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Contextualización: la zona de transición acuático terrestre (ZTAT) en la planicie de inundación (llanura aluvial) Ramsar Ayapel (Colombia), permanece inundada más de la mitad de un año y su franja litoral genera una fuerte influencia en el ecosistema. Una aproximación a la caracterización espacial y temporal de esta zona es fundamental para un posterior análisis funcional, especialmente cuando, a excepción de algunos ecosistemas amazónicos, las planicies de inundación tropical son poco exploradas. Vacío de conocimiento: la dinámica de las planicies de inundación está regulada principalmente por los pulsos de inundación, que influyen directamente en las condiciones físicas y químicas del agua y el sedimento; por lo anterior, la biota presenta adaptaciones a las condiciones de inundación y anegamiento del ecosistema. Sin embargo, las investigaciones han abordado la fase terrestre y acuática como sistemas separados, haciéndose necesario acudir a metodologías que evidencien la conectividad en el sistema y faciliten la interpretación de factores clave en el funcionamiento ecológico en los humedales tropicales. Propósito: la investigación analizó la estructura y el funcionamiento de la ZTAT a través de variables físicas y químicas en diferentes momentos del pulso de inundación. Metodología: en dos humedales del complejo cenagoso, sensibles al pulso de inundación, se realizaron tres muestreos: aguas en ascenso (julio de 2021); aguas altas (septiembre de 2021); y aguas en descenso (marzo de 2022). Se monitoreó la ZTAT delimitándola en cuatro subzonas: agua, sedimentos, suelo inundable y suelo. Resultados y conclusiones: se revelaron cambios significativos en el tiempo asociados al nivel del agua y a las concentraciones de nitrógeno; mientras en el espacio, asistido por el contraste de la ZTAT en los dos sitios, se reflejaron diferenciaciones a través de las variables in situ y las características del suelo. Se detectó que la profundidad, transparencia y una mayor concentración de formas de nitrógeno y algunos iones como aluminio y magnesio generaron diferencias a nivel temporal; mientras la conductividad, concentración del calcio y variables asociadas a las características del suelo lo expresaron a nivel espacial gracias a la exploración de la ZTAT; por tanto, la dinámica fisicoquímica de momentos y sitios en un humedal requiere un diseño de muestreo que por medio de la ZTAT facilita la escala de análisis fisicoquímico.

Abstract Megaselia scalaris, commonly known as the scuttle fly, is a cosmopolitan species in the family Phoridae. It is an easily cultured fly species that is an emerging model organism in the fields of genetics and developmental biology. Its affinity for carrion and its predictable life cycle makes it useful in the field of forensic science for estimating the post-mortem interval (PMI) of human remains. Cases of human myasis caused by M. scalaris have also been reported in the medical literature. Despite its ubiquitous prevalence and its relevance across multiple fields, its morphology has not been adequately characterized. Here, we report the complete morphological characterization of all lifestages of M. scalaris, ranging from egg to adult. Scanning electron microscopy has enabled us to uncover morphological features and developmental processes that have previously not been reported in the literature. Our data lays the groundwork for future genetic studies: a morphological characterization of the wild type must be performed before mutants displaying different phenotypes can be identified. In this vein, we also report the observation of a acephalic, or 'headless’, adult phenotype whose study could yield insights into the process of cephalogenesis. Finally, all morphological features observed have been compiled into an ’atlas’ that should be of use to all workers in the field.

Abstract Background One hour plasma glucose concentration (1hPG) during an oral glucose tolerance test (OGTT) may be an alternative to 2-h plasma glucose concentration (2hPG) in the identification of individuals at increased risk of hyperglycaemia, although its role is not fully understood. Aim We aim to investigate the relationship of these measures with other glucose parameters, as well as their relationship with cardiometabolic risk markers and the level of agreement for prediabetes mellitus diagnosis, in a sample of patients with morbid obesity. Methods We retrospectively evaluated 656 patients with morbid obesity without diagnosed diabetes. To define prediabetes with 2hPG, 2022 American Diabetes Association guidelines criteria were used, while for 1hPG, glucose ≥ 155 mg/dL was considered. Cohen’s Kappa coefficient was used to assess the agreement between both measures of prediabetes mellitus diagnosis. Results A Cohen’s Kappa coefficient of 0.405 (p

El presente artículo describe el marco jurídico institucional del reconocimiento del derecho humano al agua en el Ecuador, con el propósito de contar con el sustento cualitativo para el diseño de una metodología que permita medir la implementación de dicho derecho. Para ello, analiza las circunstancias que influyeron en su consagración y la manera en que las normas deberían emplearse a la hora de garantizar su contenido. La investigación utiliza como base el informe de la Organización de los Estados Americanos sobre el abordaje del derecho humano al agua en algunos países de Centroamérica y lo adapta a la realidad ecuatoriana, así como otros en relación con la inclusión de la población vulnerable. Además, lleva a cabo un análisis exegético, haciendo un recorrido histórico de la protección del agua en Ecuador a nivel constitucional y legal, así como un recuento de los diarios de debates de la Asamblea Constituyente de 2008. Los resultados del estudio se presentan en función de las variables diseñadas por el Relator Especial del Derecho Humano al Agua y al Saneamiento. El trabajo concluye que si bien existe un reconocimiento normativo del derecho al agua, la debilidad institucional influye de manera negativa para su efectiva realización.

Abstract Bariatric surgery (BS) can lead to remission of type 2 diabetes mellitus (T2DM), however, the evidence on the influence of preoperative serum magnesium levels on this reversal is scarce. To study the influence of preoperative serum magnesium levels on the pre-T2DM and T2DM remission one year after BS. Retrospective study carried out among 1656 patients with obesity who underwent BS in the Centro Hospitalar Universitário São João. T2DM and pre-T2DM remission were defined as being normal glycaemic measures of at least one year’s after BS and without pharmacological therapy. To assess the association between preoperative serum magnesium levels and pre- and T2DM remission, logistic regression models, crude and adjusted for sex, age and body mass index were computed. Patients with normoglycaemia presented hypomagnesaemia less often than those patients with pre-T2DM and T2DM (17.0% vs. 21.3% vs. 39.9%) (p

Citizen science has grown as a promising way to promote scientific education and democracy. However, the realization of these goals has been hampered as most programs in educational and other settings have used top-down approaches (where scientists direct the whole research path). Here we present a school bottom-up initiative, where students’ interests are raised and collaborative projects are developed in academies formed by students, teachers and scientists. Projects addressing local territorial identities are especially motivated by the program. In this work, we explored: (i) diversity of interests, (ii) learning outcomes, and (iii) the scientific quality of the projects. In two years of implementation in the intercultural south of Chile, we have worked with 52 academies, in projects covering a variety of research topics, including some that seek to rescue Mapuche’s traditional knowledge. We have observed the promotion of scientific and socioemotional skills in students, and projects have been judged of high quality by independent panels of experts. These results support the feasibility of citizen science to promote learning and to foster links between school and scientific institutions towards a more democratic scientific development.

Abstract Background The clinical characteristics and complications of Cushing syndrome (CS) are well known and described in the literature. Nevertheless, rare, atypical presentations may go unnoticed. Osteonecrosis is a well-documented complication of glucocorticoid therapy. However, endogenous hypercortisolism is a rare, but relevant, cause of bone avascular necrosis. We describe the case of a woman with CS undiagnosed for 2 years after presenting with femoral avascular necrosis. Case presentation A 38-year-old Caucasian woman was referred for evaluation of secondary amenorrhea, associated with oral contraception withdrawal in the context of deep venous thrombosis (DVT). She had a previous right hip arthroplasty for treatment of avascular necrosis of the femoral head, diagnosed after 3 years of progressive right hip pain and limited mobility. She also had high blood pressure (HBP) of 5 years’ duration, and reported weight gain (4 kg in 2 years). There was no history of infertility (gravida 2, para 2). Physical examination revealed buffalo hump, truncal obesity, facial plethora, muscular atrophy and proximal myopathy, and easy bruising (under anticoagulant treatment for DVT). Workup showed abnormal overnight dexamethasone suppression test (DST) (serum cortisol 21.5 µg/dL; normal < 1.8 µg/dL), elevated 24-hour urinary free cortisol (UFC) (728.9 µg/day; reference range 36.0–137.0 µg/day), and suppressed plasma adrenocorticotropic hormone (ACTH) (< 1.0 pg/mL), findings consistent with ACTH-independent CS. Urinary metanephrines and catecholamines were normal, and the remaining analytical study showed no major changes, apart from glycated hemoglobin (HbA1c) of 6.8%. Adrenal computed tomography (CT) scan showed a 25 mm lesion in the left adrenal gland, with density non-suggestive of adenoma. The patient underwent unilateral adrenalectomy and started steroid replacement. Histology revealed an adrenal cortex adenoma. Three months after surgery the patient presented with resolution of HBP and hypercortisolism (UFC 37.4 µg/day; reference range 36.0–137.0 µg/day). Conclusion In some cases, CS signs may go unnoticed and the diagnosis postponed. Avascular necrosis is a rare presenting feature of endogenous hypercortisolism, and, if left untreated, complete collapse of the femoral head may ensue, rendering the need for hip replacement in up to 70% of patients. Suspicion and recognition of atypical features is therefore important in avoiding complications and delay in treatment of CS.

Introduction: Despite the abundance of data addressing the influence of patient’s age on surgery-related complications, its impact on cardiometabolic outcomes following bariatric surgery has been overlooked. Methods: Retrospective unicentric study of 1,728 obese patients who underwent bariatric surgery between January 2010 and June 2015. Patients were divided in 3 age groups, according to their age at surgery: ˂40 (n = 751), 40–59 (n = 879), and ≥60 years (n = 98). Parameters with cardiometabolic impact, such as body anthropometric measures, lipid profile, and glycemic status, before and 24 months after surgery, were compared between these groups. A multiple linear regression was performed, adjusting differences between groups for sex, surgery type, and body mass index variation. Results: The group ˂40 years presented more weight loss (–35.4 ± 9.0 kg, p ˂ 0.001), greater BMI reduction (–15.8 ± 6.1 kg/m2, p ˂ 0.001), and larger changes in waist (–34 ± 13.8 cm, p ˂ 0.001) and hip circumferences (–28.7 ± 11.9 cm, p ˂ 0.05). The group of ≥60 years presented the heaviest reduction in fasting glucose (–17.7 ± 32.8 mg/dL, p ˂ 0.001) and HbA1c (0.7 ± 1.0, p ˂ 0.001), and also had a tendency to have the biggest changes in systolic blood pressure (–14.7 ± 18.7 mm Hg, p = 0.071). Conclusion: Patients with ≥60 years benefit the most from bariatric surgery regarding cardiometabolic parameters, presenting heavier reductions in fasting glucose, as well as HbA1c and a tendency towards a higher decrease in systolic blood pressure. No clinically significant differences in lipid profile were observed between groups.

Introduction: The association between obesity and depression has been repeatedly established. However, little is known about the impact that the diagnosis of depression before bariatric surgery (DDBS) may have on weight loss. Objective: To evaluate the impact of DDBS on weight outcomes. Methods: Retrospective study of patients submitted to BS. Patients with no weight, no current medication data, or those submitted to revision surgery were excluded. Patients were considered to have DDBS based on taking antidepressants prior to BS or if there was a medical history of past or current depression. Patients with and without a depression history were compared using independent t test. A multivariate logistic regression model was created to evaluate predictors of weight variation (variables included: age, sex, and type of surgery). Results: A total of 616 patients did not have a history of depression and 230 had DDBS. There was a statistically significant difference in the BMI variation between groups. On average, individuals with DDBS lost 1.4 kg/m2 less than those without DDBS. In the multivariate analysis, the group with DDBS, compared with the group without DDBS, presented on average less –0.9 kg/m2 (95% CI –1.7 to –0.2, p = 0.018) BMI variation. Conclusion: DDBS is a predictor of lower weight loss after the surgical procedure. Even after adjusting for confounding variables such as age, sex, and BS type, this effect remains.

Abstract Prior to bariatric surgery, endocrine causes of obesity must be excluded. The diagnosis of osteoporosis in a male requires the study of secondary causes of this condition. The diagnostic delay of Cushing's syndrome may have irreversible consequences.

Innovative alternatives in the classroom are essential due to the limitations of the master class. In this sense, technological advances have allowed new alternatives for interactive teaching, where Cinema is a significant example of medical education. Through Cinema it is possible to contextualize basic, clinical and even humanistic concepts of diseases; Therefore, this study presents a filmbased experience of the teaching of infectious diseases and microbiology. We review the historical, epidemiological, microbiological and clinical aspects of Syphilis through the Miss Evers' boys film, selecting key scenes for each aspect, and comparing them with current literature. The results showed that the film reflects important elements of the progress, diagnosis, and treatment of syphilis; where the understanding of the students improves, even in the absence of scenes about the complete development of the disease; therefore, we propose this strategy as a useful and meaningful tool for learning in this and other areas.

BackgroundObesity is a multifactorial disease, which is strongly associated to other metabolic disorders. Bariatric surgery is the most effective treatment of morbid obesity. The role of beta cell function in weight loss after bariatric surgery is uncertain.AimTo evaluate the association between beta cell function and percentage of total body weight loss (TBWL%) 1, 2, 3, and 4 years after bariatric surgery in patients with morbid obesity.MethodsRetrospective longitudinal study in patients with morbid obesity followed in our center between January 2010 and July 2018. Patients were excluded if they had diabetes at baseline or missing data on the needed parameters. We evaluated baseline Homeostatic Model Assessment of IR, Homeostatic Model Assessment of β-cell function (HOMA-beta), Quantitative Insulin Sensitivity Check Index, and Matsuda and DeFronzo index, and TBWL% at years 1 to 4. Linear regression models were used to evaluate the association of indexes of insulin resistance with TBWL% (unadjusted and adjusted for age, sex, BMI, and type of surgery).ResultsThere were 1,561 patients included in this analysis. HOMA-beta was negatively associated with TBWL% at second, third, and fourth years post-surgery (β = −1.04 [−1.82 to −0.26], p

Introduction: Bariatric surgery is an effective treatment for morbid obesity and its metabolic related comorbidities. However, the literature reports inconsistent results regarding weight loss (WL) and the resolution of comorbidities associated with obesity. Objective: We aim to evaluate long-term differences in WL between different surgical techniques and the impact of each surgical technique on metabolic parameters (type 2 diabetes mellitus [T2DM], dyslipidemia,hypertension, and metabolic syndrome). We also aim to evaluate the effect of baseline clinical characteristics in WL and in the evolution of metabolic syndrome (MetS) components. Our hypothesis is that different types of surgery have different effects on WL and the prevalence of comorbidities over time. Methods: We retrospectively evaluated WL and metabolic parameter remission (T2DM, dyslipidemia, hypertension, and MetS) during 4 years in 1,837 morbidly obese patients (females, 85%; age, 42.5 ± 10.6 years; BMI, 44.0 ± 5.8) who underwent bariatric surgery (Roux-en-Y gastric bypass [RYGB], laparoscopic sleeve gastrectomy [LSG], and laparoscopic adjustable gastric band [LAGB]). Results: The mean percentage of WL for RYGB, LSG, and LAGB was, respectively, 32.9 ± 8.7, 29.8 ± 9.8, and 16.2 ± 9.6 at 12 months and 30.6 ± 9.1, 22.7 ± 10.0, and 15.8 ± 10.8 at 48 months (p < 0.001), even after adjustment for baseline weight, BMI, age, and sex (p < 0.001). Women had more WL during the first 36 months (p = 0.013 and 0.007 at 12 and 36 months, respectively) and older patients had less WL compared to younger ones (p

A partir de una metodología proveniente de los estudios de derecho/literatura, este artículo se propone establecer las relaciones intertextuales existentes entre la sentencia Gelman vs. Uruguay (dictada por la Corte Interamericana de Derechos Humanos) y la obra literaria y paraliteraria del escritor Juan Gelman. Esta comparación entre ambos archivos permite vislumbrar los dolorosos sucesos en torno a la desaparición de varias personas de la familia del autor argentino, en el marco de la Operación Cóndor de las dictaduras del Cono Sur, que se entienden y se resuelven de mejor manera en sede judicial atendiendo al poder de las palabras que rellenan los vacíos de la sentencia. Efectivamente, nuestra hipótesis es que para comprender cuestiones como el medio probatorio, la reparación jurídica o las afectaciones en el contexto de los derechos humanos, los textos literarios pueden ocupar, contrario a lo que ha mantenido la doctrina jurídica, un lugar trascendente. Esto, a la par, intenta demostrar el poder que tiene la literatura para entrar en ciertos documentos jurídicos así como la necesidad de cuestionar compartimentos tan excluyentes del saber.

BackgroundAn association between hypothyroidism and the risk of Non-alcoholic Fatty Liver Disease (NAFLD) has been suggested. This association remains to be elucidated in patients with morbid obesity.AimTo evaluate the association between thyroid function and parameters of liver function and hepatic scores in patients with morbid obesity.MethodsPatients with morbid obesity followed in our center between January 2010 and July 2018 were included. The ones without evaluation of liver and thyroid functions were excluded. Fatty Liver Index (FLI) and BARD scores were used as predictors of hepatic steatosis and fibrosis, respectively.ResultsWe observed a positive association between TSH and both BARD (OR 1.14; p = 0.035) and FLI (OR 1.19; p = 0.010) in the unadjusted analysis. We found a negative association between free triiodothyronine levels and BARD (OR 0.70; p

Este documento aborda duas questões principais: Que museu podemos criar através da prática teatral? E, que tipo de prática teatral podemos criar através da perspectiva do museu? Esta análise crítica tem como ponto de partida a rela- ção entre estas duas instâncias culturais: o Museu e o Teatro (principalmente a sua prática como disciplina artística). O objectivo deste trabalho é definir algumas linhas e formas de reflexão sobre estes processos curatoriais, musealização, preservação e institucionalização da memória e história do teatro. Por outro lado, este trabalho visa também dar algumas novas formas de pensar uma nova concepção do lugar do museu com base nas características que definem a prática teatral. Este exercício de uma análise crítica e também de uma complementaridade e oposição de duas perspectivas e lugares diferentes será o veículo da apresentação de alguns estudos de caso que apoiarão a sua argumentação: Um Museu Vivo de Memórias Pequenas e Esquecidas, de Joana Craveiro (2014), O Gabinete das Curiosidades, de Karnart (desde 2012) e a obra de Alexandra do Carmo Tudo foi Capturado (mesmo os movimentos da Cabra) (Galeria Quadrum, 2011).

The removal of necrotic and vital pulp substrates and microorganisms and their toxins from the root canal system (RCS) has been found to be the basis for a successful endodontic treatment. In this study, our aim was to evaluate the effect of passive ultrasonic irrigation (PUI) on the elimination of the organic remnant tissue from infected, narrow and curved mandibular root canals during their instrumentation. For this purpose, mesiobuccal canals from mandibular first molars were instrumented with the RaCe rotary system, using PUI activation or conventional irrigation (CI) and two apical diameters (#25 and #35). The root canal cleanness of the samples was evaluated by microscopy and using a modified Langeland’s ordinal scale. Parametric and non-parametric statistical analyses and principal coordinates analysis (PCoA) of the samples were performed. When PUI was used, there was a significant reduction of the organic remnant in the apical enlargement of 25 at 2 mm from the apex (p < 0.001). After pooling the groups, regardless of the depth of the observation (2 and 4 mm from the apex), the pair #35 + PUI vs. #25 + CI showed statistically significant differences (p < 0.001). The effect of PUI explained 65% of the overall variance when compared with the CI samples. The use of PUI reduced the organic material of narrow infected and curved root canals with an apical enlargement of #25 and #35. When PUI is not used, a biomechanical instrumentation up to a diameter ≥#35 is recommended.

La obligatoriedad de las Opiniones Consultivas de la Corte Interamericana de Derechos Humanos se sostiene en los principios rectores del Derecho Internacional Público y las normas de interpretación de los tratados internacionales. Cuando se ratifica un tratado y el órgano encargado de su supervisión emite una interpretación autorizada, los Estados Parte deben cumplir de buena fe con esta interpretación. Durante estos años, el cuestionamiento de la obligatoriedad de las Opiniones Consultivas ha tenido un largo debate doctrinario en los distintos países de Latinoamérica. El objetivo principal de este trabajo es aportar argumentos para reforzar la obligación que tienen los jueces de aplicar los estándares contenidos en la Opinión Consultiva 24/17, realizando el respectivo control de convencionalidad de sus decisiones y tomando en cuenta que los tratados e instrumentos internacionales de derechos humanos forman parte del ordenamiento jurídico a través del bloque de constitucionalidad, como ha sido reconocido por la Corte Constitucional en sus diversas sentencias. Sostenemos que la tarea de los jueces no puede limitarse a observar normas expresas contenidas en textos constitucionales e infraconstitucionales, sino que debe abarcar un control de convencionalidad que garantice el efectivo goce y ejercicio de los derechos fundamentales de toda persona.

La menopausia es el periodo de transición en que la mujer culmina su edad reproductiva y trae consigo cambios anatómicos y fisiológicos, manifestados principalmente por síntomas vasomotores y urogenitales, con gran afectación de la calidad de vida de las pacientes. Es de gran importancia conocer las alternativas terapéuticas que existen, la evidencia que las respalda, y así ofrecer la mejor alternativa según indicaciones, eficacia, perfil de efectos adversos y contraindicaciones de cada una. Métodos: Se realizó una búsqueda y selección de la literatura en las bases de datos Cochrane, Pubmed, SciELO, JAMA, en idiomas español e inglés, sin restricción de fecha. Conclusiones: Las terapias actuales no son satisfactorias, bien sea por la baja eficacia en el control de los síntomas o por su asociación con efectos adversos de importancia. Es necesario evaluar acuciosamente el riesgo-beneficio de cada intervención.

INTRODUCCIÓN: en la preparación del sistema de canales radiculares se debe lograr una conformación progresivamente cónica desde apical hacia coronal, sin generar accidentes de procedimiento. Se define como transportación al cambio de ubicación espacial del canal radicular con respecto a su ubicación original, produciéndose así el desgaste no proporcional de alguna de las paredes dentinarias en relación con la anatomía original de este. Durante la última década, se han fabricado nuevos instrumentos endodónticos rotatorios con base en níquel-titanio (NiTi), lo que provee mayor flexibilidad y resistencia a la fractura, disminuye el tiempo de trabajo y la fatiga del operador, facilitando así la conformación adecuada del canal y reduciendo accidentes durante los procedimientos. MÉTODOS: estudio in vitro, de 45 canales radiculares humanos superiores e inferiores con curvaturas severas seleccionados a través de radiografías convencionales. Se formaron 3 grupos de 15 conductos que fueron preparados con los sistemas de instrumentación rotatoria antes mencionados. Se utilizó tecnología Cone beam para registro de imágenes previas y posteriores a la instrumentación, las que se tomaron a través de rodetes de silicona conformando una arcada dentaria con la idea de ser un montaje reproducible posinstrumentación. Se hicieron mediciones en los cortes tomados a los 2, 4, 6, y 8 mm desde el ápice por canal instrumentado, en cada corte se hicieron 4 mediciones, pared vestibular, lingual, furca y cara libre. Los datos obtenidos fueron analizados mediante test Wilcoxon para muestras pareadas y el test ANOVA. RESULTADOS Y CONCLUSIONES: el los resultados indican que el sistema ProTaper Universal (Dentsplay-Maillefer, Switzerland) produce mayor transportación del canal radicular a nivel del tercio medio en comparación con los sistemas RaCe (FKG-Dentaire, Switzerland) y K3 (SybrondEndo, USA). Además el sistema K3 mostró un desgaste más conservador a los 2, 4 y 6 mm de instrumentación de los canales radiculares haciéndolo recomendable para instrumentación de canales finos y curvos.

Avaliamos o rendimento diagnóstico da fibrobroncoscopia óptica no diagnóstico de tuberculose pulmonar com baciloscopia negativa em pacientes atendidos em um hospital de referência em Lima, Peru. Dos 611 pacientes submetidos ao procedimento, 140 (23%) foram diagnosticados com tuberculose com base nas amostras de LBA. Ser mais jovem e do sexo masculino foi associado a culturas positivas. Além disso, 287 pacientes realizaram baciloscopia de escarro após a broncoscopia, e os resultados aumentaram o rendimento diagnóstico em 22% em relação às amostras de LBA. Concluímos que amostras de LBA e de escarro pós-broncoscopia tiveram um bom rendimento diagnóstico nos pacientes com suspeita de tuberculose pulmonar com baciloscopia negativa.We evaluated the diagnostic yield of fiberoptic bronchoscopy for the diagnosis of smear-negative pulmonary tuberculosis in patients treated at a referral hospital in Lima, Peru. Of the 611 patients who underwent the procedure, 140 (23%) were diagnosed with tuberculosis based on the analysis of BAL samples. Being young and being male were significantly associated with positive cultures. In addition, 287 patients underwent post-bronchoscopic sputum smear testing for AFB, the results of which increased the diagnostic yield by 22% over that obtained through the analysis of BAL samples alone. We conclude that the analysis of BAL samples and post-bronchoscopic sputum samples provides a high diagnostic yield in smear-negative patients suspected of having pulmonary tuberculosis.

We report a case of severe toxoplasmosis in an immunocompetent patient, characterized by pneumonia, retinochoroiditis, hepatitis and myositis. Diagnosis was confirmed by serology, T. gondii in thick blood smear and presence of bradyzoites in muscle biopsy. Treatment with pyrimethamine plus sulfadoxine was successful but visual acuity and hip extension were partially recovered. This is the first case report of severe toxoplasmosis in an immunocompetent patient from Peru.Reportamos un caso de toxoplasmosis severa en un paciente inmunocompetente caracterizado por neumonía, retinocoroiditis, hepatitis y miositis. El diagnóstico fue confirmado por serología, el hallazgo de T. gondii en gota gruesa y la presencia de bradizoitos en biopsia muscular. El tratamiento con pirimetamina mas sulfadoxina fue exitoso pero solo hubo una parcial recuperación de la agudeza visual y de la capacidad de extensión de la cadera. Este es el primer reporte de un caso de toxoplasmosis severa en el Perú.