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Biomedical subjects

R Carrasco

Publications and source records attributed to R Carrasco.

At least 37 records · Page 2Linked to original sources

Stage I ovarian carcinoma: specialty-related differences in survival and management.

BACKGROUND: In patients with FIGO (International Federation of Gynecology and Obstetrics) stage I ovarian carcinoma given care with or without subspecialists, we compared completeness of initial staging and disease-free survival. METHODS: Two groups of patients with stage I ovarian carcinoma were compared. Patients were managed by either gynecologic oncologists or community-based physicians. The two groups were compared for similarities in demographic, tumor, and substage characteristics and survival differences. RESULTS: Fifty-four patients with stage I ovarian cancer were included. The two groups were comparable in age, gravidity, parity, grade, and substage. Substaging was determined to be adequate in 100% of the gynecologic oncologist group and 28% of the community-based group. Postoperative chemotherapy was given to 79% and 36% of the two groups, respectively. Six-year survival was 90% in the gynecologic oncologist group and 68% in the community-based group. CONCLUSIONS: Of these two groups of patients with stage I ovarian cancer, the group managed without gynecologic oncology involvement had significantly less adequate staging, decreased administration of chemotherapy, and lower survival rates.

Adenocarcinoma, Mucinous↗

Sylvatic triatomines (Hemiptera: Reduviidae) in Bolivia: trends toward domesticity and possible infection with Trypanosoma cruzi (Kinetoplastida: Trypanosomatidae).

The risk of domestic transmission of Trypanosoma cruzi (Chagas) by sylvatic triatomines was assessed in an isolated area of the subandean region of Bolivia. None of the 390 residents examined had serological evidence of infection. Two sylvatic triatomine species, Eratyrus mucronatus (Stål) and Triatoma sordida (Stål), were found in houses and in peridomestic structures. The collection of nymphal instars of both species from some houses indicated possible domesticity. Microscopic examination of feces from 92 insects showed no parasites, and cultures from the guts of 30 insects were negative. Nevertheless, a polymerase chain reaction (PCR) test performed on the same fecal samples showed the presence of T. cruzi DNA in 19.1 and 12.5% of E. mucronatus and T. sordida, respectively. These 16 PCR-positive samples were hybridized with 2 T. cruzi-specific probes known from the domestic cycle in Bolivia (clones 20 and 39). At least 1 of these clones was identified in 7 bugs (5 E. mucronatus and 2 T. sordida). Moreover, no hybridization was observed with these probes in S E. mucronatus and 1 T. sordida samples that showed an amplified band by PCR. These data indicated that T. cruzi clones, genetically unrelated to clones 20 and 39, also were circulating in this area. Based on these results, the 2 sylvatic triatomine species encountered in Apolo should not be overlooked as possible local vectors of T. cruzi.

Animals↗

Prevalence of anti-R-13 antibodies in human Trypanosoma cruzi infection.

Infection with Trypanosoma cruzi develops in three phases: acute, indeterminate or asymptomatic, and chronic phase (with cardiac or digestive manifestations). Moreover, transmission may occur from infected mothers to newborn, the so-called congenital form. In the present study, humoral responses against T. cruzi total extract and against the 13 amino acid peptide named R-13 derived from the parasite ribosomal P protein, previously described as a possible marker of chronic Chagas heart disease, were determined in chagasic patients and in blood bank donors from endemic areas. While in sera from acute phase, only IgM anti-T.cruzi response was observed, both IgM and IgG anti-T. cruzi antibodies were detected in sera from congenitally infected newborns. The percentage of positive response in sera from blood bank donors was relatively high in endemic regions. Antibodies against the R-13 peptide were present in a large proportion of cardiac chagasic patients but were totally lacking in patients with digestive form of Chagas' disease. Furthermore, anti-R-13 positive responses were detected in congenitally infected newborns.

Acute Disease↗

Field application of polymerase chain reaction diagnosis and strain typing of Trypanosoma cruzi in Bolivian triatomines.

A new approach for direct identification and characterization of Trypanosoma cruzi stocks in biological samples was tested for field applicability on an extensive sample of feces collected from triatomine vectors from four different species found in Bolivia. The first step of the technique is polymerase chain reaction (PCR) amplification of the hypervariable region of kinetoplast DNA minicircles of T. cruzi parasites. In this report, 345 fecal samples were analyzed and the PCR results were compared with microscopic examination. For Triatoma infestans, the principal Bolivian vector, both techniques were in concordance 85.3% of the time. For the three other species, Rhodnius pictipes, Eratyrus mucronatus, and Triatoma sordida, the fecal samples were all negative by microscopic examination whereas PCR results showed several T. cruzi-infected insects in each species. The second step of the procedure is the characterization of the T. cruzi clones by means of hybridization of the PCR products with clone-specific probes generated by the PCR. We used two probes corresponding to major clones circulating in high frequency in Bolivia (as shown by previous population genetic studies using isoenzyme characterization). We obtained four primary results: 1) we confirm the importance of two major clones in Bolivia in two distinct regions; 2) we report high rates of mixed infections (multiple clones in a single vector) in Triatoma infestans, up to 22% and 35% in Cochabamba and La Paz departments, respectively; 3) the results favor the absence of interaction between different clones; and 4) we find, for the first time, evidence of the major clones circulating in three species of triatomines that are known as mainly sylvatic species.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

[Size and echogenicity of the pancreas in Chilean adults: echotomography study in 261 patients].

The aim of this work was to perform ultrasonographic measurements of normal pancreas in the Chilean population. Among 5000 subjects referred for an ultrasound abdominal examination, those without history of alcoholism, pancreatitis or liver disease were selected for the study. 261 individuals (157 female) aged 20 to 79 years were studied. The size of the head of the pancreas ranged from 6 to 28 mm (17.7 +/- 4.2 mm), the body size ranged from 4 to 23 mm (10.1 +/- 3.8 mm) and the tail size from 5 to 28 mm (16.4 +/- 4.2 mm). These figures are lower than those reported in Europe and North America. No size differences were observed according to sex or body frame. Progressive declines in size with age, were observed in all pancreatic segments. No hypoecogenic pancreas were observed. A new technique to improve pancreatic ultrasonographic vision is proposed.

Adult↗

[Plasma levels of alanine aminotransferase in experimental liver necrosis induced by overdosage of paracetamol in mice].

OBJECTIVE: To investigate the correlation between the hepatocellular damage and ALT plasma level after paracetamol overdosage in mice. EXPERIMENTAL DESIGN: A total of 30 female, 16 week-old mice (Souris OF1 strain), weighing 25-30 g were used. After 18 hours fast period, single doses of 500 mg/kg of paracetamol were administered intraperitoneally. The animals were killed by decapitation 24 hours after paracetamol injection, fasting being continued, although free access to water was allowed. ALT plasma levels were determined. The hepatocellular damage was graded from 0-4 (+). Plasma levels of mercapturate conjugate were measured by HPLC. RESULTS: The study showed a statistically significant correlation (r = 0.8, p = 0.00001) between ALT plasma levels and the degree of hepatocellular damage but not with concentrations of mercapturate conjugate. CONCLUSIONS: These findings suggest that ALT plasma levels give a reliable indication of the severity of hepatic necrosis, after experimental paracetamol overdosage in mice.

Acetaminophen↗

[Candida laryngitis and HIV infection: description of 4 cases].

Candidiasic laryngitis is a very rare Candida spp infection of mucosa, appearing typically in immunosuppressed patients, mainly in patients with neoplasia, and, recently, in patients with Human Immunodeficiency Virus (VIH) infection. We present four cases of candidiasic laryngitis and HIV infection, as well as the clinical description and evolution of said cases after treatment with fluconazole. We review, as well, the cases published on the scientific literature. We maintain that in each HIV infected patient, with or without oral candidiasis, who shows dysphonia, candidiasic laryngitis should be ruled out.

Acquired Immunodeficiency Syndrome↗

[Fluconazole treatment of cryptococcal meningitis associated with HIV infection. Presentation of 4 cases].

We present four cases of C. neoformans meningitis (CNM) in patients with Human Immunodeficiency Virus (HIV) infection treated with fluconazole p.o. at an initial dose of 400 mg followed by 200 mg/day during a follow up period ranging from 3 to 12 months, and who presented an excellent clinical evolution. When comparing them to our previous cases who were treated with Amphotericin-B in combination with 5-fluorocytosine, a decrease in mean hospital stay (p less than 0.001) and a smaller incidence of secondary effects were observed. Treatment with fluconazole seems to be an effective alternative in treatment of CNM. Future greater studies are needed to confirm this findings.

Administration, Oral↗

[Austrian's syndrome and infection with human immunodeficiency virus].

A case of a patient diagnosed of Austrian' syndrome associated to HIV infection is presented. Our aim is to highlight the frequent but not enough described association to pneumonia, endocarditis and meningitis caused by Streptococcus pneumonia to increased its knowledge and permit a correct and early treatment, improving the bad prognosis of this association.

Endocarditis, Subacute Bacterial↗

[Intestinal tuberculosis in acquired immunodeficiency syndrome].

We present a case of disseminated tuberculosis with peritoneal and intestinal involvement in a homosexual patient who presented micronodular fibrosis and was infected by HIV, with an AIDS diagnosis since he had previously presented an esophagitis caused by candida. Diagnosis was made from a sample obtained from an ulcerated lesion from rectum-sigmoid region by colonoscopy, and when stained with Ziehl-Nielsen revealed acid-alcohol resistant bacilli (AARB) identified as M. tuberculosis. The torpid evolution of the process, which was complicated by the uncompensation of the cirrhosis determined the patient's death inspite of treatment. The characteristics of intestinal tuberculosis in HIV infected patients is reviewed.

Acquired Immunodeficiency Syndrome↗

[Meningitis caused by Candida albicans in a male patient infected by HIV and failure of treatment with amphotericin B].

We report a case of Candida albicans meningitis in a male with human immunodeficiency virus (HIV) infection. This finding has seldom been reported, both in this group of patients and in those with other causes of immunosuppression or other underlying diseases. We discuss the clinical presentation and the features of cerebrospinal fluid, which showed only a mild inflammatory reaction as found in other fungal meningitis (basically cryptococcal) in AIDS patients. Finally, we emphasize the ineffectiveness of amphotericin therapy to achieve a complete microbiological cure and to prevent the relapse of meningitis in this patient. We also stress the need to make an early diagnosis in cases of fungal meningitis in patients with VIH infection, so that appropriate therapy is begun as soon as possible.

Acquired Immunodeficiency Syndrome↗

[Candida esophagitis treated with a single dose of fluconazole in patients with HIV: presentation of 11 cases].

We have reviewed the efficacy of the use of fluconazole in patients with definitely proven Candida esophagitis (CE) associated with human immunodeficiency virus (HIV) infection, using a single 400 mg oral dose of fluconazole and evaluating the patient three days afterwards. This drug showed to be effective for the clinical and endoscopic cure in all patients (100%), and with microbiological cure in ten cases. There was no clinical feature of toxicity. The only side effect was an increased alkaline phosphatase and transaminase activity without hyperbilirubinemia, but this finding was not statistically significant (p greater than 0.05). Fluconazole, given in a single 400 mg dose, was absolutely effective to cure esophagitis in AIDS, thus permitting to avoid parenteral amphotericin.

Adult↗

[Nontraumatic deaths associated with a natural catastrophe. The experience of the earthquake in Chile 1985].

We analyzed causes of death before and after the March 1985 earthquake in Valparaíso, Chile. Causes of death were obtained from death certificates. Apart from death directly due to trauma during the earthquake, a significant increase was observed in deaths due to accidents (+51), cardiovascular disease (+38), malnutrition (+13) and psychiatric disorders (+13). Retired males over age 65 were most affected.

Adolescent↗

Chagas' disease in Bolivia: clinical and epidemiological features and zymodeme variability of Trypanosoma cruzi strains isolated from patients.

We performed serological and pathological studies on 495 patients with Chagas' disease from different areas of Bolivia. Eighty-nine Trypanosoma cruzi strains, isolated by xenodiagnosis, were characterized by 12 isoenzyme loci and were related to the presence of cardiac changes and enteric disease with megacolon. There was a high heterogeneity of human zymodemes, presenting evidence of 2 predominant zymodemes genetically dissimilar from each other and ubiquitous in Bolivia. The frequencies of these predominant zymodemes among strains from patients were compared to strains from triatomine bugs previously studied. We observed mixtures of different zymodemes within the same patient, a phenomenon seen previously in Bolivian patients. There was no apparent difference of pathogenicity between the 2 more frequent zymodemes isolated from humans.

Animals↗

Specific immunodiagnosis of Chagas disease: immunodiffusion test using a specific serum anti-Trypanosoma cruzi component 5.

A micro double diffusion test (MD), allowing the identification of precipitation brand 5 by identity reaction, using a rabbit specific anti-component 5 serum, was evaluated for the immunological diagnosis of Chagas' disease. The previous studies on the Trypanosoma cruzi specificity of component 5[g] were completed, showing it to be absent in Leishmania brazilienis, but present in different strains of T. cruzi. 200 sera from Bolivian patients were studied. (88 with a positive xenodiagnosis, 45 with mucocutaneous leishmaniasis but without Chagas' disease, and 67 controls). Band 5 was found in 74 (84.1%) of the sera with positive xenodiagnosis but was never found either in the leishmaniasis or in the control groups. MD, allowing an easy detection of T. cruzi specific band 5, cheap and simple to perform, can be recommended in association with other serological tests, when highly specific immunodiagnosis of Chagas' disease is required.

Adult↗