Uric acid and acute kidney injury in high-risk patients for developing acute kidney injury undergoing cardiac surgery: A prospective multicenter study.

PURPOSE: It is unclear whether preoperative serum uric acid (SUA) elevation may play a role in the development of acute kidney injury (AKI) associated with cardiac surgery (CSA-AKI). We conducted a cohort study to evaluate the influence of preoperative hyperuricemia on AKI in patients at high risk for developing SC-AKI. DESIGN: Multicenter prospective international cohort study. SETTING: Fourteen university hospitals in Spain and the United Kingdom. PARTICIPANTS: We studied 261 consecutive patients at high risk of developing CSA-AKI, according to a Cleveland score ≥ 4 points, from July to December 2017. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: AKIN criteria were used for the definition of AKI. Multivariable logistic regression models and propensity score-matched pairwise analysis were used to determine the adjusted association between preoperative hyperuricemia (≥7 mg/dL) and AKI. Elevated preoperative AUS (≥7 mg/dL) was present in 190 patients (72.8%), whereas CSA-AKI occurred in 145 patients (55.5%). In multivariable logistic regression models, hyperuricemia was not associated with a significantly increased risk of AKI (adjusted Odds Ratio [OR]: 1.58; 95% confidence interval [CI]: 0.81-3; P = .17). In propensity score-matched analysis of 140 patients, the hyperuricemia group experienced similar adjusted odds of AKI (OR 1.05, 95%CI 0.93-1.19, P = .37). CONCLUSIONS: Hyperuricemia was not associated with an increased risk of AKI in this cohort of patients undergoing cardiac surgery at high risk of developing CSA-AKI.

A new cotton functionalized with iron(III) trimer-like metal framework as an effective strategy for the adsorption of triarylmethane dye: An insight into the dye adsorption processes.

A new Cotton@Fe-BTC composite formed by Fe-BTC (BTC-H3: trimesic acid) metal framework (Fe-BTC MOF loading as high 38 wt %) supported by cellulose fiber is synthesized in aqueous media using a simple and green preparation method, described for the first time in this manuscript. This new strategy relies on the synergetic effect of the pure cellulose and MOFs frameworks resulting in hybrid nanofibers of MOFs@cellulose composite. A complete characterization of the composite material reveals its structural similarity to MIL-100(Fe), a Fe-BTC material. The Cotton@Fe-BTC composite potential use as an eco-friendly and low-cost adsorbent was evaluated for its adsorptive performance for the removal of dye belonging to the triarylmethane dye family (Malachite Green (MQ), Brilliant Green (BG), Pararosaniline (PR), Basic Fuchsine (BF), Crystal Violet (CV), Methyl Green (Met-G), Victoria Blue B (VB), Acid Fuchsin (AF) and Aniline Blue (AB)) in aqueous solution. The fast kinetics and high dye removal efficiencies (>90%) obtained in aqueous solutions. The structure of Cotton@Fe-BTC network, contributed to the remarkable adsorption properties towards a variety of triphenylmethanedye. The interparticle studies showed two main steps in the dye adsorption processes, with the exception of AF and BG. The equilibrium adsorption capacities qe (mg/g) follow the order: AF (3.64)

Prediction of biological activity of compounds containing a 1,3,5-triazinyl sulfonamide scaffold by artificial neural networks using simple molecular descriptors.

Simple molecular descriptors of extensive series of 1,3,5-triazinyl sulfonamide derivatives, based on the structure of sulfonamides and their physicochemical properties, were designed and calculated. These descriptors were successfully applied as inputs for artificial neural network (ANN) modelling of the relationship between the structure and biological activity. The optimized ANN architecture was applied to the prediction of the inhibition activity of 1,3,5-triazinyl sulfonamides against human carbonic anhydrase (hCA) II, tumour-associated hCA IX, and their selectivity (hCA II/hCA IX).

Metal organic framework composite, nano-Fe3O4@Fe-(benzene-1,3,5-tricarboxylic acid), for solid phase extraction of blood lipid regulators from water.

The magnetic metal-organic framework Fe3O4@(Fe-(benzene-1,3,5-tricarboxylic acid) (MMOF) was prepared, characterized and studied as a magnetic sorbent for the dispersive solid-phase extraction (DSPE) of several widely used blood lipid regulators (i.e., bezafibrate, clofibric acid, clofibrate, gemfibrozil and fenofibrate) from water samples. Characterization of the synthesized Fe3O4@Fe-BTC magnetic nanomaterial was performed by Fourier transform infrared spectroscopy, powder X-ray diffractometry, thermogravimetric analysis, scanning electron microscopy and transmission electron microscopy. The magnetic nanocomposite was found to be chemically stable and to possess a large surface area (803.62 m2/g) and pore volume (0.59 cm³/g). The concentrations of fibrates in different water samples were determined using HPLC-UV-Vis and confirmed by UPLC-MS/MS. Parameters affecting the extraction efficiency of magnetic-DSPE were studied and optimized. The maxima absorption capacities (Qmax) were determined to be (in mg/g) 197.0 for bezafibrate, 620.3 for clofibric acid, 537.6 for clofibrate, 288.7 gemfibrozil and 223.2 for fenofibrate. Validations of the optimized magnetic DSPE method for analyses at two fibrate concentrations in spiked water samples produced relative recovery values ≤ 70% for clofibrate and within the range of 80-100% for bezafibrate, clofibric acid, gemfibrozil and fenofibrate. LODs ranging from 4 µg/L for fenofibrate to 99 µg/L for gemfibrozil were obtained. The validated methodology produced recovery values ranging from 70 to 112% (relative standard deviations < 7%).

Consenso Mexicano para el Tratamiento de la Hepatitis C / The Mexican consensus on the treatment of Hepatitis C

El objetivo del Consenso Mexicano para el Tratamiento de la Hepatitis C fue el de desarrollar un documento como guía en la práctica clínica con aplicabilidad en México. Se tomó en cuenta la opinión de expertos en el tema con especialidad en: gastroenterología, infectología y hepatología. Se realizó una revisión de la bibliografía en MEDLINE, EMBASE y CENTRAL mediante palabras claves referentes al tratamiento de la hepatitis C. Posteriormente se evaluó la calidad de la evidencia mediante el sistema GRADE y se redactaron enunciados, los cuales fueron sometidos a voto mediante un sistema modificado Delphi, y posteriormente se realizó revisión y corrección de los enunciados por un panel de 34 votantes. Finalmente se clasificó el nivel de acuerdo para cada oración. Esta guía busca dar recomendaciones con énfasis en los nuevos antivirales de acción directa y de esta manera facilitar su uso en la práctica clínica. Cada caso debe ser individualizado según sus comorbilidades y el manejo de estos pacientes siempre debe ser multidisciplinario.

The aim of the Mexican Consensus on the Treatment of Hepatitis C was to develop clinical practice guidelines applicable to Mexico. The expert opinion of specialists in the following areas was taken into account: gastroenterology, infectious diseases, and hepatology. A search of the medical literature was carried out on the MEDLINE, EMBASE, and CENTRAL databases through keywords related to hepatitis C treatment. The quality of evidence was subsequently evaluated using the GRADE system and the consensus statements were formulated. The statements were then voted upon, using the modified Delphi system, and reviewed and corrected by a panel of 34 voting participants. Finally, the level of agreement was classified for each statement. The present guidelines provide recommendations with an emphasis on the new direct-acting antivirals, to facilitate their use in clinical practice. Each case must be individualized according to the comorbidities involved and patient management must always be multidisciplinary.

Multinational case-control study of risk factors for the development of late invasive pulmonary aspergillosis following kidney transplantation.

OBJECTIVES: To assess the risk factors for development of late-onset invasive pulmonary aspergillosis (IPA) after kidney transplantation (KT). METHODS: We performed a multinational case-control study that retrospectively recruited 112 KT recipients diagnosed with IPA between 2000 and 2013. Controls were matched (1:1 ratio) by centre and date of transplantation. Immunosuppression-related events (IREs) included the occurrence of non-ventilator-associated pneumonia, tuberculosis, cytomegalovirus disease, and/or de novo malignancy. RESULTS: We identified 61 cases of late (>180 days after transplantation) IPA from 24 participating centres (accounting for 54.5% (61/112) of all cases included in the overall study). Most diagnoses (54.1% (33/61)) were established within the first 36 post-transplant months, although five cases occurred more than 10 years after transplantation. Overall mortality among cases was 47.5% (29/61). Compared with controls, cases were significantly older (p 0.010) and more likely to have pre-transplant chronic obstructive pulmonary disease (p 0.001) and a diagnosis of bloodstream infection (p 0.016) and IRE (p <0.001) within the 6 months prior to the onset of late IPA. After multivariate adjustment, previous occurrence of IRE (OR 19.26; 95% CI 2.07-179.46; p 0.009) was identified as an independent risk factor for late IPA. CONCLUSION: More than half of IPA cases after KT occur beyond the sixth month, with some of them presenting very late. Late IPA entails a poor prognosis. We identified some risk factors that could help the clinician to delimit the subgroup of KT recipients at the highest risk for late IPA.

Detección serológica directa de hipotiroidismo congénito vs. método del papel filtro / Direct serological detection of congenital hypothyroidism vs. filter paper method

OBJETIVOS: demostrar la utilidad del método serológico directo para detección de hipotiroidismo congénito. MÉTODOS: es un estudio transversal, comparativo; destinado a comparar la capacidad diagnóstica de la técnica del papel filtro con la detección serológica directa de TSH neonatal en el mismo grupo de neonatos examinados. Se incluyó a 202 Recién Nacidos sanos del Hospital Materno Infantil Cochabamba, entre las 48 hrs. y los 21 días de vida; en el primer trimestre del año 2014. El análisis estadístico se realizó comparando las curvas de sensibilidad y especificidad con el Receiver Operating Characteristic (Característica Operativa del Receptor), del paquete estadístico especializado MedCalc, versión 12.7. El análisis descriptivo se realizó con el paquete estadístico SPSS-IBM STADISTIC, versión 19. RESULTADOS: ambas técnicas mostraron sensibilidad y especificidad altas, con un área bajo la curva de ambas, cercana a 0.972 (ROC), IC 0,941 - 0,989, al 95%. CONCLUSIONES: ambas técnicas demostraron ser eficientes en la pesquisa diagnóstica de hipotiroidismo congénito.

Objectives: to demonstrate the usefulness of direct serological method for direct detection of congenital hypothyroidism. Methods: a cross-sectional comparative study; for comparing the diagnostic performance of the technique of filter paper with the direct serological detection of neonatal TSH in the same group of infants examined. The study included 202 healthy newborns Hospital Materno Infantil Cochabamba, between 48 hrs. and 21 days of life; in the first quarter of 2014. The statistical analysis was performed comparing the curves of sensitivity and specificity with the Receiver Operating Characteristic (Receiver Operating Characteristic), specialized MedCalc statistical package, version 12.7. The descriptive analysis was performed using SPSS-IBM STADISTIC, version 19. Results: both techniques showed high sensitivity and specificity, with an area under the curve both close to 0.972 (ROC) IC 0.941 to 0.989, 95 %. Conclusions: both techniques proved effective in the diagnostic screening for congenital hypothyroidism.

[Recurrent meningitis due to anatomical defects: The bacteria indicates its origin]. / Meningitis recurrente por defectos anatómicos: la bacteria indica su origen.

INTRODUCTION: Recurrent meningitis is a rare disease. Anatomical abnormalities and immunodeficiency states are predisposing factors. Four cases, in which immunodeficiency was excluded, are presented. The causal microorganism led to the detection of the anatomical defect responsible for the recurrences. PATIENTS AND METHODS: Retrospective review of 4 cases with clinical diagnosis of recurrent bacterial meningitis. RESULTS: Case 1: a thirty month-old boy with unilateral hearing loss, diagnosed with Mondini abnormality by magnetic resonance imaging (MRI) after 2 episodes of Haemophilus influenzae meningitis. Surgical repair after third recurrence. Case 2: fourteen year-old girl diagnosed by MRI with cribriform plate defect after 3 episodes of meningitis due to Streptococcus pneumoniae. Ventriculoperitoneal shunt was placed. Case 3: girl with meningitis due to Staphylococcus aureus at 2 and 7 months. MRI shows occipital dermal sinus requiring excision. Complication with cerebellar abscesses because of a coexisting dermoid cyst. Case 4: child with meningitis due to Streptococcus bovis at 9 days and Enterococcus faecium, Klebsiella pneumoniae and Escherichia coli at 7 months, with positive cultures to Citrobacter freundii and E. faecium later on. Spinal MRI led to the diagnosis of Currarino syndrome with CSF fistula, which was surgically repaired. The 4 patients had undergone image studies reported as normal during the first episodes. CONCLUSIONS: In patients with recurrent meningitis the possibility of an anatomical defect should be considered. The isolated microorganism should help to locate it. It is essential to know the normal flora of the different anatomical sites. The definitive treatment is usually surgical.

ERCC1 is a prognostic biomarker in locally advanced head and neck cancer: results from a randomised, phase II trial.

BACKGROUND: Cisplatin-radiotherapy is a preferred standard for locally advanced, head and neck squamous cell carcinoma (HNSCC). However, the cisplatin-attributable survival benefit is small and toxicity substantial. A biomarker of cisplatin resistance could guide treatment selection and spare morbidity. The ERCC1-XPF nuclease is critical to DNA repair pathways resolving cisplatin-induced lesions. METHODS: In a phase II trial, patients with untreated Stage III-IVb HNSCC were randomised to cisplatin-radiotherapy with/without erlotinib. Archived primary tumours were available from 90 of 204 patients for this planned substudy. Semi-quantitative ERCC1 protein expression (H-score) was determined using the FL297, 4F9, and 8F1 antibodies. The primary analysis evaluated the relationship between continuous ERCC1 protein expression and progression-free survival (PFS). Secondary analyses included two pre-specified ERCC1 cutpoints and performance in HPV-associated disease. RESULTS: Higher ERCC1 expression was associated with inferior PFS, as measured by the specific antibodies FL297 (HR=2.5, 95% CI=1.1-5.9, P=0.03) and 4F9 (HR=3.0, 95% CI=1.2-7.8, P=0.02). Patients with increased vs decreased/normal ERCC1 expression experienced inferior PFS (HR=4.8 for FL297, P=0.003; HR=5.5 for 4F9, P=0.007). This threshold remained prognostic in HPV-associated disease. CONCLUSION: ERCC1-XPF protein expression by the specific FL297 and 4F9 antibodies is prognostic in patients undergoing definitive cisplatin-radiotherapy for HNSCC, irrespective of HPV status.

Características de las lesiones intestinales en traumatismo cerrado de abdomen / Characteristics of intestinal injury in blunt abdominal trauma

En una revisión de archivo relacionado a lesiones intestinalespor traumatismo cerrado de abdomen, durante un periodo de4 años, desde enero del año 2007 a diciembre del 2010 y, quefueron tratados quirúrgicamente en el servicio de EmergenciasMédicas de Asunción Paraguay MSP Y BS, se evidenció:a) Su relación importante a accidentes de vehículos automotores.b) La presencia de graves lesiones asociadas a su presentación.c) La mayor frecuencia observada en personas jóvenes ydel sexo masculino.d) La alta frecuencia de lesiones del intestino delgado enrelación a las de colon.

Chemomodulatory potential of Glycine max against murine skin and cervical papillomagenesis.

In the present study, chemopreventive potential of Glycine max (G. Max) seeds was examined against DMBA-induced skin and MCA-induced cervical papillomagenesis in Swiss albino mice. Different doses (2.5, 5, and 7.5% w/w) of G. max were provided to animals in feed. Results exhibited a significant reduction in skin as well as cervical tumor incidence and tumor multiplicity (up to 75%) at all doses of test diet as compared to the control. Relatively, 7.5% test diet was most effective in protecting the animals against carcinogenesis. Further, detoxifying enzymes and antioxidative status was also evaluated in the liver of mice to understand the role of G. max in prevention of cancer. It was observed that the test diet containing G. max significantly elevated the specific activities of glutathione-S-transferase (GST), DT-diaphorase (DTD), superoxide dismutase (SOD), catalase (CAT), and glyoxalase I (Gly I). The test diet also elevated the content of reduced glutathione whereas it decreased the level of the peroxidative damage along with the specific activity of lactate dehydrogenase. It appeared that G. max seeds provided chemoprevention against skin and cervical papillomagenesis probably by modulating the detoxifying and antioxidative enzymes. It could be inferred that intake of G. max might help in reducing the risk of cancer.

Hemangioma cavernoso orbitario: presentación de un caso clínico y revisión del tema / Orbital cavernous hemangioma: report of a case and review of the topic

El hemangioma cavernoso orbitario (HCO) constituye una tumoración vascular benigna no infiltrante, que crece lentamente y en función de la clínica, se decidirá la actitud terapéutica más conveniente, la observación o la extirpación quirúrgica. El diagnóstico definitivo se establece tras la extirpación del tumor y posterior estudio histopatológico del mismo. Presentamos el caso de una niña de 6 años de edad, con proptosis ocular derecha progresiva, con diagnóstico imagenológico sugestivo de lesión vascular, el cual fue confirmado en el estudio anatomo-patológico tras la intervención quirúrgica y la paciente evolucionó satisfactoriamente.

Triage, temperatura, frecuencia cardíaca y saturación de O2, en la clasificación de pacientes en un servicio de urgencia pediátrico / Weight of triage, temperature, cardiac rate, and oxigen saturation in the classification of patients seen in a pediatric emergency service

This study evaluates the association of Triage (Tr), body temperature (t) and Oxygen saturation (SatO2) at the time of admission to a Pediatric Emergency Service (PES) with discharge home or hospitalization. Method: 1 863 patients admitted to a PES in June and July of 2007 were included, stratified by age (< 2 mo, 3-12 mo, 13-36 m, 37-60 mo, 61-120 mo, 121-187 mo). Chi Square test was used, screening for p < 0.05. Results: Hospitalization was most likely for children under 6 months old, (5.42, range 3.9-7.6), scoring Triage < 2 (6.9, range 4.7-10.2), or a Saturation level below 93 percent (23.68, range 14.6-38.3). No significant association was seen between fever and hospitalization (1.31, range 0.9-1.8). SatO2 < 93 percent was associated to tachycardia in all ages (3.62, range 2.09-5.79), so did fever (6.74, range 5.07-8.67). Over half (51.8 percent) of children with fever showed tachycardia, 22.8 percent of afebrile cases were associated to this symptom. Discussion: Risk of hospitalization is higher if a child is younger than 6 months old, with Oxygen Saturation below 93 percent or Triage level < 2. Over 600 children presented tachycardia (33 percent); none progressed to Shock even with SatO2 < 93 percent or Triage level < 2. Tachycardia, as an isolated sign, does not appear to be forecast significant hemodynamic change or need to be treated as such.

Se indagó la asociación Triage (Tr)- temperatura corporal (T°) y saturación de oxígeno (SO2) al consultar en Urgencia, con alta u hospitalización y se postuló asociaciones de taquicardia con T° y SO2. Pacientes y Método: Se configuró un grupo de 1 863 pacientes, de quienes acudieron en junio y julio 2007. Se emplearon razones de riesgo (OR) con IC95 por ciento y análisis estratificado por grupos de edad: < 2 m; 3-12 m; 13-36 m; 37-60 m; 61-120 m; 121-187 m. Se empleó X2 y p ≤ 0,05. Resultados: La probabilidad de hospitalización fue mayor al ser < de 6m (OR = 5,42; IC95 por ciento = 3,9-7,6), tener Triage ≤ 2 (OR: 6,94; IC95 por ciento: 4,7-10,2) o SO2 < a 93 por ciento (OR = 23,68; IC95 por ciento = 14,6-38,3). No se encontró asociación entre fiebre y hospitalización (OR = 1,31; IC95 por ciento = 0,9-1,8; NS) La SO2 < 93 por ciento, se asoció con taquicardia en todas las 3,62; IC95 por ciento = 2,09-5,79; p < 0,000), igual ocurre cuando hubo fiebre (OR = 5,07-8,67; p < 0,000). El 51,8 por ciento de los casos febriles estaban taquicárdicos y el edades (OR ponderado = ponderado = 6,74; IC95 por ciento 22,8 por ciento de los afebriles. Comentario: El riesgo de hospitalización en un niño es mayor si tiene < 6 m, ≤ SO(2)93 por ciento o Triage ≤ 2. En más de 600 niños taquicárdicos (33 por ciento) ninguno evolucionó al shock, incluso si tuvieron Triage ≤ 2 y SO2 ≤ 93. La taquicardia como signo relativamente aislado, no permite plantear alteración hemodinámica de magnitud y menos tratarla como si fuere.

Characterization of a persistent respiratory syncytial virus showing a low-fusogenic activity associated to an impaired F protein.

In this work we have characterized the virus (RSV(48)) present in passage 48 of a respiratory syncytial virus persistently infected murine macrophage-like cell culture. This virus was noncytopathic in macrophages and had a low-fusogenic activity in RSV-permissive cell lines, although the level of this activity varied among the different cell lines tested. The fusogenic activity of RSV(48) in Vero cells, as evaluated by the number and size (nuclei per syncytium) of syncytia, was lower than that shown in cells H358. However, the syncytia formed by RSV(48) in Vero cells increased significantly when the virus was treated with trypsin previous to cell infection and the protease was left in the medium during the development of polykarions. Moreover, the fusogenic activity of RSV(48) was increased by a brief acidic pH treatment of infected cells. These results imply that the RSV(48) F protein was inefficiently activated by intracellular proteases in Vero cells and exposure to low pH favours membrane fusion. Analysis of the nucleotide and the deduced amino acid sequences of the RSV(48) F protein showed nine amino acid residue differences with respect to the RSV(wt) sequence, some of which mapped to positions that suggest they might be responsible for the low-fusogenic activity observed for the RSV(48) F protein.

Meningitis por Streptococcus suis en un paciente inmunocompetente / Streptococcus suis meningitis in an immunocompetent patient

Se describe un caso de meningitis por Streptococcus suis en un paciente inmunocompetente. Presentaba astenia, debilidad generalizada, fiebre (39 °C), vómitos, deterioro del sensorio y desorientación témporo-espacial. Los cultivos de sangre (2/2) y de líquido cefalorraquídeo fueron positivos. La identificación preliminar se realizó utilizando las pruebas bioquímicas convencionales y fue completada en el Servicio Bacteriología Especial del INEI-ANLIS "Dr. Carlos G. Malbrán". Se comenzó el tratamiento con ampicilina y ceftriaxona. El microorganismo aislado demostró sensibilidad a ampicilina, cefotaxima y vancomicina. El paciente evolucionó favorablemente, pero se comprobó leve hipoacusia. Reingresó a los 4 meses con marcha atáxica, anacusia en oído izquierdo e hipoacusia en oído derecho. Continúa con seguimiento neurológico y audiométrico. Retrospectivamente se constató el contacto del paciente con cerdos. Se destaca la importancia de la anamnesis para alertar la sospecha de este agente etiológico en meningitis y bacteriemias.

A case of Streptococcus suis meningitis is described in an immunocompetent patient presenting asthenia, general weakness, fever, vomiting, sensory deterioration and temporospatial disorder. The cerebrospinal fluid and two blood cultures (2/2 bottles) were positive. The isolate was preliminary identified by conventional biochemical tests, and the identification was completed at the Special Bacteriology Service of INEI-ANLIS "Dr. Carlos G. Malbrán". Ampicillin and ceftriaxone treatment was initiated. The isolate was susceptible to ampicillin, cefotaxime and vancomycin. The patient experienced a good outcome but suffered hearing loss. However, after four months he returned with walking ataxia, deafness in his left ear, and hearing loss in the right ear. The patient’s retrospective exposure to pigs had been verified. It is important to evaluate predisposing and epidemiologic factors in order to alert about the possible presence of this etiological agent in cases of meningitis or bacteremia.

Vigilancia de la resistencia de Neisseria gonorrhoeae en un hospital de la provincia de Santa Fe, Argentina: 1997-2004 / Resistance surveillance of Neisseria gonorrhoeae in a hospital in Santa Fe province, Argentina: 1997-2004

Se determinaron los fenotipos de resistencia caracterizados por la concentración inhibitoria mínima, la difusión con discos y la producción de β-lactamasa de 434 aislamientos de Neisseria gonorrhoeae obtenidos de pacientes atendidos en el Servicio de Enfermedades de Transmisión Sexual del Hospital Dr. José María Cullen, Santa Fe, Argentina. Se realizaron pruebas de sensibilidad a los siguientes antimicrobianos: penicilina, tetraciclina, ciprofloxacina, espectinomicina, azitromicina y ceftriaxona. A tres aislamientos resistentes a ciprofloxacina se les realizó electroforesis de campo pulsado. Se destacaron tres situaciones epidemiológicas de interés: en el año 1997, alta incidencia de aislamientos con resistencia plasmídica a tetraciclina (33,3%); en el período 2002-2004, un aumento significativo de la resistencia plasmídica a penicilina (9,7% a 34,8%); y en el año 2000, la emergencia de dos de los tres primeros aislamientos con resistencia a quinolonas del país. El primer aislamiento resistente a azitromicina en nuestro hospital emerge en el 2004. Este trabajo jerarquiza el rol del Laboratorio de Microbiología Clínica en la orientación del tratamiento empírico de la gonorrea.

Resistance phenotypes characterized by minimum inhibitory concentration, disk diffusion and β-lactamase production were determined in 434 isolates from patients attending the Sexually Transmitted Disease Service at Dr. José María Cullen Hospital in Santa Fe, Argentina. Susceptibility tests to penicillin, tetracycline, ciprofloxacin, espectinomycin, azithromycin and ceftriaxone were performed. Pulsed-field gel electrophoresis was conducted made to on three ciprofloxacin-resistant isolates. Epidemiologically speaking, three interesting events should be highlighted: during 1997, plasmid-mediated high level tetracycline-resistant strains were observed (33.3%); from 2002 to 2004 a significant increase of plasmid-mediated penicillin-resistant strains was registered (9.7% to 34.8%); and in the year 2000 the first two quinolone-resistant strains emerged in the province. In our hospital, the first azithromycin-resistant isolate emerged in 2004. We therefore emphasize the importance of the Clinical Microbiology Laboratory in order to provide information for the empiric treatment of this infection.

Paracoccidioidomicosis perianal asociada a lepra lepromatosa: Presentación de un caso clínico / Perianal paracoccidioidomycosis associated with lepromatous leprosy: A clinical case report

Se presenta el caso de un paciente alcoholista con una ulceración perianal y manifestaciones cutáneas de enfermedad de Hansen. La biopsia de la lesión perianal y otros estudios arribaron al diagnóstico de una forma diseminada de paracoccidioidomicosis, así como también las biopsias cutáneas y los estudios baciloscópicos fueron diagnósticos de lepra lepromatosa. La respuesta a la terapéutica fue satisfactoria con desaparición de las lesiones cutáneas. La disminución de la respuesta inmunológica celular genera un terreno propicio para la infección de estos gérmenes y al compartir área endémica la asociación entre ambas patologías puede ocurrir.

Lepra and Paracoccidioidomycosis are endemic diseases in Argentina. We report a case of a patient with an unusual perianal ulceration and cutaneous manifestations of Hansen's disease. The biopsy of perianal lesion and subsequent studies revealed a disseminated form of paracoccidioidomycosis, as well as skin biopsy and baciloscopic finding diagnostic of Lepromatous Leprosy. The main portal of entry of paracoccidioides is the lung. Hematogenous dissemination of the fungus may occur at this time, with the establishment of metastatic foci in any organ. Anal and perianal lesions are present only in 1.3 to 2.4% of the patients. The pathogenesis of anal lesions remains unclear, it may be secondary from a systemic or a local disease. The patient response to the therapeutic was notable, with disappearance of lesions up to the third month of started itraconazole orally 400 mg/day leading just atrophy scars in perianal areas. The treatment of Hansen's disease was made according to OMS guidelines for multibacillary disease.

Úlcera de lengua como presentación del Histoplasma capsulatum / Tongue ulceration as a presentation of Histoplasma capsulatum infection

La histoplasmosis diseminada progresiva es una enfermedad que se manifiesta como reactivación de una infección latente en pacientes inmunodeprimidos, especialmente en personas con déficit en la inmunidad celular. Existen formas agudas, subagudas y crónicas. Las lesiones focales, en especial úlceras mucocutáneas, predominan en la forma diseminada crónica. Reportamos el caso de una paciente con artritis reumatoidea, que controlaba su patología con fármacos antirreumáticos modificadores de la enfermedad (DMARD), la que consultó por úlcera de lengua como única manifestación de una histoplasmosis diseminada crónica. La histopatología fue compatible y el cultivo positivo para Histoplasma capsulatum. La serología para el HIV fue negativa. Existen pocos casos publicados de pacientes con esta localización atípica en forma aislada, en particular aquellos HIV negativos. El itraconazol y la anfotericina B son las dos drogas más utilizadas para tratar esta enfermedad. Los datos clínicos sobre los nuevos azoles, voriconazol y posaconazol son limitados.

The progressive disseminated histoplasmosis is a disease produced by reactivation of latent infection in immunocompromised host, specially in persons with defective cell-mediated immunity. There are acute, subacute and chronic forms in the progressive illness. Focal lesions, specially mucocutaneous ulcers, are most frequent in the chronic disseminated forms. We reported a patient with rheumatoid arthritis treated with disease modifying antirheumatic drug (DMARD), with an ulcer of the tongue as only clinical manifestation of a chronic disseminated histoplasmosis. The histopathology was compatible, and the culture was positive for Histoplasma capsulatum. The serology for the HIV was negative. There are few published cases of this isolated form, particularly in patients with HIV negative serological test. Itraconazole and amphotericin B are the most frequently drugs used for the treatment in this disease. Clinical data on the new azoles, voriconazole and posaconazole, are limited.