Is it in their eyes? Correlation between microorganisms isolated from bronchial aspirates and conjunctival swabs in a Pediatric Intensive Care Unit / ¿Está en sus ojos? Correlación entre microorganismos aislados de aspirados bronquiales e hisopos conjuntivales en una Unidad de Cuidados Intensivos Pediátricos

Objectives. Our observational, retrospective study aimed to determine the correlation between bacteria isolated from bronchial aspirates of pediatric ICU patients (PICU) with respiratory infections and those obtained from conjunctival swabs of the same patients exhibiting clinical conjunctivitis. Material and methods. Throughout the period from 2015 to 2022, we reviewed all clinically significant bronchial aspirates (≥105 CFU/mL) and positive conjunctival swabs obtained from PICU patients. These records were retrieved from the microbiology database, cross-referencing the data to identify patients who tested positive for both during the same clinical episode. Results. The median age of the patients was 5 months (interquartile range: 1-7). Among the cohort, twenty-one patients exhibited positivity in both bronchial aspirate and conjunctival swab samples, showcasing a microbial match in 85.71% of cases (18 out of 21). The most frequently isolated microorganisms were Haemophilus influenzae (55.6%), followed by Pseudomonas aeruginosa (14.3%), Klebsiella aerogenes (9.5%), and Escherichia coli, Stenotrophomonas maltophilia, and Enterobacter cloacae, each accounting for 4.8% of the isolates. Conclusions. Our study demonstrates a strong concordance between the isolated microorganisms from both samples in patients presenting clear symptoms of clinical conjunctivitis. These findings provide a basis for future prospective studies that may leverage conjunctival swabs as a predictive tool for identifying microorganisms involved in respiratory infections. (AU)

Objetivos. Nuestro estudio observacional y retrospectivo tuvo como objetivo determinar la correlación entre las bacterias aisladas de aspirados bronquiales de pacientes de UCI pediátrica (UCIP) con infecciones respiratorias y las obtenidas de hisopos conjuntivales de los mismos pacientes que presentaban conjuntivitis clínica. Material y métodos. A lo largo del periodo comprendido entre 2015 y 2022, se revisaron todos los aspirados bronquiales clínicamente significativos (≥105 UFC/mL) y los hisopos conjuntivalespositivos obtenidos de pacientes de UCIP. Estos registros se recuperaron de la base de datos de microbiología, cruzando los datos para identificar a los pacientes que dieron positivo en ambos durante el mismo episodio clínico. Resultados. La mediana de edad de los pacientes fue de 5 meses (rango intercuartílico: 1-7). Entre la cohorte, veintiún pacientes presentaron positividad tanto en las muestras de aspirado bronquial como en las de hisopo conjuntival, mostrando una coincidencia microbiana en el 85,71% de los casos (18 de 21). Los microorganismos más frecuentemente aislados fueron Haemophilus influenzae (55,6%), seguido de Pseudomonas aeruginosa (14,3%), Klebsiella aerogenes (9,5%) y Escherichia coli, Stenotrophomonas maltophiliay Enterobacter cloacae, cada uno de los cuales representó el 4,8% de los aislamientos. Conclusiones. Nuestro estudio demuestra una fuerte concordancia entre los microorganismos aislados de ambas muestras en pacientes que presentan síntomas claros de conjuntivitis clínica. Estos hallazgos proporcionan una base para futuros estudios prospectivos que podrían aprovechar los hisopos conjuntivales como herramienta predictiva para identificar microorganismos implicados en infecciones respiratorias. (AU)

Reparative regeneration by substitution of bone tissue defects with bioglass, using regeneration technologies / Regeneración reparadora mediante sustitución de defectos del tejido óseo por biovidrio, utilizando tecnologías de regeneración

SUMMARY: Bioactive glass (BG) induces osteogenesis of damaged bone, causing excessive bone formation. This study included a morphological and morphometrical data of the bone tissue regeneration by filling bone defects with BG with autologous native platelet rich plasma (PRP) or fibrin (PRF) and aspirate of bone marrow (ABM). The parameters of newly formed bone in rabbits bone defect were analyzed and compared with terms 4th and 12th week. The groups with ABM-BG, PRF-BG and PRP-BG have shown common tendency: development of newly formed bone tissue, the external contour of the bone has been enlarged; an additional trabecular bone has been formed under the cortical layer, which has often been limited by a solid compact bone from the bone marrow. The induced osteogenesis resulted in the appearance of a significant amount of bone tissue exceeding the original size of the defect. Increased density of the newly formed tissue at the defect level relative to ABM-BG was detected in the PRF-BG group at 12 weeks and PRP-BG at 4 and 12 weeks (p<0.05). In this case, the bone thickness in the substituted defect was greater in the ABM-BG group. The number of newly formed bone tissue in the ABM-BG group at 4 weeks also exceeded the value of the BG group, but the density of such bone did not differ between the groups. That is, ABM-BG stimulated greater trabecular bone formation and fibrous reticular tissue was located in the lacunae between trabeculae. These results indicate that the additional use of tissue technology (ABM, platelet plasma) facilitated osteogenesis, and the newly formed bone tissue was tightly coupled and remodeled to the cortical bone layer in the form of compact bone tissue. PRP, to a greater extent than ABM, promoted the formation of compact bone tissue.

RESUMEN: El vidrio bioactivo (VB) induce la osteogénesis del hueso dañado, provocando una formación excesiva de hueso. Este estudio incluyó datos morfológicos y morfométricos de la regeneración del tejido óseo mediante el llenado de defectos óseos con VB con plasma rico en plaquetas (PRP) nativo autólogo o fibrina (PRF) y aspirado de médula ósea (AMO). Se analizaron los parámetros de hueso recién formado en el defecto óseo de conejos y se compararon a las 4 y 12 semanas. Se observó una tendencia similar en los grupos con AMO-VB, PRF-VB y PRP-VB: el desarrollo de tejido óseo recién formado, aumentó el contorno externo del hueso; formación de un hueso trabecular adicional debajo de la capa cortical, que a menudo ha estado limitada por un hueso sólido compacto de la médula ósea. La osteogénesis inducida dio como resultado la aparición de una cantidad significativa de tejido óseo que excedía el tamaño original del defecto. Se detectó un aumento de la densidad del tejido recién formado a nivel del defecto en relación con AMO-VB en el grupo PRF-VB a las 12 semanas y PRP-VB a las 4 y 12 semanas (p <0,05). En este caso, el grosor óseo en el defecto sustituido fue mayor en el grupo AMO-VB. El número de tejido óseo recién formado en el grupo AMO- VB a las 4 semanas también excedió el valor del grupo VB, pero la densidad de dicho hueso no cambió entre los grupos. Es decir, AMO-VB estimuló una mayor formación de hueso trabecular y se localizó en el tejido reticular fibroso en las lagunas entre trabéculas. Estos resultados indican que el uso adicional de tecnología de tejidos (AMO, plasma plaquetario) facilitó la osteogénesis, y el tejido óseo recién formado se acopló y remodeló estrechamente a la capa de hueso cortical en forma de tejido óseo compacto. El PRP, en mayor medida que el AMO, promovió la formación de tejido óseo compacto.

Comparison between concentrated bone marrow aspirate and corticoid in gluteal tendinopathy / Comparação entre o aspirado de medula óssea concentrado e o corticóide na tendinopatia glútea

INTRODUCTION Adult gluteal tendinopathy is part of a group of pathologies of Greater Trochanteric Pain Syndrome (GTPS). This disorder is characterized by pain, functional limitation and loss of local strength. The diagnosis is made from clinical examination associated with complementary exams (Ultrasound or Magnetic Resonance). OBJECTIVE Comparative study between standard treatment and bone marrow aspirate concentrate (BMAC) for the treatment of gluteal tendinopathies. The randomized clinical trial selected patients diagnosed with gluteal tendinopathy at a university hospital and divided them into two groups: (G1) bone marrow aspirate concentrate and (G2) Corticosteroids injection. RESULTS 48 patients were selected, of which 40 were monitored for 06 months, with an improvement in scores in both groups. Patients who were submitted to the BMAC treatment had a statistically significant improvement in VAS scores and Lequesne scores compared to standard treatment. There was an improvement in the assessment of the quality of life in both groups with no statistically significant difference. CONCLUSION BMAC arises as an alternative to the standard treatment of gluteal tendinopathy, proving to be a safe technique and with promising results when combined with multidisciplinary team behavioral therapy.

INTRODUÇÃO A tendinopatia glútea adulta faz parte de um grupo de patologias da Síndrome Dolorosa Trocantérica (SDT). Esse distúrbio é caracterizado por dor, limitação funcional e perda de força local. O diagnóstico é feito a partir de exames clínicos associados a exames complementares (ultrassonografia ou ressonância magnética). OBJETIVO Estudo comparativo entre tratamento com corticóide e aspirado de medula óssea concentrado (BMAC) para o tratamento de tendinopatias glúteas. MATERIAL E MÉTODOS O ensaio clínico randomizado selecionou pacientes diagnosticados com tendinopatia glútea e os dividiu em dois grupos: (G1) aspirado de medula óssea concentrada e (G2) injeção de corticosteróide . RESULTADOS Foram selecionados 48 pacientes, dos quais 40 foram monitorados por 06 meses, com melhora nos escores nos dois grupos. Os pacientes que foram submetidos ao tratamento com BMAC tiveram uma melhora estatisticamente significativa nos escores de EVA e nos escores de Lequesne em comparação ao tratamento padrão. Houve uma melhora na avaliação da a qualidade de vida em ambos os grupos, sem diferença estatisticamente significativa. CONCLUSÃO O aspirado de medula óssea concentrada surge como uma alternativa ao tratamento padrão da tendinopatia glútea, provando ser uma técnica segura e com resultados promissores quando combinada à terapia comportamental de equipe multidisciplinar.  Ensaio Clínico Randomizado.

Desenlace de los pacientes pediátricos con falla medular tratados en un centro de alta complejidad / Outcomes in pediatrics patients diagnosed with bone marrow failure disorders treated in a tertiary care center

INTRODUCCIÓN: Los síndromes de falla medular (SFM) son trastornos infrecuentes, con una incidencia anual de 2-4 casos por millón. Las opciones de tratamiento incluyen terapia de inmunosupresión (TIS) y restaura ción de la hematopoyesis con trasplante de progenitores hematopoyéticas (TPH). OBJETIVO: Analizar los desenlaces de pacientes pediátricos diagnosticados con SFM tratados en una institución de alta complejidad. PACIENTES Y MÉTODO: Estudio retrospectivo de pacientes pediátricos con diagnóstico de SFM que consultaron a la Fundación Valle del Lili, Cali. Se realizo análisis estadístico descriptivo según SFM adquirida (SFMA) y SFM congénita (SFMC). Los desenlaces incluyeron: tratamiento, complicaciones, supervivencia global (SG) en los trasplantados, calculada con el método Kaplan Meier. RESULTADOS: Se incluyeron 24 pacientes con SFM, edad 6,5 ± 4 años, 50% mujeres. El 58% fue ron SFMC, 9 con anemia de Fanconi, 2 disqueratosis congénita, 2 trombocitopenia amegacariocítica congénita, uno anemia Diamond-Blackfan. Doce pacientes con TPH tuvieron SG a 5 años de 83%. SFMA correspondió al 42%, 6 recibieron TIS-TPH, 3 TIS y 1 TPH, la SG del grupo con TIS-TPH fue 86%. Seis pacientes fallecieron, 4/6 relacionadas con infección. CONCLUSIONES: En esta serie fue mayor el número de casos con SFMC. La SG de los pacientes llevados a TPH es comparable con la reportada en estudios recientes. La causa de muerte predominante fue infecciosa que también se ha reportado previamente. El tratamiento instaurado en los pacientes de esta serie mostró resultados favorables en un centro de alta complejidad en un país latinoamericano.

INTRODUCTION: Bone marrow failure (BMF) syndromes are rare disorders with an annual incidence of 2-4 cases per million. Treatment options include immunosuppressive therapy (IST) and hematopoietic stem cell transplantation (HSCT). OBJECTIVE: To analyze the outcomes of pediatric patients diagnosed with BMF treated in a tertiary care center. PATIENTS AND METHODP: Retrospective study of pediatric patients diagnosed with BMF who consulted at Fundación Valle de Lili, Cali. Descriptive statistical analysis was performed according to Acquired BMF (ABMF) and Inherited BMF (IBMF). The outcomes include treatment, complications, overall survival (OS) in transplant patients, calculated using the Kaplan Meier method. RESULTS: We included 24 patients with BMF, average age 6.5 ± 4 years, and 50% were women. 58% presented IBMF, 9 with Fanconi anemia (FA), 2 dyskeratosis congenita, 2 congenital amegakaryocytic thrombocytopenia, and 1 presented Diamond-Blackfan anemia. 12 patients treated with HSCT had a 5-year OS of 83%. ABMF represented 42%. 6 patients received IST-HSCT, 3 received IST, and 1 received HSCT. The OS of the IST-HSCT group was 86%. Six patients died, four of them related to infection. CONCLUSIONS: In this series, there was a higher number of cases with IBMF. The OS of patients treated with HSCT is similar to that reported in recent studies. The most frequent cause of death was of infectious origin which has also been previously reported. The treatment esta blished in the patients showed favorable results in a Latin American tertiary care center.

[Results of the implementation of a protocol for outpatient management of the paediatric patient with tuberculosis]. / Resultados de la implantación de un protocolo para el manejo ambulatorio del paciente pediátrico con enfermedad tuberculosa.

OBJECTIVE: To assess the results of the implementation of a protocol for the outpatient management of paediatric patients with tuberculosis, and to compare it with the previous approach. MATERIAL AND METHODS: All patients younger than 14 years of age diagnosed with tuberculosis in Cantabria between 2005 and 2014 were included in the study. The pre-implementation period included patients admitted for gastric aspirate collection and to start treatment until 2010 (Pre-group). The post-implementation period was from 2010 onwards, using a protocol established for the outpatient management of these patients, with admission only being for clinical or social reasons, post-implantation period (Post-group). RESULTS: A total of 82 patients were studied: 29 from the Pre-group and 53 from Post-group. The median age was 61 months (IQR 32.5-97.75). All patients in the Pre-group were systematically admitted, compared to 26.4% of the Post-group (P<.001). The mean hospital stay was higher (7.27±7.1 days) in the Pre-group than in Post-group (3.4±11.46 days) (P<.0001). Only in 6.9% of patients from Pre-group were the 3 microbiological samples recommended for diagnosis following the international guidelines were provided, whereas they were provided by 73.58% patients from Post-group (P<.001). Of the cultures performed, 26.6% were positive for Mycobacterium tuberculosis, 37.5% of the Pre-group and 21.6% of the Post-group (P=.121). No significant differences were observed between the groups in other parameters related to treatment such as, therapeutic adherence, treatment not adjusted to the guidelines, treatment withdrawal or relapse.. DISCUSSION: Although guidelines recommend three microbiological samples for culture, no superior microbiological isolation was detected despite the increased number of samples collected. The management in hospital clinics of patients with suspected tuberculosis with stable clinical situation show similar or better clinical and microbiological results to the previous management, with lower hospital admission rate and with the subsequent cost savings.

Bone marrow necrosis: literature review / Necrose de medula óssea: revisão da literatura

ABSTRACT Introduction: Bone marrow necrosis (BMN) is a rare pathologic entity that is commonly undiagnosed, and often associated with hematologic diseases. Methodology: We conducted a literature review at PubMed using "bone marrow necrosis" as key words. Our search retrieved 25 articles written in English, and a further 65 case reports. Results and discussion: BMN pathophysiology is not well understood, but appears to be associated with vascular injuries that lead to oxygen and nutrient deprivation. Destructive tumor necrosis factor alpha (TNF-α) activity is also likely involved in the development of endothelial and bone marrow sinusoidal lesions. Diagnoses of BMN are commonly indicated by anemia, thrombocytopenia, high levels of lactic dehydrogenase and alkaline phosphatase, and the identification of leukoerythroblastic reactions. Bone marrow (BM) aspirate and biopsy, and magnetic nuclear resonance imaging are the main diagnostic options. The only available treatments are those directed against the primary cause, with associated supportive care for what is ordinarily a rapidly lethal state. Conclusion: The search for an underlying associated malignancy is important for the management of BMN.

RESUMO Introdução: Necrose de medula óssea (NMO) é uma entidade rara, frequentemente não diagnosticada e mais comumente associada a doenças hematológicas. Metodologia: Realizou-se revisão da literatura na base de dados do PubMed, utilizando o termo "necrose de medula óssea". Foram encontrados 25 artigos em inglês e 65 relatos de caso. Resultados e discussão: A fisiopatologia da NMO não é bem elucidada e parece estar associada a lesão vascular com consequente hipóxia celular por desbalanço na oferta de oxigênio e nutrientes. O fator de necrose tumoral alfa (TNF-α) provavelmente também está implicado na lesão endotelial e nos sinusoides da medula óssea. Sugere-se o diagnóstico pela presença de anemia, trombocitopenia, reação leucoeritroblástica, níveis elevados de desidrogenase lática e fosfatase alcalina. Aspirado e biópsia de medula óssea e ressonância nuclear magnética são os principais exames diagnósticos. As únicas possibilidades terapêuticas são tratamento da causa de base e medidas suportivas. Conclusão: O ponto mais importante no manejo da NMO é a busca por condições neoplásicas associadas.

Diagnostic performance of fluorescent light-emitting diode microscopy for tuberculous lymphadenitis in a high-burden setting.

OBJECTIVE: Diagnosis of tuberculous lymphadenitis using fine-needle aspiration cytology is a simple and safe but low-specificity method, whereas conventional smear microscopy has variable sensitivity due to low bacterial load. We evaluated the diagnostic performance of fluorescent light-emitting diode (LED) microscopy on routinely collected fine-needle aspirates from tuberculous lymphadenitis presumptive cases. METHODS: Fine-needle aspirates were collected from patients clinically suspected of having tuberculous lymphadenitis as part of routine diagnosis. Smear preparation was performed from the aspirate and processed for cytology, conventional Ziehl-Neelsen and LED microscopy. The remaining aspirate was processed for culture on Lowenstein-Jensen media. Capilia TB-Neo test was used to differentiate M. tuberculosis complex from non-tuberculous mycobacteria. RESULT: A total of 144 tuberculous lymphadenitis presumptive cases were included. 66.7% (96/144) were positive for M. tuberculosis complex on culture. Only one isolate was identified as non-tuberculous mycobacteria. The detection rates of Ziehl-Neelsen and LED microscopy were 18.8% (27/144) and 34% (49/144), respectively. As compared to culture, sensitivity was 25.0% [95% CI: 16.3-33.7] for Ziehl-Neelsen microscopy and 45.8% [95% CI: 35.9-55.8] for LED microscopy. The specificity was 93.8% [95% CI: 86.9-100] for Ziehl-Neelsen microscopy and 89.6% [95% CI: 80.9-98.2] for LED microscopy. LED microscopy showed a statistically significant increase in sensitivity and similar specificity compared to Ziehl-Neelsen microscopy. Mean reading time of positive slides was 2.62 min/slide for Ziehl-Neelsen and 1.60 min/slide for LED microscopy. Cytology showed sensitivity of 82.3% and specificity of 54.2%. LED microscopy detected TB bacilli in 33.3% of cases cytologically classified as suppurative abscess. CONCLUSION: The LED microscopy for tuberculous lymphadenitis had significantly higher sensitivity and shorter screening time than Ziehl-Neelsen microscopy. Use of LED microscopy among cases classified as suppurative abscess on fine-needle aspirate cytology improves evidence-based diagnosis of presumptive tuberculous lymphadenitis cases. Moreover, LED microscopy could be considered as an alternative approach in settings where fine-needle aspirate cytology is impractical.

Sensitivity and specificity of occult blood testing in symptomatic single duct nipple discharge to detect ducta carcinoma / Sensibilidad y especificidad de la presencia de sangre oculta en la secreción patológica del pezón para detectar cáncer ductal de seno

Introduction: Testing asymptomatic nipple discharge in women for occult hemoglobin to predict the presence of ductal carcinoma remains controversial. The purpose of this study is to describe the sensitivity and specificity of occult blood testing in patients with asymptomatic single duct nipple discharge. Methods: Data was collected ambispectively during a 7 year period. All patients with asymptomatic single duct nipple discharge were included in this study. The results of occult blood testing were correlated with the histopathological results after microductectomy. Results: All 63 patients were female. They underwent mammography and ultrasound examination of the discharging breast which were normal in all cases. The average follow up period was 2 years (0.5 to 5 years). Occult blood was positive in 37 (58.8 %) patients and negative in 26 (41.2 %) patients. Histopathological diagnosis was ductal ectasia in 30 % (n=18), intraductal papilloma in 44 % (n=28), granuloma 2 % (n=1), normal 12 % (n=8) and ductal carcinoma in situ 12 % (n=8). The most frequent cause for positive occult blood was ductal papilloma (n=23) followed by ductal ectasia (n=13). The sensitivity of the test was 87.5 % and specificity 45.4 %, with a positive predictive value of 18.9 % and a negative predictive value of 96.1 % and an Odds ratio of 5,833. Discussion: Positive occult blood testing can help to predict the presence of either in situ or invasive ductal carcinoma in the absence of other symptoms. We recommend, however, an approach based on clinical examination, radiological testing and risk factor analysis to decide which patients require microductectomy to exclude the presence cancer definitively.

Introducción: la utilidad de la prueba de sangre oculta en la secreción patológica por el pezón en pacientes no lactantes para detectar cáncer de seno, es motivo de gran debate en la actualidad. El propósito de este estudio fue describir la sensibilidad y especificidad de la prueba en esta población. Materiales y métodos: estudio de cohorte ambispectivo por un periodo de siete años. Se incluyeron pacientes con secreción patológica por el pezón, a quienes se les realizó prueba de sangre oculta y se obtuvieron características operativas de una prueba diagnóstica con los resultados histopatológicos luego de una micro-ductectomía. Resultados: se obtuvo información de 63 pacientes de sexo femenino. En todos los casos se realizaron mamografía y ultrasonido de mama, adicional al examen físico. El tiempo se seguimiento fue en promedio de dos años (0,5 a 5 años). La sangre oculta fue positiva en 58,8 % de las pacientes. Se obtuvo un resultado negativo (líquido claro) en 41,2 % de las pacientes. Los diagnósticos histopatológicos obtenidos fueron: ectasia ductal 30 %, papiloma intraductal 44 %, granuloma 2 %, normal 12 % y carcinoma ductal in situ 12 %. La causa más frecuente de sangre oculta positiva en la secreción fue el papiloma ductal (n=23) seguido por la ectasia ductal (n=13). La sensibilidad fue del 87,5 % y la especificidad del 45,4 %, el valor predictivo positivo fue 18,9 % y el valor predictivo negativo fue del 96,1 %, con un Odds Ratio de 5,8. Conclusiones: detectar sangre oculta en la secreción asintomática de un solo ducto del pezón puede ayudar a predecir la presencia de cáncer en los ductos mamarios. Sin embargo, recomendamos una aproximación basada en un algoritmo de decisiones utilizando una combinación de examen físico, pruebas de laboratorio e ima-genología avanzada para detectar la presencia de malignidad en el tejido ductal.

Molecular and parasitological detection of Leishmania spp. in dogs caught in Palmas, TO, Brazil / Detecção molecular e parasitológica de Leishmania spp. em cães capturados em Palmas, TO, Brasil

This study evaluated occurrences of Leishmania infantum in dogs in the municipality of Palmas, Tocantins, comparing diagnostic data obtained using the polymerase chain reaction (PCR) and parasitological diagnosis. Blood samples and lymph node aspirates were collected from 63 dogs of males and females and various ages and races, with or without owners, between August 2009 and June 2010. Slides containing smears of lymph node aspirates were stained with Giemsa stained. In PCR, the 145 bp target sequence of the LT1 fragment, located in the Leishmania donovani kDNA minicircle was detected using the RV1 and RV2 oligonucleotide primers. The chi-square test revealed that there was a significant relationship between the symptoms and dogs that were positive for visceral leishmaniasis (VL). The parasitological investigation showed concordance of 66.7% with PCR on blood and 84.1% with PCR on lymph node aspirate. In addition to these tests, evaluations of the diagnoses in parallel and in series were conducted, which showed concordances with the parasitological test of 76.2% and 74.6%, respectively. The results make it possible to suggest that PCR on lymph nodes should be used in evaluating large populations (surveys) and that the parasitological test should be used for initial clinical evaluations in veterinary consultation offices.

Avaliou-se a ocorrência de Leishmania infantum em cães do município de Palmas-TO, comparando dados diagnósticos obtidos pela Reação em Cadeia da Polimerase (PCR) e pelo diagnóstico parasitológico. Foram coletadas amostras de sangue e de aspirado de linfonodo de 63 cães machos e fêmeas, várias idades e raças, domiciliares ou não de agosto de 2009 a junho de 2010. As lâminas contendo esfregaço dos aspirados de linfonodos foram coradas pelo corante Giemsa. Na PCR, a sequência alvo de 145 pb do fragmento LT1, situado no minicírculo do kDNA do grupo Leishmania donovani, foi detectada através dos oligonucleotídeos iniciadores RV1 e RV2. O teste χ² (Qui-quadrado), demonstrou haver relação significativa entre a sintomatologia e a positividade dos cães para Leishmaniose Visceral (LV). O exame parasitológico mostrou uma concordância de 66,7% com a PCR em sangue e 84,1% com a PCR de aspirado de linfonodo. Além destas análises, houve a avaliação dos diagnósticos em paralelo e em série, onde as concordâncias com o exame parasitológico foram de 76,2% e 74,6%, respectivamente. Os resultados permitem sugerir a utilização da PCR de linfonodos na avaliação de grandes populações (inquéritos), e o exame parasitológico para a avaliação clínica inicial em consultórios veterinários.

Uso de cultivo cuantitativo de aspirado endotraqueal para el diagnóstico de neumonía asociada a ventilación mecánica en pediatría: estudio prospectivo, analítico / Evaluation of quantitative cultures of endotracheal aspirates for pediatric ventilator-associated pneumonia diagnosis: analytic, prospective study

Introduction: Ventilator-associated pneumonia (VAP) is difficult to diagnose because of the absence of a gold standard. Aim: To evaluate the use of quantitative cultures of endotracheal aspirates for diagnosis of pediatric VAP and to obtain acceptable sensitivity and specificity cutoff points. Patients and Methods: Prospective, analytic study which included patients under 15 years, who were connected to mechanical ventilation at Hospital Luis Calvo Mackenna's intensive care units. They were classified as cases or controls according to NNIS criteria. Results: During a period of 21 months we recruited a total of 43 patients with a mean age of 16 months. We obtained endotracheal aspirated samples to perform quantitative cultures. Most frequently isolated pathogens were Staphylococcus aureus (34,5 percent) and non-fermentative Gram-negative bacilli (24,1 percent). We obtained a sensitivity of 88 percent, specificity of 70 percent, PPV of 82 percent, and NPV of 79 percent for samples greater than 10(6) CFU. Conclusions: Quantitative culture of endotracheal aspirates is a reliable method for diagnosing pediatric VAP when the value is greater than 10(6) CFU.

Introducción: La neumonía asociada a ventilación mecánica (NAVM) presenta una importante dificultad en su diagnóstico ya que no existe un patrón de referencia. Objetivo: Evaluar el uso del recuento cuantitativo de aspirado endotraqueal como método diagnóstico de NAVM en pediatría, obteniendo puntos de cortes con una sensibilidad y especificidad aceptables. Materiales y Métodos: Estudio analítico, prospectivo, que incluyó pacientes bajo 15 años de edad, conectados a ventilación mecánica en unidades de cuidados intensivos del Hospital Luis Calvo Mackenna. Se clasificaron en casos y controles según criterios de NNIS. Resultados: Durante 21 meses se enrolaron 43 pacientes cuya edad promedio fue de 16 meses. Se tomaron muestras de aspirado endotraqueal para cultivos cuantitativos. Los principales microorganismos aislados fueron Staphylococcus aureus (34,5 por ciento) y bacilos gramnegativos no fermentadores (24,1 por ciento). Para las muestras con recuento mayor 10(6) ufc se obtuvo una sensibilidad de 88 por ciento, especificidad de 70 por ciento, VPP de 82 por ciento y VPN de 79 por ciento. Discusión: El cultivo cuantitativo de aspiración endotraqueal constituye un método diagnóstico confiable para NAVM en pediatría cuando se obtienen recuentos mayores a 10(6) ufc.

Gérmenes presentes en cultivos de aspirado gástrico de recién nacidos de pacientes con sospecha de infección intramniótica / Germs present in newborns gastric aspírate cultures from intramnioticinfecction suspected patients

El presente trabajo desarrollado en el Maternológico infantil Geman Urquidi de Cochabamba, persigue, identificar mediante cultivo, el o los gérmenes presentes en el liquido amniotico, aspirado de la cavidad gástrica de recién nacidos, dentro los primeros 5 minutos de nacido (patógenos potenciales de infecciones materno infantiles), de madres con sospecha de infección intraamniotica, cuyas gestaciones fueron complicadas con rotura prematura de membranas. Se realizo un estudio prospectivo, longitudinal, laboratorial, correlacional, tomándose como muestra a 40 pacientes que reunían los criterios de inclusión para el estudio, cuyas muestras de líquido amniotico fueron cultivadas en el laboratorio Gastroenterológico Boliviano Japonés, al mismo tiempo fueron estudiadas histopatológicamente las placentas de las pacientes. Se obtuvo como resultado, cultivos positivos en un 75 % de las muestras, donde el germen presente mas frecuente cultivado en medios comunes, fue la Escherichia coli, seguido del Stafilococo aureus, cuyas sensibilidades antibióticas se mostraban adecuadas para las quinolonas y cefalosporinas , dejando de lado a los medicamentos convencionales, por la resistencia que presentaban, así mismo se pudo demostrar que la la corioamnionitis histológica, es con mucho mas frecuente que la corioamnionitis clínica, siendo positivo inclusive en aquellos casos que no se cultivo germen alguno.

The purpose ofthe current work, carried out atthe Maternal-lnfant Hospital "Germán Urquidi" in Cochabamba, isto identify, by means of a culture, the germ(s) present in the amniotic fluid, aspirated from the gastric cavity of newborns, within the first 5 minutes of being born (potential pathogens of maternal-infant infections), of mothers suspected of intra-amniotic infection, whose pregnancies were complicated and presented premature sack breakage. A prospective, longitudinal, laboratory, correlational study was performed, taking samples from 40 patients who met the criteria for inclusion in the study and whose amniotic fluid samples were cultivated at the Bolivian Japanese Gastroenterological laboratory. At the same time, patients'afterbirths were studied histopathologically. As a result, positive cultures were identified in 75% ofthe samples, where the most common germ present was Escherichia coli, followed by Stafilococo aureus, whose antibiotic sensitivities were found to be adequate for quinolones and cephalos porins, disregarding conventional drugs, due to the resistance they showed. Likewise, it was possible to demonstrate that histological chorioamnionitis is much more frequent than clinical chorioamnionitis, resulting positive even in cases in which no germ at all was cultivated.

Diagnóstico de leishmaniasis utilizando medio d cultivo tstb en pacientes de trópico de Cochabamba / Diagnóstico de leishmaniasis utilizando medio d cultivo tstb en pacientes de trópico de Cochabamba

Se realizó un estudio prospectivo, analítico y experimental para determinar el porcentaje de sensibilidad de un nuevo medio de cultivo para el diagnóstico de Leishmania, denominado TSTB (Torrico-Solano-Torrico-Bermúdez). Se obtuvieron las muestras por aspirado de úlceras con sospecha clínica de Leishmaniasis de pacientes provenientes del trópico de Cochabamba. Los objetivos planteados fueron determinar el porcentaje de sensibilidad del cultivo ya mencionado y analizar el crecimiento de parásitos de Leishmania. Como resultados se obtuvo un 90% de sensibilidad mediante este método diagnóstico y una mínima contaminación por hongos (mohos y levaduras); además, un cambio de coloración en el medio de cultivo debido al crecimiento y multiplicación de los parásitos por consumo de los nutrientes.

A prospective, analytic and experimental study was realized, in which we tried to determine the percentage of sensitive of a new culture medium for the diagnosis of Leishmania, denominated Torrico-Solano-Torrico-Bermudez (TSTB). Samples were obtained by a piration of ulcers with clinical suspicion of Leishmaniasis from patients proceeding from the tropical area of Cochabamba. The objectives planted were to determine the percentage of sensitive of the mentioned culture and to analyze the growth of the parasites of Leishmania. As a result, a 90 % of positivity was obtained with this diagnostic method, with a minimum contamination by fungus (moss and yeast); further more, a change in the colour of culture medium was observed, because of the growth and multiplication of the parasites by consumption of the nutrients.

Perfil de resistência aos antimicrobianos de Pseudomons isoladas no Hospital Geral de Fortaleza / Antimicrobials profile resistance from isolated Pseudomonas at the Fortleza's General Hospital

O objetido deste trabalho foi avaliar a resistência das Pseudomonas isoladas de pacientes internados no Hospital Geral de Fortaleza, na cidade de Fortaleza. No período de 1 de janeiro a 30 de junho de 2001, foram isoladas 700 bactérias no Laboratório de Patologia Clínica do Hospital Geral e Fortaleza, as cepas foram isoladas em placas de ágar sangue, ágar MacConkey, ágar CLED e caldo BHI e identificadas pelo sistema Walkway e também os Testes de Susceptibilidade aos Antimicrobianos. Das 700 cepas isoladas 79 (11,28%) foram Pseudomonas e destas 64 cepas (81%) foram Pseudomonas aeruginosa. A urina e o aspirado traqueal foram as amostras em que ocorreram as maiores frequências de isolamento com 30 cepas (37,97%) e 22 cepas (27,8%) respectivamente. Em relação à resistência e a sensibilidade das bactérias isoladas a Piperacilina/Tazobactan foi o antimicrobiano mais sensível e a Tetraciclina o mais resistente. Quanto à procedência das amostras a UTI foi o setor que teve maior frequência de cepas isolada com 25,31%, seguido da UTU (Unidade de Tratamento de Urgência) com 21,51%.

Comparação do rendimento em cultura entre as técnicas do aspirado gástrico e do lavabo tráqueo-brônquico no diagnóstico da tuberculose / A culture yield comparison by the gastric aspirate and the tracheal-bronchial washing techniques in the tuberculosis diagnosis

Uma comparação do rendimento em cultura de amostras obtidas por duas técnicas diferentes, o aspirado gástrico e o lavado tráqueo-brônquico, foi realizada para verificar qual o melhor material para diagnóstico da tuberculose pulmonar. Essas amostras foram colhidas de pacientes ambulatoriais, em jejum, que apresentavam imagens pulmonares sugestivas da doença. O exame microscópico do escarro de parte desses pacientes foi negativo. A outra parte não apresentava expectoração. A análise estatística dos resultados não revelou diferenças significativas. Assim, devido às vantagens de realização do lavado tráqueo-brônquico sobre o aspirado gástrico, tanto para o laboratorista quanto para o paciente, recomendamos o primeiro método nas condições de rotina.