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OBJECTIVE: To design and validate a questionnaire on the knowledge of primary open-angle glaucoma (POAG) in Spanish-speaking patients. METHODS: An observational study was conducted on adults with diagnosis of POAG and who received outpatient medical care in a national reference health care institute of Peru. The questionnaire was based on a literature review and expert judgment. A pilot study was carried out on 60 patients. The items were classified and weighted according to the expert judgment. The final questionnaire was completed by 314 patients and its overall score was scaled by tertiles. RESULTS: A total of 72 items were found by primary searching. The initial questionnaire was made up of 20 items, which was tested in a pilot study. A total of 14 items were selected that were then classified into 3weighted domains: risk factors (10%), clinical aspects (36%), and treatment (54%). The questionnaire has a score range from 0 to 100 points (lowest to highest level). In patients, the mean score was 62.6±14.1. The overall score was classified into 3categories of knowledge level: low (0 to 55 points), medium (56 to 69 points), and high (70 to 100 points). CONCLUSIONS: The questionnaire provides evidence of validity to assess knowledge of POAG in Peruvian Spanish-speaking patients.

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Objetivo: Describir las características clínico epidemiológicas de la Toxoplasmosis ocular activa, enpacientes del Servicio de Úvea del Instituto Nacional de Oftalmología (INO), desde el 2003 hasta el 2007. Materiales y Métodos: Estudio descriptivo retrospectivo, en el que se utilizaron 1498 historiasclínicas de pacientes del servicio de Úvea del Instituto Nacional de Oftalmología desde enero del 2003hasta octubre del 2007. Se obtuvieron 210 historias con diagnóstico de Toxoplasmosis ocular, siendo excluidos del estudio 109 pacientes por presentar: 16 IgG toxoplasma negativo, 46 sin coriorretinitis exudativa activa, 45 sin IgG toxoplasma y dos con opacidad vítrea intensa. La ceguera legal fue definida como la mejor agudeza visual corregida en el ojo afectado, menor o igual a 20/200. Se utilizaron comovariables: la edad, sexo, lugar de nacimiento y procedencia, características clínicas, tiempo de seguimiento, tiempo de inactivación de la lesión, complicaciones y agudeza visual final. Resultados: De 99 pacientes(102 ojos), el 55,56% fueron del sexo masculino. El grupo etario mayormente comprometido fueel de 21-30 años (31,31%). El 96,97% presentó lesión unilateral. La localización más frecuente fue la perifé-rica (61,90%). La complicación más frecuente: lesiones maculares (23,53%). El 7,07% de pacientes fue VIH(+), sin diferencias en la presentación clínica con respecto a los otros pacientes. Conclusiones: Lafrecuencia de Toxoplasmosis Ocular fue de 14,02%, inferior a los reportes mundiales (22,5%), lapresentación clínica-epidemiológica fue similar a la descrita en la literatura, mayormente en nacidos enel interior del país, en la tercera década de la vida, afección ocular unilateral y localización periférica de lalesión retinal. (AU)

Objective: To describe clinical - epidemiological characteristics of the ocular active toxoplasmosis, in patients of Uvea's Service of the National Institute of Ophthalmology, from 2003 to 2007. Materials and Methods: Retrospective descriptive study, which used 1498 patient records Uveal Service National Eye Institute from January 2003 to October 2007 as an information source. Were 210 patients obtained with diagnosis of ocular toxoplasmosis. Were 109 patients excluded: 16 IgG toxoplasma negative, 46 without exudative chorioretinitis activate, 45 without IgG toxoplasma, 02 with intense vitreous opacity. Legal blindness was definite to the best visual keenness corrected in the affected, minor eye or like 20/200. Variables were used as age, sex, place of birth and origin, clinical characteristics, time of follow-up, time of unactivation of the injury, complications and visual final keenness. Results: From 99 patients (102 eyes), 55.56 %. The age group mainly damaged was from 21 to 30 years old (31.31 %). 96.97 % showed unilateral injury. The most frequent location: peripheral (61.90 %).The most frequent complication: cataract (8.82 %). 7.07 % were HIV (+), without differences in the clinical presentation regarding the other patients. Conclusions: The predominance of the ocular Toxoplasmosis was 14.02 %, lower than the world reports (22.5 %).The clinical - epidemiologic presentation was similar to that described in the documentation, where the unilateral ocular condition and the peripheral location of the retinal injury affected to those born inside the country (Lima-Callao), in the third decade of the life. (AU)

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The extracellular ligninolytic enzyme system of Pleurotus laciniatocrenatus, grown under different culture conditions, was characterized and the ability of this strain to degrade different components of Eucalyptus globulus wood was determined. In shaken liquid cultures grown on a C-limited medium supplemented with yeast extract (0.1%) and peptone (0.5%), the fungus produced extracellular aryl-alcohol oxidase (Aao), laccase (Lac), manganese-dependent peroxidase (MnP) and manganese-independent peroxidase (MiP) activities, their maximum levels being, respectively, about 600, 50, 1360, and 920 pkat/mL. The supplementation of 1 mmol/L vanillic acid and 150 micromol/L CuSO4 produced an increase of Lac activity levels up to 4-fold and 68.3-fold, respectively. No significant differences were found in the levels of the other ligninolytic enzyme activities when compared to the basal medium. Solid-state fermentation cultures on E. globulus wood chips revealed Lac and MiP activities. These cultures showed degradative activity on lignin and lipophilic wood extractives.

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BACKGROUND: Retinoblastoma (RB) is a relatively uncommon tumour in childhood. The incidence of retinoblastoma in Mexico is probably higher than the incidence reported worldwide, however there is not enough information about the characteristics of this illness in Mexico. This report aims to present the results of a multicentre clinical survey of RB in Mexico. METHODS: A retrospective study was carried out on all RB cases treated in 16 institutions during the last six years. The variables analysed were age at diagnosis, sex, affected eyes, treatment modalities, and pathological staging. Overall survival was obtained. RESULTS: The authors analysed 500 cases; age range was 0-182 months. There were 364 unilateral cases (72.8%). Enucleation was performed in 84.9% of the patients. The St Jude's staging was: 7.4% stage I, 52.8% stage II, 18.0% stage III, 11.4% stage IV, 7.2% not evaluated, and 3.2% missing data. Chemotherapy was used in 74.4% of the patients. Disease free survival was 89% at 73 months follow up. CONCLUSIONS: The paper presents a great number of cases and pioneers multicentre studies in paediatric ophthalmology and oncology in this country. Given the great number of patients in advanced stages and the variability on treatment schemes, it is evident that it is mandatory to work in a cooperative group and develop a national early detection programme as well as a treatment protocol which include all specialists involved in the care of patients with RB.

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OBJECTIVE: Systemic Lupus Erythematousus (SLE), an autoimmune disease of unknown etiology manifesting as a pleomorphic systemic disease, affects mostly females, (female:male ratio 9:1). Clinical differences between genders, including a higher death rate in males, has been reported. Here we compared clinical manifestations and the 5-year survival probability in Mexican male and female crossbred cases living under similar socioeconomic conditions. A systematic review of published literature was also carried out. MATERIAL AND METHODS: SLE patients treated at the Instituto Nacional de Cardiología "Ignacio Chávez" México City who fulfilled at least four classification criteria (ACR) were included. The frequency of clinical variables with emphasis on cardiovascular findings before and after the diagnosis were described, disease activity based on a validated scale (SLEDAI) was determined, and the 5-year survival rate was estimated. RESULTS: There were 33 men and 158 women, average age of 31 in both groups ranging from 7 to 65 and from 10 to 75 year in male and female patients respectively; both groups were followed for 3.8 years (median), average activity was of 12 points with a range of 5 to 23 in men, and 11 with a range of 2 to 24 in women. Main clinical characteristics in men were: discoid lupus, psychosis, pericarditis, lymphopenia, thrombocytopenia and SLE kidney disease. Immunological tests showed gender-linked differences in regard auto-antibodies (U1-nRNP, Sm, anticardiolipine and false VDRL) and hypocomplementemia. Cardiovascular features and survival rate were not different between gender. CONCLUSION: Male Mexican SLE patients share clinical findings with other male SLE cases reported everywhere as can be deducted from systematic literature review covering 25-year.

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The gastric pathogen Helicobacter pylori has been recognized as the major aetiologic agent of chronic gastritis and peptic ulcers and also a risk factor for gastric cancer; eradication of H pylori prevents peptic ulcer recurrence and may also decrease the prevalence of gastric cancer in high risk populations around the world. Currently the only accepted indication for treatment is ulcer disease and maltosa, infected with Helicobacter pilory. However treatment is difficult and easily develops resistance. The elaboration of an antibiotic profile is recommended after a treatment failure. There is a lack of information in developing countries so the aim of this work was to determine the antibiotic profile of 51 strains isolated from patients gastric biopsies attended at Hospital San Juan de Dios in Costa Rica, using egg yolk broth and finding a resistance of 63.0% to metronidazole with a breakpoint of 8.0 microg/ml and 20.0% resistance to tetracycline (MIC1.0 microg/ml), 6.0% to clarithromicyn with a MIC of 0.125 microg/ml. There was no resistance to amoxicilin (MIC 0.015 microg/ml). The microdilution technique is very laborious, but highly reproducible with results accordingly to previous work, and we recommended it for the designing of therapeutical scheme.

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The gastric pathogen Helicobacter pylori has been recognized as the major aetiologic agent of chronic gastritis and peptic ulcers and also a risk factor for gastric cancer; eradication of H pylori prevents peptic ulcer recurrence and may also decrease the prevalence of gastric cancer in high risk populations around the world. Currently the only accepted indication for treatment is ulcer disease and maltosa, infected with Helicobacter pilory. However treatment is difficult and easily develops resistance. The elaboration of an antibiotic profile is recommended after a treatment failure. There is a lack of information in developing countries so the aim of this work was to determine the antibiotic profile of 51 strains isolated from patients gastric biopsies attended at Hospital San Juan de Dios in Costa Rica, using egg yolk broth and finding a resistance of 63.0% to metronidazole with a breakpoint of 8.0 microg/ml and 20.0% resistance to tetracycline (MIC1.0 microg/ml), 6.0% to clarithromicyn with a MIC of 0.125 microg/ml. There was no resistance to amoxicilin (MIC 0.015 microg/ml). The microdilution technique is very laborious, but highly reproducible with results accordingly to previous work, and we recommended it for the designing of therapeutical scheme.

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Helicobacter Pylori colonize the gastric mucosa and their adaptation to this environment is related with its high activity urease. This enzyme hydrolyzes the gastric urea, neutralizing the acid environment of the bacteria. Based on that reaction numerous presumptive diagnosis tests, have been developed using a solution of urea (usually 6%) with a pH indicator (usually 0.05% fenol-red); nevertheless, the color changes are so light that some persons do not detect it. For that reason, a modification of that reaction was proposed using a mix of pH indicators (0.05% fenolred and 0.002 bromothymol blue) which induces a color change from light green to deep purple. Also, the reaction of urease was evaluated using only bromothymol blue. The reaction using fenol red as indicator showed the higher values for sensitivity of 58.8% and the specificity of 66.6%; whereas using only bromothymol-blue those values were 46 y 71.4% respectively. The efficiency of the test using fenol-red or the mix of this bromothymol- was 64.2 y 62.2%, respectively; however, the mix of indicators induce a change color easily detected, because of changes from ligh-green to deep-purple.

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Helicobacter Pylori colonize the gastric mucosa and their adaptation to this environment is related with its high activity urease. This enzyme hydrolyzes the gastric urea, neutralizing the acid environment of the bacteria. Based on that reaction numerous presumptive diagnosis tests, have been developed using a solution of urea (usually 6

) with a pH indicator (usually 0.05

fenol-red); nevertheless, the color changes are so light that some persons do not detect it. For that reason, a modification of that reaction was proposed using a mix of pH indicators (0.05

fenolred and 0.002 bromothymol blue) which induces a color change from light green to deep purple. Also, the reaction of urease was evaluated using only bromothymol blue. The reaction using fenol red as indicator showed the higher values for sensitivity of 58.8

and the specificity of 66.6

; whereas using only bromothymol-blue those values were 46 y 71.4

respectively. The efficiency of the test using fenol-red or the mix of this bromothymol- was 64.2 y 62.2

, respectively; however, the mix of indicators induce a change color easily detected, because of changes from ligh-green to deep-purple.

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PURPOSE: To analyse the transseptal catheterization technique, its indications and possible complications. METHODS: The transseptal catheterization has been undertaken in 233 patients, 202 children (aged 0.1 to 16 years) with congenital heart disease and 31 adults (aged 37 to 73 years) submitted to mitral valvuloplasty. The Mullins technique was employed to access left heart chambers. RESULTS: In the pediatric group, the indications for transseptal catheterization were coarctation of the aorta and valvular or subvalvular aortic stenosis. By this technique, multiple diagnostic analysis and therapeutic procedures, such as blade atrioseptostomy and mitral valvuloplasty, became available. Among the complications in the 2 groups, pericardial perforation was the most frequent, depending on the laboratory practice with this technique. CONCLUSION: The transseptal cardiac catheterization is a safe and effective technique to investigate hemodynamic data in several congenital heart diseases and is essential to many therapeutic procedures. The technique has a low incidence of complications when employed by experienced teams.

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This report presents the results of an operations research project to increase male involvement in family planning in Peru. Two community-based distribution (CBD) programs, PROFAMILIA of Lima and CENPROF of Trujillo, Peru, recruited male contraceptive distributors and compared their performance to that of female distributors recruited at the same time. Both programs found it harder to recruit men than women as distributors. Program supervisors, who were women, were less comfortable with men than with other women, even though there were no differences in distributor compliance with program norms. Male distributors were more likely to serve male clients and sell male methods (condoms), while female distributors were more likely to serve female clients and sell female methods (pills). Men sold as much or more total couple-years of protection than did women, and they recruited as many or more new acceptors. Gender was found to exert an impact on method mix independent of other distributor characteristics, such as age, education, marital status, and number of living children. The study suggests that family planning programs can influence method mix and client characteristics by recruiting men as CBD distributors.

PIP: The findings of an operations research (OR) project designed to compare the effectiveness of male vs. female contraceptive distributors in Peru are reported. The OR project was conducted by 2 private, nonprofit family planning agencies that have community-based distribution (CBD) programs: PROFAMILIA in Lima and CENPROF in Trujillo. The OR project sought to test 3 hypotheses: 1) male distributors would sell more condoms and female distributors would sell more oral contraceptives; 2) male distributors would serve more male clients and female distributors would serve more female clients; and 3) male distributors would sell less contraceptive protection than female distributors. Between 1987 and January 1988, the 2 agencies recruited new male and female distributors to serve in the project. Both agencies had a more difficult time recruiting male than female distributors. PROFAMILIA recruited 38 men and 171 women, while CENPROF recruited 52 men and 94 women. All but one of the supervisors in both agencies were female. The supervisors generally regarded the male distributors with skepticism, but the study found no significant difference in the reporting compliance of male and female distributors. The project confirmed hypotheses 1 and 2. In both agencies men sold twice as many condoms as did women, and women sold more oral contraceptives; and male distributors were more likely to serve men, while female distributors were more likely to serve women. The 3rd hypothesis, however, was unsupported. Men sold as much or more contraceptive protection than did women and recruited as many or more new acceptors. It is concluded that men can be effective CBD distributors, and that CBD programs can influence method and client mix by recruiting more men as distributors.

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