Tuberculosis y micosis sistémicas en indígenas del Municipio Cedeño Estado Bolívar Venezuela / Tuberculosis and systemic mycoses in indigenous Cedeño Municipality Bolivar State Venezuela

Determinar la prevalencia de tuberculosis y micosis sistémicas endémicas, Paracoccidioidomicosis e Histoplasmosis, en poblaciones indígenas. Se realizó un estudio transversal en pacientes sintomáticos respiratorios de 3 comunidades indígenas del municipio Cedeño del estado Bolívar, Venezuela. Se obtuvieron muestras de esputo y secreción ganglionar para la búsqueda de bacilos ácido-resistentes, el complejo Paracoccidioides sppe Histoplasma capsulatum; se realizó cultivo en medio Lowëstein Jensen y medios selectivos para hongos, además estudio molecular para micobacterias. Se estudiaron muestras de suero para la demostración de anticuerpos específicos contra el Complejo Paracoccidioides sppe H. capsulatum. Se evaluaron 60 pacientes sintomáticos respiratorios. Se demostraron bacilos ácido-resistentes por baciloscopia en 26 casos (43,3%) y 29 cultivos positivos para Mycobacterium tuberculosis (48,3%) resultando un total de 33 pacientes con diagnóstico de tuberculosis; hubo correlación significativa entre los hallazgos en el Ziehl-Nielsen y el crecimiento de M. tuberculosis en cultivo (p=0,013). Se demostró la presencia del Complejo Paracoccidioides spp en 2 casos (3,3%), con coexistencia de bacilos ácido-resistentes. No se evidenció la presencia de H. capsulatum. La tuberculosis constituye la principal causa de infección respiratoria crónica en estas comunidades indígenas y obliga a que se revisen de forma urgente los programas regionales para la atención de estas poblaciones vulnerables, así como a realizar estudios en otras poblaciones.

To determine prevalence of tuberculosis and endemic systemic mycoses, Paracoccidiodomycosis (PCM) and Hystoplasmosis in native populations. A transversal study in individuals with respiratory symptoms from 3 native populations from Cedeño County from Bolivar state, Venezuela, was realized. Sputum and spontaneous lymphatic node secretion samples were obtained to look for acid-resistant bacilli, Paracoccidioides spp complex and Histoplasma capsulatum. Culture in Lowëstein-Jensen and selective media to fungi, andmolecular study formycobacteria were realized. Serum samples were studied to demonstrate specific antibodies against Paracoccidioides spp complex and H. capsulatum. Sixty individuals had respiratory symptoms. Acid-resistant bacilli were demonstrated in 26 cases by bacilloscopy (43.3%) and 29 positive cultures for Mycobacterium tuberculosis (48.3%), resulting 33 patients with diagnosis of tuberculosis; there was significative correlation between features in bacilloscopy and growing of M. Tuberculosis in Lowëstein-Jensen media (p=0.013). Presence of the characteristic yeastlike forms of Paracoccidioides spp complex was found in 2 cases (3.3%) with coexistence of acidresistant bacilli in both. There was no evidence of H. capsulatum. Tuberculosis constitutes the principal origin of chronic respiratory infection in these native populations and it should conduce to revise urgently the regional programs attending to these vulnerable populations.

Identificación de micobacterias no tuberculosas: comparación de métodos bioquímicos y moleculares / Identification of non-tuberculosis mycobacteria: comparison between biochemical and molecular methods

Las infecciones causadas por micobacterias no tuberculosas (MNT) o atípicas constituyen en la actualidad un grave problema de salud, especialmente en pacientes inmunocomprometidos. Estas micobacterias presentan patrones de susceptibilidad a antibióticos particulares y distintos a M. tuberculosis, por lo que la administración del tratamiento adecuado requiere de un método rápido, sencillo y sensible de identificación. La técnica de PRA (Análisis de Restricción de Productos de PCR), basada en la digestión enzimática del producto de amplificación del gen hsp65, ha mostrado ser un método adecuado de identificación de micobacterias. En el presente trabajo se comparó la técnica de PRA con el estándar de identificación de micobacterias representado por las pruebas bioquímicas en 30 aislados provenientes del Laboratorio de Tuberculosis del Instituto de Biomedicina. La técnica de PRA permitió identificar 96% de las cepas analizadas, en comparación con 92.% de cepas identificadas por las técnicas bioquímicas. Los resultados obtenidos fueron idénticos en 18 de 22 cepas, correspondiendo al 82% de los resultados. Se concluye que el PRA es un método rápido, sencillo y económico que produce resultados concordantes con las técnicas tradicionales, con un menor grado de error. Basados en estos resultados se recomienda el uso del PRA en los laboratorios clínicos como método de identificación de rutina para micobacterias.

Infections caused by atypical mycobacteria at present constitute a serious health problem, especially in immunocompromised patients. These mycobacteria present particular susceptibility patterns, different from M. tuberculosis, due to which the administration of an adequate treatment requires a fast, simple and sensitive identification method. The PRA technique (PCR Restriction), based on the enzymatic digestion of the amplification product of the hsp65 gene has shown to be an adequate method for the identification of mycobacteria. In this study we compared the PRA technique with the standard mycobacterial identification method, represented by biochemical tests, in 30 isolates from the Tuberculosis Laboratory of the Instituto de Biomedicina. The PRA technique allowed the identification of 96% of the strains analyzed, as compared with 92% of strains identified through biochemical methods. The results obtained were identical in 18 of 22 strains, corresponding to 82% of the results. It is concluded that the PRA technique is a fast, simple and economical method that produces results in concord with traditional techniques, with a lesser degree of error. Based in these results, the use of PRA as routine identification technique for mycobacteria is recommended for clinical laboratories.

El diagnóstico convencional de Mycoplasma pneumoniae como agente causal de Neumonías Adquiridas en la Comunidad (NAC) / Conventional diagnosis of Mycoplasma pneumonia as causative agent of Community Acquired Pneumonia (CAP)

Resumen Las enfermedades infecciosas constituyen un importante problema de salud y específicamente la neumonía se encuentra entre las diez primeras causas de muerte a nivel mundial y en novena posición entre las principales causas de muerte en Venezuela. La Neumonía Adquirida en la Comunidad (NAC), se define como aquella que se presenta en pacientes no hospitalizados en los siete días previos al diagnóstico, o durante las primeras 48 horas de ingreso en pacientes hospitalizados. Entre los principales agentes etiológicos de la NAC, ocupando un segundo lugar en orden de frecuencia, se encuentra Mycoplasma pneumoniae. Los patógenos implicados en la neumonía extra-hospitalaria, difieren de aquellos causales de neumonías originadas en el hospital, y existe una notable diferencia en cuanto a su frecuencia de aparición y patrones de sensibilidad a drogas, por lo que es importante la identificación del agente causal. En este trabajo revisaremos los principales métodos convencionales (cultivo y serología) para el diagnóstico de este microorganismo, y analizaremos sus limitaciones, las cuales a menudo resultan en la aplicación de tratamiento de forma empírica.

Abstract Communicable diseases. among them specifically pneumonia, constitute an important public health problem, and they appear among the ten most important causes of death at a world wide level, and in the ninth place of causes of death in Venezuela. Community Acquired Pneumonia (CAP) is defined as that which occurs in non hospitalized patients during the seven days prior to diagnosis, or during the first 48 hours after internment in hospitalized patients. Mycoplasma pneumoniae is one of the main etiological agents of CAP, occupying the second place in order of frequency. Pathogens implicated in extra-hospital pneumonia differ from those that produce hospital originated pneumonia and there is a notable difference regarding their frequency of occurrence and drug sensibility patterns; therefore, it is important to identify the causative agent. In this study we will revise the main conventional diagnostic methods (culture and serology) for this microorganism, and we will analyze their limitations, that often are consequence of empirically applied treatments.

Evaluación de trastornos disociativos en población psiquiátrica mexicana: prevalencia, comorbilidad y características psicométricas de la Escala de Experiencias Disociativas

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Abstract: Introduction: Dissociative disorders are characterized by impaired conscious integration functions, personal identity, memory and environment perception. Their frequent psychopathological manifestations are amnesia, depersonalization, fugue states, extra sensorial experiences, trance states and total personality changes. They usually appear under different life stressors, and their clinical course is highly variable. Prevalence estimates give figures ranging from 5 to 10% among general population, and reach 10.2 to 41.4% among psychiatric populations. This wide variation is one of the indicators of the complexity of this diagnostic entities and of its difficulty to be studied. Culture is a key factor in functionality of subjects with a dissociative disorder, because the acceptance of many of its clinical features varies. It is accepted that these diagnostic categories are barely-recognized, not only by general physicians, but by experienced mental health specialists. The original Structured Diagnostic Interviews (SCID, CIDI, SADS, SCAN), did not include them in their widely distributed packages, and many of them decided to create a separate appendix to address them. Unfortunately, structured interviews face an important limitation as there is a lack of trained, and some times, experienced psychopathologist, a fact that difficults to use them in large samples. Self-report instruments, when they show good reliability and validity, are of great value in terms of time, costs and feasibility. Their major limitation is the low reliability that they show in psychiatric conditions in which lack of insight is present (psychotic disorders). To evaluate the psychometric properties of translated versions of instruments is highly desirable. This is specially important when elusive disorders are being evaluated. Given that the cultural environment of Mexico is surrounded by several factors that influence this kind of disorders, the availability of reproducible research instruments is of outmost relevance. Therefore, the Dissociative Experiences Scale (DES) -the most widely used measure in this field- in contrast with the Dissociative Disorders Interview Schedule (DDIS), was evaluated, with the purpose to give a first approach to a 12 month prevalence of some Dissociative disorders in Mexican psychiatric patients. Methods: Subjects: A non-random, consecutive sample of male and female patients, between 18 and 63 years old were included. They were receiving treatment, regardless of the diagnosis, at the Institute of Mental Health of Jalisco, from the State's Ministry of the Health in Mexico. The ethics committee authorized the study, and they all gave informed consent. Translation: The Spanish version of the DES, has a Spanish translation, and a Mexican Spanish idiomatic adaptation was performed by consensus. The DDIS was translated by one bilingual psychiatrist, and independently reviewed by another. Consensus was reached in controverted items. Once a final translated version was obtained, it was given to 10 subjects (mainly with primary school level), to assess item understanding. A second review was performed to reach a culturally compatible version, concentrating in respecting item content validity. Back translation was not considered, because this method does not capture common language of low school population, which is the case of most Mexicans. Measures: Dissociative Experiences Scale (DES): This is a 28 items, self-report scale, designed to evaluate different kinds and severity of Dissociative conditions, in a 0 to 100 range. Most populations without a psychiatric condition or with a non-Dissociative disorder, scored under 20. A cut-off point of 30, usually indicates the possibility of a Dissociative disorder diagnosis. Given that a Spanish version of the DES is available from Spain, only an idiomatic adaptation to Mexican Spanish was performed (changes in slang or word content differences between countries). Dissociative Disorder Interview Scale (DDIS): This is a structured diagnostic interview, of 132 yes/no items, designed to assess the presence of DSM-IV Dissociative disorders entities. It is to be applied by mental health professionals, properly trained on its use. It does not give a total score, it assesses each disorder independently. As previous studies performed in different languages, it has adequate psychometric properties, and is the usual golden standard for Dissociative categories. Previous reports on DDIS correlation with DES have shown variations between disorders, with Kappa values for Identity Dissociative Disorder ranging 0.68 to 0.95. Procedures: A 4th year general psychiatry residency doctor was trained in the DDIS, and, after obtaining the patient's consent, applied the DDIS interview, and then gave the patient the DES to be completed. Demographic and clinical variables were obtained, as well as the diagnosis assigned in the patient chart. To analyze results two procedures were planned: 1) compare DES total score punctuation between positive and negative presence of Dissociative disorders according with the DDIS and 2)compare between patients with a Dissociative disorder with or without concomitant major depression. Results: A total of 100 subjects were included, 63% female, with a mean age of 32.4±12.5 (range 18 - 63) years old. The DES internal consistency index was 0.96. Patients with a Dissociative Disorder (according to the DDIS), showed clinically and significantly higher DES values than non-Dissociative patients (34.7±24.8 n= 38 vs. 10.7±9.6 n=62; T -6.8, d.f. 98, p< 0.001). Frequency of Dissociative disorders and symptoms: Mean DES total score was 19.8±20.6. According to DDIS criteria, 38 subjects fulfilled DSM IV diagnostic criteria for a Dissociative disorder: Dissociative identity disorder 24, Depersonalization Disorder 6, psychogenic fugue 3. The most common concomitant diagnosis as assessed in the patient chart was unipolar major depression (17 44.7%. When a Dissociative disorder was comorbid with major depression, comparing it with Dissociative disorders only, the difference was greater (34.7±24.2 n= 38, 9.3±8.55, T 6.3, d.f. 80, p<000.1. Discussion: Dissociative disorder measurements evaluated, seem to work adequately in Mexican population. Prevalence of dissociative disorders found in this psychiatric population, is consistent with other studies. Further research in the field is needed, to evaluate the influence of cultural factors, including rural and indigenous samples.

Aislamiento e identificación de micobacterias mediante métodos bacteriológicos y de biología molecular / Mycobacteria isolation and identification by bacteriological methods and molecular biology

La tuberculosis constituye un problema de salud a nivel mundial y se necesitan esfuerzos concertados para lograr un diagnóstico oportuno. Las infecciones por micobacterias no-tuberculosas (MNT) se agregan al reto diagnóstico. En este trabajo mostramos el aislamiento e identificación de micobacterias, usando métodos bacteriológicos y moleculares a partir de 256 muestras clínicas obtenidas de 188 pacientes con impresión diagnóstica de tuberculosis. De las 41 muestras en las cuales hubo aislamiento (16 por ciento del total), 24 fueron baciloscopia positiva (BK+), 58,5 por ciento y 17 BK- (41,5 por ciento). M. tuberculosis representó el 58,14 por ciento de los aislados y MNT el 37,2 por ciento: 6 M. chelonae, 4 M. marinum, 3 M. fortuitum, 3 no identificadas. La correlación entre la identificación bacteriológica y molecular fue del 93 por ciento. La presencia de un alto porcentaje de MNT aisladas de pacientes clínicamente enfermos señala la importancia de incluirlas en el diagnóstico clínico diferencial y la necesidad de implementar el cultivo como herramienta obligatoria de diagnóstico bacteriológico.

Regulación de la transcripción en el operón de ARN ribosomal en micobacterias / Transcription regulation in the ribosomal RNA operon of mycobacterium

La tuberculosis es una importante enfermedad causada por el bacilo Mycobaterium tuberculosis. Entre las características particulares de esta bacteria destaca su lenta tasa de crecimiento, que le permite sobrevivir por largos períodos de tiempo en el interior celular. Uno de los elementos genéticos de importancia en la regulación del crecimiento es el operón rrn. Este operón contiene los genes que codifican las tres moléculas de ARN ribosómico, componente esencial de los ribosomas bacterianos. El bacilo tuberculoso, a diferencia de la mayoría de los microorganismos, tiene una copia única del operón rrn por genoma, lo cual necesariamente significa que el mismo debe estar sometido a estrictos mecanismos de control, otra conclusión es que el operón rrn de M.tuberculosis constituye el blanco ideal para el diseño de drogas antituberculosas. En el presente trabajo hemos estuadiado algunos elementos importantes en el control de la transcripción en M.tuberculosis, particularmente aquellos presentes en la región líder del operón. Usando técnicas de biología molecular, hemos identificado elementos de secuencia que parecen estar involucrados en el control de la elongación mediante un mecanismo similar a la anti-terminación, crecimiento

Quistes de vesículas seminales. ¿Un hallazgo irrelevante? / Cysts of the seminal vesicles: an irrelevant finding?

Objetivo: Analizar la relación entre quistes de vesículas seminales (QVS) y presencia de malformaciones congénitas del sistema genitourinario.Material y métodos: Se analizan retrospectivamente las imágenes abdominales de ocho pacientes con criterios ecográficos y diagnóstico definitivo de QVS, estudiados durante siete años. La valoración diagnóstica se completó con RM (cinco casos), TC (tres casos), UIV (un caso) y vesículo-deferentografía (dos casos).Resultados: En seis casos (75 por ciento) los QVS se asociaron a anomalías congénitas urológicas: enfermedad poliquística autosómica dominante (tres casos), agenesia-hipoplasia renal (dos casos) y estenosis de la unión pieloureteral (un caso). Los quistes fueron bilaterales en seis casos; dos casos unilaterales correspondieron a la asociación con agenesia-hipoplasia renal y fueron ipsilaterales a la malformación renal. Un caso de hipoplasia asoció uréter ectópico desembocando en la vesícula seminal afectada. En dos casos el QVS fue un hallazgo aislado, con antecedente de tuberculosis urinaria en uno, y sin antecedentes de interés en el otro.Conclusiones: Ante el hallazgo de QVS es preciso explorar todo el tracto urinario, dada la alta incidencia de asociación con malformaciones congénitas renales y del sistema excretor. En los casos aislados debe investigarse un posible antecedente infeccioso que pueda justificar una etiología obstructiva (AU)

Magnetic Behavior and Crystal Structure of [Fe(cyclam)(NCS)(2)](TCNQ)(2): An Unusual One-Dimensional (TCNQ)(2)(-) Radical-Ion System.

The compound [Fe(cyclam)(NCS)(2)](TCNQ)(2), where cyclam is 1,4,8,11-tetraazacyclotetradecane and TCNQ is a partially reduced 7,7,8,8-tetracyanoquinodimethane fragment, has been obtained from the corresponding thiocyanate by metathesis reaction. The compound crystallizes in the triclinic system, space group P&onemacr;, a = 7.832(3) Å, b = 8.008(2) Å, c = 15.501(3) Å, alpha = 79.85(2) degrees, beta = 85.11(2) degrees, gamma = 74.18(3) degrees, Z = 1. The crystalline lattice consists of one-dimensional TCNQ units, stacked along the a direction, and it is stabilized by interactions with the Fe(III) hexacoordinated complex cations. All of the TCNQ's are crystallographically equivalent, with bond parameters typical of partially reduced acceptors with a formal charge of 0.5 electron. Two different distances between adjacent TCNQ units are observed, i.e., 3.29 and 3.42 Å, indicating the presence of dimeric (TCNQ)(2)(-) in the chains. The temperature dependence of the magnetic susceptibility was described as due to two contributions: the first one comes from the Curie contribution of the Fe(III) complex while the second arises from the magnetic exchange interactions between the nearest neighbor TCNQ anions. The latter is typical of one-dimensional antiferromagnetic chains of S = (1)/(2) spins, localized on (TCNQ)(2)(-) units, and it could be fitted according to a one-dimensional Heisenberg antiferromagnet model.