada y transaminasas muy elevadas debe hacer sospechar de fiebre amarilla; mientras que los pacientes que acuden por ascitis, derrame pleural, aumento de hematocrito y deficiencia de plaquetas, se debe tratar como dengue grave sobre todo en Unidades de Emergencia con poco apoyo de laboratorio(AU)

In Emergency centers with little laboratory support, differentiating patients with dengue and yellow fever is difficult. The Aim was to compare the clinical and laboratory profile of patients with severe dengue and severe yellow fever in the Emergency unit. We conducted a retrospective observational study of patients with a confirmed diagnosis of dengue and yellow fever in the period 2018 to 2020 treated in the Emergency Unit of the Carrión hospital, Huancayo-Peru. A total of 35 patients were evaluated, 11 patients (31.4%) were diagnosed with severe yellow fever and 24 patients (68.5%) with severe dengue. The mean laboratory results in patients with severe yellow fever were indirect bilirubin 4.7 ml/dL, aspartate transaminase 4463 IU/L, transaminase aminotransferase 4329 IU/L, creatinine 4.9 mg / dl. In patients with severe dengue were hematocrit 51.8, hemoglobin 17.6 g / dl, platelets 24 × 103 / mm. In patients with syndrome jaundice and fever the presence of bradycardia, elevated indirect bilirubin, and very elevated transaminases should be suspicious for yellow fever; while in patients who come for ascites, pleural effusion, increased hematocrit and platelet deficiency, it should be treated as severe dengue especially in Emergency Units with little laboratory support(AU)

Perfil del recién nacido con síndrome de dificultad respiratoria hospitalizado en una Unidad de Cuidados Intensivos e Intermedios Neonatales. Perú-2016 / Profile of the newborn with respiratory distress syndrome hospitalized in a Unit of Intensive Care and Neonatal Intermediate. Peru-2016

Introducción: El síndrome de dificultad respiratoria del recién nacido (SDRN) es una condición compleja que afecta al proceso normal de la relación a la ventilación, afecta aproximadamente al 6-7 por ciento de todos los recién nacidos. Contribuye en más del 50 por ciento a la mortalidad neonatal precoz. En el Perú durante la última década se logró disminuir la tasa de mortalidad en más de los 2/3 partes alcanzando así el cuarto objetivo del mileno. A pesar de ello el SDRN es la patología neonatal más frecuente por lo que es importante caracterizar al recién nacido con el SDRN hospitalizado en la UCI y/o UCIN neonatal de un hospital nacional del Perú. Objetivo: caracterizar al recién nacido con SDRN hospitalizado en la unidad de cuidados intensivos e intermedios del hospital Nacional Daniel Alcides Carrión. Materiales y métodos: se realizó un estudio observacional descriptivo de corte retrospectivo. Población: se incluyó a todos los recién nacidos ingresados a la UCI y UCIN neonatal por el diagnóstico de SDRN durante e12015. Intervención: se revisó las epicrisis y las historias clínicas de los pacientes incluidos en el estudio. Resultados: El 40 por ciento de los ingresos fueron a causa del SDRN de los cuales el 10 por ciento fallecieron, asimismo se encontró que el 60,39 por ciento (215) de los casos se debieron a la taquipnea transitoria del recién nacido (TTRN); el 15 por ciento (54) a la enfermedad de la membrana hialina, el 11,8 por ciento al síndrome de aspiración meconial y el otro 5,6 por ciento (20) debido a la bronquiolitis. Discusión: La incidencia anual del SDRN fue de 40 por ciento siendo la principal causa de ingreso, estos resultados son similares a los encontrados por Hibbard JU and cols. El 60 por ciento fueron hospitalizados en la UCI neonatal donde el 100 por ciento de los casos de la enfermedad de la membrana hialina requirieron atención en la UCI, y por el contrario el 45 por ciento de los casos de TTRN requirieron atención exclusivamente...

Introduction: Respiratory distress syndrome of the newborn (SDRN) is a complex condition that affects the normal process of the relationship Ventilation, affects approximately 6-7 per cent of all newborns. It contributes more than 50 per cent early neonatal mortality. In Peru during the last decade reduced the death rate by more than the two thirds parts thus achieving the fourth goal of the millennium. Despite this SDRN is the most common neonatal disease so it is important to characterize the newborn with SDRN hospitalized in the ICU and / or neonatal NICU of a national hospital in Peru. Objective: To characterize the newborn with SDRN hospitalized in intensive care and intermediate National hospital Daniel Alcides Carrion. Materials and Methods: A descriptive observational retrospective cohort study was performed. Population: included all newborns admitted to the neonatal ICU and NICU for the diagnosis of SDRN during 2015. Intervention: the epicrisis and clinical records of patients included in the study was reviewed. Results: 40 per cent of revenue was due to SDRN of which 10 per cent died of SDRN also found that 60.39 per cent (215) of the cases were due to transient tachypnea of the newborn; 15 per cent (54) was due to hyaline membrane disease, 11.8 per cent was due to meconium aspiration syndrome and the other 5.6 per cent (20) was due to bronchiolitis. Discussion: The annual incidence was 40 per cent SDRN being the main cause of admission, these results are similar to those found by Hibbard JU and cols. We found that 60 per cent were hospitalized in the neonatal ICU where 100 per cent of cases of the disease hyaline membrane required ICU care, and conversely 45 per cent of cases of transient tachypnea of the newborn requiring attention exclusively in the ICU. However Li-ling et al. They found that only 20 per cent of cases of cases requiring hospitalization in the ICU. Conclusions: transient tachypnea of the newborn is the most common cause of the...

Factores sociodemográficos asociados a actividad física y sedentarismo en población peruana adulta / Sociodemographic factors associated with physical activity and sedentary behavior in adult peruvian population

La actividad física constituye uno de los pilares para la prevención de las enfermedades crónicas no transmisibles como el cáncer, la diabetes, la cardiopatía isquémica, entre otras. Objetivo: analizar las preguntas de la Encuesta Demográfica y de Salud Familiar (ENDES) 2012 relacionadas a actividad física y sedentarismo en la población peruana de 40 a más años de edad y determinar cuáles son los factores sociodemográficos asociados. Métodos: Se realizó un análisis secundario de la ENDES 2012, de diseño probabilístico, estratificado y multietápico. Se realizó el análisis de cada pregunta relacionada a actividad física y el de las variables sociodemográficas. Resultados: Se analizaron los datos de 31 348 personas, de los cuales el 53,7% fueron mujeres. El 19,2% de la población realiza sus actividades sentado, 29,1% realiza esfuerzo leve para sus actividades diarias; el 45,2% no practica deporte y el 15,5% ve televisión más de 3 horas los días domingo. Las mujeres presentaban menor práctica de deportes (OR: 2,13 IC95%: 2,03 – 2,23) y más esfuerzo leve que moderado a intenso (OR: 1,47 IC95%: 1,40 – 1,54), además a partir de los 60 años se presenta menor práctica deportiva (OR:1,18 IC95%: 1,11 – 1,26) , mayor actividad diaria sentado (OR: 1,12 IC95%: 1,03 – 1,22) con esfuerzo físico leve (OR: 1,42 IC95%: 1,32 – 1,52). Conclusiones: Estudios realizados en Perú asociaron la práctica de actividad física con la disminución del riesgo de desarrollar síndrome metabólico, diversas estrategias para incentivar estas prácticas en áreas urbanas, han demostrado que esto es posible. Según la ENDES 2012 la mayoría de personas realiza actividad de pie que demanda un esfuerzo de moderado a alto, siendo menor en las zonas urbanas. Las conductas sedentarias aumentan con la edad. Se recomienda mayores estudios en la población adulta de sexo femenino que reside en áreas urbanas.

Physical activity is considered one of the main pillars to prevent non-transmissible chronic diseases. It's well known that sedentarism is associated with cancer, diabetes and ischemic heart disease. Objective: to analyze the questions regarding physical activity and sedentarism used at the Population and Family Health Survey (ENDES) 2012 in peruvian population of 40 years of age or more and to identify sociodemographic factors associated. Methods: Secondary data analysis of the ENDES 2012, a probabilistic, stratified and multistage sample study. Each question was analyzed separately and bivariate analysis was performed to assess the association with sociodemographic characteristics. Results: 31 348 individuals were included, 53,7 % were women. 19,2% remain seated in order to do their jobs, and 29,1% required low efforts. 45,2% did not practice sports at least once a week, and 15,5% watched more than 3 hours of television on Sundays. Women presented less chance of practicing sports (OR: 2,13 95%CI: 2,03 – 2,23) and required low efforts for their daily activities (OR: 1,47 95%CI: 1,40 – 1,54). People older than 60 years practiced less sports (OR:1,18 95%CI: 1,11 – 1,26) and spent more time seated (OR: 1,12 95%CI: 1,03 – 1,22) doing activities that required less effort (OR: 1,42 95%C: 1,32 – 1,52). Conclussions:The practice of physical activity has been associated with a decrease in the risk for developing metabolic syndrome in Perú, several strategies have been proven effective at urban areas. According to the ENDES 2012 analysis most of peruvians practice their daily activity standing and required moderate to high effort. Sedentarism grew higher with age. More studies in adult population and women living at urban areas should be performed.

A new paradigm for military humanitarian medical operations: mission-generic metrics.

OBJECTIVE: We report the history of military humanitarian medical operations, define the current science of process and outcome evaluation, and propose a set of generic metrics for monitoring and evaluation in military humanitarian operations. METHODS: We comprehensively reviewed the unclassified literature and used our own experiences in military humanitarian activities. RESULTS: Our literature review shows that efforts to evaluate the relative quality or cost-effectiveness of military humanitarian missions have been largely unsuccessful. In response to this finding, the authors propose a monitoring and evaluation checklist system with generic metrics, which are broadly applicable but also can be customized specifically for the user. CONCLUSIONS: Military humanitarian operations can provide substantial security value to their many different stakeholders. Refinement of our proposed mission-generic metrics list is one method to measure performance and relative quality. Better assessment of outcomes can clarify decisions about the utilization of limited military medical humanitarian funds and personnel.

U.S. Air Force Mobile Ophthalmic Surgery Team.

OBJECTIVE: The objective of this study was to report the evolution of the U.S. Air Force Mobile Ophthalmic Surgical Team (MOST). METHODS: U.S. Air Force ophthalmologists at Wilford Hall Medical Center in San Antonio, Texas, designed a small, portable, rapid-response eye surgical team. Field testing with humanitarian deployments refined the deployment package and provided operational training. RESULTS: MOST successfully deployed to Central and South America, the Caribbean, and Africa 42 times since 1991, with 50,287 patients examined/treated and 4,812 surgeries performed. Realistic readiness training was provided for 80% of U.S. Air Force ophthalmologists and Army, Navy, and Reserve colleagues. Subsequent modifications to the MOST improved its capability while reducing the size and weight of the team, equipment, and supplies by 50%. CONCLUSIONS: Using MOST humanitarian missions as a refining model, U.S. Air Force deployable ophthalmic assets are modular, lightweight, and multifunctional, which allows commanders to custom-build an appropriate response to each unique contingency, disaster, or humanitarian need with mission-ready ophthalmologists.

Comportamiento clínico y evolución de los embarazos abdominales / Clinical behaviour and evolution of abdominal pregnancy

Con el objetivo de determinar el comportamiento clínico y la evolución de los embarazos abdominales en el Hospital de Maternidad Nuestra Señora de la Altagracia se analizaron todos los casos que se presentaron en un período de ocho años (Diciembre 1988 a diciembre 1993). Ocurrieron 11 casos, representando 1 por cada 15,210 nacimientos y 1 de cada 22 embarazos ectópicos, 91// de las pacientes tenían una edad entre 15 y 35 años y 90.9// eran multíparas. La sintomatología más frecuente fue: dolor abdominal (100//), sangrado transvaginal (63.6//), y vómitos (54.5//). En todos los casos (100//) el manejo fue quirúrgico, se le extrajo la placenta a 81.8//, 7 productos (63.6//) fueron catalogados como abortos y 4 (36.4//) como productos viables, de esos 1 presentó malformación congénita. Solo una de las pacientes (9//) presentó complicaciones y falleció