Emotional journey of patients with specified intractable diseases in Japan.

This study aimed to depict the emotional journey of Japanese patients with specific intractable diseases facing challenges associated with a delayed diagnosis. Specifically, our focus was on elucidating the emotional journey of patients and identifying the unmet needs caused by a delayed diagnosis. We conducted a web-based survey targeting 179 patients with 11 specified intractable diseases. They reported their emotional states during each journey phase using a 10-point scale. The results revealed that the period from noticing bodily changes to clinic visits was characterized by the most negative emotional states. Furthermore, the patients experienced a gradual shift towards positive emotional states as they decided to complete a consultation at a specialized hospital. They reached their most positive emotional states when they received a definitive diagnosis, subsequent treatment, and care. The thematic classification of emotional changes at the time of definitive diagnosis showed that "relief" was the most prevalent emotion (41.9%), followed by "no change" (19.9%), "anxiety" (14.0%), "shock" (13.4%), and "resignation" (6.5%). Additionally, when classifying the thematic changes in emotions during the period of bodily changes and clinic visits, "frustration" was the most common (51.3%), followed by "fear and anxiety" (43.6%). Patients tended to be most psychologically distressed during the period leading up to the definitive diagnosis. These results reveal that patients with intractable diseases are seeking a fast and accurate diagnosis, and that achieving these is a key unmet need for the patients.

Delay in identification, healthcare-seeking, and definitive diagnosis of tuberculosis among students in Urumqi City from 2010 to 2019 / 预防医学

Objective@#To investigate the delay in identification, healthcare-seeking, and definitive diagnosis of tuberculosis among students in Urumqi City from 2010 to 2019, and to identify the influencing factors, so as to provide insights into tuberculosis control among students.@*Methods@#The demographic and diagnosis data of tuberculosis patients in Urumqi City from 2010 to 2019 were captured from the Tuberculosis Information Management System of Chinese Disease Control and Prevention Information System. The delay in identification, healthcare-seeking and definitive diagnosis of tuberculosis was analyzed among students, and the factors affecting the delay in identification, healthcare-seeking and definitive diagnosis of tuberculosis were identified using a multivariable logistic regression model. @*Results@#A total of 996 tuberculosis cases were identified among students in Urumqi City from 2010 to 2019. There were 702 students with delay in identification of tuberculosis (70.48%), 500 students with delay in healthcare-seeking (55.22%) and 534 students with delay in definitive diagnosis (53.61%). Multivariable logistic regression analysis identified active identification (OR=0.116, 95%CI: 0.032-0.420) as a factor affecting delay in identification of tuberculosis, women (OR=1.424, 95%CI: 1.104-1.836), non-local household registration (OR=1.311, 95%CI: 1.016-1.694) and active identification (OR=0.232, 95%CI: 0.064-0.848) as factors affecting delay in healthcare-seeking, and active identification (OR=0.143, 95%CI: 0.032-0.644) as a factor affecting delay in definitive diagnosis of tuberculosis among students.@*Conclusions@#There is a high proportion of delay in identification, healthcare-seeking and definitive diagnosis of tuberculosis among students in Urumqi City from 2010 to 2019, and female and non-locally household-registered students were at a high risk of delay in healthcare-seeking for tuberculosis. Active detection and screening of tuberculosis should be reinforced.

Functional profiling of LDLR variants: Important evidence for variant classification: Functional profiling of LDLR variants.

BACKGROUND: Familial Hypercholesterolemia (FH) is a semidominant disorder of the lipid metabolism associated with premature atherosclerosis and coronary heart disease. So far, about 3,000 unique LDLR variants have been described, most of which lack functional evidence proving their effect on LDLR function, despite the important role that functional studies play in variant classification. OBJECTIVE: In this work, we aimed to functionally characterize 13 rare missense variants, identified worldwide and in Portugal, in clinical FH patients. METHODS: LDLR-deficient CHO-ldlA7 cells were transfected with plasmids carrying different LDLR variants generated by site-directed mutagenesis. LDLR activity and expression were assessed by FACS. RESULTS: 11/13 variants affect LDLR function (p.Cys109Phe; p.Cys143Arg; p.Glu267Lys; p.Cys352Ser; p.Ile451Thr; p.His485Gln; p.Asp492Asn; p.Val500Ala; p.Gly529Arg; p.Phe614Ile; p.Glu626Lys) and 2/13 are inconclusive (p.Arg81Cys; p.Gly98Arg;). CONCLUSION: Of the 13 variants studied, 8 were classified as VUS by ACMG criteria, but for 7 of these 8, our functional studies were able to reassign them as Likely pathogenic or Pathogenic. For an accurate diagnosis, an effort must be made to improve functional characterization of putative disease-causing variants.

Estudio transoperatorio de tumores limítrofes de ovario. Características que pueden repercutir en el diagnóstico / The intraoperative study in borderline ovarian tumors. Characteristics that can impact the diagnosis

Resumen OBJETIVO: Determinar el porcentaje de concordancia del estudio transoperatorio con el diagnóstico definitivo de tumores limítrofes de ovario. MATERIALES Y MÉTODOS: Estudio observacional, transversal, retrospectivo y descriptivo efectuado en el Hospital de Ginecoobstetricia 4 Luis Castelazo Ayala, Ciudad de México, en pacientes operadas entre el 1 de enero de 2018 y el 31 diciembre de 2020 de un tumor abdominopélvico, con examen transoperatorio de tumor limítrofe de ovario. El estudio transoperatorio se evaluó como prueba diagnóstica y el diagnóstico definitivo como patrón de referencia para establecer la concordancia del primero con el diagnóstico definitivo de tumores limítrofes de ovario. RESULTADOS: Se analizaron 68 tumores limítrofes de ovario, entre los diagnosticados en el estudio transoperatorio y el definitivo. Se encontraron 59 casos con diagnóstico definitivo de tumor limítrofe de ovario. La concordancia con el estudio transoperatorio fue de 63.2%. Se sobrediagnosticaron 2 de 68 pacientes (2.9%) y se subdiagnosticaron 23 de 68 (33.8%). CONCLUSIONES: La concordancia obtenida es semejante a lo reportado en la bibliografía internacional. Los tumores mucinosos mayores de 10 cm son subdiagnosticados con mayor frecuencia debido a su extensión.

Abstract OBJECTIVE: To determine the percentage of concordance of the transoperative study with the definitive diagnosis of borderline ovarian tumors. MATERIALS AND METHODS: Observational, cross-sectional, retrospective and des-criptive study performed at the Hospital de Gineco Obstetricia 4 Luis Castelazo Ayala, Mexico City, in patients operated between January 1, 2018 and December 31, 2020 for an abdominopelvic tumor, with transoperative examination of borderline ovarian tumor. The transoperative study was evaluated as a diagnostic test and the definitive diagnosis as a reference standard to establish the concordance of the former with the definitive diagnosis of borderline ovarian tumors. RESULTS: Sixty-eight borderline ovarian tumors were analyzed, between those diagnosed in the transoperative study and the definitive one. We found 59 cases with definitive diagnosis of borderline ovarian tumor. The concordance with the transoperative study was 63.2%. Two of 68 patients (2.9%) were overdiagnosed and 23 of 68 (33.8%) were underdiagnosed. CONCLUSIONS: The concordance obtained is like that reported in the international literature. Mucinous tumors larger than 10 cm are most frequently underdiagnosed due to their extension.

Calidad de la biopsia hepática en 10 instituciones hospitalarias de Bogotá / Quality of liver biopsies taken in ten hospitals of Bogotá

Resumen Introducción: La biopsia hepática es la prueba de oro para el diagnóstico de las enfermedades que comprometen el hígado, una muestra adecuada y una muy buena lectura son elementos que determinan la utilidad de la prueba y el impacto en la toma de decisiones. Objetivo: Evaluar la calidad de las biopsias hepáticas a partir de la frecuencia de un diagnóstico definitivo en la lectura de las mismas y su relación con el número de espacios porta y su longitud informada. Materiales y métodos: Estudio observacional retrospectivo basado en registros, entre el 1 de enero de 2010 y el 30 de julio de 2017. Se realizó la revisión de las historias clínicas de los pacientes a quienes se les realizó biopsia hepática y se evaluó el resultado de la patología. Resultados: Se incluyeron 659 informes de patología de 10 instituciones. El porcentaje de reporte de espacios porta varió entre un 15 % y un 87,4 %, entre las instituciones. La mediana de longitud de la biopsia fue 15 mm (rango intercuartílico [RIC]: 10-20) con el valor más bajo de 1,3 (1-1,5) y el más alto de 1,8 (1,4-2) y la del número de espacios porta fue de 10 (RIC: 7-15), con el valor más bajo de 5 (1-8) y el más alto de 13 (10-17). Los diagnósticos definitivos se presentaron entre 35 % y 69 %, diagnósticos probables entre 25 % y 63 %, y sin diagnóstico entre un 5 % y 31,8 %. En el resultado de la regresión logística del diagnóstico y análisis univariado, se encontró que el número de espacios porta presentó un Odds ratio (OR) de 1,12 (intervalo de confianza [IC] 95 %: 1,05-1,19) y la longitud, OR: 1,74 (1,06-2,87); con el análisis multivariado, el número de espacios porta sigue siendo significativo (OR: 1,12 [1,02 a 1,22], p = 0,011). Conclusiones: En Bogotá existen 3 instituciones hospitalarias con adecuada calidad preanalítica en la toma de biopsias hepáticas y diagnósticos definitivos por encima del 60 %, asociados en esta serie con la presencia de un cilindro de tejido hepático de longitud y número de espacios porta adecuados. Con el análisis multivariado, el número de espacios porta presentó significancia. Se insiste en la importancia de la experiencia y entrenamiento del patólogo que evalúa la biopsia.

Abstract Introduction: Liver biopsy is the gold-standard test for the diagnosis of diseases involving the liver. An adequate sample and an accurate reading of the report are key to determine the usefulness of the test and its impact on decision-making. Objective: To assess the quality of liver biopsies based on the frequency of a "definitive diagnosis" in their report and their association with the number of portal spaces and reported length. Materials and methods: Record-based retrospective observational study, from January 1, 2010, to July 30, 2017. A review of the medical records of patients who underwent liver biopsy was performed, and the pathology result was evaluated. Results: 659 pathology reports from 10 hospitals were included. The percentage of portal space reporting varied between 15% and 87.4%. The median biopsy length was 15mm (IQR: 10-20) and the median number of portal spaces was 10 (IQR: 7-15). Definitive diagnoses were between 35% and 69%, probable diagnoses between 25% and 63%, and no diagnosis between 5% and 31.8%. The logistic regression of the diagnosis and a univariate analysis found that the number of portal spaces had an OR of 1.12 (95%CI: 1.05-1.19), while length had an OR of 1.74 (95%CI: 1.06-2.87). The multivariate analysis showed that the number of portal spaces is significant [OR: 1.12 (95%CI:1.02 to 1.22), p = 0.011]. Conclusions: In Bogotá, there are 3 hospitals with adequate pre-analytical quality of liver biopsies and definitive diagnoses above 60%, which in this series is associated with the presence of a cylinder of liver tissue of adequate length and the number of portal spaces. Multivariate analysis showed that the number of portal spaces is significant. The importance of the experience and training of the pathologist who evaluates the biopsy is stressed.

Epidemiological, clinical and laboratory characteristics of acute Q fever in an endemic area in Israel, 2006-2016.

Our purpose was to describe the clinical, epidemiological and laboratory characteristics of patients hospitalised with acute Q fever in an endemic area of Israel. We conducted a historical cohort study of all patients hospitalised with a definite diagnosis of acute Q fever, and compared them to patients suspected to have acute Q fever, but diagnosis was ruled out. A total of 38 patients had a definitive diagnosis, 47% occurred during the autumn and winter seasons, only 18% lived in rural regions. Leucopaenia and thrombocytopaenia were uncommon (16% and 18%, respectively), but mild hepatitis was common (mean aspartate aminotransferase 76 U/l, mean alanine aminotransferase 81 U/l). We compared them with 74 patients in which acute Q fever was ruled out, and found that these parameters were not significantly different. Patients with acute Q fever had a shorter hospitalisation and they were treated more often with doxycycline than those without acute Q fever (6.4 vs. 14 days, P = 0.007, 71% vs. 38%, P = 0.001, respectively). In conclusion, acute Q fever can manifest as an unspecified febrile illness, with no seasonality. We suggest that in endemic areas, Q fever should be considered in the differential diagnosis in any febrile patient with risk factors for a persistent infection.

Clinical features, BTD gene mutations, and their functional studies of eight symptomatic patients with biotinidase deficiency from Southern China.

Biotinidase (BTD) deficiency is a rare autosomal recessive metabolic disease, which develops neurological and cutaneous symptoms because of the impaired biotin recycling. Pathogenic mutations on BTD gene cause BTD deficiency. Clinical features and mutation analysis of Chinese children with BTD deficiency were rarely described. Herein, for the first time, we reported the clinical features, BTD gene mutations and their functional studies of eight symptomatic children with BTD deficiency from southern China. Fatigue, hypotonia, proximal muscular weakness, hearing deficits, rash and respiratory problems are common clinical phenotype of our patients. Seizures are observed only in patients with profound BTD deficiency. Five novel mutations were detected, among which c.637delC (H213TfsTer51) was found in 50% of our patients and might be considered as a common mutation. In vitro studies confirmed three mild mutations c.1368A>C (Q456H), c.1613G>A (R538H), and c.644T>A (L215H) which retained 10-30% of wild type enzyme activity, and six severe mutations c.235C>T (R79C), c.1271G>C (C424S), c.1412G>A (C471Y), c.637delC (H213TfsTer51), c.395T>G (M132W), c.464T>C (L155P), and c.1493dupT (L498FfsTer13) which retained <10% of wild type enzyme activity. c.1330G>C (D444H) decreased the protein expression but not activity of BTD enzyme, and H213TfsTer51 was structurally damaging while L498FfsTer13 was functionally damaging. These results will be helpful in establishing the definitive diagnosis of BTD deficiency at the gene level, offering appropriate genetic counseling, and providing clues to structure/function relationships of the enzyme.

Utility of bronchoscopy in the definitive diagnosis of patients with haematological malignancies presenting with radiological abnormalities.

INTRODUCTION: Patients with haematological malignancies usually have a plethora of respiratory complications. Bronchoscopy is one of the most important procedures used to diagnose respiratory complications. Despite enormous benefit, patients should be carefully selected for bronchoscopy as the process is invasive; however, there are only few reports evaluating the contributing factors of bronchoscopy that result in the definitive diagnosis of respiratory complications in these patients. OBJECTIVE: This study aimed to elucidate and identify the contributing factors of bronchoscopy for definitive diagnosis in patients with haematological malignancies. METHODS: We retrospectively analysed 275 patients with haematological malignancies who later showed respiratory complications, requiring consultation with pulmonologists. We found that 62 patients underwent bronchoscopy. Our data analysis focused on this particular subset of patients to identify the factors crucial for definitive diagnosis via bronchoscopy. RESULTS: Bronchoscopy provided definitive diagnosis for 25 patients (diagnostic yield = 40.3%). We determined that nodular shadow was associated with high diagnostic yields by multivariate logistic regression [odds ratio (OR): 6.6 (2.1-23)]. Furthermore, in several bronchoscopic procedures, biopsy also contributed to definitive diagnosis of patients with nodular shadow [OR: 17 (1.5-180)]. Life-threatening complications were not observed due to bronchoscopy in our study. CONCLUSIONS: Our study demonstrated that patients with haematological malignancies who showed lung nodular shadows are more likely to be definitively diagnosed by bronchoscopy, whereas transbronchial biopsy may also be beneficial for these patients.

Cancer-type OATP1B3 mRNA has the potential to become a detection and prognostic biomarker for human colorectal cancer.

AIM: We aimed to clarify diagnostic and prognostic biomarker potentials of cancer-type organic anion transporting polypeptide 1B3 (Ct-OATP1B3) mRNA in colorectal cancer (CRC) patients. PATIENTS & METHODS: Ct-OATP1B3 mRNA levels in 97 CRC and adjacent normal colon tissues were measured by real-time PCR. The receiver operating characteristic curve analysis and the Kaplan-Meier curve analysis were performed to characterize its biomarker potentials. RESULTS: Ct-OATP1B3 mRNA showed noticeable diagnostic power (the area under the receiver operating characteristic = 0.91) in the CRC patients. Additionally, the higher/lower mRNA expression was clearly associated with better/poorer overall survival in the CRC patients (p < 0.05). CONCLUSION: Ct-OATP1B3 mRNA has the potential to be a tissue-based biomarker for definitive diagnosis and prognostic stratification in CRC.

Making the Difference in Exotic Animal Practice: The Value of Endoscopy.

The definitive diagnosis has often been elusive in exotic pet medicine, and its absence has been, and continues to be, the source of much client anguish and practitioner frustration. To reach a definitive diagnosis, demonstration of a pathologic response and the etiologic agent are required. This article demonstrates why such an approach is necessary and how it can be readily achieved in practice using endoscopy.

Time to definitive diagnosis of breast cancer in Latina and non-Hispanic white women: the six cities study.

Time delay after an abnormal screening mammogram may have a critical impact on tumor size, stage at diagnosis, treatment, prognosis, and survival of subsequent breast cancer. This study was undertaken to evaluate disparities between Latina and non-Hispanic white (NHW) women in time to definitive diagnosis of breast cancer after an abnormal screening mammogram, as well as factors contributing to such disparities. As part of the activities of the National Cancer Institute (NCI)-funded Redes En Acción research network, clinical records of 186 Latinas and 74 NHWs who received abnormal screening mammogram results were reviewed to determine the time to obtain a definitive diagnosis. Data was obtained from participating clinics in six U.S. cities and included demographics, clinical history, and mammogram characteristics. Kaplan-Meier estimates and Cox proportional hazards models were used to test differences in median time to definitive diagnosis by ethnicity after adjusting for clinic site, demographics, and clinical characteristics. Time-to-event analysis showed that Latinas took 2.2 times longer to reach 50% definitively diagnosed with breast cancer relative to NHWs, and three times longer to reach 80% diagnosed (p=0.001). Latinas' median time to definitive diagnosis was 60 days compared to 27 for NHWs, a 59% gap in diagnosis rates (adjusted Hazard Ratio [aHR] = 1.59, 95% CI = 1.09, 2.31; p=0.015). BI-RADS-4/5 women's diagnosis rate was more than twice that of BI-RADS-3 (aHR = 2.11, 95% CI = 1.18, 3.78; p=0.011). Disparities in time between receipt of abnormal screening result and definitive diagnosis adversely affect Latinas compared to NHWs, and remain significant after adjusting for demographic and clinical variables. With cancer now the leading cause of mortality among Latinos, a greater need exists for ethnically and culturally appropriate interventions like patient navigation to facilitate Latinas' successful entry into, and progression through, the cancer care system.

Muerte súbita cardíaca. Comportamiento en las áreas de salud municipio Arroyo Naranjo. Ciudad de la Habana 2000-2004 / Sudden cardiac death. Behaviorin the Arroyo Naranjo communities in Havana City during the period 2000-2004

Problema científico: ¿Cómo se ha comportado la Muerte Súbita Cardíaca en las áreas de salud del Municipio Arroyo Naranjo, en Ciudad de La Habana durante el período 2000-2004? Propósito: Describir el comportamiento de la Muerte Súbita Cardíaca en las áreas de salud del Municipio Arroyo Naranjo, en Ciudad de La Habana durante el período 2000- 2004. Material y Método: Se realiza un estudio epidemiológico en una población de 210000 habitantes en las áreas de salud de la municipalidad de Arroyo Naranjo (Julián Grimau, Eléctrico, Párraga, Mantilla, Capri, Los Pinos y Managua), con un seguimiento de 5 años. Participaron el Grupo Cubano para el Estudio de la Muerte Súbita Cardíaca (GEMSC), el Centro de Investigaciones y Referencias de Aterosclerosis de La Habana (CIRAH) y la Universidad de Ciencias Médicas "Julio Trigo López". El estudio SUCADES I (SUdden CArdiac DEath Study) incluyó 5 098 fallecidos de muerte natural, a quienes se les aplicó los criterios de Muerte Súbita Cardiaca (MSC) de la Organización Mundial de la Salud (OMS). Resultados: El 9.3 % de las muertes estudiadas acontecieron de forma súbita. El 50.6 % de los eventos se manifestó en el sexo masculino, en edades de 60-74 años. La localidad de Párraga resultó la más afectada (23.4 %). El domicilio de la víctima fue el lugar de ocurrencia de 35.0 % de los eventos. El Infarto agudo del miocardio (IAM) se corroboró en 58.4 %. Conclusiones: Existió un predominio de la Muerte Súbita Cardíaca en el sexo masculino, en el grupo de 60-74 años, en el área de salud de Párraga, documentándose con mayor frecuencia en el medio extrahospitalario (domicilio de la víctima). El Infarto agudo del miocardio, los trastornos del ritmo cardíaco y la disfunción miocárdica ventricular izquierda constituyeron los principales diagnósticos definitivos.

Scientific Problem: How has the Sudden Cardiac Death behaved on the Clinical-Pathological bases in Arroyo Naranjo communities, in Havana City during the period 2000-2004?Objective:To describe the Sudden Cardiac Death behavior in the Arroyo Naranjo communities, in Havana City during the period 2000-2004. Material and method: An epidemiologic study was carried out in a population of 210000 inhabitant in the health areas of the Arroyo Naranjo municipality (Julián Grimau, Eléctrico, Párraga, Mantilla, Capri, Los Pinos y Managua), followed for 5 years. The Cuban Group for the Sudden Cardiac Death Study (GEMSC), The Research and Reference Center for Aterosclerosis from Havana (CIRAH) and the Medical Sciences Faculty "Julio Trigo López" took part. The SUCADES I study (SUdden CArdiac DEath Study) included 5098 dead of natural causes, to which the criteria of Sudden Cardiac Death (MSC) from the World Health Organization (OMS) were applied. Results:The 9.3 % of the deaths studied happened in a sudden way. The 50.6 % of the events occurred in the male sex, in ages between 60-74 years old. Párraga was the most affected area (23.4 %).The victim's house was the place where the 35.0% of the events happened. The acute myocardial infarct (AMI) was corroborated in the 58.4 %. Conclusions: Sudden Cardiac Death was predominant in the male sex, in the group between 60-74 years old, in Párraga's health area, most frequently documented in the extra hospital media (victim's house). The acute myocardial Infarct, the cardiac rhythm troubles and the left ventricular myocardial dysfunction constituted the main definitive diagnosis.

Muerte súbita cardíaca. Comportamiento en las áreas de salud municipio Arroyo Naranjo. Ciudad de la Habana 2000-2004 / Sudden cardiac death. Behaviorin the Arroyo Naranjo communities in Havana City during the period 2000-2004

Problema científico: ¿Cómo se ha comportado la Muerte Súbita Cardíaca en las áreas de salud del Municipio Arroyo Naranjo, en Ciudad de La Habana durante el período 2000-2004?Propósito: Describir el comportamiento de la Muerte Súbita Cardíaca en las áreas de salud del Municipio Arroyo Naranjo, en Ciudad de La Habana durante el período 2000- 2004. Material y Método: Se realiza un estudio epidemiológico en una población de 210000 habitantes en las áreas de salud de la municipalidad de Arroyo Naranjo (Julián Grimau, Eléctrico, Párraga, Mantilla, Capri, Los Pinos y Managua), con un seguimiento de 5 años. Participaron el Grupo Cubano para el Estudio de la Muerte Súbita Cardíaca (GEMSC), el Centro de Investigaciones y Referencias de Aterosclerosis de La Habana (CIRAH) y la Universidad de Ciencias Médicas Julio Trigo López. El estudio SUCADES I (SUdden CArdiac DEath Study) incluyó 5 098 fallecidos de muerte natural, a quienes se les aplicó los criterios de Muerte Súbita Cardiaca (MSC) de la Organización Mundial de la Salud (OMS). Resultados: El 9.3 por ciento de las muertes estudiadas acontecieron de forma súbita. El 50.6 por ciento de los eventos se manifestó en el sexo masculino, en edades de 60-74 años. La localidad de Párraga resultó la más afectada (23.4 opr ciento). El domicilio de la víctima fue el lugar de ocurrencia de 35.0 por ciento de los eventos. El Infarto agudo del miocardio (IAM) se corroboró en 58.4 por ciento. Conclusiones: Existió un predominio de la Muerte Súbita Cardíaca en el sexo masculino, en el grupo de 60-74 años, en el área de salud de Párraga, documentándose con mayor frecuencia en el medio extrahospitalario (domicilio de la víctima). El Infarto agudo del miocardio, los trastornos del ritmo cardíaco y la disfunción miocárdica ventricular izquierda constituyeron los principales diagnósticos definitivos(AU)

Scientific Problem: How has the Sudden Cardiac Death behaved on the Clinical-Pathological bases in Arroyo Naranjo communities, in Havana City during the period 2000-2004?Objective:To describe the Sudden Cardiac Death behavior in the Arroyo Naranjo communities, in Havana City during the period 2000-2004. Material and method: An epidemiologic study was carried out in a population of 210000 inhabitant in the health areas of the Arroyo Naranjo municipality Julián Grimau, Eléctrico, Párraga, Mantilla, Capri, Los Pinos y Managua), followed for 5 years. The Cuban Group for the Sudden Cardiac Death Study (GEMSC), The Research and Reference Center for Aterosclerosis from Havana (CIRAH) and the Medical Sciences Faculty Julio Trigo López took part. The SUCADES I study (SUdden CArdiac DEath Study) included 5098 dead of natural causes, to which the criteria of Sudden Cardiac Death (MSC) from the World Health Organization (OMS) were applied. Results:The 9.3 percent of the deaths studied happened in a sudden way. The 50.6 percent of the events occurred in the male sex, in ages between 60-74 years old. Párraga was the most affected area (23.4 percent).The victim's house was the place where the 35.0 percent of the events happened. The acute myocardial infarct (AMI) was corroborated in the 58.4 percent. Conclusions: Sudden Cardiac Death was predominant in the male sex, in the group between 60-74 years old, in Pßrraga's health area, most frequently documented in the extra hospital media (victim's house). The acute myocardial Infarct, the cardiac rhythm troubles and the left ventricular myocardial dysfunction constituted the main definitive diagnosis(AU)

Pulmonary coinfection by Pneumocystis jiroveci and Cryptococcus neoformans.

We communicate the diagnosis by microscopy of a pulmonary coinfection produced by Cryptococcus neoformans and Pneumocystis jiroveci, from a respiratory secretion obtained by bronchoalveolar lavage of an AIDS patient. Our review of literature identified this coinfection as unusual presentation. Opportunistic infections associated with HIV infection are increasingly recognized. It may occur at an early stage of HIV-infection. Whereas concurrent opportunistic infections may occur, coexisting Pneumocystis jiroveci pneumonia (PCP) and disseminated cryptococcosis with cryptococcal pneumonia is uncommon. The lungs of individuals infected with HIV are often affected by opportunistic infections and tumours and over two-thirds of patients have at least one respiratory episode during the course of their disease. Pneumonia is the leading HIV-associated infection. We present the case of a man who presented dual Pneumocystis jiroveci and cryptococcal pneumonia in a patient with HIV. Definitive diagnosis of PCP and Cryptococcus requires demonstration of these organisms in pulmonary tissues or fluid. In patients with < 200/microliter CD4-lymphocytes, a bronchoalveolar lavage should be performed. This patient was successfully treated with amphotericin B and trimethoprim sulfamethoxazole. After 1 week the patient showed clinical and radiologic improvement and was discharged 3 weeks later.

Pulmonary coinfection by Pneumocystis jiroveci and Cryptococcus neoformans

We communicate the diagnosis by microscopy of a pulmonary coinfection produced by Cryptococcus neoformans and Pneumocystis jiroveci, from a respiratory secretion obtained by bronchoalveolar lavage of an AIDS patient. Our review of literature identified this coinfection as unusual presentation. Opportunistic infections associated with HIV infection are increasingly recognized. It may occur at an early stage of HIV-infection. Whereas concurrent opportunistic infections may occur, coexisting Pneumocystis jiroveci pneumonia (PCP) and disseminated cryptococcosis with cryptococcal pneumonia is uncommon. The lungs of individuals infected with HIV are often affected by opportunistic infections and tumours and over two-thirds of patients have at least one respiratory episode during the course of their disease. Pneumonia is the leading HIV-associated infection. We present the case of a man who presented dual Pneumocystis jiroveci and cryptococcal pneumonia in a patient with HIV. Definitive diagnosis of PCP and Cryptococcus requires demonstration of these organisms in pulmonary tissues or fluid. In patients with < 200/microliter CD4-lymphocytes, a bronchoalveolar lavage should be performed. This patient was successfully treated with amphotericin B and trimethoprim sulfamethoxazole. After 1 week the patient showed clinical and radiologic improvement and was discharged 3 weeks later.

Pulmonary coinfection by Pneumocystis jiroveci and Cryptococcus neoformans

We communicate the diagnosis by microscopy of a pulmonary coinfection produced by Cryptococcus neoformans and Pneumocystis jiroveci, from a respiratory secretion obtained by bronchoalveolar lavage of an AIDS patient. Our review of literature identified this coinfection as unusual presentation. Opportunistic infections associated with HIV infection are increasingly recognized. It may occur at an early stage of HIV-infection. Whereas concurrent opportunistic infections may occur, coexisting Pneumocystis jiroveci pneumonia (PCP) and disseminated cryptococcosis with cryptococcal pneumonia is uncommon. The lungs of individuals infected with HIV are often affected by opportunistic infections and tumours and over two-thirds of patients have at least one respiratory episode during the course of their disease. Pneumonia is the leading HIV-associated infection. We present the case of a man who presented dual Pneumocystis jiroveci and cryptococcal pneumonia in a patient with HIV. Definitive diagnosis of PCP and Cryptococcus requires demonstration of these organisms in pulmonary tissues or fluid. In patients with < 200/microliter CD4-lymphocytes, a bronchoalveolar lavage should be performed. This patient was successfully treated with amphotericin B and trimethoprim sulfamethoxazole. After 1 week the patient showed clinical and radiologic improvement and was discharged 3 weeks later.

Rare presentation of definitive ocular tuberculosis in an immunocompetent young patient.

Ocular tuberculosis is not uncommon ocular presentation in our community nowadays. Rare presentations described mainly in the immunocompromised patients. The diagnosis of ocular TB is presumed in the vast majority of the cases of the intraocular TB. We are presenting a very rare presentation of definitive intraocular TB in a healthy 24-year-old male.