First report of a primitive neuroectodermal tumor of the bladder in a newborn

Primitive neuroectodermal tumor (PNET) is part of the Ewing sarcoma family of tumors. The present case reports a primitive neuroectodermal tumor (PNET) of rare location in the bladder in a newborn. It was evaluated with prenatal ultrasound and postnatal tomography that revealed a mass in the posterior wall of the bladder. The patient underwent partial cystectomy with subsequent analysis of the surgical piece removed, the histopathological study indicated a tumor of mesenchymal origin, and immunohistochemical staining confirmed the diagnosis of PNET of the bladder. Satisfactory result and short-term follow-up.Revisión por paresCampus Lima Centr

First report of myroides phaeus bacteraemia identified by polymerase chain reaction and genetic sequencing

We report the first case of Myroides phaeus isolated from blood, causing bacteremia in an immunocompromised patient using the automated MicroScan Walk Away 96 system, followed by bacterial identification by amplication-sequencing of the 16S rDNA. The sequences obtained were compared with the reference sequence of the BLAST platform - National Library of Medicine, USA, and the isolation was identified as Myroides phaeus strain with 99.67% identity in Blast report. In the literature we did not find previous reported cases of infections by this bacterium, however its pathogenic role is still controversial; therefore, this isolation alerts us to carry out an exhaustive surveillance of other possible acquisition routes.Revisión por paresCampus Lima Centr

Factors associated with the severity of pruritus in patients with terminal chronic kidney disease undergoing hemodialysis in Lima, Peru

The objective of the study is to analyze the factors associated with the severity of pruritus in patients with terminal chronic kidney disease undergoing hemodialysis. The methodology used is based on a cross-sectional study in patients receiving hemodialysis at the Centro Nacional de Salud Renal. Severe pruritus was defined as a score on the visual analogue scale greater than or equal to 7, and the strength of association with the possible risk factors was assessed by calculating prevalence ratios. Regarding the results, 264 patients were included, 59.9% were male, with a mean time on hemodialysis of 10.26 ± 7.14 years. 75% experienced pruritus, of this group, 1 in 3 presented severe pruritus. Hyperphosphatemia and the use of antihistamines were associated with a higher prevalence of severe pruritus (RP 1.71, 95% CI 1.09-267 and RP 2.39, 95% CI 1.51-3.75, respectively). The positive serology for Hepatitis C Virus was described as a protective factor for presenting severe pruritus (RP 0.55, 95% CI 0.33 - 0.89). In conclusion, severe uremic pruritus is a frequent problem in patients with chronic terminal kidney disease who have hyperphosphatemia and treatment with antihistamines independently of the time they have been on hemodialysis.Revisión por pare

Multi-Locus Sequence Typing of Bartonella bacilliformis DNA Performed Directly from Blood of Patients with Oroya's Fever During a Peruvian Outbreak.

Background Bartonella bacilliformis is the etiological agent of Carrion’s disease, a neglected tropical poverty-linked illness. This infection is endemic of Andean regions and it is estimated that approximately 1.7 million of South Americans are at risk. This bacterium is a fastidious slow growing microorganism, which is difficult and cumbersome to isolate from clinical sources, thereby hindering the availability of phylogenetic relationship of clinical samples. The aim of this study was to perform Multi Locus Sequence Typing of B. bacilliformis directly in blood from patients diagnosed with Oroya fever during an outbreak in Northern Peru. Methodology/Principal Findings DNA extracted among blood samples from patients diagnosed with Oroya’s fever were analyzed with MLST, with the amplification of 7 genetic loci (ftsZ, flaA, ribC, rnpB, rpoB, bvrR and groEL) and a phylogenetic analysis of the different Sequence Types (ST) was performed. A total of 4 different ST were identified. The most frequently found was ST1 present in 66% of samples. Additionally, two samples presented a new allelic profile, belonging to new STs (ST 9 and ST 10), which were closely related to ST1. Conclusions/Significance The present data demonstrate that B. bacilliformis MLST studies may be possible directly from blood samples, being a promising approach for epidemiological studies. During the outbreak the STs of B. bacilliformis were found to be heterogeneous, albeit closely related, probably reflecting the evolution from a common ancestor colonizing the area. Additional studies including new samples and areas are needed, in order to obtain better knowledge of phylogenetic scenario B. bacilliformisThis work has been supported by the Spanish Network for the Research in Infectious Diseases [REIPI RD12/0015],by Generalitat de Catalunya, Departament d’Universitats, Recerca i Societat de la Informació [2014 SGR 26] and by by a grant of the Instituto de Salud Carlos III - Spain (PI11/ 00983) which included FEDER funds (JR). MJP has a postdoctoral fellowship from CONCYTEC/ FONDECYT (grant number: CG05-2013- FONDECYT). JR has a fellowship from the programRevisión por pare

Asociación entre síndrome metabólico y enfermedad nodular tiroidea en el Hospital Nacional Edgardo Rebagliati Martins en el año 2014

Introducción: Pocos son los estudios que analizan la relación entre el síndrome metabólico y la enfermedad nodular tiroidea, tema en el que existe un vacío de conocimiento. El objetivo de este estudio es determinar la asociación entre síndrome metabólico y enfermedad nodular tiroidea en un hospital de Lima, Perú. Materiales y métodos: Estudio longitudinal, prospectivo, analítico, observacional de casos y controles, realizado en el Hospital Nacional Edgardo Rebagliati Martins en Lima - Perú. Un total de 182 pacientes se separaron como casos a los pacientes en los que se encontrara por lo menos un nódulo tiroideo detectado por ultrasonografía mayor a 3 mm (n=91) y como controles a los pacientes en los cuales se excluyera la presencia del nódulo de las características descritas por la misma técnica diagnostica (n=91). Se evaluaron el nivel y la fuerza de asociación entre la presencia de síndrome metabólico y cada uno de sus componentes por separado con la presencia de enfermedad nodular tiroidea. Resultados: El análisis bivariado muestra asociación significativa entre la presencia de nódulo tiroideo y síndrome metabólico con un OR de 2.56 (IC: 95% 1.41 a 4.66, p < 0.05). Se evidenció que los niveles de HDL bajo y la glicemia basal alterada se encuentran asociadas significativamente con la presencia de nódulo tiroideo, independientemente de la presencia de síndrome metabólico con OR de 2.81 ( IC: 95% 1.54 a 5.12, p<0.05) y 2.05 (IC:95% 1.10 a 3.78, p<0.05) respectivamente. El análisis multivariado mantuvo la asociación entre nódulo tiroideo y el síndrome metabólico con un OR de 2.96 (IC: 95% 1,47 a 5,95 , p<0.05), así mismo con niveles de HDL bajo con un OR de 2.77 (IC:95 % 1,44 a 5,3, p<0.05) y con la glicemia basal alterada con un OR de 2,23 (IC:95% 1,14 a 4,34, p<0,05). Conclusiones: El Síndrome metabólico incrementa el riesgo de padecer enfermedad nodular tiroidea, específicamente la disminución de valores de HDL y la glicemia basal alterada fueron los factores en los que halló mayor asociación.Introduction: Few studies analyses the relation between metabolic syndrome and thyroid nodular disease, subject in which there is a knowledge gap. The object of this study is to determinate the association between metabolic syndrome and thyroid nodular disease in a hospital in Lima, Peru. Materials and methods: A longitudinal, prospective, analytic, observational, case - control study, was performed “Hospital Nacional Edgardo Rebagliati Martins” in Lima- Peru. A total of 182 patients were separated as cases in which at least find a thyroid nodule detected by ultrasonography greater than 3 mm ( n = 91) and controls as patients in whom the presence of the node with the characteristics described was excluded by the same technique (n=91). The level and strength of association was evaluated between the presence of metabolic syndrome and each of its components by itself with the presence of thyroid nodular was evaluated. Results: Bivariate analysis shows significant association between the presence of thyroid nodule and metabolic syndrome with an OR of 2.56 (IC:95% 1.41 to 4.66, p < 0.05). Low levels of HDL and impaired fasting glucose are significant associated with the presence of thyroid nodule, independent of the presence of metabolic syndrome, with an OR of 2.81 (IC:95% 1.54 to 5.12, p<0.05) and 2.05 (IC: 95% 1.10 to 3.78, p<0.05) respectively. The multivariate analysis maintained the association between thyroid nodule and metabolic syndrome with an OR of 2.96 (IC: 95% 1,47 to 5,95 , p<0.05); like was the low levels of HDL with an OR of 2.77 ( IC: 95% 1,44 to 5,3, p<0.05) and with impaired fasting glucose with an OR of 2,23 ( IC 95% 1,14 to 4,34, p<0,05).Conclusions: Metabolic syndrome increases de risk of having thyroid nodule disease. Low HDL levels and impaired fasting glucose were the factors with more association.Tesi

Poliquistosis parotídea (Adenosis poliquística esclerosante asociada a Enfermedad poliquística disgenética): Reporte de caso

Introduction: Polycystic sclerosing adenosis / adenoma (SPA) is accepted as a very rare new benign neoplastic entity of the salivary glands that generally involves the parotid gland. Dysgenetic polycystic disease is another rare entity with histology similar to SPA and that also affects the parotid gland more frequently. Case report: The case of a 28-year-old woman with increased volume of the right parotid gland of approximately 3 years of evolution is presented, whose histopathological analysis suggested the diagnosis of Polycystic Sclerosing Adenosis / adenoma associated with Polycystic Dysgenetic Disease of the right parotid gland. The patient received surgical treatment of total parotidectomy with preservation of the facial nerve. At the moment with remission of the disease.Introducción: La adenosis/adenoma poliquistico esclerosante (SPA) es aceptada como una nueva entidad neoplásica benigna muy poco frecuente de las glándulas salivales que compromete por lo general la glándula parótida. La enfermedad poliquística disgenética es otra entidad poco común con histología similar a la SPA y que también afecta a la gládula parótida con mayor frecuencia. Reporte de caso: Se presenta el caso de una mujer 28 de años con aumento de volumen de la glándula parótida derecha de aproximadamente 3 años de evolución cuyo análisis histopatológico sugirió el diagnostico de Adenosis/adenoma Poliquístico Esclerosante asociado a Enfermedad Poliquística Disgenética de la glándula parótida derecha. La paciente recibió tratamiento quirúrgico de parotidectomía total con preservación del nervio facial. Al momento con remisión de la enfermedad

WITHDRAWN: Encephalitis with convulsive status in an immunocompetent pediatric patient caused by Bartonella henselae

The Publisher regrets that this article is an accidental duplication of an article that has already been published, http://dx.doi.org/10.1016/j.apjtm.2016.03.030. The duplicate article has therefore been withdrawn.The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy

Encephalitis with convulsive status in an immunocompetent pediatric patient caused by Bartonella henselae

Cat scratch's disease caused by Bartonella henselae, is known to be a self-limited benign process in immunocompetent children. The association with neurologic manifestations is very uncommon especially in patient with no immunologic defects and in cases without specific treatment. A 7 years old male patient, without any immunocompromised defect, presented an atypic presentation of the cat scratch disease. The patient came to the hospital in two opportunities in a status epilepticus, in both cases the diagnosis was encephalitis by Bartonella henselae and the evolution with treatment was monitored with PCR (polymerase chain reaction) in cerebrospinal fluid and blood, as well as IFI (IgM, IgG) serology (indirect immunofluorescence). The patient had a favorable clinical and laboratory evolution for 6 months showing no recurrence of the disease.This work has been partially supported by the Programa Nacional de Innovacion para la Competitividad y Productividad ´ (Innovate Per ´ u), under the contract 116-PNICP-PIAP-2015

Effect of Phenylalanine–Arginine Beta-Naphthylamide on the Values of Minimum Inhibitory Concentration of Quinolones and Aminoglycosides in Clinical Isolates of Acinetobacter baumannii

Acinetobacter baumannii; Antimicrobial resistance; Efflux pump inhibitorsAcinetobacter baumannii; Resistencia antimicrobiana; Inhibidores de bomba de eflujoAcinetobacter baumannii; Resistència antimicrobiana; Inhibidors de bomba d'eflux(1) Background: Acinetobacter baumannii has become the most important pathogen responsible for nosocomial infections in health systems. It expresses several resistance mechanisms, including the production of β-lactamases, changes in the cell membrane, and the expression of efflux pumps. (2) Methods: A. baumannii was detected by PCR amplification of the blaOXA-51-like gene. Antimicrobial susceptibility to fluoroquinolones and aminoglycosides was assessed using the broth microdilution technique according to 2018 CLSI guidelines. Efflux pump system activity was assessed by the addition of a phenylalanine–arginine beta-naphthylamide (PAβN) inhibitor. (3) Results: A total of nineteen A. baumannii clinical isolates were included in the study. In an overall analysis, in the presence of PAβN, amikacin susceptibility rates changed from 84.2% to 100%; regarding tobramycin, they changed from 68.4% to 84.2%; for nalidixic acid, they changed from 73.7% to 79.0%; as per ciprofloxacin, they changed from 68.4% to 73.7%; and, for levofloxacin, they stayed as 79.0% in both groups. (4) Conclusions: The addition of PAβN demonstrated a decrease in the rates of resistance to antimicrobials from the family of quinolones and aminoglycosides. Efflux pumps play an important role in the emergence of multidrug-resistant A. baumannii strains, and their inhibition may be useful as adjunctive therapy against this pathogen.This research was supported through Incentive for Research of the Universidad Peruana de Ciencias Aplicadas (Nº UPC-C007-2020), Lima, Peru. The funders had no role in the study design, data collection, and analysis, nor in the decision to publish or the preparation of the manuscript

Molecular detection and clinical characteristics of Bartonella bacilliformis, Leptospira spp., and Rickettsia spp. in the Southeastern Peruvian Amazon basin

Background Acute febrile illness (AFI) represent a significant health challenge in the Peruvian Amazon basin population due to their diverse etiologies and the unavailability of specific on-site diagnostic methods, resulting in underreporting of cases. In Peru, one of the most endemic regions to dengue and leptospirosis is Madre de Dios, a region also endemic to emergent bacterial etiologic agents of AFI, such as bartonellosis and rickettsiosis, whose prevalence is usually underreported. We aimed to molecularly identify the presence of Leptospira spp., Bartonella bacilliformis, and Rickettsia spp. by Polymerase Chain Reaction in serum samples from patients with AFI from Puerto Maldonado-Madre de Dios in Peru. Methods Serum samples from patients with acute febrile illness were analyzed by real-time PCR for detecting the presence of Bartonella bacilliformis, Leptospira spp. and Rickettsia spp. Results Bartonella bacilliformis was the most prevalent bacteria identified in 21.6% (30/139) of the samples, followed by Leptospira spp. in 11.5% (16/139) and Rickettsia spp. in 6.5% (9/139) of the samples. No co-infections were observed between these bacteria. The most frequent symptoms associated with fever among all groups, were headaches, myalgias, and arthralgias. We found no statistically significant differences in the clinical presentation between patients infected with each bacterium. Conclusions In a previous study, we shown the presence of dengue, chikungunya, Zika and oropouche virus. We were able to identify these pathogens in 29.5% of all the samples, with chikungunya and OROV as the most frequently found in 9.4 and 8.6% of all the samples, respectively. In this study we show that B. bacilliformis (21.6%), Leptospira spp. (11.5%) and Rickettsia spp. (6.5%) accounted for the main etiologies of AFI in samples from Puerto Maldonado-Madre de Dios, Perú. Our analysis of their clinical presentation, further shows the importance of implementing more sensitive and specific on-site diagnostic tools in the national surveillance programs.This study confirms that the un-specificity of signs and symptoms is not only associated with arboviral infections, but also with the clinical presentation of endemic bacterial infections.Peer ReviewedPostprint (published version