The Asociación Mexicana de Gastroenterología consensus on the diagnosis and treatment of acute pancreatitis in children and adolescents.

Acute pancreatitis (AP) and recurrent acute pancreatitis (RAP) are conditions, whose incidence is apparently on the rise. Despite the ever-increasing evidence regarding the management of AP in children and adults, therapeutic actions that could potentially affect having a poor prognosis in those patients, especially in the pediatric population, continue to be carried out. Therefore, the Asociación Mexicana de Gastroenterología convened a group of 24 expert pediatric gastroenterologists from different institutions and areas of Mexico, as well as 2 pediatric nutritionists and 2 specialists in pediatric surgery, to discuss different aspects of the epidemiology, diagnosis, and treatment of AP and RAP in the pediatric population. The aim of this document is to present the consensus results. Different AP topics were addressed by 6 working groups, each of which reviewed the information and formulated statements considered pertinent for each module, on themes involving recommendations and points of debate, concerning diagnostic or therapeutic approaches. All the statements were presented and discussed. They were then evaluated through a Delphi process, with electronic and anonymous voting, to determine the level of agreement on the statements. A total of 29 statements were formulated, all of which reached above 75% agreement in the first round of voting.

Recommendations for antibiotic selection for severe nosocomial infections.

Severe infection and its evolution to sepsis are becoming more prevalent every day and are among the leading causes of critical illness and mortality. Proper management is crucial to improve prognosis. This document addresses three essential points that have a significant impact on this objective: a) early recognition of patients with sepsis criteria, b) identification of those patients who suffer from an infection and have a high risk of progressing to sepsis, and c) adequate selection and optimization of the initial antimicrobial treatment.

Dietary fiber and the microbiota: A narrative review by a group of experts from the Asociación Mexicana de Gastroenterología.

Dietary fiber intake is one of the most influential and efficacious strategies for modulating the gut microbiota. Said fiber can be digested by the microbiota itself, producing numerous metabolites, which include the short-chain fatty acids (SCFAs). SCFAs have local and systemic functions that impact the composition and function of the gut microbiota, and consequently, human health. The aim of the present narrative review was to provide a document that serves as a frame of reference for a clear understanding of dietary fiber and its direct and indirect effects on health. The direct benefits of dietary fiber intake can be dependent on or independent of the gut microbiota. The use of dietary fiber by the gut microbiota involves several factors, including the fiber's physiochemical characteristics. Dietary fiber type influences the gut microbiota because not all bacterial species have the same capacity to produce the enzymes needed for its degradation. A low-fiber diet can affect the balance of the SCFAs produced. Dietary fiber indirectly benefits cardiometabolic health, digestive health, certain functional gastrointestinal disorders, and different diseases.

Technical opinion of the Asociación Mexicana de Gastroenterología on soy plant-based beverages. / Posición técnica de la Asociación Mexicana de Gastroenterología sobre las bebidas vegetales a base de soya.

There has been a recent increase in the consumption of cow's milk substitutes, specifically plant-based beverages, which have erroneously been named "plant milks". Plant-based beverages do not have a standard of identity, and so their nutritional composition can vary from one brand to another, even within the same category. The aim of the present narrative review was to produce a technical opinion to serve as a frame of reference for sustaining the recommendation of soy plant-based beverages. Nutrition and gastroenterology experts that belong to the Asociación Mexicana de Gastroenterología jointly commented on and analyzed themes on plant-based beverages, and on soy drinks in particular, including their nutritional characteristics, consumption in children, and potential growth and development alterations, as well as soy drink consumption in adults and its association with gastrointestinal alterations and other conditions. Plant-based beverages, including those made from soy, are not a replacement for breastmilk or breastmilk substitutes. Soy beverages are considered safe and can enrich the varied diet of its consumers, as long as they are considered an additional liquid portion of the diet. They can be ingested by adults and children above two years of age that present with cow's milk protein allergy or lactose intolerance.

Prevención de las náuseas y vómitos postoperatorios con dimenhidrinato en pacientes con riesgo moderado (según escala de Apfel) intervenidos de colecistectomía laparoscópica en régimen ambulatorio / Prevention of postoperative nausea and vomiting with dimenhydrinate in outpatients with moderate risk (as scale Apfel) undergoing laparoscopic cholecystectomy

Introducción: Las náuseas y vómitos postoperatorios (NVPO) constituyen uno de los principales problemas asociados a las intervenciones quirúrgicas. En la actualidad, estos episodios se siguen produciendo en un 20-30 % de los pacientes que son sometidos a una intervención quirúrgica. Además del alto grado de disconfort que este problema puede generar en los pacientes, pueden acarrear otras consecuencias negativas como deshidratación y alteraciones hidroelectrolíticas por vómitos recurrentes, evisceración o dehiscencia de suturas debido a la mecánica del esfuerzo, retraso en la reinstauración de la dieta por vía oral, retraso del alta en las unidades de cirugía ambulatoria, etc. (1-3). Todas estas complicaciones suponen también un aumento del gasto sanitario (2,3). Material y métodos: La evidencia actual muestra que los fármacos más efectivos son droperidol, ondansetrón y dexametasona. Nuestro estudio trata de profundizar en el conocimiento de los fármacos antieméticos menos usados, como el dimenhidrinato, con el fin de proporcionar nuevas alternativas con una buena relación coste/efectividad para la prevención de las NVPO. Para ello se han comparado la combinación dimenhidrinato + dexametasona frente a ondasentrón + dexametasona para la prevención de las NVPO en pacientes de riesgo moderado según la escala de Apfel, intervenidos de colecistectomía laparoscópica en régimen ambulatorio. Resultados: En este estudio no se han observado diferencias significativas en ambos grupos, tanto en la eficacia como en la seguridad. Conclusión: Podemos concluir que el dimenhidrinato es una buena alternativa para la prevención de las NVPO en pacientes de riesgo moderado que precisan una doble terapia (AU)

Introduction: Postoperative nausea and vomiting (PONV) is one of the main problems associated with surgical procedures. Currently these episodes still occur in 20-30 % of patients who undergo an surgery. In addition to the high degree of discomfort that this problem can be generated in patients, they may lead to other negative consequences such as dehydration and electrolyte disturbances by recurrent vomiting, evisceration or wound dehiscence due to mechanical effort, delay in reinstating the oral diet, delayed discharge in outpatient surgery units, etc. (1-3). All of these complications are also an increase in spending health (2,3). Objective and methods: The evidence shows that the most effective drugs are: droperidol, ondansetron and dexamethasone. Our study seeks to deepen the unders-tanding of antiemetic drugs less used as dimenhydrinate, in order to provide new alternatives with a good cost / effectiveness in the case of PONV. This has been compared the dimenhydrinate combination + dexamethasone versus dexamethasone + ondansetron for the prevention of PONV in outpatients undergoing laparoscopic cholecystectomy moderate risk according to the scale of Apfel. Results: In this study we have observed no significant differences in both groups in both efficacy and safety. Conclusion: We can conclude that dimenhydrinate is a good alternative for the prevention of PONV in moderate-risk patients who require dual therapy (AU)

The relationship between executive functions and fluid intelligence in Parkinson's disease.

BACKGROUND: We recently demonstrated that decline in fluid intelligence is a substantial contributor to frontal deficits. For some classical 'executive' tasks, such as the Wisconsin Card Sorting Test (WCST) and Verbal Fluency, frontal deficits were entirely explained by fluid intelligence. However, on a second set of frontal tasks, deficits remained even after statistically controlling for this factor. These tasks included tests of theory of mind and multitasking. As frontal dysfunction is the most frequent cognitive deficit observed in early Parkinson's disease (PD), the present study aimed to determine the role of fluid intelligence in such deficits. METHOD: We assessed patients with PD (n=32) and control subjects (n=22) with the aforementioned frontal tests and with a test of fluid intelligence. Group performance was compared and fluid intelligence was introduced as a covariate to determine its role in frontal deficits shown by PD patients. RESULTS: In line with our previous results, scores on the WCST and Verbal Fluency were closely linked to fluid intelligence. Significant patient-control differences were eliminated or at least substantially reduced once fluid intelligence was introduced as a covariate. However, for tasks of theory of mind and multitasking, deficits remained even after fluid intelligence was statistically controlled. CONCLUSIONS: The present results suggest that clinical assessment of neuropsychological deficits in PD should include tests of fluid intelligence, together with one or more specific tasks that allow for the assessment of residual frontal deficits associated with theory of mind and multitasking.

Enfermedad de Gaucher tipo 1: reporte del tratamiento enzim tico en dos hermanos / Gaucher's disease type 1: report of enzymatic treatment in two broters

La enfermedad de Gaucher es un trastorno hereditario, causado por la deficiencia de la enzima glucocerebrosidasa, producida en los lisosomas. Esta enzima participa en el metabolismo del glucolípido cerebrósido; su deficiencia provoca la acumulación de éste en los macrófagos; dichas células se han denominado células de Gaucher y se acumulan en hígado, bazo y médula ósea. Se presenta el caso de dos hermanos con enfermedad de Gaucher tipo 1; con terapia de reemplazo enzimático a base de imiglucerase (cerezyme) endovenoso durante un año, lo que revirtió los síntomas de la enfermedad de Gaucher. La imiglucerase inyectable es una forma modificada de la enzima glucocerebrosidasa, producto obtenido por ingeniería genética, indicada en pacientes con diagnóstico de enfermedad de Gaucher tipo 1.1,2

Hernia de Bochdalek derecha asociada con dextrocardia sin repercusión respiratoria grave en un lactante de cuatro meses / Right Bochdalek hernia associated with dextrocardia and no serious respiratory repercusion in a four month infant

Se reporta el caso de un lactante con una hernia de Bochdalek en hemidiafragma derecho, la cual fue corregida quirúrgicamente a los cuatro meses de edad; el paciente sólo presentó datos leves de dificultad respiratoria. El presente caso llama la atención debido a que el defecto embriogénico es mucho más frecuente en el hemidiafragma izquierdo; las condiciones más frecuentemente asociadas con éste son las desviaciones del mediastino y la hipoplasia pulmonar. La dextrocardia rara vez se reporta como asociada a la patología, y cuando está presente, por lo general conlleva consecuencias fatales.

Síndrome de Caroli: reporte de un caso pediátrico y revisión de la literatura / Caroli's syndrome: a pediatric case report and literature revision

La enfermedad de Caroli es una dilatación congénita de los conductos biliares intrahepáticos, en ausencia de cualquier otra anormalidad histológica del hígado. Cuando se asocia a fibrosis hepática congénita, con o sin datos de hipertensión portal, el padecimiento se denomina síndrome de Caroli. El síndrome de Caroli se asocia con frecuencia con alteraciones quísticas a nivel renal. En el presente reporte, se describe el caso de un paciente preescolar masculino, que fue estudiado por una hepatoesplenomegalia, en el que se integró el diagnóstico clínico, imagenológico e histológico de síndrome de Caroli, pero en el que no se evidenció ninguna alteración funcional o estructural en ambos riñones. Asimismo, se hace una revisión de la literatura médica relacionada con esta patología.

A clinical, pharmacologic, and polysomnographic study of sleep benefit in Parkinson's disease.

We assessed the effect of sleep benefit on motor performance in Parkinson's disease (PD) and analyzed its relation to pharmacologic and sleep measures. The sleep benefit phenomenon-motor improvement after sleep before drug intake-in patients with PD has been addressed by questionnaire studies, but objective data are scarce. Ten PD patients with sleep benefit were pairwisely matched to 10 PD patients without sleep benefit for gender, age, PD symptom duration, and medications. We examined motor performance at night before sleep, during morning baseline state immediately after spontaneous awakening, and continuously after intake of the usual levodopa dose. Plasma levodopa concentrations were measured serially and all-night polysomnography was performed. Between night and morning evaluations, motor state improved slightly in patients with sleep benefit and deteriorated slightly in patients without sleep benefit. The difference between both groups proved to be significant. After levodopa induced "on" state, patients with sleep benefit had more severe interdose "off" than those without. Levodopa concentrations and polysomnographic findings were similar in both conditions, although there was a trend toward more abnormal sleep measures in sleep benefit patients. Sleep benefit is a small but significant phenomenon. It does not clearly relate to a specific sleep variable; however, patients with sleep benefit showed a different response profile to levodopa. Subjective perception or possibly sensory mechanisms could play an additional role in sleep benefit in PD.

Clinical and pharmacological differences in early- versus late-onset Parkinson's disease.

We evaluated whether patients with early-onset Parkinson's disease (EOPD) have a different clinical profile and pharmacological response than those with late-onset disease (LOPD). We performed a retrospective analysis and an acute pharmacological challenge with L-Dopa in 34 EOPD (age at onset between 21 and 40 years) and 34 LOPD (onset after age 60) patients. All patients completed a structured questionnaire cross-checked against medical record charts and underwent an acute levodopa test. Most significant differences were in the mode of onset, time of diagnosis, and degree of initial improvement. We did not observe differences with regard to motor fluctuations. The acute levodopa test showed no differences in latency to response onset between groups. However, the magnitude of the response was greater and the duration shorter in EOPD patients. Younger patients had greater reductions in bradykinesia scores, whereas posture/gait symptomatology was less responsive in older patients. The type and severity of dyskinesias also differed significantly between groups. Our findings suggest that central pharmacokinetics, pharmacodynamics, and possibly, nondopaminergic systems play a role in the age-related differences observed in Parkinson's disease.

Genetic Characterization by RAPD Analysis of Isolates of Fusarium oxysporum f. sp. erythroxyli Associated with an Emerging Epidemic in Peru.

ABSTRACT An epidemic of vascular wilt caused by Fusarium oxysporum f. sp. erythroxyli is currently occurring on Erythroxylum coca var. coca in the coca-growing regions of the Huallaga Valley in Peru. Random amplified polymorphic DNA (RAPD) analysis of isolates of the pathogen was undertaken to elucidate its genetic complexity, as well as to identify a specific DNA fingerprint for the pathogen. Two hundred isolates of Fusarium were collected from 10 coca-growing regions in Peru. Of these, 187 were confirmed to be F. oxysporum, and 143 of the F. oxysporum were shown to be pathogens of coca by a root-dip pathogenicity test. The pathogens could be grouped into two subpopulations based on RAPD analysis, and no polymorphism in RAPD pattern was observed among isolates of either subpopulation. Both subpopulations were present in the central Huallaga Valley, where earliest reports of the epidemic occurred. RAPD analysis could easily distinguish the isolates of F. oxysporum f. sp. erythroxyli from the nonpathogenic isolates of F. oxysporum from E. coca var. coca, indicating its utility in DNA fingerprinting.

Modulatory effect of clozapine on levodopa response in Parkinson's disease: a preliminary study.

Clozapine has been shown not only to be effective in ameliorating dopaminomimetic psychosis but to improve parkinsonian symptomatology. Six parkinsonian patients with motor fluctuations under levodopa treatment and severe interdose "off" periods (believed to be mediated by an inhibitory effect of subthreshold levels of levodopa) underwent a trial of clozapine. The effects of this drug on levodopa response were measured by means of an acute levodopa test both before and after receiving clozapine. After 1 month of treatment, clozapine 25 mg/day reduced parkinsonian scores at all stages of the evaluation (pre-levodopa "off," "on," and interdose "off"). The effect was consistently more significant for the interdose "off." Clozapine could be exerting its beneficial effects through the inhibition of an inhibitory effect mediated by low-level dopaminergic stimulation, thus behaving as an apparent anti-parkinsonian drug.

Prevalence of familial dysalbuminemic hyperthyroxinemia in serum samples received for thyroid testing.

The prevalence of familial dysalbuminemic hyperthyroxinemia (FDH), a condition sometimes mistaken for hyperthyroidism, has not been clearly established. I present a study of the prevalence of FDH in serum samples received for thyroid-function tests in a reference laboratory. A prospective study of 15,674 serum samples was carried out over 24 months, of which 13,232 cases were from women (84.42%) and 2442 were from men (15.58%). FDH was diagnosed in 26 cases, 22 in women and four in men. Therefore, the prevalence of FDH in the total number of samples from both sexes was 0.17%, 0.17% in women, and 0.16% in men, which is consistent with a dominant autosomal type of familial transmission. These findings demonstrate that cases of FDH occur frequently; therefore, every laboratory must be prepared to recognize them and thus avoid an incorrect diagnosis of the patient's thyroid function.

Binding of labeled thyroxin analog to serum proteins evaluated after radioimmunoassay of free thyroxin.

In ambulatory patients, assay of free thyroxin (FT4) in serum correlates well with thyroid status and with results obtained by equilibrium dialysis. The validity of FT4 results has been questioned mainly in euthyroid patients with altered concentrations of thyroid hormone-binding proteins, as in nonthyroidal illness, hereditary analbuminemia, familial dysalbuminemic hyperthyroxinemia (FDH), and the presence of iodothyronine-binding antibodies. I present here a study of the binding of [125I]T4-derivative to serum proteins in the supernate, which is ordinarily discarded after determination of FT4 by one-step radioimmunoassay with dextran-coated charcoal used to separate the free and bound fractions. The results are expressed as a ratio, with results for a normal serum pool as reference. The average ratio was high in hyperthyroid subjects, 1.26 (SD 0.12, n = 25), and in hypoalbuminemia, 1.20 (SD 0.10, n = 15), and low in FDH, 0.62 (SD 0.11, n = 9), and hypothyroid subjects, 0.90 (SD 0.06, n = 20). In normal individuals it was 0.98 (SD 0.05, n = 30). Determination of the analog-binding rate complements the FT4 result and allows for the recognition of cases with abnormal binding by serum proteins, without recourse to other tests recommended for thyroid-function studies.

Thyroxin binding by human serum albumin after denaturation of the thyroxin-binding globulin in familial dysalbuminemic hyperthyroxinemia.

Abnormal binding of thyroxin (T4) to serum albumin of subjects with familial dysalbuminemic hyperthyroxinemia (FDH) is generally demonstrated by the T4-loaded charcoal uptake test, with T4 added in excess (0.1 mmol/L) to accentuate T4 binding to albumin in FDH. I describe a binding study involving T4 tracer in which thyroxin-binding globulin is denatured in samples by treatment with mild acid at pH less than 3.0. The tracer is bound to the serum albumin and, to a greater extent, to the FDH albumin, because the binding by thyroxin-binding prealbumin is blocked by barbital buffer. The result of the [125I]T4 binding to the albumin is expressed as a T4 binding index, based on results for pooled sera from patients with normal thyroid function as a reference. The mean index in FDH was 4.08 (SD 0.92, n = 5); in hypoalbuminemia, 0.66 (SD 0.18, n = 8); in normal subjects, 1.00 (SD 0.11, n = 20). This albumin-binding index enables the rapid and unequivocal diagnosis of subjects with FDH, without the addition of unlabeled T4.

Preclinical and clinical studies with latex from Ficus glabrata HBK, a traditional intestinal anthelminthic in the Amazonian area.

Ficus glabrata latex has been a well-known anthelminthic remedy in the neotropical regions since ancient times. The latex has been commercially exploited for decades because of its content of the proteolytic enzyme-complex ficin. A safe dosage regimen with direct use of the latex has been elucidated to control intestinal helminthiasis in the Indian and non-Indian rural population. Helminthiasis was common in three Amazonian villages, field bases for the clinical study, with an overall prevalence of 92%. Specific prevalences were: Ascaris 68%, Strongyloides 42%, Trichuris 41%, Ancylostoma/Necator 26% and Taenia 1%. Variation in the biological activity of the latex was estimated by using a milk coagulating test. Pharmacological studies with live Ascaris demonstrated a lethal effect at concentrations down to 0.05% latex in physiological saline solution. A clinical trial on 181 persons has resulted in a recommended dosage of 1.0 cm3 of prepared latex/kg per day for 3 days to be repeated every 3 months.

Renal tubular function in glycerol-induced acute renal failure.

The purpose of this study was to examine proximal and distal tubular function in rats with nonoliguric, myohemoglobinuric acute renal failure (ARF). ARF was induced with glycerol (50%, 10 ml/kg of body wt, i.m.), and renal function was studied 24 hours after glycerol or saline (controls) injection. Glycerol injection caused a 50 to 90% depression in GFR and a significant rise in blood urea nitrogen concentration. Animals with ARF exhibited glycosuria with normal blood sugar levels and a striking depression in tubular glucose reabsorption per milliliter of GFR. The capacity to reabsorb (mEq/liter GFR) was intact at normal blood bicarbonate levels, but was markedly depressed when blood bicarbonate was raised. The tubular maximum for para-aminohippurate (PAH) secretion and the renal extraction fraction of PAH were strikingly depressed in rats with ARF. Distal acidification as assessed by the urine-to-blood gradient of PCO2 (UB PCO2) was normal both during maximal alkalinization of the urine with bicarbonate (urine pH, approximately 7.8) or during neural phosphate infusion (urine pH, approximately 7.0). Net acid excretion per milliliter GFR and minimal urine pH (less than 5.5) following 3 days of ammonium chloride ingestion was similar in control and ARF animals. Potassium excretion was intact in maximal urinary osmolality were significantly altered in animals with ARF. Cortical and outer medullary Na-K-ATPase specific activities were significantly depressed in ARF rats. This occurred as a consequence of enzyme loss and not secondary to alterations in enzyme kinetics of absolute tubular sodium reabsorption. Light and electron microscopy showed diffuse proximal tubular damage, whereas glomeruli and distal tubules were intact. These data demonstrate that glycerol injection produces a diffuse proximal tubular transport defect associated with histologic and enzymatic alterations.