Estandarización de la técnica Real Time PCR para la detección molecular de la mutación V617F en el gen de JAK-2 en neoplasias mieloproliferativas crónicas / Standardization of the Real Time PCR technique for the molecular detection of the V617F mutation in the JAK-2 gene in chronic myeloproliferative neoplasms

V617F mutation in exon 14 of Janus Kinase 2 gene (jak-2) is used as a molecular marker for the diagnosis of Philadelphia negative myeloproliferative neoplasms (Phi-) such as Polycythemia Vera (PV), Essential Thrombocythemia (ET) and Primary Myelofibrosis (MFP). To detect this mutation, we used conventional polymerase chain reaction technique (PCR), a simple and inexpensive technique, however, has some drawbacks that current technology allows to solve. During the last years, more sensitive molecular techniques have been incorporated in clinical practice to support the diagnosis, prognosis and follow-up of hematological patients. For its implementation in the clinical routine should be considered technical and economic aspects, so in this work, we evaluate the Real Time PCR technique as a diagnostic method for the detection of the Jak-2-V617F mutation, using in house primers design. Our result show that the technique implemented has a concordance index of 0.87 with the conventional PCR used in the molecular diagnosis of myeloproliferative neoplasms. In addition, it has the same specificity, greater sensitivity and, shorter execution time in relation to conventional PCR. The implementation of this diagnostic method in our Hospital is technically possible and commercially convenient. (AU)

Accidentes de riesgo biológico entre estudiantes de carreras de la salud: Cinco años de experiencia / Biological risk accidents among undergraduate healthcare students: Five years experience

Undergraduate healthcare students are exposed to bloodborne pathogens, and data from developing countries is scarce. We report the experience of a comprehensive program dedicated to the management of this risk. The program includes financial coverage, a 24-hour attention system, HIV, HBV, HCV testing, and free provisión of post-exposure antiretroviral drugs. During 2003-2007, incidence rates of these exposures reached 0.9 per 100 student-years. Events were only observed among medicine, nursing, and midwifery students, with rates highest among nursing students (RR 3.5 IC95 1.93 - 6.51). Cuts andneedle stick injuries predominated (74.7 percent of accidents). Three students were exposed to HIV patients (1.9 percent), all of them received prophylactic drugs, infection was discarded after follow up, and also discarded after exposures to HBV or HCV (0.6 percent of all accidents). Cost per 1000 student-year was less than 2000 USD. Healthcare students are exposed to biological risks during their studies and a comprehensive program is feasible in a developing country.

Los estudiantes de pregrado de las carreras de la salud están expuestos a riesgos biológicos con agentes de transmisión sanguínea. En este trabajo se reporta la experiencia acumulada con un programa integral para este tipo de accidentes y que incluye atención gratuita las 24 horas, estudio serológico de la fuente para VIH, VHC y VHB, y entrega de anti-retrovirales post-exposición a pacientes infectados por VIH. Desde el año 2003 al 2007 la tasa de incidencia alcanzó una cifra de 0,9 eventos por 100 estudiantes-año. Las exposiciones de riesgo fueron observadas sólo entre estudiantes de medicina, enfermería y obstetricia, siendo la mayor tasa en alumnos de enfermería (RR 3,5 IC95 1,93 a 6,51). Tres alumnos estuvieron expuestos a pacientes con infección por VIH (l,9 por cientoo de todos los accidentes), todos ellos recibieron profilaxis, descartándose seroconversión en el seguimiento, al igual que en casos con exposición ante VHB y VHC (0,6 por cientoo del total de accidentes). El costo del programa fue menor a US$ 2000 por 1.000 estudiantes-año. Los estudiantes de las carreras de la salud están expuestos a riesgos biológicos durante sus estudios y requieren de un programa de manejo, el que es posible de lograr en un país en desarrollo.

Docencia universitaria: al rescate del valor público / University teaching: to the rescue of the public value

Superior Education is a fundamental area in our society, very often postponed without considering enough the urgent need of changes, even though discussion is persistent about its importance as essential instrument for developing citizenship, and a fair, consistent and coherent community. In our institutional setting, being such a teacher is a far distant model. A review of what is felt lacking in our environment to get the necessary human resource to recover the plain public wealth in health education and assistance. The most significant aspects to be covered are noted as: 1) - to keep good proportion between the opportunities of practical learning and consequent teaching, and the medical service provided by activities that may accomplish both goals. 2) - giving adequate stimulus to enhanced accessing and perform as a competent health professional and to become an outstanding health graduate. 3) - privileging programs for advanced though rational knowledge, under professionals criteria, which put emphasis in problems resolution and decision making better than in contingent and concrete abilities. 4) - give due relevance to autonomic practice; development of assertive,critical and “autopoietic” aptitudes; rely on humanistic and ethic procedures. 5) - support quality and dignity of the professions in values comprise in professionalism itself, conceived regulated by a safeguard of personal responsibility and suitable accreditation.

Anti-VHE IgM en casos de infección por el virus hepatitis E / Detection of IgM antibodies against hepatitis E virus

Background: Hepatitis E virus is the main enterically transmitted non A non B hepatitis agent. The host IgM response in the acute infection phase is short lived. Therefore, only IgG antibodies against E virus are usually investigated. Aim: To measure IgM antibodies against virus E in serum samples. Material and Methods: IgM antibodies against virus E were measured by ELISA in 35 positive and 18 negative serum samples for IgG antibodies against hepatitis virus E, without evidence of infection with hepatitis A, B or C virus. Measurement of the same antibodies in 25 additional samples positive for IgM antibodies against hepatitis A virus but without study for hepatitis virus B or C. Results: IgM antibodies against virus E were detected in 12 of the 35 samples positive for IgG antibodies (34%) and in five of the 25 samples positive for antibodies against virus A (20%). Conclusions: An acute hepatitis E virus infection was detected in 34% of samples positive for IgG antibodies against this virus. The absence of IgM antibodies in the rest of the IgG positive samples could be due to an old or a recent virus E infection in the stage of antibody titer reduction. The detection of IgM antibodies against virus E in samples positive for virus A antibodies, could be due to co infection by virus A and E or a cross reaction of assays.

Hepatitis colestásica por piroxicam: caso clínico / Cholestatic hepatitis associated to piroxicam use: report of one case

Most nonsteroidal antiinflammatory drugs can produce hepatotoxicity. We report a 22 years old female who presented with an acute cholestatic hepatitis after a prolonged period of piroxicam use. Hepatitis was attributed to this drug since all markers for hepatitis virus (A, B, C, E, Epstein Barr, Cytomegalovirus and Herpex Simplex) were negative, autoimmune markers were negative, serum iron and ceruloplasmin were normal, there was a temporal relationship between the administration of piroxicam and the hepatitis, the histological picture was compatible with this etiology and the patient had a favorable evolution after the discontinuance of the drug. This type of hepatotoxicity is not common but it must be born in mind when patients must receive nonsteroidal antiinflammatory drugs for prolonged periods

Enzimo inmunoanálisis en el diagnóstico rápido de meningitis tuberculosa / Enzyme immunoassay in rapid diagnosis of tuberculous meningitis

La meningitis tuberculosa es una enfermedad grave por su alta letalidad y frecuencia de secuelas, que requiere un inicio precoz y oportuno de tratamiento antituberculoso. Con el objetivo de desarrollar un método de diagnóstico rápido se implementó un enzimo inmunoanálisis para determinar anticuerpos anti PPD IgG e IgM y anticuerpos IgG anti Mycobacterium bovis BCG en muestras de líquido cefaloraquídeo (LCR). Se estudiaron LCR de 72 pacientes con meningitis tuberculosa, meningitis a LCR claro, meningitis bacteriana aguda (MBA) y controles con LCR normal. Se establecieron puntos de corte para cada clase de anticuerpos. Se encontraron niveles de anticuerpos anti PPD y BCG significativamente superiores en el grupo de meningitis tuberculosa en comparación con el grupo de meningitis a LCR claro y con los controles. No hubo diferencia significativa, en cambio, con el grupo de las MBA. La sensibilidad del test fue de un 90 por ciento y la especificidad fue de un 89 por ciento. Los resultados obtenidos hacen que este test sea altamente recomendado en el diagnóstico rápido de la enfermedad

Estudio en pacientes con diagnóstico serológico de infección por VIH-1 indeterminado / An immunologic study on patients with an HIV-1 indeterminate diagnosis

Western blott is the technique most frequently used to determine the presence of HIV-1 antibodies. However, some patients remain with an indeterminate diagnosis for HIV-1 according to the technique. We followed 8 such patients for 2 18 months. Immunologic studies included standard ELISA, immunofluorescence and Abbott anti-p-24 ELISA. We found selective reactivity for certain viral proteins such as isolated p24,p24 plus p51 or p55, gp41 plus gp120, p17 plu p24 and p25