Latin American consensus on the quality indicators for comprehensive care clinics for patients with inflammatory bowel disease: PANCCO-GETECCU.

INTRODUCTION: Inflammatory bowel disease (IBD) is a chronic and incurable entity. The aim of the Pan American Crohn's and Colitis Organisation (PANCCO) is to create awareness of IBD, with special emphasis on Latin America, and the primary objective of the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU, the Spanish acronym) is to obtain the accreditation of the clinical and therapeutic criteria for the diagnosis and treatment of IBD. AIM: To carry out a consensus for evaluating the approval criteria that a Comprehensive Care Clinic for Latin American IBD patients must meet, to be considered a center of excellence. MATERIALS AND METHODS: Fourteen clinical experts participated in the consensus. They were made up of specialists in gastroenterology, with broad clinical experience, spanning several years, in managing the care of a large number of patients with IBD, as well as advanced specialists in IBD. Thirteen of the participants came from 11 Latin American countries (Argentina, Brazil, Colombia, Dominican Republic, Ecuador, Guatemala, Mexico, Peru, Puerto Rico, Uruguay, and Venezuela) that have IBD clinics. An expert from Spain, representing the GETECCU, provided the methodologic support. The consensus consisted of 52 statements divided into three sections: 1) Structure indicators, 2) Process indicators, and 3) Result indicators. The Delphi panel method was applied. RESULTS: The present Latin American consensus describes the quality indicators that a Comprehensive Care Clinic for IBD patients must meet, to be considered a center of excellence, taking into account the needs of our region. CONCLUSIONS: This is the first Latin American consensus, jointly carried out by the PANCCO and GETECCU, to present accreditation standards for centers of excellence in the care of patients with IBD.

The Mexican consensus on the diagnosis and treatment of diverticular disease of the colon. / Consenso mexicano sobre el diagnóstico y tratamiento de la enfermedad diverticular del colon.

Since the publication of the 2008 guidelines on the diagnosis and treatment of diverticular disease of the colon by the Asociación Mexicana de Gastroenterología, significant advances have been made in the knowledge of that disease. A systematic review of articles published in the medical literature from January 2008 to July 2018 was carried out to revise and update the 2008 guidelines and provide new evidence-based recommendations. All high-quality articles in Spanish and English published within that time frame were included. The final versions of the 43 statements accepted in the three rounds of voting, utilizing the Delphi method, were written, and the quality of evidence and strength of the recommendations were established for each statement, utilizing the GRADE system. The present consensus contains new data on the definition, classification, epidemiology, pathophysiology, and risk factors of diverticular disease of the colon. Special emphasis is given to the usefulness of computed tomography and colonoscopy, as well as to the endoscopic methods for controlling bleeding. Outpatient treatment of uncomplicated diverticulitis is discussed, as well as the role of rifaximin and mesalazine in the management of complicated acute diverticulitis. Both its minimally invasive alternatives and surgical options are described, stressing their indications, limitations, and contraindications. The new statements provide guidelines based on updated scientific evidence. Each statement is discussed, and its quality of evidence and the strength of the recommendation are presented.

Consenso mexicano sobre el diagnóstico y tratamiento de la enfermedad diverticular del colon / The Mexican consensus on the diagnosis and treatment of diverticular disease of the colon

Desde la publicación en 2008 de las guías de diagnóstico y tratamiento de la enfermedad diverticular del colon de la Asociación Mexicana de Gastroenterología ha habido avances significativos en el conocimiento de esta enfermedad. Se realizó una revisión sistemática de la literatura en PubMed de enero de 2008 a julio de 2018 con el fin de revisar y actualizar las guías 2008 y proporcionar nuevas recomendaciones basadas en la evidencia. Se incluyeron todas las publicaciones en español e inglés, de alta calidad. Se redactaron los enunciados, que fueron votados utilizando el método Delphi. Se estableció la calidad de la evidencia y la fuerza de las recomendaciones según el sistema GRADE para cada enunciado. Cuarenta y tres enunciados fueron finalmente votados y calificados. Se informan nuevos datos sobre definición, clasificación, epidemiología, fisiopatología y factores de riesgo. Se revisó con especial énfasis la utilidad de la tomografía computarizada y de la colonoscopia, así como los métodos endoscópicos para el control de la hemorragia. Se discutió sobre el tratamiento ambulatorio de la diverticulitis no complicada, el papel de la rifaximina y la mesalazina, en el manejo de la diverticulitis aguda complicada tanto en sus alternativas mínimamente invasivas hasta las opciones quirúrgicas con énfasis en sus indicaciones, limitaciones y contraindicaciones. Los nuevos enunciados proporcionan directrices basadas en la evidencia actualizada. Se presentan la discusión, el grado y la fuerza de la recomendación de cada uno de ellos.

Incidence of multiple sclerosis in Chile. A hospital registry study.

OBJECTIVE: To study the incidence of MS in Chile by examining the hospitalizations across all geographical regions of the country and to examine whether there is a correlation between these rates and the latitude or ultraviolet radiation. METHODS: This is a descriptive study examining the national registry of hospitalizations because of MS (code G35 in ICD-10) from January 1, 2001, to December 31, 2006. Incidence rates were calculated by gender and geographical region and standardized to the world population estimated for 2010. RESULTS: A total of 6857 hospitalizations were analyzed. There were 935 individuals; 63.9% were women. The mean incidence rate for 2002-2006 period was 0,90 (95% CI: 0.75-1.05). The annualized incidence rates for regions from North to South were as follows: I Tarapaca 0.54 (95% CI: 0.0-1.21), II Antofagasta 0,93 (0.10-1.75), III Atacama 1.07 (0.0-2.31), IV Coquimbo 0.63 (0.01-1.24), V Valparaiso 0.83 (0.38-1.27), VI O'Higgins 0.72 (0.14-1.30), VII Maule 0.52 (0.06-0.98), VIII BIO BIO 0.81 (0.41-1.21), IX Araucanía 0.43 (0.0-0.86), X Los Lagos 0.91 (0.35-1.46), XI Aysen 0.99 (0.0-2.98), XII Magallanes 3.54 (0.57-6.51), and XIII Metropolitana 1.10 (0.84-1.36). There were no significant correlations between hospitalization rates and latitude, except for region XII. UV radiation levels showed significant differences only for region XII. CONCLUSION: There is a moderate risk of MS in Chile. The southernmost region showed significantly higher incidence rates than those in the rest of the country (a cluster zone). We did not find any correlation between incidence rates and latitude or UV radiation.

Is obesity a risk factor in acute pancreatitis? A meta-analysis.

BACKGROUND/AIMS: Obesity has been associated with a worse prognosis in acute pancreatitis. According to some authors, obesity favours the development of local complications, while according to other reports obese patients presented more frequently systemic complications. Few studies find a relationship between obesity and mortality in acute pancreatitis. We conducted a meta-analysis of several reports that evaluate the relationship between obesity and the outcome of acute pancreatitis in order to assess its prognostic role in this disease. METHODS: A MEDLINE search was conducted from 1965 to December 2002 with search terms including obesity, body mass index (BMI) and pancreatitis. A total of 12 reports were identified. Of these, only four studies included patients with mild and severe acute pancreatitis and measured obesity by BMI. The end points of the meta-analysis were the severity of acute pancreatitis, local complications, systemic complications and mortality. Obesity was defined when BMI was > or =30 kg/m2. Pooled odds ratio (OR) and confidence intervals (CI) were calculated according to the Mantel-Haenszel method, and heterogeneity was assessed by the multiplicative inverse variance method. RESULTS: A total of 607 patients were evaluated. There was no heterogeneity for the variables severity, systemic complications, local complications and mortality among the included studies. Severe AP was significantly more frequent in obese patients (OR 2.6, 95% CI 1.5-4.6). Furthermore, those patients developed significantly more systemic (OR 2.0, 95% CI 1.1-4.6) and local complications (OR 4.3, 95% CI 2.4-7.9). Mortality in obese patients was only slightly higher (OR 1.3, 95% CI 0.5-3.6). CONCLUSION: Obesity is a prognostic factor favouring the development of systemic and local complications in this disease. Therefore, it should be used routinely as part of the initial assessment of the severity of a case of acute pancreatitis.

[Effectivity versus toxicity of minoxidil as antiproliferative agent for lens epithelial cells. In vitro study]. / Efectividad versus toxicidad del minoxidil como agente antiproliferativo de células epiteliales de cristalino. Estudio in vitro.

PURPOSE: To evaluate the inhibitory effect of minoxidil on cultured proliferating lens epithelial cells (LECs) versus cytotoxic effect over corneal endothelial cells in culture, because minimum side effects over anterior chamber structures and particularly on corneal endothelium are required for successful therapy and prevention of posterior capsular opacification (PCO). METHODS: New Zealand Rabbit LECs and corneal endothelium were cultured in DMEM at 35 degrees C in 5% CO2 in multiwells during 7 days. Both types of cells were exposed to minoxidil (1, 2 and 4 mM) for 1 and 24 hours. Control group and balanced salt solution group were included. After seven days multiwells were processed for light microscopy study. Morphometric study of cellular population of LECs and corneal endothelium cells were done using a computed planimetry system. RESULTS: Dose-dependent effect on LECs proliferation was noted and non-confluent colonies of cells were observed on all treated groups. Morphologic changes in normal appearance of corneal endothelial cells after 1 hour of minoxidil treatment was observed and intracellular alterations were confirmed even with the lowest dose exposure. CONCLUSIONS: Although effectiveness of minoxidil suppressing in vitro LECs proliferation could be suggest as a useful therapeutic agent to prevent PCO, however the inhibitory effect of different concentrations on corneal endothelial cells conditioned its possible use on ocular surgery.

Efectividad versus toxicidad del minoxidil como agente antiproliferativo de células epiteliales de cristalino. Estudio in vitro / Effectivity versus toxicity of minoxidil as antiproliferative agent of lens epithelial cells. In vitro study

Objetivo: Evaluar el efecto inhibitorio del minoxidil sobre la supervivencia de células epiteliales de cristalino (CEC) en cultivo versus el efecto sobre el endotelio corneal, ya que para un eficaz tratamiento y prevención de la opacificación capsular posterior (OCP), se requiere una mínima afectación de las estructuras de la cámara anterior y especialmente del endotelio corneal. Métodos: Las células de epitelio de cristalino y de endotelio corneal procedentes de ojo de conejo New Zealand fueron cultivadas en medio de DMEM a 35 ºC y 5 por ciento de CO2 en portas multipocillos durante 7 días. Ambos tipos de células fueron expuestos a minoxidil (1,2 y 4 mM) durante 1 y 24 horas. Se incluyeron igualmente un grupo control y un grupo expuesto a solución salina balanceada. Las placas fueron procesadas para estudio con microscopía óptica a las 24 horas y a los 7 días de seguimiento. El estudio morfométrico de la población de CEC y del endotelio corneal se realizó con un sistema de planimetría computarizado. Resultados: El efecto observado sobre la supervivencia fue dosis-dependiente en los cultivos celulares de CEC y se observaron colonias no confluentes en todos los grupos tratados. Se observaron cambios morfológicos en el endotelio corneal después de 1 hora de tratamiento con minoxidil y se confirmaron alteraciones intracelulares incluso en la dosis más baja empleada. Conclusiones: La efectividad del minoxidil como inhibidor del crecimiento in vitro de CEC podría sugerir su uso como agente preventivo en la OCP sin embargo el efecto inhibitorio que igualmente se observa sobre las células de endotelio corneal a las concentraciones utilizadas, condiciona su posible utilización en cirugía ocular (AU)

Potential harmful effect of iodinated intravenous contrast medium on the clinical course of mild acute pancreatitis.

HYPOTHESIS: A worse clinical outcome might be expected in patients with acute pancreatitis (AP) who receive intravenous contrast medium for a nondynamic contrast-enhanced computed tomographic (CECT) study early during hospital admission. DESIGN: Cohort analytic study. SETTING: Tertiary care center. PATIENTS: Of 126 patients with mild AP, 52 patients underwent CECT to establish AP diagnosis (group 1), and the remaining 74 did not (group 2). MAIN OUTCOME MEASURES: Survival and development of local or systemic complications during the hospital stay. Potential confounders were demographic, clinical, and biochemical data, as well as therapeutic measures. The Atlanta classification was used to define local and systemic complications. RESULTS: Mean age, etiology of AP, prognostic score on admission, and pharmacologic treatment were similar between groups. Local and systemic complications were more frequently observed in patients who underwent CECT (odds ratio, 11.4; 95% confidence interval, 2.0-64.8; P =.008). Six patients, all in group 1, developed a pancreatic abscess (odds ratio, 20.8; P =.004). In 5 of them, a second CECT showed more severe AP changes. The association between CECT and abscess development was more apparent in patients with a body mass index of 25 or more and/or nasogastric suction. Six patients in group 1 and 1 in group 2 had systemic complications (odds ratio, 9. 5; P =.01). There were no deaths. CONCLUSIONS: The observed increased incidence of local and systemic complications in patients with mild AP who undergo CECT, particularly in those with a body mass index of 25 or more, suggests a potentially harmful effect of intravenous contrast medium. Until this issue is clarified, it seems reasonable to restrict the use of dynamic CECT to patients with severe AP, protracted clinical course, or suspected local septic complication.

Efecto de la mitomicina c sobre el endotelio corneal. Estudio in vitro / Effect of mitomycin C on corneal endothelium cells. In vitro study

Objetivo: La mitomicina C es un antibiótico con capacidad antimitótica que ha demostrado su eficacia como inhibidor de la proliferación fibroblástica y su uso se ha extendido en la cirugía del glaucoma. En el presente estudio se evaluó el efecto de la mitomicina sobre cultivos monocapa de endotelio corneal de conejo albino. Métodos: La fuente de células endoteliales para los cultivos fueron ojos de conejo albino raza New Zealand. El aislamiento de las células se realizó mediante disociación mecánico-enzimática a partir del complejo endotelio corneal-membrana de Descemet. El medio de cultivo empleado fue EMEM. Se realizó el tratamiento de tres grupos de placas expuestas a mitomicina C a tres concentraciones de 2x10 (AU)

[Effect of mitomycin C on corneal endothelium cells. In vitro study]. / Efecto de la mitomicina C sobre el endotelio corneal. Estudio in vitro.

PURPOSE: Mitomycin C is an antibiotic with a demonstrated antiproliferative capacity as an inhibitor of fibroblastic cells proliferation. Its use has been extended in glaucoma surgery. In the present study, we evaluated mitomycin C effect on cell culture monolayer of rabbit corneal endothelium. METHODS: The source of corneal endothelium for cell culture was New Zealand albino rabbit eyes. Desegregation of cells was carried out with mechanic and enzymatic dissociation from corneal endothelium and Descemet membrane. Culture medium was EMEM. Three treatment groups of plates were exposed to three different concentrations of mitomycin C 2x10(-3) mg/ml, 2x10(-2) mg/ml and 2x10(-1) mg/ml. Control and witness plate groups were also established. The morphometric study was performed through quantitative analysis with a video system connected to the light microscope. RESULTS: Different morphological changes related with cell size, cytoplasm and dyeing were seen at the morphological study and several degenerative signs were established indicating cellular death and a very decrease of the cellular population. In the groups treated with minimal dose (2x10(-3) mg/ml) and 3 days evolution time, cellular population was 434 cels/mm(2), 7 evolution days group cell density was 300.97cels/mm(2), and at 14 days it was 201.88 cels/mm(2). The percentage of survival in all the groups of treated cells was under 50%. CONCLUSIONS: Mitomycin C in concentrations and exposure time as used in this study has a potent lethal effect on this cellular type that compromises to a greater or smaller extent their function and integrity.

Obesity: a risk factor for severe acute biliary and alcoholic pancreatitis.

OBJECTIVE: In this study we evaluate the association between obesity and complication development in patients with a first-attack acute pancreatitis (AP), and investigate the influence of comorbid factors on this association. METHODS: Medical records of 150 patients with AP were reviewed. General data, AP etiology, admission AP prognostic criteria, and occurrence of complications were recorded. Patients were classified according to body mass index (BMI) as obese (BMI > 25 kg/m2) and nonobese (BMI < or = 25 kg/m2). RESULTS: Prevalence of obesity was 57%. Thirty-eight percent of the obese patients developed complications as compared with 21% of the nonobese (RR=1.74; 95% CI, 1-2.9). The risk for severe AP increased according to the degree of obesity. Pancreatic and peripancreatic necrosis was more common in obese patients (17.6% vs 6%), as was the incidence of infectious complications. The risk for severe AP was highest in obese patients with either alcoholic (RR=5.3; 95% CI, 1.2-23) or biliary etiology (RR=5.2, 95% CI, 1-26). CONCLUSION: Obesity may predispose to a complicated course of AP, especially if it is secondary to alcohol or gallstones. Further studies are needed to establish the precise prognostic value of obesity in AP, as well as the pathogenic mechanisms involved in the process.

[Use and abuse histamine H2 receptor blockers in hospitalized patients]. / Uso y abuso de los bloqueadores de los receptores H2 de la histamina en pacientes hospitalizados.

OBJECTIVE: To evaluate if the histamine H2 blockers (H2B) are adequately prescribed in hospitalized patients outside intensive care units. BACKGROUND: H2B are frequently prescribed. However their good tolerance and easy access have contributed to misuse them. METHODS: Six hundred and seventy eighth hospitalized patients from three different Mexican institutions were included in a prospective study, 100 patients from each hospital who were taking H2B were selected. We investigated the indication for prescribing them as well as the type, dose and adverse effects, international recommendations were taken into account to assess if the treatment was correctly prescribed. RESULTS: Two hundred twenty seven patients (76%) received H2B for prophylactic reasons, however a clear justification for their use was found in only 79 of the cases (35%). H2B were prescribed to treat peptic ulcer disease or upper gastrointestinal bleeding in 17 patients (6%). Two out of three patients received more than 10 doses of H2B, being ranitidine the most frequently prescribed. CONCLUSIONS: Although H2B have a low rate of adverse reactions, their use in hospitalized patients should be rigorously controlled. In fact, the majority of our patients did not need them. Thus, their routine use should be proscribed to avoid unnecessary costs.

[Adrenal abscess in the newborn: a case report and review of the literature]. / Absceso adrenal en el recién nacido: informe de un caso y revisión de la literatura.

This is a case report concerning a 22 day newborn referred to us having an abdominal tumor, fever, an irritable nature and feeding refusal, born dystocically due to the retention of the shoulders and having an Apgar score of 5/8. When admitted the presence of the tumor was corroborated in the right flank occupying the right renal fossa and measuring 5 x 8 cm, non-mobile and painless. Studies revealed a diagnosis of calcified right adrenal hemorrhage versus neuroblastoma. During surgery a right adrenal abscess was found which was drained and a biopsy sample was taken for further study. The culture of the pus developed Proteus mirabilis. Pathology reported it to be an abscessed right adrenal hematoma which was partially calcified. The patient's wound became infected but was later sent home under good conditions. Only 15 other cases with this pathology are reported in the literature, this would be the 16th case. An emphasis is placed on including this pathology as part of the differential diagnosis of retroperitoneal tumors in the newborn.

[Central pontine myelinolysis, associated with hyperglycemia and hyponatremia: a clinical case]. / Mielinolisis pontina central asociada a hiponatremia e hiperglicemia: caso clínico.

A 68 year old diabetic male was admitted with hyponatremia and developed a "deafferentiation" syndrome. Central pontine myelinolysis was suspected after clinical, EEG and brain CAT scan. The diagnosis was confirmed at necropsy. The pathogenesis, clinical manifestations and treatment of this disorder are discussed.

On fast algorithms for interval selection in event related potentials.

In this paper a computational algorithm is proposed which allows one to detect event related potentials (ERP) components and the way these components modify their amplitude with electrode location and with the variation in experimental conditions. The results of applying this algorithm to the ERPs obtained in two experimental situations (which require different modes of cognitive processing of a same visual information) are also exposed.