Revista Médica de la Caja de Seguro Social
Caja de Seguro Social - Departamento Nacional de Docencia e Investigación - Panamá
NON-COMPACTION OF THE VENTRICULAR MIOCARDIUM ASSOCIATED WITH EBSTEIN´S ANOMALY: A CLINICAL CASE REPORT
There are multiple causes of heart failure, some more common than others. In some of these pathologies causing heart failure, the diagnosis is usually overlooked if auxiliary imaging tools such as echocardiography and cardiac magnetic resonance are not available, such as left ventricular non-compaction. This is a disorder caused by arrest in the compaction of myocardium during the embryonic period, and may be associated with other congenital heart diseases. In this case we present an uncommon association: left ventricular non-compaction with Ebstein's anomaly.
non-compaction of the ventricular myocardium
Copyright (c) 2018 https://creativecommons.org/licenses/by-nc/4.0
The term infoxication arises from the union of the words information and intoxication. It was created by Alfons Cornella, in 1996, to describe the di culty in processing the large amount of data that we are affected through the internet. The English term for infoxication is information overload proposed by Alvin To er and defines it with the excess of information that results in the Information Fatigue Syndrome. Informative Fatigue syndrome was described by David Lewis and defines it as a symptomatic picture, product of informational overload, described by fatigue and tiredness, accompanied by anxiety, stress, sleep disorders, loss of vision, attention and concentration problems, Di culty analyzing and making decisions. Faced with the wide variety of online information resources, R. B. Haynes proposed a pyramid model, which shows through a hierarchical structure, the different levels at which sources based on scientific evidence are organized.
In a world where a lot of people are expose tonigths shift works ,rotating shifts and extended working hours the physiological functions can be altered, constituting an important cause of poor work performance, as well as diseases. Sleep disorders due to circadian rhythm disturbances are an example how the physiological functions can be altered in the humans. Through recognizing this disorder in time and providing strategies to improve the quality of sleep of people, allows a better performance in the daily functions of the persons.
Frailty is a clinical condition that leads to decline and vulnerability. It is frequent in elderly people, who nowadays represent one third of patients who undergo surgical procedures. This condition is associated with poor health outcomes and increased costs of health care, and its early detection should lead us to develop preventive interventions that help maintain the quality of life of the elderly population.
VASCULAR COMPLICATIONS IN LIVER TRANSPLANTATION. PANAMA REPUBLIC. MARCH 2011 – AUGUST 2017
INTRODUCTION:Vascular complications in liver transplants have an incidence of 7-15%, representing an important cause of morbidity and mortality in patients following liver transplant. OBJECTIVE: Describe vascular complications in liver transplants performed in the Republic of Panama between March 2011 and August 2017. METHODS: Non-experimental, cross-sectional, retrospective study. 47 cases of 51 transplants performed in the study period were included and reviewed. The vascular complications, their types, the management used and their mortality were identified. They were analyzed based on their frequency and percentage. RESULTS: The incidence of vascular complications was 14.9%, arterial complications 8.5% and venous complications 6.4%. According to its type: arterial thrombosis 4.3%, arterial stenosis 4.3%, stenosis of the cavo-suprahepatic anastomosis 4.3%, portal stenosis 2.1%. There was no arterial pseudoaneurysm, arterial rupture, inferior caval vein thrombosis, or thrombosis of the portal vein. Arterial thrombosis was managed surgically in 100% of cases, arterial stenosis by endovascular management in 50 % and surgery in 50%. All venous complications were given endovascular management. There were no deaths in patients with venous complications. Mortality of arterial thrombosis was 50%. CONCLUSIONS: Despite the low number of liver transplants performed per year in our country, vascular complications showed an incidence similar to that described in the international literature, except for complications in the cavo-suprahepatic anastomosis with a higher incidence than the international one.
DESCRIPTION OF FACTORS THAT INCIDENT IN HIV RESISTANCE IN PATIENTS OF THE COLON ANTIRETROVIRAL THERAPY CLINIC. 2016-2017
Access to antiretroviral treatment is one of the most important tools for the control of HIV transmission, as well as to achieve a quality life in people living with this virus, however, the resistance to treatment and the consequent virological failure they are the main fear we have today, it has a relationship not only with the high replicative capacity of the virus, but also due to inadequate viral exposure to antiretroviral drugs, which promotes the appearance of mutated and resistant viral strains. We conducted a non-experimental, cross-sectional and retrospective review of files, managing to evaluate 37 clinical and epidemiological characteristics that could represent risk factors for TARV resistance. We were able to study a total of 48 patients with resistance to antiretrovirals treated at the Clinic of TARV of Colon in the years 2016-2017 Data were recorded from 48 patients, 52% women and 48% men, 60% being between 30-50 years of age, and 50% being black. 40% had between 6-10 years of diagnosis and 69% started TARV in the first 24 months of diagnosis. 44% presented resistance in the first 5 years of receiving TARV. Only 13% presented a university education. 66% had heterosexual relationships. We found that in addition to poor adherence, factors such as the onset of TARV, diagnosed years, viral load levels and CD4 +, opportunistic diseases, having been an AIDS stage, may represent a risk factor for the appearance of resistance to antiretroviral drugs.
HOSPITAL MORTALITY IN PATIENTS WITH DIABETES MELLITUS TYPE 2. HOSPITAL Dr. GUSTAVO NELSON COLLADO RIOS - CHITRE. JANUARY - DECEMBER, 2016
Background: Hospital mortality in diabetics ranges from 8.96% to 21.7%; Its main causes are: cardiovascular, infectious and metabolic. Oajectives: To describe the characteristics of in-hospital mortality in patients with Type 2 Diabetes Mellitus at the Dr. Gustavo Nelson Collado Ríos Hospital in the city of Chitré, from January to December 2016. We will investigate the Mortality Rate, Age, Sex, Cause of Death and Comorbidities. Methods: Quantitative, descriptive and retrospective study. Clinical records and death certificates were reviewed. A survey was applied to each file designed according to the study variables. Results: We found a total of 60 deaths. Specific hospital mortality rate = 13%. Average age 72 +/- 11. Male sex = 45% (N 27), female 55% (N 33). Cause of death: low respiratory tract infection (25% n 14), chronic kidney disease (20% n 11), acute coronary syndrome (14% n 8), soft tissue infection (13% n 7) and vascular brain event (7% n 4). Comorbidities: chronic kidney disease 42%, arterial hypertension 21%, heart diseases 18% and squeals of vascular brain event 8%. Conclusion: The characteristics of hospital mortality in patients with type 2 diabetes mellitus (DM) are similar to those reported by Latin American studies and in Spain. The main ones are associated with infectious etiologies, chronic kidney disease and acute coronary syndromes. Therefore, it is necessary to optimize the prevention, diagnosis, treatment and monitoring of patients with DM who are hospitalized for any of these causes or acquire it in-hospital.
EFFECTIVENESS OF THE PUNCTURE AND ASPIRATION WITH FINE THYROID NEEDLE IN RELATION TO THE DEFINITIVE HISTOLOGICAL DIAGNOSIS IN THE HOSPITAL COMPLEX DR. ARNULFO ARIAS MADRID. PANAMA 2015 - 2016
Puncture cytology and fine needle aspiration is a widely used tool for the diagnosis of thyroid lesions with a high degree of sensitivity, specificity and diagnostic accuracy. The taking of the sample with the puncture and aspiration with fine needle (FNAP) is of the utmost importance; It guides us to make decisions regarding treatment. The main objective of this study is to determine the e cacy of FNAP in the General Surgery Department of the Dr. Arnulfo Arias Madrid Hospital Complex from 2015 to 2016. It is a descriptive study with a retrospective transversal non-experimental design. The universe of the same is made up of 60 patients who met the inclusion criteria. The variables of the study were age, sex, cytological finding, histological diagnosis, ultrasonographic finding and the type of surgical treatment. Within the results 97.7% (58) are women and 3.33% (2) men; 78% are over 50 years old. The sensitivity 92% and specificity of 90% for FNAP in relation to the definitive diagnosis, with a PPV 97.5% and NPV: 23.07%. Total thyroidectomy was performed in 36 cases, of these 20% (12) were adenocarcinomas. 78% (47) of the cases resulted in benign lesions. 77% (46) of the nodules studied with ultrasound, do not present calcifications. The evaluation and permissions of the ethics committee of the Social Security Fund were counted. The results will be presented in the general surgery service and subsequently evaluated to be published.
CHARACTERISTICS CLINICAL AND LENGTH OF HOSPITAL STAY IN PATIENTS WITH EMPYEMA WHO WERE HOSPITALIZED IN THE PULMONOLOGY SERVICE OF THE HOSPITAL COMPLEX DR. ARNULFO ARIAS MADRID, FROM NOVEMBER 2016 TO NOVEMBER 2017
Empyema is the accumulation of pus in the pleural space. Associated with complicated pneumonia and multiple comorbidities. The initial handling is drainage, culture taking and initiation of empirical antibiotic therapy. In Panama there are no records updated since 2006 of the incidence of cases and the epidemiological description of patients. Oajective: To determine clinical characteristics and length of hospital stay in patients with empyema who were hospitalized in the Pulmonology Service of the Doctor Arnulfo Hospital Complex. Arias Madrid, from November 2016 to November 2017. Methodology: A non-experimental, cross-sectional, descriptive and retrospective study was carried out through the pre-selection by reviewing the book of procedures in the Pulmonology Service and the subsequent review of clinical files. A pre-prepared survey was applied according to the study variables to each file from November 2016 to November 2017. Results: 11 cases were registered, with an average age of 67.7 years. With a predominance of 9 men (80%). And appearance of symptoms in an average of 7-14 days. Only germs were isolated in 3 patients (intermediate streptococcus, S. pmeumonia, S. pseudoporcino). Only one required the use of fribrinolysis and one decortication. On average, they completed 2.8 weeks of antibiotic therapy and a hospital stay of 19 days. Discussion: The behavior of the population studied is comparable with the international literature.
CHARACTERISTICS OF THE PATIENT WITH EARLY SEVERE PREECLAMPSIA IN THE DEPARTMENT OF GYNECOLOGY AND OBSTETRICS HOSPITAL COMPLEX DR. ARNULFO ARIAS MADRID. 2015
Objective: To describe the characteristics of the patient with Early Severe Preeclampsia (ESP) in the Department of Gynecology and Obstetrics Hospital Complex Dr. Arnulfo Arias Madrid. Materials and Methods: Observational, descriptive, retrospective and cross-sectional study. Information from clinical records of patients diagnosed with ESP that met the inclusion criteria and exclusion through capture form was collected. Frequencies and percentages were calculated, the results are presented in tables. Results: ESP occurs most often between 18 and 35 years of age, 67.8% were nulliparous. Patients had a history of severe preeclampsia 35% and 2.4% with a history of fetal death. The most frequent pathological personal history was Chronic Hypertension 21.4%. Gestational age at diagnosis and termination of pregnancy occurs most often between 28-34 weeks. The time elapsed from the time of diagnosis until the termination of pregnancy was 7 days (0-70 days). Hypertensive crisis occurred in 16.7% of cases. The most common indications for termination of pregnancy were symptoms of persistent vasospasm 21.4% and hypertensive crisis / intrauterine growth restriction each with 16.7%. The most frequent maternal complications were 16.7% hypertensive crisis and HELLP syndrome 7.1%. The most frequent complication was newborn small for gestational age 41.7%. Conclusion: ESP occurs in 2% of all pregnancies, increases adverse outcomes such as preterm birth, hypertensive crisis and small for gestational age.
Copyright (c) 2019 https://creativecommons.org/licenses/by-nc/4.0
HEART TRANSPLANTATION IN LEFT VENTRICULAR NON-COMPACTION: FIRST CASE IN PANAMA
Left ventricular non-compaction or noncompaction of the left ventricular myocardium is a congenital cardiomyopathy that represents 0.01-0.17% of cardiomyopathies. It manifests clinically with the classical triad of heart failure, arrhythmias and thromboembolic events. Its prognosis is poor, with high morbidity and mortality, and medical management is directed to clinical manifestations. Cardiac transplantation is a therapeutic option for cases with advanced heart failure. We present a 19-year-old male patient with left ventricular non-compaction and advanced heart failure, who underwent heart transplantation.
noncompaction of the left ventricular myocardium
ANTRECTOMY WITH LAPAROSCOPIC ROUX Y RECONSTRUCTION FOR GIST OF LOWER GASTRIC CURVATURE
Gastrointestinal stromal tumors (GIST) are the most common mesodermal tumors of the gastrointestinal tract 70-80%. Originating from the interstitial cells of Cajal, due to oncogenic mutations in cKIT / CD117 and PDGFRA (85-90%), GISTs without controller mutations in KIT or PDGFRA have traditionally been grouped as wild-type GIST KIT / PDGFRA “wild type GIST” and within these there are molecular subgroups. They are usually asymptomatic, their most frequent location: Gastric (55.6%). Laparoscopic resection is the method of choice for its resection. It is described that the surgical approach is indicated in tumors> 2cm (<2cm endoscopic follow-up). The biological behavior of the same will depend on the size, immunohistochemistry and number of mitoses in 50 fields of high power (histopathological) Imatinib is a drug with inhibitory activity of tyrosine kinase receptors approved by the FDA in 2002 for the treatment of metastatic disease
The concept of Big Data is based on the analysis of a large volume of data. Big Data works mainly with unstructured and structured data. The main characteristics that define Big Data can be summarized in what is known as the seven Vs: Volume, Velocity, Variety, Veracity, Value, Variability and Visibility. A fundamental technology for the present and the future, that is Big Data, because it locates an enormous amount of data, extracts it, organizes, stores and analyzes it, all this in real time, which makes the information become an asset. very valuable, because it allows you to predict and make decisions. All the information generated in health for Big Data comes from information sources: the web and social networks, machine-to-machine data, biometric data and data generated by users (Electronic Medical Records). Big Data applied to medicine constitutes a new tool for obtaining knowledge.
BIOSECURITY IN RADIOLOGICAL PROTECTION OF OCCUPATIONALLY EXPOSED STAFF OF THE HOSPITAL COMPLEX DR. ARNULFO ARIAS MADRID. DECEMBER 2017- FEBRUARY 2018
Occupational exposure to ionizing radiation is not an innocuous process, since it can produce harmful effects on the health of occupationally exposed personnel, the latest records of personnel exposure levels are from 2012 and it is also perceived that there is little information available in medical areas that do not have the basic training of the subject within their training program. Objective: To determine the level of biosafety in radiological protection of the occupationally exposed workers in the area of Radiology and Hemodynamics of the Dr. Arnulfo Arias Madrid hospital complex. Method: A descriptive, transversal study was carried out, in which a validated, multiple choice questionnaire was applied to health workers in the area of exposure to ionizing radiation. Results: 56% (n = 73) of the respondents were physicians. The level of global knowledge ranged from 11% to 100% with an average of 67% (regular) and was categorized as deficient by 40% (n = 51) of the participants. The question with the highest percentage of error were the source of scattered radiation in the fluoroscopy room (55%). 33% of the participants do not have a personal dosimeter and only 28% claim to have continuous training courses. 69% of participants have between 0 to 9 hours of formal training in radiation protection. Conclusion: In general, study participants have little or no training in radiological protection. We suggested to improve the surveillance system and education in notions of radio protection.
RISK FACTORS ASSOCIATED WITH INFECTION BY Blastocystis hominis, POLICLÍNICA MANUEL MA. VALDÉS, PANAMA, 2018
Introduction: Blastocystis hominis is an emerging pathogen that is observed in human feces. It is transmitted directly from person to person or animal to person and indirectly through contaminated food or water. It is found in developed countries in 1.5-10% and in developing countries in 30-50%. Objectives: To determine the risk factors associated with Blastocystis hominis infection in patients treated at the Policlinica Manuel Ma. Valdés de San Miguelito, Caja de Seguro Social, Panama, between september and december 2018. Methodology: This is an analytical case study and controls. The sample was represented by 766 (383 cases and 383 controls), selected by simple random sampling. Results: A statistically significant association was found between: age group 0-19 years (X2 = 4.5001, p = 0.0339) and 20-59 years (X2 = 6.1370, p = 0.0132, OR = 1.4362), signs and symptoms (X2 = 84.2820, p = 0.0000, OR = 3.9733), coinfection with other intestinal parasites (X2 = 97.7493, p = 0.0000, OR = 41.1995), inadequate hand washing before the meal (X2 = 4.1626, p = 0.0413). The rest of the factors showed no association (p≥ 0.05). Conclusions: A statistically significant association was found between: the age group of 0-19 and 20-59 years, signs and symptoms, coinfection with other intestinal parasites and improper washing of hands before meal; not so between sex, age group> 60 years, inadequate supply of drinking water, inadequate disposal of excreta, inadequate hand washing after going to the bathroom, presence of pets in the home and comorbidities.
CHARACTERISTICS OF PEDIATRIC PATIENTS WITH LIVER STEATOSIS, AT THE OMAR TORRIJOS HERRERA PEDIATRIC SPECIALTIES HOSPITAL, 2018
Introduction: Hepatic steatosis is a pathology characterized by excessive accumulation of fat in the form of triglycerides (steatosis) at the level of hepatocytes (> 5%). The incidence in children is 5.3% and 9.6%. The objective of the research was to describe the characteristics of pediatric patients with hepatic steatosis, treated at the Pediatric Specialty Hospital, in 2018. Methods: Descriptive, cross-sectional and retrospective observational study. Results: 73 patients, 45.21% corresponded to new patients. With a predominance of adolescents (60.27%) and in the male sex (51%), with origin the province of Panama (68.49%), with a tendency towards obesity. The clinical manifestations were: hepatomegaly (32.88%), acanthosis nigricans (41.10%) and jaundice (6.85%) In the biochemical analyzes we found that 42.47% had elevated aspartate aminotransferase and 45.21% alanine aminotransferase. The diagnostic imaging method was ultrasound (98.63%). Most did not have a liver biopsy (93.15%). Conclusions: Hepatic steatosis occurred more frequently in adolescents. However, preschoolers and schoolchildren (30-35%) of the cases which is a wake-up call about eating and lifestyle habits. In addition, 42-45% presented elevation of transaminases, most studies recognize age as a risk factor and together both factors significantly increase the risk of cirrhosis, which would lead to a public health problem since Panama does not We have a pediatric liver transplant that is the cure for this condition. Keywords: hepatic steatosis, obesity, acanthosis nigricans, hepatomegaly, transaminases.
Copyright (c) 2019 Elodia T Patiño C. (Autor/a) https://creativecommons.org/licenses/by-nc/4.0
DETERMINANTS AND CLINICAL OUTCOMES OF UPTITRATION OF RENIN-ANGIOTENSIN-ALDOSTERONEINHIBITORS AND BETA-BLOCKERS IN PATIENTS WITH HEART FAILURE WITH REDUCED EJECTION FRACTION
Introduction: Multiple trials have shown that renin angiotensin aldosterone system inhibitors (RAASI) (including angiotensin-converting enzyme inhibitors [ACEI] and angiotensin receptor blockers [ARB]) and beta-blockers (BB) reduce the risk of mortality and heart failure (HF) hospitalization in patients with heart failure with reduced ejection fraction (HFREF). However, in clinical practice, the proportion of patients reaching the doses studied in these trials is small. Methods: through a prospective study, we identified patients with HFREF, admitted to Heart Failure Clinic of Dr. Arnulfo Arias Madrid Hospital Complex between February and August 2017, and were followed until November 2018. High doses were defined as equal to or greater than 50% and low doses as less than 50%, both ISRAA and BB Results: we identified 54 patients; 35.8% reached high doses of RAASI and 37.7% achieved high doses of BB. HF hospitalization rate in high-dose versus low-dose RAASI group was 0% versus 25% (p: 0.024), and 0% vs. 27.3% in high-dose versus low-dose beta-blocker group (p: 0.010) Conclusions: use of high doses of RAASI and BB reduces the risk of HF hospitalization in patients with HFREF, compared with low doses.
CLINICAL FEATURES AND MICROBIOLOGICAL PROFILE OF PATIENTS WITH SECONDARY PERITONITIS IN GENERAL SURGERY HOSPITAL RAFAEL HERNÁNDEZ. DAVID, CHIRIQUI. YEARS 2017 AND 2018.
Background: Secondary peritonitis is a common cause of morbidity worldwide with a prevalence of up to 8.6% with a mortality of 20-60%. Objectives: Describe clinical characteristics and microbiological profile of patients with secondary peritonitis in general surgery at Rafael Hernández hospital. David, Chiriquí. 2017 and 2018 years. Methods: It is an observational, descriptive and retrospective study. The universe was all the patients who were hospitalized in general surgery with surgical abdominal pathology and who have developed secondary peritonitis in the course of their hospitalization at the Rafael Hernández Hospital in the years 2017 and 2018. Results: Peritonitis had a higher prevalence in people over 60 with 36.84%. The highest proportion was in men with 62.28%. The highest diagnosis of admission was acute abdomen with 48.25%. The most frequent etiologic agent was E. coli with 64.9%. 79.82% were infections associated with a single microorganism. The most frequent antibiotic treatment was ciprofloxacin plus metronidazole with 26.32%. There was 100% correspondence of the antibiogram with the antibiotic received in cases in which there was a positive culture. And in terms of mortality it was evidenced that it had a frequency of 15.79% of which 33% was caused by bacteria producing beta lactamase. Discussion: The most frequent etiological agent, the diagnosis most associated with secondary peritonitis and the ages where it occurs most frequently are consistent with what is reported in the literature, in terms of sex, the male predominated
Pericarditis and pericardial effusion in a patient with covid-19. Case report
Several types of cardiovascular complications of coronavirus disease-2019 have been described, derived from the systemic proinflammatory state. One of them, rare, is pericarditis, which may or may not be accompanied by pericardial effusion, which may or may not lead to cardiac tamponade. I present the case of a 24-year-old man with coronavirus disease 2019, complicated with acute pericarditis and pericardial effusion with hemodynamic compromise that required surgical drainage.
Copyright (c) 2022 https://creativecommons.org/licenses/by-nc/4.0
Hepatic hematoma rupture in HELLP syndrome and hypertensive crisis a combination with a catastrophic result
Female, 32 years G2P1001, 29 weeks pregnancy, consults for epigastric pain irradiated to right costal margin and findings of acute hypertensive disorder and HELLP syndrome criteria, no surgical or medical history. She requires intravenous antihypertensive therapy with labetalol, hydralazine and nitroglycerine for the management of the hypertensive crisis associated to acute lung edema. Cesarean delivery was performed, she was transfered on post-surgical to intensive care unit to continue arterial pressure control with antihypertensive, diuretic and oxygen support with high flow nasal cannula. On her second post-surgical day after a valsalva maneuver, she describes an intense abdominal pain and serosanguinous drainage through surgical wound, she passes to surgical room where an hepatic hematoma rupture of V and VI segments is found, a liver packing is performed in a control damage surgery context.
Acute myocardial infarction and Covid-19. Reporte de caso
Several types of cardiovascular complications of coronavirus disease-2019 have been described, derived from the systemic proinflammatory state. One of them is acute myocardial infarction, whose hospitalization rates have decreased as a result of the coronavirus disease-2019 pandemic, and whose management in patients with coronavirus disease-2019 is controversial. I present the case of a 68-year-old man with coronavirus disease-2019 and acute myocardial infarction without ST-segment elevation, complicated with respiratory failure and shock due to both diseases.
Copyright (c) 2025 https://creativecommons.org/licenses/by-nc/4.0
Acute renal failure: diagnosis, management and update in covid-19. Narrative review
Acute renal failure is a clinical syndrome characterized by an abrupt and severe decrease in renal function, where structural damage or injury occurs that manifests with elevated nitrogen levels and decreased urine production. The clinical history is essential at the time of evaluation, in order to determine the time of evolution. In the event that the patient presents with COVID-19 infection, it will be important to assess whether or not he is asymptomatic and his comorbidities. Acute renal failure must be identified by all physicians, since an early approach is an important determinant in the evolution and duration of the disease and can prevent renal complications, such as chronic kidney disease, which occurs in 5 % of patients with acute renal failure.
Prevalence of mutations in the HIV genes that cause antiretroviral resistance and medication sensitivity in patients of the HIV Clinic of the Complejo Hospitalario Dr. Arnulfo Arias Madrid Hospital, 2018-2021
Antiretroviral treatment is the main support for the management of HIV infection and makes it possible to maintain undetectable viral load levels in the blood. In some patients, treatment fails to maintain viral load suppression, triggering resistance to treatment, caused by genetic changes in the virus that give it a genetic advantage over antiretrovirals. We carried out a non-experimental, cross-sectional and retrospective Master’s Thesis for the “Master’s degree on human immunodeficiency virus infection, 2021-2022 edition. ESTHER project. Rey Juan Carlos University and Ministry of Health. Madrid” where we studied 112 genotyping results of blood samples from HIV-positive patients in the period 2018-2021 carried out in the CHDr.AAM laboratory. We found that 85.6 % of the samples presented resistance and that 41.7 % belonged to Nucleotide Analog Reverse Transcriptase Inhibitors (NRTIs), 40 % to Non-Nucleotide Reverse Transcriptase Inhibitors (NNRTIs) and 4.1 % to protease inhibitors, integrase did not show resistance. Only 17 % of the mutations were high level, of which 75% corresponded to reverse transcriptase. The main mutations recorded were M184V (14 %), K103N (11 %), P225H (4.9 %), K65R (3.6 %), L74I (3.1 %), L100I (2.8 %), AT1V (2.55 %). We found that the antiretrovirals with the highest degree of resistance are: AZT, ABC,TDF, also FTC and 3TC within the NRTIs, in the NNRTIs NVP, EFV and DOR occupy the highest prevalence. To a lesser extent, there are protease inhibitors such as FPV/r, NFV, LPV/v.
Respiratory sequel of moderate to severe covid-19 in Dr. Arnulfo Arias Madrid Hospital Complex, Panama
Introduction SARS-Cov-2 has caused a large number of infections with variable symptoms. Prior to vaccination, 15 % of those infected required hospitalization, and long-term respiratory symptoms are described in these group. The objective of the study was to determine the persistence of pulmonary alterations after 12 months of hospitalization. Methodology We conducted an observational, descriptive, cross-sectional, and prospective study over a sample of patients hospitalized for COVID-19 that had used supplemental oxygen at the Dr. Arnulfo Arias Madrid Hospital Complex between April and August 2020. Prior informed consent, general variables, persistent respiratory symptoms, pulmonary function data and persistence of radiographic infiltrates at 12 months after hospitalization were registered. Evaluated and approved by the National Bioethics and Research Committee and registered with the code EC-CNBI-2020-09-95. Results A total of 28 patients with an average age of 55 years (33-83) were studied, mainly female with 60.71 %. 60.71 % without previous comorbidities; 32.14 % reported non-pulmonary comorbidities, 17.86 % pulmonary diseases. The most frequent symptom was cough with 35.71 %, followed by dyspnea with 32.14 %; 25 % presented decreased forced vital capacity and 57.14 % no longer had alterations in radiographic studies. Conclusions Cough, dyspnea and decreased forced vital capacity were the most frequent findings in the sample. Regarding imaging findings, reticular infiltrates were the most common.
post-acute sequelae of SARS-CoV-2 infection
Demographic, clinical and therapeutic characteristics of patients with rheumatoid arthritis admitted to the rheumatology service of the Dr. Arnulfo Arias Madrid, from January 2010 to September 2019
Introduction: Rheumatoid arthritis (RA) is the most common autoimmune rheumatological disease worldwide and according to the Global Burden of Diseases (GBD) 2010 study, out of the 291 conditions analyzed, it was ranked 42nd in the count of contributors to global disability and carries a global burden of disease measured in Disability Adjusted Life Years (DALYs) that has increased from 3.3 million in 1990 to 4.8 million in 2010.1 General objective: To describe the demographic, clinical characteristics and therapeutic approach of patients with RA admitted to the Rheumatology Service of the CHDRAAM, from January 1st, 2010 to September 30th, 2019. Methodology: Descriptive, retrospective, cross-sectional study that included all patients over 18 years of age admitted with a diagnosis of RA. Results: Five hundred and seven patients were studied, of which 90 % were female. Hypertension was the most frequent comorbidity (49 %) and the most common extra-articular manifestations were rheumatoid nodules (12 %). The secondary Sjögren’s syndrome was present in 10 %. Fifty three percent of the patients did not use glucocorticoids and the majority (47 %) were on dual therapy with conventional disease modifying antirheumatic drugs (cDMARDs). The most used combination was methotrexate + hydroxychloroquine (15 %) and the most common biological DMARD (bDMARDs) as a first option was the Etanercept (8.7 %). Conclusion: Most of our patients are being managed with cDMARDs which represents safety and less costs for our health system.
Drugs in pregnancy with chronic hypertension
Occupational medicine in Panama: origins and present
Pauci-immune rapidly progressive glomerulonephritis in a patient with systemic lupus erythematosus
Introduction: rapidly progressive glomerulonephritis is a nephrological emergency. Histological findings are usually characterized by the presence of crescentic glomerulonephritis with immune deposits and endocapillary proliferation. On the contrary, the absence of immune deposits is associated to a greater extent with vasculitis associated with anti-neutrophil cytoplasmic antibodies (ANCAs) Case report: a 21-year-old patient with a history of systemic lupus erythematosus presented increased creatinine, active urinary sediment, and decreased serum complement levels. A renal biopsy was performed, revealing pauci-immune crescentic glomerulonephritis, without endocapillary proliferation. Serology for ANCA was positive. Discussion: the patient of this case presented unexpected findings in the renal biopsy; positive ANCA serology confirmed that the glomerulonephritis was mediated by ANCA and not by immune deposits. Pauci-immune glomerulonephritis in patients with systemic lupus erythematosus is a rare finding, whose estimated prevalence is only 2 %.
anti-neutrophil cytoplasmic antibody-associated vasculitis