Identificación de genotipos de Helicobacter pylori, provenientes de muestras de placa dental en la población venezolana

La placa dental ha sido sugerida como un reservorio importante de Helicobacter pylori, pero la hipótesis de que esta bacteria pueda permanecer como parte integrante de la microbiota residente de la cavidad bucal. Estudios previos realizados en nuestro país demostraron la presencia del microorganismo en 12/32 pacientes, lo que representa un 37,6% de positividad. H. pylori se caracteriza por poseer una gran variabilidad genética, y se ha demostrado la presencia de genes bacterianos específicos que están asociados con la virulencia de las especies bacterianas. El objetivo de este estudio fue caracterizar los genotipos vacA y cagA de especies de H. pylori provenientes de placa dental de una muestra de la población venezolana con el fin de determinar los genotipos mas frecuentes de nuestra población a nivel de la cavidad bucal. Fueron evaluadas 69 muestras de placa dental de pacientes con indicación de endoscopia por enfermedad de las vías digestivas superiores, provenientes del Hospital Clínico Universitario de Caracas. Se tomaron muestras de placa dental de cada uno de los pacientes y se realizó la extracción de ADN para el análisis por Reacción en Cadena de la Polimerasa (RCP). Se amplificaron los segmentos de glm M, vac A and cag A. Los resultados demostraron que solo 1/69 muestras (1,4%) fue positiva para la amplificación de glmM. Ninguna de las muestras pudo ser tipificada para las diferentes formas alélicas de vacA , región media de vacA o cagA . Los resultados de la presente investigación demostraron que aún cuando en reportes previos observamos una importante prevalencia de H. pylori en muestras de placa dental, en esta investigación la prevalencia de la bacteria fue muy baja, no pudiéndose identificar los genotipos mas frecuentes a nivel de placa dental.

The aim of this study was to characterize the vacA and cagA genotypes of H. pylori strains from dental plaque of a Venezuelan population. 69 patients attending for routine gastroscopy were evaluated. Dental plaque samples were obtained for DNA extraction and PCR analysis. Amplification of glmM, vacA and cagA segments were performed as previously described. The results demonstrated that only 1/69 (1,4%) was positive for glmM amplification. None of the samples was typeable for vacA signal sequence genotype, vacA mid region or cagA. The results demonstrated that the prevalence of H. pylori in dental plaque of a Venezuelan population was not significant in this study and was not possible to identify the genotypes of H. pylori from dental plaque.

Helicobacter pylori en Venezuela: un problema infeccioso multifactorial / Helicobacter pylori in Venezuela: a problem infectious multifactorial

Los objetivos del presente trabajo fueron: establecer la seroprevalencia de la infección por Helicobacter pylori en población venezolana y su asociación con trastornos gastroduodenales y evaluar la presencia del gen cagA mediante la reacción en cadena de la polimerasa y su asociación con trastornos gastroduodenales. Para el estudio de seroprevalencia se evaluaron un total de 1041 personas de distintos estados del país, 370 adultos sintomáticos, 406 asintomáticos, 27 niños sintomáticos y 238 asintomáticos. La determinación de anticuerpos IgG específicos se realizó mediante ELISA comercial. La presencia del gen CagA fue evaluada en 133 pacientes del área metropolitana y el Centro de Cáncer Gástrico de San Cristóbal. Las biopsias se analizaron por diferentes métodos de diagnóstico para H. pylori: cultivo, prueba de ureasa, reacción en cadena de la polimerasa. En la población infantil el porcentaje de niños con valores de anticuerpos IgG específicos anti-H. pylori varía de 30 por ciento a 60 por ciento. En adultos sintomáticos la seroprevalencia varía entre un 68 por ciento a 93 por ciento según el área geográfica estudiada. Una disminución de anticuerpos IgG anti- H. pylori se observó en pacientes con gastritis antral difusa asociada con metaplasia tipo II. En el grupo de pacientes de San Cristóbal se observaron títulos elevados en pacientes con gastritis antral difusa. Un 46 por ciento de las cepas de H. pylori aisladas de pacientes del Area Metropolitana presentaron el gen cagA a diferencia de grupo de San Cristóbal donde se observó una frecuencia menor (26,41 por ciento).

Evaluación de la infección de helicobacter pylori en distintas patologías de las vías digestivas superiores y su asociación con el oncogen K-ras 12 / Evaluate the infection of helicobacter pylori in the different pathologies from the gastroduodenal tract and its association with the oncogen K-ras 12

El objetivo del presente trabajo fue evaluar la infección de helicobacter pylori en las diferentes patologías de las vías digestivas superiores y su asociación con el oncogen K-ras 12. Se estudiaron 62 pacientes a quienes se les practicó endoscopia digestiva superior y se tomaron 3 biopsia de la región del antro. Una biopsia fue empleada para el estudio histológico, otra para el cultivo y una biopsia para la determinación de mutaciones puntuales en dicho oncogen. Los resultados mostraron una alta incidencia de la infección por helicobacter pylori en pacientes con gastritis crónica activa (GCAc) (61 por ciento), el 11 por ciento fue observado en gastritis crónica atrófica (GCAt), metaplasia intestinal (MI), y cambios displásicos (CD); el 6 por ciento se observó en cáncer gástrico. En relación a la presencia de alteraciones en el codon 12 del gen K-ras, se detectaron mutaciones puntuales simples y combinadas en el mismo tejido en relación a las diferentes patologías gástricas. En GCAc se evidenció el mayor número de mutaciones. Sin embargo en la medida que progresan las etapas hacia cáncer gástrico disminuye el número de mutaciones Estas características pueden que podrían ser definidas como marcadores tumorales y determinante para el eventual desarrollo de lesiones neoplásicas

[Metabolic markers of chronic liver disease]. / Marcadores metabólicos de enfermedad hepática crónica.

The association between chronic liver disease and plasmatic lipids and glucidic metabolism was studied. The liver was evaluated with biochemical variables, ultrasound and upper gastrointestinal endoscopy. 12 chronic liver diseases patients and 10 normal were studied. 83.3% of patients showed lipidic abnormalities, 66.6% on the cholesterol levels and 41.7%, reduced HDL. When patients received 100 gr of glucose the response was abnormal in 83.3%. These results were compared with other "liver function test". 75% had abnormal bilirubin, 58.3% abnormal albumin, prothrombin time 58.3%, aminotransferases 75%. Esophageal verices were found in 75% of cases and ultrasound abnormalities in 91.6% (27.3% cirrhosis, 54.4% diffuse abnormal patter and 18.2% splenomegaly). These findings show that lipidic and glucidic metabolism, and ultrasound, in chronic liver diseases are the more frequent abnormalities.

[Complications of laparoscopic cholecystectomy]. / Complicaciones de la colecistectomía laparoscópica.

The laparoscopy cholecistectomy is a surgical procedure described in 1987, and it has had an important apogee and it's had substitute to open procedure. Between its advantages is notable, the postoperatory evolution without pain, paralytic ileus and the short time of hospitalization besides the patient can go away the same day in some cases. In Venezuela, the procedure has been received with enthusiasm by the surgeons with prefer this procedure however, there are complications derived in part for the lack of experience in the first cases, but occur non related of the experience. The quantization of the complications is not simple to realize for different reasons. We present twelve complications, two belong to patients intervened in the Hospital Universitario de Caracas and ten belong to patient transferred from other center. The complications were: pseudoaneurism of hepatic artery, hematoma of the wall, cutting of common bile duct, section the right bile duct, abscess of vesicular bed in two cases, retropneumoperitoneum, ascites by biliary fistula and four biloma. The treatment varied in every case and the utilization of radiologic technique with percutaneous drainage were useful in five cases. We conclude: first, this technique is not free of complications. Second, the percutaneous drainage (abscess, biloma), endoscopic procedure (biliary prosthesis) in fistulaes and arteriographics (arterial embolization), are useful in some cases, and could prevent the surgical reintervention.

[Endoscopic retrograde cholangiopancreatography in hepatic fascioliasis]. / Colangiopancreatografia retrógrada endoscópica en fasciolasis hepática.

We present a 60 years old female with a history of upper right quadrant pain, fever and eosinophily. We made the diagnosis of fasciolasis on clinical, parasitology studies and radiological findings. In the endoscopic retrograde cholangiopancreatography (ERCP) we found the bile duct of normal caliber, but with many filling defects. Fasciola eggs were found in the bile. This is the first case with endoscopic retrograde cholanglopancreatography and the fourth case of fasciolasis in Venezuela.

[Epidemiology of viral hepatitis in Venezuela: preliminary results of phase 1. Prevalence in the metropolitan area]. / Epidemiología de la hepatitis viral en Venezuela: resultados preliminares de la etapa 1. Prevalencia en el área metropolitana.

Two different areas of metropolitan zone in Venezuela were studied in relationship to the immunological condition associated with A, B, C and D viral hepatitis in 557 healthy subjects. We performed clinical history with personal information, that was subsequently correlated with results of the hepatitis markers. General results show prevalence different from previous reports: Anti-HAV: 90.84%, HBsAg: 1.62%, Anti-HBc: 10.6%, Anti-HCV: 0.36% y Anti HDV: 0%.

[Protective effect of ranitidine and bismuth salts on gastritis induced by ethanol]. / Efecto protector de la ranitidina y de las sales de bismuto sobre la gastritis producida por etanol.

In normal males volunteers a double-blind parallel trial was performed to study protection induced by ranitidine and bismuth subcitrate on the damage induced by ethanol on the gastric mucosa. Subjects were randomized assigned in three groups: I (R) n = 9 Ranitidine 150 mg, II (B) n = 6 Bismuth 240 mg, and III (R + B) n = 9 both compounds. Drugs were administered one hour before endoscopy. If the subject initially showed absence of any lesion, he received through and endoscopic cannula an infusion of 100 ml of ethanol at 40%. Endoscopic evaluation was performed at 15 and 30 minutes, without retrieving the endoscope. Quantification of gastric lesions was performed using the scale of Tarnawski et al (Am J Med 83:31-37, 1987). In the group I there was no lesion in 67%, in the group II 0% and in the group III 78%. Petechial lesions were observed in 33%, 67% and 11% respectively. In summary, combination R + B and the R gave the best cytoprotection that observed only bismuth. Possible mechanism of action are discussed.

[Comparative efficacy of intradermal and intramuscular active immunization against hepatitis B with a recombinant vaccine. Preliminary results]. / Eficacia comparativa de las vías intradérmica e intramuscular en la inmunización activa contra la hepatitis B con una vacuna recombinante. Resultados preliminares.

Preliminary results of a prospective, comparative and randomized study on 119 sero-negative volunteers with increased risk to acquire hepatitis B, aimed to evaluate the comparative efficacy of a recombinant vaccine administered either intramuscularly or intradermally, are discussed. A short vaccination schedule of three consecutive doses given on months 0, 1 and 2 was used. Distribution by sex and age for both groups was similar. Seroconversion and seroprotection rates were comparable (96% and 96% Vs. 98% and 93%, respectively). The geometric mean titre of anti-HBsAg in individuals immunized via I.M. (155 IU/L) was significantly higher to that of the I.D. group (71 IU/L). On the other hand, the rate of good response (> 100 IU/L) was also higher in the I.M. group (67% Vs. 39%). The percentage of good responder in women was consistently higher than in men for both groups (75% Vs. 13%, respectively). In 68 vaccinees, samples were obtained one year later. The levels of anti-HBsAg and the anamnesic response after a booster of the vaccine are currently being assayed.

[Hemobilia. Its clinical presentation and diagnosis]. / Hemobilia. Presentación clínica y diagnóstico.

Hemobilia is a rare cause of upper GI bleeding that must be suspect in order to make an early and precise diagnosis, that permits to decrease the high rate of mortality. We present our experience in three cases and analyze the clinical manifestations, diagnostic methods and follow-up.

[Treatment of parasitic liver diseases]. / Tratamiento de las parasitosis hepáticas.

Most of primary and secondary parasitic liver diseases, at present can be property treated with drugs. Venezuelan pharmaceutic market has some peculiarities that have determined the disappearance from the market of many drugs such as emetine, thiabendazole, quinacrine and niclosamide. Diloxanide never appeared. Venezuela has no commercial international treatises that protect international patents in the pharmaceutical area. In addition, government regulation of cost of drugs is very strict. This is particularly true with old drugs (such as emetine or quinacrine) which had such a low price that is non-commercial for the maker of the drug, usually a large transnational, and is withdrawn from the market. Flexibility of prices is quite easy for new antibiotics which are very expensive. Frequently small national companies import the drug from Italy and Japan which sell the drug independently from international treats. Such companies frequently produce the drug for the government social system, but are unreliable and also frequently they withdraw the drug a variable period of time. The government, through the Ministry of Public Health administer free treatment with drugs for malaria, tuberculosis and leprosy. The severe economic crisis of the country has severely impaired the preventive programs and there is an increase of malaria due to gold mining in the south of the country and falciparum chloroquine resistance and an increase of schistosomiasis in a previous free area. Also administration of drugs for malaria has been severely impaired, mainly for economic reasons. The establishment of a National Government Laboratory is an old (as far as 1946) political goal, but has remained in the political intention.(ABSTRACT TRUNCATED AT 250 WORDS)

[Leiomyosarcoma of the small intestine. Contribution of computerized tomography to its diagnosis]. / Leiomiosarcoma del intestino delbado. Contribudión de la tomografía computada para su diagnóstico.

The case of a patient with a small bowel leiomyosarcoma in whom a correct preoperative diagnosis was done due to important clues provided by computed tomography is presented. We present these findings, and suggest that this new exploratory method may be useful for the study of patients with small bowel intramural tumors, in whom other studies are often non-conclusive.

Leiomiosarcoma del intestino delgado.Contribucion de la tomografia computada para su diagnostico. / Leiomyosarcoma of the small bowel. Contribution to the computed tomography for its diagnosis

Se presenta el caso de una paciente con un leiomiosarcoma del intestino delgado, en la cual se logro un diagnostico preoperatorio correcto gracias a los datos aportados por la tomografia computada. Se analizan estos hallazgos y se sugiere que este nuevo metodo diagnostico puede ser muy util para el estudio de pacientes con tumores intramurales del intestino delgado en los cuales otros estudios usualmente no son concluyentes