Anorectal Amelanotic Melanoma: A Case Report

We present the case of a 60 year old patient suffering pain and the sensation of a foreign body in the anal region associated with traces of blood in stools. Digital rectal exam (DRE) revealed a hardened lesion located on the wall of the anal canal. Colonoscopy revealed a raised proliferating lesion with a blackish color which was about 2 inches in diameter. This was compatible with an anal canal malignancy. We proceeded to a biopsy and immunohistochemistry study which tested positive for S-100 and negative for HMB-45. A multislice helical chest, abdominal and pelvic CAT scan ruled out metastatic tumors and lymphadenopathy. The patient underwent local transanal excision of the partially pigmented tumor. Post- surgical histopathological results confi rmed the diagnosis of malignant anal amelanotic melanoma positive for S-100. The sample tested weakly positive for Melan-A and positive for KI-67. The favorable outcome of the procedure led to the patient’s discharge 3 days after surgery.
Authors: Núñez Garbín, Alexandra; Córdova Pantoja, Cesia; Patiño Ascona, Suzanne; Santillana Callirgos, Juan
Source: Rev Col Gastroenterol
URL: http://hdl.handle.net/10757/316271

Diagnosis of Carrion’s Disease by Direct Blood PCR in Thin Blood Smear Negative Samples.

Bartonella bacilliformis is the etiologic agent of Carrion’s disease. This disease has two well established phases, the most relevant being the so called Oroya Fever, in which B. bacilliformis infect the erythrocytes resulting in severe anemia and transient immunosuppression, with a high lethality in the absence of adequate antibiotic treatment. The presence of B. bacilliformis was studied in 113 blood samples suspected of Carrion’s disease based on clinical criteria, despite the absence of a positive thin blood smear, by two different PCR techniques (using Bartonella-specific and universal 16S rRNA gene primers), and by bacterial culture. The specific 16S rRNA gene primers revealed the presence of 21 B. bacilliformis and 1 Bartonella elizabethae, while universal primers showed both the presence of 3 coinfections in which a concomitant pathogen was detected plus Bartonella, in addition to the presence of infections by other microorganisms such as Agrobacterium or Bacillus firmus. These data support the need to implement molecular tools to diagnose Carrion’s disease.
Authors: Del Valle Mendoza, Juana; Silva Caso, Wilmer; Tinco Valdez, Carmen; Pons, Maria J.; Del Valle, Luis J.;Casabona Oré, Verónica; Champin Michelena, Denisse; Bazán Mayra, Jorge; Zavaleta Gavidea, Víctor; Vargas, Martha; Ruiz, Joaquim
Source: PLoS ONE

URL: http://hdl.handle.net/10757/315714

Children hospitalized with influenza pneumonia AH1N1/2009 pandemic in the INSN

ObjectiveTo determine the clinical and demographic characteristics of pneumonia with influenza virus AH1N1/2009 pandemic at the National Institute of Child. Methods. Retrospective case series in children hospitalized for influenza pneumonia pandemic AH1N1/2009 in a pediatric hospital. Reviewed the medical records between the months of June to September 2009. All cases had virological confirmation, we describe the clinical characteristics and conditions of severity. Results. A total of 74 children of pneumonia with influenza virus AH1N1/2009 pandemic (NVIp), of those 50 were community acquire pneumonia viral (NACv) and 24 pneumonia nosocomial viral (NNv), 16 required mechanical ventilation. 12 died, all had preexisting factors. NN cases showed statistical association with mortality. The most frequent factors were malnutrition, respiratory infections, congenital heart disease and neurological deficits In NACv cases the children under 6 years accounted for 72% (36/50). The median disease duration was 5 days. The most frequent symptoms were fever, cough, runny nose. Received oseltamivir 82%. The chest radiograph 48% of cases showed patchy infiltrates and 44% interstitial infiltrate on chest radiograph. Protein c reactive (CRP) more than 10mg / L was significantly associated with respiratory failure (p <0.05). Conclusions. Cases of NN found who had more mortality, even those who had the highest PCR and those with preexisting condition.
Authors: Miranda-Choque, Edwin; Ramírez, Carlos; Candela-Herrera, Jorge; Díaz, Javier; Fernández, Ana; Kolevic, Lenka; Segura, Eddy R.; Farfán-Ramos, Sonia
Source: Rev. perú. med. exp. salud publica

URL: http://hdl.handle.net/10757/314691

Abdominal obesity associated to medical-related absenteeism at a company of metal-mechanical industry in Cali, Colombia

The aim of this study was examined the abdominal obesity prevalence and association with medical-related absenteeism. A cross-sectional study in 185 men from the metal-mechanical industry was conducted. Sociodemografic and antropometrics data of was gathered, waist circumference was measured as an indicator of abdominal obesity. The prevalence of central obesity was 28.7 %. Subjects with higher values of central obesity showed higher frequency, higher duration and higher costs of medical-related absenteeism, however, this relationship was not significant. We conclude that abdominal obesity is highly frequent in this sample; however, since it’s a reversible risk, enterprises could get benefits from preventive and promotional programs destiny to control this problem.
Authors: Agredo Zúñiga, Ricardo A.; García Ordoñez, Emily S.; Osorio, Carlos; Escudero, Natalia; López-Albán, Carlos A.; Ramírez-Vélez, Robinson
Source: Rev. perú. med. exp. salud publica

URL:  http://hdl.handle.net/10757/314707

Criminal claims about medical professional liability in the Instituto de Medicina Legal of Lima, Peru.

Objectives.To determine the characteristics of the criminal complaints claining medical professional liability, based on the expert reports issued by the Forensic Examination Division of Lima, Peru. Materials and methods. A cross-sectional study was carried out, which included all the expert reports issued between 2005 and 2010 at the Forensic Examination Division of Lima, Peru. A descriptive analysis of each of the variables was performed. Results. 60.3% (495/821) of the criminal complaints for medical professional liability were valued as being in accordance with the lex artis while16.8% (138/821) were not in accordance with the lex artis. In 13% (107/821) of the cases, conclusions could not be drawn;in 9.9% (81/821) of the cases, the conclusions in the expert report did not include an valuations of the medical act.The cases in which the injury was attributed to the process of the disease itself accounted for 80.9% (502/620), and those in which in the injury was considered a result of the health care received were 19.0% (118/620). The distribution of the cause of the injury based on accordance with the lex artis showed significant differences. Conclusions. In our country, the number of claims for claimed medical liability is increasing, predominantly in relation to surgical specialties, where a medical act is more likely to be considered not in accordance with the lex artis. In addition, in a significant percentage of cases, no conclusions are drawn about the medical act.
Authors: Navarro-Sandoval, Cleyber; Arones-Guevara, Shermany; Carrera-Palao, Rosa; Casana-Jara, Kelly; Colque-Jaliri, Tomasa
Source: Rev. perú. med. exp. salud publica

URL: http://hdl.handle.net/10757/314690