Revista médico científica

Prescription of non-pharmacological treatment for the management of chronic pain in primary care

Nilka Priscilla Arosemena Sandoval — 2025-10-04

Chronic pain is a common reason for medical attention and its proper management requires a multidisciplinary approach, including non-pharmacological measures. This study seeks to determine the characteristics of the prescription of non-pharmacological measures for the management of chronic pain.

METHODOLOGY: An observational cross-sectional study was carried out by applying a questionnaire to 127 primary care physicians from the CSS Metropolitan Region´s Polyclinics between March and April 2023, where the Fisher´s exact test and chi square test were performed to assess statistical significance in the differences between groups.

RESULTS: 94% of the physicians surveyed regularly see patients with chronic pain, and 86% use non-pharmacological measures in their treatment.

Among the measures used, physical rehabilitation (39%) and lifestyle changes (38%) were the most frequent. However, the main limitations identified were lack of time (35%) and lack of resources (32%). In addition, the most common diagnosis associated with the use of these measures was chronic pain secondary to osteoarthritis (32%).

CONCLUSIONS: Non-pharmacological measures are widely used for the management of chronic pain in primary care, although there are limitations to their use. However, more complex studies are needed to help evaluate the need for and impact of these measures on patients with chronic pain.

Nutritional characterization of patients with low diamine oxidase activity

Aissé Sainz — 2025-10-04

Diamine oxidase (DAO) deficiency, responsible for degrading histamine from dietary sources, has been associated with various symptoms such as migraine, gastrointestinal discomfort, allergies, and chronic fatigue. Despite its growing recognition in other countries, there is limited information in Panama regarding its prevalence and clinical characteristics, which hinders timely diagnosis and adequate nutritional treatment.

OBJECTIVE: The aim of this study was to describe the symptoms, diagnoses, and nutritional status of patients with low DAO activity treated at a primary care facility in Panama between January 2018 and February 2020.

METHODS: A descriptive, longitudinal, and retrospective study was conducted through the review of 116 clinical records of patients with low DAO activity treated at a health center in Panama. DAO deficiency was confirmed by blood testing of radioimmunoassay (RIA). Sociodemographic, anthropometric, biochemical, dietary, clinical, and lifestyle data were collected.

RESULTS: Of the patients, 85.3% were women and 54.3% were between 19 and 65 years old. DAO activity was intermediate in 70.7% and low in 29.3%. Obesity was observed in 39.7% and dyslipidemia in 31%. The most frequently reported symptoms were chronic fatigue (54.3%), intestinal cramps (52.6%), abdominal bloating (46.6%), and constipation (41.3%). Up to 43 types of food allergies were identified, with milk and casein being the most frequently reported.

CONCLUSION: The findings show that most patients with DAO deficiency were women with metabolic comorbidities, multiple food allergies, and diverse symptoms, highlighting the need to strengthen clinical nutritional care and further research on this condition in Panama.

Fungal pulmonary infection by aspergillus in solid organ transplantation managed with caspofungin

Cristel Medina Aguilar — 2025-10-04

Solid organ transplant recipients are sensitive to complications originating from the procedure itself, critical care, side effects of the medications used, and their immunosuppressive effect. The latter causes susceptibility to opportunistic infectious diseases, such as mycoses, which are the main cause of death in solid organ transplant recipients; and carry a great diagnostic challenge today. Aspergillosis is the most frequent invasive mold infection in solid organ transplant recipients. We will focus on invasive pulmonary aspergillosis, in liver transplant recipients managed with Caspofungin, a recently approved echinocandin for patients who are intolerant or refractory to standard treatment, highlighting the importance of choosing a rescue antifungal combined with the patient's clinical status to achieve optimal results and reduce mortality.

Tracheobronchomegaly (Mounier-Kuhn Syndrome) in a 75- year-old woman

Madonna Aparicio — 2025-10-04

Tracheobronchomegaly, or Mounier-Kuhn syndrome, is a little-known disease characterized by dilation of the trachea and main bronchi, associated with recurrent respiratory infections, bronchiectasis, tracheomalacia, and tracheal diverticula. We present the case of a 75-year-old female patient with recurrent respiratory infections, with radiological and bronchoscopic findings consistent with this condition. This case highlights the importance of suspecting this entity in patients with recurrent respiratory infections for timely management.

Maxillary sinus osteoma

Annie Ng Zhang — 2025-10-04

A 38-year-old female with a history of migraine presented to the emergency department due to increased intensity of her usual headache. A computed tomography scan revealed a well-defined, hyperdense, 5-millimeter lesion in the left maxillary sinus, consistent with an osteoma. This was an incidental finding, and the patient did not report any respiratory symptoms or signs of sinusitis. The case is representative of sinus osteomas, which are typically benign, asymptomatic, and slow-growing tumors. Although maxillary sinus involvement is uncommon, the imaging features were characteristic and did not suggest a more aggressive lesion. Since the patient had no local symptoms attributable to the osteoma, surgical treatment was not indicated. This case highlights the importance of recognizing these lesions on imaging studies and distinguishing them from other bone pathologies, as they often do not require intervention when asymptomatic and without functional or aesthetic consequences.

Internuclear bridging of erythroid precursors in a patient with invasive breast cancer and human immunodeficiency virus

Carlos Pan Ng — 2025-10-04

We present a medical image from a peripheral blood smear showing an internuclear bridge between erythroid precursors. This uncommon morphological finding has been primarily described in hematologic disorders, with no previous reports in patients with solid tumors. For this reason, we highlight the case of a 44-year-old female recently diagnosed with invasive ductal breast carcinoma. This finding suggests that metastatic tumors may impact hematopoiesis, potentially disrupting normal mechanisms of cell division.

Editorial

Harry Andre Wolfschoon Pérez — 2025-10-04

Genetic therapy

Stephany J. Morales Víquez — 2025-10-04