ABSTRACT
Acute pancreatitis (AP) and recurrent acute pancreatitis (RAP) are conditions, whose incidence is apparently on the rise. Despite the ever-increasing evidence regarding the management of AP in children and adults, therapeutic actions that could potentially affect having a poor prognosis in those patients, especially in the pediatric population, continue to be carried out. Therefore, the Asociación Mexicana de Gastroenterología convened a group of 24 expert pediatric gastroenterologists from different institutions and areas of Mexico, as well as 2 pediatric nutritionists and 2 specialists in pediatric surgery, to discuss different aspects of the epidemiology, diagnosis, and treatment of AP and RAP in the pediatric population. The aim of this document is to present the consensus results. Different AP topics were addressed by 6 working groups, each of which reviewed the information and formulated statements considered pertinent for each module, on themes involving recommendations and points of debate, concerning diagnostic or therapeutic approaches. All the statements were presented and discussed. They were then evaluated through a Delphi process, with electronic and anonymous voting, to determine the level of agreement on the statements. A total of 29 statements were formulated, all of which reached above 75% agreement in the first round of voting.
Subject(s)
Pancreatitis , Adult , Humans , Child , Adolescent , Pancreatitis/diagnosis , Pancreatitis/therapy , Consensus , Acute Disease , Mexico/epidemiologyABSTRACT
Abdominal aortic aneurysms are a frequent alteration in the population over 65 years old, who have risk factor. In most of cases, are asymptomatic, and they can be diagnosed as an incidental finding in the study of other pathologies, however, in this case, the patient presents digestive symptoms and it was in abdominal exploration where we find a pulsatile abdominal mass , it necessary to request an urgent abdominal ultrasound that confirmed the existence of a high risk AAA.It is essential the physical examination as well as the clinic of the patient, making a good differential diagnosis of potentially serious pathologies. (AU)
Subject(s)
Humans , Male , Middle Aged , Microaneurysm , Aorta , Aorta, Abdominal , Constipation , Aerophagy , Hyperlipidemias , HyperuricemiaABSTRACT
BACKGROUND: Some chronic inflammatory skin diseases, such as psoriasis, have been associated with an increased prevalence of non-alcoholic fatty liver disease (NAFLD). Nevertheless, this prevalence in hidradenitis suppurativa (HS) has not been assessed to date. OBJECTIVES: To determine the prevalence of NAFLD in patients with HS and the risk factors associated with this disorder. METHODS: This case-control study enrolled 70 HS patients and 150 age- and gender-matched controls who were evaluated by hepatic ultrasonography (US) and transient elastography (TE) after excluding other secondary causes of chronic liver disease. The diagnosis of NAFLD was established if US and/or TE were altered. RESULTS: The prevalence of NAFLD was significantly increased in patients with HS compared to controls (72.9% vs. 24.7%: P < 0.001). In the multivariable regression model adjusted for age, sex and classic metabolic risk factors for NAFLD, HS was significantly and independently associated with the presence of NAFLD [OR 7.75 confidence interval (CI) 2.54-23.64; P < 0.001]. CONCLUSIONS: Our results show a high prevalence of NAFLD in HS patients independent of classic metabolic risk factors. Therefore, we suggest HS patients to be evaluated for NAFLD and managed accordingly.
Subject(s)
Hidradenitis Suppurativa/complications , Hidradenitis Suppurativa/metabolism , Non-alcoholic Fatty Liver Disease/complications , Non-alcoholic Fatty Liver Disease/epidemiology , Adult , Case-Control Studies , Female , Humans , Male , Metabolic Diseases/complications , Metabolic Diseases/epidemiology , Middle Aged , Prevalence , Risk FactorsABSTRACT
The term vasculitis encompasses a heterogeneous group of diseases that share the presence of inflammatory infiltrates in the vascular wall. The diagnosis of large-vessel vasculitis is often a challenge because the presenting clinical features are nonspecific in many cases and they are often shared by different types of autoimmune and inflammatory diseases including other systemic vasculitides. Moreover, the pathogenesis of large-vessel vasculitis is not fully understood. Nevertheless, the advent of new imaging techniques has constituted a major breakthrough to establish an early diagnosis and a promising tool to monitor the follow-up of patients with largevessel vasculitis. This is the case of the molecular imaging with the combination of positron emission tomography with computed tomography (PET/CT) using different radiotracers, especially the 18F-fluordeoxyglucose (18F-FDG). In this review we have focused on the contribution of 18F-FDG PET in the diagnosis of large-vessel vasculitis (AU)
El término vasculitis engloba un heterogéneo grupo de enfermedades que tienen en común la presencia de un infiltrado inflamatorio en la pared vascular. El diagnóstico de las vasculitis de vaso grande es a menudo dificultoso debido a que pueden comenzar con una sintomatología inespecífica que también puede aparecer en otros tipos de enfermedades autoinmunes e inflamatorias, incluyendo otras vasculitis sistémicas. Además, la patogenia de las vasculitis de vaso grande no se conoce en su totalidad. Sin embargo, el desarrollo de nuevas técnicas de imagen constituye un gran avance para establecer un diagnóstico precoz y son una herramienta prometedora para el seguimiento de las vasculitis de vaso grande. Este es el caso de la imagen molecular obtenida de la combinación de la tomografía por emisión de positrones con la tomografía computarizada (PET/TAC) utilizando diferentes radiotrazadores, especialmente la 18F- fluordeoxiglucosa (18F-FDG). En esta revisión nos hemos centrado en la contribución del 18F-FDG PET en el diagnóstico de las vasculitis de vaso grande (AU)
Subject(s)
Aged, 80 and over , Female , Humans , Male , Middle Aged , Vasculitis , Positron-Emission Tomography/instrumentation , Positron-Emission Tomography/methods , Positron-Emission Tomography , Early Diagnosis , Fluorodeoxyglucose F18 , Giant Cell Arteritis , Polymyalgia Rheumatica , Takayasu Arteritis , Positron-Emission Tomography/standards , Positron-Emission Tomography/trends , Giant Cell Arteritis/complications , Giant Cell Arteritis/physiopathologyABSTRACT
The term vasculitis encompasses a heterogeneous group of diseases that share the presence of inflammatory infiltrates in the vascular wall. The diagnosis of large-vessel vasculitis is often a challenge because the presenting clinical features are nonspecific in many cases and they are often shared by different types of autoimmune and inflammatory diseases including other systemic vasculitides. Moreover, the pathogenesis of large-vessel vasculitis is not fully understood. Nevertheless, the advent of new imaging techniques has constituted a major breakthrough to establish an early diagnosis and a promising tool to monitor the follow-up of patients with largevessel vasculitis. This is the case of the molecular imaging with the combination of positron emission tomography with computed tomography (PET/CT) using different radiotracers, especially the (18)F-fluordeoxyglucose ((18)F-FDG). In this review we have focused on the contribution of (18)F-FDG PET in the diagnosis of large-vessel vasculitis.
Subject(s)
Positron Emission Tomography Computed Tomography , Vasculitis/diagnostic imaging , Aortitis/diagnosis , Aortitis/diagnostic imaging , Autoimmune Diseases/complications , Colitis, Ulcerative/complications , Female , Fluorine Radioisotopes , Fluorodeoxyglucose F18 , Giant Cell Arteritis/diagnosis , Giant Cell Arteritis/diagnostic imaging , Humans , Male , Meta-Analysis as Topic , Polymyalgia Rheumatica/complications , Polymyalgia Rheumatica/diagnosis , Positron-Emission Tomography , Radiopharmaceuticals , Sarcoidosis/complications , Sensitivity and Specificity , Takayasu Arteritis/diagnosis , Takayasu Arteritis/diagnostic imaging , Vasculitis/diagnosis , Vasculitis/etiologyABSTRACT
Eosinophilic asthma phenotype predicts good response to corticosteroids and associates to asthmatic exacerbations. Sputum induction by hypertonic saline (HS) inhalation is technically demanding. Bronchial hyperresponsiveness (BHR) to osmotic agents indirectly mirrors active airway inflammation. We compared the safety and ability of HS and mannitol to induce sputum and measure BHR. We evaluated the stability of inflammatory phenotypes. We studied 35 non-smoking asthmatics randomized to undergo HS and mannitol challenges on 2 days 1 week apart. Sputum was sampled for cell analysis and phenotyped as eosinophilic (≥3% eosinophils) and non-eosinophilic (<3%) asthma. Nineteen subjects had BHR to mannitol and nine of them also had BHR to HS. Drops in forced expiratory volume in 1 s were higher from HS challenge than from mannitol challenge. Adequate sputum samples were obtained from 80% subjects (68% mannitol and 71% HS). Eosinophils and macrophages from both challenges correlated. Neutrophils were higher in sputum from HS. Ninety percent samples were equally phenotyped with HS and mannitol. Fractional exhaled nitric oxide, sputum eosinophils and BHR correlated in both challenges. HS and mannitol showed similar capacity to produce valuable sputum samples. BHR to both osmotic stimuli partially resembled airway eosinophilic inflammation but mannitol was more sensitive than HS to assess BHR. Eosinophilic phenotype remained stable in most patients with both stimuli.
Subject(s)
Asthma/physiopathology , Bronchial Hyperreactivity/diagnosis , Diuretics, Osmotic/pharmacology , Mannitol/pharmacology , Saline Solution, Hypertonic/pharmacology , Sputum/cytology , Sputum/drug effects , Adolescent , Adult , Asthma/complications , Asthma/immunology , Breath Tests , Bronchial Hyperreactivity/complications , Diuretics, Osmotic/adverse effects , Eosinophils , Female , Forced Expiratory Volume/drug effects , Humans , Macrophages , Male , Mannitol/adverse effects , Middle Aged , Neutrophils , Nitric Oxide/analysis , Saline Solution, Hypertonic/adverse effects , Sputum/metabolism , Young AdultABSTRACT
BACKGROUND: Gastric cancer is the second cause of death by cancer worldwide. Histologic classification may predict tumor biology, clinical behavior, and outcome. According to the Lauren classification, the disease is divided into 2 types, diffuse and intestinal, and the latter has a better prognosis. AIM: To determine the frequency of gastric adenocarcinoma and compare the histopathologic characteristics of intestinal and diffuse-type gastric adenocarcinoma in Mexican patients treated at a tertiary referral hospital. METHODOLOGY: A retrospective study evaluated the pathology reports of patients with gastric adenocarcinoma corresponding to the time frame of January 2003 to December 2012. Adenocarcinomas of the gastric cardia were excluded. Frequencies were expressed as percentages and the categorical variables were compared with the chi-square test. Statistical significance was set at a P<.05. RESULTS: A total of 417 cases of gastric adenocarcinoma were found, 230 (55.2%) of which were diffuse-type and 118 (28.2%) were intestinal-type. The mean age of the patients with diffuse type gastric cancer was 54.02±14.93 and 119 (51.3%) of those patients were men. The mean age of the patients with intestinal-type gastric cancer was 63.43±13.78, and 69 (62.2%) were men. Ninety-two of the diffuse-type patients were under the age of 50 years, compared with 22 of the patients with intestinal-type carcinoma. CONCLUSIONS: This is the first study on the Mexican population to analyze the differences in the histologic types of adenocarcinoma. Diffuse-type gastric carcinoma was the most frequent subtype in our study population and it is associated with worse outcome.
Subject(s)
Adenocarcinoma/pathology , Stomach Neoplasms/pathology , Adenocarcinoma/epidemiology , Adult , Aged , Female , Humans , Male , Mexico/epidemiology , Middle Aged , Retrospective Studies , Stomach Neoplasms/epidemiologySubject(s)
Humans , Female , Middle Aged , Rare Diseases/diagnosis , Primary Health Care/methods , Primary Health Care/trends , Delivery of Health Care/standards , Delivery of Health Care , Neglected Diseases/diagnosis , Neglected Diseases/epidemiology , Neglected Diseases/prevention & control , Primary Health Care/standards , Primary Health Care , Adrenal Cortex Hormones/therapeutic use , Biopsy/methods , Biopsy , Dermatitis/complications , Venous Insufficiency/complicationsABSTRACT
La psoriasis y la artritis psoriásica se asocian con un mayor riesgo de eventos cardiovasculares y de mortalidad cardiovascular. Además de los factores clásicos de aterosclerosis, la gravedad de la afección cutánea influye en el aumento del riesgo cardiovascular en estos pacientes. En ambos procesos se observa la presencia de disfunción endotelial y un grosor aumentado de la íntima-media de la arteria carótida, como expresión de enfermedad cardiovascular subclínica. El tratamiento activo de la enfermedad y el manejo de los factores de riesgo cardiovascular clásicos son fundamentales para disminuir la morbilidad cardiovascular en estos pacientes. El establecimiento de guías clínicas para el manejo del riesgo cardiovascular abrirá, en el futuro, un nuevo abordaje clínico integral del paciente con psoriasis y la artritis psoriásica (AU)
Psoriasis and psoriatic arthritis are associated with increased risk of cardiovascular events and cardiovascular mortality. Alongside classic risk factors such as atherosclerosis, the severity of psoriatic skin disease also influences cardiovascular risk in these patients. In both cases, endothelial dysfunction and increased intima-media thickness in the carotid artery are indicators of subclinical cardiovascular disease. Active treatment of the psoriasis and management of traditional cardiovascular risk factors are essential in order to reduce cardiovascular morbidity in these patients. Clinical practice guidelines on the management of cardiovascular risk will define a new integrated approach to the care of patients with psoriasis and psoriatic arthritis (AU)
Subject(s)
Humans , Male , Female , Arthritis, Psoriatic , Arthritis, Psoriatic/complications , Arthritis, Psoriatic/diagnosis , Arthritis, Psoriatic/mortality , Arthritis, Psoriatic/prevention & control , Arthritis, Psoriatic/therapy , Cardiovascular Diseases , Cardiovascular Diseases/mortality , Atherosclerosis , Disease Management , Risk Factors , Arthritis, RheumatoidABSTRACT
Psoriasis and psoriatic arthritis are associated with increased risk of cardiovascular events and cardiovascular mortality. Alongside classic risk factors such as atherosclerosis, the severity of psoriatic skin disease also influences cardiovascular risk in these patients. In both cases, endothelial dysfunction and increased intima-media thickness in the carotid artery are indicators of subclinical cardiovascular disease. Active treatment of the psoriasis and management of traditional cardiovascular risk factors are essential in order to reduce cardiovascular morbidity in these patients. Clinical practice guidelines on the management of cardiovascular risk will define a new integrated approach to the care of patients with psoriasis and psoriatic arthritis.
Subject(s)
Cardiovascular Diseases/etiology , Psoriasis/complications , Arthritis, Psoriatic/complications , Atherosclerosis/epidemiology , Atherosclerosis/etiology , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/prevention & control , Comorbidity , Diabetes Mellitus/epidemiology , Disease Susceptibility , Dyslipidemias/epidemiology , Endothelium, Vascular/physiopathology , Humans , Inflammation/etiology , Obesity/epidemiology , Practice Guidelines as Topic , Psoriasis/epidemiology , Risk Factors , Severity of Illness Index , Spain/epidemiologyABSTRACT
Human respiratory syncytial virus (hRSV) is the main viral cause of severe respiratory infections in children and a common cause of morbidity in the elderly. The nucleocapsid (N) and fusion (F) proteins of hRSV were expressed in insect cells and used as antigens in two independent enzyme-linked immunosorbent assays (ELISAs) to measure the serum antibody response in two populations at high risk of hRSV infection, children and the elderly. Fifty-seven serum specimens from children aged from 1 to 10 years old and 91 sera from adults over 60 years old were tested. The ELISA results were compared with those obtained by an immunofluorescence assay (IFA) based on hRSV-infected cells, which was considered as the reference technique. Sensitivity and specificity were 94% and 85% for the N-ELISA and 86% and 81% for the F-ELISA, respectively. When the immune responses of the two groups of individuals were compared, it appeared that almost 100% of the elderly had antibodies against the N or F protein whereas only 50% of the sera from children had antibodies against either of the two viral proteins. In conclusion, the F and N ELISAs can be used successfully for detecting a specific antibody response to hRSV.
Subject(s)
Antibodies, Viral/blood , Nucleocapsid Proteins , Respiratory Syncytial Virus Infections/diagnosis , Respiratory Syncytial Virus Infections/immunology , Respiratory Syncytial Virus, Human/immunology , Serum/immunology , Viral Fusion Proteins , Aged , Aged, 80 and over , Child , Child, Preschool , Enzyme-Linked Immunosorbent Assay/methods , Humans , Infant , Middle Aged , Nucleocapsid Proteins/immunology , Sensitivity and Specificity , Viral Fusion Proteins/immunologyABSTRACT
Oxytocin (OT) is a peptide involved in several physiological functions in the central nervous system including central cardiovascular regulation. To clarify the role of endogenous OT in cardiovascular control, one group of anesthetized rats received unilateral microinjections of the OT receptor antagonist [d(CH(2))(5),Tyr(Me)(2),Orn(8)]-vasotocin (OTA) in the nucleus tractus solitarii (NTS) and a second group was injected with specific OT antiserum (Anti-OT). Moreover, the modulation of the cardiovascular effect of L-glutamate (GLU) by OT was also evaluated by cardiovascular analysis using effective and threshold doses of GLU. Mean arterial pressure (MAP) and heart rate (HR) were measured from a femoral catheter. OTA significantly (p<0.01) decreased the vasopressor and tachycardiac long-lasting response elicited by an effective dose of OT. Microinjections of Anti-OT antibody did not modify the values of MAP and HR compared with the control group. With regard to the OT/GLU coinjections, a subthreshold dose of OT significantly (p<0.001) counteracted the vasodepressor and bradycardiac responses induced by GLU. The coinjection of subthreshold doses of OT and GLU did not produce a change in MAP or in HR. These findings seem to exclude an endogenous tonic action of OT on central regulation of MAP and HR, although they confirm the significant role of OT on central cardiovascular control within the NTS. In fact, the modulation of GLU responses by OT supports the importance of OT on the central cardiovascular adjustments likely acting on the baroreceptor reflex sensitivity.
Subject(s)
Blood Pressure/physiology , Glutamic Acid/metabolism , Heart Rate/physiology , Oxytocin/physiology , Solitary Nucleus/physiology , Animals , Baroreflex/drug effects , Baroreflex/physiology , Blood Pressure/drug effects , Heart Rate/drug effects , Immune Sera/administration & dosage , Male , Microinjections , Oxytocin/administration & dosage , Oxytocin/analogs & derivatives , Oxytocin/immunology , Rats , Rats, Sprague-Dawley , Receptors, Oxytocin/antagonists & inhibitors , Solitary Nucleus/drug effects , Solitary Nucleus/metabolism , Vasotocin/pharmacologyABSTRACT
No disponible
Subject(s)
Male , Infant, Newborn , Humans , Myeloproliferative Disorders/complications , Skin Diseases, Vesiculobullous/complications , Down Syndrome/complications , Diagnosis, DifferentialABSTRACT
Chronic allograft dysfunction is the primary cause of graft loss after the first posttransplant year. Graft arteriosclerosis, a main component of this pathology, has oxidative stress and interactions with lipid disorders as part of the pathogenesis. The objective of our study was to determine whether oxidative stress was associated with the vascular lesions observed in a rodent model of graft arteriosclerosis. Using model of orthotopic aortic allograft in the rat, the allotransplantation (A) group included 12 Sprague-Dawley donors to 12 Lewis recipients, and the isotransplantation (B) group. 12 Lewis donors to 12 Lewis recipients. The rats received no immunosuppressants or antioxidants. After 12 weeks, the rats were humanely killed and the aorta cryopreserved until analysis. Blood samples were drawn for lipid assessment and oxidative stress analysis. Tissue expression of NADPH oxidase was quantified by Western blot, determining the constitutive membrane unit (p22phox) and the cytosolic regulating unit (p67phox). We observed a greater increase in the plasma markers of oxidative stress in group A than group B but without lipid abnormalities. The expression of NADPH subunits p22phox and p67phox were similar in both groups. These results showed that oxidative stress was associated with vascular lesions in our aortic graft model, but the origin of oxidative stress seemed to be independent of the NADPH oxidase.
Subject(s)
Aorta/transplantation , Graft Rejection/physiopathology , Lipids/blood , Oxidative Stress , Animals , Cholesterol/blood , Disease Models, Animal , Rats , Rats, Inbred Lew , Rats, Sprague-Dawley , Thiobarbituric Acid Reactive Substances/analysis , Transplantation, Homologous , Triglycerides/bloodSubject(s)
Antirheumatic Agents/adverse effects , Arthritis, Rheumatoid/complications , Demyelinating Diseases/chemically induced , Immunoglobulin G/adverse effects , Vasculitis, Leukocytoclastic, Cutaneous/chemically induced , Etanercept , Female , Humans , Injections, Subcutaneous/adverse effects , Middle Aged , Receptors, Tumor Necrosis FactorSubject(s)
Warts/pathology , Antitubercular Agents/therapeutic use , Fingers , Humans , Male , Middle Aged , Skin/pathology , Warts/drug therapyABSTRACT
No disponible
