O refluxo gastroesofágico e a relação mãe e bebê: estudo de caso / Gastroesophageal reflux and the mother-child relations: a case study / Le reflux gastro-œsophagien et les relations mère-enfant: une étude de cas / Reflujo gastroesofágico y la relación madre-hijo: un estudio de caso

O presente artigo problematiza aspectos afetivos inerentes à relação materno-filial que podem estar associados ao surgimento e estabelecimento de sintomas psicossomáticos de refluxo gastroesofágico no bebê de até 1 ano de idade. Para tanto, apresenta-se estudo de caso de uma díade mãe-bebê auxiliado por entrevista semiestruturada, aplicação das pranchas 1, 2 e 7MF do teste de apercepção temática e observação naturalista. Cada instrumento foi analisado qualitativamente e teve seus resultados integrados e articulados à teoria psicanalítica. Os principais resultados apontaram certa fragilidade egóica e necessidade de apoio social por parte da mãe, compatíveis com o período do puerpério. São discutidas possíveis maneiras de funcionamento do psiquismo materno, por exemplo, quando sobrecarregado com afetos ansiosos, há sobredeterminação de sintomas psicofuncionais no bebê, os quais, por sua vez, causam efeitos no modo como a mãe se posiciona no exercício da maternagem suficientemente boa, marcando um interjogo relacional

This article discusses affective aspects inherent to mother-child relations that may be associated with the onset and establishment of psychosomatic gastroesophageal reflux symptoms in infants up to 1 year old. A case study of a mother-child dyad was performed by conducting semi-structured interviews, applying the 1, 2 and 7MF cards of the Thematic Apperception Test and using naturalistic observation. Instruments were analyzed qualitatively and their results were integrated and linked to psychoanalytic theoretical framework. Results pointed to a certain egoic fragility and the need for social support for the mother compatible with the puerperium. It also discusses possible ways in which the maternal psyche functions. When overloaded with anxious affections, for example, it overdetermines psychofunctional symptoms in the baby which, in turn, affects how the mother positions herself in the exercise of good maternity, marking a relational interplay

Cet article traite des aspects affectifs inhérents aux relations mère-enfant qui peuvent être associés à l'émergence et à l'installation de symptômes psychosomatiques de reflux gastro-œsophagien chez les nourrissons jusqu'à l'âge d'un an. Une étude de cas d'une dyade mère-enfant a été réalisée en menant des entretiens semi-structurés, en appliquant les planches 1, 2 et 7MF du Test d'Aperception Thématique et en utilisant l'observation naturaliste. Les instruments ont été analysés qualitativement et leurs résultats ont été intégrés et reliés au cadre théorique psychanalytique. Les résultats ont mis en évidence une certaine fragilité égoïque et le besoin d'un soutien social pour la mère compatible avec la puerpéralité. L'étude aborde également les modes de fonctionnement possibles de la psyché maternelle. Lorsque celle-ci est surchargée d'affections anxieuses, elle surdétermine des symptômes psychofonctionnels chez le bébé qui, à leur tour, affectent la façon dont la mère se positionne dans l'exercice d'une maternité suffisamment bonne, marquant une interaction relationnelle

Este artículo discute aspectos afectivos inherentes a la relación madre-hijo que pueden estar asociados con la aparición y establecimiento de síntomas psicosomáticos del reflujo gastroesofágico en el bebé de hasta 1 año de edad. Para ello, se realiza un estudio de caso de una díada madre-hijo, con la aplicación de entrevistas semiestructuradas, con el uso de los tableros 1, 2 y 7MF del Test de Apercepción Temática y una observación naturalista. Los instrumentos se analizaron cualitativamente, y sus resultados se integraron y vincularon al marco teórico psicoanalítico. Los principales resultados apuntaban a una cierta fragilidad egoica y la necesidad de apoyo social de la madre, compatibles con el puerperio. Se discuten posibles formas de funcionamiento de la psique materna, por ejemplo, cuando se sobrecarga de afectos ansiosos, sobredeterminando síntomas psicofuncionales en el bebé que, a su vez, provocan efectos sobre cómo se siente la madre en el ejercicio de una maternaje suficiente buena, marcando una interacción relacional

Hernia interna por divertículo de Meckel: una causa rara de obstrucción intestinal / Internal Hernia due to Meckel's Diverticulum: A Rare Cause of Intestinal Obstruction

Resumen El divertículo de Meckel (DM) es el remanente del conducto onfalomesentérico y se considera la malformación congénita más común del tracto gastrointestinal. La mayoría de los pacientes son asintomáticos; sin embargo, aquellos en los que se desarrollan síntomas, estos pueden manifestarse como: dolor abdominal, hemorragia de tracto gastrointestinal, perforación u obstrucción intestinal. El objetivo de este reporte es presentar un caso de hernia interna secundaria a un divertículo de Meckel, siendo esta una causa poco frecuente de obstrucción intestinal.

Abstract Meckel's diverticulum is the remnant of the omphalomesenteric duct and is considered the most common congenital malformation of the gastrointestinal tract. Most patients are asymptomatic, however patients who develop symptoms can manifest: abdominal pain, gastrointestinal tract bleeding, intestinal perforation or obstruction. The objective of this report is to present a case of internal hernia secondary to a Meckel's diverticulum, a rare cause of bowel obstruction.

A rare scenario of perforated gastrointestinal stromal tumours of ileum

Gastro-intestinal stromal tumours (GIST) are among the common mesenchymal tumours of the gastro-intestinal (GI) tract. It varies in location and presentation. GIST are reported in the stomach frequently (60-70%), followed by small intestine (20-25%). Mainly GIST manifest typically with bleeding or vague abdominal pain and discomfort. The spontaneous perforation of GIST is very rare. We report case of a middle-age male patient who presented in emergency with pain in right lower abdomen associated with features of peritonism. After clinical evaluation and preliminary radiological investigations, a working diagnosis of perforated appendix was made. Patient was undertaken for emergency surgery. A diagnostic laparoscopy followed by midline laparotomy was done. Intra-operatively, a perforated and necrotic outpouching at antimesenteric border of terminal ileum was found. Histopathological examination of the resected part of ileum revealed compatibility with GIST. It was strongly positive for cluster of differentiation 117 (CD117) and smooth muscle actin. Patient received adjuvant therapy with Imatinib. A complete surgical resection without extensive lymph node sampling is the primary treatment option. As GIST are rare, a high index of suspicion is warranted for diagnosis and appropriate treatment.

A prospective study of effectiveness of Mannheim peritonitis index scoring system in predicting the morbidity and mortality in peritonitis due to hollow viscous perforation

Background: Peritonitis is defined as inflammation of the peritoneal cavity, caused by a number of etiologic agents including bacteria, fungi, viruses, chemical irritants, and foreign bodies. The Mannheim peritonitis index (MPI) is one of the simple scoring systems in use that allows the surgeon to easily determine outcome risk. Aims and objective: To estimate outcome of patients with perforation peritonitis. To evaluate effect of MPI score in identification of high risk cases.Methods: A prospective study was conducted in 100 patients with peritonitis due to hollow viscous perforation at surgical unit of tertiary care unit. The duration of study was 2 years. All the data was recorded. Written informed consent was obtained and data was analyzed using appropriate analysis strategy.Results: In this study, total 100 patients enrolled, out of which 54 % patients were in the age group <50 years and 46% patients were in the age group >50 years. Mortality was higher among patients with age group more than 50 years (21%) and in female patients (37.93%). 18 patients had organ failure. 87 patients had preoperative duration was >24 hours. 93% patients had non-colonic origin of sepsis. In 52 (52%) patients total MPI score was <21 while 25 (25%) patients total score was 21-29 and it was >29 in 23 (23%) patients. Mortality was higher among patients with MPI Score more than 29 (95.65%).Conclusions: MPI is accurate to be used with patients with peritonitis and should be considered reliable and simple reference for estimating their risk of death. This study differs in one adverse outcome variables, non-colonic origin of sepsis, we advocate need for further studies on Mannheim peritonitis index to include colonic origin of sepsis.

Clinic-pathological aspect of gastro-intestinal stromal tumors at tertiary care Hospital India / Aspecto clínico e patológico dos tumores estromais gastrointestinais em hospital terciário da Índia

Abstract Background This study defines the disease profile in south Indian population and determine the clinic-pathological aspects of Gastro-Intestinal Stromal Tumors. Method In this prospective study patients diagnosed of gastrointestinal stromal tumors were taken thorough clinical examination and a database of Anthropometric details and clinical details were analyzed. Pathological data included tumor size, presence or absence necrosis, mitotic counts, immunohistochemistry for CD-117, CD-34. Results There were 44 patients with confirmed diagnosis of gastro-intestinal stromal tumor. The highest incidence was found in the 6th decade. The most common symptoms were abdominal pain and gastrointestinal bleed. Stomach was most frequent site for gastro-intestinal stromal tumors. Immunochemistry for CD-117 was positive in 93.18% cases. Majority of tumors (79.5%) had pure spindle cell morphology and mitotic activity showed that 34% of the GISTs were of the high risk group. Forty two patients were suggestive of surgery as the primary treatment after presentation. Conclusion Abdominal pain was the most common presenting complaint. Majority of the tumors aroused from the stomach. The majority of the tumors had pure spindle cell morphology and 93% of the tumors were CD-117 positive. A significant relationship between tumor size, tumor necrosis and mitotic activity with large tumors having necrosis and high mitotic rate having high risk of malignancy, was observed. Surgical resection is considered mainstay of treatment of gastro-intestinal stromal tumor. Imatinib therapy should be given to patients in moderate to severe risk categories.

Resumo Justificativa Este estudo define o perfil da doença na população do sul da Índia e determina os aspectos clínicos e patológicos dos tumores estromais gastrointestinais. Método Neste estudo prospectivo, os pacientes diagnosticados com tumor estromal gastrointestinl foram submetidos a um exame clínico completo, e uma série de dados dos pacientes, incluindo detalhes antropométricos e clínicos, foram analisados. Os dados patológicos incluíram tamanho do tumor, presença ou ausência de necrose, contagem mitótica e imuno-histoquímica para CD-117, CD-34. Resultados Havia 44 pacientes com diagnóstico confirmado de tumor estromal gastrointestinal. A maior incidência foi encontrada na 6ª década de vida. Os sintomas mais comuns foram dor abdominal e sangramento gastrointestinal. O estômago foi o local mais frequente para tumores estromais gastrointestinais. A imuno-histoquímica para CD-117 foi positiva em 93,18% dos casos. A maioria dos tumores (79,5%) apresentava morfologia pura de células fusiformes e a atividade mitótica mostrou que 34% dos GISTs pertenciam ao grupo de alto risco. Quarenta e dois pacientes receberam indicação para cirurgia como tratamento primário após a apresentação. Conclusão A dor abdominal foi a queixa mais comum. A maioria dos tumores afetava o estômago, apresentava morfologia pura de células fusiformes e 93% eram CD-117 positivos. Foi observada uma relação significativa entre o tamanho do tumor, a necrose tumoral e a atividade mitótica, com os tumores grandes apresentando necrose e alta taxa mitótica com alto risco de malignidade. A ressecção cirúrgica é considerada o principal tratamento do tumor estromal gastrointestinal. A terapia com imatinibe deve ser administrada a pacientes em categoria de risco de moderadas a grave.

Various addiction patterns, dietary habits, associated medical problems, and socioeconomic status in gastrointestinal malignancies: A prospective study in rural area of Maharashtra, India

Background: Gastrointestinal (GI) malignancies are increasing with advancing age. Various addictions and poor dietary habits are among the major risk factors. Early detection is difficult until patient notices symptoms. Primary prevention by knowing various risk factors and early symptom awareness will help in early diagnosis and better treatment outcome. Objectives: This study is carried out to see various addiction patterns, dietary habits, associated medical problems, and socioeconomic status with various sites involved in GI malignancies, at a tertiary care teaching hospital of Western Maharashtra, India. Materials and Methods: Prospective questionnaire-based study was carried out for 11 months. A total of 100 diagnosed carcinoma cases of GI tract malignancy were taken for study. Results and Conclusions: Out of total 100 cases, 61 were male and 39 were female. The most common site involved was esophagus (41) followed by rectosigmoid, colon and cecum, stomach, and anal canal (29, 14, 13, and 3, respectively). There were 45% of cases above 60 years of age. The most common addiction was smokeless tobacco. Most of the patients belonged to lower and upper lower class (64%). Majority of cases (81%) were nonvegetarian, only 16% were pure vegetarian. Most of the cases (85%) were in advanced stage of disease (III and IV). Awareness program for harmful effects of various addictions and importance of high-fiber diet (vegetarian diet) will help in health promotion and prevention of various malignancies. Awareness about the early symptoms of GI malignancy will help in early detection of disease and better treatment outcome.

Intraductal Papillary Mucinous Neoplasm Presenting as Bleeding Duodenal Mass: A Surgical Rarity

@#Intraductal papillary mucinous neoplasm (IPMN) is a rare pancreatic neoplasm. The presentation varies from recurrent pancreatitis, steatorrhea and weight loss to incidental findings during imaging studies. The recognition of IPMN is crucial in deciding for prompt surgical intervention, which is the best treatment modality for this precancerous condition. Here, we report a case of 55-year-old man with massive upper gastro intestinal bleeding arising from a huge fungating duodenal mass. In view of massive bleeding, a decision for emergency Whipple's pancreaticoduodenectomy was made. Final histological diagnosis confirmed as IPMN. To the best of our knowledge, this is the first case of IPMN presented with a huge fungating duodenal mass causing massive UGIB requiring surgical intervention.

Imágenes en divertículos del tubo digestivo: localizaciones infrecuentes. serie de casos / Imaging in infrequent digestive diverticula: case series

Los divertículos se pueden localizar en todo el tubo digestivo (TD): esófago, estómago, duodeno, yeyuno, íleon, apéndice, colon. Son infrecuentes, salvo en colon. Sus manifestaciones clínicas son inespecíficas, con difícil diagnóstico y mayor riesgo de complicaciones. Se presenta una serie de divertículos digestivos atípicos, mostrando las características imagenológicas multimodalidad y describir los hallazgos claves. Es una revisión retrospectiva en el archivo computacional de nuestra institución. Selección de casos de divertículos de presentación inhabitual por sus características, localización u origen. En esófago los divertículos de Zenker y Killian-Jamieson. En estómago los divertículos gástricos infrecuentes. Los divertículos en intestino delgado tienen baja prevalencia, el más frecuente en duodeno. Los divertículos colónicos pueden tener una localización o presentación atípica. Los divertículos apendiculares y Meckel presentan baja prevalencia. Los divertículos digestivos son infrecuentes, excepto los colónicos. El radiólogo debe estar familiarizado con las diferentes ubicaciones de ellos, para reconocerlos y poder diagnosticarlos.

Diverticula may occur in any segment of the digestive tract: esophagus, stomach, duodenum, jejunum, ileum, appendix, and colon. Its clinical manifestations are nonspecifi which may turn diffiult an early diagnosis, leading to a higher risk of complications. We present a cases serie of atypical digestive diverticula and to describe the fidings on the different imaging techniques. We performed a retrospective review on the imaging computer archives of our institution. The atypical diverticula were selected. Zenker and Killian-Jamieson's diverticulums in esophagus. In stomach ocasionally gastric diverticula. Diverticula in small intestine have a low prevalence, the most common location is duodenum. Colonic diverticula may present a atypical location or presentation. The appendicular and Meckel diverticuli are uncommon. The digestive diverticula are uncommon, except the colonic ones. The radiologist must be familiar with it's different locations in order to be able to recognize it and diagnose it properly.

Intestinal parasites in the slum-dwelling population in Naya Bazar, Kaski, Nepal

Background and Objectives: Gastrointestinal infection is a major cause of diarrhea, anemia, malnutrition and responsible for reducing physical and mental development especially in children. This study aimed to investigate the prevalence of the intestinal pathogens in the slum-dwelling population in Kaski, Nepal.Material and Methods: A cross-sectional study was conducted in August-September 2012 in slum-dwelling community. Overall 166 human faecal samples were collected and examined using formal ether sedimentation method.Results: The prevalence of gastrointestinal infections in slum-dwelling population was found to be 24.1%. The magnitude of infection was higher (26.9%) among females compared to males. The difference was not statistically significant (P > 0.05). The prevalence of infection was higher (37.0%, P > 0.05) in Dalit group. Children (≤10 years) had higher rate of infection than older people. 22% subjects had single and 2.4% had multiple infections. In the overall population, 12.7% had G. lamblia followed by 5.4% Ascaris lumbricoides, 4.8% Hymenolepsis nana and 3.6% Trichuris trichuria. Conclusion: Gastrointestinal infections were common in the slum-dwelling populations. Lack of health education and safe drinking water contributed higher infection rate in the community. Increased exposure time to the contaminated water and gender disparity had influenced the rate of infection. Due to the semi-urban area with absence of moist soil, protozoan infection was prevalent than helminth infections.

LAXATIVE EFFECT OF RHEUM UNDULATUM L. EXTRACT ON LOPERAMIDE INDUCED CONSTIPATION IN WISTAR RATS / Монголын эм зүй, эм судлал

Introduction: Constipation is highly prevalent, often chronic gastrointestinal disorder that affects adults. The treatment with classic drugs did not cut, in one hand with the inadequate relief of bloating and other symptoms, and with the luck of efficacy in relieving constipation. Therefore, the search for novel safe laxative drugs seems, inevitable. Rheum undulatum L. was traditionally used in constipation, thus we have attempted to evaluate the laxative effect of Rheum undulatum L. Purpose: The laxative effect of Rheum undulatum L. was evaluated against loperamide induced constipated rats. Methodology: Fifteen male normal rats were used in this study. Fifteen male constipated wistar albino rats weighing 180-250 g were also used for the study and randomized into three groups (n=5) in each of the experiments. Constipated control group rats oral administrated distilled water. Constipated rats (treatment groups) were treated with 4.1 mg/kg dose body weight /day of the preparation for one day and also Laxing a standard drug was used for the reference group. The fecal weight, the fecal humidity laxative activity were monitored in experimental rats.Results: Constipation was successfully induced in the rats by loperamide as seen in the elevated fecal properties compared to the control rats. The Rheum undulatum L. compounds preparation administered orally produced significant laxative activity and reduced loperamide induced constipation in dose dependent manner as seen in the increase of fecal output. The same doses of the Rheum undulatum L. compounds preparation produced a significant increase (P<0.05) fecal weight, the faeces humidity. The effect of the compounds preparation compares favourably well with Laxing, a standard laxative drug. Conclusion: The results of this study justify the use of Rheum undulatum L. compounds preparation as a laxative in traditional medicine. The produced significantly increase in fecal output of rats and the stimulation of gastrointestinal motility. Keywords: Laxative, gastro intestinal motility, loperamide, constipated

Applications of simulated gastro-intestinal model in foodborne pathogens: tolerance and pathogenesis / 生物工程学报

We evaluated the tolerance and pathogenesis of foodborne pathogens with a simulated gastro-intestinal tract model that simulates the chemical, physical and biological effects of human digestion process under laboratory conditions. This could be used to study the tolerance, pathogenesis, gut microbiota interaction and vaccine development of foodborne pathogens, so as to contribute to control and treatment of foodborne pathogens. This review introduces the applications of simulated gastro-intestinal tract model tp evaluate foodborne pathogens, which includes in-vitro static gastro-intestinal model, in-vitro dynamic gastro-intestinal model, conventional animal model and humanized animal model. And the concepts and characteristics of all models are described in detail. Also, the shortcomings of existing models are analyzed, and improvements of artificial gastro-intestinal tract model are prospected. In conclusion, this review could provide comprehensive data for promoting the progress of studying tolerance and pathogenesis of foodborne pathogens.

Application effect of emergency medical service in patients with acute upper gastrointestinal hemorrhage / 中国基层医药

Objective To discuss the effect of emergency integrated green channel for patients with upper gastrointestinal hemorrhage. Methods From January 2014 to August 2016,182 patients with acute upper gastrointes-tinal hemorrhage were selected in the research. Eighty - four patients with acute upper gastrointestinal hemorrhage before the emergency integrated green channel established in Zhoushan Hospital were selected as control group,while 98 patients with acute upper gastrointestinal hemorrhage after the emergency integrated green channel established in Zhoushan Hospital were selected as research group. The control group received conventional emergency treatment, while the research group received emergency medical service. The average hemostasis time,mean volume of blood transfusion,average hospitalization period,average hospital cost,the operability,recurrence rate of bleeding and mortality rate were compared between the two groups. Results The average hemostasis time,average blood transfusion volume, average hospitalization time and average hospitalization expense in the study group were (4. 52 ± 1. 24)h,(352. 37 ± 17. 35)mL,(6. 02 ± 0. 89) d,(5346. 84 ± 338. 76) yuan,respectively,which in the control group were (9. 43 ± 2. 04)h,(512. 72 ± 15. 3)mL,(9. 24 ± 1. 16)d and (7012. 38 ± 422. 12)yuan,respectively,there were statistically significant differences between two groups(t = 19. 921,65. 542,21. 160,29. 517,all P < 0. 05). The operative rate, recurrence rate and mortality rate in the study group were 2. 04％ (2 / 98),3. 06％ (3 / 98) and 2. 04％ (2 / 98), respectively,which were significantly lower than those in the control group [8. 33％ (7 / 84),9. 52％ (8 / 84) and 5. 96％ (4 / 84)], the differences were statistically significant ( χ2 = 71. 202,67. 455,74. 195, all P < 0. 01). Conclusion Application of emergency medical service in patients with acute upper gastrointestinal hemorrhage not only can control bleeding effectively,decrease blood transfusion,hospitalization period and hospital cost,but also can reduce operability,recurrence rate of bleeding and mortality rate,which can serve as an emergency treatment plan applying to clinic.

Laxative effect of Rheum undulatum L. Extract on loperamide induced constipation in wistar rats / Монголын эм зүй, эм судлал

Introduction@#Constipation is highly prevalent, often chronic gastrointestinal disorder that affects adults. The treatment with classic drugs did not cut, in one hand with the inadequate relief of bloating and other symptoms, and with the luck of efficacy in relieving constipation. Therefore, the search for novel safe laxative drugs seems, inevitable. Rheum undulatum L. was traditionally used in constipation, thus we have attempted to evaluate the laxative effect of Rheum undulatum L.@*Purpose@#The laxative effect of Rheum undulatum L. was evaluated against loperamide induced constipated rats.@*Methodology@#Fifteen male normal rats were used in this study. Fifteen male constipated wistar albino rats weighing 180-250 g were also used for the study and randomized into three groups (n=5) in each of the experiments. Constipated control group rats oral administrated distilled water. Constipated rats (treatment groups) were treated with 4.1 mg/kg dose body weight /day of the preparation for one day and also Laxing a standard drug was used for the reference group. The fecal weight, the fecal humidity laxative activity were monitored in experimental rats.@*Results@#Constipation was successfully induced in the rats by loperamide as seen in the elevated fecal properties compared to the control rats. The Rheum undulatum L. compounds preparation administered orally produced significant laxative activity and reduced loperamide induced constipation in dose dependent manner as seen in the increase of fecal output. The same doses of the Rheum undulatum L. compounds preparation produced a significant increase (P<0.05) fecal weight, the faeces humidity. The effect of the compounds preparation compares favourably well with Laxing, a standard laxative drug. @*Conclusion@#The results of this study justify the use of Rheum undulatum L. compounds preparation as a laxative in traditional medicine. The produced significantly increase in fecal output of rats and the stimulation of gastrointestinal motility.

A short-time economic evaluation of various modalities of glutamine dipeptide-enriched parenteral nutrition support in patients undergoing elective surgery for gastrointestinal tumors using decision-tree model / 中华临床营养杂志

Objective To assess the short-time economics of various glutamine dipeptide-enriched parenteral nutrition (PN) for patients undergoing elective surgery for gastrointestinal tumors, with an attempt to provide evidence for decision makers on clinical nutrition support.Methods A prospective cohort study was designed.From payer/disburser''s perspective, a cost-effectiveness decision-tree model was developed to assess the clinical outcomes and short-time economic effects of glutamine dipeptide-enriched PN that used in different time points (early postoperative or perioperative).Cost-effectiveness analysis, cost-utility analysis, and incremental cost-effectiveness analysis were adopted in the decision-tree model.One-way sensitivity analysis was performed to determine the robustness of the results.Results Totally 107 patients were included.There was no significant difference between the perioperative alanine(Ala) glutamine(Gln) nutrition support (group A) and early postoperative Ala-Gln nutrition support (group B) in the ratio of 5％ weight declines on the 8th day after surgery and infection-related postoperative complications (72.1％ vs.78.1％, χ2=0.509, P=0.498 and 2.32％ vs.4.69％, χ2=0.060, P=0.806).The levels of prealbumin (PA) and albumin(Alb) and the level of total lymphocyte count(TLC) also the time of recovering gastrointestinal function, length of stay nutritional discharge index(LOSNDI), and direct costs were significantly different [PA:(208.19±56.92)mg/L vs.(187.97±62.05)mg/L, t=2.283,P=0.039;Alb:(33.82±3.91)×109 vs.(31.96±4.57)×109, t=2.184, P=0.036;TLC:(1.19±0.55)×109 vs.(0.89±0.66)×109, t=2.461, P=0.015;the time of recovering gastrointestinal function(3.06±0.28)d vs.(3.39 ± 0.34)d, t=-3.675, P=0.000;LOSNDI:(16.84±2.92)d vs.(18.52 ±3.47)d, t=-2.613, P=0.011;direct costs:￥(17 029.05±317.28) vs.￥(15 610.64±292.56), t=23.764, P=0.000].When LOSNDI and quality-adjusted life years (QALYs) were estimated as indicators of effectiveness, the incremental cost-effectiveness ratios and incremental cost-utility ratios of group A were ￥844.3 and ￥70 920.5, respectively.Net monetary benefit of group B was more than that of group A.One-way sensitivity analysis showed that parameters had no significant effect on the model.Conclusion When using local per capita gross domestic product as threshold, early postoperative Ala-Gln PN was more economical than perioperative Ala-Gln PN strategy evaluation.

Study of histopathological types of gastro-intestinal lesions by endoscopic biopsy

Introduction: Gastro Intestinal Tract (GIT) is an important site for wide variety of lesions which include congenital, inflammatory, neoplastic conditions. The invention of flexible fiber-optic endoscope is a very good achievement towards the diagnostic field. With the use of this facility direct vision of diseased mucosa and biopsy of mucosal lesions, therapeutic induction and photographic visualization of the lesions are made possible. Aim: Aim of this study was to know the incidence of Gastro intestinal lesions with reference to age, sex and site and to study the histopathological types of Gastro Intestinal lesions. Materials and methods: The present study included 180 GIT biopsies (gastro intestinal biopsies) between the period August 2013 to August 2015 .Clinical details and case histories were obtained from the patients presented to the gastroenterology department. Biopsies were obtained by the gastroenterologist with fiber optic forward viewing endoscope. Results: Among all the GIT biopsies, esophageal biopsies were 11 (6.11%), gastric biopsies were 31 (17.22%), gastro esophageal junction 4 (2.22%), and small Intestinal 67 (37.22%) and 67 (37.22%) was from large intestine. Conclusion: Endoscopy and subsequent biopsy for histopathology can detect early malignant lesions. In the absence of endoscopic screening, detection of these lesions may be missed. Such patients may present with advanced stage of disease in later life. In endoscopic biopsy only mucosa is seen, the level of invasion cannot be ascertained.

Site predilection of extrapulmonary tuberculosis: study from a tertiary care centre.

Background: Extrapulmonary tuberculosis (EPTB) still constitutes an important clinical problem. We aimed to evaluate the site prevalence of extrapulmonary tuberculosis. Methods: We retrospectively evaluated 187 extrapulmonary tuberculosis patients diagnosed between 1st June 2013 and 31st May 2015 in a tertiary care hospital, Kanpur, Kerala, India. Results: Among the extra pulmonary tuberculosis 112 (59.9%) were males. About 170 (90.9%) patients received CAT1 treatment and 17 (9%) patients received CAT2 treatment. Overall, the total number of different types of EPTB cases included Lymph node (n=55, 29.41%), GIT (n=45, 24.04%), Pleura (n=44, 23.53%), Skeletal (n =14, 7.49%), CNS (n=7, 3.74%) EPTB cases other site included mainly genitourinary (6), breast (6), skin (5), pericardium (3), Psoas (4) a vocal cord (1) and eye (1). Conclusions: EPTB still constitutes an important clinical problem. In the current study, we assessed the site of predilection of EPTB patients. In this study, EPTB cases constituted 52.08% of all tuberculosis cases presented to our center in the study period. Lymph node tuberculosis is the most common type.

Use of green fluorescent protein to monitor Lactobacillus plantarum in the gastrointestinal tract of goats

The experiment aimed to specifically monitor the passage of lactobacilli in vivo after oral administration. The green fluorescent protein (GFP) gene was cloned downstream from the constitutive p32 promoter from L. lactis subsp. cremoris Wg2. The recombinant expression vector, pLEM415-gfp-p32, was electroporated into Lactobacillus plantarum (L. plantarum) isolated from goat. Green fluorescent protein (GFP) was successfully expressed in L. plantarum. After 2 h post-administration, transformed Lactobacillus could be detectable in all luminal contents. In the rumen, bacteria concentration initially decreased, reached the minimum at 42 h post-oral administration and then increased. However, this concentration decreased constantly in the duodenum. This result indicated that L. plantarum could colonize in the rumen but not in the duodenum.

Probiotics: an update / Probióticos: informações atualizadas

OBJECTIVE: Triggered by the growing knowledge on the link between the intestinal microbiome and human health, the interest in probiotics is ever increasing. The authors aimed to review the recent literature on probiotics, from definitions to clinical benefits, with emphasis on children. SOURCES: Relevant literature from searches of PubMed, CINAHL, and recent consensus statements were reviewed. SUMMARY OF THE FINDINGS: While a balanced microbiome is related to health, an imbalanced microbiome or dysbiosis is related to many health problems both within the gastro-intestinal tract, such as diarrhea and inflammatory bowel disease, and outside the gastro-intestinal tract such as obesity and allergy. In this context, a strict regulation of probiotics with health claims is urgent, because the vast majority of these products are commercialized as food (supplements), claiming health benefits that are often not substantiated with clinically relevant evidence. The major indications of probiotics are in the area of the prevention and treatment of gastro-intestinal related disorders, but more data has become available on extra-intestinal indications. At least two published randomized controlled trials with the commercialized probiotic product in the claimed indication are a minimal condition before a claim can be sustained. Today, Lactobacillus rhamnosus GG and Saccharomyces boulardii are the best-studied strains. Although adverse effects have sporadically been reported, these probiotics can be considered as safe. CONCLUSIONS: Although regulation is improving, more stringent definitions are still required. Evidence of clinical benefit is accumulating, although still missing in many areas. Misuse and use of products that have not been validated constitute potential drawbacks. .

OBJETIVO: Motivado pelo conhecimento cada vez maior da associação entre o microbioma intestinal e a saúde humana, o interesse nos probióticos vem crescendo cada vez mais. Os autores visaram analisar a última literatura a respeito dos probióticos, de definições a benefícios clínicos com ênfase nas crianças. FONTES DOS DADOS: Foi analisada a literatura relevante de pesquisas do PubMed, do CINAHL e dos últimos consensos. SÍNTESE DOS DADOS: Apesar de um equilíbrio no microbioma estar relacionado à saúde, um desequilíbrio no microbioma ou disbiose está relacionado a vários problemas de saúde no trato gastrointestinal, como diarreia e doença inflamatória intestinal, e fora do trato gastrointestinal, como obesidade e alergia. Nesse contexto, a regulamentação rigorosa dos probióticos a alegações de saúde é urgente, pois a grande maioria desses produtos é comercializada como alimentação (suplementos), alegando benefícios à saúde que frequentemente não são comprovados com evidências clinicamente relevantes. As principais indicações de probióticos são feitas na área da prevenção e tratamento de doenças gastrointestinais, porém mais dados têm sido disponibilizados a respeito de indicações extraintestinais. Pelo menos dois ensaios clínicos controlados e randomizados publicados com o probiótico comercializado na indicação declarada são a condição mínima antes de uma afirmação poder ser mantida. Atualmente, o Lactobacillus rhamnosus GG e Saccharomyces boulardii são as melhores cepas estudadas. Apesar de efeitos adversos terem sido esporadicamente relatados, os probióticos podem ser considerados seguros. CONCLUSÕES: Apesar de a regulamentação estar aumentando, ainda são necessárias definições mais rigorosas. As evidências de benefícios clínicos estão aumentando, apesar de ainda ausentes em várias áreas. O uso inadequado e a utilização de produtos não validados constituem possíveis desvantagens. .

Not to be Missed Entity: Dieulafoy's Lesion!

Clinically missed Dieulafoy's lesion is a significant cause of gastro-intestinal bleeding with a poor prognosis. We hereby compare an autopsy case of a similar nature; thereby highlighting the importance of autopsy. 69 years old male living in a retirement home was being managed for anemia. He was admitted with a preliminary diagnosis of septicemia with deteriorating renal function. He was found dead and referred for autopsy to our institute. At autopsy, 3 small defects at the gastroesophageal junction measuring about 5-7 mm were seen, which on microscopy revealed a relatively large artery at the submocosal level with rupture. There was about 2 liters of blood in the stomach. This was a Dieulafoy's lesion, the cause of sudden massive gastrointestinal bleeding and subsequent shock. This signifies that autopsy still holds its value in this modern era of diagnostics.

Helminthiasis in School Aged Children in a Select Population in the Niger Delta.

Aim: Helminthiasis and its effects on the hematological parameters of school aged children in a select population in the Niger Delta. Study Design: A cross sectional study (Descriptive study). Place and Duration: The study was carried out in Emohua Local Government Area of Rivers State, between January–April 2011. Methodology: Concentration Method (Sedimentation) was used to examine the stool samples, Packed cell volume (PCV) was obtained by the use of hematocrit centrifugation and reader method; differential white blood count (WBC) was done according to Cheesbrough (2000). Results: Result of the study showed variability in the four gastrol-intestinal helminths among the 360 pupils investigated. Out of the 264(73.3%) positive samples, 142(53.7%) and 122(46.21%) were females and males respectively. Age specific gastroi intestinal worm load was relatively high in all age groups. This pattern of infection was attributed to favorable ecological factors that promote helminths transmission in the study area. However, the overall age related worm load showed that the 5-7 age group had relatively the highest parasite load in the study. The weight and height of infected pupils in relation to the uninfected varied statistically (p<0.05) across the age ranges but was not statistically different (p>0.05) within the age groups. A. lumbricoides (53.3%) was the most prevalent helminth amongst the infected. Conclusion: Overall mixed infection was (23.4%) while the 8-9 age range recorded the highest prevalence (28.2%). Sex related prevalence varied greatly in terms of percentage infection within and across the sexes. However, gastrointestinal parasitism was not significantly different (p>0.05) within the age groups but was significantly different (p<0.05) between the sexes. PCV values were below the normal range in both the infected uninfected in the study group indicating poor nutritional status of the population.