Active tuberculosis patients have high levels of IgA anti-alpha-crystallin and isocitrate lyase proteins.

SETTING: Mexico City, Mexico. OBJECTIVE: To identify proteins synthetised by Mycobacterium tuberculosis in hypoxic culture, which resemble more closely a granuloma environment than aerobic culture, and to determine if they are recognised by antibodies from patients with active pulmonary tuberculosis (PTB). DESIGN: Soluble extracts from M. tuberculosis H37Rv cultured under aerobic or hypoxic conditions were analysed using two-dimensional polyacrylamide gel electrophoresis, and proteins over-expressed under hypoxia were identified by mass spectrometry. The presence of immunoglobulin (Ig) G, IgA and IgM antibodies against these proteins was determined in the serum of 42 patients with active PTB and 42 healthy controls. RESULTS: We selected three M. tuberculosis H37Rv proteins (alpha-crystallin protein [Acr, Rv2031c], universal stress protein Rv2623 and isocitrate lyase [ICL, RV0467]) that were over-expressed under hypoxia. Titres of anti-Acr and anti-ICL IgA antibodies were higher in patients than in healthy controls, with an area under the receiver operating characteristic curve of 0.71 for anti-ICL IgA antibodies. CONCLUSION: ICL could be used in combination with other M. tuberculosis antigens to improve the sensitivity and specificity of current serological TB diagnostic methods.

Evaluation of the polymerase chain reaction in the diagnosis of miliary tuberculosis in bone marrow smear.

OBJECTIVE: Miliary tuberculosis (MTB) is difficult to diagnose. When prompt diagnosis is necessary, the polymerase chain reaction (PCR) to detect mycobacterial DNA may be valuable. SETTING: Tuberculosis clinic in an academic tertiary-level hospital in Mexico. DESIGN: Bone marrow (BM) aspiration samples from 30 consecutive clinically suspected MTB patients and 58 non-tuberculosis hematologic patients were evaluated by in-house PCR using a fragment of the insertion sequence IS6110; results were compared with those obtained by acid-fast-stained smears, culture in Löwenstein-Jensen medium, histology, and serology. RESULTS: Tuberculosis diagnosis was confirmed in all MTB suspects, 28 by microscopy and culture in pulmonary or extra-pulmonary samples other than BM, and two by clinical and radiologic improvement after antituberculosis treatment. In fresh BM specimens, in-house PCR was positive in 21/30 (70%) suspects, contrasting with only one positive (3.3%) in staining and culture, and four with compatible histologic findings (13.3%). BM samples from the control group showed negative results in bacteriologic and histologic studies, except in nine who had positive PCR results. These nine control cases had malignant processes. CONCLUSION: PCR in aspirates of BM is a useful diagnostic assay in cases of MTB, mainly when bacteriological results are negative.

Tuberculosis is still a major cause of cervical lymphadenopathies in adults from developing countries.

To establish the frequency of infectious aetiology in Mexican adult patients with cervical lymphadenopathies (CLAs), 87 consecutive patients with enlarged cervical lymphatic nodes, HIV negative and without anti-tuberculous treatment, were selected from a tertiary-level speciality concentration hospital. Histopathological studies, investigation of acid-fast bacilli, cultures in Löwenstein Jensen and Mycobacterium growth indicator tube (MGIT) media, and in-house polymerase chain reaction (PCR) with IS6110-based primers for Mycobacterium tuberculosis complex were performed in resected lymphatic nodes. Non-infectious aetiology corresponded to 45 cases (52 %). Tuberculosis was suspected in 42 cases (48%) by histology and confirmed positive results were obtained by staining in 8 (19%), by culture in 23 (55%), and by PCR in 34 (81 %) patients. All were confirmed after therapeutic success. In addition to the epidemiological transition process occurring in Mexico, tuberculosis remains an important cause of CLA. Histopathology with confirmatory studies including PCR can detect tuberculous aetiology.

[Usefulness of the coccidioidin skin test in patients with type diabetes mellitus in an endemic zone]. / Utilidad de la prueba cutánea a la coccidioidina en personas con diabetes mellitus tipo 2 en una zona endémica.

OBJECTIVE: There are few studies available about skin response to mycotic antigens in diabetes mellitus subjects, therefore, the possible difference of skin reactivity to coccidioidin in subjects with and without diabetes mellitus was analyzed. MATERIAL AND METHODS: The prevalence of skin reactivity to coccidioidin in a population sample of 1651 subjects in a coccidioidomycosis endemic zone was estimated using a transversal design. Subjects with diabetes mellitus were identified and the diagnosis was validated by clinical and laboratory criteria. In order to determine the reactivity association level with the diabetes mellitus history, data was compared with the population sample, through logistic regression analysis adjusted by age, sex and residence geographical area. Odds ratio (OR) and 95% confidence intervals were obtained. RESULTS: In the population study, there were 665 coccidioidin positive subjects (40.28% rate). Seventy six cases with diabetes mellitus were identified, 23 were positive to the test (30.26% rate) with an odds ratio of 0.63 for this group (95% CI 0.37-1.07). The OR decrease to 0.52 (95% CI 0.31-0.88, p = 0.014) with the adjusted logistic regression analysis. CONCLUSION: Coccidioidin reactivity was lower in the diabetes mellitus cases than in general population. It is necessary to be cautious with the coccidioidin test interpretation in people with DM 2.

La hemodinamia cardiopulmonar en el paciente neumópata crónico. Un comentario clínico / Cardiopulmonary haemodynamic in chronic neumologic patients. A clinical comment

Las enfermedades pulmonares crónicas son una causa frecuente de hipertensión pulmonar y cor pulmonale crónico, su existencia implica una menor supervivencia y por lo tanto mal pronóstico. Esta revisión analiza los probables factores fisiopatológicos que participan en la génesis de la hipertensión pulmonar de nuestros tres primeros grupos de trabajo (enfermedad pulmonar obstructiva crónica, neumopatía intersticial y apnea obstructiva del sueño). En general, la hipertensión pulmonar de este grupo de pacientes es el resultado de uno o varios factores: factores vasoactivos (hipoxia, acidosis, etcétera), factores pasivos (hiperflujo, hipertensión venocapilar y daño vascular); este último factor a su vez puede ser mediado por la patología de base (fibrosis, inflamación, obstrucción, etcétera) o bien ser secundario a remodelación de la circulación pulmonar por hipoxia crónica e hiperflujo. Otros factores de origen funcional descritos han sido la disminución del volumen pulmonar propia de las patologías intersticiales; así como el aumento en la resistencia de la vía aérea y la eritrocitosis secundaria, hallazgos que caracterizan a la enfermedad pulmonar obstructiva crónica. El adecuado conocimiento en la fisiopatología de estas enfermedades, así como la magnitud de la hipertensión pulmonar requiere del estudio de la circulación pulmonar a través del cateterismo cardiaco derecho por lo que se justifica la existencia de un servicio de hemodinamia en todo hospital dedicado a la enseñanza de la neumología.

[Who smoke at a general hospital? Clinical comment]. / Quiénes fuman en un hospital general? Comentario clínico.

BACKGROUND AND OBJECTIVE: Tobacco consumption is a public health problem. Hospitals are not free of this circumstance because there are smokers inside these institutions; thus, it is important to identify who smoke in hospitals. METHOD AND RESULTS: A general survey with closed questions was carried out among 659 workers at a tertiary level general hospital. Smoking habit was positive in 184 employees and negative in 475. The majority of smokers were married and worked in the administrative offices, 46 of which belong to the medical area. Academic level was not an important determinant for tobacco consumption. The habit began between 10 to 20 years of age, mainly in relation with a sensation of pleasure, relaxation, and the need to smoke. CONCLUSIONS: The main site for smoking was the working area, 70% of nonsmokers are converted passive non-voluntary smokers. It is important to take actions to avoid tobacco smoking in hospitals in pursuit of a hospital environment free of tobacco smoke.

[Surgical treatment of invasive thymoma with superior vena cava syndrome. 3 case reports]. / Tratamiento quirúrgico del timoma invasor con síndrome de vena cava superior. Informe de tres casos.

Three patients with invasive thymoma and superior vena cava syndrome with severe symptoms of cerebral venous hypertension and respiratory obstruction are presented. Two patients showed a type I obstruction and the other had a type II obstruction as defined by Stanford and Doty. In all of them, the tumor was resected and a graft bypass was placed between the left innominate vein and the right appendage. In two patients the grafts were venous and in the other it was a PTFE. All grafts were reinforced with wire rings. The patients improved and the symptoms of the SVCS disappeared, the average time of permeability was 10 months.

Burden of Mycobacterium tuberculosis in sputum samples can be reliably determined using a quantitative, non-radioactive polymerase chain reaction assay.

OBJECTIVE: To develop a rapid assay for quantitation of Mycobacterium tuberculosis in sputum samples using the competitive polymerase chain reaction (PCR) and a colorimetric microtiter well detection format. DESIGN: The assay relies on the co-amplification of a 419 base pair (bp) pab fragment of M. tuberculosis together with a target template (pab/tet) made by splicing a fragment of tet excised from pbr322 between the 5' and 3' ends of the pab fragment to create a 380 bp hybrid template amplified with the same primers but readily distinguishable using probes specific for either pab or tet. RESULTS: We demonstrate a good correlation between the results obtained using this assay and the results of quantitative culture. CONCLUSION: This assay provides quantitative information regarding M. tuberculosis burden in samples containing between 10(3) and 10(8) colony forming units/milliliter (CFU/ml).

Oximetría de pulso y broncoscopia / Pulse oximetry and bronchoscopy

La oximetría de pulso es un método no invasivo y barato para vigilar de manera continua la oxigenación arterial en tiempo real. La oximetría de pulso empleada de rutina durante la realización de broncoscopias, permite apreciar la oxigenación durante este procedimiento. La saturación del oxígeno se mantiene por arriba de 80 por ciento, en pacientes con neumopatía crónica, con la administración de oxígeno por puntas nasales a flujos de 3 litros por minuto, lo que permite realizar el procedimiento con seguridad

[Levels of carboxyhemoglobin in smokers and non-smokers from 2 cities of the Mexican high plateaux]. / Niveles de carboxihemoglobina en sujetos no fumadores y fumadores de dos ciudades del altiplano mexicano.

Carboxyhemoglobin levels (COHb) were determined in residents of two Mexican cities (Mexico City and Toluca) at altitudes of 2200 and 2600 meters above sea level. The figures in non-smokers of both cities were slightly higher than those seen at sea level by others: 1.63% in Mexico City and 1.54% in Toluca versus 0.5-1% at sea level. There were no intercity differences in smokers and non-smokers, but there were intergroup differences in both cities (p less than 0.01 in Mexico City, and p less than 0.05 in Toluca). Our findings suggest that the most important source of carbon monoxide in smokers is tobacco smoking, and that the COHb level may be reliable index to establish active smoking.

[Primary non-Hodgkin's lymphoma of the lung]. / Linfoma no Hodgkin pulmonar primario.

A case of small and large cells non Hodgkin lymphoma with an unusual involvement of the lung is presented. The tumor was located in the inferior lower lobe of the right lung and coincided with hemorrhagic pleural effusion. The cytopathological study of the fluid was negative for neoplastic cells, so were the aspiration biopsy of the lung and the pleural biopsy. The transmission and scanning electron microscopic study of the pleural fluid demonstrated lymphoid atypical cells. The patient was treated by resection of the lower right lobe and pleurectomy. The difficulties in the differential diagnosis of this type on non Hodgkin lymphoma are discussed. The importance of scanning and transmission electron microscopy is stressed when the light cytologic studies are negative in processes suggestive of being neoplasms. After one year of the lobectomy and treatment with vincristine-epirubicin-cyclophosphamide and methyl-prednisolone, the patient is in good condition without evidence of neoplastic activity.

[Giant bronchiectasis caused by chronic inhalation of porcine hair]. / Bronquiectasias gigantes por inhalación crónica del pelo porcino.

A rare case of gigantic bronchiectasis consecutive to chronic inhalation of pork hair (hog's bristle) is presented. The possible pathogenic mechanisms are discussed. The case was subject to surgical resection of the affected lung segment, lingula.

[Poland syndrome and myasthenia gravis]. / Síndrome de Poland y miastenia gravis.

A female patient, 17 years old with Poland's syndrome and myasthenia gravis was seen due to a bronchial infection and atelectasis. The respiratory pathology was treated by bronchial aspiration and respiratory support in the intensive care unit. The myasthenia gravis improved substantially after thymectomy. The association of Poland's syndrome and myasthenia is rare and it has not been reported previously; it may be a factor in the pulmonary pathology observed in this case.