Interleukin 18 maintains a long-standing inflammation in coeliac disease patients.

Dietary gluten induces an early response in the intestine of coeliac disease patients (CD), within a few hours, and this is driven by high levels of proinflammatory cytokines, including IFNgamma and IL-15, as has been thoroughly shown by gluten stimulation of biopsy explants. Our aim was to identify the immune mediators involved in the long-standing inflammation in untreated CD patients at diagnosis. mRNA and protein levels of TNFalpha, IL-12(p35), IL-12(p40), IL-15, IL-18 and IL-23(p19) were quantified in biopsies from active CD patients, CD patients on a gluten-free diet (GFD), healthy controls, and patients with non-CD inflammation and mild histological changes in the intestine. Biopsies from CD patients on a GFD were also stimulated in vitro with gliadin, and protein expression of IL-15 and IL-18 was analysed. Levels of IL-12 and IL-23 mRNA are nearly absent, and TNFalpha levels remain unchanged among different groups. Both the active and inactive forms of IL-18 protein have been found in all samples from active CD, and protein expression was only localized within the crypts. Levels of IL-15 mRNA remain unchanged, and protein expression, localized within the lamina propria, is found in a small number of samples. In vitro stimulation with gluten induces the expression of IL-15 and IL-18. In active CD, the early response following gluten intake characterized by high IFNgamma levels is driven by IL-18, and probably IL-15, and this alternates with periods of long-standing inflammation with moderate IFNgamma levels, maintained by IL-18 alone.

Efectividad del secnidazol en el tratamiento de escolares asintomáticos parasitados por giardia lamblia y/o entamoeba histolytica / Effectiveness of secnidazol in the treatment of asymptomatic schoolchildren parasited by giardia lamblia and/or entamoeba histolytica

El propósito de la investigación es conocer la eficacia del Secnidazol en el tratamiento de escolares asintomáticos portadores de Giardia lamblia y/o Entamoeba histolytica, así como el evaluar su tolerancia. Se escogieron 50 niños parasitados (totalizando 53 casos con Entamoeba histolytica y/o Giardia lamblia), con edades comprendidas entre 5 y 14 años, de uno u otro sexo, a quienes se les administró el medicamento y tres días después se realizaron exámenes coproparasitológicos controles. La tolerancia del medicamento se evaluó mediante encuesta. De 53 casos parasitados, la relación de protozoarios fue: Giardia lamblia (66,03 por ciento) seguidos de Entamoeba hitolytica (33,97 por ciento). La efectividad parasitológica del Secnidazol contra Giardia lamblia fue del 100 por ciento y de Entamoeba histolytica de 95,45 por ciento. Se obtuvo un solo caso portador que no respondió al tratamiento (4,55 por ciento). El medicamento fue bien tolerado en el 50 por ciento de los casos. Los síntomas más frecuentes fueron: hiporexia, cefalea, dolor abdominal, mareos, náuseas, vómitos, diarrea, fatiga, alteración del gusto y prurito. La eficacia y la relativamente buena tolerancia del Secnidazol fue demostrada en el presente estudio. Se obtuvo cura parasitológica al tercer día de administrado el medicamento

[Eosinophilic enteritis causing intestinal obstruction]. / Enteritis eosinofílica como causa de obstrucción intestinal.

Eosinophilic enteritis is an uncommon disorder of unknown etiology in which the digestive symptoms are associated with eosinophilic infiltration of the different layers of the intestinal wall. Clinical symptoms depend on the layers involved and are usually characterized by peripheral eosinophilia. Radiological findings depend on the layers involved. Definitive diagnosis is based on clinical and histopathological findings. Treatment of choice is currently with corticoids and prognosis is benign with relapses. The pathogenesis remains unclear. We report a patient who presented with intestinal obstruction and describe the follow-up.

Basal cell carcinoma of the scrotum.

An 80-year-old man with a 7 year history of a slowly enlarging, asymptomatic scrotal nodule is presented. He had a negative history for sexually transmitted disease, trauma to the area, radiotherapy and chemical or arsenic exposure. The lesion was excised with a margin of 0.8 cm of normal skin. Examination of the specimen revealed a basal cell carcinoma.

HIV-associated pityriasis rubra pilaris responsive to triple antiretroviral therapy.

HIV-associated pityriasis rubra pilaris (PRP) or PRP type VI designates a new distinctive entity reported in HIV patients. It is characterized by cutaneous lesions of PRP and variable association with lesions of acne conglobata, hidradenitis suppurativa and lichen spinulosus. We report a patient with HIV-associated PRP which was treated by triple antiretroviral therapy (zidovudine, lamivudin and saquinavir) with complete response. The patient has remained free from symptoms for 20 months of follow-up. We review the clinical features, pathology, evolution, treatment and possible aetiology of this recently described entity.

[Prenatal diagnosis. I: Prenatal diagnosis program at the Medical Genetics Unit of the Universidad de Zulia, Maracaibo, Venezuela]. / Diagnóstico prenatal. I: Programa de diagnóstico prenatal de la Unidad de Genética Médica de La Universidad del Zulia, Maracaibo, Venezuela.

The Prenatal Diagnosis Program of the Medical Genetic Unit of University of Zulia has the following objectives: Identification of Genetic Risk Factors (GRF) in those couples who attend to the Prenatal Genetic Clinic, application of different prenatal diagnostic procedures (PDP), and providing adequate genetic counseling. The goal of this paper is to show preliminary results obtained between January 1993 and December 1996. Three hundred and twenty one pregnant women were analyzed by determining the GRF and taking into account the genetic clinical history. The GRF analyzed were: Advanced maternal age (AMA), congenital malformation history (CMH), previous child with chromosomic anomalies (PCCA), defects of neural tube history (DNTH), congenital heart disease history (CHDH), any parent carrier of chromosomic anomaly (PCA), habitual abortion (HA), abnormal fetal echography (AFE), altered maternal serum levels of alpha-feto-protein (AMSAFP) and OTHERS: exposure to teratogenic agents, history of Mendelian diseases, maternal systemic diseases and anxiety in the mother or in her partner. The PDP was designed according to the GRF, which included fetal echography (FE), fetal echocardiography (FEc), amniocentesis (AMN), chordocentesis (CCT) and AMSAFP. Results showed that 58.4% of the expectant mothers asked for counseling during the 2nd trimester, 70% of the total showed only one GRF, and AMA was the most frequent GRF found (40.3%), followed by PCCA, AFE, CHDH, HA, DNTH, PCA, and OTHERS in that order. The specific PDP applied to the identified GRF allowed a health evaluation of the fetus. The GRF identification gave the opportunity of establishing a Prenatal Diagnostic Program producing a response to the couple's needs and showed the utility of an integral and multidisciplinary management directed to any expecting mother in order to identify any high GRF.

[Prenatal diagnosis. II. Importance of ultrasonographic markers in prenatal diagnosis of chromosome abnormalities]. / Diagnóstico Prenatal II: importancia de los marcadores ecográficos en el diagnóstico prenatal de cromosomopatías.

The Medical Genetic Unit of the University of Zulia (MGUUZ) has developed a Prenatal Diagnosis Program (PDP) since January-1993, in which Genetic Risk Factors are determined in couples who request prenatal genetic counseling. In this program, different prenatal diagnostic procedures are performed to detect congenital defects during intrauterine life. One of these procedures is the Fetal Sonogram (FS). FS is a non invasive technique which permits the prenatal diagnosis of many genetic dysmorphic syndromes. Through the search of abnormal specific characteristics in the fetus, chromosomopathies may be suspected. These findings are named "Echosonographic Markers of Chromosomal Abnormalities" (EMCA). During three years (January-1993 to December-1996), patients attended in the PDP included 321 pregnant women in which 312 FS were performed. Abnormal outcomes were 22 (17 with isolated congenital malformations and 5 with EMCA). Only one fetus with chromosome abnormality (46,XX21q-) could not be detected by FS. The goals of this paper are: 1) to report 5 patients with sonographic markers suggestive of chromosomal abnormalities and 2) to show the FS usefulness in prenatal diagnosis of chromosompathies. We conclude that, in the search of the EMCA the FS should be offered systematically to all pregnant women without recognizable genetic risk. They are the main group with optimal reproductive age and in consequence, with the possibility of having a relatively major number of conception outcomes with congenital defects, with or without chromosomic etiology. The majority of those defects can be detected by FS and could allow us to select the patients in which the use of an invasive prenatal diagnostic procedure could be justified.

[Behavior of Streptococcus mutans under prolonged exposure to xylitol, without reculture]. / Comportamiento de Streptococcus mutans bajo exposición prolongada a xilitol, sin recultivo.

Previous studies carried out in our laboratory showed that Streptococcus mutans--a cariogenic oral bacteria--did not metabolize an anticariogenic sugar alcohol, xylitol, even after a 10-month adaptative period with monthly transfers to a fresh medium. Due to the potential risk to adaptation observed in bacterias, it was studied the behavior of Streptococcus mutans (Strain 1161, Ingbritt) exposed to the polyol during 7 months, without monthly transfers to a new medium. After 7 months the cells were monthly transferred to a fresh medium for 7 more months. The cells were maintained and grown in a Trypticase-soytone-base medium without dextrose which contained xylitol (0.25 g/100 mL) or no sugar added. The control was represented by cells of Streptococcus mutans growing in Trypticase- soytone-base medium containing dextrose (0.25 g/100 mL). The growth pattern in the presence of xylitol was similar to that obtained in the cultures without sugar added, but it was 63-78% lower when compared with the control. The final pH in the cultures with xylitol was around 6.0; in the control it was very low (4.69 +/- 0.12). When the cells maintained in xylitol were transferred to the medium containing dextrose, the growth pattern was similar to that of the control. Any cultures fermented xylitol; the pH of the fermentation medium remained around 6.00 when the xylitol was present. No uptake of 14C-xylitol was observed and the activity of the enzyme xylitol dehydrogenase could not be detected with the experimental procedure used. The present study confirmed the Streptococcus mutans inability to metabolize xylitol, even after a prolonged adaptative period in the sugar alcohol. Moreover, it demonstrated that xylitol could be considered an inert substance to Streptococcus mutans since the cells were viable in the presence of the xylitol, or in the medium without sugar added.

[Neural tube defects at the Pedro García Clara Hospital, Zulia State, Venezuela]. / Defectos del tubo neural en el Hospital Pedro García Clara, Estado Zulia, Venezuela.

The results of a retrospective analysis of newborn population with neural tube defects (NTD) occurred in the Hospital Pedro Garcia Clara at Zulia State for the period 1982-1988, sex, birth condition, maternal age, number of pregnancies and mother's mean permanency of time in the zone, were studied. The control sample were children who were born the same day and of the same sex as the malformed children. By that period, the NTDs occupied the first place as morbidity caused for congenital malformations. NTDs had an incidence rate of 2.28 out of thousand total of births and can be considered one of the highest reported in the country. The major rate, 5.5 per 1000 was observed in 1986. The frequency of NTDs was higher in stillbirths and females. There were no differences between NTDs and controls in relation with maternal age and number of pregnancies in the mother. There was a heterogeneous geographical distribution with high concentration of cases of NTDs in Bachaquero and Mene Grande. The permanency of the NTDs's mothers was greater than that the controls' mothers. According to this investigation, it is suggested a necessity for more profound studies in order to identify and clarify some possible environmental conditions that could explain the present findings.

[Digestive manifestations and metabolic acidosis secondary to intravenous administration of cotrimoxazol]. / Manifestaciones digestivas y acidosis metabólica secundarias a la administración de cotrimoxazol intravenoso.

BACKGROUND: Digestive features and metabolic acidosis have been observed in patients with Pneumocystis carinii pneumonia treated with intravenous high dose co-trimoxazole. METHODS: To evaluate this phenomenon, a retrospective study of 22 patients (group A) and a prospective study of 12 patients (group B) were carried out. Group B patients were investigated following a protocol lasting for the 21 days of treatment. RESULTS: Metabolic acidosis developed in 23 (67%) of the overall number of study patients, and it was associated with digestive features such as nausea, vomiting and epigastralgia in 12. One patient had digestive features without metabolic acidosis. Metabolic acidosis developed early, between the days 4 and 7 of administration of the drug. The mean value of bicarbonate at the onset of therapy was 24,55 mEq; the mean value in the patients with metabolic acidosis was 16,43 mEq. The overall mean value of base excess at the onset of therapy was -2,39, and it was -8,46 in the patients who developed metabolic acidosis. CONCLUSIONS: As in all patients other causes of metabolic acidosis were ruled out, it became obvious that intravenous co-trimoxazole was directly related to the development of digestive features and metabolic acidosis, which disappeared with bicarbonate administration or with cessation of therapy.