Aspects cliniques de la maladie hémorroïdaire interne à l'hôpital du District de la Commune IV de Bamako (Mali) / Clinical aspects of internal haemorrhoidal disease in the district hospital of Council IV of Bamako (Mali)

Introduction. La maladie hémorroïdaire interne est la plus fréquente des affections proctologiques et constitue un motif extrêmement répandu de consultation en proctologie. L'objectif de ce travail était de décrire les aspects cliniques de la maladie hémorroïdaire interne à l'hôpital du district de la commune IV de Bamako. Patients et méthodes. Nous avons réalisé une étude transversale descriptive sur un groupe de malades vus en consultation à l'unité de Gastro-entérologie de l'hôpital du district de la commune IV de Bamako. Entre le 1er Novembre 2019 et le 31 Octobre 2020, le recrutement des patients a été réalisé. Les variables recueillies étaient les données sociodémographiques (âge, sexe, profession), les symptômes anaux (saignement anal, douleur anale, suintements muco-glaireux, prurit anal), les facteurs de risque (les troubles du transit intestinal, la période du troisième trimestre de la grossesse, l'accouchement, le post-partum immédiat), les stades de la maladie hémorroïdaire interne, les autres pathologies anales associées, les complications, l'hémogramme. Résultats. Durant la période d'étude, 128 patients ont été vus en consultation parmi lesquels 85 avaient une maladie hémorroïdaire interne, soit une fréquence de 66,40%. La procidence hémorroïdaire a été observée chez 18,8% de nos patients. En fonction de son degré, le grade I représentait 34,1%, le grade II 55,3%, le grade III 9,4% et le grade IV 1,2%. Conclusion. Cette première étude réalisée sur la maladie hémorroïdaire interne à l'hôpital du district de la commune IV de Bamako montre que la maladie hémorroïdaire interne est l'affection proctologique la plus fréquente.

Introduction. Internal haemorrhoidal disease is the most common proctological condition and is an extremely common reason of consultation in proctology. The objective of this work was to describe the clinical aspects of internal haemorrhoidal disease in the district hospital of the commune IV of Bamako. Patients and methods. We conducted a descriptive cross-sectional study on a cohort of patients seen in consultation at the Gastroenterology Unit of the District Hospital of Bamako's commune IV. The recruitment was carried out between November 1, 2019 and October 31, 2020. The variables of study were socio-demographic data (age, sex, profession), anal symptoms (anal bleeding, anal pain, muco-glue oozing, anal pruritus), risk factors (intestinal transit disorders, third trimester of pregnancy, childbirth, immediate postpartum), stages of internal haemorrhoidal disease, other associated anal pathologies, complications, blood count. Results. During the study period, 128 patients were seen in consultation, among whom 85 had internal haemorrhoidal disease (66.40%). Hemorrhoidal procidence was found in 18.8% of patients. Concerning the severity, grade I represented 34.1%, grade II 55.3%, grade III 9.4% and grade IV 1.2%. Conclusion. This pioneer study on internal haemorrhoidal disease in the district hospital of commune IV of Bamako (Mali) showed that internal hemorrhoidal disease is the most common proctological condition in Bamako.

Factores de Riesgo de Cáncer de Estómago, Hospital Abel Gilbert Pontón / Stomach Cancer Risk Factors, Abel Gilbert Ponton Hospital

Introducción:El cáncer de estómago es una de las neoplasias malignas más frecuentes, siendo la segunda causa de muerte en hombres y la tercera en mujeres. Ocupa el segundo lugar como causa de muerte por cáncer en el mundo. En Ecuador, representa el 12% de todos las canceres. El objetivo del presente estudio fue establecer la prevalencia, incidencia, mortalidaden un centro de referencia regional del sistema Público. Métodos:El presente estudio transversal se realizó en el Hospital Abel Gilbert Pontónde la Ciudad de Guayaquil. Se revisaron expedientes clínicos delos años 2014 al 2016 de pacientes con diagnóstico de cáncer gástrico. Se analizan variables demográficas, clínicas y de resultados. Se utiliza estadística descriptiva. Resultados:Se identificaron 99 casos de Cáncer gástrico. Fueron 38 mujeres (38.4%). El 43.4% tuvo más de 65 años.El 69.7% de pacientes con hábito de consumo de alcohol, 63.6% con consumo de tabaco, 70.7% con antecedentes de ingesta de carnes ahumadas en forma recurrente.Un 75.8% de pacientes tuvieron infección por H. pylori. La mayor prevalencia de localización fue el antro gástrico y el síntoma prevalente en el grupo fue la epigastralgia.La incidencia fue de 0.14 por 1.000 pacientes del hospital, la prevalencia fue de 1.22 por 1.000 pacientes. La mortalidad fue de 18 casos, 2.16 por 100 mil pacientes. Conclusiones:El paciente típico fue hombre, con edad >65 años, sin antecedentes de cáncer gástrico, con infección por H. pylori, consumo de dieta rica en con grasa,carne ahumada, alcohol y tabaco. Con cáncer gástrico localizado en el antro y el debut más prevalente epigastralgia.

Introduction:Stomach cancer is one of the most frequent malignant neoplasms in the world, it is the second cause of death in men and the third in women. It ranks fifth in frequency and second cause of death from cancer in the world. Cancer being one of the most frequent and investigated pathologies on the planet and in Ecuador, it represents 12% of all cancers. The objective of this study is to establish the prevalence, incidence, and mortality in a regional reference center of the Public system. Methods: The present cross-sectional study was conducted at the Abel Gilbert Pontón Hospital in the City of Guayaquil. Medical records from 2014 to 2016 of patients diagnosed with gastric cancer were reviewed. Demographic, clinical and outcome variables areanalyzed. Descriptive statistics are used. Results: 99 cases of gastric cancer were identified. There were 38 women (38.4%) and 61 men (61.6%). 43.4% of patients with gastric cancer were older than 65 years. 70.7% of patients had no family history of gastric cancer, 69.7% of patients with alcohol consumption habit, 63.6% of patients had tobacco consumption, 70.7% of patients with a recurrent history of smoked meat intake, and intake of diet rich in fat 75.8%. 75.8% of patients had H. pylori infection. The highest prevalence of location was the gastric antrum and the prevalent symptom in the group was epigastric pain. The incidence was 0.14 per 1,000 hospital patients, the prevalence was 1.22 per 1,000 patients. Mortality was 18 cases, 2.16 per 100,000 patients. Conclusions: The typical patient was male, aged> 65 years, without a history of gastric cancer, with H. pylori infection, consumption of a diet rich in fat, smoked meat, alcohol and tobacco. With gastric cancer located in the antrum and the most prevalent debut epigastralgia.

Revisión sistemática para el abordaje de síntomas desagradables gastrointestinales en cuidados paliativos / Systematic review for addressing uncomfortable gastrointestinal symptoms in palliative care / Revisão sistemática para a abordagem dos sintomas gastrointestinais desagradáveis em cuidados paliativos

Resumen Introducción Este artículo de revisión sistemática pretende examinar en detalle la evidencia cientifica para el abordaje desde la enfermería, en el manejo de síntomas desagradables, gastrointestinales tales como: síndrome anorexia caquexia, disfagia, náuseas y vómito enfocado al cuidado paliativo, basados en el referente teórico del modelo revisado del manejo de síntomas de Marylin J. Dodd. Materiales y Métodos La estrategia que se realizó fue la del sistema PICO, metodológicamente se estableció una pregunta la cual se contesta con la selección de los artículos que se realizó, continuando con la revisión sistemática se aplica la declaración (PRISMA), la investigación de los artículos fue realizada en las bases de datos Medline, Cochrane Library, Scopus, Pubmed, Dialnet, Ebscohost, ProQuest y Elsevier. Dentro de los criterios de inclusión, se tuvo en cuenta principalmente los artículos que fomentan el manejo de los síntomas gastrointestinales en cuidado paliativo. Resultados A pesar de que se evidencia los avances en conocimiento, se identifica que son insuficientes los estudios en este campo, mostrando la necesidad y la obligación de desarrollar el manejo y control de los síntomas desagradables gastrointestinales, el manejo del síntoma debe ser basado en: la experiencia del síntoma desde la percepción, evaluación y respuesta. Discusión La evidencia muestra las diferentes maneras de abordar los síntomas desagradables gastrointestinales, con una mirada holística, en constante movimiento, resaltando que se debe intervenir, desde la dimensión espiritual, física y social. Conclusiones La intención es contribuir con evidencia científica para abordar los síntomas desagradables gastrointestinales.

Abstract Introduction This systematic review article aims to examine in detail the scientific evidence from a nursing perspective in the management of uncomfortable gastrointestinal symptoms such as anorexia-cachexia syndrome, dysphagia, nausea and vomiting, focused on palliative care and based on the theoretical reference of the Revised Symptom Management Model of Marylin J. Dodd. Materials and Methods PICO strategy was used. Methodologically, a question was posed whose answer was provided in the selection of the articles made. Following the systematic review, the PRISMA statement was applied. Article research was conducted through Medline, Cochrane Library, Scopus, PubMed, Dialnet, EBSCOhost, ProQuest and Elsevier databases. As inclusion criteria, articles promoting the management of gastrointestinal in palliative care were mainly considered. Results Although advances in knowledge are evident, it was identified that field-related studies are insufficient, showing the need and the obligation to work on the management and control of uncomfortable gastrointestinal symptoms. Symptoms management should be based on the experience of symptoms from its perception, evaluation and response. Discussion The evidence indicates the different ways of addressing uncomfortable gastrointestinal symptoms under an ever-changing holistic view, emphasizing that it is necessary to intervene from spiritual, physical and social dimensions. Conclusions The purpose is to contribute by means of scientific evidence to addressing uncomfortable gastrointestinal symptoms.

Resumo Introdução Este artigo de revisão sistemática objetiva examinar detalhadamente a evidência científica para a abordagem sob a perspectiva da enfermagem do manejo de sintomas gastrointestinais desagradáveis como: síndrome anoréxico, caquexia, disfagia, náuseas e vómitos com foco no cuidado paliativo, baseados no referente teórico do modelo de manejo de sintomas de Marylin J. Dodd. Materiais e Métodos A estratégia utilizada foi aquela do sistema PICO, metodologicamente foi estabelecida uma pergunta que foi respondida a partir da seleção dos artigos que foi realizada, continuando com a revisão sistemática aplicou-se a declaração (PRISMA), a pesquisa dos artigos foi realizada nos bancos de dados Medline, Cochrane Library, Scopus, Pubmed, Dialnet, Ebscohost, ProQuest e Elsevier. Dentro dos critérios de inclusão, foram considerados principalmente os artigos que promovem o manejo dos sintomas gastrointestinais em cuidados paliativos. Resultados Apesar da constatação de avances no conhecimento, verifica-se que os estudos neste campo são insuficientes, o que demonstra a necessidade e a obrigação de desenvolver o manejo e controle dos sintomas gastrointestinais desagradáveis, o manejo do sintoma deve estar baseado: na experiência do sintoma a partir da percepção, avaliação e resposta. Discussão A evidência demonstra as diferentes maneiras de tratar os sintomas gastrointestinais desagradáveis, sob um olhar holístico, em constante movimento, salientando que a intervenção deve ser feita a partir da dimensão espiritual, física e social. Conclusões O trabalho visa contribuir com evidência científica para o manejo dos sintomas gastrointestinais desagradáveis.

Síntomas gastrointestinales en pacientes en Programa de diálisis peritoneal continua ambulatoria en Hospital Nacional Rosales, durante los meses de Febrero a Marzo 2019 / Gastrointestinal symptoms in patients in continuous ambulatory peritoneal dialysis program at Hospital Nacional Rosales, during the months of February to March 2019

Los síntomas gastrointestinales son comunes en pacientes con enfermedad renal crónica terminal (ERCT) y puede llegar a ser de un 77 a 79%, los síntomas prevalentes más comunes son estreñimiento, indigestión, dolor abdominal y pirosis. La escala de evaluación de síntomas gastrointestinales (GSRS) y el cuestionario de la calidad que vida de reflujo y dispepsia (QOLRAD), han sido desarrolladas para evaluar pacientes con dispepsia, las características psicométricas en los diferentes lenguajes son buenas con confiabilidad y validación aceptable. Materiales y Métodos: se realizó un estudio descriptivo, de tipo prospectivo de corte transversal en 64 pacientes que asisten a diálisis peritoneal continua ambulatoria (DPCA) del Hospital Nacional Rosales, se obtuvieron características clínicas de los pacientes como edad, sexo, comorbilidades asociadas, tiempo en diálisis peritoneal y de DPCA, y se evaluaron los cuestionarios GSRS y QOLRAD. Resultados: La frecuencia de síntomas gastrointestinales (GSRS >1) es de un 90.6%, la indigestión es el síntoma más frecuente con 79.7%, seguido de reflujo con un 64.7%, El QOLRAD mostró que el impacto sobre la calidad de vida es leve, donde se encontró la mayor prevalencia de síntomas fue vitalidad (36%) y en problemas con comida y bebida (29.8%). Discusión: La frecuencia de síntomas gastrointestinales medida por la escala de GSRS en pacientes en DPCA es alta, en comparación con la literatura internacional. La indigestión y reflujo son los síntomas predominantes en estos pacientes, en la escala QOLRAD hay afectación en la calidad de vida la cual es leve.

Encefalitis por enterovirus: análisis clínico y paraclínico en pacientes pediátricos de un hospital de tercer nivel en Quito-Ecuador, de enero a diciembre de 2016 / Enterovirus encephalitis: clinical and paraclinical analysis in pediatric patients in a tertiary hospital in Quito-Ecuador, from January to December 2016

La encefalitis es una entidad rara con manifestaciones clínicas variables. En los niños es usualmente leve y autolimitada. En 30 a 75% se desconoce la etiología y cuando el patógeno se identifica por PCR (reacción en cadena de la polimerasa), el 80% son enterovirus. En América Latina no están disponibles métodos específicos de diagnóstico. En nuestro país muy pocos centros realizan el examen y tampoco están disponibles estadísticas reales de su incidencia. Objetivo: correlacionar la etiología con los síntomas, resultados de laboratorio, imagen y electroencefalograma. Métodos: estudio transversal; de enero a diciembre de 2016 se revisaron las historias clínicas de 63 niños de 0 a 18 años hospitalizados con sospecha de encefalitis. Una vez identificado el enterovirus por PCR, se correlacionó con los hallazgos de los exámenes de laboratorio e imagen. Resultados: se confirmó encefalitis viral en 35 pacientes, enterovirus en 49%, predominio en la edad preescolar. Síntomas más comunes: fiebre, cefalea, signos meníngeos y síntomas digestivos, 24% alteraciones de la conciencia. Biometría hemática normal en 71%, proteina C reactiva alterada en 71%. De los pacientes con estudios de imagen, 6% tuvo resultado anormal y en aquellos con electroencefalograma 80% fue anormal. Se utilizó la U de Mann Whitney para el análisis estadístico, la relación entre enterovirus y alteración de estado de conciencia y síntomas digestivos fue significativa (p=0.029). Conclusión: en los pacientes con diagnóstico de encefalitis que presenten síntomas digestivos y alteración del estado de conciencia, se debe sospechar que el enterovirus es el agente etiológico.

Encephalitis is a rare entity with variable clinical manifestations. In children it is usually mild and self-limited. In 30-75% of cases, the etiology is unknown and when the pathogen is identified by PCR (polymerase chain reaction), 80% are enteroviruses. In Latin America specific diagnostic methods are not available. In our country very few centers carry out the specific test, real statistics of their incidence are not available Objective: To correlate etiology with symptoms, laboratory results, imaging and electroencephalogram. Methods: Cross-sectional study, clinical records of 63 children between 0 and 18 years hospitalized with suspected encephalitis from January to December 2016 were reviewed. Once Enterovirus was identified by PCR, it was correlated with the findings of laboratory and imaging tests. Results: Viral encephalitis was confirmed in 35 patients, Enterovirus in 49%, predominance in pre-school age. Most common symptoms: fever, headache, meningeal signs and digestive symptoms, 24% alterations of consciousness. Normal blood count in 71%, Protein C Reactive altered in 71%. In patients with imaging studies, 6% had an abnormal result and in those who underwent electroencephalography, 80% were abnormal. The Mann Whitney U was used for the statistical analysis, the relationship between enterovirus and alteration of consciousness and digestive symptoms was significant (p: 0.029) Conclution: In patients with a diagnosis of encephalitis presenting digestive symptoms and altered state of consciousness, Enterovirus should be suspected as an etiologic agent.

Gastrointestinal manifestations of chronic kidney disease / Manifestaciones gastrointestinales de la enfermedad renal crónica

Abstract Introduction: There is a wide variety of gastrointestinal clinical manifestations that may increase the deterioration of the quality of life in patients with chronic kidney disease (CKD), which are manageable if properly detected. Objective: The objective of this work is to perform an updated and analytical review of the literature on the manifestations in the digestive tract of patients with chronic deterioration of renal function. Results: The results indicate that some of the signs and symptoms on the gastrointestinal tract of patients with CKD are individual, and non-specific symptoms such as anorexia, nausea and vomiting predominate, which can be controlled with adequate renal replacement therapy; while others, rarer, such as ascites associated with dialysis, impoverish the prognosis and illustrate the need for transplantation.

Resumen Introducción: existe una amplia variedad de manifestaciones clínicas gastrointestinales que pueden aumentar el deterioro de la calidad de vida en los pacientes con enfermedad renal crónica (ERC), que son manejables si se detectan adecuadamente. Objetivo: el objetivo de este trabajo es realizar una actualización y revisión analítica de la literatura sobre las manifestaciones en el tracto digestivo de pacientes con deterioro crónico de la función renal. Resultados: los resultados indican que algunos de los signos y síntomas sobre el tracto gastrointestinal de los pacientes con ERC son individuales, y predominan los síntomas inespecíficos como la anorexia, las náuseas y el vómito, los cuales pueden controlarse con una adecuada terapia de reemplazo renal; mientras que otros, más raros, como la ascitis asociada a la diálisis, empobrece el pronóstico e ilustra la necesidad de trasplante.

Estado nutricional e sintomas gastrointestinais de pacientes oncológicos em cuidados paliativos / Nutritional status and gastrointestinal symptoms of cancer patients in palliative care

Objetivo: Pesquisa retrospectiva, exploratória e descritiva, de caráter quantitativo, cujo objetivo foi identificar os sintomas gastrointestinais apresentados pelos pacientes oncológicos internados em Cuidados Paliativos e relacionar ao seu estado nutricional. Método: Para a análise do estado nutricional, foram utilizados parâmetros antropométricos e a Avaliação Subjetiva Global Produzida pelo Próprio Paciente, que identifica também os sintomas gastrointestinais. Resultados: Foram avaliados 47 prontuários de pacientes internados em tratamento paliativo, no período de maio a julho de 2015. Destes, 55,32% pertenciam ao sexo masculino e 44,68% ao feminino, com média de idade de 61,51 anos. Entre os tumores primários encontrados, o câncer de pulmão totalizou 21,28%. O estadiamento clínico IV foi o predominante, com 74,46%. O estado nutricional mostrou que 51,06% dos pacientes foram classificados com desnutrição suspeita/moderada e 42,55% com desnutrição grave. As maiores incidências de sintomas gastrointestinais foram anorexia, boca seca e constipação. Houve associação significativa entre anorexia (p=0,0374) e náuseas (p=0,0232) em relação ao estado nutricional dos pacientes classificados com algum grau de desnutrição. Conclusão: A presença de sintomas gastrointestinais é frequente nessa população e está associada à piora do estado nutricional.

Objective: Retrospective, exploratory and descriptive research, quantitative approach, whose goal was to identify the gastrointestinal symptoms presented by oncologic patients in palliative care and relate to their nutritional status. Methods: For the analysis of the nutritional status, anthropometric parameters and Patient-Generated Subjective Global Assessment also identifies the gastrointestinal symptoms were used. Results: Forty-seven medical records of patients admitted to palliative treatment in the period from May to July 2015 were assessed. Of these, 55.32% were male and 44.68% female, with an average age of 61.51 years. Among the primary tumors found, lung cancer amounted to 21.28%. The clinical stage IV was the predominant, with 74.46%. The nutritional status showed that 51.06% of the patients were classified with moderate or suspected malnutrition and 42.55% with severely malnourished. The highest incidences of gastrointestinal symptoms were anorexia, dry mouth, and constipation. There was a significant association between anorexia (p=0.0374) and nausea (p=0.0232) relative to the nutritional status of patients classified with some degree of malnutrition. Conclusion: The gastrointestinal symptoms presence is frequent in this population and is associated with worsening nutritional status.

Reduced quality of life in patients with non-erosive gastroesophageal reflux disease

Introduction: Gastroesophageal reflux disease (GERD) is a highly prevalent condition in the Western world. It is a frequent cause of medical appointments and has a high impact on quality of life (QOL). This study aimed to assess health-related quality of life (HQ-QOL) of patients with non-erosive gastroesophageal disease (NERD) and compare their scores with the scores of patients with GERD symptoms and non-pathological acid reflux (non-NERD). Methods: We studied 42 patients with GERD symptoms­21 with positive pHmetry for acid reflux (NERD group) and 21 with negative pHmetry for acid reflux (non-NERD group). We enrolled patients matched by age and gender. Patient inclusion criteria were based on clinical and endoscopic findings and pHmetry. All other major diseases having an impact on QOL were excluded as well as patients in regular use of proton pump inhibitors, prokinetics, histamine-2 receptor antagonists and anti-depressants. All subjects were asked to fill in a validated translation of the SF-36 questionnaire. We described scores trough median and interquartile range (IQR) and assessed the significance of the comparisons through Mann-Whitney test and chi-square test or Student's t-test when appropriate. Results: We found no significant differences in the eight domains of SF-36 between the two groups. Conclusion: QOL of patients with GERD symptoms was equivalent, regardless of acid reflux at pHmetry (AU)

Escala Bristol de forma fecal no diagnóstico clínico da constipação na infância, Porto Alegre, Brasil / The Bristol Stool Scale in the clinical diagnosis of childhood constipation

Introdução: A constipação é frequente na infância, podendo evoluir até a adolescência e vida adulta.O diagnóstico é clínico, realizado através da descrição subjetiva das fezes. A Escala Bristol facilita o diagnóstico, analisando a consistência das fezes. O objetivo deste estudo é descrever a utilização dessa escala no diagnóstico da constipação na infância. Métodos: Foi realizado um estudo transversal, no Ambulatório do HMIPV/Porto Alegre/RS, de abril a outubro de 2015, com pacientes consecutivos, de idade entre 05 e 12 anos. Todos foram submetidos à anamnese, para descrição subjetiva das fezes pelo responsável e pelo paciente. A médica pontuava a Escala Bristol baseada nesta descrição, seguida pela pontuação do paciente e do responsável. Resultados: Foram estudados 30 pacientes, com média de idade de 8,1± 2,5 anos. A pontuação da médica na Escala Bristol foi 1,83±0,38, a da mãe, 2,43±0,97 (P=0,001) e a do paciente, 2,27±0,87 (P=0,003). O coeficiente kappa entre o Bristol medido pela médica e pela mãe do paciente foi baixo, igual a 0,30 (P< <0,001) , bem como o coeficiente kappa entre o Bristol medido pela médica e pela criança, igual a 0,34(P< 0001). Conclusão: Houve diferença entre o Bristol pontuado pela médica e o Bristol pontuado pelas mães e pacientes. Os pacientes e as mães, ao pontuar na Escala Bristol, concordam pouco com a pontuação da médica. Os autores sugerem a multiplicação desta experiência em outros locais para continuar avaliando a utilização da Escala Bristol para Consistência Fecal na constipação da infância(AU)

Introduction: Constipation is common in childhood and can progress through adolescence and adulthood. Clinical diagnosis is performed by subjective description of the stools. The Bristol Scale facilitates the diagnosis by analyzing stool consistency. The aim of this study is to describe the use of this scale in the diagnosis of childhood constipation. Methods: A cross-sectional study was conducted at the Clinic of HMIPV/Porto Alegre from Apr to Oct 2015, with consecutive patients aged between 5 and 12 years. All were submitted to anamnesis for a subjective description of the stools by parent and patient. First the physician scored this description using the Bristol scale, followed by the patient's and parent's scores. Results: Thirty patients were studied with a mean age of 8.1 ± 2.5 years. The Bristol scale score by physician was 1.83 ± 0.38, by parent 2.43 ± 0.97 (P = 0.001), and by patient 2.27 ± 0.87 (P = 0.003). The kappa coefficient between physician and parent scores was low, 0.30 (P< 0.001), as well as between physician and child scores, 0.34 (P< 0001). Conclusion: There was a difference between the Bristol Scale scores by the physician and by the parents/patients. The Bristol scale scores by the patients/parents showed little agreement with those by the physician. The authors suggest the replication of this experience elsewhere to continue evaluating the use of the Bristol Stool Scale in childhood constipation(AU)

Prevalencia de la infección por Helicobacter pylori en pacientes sintomáticos atendidos en consulta externa en el Hospital I Octavio Mongrut Muñoz - RAS - EsSalud periodo 2007 - 2010 / Prevalence of infection by Helicobacter pylori in symptomatic patients attended in outpatient consultation at the Hospital I Octavio Mongrut Muñoz - RAS – EsSalud period 2007-2010

Objetivo: Determinar la prevalencia de Helicobacter pylori en pacientes sintomáticos gástricos que acuden a la Consulta externa del Hospital I Octavio Mongrut Muñoz, a través de la prueba del Test de aliento. Planteamiento del Problema: La Organización Mundial de la Salud ha considerado al Helicobacter pylori como carcinógeno Tipo 1. Esto no significa que esta bacteria produzca sustancias carcinogénicas o mutagénicas, sino que como consecuencia de una inflamación crónica y progresiva de la mucosa gástrica, lleva a la gastritis atrófica, entidad considerada como una condición precancerosa. Material y Métodos: Se diseñó un estudio Observacional, Descriptivo y Longitudinal. El estudio se llevó a cabo en el Hospital I Octavio Mongrut Muñoz (HIOMM) que pertenece a la Red Asistencial Sabogal (RAS) de (EsSALUD); en pacientes a los cuales se les solicitó la prueba del Test de Aliento en el período comprendido entre enero a diciembre de los años 2007 al 2010. Resultados: La prevalencia de la infección por Hp., fue de 63.7 por ciento, 61.89 por ciento, 59.68 por ciento y 69.26 por ciento entre los años 2007 al 2010 respectivamente. Conclusión: La prevalencia encontrada se encuentra por encima de países desarrollados y en concordancia con la prevalencia en Latinoamérica. No encontrándose diferencias estadísticas significativas en relación al grupo etario y sexo con los estudios a nivel de Latinoamérica.

Correlación entre las características clínicas y el tipo de agente enteropatógeno bacteriano en menores de 5 años con diarrea aguda, atendidos en el Hospital de Emergencias Pediátricas durante el año 2013 / Correlation between clinical characteristics and the type of agent bacterial enteropathogens in children less than 5 years with acute diarrhea attended at the Hospital of Pediatric Emergency in 2013

Determinar la correlación entre las características clínicas y el tipo de agente enteropatógeno bacteriano en menores de 5 años con diarrea aguda infecciosa atendidos en el Hospital de Emergencias Pediátricas durante el año 2013. Metodología: El estudio es observacional, analítico comparativo, retrospectivo y transversal. Se realizó la investigación sobre la muestra de 362 niños menores de 5 años con diagnóstico de Diarrea Aguda. Para relacionar las variables se utilizó la prueba Chi-cuadrado. Resultados: De las características generales de los pacientes pediátricos en estudio, la edad promedio fue 30.02±21.7 meses (2 años y medio), en su mayoría masculino (55.5 por ciento), gran parte vive en el distrito de San Juan de Lurigancho, con un nivel socioeconómico medio y con mayor frecuencia estos cuadros diarreicos ocurren en primavera. Con respecto a las características nutricionales, el peso actual de los pacientes menores de 5 años con diarrea aguda fue de 12.8±8.12 kg en promedio. Además, sólo el 3.6 por ciento manifestó que su alimentación fue adecuada. Las características sintomatológicas más frecuentes que presentaron los menores fueron fiebre (68.8 por ciento), palidez (61 por ciento), dolor abdominal (54.1 por ciento) y vómito (46.4 por ciento); y los menos frecuentes fueron disentería y convulsiones. El grado de deshidratación fue mayormente leve (67.1 por ciento). En cuanto al tiempo de evolución de la diarrea este fue de 47.7±52.7 horas, el promedio de deposiciones fue de 3.9 veces al día y el promedio de vómitos fue 2.8 veces al día. Entre los principales enteropatógenos responsables de la diarrea aguda en niños menores de 5 años fueron Campylobacter (57.5 por ciento) y Shigella (34.3 por ciento), y en menor porcentaje el E. Coli y la Salmonella. Además, el dolor abdominal, la fiebre, el vómito los escalofríos y el grado de deshidratación estuvieron relacionados con algún tipo de bacteria (p<0.05). Por otro lado, la mayoría de pacientes...

To determine the correlation between clinical characteristics and the type of bacterial enteropathogen in children younger than 5 years with acute infectious diarrhea treated at the Pediatric Emergency Hospital during 2013. Methodology: Observational, comparative, retrospective, analytical, transversal study. The sample was 362 children younger than 5 years diagnosed with Acute Diarrhea. To relate the variables, the chi-square test was used. Results: The general characteristics of pediatric patients studied were: the mean age was 30.02±21.7 months (2 1/2 years), mostly male (55.5 per cent), Most live in the district of San Juan de Lurigancho, with middle socioeconomic level and most often these diarrheas occur in spring. Regarding the nutritional characteristics, current weight of patients younger than 5 years with acute diarrhea was 12.8 ± 8.12 kg on average. Furthermore, only 3.6 per cent said that their food was adequate. The most frequent symptomatology characteristics that children had were fever (68.8 per cent), pallor (61 per cent), abdominal pain (54.1 per cent) and vomiting (46.4 per cent); and least frequent were dysentery and seizures. The degree of dehydration was mostly mild (67.1 per cent). Regarding the duration of the diarrhea was 47.7±52.7 hours, the average deposition was 3.9 times per day and the average of vomiting was 2.8 times a day. The main enteropathogens responsible for acute diarrhea in children younger than 5 years were Campylobacter (57.5 per cent) and Shigella (34.3 per cent) and in the lowest percentage E. Coli and Salmonella. In addition, abdominal pain, fever, chills, vomiting and degree of dehydration were related to some type of bacteria (p<0.05). Moreover, the majority of patients (51.9 per cent) had more than 100 fecal leukocytes per field; also the stool was positive in 98.9 per cent of patients. In addition, fecal leukocytes per field were related to some kind of enteropathogenic bacteria (p<0.001)...

INTESTINAL PARASITIC INFECTIONS AMONG CHILDREN AND ADOLESCENTS ATTENDING IBN- KOLDON HOSPITAL, LAHAJ, YEMEN

This study reports the results of a cross-sectional survey carried out in October 2011 to September 2012 to investigate the epidemiology of intestinal parasitism among the children and -adolescents in Lahaj Governor ate, Yemen. A cross sectional survey of 476 children and adolescents who are less than twenty years in Ibn- Koldon Hospital, was conducted at hospital on a pretested self-administered questionnaire. We investigated the prevalence of intestinal parasites [protozoa and helminthes] in patients with gastrointestinal complaints in medical centers in Ibn koldon Hospital in Lahaj Governor ate, Yemen, and Laboratory of Faculty of Education -Aden University. Stool smears were examined under light microscope for intestinal parasites [protozoa and helminthes] detection were confirmed by Formalin - Ether sedimentation technique. All stool and blood samples were examined and socio-recorded information was retrieved. The prevalence of parasitic infection among children and adolescents were 54.6%. 43.3% with single infection and 11.4% with multiple infections. The proportion behveen males [56.69%] and females [52.25%] was different in patients with symptoms of intestinal parasitic infection [cases]. Majority of intestinal parasitic infection of children tmd adolescents [36.2%] were among 16-20 years of age. The lower infection less than' one third 19.2% was among 11-15 years of age. E. histolytica in both [single and multi-infection] was the most common parasite 45.4% infection identified. Patients from Pir Omar, had high fractions [85.71%] with symptoms of intestinal parasitic infection. Fraction of infection in patients with symptoms of intestinal parasitic infection was peaked in the hot months July, August, September and October [66.7%, 77.27%, 45.24% and 49.6%, respectively]. Results of the questionnaire survey showed that the majority of mothers were reasonably aware about transmission of amoebiasis, giardiasis and uscariasis. Symptoms of intestinal parasitic infections, most of the mothers suggested one or more symptoms like diarrhea [48.61%], abdominal pain [71.76%], mucus with stools [24.1%], changing in odor [44.4%], gas [10.2%], loss of appetite [36.6%], abdominal distended [35.2%] and an enlarged abdomen [30.1%]. The E. histolytica detected by enzyme-linked immunosorbent assay [ELISA] was 26.92% [35/130] from all positive Formalin - Ether sedimentation technique. The number of E. histolytica, G. lamblia and A. lumbricoides detected increased with the sedimentation technique methods and Formalin - Ether sedimentation technique. A good percentage of children and adolescents were infected by parasitic protozoa and helminthes and re-enforces the need for an urgent effort to check the unnecessary and avoidable heavy parasites load

Basidiobolomycosis: a case report

Basidiobolomycosis is a rare disease caused by the fungus Basidiobolus ranarum. Patients with Basidiobolus ranarum infection may present with subcutaneous, gastrointestinal, or systemic lesions. Recently, its etiologic role in gastrointestinal infections has been increasingly recognized. We report this case of gastrointestinal and retroperitoneal basidobolomycosis because of its rarity and also to emphasize the need to consider gastrointestinal and retroperitoneal basidiobolomycosis in the differential diagnosis of inflammatory bowel diseases, tuberculosis and malignancy

[ case report of junctional epidermolysis bullosa with gastrointestinal symptoms]

Epidermolysis bullosa is an uncommon disease with a wide spectrum of severity. Here we report a patient presenting with unusual symptoms. The patient is a 22 years old female with progressive dysphasia and odynophagia to solids and liquids and a history of spontaneously remitting blisters caused after mild trauma from her childhood till she was 13 years old. Subepidermal blisters were diagnosed as junctional type of epidermolysis bullosa by histopathology. Physicians should have a high index of suspicion regarding epidermolysis bullosa in patients presenting with dysphagia and cutaneous blisters

Rotavirus and coeliac autoimmunity among adults with non-specific gastrointestinal symptoms

To determine celiac disease [CD] serology and rotavirus [RV] by polymerase reaction [PCR] in adults with non-specific gastrointestinal complaints. The study comprised 5176 randomly selected individuals living in Tehran, Iran between September 2006 and September 2007. Six hundred and seventy individuals with GI symptoms were identified with a questionnaire and invited for a further study including stool sampling and blood tests. Stool samples were examined for detection of RV by amplification of specific gene [VP6] and by light microscopy and formalin-ether concentration methods for parasite detection. The subjects also tested for CD including anti-transglutaminase [tTG] antibodies and total immunoglobulin A [IgA]. The study was carried out in the Research Center of Gastroentrology and Liver Disease, Taleghani Hospital, Tehran, Iran. The VP6 gene was detected in 150 [22.3%] individuals. Anti-tissue transglutaminase [tTG-IgA] was positive in 22 individuals [95% CI 2.3-5.1] and IgG-tTG antibody in 3 individuals who were IgA deficient. Amplification of VP6 gene was positive in 8/25 [32%] with positive CD serology and in 142/645 [22%] with negative CD serology. This difference was not statistically significant [p=0.2]. This study shows that RV infection is common among Iranian patients with non-specific gastrointestinal symptoms. However, in contrast to studies in children, this study shows that the prevalence of active RV infection was not statistically significantly different between individuals who were tTG antibody positive and those who were tTG antibody negative

[Validity and reliability of a nutrition screening tool in patients admitted to hospital]

Malnutrition is an important health problem in hospitals and its association with increased morbidity and mortality has been well-documented. Since the condition can be readily treated, often at low cost, it is logical that efforts should be made to identify malnutrition for timely nutritional interventions. A nutrition screening tool [a questionnaire] was designed on the basis of recommendations of the British Association for Parenteral and Enteral Nutrition and used to identify individuals who are malnourished, at-risk of malnutrition, or may need nutritional support. The aim of this study was to evaluate the validity and reliability of this tool in a hospital in Tehran, Iran. A total of 446 patients, aged over 18 years, admitted consecutively to different wards of Taleghani Hospital in Tehran, Iran during six months were studied in the first 24 hours of admission. For testing validity of the questionnaire used, first a nutritionist made a full nutritional assessment of all the patients. The assessment included the following items: a. measurements of weight, height, body mass index [BMI], triceps skinfold [TSF], and mid-arm circumference [MAC]; b. weight history and percentage of involuntary weight loss over the previous 3-6 months; a 24-hour dietary recall; c. gastro-intestinal symptoms. The results of the assessment were, then, compared with the results obtained from the screening questionnaire. The inter-rater reliability of the screening tool was assessed by two nurses who completed the screening questionnaire separately during 72 hours following admission of the patients. The agreement between results was calculated. There was 66% agreement between the nutritionist's assessment results and the nurses's assessment results using the nutritional screening tool. The sensitivity and specificity of the screeing tool were 83.7% [95%CI: 80.0-87.4%] and 84.7% [95%CI: 81.1-88.1%], respectively. Further analysis of the data showed the positive predictive value to be 92.3% [95%CI: 89.6-95./0%] and the negative predictive value to be 70.2% [95%CI: 65.8-74.8%]. The mean inter-rater reliability [K=0.51] was moderate. The screening tool, completed separately for each patient by the two nurses, is reliable and, in comparison with the more objective nutritional assessment, has an acceptable validity. The questionnaire is useful for identifying malnourished patients in a hospital setting

Rare peripheral nerve schwannoma

Schwannoma, a benign tumor of nerve sheath origin, is commonly found in the head and neck, as well as flexor surfaces of the extremities. It can rarely occur in the breast and stomach with only a few cases being reported. The cases are: 1- a 57-year- old man with breast mass, 2- a 58 -year -old man with gastrointestinal complaints who were finally diagnosed as peripheral nerve schwannomas. Clinical suspicion and histopathological confirmation are the keys to schwannomas diagnosis. Surgical excision is the treatment of choice for such patients

Gastrointestinal manifestations of nephropathic cystinosis in children

Cystinosis is an autosomal recessive disorder which is characterized by both renal and extrarenal symptoms. Gastrointestinal dysfunction has been reported in adolescent with cystinosis, and it is rarely considered in the infants. The present case series reviewed gastrointestinal manifestations of these patients. Gastrointestinal signs and symptoms of 23 children aged 5.99 +/- 0.50 years [range, 1.0 to 12.5 years] on average with cystinosis, admitted to our department of nephrology between 1996 and 2005, were retrospectively reviewed. The inclusion criteria were the presence of the crystals of cystine in bone marrow aspiration and corneal deposition detected by slit lamp examination. Gastrointestinal signs and symptoms were as follows: vomiting in 16 patients [69.6%], hepatomegaly in 8 [34.8%], diarrhea in 6 [26.1%], splenomegaly in 5 [21.7%], constipation in 4 [17.4%], anorexia in 4 [17.4%], abdominal pain in 3 [13.0%], nausea in 2 [8.7%], and ascites in 2 [8.7%]. Height below the 3rd percentile in was seen in 16 patients [69.6%] and weight below the 3rd percentile, in 17 [73.9%]. Fifteen patients [65.2%] had both low weight and low height. Esophagogastroduodenoscopy had been performed in 6 cases and chronic inactive gastritis with H pylori infection was detected in 2 patients [8.7%]. Our study revealed a wide spectrum of gastrointestinal disturbances in young patients with cystinosis. Such findings should lead to greater awareness of the presence of gastrointestinal dysfunction in these children, encourage prompt gastrointestinal evaluation, and encourage treatment of more severely affected patients