Symptomatic gallstone disease: Recurrence patterns and risk factors for relapse after first admission, the RELAPSTONE study.

BACKGROUND: Delayed cholecystectomy in patients with symptomatic gallstone disease is associated with recurrence. Limited data on the recurrence patterns and the factors that determine them are available. OBJECTIVE: We aimed to determine the pattern of relapse in each symptomatic gallstone disease (acute pancreatitis, cholecystitis, cholangitis, symptomatic choledocholithiasis, and biliary colic) and determine the associated factors. METHODS: RELAPSTONE was an international multicenter retrospective cohort study. Patients (n = 3016) from 18 tertiary centers who suffered a first episode of symptomatic gallstone disease from 2018 to 2020 and had not undergone cholecystectomy during admission were included. The main outcome was relapse-free survival. Kaplan-Meier curves were used in the bivariate analysis. Multivariable Cox regression models were used to identify prognostic factors associated with relapses. RESULTS: Mean age was 76.6 [IQR: 59.7-84.1], and 51% were male. The median follow-up was 5.3 months [IQR 2.1-12.4]. Relapse-free survival was 0.79 (95% CI: 0.77-0.80) at 3 months, 0.71 (95% CI: 0.69-0.73) at 6 months, and 0.63 (95% CI: 0.61-0.65) at 12 months. In multivariable analysis, older age (HR = 0.57; 95% CI: 0.49-0.66), sphincterotomy (HR = 0.58, 95% CI: 0.49-0.68) and higher leukocyte count (HR = 0.79; 95% CI: 0.70-0.90) were independently associated with lower risk of relapse, whereas higher levels of alanine aminotransferase (HR = 1.22; 95% CI: 1.02-1.46) and multiple cholelithiasis (HR = 1.19, 95% CI: 1.05-1.34) were associated with higher relapse rates. CONCLUSION: The relapse rate is high and different in each symptomatic gallstone disease. Our independent predictors could be useful for prioritizing patients on the waiting list for cholecystectomies.

Bismuth quadruple three-in-one single capsule three times a day increases effectiveness compared with the usual four times a day schedule: results from the European Registry on Helicobacter pylori Management (Hp-EuReg).

BACKGROUND: The recommended schedule for single capsule bismuth quadruple therapy (scBQT, Pylera) includes a proton pump inhibitor (PPI) two times a day and three scBQT capsules four times a day. Four times a day treatments are inconvenient and reduce adherence. In contrast, adherence improves with three times a day schedules. In clinical practice, many gastroenterologists use four capsule scBQT three times a day. However, the effectiveness and safety of this latter approach remain uncertain. AIM: To assess the effectiveness and safety of scBQT administered three times a day in the patients included in the European Registry on Helicobacter pylori Management (Hp-EuReg). METHODS: All Spanish adult patients registered in the Asociación Española de Gastroenterología Research Electronic Data Capture (REDCap) database from June 2013 to March 2021 receiving 10-day scBQT were analysed. Modified intention-to-treat effectiveness, adherence and the safety of scBQT given three times a day were calculated and compared with the four times a day schedule. A multivariate analysis was performed to determine independent factors predicting cure of the infection. RESULTS: Of the 3712 cases, 2516 (68%) were four times a day and 1196 (32%) three times a day. Mean age was 51 years, 63% were women and 15% had a peptic ulcer. The three times a day schedule showed significantly better overall cure rates than four times a day (1047/1112, 94%; 95% CI 92.7 to 95.6 vs 2207/2423, 91%; 95% CI 89.9 to 92.2, respectively, p=0.002). Adherence and safety data were similar for both regimens. In the multivariate analysis, three times a day dosage, first-line therapy, use of standard or high-dose PPIs and adherence over 90% were significantly associated with cure of the infection. CONCLUSIONS: ScBQT prescribed three times a day was more effective than the traditional four times a day schedule. No differences were observed in treatment adherence or safety.

Use of the diadochokinetic index DDKCCVP% in the detection of articulatory inaccuracies in Parkinson's disease: a preliminary exploratory study / Utilidad del índice diadococinético DDKCVP% para la detección de imprecisiones articulatorias en enfermedad de Parkinson: estudio exploratorio preliminar

ABSTRACT Purpose: to explore whether the diadochokinetic index of syllable production variability (DDKcvp%) is useful for the detection of articulatory inaccuracies in different stages of Parkinson's disease (PD). Methods: a diadochokinetic speech task of the consonant-vowel type [pa-pa-pa] was applied to 18 people with PD (classified in stages of progression from 1 to 5 according to the Hoehn & Yahr scale) to determine their diadochokinetic performance. Records of the study group were compared to a reference value obtained from a control group made up of 40 subjects. Results: 77.78% of the study group showed articulatory inaccuracies. The DDKcvp% index allowed to detect articulatory difficulties from stage 1 of PD, and its variation showed that articulatory deficits were permanent from stage 2 onwards. A significant and direct correlation was obtained between the increase in the DDKcvp% index and the increase in the stage of evolution of the participants. Conclusion: DDKcvp% index evaluated by means of a simple and fast consonant-vowel diadochokinetic task [pa-pa-pa], could be useful to determine articulatory inaccuracies in different stages of PD, although it is suggested that investigation of this index in larger sample sizes be conducted.

RESUMEN Objetivo: explorar si el índice diadococinético de variabilidad de la producción silábica (DDKcvp%) es útil para la detección de imprecisiones articulatorias en distintos estadios de la Enfermedad de Parkinson (EP). Métodos: se aplicó una tarea diadococinética de habla del tipo consonante-vocal [pa-pa-pa] a 18 personas con EP (clasificadas en estadios de evolución del 1 al 5 según la escala Hoehn & Yahr) para determinar su rendimiento diadococinético. Los registros del grupo de estudio fueron comparados con un valor de referencia obtenido de un grupo control compuesto por 40 personas. Resultados: el 77,78% del grupo de estudio evidenció imprecisiones articulatorias. Además, el índice DDKcvp% permitió pesquisar dificultades articulatorias desde el estadio 1 de la EP, y su variación evidenció que los déficits articulatorios son permanentes desde el estadio 2 en adelante. También, se obtuvo una correlación significativa y directa entre el aumento del índice DDKcvp% con el incremento del estadio de evolución en el que se encontraban los participantes. Conclusión: el índice DDKcvp%, evaluado mediante una tarea diadococinética simple y rápida tipo consonante-vocal [pa-pa-pa], podría presentar una correcta utilidad para determinar imprecisiones articulatorias en distintos estadios de la EP, aunque se sugiere continuar investigando este índice en tamaños muestrales más amplios.

Percepción de personas con tartamudez en cuanto a sus experiencias de tratamiento basado en el modelo multidimensional CALMS / Perception of people with stuttering regarding their treatment experiences based on the multidimensional CALMS model

Conocer la percepción de personas con tartamudez sobre sus experiencias de tratamiento en base al modelo multidimensional CALMS en sus cinco dimensiones; cognitiva, afectiva o emocional, lingüística, control motor del habla y social. Esta investigación se desarrolló con un enfoque cualitativo, análisis descriptivo y abordaje fenomenológico. Participaron cinco sujetos de género masculino de entre 19 a 39 años de edad, diagnosticados con tartamudez del desarrollo persistente. Cada uno de ellos respondió a una entrevista semiestructurada de manera individual, a través de preguntas abiertas categorizadas en las cinco dimensiones del modelo multidimensional CALMS. Para el análisis de la información se utilizó el software Atlas.ti versión 7. Los resultados de la encuesta realizada indicaron que los participantes perciben el abordaje multidimensional como un modelo de intervención que les ayuda a desarrollar su confianza, desempeñarse de mejor manera en su vida cotidiana y mejorar su calidad de vida, aunque aún persistan ciclos de sentimientos y pensamientos negativos dentro de los contextos de su vida diaria y entorno en general.A pesar de que los sujetos perciben de una manera positiva la intervención fonoaudiológica, las características personales de cada participante y el impacto del entorno social influyeron en las respuestas del ámbito cognitivo y emocional basadas en las preguntas de la encuesta.

To know the perception of people with stuttering about their treatment experiences based on the CALMS multidimensional model in its five dimensions; cognitive, affective or emotional, linguistic, motor control of speech and social. This research was developed with a qualitative approach, descriptive analysis and phenomenological approach. Five male subjects between 19 and 39 years of age, diagnosed with persistent developmental stutter, participated. Each of them responded to a semi-structured interview individually, through open questions categorized in the five dimensions of the CALMS multidimensional model. The Atlas.ti version 7 software was used for the analysis of the information. The results of the survey indicated that the participants perceive the multidimensional approach as an intervention model that helps them develop their confidence, perform better in their lives and improve their quality of life, even though cycles of negative thoughts and feelings still persist within the contexts of their daily life and environment in general. Although the subjects perceive the speech-language intervention in a positive way, the personal characteristics of each participant and the impact of the social environment influenced the answers in the cognitive and emotional domain based on the questions in the survey.

Prevalence of biliary acid malabsorption in patients with chronic diarrhoea of functional characteristics: a prospective study.

BACKGROUND: Bile acid malabsorption occurs in up to one third of patients with chronic diarrhoea of functional characteristics. The gold standard test for its diagnosis is the 75Selenium homocholic acid taurine (75SeHCAT) test. The aim of this work is to confirm previous data suggesting that bile acid malabsorption, diagnosed by 75Se-HCAT test, is the underlying cause of diarrhoea in a significant proportion of patients previously diagnosed with a functional disorder. In addition, we have analysed the clinical response of bile acid sequestrants in those patients with a bile acid diarrhoea diagnosis. METHODS: This is a prospective, single-centre study including consecutive adult patients diagnosed with chronic diarrhoea of unknown origin and with functional characteristics; systematic rule out of common causes of chronic diarrhoea was performed before bile acid malabsorption evaluation by 75SeHCAT scanning. A retention percentage less than 10% was considered positive. Clinical response to cholestyramine was further evaluated in those patients with a positive diagnosis of bile acid diarrhoea RESULTS: 38 patients (20 male, mean age 37.5 years) were finally included. Twenty (52.6%) patients included had a positive 75SeHCAT test. Median body mass index was significantly higher in those patients. We did not find significant differences in other clinical or biochemical variables 75SeHCAT-positive and 75SeHCAT-negative groups. Only 6 of 17 (35.3%) patients responded to cholestyramine treatment; 10 patients did not have response or withdraw the drug due to adverse events. Logistic regression analysis showed that none of the included variables was a predictor of clinical response to cholestyramine. CONCLUSIONS: Bile acid malabsorption occurs in a high proportion of patients suffering from chronic diarrhoea with functional characteristics. Systematic investigation of bile acid malabsorption should be included in the diagnostic algorithms of patients with chronic watery diarrhoea in the routine clinical practice. Absence of response to cholestyramine does not rule out bile acid diarrhoea.

Ingesta alimentaria y presbifagia en adultos mayores activos de la comunidad de Chillán, Chile / Food intake and presbyphagia in active elderly adults in Chillán, Chile

RESUMEN El propósito del presente estudio fue determinar la prevalencia de presbifagia en adultos mayores que viven en la comunidad y estudiar el estado nutricional e ingesta alimentaria. Material y métodos: Estudio de caso-control con personas mayores de 65 años, pertenecientes a clubes de adultos mayores de Chillán, Chile. La ingesta alimentaria se evaluó a través de la encuesta de tendencia de consumo cuantificada y encuesta de modificación alimentaria creada y validada para este estudio. La presencia de presbifagia se diagnosticó mediante el cuestionario EAT-10 y el diagnóstico de disfagia por MECV-V realizado por fonoaudiólogo. El estado nutricional se evaluó a través del índice de masa corporal. Resultados: La prevalencia de presbifagia fue de 29,5% y disfagia 14,5%. El 74% de los adultos mayores con presbifagia tenía malnutrición por exceso versus 48% de los con disfagia, el 55,5% tenía un cumplimiento insuficiente de energía, situación que no coincide con el estado nutricional predominante de malnutrición por exceso. Las calorías consumidas fueron en base a carbohidratos y proteínas. Tenían una baja ingesta de agua, fibra, calcio y vitamina D y alto consumo de sodio. Los adultos mayores con disfagia demoran más tiempo en comer y han dejado de consumir alimentos que dificultan la deglución como frutas, carnes y arroz. Conclusión: La prevalencia de adultos mayores que viven en la comunidad con presbifagia fue de 29,5%, con malnutrición por exceso en el 74%, para facilitar el proceso deglutorio los adultos mayores con disfagia realizan modificaciones alimentarias a los sólidos.

ABSTRACT The purpose of the present study was to determine the prevalence of presbyphagia in community-living elderly persons and to study nutritional status and dietary intake. Material and methods: We conducted a case-control study with persons over 65 years of age, belonging to clubs for the elderly in Chillán, Chile. Dietary intake was evaluated through a food frequency questionnaire and food modification survey created and validated for this study. Presbyphagia was diagnosed by means of the EAT-10 questionnaire and dysphagia by a speech therapist with MECV-V. The nutritional status was evaluated through the body mass index. Results: The prevalence of presbyphagia was 29.5% and dysphagia 14.5%. 74% of those with presbyphagia had excess malnutrition versus 48% of those with dysphagia, 55.5% had insufficient energy compliance, a situation that does not coincide with the prevailing nutritional status of excess malnutrition. The calories consumed were based on carbohydrates and proteins. They had a low intake of water, fiber, calcium and vitamin D and high sodium in-take. Elderly persons with dysphagia took longer to eat and reported having stopped eating foods difficult to swallow such as fruits, meats and rice. Conclusion: The prevalence of community-living elderly persons with presbyphagia was 29.5% and, among those with presbyphagia, 74% had excess malnutrition. To facilitate the swallowing process, active elderly persons with dysphagia make food modifications to solid food intake.

Tan fácil (o difícil) como hervir un huevo / As easy (or difficult) as boiling an egg

No disponible

Factores asociados al burnout académico en estudiantes de internado profesional de fonoaudiologia / Associated factors with academic burnout in intern students of speech language pathology

Resumen: Los estudiantes que cursan el internado profesional de fonoaudiologia experimentan situaciones de estrés y agotamiento propias de esta acti vidad, pudiendo presentar burnout académico (BA), ya que el contacto con usuarios reales, la exigencia académica y las acciones propias de un contexto laboral son caracteristicas de la práctica profesional. El objeti vo del presente estudio es determinar la existencia del burnout acadé mico y la asociación con variables sociodemográficas en los estudiantes de 5to año de fonoaudiología. Se aplicó un cuestionario a 47 sujetos de internado profesional para recopilar antecedentes personales, académi cos y sociales. Luego, para evaluar el burnout académico, se aplicó el Maslach Burnout Inventory-Student Survey. Los estudiantes evaluados no presentan el síndrome, aunque el factor cansancio emocional se presentó con más altos puntajes. Tampoco existen diferencias entre los puntajes del síndrome para los estudiantes que realizan su práctica en las áreas de Salud y Educación. Las variables explicativas del alto cansancio emocional en este estudio son el sexo masculino, pertenecer a sector urbano y aumento de consumo de taba co. El estudio del BA es importante para tomar medidas preventivas en el transcurso de la vida universitaria para garantizar a futuro el com promiso y mejor desempeño por parte de los estudiantes que realizan su práctica profesional.

Abstract: Students who attend internship of speech language pathology expe rience situations of stress and exhaustion characteristic of this activ ity, being able to present academic burnout, due to the contact with real users, the academic requirement and the own actions of a work context, which are characteristics of the internship. The objective of this study was to determine the existence of academic burnout and its association with sociodemographic variables in the 5th year stu dents of speech language pathology. A questionnaire was applied to 47 intern students in order to gather personal, academic and social backgrounds. After to evaluate the academic burnout, the Maslach Burnout Inventory - Student Survey was applied. The students evaluated did not present the syndrome, although the emotional fatigue factor was presented with higher scores. There are also no differences in the scores of the syndrome for students who did their practice in both health and education setting. The explana tory variables of high emotional fatigue in this study were male sex, belonging to the urban sector and increased tobacco consumption. The BA study is important to take preventive measures over the university life to ensure future commitment and better performance by students who perform their professional practice.

Percepción de un grupo de adultos mayores con presbifagia sobre el fenómeno de la alimentación y las propiedades organolépticas de los alimentos / Perception of feeding phenomenon and organoleptic properties of food by a group of elderly people with presbyphagia

El envejecimiento conlleva cambios fisiológicos y no fisiológicos que afectan la percepción del adulto mayor sobre el fenómeno de la alimentación, sin embargo, las investigaciones internacionales podrían no representar a la población chilena, existiendo escasa información acerca de la percepción del adulto mayor con presbifagia y los factores que influyen en su alimentación. El objetivo del presente estudio cualitativo y de diseño fenomenológico es conocer la percepción de los adultos mayores con presbifagia sobre el fenómeno de la alimentación, abarcando factores fisiológicos y no fisiológicos, junto a las propiedades organolépticas de los alimentos que prefieren. Para ello se aplicó una entrevista semiestructurada a ocho adultos mayores con presbifagia asistentes a un Centro de Actividades Prácticas (muestreo por saturación). El discurso se procesó mediante codificación axial en dos niveles: formación de códigos (a través de citas del entrevistado), memos (conceptos de los investigadores) y la codificación selectiva, mediante la integración de los códigos en familias, aplicando el método de comparaciones constantes, utilizando Atlas.ti 6. Los resultados indican que en la alimentación intervienen factores sociales y psicológicos. Las propiedades organolépticas que influyen en la percepción del adulto mayor son: tamaño, consistencia, sabor, temperatura e intensidad del color, las cuales afectan la elección de los alimentos. En conclusión la percepción del adulto mayor con presbifagia sobre la alimentación, está influenciada por factores fisiológicos y no fisiológicos, los cuales determinan la preferencia de propiedades organolépticas y elección de alimentos. Además de encontrarse influenciada por hábitos alimentarios adquiridos y ubicación geográfica(AU)

Aging involves physiological and non-physiological changes that affect the perception of the elderly on the phenomenon of food, however, international investigations could not represent the Chilean population, because of the little information about the perception of the elderly with presbyphagia and the factors that influence their diet. The purpose of this qualitative study with phenomenological design is to know the perception of older adults with presbyphagia about food phenomenon, considering physiological and non-physiological factors along with the organoleptic properties of foods that they prefer. For this, a semistructured interview was applied to eight older adults with presbyphagia attending at the Practical Activities Center (sampling by saturation). The speech was processed through axial coding in two levels: formation of codes (through appointments of the interviewee), memos (concepts of researchers) and selective coding, through the integration of family codes, applying the method of constant comparisons, using Atlas.ti 6. The results indicate that social and psychological factors are involved in feeding. Organoleptic properties that influence the perception of the elderly are: size, consistency, taste, temperature and intensity of the color, which affect the choice of food. In conclusion the perception of the elderly with presbyphagia food, is influenced by physiological and non-physiological factors which determine the preference of organoleptic properties and food choices. In addition to being influenced by acquired habits and geographic location(AU)

Safety and Efficacy of Anti-TNFα Treatment in Crohn's Disease Patients with Abdominal Abscesses.

BACKGROUND/AIMS: It is estimated that up to 30% of CD patients develop abdominal abscesses; the management of active luminal CD in such patients represents a clinical challenge. The aim of this study is to assess the safety of biologics in patients with Crohn's disease and abdominal abscesses treated with percutaneous drainage and/or broad-spectrum antibiotics. METHODOLOGY: We performed a retrospective review of the clinical charts of consecutive Crohn's disease patients with abdominal abscesses treated with anti-TNFα therapy attended in our institution. RESULTS: 12 patients were finally included in the study. All were treated with broad-spectrum antibiotic and biological therapy (anti-TNF); indication of anti-TNFα therapy was moderate to severe activity of CD in all of them. Percutaneous drainage of the abscess was performed in 7 of the 12 patients. No complications were observed during a mean follow-up of 37,8 (16-71) months, including abscess volume increase, enterocutaneous fistula, soft tissue infections, bacteraemia, or need for emergency surgery. CONCLUSIONS: In addition to conventional treatment, the use of anti-TNFα therapy in Crohn's disease patients with abdominal abscesses seems to be safe. Usefulness of this approach has to be validated in larger cohorts.

Prospective study of BK virus infection in patients with inflammatory bowel disease.

Patients with inflammatory bowel disease (IBD) have an immune-deficient baseline status further modulated by immunosuppressive therapy that may promote the reactivation of latent viruses such as BK virus (BKV). The aim of this prospective study was to determine the prevalence of BKV infection in IBD patients and its potential relationship with the immunosuppressive treatment. Paired urine and plasma samples from 53 consecutive patients with IBD and 53 controls were analyzed. BKV detection was performed by conventional PCR and positive samples were further quantified by real-time PCR. No viremia was detected. BKV viruria was significantly more common in IBD patients than among the controls (54.7% versus 11.3%; P < 0.0001). The only risk factor for BKV viruria in IBD was age (47.2 ± 16.3 versus 37.8 ± 15.2; P = 0.036), and there was a trend towards higher rate of viruria in outpatients (61.5% versus 38.5%; P = 0.096) and in those not receiving ciprofloxacin (59.5% versus 40.5%; P = 0.17). A clear impact of the immunosuppressive regimen on BKV infection could not be demonstrated.

Estudio sobre el manejo odontológico de pacientes con epilepsia, atendidos en la unidad de salud de Unicentro, Soyapango y hospital anexo del Instituto Salvadoreño del Seguro Social, durante el período comprendido de septiembre a noviembre de 1998 / Study on the dental management of patients with epilepsy, treated in Unicentro health care unit, Soyapango and annexed hospital of the Salvadoran Social Security Institute, during the period from September to November 1998

La presente investigación se elaboró con la finalidad de conocer el manejo odontológico de los pacientes con epilepsia. Dicho estudio se realizó en el Hospital Anexos Odontológico del Instituto Salvadoreño del Seguro Social y la unidad de salud Unicentro de Soyapango. La investigación se ha organizado en cuatro capítulos. En el primer capítulo se presentan los elementos de diagnóstico, los cuales comprenden: La Justificación, Objetivos generales y específicos, alcances y limitaciones, variables e indicadores, Unidades de análisis, objeto de transformación, y definición de términos básicos. El segundo capítulo corresponde al Marco teórico, en el cual se presentan los Antecedentes de la Epilepsia y de su tratamiento, así como también se fundamenta el manejo odontológico adecuado que se les debe brindar a estos pacientes. El tercer capítulo corresponde al Marco teórico, en el cual se presentan los antecedentes de la Epilepsia y de su tratamiento, así como también se fundamenta el manejo odontológico adecuado que se les debe brindar a estos pacientes. El tercer capítulo comprende la Metodología que se utilizó para realizar la investigación, donde se explica el tipo de investigación, la población y la muestra con la que se realizó la investigación, además se explican las técnicas, instrumentos y procedimientos que se aplicaron para la recolección de los datos. También se presenta el procedimiento para la tabulación de los datos y el método empleado para el análisis de los datos. En el cuarto capítulo se presentan los Resultados del diagnóstico donde se muestran los cuadros estadísticos obtenidos de la investigación con su respectiva descripción además comprende el análisis general de la problemática estudiada. Así también se plantean las conclusiones específicas y generales, y las recomendaciones que el grupo determina entorno a la solución de los problemas encontrados. Posteriormente se presenta la bibliográfica consultada, y finalmente los anexos correspondientes.

The present investigation was elaborated with the purpose of knowing the dental management of the patients with epilepsy. This study was carried out at the Hospital Anexos Odontológico of the Salvadoran Social Security Institute and the Unicentro de Soyapango health unit. The investigation has been organized into four chapters. The first chapter presents the diagnostic elements, which include: Justification, General and specific objectives, scope and limitations, variables and indicators, Units of analysis, object of transformation, and definition of basic terms. The second chapter corresponds to the theoretical framework, in which the Antecedents of Epilepsy and its treatment are presented, as well as the adequate dental management that should be provided to these patients is based. The third chapter corresponds to the theoretical framework, in which the antecedents of epilepsy and its treatment are presented, as well as the adequate dental management that should be provided to these patients is based. The third chapter includes the Methodology that was used to carry out the research, where the type of research, the population and the sample with which the research was carried out are explained, as well as the techniques, instruments and procedures that were applied for the collection. of the data. The procedure for data tabulation and the method used for data analysis are also presented. In the fourth chapter, the Results of the diagnosis are presented, where the statistical tables obtained from the investigation are shown with their respective description, it also includes the general analysis of the problem studied. In this way, the specific and general conclusions are also raised, as well as the recommendations that the group determines around the solution of the problems encountered. Subsequently, the bibliographic consulted is presented, and finally the corresponding annexes.