Trastorno grave del medio interno por fístula enterovesical, a propósito de un caso clínico / Severe metabolic disorder associated with an enterovesical fistula: report of one case

Enterovesical fistula (EVF) is a fistulous communication between the intestine and the bladder. It is uncommon and its classic clinical manifestations are the presence of pneumaturia, fecaluria, suprapubic pain and recurrent urinary infections. Surgical repair of EVF leads to rapid correction of both diarrhea and metabolic abnormalities. We report a 73-year-old diabetic woman with a neurogenic bladder secondary to a spine meningioma. She presented with diarrhea, vomiting, impaired consciousness and metabolic acidosis. She developed hypernatremia, hypokalemia, hypocalcemia, and hypophosphatemia, which were successfully corrected.

Infección comunitaria por Clostridium difficile asociada a colitis ulcerativa idiopática / Community Clostridium difficile infection associated to idiopathic ulcerative colitis

RESUMEN Clostridium difficile es una bacteria relacionada con la colitis, asociada a antibióticos y a la diarrea adquirida en pacientes hospitalizados. Sin embargo, su comportamiento ha cambiado en los últimos años, hasta el punto de ser considerada un problema de salud mundial. Su curso clínico varía desde casos asintomáticos, colitis, hasta complicaciones que ponen en peligro la vida del paciente. Dentro de los factores de riesgo descritos se encuentra la enfermedad inflamatoria intestinal, especialmente la colitis ulcerativa idiopática. El caso reportado versa sobre la presentación de esta infección asociada a un brote de colitis ulcerativa en un paciente joven, sin antecedentes de enfermedad inflamatoria intestinal, consumo de antibióticos ni hospitalización (AU).

ABSTRACT Clostridium difficile is a bacterium related to antibiotic-associated colitis and to diarrhea acquired in hospitalized patients. However, its behavior has changed in recent years to the point of being considered as a global health problem. Its clinical course ranges from asymptomatic cases, colitis, to complications with risk for the patient's life. The inflammatory bowel disease, especially idiopathic ulcerative colitis is found among the described risk factors. The case reported deals with the presentation of this infection associated to an outbreak of ulcerative colitis in a young patient, with no previous history of inflammatory bowel disease, consumption of antibiotics or hospitalization (AU).

Probióticos en el síndrome de intestino irritable con predominio de diarrea / Probiotics for the treatment of diarrhea predominant irritable bowel syndrome

Una mujer de 36 años, diagnosticada con síndrome de intestino irritable a predominio de diarrea (SII-D) acude a la consulta médica. Ella pregunta si el uso de probióticos sería útil para controlar los episodios de diarrea, ya que los fármacos con los que está siendo tratada no le resultan eficaces. Se realizó una búsqueda bibliográfica con el objetivo de en contrar evidencia en respuesta a su consulta, tras la cual se seleccionaron dos ensayos clínicos y una revisión sistemática. Se evidenciaron diversos resultados en cuanto al uso de probióticos en el SII-D y se discutieron los riesgos y beneficios del tratamiento, así como las implicancias en la vida de la paciente. (AU)

A 36-year-old woman diagnosed with diarrhea predominant irritable bowel syndrome (D-IBS) goes to meet the doctor. She raises whether the use of probiotics would be useful for controlling diarrhea episodes, since the drugs which she is being treated with, are not effective. A bibliographic search was conducted with the objective of finding evidence in response toher query. Two clinical trials and a systematic review were found. Variable results were found regarding the use of probioticsin D-IBS. The risks and benefits of the treatment were discussed, as well as the implications in the patient's lifestyle. (AU)

Fatal nosocomial hemorrhagic enterocolitis probably caused by adenovirus: report of one case / Enterocolitis hemorrágica fatal nosocomial probablemente causada por adenovirus: informe de un caso

ABSTRACT Adenovirus (ADV) is a recognized cause of severe disease among immunocompromised patients. We report a previously healthy 39-year-old female, admitted with influenza pneumonia and evolving with lung hemorrhage and acute renal failure requiring mechanical ventilation and hemodialysis. She received high corticosteroid doses due to an initial suspicion of alveolar hemorrhage. Lymphopenia already present before steroid use (567/μL), was maintained during the whole hospital stay (mean 782/μL). From the second week of admission she presented a high-volume diarrhea (mean 2.5 L/day) associated to intermittent bloody stools. An ulcerative enterocolitis was confirmed by CT images and colonoscopy. ADV was detected in a colonic tissue sample by real time PCR but not by a commercial filmarray test. Cidofovir-probenecid and racecadotril therapy were indicated without changing the clinical course of diarrhea and the patient finally died.

Adenovirus (ADV) es una causa reconocida de enfermedades graves en pacientes inmunocomprometidos. Informamos el caso de una mujer de 39 años, previamente sana, que ingresó por neumonía grave por influenza, evolucionando con hemorragia pulmonar y falla renal aguda, requiriendo ventilación mecánica y hemodiálisis. Recibió altas dosis de corticoides por la sospecha inicial de una hemorragia alveolar. Tuvo linfopenia durante toda su estadía (promedio 782/μL), la que ya estaba presente antes del uso de los corticoides (567/μL). Desde la segunda semana de hospitalización, presentó una diarrea de alto volumen (promedio 2,5 L/día) asociada a la presencia de sangre en deposiciones en forma intermitente. Se confirmó una enterocolitis ulcerativa por tomografía computada y colonoscopía. Se detectó ADV en muestras de biopsia colónica por PCR en tiempo real pero no por un test de PCR múltiples automatizado comercial. Fue tratada con cidofovir-probenecid y racecadrotrilo sin impacto clínico y la paciente finalmente falleció.

Diarrea crónica por Lamblia intestinalis en un adulto / (Chronic diarrhea by Lamblia intestinalis in an adult)

ResumenSe presenta un caso de inmunodeficiencia común variable en un paciente masculino, joven con larga historia (9 años) de procesos infecciosos gastrointestinales y respiratorios recurrentes; a pesar de los diferentes esquemas terapéuticos, con evidencia diagnóstica de niveles bajos de inmunoglobulinas de las clases IgG, IgM e IgA; se pretende comparar su evolución a partir de su historia clínica y los resultados de sus exámenes complementarios, con la bibliografía revisada. La inmunodeficiencia común variable explica un déficit primario de IgG (al menos 2 desviaciones estándar por debajo de los valores de referencia para su edad), al menos otra de las Ig (IgA o IgM) y una reducción o ausencia de producción de anticuerpos. Esta entidad se considera poco frecuente en términos de incidencia, aunque cursa muchas veces inadvertida por el predominio de sus efectos. Clínicamente, se manifiesta por la presencia de infecciones recurrentes con preponderancia de las respiratorias y gastrointestinales. Desde el punto de vista etiológico, su génesis es controversial, pero se describen niveles bajos de inmunoglobulinas y una reducción o ausencia de producción de anticuerpos.

AbstractWe present a variable common immunodeficiency case in a young male patient with a long history (9 years) of recurrent gastrointestinal and respiratory infectious processes, despite the different therapeutic schemes, with diagnostic evidence of low levels of IgG, IgM And IgA; aiming to make a comparison of its evolution in function of its clinical history and the results of its complementary examinations, with the bibliography reviewed. Variablecommon immunodeficiency explains a primary IgG deficit (at least 2 standard deviations below the reference values for his age) and at least one other Ig (IgA or IgM) and a reduction or absence of antibody production. This entity is considered infrequent in terms of incidence, although it is often inadvertent due to the predominance of its effects. Clinically it is manifested by the presence of recurrent infections with preponderance of the respiratory and gastrointestinal. From an aetiological point of view, its genesis is controversial, but low levels of immunoglobulins and a reduction or absence of antibody production are all described.

Tomografia computada multidetector en la enfermedad diverticular del intestino delgado / Multislice computed tomography in small-bowel diverticulosis

La enfermedad diverticular del intestino delgado constituye una entidad de rara presentación, que suele confundirse con otras patologías más comunes cuando se complica. Los falsos divertículos son de origen primario o secundario, y asientan mayoritariamente en el duodeno. El divertículo verdadero más frecuente es el de Meckel. Las complicaciones aparecen en menos del 15% de los casos. Entre ellas, se destacan, por frecuencia, la perforación y/o inflamación, la obstrucción, el sangrado, y/o la diarrea crónica. El objetivo de este trabajo es mostrar el rol de la tomografía computada multidetector en el diagnóstico y manejo de la enfermedad diverticular del intestino delgado, exponiendo casos de la práctica diaria con correlato quirúrgico de pacientes evaluados en nuestra institución.

Small bowel diverticula is an uncommon and underdiagnosed pathology. False diverticula may be primary or secondary in origin and are frequently located in the duodenum. Meckel's diverticula is the most common true diverticula. Less than 15% of cases suffer complications, of which the following are, with decreasing frequency: inflammation and perforation, obstruction, bleeding, or chronic diarrhoea. In order to contribute to the best diagnosis and management of small-bowel diverticulosis, cases are presented that were initially evaluated with multislice computed tomography and confirmed surgically in our institution.

Eficacia y seguridad del uso de colestiramina en el tratamiento de diarrea cronica con malabsorción de acidos biliares / Efficacy and safety of the use of cholestyramine in the treatment of chronic diarrhea with bile acid malabsorption

INTRODUCCIÓN: Antecedentes: El presente dictamen presenta la evaluación de la eficacia y seguridad del uso de colestiramina en el tratamiento de diarrea crónica asociada a malabsorción de ácidos biliares en niños. Aspectos Generales: La diarrea crónica es el signo principal de la malabsorción de ácidos biliares (MAB), la cual se produce por un desbalance en la homeostasis de estos ácidos en la circulación enterohepática. Los ácidos biliares recirculan entre el hígado y el intestino delgado a través del sistema de circulación enterohepática. Este sistema permite la absorción de grasas en el intestino delgado y la reabsorción de los ácidos biliares en el íleon terminal. Tecnología Sanitaria de Interés: La colestiramina es un secuestrador de ácidos liliares. Esta consta de resinas no digeribles cargadas positivamente que se unen a los ácidos biliares en el intestino, y permiten su excreción en las heces en forma de complejos insolubles. Así, evita que los ácidos biliares se acumulen en el colon y provoquen desbalance hídrico y diarrea. METODOLOGIA: Estrategia de Búsqueda: Se llevó a cabo una busqueda de la literatura con respecto a la eficacia y seguridad de colestiramina en el tratamiento de diarrea crónica en la bases de datos de PubMed, Tripdatase y www.clinicaltrials.gov. RESULTADOS: Sinopsis de la Evidencia: Se llevó a cabo una búsqueda de evidencia científica relacionada al uso de colestiramina en el tratamiento de pacientes con diarrea crónica asociada a malabsorción de ácidos biliares. En la presente sinopsis se describe la evidencia disponible según el tipo de publicación, siguiendo lo indicado en los criterios de elegibilidad (Guias de Práctica Clínica, Evaluación de Tecnologías en Salud, Revisiones Sistemáticas, Resúmenes de Artículos, MA, ECA fase III). CONCLUSIONES: A la fecha (octubre 2016) no se han llevado a cabo ensayos clínicos aleatorizados que evalúen la eficacia y seguridad del uso de colestiramina en pacientes pediátricos o adultos con diarrea crónica ocasionada por la malabsorción de ácidos biliares. Los resultados reportados en el presente dictamen preliminar corresponden a cuatro GPC, una revisión sistemática basada en estudios observacionales y el resumen de un estudio retrospectivo que evalúa la respuesta al tratamiento con colestiramina en pacientes adultos con diarrea crónica acuosa. El Instituto de Evaluación de Tecnologias en Salud e Investigación (IETSI) aprueba el uso de colestiramina como alternativa de tratamiento en pacientes con diarrea crónica por ácidos biliares. En el periodo de vigencia de este dictamen es de un año y la continuación de dicha aprobación estará sujeta a los resultados obtenidos de los pacientes que se beneficien con dicho tratamiento y a nueva evidencia que pueda surgir en el tiempo.

Clinical Outcomes in Hospitalized Patients with Clostridium difficile Infection by Age Group / 대한소화기학회지

BACKGROUND/AIMS: Advanced age is a known risk factor of poor outcomes for colitis, including Clostridium difficile infection (CDI). The present study compares the clinical outcomes of young and old patients hospitalized for CDI. METHODS: The clinical records of patients admitted from January 2007 to December 2013 with a diagnosis of CDI were analyzed. Patient baseline characteristics, clinical courses, and outcomes were compared with respect to age using a cut-off 65 years. RESULTS: Of the 241,391 inpatients registered during the study period, 225 (0.1%) with a diagnosis of CDI were included in the study. The mean patient age was 67.7 years. Seventy-two patients (32.0%) were younger than 65 years and 153 patients (68.0%) were 65 years old or more. The male to female ratio in the younger group was 0.8, and 0.58 in the older group. All 225 study subjects had watery diarrhea; six patients (8.3%) complained of bloody diarrhea in the young group and 21 patients (13.7%) in the old group (p=0.246). Right colon involvement was more common in the old group (23.5% vs. 42.7%, p=0.033). Furthermore, leukocytosis (41.7% vs. 67.3%, p=0.000), a CDI score of > or =3 points (77.8% vs. 89.5%, p=0.018), and hypoalbuminemia (58.3% vs. 76.5%, p=0.005) were more common in the old group. Failure to first line treatment was more common in the old group (17 [23.6%] vs. 58 [37.9%], p=0.034). CONCLUSIONS: Severe colitis and failure to first line treatment were significantly more common in patients age 65 years or more. More aggressive initial treatment should be considered for older CDI patients.

Panenteritis as an Initial Presentation of Systemic Lupus Erythematosus / 대한소화기학회지

Lupus enteritis is a rare, severe complication of systemic lupus erythematosus (SLE), needing prompt diagnosis and proper management. However, SLE rarely presents as lupus enteritis at the time of initial diagnosis. Thus, delayed diagnosis and misdiagnosis are common. We report a case of a 25-year-old woman with lupus panenteritis. The patient had multiple hospitalizations for abdominal pain, nausea, and diarrhea, initially without any other symptoms suggestive of SLE, but was later observed to have malar rash and oral ulcers. Laboratory investigations were compatible with SLE, including positive antinuclear antibody (1:320) with speckled pattern. CT revealed diffuse hypodense submucosal thickening of the stomach, the entire small bowel, colon, appendix, and rectum. Treatment with high-dose corticosteroids followed by maintenance therapy with mycophenolate mofetil, hydroxychloroquine, and azathioprine resulted in clinical improvement. Diagnosis of lupus enteritis requires a high index of suspicion given the low incidence and nonspecific clinical findings.

Clinical Significance of Fecal Lactoferrin and Multiplex Polymerase Chain Reaction in Patients with Acute Diarrhea

BACKGROUND/AIMS: The diagnostic yield of fecal leukocyte and stool cultures is unsatisfactory in patients with acute diarrhea. This study was performed to evaluate the clinical significance of the fecal lactoferrin test and fecal multiplex polymerase chain reaction (PCR) in patients with acute diarrhea. METHODS: Clinical parameters and laboratory findings, including fecal leukocytes, fecal lactoferrin, stool cultures and stool multiplex PCR for bacteria and viruses, were evaluated prospectively for patients who were hospitalized due to acute diarrhea. RESULTS: A total of 54 patients were included (male, 23; median age, 42.5 years). Fecal leukocytes and fecal lactoferrin were positive in 33 (61.1%) and 14 (25.4%) patients, respectively. Among the 31 patients who were available for fecal pathogen evaluation, fecal multiplex PCR detected bacterial pathogens in 21 patients, whereas conventional stool cultures were positive in only one patient (67.7% vs 3.2%, p=0.000). Positive fecal lactoferrin was associated with presence of moderate to severe dehydration and detection of bacterial pathogens by multiplex PCR (21.4% vs 2.5%, p=0.049; 100% vs 56.5%, p=0.032, respectively). CONCLUSIONS: Fecal lactoferrin is a useful marker for more severe dehydration and bacterial etiology in patients with acute diarrhea. Fecal multiplex PCR can detect more causative organisms than conventional stool cultures in patients with acute diarrhea.

The Simple Predictors of Pseudomembranous Colitis in Patients with Hospital-Acquired Diarrhea: A Prospective Observational Study

BACKGROUND/AIMS: As the incidence rate of and mortality from pseudomembranous colitis (PMC) are increasing worldwide, it is important to study the simple predictive risk factors for PMC among patients with hospital-acquired diarrhea (HAD). This study focused on identifying the clinical risk factors that can easily predict PMC. METHODS: The presumed HAD patients were prospectively recruited at the Hallym University Kangdong Sacred Heart Hospital. RESULTS: Age of 70 and older (adjusted odds ratio [OR], 1.76; 95% confidence interval [CI], 1.12 to 0.75), use of proton pump inhibitors (adjusted OR, 4.07; 95% CI, 2.512 to 6.57), use of cephalosporins (adjusted OR, 2.99; 95% CI, 1.82 to 4.94), and underlying cancer (adjusted OR, 1.72; 95% CI, 1.04 to 2.82) were independent risk factors for PMC in the multivariate logistic regression analysis. The prevalence of PMC was very low in the patients with HAD who exhibited no risk factors. CONCLUSIONS: The risk factors for PMC in patients with HAD included cephalosporin use, proton pump inhibitor use, old age, and cancer. Considering the strongly negative predictive values of these risk factors, endoscopic evaluation can be delayed in patients with HAD without risk of developing PMC.

Perceptions regarding oral rehydration solutions for the management of diarrhea in Guatemalan children: implications for diarrheal management in the Americas / Ideas con respecto a las soluciones de rehidratación oral en el tratamiento de la diarrea de los niños guatemaltecos: repercusiones sobre el tratamiento de la diarrea en las Américas

OBJECTIVE: To describe knowledge and perceptions regarding the use of oral rehydration solution (ORS) for the management of diarrheal diseases among formal and informal health care providers and community caregivers in the Guatemalan department of Santa Rosa, and to recommend strategies to increase ORS use for management of diarrhea in children. METHODS: From July to September 2008, in-depth, semi-structured interviews were conducted with formal health care providers; open-ended interviews were conducted with informal health care providers; and focus group discussions and pile sorting were carried out with community caregivers. RESULT: The study participants attributed episodes of diarrhea in children to culturally recognized or folk ailments (empacho, cuajo, and varillas) that are primarily treated by traditional healers. There were knowledge deficits about 1) dehydration as a manifestation of diarrhea, and 2) management of dehydration, including the use of ORS and the need to continue feedings during diarrheal episodes. Caregivers perceived bottled/ready-made ORS products and the more expensive over-the-counter antidiarrheal medications as superior to ORS packets in the treatment of diarrhea. CONCLUSIONS: In Guatemala, folk etiologies of disease differ from those of the biomedical establishment and influence the decisions made by caregivers when treating ill children, including those related to the use of ORS. Public health campaigns addressing the treatment and management of diarrheal diseases in Santa Rosa should recognize the ailments known as empacho, cuajo, and varillas and target them for ORS use by community caregivers as well as health care providers in both the formal and informal health sectors.

OBJETIVO: Describir los conocimientos y las ideas que tienen las personas que prestan atención de salud en el sector convencional, el sector no convencional y los cuidadores de la comunidad con respecto al uso de las soluciones de rehidratación oral en el tratamiento de las enfermedades diarreicas, en el departamento guatemalteco de Santa Rosa y recomendar estrategias encaminadas a aumentar la utilización de estas soluciones en el tratamiento de la diarrea en los niños. MÉTODOS: De julio a septiembre del 2008 se llevaron a cabo entrevistas exhaustivas semiestructuradas a los profesionales de salud y entrevistas con preguntas abiertas a los proveedores no convencionales de atención sanitaria y se organizaron debates en grupos de opinión y ejercicios de ordenamiento de tarjetas con los cuidadores de la comunidad. RESULTADOS: Los participantes en el estudio atribuyeron la causa de los episodios de diarrea en los niños a dolencias culturalmente aceptadas o populares (empacho, cuajo y varillas), que tratan principalmente los curanderos. Se observaron deficiencias en los conocimientos acerca de 1) la deshidratación como una manifestación de la diarrea y 2) el tratamiento de la deshidratación, incluido el uso de las soluciones de rehidratación oral y la necesidad de continuar la alimentación durante los episodios diarreicos. Los cuidadores consideraron las soluciones de rehidratación embotelladas o preparadas y los medicamentos antidiarreicos de venta libre, que son más costosos, como mejores opciones para el tratamiento de la diarrea que las soluciones de rehidratación oral. CONCLUSIONES: En Guatemala, el concepto popular y el de las instituciones biomédicas sobre la causa de las enfermedades es diferente e influye sobre las decisiones que toman los cuidadores al tratar a los niños enfermos, por ejemplo, las relacionadas con el uso de soluciones de rehidratación oral. Las campañas de salud pública que abordan el tratamiento y el manejo de las enfermedades diarreicas en Santa Rosa deben incorporar las dolencias conocidas como empacho, cuajo y varillas y fomentar el uso de las soluciones de rehidratación oral en estos casos, por parte de los cuidadores de la comunidad, los profesionales de salud del sector convencional y los proveedores de atención del sector no convencional.

Colitis eosinofílica y colitis linfocítica: ¿diferentes manifestaciones histológicas de un mismo proceso en pacientes con diarrea crónica? / Eosinophilic and linphocitic colitis: diferent histological manifestations of a same process in a patients with chronic diarrhea

Objetivos: 1) Determinar la prevalencia de incremento de eosinófilos en mucosa colónica en pacientes con colitis linfocítica (CL). 2) Determinar la coexistencia de colitis eosinofílica (CE) en pacientes con CL. Materiales y métodos: Las biopsias colónicas de pacientes adultos con diarrea crónica diagnosticados como CL en el hospital Daniel A. Carrión durante octubre 2009 a marzo 2012 fueron revisadas de forma independiente por 2 patólogos. Microscópicamente, se investigó y cuantificó la presencia de eosinófilos en mucosa colónica. Resultados: Se incluyeron 68 casos de CL, de los cuales 76,5% tuvieron eosinófilos elevados en la mucosa colónica y en 51,4% se pudo hacer el diagnóstico de CE según los criterios establecidos. Conclusión: Tres de cuatro pacientes con CL presentan eosinófilos elevados y 1 de cada 2 pacientes con CL cumple criterios para CE.

Objectives: 1) To determine the prevalence of increased number of eosinophils in colonic mucosa of patients with lymphocytic colitis (LC). 2) To determine the coexistence of eosinophilic colitis (EC) in patients with lymphocytic colitis. Materials and methods: slides of adult patients with cronic diarrhea with diagnosis of LC were reviewed between October 2009 and March 2012. The number of eosinophils was quantified. Results: Sixty eight patients with LC were included. Elevated eosinophils were found in 76.5 and in 51.4% a diagnosis of EC was established. Conclusion: 3 out of 4 patients with LC had elevated eosinophils and 1 of 2 patients with LC had criteria for EC.

Capacidad del período oligoanúrico para predecir secuela renal en niños con síndrome urémico-hemolítico asociado a diarrea / Capacity of the oligoanuric period in the prediction of renal sequelae in patients with postdiarrheal hemolytic uremic syndrome

Introducción. La duración del período oligoanúrico es el principal marcador pronóstico de secuela renal en pacientes con síndrome urémico-hemolítico asociado a diarrea (SUH D+). Realizamos este estudio con el objetivo de determinar la capacidad del período oligoanúrico para predecir secuela renal en niños con SUH D+. Pacientes y métodos. Revisamos los datos de todos los pacientes internados en el Hospital Elizalde con SUH D+ entre 1998-2008 e incluimos sólo a aquellos seguidos más de 1 año. Consideramos secuela renal a la presencia de albuminuria y/o proteinuria patológicas y/o hipertensión arterial y/o caída de fltrado glomerular. Ingresaron al estudio 80 pacientes, que se dividieron en 2 grupos (con secuela y sin ella). Se determinó si tenían diferencias en la duración del período oligoanúrico y se calculó la capacidad de dicha variable para predecir secuela mediante curva ROC. Resultados. 32 pacientes presentaron secuela renal (prevalencia 40%), quienes tuvieron un período oligoanúrico signifcativamente más prolongado [mediana 7 días (intervalo 0-14) contra mediana 0 días (intervalo 0-30); p= 0,0003] que aquellos sin secuela. Mediante curva ROC (área bajo la curva de 0,73) se estableció en ≥ 4 días como mejor punto de corte del período oligoanúrico para predecir secuela renal (sensibilidad 68,75%, especifcidad 70,83%). Conclusión. La curva ROC no permitió identifcar un punto de corte de la duración del período oligoanúrico que permita predecir secuela renal con sensibilidad y especifcidad adecuadas. Esta observación refuerza la importancia del seguimiento periódico y a largo plazo de todos los niños afectados por SUH D+.

Introduction. Length of the oligoanuric period is the main predictor of renal sequelae in children with postdiarrehal hemolytic uremic syndrome (D+ HUS). We aimed to determine the capacity of the oligoanuric period in the prediction of renal sequelae in children with D+ HUS. Patients and methods. We reviewed data from all patients with D+ HUS admitted at Hospital Elizalde between 1998-2008, including only those with at least 1 year of follow-up. Renal sequelae were defned by the presence of pathologic albuminuria and/or proteinuria and/or arterial hypertension and/or chronic renal failure; 80 patients were included, belonging to one of two groups (with or without sequelae). Difference in the duration of the oligoanuric period between groups was determined, and the diagnostic capacity of the oligoanuric period to identifed renal sequelae was assessed by ROC curve. Results. 32 patients presented sequelae, representing a prevalence of 40%. Oligoanuric period was signifcantly longer in patients with sequelae [median 7 days (range 0-14) vs median 0 days (range 0-30); p= 0,0003]. Using ROC curve (aucROC= 0.73) we identifed an oligoanuric period ≥ 4 days as the best threshold to predict renal sequelae (sensitivity 68.75%, and specifcity 70.83%). Conclusions. By ROC curve analysis we were unable to identify a cut-off point on the length of the oligoanuric period which predicts renal sequelae with optimum sensitivity and specifcity. This observation emphasizes the need of periodic and long-term surveillance of all children who suffered from D+ HUS.

Incidence and Risk Factors of Irritable Bowel Syndrome in Community Subjects with Culture-proven Bacterial Gastroenteritis / 대한소화기학회지

BACKGROUND/AIMS: The aim of this study was to investigate the incidence and risk factors of irritable bowel syndrome (IBS) in community subjects with culture-proven bacterial gastroenteritis. METHODS: This was a prospective, community-based, cohort study, which followed patients with a recent history of culture-proven bacterial gastroenteritis. IBS was diagnosed with the use of the Rome II criteria at 3 and 6 months after bacterial dysentery. RESULTS: Sixty five cases were included and completed the 6 month follow-up. Thirty four cases (52.3%) were female. Salmonella was the pathogen most frequently identified and seen in 41 patients (63.1%). The cumulative incidence of IBS among patients with microbiologically proven bacterial gastroenteritis within a community was 9.2% and 12.3% at 3 and 6 months of follow-up, respectively. The duration of initial diarrhea (> or =7 days) was associated with an increased risk for the development of IBS (aOR, 14.50 [95% CI, 1.38-152.72]; p=0.022). CONCLUSIONS: Our study suggests that the incidence of IBS among patients with culture-proven bacterial gastroenteritis within a community is similar to that reported among Western populations. A large, prospective study is encouraged to confirm our results and to evaluate the influence of the microbial species on the epidemiology of IBS in Asian populations.

Diferentes níveis de betaína sobre incidência de diarreia, desempenho, características de carcaça e parâmetros sanguíneos de suínos / Different levels of betaine on diarrhea incidence, performance, carcass characteristics and blood parameters of pigs

Foram utilizados 36 leitões desmamados aos 19 dias de idade, distribuídos em um delineamento experimental em blocos ao acaso, aonde foram avaliados os efeitos da adição de níveis crescentes de betaína (0,0%, 0,1%, 0,2% e 0,3%) na dieta sobre o desempenho na fase inicial, crescimento e terminação. Foram monitorados os índices de incidência de diarreia nos primeiros 14 dias da fase inicial e os parâmetros sanguíneos aos 20, 75 e 150 dias de idade, como também características de carcaça ao final do experimento. Não foi observado (P > 0,05) efeito da betaína sobre a incidência de diarreia. Foram verificadas diferenças significativas (P < 0,05) entre os tratamentos na fase de terminação, para ganho diário de peso e conversão alimentar. Foram observadas diferenças (P < 0,0001) entre os dias para os parâmetros sanguíneos analisados. Para espessura de toucinho (ET), foi verificada diferença significativa (P < 0,05) entre os tratamentos

Thirty six piglets weaned at 19 days of age were useddistributed in a randomized block design, were used to evaluate the effects of the addition of crescent levels of betaine (0,0%, 0,1%, 0,2% e 0,3%) in the diets on the performance in initial, growing and finishing phases. The indexes of diarrhea incidence were monitored in the first 14 days post–weaning; and the blood parameters at 20, 75, and 150 days of age, as well as the carcass characteristics at the end of the experiment. It was not observed (P > 0,05) effect of the betaine on the diarrhea incidence. Significative differences (P < 0.05) were verified among treatments in the finishing phase for daily weight gain and feed conversion. Differences (P < 0.0001) among the days to the blood parameters analysed were also observed. In regard to the backfat thickness, it was verified significative difference (P < 0.05) among the treatments.