Archive for March, 2009

Hidatidosis en la Argentina Marzo 2009

Documento de la OPS

Profesor Eduardo Guarnera

Parasitología, INEI, ANLIS Dr Carlos G. Malbrán

Ministerio de Salud de la Nación Argentina

Carga de enfermedad

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March 31, 2009 at 11:47 am Leave a comment

Meta-analysis: Sequential Therapy Appears Superior to Standard Therapy for Helicobacter pylori Infection in Patients Naive to Treatment

Annals of Internal Medicine 17 Jun 2008 V.148 N.12


Nadim S. Jafri, MD, MSc; Carlton A. Hornung, PhD, MPH; and Colin W. Howden, MD

From University of Louisville, Louisville, Kentucky, and Northwestern University Feinberg School of Medicine, Chicago, Illinois

Background: Standard proton-pump inhibitor–based therapy for Helicobacter pylori infection fails in up to one quarter of patients. Sequential therapy may be more efficacious.

Purpose: To compare sequential therapy with standard triple therapy for H. pylori infection.

Data Sources: MEDLINE, EMBASE (1981 to October 2007), the Cochrane Central Register of Controlled Trials, and Google Scholar. PubMed and Ovid were the search engines used.

Study Selection: Randomized, controlled trials (RCTs) comparing sequential and standard triple therapies in treatment-naive patients with documented H. pylori infection.

Data Extraction: 3 reviewers independently assessed trial eligibility and quality and extracted data on eradication.

Data Synthesis: The crude rates of H. pylori eradication in 10 RCTs involving 2747 patients were 93.4% (95% CI, 91.3% to 95.5%) for sequential therapy (n = 1363) and 76.9% (CI, 71.0% to 82.8%) for standard triple therapy (n = 1384) (relative risk reduction, 71% [CI, 64% to 77%]; absolute risk reduction, 16 percentage points [CI, 14 to 19 percentage points]). The median rates of adherence were 97.4% (range, 90.0% to 98.9%) for sequential therapy and 96.8% (range, 93.0% to 100%) for standard therapy. Sequential therapy appeared superior in prespecified sensitivity (subgroup) analyses stratified by trial quality; smoking status; diagnosis (ulcer disease or nonulcer dyspepsia); resistance to clarithromycin, imidazoles, or both; duration of triple therapy; and method of diagnosis. Both treatments had similar side effect profiles.

Limitations: Only 1 study was double-blinded. Most patients were from Italy. There was clear evidence of publication bias.

Conclusions: Sequential therapy appears superior to standard triple therapy for eradication of H. pylori infection. If RCTs in other countries confirm these findings, 10-day sequential therapy could become a standard treatment for H. pylori infection in treatment-naive patients.



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Annals of Internal Medicine 17 Jun 2008 V.148 N.12


Sequential Therapy for Helicobacter pylori: A Worthwhile Effort for Your Patients

Barry Marshall, MD

From The University of Western Australia, School of Biomedical, Biomolecular, and Chemical Sciences, Microbiology & Immunology, H. pylori Laboratory, Nedlands 6009, Australia.

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March 30, 2009 at 6:33 pm Leave a comment

Diagnosis of Lyme Borreliosis

Clinical Microbiology Reviews 1 July 2005 V.18 N.3 p.484-509

Maria E. Aguero-Rosenfeld,1,4* Guiqing Wang,2 Ira Schwartz,2 and Gary P. Wormser3,4

Departments of Pathology,1 Microbiology and Immunology,2 Medicine, Division of Infectious Diseases, New York Medical College,3 Westchester Medical Center, Valhalla, New York4

A large amount of knowledge has been acquired since the original descriptions of Lyme borreliosis (LB) and of its causative agent, Borrelia burgdorferi sensu stricto. The complexity of the organism and the variations in the clinical manifestations of LB caused by the different B. burgdorferi sensu lato species were not then anticipated. Considerable improvement has been achieved in detection of B. burgdorferi sensu lato by culture, particularly of blood specimens during early stages of disease. Culturing plasma and increasing the volume of material cultured have accomplished this. Further improvements might be obtained if molecular methods are used for detection of growth in culture and if culture methods are automated. Unfortunately, culture is insensitive in extracutaneous manifestations of LB. PCR and culture have high sensitivity on skin samples of patients with EM whose diagnosis is based mostly on clinical recognition of the lesion. PCR on material obtained from extracutaneous sites is in general of low sensitivity, with the exception of synovial fluid. PCR on synovial fluid has shown a sensitivity of up to >90% (when using four different primer sets) in patients with untreated or partially treated Lyme arthritis, making it a helpful confirmatory test in these patients. Currently, the best use of PCR is for confirmation of the clinical diagnosis of suspected Lyme arthritis in patients who are IgG immunoblot positive. PCR should not be used as the sole laboratory modality to support a clinical diagnosis of extracutaneous LB. PCR positivity in seronegative patients suspected of having late manifestations of LB most likely represents a false-positive result. Because of difficulties in direct methods of detection, laboratory tests currently in use are mainly those detecting antibodies to B. burgdorferi sensu lato. Tests used to detect antibodies to B. burgdorferi sensu lato have evolved from the initial formats as more knowledge on the immunodominant antigens has been collected. The recommendation for two-tier testing was an attempt to standardize testing and improve specificity in the United States. First-tier assays using whole-cell sonicates of B. burgdorferi sensu lato need to be standardized in terms of antigen composition and detection threshold of specific immunoglobulin classes. The search for improved serologic tests has stimulated the development of recombinant protein antigens and the synthesis of specific peptides from immunodominant antigens. The use of these materials alone or in combination as the source of antigen in a single-tier immunoassay may someday replace the currently recommended two-tier testing strategy. Evaluation of these assays is currently being done, and there is evidence that certain of these antigens may be broadly cross-reactive with the B. burgdorferi sensu lato species causing LB in Europe.



March 30, 2009 at 6:28 pm Leave a comment

Proton-Pump Inhibitor Use and the Risk for Community-Acquired Pneumonia

Annals of Internal Medicine 16 Sept 2008 V.149 N.6 p.391-398

Monika Sarkar, MD; Sean Hennessy, PharmD, PhD; and Yu-Xiao Yang, MD, MSCE

From the University of Pennsylvania, Philadelphia, Pennsylvania

Background: Recent studies suggest that proton-pump inhibitors (PPIs) may increase the risk for community-acquired pneumonia (CAP).

Objective: To examine the association between PPI use and CAP in adults followed in general practices in the United Kingdom.

Design: Nested case–control study.

Setting: The General Practice Research Database (1987 to 2002) in the United Kingdom.

Participants: Patients age 18 years or older with at least 6 months of initial pneumonia-free follow-up in the database. Case patients (n = 80 066) were defined as those who received an incident diagnosis of CAP. Control participants (n = 799 881) were selected by using incidence density sampling, matching on practice site, calendar period, and follow-up duration.

Measurements: Use of PPIs within 30 days before the index date. Adjusted odds ratios (ORs) were estimated by using conditional logistic regression, adjusting for potential confounders.

Results: Overall, current PPI use was not associated with an increased risk for CAP (adjusted OR, 1.02 [95% CI, 0.97 to 1.08]) or risk for CAP that required hospitalization (adjusted OR, 1.01 [CI, 0.91 to 1.12]). There was a strong increase in risk for CAP associated with current use of PPI therapy that was started within the previous 2 days (adjusted OR, 6.53 [CI, 3.95 to 10.80]), 7 days (adjusted OR, 3.79 [CI, 2.66 to 5.42]), and 14 days (adjusted OR, 3.21 [CI, 2.46 to 4.18]), but there was no statistically significant association for longer-term current PPI therapy. A separate matched case–control analysis, which included the 3 strongest confounders as additional matching factors, yielded similar results as the primary analysis (adjusted OR, 0.96 [CI, 0.91 to 1.02]).

Limitations: Adherence to PPI prescription was assumed to be 100%. No radiographic evidence was available to corroborate a diagnosis of CAP.

Conclusion: Proton-pump inhibitor therapy started within the past 30 days was associated with an increased risk for CAP, whereas longer-term current use was not.



March 29, 2009 at 11:29 pm Leave a comment

Brief Communication: The Relationship of Regression of Cirrhosis to Outcome in Chronic Hepatitis C

Annals of Internal Medicine 16 Sept 2008 V.149 N.6 p.399-403

Vincent Mallet, MD, PhD; Hélène Gilgenkrantz, MD, PhD; Jeanne Serpaggi, MD; Virginie Verkarre, MD, PhD; Anaïs Vallet-Pichard, MD; Hélène Fontaine, MD; and Stanislas Pol, MD, PhD

From Université Paris Descartes; Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, INSERM U 567; and Assistance Publique-Hôpitaux de Paris, Hôpital Necker—Enfants Malades, Paris, France.

Background: The effect of regression of cirrhosis in chronic hepatitis C is unknown.

Objective: To evaluate the relation between regression of cirrhosis and clinical outcome in patients with chronic hepatitis C after antiviral therapy.

Design: A cohort of patients with cirrhosis treated between 1988 and 2001.

Setting: Hepatology unit of a tertiary care center in France.

Patients: 96 patients with chronic hepatitis C and biopsy-proven cirrhosis (METAVIR score F4) who were treated with an interferon-based regimen and had at least 1 posttreatment liver biopsy. Patients were followed until November 2006.

Measurements: Occurrence of a combined end point of liver-related events (ascites, hepatic encephalopathy, variceal bleeding, spontaneous bacterial peritonitis, hepatocellular carcinoma, or liver transplantation) and death in patients with regression of cirrhosis (defined as a decrease from 4 to 2 METAVIR units on posttherapy liver biopsy).

Results: The median follow-up was 118 months (interquartile range, 86 to 138 months). Eighteen patients had regression of cirrhosis. The incidence of the combined end point per 100 patient-years was 0 in patients with regression of cirrhosis and 4 in patients without regression of cirrhosis (P = 0.002, log-rank test). The transplantation-free survival rate at 10 years was 100% in patients with regression of cirrhosis and 74.2% in patients without regression of cirrhosis (P = 0.025).

Limitations: Selection of patients was retrospective; selection and survival biases may have influenced the estimates of the overall rate of regression of cirrhosis. The low number of patients who experienced regression of cirrhosis precludes analysis of factors that could predict regression of cirrhosis.

Conclusion: Regression of cirrhosis occurs after antiviral therapy in some patients with chronic hepatitis C. Regression is associated with decreased disease-related morbidity and improved survival.



March 29, 2009 at 11:27 pm Leave a comment

Prevention of Perinatal Group B Streptococcal Disease

MMWR Recommendations and Reports August 16, 2002 V.51 N.RR11 p.1-22

Revised Guidelines from CDC

Prepared by

Stephanie Schrag, D. Phil.

Rachel Gorwitz, M.D.

Kristi Fultz-Butts, M.P.H.

Anne Schuchat, M.D.

Division of Bacterial and Mycotic Diseases

National Center for Infectious Diseases

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March 28, 2009 at 11:41 am Leave a comment

A Paradigm Shift to Prevent HIV Drug Resistance

Plos Medicine May 2008

David R. Bangsberg

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March 28, 2009 at 11:39 am Leave a comment

Severe Vivax Malaria: Newly Recognised or Rediscovered

Plos Medicine June 2008

Stephen J. Rogerson*, Richard Carter

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March 28, 2009 at 11:37 am Leave a comment

Minority HIV-1 Drug Resistance Mutations Are Present in Antiretroviral Treatment–Naïve Populations and Associate with Reduced Treatment Efficacy

Plos Medicine July 2008

Jeffrey A. Johnson1*, Jin-Fen Li1, Xierong Wei1, Jonathan Lipscomb1, David Irlbeck2, Charles Craig3, Amanda Smith1, Diane E. Bennett1, Michael Monsour1, Paul Sandstrom4, E. Randall Lanier2, Walid Heneine1

1 Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America, 2 GlaxoSmithKline, Research Triangle Park, North Carolina, United States of America, 3 GlaxoSmithKline, Stevenage, United Kingdom, 4 National HIV and Retrovirology Laboratories, Public Health Agency of Canada, Ottawa, Ontario, Canada

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March 28, 2009 at 11:35 am Leave a comment

Transmitted Minority Drug-Resistant HIV Variants: A New Epidemic?

Plos Medicine July 2008

Steven G. Deeks

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March 25, 2009 at 12:10 pm Leave a comment

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