Gastric gas dynamics in healthy humans.

BACKGROUND: To cope with the daily increments of gastric gas, the stomach can propel gas to the small bowel or trigger the belching reflex. Our aim was to evaluate transit of free gastric gas in healthy humans, and its relationship with abdominal symptoms. METHODS: In 24 healthy volunteers a gas mixture was infused into the stomach at 0 mL/min (sham infusion), 25 mL/min, 50 mL/min, and 100 mL/min (n = 6 each) up to 1500 mL. Belching, rectal gas evacuation, and abdominal perception were continuously recorded for 90 min. KEY RESULTS: Sham infusion was associated to low rectal gas evacuation (187 ± 94 mL after 90 min), and belching (0 ± 0). In contrast, gastric gas infusion increased rectal gas evacuation (1198 ± 176 mL; P = .025) and belching (4 ± 1 belches; P = .0520) without differences between the infusion rates tested. Overall, there was a negative correlation between rectal gas evacuation and belching (r = -.72; P < .0001): 6 subjects had frequent belching (14 ± 2 belches) and minor rectal gas evacuation (330 ± 112 mL), whereas 12 subjects had virtually no belches (1 ± 1 belches) and greater rectal gas evacuation (1630 ± 147 mL; P < .001 vs belchers for both). Gas infusion induced lower abdominal symptoms in belchers (score increment 0.7 ± 0.3) than in rectal gas evacuators (score increment 1.7 ± 0.5; P = .033). CONCLUSIONS AND INFERENCES: An excellent balance between belching and distal gastric empting allows the stomach to adapt to great variations in gas intake. In general, most gastric gas is emptied to distal intestinal segments, but in some circumstances gastric gas induces belching, a mechanism that may improve gas tolerance.

Gas swallow during meals in patients with excessive belching.

BACKGROUND: Swallowed gas is an important source of abdominal gas, and aerophagia is often believed as a putative cause of gas-related abdominal symptoms. However, altered gas-swallow during meals has not been demonstrated. Our aim was to characterize the number of gas swallows during meals in patients complaining of excessive belching and gaseousness and a control group without abdominal symptoms during a 24-h period. METHODS: A 24-h pH-impedance monitoring was performed in 10 patients with excessive belching, and 11 patients without digestive symptoms or reflux in the pH-impedance study. During the study, patients followed their daily routine and customary meals, without any specific limitation. In each patient the number and content of swallows and belches were analyzed. KEY RESULTS: Total meal periods were similar in controls (75±26 min) and patients (79±21 min; P=.339), but the number of gaseous swallows was greater in patients (114±13 swallows) than controls (71±8 swallows; P=.007), due to a greater frequency of gaseous swallows during meals (15±2 swallows/10 min vs 10±1 swallows/10 min, respectively; P=.008). During the 24-h study period, 66±13 belches were recorded in patients, but only 13±3 belches in controls (P<.001), mainly gastric belches (80±4% and 92±2% of belches, patients, and controls, respectively) which showed a good correlation with the number of gaseous swallows performed during meals (r=.756; P=.011). CONCLUSION AND INFERENCES: Gas is frequently swallowed during meals. Patients complaining of excessive belching have a different swallow pattern during meals, with an increased ingestion of gas that correlates with increased gastric belching events.

An e-health driven laboratory information system to support HIV treatment in Peru: E-quity for laboratory personnel, health providers and people living with HIV.

BACKGROUND: Peru has a concentrated HIV epidemic with an estimated 76,000 people living with HIV (PLHIV). Access to highly active antiretroviral therapy (HAART) expanded between 2004-2006 and the Peruvian National Institute of Health was named by the Ministry of Health as the institution responsible for carrying out testing to monitor the effectiveness of HAART. However, a national public health laboratory information system did not exist. We describe the design and implementation of an e-health driven, web-based laboratory information system--NETLAB--to communicate laboratory results for monitoring HAART to laboratory personnel, health providers and PLHIV. METHODS: We carried out a needs assessment of the existing public health laboratory system, which included the generation and subsequent review of flowcharts of laboratory testing processes to generate better, more efficient streamlined processes, improving them and eliminating duplications. Next, we designed NETLAB as a modular system, integrating key security functions. The system was implemented and evaluated. RESULTS: The three main components of the NETLAB system, registration, reporting and education, began operating in early 2007. The number of PLHIV with recorded CD4 counts and viral loads increased by 1.5 times, to reach 18,907. Publication of test results with NETLAB took an average of 1 day, compared to a pre-NETLAB average of 60 days. NETLAB reached 2,037 users, including 944 PLHIV and 1,093 health providers, during its first year and a half. The percentage of overall PLHIV and health providers who were aware of NETLAB and had a NETLAB password has also increased substantially. CONCLUSION: NETLAB is an effective laboratory management tool since it is directly integrated into the national laboratory system and streamlined existing processes at the local, regional and national levels. The system also represents the best possible source of timely laboratory information for health providers and PLHIV, allowing patients to access their own results and other helpful information about their health, extending the scope of HIV treatment beyond the health facility and providing a model for other countries to follow. The NETLAB system now includes 100 diseases of public health importance for which the Peruvian National Institute of Health and the network of public health laboratories provide testing and results.

[Bilateral idiopathic carpal tunnel syndrome in a child under 10 years of age]. / Síndrome del túnel carpiano idiopático bilateral en un niño menor de 10 años.

INTRODUCTION: The carpal tunnel syndrome is the most frequent compression neuropathy in the adult population, being very uncommon in children, particularly under the age of 10 years. The most frequent etiology is the lisosomal storage diseases, followed by anatomical disorders, trauma, intensive sports practice and some idiopathic cases among others. In this paper we are presenting a case of an idiopathic and bilateral carpal tunnel syndrome in a 9 years old boy. CASE REPORT: A 9 year-old patient suffering daily paresthaesias in both hands for a year, producing limitations in hand mobility which disappear after physical movement of the hands. He played basketball at school, he was right handed and had no history of systemic family illnesses. After the exploration, he scored 4/5 in left thumb abductor strength and no thenar muscle hypotrophy. He achieved the criteria of attention deficit and hyperactivity disorder. Electroneurography tests confirmed the diagnosis. The etiology study was normal after completed. After bilateral surgery, the patient achieved a complete recovery. CONCLUSIONS: The importance of this clinical case lies in its rare manifestation in children under the age of 10, being bilateral and not being included in the most frequent etiology group. It has a late diagnosis because it has an etiology and clinical manifestation different from adults. The diagnosis is being done through electroneurography. Open surgical release is almost ever the treatment.

Síndrome del túnel carpiano idiopático bilateral en un niño menor de 10 años / Bilateral idiopathic carpal tunnel syndrome in a child under 10 years of age

Introducción. El síndrome del túnel carpiano es la neuropatía por compresión más frecuente en el adulto. Sin embargo, es un cuadro raro en la edad pediátrica, sobre todo por debajo de los 10 años de edad. La etiología más frecuente son las enfermedades de depósito lisosomal, seguidas por las anomalías anatómicas, casos familiares, traumatismos, práctica intensiva de ciertos deportes y casos idiopáticos. Presentamos un caso de síndrome del túnel carpiano, bilateral e idiopático enun niño de 9 años. Caso clínico. Niño de 9 años que presentaba desde hacía un año parestesias diurnas en ambas manos, con dificultad en la manipulación y que desaparecían tras movilizarlas. Era un jugador de baloncesto escolar, diestro y sin enfermedadessistémicas familiares. Cumplía los criterios de trastorno por déficit de atención/hiperactividad. La exploración mostró una fuerza de 4/5 en el músculo abductor del pulgar izquierdo. No había hipotrofia de la musculatura tenar. La electroneurografíaconfirmó el diagnóstico de síndrome del túnel carpiano. Se completó el estudio etiológico, que resultó normal. Tras realizar la cirugía bilateral, el paciente presentó una mejoría sintomática completa. Conclusiones. La importancia de este caso clínico es la rareza de su presentación en niños menores de 10 años, sobre todo con afectación bilateral y sin pertenecer al grupo etiológico más frecuente. La etiología y la sintomatología clínica distintas a las del adulto condicionan que el diagnóstico sea tardío. El diagnóstico de confirmación se realiza por electroneurografía y el tratamiento es casi siempre quirúrgico

Introduction. The carpal tunnel syndrome is the most frequent compression neuropathy in the adult population,being very uncommon in children, particularly under the age of 10 years. The most frequent etiology is the lisosomal storage diseases, followed by anatomical disorders, trauma, intensive sports practice and some idiopathic cases among others. In this paper we are presenting a case of an idiopathic and bilateral carpal tunnel syndrome in a 9 years old boy. Case report. A 9 year-old patient suffering daily paresthaesias in both hands for a year, producing limitations in hand mobility which disappearafter physical movement of the hands. He played basketball at school, he was right handed and had no history of systemic family illnesses. After the exploration, he scored 4/5 in left thumb abductor strength and no thenar muscle hypotrophy. Heachieved the criteria of attention deficit and hyperactivity disorder. Electroneurography tests confirmed the diagnosis. The etiology study was normal after completed. After bilateral surgery, the patient achieved a complete recovery. Conclusions. The importance of this clinical case lies in its rare manifestation in children under the age of 10, being bilateral and not being included in the most frequent etiology group. It has a late diagnosis because it has an etiology and clinical manifestationdifferent from adults. The diagnosis is being done through electroneurography. Open surgical release is almost ever the treatment

Sistemas de información: Internet, acceso y uso por trabajadores de salud y personas viviendo con VIH/SIDA / Information systems: Internet, access and use by health workers and people living with HIV/AIDS

El Instituto Nacional de Salud desarrolló NETLAB, un sistema de información basado en la Web que aumenta la disponibilidad de los resultados de laboratorio a los trabajadores de salud y a los pacientes viviendo con VIH/SIDA (PVVS). Para asegurar su efectividad se requiere conocer aspectos como recursos y acceso a Internet. Objetivos: Describir las características del acceso a Internet y NETLAB por los usuarios (personal de salud y PVVS) y la infraestructura informática en los establecimientos en donde se administra TARGA, comparando Lima û Callao con Provincias. Materiales y métodos: Se incluyeron 48 establecimientos de salud públicos y privados que brindan TARGA, ubicados en 23 departamentos del Perú. Se elaboraron tres cuestionarios dirigidos a los trabajadores de salud, a PVVS y a técnicos de informática. Resultados: Se encuestó a 246 trabajadores sanitarios, a 201 PVVS y a 45 trabajadores de informática. El 95,5 por ciento de los trabajadores sanitarios reportaron que sabían navegar en Internet, 62,6 por ciento contaban con el servicio en sus oficinas, 85 por ciento conocía NETLAB y 36 por ciento contaba con una clave de acceso. El 50,7 por ciento de las PVVS reportaron saber navegar en Internet (85,5 por ciento en Lima y 45,7 por ciento en provincias; p<0,01), 81 por ciento accede a través de cabinas públicas y 93 por ciento está interesado en conocer sus resultados de laboratorio a través de Internet. Todos los establecimientos tienen Internet, pero la infraestructura informática y calidad de conexión a Internet es muy variada. Discusión: La elevada proporción de personal sanitario que utiliza Internet favorece la introducción y uso del NETLAB y sus herramientas de comunicación. La brecha de acceso a Internet entre PVVS residentes en Lima y provincias y la elevada proporción de uso de las cabinas públicas, plantea retos y oportunidades para promover la utilización de NETLAB en este grupo.

The National Institute of Health developed NETLAB, a Web based information system that increases the availability of laboratory results to health workers and patients living with HIV / AIDS (PLWHA) in HAART. To assure its effectiveness it is necessary to explore issues available like resources access to Internet Objectives: To describe the characteristics of Internet access and NETLAB access by potential users and the IT infrastructure in places where HAART is administered. Methods: We included 48 public and private health facilities where HAART is administered for 23 departments for Peru. 3 questionnaires were prepared, one for health professionals, another for PLWA and another for informatics specialists from each center. Results: We included in the survey 246 health workers, 201 PLWA and 45 informatics workers. 95,5 per cent of the health workers reported they know how use the Internet, 62,6 per cent had Internet connection with in his offices. 85 per cent knew about NETLAB, but only 36 per cent had an access code. 50,7 per cent of PLWA knew how to use Internet (85,5 per cent in Lima and 47,7 per cent in provinces p<0,01). 81 per cent access trough the public Internet booths (ôcabinas públicasõ) and 93 per cent are interesting accessing their lab results trough the Internet. All the health facilities have Internet access though the quality of the connection is very heterogeneous. Discussion: The high proportion of health workers who knew how and uses the Internet is encouraging and favors the introduction and the use of NETLAB and communications technology. The access gap between PLWA in Lima and regions and the high frequency of use of public Internet booths represent a challenge but also opportunities to promote the use of NETLAB in this group.

Conjuntivitis folicular por Chlamydia trachomatis: Frecuencia y pruebas diagnósticas / Follicular conjunctivitis caused by Chlamydia trachomatis: Frequency and diagnosis test

La Chlamydia trachomatis es la principal causa infecciosa de ceguera en el mundo, que empieza como conjuntivitis folicular. En el Perú se han realizado pocos estudios, debido a su dificultad diagnóstica. Se realizó un estudio en 55 pacientes de 18 a 68 años con diagnóstico de conjuntivitis folicular atendidos en el Instituto Nacional de Oftalmología (Lima, Perú) durante los años 2005 y 2006, con el objetivo de determinar la frecuencia de infección por Chlamydia trachomatis y evaluar la utilidad de la tinción de Giemsa y la inmunofluorescencia directa (IFD) para el diagnóstico de C. trachomatis en relación con el cultivo celular. La frecuencia de C. trachomatis en muestras de secreciones de conjuntivitis folicular fue de 13 por ciento (7/55) por cultivo celular, 20 por ciento (11/55) por IFD y de 9 por ciento (5/55) por Giemsa; los signos y síntomas más frecuentes fueron la presencia de secreciones y fotofobia. Todos los casos fueron varones y manifestaron no tener antecendentes de infecciones de transmisión sexual previas. Se encontró una sensibilidad de 42,9 y 85,7 por ciento y una especificidad de 98,8 y 89,6 por ciento para la tinción Giemsa e IFD respectivamente.

Chlamydia trachomatis is the principal infectious cause of blindness in the world, which begins as follicular conjunctivitis. In Peru few studies was realized by its difficulty to diagnose. A study was conducted in 55 patients 18 to 68 years with follicular conjunctivitis treated at the Instituto Nacional de Oftalmología (Lima, Peru) during the years 2005 and 2006, with the objective of determining the prevalence of Chlamydia trachomatis and evaluated the usefulness of Giemsa and direct immunofluorescence (DIF) for the diagnosis of C. trachomatis in relation to cell culture. The frequency of C. trachomatis in samples of eyes secretions was 13 per cent (7/55) for cell culture, 20 per cent (11/55) for DIF and 9 per cent (5/55) for Giemsa; the signs and symptoms more frequents were the presence of secretions and photophobia. All cases were males and reported not having had prior sexually transmitted infections. We found a sensitivity of 42,9 and 85,7 per cent, and a specificity of 98,8 and 89,6 per cent for Giemsa and DIF respectively.

Theoretical prediction of relative and absolute pKa values of aminopyridines.

This work presents a study aimed at the theoretical prediction of pK(a) values of aminopyridines, as a factor responsible for the activity of these compounds as blockers of the voltage-dependent K(+) channels. To cover a large range of pK(a) values, a total of seven substituted pyridines is considered as a calibration set: pyridine, 2-aminopyridine, 3-aminopyridine, 4-aminopyridine, 2-chloropyridine, 3-chloropyridine, and 4-methylpirydine. Using ab initio G1, G2 and G3 extrapolation methods, and the CPCM variant of the Polarizable Continuum Model for solvation, we calculate gas phase and solvation free energies. pK(a) values are obtained from these data using a thermodynamic cycle for describing protonation in aqueous and gas phases. The results show that the relatively inexpensive G1 level of theory is the most accurate at predicting pK(a) values in aminopyridines. The highest standard deviation with respect to the experimental data is 0.69 pK(a) units for absolute values calculations. The difference increases slightly to 0.74 pK(a) units when the pK(a) is computed relative to the pyridine molecule. Considering only compounds at least as basic as pyridine (the values of interest for bioactive aminopyridines) the error falls to 0.10 and 0.12 pK(a) units for the absolute and relative computations, respectively. The technique can be used to predict the effect of electronegative substituents in the pK(a) of 4-AP, the most active aminopyridine considered in this work. Thus, 2-chloro and 3-chloro-4-aminopyridine are taken into account. The results show a decrease of the pK(a), suggesting that these compounds are less active than 4-AP at blocking the K(+) channel.

Inorganic particles in the skin of inhabitants of volcanic areas of Central America: their possible immunomodulatory influence in leishmaniasis and leprosy.

We have evaluated biopsies from patients with atypical nodular and typical ulcerated lesions of cutaneous leishmaniasis, from leishmanin reactions and skin from normal individuals from Nicaragua, Honduras and Guatemala for the presence of inorganic particles using confocal microscopy with a polarised light source and conventional histopathological techniques. Analysis by semiquantitative confocal microscopy permitted the demonstration of significantly larger numbers of particles in atypical lesions. Silica and aluminium, important components of these particles, were less abundant in particles from normal skin. The histology of these atypical lesions, characterised by 'naked' sarcoidal granulomas with epithelioid differentiation but very few lymphocytes, was very similar to the histological reaction observed after 14 days in persisting inflammation at leishmanin skin test sites. The presence of these unusual lesions in areas of Central American countries characterised by the presence of large amounts of volcanic ash, as well the unexpectedly low prevalence of leprosy in Central America, suggest that environmental factors may contribute significantly to the frequency and clinical manifestations of these infections. Among possible environmental features, the presence of inorganic particles with immunomodulatory properties in the skin may be a significant factor.

Widespread cutaneous necrosis and antiphospholipid antibodies: two episodes related to surgical manipulation and urinary tract infection.

Widespread cutaneous necrosis (WCN) associated with antiphospholipid antibodies is rare. Its mechanisms have yet to be elucidated, and there are no well-established guidelines for its management. We describe a woman who had two episodes of WCN related to surgical manipulation for urinary tract obstruction and urinary tract infection. Lupus anticoagulant was always positive. In the second episode anticardiolipin antibodies were elevated, and protein C levels were temporarily decreased. We found only ten previously reported cases of WCN associated with antiphospholipid antibodies, none of which were related to surgical manipulation.