[Characterization of the Helicobacter pylori vacuolating cytotoxin gene in gastric biopsy specimens from patients living in Tolima, Colombia]. / Caracterización del gen de la citotoxina vacuolizante de Helicobacter pylori a partir de biopsias gástricas de pacientes residentes en Tolima, Colombia.

Helicobacter pylori successfully colonizes the gastric niche. These bacteria produce a vacuolating cytotoxin known as VacA, which is codified by the vacA gene. This protein represents an important virulence factor. H. pylori strains have different vacA alleles, which show a variety of phenotypes that have been associated with gastrointestinal diseases. The aim of this study was to generate data about the prevalence of H. pylori and the vacA genotype in Tolima (Colombia) residents, and to evaluate if there exists a relationship between these data and the development of different gastrointestinal pathologies. Seventy three patients with different pathologies were included. The DNA extracted from biopsy specimens was analyzed and the presence of bacteria was determined by amplifying a fragment of the 16 rDNA gene. The vacA genotype was also determined by PCR. Fifty-two percent out of the 50 genotyped samples showed vacA s1m1 allele, 42% vacA s2m2, 4% s1m2, and 2% s1,s2,m1,m2. A higher sensitivity for the detection of H. pylori was evidenced by amplifying the vacA gene rather than the 16S rDNA gene. No association was found between the vacA genotype and the gastrointestinal diseases included in the study.

Caracterización del gen de la citotoxina vacuolizante de Helicobacter pylori a partir de biopsias gástricas de pacientes residentes en Tolima, Colombia / Characterization of the Helicobacter pylori vacuolating cytotoxin gene in gastric biopsy specimens from patients living in Tolima, Colombia

Helicobacter pylori es una bacteria que coloniza la mucosa gástrica de los humanos. Este microorganismo produce una citotoxina vacuolizante conocida como VacA y codificada por el gen vacA, el que se considera un factor de virulencia importante. Las cepas de H. pylori con diferentes alelos de vacA exhiben una gran variedad de fenotipos, algunos de los cuales han sido asociados con enfermedades gastroduodenales. El presente estudio pretende aportar datos sobre la prevalencia de H. pylori y de los genotipos de vacA en pacientes residentes en Tolima (Colombia), así como determinar la relación entre estos datos y el desarrollo de diferentes patologías gastroduodenales. Se incluyeron en este análisis 73 pacientes con diferentes patologías gástricas. Con el ADN total extraído de cada biopsia, se determinó la presencia de la bacteria mediante la amplificación de un fragmento específico del gen 16S ADNr. También se realizó la genotipificación del gen vacA por PCR. De las 50 muestras genotipificadas, el 52% mostró el alelo vacA s1m1, el 42% el alelo vacA s2m2, el 4% el s1m2 y el 2% los alelos s1,s2,m1,m2. Se evidenció una mayor sensibilidad en la detección de H. pylori por medio del gen vacA que por el gen 16S ADNr. En la población evaluada no se encontró asociación entre el genotipo de vacA y la presencia de las distintas patologías incluidas en este estudio.

Helicobacter pylori successfully colonizes the gastric niche. These bacteria produce a vacuolating cytotoxin known as VacA, which is codified by the vacA gene. This protein represents an important virulence factor. H. pylori strains have different vacA alleles, which show a variety of phenotypes that have been associated with gastrointestinal diseases. The aim of this study was to generate data about the prevalence of H. pylori and the vacA genotype in Tolima (Colombia) residents, and to evaluate if there exists a relationship between these data and the development of different gastrointestinal pathologies. Seventy three patients with different pathologies were included. The DNA extracted from biopsy specimens was analyzed and the presence of bacteria was determined by amplifying a fragment of the 16 rDNA gene. The vacA genotype was also determined by PCR. Fifty-two percent out of the 50 genotyped samples showed vacA s1m1 allele, 42% vacA s2m2, 4% s1m2, and 2% s1,s2,m1,m2. A higher sensitivity for the detection of H. pylori was evidenced by amplifying the vacA gene rather than the 16S rDNA gene. No association was found between the vacA genotype and the gastrointestinal diseases included in the study.

[Hypovitaminosis D: its high prevalence in elderly outpatients in Barcelona. Associated factors]. / Hipovitaminosis D: alta prevalencia en ancianos de Barcelona atendidos ambulatoriamente. Factores asociados.

BACKGROUND: Hypovitaminosis D is a frequent finding in the elderly of northern countries. In Spain because of high sun irradiation it has been traditionally considered that hypovitaminosis D is not a frequent problem. In this study we have evaluated the prevalence of hypovitaminosis D in the elderly and the associated factors. SUBJECTS AND METHODS: All individuals older than 65 years attending a primary care unit (november 1995-march 1996) and without any disease modifying vitamin D status were included. The following data were recorded: age, gender, height, weight, white and red cell counts, glycaemia, serum ions, albuminemia, plasma creatinine, creatinine clearance, urinary creatinine and calcium, parathyroid hormone (PTHi), calcidiol and calcitriol. Sun exposure and fish ingestion was also determined by questionnaire. RESULTS: 127 individuals were evaluated (age: mean [SD] 74.8 [6.4] years; 47 men, 37.0%). Forty-four subjects (34.6%; CI 95%: 26.3-42.9%) had calcidiol levels < or = 10 ng/ml, 15 (11.8%; CI 95%: 6.2-17.4%) low values of calcidiol, and 13 (10.2%; CI 95%: 4.9-15.5%) high PTHi values. Subjects with hypovitaminosis D (calcidiol levels < or = 10 ng/ml) were mainly women, older, short stature, had a lower values of body surface, albuminemia, phosphatemia, creatinine clearance, sun exposure and fish intake and higher PTHi levels. In the logistic regression model, hypovitaminosis D was positively associated with age and negatively with sun exposure, albuminemia, height and phosphoremia. CONCLUSIONS: Hypovitaminosis D is a very frequent finding in Spanish elderly people. Its presence is independently associated with age (positively) and sun exposure, serum albumin, height and phosphoremia (negatively).

[Psychiatry and primary care. A liaison experience]. / Psiquiatria e cuidados primários. Uma experiência de ligação.

Psychiatric problems are common in general medical practice. This paper reviews information supporting the need to integrate psychiatry and general medical practice. The two year liaison between the psychiatric ward of Santa Maria Hospital and Sete Rios Medical Centre is described. A model of longitudinal case supervision analogous to that used in psychiatric residency training to provide knowledge and skills in mental health can respond to the needs of general practitioners.

Atrial natriuretic factor in neonatal hypoxic-ischemic encephalopathy.

The influence of perinatal asphyxia in the secretion of atrial natriuretic factor (ANF) during the first 6 days of life, and its renal consequences are discussed. Comparison between 20 healthy term neonates and 19 with first--or second--degree hypoxic-ischemic encephalopathy (HIE) is made. Daily controls were performed on clinical and neurological examinations and administration of sodium and fluids. On the first and sixth days of life, 24 hours urine collection, natremia, natriuresis, fractionated excretion of sodium and creatinine clearance were determined. The ANF was performed at 1, 2, 3 and 6 days old, by R.I.A. The full term newborns with HIE showed a peak in ANF values on day two, as does the control group, thereafter maintaining higher levels, with a significant difference on day three and six. No correlation could be found between the ANF levels and the renal variables analyzed.

[Non-Hodgkin's lymphomas. I. Clinico-biological features of 307 cases]. / Linfomas no hodgkinianos. I. Características clínico biológicas de 307 casos.

PURPOSE: To assess the clinico-biological features appearing in 307 patients with non-Hodgkin's lymphomas (NHL). PATIENTS AND METHODS: The clinical records of 338 patients diagnosed of NHL between January 1975 and December 1988 were revised in retrospect. All cases with histologic diagnosis of NHL aged over 14 years were included, and classified in accordance with the Working Formulation criteria. The following data were analysed: age, sex, first complaints, time elapsed since onset, histologic type, number of sites involved, bulky disease, anaemia, thrombocytopenia, LDH, stage, type of treatment and initial response, survival, and cause of death. The statistical evaluation was performed by actuarial analysis (Kaplan and Meier) and comparison (log-rank test) of survival. RESULTS: According to the three categories of the malignancies, the NHL were distributed into low-grade (37.8%), intermediate (36.1%) and high-grade (26.9%). The mean age of the series was 56.6 years and the M/F ratio was 1.3. Lymph node enlargement was the commonest finding; 36.4% of the patients had symptoms related with the disease, and 26.7% had bulky disease. Anaemia was present in 37.7% of the cases and thrombocytopenia in 14.3%, with similar distribution among the three grades. High LDH levels were found in 44% of the patients. At diagnosis, 85% of the patients were in advanced stages (III+IV) already. Complete response was attained in 51.1% of the cases, with median survival of 48 months. CONCLUSIONS: The clinico-evolutive data found here are similar to other reports in the literature. In one-half of the patients the cause of the first visit is lymph node enlargement. Complete remission is achieved by one out of two patients, this figure being similar for each of the histologic groups. The Working Formulation is useful in determining the different prognostic groups with respect to survival.

[Non-Hodgkin's lymphomas. II. Analysis of the prognostic factors in a series of 307 patients]. / Linfomas no hodgkinianos. II. Análisis de los factores pronósticos en una serie de 307 enfermos.

PURPOSE: To analyse different clinico-biologic data in order to assess their prognostic value in non-Hodgkin's lymphoma (NHL) patients. MATERIAL AND METHODS: The series comprises 307 patients with NHL diagnosed and treated between 1975 and 1988. The histopathologic diagnosis was revised in accordance with the working formulation system, three prognostic groups being thus considered: low-grade (LGL), intermediate-grade (IGL) and high-grade (HGL) lymphomas. Age, sex, clinical course prior to diagnosis, presence of B symptoms, histologic type, number of lymph-node areas involved, bulky disease, anaemia, thrombocytopenia, LDH, stage and response to therapy were all evaluated for the study. Survival curves were drawn with the Kaplan-Meier method, and the log-rank test was used for comparison of median survival. Whenever the univariate analysis achieved statistical significance, a multivariate analysis was performed by means of a multiple correlation and regression study in accordance with the Cox's model, in which the variables were expressed in a binary model. RESULTS: The following 8 values were found significant in the univariate study of low-grade lymphomas: age, number of involved areas, bulky disease anaemia, thrombocytopenia, LDH, stage, and initial response to treatment. In intermediate-grade lymphomas, the significant findings were age, number of affected areas, bulky disease, thrombocytopenia, LDH, stage, and initial response. For high-grade lymphomas, number of affected areas, thrombocytopenia, LDH, stage and initial response were found statistically significant. Although no significant differences were found for survival within each of the three grades, such differences were significant between them. In the multivariate analysis, age was significant only in the LGL (p < 0.0001) in IGL, age (p < 0.07) and initial response to therapy (p < 0.0001) achieved significant value, and in HGL, stage (p < 0.02) and initial response to treatment (p < 0.0001) attained significance. CONCLUSIONS: The univariate analysis provides various prognostic factors of statistically significance, as reported in the literature, but these after the multivariate analysis was applied, were reduced to age, stage and initial response to treatment.