Manejo quirúrgico de la endometriosis colorrectal: monografía destacada del curso de la SACP 2019 / Surgical Management of Colorectal Endometriosis: featured monograph from the 2019 SACP Course

La endometriosis es una de las patologías ginecológicas benignas más frecuente, ocurre en un 7-10% de las mujeres en edad reproductiva y es causal de dolores crónicos e infertilidad. Se trata de una población joven y sana por lo demás. La sospecha diagnóstica de esta entidad debe ser alta y su manejo multidisciplinario.La endometriosis colorrectal representa una variable altamente incapacitante y es aquí donde se plantea la necesidad de un tratamiento más agresivo para su resolución. Frente a esto nos preguntamos, ¿qué rol tiene la cirugía?, ¿cuáles serían sus ventajas y desventajas?, ¿por qué deberíamos elegirla como método terapéutico?.La presente monografía fue inspirada en todas las pacientes que nos plantearon esta controversia. Que motivaron interconsultas, ateneos, búsqueda de bibliografía. Que generaron discusiones, dudas e incertidumbres y nos hicieron salir del rol de cirujanos al que estamos habituados y nos enseñaron a acompañar, cuando no pudimos curar

Human intestinal capillariasis: A rare case report from non-endemic area (Andhra Pradesh, India).

Human intestinal capillariasis is caused by Capillaria philippinensis. This disease is endemic in Philippines and Thailand. To the best of our knowledge, we report the third case of human intestinal capillariasis from India and the first case from Andhra Pradesh, which is a non-endemic area. A 40-year-old female presented with diarrhoea, vomiting, decreased urinary output, ascitis, pedal oedema, hypoalbuminemia, and electrolyte imbalance. Microscopic examination of stool sample revealed the presence of ova, larvae, and adult worms of C. philippinensis. Patient recovered from the disease after taking albendazole 400 mg daily for 1 month along with supportive treatment.

Resistencia a vancomicina en cepas de enterococcus faecium aisladas en un hospital universitario / Vancomycin resistance in enterococcus faecium strains isolated at a university hospital

Las especies que conforman el género Enterococcus, son cocos Gram positivos, que usualmente habitan el tracto intestinal de humanos y animales, pero que también pueden ser aislados de fuentes ambientales. Son capaces de sobrevivir a un amplio rango de condiciones ambientales adversas de estrés, lo que les permite colonizar un amplio rango de nichos, incluidos los ambientes hospitalarios. La patogenicidad nosocomial de los enterococos ha emergido en los últimos años, así como su incrementada resistencia a los antibióticos glicopéptidos. El presente estudio intenta determinar la resistencia a vancomicina de cepas de Enterococcus faecium aisladas en un hospital universitario en el período enero-diciembre del año 2009, así como caracterizar el determinante genético responsable de la resistencia. Para ello se utilizaron los métodos para determinar susceptibilidad a glicopéptidos descritos por el CLSI, adicionalmente se determinó el elemento genético responsable de la resistencia mediante la reacción en cadena de la polimerasa. El 48,81% de las cepas de E. faecium estudiadas fueron resistentes a vancomicina y el PCR demostró la presencia del gen vanA que confiere altos niveles de resistencia a glicopéptidos. Debido al elevado número de aislados resistentes a vancomicina dentro de la institución se sospecha de la presencia de un brote nosocomial producido por este microorganismo; esta cepa epidémica poseedora del gen vanA posiblemente está dispersa en los diferentes servicios de la institución, por lo que se sugiere realizarestudios epidemiológicos para determinar el rol que este microorganismos juega en la producción de infecciones nosocomiales en la institución estudiada

Genus Enterococcus species are gram positive cocci, usually inhabitants of human and animal intestinal tracts, but can also be isolated from their environmental sources. They are able to survive a wide range of adverse environmental stress conditions, allowing them to colonize a wide range of niches, including hospital environments. Nosocomial pathogenicity of enterococci has emerged in recent years, as well as their increased resistance to glycopeptide antibiotics. This study attempts to determine the resistance to vancomycin of Enterococcus faecium strains isolated in a university hospital during the January-December period of 2009, as well as to characterize the genetic determinant responsible for its resistance. Methods to determine susceptibility to glycopeptides described by CLSI were used; additionally, the genetic elements responsible for resistance were identified using the polymerase chain reaction. Of the E. faecium strains studied, 48.81% were resistant to vancomycin, and PCR showed presence of the vanA gene that confers high levels of resistance to glycopeptides. Due to the large number of isolates resistant to vancomycin, the presence of a nosocomial outbreak produced by this microorganism was suspected; this epidemic strain possessing a vanA gene is possibly scattered in different services of the institution; therefore, epidemiological studies should be performed to determine the role this microorganism plays in the production of nosocomial infections in the institution under study

Sobrecrecimiento bacteriano intestinal / Small intestinal bacterial overgrowth. An update

Small intestinal bacterial overgrowth (SIBO) is characterized by nutrient malabsorption, associated with an excessive number of bacteria in the proximal small intestine. Unfortunately, the diagnosis of bacterial overgrowth presents several difficulties and limitations, and as yet there is not a widespread agreement on the best diagnostic test. SIBO occurs when there are alterations in intestinal anatomy, gastrointestinal motility, or a lack of gastric acid secretion. The true association between SIBO and irritable bowel syndrome and celiac disease remains uncertain. The treatment usually consists in the eradication of bacterial overgrowth with repeated courses of antimicrobials, nutritional support and when it is possible, the correction of underlying predisposing conditions.

Successful Treatment of Protein-Losing Enteropathy Induced by Intestinal Lymphangiectasia in a Liver Cirrhosis Patient with Octreotide: A Case Report

A 47-yr-old man with hepatitis B virus associated liver cirrhosis was admitted to our hospital with diarrhea and generalized edema and diagnosed as protein-losing enteropathy due to intestinal lymphangiectasia by intestinal biopsy and 99mTc albumin scan. During hospitalization, he received subcutaneous octreotide therapy. After 2 weeks of octreotide therapy, follow-up albumin scan showed no albumin leakage, and the serum albumin level was sustained. We speculate that liver cirrhosis can be a cause of intestinal lymphangiectasia and administration of octreotide should be considered for patients with intestinal lymphangiectasia whose clinical and biochemical abnormalities do not respond to a low-fat diet.

Uso de probióticos en niños / Use of probiotics in children

En años recientes ha surgido el interés de estudiar la función de la microflora intestinal en varias condiciones clínicas, así como de evaluar formas de modificarla. Para alterar la microflora intestinal se han utilizado: probióticos, prebióticos y el uso simultáneo de ambos (simbióticos). Los probióticos son microorganismos vivos que tienen un efecto benéfico en el huésped. Los más utilizados son los Lactobacillus, aunque también se han observado beneficios con algunas especies de Saccharomyces, Bifidobacterium y Streptococcus. Para el crecimiento y actividad de estas bacterias se requieren prebióticos como los fructooligosacáridos. El uso de probióticos, prebióticos y simbióticos tiene beneficios en: diarrea, malabsorción de lactosa, síndrome de intestino irritable, alergia intestinal, cáncer, vaginitis, infecciones de vías urinarias e hipercolesterolemia. Se han realizado múltiples estudios utilizando probióticos, prebióticos y simbióticos; sin embargo, aún se requiere de mayor investigación antes de considerarlos como agentes de uso cotidiano.

Open labelled evaluation of injection Manyana (a combination of diclofenac + pitofenone + fenpiverinium) in ureteric, biliary and intestinal spasm--a preliminary report.

To study the efficacy and safety of a parenteral formulation of 'Manyana' (a combination of diclofenac + pitofenone + fenpiverinium) in ureteric, biliary and intestinal colic, an open labelled study was conducted at two centres. A total of 206 patients were enrolled and evaluated for decrease in pain with time on a visual analogue scale. A statistically significant difference was observed in pain within 30 minutes of drug administration and the pain relief lasted for as long as 24 hours post dosing. The study shows definite synergism between the antispasmodics pitofenone and fenpiverinium with the NSAID-diclofenac, reducing the prostaglandin levels and also the spasm related to colic.

Double blind, randomised, parallel, prospective, comparative, clinical evaluation of a combination of antispasmodic analgesic Diclofenac + Pitofenone + Fenpiverinium (Manyana vs Analgin + Pitofenone + Fenpiverinium (Baralgan) in biliary, ureteric and intestinal colic.

In this double blind, prospective study, the relative efficacy of Diclofenac + Pitofenone + Fenpiverinium (Manyana) and Analgin + Pitofenone + Fenpiverinium (Baralgan) in 200 patients of biliary, ureteric and intestinal colic was evaluated. Patients were given these coded drugs thrice daily for five days starting from day 0 to day 5. The results of the present clinical evaluation demonstrated that Manyana appeared to be superior to Baralgan in biliary and ureteric colic while it was therapeutically equivalent to Baralgan in reducing the pain intensity in intestinal colic. Both the medications were tolerated well and there were no side-effects reported.

"The in vitro antibacterial activity of ""tazma mar"" honey produced by the stingless bee"

"In 1993 the antibacterial effect of tazma mar was evaluated on Salmonella typhimurium; Salmonella enteritidis; Escherichia coli; Bacillus cereus and Staphylococcus aureus at concentrations of 10; 15 and 20 percent in Brain Heart Infusion Broth. In the absence of ""tazma mar""; the Gram negative test strains reached counts greater than 10 the power of 8 cfu/ml within 12 hours and maintained the count until 48 hours. At 10 percent concentration; S. typhimurium; S. enteritidis and E. coli were not inhibited until 12 hours; but thereafter their number declined faster and complete inhibition was observed at 48 hours. Retarded growth and inhibition was noted at 15 percent and 20 percent concentrations. A more marked growth retardation and inhibition at all concentrations was noted on B. cereus and Staph. aureus. ""Tazma mar"" may be effective to treat food-borne infections at low concentrations."

L'actualite sur le traitement des parasitoses intestinales

Les parasitoses intestinales sont frequentes en milieu tropical du fait des conditions socio-economiques et de l'hygiene generale defectueuse. Le medecin; dans sa pratique courante; fait face a ces differentes pathologies. Ce texte presente donc l'attitude therapeutique que doit adopter le medecin face aux parasitoses intestinales les plus frequemment rencontrees

Efecto antihelmíntico de pamoato de oxantel/pirantel y mebendazol en parasitosis intestinales: estudio comparativo en un medio rural / Antihelmintic effect of oxantel/pirantel pamoato and mebendazole in intestinal parasitosis: comparative study in a rural community

90 pacientes de las comunidades rurales de Charallave y Caucagüita, Estado Miranda, Venezuela, comprendidos entre los 2 y 15 años de edad y a los que se les diagnosticó infectación parasitaria por Ascaris, Tricurias, Necator, o mixta por Ascaris-Trichuria, mediante examen de heces directo y fueron divididos en dos grupos de 45 pacientes cada uno, administrándose a uno Pamoato de Oxantel/Pirantel y a otro Mebendazol. Se evaluó la eficacia del tratamiento con Oxantel/Pirantel frente al Mebendazol realizando exámenes de heces control a los 7 y 21 días de concluidos los tratamientos y se encontró que de los 45 pacientes tratados con Oxantel/Pirantel, 43 (95,55%) presentaron curación a los 7 días y todos (100%) a los 21 días, mientras que en el segundo grupo, tratados con Mebendazol, a los 7 días 30 pacientes (66,66%) estaban curados, persistiendo a los 21 días 10 pacientes (22,22%) no curados. El Pamoato de Oxantel/Pirantel aparece como altamente eficaz en el tratamiento individual y masivo de las parasitosis intestinales más frecuentes en el medio rural venezolano