S0253-294819970004 Revista Costarricense de Ciencias Médicas Rev. costarric. cienc. méd 0253-2948 Editorial Nacional de Salud y Seguridad Social S0253-29481997000400001 , 12 1997 1997 18 11 11
S0253-294819970004 Revista Costarricense de Ciencias Médicas Rev. costarric. cienc. méd 0253-2948 Editorial Nacional de Salud y Seguridad Social S0253-29481997000400002 Metodología para evaluar la adherencia a la dieta en diabetes mellitus no insulino dependiente Padilla Gioconda Aráuz Ana Gladys Roselló Marlene ,Instituto Costarricense de Investigación y Enseñanza en Nutrición y Salud(INCIENSA) Unidad de Nutrición y Bioquímica 12 1997 1997 18 15 28

Se diseñó una metodología que permitió analizar la adherencia a la dieta de un grupo de pacientes diabéticos no insulino dependientes (DMNID), en un Proyecto de Educación en Diabetes a nivel comunitario. Diecinueve pacientes participaron durante seis meses en sesiones educativas relacionadas con el tratamiento clínico y nutricional en DMNID; la metodología utilizada permitió analizar la adherencia en términos de si se cumplieron o no las recomendaciones dietéticas establecidas. Para esto se plantearon metas de tratamiento dietético que se utilizaron para observar el comportamiento de la adherencia a la dieta, al compararse con la ingesta real de los diferentes nutrientes evaluados, antes, durante y después de la intervención educativa. Se estableció una clasificación para determinar el grado de adherencia en la que se incluyeron las categorías buena, regular, mala. Al final del proceso, la adherencia a las recomendaciones de energía, carbohidratos, grasa total y colesterol se ubicó en categoría de "buena adherencia" ; para grasa saturada y fibra la adherencia fue catalogada como "regular", situaciones que se reflejaron en las variaciones obtenidas en la composición de la dieta. Se concluye que la metodología diseñada es efectiva para determinar el grado de adherencia a la dieta en pacientes con DMNID, a la vez permite visualizar los cambios positivos en la alimentación y en la evolución clínica de estos pacientes.

A methodology was designed to analyze diet compliance adherence in a group of patients with non-insulin-dependent diabetes mellitus (NIDDM). Nineteen patients were included in the project on Education in Diabetes at in the Community, participating for a period of six months in educational sessions in relation to clinical and nutritional treatment of NIDDM; this methodology allows to analysis of diet compliance with the prescribed specifications. With this objetive, goals were established for the diabetic treatment to be used for the observation of diet compliance in comparison to the real intake of the different nutrients under evaluation, before, during and after the educational intervention. A classification to determine the level of dieting adherence was estaldished, which included the following categories: good, moderate, and bad. At the end of the process, compliance with the energetic recommendations such as carbohydrates, total fat, and cholesterol was considered «good compliance» ; saturated fat, and fiber were placed in the «moderate» category, the effect of these variations was reflected in diet composition. In conclusion, the methodology designed is effective for determining the level of diet compliance in patients with NIDDM, and permits visualizatian of the positive changes in nourishment and clinical evolution in diabetic patients.

 Diabetes Mellitus adherencia cumplimiento educación nutricional Diabetes Mellitus adherence, compliance nutritional education Jiménez J. La promoción de la Salud: un instrumento para prevenir las enfermedades cardiovasculares Rev. Centroam. Adm Publ 1993 25 Franz M Etzwiler D Ostrom J Hollander P Learning to live well with diabetes&raquo Learning to live well with diabetes&raquo 1991 International Diabetes Center, Park Nicollet Medical Foundation Nutritional Recommendations and Principles for Individuals with Diabetes Mellitus: Position Statement Diabetes Care 1990 13 (suppl 1 Lockwood D. The Biggest Problem in Diabetes Diabetes Educator 1986 12 Vindas R. Psychosocial and Demographic Predictors of Self-care Behaviors and Glycemic Control in Type II Diabetes Psychosocial and Demographic Predictors of Self-care Behaviors and Glycemic Control in Type II Diabetes Roreno M Portilla L García R Seuc A. Adhesión al tratamiento y Educación Diabetológica Boletín de Psicología, Hospital Psiquiátrico de La Habana 1991 XIV 1 Hampson S Glasgow R Toobert D. Personal Models of Diabetes and their Relations to Self - Care Activities Health Psychology 1990 9 Aráuz A. Método de Registro de Ali-mentos de Tres Días. Manual de Encuestas de Dieta: Perspectivas en Sa-lud Pública Método de Registro de Ali-mentos de Tres Días. Manual de Encuestas de Dieta: Perspectivas en Sa-lud Pública 1996 Instituto Nacional de Salud Pública Ney D. A Tool for Assessing Compliance with a Diet for Diabetes JADA 1983 82 Guidelines for the Nutritional Management of Diabetes Mellitus in 1990’s Beta Release 1989 13 Aráuz A Jiménez J. Pautas para el Tratamiento dietético y farmacológico de las Dislipoproteinemias Pautas para el Tratamiento dietético y farmacológico de las Dislipoproteinemias 1992 INCIENSA, INCAP/OPS Becker M. Patient Adherence to Prescribed Therapies Medical Care 1985 23 Campbell L Barth R Gosper J Jupp J Simons L Chisholm D. Impact of Intensive Educational Approach to Dietary Change in NIDDM Diabetes Care 1990 13 Heiby E. Behavioral Risk Factors for Nonadherence to Diet Regimens: Changing Behavior. 1990; A newsletter for educators who have accepted the challenge Behavioral Risk Factors for Nonadherence to Diet Regimens: Changing Behavior. 1990; A newsletter for educators who have accepted the challenge Rainwater N. Stuart (De RB Teaching self - management skills to increase diet compliance in diabetics Adherence, Compliance, and Generalization in Behavioral Medicine Adherence, Compliance, and Generalization in Behavioral Medicine 1982 ^eNew York Brunner / Mazel Turk D Speers M. Burish T Bradley L Diabetes Mellitus: Stress and Adherence Coping with Chronic Disease Coping with Chronic Disease ^eNew York Academic Press Mora - Morales E Keith P Jiménez J. Chronic disease in Costa Rica: Infor-mation on Diabetes Mellitus Bulletin IDF 1990 Raz I Soskolme V Stein P Influence of Small-Group Education Sessions on Glucose Homeostasis in NIDDM Diabetes Care 1988 11 Salazar S. Mora C. Arguedas C. Eva-luación de la Educación del paciente con diabetes por medio de puntajes Rev. Asoc Latinoamer Diabetes 1995 3 Lenzi S. The Clinical Usefulnes of Glycated Hemoglobin in Monitoring Diabetes Mellitus: A Long-Term Study Clinical Chemistry 1987 33 Casillas L Vargas L La distribución de grasa corporal, posible factor de riesgo para la salud Cuadernos Nutrición 1993 16 Weight Standards Canadian Guidelines for Healthy Weights: Report of an Expert Group convened by Health Promotion Directorate Health Services and Promotion Branch Canadian Guidelines for Healthy Weights: Report of an Expert Group convened by Health Promotion Directorate Health Services and Promotion Branch 1988 Ottawa Minister of National Health and Welfare Rodríguez N Aráuz AG Meza N Roselló M. Factores Aterogénicos de la Dieta de la Población Costarricense, 1991 Archiv Latinoamer Nutrición 1996 46 Nutritional Recommendations and Principles for Individuals with Diabetes Mellitus: 1986 Diabetes Care 1987 10 Laitinen J Ahola I Sarkkinen E Winberg R Uusitupa M. Impact of intensified dietary therapy on energy and nutrient intakes and fatty acid composition of serum lipids in patients with recently diag-nosed non-insuline-dependent diabetes mellitus JADA 1993 93
S0253-294819970004 Revista Costarricense de Ciencias Médicas Rev. costarric. cienc. méd 0253-2948 Editorial Nacional de Salud y Seguridad Social S0253-29481997000400003 Intervención nutricional y farmacológica en pacientes dislipidémicos Jiménez-Montero José G. Roselló-Araya Marlene Figueroa-Sánchez Gina Mora-Morales Eric ,Instituto Costarricense de Investigación Enseñanza Nutrición y Salud ,Universidad de Costa Rica Escuela de Medicina 12 1997 1997 18 29 39

El efecto de la intervención nutricional y farmacológica sobre el perfil lípidico fue evaluado en 38 pacientes dislipidémicos (M = 15, F = 23, edad 50.0 ± 1.5 años) durante seis meses18 tenían hipercolesterolemia y 10 dislipidemia mixta. Mediante intervención nutricional, la dieta redujo el colesterol (344,0 ± 14,0 a 309,0 ± 17.0 mg/dl) y el colesterol LDL descendió un 18%. En pacientes dislipidémicos con predominio de triglicéridos, el colesterol bajó de 263,2 ± 13,0 a 249,0 ± 20.0 mg/dl (-5%), pero el colesterol LDL no varió; los triglicéridos descendieron de 379,0 ± 45,0 a 359,6 ± 27,0 mg/dl. La dislipidemia persistió a pesar de dieta por lo que los pacientes hipercolesterolémicos recibieron lovastatina y aquellos con hipertrigliceridemia, gemfibrozil. En los primeros, el colesterol se redujo (309.0 ± 16.7 a 257.0 ± 16.0 mg/dl); el colesterol LDL bajó un 28 % (p < 0.001) y el colesterol HDL subió (47,0 ± 2,6 vs 55,0 ± 3,4 mg/dl, p < 0,05). Pacientes con gemfibrozil redujeron el colesterol (244,0 ± 17,0 a 223,0 ± 17,0 mg/dl) y los triglicéridos (391,0 ± 73,0 a 273,0 ± 26,0 mg/dl, p < 0,06), el colesterol HDL varió (39,5 ± 4,1 a 37,5 ± 5,5 mg/dl). Después de la intervención nutricional, la relación colesterol/colesterol HDL fue 6,57 en hipercolesterolémicos y 6,11 en hipertrigliceridemicos. Esta relación bajó a 4,67 y a 5,36 en los tratados con lovastatina y gem-fibrozil, respectivamente. Este reporte muestra el efecto de tratamientos hipolipemiantes para reducir el riesgo de las complicaciones para alcanzar las metas deseadas en el perfil lipídico.

Thirty eight patients (15 males and 23 females) aged 50,0 ± 1.5 years old, were studied during a six month period. Eighteen had hypercholesterolemia and 10 mixed dyslipidemia. Six hypercholesterolemic, and 6 with mixed dyslipidemic patients had coronary artery disease. With a dietary intervention for three months, patients with hypercholesterolemia reduced total cholesterol (344,0 ± 14,0 309.0 ± mg/dl) and lowdensity lipoprotein concentrations cholesterol by 18 per cent. In patients with mixed dyslipidemias total cholesterol was reduced from 263,2 ± 13,0 to 249,0 ± 12,0 mg/dl, (-5%) but LDL cholesterol did not change. Triglyceride levels changed from 379,0 ± 45,0 to 359,6 ± 27,0 mg/dl. Despite dietary intervention, dyslipidemia persisted. Therefore, in patients with predominant hypercholesterolemia, lovastatinewas prescribed, whereas gemfibrozil for those with mixed dyslipidemias. In patients who received lovastatine, total cholesterol decreased from 309,0 ± 16,7 to 257,0 ± 16,0 mg/dl and LDL cholesterol by 28 percent (p < 0.001). HDL cholesterol increased from 47,0 ± 2,6 to 55,0 ± 3,4 mg/dl (p < 0.05). Patients on gemfibrozil reduced total cholesterol and triglyceride levels (244,0 ± 17,0 to 223,0 ± 17,0 mg/dl; and 391,0 ± 73,0 to 273,0 ± 26,0 mg/dl, p < 0.06, respectively) and HDL cholesterol changed from 39,5 ± 4.1 to 37,5 ± 5,5 mg/dl. The cholesterol HDL ratio was 6.56 and 6.11 after dietary intervention in hypercholesterolemic patients and in those with mixed dyslipidemias and decreased to 4.67 and to 5.36 in patients who received lovastatine and gemfibrozil, respectively. These results showed the of effect interventions on lipid profiles in dyslipidemic patients aimed to reduce cardiovascular risk an achieving the goals in the lipid profile.

 Jiménez JG. La promoción de la salud: un instrumento para prevenir las enfermedades cardiovasculares Rev Cent Adm Publ 1993 j ul Fuster V Stein B Ambrose JA Atherosclerotic plaque rupture and thrombosis evolving concepts Circulation 1988 77 Fuster V Badimon L Badimon JJ Chesebro JH The pathogenesis of coronary artery disease and the acute coronary syndromes (first of two parts) N Engl J Med 1992 326 Fuster V Badimon L Badimon JJ Chesebro JH. The pathogenesis of coronary artery disease and the acute coronary syndromes (second of two parts) N Engl J Med 1992 326 Castelli WP Epidemiology of coronary heart disease: Framingham Study Am J Med 1984 76 Abbott RD Wilson PWF Kannel WB Castelli WP High density lipoprotein cholesterol, total cholesterol and myocardial infarction: Framingham Study Arteriosclerosis 1988 8 Summary of the second report of the National Colesterol Education Program (NCEP) expert panel on detection, evaluation and treatment of high blood cholesterol in adults (Adult Treatment Panel II) JAMA 1993 269 Lipid Research Clinics coronary primary prevention trial results I.: Reduction in incidence of CHD. Lipid Research Clinics Program JAMA 1984 251 Frick MH Elo O Haapa K Heinonen OP Heinsalmi P Helsink Hert Study: Primary-prevention trial with Gemfibrozil in middle-aged men with dyslipidemia N Engl J Med 1987 317 Blankenhorn DH Nessim SA Johnson RL Beneficial effects of combined colestipol-niacin therapy on coronary atherosclerosis and coronary venous by pass grafts JAMA 1987 257 Brown G Albers JJ Fisher L. Regres-sion of coronary artery disease as a result of intensive lipid lowering therapy in men with high levels of apolipoprotein B N Engl J Med 1990 323 Ramdomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S) Lancet 1994 344 NIH consensus development panel on triglyceride, high-density lipoprotein and coronary heart disease JAMA 1993 269 Chaves Matamoros A Fuchs Cordón JR Guzmán Ovares R Instructivo general para el abordaje diagnóstico y terapéutico de las dislipidemias Farmacos 1990 90 Goldstein JL Brown MS Stambury JB Fredrickson DS Goldstein JL Brown MS Familial hypercholesterolemia The Metabolic basis of inherit-ed disease The Metabolic basis of inherit-ed disease 1983 5 ^eNew York McGraw-Hill Goldstein JL. Schrott HG Hazzard WR Hyperlipidemia in coronary heart disease II: Genetic analysis of lipid levels in 176 families and delineation of a new inherited disorder, combined hyperlipidemia J Clin Invest 1973 52 Jiménez JG Mora E. Diagnóstico y manejo de las dislipoproteinemias Rev Cost Cien Med 1990 11 1 Lipid and lipoprotein analysis: Lipid Research Clinics program Manual of laboratory operations Lipid and lipoprotein analysis: Lipid Research Clinics program Manual of laboratory operations 1974 1 ^eWashington DC Government printing office Friedewald WT Levy RL Fridrikson D.S. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifugation Clin Chem 1972 18 Araúz AG Jiménez Z Durán L Intervención nutricional en pacientes con hiperlipoproteinemia Rev Cost Cienc Med 1987 8 Wolf RN Grundy SM Influence of weight reduction on plasma lipoproteins in obese patients Arteriosclerosis 1983 3 Jiménez-Montero JG Fong BS Julien P Weight loss in massive obesity: reciprocal changes in plasma HDL cholesterol and HDL binding to human adipocyte plasma membranes Metabolism 1988 37 Cobb MM Risch N. Low-density lipoprotein cholesterol responsiveness to diet in normolipemic subjects Metabolism 1993 421 Grundy SM Vega GL Plasma cholesterol responsiveness to saturated fatty acids Am J Clin Nut 1988 47 Spady DK Dietschy JM Dietary saturated triaglycerols suppress hepatic low density lipoprotein receptor activity in the hamster Proc Natl Acad Sci 1985 82 Havel RJ Rapaprot E. Mangement of primary hyperlipidemia New Engl J Med 1995 332 Hunninghake DB Stein EA Dujovne CA The effects of intensive dietary therapy alone and or combined with lovastatin in out patients with hyper-cholesterolemia N Eng J Med 1993 328 Treasure ChB Klein JL Weintraub WS Beneficial effects of cholesterol-lowering therapy on the coronary endothelium in patients with coronary artery disease N Engl J Med 1995 332 Anderson TJ Meredith IT Yeung AC The effect of cholesterol-lowering and antioxidant therapy on endothe-lium- dependent coronary vasomotion N Engl J Med 1995 332 Shepherd J Cobbe SM Ford I for the West of Scotland Coronary Prevention Study Group N Eng J Med 1995 333 Kwiterovich PO Long-term predictors of subsequent cardio-vascular events with coronary artery disease and &laquo;desirable&raquo; levels of plasma cholesterol Circulation 1992 86 Jiménez JG Vargas MA Rosello M Nuevas direcciones en el tratamiento de la hipercolesterolemia primaria Acta Méd Cost. 1990 33
S0253-294819970004 Revista Costarricense de Ciencias Médicas Rev. costarric. cienc. méd 0253-2948 Editorial Nacional de Salud y Seguridad Social S0253-29481997000400004 Prevalencia de parásitos intestinales en las áreas de salud de Acosta y Coronado Nuria Bolaños Guevara Aixa Free Enrique ,Caja Costarricense de Seguro Social Clínica de Coronado ,Caja Costarricense de Seguro Social Clínica de Acosta ,Universidad de Costa Rica Unidad de Microscopia Electrónica San José Costa Rica 12 1997 1997 18 41 49

Se estudió la prevalencia de parásitos intestinales en las muestras de heces de los habitantes de todos los sectores de las Áreas de Salud de Acosta y Coronado que asistieron a las consultas programadas y de morbilidad de los Equipos Básicos de Atención Integral de Salud (EBAIS), durante el periodo de enero a junio de 1997. En el Area de Salud de Acosta se analizaron 2 684 muestras de heces de 17 486 habitantes encontrándose un 73.4% de positividad por parásitos, mientras que el Area de Salud de Coronado se analizaron 4 939 muestras de 71 000 habitantes presentando un 44.8% de positividad. Los parásitos más prevalentes fueron Entamoeba coli (31.3%) y Endolimax nana (18.2%) para Acosta y Coronado, respectivamente. Entamoeba histolytica siendo un protozoario potencialmente patógeno tuvo una prevalencia de 24.4% en Acosta y 6.56% en Coronado. En general los helmintos presentaron muy baja prevalencia y no se demostró la presencia de tenias. Se demuestra en este estudio un aumento de la prevalencia de parásitos intestinales, especialmente en Acosta, sugiriendo un deterioro de la infraestructura sanitaria de la región.

The prevalence of intestinal parasites in fecal samples from Acosta and Coronado inhabitants, who were attended in the EBAIS (Basic Integrated Equipments for Health Service) during January to June, 1997 were studied. The region of Acosta showed 73.4 % positive samples and Coronado region 44.8%. The more prevalent parasites were Entamoeba coli (31.3%) and Endolimax nana (18.2%) in Acosta and Coronado respectively. Entamoeba histolytica, a potential pathogen protozoa had a prevalence of 24% in Acosta and 6.56% in Coronado. Other intestinal parasites such as Helmints, showed very low prevalence and taenias were not demonstrated. This study demonstrate an increase in the prevalence of intestinal parasites in the region of Acosta. A discussion on epidemiological aspects, focusing on regional predisposing factors suggest an impairment in sanitary conditions in that region.

 Parásitos intestinales prevalencia Area de Salud de Acosta Área de Salud de Coronado EBAIS Daniel WW Bioestadística: Base para el análisis de las ciencias de la salud Bioestadística: Base para el análisis de las ciencias de la salud 1988 3 Limusa Pfaller MA Fritsche TR Murray PR Baron EJ Pfaller MA Tenover FC Yolken RH. Parasitology Manual of Clinical Microbiology Manual of Clinical Microbiology 1995 6 ^eWashington, D.C. ASM Press Schaechter M Medoff G Eisenstein B. Mechanisms of Microbial Disease Mechanisms of Microbial Disease 1993 2 Baltimore Williams and Wilkins Hidalgo M. Balantidiosis humana: Alta incidencia en la población de Acosta Rev Cost Cienc Méd 1980 1 González J. Incidencia parasitaria refe-rida al Centro de Salud de Coronado Rev Med Costa Rica Centroamér 1996 537 Diagnóstico Situacional de Salud: Area de Salud de Acosta 1997 Diagnóstico Situacional de Salud: Area de Salud de Acosta 1997 1997 San José Clínica de Acosta, C.C.S.S. Diagnóstico Situacional de Salud: Area de Salud de Coronado 1997 Diagnóstico Situacional de Salud: Area de Salud de Coronado 1997 1997 San José Clínica de Coronado, C.C.S.S Huertas A. Fundamentos de Parasito-logía Clínica Fundamentos de Parasito-logía Clínica 1984 EUNED Pardo V. Hernández F. Prevalencia de parásitos intestinales en una población atendida en la Clínica del Ministerio de Salud de Hatillo, 1995-1996 Rev. Cost. Cienc. Med. 1997 17 Cerdas L. Hernández F Mata L. Pardo V. Análisis integral de Helmintos y Protozoos: Tercera encuesta nacional de parasitismo intestinal Análisis integral de Helmintos y Protozoos: Tercera encuesta nacional de parasitismo intestinal Mata L. Pardo V. Hernandez F. Alber-tazzi C. Visconti M. Mata A. Fernández R. Nuñez E. Vizcaino M. Cambios en la prevalencia de helmintos intesti-nales en Costa Rica, 1966-1982 Control and erradication of infectious diseases: international Symposium Control and erradication of infectious diseases: international Symposium 1985 1 ^eWashington, D,C. Pan American Health Organization
S0253-294819970004 Revista Costarricense de Ciencias Médicas Rev. costarric. cienc. méd 0253-2948 Editorial Nacional de Salud y Seguridad Social S0253-29481997000400005 Alteraciones ultraestructurales en la pared celular de pseudomonas aeruginosa inducidas por amikacina Echand Karina Hernández Francisco ,Universidad de Costa Rica ,Universidad de Costa Rica 12 1997 1997 18 51 55

Los antibióticos del grupo de los aminoglicósidos se introdujeron en 1994 con la estreptomycina. Actualmente ese grupo incluye antibióticos naturales y semisintéticos como la amikacina, droga indicada para el tratamiento de infecciones por Pseudomonas aeruginosa. La acción fundamental de esta droga es sobre la síntesis proteica, no obstante, para ingresar al citoplasma debe interaccionar con componentes de la membran externa, lo que se asocia con una acción bactericida. Se sometió la cepa ATCC 27853 de Pseudomonas aeruginosa a la acción de sulfato de amikacina y como control se cultivó la bacteria en el medio libre de antibióticos. Se cosecharon las bacterias; se fijaron con una mezcla de glutaraldehido al 2,5%, rojo de rutenio al 0,075% y lisina 50 mM y se procesaron para microscopía electrónica. Se observaron alteraciones en la pared bacteriana, como separación de sus componentes y la membrana externa apareció más ondulada que en los controles no tratados con el antibiótico; además en el citoplasma de las bacterias tratadas aparecieron zonas claras aparentemente debidas, a retracción del citoplasma.

The aminoglycosides were introduced with streptomycin en 1944, today this group of antibiotics includes natural and semisynthetic drugs, such as amikacin sulfate, used for treating Pseudomonas aeruginosa infections. The best known action of this antibiotic is the inhibition of bacterial protein synthesis; nevertheless, its bactericidal activity is associated with its interactions and destabilization of the outer membrane. Pseudomonas aeruginosa (strain ATCC 27853) was treated in vitro with amikacin and as control, the strain was inoculated in culture media without antibiotic. The bacteria were harvested and suspended in cacodilate buffer and fixed with a mixture of 2.5% glutaraldehide, 0.075% ruthenium red, and 50mM lysine, and processed for electron microscopy. The bacteria treated with the antibiotic showed a wavier outer membrane than the controls and the cell wall of the bacteria exposed to the antibiotic was altered; also, their cytoplasm showed clear zones, like vacuoles, but without membranes and the remaining cytoplasm was more electrondense than the cytoplasm of the untreated control cells.

 Ultraestructura Pseudomonas aeruginosa amikacina pared celular Ultrastructure Pseudomonas aeruginosa amikacin cell wall Yao JDC Moellering RC. Balows A Hausler WJ Herrmann KL senberg HD Shadomy HJ. Antibacterial Agents Manual of Clinical Microbiology Manual of Clinical Microbiology 1991 5 ^eWashington D.C. American Society for Microbiology Grayson M. Antibiotics, chemotherapeutics and antibacteria agents for disease control Antibiotics, chemotherapeutics and antibacteria agents for disease control 1982 ^eNueva York John Wiley & Sons Ristuccia AM Cunha BA: An overview of amikacin Ther Drug Monit 1995 7 kawaguchi H A new semisinthetic aminoglycoside antibiotic J Antibiot 1972 25 Barriere SL. Aminoglycosides: A reassessment of their therapeutic role Clin Pharm 1988 7 Lamp KC Rybak MJ McGrath BJ Summers KK. Influence of antibiotic and E5 monoclonal immunoglobulin M interactiosn on endotoxin release from Escherichia coli and Pseudomona aeruginosa Antimicrob Agents Chemother 1996 402 Hancock REW Won PGW Compounds which increase the permeability of the Pseudomonas aeruginosa outer membrane Antimicrob Agents Chemother 1984 26 Hancock REW Raffle VJ Nicas TI. Involvement of the outer membrane in gentamicin and streptomycin uptake and killing in Pseudomonas aeruginosa Antimicrob Agents Chemother 1981 19 Xiong Y Caillon Q Drugeon J Potel KM Baron D Influence of pH on adaptative resistence of Pseudomona aeruginosa to aminoglycosides and their postantibiotic effects Antimicrob Agents Chemother 1996 40 Rahtmati-bahram A Magee JT Jackson SK Growth temeperature-dependent variation of cell envelope lipids and antibiotic susceptibility in Stenotrophomonas (Xanthomonas) maltophila J Antimicrobial Chemother 1995 36 Jacqes M Graham L. Improved preservation of bacterial capsule for electron microscopy J Electron Microsc Tech 1989 11 Hernández F. Coto E Colmenares A Moreira L. Aplicación del método de coagulación de plasma al estudio ultraestructural de especímenes biológicos Rev Biol Trop 1991 39 Hoffmann HP Geftic SG Gelzer J Heymann H Adair FW Ultrastructural alterations associated with the growth of resistant Pseudomonas aeruginosa in the presence of benzalkonium chloride J Bacteriol 1973 113 Chopra I Ball P. Transport of Antibiotics into bacteria Adv Microb Physiol 1982 23 Taber HW Mueller PJ Miller PF Arrow AS Bacterial uptake of aminoglycoside antibiotics Microbiol Rev 1987 51 Martin NL Beveridge TJ. Gentamicin interaction with Pseudomonas aeruginosa cell envelope Antimicrob Agents Chemother 1986 29 Beveridge TJ Ultrastructure, chemistry and function of the bacterial wall Int Rev Cytol 1981 72 Koch A Schwarz H Phase and electron microscopic observations of plasmolysis of the Gram-negative cell wall Microbiology 1995 141 Koch A L Woeste SW The elasticity of the sacculus of Escherichia coli J Bacteriol. 1992 174
S0253-294819970004 Revista Costarricense de Ciencias Médicas Rev. costarric. cienc. méd 0253-2948 Editorial Nacional de Salud y Seguridad Social S0253-29481997000400006 Hidrops fetalis causado por Anti M Marín Rojas Rafael A. Alvarez Revelo Rodrigo ,Universidad de Costa Rica Facultad de Microbiología ,Laboratorio Clínico Dr. Rodrigo Alvarez San José Costa Rica 12 1997 1997 18 59 62

Se estudia un caso de hidrops fetalis producido por Anti M. El producto fue abortado espontáneamente a los 4 meses de gestación y se trataba del segundo embarazo de una mujer que no tuvo ningún problema con su primer hijo. El suero de la madre fue absorbido en DEAE-Sephadex A-50 para eliminar la posible presencia de IgM y se obtuvo un título de 1/512 una semana después del aborto y de 1/8192 seis meses después.

A hidrops fetalis case produced by anti M is reviewed here. The product was spontaneusly aborted at four months pregnancy. It was the second pregnancy for a women without complications with her first child. The mother’s serum was absorbed on DEAE-Sephadex A-50 in order to eliminate a positive interference from IgM. The serum titer was 1/512 one week after abortion and 1/8192 six months later.

 Ig G Anti M Hidrops fetalis Fetal-Maternal Incompatibility Strohm PL Hemolytic Disease of the Fetus and Newborn Texbook of Blood Banking and Transfusion Medi-cine Texbook of Blood Banking and Transfusion Medi-cine 1995 323 ^ePhila-delphia W.B. Saunders Company Technical Manual Technical Manual 1981 8 ^ePhiladelphia J.B. Lippincott Company Wilkinson SL The MNSs Blood Group System Texbook of Blood Banking and Transfusion Medicine Texbook of Blood Banking and Transfusion Medicine 1995 ^ePhiladelphia W. B. Saunders Company Genetet B Mannoni B La Transfusión La Transfusión 1980 Barcelona Ediciones Toray S.A. Furlong MB. Jr. Monaghan WP. Delayed Hemolytic Episodes Due to Anti-M Transfusion 1981 21 Telischi M Behzad O Issitt P.D. Pavone B.G. Hemolytic Disease of the Newborn due to Anti-N Vox Sang 1976 31 Alperin JB Riglin H Branch DR Gallagher MT Petz LD Anti-M Causing Delayed Hemolytic: Trans-fusion Reaction Transfusion 1983 23 Webb AJ A 30-Minute Preparative Method for Isolation of IgG from Human Serum Vox Sang 1972 23 Graham H Morrison M Mac Andrew R A Simple Method for the Prediction of ABO Incompatibility Using Sephadex A-50 Vox Sang 1975 29
S0253-294819970004 Revista Costarricense de Ciencias Médicas Rev. costarric. cienc. méd 0253-2948 Editorial Nacional de Salud y Seguridad Social S0253-29481997000400007 Leucemia mielomonocítica crónica: una mielodisplasia singular Quesada Orlando Alvarado Ma. de los Ángeles Valverde Berta Sáenz German F. ,Universidad de Costa Rica ,CIHATA, Universidad de Costa Rica 12 1997 1997 18 63 68

En un paciente varón, hebreo, de 86 años de edad, con antecedentes de cardiopatía isquémica y portador de un carcinoma gástrico, se demostró la existencia de una leucemia mielominocítica crónica (LMMC) por citomorfología, citometría de flujo y citoquímica. La médula ósea fue muy sugestiva del trastorno por el hallazgo de megacariocitos hipoploides, sideroblastos en anillo e hipercelularidad. La evolución del paciente ha seguido el patrón esperable en una displasia refractaria del tipo que se informa.

CMML was diagnosed in an 86 year old patient, with ischemic cardiopathy, by means of cytomorphology, cytochemistry, an flow. cytometry a CMML was diagnosed. It was very suggestive the bone marrow finding of hiperploidal megacariocyte, anular ridero-blasts and hipercelularity. The evolution of the patient follow the expected pattern of this refractary displasia.

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