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Introducción: La Diabetes Mellitus (DM) es una enfermedad de alta prevalencia a nivel mundial, incluyendo Panamá. Se encuentra dentro de las primeras diez causas de muerte a nivel nacional. Objetivo: Describir las características de los pacientes con DM admitidos a Medicina Interna del Complejo Hospitalario Dr. Arnulfo Arias Madrid (CHDrAAM) desde julio a diciembre de 2023. Metodología: Estudio observacional, prospectivo de corte transversal mediante realización de entrevista y revisión de expedientes físicos y electrónicos a todos los pacientes que aceptaron participar del estudio. Resultados: Se incluyeron 162 pacientes, de los cuales se observó una distribución equitativa entre ambos sexos. La edad promedio fue de 55 años. El 70% de los pacientes están en sobrepeso y obesidad. El 90% no realiza actividad física. El 74% no cuenta con título universitario. El 88% cuenta con más de una comorbilidad, siendo hipertensión arterial la más prevalente. El 49% ingresa con descompensación de DM, el 52% no cumple con los valores de metas recomendadas de hemoglobina glicosilada. El 66% no cuenta con tratamiento óptimo. Conclusiones: Este estudio da a conocer importante información epidemiológica y clínica sobre los diabéticos y así implementar el desarrollo de programas educativos e incorporar nuevas terapias de primera línea que vayan acorde a los requerimientos de cada paciente. (provisto por Infomedic International)
Introduction: Diabetes Mellitus (DM) is a disease of high prevalence worldwide, including Panama. It is among the first ten causes of death nationwide. Objective: To describe the characteristics of patients with DM admitted to Internal Medicine at the Complejo Hospitalario Dr. Arnulfo Arias Madrid (CHDrAAM) from July to December 2023. Methodology: Observational, prospective, cross-sectional study by means of interviews and review of physical and electronic records of all patients who agreed to participate in the study. Results: 162 patients were included, with an equal distribution between both sexes. The average age was 55 years. Seventy percent of the patients were overweight and obese. Ninety percent do not engage in physical activity. 74% do not have a university degree. 88% have more than one comorbidity, with arterial hypertension being the most prevalent one. 49% were admitted with decompensation of DM, 52% did not meet the recommended target values for glycosylated hemoglobin. 66% do not have optimal treatment. Conclusions: This study provides important epidemiological and clinical information on diabetics and thus implement the development of educational programs and incorporate new first-line therapies according to the requirements of each patient. (provided by Infomedic International)
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Objetivo: Describir las características clínicas de las pacientes con cáncer de ovario epitelial en el Instituto Oncológico Nacional de PanamáÌ. Métodos: Se realizó un estudio descriptivo en el Instituto Oncológico Nacional. Se revisaron todos los expedientes de las pacientes con cáncer de ovario epitelial desde enero 2012 a diciembre 2021. Aquellas con diagnóstico histopatológico confirmado de cáncer de ovario epitelial primario fueron incluidas en el estudio. Entre las variables evaluadas, se encontraban edad, lugar de procedencia, grupo histológico, etapa al diagnóstico, tratamiento y recidivas. Resultados: Se incluyeron 547 pacientes. El 49% (266) de las pacientes residían en la provincia de Panamá. La edad media fue de 56 años (DE:13.2). El 71% (386) estaban aseguradas. El 80% (439) presentaron síntomas relacionados al cáncer. El 80% (442) presentaron valores de CA-125 elevados. El 59% (321) eran de tipo seroso. El 62% (338) fueron tratadas con una combinación de cirugía y quimioterapia. En etapa I, el 19% (27) recayeron mientras que en etapa III, el 39% (103). El 80% (138) de las recidivas recibieron sólo quimioterapia. Conclusiones: En general, el cáncer epitelial se presentó en etapas avanzadas en mujeres mayores de 40 años asociado a sintomatología y valores de CA-125 elevados. El tipo histológico más frecuente fue el seroso y el tratamiento habitual fue una combinación de cirugía y quimioterapia. El porcentaje de muerte fue directamente proporcional con la etapa al diagnóstico. (provisto por Infomedic International)
Objetivo: Describir las características clínicas de las pacientes con cáncer de ovario epitelial en el Instituto Oncológico Nacional de PanamáÌ. Métodos: Se realizó un estudio descriptivo en el Instituto Oncológico Nacional. Se revisaron todos los expedientes de las pacientes con cáncer de ovario epitelial desde enero 2012 a diciembre 2021. Aquellas con diagnóstico histopatológico confirmado de cáncer de ovario epitelial primario fueron incluidas en el estudio. Entre las variables evaluadas, se encontraban edad, lugar de procedencia, grupo histológico, etapa al diagnóstico, tratamiento y recidivas. Resultados: Se incluyeron 547 pacientes. El 49% (266) de las pacientes residían en la provincia de Panamá. La edad media fue de 56 años (DE:13.2). El 71% (386) estaban aseguradas. El 80% (439) presentaron síntomas relacionados al cáncer. El 80% (442) presentaron valores de CA-125 elevados. El 59% (321) eran de tipo seroso. El 62% (338) fueron tratadas con una combinación de cirugía y quimioterapia. En etapa I, el 19% (27) recayeron mientras que en etapa III, el 39% (103). El 80% (138) de las recidivas recibieron sólo quimioterapia. Conclusiones: En general, el cáncer epitelial se presentó en etapas avanzadas en mujeres mayores de 40 años asociado a sintomatología y valores de CA-125 elevados. El tipo histológico más frecuente fue el seroso y el tratamiento habitual fue una combinación de cirugía y quimioterapia. El porcentaje de muerte fue directamente proporcional con la etapa al diagnóstico. (provided by Infomedic International)
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Background: Malnutrition has important short- and long-term consequences in children under age five. Malnutrition encompasses undernutrition, overnutrition, and the coexistence of both of them, known as the double burden of malnutrition (DBM). Objective: The aim of this study was to estimate the prevalence of undernutrition, overnutrition, and the DBM among these children at the national level and by living area in Panama. Methods: Data from the National Health Survey of Panama (ENSPA, Spanish acronym), a population-based, cross-sectional study carried out in 2019 were used. Stunting, wasting, overweight, and obesity were defined according to the cut-off points of the World Health Organization Growth Standards. Undernutrition was defined as being stunted only, wasted only or both; overnutrition was defined as being overweight only or obese only; and the DBM was defined as the co-occurence of stunting and overweight/obesity in the same child. Prevalence and general characteristics at the national level and by living area were weighted. Findings: The prevalence of undernutrition was 15.3% (95% confidence interval (CI) 13.4-17.3) at the national level and 36.6% (CI: 30.1-43.5) in indigenous areas. The prevalence of overnutrition was 10.2% (8.2-12.6) at the national level and 11.9% (CI: 8.5-16.3), 8.4% (CI: 6.5-10.7) and 8.7% (CI: 5.2-14.3) in urban, rural and indigenous areas, respectively. The DBM prevalence was 1.4% (CI: 1.0-2.1) at the national level and 2.7% (CI: 1.4-5.1) in indigenous areas. Conclusions: Undernutrition is still the most prevalent malnutrition condition in our country. Panama has the highest prevalence of overnutrition in Central America. The highest prevalence of undernutrition and DBM was found among children living in indigenous areas.
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Transtornos do Crescimento , Desnutrição , Humanos , Panamá/epidemiologia , Pré-Escolar , Feminino , Masculino , Prevalência , Lactente , Estudos Transversais , Transtornos do Crescimento/epidemiologia , Desnutrição/epidemiologia , Transtornos da Nutrição Infantil/epidemiologia , Hipernutrição/epidemiologia , Síndrome de Emaciação/epidemiologia , Inquéritos Epidemiológicos , Obesidade Infantil/epidemiologia , Sobrepeso/epidemiologia , População Rural/estatística & dados numéricosRESUMO
Background and Objectives: The primary objective of this study was to assess the adherence of Ngäbe-Buglé women to WHO-recommended prenatal practices. The secondary objective was to compare adherence levels between women who received prenatal education from official medical providers and those educated through traditional or community-based sources within Ngäbe-Buglé communities. Materials and Methods: An eight-question survey was verbally administered to 137 Ngäbe-Buglé women at clinics set up by the non-profit NGO Floating Doctors in eight communities. A two-sided Fisher's Exact test with a p = 0.05 was used to compare the results of mothers who received prenatal education from evidence-based sources to other groups. Results: Out of the 137 surveyed women, 65 reported taking prenatal vitamins, 21 had prenatal check-ups, 136 avoided alcohol, 31 increased caloric intake, and 102 maintained their activity levels. Significant differences were observed in prenatal vitamin adherence between those educated by official sources versus unofficial sources (p = 0.0029) and official sources compared to those with no prenatal education (p < 0.0001). The difference was also significant for education from an unofficial source versus no education (p = 0.0056). However, no significant differences were found in other prenatal practices based on education sources. Conclusions: Our findings highlight deficiencies in both prenatal education and adherence to recommended practices among Ngäbe-Buglé women. Prenatal education significantly improved adherence to taking prenatal vitamins, suggesting its effectiveness as an intervention. Future interventions should prioritize culturally competent prenatal education and address barriers to accessing prenatal healthcare in Ngäbe-Buglé communities.
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Cuidado Pré-Natal , Humanos , Feminino , Cuidado Pré-Natal/estatística & dados numéricos , Cuidado Pré-Natal/normas , Gravidez , Adulto , Inquéritos e Questionários , Panamá , Cooperação do Paciente/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Povos IndígenasRESUMO
Leishmania (Viannia) spp. can harbor a double-stranded RNA virus known as Leishmania RNA virus 1 (LRV-1), whose presence has been reported in nine countries across the Americas and seven Leishmania species. Here, we studied 100 Leishmania (Viannia) isolates from patients with cutaneous leishmaniasis collected from different endemic areas in Panama from 2016 to 2022. We identified L. (V.) panamensis, L. (V.) guyanensis, L. (V.) braziliensis/guyanensis hybrid, and L. (V.) panamensis sp.1. (genetic variant). LRV-1 was detected by RT-PCR in 9% of L. (Viannia) isolates (eight cases in L. (V.) panamensis, and one in L. (V.) guyanensis). Phylogenetic analysis based on sequencing data classified all LRV-1 isolates within genotype A, suggesting that LRV phylogenetic proximity is closely aligned with geographical distribution or to the phylogenetic proximity of the Leishmania host in the case of the L. (V.) panamensis and L. (V.) guyanensis in Panama.
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Background: Syphilis is a serious global public health challenge. Despite prior progress in syphilis control, incidence has been increasing in recent years. Syphilis is a common coinfection among people living with HIV (PLHIV). In Panama, few data describe syphilis prevalence among PLHIV. We describe syphilis antibody and high-titer (⩾1:8) active syphilis prevalence and associated factors among individuals who attended an antiretroviral clinic. Methods: A cross-sectional study was undertaken during February-March 2022 and September-October 2022 for adults (⩾18 year) assigned male and female at birth, respectively. Participants provided peripheral blood samples and self-administered a questionnaire. Samples were screened using immunochromatography; antibody-positive samples were tested using rapid plasma regain to 1:512 dilutions. Logistic regression was used to identify factors associated with syphilis antibody and high-titer active syphilis. Results: In all, 378 participants gave blood samples; 377 individuals participated in the questionnaire (216 self-reported male sex [males], 158 female [females], and three intersex individuals). Median age was 36 years (interquartile range: 28-45 years). Overall, syphilis antibody prevalence was 32.3% (122/378) (males, 50.7% [108/2013]; females, 5.7% [9/158]; intersex individuals, 100.0% (3/3)], p < 0.01. High-titer active syphilis was found among 24.6% (n = 30) of samples with positive antibody test (males 27.8% [n = 30], females 0.0% [0/9], intersex individuals 0.0% [0/3]). Antibody positivity was associated in the multivariable model with males (50.7%, AOR = 24.6, 95%CI: 1.57-384.53). High-titer active syphilis was associated with younger participant age (18-30 years, 13.2%, OR = 4.82, 95%CI: 1.17-19.83); 31-40 years, 7.8%, OR = 4.24, 95%CI: 1.04-17.21 versus 3.2% >40 years), homosexual identity (16.0% OR = 34.2, 95%CI: 4.50-259.27 versus 0.6% among heterosexual identity); in the multivariable model, associated with sexual identity (bisexual 19.1%, AOR = 10.89, 95%CI: 1.00-119.06) compared to heterosexual identity (0.6%) and weakly associated with concurrency (⩾1 ongoing sexual relationships, 15.9%, AOR = 3.09, 95%CI: 0.94-10.14). Conclusion: This study found very high prevalence of syphilis antibodies and high-titer syphilis among PLHIV in Panama. Those most affected are males, younger in age, those who practice concurrent sexual relationships, and those who reported homosexual and bisexual identity. Targeted interventions should include repetitive testing and treatment, especially among individuals who may be at increased infection risk.
Prevalence of syphilis among people living with HIV who attend a large antiretroviral therapy clinic, Panama, 2022 Syphilis is a significant health challenge worldwide. On a global scale, yearly syphilis incidence is increasing, including in Panama. However, there are no current data to explain syphilis prevalence and who is most affected among people living with HIV in Panama. In order to understand syphilis in Panama and create targeted interventions among specific groups of people, it is important to describe how many people are infected, and who is most affected by this infection. Therefore, we conducted a study among 378 people living with HIV at a treatment clinic in Panama City, Panama. Blood samples and demographic data were collected. In all, syphilis antibodies were found in 32.3% of individuals (50.7% of those who self-report as males, 5.7% as females, and 100% of those who self-report as intersex. Of those with positive antibody tests, 24.6% of individuals also had active syphilis. Only individuals who identify as male had active syphilis. Our findings show high syphilis prevalence among people with HIV in Panama City, particularly among males, those who are younger, those who report sexual identity as homosexual or bisexual, and those with ongoing sexual relationships with more than one individual. Targeted interventions are needed among people living with HIV, especially among the groups most affected. These interventions could include testing more often for syphilis and providing timely treatment, especially among individuals who may be at increased risk of infection.
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Fusarium wilt of banana (FWB) is the most limiting disease in this crop. The phytosanitary emergency caused by FWB since 2019 in Colombia has required the development of ecofriendly control methods. The aim of this study was to test the effectiveness of microbial-based biofungicides against FWB caused by Fusarium oxysporum f. sp. cubense race 1 (Foc R1) and correlate such effect with plant physiological parameters. Five Trichoderma (T1 to T4 and T9) and four Bacillus (T5 to T8)-based biofungicides were evaluated in pot experiments. In vitro, dual confrontation tests were also carried out to test whether the in vitro effects on Foc growth were consistent with the in vivo effects. While Trichoderma-based T3, T4, and T9, and Bacillus-based T8, significantly reduced the growth of Foc R1 in vitro, Trichoderma-based T1, T3, T4, and T9 temporarily reduced the Foc population in the soil. However, the incidence progress of FWB was significantly reduced by Bacterial-based T7 (74% efficacy) and Trichoderma-based T2 (50% efficacy). The molecular analysis showed that T7 prevented the inner tissue colonization by Foc R1 in 80% of inoculated plants. The T2, T4, T7, and T9 treatments mitigated the negative effects caused by Foc R1 on plant physiology and growth. Our data allowed us to identify three promising treatments to control FWB, reducing the progress of the disease, delaying the colonization of inner tissue, and mitigating physiological damages. Further studies should be addressed to determine the modes of action of the biocontrol agents against Foc and validate the utilization in the field.
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The human malaria-Aotus monkey model has served the malaria research community since its inception in 1966 at the Gorgas Memorial Laboratory (GML) in Panama. Spanning over five decades, this model has been instrumental in evaluating the in vivo efficacy and pharmacokinetics of a wide array of candidate antimalarial drugs, whether used singly or in combination. The animal model could be infected with drug-resistant and susceptible Plasmodium falciparum and Plasmodium vivax strains that follow a characteristic and reproducible course of infection, remarkably like human untreated and treated infections. Over the years, the model has enabled the evaluation of several synthetic and semisynthetic endoperoxides, for instance, artelinic acid, artesunate, artemether, arteether, and artemisone. These compounds have been evaluated alone and in combination with long-acting partner drugs, commonly referred to as artemisinin-based combination therapies, which are recommended as first-line treatment against uncomplicated malaria. Further, the model has also supported the evaluation of the primaquine analog tafenoquine against blood stages of P. vivax, contributing to its progression to clinical trials and eventual approval. Besides, the P. falciparum/Aotus model at GML has also played a pivotal role in exploring the biology, immunology, and pathogenesis of malaria and in the characterization of drug-resistant P. falciparum and P. vivax strains. This minireview offers a historical overview of the most significant contributions made by the Panamanian owl monkey (Aotus lemurinus lemurinus) to malaria chemotherapy research.
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Antimaláricos , Artemisininas , Modelos Animais de Doenças , Animais , Antimaláricos/uso terapêutico , Antimaláricos/farmacocinética , Antimaláricos/farmacologia , Artemisininas/uso terapêutico , Artemisininas/farmacologia , Humanos , Panamá , Aotidae , Plasmodium falciparum/efeitos dos fármacos , Malária/tratamento farmacológico , Plasmodium vivax/efeitos dos fármacos , Malária Falciparum/tratamento farmacológico , Malária Falciparum/parasitologia , Artesunato/uso terapêutico , Artesunato/farmacologia , Artesunato/farmacocinética , Malária Vivax/tratamento farmacológico , Malária Vivax/parasitologia , História do Século XX , AminoquinolinasRESUMO
Β-lactamases-producing Escherichia coli are a widely distributed source of antimicrobial resistance (AMR), for animals and humans. Little is known about the sensitivity profile and genetic characteristics of E. coli strains isolated from domestic cats. We report a cross-sectional study that evaluated E. coli strains isolated from domestic cats in Panama. For this study the following antibiotics were analyzed: ampicillin, amoxicillin-clavulanate cefepime, cefotaxime, cefoxitin, ceftazidime, aztreonam, imipenem, gentamicin, kanamycin, streptomycin, tetracycline, ciprofloxacin, nalidixic acid, trimethoprim-sulfamethoxazole, and chloramphenicol. The data obtained were classified as resistant, intermediate, or sensitive. MDR strains were established when the strain presented resistance to at least one antibiotic from three or more antimicrobial classes. Forty-eight E. coli isolates were obtained, of which 80% presented resistance to at least one of the antibiotics analyzed, while only 20% were sensitive to all (p = 0.0001). The most common resistance was to gentamicin (58%). Twenty-nine percent were identified as multidrug-resistant isolates and 4% with extended spectrum beta-lactamase phenotype. The genes blaTEM (39%), blaMOX(16%), blaACC (16%) and blaEBC (8%) were detected. Plasmid-mediated resistance qnrB (25%) and qnrA (13%) are reported. The most frequent sequence types (STs) being ST399 and we reported 5 new STs. Our results suggest that in intestinal strains of E. coli isolated from domestic cats there is a high frequency of AMR.
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Antibacterianos , Farmacorresistência Bacteriana Múltipla , Escherichia coli , Testes de Sensibilidade Microbiana , Animais , Gatos/microbiologia , Escherichia coli/genética , Escherichia coli/efeitos dos fármacos , Escherichia coli/isolamento & purificação , Farmacorresistência Bacteriana Múltipla/genética , Antibacterianos/farmacologia , Fenótipo , beta-Lactamases/genética , Estudos Transversais , Infecções por Escherichia coli/microbiologia , Infecções por Escherichia coli/veterinária , Variação GenéticaRESUMO
As temperature rises, net carbon uptake in tropical forests decreases, but the underlying mechanisms are not well understood. High temperatures can limit photosynthesis directly, for example by reducing biochemical capacity, or indirectly through rising vapor pressure deficit (VPD) causing stomatal closure. To explore the independent effects of temperature and VPD on photosynthesis we analyzed photosynthesis data from the upper canopies of two tropical forests in Panama with Generalized Additive Models. Stomatal conductance and photosynthesis consistently decreased with increasing VPD, and statistically accounting for VPD increased the optimum temperature of photosynthesis (Topt) of trees from a VPD-confounded apparent Topt of c. 30-31°C to a VPD-independent Topt of c. 33-36°C, while for lianas no VPD-independent Topt was reached within the measured temperature range. Trees and lianas exhibited similar temperature and VPD responses in both forests, despite 1500 mm difference in mean annual rainfall. Over ecologically relevant temperature ranges, photosynthesis in tropical forests is largely limited by indirect effects of warming, through changes in VPD, not by direct warming effects of photosynthetic biochemistry. Failing to account for VPD when determining Topt misattributes the underlying causal mechanism and thereby hinders the advancement of mechanistic understanding of global warming effects on tropical forest carbon dynamics.
A medida que aumenta la temperatura, disminuye la absorción neta de carbono en los bosques tropicales, sin embargo, aún no se conocen bien los mecanismos que la subyacen. Las altas temperaturas pueden limitar la fotosíntesis directamente, por ejemplo, reduciendo la eficiencia de los procesos bioquímicos, pero también de forma indirecta a través del aumento del déficit de presión de vapor (DPV) que resulta en el cierre estomático. Para explorar los efectos independientes de la temperatura y el DPV en la fotosíntesis, analizamos datos de la absorción neta de carbono del dosel de dos bosques tropicales en Panamá utilizando modelos aditivos generalizados. La conductancia estomática y la fotosíntesis disminuyó consistentemente con el aumento de DPV, y considerando el DPV en modelas estadísticas, la temperatura óptima de la fotosíntesis (Topt) aumentó, de un Topt aparente influida por la DVP de c. 3031°C a un Topt independiente del DPV de c. 3336°C. Los árboles y las lianas mostraron respuestas similares a la temperatura y a la DVP en ambos bosques, a pesar de la diferencia de 1500 mm en la precipitación media anual. La fotosíntesis en los bosques tropicales está limitada en gran medida por los efectos indirectos del aumento de la temperatura, a través de cambios en el DPV y no por los efectos directos en los procesos bioquímicos. Si no se tiene en cuenta el DPV al determinar el Topt, se atribuye erróneamente el mecanismo causal subyacente y, por lo tanto, se obstaculiza el avance en la comprensión de los efectos del calentamiento global en la dinámica del carbono.
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Florestas , Fotossíntese , Estômatos de Plantas , Temperatura , Clima Tropical , Pressão de Vapor , Fotossíntese/fisiologia , Estômatos de Plantas/fisiologia , Árvores/fisiologia , PanamáRESUMO
Antecedentes: La vía de señalización de la fosfoisitol 3-quinasa (PI3K), que promueve el crecimiento y el metabolismo de las células cancerosas, es la vía mutada con mayor frecuencia en el cáncer de mama y es asociada con quimio resistencia y mal pronóstico. En este estudio presentamos el primer análisis en población panameña y de la región, con ataciones precisas de la mutación PIK3CA, las características clinicopatológicas y pronóstico. Métodos: Estudio exploratorio, donde se recolectaron prospectivamente tumores de 74 pacientes con cáncer de mama metastásico RH+/Her2- del Instituto Oncológico Nacional entre 2022 y 2023. Se realizó un ensayo de PCR en tiempo real para análisis de mutación en ADN extraído del material tumoral fijado en formalina e incluido en parafina para detectar mutaciones en los exones 1, 4, 7, 9 y 20 del gen PIK3CA. Resultados: La mediana de edad de las pacientes estudiadas fue 59 años. La mutación en PIK3CA se encontró en 33.8% (25/74) de pacientes con cáncer de mama, entre ellas 44% fueron mutaciones en el exón 20, 38% en el exón 9, 13% en el exón 4 y 5% en el exón 1. Se observó una correlación significativa entre la mutación y el tener historia de cáncer en la familia (p= 0.005), y en pacientes postmepáusicas (P = 0.045). encontramos asociación entre la mutación y el tipo histológico, grado, tamaño tumoral ni estatus axilar al momento del diagnóstico. La mediana de supervivencia libre de progresión se alcanzó en ambos grupos y tampoco demostró una diferencia significativa. Conclusión: La prevalencia de la mutación es relativamente alta comparada con escenarios internacionales, puede ofrecer una ventaja para elegir las mejores opciones de tratamiento por lo que debe evaluarse de forma rutinaria durante las intervenciones clínicas. (provisto por Infomedic International)
Background: The phosphoisitol 3-kinase (PI3K) signaling pathway, which promotes cancer cell growth and metabolism, is the most frequently mutated pathway in breast cancer and is associated with chemoresistance and poor progsis. In this study we present the first analysis in Panamanian and regional population, with precise antations of the PIK3CA mutation, clinicopathological characteristics and progsis. Methods: Exploratory study, where tumors were prospectively collected from 74 patients with RH+/Her2- metastatic breast cancer from the Instituto Oncológico Nacional between 2022 and 2023. A real-time PCR assay for mutation analysis was performed on DNA extracted from formalin-fixed, paraffin-embedded tumor material to detect mutations in exons 1, 4, 7, 9 and 20 of the PIK3CA gene. Results: The median age of the patients studied was 59 years. The mutation in PIK3CA was found in 33.8% (25/74) of patients with breast cancer, among them 44% were mutations in exon 20, 38% in exon 9, 13% in exon 4 and 5% in exon 1. A significant correlation was observed between the mutation and having history of cancer in the family (P = 0.005), and in postmepausal patients (P = 0.045). We found association between the mutation and histologic type, grade, tumor size or axillary status at diagsis. Median progression-free survival was t reached in both groups and did t show a significant difference. Conclusion: The prevalence of the mutation is relatively high compared to international settings, it may offer an advantage in choosing the best treatment options and should be routinely evaluated during clinical interventions. (provided by Infomedic International)
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Introducción: Las quemaduras constituyen un problema de salud pública que afecta mayormente a países en desarrollo [1,2]. En Panamá, existe una unidad de quemados para el manejo de pacientes adultos, ubicada en la ciudad capital, y no contamos con datos estadísticos sobre estas lesiones en dicha población. Objetivos: A través de este estudio descriptivo retrospectivo, buscamos generar la primera base de datos enfocada en la prevalencia y características de pacientes adultos quemados en Panamá. Métodos: Se incluyeron 110 expedientes de adultos ingresados por el Servicio de Cirugía Reconstructiva del Hospital "Dr. Rafael Hernández L." (HRRH) en Chiriquí, Panamá con diagnóstico de "Quemadura" durante los años 2016 y 2018, haciendo énfasis en sus datos demográficos, mes de admisión, mecanismo de lesión, grado de quemadura, porcentaje de superficie corporal total quemada (SCTQ), estancia intrahospitalaria (EIH) y abordaje quirúrgico. Resultados: Se obtuvo una prevalencia de período del 16%. 39% de casos se reportaron en el 2018. Se registró una mediana de edad de 42.5 años y una razón hombre: mujer de 1.4:1. Se identificó mayor frecuencia de admisiones en enero, seguido de marzo y julio (p=0.242). El mecanismo de lesión más consignado fue energía térmica (82.7%), el grado de quemadura más común fue IIa (64.5%). En 70% de los expedientes se matriculó un porcentaje de SCTQ menor del 10%. La mayor cantidad de casos tuvo una EIH menor a 30 días, encontrando una relación estadísticamente significativa entre porcentajes altos de SCTQ y una EIH mayor a un mes (p=<0.001). El 60% de los pacientes no recibió manejo quirúrgico. Conclusiones: Las quemaduras en adultos representan un porcentaje importante del censo manejado por el servicio de Cirugía Reconstructiva del HRRH. Su frecuencia a través de los años va en ascenso, con predominio en el grupo etario de 41-50 años y género masculino. El perfil de quemaduras más frecuente fue grado IIa con menos del 10% de SCTQ. Porcentajes más altos de SCTQ se relacionaron con EIH igual o mayores al mes. La mayoría de los pacientes fueron manejados con curaciones en sala de hospitalización. (provisto por Infomedic International)
Introduction: Burns constitute a public health problem that mostly affects developing countries [1,2]. In Panama, there is a burn unit for the management of adult patients, located in the capital city, and we do not have statistical data on these injuries in this population. Objectives: Through this retrospective descriptive study, we sought to generate the first database focused on the prevalence and characteristics of adult burn patients in Panama. Methods: We included 110 records of adults admitted to the Reconstructive Surgery Service of the Hospital Dr. Rafael Hernández L. (HRRH) in Chiriquí, Panama with a diagnosis of Burn during the years 2016 and 2018, with emphasis on their demographic data, month of admission, mechanism of injury, degree of burn, percentage of total body surface area burned (SCTQ), in-hospital stay (EIH) and surgical approach. Results: A period prevalence of 16% was obtained. 39% of cases were reported in 2018. A median age of 42.5 years and a male: female ratio of 1.4:1 was recorded. The highest frequency of admissions was identified in January, followed by March and July (p=0.242). The most reported mechanism of injury was thermal energy (82.7%), the most common degree of burn was IIa (64.5%). In 70% of the cases, the percentage of SCTQ was less than 10%. Most of the cases had a HIE of less than 30 days, finding a statistically significant relationship between high percentages of SCTQ and a HIE of more than one month (p=<0.001). Sixty percent of patients did not receive surgical management. Conclusions: Adult burns represent an important percentage of the census managed by the HRRH Reconstructive Surgery service. Their frequency has increased over the years, with a predominance in the 41-50 age group and male gender. The most frequent burn profile was grade IIa with less than 10% of SCTQ. Higher percentages of SCTQ were related to EIH equal to or greater than one month. Most of the patients were managed with in-patient ward dressings. (provided by Infomedic International)
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Despite ongoing efforts for elimination, malaria continues to be a major public health problem in the Republic of Panama. For effective elimination, it is key that malaria foci and areas of high transmission are identified in a timely manner. Here, we study malaria transmission records for the 2015-2022 period, a time when cases have increased by a factor of ten. Using several methods to study spatial and spatiotemporal malaria confirmed case clusters at the level of localities, including LISA and scan, we found that cases are clustered across indigenous villages located within the autonomous indigenous regions of Ngäbe-Buglé, Guna Yala, and Embera, with the latter on the eastern border of Panama (with Colombia). We discuss the different factors that might be shaping the marked increase in malaria transmission associated with these clusters, which include an inflow of malaria-exposed migrating populations hoping to reach the USA, insufficient health services, and the lack of culturally sensitive actionable tools to reduce malaria exposure among the ethnically diverse and impoverished indigenous populations of Panama.
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Vector-borne diseases are a major source of morbidity in Panama. Herein, we describe historical usage patterns of synthetic insecticides to control arthropod disease vectors in this country. We examine the influence of interventions by vector control programs on the emergence of insecticide resistance. Chemical control has traditionally focused on two mosquito species: Anopheles albimanus, a major regional malaria vector, and Aedes aegypti, a historical vector of yellow fever, and current vector of dengue, chikungunya, and Zika. Countrywide populations of An. albimanus depict hyperirritability to organochlorine insecticides administered by indoor residual spraying, although they appear susceptible to these insecticides in bioassays settings, as well as to organophosphate and carbamate insecticides in field tests. Populations of Ae. aegypti show resistance to pyrethroids, particularly in areas near Panama City, but the spread of resistance remains unknown in Ae. aegypti and Aedes albopictus. A One Health approach is needed in Panama to pinpoint the insecticide resistance mechanisms including the frequency of knockdown mutations and behavioral plasticity in populations of Anopheles and Aedes mosquitoes. This information is necessary to guide the sustainable implementation of chemical control strategies and the use of modern vector control technologies such as genetically modified mosquitoes, and endosymbiont Wolbachia-based biological control.
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Inseticidas , Controle de Mosquitos , Mosquitos Vetores , Doenças Transmitidas por Vetores , Animais , Humanos , Aedes/efeitos dos fármacos , Anopheles/efeitos dos fármacos , História do Século XX , História do Século XXI , Resistência a Inseticidas , Inseticidas/farmacologia , Controle de Mosquitos/métodos , Mosquitos Vetores/efeitos dos fármacos , Panamá , Doenças Transmitidas por Vetores/prevenção & controleRESUMO
Factors such as the Andean uplift, Isthmus of Panama, and climate changes have influenced bird diversity in the Neotropical region. Studying bird species that are widespread in Neotropical highlands and lowlands can help us understand the impact of these factors on taxa diversification. Our main objectives were to determine the biogeographic factors that contributed to the diversification of Euphoniinae and re-evaluate their phylogenetic relationships. The nextRAD and mitochondrial data were utilized to construct phylogenies. The ancestral distribution range was then estimated using a time-calibrated phylogeny, current species ranges, and neotropical regionalization. The phylogenies revealed two main Euphoniinae clades, Chlorophonia and Euphonia, similar to previous findings. Furthermore, each genus has distinctive subclades corresponding to morphology and geography. The biogeographic results suggest that the Andean uplift and the establishment of the western Amazon drove the vicariance of Chlorophonia and Euphonia during the Miocene. The Chlorophonia lineage originated in the Andes mountains and spread to Central America and the Mesoamerican highlands after the formation of the Isthmus of Panama. Meanwhile, the ancestral area of Euphonia was the Amazonas, from which it spread to trans-Andean areas during the Pliocene and Pleistocene due to the separation of the west lowlands from Amazonas due to the Northern Andean uplift. Chlorophonia and Euphonia species migrated to the Atlantic Forest during the Pleistocene through corridors from the East Andean Humid Forest and Amazonas. These two genera had Caribbean invasions with distinct geographic origins and ages. Finally, we suggested taxonomic changes in the genus Euphonia based on the study's phylogenetic, morphological, and biogeographic findings.
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Objective: It is necessary to establish the evolution that the pandemic has had in Panama by weeks and months and to clearly establish the existence of surges or peaks, according to cases and deaths and the relationship with age groups. Methodology: We conducted a retrospective cohort study of all confirmed COVID-19 cases reported by the Ministry of Health of Panama during the first 3 years of the epidemic (March 9, 2020, March 11, 2023). All cases were obtained from information provided by the Ministry of Health. We obtained daily information of the population at the national level reported as new cases, deaths, admission to hospitals, admission to intensive care units and by age groups. The information is classified by epidemiological week and by month from the diagnosis of the first case until March 2023. Results: During the three years of the study, 1,032,316 cases of COVID-19 were registered in the Republic of Panama, and the number of deaths reported was 8,621, for a fatality rate of 0.83 % throughout that period. The number of deaths decreased over the 3 years of the pandemic; however, similar to the cases, there were periods of surges (peaks) per year in June/July and in December/January. The lethality progressively increased according to the age of the affected patients. During the first year, the lethality in those under 20 years of age was 0.05 %, and in those over 80 years old, it was 17.54 %. This pattern was maintained during the second year; however, there was a large decrease in all age groups. Conclusion: the highest lethality rate in Panama occurred in the first year of the pandemic, with a great decrease in the third year; the impact of lethality is proportional to the age of the individual, with a high possibility of death in those over 80 years of age. During each pandemic year, there are two peaks (surges of new cases and deaths) per year, which are important times to take into account to generate strategies aimed at reducing the impact.
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Parechovirus A (PeV-A, Parechovirus, Picornaviridae) are human pathogens associated with mild to severe gastrointestinal and respiratory diseases in young children. While several studies have investigated the association of PeV-A with human disease, little is known about its epidemiology or detection in Latin America. Between the years 2014 and 2015, a total of 200 samples were collected from Panamanian pediatric patients aged < 16 years old exhibiting symptoms associated with respiratory (n = 64), gastrointestinal (n = 68), or neurological (n = 68) diseases. These samples were gathered from patients who had previously received negative diagnoses for the main respiratory viruses, rotavirus, and neurological viruses like herpes virus, enterovirus, and cytomegalovirus. The presence of PeV-A was analyzed by real time RT-PCR.Eight positive PeV-A infections (4.0%, 95% CI: 1.7 to 7.7) were detected: two in respiratory samples (3.0%, 95% CI: 0.3 to 10.8), five in gastrointestinal samples (7.3%, 95% CI: 2.4 to 16.3), and one in cerebrospinal fluid (1.5%, 95% CI: 1.4 to 7.9). The study provides evidence of PeV-A circulation in Panama and the data collectively, remarked on the importance of considering PeV-A in the Panamanian pediatric diagnostic landscape, especially when conventional testing for more common viruses yields negative results.
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Infecções por Enterovirus , Enterovirus , Parechovirus , Infecções por Picornaviridae , Picornaviridae , Humanos , Criança , Lactente , Pré-Escolar , Adolescente , Parechovirus/genética , Infecções por Picornaviridae/diagnóstico , Infecções por Picornaviridae/epidemiologia , Infecções por Enterovirus/diagnóstico , Infecções por Enterovirus/epidemiologia , Picornaviridae/genéticaRESUMO
Introducción; El Trasplante de Células Progenitoras Hematopoyéticas es actualmente un tratamiento para diferentes desordenes hematológicos malignos y no malignos, que se efectúa cuando existe un receptor con un donante idéntico o haploidéntico para los genes del Complejo Mayor de Histocompatibilidad. En ausencia de donante familiar compatible, hemos creado el Programa de Donantes Voluntarios con tipificación del Sistema HLA. que han expresado su consentimiento de ser donantes y comparten los alelos del Sistema de linfocitos humanos codificados en el brazo corto del cromosoma seis. Materiales y métodos: El presente estudio es un estudio descriptivo, observacional y transversal que presenta los resultados de la búsqueda de donantes voluntarios para receptores sin donante familiar en el Programa Panamá Dono y su aplicación en Panamá. Resultado: De los grupos familiares estudiados que incluye receptor y donantes familiares, un total de 783 personas estudiadas aceptaron voluntariamente ser donantes no relacionados y sus tipificaciones HLA incorporadas al Programa Panamá Dono. Un total de 321 pacientes sin donante idéntico o haploidentico en su grupo familiar, se les ha buscado donante no relacionado en el Programa y se logró Trasplantar el primer receptor con un donante voluntario compatible en 16 genes del Complejo Mayor de Histocompatibilidad en el Hospital del Niño. Conclusión: El Laboratorio Nacional de Trasplante de la Caja de Seguro Social ha logrado crear el Programa de Donantes Voluntarios de Células Progenitoras Hematopoyéticas denominado PANAMA DONO, que consta de 788 panameños que han expresado su consentimiento. En la actualidad una paciente del Hospital del Niño fue trasplantada en 2022 con esta modalidad de donante compatible no relacionado. La compatibilidad idéntica de la receptora con el donante voluntario fue de 16 alelos idénticos del Complejo Mayor de Histocompatibilidad. (provisto por Infomedic International)
Introduction: Hematopoietic Progenitor Cell Transplantation is currently a treatment for different malignant and non-malignant hematological disorders, which is performed when there is a recipient with an identical or haploidentical donor for the genes of the Major Histocompatibility Complex. In the absence of a compatible family donor, we have created the Volunteer Donor Program with HLA System typing, who have expressed their consent to be donors and share the alleles of the human lymphocyte system encoded on the short arm of chromosome six. Materials and methods: The present study is a descriptive, observational, and cross-sectional study that presents the results of the search for volunteer donors for recipients without a family donor in the Panama Dono Program and its application in Panama. Results: Of the family groups studied, which included recipients and family donors, a total of 783 persons studied voluntarily accepted to be unrelated donors and their HLA typing incorporated into the Panama Dono Program. A total of 321 patients without an identical or haploidentical donor in their family group have been searched for unrelated donors in the Program and the first recipient was transplanted with a voluntary donor compatible in 16 genes of the Major Histocompatibility Complex in the Hospital del Niño. Conclusion: The National Transplant Laboratory of the Social Security Fund has managed to create the Program of Voluntary Donors of Hematopoietic Progenitor Cells called PANAMA DONO, which consists of 788 Panamanians who have expressed their consent. Currently a patient from the Hospital del Niño was transplanted in 2022 with this unrelated compatible donor modality. The identical compatibility of the recipient with the volunteer donor was 16 identical alleles of the Major Histocompatibility Complex. (provided by Infomedic International)