Comparación de la prevalencia del grupo sanguíneo A en cáncer de estómago y población donante de sangre / Comparison of the prevalence of blood group A in gastric cancer patients and blood donors

RESUMEN Antecedentes: el cáncer gástrico constituye una enfermedad con una alta incidencia y mortalidad en Uruguay. El grupo sanguíneo A ha sido considerado un factor de riesgo así como de mayor prevalencia en esta enfermedad. Objetivo: El objetivo del trabajo es comparar el porcentaje entre el grupo sanguíneo A en pacientes con diagnóstico de cáncer gástrico y población donante de sangre en Uruguay. Material y métodos: se trata de un estudio observacional y retrospectivo. El tamaño muestral se determinó mediante la fórmula de comparación de proporciones con un nivel de confianza de 95% y una potencia de 80%. El número calculado fue de 149 para cada grupo. Se incluyeron todos los pacientes del Hospital Maciel y la Cooperativa Médica de Florida que cumplieron con los criterios de ingreso y una población de donantes de sangre de ambas instituciones. El análisis se realizó mediante la prueba de χ2 (chi cuadrado) estableciéndose un nivel de significación de 0,05. Resultados: se incluyeron 153 pacientes y usuarios en cada grupo. El grupo sanguíneo A presentó menor porcentaje en los pacientes con cáncer gástrico (35,9%) en relación con la población donante de sangre (36,6%). La diferencia no fue estadísticamente significativa entre los grupos estudiados. Conclusiones: se encontró que no hay diferencia significativa entre los porcentajes del grupo sanguíneo A de los grupos comparados.

ABSTRACT Background: Gastric cancer has high incidence and mortality in Uruguay. Blood group A has been considered a risk factor for gastric cancer and has high prevalence in this disease. Objective: The aim of this study is to compare the percentage of blood group A in patients with gastric cancer and in blood donors in Uruguay. Material and methods: We conducted an observational and retrospective study. We used the sample size calculation for comparing proportions with a confidence of 95% and 80% power. The number calculated was 149 for each group. We included all the patients from Hospital Maciel and Cooperativa Médica de Florida who met the admission criteria and a population of blood donors from both institutions. The chi-square test was used and a p value < 0.05 was considered statistically significant. Results: A total of 153 patients and blood donors were included in each group. Blood group A was less common in gastric cancer patients than in blood donors (35.9% vs. 36.6%). The difference was not statistically significant between the groups studied. Conclusions: We did not find any significant difference in the percentage of blood group A in the groups compared.

Effects of acute oral exposure to acrylamide on histological structures of the stomach in Wistar rats / Efectos de la exposición oral aguda a la acrilamida sobre las estructuras histológicas del estómago en ratas Wistar

SUMMARY: Acrylamide is a toxic chemical substance with wide implementation in chemical industry. In 2002 the presence of acrylamide was discovered in foods rich in starch which are prepared at high temperatures. The aim of this study was to investigate the histopathological changes in the gastric tissue in Wistar rats induced with injection of oral acrylamide. The research was carried out 6 groups of 5 animals (Wistar rats), two control groups and four experimental groups. Histological changes in the stomach tissue of Wistar rats are seen as a direct slight damage of the surface epithelium, accompanynig inflammatory reaction and renewal of the epithelium. Examined inflammatory and degenerative parameters show a positive correlation with respect to dose and time of exposition to acrylamide. Knowing the mechanism of action of these toxic substances, allows to apply adequate prevention in nutrition and make an appropriate choice of therapeutic methods.

RESUMEN: La acrilamida es una sustancia química tóxica con amplia aplicación en la industria química. En el año 2002 se determinó la presencia de acrilamida en alimentos ricos en almidón preparados a altas temperaturas. El objetivo de este estudio fue investigar los cambios histopatológicos en el tejido gástrico en ratas Wistar inducidos con inyección de acrilamida oral. La investigación se llevó a cabo en 6 grupos de 5 animales, dos grupos control y cuatro grupos experimentales. Los cambios histológicos en el tejido del estómago de las ratas Wistar se ven como un ligero daño directo del epitelio superficial, que acompaña a la reacción inflamatoria y la renovación del epitelio. Los parámetros inflamatorios y degenerativos examinados muestran una correlación positiva con respecto a la dosis y el tiempo de exposición a la acrilamida. El conocimiento del mecanismo de acción de estas sustancias tóxicas permite aplicar una prevención adecuada en nutrición y hacer una elección oportuna de los métodos terapéuticos.

Adaptación a la realidad de Latinoamérica de la Guía Clínica NASPGHAN/ESPGHAN 2016 sobre Diagnóstico, Prevención y Tratamiento de Infección por Helicobacter pylori en Pediatría / Adaptation to the reality of Latin America of the NASPGHAN/ESPGHAN 2016 Guidelines on the Diagnosis, Prevention and Treatment of Helicobacter pylori Infection in Pediatrics

Resumen: Introducción: Las últimas guías clínicas conjuntas de NASPGHAN y ESPGHAN en relación a la infección por H. pylori publicadas el año 2016, contienen 20 afirmaciones que han sido cuestionadas en la práctica respecto a su aplicabilidad en Latinoamérica (LA); en particular en relación a la preven ción del cáncer gástrico. Métodos: Se realizó un análisis crítico de la literatura, con especial énfasis en datos de LA y se estableció el nivel de evidencia y nivel de recomendación de las afirmaciones mas controversiales de las Guías Conjuntas. Se realizaron 2 rondas de votación de acuerdo a la técnica Delfi de consenso y se utilizó escala de Likert (de 0 a 4) para establecer el "grado de acuerdo" entre un grupo de expertos de SLAGHNP. Resultados: Existen pocos estudios en relación a diagnóstico, efectividad de tratamiento y susceptibilidad a antibióticos de H. pylori en pacientes pediátricos de LA. En base a estos estudios, extrapolaciones de estudios de adultos y la experiencia clínica del panel de expertos participantes, se realizan las siguientes recomendaciones. Recomendamos la toma de biopsias para test rápido de ureasa e histología (y muestras para cultivo o técnicas moleculares, cuando estén disponibles) durante la endoscopia digestiva alta sólo si en caso de confirmar la infección por H. pylori, se indicará tratamiento de erradicación. Recomendamos que centros regionales seleccio nados realicen estudios de sensibilidad/resistencia antimicrobiana para H. pylori y así actúen como centros de referencia para toda LA. En caso de falla de erradicación de H. pylori con tratamiento de primera línea, recomendamos tratamiento empírico con terapia cuádruple con inhibidor de bomba de protones, amoxicilina, metronidazol y bismuto por 14 días. En caso de falla de erradicación con el esquema de segunda línea, se recomienda indicar un tratamiento individualizado considerando la edad del paciente, el esquema indicado previamente y la sensibilidad antibiótica de la cepa, lo que implica realizar una nueva endoscopía con extracción de muestra para cultivo y antibiograma o es tudio molecular de resistencia. En niños sintomáticos referidos a endoscopía que tengan antecedente de familiar de primer o segundo grado con cáncer gástrico, se recomienda considerar la búsqueda de H. pylori mediante técnica directa durante la endoscopia (y erradicarlo cuando es detectado). Con clusiones: La evidencia apoya mayoritariamente los conceptos generales de las Guías NASPGHAN/ ESPGHAN 2016, pero es necesario adaptarlas a la realidad de LA, con énfasis en el desarrollo de centros regionales para el estudio de sensibilidad a antibióticos y mejorar la correcta selección del tratamiento de erradicación. En niños sintomáticos con antecedente familiar de primer o segundo grado de cáncer gástrico, se debe considerar la búsqueda y erradicación de H. pylori.

Abstract: Introduction: The latest joint H. pylori NASPGHAN and ESPGHAN clinical guidelines published in 2016, contain 20 statements that have been questioned in practice regarding their applicability in Latin America (LA); in particular in relation to gastric cancer prevention. Methods: We conduc ted a critical analysis of the literature, with special emphasis on LA data and established the level of evidence and level of recommendation of the most controversial claims in the Joint Guidelines. Two rounds of voting were conducted according to the Delphi consensus technique and a Likert scale (from 0 to 4) was used to establish the "degree of agreement" among a panel of SLAGHNP ex perts. Results: There are few studies regarding diagnosis, treatment effectiveness and susceptibility to antibiotics of H. pylori in pediatric patients of LA. Based on these studies, extrapolations from adult studies, and the clinical experience of the participating expert panel, the following recom mendations are made. We recommend taking biopsies for rapid urease and histology testing (and samples for culture or molecular techniques, when available) during upper endoscopy only if in case of confirmed H. pylori infection, eradication treatment will be indicated. We recommend that selected regional centers conduct antimicrobial sensitivity/resistance studies for H. pylori and thus act as reference centers for all LA. In case of failure to eradicate H. pylori with first-line treatment, we recommend empirical treatment with quadruple therapy with proton pump inhibitor, amoxi cillin, metronidazole, and bismuth for 14 days. In case of eradication failure with the second line scheme, it is recommended to indicate an individualized treatment considering the age of the pa tient, the previously indicated scheme and the antibiotic sensitivity of the strain, which implies performing a new endoscopy with sample extraction for culture and antibiogram or molecular resistance study. In symptomatic children referred to endoscopy who have a history of first or se cond degree family members with gastric cancer, it is recommended to consider the search for H. pylori by direct technique during endoscopy (and eradicate it when detected). Conclusions: The evidence supports most of the general concepts of the NASPGHAN/ESPGHAN 2016 Guidelines, but it is necessary to adapt them to the reality of LA, with emphasis on the development of regional centers for the study of antibiotic sensitivity and to improve the correct selection of the eradication treatment. In symptomatic children with a family history of first or second degree gastric cancer, the search for and eradication of H. pylori should be considered.

¿Por qué es importante detectar la gastritis atrófica y la metaplasia intestinal gástrica? ¿Cuál es la forma adecuada de hacerlo? / Why is it important to detect atrophic gastritis and gastric intestinal metaplasia? What is the proper way to do it?

RESUMEN La metaplasia intestinal gástrica y la gastritis atrófica son condiciones precancerosas conocidas (CPCs) del estómago, lo que significa que los pacientes con CPCs están en riesgo de desarrollar cáncer gástrico y, por lo tanto, el diagnóstico y la categorización de riesgo para estos pacientes es un tema relevante. El objetivo de esta revisión es proporcionar una actualización sobre el problema, el diagnóstico y el manejo de las CPCs con énfasis en el papel de la detección endoscópica adecuada.

ABSTRACT Gastric intestinal metaplasia and atrophic gastritis are a known precancerous condition (PCC) of the stomach, meaning that patients with PCC are at risk for gastric cancer and so, diagnosis and risk categorization for these patients is relevant. The aim of this review is to provide an update regarding the problem, diagnosis, and management of PCCs with an emphasis on the role of appropriate endoscopic detection.

Prevalencia, características endoscópicas y manejo de las lesiones subepiteliales del tracto gastrointestinal superior / Prevalence, endoscopic characteristics and management of subepitelial lesions of the upper gastrointestinal tract / Prevalência, características endoscópicas e manejo das lesões subepiteliais do trato gastrointestinal superior

Introducción: Las lesiones subepiteliales (LSE) son hallazgos incidentales en las endoscopias. Algunas tienen potencial maligno. Objetivos: Valorar la prevalencia, características endoscópicas y manejo diagnóstico/terapéutico de LSE en video-gastroscopias (VGC). Materiales y métodos: Se incluyeron todas las VGC del periodo enero 2011-junio 2018. Los casos con datos faltantes fueron excluidos. Donde se identificó una LSE se consignó: indicación, edad, sexo, tamaño, ubicación e histología, hallazgos de la ultrasonografía endoscópica (USE), punción-aspiración con aguja fina (PAAF) y resección quirúrgica. Resultados: Se evidenciaron 54 LSE en 7.983 pacientes (0,7 %). 72 % eran mujeres y la indicación más común fue dispepsia (26 %). La localización más frecuente fue en el estómago (74 %). El tamaño medio fue de 16 mm (5-50 mm) y la mitad fueron menores a 10 mm. Siete presentaban mucosa ulcerada, 4 se ubicaban en el cuerpo gástrico y 86 % eran referidos por hemorragia digestiva/anemia. En 26 casos de 54 (48 %) se realizaron biopsias estándar y en 6 de los 54 (11 %) biopsias sobre biopsias, con rendimiento diagnóstico nulo. En un 11 % de ellos se realizó USE, todas mayores de 10 mm: 2 páncreas ectópicos, una lesión compatible con leiomioma, 2 lesiones de la muscular propia (leiomioma/GIST) y 1 compresión extrínseca. No se realizó ninguna PAAF. Todas las LSE fueron manejadas de forma conservadora. Conclusiones: Este es el primer estudio nacional sobre prevalencia de LSE del tracto gastrointestinal superior y resultó comparable al de otras series. El rendimiento diagnóstico de la biopsia fue nulo. En la mayoría de los casos las lesiones se manejaron según las recomendaciones de las guías internacionales.

Introduction: Subepithelial lesions (SELs) are incidental findings in endoscopy procedures. Most are benign, but some have malignant potential. Objectives: To evaluate the prevalence, endoscopic characteristics and diagnostic / therapeutic management of SELs in upper GI endoscopy. Materials and methods: All upper GI endoscopy from January 2011 to June 2018 were included. Cases with missing data were excluded. Indication, age, sex, size, location and histology, findings of endoscopic ultrasound (EUS), fine needle aspiration (FNA) and surgical resection were recorded in patients with SELs. Results: There were 54 SELs in 7983 patients (0.7 %). 72 % were women, and the most frequent indication was dyspepsia (26 %). The most frequent location was stomach (74 %). The average size was 16 mm (5-50 mm), half were less than 10 mm. Seven had ulcerated mucosa, 4 were located in the gastric body and 86 % were referred for digestive hemorrhage/anemia. In 26 of 54 (48 %) standard biopsies and in 6 of 54 (11 %) bite-on-bite biopsy were performed, with no diagnostic yield. In 11 % of the cases EUS was performed, all of them larger than 10 mm: 2 ectopic pancreas, one lesion compatible with leiomyoma, 2 lesions of the muscularis propria (leiomyoma/GIST) and 1 extrinsic compression. No FNA was performed. All SELs were managed conservatively. Conclusions: This is the first national study of the prevalence of SELs in the upper gastrointestinal tract and was comparable to that of other series. Biopsy diagnostic yield was zero. In most cases, lesions were managed according to international guidelines.

Introdução: lesões subepiteliais (LSE) são achadas incidentais em endoscopias. A maioria são benignas, mas algumas têm potencial maligno. Objetivos: Avaliar a prevalência, características endoscópicas e manejo diagnóstico/terapêutico das LSE em vídeo-gastroscopias (VGC). Materiais e métodos: Foram incluídos todas VGC do período de janeiro de 2011 a junho de 2018. Foram excluídos os casos com dados ausentes. Quando uma LSE foi identificada, foram indagados: indicação, idade, sexo, tamanho, localização e histologia, achados da ultrassonografia endoscópica (USE), aspiração por agulha fina (PAAF) e ressecção cirúrgica. Resultados: 54 LSE foram evidenciadas em 7.983 pacientes (0,7 %). 72 % eram mulheres e a indicação mais freqüente foi dispepsia (26 %). A localização mais freqüente foi estômago (74 %). O tamanho médio era de 16 mm (5-50 mm), a metade era menor que 10 mm. Sete tinham mucosa ulcerada, quatro estavam localizadas no corpo gástrico e 86% foram referidos por sangramento/anemia gastrointestinal. Em 26 de 54 (48 %) foram realizadas biópsias padrão e em 6 de 54 (11 %) biópsias sobre biópsias, com um desempenho diagnóstico nulo. Em 11 %, foi realizado uma USE, todas maiores que 10 mm: 2 pâncreas ectópico , uma lesão compatível com leiomioma, 2 lesões musculares (leiomioma/GIST) e 1 compressão extrínseca. Não foi realizada nenhuma PAAF. Todas as LSE foram manejadas de forma conservadora. Conclusões: Este é o primeiro estudo nacional de prevalência de LSE no trato gastrointestinal superior e foi comparável ao de outras séries. O rendimento diagnóstico da biópsia foi nulo. Na maioria dos casos, as lesões foram tratadas de acordo com as recomendações das diretrizes internacionais.

Pólipos de glândulas fúndicas: a histologia pode ser utilizada para prever uso de inibidores de bomba de próton? / Gastric fundic gland polyps: can histology be useful to predict proton pump inhibitors use?

ABSTRACT BACKGROUND: Fundic gland polyps allegedly increased in frequency in recent decades, and had attracted great attention due to possible association with prolonged proton pump inhibitor therapy. Prolonged use of this drug could cause parietal cell hyperplasia, obstruction of glandular lumen and cystic dilation of the gland. OBJECTIVE: This study aims to analyze clinical and pathological features of fundic gland polyps in patients with and without proton pump inhibitor therapy in a selected population from Brazil. METHODS: It was selected a sample of 101 Brazilian patients (78 females and 23 males), from a five years retrospective search of the files from a private pathology laboratory. The patients had an average age of 57 years and we included patients with a histological diagnosis of fundic gland polyp. The clinical data were obtained from their files and all histological slides were reviewed and examined with hematoxylin and eosin (HE) and Giemsa. RESULTS: Information about the use or non-use of proton pump inhibitors (PPI) was obtained in 84 patient files. In 17 cases we could not determine if PPI were used or not. Among those in which the information was available, a positive history of anti-acid therapy was observed in 63 (75.0%) patients. Parietal cell hypertrophy/hyperplasia and parietal cell protrusions were detected in most slides. Histological findings were identical in PPI users and PPI negative patients. Helicobacter pylori infection was detected in just two samples. Epithelial dysplasia or adenocarcinoma were not observed in our cases. Histopathological analysis of fundic gland polyps could not distinguish between PPI and non-PPI related cases. Parietal cell cytoplasmic protrusions, an alleged marker of prolonged acid suppression therapy, was detected in both groups. CONCLUSION: Histological features could not discriminate anti-acid therapy related fundic glands polyps in our patients.

RESUMO CONTEXTO: Os pólipos das glândulas fúndicas do estômago supostamente aumentaram em frequência nas últimas décadas e atraíram grande atenção devido à possível associação com a terapia prolongada com inibidores da bomba de prótons. O uso prolongado deste fármaco pode causar hiperplasia das células parietais, obstrução do lúmen glandular e dilatação cística da glândula. OBJETIVO: Este estudo tem como objetivo analisar os aspectos clínicos e patológicos dos pólipos das glândulas fúndicas em pacientes com e sem terapia com inibidores da bomba de prótons em uma população selecionada do Brasil. MÉTODOS: Foi selecionada uma amostra de 101 pacientes brasileiros (78 do sexo feminino e 23 do sexo masculino), a partir de uma pesquisa retrospectiva de cinco anos dos arquivos de um laboratório privado de patologia. Os pacientes tinham uma idade média de 57 anos e foram incluídos pacientes com diagnóstico histológico de pólipo das glândulas fúndicas. Os dados clínicos foram obtidos a partir de seus prontuários e todas as lâminas histológicas foram revisadas e examinadas com hematoxilina e eosina (HE) e Giemsa. RESULTADOS: Informações sobre o uso ou não uso de inibidores da bomba de próton (IBP) foram obtidas em 84 prontuários de pacientes. Em 17 casos, não foi possível determinar se o IBP foi usado ou não. Entre aqueles em que a informação estava disponível, observou-se uma história positiva de terapia com IBP em 63 (75,0%) pacientes. A hipertrofia das células parietais/hiperplasia e protrusões das células parietais foram detectadas na maioria das lâminas. Os achados histológicos foram idênticos em usuários de IBP e pacientes não usuários. A infecção por Helicobacter pylori foi detectada em apenas duas amostras. A displasia epitelial ou o adenocarcinoma não foram observados em nossos casos. A análise histopatológica dos pólipos das glândulas fúndicas não pôde distinguir entre os casos IBP e não relacionados ao IBP. As protuberâncias citoplasmáticas das células parietais, um suposto marcador de terapia prolongada de supressão de ácido, foram detectadas em ambos os grupos. CONCLUSÃO: Características histológicas não podem discriminar os pólipos das glândulas fúndicas relacionados à terapia anti-secretora em nossos pacientes.

Doenças imunomediadas em pacientes com doença celíaca e em seus familiares: um estudo comparativo entre idade e sexo / Immune mediated diseases in patients with celiac disease and their relatives: a comparative study of age and sex

ABSTRACT BACKGROUND: Up to 15% of other immune-mediated diseases (IMDs) can occur in patients with CD throughout their lives and are associated with multiple factors, including sex and sex hormone levels. Moreover, sex is associated with differences in clinical presentation, onset, progression, and outcomes of disorders. OBJECTIVE: To investigate the prevalence of IMDs at diagnosis in patients with celiac disease (CD) and their first-degree relatives and to compare the findings between female and male patients of different age. METHODS: A retrospective study including Brazilian patients with CD who visited the same doctor during January 2012 to January 2017 was performed. Demographic and medical history data were collected through self-administered questionnaires and medical charts of the patients. In total, 213 patients were examined at diagnosis: 52 males (mean age, 40.0 years) and 161 females (mean age, 41.4 years). The patients were divided into two groups according to sex and age. RESULTS: IMDs were observed in 60.2% of the female (97/161) and 42.3% of the male patients (22/52; P=0.22). However, the frequency of IMDs was significantly higher in females aged 51-60 years than in males with same age (P=0.0002). Dermatitis herpetiformis (DH) was significantly more prevalent in males (P=0.02), whereas atopy was more prevalent in females (P=0.02). IMDs observed in first-degree relatives were similar to those observed in patients (70.9%; P<0.001), with a higher number observed in female relatives. CONCLUSION: The frequency of IMDs in CD patients was similar in all age groups and both sexes, except women diagnosed with CD after 51 years of age presented with an increased frequency of IMDs compared with males. Dermatitis herpetiformis was more prevalent in males, whereas atopy was more prevalent in females. No difference was observed in the type of IMDs between the first-degree relatives of both sexes.

RESUMO CONTEXTO: Até 15% das outras doenças imunomediadas (DIMs) podem ocorrer em pacientes com doença celíaca ao longo de suas vidas e estão associados a múltiplos fatores, incluindo sexo e níveis de hormônios sexuais. Além disso, o sexo está associado a diferenças na apresentação, início, progressão e desfecho das doenças. OBJETIVO: Investigar a prevalência de DIMs ao diagnóstico de doença celíaca e em seus familiares de primeiro grau e comparar os resultados entre sexo feminino e masculino em diferentes idades. MÉTODOS: Estudo retrospectivo incluindo pacientes brasileiros com diagnóstico de doença celíaca que realizaram acompanhamento com o mesmo médico no período de janeiro 2012 a janeiro de 2017. Dados demográficos e histórico médico foram coletados através de um questionário auto administrado e prontuários médicos dos pacientes envolvidos. No total, 213 pacientes eram portadores de doença celíaca, dos quais 52 do sexo masculino (idade média 40,0 anos) e 161 do sexo feminino (idade média 41,4 anos). Os pacientes foram divididos em dois grupos de acordo com o sexo e idade. RESULTADOS: DIMs foram observadas em 60,2% das pacientes femininas (97/161) e 42,4% dos pacientes masculinos (22/52; P=0,22). Entretanto, a frequência de DIMs foi significantemente maior em pacientes do sexo feminino com idade entre 51-60 anos que em pacientes masculinos da mesma idade (P=0,0002). Dermatite herpetiforme apresentou maior prevalência no sexo masculino (P=0,02), enquanto atopia obteve maior prevalência nas pacientes do sexo feminino (P=0,02). DIMs observadas em familiares de primeiro grau foram similares as encontradas nos pacientes (70,9%; P<0,001), com um maior número observado em familiares femininos. CONCLUSÃO: A frequência de DIMs em pacientes com doença celíaca foi similar nos grupos etários e ambos sexos, exceto as mulheres com diagnóstico de doença celíaca após a idade de 51 anos, as quais apresentaram um aumento na frequência de DIMs em comparação com os pacientes do sexo masculino. Dermatite herpetiforme apresentou maior prevalência em pacientes do sexo masculino, enquanto que atopia foi mais prevalente no sexo feminino. Em relação ao sexo, não foi observada diferença no tipo de DIMs observada entre os familiares de primeiro grau.

Effects of different periods of gastric ischemia on liver as a remote organ

Abstract Purpose: To evaluate the hepatic changes associated with gastric ischemia. Methods: Thirty male rabbits were studied, distributed in 3 groups (n=10). Group 1: ligature and section of the gastric vasculature and removal of the liver after three hours; Group 2: ligature and section of the gastric vasculature and removal of the liver after 6 hours; Group 3: ligature and section of the gastric vasculature and removal of the liver after 12 hours. Blood samples were collected immediately before surgery and after the determined time of ischemia in each group to evaluate the hepatic function. After the death of the rabbits, the liver was removed for macro and microscopic study. Results: An increase in aminotransferases and bilirubin occurred in groups 2 and 3. Total protein and albumin diminished in all of the animals. All of the rabbits from groups 2 and 3 presented hepatocellular necrosis. Conclusion: The devascularization of the stomach for a period of above three hours is associated with hepatic morphological and functional disorders.

Development and validation of a whole-cell ELISA for serologically diagnosing Helicobacter pylori infection in Brazilian children and adults: a diagnostic accuracy study

ABSTRACT BACKGROUND: Serological tests are practical, with low cost, but no noninvasive tests are available for diagnosing Helicobacter pylori (H. pylori) infection in Brazil. The aim here was to develop and validate enzyme-linked immunosorbent assay (ELISA) serological tests to detect anti-H. pylori immunoglobulin G antibodies, based on cultured strains from Brazilian patients. DESIGN AND SETTING: Cross-sectional, diagnostic accuracy study comparing a locally developed and validated ELISA and invasive tests among dyspeptic patients at two public hospitals in São Paulo, Brazil. METHODS: An ELISA test was prepared using whole-cell antigen from 56 strains. After genotypic characterization, it was standardized and optical density (OD) cutoffs were determined based on the serum antibody response of 100 H. pylori-negative samples, compared with 82 H. pylori-positive samples. Validation was performed on 174 symptomatic patients. RESULTS: The optimal OD cutoffs established (for monoclonal and polyclonal tests, respectively) were 0.167 and 0.164; overall ELISA sensitivity: 84.3%, 78.9%; specificity: 88.6%, 90.6%; positive predictive value (PPV): 75.4%, 80%; negative predictive value (NPV): 93.1%, 81.8%; accuracy: 87.3%, 86.2%; child and adolescent ELISA sensitivity: 74.2%, 81.8%; specificity: 90.8%, 86.7%; PPV: 66.6%, 84.3%; NPV: 95.8%, 84.8%; accuracy: 88.5%, 84.6; adult ELISA sensitivity: 84.4%, 75%; specificity: 86.9%, 93%; PPV: 81.8%, 78.3%; NPV: 88.9%, 91.8%; accuracy: 85.9%, 88.5%. CONCLUSION: The polyclonal serological test developed using local strains presented better diagnostic performance among children and adolescents, while the monoclonal test was better among adults. The results from both tests suggest that these in-house serological tests could be used to detect anti-H. pylori antibodies in our population, for screening purposes.

Asociación clínica, patológica y microbiológica de Helicobacter pylori en biopsias gástricas en el departamento de Caldas-Colombia / Clinical, pathological and microbiological association of Helicobacter pylori in gastric biopsies in the department of Caldas-Colombia

Objectivo: Establecer la asociación clínica, patológica y microbiológica de Helicobacter pylori en biopsias gástricas en una población del departamento de Caldas (Colombia). Materiales y método: Se incluyeron 72 pacientes que fueron remitidos para endoscopia digestiva a la clínica San Marcel de la ciudad de Manizales durante el segundo semestre de 2015; a quienes se les tomaron dos biopsias del antro y dos del cuerpo del estómago para estudio histopatológico y cultivo microbiológico. Los datos fueron sometidos a procedimientos estadísticos descriptivos y relacionales. Resultados: se encontró una proporción de H. pylori del 47,2% por análisis histológico y del 26,4% por cultivo microbiológico, con predominio del sexo femenino. Siendo la epigastralgia el principal motivo de consulta asociado a la infección por H. pylori. Conclusión: se encontró asociación entre motivo de consulta, sexo femenino, cultivo microbiológico y presencia histológica de H. pylori. La edad se asoció al diagnóstico endoscópico establecido. El cultivo presentó frente al hallazgo histopatológico una especificidad elevada (84,2%) y una baja sensibilidad (38,2%).

Objective: To establish the clinical, pathological and microbiological association of Helicobacter pylori in gastric biopsies in a population of the department of Caldas (Colombia). Materials and methods: We included 72 patients, who were referred for digestive endoscopy to the San Marcel clinic in the city of Manizales during the second half of 2015; two biopsies of the antrum and two of the body of the stomach were taken for histopathological study and microbiological culture. Data were submitted to descriptive and relational statistical procedures. Results: H. pylori was found in 47.2% by histological analysis and 26.4% by microbiological culture, with predominance in the female sex. Epigastralgia is the main reason for consultation associated with H. pylori infection. Conclusion: we found an association between the reason for consultation, female sex, microbiological culture and histological presence of H. pylori. Age was associated with established endoscopic diagnosis. The culture presented a high specificity (84.2%) and a low sensitivity (38.2%), compared to the histopathological finding.

Pharyngo-ileo-colo-anastomosis with micro-vascular blood supply augmentation for esophago-gastric replacement due to esophago-gastric necrosis after caustic ingestion / Faringo-íleo-colo-anastomose com suprimento sanguíneo microvascular para substituição esofagogástrica por necrose esofagogástrica após ingestão cáustica

ABSTRACT Background : Complete esophago-gastric necrosis after caustic ingestion is a challenging surgical scenario for reconstruction of the upper digestive transit. Aim : To present a surgical technique for reconstruction of the upper digestive tract after total esophagectomy and gastrectomy due to esophageal and gastric necrosis Method: The transit was re-established by means of a pharyngo-ileo-colic interposition with microsurgical arterial and venous anastomosis for augmentation of blood supply. Colo-duodeno-anastomosis and ileo-transverse colic anastomosis were performed for complete digestive transit reconstruction. Result: This procedure was applied in a case of 41 years male attempted suicide by ingesting alkali caustic liquid (concentrated sodium hydroxide). Total necrosis of the esophagus and stomach occurred, which required initially total esophago-gastrectomy, closure at the level of the crico-pharyngeal sphincter and jejunostomy for enteral feeding with a highly deteriorated quality of life . The procedure was performed later and there were no major early and late postoperative complications and normal nutritional conditions were re-stablished. Conclusion: The procedure is feasible and must be managed by multidisciplinary team in order to re-establish a normal quality of life.

RESUMO Racional: A necrose esofagogástrica completa após ingestão cáustica é um cenário cirúrgico desafiador para a reconstrução do trânsito digestivo alto. Objetivo: Apresentar uma técnica cirúrgica para reconstrução do trato digestivo superior após esofagectomia total e gastrectomia por necrose esofágica e gástrica. Método: O trânsito foi restabelecido por interposição faringo-íleo-cólica com anastomose arterial e venosa microcirúrgica com aumento do suprimento sanguíneo. Adicionalmente, anastomose colo-duodeno-anastomótica e íleo-transversa foram realizadas para reconstrução completa do trânsito digestivo. Resultado: Este procedimento foi aplicado em um homem de 41 anos com tentativa de suicídio pela ingestão de líquido cáustico alcalino (hidróxido de sódio concentrado). Ocorreu necrose total do esôfago e do estômago, o que exigiu inicialmente esofagogastrectomia total, fechamento ao nível do esfíncter cricofaríngeo e jejunostomia para alimentação enteral produzindo qualidade de vida altamente deteriorada. O procedimento foi realizado mais tardiamente e não houve maiores complicações pós-operatórias precoces e tardias e condições nutricionais normais foram restabelecidas. Conclusão: O procedimento é viável e deve ser manejado por equipe multidisciplinar a fim de restabelecer a qualidade de vida normal.

Eus-fna with 19 or 22 gauges needles for gastric subepithelial lesions of the muscle layer / Punção aspirativa ecoguiada com agulhas de 19 e 22 gauges para lesões subepiteliais gástricas da camada muscular própria

ABSTRACT Background: Tissue diagnosis is required for gastric subepithelial lesions for differential diagnosis of GISTs. However, there has not been consensus about the best needle for EUS-guided sampling of these lesions. Aim: To evaluate the diagnostic yield of EUS-FNA for gastric subepithelial lesions of the proper muscle layer with large-bore 19 gauge needles. Methods: A prospectively maintained database was retrospectively reviewed to identify consecutive patients who underwent EUS-FNA with 19 and 22 gauge needles for gastric subepithelial lesions of the fourth endosonographic layer in a tertiary care referral center. EUS-FNA was performed by the same endosonographer, using the fanning technique, without on-site cytopathologist. Specimens were analysed through cell blocks by the same pathologist. Procedure results were categorized into diagnostic, defined as enough material for histopathology and immunohistochemistry, or nondiagnostic. Results: Eighty-nine patients (mean age: 59 years, 77% women) underwent 92 EUS-FNA with 19 (75) or 22 (17) gauge needles. Mean lesion size was 22.6 mm. Overall diagnostic yield was 88%. The diagnostic yield of 19 gauge was higher than that of 22 gauge needle (92%x70.6%; p=0.0410), and similar for lesions >2 cm and <2 cm (93.7%x90.7%; p=0.9563). The best performance for 19 gauge needles was obtained performing <3 needle passes. Complication rate was 2.8%. Conclusions: Diagnostic yield of EUS-FNA with 19 gauge needles is 92% for gastric subepithelial lesions of the proper muscle layer. It is safe and highly valuable for differentiation between GIST and leiomyoma, no matter the size of the lesion.

RESUMO Racional: O diagnóstico tecidual é mandatório nas lesões subepiteliais gástricas da camada muscular própria para o diagnóstico diferencial das neoplasias do estroma gastrointestinal (GISTs). Contudo, ainda não há consenso quanto a melhor agulha para a punção ecoguiada destas lesões. Objetivo: Avaliar o valor da punção aspirativa ecoguiada com agulhas calibrosas de 19 gauge para o diagnóstico diferencial das lesões subepiteliais gástricas da camada muscular própria. Métodos: Foram revisados retrospectivamente os registros de pacientes consecutivos submetidos à punção aspirativa ecoguiada com agulhas de 19 e 22 gauge de lesões subepiteliais gástricas da quarta camada ecográfica em um centro de referência. A punção aspirativa foi realizada sempre pelo mesmo endoscopista, com o emprego da técnica de fanning, sem presença de citopatologista em sala. O material aspirado foi avaliado apenas pela técnica de cell block pelo mesmo patologista. Os resultados foram considerados diagnósticos, na presença de material adequado para coloração pela H&E e imunoistoquímica, ou não-diagnósticos. Resultados: Oitenta e nove pacientes (idade média: 59 anos, 77% do sexo feminino) foram submetidos a 92 punções aspirativas ecoguiadas com agulhas de 19 (75) ou 22 (17) gauges. O tamanho médio das lesões foi de 22,6 mm. O ganho diagnóstico geral foi de 88%. O ganho diagnóstico para as agulhas de 19 gauge foi superior ao das agulhas de 22 gauge (92%x70,6%; p=0,0410), e similar para lesões >2 cm e <2 cm (93,7%x90,7%; p=0,9563). Os melhores resultados com a agulha de 19 gauge foram obtidos com a realização de até três punções. A taxa de complicações foi de 2,8%. Conclusão: O ganho diagnóstico da punção aspirativa ecoguiada de lesões subepiteliais gástricas da camada muscular própria com agulhas de 19 gauge é de 92%. A punção com a agulha mais calibrosa para lesões de qualquer tamanho é procedimento seguro e de grande valor no diagnóstico diferencial dos GISTs e leiomiomas.

Rotinas e condutas em cirurgias para as doenças malignas e benignas do esôfago, estômago e duodeno / Preoperative care in surgeries for the malignant and benign diseases of oesophagus, stomach and duodenum

Resumo: As doenças que acometem o trato digestivo alto, mais precisamente o esôfago, estômago e duodeno revestem-se de grande importância não só devido à relevância epidemiológica (com incidências elevadas e crescentes), mas também pela intensidade dos sintomas e a gravidade das complicações, comprometendo de forma significativa a qualidade de vida dos seus portadores. Nas últimas décadas, os avanços nos cuidados a pacientes portadores de doenças benignas e malignas do aparelho digestivo superior se manifestaram por meio da introdução de novos métodos de diagnóstico e estadiamento, mudanças no paradigma das estratégias perioperatórias e desenvolvimento de novos procedimentos, técnicas e vias de acesso cirúrgicos; ampliando ainda mais o espectro de opções diagnósticas e terapêuticas. Diante do amplo acesso a uma quantidade imensa de informações provida pela medicina atual, o desenvolvimento de protocolos de cuidados pré- e pós-operatórios baseados em evidências, resulta em auxílio na tomada de decisão e certamente também contribui para melhoria dos resultados cirúrgicos. Pela complexidade associada, é imperativo que o seguimento destes pacientes seja realizado em serviços terciários, muitos dos quais também se constituem em hospitais de ensino, com participação contínua de profissionais em treinamento e aprendizado. O presente projeto objetiva à elaboração de manual de rotinas e condutas específicas para o tratamento cirúrgico das doenças malignas e benignas do esôfago, estômago e duodeno; fundamentado em evidências clínicas e com aplicação em hospital de nível terciário. No contexto de hospitais universitários, de ensino e de referência ¿ que contem com equipes médicas, de enfermagem e multidisciplinares, além do envolvimento de alunos e médicos residentes em treinamento ¿ a implementação de protocolos de assistência possui relevância ainda maior, visto que não apenas diferencia e favorece melhores resultados operatórios, menor morbimortalidade e maior sobrevida em geral, mas também uniformiza condutas facilitando o processo de aprendizagem(AU)

Abstract: The diseases that affect the upper digestive tract, the esophagus, stomach and duodenum, are of great importance not only due to the epidemiological relevance (with high and increasing incidence), but also the intensity of the symptoms and the severity of the complications, compromising patients quality of life. Lately, the advances in patients care with benign and malignant diseases of the upper digestive system have consisted in the introduction of new diagnostic methods, changes in the paradigm of perioperative strategies and the development of new procedures, techniques and surgical access; expanding the spectrum of diagnostic and therapeutic options. Given the broad access to a vast amount of information provided by current medicine, the development of pre-and post-operative guidelines based on evidence, results in better decision making and certainly also contributes to improved surgical outcomes. Because of the associated complexity, it is imperative that the follow-up of these patients be performed in tertiary services, many of which also constitute teaching hospitals, with continuous participation of professionals in training and learning. The present project aims the elaboration of a guideline of specific routines and procedures for the surgical treatment of malignant and benign diseases of the esophagus, stomach and duodenum; based on clinical evidence. In the context of university, teaching and reference hospitals - which includes medical, nursing and multidisciplinary teams, as well as the involvement of students and physicians in training - the implementation of assistance protocols will have even greater influence, since it not only favors better overall survival, but also facilitates the learning process(AU)

Resistance to rupture of the equine stomach / Resistência à ruptura do estômago equino

Equine colic is an important and common cause of disease and death in horses. Gastric rupture has been extensively described in the literature, and is known to affect expressive numbers of horses. Gastric dilatation, which precedes rupture, may be observed when the animal consumes large amounts of recently harvested grass or drinks water too fast, though diagnosis criteria also include infestation with Gastherophilus and the presence of ileus and distal intestinal obstructions. The objective of the present study was to determine the resistance to rupture of the equine stomach to air (mm Hg) and water (L) injection. Forty stomachs of young horses (20 geldings and 20 mares) with no defined breed were analyzed. Total organ length (cm), weight (g), greater curved length (cm), lesser curved length (cm) and height (cm) were measured, with no statistical difference between males and females (p > .05). However, stomachs of horses were larger than those of mares and therefore presented higher volumetric capacity (p<0.05). No difference between males and females was observed in the pressure assay (93mmg Hg). Rupture occurred along the greater curvature (99%) and on the visceral (80%) and diaphragmatic (20%) surfaces, across all layers of the gastric wall. Although the equine stomach is relatively small, the organ is considerably resistant to rupture, whether by injection of air or liquid. Horses and mares exhibit similar resistance values, although the stomach of females has smaller volumetric capacity.(AU)

A cólica é um dos problemas mais comuns na clínica de equinos sendo responsável por grande número de mortes. A ruptura gástrica tem sido amplamente descrita na literatura e acomete número expressivo de animais. A dilatação gástrica, que antecede a ruptura, pode advir do consumo excessivo de capim recém-cortado, ingestão rápida de água, infestação por Gastherophilus, ocorrência de íleo paralítico e obstruções intestinais distais. A ruptura gástrica tem sido amplamente descrita na literatura e acomete um número expressivo de animais. Este estudo objetivou determinar a resistência à ruptura do estômago equino mediante a insuflação de ar atmosférico (mmHg) e do preenchimento com água (L). Foram utilizados 40 estômagos de equinos adultos jovens (20 machos castrados e 20 fêmeas) sem raça definida. Medidas relativas ao comprimento total do órgão (cm), peso do órgão (g), curvatura maior (cm), curvatura menor (cm) e altura (cm) foram aferidas e não diferiram entre machos e fêmeas (p>0,05). No entanto, os estômagos dos machos apresentaram medidas superiores as das fêmeas e por assim serem, comportaram um maior volume de água (p<0,05). No teste de resistência mediante insuflação de ar atmosférico não houve diferença entre machos e fêmeas (93mmHg). Os rompimentos ocorreram ao longo da curvatura maior (99%) nas faces visceral (80%) e diafragmática (20%) e abrangeram todas as camadas da parede gástrica. Apesar de ser um órgão relativamente pequeno, o estômago dos equinos apresenta considerável resistência à ruptura, seja por líquido ou por ar atmosférico. Machos e fêmeas possuem resistência gástrica semelhante, embora o estômago das fêmeas equinas comporte um menor volume.(AU)

Pólipo fibroide inflamatorio gástrico: presentación de un caso clínico patológico y revisión de la literatura / Inflammatory fibroid polyp of the gastrointestinal tract: clinical case and review of the literature

A case report of a 67 year old female presenting upper gastrointestinal symptoms characterized by epigastric pain and nausea. Her endoscopic examination reveals the presence of a polypoid submucosal lesion measuring 5 mm in diameter. Biopsies were reported as inflammatory fibroid polyp. Clinical pathological aspects, immunohistochemical findings, differential diagnosis and described new genetic alterations associated with this lesion are discussed.

Se presenta caso de paciente mujer de 67 años con sintomatología digestiva alta caracterizada por epigastralgia y náuseas. Su examen endoscópico muestra la presencia de lesión solevantada submucosa de 5 mm de diámetro. Las biopsias revelan la presencia de pólipo fibroide inflamatorio. Se discuten los aspectos clínico-patológicos, inmunohistoquímicos, diagnóstico diferencial y nuevas alteraciones genéticas descritas, asociadas a esta lesión.

Emergency endoscopic variceal ligation in cirrhotic patients with blood clots in the stomach but no active bleeding or stigmata increases the risk of rebleeding

BACKGROUND/AIMS: This study aimed to evaluate the efficacy and safety of emergency variceal ligation for the prevention of rebleeding in cirrhotic patients who are found on initial endoscopy to have blood clots in the stomach but no actively bleeding esophageal and gastric varices or stigmata. METHODS: This study included 28 cirrhotic patients who underwent emergency prophylactic EVL and 41 who underwent an elective intervention between January 2009 and June 2014. Clinical outcomes were analyzed, including the rebleeding, 6-week mortality, and rebleeding-free survival rates. RESULTS: The rebleeding rate was higher in the emergency than in the elective group (28.6% vs. 7.3%, P=0.041). Multivariate analysis showed that emergency prophylactic EVL (odds ratio [OR] = 7.4, 95% confidence interval [CI]=1.634.8, P=0.012) and Child-Pugh score C (OR=10.6, 95% CI=1.4-80.8, P=0.022) were associated with rebleeding. In the emergency group, the gastric varices were associated with rebleeding (OR=12.0, 95% CI=1.7-83.5, P=0.012). CONCLUSIONS: Emergency EVL may be associated with variceal rebleeding when blood clots are present in the stomach without active esophageal and gastric variceal bleeding or stigmata. Elective intervention should be considered as a safer strategy for preventing variceal rebleeding in this situation.

Negative Biopsy after Referral for Biopsy-Proven Gastric Cancer

BACKGROUND/AIMS: Repeat endoscopy with biopsy is often performed in patients with previously diagnosed gastric cancer to determine further treatment plans. However, biopsy results may differ from the original pathologic report. We reviewed patients who had a negative biopsy after referral for gastric cancer. METHODS: A total of 116 patients with negative biopsy results after referral for biopsy-proven gastric cancer were enrolled. Outside pathology slides were reviewed. Images of the first and second endoscopic examinations were reviewed. We reviewed the clinical history from referral to the final treatment. RESULTS: Eighty-eight patients (76%) arrived with information about the lesion from the referring physician. Among 96 patients with available outside slides, the rate of interobserver variation was 24%. Endoscopy was repeated at our institution; 85 patients (73%) were found to have definite lesions, whereas 31 patients (27%) had indeterminate lesions. In the group with definite lesions, 71% of the lesions were depressed in shape. The most common cause of a negative biopsy was mistargeting. In the group with indeterminate lesions, 94% had insufficient information. All patients with adequate follow-up were successfully treated based on the findings in the follow-up endoscopy. CONCLUSIONS: A negative biopsy after referral for biopsy-proven gastric cancer is mainly caused by mistargeting and insufficient information during the referral.

EFFECTS OF DIFFERENT PERIODS OF GASTRIC ISCHAEMIA IN THE VIABILITY OF THE TISSUE OF BODY, FUNDUS AND ANTRUM REGION OF RABBIT STOMACH / EFEITOS DE DIFERENTES TEMPOS DE ISQUEMIA GÁSTRICA SOBRE A VIABILIDADE DOS TECIDOS DO CORPO, FUNDO E ANTRO DO ESTÔMAGO DE COELHOS

BACKGROUND: Despite the rich vascular arcade of the stomach, gastric ischemia represents an important medical challenge and can be the consequence of obstructive or non-obstructive vascular processes of pathological or iatrogenic origin.AIM: To assess the effects of acute gastric ischaemia on the different regions of the stomach.METHOD: Fifteen New Zeland rabbits were divided into three groups: group 1, animals were observed during 3 h; group 2, during 6 h; group 3, during 12 h. Rabbit stomachs were subjected to devascularization of the greater and lesser curvatures. After predetermined time, the stomachs were removed for macro and microscopic studies.RESULTS: Haemorrhagic necrosis was more marked in the gastric fundus and body. In contrast, the antropylorus remained preserved in 80% of the animals. Necrosis of the gastric body and fundus mucosa were observed in all animals after 6 h and 12 h of ischaemia.CONCLUSION: Acute gastric ischaemia in rabbits produces haemorrhagic necrosis of the gastric fundus and body even in a short period of time. Beside this, the antropyloric region was significantly more resistant to ischaemia.

RACIONAL: Isquemia gástrica representa importante desafio médico e geralmente é decorrente de processos vasculares obstrutivos ou não-obstrutivos. Apesar da rica arcada vascular do estômago, lesões de isquemia gástrica têm sido observadas. Quando a isquemia progride, pode culminar em necrose do órgão.OBJETIVO: Avaliar os efeitos dos diferentes tempos de isquemia gástrica sobre os tecidos da parede do estômago de coelhos mediante desvascularização total de ambas as curvaturas gástricas.MÉTODO: Foram utilizados 15 coelhos machos da raça Nova Zelândia. Os animais foram distribuídos nos seguintes grupos: grupo 1, observados por 3 h; grupo 2, por 6 h; grupo 3, por 12 h. A técnica cirúrgica foi a mesma em todos os animais e consistiu na ligadura e secção de todas as veias e artérias da parede gástrica. Após o período pré-determinado de observação, o estômago foi removido por completo para estudo macro e microscópico.RESULTADOS: As alterações macroscópicas e histológicas tornaram-se mais intensas com o aumento do tempo de isquemia e foram mais evidentes nas regiões do fundo e do corpo. Por outro lado, o antro manteve-se preservado na maioria dos animais operados. Necrose de mucosa do corpo e do fundo foi observada em todos os animais estudados, e foi acompanhada por hemorragia em 60% dos coelhos dos grupos 2 e 3.CONCLUSÃO: O modelo experimental de isquemia gástrica foi eficaz para produzir necrose hemorrágica de fundo e corpo do estômago de coelhos mesmo em curto tempo. Por outro lado, a região do antro pilórico desses animais mostrou-se significativamente mais resistente à isquemia do que as demais regiões.

Dyspeptic symptoms in patients with type 1 diabetes: endoscopic findings, Helicobacter pylori infection, and associations with metabolic control, mood disorders and nutritional factors

Objectives To evaluate, in a group of patients with long-standing type 1 diabetes (DM1), an association of dyspepsia symptoms with: changes in the gastroduodenal mucosa, infection by Helicobacter pylori, glycemic control, and psychological and nutritional factors. Subjects and methods A total of 32 patient with DM1 were studied (age: 38 ± 9 years; females: 25; diabetes duration: 22 ± 5 years). All patients answered a standardized questionnaire for the evaluation of gastrointestinal symptoms and underwent upper gastrointestinal endoscopy, with gastric biopsies for the evaluation of Helicobacter pylori infection. The presence of anxiety and depression was evaluated by the HAD scale. Nutritional parameters were BMI, arm and waist circumference, skinfold measurement, and body fat percentage. Results Upper endoscopy detected lesions in the gastric mucosa in 34.4% of the patients, with similar frequency in those with (n = 21) and without dyspepsia (n = 11). The patients with dyspepsia complaints showed greater frequency of depression (60% vs. 0%; p = 0.001), higher values for HbA1c (9.6 ± 1.7 vs. 8.2 ± 1.3%; p = 0.01) and lower values for BMI (24.3 ± 4.1 vs. 27.2 ± 2.6 kg/m2; p = 0.02), body fat percentage (26.6 ± 6.2 vs. 30.8 ± 7.7%; p = 0.04), and waist circumference (78.7 ± 8 vs. 85.8 ± 8.1 cm; p = 0.02). No association was found between the symptoms and the presence of Helicobacter pylori. Conclusions Dyspepsia symptoms in patients with long-standing DM1 were associated with glycemic control and depression, and they seem to negatively influence the nutritional status of these patients. .

Histological evaluation of the effects of borax obtained from various sources in different rat organs / Evaluación histológica de los efectos del borax obtenido de diversas fuentes en diferentes órganos de rata

Boron is an essential element for life and intake via different sources into the body. Because effects of boron and compounds on the body has not been studied enough especially in tissue level, we planned this study to evaluate the effects of borax the most intaken form of boron compound on different intraabdominal organs histologically and also clinically. 42 male rats divided into equal 7 groups and different toxicological doses consistent with its LD50 dose (5000 mg/kg/d) were administered by gavage except control and sham groups. In the study, 2 different kinds of borax one of which was produced for research and the other for agriculture but the same formulation, were used and their effects were also compared. As a result it was found that borax did not cause any histological changes in kidney, large intestine, liver and stomach in lower doses. But if doses were increased, a slightly inflammatory cell migration was detected without clinical signs in liver and large intestine. However, when a single very high dose of borax was administered, very high edema, inflammatory cell migration and neovascularization was observed and clinically 2 out of 6 rats died within 5 hours. We suggested that very high dose intake of borax may cause sudden death and also during long periods and higher dose intake may pave the way of inflammatory bowel diseases. At the same time, in boron related studies we advice that the kind of boron and also their source should be evaluated carefully and the most suitable compound should be chosen in case of faulty results.

El boro es un elemento esencial para la vida e ingresa a través de diferentes fuentes al cuerpo. Dado que los efectos del boro y sus compuestos en el cuerpo no se han estudiado lo suficiente, especialmente a nivel tisular, se planificó este estudio para evaluar sus efectos y la forma de consumo más común del compuesto de boro sobre diferentes órganos intraabdominales a nivel histológico y clínico. Cuarenta y dos ratas macho divididas en 7 grupos, con diferentes dosis toxicológicas de acuerdo con su dosis DL50 (5000 mg/kg/d) administradas por sonda, excepto en los grupos control y simulado. En el estudio fueron usados 2 tipos diferentes de boro, uno producido para la investigación y el otro para la agricultura, pero de la misma formulación, y sus efectos fueron comparados. Se encontró que el boro no causó cambios histológicos en el riñón, intestino grueso, hígado y estómago en dosis bajas. Sin embargo, al aumentar la dosis, se detectó una leve migración de células inflamatorias, sin signos clínicos, en el hígado e intestino grueso. Por otra parte, cuando se administró una sola dosis muy alta de boro, se observó un amplio edema, migración de células inflamatorias y neovascularización; clínicamente 2 de 6 ratas murieron dentro de 5 horas. Sugerimos que la ingesta de dosis muy altas de bórax pueden causar la muerte súbita, además la ingesta de dosis altas y durante periodos de tiempo prolongado puede causar enfermedades inflamatorias del intestino. Es recomendable que en los estudios relacionados con el boro, el tipo de boro así como su fuente sean evaluados cuidadosamente, eligiendo el compuesto más adecuado en caso de resultados erróneos.