CARMEN CUARESMA - Academia.edu (original) (raw)

Papers by CARMEN CUARESMA

The American journal of tropical medicine and hygiene, 2005

The World Health Organization (WHO) scheme for classification of dengue severity was evaluated in... more The World Health Organization (WHO) scheme for classification of dengue severity was evaluated in a three-year study of 1,671 confirmed dengue cases in three Nicaraguan hospitals. The WHO classification of dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) was compared with the presence of hemorrhagic manifestations, signs of vascular permeability, marked thrombocytopenia, and shock in 114 infants, 1,211 children, and 346 adults. We found that strict application of the WHO criteria fails to detect a significant number of patients with severe manifestations of dengue, especially in adults.

The American journal of tropical medicine and hygiene, 2006

Dengue, the most prevalent arthropod-borne viral disease of humans, is caused by four serotypes o... more Dengue, the most prevalent arthropod-borne viral disease of humans, is caused by four serotypes of dengue virus (DENV 1-4). Although all four DENV serotypes cause a range of illness, defining precisely which clinical characteristics are associated with the distinct serotypes has been elusive. A cross-sectional study was conducted on 984 and 313 hospitalized children with confirmed DENV infections during two time periods, respectively, in the same hospitals in Nicaragua: a 3-year period (1999-2001) when DENV-2 accounted for 96% of the viruses identified, and the 2003 dengue season when DENV-1 predominated (87% of identified serotypes). When the two periods were compared, more shock (OR 1.91, 95% CI 1.35-2.71) and internal hemorrhage (OR 2.05, CI 1.16-3.78) were observed in the period when DENV-2 predominated, whereas increased vascular permeability was associated to a greater degree with the DENV-1 period (OR 2.36, CI 1.80-3.09). Compared with the DENV-2 period, the DENV-1 season was...

Endocrinología y Nutrición, 2010

Objectives: Results of studies on the prevalence of distal diabetic polyneuropathy (DPN) are cont... more Objectives: Results of studies on the prevalence of distal diabetic polyneuropathy (DPN) are contradictory. Conventional methods used for the diagnosis of DPN in clinical practice have limited effectiveness. The present study aimed to assess the prevalence of DPN in a population with long-standing diabetes (more than 10 years disease duration) by measuring vibratory, thermal and tactile sensitivities with quantitative sensory devices, as well as their relationship with associated clinical risk factors. Patients and methods: A total of 1011 diabetic patients were evaluated in a multicenter, cross-sectional, observational study. The three sensitivities were assessed by ultrabiothesiometer, aesthesiometer and thermoskin devices, respectively. The prevalence of neuropathic pain was validated by the DN4 questionnaire. Results: Of the 1011 cases included, 400 (39.6%) met the diagnostic criteria of DPN, while no DPN was found in the remaining 611 (60.4%). Of the 400 patients with DPN, 253 (63.2%) showed clinical manifestations, while 147 (36.8%) were diagnosed as subclinical DPN. The prevalence of DPN increased with disease duration. There was a progressive loss of the three sensitivities with increased disease duration, particularly thermal and vibratory sensitivities. This loss was statistically significant for the latter two sensitivities. Among patients with clinical DPN, 84.2% had painful neuropathic symptoms. The prevalence of DPN was positively related to micro-and macroangiopathic complications and with dyslipidemia. Conclusion: This study reveals a high degree of underdiagnosis of DPN, most likely due to the asymptomatic nature of the disease in a considerable proportion of patients. Our

PLOS Neglected Tropical Diseases, 2011

Dengue is a major public health problem worldwide and continues to increase in incidence. Dengue ... more Dengue is a major public health problem worldwide and continues to increase in incidence. Dengue virus (DENV) infection leads to a range of outcomes, including subclinical infection, undifferentiated febrile illness, Dengue Fever (DF), life-threatening syndromes with fluid loss and hypotensive shock, or other severe manifestations such as bleeding and organ failure. The long-standing World Health Organization (WHO) dengue classification and

Proceedings of SPIE, 1999

In this article we present the different groups of investigation which work at the Department of ... more In this article we present the different groups of investigation which work at the Department of Optics and Applied Physics of the University of Valladolid (Spain). The areas covered by these groups are the following: (1) optical diagnostic techniques in plasmas, (2) calculation of spectral line shapes, (3) atmospheric optics, (4) radiometry and photometry, and (5) history of science and

Rheumatology, 2007

in cooperation with the Juvenile Dermatomyositis Disease Activity Collaborative Study Group Ã Obj... more in cooperation with the Juvenile Dermatomyositis Disease Activity Collaborative Study Group Ã Objectives. Clinical care and therapeutic trials in idiopathic inflammatory myopathies (IIM) require accurate and consistent assessment of cutaneous involvement. The Cutaneous Assessment Tool (CAT) was designed to measure skin activity and damage in IIM. We describe the development and inter-rater reliability of the CAT, and the frequency of lesions endorsed in a large population of juvenile IIM patients. Methods. The CAT includes 10 activity, 4 damage and 7 combined lesions. Thirty-two photographic slides depicting IIM skin lesions were assessed by 11 raters. One hundred and twenty-three children were assessed by 11 paediatric rheumatologists at 10 centres. Inter-rater reliability was assessed using simple agreements and intra-class correlation coefficients (ICC). Results. Simple agreements in recognizing lesions as present or absent were generally high (0.5-1.0). ICCs for CAT lesions were moderate (0.4-0.75) in both slides and real patients. ICCs for the CAT activity and damage scores were 0.71 and 0.81, respectively. CAT activity scores ranged from 0 to 44 (median 7, potential range 0-96) and CAT damage scores ranged from 0 to 13 (median 1, potential range 0-22). The most common cutaneous lesions endorsed were periungual capillary loop changes (63%), Gottron's papules/sign (53%), heliotrope rash (49%) and malar/facial erythema (49%). Conclusions. Total CAT activity and damage scores have moderate to good reliability. Assessors generally agree on the presence of a variety of cutaneous lesions. The CAT is a promising, semi-quantitative tool to comprehensively assess skin disease activity and damage in IIM.

PLoS Neglected Tropical Diseases, 2011

The four dengue virus serotypes (DENV1-4) cause the most prevalent mosquito-borne viral disease a... more The four dengue virus serotypes (DENV1-4) cause the most prevalent mosquito-borne viral disease affecting humans worldwide. In 2009, Nicaragua experienced the largest dengue epidemic in over a decade, marked by unusual clinical presentation, as observed in two prospective studies of pediatric dengue in Managua. From August 2009-January 2010, 212 dengue cases were confirmed among 396 study participants at the National Pediatric Reference Hospital. In our parallel community-based cohort study, 170 dengue cases were recorded in 2009-10, compared to 13-65 cases in 2004-9. In both studies, significantly more patients experienced ''compensated shock'' (poor capillary refill plus cold extremities, tachycardia, tachypnea, and/or weak pulse) in 2009-10 than in previous years (42.5% [90/212] vs. 24.7% [82/332] in the hospital study (p,0.001) and 17% [29/170] vs. 2.2% [4/181] in the cohort study (p,0.001). Signs of poor peripheral perfusion presented significantly earlier (1-2 days) in 2009-10 than in previous years according to Kaplan-Meier survival analysis. In the hospital study, 19.8% of subjects were transferred to intensive care, compared to 7.1% in previous yearssimilar to the cohort study. DENV-3 predominated in 2008-9, 2009-10, and 2010-11, and full-length sequencing revealed no major genetic changes from 2008-9 to 2010-11. In 2008-9 and 2010-11, typical dengue was observed; only in 2009-10 was unusual presentation noted. Multivariate analysis revealed only ''2009-10'' as a significant risk factor for Dengue Fever with Compensated Shock. Interestingly, circulation of pandemic influenza A-H1N1 2009 in Managua was shifted such that it overlapped with the dengue epidemic. We hypothesize that prior influenza A H1N1 2009 infection may have modulated subsequent DENV infection, and initial results of an ongoing study suggest increased risk of shock among children with anti-H1N1-2009 antibodies. This study demonstrates that parameters other than serotype, viral genomic sequence, immune status, and sequence of serotypes can play a role in modulating dengue disease outcome.

$Research paper thumbnail of Assessment of 2D and 3D fractal dimension measurements of trabecular bone from high-spatial resolution magnetic resonance images at 3 T$

Medical Physics, 2010

In vivo two-dimensional ͑2D͒ fractal dimension ͑D 2D ͒ analysis of the cancellous bone at 1.5 T h... more In vivo two-dimensional ͑2D͒ fractal dimension ͑D 2D ͒ analysis of the cancellous bone at 1.5 T has been related to bone structural complexity and shown to be a potential imaging-based biomarker for osteoporosis. The objectives of this study were to assess at 3 T the in vivo feasibility of three-dimensional ͑3D͒ bone fractal dimension ͑D 3D ͒ analysis, analyze the relationship of D 2D and D 3D with osteoporosis, and investigate the relationship of D 3D with spinal bone mineral density ͑BMD͒. Methods: A total of 24 female subjects ͑67Ϯ 7 yr old, meanϮ SD͒ was included in this study. The cohort consisted of 12 healthy volunteers and 12 patients with osteoporosis. MR image acquisitions were performed in the nondominant metaphysis of the distal radius with a 3 T MR scanner and an isotropic resolution of 180 m. After segmentation and structural reconstruction, 2D and 3D boxcounting algorithms were applied to calculate the fractal complexity of the cancellous bone. D 2D and D 3D values were compared between patients with osteoporosis and healthy subjects, and their relationship with radius BV/TV and spinal BMD was also assessed. Results: Significant differences between healthy subjects and patients with osteoporosis were obtained for D 3D ͑p Ͻ 0.001͒, with less differentiation for D 2D ͑p = 0.04͒. The relationship between fractal dimension and BMD was not significant ͑r = 0.43, p = 0.16 and r = 0.23, p = 0.48, for D 2D and D 3D , respectively͒. Conclusions: The feasibility of trabecular bone D 3D calculations at 3 T and the relationship of both D 2D and D 3D parameters with osteoporosis were demonstrated, with a better differentiation for the 3D method. Furthermore, the D 3D parameter has probably a different nature of information regarding the trabecular bone status not directly explained by BMD alone. Future studies with subjects with osteopenia and larger sample sizes are warranted to further establish the potential of D 2D and D 3D in the study of osteoporosis.

Echocardiography, 1997

Background: Severe mitral regurgitation induces reversal of flow in the pulmonary veins. We hypot... more Background: Severe mitral regurgitation induces reversal of flow in the pulmonary veins. We hypothesized that severe tricuspid regurgitation may disrupt normal coronary sinus flow. The purpose of this study was to analyze the Doppler flow pattern of the coronary sinus and to determine its value i n the assessment of the severity of tricuspid regurgitation. Methods: The coronary sinus flow was analyzed i n 70 consecutive patients with some degree of tricuspid regurgitation (27 mild, 14 moderate, and 29 severe) and in 35 patients without tricuspid regurgitation. The coronary sinus flow was obtained by pulsed-Doppler transesophageal echocardiography in a transverse plane, which showed its drainage into the right atrium. Results: The number of patients with adequate studies of the coronary sinus tended to increase with the severity of the tricuspid regurgitation. I n patients without or with only mild tricuspid regurgitation the coronary sinus Doppler flow pattern was formed by two negative waves, a late systolic wave and another diastolic one with higher velocity and longer

Canadian Journal of Microbiology, 2007

The few studies that have reported the incidence of methicillin-resistant Staphylococcus aureus (... more The few studies that have reported the incidence of methicillin-resistant Staphylococcus aureus (MRSA) in Saudi Arabia have indicated that a diverse number of circulating MRSA strains have been detected in several major hospitals. Thus, this study was designed to track the presence of MRSA strains in major hospitals in Riyadh, Saudi Arabia, and perform comparative chromosomal DNA analysis of MRSA strains for epidemiological investigation using pulsed-field gel electrophoresis (PFGE). Correlation of the PFGE types generated with microbiological and clinical data of the isolates was attempted. Screening for decreased susceptibility to vancomycin among the isolates was also done. A dendogram was generated using PFGE macrorestriction fragments and 6 types were identified (M1–M6) with M1 being predominant and widespread. A clear link between PFGE types and some clinical and microbiological data available for the strains was found. For example, M1 was statistically associated with male pa...

Arthritis Research & Therapy, 2009

Introduction Evidence suggests that citrullinated fibrin(ogen) may be a potential in vivo target ... more Introduction Evidence suggests that citrullinated fibrin(ogen) may be a potential in vivo target of anticitrullinated protein/ peptide antibodies (ACPA) in rheumatoid arthritis (RA). We compared the diagnostic yield of three enzyme-linked immunosorbent assay (ELISA) tests by using chimeric fibrin/ filaggrin citrullinated synthetic peptides (CFFCP1, CFFCP2, CFFCP3) with a commercial CCP2-based test in RA and analyzed their prognostic values in early RA. Methods Samples from 307 blood donors and patients with RA (322), psoriatic arthritis (133), systemic lupus erythematosus (119), and hepatitis C infection (84) were assayed by using CFFCP-and CCP2-based tests. Autoantibodies also were analyzed at baseline and during a 2-year follow-up in 98 early RA patients to determine their prognostic value. Results With cutoffs giving 98% specificity for RA versus blood donors, the sensitivity was 72.1% for CFFCP1, 78.0% for CFFCP2, 71.4% for CFFCP3, and 73.9% for CCP2, with positive predictive values greater than 97% in all cases. CFFCP sensitivity in RA increased to 80.4% without losing specificity when positivity was considered as any positive anti-CFFCP status. Specificity of the three CFFCP tests versus other rheumatic populations was high (> 90%) and similar to those for the CCP2. In early RA, CFFCP1 best identified patients with a poor radiographic outcome. Radiographic progression was faster in the small subgroup of CCP2-negative and CFFCP1positive patients than in those negative for both autoantibodies. CFFCP antibodies decreased after 1 year, but without any correlation with changes in disease activity. Conclusions CFFCP-based assays are highly sensitive and specific for RA. Early RA patients with anti-CFFCP1 antibodies, including CCP2-negative patients, show greater radiographic progression.

Arthritis Care & Research, 2004

To document and evaluate the scores that normal, healthy children achieve when performing 9 maneu... more To document and evaluate the scores that normal, healthy children achieve when performing 9 maneuvers of the Childhood Myositis Assessment Scale (CMAS). A total of 303 healthy children, 4-9 years of age, were scored as they performed 9 CMAS maneuvers. The data were then evaluated to determine whether normal scores for some maneuvers are age and sex dependent. All children were able to achieve maximum possible scores for the supine to prone, supine to sit, floor sit, floor rise, and chair rise maneuvers. All but 2 4-year-olds achieved a maximum possible score for the arm raise/duration maneuver. Performance of the head lift and sit-up maneuvers varied significantly, depending primarily on age. Children in all age groups had less difficulty performing the leg lift than the head lift or sit-up. The normative data generated by this study are of value for interpreting the serial CMAS scores of children with idiopathic inflammatory myopathies.

Arthritis & Rheumatism, 2008

Objective. To provide preliminary validation of the Cutaneous Assessment Tool (CAT), a new tool t... more Objective. To provide preliminary validation of the Cutaneous Assessment Tool (CAT), a new tool to assess cutaneous manifestations of juvenile dermatomyositis (DM), and to explore the clinical meaning of CAT scores. Methods. Children with juvenile DM (n ‫؍‬ 113) were assessed at baseline and 7-9 months later (n ‫؍‬ 94). Internal consistency, redundancy, construct validity, and responsiveness of the CAT were examined. CAT scores corresponding to ordinal global assessments were determined. Results. Item-total correlations ranged from 0.27-0.67 for activity lesions present in >10% of patients; item-domain and domain-total correlations ranged from 0.25-0.99. Cronbach's alpha was 0.79 for the CAT activity score and 0.74 for the CAT damage score. As predicted, the CAT activity score correlated strongly with both global disease activity and skin disease activity and moderately with the Childhood Myositis Assessment Scale, whereas the CAT damage score correlated moderately with the physician global disease and skin disease damage scores. Median CAT activity scores of 1, 7, 13, 18, and 31 corresponded to absent, mild, moderate, severe, and extremely severe skin disease activity, respectively. Median CAT damage scores of 0, 1, 2, and 5 correlated with the same descriptions of damage (severe and extremely severe combined). Conclusion. Preliminary validation of the CAT demonstrated good internal consistency, nonredundancy, good construct validity, and appropriate responsiveness. The CAT is a comprehensive, semiquantitative assessment tool for skin disease in juvenile DM.

Arthritis & Rheumatism, 2004

To examine the measurement characteristics of the Childhood Myositis Assessment Scale (CMAS) in c... more To examine the measurement characteristics of the Childhood Myositis Assessment Scale (CMAS) in children with juvenile idiopathic inflammatory myopathy (juvenile IIM), and to obtain preliminary data on the clinical significance of CMAS scores. One hundred eight children with juvenile IIM were evaluated on 2 occasions, 7-9 months apart, using various measures of physical function, strength, and disease activity. Interrater reliability, construct validity, and responsiveness of the CMAS were examined. The minimum clinically important difference (MID) and CMAS scores corresponding to various degrees of physical disability were estimated. The intraclass correlation coefficient for 26 patients assessed by 2 examiners was 0.89, indicating very good interrater reliability. The CMAS score correlated highly with the Childhood Health Assessment Questionnaire (C-HAQ) score and with findings on manual muscle testing (MMT) (r(s) = -0.73 and 0.73, respectively) and moderately with physician-assessed global disease activity and skin activity, parent-assessed global disease severity, and muscle magnetic resonance imaging (r(s) = -0.44 to -0.61), thereby demonstrating good construct validity. The standardized response mean was 0.81 (95% confidence interval 0.53, 1.09) in patients with at least 0.8 cm improvement on a 10-cm visual analog scale for physician-assessed global disease activity, indicating strong responsiveness. In bivariate regression models predicting physician-assessed global disease activity, MMT remained significant in models containing the CMAS (P = 0.03) while the C-HAQ did not (P = 0.4). Estimates of the MID ranged from 1.5 to 3.0 points on a 0-52-point scale. CMAS scores corresponding to no, mild, mild-to-moderate, and moderate physical disability, respectively, were 48, 45, 39, and 30. The CMAS exhibits good reliability, construct validity, and responsiveness, and is therefore a valid instrument for the assessment of physical function, muscle strength, and endurance in children with juvenile IIM. Preliminary data on MID and corresponding levels of disability should aid in the clinical interpretation of CMAS scores when assessing patients with juvenile IIM.

Arthritis & Rheumatism, 1997

ABSTRACT Objective. To determine the reliability, content validity, and responsiveness of physici... more ABSTRACT Objective. To determine the reliability, content validity, and responsiveness of physician global assessments of disease activity and damage in the juvenile idiopathic inflammatory myopathies (IIM), and to investigate concordance among physician, parent, and patient global ratings.Methods. Sixteen pediatric rheumatologists rated 10 juvenile IIM paper patient cases for global disease activity and damage, and assessed the importance of 51 clinical and laboratory parameters in formulating their global assessments. Then, 117 juvenile IIM patients were enrolled in a protocol to examine the relationship between Likert and visual analog scale global assessments, their sensitivity to change, and the comparability of physician, parent, and patient global ratings.Results. Pediatric rheumatologists demonstrated excellent interrater reliability in their global assessments of juvenile IIM disease activity and damage (97.7% and 94.7% agreement among raters, respectively), and agreed on a core set of clinical parameters in formulating their judgments. Likert scale ratings correlated with those on a visual analog scale, and both were comparable in responsiveness (standardized response means −0.56 for disease activity, 0.02 [Likert] and 0.14 [visual analog] for damage, measured over 8 months). Parent global ratings of disease activity correlated with physician assessments, but were not colinear (Spearman's correlation [r] = 0.41−0.45). Patient global disease activity assessments correlated with those done by parents (r = 0.57−0.84) and physicians (r = 0.37−0.63), but demonstrated less responsiveness (standardized response means −0.21 and −0.12, respectively, over 8 months).Conclusion. Physician global assessments of juvenile IIM disease activity and damage demonstrated high interrater reliability and were shown to be comprehensive measures. Both physician and parent disease activity assessments should be considered valuable as quantitative measures for evaluating therapeutic responses in juvenile IIM patients.

The Annals of Thoracic Surgery, 1998

Internal mammary arteriovenous fistulas are a rare complication of sternotomy. We present a case ... more Internal mammary arteriovenous fistulas are a rare complication of sternotomy. We present a case of a 64-yearold woman with a poststernotomy fistula between the left mammary vein and artery with formation of a pseudoaneurysm with subcutaneous extension. We describe the different imaging techniques that led to the diagnosis and the resolution of the fistula via endovascular embolization.

Annals of Hematology, 2004

Genetic diagnosis is currently considered the most reliable method to accurately identify patient... more Genetic diagnosis is currently considered the most reliable method to accurately identify patients with acute promyelocytic leukemia (APL) requiring tailored therapy including all-trans retinoic acid (ATRA). We investigated the clinical effectiveness of immunofluorescence techniques with the anti-PML monoclonal antibody PG-M3 for rapid and accurate diagnosis of APL. PML immunofluorescence staining was analyzed in 164 patients with acute myeloblastic leukemia (AML), including APL (110 patients) and non-APL subtypes (54 patients). All 54 patients with an AML phenotype, in whom tests for t (15;17) or its fusion gene PML/RARα were negative, showed a speckled (macrogranular) nuclear pattern. Of the 110 genetically diagnosed APL patients, 108 showed a microgranular pattern that confirmed PG-M3 positivity. The remaining two patients were not evaluable for PG-M3 reactivity because of scarcity of cells. No patient with APL showed a normal pattern. The high sensitivity and specificity of immunolabeling using PG-M3 monoclonal antibody show that it is a highly efficient and reliable tool to identify PML/RARα-positive patients with APL and that it should be standardized as a first-line diagnostic procedure. In addition, it is technically simple, fast, and cheap, only requiring small tissue samples and nonsophisticated equipment.

Alzheimer's & Dementia, 2009

The American journal of …, 2005

To investigate age-related differences in dengue severity, 114 infants, 1,211 children, and 346 a... more To investigate age-related differences in dengue severity, 114 infants, 1,211 children, and 346 adults with laboratory-confirmed dengue virus (DEN) infections presenting to three hospitals in major urban centers in Nicaragua were recruited from 1999 to 2001. The age ...

… of psychology and …, 2006

Learning strategies in secondary-school students and relationship with self-steem. A con- siderab... more Learning strategies in secondary-school students and relationship with self-steem. A con- siderable number of studies have been published providing data in support of the hypothesis of a relationship between pupils' self-image and the selection and/or use of learning strategies. The main objective of the present work was to examine this hypothesis by exploring the relationship between high scores in self-esteem