Gastroduodenal and Colorectal Tuberculosis: Report of 2 Cases.

Introduction: Tuberculosis remains a public health concern in developing countries, as well as in developed countries as a result of immigration from endemic areas. Gastroduodenal and colorectal tuberculosis are rare manifestations of gastrointestinal infection. Case Presentation: We present 2 cases of gastric, duodenal, and colorectal tuberculosis. The first case, a 17-year-old male with no medical record, presented with chronic diarrhea and abdominal pain. At endoscopy, he had multiple ulcers in the stomach, colon, and rectum, which were positive to Mycobacterium tuberculosis. The second case was a 43-year-old HIV-positive male, with a history of intermittent fever, nausea, and vomiting. Upper gastrointestinal endoscopy revealed a deep ulcer on gastric fundus that tested positive to M. tuberculosis in the acid-fast bacilli staining. Discussion/Conclusion: Gastroduodenal and colorectal tuberculosis, although rare, should be considered in the differential diagnosis in both immunosuppressed and immunocompetent patients. An adequate tissue sample and appropriate diagnostic tests are essential for the diagnosis and prompt start of first-line antituberculosis agents.

Introdução: A tuberculose continua sendo um problema de saúde pública nos países em desenvolvimento, bem como nos países desenvolvidos, em decorrência da imigração. A tuberculose gastroduodenal e colorretalsão manifestações raras de infecção gastrointestinal. Apresentação do Caso: Apresentamos dois casos de tuberculose gástrica, duodenal ecolorretal. O primeiro caso, um jovem de 17 anos, apresentou diarreia crônica e dor abdominal. Na endoscopia, tinha múltiplas úlceras no estômago, cólon e reto que foram positivas para Mycobacterium Tuberculosis. O segundo caso foi um homem de 43 anos, HIV positivo, com relato de febre intermitente, náuseas e vômitos. A endoscopia digestiva alta revelou úlcera profunda do fundo gástrico positivo para Mycobacterium tuberculosis na coloração de bacilos álcool-ácido resistentes. Discussão/Conclusão: Tuberculosegastroduodenal e colorretal, embora raras, deve ser considerada como diagnóstico em pacientes imunossuprimidos e imunocompetentes. Uma amostra de tecido adequada e testes diagnósticos apropriados são essenciais para o diagnósticoe início imediato dos tuberculostáticos de primeira linha.

Oral squamous cell carcinoma-released brain-derived neurotrophic factor contributes to oral cancer pain by peripheral tropomyosin receptor kinase B activation.

ABSTRACT: Oral cancer pain is debilitating and understanding mechanisms for it is critical to develop novel treatment strategies treatment strategies. Brain-derived neurotrophic factor (BDNF) signaling is elevated in oral tumor biopsies and is involved with tumor progression. Whether BDNF signaling in oral tumors contributes to cancer-induced pain is not known. The current study evaluates a novel peripheral role of BDNF-tropomyosin receptor kinase B (TrkB) signaling in oral cancer pain. Using human oral squamous cell carcinoma (OSCC) cells and an orthotopic mouse tongue cancer pain model, we found that BDNF levels were upregulated in superfusates and lysates of tumor tongues and that BDNF was expressed by OSCC cells themselves. Moreover, neutralization of BDNF or inhibition of TrkB activity by ANA12, within the tumor-bearing tongue reversed tumor-induced pain-like behaviors in a sex-dependent manner. Oral squamous cell carcinoma conditioned media also produced pain-like behaviors in naïve male mice that was reversed by local injection of ANA12. On a physiological level, using single-fiber tongue-nerve electrophysiology, we found that acutely blocking TrkB receptors reversed tumor-induced mechanical sensitivity of A-slow high threshold mechanoreceptors. Furthermore, single-cell reverse transcription polymerase chain reaction data of retrogradely labeled lingual neurons demonstrated expression of full-form TrkB and truncated TrkB in distinct neuronal subtypes. Last but not the least, intra-TG siRNA for TrkB also reversed tumor-induced orofacial pain behaviors. Our data suggest that TrkB activities on lingual sensory afferents are partly controlled by local release of OSCC-derived BDNF, thereby contributing to oral cancer pain. This is a novel finding and the first demonstration of a peripheral role for BDNF signaling in oral cancer pain.

Esófago negro como causa de hemorragia digestiva alta: reporte de un caso / Black esophagus as a cause of upper gastrointestinal bleeding: a case report

Resumen La esofagitis necrotizante aguda es una entidad poco común que afecta sobre todo a ancianos. La presentación clínica más común es hemorragia digestiva alta. El pronóstico depende de las enfermedades de base con una mortalidad de hasta el 50 %. Se presenta el caso de un varón de 77 años con historia de una semana de melena, 3 episodios de hematemesis y epigastralgia. La endoscopia digestiva alta reveló una mucosa con necrosis en parches y fibrina en el esófago medio y distal. La biopsia de esófago fue compatible con necrosis de mucosa.

Abstract Acute necrotizing esophagitis is a rare entity that affects mainly elderly patients. The most common clinical presentation is upper gastrointestinal bleeding. The prognosis depends on the underlying diseases, with a mortality of up to 50%. This is the case of a 77-year-old male patient who presented with melena, three episodes of hematemesis, and epigastric pain for a week. Upper endoscopy revealed mucosa with spotty necrosis and fibrin in the middle and distal esophagus. Esophageal biopsy was compatible with mucosal necrosis.

[Jejunal phlebectasia as a cause of massive gastrointestinal haemorrhage]. / Flebectasia yeyunal como causa de hemorragia digestiva media masiva.

Vascular abnormalities of the gastrointestinal tract are a common cause of gastrointestinal bleeding. Most of them are located within the reach of the upper endoscopy or colonoscopy, although once discarded, it forces to consider small bowel as the source of bleeding. The successful management of a gastrointestinal bleeding depends mainly on the timely location of the source of bleeding. Nevertheless this task can be difficult when the cause is not within the reach of conventional methods. We present a case of a 21 year-old men in which the diagnosis of bleeding yeyunal phlebectasia was made by the findings of the capsule endoscopy and laparoscopy.

Flebectasia yeyunal como causa de hemorragia digestiva media masiva / Jejunal phlebectasia as a cause of massive gastrointestinal hemorrhage

Las anormalidades vasculares del tracto gastrointestinal son una causa común de sangrado digestivo. La mayoría se localizan al alcance de la endoscopía digestiva alta y/o colonoscopía, una vez descartado ello, obliga a considerar al intestino delgado como causa de la hemorragia. El manejo exitoso de una hemorragia digestiva depende principalmente de la localización oportuna de la fuente del sangrado, sin embargo esta tarea puede ser difícil, cuando la causa no está al alcance de los métodos convencionales. Presentamos el caso de un paciente varón de 21 años cuyo diagnóstico fue una flebectasia yeyunal sangrante, luego de una cuidadosa evaluación de los hallazgos de la cápsula endoscópica y laparoscopía.

Vascular abnormalities of the gastrointestinal tract are a common cause of gastrointestinal bleeding. Most of them are located within the reach of the upper endoscopy or colonoscopy, although once discarded, it forces to consider small bowel as the source of bleeding. The successful management of a gastrointestinal bleeding depends mainly on the timely location of the source of bleeding. Nevertheless this task can be difficult when the cause is not within the reach of conventional methods. We present a case of a 21 year-old men in which the diagnosis of bleeding yeyunal phlebectasia was made by the findings of the capsule endoscopy and laparoscopy.

[Actinic enteritis as a cause of digestive bleeding of obscure origin]. / Enteritis actínica como causa de hemorragia digestiva de origen oscuro.

Chronic actinic enteritis is a malfunction of the small bowel, occurring in the 6 months post-radiotherapy, and it can be manifestated as malabsortion, stenosis, fistula formation, local abscesses, perforation and bleeding, We report a case of an elderly patient who presents an episode of obscure gastrointestinal bleeding (OGIB) secondary to actinic enteritis. She is a 64-year- old female patient with the past medical history of cervical cancer who received radiotherapy and brachytherapy. One year after the treatment, the patient presents a chronic episode of melena and symptomatic anemia and 1 week before the admission she had hematochezia. At admission she has hemodynamic instability with a hemoglobin value of 2.7 gr/dl. We did an upper endoscopy, a colonoscopy and abdomino-pelvic tomography without any findings of the bleeding’s source. Reason why an endoscopic capsule was done, showing bleeding areas in the medial and distal small bowel. The patient had another gastrointestinal bleeding requiring a surgery where they decide to do a resection of the small bowel and a right hemicholectomy. The pathology was compatible with actinic enteritis. The patient after the surgery had a torpid evolution, and finally dies. We describe this case and do a review of all the existent data around the world, because is the first case reported in Peru of an actinic enteritis as a cause of OGIB.

Enteritis actínica como causa de hemorragia digestiva de origen oscuro / Actinic enteritis as a cause of digestive bleeding of obscure origin

La enteritis actínica crónica es un trastorno del intestino delgado que ocurre a partir de los 6 meses post radioterapia y se puede manifestar como malabsorción, estenosis, formación de fístulas, abscesos locales, perforación y sangrado. Se reporta el caso de una paciente adulta mayor la cual presentó un cuadro de hemorragia digestiva de origen oscuro (HDO) secundario a enteritis actínica. Es una paciente mujer de 64 años con antecedente de neoplasia maligna de cérvix quien recibió sesiones de radioterapia y braquiterapia, La paciente un año después de dicho tratamiento presenta un cuadro crónico de melena y anemia, presentando hematoquezia en la última semana previa a la hospitalización. Al ingreso presenta inestabilidad hemodinámica con valores de hemoglobina en 2,7gr/dL. Se realiza una endoscopia, colonoscopia y tomografía abdomino pélvica, las cuales no mostraron la causa del sangrado, motivo por el cual se realiza una cápsula endoscópica evidenciando áreas de sangrado en intestino delgado medio y distal. La paciente vuelve a presentar un episodio de sangrado agudo siendo sometida a una cirugía de emergencia en donde se decide realizar resección de intestino más hemicolectomia derecha. En la biopsia de la pieza quirúrgica se encuentran hallazgos compatibles con enteropatía actínica. La paciente posterior a la cirugía evoluciona tórpidamente, llegando a fallecer. Describimos el presente caso y hacemos una recolección de la data existente debido a que es el primer caso en el Perú en el que se reporta a una enteritis actínica como causante de HDO...

Chronic actinic enteritis is a malfunction of the small bowel, occurring in the 6 months post-radiotherapy, and it can be manifestated as malabsortion, stenosis, fistula formation, local abscesses, perforation and bleeding, We report a case of an elderly patient who presents an episode of obscure gastrointestinal bleeding (OGIB) secondary to actinic enteritis. She is a 64-year-old female patient with the past medical history of cervical cancer who received radiotherapy and brachytherapy. One year after the treatment, the patient presents a chronic episode of melena and symptomatic anemia and 1 week before the admission she had hematochezia. At admission she has hemodynamic instability with a hemoglobin value of 2.7 gr/dl. We did an upper endoscopy, a colonoscopy and abdomino-pelvic tomography without any findings of the bleedingÆs source. Reason why an endoscopic capsule was done, showing bleeding areas in the medial and distal small bowel. The patient had another gastrointestinal bleeding requiring a surgery where they decide to do a resection of the small bowel and a right hemicholectomy. The pathology was compatible with actinic enteritis. The patient after the surgery had a torpid evolution, and finally dies. We describe this case and do a review of all the existent data around the world, because is the first case reported in Peru of an actinic enteritis as a cause of OGIB...

Estudio sobre la pertinencia del uso de las normas disponibles del Raven en adultos mayores chilenos / Study on the relevance of using available norms Raven in Chileans older adults / Estudo sobre a pertinência da utilização das normas disponíveis de Raven em idosos chilenos

La evaluación de la inteligencia en población adulto mayor ha aumentado su relevancia debido al incremento de la esperanza de vida. Este estudio centra su interés en la pertinencia de normas disponibles para el Test de Matrices Progresivas de Raven para dicha población. Se utilizaron normas de Colchester (1942, en Raven, Court y Raven, 2008), las más completas existentes. Participaron 102 adultos mayores voluntarios (más de 60 años). El diseño fue no experimental transversal correlacional. Los resultados indican que las normas resultan poco exigentes para ese grupo y que existen diferencias significativas entre los adultos de la tercera y cuarta edad, privilegiando a los del primer grupo. El índice de discrepancia mostró alta sensibilidad, indicando que la distribución de puntajes esperados no se corresponde al de la población general. Se discuten los resultados en torno a la necesidad de actualización de las normas y la consideración de las nuevas características de este periodo vital.

The assessment of intelligence in the elderly population has increased its importance in terms of increased life expectancy. The present study focuses its interest on the relevance of available norms for Raven Progressive Matrices Test in the evaluation of elderly population. Standards were used Colchester (1942, en Raven, Court y Raven, 2008), the most comprehensive available. The non-probability sample involved 102 elderly (aged over 60 years old) who were volunteers. The study used a non-experimental cross-correlation design. The results indicate that the current norms are not very demanding for the aging population, and that there are significant differences between adults of the third and fourth age, better for the first group. Moreover, the discrepancy index showed high sensitivity, indicating that the expected distribution of scores does not correspond to the general population. Results are discussed regarding the need to update the norms and the consideration of the new features involved in this vital period.

A avaliação da inteligência na população idosa tem aumentado sua importância devido ao aumento da expectativa de vida. Este estudo está centrado na relevância das normas disponíveis para o teste de Matrizes Progressivas de Raven para essa população. Foram utilizadas as normas de Colchester (1942, citado por Raven, Court y Raven, 2008), as mais completas disponíveis. Participaram 102 idosos voluntários (com idade superior a 60 anos). O desenho do estudo foi não experimental transversal correlacional. Os resultados indicam que as normas são pouco exigentes para esse grupo e que existem diferenças significativas entre os adultos da terceira e quarta idade, privilegiando o primeiro grupo. O índice de discrepância mostrou alta sensibilidade, indicando que a distribuição de pontuações esperadas não corresponde a da população em geral. Os resultados são discutidos em relação à necessidade de atualização das normas e da consideração das novas características desse período vital.

Estudio sobre la pertinencia del uso de las normas disponibles del Raven en adultos mayores chilenos / Study on the relevance of using available norms Raven in Chileans older adults / Estudo sobre a pertinência da utilização das normas disponíveis de Raven em idosos chilenos

La evaluación de la inteligencia en población adulto mayor ha aumentado su relevancia debido al incremento de la esperanza de vida. Este estudio centra su interés en la pertinencia de normas disponibles para el Test de Matrices Progresivas de Raven para dicha población. Se utilizaron normas de Colchester (1942, en Raven, Court y Raven, 2008), las más completas existentes. Participaron 102 adultos mayores voluntarios (más de 60 años). El diseño fue no experimental transversal correlacional. Los resultados indican que las normas resultan poco exigentes para ese grupo y que existen diferencias significativas entre los adultos de la tercera y cuarta edad, privilegiando a los del primer grupo. El índice de discrepancia mostró alta sensibilidad, indicando que la distribución de puntajes esperados no se corresponde al de la población general. Se discuten los resultados en torno a la necesidad de actualización de las normas y la consideración de las nuevas características de este periodo vital.(AU)

The assessment of intelligence in the elderly population has increased its importance in terms of increased life expectancy. The present study focuses its interest on the relevance of available norms for Raven Progressive Matrices Test in the evaluation of elderly population. Standards were used Colchester (1942, en Raven, Court y Raven, 2008), the most comprehensive available. The non-probability sample involved 102 elderly (aged over 60 years old) who were volunteers. The study used a non-experimental cross-correlation design. The results indicate that the current norms are not very demanding for the aging population, and that there are significant differences between adults of the third and fourth age, better for the first group. Moreover, the discrepancy index showed high sensitivity, indicating that the expected distribution of scores does not correspond to the general population. Results are discussed regarding the need to update the norms and the consideration of the new features involved in this vital period.(AU)

A avaliação da inteligência na população idosa tem aumentado sua importância devido ao aumento da expectativa de vida. Este estudo está centrado na relevância das normas disponíveis para o teste de Matrizes Progressivas de Raven para essa população. Foram utilizadas as normas de Colchester (1942, citado por Raven, Court y Raven, 2008), as mais completas disponíveis. Participaram 102 idosos voluntários (com idade superior a 60 anos). O desenho do estudo foi não experimental transversal correlacional. Os resultados indicam que as normas são pouco exigentes para esse grupo e que existem diferenças significativas entre os adultos da terceira e quarta idade, privilegiando o primeiro grupo. O índice de discrepância mostrou alta sensibilidade, indicando que a distribuição de pontuações esperadas não corresponde a da população em geral. Os resultados são discutidos em relação à necessidade de atualização das normas e da consideração das novas características desse período vital.(AU)