S0253-294819980003 Revista Costarricense de Ciencias Médicas Rev. costarric. cienc. méd 0253-2948 Editorial Nacional de Salud y Seguridad Social S0253-29481998000300001 A nuestros lectores , 12 1998 1998 19 143 143
S0253-294819980003 Revista Costarricense de Ciencias Médicas Rev. costarric. cienc. méd 0253-2948 Editorial Nacional de Salud y Seguridad Social S0253-29481998000300002 Leptospira interrogans: primeros aislamientos de humanos en Costa Rica García Jiménez Ricardo Bustamante García Warner Villalobos Bastos Silvia Marín Noguera María Auxiliadora ,Hospital de Ciudad Neily Laboratorio Clínico Costa Rica 12 1998 1998 19 147 154

La leptospirosis es una zoonosis que puede causar un amplio espectro de manifestaciones clínicas en humanos. Puede ser difícil orientar el diagnóstico, si no se toma en cuenta en el diagnóstico diferencial de los cuadros febriles agudos. Se requiere además, de técnicas especiales para obtener un diagnóstico microbiológico. Dado que en el Hospital de Ciudad Neily (HCN) son frecuentes los casos de pacientes con diagnóstico de cuadro febril agudo sin causa determinada y teniendo en cuenta el antecedente de una epidemia surgida en octubre de 1988 en Ciudad Cortés, donde el diagnóstico presuntivo de leptospirosis se estableció mediante datos clínicos y serológicos, nos propusimos aislar el agente etiológico para confirmar la existencia de infecciones por Leptospira interrogans en seres humanos, esclarecer el diagnóstico de algunas de estas fiebres agudas y obtener serovares autóctonos para futuras investigaciones. En el período comprendido entre junio de 1995 y junio de 1996, se realizaron 228 hemocultivos por Leptospira sp en pacientes con cuadros febriles agudos, los cuales consultaron el Servicio de Emergencias Médicas del HCN; se obtuvieron 6 aislamientos (2,6%) identificados como Leptospira interrogans, tres de pacientes varones, dos de mujeres y uno que por error en la identificación del cultivo no se pudo conocer su procedencia. Todos los aislamientos se obtuvieron entre los meses de julio a setiembre de 1995, coincidiendo con la época de mayor precipitación pluvial en la Región del Pacífico Sur del país. Se hace una breve descripción de los casos y finalmente se discute la importancia de obtener cepas autóctonas para la investigación y el desarrollo de métodos alternos de diagnóstico más oportunos, sensibles y específicos.

This summary reports the main findings of an attempt to isolate Leptospira interrogans in blood in febrile patients at the Hospital de Ciudad Neily in Costa Rica during 1995 and 1996. Leptospirosis is an spirochaetal zoonosis that may cause wide clinical variation in humans. Early detection can be delayed if the disease is not suspected in acute febrile episodes. Also, bacterial diagnosis requieres specialized diagnostic procedures. Before this study, an epidemic of leptospirosis was observed in a neraby geographical area. During this epidemic period the diagnosis was established by clinical and serological methods. After that experience we decided to search and isolate the bacteria in human blood samples. To improve the posibilities we selected acute febrile patients with different conditions. During a 12 month period (from July 1995 to June 1996) 228 hemocultures were done. Among these 228, six positive blood cultures were obtained and identified as Leptospira interrogans. The blood samples of these cases were obtained during the period from July to September of 1995. Three cases were males, two females. In one case the sex was not registered. The period of isolation corresponds to the period of heavy precipitation in this part of the country. Two of the samples underwent further analysis at the Institute of Tropical Medicine in Holland. Both correspond to Sejroe group. The bacteriological methods are described in detail.

 Leptospira interrogans leptospirosis aislamiento en humanos Leptospira interrogans Leptospirosis Culture isolation in humans Myer D M. Leptospirosis Leptospirosis 1985 OPS/OMS Faine S. Leptospira and leptospirosis Leptospira and leptospirosis 1994 CRC Press, Inc Lennette E. Spaulding E. Truant J. Manual of Clinical Microbiology Manual of Clinical Microbiology 1974 2 Editorial Board Wesley R. Leptospirosis Clin Infect Dis 1995 21 Boza R. Leptospirosis anictérica: análisis de una epidemia en Costa Rica Acta Méd Cost 1990 33 2 Mazonelli J. Dorta G. Mailloux M Recherche sur les antigenes des Leptospires Tropenmed Parasit 1975 26 Cura E. Wendel S. Manual de procedimientos de control de calidad para los laboratorios de serología de los bancos de sangre Manual de procedimientos de control de calidad para los laboratorios de serología de los bancos de sangre 1994 OPS Bal E. Gravekamp C. Hartskeerl R. De Meza-Brewster J. Korver H. Terpstra W. Detection of Leptospires in Urine by PCR for Early Diagnosis of Leptospiros J Clin Microb 1994 32 Appassakij H. Silpapojakul K. Wansit R. Woodtayakorn J. Evaluation of the Inmunofluorescent Antibody Test for the Diagnosis of Human Leptospirosis Am J Trop Med Hyg 1995 52 Aritsu Y. Kmety E. Evaluation of the one-point microcapsule aglutination test for diagnosis of leptospirosis Bul WHO 1994 72
S0253-294819980003 Revista Costarricense de Ciencias Médicas Rev. costarric. cienc. méd 0253-2948 Editorial Nacional de Salud y Seguridad Social S0253-29481998000300003 Resultados de un programa de estandarización interlaboratorios y evaluación externa de la calidad para el perfil lipídico en Costa Rica Vargas Picado Marco Antonio Vargas Umaña Marianela Astua Vega Jorge ,Intituto Costarricense de Investigación y Enseñanza en Nutrición y Salud (INCIENSA) Laboratorio de Bioquímica Tres Ríos Costa Rica ,Universidad de Costa Rica Departamento de Análisis Clínicos San José Costa Rica 12 1998 1998 19 155 162

Se evaluó la variabilidad interlaboratorio de los parámetros séricos involucrados en el perfil lipídico: colesterol total, triglicéridos y colesterol-HDL, a un grupo de 32 laboratorios en el área metropolitana en Costa Rica. Para ello se prepararon materiales control de suero humano y se distribuyeron durante cinco encuestas realizadas entre marzo de 1995 y abril de 1996. En las primeras cuatro encuestas se utilizó sueros congelados y en la quinta encuesta suero liofilizado. Los coeficientes de variación promedio observados para cada parámetro evaluado y su ámbito fueron 7,2% (5,5-8,5%) para colesterol, 11,2% (9,7-12,1%) para triglicéridos y 20% (14,9-25,0%) para colesterol-HDL. La variación máxima (error total) permitida para considerar el desempeño adecuado fue igual o menos de 9% para colesterol total,15% para triglicéridos y 22% para colesterol-HDL. El porcentaje de laboratorios participantes que cumplieron con este criterio fue en promedio de 68,4%, 69,3% y 70,6% para cada parámetro respectivamente. Ello revela que aproximadamente el 30% de los laboratorios participantes requieren mejorar su desempeño analítico en los parámetros séricos del perfil lipídico.

The interlaboratory variability of serum parameters related to the lipid profile (total cholesterol, triglycerides and HDL-cholesterol) was evaluated in a group of 32 laboratories in Costa Rica. For that purpose human serum based control materials were prepared and distributed through five surveys performed between March 1995 and April 1996.Frozen serum was used for the first four surveys and liophylized serum for the fifth one. The average coefficients of variation and intervals observed for each parameter were 7,2% (5,5-8,5%) for cholesterol, 11,2% (9,7-12,1%) for triglycerides and 20,0% (14,9-25,0%) for HDL-cholesterol. The maximun variability (total error) allowed to consider aceptable the laboratory performance was equal or less than 5% for total cholesterol, 15% for triglycerides and 22% for HDL-cholesterol. The average percentage of laboratories meeting this criteria was 68,4%, 69,3% and 70,6% for each parameter respectively.This indicated that around 30% of the participating laboratories need to improve their analitical performance in the analysis involved in lipid profile.

 total cholesterol triglycerides HDL-cholesterol proficiency testing standardization lipid profile Jiménez J.G Castro V. J Díaz W G; Valverde P Díaz G Colesterol y triglicéridos en la población costarricense:. Interpretación de los resultados obtenidos en la encuesta Nacional de Nutrición de 1982 Rev Cost Cienc Med. 1987 8 2 Resumen del segundo informe del Panel de Expertos sobre detección, evaluación y tratamiento de la hipercolesterolemia en adultos del Programa Nacional de Educación sobre Colesterol (NCEP): (Panel II sobre tratamiento en adultos) JAMA 1993 269 Warnick R Wood P. National Cholesterol Education Program Recomendations for Measurement of High-Density Lipoprotein Cholesterol: Executive Summary Clin Chem 1995 3 Reaven G. ¿Los triglicéridos como factor de riesgo de enfermedad coronaria? Heart Disease and Stroke (en español). 1995 3 Bachorik PS Ross JW National Cholesterol Educatiosn Program Recommendations for Measurements of Low-Density Lipoprotein Clin Chem. 1995 41 Stein EA Myer GL National Cholesterol Education Program Recommendations for measurement of triglycerides Clin Chem 1995 41 McNamara J Cohn J S Wilson P. W. Schaefer E. J. Calculated values for Low-density cholesterol in the assesment of lipid abnormalities and coronary disease risk. Clin. Chem 1990 36 Vargas M León D Orlich J Schosinsky K Variabilidad interlaboratorio en Química Clínica en un grupo de laboratorios clínicos costarricenses Rev Cost. Cien. Med. 1989 10 Hainline A Karon J Lippel K Manual of Laboratory Operations: Lipid Research Clinics Program Lipid and Lipoprotein Analysis Manual of Laboratory Operations: Lipid Research Clinics Program Lipid and Lipoprotein Analysis 1982 2do De. U.S.Department of Health and Human Services Naito H. Kaplan LA Pesce Amadeo J. Cholesterol Clinical Chemistry.: Theory, analysis and correlation Clinical Chemistry.: Theory, analysis and correlation 1989 St. Louis 2do Ed. CV Mosby Co Naito Kaplan LA Pesce Amadeo J. Triglycerides Clinical Chemistry: Theory, analysis and correlation Clinical Chemistry: Theory, analysis and correlation 1989 St. Louis 2do Ed. CV Mosby Co Naito H. Kaplan LA Pesce Amadeo J. High-density lipoprotein (HDL) cholesterol Clinical Chemistry: Theory, analysis and correlation Clinical Chemistry: Theory, analysis and correlation 1989 St. Louis 2do Ed..CV Mosby Co Myers G. L Cooper G.R. Sampson E.J. Traditional lipoprotein profile: clinical utility , perfomance requirements and standardization Atherosclerosis 1994 ^s108 Schosinsky K. Chavarría A. Jiménez M. Holst I. Vargas M. Manual de Técnicas de Laboratorio en Química Clínica Manual de Técnicas de Laboratorio en Química Clínica 1997 10 Oficina de Publicaciones de la Universidad de Costa Rica Cooper G. R. Interlaboratory testing of the transferability of a candidate reference method for total cholesterol in serum Clin Chem 1986 32 6 Hainline A. Karon J. M. Winn C. L. Gill J.B. Accuracy and Comparability of long-term meassurements of cholesterol Clin Chem 1986 32 4 Whitehead T.P Woodford F.P. External quality assesment of clincal laboratories in the United Kingdom J Clin. Path. 1981 34 Naito HK Kwak YS Hartfield JL Matrix effects on proficiency testing materials.: Impact on accurancy of cholesterol measurement in laboratories in the Nation`s largest hospital system Arch Pathol Lab Med. 1993 117 Ross JW Myers GL Gilmore BF Matrix Effects and the accuracy of Cholesterol analysis Arch Pathol Lab Med. 1993 117 McQueen MJ Henderson RA Patten RL Results of a Province Wide Quality Assurance program Assessing the Accuracy of Cholesterol, Triglycerides, and High-Density Lipoprotein Cholesterol Measurements and calculated Low-Density Lipoprotein Cholesterol in Ontario, Using Fresh Human Serum Arch Pathol Lab Med. 1991 115 Stein E A Myers G L. Burtis CA Ashwood ER Lipids, Lipoproteins and Apolipoporteins Tietz Textbook of Clinical Chemistry. Tietz Textbook of Clinical Chemistry. 1994 2do Ed.WB Saunders Co
S0253-294819980003 Revista Costarricense de Ciencias Médicas Rev. costarric. cienc. méd 0253-2948 Editorial Nacional de Salud y Seguridad Social S0253-29481998000300004 Análisis farmacocinético del Loracepam en hombres y mujeres Sáenz-Campos Desirée Parra B. Pilar Barbanoj R. Manel J. ,Universidad de Costa Rica Departamento de Farmacología y Toxicología Clínica ,Hospital de la Santa Cruz y San Pablo (HSCSP) Laboratorio de Cromatografía Barcelona ,Hospital de la Santa Cruz y San Pablo (HSCSP) Area de Investigación Farmacológica 12 1998 1998 19 163 169

Los informes de la evaluación cinética de los medicamentos desarrollados en los últimos 20 años documentan, prioritariamente, los resultados de ensayos realizados exclusivamente con varones; o bien, con muestras mixtas pero cuyos resultados no se reagrupan ni analizan por la variable sexo. El objetivo de este ensayo fue evaluar la influencia del sexo en el comportamiento farmacocinético de una benzodiacepina (loracepam) en sujetos sanos. Se administró una dosis oral de 2 mg de loracepam (LOR) a 7 varones (V) y 8 mujeres (M) sanos; se extrajeron muestras sanguíneas antes y después de la administración del fármaco a diferentes tiempos; se cuantificaron las concentraciones plasmáticas (Cp) con HPLC y para cada sujeto se calculó sus parámetros cinéticos. Los resultados mostraron que la concentración máxima (C MAX) fue de ± 19.66 ng/mL (V= 16.28 ± 2.51 ng/mL, M= 23.04 ± 6.12 ng/mL), los tiempos para alcanzar C MAX (tMAX) oscilaron entre 1h (n= 7, V=3, M= 4) y 1,5 hs (n= 4, V= 2, M= 2). El tiempo de vida media (t1/2) de eliminación fue de 11.33 hs (V= 11.98 ± 2.39 hs, M= 10.68 ± 2.69 hs) y el Area Bajo la Curva de 0 a 48 hs (ABC0-48) alcanzó una magnitud de 199,46 ng/mL·h (V= 168.36 ± 28.09 ng/mL·h, M= 230.57 ± 100.38 ng/mL·h). A partir de +1h las Cp resultaron más elevadas en mujeres, siendo significativamente mayor a +1.5hs (V= 14.69 ng/mL, M= 19.18 ng/mL; p= 0.033) pero los diferentes parámetros evaluados no se diferenciaron en función del sexo. Todos los sujetos mostraron una buena tolerabilidad al fármaco. En conclusión, se registra una tendencia a la diferenciación en la farmacocinética del LOR atribuible al factor sexo, pero es necesaria la realización de ensayos con muestras de mayor tamaño para establecer una diferenciación real y significativa. Es procedente realizar análisis cinéticos con los diversos medicamentos para explorar y describir posibles diferencias cinéticas atribuibles al sexo y analizar su repercusión clínica.

Pharmacokinetic evaluation of new drugs during the last 20 years presents results of clinical trials performed with males or both sex samples without sex-related description and analysis. The aim of this trial was to investigate the sex-related pharmacokinetic differences of benzodiazepina (lorazepam) in healthy subjects of both sexes. A single oral dose of lorazepam 2 mg was administred 7 males (M) and 8 females (F). Blood samples to assess lorazepam plasma concentration by HPLC were obtained before and at different times following drug intake. Kinetic parameters were calculated for each subject. Peak levels (C MAX) were 19,66 ng/mL (M= 16,28 ±2,51 ng/mL, F= 23.04 ±6.12 ng/mL). The time to reach maximum concentration (tMAX) was between 1h (n= 7; M= 3, F= 4) and 1,5 hs (n= 4; M= 2, F=2). The biological elimination half-life (t1/2) was 11,33 hs (M= 11.98 ±2.39 hs, F= 10.68 ±2,69 hs) and the Area Under the concentration-time Curve 0 to 48 hs (AUC0-48) reached a maximum of 199,46 ng/mL·h (M= 168,36 ±28,09 ng/mL·h, F= 230,57 ±100,38 ng/mL·h). At +1h females showed higher values than males, significant differences in lorazepam levels were observed only at +1.5hs (M= 14,69 ng/mL, F= 19,18 ng/mL, p= 0,033) but no significant differences was obtained when comparing pharmacokinetic parameters by sex. Lorazepam was well tolerated by all subjects. In conclusions, the analysis of pharmacokinetic parameters by sex with lorazepam showed as light variation, new trials with larger samples must be made to determine whether or not the pharmacokinetic profile is sex-dependent. The perfomance of clinical trials to evaluate sex-related differences is very important to help optimize clinical use and drug prescription.

 loracepam farmacocinética diferencias por sexo lorazepam pharmacokinetics sex-related differences healthy subjects Levey BA. Bridging the gender gap in research Clin Pharmacol Ther 1991 50 Rosser SV. Gender bias in clinical research and the difference it makes Appl Clin Trials 1993 2 Yonkers KA Harrison W. The inclusion of women in psychophar-macologic trials J Clin Psychopharmacol 1993 13 Yonkers KA Kando J Cole JO Blumenthal S. Gender differences in human pharmacokinetics and pharmacodynamics of psychotropic medication Am J Psychiatry 1992 149 Gallant D Krinsky SL. Prien RF Robinson DS Ethical and legal considerations in drug trials Clinical evaluation of psychotropic drugs: principles and guidelines Clinical evaluation of psychotropic drugs: principles and guidelines 1994 New York Raven Press Lentner C. Body mass and height of adults 1984 vol 3 Basle: International Medical and Phamaceutical Information Ciba-Geigy Limited Shumaker RC. PKcalc a basic interactive computer program for statistical and pharmacokinetic analysis of data Drug Metab Rev 1986 17 Greenblatt DJ Shader RI Franke K Pharmacokinetics and bioavailability of intravenous, intramuscular and oral lorazepam in humans J Pharmaceut Sci 1979 68 Klotz U Kangas L Kanto J. Clinical pharmacokinetics of benzodiazepines (lorazepam) Progress Pharmacol 1980 3 Bourin M. Pharmacocinétique des benzodiacépines Les benzodiacépines, de la pharmacocinétique á la dependence Les benzodiacépines, de la pharmacocinétique á la dependence 1989 2éme édition Paris Ellipses Abernethy DR Greenblatt DJ. Drug disposition in obese humans: An update Clin Pharmacokinet 1986 11 Herrman RJ VanPham JD Szakacs CBN. Disposition of lorazepam in humans beings: enterohepatic recirculation and first-pass effects Clin Pharmacol Ther 1989 46 Feely M Pullar T. Hindmarch I Beaumont G Brandon S Leonard BE Pharmacokinetic differences between benzodiazepines Benzodiazepines, current concepts Benzodiazepines, current concepts 1990 John Wiley & Sons Ltd. Kirkwood C Moore A Hayes P DeVane L Pelonero A. Influence of menstrual cycle and gender on alprazolam pharmacokinetics Clin Pharmacol Ther 1991 50 Sáenz-Campos D Bayés MC Martín S Gender related pharmacokinetics od diltiazem in healthy subjects Int J Clin Pharmacol Ther 1995 33 Sáenz-Campos D Bayés MC Massana E Sex-related pharmacokinetic and pharmacodynamic variation of lisinopril Meth Find Exp Clin Pharmacol 1996 18 Boni JP DeCleene ShA Cevallos WH Hicks DR Korth-Bradley JM. Effects of age and grender on the pharmacokinetics of bromfenac in healthy volunteers Ann Pharmacother 1997 31
S0253-294819980003 Revista Costarricense de Ciencias Médicas Rev. costarric. cienc. méd 0253-2948 Editorial Nacional de Salud y Seguridad Social S0253-29481998000300005 La madre adicta a la cocaína y el producto de su embarazo Celada-Quezada Rolando , 12 1998 1998 19 170 176

La adicción a la cocaína va en aumento en Costa Rica, la población femenina en edad reproductiva resulta una de sus víctimas lo mismo que el producto de los embarazos de esas madres. En el presente trabajo se describe la incidencia de nacimientos de hijos de madres adictas a cocaína en el hospital San Juan de Dios durante el año 1994, la que resulta ser de cuatro por mil nacimientos. Se describen los antecedentes obstétricos y sociales de las madres adictas y se comparan esos antecedentes con un grupo control constituido por 120 pacientes recién nacidos internados por otras causas en el servicio de neonatología del hospital San Juan de Dios. Los hallazgos permiten caracterizar las madres adictas a la cocaína como de bajo nivel socioeconómico, con una historia obstétrica con mayor número de embarazos y una mayor proporción de abortos, así como con bajo nivel de control prenatal. Los hijos de madres adictas se caracterizan por presentar una alta proporción de bajo peso al nacer (40%), menor talla y circunferencia cefálica, así como una mayor prevalencia de malformaciones congénitas, una mayor incidencia de sífilis congénita, y finalmente una estancia hospitalaria que es del doble que la de los controles.

Cocaine addiction is increasing in Costa Rica. The female population in fertile age is one of the targets of the increasing addiction to cocaine as are the products of their pregnancies. This study describes the incidence of babies born of cocaine addict mothers who deliverad at San Juan de Dios Hospital during 1994. The incidence was four per thousand new born. The obstetric history and social background of cocaine addicted mothers are compared with the obstetric history and social background of a control group composed of neonates hospitalized for other reasons. Results describe the profile of cocaine addicted mothers as pertaining to a low socioeconomic status, with an obstetric history of higher number of pregnancies and a high rate of miscarriages, as well as a very low level of prenatal care. The newborn from addicted mothers present a high rate of low birth weight (40%), are shorter and have smaller head circumference than the controls. They also present a greater prevalence of birth anomalies increasing hospital stays to double the controls.

 Cocaína malformaciones congénitas sífilis congénita tiempo de internamiento bajo peso al nacer factores de riesgo cocaine congenital anomalies syphilis congenital length of stay low birth weight risk factors Goodman A Goodman LS Rall TW Murad F Las bases farmacológicas de la terapeútica Las bases farmacológicas de la terapeútica 1988 Séptima edición Buenos Aires Editorial Médica Panamericana Coleman FS Kay J Biology of addiction Obstet Gynecol Clin North Am 1998 25 Bandstra ES Burkerr G Maternal-fetal and neonatal effects of in utero cocaine exposure Seminars in Perinatology 1991 15 Frank DA Zuckerman BS Amaro H Cocaine use during pregnancy: Prevalence and correlates Pediatrics 1988 82 Zuckerman B Frank DA Hingson R Effects of maternal marijuana an cocaine on fetal growth N Engl J Med 1989 320 Plessinger MA Woods JR Cocaine and pregancy: Recent data on maternal and fetal risks Obstet Gynecol Clin 1988 25 Ryan RM Wagner CL Schulz JM Meconium analisys improves identification of intrauterine cocaine exposed infants J Pediatr 1991 88 Burkett G Gomez Marín O Yasin SY Martinez M Prenatal care in cocaine exposed pregancies. Obstet Gynecol 1998 92 Chasnoff IJ Burns WJ Schnoll SH Cocaine use in pregnancy N Engl J Med 1985 313 Khalsa Jh Gfroerer J. Epidemiology and health consequences of drug abuse among pregnant women Seminars in Perinatology 1991 15 Bejarano J Abuso de drogas: Características de consumo y algunos aspectos psicológicos asociados Abuso de drogas: Características de consumo y algunos aspectos psicológicos asociados 1994 Departamento de Investigación. IAFA Estadísticas del servicio de recién nacidos del hospital San Juan de Dios Estadísticas del servicio de recién nacidos del hospital San Juan de Dios Monga M Weisbrodt NW Adres RL The acute effect of cocaine exposure on pregnant human myometrial contractile activity Am J Obstet Gynecol 1993 169 Zuckerman B Frank DA Higson R Effects of maternal marihuana and cocaine on fetal growth N Engl J Med 1989 320 Frank DA Bauchner H Parker S Neonatal body proportionality and body composition after in utero exposure to cocaine and Marihuana J Pediatr 1990 117 Dixon SD Bejar R Echoencephalografic findings in neonates associated with maternal cocaine and methanphetamine use: Incidence and clinical correlates J Pediatr 1989 115 Trounce JQ Fagan D Levene MI Intraventricular haemorrage and periventricular Leukomalacia: Ultrasound and autopsy correlation Arch Dis Child 1986 61 Minkoff HL McCalla S Delke I The relationship of cocaine use to syphillis and human immunodeficiency virus infectious among inner city parturient women Am J Obstet Gynecol 1990 163 Goodman A Goodman LS Rall TW Murad F Las bases farmacológicas de la terapeútica Las bases farmacológicas de la terapeútica 1988 Séptima Buenos Aires Editorial Médica Panamericana Coleman FS Kay J Biology of addiction Obstet Gynecol Clin North Am 1998 25 Bandstra ES Burkerr G Maternal-fetal and neonatal effects of in utero cocaine exposure Seminars in Perinatology 1991 15 Frank DA Zuckerman BS Amaro H Cocaine use during pregnancy: Prevalence and correlates Pediatrics 1988 82 Zuckerman B Frank DA Hingson R Effects of maternal marijuana an cocaine on fetal growth N Engl J Med 1989 320 Plessinger MA Woods JR Cocaine and pregancy: Recent data on maternal and fetal risks Obstet Gynecol Clin NA 1988 25 Ryan RM Wagner CL Schulz JM Meconium analysisimproves identification of intrauterine cocaine exposed infants J Pediatr 1991 88 Burkett G Gomez Marín O Yasin SY Martinez M Prenatal care in cocaine exposed pregancies Obstet Gynecol 1998 92 Chasnoff IJ Burns WJ Schnoll SH Cocaine use in pregnancy N Engl J Med 1985 313 Khalsa Jh Gfroerer J Epidemiology and health consequences of drug abuse among pregnant women Seminars in Perinatology 1991 15 Bejarano J Abuso de drogas. Características de consumo y algunos aspectos psicológicos asociados Abuso de drogas. Características de consumo y algunos aspectos psicológicos asociados 1994 Departamento de Investigación. IAFA Estadísticas del servicio de recién nacidos del hospital San Juan de Dios Estadísticas del servicio de recién nacidos del hospital San Juan de Dios Monga M Weisbrodt NW Adres RL The acute effect of cocaine exposure on pregnant human myometrial contractile activity Am J Obstet Gynecol 1993 169 Zuckerman B Frank DA Higson R Effects of maternal marihuana and cocaine on fetal growth N Engl J Med 1989 320 Frank DA Bauchner H Parker S Neonatal body proportionality and body composition after in utero exposure to cocaine and Marihuana J Pediatr 1990 117 Dixon SD Bejar R Echoencephalografic findings in neonates associated with maternal cocaine and methanphetamine use: Incidence and clinical correlates J Pediatr 1989 115 Trounce JQ Fagan D Levene MI Intraventricular haemorrage and periventricular Leukomalacia: Ultrasound and autopsy correlation Arch Dis Child 1986 61 Minkoff HL McCalla S Delke I The relationship of cocaine use to syphillis and human immunodeficiency virus infectious among inner city parturient women Am J Obstet Gynecol 1990 163
S0253-294819980003 Revista Costarricense de Ciencias Médicas Rev. costarric. cienc. méd 0253-2948 Editorial Nacional de Salud y Seguridad Social S0253-29481998000300006 Profilaxis antibiótica en pacientes de cirugía y ginecología Solano-Chinchilla Antonio Crespo Cera Vennys Vargas-Leitón Maricel Ghisellini Maricella Perera Mónica Tabush Christine ,H.C.G. Servicio de Infectología ,H.C.G. Medicina Interna ,H.C.G. Farmacia 12 1998 1998 19 177 180

Se realizó un estudio observacional durante los meses de marzo y abril de 1997, en los servicios de cirugía y ginecología del Hospital Dr.Rafael Angel Calderón Guardia, con el fin de evaluar las indicaciones y el uso de la profilaxis antibiótica en pacientes programados para cirugía electiva limpia y limpia-contaminada, asimismo se determinó la incidencia de infección nosocomial de la herida quirúrgica y su relación con el uso incorrecto de la profilaxis. Los resultados mostraron que el porcentaje de infección encontrado en los servicios de cirugía y ginecología (3,79%) con respecto a los estándares ideales aceptados en la literatura (1%) para este tipo de cirugías muestran una diferencia altamente significativa. Además, la investigación mostró un alto porcentaje de profilaxis incorrecta a pesar de tener una indicación adecuada. La proporción entre el uso correcto e incorrecto de la profilaxis es estadísticamente significativa, siendo la profilaxis correcta significativamente menor.

A two month observational study was carried out during March and April of 1997. In the services of surgery and ginecology of the Hospital Dr. R.A. Calderon Guardia to evaluate the antibiotic prophylaxis in patients with clean and clean-contamined surgery, determining the percentage of nosocomial surgical wound infection. The data shows an index of surgical wound infection of 3.79% versus 1%, the accepted gold standard for this surgery; there was also a high porcentage of wrong prophylaxis in spite of an adecuate indication, the percentage of correct prophylaxis was signifcantly lower.

 Burke JF The efective period of preventive antibiotic action in experimental incisions and dermal lesions Surgery 1961 50 Miles A. Miles E Burke J. The value and duration of defense reactions of the skin to primary lodgement of bacteria Br J Pathol 1957 38 Garner JS Guideline for prevention of surgical wound infection Infection Control 1986 ; 7 193 Kaiser AB Antimicrobial prophylaxis in surgey N Engl Med 1986 315 Nichols RL. Mandell G Postoperative infections and antimicrobial prophylaxis Principles and Practices of Infectious Discase Principles and Practices of Infectious Discase 1995 3rd edition New York Churchill Cruse P Ford R The epidemiology of wound infection a 10 year prospective study of 62,939, wounds Surg Clin North Am 1980 60 Haley RW. Nosocomial infections in surgical patients: Developing valid measures of intrinsic patient risk Am J Med 1991 91 5 Ponce de León RS Infecciones Intrahospitalarias más frecuentes: Manual de Prevención y Control de Infecciones hospitalarias Infecciones Intrahospitalarias más frecuentes: Manual de Prevención y Control de Infecciones hospitalarias 1996
S0253-294819980003 Revista Costarricense de Ciencias Médicas Rev. costarric. cienc. méd 0253-2948 Editorial Nacional de Salud y Seguridad Social S0253-29481998000300007 Moraxella Catarrhalis en tracto respiratorio inferior Mora Mora Minor ,Hospital San Vito Laboratorio Clínico Puntarenas Costa Rica 12 1998 1998 19 181 187

Se analizaron 1598 muestras de tracto respiratorio inferior de pacientes admitidos en el Hospital San Juan de Dios, San José, Costa Rica de noviembre de 1996 a agosto de 1997 y se determinó una frecuencia de aislamiento de Moraxella catarrhalis de 4,3%. Los pacientes con enfermedad pulmonar obstructiva crónica (EPOC), tuvieron mayor riesgo de presentar la bacteria Moraxella catarrhalis (p< 0,05), siendo los mayores de 60 años más susceptibles a la infección . Moraxella catarrhalis mostró un patrón de sensibilidad a los antimicrobianos mayor del 90% frente a amikacina, ampicilina, cefotaxima, cefalotina y cloranfenicol. Se determinó que Moraxella catarrhalis no es un agente primario de las infecciones del tracto respiratorio inferior; sin embargo, la historia clínica del paciente debe ser tomada en cuenta para sospechar la presencia de éste microorganismo y el subsecuente tratamiento.

Among 1598 lower respiratory tract samples corresponding to patients admitted at the San Juan de Dios Hospital, San José, Costa Rica, between november 1996 and august 1997 (The frecuency of isolation of Moraxella catarrhalis) was 4,3%. Patients with Chronic Obstrutive Pulmonary Disease (copd) had a higher risk of presenting Moraxella catarrhalis (p< 0,05) and those 60 or more years of age were more susceptibility to infection. Antibiotic susceptible tests were performed for all the strains of Moraxella catarrhalis that were obtained and they yielded ad more than 90% susceptibility to amikacin, ampicillin, cefotaxime, cephalothin and chloramphenicol . It was determined that Moraxella catarrhalis is not a primary lower respiratory tract infection agent, even though the clinical history of the patient must be considered as an important guide on the isolation of this microorganism and subsequent treatment.

 Moraxella catarrhalis EPOC tracto respiratorio inferior Davies Bl. Moraxella catarrhalis - Clinical significance and therapeutic problems Inf Dis Newsletter 1991 10 Wright PW Wallace RJ Shepherd JR A descriptive study of 42 cases of Branhamella catarrhalis pneumonia Am J Med 1990 88 Jawetz E Melnick JL Adelberg EA Microbiología Médica: El Manual Moderno Microbiología Médica: El Manual Moderno 1988 México, D.F. Murphy TF Branhamella catarrhalis : epidemiology, surface antigenic structure, and inmune response Microbiol Rev 1996 60 Morello JA Janda WM Doern GV Neisseria and Branhamella Manual of Clinical Microbiology Manual of Clinical Microbiology 1991 Washington, D.C American Society for Microbilogy Doern GV Branhamella catarrhalis - An emerging human pathogen Diagn Microbiol Infect Dis 1986 4 Marchant CD Spectrum of Discase Due to Branhamella catarrhalis in children with particular reference to acute otitis media Am J Med 1990 88 Aitken JM Thornley PE Isolation of Branhamella catarrhalis from sputum and tracheal aspirate J Clin Microbiol 1983 18 Johnson MA Drew WL Roberts M Branhamella (Neisseria) catarrhalis - a lower respiratory tract pathogen ?. J Clin Microbiol 1981 13 Soto JL Holtsclaw-Berk S Harvill LM Berk SL Phenotypic characteristic of Branhamella catarrhalis strains J Clin Microbiol 1989 27 Dealler SF Abbott M Croughan MJ Hawkey PM Identification of Branhamella catarrhalis in 2,5 min with Indoxyl butyrate strip test J Clin Microbiol 1989 27 Barbé G Babolat M Boeufgras JM Monget D Freney J Evaluation of API NH, a new 2-hour system for identification of Neisseria and Haemophilus species and Moraxella catarrhalis in a routine clinical laboratory J Clin Microbiol 1994 32 Speeleveld E Fossépré JM Gordts B Van Landuyt HW Comparison of three rapid methods, tributyrine, 4-methylumbelliferyl butyrate, and indoxyl acetate, for rapid identification of Moraxella catarrhalis J Clin Microbiol 1994 32 Doern GV Morse SA Branhamella (Neisseria) catarrhalis : criteria for laboratory Identification J Clin Microbiol 1980 11 Waller JR Hodel SL Nuti RN Improvement of two toluidine blue O - mediated techniques for DNase detection J Clin Microbiol 1985 21 Bauer AW Kirby WM Sherris JC Turck M Antibiotic susceptibility testing by standarized single disk method Am J Clin Pathol 1966 45 Dean AG Dean JA Burton A Dicker R Epi Info Epi Info 1992 Version 5 Ginebra World Health Organization La Force FM Approach to the patient whit pleuropulmonary infection Infectious Diseases Infectious Diseases 1992 W. B. Saunders Company Levison MA Harrison Neumonia, comprendidas las infecciones pulmonares necrosantes (absceso pulmonar). Principios de Medicina Interna Principios de Medicina Interna 1994 Vol. 1 McGraw-Hill Interamericana de España Wood GM Johnson BC Moraxella catarrhalis : Pathogenic significance in respiratory tract infections treated by community practitioners Clin Inf Dis 1996 22 Sarubbi FA Myers JW Williams JJ Shell CG Respiratory infections caused by Branhamella catarrhalis Am J Med 1990 88 Doern GV Brueggemann AB Pierce G Hogan T Holley HP Rauch A Prevalence of antimicrobial resistance among 723 outpatient clinical isolates of Moraxella catarrhalis in the United States in 1994 and 1995: results of a 30-center national surveillance study Antimicrob Agents Chemother 1996 40 Pollard JA Wallace Rj Nash DR Luman Jl Wilson RW Incidence the Branhamella catarrhalis in the sputa of pacients whit chronic lung disease Drugs 1986 31
S0253-294819980003 Revista Costarricense de Ciencias Médicas Rev. costarric. cienc. méd 0253-2948 Editorial Nacional de Salud y Seguridad Social S0253-29481998000300008 Frecuencia de marcadores serológicos del virus de la hepatitis B en sujetos fallecidos en un hospital clase A de San José San Gil Enrique Mata Leonardo ,Universidad de Costa Rica Instituto de Investigaciones en Salud 12 1998 1998 19 188 193

Objetivo: Conocer la frecuencia de tres marcadores serológicos del virus de la hepatitis B (VHB): antígeno de superficie (HBsAg), anticuerpos anti-antígeno de superficie (anti-HBs) y anticuerpos totales al antígeno central (anti-HBc) en una población de adultos fallecidos en un hospital general. Material y Métodos: Mediante las técnicas de ELISA y RIA se hizo determinación de la presencia de tres marcadores del VHB en el suero de 336 pacientes fallecidos. Resultados: Se encontró HBsAg en el 2,4% de los casos; anticuerpos anti-HBs en el 29,8%; y anti-HBc en el 31,8%. Conclusiones: La frecuencia de los tres marcadores mencionados fue más alta en esta casuística, que en otras de personas vivas del país descritas por otros autores. Los autores no pudieron ubicar investigaciones similares a ésta, en personas hospitalizadas que mueren en nosocomios. Este estudio sugiere que la infección con VHB es más frecuente en la población hospitalizada que muere en el hospital, que en la población general.

Objective: To determine the frequency of three serological markers of Hepatitis B virus (HBV) in a series of corpses in a Class A general hospital of Costa Rica. Material and Methods: Using ELISA and RIA methods, three serological markers of HBV were investigated in the serum of the corpses. Results: HBsAg was found in 2.4% of the deceased, anti-HBs in 29.8%; and anti-HBc in 31.8%. Conclusions: The frequency of the markers studied was relatively high in this sample, in comparison with rates in blood donors and other population groups in the country. Similar studies of hospitalized deceased persons were not found in the world literature. The present study suggests that infection with HBV is more common in nosocomial populations.

 Marcadores serológicos Hepatitis B Decesos hospitalarios Costa Rica Fuentes L Gutiérrez A Somogyi T Investigación por virus de la hepatitis B y citomegalovirus en donadores de sangre Rev Cost Cienc Med 1987 8 Rodríguez M Carboni L Greenwood G Detección de antígeno de superficie de hepatitis B (HBsAg) en donadores de sangre del Hospital México Acta Méd Cost 1996 38 Salom I Román S Macaya G Fonseca J Brenes F Mora C Martén A Revision retrospectiva de la prevalencia del virus de la hepatitis B (VHB) en varios grupos de población Rev Biol Trop 1990 38 Informe sobre la salud en el mundo 1998: La vida en el siglo XXI: Una perspectiva para todos Informe sobre la salud en el mundo 1998: La vida en el siglo XXI: Una perspectiva para todos 1998 Ginebra Organización Mundial de la Salud Las condiciones de Salud en las Américas Las condiciones de Salud en las Américas 1994 11 ed Washington DC: Organización Panamericana de la Salud Alter M.J. Mast E.E. The epidemiology of viral hepatitis in the United States Gastroenterology Clinics of North America 1994 23 Benenson AS Hepatitis vírica B: El control de las enfermedades trasmisibles en el hombre Hepatitis vírica B: El control de las enfermedades trasmisibles en el hombre 1992 15 ed Washington DC American Public Health Association, Inc Sjogren MH Serologic diagnosis of viral hepatitis Gastroenterol Clin North Am 1994 23 Yeoh EK. Hepatitis B virus infection in children Vaccine 1990 8 Krugman S Villarejos VM Hepatitis B: clinical evolution and late sequelae Viral Hepatitis and AIDS. Viral Hepatitis and AIDS. 1987 San José Trejos Hnos Maynard JE Hepatitis B: global importance and need for control Vaccine 90 8 Piot P Goilav C Kegels E Hepatitis B:transmission by sexual contact and needle sharing Vaccine 1990 8 Rosenblum LS Hadler SC Castro KG Lieb S Jaffe HW Heterosexual transmission of hepatitis B virus in Belle Glade, Florida J Infect Dis 1990 161 Yolken RH Viscidi R. Schmidt NJ Emmons RW Enzyme immunoassay and radioimmunoassay Diagnostic Procedures for Viral, Rickettsial and Chlamydial Infections Diagnostic Procedures for Viral, Rickettsial and Chlamydial Infections 1989 6 ed Washington DC American Public Health Association, Inc Wolters G Kuijpers L Kacaki J Schuurs A Solid-phase enzyme-immunoassay for detection of hepatitis B surface antigen J Clin Pathol 1976 29 Hoofnagle JH Seeff LB Bales ZB Vyas GN Cohen SN Schmid R Serologic responses in hepatitis B Viral Hepatitis. Viral Hepatitis. 1978 Philadelphia Franklin Institute Press Kemeny DM A practical guide to ELISA A practical guide to ELISA 1991 Oxford Pergamon Press Seeff LB Beebe GW Hoofnagle JH Norman JE Buskell-Vales Z Waggoner JG A serologic follow-up of the 1942 epidemic of the post-vaccinal hepatitis in the United States Army N Engl J Med 1987 316 Hoofnagle JH Alter JH Vyas GN Dienstag JL Hoofnagle JH Chronic viral hepatitis Viral Hepatitis and Liver Disease Viral Hepatitis and Liver Disease 1984 New York Grune and Stratton Katchaki JN Siem TH Brouwer R Brandt KH Van Der Waart M Detection and significance of anti-HBc in the blood bank; preliminary results of a controlled prospective study J Virol Methods 1980 2 Sherlock S Chronic hepatitis in diseases of the liver and biliary system Chronic hepatitis in diseases of the liver and biliary system 1989 8 ed Oxford Blackwell Scientific Publications Morgan T Redeker A Yamada S HBsAg clearance in chronic active hepatitis B: A possible cause of cryptogenic cirrhosis Dig Dis Sci. 1986 31 Ginsberg AL Conrad ME Bancroft WH Antibody to Australia antigen: detection with a simple radioimmune assay, incidence in military population, and role in the prevention of hepatitis B with gammaglobulin J Lab Clin Med 1973 82 ^s2 Sjogren MH Lemon SM Low molecular weight IgM antibody to hepatitis B core antigen in chronic hepatitis B virus infection J Infect Dis 1983 148 Sjogren MH Hoofnagle JH Immunoglobulin M antibody to hepatitis B core antigen in patients with chronic type B hepatitis Gastroenterology 1985 89
S0253-294819980003 Revista Costarricense de Ciencias Médicas Rev. costarric. cienc. méd 0253-2948 Editorial Nacional de Salud y Seguridad Social S0253-29481998000300009 Varios genes descartados como causantes de retinosis pigmentaria autosómica recesiva en dos familias costarricenses Leal Alejandro Gutiérrez-Espeleta Gustavo Barrantes Ramiro ,Universidad de Costa Rica Instituto de Investigaciones en Salud y Escuela de Biología San José Costa Rica 12 1998 1998 19 194 205

Se estudiaron dos familias costarricenses con Retinosis Pigmentaria (RP) de herencia autosómica recesiva, con el fin de descartar genes relacionados con la enfermedad. Para esto se efectuó un análisis de ligamiento con marcadores polimórficos por repeticiones en tandem (STRPs). En una familia (C1) los afectados presentan una degeneración de aparición temprana y severa. En la otra familia (P1) la aparición es temprana pero con una degeneración más lenta que en C1. Las diferencias fenotípicas sugieren que se trata de mutaciones diferentes en ambas familias. En C1 los siguientes genes quedan descartados (Z (0,0) =<IMG SRC="http:/img/fbpe/rccm/v19n3-4/infinito.JPG" WIDTH=12 HEIGHT=9><IMG SRC="http:/img/fbpe/rccm/v19n3-4/infinito.JPG" WIDTH=12 HEIGHT=9>): el de herencia autosómica recesiva (RPAR) de la región 1q31-32.1, RPAR por mutación en la fosfodiesterasa B en 4p16.3, RPAR de 6p a 20 cM del gen de la periferina, el de la distrofia macular del cromosoma 6, y del proto-oncogen myc. Por su parte, el puntaje Lod con el marcador RDS no permite descartar con certeza al gen RDS (Z (0,0) =<IMG SRC="http:/img/fbpe/rccm/v19n3-4/infinito.JPG" WIDTH=12 HEIGHT=9> 0,0083) y se observan puntajes Lod positivos en el caso de los marcadores myc en 8q24.12-q24.13 (Z (0,2) = 0,3050) y periferina/RDS en 6p12 (Z (0,1) = 0.2063), pero no son significativos. En P1 se descarta el gen que codifica la rodopsina, el de la fosfodesterasa B, el de RPAR cercano a la periferina, el de la periferina, RPAD del cromosoma 7 y el proto-oncogen myc. Por otra parte, se encontraron valores positivos en marcadores cercanos al gen de la rodopsina (RHO, Z (0.1) = 0.3991), periferina (RDS, Z (0.2) = 0.3390) y Usher 1A del cromosoma 14q (P1, Z (0.09) = 0.7647). En lo sucesivo deberán descartarse por completo las regiones correspondientes a genes que participan en la transmisión de la señal visual o que forman parte de alguna estructura en la retina. La metodología aquí seguida es útil y factible en Costa Rica para descartar genes implicados en enfermedades hereditarias humanas, y se puede utilizar para conocer los orígenes de otras patologías, realizar un diagnóstico preciso, ofrecer asesoría genética y apoyar el diseño de terapias.

In order to discard some candidate genes for autosomal recessive Retinitis Pigmentosa (RP), two families with this disease were studied. Linkage analysis was done, using polymorphic markers (STRPs). In one family (C1) affected members present an early onset and severe degeneration of the retina. In the other family (P1) the onset is earlier but the degeneration is slower than in C1. Phenotypic differences indicate that there are different mutations in both families. The following genes are not responsible for the disease in family C1 (Z (0.0)=<IMG SRC="http:/img/fbpe/rccm/v19n3-4/infinito.JPG" WIDTH=12 HEIGHT=9>: autosomal recessive RP (arRP) on 1q31-32.1, arRP by mutation in the PDEB gene on 4p16.3, arRP on 6p at 20 cM of peripherin gene, macular dystrophy on chromosome 6 and proto-oncogene myc. On the other hand, the marker RDS´ lod score certainly does not allow discard in a the peripherin gene as responsible (Z(0.1)= <IMG SRC="http:/img/fbpe/rccm/v19n3-4/infinito.JPG" WIDTH=12 HEIGHT=9>0.0083), and there are positive lod scores for myc on 8q (Z (0.2)= 0.3050) and peripherin/RDS on 6p12 (Z(0.1)= 0.2063), but they are not significant. In the case of P1, results suggest that the following genes could be discarded: rodopsin, PDEB, arRP close to peripherhin, peripherin/RDS, adRP on chromosome 7 and myc. Nevertheless positive values were found near regions of rodopsin (RHO, Z(0.1)= 0.3991), peripherin (RDS, Z(0.2)= 0.3390) and Usher 1A on 14q (P1, Z(0.09)= 0.7647). The next step is to discard the regions with genes implicated in the visual transmission system or in the structure of the retina. This methodology can be used in Costa Rica for discarding genes implicated in other human hereditary diseases, for ascertaining information on the origen of certain pathologies, in order to get a precise diagnosis, to offer genetic counseling, and to support the design of therapies.

 Genética humana Enfermedades hereditarias Diagnóstico molecular Análisis de ligamiento genético Retinosis Pigmentaria Marcadores polimórficos Bunker C Berson E Bromley W Haves R Roderick T Prevalence of retinitis pigmentosa in Maine Am J Ophtalmol 1984 97 Boughman J Conneally M Nance W Population genetic studies of retintitis pigmentosa Am J Hum Genet 1980 32 Bundey S Crews J A study of retinitis pigmentosa in the city of Birmingham: clinical and genetic heterogeneity J Med Genet 1984 21 Amman F Klein D Franceschetti A Genetic and epidemiological investigations on pigmentary degeneration of retina and allied disorders in Switzerland J Neurol Sci 1965 2 Heckenlively J The diagnosis and classification of retinitis pigmentosa Retinitis Pigmentosa Retinitis Pigmentosa 1988 Philadelphia JB Lippincott Farber D Heckenlively J Sparkes R Bateman B Molecular genetics of retinitis pigmenosa West J Med 1991 155 Kumaramanickavel G Maw M Denton M John S Srisailapathy C Orth U Oehlmann R Gal A Missense rhodopsin mutation in a family with recessive retinitis pigmentosa Nat Genet 1994 8 McLaughlin M Berson E Dryja T Recessive mutations in the gene encoding the B-subunit of rod phosphodiesterase in patients with retinitis pigmentosa Nat Genet 1993 4 Bruford E Mansfield D Teague P Barber A Fossarello M Wright A Genetic linkage in autosomal recessive retinitis pigmentosa Am J Hum Genet 1994 55 Knowles J Shugart Y Banerjee P Gilliam C Lewis C Jacobson S Ott J Identification of a locus, distinct from RDS-peripherin, for autosomal recessive retinitis pigmentosa on chromosome 6p Hum Molec Genet 1994 3 van Soest S van der Born L Gal A Farrar J Bleeker L Westerveld A Humphries P Sandkuijl L Bergen A Assignmento of a gene for autosomal recessive retinitis pigmentosa (RP12) to chromosome 1q31-q32.1 in an inbred and genetically heterogeneous disease population Genomics 1994 22 Kajiwara K Berson E Dryja T Digenic retinitis pigmentosa due to mutations at the unlinked peripherin/RDS and ROM1 loci Science 1994 264 Dryja TP Li T Molecular genetics of retinitis pigmentosa Hum Molec Genet 1995 4 Haim M Retinitis pigmentosa: problems associated with genetic classification Clin Genet 1993 44 Madisen L Hoar D Holroyd CD Crsip M Hodes ME DNA Banking: the effects of storage of blood and isolated DNA on the integrity of DNA Am J Med Genet 1987 27 Weissenbach J Gyapay G Dib C Vignal A Morissette J Millasseau P Vaysseix G Lanthrop M A second generation linkage map of the human genome Nature 1992 359 Nichols B Linkage interphase for Macintosh 3.1 Linkage interphase for Macintosh 3.1 1994 Iowa Molecular Ophthalmology Lab. University of Iowa Lathrop G Lalouel J Julier C Strategies for multilocus linkage analysis in humans Proc Natl Acad Sci USA 1984 81 Morton N Sequential tests for the detection of linkage Am J Hum Genet 1955 7 Terwilliger JD Ott J Handbook of human genetic linkage Handbook of human genetic linkage 1994 1 ed. Baltimore^eMaryland The Johns Hopkins University Press Boughman J Caldwell R Cotlier E Maumenee I Berman E Genetic an clinical characterization of a survey population with retinitis pigmentosa Clinical, stuctural and biochemical advances in hereditary eye disorders Clinical, stuctural and biochemical advances in hereditary eye disorders 1982 New York Alan R. Liss
S0253-294819980003 Revista Costarricense de Ciencias Médicas Rev. costarric. cienc. méd 0253-2948 Editorial Nacional de Salud y Seguridad Social S0253-29481998000300010 Microsporidiosis: una parasitosis de reciente adaptación al hombre Chinchilla C. Misael Reyes L Lilliana Guerrero B. Olga Marta Castro C Alfredo , 12 1998 1998 19 209 221

Se hace un análisis general de la literatura y del trabajo de los autores sobre microsporidiosis, una parasitosis que se ha puesto en boga a raíz de los problemas de inmunosupresión, especialmente en personas infectadas con el virus del SIDA. Se hace una revisión histórica, se describe básicamente la morfología de los géneros más importantes de los microsporidios y se comentan algunos aspectos de la epidemiología. Se revisan los cambios patológicos debidos a la infección con estos parásitos, los métodos de diagnóstico más usados, el tratamiento y la prevención contra esta parasitosis. Se enfatiza sobre el hallazgo por primera vez en Costa Rica y probablemente en Centro América, de casos humanos de infección con Enterocytozoon bieneusi y con el género Nosema.

Microsporidiosis is a recent and important disease related particularly specially with problems of immunosuppression as is the case in AIDS. The authors mention several studies related with this parasitosis, especially the presentation, for the first time in Costa Rica and probably in Central America, of Enterocytozoon bieneusi or Nosema infestation in human. Some data dealing with the history of this parasitosis are mentioned, and the morphology of the known genera and species is briefly described. Notes on the epidemiology and transmissión of these organisms, as well as the pathology produced by microsporidial infection are also presented. The more relevant and useful diagnostic methods, and the known treatment and prevention measures are indicated.

 Microsporidia microsporidiosis Enterocytozoon Encephalitozoon Pleistophora Nosema Microsporidia microsporidiosis Enterocytozoon Encephalitozoon Pleistophora Nosema Shadduck J A Meccoli R A Davis R Font R L First isolation of a microsporidian from a human patient J Infect Dis 1990 162 Nägeli K W Ueber die neue krankheit der Seidenraupe und verwandte organismen Bot Z 1857 15 Weber R Bryan R T Schwartz D A Owen R L Human microsporidial infections Clin Microbiol Rev 1994 7 Matsubayashi H Koike T Mikata T Hagiwara S A case of Encephalitozoon-like body infection in man Arch Pathol 1959 67 Desportes I Le Charpantier Y Galian A Ocurrence of a new microsporidian, Enterocytozoon bieneusi n.g., n.sp., in the enterocytes of a human patients with AIDS J Protozool 1985 32 Field A S Marriott D J Milleken S T Myositis associated with a newly described microsporidian, Trachipleistophora hominis, in a patient with AIDS J Clin Microbiol 1996 34 Cali A Owen R L Intracellular development of Enterocytozoon, a unique microsporidian found in the intestine of AIDS patients J Protozool 1990 Wrigth J H Craighead E M Infectious motor paralysis in young rabbit J Exp Med 1992 36 Levaditi C Nicolau S Schoen R L’agent etiologique de l’encéphalite epizootique du lapin (Encephalitozoon cuniculi). C.R Soc Biol Paris 1923 89 Weiser J On the taxonomic position of the genus Encephalitozoon Levaditi, Nicolau & Schoen, 1923 (Protozoa, Microsporidia). Parasitology 1964 54 Didier E S Shadduck J A Didier P J Studies on ocular microsporidia J Protozool 1991 38 Cali A Kotler D P Orenstein J M Septata intestinalis n.g.; n.sp., an intestinal microsporidian associated with chronic diarrhoea and dissemination in AIDS patient J Euk Microbiol 1993 40 Hartskeerl R A Schuitema R J de Wachter R Secundary structure of the small subunit ribosomal RNA sequence of the microsporidium Encephalitozoon cuniculi Nucleic acids Res. 1993 21 Dore G J Marriott D J Hing MC Disseminated microsporidiosis due to Septata intestinalis in nine patients infected with the human immunodeficiency virus: Response to therapy with albendazole Clin Infect Dis 1995 21 Larson R J I Identification of microsporidian genera (Protozoa, Microspora) a guide with comments on the taxonomy Arch Protistenkd 1988 136 Ledford D K Overman M D Gonzalo A Microsporidiosis myositis in a patient with acquired immunodeficiency syndrome Ann Intern Med 1985 102 Cali A General microsporidian features and recent findings on AIDS isolates J Protozool 1991 38 Margileth A M Strano A J Chandra R Disseminated nosematosis in an immunologically compromised infant Arch Pathol 1973 95 Croft S L Williams J McGowan I Intestinal microsporidiosis Semin Gastroint Dis 1977 8 Cali A Meisler D Lowder C Y Corneal microsporidosis: Characterization and identification J Protozool 1991 38 Ashton N Wirasinha PA Encephalitozoonosis (Nosematosis) of the cornea Br J Ophthalmol 1973 57 Pinnolis M Egbert P R Font R L Winter FC Nosematosis of the cornea Arch Ophthalmol 1981 99 Orenstein J M Microsporidiosis in the acquired immunodeficiency Syndrome J Parasitol 1991 77 Shadduck J A Orenstein J M Comparative Pathology in microsporidiosis Arch Pathol Lab Med 1993 117 Sandford J Hannermann A Gelderblom H Enterocytozoon bieneusi infection in an immunocompetent patient who had acute diarrhea and who was not infected with the human immunodeficiency virus Clin Infect Dis 1994 19 Bryan R T Weber R Microsporidia emerging pathogens in immunodeficient persons Arch Pathol Lab Med 1993 117 Weber R Kuster H Visvesvara G Disseminated microsporidiosis due to Encephalitozoon hellem: Pulmonary colonization, microhematuria and mild conjuntivitis in patient with AIDS Clin Infect Dis 1993 17 Reyes L Chinchilla M Frajman M Presencia de parásitos intestinales en pacientes HIV seropositivos con el primer informe de microsporidiosis humana en Costa Rica Parasitología al Día 1997 21 Orenstein J M Dieterich D T Kotler D M Systematic dissemination by a newly recognized microsporidia species in AIDS AIDS 1992 6 Weber R Bryan R T Microsporidial infection in immunodeficient and immunocompetent patients Clin Infect Dis 1994 19 Molina J M Sarfati C Beauvais B Intestinal microsporidiosis in human immunodeficiency virus-infected patients with chronic unexplained diarrhea: Prevalence and Clinical and biological features J infect Dis 1993 167 Chinchilla M Reyes L Guerrero O M Enterocytozoon bieneusi (Orden Microsporidia, Familia Enterocytozoonidae) in Costa Rica: Report of the first human case in Central America Parasitología al Día 1997 21 Weber R Kuster H Keller R Pulmonary and intestinal microsporidiosis in a patient with the acquired immunodeficiency syndrome Am Rev Respir Dis 1992 146 Bryan R T Cali A Owen R L Spencer H L Sun T. Microsporidia oportunistic pathogens in patients with AIDS. Progress in Clinical Parasitology Progress in Clinical Parasitology 1991 Vol 2 Philadelphia Cali A Meisler D M Rutherford I Corneal microsporidiosis in a patient with AIDS Am J Trop Med Hyg 1991 44 ^s5 Chup G L Alroy J Adelman LS Myositis due to Pleistophora (Microsporidia) in a patient with AIDS Clin Infect Dis 1993 16 Mertens R B Didier E S Fishbein M C Encephalitozoon cuniculi microsporidiosis: infection of the brain, heart, kidney, trachea, adrenal glands and urinary bladder in a patient withs AIDS Mod Pathol 1997 10 Weber R Bryan R T Owen R L Improved light-microscopical detection of microsporidia spores in stool and duodenal aspirates N Engl J Med 1992 326 Ryan N Sutherland G Coughlan K A new trichrome-blue stain for detection of microsporidial species in urine, stool, and nasopharingeal specimens J Clin Microbiol 1993 31 Luna V A Stewart B K Bergeron DL Use of the fluorochrome calcofluor white in the screening of stool specimens for spores of microsporidia Am J Clin Pathol 1995 103 Connolly G M M Ellis D S Williams J E Use of electron microscopy in examination of faeces and rectal and jejunal biopsy specimens J Clin Pathol 1991 44 Aldras A M Orenstein J M Kotler D P Detection of microsporidia by indirect immunofluorescence antibody test using polyclonal and monoclonal antibodies J Clin Microb 1994 32 Zhu X Wittner M Tanowitz HB Small subunit rRNA sequence of Enterocytozoon bieneusi and its potential diagnostic role with use of the polymerase chain reaction J Infect Dis 1993 168 Weiss L M Cali A Levee E Diagnosis of Encephalitozoon cuniculi infection by western blot and the use of cross-reactive antigens for the possible detection of microsporidiosis in humans Am J Trop Med Hyg 1992 47 Hollister W S Canning E U Wilcox A Evidence for widespread ocurrence of antibodies to Encephalitozoon cuniculi (Microspora) in man provided by ELISA and another serological test Parasitology 1991 102 Ombrouck C Ciceron L Biligui S Specific PCR assay for direct detection of intestinal microsporidia Enterocytozoon bieneusi and Encephalitozoon intestinalis in fecal specimens from human immunodeficiency virus-infected patient J Clin Microbiol 1977 35 Dieterich D T Lew E A Kotler D P Treatment with albendazole for intestinal disease due to Enterocytozoon bieneusi in patients with AIDS J Infect Dis 1994 169 Sharpstone D Rowbotton A Francis N Thalidomide: a novel therapy for microsporidiosis Gastroenterology 1997 112
S0253-294819980003 Revista Costarricense de Ciencias Médicas Rev. costarric. cienc. méd 0253-2948 Editorial Nacional de Salud y Seguridad Social S0253-29481998000300011 Lesión ósea renal e hiperparatiroidismo secundario Herra-Sánchez Sergio A. Alvarez-Orellanos Aly ,Hospital San Juan de Dios Servicio de Nefrología ,Universidad Autónoma de Ciencias Médicas Cátedra de Medicina Interna Santo Domingo República Dominicana 12 1998 1998 19 225 231

Se presentan los datos de 40 pacientes, portadores de insuficiencia renal crónica, atendidos en el Servicio de Nefrología y la Unidad de Hemodiálisis del Hospital San Juan de Dios, San José, Costa Rica, de enero a junio de 1997. De ellos 9 pacientes con insuficiencia renal crónica en etapa prediálisis, 7 casos en terapia de hemodiálisis y 24 pacientes postrasplante renal, analizando la incidencia y severidad del daño óseo, la repercusión sobre las paratiroides y el daño renal secundario al hiperparatiroidismo.

A study of 40 patients with chronic renal failure, is presented. All were attendedat in the Nephrology Service and Hemodialysis Unit of Hospital San Juan de Dios, San José, Costa Rica, between january and june 1997. Nine of the cases did not receive dialysis therapy support, seven hemodialysis treatment and twenty-four patients were post kidney transplant. Incidence and severity of bone disease, repercussion on parathyroid glands and kidney disease secondary to hyperparathyroidism are analyzed.

 Hiperparatiroidismo secundario osteodistrofia renal insuficiencia renal crónica parathormona trasplante renal Secondary Hyperparathyroidism bone disease renal osteodystrophia in chronic renal failure kidney transplantation parathormone Bikle DD A bright future for the sunshine hormone Scient Am Science & Med 1995 March/April Lewin E Wang W Olgaard K Reversibility of experimental secondary hyperparathyroidism Kidney Int 1997 52 Parfitt AM The hyperparathyroidism of chronic renal failure: A disorder of growth Kidney Int. 1997 52 Klaus G May T H(gel U von Eichel B Rodríguez J Fernández P Reichrath J Ritz E Mehls O Parathyroid hormone prevents 1,25(OH)2D3 induced down- regulation of the vitamin D receptor in growth plate chondrocytes in vitro Kidney Int 1997 51 Malluche H Faugere MC Renal bone disease 1990: An unmet challenge for the nephrologist Kidney Int 1990 38 Julian BA Darryl Quarles L Niemann KMW Musculoskeletal complications after renal transplantation: Pathogenesis and Treatment Am J Kidney Dis 1992 XIX ^s2 Lovis C Ruedin P Osteodistrofia renal Médicine et Hygiène 1991 49 ^s1876 Alvarez-Ude F Feest TG Ward MK Hemodialysis bone disease: Correlation between clinical, histologic and other findings Kidney Int 1978 14 Massry S Smogorzewski M Mechanisms through which parathyroid hormone mediates its deleterious effects on organ funcion in uremia Seminars in Nephrology 1994 14 ^s3 Llach F Massry S Singer F Yurokawa K Kaye J Coburn J Skeletal resistance to endogenous parathyroid hormone in patients with early renal failure. A possible cause of secondary hyperparathyroidism J Clin Endocrinol Metab 1975 41 De Vita MV Rasenas LL Bansal M Gleim GW Zabetakis PM Gardenswartz MH Michelis MF Assessment of renal osteodystrophy in hemodialysis patients Medicine 1992 71 Negri AL Bogado CE Insua A Zanchetta JR Contenido mineral óseo total en pacientes en hemodiálisis crónica con hiperparatiroidismo secundario Nefrología Latinoamericana 1996 3 ^s4 Pocok NA Eisman JA Dunstan CR Recovery from steroid-induced osteoporosis Ann Intern Med 1987 107 Lukert BP Raisz LG Glucocorticoid-induced osteoporosis: Pathogenesis and management Ann Intern Med 1987 112 Ott SM Does strogen play a role in renal osteodystrophy ? Semin Dial 1995 8 Stewart PJ Green OC Stern PH Cyclosporine A inhibits calcemic hormone- induced bone resorption in vitro J Bone Miner Res 1986 1 Stein MS Packham DK Ebeling PR Wark JD Becker GJ Prevalence and risk factors for Osteopenia in dialysis patients Am J Kid Dis 1996 28 ^s4 McCarthy JT Kumar R Renal Osteodystrophy Endocrinol Metab Clin North Am 1990 19 Piga M Bolasco P Satta L Double-Phase parathyroid technetium-99m- MIBI Scintigraphy to identify functional autonomy in Secondary Hyperparathyroidism J Nucl Med 1996 37 Felsenfeld AJ Llach F Parathyroid gland function in chronic renal failure Kidney Int 1993 43 Rapaport J Mostoslavski M Ben - David A Successful treatment of secondary hyperparathyroidism in hemodialysis patients with oral pulse 1 - alfa hidroxy - cholecalciferal therapy Nephron 1996 72 Hutchison AJ Whitehouse RW Boulton HF Adams JE Barbara Mawer E Freemont TJ Gokal R Correlation of bone histology with parathyroid hormone, vitamin D3, and radiology in end-stage renal disease Kidney Int 1993 44 Golconda MS Larson TS Kolb LG Kumar R 1, 25-Dihydroxyvitamin D-mediated hypercalcemia in a renal transplant recipient Mayo Clin Proc 1996 71 Madsen KM Zhang L Abu Shamat A-R Siegfried S Cha JH Ultrastructural localization of ostepontin in the kidney: induction by lipopolysaccharide J Am Soc Nephrol 1997 8 Shaikh SJK Huttchison AJ Adams JE Freemont A Gokal R Spectrum of bone disease after renal transplantation: Correlation between histomorphometry and densitometry Kidney Int 1997 52 Graham KA Hoenich NA Tarbit M Ward MK Goodship THJ Correction of acidosis in hemodialysis patients increases the sensitivity of the parathyroid glands to calcium J Am Soc Nephrol 1997 8 Goodman WG Veldhuis JD Belin TR Juppner H Salusky IB Suppressive effect of calcium on parathyroid hormone release in adynamic renal osteodystrophy and secondary hyperparathyroidism Kidney Int 1997 51 Stein MS Packham DK Ebeling PR Wark JD Becker GJ Large, rapid increase in bone mineral density after parathyroidectomy occur and are predominantly at the axial skeleton Kidney Int 1997 51 Yoon SN Wang CW Kim SY Choi EJ Chang YS Bang BK The effect of intravenous calcitriol on secondary hyperparathyroidism and bone mineral density in chronic hemodialysis patient Kidney Int 1997 51 Ruedin P Rizzoli R Slosman D Leski M Bonjour J-P Effect of oral calcitriol on bone mineral density in patients with end-stage renal failure Kidney Int 1994 45 Teruel JL Tato AM Tenorio T Control of secondary hyperparathyroidism in hemodialysis with oral calcium supplements and low- calcium dialysate Kidney Int 1997 52 Goicoechea M Vozmediano MC Pérez García R Treatment of secondary hyperpathyroidismo with intravenous (i.v.) calcitriol. Factors related with the lack of response to treatment Kidney Int 1997 52 Felsenfeld AJ Considerations for the treatment of secondary hyperparathyroidism in renal failure J Am Soc Nephrol 1997 8 Coates PTH Cochran M Effect of calcitriol on tubular reabsorption of calcium in moderate CRF Kidney Int 1997 51 Dumoulin G Hory B Nguyen NU Henriet MT Bresson C Bittard H Saint- Hillier Y Regmard J Lack of increased urinary calcium-oxalate supersaturation in long-term kidney transplant recipients Kidney Int 1997 51 Emmett M Sirmon MD Kirkpatrick WG Nolan CR Schmitt GW Cleveland MB Calcium acetate control of serum phosphorus in hemodialysis patients Am J Kidney Dis 1991 17 ^s5 Laouari D Friedlander G Burtin M Silve C Dechaux M Garabedian M Kleinknecht C Subtotal nephrectomy alters tubular function: Effect of phosphorus restriction Kidney Int 1997 52 Massari PU Disorders of bone and mineral metabolism after renal transplantation Kidney Int 1997 52 Peng SJ Yang CS Ferng SH Chen LY A crossover comparison of intermittent oral and intravenous administration of calcitriol on the parathyroid hormone concentration in hemodialysis patients Miner Electrolyte Metab 1997 23 Brossard J-H Roy L Lepage R Gascon-Barré M D'Amour P Intravenous 1,25 (OH)2 D therapy increases the intact parathyroid hormone secretion set point in hemodialyzed patients Miner Electrolyte Metab 1997 23 Teruel JL Navarro JF Marcen R Aguilera A Tato A Ortuño J Satisfactory control of secondary hyperparathyroidism with low-calcium dialysate in patients not receiving vitamin D Miner Electrolyte Metab 1997 23 Herra S Rodríguez R Estroncio y aluminio en pacientes con insuficiencia renal crónica, Hospital San Juan de Dios, San José, Costa Rica Nefrología Americana 1998 5 ^s1 -2
S0253-294819980003 Revista Costarricense de Ciencias Médicas Rev. costarric. cienc. méd 0253-2948 Editorial Nacional de Salud y Seguridad Social S0253-29481998000300012 Salpingitis tuberculosa: informe de un caso Castro A. Virya Montvelisky K Herman ,Hospital San Juan de Dios Servicio de Ginecología 12 1998 1998 19 232 236

La incidencia de tuberculosis ha aumentado en los últimos años por diversos factores, entre ellos la pandemia del SIDA, las migraciones poblacionales, el deterioro de las condiciones económicas, etc. La tuberculosis genital es una entidad de curso insidioso e indolente que se manifiesta principalmente con infertilidad, amenorrea, sangrado uterino anormal y/o masa pélvica. El diagnóstico definitivo se hace a través de cultivo de flujo menstrual o biopsia endometrial para Mycobacterium tuberculosis. Debido a que esta afección es infrecuente, en la mayoría de los casos el diagnóstico se realiza posterior a una laparotomía realizada por otra causa. Se analiza el caso de una paciente asintomática de 40 años, portadora de una esterilidad primaria y sometida a cirugía por un hidrosalpinx bilateral. El diagnóstico final fue una salpingitis tuberculosa.

In recent years, the incidence of tuberculosis has increased due to the HIV pandemia, migrations, worsening of economic conditions, etc. Genital tuberculosis is a disease with unspecific or absent symptoms which makes diagnosis dificult. Infertility, amenorrea, abnormal uterine bleeding or a pelvic mass are the most frecuent manifestations. Microscopic examination and culture of infected body fluids and /or tissue are necessary for definite diagnosis. Freguently, diagnosis is made after surgery for other reasons. We present the case of a 40 year old patient with primary sterility who is taken to surgery for bilateral hidrosalpinx. Final diagnosis was tuberculous salpingitis.

 Tuberculosis genital femenina infertilidad masa pélvica Antígeno Ca-125 Female genital tuberculosis infertility pelvic mass Ca-125 antigen Robinson CA Rose NC Tuberculosis : Current Implications and Management in Obstetrics Obstet Gynecol Survey 1996 51 Boza R Fuchs J Manley D Tuberculosis multiresistente. A propósito de dos pacientes. Rev Cost Cienc Méd 1996 17 Boletín de Enfermedades de Declaración Obligatoria en Costa Rica 1987 - 1996: Cuadro #5 Boletín de Enfermedades de Declaración Obligatoria en Costa Rica 1987 - 1996: Cuadro #5 Carter JR Unusual presentations of genital tract tuberculosis Int-Gynaecol- Obstet 1990 33 Elder NC Extrapulmonary tuberculosis: A review Arch-Fam-Med 1992 1 Farga Victorino Tuberculosis Tuberculosis 2ed. Santiago de Chile Editorial Mediterráneo Figueroa R Martínez I Villagrana R Arredondo JL Tuberculosis of the female reproductive tract: effect on function Int-J-Fertil-Menopausal-Stud 1996 41 Aka N Vural EZ Evaluation of patients with active pulmonary tuberculosis for genital involvement J Obstet Gynaecol Res 1997 23 de-Vynck WE Kruger TF Joubert JJ Genital tuberculosis associated with female infertility in the western Cape S-Afr-Med-J 1990 77 Margolis K Wranz PA Kruger TF Joubert JJ Odendaal HJ Genital Tuberculosis at Tygerberg Hospital -prevalence, clinical presentation and diagnosis S-Afr-Med-J 1992 81 Emembolu JO Anyanwu DO Ewa B Genital tuberculosis in infertile women in northern Nigeria West-Afr-J-Med 1993 12 Ma YY Hsu TY Changchien CC Chang SY Lin JW Vulvovaginal tuberculosis : a case report Chang Keng I Hsueh 1997 20 Castelo C Mallofre C Torne A Gratacos E Iglesias X Primary adenocarcinoma of the endometrium associated with genital tuberculosis: A case report J Reprod Med 1995 40 Dhall K Das SS Dey P Tuberculosis of Bartholinís gland [letter]. Int J Gynaecol Obstet 1995 48 Parikh FR Nadkarni SG Kamat SA Genital tuberculosis -a major pelvic factor causing infertility in Indian women Fertil Steril 1997 67 Saracoglu OF Mungan T Tanzer F Pelvic tuberculosis Int J gynaecol Obstet 1992 37 Chang YC Chen RJ Wu RT Female genital tuberculosis : report of seven cases J Formos Med Assoc 1995 94 Simsek H Savas MC Kadayifci A Tatar G Elevated serum Ca-125 concentration in patients with tuberculous peritonitis : a case-control study Am J Gastroenterol 1997 92 Miranda P Jacobs AJ Roseff L Pelvic tuberculosis presenting as an asymptomatic pelvic mass with rising serum Ca-125 levels: A case report J Reprod Med 1996 41
S0253-294819980003 Revista Costarricense de Ciencias Médicas Rev. costarric. cienc. méd 0253-2948 Editorial Nacional de Salud y Seguridad Social S0253-29481998000300013 Prolactinoma resistente a bromocriptina: informe de un caso Castro A Virya Montvelisky K Herman ,Hospital San Juan de Dios 12 1998 1998 19 237 241

El adenoma hipofisario más frecuente es el prolactinoma. Esta patología de evolución usualmente benigna, se acompaña de amenorrea, galactorrea y/o síntomas por efecto de masa. Responde en forma muy efectiva a la bromocriptina, agonista dopaminérgico, disminuyendo la prolactina sérica a valores normales con desaparición de la galactorrea y permite recuperar el ciclo menstrual normal. Además tiene otros efectos como disminuir el tamaño de la masa tumoral. En el presente artículo se analiza el caso de una paciente de 22 años que inició control en el Hospital San Juan de Dios a los 17 años por amenorrea primaria, razón por la que fue sometida a cirugía por un prolactinoma resistente a bromocriptina.(Rev. Cost. de C. Méd. 1998-19 (3-4): 237-241)

The prolactinoma is the most frecuent pituitary adenoma. This pathology usually has a benign evolution and is asociated with amenorrhea, galactorrhea and/or mass effect symptoms. It responds in a very effective way to bromocriptine, a dopaminergic agonist, reaching normal values of prolactin with improvement of galactorrhea and a restoration of gonadal function. It is also effective in shrinking tumor size. In the present article, we analize the case of a 22 year old patient that began control in the Hospital San Juan de Dios 5 years before, with a diagnosis of primary amenorrhea. She had to undergo surgery due to a prolactinoma resistent to bromocriptine and she is actually pregnant.

 Prolactinoma Ago-nista Dopaminérgico Bromocriptina Resistencia a tratamiento Prolactinoma Dopamine Agonist Bromocriptine Drug Resistance Speroff León Clinical Gynecologic Endocrinology and Infertility Clinical Gynecologic Endocrinology and Infertility 1994 5de Baltimore^eMaryland Williams and Wilkins Mishell Daniel R. Infertility, Contraception and Reproductive Endocrinology Infertility, Contraception and Reproductive Endocrinology 1997 4ed Blackwell Science Vance Evans W Thorner M Bromocriptine Annals of Internal Medicine 1984 100 Brue T Pellegrini I Priou A Morenge I Jaquet P Prolactinomas and Resistence to Dopamine Agonists Horm Res 1992 38 Robert B Prolactinomas Resistant to Bromocriptine: Long Term Efficacy of Quinagolide and Outcome of Pregnacy Obstetrical and Gynecological Survey 1996 52 Thorner M Schran H Evans W Rogol AD Morris L MacLeod R A Broad Spectrum of Prolactin Suppression by Bromocriptine in Hyperprolactinemia Women: A Study of Serum Prolactim and Bromocriptine Levels after Acute and Chronic Administration of Bromocriptine J Clin Endocrinol Metab 1980 50 Brue T Pellegrini I Gunz G Effects of the Dopamine Agonist CV 205-502 in Human Prolactinomas Resistent to Bromocriptine J Clin Endocrinol Metab 1992 74 Morange I Barlier A Pellegrini I Brue T Enjalbert A Jaquet P Prolactinomas Resistent to Bromocriptine: long-term efficacy of quinagolide and outcome of pregnancy Eur J Endocrinol 1996 135 Colao A Di Sarno A Sarnacchiaro F Prolactinomas Resistent to Standard Dopamine Agonists Respond to Chronic Cabergoline Treatment J Clin Endocrinol Metab 1997 82 Vance M Cragon J Reimnitz C CV-205-502 Treatment of Hyperprolactinemia J Clin Endocrinol Metab 1989 68 Espinos J Rodríguez J Webb S Calaf J Long-acting repeatable bromocriptine in the treatment of patients with Microprolactinoma Intolerant or Resistent To Oral Dopaminergics Fertility and Sterility 1994 62 Wass J Williams J Charles Worth M Bromocriptine in Management of large Pituitary Tumours British Medical Journal 1982 284 Collo R Bouvier C Lagacé G Selective Deficiency of Guanine Nucleotide-Binding Protein Go in Two Dopamine-Resistent Pituitary Tumors Endocrinology 1980 122 Chiodini P Liuzzi A Cozzi R Size Reduction of Macroprolactinomas by Bromocriptine or Lisuride Treatment J Clin Endocrinol Metab 1981 53 Khalfallah Y Claustrat B Grochowicki M Effect of a New Prolactin Inhibitor, CV 205-502, in the Treatment of Human Macroprolactinomas J Clin Endocrinol Metab 1990 71 Ciccarelli E Giusti M Miola C Effectiveness and Tolerability of Long Term Treatment with Cabergoline, a New Long-Lasting Ergoline Derivate, in Hyperprolactinemic Patients J Clin Endocrinol Metabol 1989 69 Ferrari C Barbieri C Caldara R Long- Lasting Prolactin-Lowering Effect of Cabergoline, A New Dopamine Agonist, in Hyperprolactinemic Patients J Clin Endocrinol Metab 1986 63 Johnston D Prescott R Taylor P Hall K Crombie A Hyperprolactinemia: Long-Term Effects of Bromocriptine The American Journal of Medicine 1983 75
S0253-294819980003 Revista Costarricense de Ciencias Médicas Rev. costarric. cienc. méd 0253-2948 Editorial Nacional de Salud y Seguridad Social S0253-29481998000300014 Parasitismo en un precario de San José, Costa Rica Hernández Francisco León Denis Brenes Ana Robinson Christofer ,UCR San José Costa Rica ,Universidad de Costa Rica San José Costa Rica ,Universidad de Costa Rica San José Costa Rica ,Minsterio de Salud San José Costa Rica ,Ohio University Cincinnati U.S.A. 12 1998 1998 19 245 247

Las dos últimas encuestas nacionales realizadas sobre parasitosis intestinal en Costa Rica (1982, 1996) muestran una impresionante mejoría en las parasitosis intestinales, con tasas de helmintiasis menores del 5%. No obstante el problema está relegado a poblaciones marginales, como se demuestra en este trabajo. Se analiza la prevalencia de parásitos intestinales en 76 (56%) de los habitantes de un precario ubicado en Hatillo en las márgenes del río Tiribí, San José, Costa Rica. De cada individuo estudiado se analizó una muestra de heces por examen directo, Kato, Stoll y cultivo en agar para Strongyloides. El 45% de la población estudiada estaba parasitada por al menos un helminto o un protozoario. Los parásitos encontrados con mayor frecuencia fueron Entamoeba coli (27%), Trichuris (18%) y Ascaris (15%). Estos valores contrastan marcadamente con los hallados en las encuestas de parasitología realizadas en 1982 y 1996, en los cuales la prevalencia de helmintos intestinales fue de 5 y 3,8%, respectivamente. Ello demuestra que los estudios globales enmascaran los problemas de parasitismo intestinal de las poblaciones marginales y de otros grupos de alto riesgo y brindan un panorama ficticio que indica una mejoría general a nivel nacional.

The last two national surveys on intestinal parasitosis realized in Costa Rica (1982 and 1996) showed an impressive improvement of intestinal helmintiasis, with rates lower than 5%. Nevertheless, this problem is relegated to marginal communities, such as is demonstrated in this paper. Stool Samples of feces from 76 (56%) of the inhabitants of a squatter settlement near the Tiribí River, San José, Costa Rica were analyzed by direct wet smears, Kato, Stoll, and agar culture method to looking for Strongyloides. The forty-five percent of the people studied had at least one kind of intestinal parasites. The most frequently found parasites were Entamoeba coli (27%), Trichuris (18%), Ascaris (15%). These data prove that the problem of intestinal parasitosis is ongoing and is masked in national surveys that show a fictitiously low rates for the country.

 Parasitismo intestinal helmintiasis protozoosis comunidades precarias Mata L Pardo V Hernández F Albertazzi C Visconti M Mata A Fernández R Nuñez E Viscaíno M Cambios en la prevalencia de helmintos intestinales en Costa Rica: 1966-1982 Control and erarication of infectious diseases Control and erarication of infectious diseases 1985 Ser No.1 Washington DC PAHO Copubl Mata L Hernández F Pardo V Fascículo Helmintos intestinales Encuesta Nacional de Nutrición 1996 Encuesta Nacional de Nutrición 1996 1998 Ministerio de Salud Kossoff P Hernández F Pardo V Visconti M Zimmerman M Urban helminthiasis in two socioeconomically distinct Costa Rican communities Rev Biol Trop 1989 37 Koga K., Kasuya S. Khamboonruang C. Sukavat K Nakamura Y. Tani S. Ieda M. Tomita K. Tomita S. Hattan N. Mori M. Makino S. J Trop Med Hyg 1990 93 Cerdas L Parásitos intestinales en Costa Rica, 1996. Parásitos intestinales en Costa Rica, 1996.
S0253-294819980003 Revista Costarricense de Ciencias Médicas Rev. costarric. cienc. méd 0253-2948 Editorial Nacional de Salud y Seguridad Social S0253-29481998000300015 Hacer frente al SIDA: prioridades de la acción pública ante una epidemia mundial Boza Ricardo , 12 1998 1998 19 251 251