From Head to Toe: Granulomatosis with Polyangiitis.

Granulomatosis with polyangiitis (GPA) is an antineutrophil cytoplasmic antibody-associated vasculitis. It is an uncommon multisystem disease involving predominantly small vessels and is characterized by granulomatous inflammation, pauci-immune necrotizing glomerulonephritis, and vasculitis. GPA can involve virtually any organ. Clinical manifestations are heterogeneous and can be classified as granulomatous (eg, ear, nose, and throat disease; lung nodules or masses; retro-orbital tumors; pachymeningitis) or vasculitic (eg, glomerulonephritis, alveolar hemorrhage, mononeuritis multiplex, scleritis). The diagnosis of GPA relies on a combination of clinical findings, imaging study results, laboratory test results, serologic markers, and histopathologic results. Radiology has a crucial role in the diagnosis and follow-up of patients with GPA. CT and MRI are the primary imaging modalities used to evaluate GPA manifestations, allowing the differentiation of GPA from other diseases that could simulate GPA. The authors review the main clinical, histopathologic, and imaging features of GPA to address the differential diagnosis in the affected organs and provide a panoramic picture of the protean manifestations of this infrequent disease. The heterogeneous manifestations of GPA pose a significant challenge in the diagnosis of this rare condition. By recognizing the common and unusual imaging findings, radiologists play an important role in the diagnosis and follow-up of patients with GPA and aid clinicians in the differentiation of disease activity versus disease-induced damage, which ultimately affects therapeutic decisions. Online supplemental material is available for this article. ©RSNA, 2021.

Analysis of Availability and Access of Anti-myeloma Drugs and Impact on the Management of Multiple Myeloma in Latin American Countries.

INTRODUCTION: Latin American countries (LATAMC) represent a large fraction of patients treated for multiple myeloma (MM) worldwide. In order to understand the difficulty of access to anti-myeloma therapy in LATAMC, we designed this study that explores areas involved in the availability of drugs, such as health care systems, approval times, coverage of new agents, old drugs, use of generics, and the first-line treatments. MATERIAL AND METHODS: We collected data from 16 countries in 2015. RESULTS: The majority of LATAMC (88%; n = 14) had mixed public and private coverage, with patients with MM cared for in public institutions. Although bortezomib and lenalidomide were approved in 100% and 73% in LATAMC, these figures did not translate to real-world practice as one-half of the nations reported unequal access to the new agents (thalidomide, bortezomib, and lenalidomide) in both public and private systems. Conversely, cheaper old drugs, represented by melphalan, were not available commercially in 44% (n = 7) of nations. Thus, first-line MM treatments for old and young patients in public practice were triplets with thalidomide-alkylating agent-steroid, whereas in private practice, treatments involved bortezomib-alkylating agent-steroid. An alarming rate of 30% of the nations reported suboptimal regimens (eg, VAD [vincristine, adriamycin, and dexamethasone]) or the impossibility of transplantation. CONCLUSION: Our data indicates that bortezomib and transplant are still an unmet medical necessity in public systems. In the complex puzzle of myeloma drug access in LATAMC, important issues, such as the adjustment of disparities between health systems, the incorporation of new drugs with an economic cost-effectiveness view, and the re-establishment of essential old drugs, can be a platform to the future.

Estudio multicéntrico para evaluar la eficacia y seguridad de las enzimas pancreáticas en el tratamiento del síndrome dispéptico funcional / multicentric Study to evaluate the effectiveness and security of pancreáticas enzymes in the processing of the functional dispéptico syndrome

Expone que el tratamiento con enzimas pancreáticas está restringuido a un grupo pequeño de pacientes con insufiencia pancreática exócrina. Sin embargo, las enzimas pancreáticas son mucho más a menudo prescritas para aliviar diferentes trastornos digestivos. La evidencia clínica para este uso no está bien documentada en la literatura. Por lo tanto un estudio piloto fue iniciado para evaluar la eficacia y seguridad de las enzimas pancreáticas en el tratamiento del Síndrome dispético funcional. Este estudio prospectivo y multicéntrico se realizó en 50 pacientes con una historia muy clara de síndrome dispéptico y con muy específicos criterios de exclusión e inclusión. Ellos fueron tratados por un período de dos meses con enzimas pancreáticas: lipasa 8.000 U.S.P. proteasa 30.000 U.S.P. y amilasa 30.000 U.S.P.. Durante este período se realizaron tres determinaciones de grasa fecal cuantitativa en cada paciente: al comienzo, después de un mes y al final del estudio. Los resultados son positivos ya que la mayoría de síntomas desaparecen o mejoran considerablemente: náusea, eructos, regurgitación ácida, quemadura retroesternal, dolor abdominal difuso, molestias después de comer, meteorismo, flatulencia, distensión abdominal, síntomas nerviosos y anormalidades de la defecación. Es de suma importancia la forma de administrar las enzimas pancreáticas en el duodeno y la cantidad total diaria que cada paciente debe recibir especialmente en forma de actividad enzimática, sobre todo de lipasa...

Fundoplicación como tratamiento para el reflujo gastro-esofágico en niños / Fundoplication as treatment of gastroesophageal reflux in children

Estenosis esofagica como consecuencia del reflujo gastro-esofágico es común en la población pediátrica del Ecuador. La sucesión de eventos es la siguiente: vómito, neumonías recurrentes, falla de crecimiento y estenosis con consecuente malnutrición. El diagnóstico se confirma con esofagogramas y esofagoscopías. La edad de la población afectada varía entre un mes de nacido hasta doce años. El tratamiento más apropiado es la fundoplicación de Nissen para restaurar la función esfintérica esófago-gástrica. Se presentan 10 casos tratados en el Hospital Baca Ortiz de Quito, en los ultimos 2 años