Diverticulitis aguda del intestino delgado como causa infrecuente de abdomen agudo en el adulto mayor: Reporte de caso / Acute diverticulitis of small bowel as rare cause of acute abdomen inthe elderly: Case report

Introducción. El dolor abdominal es uno de los principales motivos de admisión a urgencias y una de las causas más frecuentes es la enfermedad diverticular, que aumenta su prevalencia en el adulto mayor. Sin embargo, la diverticulitis del intestino delgado es una enfermedad infrecuente y en la mayoría de casos es asintomática. No obstante, la perforación de un divertículo intestinal es una complicación común de esta patología, por lo que debe ser considerado como un diagnóstico diferencial de abdomen agudo en este grupo poblacional. Caso clínico. Paciente masculino de 71 años, quien consultó por dolor abdominal de inicio súbito, con signos de irritación peritoneal al examen físico. Dado su deterioro hemodinámico fue llevado a cirugía y en la laparotomía exploratoria se halló una diverticulitis aguda perforada de yeyuno e íleon distal. Resultados. El paciente cursó con una adecuada evolución postoperatoria, sin reingresos. Conclusión. La diverticulitis aguda yeyuno-ileal es una causa importante, pero no frecuente de perforación intestinal. Hay muy pocos casos reportados en la literatura, lo que la convierte en un reto diagnóstico para el médico de urgencias y el cirujano general. No obstante, debe ser considerado como un diagnóstico diferencial en adultos mayores con abdomen agudo.

Introduction. Abdominal pain is one of the main reasons for admission to the emergency room and one of the most frequent causes is diverticular disease, which increases its prevalence in the elderly. However, diverticulitis of the small bowel is rare and in most cases asymptomatic. However, perforation of an intestinal diverticulum is a common complication of this pathology and should be considered as a differential diagnosis of acute abdomen in this population group. Clinical case. A71-year-old male patient presented with abdominal pain of sudden onset, with signs of peritoneal irritation. Given his hemodynamic deterioration, he was taken to surgery and in the exploratory laparotomy an acute perforated diverticulitis of the jejunum and distal ileum was found. Results. The patient had an adequate postoperative evolution, without readmissions. Conclusion. Acute jejuno-ileal diverticulitis is an important but uncommon cause of intestinal perforation. There are very few cases reported in the literature, which makes it a diagnostic challenge for the emergency physician and general surgeon. However, it should be considered as a differential diagnosis in older adults with acute abdomen.

Asociación de trastornos cutáneos y microorganismos presentes en el tracto intestinal ligados a disbiosis / Association of skin disorders and microorganisms present in the intestinal tract linked to dysbiosis / Associação de doenças de pele e microrganismos presentes no trato intestinal ligados à disbiose

Introducción: Existe una conexión bidireccional entre mecanismos fisiológicos del intestino y la piel que puede asociarse al desarrollo de patologias cutâneas. Objetivo: estudiar la relación entre afecciones cutáneas con la presencia de patógenos intestinales causantes de disbiosis intestinal. Metodología: se realizó un estudio para identificar la presencia de bacterias aeróbicas y anaeróbicas facultativas en un grupo de 45 pacientes (edad de 32,8 ± 18 años) que presentaron distintas afecciones cutáneas diagnosticadas en la consulta de Dermatología de UNIMEL, Caracas, Venezuela. La presencia de bacterias se determinó por cultivo diferencial, y la identificación de microorganismos mediante pruebas bioquímicas convencionales, prueba de filamentización en suero, medios automatizados (VITEK® 2 Compact) y pruebas de aglutinación. Se realizó un análisis estadístico descriptivo de la abundancia relativa de la microbiota gastrointestinal asociada a las afecciones cutáneas presentes (GraphPad Prism versión 8.0.2 para Windows) y análisis multivariado (NMDS) con (software PAST v4.13). Resultados: la presencia de acné, dermatitis atópica y nevus se asoció (p<0.05) al aumento de las colonias de Enterococcus faecium, E. coli, Enteroccocus faecalis y Klepsiella sp. Una disminución significativa en el número de colonias de E. coli (p<0.05) se asoció con la presencia de rosácea y acné inflamatorio mientras que su abundancia se asoció a la presencia de patologías como acantosis nigicans, dermatitis atópica, dermatitis papular y queratosis. La presencia de pseudomonas se relacionó con queratosis y Nevus melanocítico. Conclusión: aunque preliminares, estos resultados sugieren que alteraciones en la composición microbiana intestinal pueden asociarse significativamente a afecciones cutáneas

Introduction: There is a bidirectional connection between physiological mechanisms of the intestine and the skin that can be associated with the development of skin pathologies. Objective: To study the relationship between skin conditions with the presence of intestinal pathogens that cause intestinal dysbiosis. Methodology: a study was carried out to identify the presence of aerobic and facultative anaerobic bacteria in a group of 45 patients (age 32.8 ± 18 years) who presented different skin conditions diagnosed in the Dermatology clinic of UNIMEL, Caracas, Venezuela. The presence of bacteria was determined by differential culture, and the identification of microorganisms by conventional biochemical tests, serum filamentation test, automated media (VITEK® 2 Compact) and agglutination tests. A descriptive statistical analysis of the relative abundance of the gastrointestinal microbiota associated with the present skin conditions was performed (GraphPad Prism version 8.0.2 for Windows) and multivariate analysis (NMDS) with (PAST v4.13 software). Results: the presence of acne, atopic dermatitis and nevus was associated (p<0.05) with the increase in colonies of Enterococcus faecium, E. coli, Enteroccocus faecalis and Klepsiella sp. A significant decrease in the number of E. coli colonies (p<0.05) was associated with the presence of rosacea and inflammatory acne while its abundance was associated with the presence of pathologies such as acanthosis nigicans, atopic dermatitis, papular dermatitis and keratosis. The presence of pseudomonas was related to keratosis and melanocytic nevus. Conclusion: although preliminary, these results suggest that alterations in intestinal microbial composition can be significantly associated with skin conditions.

Introdução: existe uma ligação bidirecional entre mecanismos fisiológicos do intestino e da pele que pode estar associada ao desenvolvimento de patologias cutâneas. Objetivo: estudar a relação entre as condições da pele com a presença de patógenos intestinais causadores de disbiose intestinal. Metodologia: foi realizado um estudo para identificar a presença de bactérias aeróbias e anaeróbias facultativas em um grupo de 45 pacientes (idade 32,8 ± 18 años) que apresentavam diferentes condições de pele diagnosticadas na clínica de Dermatologia da UNIMEL, Caracas, Venezuela. A presença de bactérias foi determinada por cultura diferencial, e a identificação de microrganismos por testes bioquímicos convencionais, teste de filamentação sérica, meios automatizados (VITEK® 2 Compact) e testes de aglutinação. Foi realizada análise estatística descritiva da abundância relativa da microbiota gastrointestinal associada às presentes condições de pele (GraphPad Prism versão 8.0.2 para Windows) e análise multivariada (NMDS) com (software PAST v4.13). Resultados: A presença de acne, dermatite atópica e nevo esteve associada (p<0,05) ao aumento de colônias de Enterococcus faecium, E. coli, Enteroccocus faecalis e Klepsiella sp. Uma diminuição significativa no número de colônias de E. coli (p<0,05) foi associada à presença de rosácea e acne inflamatória, enquanto sua abundância foi associada à presença de patologias como acantose nigicans, dermatite atópica, dermatite papular e ceratose. A presença de pseudomonas foi relacionada à ceratose e ao nevo melanocítico. Conclusão: embora preliminares, estes resultados sugerem que alterações na composição microbiana intestinal podem estar significativamente associadas a doenças da pele.

Asociación de trastornos cutáneos y microorganismos presentes en el tracto intestinal ligados a disbiosis

Introducción: Existe una conexión bidireccional entre mecanismos fisiológicos del intestino y la piel que puede asociarse al desarrollo de patologias cutâneas. Objetivo: Estudiar la relación entre afecciones cutáneas con la presencia de patógenos intestinales causantes de disbiosis intestinal. Metodología: Se realizó un estudio para identificar la presencia de bacterias aeróbicas y anaeróbicas facultativas en un grupo de 45 pacientes (edad de 32,8 ± 18 años) que presentaron distintas afecciones cutáneas diagnosticadas en la consulta de Dermatología de UNIMEL, Caracas, Venezuela. La presencia de bacterias se determinó por cultivo diferencial, y la identificación de microorganismos mediante pruebas bioquímicas convencionales, prueba de filamentización en suero, medios automatizados (VITEK® 2 Compact) y pruebas de aglutinación. Se realizó un análisis estadístico descriptivo de la abundancia relativa de la microbiota gastrointestinal asociada a las afecciones cutáneas presentes (GraphPad Prism versión 8.0.2 para Windows) y análisis multivariado (NMDS) con (software PAST v4.13). Resultados: La presencia de acné, dermatitis atópica y nevus se asoció (p<0.05) al aumento de las colonias de Enterococcus faecium, E. coli, Enteroccocus faecalis y Klepsiella sp. Una disminución significativa en el número de colonias de E. coli (p<0.05) se asoció con la presencia de rosácea y acné inflamatorio mientras que su abundancia se asoció a la presencia de patologías como acantosis nigicans, dermatitis atópica, dermatitis papular y queratosis. La presencia de pseudomonas se relacionó con queratosis y Nevus melanocítico. Conclusión: Aunque preliminares, estos resultados sugieren que alteraciones en la composición microbiana intestinal pueden asociarse significativamente a afecciones cutáneas.

Introduction: There is a bidirectional connection between physiological mechanisms of the intestine and the skin that can be associated with the development of skin pathologies. Objective: To study the relationship between skin conditions with the presence of intestinal pathogens that cause intestinal dysbiosis. Methodology: A study was carried out to identify the presence of aerobic and facultative anaerobic bacteria in a group of 45 patients (age 32.8 ± 18 years) who presented different skin conditions diagnosed in the Dermatology clinic of UNIMEL, Caracas, Venezuela. The presence of bacteria was determined by differential culture, and the identification of microorganisms by conventional biochemical tests, serum filamentation test, automated media (VITEK® 2 Compact) and agglutination tests. A descriptive statistical analysis of the relative abundance of the gastrointestinal microbiota associated with the present skin conditions was performed (GraphPad Prism version 8.0.2 for Windows) and multivariate analysis (NMDS) with (PAST v4.13 software). Results: The presence of acne, atopic dermatitis and nevus was associated (p<0.05) with the increase in colonies of Enterococcus faecium, E. coli, Enteroccocus faecalis and Klepsiella sp. A significant decrease in the number of E. coli colonies (p<0.05) was associated with the presence of rosacea and inflammatory acne while its abundance was associated with the presence of pathologies such as acanthosis nigicans, atopic dermatitis, papular dermatitis and keratosis. The presence of pseudomonas was related to keratosis and melanocytic nevus. Conclusion: Although preliminary, these results suggest that alterations in intestinal microbial composition can be significantly associated with skin conditions.

Introdução: Existe uma ligação bidirecional entre mecanismos fisiológicos do intestino e da pele que pode estar associada ao desenvolvimento de patologias cutâneas. Objetivo: Estudar a relação entre as condições da pele com a presença de patógenos intestinais causadores de disbiose intestinal. Metodologia: Foi realizado um estudo para identificar a presença de bactérias aeróbias e anaeróbias facultativas em um grupo de 45 pacientes (idade 32,8 ± 18 años) que apresentavam diferentes condições de pele diagnosticadas na clínica de Dermatologia da UNIMEL, Caracas, Venezuela. A presença de bactérias foi determinada por cultura diferencial, e a identificação de microrganismos por testes bioquímicos convencionais, teste de filamentação sérica, meios automatizados (VITEK® 2 Compact) e testes de aglutinação. Foi realizada análise estatística descritiva da abundância relativa da microbiota gastrointestinal associada às presentes condições de pele (GraphPad Prism versão 8.0.2 para Windows) e análise multivariada (NMDS) com (software PAST v4.13). Resultados: A presença de acne, dermatite atópica e nevo esteve associada (p<0,05) ao aumento de colônias de Enterococcus faecium, E. coli, Enteroccocus faecalis e Klepsiella sp. Uma diminuição significativa no número de colônias de E. coli (p<0,05) foi associada à presença de rosácea e acne inflamatória, enquanto sua abundância foi associada à presença de patologias como acantose nigicans, dermatite atópica, dermatite papular e ceratose. A presença de pseudomonas foi relacionada à ceratose e ao nevo melanocítico. Conclusão: Embora preliminares, estes resultados sugerem que alterações na composição microbiana intestinal podem estar significativamente associadas a doenças da pele.

Neumatosis quística intestinal, un reto diagnóstico: reporte de caso / Cystic intestinal pneumatosis, a diagnostic challenge: case report

Introducción. La neumatosis quística intestinal se describe como la presencia de gas dentro de la pared intestinal. Es una entidad poco frecuente, con una incidencia del 0,03 % en la población global. Aparece con predilección en el género masculino después de los 45 años yse localiza principalmente en el intestino delgado (42 %) y el colon. Se puede asociar a varias condiciones que en ocasiones requieren manejo quirúrgico. Caso clínico. Se presenta el caso de un hombre 75 años, con antecedente de hipertensión arterial, quien consultó por un cuadro de 15 días de evolución consistente en distensión abdominal, dolor y estreñimiento. En urgencias se solicitó una radiografía de tórax que mostró neumoperitoneo y varios niveles hidroaéreos, por lo que el cirujano de turno consideró una posible ruptura de víscera hueca. Resultados. Fue llevado a laparotomía exploratoria, donde se identificó neumatosis quística intestinal y estómago muy aumentado de tamaño, compatible con gastroparesia. Como resultado del tratamiento brindado, el paciente tuvo un desenlace satisfactorio logrando alta médica, apoyado con cuidados básicos de enfermería. Conclusiones. Si bien los casos de neumatosis quística intestinal son de presentación inusual, se puede encontrar en pacientes con hallazgos imagenológicos de neumoperitoneo. Por eso, se debe realizar un análisis concienzudo de cada paciente e individualizar el caso para el correcto diagnóstico.

Introduction. Cystic pneumatosis intestinalis is described as the presence of gas within the intestinal wall. It is a rare entity, with an incidence of 0.03% in the global population. It appears with a predilection in the male gender after 45 years of age and is located mainly in the small intestine (42%) and the colon. It can be associated with several conditions that sometimes require surgical management. Clinical case. The case of a 75-year-old man with a history of high blood pressure is presented, who consulted for a 15-day history consisting of abdominal distention, pain and constipation. In the emergency room, a chest x-ray was requested, which showed pneumoperitoneum and several air-fluid levels. The surgeon on call considered a possible rupture of the hollow viscus. Results. The patient was taken to exploratory laparotomy, where intestinal cystic pneumatosis and a greatly enlarged stomach were identified, compatible with gastroparesis. As a result of the treatment provided, the patient had a satisfactory outcome, achieving medical discharge, supported with basic nursing care. Conclusions. Although cases of intestinal cystic pneumatosis have an unusual presentation, it can be found in patients with imaging findings of pneumoperitoneum. Therefore, a thorough analysis of each patient must be carried out and the case individualized for the correct diagnosis.

Disorders of Gut-Brain Interaction (Functional Gastrointestinal Disorders): Neuromodulators in Clinical Practice (Part I) / Trastornos de la interacción cerebro-intestino (trastornos funcionales digestivos): neuromoduladores en la práctica clínica (parte I)

Abstract Introduction: This review article develops the basic principles for the use and action mechanisms of neuromodulators applied in clinical practice and their role in treating different disorders of gutbrain interaction (DGBI), particularly, esophageal disorders in part I. Materials and methods: The working group reviewed the most frequent pathologies and medications used according to the most recent literature and presented those with the best clinical evidence in each case. Results: Due to the diversity of disorders, types of studies, and therapeutic options, we decided to present the evidence with the best results for each case. We determined the doses used, their results, and the side effects of each one. Conclusions: The basic principles of the use and mechanisms of action of the main neuromodulators were reviewed, including their use in this section in the main esophageal gastrointestinal functional disorders. Given that the available evidence is not definitive, more controlled clinical trials are needed for each condition to confirm the effectiveness and safety of neuromodulators.

Resumen Introducción: En este artículo de revisión se desarrollan los principios básicos para el uso y los mecanismos de acción de los neuromoduladores utilizados en la práctica clínica y su papel en el tratamiento de los diferentes trastornos de la interacción cerebro-intestino (TICI), particularmente los esofágicos en la parte I. Materiales y métodos: El grupo de trabajo revisó las patologías más frecuentes y los medicamentos utilizados según la bibliografía más reciente, y presenta a los que tienen la mejor evidencia clínica en cada caso. Resultados: Debido a la diversidad de trastornos, tipos de estudios y opciones terapéuticas, se decide presentar las evidencias con los mejores resultados para cada caso, y en cada uno se determinan las dosis utilizadas, sus resultados y efectos colaterales. Conclusiones: Se revisan los principios básicos del uso y mecanismos de acción de los principales neuromoduladores, así como la utilización de los mismos en esta sección en los principales trastornos funcionales gastrointestinales esofágicos. Dado que la evidencia disponible no resulta definitiva, para cada condición se requieren más experimentos clínicos controlados que puedan confirmar la efectividad y seguridad de los neuromoduladores.

Novedades en la evaluación y tratamiento de la obstrucción intestinal alta

La obstrucción intestinal mecánica es un problema quirúrgico significativo en términos de prevalencia, morbimortalidad y costos económicos asociados. En los últimos años se han realizado avances en: detectar mecanismos fisiopatológicos del desarrollo de adherencias, optimizar el diagnóstico de pacientes aptos para manejo conservador, valorar la utilidad intraoperatoria de herramientas que definan la necesidad de resección intestinal y hallar terapias preventivas. El objetivo de esta revisión narrativa es sintetizar la evidencia científica actualizada, publicada referente al diagnóstico y tratamiento de una obstrucción intestinal alta mecánica.

Mechanical small bowel obstruction is a significant surgical problem in terms of prevalence, morbimortality, and associated economic costs. In recent years, advances have been made in: detection of physio pathological mechanisms of adhesion genesis, improvement in diagnosis of patients suitable for conservative treatment, assessment the efficacy of intraoperative tools that define the need for intestinal resection, and development of preventive therapies. The objective of this narrative review is to synthesize the updated scientific evidence published, regarding the diagnosis and treatment of mechanical small bowel obstruction.

Factores asociados al desenlace en niños con mal rotación intestinal manejados en el Hospital Infantil de San Vicente Fundación, Medellín, Colombia / Factors associated with outcome in children with intestinal malrotation managed at the Hospital Infantil of San Vicente Fundación, Medellín, Colombia

Introducción. El intestino primitivo rota durante la vida embrionaria. Cuando ocurre de forma inadecuada aparece la malrotación intestinal que puede llevar a la obstrucción o al vólvulo del intestino medio. La incidencia disminuye con el aumento de la edad. La malrotación intestinal es una de las principales causas de complicaciones del tracto gastrointestinal en la edad pediátrica. Métodos. Estudio retrospectivo, observacional, transversal y analítico, de la experiencia durante 10 años en pacientes menores de 15 años con diagnóstico de malrotación intestinal, tratados en el Hospital Infantil de San Vicente Fundación, en Medellín, Colombia. Se buscó la asociación entre variables demográficas, clínicas e imagenológicas con los desenlaces. Resultados. Se obtuvieron 58 pacientes con malrotación intestinal, 65 % menores de 1 año. En 29,3 % de los pacientes se hizo el diagnóstico con la presentación clínica; los síntomas predominantes fueron distensión abdominal y emesis. En el 24,1 % se confirmó el diagnóstico con imágenes. Las variables con una diferencia estadísticamente significativa a favor de encontrar una malrotación complicada fueron choque séptico (OR=11,7), síndrome de respuesta inflamatoria sistémica (OR=8,4) y deshidratación (OR=5,18). Conclusiones. La malrotación intestinal tiene complicaciones como perforación, peritonitis, vólvulo e intestino corto. El vólvulo se acompaña de shock y sepsis, con mortalidad hasta del 50 %. Las imágenes diagnósticas son una ayuda, pero no se puede basar la conducta médica en estas porque ninguna imagen garantiza el diagnóstico definitivo. Los signos de alarma son poco específicos. En menores de un año con emesis, distensión y dolor abdominal se debe sospechar malrotación intestinal.

Introduction. The primitive intestine rotates during embryonic life. When it occurs inappropriately, intestinal malrotation appears, which can lead to obstruction or midgut volvulus. The incidence decreases when age increases. Intestinal malrotation is one of the main causes of complications of the gastrointestinal tract in pediatric age. Method. Retrospective, observational, cross-sectional and analytical study of the experience over 10 years in patients under 15 years of age with a diagnosis of intestinal malrotation, treated at Hospital Infantil of San Vicente Fundación, in Medellín, Colombia. The association between demographic, clinical and imaging variables with the outcomes was sought. Results. There were 58 patients with intestinal malrotation, 65% under one year of age. In 29.3% of patients, intestinal malrotation was diagnosed clinically. The predominant symptoms were abdominal distension and emesis. In 24.1% the diagnosis was confirmed with imaging. The variables with a statistically significant difference in favor of finding a complicated malrotation were septic shock (OR=11.7), systemic inflammatory response syndrome (OR-8.4), and dehydration (OR=5.18). Conclusions. Malrotation has complications such as perforation, peritonitis, volvulus, and short bowel. Volvulus is accompanied by shock and sepsis, with mortality of up to 50%. Diagnostic images are helpful, but medical conduct cannot be based on them because no image guarantees a definitive diagnosis. The warning signs are not very specific. In children under one year of age with emesis, distension and abdominal pain, intestinal malrotation should be suspected.

Irritable bowel syndrome in medical students from Lima, Peru,during the COVID-19 pandemic, using virtual questionnaires according to the Rome IV criteria: prevalence and associated factors / Síndrome de intestino irritable en estudiantes de medicina de Lima, Perú, durante la pandemia de COVID-19, usando cuestionarios virtuales según los criterios de Roma IV: prevalencia y factores asociados

ABSTRACT Irritable bowel syndrome (IBS) is a functional gastrointestinal (GI) disorder, characterized by changes of the intestinal habit associated with abdominal pain. This study analyzed factors associated with this pathology during the COVID-19 pandemic, and it was seen that the impact of IBS was higher in young women who had ongoing studies in the medical field. Objectives: Determine the prevalence of IBS in medical students and explore the associated factors with the increase of its symptoms, through the use of digital tools. Materials and methods: Descriptive observational study with exploration of associations, with nonprobabilistic sampling, until reaching the minimum sample of 110 participants with a confidence interval of 95%, finally having a total sample of 131 students, distributed in 3 proportional and representative subgroups of the last 3 years of study of the medical career from a university from Lima, Peru. The inclusion criteria were students of both sexes and legal age, who gave their consent to participate and did not have risk factors for GI disease. Once the study was approved, the link of a validated virtual questionnaire was shared through the institutional email. To explore the associated factors, the Chi-square test was used with a statistical significance of p < 0.05. Results: Responses were obtained from 195 students; 64 (32.82%) of them had at least one exclusion criteria, finally having a sample size of 131; 64 (48.85%) were women, and 52 (39.69%) were from 7th year. Using the Rome IV criteria, 23 participants were classified as having IBS, which indicates a prevalence of 17.56%, 14 (60.87%) of them were women and 10 (43.48%) were from the 7th year (last year of study of the medical career in Peru). It was observed that 1 in 3 students (32.06%) had chronic abdominal pain, and 1 in 2 (53.44%) reported having a history of Major Depression or Generalized Anxiety Disorder. Of the total, 51 (38.93%) had a history of having a positive COVID-19 test result. Regarding the associated factors, a significant association was only found between IBS and the diarrhea type, classified according to the Bristol Scale. Conclusions: The prevalence of IBS in medical students was 17.56%, the highest compared with studies in the general population and in medical students using Rome IV criteria. Of the associated factors, the clinical presentation of diarrhea, according to the Bristol scale, was associated with IBS.

RESUMEN El síndrome de intestino irritable (SII) es una patología gastrointestinal (GI) funcional, caracterizado por cambios y alteraciones del hábito intestinal asociado a dolor abdominal. El presente estudio analizó los factores asociados a esta patología durante la pandemia de COVID-19, y se vio que el impacto de SII fue mayor en mujeres jóvenes que tenían estudios en el área médica. Objetivo: Determinar la prevalencia de SII en estudiantes de medicina y explorar los factores asociados con el aumento de estos síntomas, usando herramientas digitales. Materiales y métodos: Estudio observacional descriptivo con exploración de asociaciones con muestreo no probabilístico, hasta alcanzar la muestra mínima de 110 participantes con un intervalo de confianza de 95%, teniendo una muestra final de 131 estudiantes distribuidos en 3 grupos proporcionales y representativos de los 3 últimos años de medicina de una universidad de Lima, Perú. Los criterios de inclusión fueron estudiantes de ambos sexos y mayores de edad, quienes dieron su consentimiento para participar y no tenían factores de riesgo para enfermedad GI. Una vez que el estudio fue aprobado, el link del cuestionario virtual validado fue compartido por el correo institucional. Para explorar los factores asociados, se usó la prueba de Chi-cuadrado con una significancia estadística de p<0,05. Resultados: Se obtuvieron respuestas de 195 estudiantes; 64 (32,82%) tuvieron al menos un criterio de exclusión, teniendo una muestra final de 131; 64 (48,85%) fueron mujeres y 52 (39,69%) del 7mo año. Utilizando los criterios de ROMA IV, 23 participantes fueron clasificados con SII, lo que indica una prevalencia del 17,56%, de los cuales 14 (60,87%) fueron mujeres y 10 (43,48%) del 7mo año (último año de la carrera de medicina en Perú). Se observó que uno de cada tres estudiantes (32,06%) tenía dolor abdominal crónico, y 1 de cada 2 (53,44%) reportó antecedente de Depresión mayor o Trastorno de ansiedad generalizada. Del total, 51 (38,93%) tenían antecedente de resultado positivo a COVID-19. Respecto a los factores asociados, solo se encontró una asociación significativa entre el SII y el tipo diarrea clasificada según la escala de Bristol. Conclusiones: La prevalencia de SII en estudiantes de medicina fue de 17,56%, la más alta en comparación a estudios en población general y estudiantes de medicina usando los criterios de Roma IV. De los factores asociados, la presentación clínica de diarrea según la escala de Bristol estuvo asociada a SII.

Consenso de endoscopia en enfermedad inflamatoria intestinal de la Organización Panamericana de Crohn y Colitis (PANCCO) y la Sociedad Interamericana de endoscopia (SIED) / Pan American Crohn's and Colitis Organization (PANCCO) and the Interamerican Society of Endoscopy (SIED) consensus on endoscopy in inflammatory bowel disease

resumen está disponible en el texto completo

ABSTRACT Introduction: Endoscopy plays a fundamental role in inflammatory bowel disease (IBD), and becomes essential in diagnosis, treatment monitoring, and detection and management of complications. Materials and methods: The Pan American Crohn's and Colitis Organization (PANCCO) and the Inter-American Society of Endoscopy (SIED) appointed 22 Latin American experts in IBD to develop a consensus study using the modified Delphi method, based on the best available evidence. A working group of 22 members from 9 countries identified 15 topics and formulated 98 statements, who participated in 2 rounds of voting. It was defined as agreement of ≥80% of experts for each statement. Results: After the voting of all the statements, 8 statements were obtained that did not reach 80% consensus among the participants, so the questions were reconsidered in the Coordinating Committee of the consensus with the participation of the expert reviewers of these questions and 7 final statements were voted again by all the experts in a second round and 1 was eliminated with consensus. After two rounds of voting, the experts reached consensus with literature review with the best available evidence, the most important issues were developed with scientific evidence supporting each of the statements around the topic of endoscopy in IBD. Conclusions: Consensus statements were developed and based on the best available evidence about endoscopy in inflammatory bowel disease.

Hemorragia digestiva por intususcepción de un lipoma ulcerado en yeyuno / Gastrointestinal bleeding due to ulcerated intussuscepted jejunal lipoma

RESUMEN Los lipomas yeyunales son tumores gastrointestinales benignos e infrecuentes, de origen mesenquimático, compuestos por adipocitos que suelen estar confinados a la submucosa. Generalmente son asintomáticos y se descubren de manera incidental al realizar estudios por imágenes o endoscópicos. Sin embargo, aquellos mayores de 2 cm pueden presentar síntomas como resultado de complicaciones, como intususcepción intestinal, obstrucción o rara vez, hemorragias. Presentamos un caso infrecuente de intususcepción de un lipoma yeyunal ulcerado en un adulto, diagnosticado en el contexto de un cuadro de hemorragia digestiva.

ABSTRACT Jejunal lipomas are rare benign mesenchymal tumors made up of adipocytes confined to the submucosa layer. They are usually asymptomatic and are incidentally found during imaging or endoscopic tests. Those measuring > 2 cm may become symptomatic as a result of complications as intestinal intussusception, obstruction and bleeding. We herein report a rare case of intussusception of an ulcerated jejunal lipoma in an adult patient, that was diagnosticated in the setting of an intestinal hemorrhage.

Intervención nutricional orientada al control del proceso inflamatorio en pacientes con espondilitis enteropática

Introducción: La espondilitis enteropática es una enfermedad inflamatoria, sistémica y crónica que se caracteriza por afectar el aparato digestivo y el sistema osteomioarticular; el proceso inflamatorio genera manifestaciones clínicas que afectan la capacidad funcional y la percepción de calidad de vida de los pacientes. Objetivo: Evaluar los resultados de una intervención nutricional orientada al control del proceso inflamatorio en pacientes con espondilitis enteropática. Métodos: Se realizó una investigación observacional y descriptiva longitudinal que incluyó como universo a 19 pacientes con diagnóstico confirmado de espondilitis enteropática atendidos en el Hospital Andino de Chimborazo en el periodo comprendido entre julio 2022 y julio 2023. La muestra quedó conformada por 17 pacientes. Se aplicó una intervención nutricional durante 10 meses que incluyó como elemento central la suplementación con alimentos ricos en probióticos según esquema definido por especialista en nutrición clínica. Resultados: Promedio de edad de 43,51 años, predominio del sexo femenino (64,70 %) y del tiempo de evolución de la enfermedad entre 5 y 10 años (58,82 %). Todos los marcadores de inflamación medidos durante el estudio mejoraron durante el seguimiento realizado a los pacientes; a los 9 meses se identificó aumento del porcentaje de pacientes con proteína C reactiva negativa y fibrinógeno y velocidad de sedimentación globular normal. Conclusiones: La intervención nutricional aplicada contribuye a mejorar los valores séricos de los marcadores de inflamación en los pacientes con diagnóstico de espondilitis enteropática.

Introduction: Enteropathic spondylitis is an inflammatory, systemic and chronic disease that is characterized by affecting the digestive system and the osteomyoarticular system; The inflammatory process generates clinical manifestations that affect the functional capacity and perception of quality of life of patients. Objective: To evaluate the results of a nutritional intervention aimed at controlling the inflammatory process in patients with enteropathic spondylitis. Methods: A longitudinal observational and descriptive investigation was carried out that included as a universe 19 patients with a confirmed diagnosis of enteropathic spondylitis treated at the Andino Hospital of Chimborazo in the period between July 2022 and July 2023. The sample was made up of 17 patients. A nutritional intervention was applied for 10 months that included as a central element supplementation with foods rich in probiotics according to a scheme defined by a clinical nutrition specialist. Results: Average age of 43.51 years, predominance of the female sex (64.70%) and duration of the disease between 5 and 10 years (58.82%). All inflammation markers measured during the study improved during the patients' follow-up; At 9 months, an increase in the percentage of patients with negative C-reactive protein and fibrinogen and normal erythrocyte sedimentation rate was identified. Conclusions: The applied nutritional intervention contributed to improving serum values ​​of inflammation markers in patients diagnosed with enteropathic spondylitis.

El papel de la microbiota sobre la percepción del dolor visceral / The gut microbiota and its role on visceral pain

Resumen: La microbiota intestinal tiene un impacto bien documentado en diversos aspectos de la salud. En este estudio se recoge la evidencia disponible acerca de la repercusión de la dieta individual y de la microbiota en la percepción del dolor visceral.

Abstract: The gut microbiota has a well-documented impact on various aspects of health. In this study we review the available evidence on the impact of individual diet and microbiota on visceral pain perception.

Usefulness and description of the intestinal bypass technique in children with short bowel syndrome: report of a Mexican cohort / Utilidad y descripción de la técnica de puenteo intestinal en niños con síndrome de intestino corto: reporte de una cohorte en México

Abstract Background: Short bowel syndrome (SBS) is one of the most frequent causes of intestinal failure, needing parenteral nutrition to maintain an energy-protein and water-electrolyte balance. At the Hospital Infantil de México Federico Gómez (HIMFG), the formation of two stomas is a technique used for intestinal rehabilitation, where the use of residue through the bypass technique (BT) helps to maintain gastrointestinal functionality, water-electrolyte, and nutritional stability. This study aimed to describe the technique of using intestinal residue through BT as a treatment strategy in intestinal rehabilitation and its effect on the biochemical and nutritional status of pediatric patients with SBS. Methods: An analytical and retrospective cross-sectional study was performed in patients hospitalized at HIMFG with SBS who underwent BT during their hospital stay between 2019 and 2020 and then followed up for 8 weeks. Results: A total of 10 patients were included in this study, with a mean age of 24 months; 50% were female. BT was able to reduce the inflammatory process in the liver caused by the continuous use of parenteral nutrition; enteral caloric intake increased from 25.32 kcal/kg/day to 72.94 kcal/kg/day, but it was insufficient to improve their nutritional status. Conclusions: BT is a safe and effective alternative in intestinal rehabilitation in patients with SBS to stimulate trophism and intestinal functionality, allowing a progression of enteral feeding and a decrease in the hepatic inflammatory process that occurs in these patients with prolonged parenteral nutrition.

Resumen Introducción: El síndrome de intestino corto (SIC) es una de las causas más frecuentes de insuficiencia intestinal que requiere del uso de nutrición parenteral para mantener un balance energético-proteico e hidroelectrolítico. En el Hospital Infantil de México Federico Gómez (HIMFG) la formación de dos estomas es una técnica empleada para la rehabilitación intestinal, donde con el aprovechamiento de residuo mediante la técnica de puenteo (TP) se ayuda a mantener la funcionalidad gastrointestinal, equilibrio hidro-electrolítico y estabilidad nutricional. El objetivo de este estudio fue describir la técnica del aprovechamiento de residuo intestinal mediante TP como estrategia de tratamiento en la rehabilitación intestinal y su efecto en el estado bioquímico y nutricional de pacientes pediátricos con SIC. Métodos: Se llevó a cabo un estudio transversal analítico y retrospectivo en pacientes hospitalizados en el HIMFG con SIC en quienes se realizó la TP durante su estancia intrahospitalaria entre 2019 y 2020. Resultados: Se incluyeron 10 pacientes en este estudio, con una edad promedio de 24 meses, y el 50% de sexo femenino. La TP logró disminuir el proceso inflamatorio hepático ocasionado por el uso continuo de nutrición parenteral; la ingesta calórica por vía enteral incrementó de 25.32 kcal/kg/día a 72.94 kcal/kg/día, pero fue insuficiente para mejorar el estado nutricional. Conclusiones: La TP es una alternativa segura y efectiva en la rehabilitación intestinal en pacientes con SIC para estimular el trofismo y funcionalidad intestinal, permitiendo una progresión de la alimentación enteral y disminución del proceso inflamatorio hepático que se presentan en estos pacientes con nutrición parenteral prolongada.

Fenotipificación y genotipificación en pacientes con enfermedad inflamatoria intestinal en un centro de referencia de Colombia / Phenotyping and genotyping in patients with inflammatory bowel disease in a reference center in Colombia

RESUMEN Introducción: Se ha tratado de identificar los factores genéticos relacionados con susceptibilidad para enfermedad inflamatoria intestinal (EII), y los hallazgos actuales se inclinan por un modelo de patología complejo, sin un patrón hereditario claro. Objetivo: Realizar caracterización fenotípica y genotípica de pacientes con EII en población colombiana y describir su posible asociación con predisposición. Materiales y métodos: Serie de casos, 16 pacientes con EII por criterios clínicos y anatomopatológicos, inicio de síntomas gastrointestinales después de los 18 años. Todos tuvieron asesoramiento genético pre-test y se realizaron árboles genealógicos de mínimo tres generaciones. También, genotipificación, por medio de un panel de genes múltiples que incluía genes relacionados con EII y algunos trastornos autoinmunitarios. Finalmente, se realizó análisis genómico de variantes. Resultados: 9 mujeres y 7 hombres, con edad media de diagnóstico de EII 35 años, y 32 años para aparición de síntomas gastrointestinales. 11/16(68,75%) requirieron terapia biológica. 10/16 (62,5%) presentaron refractariedad a terapia estándar. 3/16 (18,75%) tenían antecedentes familiares positivos de EII. 100% casos presentaron al menos un single nucleotide polymorphism relacionado con riesgo de EII en más de un gen. Los genes más relacionados con colitis ulcerosa (CU), fueron CD48, CD6, y TYK2 para CU, y CD6 e ITGAM para la enfermedad de Crohn. El gen más frecuente fue CD6. Se observó en 3/16 (18,75%) presencia de hasta 5 genes, 4 en 3/16 (18,75%), y tres en 5/16 (31,25%). Conclusión: En EII hay presencia de variantes genéticas con predisposición asociada, pero sin patogenicidad confirmada, y cuya sumatoria parece contribuir en su fisiopatología.

ABSTRACT Introduction: Attempts have been made to identify the genetic factors related to susceptibility to inflammatory bowel disease (IBD), and the current conclusions are in favor of a complex pathology model, without a clear hereditary pattern. Objective: To perform phenotypic and genotypic characterization of patients with IBD in Colombian population and to describe its possible association with predisposition. Materials and methods: case series, 16 patients with IBD according to clinical and pathological criteria, onset of gastrointestinal symptoms after 18 years of age. All had pre-test genetic counseling and family trees of at least three generations were made. Also, genotyping, using a multigene panel that included genes related to IBD and some autoimmune disorders. Finally, a genomic analysis of variants was performed. Results: 9 women and 7 men, with mean age of diagnosis of IBD of 35 years, and gastrointestinal symptoms appearance of 32 years. 11/16 (68.75%) required biological therapy. 10/16 (62.5%) were refractory to standard therapy. 3/16 (18.75%) had positive family history of IBD. 100% cases presented at least one single nucleotide polymorphism related to IBD risk in more than one gene. The genes most related to ulcerative colitis (UC) were CD48, CD6, and TYK2 for UC, and CD6 and ITGAM for Crohn's disease. The most frequent gene was CD6. It was found presence of up to 5 genes in 3/16 (18.75%), 4 in 3/16 (18.75%), and three in 5/16 (31.25%). Conclusion: In IBD there is the presence of genetic variants with associated predisposition, but without confirmed pathogenicity, and whose sum seems to contribute to its pathophysiology.

Isolation and characterization of bacteria associated with silkworm gut under antibiotic-treated larval feeding / Isolamento e caracterização de bactérias associadas ao trato intestinal do bicho-da-seda sob alimentação larval tratada com antibióticos

Abstract The impact of antibiotics on growth, cocoon production was assessed in addition to isolation and characterization of bacteria associated with silkworm gut of infected larvae. Larval rearing was maintained at recommended conditions of temperature and humidity. Silkworm larvae showing abnormal symptoms were collected from the control group and dissected for gut collection. Bacteria were isolated from the gut content by spreading on agar plates and incubated at 37 °C for 48 hrs. Bacterial identification and phylogenetic analysis were carried out by 16S rRNA gene sequencing. The isolated bacteria were subjected to antimicrobial susceptibility test (disc diffusion methods) by using Penicillin (10 µg/mL), Tetracycline (30 µg/mL), Amoxicillin (25 µg/mL), Ampicillin (10 µg/mL), and Erythromycin (15 µg/mL). All isolated strains showed positive results for the catalase test. We isolated and identified bacterial strains (n = 06) from the gut of healthy and diseased silkworm larvae. Based on the 16S rRNA gene sequence, isolated bacteria showed close relation with Serratia, Bacillus, and Pseudomonas spp. Notably, 83.3% of strains were resistant to Penicillin, Tetracycline, Amoxicillin, Ampicillin, and Erythromycin but 16.6% showed antibiotic susceptibility to the above-mentioned commonly used antibiotics. Silkworm larvae fed on penicillin-treated leaves showed significant improvement in larval weight, larval length, and cocoon production. Significantly higher larval weight (6.88g), larval length (5.84cm), and cocoon weight (1.33g) were recorded for larvae fed on leaves treated with penicillin as compared to other antibiotics. Isolated bacterial strains showed close relation with Serratia spp., Bacillus spp. and Pseudomonas spp.

Resumo O impacto dos antibióticos no crescimento e na produção do casulo foi avaliado, além do isolamento e caracterização das bactérias associadas ao intestino de larvas infectadas do bicho-da-seda. A criação das larvas foi mantida nas condições recomendadas de temperatura e umidade. As larvas do bicho-da-seda com sintomas anormais foram coletadas do grupo controle e dissecadas para coleta do intestino. As bactérias foram isoladas do conteúdo intestinal por espalhamento em placas de ágar e incubadas a 37° C durante 48 horas. A identificação bacteriana e a análise filogenética foram realizadas pelo sequenciamento do gene 16S rRNA. As bactérias isoladas foram submetidas a teste de sensibilidade antimicrobiana (métodos de difusão em disco) com penicilina (10 µg / mL), tetraciclina (30 µg / mL), amoxicilina (25 µg / mL), ampicilina (10 µg / mL) e eritromicina (15 µg / mL). Todas as cepas isoladas apresentaram resultados positivos para o teste da catalase. Isolamos e identificamos cepas bacterianas (n = 06) do intestino de larvas de bicho-da-seda saudáveis e doentes. Com base na sequência do gene 16S rRNA, as bactérias isoladas mostraram estreita relação com Serratia, Bacillus e Pseudomonas spp. Notavelmente, 83,3% das cepas eram resistentes a penicilina, tetraciclina, amoxicilina, ampicilina e eritromicina, mas 16,6% mostraram suscetibilidade aos antibióticos comumente usados mencionados acima. As larvas do bicho-da-seda alimentadas com folhas tratadas com penicilina apresentaram melhora significativa no peso larval, comprimento larval e produção de casulo. Peso larval significativamente maior (6,88g), comprimento larval (5,84cm) e peso do casulo (1,33g) foram registrados para larvas alimentadas com folhas tratadas com penicilina, em comparação com outros antibióticos. Cepas bacterianas isoladas mostraram estreita relação com Serratia spp., Bacillus spp. e Pseudomonas spp.

Isolation and characterization of bacteria associated with silkworm gut under antibiotic-treated larval feeding

Abstract The impact of antibiotics on growth, cocoon production was assessed in addition to isolation and characterization of bacteria associated with silkworm gut of infected larvae. Larval rearing was maintained at recommended conditions of temperature and humidity. Silkworm larvae showing abnormal symptoms were collected from the control group and dissected for gut collection. Bacteria were isolated from the gut content by spreading on agar plates and incubated at 37 °C for 48 hrs. Bacterial identification and phylogenetic analysis were carried out by 16S rRNA gene sequencing. The isolated bacteria were subjected to antimicrobial susceptibility test (disc diffusion methods) by using Penicillin (10 µg/mL), Tetracycline (30 µg/mL), Amoxicillin (25 µg/mL), Ampicillin (10 µg/mL), and Erythromycin (15 µg/mL). All isolated strains showed positive results for the catalase test. We isolated and identified bacterial strains (n = 06) from the gut of healthy and diseased silkworm larvae. Based on the 16S rRNA gene sequence, isolated bacteria showed close relation with Serratia, Bacillus, and Pseudomonas spp. Notably, 83.3% of strains were resistant to Penicillin, Tetracycline, Amoxicillin, Ampicillin, and Erythromycin but 16.6% showed antibiotic susceptibility to the above-mentioned commonly used antibiotics. Silkworm larvae fed on penicillin-treated leaves showed significant improvement in larval weight, larval length, and cocoon production. Significantly higher larval weight (6.88g), larval length (5.84cm), and cocoon weight (1.33g) were recorded for larvae fed on leaves treated with penicillin as compared to other antibiotics. Isolated bacterial strains showed close relation with Serratia spp., Bacillus spp. and Pseudomonas spp.

Resumo O impacto dos antibióticos no crescimento e na produção do casulo foi avaliado, além do isolamento e caracterização das bactérias associadas ao intestino de larvas infectadas do bicho-da-seda. A criação das larvas foi mantida nas condições recomendadas de temperatura e umidade. As larvas do bicho-da-seda com sintomas anormais foram coletadas do grupo controle e dissecadas para coleta do intestino. As bactérias foram isoladas do conteúdo intestinal por espalhamento em placas de ágar e incubadas a 37° C durante 48 horas. A identificação bacteriana e a análise filogenética foram realizadas pelo sequenciamento do gene 16S rRNA. As bactérias isoladas foram submetidas a teste de sensibilidade antimicrobiana (métodos de difusão em disco) com penicilina (10 µg / mL), tetraciclina (30 µg / mL), amoxicilina (25 µg / mL), ampicilina (10 µg / mL) e eritromicina (15 µg / mL). Todas as cepas isoladas apresentaram resultados positivos para o teste da catalase. Isolamos e identificamos cepas bacterianas (n = 06) do intestino de larvas de bicho-da-seda saudáveis e doentes. Com base na sequência do gene 16S rRNA, as bactérias isoladas mostraram estreita relação com Serratia, Bacillus e Pseudomonas spp. Notavelmente, 83,3% das cepas eram resistentes a penicilina, tetraciclina, amoxicilina, ampicilina e eritromicina, mas 16,6% mostraram suscetibilidade aos antibióticos comumente usados mencionados acima. As larvas do bicho-da-seda alimentadas com folhas tratadas com penicilina apresentaram melhora significativa no peso larval, comprimento larval e produção de casulo. Peso larval significativamente maior (6,88g), comprimento larval (5,84cm) e peso do casulo (1,33g) foram registrados para larvas alimentadas com folhas tratadas com penicilina, em comparação com outros antibióticos. Cepas bacterianas isoladas mostraram estreita relação com Serratia spp., Bacillus spp. e Pseudomonas spp.

Composição da microbiota intestinal durante a gestação e puerpério em mulheres com diferentes intensidades de sintomas depressivos / Composition of Gut Microbiota During Pregnancy and Postpartum in Women with Varying Degrees of Depressive Symptoms

Os sintomas depressivos durante a gravidez e o período pós-parto (PP) são prevalentes e podem ter implicações profundas para o bem-estar materno e infantil. Evidências emergentes sugerem que a microbiota intestinal pode desempenhar um papel na regulação do humor. Este estudo explora a relação entre a composição da microbiota intestinal e os sintomas depressivos em mulheres grávidas e no pós-parto com diferentes intensidade de sintomas. Foram recrutadas gestantes que faziam acompanhamento nos hospitais HCFMUSP e HU- USP. A partir do preenchimento do questionário de Escala de Edimburgo as participantes foram triadas para os grupos de sintomas ausentes ou leves (AL) e sintomas graves ou moderados (MG). Para a análise de microbiota, as participantes forneceram amostras de fezes em três momentos diferentes. Uma no terceiro trimestre de gestação (G) e duas no período pós-parto. A primeira amostra deste período foi coletada durante a internação do pós-parto (P1), e a segunda durante a consulta de retorno um mês após o parto (P2). A composição da microbiota intestinal foi analisada usando técnicas de sequenciamento de alto rendimento e os ácidos graxos de cadeia curta (AGCC) foram quantificados por cromatografia gasosa acoplada à espectrometria de massas (GC-MS). Análises bioinformáticas e estatísticas foram realizadas utilizando os softwares QIIME 2 (2022.2) e R (4.3.1) para identificar possíveis associações entre a composição da microbiota intestinal e a gravidade dos sintomas depressivos. Os resultados indicam que a familia Enterobacteriacea aparece com maior abundância nas mulheres do grupo MG, especialmente durante o período P1 (p<0,05) e que há uma diminuição significativa (p<0,05) de sintomas depressivos nas participantes do grupo MG desde sua triagem até o fim do acompanhamento do estudo, indicando que conduta terapêutica está sendo eficaz. Apesar de não ter sido estabelecida diferença estatística na abundância relativa da microbiota entre os grupos durante a gestação e nos índices de alfa e beta diversidade entre grupos e entre os períodos, é possivel observar uma tendência de mudança de microbiota ao longo do tratamento com aumento do gênero Bifidobacterium, diminuição da familia Enterobacteraceae e é possivel observar uma aparente correlação inversa entre a diminuição da intensidade de sintomas depressivos e o aumento da abundância dos gêneros Bifidobacterium e Clostridium, além do aumento das concentrações de AGCC. Em conclusão, a composição da microbiota intestinal parece ser influenciada pela gravidade dos sintomas depressivos em mulheres grávidas e no pós-parto. Pesquisas adicionais são necessárias para explorar a relação entre a microbiota intestinal e a depressão perinatal e determinar as implicações clínicas dessas descobertas para a saúde materna e infantil.

Depressive symptoms during pregnancy and the postpartum period (PP) are prevalent and can have profound implications for maternal and infant well-being. Emerging evidence suggests that the gut microbiota may play a role in mood regulation. This study explores the relationship between gut microbiota composition and depressive symptoms in pregnant and postpartum women with different symptom severities. A cohort of pregnant women were recruited from HCFMUSP and HU-USP. Participants completed standardized depression assessment tools and were allocate in groups of absent or mild depressive symptoms (AL) and moderate or severe depressive symptoms (MG) and provided stool samples in three different time periods. One at the third gestation trimester (G) and two at the postpartum period. The first sample from this period was collected during postpartum hospitalization(P1), and the second during the onemonth postpartum follow-up appointment (P2). Their gut microbiota composition was analyzed using high-throughput sequencing techniques and Gas chromatography mass spectrometry (GS-MS) for quantification of short-chain fatty acids (SCFAs). Bioinformatic and statistical analyses were performed using softwares QIIME 2 (2022.2) and R (4.3.1) to identify potential associations between gut microbiota composition and depressive symptom severity. Findings that the Enterobacteriaceae family appears more abundantly in women of the MG group, especially during period P1 (p<0.05), and that there is a significant decrease (p<0.05) in depressive symptoms among the participants of the MG group from their screening to the end of the study follow-up, suggesting that the therapeutic approach is effective. Although no statistical differences in alpha and beta diversity indices were established between groups and across periods, it is possible to observe a trend of microbiota change during the treatment, with an increase in the Bifidobacterium genus, a decrease in the Enterobacteriaceae family, and an apparent inverse correlation between the reduction in the intensity of depressive symptoms and the increased abundance of the Bifidobacterium, Clostridium, and Dorea genera, as well as an increase in the concentrations of SCFAs. In conclusion, composition of gut microbiota appears to be influenced by the severity of depressive symptoms in pregnant and postpartum women. Further research is warranted to explore links between gut microbiota and perinatal depression and to determine the clinical implications of these findings for maternal and infant health

Influência da microbiota intestinal no transtorno obsessivo- compulsivo e nos transtornos relacionados: protocolo de revisão de escopo / Influence of the gut microbiome on obsessive-compulsive disorder and related disorders: scoping review protocol

RESUMO Objetivo Identificar e mapear as evidências disponíveis sobre a composição da Microbiota Intestinal em indivíduos com Transtorno Obsessivo-Compulsivo e seus transtornos relacionados. Métodos https://osf.io/bd2ns Resultados Espera-se encontrar uma relação entre a composição da Microbiota Intestinal, em quantidade e tipo de espécies, e os sintomas do TOC e dos seus Transtornos relacionados. Conclusão Esta será a primeira scoping review que procura investigar a relação entre a microbiota intestinal e o Transtorno Obsessivo-Compulsivo e Transtornos relacionados. A publicação prévia deste protocolo de revisão irá colaborar para um melhor planejamento do estudo e divulgação da investigação junto da comunidade científica.

ABSTRACT Objective To identify and map the available evidence regarding Gut Microbiota composition in individuals with obsessive-compulsive disorder and its related Disorders. Methods https://osf.io/bd2ns Results It's hoped to find a relationship between the composition of the gut microbiota, in terms of quantity and type of species, and the symptoms of OCD and its related disorders. Conclusion This will be the first scoping review that seeks to investigate the relationship between Gut Microbiota and Obsessive-Compulsive Disorder and its related disorders. The previous publication of this review protocol will collaborate for a better planning of the study and dissemination of the research to the scientific community.

Giant Submucosal Lipoma of the Right Colon Spontaneously Expelled Rectally: Case Report

Colonic lipomas are benign tumors originating in mesenchymal tissue and are considered the second most common benign tumor in the colon after adenomatous polyps. They tend to affect women more; their most frequent location is the right colon. Generally, these lipomas do not exhibit symptoms, but when they reach a considerable size, they can cause manifestations. They can also result in complications such as obstruction, intussusception, and perforation. Since their radiological characteristics are similar to fat, they can be visualized using computed tomography. Still, the final diagnosis is made through colonoscopy, where a fatty mass with an oval shape and elastic capacity is observed. Lesions can be removed endoscopically or surgically. Spontaneous expulsion of a lipoma rectally is rare, and its mechanism is not yet fully understood. Although the literature establishes a cut-off point of 2 cm to decide between endoscopic or laparoscopic resection, the former is increasing and can extend this limit. Surgical resection is recommended in cases such as the one in this article. This case is the biggest reported colonic lipoma (13 cm) expelled spontaneously.

Los lipomas colónicos son tumores benignos que se originan en el tejido mesenquimal y se consideran el segundo tumor benigno más común en el colon, después de los pólipos adenomatosos. Tienden a afectar más a mujeres y su localización más frecuente es el colon derecho. Por lo general, estos lipomas no presentan síntomas, pero cuando alcanzan un tamaño considerable pueden causar manifestaciones. También pueden dar lugar a complicaciones como obstrucción, intususcepción y perforación. Dado que sus características radiológicas son similares a la grasa, pueden ser visualizados mediante tomografía computarizada, aunque el diagnóstico definitivo se realiza mediante colonoscopia, donde se observa una masa grasa con forma ovalada y capacidad elástica. Las lesiones pueden ser extirpadas endoscópicamente o quirúrgicamente. La expulsión espontánea de un lipoma por vía rectal es rara y su mecanismo aún no está completamente comprendido. Aunque la literatura establece un punto de corte de 2 cm para decidir entre resección endoscópica o laparoscópica, la primera está en aumento y puede ampliar este límite. En casos grandes, como el reportado en este artículo, se recomienda una resección quirúrgica. Este caso particular se destaca por ser el lipoma de colon más grande reportado hasta ahora (13 cm) expulsado espontáneamente.

Fallo intestinal crónico secundario a síndrome de intestino corto: papel actual de la cirugía, la rehabilitación médica y el trasplante intestinal. Informe evolutivo a 16 años de manejo multidisciplinario / Chronic intestinal failure due to short bowel syndrome: current role of surgery, medical rehabilitation, and intestinal transplantation. A progress report after 16 years of multidisciplinary management

RESUMEN Antecedentes: la insuficiencia intestinal, en su grado más grave, se conoce como fallo intestinal crónico (FIC). Las últimas décadas han sido testigo de la incorporación, evolución y perfeccionamiento de tratamientos que, en su conjunto, se denominan rehabilitación intestinal y abarcan tanto procedimientos quirúrgicos como tratamientos médicos que, llevados a cabo por equipos multi e interdisciplinarios, alcanzan altas tasas de éxito. Objetivo: describir los resultados de 16 años en el tratamiento de pacientes con FIC secundario a síndrome de intestino corto (SIC), y la evolución del papel de la cirugía, la rehabilitación médica y el trasplante. Material y métodos: análisis retrospectivo de una base de datos prospectiva de pacientes con fallo intestinal crónico secundario a SIC entre febrero de 2006 y marzo de 2022. Resultados: se incluyeron 492 pacientes (368 adultos-A y 124 pediátricos-P). Grupo A: 111 pacientes recibieron cirugía de reconstrucción autóloga del tracto gastrointestinal (CRATGI), 16 péptido semisintético similar al glucagón de tipo 2 (sGLP-2); el 83% logró la rehabilitación, con un 77% de supervivencia a 10 años; el 6,8% (17 pacientes) requirió trasplante intestinal (TxI), con un 89% de independencia de la nutrición parenteral (NP) al año y supervivencia post-TxI del 29% a los 10 años. Grupo B: 18 recibieron CRATGI; 9, enteroplastia serial transversa (STEP); y 6, sGLP-2; el 52% se rehabilitó, con una supervivencia del 69% a los 10 años; 28 pacientes recibieron TxI, con 69% de independencia de nutrición parenteral (NP) al año y supervivencia del 39% a los 10 años. Conclusión: los resultados presentados resaltan el papel central de la cirugía y la rehabilitación médica para alcanzar la suficiencia intestinal.

ABSTRACT Background: Severe intestinal insufficiency is known as chronic intestinal failure (CIF). In recent decades, medical treatments and surgical procedures have been incorporated, developed and improved under the name intestinal rehabilitation. When performed by multiand interdisciplinary teams, these treatments have high success rates. Objective: The aim of present study is to describe the 16-year outcomes in the management of patients with CIF secondary to short bowel syndrome (SBS) and the role of surgery, medical rehabilitation, and transplantation. Material and methods: We conducted a retrospective analysis on a prospective database of patients treated with chronic intestinal failure due to SBS between February 2006 and March 2022. Results: A total of 492 patients (368 adults (Group A) and 124 pediatric patients (Group B)] were included. Group A: 111 patients underwent autologous gastrointestinal reconstruction surgery (AGIRS), 16 were treated with semisynthetic glucagon-like peptide-2 (sGLP2); 83% achieved rehabilitation, with 77% survival at 10 years; 6.8% (17 patients) required intestinal transplantation (ITx), with 89% independence from parenteral nutrition (PN) at 1 year and post-ITx survival of 29% at 10 years. Group B: 18 patients underwent AGIRS; 9 underwent serial transverse enteroplasty (STEP); and 6 received sGLP2; 52% were rehabilitated, with 69% survival at 10 years; 28 patients received ITx, with 69% independence from PN at 1 year and 39% survival at 10 years. Conclusion: These results highlight the central role of surgery and medical rehabilitation in the recovery of intestinal function.