[Cyclospora cayetanensis infection. Laboratory diagnosis]. / Infección por Cyclospora cayetanensis. Diagnóstico de laboratorio.

Cyclospora cayetanensis is an Apicomplexa protozoa which was found to cause gastroenteritis in humans in 1979. This paper reviews the laboratory diagnosis of the disease. The usefulness of direct examination of fresh fecal matter with special acid-fast stains is emphasized as well as the morphometric differentiation between this organism and other similar coccidia. The paper reviews the sporulation technique of Cyclospora cayetanensis for the recognition and differentiation of artifacts and green-blue algae. Another aspect discussed is the morphology of the parasite in histological sections and with electromicroscopic examination whereby tissue morphology changes caused by the microorganism can be identified. The experience of the Service and Laboratory of Parasitology of the Instituto Nacional de Pediatría of Mexico in the laboratory diagnosis of this protozoosis is described. The paper is oriented towards the inclussion of Cyclospora cayetanensis in the diagnostic protocols for the study of diarrheas in our health Institutions.

[Effectiveness and safety of ciclopirox olamine 1% vaginal cream versus terconazole 0.8% vaginal cream in the treatment of genital candidiasis]. / Eficacia y seguridad de ciclopirox olamina en crema vaginal al 1% contra terconazol en crema vaginal al 0.8% en el tratamiento de candidiasis genital.

A multicenter randomized study was performed. One hundred and seventy patients were selected. The patients were 18 years and older. They presented signs and symptoms of genital candidiasis and had positive smear culture for Candida. Eighty five patients were assigned to receive Cicloprox olamine 1%, and eighty five patients were assigned to receive Terconazol 0.8%. The treatment lasted six days with the objective to compare the clinical and antifungal efficiency and safety with both treatments. The result of mixed efficiency (clinical and microbiology) for Cicloprox olamine was 48 cases (62.3%) at the end of the treatment were cured--day 7-; and at the continuation--day 21-42 of them had the same result (55.3%); improvement was seen at the end in 25 cases (32.5%) and at the continuation 21 cases had the same result (27.6%). For Terconazol the result was 45 cases (61.6%) were cured at the end of the treatment, and at the continuation 39 had the same result (57.4%); improvement was seen at the end in 23 cases (31.5%) and at the continuation 22 cases had the same result (32.4%). We conclude that both treatments are effective and well tolerated for genital candidiasis treatment.

[Toxoplasmosis and threatened abortion]. / Toxoplasmosis y aborto en evolución.

To know the situation of the toxoplasmosis in Comitán Chiapas, we made a serological indirect inmunofluorecent antibody test (IFA) to the population of this city and to fifty women with abortion in evolution. The results show us that around five percent of the population in general have positive title of antitoxoplasma gondii antibiodies, and 18% in the women with abortion evolution case. The statistics concluded that seropositive for this parasitic disease is real higher between cases of abortion than population in general (P < 0.006), as well as it is significantly higher in abortion cases than women of the general population of Comitán Chiapas (P < 0.01).

[Infection by Toxoplasma gondii in children with infantile cerebral palsy]. / Infección por Toxoplasma gondii en niños con parálisis cerebral infantil.

An analytic relationship between positivity of the indirect immunofluorescent test (IIFT) for toxoplasmosis and clinical findings in a population of 328 children with cerebral infantile palsy (CIP) was performed. Children were distributed by age in one of four groups: I (0-2 years); II (3-6 years); III (7-12 years) and IV (13-18 years). One control group of 168 children with no PCI clinical findings was included. 125 sera were positive at 1:64 dilutions. The study of the binomial mother-child of 40 cases rendered 26 mothers with significant titer values. The majority of positive mothers to IIFT correlated with the youngest children (Groups I, II and III), mainly with group I (70.0%), which showed the highest titer ranges. Correlation between positive IIFT and clinical features was as high as 100.0%.

[Frequency of intraepithelial neoplasia of the cervix and risk factors in women in Mexico City]. / Frecuencia de neoplasia intraepitelial del cérvix y factores de riesgo en mujeres de la ciudad de México.

Cervical intraepithelial neoplasies (CIN), are very frequent in women with active sexual life who present risk factors. In this paper 220 exfoliative cytology reports from the National Cancer Register of the Direction of Epidemiology, Health Secretory, taken to women from eight Political Delegations in Mexico City, were revised. 134 cases presented CIN. 70.2% were grade III, corresponded to the age group between 26 and 35 years old; more than three pregnancies (47.76%) and more than three births (46.80%). Viral genital infections were related with CIN grades II and III. There are another risk factors that have been poorly analyzed in the national existent literature, therefore, it is necessary to effect further studies to determine the development of CIN in women with active sexual life.

[Comparative study for the evaluation of the efficacy and safety of metronidazole and secnidazole in the treatment of vaginal trichomoniasis]. / Estudio comparativo para evaluar la eficacia y seguridad de metronidazol y secnidazol en presentación de óvulos, para el tratamiento de tricomoniasis vaginal.

Presently study included 3 groups of 20 women with tricomoniasis demonstrated parasitologicaly for oozing vaginal, the first group received treatment with vaginal ova with metronidazol for 10 days, the second group ova of secnidazol for 3 days and the third group ova of secnidazol for 7 days. The results showed that the clinical manifestations dimanished significantly and the presence of Trichomonas vaginalis disappeared from the vaginal cavity, therefore cure was achieved parasitological in all the cases. We concluded that they are equally useful the metronidazol for 10 days, and the secnidazol for 3 or 7 days, without the presence of adverse effects.

Nitazoxanide for the treatment of intestinal protozoan and helminthic infections in Mexico.

A study to evaluate the efficacy and safety of nitazoxanide as a single agent for the treatment of a broad spectrum of mixed parasitic infections, both protozoa and helminths, was conducted at a primary school in San Pedro Tolimán, Querétaro, Mexico. Three faecal samples from 1824 adults and children were screened for the presence of oocysts, cysts, trophozoites, eggs or larvae of intestinal protozoa or helminths. Two hundred and forty-six adults and children infected with at least one protozoan and 2 helminths were given 7.5 mg/kg of nitazoxanide (500 mg to adults and 200 mg to children less than 12 years old) every 12 h for 3 consecutive days. Faecal samples were examined on days 6, 7, 8, 13, 14 and 15 (+/- 1) following initiation of treatment, using formalin-ether concentration and Kato-Katz egg counting. Treatment with nitazoxanide was 71-100% effective in eliminating evidence of infection with Entamoeba histolytica/E. dispar, Giardia duodenalis, Blastocystis hominis, Isospora belli, Enterobius vermicularis, Ascaris lumbricoides, Trichuris trichiura and Hymenolepis nana. Haematology and clinical chemistry values obtained before and after treatment remained unaffected by nitazoxanide. The drug was well tolerated, with only 15 patients (6.1%) reporting mild abdominal pain that lasted less than 24 h.

[New sites with Triatominae infected by Trypanosoma cruzi in the Mexican Republic]. / Nuevas localidades con triatominos infectados por Trypanosoma cruzi en la República mexicana.

We report 29 new localities with Triatominae in the Republic of México; these Triatominae belong to 8 different species. Infection by Trypanosoma cruzi in the majority of these localities with high rates of positivity was found. Biological observations concerning the collected Triatominae are given. The necessity of continued work in relation to geographical distribution, ecology, frequency of infection by T. cruzy, and the role played by Triatominae of the Republic of México in the transmission of the infection to the man is stressed.

[Randomized study comparing the safety and efficacy of albendazole and metronidazole in the treatment of giardiasis in children]. / Estudio aleatorio para comparar seguridad y eficacia de albendazol y metronidazol en el tratamiento de giardiasis en niños.

An open, randomized study was carried out with 100 children to compare the efficacy and security of albendazole and metronidazole to eradicate Giardia lamblia. We included 100 patients in primary school age with giardiasis confirmed by parasitoscopic test who had not received treatment during the 2 previous months. A complete clinical study was performed. By using an aleatory code, the children were distributed in 2 groups: A and B. The clinical data was corroborated and the following tests were made: cell blood count, blood chemistry, direct and concentrated coproparasitoscopic study. Both groups were given an antiparasite treatment consisting of albendazole for group A or metronidazole for group B. Clinical, parasitological and blood controls were conducted before, during and after the treatment. A therapeutic efficacy of 94% and 98% for group A and B, respectively, was found. We concluded that albendazole and metronidazole are equally effective in a 5 days treatment period, but some undesirable effects may occur with metronidazole.

[Intestinal helminthiasis in the Mexican Republic]. / Las helmintiasis intestinales en la República Mexicana.

Very few uncertain and not trustworthy reports about the frequency of intestinal helminthiases found in humans have been made in México. However, with the few trustful studies carried out from 1981 to 1992, it is possible in México to verify that ascariasis, trichuriasis, hookworm infection and hymenolepiasis are present with significant percentages of infected people 11.2%, 1.7%, 0.15% and 1.8%, respectively. With the information obtained from the researches analyzed in this article, one can conclude that human infections by intestinal helminths in México, at the present time are almost as frequent as in past decades. Without any doubt, this occurs because still remain the factors that contribute to the persistence and spreading of the intestinal helminths, such as fecalism, poor hygienic and alimentary habits within deficient environmental sanitary conditions.

Successful treatment of severe complicated measles with non-specific transfer factor.

Severe complicated measles has a high mortality rate and no specific treatment. Ten patients with complicated measles - 9 infants with respiratory failure and a 15 year old boy with encephalitis - received immunotherapy with Non-specific Transfer Factor (NTF). The patients had variable degrees of undernourishment and were severely ill when immunotherapy was started. 8/9 cases with respiratory failure were cured. One died of bronchoaspiration while recovering from the measles. The case with encephalitis showed no neurological sequelae two weeks after receiving the last dose of NTF. Treatment of complicated measles with NTF in these patients seemed very effective and deserves further trial.

[Clinical aspects of hymenolepiasis in pediatrics]. / Aspectos clínicos de la himenolepiasis en pediatría.

The present integral clinical and laboratory study was carried out in 325 children infected with Hymenolepis nana. Results showed that H. nana is found among the top five intestinal parasitosis in school children in Mexico City, in the majority of the cases associated with protozoans and other helminths, especially and with Giardia lamblia. Although the amount of parasites found is small, the clinical manifestations vary very little with larger amounts. The most important and more constant clinical manifestations in those solely infected with H. nana and with other combinations are: abdominal pain, hyporexia and irritability. We have seen that in patients infected solely with H. nana, there is weight loss, meteorism and flatulences. In those associated with G. lamblia, diarrhea is one of the most frequent manifestations. Hymenolepiasis is an important disease in our environment due to its high frequency among pre-school and school children and its constant identifiable clinical manifestations.

Tratamiento de las mordeduras por serpientes ponzonosas / Treatment of poisonous snake bites

RESUMEN En el presente trabajo se estudian los efectos terapéuticos del prazicuantel (pirazino isoquinoleinn¡ en el tratamiento de la, cisticercosis cerebral humana. Se administró la droga a 100 enfermos, 52 hombres y 48 mujeres. cuyas edades oscilaron entre los cuatro y los 70 años; entre ellos había cinco niños. El medicamento se dio bajo la forma de cápsulas o tabletas fanuradas, a la dosis de 50 mg por kilogramo de peso repartida en dos tomas al día, siempre con las comidas y durante 15 días consecutivos. Todos los enfermos fueron hospitalizadas en la sección clínica del Instituto de Salubridad y Enfermedades Tropicales de México, Se les practicó, además del examen clínico de rutina. electroencefalograma. tomograffa axial computarizada, estudio completo del líquido ceralorraquideo incluyendo la reacción de fijación del complemento a la cisticercosis y dosificación de anticuerpos. Todas estas pruebas se repitieron al terminar el tratamiento y a los pacientes se les ha seguido en la con una externa durante un lapso variable entre uno y 12 meses. Se excluyeron enfermos con padecimiento asociados, toxicómanos, mujeres embarazadas y casos sumamente graves más allá de toda esperanza razonable. Se consideraron curados a Jos enfermos que después del tratamiento han permanecido asintomáticos, que no requieren ningún medicamento y que han vuelto a trabajar. se consideran mejorados los que presentaron algún adelanto que fue clasificado de a. Fueron considerados como sin cambio los que quedaron igual y empeorados los que desmejoraron. Se estudió la mortalidad inmediata en los que fallecieron durante su permanencia en el hospital y la tardía cuando ya habían abandonado el establecimiento. sin importar el tiempo transcurrido. La mortalidad inmediata fue de tres casos por ciento y se debió siempre a hipertensión intracraneana: la mortalidad tardía fue de seis casos y se debió en la mayoría de las veces a ependirnitis udhexivu o a otro padecimientos. Después del tratamiento fueron clasificados como muy mejorados o curados hasta el 77% de los casos

[The community health technician and alternative in the training of health manpower]. / El técnico en salud comunitaria: una alternativa en la formación de recursos humanos para la salud.

This paper describes the general conditions of the social and economic dynamics of the rural area, with emphasis on the development of the factors that affect health in Mexico, and briefly analyzes the system for the education and training of manpower for health care. The author presents arguments in support of an alternative proposal for the training of the "community health technician" as a professional produced by four years of study following graduation from secondary school, and trained to take measures that contribute to the integral development of the community by acting upon the factors involved in the occurrence of pathological states, and to be the first contact for persons with medical problems. The course of training is described in terms of its ultimate purpose, which is improvement of the health status of a rural community, and of the general objectives in the "community development" and "medical care" areas. The course is administered in 25 modules as follows: four introductory modules to acquaint the student with the requirements for dealing with the areas, 11 modules on community development, eight modules on first-contact medical care, and the last two for practical exercises and community work, in which the student is required to bring all his knowledge to bear on a given community. Lastly, the course content of each semester is described together with the distribution of the theoretical and practical work in each module, and the outlook for its success, which points to the possibility of incorporating this resource into programs for extending coverage to rural areas.

El técnico en salud comunitaria: una alternativa en la formación de recursos humanos para la salud / The community health technician and alternative in the training of health manpower

This paper describes the general conditions of the social and economic dynamics of the rural area, with emphasis on the development of the factors that affect health in Mexico, and briefly analyzes the system for the education and training of manpower for health care. The author presents arguments in support of an alternative proposal for the training of the «community health technician» as a professional produced by four years of study following graduation from secondary school, and trained to take measures that contribute to the integral development of the community by acting upon the factors involved in the occurrence of pathological states, and to be the first contact for persons with medical problems. The course of training is described in terms of its ultimate purpose, which is improvement of the health status of a rural community, and of the general objectives in the «community development» and «medical care» areas. The course is administered in 25 modules as follows: four introductory modules to acquaint the student with the requirements for dealing with the areas, 11 modules on community development, eight modules on first-contact medical care, and the last two for practical exercises and community work, in which the student is required to bring all his knowledge to bear on a given community. Lastly, the course content of each semester is described together with the distribution of the theoretical and practical work in each module, and the outlook for its success, which points to the possibility of incorporating this resource into programs for extending coverage to rural areas (Au)