Occurrence in Mexico, 1998-2008, of Vibrio cholerae CTX+ El Tor carrying an additional truncated CTX prophage.

The seventh cholera pandemic caused by Vibrio cholerae O1 El Tor (ET) has been superseded in Asia and Africa by altered ET possessing the cholera toxin (CTX) gene of classical (CL) biotype. The CL biotype of V. cholerae was isolated, along with prototypic and altered ET, during the 1991 cholera epidemic in Mexico and subsequently remained endemic until 1997. Microbiological, molecular, and phylogenetic analyses of clinical and environmental V. cholerae isolated in Mexico between 1998 and 2008 revealed important genetic events favoring predominance of ET over CL and altered ET. V. cholerae altered ET was predominant after 1991 but not after 2000. V. cholerae strains isolated between 2001 and 2003 and a majority isolated in 2004 lacked CTX prophage (Φ) genes encoding CTX subunits A and B and repeat sequence transcriptional regulators of ET and CL biotypes: i.e., CTXΦ(-). Most CTXΦ(-) V. cholerae isolated in Mexico between 2001 and 2003 also lacked toxin coregulated pili tcpA whereas some carried either tcpA(ET) or a variant tcpA with noticeable sequence dissimilarity from tcpA(CL). The tcpA variants were not detected in 2005 after CTXΦ(+) ET became dominant. All clinical and environmental V. cholerae O1 strains isolated during 2005-2008 in Mexico were CTXΦ(+) ET, carrying an additional truncated CTXΦ instead of RS1 satellite phage. Despite V. cholerae CTXΦ(-) ET exhibiting heterogeneity in pulsed-field gel electrophoresis patterns, CTXΦ(+) ET isolated during 2004-2008 displayed homogeneity and clonal relationship with V. cholerae ET N16961 and V. cholerae ET isolated in Peru.

Pseudomonas aeruginosa ATCC 9027 is a non-virulent strain suitable for mono-rhamnolipids production.

Rhamnolipids produced by Pseudomonas aeruginosa are biosurfactants with a high biotechnological potential, but their extensive commercialization is limited by the potential virulence of P. aeruginosa and by restrictions in producing these surfactants in heterologous hosts. In this work, we report the characterization of P. aeruginosa strain ATCC 9027 in terms of its genome-sequence, virulence, antibiotic resistance, and its ability to produce mono-rhamnolipids when carrying plasmids with different cloned genes from the type strain PAO1. The genes that were expressed from the plasmids are those coding for enzymes involved in the synthesis of this biosurfactant (rhlA and rhlB), as well as the gene that codes for the RhlR transcriptional regulator. We confirm that strain ATCC 9027 forms part of the PA7 clade, but contrary to strain PA7, it is sensitive to antibiotics and is completely avirulent in a mouse model. We also report that strain ATCC 9027 mono-rhamnolipid synthesis is limited by the expression of the rhlAB-R operon. Thus, this strain carrying the rhlAB-R operon produces similar rhamnolipids levels as PAO1 strain. We determined that strain ATCC 9027 with rhlAB-R operon was not virulent to mice. These results show that strain ATCC 9027, expressing PAO1 rhlAB-R operon, has a high biotechnological potential for industrial mono-rhamnolipid production.

Pseudomonas aeruginosa clinical and environmental isolates constitute a single population with high phenotypic diversity.

BACKGROUND: Pseudomonas aeruginosa is an opportunistic pathogen with a high incidence of hospital infections that represents a threat to immune compromised patients. Genomic studies have shown that, in contrast to other pathogenic bacteria, clinical and environmental isolates do not show particular genomic differences. In addition, genetic variability of all the P. aeruginosa strains whose genomes have been sequenced is extremely low. This low genomic variability might be explained if clinical strains constitute a subpopulation of this bacterial species present in environments that are close to human populations, which preferentially produce virulence associated traits. RESULTS: In this work, we sequenced the genomes and performed phenotypic descriptions for four non-human P. aeruginosa isolates collected from a plant, the ocean, a water-spring, and from dolphin stomach. We show that the four strains are phenotypically diverse and that this is not reflected in genomic variability, since their genomes are almost identical. Furthermore, we performed a detailed comparative genomic analysis of the four strains studied in this work with the thirteen previously reported P. aeruginosa genomes by means of describing their core and pan-genomes. CONCLUSIONS: Contrary to what has been described for other bacteria we have found that the P. aeruginosa core genome is constituted by a high proportion of genes and that its pan-genome is thus relatively small. Considering the high degree of genomic conservation between isolates of P. aeruginosa from diverse environments, including human tissues, some implications for the treatment of infections are discussed. This work also represents a methodological contribution for the genomic study of P. aeruginosa, since we provide a database of the comparison of all the proteins encoded by the seventeen strains analyzed.

Effects of Climate Change on the Distribution of Prosthechea mariae (Orchidaceae) and within Protected Areas in Mexico.

The impact of climate change on the distribution of native species in the Neotropics remains uncertain for most species. Prosthechea mariae is an endemic epiphytic orchid in Mexico, categorized as threatened. The objective of this study was to assess the effect of climate change on the natural distribution of P. mariae and the capacity of protected areas (PAs) to safeguard optimal environmental conditions for the species in the future. Historical records were obtained from herbaria collections and through field surveys. We utilized climate variables from WorldClim for the baseline scenario and for the 2050 period, using the general circulation models CCSM4 and CNRM-CM5 (RCP 4.5). Three sets of climate data were created for the distribution models, and multiple models were evaluated using the kuenm package. We found that the species is restricted to the eastern region of the country. The projections of future scenarios predict not only a substantial reduction in habitat but also an increase in habitat fragmentation. Ten PAs were found within the current distribution area of the species; in the future, the species could lose between 36% and 48% of its available habitat within these PAs. The results allowed for the identification of locations where climate change will have the most severe effects, and proposals for long-term conservation are addressed.

A Novel Dependoparvovirus Identified in Cloacal Swabs of Monk Parakeet (Myiopsitta monachus) from Urban Areas of Spain.

The introduction of invasive birds into new ecosystems frequently has negative consequences for the resident populations. Accordingly, the increasing population of monk parakeets (Myiopsitta monachus) in Europe may pose a threat because we have little knowledge of the viruses they can transmit to native naïve species. In this study, we describe a new dependoparvovirus detected by metagenomic analysis of cloacal samples from 28 apparently healthy individuals captured in urban areas of Madrid, Spain. The genomic characterization revealed that the genome encoded the NS and VP proteins typical of parvoviruses and was flanked by inverted terminal repeats. No recombination signal was detected. The phylogenetic analysis showed that it was closely related to a parvovirus isolated in a wild psittacid in China. Both viruses share 80% Rep protein sequence identity and only 64% with other dependoparvoviruses identified in Passeriformes, Anseriformes, and Piciformes and are included in a highly supported clade, which could be considered a new species. The prevalence was very low, and none of the additional 73 individuals tested positive by PCR. These results highlight the importance of exploring the viral genome in invasive species to prevent the emergence of novel viral pathogenic species.

Vibrio cholerae classical biotype strains reveal distinct signatures in Mexico.

Vibrio cholerae O1 classical (CL) biotype caused the fifth and sixth pandemics, and probably the earlier cholera pandemics, before the El Tor (ET) biotype initiated the seventh pandemic in Asia in the 1970s by completely displacing the CL biotype. Although the CL biotype was thought to be extinct in Asia and although it had never been reported from Latin America, V. cholerae CL and ET biotypes, including a hybrid ET, were found associated with areas of cholera endemicity in Mexico between 1991 and 1997. In this study, CL biotype strains isolated from areas of cholera endemicity in Mexico between 1983 and 1997 were characterized in terms of major phenotypic and genetic traits and compared with CL biotype strains isolated in Bangladesh between 1962 and 1989. According to sero- and biotyping data, all V. cholerae strains tested had the major phenotypic and genotypic characteristics specific for the CL biotype. Antibiograms revealed the majority of the Bangladeshi strains to be resistant to trimethoprim-sulfamethoxazole, furazolidone, ampicillin, and gentamicin, while the Mexican strains were sensitive to all of these drugs, as well as to ciprofloxacin, erythromycin, and tetracycline. Pulsed-field gel electrophoresis (PFGE) of NotI-digested genomic DNA revealed characteristic banding patterns for all of the CL biotype strains although the Mexican strains differed from the Bangladeshi strains in 1 to 2 DNA bands. The difference was subtle but consistent, as confirmed by the subclustering patterns in the PFGE-based dendrogram, and can serve as a regional signature, suggesting the pre-1991 existence and evolution of the CL biotype strains in the Americas, independent from Asia.

Cholera between 1991 and 1997 in Mexico was associated with infection by classical, El Tor, and El Tor variants of Vibrio cholerae.

Vibrio cholerae O1 biotype El Tor (ET), the cause of the current 7th pandemic, has recently been replaced in Asia and Africa by an altered ET biotype possessing cholera toxin (CTX) of the classical (CL) biotype that originally caused the first six pandemics before becoming extinct in the 1980s. Until recently, the ET prototype was the biotype circulating in Peru; a detailed understanding of the evolutionary trend of V. cholerae causing endemic cholera in Latin America is lacking. The present retrospective microbiological, molecular, and phylogenetic study of V. cholerae isolates recovered in Mexico (n = 91; 1983 to 1997) shows the existence of the pre-1991 CL biotype and the ET and CL biotypes together with the altered ET biotype in both epidemic and endemic cholera between 1991 and 1997. According to sero- and biotyping data, the altered ET, which has shown predominance in Mexico since 1991, emerged locally from ET and CL progenitors that were found coexisting until 1997. In Latin America, ET and CL variants shared a variable number of phenotypic markers, while the altered ET strains had genes encoding the CL CTX (CTX(CL)) prophage, ctxB(CL) and rstR(CL), in addition to resident rstR(ET), as the underlying regional signature. The distinct regional fingerprints for ET in Mexico and Peru and their divergence from ET in Asia and Africa, as confirmed by subclustering patterns in a pulsed-field gel electrophoresis (NotI)-based dendrogram, suggest that the Mexico epidemic in 1991 may have been a local event and not an extension of the epidemics occurring in Asia and South America. Finally, the CL biotype reservoir in Mexico is unprecedented and must have contributed to the changing epidemiology of global cholera in ways that need to be understood.

UPEC strain characterization isolated from Mexican patients with recurrent urinary infections.

INTRODUCTION: Any microorganism is capable of causing urinary tract infections (UTI). However, Uropathogenic Escherichia coli (UPEC) is responsible for the majority of UTI. A variety of virulence genes have been identified in UPEC. Diverse epidemiological studies support that specific subsets of genes are characteristic of each E. coli uropathogenic subtype involved in the development of cystitis, pyelonephritis, and urosepsis. METHODOLOGY: Twenty-three E. coli strains isolated from women with cystitis, 25 from men with prostatitis were characterized according to serotype, virulence genes, PFGE profile and susceptibility antimicrobials. RESULTS: E. coli O25:H4-ST131 was more frequently isolated from cystitis than prostatitis. The majority of cystitis strains presented almost all the virulence genes, contrary to 60% of prostatitis strains. The strains characterized by serology, PFGE and MLST and virulence profile showed that cystitis strains shared a lineage with their own genomic fingerprint, indicating that these strains derived from a common ancestor. The prostatitis strains showed serotypes diverse and much higher degree of genetic diversity, indicating that they are an unrelated group.  More than 50% of isolates were resistant to at least 7 of the antimicrobials tested. Antibiotic-tolerant cells were observed, presenting with more frequency in response chloramphenicol, tetracycline, trimethoprim-sulfometoxazole and dicloxicillin. CONCLUSIONS: Persister cells can be detected from the beginning of the infection. The importance of these persister cells that exhibit multidrug tolerance is that a single surviving bacterium can initiate again an infection making it clinical relevant in the chronic urinary tract infection.

Genetic characterization of atypical Citrobacter freundii.

The ability of a bacterial population to survive in different niches, as well as in stressful and rapidly changing environmental conditions, depends greatly on its genetic content. To survive such fluctuating conditions, bacteria have evolved different mechanisms to modulate phenotypic variations and related strategies to produce high levels of genetic diversity. Laboratories working in microbiological diagnosis have shown that Citrobacter freundii is very versatile in its colony morphology, as well as in its biochemical, antigenic and pathogenic behaviours. This phenotypic versatility has made C. freundii difficult to identify and it is frequently confused with both Salmonella enterica and Escherichia coli. In order to determine the genomic events and to explain the mechanisms involved in this plasticity, six C. freundii isolates were selected from a phenotypic variation study. An I-CeuI genomic cleavage map was created and eight housekeeping genes, including 16S rRNA, were sequenced. In general, the results showed a range of both phenotypes and genotypes among the isolates with some revealing a greater similarity to C. freundii and some to S. enterica, while others were identified as phenotypic and genotypic intermediary states between the two species. The occurrence of these events in natural populations may have important implications for genomic diversification in bacterial evolution, especially when considering bacterial species boundaries. In addition, such events may have a profound impact on medical science in terms of treatment, course and outcomes of infectious diseases, evading the immune response, and understanding host-pathogen interactions.

Propágulos de Rhizophora mangle (Rhizophoraceae) barrenados por Coccotrypes rhizophorae (Coleoptera: Curculionidae) en el manglar de Tumilco, Veracruz, México / Propagules of Rhizophora mangle (Rhizophoraceae) bored by Coccotrypes rhizophorae (Coleoptera: Curculionidae) in the Tumilco mangrove, Veracruz, México

Resumen: Los propágulos de las especies de manglar presentan una particular estrategia de superviviencia y dispersión. Desafortunadamente algunos reportes han afirmado que los propágulos de Rhizophora mangle son frecuentemente atacados por coleópteros y lepidópteros antes y después de su período de dispersión. El escarabajo Coccotrypes rhizophorae es un parásito obligado que puede causar la mortalidad de propágulos y plántulas de R. mangle, moldeando la estructura de sus poblaciones. Debido a la importancia de esta especie de mangle, su sobrevivencia y el aumento del impacto humano en la zona, este trabajo evaluó la presencia de propágulos barrenados por C. rhizophorae en el manglar de Tumilco, en el estado de Veracruz, México. Para esto, se establecieron tres zonas de muestreo: 1) manglar de R. mangle, 2) zona más impactada al borde de un camino de terracería con R. mangle y A. germinans, y 3) borde con Typha latifolia y R. mangle; en cada área, tres parcelas aleatorias de 25x25 m fueron analizadas. Se registró el número de propágulos barrenados por zona cada 15 días durante un año de muestreo (n= 567) de enero a diciembre 2012. También observamos el área dañada del propágulo (basal, medio, apical) y los propágulos barrenados vivos y muertos por temporada y los resultados para diferentes temporadas en el área: lluvias, nortes y secas. Los insectos fueron identificados por un experto. Nuestros resultados muestran un incremento en el número de propágulos barrenados durante la temporada de secas, principalmente en la zona 2 y 3. La supervivencia de los propágulos barrenados fue mayor cuando se presentó la perforación en el área basal, y durante la temporada de secas y nortes. En particular, la zona de estudio 2 presentó mayor número de propágulos vivos cuando el daño se encontró en el área basal del propágulo. En las tres zonas hubo mayor mortalidad cuando el daño fue apical. La zona 1 y 3 presentaron mayor supervivencia de propágulos durante las secas, mientras que en la zona 2 la supervivencia fue mayor durante la temporada de lluvias y nortes. El número de propágulos disminuyó conforme los niveles de inundación aumentaron. Los resultados muestran que C. rhizophorae tiene una amplia distribución en el manglar de Tumilco, pero la mortalidad de los propágulos de R. mangle está infuenciada por el área dañada, por la temporada del año y por las características de la zona en donde se encuentre la infestación. Se requieren estudios para evaluar la forma en que la mortalidad de los propágulos afecta la estructura poblacional de R. mangle.

Abstract: Mangrove species propagules represent a particular survival and dispersal strategy. Unfortunately, some reports have stated that Rhizophora mangle propagules are frequently attacked by Coleoptera and Lepidoptera before and after their dispersion period. The beetle species Coccotrypes rhizophorae is an obligate parasite that can cause mortality in propagules and seedlings of R. mangle, and may modify the structure of its populations. Because of the importance on this mangrove species, survival and increasing human impacts in the area, this study evaluated the presence of propagules with C. rhizophorae boring evidence in the Tumilco mangrove, in Veracruz State, Mexico. For this, three sampling areas were established: 1) mangrove core of R. mangle, 2) most impacted edge of an unpaved road with R. mangle and A. germinans, and 3) edge with Typha latifolia and R. mangle; in each area, three 25x25 m random plots were analyzed. The number of bored propagules per site was recorded every 15 days over a sampling period of one year (n= 567) from January to December 2012. We also observed the damaged part of the propagule (basal, central, apical) and the number of live and dead bored propagules per season, and compared results for different seasons in the area: rainy, cold northerly fronts or "norte" and dry. Insects were identified by an expert. Our results showed that a higher number of bored propagules was observed during the dry season, mainly in zones 2 and 3. Survival of bored propagules was higher when the perforation occurred in the basal part of the plant, and during the dry and norte seasons. Study zone 2 in particular presented a higher number of live propagules when the damage occurred in the basal part of the propagule. In all three zones, mortality was higher when the damage was apical. Zones 1 and 3 presented higher propagule survival during the dry season, while survival in zone 2 was higher during the rainy and norte seasons. The number of propagules decreased with rising flooding levels. The results showed that C. rhizophorae has a wide distribution in the Tumilco mangrove, but the mortality of R. mangle propagules is influenced by the part of the propagule that suffers damage, as well as by the season of the year and the characteristics of the area in which the infestation occurs. Futher studies are required to evaluate the impact of propagule mortality on the population structure of R. mangle. Rev. Biol. Trop. 65 (3): 1120-1128. Epub 2017 September 01.

Humoral immunity in tuberculin skin test anergy and its role in high-risk persons exposed to active tuberculosis.

The most common test to identify latent tuberculosis is the tuberculin skin test that detects T cell responses of delayed type hypersensitivity type IV. Since it produces false negative reactions in active tuberculosis or in high-risk persons exposed to tuberculosis patients as shown in this report, we studied antibody profiles to explain the anergy of such responses in high-risk individuals without active infection. Our results showed that humoral immunity against tuberculin, regardless of the result of the tuberculin skin test is important for protection from active tuberculosis and that the presence of high antibody titers is a more reliable indicator of infection latency suggesting that latency can be based on the levels of antibodies together with in vitro proliferation of peripheral blood mononuclear cells in the presence of the purified protein derivative. Importantly, anti-tuberculin IgG antibody levels mediate the anergy described herein, which could also prevent reactivation of disease in high-risk individuals with high antibody titers. Such anti-tuberculin IgG antibodies were also found associated with blocking and/or stimulation of in vitro cultures of PBMC with tuberculin. In this regard, future studies need to establish if immune responses to Mycobacterium tuberculosis can generate a broad spectrum of reactions either toward Th1 responses favoring stimulation by cytokines or by antibodies and those toward diminished responses by Th2 cytokines or blocking by antibodies; possibly involving mechanisms of antibody dependent protection from Mtb by different subclasses of IgG.

“Las raíces de la psicopatología moderna. La melancolía y la esquizofrenia” / No disponible

No disponible

Un caso de trastorno de la conducta alimentaria en la infancia / A case of eating behavior disorder in childhood

No disponible

El deseo y el poder: problemas del discurso de la medicina basada en la evidencia aplicado a salud mental / Desire and power: problems of evidence-based medicine discourse applied in mental health

En este trabajo analizamos las variables de deseo y de poder que están presentes en todos los discursos y, en particular, que atraviesan al discurso de la Medicina Basada en la Evidencia en su aplicación dentro del ámbito de la salud mental, por lo que la introducción nos servirá de marco definitorio de dichas variables. Seguidamente partiremos de las dificultades que la adopción del enfoque de la Medicina Basada en la Evidencia encuentra dentro de la práctica clínica de la salud mental y que nos hacen dudar de su condición de nuevo paradigma científico. Con el fin de comprender cómo la Medicina Basada en la Evidencia se convierte en un discurso atravesado por el deseo y el poder, examinaremos los elementos retóricos que ayudan a establecer en ciencia la verdad de una proposición cualquiera para, posteriormente, dilucidar de qué forma se adquieren y actúan en el discurso científico el deseo y el poder. Para finalizar abordaremos brevemente las implicaciones éticas y las consecuencias epistemológicas que conllevan el conocimiento del deseo y el poder en el discurso de la Medicina Basada en la Evidencia(AU)

In this work we analyze variables of desire and power which are present in all discourses and, in particular, that cross Evidence-Based Medicine discourse in its application inside the field of mental health. Therefore, introduction will serve us as a frame to define those variables. Afterwards we will start from difficulties that the adoption of Evidence-Based Medicine approach finds inside clinical practice of mental health, and how that difficulties make us doubt about its condition as new scientific paradigm. With the purpose of uderstanding how Evidence-Based Medicine becomes in a discourse crossed by desire and power, we will examine rhetorical elements which help to establish the truth of any proposition in science in order to elucidate, subsequently, how desire and power are acquired and acted in scientific discourse. To conclude we will raise briefly ethical implications and epistemological consequences that are involved by the knowledge of desire and power in Evidence-Based Medicine discourse(AU)

Parto vertical: retornando a una costumbre ancestral / Vertical childbirth: return to an ancestral tradition

OBJETIVO: Determinar las ventajas del parto vertical frente al parto horizontal. DISEÑO: Estudio observacional, comparativo y transversal. LUGAR: Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima, Perú. PARTICIPANTES: Gestantes que tuvieron parto vertical o parto horizontal.INTERVENCIONES: Entre junio 2006 y junio 2007 se estudió 160 parturientas, 80 de las cuales tuvieron parto vertical (PV) y 80, parto horizontal (PH). PRINCIPALES MEDIDAS DE RESULTADOS: Tiempo de expulsivo, volumen de sangrado uterino, necesidad de episiotomía, complicaciones, percepción de la madre. RESULTADOS: El tiempo de expulsivo fue menor para el parto vertical frente al parto horizontal (11,39 min y 19,48 min, respectivamente). El volumen de sangrado promedio fue similar en ambos grupos (300 mL y 296,74 mL). Considerando el uso y el no uso de oxitocina posparto, se encontró diferencias estadísticamente significativas en el volumen de sangrado,siendo mayor cuando no se usó oxitocina. La maniobra de Kristeller casi fue innecesaria para el parto vertical (1,3 por ciento), mientras fue realizada en 16 pacientes con parto horizontal (20 por ciento). Se requirió la episiotomía con menor frecuencia para el parto vertical que para el parto horizontal (26,5 por ciento vs. 56,3 por ciento). Se necesitó instrumentación del parto en solo dos casos de parto horizontal (1 vacuum, 1 fórceps de salida). Se presentó un hematoma vaginal y una hemorragia posparto,para el parto horizontal, sin diferencia estadísticamente significativa. Hubo más desgarros vaginales en el grupo de parto vertical (en quienes no se realizó episiotomía), pero de poca profundidad (83 por ciento vs. 60 por ciento). Respecto a la percepción de la madre sobre el parto vertical, este fue percibido como más rápido, más cómodo y menos doloroso; la mayoría de las mujeres con parto vertical tuvo la satisfacción de ver la salida de su bebé (96,3 por ciento vs. 42,5 por ciento).

OBJECTIVE: To determine the advantages of vertical childbirth over supine confinement. DESIGN:Observational, comparative and cross sectional study. SETTING: Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima, Peru, a medical residency hospital. Participants: Pregnant women who had either vertical or supine childbirth. INTERVENTIONS: We studied 160 women from June 2006 through June 2007; 80 had vertical delivery and 80 supine childbirth. Main outcome measures: Time of delivery, uterine bleeding volume, episiotomy need, complications, maternal perception. RESULTS: Time for third stage of labor was shorter in vertical versus supine confinement (11,39 versus 19,48 minutes respectively). Average bleeding volume was similar in both groups (300 mL and 296,74 mL respectively). Considering the use and non-use of post partum oxytocin, significant higher bleeding volume was encountered when oxytocin was not used in both groups. Kristeller’s maneuver was hardly necessary for vertical delivery (1,3 per cent) but it was performed in 16 patients with supine childbirth (20 per cent). Episiotomy need was less for vertical delivery (26,5 per cent and 56,3 respectively). Instrumentaldelivery was required in two supine childbirth cases (1 vacuum, 1 output forceps). There was one case of vaginal hematoma and one postpartum hemorrhage with supine childbirth, withno statistical significance. There were more vaginal superficial tears in the vertical delivery group when episiotomy was not done (83 per cent and 60 per cent respectively). Mothers perceived vertical birth as faster, more comfortable and less painful; they enjoyed seeing their babies being born (96,3 per cent vs. 42,5 per cent respectively) and vertical childbirth was recommended by most women from both groups (81,9 per cent of the 160 women). CONCLUSIONS: Vertical delivery offers significant...

Experiencia de una innovación pedagógica / A pedagogy innovation experience

En el presente artículo de reflexión sobre cómo implementar innovaciones en educación médica, el autor parte del análisis de la experiencia de un caso de implementación de una innovación pedagógica en una facultad de medicina. Basado en una realidad encontrada, realiza un ejercicio de diagnóstico sobre los problemas que impiden un adecuado desarrollo de la innovación y formula una propuesta metodológica original de cómo implementar innovaciones pedagógicas. Dicha propuesta incluye el cuadro de mando integral como elemento organizacional y la andragogía como base teórica en el proceso de aprendizaje individual y organizacional.

Anticuerpos contra mitocondrias, corazón y perinúcleo. ¿Asociación con el título de anticuerpos anticardiolipina en el síndrome antifosfolípido primario?: estudio exploratorio / Seric antibodies as antiheart, antimithocondrial and antiperinuclear. These antibodies es related to the anticardiolipin antibodies level. Exploratory study

En el suero de pacientes con síndrome antifosfolípido primario se han descrito anticuerpos antimitocondriales (AM), anticorazón (ACOR) y contra perinúcleo (AP); algunos se nagativizan al inhibir los sueros con micelas de cardilipina. Decidimos evaluar si la fecuencia de AM, ACOR y AP tiende a aumentar en proporción directa al título de anticuerpos anticardiolipina (aCL). Se incluyeron sueros de pacientes: 12 con SAFP y 3 con lupus eritematoso sistémico. Se distribuyeron en 3 grupos de 5 sueros cada uno según el título de aCL (ensayo inmunoenzimático, punto de corte densidad óptica 0.21). Grupo bajo (DO de 0.816 a 1.360) y grupo alto (DO de 1.850 a 3.000). Detección de AM, ACOR y AP por inmunofluorescencia indirecta. Los resultados fueron: positivos, grupo bajo (O), grupo medio MA y ACOR en 1/5 y AP en 1/5 respectivamente, grupo alto ACOR y AP en el 20 por ciento (1/5), ACOR en el 20 por ciento (1/5), y AP en el 40 por ciento (2/5) y AM en 0 por ciento. Observamos tendencia a mayor frecuencia de ACOR y AP en relación directa a título de aCL y aunque el tamaño de la muestra no permite ser concluyente, los resultados justifican estudios posteriores para dilucidar este aspecto

Diagnostic methods of primary tuberculous pleural effusion in a region with high prevalence of tuberculosis

Objetivo. 1) Determinar la distribución de edad de los pacientes con derrame pleural tuberculoso, como una manifestación de tuberculosis primaria, en una región de alta prevalencia de tuberculosis. 2) Evaluar la eficacia de diferentes métodos diagnósticos usados en dicha patología. Sitio. El Instituto Nacional de Enfermedades Respiratorias de la ciudad de México (hospital de tercer nivel de referencia de enfermedades respiratorias). Diseño. Estudio retrospectivo. Pacientes. Se revisaron 452 expedientes de pacientes diagóstico de derrame pleural que ingresaron de enero de 1991 a septiembre de 1996; fueron incluídos 133 con diagnóstico de derrame pleural tuberculoso de presentación primaria y sin anormalidades parenquimatosas en la radiografía de tórax. Fueron excluídos aquéllos con reactivación de la tuberculosis o con derrame no tuberculoso. Resultados. Fueron 133 pacientes con edad media 42 ñ 17 años (98 hombres, 35 mujeres). Se observaron granulomas pleurales en el estudio morfológico en 87 por ciento mientras que la baciloscopía y el cultivo del líquido pleural fueron positivos en el 8 por ciento y 19 por ciento respectivamente. La determinación de la adenosíndesaminasa (ADA) dio una eficiencia diagnóstica de 84 por ciento. Conclusiones. 1) La tuberculosis pleural de presentación primaria, como se reporta en la literatura, se presentó en adultos en México; 2) la biopsia pleural continuó siendo el método diagnóstico más efectivo en el diagnóstico; 3) la determinación de la ADA en un área de alta prevalencia de la enfermedad resultó un método barato y confiable

Correlación adenosindesaminasa/linfocitos en el líquido pleural de origen tuberculoso / Adenosindeaminase/lymphocyte correlation in pleural liquid of tuberculosis

El presente estudio fue llevado a cabo para evaluar prospectivamente la correlación entre la actividad de la adenosindesaminasa, (ADA) y la proporción de linfocitos en líquido pleural en una región de alta prevalancia de tuberculosis. Durante el periodo de 1991 a 1996 se estudiaron 222 pacientes que ingresaron al Instituto Nacional de Enfermedades Respiratorias con diagnóstico de derrame pleural tuberculoso (TB) y secundario a cáncer (Ca). Hubo 133 TB y 89 Ca, (146 hombres y 76 mujeres). Todos los pacientes fueron diagnosticados con los métodos convencionales. La edad promedio de los pacientes con TB fue 42 ñ 17 y los Ca 61 ñ 13, (-x ñ D.E.). El nivel medio de la actividad de la ADA en el grupo TB (101.6 ñ 41.3 U/L) fue significativamente más alto (p< 0.0001) que en Ca (24.3 ñ 19.1). El porcentaje de linfocitos en el líquido pleural de los pacientes con TB fue 75.5 ñ 16.6 contra 66.8 ñ 17.1 de los Ca (p < 0.0001). La relación entre los niveles de ADA y el porcentaje de linfocitos en líquido pleural de los dos grupos estudiados produjo una significativa curva de regresión (r = 0.750, p< 0.0001), la cual mostró una correlación positiva entre estos dos parámetros. Estos resultados nos sugieren: 1) que la ADA puede ser un buen marcador de inmunidad mediada por células y 2) que existe una buena correlación entre los niveles de ADA y la proporción de linfocitos en líquido pleural tuberculoso