Bacteremia por Vibrio cholerae NO-O1/NO-O139 en un paciente cirrótico: Primer reporte de caso en el Perú y revisión de la literatura / Vibrio cholerae NO-O1/NO-O139 bacteremia in a cirrhotic patient: First case report in Peru and literatura review

Vibrio cholerae serogrupo NO-O1/NO-O139 (VCNO) es causa infrecuente de gastroenteritis. Sin embargo, se le asocia a infección extra-intestinal severa en huéspedes inmunocomprometidos, y entre ellas, la bacteremia en pacientes con cirrosis hepática es digna de mención. A continuación, presentamos el caso de una mujer de 58 años, con el diagnóstico de cirrosis hepática de fondo, que desarrolló progresivamente choque séptico, disfunción orgánica múltiple y desenlace fatal al cuarto día de su admisión. Los resultados obtenidos post mortem, de los hemocultivos previamente tomados, aislaron bacilos gram negativos compatibles con Vibrio cholerae. Posteriormente, se identificó el serogrupo NO-O1/NO-O139, a través de aglutinación en placa y PCR negativo para el gen ctxA. El antibiograma mostró susceptibilidad conservada a ampicilina, cloranfenicol, tetraciclina y ciprofloxacino, con resistencia al trimetoprim-sulfametoxazol. El presente caso, descrito en el Hospital Nacional Dos de Mayo, es hasta la fecha, el primer reporte de bacteremia VCNO en el Perú.

Non-O1, non-O139 Vibrio cholerae (NOVC) strains are an uncommon cause of gastroenteritis. However, they have been recently associated with severe extraintestinal infections in immunocompromised hosts. Among them, bacteremia in cirrhotic patients is noteworthy. We present the case of a 58-year-old woman with cirrhosis that developed septic shock, multiple organ failure and died four days after admission. Blood cultures yielded Gram-negative rods identified as Vibrio cholerae. Further serogrouping by slide agglutination and a negative PCR for ctxA gen confirmed the strain to be NOVC. Antimicrobial susceptibility testing showed sensitivity to ampicillin, chloramphenicol, tetracycline and ciprofloxacin; and resistance to trimethoprim-sulfamethoxazole. To the best of our knowledge, this is first report in Peru, described in the Hospital Nacional Dos de Mayo, of NOVC bacteremia.

Helicobacter pylori Eradication within 120 Days Is Associated with Decreased Complicated Recurrent Peptic Ulcers in Peptic Ulcer Bleeding Patients

BACKGROUND/AIMS: The connection between Helicobacter pylori and complicated peptic ulcer disease in peptic ulcer bleeding (PUB) patients taking nonsteroidal anti-inflammatory drugs has not been established. In this study, we sought to determine whether delayed H. pylori eradication therapy in PUB patients increases complicated recurrent peptic ulcers. METHODS: We identified inpatient PUB patients using the Taiwan National Health Insurance Research Database. We categorized patients into early (time lag < or =120 days after peptic ulcer diagnosis) and late H. pylori eradication therapy groups. The Cox proportional hazards model was used. The primary outcome was rehospitalization for patients with complicated recurrent peptic ulcers. RESULTS: Our data indicated that the late H. pylori eradication therapy group had a higher rate of complicated recurrent peptic ulcers (hazard ratio [HR], 1.52; p=0.006), with time lags of more than 120 days. However, our results indicated a similar risk of complicated recurrent peptic ulcers (HR, 1.20; p=0.275) in time lags of more than 1 year and (HR, 1.10; p=0.621) more than 2 years. CONCLUSIONS: H. pylori eradication within 120 days was associated with decreased complicated recurrent peptic ulcers in patients with PUB. We recommend that H. pylori eradication should be conducted within 120 days in patients with PUB.

Caracterización clínico-endoscópica de pacientes con hemorragia digestiva alta, Hospital General Pedro Betancourt de Jovellanos / Clinic-endoscopic characterization of patients with upper gastrointestinal bleeding in the General Hospital Pedro Betancourt, Jovellanos

Introducción: la hemorragia digestiva alta es una de las emergencias más frecuentes en los servicios de urgencias. Su mortalidad promedio es del 10 por ciento. La etiología más común continúa siendo la úlcera péptica y es más frecuente en hombres y adultos mayores. Objetivo: caracterizar clínica y endoscópicamente a los pacientes con hemorragia digestiva alta atendidos en el departamento de Gastroenterología del Hospital General Pedro Betancourt en el período comprendido entre Enero del 2012 a Enero del 2013. Métodos: se realizó un estudio descriptivo prospectivo, se tuvieron en cuenta diferentes variables clínicas y endoscópicas como: edad, sexo, presentación clínica, tipo de lesión y clasificación de la hemorragia por úlcera; estas fueron representadas en tablas y gráficos por frecuencias absolutas y relativas. Resultados: de los 40 pacientes estudiados con una edad promedio de 57,3 años más o menos 13,5 años; predominó del sexo masculino (72,5 por ciento). La presentación clínica más frecuente fue la melena (65 por ciento). El principal hallazgo endoscópico fue la úlcera duodenal (45 por ciento) y la clasificación de la complicación hemorrágica de la úlcera más frecuente fue el sangrado reciente. Conclusión: la hemorragia digestiva alta continúa siendo una urgencia que se presenta con mayor frecuencia en pacientes mayores de 60 años, fue la úlcera gastroduodenal con estigmas de sangrado reciente el hallazgo endoscópico más común

Introduction: the upper gastrointestinal bleeding is one of the most common emergencies treated at the emergency services. Its average mortality rate reaches 10 per cent. The most common etiology is still the peptic ulcer, and it is more frequent in men and elder people.Objective: to characterize, clinically and endoscopically, the patients with upper gastrointestinal bleeding attended at the Department of Gastroenterology of the General Hospital Pedro Betancourt in the period from January 2012 to January 2013. Methods: it was carried out a descriptive- prospective study, taking into account clinical and endoscopic variables like age, gender, clinical presentation, endoscopic findings, kind of lesion and classification of the ulcer hemorrhage complication. The variables were represented in charts and pictures per absolute and relative frequencies. Results: a sample of 40 patients were enrolled with an average age of 57,3 plus or less 13,5 years. The predominant gender was the male one with 72,5 per cent. The most common clinical presentation was the melena (65 per cent). The main endoscopic finding was the duodenal ulcer (45 per cent) and the most frequent ulcer hemorrhagic complication was the recent bleeding. Conclusion: the upper gastrointestinal bleeding still remains as an urgency more frequently in male patients older than 60 years. The gastroduodenal ulcer with recent bled stigmas was the most common endoscopic finding

Factores predictores de la evolución clínica de pacientes con hemorragia digestiva alta (HDA) por úlcera péptica en el Servicio de Emergencia del Hospital Nacional Dos De Mayo. Lima, Perú. 2009-2011 / Factors predictors of clinical outcome in patients with Upper Gastrointestinal Bleeding (UGB) secondary to peptic ulcer presenting at the Emergency Service of the National Hospital Dos de Mayo. Lima, Peru. 2009-2011

Objetivo: Determinar los factores predictores de la evolución clínica en pacientes con HDA por úlcera péptica atendidos en el Servicio de Emergencia del Hospital Nacional Dos de Mayo entre enero 2009 y diciembre 2011. Metodología: Se realizó un estudio observacional, analítico, transversal y retrospectivo. Se revisaron las historias clínicas de pacientes atendidos en el Servicio de Emergencia del Hospital Nacional Dos de Mayo con diagnóstico principal de HDA entre enero 2009 y diciembre 2011. Resultados: Se vieron un total de 403 casos. La prevalencia hospitalaria de ulcera péptica según diagnóstico endoscópico en el Hospital Nacional Dos de Mayo fue de 52,3 por ciento; siendo la media de edad de 54,39±14,067. Predominó el sexo masculino, los pacientes con empleo y solteros. Con respecto al estado clínico, la mayoría de pacientes ingresaron hemodinámicamente estables, presentándose en estado de shock solo el 4 por ciento. Se realizó tratamiento endoscópico en 32,6 por ciento, encontrándose en su mayoría el diagnóstico de úlcera gástrica. Se requirió terapia transfusional en emergencia para 31,9 por ciento de la población, mientras que 11,9 por ciento recibió terapia transfusional en hospitalización. 4,4 por ciento de la población estudiada necesitó tratamiento quirúrgico, 20,9 por ciento presentó resangrado; se reportaron 8 casos letales, lo cual significó el 1.98 por ciento. Se encontró como factores predictores de la morbilidad y mortalidad de la HDA a la presencia de enfermedades concomitantes (OR: 1.6; IC: 1.03-2.17) y edad mayor de 60 años (OR: 1.32; IC 1.11-1.53). Conclusiones: La presencia de enfermedades concomitantes y la edad mayor de 60 años son factores predictores de morbimortalidad en pacientes con HDA por úlcera péptica.

Objective: To determine predictors of clinical outcome in patients with Upper Gastrointestinal Bleeding (UGB) secondary to peptic ulcer presenting at Emergency Service of National Hospital Dos de Mayo between January 2009 and December 2011. Methodology: An observational, analytical, transversal and retrospective study was realized. We reviewed the medical records of patients attending at the Emergency Service of the National Hospital Dos de Mayo with a diagnosis of UGB between January 2009 and December 2011. Results: The hospital prevalence of peptic ulcer made by endoscopic diagnosis in the National Hospital Dos de Mayo was 52.3 per cent; the mean age was 54.39±14.067. We found mainly males patients, employed and single. With respect to clinical status, most of patients were hemodynamically stable, appearing in shock only 4 per cent. Endoscopic treatment was performed in 32.6 per cent, being mostly diagnosing gastric ulcer. It took emergency transfusion therapy in 31.9 per cent of the population, while 11.9 per cent received transfusion therapy in rooms of hospitalization. 4.4 per cent of the study population required surgery, 20.9 per cent had rebleeding; 8 lethal cases were reported, which meant 1.98 per cent. It was found as predictors of morbidity and mortality of upper gastrointestinal bleeding the presence of comorbidities (OR: 1.6, CI: 1.03-2.17) and age over 60 years (OR: 1.32, CI 1.11-1.53). Conclusions: The presence of comorbidities and age over 60 years are predictors of mortality in patients with UGB peptic ulcer.

A Case of Superior Mesenteric Venous Thrombosis Due to Protein C Deficiency in a Patient with Duodenal Ulcer Bleeding / 대한소화기학회지

Mesenteric venous thrombosis is a clinically very rare disease, and may cause bowel infarction and gangrene. Difficulty in the dignosis the disease due to its non-specific symptoms and low prevalence can cause a clinically fatal situation. Mesenteric venous thrombosis may be caused by both congenital and acquired factors, and protein C deficiency, which is a very rare genetic disorder, is one of many causes of mesenteric thrombosis. The authors experienced a case of mesenteric venous thrombosis caused by protein C deficiency in a patient with duodenal ulcer bleeding, so here we report a case together with literature review.

Oral omeprazole in patients undergoing combination endoscopic therapy for bleeding peptic ulcers A: prospective double-blind randomized study

Endoscopic therapies can decrease the morbidity of patients with high risk peptic ulcer. The aim of this study was to evaluate the beneficial effects of oral omeprazole therapy in patients with bleeding peptic ulcer who received combined endoscopic treatment [epinephrine injection and Argon Plasma Coagulation]. Eighty six patients with bleeding from gastric, duodenal or stomal ulcers and endoscopic stigmata of recent bleeding were enrolled in our study. All patients received injection of epinephrine [1:10,000] and also their ulcers were treated with Argon Plasma Coagulator. The patients then randomly assigned to receive oral omeprazole [40 mg every 12 hours] or placebo. Five [11.6%] of 43 patients in the placebo group had rebleeding; but no rebleeding was detected among 43 patients in omeprazole group [p= 0.05]. One patient in the Placebo group underwent surgery for control of his rebleeding; but none of the patients in omeprazole group needed surgery. One patient in the placebo group and none of the patients in the omeprazole group died. The average hospital stay was 5 days in the omeprazole group and 5.8 days in the placebo group. Addition of oral omeprazole to combined endoscopic therapy significantly reduces recurrent bleeding rates

What is the best method to diagnose Helicobacter infection in bleeding peptic ulcers?: a prospective trial

BACKGROUND: It has been debated which diagnostic test should be preferred for the diagnosis of Helicobacter pylori (HP) in patients with peptic ulcer diseases. Several limitations are reported in bleeding peptic ulcers because of intragastric blood and possibility of changed numbers of organisms by medication. This study was designed to find out the best method for diagnosis of HP infection, in aspect of deciding the times of detection and the specific tests in bleeding peptic ulcers. METHODS: We prospectively examined histology, rapid urease test (CLO test), urea breath test (13C-UBT) and serology in HP diagnostics in 32 patients with bleeding peptic ulcers to detect HP infection. Each test was performed two times (four methods at first 24 hours and former three methods at 7th day after initial therapeutic endoscopy). We evaluated the sensitivity of each test, compared the two-times results and evaluated the effect of these tests to an outcome of endoscopic hemostasis. RESULTS: Diagnostic sensitivities of histology, CLO test, 13C-UBT and serology are 75%, 67.8%, 100% and 100% at first endoscopy, and 71.4%, 78.5%, 89.3% at 7th day endoscopy, respectively. Histologic study and CLO test had diagnostic limitation at emergent first endoscopy contrary to UBT (p < 0.01). Histologic study, CLO test and UBT have limitations at 7th day endoscopy. Only 3 patients (9.4%) rebled with subsequent complete endoscopic hemostasis and all diagnostic tests at initial endoscopy did not influence the outcome of hemostasis. CONCLUSION: First day histologic and CLO tests are inadequate methods in detecting HP infection in patients with bleeding peptic ulcers. 7-day histologic, CLO test and UBT have a low sensitivity. First-day UBT can be a standard test to diagnose HP infection in patients with bleeding peptic ulcers.

Lesäo péptica hemorrágica : avaliaçäo de resultados com aplicaçäo de um score / Peptic hemorrhage lesion: evaluation of results with application score

O presente trabalho consiste de estudo retrospectivo na avaliaçäo de resultados com aplicaçäo de um score, utilizado na clínica cirúrgica do HUSF, nas lesöes pépticas hemorrágicas. O score desenvolvido e publicado por Pimpl et al. Auxilia no prognóstico, índice de mortalidade e na comparaçäo dos pacientes e resultados, cotejando com doentes e resultados obtidos em outros serviços - facilitando estudos multicêntricos. A esclerose endoscópica deve ser enfatizada como método hemostático provisório nas lesöes pépticas hemorrágicas, para obtençäo de melhores resultados

Intra pulmonary thrombolytic therapy with balloon dilatation in recurrent acute pulmonary embolism.

A 52-year-old man had recurrent pulmonary thrombo embolism following fracture in tibia and subsequent deep vein thrombosis. One episode of massive pulmonary embolism with haemodynamic compromise was managed successfully by balloon compression of the thrombus and thrombolysis with urokinase. Patient was rehabilitated in his previous profession.

Hemorragias digestivas altas graves: estudio prospectivo de 100 casos / Acute upper gastrointestinal tractbleeding: prospective series of 100 cases

Se presentan 100 hemorragias digestivas altas graves, 55 por úlceras gástricas y duodenales en ocasiones asociadas a lesiones mucosas agudas gastroduodenales, 27 lesiones mucosas agudas gastroduodenales, 11 pacientes con un síndrome de hipertensión portal con várices esofágicas y/o lesiones mucosas agudas gastroduodenales, 2 cánceres de muñón gástrico, 2 leiomiomas gástricos y 3 pacientes a los cuales se le había practicado una papilotomía. Se evalúan la mortalidad global y la relacionada con la edad, la presencia de patologías concomitantes, el curso evolutivo de la hemorragia (detenidas, recidivantes y persistentes), la oportunidad quirúrgica (electiva o de urgencia), el volumen de sangre transfundido y la etiopatogenia de la hemorragia

Tratamiento endoscópico de la hemorragia por úlcera péptica / Endoscopic treatment of peptic ulcer hemorrhge

Se ha realizado un análisis retrospectivo en el Instituto de Gastroenterológico Boliviano Japones para evaluar el efecto hemostático de la infección endoscópica del alcohol absoluto y tomados en cuenta los pacientes con úlcera péptica con signos endoscópicos de riesgo de recesiva como son la existencia de hemorragia activa, de un vaso visible o de un coágulo, pacientes que hasta hace poco según datos combinados de diversos estudios requerían cirugía urgente. En esta serie no se observaron complicaciones y la inyección endoscópica fue utilizada como de primera linea para detener ala hemorragía por úlcera péptica.

Hemorragia digestiva alta / Upper digestive bleeding

En los ultimos cinco anos se han presentado una serie de avances en el diagnostico y tratamiento de la hemorragia digestiva alta. La presente revision hace enfasis en entidades recientemente descritas o poco conocidas que pueden causar hemorragia, en los criterios clinicos y endoscopicos que permiten identificar los pacientes de alto riesgo y en los nuevos procedimeintos terapeuticos aplicables por via endoscopica. Asimismo se analizan de manera critica las formas tradicionales de tratamiento, como el lavado gastrico, que adolecen de soporte cientifico serio para justificar su utilidad