Stability studies of tablets containing 5 mg of policosanol

The stability studies of tablets containing 5 mg of policosanol, a new cholesterol lowering drug, were conducted to predict an expiration date and to search the appearance of putative degradation products. All quality parameters such as colour, moisture content, hardness, disintegration, policosanol content and microbiological limits of the tablets were assessed. The effect of extreme treatments such as acid and basic hydrolysis, oxidative and photolytic degradation as well as thermal degradation, on the policosanol content was studied. In addition, studies under extreme conditions of storage [(40 +/- 2) degree C and (75 +/- 5)% R.H.] as well as 37, 45, 55 and 60 degrees C combined with 50, 75 and 92% R.H.) and under ambient conditions of storage for climatic zones II and IV were performed. These studies demonstrate that these tablets are a stable pharmaceutical formulation, without significant changes in their quality criteria at the stressed conditions used, so that policosanol content remains unchanged during the entire studies. The chromatographic profile of the samples after 9 months of thermal degradation shows chromatographic peaks that corresponds to the palmitate and stearate esters of octacosanoyl, triacontanoyl and hexacosanoyl, being the only degradation products observed on these studies.

Taenia solium infection in a rural community in the Peruvian Andes

An epidemiological study was conducted in a highland, rural community in Peru, to determine the seroprevalences of human and porcine infection with Taenia solium and the risk factors associated with human infection. The seroprevalences, determined using an assay based on enzyme-linked-immuno-electrotransfer blots (EITB), were 21% (66/316) in the humans and 65% (32/49) in the pigs. The human subjects aged <30 years were more likely to be positive for anti-T. solium antibodies than the older subjects (P < 0.001). The risk factors associated with human seropositivity were lack of education beyond the elementary level [odds ratio (OR)=2.69; 95% confidence interval (CI)=1.09-6.65] and pig-raising (OR=1.68; CI=0.96-2.92). Curiously, sheep-raising was inversely associated with human T. solium infection (OR=0.50; CI=0.28-0.90). The study site appears to be a new endemic focus for T. solium in the central Peruvian Andes. Although, in earlier studies, the seroprevalence of T. solium infection has generally been found to increase with age, the opposite trend was observed in the present study. The results of follow-up studies should help determine if the relatively high seroprevalence in the young subjects of the present study is the result of a transient antibody response.

Study of the stability of tablets containing 10 mg of policosanol as active principle

The stability studies of tablets containing 10 mg of policosanol, a new cholesterol lowering drug, were conducted to predict an expiration date and to search the appearance of putative degradation products. All quality specification parameters such as colour, moisture content, hardness, disintegration, policosanol content and microbiological limits of the tablets were done. The effect of drastic treatments such as acid and basic hydrolysis, oxidative and photolytic degradation as well as thermolysis on such parameters was studied. In addition; studies under drastic conditions of storage (40 degrees C and 75% R.H.) and under ambient conditions of storage for climatic zones II and IV were performed. These studies demonstrate that these tablets are a stable pharmaceutical formulation, without significant changes on their quality criteria at the stressed conditions studied. The chromatographic profile of the samples after 9 months of thermal degradation shows chromatographic peaks that corresponds to the octacosanoyl, triacontanoyl and hexacosanoyl esters of palmitate and stearate, being the only degradation products observed on these studies.

Study of the interaction between policosanol and excipients

Policosanol is an active principle, composed by 8 fatty alcohols: 1tetracosanol, 1-hexacosanol, 1-heptacosanol, 1-octacosanol, 1-nonacosanol, 1-triacontanol, 1-dotriacontanol and 1-tetratriacontanol that shows a very stable, well defined and reproducible composition from batch to batch that is analysed using gas chromatography. Continuing the studies of the compatibility among policosanol and different tablet excipients, it was studied if the mixtures of those excipients with policosanol produce chemical interactions between them, the samples were analysed using gas chromatography and was determined if it was affected the content of policosanol in them. When all the samples were analysed, no changes in the policosanol content of the samples were observed, and it was considered that no interactions are produced in any of the mixtures policosanol/excipients under study.

Acute Helicobacter pylori infection is followed by an increase in diarrheal disease among Peruvian children

BACKGROUND

Cohort and case-crossover studies were conducted to evaluate whether new Helicobacter pylori infections are followed by increased diarrhea.

METHODS

Participants were 6-month-old to 12-year-old shantytown residents living near Lima, Peru. Baseline data were collected from community households. Health interviews were completed daily, and sera, drawn every 4 months, were tested for H pylori immunoglobulin G. Diarrhea rates among newly H pylori-infected (seroconverting) children were compared with rates among persistently uninfected and infected children using cohort and case-crossover analyses.

RESULTS

Sera were obtained from 345 children from January 1, 1995, through September 1, 1997. H pylori incidence was 12% per year (36 H pylori infections in 109 866 seronegative days). In adjusted cohort analyses, seroconverters had more diarrhea days (rate ratio: 2.0; 95% confidence interval: 1.6-2.4), episodes, and sick days in the year after infection than did uninfected children; and more diarrhea days and sick days than did persistently infected children. This effect was strongest in the first 2 months. Case-crossover analyses supported these findings.

CONCLUSION

Preventing H pylori infection may help reduce pediatric diarrheal disease.

[Severe gastrointestinal complications potentially associated with the use of non-steroidal anti-inflammatory agents: hospital treatment costs for the National Health System of our country]

BACKGROUND

Non-steroidal antiinflammatory drugs (NSAIDs) produce severe gastrointestinal (G-I) complications in 1-4% of cases which need to be treated into the hospital. The aim of this study has been to assess the hospital cost secondary to treat these complications in our National Health Service (NHS).

MATERIAL AND METHODS

In the first phase a cross-sectional study was performed in order to know the number of patients who were hospitalized due to a severe G-I complication during 1998 in two tertiary hospital in our country. It was reviewed their clinical charts to know whether they had taken any NSAIDs. In those positive cases all resources used during the hospitalization were collected.

RESULTS

In both hospitals studied 38.1% of hospitalized patients for a severe G-I complication had taken any NSAIDs during the same day or previous days. The cost/patient was of 389,831 pesetas. During 1998 in the whole NHS there were 54,623 hospitalizations owing to the same reason. Assuming that 38.1% of them had also taken any NSAIDs, 20,811 patients would have suffered a severe G-I complication potentially due to the intake of NSAIDs. Extrapolating the cost/patient obtained in both hospitals to the global number of patients hospitalized into the NHS, the cost of treating all severe G-I complications related to the consumption of NSAIDs during 1998 was of 8,112 millions pesetas.

CONCLUSIONS

Bearing in mind the elevated prevalence of osteo-articular pathology in our country and the high consumption of NSAIDs for its treatment, the coming of new therapeutic options with a better safety profile would mean an important resources' saving for our NHS.

Posttreatment follow-up of Helicobacter pylori infection using a stool antigen immunoassay

The Helicobacter pylori stool antigen enzyme immunoassay (HpSA) was evaluated during posttreatment follow-up of patients in a country with a very high prevalence of H. pylori infection. From among 273 dyspeptic individuals (18 to 55 years) initially recruited from a shantytown in Lima, Peru, 238 participants who met the inclusion criteria and were suspected to be H. pylori positive based on (14)C urea breath test (UBT) results underwent endoscopy. Participants with endoscopy-proven infections received standard eradication therapy and were monitored by UBT and HpSA at 1 month following treatment and at 3-month intervals for 9 months posttreatment. A second endoscopy was performed if UBT results showed evidence of treatment failure or H. pylori recurrence. Biopsy results were considered the "gold standard" in all analyses. Among patients who underwent endoscopy, HpSA had a pretreatment sensitivity of 93%. Two-hundred thirty patients completed the treatment regimen, of whom 201 (93%) were considered to have had successful treatment outcomes based on a negative follow-up UBT. Thirty-two patients with UBT-defined treatment failures or H. pylori recurrences at any point during the 9-month follow-up underwent a second endoscopy. In the posttreatment setting, HpSA had an overall sensitivity of 73% and a specificity of 67%. Agreement between UBT and HpSA diminished throughout the follow-up. Among 14 participants in whom HpSA remained positive at 1 month following treatment despite UBT evidence of treatment success, 12 (86%) became HpSA negative within 3 months posttreatment. Although this study confirmed the validity of the HpSA in the initial assessment of dyspeptic patients, the test demonstrated a reduced overall accuracy in the detection of treatment failures and H. pylori recurrences during 9 months of posttreatment follow-up. Furthermore, in some patients it may take up to 3 months after successful eradication for antigen shedding to diminish to levels within the negative HpSA range.

Assessment of hospital costs related to the diagnosis and treatment of upper gastrointestinal haemorrhages in patients consuming non steroid anti-inflammatory drugs

BACKGROUND

Non-steroid anti-inflammatory drugs (NSAIDs) can produce haemorrhages of the digestive tract, whose treatment result in significant hospital costs.

OBJECTIVE

The aim of this analysis has been to estimate hospital costs related to the treatment of digestive haemorrhages potentially caused by the intake of NSAIDs.

MATERIAL AND METHODS

The study was conducted by reviewing the clinical history of all patients admitted in two tertiary Spanish hospitals during 1998 due to digestive haemorrhage following NSAID treatment. After the identification of cases, all resources consumed during their hospitalisation (concomitant medication, complementary examinations and tests, surgery, blood products consumption, inpatient consultations and length of stay in the hospital) until the complete resolution of each case, were recorded.

RESULTS

Thirty-six percent of patients admitted due to digestive haemorrhage had taken some NSAID the same day of their hospitalisation (85.4%) or in previous days. The cost related to the treatment of these patients amounted to some 71 million pesetas for both hospitals, with a cost/patient of 434,407 pesetas.

CONCLUSIONS

Given the high consumption of NSAIDs in our normal clinical setting, costs related to the diagnosis and treatment of digestive haemorrhages in hospitals are a highly significant burden for the National Health System.

Identification of 5 types of Cryptosporidium parasites in children in Lima, Peru

Cryptosporidium parvum is usually considered to be the pathogen responsible for human cryptosporidiosis. We genotyped Cryptosporidium in 132 stool specimens from 80 Peruvian children, representing 85 infection episodes, using techniques that differentiate Cryptosporidium species and C. parvum genotypes. Five types of Cryptosporidium were identified: C. parvum human (67), bovine (8), and dog (2) genotypes, C. meleagridis (7), and C. felis (1). Twenty-five (29%) of the 85 infection episodes were associated with diarrhea. There was no significant difference in age, antecedent stunting, percentage with diarrhea, or duration of diarrhea for episodes with human genotype, compared with those of zoonotic Cryptosporidium. Duration of oocyst shedding was longer for human genotype than for zoonotic Cryptosporidium (mean, 13.9 days and 6.4 days, respectively; P=.004). Serum samples from 8 children with C. meleagridis, C. felis, or C. parvum dog genotype were tested for anti-human immunodeficiency virus (HIV) type 1 antibodies; all were found to be negative. Contrary to common belief, novel Cryptosporidium species and C. parvum genotypes can infect HIV-negative children.

Urinary selenium excretion in patients with cervical uterine cancer

In this work, we report on a relationship between urinary selenium and the development of cervical uterine cancer. A simple chemical method was developed to concentrate trace amounts of selenium from relatively large urine samples by use of small activated carbon filters. When these filters are irradiated with thermal neutrons, selenium can be determined either by 77mSe (t1/2 = 17.5 s) or 75Se (t1/2 = 120 d). In this article, we report the results for 82 urine samples from women with cervical uterine cancer in several stages of development and from healthy controls. These results show a statistically significant increase of selenium excretion in cancer patients as compared to controls. Urinary selenium excretion is highest for patients in the intermediate stages of the disease.

[Nesidioblastosis as extracolonic manifestation associated with adenomatous familial polyposis]

OBJECTIVE

To describe the case of a patient with familial adenomatous polyposis (FAP) who developed organic hyperinsulinemia and hypoglycemia due to pancreatic nesidioblastosis.

BACKGROUND

FAP can be considered as one of the familial cancer syndromes. The development of endocrine tumors in these patients is an infrequent event, and most of these tumors have been well-differentiated thyroid neoplasms. To our knowledge, the occurrence of organic hyperinsulinemia in the context of FAP has not been reported.

METHODS

Organic hyperinsulinemia was demonstrated during a 72-h fast, measuring insulin and C-peptide by RIA at the time of hypoglycemia. Immunohistochemistry for insulin and other pancreatic hormones was performed on the surgical pancreatic specimen.

RESULTS

The patient underwent a distal pancreatectomy with resolution of hypoglycemia. Histopathologically, the excised pancreas showed beta cell hyperplasia arising from the ductal epithelium. Such beta cells strongly immunostained for insulin, pancreatic polypeptide, and neuron-specific enolase.

CONCLUSIONS

The development of endocrine tumors in an inherited cancer syndromes such as FAP is rare. Such an association may suggest shared mechanisms of tumorigenesis. The case herein reported should prompt us to consider organic hyperinsulinism as an extracolonic manifestation of FAP.

Natural history of infection with Bartonella bacilliformis in a nonendemic population

An investigation was performed after an outbreak of bartonellosis in a region of Peru nonendemic for this disorder. Symptoms of acute and chronic bartonellosis were recorded. Serological analysis was performed on 55% of the affected population (554 individuals), 77.5% of whom demonstrated previous infection with Bartonella bacilliformis. The attack rate of Oroya fever was 13.8% (123 cases); the case-fatality rate was 0.7%. The attack rate of verruga peruana was 17.6%. A new specific immunostain was developed and used to confirm the presence of B. bacilliformis in the biopsied skin lesions. Most seropositive individuals (56%) were asymptomatic. The symptoms that were associated with prior infection, as determined by Western blot, included fever (37.2% of the seropositive vs. 17.2% of the seronegative population; P<.001), bone and joint pain (27% vs. 9%; P<.001), headache (27% vs. 12.3%; P <.001), and skin lesions described as verruga peruana (26.8% vs. 4.9%; P<.001). Our findings suggest that infection with B. bacilliformis causes a broad spectrum of disease that is significantly milder in severity than that frequently reported.

Comparison of invasive and noninvasive methods for the diagnosis and evaluation of eradication of Helicobacter pylori infection in children

BACKGROUND

Acquisition of Helicobacter pylori infection occurs mainly during childhood. To study the events associated with H. pylori colonization in children it is important to have reliable diagnostic methods. Our objective was to validate invasive and noninvasive tests for diagnosis of H. pylori infection in children before and after antimicrobial treatment.

METHODS

Before treatment, invasive rapid urease test (RUT) culture and histology, as well as the noninvasive carbon-13 urea breath test (13C-UBT) and serology were validated in 59 children. The gold standard for H. pylori infection was any of three positives of the five tests. After antimicrobial treatment culture, histology, and 13C-UBT were validated in 43 children to determine eradication. The gold standard for eradication was negative in all three tests.

RESULTS

For primary diagnosis, RUT was the most sensitive and specific test, followed by 13C-UBT, which performed better than serology, culture, and histology. Concordance tests also showed that RUT and 13C-UBT performed better. For determination of eradication, 13C-UBT and histology were better than culture, which showed poor sensitivity.

CONCLUSIONS

RUT performed better for primary diagnosis. However, as endoscopy might not be indicated in most children, 13C-UBT could be the test of choice for diagnosis of H. pylori infection both before and after eradication treatment.

Gallstone disease in Peruvian coastal natives and highland migrants

BACKGROUND

In a previous study, we found that gallstones were a common occurrence in the high altitude villages of the Peruvian Andes.

AIMS

To determine if high altitude (> or = 1500 m) is a contributing risk factor for gallstone disease.

METHODS

We conducted a cross sectional study in a periurban community in Lima, Peru, and compared the prevalence of gallstone disease between coastal natives, highland (Sierra) natives and Sierra natives who had migrated to the coast. We also compared the prevalence rates from this study with those from a previous study conducted at high altitude. We examined 1534 subjects >15 years of age for gallstone disease. Subjects were interviewed for the presence or absence of risk factors.

RESULTS

Gallstone disease was more common in females (16.1 cases per 100, 95% CI 13.8-18.2) than in males (10.7 per 100, 95% CI 8.0-13.4). Females had a greater risk of gallstone disease, especially if they had used oral contraception and/or had four or more children. The age adjusted prevalence was not significantly different between coastal natives, Sierra migrants, and Andean villagers. The prevalence of gallstone disease was not associated with time since migration or with having native Sierra parents. After adjusting for other risk factors, Sierra natives who migrated to the coast had a lower prevalence of gallstone disease than coastal natives (odds ratio 0.74, 95% CI 0.58-0.94).

CONCLUSIONS

This study indicates that high altitude is not a positive risk factor for gallstone disease and confirms that this disease is common in Peruvians, which may be attributable to Peruvian-Indian ethnicity.

Field diagnosis of Echinococcus granulosus infection among intermediate and definitive hosts in an endemic focus of human cystic echinococcosis

Human, canine and ovine echinococcosis prevalence was determined in a highland community located in the central Peruvian Andes during 1997 and 1998. Human echinococcosis was determined using portable ultrasonography, chest X-ray examination, and an enzyme-linked immunoelectrotransfer blot (EITB) assay. Canine echinococcosis was determined using microscopy stool examinations and a coproantigen detection enzyme-immunoassay (EIA) for Echinococcus granulosus. Ovine echinococcosis was determined by an EITB assay for sheep echinococcosis and necropsy examination of viscera from domestic slaughtered animals. An abdominal ultrasound, a chest X-ray examination and an EITB for echinococcosis were performed on 214 subjects (45% of the village population). The frequency of presumptive liver/abdominal, lung and liver-lung hydatid cysts was 5.1% (11/214), 3.7% (8/214) and 0.5% (1/214), respectively. The overall prevalence of human cystic echinococcosis was 9.3% (20/214). The frequency of canine echinococcosis was 46% (23/50) and 32% (16/50) by the coproantigen EIA test and arecoline purging, respectively. The frequency of sheep echinococcosis was 65% (22/34) by the EITB and 38% (13/34) by necropsy. We demonstrated a high prevalence of human and animal echinococcosis in this Peruvian village. In remote areas where echinococcosis is endemic, both the coproantigen EIA and arecoline purging may be used for the study of canine echinococcosis; the EITB is useful in establishing the diagnosis of echinococcosis in sheep prior to necropsy.

A placebo-controlled trial of Lactobacillus GG to prevent diarrhea in undernourished Peruvian children

OBJECTIVE

Lactobacillus GG (L-GG), an acid- and bile-resistant strain that colonizes the intestinal mucosa, has been used to manage diarrhea in children. Our objective was to evaluate the prophylactic use of L-GG to prevent diarrhea in children at high risk from a developing country in a randomized, placebo-controlled trial.

STUDY DESIGN

Two hundred four undernourished children 6 to 24 months old from an indigent peri-urban Peruvian town received either L-GG or placebo in flavored gelatin once daily, 6 days a week, for 15 months. Episodes of diarrhea were documented by daily home visits, and diagnostic studies were done in a subset of cases. Recovery of L-GG in stool from subjects and from family contacts was examined.

RESULTS

Subjects in the L-GG group had significantly fewer episodes of diarrhea (5.21 episodes diarrhea/child/year ['ecy'] L-GG group, 6. 02 ecy placebo group; P =.028). The decreased incidence of diarrhea in the L-GG group was greatest in the 18- to 29-month age group (P =. 004) and was largely limited to nonbreastfed children (Breastfed: 6. 59 ecy L-GG, 6.32 ecy placebo, P =.7; Nonbreastfed: 4.69 ecy L-GG, 5. 86 ecy placebo, P =.005). The duration of diarrhea episodes and the causes of diarrhea were similar in both groups, except adenovirus was more common in the placebo group.

CONCLUSION

L-GG supplementation may be useful as a prophylactic measure to control diarrhea in undernourished children at increased risk, especially nonbreastfed children in the toddler age group.