Gestión de equipos médicos: implementación y validación de una herramienta de auditoría / Health technology management: implementation and validation of an audit tool

Resumen: La auditoría en salud es un proceso dinámico y en continuo avance que permite evaluar y controlar estándares de calidad en las instituciones de salud, sin embargo, la falta de estandarización y confiabilidad de resultados sigue siendo un reto por superar. Este trabajo presenta la validación de un prototipo de herramienta de auditoría para la gestión de equipos médicos la cual se realizó en dos fases: primero durante la implementación en tres hospitales del Área Metropolitana del Valle de Aburra, en Antioquia, Colombia, y posteriormente a través del análisis estadístico del juicio de expertos. Los hallazgos permitieron generar acciones de mejora con base en los informes de fortalezas y debilidades puntuales. Por su parte las mediciones de coeficientes de confiabilidad (Cronbach α= 0.90) y correlación de expertos (Spearman =0.88) indicaron resultados favorables para la herramienta. Además, la medición de promedios, desviaciones estándar y coeficientes de variación para cada ítem de la validación, expuso las mejoras que requiere la herramienta para una versión futura. La propuesta de la herramienta se limita a la regulación en salud Colombiana sin embargo no se aleja del marco normativo internacional, por lo que se considera es un paso relevante importante para convertir las auditorias en salud en procesos estandarizados. Puede concluirse que integrar al ingeniero biomédico en actividades de auditoría de calidad en salud con herramientas confiables ofrece un beneficio importante para la toma de decisiones oportuna en la gestión de los equipos médicos.

Abstract: Audit in health is a dynamic process and continuous advancement that permits to asses monitor and improve quality standards in healthcare institutions; however, the lack of standardization and reliability of results remains a challenge to be overcome. This study presents the validation of a prototype of an audit tool to the management of medical equipment which took place in two phases: first during the implementation in three hospitals in the metropolitan area of Antioquia, Colombia, and subsequently through the statistical analysis of the trial of twelve selected experts. As results audit reports were generated with strengths and weaknesses points, which enabled us to build improvement measures suitable for hospitals. Measurements of coefficients of reliability (Cronbach α= 0.90) and correlation of experts (Spearman =0.88) indicated favorable results for the tool. In addition, the measurement of mean, standard deviations and coefficients of variation for each item of the validation set out the improvements required by the tool for a future version. This tool is limited to the health regulation in Colombia; nevertheless, the tool is an important step to find and transform the health audits in standardized process that can have an objective assessment. To can be concluded to integrate the biomedical engineer in the activities of audit quality on health with reliable tools offers an important benefit for accurate decision making and timely management of the medical equipment.

Phenotypic and Genotypic Antibiotic Resistance of Salmonella from Chicken Carcasses Marketed at Ibague, Colombia

Salmonella enterica is responsible for alimentary toxic infections associated with the consumption of contaminated poultry products and the antimicrobial resistant patterns of Salmonella circulating in the Tolima region are currently unknown. To address this issue, both the phenotype and genotype antibiotic resistance patterns of 47 Salmonella isolated from raw chicken carcasses sold at the Ibague city were analyzed by the disc diffusion, microdilution and PCR assays. All 47 Salmonella isolates showed resistance to five or more antimicrobial agents. Resistance to Ampicillin (AMP), Amikacin (AMK), Gentamicin (GEN), Tobramycin (TOB), Cefazoline (CFZ), Cefoxitin (FOX), Nitrofurantoin (NIT), Trimethoprim-Sulfamethoxazole (SXT), Tetracycline (TET), Ciprofloxacin (CIP) and Enrofloxacin (ENR) was observed in 42.35% of Salmonella isolates. All tested S. Paratyphi B var Java isolates showed resistance to at least 12 antibiotics. S. Hvittingfoss showed resistance to 5 antibiotics, whereas S. Muenster showed resistance to seven antibiotics. Amplification of a number of antibiotic resistance genes showed that blaTEM (100%) correlated well with resistance to Ampicilin and Cephalosporin, whereas aadB (87%) correlated well with resistance to Aminoglycosides. It is concluded that Salmonella isolated from raw chicken meat marketed at Ibague showed MDR by both phenotypic and genotypic methods and they may represent an important threat to human health. Additional studies are needed to establish the relationship between antibiotic resistance in Salmonella from poultry products and clinical isolates.(AU)

Phenotypic and Genotypic Antibiotic Resistance of Salmonella from Chicken Carcasses Marketed at Ibague, Colombia

Salmonella enterica is responsible for alimentary toxic infections associated with the consumption of contaminated poultry products and the antimicrobial resistant patterns of Salmonella circulating in the Tolima region are currently unknown. To address this issue, both the phenotype and genotype antibiotic resistance patterns of 47 Salmonella isolated from raw chicken carcasses sold at the Ibague city were analyzed by the disc diffusion, microdilution and PCR assays. All 47 Salmonella isolates showed resistance to five or more antimicrobial agents. Resistance to Ampicillin (AMP), Amikacin (AMK), Gentamicin (GEN), Tobramycin (TOB), Cefazoline (CFZ), Cefoxitin (FOX), Nitrofurantoin (NIT), Trimethoprim-Sulfamethoxazole (SXT), Tetracycline (TET), Ciprofloxacin (CIP) and Enrofloxacin (ENR) was observed in 42.35% of Salmonella isolates. All tested S. Paratyphi B var Java isolates showed resistance to at least 12 antibiotics. S. Hvittingfoss showed resistance to 5 antibiotics, whereas S. Muenster showed resistance to seven antibiotics. Amplification of a number of antibiotic resistance genes showed that blaTEM (100%) correlated well with resistance to Ampicilin and Cephalosporin, whereas aadB (87%) correlated well with resistance to Aminoglycosides. It is concluded that Salmonella isolated from raw chicken meat marketed at Ibague showed MDR by both phenotypic and genotypic methods and they may represent an important threat to human health. Additional studies are needed to establish the relationship between antibiotic resistance in Salmonella from poultry products and clinical isolates.

Control de daño de extremidad pélvica en lesión compleja del pie: Reporte de un caso / Pelvic limb damage control following a complex foot injury: Case report

Las lesiones de la articulación tarsometatarsal (Lisfranc) son producidas en accidentes automovilísticos en más de 20% de los casos, siendo poco común este tipo de trauma y su reducción ha sido reportada en 50% de los casos de manera cerrada. Un paciente masculino de 18 años de edad electricista participa en trauma de alta energía, presentando fractura luxación de Lisfranc expuesta de pie izquierdo grado III B Gustilo y Anderson, siendo sometido a lavado y desbridamiento quirúrgicos, reducción abierta y fijación interna y cobertura cutánea inmediata. Con el tratamiento estricto y los cuidados de las lesiones ortopédicas severas, la proporción de las complicaciones secundarias pueden disminuir. El tratamiento de las lesiones severas de las extremidades incluyendo las óseas combinadas con la de los tejidos blandos (piel, tejido subcutáneo, fascias, uniones músculo-tendinosas, ligamentos, periostio y estructuras neurovasculares), deben seguir un protocolo multidisciplinario: desbridamiento extenso de tejido no viable, erradicación de infecciones y reconstrucción o cobertura de tejidos. Por lo que todo cirujano ortopedista debe tener conocimiento básico del mismo, teniendo vital importancia el manejo adecuado, la técnica precisa para cada caso y el momento preciso para su solución.

More than 20% of the tarsometatarsal joint injuries (Lisfranc injuries) occur during motor vehicle accidents. This kind of trauma is infrequent and in 50% of cases closed reduction is used. A 18 year-old male patient sustained a high-energy trauma resulting in a Gustilo and Anderson III B open Lisfranc fracture dislocation of the left foot. Surgical debridement, open reduction and internal fixation, and immediate skin coverage were performed. The secondary complication rate may decrease with stringent treatment adherence and proper care of severe orthopedic injuries. Treatment of the latter, including bone and soft tissue injuries (skin, subcutaneous tissue, fascias, musculotendinous junctions, ligaments, periosteum, and neurovascular structures) should follow a multidisciplinary protocol: extensive debridement of nonviable tissue, eradication of infections, and tissue reconstruction or coverage. Thus, any orthopedic surgeon should possess basic knowledge of this protocol. Proper management, using the right technique in each case, and the right timing of treatment are of the utmost importance.

[Pelvic limb damage control following a complex foot injury. Case report]. / Control de daño de extremidad pélvica en lesión compleja del pie. Reporte de un caso.

More than 20% of the tarsometatarsal joint injuries (Lisfranc injuries) occur during motor vehicle accidents. This kind of trauma is infrequent and in 50% of cases closed reduction is used. A 18 year-old male patient sustained a high-energy trauma resulting in a Gustilo and Anderson III B open Lisfranc fracture dislocation of the left foot. Surgical debridement, open reduction and internal fixation, and immediate skin coverage were performed. The secondary complication rate may decrease with stringent treatment adherence and proper care of severe orthopedic injuries. Treatment of the latter, including bone and soft tissue injuries (skin, subcutaneous tissue, fascias, musculotendinous junctions, ligaments, periosteum, and neurovascular structures) should follow a multidisciplinary protocol: extensive debridement of nonviable tissue, eradication of infections, and tissue reconstruction or coverage. Thus, any orthopedic surgeon should possess basic knowledge of this protocol. Proper management, using the right technique in each case, and the right timing of treatment are of the utmost importance.

Las lesiones de la articulación tarsometatarsal (Lisfranc) son producidas en accidentes automovilísticos en más de 20% de los casos, siendo poco común este tipo de trauma y su reducción ha sido reportada en 50% de los casos de manera cerrada. Un paciente masculino de 18 años de edad electricista participa en trauma de alta energía, presentando fractura luxación de Lisfranc expuesta de pie izquierdo grado III B Gustilo y Anderson, siendo sometido a lavado y desbridamiento quirúrgicos, reducción abierta y fijación interna y cobertura cutánea inmediata. Con el tratamiento estricto y los cuidados de las lesiones ortopédicas severas, la proporción de las complicaciones secundarias pueden disminuir. El tratamiento de las lesiones severas de las extremidades incluyendo las óseas combinadas con la de los tejidos blandos (piel, tejido subcutáneo, fascias, uniones músculo-tendinosas, ligamentos, periostio y estructuras neurovasculares), deben seguir un protocolo multidisciplinario: desbridamiento extenso de tejido no viable, erradicación de infecciones y reconstrucción o cobertura de tejidos. Por lo que todo cirujano ortopedista debe tener conocimiento básico del mismo, teniendo vital importancia el manejo adecuado, la técnica precisa para cada caso y el momento preciso para su solución.

Effects of the AMP-activated protein kinase inhibitor compound C on the postconditioned rat heart.

Ischemic postconditioning (IPOC) protects the myocardium from ischemic-reperfusion injury, improving functional recovery and cell viability. This protection is concurrent with stimulation of glycogen breakdown, increased mitochondrial ATP synthesis and content, maintenance of reduced-to-oxidized glutathione ratio (GSH/GSSG), and decreased oxidative damage. The present study's objective was to assess whether these effects are associated with increased resistance to mitochondrial permeability transition pore (MPTP) opening. The effects of the AMP-activated protein kinase (AMPK) inhibitor, compound C (CC), were measured to investigate association with AMPK. Mitochondria removed from postconditioned hearts required higher calcium levels to induce MPTP opening. Improved functional recovery, increased glycogen mobilization, maintenance of the GSH/GSSG ratio, decreased oxidative damage, and increased resistance to MPTP opening were abrogated when the hearts were postconditioned in the presence of CC, without affecting preservation of cell viability. Although AMPK appears to play a role in IPOC, it would not be the major cellular mediator.

Haga su diagnóstico / Do your diagnostic

Presentamos un caso de esta entidad en una paciente caucásica, con lesiones maculosas purpúricas en zona tibial posterior de pierna derecha, sin afectación sistémica, de curso crónico y persistente en la actualidad, tras dieciocho meses de seguimiento con mejoría parcial, después de recibir tratamiento con esteroides e inmunosupresores tópicos. Los anticonceptivos orales y la hipercolesterolemia leve, podrían ser datos asociados en nuestro caso a dicha entidad, aunque se necesitarían más estudios para confirmar esta hipótesis.

We present a case of this entity in a Caucasian, patient with purpuric macular lesion area with her right posterior tibial, without affecting systemic, chronic and persistent course now, after eighteen months of follow-up with partial improvement after treatment with topical steroids and immunosuppressors. Oral contraceptives and mild hypercholesterolemia may be associated data in our case to the entity, althought further studies are needed to confirm this hypothesis.

Total and bioavailable arsenic concentration in arid soils and its uptake by native plants from the pre-Andean zones in Chile.

Arsenic is the most important contaminant of the environment in northern Chile. Soil samples and plant organs from three native plant species, Pluchea absinthioides, Atriplex atacamensis and Lupinus microcarpus, were collected from arid zones in order to determine the total and bioavailable arsenic concentrations in soils and to assess the bioconcentration factor (BCF) and transport index (Ti) of arsenic in the plants. Total arsenic concentrations in soils (pH 8.3-8.5) where A. atacamensis and P. absinthioides were collected, reached levels considered to be contaminated (54.3 ± 15.4 and 52.9 ± 9.9 mg kg⁻¹, respectively), and these values were approximately ten times higher than in soils (pH 7.6) where L. microcarpus was collected. Bioavailable arsenic ranged from 0.18 to 0.42% of total arsenic concentration. In the three plant species, arsenic concentration in leaves were significantly (p ≤ 0.05) higher than in roots. L. microcarpus showed the highest arsenic concentration in its leaves (9.7 ± 1.6 mg kg⁻¹) and higher values of BCF (1.8) and Ti (6.1), indicating that this species has a greater capacity to accumulate and translocate the metalloid to the leaf than do the other species.

Association of SLC11A1 with tuberculosis and interactions with NOS2A and TLR2 in African-Americans and Caucasians.

SETTING: Host defense factors may influence the development of active tuberculosis (TB). OBJECTIVE: To test variants in solute carrier family 11A, member 1 (SLC11A1), for an association with TB. METHODS: A mixed case-control study of TB cases, relatives or close contact controls, consisting of 474 African-Americans (243 families) and 381 Caucasians (192 families), examined 13 SLC11A1 polymorphisms for association with pulmonary TB using generalized estimating equations adjusting for age and sex. RESULTS: Two associations were observed in Caucasians (rs3731863, P = 0.03, and rs17221959, P = 0.04) and one in African-Americans (rs3731865, P = 0.05). Multilocus analyses between polymorphisms in SLC11A1 and 11 TB candidate genes detected interactions between SLC11A1 and inducible nitric oxide synthase (NOS2A) in Caucasians (rs3731863 [SLC11A1] x rs8073782 [NOS2A], P = 0.009; rs3731863 [SLC11A1] x rs17722851 [NOS2A], P = 0.007) and toll-like receptor 2 (TLR2) in African-Americans (rs3731865 [SLC11A1] x rs1816702, P = 0.005). CONCLUSIONS: No association was detected with 5'(GT)(n) promoter polymorphism previously associated with lower SLC11A1 expression, rs17235409 (D543N), or rs17235416 (3' TGTG insertion/deletion polymorphism). SLC11A1 polymorphism rs3731865 was associated with TB in African-Americans, consistent with previous findings in West Africans. These results suggest that variants in SLC11A1 increase susceptibility to pulmonary TB and interact with other variants that differ by race.

Panhipopituitarismo: presentación de un caso clínico / Panhypopituitarism: clinical case

El Panhipopituitarismo es el déficit de las hormonas producidas en la adenohipofisis, clínicamente evidente cuando se ha destruido el 70 a 75 de la glándula. Las manifestaciones dependen del tipo de hormona afectada, edad, causa y rapidez de inicio. El déficit hormonal es progresivo: comienza con disminución de la GH, luego de la FSH /LH, TSH y finalmente la ACTH. Una mujer de 63 años de edad ingresa a UCI del hospital Abel Gilbert, con cuadro clínico de estupor, sudoración profusa, despigmentación de la piel, pérdida del vello axilar y pubiano. Antecedentes obstétricos: histerectomía por sangrado profuso y sepsis posparto. Por los datos clínicos y de laboratorio concluimos que se trataba de un Síndrome de Sheehan.

The panhypopituitarism is a deficit of the hormones produced by the adenohypophysis this is clinically evident when the 75 to 70 of the gland is destroyed. The symptoms depend on the type of hormone affected, age, cause and onset. The hormonal deficiency is progressive: it starts with a decrease of GH then of FSH/LH, TSH and finally ACTH. We have a clinical case of 63 year old woman admitted to ICU of Able Gilbert Hospital with a clinical case of stupor, hyperhidrosis, depigmentation of the skin, loss of pubic and axillary hair. Has an obstetric history of hysterectomy post-operative hemorrhaging and sepsis. Due the symptoms and lab findings we conclude that the diagnosis is Sheehan Syndrome.

Integrating qualitative and quantitative methods: comparing HIV-related risk behaviors among Puerto Rican drug users in Puerto Rico and New York.

A dual site project was conducted to assess determinants of injection and sex-related risk behaviors among Puerto Rican drug users. The project focused on injection drug users and crack smokers, and was conducted in East Harlem, NY and Bayamón, PR in 1996-2000. Qualitative methods included ethnographic mapping, focus groups, in-depth interviews, and observations. A survey component (East Harlem, n = 800; Bayamón, n = 400) was also conducted. Procedures to ensure integration of methodologies and comparability of data were developed. This paper describes the qualitative and survey methods used, and presents the comparative HIV risk behaviors. The integration of the two methodologies served multiple functions: each component identified issues to be addressed in the other, enhanced cross-site comparability of data, and assisted in interpretation of findings. The survey data showed high levels of risk behaviors in both communities, with significantly higher levels of risk reported in Bayamón. Conducting studies of similar ethnic groups in different communities provides opportunities to examine diverse sources of influence on risk behaviors. The integration of qualitative and quantitative methods can enhance comparability and understanding of findings, particularly when there are differences in behaviors between communities.

Internal stochastic resonance in the coherence between spinal and cortical neuronal ensembles in the cat.

Internal stochastic resonance is a phenomenon in which the coherence of a non-linear system is enhanced by the presence of a particular, non-zero level of noise generated by internal or external sources without a periodic input signal. The aim of this study was to demonstrate the experimental occurrence of internal stochastic resonance in the coherence between spinal and cortical neuronal ensembles. Simultaneous recordings of spinal and cortical evoked potentials were made in the somatosensory system of the anaesthetized cat. Evoked potentials were produced by input noise introduced in the tactile stimulation of the hindpaw skin. Coherence between the spinal and cortical evoked activity recorded during different levels of input noise was calculated. All animals showed distinct internal stochastic resonance like behavior. We found that the mean coherence was an inverted U-like function of the level of input noise with a mean coherence peak of 0.43. To our knowledge, this is the first documented evidence of such phenomenon in an in vivo preparation of the central nervous system.

Amplitude of somatosensory cortical evoked potentials is correlated with spontaneous activity of spinal neurones in the cat.

Simultaneous recordings of cortical evoked potentials in the posterior sigmoid gyrus, and spontaneous negative cord dorsum potentials (CDPs) of the L6 lumbar spinal segment, were made in the anaesthetised cat. The electrodes were positioned in cortical and spinal somatosensory regions where the largest spontaneous and evoked negative potentials were detected. Evoked potentials were produced by electrical stimulation to cutaneous nerves or by mechanical stimulation of the hindpaw skin. We found that both electrically and mechanically cortical evoked potentials were facilitated during the spontaneous negative CDPs. The magnitude of such facilitation was proportional to the amplitude of the 'conditioning' spontaneous negative CDPs. This led to a high positive correlation between amplitude fluctuations of spontaneous negative CDPs and fluctuations of the cortical evoked potentials. This observation suggests that transmission of cutaneous sensory information in ascending pathways could be facilitated when dorsal horn spinal neurones are active.

Residential status and HIV risk behaviors among Puerto Rican drug injectors in New York and Puerto Rico.

This article investigates the association between residential status and human immunodeficiency virus (HIV) risk behaviors among island and New York Puerto Rican injection drug users (IDUs). We assigned 561 subjects from New York City and 312 from Puerto Rico to five residential status categories: living in parent's home, living in own home, living in other's home, living in temporary housing (hotel, single-room occupancy [SRO] hotels), and homeless (living in streets/shelters). Dependent variables included injection- and sex-related risk behaviors (sharing syringes, sharing other injection paraphernalia, shooting gallery use, and having paid sex). Chi square, t tests, and multivariate logistic analysis tests were performed separately by site. About one-quarter of the sample in each site was homeless. Island Puerto Ricans were more likely to live with their parents (44% vs. 12%, p < .001), and more New York IDUs lived in their own home (30% vs. 14%, p < .001). In New York, gallery use and paid sex were associated with living in other's home, living in parent's home, and being homeless. Sharing paraphernalia was related to living in other's home, living in temporary housing, and being homeless. In Puerto Rico, having paid sex was associated with homelessness. High-risk behaviors were more likely among homeless IDUs in both sites. Programs to provide housing and target outreach and other prevention programs for homeless IDUs would be helpful in reducing HIV risk.

Between-city variation in frequency of injection among Puerto Rican injection drug users: East Harlem, New York, and Bayamon, Puerto Rico.

Frequency of injection has been consistently found to be higher among Puerto Rican Injection drug users (IDUs) than among other groups of IDUs. Several explanations have been suggested, but an empirical explanation has yet to be presented. This study compares the frequency of injection of Puerto Rican IDUs in East Harlem, New York, with that of IDUs in Bayamon, Puerto Rico. Study subjects comprised 521 Puerto Rican IDUs from East Harlem and 303 IDUs from Bayamon. The mean frequency of injection among IDUs in East Harlem was 2.8, the corresponding mean in Bayamon was 5.4. Younger IDUs reported a higher number of daily injection episodes than older IDUs, and the IDU group in Bayamon was 5 years younger than the group in East Harlem. The drug use variables accounted for a greater portion of the between-city difference than the demographic and psychosocial variables. Use of noninjected drugs, as well as the use of prescribed methadone, were found to be associated with a lower number of daily injections. Conversely, injection of cocaine, injection of cocaine mixed with heroin ("speedball"), and injection of larger amounts of drug solution were found to be associated with a higher number of daily injections.

Fibrotic sequelae in pulmonary paracoccidioidomycosis: histopathological aspects in BALB/c mice infected with viable and non-viable paracoccidioides brasiliensis propagules.

Patients with paracoccidioidomycosis often present pulmonary fibrosis and exhibit important respiratory limitations. Based on an already established animal model, the contribution of viable and non-viable P. brasiliensis propagules to the development of fibrosis was investigated. BALB/c male mice, 4-6 weeks old were inoculated intranasally either with 4x10(6) viable conidia (Group I), or 6. 5x10(6) fragmented yeast cells (Group II). Control animals received PBS. Six mice per period were sacrificed at 24, 48, 72h (initial) and 1, 2, 4, 8, 12 and 16 weeks post-challenge (late). Paraffin embedded lungs were sectioned and stained with H&E, trichromic (Masson), reticulin and Grocot&tacute;s. During the initial period PMNs influx was important in both groups and acute inflammation involving 34% to 45% of the lungs was noticed. Later on, mononuclear cells predominated. In group I, the inflammation progressed and granulomas were formed and by the 12th week they fussed and became loose. Thick collagen I fibers were observed in 66.6% and 83.3% of the animals at 8 and 12 weeks, respectively. Collagen III, thick fibers became apparent in some animals at 4 weeks and by 12 weeks, 83% of them exhibited alterations in the organization and thickness of these elements. In group II mice, this pattern was different with stepwise decrease in the number of inflammatory foci and lack of granulomas. Although initially most animals in this group had minor alterations in thin collagen I fibers, they disappeared by the 4th week. Results indicate that tissue response to fragmented yeast cells was transitory while viable conidia evoked a progressive inflammatory reaction leading to granuloma formation and to excess production and/or disarrangement of collagens I and III; the latter led to fibrosis.

Nitric oxide participation in the fungicidal mechanism of gamma interferon-activated murine macrophages against Paracoccidioides brasiliensis conidia.

Paracoccidioidomycosis, a systemic mycosis restricted to Latin America and produced by the dimorphic fungus Paracoccidioides brasiliensis, is probably acquired by inhalation of conidia produced by the mycelial form. The macrophage (Mphi) represents the major cell defense against this pathogen; when activated with gamma interferon (IFN-gamma), murine Mphis kill the fungus by an oxygen-independent mechanism. Our goal was to determine the role of nitric oxide in the fungicidal effect of Mphis on P. brasiliensis conidia. The results revealed that IFN-gamma-activated murine Mphis inhibited the conidium-to-yeast transformation process in a dose-dependent manner; maximal inhibition was observed in Mphis activated with 50 U/ml and incubated for 96 h at 37 degrees C. When Mphis were activated with 150 to 200 U of cytokine per ml, the number of CFU was 70% lower than in nonactivated controls, indicating that there was a fungicidal effect. The inhibitory effect was reversed by the addition of anti-IFN-gamma monoclonal antibodies. Activation by IFN-gamma also enhanced Mphi nitric oxide production, as revealed by increasing NO(2) values (8 +/- 3 microM in nonactivated Mphis versus 43 +/- 13 microM in activated Mphis). The neutralization of IFN-gamma also reversed nitric oxide production at basal levels (8 +/- 5 microM). Additionally, we found that there was a significant inverse correlation (r = -0.8975) between NO(2)(-) concentration and transformation of P. brasiliensis conidia. Additionally, treatment with any of the three different nitric oxide inhibitors used (arginase, N(G)-monomethyl-L-arginine, and aminoguanidine), reverted the inhibition of the transformation process with 40 to 70% of intracellular yeast and significantly reduced nitric oxide production. These results show that IFN-gamma-activated murine Mphis kill P. brasiliensis conidia through the L-arginine-nitric oxide pathway.