Detection of Chlamydia trachomatis in pregnant women by the Papanicolaou technique, enzyme immunoassay and polymerase chain reaction.

OBJECTIVE: To compare Papanicolaou staining, enzyme immunoassay (EIA) and the polymerase chain reaction (PCR) techniques for detecting Chlamydia trachomatis in pregnant women. STUDY DESIGN: Endocervical specimens were taken randomly from 125 pregnant women with or without symptoms. These women attended their first medical consultation at the Regional General Ignacio Zaragoza Hospital. Samples were analyzed for detection of C trachomatis. When results differed between tests, specimens were evaluated by direct immunofluorescence staining. RESULTS: The prevalence of chlamydial infection was 2.4%. The characteristics of patients positive for Chlamydia were: average age, 24 years; first sexual encounter at age 21 years, one partner and six to nine months of gestation. The sensitivity, specificity, accuracy, positive predictive values and negative predictive values were 100%, 99.18%, 99.20%, 75% and 100%, respectively, for Papanicolaou staining; 100%, 92.62%, 92%, 25% and 100% for EIA; and 100%, 100%, 100% and 100% for PCR. CONCLUSION: Both Papanicolaou staining and PCR were adequate for diagnosis of C trachomatis infection. EIA was not reliable and therefore is not recommended for use as a diagnostic technique in a pregnant population with low risk and low prevalence.

In vitro study of biosynthesis of protoporphyrin IX induced by delta-aminolevulinic acid in normal and cancerous cells of the human cervix.

BACKGROUND: delta-Aminolevulinic acid (ALA) is recognized as the starter in the biosynthesis of the heme group, the structural basis of cytochromes, chlorophylls, biliary pigments, and other porphyrins. It is the first intermediary in the biosynthesis of protoporphyrin IX (PpIX), and of the heme group. PpIX is present in low concentration in normal cells, and in high concentration in tumor cells. METHODS: The accumulation of protoporphyrin IX (PpIX) induced by delta-aminolevulinic acid (ALA) was tested in two cervico-uterine cancer cell lines (HeLa and CaLo), and in normal human cervical epithelial (NHCE) cells. RESULTS: The optimal concentration of ALA that induced maximum levels of intra- and extracellular accumulation of PpIX in both HeLa and NHCE cells was 300 micrograms of ALA/mL, and for CaLo cells, 150 micrograms/mL. The viability of HeLa, CaLo, and NHCE cells exposed to ALA measured 81, 98, and 84%, respectively. The optimal time for accumulation of PpIX, both intra- and extracellular, was 4 h for HeLa and NHCE cells and 5 h for CaLo cells per 24 h of exposure to optimal concentrations of ALA. After the maximum level of PpIX accumulation was reached, there was a gradual decrease until there was only a small quantity. A statistically significant difference (p < 0.0001) was found in the accumulation of PpIX, depending on the concentrations of ALA used as well as between cervical cancer cell lines and NHCE cells (p < 0.0001). The concentration ratio of PpIX for NHCE and HeLa cells was 1:7, and for NHCE and CaLo cells, 1:5. CONCLUSIONS: These results are important for determining the usefulness of the sensitizer (PpIX).

[Use of an index of social welfare for health planning at a municipal level]. / Uso de un índice de bienestar social para la planificación de la salud a nivel municipal.

OBJECTIVE: This paper analyzes the relationship between a living standards index for small areas based on census data and information on morbidity and health care utilization. MATERIAL AND METHODS: The information was gathered through a health interview survey of a random sample of 1 238 households from rural areas of Tlaxcala, Mexico. RESULTS: The population from localities with lower living standards showed significantly higher prevalences of morbidity and worse self-reported health status measures, as compared to localities with higher living standards. On the contrary, higher living standards were related with a greater utilization of health services. CONCLUSIONS: The approach proved to be useful in discriminating localities and areas of high and low prevalence of morbidity and utilization of health care services, which in turn could be used to identify those areas where needs are greatest. The implications of the results for health planning and resource allocation (based on population health needs and underlying social conditions) at the local level are discussed.