Clinical impact of capsule endoscopy on patients with suspected small bowel bleeding: Experience at a highly specialized hospital in Colombia.

INTRODUCTION AND AIMS: Capsule endoscopy is part of the diagnostic approach to patients with suspected small bowel bleeding and data on its clinical impact are still limited in developing countries. The primary aim of the present study was to determine its impact on subsequent diagnostic and therapeutic decisions. MATERIAL AND METHODS: A retrospective study was conducted that included all the patients that underwent capsule endoscopy with the PillCam™ SB 3 Capsule system due to suspected small bowel bleeding treated at the Hospital Universitario Fundación Valle del Lili between January 2011 and December 2020. RESULTS: A total of 158 patients met the inclusion criteria. Mean patient age was 63 years (interquartile range [IQR], 52-74), 53.6% of the patients were women, and high blood pressure was the most frequent comorbidity (43.7%). The main indication was overt bleeding (58.2%). Of all the capsule endoscopies carried out, 63.9% showed lesions that were potentially responsible for bleeding. Medical or surgical treatment was indicated in 63.3% of the case total. Rebleeding at 6 months occurred in 15 patients and there were 2 deaths due to gastrointestinal bleeding at 6 months. CONCLUSIONS: Capsule endoscopy has a high impact on patients with suspected small bowel bleeding, with respect to clinical decision-making, as well as rebleeding, hospitalization, and mortality outcomes. The positivity rate of lesions potentially responsible for bleeding was similar to that reported in developed countries.

Instrucciones con foco atencional durante el ejercicio terapéutico en personas con trastornos musculoesqueléticos. Una revisión de alcance / Attentional focus instructions for therapeutic exercise in people with musculoskeletal disorders. A scoping review

Las instrucciones con foco atencional son estrategias verbales que podrían maximizar los efectos del ejercicio. El objetivo de esta revisión fue explorar y sintetizar la evidencia sobre la incorporación de instrucciones con foco atencional al ejercicio terapéutico de personas con trastornos musculoesqueléticos. Se realizó una búsqueda en 11 bases de datos hasta octubre de 2020. De 4.227 estudios identificados en las búsquedas, 15 fueron incluidos. Los estudios presentaron deficiencia en la conceptualización y definición de instrucciones con foco atencional. La evidencia disponible indica que el foco externo es efectivo para mejorar el aprendizaje motor y la función. Sin embargo, limitaciones metodológicas, la heterogeneidad clínica, el reducido número de artículos incluidos y los nuevos estudios experimentales desafían las conclusiones de las revisiones sistemáticas disponibles a la fecha. Las instrucciones con foco atencional en los trastornos musculoesqueléticos es un campo emergente y requiere más investigación. Esta revisión es una guía para futuros estudios.(AU)

Attentional focus instructions are verbal strategies that could maximize the effects of exercise. The objective of this review was to explore and synthesize the available evidence on the incorporation of attentional focus instruction in the exercise of people with musculoskeletal disorders. A search of 11 databases was carried out until October 2020. Of 4,227 studies identified in the searches, 15 were included. The studies showed deficiencies in the conceptualization and definition of attentional focus instructions. The available evidence indicates that external focus is effective in improving motor learning and function. However, methodological limitations, clinical heterogeneity, the small number of articles included, and new experimental studies challenge the conclusions of the systematic reviews available to date. Attentional focus instructions in musculoskeletal disorders is an emerging field and requires further research. This review is a guide for future studies.(AU)

[Attentional focus instructions for therapeutic exercise in people with musculoskeletal disorders. A scoping review]. / Instrucciones con foco atencional durante el ejercicio terapéutico en personas con trastornos musculoesqueléticos. Una revisión de alcance.

Attentional focus instructions are verbal strategies that could maximize the effects of exercise. The objective of this review was to explore and synthesize the available evidence on the incorporation of attentional focus instruction in the exercise of people with musculoskeletal disorders. A search of 11 databases was carried out until October 2020. Of 4,227 studies identified in the searches, 15 were included. The studies showed deficiencies in the conceptualization and definition of attentional focus instructions. The available evidence indicates that external focus is effective in improving motor learning and function. However, methodological limitations, clinical heterogeneity, the small number of articles included, and new experimental studies challenge the conclusions of the systematic reviews available to date. Attentional focus instructions in musculoskeletal disorders is an emerging field and requires further research. This review is a guide for future studies.

Hemorragia del tracto digestivo superior, enfoque para el médico general / Upper digestive tract bleeding, approach for the general Practitioner / Hemorragia do trato digestivo superior, enfoque para o médico geral

La hemorragia del tracto digestivo superior (HTDS) es el sangrado originado por encima del ángulo de Treitz. A pesar del aumento en las estrategias de prevención, del incremento en los tratamientos con Inhibidor de bomba de protones (IBP) y de la intervención endoscópica temprana, esta patología sigue siendo una causa frecuente de consulta a urgencias, con una morbimortalidad no despreciable y alta carga para el sistema de salud. Esta revisión se enfoca en la HTDS de causa diferente a las varices. La principal causante de esta entidad es la enfermedad ácido-péptica, que es consecuencia del gran consumo de antiinflamatorios no esteroideos (AINES) y de la infección por Helicobacter Pylori. Otras causas son el síndrome de Mallory Weiss, la esofagitis erosiva, las malformaciones arteriovenosas y la malignidad.

Upper gastrointestinal bleeding (UGIB) refers to any bleeding originating above the angle of Treitz. Despite an increase in prevention strategies, proton pump inhibitor (PPI) therapy and early endoscopic intervention, this pathology continues to be an important cause of admission to the emergency department for gastrointestinal causes, having a pretty high morbidity and mortality in addition to a high burden on the health system. This review focuses on non-variceal UGIB. The main cause of this entity being peptic acid disease, due to great consumption of NSAIDs and Helicobacter Pylori infection. Other causes are Mallory Weiss syndrome, erosive esophagitis, arteriovenous malformations, and malignancy.

A hemorragia do trato digestivo superior (HTDS) é o sangrado originado acima do ângulo de Treitz. Apesar do aumento nas estratégias de prevenção, do incremento nos tratamentos com Inibidor da bomba de prótons (IBP) e da intervenção endoscópica precoce, esta patologia segue sendo uma causa frequente de consulta a urgências, com uma morbimortalidade não depreciável e alta carga para o sistema de saúde. Esta revisão se enfoca na HTDS de causa diferente às varizes. A principal causante desta entidade é a doença ácido-péptica, que é consequência do grande consumo de anti-inflamatórios não esteróideos (AINES) e da infecção por HelicobacterPylori. Outras causas são a síndrome de Mallory Weiss, a esofagites erosiva, as malformações arteriovenosas e a malignidade. Palavras-chave: hemorragia gastrointestinal; úlcera péptica; endoscopia gastrointestinal; inibidores da bomba de prótons; medicina geral.

Recomendaciones clínicas para la rehabilitación de personas con fibromialgia. Una revisión narrativa / Clinical recommendations for rehabilitation of people with fibromyalgia. A narrative review

Introducción: La evidencia actual sugiere como primera línea de tratamiento para personas con fibromialgia al manejo no farmacológico. Sin embargo, revisiones con énfasis en la aplicabilidad clínica son escasas. Objetivo: Describir recomendaciones clínicas basadas en evidencia para la rehabilitación de personas con fibromialgia. Métodos: Se realizaron búsquedas electrónicas en las bases de datos Medline, Web of Science y Scielo para cada uno de los apartados de esta revisión. Diferentes estrategias de búsqueda fueron realizadas con la combinación de términos MESH y claves. Se incluyeron estudios primarios y secundarios publicados en inglés o español en revistas revisadas por pares. Resultados: Los profesionales de la salud deben conocer aspectos teóricos contemporáneos del dolor crónico y de la fibromialgia con el fin de evitar el sobrediagnóstico, la estigmatización y la persistencia de los síntomas por instrucción profesional. Una evaluación clínica multidimensional en un contexto positivo, con énfasis en la construcción de alianza terapéutica, facilita la toma de decisiones compartidas y la selección de estrategias de intervención. La educación es el punto de inicio de la rehabilitación y su combinación con terapia psicológica, facilita el afrontamiento activo y la adherencia terapéutica. La actividad física y el ejercicio regular son las intervenciones no farmacológicas con mayor evidencia para mejorar el dolor, discapacidad, calidad de vida, función física, fatiga, fuerza muscular, rigidez, sueño y el estado de ánimo en personas con fibromialgia.Conclusión:Los abordajes no farmacológicos son prometedores en el manejo de la fibromialgia. Esta revisión aporta recomendaciones prácticas para la implementación clínica por equipos de salud interdisciplinarios.(AU)

Introduction: Current evidence suggests non-pharmacological management as the first line of treatment for people with fibromyalgia. However, reviews with an emphasis on clinical applicability are rare. Objective: To describe evidence-based clinical reco­mmendations for the rehabilitation of people with Fibromyalgia. Methods: Medline, Web of Science and, Scielo databases were electronically searched for each of the sections of this review. Different search strategies were carried out with the combination of MESH terms and keywords. Primary and secondary studies published in English or Spanish in peer-reviewed journals were included. Results: Health professionals must know contemporary theoretical aspects of chronic pain and fibromyalgia to avoid overdiagnosis, stigmatization, and persistence of symptoms by professional instruction. A multidimensional clinical assessment with objective and subjective evaluations in a positive context with an emphasis on the construction of a therapeutic alliance facilitates shared decision-making and the selection of successful intervention strategies. Education is the starting point of rehabilitation and its combination with psycholo­gical therapy, facilitates active coping and therapeutic adherence. Physical activity and regular exercise are the most evidenced non-pharmacological interventions for improving pain, disability, quality of life, physical function, fatigue, muscle strength, stiffness, sleep, and mood in people with fibromyalgia.Conclusion:Non-pharmacological approaches are promising in the management of fibromyalgia. This review provides practical recommendations for clinical implementation by interdisciplinary health teams.(AU)

Entrenamiento con restricción parcial de flujo sanguíneo en personas con enfermedades cardiovasculares: una revisión exploratoria / Blood flow restriction training for people with cardiovascular disease: an exploratory review

OBJETIVO: Analizar la evidencia sobre los efectos del entrenamiento con restricción parcial del flujo sanguíneo en personas con enfermedades cardiovasculares. MATERIALES Y MÉTODOS: Se realizó una búsqueda en las bases de datos de MEDLINE, EMBASE, SPORTDiscus, CINAHL, LILACS, SCOPUS y Wiley. Fueron incluidos estudios experimentales y no experimentales que investigaron sobre los efectos de la restricción parcial del flujo sanguíneo en sujetos con enfermedad cardiovascular. RESULTADOS: Seis ensayos clínicos y tres estudios no experimentales cumplieron los criterios de inclusión. Los estudios experimentales fueron realizados en sujetos con hipertensión arterial y enfermedad isquémica del corazón. Los estudios no experimentales describieron las adaptaciones hemodinámicas y los potenciales efectos secundarios de la terapia. El riesgo de sesgo de los ensayos clínicos incluidos fue de moderado a alto. El estrés hemodinámico inducido por el ejercicio aumenta significativamente durante el entrenamiento con restricción parcial del flujo sanguíneo en comparación al entrenamiento tradicional. La limitada cantidad de estudios disponibles se han centrado mayoritariamente en los efectos agudos, sin embargo, los efectos crónicos son desconocidos. CONCLUSIÓN: Actualmente no hay evidencia que recomiende el uso de la restricción parcial del flujo sanguíneo en personas con enfermedades cardiovasculares

OBJECTIVE: To analyse the evidence on the effects of blood flow restriction training in people with cardiovascular disease. MATERIALS AND METHODS: We searched MEDLINE, EMBASE, SPORTDiscus, CINAHL, LILACS, SCOPUS and Wiley databases. Experimental and non-experimental studies investigating the effects of blood flow restriction in participants with cardiovascular disease were included. RESULTS: Six clinical trials and three non-experimental studies met the inclusion criteria. The experimental studies were conducted in participants with hypertension and ischaemic heart disease. Non-experimental studies described hemodynamic adaptations and potential adverse effects of therapy. The risk of bias of the included clinical trials was moderate to high. Exercise-induced hemodynamic stress increased significantly during training with blood flow restriction compared with traditional training. The small number of available studies have focused mostly on acute effects, but chronic effects are unknown. CONCLUSION: There is currently no evidence to recommend the use of blood flow restriction in people with cardiovascular disease

[Blood flow restriction training for people with cardiovascular disease: An exploratory review]. / Entrenamiento con restricción parcial de flujo sanguíneo en personas con enfermedades cardiovasculares: una revisión exploratoria.

OBJECTIVE: To analyse the evidence on the effects of blood flow restriction training in people with cardiovascular disease. MATERIALS AND METHODS: We searched MEDLINE, EMBASE, SPORTDiscus, CINAHL, LILACS, SCOPUS and Wiley databases. Experimental and non-experimental studies investigating the effects of blood flow restriction in participants with cardiovascular disease were included. RESULTS: Six clinical trials and three non-experimental studies met the inclusion criteria. The experimental studies were conducted in participants with hypertension and ischaemic heart disease. Non-experimental studies described hemodynamic adaptations and potential adverse effects of therapy. The risk of bias of the included clinical trials was moderate to high. Exercise-induced hemodynamic stress increased significantly during training with blood flow restriction compared with traditional training. The small number of available studies have focused mostly on acute effects, but chronic effects are unknown. CONCLUSION: There is currently no evidence to recommend the use of blood flow restriction in people with cardiovascular disease.

Influencia de los factores psicosociales en la experiencia de dolor musculoesquelético: una revisión de la literatura / Influence of psychosocial factors on the experience of musculoskeletal pain: a literature review

El dolor musculoesquelético es un problema sanitario que afecta aproximadamente a un 33 % de la población adulta, del cual un 56 % corresponde a personas adultas mayores y un 35 % a personas en edad laboral. Algunas investigaciones epidemiológicas han demostrado que existen ciertos grupos de personas dentro de la población más propensos a desarrollar dolor crónico musculoesquelético; estos estudios han permitido identificar diferentes debilidades y necesidades en las intervenciones de los profesionales de la salud en esta problemática. Los datos han demostrado que la prevalencia del dolor es mayor en mujeres, personas fumadoras, con educación incompleta, con riesgo psicológico o social, de esta manera la evidencia le ha quitado la atención a la nocicepción de las estructuras corporales como único factor causal de dolor musculoesquelético. Esto ha obligado a los investigadores a explorar la influencia de los factores psicosociales en la experiencia de dolor musculoesquelético, considerar la integración de diversos factores y mecanismos para provocar explicar el desarrollo de la experiencia dolorosa. La presente revisión tiene como objetivo describir los factores psicosociales que influyen en la experiencia de dolor musculoesquelético para relacionarlos con los modelos neurocientíficos contemporáneos

Musculoskeletal pain is a health problem that affects approximately 33 % of the adult population, of which 56 % corresponds to elderly people and 35% to people of working age. Some epidemiological investigations have shown that there are certain groups of people within the population most likely to develop chronic musculoskeletal pain, these studies have allowed to identify different weaknesses and needs in the interventions of health professionals in this problem. The data have shown that the prevalence of pain is higher in women, smokers, with incomplete education, with psychological or social risk, in this way the evidence has removed attention to the nociception of body structures as the only causal factor of pain musculoskeletal This has forced researchers to explore the influence of psychosocial factors in the experience of musculoskeletal pain, consider the integration of various factors and mechanisms to explain the development of the painful experience. The objective of this review is to describe the psychosocial factors that influence the experience of musculoskeletal pain in order to relate them to contemporary neuroscientific models

Tiroidectomía transoral endoscópica por abordaje vestibular (TOETVA): reporte del primer caso en humanos realizado en Latinoamérica / Transoral endoscopic thyroidectomy vestibular approach (TOETVA): report of the first human case in Latin America

Introducción: Desde hace aproximadamente 20 años se han venido realizando varias técnicas de tiroidectomía por mínimo acceso, apoyadas en la videoendoscopia en pro de reemplazar la incisión clásica descrita por Kocher. Se han diseñado múltiples abordajes, sin embargo, ninguno ha conseguido evitar totalmente las cicatrices. En el año 2008 Witzel introdujo la técnica transoral y en el 2015, Anuwong publicó la primera serie realizada en humanos. Presentación del caso: Se trata de una paciente de 47 años a quien se ha diagnosticado por PAAF una lesión folicular en el lóbulo izquierdo de la tiroides. Discusión: La paciente fue sometida a hemitiroidectomía izquierda más estudio de congelación transoperatoria que resultó negativo. Se realizó un abordaje transoral endoscópico, con un tiempo de 280 min y sangrado de 40 ml. No se registraron complicaciones en el transoperatorio ni en el postoperatorio. Conclusión: La tiroidectomía transoral endoscópica por abordaje vestibular (TOETVA) representa, entre las cirugías de mínimo acceso, la única que potencialmente está totalmente libre de cicatrices, ofreciendo seguridad y resultados comparables con otras técnicas.

Introduction: For about 20 years we has been conducting several techniques of minimal access thyroidectomy, supported by videoendoscopy towards replacing the classic Kocher incision. Multiple approaches have been described, however none has achieved completely avoid scarring. Witzel in 2008 introduced the transoral technique and in 2015 Anuwong published the first series performed in humans. Case presentation: This is a 47 years old patient who have been diagnosed by FNAB follicular lesion in the left lobe of her thyroid. Discussion: The patient underwent a left hemithyroidectomy + intraoperative frozen study that was negative, transoral endoscopic approach was performed with a time of 280 min and 40 ml bleeding. No complications occurred intraoperatively or postoperatively. Conclusion: Transoral endoscopic thyroidectomy vestibular approach (TOETVA) represents between the minimum access surgeries the only one that is potentially totally free of scars, offering safety and comparable results with other techniques.

Optimal dosing of trimethoprim-sulfamethoxazole when used with loperamide to treat traveler's diarrhea.

To explore the optimal dosing regimen for trimethoprim-sulfamethoxazole (TMP-SMX) when used in combination with loperamide to treat traveler's diarrhea, 190 U.S. adults with acute diarrhea were enrolled in a double-blind, randomized trial in Guadalajara, Mexico. All patients received loperamide (4-mg loading dose; 2 mg after each loose stool, not to exceed 16 mg/day for 3 days) and were randomized to receive a 3-day course of TMP-SMX (160:800 mg twice daily for six doses) (group A), a single large dose of TMP-SMX (320:1,600 mg) (group B), or a large loading dose (320:1,600 mg) followed by standard doses for 3 days (160:800 mg twice daily for five doses) (group C). Patients in group C responded best (P < 0.01), with 75% of subjects recovered from diarrhea in 12 h compared with 34 h (group A) and 33 h (group B). Similar differences in favor of group C were noted in the subset of patients who presented with moderate to severe diarrhea. On average, patients in group C took significantly (P < 0.05) less loperamide (1.2 mg) after the 4-mg loading dose compared with patients in group A (2.4 mg) or group B (2.0 mg). We conclude that the most efficacious treatment of traveler's diarrhea in the interior of Mexico is to take loperamide in usual doses to control symptoms in combination with a single large dose of TMP-SMX, which should then be continued for 3 days in standard doses.

The pharmacokinetics of nifurtimox in chronic renal failure.

The pharmacokinetics of nifurtimox, a drug used in the treatment of Trypanosoma cruzi infections, has been studied in seven patients with chronic renal failure undergoing haemodialysis, and in seven healthy subjects. Each subject took nifurtimox 15 mg.kg-1 orally and blood samples were obtained for 10 h after administration. Nifurtimox in serum was analyzed by HPLC. The patients with chronic renal failure had a higher Cmax than the control subjects due to a change in systemic availability. An alternative explanation would be that both the distribution volume and the clearance had changed. The mean half-life in the patients with chronic renal failure was similar to that in the healthy subjects.

[Clinical significance of cervical arthropathy in patients with vertigo]. / Significado clínico de la artropatía cervical en pacientes con vértigo.

We performed a thorough neuro-otological evaluation and a radiological study of the cervical spine in 102 patients with vestibular symptoms. A group of 20 asymptomatic subjects served as control. Some degree of cervical spondylosis was found in 121 of 122 patients but also in the majority of control subjects. No relationship was observed between the degree of cervical spondylosis and vestibular abnormalities. Instead, the latter were strongly related to age. Thus, an age dependent microvascular damage may be more likely as an etiological factor for vestibular symptoms in the elderly.

Pharmacokinetics of a nitrofuran compound, nifurtimox, in healthy volunteers.

Nifurtimox disposition was evaluated in 7 healthy volunteers. Each subject received an oral dose of 15 mg/kg of nifurtimox and blood sample was obtained 11 h after the drug administration. We used an analytical method previously assessed in the literature. The pharmacokinetic analysis was carried out according to a one-compartment model and the most important parameters established were elimination half-life, distribution volume, and clearance. Serum concentrations were low in relation to the high doses administered. The low serum concentration is probably the result of a marked first pass effect.

Preparacion y aprovechamiento de los subproductos animales

Contenido: 1.Resumen 2.Mercado.Caracteres generales de la ganaderia, la industria de la carne y los subproductos en America Latina.Poblacion nacional actual de la ganaderia.Poblacion gandera actual de Cochabamba.Series estadisticas de faeneo.Demanda de los subproductos animales.Comercializacion 3.Tamano.Tamano optimo.tamano del equipo de subproductos.Tamano minimo 4.Localizacion 5.Ingenieria.Generalidades.Usos y aplicaciones de los subproductos.Proceso de produccion faeneo.Balance de materia y rendimientos.Sangre.Decomisos y despojos.Grasa.Huesos.Pezunas y cuernos.Cerdas y pelos.Bilis.Estiercol y orina.Cueros.Balance termico.Obra civil.Mano de obra.Combustibles y lubricantes.Materiales.Energia electrica 6.Inversiones.Inversiones fijas.Capital de trabajo 7.Financiamiento.Financiamiento del capital.Amortizacion de los creditos 8.Costos e ingresos 9.Evaluacion.Flujo de fondos.Analisis de sensibilidad.Conclusiones y recomendaciones 10.Anexos.