Abstract: OBJECTIVE: To establish survival years in patients with a history of preeclampsia and subsequent chronic disease. MATERIALS AND METHODS: Retrospective, descriptive, comparative and analytical study carried out between March 2018 and March 2019 in patients attended at the Hospital General de México Dr. Eduardo Liceaga in follow-up due to pregnancy and diagnosis of chronic kidney disease and history of preeclampsia in any of the pregnancies. RESULTS: We evaluated 66 patients with preeclampsia, average age 23.7 years, and mean age 37.9 years at diagnosis of chronic renal failure. 60.6% had systemic arterial hypertension following the preeclampsia event (OR of 3.34; 95%CI: 0.94-11.95) and onset of chronic renal failure. Kaplan-Meier survival in association with chronic renal failure following preeclampsia was 9.9 years (95%CI: 7.8 -1.8). CONCLUSIONS: Although the relationship between a history of preeclampsia and chronic kidney disease has been demonstrated, studies are still limited. Kaplan-Meier survival shows that at least 50% of patients with CKD had preeclampsia and were diagnosed with CKD 9.9 years later. Based on this study and similar outcomes in international evidence, it can be concluded that multidisciplinary care, prioritizing prevention and including preeclampsia as a risk factor for CKD, is essential.

Resumen: OBJETIVO: Determinar los años de supervivencia en las pacientes con antecedente de preeclampsia y posterior enfermedad renal crónica. MATERIALES Y MÉTODOS: Estudio retrospectivo, descriptivo, comparativo y analítico efectuado entre los meses de marzo de 2018 a marzo de 2019 en pacientes atendidas en el Hospital General de México Dr. Eduardo Liceaga y en seguimiento por embarazo y diagnóstico de enfermedad renal crónica y antecedente de preeclampsia en alguno de los embarazos. RESULTADOS: Se evaluaron 66 pacientes con preeclampsia, con edad promedio de 23.7 años y media de 37.9 años al diagnóstico de insuficiencia renal crónica. Posterior al evento de preeclampsia 60.6% tuvieron hipertensión arterial sistémica (RM de 3.34; IC95%: 0.94-11.95) e iniciaron con insuficiencia renal crónica. La supervivencia Kaplan-Meier en asociación con la insuficiencia renal crónica posterior a preeclampsia fue de 9.9 años (IC95%: 7.8-1.8). CONCLUSIONES: Pese a estar demostrada la relación entre antecedente de preeclampsia y enfermedad renal crónica los estudios aún son limitados. La supervivencia Kaplan-Meier arroja que, por lo menos, el 50% de las pacientes con enfermedad renal crónica tuvieron preeclampsia y a los 9.9 años siguientes se les diagnosticó enfermedad renal crónica. Con base en este estudio y la evidencia internacional puede concluirse que lo primordial es la atención multidisciplinaria, priorizar la prevención e incluir a la preeclampsia como factor de riesgo de enfermedad renal crónica.

Abstract The accumulation of greenhouse gases in the Earth's atmosphere is causing an unprecedented climate change with serious implications, such as extreme weather events and changes in the function and composition of ecosystems. Due to its importance it is relevant to analyze the impact of climate change on livestock systems. An area that requires special attention is precisely animal health, the emergence and re-emergence of vector-borne diseases in numerous regions of the planet are a clear example of the association between climate change and its effects on the human/animal health interface. The effects on health animal can obey multiple social and environmental factors causing the so-called "diseases of production", which influence the appearance of emerging diseases. However, each region and each livestock system has its own vulnerabilities. These aspects must be taken into account for the design of local and regional risk maps, as well as for the efficient design, implementation and socialization of risk management processes for diseases.

Resumen La acumulación de gases de efecto invernadero en la atmósfera terrestre está ocasionando un cambio climático con graves implicaciones, como fenómenos meteorológicos extremos, cambios en la función y composición de los ecosistemas. Debido a su importancia, resulta relevante analizar el impacto del cambio climático en los sistemas de producción pecuarios. Un área que requiere especial atención es precisamente la salud animal, la emergencia y reemergencia de enfermedades vectoriales en numerosas regiones del planeta constituye un claro ejemplo de asociación entre cambio climático y efectos sobre la interfaz de la salud humana/animal. Dichas afectaciones a la salud animal pueden obedecer a múltiples factores sociales y medioambientales, provocando las llamadas “enfermedades de la producción”, los cuales influencian la aparición de enfermedades emergentes. Sin embargo, cada región y cada sistema de producción tiene sus propias vulnerabilidades. Estos aspectos deben tomarse en cuenta para diseñar mapas de riesgos locales y regionales; así como diseñar, instrumentar y socializar eficientemente procesos de manejo de riesgos ante enfermedades.

Abstract: Bovine tuberculosis (bTB) is a chronic disease of cattle and other animal species caused by Mycobacterium bovis. The importance of bTB is that it represents a risk to public health, and causes economic losses to the livestock industry. Because of this, many countries have established control and eradication programs with partial success. Therefore, the search for new strategies to control this disease is relevant. In Mexico, the prevalence of bTB is estimated in 16 % in dairy cattle and in less than 1 % in beef cattle; however, field studies have proved that in spite of the high prevalence in some herds (25-35 %), and long periods of exposure (3 to 5 yr average), the prevalence never reaches 100 %; this suggests that some animals are naturally resistant to tuberculosis. Considering that clinical manifestation of bTB depends on the interaction of various factors, it is reasonable to think that genetic variations in the host can be associated to resistance to this disease. This review, presents the state of the art in this matter; it describes the results of studies performed in different animal species and humans with the purpose of detecting genetic variation associated with disease resistance. The main genes associated with resistance are described and discussed individually. The conclusion is that genetic variation in cattle is associated with resistance to tuberculosis, and that this variation can be identified, measured, and incorporated into the current process of animal selection in the livestock industry to obtain animals more resistant to infection.

Resumen: La tuberculosis bovina (TBb) es una enfermedad crónica del ganado y otras especies animales. Es causada por Mycobacterium bovis, y su importancia radica en el riesgo que representa para la salud pública y en las severas pérdidas ocasionadas a la industria ganadera. Actualmente, muchos países tienen programas de control pero de éxito parcial; por lo tanto, son necesarias nuevas estrategias contra esta enfermedad. En México la prevalencia de tuberculosis bovina se estima en 16 % en ganado lechero, y poco menos de 1 % en ganado para carne; sin embargo, observaciones de campo indican que a pesar de las altas prevalencias en algunos hatos (25-35 %) y la exposición prolongada, la prevalencia nunca llega al 100 %, lo que sugiere que algunos animales son naturalmente resistentes. Considerando que la manifestación clínica de la tuberculosis depende de la interacción de varios factores, es lógico pensar que las variaciones genéticas en el hospedero pueden estar asociadas a resistencia o susceptibilidad. En este trabajo se presenta el resultado de una revisión minuciosa de reportes en la literatura sobre este tema. Se describen de manera resumida trabajos cuyo objetivo es identificar variaciones genéticas entre individuos con y sin la enfermedad, con el propósito de determinar variación genética asociada con resistencia a enfermedades. Se hace mención de los genes frecuentemente relacionados con resistencia. Se concluye que la resistencia a la tuberculosis en el ganado presenta una variación genética que puede ser identificada, medida e incorporada a procesos actuales de selección en ganadería para obtener animales resistentes a la infección.

ABSTRACT Laboratory diagnosis of human leptospirosis usually relies on indirect methods exploring specific immune response. Isolation and identification of the involved strains are cumbersome, but can provide biological resources for pathogenic studies and relevant information for guiding prevention and control measures. The aim of the research we are hereby reporting was the characterization of Leptospira isolates obtained from humans and the environment in Uruguay. Blood cultures were performed from early samples of 302 Uruguayan patients, mainly rural workers, and from 36 water samples taken from their living or working environments. Eight human isolates and seven environmental isolates were obtained and analyzed by end point Polymerase Chain Reaction (PCR), Multilocus Variable Number of Tandem Repeat Analysis (MLVA) and other molecular methods. Human isolates corresponded to several serogroups and serovars of Leptospira interrogans and Leptospira kirschneri species, probably reflecting the infection with similar involved Leptospira species and serovars of an extended animal reservoir in rural settings of the country, mostly dedicated to meat and dairy production. Culture-positive patients were older than usually affected workers, and presented signs and symptoms of severe illness. A high organic and circulating bacterial burden may explain an easier positive result from these workers’ samples. Environmental isolates were mainly identified as Leptospira biflexa strains, with a single L. meyeri isolate of uncertain significance.

Introducción: la leptospirosis es una enfermedad febril, aguda, que presenta manifestaciones clínicas variadas. Esto dificulta o retarda el diagnóstico clínico, por lo cual es útil disponer de métodos de laboratorio adecuados para orientar el manejo inicial de estos pacientes. Objetivo: evaluar un procedimiento de inmunofluorescencia para detectar IgM (IF-IgM) de elaboración propia aplicado al diagnóstico temprano de leptospirosis. Material y método: se analizaron por IF-IgM y microaglutinación (MAT) (tomada como estándar de referencia) sueros obtenidos de pacientes con sospecha clínica de leptospirosis. La sensibilidad y especificidad de la IF-IgM versus MAT se establecieron utilizando una tabla de doble entrada. La concordancia entre dos observadores se determinó por el test Kappa. Resultados: de 161 muestras precoces analizadas, 97 sueros correspondieron a pacientes con infección aguda confirmada por MAT y 64 sin infección. La sensibilidad y especificidad de la IF-IgM con sueros de fase aguda fueron 79% y 100%, respectivamente. El índice Kappa fue 1. Conclusiones: la IF-IgM aparece como una herramienta útil para el diagnóstico temprano de pacientes con leptospirosis. No requiere el manejo de bacterias viables, puede realizarse en laboratorios que cuenten con microscopio de luz ultravioleta, se necesita una sola muestra de suero y el resultado está listo en tres a cuatro horas. En cuanto a las desventajas, no identifica los serovares involucrados y un resultado negativo no descarta la infección. Teniendo en cuenta esto último es obligatorio analizar por MAT una segunda muestra de suero obtenida a los 10-20 días de la primera para descartarla o confirmarla.

Resumo Introdução: a leptospirose é uma doença febril, aguda, com diferentes manifestações clínicas o que dificulta ou atrasa o diagnóstico clínico. Por essa razão é importante contar com métodos de laboratório adequados para orientar o manejo inicial dos pacientes. Objetivo: avaliar uma técnica de imunofluorescencia para detectar IgM (IF-IgM) para o diagnóstico precoce de leptospirose. Material e método: foram analisados por IF-IgM e microaglutinaçao (MAT) (usada como padrão de referencia) soros de pacientes com suspeita clínica de leptospirose. A sensibilidade e a especificidade da IF-IgM comparada com MAT foi determinada usando uma tabela de dupla entrada. A concordância entre dois observadores foi determinada usando o teste Kappa. Resultados: Cento sessenta e uma amostras da fase precoce foram analisadas, sendo 97 de pacientes com infecção aguda confirmada por MAT e 64 sem infecção. A sensibilidade e a especificidade da IF-IgM com soros obtidos na fase aguda foram 79% e 100%, respectivamente. O índice Kappa foi igual a 1. Conclusões: a técnica IF-IgM que desenvolvemos, pode ser uma ferramenta útil para o diagnóstico precoce de pacientes com leptospirose. Não é necessário manipular bactérias viáveis, pode ser realizada em laboratórios que tenham microscópio com luz ultravioleta, somente é necessária uma amostra de soro e o resultado está disponível em três-quatro horas. Com relação às desvantagens, esta técnica não identifica os serovares e um resultado negativo não descarta a presença de infecção. Considerando estas desvantagens, é obrigatório analisar por MAT uma segunda amostra de soro obtida 10 a 20 dias depois da primeira para descartar ou confirmar a infecção.

Abstract Introduction: leptospirosis is a severe febrile disease, with a variety of clinical presentations. This results in the delay of clinical diagnosis, or in difficulties achieving it, so having the appropriate laboratory tests may deem useful to guide the initial care of these patients. Objective: to evaluate a self-made immunofluorescence technique for the detection of IgM antibodies (IF-IgM) in the early diagnosis of leptospirosis. Method: serum samples obtained from patients with a clinical suspicion of leptospirosis were analysed by IF-IgM antibodies and the microagglutination test (MAT) . Sensitivity and specificity of IF-IgM versus MAT were determined using a double entry table. Agreement between two observers was determined by the Kappa test. Results: out of one hundred and sixty one early samples analysed, 97 serum samples corresponded to patients with a confirmed acute infection by MAT and 64 evidenced no infection. Sensitivity and specificity of IF-IgM assays in the acute phase were 79% and 100% respectively. The Kappa value was 1. Conclusions: IF-IgM seems to be a useful tool for the early diagnosis of patients with leptospirosis. It does not need viable bacteria to be handled; it may be applied in laboratories equipped with ultraviolet light microscopes, a single serum sample is needed and the result is seen three to four hours later. As to its disadvantages, it fails to identify the involved serovars and a negative result does not discard infection. Bearing the latter into account, the MAT test is mandatory in a second serum sample obtained 10-20 days after the first one, to either discard or confirm the disease.

Background. The possible influence of vitamin D receptor (VDR) gene polymorphisms on the regulation of the calcium-parathyroid hormone-vitamin D axis is particularly important in end-stage renal disease (ESRD) patients due to alterations in bone mineral metabolism. The aim of the study was to describe the frequency of VDR gene polymorphisms rs7975232 (ApaI), rs731236 (TaqI), rs1544410 (BsmI) and their relationship with serum calcium, phosphate, alkaline phosphatase and parathyroid hormone in children with ESRD. Methods. Thirty one patients were included in the study. Blood samples were drawn for biochemical determinations and DNA extraction. VDR genotypes were analyzed as restriction fragment length polymorphisms using ApaI, BsmI and TaqI. Results. Mean age of the patients was 15.6 ± 3.6 years. For ApaI, seven patients were AA (22.58%), 18 patients were Aa (58.06%) and six patients were aa (19.35%). For BsmI, 14 patients were BB (45.16%) and 17 were Bb (54.83%). Patients who were homozygous for BB had higher serum calcium concentrations than Bb patients (p = 0.04). For TaqI, 19 patients were TT (61.3%), 11 were Tt (35.48%) and one was tt (3.22%). Those with t allele (Tt or tt) had serum calcium concentrations significantly lower than TT patients. Conclusions. Genotype and allele frequency of the VDR gene is reported in Mexican patients with ESRD. Those with BB or TT genotype had higher serum calcium concentrations.

Introducción. La posible influencia de los diferentes polimorfismos del receptor de vitamina D sobre la regulación del eje calcio-hormona paratiroidea -vitamina D es particularmente importante en pacientes con enfermedad renal crónica, ya que cursan con trastornos en el metabolismo mineral óseo. El objetivo del trabajo fue describir la frecuencia de los polimorfismos rs7975232 (ApaI), rs731236 (TaqI) y rs1544410 (BsmI) en el receptor de vitamina D y su relación con el calcio, el fósforo, la fosfatasa alcalina y la hormona paratiroidea en pacientes pediátricos con enfermedad renal crónica. Métodos. Se incluyeron 31 pacientes con enfermedad renal crónica. Se tomaron muestras de sangre a cada uno para la determinación de marcadores bioquímicos y muestras de ADN para la genotipificación del gen del receptor a vitamina D utilizando el método de la reacción en cadena de la polimerasa y restricción enzimática. Resultados. La edad promedio de los pacientes fue de 15.6 ± 3.6 años. Para ApaI, fueron homocigotos AA siete pacientes (22.58%); Aa, 18 pacientes (58.06%) y AA, seis pacientes (19.35%). Para BsmI, 14 pacientes fueron BB (45.16%) y 17 pacientes fueron Bb (54.83%). Los pacientes BB tuvieron calcio sérico mayor que los Bb (p = 0.04). Para TaqI, fueron TT 19 pacientes (61.3%); Tt, once pacientes (35.48%) y uno, tt (3.22%). Aquellos con alelo t (Tt o tt) presentaron concentraciones de calcio sérico significativamente más bajas que el homocigoto TT. Conclusiones. Se reportaron las frecuencias de genotipos y alelos del receptor de vitamina D en niños mexicanos. Se obtuvieron valores de calcio sérico más elevados en aquellos con alelo BB o TT.

Leptospira spp. are delicate bacteria that cannot be studied by usual microbiological methods. They cause leptospirosis, a zoonotic disease transmitted to humans through infected urine of wild or domestic animals. We studied the incidence of this disease in the Uruguayan population, its epidemiologic and clinical features, and compared diagnostic techniques. After examining 6,778 suspect cases, we estimated that about 15 infections/100,000 inhabitants occurred yearly, affecting mainly young male rural workers. Awareness about leptospirosis has grown among health professionals, and its lethality has consequently decreased. Bovine infections were probably the principal source of human disease. Rainfall volumes and floods were major factors of varying incidence. Most patients had fever, asthenia, myalgias or cephalalgia, with at least one additional abnormal clinical feature. 30-40% of confirmed cases presented abdominal signs and symptoms, conjunctival suffusion and altered renal or urinary function. Jaundice was more frequent in patients aged > 40 years. Clinical infections followed an acute pattern and their usual outcome was complete recovery. Laboratory diagnosis was based on indirect micro-agglutination standard technique (MAT). Second serum samples were difficult to obtain, often impairing completion of diagnosis. Immunofluorescence was useful as a screening test and for early detection of probable infections.

El género Leptospira comprende bacterias delicadas, que requieren métodos de estudio especiales. Causan una zoonosis transmitida a los seres humanos por la orina de animales domésticos o silvestres. Estudiamos la incidencia de la leptospirosis en la población humana de Uruguay, sus características epidemiológicas y clínicas, y comparamos técnicas diagnósticas. Tras examinar 6778 casos sospechosos, estimamos que anualmente ocurren unas 15 infecciones/100.000 habitantes, principalmente en trabajadores rurales jóvenes de sexo masculino. El nivel de alerta sobre la leptospirosis ha avanzado en el personal sanitario, y su letalidad ha descendido. La enfermedad humana se asocia principalmente con las infecciones bovinas. Lluvias e inundaciones influyen sobre su incidencia. La mayoría de los pacientes experimentaron fiebre, astenia, mialgias o cefaleas, con al menos un síntoma o signo adicional. 30 a 40% presentaban sintomatología abdominal, hiperemia conjuntival o alteraciones nefro-urológicas. La ictericia era más frecuente en mayores de 40 años. La enfermedad era habitualmente aguda y la recuperación completa. El diagnóstico de laboratorio se basó en la técnica de microaglutinación (MAT), con cepas vivas de distintos serovares. Se requieren segundas muestras de suero, de difícil obtención. El test de inmunofluorescencia se reveló útil para screening y detección precoz de la infección.