Inhibition of Phytopathogenic and Beneficial Fungi Applying Silver Nanoparticles In Vitro.

In the current research, our work measured the effect of silver nanoparticles (AgNP) synthesized from Larrea tridentata (Sessé and Moc. ex DC.) on the mycelial growth and morphological changes in mycelia from different phytopathogenic and beneficial fungi. The assessment was conducted in Petri dishes, with Potato-Dextrose-Agar (PDA) as the culture medium; the AgNP concentrations used were 0, 60, 90, and 120 ppm. Alternaria solani and Botrytis cinerea showed the maximum growth inhibition at 60 ppm (70.76% and 51.75%). Likewise, Macrophomina spp. required 120 ppm of AgNP to achieve 65.43%, while Fusarium oxisporum was less susceptible, reaching an inhibition of 39.04% at the same concentration. The effect of silver nanoparticles was inconspicuous in Pestalotia spp., Colletotrichum gloesporoides, Phytophthora cinnamomi, Beauveria bassiana, Metarhizium anisopliae, and Trichoderma viridae fungi. The changes observed in the morphology of the fungi treated with nanoparticles were loss of definition, turgidity, and constriction sites that cause aggregations of mycelium, dispersion of spores, and reduced mycelium growth. AgNP could be a sustainable alternative to managing diseases caused by Alternaria solani and Macrophomina spp.

Weeds Harbor Fusarium Species that Cause Malformation Disease of Economically Important Trees in Western Mexico.

Mango malformation disease (MMD) caused by Fusarium spp. is an important limiting factor in most production areas worldwide. Fusarium mexicanum and F. pseudocircinatum have been reported as causing MMD in Mexico. These two pathogens also cause a similar disease in Swietenia macrophylla (big-leaf mahogany malformation disease) in central western Mexico, and F. pseudocircinatum was recently reported as causing malformation disease in Tabebuia rosea (rosy trumpet) in the same region. These studies suggest that additional plant species, including weeds, might be hosts of these pathogens. The role that weed hosts might have in the disease cycle is unknown. The objectives of this work were to recover Fusarium isolates from understory vegetation in mango orchards with MMD, identify the Fusarium isolates through DNA sequence data, and determine whether F. mexicanum is capable of inducing disease in the weedy legume Senna uniflora (oneleaf senna). Additional objectives in this work were to compare Fusarium isolates recovered from weeds and mango trees in the same orchards by characterizing their phylogenetic relationships, assessing in vitro production of mycotoxins, and identifying their mating type idiomorph. A total of 59 Fusarium isolates from five species complexes were recovered from apical and lateral buds from four weed species. Two of the species within the F. fujikuroi species complex are known to cause MMD in Mexico. Trichothecene production was detected in five isolates, including F. sulawense and F. irregulare in the F. incarnatum-equiseti species complex and F. boothii in the F. sambucinum species complex. Both mating types were present among mango and weed isolates. This is the first report of herbaceous hosts harboring Fusarium species that cause mango malformation in Mexico. The information provided should prove valuable for further study of the epidemiological role of weeds in MMD and help manage the disease.

Malformation Disease in Tabebuia rosea (Rosy Trumpet) Caused by Fusarium pseudocircinatum in Mexico.

Tabebuia rosea (rosy trumpet) is an economically important neotropical tree in Mexico that is highly valued for the quality of its wood, which is used for furniture, crafts, and packing, and for its use as an ornamental and shade tree in parks and gardens. During surveys conducted in the lower Balsas River Basin region in the states of Guerrero and Michoacán, symptoms of floral malformation were detected in T. rosea trees. The main objectives of this study were to describe this new disease, to determine its causal agent, and to identify it using DNA sequence data. A second set of objectives was to analyze the phylogenetic relationship of the causal agent to Fusarium spp. associated with Swietenia macrophylla trees with malformation surveyed in the same region and to compare mycotoxin production and the mating type idiomorphs of fusaria recovered from T. rosea and S. macrophylla. Tabebuia rosea showed malformed inflorescences with multiple tightly curled shoots and shortened internodes. A total of 31 Fusarium isolates recovered from symptomatic T. rosea (n = 20) and S. macrophylla (n = 11) trees were identified by molecular analysis as Fusarium pseudocircinatum. Pathogenicity tests showed that isolates of F. pseudocircinatum recovered from T. rosea induced malformation in inoculated T. rosea seedlings. Eighteen F. pseudocircinatum isolates were tested for their ability to produce mycotoxins and other secondary metabolites. Moniliformin, fusaric acid, bikaverin, beauvericin, aurofusarin. and 8-O-methylbostrycoidin were produced by at least one strain of the 18 isolates tested. A multiplex PCR assay for mating type idiomorph revealed that 22 F. pseudocircinatum isolates were MAT1-1 and that 9 were MAT1-2. Here, we report a new disease of T. rosea in Mexico caused by F. pseudocircinatum.

Heme-Induced Oxidation of Cysteine Groups of Myofilament Proteins Leads to Contractile Dysfunction of Permeabilized Human Skeletal Muscle Fibres.

Heme released from red blood cells targets a number of cell components including the cytoskeleton. The purpose of the present study was to determine the impact of free heme (20-300 µM) on human skeletal muscle fibres made available during orthopedic surgery. Isometric force production and oxidative protein modifications were monitored in permeabilized skeletal muscle fibre segments. A single heme exposure (20 µM) to muscle fibres decreased Ca2+-activated maximal (active) force (Fo) by about 50% and evoked an approximately 3-fold increase in Ca2+-independent (passive) force (Fpassive). Oxidation of sulfhydryl (SH) groups was detected in structural proteins (e.g., nebulin, α-actinin, meromyosin 2) and in contractile proteins (e.g., myosin heavy chain and myosin-binding protein C) as well as in titin in the presence of 300 µM heme. This SH oxidation was not reversed by dithiothreitol (50 mM). Sulfenic acid (SOH) formation was also detected in the structural proteins (nebulin, α-actinin, meromyosin). Heme effects on SH oxidation and SOH formation were prevented by hemopexin (Hpx) and α1-microglobulin (A1M). These data suggest that free heme has a significant impact on human skeletal muscle fibres, whereby oxidative alterations in structural and contractile proteins limit contractile function. This may explain and or contribute to the weakness and increase of skeletal muscle stiffness in chronic heart failure, rhabdomyolysis, and other hemolytic diseases. Therefore, therapeutic use of Hpx and A1M supplementation might be effective in preventing heme-induced skeletal muscle alterations.

Genetic diversity of Fusarium pseudocircinatum in the central western region of Mexico: the case of big-leaf mahogany malformation disease.

Fusarium pseudocircinatum is the main causal agent of big-leaf mahogany malformation disease (BLMMD) of mahogany (Swietenia macrophylla) in Mexico. Although, BLMMD is the most important disease for this high-value timber species, there is a lack of information on the genetic variation present in geographically diverse isolates of F. pseudocircinatum. The objective of this study was to determine the genetic diversity of populations of F. pseudocircinatum causing BLMMD in the central western region of Mexico. A total of 611 big-leaf mahogany trees were inspected at eight sites in four states (Colima, Guerrero, Jalisco and Michoacán); of these, 42.7% showed malformation symptoms similar to those of BLMMD. Of 374 Fusarium isolates that were recovered, 277 were identified as F. pseudocircinatum, 56 were F. mexicanum, and 41 were Fusarium spp. An ISSR analysis of the F. pseudocircinatum isolates generated 51 bands of which 38 were polymorphic (76.8%) with a mean of 17 bands per primer. A total of 87 multilocus genotypes (MLGs) were identified. Nei's genetic diversity analysis showed that the isolates had a high genetic diversity average (0.147), with values ranging from 0.070 to 0.365 depending of the geographical location. An analysis of molecular variance revealed that the variation within the populations was low (27.36%), while the variation within MLGs was significant (72.64%), indicating genetic flow. Overall, the genetic variability of F. pseudocircinatum populations was high and the MLGs from Colima (Colima) and Gabriel Zamora (Michoacán) were placed centrally, which possibly is evidence of ancestry and indicates its dispersion routes in the central western region of Mexico.

Design and validation of a robust multiplex polymerase chain reaction assay for MAT idiomorph within the Fusarium fujikuroi species complex.

We discovered that published polymerase chain reaction (PCR) assays for determining mating type (MAT) idiomorph failed to genotype some of the Fusarium fujikuroi species complex (FFSC) isolates recovered from Mangifera indica (mango), Swietenia macrophylla (big-leaf mahogany), Annona muricata (soursop), Bursera sp., and Tabebuia sp. in Mexico. Thus, the primary objective of this study was to design and validate a robust multiplex PCR-based diagnostic for typing MAT within the FFSC. To accomplish this objective, we mined the MAT1-1 or MAT1-2 locus from the genomes of 60 FFSC isolates, representing 56 phylospecies, and from four species in its sister group, the F. nisikadoi species complex (FNSC). Bioinformatic searches were facilitated by targeting DNA lyase (SLA2) and apurinic endonuclease (APN1), the genes that flank the MAT locus in Fusarium. As expected, three genes were identified within MAT1-1 (MAT1-1-1, MAT1-1-2, and MAT1-1-3) and two in MAT1-2 (MAT1-2-1 and MAT1-2-9), using the ab initio prediction tool AUGUSTUS. Of the three multiplex PCR assays we designed and tested, the one targeting MAT1-1-2 and MAT1-2-1 successfully genotyped the entire 71-isolate validation panel, which included 56 FFSC and 4 FNSC phylospecies. By contrast, the published PCR assays we tested produced positive genotypes for only 46.5-59% of the 71-isolate validation panel, but only when they were run as a uniplex assay. Although only one-fifth of the FFSC/FNSC are known to reproduce sexually, our results suggest that if they possess a sexual cycle, it is heterothallic (self-sterile).

Genome Sequence Data of Six Isolates of Phytophthora capsici from Mexico.

Phytophthora capsici is an oomycete plant pathogen with a wide host range. Worldwide, P. capsici is known for causing the principal disease of chili pepper crops. Our goal was to expand the available genome resources for this diverse pathogen by generating whole-genome sequences for six isolates of P. capsici from Mexico.

Genetic diversity of Fusarium mexicanum, causal agent of mango and big-leaf mahogany malformation in Mexico.

In Mexico, Fusarium mexicanum has been reported causing mango malformation disease and big-leaf mahogany malformation disease. Our objective was to determine the genetic diversity of F. mexicanum isolates obtained from malformed big-leaf mahogany and mango trees, using an internal simple sequence repeat (ISSR) analysis. A total of 61 isolates of F. mexicanum, 32 from mango and 29 from big-leaf mahogany, were initially genotyped using fourteen ISSR primers. Data from five primers that produced the highest number of polymorphic bands were selected for further analysis. The primers generated 49 polymorphic bands (85.96%) from a total of 57 fragments ranging in size from 250 to 2800 bp, with an average of 11.4 bands per primer. An analysis of molecular variance (AMOVA) indicated that the variation within populations, isolates grouped by host and geographic origin, was significant (43%), followed by the variation between the big-leaf mahogany versus mango isolates (34%), while among populations the variation was the lowest (22%). The genetic fingerprints suggested that genetic variability of F. mexicanum populations are structured by the host of origin rather than the geographic region.

Deletions of pfhrp2 and pfhrp3 genes of Plasmodium falciparum from Honduras, Guatemala and Nicaragua.

BACKGROUND: Malaria remains a public health problem in some countries of Central America. Rapid diagnostic tests (RDTs) are one of the most useful tools to assist in the diagnosis of malaria in remote areas. Since its introduction, a wide variety of RDTs have been developed for the detection of different parasite antigens. PfHRP2 is the most targeted antigen for the detection of Plasmodium falciparum infections. Genetic mutations and gene deletions are important factors influencing or affecting the performance of rapid diagnostic tests. METHODS: In order to demonstrate the presence or absence of the pfhrp2 and pfhrp3 genes and their flanking regions, a total of 128 blood samples from patients with P. falciparum infection from three Central American countries were analysed through nested or semi-nested PCR approaches. RESULTS: In total, 25.8 and 91.4% of the isolates lacked the region located between exon 1 and exon 2 of pfhrp2 and pfhrp3 genes, respectively. Parasites from the three countries showed deletions of one or both genes. The highest proportion of pfhrp2 deletions was found in Nicaragua while the isolates from Guatemala revealed the lowest number of pfhrp2 deletions. Parasites collected from Honduras showed the highest proportion of phfrp3 absence (96.2%). Twenty-one percent of isolates were double negative mutants for the exon 1-2 segment of both genes, and 6.3% of isolates lacked the full-length coding region of both genes. CONCLUSIONS: This study provides molecular evidence of the existence of P. falciparum isolates lacking the pfhrp2 and pfhrp3 genes, and their flanking regions, in Honduras, Guatemala and Nicaragua. This finding could hinder progress in the control and elimination of malaria in Central America. Continuous evaluation of RDTs and molecular surveillance would be recommended.

High levels of diversity and population structure in the potato late blight pathogen at the Mexico centre of origin.

Globally destructive crop pathogens often emerge by migrating out of their native ranges. These pathogens are often diverse at their centre of origin and may exhibit adaptive variation in the invaded range via multiple introductions from different source populations. However, source populations are generally unidentified or poorly studied compared to invasive populations. Phytophthora infestans, the causal agent of late blight, is one of the most costly pathogens of potato and tomato worldwide. Mexico is the centre of origin and diversity of P. infestans and migration events out of Mexico have enormously impacted disease dynamics in North America and Europe. The debate over the origin of the pathogen, and population studies of P. infestans in Mexico, has focused on the Toluca Valley, whereas neighbouring regions have been little studied. We examined the population structure of P. infestans across central Mexico, including samples from Michoacán, Tlaxcala and Toluca. We found high levels of diversity consistent with sexual reproduction in Michoacán and Tlaxcala and population subdivision that was strongly associated with geographic region. We determined that population structure in central Mexico has contributed to diversity in introduced populations based on relatedness of U.S. clonal lineages to Mexican isolates from different regions. Our results suggest that P. infestans exists as a metapopulation in central Mexico, and this population structure could be contributing to the repeated re-emergence of P. infestans in the United States and elsewhere.

Heme-induced contractile dysfunction in human cardiomyocytes caused by oxidant damage to thick filament proteins.

Intracellular free heme predisposes to oxidant-mediated tissue damage. We hypothesized that free heme causes alterations in myocardial contractility via disturbed structure and/or regulation of the contractile proteins. Isometric force production and its Ca(2+)-sensitivity (pCa50) were monitored in permeabilized human ventricular cardiomyocytes. Heme exposure altered cardiomyocyte morphology and evoked robust decreases in Ca(2+)-activated maximal active force (Fo) while increasing Ca(2+)-independent passive force (F passive). Heme treatments, either alone or in combination with H2O2, did not affect pCa50. The increase in F passive started at 3 µM heme exposure and could be partially reversed by the antioxidant dithiothreitol. Protein sulfhydryl (SH) groups of thick myofilament content decreased and sulfenic acid formation increased after treatment with heme. Partial restoration in the SH group content was observed in a protein running at 140 kDa after treatment with dithiothreitol, but not in other proteins, such as filamin C, myosin heavy chain, cardiac myosin binding protein C, and α-actinin. Importantly, binding of heme to hemopexin or alpha-1-microglobulin prevented its effects on cardiomyocyte contractility, suggesting an allosteric effect. In line with this, free heme directly bound to myosin light chain 1 in human cardiomyocytes. Our observations suggest that free heme modifies cardiac contractile proteins via posttranslational protein modifications and via binding to myosin light chain 1, leading to severe contractile dysfunction. This may contribute to systolic and diastolic cardiac dysfunctions in hemolytic diseases, heart failure, and myocardial ischemia-reperfusion injury.

Descripción epidemiológica y tratamiento de los pacientes con enfermedad de Crohn / Epidemiological description and treatment of Crohn's disease patients

Antecedentes: la enfermedad de Crohn es un proceso inflamatorio crónico granulomatoso que puede afectar todo el tracto digestivo. Se diagnostica cada vez más frecuentemente en nuestro medio, y es causa importante de morbimortalidad en los pacientes afectados. El presente estudio tiene como objetivo conocer la prevalencia de esta enfermedad, sus manifestaciones clínicas más frecuentes, los diversos tratamientos utilizados y la respuesta a estos. Métodos: se revisaron los expedientes clínicos de todos los pacientes con diagnóstico de enfermedad de Crohn evaluados durante 2009 en el Servicio de Gastroenterología de un centro de salud terciario, el Hospital "Dr. Rafael A. Calderón Guardia". Resultados: de un total de 28 pacientes con enfermedad de Crohn, solo tres casos fueron diagnosticados en la década 1990-2000, mientras que los restantes 25 casos fueron diagnosticados de 2001 a 2009. Un 60 por ciento de los casos diagnosticados corresponden a pacientes del sexo masculino. La población estudiada tiene una distribución de edades entre los 17 y 72 a¤os, con un promedio de edad de 39 años de edad. El 82 por ciento de los pacientes se encuentran con tratamiento de mantenimiento con base en derivados del ácido 5-aminosalicílico, mientras que un 62 por ciento también utiliza azatiprina, 6-mercaptopurina o metotrexate, un 51 por ciento reciben esteroides sistemáticos y solo siete pacientes recibieron inflimixab. Un 68 por ciento de los pacientes del presente estudio requirió manejo quirúrgico en algún momento de su evolución, y en un 96 por ciento de los pacientes se logró remisión de la enfermedad. Conclusión: la prevalencia de la enfermedad de Crohn parece encontrarse en aumento, y en los casos en los cuales hay fallo terapéutico al régimen farmacológico, puede ser necesario un abordaje quirúrgico...

Identification and characterization of a novel etiological agent of mango malformation disease in Mexico, Fusarium mexicanum sp. nov.

The primary objective of this study was to characterize Fusarium spp. associated with the economically devastating mango malformation disease (MMD) in Mexico. In all, 142 Fusarium strains were isolated from symptomatic mango inflorescences and vegetative tissues in eight geographically diverse Mexican states from 2002 through 2007. Initially, all the Mexican isolates were screened for genetic diversity using appolymerase chain reaction and random amplified polymorphic DNA markers and were grouped into seven distinct genotypes. Based on results of these analyses, evolutionary relationships and species limits of the genetically diverse MMD-associated Fusarium spp. were investigated using multilocus DNA sequence data and phylogenetic species recognition. Maximum parsimony analyses of a five-locus data set comprising 5.8 kb of aligned DNA sequence data indicated that at least nine phylogenetically distinct Fusarium spp. within the Gibberella fujikuroi species complex are associated with MMD, including one species within the African clade (Fusarium pseudocircinatum), two species within the Asian clade (F. mangiferae and F. proliferatum), and at least six species within the American clade (F. sterilihyphosum and five undescribed Fusarium spp.). Molecular phylogenetic analyses indicate that a novel genealogically exclusive lineage within the American clade was the predominant MMD associate in Mexico. This new Fusarium sp. caused MMD and could be distinguished from all other known species morphologically by the production of mostly sterile, coiled hyphae which are typically associated with sporodochial conidiophores together with unbranched or sparsely branched aerial conidiophores. Koch's postulates were completed for isolates of the new species on nucellar seedlings of mango cv. Ataulfo. This pathogen is formally described herein as F. mexicanum.

Acalasia, experiencia de 6 años. Hospital "Dr. Rafael Ángel Calderón Guardia" (2001-2007) / Achalasia, a 6 Years Study at the Calderon Guardia Hospital

Objetivos: Caracterizar la población de pacientes vistos con esta entidad en el Hospital "Dr. Rafael Angel Calderón Guardia" durante los últimos 6 años y determinar su presentación clínica, método(s) de diagnóstico utilizado (s), tratamiento brindado y evolución durante el primer año postratamiento. Materiales y métodos: Se analizaron los expedientes clínicos de hospitalización de los pacientes con acalasia atendidos desde enero de 2001 hasta enero de 2007; luego se revisaron las notas de evolución de la consulta externa de Gastroenterología durante el año posterior a la terapia brindada. Resultados: Durante el periodo se analizaron 30 pacientes en total. Hubo una discreta predominancia del género masculino y la edad promedio en el momento del diagnóstico fue de 50,37 años. El 100% de los pacientes presentó disfagia de larga data y los síntomas asociados más frecuentes fueron la pérdida de peso y el dolor torácico. Los métodos diagnósticos más utilizados fueron la manometría esofágica, la endoscopía y el esofagograma. El tratamiento que más se empleó fue la dilatación neumática seguida de la cirugía. El 50% de los pacientes reinició o persistió con disfagia durante el año siguiente a su tratamiento. La incidencia de complicaciones fue baja y no hubo perforación esofágica. Conclusiones: Las características generales y la presentación clínica de los pacientes coincidieron con lo descrito en la bibliografía. El tratamiento que más se brindó fue la dilatación neumática. La mitad de los pacientes presentaron o continuaron con síntomas postratamiento.

Objectives: To determine the general characteristics of patients with diagnosis of achalasia seen during the last 6 years at the Dr. Rafael Angel Calderon Guardia Hospital, their clinical presentation, diagnostic methods utilized, treatments given and the presence of disphagia within the following year after therapy. Methods: We analized the clinical records of patients with achalasia seen from january 2001 to january 2007. We also reviewed out patient clinic notes, looking for the persistence or recurrence of disphagia during the first year after therapy. Results: 30 patients were found and included in the study. There was a slight male gender predominance, and an average age of 50,37 years. All the patients had long standing dysphagia, the other most frequent symptoms were weight loss (43,33%) and chest pain (13,33%). The more commonly used diagnostic methods were esophageal manometry, endoscopy and barium esophagogram. Pneumatic dilation was the most frequently utilized treatment (46,67%) followed by surgery (26,67%). Half the patients recurred or continue having dysphagia during the year following treatment. The rate of complications was low and there were no esophageal perforations or mediastinitis. Conclusions: The general characteristics and clinical presentation of the patients agreed with those mentioned in the literature. Esophagic manometry was the most used diagnostic test and esophageal dilation was the preferred treatment. The rate of dysphagia within a year posttreatment was high.

Virus B e interferón / Virus B and interferon

La aparición de nuevas drogas y formas de diagnóstico, han transformado la hepatitis crónica B de una enfermedad fatal a una manejable y aún curable. Se distinguen dos tipos de enfermedad crónica por virus B, la que se desarrolla con antígeno e positivo y la que cursa con antígeno e negativo. La enfermedad crónica puede presentarse con ALT normal, ALT en continua elevación, fluctuaciones de ALT sin llegar a ser normales o elevaciones intermitentes. El éxito de la terapia antiviral para el virus B incluye, suprimir la replicación viral al nivel más bajo posible, lograr mejoría bioquímica e histológica y prevenir el desarrollo de complicaciones. Existen dos estrategias de tratamiento para el virus B, una de duración limitada (interferones) y otra de largo plazo (análogos nucleós(t)idos). Existen factores que influencian favorablemente la respuesta al tratamiento con interferón: niveles bajos de HBV DNA, niveles altos de ALT, niveles bajos de HBeAg y genotipos A y B. En el manejo de la enfermedad crónica tanto por virus B e ( + ) y e ( - ) se han utilizado interferón αlfa y actualmente el interferón pegilado α-2a. El interferón pegylado también ha mostrado ser superior al interferón simple en cuanto a normalización de ALT, pérdida del HBe y pérdida sostenida del HBV DNA. El interferón pegylado también ha mostrado ser superior a la terapia combinada o a la lamivudina sola en cuanto a rangos de respuesta y seroconversión en e (+) y e (-). En los pacientes e (-) sigue existiendo controversia por ameritar tratamiento a largo plazo el uso de interferón o iniciar con análogos nucleósidos.

The appearance of new drugs and new forms of diagnosing has transformed chronic hepatitis B from being a lethal disease to becoming a treatable and even curable disease. There are two kinds of chronic hepatitis B, one that develops with antigen e positive and the other one with antigen e negative. This chronic disease can appear with normal ALT, ALT continuous elevation, and ALT fluctuations without becoming normal or intermittent elevations. The success of the antiviral therapy for HBVincludes, suppressing the replicative state to the lowest level possible, getting biochemical and histological amelioration; and preventing the development of complications. There are two strategies for HBV treatment, one with limited duration (interferon) and the other long term treatment (nucleotide analogue). There are factors that influence satisfactorily, the response to the treatment with interferon: low levels of HBV DNA, high levels of ALT, long levels of HBeAg and A & B genotypes. Alpha interferon and more recently Pegylated α-2a have been used for the management of HBVe (+) and HBVe (-). The Pegylated interferon has shown to be more effective than conventional interferon, in terms of ALT normalization, HBe loss, and sustainable loss of HBV DNA. The Pegylated interferon has also shown to be superior to the combined therapy or only to lamivudine, in terms of range response and seroconversion in e (+) and e (-). There is still controversy when treating patients with e (-) who need long term usage of interferon or those who need to start nucleoside analogue.

Erradicación de Helicobacter pylori mediante triple terapia (amoxicilina, claritromicina y omeprazole), en pacientes del Hospital Rafael Ángel Calderón Guardia / Eradication of Helicobactr Pylori by means of triple therappy (amoxicilin, claroitromicina and omeprazole), in patients of the Hospital Rafael Calderón Guardia

Justificación y objetivo: H. pylori es un factor importante en el desarrollo de diversos tipos de patologías gástricas como: gastritis crónica, úlcera péptica, adenocarcinoma tipo intestinal y linfoma. Erradicar la infección es una importante posibilidad en la terapia de los pacientes con esas patologías. En el estudios se analizó la utilidad de la triple terapia para erradicar de la infección por H. pylori en pacientes con gastritis crónica y úlcera péptica. Métodos: Se incluyeron 267 pacientes que atendieron el Servicio de gastroenterología del HCG, entre enero y mayo de 2000. La presencia de H. pylori fue dterminada por ureasa rápida, cultivo y antígenos fecales específicos. Se determinó la CIM de algunos aislamientos mediante la prueba de E-test. Los pacientes recibieron triple terapia con amoxicilina (1000 mg bid vo), claritromicina (500 mg bid vo - Claritrobac,) y omeprazole (20 mg bid vo - Proton,), por 10 días. La erradicación de la infección se definió como presencia de H. pylori al principio del tratamiento y un resultado negativo en la prueba de antígenos fecales específicos, entre 30 y 45 días después de finalizado el tratamiento. Resultados: De los 267 pacientes que recibieron la triple terapia, 189 (70.8 por ciento) la completaron. La erradicación de la bacteria se confirmó en 127 (84,7 por ciento) de los pacientes que completaron el tratamiento. Treinta y siete (94,9 por ciento) de los 39 pacientes con diagnóstico endoscópico de úlcera péptica erradicaron la bacteria. La erradicación fue exitosa incluso en pacientes portadores de cepas que mostraron resistencia in vitro a amoxicilina o a claritromicina, aunque en este estudio la presencia de cepas sensibles no predice el éxito del tratamiento en todos los casos. Conclusión: La triple terapia basada en amoxicilina (1000 mg bid vo), claritromicina (500 mg bid vo - Claritrobac,) y omeprazole (20 mg bid vo - Proton,), por 10 días, erradicó la infección por H. pylori en el 84,7 por ciento de los pacientes que cumplieron el tratamiento, incluyeron a 37 de 39 pacientes (94,9 por ciento) con enfermedad úlcero-péptica. La triple terapia por 10 días constituye una opción exitosa para erradicar de la infección por H. pylori. Descriptores: Helicobacter pylori, triple terapia, resistencia a antibióticos, amoxicilina, claritromicina, omeprazole.

Las secuelas neurológicas de origen perinatal en su relación con los factores de riesgo. Modelo de estudio / Neurological sequels of perinatal origin and factor risk. A model to study

Antecedentes. Se postula la importancia de las secuelas neurológicas de origen perinatal. Se revisa la definición de secuela, insistiendo en considerarla como un proceso que se desencadena a partir de ciertos factores de riesgo que la condicionan, para poder abordar el problema a partir de los factores de riesgo y establecer pogramas que prevengan los síndromes de parálisis cerebral, retardo mental y alteraciones de conducta. Objetivo. Señalar la insuficiencia de los procedimientos estadísticos descriptivos y univariados, y proponer el empleo de modelos complejos de análisis. Material y métodos. Se presentan algunos datos publicados en la literatura relativos a la frecuencia de presentación de secuelas y finalmente se expone el programa de la Clínica de Neurodesarrollo del Instituto Nacional de Pediatría-Universidad Autónoma Metropolitana, Unidad Xochimilco. Resultados. Mediante los procedimientos estadísticos descriptivos y univariados no se comprueba la asociación entre factores de riesgo como peso, condición al nacimiento, edad gestacional y datos del diagnóstico de la encefalopatía por US cerebral, EEG, potenciales evocados, exploración clínica neurológica y los datos de los casos y desarrollo posterior de secuelas. Con análisis complejos sí se demuestra la asociación y se insiste en que no es directa ni lineal

Fístula vesicovaginal: experiencia en 41 pacientes / Vesicovaginal fistula: experience in 41 patients

Revisamos la experiencia institucional en la reparación de las fístulas vesicovaginales operadas entre marzo de 1974 y marzo de 1995. Se estudiaron 41 pacientes con 44 fístulas vesicovaginales. La etiología fue variada con una preponderancia de la cirugía ginecológica. Hubo corrección quirúrgica en todos los casos, predominando el abordaje abdominal de O'Connor en la reparación de las fístulas vesicovaginales