Objetivo: Evaluar la concordancia del método manual MGIT AST SIRE (mycobacteria growth indicator tube for antimicrobial susceptibility testing to isoniazid, rifampin, ethambutol and streptomycin) frente al método de proporciones múltiples (PM) para determinar susceptibilidad antimicrobiana en cepas de Mycobacterium tuberculosis. Métodos: Se analizaron 45 cepas de M. tuberculosis aisladas en la ciudad de Montería, entre 2003 y 2005, para susceptibilidad a (INH), rifampicina (RMP), etambutol (EMB) y estreptomicina (SM). El análisis de concordancia del método MGIT manual vs PM, se realizó con la prueba Kappa. Resultados: De las 45 cepas analizadas, 38 tuvieron idéntico resultado con ambos métodos y 7 tuvieron resultados discordantes. Los porcentajes globales de resistencia a drogas antituberculosas de las cepas analizadas por el MGIT manual y las PM fueron de 33.3% y 31.1%, respectivamente, la MDR fue 5 (11.1%) por PM y de 4 (8.8%) por MGIT manual. La concordancia del MGIT AST SIRE con el PM fue 95.5% para cada una de las drogas analizadas y kappa global de 0.8374. En cada antibiótico se encontraron dos cepas discordantes para INH, RIF (un falso resistente y un falso susceptible). En STR y EMB (dos falsos sensibles). El tiempo promedio de resultado para cualquiera de los antimicrobianos fue 6.5 días (rango 5-8 días) por MGIT, mientras que para PM fue 20 a 25 días. Conclusión: El presente estudio mostró que MGIT manual es concordante con PM, es rápido, sencillo y eficaz, para determinar la susceptibilidad de cepas de M. tuberculosis.

Objective: To evaluate the agreement of manual MGIT (mycobacteria growth indicator tube for antimicrobial susceptibility testing to isoniazid, rifampin, ethambutol and streptomycin) for susceptibility testing vs proportion method on Lowenstein-Jensen (PM) in Mycobacterium tuberculosis strains. Methods: A total of forty-five isolates of M. tuberculosis were tested for susceptibility to isoniazid (INH), rifampin (RMP), ethambutol (EMB), and streptomycin (SM). The strains were isolated in Montería, during 2003 and 2005. The agreement between the two assays mentioned was estimated by the Kappa test. Results: There were thirty-eight strains with identical results while 7 had discrepant results with both methods. The overall resistance to antituberculosis drugs were 33.3% y 31.1% for manual MGIT and PM, respectively. MDR was 5 (11.1%) by PM and 4 (8.8%) by manual MGIT. The agreement between MGIT AST and PM was 95.5% for all drug tested and overall kappa value 0.8374. Two discrepancies were found in each drug; with INH and RIF (one false resistant and one false susceptible). STR and EMB (two false susceptibles). Turnaround times were 5 to 8 days (median, 6.5 days) for MGIT and 20 to 25 days for MP. Conclusions: These preliminary data show a good level of agreement between manual MGIT AST SIRE and MP. Also MGIT is a rapid, easy and efficient method for the drug susceptibility testing of M. tuberculosis.

Objetivo: Analizar la susceptibilidad antimicrobiana y la variabilidad genética de algunas cepas de Mycobacterium tuberculosis aisladas en la ciudad de Montería. Métodos: Se incluyeron pacientes con diagnóstico clínico de tuberculosis y se tomaron datos sociodemográficos y epidemiológicos. Las muestras de esputos se cultivaron en el medio de Lowenstein-Jensen. Se llevaron a cabo las pruebas de susceptibilidad antimicrobiana por el método de las proporciones múltiples y rifoligotyping de segunda generación. La variabilidad genética se estudió a través del RFLP. Resultados: Mycobacterium tuberculosis se aisló en 67 personas con tuberculosis pulmonar. La baciloscopia fue positiva en 59 (88%) y la edad estuvo entre 14 y 83 años (media 41.5 años). La resistencia fue 29.2% (14/48), y la multirresistencia 6.7% (3/48). La técnica rifoligotyping descubrió 4 cepas con mutación en el gen rpoB, región hot spot codón 531. El número de copias de IS6110 varió entre 3 y 13 y 12 (48%) cepas presentaron entre 8 y 9 copias. El RFLP permitió establecer dos grupos A y B. El grupo A estuvo conformado por 20 (80%) cepas, con un único cluster formado por los pacientes 17, 45, 54. El grupo B, conformado por 5 (20%) cepas, con un único cluster formado por los pacientes 31 y 32. Conclusiones: Se demostró que en Montería, existe una alta tasa de resistencia a los fármacos anti-tuberculosos y una gran variabilidad genética de las cepas de M. tuberculosis. Se sugiere establecer medidas de vigilancia en epidemiología y salud pública para el control de esta enfermedad.

Objective: The aim of this preliminary study was to investigate the drug susceptibility and genetic variability of Mycobacterium tuberculosis isolated from patients of Montería. Methods: Patients with tuberculosis were included in the study. Socio-demographics and epidemiologic information was collected from each patient. Sputum samples were cultured on Lowenstein-Jensen medium. Antibiotic susceptibility testing was performed using the proportion method and rifoligotyping. The study of genetic variability was performed by RFLP. Results: 67 strains of M. tuberculosis isolated from patients with pulmonary tuberculosis were included; fifty-nine patients (88%) were smear positive, the patients ranged from 14 to 83 of age, mean 41.5 years. The initial resistance and multidrug-resistance was 29.2% (14/48) and 6.7% (3/48) respectively. The rifoligotyping detected 4 strains (4, 17, 21 and 45) with the mutation in the rpoB gen, hot spot region codon 531. The number of IS6110-bands varied from 3 to 13, 12 (48%) isolates had among 8 and 9 copies. RFLP revealed genetic diversity of isolates in 2 groups: group A and B. Group A included 20 (80%) strains and only one cluster constituted by the patients 17, 45, 54. Group B, had 5 (20%) strains with only one cluster conformed by two patients 31 and 32. Conclusions: The study demonstrated high levels of drug resistance and variability of strains of M. tuberculosis in Montería. Our results suggest establishing urgent measures of surveillance in epidemiology and public health for the control of the disease.

OBJETIVO: Diante das controvérsias encontradas na literatura, procurou-se verificar a influência do uso de albumina humana exógena sobre o estado nutricional e a evolução de parâmetros clínicos de recém-nascidos em nutrição parenteral total. MÉTODOS: Estudo caso-controle incluindo 30 recém-nascidos gravemente doentes com peso inferior a 2.500 g, divididos em dois grupos: 15 recém-nascidos recebendo nutrição parenteral total sem albumina (grupo controle C) e 15 com albumina humana (grupo A). Foram realizadas dosagens de proteínas totais, albumina, pré-albumina e proteína ligadora do retinol no início (3-4 dias) e no fim do estudo (10-11 dias de idade pós-natal). No sétimo dia de estudo, foi realizado balanço da retenção de nitrogênio. Foram avaliados os seguintes parâmetros clínicos: peso, idade de início da alimentação enteral, tempo para atingir volume enteral pleno, tempo de permanência na unidade de terapia intensiva, tempo total de internação e mortalidade. RESULTADOS: Houve diferença significativa (p < 0,05) nos níveis séricos de albumina e das proteínas totais entre os grupos ao final do estudo. Para os níveis de albumina, o grupo C obteve mediana de 2,95 g/dl (2,71-3,16 g/dl), e o grupo A, mediana de 4,10 g/dl (3,76-4,66 g/dl). Para os níveis de proteínas totais, os grupos obtiveram 4,9 g/dl (4,4-5,2 g/dl) e 5,6 g/dl (5,5-6,3 g/dl), respectivamente, porém sem repercussão sobre nenhum dos demais parâmetros avaliados. CONCLUSÕES: No presente estudo, não foram encontrados indicadores de benefício com o uso de albumina humana na nutrição parenteral total de recém-nascidos gravemente doentes que suportem a recomendação do seu uso, a não ser que o objetivo seja a elevação dos níveis da albuminemia.

OBJECTIVE: In view of the controversies found in the literature, the present study was conducted to determine the effect of the use of exogenous human albumin on the nutritional status of newborn infants submitted to total parenteral nutrition. METHODS: Thirty critically ill newborn infants weighing less than 2,500 g were divided into two groups: 15 infants receiving total parenteral nutrition without human albumin (C control group) and 15 with human albumin (group A). Total protein, albumin, prealbumin, and retinol-binding protein were determined at the beginning (3-4 days of postnatal age) and at the end of the study (10-11 days of postnatal age). On the seventh day of the study, nitrogen balance (retention) was measured. The following clinical parameters were evaluated: weight, age at the beginning of enteral nutrition, time to reach a full enteral volume, length of stay in the intensive care unit, total hospitalization time, and mortality. RESULTS: The results showed a significant difference (p < 0.05) in serum albumin and total protein levels (p < 0.05) between groups at the end of the study. Median albumin levels were 2.95 g/dl in group C (2.71-3.16 g/dl), whereas group A showed median albumin levels of 4.10 g/dl, (3.76-4.66 g/dl). Total protein levels were 4.9 g/dl (4.4-5.2 g/dl) and 5.6 g/dl (5.5-6.3 g/dl), respectively, with no repercussions on any of the remaining parameters evaluated. CONCLUSIONS: On the basis of the results obtained in the present study, no benefits were derived from the use of human albumin in total parenteral nutrition in severely ill newborns; therefore its use cannot be recommended, unless the objective is exclusively to elevate albumin levels.

Este estudo teve por objetivo avaliar a freqüência de complicações materno-fetais, tipo de parto e controle metabólico das gestantes diabéticas atendidas no HCFMRP-USP, entre 1992 e 1999. Foram estudadas 261 pacientes, das quais 44 (16,3%) tinham diabetes mellitus tipo 1 (DM1), 82 (30,5%) diabetes tipo 2 (DM2) e 143 (53,2%) diabetes gestacional (DMG). Observou-se uma freqüência elevada de obesidade previamente à gestação nas pacientes com DMG (47,6%) e DM2 (65,9%) e também de HAS nesse último grupo (46,3%). Apesar do início tardio, houve no decorrer do seguimento melhora do controle metabólico do DM nos 3 grupos, observada através da redução dos níveis glicêmicos (DM1 às 10h: 197±40 vs. 128±39mg/dl, p= 0,003; DM2 às 7h: 147±53 vs. 102±19mg/dl, p= 0,001; 14h: 164±53 vs. 121±28mg/dl, p= 0,01; e 20h: 201±55 vs. 147±43mg/dl, p= 0,01; DMG às 7h: 100±34 vs. 89±20mg/dl, p= 0,003; 10h: 144±49 vs. 122±29mg/dl, p= 0,03 e 14h: 126±38 vs. 112±27mg/dl, p= 0,001) e da HbA1 (DM1: 11,1±2,9 vs. 5,7±1,8%, p= 0,02). As complicações maternas mais incidentes foram hipoglicemias, infecções do trato urinário (ITU), vulvovaginites, hipertensão arterial sistêmica (HAS) e doença hipertensiva específica da gravidez (DHEG). Foi significativamente maior a freqüência de hipoglicemias (29,5%, p< 0,0001), de ITU (29,5%, p= 0,02) e de abortos (11,4%, p= 0,003) nas pacientes com DM1 que nos outros grupos. Não houve nenhum óbito materno. Nos 3 grupos, o parto cesária foi o mais utilizado (DM1: 74,3%; DM2: 79,5%; DMG: 60,5%). Hipoglicemias, prematuridade, icterícia e macrossomia foram as complicações fetais de maior incidência. Foram complicações significativamente mais freqüentes nos recém-nascidos de gestantes com DM1: prematuridade (53,7%, p< 0,0001), natimortalidade (14,6%, p< 0,0001) e síndrome do desconforto respiratório do recém-nascido (13,9%, p= 0,003). Embora tenha havido melhora do controle metabólico nos grupos estudados, não foi atingida uma completa normalização dos níveis sangüíneos de glicose e hemoglobina glicada, o que provavelmente contribuiu para as taxas de complicações materno-fetais verificadas nas nossas pacientes.

The objective of the present study was to evaluate the frequency of maternal and fetal complications, type of delivery and metabolic control of diabetic pregnant women followed at HCFMRP-USP, between 1992 and 1999. Outcome data were obtained on 261 patients where 44 (16.3%) had type 1 (DM1), 82 (30.5%) had type 2 (DM2) and 143 (53.2%) had gestational diabetes mellitus (GDM). The occurrence of obesity prior to gestation was elevated in patients with GDM (47.6%) and DM2 (65.9%). Hypertension was also frequent in the latter group (46.3%). In spite of the late beginning of the prenatal care in all three groups, there was metabolic control improvement, observed through reduction of glycemias (DM1: 10h: 197±40 vs. 128±39mg/dl, p= 0.003; DM2: 7h: 147±53 vs. 102±19mg/dl, p= 0.001; 14h: 164±53 vs. 121±28mg/dl, p= 0.01; 20h: 201±55 vs. 147±43mg/dl, p= 0.01; DMG: 7h: 100±34 vs. 89±20mg/dl, p= 0.003; 10h: 144±49 vs. 122±29mg/dl, p= 0.03; 14h: 126±38 vs. 112±27mg/dl, p= 0.001), and HbA1 levels (DM1: 11.1±2.9 vs. 5.7±1.8%, p= 0.02). Hypoglycemia, urinary tract infections, vulvovaginites, hypertension and pre-eclampsia/ eclampsia were the most incident maternal complications. Hypoglycemia (29.5%, p< 0.0001), urinary tract infections (29.5%, p= 0.02), and abortions (11.4%, p= 0.003) were significantly more common in DM1 patients (11.4%) than in other groups. No maternal death was observed. Cesarea section was the mode of delivery predominantly used in all groups. Hypoglycemia, prematurity, jaundice and macrossomia were the most incident fetal complications. Prematurity (53.7%, p< 0.0001), natimortality (14.6%, p< 0.0001), and respiratory distress syndrome (13.9%, p= 0.003) were more frequent in newborns of DM1 patients. Although some degree of metabolic control improvement has been observed in all groups, a complete normalization of glucose and glycated hemoglobin levels has not been achieved, and probably contributed for the maternal and fetal complications rates observed.

Estudou-se de forma longitudinal e prospectiva a duração do aleitamento materno no primeira ano de vida de 222 crianças nascidas com peso menor ou igual a 2.500 gramas no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto (Brasil), no período de outubro de 1985 a setembro de 1986. A incidência do aleitamento materno foi de 86,5%. A prevalência encontrada para as crianças que foram amamentadas foi de 62,5% aos 3 meses, 38,5% aos 6 meses, 28,7% aos 9 meses e 25,0% aos 12 meses de vida. A mediana da duração do aleitamento materno foi de 4 meses. O peso ao nascer mostrou associação positiva com a incidência e duração do aleitamento materno, O nível de escolaridade materno associou-se positivamente com sua duração. A idade materna, situação conjugal e o número de consultas pré-natais não apresentaram associação com o aleitamento materno. Estes dados mostram índices menores em relação aos de populações de países desenvolvidos, em especial os pré-termos finlandeses nascidos com peso menor do que 1.500 gramas. Programas de ações envolvendo a comunidade e/ou instituições devem resultar em melhoria de nossos índices, se bem implementados.

The present situation regarding the breast feeding of children born with a weight of 2,500 grammes or less (LWB) at the Hospital das Clínicas of the Medical School of the Universidade de S. Paulo in Ribeirão Preto (Brazil) was studied. The study was descriptive and the data were obtained through a longitudinal follow-up carried over the period from October 1985 to September 1986 inclusive. Of the 222 children included in the study, 30 (13.5%) infants were not breastfed. Thus the incidence of breast feeding among this population was of 86.5%. At 3 months 62.5% of these infants were still being breastfed. At 6 months this figure fell to 38.5% and only 25.0% were still being breast-fed at the end of 12 months. The average duration of breast feeding for the 192 children that had started it was of 4 months. An association was found between the level of literacy of the mothers and the duration of breast feeding. Birthweight was found to be associated with the incidence and duration of breast feeding in general, as well as with the incidence of exclusive breast feeding. These data are considerably lower than recent figures obtained from the populations of well-developed countries, especially than those of Finnish infants born with a weight of less than 1.500 g. Action programmes involving the community and/or the Institution must be implemented in order to improve these figures.

Estudou-se de forma longitudinal e prospectiva a duração do aleitamento materno no primeira ano de vida de 222 crianças nascidas com peso menor ou igual a 2.500 gramas no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto (Brasil), no período de outubro de 1985 a setembro de 1986. A incidência do aleitamento materno foi de 86,5%. A prevalência encontrada para as crianças que foram amamentadas foi de 62,5% aos 3 meses, 38,5% aos 6 meses, 28,7% aos 9 meses e 25,0% aos 12 meses de vida. A mediana da duração do aleitamento materno foi de 4 meses. O peso ao nascer mostrou associação positiva com a incidência e duração do aleitamento materno, O nível de escolaridade materno associou-se positivamente com sua duração. A idade materna, situação conjugal e o número de consultas pré-natais não apresentaram associação com o aleitamento materno. Estes dados mostram índices menores em relação aos de populações de países desenvolvidos, em especial os pré-termos finlandeses nascidos com peso menor do que 1.500 gramas. Programas de ações envolvendo a comunidade e/ou instituições devem resultar em melhoria de nossos índices, se bem implementados.

The present situation regarding the breast feeding of children born with a weight of 2,500 grammes or less (LWB) at the Hospital das Clínicas of the Medical School of the Universidade de S. Paulo in Ribeirão Preto (Brazil) was studied. The study was descriptive and the data were obtained through a longitudinal follow-up carried over the period from October 1985 to September 1986 inclusive. Of the 222 children included in the study, 30 (13.5%) infants were not breastfed. Thus the incidence of breast feeding among this population was of 86.5%. At 3 months 62.5% of these infants were still being breastfed. At 6 months this figure fell to 38.5% and only 25.0% were still being breast-fed at the end of 12 months. The average duration of breast feeding for the 192 children that had started it was of 4 months. An association was found between the level of literacy of the mothers and the duration of breast feeding. Birthweight was found to be associated with the incidence and duration of breast feeding in general, as well as with the incidence of exclusive breast feeding. These data are considerably lower than recent figures obtained from the populations of well-developed countries, especially than those of Finnish infants born with a weight of less than 1.500 g. Action programmes involving the community and/or the Institution must be implemented in order to improve these figures.