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BACKGROUND: The purpose of these studies was to determine the safety of a botanical treatment for supporting healthy liver function developed in Peru. The formulation, A4+, contains extracts of Curcuma longa L. rhizome (A4R), Cordia lutea Lam. flower (A4F) and Annona muricata L. leaf (A4L). The tests were used to support an application for a non-traditional Natural Health Product Licence from the Natural Health Product Directorate of Health Canada and future clinical trials. METHODS: Besides reviewing the scientific and clinical information from Peru on the ingredients and conducting an initial Ames test for mutagenicity, we analysed A4+ for its chemical profile and tested genotoxicity (micronucleus test) and general toxicity (28-day repeated dose). RESULTS: A4+ and extracts from the three plants provided distinctive chemical fingerprints. A4L contained acetogenins, requiring a second chromatographic method to produce a specific fingerprint. The Ames test proved positive at the highest concentration (5,000 µg/mL) but A4+ showed no evidence of genotoxicity in the more specific mouse micronucleus test. The 28-day repeated dose (general toxicity) study in rats showed no toxicity at 2,000 mg/kg. CONCLUSIONS: We conclude that under the conditions of these studies, A4+ shows no evidence of toxicity at the levels indicated. A no observed adverse effect level (NOAEL) of 2,000 mg/kg was assigned.

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Los tumores estromales gastrointestinales son los tumores mesenquimáticos más frecuentes. Se localizan con frecuencia en el estómago y sus manifestaciones clínicas son variadas. Presentamos el caso de una paciente de 57 años que ingresó por hemorragia digestiva de dos días de evolución. Los estudios de imagen demostraron un tumor en pared gástrica. La paciente fue sometida a resección quirúrgica del tumor y el diagnóstico definitivo se realizó utilizando marcadores CD117 y CD34. A pesar de que el tratamiento definitivo es la resección quirúrgica, se ha desarrollado nuevos modelos de tratamiento utilizando terapia molecular dirigida. Diversos estudios están llevándose a cabo en la actualidad y algunos muestran resultados prometedores.

Gastrointestinal stromal tumors are the most frequent mesenchimal neoplasms of gastrointestinal tract. They arise more frequently in the stomach and have a broad clinical spectrum. We report the case of a fifty-seven year-old female with history of two day gastrointestinal bleeding. The patient underwent surgical resection and the diagnosis was done using CD117 and CD34 markers. Though surgical resection is the only definitive treatment new therapeutic models are in development that use molecular targeted drug therapy. Various clinical essays are currently in course and some of them show promising results.

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Existen pocos estudios que reporten datos acerca de autopsias de pacientes con VIH en Sudamérica y ninguno que documente los resultados post mórtem en los pacientes con VIH/SIDA en el Perú. Objetivos: Determinar el espectro de las infecciones oportunistas y las causas de mortalidad en pacientes VIH-positivos en un hospital público en Lima. Asimismo, se revisa la información clínico-epidemiológica con respecto a la infección con VIH en el Perú. Materiales y métodos: Se incluyeron en este análisis retrospectivo, 16 autopsias relacionadas con VIH del Hospital Dos de Mayo, realizadas entre 1999-2004. Resultados: La causa primaria de la muerte fue establecida en 12 pacientes: uno murió de neoplasia y 11 de enfermedades infecciosas, incluyendo tres con infección pulmonar, siete con infección diseminada, y dos con infección del sistema nervioso central (un caso presentó patología dual). Las infecciones oportunistas fueron identificadas en 14 casos, incluyendo citomegalovirus, histoplasmosis, criptococcosis, toxoplasmosis, neumonía por Pneumocistis, aspergilosis, tuberculosis, virus de la varicela-zoster y criptosporidiosis. Catorce pacientes tenían por lo menos una enfermedad relacionada con el SIDA que no había sido sospechada clínicamente ni diagnosticada antes de la muerte. Por otra parte, 82% de los diagnósticos considerados de significancia clínica importante, no habían sido sospechados antes de la muerte. Conclusiones: El espectro y la frecuencia de ciertas infecciones oportunistas reportadas en el presente estudio lo diferencia de otros estudios de autopsias realizados en Sudamérica; destacando la importancia de realizar necropsias en VIH/SIDA en países de recursos limitados, con el fin de observar los patrones locales específicos de la enfermedad.

There is a paucity of HIV autopsy data from South America and none that document the postmortem findings in patients with HIV/AIDS in Peru. Objectives: The purpose of this autopsy study was to determine the spectrum of opportunistic infections and the causes of mortality in HIV-positive patients at a public hospital in Lima. Material and methods: Clinico-epidemiological information regarding HIV infection in Peru is also reviewed. Sixteen HIV-related hospital postmortems, performed between 1999-2004, were included in this retrospective analysis. Results: The primary cause of death was established in 12 patients: one died of neoplasia and 11 of infectious diseases, including 3 from pulmonary infection, 7 from disseminated infection, and 2 from central nervous system infection (one case had dual pathology). Opportunistic infections were identified in 14 cases, comprising cytomegalovirus, histoplasmosis, cryptococcosis, toxoplasmosis, Pneumocystis pneumonia, aspergillosis, tuberculosis, varicella zoster virus and cryptosporidiosis. Fourteen patients had at least one AIDS-related disease that had been neither clinically suspected nor diagnosed premortem. Moreover, 82% of the diagnoses deemed of important clinical significance, had not been suspected antemortem. Conclusions: The spectrum and frequency of certain opportunistic infections differed from other South American autopsy studies, highlighting the importance of performing HIV/AIDS postmortems in resource-limited countries where locallyspecific disease patterns may be observed.

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There is a paucity of HIV autopsy data from South America and none that document the postmortem findings in patients with HIV/AIDS in Peru. The purpose of this autopsy study was to determine the spectrum of opportunistic infections and the causes of mortality in HIV-positive patients at a public hospital in Lima. Clinico-epidemiological information regarding HIV infection in Peru is also reviewed. Sixteen HIV-related hospital postmortems, performed between 1999 and 2004, were included in this retrospective analysis. The primary cause of death was established in 12 patients: one died of neoplasia and 11 of infectious diseases, including 3 from pulmonary infection, 7 from disseminated infection, and 2 from central nervous system infection (one case had dual pathology). Opportunistic infections were identified in 14 cases, comprising cytomegalovirus, histoplasmosis, cryptococcosis, toxoplasmosis, Pneumocystis pneumonia, aspergillosis, tuberculosis, varicella zoster virus, and cryptosporidiosis. Fourteen patients had at least one AIDS-related disease that had been neither clinically suspected nor diagnosed premortem. Moreover, 82% of the diagnoses considered to be of important clinical significance had not been suspected antemortem. The spectrum and frequency of certain opportunistic infections differed from other South American autopsy studies, highlighting the importance of performing HIV/AIDS postmortems in resource-limited countries where locally specific disease patterns may be observed.

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Introducción: La coinfección de virus de inmundeficiencia humana (VIH) y tuberculosis altera la presentación histológica de la tuberculosis; esto es particularmente frecuente en la linfadenitis tuberculosa. Objetivos: Identificar las diferencias histológicas más importantes entre linfadenitis tuberculosa asociada a VIH y no asociada a VIH. Diseño: Estudio descriptivo, transversal, comparativo. Lugar: Servicio de Anatomía Patológica, Hospital Dos de Mayo. Participantes: Pacientes con linfadenitis tuberculoso asociada o no a VIH. Intervenciones: Se realizó un estudio en todos los casos diagnosticados como linfadenitis tuberculosa asociados a VIH y no asociados a VIH, durante los años 2005 y primera mitad del 2006. Principales medidas de resultados: Presentación histológica de la tuberculosis. Resultados: Se identificó 22 casos de linfadenitis tuberculosa, de los cuales 27,3 porcentaje presentaba coinfección con VIH. Se identificó necrosis caseosa en 83,3 porcentaje de los casos asociados a VIH y en 100 porcentaje de los no asociados a VIH (p=0,00). La presencia de bacilos ácido alcohol resistentes se observó en 50 porcentaje de los casos asociados a VIH y en ningún caso de los VIH negativos (p=0,01). Adicionalmente, se obtuvo un riesgo atribuible de 52,3 por ciento para la presencia de células de Langhans y el desarrollo de necrosis caseosa. Conclusiones: Se ha encontrado mayor presencia de mycobacterium en los pacientes VIH positivos y mayor presencia de necrosis caseosa en los pacientes VIH negativos.

Introduction: Coinfection of human virus immunodeficiency (VIH) and tuberculosis changes the histological features of tuberculosis; this is particularly frequent in tuberculous lymphadenitis. Objective: To identify main histological diferences between tuberculous lymphadenitis associated to VIH and not associated to VIH. Design: Descriptive, transversal, comparative stufy. Setting: Pathological Anatomy Service, Dos de Mayo Hospital. Participants: Patients with tuberculous lymphadenitis associated or not to VIH. Interventions: Study of histological differences between lymphadenitis tuberculosis associated with HIV and non associated with HIV, during 2005 and first half of 2006. Main outcome measures: Histological presentation of tuberculosis. Results: Twenty-two cases of tuberculous lymphadenitis were identified, 27,3 per cent showed VIH coinfection; caseum necrosis was identified in 83,3 per cent of cases HIV-associated and in 100 per cent of non-HIV associated cases (p=0,00). Koch bacillus was identified in 50 per cent of associated HIV cases and it was not identified in any non related HIV case (p=0,01). We also found an attributable risk of 52,3 per cent for the development of caseum necrosis and presence of Langhans cells. Conclusions: We found higher presence of mycobacterium in HIV positive patients and higher presence of caseum necrosis in HIV negative patients.

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