Diverticulosis of the small intestine

Seven patients with small-intestinal diverticulosis were studied by means of intestinal absorptive tests, biopsies, and bacterial cultures of small-intestinal aspirates. Aerobic bacterial cultures were obtained in all patients, while anaerobic cultures with a modified Hungate roll-tube technic were performed in 3. Three of the patients manifested steatorrhea and were studied over prolonged periods of time. The bacterial flora varied over a wide quantitative range, with highest total counts in excess of 10⁹ colony-forming units per milliliter found in the 2 patients with the most severe malabsorption. Despite multiple diverticulosis, 1 patient without steatorrhea had no recoverable aerobic or anaerobic bacterial flora. E. coli predominated among the recovered aerobic organisms in this series, but A. aerogenes and various streptococci also were encountered repeatedly. Patients treated with antibiotics directed at the aerobic flora showed prompt improvement in absorption, and reduction in bacterial counts. Repeated short courses of antibiotics were needed to treat early bacteriologic and clinical relapses. After several such courses, all 3 patients treated maintained their clinical and metabolic improvement for periods of close observation ranging from 2 to 15 months without additional antibiotic treatment, and the clinical remissions were accompanied by gradual reductions in total bacterial counts to “borderline normal” limits. Of the 3 patients, 1 has now been followed for 5 years without relapse. It is apparent that the mere presence of diverticulosis does not lead necessarily to malabsorption. Malabsorption of fat, Vitamin B₁₂, and other nutrients was found only in patients with excessive bacterial flora, emphasizing the crucial role bacteria play in the pathogenesis of malabsorption in diverticulosis of the small intestine.     

Sugar-Sweetened Beverage Consumption in Adults: Evidence from a National Health Survey in Peru

High consumption of sugar-sweetened beverages (SSB) is associated with a high risk of non-communicable diseases. Evidence of SSB consumption is needed to inform SSB-related policies, especially in countries with a high consumption, such as Peru. Using data from Peru’s National Health Survey conducted in 2017–2018, the consumption of homemade and ready-to-drink SSB was estimated from a single 24 h dietary recall, accounting for socio-demographic and health-related variables. Regression models were fitted to assess which variables were linked to a high/low SSB consumption. There were 913 people and mean age was 37.7 years (95% confidence interval (CI): 36.9–38.6). Mean consumption (8 oz servings/day) of homemade SSB (1.2) doubled that of ready-to-drink SSB (0.5). The intake of homemade and ready-to-drink SSB was higher in men (1.3 and 0.7) than women (1.1 and 0.3). The intake of ready-to-drink SSB was higher in urban (0.6) compared to rural (0.2) populations. People aware of having diabetes had a lower consumption of both ready-to-drink (0.9 vs. 0.4) and homemade SSB (1.3 vs. 0.8) than those unaware of having diabetes. Male sex and living in urban locations were associated with higher ready-to-drink SSB intake. Older age was associated with a higher intake of homemade SSB. Amongst Peruvian adults, the consumption of SSB products (particularly homemade) remains high. Population-wide interventions should also aim to improve awareness of the nutritional components of homemade beverages.     

American cutaneous leishmaniasis in infancy and childhood

Infant and young child skin diseases are among the most common features of morbidity throughout the tropics. Because the skin is directly exposed to the environment, it is considerably affected by climatic and local conditions such as vectors and microorganisms, as in the case of leishmaniasis. In America the observed magnitude of cutaneous leishmaniasis in children has led to the study of increased risk of exposure of this group due to the possibility of peri‐ and intradomiciliary transmission. The present review pretends to make a concrete approach all through the broad and main figures of this parasitic disease, including the clinical, physiopathological, epidemiological, diagnostic, and therapeutic aspects, in order to be used as a practical source of reference for pediatricians leading with tropical cutaneous pathology in the region.     

Calciphylaxis: emerging concepts in prevention,diagnosis, and treatment

Calciphylaxis is a small vessel vasculopathy involving mural calcification with intimal proliferation, fibrosis, and thrombosis. This syndrome occurs predominantly in individuals with renal failure and results in ischemia and necrosis of skin, subcutaneous fat, visceral organs, and skeletal muscle. The syndrome causes significant morbidity in the form of infection, organ failure, and pain. Mortality rates are high. In individuals with renal failure, risk factors for the development of calciphylaxis include female sex, Caucasian race, obesity, and diabetes mellitus. Many cases occur within the first year of dialysis treatment. Several recent reports demonstrate that prolonged hyperphosphatemia and/or elevated calcium x phosphorus products are associated with the syndrome. Protein malnutrition increases the likelihood of calciphylaxis, as does warfarin use and hypercoagulable states, such as protein C and/or protein S deficiency. Recent advances in diagnostic tools and therapeutic strategies have helped in the management of patients with calciphylaxis.     

Evaluation of a simple operational approach for monitoring resistance to antimalarial drugs in Peru

Since 1994, the Peruvian Malaria Control Program has used a simplified operational approach for monitoring antimalarial drug efficacy, in which blood smears are taken 7 and 14 days after treatment from all patients diagnosed with malaria at Ministry of Health facilities. The proportion of patients with parasitaemia on one of their return visits provides an indication of the efficacy of the drug being administered. We compared this approach for antimalarial drug resistance monitoring to the more labour-intensive and expensive World Health Organization (WHO) 14-day in vivo efficacy trial at six sites in the Amazon Basin and the north coast of Peru. Although the proportion of treatment failures at 7 and 14 days identified by the operational monitoring system was considerably lower than the results of the WHO in vivo efficacy test, the operational approach did accurately reflect the overall efficacy or lack of efficacy of the drugs being evaluated. Differences in the results of the two methods were greatest in the Peruvian Amazon region, where fully supervised treatment and patient follow-up is very difficult due to the widely dispersed population. While the operational approach cannot be considered an alternative to WHO in vivo testing for evaluating the efficacy of antimalarial drugs or for recommending changes in malaria treatment policy, if treatment is supervised and follow-up blood smears taken as scheduled, this method could serve as a simple, inexpensive and sustainable early warning system for reduced drug efficacy.     

Needs and feelings of anxiety of relatives of patients hospitalized in intensive care units: implications for social work

INTRODUCTION: This study explores the needs and anxiety levels of relatives faced with the stress of a family member's critical care hospitalization in relation to the relatives' age, gender, educational level and type of kinship with the patient and in relationship to the characteristics of the admission and the condition of the patient. METHODS: Participants were 200 relatives of 120 different critical care patients. Family needs were measured by means of the Critical Care Family Needs Inventory. Anxiety was measured by means of the State version of the State-Trait Anxiety Inventory. RESULTS AND CONCLUSION: Relatives' needs and anxiety levels are found to be significantly related to demographic variables and type of kinship with the patient. The implications for clinical practice are discussed.     

Sister chromatid exchange induction in human lymphocytes exposed to benzene and its metabolites in vitro

Previous in vivo studies have shown that low-dose benzene exposure (10 to 28 ppm for 4 to 6 h) in mice can induce sister chromatid exchange (SCE) in peripheral blood B-lymphocytes and bone marrow as well as micronuclei in bone marrow polychromatic erythrocytes. Because benzene is metabolized to a variety of intermediate compounds and two of these, catechol and hydroquinone, have been reported to be potent SCE-inducers, it is possible that other known and proposed metabolites could have chromosome-damaging effects in lymphocytes. Induced SCE frequencies, mitotic indices, and cell cycle kinetics were quantitated in human peripheral blood T-lymphocytes exposed to benzene, phenol, catechol, 1,2,4-benzenetriol, hydroquinone, 1,4-benzoquinone, or trans,trans-muconic acid. Three proposed metabolites of phenol, 4,4'-biphenol, 4,4'-diphenoquinone, and 2,2'-biphenol, which can be generated by a phenol-horseradish peroxidase-hydrogen peroxide system were also examined. Benzene, phenol, catechol, 1,2,4-benzenetriol, hydroquinone, and 1,4-benzoquinone induced significant concentration-related increases in the SCE frequency, decreases in mitotic indices, and inhibition of cell cycle kinetics. Based on the slope of the linear regression curves for SCE induction, the relative potencies were as follows: catechol greater than 1,4-benzoquinone greater than hydroquinone greater than 1,2,4-benzenetriol greater than phenol greater than benzene. On an induced SCE per microM basis, catechol was approximately 221 times more active than benzene at the highest concentrations studied. trans,trans-Muconic acid had no significant effect on the cytogenetic parameters analyzed. 2,2'-Biphenol induced a significant increase in SCE only at the highest concentration analyzed, and 4,4'-biphenol caused a significant increase in SCE frequency that was not clearly concentration related. However, both 2,2'- and 4,4'-biphenol caused significant cell cycle delay and mitotic inhibition. 4,4'-Diphenoquinone caused only a significant decrease in mitotic activity. These data indicate that in addition to phenol, di- and trihydroxybenzene metabolites play important roles in SCE induction. Furthermore, the results suggest either that benzene alone can induce SCE or, a more likely possibility, that mononuclear leucocytes have a limited capability to activate benzene.