Identification of Aspergillus tubingensis in a primary skin infection.

OBJECTIVE: Aspergillus section Nigri comprises a group of related species that include Aspergillus niger, A. welwitschiae, A. carbonarius, A. brasiliensis and A. tubingensis. Some of these species are morphologically very similar to A. niger but exhibit different patterns of susceptibility to antifungal agents; such is the case for A. tubingensis. Therefore, when diagnosing aspergillosis, it is important to identify the pathogen at the species level. This study aimed to identify the species of an Aspergillus spp. isolate (MM-82) obtained from a patient with a dermatosis localized to the right leg. MATERIALS AND METHODS: The MM-82 isolate was examined for macro- and microscopic morphology, conidia size and thermotolerance, and a phylogenetic analysis of a benA gene segment was performed for molecular identification. Susceptibility to antifungals was determined using antifungal microdilution according to the methodology of European Society of Clinical Microbiology and Infectious Diseases (EUCAST). RESULTS: Based on its phenotypic characteristics and the phylogenetic analysis of the sequence of a benA gene segment, the MM-82 isolate was identified as A. tubingensis. This fungus did not show resistance to antifungal agents commonly used for treatment. CONCLUSION: This study demonstrated that A. tubingensis can cause skin infection; this constitutes the first report of a case of aspergillosis caused by A. tubingensis in Mexico.

Eliminación de albúmina en orina de una cohorte de mujeres embarazadas normotensas / Elimination of urinary albumin in a cohort of normotensive pregnant women

Introducción: La excreción de proteínas en orina depende de la cantidad que llega al glomérulo, de su facilidad de paso a través de la barrera glomerular y del grado de degradación por el túbulo proximal. La proteinuria durante el embarazo normal debe ser menor a 300 mg en orina de 24 h. Estudios previos han demostrado que la excreción de proteínas en orina está aumentada en el embarazo y se incrementa con las semanas de gestación. Objetivo: Determinar la excreción renal de albúmina en una cohorte de mujeres embarazadas sin hipertensión arterial o preeclampsia, en diferentes semanas de gestación. Determinar la sensibilidad y especificidad de la tira reactiva para identificar albuminuria durante el embarazo. Material y métodos: Se incluyeron 100 muestras de orina de 24 mujeres de diferentes edades gestacionales, 11 primigestas y 13 multigestas. La edad de las pacientes fue de 27,83 ± 5,91 años, la presión arterial sistólica fue de 108,18 ± 17,68 mmHg, la diastólica 70,90 ± 11,08 mmHg. La excreción de albúmina durante el primer trimestre fue de 8 ± 8,02 μg/mL; en el segundo trimestre de 11,62 ± 11,43 μg/mL y en el tercer trimestre de 13,15 ± 11,79 μg/mL. La sensibilidad fue de 80% y la especificidad de 87% para la determinación de proteinuria mediante la tira reactiva; 11% fueron falsos positivos. Conclusión: No hubo diferencias estadísticamente significativas al comparar la excreción de albúmina durante los 3 trimestres de la gestación ni encontramos diferencias entre primigestas y multigestas en la pérdida de proteínas. Recomendamos utilizar con reserva la determinación de proteinuria mediante la tira reactiva por la cantidad de falsos positivos

Introduction: Urinary protein excretion depends on the quantity of proteins reaching the glomerulus, its ease of transport through the glomerular barrier, and the degree of degradation by the proximal tubule. Urinary protein levels during normal pregnancy should be ≤ 300 mg in 24-h urine. Previous studies have demonstrated that urinary protein excretion is increased in pregnancy and continues to rise as the pregnancy progresses. Objective: To determine renal albumin excretion in a group of pregnant women without hypertension or preeclampsia at distinct time points in pregnancy, as well as the sensitivity and specificity of the reactive strip in analyzing albuminuria during pregnancy. Material and methods: A total of 100 urine samples were included from 24 women at distinct stages of pregnancy. There were 11 primiparas and 13 multiparas. The mean age was 27.83 ± 5.91 years, the mean systolic blood pressure was 108.18 ± 17.68 mmHg, and the mean diastolic pressure was 70.90 ± 11.08 mmHg. The mean albumin excretion was 8 ± 8.02 μg/mL during the first trimester, 11.62 ± 11.43 μg/mL during the second trimester, and 13.15 ± 11.79 μg/mL during the third trimester. Protein determination by means of the reactive strip had a sensitivity of 80% and a specificity of 87%; 11% of the results were false positives. Conclusion: We found no statistically significant differences in albumin excretion during the three trimesters of pregnancy, or in protein loss between primigravidas and multigravidas. Because of the percentage of false-positive results, the reactive strip should be used sparingly for protein determination

Hemorragia obstétrica manejada con balón de Bakri / Obstetric hemorrhage management with the Bakri SOS balloon

Antecedentes: La Organización Mundial de la Salud reporta que existen en el mundo 536.000 muertes maternas al año, de las cuales 140.000 son originadas por hemorragia obstétrica, representando el 25% del total de dichas muertes. En México, se considera la segunda causa de muerte materna, con una tasa de mortalidad de 14,3 por 100.000 nacidos vivos. Objetivo: Conocer el porcentaje de éxitos de las pacientes con hemorragia obstétrica tratadas con balón de Bakri en el Instituto Nacional de Perinatología. Material y métodos: Se analizó una serie de casos, durante 2 años (2009-2011) en pacientes complicadas con hemorragia obstétrica, las cuales recibieron manejo conservador con balón de Bakri. Se encontró a 19 pacientes y se describieron los antecedentes obstétricos, personales, control prenatal, atención obstétrica, parámetros de laboratorios y desenlace perinatal. Resultados: El porcentaje de éxito con el balón de Bakri fue del 95% y solo el 5% se consideró fallido, ameritando histerectomía obstétrica. La pérdida hemática promedio fue 1.290 cc, con diferencia de 4 g/dl en los controles de hemoglobina pre- y posquirúrgicos. Dos días promedio de estancia en unidad de cuidados intensivos. El peso promedio de los recién nacidos fue 2.580 g y el 63% fue de sexo femenino. No se reportaron complicaciones por el uso del balón de Bakri. Se realizó una fórmula para estimar el llenado de balón en cc = 41 + (11 × semanas de gestación). Conclusión: El uso del balón de Bakri puede ser útil en el manejo conservador ante una hemorragia obstétrica con una tasa considerable de éxito y sin reportes de complicación debida al uso

Background: The World Health Organization reports that 536,000 maternal deaths occur per year, of which 140,000 are caused by obstetric hemorrhage, representing 25% of all maternal deaths. In Mexico, obstetric hemorrhage is the second cause of maternal death, with a mortality rate of 14.3/100,000 newborns. Objective: To describe the success rate in obstetric hemorrhage patients treated with the Bakri SOS balloon in the National Institute of Perinatology. Material and methods: From 2009- 2011, data were collected from obstetric hemorrhage patients (n = 19) who were treated conservatively with the Bakri SOS balloon in the Institute. Data on obstetric and personal history, prenatal care, obstetric care, laboratory values and perinatal outcomes were obtained. Results: The success rate with the Bakri SOS balloon was 95%, with a failure rate of only 5%; these patients required further hysterectomy. The mean blood loss was 1,290 cc, with a difference of 4 g of hemoglobin before and after surgery. The mean length of stay in the intensive care unit was 2 days. The mean birth weight was 2,580 g, and 63% of the neonates were females. There were no incidents or complications with the use of the Bakri SOS balloon. The formula to estimate balloon filling was cc = 41 + (11 × gestational age). Conclusion: The Bakri SOS balloon can be helpful to treat obstetric hemorrhage and has high success rates and no complications

Papel de la inseminación intrauterina en la era de la fertilización in vitro / Role of intrauterine insemination in the era of i n vitro fertilization

La inseminación intrauterina es un proceso de reproducción asistida de baja complejidad, donde los espermatozoides previamente capacitados se depositan en la cavidad uterina junto con estimulación ovárica, es invasiva, aceptable y con tasas acumulativas de embarazos que proporcionan resultados similares a los obtenidos en un solo ciclo de técnicas de reproducción asistida más complejas; se compararon métodos de reproducción asistida: fertilización in vitro e inseminación intrauterina en relación con su eficacia y coste, concluyendo que la inseminación intrauterina es el tratamiento de primera línea, cuando la infertilidad es por factor masculino sin una alteración severa o infertilidad inexplicable; donde el manejo con 3 a 6 ciclos se logra el embarazo en un alto porcentaje a menor coste. No se consideraron otras técnicas como inyección intracitoplasmática de espermatozoides, que también es indicación para el tratamiento del factor masculino, ya que esta técnica requiere mayores recursos técnicos y humanos, y por sí misma impide su comparación

Intrauterine insemination is a low-complexity assisted reproduction technology in which previously washed sperm are deposited in the uterine cavity with ovarian stimulation. This invasive technique is well accepted by patients and achieves cumulative pregnancy rates similar to those obtained in a single cycle of more complex assisted reproduction techniques. We compared two methods of assisted reproduction: in vitro fertilization and intrauterine insemination in relation to their effectiveness and cost. We conclude that intrauterine insemination is the first-line treatment in male factor infertility without severe disruption or unexplained infertility; pregnancy can be achieved with 3 to 6 cycles in a high percentage of these cases at lower cost and with lower risk of multiple pregnancy than with in vitro insemination. We did not consider other techniques, such as intracytoplasmic sperm injection, which is also indicated for the treatment of male factor infertility, since this technique requires greater technical and human resources, thus precluding comparison

[The prevalence of antibodies against Giardia lamblia in umbilical cord serum and in maternal peripheral blood]. / Prevalencia de anticuerpos contra Giardia lamblia en suero de cordón umbilical y en sangre periférica materna.

Using an immunoenzymatic assay (ELISA), 40 serum samples from the peripheral blood of women in labor and serum from the umbilical cord of their offspring were analyzed in order to detect the prevalence of antibodies against Giardia lamblia. The results show that 12.5% of the maternal serum samples and 15.0% of those from the umbilical cord had optical density values comparable to those positive for G. lamblia used in the assay. This suggests that important concentrations of maternal IgG antibodies for the parasite are transferred through the placenta. The role that these antibodies play in the neonatal protection is still to be determined.