Comparison of Two Tuberculosis Infection Tests in a South American Tertiary Hospital: STANDARD F TB-Feron FIA vs. QIAreachTM QuantiFERON-TB.

INTRODUCTION: Tuberculosis (TB) is one of the most prevalent respiratory diseases in the world. In 2020 there were at least 9.9 million new infections, with 1.5 million deaths. Approximately 10% of people infected with Mycobacterium tuberculosis develop the disease during the first 2 to 5 years after infection. In South America, the diagnosis of Latent Tuberculosis Infections (LTBI) continues to be performed through the Mantoux tuberculin skin test (TST). OBJECTIVE: The objective of our study was to compare the sensitivity of a new immunofluorescence IGRA test against a widely available IGRA kit on the market. MATERIAL AND METHOD: Close contact with infectious TB patients, HIV patients, or immunocompromised for another cause were recruited. Two interferon-gamma release assay (IGRA) diagnostic kits were used and compared with TST. RESULTS: 76 patients were recruited, 93.42% were Chilean nationality, and 98.68% of the patients did not have immunosuppression. The sensitivity of the new technique was 88.89%, and the specificity was 92.50% in the study population compared to the IGRA previously used. In the subgroup older than 36 years, the sensitivity was 95.65%, and the specificity was 89.47%. CONCLUSION: IGRA techniques are a new resource in clinical laboratories to make an accurate diagnosis of LTBI in the region of the Americas. In our population, the greatest benefit of this new IGRA would be observed in people over 36 years of age, where the sensitivity of the technique was like that of the currently available test.

El dilema en los laboratorios de Koch, ¿Cultivar o no Cultivar? / The Dilemma in Koch's Laboratories, To Cultivate or Not to Cultivate?

La nueva norma técnica para el control y la eliminación de la tuberculosis es un gran avance para el diagnóstico de este microorganismo en Chile. Actualmente la principal técnica microbiológica para el diagnóstico de laboratorio es la biología molecular, que reduce el tiempo del resultado a tan solo un par de horas. La normativa actual indica que en el paciente caso presuntivo de tuberculosis (CPT) la técnica exclusiva a realizar es Biología molecular. La literatura indica que la detección a través de amplificación de material genético de la micobacteria tiene un límite de detección de 15,6 UFC/ ml, por tanto, todas las muestras bajo ese límite umbral potencialmente podrían no ser diagnosticadas bajo esta estructura emanada por el ministerio de Salud en Chile. Nuestra recomendación es continuar con el estudio de cultivo en medios líquidos o sólidos para todas las muestras hasta obtener literatura que avale lo contrario

The new technical standard for the control and elimination of tuberculosis in Chile is a great advance for the diagnosis of this microorganism. Currently the main microbiological technique for laboratory diagnosis is PCR, which reduces the time to result to just a couple of hours. The current regulations indicate that in the patient with a presumptive case of tuberculosis (CPT) t he exclusive technique to be performed is PCR. The literature indicates that the detection through amplification of genetic material of the mycobacterium has a detection limit of 15.6 CFU/ml, therefore, all samples under this threshold limit could potentially not be diagnosed under this structure emanated by the Ministry of Health in Chile. Our recommendation is to continue with the study of culture in liquid or solid media for all samples until literature confirms otherwise

Emergence of SARS-CoV-2 Variants in the World: How Could This Happen?

The COVID-19 pandemic has had a significant global impact, with more than 280,000,000 people infected and 5,400,000 deaths. The use of personal protective equipment and the anti-SARS-CoV-2 vaccination campaigns have reduced infection and death rates worldwide. However, a recent increase in infection rates has been observed associated with the appearance of SARS-CoV-2 variants, including the more recently described lineage B.1.617.2 (Delta variant) and lineage B.1.1.529/BA.1 (Omicron variant). These new variants put the effectiveness of international vaccination at risk, with the appearance of new outbreaks of COVID-19 throughout the world. This emergence of new variants has been due to multiple predisposing factors, including molecular characteristics of the virus, geographic and environmental conditions, and the impact of social determinants of health that favor the genetic diversification of SARS-CoV-2. We present a literature review on the most recent information available on the emergence of new variants of SARS-CoV-2 in the world. We analyzed the biological, geographical, and sociocultural factors that favor the development of these variants. Finally, we evaluate the surveillance strategies for the early detection of new variants and prevent their distribution outside these regions.

Desarrollo embriofetal del iris: inmunotinción del morfógeno Shh / Embryo-fetal development of iris: immunohistochemestry of morphogen Shh

RESUMEN: Para que se desarrolle el iris, se requiere una especificación de la capa periférica de la copa óptica a un destino no neuronal y además la migración de células mesenquimales perioculares. Nuestro objetivo fue reconocer los cambios histológicos de los derivados periféricos de la copa óptica y mesénquima periocular, como también reconocer la presencia del morfógeno Sonic hedgehog (Shh) en las capas que constituyen el esbozo de iris. Se utilizaron 15 ratones hembras (Mus musculus) adultas jóvenes gestantes. Se realizó eutanasia con tiopental sódico. Los embriones y fetos de 12, 14,5 y 17 días post-coital (dpc) fueron procesados con técnica histológica e inmunohistoquímica con anticuerpo anti-Shh (scbt, H-160, conejo) con dilución 1:100 en PBS. A los 12 dpc, se observa una cópa óptica que presenta capas retinianas interna y externa, y el iris no se observa. Entre el cristalino y el ectodermo superficial se identifican 4 capas de células mesenquimales. A los 14,5 dpc, el iris contiene dos capas epiteliales (interna y externa) que se continúan con las capas neural y pigmentaria de la retina. Se observan 8 capas de células mesenquimales. A los 17 dpc, la capa epitelial interna del iris presenta un segmento más elongado con inmunotinción positiva a Shh y otra parte que constituye un epitelio de células cilíndricas simples negativas a este anticuerpo. La capa epitelial externa presenta el mismo epitelio inmunonegativo. Las capas de la retina también son positivas, como también la periferia del cristalino. No esta formado el iris ni tampoco el cuerpo ciliar. La inmunopositividad en el cristalino, en el primer segmento de la capa interna del esbozo del iris y en la capa ganglionar retinal a los 17 dpc, se relaciona con la diferenciación tardía del iris y con los ojos cerrados de las crías al nacimiento.

SUMMARY: In order for the iris to develop, a specification of the peripheral layer of the optic cup to a non-neuronal target is required, as well as the migration of periocular mesenchymal cells. Our aim was to recognize the histological changes of peripheral derivatives of the optic cup and periocular mesenchyme, as well as recognize the presence of the morphogen Sonic hedgehog (Shh) in the layers constituting the outline of the iris. 15 female mice (Mus musculus) pregnant young adults were used. Euthanasia was performed with sodium thiopental. Embryos and fetuses of 12, 14.5 and 17 days post-coital (dpc) were processed with histological and immunohistochemical technique with anti-Shh antibody (scbt, H 160, rabbit) with dilution 1:100 in PBS. At 12 dpc, an optic cup showing internal and external retinal layers is observed, and the iris is not observed. Between the lens and the superficial ectoderm, 4 layers of mesenchymal cells are identified. At 14.5 dpc, the iris contains two epithelial layers (internal and external) that are continued with the neural and pigmentary layers of the retina. 8 layers of mesenchymal cells are observed. At 17 dpc, the inner epithelial layer of the iris presents a more elongated segment with positive immunostaining to Shh and another part that constitutes an epithelium of simple cylindrical cells negative to this antibody. The outer epithelial layer presents the same immunonegative epithelium. The layers of the retina are also positive, as well as the periphery of the lens. The iris is not formed nor is the ciliary body.The immunopositivity in the lens, in the first segment of the inner layer of the iris outline and in the retinal ganglion layer at 17 dpc, is related to the late differentiation of the iris and the closed eyes of the offspring at birth.

Inmunolocalización de Sonic hedgehog en el desarrollo embrio-fetal de ratones ( Mus musculus ) / Immunolocalization of Sonic hedgehog in embryo-fetal mouse ( Mus musculus ) development

Sonic hedgehog (Shh) es un morfógeno esencial para el desarrollo de diversas estructuras, tales como notocorda, placa del piso del tubo neural, miembros, entre otros. Se buscó determinar la inmunolocalización de Shh en embriones y fetos de ratón. Para ello, se eutanasiaron 10 ratones gestantes (Mus musculus) BALB/c, un grupo de 5 animales a los 12,5 días post-coito (dpc), y otro grupo a los 17,5 dpc. Los embriones y fetos obtenidos fueron fijados en formalina al 10 % tamponada en PBS e incluidos en paraplast. Se realizaron cortes transversales seriados. Se utilizó anticuerpo policlonal Shh (Santa Cruz Biotechnology, H-160, conejo), dilución 1:100. Se identificó y describió la inmunolocalización de las muestras marcadas positivamente. La expresión de Shh en los embriones de 12,5 dpc fue inmunopositiva en notocorda, placa del piso del tubo neural, precartílago de radio y ulna, y prácticamente todos los epitelios: bronquial, intestinal, vejiga y uretra. En la etapa fetal, a los 17,5 dpc la inmunopositividad desaparece en el cartílago a excepción de zonas de osificación, disminuye en la epidermis pero aparece en folículos pilosos. La mucosa intestinal se ha diferenciado en segmentos, mostrando una inmunotinción mayor a nivel de las vellosidades intestinales. Shh actúa en distintos estadios del periodo gestacional, siendo clave en la diferenciación de distintas estructuras. En etapas embrionaria, es vital en la formación del sistema nervioso, organogénesis y formación de miembros, por lo que su expresión se encuentra en estas zonas. Sin embargo, en la etapa fetal la expresión cambia a estructuras de mayor especialización como folículo piloso y vellosidades intestinales.

Sonic hedgehog (Shh) is an essential morphogen for the development of various structures, such as notochord, neural tube floor plate, limbs, among others. We sought to determine the immunolocalization of Shh in embryos and mouse fetuses. To do this, 10 pregnant mice (Mus musculus) BALB /c were euthanized, a group of 5 animals at 12.5 days postcoitus (dpc), and another group at 17.5 dpc. Embryos and fetuses obtained were fixed in 10 % formalin buffered in PBS and embedded in paraplast. Serial cross sections were made. Polyclonal antibody Shh (Santa Cruz Biotechnology, H-160, rabbit), dilution 1:100 was used. The immunolocalization of the positively labeled samples was identified and described. Shh expression in 12.5 dpc embryos was immunopositive in notochord, neural tube floor plate, radius precartilage and ulna, and practically all epithelia: bronchial, intestinal, bladder and urethra. In the fetal stage, at 17.5 dpc the immunopositivity disappears in the cartilage except for areas of ossification, decreases in the epidermis but appears in hair follicles. The intestinal mucosa has differentiated into segments, showing greater immunostaining at the level of the intestinal villi. Shh acts in different stages of the gestational period, being key in the differentiation of different structures. In embryonic stages, it is vital in the formation of the nervous system, organogenesis and formation of limbs, so its expression is found in these areas. However, in the fetal stage the expression changes to more specialized structures such as hair follicles and intestinal villi.

Immunolocalization of morphogen sonic Hedgehog in salmon fry (Salmo salar) / Inmunolocalización del morfógeno sonic Hedhehog en alevines de salmón (Salmo salar)

With the purpose of carrying out a diagnosis of the different pathologies that affect the salmon fry stage (Salmo salar) and analyze the regeneration phases of the organizational centers and subjacent tissue in case of an amputation, we realized a study that allowed identifying the temporary and spatial location of the Sonic Hedgehog (Shh) morphogen in hatched fry stage. Fifteen salmon fry (Salmo salar) were used. They were anesthetized with 5 % benzocaine (BZ-20®, Veterquímica), fixed in 10 % buffered formalin, and embedded in paraffin, Shh polyclonal antibody (Santa Cruz H-160, rabbit) was used diluted at 1/100. They were subsequently rinsed in PBS-1 % Triton and incubated with anti-rabbit conjugated polymer antibody and HRP for 10-15 min. The development was done with DAB (Vector) for 1-5 min. The negative control was incubated without primary antibody. As an internal positive control the notochord was considered. Serial sagittal sections were analyzed consigning tissues and organs marked positively and were described morphologically. The objective of recognizing the spatial and temporal location of Shh was achieved. The notochord, spinal cord neurons and ganglia, the basal layer of the skin and also the lepidotriquias escleroblastos were positively identified for Shh. Finally positivity was also observed in the intestine and renal tubules. The heterogeneity observed in the location of the Shh morphogen suggests its potential use as a marker of regulatory centers in Salmo salar, and a potential advantage in the diagnosis of malformations of salmon fry stage, in addition to a better understanding of tissue regeneration.

Con el fin de llevar a cabo un diagnóstico de las diferentes patologías que afectan a la etapa de alevín de salmón (Salmo salar) y analizar las fases de regeneración de los centros de organización y el tejido subyacente en caso de una amputación, se realizó un estudio que permitió identificar la ubicación temporal y espacial del morfógeno Sonic hedgehog (Shh) en la etapa de alevines eclosionados. Se utilizaron quince alevines de salmón (Salmo salar). Fueron anestesiados con benzocaína al 5% (BZ-20®, Veterquímica), se fijaron en formalina tamponada al 10%, e incluidos en paraplast. Se utilizó Shh anticuerpo policlonal (Santa Cruz H-160, conejo) dilución 1/100. Se enjuagaron posteriormente en PBS-1% Triton y se incubaron con anticuerpo conjugado con polímero anti-conejo y HRP durante 10-15 minutos. Se utilizó como sustrato DAB (Vector) durante 1-5 minutos. El control negativo se incubó sin anticuerpo primario. Como un control positivo interno se consideró la notocorda. Se analizaron secciones sagitales en serie consignando los tejidos y órganos marcados positivamente y se describieron morfológicamente. Se logró el objetivo de reconocer la localización espacial y temporal de Shh. La notocorda, las neuronas de la médula espinal y los ganglios, la capa basal de la piel y también los escleroblastos de las lepidotriquias fueron identificados positivamente para Shh. También se observó positivo el intestino y los túbulos renales. La heterogeneidad observada en la ubicación del morfógeno Shh sugiere su uso potencial como un marcador de los centros de regulación en Salmo salar, y una ventaja potencial en el diagnóstico de las malformaciones de la etapa de alevines de salmón, además de una mejor comprensión de la regeneración de tejidos.

Morphology of the eyeball, orbit and retina of Atlantic salmon (Salmo salar) alevins under hypoxic conditions / Morfología del bulbo ocular, órbita y retina de alevines del salmón del Atlántico (Salmo salar) bajo condiciones hipóxicas

It has been demonstrated that hypoxia retards the growth of fish, reduces the survival of their larvae, deforms their vertebral column, but despite this teleost fish have the ability to completely regenerate many of their tissues, particularly the retina. As we do not have enough information about the effects of hypoxia on the eyeball, orbit and retina of Atlantic salmon (Salmo salar), we propose the following objectives: 1) Compare the morphological changes of the eyeball of fish subject to hypoxia and normoxia. 2) Determine changes in the orbit structure. 3) Describe the retina of salmon alevins. 4). Recognize hypoxic cells using the anti-Hif1a antibody in the retina of alevins as a sensor. 5) Determine the Shh morphogenic expression in alevins exposed to different times of hypoxia. Around 1,000 Salmo salar alevins were placed in a continuous water flow of 9 °C at 100 % SatO2 and alevins maintained at a hypoxia of 60 % SatO2. The latter were transferred to normoxia (at days two, four, and eight after hatching). A control group maintained at continuous normoxia and another at continuous hypoxia was also considered. All the alevins were euthanized at 950 UTAs (±2 months after hatching). Diaphonization (double-stain) according to the Hanken & Wassersug technique was undertaken to describe the morphology of the periocular cartilage and to measure the ocular diameter. The HIF-1a factor antibody 1:50, and the anti-Shh antibody dilution of 1:100 were used. The alevins after hatching had large eyeballs with the optic cup having an embryonic shape, even a choroidal fissure. The greatest thickness was observed in the nasal ventral zone which corresponds to a zone of pluripotent cells. The optic cup aspect with embryonic characteristics has only been reported in salmonids. The central retina of the alevins those were cultivated with a 60 % saturation of O2 for two, four or eight days had positive immunostaining when analyzed with the anti-HIF1a antibody hypoxia sensor. The inner ganglion and nuclear layers had immunopositive cells, with the highest in the alevins that were two days in hypoxia and the lowest when the hypoxia was chronic. Nevertheless, in the latter case the alevins had anatomical deformation of the eyeball and periocular cartilage. The anti-Shh antibody clearly shows a gradient that is expressed in the germinative zone and in the cells of the inner ganglion and nuclear layers. The eyeball and particularly the retina in salmon alevins are an example of neuronal plasticity and neurogenesis.

Se ha demostrado que la hipoxia retarda el crecimiento de los peces, reduce la supervivencia de sus larvas, deforma su columna vertebral, pero a pesar de esto, este pez teleósteo tiene la capacidad de regenerar completamente muchos de sus tejidos, en particular la retina. Como no existe suficiente información sobre los efectos de la hipoxia en el bulbo ocular, la órbita y retina del salmón del Atlántico (Salmo salar), los objetivos de este trabajo fueron: 1) Comparar los cambios morfológicos del bulbo ocular del pescado sujetos a hipoxia y normoxia; 2) Determinar los cambios en la estructura de la órbita; 3) Describir la retina de los alevines de salmón; 4) Reconocer las células hipóxicas utilizando el anticuerpo anti-Hif1a en la retina de alevines como un sensor; 5) Determinar la expresión morfogenética de Shh en alevines expuestos a diferentes momentos de hipoxia. Alrededor de 1.000 alevines Salmo salar se colocaron en un flujo continuo de agua a 9 °C, con 100 % de SatO2 y otros alevines se mantuvieron con una hipoxia de 60 % SatO2. Estos últimos fueron trasladados a normoxia (en los días dos, cuatro y ocho después de la eclosión). Un grupo control se mantuvo a normoxia continua y otro grupo a hipoxia continua. Todos los alevines se sacrificaron a 950 UTA (+ dos meses después de la eclosión). Se realizcón una diafonización (doble tinción), de acuerdo con la técnica de Hanken & Wassersug, para describir la morfología del cartílago periocular y para medir el diámetro ocular. Se utilizaron el anticuerpo anti-Hif1a a una dilución 1:50, y el anticuerpo anti-Shh a una dilución de 1:100. Los alevines después de la eclosión presentaron grandes bulbos oculares, con la copa óptica con forma embrionaria, incluso una fisura coroidea. El mayor espesor se observó en la zona ventral nasal que corresponde a una zona de células pluripotentes. El aspecto de la copa óptica con características embrionarias sólo se ha informado en los salmónidos. La retina central de los alevines fueron cultivadas con una saturación de 60 % de O2 para dos, cuatro y ocho días, y presentó inmunotinción positiva cuando se analizó con el sensor de hipoxia, el anticuerpo anti-HIF1a. El ganglio interior y las capas nucleares presentaron células immunopositivas, con los niveles más altos en los alevines con dos días de hipoxia y niveles más bajos en hipoxia crónica. Sin embargo, en éste último caso los alevines presentaron una deformación anatómica del bulbo ocular y el cartílago periocular. El anticuerpo anti-Shh mostró claramente un gradiente expresado en la zona germinativa y en las células del ganglio interior y las capas nucleares. El bulbo ocular y en particular la retina en alevines de salmón son un ejemplo de plasticidad neuronal y neurogénesis.

Description of deaths on Easter Island, 2000-2012 period.

Easter Island is a small island of 180 km2, located 3,800 km from the Chilean coast and one of the most isolated inhabited places in the world. Since the mid-twentieth century, it has been undergoing an epidemiological transition in relation to the causes of death, from a predominance of infectious to non-communicable diseases (NCDs) such as cardiovascular ailments and cancer. The aim of this study is to describe the causes of death to Easter Island between 2000 and 2012, so the statistical records of Hanga Roa Hospital and death certificates were reviewed. The period under review of 13 years there was a total of 252 deaths, an average to 19.3 deaths per year. The most frequent causes of death found in the general population of Easter Island were cardiovascular diseases (25.4%), followed by neoplasms (23.4%), accidents (18.6%). Related to Rapa Nui people, cardiovascular and neoplastic diseases (both 26.7%) predominate, while in the population without belonging to the ethnic group the main causes were traumatic (25%) and cardiovascular (22.2%). Comparing the leading causes of death of Easter Island with mainland Chile, it can be seen how they resemble. Taking the island death profile, it is necessary to work on public health strategies aimed to this, considering that some of the causes are completely preventable.