Florentina Laspina

Susceptibilidad a antibióticos de cepas paraguayas de Helicobacter pylori aisladas de pacientes con enfermedad gastro-duodenal

BACKGROUND Antimicrobial resistance is one of the main obstacles for an effective eradication of H. pylori infection. AIM To determine the susceptibility of H. pylori strains obtained from gastric biopsies to metronidazole, clarithromycin and amoxicillin. MATERIAL AND METHODS Susceptibility to metronidazole, clarithromycin and amoxicillin was determined using E-test in 46 isolates of H. pylori obtained from gastric biopsies of 54 adult patients. RESULTS Thirty three percent of isolates were resistant to metronidazole and 2% were resistant to clarithromycin and amoxicillin. One isolate was resistant to metronidazole and clarithromycin. CONCLUSIONS The antimicrobial susceptibility of these strains of H. pylori obtained from Paraguayan patients, may help to decide the initial therapy to eradicate this infection.

A prospective study demonstrating the effect of 5% povidone-iodine application for anterior segment intraocular surgery in Paraguay

PURPOSE To determine the conjunctival bacterial flora in cataract surgery patients and the effect of presurgical irrigation with 5% povidone-iodine solution. METHODS Three samples from the inferior conjunctival fornix of the eye to be operated were obtained at baseline before washing (T0) with 10 ml 5% povidone-iodine solution, immediately after washing (T1), and upon completion of surgery (T2). Bacteria from the samples were inoculated in blood agar, chocolate agar, and thioglycolate broth. RESULTS A total of 221 patients (n=224 eyes) with a mean age of 67 +/- 13 years were included in the study. Bacteria from the (T0) samples were successfully grown in 73.2% of the thioglycolate agars, 21.0% of the blood agars, and 19.2% of the chocolate agars. Compared with T1 samples, the use of povidone-iodine wash translated into a 60.8% reduction (from 73.2% to 12.5%) in colonization of the conjunctiva (p<0.001), while no significant difference was found between the T1 and T2 samples. CONCLUSION Conjunctival irrigation with a 5% povidone-iodine solution effectively reduces conjunctival flora and is therefore strongly recommended as a means of preventing postsurgical endophthalmitis following cataract surgery.

Staphylococcus coagulasa-negativa clínicamente significativos: Especies más frecuentes y factores de virulencia

BACKGROUND Coagulase-negative staphylococci have emerged as responsible for a large number of infections. However, it is often difficult to assess its pathogenic role or to discard it as a contaminant. AIM The goal of this study was to identify clinically significant coagulase-negative staphylococci to the species level and their virulence factors. Isolates came from patients consulting at the San Roque Laboratory from 2009 to 2011. MATERIAL AND METHODS Species identification was performed by De Paulis et al simplified method. Production of biofilm, hemolysins, lipases, lecithinases and DNase were determined by conventional methods; methicillin-resistance by diffusion method and mecA and Panton-Valentine genes, by multiplex PCR. RESULTS Out of 64 isolates, 40.6% were S. epidermidis; 20.3%, S. haemolyticus, and 15.6%, S. lugdunensis. Biofilm production was detected in 73.1% of S. epidermidis, 53.8% of S. haemolyticus and 40% of S. lugdunensis. mecA gene was identified in 69.2% of S. epidermidis, 92.3% of S. haemolyticus and none of S. lugdunensis. 83% of mecA (+) S. epidermidis isolates were biofilm producers as compared to 50% of the mecA (-). CONCLUSION The frequency of S. lugdunensis, the most virulent coagulase-negative staphylococci species, was relatively high. The main virulence factor in S. epidermidis was biofilm production, being higher in those resistant to methicillin.

Eficacia de la aplicación tópica de 0,3% ciprofloxacina en la reducción de la biota conjuntival de pacientes operados de cataratas

OBJECTIVE To determine the efficacy of topical 0.3% ciprofloxacin in reducing conjunctival biota in patients undergoing cataract surgery. PATIENTS AND METHODS Experimental, prospective, randomized, controlled and single-blind study. Forty-six eyes of 46 patients were randomized into 2 groups, the study group (n=23) received topical 0.3% ciprofloxacin one day before surgery for six times, and on the day of the surgery one drop every 15minutes starting one hour before surgery until 3 doses were completed. The control group (n=23) did not receive any antibiotics. For both groups for the surgical field 10% povidone-iodine was applied. Samples from the conjunctiva were taken at four different times and then cultured on solid media (chocolate agar, blood agar) and enrichment broth (thioglycolate). The aqueous humor samples were also cultured in thioglycolate. The presence of bacteria was identified quantitatively and qualitatively, and the frequency of contamination was measured by considering the presence of bacteria in liquid and solid culture media. The number of colony forming units (CFU) was counted in the solid culture medium. RESULTS Positive cultures were obtained in 82.6% and 78.2% of the patients in the study and control groups, respectively, before the administration of 0.3% ciprofloxacin. The administration of 0.3% ciprofloxacin significantly reduced the CFU compared to the control group (P<.05). Immediately after the use of povidone-iodine, the proportion of patients with a positive culture decreased to 21.7% in the study group, and 8.7% in the control group. At the end of the surgery, this percentage was 26% and 30.4%, respectively. The most common isolated pathogen was negative-coagulase Staphylococcus (66.7%). CONCLUSION The administration of 0.3% ciprofloxacin reduces conjunctival bacterial load in the preoperative period. However, it was unable to eradicate the bacteria completely. The administration of povidone-iodine reduced conjunctival biota in 50%-70% of patients undergoing cataract surgery.

Demodex spp en pacientes con blefaritis crónica

Introduccion: La blefaritis es una enfermedad muy comun en la practica oftalmologica, generalmente de curso cronico con exacerbaciones intermitentes. Varios estudios han relacionado la presencia del Demodex folliculorum con la blefaritis cronica, por su capacidad potencial de perpetuar el proceso inflamatorio a nivel folicular. La frecuencia de D. folliculorum varia de acuerdo a la poblacion. Objetivo: Determinar la presencia de Demodex spp y, caracterizar la microbiota ocular en pacientes con blefaritis cronica y dar a conocer estos resultados. Pacientes y Metodos: Las muestras fueron obtenidas de pacientes que consultaron en la Catedra de Oftalmologia del Hospital de Clinicas de la Universidad Nacional de Asuncion (UNA). Fueron incluidos en forma consecutiva 28 pacientes con blefaritis cronica que accedieron a participar en forma voluntaria en el estudio. Se extrajeron las pestanas del parpado superior e inferior de los pacientes para la busqueda inmediata del acaro por observacion directa bajo el microscopio optico. Para el cultivo de microorganismos se tomaron muestras del parpado con espatula de Kimura, las que fueron cultivadas en agar sangre y en medios de enriquecimiento e incubadas en CO2 al 5% a 35°C durante 72 h. Resultados: El sexo femenino fue mas frecuente (64%), el rango de edad estuvo entre 17 y 87 anos con una media de 37,9 ± 13,5. Se observo la presencia de Demodex sp en 54% y aislamiento de bacterias en 92,9%; Staphylococcus coagulasa negativa fue el mas frecuente (75%). No se encontraron asociaciones entre las caracteristicas socio-demograficas o clinicas y la presencia de Demodex sp. Conclusion: La alta infestacion por Demodex spp observada en los pacientes con blefaritis cronica coincide con otros estudios.

Queratitis por Lasiodiplodia theobromae: comunicación de un caso y revisión de la literatura

We report a case of mycotic keratitis caused by Lasiodiplodia theobromae in a 60-year-old man with a history of ocular trauma with vegetable matter. Ophthalmological assessment with slit-lamp and microbiological evaluation of the corneal ulcer by conventional microbiological techniques were performed. Mycology study of the corneal scraping showed the presence of fungal filaments and the isolate was identified as Lasiodiplodia theobromae. Patient was treated with natamycin 5% and fluconazole 0.2% for 37 days. The infection was controlled but the corneal scars required a cornea transplant. This is the first case of keratitis by Lasiodiplodia theobromae in Paraguay. Difficulties in the management of these cases, which often requires surgical procedures, are discussed.

Distribution of human papillomavirus (HPV) genotypes and bacterial vaginosis presence in cervical samples from Paraguayan indigenous

OBJECTIVE To determine the frequency of human papillomavirus (HPV) types and to assess bacterial vaginosis (BV) possible associations with cervical infections in indigenous Paraguayan women of the Department of Presidente Hayes. METHODS This study included 181 sexually active women without cervical lesions. HPV typing was performed by polymerase chain reaction with primers PGMY 09/11 followed by reverse line hybridization. BV was diagnosed by the Nugent criteria using the results from a Gram stain smear. RESULTS Sixteen percent of women were positive for at least one high risk HPV type (HR-HPV). The most frequent genotypes were HPV 16 (4.4%), followed by HPV 58 (3.3%), HPV 45 (3.3%), HPV 53 (2.8%) and HPV 11 (2.8%). A significant association between HR-HPV and BV was observed (p=0.01). In addition, women with BV had a higher frequency of Chlamydia trachomatis (p=0.0007), Trichomonas vaginalis (p=0.00009), Mycoplasma hominis (p=0.001). CONCLUSIONS A large variety of HPV genotypes was detected and showed a slightly different pattern from previous studies on urban women in Paraguay, with the predominance of HR-HPV. Furthermore, the information of co-infections involved in BV could be useful for the improvement of national prevention programs, as well as for laboratory surveillance of these genital infections.

Estudio comparativo de la eficacia de diversas modalidades terapéuticas en pacientes con blefaritis crónica

OBJECTIVE To compare the efficacy of 3 treatment options in patients with chronic blepharitis. METHODOLOGY An experimental, randomized, controlled study was conducted on 45 patients (female 67%; Mean age: 40.5 years) diagnosed with chronic blepharitis, in order to compare the effectiveness of three treatment options. Group 1: eyelid hygiene with neutral shampoo three times/day; group 2: neutral shampoo eyelid hygiene plus topical metronidazole gel 0.75% twice/day; group 3: neutral eyelid hygiene with shampoo plus neomycin 3.5% and polymyxin 10% antibiotic ointment with 0.5% dexamethasone 3 times/day. The symptoms and signs were assessed by assigning scores from 0: no symptoms and/or signs; 1: mild symptoms and/or signs, 2: moderate symptoms and/or signs; and 3: severe symptoms and/or signs. RESULTS A significant improvement was observed in the signs and symptoms in all 3 treatment groups. While groups 1 and 2 had more improvement in all variables studied (P<.05), Group 3 showed no clinical improvement for itching (P=.16), dry eye (P=.29), eyelashes falling (P=.16), and erythema at the eyelid margin (P=.29). CONCLUSIONS Shampoo eyelid hygiene neutral and neutral shampoo combined with the use of metronidazole gel reported better hygiene results than neutral shampoo lid with antibiotic ointment and neomycin and polymyxin dexamethasone.

Anemia y deficiencia de hierro en mujeres indígenas del Departamento de Presidente Hayes, Paraguay, 2010-2011

Segun datos de la UNICEF, entre 4 mil y 5 mil millones de personas en el mundo padecen carencia de hierro, y se calcula que 2 mil millones sufren de anemia. La mujer puede presentar diversos tipos de anemia, ya sea por menstruaciones abundantes o por deficiencia de aporte de hierro. El objetivo de este trabajo fue evaluar los parametros hematologicos e indicadores quimicos de la anemia y carencia de hierro en las mujeres indigenas del Departamento de Presidente Hayes, Paraguay, realizado de octubre de 2010 a octubre de 2011. En este estudio observacional descriptivo de corte transverso, se incluyeron 222 mujeres de 12 a 60 anos de edad de las etnias maka, nivacle, sanapana, enxet y tobaqom. Se determino la concentracion de la hemoglobina e indices hematimetricos: VCM, HCM y CHCM mediante un contador hematologico. El hierro serico y transferrina se determino por metodo enzimatico colorimetrico y la saturacion de la transferrina por calculo manual. En el 40% (88/222) de las mujeres se observo hemoglobina por debajo de 12 g/dL. Con respecto a los indices hematimetricos, presentaron valores inferiores al punto de corte, siendo el 33% para VCM, 22% HCM y el 16% para CHCM. Estos resultados indican una deficiencia de hierro en diferentes fases, lo que tendria consecuencias negativas como la anemia, baja resistencia a infecciones, retraso en el desarrollo psicomotor y funcion cognoscitiva de los ninos, bajo rendimiento academico, fatiga, entre otras patologias en una poblacion vulnerable donde la mayoria de las mujeres estudiadas son de edad fertil.