A new formula proposal for placing pH-impedance catheters in pediatric patients.

INTRODUCTION: Esophageal pH-impedance monitoring is a tool for diagnosing gastroesophageal reflux in children. The position of the pH catheter is essential for a reliable reading and the current formulas for calculating catheter insertion length are not completely accurate. The aim of the present study was to develop a new formula for adequate insertion of the pH catheter. MATERIAL AND METHODS: A cross-sectional study was conducted on children that underwent pH-impedance monitoring and later radiographic control, to calculate the correct catheter insertion length. The documented variables were age, sex, weight, height, naris to tragus distance, tragus to sternal notch distance, sternal notch to xiphoid process distance, and initial insertion length determined by the Strobel and height interval formulas. A multivariate regression analysis was carried out to predict the final insertion length. Regression ANOVA and Pearson's adjusted R-squared tests were performed. RESULTS: Forty-five pH-impedance studies were carried out, 53% of which were in males. The age and weight variables were not normally distributed. In the initial regression model, the variables that did not significantly correlate with the final insertion length were: sex (P 0.124), length determined by the Strobel or height interval formulas (P 0.078), naris to tragus distance (P 0.905), and tragus to sternal notch distance (P 0.404). The final equation: 5.6 + (height in cm * 0.12) + (sternal notch to xiphoid process distance * 0.57) produced an R2 of 0.93 (P 0.000). CONCLUSIONS: This formula can be considered a valid option for placement of the pH-impedance monitoring catheter in pediatrics.

A comparison of endoscopic procedures performed at a tertiary care hospital before and during the SARS-CoV-2 pandemic.

INTRODUCTION AND AIM: SARS-CoV-2 emerged in 2019 and had a huge impact on the world. The area of endoscopy suffered great changes, causing a reduction in the number of procedures and its indications. The aim of our study was to compare the quantity, indication, and type of procedures in 2019 with those in 2020. METHOD: A retrospective, observational, analytic, and cross-sectional study was conducted, obtaining information from the endoscopy registry. The STROBE checklist was employed. STATISTICAL ANALYSIS: The quantitative variables were analyzed with descriptive statistics (measures of central tendency and dispersion) and the categorical variables with frequencies and percentages. The quantitative variables were compared, using the Student's t test/Mann-Whitney U test, and the categorical variables with contingency tables, using the Fisher's exact test. RESULTS: In 2019, a total of 277 procedures were performed, compared with 139 in 2020. Mean patient age was 98.53 months (61.46 SD) in 2019 and 77.02 months (59.81 SD) in 2020; 352 diagnostic procedures and 136 therapeutic procedures were carried out in 2019, compared with 51 diagnostic procedures and 88 therapeutic procedures in 2020. The number of diagnostic and therapeutic procedures were inverted (72.1%-36.7% and 27.9%-63.3%, respectively) (p<0.0001). Esophageal varices, upper gastrointestinal bleeding (UGIB), and foreign body extraction were the indications, in order of predominance in 2019, compared with foreign body extraction (p<0.05), UGIB, and esophageal varices in 2020. There were no differences regarding colonoscopy. CONCLUSION: There was a clear difference in indication and type of procedure, with an increase in foreign body extraction in preschoolers.

Clinical evaluation of the sedative, antinociceptive and cardiorespiratory effects of intranasal dexmedetomidine combined with methadone in healthy dogs.

In this prospective, randomised, blinded clinical study, we compared the sedative, antinociceptive and cardiorespiratory effects of intranasal (IN) dexmedetomidine at 5 µg/kg (diluted with 0.03 mL/kg NaCl 0.9%, DEX) with or without methadone (0.3 mg/kg; DEXMET), through a mucosal atomization device to one nostril in twenty healthy client-owned dogs. At 5-min intervals over 45 min, sedation score, onset, cardiopulmonary variables, mechanical nociceptive thresholds (MNTs) were assessed, also ease of administration, adverse effects, and response to IV catheterization. Statistical analysis employed t-test, the Mann-Whitney U, repeated measures ANOVA and Chi-square tests as appropriate (P < 0.05). Higher sedation ocurred in DEXMET (7 [5-10]) compared to DEX (5 [2-7]) from 15 to 30 min (P < 0.01, median [interquartile range]). Heart rate was lower in DEXMET (P < 0.01; 65% reduction vs. 41% in DEX, P = 0.001). The MNTs were higher in DEXMET than DEX from 15 to 45 min (P < 0.01), peaking at T30 (17.1 ± 3.8, DEXMET and 8.5 ± 5.4 N, DEX). No differences were observed in mean arterial blood pressure and respiratory rate. Intranasal administration was considered easy for 8 dogs per group. Reverse sneezing (8 dogs; P < 0.001), sialorrhea and retching (4 and 2 dogs, respectively) occurred in DEXMET. Response to catheterisation was lower in DEXMET than DEX (P = 0.039; 2 and 7 dogs, respectively). In conclusion, intranasal methadone (0.3 mg/kg) increased the sedative and antinociceptive effects produced by dexmedetomidine (5 µg/kg) in healthy dogs and resulted in lower heart rate.

A non-second-gradient model for nonlinear elastic bodies with fibre stiffness.

In the past, to model fibre stiffness of finite-radius fibres, previous finite-strain (nonlinear) models were mainly based on the theory of non-linear strain-gradient (second-gradient) theory or Kirchhoff rod theory. We note that these models characterize the mechanical behaviour of polar transversely isotropic solids with infinitely many purely flexible fibres with zero radius. To introduce the effect of fibre bending stiffness on purely flexible fibres with zero radius, these models assumed the existence of couple stresses (contact torques) and non-symmetric Cauchy stresses. However, these stresses are not present on deformations of actual non-polar elastic solids reinforced by finite-radius fibres. In addition to this, the implementation of boundary conditions for second gradient models is not straightforward and discussion on the effectiveness of strain gradient elasticity models to mechanically describe continuum solids is still ongoing. In this paper, we develop a constitutive equation for a non-linear non-polar elastic solid, reinforced by embedded fibers, in which elastic resistance of the fibers to bending is modelled via the classical branches of continuum mechanics, where the development of the theory of stresses is based on non-polar materials; that is, without using the second gradient theory, which is associated with couple stresses and non-symmetric Cauchy stresses. In view of this, the proposed model is simple and somewhat more realistic compared to previous second gradient models.

Foreign body ingestion and associated factors in pediatric patients at a tertiary care center.

INTRODUCTION AND AIMS: Foreign body (FB) ingestion is a common problem in children under 5 years of age and is one of the main indications for endoscopy. The aim of the present study was to describe the clinical, radiographic, and endoscopic characteristics of patients with FB ingestion, as well as the factors associated with the anatomic location and the type of object ingested. MATERIALS AND METHODS: An analytic cross-sectional study was conducted on all patients with FB ingestion seen at the gastroenterology service from January 2013 to December 2018. The data were analyzed using the SPSS program, obtaining frequencies, percentages, medians, and interquartile ranges. Associations were assessed through the chi-square test. RESULTS: Eighty-five patients (52 males and 33 females) were included, with a median age of 4 years. The most common symptom was vomiting (29.4%). Two radiographic projections were carried out in 72.9% of the cases and the stomach was the site where the FB was most frequently visualized (32.9%). The objects most commonly ingested were coins (36%), with esophageal location (p<0.05), as well as objects with a diameter larger than 2cm (p<0.05). An endoscopic procedure was performed on 76 patients (89.4%) for FB extraction, with findings of erythema (28.9%), erosion (48.6%), ulcer (10.5%) and perforation (1.3%). CONCLUSIONS: Numerous factors should be taken into account in the approach to FB ingestion in pediatric patients, including type and size of the FB, time interval from ingestion to hospital arrival, and patient clinical status and age.

Gastric adenocarcinoma in childhood: a case report and a literature review. / Adenocarcinoma gástrico en la infancia. Reporte de caso y revisión de la literatura.

Gastric tumors, especially gastric adenocarcinomas, are rare in childhood and adolescence, as a result of which there is limited information. Therefore, management is typically extrapolated from adult patients. We report the case of a 10-year-old girl referred to our institution with systemic symptoms and pyloric syndrome. An infiltrating antro-pyloric lesion without evidence of metastasis was found. Histopathological analysis confirmed the presence of an undifferentiated diffuse gastric adenocarcinoma with signet ring cells. Diagnostic laparoscopy was carried out, which demonstrated signs of peritoneal carcinomatosis, so palliative chemotherapy was proposed.

Los tumores gástricos, en especial el adenocarcinoma gástrico, son infrecuentes en la infancia y la adolescencia. Por ello, la información sobre esta patología es limitada, de ahí que el manejo sea extrapolado de pacientes adultos. Reportamos el caso de una niña de 10 años de edad, remitida a nuestra institución, con síndrome constitucional y síndrome pilórico, en quien se encontró una lesión infiltrativa antropilórica sin evidencia de metástasis. El reporte histopatológico confirmó un adenocarcinoma gástrico difuso indiferenciado con células en anillo de sello. Se realizó laparoscopia diagnóstica donde se encuentran signos de carcitonamatosis peritoneal, por lo que se ofreció quimioterapia con intención paliativa.

Esophagogastric junction outflow obstruction in the differential diagnosis of post-fundoplication dysphagia in children.

INTRODUCTION AND AIMS: Post-fundoplication dysphagia is resolved with no therapeutic intervention in the majority of cases but it can persist in 5.3% of children that undergo the procedure. Among the differential diagnoses, esophagogastric junction outflow obstruction (EGJOO) is a disorder that should be suspected if there is a persistence of dysphagia. The aim of our study was to describe the clinical characteristics, treatment, and follow-up in a case series of patients diagnosed with post-fundoplication EGJOO. MATERIALS AND METHODS: The clinical records of patients diagnosed with EGJOO at a tertiary care hospital within the time frame of September 2015 to September 2019 were reviewed, with respect to manometry, etiology, treatment, and clinical course of the disease. RESULTS: Of the 213 high-resolution esophageal manometries performed, 4 patients met the criteria for post-fundoplication EGJOO. The primary symptom was dysphagia, presenting 15 days after the procedure. Esophageal dilations were carried out on all the patients but with no improvement. Symptoms related to the condition resolved spontaneously in three of the four patients. CONCLUSION: The management of children with post-fundoplication EGJOO continues to be a challenge. Even though more than half of the cases resolve with no intervention, optimum management of the motility disorder is still limited, given the scant experience with the condition in the pediatric population.

Adenocarcinoma gástrico en la infancia. Reporte de caso y revisión de la literatura / Gastric adenocarcinoma in childhood: a case report and a literature review

Los tumores gástricos, en especial el adenocarcinoma gástrico, soninfrecuentes en la infancia y la adolescencia. Por ello, la informaciónsobre esta patología es limitada, de ahí que el manejo sea extrapoladode pacientes adultos.Reportamos el caso de una niña de 10 años de edad, remitida anuestra institución, con síndrome constitucional y síndrome pilórico,en quien se encontró una lesión infiltrativa antropilórica sin eviden-cia de metástasis. El reporte histopatológico confirmó un adenocar-cinoma gástrico difuso indiferenciado con células en anillo de sello.Se realizó laparoscopia diagnóstica donde se encuentran signos decarcitonamatosis peritoneal, por lo que se ofreció quimioterapia conintención paliativa.(AU)

Gastric tumors, especially gastric adenocarcinomas, are rare inchildhood and adolescence, as a result of which there is limited infor-mation. Therefore, management is typically extrapolated from adultpatients.We report the case of a 10-year-old girl referred to our institutionwith systemic symptoms and pyloric syndrome. An infiltrating antro-py-loric lesion without evidence of metastasis was found. Histopathologicalanalysis confirmed the presence of an undifferentiated diffuse gastricadenocarcinoma with signet ring cells. Diagnostic laparoscopy wascarried out, which demonstrated signs of peritoneal carcinomatosis, sopalliative chemotherapy was proposed.(AU)

Foreign body ingestion and associated factors in pediatric patients at a tertiary care center. / Ingesta de cuerpo extraño en pacientes pediátricos en un hospital de tercer nivel y factores asociados.

INTRODUCTION AND AIMS: Foreign body (FB) ingestion is a common problem in children under 5 years of age and is one of the main indications for endoscopy. The aim of the present study was to describe the clinical, radiographic, and endoscopic characteristics of patients with FB ingestion, as well as the factors associated with the anatomic location and the type of object ingested. MATERIALS AND METHODS: An analytic cross-sectional study was conducted on all patients with FB ingestion seen at the gastroenterology service from January 2013 to December 2018. The data were analyzed using the SPSS program, obtaining frequencies, percentages, medians, and interquartile ranges. Associations were assessed through the chi-square test. RESULTS: Eighty-five patients (52 males and 33 females) were included, with a median age of 4 years. The most common symptom was vomiting (29.4%). Two radiographic projections were carried out in 72.9% of the cases and the stomach was the site where the FB was most frequently visualized (32.9%). The objects most commonly ingested were coins (36%), with esophageal location (p <0.05), as well as objects with a diameter larger than 2cm (p <0.05). An endoscopic procedure was performed on 76 patients (89.4%) for FB extraction, with findings of erythema (28.9%), erosion (48.6%), ulcer (10.5%) and perforation (1.3%). CONCLUSIONS: Numerous factors should be taken into account in the approach to FB ingestion in pediatric patients, including type and size of the FB, time interval from ingestion to hospital arrival, and patient clinical status and age.

Anorectal manometry in children with retentive fecal incontinence: What parameters should we evaluate? / Manometría anorrectal en niños con incontinencia fecal retentiva: ¿Qué parámetros debemos evaluar?

INTRODUCTION: Children with functional constipation frequently present with alterations in rectal compliance and the urge-to-defecate sensation that can be evaluated through anorectal manometry (ARM). In the present study, we evaluated the usefulness of the parameters obtained through ARM in children with retentive fecal incontinence (RFI). MATERIALS AND METHODS: Children with functional constipation, aged 4 to 17years, that underwent ARM were included in the study. RESULTS: Of the 35 children evaluated, 21 presented with functional constipation and 14 had functional constipation and RFI. The children with both constipation and RFI tolerated greater volumes of air insufflation for triggering the urge to defecate and reaching maximum tolerance of pain, compared with the children that did not have RFI. We identified the cutoff point of 135ml of air as the maximum tolerance sensation for distinguishing children with RFI. CONCLUSIONS: Maximum tolerance of pain was the most useful parameter for evaluating RFI in children with functional constipation.

Síndrome de hipertensión intracraneal en una paciente con psoriasis tratada con ustekinumab / Intracranial hypertension syndrome in a patient with psoriasis receiving ustekinumab

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