The Burkholderia contaminans prevalent phenotypes as possible markers of poor clinical outcomes in chronic lung infection of children with cystic fibrosis.

Burkholderia contaminans, a species of the Burkholderia cepacia complex-prevalent in certain Latin-American and European countries-can cause chronic pulmonary infection in persons with cystic fibrosis. Our aim was to gain insights into long-term lung infections with a focus on correlating how bacterial phenotypic traits in the chronic infection impact on patients' clinical outcome. Genotypic characteristics of 85 B. contaminans isolates recovered from 70 patients were investigated. For 16 of those patients, the clinical status and bacterial phenotypic characteristics, e.g. several virulence factors, phenotypic variants, and the antimicrobial susceptibility pattern, were evaluated. Two clones were found in the whole bacterial population: (i) the multiresistant ST 872 PCR-recA-RFLP-HaeIII-K-pattern clone, which carries a pathogenic island homologous to BcenGI11 of B. cenocepacia J2315, and (ii) the ST 102 PCR-recA-RFLP-HaeIII-AT-pattern clone. The emergence of certain bacterial phenotypes in the chronic infection such as the nonmucoid phenotype, small colony variants, brownish pigmented colonies, and hypermutators, proved to be, together with coinfection with Pseudomonas aeruginosa, the possible markers of more challenging infections and poor prognosis. The presence of cocolonizers and the bacterial phenotypes that are especially adapted to persist in long-term respiratory tract infections have a crucial role in patients' clinical outcomes.

Comunicación en el consultorio de medicina familiar: trabajo multicéntrico, cualitativo cuantitativo, en los meses de abril a julio de 2014, en Buenos Aires, Rosario y Tucumán / Communication in Family Medicine practice: multicenter research trial, qualitative and quantitative, from April to June 2014. in the City of Buenos Aires, Rosario and Tucumán

Introducción: la comunicación es trascendental para la vida en sociedad. El éxito de cualquier entrevista clínica depende de la calidad de la comunicación entre el médico y el paciente. Distintos factores pueden interferir en esta, como el ambiente, el tiempo y las interrupciones. Objetivo: Evaluar el grado de comprensión del mensaje transmitido por el médico hacia el paciente. Material y método: Trabajo multicéntrico, cualitativo cuantitativo. Componente cuantitativo: descriptivo de corte transversal de abril a julio de 2014. Se incluyeron 1200 adultos de ambos sexos, que asistieron a los Ce.M.A.P y 40 médicos de familia. Componente cualitativo: Muestreo no probabilístico, intencional, hasta saturación de datos. Triangulación y convergencia de datos. Resultados y discusión: Respecto al componente cuantitativo, se encontró que nuestras hipótesis acerca de la falta de comprensión del mensaje (indicaciones y problema de salud) no pudieron comprobarse. Ya que las indicaciones realizadas por el médico tuvieron una adecuación total del 60% y comprendieron el problema de salud un 77% de los pacientes entrevistados. Para el componente cualitativo luego del análisis temático se obtuvieron barreras (tiempo, paciente polidemandante, ideas previas, omisión de indicaciones no farmacológicas) y facilitadores (conocimiento previo del problema de salud, longitudinalidad, paciente acompañado) para la comprensión del mensaje. Conclusiones: Los pacientes entienden el mensaje de sus médicos de familia, ya que contamos con herramientas concretas como la escucha empática, el proceso clínico centrado en la persona y la longitudinalidad en la atención (AU)

Introduction: communication is important for life in a society. Success in any clinical interview depends on the quality of patient-doctor communication. Different factors may interfere, like the environment, time and interruptions. Objective: Asses the level of understanding of the message given to the patient by the doctor. Material and method: Multicenter research trial, qualitative and quantitative. Quantitative component: cross sectional descriptive from April to June 2014. 1200 adults of both sexes who assisted to the primary health care center: "Ce.M.A.P." in the City of Buenos Aires, Rosario and Tucumán and 40 family practitioners. Qualitative component: nonprobability, intentional sampling upon data saturation. Data triangulation and convergence. Results and discussion: as regards the quantitative component, we found out that our hypothesis in relation to the lack of understanding in the message (indications and health problem) could not be proven. Since 60% of the practitioner's indications were followed and 77% of the interviewed patients understood the health problem. Considering the qualitative component after the thematic analysis, barriers (time, highly demanding patient, previous knowledge, omission of non-pharmacological indications) and facilitators were obtained (previous knowledge of health problem, longitudinality, accompanied patient) to understand the message. Conclusion: patients understand their family practitioner's message since we have specific tools like empathic listening, patient centered healthcare and longitudinality in attention (AU)

[The frequency and clinical profile of gallbladder cancer in patients undergoing cholecystectomy in 3 reference hospitals in Chiclayo between 2011-2015]. / Frecuencia y perfil clínico de cáncer de vesícula biliar en pacientes colecistectomizados en 3 hospitalesreferenciales de Chiclayo entre 2011 y 2015.

OBJECTIVES: To describe the frequency and clinical profile of gallbladder cancer in patients undergoing cholecystectomy in 3 reference hospitals in Chiclayo between 2011-2015. MATERIALS AND METHODS: A retrospective cross-sectional study. The study is divided into 2 phases, the first was to count the total number of reports of gallbladder pathology and select positive cases for cancer; the second phase was to collect data from the medical records of patients positive for cancer. RESULTS: From 5720 pathology reports gallbladder, 58 (1.01%) were positive for vesicular neoplasia. 42 cases (72.4%) were women and only 16 (27.6%) were men. The most common symptom was abdominal pain in 41 cases (70.7%). 18 patients (31%) reported other symptoms, the hyporexia was the most frequent with 8 cases (13.8%). 41 cases (70.7%) had gallstone. The predominant type of cancer was adenocarcinoma in 48 cases (82.8%) followed by mucinous carcinoma in 3 cases (5.2%). CONCLUSIONS: In the department of Lambayeque frequency of gallbladder cancer was 1.01% with predominance in females and sixth decade of life, being Adenocarcinoma, the most common type. Likewise, patients had more frequent abdominal pain and jaundice.

Frecuencia y perfil clínico de cáncer de vesícula biliar en pacientes colecistectomizados en 3 hospitales referenciales de Chiclayo entre 2011 y 2015 / The frequency and clinical profile of gallbladder cancer in patients undergoing cholecystectomy in 3 reference hospitals in Chiclayo between 2011-2015

Objetivos: Describir la frecuencia y perfil clínico de cáncer de vesícula biliar en pacientes colecistectomizados en 3 hospitales referenciales en Chiclayo entre 2011-2015. Materiales y métodos: Estudio descriptivo transversal retrospectivo. El estudio está dividido en 2 fases, la primera consistió en contabilizar el número total de informes de patología de vesícula biliar y seleccionar los casos positivos para cáncer; la segunda fase consistió en recolectar datos de las historias clínicas de los pacientes positivos para cáncer. Resultados: De 5720 reportes de anatomía patológica de vesícula biliar, 58 (1,01%) fueron positivas para neoplasia vesicular. 42 casos (72,4%) fueron mujeres y solo 16 (27,6%) fueron hombres. El síntoma más frecuente fue el dolor abdominal con 41 casos (70,7%). 18 pacientes (31%) refirieron otra sintomatología, la hiporexia fue la más frecuente con 8 casos (13,8%). 41 casos (70,7%) presentaron cálculos vesiculares. El tipo de cáncer que predomino fue el adenocarcinoma con 48 casos (82,8%) seguido por el carcinoma mucinoso con 3 casos (5,2%). Conclusiones: En el departamento de Lambayeque la frecuencia de cáncer de vesícula biliar fue de 1,01% con predominancia en el sexo femenino y sexta década de la vida, siendo el Adenocarcinoma, el tipo más común. Así mismo, los pacientes presentaron con mayor frecuencia dolor abdominal e ictericia

ABSTRACT Objectives: To describe the frequency and clinical profile of gallbladder cancer in patients undergoing cholecystectomy in 3 reference hospitals in Chiclayo between 2011-2015. Materials and methods: A retrospective cross-sectional study. The study is divided into 2 phases, the first was to count the total number of reports of gallbladder pathology and select positive cases for cancer; the second phase was to collect data from the medical records of patients positive for cancer. Results: From 5720 pathology reports gallbladder, 58 (1.01%) were positive for vesicular neoplasia. 42 cases (72.4%) were women and only 16 (27.6%) were men. The most common symptom was abdominal pain in 41 cases (70.7%). 18 patients (31%) reported other symptoms, the hyporexia was the most frequent with 8 cases (13.8%). 41 cases (70.7%) had gallstone. The predominant type of cancer was adenocarcinoma in 48 cases (82.8%) followed by mucinous carcinoma in 3 cases (5.2%). Conclusions: In the department of Lambayeque frequency of gallbladder cancer was 1.01% with predominance in females and sixth decade of life, being Adenocarcinoma, the most common type. Likewise, patients had more frequent abdominal pain and jaundice

El peso de un diagnóstico / The weight of a diagnosis

Introducción: el estado nutricional (EN) infantil requiere adecuada evaluación. Objetivos: Describir el EN de niños de 1-5 años que asistieron a tres centros de atención primaria de una obra social en 2014 y su método de evaluación. Conocer el impacto del diagnóstico en sus familias. Materiales y métodos: Estudio multicéntrico cuali-cuantitativo, n=891. Se revisaron historias clínicas y se entrevistó a padres de niños con diagnóstico de obesidad o bajo peso. Resultados: El 52% de los niños fueron evaluados con percentilos Peso/Edad, hallándose 71% eutrófico, 6% con obesidad, y 4% bajo peso. Utilizando percentilos IMC/Edad, 60% resulto eutrófico, 14 % con obesidad y 1% con bajo peso. En el análisis cualitativo se observaron: naturalización diagnóstico, dificultad de los padres para poner límites, sentimientos de culpa y frustración y déficit en la comunicación médico-familia. Conclusión: El 60% de los niños de 1-5 años que consultaron en tres centros de atención primaria de un obra social en el 2014 resultaron eutróficos, 14% con obesidad y 1% bajo peso. La mayoría de los niños fueron evaluados utilizando percentilos incorrectos. La subestimación del diagnóstico por parte de los padres fue favorecida por el uso de eufemismos y lenguaje diminutivo por parte de los médicos.

Introduction: childhood nutritional status (NS) requires adequate assessment. Objectives: To describe NS of children aged 1-5 that attended three primary care centers of a social security organisation during 2014 and its method of assessment. To know the impact the diagnosis had on their families. Materials and methods: Quali-quantitative multicenter study, n=891. Charts were reviewed and parents of children diagnosed with obesity or low weight were interviewed. Results: 52% of children were assessed using Weight/Age percentiles, being 71% eutrophic, 6% with obesity, and 4% low weight. Using BMI/Age percentiles, 60% were eutrophic, 14% with obesity and 1% with low weight. In the qualitative analysis were observed: naturalization of the diagnosis, parental difficulties in setting limits, feelings of the quilt and frustration, anddeficits in physician-family communication. Conclusion: Using the BMI/Age curve, 60% of the 1-5 year olds who were attended at three primary care centers of a social security organisation in 2014 were eutrophic, 14% were obese and 1% had low weight. Most children were assessed using wrong percentiles. Underestimation of the diagnosis by parents was favored by the use of euphemisms and diminutive language by physicians.

Cystic Fibrosis Cloud database: Un sistema informático para el almacenamiento y manejo de datos clínicos y microbiológicos del paciente con fibrosis quística / Cystic Fibrosis Cloud database: An information system for storage and management of clinical and microbiological data of cystic fibrosis patients

El manejo clínico y epidemiológico de los pacientes con fibrosis quística (FQ) con exacerbaciones pulmonares agudas o infecciones pulmonares crónicas demanda una actualización permanente de procedimientos médicos y microbiológicos, estos se asocian con la constante evolución de los agentes patógenos durante la colonización de su hospedador. Para poder monitorear la dinámica de estos procesos es fundamental disponer de sistemas expertos que permitan almacenar, extraer y utilizar la información generada a partir de estudios realizados sobre el paciente y los microorganismos aislados de aquel. En este trabajo hemos diseñado y desarrollado una base de datos on-line basada en un sistema informático que permite el almacenamiento, el manejo y la visualización de la información proveniente de estudios clínicos y de análisis microbiológicos de bacterias obtenidas del tracto respiratorio del paciente con FQ. Este sistema informático fue designado como Cystic Fibrosis Cloud database (CFC database) y está disponible en el sitio http://servoy.infocomsa.com/cfc_database. Está compuesto por una base de datos principal y una interfaz on-line, la cual emplea la arquitectura de productos Servoy basada en tecnología Java. Si bien el sistema CFC database puede ser implementado como un programa local de uso privado en los centros de asistencia a pacientes con FQ, admite también la posibilidad de ser empleado, actualizado y compartido por diferentes usuarios, quienes pueden acceder a la información almacenada de manera ordenada, práctica y segura. La implementación del CFC database podría tener una gran impacto en la monitorización de las infecciones respiratorias, la prevención de exacerbaciones, la detección de organismos emergentes y la adecuación de las estrategias de control de infecciones pulmonares en pacientes con FQ

The epidemiological and clinical management of cystic fibrosis (CF) patients suffering from acute pulmonary exacerbations or chronic lung infections demands continuous updating of medical and microbiological processes associated with the constant evolution of pathogens during host colonization. In order to monitor the dynamics of these processes, it is essential to have expert systems capable of storing and subsequently extracting the information generated from different studies of the patients and microorganisms isolated from them. In this work we have designed and developed an on-line database based on an information system that allows to store, manage and visualize data from clinical studies and microbiological analysis of bacteria obtained from the respiratory tract of patients suffering from cystic fibrosis. The information system, named Cystic Fibrosis Cloud database is available on the http://servoy.infocomsa.com/cfc_database site and is composed of a main database and a web-based interface, which uses Servoy's product architecture based on Java technology. Although the CFC database system can be implemented as a local program for private use in CF centers, it can also be used, updated and shared by different users who can access the stored information in a systematic, practical and safe manner. The implementation of the CFC database could have a significant impact on the monitoring of respiratory infections, the prevention of exacerbations, the detection of emerging organisms, and the adequacy of control strategies for lung infections in CF patients

[Cystic Fibrosis Cloud database: An information system for storage and management of clinical and microbiological data of cystic fibrosis patients]. / Cystic Fibrosis Cloud database: Un sistema informático para el almacenamiento y manejo de datos clínicos y microbiológicos del paciente con fibrosis quística.

The epidemiological and clinical management of cystic fibrosis (CF) patients suffering from acute pulmonary exacerbations or chronic lung infections demands continuous updating of medical and microbiological processes associated with the constant evolution of pathogens during host colonization. In order to monitor the dynamics of these processes, it is essential to have expert systems capable of storing and subsequently extracting the information generated from different studies of the patients and microorganisms isolated from them. In this work we have designed and developed an on-line database based on an information system that allows to store, manage and visualize data from clinical studies and microbiological analysis of bacteria obtained from the respiratory tract of patients suffering from cystic fibrosis. The information system, named Cystic Fibrosis Cloud database is available on the http://servoy.infocomsa.com/cfc_database site and is composed of a main database and a web-based interface, which uses Servoy's product architecture based on Java technology. Although the CFC database system can be implemented as a local program for private use in CF centers, it can also be used, updated and shared by different users who can access the stored information in a systematic, practical and safe manner. The implementation of the CFC database could have a significant impact on the monitoring of respiratory infections, the prevention of exacerbations, the detection of emerging organisms, and the adequacy of control strategies for lung infections in CF patients.

Caracterización molecular de cáncer colorrectal hereditario en Perú / Molecular characterization of hereditary colorectal cancer in Peru

Investigar molecularmente la deficiencia en los genes de reparo de DNA (MMR) asociados al síndrome de Lynch. Materiales y métodos: Realizar los análisis de inmunohistoquímica e inestabilidad de microsatélites (MSI) en 5 familias con sospecha de síndrome de Lynch de acuerdo a los criterios clínicos de Amsterdam y/o Bethesda, atendidos en el Hospital Nacional Almanzor Aguinaga Asenjo de la ciudad de Chiclayo (Lambayeque-Perú) durante 2007-2010. Resultados. La falta de expresión de las proteínas MLH1/PMS2 y una alta MSI (MSI-H) fueron observados en un paciente de sexo masculino de 60 años diagnosticado con adenocarcinoma de grado I. Adicionalmente, se realizó el análisis mutacional puntual en el gen BRAF (V600E) a fin de descartar que se trate de un caso esporádico de cáncer colorrectal. La ausencia de mutación en el gen analizado asociado a los resultados moleculares del tumor, sugiere la caracterización de este paciente como sospecha de síndrome de Lynch. Conclusiones: Es el primer estudio molecular reportado en la población peruana y demuestra la importancia del análisis molecular en familias con sospecha de cáncer colorrectal hereditario a fin de ofrecer posibilidades de vigilancia y seguimiento que han demostrado reducir la morbilidad y la mortalidad del cáncer colorrectal así como contribuir a la caracterización a nivel genética y clínica de este tipo de cáncer en la población peruana...

To investigate the molecular deficiency in MMR genes associated to Lynch syndrome. Material and methods: Immunohistochemical and microsatellite instability (MSI) analysis were performed in 5 families with suspected Lynch syndrome according to the clinical criteria, Amsterdam and/or Bethesda that had been treated at the Hospital Nacional Almanzor Aguinaga Asenjo (Lambayeque-Peru) during 2007-2010. Results: The absence of expression of MLH1/PMS2 and high MSI (MSI-H) were observed in a male patient aged 60 with adenocarcinoma grade I. In addition, the point mutational analysis was performed in BRAF (V600E) to rule that it is a sporadic case of colorectal cancer. The absence of mutation in BRAF together with the molecular analysis suggests the suspicion as a Lynch syndrome. Conclusions: It is the first molecular study reported in the Peruvian population and demonstrates the importance of molecular analysis in families with suspected hereditary colorectal cancer in order to provide possibilities of surveillance and monitoring that have been shown to reduce morbidity and mortality of colorectal cancer. The present study contributes to the genetic and clinical characterization of the Lynch syndrome in the Peruvian population...

Identificación de cáncer colorrectal hereditario / Identification of heredity colorectal cancer: Lynch Syndrome

El síndrome de Lynch representa aproximadamente 4% de todos los tipos de cáncer colorrectal. Este síndrome se manifiesta en las familias de manera autosómica dominante y predispone a los individuos al desarrollo de cánceres temprano en la vida. El síndrome de Lynch es causado por mutaciones en la línea germinal de los genes que codifican las proteínas responsables de la reparación del daño al ADN, MLH1, MSH2, MSH6 y PMS2. La correcta historia familiar es en la actualidad el principal método para la identificación de pacientes con alto riesgo de presentar esta enfermedad, no obstante existen criterios clínicos ya establecidos. Es muy importante establecer medidas de vigilancia y monitoreo en los personas identificadas como portadoras de este síndrome, con la finalidad de ofrecer un programa de diagnóstico a sus familiares, ya que ayuda a reducir la morbimortalidad. El objetivo de esta revisión es describir los nuevos avances y conceptos sobre el síndrome de Lynch, su espectro tumoral, las características clínicas-patológicas, la correlación genotipo-fenotipo, los métodos de diagnóstico e identificación de mutaciones, así como resaltar su impacto en salud pública.

[Molecular characterization of hereditary colorectal cancer in Peru]. / Caracterización molecular de cáncer colorrectal hereditario en Perú.

OBJECTIVE: To investigate the molecular deficiency in MMR genes associated to Lynch syndrome. MATERIAL AND METHODS: Immunohistochemical and microsatellite instability (MSI) analysis were performed in 5 families with suspected Lynch syndrome according to the clinical criteria, Amsterdam and/or Bethesda that had been treated at the Hospital Nacional Almanzor Aguinaga Asenjo (Lambayeque-Peru) during 2007-2010. RESULTS: The absence of expression of MLH1/PMS2 and high MSI (MSI-H) were observed in a male patient aged 60 with adenocarcinoma grade I. In addition, the point mutational analysis was performed in BRAF (V600E) to rule that it is a sporadic case of colorectal cancer. The absence of mutation in BRAF together with the molecular analysis suggests the suspicion as a Lynch syndrome. CONCLUSIONS: It is the first molecular study reported in the Peruvian population and demonstrates the importance of molecular analysis in families with suspected hereditary colorectal cancer in order to provide possibilities of surveillance and monitoring that have been shown to reduce morbidity and mortality of colorectal cancer in the Peruvian population.