Analysis of the reasons for requesting HIV serology in the emergency department other than those defined in the targeted screening strategy of the "Urgències VIHgila" program and its potential inclusion in a future consensus document.

OBJECTIVE: To describe other reasons for requesting HIV serology in emergency departments (ED) other than the 6 defined in the SEMES-GESIDA consensus document (DC-SEMES-GESIDA) and to analyze whether it would be efficient to include any of them in the future. METHODS: Review of all HIV serologies performed during 2 years in 20 Catalan EDs. Serologies requested for reasons not defined by the DC-SEMES-GESIDA were grouped by common conditions, the prevalence (IC95%) of seropositivity for each condition was calculated, and those whose 95% confidence lower limit was >0.1% were considered efficient. Sensitivity analysis considered that serology would have been performed on 20% of cases attended and the remaining 80% would have been seronegative. RESULTS: There were 8044 serologies performed for 248 conditions not recommended by DC-SEMES-GESIDA, in 17 there were seropositive, and in 12 the performance of HIV serology would be efficient. The highest prevalence of detection corresponded to patients from endemic countries (7.41%, 0.91-24.3), lymphopenia (4.76%, 0.12-23.8), plateletopenia (4.37%, 1.20-10.9), adenopathy (3.45%, 0.42-11.9), meningoencephalitis (3.12%, 0.38-10.8) and drug use (2.50%, 0.68-6.28). Sensitivity analysis confirmed efficiency in 6 of them: endemic country origin, plateletopenia, drug abuse, toxic syndrome, behavioral-confusional disorder-agitation and fever of unknown origin. CONCLUSION: The DC-SEMES-GESIDA targeted HIV screening strategy in the ED could efficiently include other circumstances not previously considered; the most cost-effective would be origin from an endemic country, plateletopenia, drug abuse, toxic syndrome, behavioral-confusional-agitation disorder and fever of unknown origin.

Association of the serological status of rheumatoid arthritis patients with two circulating protein biomarkers: A useful tool for precision medicine strategies.

Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic inflammation of the joints and presence of systemic autoantibodies, with a great clinical and molecular heterogeneity. Rheumatoid Factor (RF) and anti-citrullinated protein antibodies (ACPA) are routinely used for the diagnosis of RA. However, additional serological markers are needed to improve the clinical management of this disease, allowing for better patient stratification and the desirable application of precision medicine strategies. In the present study, we investigated those systemic molecular changes that are associated with the RF and ACPA status of RA patients. To achieve this objective, we followed a proteomic biomarker pipeline from the discovery phase to validation. First, we performed an iTRAQ-based quantitative proteomic experiment on serum samples from the RA cohort of the Hospital of Santiago de Compostela (CHUS). In this discovery phase, serum samples from the CHUS cohort were pooled according to their RF/ACPA status. Shotgun analysis revealed that, in comparison with the double negative group (RF-/ACPA-), the abundance of 12 proteins was altered in the RF+/ACPA+ pool, 16 in the RF+/ACPA- pool and 10 in the RF-/ACPA+ pool. Vitamin D binding protein and haptoglobin were the unique proteins increased in all the comparisons. For the verification phase, 80 samples from the same cohort were analyzed individually. To this end, we developed a Multiple Reaction Monitoring (MRM) method that was employed in a comprehensive targeted analysis with the aim of verifying the results obtained in the discovery phase. Thirty-one peptides belonging to 12 proteins associated with RF and/or ACPA status were quantified by MRM. In a final validation phase, the serum levels of alpha-1-acid glycoprotein 1 (A1AG1), haptoglobin (HPT) and retinol-binding protein 4 (RET4) were measured by immunoassays in the RA cohort of the Hospital of A Coruña (HUAC). The increase of two of these putative biomarkers in the double seropositive group was validated in 260 patients from this cohort (p = 0.009 A1AG1; p = 0.003 HPT). The increased level of A1AG1 showed association with RF rather than ACPA (p = 0.023), whereas HPT showed association with ACPA rather than RF (p = 0.013). Altogether, this study has allowed a further classification of the RA seropositive patients into two novel clusters: RF+A1AG+ and ACPA+HPT+. The determination of A1AG1 and HPT in serum would provide novel information useful for RA patient stratification, which could facilitate the effective implementation of personalized medicine in routine clinical practice.

[Leukemia associated to human T cell lymphotropic virus type 1 (HTLV-1) infection and intrafamily transmission in Santiago del Estero]. / Leucemia asociada al virus linfotrópico T humano tipo 1 (HTLV-1) y transmisión intrafamiliar de la infección en Santiago del Estero.

Adult T-cell leukemia/lymphoma (ATLL) is an hematological disease caused by human T-cell lymphotropic virus type 1 (HTLV-1) that develops after 20 years of incubation preferentially when the infection is acquired by vertical transmission. In cases of transmission by transfusion or organ transplant, this time is reduced from 3 months to 3 years. Acute ATLL is difficult to diagnose because it is unusual and has a rapid progression to death. In the Argentine Northwest, where the virus is endemic, ATLL is more frequent, however it is also detected continuously in the rest of the country. The treatment of choice, in the first instance, is the combined use of antivirals. We present a case of acute ATLL developed in a 59-year-old man from Santiago del Estero from which intrafamilial transmission of HTLV-1 infection was identified.

La leucemia/linfoma a células T del adulto (ATLL) es una enfermedad hematológica causada por el virus linfotrópico T humano tipo 1 (HTLV-1) que se desarrolla luego de 20 años de incubación, preferencialmente cuando la infección se adquiere por transmisión vertical. Este tiempo se reduce de 3 meses a 3 años cuando la transmisión del virus es por transfusión o trasplante de órganos. La ATLL aguda es de difícil diagnóstico por ser inusual y tener una rápida progresión a la muerte. En el Noroeste argentino, donde el virus es endémico, la ATLL es más frecuente, sin embargo, también se la detecta continuamente en el resto del país. El tratamiento de elección, en primera instancia, es el uso combinado de antivirales. Presentamos un caso de ATLL aguda desarrollada en un hombre de 59 años de Santiago del Estero a partir del cual se identificó transmisión intrafamiliar de la infección por HTLV-1.

Klebsiella pneumoniae blaNDM-1 carrying a class 1 integron causing a hospital outbreak in a Mexican attention center.

INTRODUCTION: Infections acquired in hospitals are the cause of high morbidity and mortality and with the emergence of resistant bacteria, the problem is greater. The aim of this work was to determine the genetic characteristics and timeline of Klebsiella pneumoniae blaNDM-1 carrying a class 1 integron involved in an intrahospital outbreak. METHODOLOGY: Investigation was made from the first detection of K. pneumoniae blaNDM-1, strain "466", and the last clone "423". 16S rRNA gene analysis showed that 466 strain and clones were related to K. pneumoniae. Extended-spectrum ß-lactamases (ESBL) was detected according to the Clinical and Laboratory Standards Institute (CLSI) and real time-PCR. Typing of K. pneumoniae blaNDM-1 strains was carried by ERIC-PCR and sequencing the variable region of the integrons were performed. RESULTS: A cluster of six resistant isolates of K. pneumoniae blaNDM-1 was detected in intensive care unit (ICU), internal medicine (IM) and orthopedics (OT). Timeline revealed that the first bacterial identification was in ICU and the last clone in OT service. The array genetic of variable region was "IntI/aadA5-drfA17/qacEΔ1-Sul1". CONCLUSIONS: The evidences highlight the importance of the epidemiological surveillance of Extended-spectrum ß-lactamases (ESBL) strains, as well as the need for molecular epidemiological studies to identify the routes of transmission and the contamination sources within health personnel.

Prospective study of urinary tract infection surveillance after kidney transplantation.

BACKGROUND: Urinary tract infection (UTI) remains one of the main complications after kidney transplantation and it has serious consequences. METHODS: Fifty-two patients with kidney transplantation were evaluated for UTI at 3-145 days (mean 40.0 days) after surgery.. Forty-two received a graft from a live donor and 10 from a deceased donor. There were 22 female and 30 male patients, aged 11-47 years. Microscopic examinations, leukocyte esterase stick, and urinary culture were performed every third day and weekly after hospitalization. A positive culture was consider when patients presented bacterial counts up to 105 counts. RESULTS: UTI developed in 19/52 (37%) patients at 3-75 days (mean 19.5 days after transplantation. Recurrent infection was observed in 7/52 (13.4%) patients at days 17-65. UTI was more frequent in patients who received deceased grafts compared with live grafts (7/10, 70% vs. 12/42, 28%; p < 0.007). Female patients were more susceptible than male (11/22, 50% vs. 8/22, 36.35%; p < 0.042). Five-year survival rate was 94.5% (49/52 patients). Kidney Graft exit update is 47/52 (90.2%), and there were no significant differences between graft rejection and UTI (p = 0.2518). Isolated bacteria were Escherichia coli (31.5%), Candida albicans (21.0%) and Enterococcus spp. (10.5%), followed by Pseudomonas aeruginosa, Klebsiella pneumoniae, Morganella morganii, Enterobacter cloacae and Micrococcus spp. Secondary infections were produced by (7/19, 36.8%). Enterococcus spp. (57%), E. coli (28%) and Micrococcus spp. (14.2%). Antibiotic resistance was 22% for ciprofloxacin and 33% for ampicillin. Therapeutic alternatives were aztreonam, trimethoprim-sulfamethoxazole, netilmicin and fosfomycin. CONCLUSIONS: Surveillance of UTI for the first 3 months is a good option for improving quality of life of kidney transplantation patients and the exit of graft function especially for female patients and those receiving deceased grafts. Antibiograms provided a good therapeutic alternative to patients who presented with UTIs after receiving a kidney allograft.

Comparative study of the antimutagenic properties of vitamins C and E against mutation induced by norfloxacin.

BACKGROUND: Norfloxacin like other fluoroquinolones, is known to mbe mutagenic for Salmonella typhimurium TA102 strain. This mutagenic effect is due to free oxygen radicals (ROS), because it is inhibited by antioxidants such as beta-carotene and naturally occurring antioxidants of Roheo discolor and other plants. The aim of this work was to evaluate combination therapy with norfloxacin and vitamins C and E, to reduce the possible genotoxic risk associated with fluoroquinolones. METHOD: The antimutagenicity of alpha-tocoferol (Vitamin E) and ascorbic acid (Vitamin C) against norfloxacin-induced mutation was evaluated on S. typhimurium TA102, using the aroclor-1254-induced S9 rat liver homogenate. The minimum inhibitory concentration (MIC) a measure of the bactericidal effect of norfloxacin, was obtained in vitro by the plate dilution method. RESULTS: Vitamin E (0.5 mg per Petri dish) induced a statistically significant reduction (P < 0.001) in the mutagenicity of norfloxacin, whereas Vitamin C (1 mg per Petri dish) had no such effect. Neither of these vitamins altered the MIC for norfloxacin against 25 uropathogenic strains of Escherichia coli. CONCLUSION: These results suggest that Vitamin E is a potent antimutagen that would be worthwhile being used in conjunction with fluoroquinolone treatment. The minimal antimutagenic effect of Vitamin C observed under these experimental conditions may have been because Vitamin C in the Ames test induces a Fenton reaction, and if divalent cations are present, it can act as a pro-oxidant rather than an antioxidant. Ascorbic acid should be further evaluated in the presence of different divalent cations concentrations.

Detección en urgencias de infección por VIH en pacientes que consultan por condiciones potencialmente relacionadas con infección oculta: Resultados iniciales del programa “Urgències VIHgila” / Emergency detection of HIV infection in patients consulting for conditions potentially related to occult infection: Initial results of the “Urgències VIHgila” program

Objective: To estimate the prevalence of unknown HIV infection in patients who consulted in hospital emergency services (ED) for conditions defined in the SEMES-GESIDA Consensus Document (DC), evaluate the efficiency of its im-plementation and investigate the efficiency of HIV serology determination in other conditions. Methods: Results were reviewed in 10 Catalan EDs for 12 months (July-21-June-22) after implementing CD recommendations: request HIV serology in case of suspected sexually transmitted infection, chemsex, post-exposure prophylaxis (PEP), mononucleosis syndrome, community pneumonia (18-65 y-o) or herpes zoster (18-65 y-o). Other reasons for request were included. Prevalence (%) of global seropositivity and for each circumstance was calculated, with a 95% confidence interval (95%CI). The efficient strategy was considered if the lower limit of the CI95%>0.1%. Results: A total of5,107 HIV serologies were performed: 2,847(56%) in situations specified in CD, and 2,266 (44%) in other 138 circumstances. Forty-eight unknown HIV infections were detected (prevalence=0.94%;95%CI=0.69-1.24). The prevalence was somewhat higher in DC requests (30 cas-es 1.12%) than the rest (18 cases 0.71%; p=0.16). The individualized prevalence of CD reasons ranged between 7.41% (95%CI=0.91-24.3) in chemsex and 0.42% 95%CI=0.14-0.98) in PPE, always efficient except herpes zoster (0.76%; CI95%=0.02-4.18). In other reasons, cases were detected in 12 circumstances, and in four the determination could be efficient: lymphopenia (10%;CI95%=0.25-44.5), fever with polyarthralgia-polyarthritis (7.41%;CI95% =0.91-24.3), behavioral alteration-confusion-encephalopathy (3.45%;95%CI=0.42-11.9) and fever of unknown origin (2.50%;95%CI=0.82-5.74). (AU)

Objetivo: Estimar la prevalencia de infección por VIH des-conocida en pacientes que consultan en servicios de urgencias hospitalarios (SUH) por las condiciones definidas en el Documento de Consenso (DC) de SEMES-GESIDA, evaluar la eficiencia de su implementación e investigar si en otras condiciones la determinación de serología VIH puede resultar eficiente.Método: Se revisaron los resultados obtenidos en 10 SUH catalanes durante los 12 meses (julio-21 a junio-22) siguientes a implementar las recomendaciones del DC de solicitar serología VIH a pacientes con sospecha de infección de transmisión sexual, práctica de chemsex, solicitud profilaxis post-exposición (PPE), síndrome mononucleósico, neumonía comunitaria (18-65 años) o herpes zóster (18-65 años). Se consignaron también otros motivos de solicitud. Se calculó la prevalencia (%) de seropositividad global y para cada circunstancia, con su intervalo de confianza del 95% (IC95%). Se consideró la estrategia eficiente si el límite inferior del IC95% era >0,1%.Resultados: Se realizaron 5.107 serologías VIH: 2.847 (56%) en situaciones especificadas en el DC, y 2.266 (44%) en otras 138 circunstancias. Se detectaron 48 infecciones por VIH desconocidas (prevalencia=0,94%; IC95%=0,69-1,24). La preva-lencia fue algo superior en las solicitudes ajustadas al DC (30 ca-sos, 1,12%) que en las que no (18 casos, 0,71%; p=0,16). La prevalencia individualizada para los motivos especificados en el DC osciló entre 7,41% IC95%=0,91-24,3) en práctica de chemsex y 0,42% (IC95%=0,14-0,98) en PPE, y siempre resultó eficiente, con excepción de herpes zóster (0,76%, IC95%=0,02-4,18). Respecto al resto de motivos de solicitud, se detectaron casos en 12 circunstancias, y en cuatro la determinación podría ser eficiente: linfopenia (10%, IC95%=0,25-44,5), fiebre con poliartralgias-poliartritis (7,41%, IC95%=0,91-24,3), alteración conductual-confusión-encefalopatía (3,45%,IC95%=0,42-11,9) y fiebre de origen desconocido(2,50%,IC95%=0,82-5,74)(AU)

Utilidad del antígeno prostático específico total y del índice de antígeno prostático específico libre para detectar cáncer de próstata en el paciente asintomático / Utility of total prostate-specific antigen and free prostate- specific antigen index to detect prostate cancer in the asymptomatic patient

Resumen El antígeno prostático específico (PSA) en circulación se encuentra ligado a la alfa-1-quimiotripsina y una pequeña fracción circula de manera libre (PSAl). Se valoró la utilidad clínica del PSA total (PSAt) y el índice de PSA libre para la detección de cáncer prostático en pacientes asintomáticos. Se cuantificó el PSAt, el PSAl y el índice de PSAl en 364 pacientes estratificados por grupo de edad. La frecuencia de valores anormales de PSAt fue del 8,79% (32/364). El grupo de 50-59 años presentó la mayor incidencia de resultados anormales (19/32). No hubo diferencia estadísticamente significativa entre PSAt y el índice de PSAl (p<0,05). El índice PSAl puede potencializar el valor del PSAt para determinar la presencia o ausencia de cáncer prostático. Un índice superior a 0,24 ng/mL puede ayudar a evitar o posponer la indicación de biopsia, principalmente cuando los valores de PSAt están entre 4 y 10 ng/mL.

Abstract Circulating prostate-specific antigen (PSA) is bound to alpha-1-chymotrypsin and a small fraction is free (PSAl). The clinical utility of the total PSA (PSAt) and the PSAl index for prostate cancer screening in asymptomatic patients was assessed. PSAt, PSAl and the PSAl index were quantified in 364 patients stratified by age group. The frequency of abnormal PSAt values was 8.79% (32/364). The 50-59 year-old group presented the highest incidence of abnormal results (19/32). There was no statistically significant difference between PSAt and the PSAl index (p<0.05). The PSAl index can potentiate the PSAt value to determine the presence or absence of prostate cancer. An index greater than 0.24 ng/mL can help to avoid or postpone the indication for a biopsy, especially when the PSAt values are between 4 and 10 ng/mL.

Resumo O antígeno prostático específico (PSA) em circulação é ligado à alfa-1-quimotripsina e a uma pequena fração circula livremente (PSAl). A utilidade clínica do PSA total (PSAt) e do índice de PSAl livre para o rastreamento do câncer de próstata em pacientes assintomáticos foi avaliada. PSAt, PSAl e o índice de PSAl foram quantificados em 364 pacientes estratificados por faixa etária. A frequência de valores anormais de PSAt foi de 8,79% (32/364). O grupo de 50-59 anos apresentou a maior incidência de resultados anormais (19/32). Não houve diferença estatisticamente significativa entre o PSAt e o índice PSAl (p<0,05). O índice PSAl pode potencializar o valor do PSAt para determinar a presença ou ausência de câncer de próstata. Um índice superior a 0,24 ng/mL pode ajudar a evitar ou adiar a indicação de biópsia, principalmente quando os valores de PSAt estão entre 4 e 10 ng/mL.

Leucemia asociada al virus linfotrópico T humano tipo 1 (HTLV-1) y transmisión intrafamiliar de la infección en Santiago del Estero / Leukemia associated to human T cell lymphotropic virus type 1 (HTLV-1) infection and intrafamily transmission in Santiago del Estero

Resumen La leucemia/linfoma a células T del adulto (ATLL) es una enfermedad hematológica causada por el virus linfotrópico T humano tipo 1 (HTLV-1) que se desarrolla luego de 20 años de incubación, preferencialmente cuando la infección se adquiere por transmisión vertical. Este tiempo se reduce de 3 meses a 3 años cuando la transmisión del virus es por transfusión o trasplante de órganos. La ATLL aguda es de difícil diagnóstico por ser inusual y tener una rápida progresión a la muerte. En el Noroeste argentino, donde el virus es endémico, la ATLL es más frecuente, sin embargo, también se la detecta continuamente en el resto del país. El tratamiento de elección, en primera instancia, es el uso combinado de antivirales. Presentamos un caso de ATLL aguda desarrollada en un hombre de 59 años de Santiago del Estero a partir del cual se identificó transmisión intrafamiliar de la infección por HTLV-1.

Abstract Adult T-cell leukemia/lymphoma (ATLL) is an hematological disease caused by human T-cell lymphotropic virus type 1 (HTLV-1) that develops after 20 years of incubation preferentially when the infection is acquired by vertical transmission. In cases of transmission by transfusion or organ transplant, this time is reduced from 3 months to 3 years. Acute ATLL is difficult to diagnose because it is unusual and has a rapid progression to death. In the Argentine Northwest, where the virus is endemic, ATLL is more frequent, however it is also detected continuously in the rest of the country. The treatment of choice, in the first instance, is the combined use of antivirals. We present a case of acute ATLL developed in a 59-year-old man from Santiago del Estero from which intrafamilial transmission of HTLV-1 infection was identified.

A new test of disk-diffusion to help in staphylococci identification.

A modified carbohydrate fermentation test (MCFT) of disk-diffusion assay was performed using a peptone-free agar medium, in order to improve the identification of clinical staphylococci species. Results were compared with the standard method of carbohydrate fermentation in tubes (SCFT) containing methyl red broth. MCFT was able to identify correctly 12 different species of staphylococci from the ATCC collection and 646 clinical isolates. MCFT showed sensitivity between 91.6% and 100% and specificity between 99.6% and 100%, for the different carbohydrates studied. MCFT could replace the SCFT, with the evident advantage of reducing time for materials preparation. The method presented herein is easy to perform in clinical or research microbiology laboratories, because it can differentiate species of staphylococci.

Mortalidad de dientes permanentes y sus principales causas en usuarios de unidades comunitarias de salud familiar Villa Mariona, Ozatlán y Taquillo. El Salvador, 2016 / Mortality of permanent teeth and its main causes in users of community family health units Villa Mariona, Ozatlán and Taquillo. El Salvador, 2016

Objetivo: Determinar la mortalidad de dientes permanentes y sus principales causas en usuarios atendidos en las Unidades Comunitarias de Salud Familiar, en El Salvador durante el año 2016. Metodología: La investigación corresponde a un estudio observacional, descriptivo y transversal, con una muestra de 1065 usuarios, en edades de 7 a más de 60 años del sistema público de salud que acudieron a consulta odontológica de septiembre a diciembre; en donde se describe la mortalidad de dientes permanentes con sus principales causas de pérdida y factores sociodemográficos; se utilizó una entrevista y una guía de observación donde se determinó el porcentaje de mortalidad referida y mortalidad indicada, haciendo uso del programa SPSS para el vaciado, análisis e interpretación de resultados. Resultados: La caries dental representa la causa más frecuente de mortalidad dental en los tres municipios con 64.85%, seguida de la enfermedad periodontal con 27.41%, otras causas con 5.16% y por trauma con 2.58%. Los órganos dentales con mayor frecuencia de perdida fueron el 3-6, 4-7 por caries dental y 3-1, 4-2 por enfermedad periodontal. Conclusión: La mortalidad de dientes permanentes se presentó mayormente por caries dental, afectando a hombres mayores de 60 años con baja escolaridad, residentes en zona rural, con oficio o trabajo informal y residentes de viviendas con piso de cemento.

Objective: Determinate the permanent teeth mortality and its main causes on users atended in the family health community centers in El Salvador. Methodology: This is a decriptive, observational and transversal study, it has a sample of 1065 users, between 7 to +60 years old, who were attended in the public dental health system, betweeen September to December, wich describes the permanent teeth mortality and principal lost causes and sociodemographic factors; and interview and mortality indicated was determined; the data was processed using the SPSS program for emptying, analize and results. Results: Tooth decay represents the most frequent cause of dental morality in the three municipalities with 64.85%, followed by periodontal disease with 27.41%, other causeswith 5.16% and dental trauma with 2.58%. The most extracted dental pieces were 3-6 and 4-7 due to cavities; the teeth 3-1 and 4-2 were the most extracted dental pieces becsause of periodontal disease. Conclusion: Permanent teeth mortality were shown mostly due to cavities, affecting males with 60 years or more. With low scholarship, were rural residents living in hpuses with concrete floors , and non-formal jobs as well.

[Benefits of Affirm VPIII and L-PAP in the diagnosis of bacterial vaginosis]. / Utilidad del sistema Affirm VPIII y de la prueba L-Pap para el diagnóstico de vaginosis bacteriana.

INTRODUCTION: Bacterial vaginosis is a syndrome occurring in women of reproductive age, characterized by abnormal vaginal discharge and associated with gynecological and obstetric problems during pregnancy. AIM: This study assesses the value of proline aminopeptidase (L-Pap) detection and DNA hybridization with the Affirm VPIII microbial identification test, as analytical tools for the diagnosis of bacterial vaginosis. MATERIAL AND METHODS: Vaginal secretions from 406 women were collected and analyzed to investigate bacterial vaginosis with the Affirm VPIII commercial kit and the L-Pap reaction. The criteria of Nugent et al, and Amsel et al. were used to characterize patients with bacterial vaginosis syndrome. Results were analyzed with a 2 x 2 contingency table and evaluated by the chi-square test, at a significance level of P < 0.05. RESULTS: L-Pap showed a sensitivity of 92.2%, specificity of 93.4%, PPV of 91.7% and NPV of 93.8%. The Affirm VPIII method had a sensitivity of 91.1%, specificity of 94.7%, PPV of 93.1% and NPV of 93.8%. The diagnostic performance of the two tests showed no statistical differences. CONCLUSION. L-Pap and Affirm VPIII are both suitable tests for fast, accurate diagnosis of bacterial vaginosis.

[Identification of Candida species causing vaginitis in Mexican patients]. / Identificación de especies de Candida causantes de vaginitis en la población mexicana.

INTRODUCTION: The increasing frequency of candidiasis due Candida spp. other than C. albicans suggests that these organisms may also have emerged as a cause of vaginitis. OBJECTIVE: The aim of this study was to investigate the species of Candida most frequently isolated from Mexican patients with vaginal candidiasis. MATERIAL AND METHODS: A total of 631 isolates of Candida were identified by the API 20C system and standard bacteriological tests. RESULTS: The most frequently identified species were C. albicans (39.0%), C. glabrata (35.9%), and C. tropicalis (16.2%). CONCLUSIONS: The results of this study show that in addition to C. albicans, C. glabrata and C. tropicalis can also be considered important vaginal pathogens in Mexican patients.

[Etiology of cervical vaginal infection among patients of the Juárez Hospital of Mexico]. / Etiología de la infección cérvico vaginal en pacientes del Hospital Juárez de México.

OBJECTIVE: To identify the etiologic agents of cervicovaginal infection in order to establish an accurate diagnosis and proper treatment. MATERIAL AND METHODS: From January 1995 to December 1999, bacteriological studies were done in cervical discharge specimens from 6,811 patients aged 13 to 65 years, seen at Hospital Juarez in Mexico City. All patients had leucorrhea, pruritus, hyperemia, and abdominal pain. Statistical significance was assessed using the chi-squared test. RESULTS: The frequencies of infectious agents were as follows: G. vaginalis, 22.65%, Candida spp, 19.13%, C, albicans, 7.8%, T. vaginalis, 1.5%, Streptococcus group D, 11.78%, Streptococcus beta hemolytic, 4.59%, E. coli, 13.46%, and Klebsiella spp, 2.0%. Less frequent enterobacteria were: Citrobacter spp, Enterobacter spp, Pseudomonas spp, M. morganii, and P. mirabilis. Almost 3% of patients presented anaerobic species, which were always associated with G. vaginalis. Neisseria spp and N. weaveri were isolated in 0.15% each; N. gonorrhoeae was not isolated in any of the patients. Comparative data showed that Streptococcus beta hemolytic and E. coli increased markedly in the past two years (p < 0.001 for the latter). CONCLUSIONS: The diversity of etiologic agents requires performing bacteriological cultures of cervical and vaginal discharge to all symptomatic patients. The English version of this paper is available at:http://www.insp.mx/salud/index.html.

Etiología de la infección cérvico vaginal en pacientes del Hospital Juárez de México / Etiology of cervicovaginal infection in Mexican women

OBJETIVO: Conocer la etiología de la infección cérvico vaginal, con el fin de establecer un diagnóstico acertado que permita ofrecer a las pacientes el tratamiento más apropiado. MATERIAL Y MÉTODOS: De enero de 1995 a diciembre de 1999 se realizó un estudio bacteriológico a 6 811 muestras de exudado cérvico vaginal de pacientes del Hospital Juárez de México, de la Ciudad de México, con edades comprendidas entre los 13 y los 65 años, que referían leucorrea, prurito, hiperemia y dolor abdominal bajo. RESULTADOS: La frecuencia de infección por cada germen fue G vaginalis, 22.65 por ciento, Candida spp, 19.13 por ciento, C albicans, 7.8 por ciento, T vaginalis, 1.5 por ciento, Streptococcus del grupo D, 11.78 por ciento, Streptococcus b haemolyticus, 4.59 por ciento, E coli, 13.46 por ciento, Klebsiella ssp, 2.0 por ciento, además de otras enterobacterias menos frecuentes como Citrobacter spp, Enterobacter spp, Pseudomonas spp, M morganii y P mirabilis. El 2.9 por ciento presentó anaerobios siempre asociados con G vaginalis. Se aislaron Neisseria spp y N weaveri en 0.15 por ciento de las muestras. La N gonorrhoeae no se encontró en ningún caso. Datos comparativos indican que, tanto Streptococcus hemoliticos como E coli tuvieron un marcado incremento en los dos últimos años, siendo el de esta última estadísticamente significativo (p<0.001). El método de ji cuadrada se aplicó para la evaluación de los datos. CONCLUSIONES: Considerando la diversidad de la etiología de la infección se recomienda realizar cultivos de la secreción cérvico vaginal a todas las pacientes con sintomatología sugestiva de ella.

Utilidad del sistema Affirm VPIII y de la prueba L-Pap para el diagnóstico de vaginosis bacteriana / Benefits of Affirm VIII and L-PAP in the diagnosis of bacterial vaginosis

INTRODUCCIÓN. La vaginosis bacteriana es un síndrome asociado con secreción vaginal anormal en la mujer en edad reproductiva y se asocia con complicaciones ginecológicas y obstétricas. OBJETIVO. El propósito de este estudio fue determinar que la detección de prolina aminopeptidasa (L-Pap) y la hibridación de ADN son herramientas útiles para el diagnóstico de vaginosis bacteriana. MATERIAL Y MÉTODOS. Se recogieron y analizaron406 muestras de secreción vaginal, para el estudio de vaginosis bacteriana usando el sistema comercial Affirm VPIII y la prueba L-Pap. Como método estándar se utilizó la combinación de la puntuación de Nugent y los criterios de Amsel et al. Los resultados se analizaron usando la tabla de contingencia de 2 × 2 y la prueba de chi al cuadrado con un nivel de significancia de p < 0,05.RESULTADOS. La L-Pap exhibió una sensibilidad del 92,2%,una especificidad del 93,4%, un valor predictivo positivo(VPP) del 91,7% y un valor predictivo negativo (VPN) del 93,8%. La prueba comercial de hibridación de ADN mostró una sensibilidad del 91,1%, una especificidad del 94,7%, un VPP del 93,1% y un VPN del 93,8%. Ambas pruebas ofrecieron resultados sin diferencias estadísticamente significativas (AU)

INTRODUCTION. Bacterial vaginosis is a syndrome occurring in women of reproductive age, characterized by abnormal vaginal discharge and associated with gynecological and obstetric problems during pregnancy. AIM. This study assesses the value of prolineaminopeptidase (L-Pap) detection and DNA hybridization with the Affirm VPIII microbial identification test, as analytical tools for the diagnosis of bacterial vaginosis. MATERIAL AND METHODS. Vaginal secretions from 406 women were collected and analyzed to investigate bacterial vaginosis with the Affirm VPIII commercial kit and the L-Pap reaction. The criteria of Nugent et al, and Amselet al. were used to characterize patients with bacterial vaginosis syndrome. Results were analyzed with a2 × 2 contingency table and evaluated by the chi-square test, at a significance level of P < 0.05.RESULTS. L-Pap showed a sensitivity of 92.2%, specificity of 93.4%, PPV of 91.7% and NPV of 93.8%. The Affirm VPIII method had a sensitivity of 91.1%, specificity of 94.7%,PPV of 93.1% and NPV of 93.8%. The diagnostic performance of the two tests showed no statistical differences. CONCLUSION. L-Pap and Affirm VPIII are both suitable tests for fast, accurate diagnosis of bacterial vaginosis (AU)

Identificación de especies de Candida causantes de vaginitis en la población mexicana / Identification of Candida species causing vaginitis in Mexican patients

Introducción. El incremento de las candidiasis producidas por Candida no albicans puede sugerir la creciente importancia de estos microorganismos como causa de vaginitis. Objetivo. Conocer las especies de Candida aisladas más frecuentemente en mujeres mexicanas con candidiasis vaginal. Material y métodos. Empleando el sistema API 20C y otras pruebas convencionales se identificaron 631 especies de Candida. Resultados. Las especies más frecuentemente identificadas fueron las siguientes: C. albicans 39,0%, C. glabrata 35,9% y C. tropicalis 16,2%. Conclusiones. Los resultados de este estudio indican que, en pacientes mexicanas, además de C. albicans, C. glabrata y C. tropicalis deben considerarse también patógenos vaginales importantes (AU)

Introduction. The increasing frequency of candidiasis due Candida spp. other than C. albicans suggests that these organisms may also have emerged as a cause of vaginitis. Objective. The aim of this study was to investigate the species of Candida most frequently isolated from Mexican patients with vaginal candidiasis. Material and methods. A total of 631 isolates of Candida were identified by the API 20C system and standard bacteriological tests. Results. The most frequently identified species were C. albicans (39.0%), C. glabrata (35.9%), and C. tropicalis (16.2%). Conclusions. The results of this study show that in addition to C. albicans, C. glabrata and C. tropicalis can also be considered important vaginal pathogens in Mexican patients (AU)

Genotoxic evaluation of Norfloxacin and Pipemidic acid with the Eschirichia coli PolA-/polA+ and the ames test

Background. Genotoxicity of antibiotic has not been well evaluted, and there is not much information on the genetic risk of quinolone drugs, even though they are widely used as alternative choice drugs in urinary infections. Methods. Pipemidic acid and norfloxacin were tested for their capacity to induce point mutations using the Ames test and DNA damage on Escherichia coli PolA-/PolA+. Results. At non-toxic doses, all of the drugs studied were negative on the E. coli PolA-/PolA+ test with or without in vitro metabolic activation with induced arochlor 1254 rat liver (S9). They did not procedure frameshift mutations in TA98, or base-air substitutions in S. typhimurium hisG46 strains TA100, or UTH8414. Norfloxacin and its induced metabolites in vitro with S9 rat liver were mutagenic to hisG48 strains TA102 and TA104, both of which detect oxidative chemicals. Pipemidic acid induced mutations in S. typhimurium hisG48 strains only when they had an efficient DNA excision repair system. Conclusions. These results suggest that the risk of oxygen-free radical generation from quinolones should be considered