Primer consenso venezolanode enfermedad por reflujo gastroesofágico / Venezuelan consensus on gastroesophageal reflux diseases

El Consenso Venezolano de Enfermedad por Reflujo Gastroesófágico (ERGE) se realizó con el objeto de proveer guías para mejorar la identificación, el diagnóstico y el tratamiento de este trastorno en el país. Los coordinadores establecieron las líneas de consenso, basado en una revisión sistemática de la literatura médica de los últimos 15 años a partir de 1995. Participaron 55 miembros con el aval de sus respectivas cátedras y sociedades locales de gastroenterología. Éstos revisaron y presentaron los temas con sus niveles de evidencia y grados de recomendación para discutirlos y votarlos en una reunión plenaria. Tras un informe final de los miembros, los coordinadores prepararon las declaraciones finales. El consenso concluyó que la enfermedad por reflujo gastroesofágico tiene una prevalencia estimada del 11,54% en Venezuela, a predominio del sexo femenino (Grado B). El diagnóstico es fundamentalmente clínico, basado en la presencia de síntomas típicos y/o atípicos, e incluso síntomas de alarma que sugieren alguna complicación (Grado B). La endoscopia es importante en la investigación de la presencia de esofagitis de reflujo y laringitis de reflujo (Grado B). Las otras pruebas diagnósticas como lo son la pHmetría esofágica de 24 horas con o sin impedancia intraluminal multicanal son importantes en los pacientes que no tienen esofagitis, tienen síntomas atípicos o cuando hay falla en la respuesta al tratamiento médico (Grado B). La radiología, manometría esofágica y el ultrasonido endoscópico no están indicados en el diagnóstico de la ERGE (Grado B). El objetivo del tratamiento es reducir la exposición ácida en el esófago y con esto: aliviar los síntomas, cicatrizar las lesiones en la mucosa esofágica, prevenir la recurrencia y las complicaciones. Los inhibidores de bomba de protones deberían ser la primera opción en el tratamiento en el síndrome de ERGE y en la esofagitis por reflujo tanto en la fase aguda como durante el mantenimiento...

The Venezuelan Gastroesophageal Reflux Disease (GERD) Consensus was carried out in order to provide guidelines to improve the identification, diagnosis and treatment of this illness in Venezuela.  The coordinators established the consensuslines, based on a systematic revision of the medical literature of the last 15 years starting from 1995. 55 physicians participated with the support of their respective medical schools and local societies. They revised and presented the topics with their respective evidence levels and recommendation grades to discuss and vote them in a plenary meeting. After a final report of the members, the coordinators prepared the definitive declarations. The consensus concluded that GERD prevalence in Venezuela is 11,54%, higher in women than men (Grade B). The diagnosis is mainly clinical, based on the presence of typical and/or atypical symptoms and alarm symptoms that may suggest the presence of complications (Grade B). Endoscopy is important when reflux esophagitis and laryngitis are present (Grade B). Other diagnostic tests as ambulatory 24 hours pH monitoring with or without multichannel intraluminal impedance are important in patients without esophagitis, with atypical symptoms or when there is flaw in the answer to the medical treatment (Grade B). Radiology, esophageal manometry and endoscopic ultrasonography are not indicated in the diagnosis of GERD (Grade B). The objective of the treatment is to reduce the presence of acid in the esophagus and consequently: alleviate the symptoms and heal lesions in the esophagus mucosa to prevent recurrence and complications. Proton pump inhibitors should be the first option drug in the treatment of GERD syndrome andin esophagitis during the acute and the maintenance phase using standard or half dose (Grade A). So far, pokinetics are drugs with a limited use in GERD patients; they stimulate the esophagus/gastric motility...

Effect of human immunodeficiency virus type 1 on intracellular activation and superoxide production by neutrophils.

The immunopathogenesis of AIDS is associated with the development of opportunistic infections by intracellular pathogens that can invade and reproduce freely because of impaired cellular functions. Neutrophils from asymptomatic human immunodeficiency virus (HIV) type 1-infected persons and from symptomatic patients with AIDS were found to retain normal phagocytosis activity while producing significantly less superoxide than neutrophils from HIV-1-negative subjects, when stimulated through Fc receptors or protein kinase C. After priming with a synthetic HIV-1 envelope peptide and stimulation via the Fc receptor, the neutrophils from HIV-1-negative controls had suppressed superoxide production, reduced phosphorylation of two unidentified cellular proteins, and increased expression of a third phosphoprotein. These results suggest that HIV-1 can produce direct functional damage of neutrophils through binding of envelope components to the cell membrane.

Prevalencia de enteroparásitos en una comunidad rural venezolana / Prevalence of enteroparasites in a venezuelan rural community

Se realizó un estudio epidemiológico en una región rural de los Andes venezolanos, (El Dividive, Edo. Trujillo), con la finalidad de dterminar el perfil de enteroparásitos. Se seleccionaron aleatoriamente 332 viviendas y se procedió a encuestar y realizar exámenes parasitológicos de las muestras fecales de 1.124 personas. La mayoría de las viviendas contaba con servicio de acueducto intradomiciliario muy irregular (69,9 por ciento), el 30 por ciento no poseía instalaciones sanitarias ni cloacas, el 40,7 por ciento no tenía sistema de recolección de basura intradomiciliaria. El promedio de edad fue de 23 años; solo el 26,8 por ciento de los habitantes había concluido la educación primaria, el 13,7 por ciento tenía empleo fijo, el resto se dedicaba a oficios domésticos, actividades agrícolas y al comercio informal. En el 72,3 por ciento de las muestras se pudo detectar la presencia de al menos un tipo de parásito; el poliparasitismo se evidenció en el 66 por ciento de los sujetos y sólo el 27,8 por ciento fue negativo al examen de heces. Se observó predominio de los protozoarios (83,7 por ciento) sobre los helmintos (16,3 por ciento). Los parásitos más comunes fueron: Blastocystis hominis 38 por ciento, Endolimax nana 28,6 por ciento, Entamoeba hystolitica 24,2 por ciento, Entamoeba coli 14,3 por ciento, Entamoeba hartmanni 11,3 por ciento, Giardia lamblia 9,3 por ciento, Ascaris lumbricoides 10,3 por ciento, Trichuris trichuria 6,0 por ciento y otros 8,0 por ciento. Se evidenció en esta población de precarias condiciones socioeconómicas: elevada presencia de parasitosis (72,3 por ciento) y alto grado de poliparasitismo. Se concluye que, en esta región, el escaso saneamiento ambiental está estrechamente asociado al nivel de parsitosis

Evaluación inmunoquímica de cepas de entamoeba hystolitica venezolanas / Immunochemical evaluation of venezuelan strains of entamoeba hystolitica

La identificación de la patogenicidad de la Entamoeba hystolítica ha sido útil como punto de partida en la búsqueda de antígenos relevantes para el inmunodiagnóstico y la inmunoprofilaxia. Recientemente se describió el aislamiento y axenización de las dos primeras cepas de E.hystolítica venezolanas: IULA:1092:1 (MMM) e IULA:0593:2 (NER). En el presente estudio evaluamos los siguientes parámetros: perfiles electroforéticos, reactividad frente a anticuerpos monoclonales y policlonales y la virulencia cuando son inoculadas en animales de laboratorio y los comparamos con la cepa patógena de referencia (HM-1). Los extractos amibianos fueron cromatografiados en geles de poliacrilamida SDSPAGE, se electrotransfirieron a membranas de nitrocelulosa y se enfrentaron a sueros humanos y de animales positivos negativos. La capacidad de las cepas para producir abscesos, se evaluó, inoculándolas en el hígado de hamsters. El análisis de los resultados nos permitieron concluir que las dos cepas en estudio presentan un perfil electroforético similar a la cep patógena de referencia internacional (HMI); que son de alta virulencia, demostrada por la producción de abscesos hepáticos amibianos en todos los animales inoculados y que presentan un complejo patrón de reactividad frente a los sueros positivos y que en ellas está presente un antígeno marcador de patogenicidad reconocido por el monoclonal HU-511. Con base en estos criterios y los anteriormente evaluados podemos concluir que las dos cepas son alto potencial patógeno, pudiendo ser usadas como antígeno en los ensayos de inmunodiagnóstico e inmunoprofilaxis

Prevalencia de anticuerpos contra el virus de la hepatitis C en pacientes multitransfundidos / Anti-hepatitis C virus antibodies in politransfused patients

Se realizó un estudio transversal para conocer la prevalencia de anticuerpos contra el virus de la Hepatitis C en pacientes politransfundidos por: hemofilia, leucemia y anemia hemolítica, procedentes de la región andina. Se analizaron 39 muestras, 10 procedentes de pacientes hemofílicos, 12 de pacientes con leucemia, linfoma y anemia hemolítica, transfundidos por lo menos 6 meses antes del estudio. El resto de las muestras, 17, fueron controles sanos sin antecedentes de transfusion previa. Utilizando un ELISA de segunda generación, se detectaron 4 muestras positivas (10,26 por ciento), 3 de hemofílicos y la restante de un paciente con linfoma. Esto correponde a una positividad de 30 por ciento para el grupo de hemofilicos, lo cual contrasta con lo reportado en otros países. Se demostró una asociación estadísticamente significativa entre la positividad del ELISA y la cantidad de material transfundido (p< 0.0004), asi mismo con el tipo de material suministrado: Crioprecipitado (p= 0.000) y plasma (p= 0.000)

[Prevalence of antibodies against hepatitis C virus in multitransfused patients]. / Prevalencia de anticuerpos contra el virus de la hepatitis C en pacientes multitransfundidos.

We have done a study in order two know the prevalence of anti-hepatitis C virus antibodies in polytransfused patients with hemophilia, leukemia and hemolytic anemia, along with 17 healthy donors, without previous history of transfusions. We analyzed samples from 10 hemophilic patients and 12 from leukemia, lymphoma and hemolytic anemia, all of them had received blood or blood products, at least six months before the study. Using a second generation ELISA, 4 positive sample (3 hemophilic and 1 lymphoma) were detected (10.26%), which represent a prevalence of 30% in the hemophilic group, in contrast with the prevalence detected in other countries. A very significant statistic association was demonstrated, between the positive ELISA, the amount of the transfused product (P < 0.0004) and the type of blood product used for transfusion (crioprecipited, P = 0.000, plasma P = 0.000).

Synaptic detachment from hypoglossal neurons after different types of nerve injury in the cat.

Quantitative electron microscopy was used to examine synaptic numbers and total relative synaptic coverage on hypoglossal neuronal perikarya following transection or crush of the hypoglossal nerve in the cat. In cats subjected to nerve transection there was a statistically significant decrease in total synaptic coverage as well as in number of synaptic contacts/soma profile. After nerve crush there was a statistically significant decrease in total synaptic coverage but not in the number of synaptic contacts. These results indicate that the degree of synaptic detachment on motor neurons in the cat is influenced by the type of nerve injury.

Changes in microglial cell numbers in the spinal cord dorsal horn following brachial plexus transection in the adult rat.

The effect of peripheral nerve transection on the size of the microglial cell population in cytoarchitecturally distinct regions of the spinal cord dorsal horn of rats was evaluated at selected intervals 2 through 35 days after unilateral brachial plexotomy. The identification of cells was verified by electron microscopic examination of a representative random sample of cells included in the counts. Microglial cell numbers were increased in laminae I, II as well as the arbitrarily defined deeper laminae 3.5 days after surgery. Although microglial cell numbers in laminae I were within normal range 35 days after axotomy, those of the more ventrally located laminae remained significantly greater than control values for the duration of the experimental period. These findings demonstrate that: 1) microglial cell proliferation in the dorsal horn is an early event in the central changes that are attendant to peripheral nerve injury 2) the time course of the response varies in cytoarchitecturally different regions.

Effect of axotomy on perineuronal glial cells in the hypoglossal and dorsal motor vagal nuclei of the cat.

An approximate twofold increase in microglial cell densities occurred in the hypoglossal and dorsal motor vagal nuclei of the cat after transection of their respective nerves. The densities of astrocytes and oligodendrocytes were unaffected. A significant loss of neurons was demonstrated in both nuclei. These findings indicate that a perineuronal microglial cell reaction occurs in craniomotor nuclei of the cat following nerve transection, but to a considerably lesser extent than in rats and rabbits. We suggest that the different glial response after nerve transection compared with nerve crush in the cat may be related to differences in the degree of axotomy-induced neuronal degeneration.

A morphological study of glial cells in the hypoglossal nucleus of the cat during nerve regeneration.

The cat hypoglossal nerve and nucleus have been used as a model for the study of the occurrence and time course of modifications in the size and composition of the perineuronal glial cell population as they relate to cytological changes in the nerve cell body and the initiation and progress of axon regeneration. Animals were killed at 2, 5, 10, 20, 35, 65, and 115 days after crush injury to the hypoglossal nerve. At 5 days after surgery, growth cones and regenerating unmyelinated axons were present at the lesion site, but no conspicuous changes were apparent in the nerve cell bodies. At 10 days after surgery, the granular endoplasmic reticulum was disaggregated and depleted. The elongation phase appeared to be completed at 20 days, as judged by the bilateral retrograde labeling of the hypoglossal nuclei with horseradish peroxidase. By 35 days, the cytoarchitecture of the nerve cell bodies and maturation of axons, as determined by a comparison of the relative frequency distribution of cross sectional areas proximal and distal to the lesion, were completely restored. Comparative quantitative light microscopic examination of the hypoglossal nuclei of intact and experimental animals failed to reveal any statistically significant differences in the total number of glial cells, number of glial cells/unit area of neuropil, or relative proportions of glial cell types at any of the postoperative time intervals. Moreover, electron microscopic quantitation of the microglial cell population did not reveal any significant alterations in the number, density, location, or morphology of these cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Pigmented cells in the leptomeninges of the cat.

Cells laden with pigment granules are described in the leptomeningeal tissues of the cat and kitten. These cells can be identified consistently by gross observation following vascular perfusion. The fusiform or stellate pigmented cells are most often found in association with the outermost layers of the arteries of the subarachnoid space. They are typically separated from the cerebrospinal fluid by an attenuated layer of pial cells. Vessels that are described as having pigmented cells along their course are the anterior and posterior cerebellar; the anterior, middle, and posterior cerebral; and the basilar. Electron microscopic studies confirm the presence of abundant pigment granules. The pigment granules are the predominant component of the cytoplasm. Few organelles are demonstrable except for a large central nucleus. The data provide support for the concept of neural crest contribution to leptomeningeal structures. Identification of this isolated, easily defined population of melanocytes may provide a model for further studies of neural crest distribution as well as experimental approaches to melanogenesis and melanoma production and control.

Effect of nerve section on perineuronal glial cells in the CNS of rat and cat.

The effect of axotomy on the numbers and density of perineuronal cell populations was evaluated in rats, cats and kittens. Cats were sacrificed at different postoperative time intervals two through 90 days after unilateral plexotomy. Kittens (6-10 weeks of age) were subjected to the same surgical procedure and sacrificed one through 28 days after surgery. Rats were sacrificed 10 and 15 days after unilateral section of the brachial plexus or at 7 or 10 days after section of the left hypoglossal nerve. A marked increase in the total number and density of perineuronal cells occurred in the rat ventral horn 10 and 15 days after axotomy. A similar response was noted in the rat hypoglossal nucleus 7 and 10 days after neurotomy. In contrast, no significant change in these parameters was observed in the ventral horns of cats and kittens at any of the postoperative time intervals. Although quantitatively demonstrable increases in the perineuronal cell populations occur in the ventral horns and hypoglossal nuclei of rats, similar modifications do not occur in the cat following axon injury. These findings suggest that evolutionary modifications may have occurred in how perineuronal glia respond to peripheral axon injury.

Morphometric measurements and RNA content of axotomized feline cervical motoneurons.

Microspectrophotometric estimates of RNA content and morphometric measurements of cytoplasmic, nuclear and nucleolar areas were made on 30 to 60 motoneurons (somal areas greater than 1000 microns2) ipsilateral and contralateral to brachial plexotomy performed unilaterally on adult cats 2-90 days before sacrifice. Nerve cells of unoperated animals were also assayed. Somal and cytoplasmic areas of axotomized motoneurons were larger than those of the corresponding, contralateral motor nerve cells 4, 6 and 75 days postoperatively. Because of between animal variability, it could not be determined, however, whether this difference was due to an increase in the area of the axotomized motoneurons or to a decrease in the area of the contralateral nerve cells. Nucleolar sizes did not change. In contrast, nuclei of axotomized motoneurons showed a temporary but unequivocal areal decrease. The cytoplasmic RNA content of axotomized motoneurons fell 14-28 days postoperatively but rose thereafter, being increased slightly but significantly 75-90 days after operation. At no postoperative interval, however, did the nucleolar RNA content of the axotomized cells deviate unequivocally from the unoperated or zero day condition. The following points may be emphasized: 1. these results differ from similar measurements of axotomized motoneurons of rodents and lagomorphs; 2. the data do not provide certain evidence of change in either morphometric parameters or RNA content of motoneurons on the side contralateral to surgery, although the possibility of a decrease in the size of these uninjured neurons should be considered; 3. morphometric and RNA measurements on axotomized peripheral (extrinsic) neurons of spinal anterior horn of cat contrast with similar measurements on axotomized central (intrinsic) neurons of cat red nucleus.

Quantitative cytochemistry of RNA in axotomized feline rubral neurons.

One-sided lateral funiculotomy at the C-2 segment induced axon reaction in the contralateral red nucleus of adult cats. Two to 60 days postoperatively the animals were sacrificed and the mesencephalon was fixed in ethanol-acetic acid, 3:1. Ten micrometer paraffin sections including both red nuclei were stained for RNA with azure B after incubation in DNAse. Cytophotometric measurements of RNA content of neurons from the caudal 600-1000 micrometer of each red nucleus were made with a Zeiss Cytoscan system using an automatic scanning stage. In contrast to the heightened RNA synthesis that has been reported for axotomized peripheral (extrinsic) neurons, the axotomized central (intrinsic) neurons of the red nucleus showed no evidence of accumulation of cytoplasmic or nucleolar RNA. Rather depletion of cellular RNA occurred. Further indication of the regressive nature of rubral axon reaction derived from morphometric measurements that showed cytoplasmic, nuclear and nucleolar atrophy of the neurons of the red nucleus contralateral to operation with the exception of a possible transient cytoplasmic enlargement 9 days postoperatively. From the cytophotometric and morphometric data here reported we are led to suggest that the frequently observed failure of axonal repair in mammalian CNS results from the innately regressive nature of the axon reaction of many mammalian central neurons.

Quantitative relationships of the fourth complement component in human cerebrospinal fluid.

A technique for the measurement of cerebrospinal fluid C4 concentration in unconcentrated specimens has been developed with the methods of electroimmunodiffusion and immunofixation. The method has proved to be reproducible and requires only microliter volumes of undiluted cerebrospinal fluid (CSF). The mean value for CSF C4 concentrations in 16 neurologically normal individuals was 325 +/- 32 mug/100 ml. A positive correlation between CSF C4 concentration and the concentration of CSF albumin and total protein was observed. The positive correlation between the concentrations of CSF C4 and albumin was, however, more clearly defined than the relationship of CSF C4 to total CSF protein.