Dieulafoy’s lesion in the cecal pole diagnosed by video-capsule endoscopy. A rare cause of lower gastrointestinal bleeding / Lesión de Dieulafoy en el cecal polo diagnosticado por videocápsula endoscopia. Una causa rara de sangrado gastrointestinal bajo

Dieulafoy's lesion is a rare vascular malformation that can cause massive acute gastrointestinal hemorrhage threatening the patient's life. This correspondence to the editor outlines the clinical presentation of a patient in whom, owing to the utilization of capsule endoscopy followed by subsequent colonoscopy, a diagnosis of hemorrhage resulting from a Dieulafoy's lesion located in the colon, a relatively uncommon site, was successfully established. Following intervention involving the application of hemoclips, the patient experienced a favorable clinical evolution.(AU)

Dieulafoy's lesion in the cecal pole diagnosed by video-capsule endoscopy. A rare cause of lower gastrointestinal bleeding.

Dieulafoy's lesion is a rare vascular malformation that can cause massive acute gastrointestinal hemorrhage threatening the patient's life. This correspondence to the editor outlines the clinical presentation of a patient in whom, owing to the utilization of capsule endoscopy followed by subsequent colonoscopy, a diagnosis of hemorrhage resulting from a Dieulafoy's lesion located in the colon, a relatively uncommon site, was successfully established. Following intervention involving the application of hemoclips, the patient experienced a favorable clinical evolution.

Blue rubber bleb nevus syndrome.

Gastrointestinal bleeding of obscure origin accounts for less than 5% of gastrointestinal hemorrhages. It is typically difficult to diagnose due to limited accessibility through standard endoscopic techniques and generally requires a significant number of procedures to reach a diagnosis. The "blue rubber bleb nevus syndrome" is a rare condition, of a probably hereditary origin, characterized by the presence of multiple hemangiomatous lesions, which can manifest as gastrointestinal bleeding of obscure origin. These lesions are generally nodular, rubbery to the touch, and have a submucosal appearance, primarily affecting the skin and gastrointestinal tract. We present the case of a 72-year-old male who was investigated for iron deficiency anemia with upper and lower gastrointestinal endoscopies conducted on two occasions, without revealing any findings that could explain the condition. Subsequently, a study with video-capsule endoscopy was performed, which revealed multiple submucosal and vascular lesions, measuring between 3-5 mm, located in the distal duodenum and jejunum, consistent with "Blue rubber bleb nevus syndrome".

Detection of Neuroendocrine Tumours by Enteroscopy: A Case Report.

We present the case of a 62-year-old patient who developed melenas and in whom conventional endoscopic tests could not detect any bleeding lesion. In our case, capsule endoscopy and enteroscopy were the pivotal elements in establishing the diagnosis of a neuroendocrine tumour with an atypical location. As a result, it was possible to surgically remove the lesions at an early stage of the malignancy without metastatic disease and without the need for adjuvant therapy. Our case demonstrates the need for these new techniques in tumours of atypical location and aggressive course. Otherwise, this malignancy may be underdiagnosed until an advanced stage.

Immune checkpoint inhibitor-mediated colitis in a patient with epidermoid metastatic lung cancer: new and emerging toxicities.

In recent years, the development of immunotherapy has been stablished with monoclonals antibodies against control immune molecules in T lymphocytes, tumor cells and other cells, which block lymphocyte activation and suppress immune response. These molecules are Cytotoxic T-Lymphocyte Antigen 4 (CTLA-4) and Programmed Death-ligand 1 (PD-1). Despite clinical benefits, these therapies are not exempt from side effects known as immune-related adverse events (irAEs). We report the case of a 68-year-old female with stage IIIB epidermoid lung cancer diagnosed in 2017.

Combining spectral analysis and geochemical tracers to investigate surface water-groundwater interactions: A case study in an intensive agricultural setting (southern Guatemala).

An increase in the frequency of severe hydrological events has highlighted the importance of sustainable water management in intensive agricultural regions. In a warming climate, improved understanding and stewardship of water resources are needed to guarantee water supply, ensure food security, and build resilience against extreme events. In this study, we evaluate a framework that combines spectral analysis and geochemical tracers as a potential tool for (1) gaining valuable insights into surface water (SW)-groundwater (GW) interactions, and (2) providing guidance for improved water management in an intensive agricultural basin in southern Guatemala. The framework proves to be useful in revealing important water dynamics, exposing key feedback mechanisms for water availability and quality. With the use of power density functions and hydrochemistry (T, pH, EC, and major ions), two specific interaction regimes (influent and effluent) were identified and delimited for the main watercourse. These segments are estimated to interact at high rates with the shallow aquifer in the river channel proximities and would lose influence towards the basin flanks. Furthermore, the δ2H and δ18O values indicate that regional groundwater flow systems play an essential role in the basin groundwater recharge. Lastly, we established three influence zones that depict the spatial extent of the SW-GW interactions within the basin. With these zones, we provide recommendations that will allow for further investigation and application into better water management strategies regulating groundwater development and land use activities within the agricultural context of the area.

Psychometric Properties of the Spanish Version of the Functional Evaluation of Cardiac Health Questionnaire "FETCH-Q™" for Assessing Health-related Quality of Life in Dogs with Cardiac Disease.

To evaluate the psychometric properties of the Spanish version of the "FETCH-Q™", 228 dogs with cardiovascular diseases were included. After forward and back translation of the original questionnaire, nonexperts, ethologists and veterinary colleagues evaluated the content's validity through feedback. For criteria validity, the total score was correlated with the heart disease/failure class. For construct validity, the overall quality of life of the dog and the results obtained in each question was correlated. The reliability of the questionnaire was assessed using the Cronbach's alpha coefficient. To evaluate the test-retest validity the intra-class correlation coefficient and Wilcoxon signed-rank test were used. A good agreement with the original questionnaire was evident. For construct validity, the questionnaire obtained r > 0.09 to < 0.82. The criterion validity was appropriate and the correlation was rho = 0.82, with an effect size of 0.55 (P < 0.05). Cronbach's alpha coefficient was (α = 0.89). The test-retest assessment revealed adequate repeatability (correlation coefficient = 0.87; P < .001). There was no difference in the owner responses to the questionnaire at baseline and 2 weeks later in dogs with stable cardiac disease (P > .05). This study supports the validity of psychometric properties of the Spanish version of the functional evaluation of cardiac health questionnaire "FETCHSV2-Q™" to assess Health-related Quality of Life in dogs with cardiovascular disease in clinical settings and research.

Propiedades delppropóleo como aditivo natural funcional en la nutrición animal / Propolis properties as funtional natural additive on animal nutrition

El própolis es una resina cérea de composición compleja y consistencia viscosa, que usado en la alimentación de animales, favorece el incremento de peso y masa muscular, mediante la estimulación de la ingesta alimenticia. En cabras estimula la producción de sólidos totales, grasa y proteína en la leche; resultando benéfico también en bovinos, pollos, porcinos, tilapias y trucha arco iris. El propóleo al ser evaluado en diferentes especies animales, ha demostrado poseer propiedades inmunoestimulantes, antioxidantes, antibacteriales, antitumorales y antivirales. Estas características hacen del propóleo una sustancia importante, que puede ser incluida en la dieta de los animales para fortalecer su sistema inmunológico, por su resistencia a enfermedades y ayudan a mejorar el rendimiento productivo, características que lo clasifican como aditivo natural funcional.

Propolis is a waxy resin of a complex composition and a viscose consistency, that used in animal feeding, favors weight increase and muscle mass gain, by stimulation of food intake. In goats it stimulates production of total solid, fat and milk proteins. It also shows beneficial results in bovines, broilers, pigs, tilapia and rainbow trout. Propolis, when evaluated in different animal species, has shown to have immunostimulatory, antioxidant, antibacterial, antiviral and antitumor properties. These characteristics make of propolis an important substance that can be included in the animal diet in order to strengthen their immune system, because of its resistance to disease and because they help improve production efficiency, characteristics that classify it as a functional natural additive.

Disfagia orofaríngea en el perro: reporte de dos casos / Oropharyngeal dysphagia in dog: report of cases

Se describen dos casos clínicos, que fueron presentados a consulta en el Hospital veterinario Diego Villegas de la Universidad de caldas, con un cuadro neumónico grave; luego del examen físico y de realizar diversas pruebas, se concluyo que los diagnósticos más probables incluían acalasia cricofaríngea (AC) y disfagia faríngea (DF). Se discuten las alternativas terapéuticas y la evolución clínica de los pacientes. Se menciona el ensayo terapéutico realizado en uno de los pacientes de acuerdo con lo sugerido por la literatura....

Hematuria renal idiopática: reporte de un caso clínico / Idiopathic renal hematuria: a case report

Se describe un caso de hematuria renal idiópatica en un canino de la raza mastín Napolitano de 7,5 años de edad, presentado a consulta por hematuria con varios meses de evolución; los análisis de sangre, orina y las ayudas de imagenología (radiografía y ecografía) no fueron suficientes para indicar un diagnóstico. Se recomendó la celiotomía exploratoria y, después de cateterizar los uréteres desde el interior de la vejiga, se estableció que el sangrado provenía del riñón derecho, el cual fue extirpado con su uréter. Se realizaron exámenes de histopatología del riñón extirpado, encontrándose nefrosis y un proceso degenerativo generalizado a nivel de la corteza y médula en el postoperatorio, seguramente por ser de origen bilateral; el paciente murió de otra causa no relacionada, y no fue posible evaluar el riñón contralateral...

[Retrospective study of patients who undergo pacemaker implantation in short-stay ambulatory surgery. Long-term follow-up and cost analysis]. / Estudio retrospectivo de pacientes sometidos a implante de marcapasos en cirugía mayor ambulatoria y de corta estancia. Seguimiento a largo plazo y análisis de costes.

INTRODUCTION AND OBJECTIVES: The aim of this study was to analyze data concerning mortality, morbidity, the number of re-admissions, complications, and cost per patient after pacemaker implantation, in groups of patients with different postoperative follow-up regimens. PATIENTS AND METHOD: Data from 2108 patients with definitive pacemakers implanted between January, 1991 and December, 2001 were analyzed retrospectively. We took into account the length of hospital stay and pacemaker dependence: group I, non-pacemaker dependent ambulatory patients with no hospital admission (NPMD) (n=710); group II, pacemaker-dependent patients with a short hospital stay of up to 48 hours (PMD) (n=779); group III, non-pacemaker-dependent patients with routine hospitalization for more than 48 hours (NPMD) (n=289); and group IV, pacemaker-dependent patients with routine hospitalization for more than 48 hours (PMD) (n=330). RESULTS: Total mortality was 3.9% (n=83), and no deaths were directly related to surgery. The cause of death was cardiac in 1.4% (n=30), non-cardiac in 2.3% (n=49), and unknown in 0.2% (n=4) of the patients. Mortality was premature (<30 days) in 38 patients (1.8%) and non-premature (>30 days) in 45 patients (2.1%). Total mortality was the same in Groups I and II (0.2%), and morbidity was 0.75%, and 0.9%, respectively. There were no premature deaths in these first 2 groups. In groups III and IV, mortality rose to 1.5% and 2% and morbidity to 0.9% and 1%. The total number of re-admissions (premature and non-premature) was higher in Groups III (6 re-admissions) and IV (9 re-admissions). The average total cost per patient, considering the sum of the average unit costs of the activities in each one of the medical processes which were studied (i.e., hospitalization, home visits, surgical activity, re-admissions, and second operations) was 117 euros in group I (ambulatory surgery) and 280 euros in group II (short stay). In both groups III and IV (hospitalization) the average total cost rose to 917.80 euros. CONCLUSIONS: Major ambulatory surgery may be an economical and efficient procedure for the health care system if it is used in carefully screened patients with cardiac stimulation.

[Intermittent atrioventricular block in an accessory pathway associated with complete infrahissian block]. / Sínsope por bloqueo auriculoventricular completo en un paciente con preexcitación.

The appearance of syncope in a patient with an accessory pathway is often a sign of high conduction capacity along the pathway, and calls for urgent ablation. Serious complications may ensue if it is assumed that these patients have an underlying mechanism of tachyarrhythmia, and ablation of the accessory pathway performed hastily without careful electrophysiological evaluation may lead to serious complications. The case described here, despite the patient's unusual presenting features, illustrates that the causal mechanism of syncope is not always what it appears to be. Although our patient had an obvious accessory pathway that was clearly evident in the electrocardiogram, the actual cause of the problem was complete infrahissian atrioventricular block.