Prevalence of intestinal parasitic infection among children from a shanty town in Tucuman, Argentina.

A parasitological survey was conducted in children living in a poor area next to a drainage channel, in Tucumán province, Argentina. Stool specimens from 115 children were collected and samples were analyzed by direct microscopy examination and concentration techniques. The prevalence rate of intestinal parasites infection was high (78.3%) and Blastocystis hominis was the most frequent protozoan parasite found (68.9%) followed by Giardia intestinalis (33.3%), Entamoeba coli (24.4%), Endolimax nana (12.2%), Chilomastix mesnili (5.6%) and Iodamoeba bütschlii (2.2%). Ascaris lumbricoides was the most prevalent intestinal helminth, with an infection frequency of 38.9%, followed by Trichuris trichiura (13.3%), Strongyloides stercoralis (13.3%), Hymenolepis nana (7.8%) and Enterobius vermicularis (3.3%). Multiple parasitic infections were also high, affecting 71.1% of infected population. These results indicate that sanitary policies, including health care and sanitary education have been inadequate for the control of intestinal parasitism in this high-risk population. Implementation of sanitation programs is a basic need and a joint collaboration between public servant and health professionals should be a priority.

Parasitological survey of schoolchildren from a highaltitude community from Tucumán Province, Argentina: Remarkable low detection of soil-transmitted helminths in comparison with coastal communities.

The prevalence of intestinal parasitic infections among schoolchildren in Colalao del Valle, a high-altitude community in Tucumán province, Argentina, was investigated. The data revealed a high prevalence of parasitism (79.7%) with no significant differences in distribution by sex or age. Protozoa infections were the most common with Blastocystis hominis being the most prevalent (62.5%), followed by Giardia lamblia (29.7%), Endolimax nana (15.6%), Entamoeba coli (12.5%) and Iodamoeba bütschlii (3.1%). Interestingly, there was an absence of soil-transmitted helminths among the studied population which could be related to climate (variable temperatures, moderate rainfall) and soil type (clay).

Parasitological survey of schoolchildren from a highaltitude community from Tucumán Province, Argentina: Remarkable low detection of soil-transmitted helminths in comparison with coastal communities

The prevalence of intestinal parasitic infections among schoolchildren in Colalao del Valle, a high-altitude community in Tucumán province, Argentina, was investigated. The data revealed a high prevalence of parasitism (79.7%) with no significant differences in distribution by sex or age. Protozoa infections were the most common with Blastocystis hominis being the most prevalent (62.5%), followed by Giardia lamblia (29.7%), Endolimax nana (15.6%), Entamoeba coli (12.5%) and Iodamoeba bütschlii (3.1%). Interestingly, there was an absence of soil-transmitted helminths among the studied population which could be related to climate (variable temperatures, moderate rainfall) and soil type (clay).

Prevalence of intestinal parasitic infection among children from a shanty town in Tucuman, Argentina

A parasitological survey was conducted in children living in a poor area next to a drainage channel, in Tucumán province, Argentina. Stool specimens from 115 children were collected and samples were analyzed by direct microscopy examination and concentration techniques. The prevalence rate of intestinal parasites infection was high (78.3%) and Blastocystis hominis was the most frequent protozoan parasite found (68.9%) followed by Giardia intestinalis (33.3%), Entamoeba coli (24.4%), Endolimax nana (12.2%), Chilomastix mesnili (5.6%) and Iodamoeba bütschlii (2.2%). Ascaris lumbricoides was the most prevalent intestinal helminth, with an infection frequency of 38.9%, followed by Trichuris trichiura (13.3%), Strongyloides stercoralis (13.3%), Hymenolepis nana (7.8%) and Enterobius vermicularis (3.3%). Multiple parasitic infections were also high, affecting 71.1% of infected population. These results indicate that sanitary policies, including health care and sanitary education have been inadequate for the control of intestinal parasitism in this high-risk population. Implementation of sanitation programs is a basic need and a joint collaboration between public servant and health professionals should be a priority.

Primer consenso venezolanode enfermedad por reflujo gastroesofágico / Venezuelan consensus on gastroesophageal reflux diseases

El Consenso Venezolano de Enfermedad por Reflujo Gastroesófágico (ERGE) se realizó con el objeto de proveer guías para mejorar la identificación, el diagnóstico y el tratamiento de este trastorno en el país. Los coordinadores establecieron las líneas de consenso, basado en una revisión sistemática de la literatura médica de los últimos 15 años a partir de 1995. Participaron 55 miembros con el aval de sus respectivas cátedras y sociedades locales de gastroenterología. Éstos revisaron y presentaron los temas con sus niveles de evidencia y grados de recomendación para discutirlos y votarlos en una reunión plenaria. Tras un informe final de los miembros, los coordinadores prepararon las declaraciones finales. El consenso concluyó que la enfermedad por reflujo gastroesofágico tiene una prevalencia estimada del 11,54% en Venezuela, a predominio del sexo femenino (Grado B). El diagnóstico es fundamentalmente clínico, basado en la presencia de síntomas típicos y/o atípicos, e incluso síntomas de alarma que sugieren alguna complicación (Grado B). La endoscopia es importante en la investigación de la presencia de esofagitis de reflujo y laringitis de reflujo (Grado B). Las otras pruebas diagnósticas como lo son la pHmetría esofágica de 24 horas con o sin impedancia intraluminal multicanal son importantes en los pacientes que no tienen esofagitis, tienen síntomas atípicos o cuando hay falla en la respuesta al tratamiento médico (Grado B). La radiología, manometría esofágica y el ultrasonido endoscópico no están indicados en el diagnóstico de la ERGE (Grado B). El objetivo del tratamiento es reducir la exposición ácida en el esófago y con esto: aliviar los síntomas, cicatrizar las lesiones en la mucosa esofágica, prevenir la recurrencia y las complicaciones. Los inhibidores de bomba de protones deberían ser la primera opción en el tratamiento en el síndrome de ERGE y en la esofagitis por reflujo tanto en la fase aguda como durante el mantenimiento...

The Venezuelan Gastroesophageal Reflux Disease (GERD) Consensus was carried out in order to provide guidelines to improve the identification, diagnosis and treatment of this illness in Venezuela.  The coordinators established the consensuslines, based on a systematic revision of the medical literature of the last 15 years starting from 1995. 55 physicians participated with the support of their respective medical schools and local societies. They revised and presented the topics with their respective evidence levels and recommendation grades to discuss and vote them in a plenary meeting. After a final report of the members, the coordinators prepared the definitive declarations. The consensus concluded that GERD prevalence in Venezuela is 11,54%, higher in women than men (Grade B). The diagnosis is mainly clinical, based on the presence of typical and/or atypical symptoms and alarm symptoms that may suggest the presence of complications (Grade B). Endoscopy is important when reflux esophagitis and laryngitis are present (Grade B). Other diagnostic tests as ambulatory 24 hours pH monitoring with or without multichannel intraluminal impedance are important in patients without esophagitis, with atypical symptoms or when there is flaw in the answer to the medical treatment (Grade B). Radiology, esophageal manometry and endoscopic ultrasonography are not indicated in the diagnosis of GERD (Grade B). The objective of the treatment is to reduce the presence of acid in the esophagus and consequently: alleviate the symptoms and heal lesions in the esophagus mucosa to prevent recurrence and complications. Proton pump inhibitors should be the first option drug in the treatment of GERD syndrome andin esophagitis during the acute and the maintenance phase using standard or half dose (Grade A). So far, pokinetics are drugs with a limited use in GERD patients; they stimulate the esophagus/gastric motility...

Tako-Tsubo syndrome after an exercise echocardiography.

The Tako-Tsubo syndrome is a clinical entity recently described that associate a chest pain occurring during a stress, an abnormal ECG and/or an increase in the troponin blood level and a transient left ventricular dysfunction with an akinesis involving generally the midsection and the apex of the heart. It has also been reported that left ventricle (LV) dysfunction may involve only the midventricle, although it seems less common. We report the case of a 66 year old woman that developed a stress-induced cardiomyopathy (Tako-Tsubo syndrome) involving the midventricle when performing an exercise echocardiography. To our knowledge, this is the first case reported in such circumstances.

[Very late intrastent thrombosis--at 27 months!]. / Une thrombose de stent très tardive...à 27 mois!

Interrupting platelet antiaggregant therapy in coronary patients treated by stenting exposes them to the risk of cardiac complications. The risk of acute thrombosis of the stent is well known but late intrastent thrombosis is less common and mainly observed with drug eluting stents. The authors report the case of a 54 year old man who had thrombosis of an ordinary stent implanted 27 months previously which occurred in the immediate post-operative period after repair of an inguinal hernia. The interruption of platelet antiaggregant therapy was relayed by flurbiprofen in accordance with recommendations of scientific societies. After a review of the literature, the authors discuss late stent thrombosis and interruption of platelet aggregant therapy in coronary patients before non-cardiac surgery.

[Aorto-coronary bypass]. / Pontage aorto-coronarien.

OBJECTIVES: Saphenous grafts used for coronary artery bypass are classically dissected via a continuous incision of the leg, the thigh or both. Recently, a new video-surgery technique has been introduced in an attempt to reduce the trauma of saphenous vein dissection. The aim of this work was to evaluate the possible benefits of this new technique compared with classical dissection. PATIENTS AND METHODS: Sixty patients requiring coronary artery bypass grafts were included in this study and randomly divided into two groups. In group I (30 patients) the saphenous vein was dissected according to the classical technique. The video-surgery technique was used for the other 30 patients in group II. The two groups were not significantly different for mean age, sex ratio, or history of diabetes or lower limb arteriopathy. The same number of bypasses was performed in both groups (2.6 +/- 0.7). Outcome was compared for: dissection related complications (hematomas, infections), length of the skin incision over the length of the dissected vein, duration of the dissection procedure, and post-operative pain. RESULTS: A leg incision was used in 28 cases out of 30 cases in both groups. The length of the saphenous vein dissected was 27.6 cm in group I and 21.8 cm in group II. The length of the skin incision was 27 cm in group I and only 4.7 cm in the video-surgery group II, giving an incision/vein ratio of 97% and 21% respectively. Operative time was however 37.9 min for group I and 48.5 min for group II. There was no significant difference between the groups for hematoma formation or infection but the patients in the video-surgery group experienced less post-operative pain. CONCLUSION: Besides an improvement in the esthetic result, video-surgery dissection of the saphenous vein reduces post-operative pain at the cost of a slightly longer operative procedure.

[Why so many stents?]. / Pourquoi autant de stents?

BETTER THAN ANGIOPLASTY: Prolonging inflation with a perfusion balloon decreases the risk of acute coronary occlusion after angioplasty. The longer the artery remains patent, the greater the chances of 0% residual stenosis. This is what the sent allows. Stent act on both mechanisms of stenosis: elastic recoil and fibrous remodeling of the arterial plaque. TARGETTED ACTION: Stents improve angioplasty prevention of acute stenosis. They have a real action on preventing degeneration of the saphenous graft and lead to a significant reduction in the rate of restenosis of the dilated site. There are however two specific complications: subacute occlusion and greater incidence of vascular events. Stents are particularly indicated for the treatment of restenosis and chronic occlusions. TWO IMPROVEMENTS: Risks related to the implantation of a foreign body in the vascular system have been reduced with the use of ticlopidine and high-pressure stent implantation. POSITIVE RESULTS: Stents have produced better angiographic results. They limit restenosis and the number of revascularizations required in treated patients. Several questions concerning indications remain open.

Comparison of arbutamine and exercise echocardiography in diagnosing myocardial ischemia.

Arbutamine is a new catecholamine designed for use as a pharmacologic stress agent. This study compared the sensitivity of arbutamine with symptom-limited exercise to induce echocardiographic signs of ischemia. Arbutamine was administered by a computerized closed-loop delivery system that controls the infusion rate of arbutamine toward a predefined rate of heart rate increase and maximum heart rate limit. Beta blockers were stopped > or = 48 hours before both tests. Stress was stopped for intolerable symptoms, or clinical, electrocardiographic or echocardiographic signs of ischemia (new or worsening wall motion abnormality), target heart rate (> or = 85% age predicted maximum heart rate), or plateau of heart rate response. Thirty-seven patients were entered into the study (35 arbutamine and exercise, 1 arbutamine only, 1 exercise only), of which 30 had angiographic evidence of coronary artery disease (> or = 50% lumen diameter narrowing). Rate-pressure product increased significantly in response to both stress modalities (p < 0.001) and was significantly greater with exercise (11,308 +/- 2,443) than with arbutamine (9,486 +/- 2,479, p < 0.001). The time to maximum heart rate was longer during arbutamine stress echocardiography than during exercise testing (17.3 +/- 9.4 versus 9.3 +/- 4.2 minutes, respectively, p < 0.001). There were more patients with interpretable echo data for arbutamine (82%) than for exercise (67%). Sensitivity for recognition of myocardial ischemia was 94% (95% confidence interval 70% to 100%) and 88% (95% confidence interval 62% to 98%), respectively. The most frequent adverse events during arbutamine (n = 36) were dyspnea (5.6%) and tremor (5.6%). Two arbutamine stress tests were discontinued due to arrhythmias: 1 patient had premature atrial and ventricular beats, and the other had premature atrial contractions and atrial fibrillation. Arrhythmias were well tolerated and resolved without sequelae. In conclusion, the sensitivity of arbutamine to induce echocardiographic signs of ischemia was similar to that of exercise despite a lower rate-pressure product. Arbutamine was well tolerated and provides a reliable alternative to exercise echocardiography.

Relation of functional improvement in congestive heart failure after quinapril therapy to peripheral limitation.

Angiotensin-converting enzyme inhibitors have been shown to increase maximal muscle blood flow in parallel to peak VO2 in patients with congestive heart failure (CHF). Whether this increase shifts factors limiting peak aerobic capacity from periphery (skeletal muscle or vessels) to central factors (cardiac or respiratory) is unknown. Comparison of peak oxygen consumption (VO2) obtained during leg cycling (VO2 leg) with peak VO2 obtained during combined leg cycling and arm cranking (VO2 arm + leg) allows determination of the relative role of central or peripheral factors. We compared VO2 leg with VO2 arm + leg before and after 3 months of therapy with quinapril 40 mg in 16 patients with CHF (age 53 +/- 13 years) due to left ventricular systolic dysfunction (ejection fraction 0.25 +/- 0.07). Before quinapril, VO2 arm + leg was significantly higher than VO2 leg (19.0 +/- 3.3 vs 16.9 +/- 3.8 ml/kg/min, p < 0.001), whereas after therapy these 2 values were similar (20.3 +/- 4.3 vs 21.0 +/- 4.3 ml/kg/min; p = NS), indicating that patients were no longer limited by peripheral factors. Besides, VO2 leg increase after therapy was higher in patients in whom difference between VO2 arm + leg and VO2 leg was the greatest (i.e., in patients who were initially more limited by peripheral factors). Simultaneously, calf peak reactive hyperemia and circumference significantly increased, indicating an improvement in vascular dilating capacity and an increase in skeletal muscle mass. No significant modification occurred in the forearm. Thus, patients who improved the most after 3 months of quinapril therapy were those who were initially limited by peripheral factors. The restricting role of these factors was reduced after quinapril therapy.

The age of the patient should be taken into account when interpreting Doppler assessed pulmonary artery pressures.

The impact of aging on the systolic artery pressure (SPAP) value is not well known. We selected 134 echocardiographic Doppler examinations considered as normal (presence of a sinus rhythm, absence of chronic obstructive pulmonary disease or pulmonary embolism, normal global or segmental wall motion, no right or left ventricular hypertrophy or dilatation, no significant valvular disease, no pericarditis), with a clearly measurable tricuspid insufficiency allowing us to measure the SPAP with the simplified Bernoulli equation. There was a highly significant (p = 0.0001) correlation (r = 0.47) between SPAP values and the age of the patient. SPAP increased progressively with age from 23 +/- 5 mm Hg between 20 to 29 years old to 32 +/- 6 mm Hg when 80 years old or more. The interpretation of the SPAP should take into account the age.