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In Panama, epidemiological data on congenital toxoplasmosis are limited, making it difficult to understand the scope of clinical manifestations in the population and factors that may increase the risk of infection. This study provides insight into the epidemiological situation of maternal and congenital toxoplasmosis in Panama and contributing information on the burden of this disease in Central America. Blood samples were collected from 2326 pregnant women and used for the detection of anti-T. gondii antibodies. A high seroprevalence (44.41%) was observed for T. gondii infection in pregnant women from different regions of Panama, with an estimated incidence rate of congenital toxoplasmosis of 3.8 cases per 1000 live births. The main risk factors associated with T. gondii infection using bivariate statistical analysis were an elementary level education and maternal age range of 34-45 years. Multivariate statistical analyses revealed that in some regions (San Miguelito, North and West regions), the number of positive cases correlated with the presence of pets, stray dogs and the consumption of poultry. In other regions (East and Metropolitan regions), the absence of pets was considered a protective factor associated with negative cases, while the presence of stray cats and the age range of 25-34 years did not represent any risk in these regions.

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Introducción: Los antibióticos son los medicamentos más comúnmente utilizados en las unidades de cuidados intensivos neonatales (UCIN). El objetivo de este estudio fue evaluar el impacto de la implementación de intervenciones sobre el uso de antibióticos en la sala de neonatología del Hospital del Niño Dr. José Renán Esquivel. Panamá, República de Panamá. Materiales y métodos: En este estudio se realizó una evaluación retrospectiva del uso de antibióticos en dos períodos, antes y después de la implementación de intervenciones en las políticas de uso de antibióticos. El uso de antibióticos se cuantificó por días de tratamiento (DDT) días de tratamiento antibiótico / 1000 días-paciente y dosis de tratamiento antibiótico (DOT) / 1000 días- paciente. El análisis estadístico de las frecuencias en ambos períodos se realizó mediante el valor de X2. Se aceptó como significancia estadística valores de p <0.05 para intervalos de confianza del 95%. Resultados:  Obtuvimos una muestra de 600 recién nacidos para los dos períodos y de estos ingresaron a nuestro estudio 555 recién nacidos. El 60.35 % de los recién nacidos que ingresaron al estudio en el primer período recibieron antibióticos y un 52.96% en el segundo grupo de estudio. Al realizar el análisis de proporciones en DOT y DDT de ambos períodos hubo una diferencia estadísticamente significativa en el DOT y DDT luego de las intervenciones en el uso de antibióticos. (p ≤ 0.001). Observamos una disminución en el número de cursos de antibióticos ( 2 ó más) de 41 (23.8%) a 22 (15.3%) entre el primer y segundo período. Los antibióticos más usados en ambos grupos de estudio fueron la ampicilina y la gentamicina. Conclusión: Hubo una diferencia estadísticamente significativa en el análisis de las proporciones de DOT y DDT luego de las intervenciones en las políticas de uso de antibióticos.

Introduction: Antibiotics are the drugs most commonly used in neonatal intensive care units (NICU). The objective of this study was to evaluate the impact of the implementation of interventions on the use of antibiotics in the neonatal unit of the Children Hospital "Dr. José Renán Esquivel" Materials and methods: This study was a retrospective evaluation of the use of antibiotics in two periods, before and after the implementation of interventions in antibiotic use policies. The use of antibiotics was quantified by days of treatment (DDT), days of antibiotic treatment / 1000 patient days and dose of antibiotic treatment (DOT) / 1000 patient days. The statistical analysis of the frequencies in both periods was carried out using the value of X2. Values ​​of p <0.05 for 95% confidence intervals were accepted as statistical significance. Results: We obtained a sample of 600 newborns for the two periods and of these 555 newborns entered our study. 60.35% of the newborns that entered the study in the first period received antibiotics and 52.96% in the second study group. When performing the analysis of proportions in DOT and DDT of both periods there was a statistically significant difference in DOT and DDT after the interventions in the use of antibiotics. (p ≤ 0.001). We observed a decrease in the number of antibiotics course of 41 (23.8%) received two or more courses of antibiotics in the first period and in the second to 22 (15.3%). The antibiotics most used in both periods were ampicillin and gentamicin. Conclusion: There was a statistically significant difference in the analysis of the proportions of TOD and DDT after interventions in antibiotic use policies.

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El síndrome de Eagle-Barret o síndrome de Prune Belly también conocido como "síndrome de abdomen en ciruela pasa", es un cuadro cuya etiología aún se desconoce. Se caracteriza por la de ciencia de la musculatura de la pared abdominal, dilatación del tracto urinario y criptorquidia bilateral. La incidencia estimada es de 1 en 35,000 a 1 en 50,000 recién nacidos vivos, ocurriendo aproximadamente más del 95% de los casos en masculinos. Las manifestaciones clínicas de la triada de anormalidades presentes en esta entidad, van desde el defecto muscular presente en la pared abdominal, que consta solamente de piel y peritoneo, razón por la cual el tejido dérmico presenta una serie de estriaciones, que permiten la palpación fácil de las vísceras, asociándose además una alteración del sistema urogenital que se caracteriza por la dilatación de la vejiga como consecuencia de una obstrucción distal, con reflujo vesico-ureteral. Se describe un neonato con Síndrome de abdomen en ciruela pasa, de sexo masculino, nacido de 40 semanas de gestación y pesó 3 050 g al nacer. El examen clínico mostró un neonato con un abdomen globuloso, con redundancia de la piel que huelga a los costados rebosantes, la palpación del abdomen no descubre la tonalidad muscular. No se palpa visceromegalia y hay presencia normal de ruidos hidroaéreos. El examen físico del tórax y cardiovascular no reportó datos patológicos. Examen neurológico normal. La ecografía renal mostró alteraciones en el tracto urinario. Revela además criptorquidia bilateral. Este caso destaca la importancia del diagnóstico temprano y el manejo adecuado del paciente tanto a nivel primario como en el tercer nivel de atención; ya que si ofrecemos el manejo adecuado podemos brindarle a este tipo de pacientes un mejor pronóstico de vida.

Eagle-Barrett syndrome, formerly known as prune-belly syndrome, it's a disease whose etiology is still unknown. It's characterized by deficiency of abdominal wall musculature,a dilated urinary tract,and bilateral cryptorchidism. The estimated incidence is 1 in 35,000 to 1 in 50,000 live births, with more than 95% of cases occurring in males. Clinical manifestations of the triad of abnormalities present in this entity, ranging from muscle defect present in the abdominal wall, consisting only of skin and peritoneum, reason why the dermal tissue presents a series of striations, allowing easy palpation of the viscera, further associating an alteration of the urogenital system characterized by the expanded bladder following a distal obstruction, with vesicoureteral reflux. We report the case of a male neonate born after 40 weeks of gestation with a body weight of 3 050 g with Prune Belly syndrome. The physical examination revealed a distended abdomen with redundant skin that wrinkle like a prune, no visceromegaly was found and normal abdominal sounds were heard. The examination of thorax and cardiovascular systems were normal. The neurologic exam was normal. A renal ultrasound revealed alteration of the urogenital system. Bilateral cryptorchidism was also observed. This case highlights the importance of early diagnosis andappropriatemanagement both in primary health as tertiary,because if we bring the adequate treatment we will be able to o er to this patients a better life prognosis.

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Se presentó un paciente con APP de hipertensión arterial desde hace 15 años que 2 meses antes del ingreso comenzó a padecer cuadros de decaimiento, disminución del apetito, disuria y escalofríos. Se le diagnosticó sepsis urinarias a repetición, sin mejoría clínica. Al ingresar, presentaba aumento de volumen de los miembros inferiores, principalmente en horas de la tarde, pérdida de peso de, aproximadamente, 20 libras y dolor en hemiabdomen superior. Se describió la evolución clínica y los estudios realizados mediante los cuales se le diagnosticó la presencia de: urinoma infestado, sepsis urinaria, hiperplasia benigna de próstata y litiasis renal bilateral con hidronefrosis complicada con insuficiencia renal(AU)

This is the case of a patient presenting with APP of high blood pressure from 15 years ago that two months before admission suffered from weakness, lost of appetite, dysuria and shivers and also diagnosing repeated urinary sepsis without clinical improvement. At admission, patient showed an increase in volume of lower extremities mainly in the afternoon, weight loss of approximately 20 pounds and pain in the superior hemi-abdomen. We describe the clinical course and the studies conducted served to diagnose the presence of: infected urinoma, urinary sepsis, prostatic benign hyperplasia and bilateral renal lithiasis with hydronephrosis complicated by renal failure(AU)

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RESUMO

Se presentó un paciente con APP de hipertensión arterial desde hace 15 años que 2 meses antes del ingreso comenzó a padecer cuadros de decaimiento, disminución del apetito, disuria y escalofríos. Se le diagnosticó sepsis urinarias a repetición, sin mejoría clínica. Al ingresar, presentaba aumento de volumen de los miembros inferiores, principalmente en horas de la tarde, pérdida de peso de, aproximadamente, 20 libras y dolor en hemiabdomen superior. Se describió la evolución clínica y los estudios realizados mediante los cuales se le diagnosticó la presencia de: urinoma infestado, sepsis urinaria, hiperplasia benigna de próstata y litiasis renal bilateral con hidronefrosis complicada con insuficiencia renal

This is the case of a patient presenting with APP of high blood pressure from 15 years ago that two months before admission suffered from weakness, lost of appetite, dysuria and shivers and also diagnosing repeated urinary sepsis without clinical improvement. At admission, patient showed an increase in volume of lower extremities mainly in the afternoon, weight loss of approximately 20 pounds and pain in the superior hemi-abdomen. We describe the clinical course and the studies conducted served to diagnose the presence of: infected urinoma, urinary sepsis, prostatic benign hyperplasia and bilateral renal lithiasis with hydronephrosis complicated by renal failure

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RESUMO

Systemic fungal infections are associated with substantial case-morbidity and fatality rates in premature infants. Considerable evidence indicates that prophylaxis with fluconazole given to premature infants reduces the risk of invasive fungal infection. There is scant information from developing countries. A comparative study of 2 years, one with fluconazole prophylaxis and the other without was conducted in all premature babies weighing less than 1250 g at birth. Fluconazole was administered in 3 mg/kg doses, given every 48 hours, starting on day 3 of life, for a period of 6 weeks. Documented systemic Candida infection was the primary outcome. A total of 271 and 252 patients, respectively, were evaluated during the year before (control group) and after (treatment group) routine fluconazole prophylaxis. The control group developed 21 Candida infections (7.7%) while the treatment group had only 3 Candida infections (1.1%). This difference was statistically significant (P = 0.007; odds ratio, 0.13; 95% confidence interval, 0.03-0.47). The number needed to treat to prevent one case was 7. Although case-fatality rates for documented Candida infection were similar in both periods (76% vs. 67%), fewer deaths attributed to the fungal infection were noted in the prophylaxis year (6% vs. 1%, P = 0.003). Routine fluconazole prophylaxis given to premature infants of less than 1250 g at birth is associated with a significant impact on frequency of documented systemic Candida infections.

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Os objetivos foram avaliar como a raiva se relaciona à gastrite e esofagite, e compreender a raiva quanto a experiência, expressão, estado crônico, gênero e idade. Foram avaliados 41 homens e 68 mulheres, distribuídos em quatro faixas etárias, entre 20 e 60 anos. Os dados foram obtidos do Inventário de Expressão de Raiva como Estado e Traço (STAXI), da entrevista psicológica e do prontuário. Os sujeitos vivenciavam sentimentos de raiva, reprimida e direcionada para dentro; mostravam alto grau de impulsividade e sensibilidade a críticas. Homens apresentaram traços de raiva de maior intensidade do que mulheres. Houve alta frequência de raiva de 20 a 29 anos e de 40 a 49. O controle da raiva foi maior entre 50 e 60 anos e menor entre 20 e 30 anos. Apresentaram índices acima da média em raiva crônica, predominantes nos homens e em sujeitos de 40 a 50 anos.

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RESUMO

Os objetivos foram avaliar como a raiva se relaciona à gastrite e esofagite, e compreender a raiva quanto a experiência, expressão, estado crônico, gênero e idade. Foram avaliados 41 homens e 68 mulheres, distribuídos em quatro faixas etárias, entre 20 e 60 anos. Os dados foram obtidos do Inventário de Expressão de Raiva como Estado e Traço (STAXI), da entrevista psicológica e do prontuário. Os sujeitos vivenciavam sentimentos de raiva, reprimida e direcionada para dentro; mostravam alto grau de impulsividade e sensibilidade a críticas. Homens apresentaram traços de raiva de maior intensidade do que mulheres. Houve alta frequência de raiva de 20 a 29 anos e de 40 a 49. O controle da raiva foi maior entre 50 e 60 anos e menor entre 20 e 30 anos. Apresentaram índices acima da média em raiva crônica, predominantes nos homens e em sujeitos de 40 a 50 anos. (AU)

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