S0001-600220090003 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022009000300001 Dr. Carlos Durán Cartín Jaramillo Antillón Juan ,UCR Facultad de Medicina 09 2009 2009 51 130 131 Jaramillo Juan El Dr. Carlos Durán Cartín Salud y seguridad social Salud y seguridad social 1993 Editorial Universidad de Costa Rica Pupo, Pérez Carlos El Dr. Carlos Durán El Dr. Carlos Durán 1924 San José Pub. Imprenta Nacional Reseña Histórica Reseña Histórica 1981 2da San José Imprenta de Valores Junta de Protección Social Reseña Histórica de las diferentes etapas del Colegio de Médicos y Cirujanos Reseña Histórica de las diferentes etapas del Colegio de Médicos y Cirujanos 1962 San José Pub. Colegio de Médicos. Imprenta San Martín Jaramillo J Dr. Carlos Durán Historia y evolución del Seguro Social de Costa Rica Historia y evolución del Seguro Social de Costa Rica 2004 San José EDNASSS Acuña José Thomas P Sánchez R A Gallegos y González G La Psiquiatría y la Psicología en Costa Rica La Psiquiatría y la Psicología en Costa Rica 1979 San José EUNED Pupo Carlos Nuestros males: Principios sanitarios que nadie debe ignorar Nuestros males: Principios sanitarios que nadie debe ignorar 1935 San José Banco Nacional de Seguros Jaramillo J Precursores de la Cirugía Académica en Costa Rica Historia Filosofía de la Medicina Historia Filosofía de la Medicina 2005 San José Universidad de Costa Rica Fernández Guardia R Gobierno Interino del doctor Durán: Cartilla Histórica de Costa Rica Gobierno Interino del doctor Durán: Cartilla Histórica de Costa Rica 1974 47 Librería, Imprenta y Litografia Lehman S. A Monge, Alfaro Carlos. Dr Carlos Durán: Historia de Costa Rica Carlos Durán: Historia de Costa Rica 1974 San José Librerí Trejos Dr. Carlos Durán Cartín La Nación 15 d e ag
S0001-600220090003 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022009000300002 Influenza AH1N1: Un riesgo global Ávila-Agüero María Luisa , 09 2009 2009 51 132 135 Nava G Attene-Ramos M Ang J Escorcia M Origins of the new influenza A(H1N1) virus: time to take action Euro Surveill 2009 Hospitalized patients with novel influenza A (H1N1) virus infection - California MMWR Morb Mortal Wkly Rep Apri l- Ma 58 Serum crossreactive antibody response to a novel influenza A (H1N1) virus after vaccination with seasonal influenza vaccine MMWR Morb Mortal Wkly Rep 2009 58 Lau SK Chan KH Yip CC Ng TK Tsang OT Woo PC Yuen KY Confirmation of the first Hong Kong case of human infection by novel swine-origin influenza A (H1N1) virus using ultra-rapid & realtime RT-PCR J Clin Microbiol 2009 Stein RA Lessons from Outbreaks of H1N1 Influenza Ann Intern Med 2009 Garten RJ Davis CT Russell CA Shu B Lindstrom S Balish A Antigenic and genetic characteristics of swine-origin 2009 A(H1N1) Influenza viruses circulating in humans Science 2009 Human infection with new influenza A (H1N1) virus: clinical observations from Mexico and other affected countries, May 2009 Wkly Epidemiol Rec 2009 84 Cohen J Swine flu outbreak: Past pandemics provide mixed clues to H1N1’s next moves Science 2009 22 324 Fineberg HV Wilson ME Epidemic science in real time Science 2009 324 New influenza A(H1N1) virus infections: global surveillance summary, May 2009 Wkly Epidemiol Rec 2009 84 Novel influenza A (H1N1) virus infections in three pregnant women - United States, April-May 2009 MMWR Morb Mortal Wkly Rep 2009 58 Swine-origin influenza A (H1N1) virus infections in a school - New York City, April 2009 MMWR Morb Mortal Wkly Rep 2009 58 Outbreak of swine-origin influenza A (H1N1) virus infection - Mexico, March- April 2009 MMWR Morb Mortal Wkly Rep 2009 8 58 Update: novel influenza A (H1N1) virus infections - worldwide, May 6, 2009 MMWR Morb Mortal Wkly Rep 2009 58 Enserink M Swine flue outbreak: Swine flu names evolving faster than swine flu itself Science 2009 324
S0001-600220090003 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022009000300003 Paradojas de la medicina actual Arrea Baixench Carlos , 09 2009 2009 51 136 137
S0001-600220090003 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022009000300004 Fibrilación atrial en los adultos mayores Atrial Fibrillation in the Elderly Brizuela-Torres Jorge Morales-Martínez Fernando ,Hospital Nacionald e Geriatría y Gerontología Dr. Raúl Blanco Cervantes 09 2009 2009 51 138 146

La fibrilación atrial es la taquiarritmia más prevalente en los adultos mayores. La frecuencia de dicha arritmia aumenta con la edad, presentándose en un 1.5% de los 50 a 59 años a 10% de los 80 a 89 años. La fibrilación atrial no valvular incrementa el riesgo de sufrir un evento cerebrovascular isquémico cardioembólico en 5 veces y causa el 15% de todos los accidentes cerebrovasculares isquémicos en Estados Unidos de América. El manejo de la fibrilación atrial se enfoca, principalmente, en la prevención de los fenómenos tromboembólicos y en el control de la frecuencia y ritmo cardiaco. La anticoagulación, cuando está indicada, ha demostrado ser la principal herramienta en la prevención de dichos eventos. Sin embargo, aunque las complicaciones hemorrágicas son más frecuentes, en esta población, y aumentan con la edad, sobrepasa por mucho, el beneficio al riesgo. El control de la frecuencia cardiaca ha demostrado ser igual o mejor que el control del ritmo en cuanto a prevención de eventos cerebrovasculares y mortalidad en estos pacientes. La edad cronológica por sí sola, no es contraindicación alguna para ofrecer una terapia óptima. Debe tomarse en cuenta el estado funcional, cognitivo y social, así como aspectos fisiológicos del envejecimiento con respecto a la prescripción de medicamentos. Cuando, a pesar del tratamiento adecuado, la sintomatología persiste, las estrategias invasivas han demostrado ser beneficiosas, pero faltan estudios que involucren a individuos mayores.

Atrial fibrillation is the most prevalent arrhythmia in the elderly. Its frequency increases with age, being 1.5% from 50 to 59 years old and 10% from 80 to 89 years old. Non valvular atrial fibrillation increases 5 fold the risk of suffering an stroke and causes 15% of strokes in the USA. Atrial fibrillation management focuses in the prevention of thromboembolic phenomena and heart rate and rhythm control. Anticoagulation, when indicated, has demonstrated to be the main tool in the prevention of these events. Nevertheless, although bleeding complications are more frequent in this population and increase with age, anticoagulation benefits are greater than the risks. Heart rate control is better than rhythm control regarding cerebrovascular accidents and mortality. Age by itself is not a contraindication to offer optimal therapy. Functional, mental and social status, must be taken into account as well as physiological aspects of aging when it comes to prescribing medications. If symptoms persist in spite of adequate treatment, invasive strategies have demonstrated to be of benefit, however studies in elderly population are lacking.

 fibrilación atrial adulto mayor anticoagulación prevención antiplaquetarios accidente cerebrovascular atrial fibrillation elderly anticoagulation prevention antiplatelet agents stroke Go AS Hylek EM Phillips KA Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: The Anticoagulation and Risk factors in Atrial Fibrillation (ATRIA) Study JAMA 2000 285 Wolf PA Abbott RD Kannel WB Atrial fibrillation as an independent risk factor for stroke: The Framingham Study Stroke 1991 22 Lakshminarayan K Solid CA Collins AJ Atrial fibrillation and stroke in general medicare population: a 10 year perspective (1992-2002) Stroke 2006 37 Lin HJ Wolf PA Kelly Hayes M Stroke severity in atrial fibrillation: The Framinghan Study Stroke 1996 27 Hylek EM Go AS Chang Y Effect of intensity of oral anticoagulation on stroke severity and mortality in atrial fibrillation N Engl J Med 2003 349 Hart R Benavente O McBride R Antithrombotic therapy to prevent stroke in patients with atrial fibrillation: a meta-analysis Ann Intern Med 1999 131 Mccrory DC Matchar DB Samsa Physician attitudes about anticoagulation for nonvalvular atrial fibrillation in the elderly Arch Intern Med 1995 155 Jencks SF Cuerdon T Burwen DR Quality of medical care delivered to Medicare beneficiaries: a profile at state and national levels JAMA 2000 284 David A Garcia MD Elaine Hylek Reducing the risk for stroke in patients who have atrial fibrillation Cardiol Clin 2008 Garcia D Regan S Crowther M Warfarin maintenance dosing patterns in clinical practice: implications for safer anticoagulation in the elderly population Chest 2005 127 Hylek EM Skates S Sheehan M An analysis of the lowest effective intensity of prophylactic anticoagulation for patients with nonrheumatic atrial fibrillation N Engl J Med 1996 335 Fang MC Chang Y Hylek EM Advanced age, anticoagulation intensity and risk for intracranial hemorrhage among patients taking warfarin for atrial fibrillation Ann Intern Med 2004 141 The use of oral anticoagulants (warfarina) in older people: American Geriatrics Society Guideline J AM Geritr Soc 2002 50 Palareti G Leali N Coccheri S Bleeding complications of oral anticoagulant treatment: an inception cohort, prospective collaborative study (ISCOAT). Italian Study on Complications of Oral Anticoagulant Therapy Lancet 1996 348 Fanikos J Grasso-Correnti N Shah R Major Bleeding complications in a specialized anticoagulation service Am J Cardiol 2005 96 Landefeld CS Goldman L Major bleeding in outpatients treated with warfarin: incidence and prediction by factors known at the start of outpatient therapy Am J Med 1989 87 Fang MC Go AS Hylek EM Age and the risk of warfarin associated hemorrhage: the Anticoagulation and Risk Factors In Atrial Fibrillation (ATRIA) Study J Am Geritr Soc 2006 54 Levine MN Raskob G Beyth RJ Hemorrhagic complications of anticoagulant treatment: the Seventh ACCP Conference on Antithrombotic and Thrombolitic Therapy Chest 2004 126 Kagansky N Knobler H Rimon E Safety of anticoagulation therapy in well informed old patients Arch Intern Med 2004 164 vanWalraven C Hart RG Singer DE Oral anticoagulants vs aspirin in nonvalvular atrial fibrillation: an individual patient metanalysis JAMA 2002 288 Rash A Downes T Portner R A randomized controlled trial of warfarin vs aspirin for stroke prevention in octogenarians with atrial fibrillation (WASPO) Age and Ageing 2006 Olsson S Stroke prevention with the oral direct thrombin inhibitor ximelagatran compared with warfarin in patients with nonvalvular atrial fibrillation (SPORTIF III): randomized controlled trial Lancet 2003 362 Ximelagatran vs warfarin for stroke prevention in patients with nonvalvular atrial fibrillation: a randomized trial JAMA 2005 293 McCrory DC Matchar DB Samsa G Physician attitudes about anticoagulation for novalvular atrial fibrillation in the elderly Arch Intern Med 1995 155 Quilliam BJ Lapane KL Clinical correlates and drug treatment of residents with stroke in long term care Stroke 2001 32 McCormick D Gurwitz JH Goldberg RJ Prevalence and quality of warfarin use for patients with atrial fibrillation in long term care setting Arch Intern Med 2001 161 Fang MC Stafford RS Ruskin JN National trends in antiarrhythmic and antithrombotic medication use in atrial fibrillation Arch Intern Med 2004 164 Man-Son-Hing M Nichol G Lau A Laupacis A Choosing antithrombotic therapy for elderly patients with atrial fibrillation who are at risk for falls Arch Intern Med 1999 159 Gage BF Birman-Deych E Kerzner R Incidence of intracranial hemorrhage in patients with atrial fibrillation who are prone to fall Am J Med 2005 118 Hart R Pearce L MacBride R Factors associated with ischemic stroke during aspirin therapy in atrial fibrillation: analysis of 2012 participants in the SPAF I-III clinical trials Stroke 1999 30 Fang MC Singer DE Chang Y Gender differences in the risk of ischemic stroke and peripheral embolism in atrial fibrillation (ATRIA) study Circulation 2005 112 Gage BF Waterman AD Shannon W Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation JAMA 2001 285 Go AS Hylek EM Chang Y Anticoagulation therapy for stroke prevention in atrial fibrillation: how well do randomized trials translate into clinical practice JAMA 2003 290 AFFIRM Investigators: A comparison of rate control and rhythm control in patients with atrial fibrillation N Engl J Med 2002 347 Van Gelder I.C Hagens V.E Bosker H.A A comparison of rate control and rhythm control in patients with recurrent persistent atrial fibrillation N Engl J Med 2002 347 Alpert MA Medical cardioversion of atrial fibrillation Chest 2000 117 Hohnloser SH Kuck K Lilienthal J Rhythm or rate control in atrial fibrillation-pharmacological intervention in atrial fibrillation (PIAF): a randomized trial Lancet 2000 356 Tsivgoulis G Spengos K Zacopoulos N Efficacy of anticoagulation for secondary stroke prevention in older with non-valvular atrial fibrillation: a prospective case series study Age and Ageing 2005 34 Hart RG Pearce LA Rothbart RM Stroke with intermittent atrial fibrillation: incidence and predictors during aspirin therapy J Am Coll Cardiol 2000 35 de Denus S Sanoski C.A Carlsson J Rate vs rhythm control in patients with atrial fibrillation: a meta-analysis Arch Intern Med 2005 165 Echt DS Liebson PR Mitchell LB Mortality and morbidity in patients receiving encinide, flecainide or placebo: The cardiac arrhythmia suppression Trial N Engl J Med 1991 324 Allan J McLean G McLean D Aging Biology and Geriatric Clinical Pharmacology Pharmacol Rev 2004 56 Zimetbaum P Amiodarone for Atrial Fibrillation N Engl J Med 2007 356 Goldschlager N Epstein AE Naccarelli G Practical Guidelines for clinicians who treat patients with amiodarone Arch Inter Med 2000 160 Olshansky B Sami M Rubin A Use of amiodarone for atrial fibrillation In patients with preexisting pulmonary disease in the AFFIRM study Am J Cardiol 2005 95 Ahmad S Amiodarone and reversible alopesia Arch Intern Med 1995 155 Singh BN Singh SN Reda DJ Amiodarone vs Sotalol for atrial fibrillation N Engl J Med 2005 352 Jacobs LG Warfarin Pharmacology, Clinical management and evaluation of hemorrhagic risk for the elderly Cardiol Clin 2008 26 Fuster V Ryden L.E Cannom D.S ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society Circulation 2006 114 Singh B Connolly SJ Dronedarone for maintenance of sinus rhythm in atrial fibrillation or flutter N Engl J Med 2007 357 Hohnloser S EURIDIS and ADONIS: Maintenace of sinus rhythm with dronedarone in patients with atrial fibrillation or flutter EURIDIS and ADONIS: Maintenace of sinus rhythm with dronedarone in patients with atrial fibrillation or flutter Program and abstracts from European Society of Cardiology Congress 2004 August 28-September 1,2004 Hohnloser S Crijns HJ van Eickels M The ATHENA trial: Effects of dronedarone on cardiovascular hospitalization and death in patients with atrial fibrillation or flutter The ATHENA trial: Effects of dronedarone on cardiovascular hospitalization and death in patients with atrial fibrillation or flutter Program and abstracts from Heart Rhythm 2008: The Heart Rhythm Society (HRS) Annual Scientific Sessions May 14-17,2008 San Francisco California Adams KF Gheroghiade M Uretzky BF Clinical benefits of low serum digoxin concentrations in heart failure J Am Coll Cardiol 2002 39 Lista Oficial de Medicamentos (LOM) Lista Oficial de Medicamentos (LOM) 2006 Caja Costarricense del Seguro Social (CCSS) Ozcan C Jahangir A Friedman P A. Long-term survival after ablation of the atrioventricular node and implantation of a permanent pacemaker in patients with atrial fibrillation 2001 344 Haissaguerre M Jais P Shah D.C Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins N Engl J Med 1998 339 Wazni O.M Marrouche N.F Martin D.O Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of symptomatic atrial fibrillation: a randomized trial JAMA 2005 293 Peters NC Schilling RJ Karagaratman PV Atrial fibrillation: strategies to control, combat and cure Lancet 2002 359 Pappone C Oral H Santinelli V Atrio-esophageal fistula as a complication of percutaneous transcatheter ablation of atrial fibrillation Circulation 2004 109 Oral H Pappone C Chugh A Circumferential pulmonary-vein ablation for chronic atrial fibrillation N Engl J Med 2006 354 Ad N Cox J.L Stroke prevention as an indication for the Maze procedure in the treatment of atrial fibrillation Semin Thorac Cardiovasc Surg 2000 12
S0001-600220090003 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022009000300005 Micronutrientes y enfermedades crónicas: ¿ hacia donde apunta la evidencia científica? Micronutrients and Chronic Diseases: Which Way Is The Scientific Evidence Pointing To? Gómez-Salas Georgina ,Universidad de Costa Rica Escuela de Medicina Departamento de Bioquímica 09 2009 2009 51 147 154

Los estudios observacionales han demostrado, de manera consistente, una asociación positiva entre el consumo de dietas ricas en frutas y vegetales, y un menor riesgo de enfermedad cardiovascular, cáncer, enfermedad cerebrovascular y otras enfermedades crónicas. El consumo de suplementos de vitaminas antioxidantes ha ido en aumento, bajo la premisa de que estos podrían ayudar a prevenir o curar enfermedades crónicas. Sin embargo, a pesar de la gran cantidad de investigaciones que se han realizado en este campo, no se ha logrado esclarecer realmente el papel que la suplementación con estos micronutrientes pueda estar ejerciendo en la patología de esas enfermedades. El Instituto Nacional de Salud de los Estados Unidos establece, que no existe, suficiente evidencia científica para promover o desestimular, el uso de suplementos multivitamínicos para la prevención de las enfermedades crónicas. Los datos emergentes cuestionan los beneficios reales que los suplementos antioxidantes puedan tener en los sujetos con un adecuado estado nutricional, y sugiere que su consumo podría no ser seguro en comparación con las vitaminas y minerales contenidos naturalmente, en los alimentos. Los meta-análisis realizados, con estudios randomizados no han logrado demostrar efectos benéficos de la suplementación con multivitaminas sobre la mortalidad por enfermedades crónicas, y más bien, algunos análisis han sugerido que los β -catorenos, la vitamina A y la vitamina E podrían aumentar el riesgo de muerte.

Observational studies have consistently demonstrated a positive association between high fruits and vegetables intake and a reduced risk of heart disease, cancer, cerebrovascular disease, and other chronic diseases. Under the premise that vitamin and mineral supplements can have the same effects of those naturally found in food, many people are using them to prevent or treat chronic diseases. But in spite of intensive research, the benefitial effect of antioxidant supplements is still not clear. The US National Institute of Health states that there is not enough evidence to recommend or discourage the use of multivitamin supplements to prevent chronic diseases. Growing scientific data questions the benefitial value of supplementing with antioxidant vitamins, in well nourished population and raises the possibility that they may not be safe compared with vitamin consumption within a healthy diet. Meta-analyses of randomized trials have failed to demonstrate that supplementations with antioxidant vitamins can have benefitial effects on mortality. Even more, some analyses suggested that β-carotenes, vitamin A or vitamin E can increase the risk of death.

 suplementos vitaminas minerales enfermedades crónicas supplements vitamins minerals chronic diseases National Institute of Health State-of-the-Science Conference Statement: Multivitamin/Mineral Supplements and Chronic Disease Prevention Ann Intern Med 2006 145 Shenkin A Micronutrients in health and disease: Review Postgrad Med J 2006 82 Woodside J McCall D McGartland C Young IS Micronutrients: dietary intake v. supplement use Proceedings of the Nutrition Society 2005 64 Kennedy G Nantel G Shetty P The scourge of "hidden hunger": global dimensions of micronutrient deficiencies FNA/ANA 2003 32 Allen LH Interventions for micronutrient deficiency control in developing countries: past, present and future J Nutr 2003 133 Deficit Vitamínico & Mineral: Un informe sobre el progreso local Deficit Vitamínico & Mineral: Un informe sobre el progreso local 2004 ^eNew York UNICEF Neumann CG Symposium: Food-Based approaches to combating micronutrient deficiencies in children of developing countries. Background J Nutr 2007 137 Ulate E Duodécimo informe del Estado de la Nación en Desarrollo Humano Sostenible: Informe Final. Principales tendencias de la situación nutricional de la población de Costa Rica y su atención en el periodo 1996-2006 Duodécimo informe del Estado de la Nación en Desarrollo Humano Sostenible: Informe Final. Principales tendencias de la situación nutricional de la población de Costa Rica y su atención en el periodo 1996-2006 CONARE Memoria Institucional 2006-2007 Memoria Institucional 2006-2007 San José Greenwald P Anderson D Nelson SA Taylor PR Clinical trials of vitamin and mineral supplements for cancer prevention Am J Clin Nutr 2007 85 ^ssuppl Lichtenstein AH Russell RM Essential Nutrients: Food or Supplements? Where should the emphasis be? JAMA 2005 294 Bjelakovic G Gluud C Surviving antioxidant supplements J Natl Cancer Inst 2007 99 Huang HY Caballero B Chang S Alberg AJ Semba RD Schneyer C Wilson RF Cheng TY Barnes GPG Bass EB Multivitamin/Mineral Supplements and Prevention of Chronic Disease: Executive Summary Am J Clin Nutr 2006 85 ^ssuppl Carballoso M Sacristán M Sena C Bonfill X Drugs for preventing lung cancer in healthy people Cochrane Database Syst Rev 2003 2 Fairfield KM Fletcher RH Vitamin for Chronic Disease Prevention in Adults: Scientific Review JAMA 2002 287 Rock CL Multivitamin-multimineral supplements: who uses them? Am J Clin Nutr 2007 85 ^ssuppl Murphy SP White KK Park SY Sharma S Multivitamin-multimineral supplements’ effect on total nutrient intake Am J Nutr 2007 85 ^ssuppl Block G Jensen C Norkus EP Dalvi TB Wong LG McManus JF Hudes ML Usage patterns, health, and nutritional status of long-term multiple dietary supplement users: a cross-sectional study Nutrition Journal 2007 6 Lee Y Mitchell DC Smiciklas-Wright H Birch LL Maternal Influence on 5 to 7 year-old Girls´Intake of Multivitamin-Mineral Supplements Pediatrics 2002 20 02 109 3 Kim SH Keen CL Vitamin and mineral supplement use among children attending elementary schools in Korea: a survey of eating habits and dietary consequences Nutrition Research 2001 Touvier M Kesse E Volatier JL Clavel-Chapelon F Boutron-Ruault MC Dietary and cancer-related behaviors of vitamin/mineral dietary supplements users in a large cohort of French women Eur J Nutr 2006 45 Reedy J Haines PS Campbell MK Differences in fruit and vegetable intake among categories of dietary supplement users J Am Diet Assoc 2005 105 McNaughton SA Mishra GD Paul AA Prynne CY Wadsworth MEJ Supplement use is associated with health status and health-related behaviors in the 1946 British Birth Cohort J Nutr 2005 135 Traber MG Heart disease and single-vitamin supplementation Am J Clin Nutr 2007 85 ^ssuppl Huang HY Caballero B Chang S Alberg AJ Sembra RD Schneyer C Wilson RF Cheng TY Vassy J Prokopowicz G Barnes GJ Bass EB The Efficacy and Safety of Multivitamin an Mineral Supplements Use To Prevent Cancer and Chronic Disease in Adults: A Systematic Review for a National Institute of Health-State-of-the-Science Conference Ann Intern Med 2006 145 Brigelius-Flohé R Kelly FJ Salonen JT Neuzil J Zing JM Azzi A The European perspective on vitamin E: current knowledge and future research Am J Clin Nutr 2002 76 Thompson MJ Puntmann V Kaski JC Atherosclesoris and oxidative stress: the end of the road for antioxidant vitamin treatment? Cardiovasc Drugs Ther 2007 21 Rimm EB Stampfer MJ Ascherio A Giovannucci E Colditz GA Willet WC Vitamin E consumption and the risk of coronary heart disease in men N Engl J Med 1993 328 Stampfer MJ Hennekens CH Manson JE Colditz GA Rosner B Willet WC Vitamin E consumption and the risk of coronary disease in women N Engl J Med 1993 328 Stephens NG Parson A Schofield PM Kelly F Cheeseman K Mitchinson MJ Brown MJ Ramdomised controlled trial of vitamin E in patients with coronary disease: Cambridge Heart Antioxidant Study (CHAOS) Lancet 1996 347 Rapola JM Virtamo J Ripatti S Huttunen JK Albanes D Taylor PR Heinonen OP 1997 The effect of vitamin E and beta carotene on the incidence of lung cancer and other cancers in male smokers N Engl J Med 1994 330 Blot WJ Li JY Taylor PR Guo W Dawsey S Wang GQ Zheng SF Gail M Li GY Yu Y Liu B Tangrea J Sun Y Liu F Fraumeni JF Zhang YH Li B Nutritional Intervention Trial in Linxian, China: Supplementation with Specific Vitamin/Mineral Combination, Cancer Incidence, and Disease-Specific Mortality in the General Population J Natl Cancer Inst 1993 18 Vitamin E supplementation and cardiovascular events in highrisk patitents N Engl J Med 2000 20 342 Omenn GS Goodman GE Thornquist MD Balmes J Cullen MR Glass A Keogh JP Meysken FL Jr Valanis B Williams JH Jr Barnhart S Cherniack MG Brodkin CA Hammar S Risk factors for lung cancer and for intervention effects in CARET, the Beta-Carotene and Retinol Efficacy Trial J Natl Cancer Inst 1996 88 Hercberg S Galan P Preziosi P Bertrais S Mennen L Malvy D Roussel AM Favier A Briancon S A randomized, placebo-controlled trial of the health effects of antioxidant vitamins and minerals Arch Intern Med 2004 164 Lee IM Cook NR Gaziano JM Gordon D Ridker PM Manson JE Hennekens CH Buring JE Vitamin E in the primary prevention of cardiovascular disease and cancer: the Women´s Health Study: a randomized control trial JAMA 2005 20 05 294 Booth SL Golly I Sacheck JM Roubenoff R Dall GE Hamada K Blumberg JB Effect of vitamin E supplementation on vitamin K status in adults with normal coagulation status Am J Clin Nutr 2004 80 Kris-Etherton PM Lichtenstein AH Howard BV Steinberg D Witztum JL Nutrition Committee of the American Heart Association Council on Nutrition, Physical Activity, and Metabolism: Antioxidant vitamin supplements and cardiovascular disease Circulation 2004 110 Gibbson RJ Abrams J Chatterjee K Daley J Deedwania P Douglas J Ferguson TBJr Fihn S Fraker T Gardin J O’Rourke R Pasternak R Williams S Alpert J Antman E Hiratzka L Fuster V Faxon D Gregoratos G Jacobs A Smith S ACC/AHA 2002 guideline update for the anagement of patients with chronic stable angina- summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Circulation 2003 107 Miller ER Pator-Barriuso R Dalal D Riemrsma RA Appel LJ Guallar E Meta-Analysis: High -dosage vitamin E supplementation may increase all-cause mortality Ann Intern Med 2004 142 Ford ES Ajani UA Mokdad AH Brief communication: The prevalence of high intake of vitamin E from the use of supplements among US adults Ann Intern Med 2005 143 Prendice RL Clinical trials and observantional studies to assess the chronic disease benefits and risks of multivitamin-multimineral supplements Am J Clin Nutr 2007 85 ^ssuppl Tatsioni A Bonitsis NG Ioannidis JP Persistence of contradicted claims in literature JAMA 2007 298 Wald NJ Oakely GP Should folic acid fortification be mandatory? Yes BMJ 2007 334 Johnston RB Will increasing folic acid in fortified grain products further reduce neural tube defects without causing harm: Consideration of the evidence Pediatr Res 2008 63 Ulrich CM Folate and cancer prevention: a closer look at a complex pic Am J Clin Nutr 2007 20 07 86 Mason JB Dickstein A Jacques PF Haggarty P Selhub J Dallal G Rosenberg IH A temporal association between folic acid fortification and an increase in colorectal cancer rates may illuminating important biological principles: A hypothesis Cancer Epidemiol Biomarkers Prev 2007 16 Cole BF Baron JA Sandler RS Haile RW Ahnen DJ Polyp Prevention Study Group: Folic acid for the prevention of Colorectal Adenoma JAMA 2007 297 Morris MC Evans DA Bienias JL Dietary folate and vitamin B12 intake and cognitive decline among community-dwelling older persons Arch Neurol 2005 62 Watkins ML Erickson JD Thun MJ Mulinare J Heath CW Multivitamin use and mortality in a large prospective study Am J Epidemiol 2000 152 Lawson KA Wright ME Subar A Mouw T Hollenbeck A Schatzkin A Leitzmann MF Multivitamin use and risk of prostate cancer in the National Institutes of Health-AARP Diet and Health Study J Natl Cancer Inst 2007 99 Bjelakovic G Nikolova D Gluud LL Simonetti RG Gluud C Mortality in randomized trials of antioxidant supplements for primary and secondary prevention: Systematic review and Meta-analysis JAMA 2007 297 Heidemann C Schulze MB Franco OH van Dam RM Mantzoros CS HU FB Dietray patterns and risk of mortality from cardiovascular disease, cancer and all causes in a prospective cohort of women Circulation 2008 118 Hung HC Joshipura KJ Jiang R Hu FB Hunter D Smith-Warner SA Colditz GA Rosner B Spiegelman D Willett WC Fruit and vegetable intake and risk of mayor chronic disease Natl Cancer Inst 2004 96
S0001-600220090003 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022009000300006 La búsqueda bibliográfica Arguedas-Arguedas Olga ,Caja Costarricense de Seguro Social Hospital Nacional de Niños Dr. Carlos Sáenz Herrera 09 2009 2009 51 155 157
S0001-600220090003 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022009000300007 Estado actual de la leishmaniosis en Costa Rica Current status of Leishmaniosis in Costa Rica Jaramillo-Antillón Orlando Espinoza-Aguirre Azálea Lobo-Philp Raquel ,Universidad de Costa Rica Escuela de Medicina 09 2009 2009 51 158 164

Se realizó esta investigación, para conocer el comportamiento epidemiológico de esta enfermedad, los vectores relacionados y las especies de leishmanias causantes. Métodos: fuentes de información fueron los boletines epidemiológicos del Ministerio de Salud del 2001 al 2007 y el Instituto Nacional de Estadísticas y Censos. Se calcularon tasas de incidencia por sexo, grupos de edad, provincia y cantón. Las tasas del último trienio se compararon con una investigación que describe la situación epidemiológica de 1973 a 1975, para identificar cambios epidemiológicos de la enfermedad. La revisión bibliográfica permitió describir las formas clínicas y la distribución geográfica de los vectores que la ocasionan. Resultados y conclusión: la incidencia aumentó de 10,5 del 2001 a 40,7 x100.000 habitantes en el 2007. Los menores de 19 años fueron los más afectados. Talamanca presentó la mayor incidencia cantonal. El agente etiológico más frecuente de la leishmaniosis cutánea es la Leishmania (Viannia) panamensis, aunque también existe la L. (V.) braziliensis. Los mosquitos trasmisores fueron Lutzomyia ylephiletor y L. trapidoi. Los reservorios del parásito son los perezosos: Bradypus griseus y Choloepus hoffmanni y un roedor Heteromys desmarestianus. Existe también la leishmaniosis cutánea atípica, producida por Leishmania infantum (= Leishmania chagasi), productora responsable de un caso de leishmaniosis visceral. L.longipalpis, esta asociada a la transmisión de estas dos últimas formas de leishmaniosis. Debe entrenarse al personal de salud, en la detección de esta enfermedad, y educar a la población.

Justification and aim: We conducted an investigation to study the epidemiological behavior of the disease, its related vectors and the species that cause leishmania. Methods: As sources of information we used epidemiological bulletins from the Costa Rican Ministry of Health covering the years 2001 to 2007 and also those from the National Institute of Statistics and Census. The rates of incidence of the disease were calculated according to sex, age group, and distribution in different provinces and counties. These rates of incidence for the last 30 years were compared to an investigation that described the epidemiology of the disease from 1973 to 1975, in order to identify epidemiological changes of the disease. Having studied the bibliography of information compiled concerning this disease, we were able to describe the clinical forms and the geographic distribution of its vectors. Results: The incidence increased from 10,5 per 100.000 inhabitants found in 2001 to 40,7 per 100.000 inhabitants found in 2007. Young people of less than 19 years of age were found to be the most affected. The greatest rate of incidence for the country was found in Talamanca. The main etiological agent of cutaneous leishmaniasis is Leishmania (Viannia) panamensis, although L. (V.) braziliensis also exists. The vectors agents were Lutzomyia ylephiletor and L. trapidoi mosquitoes. The natural carriers of these parasites found in the wild are Bradypus griseus and Choloepus hoffmanni sloths and Heteromys desmarestianus rodents. There are also cases identified of atypical cutaneous leshmaniasis, produced by Leishmania infantum (= Leishmania chagasi), also responsible of a case of visceral leishmaniasis. L. longipalpis has been found to transmit these two forms of leishmaniasis. Conclusion: We found that it is important to train health workers on detecting leshmaniasis and educate the general population about this disease.

 leishmaniosis tasas vectores reservorios especies de cepa de leishmania leishmaniasis, rates vectors carriers species causing leishmania Ceballos E Cevallos L Burstein Z Galimberti R Pierini A Cervini A 2007 Historia de la dermatología en el Perú Historia de la Dermatología Latinoamericana Historia de la Dermatología Latinoamericana Tolouse Editions Privat Chan A Formas clínicas de leishmaniasis muco-cutáneas en Costa Rica y su diagnóstico diferencial Formas clínicas de leishmaniasis muco-cutáneas en Costa Rica y su diagnóstico diferencial Peña A Leishmaniosis tegumentaria en Costa Rica. Segundo Congreso Centro-americano Gaceta Médica de Caracas 1934 19 24 43 Zeledón R Chang K.P Bray R.S Leishmaniasis in north america, central america and the caribbean islands: Leishmaniasis 1985 Amsterdam^eNew York Elsevier. Publ Tuon F Amato V Graf M Machado A Nicodemo A Neto A Treatment of New World cutaneous lesihmaniais-a systematic review with a metaanalysis Int J Dermatol 2008 47 Jaramillo O Loría R Leishmaniasis en Costa Rica Normas Pediátricas Normas Pediátricas 1986 Editorial Universidad de Costa Rica Talhari S Talhari A Ferreira L Naiff R 1995 Leishmaniosis cutaneomucosa: Dermatología Tropical 1995 Leishmaniosis cutaneomucosa: Dermatología Tropical 1995 MEDSI Editora Médica e Cientifica Ltda Machado - Coelho G Caiaffa W Genaro O Magal AES Mayrink W 2005 Risk factors for mucosal manifestation on American cutaneous leishmaniasis Trans R Soc Trop Med Hyg 2005 99 A Schwartz E Hatz C Blum J 2006 New world cutaneous leishmaniasis in travelers Lancet Infect Dis 2006 6 Cardoso de Brito A Azulay D Azulay R Azulay R Azulay D Azulay Abulafia L Leishmaniosis y demás protozoonosis de interés dermatológico Dermatología Dermatología 2006 Cuarta Zeledón R Cosenza H Kroeger A Leishmaniasis en el Istmo Centroamericano e Islas del Caribe: Enfermedades parasitarias de mayor prevalencia y transmitidas por vectores en Centroamérica 1992 19 92 Zeledón R Hidalgo H Víquez A Atypical cutaneous leishmaniasis in a semiarid region of north-west Costa Rica Trans R Soc Trop Med Hyg 1989 83 Peraza J Urbina A Zeledón R Zymodeme and Serodeme Characterisation of Leishmania Isolates Obtained from Costa Rican Patients Mem. Inst. Osvaldo Cruz 1998 93 Río de Janeiro Passos VM Falcao AL Marzochi MC Epidemiological aspects of American cutaneous leishmaniais in a periurban area of the metropolitan region of Belo Horizonte: Minas Gerais. Brazil Mem. Inst. Oswaldo Cruz 1993 88 Bejarano EE Uribe S Rojas W Velez D Phlebotomine sand flies Diptera: Psichodidae, asociated with the appearance of urban leishmaniasis in the city of Sincelejo, Colombia Mem. Inst .Oswaldo Cruz 2002 97 Rojas J Zeledón R Murillo J Urbina A Walton B.C Wijeyaratne P.M Modabber F Identification of risk factor associated with cutaneous leishmaniasis in Costa Rica 1998 Ottawa International Development Research Centre Murillo J Zeledón R Flebótomos de Costa Rica (Diptera, Psychodidae ) Brenesia 1985 23 ^s137 Mata L Achí R Salas P Leishmaniasis tegumentaria americana en amerindios de Costa Rica Rev Med Hosp Nal Niños Costa Rica 1985 20 Echandi C Estudios sobre la sensibilidad cutánea en la leishmaniasis tegumentaria en Costa Rica Rev Biol Trop 1953 1 Oumeish Y Cutaneous Leishmaniasis: A historical perspective Clin Dermatol 1999 17 Soto J Arana B Toledo J Rizzo N Vega J Díaz A Gutiérrez P Luz M Arboleda M Berman J Junge K Engel J Sindermann H Miltefosine for new world cutaneous leishmaniasis CID 2004 38 Gayoso R Mendoca S Callahan H Portal A Grögl M Sensitivity of Leishmania braziliensis promastigotes to meglumine antimoniate (glucantime) is higher than that of other leishmania species and correlates with response to therapy in american tegumentary leishmaniasis J. Parasitol 2007 93 Oliveira-Netto M.P Schubach A Mattos M Goncalves-Costa C Pirmez C A low-dose antimony treatment in 159 patients with american cutaneous leishmaniasis: Extensive follow-up studies (up to 10 years) Amer J Trop Med Hyg 1997 56 Ponce C Ponce E Morrison A Cruz A Kreutzer R McMahon-Pratt D Neva F Leishmania donovani chagasi: new clinical variant of cutaneous leishmaniasis in Honduras The Lancet 1991 337 Convit J Ulrich M Pérez M Hung J Castillo J Rojas H Víquez A Araya L.N De Lima H Atypical cutaneous leishmaniasis in Central America: Possible interaction between infectious and environmental elements Trans R Soc Trop Med Hyg 2005 99 Carrillo J Chinchilla M Valverde B Porras O Mora L Visceral Leishmaniasis in Costa Rica: First case report Clin Infect Dis 1999 29 Mendoza L Podetti M Chavez F Zeledón R Visceral leishmaniasis in a dog introduced into Costa Rica Trans R Soc Trop Med Hyg 1983 77 Zeledón R McPherson B Ponce C Isolation of Leishmania braziliensis from a wildrodent in Costa Rica Am J Trop Med Hyg 1977 26 Zeledón R Murillo J Gutiérrez H Flebótomos antropófilos y leishmaniasis cutánea en Costa Rica Bol Of Sanit Panam 1985 99 Zeledón R Rojas J Castro R Schnur L Leishmaniasis - Vector biology and Control of Leishmaniais.MoS13-1 Abstracts XVI International Congress for Tropical Medicine and Malaria August 2025, 2000 Cartagena de Indias Hidalgo H Jaramillo O Contribución a la epidemiología de la leishmaniasis en Costa Rica Act Méd Costarric 1977 20 Dobles-Ulloa A Perriard C Representaciones, Actitudes y Prácticas Respecto a la Leishmaniasis Cutánea en la Población del Cantón de Acosta .Provincia de San José, Costa Rica: Estudio Antropológico Exploratorio Cad. Saúde Públ 1994 10 Río de Janeiro
S0001-600220090003 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022009000300008 Aislamiento de Candida spp. y otras levaduras en el personal que labora en áreas críticas del Hospital San Juan de Dios Isolation of Candida spp. and other yeasts from Health Care Workers in Critical Care Units of the San Juan de Dios Hospital Carrillo-Dover Pedro Álvarez-Vega Carolina Salas-Campos Ingrid Mora-Brenes Nury ,Universidad de Costa Rica Facultad de Microbiología Centro de Investigación en Enfermedades Tropicales ,Caja Costarricense de Seguro Social Hospital San Juan de Dios Laboratorio Clínico Dr. Clodomiro Picado Twigth 09 2009 2009 51 165 171

Justificación y objetivos: Los pacientes internados en hospitales, principalmente aquellos que se encuentran severamente enfermos, son más susceptibles a las infecciones por hongos oportunistas, en comparación con la población general. El personal hospitalario puede ser fuente potencial de infección para estos pacientes, ya que normalmente actúa como portador de gérmenes, que eventualmente podrían ser transmitidos a los pacientes. Se describe, en esta investigación, el aislamiento de hongos levaduriformes a partir de las manos y la cavidad oral, en un grupo de 77 trabajadores del Hospital San Juan de Dios, en servicios donde se han reportado más casos de infecciones por este tipo de hongos. Métodos: Se realizó un hisopado de cavidad oral y manos de cada participante y se cultivaron placas con agar glucosado de Sabouraud (AGS) y Mycosel. A los aislamientos de levaduras se les determinó la capacidad de crecimiento a 37°C, resistencia a la cicloheximida, producción de tubo germinativo, fosfolipasas y proteinasas y se determinó la sensibilidad in vitro al fluconazol por medio de método de microdilución en placa. Resultados: El 72,7% de los participantes resultaron positivos para el aislamiento de levaduras, la especie aislada con mayor frecuencia fue Candida parapsilosis, seguida de C. albicans y C. famata. La mayor positividad se obtuvo en el servicio de Cirugía 3 (83.3%), seguido de la UCI (71.4%) y Neonatología (58%). Conclusión: Estos resultados instan a mejorar las acciones preventivas en el manejo de los pacientes, a ser más estrictos en las normas de higiene de manos y promover, en otros centros hospitalarios, la realización de este tipo de estudios, para disminuir los brotes nosocomiales por transmisión horizontal.

Justification and aim: Critically ill patients are more susceptible than the general population to opportunistic fungal infections. Health workers could be a potential infectious focus to these patients. Thus in this investigation we report the isolation of yeast from the hands and oral cavity in a group of 77 employees of the San Juan de Dios Hospital from Services where infecctionsdue to these fungi had previously been reported. Methods: Samples from oral cavity and both hands were taken from 77 individuals. Each sample was platted into Sabouraud´s dextrose agar and Mycosel agar. Each yeast isolate was analyzed for growth capacity at 37°C, cycloheximide resistance, germ tube formation, phospholipase and proteinase production. Further, in vitro susceptibility testing of each isolate to fluconazol was performed using a microdilution method. Results: A 72.7% yeast positivity was found in all samples taken. Candida parapsilosis was the most frequent isolate, followed by C. albicans and C. famata. The ward with the greatest positivity was Surgery 3 (83.3%), followed by Intensive Care Unit (71.4%) and Neonatology (58%). Conclusion: These findings suggest that strict aseptic handling of patients should be observed to avoid horizontal transmission of yeasts in these wards. Similar studies should be conduced in others hospitals.

 Candida levaduras infección nosocomial proteinasas fosfolipasas transmisión horizontal Candida yeast nosocomial infection proteinases phospholipases horizontal transmission Hazen KC New and emerging yeast pathogens Clin Microbiol Rev 1995 8 Levy I Rubin LG Vasishtha S Tucci V Sood SK Emergence of Candida parapsilosis as the predominant species causing candidemia in children Clin Infect Dis 1998 26 Sota M Ezpeleta C Cisterna R Descripción de 165 episodios de fungemia de un estudio multicéntrico Rev Iberoam Micol 1999 16 Cantón E Viudes A Pemán J Infección sistémica nosocomial por levaduras Rev Iberoam Micol 2001 18 Ostrosky-Zeichner L New approaches to the risk of Candida in the intensive care unit Curr Opin Infect Dis 2003 16 Kaufman D Fungal infection in the very low birthweight infant Curr Opin Infect Dis 2004 17 Hajjeh RA Sofair AN Harrison LH Lyon GM Arthington-Skaggs BA Mirza SA Incidence of bloodstream infections due to Candida species and in vitro susceptibilities of isolates collected from 1998 to 2000 in a population-based active surveillance program J Clin Microbiol 2004 42 Morrell M Fraser VJ Kollef MH Delaying the empiric treatment of Candida bloodstream infection until positive blood culture results are obtained: a potential risk factor for hospital mortality Antimicrob Agents Chemother 2005 49 Garey KW Rege M Pai MP Mingo DE Suda KJ Turpin RS Time to initiation of fluconazole therapy impacts mortality in patients with candidemia: a multi-institutional study Clin Infect Dis 2006 43 Arenas R Micología Médica Ilustrada Micología Médica Ilustrada 2003 McGraw Hill Interamericana Editores S.A. de CV Strausbaugh LJ Sewell DL Ward TT Pfaller MA Heitzman T Tjoelker R High frequency of yeast carriage on hands of hospital personnel J Clin Microbiol 1994 32 Reagan DR Pfaller MA Hollis RJ Wenzel RP Evidence of nosocomial spread of Candida albicans causing bloodstream infection in a neonatal intensive care unit Diagn Microbiol Infect Dis 1995 21 Silva V Zepeda G Rybak ME Febré N Portación de levaduras en manos de estudiantes de Medicina Rev Iberoam Micol 2003 20 Caballero E Boza R González K Candidiasis sistémica - Experiencia en el Hospital San Juan de Dios 1996 - 1998 Rev Costarric Cienc Méd 1999 20 Campos M Herrera ML Marín JP Moya T Vargas A Especies de Candida en el Hospital Nacional de Niños 1995 - 2001 Rev Med Hosp Nac Niños (Costa Rica) 2003 38 Mora N Carrillo P Candidemia en el Hospital San Juan de Dios: casos del 2003 - 2005 Rev. Colegio de Microbiólogos y Químicos Clínicos de Costa Rica 2005 11 Ávila-Agüero ML Cañas-Coto A Ulloa-Gutiérrez R Caro MA Alfaro B Paris MM Risk factors for Candida infections in a neonatal intensive care unit in Costa Rica Int J Infect Dis 2005 9 Alfaro PM Relación entre el uso de catéteres venosos y septicemia en pacientes del Hospital San Juan de Dios Relación entre el uso de catéteres venosos y septicemia en pacientes del Hospital San Juan de Dios Orellana NG Importancia del desarrollo de septicemia con uso de catéteres venosos en pacientes del Hospital San Juan de Dios Importancia del desarrollo de septicemia con uso de catéteres venosos en pacientes del Hospital San Juan de Dios Mukherjee PK Chandra J Kuhn DM Ghannoum MA Differential expression of Candida albicans phospholipase B (PLB1) under various environmental and physiological conditions Microbiol 2003 149 Naglik JR Challacombe SJ Hube B Candida albicans secreted aspartyl proteinases in virulence and pathogenesis Microbiol Mol Biol Rev 2003 67 Williamson MI Samaranayake LP MacFarlane TW Phospholipase activity as a criterion for biotyping Candida albicans J Med Vet Mycol 1986 24 Ra TL Payne CD Comparative Production and Rapid Purification of Candida Acid Proteinase from Protein-Suplemented Cultures Infect Immun 1990 58 Method for determination of minimal inhibitory concentration (MIC) by broth dilution of fermentative yeasts: Discussion document E. Dis. 7.1 Method for determination of minimal inhibitory concentration (MIC) by broth dilution of fermentative yeasts: Discussion document E. Dis. 7.1 2002 Taufkirchen European Society of Clinical Microbiology and Infectious Diseases Hernández-Chavarría F Alvarado K Madrigal W Microorganismos presentes en el reverso de las uñas de trabajadores de la salud, Hospital Max Peralta, Cartago, Costa Rica Rev costarric cienc Méd 2003 24 Posteraro B Bruno S Boccia S Ruggiero A Sanguinetti M Spica VR Candida parapsilosis Bloodstream Infection in Pediatric Oncology Patients: Results of an Epidemiologic Investigation Infect Control Hosp Epidemiol 2004 25 Weems J Chamberland M Ward J Willy M Padhye A Solomon S Candida parapsilosis fungemia associated with parenteral nutrition and contaminated blood pressure transducers J Clin Microbiol 1987 25 Vázquez JA Dembry LM Sánchez V Vázquez MA Sobel JD Dmuchowski C Nosocomial Candida glabrata colonization: an epidemiologic study J Clin Microbiol 1998 36 Ibrahim AS Mirbod F Filler SG Banno Y Cole GT Kitajima Y Evidence implicating phospholipase as a virulence factor of Candida albicans Infect Immun 1995 63 Bennett DE McCreary CE Coleman DC Genetic characterization of a phospholipase C gene from Candida albicans: presence of homologous sequences in Candida species other than Candida albicans Microbiology 1998 144 Vidotto V Koga-Ito KY Milano R Fianchino B Pontón J Correlation between germ tube production, phospholipase activity and serotype distribution in Candida albicans Rev Iberoam Micol 1999 16 Ghannoum MA Potential role of phospholipases in virulence and fungal pathogenesis Clin Microbiol Rev 2000 13 Levenson D Pfaller MA Smith MA Hollis R Gerarden T Tucci CB Candida zeylanoides: another opportunistic yeast J Clin Microbiol 1991 29 Yoon SA Vázquez JA Steffan PE Sobel JD Akins RA Highfrequency, in vitro reversible switching of Candida lusitaniae clinical isolates from amphotericin B susceptibility to resistance Antimicrob Agents Chemother 1999 43 Leung AYH Chim CS Ho PL Cheng VCC Yuen KY Lie AKW Candida tropicalis fungemia in adult patients with haematological malignancies: clinical features and risk factors J Hosp Infect 2002 50 El-Tahawy ATA Khalaf RMF Rhodotorula rubra fungemia in an immunocompromised patient Ann Saudi Med 1999 19 Hsueh PR Teng LJ Ho SW Luh KT Catheter-related sepsis due to Rhodotorula glutinis J Clin Microbiol 2003 41 Hsueh PR Lau YJ Chuang YC Wan JH Huang WK Shyr JM Antifungal susceptibilities of clinical isolates of Candida species, Cryptococcus neoformans, and Aspergillus Species from Taiwan: surveillance of multicenter antimicrobial resistance in Taiwan program data from 2003 Antimicrob Agents Chemother 2005 49 White TC Marr KA Bowden RA Clinical, cellular and molecular factors that contribute to antifungal drug resistance Clin Microbiol Rev 1998 11 Lupetti A Tavanti A Davini P Ghelardi E Corsini V Merusi I Horizontal transmission of Candida parapsilosis candidemia in a neonatal intensive care unit J Clin Microbiol 2002 40 Kuhn DM Mukherjee PK Clark TA Pujol C Chandra J Hajjeh RA Candida parapsilosis characterization in an outbreak setting Emerg Infect Dis 2004 10
S0001-600220090003 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022009000300009 Shewanella algae en un paciente con diarrea crónica. Primer caso en Costa Rica Shewanella Algae in a Patient with Chronic Diarrhea. First Case in Costa Rica Molina- Guevara Erick Ureña- Romero Sofía Ramírez-Salas Alcira Oropeza-Barrios Gletty ,COOPESALUD R.L Clínica de Pavas ,INCIENSA Centro Nacional de Referencia de Bacteriología 09 2009 2009 51 172 174

Se presenta el caso de un paciente masculino, vecino de Pavas-San José, con historia de diarrea crónica. En el coprocultivo se identificó Shewanella algae. Casos de infección en humanos por esta bacteria son raros y se han encontrado, predominantemente localizadas, en piel, oídos y tejidos blandos con o sin bacteremia, en la mayoría de los cuales existe el antecedente de contacto con ambientes marinos. Shewanella algae es sensible a aminoglicósidos, carbapenemes, eritromicina y quinolonas, pero resistente a penicilinas. La sensibilidad a ampicilina y cefalosporinas es variable. Nuestro paciente fue tratado con cefalexina y tuvo una respuesta satisfactoria al mismo, con cese de los síntomas. De acuerdo con nuestro conocimiento este el primer caso documentado, en Costa Rica, de infección gastrointestinal por esta bacteria.

We report herein the case of a male patient, from Pavas, San Jose, with chronic diarrhea whose stool culture grew Shewanella algae. Infections caused by this micro-organism are infrequent and most commonly involve ears, skin and soft tissue, with or without bacteremia and are usually linked to ocean contact in warm climate countries. Shewanella algae is sensitive to aminoglycosides, carbapenems, erythromycin and quinolones, but resistant to penicillin. Sensitivity to amplicilin and cephalosporins is variable. Our patient was treated with cefalexin, with satisfactory results. To our knowledge, this is the first documented case in Costa Rica of gastrointestinal infection caused by this microorganism.

 Shewanella algae diarrea Pavas Shewanella algae diarrhea Pavas Holt HM Gahrn-Hansen B Bruun B Shewanella algae and Shewanella putrefaciens: clinical and microbiological characteristics Clinical Microbiol Infect 2005 11 Richards GP Watson MA Crane EJ Bushek D Burt I Shewanella and Photo bacterium in oysters and seawater from the Delaware Bay Applied and Enviromental Microbiology 2008 74 Jorens P Goovaerts K Leven M Shewanella putrefaciens isolated in a case of ventilator associated pneumonia Respiraton 2004 71 Dominguez H Fonnesbech B Gram L Hoffman S Shaebel S Shewanella algae bacteremia in two patients with lower leg ulcers Clin Infect Dis 1996 22 Vargas J V Bustamante W Mordedura de tortuga marina con infección concomitante por Shewanella putrefasciens (Pseudomonadales: Vibrionaceae): Reporte del primer caso humano en Costa Rica Rev Med Hosp Nac Niños 1996 31 Butt A Figueroa J Martin D Ocular infection caused by three unusual marine organisms Clin Infect Dis 1997 24 Paccalin M Grollier G Le Moal G Rayeh F Camiade C Rupture of a primary aortic aneurysm infected with Shewanella alga Scand J Infect Dis 2001 33 Botelho Nevers E Gouriet F Roverty C Paris P Roux V Raoult D Brouqui P First case of ostemyelitis due to Shewanella algae J Clin Microbiol 2005 43 Pagniez H Berche P Opportunistic infections caused by Shewanella, new emergent bacteria Med.Mal infect 2005 35 Agvald-Ohman C Wernerman J Nord CE Edlund C Anaerobic bacteria commonly colonize the lower airways of intube ICU patients Clin Microbiol Infect 2003 9 Iwata M Tateda K Matsumoto T Furuya N Mizuiri S Yamaguchi K Primary Shewanella algae septicemia in patient with hemodyalisis J Clin Microbiol 1999 37 Mira Gutierrez J García Martos P Vibrios de origen marino en patología humana Enfermedades Infecciosas y Microbiología Clínica Agos to -S 15 7 Huss H Aseguramiento de la calidad de productos pesqueros: Fao Documento técnico de pesca .N° 334 Aseguramiento de la calidad de productos pesqueros: Fao Documento técnico de pesca .N° 334 1997 Aw D Silva A Palmer D Immunosenescence: emerging challenges for an ageing population Immulogy 2007 120 Htwe TH Mushtaq A Robinson SB Rosher RB Kardori N Infection in the elderly Infect Dis Clin North Am 2007 21 Derhovanessian E Solana R Larbi A Pawelec G Immun Ageing 2008 5 Khashe S Janda JM Biochemical and pathogenic properties of Shewanella alga and Shewanella putrefaciens J Clin Microbiol 1998 36
S0001-600220090003 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022009000300010 Sepsis neonatal por Estreptococos Pyogenes Neonatal Sepsis by Streptococcus pyogenes Rodríguez-Herrera Gilberto Ramírez-Navarro Cinthya ,Hospital Nacional de Niños Dr. Carlos Sáenz Herrera Servicio de Neonatología 09 2009 2009 51 175 178

Se presenta el caso de un paciente masculino, recién nacido a término adecuado para la edad gestacional, quien nace por parto vaginal, con el antecedente de fiebre en la madre durante el periodo de postparto inmediato. Los padres consultan a los 2 días de vida pues le notan dificultad respiratoria, hipoactividad y rechazo a la leche materna. El paciente se interna y se aborda como una sepsis. Durante su estancia en el servicio de neonatología del Hospital Nacional de Niños asocia fallo respiratorio que amerita ventilación mecánica asistida por varios días en diferentes ocasiones, derrame pleural exudativo, convulsiones de origen hipóxico isquémico. Con reporte de hemocultivos positivos por Estreptococos pyogenes. El Estreptococos pyogenes o estreptococo β-hemolνtico del grupo A, fue un problema en los comienzos del siglo pasado, siendo frecuente en las infecciones puerperales y del reciιn nacido. En la actualidad es un germen sumamente raro en los procesos de sepsis neonatal.2 La gravedad de la enfermedad causada por este microorganismo en el periodo neonatal varνa desde una onfalitis crónica de bajo grado a una septicemia, una meningitis fulminante y la muerte.1 El presente artículo pretende hacer un resumen del paciente, con su evolución clínica, radiológica y además ejemplificar todas las complicaciones que tuvimos con este germen tan poco frecuente en la actualidad en sepsis neonatal.

We present herein the case of a newborn patient of appropriate gestational age weight ( 3700 grams), born by vaginal delivery, from a mother that had had 2 previous pregnancies (2 normal deliveries). During the immediate puerperium she had fever. The parents consulted at the age of 2 days, stating that they had noticed difficult breathing since his birth, hipoactivity and poor appetite. He was admitted to the hospital and underwent several studies searching for the origin and germ causing the sepsis. He developed respiratory failure and needed mechanical ventilation for several days on different occasions. He had exudative pleural effusion and hypoxic ischemic seizures. Later on, his blood cultures were positive for Streptococcus pyogenes. Streptococcus pyogenes or Streptococcus β- hemolytic group A infection, used to be a common entity in the beginning of the past century, it was commonly associated with puerperal infections and newborn infections, but its incidence declined and nowadays, is uncommon during the neonatal period. Its clinical manifestations could vary from chronic omphalitis up to a low grade septicemia or fulminant meningitis. Since its incidence has declined, at the present time; is an unusual infection of the neonatal period. Ampicillin and gentamicin are currently recommended as first-line antimicrobials, ampicillin replacing the previously recommended penicillin.

 estreptococos del grupo A neonatos fiebre puerperal sepsis neonatal Streptococcus pyogenes neonates puerperal fever neonatal sepsis William H. T Ballard R.A Tratado de neonatologia Avery Tratado de neonatologia Avery 2000 Sétima McGraw Hill Bizarro M J Raskind C Baltimore R. S Gallagher P.G Seventy years of neonatal sepsis at Yale Pediatrics 1928 -2 116 Osrin D Vergnano S Costello A Serious bacterial infections in newborn infants in developing countries Current Opinion infect disease 2004 17 Miyari I Berlingieri D Protic J Belko J Neonatal invasive group A streptococcal disease: case report and review Pediatric Infectologic Dissease J 2004 23 Pickering L. K Backer C.J Doventurf G Prober C.G Enfermedades infecciosas en pediatría Enfermedades infecciosas en pediatría 26 Verboon-Maciotek M.A Krechet T.G Van Ertbruggent I Gerardo L. J Fleer A Severe neonatal group A streptococcal disease Eur. J. Pediatr 2000 159 Greenberg D Leibovitz E Shinnwell E Yagupsky P Dagan R Neonatal sepsis caused by streptococcus pyogenes: Resurgence of an old etiology The Pediatric Infectious Disease 1999 18 Díaz M Síndrome de Shock toxico neonatal por estreptococos pyogenes Rev Chilena Infectol 2007 24 Schrag S Schuchat P Prevention of Neonatal Sepsis Clin Perinatol 2005 32 Remington J Klein J O Wilson C Infectious Diseases of the fetus and newborn infant Infectious Diseases of the fetus and newborn infant 2006 6ta Elsevier Gerdes J Diagnosis and management of bacterial infections in the neonate Pediatr Clin N Am 2004 51 Thaarup J Sellerman- Ericksen J Stjernholm Neonatal pleural empyema with group A streptococcus Acta Paediatr 1997 86
S0001-600220090003 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022009000300011 Jaramillo Antillón Juan , 09 2009 2009 51 171 178
S0001-600220090003 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022009000300012 , 09 2009 2009 51 179 179