Multiplex PCR in the empirical antibiotic treatment of patients with SARS-CoV-2 and bacterial respiratory superinfection.

Background: The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic led to overuse of antimicrobials, which increased concerns regarding antimicrobial resistance. Objective: To measure the impact of a multiplex polymerase chain reaction (PCR) pneumonia panel on empirical antibiotic treatment for patients with critical coronavirus disease 2019 (COVID-19) with suspected bacterial respiratory superinfection. Methods: This descriptive, prospective study was undertaken in a 36-bed intensive care unit from June 2020 to July 2021. Patients with severe COVID-19 who were ventilated and under suspicion of bacterial respiratory superinfection were included in the study. The intervention was a semi-quantitative multiplex PCR alongside concurrent standard cultures. When PCR panel results were expected to be obtained within 3 h of sampling, empirical antibiotic treatment was not administered while awaiting the results. Otherwise, empirical treatment was initiated. Patients classified as 'avoided empirical treatment' avoided 48-72 h of empirical antibiotic therapy. For those patients who received empirical treatment, the PCR panel results were used to decide whether treatment should be escalated, de-escalated, maintained or stopped. Positive and negative predictive values, and 'avoided empirical treatment' were calculated. Medical conduct and panel results were analysed for patients who received empirical treatment. Results: Eighty-two patients (71% male, 29% female) were included in this study. The mean age was 57.5 years, and the mean APACHE II score was 16. Ninety PCR panels were performed, and the negative and positive predictive values were 99.9% and 66.7%, respectively. Empirical treatment was avoided in 61% of episodes. Of those patients who were receiving antibiotics when the PCR panel was performed, treatment was de-escalated in 71%, escalated in 14%, stopped in 9% and maintained in 6%. A diagnosis of bacterial respiratory superinfection was ruled out in 19% of cases. Conclusions: PCR panels prevented the initiation of empirical antibiotic treatment in two-thirds of patients, and led to de-escalation in more than two-thirds of those who had started empirical antibiotic treatment. The high negative predictive value of the PCR panel allowed the diagnosis of bacterial respiratory superinfection to be ruled out. This tool represents a significant contribution to diagnostic stewardship in order to avoid the unnecessary use of antibiotics.

Hospital environment hygiene nurse: a key player to reduce healthcare associated infections by multi-resistant organisms.

BACKGROUND: Multi-Resistant Organisms (MRO) healthcare-associated infections (HAI) are closely associated with contamination of surfaces. Outsourced companies are usually in charge of both hospital hygiene and environmental hygiene personnel (EHP) supervision, which can result in bias. METHODS: A quasi-experimental study. The intervention was to add the "Hospital Environment Hygiene Nurse" (HEHN). MRO acquired infection rate and MRO acquired colonized rate were calculated, pre and post intervention. Confounding variables: MRO carriage rate upon admission and hospitalisation days median (HDM) were calculated. RESULTS: Median length of stay: 5 days (p=0.85, interquartile range=6 days). Carriage rate upon admission: 4.3% for pre-intervention vs 5.3% post-intervention, dif. (CI 95%): 1% (-1% to 2.9%) p=0.33. MRO acquired infection rate: 4.3% for pre-intervention vs. 2% post-intervention, Standardized Infection Ratio (SIR) (CI 95%): 0.47 (0.25 to 0.87). MRO acquired colonization rate:10.4% for pre-intervention vs. 7.9% post-intervention, SIR (CI 95%): 0.75 (0.53 to 1.07). CONCLUSIONS: As a reinforcement to standard infection control (IC) measures in place, the incorporation of an exclusive, full-time HEHN was significantly useful to reduce MRO HAI.

Diagnostic performance of 18F-choline PET-CT in prostate cancer.

OBJECTIVES: To evaluate the diagnostic performance of 18F-choline PETCT in staging prostate cancer (PC) and whether the use of this imaging modality changes the therapeutic decision in patients previously staged by conventional imaging. The secondary aim was to determine the prognostic factors associated with positive choline PETCT findings in both detection of disseminated disease and in changes in the therapeutic indication. MATERIALS AND METHODS: Multicentre, retrospective, observational study of 269 patients diagnosed with PC. Mean age was 69 ± 9.2 years. Of the 269 patients, 62 (23%) had high-risk localized PC (group 1), 118 (43.9%) biochemical failure after radical prostatectomy (group 2), and 89 (33.1%) biochemical failure after radiotherapy (group 3). None of the patients showed clear evidence of distant disease on computed tomography or bone scans. The following potential prognostic factors were assessed: PSA level at diagnosis; primary and secondary Gleason; Gleason score (GS); clinical and pathologic T and N stage; number of positive cylinders in the biopsy; presence of vascular or lymphatic invasion; status of surgical margins; androgen deprivation therapy (ADT); time to biochemical recurrence; and PSA, PSA doubling time (PSADT), and PSA velocity (PSAV) at failure. Univariate and multivariate analyses were performed, and receiver-operating curves calculated. RESULTS: The mean PSA by groups was, group 1: 31.22 ng/ml, group 2: 2.52 ng/ml and group 3: 5.85 ng/ml. The tumor detection rate with 18F-choline PETCT was 74% (group 1: 85.5%, group 2: 55.1% and group 3: 91%). Prognostic factors for positive 18F-choline PETCT were identified only in group 2: PSA at failure and PSADT. 18F-choline PETCT changed the therapeutic indication in 62.8% (group 1: 71%, group 2: 55.2% and group 3: 70.1%). The prognostic factors for a change in treatment were identified only in group 1: secondary Gleason ≤ 4 and GS ≤ 7 and in group 2: PSA at failure, PSA nadir after surgery and pathologic stage N0. 18F-choline PETCT identified lymph node and/or metastatic disease in 32.7% (group 1: 25.8%, group 2: 29.7% and group 3: 41.6%). Prognostic factors for detecting lymph node/metastasis were identified in the group 2: PSA failure ≥ 1.37 ng/ml and PSADT < 4 months and in the group 3: PSADT < 4.6 months and time to failure < 5 years. CONCLUSION: These findings support the clinical use de 18F-choline PET-CT in staging high-risk patients with a secondary Gleason ≤ 4 and GS ≤ 7, in restaging patients with biochemical recurrence after RP if PSA at failure ≥ 1.37 ng/ml or PSADT ≤ 4 months and in patients with biochemical failure after RT, if PSADT ≤ 4.6 months and time to failure < 5 years, because it determines a change in the therapeutic indication.

Environmental factors associated with childhood norovirus diarrhoea in León, Nicaragua.

Norovirus is detected in one in five diarrhoea episodes in children, yet little is known about environmental risk factors associated with this disease, especially in low-income settings. The objective of this study was to examine environmental risk factors, and spatial and seasonal patterns of norovirus diarrhoea episodes in children in León, Nicaragua. We followed a population-based cohort of children under age 5 years for norovirus diarrhoea over a 1-year period. At baseline, characteristics of each household were recorded. Households were geocoded and spatial locations of garbage dumps, rivers, and markets were collected. In bivariate analysis we observed younger children and those with animals in their households were more likely to have experienced norovirus episodes. In adjusted models, younger children remained at higher risk for norovirus episodes, but only modest associations were observed with family and environmental characteristics. We next identified symptomatic children living in the same household and within 500 m buffer zones around the household of another child infected with the same genotype. Norovirus diarrhoea episodes peaked early in the rainy season. These findings contribute to our understanding of environmental factors and norovirus infection.

Antibiotic resistance patterns of Escherichia coli isolates from different aquatic environmental sources in León, Nicaragua.

Antibiotic-resistant bacteria have emerged due to the selective pressure of antimicrobial use in humans and animals. Water plays an important role in dissemination of these organisms among humans, animals and the environment. We studied the antibiotic resistance patterns among 493 Escherichia coli isolates from different aquatic environmental sources collected from October 2008 to May 2009 in León, Nicaragua. High levels of antibiotic resistance were found in E. coli isolates in hospital sewage water and in eight of 87 well-water samples. Among the resistant isolates from the hospital sewage, ampicillin, chloramphenicol, ciprofloxacin, nalidixic acid, trimethoprim-sulphamethoxazole was the most common multi-resistance profile. Among the resistant isolates from the wells, 19% were resistant to ampicillin, ceftazidime, ceftriaxone, cefotaxime, chloramphenicol, ciprofloxacin, gentamicin, nalidixic acid and trimethoprim-sulphamethoxazole. E. coli producing ESBL and harbouring bla(CTX-M) genes were detected in one of the hospital sewage samples and in 26% of the resistant isolates from the well-water samples. The bla(CTX-M-9) group was more prevalent in E. coli isolates from the hospital sewage samples and the bla(CTX-M-1) group was more prevalent in the well-water samples.

Resistance of uropathogens in symptomatic urinary tract infections in León, Nicaragua.

Management of urinary tract infections (UTI) in Central America and especially Nicaragua, is complicated by the lack of knowledge about the antibiotic resistance of uropathogens. We conducted a prevalence study to gain more insight into the aetiology, bacterial resistance and risk factors for symptomatic UTI in the region of León, Nicaragua. In 2002, all consecutive patients with UTI symptoms and pyuria >/=10 WBC/hpf were admitted to the study. Positive cultures from midstream urine specimens were defined as >/=10(5) cfu/ml of a single uropathogen. Susceptibility tests were performed with disc diffusion tests using the Kirby-Bauer method and broth microdilution using National Committee for Clinical Laboratory Standards criteria both in León and a reference laboratory in Utrecht. A positive culture was present in 62 of 208 study subjects (30%). Escherichia coli (56%), Klebsiella spp. (18%) and Enterobacter spp. (11%) were the most frequent pathogens isolated. Presence of cystocele, incontinence and increasing age were risk factors for bacterial UTI. E. coli was least resistant to ceftriaxone, amikacin and nitrofurantoin (>90% susceptible). We observed high resistance rates in E. coli to amoxicillin (82%, MIC(90) 128 mg/l), trimethoprim-sulphamethoxazole (TMP-SMX) (64%, MIC(90) 32 mg/l), cephalothin (58%, MIC(90), 32 mg/l), ciprofloxacin (30%; MIC(90), 32 mg/l), amoxicillin/clavulanate (21%, MIC(90) 8 mg/l) and gentamicin (12%, MIC(90) 2 mg/l). Our results suggests that community acquired uropathogens in Nicaragua are highly resistant to many antimicrobial agents. The use of amoxicillin, trimethoprim-sulphamethoxazole and cephalothin against uropathogens needs to be reconsidered. High quinolone resistance rates among E. coli in Nicaragua gives cause for great concern.

Calibrated serological techniques demonstrate significant different serum response rates to an oral killed cholera vaccine between Swedish and Nicaraguan children.

Serum responses to oral cholera vaccines were assessed in three paediatric vaccine trials, two in León, Nicaragua and one in Stockholm, Sweden. A calibrated anti-cholera toxin B subunit (CTB) IgA ELISA was used together with an assay for vibriocidal antibodies. Swedish children had lower pre-vaccination levels of antibody, but serum responses were more pronounced in Swedish children than in Nicaraguan children. Post-vaccination levels of anti-toxin antibody were generally above those found after natural infections with enterotoxigenic Escherichia coli, that cross-reacts serologically with Vibrio cholerae. Adverse events seen after vaccination were generally mild and of little clinical significance.

[Cryptosporidium parvum infection in malnourished and non malnourished children without diarrhea in a Mexican rural population]. / Infección por Cryptosporidium parvum en niños desnutridos y no desnutridos sin diarrea en una población rural mexicana.

UNLABELLED: Cryptosporidium parvum is associated with diarrheic disease and mainly affects children and immunocompromised hosts. In most of the cases, cryptosporidiosis infection is asymptomatic in immunocompetent subjects. The objectives of the study were to determine the frequency of asymptomatic infection caused by the parasite in children with and without malnutrition and to determine the risk factors associated to infection. METHODS: Children from one to fifteen years old without diarrhea were included, somatometry were performed. The socioeconomic and sanitary conditions were investigated for each family and community. The Faust method and Kinyoun stain were employed identify parasites and Cryptosporidium parvum in feces. Odds ratio (OR), 95% confidence intervals (75% CI), chi 2 Mantel-Haenszel, Fisher exact test and chi 2 trends were calculated. RESULTS: One hundred thirty two children were included. In 10/132 (7.5%) cysts of Cryptosporidium were found, 7/71 in children with malnutrition (9.8%) and 3/61 without malnutrition (4.9%) p = 0.23. 69.7% of the children had parasitosis. According to the presence of C. parvum in feces, the different factors calculated were: Diarrhea in family OR = 5.82 (95%IC 0.86-39.18), not hand washing OR = 5.08 (95%IC 0.62-110.49), age less than 5 years old OR = 4.90 (95%IC 0.60-106.9), drinking non-potable water OR = 3.34 (95%IC 0.40-73.01) and malnutrition 2.11 (95%IC 0.46-10.89). Association was found between the number of people in the same house and the risk of infection (p = 0.005). The presence of diarrhea in the family (OR = 4.15, 95%IC 0.47-36.91) and drinking non-potable water (OR = 4.19, 95%IC 0.48-36.32) were the significant factors in the regression logistic model. CONCLUSIONS: The frequency of Cryptosporidium infection were 7.5%. Diarrhea in the family, overcrowding and drinking non-potable water were associated with C. parvum infection, malnutrition was not a significant risk factor.

[Exfoliative cytology for diagnosis of Helicobacter pylori]. / Citología exfoliativa en el diagnóstico de Helicobacter pylori.

The development of more reliable diagnostic methods has undoubtedly contributed to a better knowledge of the epidemiology and role of Helicobacter pylori (Hp) in the physiopathology of upper digestive tract diseases. Non abrasive and abrasive diagnostic methods have been used; among the latter, the exfoliating of abrasive cytology has been very popular during the last years. This fact motivated us to do this investigation. A descriptive-prospective study was developed in which the sample was composed by 235 patients of both sexes. The patients underwent gastro-duodenoscopy on account of dyspeptic symptoms and in order to determine the presence of Hp and its association with endoscopically diagnosed gastritis, with or without duodeno-gastric reflux, using the SYDNEY classification system. The frequency of Hp was assessed and the density of this microorganism was correlated with the hystological type of chronic gastritis following the above-mentioned classification. As a method of diagnosis of this disease, cytology showed a sensibility of 72% a specificity of 100% and an efficiency of 77% compared with histology, that was considered the "golden test". It was histologically proved that there exists a close relationship between chronic gastritis and the presence of Hp in the gastric antrum and that when the density of the bacterial population increases, the severity of chronic gastritis increases too. This germ may show up in histologically normal mucose, being able to provoke dyspeptic symptoms and colonizing the gastric antrum independently of the presence of duodeno-gastric reflux.

Citologia exfoliativa en el diagnostico de Helicobacter pylori / Abrasive cytology in diagnostic Helicobacter pylori

El desarrollo de métodos diagnósticos más confiables ha contribuido indudablemente al mejor conocimiento de la epidemiología y el papel del Helicobacter pylori en la fisiopatología de las enfermedades del tracto digestivo superior. Métodos diagnósticos no abrasivos y abrasivos han sido utilizados; entre los últimos, la citología exfoliativa abrasiva há sido muy popular en los últimos años. Este hecho nos motivó para hacer esta investigación. Se desarrolló un estudio descriptivo-prospectivo en un total de 235 pacientes de ambos sexos. Los pacientes fueron sometidos a una gastroduodenoscopía por presencia de síntomas dispépticos y con la finalidad de determinar la presencia del Hp y su asociación com la gastritis diagnosticada por endoscopía, con o sin reflujo duodeno-gástrico, y utilizando el sistema Sydney de clasificación. La presencia del Hp fue confirmada y la densidad de los microorganismos fue correlacionada con el tipo histológico de la gastritis crónica siguiendo a la mencionada clasificación. Como método de diagnóstico de esta enfermedad, la citología demostró una sensibilidad del 72 por ciento, una especificidad de 100 por ciento y una eficiencia de 77 por ciento comparado com la histología que fue considerada el "test dorado". Fue histológicamente probado que existe una relación muy próxima entre la gastritis crónica y la presencia de Hp en el antrogástrico y que cuando la densidad de la población bacteriana aumenta. También aumenta la severidad de la gastritis crónica. Este germen puede aparecer en mucosa gástrica histológicamente normal, provocando síntomas dispéptico, y colonizando al antrogástrico independientemente de la presencia de reflujo duodeno-gástrico.

Citologia exfoliativa en el diagnostico de Helicobacter pylori / Abrasive cytology in diagnostic Helicobacter pylori

El desarrollo de métodos diagnósticos más confiables ha contribuido indudablemente al mejor conocimiento de la epidemiología y el papel del Helicobacter pylori en la fisiopatología de las enfermedades del tracto digestivo superior. Métodos diagnósticos no abrasivos y abrasivos han sido utilizados; entre los últimos, la citología exfoliativa abrasiva há sido muy popular en los últimos años. Este hecho nos motivó para hacer esta investigación. Se desarrolló un estudio descriptivo-prospectivo en un total de 235 pacientes de ambos sexos. Los pacientes fueron sometidos a una gastroduodenoscopía por presencia de síntomas dispépticos y con la finalidad de determinar la presencia del Hp y su asociación com la gastritis diagnosticada por endoscopía, con o sin reflujo duodeno-gástrico, y utilizando el sistema Sydney de clasificación. La presencia del Hp fue confirmada y la densidad de los microorganismos fue correlacionada con el tipo histológico de la gastritis crónica siguiendo a la mencionada clasificación. Como método de diagnóstico de esta enfermedad, la citología demostró una sensibilidad del 72 por ciento, una especificidad de 100 por ciento y una eficiencia de 77 por ciento comparado com la histología que fue considerada el "test dorado". Fue histológicamente probado que existe una relación muy próxima entre la gastritis crónica y la presencia de Hp en el antrogástrico y que cuando la densidad de la población bacteriana aumenta. También aumenta la severidad de la gastritis crónica. Este germen puede aparecer en mucosa gástrica histológicamente normal, provocando síntomas dispéptico, y colonizando al antrogástrico independientemente de la presencia de reflujo duodeno-gástrico. (AU)

Rotavirus infections in young Nicaraguan children.

BACKGROUND: Rotavirus is an important cause of dehydrating diarrhea in young children throughout the world. Knowledge about frequency of reinfections, development of immunity to the virus and the possible protective effect of breast milk is important, in particular in relation to possible strategies for immunization. METHODS: A prospective study of rotavirus infections in a cohort of 235 infants followed from birth until 2 years of age was performed in León, Nicaragua. Fecal and serum specimens were collected at specified times, and stools were also obtained during episodes of diarrhea. Fecal specimens were screened by rotavirus antigen detection and serum and colostral specimens were analyzed by isotype-specific rotavirus antibody enzyme-linked immunosorbent assay. RESULTS: As judged by anti-rotavirus IgA antibody seroconversion and/or demonstration of rotavirus antigen in fecal specimens, > 50% of the babies had evidence of past rotavirus infection by the age of 2 months. The total incidence of rotavirus infections, including many reinfections, was 0.7 infection/child-year, of which only 17% were associated with diarrhea. The time from birth to the first demonstration of rotavirus in stool samples correlated significantly with the concentration of anti-rotavirus IgA antibodies in colostrum. There was also a tendency toward a relationship between long duration of breast-feeding and asymptomatic infection. CONCLUSIONS: Rotavirus infections are acquired very early in infants in León, Nicaragua, and reinfections are common. Most infections are asymptomatic. Breast milk appears to confer partial protection against rotavirus infection, probably mediated by specific IgA antibodies. To be effective rotavirus vaccination would probably have to be given at a very early age to infants in developing countries.

Analysis of incidence of infection with enterotoxigenic Escherichia coli in a prospective cohort study of infant diarrhea in Nicaragua.

Diarrheal episodes with enterotoxigenic Escherichia coli (ETEC) were prospectively monitored during the first 2 years of life in a cohort of 235 infants from Leon, Nicaragua. ETEC was an etiological finding in 38% (310 of 808) of diarrheal episodes and in 19% (277 of 1,472) of samples taken as asymptomatic controls at defined age intervals (P = <0.0001). The majority of diarrheal episodes (80%) occurred before 12 months of age. The major ETEC type was characterized by colonization factor CFA I and elaboration of both heat-labile enterotoxin and heat-stable enterotoxin (ST). The proportion of E. coli strains with CFA I was significantly higher in cases with diarrhea (P = 0.002). The second most prevalent type showed putative colonization factor PCFO166 and production of ST. The prevalence of PCFO166 was approximately 20%, higher than reported before. Children with a first CFA I episode contracted a second ETEC CFA I infection 24% of the time, compared with 46% for ETEC strains of any subtype. Most of the ETEC episodes were of moderate severity, and only 5% (15 of 310) were characterized as severe. In conclusion, our results give valuable information for the planning of intervention studies using ETEC vaccines.

Accion de la celulosa microcristalina en la gastritis alcalina por reflujo biliar / Action of the microcrystalline cellulose in the alkaline gastritis due to bile reflux

Los ácidos biliares presentes en el contenido gástrico, productos de un reflujo duodeno gástrico han sido incriminados como responsables de agredir la mucosa gástrica mediante una acción detergente sobre la barrera defensiva. Esta acción nociva determina una lesión inflamatoria en dicha mucosa, constituyendo una gastritis crónica que se expresa clínicamente por dolor epigástrico pirosis y vómitos de aspecto biliosos entre otros síntomas, lo que ha constituido una entidad clínica llamada Gastritis Alcalina por Reflujo Duodenogástrico, más recientemente, Gastritis Reactiva según el Sistema Sydney. Las fibras dietéticas, más especialmente la celulosa, se han señalado como las más activas en la capacitación e inactivación de los ácidos biliares en recientes investigaciónes, lo que constituye una acción citoprotectora sobre la mucosa del estómago en los pacientes que presentan esta patología. En relación con estos conocimientos hemos realizado un estudio en 50 pacientes con gastritis alcalina diagnosticados por estudio endoscópico, dosificación de àcidos biliares totales en contenido gástrico y biopsia (excluyendo los pacientes con presencia de H. pylori); los cuales fueron divididos en 2 grupos de 25 cada uno, siendo tratados, el primer grupo (A) con almidón de maíz en polvo y el segundo grupo (B) con celulosa microcristalina en polvo a la dosis de 5 gramas diarios durante 3 meses observándose los seguientes resultados: los ácidos biliares totales en contenido gástrico disminuyeron al final del tratamiento de una forma mayoritaria en los pacientes tratados con microcelulosa, aunque no fue estadísticamente significativa. Desde el punto de vista clínico, hubo una respuesta altamente satisfactoria en el dolor, vómitos y pirosis al tratamiento con microcelulosa. Los signos endoscópicos inflamatorios localizados en la región antral y difusamente en toda la mucosa del estómago, mejoraron cuantitativamente, observándose, diferencia significativa en la localización antral. Los hallazgos histológicos al final del tratamiento, en el grupo A y en el grupo B no mostraron variaciones evolutivas en el estudio comparativo de las lesiones encontradas al inicio del tratamiento. Los resultados se muestran en tablas.

Accion de la celulosa microcristalina en la gastritis alcalina por reflujo biliar / Action of the microcrystalline cellulose in the alkaline gastritis due to bile reflux

Los ácidos biliares presentes en el contenido gástrico, productos de un reflujo duodeno gástrico han sido incriminados como responsables de agredir la mucosa gástrica mediante una acción detergente sobre la barrera defensiva. Esta acción nociva determina una lesión inflamatoria en dicha mucosa, constituyendo una gastritis crónica que se expresa clínicamente por dolor epigástrico pirosis y vómitos de aspecto biliosos entre otros síntomas, lo que ha constituido una entidad clínica llamada Gastritis Alcalina por Reflujo Duodenogástrico, más recientemente, Gastritis Reactiva según el Sistema Sydney. Las fibras dietéticas, más especialmente la celulosa, se han señalado como las más activas en la capacitación e inactivación de los ácidos biliares en recientes investigaciónes, lo que constituye una acción citoprotectora sobre la mucosa del estómago en los pacientes que presentan esta patología. En relación con estos conocimientos hemos realizado un estudio en 50 pacientes con gastritis alcalina diagnosticados por estudio endoscópico, dosificación de Ocidos biliares totales en contenido gástrico y biopsia (excluyendo los pacientes con presencia de H. pylori); los cuales fueron divididos en 2 grupos de 25 cada uno, siendo tratados, el primer grupo (A) con almidón de maíz en polvo y el segundo grupo (B) con celulosa microcristalina en polvo a la dosis de 5 gramas diarios durante 3 meses observándose los seguientes resultados: los ácidos biliares totales en contenido gástrico disminuyeron al final del tratamiento de una forma mayoritaria en los pacientes tratados con microcelulosa, aunque no fue estadísticamente significativa. Desde el punto de vista clínico, hubo una respuesta altamente satisfactoria en el dolor, vómitos y pirosis al tratamiento con microcelulosa. Los signos endoscópicos inflamatorios localizados en la región antral y difusamente en toda la mucosa del estómago, mejoraron cuantitativamente, observándose, diferencia significativa en la localización antral. Los hallazgos histológicos al final del tratamiento, en el grupo A y en el grupo B no mostraron variaciones evolutivas en el estudio comparativo de las lesiones encontradas al inicio del tratamiento. Los resultados se muestran en tablas. (AU)

Prevalence and characteristics of severe rotavirus infections in Nicaraguan children.

We analyzed the prevalence of rotavirus in 296 children age between 3 and 36 months who were hospitalized in 1994 with severe gastro-enteritis at two health centres for diarrhoea treatment in León, Nicaragua. Enteric viruses were detected in 96 (32.4%) of the children and rotaviruses were the most common pathogens detected in 84 (28%). The majority of rotavirus infections occurred in children less than 1 year old and all strains isolated belonged to subgroup II and had 'long' RNA patterns. Molecular epidemiology of 55 rotavirus strains revealed that all had the same RNA migration pattern and serotyping of 37 strains by PCR technology revealed that all isolates belonged to serotype 3. A significant observation was that only one electropherotype of rotavirus circulated. No non-group A rotaviruses were found by RNA gel electrophoresis. Adenoviruses were found by ELISA in 14 of 265 (5%) children and were most frequently detected during the 1st year of life. Of 103 faecal samples analyzed by electron microscopy, four contained small round structured viruses.

[Effect of microcrystalline cellulose on alkaline gastritis due to bile reflux]. / Acción de la celulosa microcristalina en la gastritis alcalina por reflujo biliar.

Biliary acids present in gastric content due to a duodena-gastric reflux have been blamed for attacking the gastric mucosa through detergent action on the defensive barrier. This harmful action produces an inflammatory lesion on this mucosa, resulting in a chronic gastritis which is clinically expressed by epigastric pain, heartburn and vomits of biliar aspect among other symptoms, and it has constituted a clinical entity named Alcaline Gastritis by Duodenal-gastric Reflux, more recently, Reactive Gastritis according to the Sydney System. Among dietetic fibers, cellulose has been reported in recent investigations as most active in capturing and inactivating biliary acids: this constitutes a cytoprotective action on the stomach mucosa of patients who suffer this pathology. Concerning these aspects, we studied 50 patients with alcaline gastritis, excluding those who have H. pylori. The patients were diagnosed by endoscopy studies, dosage of total biliary acids in gastric content and biopsy and were divided into two groups of 25 subjects each. The first group (A) received powdered corn starch and the second group (B) powdered microcrystalline cellulose dosed 5 g/day during three months. The results showed that total biliary acids in gastric content decreased at the end of treatment mostly in patients treated with microcellulose, even though there was no statistical significance. From the clinical view point of vue, there was a highly satisfactory response in pain, vomits and heartburn after microcellulose treatment. The endoscopic inflammatory located in the antral region and diffusely, in the whole gastric mucosa, quantitatively improved and there was a significant difference in the antral location. The histological findings at the end of the treatment in either group showed no evolutive variation in the comparative study of the lesions found at the beginning of the treatment. Results are shown in tables.

Prevalence of antibodies to hepatitis A, B, C, and E viruses in a healthy population in Leon, Nicaragua.

A cross-sectional survey of the seroprevalence of hepatitis A virus (HAV), B (HBV), C (HCV), and E (HEV) antibodies in a healthy population in Leon, Nicaragua was conducted and associated with demographic data. The overall prevalence of antibodies to HAV was 94.6%, to HBV 6.5% and to HEV between 4.6% and 8.0%, whereas none of 399 tested subjects showed confirmed seropositivity to HCV. A high HAV seropositivity rate (72.7%) was observed even in the lowest age groups tested (2-4 years of age). In contrast, HBV and HEV seropositivity was observed mainly in adults, the seroprevalence in > 40-year-old individuals being 15.4% and 17.6%, respectively. The overall mean hepatitis B surface antigen carrier rate was estimated to be 0.9%, and in individuals more than 20 years of age, 2.0%. The prevalence of anti-HAV as well as anti-HEV was significantly higher in people having their water supply outside rather than inside the house. Furthermore anti-HAV seroprevalence correlated with lack of access to a flush toilet. Hepatitis B virus seropositivity was more frequent in people living in a crowded environment than in those living with few household members. These findings indicate that hepatitis A is a childhood infection in Nicaragua and that the spread of the infection is facilitated by poor socioeconomic conditions. In contrast, HBV infection is relatively infrequent in the country and HCV seems to be very uncommon. Hepatitis E virus infection may occur in all age groups and is apparently associated with water-borne transmission.

[Effect of microcrystalline cellulose on the excretion of total biliary acids in feces]. / Acción de la celulosa microcristalina en la excreción de ácidos biliares totales en heces fecales.

The colorectal neoplasia is the second cause of death from neoplasia in our country, and in international statistics, blaming for this, the dietetic habits of industrialized countries having a high content of satured fat, cholesterol, refined carbohydrate, red meat, and with few dietetic fibers. In the last years special attention has been focused to the action of the total biliar acids (TBA) primarily the secondary ones, over the colon mucosa, showing evidences of cancerous effects. Recently, American authors have published the favoring action of the cellulose fiber over the TBA through a catalytic reaction and their polysterification, inactivating them in their aggressive action over the colon mucosa. Through these experiences and willing to prove the action of the product, we have treated with microcrystalline cellulosa (Microcel Lab. Blanver, Brasil) 20 patients of the Institute of Gastroenterology of Havana City, who showed high figures of TBA in stools for 2 months, compared with the 5 g. dose per day. Another group of 20 patients also with high figures of TBA in stools being treated with corn fecula same dose, same time by equal time, making every month determinations to both groups, determining that in the first group the figures of TBA in stools were normalized in 95% the first month of treatment and in 100% the second month. The second group had only an answer of 65% the first month and of 80% the second month, which shows evidently the high efficacy of Microcel in reducing the TBA in stools.