Prevalence of eosinophilic esophagitis: A multicenter study on a pediatric population evaluated at thirty-six Latin American gastroenterology centers. / Prevalencia de esofagitis eosinofílica: estudio multicéntrico en población pediátrica evaluada en 36 centros de gastroenterología de América Latina.

INTRODUCTION AND OBJECTIVE: Eosinophilic esophagitis is a chronic, immune-mediated disease described in case series and publications worldwide. Over the past twenty years, the authors of different studies have attempted to evaluate its incidence and prevalence. The objetive of the present study was to estimate the prevalence of eosinophilic esophagitis in a group of children seen at 36 pediatric gastroenterology centers in ten Latin American countries. MATERIALS AND METHODS: A multicenter, observational, and cross-sectional study was conducted that estimated the period prevalence of eosinophilic esophagitis in children seen at outpatient consultation and that underwent diagnostic upper gastrointestinal endoscopy for any indication at 36 centers in 10 Latin American countries, within a 3-month time frame. RESULTS: Between April and June 2016, 108 cases of eosinophilic esophagitis were evaluated. Likewise, an average of 29,253 outpatient consultations and 4,152 diagnostic upper gastrointestinal endoscopies were carried out at the 36 participating centers. The period prevalence of eosinophilic esophagitis in the population studied (n=29,253) was 3.69 cases×1,000 (95% CI: 3.04 to 4.44), and among the children that underwent routine upper gastrointestinal endoscopy (n=4,152), it was 26x1,000 (95% CI: 22.6 to 29.4). CONCLUSIONS: The general period prevalence of eosinophilic esophagitis in a group of children evaluated at 36 Latin American pediatric gastroenterology centers was 3.69×1,000, and in the children that underwent endoscopy, it was 26×1,000. There was important prevalence variability between the participating countries and centers. The present analysis is the first study conducted on the prevalence of pediatric eosinophilic esophagitis in Latin America.

Benefits and limitations of adding hyperbranched polymers to dental resins.

Volumetric shrinkage reduction is a constant challenge in the improvement of dental resins. The inclusion of hyperbranched polymers (HBPs) with modified functionalities (hydroxyl, propionate, and methacrylate) instead of conventional dimethacrylate monomers has the potential to reduce shrinkage, but can also affect other properties. The null hypothesis was that the addition of HBPs (from 5 to 40 mass%) to a 50/50 mass% Bis-GMA/TEGDMA mixture reduces shrinkage without affecting degree of conversion, elastic modulus, glass transition temperature, Wallace hardness (before/after ethanol storage), and viscosity. This hypothesis was rejected, since HBP incorporation significantly affected most properties either negatively or positively. When HBP amounts in the resin were increased, the following general trends were observed: Volumetric shrinkage decreased significantly (p < 0.0001), down to about one-third of the control value at 40% HBP; Wallace hardness (both before and after ethanol) and viscosity increased progressively, while elastic modulus showed a parabolic profile, with a maximum at 10% HBP; and finally, degree of conversion and glass transition temperature were relatively stable, regardless of the HBP content. These results indicate that HBPs with modified end groups might be interesting substitutes for Bis-GMA/TEGDMA.

Irradiation modes' impact on radical entrapment in photoactive resins.

Different irradiation protocols are proposed to polymerize dental resins, and discordances remain concerning their impact on the material. To improve this knowledge, we studied entrapment of free radicals in unfilled Bis-GMA/TEGDMA (50:50 wt%) resin after light cure. The tested hypothesis was that various irradiation parameters (curing time, irradiance, and radiant exposure) and different irradiation modes (continuous and pulse-delay) led to different amounts of trapped free radicals. The analysis of cured samples (n = 3) by electron paramagnetic resonance (EPR) revealed that the concentrations of trapped free radicals significantly differed according to the curing protocol. When continuous modes with similar radiant exposure were compared, higher concentrations of trapped free radicals were measured for longer times with lower irradiance. Concerning pulse modes, the delay had no influence on trapped radical concentration. These results give new insights into the understanding of the photopolymerization process and highlight the relevance of using EPR when studying polymerization of dimethacrylate-based materials.

A process view of the self.

This paper further develops the concept of the self as experiential being, and its relevance for an understanding of psychopathology. It is proposed that the self, or 'I', processes and regulates its experiences by means of three modalities that are dynamically interrelated throughout life: exchanges/boundaries, internal mirroring/affective awareness, and the representational space. It is further proposed that pathology develops when these processes of self-regulation go wrong. As a result, different psychopathological positions are identified which, in the case of severe disorders, require a distinctive initial approach to therapy.

Markers of infection and their relationship to preterm delivery.

In this study we evaluated different markers of infection and their relationship to preterm delivery. Forty-four consecutive women with singleton pregnancies in uncomplicated preterm labor were investigated. C-reactive protein (CRP) in peripheral maternal blood, amniotic fluid cytokines, amniotic fluid leukocyte count, and amniotic fluid culture were performed in all patients. Thirty-six patients responded to standard tocolytic therapy and delivered after 34 weeks' gestation. In eight patients treatment failed and they delivered before 34 weeks' gestation. Two of these eight patients had a positive amniotic fluid culture for Ureaplasma urealyticum. The positive culture was accompanied by an elevated neutrophil count in the amniotic fluid. Elevated amniotic fluid levels of tumor necrosis factor (TNF) (more than 23 pg/mL), interleukin-6 (IL-6) (more than 2292 pg/mL) and interleukin-8 (more than 164 pg/mL) correlated with early preterm delivery. CRP levels in serum had a low sensitivity (38%) but a high specificity (94%) in predicting preterm delivery. This study indicates that preterm labor can be initiated by infection. Markers of infection obtained by amniocentesis have a better sensitivity and positive predictive value than noninvasive markers. Elevated IL-6 (more than 2292 pg/mL) seems to be the best predictor for preterm delivery, with a sensitivity of 75% and a specificity of 97%.

Clinical usefulness and safety of bronchoalveolar lavage (BAL) in elderly patients.

Little is known about the indications, safety and clinical usefulness of bronchoalveolar lavage (BAL) in elderly patients. In order to address these issues, we reviewed our last 200 consecutive BAL procedures, of which 23 (11.5%) were performed in patients older than 75 years (range 75-90, mean age 80.7 years, 13 men and 10 women). All procedures were well tolerated and no complications were observed. In 17 of the 23 patients (74%), BAL results were compatible with or diagnostic for infectious pneumonia (6 cases), idiopathic pulmonary fibrosis (5 cases), lung cancer (2 cases), hypereosinophilic syndrome (2 cases), chronic eosinophilic pneumonia (1 case) and lymphoma (1 case). In 6 of the 23 patients (26%), BAL yielded no specific diagnostic information. These data indicate that BAL is a safe procedure with a high diagnostic yield in an elderly population with pulmonary disease of unknown origin.

Idiopathic hypereosinophilic syndrome-related pulmonary involvement diagnosed by bronchoalveolar lavage.

Patients with HES and pulmonary infiltrates may pose certain diagnostic problems as the infiltrates may be attributed to infection, infarction, congestive heart failure, or HES itself. We report an 87-year-old woman with idiopathic HES presenting with bibasal alveolar infiltrates. Differential cell count in BAL fluid yielded a very high percentage (73 percent) of eosinophils. Other authors previously mentioned the absence of eosinophils in the lavage fluid despite an important peripheral eosinophilia in a patient with the idiopathic HES but without HES-related pulmonary involvement. Thus, BAL fluid eosinophilia may suggest HES-related pulmonary involvement. Therefore, BAL might be an important diagnostic tool in the management of pulmonary infiltrates in idiopathic HES.

The effects of short-term treatment with levamisole on cytokines in volunteers and cancer-patients.

In search for clues to the potential immunomodulating mechanism of action of levamisole which might be used as monitoring parameters, we have determined a variety of cytokines in the peripheral blood of volunteers and carcinoma patients before and after a single or a 3-day-treatment with 150 mg/day. In cancer patients no changes could be detected 4 days after a 3-day-treatment course in the levels of TNF-alpha, IL-1beta, IL-2 or IL-6. In a placebo-controlled volunteer study the same treatment did not affect the levels of beta2-microglobulin, IL-1beta, IL-1alpha, IL-2 or IL-6. However, 24hr after the last treatment the concentration of neopterin was slightly but significantly increased and the concentration of soluble IL-2 receptors decreased. A single treatment failed to produce such an effect. It is suggested that the measurement of neopterin and soluble IL-2 receptors may provide useful information in future trials.

A conservative approach to anterior knee pain.

Eight-five patients with sole anterior knee pain were treated with a physical therapy program and a nonsteroidal antiinflammatory medication. Physical therapy consisted of regimented stretching exercises, quadriceps electrical stimulation, isometric quadriceps sets, ice application after treatment, progressive straight-leg raising, and short-arc quadriceps sets. After a disciplined progression of physical therapy and daily activity, patients were questioned about the amount of their knee dysfunction secondary to pain and their level of activity. Eighty-seven percent of these patients described their knee symptoms as improved immediately after a physical therapy program. Sixty-eight percent believed their symptoms were improved when reviewed at follow-up interview (mean duration, 16.0 months). All follow-up information was obtained via phone interview using a checksheet question form to eliminate subject bias. At the time of interview, 57% believed that their level of activity substantially increased from their level at initial evaluation. These data dictate that a trial of physical therapy and nonsteroidal antiinflammatory medication should be used as initial treatment for anterior knee pain.

Chronic Ureaplasma urealyticum amnionitis associated with abruptio placentae.

Ureaplasma urealyticum is a common inhabitant of the lower genital tract of women. It is unclear whether or not the microorganism plays a role in provoking spontaneous abortion. Reported is a U urealyticum infection of placenta and amniotic fluid in an immunologically competent host resulting in abruptio placentae and spontaneous abortion during the second trimester of pregnancy. U urealyticum was isolated from peripheral maternal blood twice. Immunologic alterations, namely a transiently reversed OKT4/OKT8 rate and a decrease in immunoglobulin G levels, were detected in the patient. U urealyticum must be considered as a pathogen able to interfere with normal fetal development.