Colesterolosis vesicular: algunos aspectos de su fisiopatología / Vesicular cholesterolosis: some aspects of its pathophysiology

Gallbladder cholesterolosis is a nosological clinical entity where the central element is the deposit of lipids in immune cells that reside under the gallbladder epithelium. The mechanisms involved in its development are not entirely clear, but they seem to have some resemblances that are observed in the wall of the arteries with atherosclerosis. The lipid-laden cells observed in the gallbladder wall appear to share many of the characteristics of atherosclerosis foam cells, which by means of scavenger receptors have endocited oxidized low-density lipoproteins and accumulate them in their cytoplasm. Foam cells, in themselves, are not dangerous, but in atherosclerosis at least they can become a problem when they are located in vessels and specific anatomic sites. The role they may have in the gallbladder is not known to date. We will review some considerations that seem relevant to us to elucidate if these entities share the same protagonist: macrophages transformed by modified lipids. (AU)

Péptidos inmunogénicos del gluten en deposiciones: nuevo método para evaluar la adherencia a la dieta en pacientes celíacos / Immunogenic gluten peptides in stools: new method to evaluate in the dietary adherence in celiac patients

Celiac disease (CD) is an autoimmune pathology caused by the ingestion of gluten in genetically susceptible people, currently considered multisystemic. The treatment of CD is a lifelong strict Gluten-Free Diet (GFD), which allows a symptomatic improvement in most patients and achieve intestinal mucosa healing confirmed with histological study. The adherence to the GFD is variable, arguing as possible factors related to failure the economic, cultural, social aspects and the consumption of gluten inadvertently. The management of celiac patients contemplates instructing in the proper follow-up of GFD and evaluating their adherence. So far, the only way to assess adherence to GFD is through surveys, self-reports of eating habits and serology, being the main disadvantage the subjectivity factor. Recently the immunogenic gluten peptides have acquired relevance for the objective evaluation of the adherence to the GFD and the measurement appears as an efficient and sensitive option to determine the gluten intake, providing relevant information for the clinical management.

¿Son útiles los marcadores serológicos ASCA y p-ANCA en la enfermedad inflamatoria intestinal? / Are useful the ASCA and p-ANCA serologic markers in inflammatory bowel disease?

Background: Several studies have suggested that Anti-Saccharomyces cerevisiae antibodies (ASCA) and perinuclear anti-neutrophil cytoplasmic antibodies (p-ANCA) are useful serological markers associated with inflammatory bowel disease (IBD). However, neither the indication nor its use in clinical practice have been clearly established. Aim: to assess whether the presence of these markers have a possible diagnostic role and clinical significance. Patients and Methods: Retrospective chart review of 93 patients, average age 42 years, 48 female. ASCA and p-ANCA were determinated by ELISA and IFI. The sensitivity (S), specificity (E), positive and negative predictive values (PPV and NPV), and X2 were determinated. Results: Sixty eight patients with IBD (35 Crohn´s disease (CD), 31 ulcerative colitis (UC), one IBD unclassified and one indeterminate colitis patients) and 25 patients with other gastrointestinal diseases. In the total group of patients the S and E of ASCA and p-ANCA for diagnosis of CD and UC was 48.6 percent, 74.1 percent and 77.4 percent, 82.3 percent respectively. In patients with IBD, the presence of ASCA(+)/p-ANCA(-) had a S, E, PPV, and NPV for diagnosis of CD 37.1 percent, 93.5 percent, 86.7 percent and 56.9 percent respectively. On the other hand, the presence of ASCA(-)/p-ANCA(+) had a S, E, PPV, and NPV for diagnosis of UC 64.5 percent, 85.7 percent, 80 percent and 73.1 percent respectively. The evolution of IBD patients was not associated with the presence of these markers. Conclusions: Our study showed that both p-ANCA and ASCA did not have an important role in the differential diagnosis of CD and UC and in their prognosis. New strategies to differentiate CD and UC and to determinate their prognosis are needed.

Existen estudios que han sugerido que los anticuerpos Anti-Saccharomyces cerevisiae (ASCA) y los anticuerpos anticitoplasma de los neutrófilos perinuclear (p-ANCA), son marcadores serológicos asociados a las enfermedades inflamatorias intestinales (EII). Sin embargo, su indicación y uso en la práctica clínica no han sido aún clarificados. Objetivos: Evaluar si la presencia de estos marcadores posee algún papel en el diagnóstico y pronóstico. Pacientes y Métodos: Noventa y tres pacientes, edad promedio 42 años, 48 mujeres. Los anticuerpos ASCA fueron determinados por técnica de ELISA y los p-ANCA por IFI. Se calculó la sensibilidad (S), especificidad (E), valor predictivo positivo (VPP) y negativo (VPN) y X2. Resultados: Se incluyen sesenta y siete pacientes con EII (35 enfermedad de Crohn (EC), 31 colitis ulcerosa (CU), uno con EII no clasificable y un paciente con Colitis Indeterminada) y 25 pacientes con otras enfermedades gastrointestinales. En el grupo total de pacientes, la S y E de ASCA y p-ANCA para el diagnóstico de EC y CU fue de 48,6 y 74,1 por ciento y 77,4 y 82,3 por ciento respectivamente. En pacientes con diagnóstico establecido de EII, la presencia de ASCA(+)/p-ANCA(-) tuvo una S, E, VPP y VPN para el diagnóstico de EC 37,1, 93,5, 86,7 y 56,9 por ciento, respectivamente. Por otro lado, la presencia de ASCA(-)/p-ANCA(+) tuvo una S, E, VPP y VPN para el diagnóstico de CU 64,5, 85,7, 80 y 73,1 por ciento, respectivamente. La evolución favorable o desfavorable de los pacientes con EII (EC o CU) no se correlacionó con la presencia (positividad) de uno o ambos marcadores (p ≥ 1). Conclusiones: Nuestro estudio demostró que los marcadores serológicos ASCA y ANCA utilizados en conjunto no poseen actualmente un papel importante en la diferenciación de la EC de la CU, como tampoco para establecer un pronóstico de su evolución. Por lo tanto, es necesario encontrar nuevas estrategias para poder diferenciar estos dos cuadros y poder determinar...

Enfermedad celíaca silente en epilepsia criptogénica del adulto / Silent celiac disease among 21 patients with cryptogenic epilepsy

Background: Celiac disease (CD) is predominant in women and young people. Atypical, non-enteric symptoms are more common among adults. There is also an association between CD and neurological disorders, especially with cerebellar ataxia, polyneuropathy and epilepsy. Aim: To study the frequency of CD in a group of adults with cryptogenic epilepsy. Material and Methods: Twenty one patients with cryptogenic epilepsy, aged 20 to 65years (14 women) were studied, measuring IgA-anti transglutaminase antibodies and deamidated gliadin peptide (DGP) IgG and IgA antibodies. Results: One patient had elevated titers of both types of antibodies. Small bowel biopsy showed villous atrophy and lymphocytic infiltration compatible with CD. Conclusions: One of 21 adult patients with cryptogenic epilepsy had a silent CD.

Accidentes de riesgo biológico entre estudiantes de carreras de la salud: Cinco años de experiencia / Biological risk accidents among undergraduate healthcare students: Five years experience

Undergraduate healthcare students are exposed to bloodborne pathogens, and data from developing countries is scarce. We report the experience of a comprehensive program dedicated to the management of this risk. The program includes financial coverage, a 24-hour attention system, HIV, HBV, HCV testing, and free provisión of post-exposure antiretroviral drugs. During 2003-2007, incidence rates of these exposures reached 0.9 per 100 student-years. Events were only observed among medicine, nursing, and midwifery students, with rates highest among nursing students (RR 3.5 IC95 1.93 - 6.51). Cuts andneedle stick injuries predominated (74.7 percent of accidents). Three students were exposed to HIV patients (1.9 percent), all of them received prophylactic drugs, infection was discarded after follow up, and also discarded after exposures to HBV or HCV (0.6 percent of all accidents). Cost per 1000 student-year was less than 2000 USD. Healthcare students are exposed to biological risks during their studies and a comprehensive program is feasible in a developing country.

Los estudiantes de pregrado de las carreras de la salud están expuestos a riesgos biológicos con agentes de transmisión sanguínea. En este trabajo se reporta la experiencia acumulada con un programa integral para este tipo de accidentes y que incluye atención gratuita las 24 horas, estudio serológico de la fuente para VIH, VHC y VHB, y entrega de anti-retrovirales post-exposición a pacientes infectados por VIH. Desde el año 2003 al 2007 la tasa de incidencia alcanzó una cifra de 0,9 eventos por 100 estudiantes-año. Las exposiciones de riesgo fueron observadas sólo entre estudiantes de medicina, enfermería y obstetricia, siendo la mayor tasa en alumnos de enfermería (RR 3,5 IC95 1,93 a 6,51). Tres alumnos estuvieron expuestos a pacientes con infección por VIH (l,9 por cientoo de todos los accidentes), todos ellos recibieron profilaxis, descartándose seroconversión en el seguimiento, al igual que en casos con exposición ante VHB y VHC (0,6 por cientoo del total de accidentes). El costo del programa fue menor a US$ 2000 por 1.000 estudiantes-año. Los estudiantes de las carreras de la salud están expuestos a riesgos biológicos durante sus estudios y requieren de un programa de manejo, el que es posible de lograr en un país en desarrollo.

Estudio de test de ureasa en exámenes endoscópicos con patologías benignas: ¿algún cambio en diez años? / Positivity of urease tests: results of its application in an open-access unity after a decade is there any change?

Epidemiological studies have shown changes in upper digestive diagnosis in recent times. It has been observed especially in developed countries, consisting in a diminution of duodenal peptic ulcers and non cardial gastric cancer and an increase of symptoms and lesions attributable to gastroesophageal reflux. Both circumstances have been considered as a consequence of a reduction in the prevalence, of infection with Helicobacter pylori and its more aggressive strains. There is little information of Possible changes in our country, so we have studied our experience in years 1996 and 2006 observing the results of Helicohacter pylori presence through urease tests and biopsies in a 10 year period. Patients were assessed with endoscopy indicated for upper digestive symptoms in an open access University Endoscopy Center. The accuracy of the test compared with biopsies was similar in both years. We observed after a decade: increase in the number of examinations and urease tests similar percentages of normal endoscopies and those with esophagitis, gastritis, or ulcers. In patients studied for suspected gastroesophageal reflux, there were similar percentages of those with and without esophageal erosions. The Urease Test was positive in similar high percentage in duodenal ulcers, but showed decreased values in patients studied for reflux, both erosive and non erosive esophagitis and also in erosive gastritis. In conclusion, Helicobacter pylori infection is still important in duodenal ulcer, with reductions in other diagnosis, possibly as a consequence of differences in patients social status or the very common medication aiming at the eradication of the infection or control of gastroesophageal symptoms.

Estudios epidemiológicos han mostrado cambios en la incidencia de patologías digestivas consistentes en disminución de úlceras duodenales y cáncer gástrico y aumento de cuadros atribuidos a reflujo gastroesofágico. Ambas tendencias se han asociado a disminución de la tan difundida infección por Helicobacter pylori y sus cepas genéticamente más agresivas. El presente estudio tuvo come objeto revisar retrospectivamente los resultados de endoscopias en 1996 y 2006 para observar eventuales cambios en la patología de esófago y gastroduodenal. Los resultados en la última década indican: aumento del número de exámenes y de tests de ureasa; proporción similar, de: endoscopias normales, esofagitis erosiva, síntomas de reflujo no erosivo, gastritis erosiva, úlcera gástrica, úlcera duodenal; porcentaje similar de esofagitis erosiva y reflujo no erosivo en pacientes estudiados por síntomas sugerentes de reflujo gastroesofágico y disminución de la positividad del TU, significativamente en EE y GE. Pensamos que el Hp continúa siendo factor patogénico en UD y que la disminución de positividad en pacientes con RGE puede atribuirse a cambios en la composición de la población examinada y al uso de medicación que puede modificar su presencia en la mucosa de estómago, siendo similar la reducción en reflujo con y sin esofagitis erosiva.

Sobrecrecimiento bacteriano intestinal en pacientes con pancreatitis crónica / Small intestine bacterial overgrowth in patients with chronic pancreatitis

Background: Previous reports describe 30-40 percent of small intestine bacterial overgrowth (SIBO) in patients with chronic pancreatitis (CP), SIBO is a cause of persistent symptoms in this group of patients even when they are treated with pancreatic enzymes. Aim: To asses the frequency of SIBO in patients with CP. Patients and methods: We studied 14 patients with CP using an hydrogen breath test with lactulose to detect SIBO, a nonabsorbable carbohydrate, whose results are not influenced by the presence of exocrine insufficiency. Main symptoms and signs were bloating in 9 (64 percent), recurrent abdominal pain in 8 (57 percent), intermittent diarrhea in 5 (36 percent) and steatorrhea in 5 (36 percent). At the same time we studied a healthy control group paired by age and sex. Results: SIBO was present in 13 of 14 patients with CP (92 percent) and in 1 of 14 controls (p<0.001). The only patient with CP and without SIBO was recently diagnosed and had minimal morphologic alterations in computed tomography and endoscopic pancreatography Conclusions: SIBO is common in CP and may be responsible for persistent symptoms. Proper diagnosis and treatment could alleviate symptoms and improve quality of life.

Estudio de enfermedad celíaca en pacientes con psoriasis / Frequency of celiac disease among patients with psoriasis

Background: A possible relationship has been reported between psoriasis and celiac disease, with common pathogenic mechanisms that may need further investigation. Aim: To investigate the presence of clinical and serological markers for celiac disease in a group of Chilean psoriatic patients. Material and methods: We included 80 psoriatic patients (42 males) aged 16 to 79 years, whose serum was tested for antitransglutaminase antibodies (ATGA) and antiendomysial antibodies (AEMA). Patients with weakly positive AEMA tests were also tested for antigliadin antibodies (AGA). Results: In six patients (7.5 percent), AEMA and AGA were positive and one patient was positive for ATGA. An upper gastrointestinal endoscopy and duodenal biopsy was offered to these six patients and five accepted the procedure. Only one had a pathological diagnosis of celiac disease. Conclusions: Only one of 80 patients with psoriasis had celiac disease (1.2 percent). Other four patients with positive serologic markers had a normal duodenal biopsy. This group of patients may have latent celiac disease and they should be followed up.

Seroprevalencia de anticuerpos anti Helicobacter pylori en personal de la sección gastroenterología del hospital clínico de la Universidad de Chile / Seroprevalence of antibodies against Helicbacter pylori in personnel working in the gastroenterology section of the clinical hospital of the University of Chile

Introduction: Helicobacter Pylori (Hp), a bacterium that colonizes gastric mucosa, is considered an important pathogen in some forms of histological gastritis, gastric and duodenal ulcers and a risk factor for gastric adenocarcinoma and lymphoma. Means of transmission are the oro-oral and feco-oral routers. Infection could be acquired by contamination with products as saliva, vomits, aerosols or feces from people colonized by the bacterium. Aim: was to study the seroprevalence of antibodies against Helicobacter Pylori in personnel working in the gastroenterology section of the clinical hospital of the University of Chile. Material and methods: the study included physicians that perform endoscopic procedures, technical assistants for them and laboratory personnel. Anti-Hp antibodies were determined with an ELFA (fluorescent immunoassay) method. Results: the group was formed by 35 persons, being 19 males and 16 females and 26 (74 percent) were anti-Hp positive, among them 14/19 (78 percent) males and 12/16 (75 percent) females, without difference. No difference was found in endoscopy 18/24 (73 percent) or extraendoscopy 8/11 (75 percent) personnel, or professionals (68 percent) and non professional assistants (90 percent). Conclusion: prevalence of antibodies against Hp is high in our section (74 percent) in accordance with what has been found in other studies in our population.

Antecedentes: el Helicobacter pylori (Hp) es una bacteria que coloniza principalmente la mucosa gástrica y desempeña un rol etiopatogénico importante en algunas formas de gastritis, ulceraciones gastro-duodenales y es además un factor de riesgo de padecer adenocarcinoma y linfoma gástrico. Se ha postulado que la vía de contagio principal seria, oral-oral o fecal-oral. Existiría un riesgo de adquirir la infección al estar en contacto con secreciones orales, aerosoles, vómitos o deposiciones de sujetos colonizados con la bacteria. El propósito de la siguiente investigación fue estudiar la seroprevalencia de anticuerpos anti Helicobacter pylori en la sección de gastroenterología del hospital clínico de la Universidad de Chile. Material y métodos: el grupo de estudio estuvo formado por los médicos que realizan endoscopias, el personal técnico de apoyo a este procedimiento y el personal del laboratorio clínico de la sección gastroenterología. Los anticuerpos anti-Helicobacter pylori se analizaron empleando la técnica ELFA, (inmunoensayo de fluorescencia), Resultados: se estudiaron 35 personas, 19 hombres y 16 mujeres. Veintiséis sujetos (74 por ciento) tuvieron anticuerpos anti Hp positivos. No se encontró diferencia según sexo, siendo positivos 14/19 hombres y 12/16 mujeres, 78 y 75 por ciento, respectivamente. Tampoco se encontró diferencia entre los que trabajan en área de endoscopia o extraendoscopia, 18/24 y 8/11, 73 y 75 por ciento, respectivamente, ni entre los profesionales 68 por ciento y ayudantes 90 por ciento. Conclusión: la presencia de anticuerpos anti Hp fue altamente prevalente en nuestra sección (74 por ciento) aunque concordante con las cifras de infección que se manejan a nivel poblacional.

Test inmunológico para hemorragia oculta: correlación con hallazgos colonoscópicos / Immunological testing for fecal occult blood: correlation with colonoscopic findings

El hallazgo de sangre oculta en deposiciones permite sospechar la presencia de lesiones del tubo digestivo como cáncer colorrectal y pólipos precancerosos, existiendo estudios con rendimiento variable para este método. Objetivo: Correlacionar los resultados de un examen inmunológico para hemoglobina humana (Actim Fecal BloodR=AFB) con la colonoscopía. Métodos: Se realizó AFB en 94 pacientes que fueron sometidos concomitantemente a colonoscopía por diversas causas y sin evidencias de sangrado macroscópico, antecedentes de enfermedad inflamatoria intestinal o pólipos de colon, correlacionando sus resultados con el test. Resultados: AFB fue positivo en 32 pacientes (34 por ciento): en los 3 enfermos con cáncer colorrectal, en 4 casos con enfermedad inflamatoria intestinal, en 6 de los 9 pacientes con pólipos mayores a 1 cm, (sensibilidad de 67 por ciento para la detección de estas lesiones con mayor riesgo neoplásico), y en 4 de 15 pacientes con pólipos más pequeños. Hubo 7 casos con AFB positivo y colonoscopía normal, arrojando una especificidad de 76 por ciento. Conclusión: El test estudiado tiene una sensibilidad y especificidad aceptable para las lesiones descritas, y pudiera aplicarse principalmente en grupos con mayor riesgo de estas neoplasias.

Detection of minute amounts of blood in faeces has been used with variable results as a screening test in early diagnosis of colorectal cancer and premalignant polyps. Aims: To compare the results of a specific antibody against human hemoglobin (Actim fecal bloodR) with colonoscopic findings. Methods: The test was performed in 94 consecutive patients before colonoscopy. Overt gastrointestinal bleeding, previously known inflammatory bowel disease or colorectal polyps were excluded. Results: Actim fecal bloodR was positivein 32 of 94 patients (34%): in all of three colorectal cancer, in 6 of 9 polyps greater than 1 cm (67% sensibility for lesions with major neoplasic risk)), but only 4 of 15 minor polyps. On the other hand, 7 positive results were obtained in 29 patients with normal colonoscopy, i.e. the specificity of the test was 76%. Conclusion: The immunologic test studied had an acceptable specificity and a good sensibility for the screening of colorectal cancer and major colorectal polyps

Función pancreática exocrina en diabetes mellitus: Determinación de elastasa fecal / Pancreatic exocrine function in diabetes mellitus: Determination of fecal elastase

Background: One of the complications of diabetes mellitus is the development of pancreatic exocrine insufficiency. Aim: To study pancreatic exocrine function in diabetics patients. Material and methods: Seventy two diabetic patients were included in the protocol, but two were withdrawn because an abdominal CAT scan showed a chronic calcified pancreatitis, previously undiagnosed. Fecal elastase was measured by ELISA and the presence of fat in feces was assessed using the steatocrit. Results: Mean age was 60±12 years and 67 (96%) patients had a type 2 diabetes. Fecal elastase was normal (elastase >200 µg/g) in 47 (67%) patients, mildly decreased (100-200 µg/g) in 10 (14%) and severely decreased in 13 (19%). There was a significant association between elastase levels and time of evolution of diabetes (p=0.049) and between lower elastase levels and the presence of a positive steatocrit (p=0.042). No significant association was found between elastase levels and other chronic complications of diabetes such as retinopathy, nephropathy, neuropathy, microangiopathy or with insulin requirement. Conclusions: One third of this group of diabetic patients had decreased levels of fecal elastase, that was associated with the time of evolution of diabetes. Patients with lower levels of elastase have significantly more steatorrhea. Among diabetics it is possible to find a group of patients with non diagnosed chronic pancreatitis.

Enfermedad Celíaca del adulto: experiencia clínica / Adult celiac disease: clinical experience

Background: The prevalence of celiac disease (CD) is unknown in Chile. We have recently noted a rise in the number of cases diagnosed among adults. Aim: To describe the clinical characteristics of a group of adult celiac patients. Patients and methods: Clinical data of patients older than 15 years with positive antitransglutaminase or antiendomysial autoantibodies and a duodenal biopsy characteristic of CD were retrospectively reviewed. Age at diagnosis, symptoms and signs and laboratory, endoscopic and histological findings, were analyzed. Results: Thirty seven patients (28 women), were studied. Median age at diagnosis was 41 years (range 15-69). Main symptoms and signs were diarrhea (78%), weight loss (38%) and abdominal pain (38%). Anemia was found in 49%, elevation of ESR in 57%, elevation of alkaline phosphatases in 54%, elevation of aspartate aminotransferase in 38% and a rise in alanine aminotransferase in 27%. Antiendomysial antibodies were positive in 17/22 (77%) and antitransglutaminase in 19/22 (86%) patients. Endoscopic findings were suggestive of CD in 47% of cases and duodenal biopsy showed intestinal villi atrophy in 34 (92%) patients. The three patients with normal histology had positive serology and a good response to gluten free diet. Conclusions: CD should be considered in the differential diagnosis of patients with unespecific digestive symptons, even when they present late in adult life. Serologic markers are a good diagnostic tool. A normal duodenal pathology does not exclude the diagnosis, if other diagnostic features are present.

Anti-VHE IgM en casos de infección por el virus hepatitis E / Detection of IgM antibodies against hepatitis E virus

Background: Hepatitis E virus is the main enterically transmitted non A non B hepatitis agent. The host IgM response in the acute infection phase is short lived. Therefore, only IgG antibodies against E virus are usually investigated. Aim: To measure IgM antibodies against virus E in serum samples. Material and Methods: IgM antibodies against virus E were measured by ELISA in 35 positive and 18 negative serum samples for IgG antibodies against hepatitis virus E, without evidence of infection with hepatitis A, B or C virus. Measurement of the same antibodies in 25 additional samples positive for IgM antibodies against hepatitis A virus but without study for hepatitis virus B or C. Results: IgM antibodies against virus E were detected in 12 of the 35 samples positive for IgG antibodies (34%) and in five of the 25 samples positive for antibodies against virus A (20%). Conclusions: An acute hepatitis E virus infection was detected in 34% of samples positive for IgG antibodies against this virus. The absence of IgM antibodies in the rest of the IgG positive samples could be due to an old or a recent virus E infection in the stage of antibody titer reduction. The detection of IgM antibodies against virus E in samples positive for virus A antibodies, could be due to co infection by virus A and E or a cross reaction of assays.

Infección con el virus hepatitis en casos de hepatitis autoinmune / Hepatitis E virus infection in cases of autoimmune hepatitis

Se ha postulado que las infecciones con algunos virus hepatitis podrían asociarse a casos de hepatitis autoinmune (HAI). Recientemente se ha comunicado una alta prevalencia del virus hepatitis E (VHE) en casos de HAL. Nuestro objetivo fue investigar la exposición al VHE en un grupo de pacientes con HAL. Se estudiaron 25 HAL, 21 Cirrosis Biliar Primaria (CBP) y 174 donantes de sangre (DS). El Anti VHE IgG se estudió mediante un test de ELISA y se correlacionó los resultados con los niveles de IgG séricos. El Anti VHE se detectó en 9 de 25 HAL (36 por ciento), en 1 de 21 CBP (5 por ciento) y en 7 de 174 DS (4 por ciento). Los casos de HAL Anti VHE positivos, no tuvieron niveles mayores de IgG respecto a los casos Anti VHE negativo. En conclusión, efectivamente encontramos una mayor exposición al VHE en sujetos con HAI que en DS y CBP, lo que podría indicar que este virus podría tener un rol patogénico

Prueba de Elisa en deposición para detectar infección por helicobacter pylori / An Elisa stool test to detect helicobacter pylori infection

Background: Infection with Helicobacter pylori is frequent in Chile, and a good test for its diagnosis ideally should be non-invasive, fast, easy and inexpensive. Aim: To report the use of an immunoassay test, that detects antigens of Helicobacter pylori in stools. Material and methods: One hundred and four patients that required an upper gastrointestinal endoscopy were studied. Stool samples were analyzed using an enzymatic immunoassay. These results were compared with those obtained with the urease test and microscopic examination of smears taken from biopsies obtained during the diagnostic endoscopy. Results: In 81 of 83 patients considered to have the infection according to the endoscopic tests, the antigen was also present in the stools. The test was negative in 16 of 21 patients considered to be without the infection. The resulting sensitivity and specificity for the immunoassay was thus 97.6 and 76.2 percent respectively, with positive and negative predictive values of 92.4 and 88.9 percent, respectively. Conclusions: These results are in agreement with those reported in the literature. Further studies are needed to define its usefulness in massive screening, follow up after antibiotic treatments or the detection of coccoid forms of Helicobacter pylori

Creación de un comité de prevención y control de úlceras por presión / Creating a committee on prevention and control of ulcers due to pressure

En los últimos años se ha desarrollado el consenso de que la incidencia de úlceras por presión es un importante indicador de calidad de atención de salud. Sin embargo, en muchos hospitales la predicción del riesgo de úlceras por presión y las medidas de prevención por mucho tiempo no han sido considerados. Es conocido que el costo económico y el sufrimiento humano asociados al tratamiento de úlceras por presión es enorme y en la mayoría de los casos innecesarios. Un programa de prevención basado en la medición del riesgo puede simultáneamente reducir la incidencia institucional de úlceras por presión, como los costos de la prevención y tratamiento. Para este propósito fue creado un comité multidisciplinario

Inmunoglobulina A ¿un predictor de daño hepático crónico por alcohol? / Immunoglobulin A: predictor of alcoholic chronic liver damage?

La relación entre etiología, severidad del daño hepático y niveles aumentados de IgA ha sido motivo de controversia. Nuestros objetivos fueron a) analizar el efecto del alcohol sobre la concentración sérica de IgA en pacientes con cirrosis alcohólica, b) estudiar la relación entre IgA y severidad del daño hepático y c) evaluar el efecto de la suspensión del consumo de alcohol sobre sus niveles. Se estudiaron 48 pacientes cirróticos, 30 alcohólicos y 18 no alcohólicos. En todos se midieron inmunoglobulinas séricas (IgA, IgG, IgM) y se determinó la puntuación de Child-Pugh. En 16 pacientes alcohólicos se realizó una segunda determinación de inmunoglobulinas luego de al menos 7 meses de abstinencia. Los valores de la IgA fueron significativamente mayores en pacientes alcohólicos y cifras más elevadas se observaron en la medida que aumentó el grado de insuficiencia hepática, de acuerdo a los niveles de Child-Pugh. No se observó relación entre los valores de IgA y transaminasas. Estos valores aumentados de IgA se mantienen más allá de los seis meses

Altos valores de adenosín deaminasa plasmática no asociados a fiebre tifoidea / High plasmatic adenosin deaminase activity not associated to typhoid fever

Valores plasmáticos elevados de ADA han sido asociados a fiebre tifoidea y utilizados para su diagnóstico debido a su bajo costo y rápida lectura. Sin embargo, diferentes registros han señalado un aumento de esta actividad en otras enfermedades lo que puede limitar su precisión diagnóstica. Para confirmar si valores elevados de ADA plasmática están asociados específicamente a fiebre tifoidea, se desarrolló un estudio retrospectivo con los registros de este examen desde un laboratorio hospitalario. Diez pacientes fueron identificados (todos ellos hospitalizados). Seis pacientes padecían fiebre tifoidea y los restantes cuatro tenían otras patologías febriles: leucemia mieloide aguda, dermatomiositis y linfoma no Hodgkin (n=2). Los valores de ADA plasmática fueron similares en ambos grupos pero los pacientes sin fiebre tifoidea se caracterizaron por tener simultáneamente una mayor edad (>35 años) y velocidad de eritrosedimentación (>50 mm/h) (p = 0,004, test de Fisher bilateral). Estos resultados indican que valores plasmáticos elevados de ADA tienen una baja especificidad para el diagnóstico de fiebre tifoidea en pacientes hospitalizados y pueden estar asociados a enfermedades malignas o autoinmunes

Infección con el virus de la hepatitis E en Chile: comunicación preliminar / Hepatitis E virus infection in Chile: preliminary report

Using and Elisa technique, IgG antibodies against hepatitis E virus were measured in 40 alcoholics, 40 hemophilics, 174 blood donors, 36 subjects with acute non A non B non C hepatitis and 66 subjects with acute hepatitis A. Antibodies were detected in 1 alcoholic (2,5 percent), 3 hemophilics (7,5 percent), 7 blood donors (4 percent), 3 patients with non-A-non-B-non-C hepatitis (8,3 percent) and 3 patients with acute hepatitis A (4,5 percent). A low frequency of hepatitis E infection was detected in the studied subjects