Biomedical subjects

Jaime Cok

Publications and source records attributed to Jaime Cok.

9 recordsLinked to original sources

PubMed2006

Validation of string test for diagnosis of Helicobacter pylori infections.

The method of recovering Helicobacter pylori DNA or viable cells absorbed on a string that a person has swallowed and that is retrieved an hour later (string test) should be a useful alternative to traditional analysis of cells or DNA obtained by endoscopy, which is invasive, uncomfortable, relatively costly, and ill-suited for community-based and pediatric studies. Here we assayed the sensitivity and validity of the string test versus conventional endoscopic biopsy for detecting and analyzing H. pylori infection. Forty-four people with gastric complaints were studied using both H. pylori culture and urease gene (ureB) PCR. H. pylori organisms cultured from strings and biopsy specimens from the same patients were fingerprinted by the randomly amplified polymorphic DNA (RAPD) method. Biopsy sections were also hematoxylin and eosin and silver stained for H. pylori detection. H. pylori was cultured from 80% of strings and detected by PCR from 91% of strings from participants whose biopsies had been H. pylori positive by culture, PCR, and/or histology. Strains recovered from strings and biopsy specimens yielded identical or closely related RAPD profiles in each of the 24 cases tested. We conclude that the string test is a useful method for H. pylori recovery and analysis when relatively noninvasive procedures are needed.

Adult↗

PubMed2002

Optimization and evaluation of a PCR assay for detecting toxoplasmic encephalitis in patients with AIDS.

Toxoplasma gondii is a common life-threatening opportunistic infection. We used experimental murine T. gondii infection to optimize the PCR for diagnostic use, define its sensitivity, and characterize the time course and tissue distribution of experimental toxoplasmosis. PCR conditions were adjusted until the assay reliably detected quantities of DNA derived from less than a single parasite. Forty-two mice were inoculated intraperitoneally with T. gondii tachyzoites and sacrificed from 6 to 72 h later. Examination of tissues with PCR and histology revealed progression of infection from blood to lung, heart, liver, and brain, with PCR consistently detecting parasites earlier than microscopy and with no false-positive results. We then evaluated the diagnostic value of this PCR assay in human patients. We studied cerebrospinal fluid and serum samples from 12 patients with AIDS and confirmed toxoplasmic encephalitis (defined as positive mouse inoculation and/or all of the Centers for Disease Control clinical diagnostic criteria), 12 human immunodeficiency virus-infected patients with suspected cerebral toxoplasmosis who had neither CDC diagnostic criteria nor positive mouse inoculation, 26 human immunodeficiency virus-infected patients with other opportunistic infections and no signs of cerebral toxoplasmosis, and 18 immunocompetent patients with neurocysticercosis. Eleven of the 12 patients with confirmed toxoplasmosis had positive PCR results in either blood or cerebrospinal fluid samples (6 of 9 blood samples and 8 of 12 cerebrospinal fluid samples). All samples from control patients were negative. This study demonstrates the high sensitivity, specificity, and clinical utility of PCR in the diagnosis of toxoplasmic encephalitis in a resource-poor setting.

AIDS-Related Opportunistic Infections↗

PubMedDate not supplied

A prospective study of Cat-Scratch Disease in Lima-Peru.

Cat-Scratch Disease (CSD) is a benign lymphadenitis that may progress to severe or recurrent forms, and it is occasionally associated with morbidity. Between January of 1998 and March of 1999, forty-three suspected CSD patients were assessed in the Hospital Cayetano Heredia and the Instituto de Salud del Niño, in Lima, Peru. Twelve patients had a confirmed diagnosis, 8 of whom were women, and the mean age was 10 years old. The majority (53%) of the cases were encountered in the summer. All patients reported having had contact with cats. Fever, malaise, lymphadenopathy and skin lesions were the most frequent clinical features. Twelve patients had indirect immunofluorescence antibody test titers of between 1/50 and 1/800 for Bartonella henselae and Bartonella clarridgeiae. Two lymph node biopsies were histologically compatible with CSD. No positive blood cultures could be obtained. This is the first Peruvian prospective study able to identify B. henselae and B. clarridgeiae in pediatric patients.

Adolescent↗

PubMedDate not supplied

Rhinoscleroma: eight Peruvian cases.

Rhinoscleroma is a rare infection in developed countries; although, it is reported with some frequency in poorer regions such as Central Africa, Central and South America, Eastern and Central Europe, Middle East, India and Indonesia. Nowadays, rhinoscleroma may be erroneously diagnosed as mucocutaneos leishmaniasis, leprosy, paracoccidioidomycosis, rhinosporidiasis, late syphilis, neoplasic diseases or other upper airway diseases. From 1996 to 2003, we diagnosed rhinoscleroma in eight patients attended in the Dermatologic and Transmitted Diseases service of "Cayetano Heredia" National Hospital, in Lima, Peru. The patients presented airway structural alterations producing nasopharyngeal, oropharyngeal and, in one patient, laryngeal stenosis. Biopsy samples revealed large vacuolated macrophages (Mikulicz cells) in all patients. Ciprofloxacin 500 mg bid for four to 12 weeks was used in seven patients and oxytetracycline 500 mg qid for six weeks in one patient. After follow-up for six to 12 months the patients did not show active infection or relapse, however, all of them presented some degree of upper airway stenosis. These cases are reported because of the difficulty diagnosing the disease and the success of antibiotic treatment.

Adult↗

PubMedDate not supplied

[HYSTOLOGICAL FEATURES IN NODULAR GASTRITIS EXPERIENCE IN CAYETANO HEREDIA NATIONAL HOSPITAL]

Histopathologic findings in Nodular Gastritis at Cayetano Heredia National Hospital.Nodular Gastritis (NG) is not a so unfrequently finding in adults. From January 1994 to April 1997, 261 patientes from a total number of 3600 that were submitted to an upper endoscopy at Cayetano Heredia National Hospital in Lima, Per , had this finding. The aim of this study is to find whether there is a characteristic histopathologic pattern in NG. Material and methods : 112 endoscopy reports with the diagnosis of NG that at the same time had biopsies, were reviewed. These patients were compared to a group matched for age and sex with an endoscopic finding of normality, or a diagnosis different from NG, excluding diagnosis of gastric or duodenal ulcers, duodenitis or neoplasia, that had also biopsies. The biopsies of both groups were reviewed by an experimented pathologist in a double blind fashion. The following parameters were considered : Presence and type of gastritis, presence and grade of mucosal inflammation, presence and type of intestinal metaplasia, presence and degree of inflammatory activity, presence and number of lymphoid follicles, presence and number of eosinophils in the mucosa, presence of Helicobacter pylori and edema.RESULTS : Significative statistic difference was found in the group of patients with NG on the following parameters: grade of mucosal inflammation, gastritis activity, presence of eosinophils and presence of Helicobacter pylori. Conclusion : NG is a chronic gastritis with superficial eosinophilic infiltration and a very important inflammatory activity associated to the presence of Helicobacter pylori. Further studies are required to determine the cause for these histopathologic findings.

Journal Article↗

PubMedDate not supplied

[EARLY HEPATOCARCINOMA AT HOSPITAL CAYETANO HEREDIA(January 1969 - April 1997) CLINICAL AND LABORATORY FINDINGS]

In this work, 60 patients with an hepatocarcinoma diagnosis, corrobarated with hepatic biopsies at the Hospital Cayetano Heredia, between 1969 and 1997, are studied to determine clinical presentation and laboratory findings of this entity within us. The early hepatocarcinoma cases studied were 60. The age group that suffered mostly from this pathology was between 60 to 69 years (23.33%), followed by the age group of 20 to 29 years (20%). While the mean age was of 45 years. 56.66% were male, and 43.33% were female. 56.66% of cases came from the Coast, 30% from the Mountains, and 13.33% from the Jungle. Cronic and excessive alcohol ingestion appeared as background in 25% of cases. The average period of apparent disease was seven (7) weeks. The main symptoms at their admission were: abdominal mass sensation (81.66%), weight loss (81.66%) superior hemiabdominal pain (80%), and anorexia (60%). In 95% of cases the predominant sign was Hepatomegaly. The survival term of those patients whom we were able to follow-up was of less than six (6) months in 86.84 /x, less or equal to.

Journal Article↗

PubMedDate not supplied

[DUODENAL PEPTIC ULCER TREATMENT BY H. PYLORI ERADICATION: CONTROLED RANDOMIZED STUDY]

As Helicobacter pylori infection represents a very important causal factor in the development of duodenal peptic ulcer, several therapeutic trials have been developed in order to obtain an efficient eradication of the microorganism. The aim of our study has been to evaluate, in patients with duodenal peptic ulcer, the effect of double antibiotic short therapy associated to famotidine on the eradication of Helicobacter pylori, cicatrization of ulcerous lesion and the histological changes after the treatment. Forty patients with duodenal ulcer and Helicobacter pylori infection were distributed al random in two groups (I and II). Group I received tetracycline 2 gr per day plus furazolidone 400 mg per day for a week, and famotidine 40 mg per day for four weeks. Group II received just famotidine 40 mg per day for six weeks. Al the initial endoscopy, four biopsies were taken from the gastric antrurn for histological study and determination of Helicobacter pylori. The endoscopy was repeated between 6 and 8 weeks after the beginning of the antibiotic treatment, when four biopsies were taken again from the gastric antrum with the same purpose, and the results were compared. Twenty-eight patients completed the study, 14 in group I and 14 in group II. Helicobacter pylori eradication was obtained in 85,7% of patients in group I and 0% in group II (p=0.00002). Ulcer cicatrization was obtained in 100% of patients of group I compared to 85,7% of patients of group II (p=0.48). The histological degree of gastritis significantly diminished after the treatment in patients of Group I, in relation to the histological parameters of severity (p=0,002), activity (p=0,00002) and presence of lymphoid follicles (p=0.02). These changes were not significantly observed in group II. Two patients of group I had mild sideeffects (14,3%), and none of them was observed in group II (p=0.48). We concluded that the treatment used (tetracycline + furazolidone) was highly efficacious in the eradication of Helicobacter pylori, as well as in the cicatrization, reduction of antral gastric mucous inflammation, and a low rate of side-effects.

Journal Article↗

PubMedDate not supplied

[HELICOBACTER PYLORI INFECTION ERRADICATION IN DISPEPTIC PATIENTS WITH AND WITHOUT PEPTIC ULCER]

BACKGROUND: Helicobacter pylori (HP) infection is very prevalent worldwide, and has been associated with the presence of duodenal ulcer, gastric ulcer and chronic active gastritis. It is also speculated that HP may have a role in gastric cancer development. Triple drug schemes have been shown to be the most effective approach to erradicate HP infection. Nevetheless, high rates of resistance against some antibiotics as well as high costs affect the effectiveness of these therapies. The goal of the present study is to assess the effectiveness of the combination of tetracycline, furazolidone and bismuth in erradicating HP, as well as the changes in the histology.METHODS: Patients with diagnosis of HP infection, found in their antral gastric biopsies (hematoxylin and eosin staining (H-E)), were included. They received the following scheme for 10 days: tetracycline 500 mg qid., furazolidone 100 mg qid., and colloidal bismuth subcitrate 120 mg qid. Patients were instructed to come back for follow-up 6 to 8 weeks after starting the therapy. At that time a control upper endoscopy was performed and 3 antral biopsies were taken. Biopsies were stained with H-E and read by experienced pathologists. In both, the biopsy before treatment and the control biopsy, the following parameters were looked for: presence and density of HP; presence, depth and grade of chronic gastritis (lymphoplasmocytic infiltrate); presence and grade of inflammatory activity (polymorphonuclear inflitrate); presence of glandular atrophy; presence, grade (partial or total) and extent (focal or multifocal) of mucinous damage (epithelial damage); presence of intestinal metaplasia; and presence of lymphoid follicles.RESULTS: Fifty-nine patients (30 men and 29 women) completed per protocol. Mean age was 43 +/- 18 (range: 14-73). HP erradication was achieved in 54 patients (91.5%). Control biopsies showed improvement in the following parameters: presence and density of HP (p<0.001); presence, depth and grade of chronic gastritis (p<0.001); presence and grade of inflammatory activity (p<0.001); presence, grade and extent of mucinous damage (p<0.001); and presence of lymphoid follicles (p<0.001). Neither the presence of glandular atrophy nor the presence of intestinal metaplasia showed any significant change. Patients who did not erradicate HP showed no significant difference in any of the parameters.CONCLUSIONS: The triple drug scheme including tetracycline, furazolidone and bismuth is effective in HP erradication. Erradication of HP is followed by an improvement in the following histologic parameters: presence, depth and grade of chronic gastritis (LMN infiltrate); presence and grade of inflammatory activity (PMN infiltrate); presence, grade and extent of mucinous damage; and presence of lymphoid follicles. This scheme is a cost-effective alternative for the therapy of HP infection in low income populations with a high prevalence of infection with this bacteria.

Journal Article↗

PubMedDate not supplied

[GASTROINTESTINAL INVOLVEMENT IN HUMAN BARTONELLOSIS]

We present a prospective study of 68 patients with the acute phase of human bartonellosis, admitted to Cayetano Heredia National Hospital.Gastrointestinal symptoms were reported as follows: abdominal pain 46,3%, coluria 44,4%, vomiting 40,3%, jaundice 38,5%, diarrhea 29,9%, constipation 8,9%. The more common signs were pallor 97%, hepatomegaly 82%, fever 79,1%, malnutrition 75,2%, systolic heart murmur 77,9%, jaundice 71,6%, lymph node enlargement 70,1%.Signs observed during the hospital course were 29,4% lower extremities edema, 22,6% myalgia, 16,4% pericardial effusion, 16,4% generalized edema. The more common gastrointestinal signs were hepatomegaly 82%(52/68), jaundice 71,6% (48/68) and splenomegaly 29,4%(20/68).The -lower liver border was found between 1 to 4 below the lower rib border in 71,6%(48/67) and below 5 cm b. l. r. b. in 11,9%(8/67).60% had abnormal liver function tests, 54,6% had mainly direct bilirrubin elevationand 45,4% mainly indirect.SGOT was elevated in 28,5% and SGPT in 25%, 28,3% had elevated alkaline phosphatase. The bilirrubin media was 3,5 mg/dI (range 0,6-21), the indirect bilirrubin media was 1,6 mg/dI (range 0,5-11,5), the direct bilirrubin media was 1,9 mg/dI (range 0,3-18), The SGOT media 73,9 U/L (range 9-1250), SGPT media 65,5U/L (range 6-1596). Alkaline phosphatase 5,9 mui/ml (range 3-497). Albumin media 3,09 (range 2-4,2).Patients with bacterial coinfection (salmonella, staphilococcus, enterobacter, shigella) had a higher increase in bilirrubin and transaminases.Three patients had liver biopsies, two revealed Küpffer cells hyperplasia (moderate to severe), one revealed intracellular hyperplasia, one patient coinfected with diseminated hystoplasmosis had granulomas in the liver.Mortality(8,8%) was associated to hepatocellular involvement (SGOT media 330U/L, SGPT media 207 U/L, alkaline phosphatase media 183 mui/ml), hypoalbuminemia media = 2,4 gr/1) and generalized edema.

Journal Article↗