Julie Parsonnet
Stanford University, Medicine, Faculty Member
Research Interests:
In a cross-sectional study of the 1991 Peruvian cholera epidemic, Vibrio cholerae 01 infection was associated with Helicobacter pylori infection, particularly in young children. These data support the hypothesis that hypochlorhydria... more
In a cross-sectional study of the 1991 Peruvian cholera epidemic, Vibrio cholerae 01 infection was associated with Helicobacter pylori infection, particularly in young children. These data support the hypothesis that hypochlorhydria induced by H pylori is important in the pathogenesis of diarrhoeal disease.
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Research Interests: Statistics, Epidemiology, Japan, Helicobacter pylori, Adolescent, and 19 moreWar, Humans, Child, Female, Male, Infant, Newborn Infant, Sanitation, Social Conditions, Aged, Prevalence, Middle Aged, Adult, Public health systems and services research, Analysis of Variance, Retrospective Studies, Age Factors, Cohort Studies, and Child preschool
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Research Interests: Algorithms, Pediatrics, Peru, Helicobacter pylori, Diarrhea, and 16 moreHumans, Child, Poisson regression, Cohort Study, Infant, Incidence, Risk factors, Epidemiology of Helicobacter pylori infection, Analysis of Variance, Risk Factors, Cross-Over Studies, H Pylori, Confidence Interval, Cohort Studies, Acute Disease, and Child preschool
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Research Interests: Gastroenterology, Risk assessment, Helicobacter pylori, Humans, Female, and 14 moreMale, Bacteria, Epidemiology of Helicobacter pylori infection, Clinical Sciences, Aged, Middle Aged, Risk Factor, Precancerous Conditions, Adult, Gut, Risk Assessment, Gastroesophageal Reflux, Adenocarcinoma, and Case Control Studies
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In Chiapas, Mexico, diarrheal disease causes the majority of all deaths in children under the age of five. Treatment of childhood diarrhea may be influenced by local beliefs and cultural practices. Few studies have attempted to... more
In Chiapas, Mexico, diarrheal disease causes the majority of all deaths in children under the age of five. Treatment of childhood diarrhea may be influenced by local beliefs and cultural practices. Few studies have attempted to quantitatively evaluate health seeking behavior (HSB) for diarrheal diseases in indigenous communities, while controlling for potential confounding factors such as parental education or socioeconomic status. A rapid ethnographic survey was conducted in Nabenchauc, Chiapas, to determine hypothetical HSB patterns for each of four major types of childhood diarrhea. Additionally, we examined the actual HSB for the last episode of childhood diarrheal illness within the household.One hundred households participated in the survey; 94 households with children <5 years old reported a mean of 1.9 diarrheal episodes during the preceding month. Households reported using a mean of 1.3 types of in-home remedies. Oral rehydration therapy (ORT) was used in <2% of the 368 HSB patterns elicited for the four types of diarrhea. HSB patterns utilized an eclectic combination of traditional, allopathic, local and distant health care options. A mean of 2.5 outside-the-home health care options were reported for each diarrheal type; the local grocery store was reported in 245 (67%) of the hypothetical HSB patterns and as a first option in 199 (54%). Maternal and/or paternal education had little impact on hypothetical HSB. Households with lower SES were more likely to report using local grocery stores as a first option and were less likely to use options outside the village.The rapid ethnographic survey approach allows for assessment of changes in the approach to health care option utilization in cultures incorporating new health care paradigms. Public health interventions targeting local stores may lead to increased use of ORT, thereby potentially reducing early morbidity and mortality due to childhood diarrhea.
Research Interests: Sociology, Anthropology, Research Methodology, Health Care, Treatment, and 27 moreDeveloping Countries, Population Dynamics, Health, Public Health, Medicine, Mexico, Diarrhea, Social Science & Medicine, Population, Humans, Child, Surveys, Female, Male, Cultural Practice, Socioeconomic Status, Adult, Public health systems and services research, Ethnic Group, Indigenous Communities, MEXICO, Fluid Therapy, Survivorship, Social Science, Quantitative Evaluation, Nino, and Target Localization(Developing Countries, Population Dynamics, Health, Public Health, Medicine, Mexico, Diarrhea, Social Science & Medicine, Population, Humans, Child, Surveys, Female, Male, Cultural Practice, Socioeconomic Status, Adult, Public health systems and services research, Ethnic Group, Indigenous Communities, MEXICO, Fluid Therapy, Survivorship, Social Science, Quantitative Evaluation, Nino, and Target Localization)
(Developing Countries, Population Dynamics, Health, Public Health, Medicine, Mexico, Diarrhea, Social Science & Medicine, Population, Humans, Child, Surveys, Female, Male, Cultural Practice, Socioeconomic Status, Adult, Public health systems and services research, Ethnic Group, Indigenous Communities, MEXICO, Fluid Therapy, Survivorship, Social Science, Quantitative Evaluation, Nino, and Target Localization)
Research Interests: Medical Microbiology, Health Education, Malaria, Evaluation, Developing Countries, and 19 moreHealth, Public Health, Adolescent, Mali, Insecticides, Humans, Needs Assessment, Standard Deviation, Female, Male, Educational Change, Randomised Controlled Trial, Mosquito Control, Aged, Middle Aged, Adult, Randomized Controlled Trial, Interventions, and Control Group
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Background. Prophylactic vaccination has been suggested as a better strategy than antibiotics to control Helicobacter pylori infection. We evaluated the cost-effectiveness (CE) of H. pylori vaccine development and use in the United States... more
Background. Prophylactic vaccination has been suggested as a better strategy than antibiotics to control Helicobacter pylori infection. We evaluated the cost-effectiveness (CE) of H. pylori vaccine development and use in the United States and developing countries, using a method developed by the Institute of Medicine (IOM).Methods. The IOM model includes costs of vaccine development, vaccination program, and averted medical treatments; morbidity and mortality prevented; expected efficacy and use; and proportion of disease that is vaccine-preventable. The model employs infant mortality equivalence (IME) to estimate disease burden; with IME, the societal cost of infection-related morbidity is expressed as equivalent to a specific rate of infant deaths. We tested model assumptions by univariate sensitivity analyses.Results. In the United States, H. pylori vaccine would save 1,176 IME and would cost $58.71 million (1997 dollars) annually, yielding a CE ratio of $49,932 per IME; the health benefits would exceed all IOM-studied vaccines, even when efficacy dropped to 55%. H. pylori vaccine could be cost-saving if priced at less than $60 per course. In developing countries, H. pylori vaccine would rank unfavorably both in terms of health benefits (33,518 IME) and costs ($5,254 million). None of the changes in assumptions improved significantly the H. pylori vaccine's ranking relative to other IOM-studied vaccines.Conclusions. Compared to other vaccines evaluated in the IOM study, H. pylori vaccine warrants public resource allocation for accelerated development and use in the United States but not for use in developing countries.
Research Interests: Developing Countries, Helicobacter pylori, Adolescent, Biological Sciences, Humans, and 13 moreChild, Cost Effectiveness Analysis, United States, Infant, Vaccination, Aged, Middle Aged, Adult, Institute of Environmental Medicine, Cost Benefit Analysis, Peptic Ulcer, Immunization Programs, and Child preschool
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Background: Helicobacterpylori vaccines, which have been suggested as promising interventions to control infection, are under development. We sought to quantify the potential population impact of a prophylactic H. pylori vaccine. Methods:... more
Background: Helicobacterpylori vaccines, which have been suggested as promising interventions to control infection, are under development. We sought to quantify the potential population impact of a prophylactic H. pylori vaccine. Methods: We developed a mathematical model that compartmentalized the population according to age, infection status and clinical state. A proportion of individuals was assumed to acquire infection and develop gastritis, duodenal ulcer (DU), chronic atrophic gastritis and gastric cancer (GC). We first simulated the model without vaccine intervention, to obtain estimates of H. pylori prevalence, and GC and DU incidences based on intrinsic dynamics. We then incorporated a prophylactic vaccine (80% efficacy, lifetime protection, 80% coverage) targeting all infants. We tested vaccination programs over unlimited as well as limited time spans. Analyses were performed for the US, Japan and a prototypical developing country. Results: In the US, our model predicted a decrease in H. pylori prevalence from 12.0% in 2010 to 4.2% in 2100 without intervention. With 10 years of vaccination beginning in 2010, prevalence would decrease to 0.7% by year 2100. In the same period, incidence of H. pylori-attributable GC would decrease from 4.5 to 0.4 per 100,000 with vaccine (compared to 1.3 per 100,000 without vaccine). Incidence of H. pylori-attributable DU would decrease from 33.3 to 2.5 per 100,000 with vaccine (compared to 12.2 per 100,000 without vaccine). In Japan, incidence of H. pylori-attributable GC would decrease from 17.6 to 1.0 per 100,000 after 10 years of vaccination (compared to 3.0 per 100,000 without vaccine). In a prototypical developing country, after 10 years of vaccination, H. pylori-attributable GC would decrease from 31.8 to 22.5 per 100,000 by 2090, returning to the original level by mid-2100s. Under continuous vaccination, it would decrease to 5.8 per 100,000 by 2100. Interpretation: In the US and Japan, a 10-year vaccination program would confer almost the same reduction in H. pylori and associated diseases as a vaccination effort that extends beyond 10 years. In developing countries, a continuous vaccination effort would be required to eliminate the pathogen and its associated diseases.
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Research Interests: Eastern Europe, Africa, Adolescent, Refugees, Middle East, and 19 moreCalifornia, Humans, Child, United States, Female, Animals, Asia, Male, Infant, Risk factors, Newborn Infant, Prevalence, Adult, Feces, Risk Factors, Helminths, Helminthiasis, The American, and Child preschool(California, Humans, Child, United States, Female, Animals, Asia, Male, Infant, Risk factors, Newborn Infant, Prevalence, Adult, Feces, Risk Factors, Helminths, Helminthiasis, The American, and Child preschool)
(California, Humans, Child, United States, Female, Animals, Asia, Male, Infant, Risk factors, Newborn Infant, Prevalence, Adult, Feces, Risk Factors, Helminths, Helminthiasis, The American, and Child preschool)
Research Interests: Epidemiology, Developing Countries, Infectious Diseases, Helicobacter pylori, Biological Sciences, and 21 moreCalifornia, Serology, Race, Humans, Female, Male, Bacteria, Young Adult, Ethnic Groups, African Americans, Prevalence, Developed Countries, Risk Factor, Adult, Ethnic Group, Age Factors, European Continental Ancestry Group, Cross Sectional Studies, Enzyme Linked Immunosorbent Assay, immunoglobulin G, and Socioeconomic Factors(California, Serology, Race, Humans, Female, Male, Bacteria, Young Adult, Ethnic Groups, African Americans, Prevalence, Developed Countries, Risk Factor, Adult, Ethnic Group, Age Factors, European Continental Ancestry Group, Cross Sectional Studies, Enzyme Linked Immunosorbent Assay, immunoglobulin G, and Socioeconomic Factors)
(California, Serology, Race, Humans, Female, Male, Bacteria, Young Adult, Ethnic Groups, African Americans, Prevalence, Developed Countries, Risk Factor, Adult, Ethnic Group, Age Factors, European Continental Ancestry Group, Cross Sectional Studies, Enzyme Linked Immunosorbent Assay, immunoglobulin G, and Socioeconomic Factors)
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Although most of Helicobacter pylori–related diseases are associated with male gender, the role of gender as a risk factor for H. pylori infection is still debated. To assess the true association between H. pylori and gender, we conducted... more
Although most of Helicobacter pylori–related diseases are associated with male gender, the role of gender as a risk factor for H. pylori infection is still debated. To assess the true association between H. pylori and gender, we conducted a meta-analysis of large, population-based studies where the measure of association had been adjusted at least for age and socioeconomic status, and obtained primary data from authors when information on gender associations were not presented. In 18 adult populations, the test of heterogeneity was not significant and male gender was significantly associated with H. pylori infection (summary odds ratio [OR] 1.16 [95% confidence interval (CI) 1.11, 1.22]). In 10 pediatric populations, the test of heterogeneity was of borderline significance, and the summary OR computed using a random effect model was close to 1 (summary OR 1.03 [95% CI 0.91, 1.17]). This study confirms the male predominance of H. pylori infection in adults as a global and homogeneous phenomenon; such predominance is not apparent in children. Differential antibiotic exposure or differential protective immunity between genders may explain the different results observed between children and adult studies.
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Research Interests: Microbiology, Aging, Helicobacter pylori, Clinical Microbiology, Social Housing, and 21 moreBiological Sciences, Water Supply, Humans, Developing Country, Female, Animals, Male, Bacteria, DNA fingerprinting, Epidemiology of Helicobacter pylori infection, Gram-negative bacteria, Age of Acquisition, First Year, Rhesus macaques, Young Children, Macaca Mulatta, Birth Cohort, Cross sectional Study, Peptic Ulcer Disease, H Pylori, and Gastric mucosa(Biological Sciences, Water Supply, Humans, Developing Country, Female, Animals, Male, Bacteria, DNA fingerprinting, Epidemiology of Helicobacter pylori infection, Gram-negative bacteria, Age of Acquisition, First Year, Rhesus macaques, Young Children, Macaca Mulatta, Birth Cohort, Cross sectional Study, Peptic Ulcer Disease, H Pylori, and Gastric mucosa)
(Biological Sciences, Water Supply, Humans, Developing Country, Female, Animals, Male, Bacteria, DNA fingerprinting, Epidemiology of Helicobacter pylori infection, Gram-negative bacteria, Age of Acquisition, First Year, Rhesus macaques, Young Children, Macaca Mulatta, Birth Cohort, Cross sectional Study, Peptic Ulcer Disease, H Pylori, and Gastric mucosa)
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Research Interests: Helicobacter pylori, Chlamydia pneumoniae, Multivariate Analysis, Humans, Female, and 17 moreMale, Cytomegalovirus, Control Design, Risk factors, Socioeconomic Status, Aged, Middle Aged, C reactive protein, Myocardial Infarction, Adult, Odds ratio, Risk Factors, Cytomegalovirus Infections, Coronary Artery Disease, Prospective Study, H Pylori, and Case Control Studies
Atrophy and intestinal metaplasia (IM) are preneoplastic gastric lesions associated with Helicobacter pylori infection. Atrophy and IM are usually found together; however, the association between increasing degrees of severity of both... more
Atrophy and intestinal metaplasia (IM) are preneoplastic gastric lesions associated with Helicobacter pylori infection. Atrophy and IM are usually found together; however, the association between increasing degrees of severity of both atrophy and IM has not been evaluated completely. Two pathologists graded atrophy and IM using the visual analog scale of the Sydney classification in gastric biopsies from 368 H pylori-infected patients. Extent of IM also included determining the number of specimens affected. We then correlated the degree of atrophy with the degree and number of specimens affected with IM by calculating relative risks (RR) and 95% confidence intervals (95% CI). The mean number of biopsies examined from each patient was 6.5. Atrophy and IM were found more frequently in the antrum (85% and 75% of biopsies, respectively). One hundred thirty-eight patients had a combination of atrophy and IM, 48 had IM only, and 89 had atrophy only. Fifty-three subjects had mild atrophy and IM (RR = 1.57; 95% CI 1.2-2.1), 69 had moderate atrophy and IM (RR = 1.86; 95% CI 1.9-2.4), and 16 had marked atrophy and IM (RR = 2.47; 95% CI 1.8-3.3). The median number of biopsy specimens with IM increased from 0 in subjects with no atrophy to 3 in subjects with severe atrophy. The degree of IM correlated with the degree of atrophy; the median degree was 0.6 in subjects with no atrophy and increased to 2.32 in those with severe atrophy. Our data suggest that higher degrees of IM in an individual specimen and increasing number of specimens with IM are associated with moderate or severe degrees of atrophy. HUMPATHOL32:31-35. This is a US Government work. There are no restrictions on its use.
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The ability to understand and integrate new knowledge into clinical practice is a necessary quality of good physicians. Student participation in in-depth scholarship could enhance this skill in physicians while also creating a larger... more
The ability to understand and integrate new knowledge into clinical practice is a necessary quality of good physicians. Student participation in in-depth scholarship could enhance this skill in physicians while also creating a larger cadre of physician-scientists prepared to advance the field of medicine. However, because no definitive data exist demonstrating that in-depth scholarship in medical school leads to improved patient care or to productive academic careers, whether such scholarship should be required as part of the medical school curriculum is unclear. In this article, the authors present both sides of this debate. Theoretical benefits to students of a required scholarly program include closer mentorship by individual faculty, enhanced capabilities in critical interpretation of research findings, and increased confidence to investigate conundrums encountered in clinical care. Society may also benefit by having physicians available to create and apply new knowledge related to biomedicine. These theoretical benefits must be balanced, however, by pragmatic considerations of required scholarly projects including their impact on medical school applications, their effect on the medical curriculum, their costs, the availability of mentors, and their effects on the school&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s educational culture.
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Many medical curricula now include programs that provide students with opportunities for scholarship beyond that provided by their traditional, core curricula. These scholarly concentration (SC) programs vary greatly in focus and... more
Many medical curricula now include programs that provide students with opportunities for scholarship beyond that provided by their traditional, core curricula. These scholarly concentration (SC) programs vary greatly in focus and structure, but they share the goal of producing physicians with improved analytic, creative, and critical-thinking skills. In this article, the authors explore models of both required and elective SC programs. They gathered information through a review of medical school Web sites and direct contact with representatives of individual programs. Additionally, they discuss in-depth the SC programs of the Warren Alpert Medical School of Brown University; the University of South Florida College of Medicine; the University of California, San Francisco; and Stanford University School of Medicine. The authors describe each program&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s focus, participation, duration, centralization, capstone requirement, faculty involvement, and areas of concentration. Established to address a variety of challenges in the U.S. medical education system, these four programs provide an array of possible models for schools that are considering the establishment of an SC program. Although data on the impact of SC programs are lacking, the authors believe that this type of program has the potential to significantly impact the education of medical students through scholarly, in-depth inquiry and longitudinal faculty mentorship.
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Helicobacter pylori is transmitted within households and high concordance is observed among siblings. To better understand the contributions of close interpersonal contact and family relatedness to transmission, we compared concordance of... more
Helicobacter pylori is transmitted within households and high concordance is observed among siblings. To better understand the contributions of close interpersonal contact and family relatedness to transmission, we compared concordance of H. pylori infection among 241 sibling and non-sibling children aged 2-18 years in 68, predominantly low-income, Hispanic households with at least two nuclear families. Prevalence of H. pylori infection was 24%. Compared to children with no infected siblings or non-siblings and adjusting for age, odds of H. pylori infection were 1.2 (95% CI 0.52-2.9), 3.2 (95% CI 1.14-9.1), and 9.4 (95% CI 3.1-28.5) for children residing with at least one infected non-sibling, one infected sibling, and with at least one infected sibling and non-sibling, respectively. The study further implicates intersibling transmission as a pathway for H. pylori infection in childhood. In addition, living with a non-sibling in extended-family homes may contribute to infection risk but only in households with prevalent H. pylori infection within all family groups.
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Background. Strains of Helicobacter pylori that express the CagA protein are associated with a threefold increased gastric cancer risk as compared to H. pylori strains that do not express CagA. Screening and treatment only for CagA... more
Background. Strains of Helicobacter pylori that express the CagA protein are associated with a threefold increased gastric cancer risk as compared to H. pylori strains that do not express CagA. Screening and treatment only for CagA antibodies should target those individuals at highest gastric cancer risk while reducing the number of patients requiring antibiotics. We compared the costs and benefits of screening asymptomatic 50-year-old individuals for CagA, screening for all H. pylori strains, and no screening, both in the United States and abroad.Materials and Methods. We employed Markov cost-effectiveness analysis using data from randomized, case-control, and cohort studies.Results. In the United States, CagA screening would result in 1.5 million fewer antibiotic treatments but would prevent 1,400 fewer gastric cancers than would screening for all H. pylori. The incremental cost-effectiveness of CagA screening is $23,900 per life-year gained; for H. pylori screening, it is $25,100. Screening in countries with epidemiological characteristics similar to those of Colombia, Finland, and Japan costs less than $5,000 per life-year gained, and the difference between CagA and H. pylori screening is smaller than that in the United States.Conclusions. Screening only for CagA-positive H. pylori is not substantially better than is screening for all H. pylori, either in the United States nor abroad. Screening is substantially more cost-effective outside the United States. Whether population screening is justified, however, is uncertain pending conclusive data regarding the reduction in gastric cancer risk from antibiotics.
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Gastric cancer is the second most common cause of cancer death worldwide. A large body of evidence supports a causal role of Helicobacter pylori in the majority of gastric malignancies. Great strides have been made in understanding the... more
Gastric cancer is the second most common cause of cancer death worldwide. A large body of evidence supports a causal role of Helicobacter pylori in the majority of gastric malignancies. Great strides have been made in understanding the pathogenesis of this relationship, but much remains to be learned. Moreover, because of the high prevalence of infection, the lack of definitive trials, and the challenges of H. pylori treatment, there remains no consensus on the role of routine screening and treatment of this infection to prevent cancer. This article reviews the current knowledge on H. pylori and gastric cancer and presents some of the clinical and public health challenges associated with this pathogen.
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Paraquat is a bipyridyl herbicide used world-wide. Although accidental and deliberate ingestions of lethal doses have been reported from many countries, no case has ever been described in Mexico. The authors report on 25 cases of Paraquat... more
Paraquat is a bipyridyl herbicide used world-wide. Although accidental and deliberate ingestions of lethal doses have been reported from many countries, no case has ever been described in Mexico. The authors report on 25 cases of Paraquat poisoning in the state of Chiapas, Mexico, that occurred between 1988 and 1990. Eighty percent of the cases were men, and 64% of the cases died. Alcohol intoxication or suicidal intent were factors at the time of Paraquat ingestion in 75% of the cases. The majority of cases had learned to use Paraquat from a friend; none had been instructed by a professional. Eighty percent of cases did not know the dilution for the proper use of the herbicide, and none kept the herbicide in its original container. Attention to the law, redesign of the Paraquat packaging, and educational efforts directed at populations at risk might reduce the occurrence of poisoning in this region.
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Helicobacter pylori (HP) infection can cause hypochlorhydria, a positive risk factor for Mycobacterium tuberculosis (MTB) infection. This study examined the association between HP and MTB infections among persons attending the Policlinico... more
Helicobacter pylori (HP) infection can cause hypochlorhydria, a positive risk factor for Mycobacterium tuberculosis (MTB) infection. This study examined the association between HP and MTB infections among persons attending the Policlinico Peruano Japonés Gastrointestinal Clinic in Lima, Peru. From 23 June 2000 to 18 August 2000, consenting 18-55 year olds who attended the clinic for gastric biopsy gave blood for HP serologic testing, underwent tuberculin skin testing (TST) and completed a social and medical history. Of 128 participating patients, 78 (61%) were TST positive for MTB, and 107 (84%) were infected with HP by serology. Of the patients who were HP positive, 67 (63%) developed positive TST reactions compared to 11 (52%) of 21 HP-seronegative subjects (OR 1.29; 95% CI 0.54-3.11; P = 0.6). There was no association after adjusting for covariates of H. pylori infection (OR 0.78; 95% CI 0.23-2.71; P = 0.7). However, study power was limited by high prevalence of the two infections.
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Research Interests: Malaria, Travel, Humans, Infant, Risk factors, and 2 moreAntimalarials and Risk Factors(Antimalarials and Risk Factors)
(Antimalarials and Risk Factors)
Research Interests: Helicobacter pylori, Social Class, Latin America, Humans, Mathematical Sciences, and 13 moreUnited States, Female, Male, San Francisco, American, Epidemiology of Helicobacter pylori infection, Prevalence, Animals and disease transmission, Adult, San Francisco Bay, H Pylori, Confidence Interval, and Cohort Studies
Primary human cerebral myiasis is an exceedingly rare condition and is almost never encountered by physicians in developed countries. The case report summarizes a case of extensive cerebral myiasis in a periurban community in the United... more
Primary human cerebral myiasis is an exceedingly rare condition and is almost never encountered by physicians in developed countries. The case report summarizes a case of extensive cerebral myiasis in a periurban community in the United States. After a minor motor vehicle accident, police brought a 75-year-old man to the emergency room because he was observed to have a large cranial lesion. Examination revealed a 15 x 17 cm frontal bone defect with eroded frontal dura, exposed cortex, and massive cortical maggot infestation. The patient was empirically treated with intravenous antibiotics for meningitis. Maggots (Phaenicia sericata, or the green bottle fly) were removed by suction, attrition, and gentle contact exposure to a mild bleach solution. Biopsy of the scalp and cranium revealed angiosarcoma, for which operative treatment was refused. The patient was transferred to a skilled nursing facility for palliative care where he died 3 months later. This is the first published case of cerebral myiasis in the United States. Although human cerebral myiasis is rare, conditions do exist in this country that permit myiasis.
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Research Interests: Malaria, Travel, Humans, Infant, Risk factors, and 2 moreAntimalarials and Risk Factors(Antimalarials and Risk Factors)
(Antimalarials and Risk Factors)
Background:Gastric acid is an important defence against enteric infection. Studies investigating the relationship between hypochlorhydria and enteric infections or gastric malignancy have been limited by difficulties in the non-invasive... more
Background:Gastric acid is an important defence against enteric infection. Studies investigating the relationship between hypochlorhydria and enteric infections or gastric malignancy have been limited by difficulties in the non-invasive measurement of gastric acidity.Gastric acid is an important defence against enteric infection. Studies investigating the relationship between hypochlorhydria and enteric infections or gastric malignancy have been limited by difficulties in the non-invasive measurement of gastric acidity.Aim:To develop a blood test for hypochlorhydria based on the quininium resin test.To develop a blood test for hypochlorhydria based on the quininium resin test.Methods:Quininium resin dissociates to liberate free quinine at pH ≤ 3.5. Ten fasting adult volunteers ingested 100 mg/kg of quininium resin twice: once before (control) and once after acid suppression with rabeprazole (10 mg b.d. for 3 days). Blood and serum samples were collected at baseline and 45, 60, 75, 90 and 120 min after ingestion. Quinine levels were measured fluorometrically from 100 μL samples after simple extraction. Results obtained by the quininium resin test were compared with gastric juice pH measurements.Quininium resin dissociates to liberate free quinine at pH ≤ 3.5. Ten fasting adult volunteers ingested 100 mg/kg of quininium resin twice: once before (control) and once after acid suppression with rabeprazole (10 mg b.d. for 3 days). Blood and serum samples were collected at baseline and 45, 60, 75, 90 and 120 min after ingestion. Quinine levels were measured fluorometrically from 100 μL samples after simple extraction. Results obtained by the quininium resin test were compared with gastric juice pH measurements.Results:After quininium resin ingestion, mean quinine levels were lower in the acid-suppressed than in the control condition at all times (P < 0.001). Optimized cut-off values at 90 min post-ingestion yielded 95% accuracy rates in both serum and blood. Quininium resin was well tolerated.After quininium resin ingestion, mean quinine levels were lower in the acid-suppressed than in the control condition at all times (P < 0.001). Optimized cut-off values at 90 min post-ingestion yielded 95% accuracy rates in both serum and blood. Quininium resin was well tolerated.Conclusions:Using blood or serum, the quininium resin test identifies hypochlorhydria accurately and non-invasively. This test may be useful in screening for gastric atrophy and in studies investigating hypochlorhydria.Using blood or serum, the quininium resin test identifies hypochlorhydria accurately and non-invasively. This test may be useful in screening for gastric atrophy and in studies investigating hypochlorhydria.
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Research Interests: Helicobacter pylori, Humans, Female, Gastric Cancer, Male, and 18 moreRisk factors, ROC Curve, Recurrence, Clarithromycin, Clinical Sciences, Middle Aged, Anti-Bacterial Agents, Precancerous Conditions, Adult, Amoxicillin, Combination drug therapy, Risk Factors, Stomach Cancer, Enzyme Linked Immunosorbent Assay, H Pylori, immunoglobulin G, Adenocarcinoma, and The American(Risk factors, ROC Curve, Recurrence, Clarithromycin, Clinical Sciences, Middle Aged, Anti-Bacterial Agents, Precancerous Conditions, Adult, Amoxicillin, Combination drug therapy, Risk Factors, Stomach Cancer, Enzyme Linked Immunosorbent Assay, H Pylori, immunoglobulin G, Adenocarcinoma, and The American)
(Risk factors, ROC Curve, Recurrence, Clarithromycin, Clinical Sciences, Middle Aged, Anti-Bacterial Agents, Precancerous Conditions, Adult, Amoxicillin, Combination drug therapy, Risk Factors, Stomach Cancer, Enzyme Linked Immunosorbent Assay, H Pylori, immunoglobulin G, Adenocarcinoma, and The American)
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Research Interests: Obesity, Helicobacter pylori, Ghrelin, Humans, Female, and 16 moreMale, Bacteria, Esophageal Cancer, Food intake, Clinical Sciences, Middle Aged, Risk Factor, Body mass index (BMI), Adult, Odds ratio, Peptide hormones, Case Control Study, Gastroesophageal Reflux, H Pylori, Adenocarcinoma, and The American
Background: Gastric colonization with Helicobacter pylori is a proposed protective factor against gastroesophageal reflux disease (GERD), but little population-based data exist and other data conflict.Methods: We conducted a... more
Background: Gastric colonization with Helicobacter pylori is a proposed protective factor against gastroesophageal reflux disease (GERD), but little population-based data exist and other data conflict.Methods: We conducted a case–control study within the membership of a large integrated health-care system that compared GERD-free subjects with two groups: subjects with a physician-assigned GERD diagnosis and randomly selected members with self-described weekly GERD symptoms. Subjects completed interviews, GERD questionnaires, and antibody testing for H. pylori and its cagA protein.Results: Serologic data were available for 301 physician-assigned GERD patients, 81 general membership subjects with GERD symptoms, and 175 general membership subjects without GERD symptoms. Physician-assigned GERD patients were less likely to have H. pylori antibodies than GERD-free member controls (odds ratio (OR) = 0.27, 95% confidence interval (CI) 0.15–0.47); there was also an inverse association between H. pylori and GERD symptom severity (OR = 0.18, 95% CI 0.08–0.41; severe or very severe symptoms) and GERD frequency (OR = 0.18, 95% CI 0.09–0.38; for symptoms at least weekly). The association was stronger among persons with erosive GERD and was similar between H. pylori-positive subjects with and without cagA. There was no association among persons who were cagA positive, but H. pylori negative. Similar findings were found in analyses of the general membership with self-described GERD symptoms.Conclusions: H. pylori antibody status was inversely associated with a GERD diagnosis and GERD symptoms compared with a general membership population.
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No dyspepsia-specific questionnaire currently exists in Spanish. The Spanish Language Dyspepsia Questionnaire (SLDQ) was developed based on Rome dyspepsia criteria, other questionnaires, and common symptoms. Self-reported normal and... more
No dyspepsia-specific questionnaire currently exists in Spanish. The Spanish Language Dyspepsia Questionnaire (SLDQ) was developed based on Rome dyspepsia criteria, other questionnaires, and common symptoms. Self-reported normal and dyspeptic volunteers (N = 63) in Chiapas, Mexico, participated in a validation study. We assessed intra- and interrater reliability by test–retest studies and established validity by both correlation to the Short Form-36 (SF-36) and comparison of scores between normals and dyspeptics. The total SLDQ score showed a wide distribution (range 0–78, mean 23.7 ± 21.9). Internal reliability of the SLDQ was high (Cronbach's α = 0.93). Intra- and interrater reliability were excellent (scores from the first and second interviews not statistically different; P = 0.94; intraclass correlation coefficient = 0.96). SLDQ scales correlated appropriately with the SF-36. The SLDQ distinguished self-classified normals from dyspeptics (P < 0.001). The SLDQ fills the unmet need for a valid, reproducible, and multidimensional Spanish-language instrument to measure dyspepsia. Additionally, we have made suggestions for the development of symptom-quantifying questionnaires.