Mutations associated with Helicobacter pylori antimicrobial resistance in the Ecuadorian population.

AIMS: We described the presence of Helicobacter pylori (HP) and estimated the prevalence of primary and secondary resistance using molecular detection in gastric biopsies of Ecuadorian patients. METHODS AND RESULTS: 66.7% (238/357) of the patients demonstrated the presence of HP using CerTest qPCR. Of these, 69.79% (104/149) were without previous HP eradication treatment and 64.42% (134/208) with prior HP eradication treatment. The mutation-associated resistance rate for clarithromycin was 33.64% (primary resistance) and 32.82% (secondary resistance), whereas that in levofloxacin the primary and secondary resistance was 37.38% and 42%, respectively. For tetracycline and rifabutin, primary and secondary resistance was 0%. Primary and secondary resistance for metronidazole and amoxicillin could not be evaluated by genotypic methods (PCR and sequencing). CONCLUSIONS: The analysis of mutations in gyrA, 23S rRNA and 16S rRNA is useful to detect bacterial resistance as a guide for eradication therapy following failure of the first-line regimen. SIGNIFICANCE AND IMPACT OF THE STUDY: This study carried out in an Ecuadorian population indicates that the resistance of HP to first-line antibiotics is high, which may contribute to the high rates of treatment failure, and other treatment alternatives should be considered.

Etiología, complicaciones y mortalidad en cirrosis hepática, hospital Carlos Andrade Marín; evaluación retrospectiva de 15 años, 1989 – 2003 / Etiology, complications and mortality in cirrhosis at the Carlos Andrade Marin Hospital, 15 years of retrospective evaluation, 1989-2003

Introducción: La cirrosis hepática es una de las patologías prevalentes en el Ecuador, con un elevado índice de consultas, hospitalizaciones, gastos en salud y mortalidad. Objetivos: A consecuencia de la escasez de estudios similares, el objetivo principal es determinar la etiología de la cirrosis en nuestro medio y las causales de mortalidad. También se consigna variables biosociodemográficas y la sobrevida después del primer episodio de descompensación. Método: Estudio retrospectivo en el que se analizaron las historias clínicas de todos los pacientes diagnosticados de cirrosis hepática entre los años 1989 y 2003, en el hospital “Carlos Andrade Marín”, de Quito-Ecuador. Se incluyeron aquellos con el diagnóstico histológico mediante biopsia percutánea, guiada por tomografía o quirúrgica-laparóscópica y a aquellos con diagnóstico clínico. Se realizó un seguimiento personalizado de la evolución de los pacientes mediante los controles clínicos en consulta ambulatoria, hospitalización, y se registró el fallecimiento de los pacientes que estuvieron hospitalizados, de los que se analizó la causa de muerte. Resultados: Se incluyeron para el análisis 770 pacientes, 534 varones. El promedio de edad al diagnóstico fue de 64,1 años +/- 12,7 años. La etiología fue: alcohol 48,31, no determinada 44,16, viral 2,86 y otras en el 4,67 (incluye autoinmune, tóxica, cardiaca, biliar). Las causas de muerte en 183 pacientes (23,7) fueron: hemorragia variceal 37,7, síndrome hepatorrenal 30,1, insuficiencia hepática 24,6, sangrado digestivo alto no variceal 2,2, carcinoma hepatocelular 2,7 y causas extrahepática en un 2,7. Conclusiones: La etiología alcohólica es prevalente en nuestro país. La elevada frecuencia de casos de causa no determinada, implica extremar los esfuerzos para estudiar causas como hemocromatosis, autoinmunidad, cirrosis biliar primaria, esteatohepatitis no alcohólica, alcoholismo no declarado, viral. La principal causa de muerte es la hemorragia.

Introduction: Hepatic cirrhosis is one of the most common pathologies in Ecuador with a high incidence of hospitalizations and mortality. Objectives: Determine the etiology of cirrhosis in our society and the factors that lead to mortality; Determine the bio-socio-demographic variables and the survival rate after the first episode of decompensation. Method: Retrospective study in which the clinical history of all the patients diagnosed with cirrhosis was analyzed during the years of 1989 and 2003 at the “Carlos Andrade Marin” hospital in Quito, Ecudor. We included in this study patients with histological diagnosis of cirrhosis using the method of precutanous biopsy guided by ct scan or laparoscopy and those with clinical diagnosis. Results: We included in this study 770 patients, 534 were men. The average age of diagnosis was 64.1 years +/- 12.7 years. The etiology was: alchohol 48.31, not determined 44.16, viral 2.86 and others 4.67 ( includes autoimmune, toxic, cardiac and biliar) The cause of death in 183 patients (23.7) was: variceal hemorrhage 37.7, hepatorrenal syndrome 30.1, liver failure 24.6, upper gastrointestinal bleeding 2.2, hepatocelular carcinoma 2.7 and extrahepatic causes 2.7. Conclusions: The most common etiology in our country is alcohol. Most of the cases the etiology could not be determined that is why we should study causes like hemochromatosis, autoimmune, primary biliar cirrhosis, non alcoholic steatohepatitis and viral. The most common cause of death is variceal hemorrhage. Hepatocarcinoma is not a common cause of mortality in our society and is related to the low rate of infections by virus B and C in our society.

Leiomiosarcoma: reporte de un caso clínico / Leiomyosarcomas: a case report

Los leiomiosarcomas son tumores del músculo liso que se presentan con escasa frecuencia en el tracto gastrointestinal. Se derivan del tejido mesenquimal y generalmente metastatizan a hígado o pulmones. Su malignidad depende de factores celulares, de la localización y el tamaño tumoral. Presentamos el caso de un paciente de 82 años de edad con antecedente de un leiomioma gástrico, que acude con sangrado digestivo alto e ictericia progresiva, hepatomegalia y perdida de peso considerable. Los estudios finales concluyen en un leiomiosarcoma con metástasis hepáticas.

Leiomyosarcomas are rare tumors of the gastrointestinal tract, and drift to the mesenchymal tissue. Rarely invade adyacent organs and metastasize to liver and lungs. The malignant features depend on cell changes, place and size of tumor. The case report is a 82 year old male with history of gastric leiomyoma which he has had for the last 3 years ago. He was admitted for upper gastrointestinal bleeding, jaundice, hepatomegaly and weight loose. The final investigation reveals a leiomyosarcoma with liver metastasis.