RESUMEN
Fusarium wilt of banana (Musa spp.), caused by the soil-borne fungus Fusarium oxysporum f. sp. cubense (Foc), is a major constraint to banana production worldwide (Dita et al., 2018). A strain of Foc that affects Cavendish (AAA) bananas in the tropics, called Foc tropical race 4 (TR4; VCG 01213), is of particular concern. Foc TR4 was first detected in Malaysia and Indonesia around 1990 but was restricted to Southeast Asia and northern Australia until 2012. The fungus has since been reported from Africa, the Indian subcontinent, and the Middle East (Viljoen et al., 2020). Foc TR4 was detected in Colombia in 2019 and in Perú in 2021 (Reyes-Herrera et al., 2020). The incursions into Latin America and the Caribbean (LAC) triggered global concerns, as 75% of international export bananas are produced in the region. Banana production in Venezuela, however, is primarily intended for domestic consumption (Aular and Casares, 2011). In 2021 the country produced 533,190 metric tons of banana on an area of 35,896 ha, with an approximate yield of 14,853 kg/ha (FAOSTAT, 2023). In July 2022, severe leaf-yellowing, and wilting, along with internal vascular discoloration of the pseudostem, were noted in Cavendish banana plants cultivar 'Valery' in the states of Aragua (10°11'8â³N; 67°34'51â³W), Carabobo (10º14'24â³N; 67º48'51â³W), and Cojedes (9°37'44â³N; 68°55'4â³W). Necrotic strands from the pseudostems of diseased plants were collected for identification of the causal agent using DNA-based techniques, vegetative compatibility group (VCG) analysis and pathogenicity testing. The samples were first surface disinfected and plated onto potato dextrose agar medium. Single-spored isolates were identified as F. oxysporum based on cultural and morphological characteristics, including white colonies with purple centres, infrequent macroconidia, abundant microconidia on short monophialides, and terminal or intercalary chlamydospores (Leslie and Summerell, 2006). Foc TR4 was identified from five isolates by endpoint and quantitative-PCR using four different primer sets (Li et al. 2013; Dita et al. 2010; Aguayo et al. 2017; Matthews et al. 2020). The same isolates were identified as VCG 01213 by successfully pairing nitrate non-utilizing (nit-1) mutants of the unknown strains with Nit-M testers of Foc TR4 available at Stellenbosch University (Leslie and Summerell, 2006). For pathogenicity testing, 3-month-old Cavendish banana plants cultivar 'Williams' were inoculated with isolates from Venezuela grown on sterile millet seed (Viljoen et al., 2017). Plants developed typical Fusarium wilt symptoms 60 days after inoculation, including yellowing of leaves that progressed from the older to the younger leaves, wilting, and internal discoloration of the pseudostem. Koch's postulates were fulfilled by reisolating and identifying Foc TR4 from the plants by qPCR (Matthews et al., 2020). These results provide scientific proof of the presence of Foc TR4 in Venezuela. The Venezuelan Plant Protection Organization (INSAI) has declared Foc TR4 as a newly introduced pest (January 19, 2023), and infested banana fields were placed under quarantine. Comprehensive surveys are now conducted in all production areas in Venezuela to assess the presence and impact of Foc TR4, and information campaigns were started to make farmers aware of biosecurity protocols. Collaborative initiatives and coordinated actions among all stakeholders are needed to prevent the spread of Foc TR4 to other countries in Latin America, and to develop Foc TR4-resistant bananas (Figueiredo et al. 2023).
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Introducción: El derrame pleural paraneumónico resulta la complicación más frecuente de la neumonía bacteriana, de manejo complejo y muchas veces quirúrgico. No existen publicaciones en Cuba provenientes de ensayos clínicos controlados y aleatorizados ni del uso de la estreptoquinasa recombinante (Heberkinasa®) en el derrame pleural. Objetivo: Evaluar la eficacia y la seguridad de la Heberkinasa® en el tratamiento del derrame pleural paraneumónico complicado complejo y el empiema en niños. Métodos: Ensayo clínico fase III, abierto, aleatorizado (2:1), en grupos paralelos y controlado. Se concluyó la inclusión prevista de 48 niños (1-18 años de edad), que cumplieron los criterios de selección. Los progenitores otorgaron el consentimiento informado. Los pacientes se distribuyeron en dos grupos: I- experimental: terapia estándar y administración intrapleural diaria de 200 000 UI de Heberkinasa® durante 3-5 días y II-control: tratamiento estándar. Las variables principales: necesidad de cirugía y la estadía hospitalaria. Se evaluaron los eventos adversos. Resultados: Ningún paciente del grupo I-experimental requirió cirugía, a diferencia del grupo II-control en el que 37,5 por ciento necesitó cirugía video-toracoscópica, con diferencia altamente significativa. Se redujo la estadía hospitalaria (en cuatro días), las complicaciones intratorácicas y las infecciones asociadas a la asistencia sanitaria en el grupo que recibió Heberkinasa®. No se presentaron eventos adversos graves atribuibles al producto. Conclusiones: La Heberkinasa® en el derrame pleural paraneumónico complicado complejo y empiema resultó eficaz y segura para la evacuación del foco séptico, con reducción de la necesidad de tratamiento quirúrgico, de la estadía hospitalaria y de las complicaciones, sin eventos adversos relacionados con su administración(AU)
Introduction: Paraneumonic pleural effusion is the most frequent complication of bacterial pneumonia, with complex and often surgical management. There are no publications in Cuba from randomized controlled clinical trials or the use of recombinant streptokinase (Heberkinase®) in pleural effusion. Objective: To evaluate the efficacy and safety of Heberkinase® in the treatment of complex complicated parapneumonic pleural effusion and empyema in children. Methods: Phase III, open-label, randomized (2:1), parallel-group, controlled clinical trial. The planned inclusion of 48 children (1-18 years of age), who met the selection criteria, was completed. Parents gave informed consent. The patients were divided into two groups: I-experimental: standard therapy and daily intrapleural administration of 200,000 IU of Heberkinase® for 3-5 days; and II-control: standard treatment. The main variables: need for surgery and hospital stay. Adverse events were evaluated. Results: No patient in group I-experimental required surgery, unlike group II-control in which 37.5 percent required video-assisted thoracoscopic surgery, with a highly significant difference. Hospital stay (to 4 days), intrathoracic complications and infections associated to healthcare in the group that received Heberkinase® was reduced. No serious adverse events attributable to the product occurred. Conclusions: Heberkinase® in complex complicated parapneumonic pleural effusion and empyema was effective and safe for the draining of the septic focus, with reduction of the need for surgical treatment, hospital stay and complications, with no adverse events related to its administration(AU)
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Humanos , Lactante , Preescolar , Niño , Adolescente , Derrame Pleural/complicaciones , Neumonía/complicaciones , Estreptoquinasa/uso terapéutico , Resultado del Tratamiento , Empiema Pleural/tratamiento farmacológico , Neumonía Bacteriana/etiología , Unidades de Cuidado Intensivo Pediátrico , Ensayo Clínico Controlado Aleatorio , Ensayo Clínico Fase IIIRESUMEN
With the aim of identifying key factors that determine oviposition decisions by Anastrepha obliqua for management purposes, we conducted a behavioral study under natural/semi-natural field conditions to identify where exactly in the fruit (upper, middle, or lower sections) females preferred to lay eggs in a highly susceptible mango cultivar ("Criollo"), and whether sunlight incidence and fruit chemical compounds influenced oviposition site selection by this pestiferous fly. Females oviposited in shaded, upper fruit sections where pulp had higher total carbohydrate concentrations but similar total protein, lipid, and polyphenol concentrations than non-oviposited sections. Peel had higher overall nutrient and mangiferin/quercetin-3-D-galactoside (polyphenols) concentrations. An untargeted metabolomic analysis of oviposited and non-oviposited fruit sections identified abscisic acid (ABA) and dihydrophaseic acid glucoside, a by-product of ABA catabolism, as potential chemical markers that could play a role in fruit acceptance behaviors by female flies. We conclude that females preferentially oviposit in fruit sections with optimal chemical and environmental conditions for larval development: more carbohydrates and antioxidants such as mangiferin and ferulic acid and lesser sunlight exposure to avoid lethal egg/larval desiccation/overheating. We make specific recommendations for A. obliqua management based on female host selection behavior, a tree pruning scheme exposing fruit to direct sunlight, application of a host marking pheromone, and the use of egg sinks in the orchard.
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Introducción: La presentación clínica de la enfermedad provocada por el SARS-CoV-2 es heterogénea. Los pacientes pueden ser asintomáticos o tener una enfermedad leve de las vías respiratorias superiores o desarrollar una neumonía grave que puede progresar al síndrome de dificultad respiratoria aguda y provocar la muerte. La fisiopatología de las formas graves de la enfermedad se caracteriza por una marcada hiperinflamación. Las terapias que modulan la respuesta inmunitaria pueden ser cruciales para tratar y prevenir este estado. El péptido CIGB-258, marca comercial Jusvinza, es una opción terapéutica para este propósito, por sus propiedades inmunomoduladoras. Objetivo: Describir la evolución clínica de un paciente pediátrico con neumonía grave por SARS-CoV-2, tratado con el péptido CIGB-258 Presentación del caso: Adolescente de 12 años con epilepsia refractaria, parálisis cerebral infantil y antecedentes epidemiológicos de contacto con paciente positivo a test confirmatorio de reacción en cadena de la polimerasa con transcriptasa inversa para SARS-CoV-2 que ocho días después del contacto, muestra evidencias clínicas, radiográficas y de laboratorio de neumonía grave por COVID-19. Dentro del protocolo terapéutico, recibió tratamiento con el péptido inmunomodulador CIGB-258, con una evolución favorable y egreso hospitalario. Conclusiones: El uso del péptido CIGB-258 en el tratamiento de la neumonía grave por COVID-19 en pediatría, podría contribuir a evitar la progresión hacia las etapas críticas de la enfermedad(AU)
Introduction: The clinical presentation of the disease caused by SARS-CoV-2 is heterogeneous. Patients may be asymptomatic or have mild upper respiratory tract disease, or develop severe pneumonia that can progress to acute respiratory distress syndrome and lead to death. The pathophysiology of severe forms of the disease is characterized by a marked hyperinflammation. Therapies that modulate the immune response can be crucial in treating and preventing this state. The CIGB-258 peptide, brand name Jusvinza, is a therapeutic option for this purpose, due to its immunomodulatory properties. Objective: Describe the clinical evolution of a pediatric patient with severe pneumonia due to SARS-CoV-2, and treated with the CIGB-258 peptide. Case Presentation: A 12-year-old adolescent with refractory epilepsy, infantile cerebral palsy, and an epidemiological history of contact with a patient positive to PCR confirmatory test for SARS-CoV-2 who, eight days after contact, shows clinical, radiographic, and laboratory evidence of severe pneumonia due to COVID-19. Within the therapeutic protocol, he received treatment with CIGB-258 immunomodulatory peptide, with a favorable evolution and hospital discharge. Conclusions: The use of CIGB-258 peptide in the treatment of severe pneumonia due to COVID-19 in pediatrics could contribute to prevent progression to the critical stages of the disease(AU)
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Humanos , Femenino , Niño , Neumonía/fisiopatología , Síndrome de Dificultad Respiratoria del Recién Nacido/etiología , SARS-CoV-2 , COVID-19/epidemiología , Evolución Clínica , Protocolos ClínicosRESUMEN
BACKGROUND: Hepatic and biliary diseases are prevalent worldwide, but the majority of people lack access to diagnostic medical imaging for their assessment. The liver and gallbladder are readily amenable to sonographic examination, and ultrasound is a portable, cost-effective imaging modality suitable for use in rural and underserved areas. However, the deployment of ultrasound in these settings is limited by the lack of experienced sonographers to perform the exam. In this study, we tested an asynchronous telediagnostic system for right upper quadrant abdominal ultrasound examination operated by individuals without prior ultrasound experience to facilitate deployment of ultrasound to rural and underserved areas. METHODS: The teleultrasound system utilized in this study employs volume sweep imaging and a telemedicine app installed on a tablet which connects to an ultrasound machine. Volume sweep imaging is an ultrasound technique in which an individual scans the target region utilizing preset ultrasound sweeps demarcated by easily recognized external body landmarks. The sweeps are saved as video clips for later interpretation by an experienced radiologist. Teleultrasound scans from a Peruvian clinic obtained by individuals without prior ultrasound experience were sent to the United States for remote interpretation and quality assessment. Standard of care comparison was made to a same-day ultrasound examination performed by a radiologist. RESULTS: Individuals without prior ultrasound experience scanned 144 subjects. Image quality was rated "poor" on 36.8% of exams, "acceptable" on 38.9% of exams, and "excellent" on 24.3% of exams. Among telemedicine exams of "acceptable" or "excellent" image quality (n = 91), greater than 80% of the liver and gallbladder were visualized in the majority of cases. In this group, there was 95% agreement between standard of care and teleultrasound on whether an exam was normal or abnormal, with a Cohen's kappa of 0.84 (95% CI 0.7-0.98, p <0.0001). Finally, among these teleultrasound exams of "acceptable" or "excellent" image quality, the sensitivity for cholelithiasis was 93% (95% CI 68.1%-99.8%), and the specificity was 97% (95% CI 89.5%-99.6%). CONCLUSION: This asynchronous telediagnostic system allows individuals without prior ultrasound experience to effectively scan the liver, gallbladder, and right kidney with a high degree of agreement with standard of care ultrasound. This system can be deployed to improve access to diagnostic imaging in low-resource areas.
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Abdomen/diagnóstico por imagen , Procesamiento de Imagen Asistido por Computador/métodos , Telemedicina , Ultrasonografía , Colelitiasis/diagnóstico , Hígado Graso/diagnóstico , Humanos , Área sin Atención Médica , Perú , Población Rural , Sensibilidad y EspecificidadRESUMEN
BACKGROUND: Ninety-four percent of all maternal deaths occur in low- and middle-income countries, and the majority are preventable. Access to quality Obstetric ultrasound can identify some complications leading to maternal and neonatal/perinatal mortality or morbidity and may allow timely referral to higher-resource centers. However, there are significant global inequalities in access to imaging and many challenges to deploying ultrasound to rural areas. In this study, we tested a novel, innovative Obstetric telediagnostic ultrasound system in which the imaging acquisitions are obtained by an operator without prior ultrasound experience using simple scan protocols based only on external body landmarks and uploaded using low-bandwidth internet for asynchronous remote interpretation by an off-site specialist. METHODS: This is a single-center pilot study. A nurse and care technician underwent 8 h of training on the telediagnostic system. Subsequently, 126 patients (68 second trimester and 58 third trimester) were recruited at a health center in Lima, Peru and scanned by these ultrasound-naïve operators. The imaging acquisitions were uploaded by the telemedicine platform and interpreted remotely in the United States. Comparison of telediagnostic imaging was made to a concurrently performed standard of care ultrasound obtained and interpreted by an experienced attending radiologist. Cohen's Kappa was used to test agreement between categorical variables. Intraclass correlation and Bland-Altman plots were used to test agreement between continuous variables. RESULTS: Obstetric ultrasound telediagnosis showed excellent agreement with standard of care ultrasound allowing the identification of number of fetuses (100% agreement), fetal presentation (95.8% agreement, κ =0.78 (p < 0.0001)), placental location (85.6% agreement, κ =0.74 (p < 0.0001)), and assessment of normal/abnormal amniotic fluid volume (99.2% agreement) with sensitivity and specificity > 95% for all variables. Intraclass correlation was good or excellent for all fetal biometric measurements (0.81-0.95). The majority (88.5%) of second trimester ultrasound exam biometry measurements produced dating within 14 days of standard of care ultrasound. CONCLUSION: This Obstetric ultrasound telediagnostic system is a promising means to increase access to diagnostic Obstetric ultrasound in low-resource settings. The telediagnostic system demonstrated excellent agreement with standard of care ultrasound. Fetal biometric measurements were acceptable for use in the detection of gross discrepancies in fetal size requiring further follow up.
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Atención Perinatal , Consulta Remota/métodos , Desarrollo de Personal , Telemedicina/métodos , Ultrasonografía Prenatal , Diagnóstico Precoz , Intervención Médica Temprana/normas , Femenino , Humanos , Obstetricia/educación , Atención Perinatal/métodos , Atención Perinatal/normas , Perú/epidemiología , Pruebas en el Punto de Atención/organización & administración , Embarazo , Trimestres del Embarazo , Mejoramiento de la Calidad/organización & administración , Servicios de Salud Rural/normas , Servicios de Salud Rural/tendencias , Enfermería Rural/métodos , Desarrollo de Personal/métodos , Desarrollo de Personal/organización & administración , Ultrasonografía Prenatal/métodos , Ultrasonografía Prenatal/normasRESUMEN
Anastrepha ludens is a key pest of mangoes and citrus from Texas to Costa Rica but the mechanisms of odorant perception in this species are poorly understood. Detection of volatiles in insects occurs mainly in the antenna, where molecules penetrate sensillum pores and link to soluble proteins in the hemolymph until reaching specific odor receptors that trigger signal transduction and lead to behavioral responses. Scrutinizing the molecular foundation of odorant perception in A. ludens is necessary to improve biorational management strategies against this pest. After exposing adults of three maturity stages to a proteinaceous attractant, we studied antennal morphology and comparative proteomic profiles using nano-LC-MS/MS with tandem mass tags combined with synchronous precursor selection (SPS)-MS3. Antennas from newly emerged flies exhibited dense agglomerations of olfactory sensory neurons. We discovered 4618 unique proteins in the antennas of A. ludens and identified some associated with odor signaling, including odorant-binding and calcium signaling related proteins, the odorant receptor co-receptor (Orco), and putative odorant-degrading enzymes. Antennas of sexually immature flies exhibited the most upregulation of odor perception proteins compared to mature flies exposed to the attractant. This is the first report where critical molecular players are linked to the odor perception mechanism of A. ludens.
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Frutas/química , Feromonas/farmacología , Proteoma/análisis , Proteoma/metabolismo , Tephritidae/metabolismo , Animales , Tephritidae/efectos de los fármacosRESUMEN
Despite their enormous economic importance and the fact that there are almost 5000 tephritid (Diptera) species, fruit fly - host plant interactions are poorly understood from a chemical perspective. We analyzed the interactions among Anastrepha acris (a little studied monophagous tephritid) and its highly toxic host plant Hippomane mancinella from chemical, ecological and experimental perspectives, and also searched for toxicants from H. mancinella in the larval-pupal endoparasitoid Doryctobracon areolatus. We identified 18 phenolic compounds from H. mancinella pulp belonging to different chemical groups including phenylpropanoids, flavonoids, chalcones and coumarins. No traces of Hippomanin A were detected in larvae, pupae or A. acris adults, or in D. areolatus adults, implying that A. acris larvae can metabolize this toxicant, that as a result does not reach the third trophic level. We tested the "behavioral preference - lack of larval specialization-hypothesis" via feeding experiments with a larval rearing medium containing H. mancinella fruit (skin + pulp or pulp alone). The high toxicity of H. mancinella was confirmed as only two (out of 2520 in three experiments) A. ludens larvae (a polyphagous pest species that preferentially feeds on plants within the Rutaceae) survived without reaching the adult stage when fed on media containing H. mancinella, whereas A. acris larvae developed well and produced healthy adults. Together, these findings open a window of opportunity to study the detoxification mechanisms used by tephritid fruit flies.
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Cadena Alimentaria , Hippomane/química , Interacciones Huésped-Parásitos , Larva/parasitología , Fenoles/metabolismo , Pupa/parasitología , Tephritidae/fisiología , Tephritidae/parasitología , Avispas/fisiología , Animales , Preferencias Alimentarias , Larva/crecimiento & desarrollo , Pupa/crecimiento & desarrollo , Tephritidae/crecimiento & desarrollo , Avispas/crecimiento & desarrolloRESUMEN
El bocio congénito es una patología infrecuente, que se genera por alteración de la función tiroidea fetal de causa endógena o exógena: disfunción tiroidea materna, déficit de aporte de yodo en la dieta o secundario a la toma de medicación. La repercusión en la maduración del feto, la compresión de estructuras adyacentes debido al aumento de tamaño, lo cual puede ser un factor de riesgo de obstrucción de la vía aérea y de lesiones hipóxico-isquémicas, hacen que el diagnóstico y tratamiento de esta patología sea de vital importancia. Habitualmente, se diagnostica por ecografía en el segundo o tercer trimestre de embarazo, pero la resonancia magnética (RM) se ha convertido en una técnica diagnóstica complementaria e importante ante un eventual tratamiento intraparto
Congenital goiter is an uncommon condition caused by altered fetal thyroid function of endogenous or exogenous cause (maternal thyroid dysfunction, iodine deficiency in the diet or secondary to taking medication). The impact on the mature development of the fetus, as well as the compression of adjacent structures due to increased size, which may be a risk factor for airway obstruction and hypoxic-ischemic lesions, make the diagnosis and treatment of this pathology of vital importance. It is usually diagnosed by ultrasound in the second or third trimester of pregnancy, but magnetic resonance imaging (MRI) has become a complementary and important diagnostic technique in the event of an intrapartum treatment procedure
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Humanos , Bocio , Recién Nacido , Imagen por Resonancia Magnética , UltrasonografíaRESUMEN
En este estudio se evaluó, in vitro, la capacidad de acumulación de mercurio (Hg) que pueda poseer la caña flecha (Gynerium sagittatum) (Aubl) Beauv. como una alternativa viable de ser implementada para la rehabilitación de suelos contaminados. Este estudio fue realizado en el laboratorio de Biotecnología Vegetal de la Universidad de Sucre (9º18 N, 75º23 O). Se usó un diseño experimental de bloques al azar, un análisis de varianza para comparación de medias, una prueba de Tukey (p≤0,05) para la establecer las diferencias significativas entre los tratamientos, pruebas de normalidad (Kolmogorov-Smirnov) y test de homogeneidad de varianza de Bartlett. Los análisis de mercurio se realizaron en un espectrofotómetro de absorción atómica Thermo Electron S4, provisto de una celda con ventanas de cuarzo, por el método de espectroscopia de absorción atómica con vapor frío. Los resultados muestran que la parte de la planta que presenta mayor acumulación es la raíz con 55,98 µg g-1 HgT, seguida de los tallos-hojas con 14,84 µg g-1 HgT, valores relacionados con el grado de concentración del metal en el medio de cultivo. Además, la acumulación de mercurio en raíces y tallos aumentó con el tiempo. En conclusión, in vitro esta planta acumula Hg debido a las altas concentraciones en sus tejidos sin afectar la viabilidad de las plantas.
In this in vitro study was evaluated the potential for accumulation of mercury (Hg) that can hold the cane arrow (Gynerium sagittatum) (Aubl) Beauv. as a viable alternative to be implemented for the rehabilitation of contaminated soils. This study was conducted at the Plant Biotechnology Laboratory, University of Sucre (9º 18' N, 75° 23' W). An experimental design was randomized block, an analysis of variance to compare means, Tukey test (p ≤ 0.05) to establish significant differences between the treatments, tests of normality (Kolmogorov-Smirnov) and homogeneity test Bartlett variance. The mercury analyses were performed on atomic absorption spectrophotometer Thermo Electron S4, a cell equipped with quartz windows, by the method of atomic absorption spectrometry with cold steam. The results show that the plant part that presents the greatest accumulation is the root with 55.98 mg g-1 HgT, followed by the stems, leaves 14.84 g g-1 HgT and these values are related to the degree of metal concentration in the culture medium. Furthermore, the accumulation of mercury in roots and stems increased with time. In conclusion, in vitro this plant accumulates due to the high Hg concentrations in their tissues without affecting the viability of plants.
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Metales Pesados/aislamiento & purificación , Metales Pesados/análisis , Metales Pesados/efectos adversos , Metales Pesados/efectos de la radiación , Metales PesadosRESUMEN
OBJECTIVE: To evaluate the impact of preventive programs at enterprises affiliated to the Instituto Mexicano del Seguro Social (IMSS) during 2004. METHODS: Transversal study in 987 enterprises. VARIABLES: labor injuries (LI) of temporal disability, permanent disability and death. ANALYSIS: simple and relative frequencies, rates and Anova application to differences. RESULTS: 64.4% of the enterprises decrease LI (p < 0.04), with a decrement of 2602 LI (16%); the rate of LI per 100 workers declined from 4.19 to 3.60 (p < 0.08), with a decrease of 43,369 disability days (10.93%), which represents $8,456,955 MXP. States with larger decreases were: Queretaro (80%) p < 0.05; Sinaloa (63%) p < 0.05, and Morelos (61%) p < 0.05. Permanent incapacities diminished at 12.1%, p < 0.09; the rate of permanent disability per 1000 workers diminished from 1.37 to 1.32 and death cases increased from 42 to 49. CONCLUSIONS: the expenses on consultancy by IMSS was estimated as $9,341,955 MXP. The savings on temporal and permanent incapacities was $33,691,255 MXP with a cost containment of $19,701,310 MXP. Preventive programs are profitable, because they generate benefits to the workers, the IMSS and the enterprises.
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Accidentes de Trabajo/prevención & control , Salud Laboral , Estudios Transversales , Humanos , México , Prevención PrimariaRESUMEN
La tuberculosis (TB) pulmonar multidrogorresistente (MDR) constituye un problema de salud pública debido a lo complicado del tratamiento y sus tasas de cura menores que la TB Sensible. Un aspecto adicional estß constituido por el manejo de los contactos que desarrollan enfermedad (casos secundarios) y en quienes no se puede precisar el tipo de tratamiento requerido al desconocerse su perfil de sensibilidad en ese momento. Para determinar el grado de concordancia entre las pruebas de sensibilidad de los casos índice y los casos secundarios, se llevó a cabo un estudio retrospectivo, descriptivo, revisßndose registros clínicos y pruebas de sensibilidad a drogas de primera línea de casos secundarios y sus casos índice diagnosticados de TB MDR entre el 2000 y 2005 en la jurisdicción de la DISA Callao. Cumplieron criterios de inclusión 27 pacientes. La frecuencia de concordancia (pruebas idénticas) fue de 40.7 por ciento y la frecuencia de cepas MDR entre los casos secundarios fue 66.7 por ciento, siendo el restante 18.5 por ciento de los casos secundarios pansensibles a drogas de primera línea, y otro 14.8 por ciento pacientes drogoresistentes (DR) no MDR. Con respecto al anßlisis multivariado, el antecedente del caso índice de haber recibido mßs de 2 tratamientos antituberculosos se asoció con la concordancia entre las pruebas de sensibilidad estudiadas y con la presencia de cepas MDR en el caso secundario. Se concluye que es necesario de manera rutinaria asegurar una prueba de sensibilidad para identificación de drogo resistencia y que nuestros hallazgos justifican el empleo de un tratamiento estandarizado para los casos secundarios que debe ser ajustado de acuerdo a la prueba de sensibilidad solicitada antes de iniciar el tratamiento.
Multidrug-resistant (MDR) pulmonary tuberculosis represents a public health problem due to the complexity of its therapy and minor recovery rates comparing with drug susceptible tuberculosis. An additional aspect is related to the management of the contacts that develop the disease (secondary cases) in which cases it can not be defined the type of therapy they need because the drug-susceptibility pattem are unknown in this moment. To determinate the concordance degree of drug-susceptibility assays between index and secondary cases, it was performed a retrospective descriptive survey. Clinical records and first-line drug susceptibility tests of secondary cases and its index cases diagnosed with multidrug-resistant tuberculosis were reviewed between 2000 and 2005 in the jurisdiction of DISA Callao. Twenty-four patients fulfilled inclusion criteria. The rate of concordance (identical patterns) was 40.7 per cent and the rate of MDR strains in secondary cases was 66.7 per cent, there mainder 18.5 per cent were susceptible to all first-line drugs and 14.8 per cent patients were drug resistant (DR) not MDR. With regard to multivariate analysis, the index case record of having more than 2 anti-tuberculous regimens was associated with total concordance between drug-susceptibility assays and it was associated with the presence of MDR strains among secondary cases. We conclude that it is routinely necessary to make sure a susceptibility assay for identifying drug-resistance and conclude that our findings justify the use of a standardized retreatment regimen for secondary cases which must be adjusted in agreement with the susceptibility assay requested before the therapy.
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Humanos , Masculino , Femenino , Mycobacterium tuberculosis , Tuberculosis , Tuberculosis Pulmonar , Tuberculosis Resistente a Múltiples MedicamentosRESUMEN
O uso de implantes dentais é dificilmente contra-indicado por uma doença sistêmica prévia. Dentre as contra-indicações absolutas as seguintes condições são citadas: presença de infecção, paciente sistemicamente comprometido, não existência de osso viável na região de instalação dos implantes. Existe um grupo de pacientes, os que fazem uso crônico de bifosfonato, fármaco inibidor da reabsorção óssea, indicado para o tratamento de mieloma múltiplo, de metástases ósseas, hipercalcimia maligna, osteoporose e artrite reumatóide que podem apresentar como efeito adverso a osteonecrose dos maxilares. O objetivo deste trabalho é alertar para uma possível complicação em pacientes candidatos à terapia por implantes dentais que fazem uso de bifosfonatos, através de revisão da literatura e um relato de caso clínico onde o indivíduo desenvolveu exposição de tecido ósseo necrótico após a reabilitação através de um protocolo inferior, um ano após o término do tratamento.
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Humanos , Femenino , Anciano , Difosfonatos , Difosfonatos/efectos adversos , /efectos adversos , OsteonecrosisRESUMEN
Se comunica un caso de quiste congénito del colédoco en una recién nacida de 12 días, documentada clínica e histopatológicamente. Discutimos los hallazgos clínicos y los procedimientos diagnósticos utilizados