[Utility of molecular biology in the microbiological diagnosis of mycobacterial infections]. / Utilidad de la biología molecular en el diagnóstico microbiológico de las infecciones por micobacterias.

Species within the Mycobacterium genus are of major medical interest, since, together with environmental and opportunistic species, there are two species (Mycobacterium tuberculosis and Mycobacterium leprae) that remain an important public health challenge. Despite efforts to control tuberculosis (TB), this disease remains one of the most prominent health problems worldwide. In the last few years, mycobacteriology has experienced major technological advances. Nevertheless, the early diagnosis of mycobacterial infection and, especially of TB, is still based on microscopic examination of properly stained samples. At present, this procedure is still the simplest, fastest and most cost-effective method for preliminary diagnostic guidance. Effective control of TB is based on rapid detection of M. tuberculosis, followed by immediate implementation of the appropriate antituberculosis therapy. Because of the emergence of multidrug resistant strains, the development of rapid diagnostic methods, both for identification of M. tuberculosis and susceptibility testing, has become a pressing need. The availability of molecular epidemiology methods that are easy to implement and standardized and that would allow identification of related cases is of key importance to identify epidemic outbreaks and control the spread of TB. Despite the evident progress in the molecular diagnosis of mycobacterial infections, the available techniques are still inadequate. In this review, we describe the state of the art of the main molecular techniques for direct detection of mycobacteria in clinical samples, their identification, detection of resistance to the most important antituberculosis agents, and molecular epidemiology. In each case, we describe the advantages and limitations of current techniques. In the near future, clinical mycobacteriology will probably evolve to the universal use of genetic techniques for direct diagnosis and detection of resistance. The molecular epidemiology of TB will be performed, in its various applications, by faster and more automated techniques than those currently available.

Store and forward teledermatology.

Store and forward and real time or videoconferences are the two types of teledermatology services practiced. Dermatology and radio-diagnosis are visual specialties suited for store-and-forward teledermatology (SAFT). Advances in information technology, electronic instruments and biotechnology have revolutionized and brought changes in SAFT. Cellular phone, digital camera, personal digital assistants, Wi-Fi, Wi-Max and computer- aided-design software are incorporated to deliver the quality health care to remote geographic regions. Complete SAFT care equivalent to face-to-face consultation (Gold standard) is essential. Health care providers in rural areas are the 'eyes' for the consultants. Consultants to guide them should have a rapid periodic audit of visual parameters and dimensions of lesions. Given this background, this article reviews advances in 1) capture, store and transfer of images. 2) Computer Aided measurements of generalized and localized lesions and 3) the integration model to meet all the above two requirements in a centralized location. This process enables diagnosis, management, periodic assessment and complete follow-up care to achieve patient and physician satisfaction. Preservation of privacy and confidentiality of digital images is important. Uniform rules and regulations are required. Indian space research organization (ISRO), Government of India has demonstrated telemedicine pilot projects utilizing the satellite communication and mobile telemedicine units to be useful in meeting the health care needs of remote and rural India. we have to join hands with them to meet dermatology problems in rural areas.