[Endoscopic findings in HIV-infected patients with esophageal symptoms. Experience at the Cayetano Heredia National Hospital]. / Hallazgos endoscópicos en pacientes con infección por el virus de la inmunodeficiencia humana (vih) con síntomas esofágicos. Experiencia en el hospital nacional Cayetano Heredia.

UNLABELLED: This study was done in patients with HIV infection and upper digestive symptoms as odinophagia, dysphagia and/or retrosternal pain who attended the Cayetano Heredia National Hospital in Lima, Perú. Those included in the study had an upper endoscopy and a CD4 count. Also previous opportunistic infections were determined. Samples were taken from the oropharyngeal cavity and sent for direct exam and culture. During endoscopy, photos were taken from the upper, middle, and lower third of the esophagus and the esophageal compromise was classified. Biopsies and brushings samples were obtained and sent for direct exam, histopathology and culture. RESULTS: 751 patients with HIV infection attended the Cayetano Heredia National Hospital between May 1996 and June 1999, 83 were included due to esophageal symptoms. Male / Female ratio : 4/1, mean age : 30.95 +/- 9.87. Cultures positive for Candida: 84.30% of esophageal biopsies samples, 88% of esophageal brushings and 60.2% of oropharyngeal cavity. The C. albicans species was isolated in 95.7% of biopsies, 93% of brushings and 96% of oropharyngeal cavity. The most common endoscopic finding was white plaques (71%), endoscopic grade 3 (36.1%). The most frequent previous opportunistic infection was PCP pneumonia followed by TBC. The positive predictive value for white plaques in patients with dysphagia and odynophagia was 89.8%. CD4 count between 0 and 50 lymphocytes per mm(3) was seen in 70% of the cases. The mean of CD4 lymphocytes of these patients was lower (p< 0.01) when compared to the mean of patients in the control group with no symptoms. CONCLUSIONS: Candida albicans was the most common isolated pathogen in the esophagus in patients with HIV infection and with esophageal symptoms, a significant difference in CD4 count between these patients and the control group was determined. The positive predictive value for finding esophageal white plaques in patients dysphagia and odinophagia was high, and there was no difference between the average of CD4 count and the endoscopic grade of esophageal involvement.

Parietal cell antibodies among Peruvians with gastric pathologic changes. Gastrointestinal Physiology Working Group.

Parietal cell antibodies were present in 12% of 272 Peruvians presenting for endoscopy. Gender, age, socioeconomic status, ethnic background (Peruvian versus Japanese), and altitude at which the patient lived were not associated with the presence of parietal cell antibodies. No significant relationship could be shown between the presence of parietal cell antibodies and either Helicobacter pylori infection or gastric lesions, including chronic atrophic gastritis. Loss of proper gastric glands was significantly more common in patients who had H. pylori infection than in those in whom no H. pylori was found on biopsy (78 of 114 (85%) versus 14 of 36 (39%); p = 0.002). Our data suggest that, although parietal cell antibodies are present in third-world populations, they are unrelated to H. pylori infection and that pathologic changes associated with this infection are not mediated by the action of parietal cell antibodies on the cells of the stomach.

Imipenem/cilastatin vs. gentamicin/clindamycin for the treatment of moderate to severe infections in hospitalized patients.

Imipenem/cilastatin was compared with the combination of gentamicin plus clindamycin in terms of efficacy and safety for the treatment of moderate to severe infections in an open, randomized study. The rates of cure achieved with the two regimens were similar. Gentamicin/clindamycin treatment failed only in two of four instances of severe infection. Patients given imipenem/cilastatin seemed to respond more rapidly to treatment; this observation applied both to the entire group treated and to the subgroup with moderate intraabdominal infections. Susceptible etiologic agents were more frequently eradicated by imipenem/cilastatin (95%) than by gentamicin/clindamycin (79%). The most common adverse reactions were nausea or vomiting in patients given imipenem/cilastatin and urinary abnormalities in those given gentamicin/clindamycin. Self-limited diarrhea was observed with equal frequency in the two groups. No adverse reactions required the discontinuation of treatment. Colonization or superinfection with resistant organisms and Pseudomonas aeruginosa occurred significantly more often among patients given gentamicin/clindamycin. These results suggest that imipenem/cilastatin is a promising alternative to the combination of gentamicin and clindamycin for the treatment of moderate to severe infections in hospitalized patients.

Clinical evaluation of norfloxacin versus cotrimoxazole in urinary tract infections.

Forty patients with urinary tract infections were randomly assigned to receive a ten-day course of oral therapy with either norfloxacin 400 mg twice daily or cotrimoxazole (trimethoprim-sulfamethoxazole) 160/800 mg twice daily. There were 34 cases (19 in the norfloxacin and 15 in the cotrimoxazole group) of evaluable infections due to Escherichia coli (85% of cases), Klebsiella pneumoniae, Enterobacter spp., Proteus vulgaris and Alcaligenes faecalis. All organisms were sensitive to the assigned study drug. Twenty-two strains of Escherichia coli and five other isolates had a norfloxacin MIC50 of 0.03 mg/l and MIC90 of 1.0 mg/l. All patients were cured of the initial infection. Three diabetic patients in the norfloxacin group and another healthy patient in the cotrimoxazole group experienced asymptomatic recurrences due to organisms of the same species which, in the absence of causes of bacterial persistence, were considered to be reinfections. Mild reversible adverse effects of no clinical significance were observed in nine patients in each treatment group. Norfloxacin seems to be as effective and safe as cotrimoxazole in the conventional treatment of uncomplicated urinary tract infection.