Endoscopic treatment reduces bleeding recurrence, the need for surgery and mortality in patients with bleeding ulcers. However endoscopic treatment fails in 10-15% of patients, leading to high morbidity and mortality. The therapeutic measures with demonstrated effectiveness in reducing the risk of hemorrhagic recurrence and its complications are combined endoscopic treatment (adrenaline plus a second hemostatic intervention) and proton pump inhibitors. Also useful, although there is less evidence, are immediate resuscitation and < > endoscopy. Some studies suggest that activated recombinant factor VII infusion or supra-selective arterial embolization can be useful in severe hemorrhage. Further studies are required to determine optimal treatment according to the characteristics of each patient.

Anti-Ulcer Agents↗

PubMedDate not supplied

Optimum tool handle diameter for a cylinder grip.

The ideal diameter for a tool handle for males and females has been determined using an existing biomechanical model of the hand validated in previous works. The model estimates a 33-mm optimum diameter tool handle for the general population (males and females). When the optimum diameter for a tool handle is selected, the muscles exert the minimum force needed to hold the tool and perform gripping activities. Optimal handle design reduces the force required for gripping a tool, protects the underlying joint structures, and reduces the risk of developing cumulative trauma associated with repetitive task requiring high grip forces and awkward postures. This article provides a design parameter for optimal tool diameter to aid the therapist in the selection of assistive devices, built-up handles, or for the fabrication of a tool handle.

Biomechanical Phenomena↗

PubMedDate not supplied

Prospective study of enteropathogens in two communities of Misiones, Argentina.

Children under five years of age, from two communities of different socio-economic strata (97 from Zaiman and 55 from Las Dolores) were examined epidemiologically during 2 years, by means of quarterly visits of the working team, who carried out the collection of faecal samples. During the study, one or more enteropathogens were identified in 73.9% of samples in children from Zaiman and in 58.3% of the samples from Las Dolores, being associated to diarrhoea in 70.5% and to asymptomatic infections in 65.7%. The number of diarrheic episodes was higher in Zaiman (15.45%) than in Las Dolores (12.35%), being more frequent in the spring-summer seasons. In Zaiman, the bacterial enteropathogen proportion was relevantly higher (p < 0.005) in children with diarrhoea, whereas the presence of parasites was more frequent in asymptomatic children (p < 0.01). Rotavirus had an even distribution within diarrheic and asymptomatic children. In Las Dolores, no relevant differences were found in the detection of enteroparasites between diarrheic and asymptomatic children. Mixed infections were detected; enterotoxigenic Escherichia coli (ETEC)-rotavirus and ETEC-parasites being the most frequent ones. ETEC was involved in 85% of these infections. These data, together with the high enteropathogen carriage, suggest an elevated level of environmental contamination. The latter plays an important role in diarrheic diseases, and added to the most extreme poverty, it affects children's lives.

Argentina↗

PubMedDate not supplied

Asymptomatic infections by diarrheagenic Escherichia coli in children from Misiones, Argentina, during the first twenty months of their lives.

Diarrheagenics Escherichia coli are the major agents involved in diarrheal disease in developing countries. The aim of this study was to evaluate the time of appearance of the first asymptomatic infection by the different categories of diarrheagenic E. coli in 44 children since their birth and during the first 20 months of their lives. In all of the children studied, we detected at least one category of diarrheagenic E. coli through the 20 months of the study. 510 diarrheagenic E. coli (33.5%) were obtained from the 1,524 samples collected from the 44 children during the time of the study (31.4% EAggEC, 28.8% EPEC, 27.1% DAEC, and 12.7% ETEC). Neither EHEC nor EIEC were identified. The median age for diarrheagenic E. coli colonization was 7.5 months. The mean weaning period was 12.8 months and the mean age for introduction of mixed feeding (breast fed supplemented) was 3.8 months. A significantly lower incidence of diarrheal disease and asymptomatic infections was recorded among the exclusively breast-fed rather than in the supplemented and non breast-fed infants. For ETEC, EPEC and EAggEC the introduction of weaning foods and complete termination of breast-feeding were associated with an increase of asymptomatic infections.

Argentina↗

PubMedDate not supplied

[Antimicrobial resistance among species of Salmonella, Shigella, Escherichia, and aeromonas isolated from children with diarrhea in 7 Argentinian centers].

The increasing levels of resistance of enteropathogenic bacteria against antimicrobial agents present geographic variations. We have analysed the antimicrobial susceptibility of isolates obtained from 4,364 children under 5 years of age with acute diarrhea, in 7 cities of Argentina. Diarrheagenic E. coli exhibited 74.5% of resistance against ampicillin, 64.2% against sulfametoxazole-trimethoprim, and Shigella spp., 62% and 75.6% respectively. Salmonella sp. showed 35%, 14%, 41.8%, 65.4%, 14.5%, and 13.6% of resistance against ampicillin, chloranfenicol, sulfametoxazole-trimetoprim, sulfadiazin, gentamycin, and fosfomycin respectively. These values are higher than the ones observed in developed countries. Aeromonas showed significantly lower resistance percentage. Important differences in our country were observed, consequently, local trials should be carried out in order to apply corrective measures.

Acute Disease↗

PubMedDate not supplied

[Beta-lactam antibiotic sensitivity in Aeromonas spp. of clinical, animal, and environmental origin].

Susceptibility to beta-lactam antibiotics was investigated in Aeromonas spp. Microorganisms were isolated from both, clinical and water creek samples, as well as from processed raw chicken carcasses. Aeromonas like colonies were identified by means of Aerokey II and API 20 E System (Bio-Merieux). A. hydrophila prevailed both of human origin (44%) and water creek samples (41%), while A. caviae ranked first among raw chicken samples (65%). Dilution testing by Agar Method was performed to determine minimum inhibitory concentration (MIC), following NCCLS standards. All tested microorganisms were susceptible to third generation cephalosporin, cefepime, imipenem, aztreonam, and resistant to ampicillin. Only with cefepime and aztreonam exceptions, strains of human origin showed higher values of MIC90 than environmental ones. These results suggest that antibiotic resistance is mainly due to a steady environmental pressure, on account of the widely used above mentioned compounds.

Aeromonas↗

PubMedDate not supplied

Identification of enteropathogens in infantile diarrhea in a study performed in the city of Posadas, Misiones, República Argentina.

The following work informs of the results of isolation, frequency and distribution of enteropathogens in children under five years old, without previous antibiotic treatment, less than seven days with diarrhoea, ambulatory or in Hospital "Dr. Ramón Madariaga" de Posadas, Misiones, República Argentina, from June 1986 to May 1989. From a total of 972 children with diarrhoea, 78% required to be hospitalized. The greatest number of cases were found during spring and summer in children from 1 to 11 months of age. Distribution of the main enteropathogens was: enteropathogenic Escherichia coli (EPEC) (29.4%), parasites (22%), Shigella (16.3%), enterotoxigenic Escherichia coli (ETEC) (14%) and rotavirus (12.9%). Highest incidence of rotavirus was registered in the coldest months and Shigella, ETEC, Salmonella and parasites in the warm months. The group of most affected children were from 1 to 11 months of age, with higher incidence of EPEC, Salmonella and rotavirus, and parasites were found in older children. ETEC and Shigella had no relationship with the age of children. The most frequent association was EPEC with rotavirus. This is the first finding of Salmonella zaiman in humans and of Salmonella hadar in Argentina. Cryptosporidium, etiological agent of serious diarrhoea in the immunocompetent, was isolated in 3.9% of our cases.

Child, Preschool↗

PubMedDate not supplied

[The first isolations of Salmonella Zaiman in humans].

This paper describes the first three Salmonella Zaiman cases in children of more than one year old with acute infectious diarrhoea of less than seven days evolution, in the Pediatric Department of R. Madariaga Hospital in Posadas, Misiones. This sero-variety was isolated by hemoculture in an 11 year old girl with urinary infection and sepsis. This Salmonella is a new sero-variety isolated from Zaiman river which flows through suburbs of Posadas.

Adolescent↗

PubMedDate not supplied

[Gastric ulcers as the only manifestation of infection by cytomegalovirus in immunocompetent patients].

Gastritis is an infrequent manifestation of infection by cytomegalovirus (CMV) in a healthy host. This complication is usually associated to a mononucleosic syndrome during the course of a disseminated infection. Macroscopically, it presents with edema and mucosal congestion, multiple erosions or ulcers. Histologic examination of the endoscopic biopsies allows the etiologic diagnosis to be established in most cases. In immunocompetent patients the clinical course of gastritis by CMV is usually self-limited. We herein present two immunocompetent patients with gastric ulcerous disease as the only manifestation of CMV infection. Both patients required antiviral treatment due to refractoryness to the antisecretor treatment and one case evolved to pyloric stenosis requiring surgery.

Cytomegalovirus Infections↗