Diagnostic performance of faecal and tissue multiplex qPCR IS900/F57 for the detection of Mycobacterium avium subspecies paratuberculosis in cattle.

Mycobacterium avium subspecies paratuberculosis (MAP) is responsible for bovine-paratuberculosis (bPTB), which causes high production losses in cattle. A cross-sectional study was conducted in 228 cattle to evaluate the validity and diagnostic utility of a multiplex real-time PCR (qPCR) on faecal and intestinal samples [ileocaecal valve (ICV) and ileocaecal lymph nodes (ICLN)], using intestinal tissue culture as a reference test. Based on the sensitivity, specificity, and likelihood ratios (LR) obtained, the diagnostic value of faecal qPCR for confirming MAP infection was moderate (sensitivity 50.3%, specificity 93.5%, positive LR 7.8), and low to rule it out (negative LR 0.5). In areas with a prevalence of >23% the credibility of positive results was higher than 70%. In the case of negative results, their credibility was higher than 90% in herds with an infection rate below 19%, so faecal qPCR would be very useful in these areas to certify the absence of infection. For post-mortem diagnosis, qPCR on ICV samples showed good diagnostic accuracy to confirm the disease (sensitivity 71.7%, specificity 93.3%, positive LR 10.8), with a credibility higher than 70% in animals from areas or herds with a prevalence of infection greater than or equal to 18%. The best strategy to rule out the disease was the parallel combination of both tissues (ICV + ICLN) (sensitivity 81.3%, specificity 89.5%, negative LR 0.2) with a credibility of over 95% in animals from areas with an infection prevalence of 0-20%. Faecal and tissues qPCR techniques can be used to monitor bPTB, the interpretation of results, according to epidemiological situation of the herd or area, are shown.

Real-Time PCR Validation for Mycobacterium tuberculosis Complex Detection Targeting IS6110 Directly From Bovine Lymph Nodes.

Rapid and accurate diagnostic tools, such as Real-Time PCR (qPCR), need to be implemented as a confirmatory test in the framework of bovine tuberculosis (bTB) surveillance and control programs, shortening the turnaround time to confirm bTB infection. The present study aimed to evaluate a direct qPCR from fresh tissue samples targeting the insertion sequence IS6110 using individually homogenized bovine lymph nodes compared with microbiological culture. Retropharyngeal, tracheobronchial, and mesenteric lymph nodes fresh tissue samples (n = 687) were collected from 230 different cattle carcasses at the slaughterhouse. Only 23 of the 230 examined animals showed tuberculosis-like lesions, with 62 of 230 considered as positive. Among these 62 animals, 61 resulted as culture-positive, whereas 48 were qPCR-positive. Thus, this qPCR targeting IS6110 showed an apparent diagnostic sensitivity and specificity values of 77.1% [95% confidence interval (CI): 66.5-87.6%] and 99.4% (95% CI: 98.3-100.6%), respectively, and a positive predictive value of 97.9% (95% CI: 93.9-102.0%) and negative predictive value of 92.3% (95% CI: 88.4-96.2%). Positive and negative likelihood ratios were 130.2 and 0.2, respectively, and the agreement between microbiological culture and this qPCR was almost perfect (κ = 0.82). These results highlight this qPCR targeting IS6110 as a suitable complementary method to confirm bTB in animals with either tuberculosis-like lesions or non-tuberculosis-like lesions, decreasing the number of samples subjected to microbiological culture and, hence, its overall associated costs and the turnaround time (under 48 h) to confirm bTB infection. Besides, sampling mesenteric lymph node, which is uncommonly sampled, together with tracheobronchial and retropharyngeal ones, is advisable during postmortem inspection in bTB surveillance programs at the slaughterhouse, especially in areas with a low bTB prevalence scenario.

[Acute silicosis. An infrequent pneumoconiosis]. / Silicosis aguda, una neumoconiosis rara.

BACKGROUND: Acute Silicosis was first described in 1900 by Betts. It's also denominated as silicoproteinosis. It's an infrequent way of pneumoconiosis which is produced when sandblasting. CLINICAL CASE: 27 year old male who has been working for four years in a glass shop, etching them through sandblasting. Four years before with dyspnea on exertion rapidly progressing. Coughing spell, emetic and wheezing, with daily hyaline expectoration of 50 cc, yearly weight loss of 44 lbs and intense chest pain. Breathing rates 36X'. He was polypneic, with basal bilateral crackling rales. Thorax X-rays shows Mengeaux Festoon, right lung apex, rounded opacities between 3 and 10 mm in diameter, type 2/2 r/r in the ILO 2000 Classification. Opacities in the left lung flux to mix into a honeycomb shape type B silicoma. Cardiac silhouette frayed and Grade 1 Cardiomegaly. Dies five years after his condition started. CONCLUSIONS: This kind of operations should be prohibited unless an industrial safety program using a Self-Contained Breathing Apparatus (SCBA) is applied.

Introducción: la silicosis aguda fue descrita inicialmente en 1900 por Betts. Se le denomina también silicoproteinosis alveolar. Es una forma infrecuente de neumoconiosis producida al utilizar chorro de arena (sandblast) para pulir. Caso clínico: masculino de 27 años, trabajó 4 años en un expendio de vidrios, esmerilándolos por medio de chorro de arena. Padecimiento de 4 años con disnea de esfuerzos rápidamente progresiva hasta mínimos esfuerzos, tos seca, emetizante y disneizante, con expectoración hialina 50 ml diarios, pérdida de 20 kg de peso en 1 año y dolor torácico generalizado de tipo pungitivo intenso. Frecuencia respiratoria 36X´ frecuencia cardiaca 120X´, estertores crepitantes basales bilaterales. En la telerradiografía de tórax se observa festón de Mengeaux en hemidiafragma derecho y en el vértice derecho, opacidades redondeadas entre 3 y 10 mm de diámetro tipo 2/2 r/r de la Clasificación de la OIT, 2000. En el pulmón izquierdo las opacidades confluyen formando un silicoma tipo B e imágenes en panal de abeja. Silueta cardiaca deshilachada y cardiomegalia grado 1. Fallece a los 5 años de iniciado su padecimiento. Conclusiones: se deben prohibir estas operaciones o aplicar programa de higiene industrial con uso de respirador autónomo.

Cement dust exposition and bronchioalveolitis. A case report.

The goal of the current investigation was to report an unusual case of a worker acutely exposed to big amounts of cement dust. This exposure caused chemical bronchioalveolitis and dermatitis due to chromium contact. This person suffered the exposure when a cement deposit exploded at work. This exposed the worker to big amounts of cement dust. After the accident, the individual suffered dyspnea and bilateral basal pulmonary crackles. The subject also presented an atypical restrictive pattern, which could also be seen on X-rays as 1/1 q/q images of the classification of 2000 of the International Labour Organization (ILO), and a bulging of a pulmonary artery. A restrictive pattern pure atypical was observed, and arterial blood gas with hipoxemia. A treatment with steroids was prescribed and the worker showed some improvement. There is high risk of developing pulmonary fibrosis with the progressive evolution in stages of the bronchioalveolitis, even when the subject is isolated. Therefore, it would be very convenient to create a specialized medical center where workers that have this kind of accidents can have the proper care by qualified personnel.

El objetivo de esta publicación es informar del caso poco habitual de un trabajador expuesto de forma aguda a grandes cantidades de cemento, lo cual le produjo un cuadro de broncoalveolitis química industrial y dermatitis de contacto por cromo. El trabajador sufrió un accidente de trabajo cuando se rompió un depósito de cemento y lo expuso a cantidades muy elevadas del polvo de cemento. Presentó disnea de grandes esfuerzos, con estertores crepitantes basales bilaterales. Tuvo, asimismo, una frecuencia respiratoria de 32 por minuto y rash cutáneo. La espirometría mostró un patrón restrictivo atípico incipiente que se correlacionó radiográficamente con imágenes 1/1 q/q de la Clasificación del 2000 de la Organización Internacional del Trabajo (OIT) y abombamiento de la arteria pulmonar. En la gasometría arterial efectuada al trabajador se encontró hipoxemia en posición de decúbito supino. Se prescribió tratamiento esteroideo con mejoría del padecimiento. Dado que hay un alto riesgo de que la fase aguda de las broncoalveolitis termine en fibrosis pulmonar por su evolución en etapas (pues son progresivas aunque se suspenda la exposición), se sugiere crear un servicio especializado, atendido por personal calificado, para el manejo médico de este tipo de accidentes.

[Gynecological care to children and adolescents. Twelve-year experience at National Pediatrics Institute, Mexico]. / Atenció ginecológica a niñas y adolescentes. Doce años de experiencia en el Instituto Nacional de Pediatría.

BACKGROUND: In major regions of the world, the importance of gynecological care to children and adolescents has been recognized. There are multiple publications, journals and associations dedicated to this purpose. In Mexico, it has not been the case. OBJECTIVE: The aim of this publication is to raise awareness to the medical community about the importance of sub specialized gynecological care to children and adolescents. MATERIAL AND METHODS: Retrospective study. The number of office evalu- ations issued by the Department of Gynecology of the National Institute of Pediatrics (INP) from January 1, 2002 to December 31, 2013 were counted. Results were grouped by age groups. Group 1: 1 year or less. Group 2: 2 to 9 years. Group 3: 10 to 18 years. The major causes of morbidity were analyzed by groups and in general. RESULTS: In the 12 year period reported, 21,190 girls granted gynecological consultation: 15.2% were first consultations (n = 3,221), 74.76% subsequent consultations (n = 15,842) and 10.04% evaluations and interconsultations (n = 2,127). The yearly average was 1,766 consultations. From 2002 to 2005, two certififyed obstetrician-gynecologists (OB-GYN) worked in the Departament, with the subsecuent increase in the number of attentions; 2005 was the year with the highest productivity (2,265). From 2006, only one OB-GYN continued laboring, and the number of visits decreased gradually. 2013 was the year with fewer productivity (1,351). The main causes of morbidity were: abnormal uterine bleeding (26.48%), inflammatory conditions of vagina and vulva (13.58%), dysmenorrhea (12.31%); which occupied 52.37% of the total (10,404 / 19,867). 81% of the patients corresponded to group 3 (17,079/21,190). To a younger patient, corresponded a smaller number of visits. CONCLUSION: It is required to institute the subspecialty of Child and Adolescent Gynecology in Mexico and to establish Services formed by subspecialists in this matter in the top pediatric hospitals of the country.

[Scientific evidence on the legalization of abortion in Mexico City]. / Evidencias científicas en torno a la legalización del aborto en la Ciudad de México.

BACKGROUND: On April 24 2007, abortion before 12 weeks became legal in Mexico City. The arguments for this decision were: diminish the maternal morbidity and mortality, avoid a "severe health problem" and accomplish the women's physical, mental and social well being. OBJECTIVE: To analyze the scientific evidences that support or reject this arguments. MATERIAL AND METHOD: Retrospective study realized by bibliographic search of electronic data basis and Internet portals of interested groups. RESULTS: Mexico is considered by the World Health Organization, one of the countries in the world with low maternal mortality rates (<100/100,000 live births). The main causes are: preeclampsia-eclampsia, pregnancy related hemorrhage, complications of pregnancy, delivery and puerperium, and other causes (92.2 to 93.1%). In 2007, the Health Services of Mexico City reported 11 deaths (0.03% of the total maternal deaths) associated with "non-spontaneous abortion". In the hospitals of the Mexican Institute of Social Security, maternal deaths as consequence of induced abortions were, approximately, three every year. The evidences used as arguments in favor of abortion come from studies performed in Sub-Saharan African countries, which do not apply to Mexico. DISCUSSION: The scientific evidences show that induced abortion has important psychological sequels in women, a higher frequency of illegal drug abuse, alcoholism, child abuse, low birth weight in the following pregnancy, greater risk of subsequent miscarriage and greater mortality rate. CONCLUSIONS: There are no scientific evidences to support the arguments used for the legal approval of abortion in Mexico City.

[Fetal cardiac rhabdomyoma as a rare cause of hydrops fetalis. A report of a case]. / Rabdomioma cardiaco fetal como causa rara de hydrops fetalis. Reporte de un caso.

Cardiac tumors are rare entities at any age. The reported incidence in fetal echocardiograms is 0.17%. This case report presents the detection of a cardiac rhabdomyoma in a 27.5 weeks of gestational age (WGA) fetus during a routine sonogram. Treatment with terbutaline, as a cardiac inotropic and chronotropic agent, was started because of fetal bradichardia of 86 beats per minute, as well as fetal lung maturity inductors. At 30 WGA furosemide was added because of fetal hydrops. At 32 WGA a cesarean section was performed. The fetal development at the time of birth was in accordance to the gestational age, the newborn weight was 1,820 g and the Apgar score was 1-0, at one and five minutes after delivery. The newborn died immediately after the interruption of the umbilical circulation, because of a 90% obstruction of the left ventricular cavity caused by the tumor. The present case is an evidence of the utility of a medical treatment in a severely ill fetus, that allowed it to continue with its normal development for four weeks after the diagnosis and opens the possibility for fetal medical therapy in the future for similar cases.

[Condom effectiveness to prevent sexually transmitted diseases]. / Efectividad del preservativo para prevenir el contagio de infecciones de trasmisión sexual.

BACKGROUND: Sexual transmitted diseases (included HIV/AIDS) are a common and preventable cause of perinatal morbidity and mortality. When used consistently and correctly, condoms are effective to prevent these diseases, however, its protection does not account for 100%. OBJECTIVE: To know the effectiveness of male condom, through bibliographic evidence, to prevent sexual transmitted infections in heterosexual serodiscordant partners. MATERIAL AND METHODS: A bibliographical review of Medline/Pubmed, LILACS and Cochrane databases, and publications of the National Health Institutes, Centers for Disease Control and Prevention, World Health Organization, and WHO AIDS Global Program was done to analyze male condom effectiveness to prevent sexual transmitted diseases. RESULTS: Reports demonstrated that male condom protection against HIV/AIDS in heterosexual serodiscordant partners goes from 60 to 95%. Most recent information (2006) showed 80%. Two studies demonstrated no HPV protection with male condom, and another one 70% of protection. Male condom demonstrated no HPV-1 protection, but decrease of risk in HVS-2 transmission in women (0.85 of protection). CONCLUSION: Male condom protection against sexual transmitted diseases is not 100%. There must be used additional measures that have demonstrated its utility to decrease transmission risk.

[Gynecological clinical study in girls and adolescent victims of sexual abuse]. / Estudio clínico ginecológico en niñas y adolescentes que sufrieron abuso sexual.

In spite of a very important under-registration, sexual abuse represents a social and public health problem worldwide. In Mexico, estimated prevalence of sexual abuse in women is 17.3%, half of them in youngsters under 15 years old. Most of cases have a late gynecological evaluation, due to a delay in a formal complaint. Gynecologist or pediatrician are the specialists who most frequently perform the genital examination of girls suspected of sexual abuse, due to this a complete knowledge of the topic is necessary in order to make an accurate diagnosis, register the physical findings and give prompt medical and psychological treatment as well as follow up to the patient. Despite the low risk of acquiring a sexually transmitted infection, it is important to evaluate the use of prophylactic treatment and the prevention of unwanted pregnancy with emergency contraception. Big efforts are being made by preventive programs on sexual abuse, sexually transmitted infections and unwanted pregnancy, all of which are serious problems in Mexican children and youths, and should constitute a fundamental part of the public politics on sexual health.

Los paisajes físico geográfico de los manglares de la laguna de la mancha Veracruz México / Fhysical geographical landscapes of the mangroves of La Mancha lagoon Veracruz México

Los manglares que rodean la laguna de La Mancha en Veracruz, México, en condiciones de adecuada conservación, se caracterizan por la complejidad físico-geográfica de sus paisajes. Este trabajo profundiza en la estructura y composición de los geocomplejos en ese territorio. El empleo de los principios estructuro-genético e histórico-evolutivo permitió el levantamiento, clasificación y cartografía de los paisajes de manglares a escala detallada (1: 25000). Se lograron diferenciar 28 unidades inferiores, 6 intermedias y 5 de orden superior. Los resultados sugieren que el enfoque físico-geográfico complejo puede ser de gran utilidad para el inventario, caracterización y cartografía de manglares a escala detallada, brindando información sobre el tipo genético del relieve, composición litológica, periodicidad de inundación de las superficies, cobertura vegetal y suelos, lo cual es de inestimable valor para el ordenamiento ecológico y la preservación de estos ecosistemas

Utilidad de dos pruebas para el diagnóstico presuntivo rápido en infección de vías urinarias y embarazo / Usefulness of two tests for the diagnosis, presuntive and quick, in urinary infection and pregnancy

Se estudiaron a 60 pacientes que acudieron al Servicio de Urgencias del INPer, refiriendo sintomatología de IVU. Se les realizó toma de urocultivo y detección de nitritos y estearasa leucocitaria en orina con la tira reactiva Multistix 10 SG (R). Se tomó como grupo testigo a 20 pacientes obstétricas de primera vez, sin sintomatología de IVU bajo la misma metodología. En el grupo de estudio se informaron 34 urocultivos negativos, 9 urocultivos contaminados y 17 urocultivos positivos, con una semsibilidad y especificidad de 94 por ciento para la prueba de nitritos y de 64 por ciento y 100 por ciento, respectivamente, para la prueba de estearasa leucocitaria. En el grupo testigo se observaron dos urocultivos contaminados, 13 negativos y 5 positivos a un microorganismo. La sensibilidad fue de 100 por ciento y la especificidad de 92 por ciento para la prueba de nitritos; y de 40 por ciento y 100 por ciento respectivamente para la estearasa leucocitaria.

El embarazo en la quinta década de la vida / Pregnancy in the fifth decade of life

Se analizan los resultados de 163 embarazos en pacientes de 40 años o más, comparado con un grupo control. Se demuestra que las embarazadas mayores de 40 años tienen mayor incidencia de patología previa a la gestación (24%), diabetes y gestación, miomatosis e hipertensión arterial crónica. Durante el parto son más frecuentes el sufrimiento fetal agudo y la césarea (41%). En los recién nacidos se demostró mayor frecuencia de asfixia neonatal, bajo peso de nacimiento y síndrome de Down (3,6%). La mortalidad perinatal es de 36,8% nacidos vivos, sin diferencia estadística respecto al grupo control (p = 0,054), pero se eleva al 75% en los hijos de pacientes con patología previa al embarazo. Como conclusión, el embarazo sobre los 40 años condiciona un riesgo, principalmente por la patología asociada. El 93% (con limites de confianza de 90-96%), logra un niño vivo, sano y sin malformaciones, y esta cifra mejora en las pacientes sin patología previa