Browsing by Author "GUIRALDES, E"

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    COMPARISON OF AN ORAL RICE-BASED ELECTROLYTE SOLUTION AND A GLUCOSE-BASED ELECTROLYTE SOLUTION IN HOSPITALIZED INFANTS WITH DIARRHEAL DEHYDRATION
    (LIPPINCOTT WILLIAMS & WILKINS, 1995) GUIRALDES, E; TRIVINO, X; FIGUEROA, G; PARKER, M; GUTIERREZ, C; VASQUEZ, A; HARUN, A
    This randomized trial compared the efficacy of a rice-based (50 g/L) oral rehydration solution with the standard glucose-based WHO/UNICEF solution in the treatment of 100 hospitalized infants, ages 3-18 months, with acute dehydrating diarrhea. The main outcomes examined were stool output and duration of diarrhea. Patients were placed on a ''metabolic'' bed so that intake and losses could be measured accurately throughout the study. Overall, 89% of patients were successfully rehydrated orally; the rehydration failure rate was similar in the two groups and it was significantly associated with infection by specific E. coli serotypes. Stool output in the first 24 h was 11% lower in the rice group (112 versus 126 ml/kg), but this difference was not significant. Neither stool output in the second 24 h nor total stool output were different between groups. The median duration of diarrhea was 3.8 days in the rice group and 3.9 days in the glucose group (p = NS). Other (secondary) outcomes, such as fluid intake, urine output, emesis losses, weight change, and electrolyte balance were also similar between the two groups. Some evidence of carbohydrate malabsorption was detected in 61% of the rice group versus 45% of the glucose group (p = NS) and was not associated with any particular treatment outcome. These results show that a rice-based oral rehydration solution is as efficacious as, but not better than the standard glucose-based solution in the treatment of infants with acute dehydrating diarrhea not associated with cholera.
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    HELICOBACTER-PYLORI-ASSOCIATED GASTRODUODENAL DISEASE IN SYMPTOMATIC CHILEAN CHILDREN - DIAGNOSTIC-VALUE OF SEROLOGICAL ASSAY
    (LIPPINCOTT-RAVEN PUBL, 1995) HODGSON, MI; PANTOJA, T; LATORRE, JJ; VIAL, P; HENRIQUEZ, A; WENGER, J; PENA, Y; SIRI, MT; GUIRALDES, E
    A newly developed enzyme-linked immunosorbent assay (ELISA) IgG serological assay for the diagnosis of Helicobacter pylori infection was used recently in two epidemiological surveys in Chile. To evaluate the diagnostic efficacy of this assay in a local symptomatic pediatric population, we studied 70 school-age patients referred for upper gastrointestinal endoscopy because of complaints suggestive of gastroduodenal disease. Evidence for antral H. pylori infection was sought by three biopsy-related methods: culture, histology, and urease activity. IgG anti-H. pylori serum antibodies were deter mined by ELISA. Altogether, chronic antral gastritis was found in 55 patients and duodenal ulcers in nine; 11 subjects had normal histology. Sixty (86%) patients had H. pylori in the antrum. This group had significantly higher mean IgG optical density values when compared with the H. pylori-negative group (1.860 versus 0.669; p < 0.001). The sensitivity and specificity of the assay in detecting antral H. pylori were both 90%; the positive predictive value was 98% and the negative, 60%. Accuracy of the assay was superior in predicting the presence or absence of gastroduodenal lesions with a sensitivity of 96%, a specificity of 92%, a positive predictive value of 98%, and a negative predictive value of 86%. We conclude that the diagnostic efficiency of this assay renders it appropriate both to screen for H. pylori-associated gastroduodenal disease in individual patients and to be used in seroepidemiological surveys.
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    THE USE OF ORAL HYDRATION IN THE TREATMENT OF CHILDREN WITH ACUTE DIARRHEA IN PRIMARY CARE
    (1989) DELUCCHI, MA; GUIRALDES, E; HIRSCH, T; NUNEZ, N; SCHELE, C; GUTIERREZ, H; TORRESPEREYRA, J
    The use of oral rehydration solutions (ORSs) for treating children with diarrhea is spreading in hospitals in Chile, but it has not yet been incorporated into routine primary care programs. We sequentially compared the effectiveness of an ORS, with 60 mmol/L of Na+, with the standard treatment for diarrhea used in primary care centers, in a study with 285 diarrheal children under 2 years of age who consulted a health center in a low-income periurban neighborhood of Santiago. When compared with the control group, the patients treated with ORS showed a significantly higher percentage weight gain in the first few days after treatment was begun, required fewer medical visits for follow-up treatment at other facilities (8.4 vs. 15.5%; p < 0.05), and experienced fewer episodes of subsequent clinical dehydration that needed rehydration (oral or intravenous) in emergency services (2.8 vs. 10.6%; p < 0.01). In addition there were no metabolic complications in either group. Our results reinforce the feasibility, efficaciousness, and safety of programs that use ORS at the primary care level and indicate that this is an effective method of preventing metabolic complications and reducing hospitalizations of children with acute diarrhea.