Microbiota intestinal y cólicos infantiles: ¿hay lugar para los prebióticos, probióticos y posbióticos? / Gut Microbiota and Infant Colic: is there a Place for Prebiotics, Probiotics, and Postbiotics?

El consumo de probióticos, prebióticos y posbióticos, o su combinación, puede contribuir a mantener una microbiota intestinal saludable ya que permite la regulación de su disbiosis en el caso de algunas enfermedades o trastornos, principalmente en los trastornos gastrointestinales funcionales (TGIF). El microbioma intestinal es protagonista esencial en la fisiopatología de los TGIF a través de sus funciones metabólicas y nutricionales, el mantenimiento de la integridad de la mucosa intestinal y la regulación de la respuesta inmunitaria. Las investigaciones realizadas hasta la fecha indican que los probióticos, prebióticos y posbióticos pueden tener efectos inmunomoduladores directos y clínicamente relevantes. Existen pruebas del uso de esta familia de bióticos en individuos sanos para mejorar la salud general y aliviar los síntomas en una serie de enfermedades como los cólicos infantiles. La colonización y establecimiento de la microbiota comienza en el momento del nacimiento; los primeros 2-3 años de vida son fundamentales para el desarrollo de una comunidad microbiana abundante y diversa. Diversos estudios científicos realizados mediante técnicas tradicionales dependientes de cultivo y más recientemente por técnicas moleculares han observado diferencias en las poblaciones bacterianas de bebés sanos y aquellos que sufren TGIF, estos últimos caracterizados por un aumento de especies patógenas y una menor población de bifidobacterias y lactobacilos, en comparación con los primeros. En tal contexto, se considera que la microbiota intestinal como protagonista en el desarrollo de esos trastornos, entre ellos los cólicos infantiles, a través de sus funciones metabólicas, nutricionales, de mantenimiento de la integridad de la mucosa intestinal y regulación de la respuesta inmunitaria. Esto ha abierto la puerta al estudio de la utilización de prebióticos, probióticos y posbióticos en el tratamiento y/o prevención de los TGIF infantiles. El parto vaginal y de término así como la lactancia son fundamentales en la constitución de una microbiota saludable. Como herramientas de apoyo, existen estudios de eficacia que sustentan la administración de esta familia de bióticos, principalmente en los casos en que la lactancia no sea posible o esté limitada. (AU)

The consumption of probiotics, prebiotics, and postbiotics, or a combination of them, can contribute to maintaining a healthy intestinal microbiota as it allows the regulation of its dysbiosis in the case of some diseases or disorders, mainly in functional gastrointestinal disorders (FGIDs). The gut microbiome is an essential player in the pathophysiology of FGIDs through its metabolic and nutritional functions, the maintenance of intestinal mucosal integrity, and the regulation of the immune response. Research results thus far indicate that probiotics, prebiotics, and postbiotics may have direct and clinically relevant immunomodulatory effects. There is evidence regarding the prescription of this family of biotics in healthy individuals to improve overall health and alleviate symptoms in many conditions like infantile colic. The colonization and microbiota establishment begins at birth; the first 2-3 years of life are critical for developing an abundant and diverse microbial community. Several scientific studies performed by traditional culture-dependent techniques and more recently by molecular techniques have observed differences in the bacterial populations of healthy infants and those suffering from FGIDs, the latter characterized by an increase in pathogenic species and a lower population of bifidobacteria and lactobacilli, compared to the former. In this context, the intestinal microbiota plays a leading role in the onset of these disorders, including infantile colic, through its metabolic and nutritional functions, maintenance of the integrity of the intestinal mucosa, and regulation of the immune response. That has opened the door to the study of prebiotics, probiotics, and postbiotics usage in the treatment and or prevention of infantile FGIDs. Vaginal and term delivery and breastfeeding are fundamental in the constitution of a healthy microbiota. As supportive tools, there are efficacy studies that support the administration of this family of biotics, mainly in cases where lactation is not possible or is limited.

Gallbladder-agenesis—a-rare-case-report

Gallbladder agenesis is a rare congenital entity. The incidence is around 1 per 6500 live births. Around 50-70% patients are asymptomatic and the rest are symptomatic with symptoms mimicking biliary colic. Right upper quadrant ultrasound (US) is usually either misleading or inconclusive. Also advanced diagnostic studies such as hepatobiliary iminodiacetic acid (HIDA) scan and endoscopic retrograde cholangio-pancreatography (ERCP) may show non- visualization of the gallbladder and erroneously lead providers to a diagnosis of cystic duct obstruction rather than Gallbladder Agenesis. So some patients are only finally diagnosed intraoperatively. Surgery in these patients becomes risky because unnecessary dissection while looking for the non-existent gallbladder can result in injury of the biliary tree, hepatic vasculature, or small bowel. Therefore, clinicians should keep Gallbladder Agenesis on their differential diagnosis list and imaging modalities such as magnetic resonance cholangiopancreatography (MRCP) should be obtained when other tests are inconclusive. We report a 48-year-old female presenting with chronic symptoms consistent with biliary colic and an equivocal US reported as cholelithiasis. She underwent laparoscopy during which the absence of the gallbladder was noted.

Arterias sigmoideas: bases para una nueva clasificación / Sigmoid arteries: bases for a new classification

Las arterias sigmoideas son ramas de la arteria mesentérica inferior e irrigan al colon sigmoideo. Se originan del tronco de las arterias sigmoideas. Esta es la descripción más frecuente según los autores consultados. El objetivo fue analizar las variaciones en el origen y distribución de las arterias sigmoideas mediante disección. Se utilizaron 13 preparados cadavéricos formolizados al 10 %. Se disecó la cavidad abdominal para identificar a las arterias sigmoideas. Se evidenció su bifurcación paralela al colon sigmoideo. Se lo delimitó mediante reparos palpables. Patrón I: 4 casos (30,8 %). Variante de la arcada sigmoidea como rama colateral de la arteria mesentérica inferior. Tipo Ia: 1 caso (25 %). Sin asociaciones. Tipo Ib: 1 caso (25 %). Asociada al tronco sigmoideo. Tipo Ic: 2 casos (50 %). Asociada a arterias sigmoideas accesorias. Patrón II: 6 casos (46,2 %). Variante del tronco común entre arteria cólica izquierda y arterias destinadas al colon sigmoideo. Tipo IIa: 3 casos (50 %). Sin asociaciones. Tipo IIb: 2 casos (33,3 %). Asociado al tronco sigmoideo. Tipo IIc: 1 caso (16,7 %). Asociado a arterias sigmoideas accesorias. Patrón III: 3 casos (23 %). Variante clásica. Se definió por la ausencia del tronco común con la arteria cólica izquierda y de la arcada sigmoidea. Tipo IIIa: 2 casos (66,7 %). Un número variable de arterias sigmoideas nacen como ramas colaterales de la arteria mesentérica inferior, sin asociarse al tronco sigmoideo. Tipo IIIb: 1 caso (33,3 %). La arteria cólica izquierda emite como rama colateral la primera arteria sigmoidea y se asocia al tronco sigmoideo. 1. El patrón II es el prevalente en este trabajo (46,2 %). 2. La variante clásica no es la predominante en esta investigación (23 %). 3. La arcada sigmoidea tiene 53,8 % de incidencia.

SUMMARY: The sigmoid arteries are branches of the inferior mesenteric artery and supply the sigmoid colon. They originate from the trunk of the sigmoids. This is the most frequent description according to the consulted authors. The objective is to analyze the variations in the origin and distribution of the sigmoid arteries through dissection. 13 cadaveric preparations formalized at 10 % and instruments were used. The abdominal cavity was dissected to identify the sigmoid arteries. Its bifurcation parallel to the sigmoid colon is evident. It is delimited by palpable repairs. Pattern I: 4 cases (30.8 %). Variant of the sigmoid arcade as a collateral branch of the inferior mesenteric artery. Type Ia: 1 case (25 %). No associations. Type Ib: 1 case (25 %). Associated with the sigmoid trunk. Type Ic: 2 cases (50 %). Associated with accessory sigmoid arteries. Pattern II: 6 cases (46.2 %). Variant of the common trunk between the left colic artery and arteries destined for the sigmoid colon. Type IIa: 3 cases (50 %). No associations. Type IIb: 2 cases (33.3 %). Associated with the sigmoid trunk. Type IIc: 1 case (16.7 %). Associated with accessory sigmoid arteries. Pattern III: 3 cases (23 %). Classic variant. It was defined by the absence of the common trunk with the left colic artery and the sigmoid arcade. Type IIIa: 2 cases (66.7 %). A variable number of sigmoid arteries arise as collateral branches of the inferior mesenteric artery, without being associated with the sigmoid trunk. Type IIIb: 1 case (33.3 %). The left colic artery gives off the first sigmoid artery as a collateral branch and is associated with the sigmoid trunk. 1. Pattern II is the most prevalent in this study (46.2 %). 2. The classic variant is not the predominant one in this research (23 %). 3. The sigmoid arcade has a 53.8 % incidence.

Predictive validity and cut-off point of the Turkish version of the Infant Colic Scale in the diagnosis of colic

Abstract Objective: To investigate the predictive validity and cut-off point of the Turkish version of the Infant Colic Scale (ICS) in the diagnosis of colic. Methods: This methodological study was carried out in a pediatric outpatient clinic of a university hospital in Turkey with infants aged 6-16 weeks (n = 133). The data were collected using the Mother-Infant Description Form, the ICS, and the Rome IV criteria form. The scale is a 6-point Likert-type scale consisting of 19 items in total. A low total mean score obtained from it indicates that the probability of colic increases, while a high mean score indicates that the probability of colic decreases. The Rome IV criteria were used as the gold standard. Results: The mean score obtained from the ICS was 59.4 ± 13.7. According to the Rome IV criteria, 26.3% of the infants had colic. The area under the ROC curve was 87.4% (95% CI = 0.815-0.934, SE = 0.30, p = 0.001), and the cut-off point for the best sensitivity value (88.6%) and the best specificity value (70.5%) of the ICS was determined to be 60.5. According to the cut-off point, the positive predictive value was 51%, and the negative predictive value was 94%. Conclusion: The predictive validity of the Turkish version of the ICS was found to be at a good level with high sensitivity and acceptable specificity for a cut-off point of 60.5. Healthcare professionals working in the child field can use the ICS to exclude colic in infants.

Therapeutic efficacy evaluation of Tuina at points on abdomen and back meridians for infantile colic / 针灸推拿医学（英文版）

Objective: To evaluate the efficacy of Tuina (Chinese therapeutic massage) at points on abdomen and back meridians in the treatment of infantile colic.Methods: A total of 120 infants with intestinal colic were randomly divided into a control group and an observation group, with 60 cases in each group. In the control group, the parents of the infants were given soothing and health education. In addition to the intervention used in the control group, the observation group was treated with Tuina at points on abdomen and back meridians once a day for 5 consecutive days as a course of treatment. The pain scale score and clinical symptoms of the two groups were recorded before and after treatment. Results: After treatment, the total effective rate of the observation group was higher than that of the control group, and the difference was statistically significant (P<0.05). The pain scale score of the observation group was lower than that of the control group, and the difference was statistically significant (P<0.05). In the 24 h behavior diary indicators, the daily attack duration, the daily attack times, and the weekly attack days in the observation group were lower than those in the control group, and the differences were statistically significant (P<0.05). Conclusion: Tuina at points on abdomen and back meridians is effective and safe in the treatment of infantile colic.

Trastornos funcionales gastrointestinales. Cómo tratar sin medicar / Functional gastrointestinal disorders. How to manage them without medication

Los trastornos funcionales gastrointestinales (TFGI) se caracterizan por síntomas atribuibles al tracto gastrointestinal que no pueden ser explicados por anormalidades estructurales ni bioquímicas. Durante el primer año de vida, pueden generar mucho malestar en el lactante y preocupación en sus padres. Su diagnóstico se basa en criterios clínicos que expertos han determinado y en una historia clínica y un examen físico completo que descartan causas orgánicas. El objetivo de esta actualización es presentar estrategias para el manejo de los TFGI más frecuentes durante el primer año de vida: cólicos, regurgitaciones, disquecia y estreñimiento, bajo la visión de los nuevos conocimientos fisiopatológicos, que eviten los estudios y medicaciones innecesarias.

Functional gastrointestinal disorders (FGIDs) are characterized by symptoms attributable to the gastrointestinal tract that cannot be explained by the presence of structural or biochemical abnormalities. During the first year of life, FGIDs can cause great discomfort in infants and concern in their parents. The diagnosis of FGIDs is based on clinical criteria determined by experts and on a comprehensive case-taking process and physical exam to rule out organic causes. The objective of this update is to describe strategies for the management of the most frequent FGIDs during the first year of life: colics, regurgitations, dyschezia, and constipation, in light of new pathophysiological insights, to avoid unnecessary tests and medications.

A rare case of neonatal intestinal obstruction

Omphalocele minor is often associated with the presence of other anomalies compared to that of omphalocele major. The occurrence of intestinal atresia is seldom associated with omphalocele minor. Prompt diagnosis and intervention can prevent morbidity and mortality. Following is a rare case report of combination of omphalocele minor and intestinal atresia with strangulation of the proximal bowel.

Oclusión intestinal mecánica secundaria a hernia de Littré / Mechanical Intestinal Occlusion Secondary to Littré's Hernia

Introducción: La hernia de Littré se define como la presencia de un divertículo de Meckel en cualquier orificio herniario. Se han reportados muy pocos casos en la literatura por su frecuencia tan baja referida al 2 por ciento de la población general. Objetivo: Reportar y compartir el tratamiento exitoso de un caso clínico poco frecuente de oclusión intestinal mecánica por hernia de Littré. Caso clínico: Se trata de un paciente masculino, de 69 años de edad, raza blanca y con antecedentes de hipertensión arterial hace siete años, para lo que lleva tratamiento regular con captopril. Acudió al Servicio de Urgencias de Cirugía general del Hospital Clínico Quirúrgico Docente "Lucía Íñiguez Landín" por presentar dolor abdominal tipo cólico localizado difusamente, de moderada intensidad, sin irradiación precisa y acompañado de dos vómitos biliosos de poca cantidad, además de parada de la emisión de gases y heces fecales dos días antes, por lo que se ingresó para tratamiento quirúrgico urgente con diagnóstico de oclusión intestinal mecánica. Conclusiones: El diagnóstico preoperatorio de la hernia de Littré es poco probable, sobre todo si se acompaña de oclusión intestinal por lo que casi siempre es transoperatorio. El tratamiento quirúrgico del divertículo depende del estado inflamatorio y vascular(AU)

Introduction: Littré's hernia is defined as the presence of a Meckel's diverticulum in any hernial orifice. Very few cases have been reported in the literature because of its very low frequency, referred to as of 2 percent of the general population. Objective: To report and share the successful management of a rare clinical case of mechanical intestinal occlusion due to Littré's hernia. Clinical case: This is the case of a 69-year-old white male patient with a history of arterial hypertension for seven years, for which he has been receiving regular treatment with captopril. He went to the general surgery emergency department of Lucía Íñiguez Landín Clinical Surgical Teaching Hospital for presenting diffusely localized colicky abdominal pain, of moderate intensity, without precise irradiation and accompanied by two small amounts of bilious vomiting, in addition to stopping gas and stool emission two days earlier, for which he was admitted for urgent surgical treatment with a diagnosis of mechanical intestinal occlusion. Conclusions: The preoperative diagnosis of Littré's hernia is unlikely, especially if accompanied by intestinal occlusion, a reason why it is almost always transoperative. The surgical treatment of the diverticulum depends on the inflammatory and vascular status(AU)

Prematurity and functional gastrointestinal disorders in infancy: a cross-sectional study

ABSTRACT BACKGROUND: Functional gastrointestinal disorders (FGIDs) are defined as a variable combination of chronic or recurrent gastrointestinal symptoms that are not explained by structural or biochemical abnormalities. Their relationship with prematurity has been increasingly studied. OBJECTIVE: To compare the frequency of FGIDs in preterm and term infants and to evaluate whether invasive procedures during the neonatal period in preterm infants are associated with greater likelihood of FGIDs in the first two years of life. DESIGN AND SETTING: Controlled nested cross-sectional study conducted in a Brazilian university hospital. METHODS: This was a controlled nested cross-sectional study on a retrospective cohort of infants born preterm who were compared with infants born at term regarding the presence of FGIDs. Medical consultations were conducted by a single pediatric gastroenterologist to obtain information on the gestational and neonatal periods and on clinical manifestations of the digestive tract. The Rome IV criteria for the diagnosis of FGIDs were used. RESULTS: A total of 197 infants (< 24 months), including 99 preterm and 98 term infants, were studied. Infant regurgitation was more prevalent in term infants (35.1% and 15.6%; P < 0.001). The frequencies of other FGIDs (infant colic, functional constipation, functional diarrhea and infant dyschezia) in preterm infants did not differ from those of term infants (P > 0.05). No relationship was found between invasive procedures during the neonatal period and development of FGIDs in preterm infants. CONCLUSION: Infants born preterm did not have higher frequency of FGIDs in the first two years of life.

Analysis of risk factors for urinary tract infection in pregnant women with acute renal colic after indwelling ureteral D-J tube / 中华全科医师杂志

Objective:To investigate the risk factors related to urinary tract infection after indwelling ureteral D-J tube in pregnant women with acute renal colic.Methods:Clinical data of 109 pregnant women with acute renal colic undergoing indwelling ureteral D-J tube in emergency department of Taizhou Hospital or Enze Hospital from January 2008 to December 2019 were retrospectively analyzed. There were 31 cases (28.4%) with urinary tract infection after discharge and before delivery (infection group) and 78 cases without infection (non-infected group). Univariate and multivariate logistic regression analyses were used to evaluate the risk factors of urinary tract infection after ureteral D-J tube insertion.Results:In 109 patients the average age was 28 (25,33) years, the average gestational age was 26 (21,31)weeks, and the average body mass index (BMI) was 24.84 (22.60,27.43) kg/m 2. Compared with the non-infected group, the infection group had a higher rate of positive urine culture [38.7%(12/31) vs. 15.4%(12/78), χ2=6.56, P=0.010] and diabetes [45.2%(14/31) vs. 11.5%(9/78), χ2=13.86, P<0.001], and a lower gestational age [23(20,28) vs.27(21,32) weeks, Mann-Whitney U test, P=0.006]. Multivariate analysis showed that diabetes( OR=7.739,95 %CI:2.579-23.223, P<0.001), positive urine culture( OR=3.249,95 %CI:1.131-9.330, P=0.029), and gestational age( OR=0.201,95 %CI:0.042-0.955, P=0.044) were independent risk factors for urinary tract infection in pregnant women with acute renal colic after ureteral D-J tube insertion. Conclusion:History of diabetes, gestational age, and positive preoperative urine culture are risk factors for urinary tract infection after ureteral D-J tube insertion in pregnant women with acute renal colic.

Recognition and management of infantile colic / 中国小儿急救医学

Infantile colic(IC)is a common process that occurs in the infants within five months of age.The main characteristic of IC is paroxysm of inconsolable crying.Although IC is a benign self-limiting process, it is a common source of concern for family, and usually bring challenge to doctors.The diagnostic criteria is Roma Ⅳ criteria, which is mainly based on the typical feature and duration of crying.The etiology is unknown.The proposed causes can be classified into gastrointestinal and non-gastrointestinal factors.There is still no standard treatment for IC.The current management includes dietary modification, behavioral modification, pharmacological intervention, manual therapy, and so on.More clinical studies are needed to confirm the effect of these treatment strategies.Pediatricians should be familiar with the main causes and management of IC, and should also be adept at recognizing the individual reasons, managing the infants, and improving the prognosis.

Actualización de los tratamientos para el cólico del lactante

RESUMEN Introducción: El cólico del lactante es un cuadro caracterizado por llanto repetitivo y continuado con dificultad para calmarse. Su origen no está definido, lo cual obstaculiza la existencia de un tratamiento de éxito. Objetivo: Analizar las evidencias científicas más actuales acerca de los tratamientos existentes y susceptibles de usar en el cólico del lactante. Métodos: Se realizó una búsqueda bibliográfica en las bases de datos Cinhal, Medline y Scopus utilizando los descriptores, "Infant", "Colic", "Therapeutics" y la palabra clave "Treatment". Se obtuvieron 97 resultados totales, de los cuales resultaron ser válidos 15. Análisis e integración de la información: La finalidad común de los trabajos analizados es la disminución de la sintomatología del cólico del lactante, centrándose en la disminución del llanto, con tratamientos que van desde la administración de dosis orales de probióticos, hierbas medicinales y homeopatía, hasta el tratamiento con estímulos físicos como la terapia cráneo-sacra, la acupuntura, el masaje o la reflexología. Conclusiones: Existen múltiples tratamientos para el cólico del lactante, pero no se puede afirmar que uno sea más eficaz que los demás.

ABSTRACT Introduction: Infant colic is a condition characterized by repetitive and continuous crying with difficulty calming down. Its origin is not defined, which hinders the existence of a successful treatment. Objective: To analyze the most current scientific evidence on the existing treatments that can be used in infant colic. Methods: A bibliographic search was carried out in Cinhal, Medline and Scopus databases using the descriptors, "Infant", "Colic", "Therapeutics" and the keyword "Treatment". Ninety-seven total results were obtained, 15 of them were valid. Analysis and integration of information: The common purpose of the studies analyzed is to reduce the symptoms of colic in infants, focusing on reducing crying, treatments ranged from the administration of oral doses of probiotics, medicinal herbs and homeopathy, to treatment with physical stimuli such as cranio-sacral therapy, acupuncture, massage or reflexology. Conclusions: There are multiple treatments for infant colic but it cannot be said that one is more effective than the others.

In vitro evaluation of the dissolving effect of carbonated beverages (Coca-Cola®) and enzyme-based solutions on enteroliths obtained from horses: pilot study / Avaliação in vitro do efeito dissolvente de bebidas carbonatadas (Coca-Cola®) e soluções à base de enzimas sobre enterólitos obtidos de cavalos: estudo piloto

Enteroliths are concretions of minerals that cause partial or total obstruction of the intestinal lumen, resulting in recurrent and chronic colic in horses. This pilot study aimed to evaluate the in vitro solvent effect of carbonated beverages (Coca-Cola® and Coca-Cola® Zero), and papain and cellulase enzymes (Robinson Pharma®, Santa Ana, CA, USA) on enteroliths obtained from horses. Six 51-grams-samples of six enteroliths were assigned to six treatments of immersion solutions: T1, Coca-Cola®; T2: Coca-Cola® Zero; T3: distilled water + papain (90 mg) and cellulase (120 mg); T4: Coca-Cola® + papain and cellulase; T5: Coca-Cola® Zero + papain and cellulase; and, CT: distilled water (control). The volume for immersion in the assigned solution was 150 mL, at a pH of 7.1, using an incubation shaker (Heidolph®, Germany) at 37ºC and 25 rpm, for 72 h. The evaluation periods of the dissolution percentage (difference between the initial weight and final weight of the samples), were 0, 3, 12, 24, 36, 48, 60, and 72 h. After 72 h of immersion, solutions T4, T5, and T1 presented 47, 38.8, and 14.9% of dissolution, respectively. The other solutions did not have major differences with CT (control). Under the in vitro conditions of this pilot study, papain and cellulase enzymes potentiated the dissolving effect of the carbonated solutions on the enteroliths obtained from horses. Further studies are suggested since the existing literature is on the dissolution of phytobezoars and not of enteroliths.(AU)

Enterólitos são concreções de minerais que causam obstrução parcial ou total do lume intestinal, resultando em cólica crônica e recorrente nos cavalos. Este estudo piloto teve como objetivo avaliar in vitro o efeito dissolvente sobre os enterólitos das bebidas carbonatadas (Coca-Cola® e Coca-Cola® Zero) e a solução à base das enzimas papaína e celulase (Robinson Pharma®, Santa Ana, CA, USA). Seis (6) amostras de seis (6) enterólitos de 51gramas de peso foram distribuídas em seis tratamentos de imersão: T1: Coca-Cola®; T2: Coca-Cola® Zero; T3: água destilada + papaína (90 mg) e celulase (120 mg); T4: Coca-Cola® + papaína e celulase; T5: Coca-Cola® Zero + papaína e celulase; e, CT: água destilada (controle). O volume das soluções de imersão foi de 150 mL, com pH de 7.1, usando um shaker de incubação (Heidolph®, Germany) com 37ºC e 25 rpm, durante 72 horas. A avaliação dos períodos da porcentagem de dissolução (diferenças entre o peso inicial e o peso final das amostras) foram 0, 3, 12, 24, 36, 48, 60 e 72 h. Depois de 72 h de imersão, as soluções T4, T5 e T1 apresentaram 47, 38,8 e 14,9% de dissolução, respectivamente. As outras soluções não tiveram diferenças com relação ao CT (controle). Nas condições in vitro deste estudo piloto, as enzimas papaína e celulase potenciam o efeito dissolvente das bebidas carbonatadas sobre os enterólitos obtidos de cavalos. Mais estudos são sugeridos, uma vez que só existe literatura sobre a dissolução de fitobezoares e não de enterólitos.(AU)

Poisoning by Megathyrsus maximus (Sin. Panicum maximum) cv. Colonião in horses in the state of Rio de Janeiro / Intoxicação por Megathyrsus maximus (Sin. Panicum maximum) cv. Colonião em equinos no estado do Rio de Janeiro

Colic outbreaks in horses have been associated with the grazing of several Megathyrsus maximus (Sin. Panicum maximum) cultivars in the North and Central-West regions of Brazil. In this paper, we report a horse colic outbreak in the Southeast region of Brazil caused by ingestion of the "Colonião" cultivar of M. maximus, which has not previously been considered as toxic. The five affected horses belonged to the Veterinary Platoon based at the Central Ammunition Deposit of the Brazilian Army in the city of Paracambi, Rio de Janeiro state, Brazil. The horses had access to treated water and commercial concentrate, and were located in a field of M. maximus at the time of the outbreak. All horses exhibited clinical signs of colic and bloat, and three of them died. The extend of the clinical course ranged from four to five days in the three animals that died; in the two animals that recovered from the colic episodes, the extend of the clinical courses were 10 and 15 days. Necropsy findings revealed intestinal and gastric bloating and hemorrhages involving the intestinal wall. Light microscopy showed moderate diffuse lymphoplasmacytic and eosinophilic enteritis with multifocal erosions, in addition to submucosal edema associated with multifocal vasculitis. The pathogenesis of colic caused by M. maximus ingestion in horses has not yet been elucidated. Some authors have suggested that higher starch concentrations in M. maximus during the rainy season may be responsible for the toxicity of this plant. However, the findings of this study do not support this hypothesis. As a prophylactic measure, it is suggested that horses do not graze exclusively M. maximus at the beginning of rainy periods, in which regrowth of this grass occurs. In Brazil, outbreaks of horse colic associated with ingestion of varieties of Megathyrsus can also occur outside the North and Midwest regions, under specific climate conditions.(AU)

Surtos de cólica em equinos vêm sendo associados ao pastejo de várias cultivares de Megathyrsus maximus (Sin. Panicum maximum) nas regiões Norte e Centro-Oeste do Brasil. Neste trabalho relata-se um surto de cólica em equinos determinado pela ingestão da variedade Colonião de M. maximus, cultivar até então não descrita como tóxico. Os cinco equinos, oriundos do Pelotão de Veterinária do Centro de munição do Exército situado no município de Paracambi/RJ, estavam em uma mesma pastagem de M. maximus, tinham acesso à água tratada e ao concentrado comercial para equinos. Todos os equinos tiveram sinais clínicos de cólica por timpanismo e três deles morreram. O curso clínico variou de quatro a cinco dias nos três equinos que morreram e de 10 a 15 dias nos dois equinos que recuperaram-se da cólica. À necropsia, os principais achados foram timpanismo intestinal e gástrico e hemorragias na parede intestinal. À microscopia havia enterite linfoplasmocítica e eosinofílica difusa moderada com erosões multifocais e edema submucoso associado à vasculite multifocal. A patogênese da cólica pela ingestão de M. maximus ainda não foi elucidada, no entanto, alguns autores têm sugerido que uma maior concentração de amido presente na forrageira durante o período de chuvas possa ser responsável pela ação tóxica da planta. Contudo as observações aqui levantadas não dão suporte a essa hipótese. Sugere-se como medida profilática evitar o pastejo exclusivo de M. maximus por cavalos, por meio de pastagens alternativas, principalmente durante o início das chuvas e rebrota da pastagem. Demonstra-se que, no Brasil, os surtos de cólica em equinos associados à ingestão de variedades de Megathyrsus, também podem ocorrer fora das regiões Norte e Centro-Oeste, desde que existam condições climáticas especiais.(AU)

Controversy and progress on whether to retain left colonic artery in radical resection of rectal cancer / 中华胃肠外科杂志

Japanese Society for Cancer of the Colon and Rectum (JSCCR) guideline 2019 recommended that lymph node dissection for advanced rectal cancer should include the lymphatic adipose tissue at the root of the inferior mesenteric vessels, but the ligation site of the inferior mesenteric artery (IMA) was not determined, and the NCCN guideline did not indicate clearly whether to retain the left colonic artery (LCA). Controversy over whether to retain LCA is no more than whether it can reduce the incidence of anastomotic complications or postoperative functional damage without affecting the patients' oncological outcome. Focusing on the above problems, this paper reviews the latest research progress. In conclusion, it is believed that the advantages of retaining LCA are supported by most studies, which can improve the blood supply of the proximal anastomosis, and technically can achieve the same range of lymph node dissection as IMA high ligation. However, whether it affects the survival of patients, reduces the incidence of anastomotic leakage, and improves the quality of life of patients, more high-quality evidence-based medical evidence is still needed.

Poisoning by Megathyrsus maximus (Sin. Panicum maximum) cv. Colonião in horses in the state of Rio de Janeiro

ABSTRACT: Colic outbreaks in horses have been associated with the grazing of several Megathyrsus maximus (Sin. Panicum maximum) cultivars in the North and Central-West regions of Brazil. In this paper, we report a horse colic outbreak in the Southeast region of Brazil caused by ingestion of the Colonião cultivar of M. maximus, which has not previously been considered as toxic. The five affected horses belonged to the Veterinary Platoon based at the Central Ammunition Deposit of the Brazilian Army in the city of Paracambi, Rio de Janeiro state, Brazil. The horses had access to treated water and commercial concentrate, and were located in a field of M. maximus at the time of the outbreak. All horses exhibited clinical signs of colic and bloat, and three of them died. The extend of the clinical course ranged from four to five days in the three animals that died; in the two animals that recovered from the colic episodes, the extend of the clinical courses were 10 and 15 days. Necropsy findings revealed intestinal and gastric bloating and hemorrhages involving the intestinal wall. Light microscopy showed moderate diffuse lymphoplasmacytic and eosinophilic enteritis with multifocal erosions, in addition to submucosal edema associated with multifocal vasculitis. The pathogenesis of colic caused by M. maximus ingestion in horses has not yet been elucidated. Some authors have suggested that higher starch concentrations in M. maximus during the rainy season may be responsible for the toxicity of this plant. However, the findings of this study do not support this hypothesis. As a prophylactic measure, it is suggested that horses do not graze exclusively M. maximus at the beginning of rainy periods, in which regrowth of this grass occurs. In Brazil, outbreaks of horse colic associated with ingestion of varieties of Megathyrsus can also occur outside the North and Midwest regions, under specific climate conditions.

RESUMO: Surtos de cólica em equinos vêm sendo associados ao pastejo de várias cultivares de Megathyrsus maximus (Sin. Panicum maximum) nas regiões Norte e Centro-Oeste do Brasil. Neste trabalho relata-se um surto de cólica em equinos determinado pela ingestão da variedade Colonião de M. maximus, cultivar até então não descrita como tóxico. Os cinco equinos, oriundos do Pelotão de Veterinária do Centro de munição do Exército situado no município de Paracambi/RJ, estavam em uma mesma pastagem de M. maximus, tinham acesso à água tratada e ao concentrado comercial para equinos. Todos os equinos tiveram sinais clínicos de cólica por timpanismo e três deles morreram. O curso clínico variou de quatro a cinco dias nos três equinos que morreram e de 10 a 15 dias nos dois equinos que recuperaram-se da cólica. À necropsia, os principais achados foram timpanismo intestinal e gástrico e hemorragias na parede intestinal. À microscopia havia enterite linfoplasmocítica e eosinofílica difusa moderada com erosões multifocais e edema submucoso associado à vasculite multifocal. A patogênese da cólica pela ingestão de M. maximus ainda não foi elucidada, no entanto, alguns autores têm sugerido que uma maior concentração de amido presente na forrageira durante o período de chuvas possa ser responsável pela ação tóxica da planta. Contudo as observações aqui levantadas não dão suporte a essa hipótese. Sugere-se como medida profilática evitar o pastejo exclusivo de M. maximus por cavalos, por meio de pastagens alternativas, principalmente durante o início das chuvas e rebrota da pastagem. Demonstra-se que, no Brasil, os surtos de cólica em equinos associados à ingestão de variedades de Megathyrsus, também podem ocorrer fora das regiões Norte e Centro-Oeste, desde que existam condições climáticas especiais.

Hospitalización en paciente con cólico renal: Caracterización clínico-epidemiológica en el Hospital Clínico Herminda Martín, período marzo 2014 - marzo 2019 / Hospitalization in a patient with renal colic: Clinical-epidemiological characterization at the Herminda Martín Clinical Hospital, period March 2014 - March 2019

INTRODUCCIÓN: El cólico renal es una condición médica común en los servicios de urgencia. Representa la manifestación clínica más frecuente de urolitiasis, cuya patogenia es multifactorial, con tasas de prevalencia varía de 1% a 20% y una recurrencia a 10 años del 42% al 50%. OBJETIVO: Establecer el perfil clínico-epidemiológico, como también el diagnóstico y manejo de los pacientes hospitalizados por cólico renal en el Hospital Clínico Herminda Martín (HCHCM). MATERIAL Y MÉTODO: Estudio descriptivo retrospectivo en pacientes hospitalizados con diagnóstico de cólico renal en el HCHM de Chillán en el período marzo 2014-marzo 2019. Se estudiaron las variables: sexo, edad, presentación clínica de ingreso, factores de riesgo asociados, motivo de hospitalización, resultados imagenológicos y manejo clínico. Resultados. El 52,45% correspondió a pacientes de sexo masculino, encontrándose la mayor cantidad de pacientes en el intervalo de 40-49 años. La obesidad, antecedente de urolitiasis e hipertensión arterial fueron las patologías asociadas más frecuentes. En la mayoría de los pacientes, el motivo de la hospitalización fue la refractariedad al tratamiento analgésico, alcanzando un 86,76%. El 56,37% de los pacientes recibió manejo médico expulsivo y a un 19,11% de los pacientes se le realizó una intervención quirúrgica durante la hospitalización. CONCLUSIÓN: El perfil de éstos pacientes no sólo permite establecer medidas que podrían evitar un evento litiásico, sino que además se demuestra la necesidad de realizar un manejo óptimo que puede evitar reconsultas, sobrecarga de los servicios de urgencia, aumento de días cama y complicaciones.

INTRODUCTION: Renal colic is a common condition in the emergency department. It represents the most frequent clinical manifestation of urolithiasis, whose prevalence rate varies between 1% to 20%. Its pathogenesis is multifactorial, with a recurrence of 10 years from 42-50%. OBJECTIVE: Establish the clinical-epidemiological profile, as well as the diagnosis and management of patients hospitalized for renal colic at the Herminda Martín Clinical Hospital(HCHM). MATERIALS AND METHODS: A retrospective descriptive study of hospitalized patients diagnosed with renal colic at the HCHM, March 2014-March 2019, the variables were studied: sex, age, the clinical presentation of admission, associated risk factors, the reason for hospitalization, imaging results, and management. Results: 52.45% were male patients, with the highest number of patients in the range of 40-49 years. Obesity, a history of urolithiasis and hypertension, occurred more frequently within the associated pathologies. In most patients, refractable to analgesic treatment was the reason for hospitalization, reaching 86.76%. 56.37% of patients received expulsion medical management, and 19.11% of patientshad surgeryduring hospitalization. CONCLUSION: The profile of these patients not only allows them to establish measures that could prevent a lithiasis event but also shows the need for effective management of patients who can avoid reconsults, an overload of emergency services, increasedbed days and complications

Clinical efficacy of three-dimensional laparoscopic radical resection of rectal cancer with left colic artery preservation and natural orfice specimen extraction surgery / 中华消化外科杂志

Objective:To investigate the clinical efficacy of three-dimensional (3D) laparos-copic radical resection of rectal cancer with left colic artery preservation and natural orfice specimen extraction surgery (NOSES).Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 186 patients with rectal cancer who were admitted to Henan Provincial People's Hospital from December 2018 to December 2019 were colleted. There were 120 males and 66 females, aged from 30 to 81 years, with a median age of 59 years. Patients underwent 3D laparoscopic radical resection of rectal cancer. Observation indicators: (1) surgical and postoperative situations; (2) follow-up. Follow-up using outpatient examination or telephone interview was conducted to detect survival of patients and tumor recurrence up to January 2021. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers and percentages. Result:(1) Surgical situations: 186 patients with rectal cancer under-went 3D laparoscopic radical resection and postoperative with left colic artery preservation and NOSES. The operation time was (123±24)minutes, volume of intraoperative blood loss was (30±20)mL, the numer of lymph nodes dissected was 15±7. The time to postoperative first flatus, time to semiliquid food intake, time to postoperative out-of-bed activities were (2.3±0.7)days, (4.1±1.4)days, (2.9±1.0)days, respectively. The incidence of postoperative complications was 8.06%(15/186). The duration of postoperative hospital stay of 186 patients was (6.6±1.9)days and the treatment cost was (3.8±1.1) ten thousand yuan. Results of postoperative pathological examination showed 54 cases of low differentiated adenocarcinoma, 97 cases of moderate differentiated adenocarcinoma, 19 cases of high differentiated adenocarcinoma and 16 cases of mucinous adenocarcinoma. (2) Follow-up: 186 patients with rectal cancer were followed up for 13 to 24 months, with a median follow-up time of 13 months. During the follow-up, 18 patients had tumor recurrence or metastasis including 6 patients of death, 168 cases recovered well.Conclusion:3D laparoscopic radical resection of rectal cancer with left colic artery preservation and NOSES is safe and feasible.

A Retrospective Study of Mortality Causes in Arabian Horses / Estudio retrospectivo de las causas de mortalidad en caballos árabes

Abstract This study aims to describe the causes of death in Arabian horses at Al Wathba, in Abu Dhabi (United Arab Emirates) during 2018-2019. This study was conducted in a cohort of all Arabian horses that died. Data was collected retrospectively and only those horses with a full necropsy report available were included in the study. The carcass and all internal organs of each horse were examined and representative samples of tissues with abnormalities were collected in 10% neutral buffered formalin and processed for histopathological examination. A descriptive statistical analysis was performed. A total of 25 Arabian horses were examined post-mortem. Out of them, 35% were females. In general, colic occurred specifically at a higher frequency (80%), cases of collapse and sudden death during exercise and races occurred in 8%, cases of perinatal death in 8% and one case of laminitis (4%). The annual mortality in relation to the estimated population was 1% approximately. In conclusion, we identified and described the causes of death in Arabian horses in Al Wathba, Abu Dhabi, UAE during the period 2018-2019. In summary, a pathology of the digestive system -specifically acute abdominal crisis (colic)- is the main cause of death in Arabian horses, with 80%; other causes of mortality with a low incidence were in order collapse and sudden death during exercise and races, perinatal death and laminitis. These results allow establishing risk prevention measures of mortality in horses for specific activities like handling, feeding, training and races.

Resumen El objetivo del presente estudio es describir las causas de muerte en caballos árabes en Al Wathba, en Abu Dhabi (Emiratos Árabes Unidos) durante el periodo 2018-2019. El presente estudio se hizo con una cohorte de todos los caballos árabes que murieron. Se recolectaron datos retrospectivamente y sólo se incluyeron en el estudio los caballos que tenían disponible un informe de necropsia completo. Los cadáveres y todos los órganos internos de cada caballo fueron examinados y se tomaron muestras representativas de tejidos con anormalidades, con una solución reguladora neutral de formalina al 10%, y fueron procesadas para su examen histopatológico. Se hizo un análisis estadístico descriptivo. Se examinaron en total 25 caballos árabes después de morir. De estos, el 35% eran yeguas. En general, el cólico ocurrió específicamente a una frecuencia más alta (80%), los casos de colapso y muerte repentina durante el ejercicio y las carreras ocurrieron en el 8%, los casos de muerte perinatal en el 8% y hubo un caso de laminitis (4%). La mortalidad anual en relación con la población estimada fue del 1% aproximadamente. En conclusión, identificamos y describimos las causas de muerte en los caballos árabes en Al Wathba, Abu Dhabi, EAU, durante el periodo de 2018-2019. En resumen, una patología del sistema digestivo -específicamente, la crisis abdominal aguda (cólico)- es la causa principal de muerte en caballos árabes, representando el 80%; otras causas de mortalidad con baja incidencia fueron, en su orden, el colapso y la muerte repentina durante el ejercicio y las carreras, la muerte perinatal y la laminitis. Estos resultados permiten establecer medidas de prevención del riesgo y de mortalidad en caballos para actividades específicas como su manejo, alimentación, entrenamiento y las carreras.

Tubular enteric duplication presenting as jejuno-colic fistula in a 38 years old adult

Colo-enteric fistula is a rare entity, malignancy being the commonest cause. Both adenocarcinoma and rarely lymphoma have been known to cause it. Benign jejuno-colic fistulas are mostly secondary to tuberculosis or inflammatory bowel disease. Here we present a case of a young adult male, who presented with altered bowel habits. Colonoscopy and oesophago-gastro-duodenoscopy (OGD) revealed a fistulous tract between the proximal jejunum to the splenic flexure of colon. Surgery revealed a small fistulous connection between the above-mentioned parts of the bowel about 1cm long. Histopathology demonstrated it to have all the layers of the intestinal anatomy, hence indicating a possibility of congenital aetiology, probably enteric duplication of communicating tubular variety.