Amebiasis in the epidemiologic transition in Mexico: its morbidity and mortality trends in the Mexican Institute of Social Security.

Amebiasis is one of the most common parasite-related diseases and one of those with the greatest impact on health. At the Instituto Mexicano del Seguro Social (Mexican Institute of Social Security-IMSS) approximately half a million cases per year are currently treated. Of these, more than 2500 correspond to the form which invades the liver. Within the process of epidemiologic transition which Mexico is undergoing, a progressive reduction has been observed in incidence of, and mortality due to, invading amebiasis in all its clinical forms. In turn, there is a significant decrease in its fatality rate. The social and economic development and improved sanitary conditions observed in Mexico, particularly in the second half of this century, may have conditioned this process. The improvement in availability, accessibility and utilization of medical care services could also explain the reduction which has been noted in its fatality rate and mortality. The model for epidemiologic transition proposed by Omran and adapted for Mexico by Frenk, offers a plausible explanation for the changes observed in the occurrence and mortality of invading amebiasis in Mexico.

[Improvement in the quality of medical care]. / Mejoría de la calidad de la atención médica.

UNLABELLED: The object of this research was investigating the existence of programs, as well as the patient's and healthy worker's opinions, concerning the quality of Medical Attention in the representative medical institutions in Mexico City (Distrito Federal). Eighteen directors of medical institutions were interviewed; as well as fifty university graduates, one hundred out patients from health centers and three hundred patients treated at general hospitals. A poll was applied to two hundred and fifty physicians and two hundred and fifty nurses from health centers and general hospitals. RESULTS: The eighteen institutions studied had permanent programs for Supervision and assemend. Other activities were also detected: sixteen had Technical Committees, five had a Department for Complaints, three had Quality Circles, two had programs for Evaluation of Educational Needs, two had Patients Polls, two had Worker's Polls, one had a Shadow Study and two had Quality Control Programs. The 86% of university graduates belonged to the social security system. Among these, 36% attended public services, 36% of them did this selectively and 28% did not use social security. 30% felt that public medical services were good, 14% less than good and 56% bad. 36% felt that public services were better than private ones, 36% said both were equally good and 28% judged the public system as worse than the private ones. The main deficiency reported was a lack of personal warmth. The patients from both the general practice and hospitalization graded the opportunity, warmth and process of medical attention as variables with figures of 80% or more. The frequency of diverse "complications" was 66% in out patients and 36% in the hospitalized ones. The physicians and nurses graded the infrastructure, teaching, laboral motivation and satisfaction, and continuity of services as variables with percentages of 50% to 60%; whereas the variables of warmth, control and supervision with values of 60% to 80%. Hospital nurses were less satisfied. These results show patients to have an acceptable satisfaction whereas the health personnel was unmotivated. Practical actions are suggested to improve the quality of medical attention.

[Localization of Entamoeba histolytica antigens using IgA]. / Localización de antígenos de Entamoeba histolytica con IgA.

The presence of IgA anti-Entamoeba histolytica antibodies has been demonstrates in intestinal secretions and serum of human amebiasis. We investigated which are the cellular components of trophozoites that react with IgA anti-ameba antibodies from immune serum, colostrum and human milk. The cellular localization of such antigens was accomplished by an indirect immunoperoxidase technique using anti-human IgA (alpha chain specific) labeled with peroxidase, both for light and transmission electron microscopy. Intracellular antigens were localized after permeating the parasites with cold acetone (-10 degrees C) for 3 min. and cryosections of 1 micron thick. The antigens that react with IgA antibodies from immune serum, colostrum and human milk were located in the plasma membrane and the internal portion of some cytoplasmic vesicles. So far, it is unknown what is the biological function of IgA in human amebiasis but in other systems it protects against certain parasites.

[Amebiasis. Has its clinical expression changed?]. / Amibiasis. Ha variado su expresión clínica?

In Mexico, like in other countries, there is an special interest for amebiasis because it represents a Public health problem; there are about 5 million people that in some time of their lives had tissue invasion by this parasite. 1-2% of mexicanas have intestinal amebiasis and probably there are 850,000 to 1,700,000 carriers of entamoeba cysts. 6% of the general population have circulating antiameba antibodies. In 1988 we studied the amebic hepatic abscess seen in the hospitals of the Instituto Mexicano del Seguro Social in the Valley of Mexico. During that year there were 396 patients with such illness (0.19% of hospital admissions) with a 1.01% mortality. Comparing this data with reports of 1969 there was a reduction in the number of patients and deaths. Also amebiasis has decreased in autopsy studies. However, we have not found recent variations in the clinical behavior of amebiasis. Advances in diagnostic methods and more liberal use of metronidazole have reduced the number of severely ill patients.

[Amebiasis. Medical treatment. Is there anything better than metronidazole?]. / Amibiasis. Tratamiento médico. Hay algo mejor que el metronidazol?

Since 1961, when Cosar pointed out for the first time that metronidazol was a useful pharmacological agent against E. histolytica, several authors have demonstrated its effectiveness against invasive amebiasis in its colonic or extraintestinal variety. The obtained results with metronidazol were so far better compared with the rest of the known amebecides, that in 1974, Elsdon Dew stated that a new era in the medical treatment of the amebiasis had started with the forthcoming use of the agent. However, the frequent and important adverse collateral effects produced in a good number of patients have forced to look for other nitroimidazole derivates, hopefully more efficient and, of course, better tolerated. Thus, the tinidazole, ornidazole, flunidazole, romidazole, ornidazole, flunidazole, dimetridazole, satranidazole, nitrimidazine, panidazole, have been tried and some others are still subject to experimentation, such as the Ro 7-0207 (alpha-chlorometil-2-metil-5-nitro-1-imidazol), the phexinidazole (HOE 239) and the CG 10213-Go from CIBA-Geigy and no significant advantage has been found over the metronidazol. The phexinidazole turned out to be twice as effective as the metronidazole in the experimental hepatic amebiasis of the golden hamster. This fact must be confirmed or discarded in the human hepatic amebiasis.

Lesion hepatica secundaria al uso de alfametildopa: informe de tres casos y revision de la literatura. / Secondary hepatic injury to the use of alphamethyldopa: report of 3 cases and literature review

En la literatura se tiene conocimiento de multiples casos de hepatopatia secundaria a la ingestion de alfametildopa, la lesion varia entre elevacion transitoria de aminotransferasas hasta hepatitis fulminante y muerte del enfermo. Al revisar la literatura al alcance se obtuvo informacion de 198 pacientes con esta complicacion. Se presentan los casos de tres pacientes con lesion hepatica en quienes la unica causa de la misma fue la ingestion de alfametildopa. Aun no se conoce exactamente cual es el mecanismo patogenico del farmaco, pero por la evolucion de los pacientes y la revision de la literatura se proponen los dos siguientes: 1. Alteraciones inmunologicas en el huesped. 2. Probable produccion de factores inmunogenos por la incorporacion del farmaco o sus metabolitos a la membrana celular del hepatocito

Sindrome de Zollinger y Ellison. / Zollinger and Ellison syndrome

El sindrome de Zollinger-Ellison es una enfermedad que en las personas que la padecen se manifiesta por presencia de ulcera peptica incurable, acompanada ademas, de hipersecrecion e hiperacidez gastrica.Es causada por la presencia de un tumor que se origina en el sistema neuroendocrino difuso, especificamente a partir de las celulas no beta de los islotes pancreaticos, que produce gastrina, hormona que normalmente se encuentra en el antro gastrico en una proporcion de casi 90 por ciento, y de la que hasta la fecha se han identificado cuatro componentes. La presente revision analiza algunos conceptos primordiales en relacion con la gastrina necesarios a nuestro juicio, para entender el problema. Enseguida aborda los aspectos clinicos, bioquimicos, radiograficos, histologicos y ultraestructurales indispensables para establecer el diagnostico preciso y por onde, el tratamiento adecuado

Cambios morfologicos en el higado del paciente sometido a nutricion parenteral. / Morphological changes in the liver of patient subjected to parenteral nutrition

La nutricion parenteral (N.P.) no es un procedimiento inocuo, cursa con complicaciones metabolicas, septicas y en la colocacion del cateter. El proposito de este trabajo fue de valorar las alteraciones funcionales y anatomicas que ocasiona este tratamiento en el higado. Se estudiaron 20 pacientes en forma prospectiva, a quienes se les instituyo N.P. con la tecnica habitual de nuestro servicio. Se les realizo pruebas de funcionamiento hepatico (P.F.H.), una vez por semana, biopsia hepatica al inicio y al finalizar el tratamiento. Las biopsias hepaticas fueron estudiadas en microscopia de luz, histoquimica y microscopia electronica. Las P.F.H.demonstraron elevacion moderada de T.G.O., T.G.P. y fosfatasa alcalina, posterior a la N.P. En microscopia de luz y pruebas de histoquimica se observaron: cambios em la distribucion del glucogeno, presencia de esteatosis, inversion de la red canalicular en la ATPasa. En microscopia electronica: Gran cantidad de figuras de mielina, dilatacion canalicular, esteatosis intracelular y mitocondrias normales. Las alteraciones hepaticas que se observaron: esteatosis, colestasis y vacuolacion nuclear son procesos reversibles, que en general no repercuten en la evolucion de los pacientes con nutricion parenteral