Is drug-resistant Mycobacterium leprae a real cause for concern?: First approach to molecular monitoring of multibacillary Colombian patients with and without previous leprosy treatment.

INTRODUCTION: There is no information in Colombia on Mycobacterium leprae primary and secondary drug resistance in regards to the WHO-multidrug therapy regime. On the other hand, public health authorities around the world have issued various recommendations, one of which prompts for the immediate organization of resistance surveillance through simple molecular methods. OBJECTIVE: To determine the prevalence of Mycobacterium leprae drug resistance to rifampicin, ofloxacin and dapsone in untreated and previously treated patients at the Centro Dermatológico Federico Lleras Acosta during the 1985-2004 period. MATERIALS AND METHODS: We conducted a retrospective study which included multibacillary patient biopsies through elective sampling: 381 of them from new patients and 560 from previously treated patients. Using a microtome, we obtained six slides from each skin biopsy preserved in paraffin, and we extracted M. leprae DNA. We amplified three molecular targets through PCR and obtained the patterns of drug resistance to dapsone, rifampicin and ofloxacin by reverse hybridization. Finally, we collected epidemiological, clinical and demographical data for analyses. RESULTS: From 941 samples under study, 4.14% of them were resistant to one or more drugs, and 5.77 and 3.04% had resistant genotypes in new and previously treated patients, respectively. Total resistance for each drug was 0.43% for dapsone, 3.19% for rifampicin and 1.17% for ofloxacin. We found statistically significant differences for rifampicin and for the total population when comparing the results from untreated versus previously treated patients. Two thirds of the resistant samples were resistant to rifampicin alone or combined. CONCLUSIONS: The standard multidrug therapy schemes continue being effective for leprosy cases; however, it is necessary to guarantee adherence and regularity. Surveillance to drug resistance in new and previously treated leprosy cases should be established.

Is drug-resistant Mycobacterium leprae a real cause for concern?: First approach to molecular monitoring of multibacillary Colombian patients with and without previous leprosy treatment / ¿Es la resistencia de Mycobacterium leprae a los medicamentos un verdadero motivo de preocupación?: Primera aproximación a la vigilancia molecular de pacientes colombianos multibacilares con tratamiento previo para lepra y sin él

Introduction: There is no information in Colombia on Mycobacterium leprae primary and secondary drug resistance in regards to the WHO-multidrug therapy regime. On the other hand, public health authorities around the world have issued various recommendations, one of which prompts for the immediate organization of resistance surveillance through simple molecular methods. Objective: To determine the prevalence of Mycobacterium leprae drug resistance to rifampicin, ofloxacin and dapsone in untreated and previously treated patients at the Centro Dermatológico Federico Lleras Acosta during the 1985-2004 period. Materials and methods: We conducted a retrospective study which included multibacillary patient biopsies through elective sampling: 381 of them from new patients and 560 from previously treated patients. Using a microtome, we obtained six slides from each skin biopsy preserved in paraffin, and we extracted M. leprae DNA. We amplified three molecular targets through PCR and obtained the patterns of drug resistance to dapsone, rifampicin and ofloxacin by reverse hybridization. Finally, we collected epidemiological, clinical and demographical data for analyses. Results: From 941 samples under study, 4.14% of them were resistant to one or more drugs, and 5.77 and 3.04% had resistant genotypes in new and previously treated patients, respectively. Total resistance for each drug was 0.43% for dapsone, 3.19% for rifampicin and 1.17% for ofloxacin. We found statistically significant differences for rifampicin and for the total population when comparing the results from untreated versus previously treated patients. Two thirds of the resistant samples were resistant to rifampicin alone or combined. Conclusions: The standard multidrug therapy schemes continue being effective for leprosy cases; however, it is necessary to guarantee adherence and regularity. Surveillance to drug resistance in new and previously treated leprosy cases should be established.

Introducción. Colombia no dispone de información sobre farmacorresistencia primaria y secundaria de Mycobacterium leprae al esquema de terapia múltiple de la Organización Mundial de la Salud (OMS) y las autoridades de salud pública del mundo han emitido varias recomendaciones, entre las cuales está organizar de inmediato la vigilancia a la resistencia empleando métodos moleculares simples. Objetivo. Determinar la prevalencia de la resistencia de M. leprae a rifampicina, ofloxacina y dapsona en pacientes del Centro Dermatológico Federico Lleras Acosta con tratamiento previo y sin él durante el período de 1985 a 2004. Materiales y métodos. Se realizó un estudio retrospectivo. Mediante muestreo electivo se incluyeron biopsias de pacientes multibacilares: 381 de pacientes nuevos y 560 de pacientes previamente tratados. Se obtuvieron con micrótomo seis cortes de cada biopsia de piel incluida en parafina, y se realizó la extracción de ADN de M. leprae. Se llevó a cabo la amplificación de tres blancos moleculares mediante PCR y se obtuvieron los patrones de resistencia a los medicamentos dapsona, rifampicina y ofloxacina por hibridación inversa. Se recolectaron datos epidemiológicos, clínicos y demográficos para llevar a cabo los análisis. Resultados. De las 941 muestras estudiadas, 4,14 % era resistente a uno o más fármacos, y se detectaron 5,77 y 3,04 % con genotipos resistentes en pacientes nuevos y previamente tratados, respectivamente. La resistencia total para cada fármaco fue de 0,43 % a dapsona, 3,19 % a rifampicina y 1,17 % a ofloxacina. Se encontró una diferencia estadísticamente significativa para rifampicina y para la población total al comparar los resultados de los pacientes no tratados con los de los pacientes tratados previamente. Dos tercios de las muestras resistentes lo fueron a rifampicina sola o combinada. Conclusiones. Los esquemas de terapia múltiple estándar siguen siendo efectivos para los casos de lepra; sin embargo, es necesario garantizar el cumplimiento y la regularidad y establecer la vigilancia de la farmacorresistencia en pacientes nuevos y previamente tratados.

Retención, efectividad, cobertura y reacción sensitiva al tratamiento restaurativo atraumático modificado utilizando tres marcas de ionómero de vidrio en escolares de 7 a 8 años de zonas rurales de los departamentos de Sonsonate y Ahuachapán / Retention, effectiveness, coverage and sensitive reaction to the modified atraumatic restorative treatment using three brands of glass ionomer in schoolchildren aged 7 to 8 years old in rural areas of the departments of Sonsonate and Ahuachapán

Objetivo: Determinar retención, efectividad, cobertura y reacción sensitiva del TRAM, utilizando tres marcas de CIV, en escolares de 7 ­ 8 Años, de 3 escuelas públicas rurales, en Sonsonate y Ahuachapán. Materiales y métodos: El diseño corresponde a un experimento clínico aleatorizado, triple ciego con una muestra de 79 escolares distribuida en tres grupos. Se analizó las variables cobertura, efectividad, supervivencia y reacción sensitiva al TRAM empleando tres marcas de Ionómeros de Vidrio. Los datos se tabularon en Excel y procesaron en SPSS v18. Resultados: La prueba efectos inter-sujetos demostró que existe diferencia significativa en tiempos operatorios entre cementos (0.00R cuadrado= .559). La cobertura del TRAM según necesidad de obturaciones y SFF fue 28.08% y 100% respectivamente. La supervivencia a 3 meses fue 69.60% (Maxxion), 88.70(FujiIX) y 33.90% (Vitro Molar), al año fue de 28.70%, 62.60% y 17.40%. En lo referente a reacción sensitiva el 94.94% de niños mostraron tranquilidad antes del tratamiento, 82.28% no evidencio dolor durante procedimientos y 82.28% ausencia de dolor posterior al tratamiento. Conclusiones: El tiempo promedio para realizar un SFF fue de 00:07:05 y para una obturación de 00:07:52 si, existe diferencia significativa en tiempos promedios de tratamientos según cemento. La cobertura según necesidad de SFF es completa, para obturaciones es baja. Los tratamientos con Fuji IX presentaron la mayor sobrevida en boca. La técnica TRAM mostro gran aceptación por los pacientes.

Objective: To determine retention, effectiveness, coverage and sensitive reaction of the TRAM, using three marks of CIV, in schoolchildren aged 7 - 8, from 3 rural public schools, in Sonsonate and Ahuachapán. Materials and methods: The design corresponds to a randomized, triple-blind clinical experiment with a sample of 79 schoolchildren distributed in three groups. The variables coverage, effectiveness, survival and sensitive reaction to TRAM were analyzed using three brands of Glass Ionomers. The data were tabulated in Excel and processed in SPSS v18. Results: The inter-subject effects test showed that there is a significant difference in operative times between cements (0.00R squared = .559). TRAM coverage according to the need for fillings and SFF was 28.08% and 100% respectively. Survival at 3 months was 69.60% (Maxxion), 88.70 (FujiIX) and 33.90% (Vitro Molar), at one year it was 28.70%, 62.60% and 17.40%. Regarding a sensitive reaction, 94.94% of children were calm before treatment, 82.28% did not show pain during procedures and 82.28% did not show pain after treatment. Conclusions: The average time to perform a SFF was 00:07:05 and for a filling of 00:07:52 yes, there is a significant difference in average treatment times according to cement. SFF coverage according to need is complete, for fillings it is low. The treatments with Fuji IX had the highest survival in the mouth. The TRAM technique showed great acceptance by patients.