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OBJECTIVE: To determine the sensitivity and specificity of the rapid diagnostic test OptiMAL® for diagnosis of Plasmodium vivax malaria. MATERIAL AND METHODS: We included all the patients who sought medical attention in the San Martin Pangoa Hospital, Junin, an area endemic for vivax malaria in Peru, between October and December 1998, who had fever during the previous 72 hours and who were older than 12 months. The gold standard for diagnosis was thick blood film microscopy. We determined the parasitemia rate for each of the positive slides. We calculated sensitivity, specificity, positive predictive value and negative predictive value of the test. RESULTS: We included 72 patients; 39 of them were positive for P. vivax by microscopic examination. The sensitivity of the Optimal test was 92.3%, the specificity 100%, the positive predictive value 100% and the negative predictive value 91.6%. The accuracy of the test was 95.8%. The sensitivity of the OptiMAL® test progressively decreased when parasitemia was lower than 1,000 parasites/microliter. CONCLUSIONS: the OptiMAL® test has a high sensitivity and specificity for diagnosis of P. vivax malaria. However, its sensitivity decreased when parasitemia levels were lower. It is a very simple technique, which makes it a good alternative for malaria diagnosis in remote places, although its elevated cost is still a problem.

To determine the prevalence of peptic ulcer and gastric adenocarcinoma in a population of middle and high socio-economic status in Lima, Peru, between 1985 and 2002.The prevalence of gastroduodenal ulcer and gastric adenocarcinoma was determined after studying by esophagogastroduodenoscopy 31,446 patients at the Policlínico Peruano Japonds (PPJ) between 1985 and 2002. All patients had chronic upper gastrointestinal symptoms and had endoscopically proven diagnosis of active peptic ulcer or histological diagnosis of gastric adenocarcinoma.Analysis of PPJ population identified a decrease in the prevalence of gastric ulcer and duodenal ulcer from 3.15% and 5.05% respectively in 1985, to 1.62% and 2.00% respectively in 2002. Gastric adenocarcinoma prevalence also decreased from 3.19% in 1988 to 0.92% in 2002. The prevalences of gastric ulcer (OR = 1.49, 95% IC 1.26-1.77, p0.001), duodenal ulcer (OR = 1.32, 95% IC 1.15-1.51, p0.001) and gastric adenocarcinoma (OR = 1.53, 95% IC 1.25-1.86, p0.001), decreased in the last eight years.Over the study period, there was a significant decrease in the prevalence of peptic ulcer and gastric adenocarcinoma at the Policlinico Peruano Japonés, where patients from middle and high socio economic status are attended.

To compare the prevalence of Helicobacter pylori infection in native Peruvians and Japaneses residing in Peru.Prospective study carried out at "Policlinico Peruano-Japonés" (Lima-Perú). We included Peruvians and Japaneses residing in Peru with chronic symptoms of the upper gastrointestinal tract. Both groups were from medium to high socioeconomic status. We excluded patients with peptic ulcer. PCR, rapid ureasa test and IgG ELISA were used to diagnose the infection.We evaluated 168 Japaneses (mean age 54.6 +/- 12.62 years, 75% female), and 161 Peruvians (mean age of 42.12 +/- 14.48 years, 61.5% female). Using the rapid ureasa test, the prevalence of Helicobacter pylori infection in Peruvians was 47.8%, and in Japaneses 47.0% (p=0.88). Using PCR, in Peruvians was 49.7% and in Japaneses 43.5% (p=0.28).Peruvians and Japaneses residing in Peru have a similar prevalence of Helicobacter pylori infection, after controlling factors such as socioeconomic status and age, suggesting that in Peru and in these ethnic groups, there is no racial predisposition to acquire the infection.

The most accepted treatment for infection by Helicobacter pylori is the proton pump inhibitor based therapy with two antibiotics. However, there is no consensus regarding the duration. The purpose here was to compare eradication percentages in the omeprazole+amoxicillin+clarithromycin regimen administered during 7 days versus 10 days and confront the results with a previous 14-day* experience in Peru.Patients from the Central Military Hospital and Peruvian-Japanese Hospital evidencing chronic upper gastrointestinal tract symptoms were recruited. We excluded patients with peptic ulcer. Biopsies were taken for diagnosis, for urease and PCR tests, culture and coloring with silver. Omeprazole+clarithromycin+amoxicillin was used during 7 days versus 10 days. Control endoscopy was performed one month after treatment had been completed and molecular biology techniques were used to differentiate recurrences from new infections. Susceptibility to clarithromycin was assessed.36 patients were included in each group. Eradication was the same in both groups: 86.1% (31/36). In several patients in whom the bacteria persisted, the same initial nucleus was found. In a previous study* using this same regimen during 14 days, a 93% eradication was obtained. 91.18% of our samples were susceptible to clarithromycin.In Peru, the omeprazole+clarithromycin+amoxicillin combination gives results higher than 80% in the eradication of infection by Helicobacter pylori. The 7 and 10 days regimens eradicated the bacteria in 86% of our patients.

In the developed countries, the prevalence of infection by H. Pylori among patients with active chronic gastritis (ACG) and peptic ulcer is diminishing. In developing countries, as far as it is known, neither a time variation of this infection nor a related epidemiological phenomena have been reported.Determine the changes in the prevalence of H. pylori in patients from medium and high socio-economic strata in Lima, with ACG and peptic ulcer from 1985 to 2002.An evaluation by means of an esophago-gastroduodenoscopy was carried out in a private hospital in 1,815 patients from the medium and upper socio-economic strata, all of them residents in Lima, Peru and showing upper gastrointestinal tract symptoms. Coloring with hematoxilin-eosin was used.1,260 patients with ACG were identified: 178 with duodenal ulcer, 55 with gastric ulcer and 292 with histologically normal gastric mucose (HNGM). Prevalence of H. pylori among patients with ACG dropped from 83.3% to 58.7% (p0.001) in males and females under 30 years old and from 31 to 50 years old (p=0.001). In patients with duodenal ulcer it decreased from 89.5% to 71.9% (p=0.004) and in those patients with gastric ulcer, from 84.8% to 77.3% (p=0.36). In patients with HNGM, prevalence remained the same (from 2.7% to 0.0%) (p=0.15).Between 1985 and 2002, in Lima, Peru, H. pylori prevalence in patients from the medium and upper socio-economic strata, with ACG and peptic ulcer, diminished.