Afecciones cutáneas en trabajadores con empleos de subsistencia y su relación con factores socioambientales y laborales. Medellín, Colombia / Skin conditions in workers with subsistence jobs and related socio-environmental and labor factors. Medellin Colombia

Introducción: La información acerca de lesiones en piel y sus factores asociados, en trabajadores informales en América Latina y el Caribe aun es escasa. Objetivo: Determinar la relación existente entre las condiciones sociodemográficas, ambientales, laborales y la prevalencia de afecciones en la piel auto-reportada por trabajadores informales “venteros” del centro de Medellín. Material y Métodos: Estudio transversal con intención analítica y fuente primaria de información. Se incluyeron 686 trabajadores. Se aplicó encuesta asistida, previa realización de prueba piloto y estandarización de los encuestadores. Variable dependiente; prevalencia de afecciones en piel. Variables independientes; condiciones laborales, sociodemográficas y ambientales. Se realizó control de errores con análisis estadísticos y sesgos de selección e información. Se realizaron análisis univariado, bivariado y multivariado. Resultados: Trabajadores fundamentalmente hombres (57.6%), edades entre 45-59 años, 60,0% procedente de zona rural. Trabajaban > 8 horas/día (80,6%), toda la semana, con > 20 años (50,7%) en su labor. El 72,2% no utilizaba mecanismos de protección personal. 61,5% consideraba que la contaminación ambiental afectaba su labor y su salud. 19,83% presentó afectaciones cutáneas, como; alergias (12,0%), prurito y sarpullido. Menor prevalencia de alergias en hombres (24,0%) y ≥ 60 años. Mayores prevalencias en quienes laboraban >8 horas/día (94,0%), toda la semana (43,0%), con exposición a sustancias químicas (RP=1,88.IC=1,11;3,20), vendedores de mercancía y cacharro (RP =2,06.IC: 1,08;3,91). Conclusión: Explican mayor prevalencia de alergias proceder de la zona urbana, vender mercancía y cacharro, trabajar >8 horas/día, toda la semana, exponerse a sustancias químicas, considerar que la calidad del aire afecta su labor, y presentar comorbilidades (AU)

Introduction: The information on skin lesions and their associated factors in informal workers in Latin America is scarce. Objective: To determine the existing relationship between sociodemographic, environmental and labor conditions and the prevalence of skin conditions, self-reported by informal workers “venteros” from the Medellin downtown. Material and Methods: Cross-sectional study with analytical intention and primary source of information. 686 workers were included. An assisted survey was applied, after conducting a pilot test and standardization of the interviewers. The presence of skin conditions was considered as the dependent variable and the working, sociodemographic and environmental conditions as independent variables. Error control was performed with statistical analysis, selection and information biases were controlled. Univariate and bivariate analysis was performed. Results: Mainly male workers (57.6%), ages 45-59 years, 60.0% from rural areas. They worked> 8 hours / day (80.6%), all week, with> 20 years (50.7%) in their work. 72.2% did not use personal protection mechanisms. 61.5% considered that environmental pollution affected their work and their health. 19.83% presented skin affectations, such as allergies (12.0%), pruritus and rash. Lower prevalence of allergies in men (24.0%) and ≥60 years. Higher prevalences in those who worked> 8 hours / day (94.0%), all week (43.0%), with exposure to chemical substances (PR = 1.88, IC = 1.11, 3.20), sellers of merchandise and equipment (PR = 2.06.IC: 1.08; 3.91). Conclusion: They explain a higher prevalence of allergies coming from the urban area, selling merchandise and junk, working> 8 hours / day, all week, being exposed to chemical substances, considering that air quality affects their work, and presenting comorbidities (AU)

Evaluación del dolor y la distensión abdominal según el agente insuflante (CO 2 frente al aire) en una unidad de endoscopia digestiva avanzada de Manizales, Colombia / Comparison of abdominal pain and distention due to insufflation with CO 2 versus insufflation with air in an advanced digestive endoscopy unit in Manizales, Colombia

Resumen Objetivo: comparar la magnitud del dolor y el perímetro abdominal; la incidencia del dolor y la distensión abdominal, y las complicaciones según el agente insuflante utilizado. Pacientes y método: estudio prospectivo analítico de cohorte. Se recolectaron datos de 43 colangiopancreatografías retrógradas endoscópicas (CPRE) y 20 colonoscopias insufladas con dióxido de carbono (CO2); para cada una se buscó un examen control con aire ambiente. En total, se sumaron 86 CPRE y 40 colonoscopias. Además, se realizó una caracterización clínica, un análisis bivariado y multivariado. Resultados: el procedimiento más doloroso fue la colonoscopia; sin embargo, el 60 % de los pacientes de colonoscopia, y el 70 % de aquellos de CPRE, no presentaron dolor 15 minutos después de haber despertado luego del examen. Asimismo, no se hallaron diferencias estadísticamente significativas según la indicación del examen, la presencia o intensidad de dolor al momento del procedimiento, la edad, el sexo o el diagnóstico. El riesgo relativo (RR) de dolor inmediato fue 4,8 veces superior, cuando la insuflación se realizó con aire en vez de CO2 (RR = 4,8; intervalo de confianza [IC], 95 %: 2,3 a 9,2; p <0,001). Entre tanto, el riesgo de distensión abdominal en el grupo con aire fue 2,6 veces superior, en comparación con el grupo insuflado con CO2 (RR = 2,6; IC, 95 %: 1,8 a 3,9; p <0,001). El CO2 redujo la probabilidad y la magnitud de la distensión abdominal y de los dolores inmediatos, posteriores a la colonoscopia o a la CPRE. No hubo complicaciones en ninguno de los 126 pacientes. Conclusiones: el dolor y la distensión abdominal se presentan con menor frecuencia e intensidad cuando se usa CO2 como agente insuflante. Ninguno de los procedimientos presentó complicaciones mayores.

Abstract Objective: This study compares the incidence of abdominal pain and distension, the magnitude of pain, abdominal perimeter, and related complications related to two different insufflating agents. Patients and Method: Prospective analytical cohort study. Data were collected from 43 performances of endoscopic retrograde cholangiopancreatography (ERCPs) and 20 colonoscopies in which patients were insufflated with CO2. A control examination using ambient air for insufflation was performed for each patient. In total, 86 ERCPs and 40 colonoscopies were performed. The study includes clinical characterizations, bivariate analysis and multivariate analysis. Results: The most painful procedure was colonoscopy, but 60% of colonoscopy patients and 70% of ERCP patients had no pain 15 minutes after waking up following their examinations. No statistically significant differences related to reasons for examination, presence or intensity of pain at the time of the procedure, age, sex or diagnosis were found. The relative risk (RR) of immediate pain is 4.8 times higher when insufflation is done with air instead of CO2 (RR = 4.8; 95% CI: 2.3 to 9.2; p <0.001). The risk of abdominal distension in the air group was 2.6 times higher than that of the group insufflated with CO2 (RR = 2.6; 95% CI: 1.8 to 3.9; p <0.001). CO2 reduces the likelihood and extent of abdominal distension and immediate post colonoscopy or ERCP pain. There were no complications in any of the 126 patients. Conclusions: Abdominal pain and bloating occur less frequently and less intensely when CO2 is used as an insufflating agent. None of the procedures presented major complications.

Estado actual del diagnóstico y manejo de la pancreatitis crónica / The current state of diagnosis and management of chronic pancreatitis

Resumen La pancreatitis crónica (PC) es una condición inflamatoria que lleva a fibrosis, con destrucción y compromiso del parénquima pancreático y de los ductos. Estos cambios permanentes pueden llevar a alteración de la función pancreática tanto exocrina como endocrina, estenosis biliares y pancreáticas, que llevan a su vez a otras consecuencias, como la formación de pseudoquistes, incluso incrementa la posibilidad de desarrollar cáncer de páncreas. La principal característica clínica de estos pacientes es el dolor, el cual altera de forma importante su calidad de vida. Para diagnosticar la PC contamos con pruebas funcionales, las cuales se pueden dividir en directas o indirectas, y pruebas de estructura pancreática. El gran reto de estos métodos consiste en diagnosticar la enfermedad en estadios iniciales, donde la aproximación diagnóstica es más difícil por la sutileza de los cambios. Una vez diagnosticada la PC, el manejo también debe ser escalonado; este se puede dividir a su vez en manejo médico, como paso inicial, manejo endoscópico y manejo quirúrgico o, en los casos más difíciles, la combinación de estos. El objetivo es manejar y entender al paciente y su enfermedad como un todo, con el fin de proporcionarle la mejor calidad de vida posible al paciente. A continuación, se presenta una revisión enfocada en el diagnóstico y manejo de esta entidad a la luz de la evidencia actual disponible.

Abstract Chronic pancreatitis (CP) is an inflammatory condition that leads to fibrosis, damage, and even destruction of the pancreatic parenchyma and ducts. These permanent changes can alter pancreatic exocrine and endocrine functioning, cause biliary and pancreatic stenosis, lead to formation of pseudocysts and even increase the possibility of developing pancreatic cancer. The main clinical characteristic is pain which significantly alters quality of life. To diagnose the CP, we have direct and indirect functional tests and the pancreatic structure test. The great challenge of these methods is early diagnosis, but this is difficult due to the subtlety of changes. Once CP is diagnosed, management must be staggered. Medical management is the initial step which can be followed by endoscopic management, surgical management, and for the most difficult cases a combination of these. The goal is to manage and understand the whole patient and illness to provide the best possible quality of life. This review article focuses on CP diagnosis and management in light of the currently available evidence.

Early childhood caries, salivary and microbiological aspects among 3- to 4-year-old children in Cali, Colombia.

AIM: To investigate the presence of early childhood caries (ECC) in relation to plaque index, colony-forming units of Streptococcus mutans (S. mutans) and Lactobacillus spp., pH and salivary buffer capacity in day-care pre-schooler's aged 3-4 years old in Cali, Colombia, 2016. METHODS: Caries prevalence was determined in 124 children using the International Caries Detection and Assessment System and plaque index. In addition, a non-stimulated saliva sample was obtained to determine its pH, and buffer capacity. RESULTS: 55.65% of the children had ECC. The mean decayed-missing-filled teeth index was 2.94 ± 4.26. The absence or presence of ECC, compared to the median plaque index showed statistically significant differences (p < 0.05). There was not an association between ECC and S. mutans, Lactobacillus spp. colonies, pH and buffer capacity of saliva. CONCLUSIONS: This study reported association between ECC and the increasing amount of bacterial plaque. Other important biological risk factors were not associated with ECC. Regular tooth cleaning can be the most important public health measure to control ECC in day-care children.

Linfoma no Hodgkin B folicular extranodal que afecta al colon: a propósito de un caso / Extra nodal follicular non-Hodgkin B lymphoma affecting the colon, on the basis of a case

Resumen Introducción: el linfoma no Hodgkin (LNH) es una enfermedad maligna que presenta una forma extraganglionar que afecta al tracto gastrointestinal hasta en un 50 % de los casos; el colon es el órgano que con menor frecuencia se ve comprometido por este linfoma. En los pocos casos que presentan afección, el compromiso es principalmente del ciego, por su gran contenido linfoide. Este caso es el de una paciente con compromiso del colon por masa en el ciego. Las biopsias reportan LNH folicular grado II, patrones folicular y difuso, siendo este tipo histológico el de mayor prevalencia y el que ha mostrado los mejores resultados con el manejo con quimioterapia (esquema R-CHOP) sola o en conjunto con radioterapia; también, en ocasiones, con cirugía. La paciente recibió tratamiento con evolución adecuada. La terapia conjunta es la que ha demostrado mayor sobrevida, aunque hay estudios en los que se han reportados buenos resultados con monoterapia, como el caso en cuestión. Caso clínico: mujer de 38 años, en quien se realiza una colonoscopia que muestra una lesión tumoral en el ciego, con patología compatible con LNH tipo B folicular extranodal, confirmado por inmunohistoquímica. Los estudios de extensión imagenológicos confirman la presencia de adenopatías abdominales y torácicas en conglomerados. Oncología inicia el manejo con quimioterapia con protocolo R-CHOP, con buena respuesta. Discusión y conclusiones: el LNH extranodal afecta muy rara vez al colon, razón por la que este caso es reportado. El manejo puede ser multidisciplinario y su pronóstico depende de las características individuales en cada caso.

Abstract Introduction: Non-Hodgkin's lymphoma (NHL) is a malignant disease that presents in an extranodal form. It affects the gastrointestinal tract in up to 50% of cases with the colon being the least frequently compromised portion. In the few cases in which it is affected, the cecum is most often compromised due to its large lymphoid content. The colon of the patient presented here was compromised by a mass in the cecum. Biopsies showed grade II follicular NHL with follicular and diffuse patterns. This histological type has the highest prevalence and has shown the best results with chemotherapy (R-CHOP scheme) alone and in conjunction with radiation therapy and occasionally with surgery. The patient received treatment followed by adequate evolution. Combination therapy has been shown to result in longer survival times, although there are studies which have reported good results with monotherapy as in this case. Clinical Case: The patient was a 38-year-old woman. A colonoscopy showed a tumor in the cecum. Its pathology was compatible with extra-follicular follicular NHL type B which was confirmed by immunohistochemistry. Imaging extension studies confirmed abdominal and thoracic adenopathies in conglomerates. The oncology department treated the patient with a chemotherapy with R-CHOP protocol with a good response. Discussion and conclusions: Since extranodal NHL rarely affects the colons, this case deserved to be reported. Management can be multidisciplinary, but the prognosis depends on individual characteristics in each case.

Incisión radial y corte endoscópico en el manejo de estenosis esofágica anastomótica refractaria. Reporte de un caso / A case of refractory anastomotic esophageal stenosis managed with a radial incision and endoscopic cutting

Resumen Una causa poco frecuente de estenosis esofágica es la que se presenta después de una anastomosis esofagoyeyunal, la cual puede llevar a comprometer la calidad de vida del paciente y su estado nutricional, que requiere un manejo endoscópico inicial con balón de dilatación o con bujías (con el riesgo que ellas generan); pero hay un grupo de pacientes quienes, a pesar de la dilatación, no encuentran mejoría, por lo que persisten con la estenosis y, por tanto, con su sintomatología. En este último tipo de pacientes con estenosis refractarias al manejo con dilatación se realiza la técnica de incisión radiada y corte endoscópico con electrobisturí de punta, con buenos resultados. Se presenta el caso de un paciente con una estenosis postoperatoria a nivel de la anastomosis esofagoyeyunal, a quien se le dio un manejo inicial con dilatación refractaria y requirió una incisión radiada y corte endoscópico con electrobisturí de punta, y obtuvo mejores resultados en su calidad de vida.

Abstract Esophageal stenoses very rarely occur after an esophagojejunal anastomosis, but when they do they can compromise patients' quality of life and nutritional status and may require endoscopic management with balloon dilation or with plugs which entail risks. Nevertheless, there is a group of patients who do not improve after dilation, whose stenoses persist, and who therefore continue to be symptomatic. For a patient with a stenosis that is refractory to dilation, a radial incision and endoscopic cutting with an electric scalpel can be performed with good results. We present the case of a patient with a postoperative stenosis at the esophagojejunal anastomosis who was refractory to initial dilation, who required a radial incision cut with an endoscopic electric scalpel whose improvement led to a better quality of life.

Hepatitis autoinmune y cáncer de colon: una asociación inusual. Caso clínico y revisión de la literatura / A case of an unusual association of autoimmune hepatitis and colon cancer: report and literature review

Resumen Introducción: la hepatitis autoinmune idiopática (HAI) es una enfermedad crónica que predomina en mujeres, con episodios de actividad y remisión, favoreciendo la fibrosis hepática. El 40% de los pacientes presenta historia familiar de enfermedades autoinmunes. Al parecer, es mediada por la interacción antígeno-anticuerpo; sin embargo, su causa es desconocida. Se conoce la asociación frecuente de HAI con cáncer hepatobiliar; menos frecuente con linfomas, cáncer de piel y cáncer de colon; y casi inexistente con síndromes hereditarios de cáncer de colon. Este caso debutó con HAI y sangrado rectal causado por poliposis adenomatosa familiar (PAF) y adenocarcinoma de colon sigmoide. Caso clínico: mujer de 51 años con HAI de 1 año de evolución manejada con prednisolona y azatioprina. Se realizó una colonoscopia total por anemia en la que se encontraron múltiples pólipos entre 5 y 10 mm y 1 de 30 mm sésil, ulcerado, en colon sigmoide. Se realizó una polipectomía endoscópica múltiple que reportó un adenoma tubulovelloso con displasia de alto y bajo grado en varios pólipos y un adenocarcinoma de bajo grado en el pólipo del sigmoide. Los estudios de extensión fueron negativos para metástasis. Se realizó una repleción nutricional prequirúrgica, luego una colectomía subtotal y una procto-ileoanastomosis con ileostomía de protección. La patología de pieza quirúrgica mostró un adenocarcinoma de colon de bajo grado y adenomas tubulares y tubulovellosos con displasias de alto y bajo grado. Discusión y conclusiones: La asociación de HAI con PAF y cáncer colorrectal (CC) es infrecuente. Es conocida la correlación de HAI con cáncer hepatobiliar (asociado con cirrosis), linfomas, cáncer de piel y otros desórdenes autoinmunes. El pronóstico es malo y no puede establecerse una correlación clara con moduladores inmunes.

Abstract Introduction: Idiopathic autoimmune hepatitis (IAH) is a chronic disease that occurs predominately in women, has episodic activity and remission, and favors hepatic fibrosis. Forty percent of patients have family histories of autoimmune diseases. It is apparently mediated by antigen-antibody interaction, but its causes are unknown. IAH is frequently associated with hepatobiliary cancer, less frequently with lymphomas, skin cancer and colon cancer and very rarely with hereditary colon cancer syndrome. This case debuted IAH and rectal bleeding caused by familial adenomatous polyposis (FAP) and adenocarcinoma of the sigmoid colon. Clinical case: The patient was a 51-year-old woman who had had IAH for one year which had been managed with prednisolone and azathioprine. A total colonoscopy, performed because of anemia, found multiple polyps that measured 5 and 10 mm and one ulcerated 30 mm sessile polyp in the sigmoid colon. A multiple endoscopic polypectomy revealed a tubulovillous adenoma with high and low grade dysplasia in several polyps and a low grade adenocarcinoma in the sigmoid polyp. Tests and examinations for metastasis were negative. Following presurgical nutritional repletion, a subtotal colectomy was performed and an ileal pouch-anal anastomosis with protective ileostomy was created. The pathology of the surgical specimen showed low grade adenocarcinoma of the colon and tubular and tubulovillous adenomas with high and low grade dysplasia. Discussion and conclusions: Association of IAH with familial adenomatous polyposis (FAP) and colorectal cancer (CC) occurs infrequently although associations of IAH with hepatobiliary cancer associated with cirrhosis, lymphomas, skin cancer and other autoimmune disorders are well-known. The prognosis is bad and no clear correlation with immune modulators can be established.

Neuropsychiatric SLE: from animal model to human.

Animal models are a key element in disease research and treatment. In the field of neuropsychiatric lupus research, inbred, transgenic and disease-induced mice provide an opportunity to study the pathogenic routes of this multifactorial illness. In addition to achieving a better understanding of the immune mechanisms underlying the disease onset, supplementary metabolic and endocrine influences have been discovered and investigated. The ever-expanding knowledge about the pathologic events that occur at disease inception enables us to explore new drugs and therapeutic approaches further and to test them using the same animal models. Discovery of the molecular targets that constitute the pathogenic basis of the disease along with scientific advancements allow us to target these molecules with monoclonal antibodies and other specific approaches directly. This novel therapy, termed "targeted biological medication" is a promising endeavor towards producing drugs that are more effective and less toxic. Further work to discover additional molecular targets in lupus' pathogenic mechanism and to produce drugs that neutralize their activity is needed to provide patients with safe and efficient methods of controlling and treating the disease.

Cross-reactivity between annexin A2 and Beta-2-glycoprotein I in animal models of antiphospholipid syndrome.

Antiphospholipid syndrome (APS) affects coagulation and the brain by autoimmune mechanisms. The major antigen in APS is beta-2-glycoprotein I (ß2-GPI) is known to complex with annexin A2 (ANXA2), and antibodies to ANXA2 have been described in APS. We measured these antibodies in mice with experimental APS (eAPS) induced by immunization with ß2-GPI. Sera of these mice reacted significantly with recombinant ANXA2 by enzyme-linked immunosorbent assay (ELISA) and the eAPS mice had significantly high levels of immunoglobulin G (IgG) in the brain by immunoblot assays compared to adjuvant immunized controls. Immunoprecipitation performed by mixing eAPS brain tissue with protein-G beads resulted in identification of two autoantigens unique to the eAPS group, one of which was ANXA2. In order to study more directly and methodically the specific role of anti-ANXA2 antibodies in APS, we immunized mice with ß2-GPI which contained no ANXA2 or with ANXA2 and measured antibodies to these proteins. Levels of antibodies to ANXA2 measured by ELISA were 0.72 ± 0.007 arbitrary units (a.u), 0.24 ± 0.03 and 0.02 ± 0.01 a.u for sera from ANXA2, ß2-GPI and control mice, respectively (p < 0.0001 and p = 0.037 for the comparison of the ANXA2 and ß2-GPI groups to the controls). Purified IgG from ß2-GPI sera did not show cross-binding with ANXA2. Antibodies to ß2-GPI and phospholipids were found in the ß2-GPI immunized group only. The present study suggests an immune response to the ß2-GPI-ANXA2 complex in eAPS and provides a novel ANXA2 immunization model which will serve to study the role of ANXA2 antibodies in of APS.

Validez diagnóstica de la endosonografía biliopancreática en el diagnóstico de colangitis aguda secundaria a obstrucción biliar / Diagnostic Validity of Biliopancreatic Endosonography in the Diagnosis of Acute Cholangitis Secondary to Biliary Obstruction

Resumen El diagnóstico de las colangiopatías obstructivas por endosonografía biliopancreática (EUS, por sus siglas en inglés) se ha estudiado en profundidad, y existe un extenso reconocimiento de su papel para el diagnóstico de coledocolitiasis, tumores de la encrucijada biliopancreática y síndromes de compresión extrínseca de la vía biliar. La colangitis, la complicación más frecuente de la obstrucción biliar y responsable de gran parte de su morbimortalidad, no se ha relacionado en forma suficiente con los hallazgos endosonográficos. Nuestro estudio buscó definir la validez diagnóstica de la endosonografía en los pacientes con colangitis aguda con el fin de limitar la morbimortalidad del retraso diagnóstico. Se realizó un estudio descriptivo, analizando las historias clínicas de pacientes sometidos a endosonografía biliopancreática, por ictericia obstructiva de cualquier etiología, y quienes posteriormente fueron llevados a colangiopancreatografía retrógrada endoscópica (CPRE) para manejo de obstrucción biliar. Comparamos los hallazgos endosonográficos compatibles con colangitis aguda (engrosamiento de la vía biliar de 1,5 mm o más, presencia de halo pericolangítico de al menos 1,5 cm de longitud y presencia de contenido de ecogenicidad mixta en el interior de la vía biliar) con el drenaje purulento durante la CPRE. Se encontró una alta frecuencia de estos hallazgos en los pacientes con colangitis, y el engrosamiento de las paredes de la vía biliar fue el más común, en el 92,6% de los casos, seguido por la presencia de halo pericolangítico en el 59,3% de los casos y contenido ductal en el 66,7% de los casos. Igualmente, se encontró asociación ascendente de las frecuencias con grado de severidad de la colangitis. Resulta recomendable realizar estudios con un mayor poder estadístico que permitan validar nuestros resultados para una futura inclusión de la EUS en el algoritmo diagnóstico de las guías de práctica clínica en colangitis aguda.

Abstract Diagnosis of obstructive cholangiopathy with biliopancreatic endosonography (BUS) has been extensively studied, and its role in the diagnosis of choledocholithiasis, biliopancreatic junction tumors and extrinsic biliary compression syndromes is widely recognized. Endosonographic diagnosis of cholangitis, a more frequent complication of biliary obstruction which is responsible for much of its morbidity and mortality, has not been sufficiently studied. Our study's objective is to define the diagnostic validity of endosonography for patients with acute cholangitis in order to limit morbidity and mortality due to diagnostic delay. This is a descriptive study that analyzes clinical histories of patients who underwent biliopancreatic endosonography because of obstructive jaundice of any etiology and who later underwent endoscopic retrograde cholangiopancreatography (ERCP) to manage biliary obstruction. We compared endosonographic findings compatible with acute cholangitis: thickening of the bile duct of 1.5 mm or more, periportal halo sign of at least 1.5 cm in length, mixed echogenicity of bile duct content, and purulent drainage during ERCP. Patients with cholangitis most frequently presented thickened gallbladders (92.6% of cases) periportal halo signs (59.3% of cases) and mixed echogenicity of bile duct content (66.7% of cases). We also found an ascending association of frequencies with the degree of severity of cholangitis. Studies with greater statistical power are needed for validation of our results and for future inclusion of EUS in the diagnostic algorithm for clinical practice guidelines in cases of acute cholangitis.

Hallazgos en endosonografía anorrectal en una cohorte prospectiva / Findings from anorectal endosonography in a prospective cohort

La endosonografía anorrectal permite diagnosticar múltiples patologías del canal anal y del recto. En Colombia se realiza en pocos sitios y es escaso el personal entrenado para ello. Un grupo de docentes de gastroenterología clínica quirúrgica de la Universidad de Caldas recibió entrenamiento en endosonografía anorrectal en Chile y España, después de lo cual inició su trayectoria, ya de 4 años. Con los datos del último año se realizó un estudio descriptivo en una cohorte prospectiva, tomando la información de los pacientes a quienes se les realizó endosonografía anorrectal entre octubre de 2014 y septiembre de 2015. Se obtuvieron datos de 136 pacientes, predominando el género femenino (72,05%); el 20,6% de los pacientes procedían de departamentos diferentes a Caldas. La principal indicación fue incontinencia fecal en 44 pacientes (32,35%), siendo 86% mujeres; otras indicaciones fueron neoplasia maligna rectal (23,5%), fístula perianal (12,5%), proctalgia (11,03%), endometriosis (7,35%) y absceso perianal (6,62%). El diagnóstico final más frecuente fue defecto de los esfínteres en 40 pacientes (29,41%), seguido por neoplasia maligna rectal (13,24%), fístula perianal (11,76%), absceso perianal (8,82%) y neoplasia benigna rectal (6,62%). Los resultados están en congruencia con la literatura mundial, donde la principal indicación es la incontinencia fecal en relación con el diagnóstico final, que es defectos de los esfínteres por alteraciones obstétricas. La endosonografía anorrectal es de gran importancia como método diagnóstico único o de apoyo para otros, con centros de referencia como el nuestro, donde se realiza en un volumen importante y siguiendo las pautas internacionales recomendadas.

Anorectal endosonography can diagnose many diseases of the anal canal and rectum. In Colombia, the procedure is performed in only a few medical centers because of the scarcity of trained personnel. Four years ago, a group of teachers from the gastroenterological surgery clinical at the University of Caldas received training in endoluminal ultrasonography in Chile and Spain and have been practicing these procedures ever since. This is a descriptive study of a prospective cohort using data from patients who underwent endoluminal ultrasonography between October 2014 and September 2015. Data were obtained from 136 patients, of whom 72.05% were women. 20.6% of the patients came from departments other than Caldas. Fecal incontinence was the reason for the procedure for 44 patients (32.35%, 86% of whom were women). Other indications were rectal malignancies (23.5%), perianal fistulas (12.5%), anal pain (11.03%), endometriosis (7.35%), and perianal abscesses (6.62%). The most common final diagnoses were defective sphincters in 40 patients (29.41%), rectal malignancy in 13.24% of the patients, perianal fistulas in 11.76% of the patients, perianal abscesses in 8.82% of the patients, and benign rectal neoplasms in 6.62% of the patients . The results are consistent with those found in the international literature where the most common final diagnoses reported for the reason for fecal incontinence are sphincter defects and obstetric disorders. Anorectal endosonography is of great importance when used alone or to support other diagnostic tools. It is recommended that this procedure be done in a referral center such as ours which performs a large volume of these procedures and which follows international guidelines.

Advances in the Interpretation of Tomographic Images as an Early Detection Method of Oil Palm Affected by Basal Stem Rot in Colombia.

Basal stem rot, one of the most important diseases of oil palm in Southeast Asia, has also been identified in Colombia. The increase in disease incidence in the last decade has attracted the attention of producers and researchers. In the search for a procedure that allows for the early identification of diseased palm, Cenipalma evaluated the use of electrical impedance tomography to identify the different stages of development of basal stem rot. The tomograms were compared with transversal sections of healthy and diseased oil palm trees. Following Cenipalma's preliminary studies on early diagnosis of basal stem rot with tomography, the present study improved upon the technique by analyzing the tomograms of 209 diseased palm trees (confirmed by symptomatology), 346 asymptomatic palm trees, and 132 healthy palm trees. The minimum and maximum electric impedance values as well as the ratio between these values was recorded. The range of 1 to 95 Ω was used to represent the internal damage. The ratios averaged 5.1 for diseased, 1.9 for asymptomatic, and 1.5 for healthy palm trees. With the range and the ratio criteria established, it was possible to identify the disease in 100% of asymptomatic sampled palm trees. This study demonstrated that electrical impedance tomography is a powerful tool for early detection of basal stem rot, which can be used to establish an early disease management program.

Ultrasonido endoscópico en patologías del páncreas / Endoscopic ultrasound in pancreatic diseases

El ultrasonido endoscópico (EUS) ha revolucionado el diagnóstico y el manejo de muchas patologías de la vía digestiva, particularmente la patología pancreática, convirtiéndose en un examen prácticamente imprescindible en el abordaje diagnóstico y terapéutico de un paciente con un problema de páncreas. Es necesario dejar en claro que el método no es único y que para lograr una sensibilidad alta y cumplir el objetivo de realizar lo más adecuado, debe sumarse a otros métodos de acuerdo a cada caso, como la ecografía, la tomografía axial computarizada (TAC), la resonancia magnética (MRI) en sus diferentes modalidades, y las pruebas del laboratorio clínico microbiológico y patología. En este artículo se revisarán algunos casos de enfermedades evaluadas con este método, que muestran por qué el EUS, es una herramienta clave para el médico de urgencias y de consulta externa, el internista, el cirujano, el médico del servicio hospitalario y el personal de salud en general, al momento de definir, clasificar y orientar el manejo de determinadas patologías en el tubo digestivo. El EUS es una importante ayuda y no debe ser extraña al personal médico, debe tenerla presente junto a las demás pruebas diagnósticas en patología pancreática. Se señalarán los aspectos más relevantes en cada caso y las indicaciones del EUS.

Endoscopic ultrasound (EUS) has revolutionized the diagnosis and management of many diseases of the digestive tract, particularly the pancreatic ones, becoming a practically essential test in the diagnosis and therapeutic management of a patient with a pancreatic problem. It's necessary to establish the final diagnosis are necesary many tests to achive high sensitivity. It should join with other methods according to each case, such as ultrasound, computed tomography (CT), magnetic resonance imaging (MRI) in its various forms, and chemical, microbiological and pathology tests. In this article we reviewed some cases of pathologies evaluated by this diagnosis test, which demonstrate why the EUS, is a key for the emergency and outpatient physician, internist, surgeon, doctor of the hospital service and staff health in general, when defining, classifying and guide the management of certain diseases in the digestive tract. The EUS is an important tool and should not be foreign to the medical staff, who must consider it, with other diagnostic tests for pancreatic disease. This article point out the most important aspects in each case and indications of EUS.

Autoimmune cytopenias after umbilical cord blood transplantation in adults with hematological malignancies: a single-center experience.

We describe incidence, clinical features, serological data, response to therapy and outcome of autoimmune cytopenias (ACs), including autoimmune hemolytic anemia (AIHA) and autoimmune thrombocytopenia (AIT) in a series of 281 consecutive adults with hematological malignancies that received single-unit umbilical cord blood transplantation (UCBT) at a single institution. AIHA was diagnosed in 15 patients at a median time of 181 days (range, 25-543), 12 of them had cold antibodies (IgM). The 3-year cumulative incidence (CI) of AIHA was 5.4% (CI 95% 2.7-8.1). Concomitant infections at the time of AIHA were present in 10 patients. Five out of nine patients that received corticosteroids achieved either a PR or a CR, whereas six out of eight patients that received rituximab responded. Four patients developed AIT giving a 3-year CI of 1.4% (CI 95% 0-2.8), concomitant infections were present in three of them. Multivariable analysis showed that development of chronic GVHD (relative risk (RR) 4; 95% CI 1.1-13.7; P=0.03) and diagnosis of CML (RR 4.3; 95% CI 1.5-12.7; P=0.008) were associated with an increased risk of AC. In conclusion, AIHA and AIT are relevant and clinically significant complications in UCBT recipients, especially among those that develop chronic GVHD. Response to therapy is sub-optimal, and rituximab should be considered as a therapeutic option, in this setting were most patients had cold AIHA and a serological profile similar to that seen in cold agglutinin disease.

EBV-associated post-transplant lymphoproliferative disorder after umbilical cord blood transplantation in adults with hematological diseases.

We analyzed the incidence, clinicopathological features, risk factors and prognosis of patients with EBV-associated post-transplant lymphoproliferative disorder (EBV-PTLD) in 288 adults undergoing umbilical cord blood transplantation (UCBT) at a single institution. Twelve patients developed proven EBV-PTLD at a median time of 73 days (range, 36-812). Three-year cumulative incidence (CI) of EBV-PTLD was 4.3% (95% CI: 1.9-6.7). All patients presented with extranodal involvement. Most frequently affected sites were the liver, spleen, central nervous system (CNS), Waldeyer's ring and BM in 7, 6, 4, 3 and 3 patients, respectively. One patient had polymorphic and 11 had monomorphic EBV-PTLD (7 diffuse large B-cell lymphomas not otherwise specified, 4 plasmablastic lymphomas). We confirmed donor origin and EBV infection in all histological samples. EBV-PTLD was the cause of death in 11 patients at a median time of 23 days (range, 1-84). The 3-year CI of EBV-PTLD was 12.9% (95% CI: 3.2-22.5) and 2.6% (95% CI: 0.5-4.7) for patients receiving reduced-intensity conditioning (RIC) and myeloablative conditioning, respectively (P<0.0001). In conclusion, adults with EBV-PTLD after UCBT showed frequent visceral and CNS involvement. The prognosis was poor despite routine viral monitoring and early intervention. An increased risk of EBV-PTLD was noted among recipients of RIC regimens.

Efectos del consumo de alcohol vía vaginal en adolescentes en cuatro colegios de la ciudad de Medellín, Colombia / Effects of alcohol vaginally in adolescents in four schools in the city of Medellin, Colombia

Antecedentes: La adolescencia es una etapa de la vida en la que los adolescentes intentan reafirmar su independencia y en muchas ocasiones se puede ver esto rechazando la escala de valores de sus padres. No es de sorprender que en este proceso los adolescentes tengan un consumo mayor de alcohol, el cual puede traer muchas consecuencias tanto en la salud física como psicológica y social. Adicional al consumo vía oral las jóvenes buscan vías alternas para evitar ser descubiertos por la sociedad como es el uso de la vía vaginal. Objetivo: Describir los efectos del uso de alcohol vía vaginal y su entorno social en adolescentes escolarizadas. Método: Estudio descriptivo, en el que se efectuaron 1028 encuestas a las adolescentes de los grados 9, 10 y 11 de cuatro colegios de diferente estrato socio-económico en la ciudad de Medellín. El análisis y la interpretación de los datos se realizaron mediante estadística descriptiva. Resultados: El consumo de alcohol en las adolescentes escolarizados es frecuente tanto vía oral como vaginal en un 59,2 por ciento y 1,7 por ciento respectivamente. El uso vaginal se acompaña de efectos locales y sistémicos. Los efectos locales en los genitales más frecuentes fueron: ardor, prurito y edema vulvo-vaginal; los efectos sistémicos se presentaron en la primera hora de uso con sensación de "borrachera". Conclusión: El consumo de alcohol vía oral y vaginal es frecuente en las adolescentes con efectos locales y sistémicos.

Background: Adolescence is a stage in life when adolescents try to reaffirm their independence. In many occasions this can be observed in their disregard of their parents' values scale. It is not a surprise that through this process adolescents consume more alcohol; which brings many psychological, social and physical health consequences. In addition to the oral consumption, adolescents look for alternative ways to avoid being discovered. Consumption via vagina is one example. Aims: Describe the side effects of alcohol consumption via vagina and the social environment of schooled adolescents. Method: Descriptive study in which 1028 surveys were administered to adolescents from 9°, 10° and 11° grades in 4 different socio-economic level schools in Medellin. The analysis and interpretation of the data was performed using descriptive statistics. Results: Schooled adolescents frequently consume alcohol orally in 59.2% as well as via vagina in 1.7%. The consumption via vagina brings with it local and systemic side effects. The most frequent local side effects in the genital area were burning sensation, itching, vulvo-vaginal edema. The only systemic side effect present during the first hour after consumption was a drunken sensation. Conclusion: The consumption of alcohol orally and via vagina is frequent among adolescents bringing with it local and systemic side effects.

Altered precipitation regime affects the function and composition of soil microbial communities on multiple time scales.

Climate change models predict that future precipitation patterns will entail lower-frequency but larger rainfall events, increasing the duration of dry soil conditions. Resulting shifts in microbial C cycling activity could affect soil C storage. Further, microbial response to rainfall events may be constrained by the physiological or nutrient limitation stress of extended drought periods; thus seasonal or multiannual precipitation regimes may influence microbial activity following soil wet-up. We quantified rainfall-driven dynamics of microbial processes that affect soil C loss and retention, and microbial community composition, in soils from a long-term (14-year) field experiment contrasting "Ambient" and "Altered" (extended intervals between rainfalls) precipitation regimes. We collected soil before, the day following, and five days following 2.5-cm rainfall events during both moist and dry periods (June and September 2011; soil water potential = -0.01 and -0.83 MPa, respectively), and measured microbial respiration, microbial biomass, organic matter decomposition potential (extracellular enzyme activities), and microbial community composition (phospholipid fatty acids). The equivalent rainfall events caused equivalent microbial respiration responses in both treatments. In contrast, microbial biomass was higher and increased after rainfall in the Altered treatment soils only, thus microbial C use efficiency (CUE) was higher in Altered than Ambient treatments (0.70 +/- 0.03 > 0.46 +/- 0.10). CUE was also higher in dry (September) soils. C-acquiring enzyme activities (beta-glucosidase, cellobiohydrolase, and phenol oxidase) increased after rainfall in moist (June), but not dry (September) soils. Both microbial biomass C:N ratios and fungal:bacterial ratios were higher at lower soil water contents, suggesting a functional and/or population-level shift in the microbiota at low soil water contents, and microbial community composition also differed following wet-up and between seasons and treatments. Overall, microbial activity may directly (C respiration) and indirectly (enzyme potential) reduce soil organic matter pools less in drier soils, and soil C sequestration potential (CUE) may be higher in soils with a history of extended dry periods between rainfall events. The implications include that soil C loss may be reduced or compensated for via different mechanisms at varying time scales, and that microbial taxa with better stress tolerance or growth efficiency may be associated with these functional shifts.

Sacrocolpopexia laparoscópica para el tratamiento del prolapso apical: resultados y seguimiento a largo plazo / Laparoscopic sacrocolpopexy for apical prolapse

Objetivos: Evaluar los resultados subjetivos, anatómicos y funcionales a largo plazo de las pacientes sometidas a sacrocolpopexia laparoscópica para manejo de prolapso apical. Métodos: Estudio observacional con pacientes a quienes se les hizo sacrocolpopexia laparoscópica entre febrero de 2006 y diciembre de 2012, en tres centros. El nivel de soporte del piso pélvico se midió mediante la escala de cuantificación del prolapso de órganos pélvicos (POP-Q). Los resultados funcionales se evaluaron mediante un cuestionario de síntomas intestinales, urinarios, sexuales y de molestias físicas. También se estimó la satisfacción global de las pacientes con una escala de uno a diez. Resultados: Se realizó sacrocolpopexia laparoscópica a 68 pacientes, pero el seguimiento fue posible sólo en 24. Ninguna paciente tuvo prolapso apical postoperatorio. El punto C medio del POP-Q fue -6,8 cm. Se observó mejoría importante con respecto a los síntomas subjetivos de prolapso con reducciones significativas en las puntuaciones del cuestionario en el seguimiento postoperatorio. La satisfacción fue en promedio de 9,1. La incontinencia urinaria preoperatoria se resolvió en el 35 por ciento de las que la reportaron, sin necesidad de cirugía de continencia concomitante. No hubo complicaciones a corto plazo. A largo plazo hubo una hernia incisional en el sitio del trocar y una obstrucción intestinal por la malla. Conclusión: La sacrocolpopexia laparoscópica es un tratamiento quirúrgico seguro y eficaz para el prolapso apical post-histerectomía. Proporciona un excelente soporte apical y buen nivel de satisfacción, con una mejoría general de los síntomas de prolapso.

Objective: To evaluate the long-term subjective, anatomical and functional outcomes after laparoscopic sacrocolpopexy for apical prolapse. Methods: An observational study of women undergoing laparoscopic sacrocolpopexy between February 2006 and December 2012 was undertaken, at three centers. Pelvic organ support was assessed objectively using the pelvic organ prolapse quantification scale (POP-Q). Functional outcomes were assessed using a questionnaire of bowel, urinary, sexual and physical discomfort symptoms postoperatively. Also was assessed the overall satisfaction of surgery with a scale of one to ten. Results: During the period of the study, sacrocolpopexy was done in 68 patients, but follow-up was possible only in 24. At a mean follow up of 34 months, all 24 women had stage 0 vault support with point C of the POP-Q score averaging -6.8 cm. Subjective improvements in prolapse symptoms were observed with significant reductions in the questionnaire scores. The satisfaction measured with visual scale averaged 9.1. Fifteen women reported stress urinary incontinence before sacrocolpopexy, and it was resolved in 35 percent without concomitant continence surgery. New onset incontinence was reported in two women. There were no intraoperative and perioperative complications. The long term complications were an incisional hernia on the trocar port site and bowel obstruction caused by the mesh that needed intestinal resection. Conclusions: Laparoscopic sacrocolpopexy is a safe and effective surgical treatment for post-hysterectomy apical prolapse. It provides excellent apical support and good level of satisfaction, with overall improvement in prolapse symptoms.

Mycorrhizal fungi inoculation and phosphorus fertilizer on growth, essential oil production and nutrient uptake in peppermint (Mentha piperita L. ) / Inoculação com fungos micorrízicos e adubação fosfatada no crescimento, produção de óleo essencial e absorção de nutrientes em hortelã-pimenta (Mentha piperita L. )

This study evaluated the effects of inoculation with the arbuscular mycorrhizal fungi Glomus mosseae, Glomus intraradices A4 and Glomus intraradices B1 and two phosphorus levels (10 and 40 mg kg-1) on root colonization, plant growth, nutrient uptake and essential oil content in Mentha piperita L. The experiment was carried out in a greenhouse, in 4x2 factorial arrangement, in completely randomized design. At sixty days after transplanting, the mycorrhizal plants had significantly higher fresh matter, dry matter and leaf area compared to non-mycorrhizal plants. The inoculation increased P, K and Ca levels in the shoot which were higher under 40 mg P kg-1 of soil. Plants grown with 40 mg P kg-1 soil increased the essential oil yield per plant by about 40-50% compared to those cultivated with 10 mg P kg-1, regardless of the mycorrhizal treatment. Among the studied fungal species, inoculation with G. intraradices A4 and a high level of P significantly increased plant growth and essential oil yield, compared to the other studied mycorrhizal fungal species. In conclusion, inoculation of arbuscular mycorrhizal fungi into peppermint plants is a feasible alternative to increase the essential oil production and reduce the use of fertilizers required to obtain economic production of peppermint under phosphorus-deficient soil condition.

Este estudo avaliou os efeitos da inoculação de fungos micorrízicos arbusculares Glomus mosseae, Glomus intraradices A4 e Glomus intraradices B1 e duas doses de fósforo (10 e 40 mg kg-1) sobre a colonização radicular, crescimento, absorção de nutrientes e óleos essenciais em Mentha piperita L. O estudo foi conduzido em casa de vegetação no delineamento inteiramente casualizado em esquema fatorial 4x2. Sessenta dias após o transplantio, as plantas micorrizadas apresentaram massa fresca, massa seca, e área foliar significativamente maior em comparação as não-micorrizadas. A inoculação aumentou o teor de P, K e Ca na parte aérea sendo superiores em 40 mg P kg-1 de solo. As plantas cultivadas com 40 mg P kg-1 de solo aumentaram a produção de óleo essencial por planta cerca de 40-50% em relação às cultivadas com 10 mg de P kg-1, independentemente da micorrização. Dentre as espécies fúngicas estudadas, a inoculação com G. Intraradices A4 e com um elevado nível de P, aumentou significativamente o crescimento e rendimento de óleos essenciais em comparação com outras espécies de fungos micorrízicos estudados. Em conclusão, a inoculação dos fungos micorrízicos arbusculares em plantas de hortelã é uma alternativa viável para aumentar a produção de óleos essenciais e reduzir o uso de fertilizantes necessários para a produção econômica de hortelã-pimenta com deficiência de fósforo no solo.