Biomedical subjects
Publications and source records attributed to G Figueroa.
Campylobacter jejuni recovered from patients with Guillain-Barré syndrome (GBS) in different geographical locations and bearing different heat-labile and heat-stable antigens were found to have identical amino acid sequences in their flagellar flaA short variable region, suggesting that it may be a potentially useful marker for GBS association.
BACKGROUND: We have entered a time of enormous and rapid technological advance. We must pause and reflect on the role of humanism in medicine on that part of our professional calling that denotes the responsibility we have for caring, and the relationship between our art and our science. OBJECTIVE: Humanism is defined as a mode of thought or action in which human interests, values and dignity are taken to be of primary importance. But Heidegger thinks that humanism esteems man too low. The purpose of this article is to review the sense of the word "humanism" in medicine. METHOD: Theories of four general sorts are identified and explained here. RESULTS: Man is inmeasurably more than a rational animal as humanistic medicine postulates. We must pass beyond the traditional interpretations of the nature of man, therefore beyond humanism and humanistic medicines. CONCLUSIONS: It is better to drop the word completely, with the danger of being taken for anti-humanistic, rather than run the risk of having a subject ist interpretation. We must think the nature of man in terms of its exclusive relationship to his being and to Being.
OBJECTIVE: The moral doctrine of diagnosis disclosure is derived from a respect for the patient's autonomy as well as the patient's beneficence. These two goals are not necessarily incompatible, but they often lead to different decisions about what information needs to be shared with patients. The ethics of veracity does not prescribe duties, either old or new, but implies a new way of thinking about ethics. METHOD: Theories of the three general sorts just mentioned are identified and explained here. RESULTS: The ethics of veracity as such is limited to unmasking the falsifications of desire that inhabit the moral life. This would meet the moral goals of shared decision-making, because patients could make sense of such data. CONCLUSIONS: Certainly other moral doctrines may turn out to be relevant to the problems discussed in this paper. Nonetheless, they are sufficiently comprehensive to provide an analytical framework by means of which moral problems of diagnosis disclosure can be evaluated. We cannot expect anything else from the enterprise of the ethics of veracity but a critique of authenticity. Its force is that of suspicion, not justification or legitimation, and still less that of prescription.
This article summarizes studies designed to evaluate the role of Helicobacter pylori infection in Chile, described in 21 reports from nine centers in various Chilean regions published between 1985 and 1995. According to their data, H. pylori infection is quite frequent among patients with a variety of gastric conditions, including adults (43%-92%) and children (6%-100%). Levels of specific IgG antibodies to H. pylori are also elevated among patients with duodenal ulcers (100%) and gastritis (86%) as well as asymptomatic adults (75%). Combination therapy with three (but not two) drugs has been proved effective, with clinical improvement, ulcer cure, and H. pylori eradication occurring in well-controlled studies. Available evidence suggests that antibiotic resistance is not a major problem in treatment. The H. pylori reinfection rate is low (4.2% per year), suggesting that combination therapy with three drugs constitutes a cost-effective alternative for treating colonized symptomatic patients. Concurrent preliminary studies revealed that antibodies to VacA but not CagA proteins correlate with disease severity in Chilean patients. It can be concluded that local research assists local administrators of health resources to implement adequate policies to prevent, control, and treat H. pylori-related pathologies.
OBJECTIVE: The author examined Freud's chest pains and arrhythmia beginning in late 1893 according to the new available data and modern psychiatry. METHOD: Published studies and recent findings were reviewed. The major works of Freud were also considered. Among the issues examined are clinical features, comorbidity, boundaries with others disorders. RESULTS: The findings of this review provided support for the dual diagnosis of panic disorder without agoraphobia and nicotine dependence. CONCLUSIONS: Freud's scientific learning was wide-ranging and his scientific ambition vast. During this period (1893-1897) Freud laid the foundations for the theory of anxiety. He referred to the conditions caused by the dammed-up libido as the actual neuroses. Although the work of Freud has the same aim as the modern DSM-IV, the classification of the Austrian author reflects a different tradition. A discrepancy exists between "anxiety neurosis" (Freud) and "anxiety disorder" (DSM-IV).
OBJECTIVES: We studied prospectively in a single-blind controlled manner the efficacy of 4-wk triple-antibiotic therapy, with amoxicillin (500 mg p.o., t.i.d.), metronidazole (250 mg p.o., t.i.d.), and bismuth subsalicylate tablets (524 mg p.o., q.i.d.), plus omeprazole (20 mg p.o., q.d.) and compared it with omeprazole (id) in the treatment of duodenal ulcer (DU) patients colonized with Helicobacter pylori. METHODS: One hundred DU patients were entered prospectively over a 12-month period. Fifty-seven of them received triple therapy plus omeprazole and 43 received omeprazole alone. Clinical, endoscopic, and bacteriological evaluations were performed on admission and at 28 days, 4, 8, and 12 months after treatment. RESULTS: After 4-wk treatment (day 28), the ulcer healing rate was high, but there was no significant difference between rates in the triple therapy and omeprazole groups (99% vs. 91%). In contrast, the long-term DU recurrence rate after 12-month follow-up was significantly lower (p > 0.01) for triple therapy (3/57, 5%), compared with omeprazole (34/43, 79%). The difference (higher relapse rate for omeprazole-treated patients) was significant (p < 0.001) by the second evaluation, 4 months after treatment. The eradication rate of H. pylori was also significantly higher among DU patients treated with triple therapy (p < 0.001) during all prospective evaluations, grand mean, 82% (range 82-87%), compared with the omeprazole-treated group, in which there were no cases in which H. pylori was eradicated. Follow-up revealed that 2/47 H. pylori-eradicated patients became reinfected after 1 yr, giving a reinfection rate of 4.2 patient/yr. CONCLUSIONS: Four-week triple-antibiotic therapy plus omeprazole constitutes an adequate alternative for treatment of Chilean DU patients.
Omeprazole may not eradicate Helicobacter pylori from the stomach but rather displace it from the antrum to the stomach body. This fact could interfere with colonization studies in patients receiving the drug. The aim of this study was to assess the presence of Helicobacter pylori, defined as a positive urease test, culture or microscopical examination, in antral and gastric body biopsies in patients receiving treatment with omeprazole. Sixty four paired antral and gastric body biopsies obtained at the end of a 28 day course of omeprazole, 62 obtained four months later, 40 obtained eight months later and 23 obtained 12 months later were analyzed. There was a 92% concordance between antral and gastric body biopsies for the presence of Helicobacter pylori. However, nine of the samples obtained at 28 days (14%) were negative for H pylori in the antrum but positive in the gastric body. It is concluded that for early assessment of Helicobacter pylori eradication after omeprazole treatment, paired biopsies of antrum and gastric body are needed.
Spina bifida is commonly associated with hydrocephalus and feet malformations, however its association with congenital dislocation of the hip is not well document. We retrospectively analyzed the medical records of 120 children aged 6 months to 15 years old, admited to a rehabilitation center with the diagnosis of spina bifida. Fifty six children (55.4%) had dislocation of the hip (36 of 53 women and 20 of 48 men). These figures are higher than those reported for newborns by the Latin-American Collaborative Stud of Congenital Malformations. We conclude that congenital dislocation of the hip is frequent in children with spina bifida.
A 1.8 ml iron supplementation of ferrous sulfate is administered for 90 days to 76 Mapuche infants, 12 months of age, male and female, from the rural area of the Cautin province of Chile. The iron nutrition is evaluated before and after the supplementation, through: hemoglobin, haematocrit, transferrin saturation and seric ferritin. Stools test are taken at the infant's home, to confirm the supplement intake and to measure the iron excreted. To study the contained of dietary Fe a Recordatory 24 hour Inquest (RI) is applied moreover a Proximal Chemical Analysis (PCHA) to meal test proceeding from the infant's homes. At 12 months before starting the supplementation, the anemia prevalence was of 28.3%, but it disappear as a result of the intervention. Also 65.3% of the infants showed and increase of 1 g or more on their hemoglobin, which indicates that they were anemic at the beginning of the iron supplementation. By means of this therapeutic test it was find 31% more of anemic infants, indicating more sensibility of this method. The high levels of anemia prevalence are due to the low iron intake, characteristic of the non lactious foods, which according results of the RI reaches an average of 2.8 +/- 1.2 mg of Fe/day, versus 4.8 +/- 4.0 mg of Fe/day according to PCHA. The observed difference between both test showed that there is a process of food environmental contamination, by the use of iron utensils and great soil contact. The high environmental contamination could also be proved by the high iron excretion stools (140 mg of Fe/100 g of stools). This method used to measure the Fe excretion of the supplement, would not be valid in rural population groups with similar characteristics to those of the studied group, because it does not discriminate between the intake and the extremely high environmental contamination. To prevent anemia due to iron absence in infants, it is absolutely necessary to have some iron fortified food starting at 6 months of age, as a complement for breast milk.
This randomized trial compared the efficacy of a rice-based (50 g/L) oral rehydration solution with the standard glucose-based WHO/UNICEF solution in the treatment of 100 hospitalized infants, ages 3-18 months, with acute dehydrating diarrhea. The main outcomes examined were stool output and duration of diarrhea. Patients were placed on a "metabolic" bed so that intake and losses could be measured accurately throughout the study. Overall, 89% of patients were successfully rehydrated orally; the rehydration failure rate was similar in the two groups and it was significantly associated with infection by specific E. coli serotypes. Stool output in the first 24 h was 11% lower in the rice group (112 versus 126 ml/kg), but this difference was not significant. Neither stool output in the second 24 h nor total stool output were different between groups. The median duration of diarrhea was 3.8 days in the rice group and 3.9 days in the glucose group (p = NS). Other (secondary) outcomes, such as fluid intake, urine output, emesis losses, weight change, and electrolyte balance were also similar between the two groups. Some evidence of carbohydrate malabsorption was detected in 61% of the rice group versus 45% of the glucose group (p = NS) and was not associated with any particular treatment outcome. These results show that a rice-based oral rehydration solution is as efficacious as, but not better than the standard glucose-based solution in the treatment of infants with acute dehydrating diarrhea not associated with cholera.
Only recently medicine has emphasized the importance of major ethical principles (autonomy, beneficence, justice and non-malificence) and only recently they have come to play an important role in medical and public policy discussions. Until the 70's, medical dilemmas and disagreements were rarely discussed in terms of rights and duties. However, at this point in history, crucial new ideas were introduced, including the notion of Medical Bioethics. What seems important at this stage is to show if Bioethics has made a significant difference in the field of medicine. This article intends to give a picture of how ethical, historical and medical factors have influenced the beginning of Bioethics, in an attempt to determine how much it has been able to fulfill a genuine need.
We report four episodes of mushroom poisoning that occurred between 1986 and 1990 in the province of Malleco. Twenty five of 36 individuals who ingested the mushroom became ill; they had an acute gastroenteritis that was followed in 7 by an acute hepatitis and in one by a massive upper gastrointestinal bleeding. Three subjects with fulminant hepatic failure and the subject with the massive bleeding died. Amanita gemmate (strain described as toxic in Chile since 1967) was found in two episodes and Amanita sp in one. The clinical picture is similar to that described for Amanita phaloides. The treatment is symptomatic but penicillin and silymarin may have an antitoxic action. The importance of warning the population about the existence of toxic mushrooms in Chile is emphasized.
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In Temuco, Chile, 114 women in fully nursing, were studied, according to their length of lactational amenorrhea and their relation with estradiol levels at 3th postpartum month. Sixty six (58%) recovery their menses before the 6th postpartum month. The length of lactational amenorrhea was 100.7-5.2 and 277 +/- 10.6 days, for those mothers who were with menses and amenorrhea, respectively. The estradiol levels were 88 pmol/l higher in the woman with short length of lactational amenorrhea. This study corroborate, that short length of lactational amenorrhea is a condition highly frequent in Chilean population. The difference in the estradiol levels may be a indicators of the early recovery of the postpartum fertility.
The adherence of 25 strains of Helicobacter pylori was evaluated in HEp-2 cells. These bacterial isolates, obtained from Chilean patients with gastric disorders, were also tested for haemagglutination of human red blood cells. Adherence of HEp-2 cells was expressed as a common property of all strains, irrespective of whether the cultures were grown on semi-solid or in liquid media. Previous reports that haemagglutinating activity was present in cells grown only on semi-solid media were confirmed. Adherence to HEp-2 cells was suppressed when bacterial cells were pretreated with homologous or heterologous whole human serum, containing specific antibodies of H. pylori. Adherence remained unaltered when bacterial cells were similarly treated with normal serum lacking specific antibodies. These observations imply that adhesions are expressed in vivo and suggest that an adherence mechanism, not depending on the expression of specific haemagglutinin antigen, operates for H. pylori.
Two groups of 124 and 108 children, respectively, living in urban Santiago, Chile in low socioeconomic conditions were prospectively followed for 6 months for their incidence of diarrhea. Each cohort was divided into two subgroups receiving either a commercial milk formula or the same formula containing 1% (wt/wt) bovine milk immunoglobulin concentrate from cows hyperimmunized with human rotaviruses and the major enteropathogenic Escherichia coli (EPEC) serogroups. Neither group differed with respect to incidence of diarrhea (98 episodes in 117 treated children versus 95 episodes in 115 control children), duration and clinical symptoms of diarrhea, and weight gain. Furthermore, neither group differed with respect to isolation of rotavirus (14 and 13 isolates in treatment and control groups, respectively) and isolation of enteropathogenic E. coli (14 and 15 isolates in treatment and control groups, respectively). The treatment but not the control formula contained neutralizing antibody against all human rotavirus serotypes. Titers were comparable to human breast milk samples. All isolated EPEC serogroups were included in the vaccine used for the immunization of the cows. The treatment, but not the control formula, protected mice against a lethal challenge with an EPEC strain. In conclusion, feeding an antibody-supplemented formula had no positive effect on diarrheal diseases under the conditions of a fairly well-controlled small-scale field trial.
The relationship between asymptomatic shedding of bacterial enteropathogens and the hygiene habits of families who have had a child with typhoid fever (TF) are investigated. The sample was made up of 80 families: 40 families in which one child had had TF (Group A) and 40 in which no children or either of the parents had had a history of TF (Group B). In each group 20 families belonged to a low socioeconomic status (SES) and 20 to a high SES. A structured interview was used to evaluate the SES and the hygiene habits of the child; observations were made to measure the hygiene habits of the family (toilet, kitchen and food preparation) and bacteriological studies (fecal samples and hand markers). Results show that carriers were more frequent in Group A than in Group B. The bacterial species found were significantly more numerous in Group A than in Group B (fecal samples: E. coli, the classic serotypes, Shigella ssp, and hand markers: E. coli). Families of Group A had higher carriage rates than those of Group B. Finally there exists a significantly higher association between inadequate hygiene habits and carrier families. These results show the need to teach specific habits of proper hygiene to the entire population, because the fact of belonging to the high SES does not in itself preclude inadequate hygiene habits.
114 women in fully nursing, were studied, according to the length of lactational amenorrhea and their relation with general characteristics and ethnic group. Of the 114 mothers, 66 (58%) recovery their menses before the 6th postpartum month. The length of lactation was 100.7 +/- 5.2 and 277.9 +/- 10.5 days, for those mothers who were with menses and amenorrhea until the 6th postpartum month, respectively. A group of Mapuche women had a higher length of lactational amenorrhea and we found differences in the frequency of suckling episodes at night. This study corroborate, that short length of lactational amenorrhea is a condition highly frequent in Chilean population and it does not have a relation the nursing pattern in general population. However, the difference in the length of lactational amenorrhea in specific ethnic group, can include some general or behavioral factors of breast-feeding.