Decoding the Gut Microbiota-Gestational Diabetes Link: Insights from the Last Seven Years.

The human microbiome, a complex ecosystem of bacteria, viruses, and protozoans living in symbiosis with the host, plays a crucial role in human health, influencing everything from metabolism to immune function. Dysbiosis, or an imbalance in this ecosystem, has been linked to various health issues, including diabetes and gestational diabetes (GD). In diabetes, dysbiosis affects the function of adipose tissue, leading to the release of adipokines and cytokines, which increase inflammation and insulin resistance. During pregnancy, changes to the microbiome can exacerbate glucose intolerance, a common feature of GD. Over the past years, burgeoning insights into the gut microbiota have unveiled its pivotal role in human health. This article comprehensively reviews literature from the last seven years, highlighting the association between gut microbiota dysbiosis and GD, as well as the metabolism of antidiabetic drugs and the potential influences of diet and probiotics. The underlying pathophysiological mechanisms discussed include the impact of dysbiosis on systemic inflammation and the interplay with genetic and environmental factors. By focusing on recent studies, the importance of considering microbial health in the prevention and treatment of GD is emphasized, providing insights into future research directions and clinical applications to improve maternal-infant health outcomes.

Empagliflozin and Dapagliflozin Improve Endothelial Function in Mexican Patients with Type 2 Diabetes Mellitus: A Double-Blind Clinical Trial.

AIM: To assess the acute effect of empagliflozin versus dapagliflozin administration on flow-mediated vasodilation in patients with type 2 diabetes mellitus. DESIGN: A double-blind clinical trial, at the Experimental and Clinical Therapeutics Institute, University Health Sciences Center, at the Universidad de Guadalajara, in inpatients with T2D according to the 2023 ADA criteria. METHODS: Thirty patients (15 males and 15 females), aged between 35 and 65 years, were included in this study, according to the 2023 ADA criteria. The eligible patients were randomly assigned to three groups: empagliflozin 25 mg once daily, dapagliflozin 10 mg once daily, or placebo once daily. Anthropometric parameters were taken using validated techniques. FMD was measured using a high-resolution semiautomatic ultrasound UNEX-EF 38G (UNEX Co., Ltd., Nagoya, Japan). Arterial tension was determined with the OMRON electronic digital sphygmomanometer (HEM 907 XL, Kyoto, Japan). RESULTS: The group of patients who received empagliflozin had a significantly lower baseline flow-mediated dilation (FMD) compared to the group receiving dapagliflozin (p = 0.017); at the end of this study, the empagliflozin group achieved a comparable FMD to the dapagliflozin group (p = 0.88). CONCLUSION: After the treatment period, the empagliflozin and dapagliflozin groups achieved similar FMD, suggesting a class effect.

Autoimmune hepatitis after COVID-19 infection.

We report the case of a 58-year-old male patient presenting with clinical and laboratory findings indicative of acute hepatitis. Abdominal ultrasound excluded biliary tract abnormalities. Two weeks prior, the patient had contracted COVID-19. Viral hepatitis was ruled out, and the presence of autoantibodies was confirmed. Liver biopsy findings were consistent with autoimmune hepatitis and grade 1 fibrosis. Initial treatment with budesonide was ineffective, leading to a switch to prednisone, with maintenance therapy comprising prednisone and azathioprine. COVID-19 infection may act as a trigger for the development of autoimmune hepatitis.

Novel approaches in the medical management of compensated cirrhosis.

INTRODUCTION: Classically, clinical practice guidelines and expert recommendations have focused on the management of decompensated cirrhotic patients, so we focused this review on improving care for compensated cirrhotic patients who are followed up in outpatient clinics. AREAS COVERED: We reviewed the current methods for establishing liver function, the diagnosis and management of advanced chronic liver disease and clinically significant portal hypertension as well as the prevention of its complications, with special attention to covert hepatic encephalopathy, we also paid attention to the extrahepatic complications of cirrhosis and the palliative care. All this from the perspective of evidence-based medicine and trying to empower precision medicine. The literature search was undertaken by PubMed with 'cirrhosis,' 'advanced chronic liver disease,' 'liver function,' 'portal hypertension,' 'covert hepatic encephalopathy,' 'minimal hepatic encephalopathy,' 'palliative care' as MeSH terms. EXPERT OPINION: We must offer compensated cirrhotic patients specific care and measures to prevent the progression of the disease and the appearance of its complications beyond the calculation of liver function and imaging screening for hepatocellular carcinoma that we perform every six months. Entities that have typically received little attention, such as covert hepatic encephalopathy, extrahepatic complications and symptoms of cirrhosis, and palliative care, must come to the spotlight.

Restorative Strategies for Bilateral Mutilated Hands in a Secondary Care Level: A Report of a Case in Mexico.

This case report aims to delineate the challenges and management strategies for a patient with bilateral mutilated hands within a secondary care level in Mexico, contributing to medical literature and potentially guiding future patient care. Mutilated hands represent a significant surgical and rehabilitative challenge due to the profound structural damage they cause, leading to considerable functional impairment and psychological distress. The complexity of these injuries necessitates a multidisciplinary approach, particularly in resource-constrained settings. We present a case of a 45-year-old male with no prior significant medical history who sustained bilateral mutilated hands from an industrial accident involving hot rollers. The patient underwent extensive surgical reconstruction and postoperative care, facing complications such as skin graft integration issues and infections, which required a multidisciplinary treatment approach.

Development of a Randomized Trial Comparing ICP-Monitor-Based Management of Severe Pediatric Traumatic Brain Injury to Management Based on Imaging and Clinical Examination Without ICP Monitoring-Study Protocol.

BACKGROUND AND OBJECTIVES: Traumatic brain injury (TBI) is a major global public health problem. It is a leading cause of death and disability in children and adolescents worldwide. Although increased intracranial pressure (ICP) is common and associated with death and poor outcome after pediatric TBI, the efficacy of current ICP-based management remains controversial. We intend to provide Class I evidence testing the efficacy of a protocol based on current ICP monitor-based management vs care based on imaging and clinical examination without ICP monitoring in pediatric severe TBI. METHODS: A phase III, multicenter, parallel-group, randomized superiority trial performed in intensive care units in Central and South America to determine the impact on 6-month outcome of children aged 1-12 years with severe TBI (age-appropriate Glasgow Coma Scale score ≤8) randomized to ICP-based or non-ICP-based management. EXPECTED OUTCOMES: Primary outcome is 6-month Pediatric Quality of Life. Secondary outcomes are 3-month Pediatric Quality of Life, mortality, 3-month and 6-month Pediatric extended Glasgow Outcome Score, intensive care unit length of stay, and number of interventions focused on treating measured or suspected intracranial hypertension. DISCUSSION: This is not a study of the value of knowing the ICP in sTBI. This research question is protocol-based. We are investigating the added value of protocolized ICP management to treatment based on imaging and clinical examination in the global population of severe pediatric TBI. Demonstrating efficacy should standardize ICP monitoring in severe pediatric TBI. Alternate results should prompt reassessment of how and in which patients ICP data should be applied in neurotrauma care.

Development of a Randomized Trial Comparing ICP-Monitor-Based Management of Severe Pediatric Traumatic Brain Injury to Management Based on Imaging and Clinical Examination Without ICP Monitoring-Research Algorithms.

BACKGROUND AND OBJECTIVES: The efficacy of our current approach to incorporating intracranial pressure (ICP) data into pediatric severe traumatic brain injury (sTBI) management is incompletely understood, lacking data from multicenter, prospective, randomized studies. The National Institutes of Health-supported Benchmark Evidence from Latin America-Treatment of Raised Intracranial Pressure-Pediatrics trial will compare outcomes from pediatric sTBI of a management protocol based on ICP monitoring vs 1 based on imaging and clinical examination without monitoring. Because no applicable comprehensive management algorithms for either cohort are available, it was necessary to develop them. METHODS: A consensus conference involving the 21 intensivists and neurosurgeons from the 8 trial sites used Delphi-based methodology to formulate management algorithms for both study cohorts. We included recommendations from the latest Brain Trauma Foundation pediatric sTBI guidelines and the consensus-based adult algorithms (Seattle International Brain Injury Consensus Conference/Consensus Revised Imaging and Clinical Examination) wherever relevant. We used a consensus threshold of 80%. RESULTS: We developed comprehensive management algorithms for monitored and nonmonitored cohort children with sTBI. We defined suspected intracranial hypertension for the nonmonitored group, set minimum number and timing of computed tomography scans, specified minimal age-adjusted mean arterial pressure and cerebral perfusion pressure targets, defined clinical neuroworsening, described minimal requisites for intensive care unit management, produced tiered management algorithms for both groups, and listed treatments not routinely used. CONCLUSION: We will study these protocols in the Benchmark Evidence from Latin America-Treatment of Raised Intracranial Pressure-Pediatrics trial in low- and middle-income countries. Second, we present them here for consideration as prototype pediatric sTBI management algorithms in the absence of published alternatives, acknowledging their limited evidentiary status. Therefore, herein, we describe our study design only, not recommended treatment protocols.

Survival and prognostic factors in pediatric patients with medulloblastoma treated at a national pediatric hospital in Peru: a retrospective cohort.

OBJECTIVE: The objectives of this study were to determine the overall survival (OS) and event-free survival (EFS) rates of patients with medulloblastoma treated in a national pediatric hospital in Peru, as well as to identify demographic, clinical, imaging, postoperative, and histopathological characteristics and prognostic factors associated with OS and EFS. METHODS: The authors conducted a retrospective study analyzing information from the medical records of children with a diagnosis of medulloblastoma who underwent surgical treatment at the Instituto Nacional de Salud del Niño-San Borja, a public hospital in Lima, Peru, from 2015 to 2020. Clinical-epidemiological variables, degree of disease extension, risk stratification, extent of resection, postoperative complications, status of oncological treatment received, histological subtype, and neurological sequelae were taken into account. The Kaplan-Meier method and Cox regression analysis were used to estimate OS, EFS, and prognostic factors. RESULTS: Of the 57 children evaluated with complete medical records, only 22 children (38.6%) underwent complete oncological treatment. OS was 37% (95% CI 0.25-0.55) at 48 months. EFS was 44% (95% CI 0.31-0.61) at 23 months. High-risk stratification-meaning patients with ≥ 1.5 cm2 of residual postoperative tumor, those younger than 3 years, those with disseminated disease (HR 9.69, 95% CI 1.40-67.0, p = 0.02), and those who underwent subtotal resection (HR 3.78, 95% CI 1.09-13.2, p = 0.04)-was negatively associated with OS. Failure to receive complete oncological treatment was negatively associated with OS (HR 20.0, 95% CI 4.84-82.6, p < 0.001) and EFS (HR 7.82, 95% CI 2.47-24.7, p < 0.001). CONCLUSIONS: OS and EFS of patients with medulloblastoma in the author's milieu are below those reported in developed countries. Incomplete treatment and treatment abandonment in the authors' cohort were also high compared with high-income country statistics. Failure to complete oncological treatment was the most important factor associated with poor prognosis, both in terms of OS and EFS. High-risk patients and subtotal resection were negatively associated with OS. Interventions are needed to promote the completion of adjuvant oncological therapy for medulloblastoma in the disadvantaged Peruvian population.

Antiangiogenic Effect of Dopamine and Dopaminergic Agonists as an Adjuvant Therapeutic Option in the Treatment of Cancer, Endometriosis, and Osteoarthritis.

Dopamine (DA) and dopamine agonists (DA-Ag) have shown antiangiogenic potential through the vascular endothelial growth factor (VEGF) pathway. They inhibit VEGF and VEGF receptor 2 (VEGFR 2) functions through the dopamine receptor D2 (D2R), preventing important angiogenesis-related processes such as proliferation, migration, and vascular permeability. However, few studies have demonstrated the antiangiogenic mechanism and efficacy of DA and DA-Ag in diseases such as cancer, endometriosis, and osteoarthritis (OA). Therefore, the objective of this review was to describe the mechanisms of the antiangiogenic action of the DA-D2R/VEGF-VEGFR 2 system and to compile related findings from experimental studies and clinical trials on cancer, endometriosis, and OA. Advanced searches were performed in PubMed, Web of Science, SciFinder, ProQuest, EBSCO, Scopus, Science Direct, Google Scholar, PubChem, NCBI Bookshelf, DrugBank, livertox, and Clinical Trials. Articles explaining the antiangiogenic effect of DA and DA-Ag in research articles, meta-analyses, books, reviews, databases, and clinical trials were considered. DA and DA-Ag have an antiangiogenic effect that could reinforce the treatment of diseases that do not yet have a fully curative treatment, such as cancer, endometriosis, and OA. In addition, DA and DA-Ag could present advantages over other angiogenic inhibitors, such as monoclonal antibodies.

Infection with SARS-CoV-2 as a potential achalasia trigger.

Idiopathic achalasia is a chronic oesophageal motility disorder caused by loss of inhibitory neurons at the esophageal myenteric plexus resulting in incomplete relaxation of the lower oesophageal sphincter and abnormal peristaltism.  Among the possible causes of this, an immune response secondary to infection by some viruses has been implicated. SARS-CoV-2 could be considered among them. The therapy option should be aimed at achieving the greatest clinical effectiveness according to each patient's health status.

Giant cavernous malformation of the posterior fossa with lymphangiomatous phenotype, associated with orbital venolymphatic anomaly in an 11-month-old patient: case report and literature review.

The synchronous presentation of venolymphatic anomalies of the orbit and noncontiguous intracranial cavernous malformations is uncommon. Herein, we present a case of an 11-month-old female patient diagnosed with orbital venolymphatic anomaly associated with a large cavernous malformation in the posterior fossa, who underwent complete surgical resection of the latter. The immunohistochemical analysis was positive for podoplanin, a marker expressed by lymphatic endothelial cells, but not vascular endothelium. This exceptional finding suggests lymphatic involvement in the etiology of the lesion. In our review of the literature, we did not find similar cases in patients under 1 year of age.

Steroid Resistance Associated with High MIF and P-gp Serum Levels in SLE Patients.

Approximately 30% of patients with systemic lupus erythematosus (SLE) present steroid resistance (SR). Macrophage migration inhibition factor (MIF) and P-glycoprotein (P-gp) could be related to SR. This work aims to evaluate the relationship between MIF and P-pg serum levels in SR in SLE. Methods: Case−control study including 188 SLE patients who were divided into two groups (90 in the steroid-resistant group and 98 in the steroid-sensitive (SS) group) and 35 healthy controls. MIF and P-gp serum levels were determined by ELISA. Multivariable logistic regression and chi-squared automatic interaction detection (CHAID) were used to explore risk factors for SR. Results: The steroid-resistant group presented higher MIF and P-gp serum levels in comparison with the SS (p < 0.001) and reference (p < 0.001) groups. MIF correlated positively with P-gp (rho = 0.41, p < 0.001). MIF (≥15.75 ng/mL) and P-gp (≥15.22 ng/mL) were a risk factor for SR (OR = 2.29, OR = 5.27). CHAID identified high P-gp as the main risk factor for SR and high MIF as the second risk factor in those patients with low P-gp. Conclusions: An association between MIF and P-gp serum levels was observed in SR. CHAID identified P-gp ≥ 15.22 ng/mL as the main risk factor for SR. More studies are needed to validate these results.

Ectopic ACTH syndrome in a patient with Crohn's disease.

We present the case of a 62-year-old man with Crohn's disease who consulted for abdominal pain and lower limbs edema. The patient developed Cushing's syndrome due to ectopic secretion of ACTH. Diagnostic imaging tests showed multiple metastatic liver lesions and asymmetric thickening of the ileum, that was suspected as the primary tumor. This tumor produced destabilizing gastrointestinal bleeding and an urgent surgical resection was performed. The histopathological study of the resection specimen confirmed a grade 3 neuroendocrine tumor.

Reef accumulation is decoupled from recent degradation in the central and southern Red Sea.

Reefs are biogenic structures that result in three-dimensional accumulations of calcium carbonate. Over geological timescales, a positive balance between the production and accumulation of calcium carbonate versus erosional and off-reef transport processes maintains positive net accretion on reefs. Yet, how ecological processes occurring over decadal timescales translate to the accumulation of geological structures is poorly understood, in part due to a lack of studies with detailed time-constrained chronologies of reef accretion over decades to centuries. Here, we combined ecological surveys of living reefs with palaeoecological reconstructions and high-precision radiometric (U-Th) age-dating of fossil reefs represented in both reef sediment cores and surficial dead in situ corals, to reconstruct the history of community composition and carbonate accumulation across the central and southern Saudi Arabian Red Sea throughout the late Holocene. We found that reefs were primarily comprised of thermally tolerant massive Porites colonies, creating a consolidated coral framework, with unconsolidated branching coral rubble accumulating among massive corals on shallow (5-8 m depth) exposed (windward), and gently sloping reef slopes. These unconsolidated reef rubble fields were formed primarily from ex situ Acropora and Pocillopora coral fragments, infilled post deposition within a sedimentary matrix. Bayesian age-depth models revealed a process of punctuated deposition of post-mortem coral fragments transported from adjacent reef environments. That a large portion of Saudi Arabian Red Sea reef slopes is driven by allochthonous deposition (transportation) has important implications for modeling carbonate budgets and reef growth. In addition, a multi-decadal lag exists between the time of death for branching in situ coral and incorporation into the unconsolidated reef rubble. This indicates that recent climate related degradation in the 21st century has not had an immediately negative effect on reef building processes affecting a large portion of the reef area in the Saudi Arabian Red Sea.

Association of Netrin 1 with hsCRP in Subjects with Obesity and Recent Diagnosis of Type 2 Diabetes.

Netrin 1 (Ntn1) is a cell migration protein with an anti-inflammatory effect, which may play a key role in the pathological development of type 2 diabetes (T2D). In this study, we evaluate the relationships between the serum concentrations of Ntn1, glucose, and high-sensitivity C-reactive Protein (hsCRP). We carried out a cross-sectional study including 90 individuals divided into three groups (n = 30): healthy subjects, individuals with obesity without glucose alterations, and individuals with newly diagnosed T2D. Serum concentrations of Ntn1 and hs-CRP were determined by enzyme-linked immunosorbent assay (ELISA). The serum concentration of Ntn1 was higher in individuals with newly diagnosed T2D (0.33 ± 0.22 ng/mL), in comparison to healthy subjects and individuals with obesity (0.13 ± 0.06 and 0.15 ± 0.07 ng/mL, respectively). In addition, we observed a positive association between the levels of Ntn1 and hsCRP (rho = 0.443; p < 0.001) as well as with serum glucose (rho = −0.110; p = 0.05). The serum concentration of Ntn1 was higher in individuals with T2D, in comparison with the other groups in this study, and presented a positive correlation with hsCRP. Therefore, Ntn1 can be considered a promising risk biomarker and a potential therapeutic target for T2D.

Arthroscopic Matrix-Assisted Autologous Chondrocyte Transplantation Versus Microfracture: A 6-Year Follow-up of a Prospective Randomized Trial.

BACKGROUND: Few randomized controlled trials with a midterm follow-up have compared matrix-assisted autologous chondrocyte transplantation (MACT) with microfracture (MFx) for knee cartilage lesions. PURPOSE: To compare the structural, clinical, and safety outcomes at midterm follow-up of MACT versus MFx for treating symptomatic knee cartilage lesions. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: A total of 48 patients aged between 18 and 50 years, with 1- to 4-cm2 International Cartilage Repair Society (ICRS) grade III to IV knee chondral lesions, were randomized in a 1:1 ratio to the MACT and MFx treatment groups. A sequential prospective evaluation was performed using magnetic resonance imaging (MRI) T2 mapping, the MOCART (magnetic resonance observation of cartilage repair tissue) score, second-look arthroscopic surgery, patient-reported outcome measures, the responder rate (based on achieving the minimal clinically important difference for the Knee injury and Osteoarthritis Outcome Score [KOOS] pain and KOOS Sport/Recreation), adverse events, and treatment failure (defined as a reoperation because of symptoms caused by the primary defect and the detachment or absence of >50% of the repaired tissue during revision surgery). RESULTS: Overall, 35 patients (18 MACT and 17 MFx) with a mean chondral lesion size of 1.8 ± 0.8 cm2 (range, 1-4 cm2) were followed up to a mean of 6 years postoperatively (range, 4-9 years). MACT demonstrated significantly better structural outcomes than MFx at 1 to 6 years postoperatively. At final follow-up, the MRI T2 mapping values of the repaired tissue were 37.7 ± 8.5 ms for MACT versus 46.4 ± 8.5 ms for MFx (P = .003), while the MOCART scores were 59.4 ± 17.3 and 42.4 ± 16.3, respectively (P = .006). More than 50% defect filling was seen in 95% of patients at 2 years and 82% at 6 years in the MACT group and in 67% at 2 years and 53% at 6 years in the MFx group. The second-look ICRS scores at 1 year were 10.7 ± 1.3 for MACT and 9.0 ± 1.8 for MFx (P = .001). Both groups showed significant clinical improvements at 6 years postoperatively compared with their preoperative status. Significant differences favoring the MACT group were observed at 2 years on the KOOS Activities of Daily Living (P = .043), at 4 years on all KOOS subscales (except Symptoms; P < .05) and the Tegner scale (P = .008), and at 6 years on the Tegner scale (P = .010). The responder rates at 6 years were 53% and 77% for MFx and MACT, respectively. There were no reported treatment failures after MACT; the failure rate was 8.3% in the MFx group. Neither group had serious adverse events related to treatment. CONCLUSION: Patients who underwent MACT had better structural outcomes than those who underwent MFx at 1 to 6 years postoperatively. Both groups of patients showed significant clinical improvements at final follow-up compared with their preoperative status. MACT showed superiority at 4 years for the majority of the KOOS subscales and for the Tegner scale at 4 to 6 years. The MACT group also had a higher responder rate and lower failure rate at final follow-up. REGISTRATION: NCT01947374 (ClinicalTrials.gov identifier).

Tumor de estroma gastrointestinal: a propósito de un caso y revisión de la literatura / Gastrointestinal stromal tumor: report of a case and review of the literature / Tumor estromal gastrointestinal: relato de um caso e revisão da literatura

RESUMEN Introducción: los tumores del estroma gastrointestinal (GIST), son las neoplasias de origen mesenquimático más frecuentes del tracto digestivo, sin embargo, representan menos del 1% de todos estos tumores. Actualmente se denominan GIST a los tumores mesenquimales CD117 positivos, fusiformes o epitelioides, primarios del tracto gastrointestinal, epiplón, mesenterio y retroperitoneo. Presentación de caso: presentamos un paciente de 60 años de edad que fue ingresado en el servicio de Medicina Interna por anemia crónica y dispepsia. Al examen físico se constata en la palpación de abdomen un tumor en hipocondrio derecho y epigastrio, no mesurable, fijo, doloroso. Se realizan complementarios como ecografía abdominal, esófago gastroduedenoscopia, TAC abdominal y laparoscopia demostrándose la presencia de un tumor de la curvatura mayor gástrica de aproximadamente 20 cm con crecimiento exofitico. Se interviene quirúrgicamente, realizándose gastrectomía total, espelenctomia y esofagoyeyunostomia. Los resultados definitivos de anatomía patológica informan: tumor de pared gástrica, fusocelular del estroma gastrointestinal, de bajo potencial. Tamaño del tumor 25cm. Índice Mitótico de 1 mitosis por 50 HPF con Inmunohistoquímica positiva para CD117, CD34, cumplió tratamiento quimioterapia y presenta una evolución favorable. Discusión: los GIST son tumores cuya presencia de síntomas dependerá del tamaño y localización del tumor y puede variar desde formas asintomáticas a casos que se presenten como una emergencia quirúrgica por perforación gástrica o sangramiento digestivo. Conclusiones: el paciente fue intervenido quirúrgicamente encontrándose un tumor fusocelular del estroma gastrointestinal (GIST) de pared gástrica, de bajo potencial de malignidad, comportamiento agresivo.

ABSTRACT Introduction: the Gastrointestinal Stroma Tumors (GIST), the neoplasia from which those stem are those of highest mesenquimatic frequency of the digestive tract, However, it represents less than 1 % of all these tumors. At present, mesenquimales name the tumors GIST CD117 positive, fusiform or epithelioid, primary of the tract gastrointestinal, epiplón, mesentery and retro-peritoneum. Case presentation: we introduced a 60-year-old patient that went through admittance in the Internal Medicine service due to chronic anemia and dyspepsia. To the physical examination through palpationof the abdomen, a tumor in straight hypochondrium and epigastrium is verified, notmeasurable, It is fixed, painful. Complementary tests are also performed, like abdominal echography, esophagus gastroduedenoscopy abdominal CAT and laparoscopy, showing the presence of a tumor of the bigger gastric curvature of approximately 20 cm with exofitic growth. Surgery is performed, coming true total gastrectomy, splenectomy and esofagoyeyunostomy, which have proven to be definite of morbid anatomy, as the inform discloses: Tumor of gastricwall, gastrointestinal fusocellular stroma, of potential bass. Size of the tumor 25cm. Meiotic index of 1 mitosis for 50 HPF with positive Inmunohistochemical for CD117, CD34, treatment fulfilled chemotherapy and it presents a favorable evolution. Discussion: the GIST symptoms are depended of the tumor size and localization. They had some types of clinical presentation such as gastric perforation or haemorrage. Conclusion: in the OR we found a gastrointestinal fusocelullar tumor, at the gastric wall. With very aggressive behavior.

RESUMO Introdução: os tumores estromais gastrointestinais (GIST) são as neoplasias mais frequentes de origem mesenquimal do trato digestivo, porém representam menos de 1% de todos esses tumores. Atualmente, os GISTs são positivos para CD117, fusiformes ou epitelióides, tumores mesenquimais primários do trato gastrointestinal, omento, mesentério e retroperitônio. Apresentação do caso: apresentamos um paciente de 60 anos que deu entrada no serviço de Clínica Médica por anemia crônica e dispepsia. O exame físico revelou tumor doloroso, fixo e não mensurável em quadrante superior direito e epigástrio à palpação de abdome. Exames complementares como ultrassonografia abdominal, gastroduedenoscopia de esôfago, tomografia computadorizada de abdome e laparoscopia são realizados, demonstrando a presença de tumor da grande curvatura gástrica de aproximadamente 20 cm com crescimento exofítico. Foi realizada intervenção cirúrgica, realizando gastrectomia total, espelenctomia e esofagojejunostomia. Os resultados definitivo do laudo anatomopatológico: tumor da parede gástrica, fusocelular do estroma gastrointestinal, de baixo potencial. Tamanho do tumor: 25cm. Índice mitótico de 1 mitose por 50 HPF com imunoistoquímica positiva para CD117, CD34, foi submetido a tratamento quimioterápico e apresenta evolução favorável. Discussão: GISTs são tumores cuja presença de sintomas dependerá do tamanho e localização do tumor e podem variar desde formas assintomáticas até casos que se apresentam como emergência cirúrgica por perfuração gástrica ou sangramento digestivo. Conclusões: a paciente foi operada e encontrou tumor de células fusiformes do estroma gastrointestinal (GIST) da parede gástrica, com baixo potencial de malignidade e comportamento agressivo.

Papel de los estudios microbiológicos en la necrosis pancreática / Role of the microbiological studies in pancreatic necrosis / Papel dos estudos microbiológicos na necrose pancreática

RESUMEN Introducción: la infección de la necrosis pancreática es la complicación local más grave de la pancreatitis aguda. Ocurre aproximadamente en un 35% de los pacientes y presenta una mortalidad cercana al 80%. Objetivo: identificar el espectro microbiológico de la necrosis pancreática infectada Métodos: realizamos un estudio longitudinal, descriptivo, prospectivo en la Unidad de cuidados intensivos del Hospital Universitario Carlos Manuel de Céspedes de la ciudad de Bayamo, Cuba, en el periodo comprendido desde enero de 2012 hasta diciembre de 2018.Fueron incluidos 71 pacientes con el diagnostico o sospecha de pancreatitis aguda necrotizante infectada que requirieron necrosectomía con toma de cultivo intraoperatorio. Resultados: del total de pacientes de la serie la mayoría fueron masculinos representando el 56,3 % de la muestra. la etiología más frecuentemente encontrada fue la litiasica con 38 pacientes (53,5%). Mientras que 52 pacientes (73,2%) presentaban más del 50% de la glándula pancreática con necrosis. En 63 pacientes se confirmó la presencia de infección de la necrosis. Con predominio de la infección monomicrobiana en 48 casos (76,2%).El germen más frecuentemente encontrado fue E. coli (47,9%).La mortalidad post-operatoria fue de 15 pacientes (21, 1%).De ellos 14 pacientes (93,3%) con infección luego de la necrosectomía. Conclusiones: predominó la infección monomicrobiana por E. coli. Los pacientes con confirmación de crecimiento bacteriano post necrosectomía presentaron mayor mortalidad.

ABSTRACT Introduction: infection of pancreatic necrosis is the most serious local complication of acute pancreatitis. It occurs in approximately 35% of patients and has a mortality rate close to 80%. Objective: to identify the microbiological spectrum of infected pancreatic necrosis Methods: we carried out a longitudinal, descriptive, prospective study in the intensive care unit of the Carlos Manuel de Céspedes University Hospital in the city of Bayamo, Cuba, in the period from January 2012 to December 2018. 71 patients with the diagnosis or suspicion of infected acute necrotizing pancreatitis that required necrosectomy with intraoperative culture taking. Results: of the total number of patients in the series, the majority were male, representing 56.3% of the sample. the most frequently found etiology was lithiasis with 38 patients (53.5%). While 52 patients (73.2%) had more than 50% of the pancreatic gland with necrosis. In 63 patients, the presence of necrosis infection was confirmed. With a predominance of monomicrobial infection in 48 cases (76.2%). The most frequent germ found was E. coli (47.9%). Post-operative mortality was 15 patients (21.1%). Of them 14 patients (93.3%) with infection after necrosectomy. Conclusions: monomicrobial infection by E. coli predominated. Patients with confirmed bacterial growth post necrosectomy had higher mortality.

RESUMO Introdução: a infecção da necrose pancreática é a complicação local mais grave da pancreatite aguda. Ocorre em aproximadamente 35% dos pacientes e tem mortalidade próxima a 80%. Objetivo: identificar o espectro microbiológico da necrose pancreática infectada Métodos: foi realizado um estudo longitudinal, descritivo e prospectivo na unidade de terapia intensiva do Hospital Universitário Carlos Manuel de Céspedes, nacidade de Bayamo, Cuba, no período de janeiro de 2012 a dezembro de 2018. 71 pacientes portadores de diagnóstico ou suspeita de pancreatite necrosante aguda infectada que exigiu necrosectomia com coleta de cultura intraoperatória. Resultados: do total de pacientes da série, a maioria era do sexo masculino, representando 56,3% da amostra. a etiologia mais encontrada foi a litíase com 38 pacientes (53,5%). En quanto 52 pacientes (73,2%) apresentavam mais de 50% da glândula pancreática com necrose. Em 63 pacientes, foi confirmada a presença de infecção de necrose. Com predomínio de infecção monomicrobiana em 48 casos (76,2%). O germe mais encontrado foi E. coli (47,9%). A mortalidade pós-operatória foi de 15 pacientes (21,1%). Destes 14 pacientes (93,3%) com infecção após necrosectomia. Conclusões: a infecção monomicrobiana por E. coli predominou. Pacientes com crescimento bacteriano confirmado após necrosectomia apresentaram maior mortalidade.