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Purine-rich element-binding protein A (PURα) regulates multiple cellular processes. Rare de novo mutations can lead to PURA syndrome, which manifests as a range of multisystem disturbances, including hypotonia, global developmental delay, swallowing disorders, apnea, seizures, visual impairments, and congenital heart defects. We report the case of a Colombian girl with no relevant medical history who was diagnosed with PURA syndrome at the age of 7, due to a heterozygous mutation located at 5q31.2, specifically the variant c.697_699del (p.Phe233del), in exon 1 of the PURA gene. This represents the first documented case of PURA syndrome in South America and the first association of the syndrome with vitiligo, thereby expanding the known phenotypic spectrum. In addition to enriching the literature concerning the phenotypic diversity of PURA syndrome, this report highlights, for the first time, the diagnostic challenges faced by developing countries like Colombia in diagnosing high-burden rare diseases such as PURA syndrome.

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Purpose: The aim of this research was to evaluate the technique of using inhaled drugs in patients with a confirmed history of COPD and describe errors in inhaler technique. Patients and Methods: Descriptive cross-sectional study was conducted in patients with a history of COPD using inhalation therapy, attending pulmonology consultation between August 2020 and April 2021 in Armenia, Colombia. A non-probabilistic sample of 80 adult participants was calculated, and the inhalation technique was evaluated (depending on the device used) using a scale validated for Colombia. Descriptive analysis of the qualitative variables was performed using frequencies and percentages. The Chi-Square test and Fisher's exact test (in corresponding cases) were used to look for association relationships between categorical variables. Results: A total of 80 participants were evaluated, of which 66.3% (n = 53) were male, and 32.5% were older than 80 years. Clinically, 30.0% (n = 24) were classified as Modified Medical Research Council Dyspnea Scale (mMRC) grade 3, and 51.2% (n = 41) had at least one exacerbation per year. The main comorbidity was hypertension (40.3%). Pressurized metered-dose inhalers with spacer were the most used device at 22.7% (n = 39). Incorrect technique (at least one error in the steps of the inhalation technique used) was found in 48.7%. The most frequent error among all the techniques was the failure to perform pre-inspiratory exhalation. No significant differences were observed between the development of the technique and the characteristics of the participants. Conclusion: Nearly half of the patients who use inhalation devices make errors in the technique. Patient education and training of healthcare personnel represent a fundamental pillar in mitigating the incorrect use of these devices.

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Purpose: The objective of this study was to describe the level of knowledge, perceptions, and practices in relation to risks and disasters in medical schools in Latin America and the Caribbean. Participants and Methods: Multicenter, observational, analytical, non-probabilistic convenience sample study with 2546 medical students in 9 countries of Latin America and the Caribbean. An online survey was conducted between October 2020 and November 2020, using an instrument validated in each country to assess knowledge, perceptions, and practices regarding risk and disaster prevention measures. Frequencies, percentages, mean and standard deviation (SD) were used for descriptive analysis. Differences resulting from the relationship between the variables studied and the level of knowledge were obtained using the Chi-square test. P-value <0.05 was accepted as statistically significant for all analyses. Results: The highest proportion of responses came from women, third-semester students, and those studying in public universities. Students from Colombia and Honduras had the highest percentage of high levels of knowledge about disasters, while Peruvian students had the highest percentage of low levels of knowledge. Women and students from public universities showed a higher proportion of high levels of knowledge. 52.7% considered that they live in a country with a medium risk of natural disasters, while 91.2% said that Latin American and Caribbean countries are not prepared to face natural disasters. Only 43.6% believe they are prepared to help in the event of a natural disaster. Conclusion: Most of medical students from Latin America and Latin America and the Caribbean have high and medium level of knowledge in risks and disasters. However, the implementation of disaster training programs for medical students has the potential to improve the preparedness, knowledge, and skills that are important for medical personnel to improve their self-confidence, and their ability to respond, resulting in more effective systems.

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BACKGROUND: Radiology is a useful tool for diagnosis and intervention in medical practice, and all the components within the teaching-learning process of this subject during undergraduate studies influence successful knowledge application. OBJECTIVE: This study aimed to describe the level of knowledge in radiology of students in the last two years of medical school and curricular characteristics of their courses in seven Latin American countries. METHODS: A multicenter cross-sectional study was carried out on medical students of 7 Latin American countries (Bolivia, Brazil, Colombia, Ecuador, Mexico, Paraguay, and Peru) in their final two years of medical school, using an online questionnaire validated by experts and adapted for each country that assessed knowledge and curricular characteristics in radiology subject. Scores were assigned according to the number of correct answers for the knowledge test. The T-test, and regression analysis with one-way ANOVA were used to search for relationships between the level of knowledge and other variables. RESULTS: A total of 1514 medical students participated in this study. All countries had similar participation (n > 200); most participants were women 57.8%. The country with the highest knowledge score was Brazil. Male, sixth year (internship) and from public universities students had higher knowledge score (n < 0.05). Participants, who considered radiology more important, and who reported higher compliance with teaching staff with the proposed syllabus, and programmed classes, obtained better scores (n < 0.05). CONCLUSIONS: Latin American medical students included in this study have a regular overall level of knowledge of Radiology, apparently influenced by curricular differences such as class and academic program compliance. Efforts to better understand and improve academic training are indispensable. LIMITATIONS: The study was subject to selection bias determined by non-probability convenience sampling. The questionnaire assessed only theoretical knowledge and the evaluation system was designed by the investigators.

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Abstract Introduction: Medical students play an important role in achieving sexual and reproductive health outcomes, including a greater participation of men in family planning. Objective: To describe the level of knowledge, perception, and acceptance of vasectomy in a sample of Latin American medical students (i.e., whether they would recommend this procedure to their patients, and in the case of male students, whether they would undergo it at some point in their lives) in a sample of Latin American medical students. Materials and methods: Multicenter, cross-sectional, analytical study conducted in November 2020 in 2 676 medical students (1st-7th year) from 8 Latin American countries. Data were collected using a questionnaire validated in each country and completed in Google Forms. The chi-square test of independence was used to determine differences in study variables (knowledge, perception, and acceptance) for each established subgroup, with a significance level of p<0.05. Results: The level of knowledge was high and medium in 55.38% and 36.32% of participants, respectively. The country with the highest ratio of students with a high level of knowledge was Mexico (77.31%) and the one with the lowest ratio was Brazil (3.33%). Regarding perception, 96.97% of the students considered that vasectomy does not affect masculinity and 98.99% that contraception is also the responsibility of men. With respect to acceptance, 94.02% would recommend the procedure, but only 69.82% of men (n=759) would undergo it. Conclusions: Most participants have a good level of knowledge, good perception, and a good level of acceptance of the procedure. However, it is necessary to implement more training strategies that allow them to promote the use of vasectomy as a family planning alternative in their professional life.

Resumen Introducción. Los estudiantes de medicina desempeñan un rol importante en el logro de resultados en salud sexual y reproductiva, incluyendo una mayor participación de los hombres en la planificación familiar. Objetivo. Describir el nivel de conocimientos, la percepción y el nivel de aceptación de la vasectomia (i.e. sí la recomendarían a sus pacientes y, en el caso de los hombres, sí se la realizarían en algún momento de su vida) en una muestra de estudiantes de medicina latinoamericanos. Materiales y métodos. Estudio multicéntrico, transversal analítico realizado en noviembre de 2020 en 2 676 estudiantes de medicina (1er-7mo año) de 8 países latinoamericanos. Los datos se recolectaron mediante un cuestionario validado en cada país y diligenciado mediante Google Forms. Se utilizó la prueba de chi-cuadrado de independencia para determinar las diferencias en las variables de estudio (nivel de conocimientos, percepción y nivel de aceptación) para cada subgrupo establecido, con un nivel de significancia de p<0.05. Resultados. El nivel de conocimientos fue alto y medio en 55.38% y 36.32% de los participantes, respectivamente. El país con mayor proporción de estudiantes con alto nivel de conocimientos fue México (77.31%) y el de menor proporción, Brasil (3.33%). Respecto a la percepción, 96.97% de los estudiantes consideró que la vasectomía no afecta la masculinidad y 98.99% que la anticoncepción también es responsabilidad del hombre. En cuanto a la aceptación, el 94.02% recomendaría el procedimiento, pero solo el 69.82% de los varones (n=759) se la realizaría. Conclusiones. La mayoría de los participantes tiene un buen nivel de conocimientos, buena percepción y un buen nivel de aceptación del procedimiento. No obstante, es necesario implementar más estrategias de capacitación que les permitan promover el uso de la vasectomía como alternativa de planificación familiar en su vida profesional.

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Resumen Objetivo: Describir la efectividad del tratamiento antiparasitario intestinal brindado a niños de cuatro a nueve años atendidos en el centro de Salud de la Universidad del Quindío entre Julio de 2017 a marzo de 2018. Materiales y métodos: Estudio observacional prospectivo. Se extrajeron datos de historias clínicas de pacientes con rango de edad de 4 a 9 años, quienes consultaron en el Centro de Salud de la Universidad del Quindío y se diagnosticaron mediante coprológico con blastocistosis o giardiasis. Se seleccionaron las historias cuyo tratamiento fuese Nitazoxanida y tuviesen un coprológico control postratamiento. Se presentan estadísticas descriptivas; porcentaje de eficacia y tolerabilidad. Resultados: De 15 niños tratados con Nitazoxanida, respondieron al tratamiento 10, en quienes no se hallaron parásitos en el coprológico control. Con una eficacia del 83,3% (IC95% 60 - 100) en blastocistosis, 57,1% (IC95% 32 - 82%) en giardiasis. Conclusión: Se evidenciaron resultados porcentuales similares a los reportados en la literatura, siendo más eficaz en blastocisotisis que en giardiasis.

Abstract Objective: To describe the effectiveness of the intestinal antiparasitic treatment given to children ranging between 4 and 9 years old that were attended in the Health Center of the University of Quindío in the period of July 2017 and March 2018. Materials and methods: Prospective observational study. Data were extracted from medical records of patients with an age range of 4 to 9 years, who consulted at the Health Center of the University of Quindío and were diagnosed through coprological tests with Blastocystis and Giardiasis. The clinical records were selected by whose treatment was done with Nitazoxanide or Albendazole with coprological results of post-treatment check-up. Descriptive statistics are presented along with percentage of efficacy and tolerability. Results: From 15 children treated with Nitazoxanide, 10 responded to the treatment, who presented no parasites in the coprological check-up. The remaining population presented some type of parasitic infection (n = 5). With an efficiency of 83,3% (IC95% 32 - 82%) in blastocystis, and 57,1% (IC95% 32 - 82%) in giardiasis. Conclusion: Percentage results similar to those reported in the literature were evidenced, being more effective in blastocystis than in giardiasis.

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Objetivo: Caracterizar la edad y el perfil étnico/racial y el número de casos de cáncer de mama, las características del tumor y el tiempo de supervivencia entre las mujeres 2012-2016. Métodos: Este análisis secundario descriptivo aprovechó la información del Registro Nacional de Cáncer de Panamá. Resultados: Hubo 4134 casos de cáncer de mama con una edad media de 58años. La mayoría de las mujeres eran blancas (n=2514; 60,8%). Las regiones con más casos fueron Panamá (53,7%), Chiriquí (10,6%), Panamá Oeste (9,5%), Colón (6,6%) y Coclé (5,5%). Pocos (n=337) casos incluyeron datos desde el diagnóstico hasta la muerte para un tiempo de supervivencia que varió de 7.08 (Colón) a 17.08 (Panamá Oeste) meses. No se observaron diferencias estadísticamente significativas en los tiempos de supervivencia entre provincias. Pocos (n=1787) casos tenían datos de estadificación; El 15,1% estaba en estadio I, el 39,1% en estadio II, el 33,6% en estadio III y el 11,2% en estadio IV. La mayoría de los casos se clasificaron como T2 (7,1%) o T3 (7,1%). Conclusiones: La edad media y la raza del cáncer de mama es similar a la del hemisferio occidental. Las mujeres en Panamá tenían más probabilidades de ser diagnosticadas en una etapa más avanzada de la enfermedad, con solo el 15% diagnosticado con enfermedad en etapa I, con un tiempo de supervivencia que oscilaba entre 7,1 y 17,8 meses. Si bien la mayoría de los casos de cáncer de mama se encuentran en la provincia metropolitana de Panamá, la razón exacta de esto sigue sin estar clara. (provisto por Infomedic International)

Objective: To characterize the age and ethnic/racial profile and the number of breast cancer cases, tumor characteristics, and survival time among women 2012-2016. Methods: This descriptive, secondary analysis leveraged information from the Panama's National Cancer Registry. Results: There were 4134 cases of breast cancer with a mean age of 58. Most women were white (n=2514; 60.8%). The regions with the most cases were Panama (53.7%), Chiriquí (10.6%), Panama Oeste (9.5%), Colon (6.6%), and Coclé (5.5%). Few (n=337) cases included data from time from diagnosis to death for a survival time ranging from 7.08 (Colón) to 17.08 (Panamá Oeste) months. No statistically significant differences were observed in survival times between provinces. Few (n=1787) cases had staging data; 15.1% were StageI, 39.1% were StageII, 33.6% were StageIII, and 11.2% were StageIV. Most cases were classified as T2 (7.1%) or T3 (7.1%). Conclusions: The mean age and race of breast cancer is similar to that of the Western hemisphere. Women in Panama were more likely to be diagnosed at a more advanced disease stage, with only 15% diagnosed with StageI disease, with a survival time ranging between 7.1 and 17.8months. While most breast cancer cases are reportedly in the metropolitan province of Panamá, the exact reason for this remains unclear. (provided by Infomedic International)

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Although motor vehicle collisions (MVCs) are a worldwide public health concern due to their high injury, mortality, and fatality rates, few studies have addressed the epidemiologic behavior of MVCs in Latin American youth. Thus, this study was aimed at describing and comparing the characteristics of MVCs involving 0 to 14-year-olds in Costa Rica, Guatemala, and Panama. A secondary aim was to estimate the crude MVC-related injury, fatality, and mortality rates and their trends over time. We conducted a descriptive, retrospective study using publicly available data for Costa Rica, Panama, and Guatemala between 2012 and 2015. We examined the reported MVC cases and calculated the crude injury, fatality, and mortality rates and their trends over time (α = 0.05). Publicly available data reported 12,020 MVC-related injuries and 431 MVC-related deaths involving 0 to 14-year-olds. The most frequent mechanisms involved 0 to 14-year-olds as passengers or pedestrians in MVCs (>85% of all cases). The highest crude MVC-related injury and mortality rates were reported for Panama (119.35 and 2.14 per 100,000 population, respectively, in 0 to 14-years-olds), while Guatemala had the highest median MVC-related fatality rate (8.84 per 100,000 events; χ2 [2] = 377.8; p < 0.001) with a statistically significant trend increasing over time (r = 0.947; p = 0.027). Although several factors play a role in the prevention of MVCs among 0 to 14-year-olds, we found that Costa Rica was the only country that implemented a policy on child restraint systems resulting in the lowest rates of MVC-related injury, mortality, and fatality. These results could be used by decision makers from the aforementioned Central American countries to develop adequate policies addressing MVC preventative strategies to protect Central American infants and children.

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Background and objectives: We aim to describe the demographic characteristics associated with suicide in Panama, to estimate the suicide mortality rate and years of potential life lost (YPLL) to suicide, and to explore the correlation of suicide rates with the Multidimensional Poverty Index (MPI). We present a descriptive retrospective epidemiological report of suicide-related mortality (Panama, 2007-2016). Materials and Methods: Data were matched-merged to calculate unadjusted suicide mortality rates (overall, and by sex, age groups, and administrative region), YPLL, and coefficients (r) for the correlation of MPI and suicide rates. Results: There were 1475 deaths by suicide (86% among men, 47% between 20 and 39 years). The average mortality rate was estimated at 3.91 per 100,000 population with an average YPLL rate of 3.79 per 1000 population. There was a statistically significant trend to reduce YPLL over time (r = -0.93; p< 0.001). Exploratory analyses did not show a significant correlation between the MPI and suicide rates. Our study showed a 6:1 male-to-female ratio of suicide, mostly affecting the age groups of 20-29 and over 80 years. Conclusions: Exploratory analyses on the correlation of the MPI and the suicide rates did not achieve statistical significance, and alternative explanations, such as access to pesticides and alcohol, were further explored to inform potential interventions.

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AIM: To compare parental satisfaction and impact on daily life among parents of children receiving whole-cell pentavalent + oral polio vaccine (Arm1) with an acellular hexavalent vaccine (Hexaxim; Arm2). METHODS: Self-administered electronic questionnaire at vaccination and one week later in six community health clinics of metropolitan Santiago, Chile, exploring parent-reported outcomes on satisfaction, acceptability, and impact on daily life after immunization. Univariate and multivariate analyses were conducted to determine differences in the responses in both groups (α = 0.05). RESULTS: The study enrolled 800 participants and 65% (222 in Arm1, 296 in Arm2) were included for according-to-protocol analysis. Demographic characteristics were comparable, except for a higher proportion of mothers answering the questionnaire at the 6-month visit. Regardless of the study arm, parental knowledge and perception of the immunization practices were good, and there were no differences in vaccination experiences in the prior 5 years. However, satisfaction with vaccination and intention to vaccinate were statistically significantly higher in Arm2 after the 6-month visit. Also, more parents in Arm2 reported no disruption in several aspects of the everyday activities of the parent, the child, and other children in the household. Parents in Arm2 were more likely to be satisfied with the vaccine received (OR 2.82; 95% CI, 1.22-7.07); return for other vaccine dose (OR 2.62; 95% CI, 1.45-4.84); follow a healthcare professional recommendation (OR 2.24; 95% CI, 1.57-3.21); and, to be confident that the vaccine will not disrupt the family's daily routine (OR 1.89; 95% CI, 1.32-2.71). CONCLUSIONS: Overall, satisfaction, intention for future vaccination, and lower impact on the family daily routine were significantly better in the group receiving the hexavalent vaccine. We also found that health care providers' recommendations to vaccinate and participants' access to health services were important factors favoring immunization.

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Resumen Introducción: Durante los años 90 en Panamá, un programa patrocinado por los EE. UU. llevo a cabo la Iniciativa para los Hospitales Amigos de los Niños (IHAN) como guía para educar a los profesionales clínicos, al público y a las mujeres en edad reproductiva sobre los beneficios de la lactancia materna. Como resultado, Panamá tiene actualmente la mayor proporción de mujeres que ofrece el pecho materno dentro de la primera hora de vida (89.9%), pero una de las menores tasas en la región de alimentación exclusiva al pecho materno hasta los 6 meses de edad. Este estudio explora la relación entre las practicas alrededor del periodo de ablactación y la historia nutricional del lactante en mujeres panameñas con un niño de hasta 1 año de edad utilizando un diseño transversal. Materiales y Métodos: Se invito una muestra por conveniencia de 35 binomios madre-hijo en dos Centros de Salud de Chitré, Herrera. Las mujeres que consintieron participar en el estudio completaron la Escala de Autoeficacia para la Lactancia Materna, Formulario Corto (BSES-SF) y se compararon las medidas antropométricas del niño utilizando los nomogramas de los CDC. Resultados: Los puntajes del BSES-SF variaron entre 29 y 56 (media = 44.2, DE = 7.9) puntos. Siete lactantes fueron considerados a riesgo para retraso en el Desarrollo; 40% estuvieron a riesgo de talla baja y 2 estuvieron a riesgo de sobrepeso. Conclusión: A pesar de que Panamá duplicó su cantidad de IHAN a 16%, muchos lactantes continúan a riesgo nutricional.

Abstract Introduction: In the 1990's, a U.S. sponsored program ran a campaign using the Baby-Friendly Hospital Initiatives (BFHI) as a guide to educate clinical professionals, the public, and women of child-bearing age in Panama about the benefits of breastfeeding. As a result, Panama has the highest proportion of women who breastfeed in the first hour of life (89.9%), but one of the lowest rates for breastfeeding at 6 months (UNICEF, 2014). This study explores the relationship between breastfeeding practices and infant nutritional history in Panamanian women with a child up to 1 year of age using a cross-sectional design. Materials and Methods: A convenience sample of 35 mother/baby dyads was recruited from two public health centers in the Azuero region of Panamá. Women who consented completed the Breastfeeding Self-Efficacy Scale, Short Form (BSES-SF), eight items from the Baby's Feeding and Health (BFH) instrument; and infant measurements were evaluated using the Centers for Disease Control standardized growth charts. Results: Breastfeeding Self-Efficacy Scale, Short Form scores ranged from 29 to 56 (mean = 44.2, SD = 7.9). Seven infants were at risk for developmental delay; 40% were at risk for short stature; 2 were at risk for overweight. Conclusion: Even though Panama has doubled its rate of Baby Friendly Hospitals to 16%, many infants remain at nutritional risk.

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BACKGROUND: Mental, neurological, and substance (MNS) use disorders are a leading cause of disability worldwide; specifically in Peru, MNS affect 1 in 5 persons. However, the great majority of people suffering from these disorders do not access care, thereby making necessary the improvement of existing conditions including a major rearranging of current health system structures beyond care delivery strategies. This paper reviews and examines recent developments in mental health policies in Peru, presenting an overview of the initiatives currently being introduced and the main implementation challenges they face. METHODS: Key documents issued by Peruvian governmental entities regarding mental health were reviewed to identify and describe the path that led to the beginning of the reform; how the ongoing reform is taking place; and, the plan and scope for scale-up. RESULTS: Since 2004, mental health has gained importance in policies and regulations, resulting in the promotion of a mental health reform within the national healthcare system. These efforts crystallized in 2012 with the passing of Law 29889 which introduced several changes to the delivery of mental healthcare, including a restructuring of mental health service delivery to occur at the primary and secondary care levels and the introduction of supporting services to aid in patient recovery and reintegration into society. In addition, a performance-based budget was approved to guarantee the implementation of these changes. Some of the main challenges faced by this reform are related to the diversity of the implementation settings, eg, isolated rural areas, and the limitations of the existing specialized mental health institutes to substantially grow in parallel to the scaling-up efforts in order to be able to provide training and clinical support to every region of Peru. CONCLUSION: Although the true success of the mental healthcare reform will be determined in the coming years, thus far, Peru has achieved a number of legal, policy and fiscal milestones, thereby presenting a unique and fertile environment for the expansion of mental health services.

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Cervical cancer remains a leading cause of mortality in developing countries regardless of biomedical advances in prevention modalities. Specifically, Panama experiences one of the highest rates of cervical cancer worldwide. The objective of this study was to explore knowledge, behavioral, and sociocultural factors related to cervical cancer prevention among Panamanian women. A theory-guided, population-based quantitative survey following participatory processes was administered to a randomized sample of females (18-44 years) residing in a high-risk Panamanian community. Participants (n = 324) reported low knowledge regarding HPV, cervical cancer, and the purpose of the Pap test. Furthermore, low perceived susceptibility, high-risk sexual behaviors (e.g., low contraception and condom use) and adverse attitudes toward the Pap test (e.g., shame, fear) were identified. Television, newspapers/magazines, and relatives/friends/neighbors were common sources to receive health information. Significant gaps in knowledge and behavioral factors were identified, which may interfere with cervical cancer prevention efforts. Future strategies should reflect the sociocultural context, such as interpersonal relations, when developing and implementing cervical cancer programs, with the ultimate goal of decreasing the persistent burden among Latin American women.

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El cáncer en la edad pediátrica presenta características que lo diferencian de otros tipos reportados en edades posteriores. La supervivencia global a 3 años es de hasta el 70%, dependiendo de la neoplasia estudiada. Los principales aparatos y sistemas afectados son el sistema hematopoyético, el sistema nervioso central y simpático, así como tejidos mesenquimatosos. El incremento en la incidencia de tumores neonatales observado en este y otros estudios se basa en el aumento del número de tumores sólidos (teratomas y neuroblastomas), ya que los casos de tumores en el sistema nervioso central y leucemias han permanecido constantes. La ultrasonografía es la primera línea de abordaje y puede detectar hasta el 70% de las anomalías fetales. La fisiología del neonato hace que el tratamiento multidisciplinario necesario en las enfermedades neoplásicas sea modificado sustancialmente en este grupo de edad, para evitar toxicidad y secuelas. El tratamiento más utilizado es la cirugía. Logrando el diagnóstico oportuno existen opciones terapéuticas efectivas para mejorar la supervivencia de estos pacientes.

Cancer in children has characteristics that differentiate it from other types reported in later ages. Overall survival at 3 years is up to 70% depending on the tumor studied. Major organs and systems affected are the hematopoietic system, central nervous system and sympathetic and mesenchymal tissues. The increased incidence of neonatal tumors observed in this and other studies is based on the increasing number of solid tumors (teratomas and neuroblastomas) because cases of central nervous system tumors and leukemias have remained constant. Ultrasonography is the first line of approach and can detect up to 70% of fetal anomalies. The physiology of the newborn causes the necessary multidisciplinary treatment in neoplastic disease to be modified substantially in this age group to avoid toxicity and sequelae. The most common treatment is surgery. Achieving timely diagnostic treatment options are effective in improving the survival of these patients.

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Introducción. La cetoacidosis diabética (CAD) es una complicación importante de la diabetes mellitus tipo 1 (DM1) que se presenta de novo o en pacientes ya diagnosticados, sin datos publicados en la literatura nacional. Objetivos. Describir las características epidemiológicas, clínicas y bioquímicas de los pacientes admitidos al Hospital de Especialidades Pediátricas "Omar Torrijos Herrera" (HEPOTH) con diagnóstico de CAD. Métodos. Se realizó una revisión retrospectiva de los expedientes clínicos de los pacientes con diagnóstico de CAD admitidos a las salas de hospitalización del HEPOTH para describir las variables edad, sexo, glicemia, gravedad de la CAD, tiempo de resolución, complicaciones y uso de bicarbonato. Se utilizó estadística descriptiva (frecuencias, media y desviación estándar) y analítica con α=0.05 para cada comparación. Resultados. Encontramos 58 casos de CAD (28 masculinos, 30 femeninos). Observamos un pico bimodal de frecuencias entre los 8 y 11 años para ambos sexos. En el 62% de los casos no se encontró un factor evidente para la descompensación. Las variables metabólicas de todos los casos fueron evaluadas y se establecieron las medias (desviación estándar) de glicemia (530.9 [144.9]), bicarbonato (8.16 [3.58]) y pH (7.12 [0.12]). Se observó que, a mayor gravedad, menor valor de bicarbonato y de pH sanguíneo; además de una relación inversa, estadísticamente significativa (p<0.001) entre el pH al inicio del tratamiento con el tiempo requerido hasta alcanzar el pH de 7.30. La complicación más frecuente fue la hipokaliemia (44.8%). El edema cerebral ocurrió en 9% de los casos, de los cuales se registró una muerte (tasa de letalidad cruda = 1.7%). Conclusiones. La CAD es más frecuente entre los 8 y 11 años de edad y usualmente se presenta con criterios de gravedad. La hipokaliemia es la complicación más frecuente y el factor predisponente es difícil de detectar. A pesar de la baja letalidad encontrada, se debe vigilar por edema cerebral.

Background Diabetic ketoacidosis (DKA) is an important complication of type 1 diabetes mellitus, presenting either de novo or in patients already diagnosed, without data published in the national literature. Aims To describe the epidemiological, clinical, and biochemical characteristics of patients admitted to the "Omar Torrijos Herrera" Pediatric Specialties with diagnosis of DKA. Methods We performed a restrospective review of clinical records of patients diagnosed with DKA admitted to the wards of the Hospital to describe the variables age, sex, glycemia, DKA severity, time to resolution, complications, and use of bicarbonate. Descriptive (frequencies, mean, standard deviation [SD]) and analysitcal statistics were used with α=0.05 for each comparison. Results We found 58 cases of DKA (28 males, 30 females). We observed a bimodal peak of frequencies between ages 8 and 11 for both genders. In 62% of the cases there was no evident factor for the descompensation. Metabolica variables in all of the cases were assessed and mean (SD) of glycemia (530.9 [144.9]), bicarbonate (8.16 [3.58]) and blood pH (7.12 [0.12]) were established. The higher the severity, the lower bicarbonate and blood pH value; besides an inverse and statistically significant relationship (p<0.001) between pH at the beginning of the treatment and the time required to reach a blood pH value of 7.30. The most frequent complication was hypokalemia (44.8%). Cerebral edema occurred in 9% of the cases, among which one decease was registered (crude lethality rate = 1.7%). Conclusions Diabetic ketoacidosis is more frequent between 8 and 11 years of age and usually presents with severity criteria. Hypokalemia is the most frequent complication and the predisposing factor is difficult to detect. Even though we found a low lethality rate secondary to cerebral edema, this complication must be always beared in mind.

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Introducción: Con miras a mejorar el programa panameño de residencia pediátrica (PPRP), se recolectaron y analizaron los datos iniciales sobre el conocimiento y actitudes de los residentes hacia las recomendaciones internacionales para la inmunización del adolescente. Materiales y Métodos: A través de un instrumento anónimo de recolección de datos y validado para este estudio transversal, se recabaron los datos demográficos, de conocimiento y actitudinales. El conocimiento se midió como el porcentaje de respuestas correctas a 50 preguntas de selección múltiple. Las actitudes se evaluaron en una escala tipo Likert. Los análisis estadísticos (α = .05) incluyeron medidas descriptivas y comparativas. Resultados: A nivel nacional, 33 residentes (64% femeninos; 11 en cada año de residencia) aceptaron participar (tasa de respuesta = 53%, poder post hoc = 69%). Excepto por el conocimiento sobre las definiciones y conceptos generales de las inmunizaciones (76.7%), cada dominio del conocimiento fue menor a 50%. Los puntajes de conocimiento para diez vacunas específicas variaron entre 20.8% y 56.5%. Ninguna de las variables demográficas evaluada estuvo significativamente asociada con los puntajes de conocimiento. La mayoría de los residentes (95.7%) está de acuerdo con la importancia del tema y muy pocos (14.6%) reconocen tener su ciente experiencia previa con el mismo. Las formas para obtener esta experiencia propuestas por los residentes serían dentro del programa de residencia (71.8%) o a través de estudio independiente (61.5%). Conclusiones: Los residentes en el PPRP carecen de un conocimiento adecuado sobre las prácticas de inmunización recomendadas para los adolescentes, probablemente por exposición insuficiente a este contenido; sin embargo, mostraron actitudes positivas para aprenderlo durante el programa de residencia.

Introduction: International professional groups advocate for a specialized training in adolescent medicine, but these desirable general competences should not escape trained pediatricians. The Panamanian pediatric residency program (PRPP) is a standardized curriculum for the training of pediatricians countrywide and will include a module on adolescent health. Baseline data on pediatric residents' current knowledge and attitudes toward international adolescent immunization recommendations was collected to guide the curricular enhancement process. Methods: Demographics, knowledge, and attitudes were collected through a voluntary, anonymous survey instrument previously validated for this cross-sectional, observational study. Knowledge was measured as the percentage of correct answers to 50 multiple-choice questions. Attitudes were assessed in a Likert-type scale. Statistical analysis (α = .05) included descriptive and comparative measures. Results: Nationwide, 33 residents (12 males, 21 females; 11 in each year of residency) agreed to participate, for a 53% response rate and 69% post hoc power. Except for the knowledge score about immunization definitions and general concepts (76.7%), every knowledge score was below 50%. Knowledge scores for ten specific vaccines ranged from 20.8% to 56.5% for meningitis and chicken pox, respectively. None of the demographic variables assessed was statistically significantly associated with increased knowledge scores. Most residents (95.7%) agree with the importance of the topic, and very few (14.6%) acknowledge a sufficient previous experience with it. The formats for gaining experience in these topics most agreed upon were the residency program itself (71.8%) and independent study (61.5%). Discussion: The current PPRP trainees lack adequate knowledge on the immunization practices recommended for adolescents. The residents corroborated an insu cient exposure to knowledge on these practices, with very positive attitudes to learn them through a module within the residency program, to be considered in the new PPRP curriculum.

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Cancer in children has characteristics that differentiate it from other types reported in later ages. Overall survival at 3 years is up to 70% depending on the tumor studied. Major organs and systems affected are the hematopoietic system, central nervous system and sympathetic and mesenchymal tissues. The increased incidence of neonatal tumors observed in this and other studies is based on the increasing number of solid tumors (teratomas and neuroblastomas) because cases of central nervous system tumors and leukemias have remained constant. Ultrasonography is the first line of approach and can detect up to 70% of fetal anomalies. The physiology of the newborn causes the necessary multidisciplinary treatment in neoplastic disease to be modified substantially in this age group to avoid toxicity and sequelae. The most common treatment is surgery. Achieving timely diagnostic treatment options are effective in improving the survival of these patients.

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La vasculitis de Churg-Strauss es una entidad clínica poco frecuente que rara vez se reporta en niños. Es una vasculitis difusa rara que casi invariablemente se acompaña de asma grave y eosinofilia. La presentación clínica de la enfermedad depende del estadio y del uso previo de corticoides. A pesar de que el pronóstico global es bueno y el tratamiento con prednisona sola o en combinación con agentes inmunosupresoras es exitoso en general típicamente el asma grave persiste. La causa de la vasculitis de Churg-Strauss todavía se desconoce, pero los hallazgos histopatológicos característicos y su asociación con el asma lo distinguen de las otras vasculitis. El caso clínico que presentamos demuestra que el asma no siempre está presente y que una eosinofilia marcada y persistente debe despertar la sospecha diagnóstica de la VCS.

Churg-Strauss vasculitis is a rare clinical entity rarely reported in children. It is a rare diffuse vasculitis that almost invariably is accompanied by severe asthma and eosinophilia. The clinical presentation of the condition depends on the clinical stage and the previous use of steroids. Even though the global prognosis is favorable and the treatment with prednisone alone or in combination with immunosuppressive agents is generally successful, severe asthma typically persists. The cause of Churg-Strauss vasculitis is still unknown, but the characteristic histopathological findings and their association with asthma distinguish this from all other vasculitis. The clinical case we present demonstrates that asthma is not always and that a severe, persistent eosinophilia must make the clinical suspect of Churg-Strauss vasculitis.

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Introducción. La leucemia linfoblástica aguda es el tipo de cáncer infantil más frecuente. Los pacientes son clasificados de acuerdo con los hallazgos clínicos, biológicos, moleculares y de respuesta a la terapia inicial. Este trabajo tuvo como objetivo caracterizar los hallazgos al diagnóstico de una muestra de pacientes mexicanos e identificar las diferencias clínicas de acuerdo con la mortalidad cruda. Métodos. Se revisaron 391 expedientes de pacientes pediátricos con leucemia linfoblástica aguda en nueve hospitales afiliados al Seguro Popular en la República Mexicana. Resultados. Se incluyeron 296 pacientes vivos y 95 fallecidos. La media de edad fue de 6.48 años en los vivos y 8.31 años en los fallecidos. Los signos y síntomas para solicitar la atención médica fueron fiebre, palidez, astenia y adinamia. Las principales alteraciones hematológicas fueron anemia y trombocitopenia. La mayor proporción de blastos en sangre periférica se observó en el grupo de los fallecidos (28.3 vs 40.7, p=0.030). El 86.4% de la muestra contaba con inmunofenotipo y 11.2% tenía estudio citogenético. En cuanto al riesgo, 148 pacientes se clasificaron como de riesgo habitual y 230 como de alto riesgo. Conclusiones. Caracterizar la población de niños con leucemia linfoblástica aguda permite a los sistemas de salud conocer sus peculiaridades e implementar acciones específicas para mejorar la atención, como el desarrollo de estrategias para realizar los inmunofenotipos y la citogenética.

Background. Acute lymphoblastic leukemia (ALL) is the most common cancer in childhood. Patients are classified according to clinical, biological, and molecular characteristics as well as their response to initial therapy. The objective of this study is aimed to characterize the diagnostic findings in a sample of Mexican patients with ALL and to identify clinical differences according to crude mortality. Methods. We reviewed clinical records of 391 pediatric ALL patients in nine hospitals in Mexico affiliated with the Seguro Popular insurance program. Results. Included in this study were 296 living patients and 95 deceased patients. Mean age was 6.48 years and 8.31 years for living and deceased patients, respectively. Signs and symptoms associated with seeking medical care were fever, pallor, fatigue and weakness. The main hematologic abnormalities were anemia and thrombocytopenia. The largest proportion of blasts in peripheral blood was observed in the group of deceased patients; 86.4% of the sample had immunophenotype in the clinical record and only 11.2% had cytogenetic study. One hundred forty eight patients were classified as standard risk and 230 patients as high risk. Conclusions. To characterize the population of children with ALL allows health systems to be aware of the features of patients with ALL and to implement specific actions and to develop strategies so that all patients have access to immunophenotype and cytogenetic studies.