Terapias de reemplazo renal contínuas (TRRC) en pacientes críticos inmunosuprimidos / Continuous renal replacement therapies (CRRT) in critically ill immunosuppressed patients

La injuria renal aguda (IRA) se caracteriza por un abrupto deterioro de la función renal asociado a lteraciones hidroelectrolíticas y metabólicas. La misma es frecuente en la unidad de cuidados intensivos (UCI) pediátricos y tiene un impacto significativo en la morbilidad y mortalidad. Las principales indicaciones de terapia de reemplazo renal (TRR) incluyen la corrección de los trastornos metabólicos y el manejo de la sobrecarga de fluidos. Varios modos de TRR pueden ser utilizadas en la UCI: hemodiálisis intermitente, diálisis peritoneal y las terapias de reemplazo renal continuas (TRRC). Las terapias de reemplazo renal continuas han ganado un rol preponderante en Cuidados Críticos ya que posibilitan dializar a pacientes hemodinámicamente inestables. Del total de pacientes admitidos en la UCI (n:1506) desde enero 2012 hasta diciembre 2018, requirieron TRRC el 6,7% (n: 102). La mortalidad predicha por el Score PIM3 fue de 19,53%, la mediana de edad en meses fue de 60 (RIC 25-75: 12-144), no hubo diferencias en cuanto al sexo. Los diagnósticos más frecuentes fueron trasplantados de órganos sólidos 33%, seguidos de trasplante de células progenitoras hematopoyéticas (TCPH) el 26%. La mediana de los días de internación fue de 16 (RIC 25-75: 7-29) y de días de requerimiento de una TRRC 5 (RIC 25-75 3-9). La técnica dialítica más utilizada fue CVVHD, en el 87% de los pacientes. La mortalidad global fue del 75%, presentando los pacientes con TCPH mayor mortalidad con respecto a otros diagnósticos. Se debe reconocer y categorizar precozmente a los pacientes con mayor riesgo de desarrollar IRA y aplicar medidas de nefroprotección para mejorar su sobrevida (AU)

Acute renal injury (IRA) is characterized by sudden deterioration of kidney function associated with hydroelectrolytic and metabolic disturbances. IRA is common in the pediatric intensive care unit (ICU) and has a significant impact on morbidity and mortality. The main indications for renal replacement therapy (RRT) include correction of the metabolic disorders and management of fluid overload. Different types of RRT may be used in the ICU: intermittent hemodialysis, peritoneal dialysis, and continuous renal replacement therapies (CRRT). Continuous renal replacement therapies have gained a major role in critical care as they allow for dialysis in hemodynamically unstable patients. Of all patients admitted to the ICU (n:1506) between January 2012 and December 2018, 6.7% required CRRT (n: 102). Predicted mortality rate according to the PIM3 score was 19.53%. Median age was 60 months (IQR 25-75: 12-144). No differences in sex were observed. The most common diagnoses were solid organ transplantation in 33%, followed by hematopoietic stem cell transplantation (HSCT) in 26%. Median length of hospital stay was 16 days (IQR 25-75: 7-29) and median days on CTTT was 5 (IQR 25-75 3-9). The most common dialysis technique was CVVHD, used in 87% of the patients. Overall mortality rate was 75%, with a higher mortality in HSCT patients compared to others. Patients at a higher risk of developing IRA should be timely recognized and categorized and nephroprotective measures should be started early to improve survival (AU)

Urgencias hematooncológicas: desde la perspectiva del intensivista / Hematology/oncology urgencies: from the perspective of the intensivist

Entre los años 2000 y 2016 en Argentina, se reportaron al Registro Oncopediátrico Hospitalario Argentino (ROHA) 22.450 casos de cáncer en niños menores de 15 años de edad. Las Leucemias constituyen la enfermedad oncológica más frecuente, seguida de los Tumores de Sistema Nervioso Central y los Linfomas. Esta distribución es similar a la descripta en los países desarrollados de Europa y Norteamérica. Su tasa de curación a nivel mundial, llega al 80% debido al uso de quimioterapia intensiva, situación que mejora la supervivencia pero que también aumenta la frecuencia de complicaciones. Estas complicaciones pueden ser debidas tanto al propio cáncer como al tratamiento y en ocasiones ser la primera manifestación de la enfermedad oncológica. Los eventos que amenazan la vida en pacientes inmunocomprometidos son mayores que en la población general, y cuando ocurren tienen una mortalidad elevada. El reconocimiento temprano es clave para el resultado en términos de sobrevida y disminución de la mortalidad. Las acciones deberán centrarse al reconocimiento temprano de eventos críticos en pacientes oncológicos. Los pacientes Hemato-Oncológicos constituyen un gran número de ingresos no planificados a las unidades de cuidados intensivos. Uno de cada 4 pacientes requerirá durante su evolución ingreso a Unidades de Cuidados Intensivos. El propósito de este artículo es describir tres de las urgencias oncológicas que requieren con mayor frecuencia admisión en UCI: la presentación y manejo del shock séptico, Shock Cardiogénico y las complicaciones neurológicas en los pacientes con leucemias agudas (AU)

Between 2000 and 2016, 22,450 cases of cancer in children younger than 15 years of age were reported to the Argentine Hospital Registry of Childhood Cancer (ROHA). Leukemia was the most common cancer reported, followed by central nervous system tumors and lymphoma. This distribution is similar to that described in the developed countries of Europe and North America. The worldwide cure rate is up to 80% due to the use of intensive chemotherapy, which improves survival but also increases the complication rate. These complications may be due both to the cancer itself and to the treatment and are sometimes the first manifestation of the disease. Life-threatening events are more common in immunocompromised patients than in the general population, and when they occur, the mortality rate is high. Early recognition is essential for the outcome in terms of survival and decreased mortality. Interventions should focus on early recognition of critical events in cancer patients. Patients with hematology-oncology diseases account for a large number of unplanned admissions to intensive care units (ICU), while one in four of these patients will require admission to the ICU in the course of their disease. The aim of this study was to describe three oncology emergencies that most frequently require ICU admission: septic shock and its management, cardiogenic shock, and neurological complications in patients with acute leukemia (AU)

Informe especial: Transmisión vertical de Chagas: situación epidemiológica de Chagas en embarazo y Chagas congénito en la maternidad Sardá: Primer semestre de 2018 / Special report: Vertical transmission of Chagas: epidemiological situation of Chagas in pregnancy and congenital Chagas in Sardá Maternity: first semester of 2018

Hasta la Semana Epidemiológica 36 de 2018 se notificaron en la Ciudad de Buenos Aires 104 casos de Chagas congénito, de los cuales se confirmaron 6 (5,8%), se descartaron 6 y el 88% restante aún no cuenta con el cierre de caso. Las comunas del sur de la Ciudad acumulan el 56% de los casos. Durante el primer semestre de 2018 se diagnosticaron en la Maternidad Sardá 67 mujeres con Chagas en el embarazo, de un total de 2972 partos realizados en la institución en ese periodo, lo que representa una prevalencia de 22,54 por cada mil embarazadas En este informe se busca describir la situación de la transmisión vertical de la enfermedad de Chagas en el primer semestre de 2018, entre SE 1 y 26; describir la modalidad de notificación de los casos por la Unidad de Promoción y Protección de la Salud (P y P); y reforzar la importancia de la notificación de Enfermedades de Notificación Obligatoria debido a su relevancia en la Salud Pública. Se presentan los casos de Chagas en embarazo por grupo etario, y según provincia de residencia, y se detallan propuestas para la optimización de resultados.

PINK1 Silencing Modifies Dendritic Spine Dynamics of Mouse Hippocampal Neurons.

PTEN-induced kinase 1 (PINK1) mutations can cause early-onset Parkinson's disease and patients are likely to develop cognitive decline, depression, and dementia. Several neurophysiological studies have demonstrated PINK1 deficiency impairs striatal and hippocampal presynaptic plasticity. Dendritic spine postsynaptic abnormalities are common in neurological diseases; however, whether PINK1 silencing modifies dendritic spine dynamics of hippocampal neurons is unclear. To address this question, confocal images of mouse cultured hippocampal neurons transfected with plasmids to silence PINK1 were analyzed. These studies revealed that PINK1 silencing increased density of thin spines and reduced head size of stubby spines. Immunoblotting analysis uncovered that PINK1 silencing decreased expression of postsynaptic density proteins (PSD95 and Shank) and glutamate receptors (NR2B and mGluR5). We also found PINK1 silencing regulated dendritic spine morphology by actin regulatory proteins (RhoGAP29 and ROCK2) and regulated neuronal survival by decreased Akt activation. These results suggest PINK1 may regulate postsynaptic plasticity in hippocampal neurons generating presymptomatic alterations in dendritic spines that eventually could lead to the neurodegeneration and cognitive decline often seen in Parkinson's disease.

Study of the diversity and short-chain fatty acids production by the bacterial community in overweight and obese Mexican children.

Obesity and overweight are health problems of multifactorial etiology, which may include changes in the microbiome. In Mexico, more than 30 % of the child population between 5 and 11 years of age suffer from being overweight or are obese, which makes it a public health issue in progress. The purpose of this work was to measure the short-chain fatty acid concentration by high-performance liquid chromatography (HPLC), and to characterize the bacterial diversity by ion torrent semiconductor sequencing, of 16S rDNA libraries prepared from stools collected from a sample of well-characterized Mexican children for normal weight, overweight, and obese conditions by anthropometric and biochemical criteria. We found that triglyceride levels are increased in overweight and obese children, who presented altered propionic and butyric acid concentrations in feces. In addition, although the colon microbiota did not show a clear bacterial dysbiosis among the three conditions, the abundance of some particular bacteria was changed with respect to normal controls. We conclude from our results that the imbalance in the abundance of at least nine different bacteria as well as altered short-chain fatty acid concentration in feces is associated to the overweight and obese conditions of Mexican children.

Prevalencia de patología cardíaca en la enfermedad de Chagas: años 2004-2012. Programa y Red de Chagas de CABA / Prevalence of cardiac pathology in Chagas disease: 2004 -2012. Program and Chagas CABA network

El Instituto Universitario de Ciencias de las Salud ha mostrado un particular compromiso con la formación de sus estudiantes en la estrategia de Atención Primaria de la Salud, con las prácticas asistenciales dedicadas al 1er nivel de atención ambulatoria y a las patologías prevalentes en ese ámbito. Del mismo modo se han desenvuelto las actividades de formación en investigación. Como exponente de esa orientación, la revista Ciencias de la Salud publicó en el Vol. 2, N°1, 2011:4-9, el artículo “Prevalencia de la Enfermedad de Chagas” de Érica G. Morais, que había obtenido el premio “Futuros Líderes”, otorgado por el Curso Anual Internacional de Investigación en Ciencias de la Salud (IUCS-AMA, Prof. Carlos Álvarez Bermúdez). Aquella investigación formaba parte de un proyecto más amplio realizado en el Hospital Teodoro Álvarez entre 2004 y 2012, en el que participaron un conjunto de investigadores, que compartieron la autoría de la actual publicación. El Dr. Jorge Mitelman, Prosecretario de Ciencia y Técnica del IUCS e integrante de ese equipo, preparó además una reseña sobre la jornada del INCOSUR, realizada en abril del presente año, describiendo asimismo el proceso de desarrollo de la Ciudad de Buenos Aires, como área no endémica, para encarar las consecuencias de la enfermedad de Chagas

[In vitro activity of tigecycline in clinical isolates of multidrug resistant Acinetobacter spp. Comparison of different methods of evaluation]. / Actividad in vitro de la tigeciclina en aislamientos clínicos de Acinetobacter spp. multirresistentes. Comparación de diferentes métodos de evaluación.

Infections caused by multidrug resistant (MDRA) Acinetobacter spp. have increased worldwide. Tigecycline provides a new therapeutic option for treating these infections. We conducted a study tailored to validate an in house methodology by broth microdilution (BM) vs. commercial BM in 32 MDRA isolates. Sixty MDRA isolated in 2 time periods (2000-2003 and 2006-2008) were compared by BM, agar dilution (AD) and disk diffusion (DD) methods, as described by the CLSI and the MIC90 for each period was determined. Susceptibility was interpreted by using the breakpoints suggested by the FDA for Enterobacteriaceae. The correlation between the methodologies was performed by a scattergram, and the errors between methods were calculated. The correlation coefficients between AD and BM, and BM and DD were, r: 0.68 in both cases. For 2002-2003, the MIC90 for BM was: 1 g/ml, and for 2006-2008: 2 microg/ml. Using the FDA breakpoints for DD, we observed an unacceptable minor error (17.6%) because of false-intermediate values, considering the MIC90 was 1-2 microg/ml.

Relación entre perímetro abdominal, nivel socioeconómico y presión arterial / Relation of abdominal circumference and socio-economic status to blood pressure

Objetivos: Relacionar perímetro abdominal y condición socioeconómica con presión arterial (PA) en comunidad urbana de Concepción. Métodos: Se midió el perímetro abdominal (PeA) de 8472 residentes mayores de 15 años de edad, proporcionados por edad, género y nivel socioeconómico. La PA fue medida con normas estandarizadas, realizando dos visitas en diferentes días, la segunda si la PA era mayor de 140/90 mm Hg. Los Pe A se distribuyeron en cuartiles, relacionando cada cuartil con los respectivos promedios de presión sistólica y diastólica y se establecieron coeficientes de correlación lineal mediante "r" de Pearson entre PeA y PA. Además, se estableció la frecuencia de cada cuartil de Pe A por nivel socioeconómico. Resultados: Los Pea tuvieron la siguiente distribución (cm): 1er cuartil, < 78; 2º cuartil, 78- 87; 3er cuartil, 88-96 y 4º cuartil, > 96. La prevalencia de hipertensión para niveles socioeconómicos alto, medio y bajo fue 17,9 por ciento, 19,5 por ciento y 24,5 por ciento, respectivamente. La PA promedio (mmHg) en hombres y en mujeres del 1er cuartil de PeA fue 112 y 109; en el 2º cuartil 118 y 118; en el 3er cuartil 123 y 122 y en el 4º cuartil 129 y 129, respectivamente. Los coeficientes de correlación entre PeA y presión sistólica y presión diastólica resultaron significativos en ambos géneros: r = 0,343, p<0.00001 y r = 0,281, p<0.00001, respectivamente. La distribución ( por ciento) de PeA fue inversa al nivel socioeconómico: en el nivel social bajo, el 22 por ciento estaba en el 1er cuartil de PeA, y el 28,8 por ciento en el 4º cuartil. En el nivel social alto se observó lo inverso: 38,9 por ciento estaba en el 1er cuartil de PeA, y sólo el 15.5 por ciento en el 4º cuartil (p<0.0001). Conclusiones: Hubo correlación positiva entre PeA y PA en ambos géneros. La frecuencia de mayor PeA en el nivel socioeconómico bajo podría explicar la mayor prevalencia de hipertensión en este grupo.

Aim: To correlate abdominal circumference (AC) and socio-economic status with blood pressure( BP) in an urban community of Concepción, Chile Methods: AC was measured in 8472 subjects above 15years of age, stratified by age, gender and socio-economic status. BP was measured by standard procedures, with a repeat recording when the initial value was > 140/90mmHg. BP was compared in quartiles of abdominal circumference and according to socio-economic status. Pearson "r" was used to correlate BP and AC Results: Cut points for quartiles of AC were 78, 87, and 96 cm. Prevalence of hypertension in high, medium and low socio-economic status was 17.9 percent, 19.5 percent and 24.5 percent, respectively Mean systolic BP was 112 - 109 mmHg (males - females) in the first AC quartile, 118 - 118, 123-122 and 129-129 in the second, third and fourth quartiles, respectively. A significant correlation between AC and BP (systolic and diastolic) was observed in both genders (r 0.345 and 0.281 for males and females, respectively, p<0.00001). 22 percent of low socio-economic subjects belonged in the first AC quartile compared to 28.8 percent in the 4th quartile. In contrast 38.9 percent of high socio-economic subjects belonged in the first AC quartile while 15.5 percent did so in the 4th quartile (p<0001). Conclusion: A positive correlation of AC and blood pressure was shown in both genders. A greater AC in low socio-economic subjects maybe related to a higher prevalence of hypertension in this group.

[Update of consensus recommendations of the Chilean Hypertension Society about ambulatory blood pressure monitoring]. / Actualización de las recomendaciones sobre el uso de la monitorización ambulatoria de presión arterial. Documento de consenso de la Sociedad Chilena de Hipertensión.

Ambulatory blood pressure monitoring (ABPM) is a valuable tool to evaluate the blood pressure pattern, to identify hypertensive patients, to diagnose white coat and masked hypertension and in situations in which a tight control of hypertension is crucial. This is an update of 1999 consensus recommendations about the use to ABPM, considering that there is new evidence concerning its benefits, and the clinical experience with its application has increased. Equipment programming, its installation, the interpretation and analysis of the data are described, and a report sheet for patients is included. New recommendations have been added to the accepted indications. Normal blood pressure ranges for children and pregnant women have been replaced by new data.

Capacity building in rural Guatemala by implementing a solid waste management program.

The development and implementation of a solid waste management program served to build local capacity in San Mateo Ixtatán between 2002 and 2003 as part of a public health action plan. The program was developed and implemented in two phases: (1) the identification and education of a working team from the community; and (2) the completion of a solid waste classification and quantification study. Social capital and the water cycle were two public health approaches utilized to build a sustainable program. The activities accomplished gained support from the community and municipal authorities. A description of the tasks completed and findings of the solid waste classification and quantification performed by a local working group are presented in this paper.

Modified Spot CAMP Test: A rapid, inexpensive and accurate method for identification of group B streptococci.

A rapid modified spot CAMP test using 183 clinical isolates of beta haemolytic streptococci was compared with the standard CAMP test described by Christie et al. The scheme of biochemical identification and serological confirmation was taken as reference method. The sensitivity of both tests was 100%, and the specificity of the rapid and standard tests was 96.8% and 88.9% respectively. The modified spot CAMP test is a rapid, inexpensive and accurate method for the identification of group B streptococci, and is more specific than the standard CAMP test.

[Microbiologic study of bacteremia and fungemia in chronic hemodialysis patients]. / Estudio microbiológico de bacteriemias y fungemias en pacientes en hemodiálisis crónica.

Microbiologic study of bacteremia and fungemia in chronic hemodialysis patients. Bloodstream infections are the second cause of death in patients in chronic hemodialysis (CHD), and the knowledge of the epidemiology is useful to establish proper empiric therapies. The aim of this study was to evaluate the frequency and distribution of microorganisms, in bacteremia and fungemia in 530 patients in CHD. Two hundred and forty eight blood culture series from 114 patients with suspected bacteremia were processed; 44% of them were positive from which 71% (n=78) were clinically significative and belonged to 58 patients. Sixty eight percent of these isolates were gram-positive cocci (n:53), and 22% gram-negative rods (n:17). Staphylococcus aureus was the most prevalent pathogen showing 23% of methicillin-resistance. Candida spp. was the fourth pathogen most common in frequency.

[Phyllodes tumor and pregnancy. A report of a case]. / Tumor phyllodes y embarazo. Reporte de un caso.

Phyllodes tumor is a rare breast fibroepithelial neoplasm of the breast, predominant in females (0.3 to 0.5%). Few cases have been described in males. Phyllodes tumor during pregnancy grows fast and its size is relatively big. These tumors can be classified as benign, malignant or neighboring. A 32-year-old patient at 23.4 week of gestation was admitted in the National Institute of Perinatology with a rapidly growing mass in the right breast; diagnosis confirmed by ultrasound study reporting echoic images on right breast, 10 x 10 cm the greatest and 3x3 cm the smallest. A simple mastectomy was performed at the 26.6 week of gestation on the right breast. A possible phyllodes tumour in the right breast was observed during surgery, weight 9.6 pounds, with partial infiltration to major pectoral muscle. Pathology reported a benign phyllodes tumor in the right breast, with surgical borders free of tumor. Phyllodes tumor is rare and can occur during pregnancy. It is unknown if the tumor is hormone-dependent. The growth of a tumor on a subsequent pregnancy is not necessarily associated with recurrency or with a new disorder on the patient, who has had a complete excision.

Modified Spot CAMP Test: A rapid, inexpensive and accurate method for identification of group B streptococci / Prueba de CAMP por spot modificada: Un método rápido, preciso y económico para la identificación de estreptococos grupo B

A rapid modified spot CAMP test using 183 clinical isolates of β haemolytic streptococci was compared with the standard CAMP test described by Christie et al. The scheme of biochemical identification and serological confirmation was taken as reference method. The sensitivity of both tests was 100%, and the specificity of the rapid and standard tests was 96.8% and 88.9% respectively. The modified spot CAMP test is a rapid, inexpensive and accurate method for the identification of group B streptococci, and is more specific than the standard CAMP test.

En este estudio se comparó los resultados de una prueba de CAMP por spot modificada en 20 minutos y la prueba de CAMP original descripta por Christie et al usada para la identificación de Streptococcus agalactiae. Se analizaron 183 aislamientos de estreptococos β hemolíticos, tomando como método de referencia el esquema tradicional de identificación bioquímica y confirmación serológica. La sensibilidad de ambas pruebas fue del 100% y la especificidad de la prueba rápida y la estándar fue de 96,8% y 88,9% respectivamente. La prueba de CAMP por spot modificada es un método rápido, económico y seguro para la identificación de estreptococos del grupo B y posee mayor especificidad que la prueba original.

Estudio microbiológico de bacteriemias y fungemias en pacientes en hemodiálisis crónica / [Microbiologic study of bacteremia and fungemia in chronic hemodialysis patients]

Microbiologic study of bacteremia and fungemia in chronic hemodialysis patients. Bloodstream infections are the second cause of death in patients in chronic hemodialysis (CHD), and the knowledge of the epidemiology is useful to establish proper empiric therapies. The aim of this study was to evaluate the frequency and distribution of microorganisms, in bacteremia and fungemia in 530 patients in CHD. Two hundred and forty eight blood culture series from 114 patients with suspected bacteremia were processed; 44

(n=78) were clinically significative and belonged to 58 patients. Sixty eight percent of these isolates were gram-positive cocci (n:53), and 22

gram-negative rods (n:17). Staphylococcus aureus was the most prevalent pathogen showing 23

of methicillin-resistance. Candida spp. was the fourth pathogen most common in frequency.

Modified Spot CAMP Test: A rapid, inexpensive and accurate method for identification of group B streptococci.

A rapid modified spot CAMP test using 183 clinical isolates of beta haemolytic streptococci was compared with the standard CAMP test described by Christie et al. The scheme of biochemical identification and serological confirmation was taken as reference method. The sensitivity of both tests was 100

, and the specificity of the rapid and standard tests was 96.8

and 88.9

respectively. The modified spot CAMP test is a rapid, inexpensive and accurate method for the identification of group B streptococci, and is more specific than the standard CAMP test.

Estudio microbiológico de bacteriemias y fungemias en pacientes en hemodiálisis crónica. / [Microbiologic study of bacteremia and fungemia in chronic hemodialysis patients]

Microbiologic study of bacteremia and fungemia in chronic hemodialysis patients. Bloodstream infections are the second cause of death in patients in chronic hemodialysis (CHD), and the knowledge of the epidemiology is useful to establish proper empiric therapies. The aim of this study was to evaluate the frequency and distribution of microorganisms, in bacteremia and fungemia in 530 patients in CHD. Two hundred and forty eight blood culture series from 114 patients with suspected bacteremia were processed; 44

of them were positive from which 71

(n=78) were clinically significative and belonged to 58 patients. Sixty eight percent of these isolates were gram-positive cocci (n:53), and 22

gram-negative rods (n:17). Staphylococcus aureus was the most prevalent pathogen showing 23

of methicillin-resistance. Candida spp. was the fourth pathogen most common in frequency.

Viscocidad sanguínea como factor de riesgo cardiovascular / Blood viscosity as a cardiovascular risk factor

El conocimiento de los factores de riesgo cardiovascular ha permitido identificar mejor a aquellos pacientes con mayor riesgo de infarto agudo del miocardio o accidentes vasculares cerebrales. Sin embargo existe un porcentaje de pacientes que , aun sufriendo estos eventos, al ser estudiados no se les encuentra ningún factor de riesgo conocido. Últimamente se le ha dado mayor importancia a la reología sanguínea, siendo la viscosidad sanguínea la principal. Se revisan conceptos fisiopatológicos, evidencia experimental, estudios clínicos y poblacionales que dan soporte para postitular que el estudio de la viscosidad sanguínea debiera hacerse en pacientes con alto riesgo.

Comparación de cuatro técnicas de laboratorio para el diagnóstico de estrongiloidiasis / Comparison of four laboratory techniques for the diagnosis of strongyloidiasis

La estrongiloidiasis es una infección parasitaria que produce cuadros digestivos o generalizados que tienden a complicarse en algunos pacientes, particularmente en los inmunocomprometidos, por lo que un diagnóstico temprano de la infección es sumamente importante. Los métodos de diagnóstico convencionales presentan bajos índices de detección de este parásito; por este motivo, el objeto de la presente investigación es discriminar la técnica más sensible y específica para detectar en heces Strongyloides stercoralis. Se analizaron las muestras fecales de 56 individuos de ambos sexos, con edades comprendidas entre 1 y 47 años, quienes residían en un área endémica para S. stercoralis, ubicada Puerto Páez, parroquia Potreritos del municipio la Cañada del estado Zulia, Venezuela. Cada muestra fue sometida al examen directo con solución salina fisiológica y lugol, método de concentración de formol-éter, técnica de Baermann y cultivo de agar en placa de Arakaki modificado. Los resultados se analizaron estadísticamente con el programa Statistix, versión 2.02. La prueba de z detreminó la diferencia de las proporciones. De los 56 individuos, 18 (32 por ciento) presentaron S. stercoralis por al menos una de las técnicas utilizadas. Al comparar las técnicas entre sí, el método de agar en placa fue el que detectó la mayoría de los casos: 16, siguiéndole el método de concentración de formol-éter, con 11 casos. Posteriormente, el examen directo, con 9 casos y, finalmente la técnica de Baermann, con 7 casos. No se encontró diferencia significativa entre la técnica de agar en placa y el método de concentración de formol-eter, pero sí entre éstos y el resto de las técnicas estudiadas

[Evaluation of a breakfast as screening test for the detection of gestational diabetes]. / Evaluación de un desayuno como prueba de tamiz para la detección de diabetes gestacional.

A standard breakfast was evaluated as a screening test (BT) for gestational diabetes in a case-control study. The breakfast had a high carbohydrate content and was designed based on women's preferences in a similar sample. Women were selected with a standard 50 g, 1 hour glucose screening test (GT). Fifteen women had a positive GT and 15 had a negative test. A glucose tolerance test (GTT) and a standard breakfast (719 kcal) were performed to all women. Age, weight, height, tricipital and subscapular skinfold thicknesses were obtained by previously standardized personnel and glucose levels were determined by an automatic technique (oxidase glucose). Ten women had gestational diabetes. Sensitivity and specificity were calculated for the GT and several values of the BT, in order to identify the threshold and optimum time. Concordance of both screening tests with GTT was calculated through Kappa test. For the BT, a sensitivity of 0.90 and specificity of 1.00 with a glucose level > or = 140 mg/L (7.2 mmol/L) at 60 and 90 minutes were found. The 60 minutes timing were preferred due to a shorter waiting time to performed the test. Concordance of GTT with GT and BT was 0.53 and 0.92 respectively, both statistically significant. GT had high frequency of false negative values (6/15) that explain the low kappa value. Standard breakfast can be used as an alternative method for assessing carbohydrate tolerance in pregnancy with a better physiological response in these women.