Antimicrobial efficacy and activity of ethanolic extract of Piper betle L. on Staphylococcus aureus-infected wound in mice and clinical isolates of multiple drug-resistant bacterial pathogens

@#This study aimed to determine the in vivo effectiveness of the ethanolic extract of Piper betle L. leaves against Staphylococcus aureus-infected wounds in mice and its antimicrobial properties on clinical isolates of multiple drug-resistant bacterial pathogens. Twenty mice were divided into four groups. Wounds were created in all mice under anesthesia by excision from the dorsal skin down to the subcutaneous fat and inoculating with S. aureus. After 24 h, the wound of each mouse was treated once daily by application of the respective cream. Group I was treated with mupirocin antibacterial cream; Group II received a cream base containing no active ingredient; Groups III and IV were treated with 2.5% and 5.0% concentrations of P. betle cream, respectively. Further, an in vitro study was performed by adding undiluted, 1:50 and 1:100 dilutions of the four studied creams in normal saline containing 1.5 × 108 CFU/mL of the following bacteria: antimicrobial-susceptible S. aureus, Escherichia coli, Pseudomonas aeruginosa, methicillin-resistant S. aureus, extended-spectrum β-lactamase-producing Escherichia coli, vancomycin-resistant Enterococcus, metallo-βlactamase-producing P. aeruginosa and carbapenem-resistant Klebsiella pneumoniae. The mice in Groups III and IV had significantly faster wound contraction and significantly shorter reepithelialization time than Group II (p < 0.05), which were not significantly different from Group I (p > 0.05). P. betle creams inhibited all studied bacterial strains at full concentration and at a dilution of 1:50. The inhibitory effect was more significant than Groups I and II (p < 0.05), except on S. aureus. Specifically, S. aureus inhibition was not significantly different for Groups III and IV (p > 0.05) when compared with Group I. Cream formulations derived from P. betle ethanolic extract have great potential as antimicrobial agents for the treatment of wound infection. Further clinical tests are recommended to determine the safety and efficacy of these formulations in other mammalian species.

Composition and abundance of anopheline species according to habitat diversity in Mexico / Composición y abundancia de especies de anofelinos según la diversidad de hábitats en México

Abstract: Objective: To determine the abundance and geographic distribution of the main malaria vectors, which are influenced by habitat characteristics and ecological factors that directly impact adult density and the dynamics of malaria transmission in Mexico. Materials and methods: Samples of larvae were collected from 19 states in Mexico. Each larval habitat was characterized in situ determining the following parameters: water depth, turbidity, percentage of vegetation cover, amount of detritus, presence of algae, light intensity, type of vegetation, amount of predators, habitat stability, altitude, and hydrologic type. Results: A total of 21 687 larvae corresponding to 13 anopheline species were obtained from 149 aquatic habitats. The most abundant species were Anopheles pseudopunctipennis (52.91%), An. albimanus (39.14%) and An. franciscanus (5.29%). The multiple logistic regression analysis showed a negative association between An. pseudopunctipennis and water turbidity (ß=-1.342; Wald=6.122; p=0.013) and the amount of detritus (ß=-2.206; Wald=3.642; p=0.050). While in An. albimanus, there was a significant positive association with water turbidity (ß=1.344; Wald=4.256; p=0.039), a negative correlation was found with the altitude (ß=-3.445; Wald=5.407; p=0.020). The highest mosquito species diversity index was found in Chiapas (Fisher's α=1.20) and the lowest diversity in Chihuahua (Fisher's α=0.26). The greatest richness was found in streams (n=11). Conclusions: The two most abundant species were: An. albimanus and An. pseudopunctipennis. Detailed knowledge of the distribution and characteristics of their larval habitats will be useful for the effective implementation of control strategies in Mexico.

Resumen Objetivo: Determinar la abundancia y la distribución geográfica de los principales vectores de la malaria, las cuales están influenciadas por las características del hábitat y los factores ecológicos que afectan directamente la densidad de los adultos y la dinámica de la transmisión de la malaria en México. Material y métodos: Se obtuvieron muestras de larvas de 19 estados de México. Cada hábitat larvario se caracterizó in situ determinando los siguientes parámetros: profundidad del agua, turbidez, porcentaje de cobertura vegetal, cantidad de detritus, presencia de algas, intensidad de luz, tipo de vegetación, cantidad de depredadores, estabilidad del hábitat, altitud y tipo hidrológico. Resultados: Se identificaron un total de 21 687 larvas pertenecientes a 13 especies de anofelinos, de 149 hábitats acuáticos. Las tres especies más abundantes fueron Anopheles pseudopunctipennis (52.91%), An. albimanus (39.14%) y An. franciscanus (5.29%). El análisis de regresión logística múltiple mostró una asociación negativa para An. pseudopunctipennis y la turbidez del agua (ß=-1.342; Wald= 6.122; p=0.013) y la cantidad de detritus (ß=-2.206; Wald= 3.642; p=0.050). Para An. albimanus se encontró una asociación positiva significativa con la turbidez del agua (ß=1.344; Wald= 4.256; p=0.039) y una correlación negativa con la altitud (ß=-3.445; Wald=5.407; p=0.020). El índice de diversidad más alto se encontró en Chiapas (α de Fisher=1.20) y la diversidad más baja en Chihuahua (α de Fisher=0.26). La mayor riqueza se encontró en los arroyos (n=11). Conclusiones: Las dos especies más abundantes fueron An. albimanus y An. pseudopunctipennis. El conocimiento detallado de la distribución y características de sus hábitats larvales será útil para la implementación efectiva de las estrategias de control en México.

Determination of insecticides' lethal concentrations and metabolic enzyme levels in Triatoma dimidiata / Determinación de concentraciones letales y niveles de enzimas metabólicas de insecticidas en Triatoma dimidiata

Abstract: Objective: The feasibility of the use of WHO impregnated paper and biochemical assays to determine lethal concentrations (LC50 and LC99) and insecticide metabolic enzyme levels of Triatoma dimidiata. Materials and methods: LC50 and LC99 were calculated with WHO papers impregnated at different concentrations of malathion, propoxur and deltamethrin; the percentage of insensitive acetylcholinesterase (iAChE); and the levels of esterases, glutathione S-transferases, and monooxygenases in laboratory nymphs of the first stage (5 to 7 days), were undertaken using the WHO biochemical assays. Results: Respectively the LC50 and LC99 µg/cm2 obtained for malathion were 43.83 and 114.38, propoxur 4.71 and 19.29, and deltamethrin 5.80 and 40.46. A 30% of the population had an iAChE, and only a few individuals had high P450 and β-eterase levels. Conclusion: Impregnated papers and biochemical tests developed by WHO for other insects, proved to be feasible methods in monitoring insecticide resistance and metabolic enzymes involved in T. dimidiata.

Resumen: Objetivo: La factibilidad de usar los papeles impregnados y ensayos bioquímicos según la OMS para determinar concentraciones letales (CL50 y CL99) y niveles enzimáticos en la resistencia a insecticidas en Triatoma dimidiata. Material y métodos: Se calcularon la CL50 y CL99 con papeles impregnados según la OMS a diferentes concentraciones de malatión, propoxur y deltametrina; el porcentaje de acetilcolinesterasa insensible (iAChE); y los niveles de esterasas, glutatión S-transferasas, y monooxigenasas en ninfas de laboratorio del estadio I (5-7 días) se determinaron usando los ensayos bioquímicos según la OMS. Resultados: Se obtuvieron las CL50 y CL99 µg / cm2 respectivamente para malatión 43.83 y 114.38, propoxur 4.71 y 19.29, y deltametrina 5.80 y 40.46. Un 30% de las chinches tuvo iAChE, y sólo pocos individuos tuvieron niveles superiores de P450 y β-eterasas. Conclusión: Los papeles impregnados y ensayos bioquímicos que describe la OMS para otros insectos demostraron ser métodos factibles para monitorear la resistencia a insecticidas y las enzimas metabólicas involucradas en T. dimidiata.

Ultraestrutura e criopreservação de sêmen de jundiá amazônico (Leiarius marmoratus) em cativeiro / Ultrastructure and sperm cryopreservation of the amazon catfish (Leiarius marmoratus) in captivity

Os objetivos do presente estudo foram analisar a ultraestrutura do espermatozoide do jundiá amazônico e avaliar a sua criopreservação com três agentes crioprotetores (metanol 10%, DMSO 10% e etilenoglicol 10%) e duas soluções ativadoras (NaCl 0,29% e NaHCO3 1%). Como diluente, foi utilizada uma solução de glicose a 5%, sendo o sêmen envasado em palhetas de 0,25mL e congelado em vapor de nitrogênio (botijão dry shipper). No sêmen fresco, o espermatozoide apresentou comprimento de 25,46±2,54µm, cabeça esférica (1,51±0,18µm), ausência de acrossoma, peça intermediária com formato cônico (0,93±0,17µm), ligeiramente assimétrica, com presença de vesículas, e flagelo único (21,48±2,45µm). O sêmen descongelado apresentou valores mais altos (P<0,05) para duração, vigor e taxa de motilidade espermática com os crioprotetores metanol 10% e DMSO 10%. A duração da motilidade espermática foi maior (P<0,05) com o ativador NaHCO3 1% (21-96 s). O sêmen de Leiarius marmoratus criopreservado com DMSO e metanol apresentou, respectivamente, 7,32±4,21% e 8,94±6,69% de taxa de motilidade. No entanto, os resultados não foram satisfatórios para estabelecer um protocolo para a espécie.(AU)

The aims of this study were to describe the spermatozoon ultrastructure and to evaluate the sperm cryopreservation of the amazon catfish with three cryoprotectant agents (10% methanol, 10% DMSO, and 10% ethylene glycol) and two activator agents (0.29% NaCl and 1% NaHCO3). Glucose 5% extender was used as a diluent solution and sperm loaded in 0.25 straws was frozen in nitrogen vapor (dry shipper). Fresh spermatozoon was 25.46±2.54µm long, the head was spherical (1.51±0.18µm) with no acrosome, the midpiece was cone shaped (0.93±0.17µm) with presence of vesicles, slightly asymmetric, and the flagellum was single (21.48±2.45µm). Post-thawed semen presented higher values (P< 0.05) for duration, vigor and sperm motility rate with cryoprotectants 10% methanol and 10% DMSO. The duration of sperm motility was longer (P< 0,05) when triggered in 1% NaHCO3 (96-21 s). Leiarius marmoratus semen cryopreserved with DMSO and methanol, presented respectively 7.32±4.21% and 8.94±6.69% of motility. However, the results were not satisfactory to establish a protocol for the specie.(AU)

Gastroenteritis eosinofílica: aspectos clínicos e imagenológicos de una entidad poco frecuente, reporte de caso / Eosinophilic gastroenteritis: clinical aspects and imagenological features of an infrequent entity, case report

Eosinophil-associated diseases constitute a group of pathologies where eosinophils play an important role. Among them, eosinophilic gastroenteritis is a rare entity. Few demographic data exist in the literature, with an estimated prevalence of 28-30/100,000. The symptoms presented by patients mainly depend on the affected segment of the gastrointestinal tract and the layer infiltrated by eosinophils. We report a 22-year-old male patient with a one-month history of diarrhea, with mucus and occasionally hematic striae. Initial laboratory tests showed leukocytosis with eosinophilia, and imaging studies showed extensive involvement of the gastrointestinal tract characterized by diffuse concentric parietal thickening and submucosal edema associated with ascites. Upper endoscopy and biopsy confirmed the presence of foci of infiltration by eosinophils. The patient was treated with corticosteroids and a lactose and wheat free diet, with a favorable evolution, without relapse after stopping corticosteroid treatment.

Las enfermedades asociadas a eosinófilos constituyen un grupo de patologías en que el aumento de los eosinófilos presenta un rol fundamental, encontrándose entre ellas la gastroenteritis eosinofílica, entidad poco frecuente. En la literatura existen pocos datos demográficos, con una prevalencia estimada entre 28-30 /100.000 habitantes. Los síntomas dependen principalmente del segmento afectado del tracto gastrointestinal y de la capa de la pared infiltrada por eosinófilos. Se presenta el caso clínico de un paciente masculino de 22 años con cuadro de diarrea de un mes de evolución, asociado a mucosidad y ocasionalmente estrías hemáticas. El estudio de laboratorio inicial mostró leucocitosis con eosinofilia, realizándose estudios de imágenes que demuestran extenso compromiso del tubo digestivo caracterizado por engrosamiento parietal difuso concéntrico y edema submucoso del estómago como también de asas de intestino delgado, asociado a ascitis. La endoscopia digestiva alta y biopsia confirmaron la presencia de focos de infiltración por eosinófilos. El paciente fue tratado con corticoides y dieta con restricción de lactosa y trigo, con evolución favorable, sin recaída tras la suspensión del tratamiento corticoidal

Resultados del uso de stent metálico autoexpandible como terapia puente en cáncer de colon izquierdo obstructivo / Results of the use of self-expanding stent as a bridge therapy in obstructive left colon cancer

Resumen Objetivo: Analizar los resultados del uso de stent como terapia puente para cirugía en cáncer de colon izquierdo obstructivo en nuestro centro. Material y Método: Se realizó un análisis retrospectivo de pacientes con cáncer de colon izquierdo obstructivo sometidos a la instalación de stent metálicos como terapia puente para una cirugía definitiva, entre enero de 2008 y diciembre de 2016. Se analizaron datos demográficos, éxito del procedimiento, complicaciones, vía de abordaje quirúrgico, anatomía patológica y seguimiento. Resultados: Se analizaron 10 pacientes. El procedimiento fue técnica y clínicamente exitoso en los 10 pacientes, sin complicaciones. Todos fueron a cirugía resectiva, logrando anastomosis primaria en 9 pacientes. En 3 se realizó un abordaje laparoscópico. Se logró una mediana de linfonodos de 41 en la pieza quirúrgica. Con una mediana de seguimiento de 34 meses, 2 presentan recidiva a distancia siendo pacientes con etapas más avanzadas al diagnóstico de su enfermedad. Discusión: El stent como terapia de puente a una cirugía electiva, permite obtener una baja tasa de colostomías, baja morbilidad, ofrecer cirugía laparoscópica y una óptima cirugía oncológica. Conclusión: El uso del stent como terapia puente en el cáncer de colon izquierdo obstructivo aparece como una buena alternativa para resolver esta patología en pacientes de mayor riesgo quirúrgico.

Objetive: To analyze the results of the use of stent as bridge therapy for surgery in obstructive left colon cancer in our center. Material and Method: We performed a retrospective analysis of patients with obstructive left colon cancer undergoing metallic stenting as a bridge therapy for definitive surgery bet- ween January 2008 and December 2016. Demographic data, procedural success, complications, surgical approach, pathological anatomy and follow-up were analyzed. Results: Ten patients. The procedure was technically and clinically successful in all 10 patients, with no complications in any of them. All patients went to resective surgery, achieving primary anastomosis in 9 of them. In 3 of them, a laparoscopic approach was performed. A median of lymph nodes of 41 it was obtained in the surgical specimen. With a median follow-up of 34 months, 2 presented distant recurrence, which were patients diagnosed at a more advanced stage of their disease. Discussion: The stent as bridge therapy to an elective surgery, allows to obtain a low rate of colostomies, low morbidity, offer a laparoscopic surgery and an optimal cancer surgery. Conclusion: The use of the stent as a bridge therapy in obstructive left colon cancer appears as a good alternative to solve this pathology in patients of greater surgical risk.

Utilização da técnica in vitro semiautomática de produção de gases na avaliação da fermentação microbiana do ceco de suínos / Use of the semi-automatic in vitro gas production technique for the evaluation of swine cecal microbial fermentation

O presente estudo teve como objetivo avaliar o os padrões de fermentação microbiana do ceco de suínos, utilizando-se um modelo aplicado na técnica in vitro de produção de gases para ruminantes. Três tipos de inóculo foram utilizados: ceco de suínos criados ao ar livre (CSF), ceco de suínos criados confinados (CSC) e líquido ruminal de bovino (LRB). Os substratos utilizados derivaram de uma dieta de suínos à base de farelo de soja e de grãos de milho, atendendo as exigências nutricionais dos suínos. Para composição dos substratos, foram estabelecidos diferentes níveis de substituição da dieta basal pela torta da amêndoa da Acrocomia aculeata (AA), coproduto da produção do biodiesel, sendo: BAS - 100% de dieta basal; M10 - 90% de dieta basal e 10% AA; M20 - 80% de dieta basal e 20% AA e o TF - feno de Tifton 85 (Cynodon spp.). A produção de gases foi avaliada nos tempos zero, três, seis, nove, 12, 16, 24, 48, 72 e 96 horas após a incubação. Foram analisados o potencial máximo de produção de gás (A) e o tempo de colonização (L). O delineamento experimental utilizado foi inteiramente ao acaso, em arranjo fatorial 4 x 3. Os dados de A e L foram submetidos à análise de variância, e as médias comparadas pelo teste de Tukey a 5%. Comparando os inóculos para A (mL/gMS), LRB e CSF apresentaram valores similares, diferindo apenas para TF. O tempo de colonização (L) entre inóculos, o CSC e o CSF apresentaram os menores tempos de colonização quando a ração foi BAS. Com os substratos M10 e M20, o inóculo LRB apresentou o menor tempo, CSF o maior tempo e CSC não diferiu de ambos. Não houve diferença significativa entre os inóculos para o substrato TF. A técnica de produção de gases utilizada para o ceco de suínos apresentou resultados semelhantes aos encontrados para ruminantes. O modelo matemático usado foi adequado para descrever a curva de fermentação no ceco de suínos, mostrando semelhanças entre as microbiotas do ceco e do rúmen.(AU)

This study aimed to evaluate the microbial fermentation patterns of the pig ceca using the technique of in vitro gas production for ruminants. Three types of inoculums were used: swine ceca raised in a free range system (CSF), swine ceca raised in a conventional confined system (CSC) and bovine rumen fluid (LRB). The substrates used were derived from pig's diet with soybean meal and corn grits, according to the nutritional requirements of swine. The substrates were composed by different set levels of substitution of basal diet by meal almond Acrocomia aculeata (AA), as: BAS - 100% of basal diet; M10 - 90% of basal diet and 10% AA (M10); M20 - 80% of basal diet and 20% AA (M20) and TF - Tifton 85 hay (Cynodon spp.).The gas production was evaluated at times 0, 3, 6, 9, 12, 16, 24, 48, 72 and 96 hours after incubation. The study analyzed the maximum potential of gas production (A) and lag time (L). The experimental design was completely randomized in a 4 x 3 factorial arrangement. The A and L data were submitted to analysis of variance and the averages compared by Tukey 5% test. Comparing the inoculum for A (ml / gDM), LRB, and CS, they showed similar values, differing only for TF. The lag time (L) between inoculum, the CSC and CSF had the lowest colonization times when the meal was BAS. With M10 and M20 substrates, the LRB inoculum showed the lowest time, CSF had the longest time and CSC did not differ from both. There was no significant difference between the inoculum for TF substrate. The gas production technique used for the ceca of pigs showed similar results to those for ruminants. The mathematical model used was adequate to describe the fermentation curve in the ceca of pigs, showing similarities between the microbiota of the ceca and the rumen.(AU)

Retención de cápsula endoscópica en un paciente con sospecha de enfermedad de Crohn / Endoscopic capsule retention in a patient with clinical suspicion of Crohn's disease

The endoscopic capsule is classically used in the study of occult bleeding, but has recently been shown to be useful in the diagnosis and follow-up of Crohn's disease. The retention of the capsule is the most frequent complication related to its use. We report the case of a 30-year-old male patient with recurrent abdominal pain and suspected Crohn's disease. A procedure with a video endoscopic capsule was performed; twelve hours after its ingestion, the patient goes to the emergency department due to worsening of the pain. Abdominal and pelvic CT demonstrates multiple areas of segmental parietal thickening of the ileum and a metallic foreign body in an area of stenosis corresponding to the retained endoscopic capsule. It evolves with persistent pain despite pharmacological therapy. Subsequently it is extracted by enteroscopy. The indications and risks of the use of the endoscopic video capsule, and the clinical and imaging factors predictive of retention are discussed.

La video cápsula endoscópica se utiliza clásicamente en el estudio de sangrado oculto, pero últimamente se ha demostrado su utilidad en el diagnóstico y seguimiento de la enfermedad de Crohn. La retención de la cápsula es la complicación más frecuente relacionada a su uso. Se presenta el caso de un paciente de sexo masculino de 30 años con dolor abdominal recurrente y sospecha de enfermedad de Crohn. Dentro del estudio se le realiza una video cápsula endoscópica; doce horas posteriores a su ingesta consulta en el servicio de urgencia por empeoramiento del dolor. La tomografía computada de abdomen y pelvis demuestra múltiples áreas de engrosamiento parietal segmentarias del íleon y un cuerpo extraño metálico en un área de estenosis, correspondiente a la cápsula endoscópica retenida. Evoluciona con persistencia del dolor pese a la terapia farmacológica. Posteriormente se procede a su extracción mediante enteroscopia. Se discuten las indicaciones y riesgos del uso de la video cápsula endoscópica, y los factores clínicos e imagenológicos predictores de retención.

Isquemia intestinal, reconocimiento y manejo / Intestinal ischemia, diagnosis and treatment

Intestinal ischemia remains a high risk mortality disease. Early detection has a huge impact in survival. The development of new biochemical markers will be useful in ischemia screening. Computed tomography (CT) scan and AngioTC, has a great value to assess viability of small bowel areas. Basic treatment and even surgery have the best results in early diagnosis setting.

La isquemia intestinal continúa siendo una patología de alto riesgo de mortalidad. El reconocimiento clínico precoz tiene impacto en la sobrevida. Se están desarrollando nuevos marcadores bioquímicos para optimizar la pesquisa de isquemia. En estos casos, la tomografía computada (TC) multicorte y angioTC, son de gran utilidad para establecer la viabilidad de un segmento y la probabilidad de resección. En tratamiento general y quirúrgico si corresponde, tiene mejores resultados en escenarios de diagnóstico precoz.

Diagnóstico nutricional de población escolar en una isla de la VIII región / Nutritional diagnosis of school children on an island of the VIII region

La Isla Mocha forma parte de la comuna de Lebu, VIII región. Por sus condiciones de aislamiento, las condiciones de vida de sus habitantes suelen ser deficientes. Objetivo: Caracterizar el estado nutricional de los niños de la Escuela G-501 Isla Mocha mediante evaluación antropométrica, para conocer la magnitud de la malnutrición por exceso en esta población. Pacientes y Método: Se pesó y midió a los 80 niños presentes matriculados en la Escuela G-501 Isla Mocha (de un total de 88) en la ronda médica de diciembre de 2012, clasificando su estado nutricional según las tablas recomendadas para cada edad. Resultados: Del total de niños, 24 (30 por ciento) tienen un diagnóstico nutricional normal o eutrófico; 25 (31,25 por ciento) están en sobrepeso y 31 (38,75 por ciento) de los niños están obesos. Desagregando por sexo, hay más niñas en sobrepeso y obesidad que niños. De un total de 120 niños de 0 a 14 años que habitan en la Isla, 56 presentan malnutrición por exceso (46,66 por ciento). Conclusiones: Las cifras de obesidad y sobrepeso en una ambiente rural, aislado y de pobreza son preocupantes, y hacen necesaria la creación de estrategias que redunden en una mejora de estilos de vida tanto en estos niños como en sus familias.

Mocha Island is part of the commune of Lebu, VIII region. By isolating location, conditions of life of its inhabitants are often deficient. Objective: To characterize the nutritional status of children attending the G-501 school in Mocha Island using anthropometric assessment, in order to determine the magnitude of malnutrition due to excessive food intake in this population. Patients and Method: Weight and measurement of 80 children enrolled in school (out of 88) were calculated during the medical round of December 2012, classifying their nutritional status according to the recommended table for each age. Results: Qf the children, 24 (30 percent) had normal or eutrophic nutritional diagnosis, 25 (31.25 percent) were overweight and 31 (38.75) were obese. There are more overweight and obese girls than boys. From a total of 120 children aged 0-14 living on the island, 56 had malnutrition due to excessive food intake (46.66 percent). Conclusions: The odds of obesity and overweight in rural, isolated and poor environments are alarming and require the creation of strategies that result in improved lifestyles for these children as well as their families.

Aspectos relevantes en la realización de la endoscopia digestiva: propuestas basadas en la evidencia. Curso ACHED 2013 / Relevant aspects of digestive endoscopy. Evidence-based suggestions. Chilean Association of Digestive Endoscopy (ACHED), Course 2013

Digestive endoscopy is a complex tool for diagnosis and treatment, with continuous development both in technical aspects and in their application for the different pathologies where this technique is required. Therefore, a continuous education program is necessary for the practitioner using this technique. With the purpose of reaching an agreement between different aspects of the performance of these procedures and also generating proposals for its application that are useful for the physicians of this area of expertise, during 2013 the Chilean Association of Digestive Endoscopy (ACHED) developed a workshop called ‘Relevant aspects of digestive endoscopy. Evidence-based suggestions’. This workshop was attended by gastroenterologists and trainee practitioners, who worked in groups during a period of two months where they reviewed available evidence to answer several questions relating to milestones and lesions that need to be described in upper gastrointestinal endoscopy, the preparation of the GI endoscopy report, technical aspects and quality measures in colonoscopy. This review resulted in proposals that were analyzed and agreed on in the form of recommendations presented for further analysis and discussion amongst endoscopic teams in our country.

La endoscopia digestiva es una herramienta de diagnóstico y tratamiento médico compleja, en continuo desarrollo tanto en lo técnico como en los conceptos de manejo de las patologías en las que se utiliza.Por lo tanto, es deseable una estrategia de formación continua del profesional que la realiza. Con el objetivode consensuar diferentes aspectos en la realización de estos procedimientos y generar propuestas de manejoque sean de utilidad para todos los médicos involucrados en esta especialidad, la Asociación Chilenade Endoscopia Digestiva (ACHED) realizó durante el año 2013 un curso taller denominado “Aspectosrelevantes en la realización de la endoscopia digestiva. Propuestas basadas en la evidencia”. Este cursoconvocó a gastroenterólogos y médicos en formación de la especialidad que conformaron grupos de trabajoque durante 2 meses revisaron la evidencia disponible para responder diversas preguntas en relación a los hitos y lesiones a describir en endoscopia digestiva alta (EDA), la realización del informe en EDA, aspectos técnicos y medidores de calidad en colonoscopia. La revisión les permitió generar propuestas que fuerondiscutidas y consensuadas en recomendaciones que se proponen para su discusión por los equipos endoscópicos de nuestro país.

Sangrado digestivo de origen oscuro: opciones actuales / Obscure gastrointestinal bleeding: current options

Obscure gastrointestinal (GI) bleeding is a diagnostic challenge, because interaction between endoscopic and radiological methods are required. After ruling out gastro-colonic causes, we should search for small bowel vascular lesions, inflammatory disorders and malignant lesions that may cause two types of obscure GI bleeding: obscure-occult and obscure-overt bleeding. The prupose of the present review is to analyze the results of these techniques and to make recommendations regarding management and treatment of this disease.

La hemorragia digestiva de origen oscuro representa un desafío diagnóstico, donde es importante el complemento entre métodos endoscópicos y radiológicos. Luego de descartar causas gastro-colónicas, el estudio se centra en la búsqueda de lesiones vasculares, inflamatorias, tumorales, que provocan el sangrado de origen oscuro, ya sea oculto o evidente. En esta revisión se analizan los resultados de estas técnicas y se proponen algunas conductas en el enfrentamiento de esta patología.

Ampuloma: ¿terapia endoscópica o quirúrgica? / Ampullary neoplasms: endoscopic or surgical treatment?

Ampullary neoplasms may correspond to adenoma or adenocarcinoma. The study of its staging is performed by means of computed tomography, magnetic resonance imaging and endosonography. The appropriate classification of the stages allows for a better planning of treatment. In benign tumors and small selected carcinoma, ampullectomy (endoscopic or surgical) is an alternative. In patients with ampullary neoplasms invading deep extension or showing high risk of recurrence, without evidence of metastasis, pancreatodudodenectomy is the treatment of choice. In those cases with distant metastasis, palliative treatment is indicated.

Las neoplasias ampulares pueden corresponder a adenomas o adenocarcinomas. El estudio de etapificación se realiza con tomografía computada, resonancia magnética y endosonografía. La correcta clasificación en estadíos, permite planificar de mejor forma el tratamiento. En tumores benignos y seleccionados carcinomas pequeños, la ampulectomía (endoscópica o quirúrgica) es una alternativa. En pacientes con neoplasias ampulares que presentan extensión en profundidad o alto riesgo de recurrencia, sin evidencia de metástasis a distancia, estaría indicada la pancreatoduodenectomía. En aquellos casos con metástasis a distancia, se aplican técnicas paliativas.

Influence of climatic conditions on in vitro production of bovine embryos / Influência do clima na produção in vitro de embriões bovinos

Temperature and rainfall were analyzed daily during six years to evaluate their influence on in vitro production of bovine embryos. Weekly replications (n=480) were performed on 14,778 ovaries collected at slaughterhouses. Cumulus oocyte complexes (n=19,180) were fertilized with a pool of Bos taurus taurus semen in one incubator with 5 percent CO2. Presumable zygotes were cultured in gasified plastic bags with 5 percent CO2, 5 percent O2, and 90 percent N2. In the first year, cleavage and embryo yield were 60.3 percent and 15.6 percent, respectively, being lower (P<0.05) than in the following years. Average cleavage rates were always lower in winter (P<0.0001), thus producing less embryos. Winter climatic conditions had a negative influence on in vitro production, when cleavage and embryo yield declined, possibly because of reduced availability and growth of native pasture.

A temperatura e a precipitação pluviométrica foram analisadas diariamente, durante seis anos, para avaliar sua influência sobre a produção in vitro de embriões bovinos. As repetições semanais (n=480) foram realizadas com 14.778 ovários coletados em matadouros. Os oócitos (n=19.180) foram maturados em estufa com atmosfera com controle de temperatura e umidade saturada com 5 por cento de CO2 e, após 20h, foram fecundados com sêmen de Bos taurus taurus e mantidos sob as mesmas condições de atmosfera da maturação. Os zigotos foram cultivados em placas de quatro poços em bolsas gaseificadas com 5 por cento de CO2, 5 por cento de O2 e 90 por cento de N2, à temperatura de 39ºC e umidade saturada. No primeiro ano, a taxa clivagem (60,3 por cento) e a produção de embriões (15,6 por cento) foram inferiores (P<0,05) aos demais anos. As taxas de clivagem foram sempre menores no inverno (P<0,0001). As condições climáticas no inverno tiveram influência negativa sobre a produção in vitro de embriões bovinos e houve diminuição nos índices de clivagem e produção de blastocistos, possivelmente devido à reduzida disponibilidade e crescimento da pastagem nativa.

Morbilidad en mujeres postmenopáusicas pobres / Morbidity in postmenopausal women with poverty

Background: Less favored social classes usually have more unhealthy life-styles and a more difficult access to Health Resources. Aim: To study the possible association between poverty and some common diseases, in a population of postmenopausal women. Material and Methods: Four hundred and forty nine poor women aged 56 ± 12 years and 776 consecutive women aged 53 ± 12 years, answered a personal interview about their lifestyles and medications used. Their medical records were reviewed and they were subjected to a complete physical examination, including weight and height measurement. A fasting blood sample was also obtained. Poverty was defined according to criteria of the Spanish National Institute of Statistics that is based on the income in Euros and the number of family members that share such income. Results: A higher proportion of poor women live in rural areas. They were shorter, had a higher weight and thus a higher body mass index, smoked less and drank less alcohol than their non-poor counterparts drink. The consumption of caffeine, the actual calcium intake and the physical activity during leisure time was similar in both groups. Compared with their counterparts, poor women had a higher prevalence of diabetes mellitus (15.9 and 10.1 percent respectively, p = < 0.01), obesity (44.2 and 24.3 percent respectively, p < 0.01) hypertension (24.3 and 16.4 percento respectively, p<0.01) and autoimmune rheumatic diseases (7.8 and 4.8 percent> respectively, p = 0.03). A multiple logistic regression model showed that obesity, hypertension, diabetes mellitus, smoking, alcohol consumption and living in rural areas, were independently associated to poverty. Conclusions: Poor postmenopausal women have a higher prevalence of diabetes mellitus, obesity, autoimmune rheumatic diseases and hypertension and lower frequency of smoking and alcohol consumption than their affluent counterparts do.

Tumores del estroma gastrointestinal (GIST): revisión de la literatura / Gastrointestinal stromal tumors (gist): literature review

Los tumores del estroma gastrointestinal representan un tipo infrecuente de tumor de origen mesenquimático, con origen en las células intersticiales de Cajal. Se caracterizan por expresar un receptor de membrana mutante con actividad tirosina quinasa anormal (c-kit CD117) que condiciona su activación permanente y una proliferación celular no controlada. Pueden encontrarse a cualquier nivel del tracto gastrointestinal, pero son más frecuentes en estómago e intestino delgado. Frecuentemente cursan de forma asintomática, constituyendo un hallazgo endoscópico o radiológico. La enfermedad localizada habitualmente es de buen pronóstico tras su resección quirúrgica, mientras que la sobrevida es baja en etapas avanzadas, con escasa respuesta a la quimioterapia convencional. El surgimiento del imatinib, un inhibidor de la tirosina quinasa, ha representado un verdadero hito, dado su eficacia en el control de la enfermedad irresecable o metastásica, permitiendo un importante aumento en la sobrevida de estos pacientes.

Conformidad con las pautas terapéuticas vigentes en pacientes hipertensos usuarios de una sala de emergencias / Compliance with current therapy guidelines in hypertensive patients at an emergency service

Arterial hypertension is one of the most prevalent health problems and one of the most important risk factors for cardiovascular and cerebrovascular disease. The purpose of this study was to identify if hypertensive patients are being treated in accordance to current recommendations (JNC-7) for this condition and to estimate the level of blood pressure control in the subjects at the moment of their participation in the study. A total of 138 patents with previous diagnosis of arterial hypertension were recruited from visitors to the Emergency Room at Dr. Pila Hospital in Ponce, Puerto Rico during the months of November 2003 through April 2004. Data was collected in the form of a questionnaire, administered by interview. The questionnaire included demographic data, blood pressure level, anthropometric variables, reported history of chronic diseases, use of antihypertensive agents and other variables. At the moment of their participation, 77 of the subjects had uncontrolled hypertension. Only 25 of subjects reported present use of diuretic agents, which are highly recommended as first line treatment for hypertension. The majority (54) of subjects were being treated with only one antihypertensive agent. The majority (58) of patients were not being treated in accordance with current recommendations (JNC-7) under the category of [quot ]compelling indications[quot ]. The results of this study could very well indicate tendencies and patterns of treatment in hypertensive patients of our community. This may warrant further research and inquiry for explanations