Determinacion de la sensibilidad in vitro de diferentes cepas de Trypanosoma cruzi al benznidazol y al extracto de hoja de la planta Zanthoxylum chiloperone / Determination of the in vitro sensitivity of different Trypanosoma cruzi strains to benznidazole and the leaf extract of the plant Zanthoxylum chiloperone

Se evaluo la sensibilidad in vitro al benznidazol y al extracto de hojas de la planta Zanthoxylum chiloperone de diez cepas del Trypanosoma cruzi. Se utilizaron formas epimastigotas de las cepas, pertenecientes a diferentes linajes, diferente procedencia geografica, incluidas tres de Paraguay, y aisladas de hospederos distintos, abarcando humanos, triatominos y animales silvestres. El grado de sensibilidad a la droga y al extracto vegetal fue estimado por el porcentaje de lisis de los parasitos a las 24 y 48 horas de exposicion. Se observo un amplio rango de variacion en el porcentaje de lisis entre las cepas, de 22,2% a 90,8% a la concentracion del benznidazol de 200 ug/mL, con el hallazgo de una cepa con sensibilidad nula al mismo. Con respecto al extracto vegetal, tres concentraciones fueron testadas, de 500, 700 y 900 ug/mL, observandose variaciones en los porcentajes de lisis entre las cepas con las dos primeras concentraciones, entre un 2,1% y 100%, con lisis total en todas las cepas a la concentracion de 900 ug/mL. No se observo asociacion entre la diversidad de respuesta a los compuestos y la clasificacion de las cepas ni con su origen geografico y tipo de hospedero. Estas diferencias observadas resaltan la heterogeneidad de las poblaciones naturales del T. cruzi, aspecto importante a tener en cuenta en los estudios de sensibilidad a quimioterapeuticos y en los tamizajes primarios de nuevos antichagasicos. Asi mismo, se destaca la eficacia del extracto vegetal sobre diferentes cepas de este parasito.

Immuno-enzymatic evaluation of the recombinant TSSA-II protein of Trypanosoma cruzi in dogs and human sera: a tool for epidemiological studies.

The rTSSA-II (recombinant Trypomastigote Small Surface II) antigen was evaluated by ELISA to detect anti-Trypanosoma cruzi antibodies in sera from naturally infected dogs and humans. For this evaluation ELISA-rTSSA-II was standardized and groups were classified according to the results obtained through xenodiagnosis, ELISA and PCR. Sensitivity (Se), Specificity (Sp), Kappa index (KI) and area under curve (AUC) were determined. The Se was determined by using 14 sera from dogs infected with T. cruzi VI (TcVI) whereas Sp was determined by using 95 non-chagasic sera by xenodiagnosis, ELISA-Homogenate and PCR. The performance of ELISA-rTSSA-II in dog sera was high (AUC=0·93 and KI=0·91). The Se was 92·85% (1 false negative) and Sp was 100%. Two sera from dogs infected with TcI and 1 with TcIII were negative. For patients infected with T. cruzi, reactivity was 87·8% (36/41), there was only 1 indeterminate, and Sp was 100%. Fifty-four sera from non-chagasic and 68 sera from patients with cutaneous leishmaniasis did not react with rTSS-II. ELISA-rTSSA-II showed a high performance when studying sera from naturally infected dogs and it also presented 100% Sp. This assay could be an important tool to carry out sero-epidemiological surveys on the prevalence of T. cruzi circulating lineages in the region.

Niveles séricos del antígeno prostático específico (PSA) dentro de la campaña de prevención del cáncer de próstata / Serum levels of the prostate-specific antigen (PSA) in the prostate cancer prevention campaign

La determinación del antígeno prostático específico (PSA) forma parte del diagnóstico del cáncer de próstata. Como en condiciones patológicas sus niveles aumentan, es considerado marcador tumoral útil de diagnóstico de cáncer de próstata en forma precoz. Determinamos los niveles séricos de PSA, dentro de la campaña “Semana de la Próstata” organizado por la Cátedra de Urología del Hospital de Clínicas en Octubre 2007. De los 89 pacientes, el 86,5% presentó niveles de PSA entre 0 y 4ng/ml, 10,1% entre 4 y 10 ng/ml y el 3,4% entre 10 y 40 ng/ml respectivamente. Se realizó una distribución por edad y se determinaron las medias de los valores de PSA en los mismos. El 12,4% del grupo E1 (41 a 50 años) con 0,5ng/ml de PSA, el 52,8% del grupo E2 (51 a 60 años) con 7,4ng/ml de PSA, el 28,1% del grupo E3 (61 a 70 años) con 5,2ng/ml de PSA y el 6,7% del grupo E4 (71 a 80 años) con 1,5 ng/ml de PSA. Hallándose valores más elevados de PSA en el grupo E2 y E3, no así en el grupo E4. En relación al tacto rectal (TR) y los valores del PSA, el 31,5%(28) presentaron TR normal con un valor medio de PSA de 3,4. Mientras que el 65,1% (58) presentaban TR patológico con valores medios de PSA de 7,17 en 55 pacientes y sólo 3 pacientes con TR patológico presentaron niveles de PSA por debajo de 2,5 ng/ml. El TR resultó ser la variable con mayor poder de discriminación, con respecto al resultado de PSA en estos pacientes.

The determination of prostate-specific antigen (PSA) is part of the diagnosis of prostate cancer.It is considered an useful tumor marker for early diagnosis of porostate cancer because in pathological conditions its levels increase.Serum levels of PSA were determined within the campaign "Prostate Week" organized by the Department of Urology of the Hospital de Clínicas in October 2007.;Of the 89 patients, 86.5% had PSA levels between 0 and 4 ng/ml, 10.1% between 4 and 10 ng/ml and 3.4% between 10 and 40 ng/ml respectively. An age distribution was made and the mean of PSA values were determined in each group. Twelve point four percent of group E1 (41 to 50 years) had 0.5 ng/ml of PSA, 52.8% of group E2 (51 to 60 years) 7.4 ng/ml PSA, 28.1% of E3 group (61 to 70 years) 5.2 ng/ ml of PSA and 6.7% of the E4 group (71 to 80 years) had 1.5 ng/ml of PSA.The highest values of PSA were found in E2 and E3 groups, but not in the E4 group. In relation to digital rectal examination (DRE) and PSA values, 31.5% (28) showed normal DRE with a mean value of PSA of 3.4 while 65.1% (58) had pathological DRE with mean values of PSA of 7.17 in 55 patients and only 3 patients had pathological TR with PSA levels below 2.5 ng/ml. The DRE was the variable with the greatest ability to discriminate in relation to the results of PSA in these patients.

Microalbuminuria en pacientes con diabetes tipo 2 / Microalbuminuria in patients with type 2 diabetes

La diabetes constituye una afección común en el Paraguay, donde unas 300.000 personas la padecen y aproximadamente otras 500.000 personas presentan un estado previo a la enfermedad. La nefropatía es una de las complicaciones mas graves, que sobreviene por la falta de control de la enfermedad. En la actualidad, el acceso al tratamiento sustitutivo, hemodiálisis y transplante renal ha desplazado a la insuficiencia renal al tercer puesto como causa de muerte del paciente diabético, después de la cardiopatía isquémica y del accidente cerebro vascular. La presencia de microalbuminuria en orina es un claro marcador de riesgo hacia la progresión de las complicaciones de la enfermedad, especialmente las nefropatías. En este estudio la prevalencia de microalbuminuria hallada en los pacientes diabéticos tipo 2, fue de 34.7%, porcentaje elevado con respeto a la referencia que oscila alrededor del 20 al 40% en la Diabetes tipo 2. Existen factores de riesgo que predisponen al desarrollo de la microalbuminuria y su progresión, como son la duración de la diabetes, la falta de control de la glicemia, la hipertensión arterial, una mala alimentación y el tabaquismo. Con el control de dichos factores se vería reducido el riesgo de avance de la enfermedad. Se observó que a medida que aumenta el tiempo de evolución de la enfermedad aumenta la proporción de pacientes diabéticos con microalbuminuria, acompañados por un progresivo aumento de la presión arterial.

Diabetes constitutes a common affection in Paraguay, where approximately 300,000 people are affected and approximately other 500,000 people present a disease­previous condition. Nephropathy is one of the most serious complications caused by the lack of control of the disease. At present, the access to the substitutive treatment, hemodialysis and renal transplant has displaced renal insufficiency to the third position as death causes of diabetic patients after ischemic cardiopathy and cerebrovascular accident. The presence of microalbuminuria is a clear risk marker of progression towards the complications of the disease, especially nephropathies. In this study, the prevalence of microalbuminuria found in the type 2 diabetic patients was 34.7 %, a high percentage in relation to the reference that ranges around 20 to 40 % in type 2 diabetes. There are risk factors predisposing to the development of microalbuminuria and its progression such as the duration of the diabetes, lack of control of glycemia, blood hypertension, malnutrition and smoking. The control of the above mentioned factors would reduce the risk of advance of the disease. It was observed that as the time of evolution of the disease increases, the proportion of diabetic patients with microalbuminuria also increases accompanied by a progressive increase of blood pressure.

[Frequency of diagnosis and clinic presentation of glomerulopathies in Uruguay]. / Frecuencia de diagnóstico y de presentación clínica de las glomerulopatías en el Uruguay.

UNLABELLED: The Uruguayan Registry of Glomerulopathies began its activity in 1974 and since 1985 is a national registry. The aim of this report is to analyze the incidence and the variations in frequencies of the histological diagnosis and clinical presentation during the 1980-2003 period. PATIENTS AND METHODS: From the 2,058 patients with renal biopsy in the whole period, we analyzed the histological diagnosis and the following data has been collected when the patients were registered: age, gender, clinical syndrome, proteinuria, hematuria, serum creatinine, blood pressure and time from the first symptom. Four periods of registry entry were considered: 1980-1989, 1990-1994, 1995-1999 and 2000-2003. Chi-square and Student test for independent samples were used to evaluate the differences among the variables frequencies in the four periods. RESULTS: The incidence of registered glomerulopathies per million population (pmp) increased from 13 (1980-1989) to 43 (2000-2003). In the 2000-2003 period, the incidences pmp were: primary glomerulopathy (PG), 25.3 and secondary glomerulopathy, 14.2. The highest incidences pmp were: focal and segmental glomeruloesclerosis (FSGS) 6.4; vasculitis 5.4; lupus nephritis 4.6; minimal change disease (MCD) 4.6; IgA nephropathy (IgAN) 4.5; and membranous nephropathy (MN) 4.0. The most frequent PG were the FSGS (29.3%) and the MCID (19.6%). The FSGS frequency decreased from 36.3% in 1995-1999 to 19.1% in 2000-2003. The IgAN frequency increased from 5.2% in 1980-1989 to 17.5% in 2000-2003. Nephrotic syndrome was the most frequent clinical presentation; its frequency was over 30% in the four periods. Asymptomatic urinary abnormality frequency increased from 14.0% in 1980-1989 to 22.7% in 2000-2003. The frequency of serum creatinine under 1.5 mg/dl, increased from 42.2% in 1980-1989 to 67.2% in 2000-2003 (p = 0.001). The frequency of serum creatinine over 6.0 mg/dl, decreased from 19.3% in 1990-1994 to 7.2% in 2000-2003. The percentage of patients referred since the first month of the apparent onset of the disease increased from 24.0% in 1980-1989 to 40.1% in 2000-2003 (p < 0.001). CONCLUSIONS: In Uruguay, the incidence of glomerulopathies with histological diagnosis has increased and the frequency of the different types has changed. Several indicators seem to show that the reference of patients to the nephrologist tended to be earlier in the last years.

Irregular field calculation on the central beam axis of photon beams using sector-integration.

A method is proposed for calculation of irregular field factors on the central beam axis and homogeneous medium for x-ray beams. The irregular field factor is introduced as the ratio of the output of a field with and without blocks on the central beam axis. The algorithm is based on the sector-integration method and the circular field quantities are calculated from in-phantom measurements. These circular field quantities are the output per beam monitor unit for circular fields defined by a hypothetical secondary collimator and reduced to a circular field by blocking. A derivation of the sector-integration equation is given from first principles. As it is shown, the circular field quantities are evaluated from data measured for rectangular, block shaped fields. Such quantities contain all beam components, including photons scattered from the blocks, the block tray, and photons scattered in the phantom. Consequently, the so called primary and secondary beam components are readily incorporated in this approach. Once the circular field quantities have been determined from rectangular field data, the irregular field factors for other geometry can be calculated. Irregular field factors for square, rectangular and circular block-shaped fields were calculated for 6 MV photon beams and compared with measured values. The results agree within 0.7%, even for heavy blocked field cases, i.e., a 40 x 40 cm2 collimator field blocked to a 5 x 5 cm2 field. The method was tested for a particular source to surface distance, depth, phantom composition, and source to block distance. Calculation of irregular field factors in another set up conditions requires the measurement of the appropriate input data.

Isoenzyme profiles of Trypanosoma cruzi stocks from different areas of Paraguay.

Twenty one Trypanosoma cruzi stocks from humans, domiciliary triatomines and one sylvatic animal of different areas of Paraguay were subjected to isoenzyme analysis. Thirteen enzyme systems (15 loci in total) were studied. MN cl2 (clonets 39) and SO34 cl4 (clonets 20) were used as references. Relationships between stocks were depicted by an UPGMA dendrogram constructed using the Jaccard's distances matrix. Among the Paraguayan stocks 14 zymodemes were identified (Par1 to Par14), Par 5 being the most frequent. Polymorphism rate and clonal diversity were 0.73 and 0.93, respectively. Average number of alleles per polymorphic locus was 2.5 (range 2-4). These measurements show a high diversity, which is confirmed by the dendrogram topology. All stocks belong to the same lineage, as MN cl2 reference strain (T. cruzi II). Moreover three distinct subgroups were identified and two of them correspond to Brazilian and Bolivian zymodemes, respectively. The third subgroup, the most common in Paraguay, is related to Tulahuen stock. The large geographical distribution of some zymodemes agrees with the hypothesis of clonality for T. cruzi populations. However sample size was not adequate to detect genetic recombination in any single locality.

Characterization of recombinant invertase expressed in methylotrophic yeasts.

We studied, for the first time, characterization of the invertase expressed in the methylotrophic yeasts Hansenula polymorpha and Pichia pastoris in terms of enzyme conformational stability and structural behaviour induced by temperature as a function of pH using enzymic assays, differential scanning calorimetry, fluorescence and CD. The enzyme produced in both hosts was very stable over a broad range of pH values, keeping its enzymic activity and structure above 60 degrees C. Thermal denaturation, as measured by differential scanning calorimetry, was always irreversible. However, the fact that scanning rate had no effect on the calorimetric curves gave us the chance to analyse the data from a thermodynamic point of view. The conformational stabilities were essentially identical under the experimental conditions studied, but stability was always slightly higher in the enzyme expressed in H. polymorpha. This fact indicates that the greater degree of glycosylation of this enzyme form contributed to its increased global stability. Reactivation upon heating at 80 degrees C depends on protein concentration, suggesting that irreversibility could be associated with slow refolding kinetics at high protein concentration.

Characterization of Mucor pusillus rennin expressed in Pichia pastoris: enzymic, spectroscopic and calorimetric studies.

The aspartic proteinase gene of Mucor pusillus rennin expressed in Pichia pastoris was characterized in terms of structural and conformational stability induced by temperature. This enzyme is 12% glycosylated, with a similar specific activity to the native fungal enzyme. The secondary structure determined by CD is mainly due to beta-sheet structures with an important contribution of aromatic components. The calorimetric studies were carried out in the temperature range in which the enzyme is most stable. The enzyme undergoes an irreversible, highly scan-rate-dependent thermal denaturation under all the experimental conditions investigated. Between pH 3.0 and 7.0, only one endotherm characterized the thermal denaturation of enzyme. At pH 5.0, the most stable condition found, the denaturation can be fitted to the two-state irreversible model. Thus the kinetic constant and activation parameters of the denaturation process could be obtained. Upon reaching pH 7.5, the denaturation is characterized by two endotherms. This evidence indicates the complex tridimensional structure of this enzyme. Finally, taking into account the conservative tertiary structure of the aspartic proteinase family we comment on our results with reference to the crystallographic structure of M. pusillus pepsin [Newman, Watson, Roychowdhury, Badasso, Cleasby, Wood, Tickle and Blundell (1993) J. Mol. Biol. 221, 1295-1309].

Photon output factor calculation from the inverse of the sector-integration equation.

A method to predict rectangular field output factors (OFs) of photon open beams for the Saturne 41 linear accelerator has been developed. The procedure is similar to the sector-integration method but the radiotherapy quantities corresponding to circular fields (circular functions) are calculated from one-dimensional OFs. In this case the one-dimensional OFs are defined as rectangular field OFs, where one side remains constant and equal to the maximum field size. The circular quantities are numerically obtained by inversion of the sector-integration equation which relates both the one-dimensional OFs and the circular function. Two one-dimensional OFs were used to take into account the asymmetry between the x and y collimator systems (collimator exchange effect). The resulting pair of circular functions corresponds to the x and y collimator systems, respectively. They contain all the information relative to head, air, and medium (phantom) scatter and, consequently, there is no need to account for the geometry of the head or fitting parameters. Using the sector-integration method, the OFs for any rectangular field can be calculated by integrating the obtained circular functions. To improve results, a procedure is given to account for corner collimators overlapping. Results agree with data to within approximately 0.4% at 6-15 MV photon beams. The proposed method is thus clinically acceptable for routine calculation. Furthermore, the circular function calculation algorithm could be extended to other radiotherapy quantities.

Structural model for family 32 of glycosyl-hydrolase enzymes.

A structural model is presented for family 32 of the glycosyl-hydrolase enzymes based on the beta-propeller fold. The model is derived from the common prediction of two different threading methods, TOPITS and THREADER. In addition, we used a correlated mutation analysis and prediction of active-site residues to corroborate the proposed model. Physical techniques (circular dichroism and differential scanning calorimetry) confirmed two aspects of the prediction, the proposed all-beta fold and the multi-domain structure. The most reliable three-dimensional model was obtained using the structure of neuraminidase (1nscA) as template. The analysis of the position of the active site residues in this model is compatible with the catalytic mechanism proposed by Reddy and Maley (J. Biol. Chem. 271:13953-13958, 1996), which includes three conserved residues, Asp, Glu, and Cys. Based on this analysis, we propose the participation of one more conserved residue (Asp 162) in the catalytic mechanism. The model will facilitate further studies of the physical and biochemical characteristics of family 32 of the glycosyl-hydrolases.

Treatment of congenital Chagas' disease diagnosed and followed up by the polymerase chain reaction.

In 1991 and 1992, a prenatal screening of Trypanosoma cruzi infection was carried out using ELISA and indirect immunofluorescence techniques. A total of 840 blood samples from pregnant women, obtained at the Maternity Ward of the Hospital de Clínicas, National University of Asunción (Asunción, Paraguay), and 1,022 samples from the Regional Hospital of the San Pedro Department of Paraguay were examined. It was observed that 7.7% and 10.5%, respectively, of the pregnant women were serologically positive for infection with T. cruzi. When blood samples obtained from newborns on the day of birth or, at the most, on the first few days afterwards were examined by direct microscopic observation, an incidence of congenital transmission of 3% was found. These results are consistent with those of neighboring countries. When a serologic follow-up was conducted on the newborns until six months of age, the incidence of congenital transmission reached 10%. The same incidence rate was obtained when the samples collected during the first days after birth were examined by the polymerase chain reaction (PCR). Fifty-eight infants born to seropositive mothers were followed-up, two of which were positive by direct microscopic observation at birth, and four who were PCR-positive, but microscopy-negative at birth. None of the infants were positive for IgM at birth. The infected babies were treated with benznidazole and were followed-up by serology and PCR for four years. We conclude that the PCR has a clear advantage over conventional techniques for the early detection of congenital transmission of T. cruzi infection, and for monitoring infants undergoing chemotherapy.

Cavernomatosis de la porta: presentación de un caso clínico / Cavernomatosis of the porthole: presentation of a clinical case

Analiza el caso de una paciente de 15 años que ingresa al Hospital Enrique Garcés por sangrado digestivo, siendo su segundo episodio, al examen físico presenta esplenomegalia, la endoscopía digestiva alta reveló várices esofágicas y gástricas, la esplenopotografía reporta cavernomatosis de la vena porta...

Relación entre el desarrollo esquelético y los estados de calcificación del canino inferior y el desarrollo esquelético / Relationship between mandibular canine calcification stages and skeletal maturity

Con el fín de determinar la relación entre los estados de desarrollo del canino inferior y los indicadores de madurez esquelética (más específicamente del brote de crecimiento), se tomaron radiografías de mano y muñeca y periapical del canino inferior a 61 ninños y 56 niñas. Las pruebas Chi-cuadrado y Kendall Tau mostraron relaciones significativas (P<0.001) entre los indicadores de madurez esquelética y los estados de calcificación del canino inferior. Las asociaciones se presentaron en un rango de (0.66-0.79). La falange distal del tercer dedo mostró la más alta correlación con la madurez del canino para los dos sexos. El estado G de calcificación del canino inferior se correlacionó en niñas con el estadio de capping, así como con la aparición del sesamoideo. En niños, se presentaron asociaciones con estados de desarrollo esqueléticos menos avanzados para cada estado de calcificación del canino. Se determinó, que el estado F de calcificación del canino inferior es indicativo en niñas de la iniciación del brote de crecimiento, en tanto que el estado G es indicativo del pico del mismo (PVH). Lo anterior, hace al desarrollo del canino una herramienta útil en la evaluación del desarrollo esquelético y somático.

Síndrome de feminización testicular completa: presentación de un caso clínico

Describimos el caso de una paciente de 18 añoss que presentaba anemorrea primaria, quien ingreso al Hospital Eugenio Espejo para el estudio de una masa inguinal izquierda la cual había sufrido un incremento considerable en su tamaño tras un traumatismo en dicha región, luego de una exhaustiva investigación que incluyó examinación física, determinaciones hormonales, toma de muestras citológicas e inclusive evaluación genética, se llegó a determinar que la paciente en cuestión presentaba un seminoma esperamatocitico como complicación de su patología de base que era un síndrome de Morris o de feminización testicular, el mismo que enmarca dentro del grupo de transtornos de diferenciación sexual conocidos como pseudohermafroditismo masculino. El caso tiene importancia particular por ser una patología en extremo rara y que en este caso se ajustaba prácticamente textualmente a la descripción bibliográfica del mismo.

Characterization of Paraguayan Trypanosoma cruzi strains isolated from acute patients of Chagas disease.

Five Paraguayan Trypanosoma cruzi strains, isolated from acute chagasic patients, were studied by their behavior in BALB/c mice, metacyelogenesis, bio-metry of metacyclic forms and lectin agglutination. Early and intermediate parasitemic peaks were observed and the strains did not show high virulence. Metacyclogenesis capacity was not higher than 50% in all cases and there were no considerable differences in the biometry. They all belong to WGA-type strains according to the lectin agglutination assays except for one strain that agglutinated with WGA and PNA lectins. Although previous schizodeme analysis of these strains showed rather homogeneous profiles, biological features were quite heterogeneous.

Mutagenicity, insecticidal and trypanocidal activity of some Paraguayan Asteraceae.

The insecticidal, moulting inhibition and trypanocidal effects of crude extracts of 7 Paraguayan Asteraceae were evaluated on Triatoma infestans and bloodstream forms of Trypanosoma cruzi, respectively. Both mutagenicity and toxicity were evaluated by sister chromatid exchange (SCE) in human peripheral lymphocyte culture and by the lethality test of Artemia salina. The ethanolic extracts from Chromolaena christieana (stem and bark), Achyrocline satureoides (leaves and flowers) and Mikania cordifolia (root and stem), at a concentration of 250 micrograms/ml, showed the highest percentage of lysis on bloodstream forms of Trypanosoma cruzi. The extracts of Chromolaena christieana and Achyrocline satureoides also presented high mutagenic and toxic capacity when they were evaluated by the SCEs assay and Artemia salina test, respectively. Insecticidal activity was only observed in the hexane extract of flowers of Achyrocline satureoides (45% of mortality), when 0.05 microgram of crude concentration was applied on Triatoma infestans. The ethanolic extracts of stem from Mikania cordifolia and Vernonia brasiliana inhibited the moulting of Triatoma infestans when it was compared with their controls. Since no ethnobotanical information on these plants has been found related to similar use in Paraguay, our findings suggest, for the first time, the potential anti-trypanocidal and moulting inhibition of these Asteraceae.

Síndrome de feminización testicular completa: presentación de un caso clínico

Describimos el caso de una paciente de 18 años que presentaba amenorrea primaria, quien ingresó al Hospital Eugenio Espejo para el estudio de una masa en región inguinal izquierda la cual había sufrido un incremento considerable en su tamaño tras un traumatismo en dicha región, luego de una exhaustiva investigación que incluyó examinación física, determinaciones hormonales, toma de muestras citológicas e inclusive evaluación genética, se llegó a determinar que la paciente en cuestión presentaba un semitoma espermatocítico como complicación de su patología de base que era un síndrome de Morris o de feminización testicular, el mismo que se enmarca dentro del grupo de trastornos de la diferenciación sexual conocidos como pseudohermafroditismo masculino...