Increased risk of acute myocardial infarction associated with beedi and cigarette smoking in Indians: final report on tobacco risks from a case-control study.

BACKGROUND: Tobacco smoking is an important risk factor for ischemic heart disease. In India, tobacco is smoked both as cigarettes and beedies. No studies have evaluated their importance as risk factors for ischemic heart disease among the Indian population. The present study explores the importance of smoking either cigarettes or beedies as risk factors for acute myocardial infarction. METHODS AND RESULTS: The study had a case-control design and was conducted in a tertiary teaching hospital in Bangalore. Three hundred subjects aged 30-60 years with a first acute myocardial infarction and 300 age- and sex-matched controls were recruited prospectively. Smoking, dietary and social history were recorded, body mass index and waist-hip ratio measured, and blood glucose, lipids, fasting plasma and insulin levels estimated. Cases and controls had a mean age of 47.2 years and 46.8 years, respectively. There were 279 (93%) males in each group. Diabetes mellitus (odds ratio 2.69, p<0.0009). hypertension (odds ratio 2.36, p=0.0009), fasting and post-load blood glucose (p<0.0001). and waist-hip ratio (p<0.0001) were found to be important risk factors for acute myocardial infarction. Smoking was an independent risk factor with a clear dose effect. Adjusted odds ratio for smoking > or = 10 cigarettes/day was 3.58 (p<0.0001) and was 4.36 (p<0.0001) for smoking > or = 10 beedies/day. CONCLUSIONS: Smoking > or = 10 cigarettes or beedies/day carries an independent four-fold increased risk of acute myocardial infarction. This reiterates the need for urgent tobacco control measures in India.

Esofagitis asociada con el uso de alendronato en 5 pacientes posmenopáusicas / Esophagitis associated with use of alendronate in 5 postmenopausic patients

The biphosphonate, alendronate sodium (e.g. Fosamax) is a bone resorption inhibitor used to treat posmenopausal osteoporotic women and osseous Paget's disease. Esophaghitis is one of the adverse effects (AE) associated to its use. Five (5) patients with alendronate-associated esophagitis assisted in the Gastroenterologic Center, Rosario, Argentina, between October 1996 and December 1999 are described. The aim is to correlate the clinical, endoscopic and histopathological findings in 5 women (ages 57-71) complained for upper digestive symptoms (disphagia, epigastrialgia, retroesternal pain). All had osteoporosis treated with alendronate 10 mg/day and received detailed instructions about how to take the medication. The time from the beginning of alendronate intake and the appearence of the symptoms was elapsed 30, 35, 67, 85 and 90 days. The esophagitis was graded according to the Savary-Miller Classification. The videoscopy disclosed esophagitis of III and IV grades. Three patients has also antral and antroduodenal lesions, one of them associated to Helicobacter pylori. Anatomopathological findings confirm esophagitis and esophagic ulceration. Some authors claim that disphosphonates as a new class of gastrotoxic drugs with AE similar to aspirin. Even when it is administrated according to the instructions of the manufactures it should be used with caution. Our contribution emphazise the importance of this AE and suggest measures to diminish or suppres them, and take into consideration those patients who are taking aspirin. With alendronate, as well as with other potentially corrosive agents, is very important to take in mind the measures to prevent AE.

Use of the logistic organ dysfunction system to study mortality in an Indian intensive care unit.

BACKGROUND: Mortality in Indian intensive care units has not been well studied. Scoring systems are used to predict mortality of patients admitted to such units. Some scoring systems predict hospital mortality while others predict mortality in intensive care units. We used the logistic organ dysfunction system to study the hospital and intensive care unit mortalities in our intensive care unit. METHODS: We prospectively studied 527 consecutively admitted patients in 1997 to the medical intensive care unit in St John's Medical College Hospital, Bangalore. The outcomes studied were death in hospital and death in the intensive care unit. Using standardized mortality ratios, we compared our observed hospital and intensive care unit mortalities with the hospital mortality predicted by the logistic organ dysfunction system. RESULTS: The standardized mortality ratios for hospital deaths was 1.3 with a confidence interval of 1.17-1.49 and for intensive care unit deaths it was 1.0 with a confidence interval of 0.89-1.18. The hospital mortality rates in our setting are significantly higher (p < 0.05) than the predicted hospital mortality rates of the published western model for intensive care unit patients. The intensive care unit mortality rates are not significantly different from the predicted hospital mortality rates of the published western model for intensive care unit patients. CONCLUSION: Our intensive care unit mortality rate is comparable to the western hospital mortality rate. However, after transfer of patients out of the unit, the hospital mortality is higher.

Detection del Helicobacter pylori por reacción en cadena de la polimerasa en muestras de bilis de pacientes con litiasis vesicular y coledociana / Detection of Helicobacter pylori by polimerase reaction in bile samples from gallblader and bile stones

Algunos trabajos describen la presencia de H. Pylori en muestras de bilis obtenidas durante la cirurgía por litiasis en vesícula y vías biliares. El objetivo de este trabajo, ha sido detectar la presencia del ADN del H. Pylori por medio de la Reacción en cadena de la Polimerasa (PCR) en muestras de bilis de pacientes con litasis vesicular y/o de vías biliares. Las muestras de bilis fueron obtenidas de 26 pacientes, 19 con litiasis vesicular y 7 con litiasis vesicular y coledociana, con edades comprendidas entre 22 a 69 años, media de 49,6 años, por punción de vesicular durante la colecistectomia. Las muestras fueron tratadas adecuadamente y preparadas para su investigación por PCR. 2 de 26 casos (7,6 por ciento) fueron positivos para la presencia en bilis del DNA del H. Pylori. Nuestro trabajo sugiere que el DNA del H P puede ser encontrado en muestras de bilis de pacientes portadores de litiasis biliar en la Argentina.

Evaluacion de la erradicacion postratamiento del Helicobacter pyloripor reaccion en cadena de la polimerasa en biopsias gastricas / Post-treatment control of Helicobacter pylori erradication, by polymerase chain reaction in gastric biopsies

Introducción: La detección del H.p. en el estómago de pacientes vírgenes de tratamiento ha sido solucionada; un aspecto no resuelto, al menos en nuestro medio, es la pesquisa del H.p. luego de la terapéutica, para asegurar su erradicación. Objetivos: Utilizar una metodología sensible y específica para evaluar la presencia del H.p. en biopsias gástricas postratamiento, comparándola con otras técnicas similares clásicas. De esa manera, aumentando la precisión en el diagóstico, se podrá diferenciar la recrudescencia (falsa erradicación) de la reinfección y conocer el exacto porcentaje de curación. Materiales y Métodos: La PCR para H.p. fue realizada en 97 pacientes (62 hombres y 35 mujeres) con edad propedio de 49 años (+/- 14), en los cuales ya se había confirmado la erradicación por histología-Giemsa más CLO TEST. La metodología fue la siguiente: se realizaron 5 biopsias gástricas endoscópicas por paciente, 2 de antro, 2 de cuerpo, y 1 para CLO; todos los pacientes fueron estudiados luego de 6 ou 8 semanas de terminado el tratamiento y durante ese período no recibieron ninguna medicación. La metodología fue: las biopsias gástricas fueron fijadas en formol buffer al 10 por ciento, incluídas en parafina, y se colorearon con Giemsa y hematoxilina-eosina. El CLO TEST usado fue de Delta West Pty. Ltd. Bentley. La PCR se efectuó amplificando un fragmento de 296 pares de bases correspondiente al gen codificante del antígeno especie especifico de Helicobacter pylori, y la visualización del producto amplificado se realizó por electroforesis en gel de agarosa teñido con bromuro de etidio y U.V. Resultados: ninguno de estos pacientes presentaba úlcera gástrica o duodenal en el momento del control.Conclusiones: La PCR puede detectar secuencias de ADN especificas del H.p., incluso en su forma cocoide de resistencia, como se observan postratamiento. Las tinciones más utilizadas en biopsia (Giemsa/W-S) detectan aproximadamente 100000 microorganismos por ml; la PCR puede detectar 100, vale decir que es tres órdenes más sensible que la metodología clásica. En nuestra experiencia detectamos un 13 por ciento de falsos erradicados, los cuales clínicamente deberán ser considerados como recrudescencia y no como reinfección.