Background: We have previously shown that a single dose of Inorganic nitrate supplementation incr... more Background: We have previously shown that a single dose of Inorganic nitrate supplementation increases peak oxygen consumption in heart failure with preserved ejection fraction (HFpEF). Inorganic n...
To assess the haemodynamic effects of organic vs. inorganic nitrate administration among patients... more To assess the haemodynamic effects of organic vs. inorganic nitrate administration among patients with heart failure with preserved ejection fraction (HFpEF).
Objective: Increased penetration of pulsatile power to the brain has been implicated in the patho... more Objective: Increased penetration of pulsatile power to the brain has been implicated in the pathogenesis of age-related cognitive dysfunction and dementia, a common comorbidity in patients with heart failure and preserved ejection fraction (HFpEF). However, there is a lack of knowledge on the effects of organic and inorganic nitrates administration in this population on the power carried by pressure and flow waves traveling through the proximal aorta and penetrating the carotid artery into the brain microvasculature. Approach: We assessed aortic and carotid hemodynamics non-invasively in two sub-studies: (1) at baseline and after administration of 0.4 mg of sublingual nitroglycerine (an organic nitrate; n = 26); and (2) in a randomized controlled trial of placebo (PB) versus inorganic nitrate administration (beetroot-juice (BR), 12.9 mmol NO 3 ; n = 16). Main results: Wave and hydraulic power analysis demonstrated that NTG increased total hydraulic power (from 5.68% at baseline to 8.62%, P = 0.001) and energy penetration (from 8.69% to 11.63%;P = 0.01) from the aorta to the carotid, while inorganic nitrate administration did not induce significant changes in aortic and carotid wave power (power: 5.49%PB versus 6.25%BR, P = 0.49; energy: 8.89%PB versus 10.65%BR, P = 0.27). Significance: Organic nitrates, but not inorganic nitrates, increase the amount of hydraulic energy transmitted into the carotid artery in subjects with HFpEF. These findings may have implications for the adverse effect profiles of these agents (such as the differential incidence of headaches) and for the pulsatile hemodynamic stress of the brain microvasculature in this patient population.
To assess the haemodynamic effects of organic vs. inorganic nitrate administration among patients... more To assess the haemodynamic effects of organic vs. inorganic nitrate administration among patients with heart failure with preserved ejection fraction (HFpEF).
Background: Heart Failure with Preserved Ejection Fraction (HFpEF) leads to significant impairmen... more Background: Heart Failure with Preserved Ejection Fraction (HFpEF) leads to significant impairments in exercise and quality of life (QOL). Inorganic nitrate has been shown to improve exercise in HF...
Background: large artery stiffness increases pulsatile afterload to the LV and is strongly predic... more Background: large artery stiffness increases pulsatile afterload to the LV and is strongly predictive of adverse outcomes in heart failure and reduced ejection fraction (HFrEF). The identification ...
Background: Travelers’ diarrhea is a common cause of illness in travelers. Antimicrobial resistan... more Background: Travelers’ diarrhea is a common cause of illness in travelers. Antimicrobial resistance is becoming a concern worldwide and resistance to enteropathogens is increasing some areas of the world. We did a retrospective analysis of the enteric pathogens causing travelers’ diarrhea that required hospitalization, determining the frequency of antibiotic resistance. Methods: Patients with travelers’ diarrhea hospitalized at the British American Hospital between 2000 and 2012 with positive stool cultures were included in the study. Charts were reviewed for demographic data and microbiologic results. Results: During our study period 352 travelers were hospitalized because of diarrhea. Of the 242 who had a stool culture done, 107 (44.2%) had a positive stool culture. The median age was 36.3 years (range: 18-72,SD 13.1). Most travelers were from North America (42%) and Europe (39%). More than one third of cases (35.5%) occurred during the summer months. The most common pathogen isol...
Background: Organic nitrate therapy reduces physical activity, without enhancing exercise capacit... more Background: Organic nitrate therapy reduces physical activity, without enhancing exercise capacity in heart failure with preserved ejection fraction (HFpEF). In contrast, inorganic nitrate therapy increases exercise capacity in HFpEF. We assessed the effects of organic and inorganic nitrates on: (1) wave reflections arriving at the central aorta; (2) Carotid bed vascular properties, in HFpEF. Methods: Carotid and aortic pressure-flow relations were studied before and after the administration of 0.4 mg of sublingual nitroglycerin (NTG; n=26). We also performed a placebo-controlled cross-over trial of a single dose of inorganic nitrate administration (12.9 mmil; n=16). Results: NTG did not consistently reduce wave reflections arriving at the proximal aorta across the first 3 harmonics (change in real part of reflection coefficient, 1st harmonic:-0.09; P =0.01; 2nd harmonic:-0.045, P =0.16; 3rd harmonic:+0.087; P =0.05), but produced profound vasodilation in the carotid territory, with a marked reduction in carotid bed vascular resistance (14092 vs. 11024 dynes·s/cm 5 ; P =0.007) and carotid artery characteristic impedance (2555 vs. 1663 dynes·s/cm 5 ; P =0.007). Inorganic nitrate administration, in contrast, produced consistent reductions in wave reflections across the first 3 harmonics (change in real part of reflection coefficient, 1st harmonic: -0.12; P =0.03; 2nd harmonic:-0.11, P =0.01; 3rd harmonic:-0.087; P =0.09) and did not reduce carotid bed vascular resistance (12819 vs. 13175 dynes·s/cm 5 ; P =0.80) or carotid artery characteristic impedance (2221 vs. 2138 dynes·s/cm 5 ; P =0.71). Conclusions: NTG produces marked vasodilation in the carotid circulation, with inconsistent effects on wave reflections arriving at the central aorta. Inorganic nitrate, in contrast, produces consistent reductions in wave reflections arriving at the central aorta, without significant cerebrovascular dilatation. These hemodynamic differences may underlie the different effects on exercise capacity and side effect profile of inorganic vs. organic nitrate in HFpEF.
Arterial wave reflections, which are increased in heart failure with preserved ejection fraction ... more Arterial wave reflections, which are increased in heart failure with preserved ejection fraction (HFpEF), impair diastolic function and promote pathologic myocardial remodeling. Organic nitrates reduce wave reflections acutely, but whether this is sustained chronically or affected by hydralazine is unknown. We randomized 44 subjects with HFpEF in a double-blinded fashion to isosorbide dinitrate (ISDN), ISDN+hydralazine (ISDN+Hydral), or placebo for 24 weeks. The primary endpoint was the change in reflection magnitude (RM, assessed with arterial tonometry and Doppler echocardiography). Secondary endpoints included the change in LV mass and fibrosis on cardiac MRI and six-minute walk (6MW) distance. ISDN reduced aortic characteristic impedance (Median baseline: 0.13 [IQR 0.12,0.17]; 3-month: 0.10 [0.06,0.17]; final: 0.09 [0.08,0.15] mmHg/mL/s, P =0.003) and forward wave amplitude (P f , median baseline: 48.7 [IQR 42.5,63.1], 3-month: 38.0 [25.8,49.0]; final: 40.4 [23.6,52.0] mmHg, P =...
3 Geosentinel site co-directors. Table 1. Epidemiologic Characteristics in Travelers presenting w... more 3 Geosentinel site co-directors. Table 1. Epidemiologic Characteristics in Travelers presenting with C.cayetanensis diarrhea S Session 206 Poster 1698 Introduction
Background: In developing countries self-prescription is a common practice, a practice that has t... more Background: In developing countries self-prescription is a common practice, a practice that has to be discouraged as this increases antibiotic resistance. Urinary tract infections (UTIs) caused by ESBL-producing bacteria are a growing problem worldwide. The aim of this study was to report the increased frequency of ESBL producing Escherichia coli strains isolated from urine cultures over a 10 year period. Methods: Bacterial identification was based on standard culture and biochemical characteristics of isolates. Antimicrobial susceptibility testing was performed by the Kirby-Bauer disc diffusion method at British American hospital in Lima Peru. Extended spectrum beta lactamase (ESBL) production was determined by the double disk approximation test and the Clinical and Laboratory Standards Institute (formerly NCCLS) confirmatory method. Results: From January 2002 to December 2011, 8487 positive urine cultures were found, of which 6269 (74%) were positive for E.coli. Of these, 770 (12....
Background: Older travelers are susceptible to develop travel and non-travel related conditions d... more Background: Older travelers are susceptible to develop travel and non-travel related conditions during their trips. There are only limited data describing older travelers hospitalized during travel. The aim of the present study was to investigate the epidemiologic, clinical characteristics and outcomes of older international travelers hospitalized at our institution. Methods: We retrospectively evaluated travelers from a database of hospitalized travelers seen at our institution between 2000 and 2005. All the available epidemiologic and clinical data was obtained from available medical records. We compared our patients aged 60 years of age or older (older group) with patients aged 14-45 years of age (younger reference group). Results: A total of 152 travelers aged 60 or older were hospitalized during the study period accounting for 27.4% of all the hospitalized travelers. The mean age was 69 in the older group (median 68, range 60-90y), and 30.5 (median 30, range 14-45y) in the youn...
La diarrea del viajero es una de las condiciones que con mayor frecuencia afecta a los viajeros d... more La diarrea del viajero es una de las condiciones que con mayor frecuencia afecta a los viajeros de países industrializados que visitan las zonas tropicales y subtropicales del planeta. El 20 a 50% de viajeros se van afectar por esta condición, siendo en ocasiones tan severa como para afectar los planes del viajero en la quinta parte de pacientes. El cuadro se manifiesta por la aparición de diarrea asociada a síntomas entéricos como dolor abdominal, nauseas, vómitos y en caso de diarrea inflamatoria fiebre y deposiciones con sangre. Entre los agentes etiológicos bacterianos más frecuentes están Escherichia coli enterotoxigénica, Salmonella, Shigella, entre otros agentes, aunque en cerca de la mitad de los casos no se aísla un agente etiológico. En caso de diarrea persistente debe descartarse parásitos y en zonas endémicas debe realizarse las pruebas especiales para descartar infección por Cyclospora cayetanensis. En pacientes con diarrea del viajero está indicado el manejo empírico con antibióticos, lo cual disminuye la duración de la enfermedad. En ausencia de fiebre o diarrea con sangre puede usarse loperamida. La prevención es importante en especialmente en pacientes de alto riesgo o en quienes sea importante que no se afecte el viaje.
Background: Cyclospora cayetanensis is a coccidian recognized as a cause of diarrhea and enteric ... more Background: Cyclospora cayetanensis is a coccidian recognized as a cause of diarrhea and enteric symptoms. Because it requires special stool staining it is not often looked for or recognized of as a cause of diarrhea in non-endemic areas. Travelers can also be affected by this enteric pathogen. The aim of the present study was to investigate the epidemiologic and clinical characteristics of international travelers with laboratory confirmation of Cyclospora cayetanensis at our institution Methods: We retrospectively evaluated travelers in whom C. cayetanensis was isolated between January 2004 and December 2009 at the British American Hospital. Stool samples were analyzed using the modified acid fast stain. Medical records of foreign travelers with positive samples were reviewed and the available epidemiologic and clinical information was recorded. Results: A total of 14 positive travelers with a diagnosis of C. cayetanensis were found. All cases occurred between October and May, with...
ABSTRACT Background: Older travelers are susceptible to develop travel and non-travel related con... more ABSTRACT Background: Older travelers are susceptible to develop travel and non-travel related conditions during their trips. There are only limited data describing older travelers hospitalized during travel. The aim of the present study was to investigate the epidemiologic, clinical characteristics and outcomes of older international travelers hospitalized at our institution. Methods: We retrospectively evaluated travelers from a database of hospitalized travelers seen at our institution between 2000 and 2005. All the available epidemiologic and clinical data was obtained from available medical records. We compared our patients aged 60 years of age or older (older group) with patients aged 14-45 years of age (younger reference group). Results: A total of 152 travelers aged 60 or older were hospitalized during the study period accounting for 27.4% of all the hospitalized travelers. The mean age was 69 in the older group (median 68, range 60-90y), and 30.5 (median 30, range 14-45y) in the younger group. Older patients were hospitalized for an average of 4.3 days (Median 3, range 1-23 ) compared with 3.2 days (median 2, range 1-30 ) for the younger group (P=0.01). There were 38 cases of Travelers’ diarrhea (25%), 18 trauma related problems (11.8%), 13 myocardial infarctions (8.6%), 8 cases of high altitude pulmonary edema (HAPE) (5.3%), 6 cases of congestive heart failure (3.9%) and 5 cases of unstable angina (3.3%) in the older group; compared with 105 travelers’ diarrhea (37%), 35 trauma related problems (12.3%), 19 appendicitis (6.7%) and 15 cases of HAPE (5.3%) among the younger group. There were more travel related conditions in the younger group (162, 57% versus 66, 43%; P=0.01), including dengue, Malaria and Hepatitis A. In the older traveler group 30 (19.7%) had to be transported to their home countries due to their illness, compared with 25 (8.8%) in the younger group (P=0.0002). Three patients died in the older group. Conclusion: Older ill travelers are more likely to suffer from life-threatening diseases and more frequently require to be transferred to their home countries. By contrast, they are less likely to develop travel related problems than younger adults, particularly travelers’ diarrhea.
Background: Travelers’ diarrhea is a common cause of illness in travelers. Antimicrobial resistan... more Background: Travelers’ diarrhea is a common cause of illness in travelers. Antimicrobial resistance is becoming a concern worldwide and resistance to enteropathogens is increasing some areas of the world. We did a retrospective analysis of the enteric pathogens causing travelers’ diarrhea that required hospitalization, determining the frequency of antibiotic resistance. Methods: Patients with travelers’ diarrhea hospitalized at the British American Hospital between 2000 and 2012 with positive stool cultures were included in the study. Charts were reviewed for demographic data and microbiologic results. Results: During our study period 352 travelers were hospitalized because of diarrhea. Of the 242 who had a stool culture done, 107 (44.2%) had a positive stool culture. The median age was 36.3 years (range: 18-72,SD 13.1). Most travelers were from North America (42%) and Europe (39%). More than one third of cases (35.5%) occurred during the summer months. The most common pathogen isol...
Background: In developing countries self-prescription is a common practice, a practice that has t... more Background: In developing countries self-prescription is a common practice, a practice that has to be discouraged as this increases antibiotic resistance. Urinary tract infections (UTIs) caused by ESBL-producing bacteria are a growing problem worldwide. The aim of this study was to report the increased frequency of ESBL producing Escherichia coli strains isolated from urine cultures over a 10 year period. Methods: Bacterial identification was based on standard culture and biochemical characteristics of isolates. Antimicrobial susceptibility testing was performed by the Kirby-Bauer disc diffusion method at British American hospital in Lima Peru. Extended spectrum beta lactamase (ESBL) production was determined by the double disk approximation test and the Clinical and Laboratory Standards Institute (formerly NCCLS) confirmatory method. Results: From January 2002 to December 2011, 8487 positive urine cultures were found, of which 6269 (74%) were positive for E.coli. Of these, 770 (12....
Background: We have previously shown that a single dose of Inorganic nitrate supplementation incr... more Background: We have previously shown that a single dose of Inorganic nitrate supplementation increases peak oxygen consumption in heart failure with preserved ejection fraction (HFpEF). Inorganic n...
To assess the haemodynamic effects of organic vs. inorganic nitrate administration among patients... more To assess the haemodynamic effects of organic vs. inorganic nitrate administration among patients with heart failure with preserved ejection fraction (HFpEF).
Objective: Increased penetration of pulsatile power to the brain has been implicated in the patho... more Objective: Increased penetration of pulsatile power to the brain has been implicated in the pathogenesis of age-related cognitive dysfunction and dementia, a common comorbidity in patients with heart failure and preserved ejection fraction (HFpEF). However, there is a lack of knowledge on the effects of organic and inorganic nitrates administration in this population on the power carried by pressure and flow waves traveling through the proximal aorta and penetrating the carotid artery into the brain microvasculature. Approach: We assessed aortic and carotid hemodynamics non-invasively in two sub-studies: (1) at baseline and after administration of 0.4 mg of sublingual nitroglycerine (an organic nitrate; n = 26); and (2) in a randomized controlled trial of placebo (PB) versus inorganic nitrate administration (beetroot-juice (BR), 12.9 mmol NO 3 ; n = 16). Main results: Wave and hydraulic power analysis demonstrated that NTG increased total hydraulic power (from 5.68% at baseline to 8.62%, P = 0.001) and energy penetration (from 8.69% to 11.63%;P = 0.01) from the aorta to the carotid, while inorganic nitrate administration did not induce significant changes in aortic and carotid wave power (power: 5.49%PB versus 6.25%BR, P = 0.49; energy: 8.89%PB versus 10.65%BR, P = 0.27). Significance: Organic nitrates, but not inorganic nitrates, increase the amount of hydraulic energy transmitted into the carotid artery in subjects with HFpEF. These findings may have implications for the adverse effect profiles of these agents (such as the differential incidence of headaches) and for the pulsatile hemodynamic stress of the brain microvasculature in this patient population.
To assess the haemodynamic effects of organic vs. inorganic nitrate administration among patients... more To assess the haemodynamic effects of organic vs. inorganic nitrate administration among patients with heart failure with preserved ejection fraction (HFpEF).
Background: Heart Failure with Preserved Ejection Fraction (HFpEF) leads to significant impairmen... more Background: Heart Failure with Preserved Ejection Fraction (HFpEF) leads to significant impairments in exercise and quality of life (QOL). Inorganic nitrate has been shown to improve exercise in HF...
Background: large artery stiffness increases pulsatile afterload to the LV and is strongly predic... more Background: large artery stiffness increases pulsatile afterload to the LV and is strongly predictive of adverse outcomes in heart failure and reduced ejection fraction (HFrEF). The identification ...
Background: Travelers’ diarrhea is a common cause of illness in travelers. Antimicrobial resistan... more Background: Travelers’ diarrhea is a common cause of illness in travelers. Antimicrobial resistance is becoming a concern worldwide and resistance to enteropathogens is increasing some areas of the world. We did a retrospective analysis of the enteric pathogens causing travelers’ diarrhea that required hospitalization, determining the frequency of antibiotic resistance. Methods: Patients with travelers’ diarrhea hospitalized at the British American Hospital between 2000 and 2012 with positive stool cultures were included in the study. Charts were reviewed for demographic data and microbiologic results. Results: During our study period 352 travelers were hospitalized because of diarrhea. Of the 242 who had a stool culture done, 107 (44.2%) had a positive stool culture. The median age was 36.3 years (range: 18-72,SD 13.1). Most travelers were from North America (42%) and Europe (39%). More than one third of cases (35.5%) occurred during the summer months. The most common pathogen isol...
Background: Organic nitrate therapy reduces physical activity, without enhancing exercise capacit... more Background: Organic nitrate therapy reduces physical activity, without enhancing exercise capacity in heart failure with preserved ejection fraction (HFpEF). In contrast, inorganic nitrate therapy increases exercise capacity in HFpEF. We assessed the effects of organic and inorganic nitrates on: (1) wave reflections arriving at the central aorta; (2) Carotid bed vascular properties, in HFpEF. Methods: Carotid and aortic pressure-flow relations were studied before and after the administration of 0.4 mg of sublingual nitroglycerin (NTG; n=26). We also performed a placebo-controlled cross-over trial of a single dose of inorganic nitrate administration (12.9 mmil; n=16). Results: NTG did not consistently reduce wave reflections arriving at the proximal aorta across the first 3 harmonics (change in real part of reflection coefficient, 1st harmonic:-0.09; P =0.01; 2nd harmonic:-0.045, P =0.16; 3rd harmonic:+0.087; P =0.05), but produced profound vasodilation in the carotid territory, with a marked reduction in carotid bed vascular resistance (14092 vs. 11024 dynes·s/cm 5 ; P =0.007) and carotid artery characteristic impedance (2555 vs. 1663 dynes·s/cm 5 ; P =0.007). Inorganic nitrate administration, in contrast, produced consistent reductions in wave reflections across the first 3 harmonics (change in real part of reflection coefficient, 1st harmonic: -0.12; P =0.03; 2nd harmonic:-0.11, P =0.01; 3rd harmonic:-0.087; P =0.09) and did not reduce carotid bed vascular resistance (12819 vs. 13175 dynes·s/cm 5 ; P =0.80) or carotid artery characteristic impedance (2221 vs. 2138 dynes·s/cm 5 ; P =0.71). Conclusions: NTG produces marked vasodilation in the carotid circulation, with inconsistent effects on wave reflections arriving at the central aorta. Inorganic nitrate, in contrast, produces consistent reductions in wave reflections arriving at the central aorta, without significant cerebrovascular dilatation. These hemodynamic differences may underlie the different effects on exercise capacity and side effect profile of inorganic vs. organic nitrate in HFpEF.
Arterial wave reflections, which are increased in heart failure with preserved ejection fraction ... more Arterial wave reflections, which are increased in heart failure with preserved ejection fraction (HFpEF), impair diastolic function and promote pathologic myocardial remodeling. Organic nitrates reduce wave reflections acutely, but whether this is sustained chronically or affected by hydralazine is unknown. We randomized 44 subjects with HFpEF in a double-blinded fashion to isosorbide dinitrate (ISDN), ISDN+hydralazine (ISDN+Hydral), or placebo for 24 weeks. The primary endpoint was the change in reflection magnitude (RM, assessed with arterial tonometry and Doppler echocardiography). Secondary endpoints included the change in LV mass and fibrosis on cardiac MRI and six-minute walk (6MW) distance. ISDN reduced aortic characteristic impedance (Median baseline: 0.13 [IQR 0.12,0.17]; 3-month: 0.10 [0.06,0.17]; final: 0.09 [0.08,0.15] mmHg/mL/s, P =0.003) and forward wave amplitude (P f , median baseline: 48.7 [IQR 42.5,63.1], 3-month: 38.0 [25.8,49.0]; final: 40.4 [23.6,52.0] mmHg, P =...
3 Geosentinel site co-directors. Table 1. Epidemiologic Characteristics in Travelers presenting w... more 3 Geosentinel site co-directors. Table 1. Epidemiologic Characteristics in Travelers presenting with C.cayetanensis diarrhea S Session 206 Poster 1698 Introduction
Background: In developing countries self-prescription is a common practice, a practice that has t... more Background: In developing countries self-prescription is a common practice, a practice that has to be discouraged as this increases antibiotic resistance. Urinary tract infections (UTIs) caused by ESBL-producing bacteria are a growing problem worldwide. The aim of this study was to report the increased frequency of ESBL producing Escherichia coli strains isolated from urine cultures over a 10 year period. Methods: Bacterial identification was based on standard culture and biochemical characteristics of isolates. Antimicrobial susceptibility testing was performed by the Kirby-Bauer disc diffusion method at British American hospital in Lima Peru. Extended spectrum beta lactamase (ESBL) production was determined by the double disk approximation test and the Clinical and Laboratory Standards Institute (formerly NCCLS) confirmatory method. Results: From January 2002 to December 2011, 8487 positive urine cultures were found, of which 6269 (74%) were positive for E.coli. Of these, 770 (12....
Background: Older travelers are susceptible to develop travel and non-travel related conditions d... more Background: Older travelers are susceptible to develop travel and non-travel related conditions during their trips. There are only limited data describing older travelers hospitalized during travel. The aim of the present study was to investigate the epidemiologic, clinical characteristics and outcomes of older international travelers hospitalized at our institution. Methods: We retrospectively evaluated travelers from a database of hospitalized travelers seen at our institution between 2000 and 2005. All the available epidemiologic and clinical data was obtained from available medical records. We compared our patients aged 60 years of age or older (older group) with patients aged 14-45 years of age (younger reference group). Results: A total of 152 travelers aged 60 or older were hospitalized during the study period accounting for 27.4% of all the hospitalized travelers. The mean age was 69 in the older group (median 68, range 60-90y), and 30.5 (median 30, range 14-45y) in the youn...
La diarrea del viajero es una de las condiciones que con mayor frecuencia afecta a los viajeros d... more La diarrea del viajero es una de las condiciones que con mayor frecuencia afecta a los viajeros de países industrializados que visitan las zonas tropicales y subtropicales del planeta. El 20 a 50% de viajeros se van afectar por esta condición, siendo en ocasiones tan severa como para afectar los planes del viajero en la quinta parte de pacientes. El cuadro se manifiesta por la aparición de diarrea asociada a síntomas entéricos como dolor abdominal, nauseas, vómitos y en caso de diarrea inflamatoria fiebre y deposiciones con sangre. Entre los agentes etiológicos bacterianos más frecuentes están Escherichia coli enterotoxigénica, Salmonella, Shigella, entre otros agentes, aunque en cerca de la mitad de los casos no se aísla un agente etiológico. En caso de diarrea persistente debe descartarse parásitos y en zonas endémicas debe realizarse las pruebas especiales para descartar infección por Cyclospora cayetanensis. En pacientes con diarrea del viajero está indicado el manejo empírico con antibióticos, lo cual disminuye la duración de la enfermedad. En ausencia de fiebre o diarrea con sangre puede usarse loperamida. La prevención es importante en especialmente en pacientes de alto riesgo o en quienes sea importante que no se afecte el viaje.
Background: Cyclospora cayetanensis is a coccidian recognized as a cause of diarrhea and enteric ... more Background: Cyclospora cayetanensis is a coccidian recognized as a cause of diarrhea and enteric symptoms. Because it requires special stool staining it is not often looked for or recognized of as a cause of diarrhea in non-endemic areas. Travelers can also be affected by this enteric pathogen. The aim of the present study was to investigate the epidemiologic and clinical characteristics of international travelers with laboratory confirmation of Cyclospora cayetanensis at our institution Methods: We retrospectively evaluated travelers in whom C. cayetanensis was isolated between January 2004 and December 2009 at the British American Hospital. Stool samples were analyzed using the modified acid fast stain. Medical records of foreign travelers with positive samples were reviewed and the available epidemiologic and clinical information was recorded. Results: A total of 14 positive travelers with a diagnosis of C. cayetanensis were found. All cases occurred between October and May, with...
ABSTRACT Background: Older travelers are susceptible to develop travel and non-travel related con... more ABSTRACT Background: Older travelers are susceptible to develop travel and non-travel related conditions during their trips. There are only limited data describing older travelers hospitalized during travel. The aim of the present study was to investigate the epidemiologic, clinical characteristics and outcomes of older international travelers hospitalized at our institution. Methods: We retrospectively evaluated travelers from a database of hospitalized travelers seen at our institution between 2000 and 2005. All the available epidemiologic and clinical data was obtained from available medical records. We compared our patients aged 60 years of age or older (older group) with patients aged 14-45 years of age (younger reference group). Results: A total of 152 travelers aged 60 or older were hospitalized during the study period accounting for 27.4% of all the hospitalized travelers. The mean age was 69 in the older group (median 68, range 60-90y), and 30.5 (median 30, range 14-45y) in the younger group. Older patients were hospitalized for an average of 4.3 days (Median 3, range 1-23 ) compared with 3.2 days (median 2, range 1-30 ) for the younger group (P=0.01). There were 38 cases of Travelers’ diarrhea (25%), 18 trauma related problems (11.8%), 13 myocardial infarctions (8.6%), 8 cases of high altitude pulmonary edema (HAPE) (5.3%), 6 cases of congestive heart failure (3.9%) and 5 cases of unstable angina (3.3%) in the older group; compared with 105 travelers’ diarrhea (37%), 35 trauma related problems (12.3%), 19 appendicitis (6.7%) and 15 cases of HAPE (5.3%) among the younger group. There were more travel related conditions in the younger group (162, 57% versus 66, 43%; P=0.01), including dengue, Malaria and Hepatitis A. In the older traveler group 30 (19.7%) had to be transported to their home countries due to their illness, compared with 25 (8.8%) in the younger group (P=0.0002). Three patients died in the older group. Conclusion: Older ill travelers are more likely to suffer from life-threatening diseases and more frequently require to be transferred to their home countries. By contrast, they are less likely to develop travel related problems than younger adults, particularly travelers’ diarrhea.
Background: Travelers’ diarrhea is a common cause of illness in travelers. Antimicrobial resistan... more Background: Travelers’ diarrhea is a common cause of illness in travelers. Antimicrobial resistance is becoming a concern worldwide and resistance to enteropathogens is increasing some areas of the world. We did a retrospective analysis of the enteric pathogens causing travelers’ diarrhea that required hospitalization, determining the frequency of antibiotic resistance. Methods: Patients with travelers’ diarrhea hospitalized at the British American Hospital between 2000 and 2012 with positive stool cultures were included in the study. Charts were reviewed for demographic data and microbiologic results. Results: During our study period 352 travelers were hospitalized because of diarrhea. Of the 242 who had a stool culture done, 107 (44.2%) had a positive stool culture. The median age was 36.3 years (range: 18-72,SD 13.1). Most travelers were from North America (42%) and Europe (39%). More than one third of cases (35.5%) occurred during the summer months. The most common pathogen isol...
Background: In developing countries self-prescription is a common practice, a practice that has t... more Background: In developing countries self-prescription is a common practice, a practice that has to be discouraged as this increases antibiotic resistance. Urinary tract infections (UTIs) caused by ESBL-producing bacteria are a growing problem worldwide. The aim of this study was to report the increased frequency of ESBL producing Escherichia coli strains isolated from urine cultures over a 10 year period. Methods: Bacterial identification was based on standard culture and biochemical characteristics of isolates. Antimicrobial susceptibility testing was performed by the Kirby-Bauer disc diffusion method at British American hospital in Lima Peru. Extended spectrum beta lactamase (ESBL) production was determined by the double disk approximation test and the Clinical and Laboratory Standards Institute (formerly NCCLS) confirmatory method. Results: From January 2002 to December 2011, 8487 positive urine cultures were found, of which 6269 (74%) were positive for E.coli. Of these, 770 (12....
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