Ecology of bats and their role in emerging zoonotic diseases: a review.

The order Chiroptera is the second largest order of mammals and shows great physiological and ecological diversity. These animals play significant ecological roles as prey and predator as well as facilitating pollination, seed dispersal, arthropod reduction and nutrient distribution and reutilisation in nature. Bats act as hosts to a range of viral, bacterial, fungal and parasitic zoonoses. Human activities increase the likelihood of exposure to bats, thereby increasing the opportunity for infections to spill over. Continuing ecological processes, emergence and spillover of novel pathogens in naïve hosts, including humans, along with other complex natural phenomena require proper understanding that may help in predicting the next spillover. This review will discuss the ecology of bats and their role in the emergence of different zoonoses, particularly those of viral origin, in an organised manner to increase understanding of the factors that may play significant roles in spillover of these pathogens from bats to other animals, including humans.

L'ordre des Chiroptères, le deuxième des mammifères en nombre d'espèces, présente des caractéristiques physiologiques et écologiques très diverses. Ces animaux jouent un rôle écologique majeur à divers titres, en tant que proies et prédateurs, mais aussi parce qu'ils interviennent dans la pollinisation, la dispersion des semences, la réduction des populations d'arthropodes et la répartition et réutilisation des nutriments dans la nature. Les chauves-souris sont les hôtes d'un large éventail de virus, bactéries, champignons et parasites zoonotiques. Les activités humaines entraînent une probabilité accrue d'exposition aux chauves-souris, ce qui à son tour multiplie les situations à la faveur desquelles les maladies infectieuses peuvent se transmettre d'une espèce réservoir à des hôtes accidentels. Les processus écologiques continus, l'émergence d'agents pathogènes nouveaux et l'atteinte accidentelle d'une espèce réceptive mais habituellement non touchée, y compris l'homme, ainsi que d'autres phénomènes naturels complexes, doivent être correctement appréhendés afin de pouvoir prédire la prochaine occurrence de ce type de transmission inter-espèces. Les auteurs examinent l'écologie des chauves-souris et leur rôle dans l'émergence de plusieurs zoonoses, notamment d'origine virale, en les présentant sous forme raisonnée afin de mieux faire comprendre les facteurs susceptibles de jouer un rôle significatif dans la transmission de ces agents pathogènes des chauves-souris à d'autres espèces, y compris l'homme.

El orden de los quirópteros, que es el segundo más grande de los órdenes de mamíferos, presenta una gran diversidad fisiológica y ecológica. Estos animales cumplen importantes funciones ecológicas como presas y predadores, además de facilitar la polinización, la dispersión de semillas, la reducción de las poblaciones de artrópodos y la distribución y reutilización de nutrientes en el medio natural. Los murciélagos son hospedadores de una serie de zoonosis víricas, bacterianas, fúngicas y parasitarias. Las actividades humanas aumentan la probabilidad de exposición a murciélagos, acrecentando con ello las posibilidades de extensión secundaria de una infección. Los continuos procesos ecológicos, la aparición de nuevos patógenos y su extensión a hospedadores no expuestos previamente, incluidas las personas, junto con otros fenómenos naturales complejos, obligan a conocer cabalmente estos procesos para ayudar a predecir dónde puede darse la siguiente extensión secundaria. Los autores examinan la ecología de los murciélagos y la función que estos cumplen en el surgimiento de diferentes zoonosis, en especial las de origen vírico, de manera organizada para conocer mejor los factores que pueden influir sustancialmente en el paso de esos patógenos del murciélago a otros animales, en particular el ser humano.

Hyperglycaemia and Survival in Solid Tumours: A Systematic Review and Meta-analysis.

AIMS: Diabetes is associated with adverse cancer outcomes. However, the effect of hyperglycaemia in non-diabetic cancer patients is unclear. MATERIALS AND METHODS: A systematic search of electronic databases identified publications exploring the effect of hyperglycaemia on overall survival, disease-free survival (DFS) or progression-free survival (PFS). Data from studies reporting a hazard ratio and 95% confidence interval and/or a P-value were pooled in a meta-analysis using generic inverse-variance and random effects modelling. Subgroup analyses were conducted based on method of hyperglycaemia measurement (HbA1c, other) and stage (early, advanced, mixed). Meta-regression was performed to evaluate the influence of clinical characteristics including baseline diabetes status on the hazard ratio for overall survival. RESULTS: Twelve studies comprising a total of 9872 patients were included. All studies reported hazard ratios for overall survival. Three studies reported DFS; two reported PFS outcomes. Definitions of hyperglycaemia and cut-offs varied between studies. Hyperglycaemia was associated with worse overall survival (hazard ratio 2.05, 95% confidence interval 1.67-2.51; P < 0.001) and DFS (hazard ratio 1.98, 95% confidence interval 1.20-3.27; P = 0.007), but did not affect PFS (hazard ratio 1.08, 95% confidence interval 0.72-1.62; P = 0.71). The association with worse overall survival was maintained in subgroups based on method of hyperglycaemia measurement (subgroup difference P = 0.46) and stage (P = 0.14). Meta-regression showed a significantly greater magnitude of association between hyperglycaemia and decreased overall survival in studies with higher proportions of women and diabetic patients. CONCLUSIONS: Hyperglycaemia is associated with adverse overall survival and DFS in patients with cancer. The therapeutic role of glycaemic control in cancer patients warrants further investigation.

Validation of a low field Rheo-NMR instrument and application to shear-induced migration of suspended non-colloidal particles in Couette flow.

Nuclear magnetic resonance rheology (Rheo-NMR) is a valuable tool for studying the transport of suspended non-colloidal particles, important in many commercial processes. The Rheo-NMR imaging technique directly and quantitatively measures fluid displacement as a function of radial position. However, the high field magnets typically used in these experiments are unsuitable for the industrial environment and significantly hinder the measurement of shear stress. We introduce a low field Rheo-NMR instrument (1H resonance frequency of 10.7MHz), which is portable and suitable as a process monitoring tool. This system is applied to the measurement of steady-state velocity profiles of a Newtonian carrier fluid suspending neutrally-buoyant non-colloidal particles at a range of concentrations. The large particle size (diameter >200µm) in the system studied requires a wide-gap Couette geometry and the local rheology was expected to be controlled by shear-induced particle migration. The low-field results are validated against high field Rheo-NMR measurements of consistent samples at matched shear rates. Additionally, it is demonstrated that existing models for particle migration fail to adequately describe the solid volume fractions measured in these systems, highlighting the need for improvement. The low field implementation of Rheo-NMR is complementary to shear stress rheology, such that the two techniques could be combined in a single instrument.

Comparative efficacy and safety of trimebutine versus mebeverine in the treatment of irritable bowel syndrome.

Irritable bowel syndrome (IBS) is a functional disorder characterized by chronic or recurrent abdominal pain or discomfort with bowel disturbances. This prospective, randomized clinical trial has been conducted on IBS patients, using trimebutine and Mebeverine in separate group in parallel design to compare the efficacy and safety of Trimebutine 100mg twice daily with mebeverine 135mg twice daily. Patients of 15 to 60 years old and both sexes were included from the out patient department (OPD) of gastroenterology, Bangabandhu Sheikh Mujib Medical University (BSMMU) from June 2010 to December 2011. A validated IBS-QOL instrument consisted of 34 questions used to assess improvement of quality of life before and after treatment. A total of 140 patients were enrolled in this study. Eighteen patients dropped out. One hundred twenty two patients completed the trial. In this study at the end of 6 weeks therapy, improvement of symptoms was statistically significant. However, differences of improvement between the two groups in relieving various symptoms were not statistically significant. Mean QOL score before treatment was 103 in Trimebutine group and 106 in Mebeverine group. After 6 weeks of treatment mean QOL score was 82 in Trimebutine group and 95 in Mebeverine group indicating improvement in both groups was statistically significant. The difference between the two groups was also significant. No worsening of symptoms and no side effects of the therapeutic agents was observed in any patient during the trial.

Sustained virological response after treatment in patients with chronic hepatitis C infection--a five year follow up.

Peginterferon alpha-2a and ribavirin combination therapy achieves a sustained virological response (SVR) in patients with chronic hepatitis C. Little is know about long-term durability of hepatitis C virus--Ribonucleic acid (HCV-RNA) negativity in patient treated with pegylated interferon and ribavirin therapy. Aim of this study was to evaluate the durability of virologic response in patients with SVR to anti-viral therapy treated at our centre. A total of 52 patients with chronic hepatitis C virus infection who had obtained SVR after Peginterferon alpha-2a and ribavirin combination therapy were followed up to 5 years with annual HCV-RNA testing. During this follow up period, 4 of 52 patients with initial SVR developed late relapse of hepatitis C virus infection. Relapse was more common in patients who has cirrhosis (3/6 [50%]) vs (1/46 [2.17%]) without cirrhosis. In conclusion, SVR is durable in most patients, but some patients do have late relapse; long-term follow up may be particularly important in a subset of patients with hepatitis C virus infection who have liver cirrhosis.

Comparative efficacy of subcutaneous versus oral methotrexate in active rheumatoid arthritis.

This prospective study was conducted in rheumatology clinic under the department of medicine of Bangabandhu Sheikh Mujib Medical University from December 2004 to December 2005 to asses the efficacy, safety and compliance of subcutaneous methotrexate (MTX) in active rheumatoid arthritis (RA) patients. A total of 92 active rheumatoid arthritis patients according to American College of Rheumatology (ACR) criteria were recruited for the trial for six months. Among them 46 cases belonged to injectable MTX group and 46 cases belonged to oral MTX group. Mean±SD age of patients was 45.54±12.42 vs. 44.63±13.99 years in subcutaneous group and oral group respectively. In the subcutaneous group 41 were female and 5 male; in the oral group 34 were female and 12 male. Mean duration of the disease was 49.74 months in subcutaneous group and 49 months in oral group. RA test was positive in 35 cases in both groups whereas Rose Waaler test was positive in 19 patients in subcutaneous group and 14 patients in oral group. At 24 week, response rate of ACR 20 was significantly higher in subcutaneous MTX than oral MTX group (93% vs. 80%, p=0.02). Similarly ACR 50 response was significantly higher in subcutaneous MTX than in oral group (89% vs. 72%, p=0.03). ACR 70 response was not significantly higher in SCMTX group then oral group (11% vs. 9 %, p=0.72). Adverse effects were relatively less in subcutaneous MTX and most common side effects were nausea (37% vs. 63%), vomiting (11% vs. 30%), dyspepsia (29% vs. 48%), dizziness (4l% vs. 52%) and alopecia (72% vs. 85%). The results of the study demonstrated that subcutaneous MTX was significantly more effective than oral MTX at the same dosage in active Rheumatoid arthritis patients with no increase in side effects.

Cough in systemic lupus erythematosus.

This observational study was conducted in the lupus clinic of Department of Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from January 2007 to July 2007. Thirty-six consecutive SLE patients fulfilled American College of Rheumatology (ACR) diagnostic criteria and having cough for any duration was enrolled. Equal number of age and sex matched controls (The patient attending in the out patient department in the Medicine having cough without SLE) was taken after having informed consent. Severely disabled cases and cases unwilling to participate with a cough were excluded. Mean age of study population was 29.1±8.7 years and 29.8±9.9 years in controls. Duration of cough was less than 3 weeks in 17% of SLE patients and 8% of control group and was more than three weeks in 83% and 92% respectively. In SLE patient commonest causes of cough was bronchial asthma 47% and was 33% in controls. Post nasal drip syndrome was the next common causes and frequently due to sinusitis and allergic rhinitis. Its frequency was 14% and 16% in SLE and control groups respectively. Other causes were pneumonia (11%, 14%), Diffuse Parenchymal Disease lung (DPLD) (5.6% & 2.8%), and tuberculosis (5.6% & 8%) in SLE & control groups respectively. Gastro esophageal reflux disease (GERD) was 2.6% in SLE group but was not found in control group. Cough is common in SLE patients. Frequency distribution though similar to that of causes of cough in community but warns the possibility of serious underlying diseases in SLE cases and attentive evaluation.

Demographic and clinical evaluation of secondaries to liver.

Liver is one of the common sites of metastasis from primary malignancies from different sources. The study was undertaken to know the demographic profile, clinical presentation, investigation findings and primary sources of metastatic lesions in liver among Bangladeshi patients. The study was done on patients with secondary lesion in liver who were admitted into the department of Gastroenterology and department of Hepatology in Bangabandhu Sheikh Mujib Medical University over the period of one year from July 2009 to June 2010. Total 75 patients were included. Mean age of 49.6±6.92 years and the peak incidence was between 41 to 50 years. Seventy six percent (76%) were male and 24% were female and male to female ratio was 3.17:1. Only 5.3% had family history of cancer. More than half of patients had Hb level ≤11gm/dl and two third had raised ESR. All patients showed raised alkaline phosphatase and prolonged prothrombin time found in one forth of patients. Carcinoma stomach was the most common primary source of liver metastasis followed by carcinoma gallbladder, carcinoma pancreas, carcinoma of unknown primary and carcinoma colon.

Microscopy and microanalysis of hematological parameters in common carp, Cyprinus carpio, inhabiting a polluted lake in North East India.

Optical and scanning electron microscopy (SEM) of red blood cells (RBCs) of common carp, Cyprinus carpio, inhabiting a polluted lake in Northeast India revealed a number of abnormalities. About 7% of the RBC showed the presence of a micronucleus, besides the presence of some bi-nucleated and abnormally shaped nuclei. RBCs, white blood cells, and hemoglobin content were found to be reduced significantly as compared to the control. SEM showed the presence of spherocytes, early stages of echinocytes, cytoplasmic blebbing, erythrocytes with contraction from one side, abnormal shape of erythrocytes (hexagonal/pentagonal/tetragonal), development of lobopodial projections, cell rupture, membrane internalization, and formation of ring-shaped RBC. Energy dispersive X-ray spectroscopy (EDS) showed the presence of a considerable percentage of silicon and lead in erythrocytes of the fish collected from the polluted lake, in contrast to a negligible concentration of the two elements in control fish. Significance of the study in relation to fish health in a polluted body of water and the importance of SEM, EDS, and light microscopy in utilizing hematological parameters as pollution indicators are discussed.

Comentarios sobre el síndrome de intestino irritable / Comments on irritable bowel syndrome

Se hace comentarios de lo inadecuado de la terminología orgánico y funcional en la descripción de los problemas digestivos catalogados como Síndrome de Intestino Irritable (SII), igualmente el calificativo de irritable es ambiguo y equivoco, y la definición de los criterios de Roma I, II, y III de considerar el SII a partir de 3 meses de molestias esta sujeto a gran discusión.

The Author comments about the inadequacy of the organic and functional terminology in the description of digestive problems categorized as Irritable Bowel Syndrome (IBS),also the adjective irritable and wrong is ambiguous and equivocal and the consideration in the definition of the Rome I, II , and III criteria for IBS since 3 months of discomfort is subject to great debate.

Gastric emptying rates in idiopathic dyspepsia with and without hunger pain

It has been previously observed that in dyspeptic patients with hunger pain, that is, with pain suggestive of the presence of peptic ulcer, only 12% had an endoscopically demonstrated ulcer, the remaining 88% showing absence of important macroscopically detectable lesions (idiopathic dyspepsia). In order to investigate the possibility of a relationship between hunger pain and some alteration in gastroduodenal motility, the gastric emptying rates of patients presenting idiopathic dyspepsia with and without hunger pain were compared with those of normal control subjects. The study was conducted in 40 patients presenting idiopathic dyspepsia, 20 with and 20 without hunger pain, and 30 voluntary apparently normal control subjects. The patients and the controls ingested, with a standard breakfast, a gelatine capsule containing 10 radioopaque polyurethane markers, and the gastric emptying of the markers was evaluated taking 3 x-ray films of the abdomen at 1.5, 3.0 and 4.5 hours after the breakfast. The gastric emptying rates of the markers were significantly higher in the patients with hunger pain, and significantly lower in the patients without hunger pain, than in the normal control subjects. In idiopathic dyspepsia with and without hunger pain there are, respectively, abnormally increased and abnormally decreased gastric emptying rates of undigestible solid markers. Our findings could help to better understand the pathogenesis of those different types of dyspepsia and, consequently, to improve their treatment.

Gastric emptying rates in idiopathic dyspepsia with and without hunger pain

It has been previously observed that in dyspeptic patients with hunger pain, that is, with pain suggestive of the presence of peptic ulcer, only 12% had an endoscopically demonstrated ulcer, the remaining 88% showing absence of important macroscopically detectable lesions (idiopathic dyspepsia). In order to investigate the possibility of a relationship between hunger pain and some alteration in gastroduodenal motility, the gastric emptying rates of patients presenting idiopathic dyspepsia with and without hunger pain were compared with those of normal control subjects. The study was conducted in 40 patients presenting idiopathic dyspepsia, 20 with and 20 without hunger pain, and 30 voluntary apparently normal control subjects. The patients and the controls ingested, with a standard breakfast, a gelatine capsule containing 10 radioopaque polyurethane markers, and the gastric emptying of the markers was evaluated taking 3 x-ray films of the abdomen at 1.5, 3.0 and 4.5 hours after the breakfast. The gastric emptying rates of the markers were significantly higher in the patients with hunger pain, and significantly lower in the patients without hunger pain, than in the normal control subjects. In idiopathic dyspepsia with and without hunger pain there are, respectively, abnormally increased and abnormally decreased gastric emptying rates of undigestible solid markers. Our findings could help to better understand the pathogenesis of those different types of dyspepsia and, consequently, to improve their treatment. (AU)

Gastric emptying rates in idiopathic dyspepsia with and without "hunger pain".

It has been previously observed that in dyspeptic patients with "hunger pain", that is, with pain suggestive of the presence of peptic ulcer, only 12% had an endoscopically demonstrated ulcer, the remaining 88% showing absence of important macroscopically detectable lesions (idiopathic dyspepsia). In order to investigate the possibility of a relationship between "hunger pain" and some alteration in gastroduodenal motility, the gastric emptying rates of patients presenting idiopathic dyspepsia with and without "hunger pain" were compared with those of normal control subjects. The study was conducted in 40 patients presenting idiopathic dyspepsia, 20 with and 20 without "hunger pain", and 30 voluntary apparently normal control subjects. The patients and the controls ingested, with a standard breakfast, a gelatine capsule containing 10 radioopaque polyurethane markers, and the gastric emptying of the markers was evaluated taking 3 x-ray films of the abdomen at 1.5, 3.0 and 4.5 hours after the breakfast. The gastric emptying rates of the markers were significantly higher in the patients with "hunger pain", and significantly lower in the patients without "hunger pain", than in the normal control subjects. In idiopathic dyspepsia with and without "hunger pain" there are, respectively, abnormally increased and abnormally decreased gastric emptying rates of undigestible solid markers. Our findings could help to better understand the pathogenesis of those different types of dyspepsia and, consequently, to improve their treatment.

Gastric emptying rates in idiopathic dyspepsia with and without [quot ]hunger pain[quot ].

It has been previously observed that in dyspeptic patients with [quot ]hunger pain[quot ], that is, with pain suggestive of the presence of peptic ulcer, only 12

had an endoscopically demonstrated ulcer, the remaining 88

showing absence of important macroscopically detectable lesions (idiopathic dyspepsia). In order to investigate the possibility of a relationship between [quot ]hunger pain[quot ] and some alteration in gastroduodenal motility, the gastric emptying rates of patients presenting idiopathic dyspepsia with and without [quot ]hunger pain[quot ] were compared with those of normal control subjects. The study was conducted in 40 patients presenting idiopathic dyspepsia, 20 with and 20 without [quot ]hunger pain[quot ], and 30 voluntary apparently normal control subjects. The patients and the controls ingested, with a standard breakfast, a gelatine capsule containing 10 radioopaque polyurethane markers, and the gastric emptying of the markers was evaluated taking 3 x-ray films of the abdomen at 1.5, 3.0 and 4.5 hours after the breakfast. The gastric emptying rates of the markers were significantly higher in the patients with [quot ]hunger pain[quot ], and significantly lower in the patients without [quot ]hunger pain[quot ], than in the normal control subjects. In idiopathic dyspepsia with and without [quot ]hunger pain[quot ] there are, respectively, abnormally increased and abnormally decreased gastric emptying rates of undigestible solid markers. Our findings could help to better understand the pathogenesis of those different types of dyspepsia and, consequently, to improve their treatment.

A new questionnaire for the diagnosis of dyspepsia.

A questionnaire to diagnose dyspepsia was created. The questionnaire consists in 9 items written in very clear and understandable language and related to the cardinal symptoms of dyspepsia (easy sensation of fullness, postprandial epigastric fullness, heartburn, regurgitation, nausea, vomiting, postprandial epigastric pain, excessive belching and hunger pain). The questionnaire also includes a system of quantification levels for each symptom, taking into account its frequency and intensity of presentation in the previous two weeks: 1 point, if the symptom did not bother at all or only infrequently; 2 points, if it bothered only a little; 3 points, if it bothered moderately; and 4 points, if it bothered a lot. The questionnaire was applied to 40 patients with dyspepsia and 20 healthy control subjects, and their answers were compared with data obtained by anamnesis. For the comparison, three criteria were considered to define, with the questionnaire, the existence of dyspepsia: A) Presence of a minimum of 2 symptoms, and at least one of them with a quantification level of 2 points or more; B) Presence of a minimum of 2 symptoms, and at least one of them with a quantification level of 3 points or more; and C) Presence of a minimum of 2 symptoms with a quantification level of 3 points or more. Of these three criteria, criterion B was found to be the best, and following it, the sensitivity and specificity of the questionnaire were, respectively, 95% and 100%. The new questionnaire will be, for sure, a useful instrument to accurately investigate dyspepsia, specially in large population groups.

A new questionnaire for the diagnosis of dyspepsia

A questionnaire to diagnose dyspepsia was created. The questionnaire consists in 9 items written in very clear and understandable language and related to the cardinal symptoms of dyspepsia (easy sensation of fullness, postprandial epigastric fullness, heartburn, regurgitation, nausea, vomiting, postprandial epigastric pain, excessive belching and hunger pain). The questionnaire also includes a system of quantification levels for each symptom, taking into account its frequency and intensity of presentation in the previous two weeks: 1 point, if the symptom did not bother at all or only infrequently; 2 points, if it bothered only a little; 3 points, if it bothered moderately; and 4 points, if it bothered a lot. The questionnaire was applied to 40 patients with dyspepsia and 20 healthy control subjects, and their answers were compared with data obtained by anamnesis. For the comparison, three criteria were considered to define, with the questionnaire, the existence of dyspepsia: A) Presence of a minimum of 2 symptoms, and at least one of them with a quantification level of 2 points or more; B) Presence of a minimum of 2 symptoms, and at least one of them with a quantification level of 3 points or more; and C) Presence of a minimum of 2 symptoms with a quantification level of 3 points or more. Of these three criteria, criterion B was found to be the best, and following it, the sensitivity and specificity of the questionnaire were, respectively, 95% and 100%. The new questionnaire will be, for sure, a useful instrument to accurately investigate dyspepsia, specially in large population groups

A new questionnaire for the diagnosis of dyspepsia

A questionnaire to diagnose dyspepsia was created. The questionnaire consists in 9 items written in very clear and understandable language and related to the cardinal symptoms of dyspepsia (easy sensation of fullness, postprandial epigastric fullness, heartburn, regurgitation, nausea, vomiting, postprandial epigastric pain, excessive belching and hunger pain). The questionnaire also includes a system of quantification levels for each symptom, taking into account its frequency and intensity of presentation in the previous two weeks: 1 point, if the symptom did not bother at all or only infrequently; 2 points, if it bothered only a little; 3 points, if it bothered moderately; and 4 points, if it bothered a lot. The questionnaire was applied to 40 patients with dyspepsia and 20 healthy control subjects, and their answers were compared with data obtained by anamnesis. For the comparison, three criteria were considered to define, with the questionnaire, the existence of dyspepsia: A) Presence of a minimum of 2 symptoms, and at least one of them with a quantification level of 2 points or more; B) Presence of a minimum of 2 symptoms, and at least one of them with a quantification level of 3 points or more; and C) Presence of a minimum of 2 symptoms with a quantification level of 3 points or more. Of these three criteria, criterion B was found to be the best, and following it, the sensitivity and specificity of the questionnaire were, respectively, 95% and 100%. The new questionnaire will be, for sure, a useful instrument to accurately investigate dyspepsia, specially in large population groups (AU)

[Microscopic colitis in patients with chronic diarrhea]. / Colitis microscópica en pacientes con diarrea crónica

It has recently been suggested that there is an association between infectious gastroenteritis and irritable bowel syndrome with chronic diarrhea; and a striking similarity between the microscopic lesion observed in this condition and the lesion described in microscopic colitis (MC). As in developed countries MC is found in only 12.6 to 15% of patients with chronic diarrhea, we thought it worthwhile to investigate in Perú, a developing country with high prevalence of infectious gastroenteritis, the prevalence of MC also in patients with chronic diarrhea. One hundred and ten patients with chronic diarrhea underwent biopsies from the right and left colon, and the biopsies were examined histologically to detect MC of lymphocytic or collagenous type.MC was present in 44 (40%) of the 110 patients with chronic diarrhea, being of lymphocytic type in 42, and of collagenous type in. The prevalence of MC observed in Peruvian patients with chronic diarrhea is high when compared to reports from developed countries. This finding supports the idea that infectious gastroenteritis may, under certain conditions, precipitate the appearance of MC, probably by an autoimmune reaction.

A new questionnaire for the diagnosis of dyspepsia.

A questionnaire to diagnose dyspepsia was created. The questionnaire consists in 9 items written in very clear and understandable language and related to the cardinal symptoms of dyspepsia (easy sensation of fullness, postprandial epigastric fullness, heartburn, regurgitation, nausea, vomiting, postprandial epigastric pain, excessive belching and hunger pain). The questionnaire also includes a system of quantification levels for each symptom, taking into account its frequency and intensity of presentation in the previous two weeks: 1 point, if the symptom did not bother at all or only infrequently; 2 points, if it bothered only a little; 3 points, if it bothered moderately; and 4 points, if it bothered a lot. The questionnaire was applied to 40 patients with dyspepsia and 20 healthy control subjects, and their answers were compared with data obtained by anamnesis. For the comparison, three criteria were considered to define, with the questionnaire, the existence of dyspepsia: A) Presence of a minimum of 2 symptoms, and at least one of them with a quantification level of 2 points or more; B) Presence of a minimum of 2 symptoms, and at least one of them with a quantification level of 3 points or more; and C) Presence of a minimum of 2 symptoms with a quantification level of 3 points or more. Of these three criteria, criterion B was found to be the best, and following it, the sensitivity and specificity of the questionnaire were, respectively, 95

and 100

. The new questionnaire will be, for sure, a useful instrument to accurately investigate dyspepsia, specially in large population groups.