Helicobacter pylori en Venezuela: un problema infeccioso multifactorial / Helicobacter pylori in Venezuela: a problem infectious multifactorial

Los objetivos del presente trabajo fueron: establecer la seroprevalencia de la infección por Helicobacter pylori en población venezolana y su asociación con trastornos gastroduodenales y evaluar la presencia del gen cagA mediante la reacción en cadena de la polimerasa y su asociación con trastornos gastroduodenales. Para el estudio de seroprevalencia se evaluaron un total de 1041 personas de distintos estados del país, 370 adultos sintomáticos, 406 asintomáticos, 27 niños sintomáticos y 238 asintomáticos. La determinación de anticuerpos IgG específicos se realizó mediante ELISA comercial. La presencia del gen CagA fue evaluada en 133 pacientes del área metropolitana y el Centro de Cáncer Gástrico de San Cristóbal. Las biopsias se analizaron por diferentes métodos de diagnóstico para H. pylori: cultivo, prueba de ureasa, reacción en cadena de la polimerasa. En la población infantil el porcentaje de niños con valores de anticuerpos IgG específicos anti-H. pylori varía de 30 por ciento a 60 por ciento. En adultos sintomáticos la seroprevalencia varía entre un 68 por ciento a 93 por ciento según el área geográfica estudiada. Una disminución de anticuerpos IgG anti- H. pylori se observó en pacientes con gastritis antral difusa asociada con metaplasia tipo II. En el grupo de pacientes de San Cristóbal se observaron títulos elevados en pacientes con gastritis antral difusa. Un 46 por ciento de las cepas de H. pylori aisladas de pacientes del Area Metropolitana presentaron el gen cagA a diferencia de grupo de San Cristóbal donde se observó una frecuencia menor (26,41 por ciento).

[Etiologic, clinical and socio-democratic characteristics of acute diarrhea in Venezuela]. / Características etiológicas, clínicas y sociodemográficas de la diarrea aguda en Venezuela.

In four cities of Venezuela a study was carried out to evaluate the epidemiological, clinical, and etiological characteristics of acute diarrhea in children under 5 years of age. The study was done between June 1993 and May 1995 and involved children who were seen in a hospital, 2,552 with diarrhea and 793 controls. The Fisher exact test was used for the statistical analysis of the results. Rotaviruses were the most important agents, both in terms of their frequency (30%) and their association with dehydration (58%). Following in importance were Campylobacter spp. (13%) and Escherichia coli classical O serogroups (9%), but their association with diarrhea was only statistically significant among children less than 3 months old, a fact that is particularly important from the standpoint of treatment. The importance of age was confirmed as a determining factor in the prevalence and severity of diarrhea.

[Immunoenzymatic assay for serodiagnosis of Helicobacter pylori infections]. / Ensayo inmunoenzimático para el serodiagnóstico de la infección de Helicobacter pylori.

Enzyme-linked immunosorbent assays (ELISA) have been developed to diagnose H. pylori infection. However, the methods are not standardized. We therefore evaluated the sensitivity of ELISA developed in our laboratory in a study population comprising 38 patients with dyspeptic symptoms and 41 healthy children under 10 years. The assays for immunoglobulin G used a pool of sonicated isolates of H. pylori from five patients with dyspeptic symptoms. Serum levels IgG antibodies to cell sonicates of H. pylori were significantly higher (p < 0.001) in patients with positive culture than in the control group. Cutoff score of 0.231 for positive results was determined with mean + 3ds of the healthy group analyzed. On the basis of this survey, we conclude that a serum dilution of 1:300 and 5 micrograms/ml of antigen, are the optimal condition for rapid screening with high sensitivity of 92% of symptomatic patients for the presence of H. pylori.

[Non ulcer dyspepsia, endoscopic gastritis and Helicobacter pylori]. / Dispepsia no ulcerosa, gastritis endoscópica y Helicobacter pylori.

We studied 33 patients with non ulcer dyspepsia and endoscopic gastritis. 21 were female (63.4%) and 12 male (36.4%). Helicobacter pylori (HP) was investigated by gastric mucosal biopsy. Urease test, Gram, culture, and histology were performed in all and two or more of these test hat to be positive to consider HP infection. 16/33 resulted HP positive (48.8%). Erosive gastritis was most commonly associated with H.P. infection (62.5%). This was statistically significant. In all the cases HP positive chronic gastritis was present. 15/16 were active chronic gastritis. Our results suggest that erosive gastritis is most frequently associated with HP infection and non ulcer dyspepsia.

Realimentation of dehydrated children with acute diarrhea: comparison of cow's milk to a chicken-based formula.

A randomized, prospective study was performed on 73 male children between 3 and 14 months of age with mild to moderate dehydration caused by acute diarrhea, and who were rehydrated with WHO-ORS, and then at 4 h after admission were fed either cow's milk or an experimental diet based on chicken, plantain, and coconut oil. There were no statistically significant differences in the admission characteristics. The group of children fed cow's milk had a higher total volume of diarrheic evacuations (p less than 0.05). The average duration of diarrhea was 20 h shorter in the group of infants on the milk-free formula. A significant correlation was observed between the volume of diarrhea and the WHO-ORS consumed during the first 48 h, but not to the volume of diet intake.

[The pH of feces in children with acute diarrhea during the first hours of oral rehydration]. / El pH de las heces en los niños con diarrea aguda durante las primeras horas de rehidratación oral.

We studied 108 children between 3 and 36 months of age with acute diarrhea and dehydration when their diarrhea continued more than 24 hours following initiation of ORT and in whom we measured pH and glucose of stools with strips in all evacuations. According to the average stool pH and glucose in the first six hours, the patients were grouped in pH < or = 5.5 and > 5.5 and a glucose < or = 1+ and > 1+. The pH of stools < or = 5.5 increased significantly (P < or = .0005) in children between > 6-12 hours and by 48 hours, it was similar to those with an initial average pH 6.6 Stool glucose declined considerably between > 12 and 24 hours. Contrary to what we expected to find, children with pH > 5.5 excreted more stools and had a higher ORT intake in the first 24 hours. The systematic studies of pH and glucose of stools did not appear to be useful for children with acute diarrhea who had a satisfactory evolution.

[Retrograde endoscopic cholangiopancreatography. Incidence of bacteremia]. / Colangiopancreatografía retrógrada. Incidencia de bacteriemia.

ERCP like all the endoscopic procedures, implies some risks of complications, between them, infections. Bacteremia may occur in any endoscopic and gastrointestinal procedure. The rate on ERCP is about 0 to 5.6%. In the present investigation we intended to determine the rate of bacteremia produced by ERCP, the organism that cause bacteremia and to correlate ductal pathology, stasis and bacteremia. From May to October 1988, at the Hospital Vargas of Caracas, 22 ERCP were performed in patients that were included for analysis. Haemocultives were taken for aerobics and anaerobics, gems before ERCP, immediately after the cannulation of biliary and/or pancreatic ducts and 5 minutes later after concluding the study. A high incidence of bacteremia was reported, 13.6%, all the previous haemocultives were negative. The positive haemocultives were during the cannulation procedure and no haemocultive after the study was positive. The organism isolate were Peptococcus sacharoliticcus and Staphylococcus epidermidis both of the normal flora of small intestine and the last one on the skin too. There were not relation between the ductal pathology, stasis and bacteremia. Some organisms were related to nosocomial agents, we considered though the disinfection and polishment of the accessories and equipment adequate. It is recommendable to use prophylactic antibiotic in immunosuppressed patients with valvular prosthesis.

Effect of three dietary treatments upon the histopathology of jejunal biopsies of children with chronic diarrhea.

Thirty two children with chronic diarrhea of unknown etiology were prospectively investigated in a special hospitalization unit. They were all under 5 percentile for weight/height (NCHS). They had no edema and their age range was between three and eighteen months. The patients were given cow's milk and following the first jejunal biopsy they were fed one of three different diets as their only intake for a period of 15 days. The diets consisted of cow's milk and of two semi-elemental diets with different carbohydrate compositions. A second biopsy was taken at the conclusion of the specific diet. The jejunal biopsies were taken with a Crosby capsule just after the duodenal-jejunal junction and were analyzed by light microscopy. The morphological changes before and after 15 days of dietary treatment were evaluated. The children on semi-elemental diets showed a marked reduction of the number of interepithelial lymphocytes, and of lymphocytes in lamina propria. The infants on cow's milk showed no improvement. Our results suggest that cow's milk could be the cause of the persistent mucosal alterations observed in these infants.

[Comparative study of nitrogen, lipids and energy loss through the feces in children dehydrated by acute diarrhea due to rotavirus and other agents]. / Estudio comparativo de las pérdidas en las heches de nitrogeno, lipidos y energía en niños deshidratados por diarrea aguda debida a rotavirus y otros agentes.

With a view to observing if gastroenteritis to rotavirus produced greater carbohydrate malabsorption, we studied 94 male infants, between three and thirty six months of age, with acute diarrhea and dehydration. The metabolic study included the analysis of every intake and excretion during the first 24 hours of oral rehydration and realimentation. Thirty two infants had rotavirus as the single etiological agent, but in numbers it could only be compared to 35 patients in whom we were unable to establish the causal etiological agent of diarrhea in spite of the application of all the usual techniques. No differences were noted with regard to stool and urine losses, nor nutrient intakes of the groups. The present study does not confirm the observation reported in other papers that diarrhea to rotavirus causes a greater loss of carbohydrates.

[Mycotic and bacterial flora in patients with nail disorders]. / Estudio de la flora micótica y bacteriana en pacientes con lesiones de las uñas.

249 patients with a possible diagnosis of onychomycosis were studied. The majority of patients with diagnosis of mycosis had a different cause In our study only 96 cases (38.5%) had proved mycotic infection, 4 (1.6%) had a bacterial infection and the rest had different causes of lesion such as trauma, contact dermatitis, psoriasis, etc. The mycotic lesions were usually caused by dermatophytes: Trichophyton rubrum, T. mentagrophytes and T. tonsurans. The 2nd most frequent agents were years most of them Candida albicans. The 3rd group was formed by opportunist fungi. Most of the isolated bacterial were of cutaneous saprophytic flora, and in only 4 cases Pseudomonas aeruginosa was found.