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We report an unusual case of an amelanotic melanoma in a 7 year old hispanic child with subclinical globe perforation. Uveal melanoma rarely occurs in children. Young affected patients are mostly light-colored eye Caucasian adolescents. Since they are not common, these tumors are usually not recognized and misdiagnosed. Differential diagnoses and therapeutic options are outlined.

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Aging and gender are factors that affect the variation of physical work capacity. The present paper highlights the importance of the metabolism used by ergonomics to establish the appropriate limits of loads at work. This study compares the aerobic capacity of people from 20 to 71 years old split in 5 different groups. The laboratory experiment tested 33 volunteers (19 women and 14 men). A submaximal step test was used to measure the VO(2) using a portable breath by breath metabolic system and a telemetric heart rate monitor. Three methods to estimate the VO(2max) were compared: 1) a direct measurement of VO(2), 2) estimation by heart rate, and 3) a step test method using predetermined charts. Significant difference was encountered among the estimation methods as well as among the age ranges (F(2,92)=6.43, p<0.05 y F(4,92)=7.18, p<0.05 respectively). The method of direct measurement and the method of predetermined charts were different for the estimation of the VO(2max) with a confidence level of 95%. The method of predetermined charts is better adapted for males and people younger than 30 years. The estimation through non invasive heart rate apparatus was a good appraiser of the maximal oxygen consumption considering both genders and all the age groups.

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We report a systematic collection of Triatominae inside houses and in the peridomestic environment of Alto Beni, department of La Paz, Bolivia. This area is free of Triatoma infestans and although we detected previously seropositivity for Trypanosoma cruzi, the Alto Beni region is not officially considered as endemic for Chagas disease. From 11 houses of five localities, we collected adults, nymphs and eggs of a Rhodnius species, which was confirmed by morphological and morphometric analysis as Rhodnius stali. This little-known species has long been confused with R. pictipes, and was originally described from museum specimens labelled as R. pictipes. Our data show that R. stali is able to establish colonies in domestic and peridomestic habitats in Bolivia, and it is probably the vector responsible for Chagas disease seropositivity observed in the indigenous population of Alto Beni.

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Toro Toro (T) and Yungas (Y) have been described as genetically well differentiated populations of the Lutzomyia longipalpis (Lutz & Neiva, 1912) complex in Bolivia. Here we use geometric morphometrics to compare samples from these populations and new populations (Bolivia and Nicaragua), representing distant geographical origins, qualitative morphological variation ("one-spot" or "two-spots" phenotypes), ecologically distinct traits (peridomestic and silvatic populations), and possibly different epidemiological roles (transmitting or nor transmitting Leishmania chagasi). The Nicaragua (N) (Somotillo) sample was "one-spot" phenotype and a possible peridomestic vector. The Bolivian sample of the Y was also "one-spot" phenotype and a demonstrated peridomestic vector of visceral leishmaniasis (VL). The three remaining samples were silvatic, "two-spots" phenotypes. Two of them (Uyuni and T) were collected in the highlands of Bolivian where VL never has been reported. The last one (Robore, R) came from the lowlands of Bolivia, where human cases of VL are sporadically reported. The decomposition of metric variation into size and shape by geometric morphometric techniques suggests the existence of two groups (N/Y/R, and U/T). Several arguments indicate that such subdivision of Lu. longipalpis could correspond to different evolutionary units

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This is the first report of adult and nymphs (20 nymphs of all stages and 4 adults) of Microtriatoma trinidadensis (Lent 1951) (Hemiptera: Reduviidae: Triatominae) collected in peridomestic environment, in the department of La Paz, Bolivia. These specimens were associated to Rhodnius stali Lent, Jurberg & Galvão 1993. The exceptional finding of M. trinidadensis in peridomestic environment, illustrates the general tendency of triatominae to adapt to human dwellings and dependences.

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This is the first report of adult and nymphs (20 nymphs of all stages and 4 adults) of Microtriatoma trinidadensis (Lent 1951) (Hemiptera: Reduviidae: Triatominae) collected in peridomestic environment, in the department of La Paz, Bolivia. These specimens were associated to Rhodnius stali Lent, Jurberg & Galväo 1993. The exceptional finding of M. trinidadensis in peridomestic environment, illustrates the general tendency of triatominae to adapt to human dwellings and dependences

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Primary systemic amyloidosis or AL-amyloidosis is an uncommon disease characterized by the accumulation in vital organs of a fibrillar protein consisting of monoclonal light chains. It is a plasma-cell dyscrasia related to multiple myeloma where clonal plasma cells in the bone marrow produce immunoglobulins that are amyloidogenic. A monoclonal component is present in the serum or urine of 90% of patients. The presentation of most patients with AL amyloidosis is usually related to congestive heart failure, nephrotic syndrome o peripheral neuropathy, but there are unusual features suggesting giant cell arteritis (GCA) and polymyalgia rheumatic (PMR). Although in the majority of AL cases the plasma cells clone is small, the assumption is that the outcome of the disease is uniformly fatal (median survival 12-15 months) and treatment is analogous to those used in malignant proliferative disease. We describe a patient with AL amyloidosis who presented with manifestations of GCA and PMR, and we review the main characteristics of primary amyloidosis.

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La amiloidosis primaria o amiloidosis AL es una discrasia de células plasmáticas difícil de diferenciar del mieloma múltiple, que se caracteriza por el depósito de una proteína fibrilar de cadenas ligeras monoclonales en tejidos y órganos. Es una enfermedad poco frecuente, en la que un clon de células plasmáticas en la médula ósea produce inmunoglobulinas amiloidogénicas. En el 90 por ciento de los casos se detecta por inmunoelectroforesis inmunoglobulinas monoclonales en sangre u orina. Habitualmente se manifiesta como insuficiencia cardiaca, síndrome nefrótico o neuropatía periférica, pero excepcionalmente pueden existir síntomas sugestivos de arteritis de células gigantes (ACG) o polimialgia reumática (PMR). Aunque el número de clones de células plasmáticas en la médula ósea suele ser pequeño, la actitud terapeútica es la de una enfermedad proliferativa maligna, siendo la supervivencia media de 12 a 15 meses.Presentamos un paciente cuya primera manifestación de amiloidosis primaria fueron síntomas de ACG y PMR, y revisamos las principales características de esta enfermedad. (AU)

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Toro Toro (T) and Yungas (Y) have been described as genetically well differentiated populations of the Lutzomyia longipalpis (Lutz & Neiva, 1912) complex in Bolivia. Here we use geometric morphometrics to compare samples from these populations and new populations (Bolivia and Nicaragua), representing distant geographical origins, qualitative morphological variation ("one-spot" or "two-spots" phenotypes), ecologically distinct traits (peridomestic and silvatic populations), and possibly different epidemiological roles (transmitting or nor transmitting Leishmania chagasi). The Nicaragua (N) (Somotillo) sample was "one-spot" phenotype and a possible peridomestic vector. The Bolivian sample of the Y was also "one-spot" phenotype and a demonstrated peridomestic vector of visceral leishmaniasis (VL). The three remaining samples were silvatic, "two-spots" phenotypes. Two of them (Uyuni and T) were collected in the highlands of Bolivian where VL never has been reported. The last one (Robore, R) came from the lowlands of Bolivia, where human cases of VL are sporadically reported. The decomposition of metric variation into size and shape by geometric morphometric techniques suggests the existence of two groups (N/Y/R, and U/T). Several arguments indicate that such subdivision of Lu. longipalpis could correspond to different evolutionary units.

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La hipertensión arterial afecta la función y la estructura cardiovascular, con hipertrofia y disfunción ventricular frecuentes, en especial en pacientes con cardiopatía isquémica asociada. Evaluamos 20 pacientes entre 40 y 70 años de edad, con diagnóstico de hipertensión esencial (presión arterial diastólica entre 95 y 115 mmHg) asociada a disfunción ventricular (fracción de eyección ó 45 por ciento). Se estudiaron por angiografía radioisotópica la función sistólica, la función diastólica y la circulación periférica en las siguientes etapas: A) al final del período lavado-placebo (pretratamiento); B) en fase aguda, a las 6 horas de amlodipina (10 mg) por vía oral; C) en fase crónica, al final de 8 semanas de igual tratamiento con monodosis. El tratamiento en fase aguda y crónica mostró una disminución significativa de la presión arterial sistólica, diastólica y de la resistencia periférica total (en un 15 por ciento, 14 por ciento y 20 por ciento respectivamente). El pico de llenado del ventrículo izquierdo basal fue 1,9 ñ 0,4 (VFD/S), mejorando un 21 por ciento en el tratamiento crónico en reposo y 17 por ciento durante el ejercicio ergométrico, lo que evidenció una mejoría de la función diastólica del ventrículo izquierdo (p<0,01). El volumen de fin de sístole o residual, aumentado como expresión de la falla de bomba, disminuyó en 15 y 19 por ciento en reposo y esfuerzo. En el pretratamiento los parámetros hemodinámicos muestran disfunción ventricular sistólica y diastólica del ventrículo izquierdo con compromiso del ventrículo derecho, tanto en reposo como en esfuerzo, con disminución de la reserva cardíaca. El efecto vasodilatador de la amlodipina, con disminución de la poscarga, produjo efectos hemodinámicos favorables, tanto en el control de la hipertensión arterial como en la mejoría de la disfunción biventricular asociada

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La hipertensión arterial afecta la función y la estructura cardiovascular, con hipertrofia y disfunción ventricular frecuentes, en especial en pacientes con cardiopatía isquémica asociada. Evaluamos 20 pacientes entre 40 y 70 años de edad, con diagnóstico de hipertensión esencial (presión arterial diastólica entre 95 y 115 mmHg) asociada a disfunción ventricular (fracción de eyección ó 45 por ciento). Se estudiaron por angiografía radioisotópica la función sistólica, la función diastólica y la circulación periférica en las siguientes etapas: A) al final del período lavado-placebo (pretratamiento); B) en fase aguda, a las 6 horas de amlodipina (10 mg) por vía oral; C) en fase crónica, al final de 8 semanas de igual tratamiento con monodosis. El tratamiento en fase aguda y crónica mostró una disminución significativa de la presión arterial sistólica, diastólica y de la resistencia periférica total (en un 15 por ciento, 14 por ciento y 20 por ciento respectivamente). El pico de llenado del ventrículo izquierdo basal fue 1,9 ñ 0,4 (VFD/S), mejorando un 21 por ciento en el tratamiento crónico en reposo y 17 por ciento durante el ejercicio ergométrico, lo que evidenció una mejoría de la función diastólica del ventrículo izquierdo (p<0,01). El volumen de fin de sístole o residual, aumentado como expresión de la falla de bomba, disminuyó en 15 y 19 por ciento en reposo y esfuerzo. En el pretratamiento los parámetros hemodinámicos muestran disfunción ventricular sistólica y diastólica del ventrículo izquierdo con compromiso del ventrículo derecho, tanto en reposo como en esfuerzo, con disminución de la reserva cardíaca. El efecto vasodilatador de la amlodipina, con disminución de la poscarga, produjo efectos hemodinámicos favorables, tanto en el control de la hipertensión arterial como en la mejoría de la disfunción biventricular asociada (AU)

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With the objective of finding reliable, valid, and economic diagnostic tests to identify Chlamydia trachomatis in conjunctival smears, the sensitivity, specificity, and positive and negative predictive values of Lendrum and Giemsa stains were evaluated using direct immunofluorescence as the gold standard. In addition, inter- and intraobserver reproducibility were estimated through the use of two independent observers, who were blinded to the results during their readings. The prevalence of ocular chlamydiosis in the study area was around 50%. In all, 103 persons (206 eyes) were studied. Three smears from each eye were taken for each subject. The kappa statistic was used to estimate the reproducibility of the stains. Interobserver reproducibility was null, and intraobserver reproducibility ranged between 0.35 and 0.79. The sensitivity of the Giemsa stain was a bit higher than that of the Lendrum stain (28% and 22%, respectively), and the specificity was similar (82% and 85%, respectively). Based on these results, the ability of both stains to detect positive cases was judged to be low, as was their reliability. The Lendrum and Giemsa stains are not adequate tests for the diagnosis of ocular chlamydiosis. For this purpose the use of direct immunofluorescence is recommended.

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