The Asociación Mexicana de Gastroenterología consensus on the diagnosis and treatment of acute pancreatitis in children and adolescents.

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.

Primera onda pandémica de COVID-19 en Navarra, febrero-junio 2020 / First wave of the COVID-19 pandemic in Navarre, Spain, February-June 2020

Fundamento. En 2020 se declaró la pandemia de COVID-19. La escasez de pruebas diagnósticas limitó la monitorización de la primera onda pandémica. El objetivo fue estimar y describir esta onda en Navarra (España). Métodos. La primera onda pandémica en Navarra, desde febrero a junio de 2020, se caracterizó a partir de la vigilancia epidemiológica reforzada, de la encuesta seroepidemiológica nacional y del registro de mortalidad. Resultados. Se confirmaron 10.358 personas con COVID-19 (1,6 % de la población), 1.943 requirieron ingreso hospitalario (3 por 1.000 habitantes), 139 ingresaron en UCI (21 por 100.000) y 529 fallecieron (80 por 100.000). La mortalidad aumentó exponencialmente con la edad, superando el 1 % en mayores de 85 años. El 58 % de las defunciones ocurrieron en residentes en centros socio-sanitarios. El registro de mortalidad recibió notificación de 733 muertes por COVID-19 confirmado o probable, mientras que el exceso de mortalidad fue de 613 defunciones (20,9 %) concentradas entre mediados de marzo y finales de abril. Al final de la onda, se estima que el 6,7 % (n = 44.000) de la población tenía anticuerpos detectables frente al SARS-CoV-2 y el 10,3 % había pasado la infección. La incidencia de infección estimada aumentó abruptamente en la primera quincena de marzo y descendió rápidamente durante el confinamiento domiciliario en la segunda quincena de marzo. Conclusiones. La primera onda pandémica produjo un número enorme de casos, hospitalizaciones y defunciones en Navarra en pocas semanas. El marcado descenso de los contagios durante el confinamiento domiciliario sugiere una eficacia y un impacto considerables de esta medida en la contención de la transmisión.(AU)

Background. The COVID-19 pandemic was declared in 2020. The shortage of diagnostic tests limited monitoring of the first wave of the pandemic. This study estimates and describes the wave in Navarre (Spain). Methods. Enhanced epidemiological surveillance, seroepidemiological survey estimates and mortality registries were used to characterise the first wave of the COVID-19 pandemic from February to June 2020 in Navarre. Results. A total of 10,358 persons (1.6 % of population) were confirmed with COVID-19, 1,943 cases were hospitalized (3 per 1,000 inhabitants), 139 were admitted to the ICU (21 per 100,000 inhabitants), and 529 people died from confirmed COVID-19 (80 per 100,000). Mortality increased exponentially with age, exceeding 1 % in people over 85 years. 58 % of deaths occurred amongst nursing home residents. The mortality registry received reporting of 733 confirmed or probable COVID-19 deaths, while the excess deaths during this period were 613 (20.9 %) concentrated from mid-March to the end of April. It is estimated that, at the end of June, 6.7 % (n = 44,000) of the population had detectable antibodies against SARS-CoV-2 and 10.3 % had had the infection. The estimates of SARS-CoV-2 infection incidence increased sharply in the first half of March and decreased quickly during the home lockdown in the second half of March. Conclusions. The first wave of the pandemic produced a high number of cases, hospitalizations and deaths in Navarre in a few weeks. The pronounced decrease of SARS-CoV-2 infections during the home lockdown suggests considerable efficacy and impact of this measure for transmission control.(AU)

[First wave of the COVID-19 pandemic in Navarre, Spain, February-June 2020].

BACKGROUND: The COVID-19 pandemic was declared in 2020. The shortage of diagnostic tests limited monitoring of the first wave of the pandemic. This study estimates and describes the wave in Navarre (Spain). METHODS: Enhanced epidemiological surveillance, seroepidemiological survey estimates and mortality registries were used to characterise the first wave of the COVID-19 pandemic from February to June 2020 in Navarre. RESULTS: A total of 10,358 persons (1.6?% of population) were confirmed with COVID-19, 1,943 cases were hospitalized (3 per 1,000 inhabitants), 139 were admitted to the ICU (21 per 100,000 inhabitants), and 529 people died from confirmed COVID-19 (80 per 100,000). Mortality increased exponentially with age, exceeding 1?% in people over 85 years. 58?% of deaths occurred amongst nursing home residents. The mortality registry received reporting of 733 confirmed or probable COVID-19 deaths, while the excess deaths during this period were 613 (20.9?%) concentrated from mid-March to the end of April. It is estimated that, at the end of June, 6.7?% (n?=?44,000) of the population had detectable antibodies against SARS-CoV-2 and 10.3?% had had the infection. The estimates of SARS-CoV-2 infection incidence increased sharply in the first half of March and decreased quickly during the home lockdown in the second half of March. CONCLUSIONS: The first wave of the pandemic produced a high number of cases, hospitalizations and deaths in Navarre in a few weeks. The pronounced decrease of SARS-CoV-2 infections during the home lockdown suggests considerable efficacy and impact of this measure for transmission control.

Vulnerability of a top marine predator to coastal storms: a relationship between hydrodynamic drivers and stranding rates of newborn pinnipeds.

Coastal storms have increased in recent decades, affecting many species, including the South American sea lion (Otaria byronia). Reports of stranded sea lion pups are becoming common in Chile, presumably due to the increase in the frequency and intensity of coastal storms. To validate this assumption, a 10-year database was built by coupling wave generation and coastal propagation models to correlate pure wave parameters (significant wave height Hs, peak period Tp, normalized wave power Hs2 Tp) and wave parameters including the tidal level (maximum surface elevation η, modified wave power η2 Tp) with records of stranded pups in Cobquecura, the largest breeding colony in central Chile. The correlation between the number of pups stranded per day and wave parameters in the first half of January and the last half of February is poor, while they are stronger for the second half of January and the first half of February. The higher number of stranded pups coincide with coastal storms with normalized wave power values exceeding a threshold of 100 m2/s. Conversely, below this threshold there is wide dispersion between the number of strandings and wave parameters. Identifying wave parameter thresholds could be used to predict when newborn pups will be most affected by coastal storms, and thus help institutions to develop remediation techniques for animals at risk.

Transitando hacia el ejercicio de autonomía y liderazgo:… «para el posicionamiento hay que luchar¼ / Moving towards the practice of autonomy and leadership:… «Positioning requires striving¼ / Transitar para o exercício de autonomia e liderança:… «Para o posicionamento, tem que lutar¼

Resumen Introducción: En Chile, las enfermeras/os tienen respaldo legal para gestionar el cuidado, esto facilita el desarrollo de competencias para ejercer autonomía y liderazgo. Actualmente persisten barreras para transitar hacia un reconocimiento real de la independencia profesional. Objetivo: Develar la experiencia vivida de enfermeras con cargos en niveles de jefatura respecto al propio desarrollo para lograr el liderazgo y autonomía profesional. Metodología: Estudio cualitativo, descriptivo-interpretativo, desde la trayectoria fenomenológica de Edmund Husserl. Muestreo selectivo de caso homogéneo de tres enfermeras que desempeñaban rol de jefatura en instituciones de salud, región Valparaíso, Chile. Participación consentida. Entrevista no estructurada. Análisis del discurso utilizando el modelo de liderazgo integral de Ken Wilber. Resultados: Categorías: Conciencia del líder «ser inquieta...intelectualmente¼. Construyendo competencias «el liderazgo se aprende¼. Transitando hacia el ejercicio de la autonomía y el liderazgo, "para el posicionamiento hay que luchar". El peso de las estructuras organizacionales «tu rol es parte de un hospital¼. Interpretación: El ejercicio del liderazgo y la autonomía se fundamenta en competencias actitudinales por sobre las cognitivas y técnicas. Existe mayor apoyo y reconocimiento a nivel institucional, que al interior del equipo de salud. Persisten limitaciones para lograr máxima expresión del liderazgo y autonomía, por persistencia de modelos institucionales hegemónicos, centrados en decisiones médicas y desconocimiento del rol integrado. Conclusión: El líder se mueve en un escenario dual, entre un menor reconocimiento del equipo y un creciente empoderamiento del rol autónomo y visibilidad a nivel directivo institucional.

Abstract Introduction: In Chile, nurses have legal support to manage care, a situation which facilitates the development of competencies to perform with autonomy and leadership; however, barriers still persist while moving towards a real acknowledgement of professional independency. Objective: To unveil the lived experience of nurses in executive roles regarding their own development towards leadership and professional autonomy. Methodology: This is a descriptive and interpretative qualitative study framed by the Edmund Husserl phenomenological approach. The sample by homogeneous case included three nurses in executive roles in health institutions in Valparaiso, Chile. The participation was by consent. An unstructured interview was used. For the discourse analysis, the Ken Wilber integral leadership model was followed. Results: Categories: Leadership awareness <being inquiring… intellectually>… Building Competencies <leadership is learned>. Moving towards the practice of autonomy and leadership, "positioning requires striving". Weight of the organizational structures <your role is part of a hospital>. Interpretation: A practice of leadership and autonomy is based on attitude competencies over the cognitive and technical ones. Nevertheless, there still persist limitations to achieve a maximal expression of leadership and autonomy due to hegemonic institutional models which focus on medical decisions and neglect the integrated roles. Conclusion: The leader moves in a dual setting between a lower acknowledgement from the team, and a higher empowerment of the autonomous role and the visibility at the institutional directive level.

Resumo Introdução: No Chile, as enfermeiras/os têm apoio legal para gerenciar o cuidado, isto facilita o desenvolvimento de competências para exercer autonomia e liderança. Atualmente, persistem barreiras para transitar em direção a um reconhecimento real da independência profissional. Objetivo: Desvendar a experiência vivida de enfermeiras com cargos em níveis de chefia ao respeito do próprio desenvolvimento, para atingir a liderança e autonomia profissional. Metodologia: Estudo qualitativo, descritivo-interpretativo, desde a trajetória fenomenológica de Edmund Husserl. Amostragem seletiva de caso homogéneo de três enfermeiras que desempenhavam papel de chefia em instituições de saúde, região Valparaíso, Chile. Participação consentida. Entrevista não estruturada. Análise de discurso, utilizou-se o modelo de liderança integral de Ken Wilber. Resultados: Categorias: Consciência do líder «ser irrequieta...intelectualmente¼. Ir construindo competências «a liderança se aprende¼. Transitar em direção ao exercício da autonomia e a liderança, "para o posicionamento tem que lutar". O peso das estruturas organizacionais «seu rolo é parte de um hospital¼. Interpretação: O Exercício da liderança e a autonomia fundamenta-se em competências atitudinais, sobre as cognitivas e técnicas. Existe maior apoio e reconhecimento a nível institucional, que no interior da equipe de saúde. Persistem limitações para atingir a máxima expressão de liderança e autonomia, por persistência de modelos institucionais hegemónicos, centrados em decisões médicas e desconhecimento do rolo integrado. Conclusão: O líder movimenta-se em um cenário dual, entre um menor reconhecimento da equipe e um empoderamento crescente do rolo autónomo e visibilidade a nível diretivo institucional.

Gastrointestinal tract and liver graft-versus-host disease in pediatric patients with hematopoietic progenitor cell transplantation at a tertiary care center in Mexico. / Enfermedad injerto contra huésped gastrointestinal y hepático en pacientes pediátricos con trasplante de células progenitoras hematopoyéticas en el Hospital Infantil de México Federico Gómez.

INTRODUCTION AND AIMS: Graft-versus-host disease (GVHD) is a common multisystemic complication of allogeneic hematopoietic cell transplantation. The most frequent presentations of graft-versus-host disease involve the skin, the gastrointestinal tract, and the liver. The aim of the present study was to know the frequency of gastrointestinal tract and liver GVHD and the characteristics of disease presentation in pediatric patients that underwent hematopoietic stem cell transplantation (HSCT) at a tertiary care hospital center in Mexico City. MATERIAL AND METHODS: A retrospective study was carried out, utilizing the case records of patients that underwent HSCT in 2015, to determine the frequency of GVHD in pediatric patients at a Mexican tertiary care hospital center. RESULTS: In 2015, 16 HSCT were performed, 11 of which were carried out in males (68%). Only 3 patients developed graft-versus-host disease (18.7%). One patient presented with skin and liver GVHD and 2 patients presented with gastrointestinal tract and liver GVHD, which was the most frequent type. CONCLUSIONS: HSCT is still an uncommon procedure in Mexico and there is a lower frequency of gastrointestinal tract and liver GVHD than that reported in other studies. Most certainly, there will be an increase in this type of patient and risk factors in the Mexican population must still be determined to help predict the onset of GVHD.

Unclassifiable arrhythmic cardiomyopathy associated with Emery-Dreifuss caused by a mutation in FHL1.

Emery-Dreifuss muscular dystrophy (EDMD) is a heterogeneous genetic disorder characterized by peripheral muscular weakness often associated with dilated cardiomyopathy. We characterize clinically a large family with a mutation in FHL1 gene (p.Cys255Ser). Penetrance was 44%, 100% for males and 18% for females. The heart was the main organ involved. Affected adult males had mild hypertrophy, systolic dysfunction and restriction with non-dilated ventricles. Carriers had significant QTc prolongation. The proband presented with resuscitated cardiac arrest. There were two transplants. Pathological study of explanted heart showed fibrofatty replacement and scarring consistent with arrhythmogenic cardiomyopathy and prominent left ventricular trabeculations. Myopathic involvement was evident in all males. Females had no significant neuromuscular disease. Mutations in FHL1 cause unclassifiable cardiomyopathy with coexisting EDMD. Prognosis is poor and systolic impairment and arrhythmias are frequent. Thrombopenia and raised creatine phosphokinase should raise suspicion of an FHL-1 disorder in X-linked cardiomyopathy.

Reduction in bacterial loading using 2% chlorhexidine gluconate as an irrigant in pulpectomized primary teeth: a preliminary report.

OBJECTIVE: The aim of this study was to evaluate the reduction in bacterial loading using 2% chlorhexidine gluconate as an irrigating solution in pulpectomized primary teeth. STUDY DESIGN: A randomized, controlled clinical trial was performed that included primary teeth with pulp necrosis. Forty necrotic teeth were included, 20 irrigated with 2% chlorhexidine gluconate (experimental group) and 20 with sterile saline solution (control group); in all cases, 2 microbiological samples from within the canals were taken with sterile paper points, the first after the canal opening and before the first irrigation, and the second after instrumentation and final irrigation, before filling. All samples were evaluated by McFarlands scale. RESULTS: The results were statistically analyzed by the Mann-Whitney U test. After analyzing samples before and after irrigation in the control group (saline), we found a significant decrease of bacterial load (P < 0.0002). The same occurred in the chlorhexidine group samples (P < 0.0001). When both groups were compared post-irrigation, a statistically significant difference was observed in favor of 2% chlorhexidine gluconate. CONCLUSION: Two percent chlorhexidine gluconate showed a greater reduction of intracanal bacterial loading compared with that observed with sterile saline solution. This irrigating solution is suggested as an alternative for pulpectomy of necrotic primary teeth.

Interactions between clopidogrel and proton pump inhibitors: a review of evidence.

Clopidogrel is a thienopyridine, which inhibits the platelet P2Y adenosine diphosphate (ADP) receptor termed P2Y(12). It is taken as a prodrug that requires biotransformation to an active metabolite by cytochrome P450 (CYP) isoenzymes. In addition, esterases shunt the majority of clopidogrel to an inactive pathway, whilst the remaining prodrug requires two separate CYP-dependent oxidative steps. PPIs might diminish the antiplatelet effects and the clinical effectiveness of clopidogrel possibly through inhibition of CYP2C19 and CYP3A4 isoenzymes. Treatment with clopidogrel and aspirin decreases recurrent cardiovascular events after an acute coronary syndrome. However, an inherent increment of major bleeding is also associated with antiplatelet therapy, as well as dyspepsia with aspirin. Also, major bleeding has been associated with high risk for ischemic events and mortality. For this reason, a proton pump inhibitor (PPI) is often co-prescribed to reduce the risk of gastrointestinal tract bleeding, but its concomitant use might reduce the inhibitory effect of clopidogrel on platelet aggregation. Nevertheless, doubts exist about the possible interaction of concomitant PPI use that may reduce the inhibitory effect of clopidogrel on platelet aggregation. Indeed, there is some controversy with regard to the true risk of cardiovascular adverse events arising from a potential drug-drug interaction between clopidogrel and PPI. In this article, we will review the current status and controversies in relation to a possible interaction between clopidogrel and PPIs.

Si fiebre, ¿hemocultivos? / Blood cultures when fever?

Varón de 78 años, con antecedentes de hipertensión arterial y diabetes mellitus, remitido a urgencias desde su residencia por deterioro del estado general y caídas frecuentes en la última semana. Dos semanas antes precisó sondaje vesical, que fue traumático y de forma profiláctica se prescribió ciprofloxacino. En la exploración física destaca desorientación, TA90/40mmHg, frecuencia cardíaca 120lpm, T.a 37,3 1C, 24 respiraciones por minuto y dolor a la palpación en hipocondrio izquierdo. En el electrocardiograma se objetiva taquicardia sinusal. Al canalizar la vía periférica se nos pregunta: ¿le saco hemocultivos?(AU)

A 78-year-old man was refrerred from his residency where he lives to the emergency division due to general deterioration and frequent falls in the last week. His personal history is remarkable for arterial hypertension and diabetes. Two weeks before he needed a vesical catheterism that was traumatic and profilactic ciprofloxacin was prescriped. On phisical exploration he appears desoriented, blodd pressure is 9/40mmHg, cardiac rythm 120 beats per minute, temperature 37,3°C and 24 respirations per minute. He appears to have pain on his upper left abdomen cuadrant. When the nurse gets a peripheral vein she asks, ¿should I obtain hemocultures?(AU)

[Blood cultures when fever?]. / Si fiebre, ¿hemocultivos?

A 78-year-old man was referred from his residency where he lives to the emergency division due to general deterioration and frequent falls in the last week. His personal history is remarkable for arterial hypertension and diabetes. Two weeks before he needed a vesical catheterism that was traumatic and profilactic ciprofloxacin was prescribed. On physical exploration he appears disoriented, blood pressure is 9/40 mm Hg, cardiac rythm 120 beats per minute, temperature 37,3 °C and 24 respirations per minute. He appears to have pain on his upper left abdomen cuadrant. When the nurse gets a peripheral vein she asks, ¿should I obtain hemocultures?

Hemofilia adquirida / No disponible

No disponible

Vigilancia epidemiológica de la intoxicación aguda en el área sur de la Comunidad de Madrid: estudio VEIA 2004 / Epidemiologic survey of acute poisoning in the south area of the Community of Madrid. The VEIA 2004 study

Objetivo: VEIA es un registro evolutivo de las intoxicaciones agudas (IA) atendidas en Urgencias del Hospital Doce de Octubre de Madrid en un año completo (1979 [2], 1985 [3], 1990 [4], 1994 [5], 1997 [6] y 2000 [7]) presentamos el estudio del año 2004 y comparamos los resultados con los de años anteriores (1-7). Métodos y resultados: el método es idéntico. De las 1.508 IA, 610 son intentos de suicidio (IBAIS) 319 etílicas (IAVE) y 219 drogas (IAVD). De los 2.259 tóxicos implicados el 48% son medicamentos (50% diazepóxidos) alcohol 25% y drogas el 13%. Conclusiones: este año ha supuesto un importante aumento (34%) del número de casos y la incidencia supera a todas las publicadas en nuestro país (25,31,40). Aunque en el conjunto no hay diferencia significativa de género con el Censo de Área, la hay en IBAIS, IAVE y IAVD. Las IBAIS crecen un 35%; Se duplica el uso de benzodiacepinas y antidepresivos en los IS de mujeres y crecen también en hombres pero menos; El paracetamol se mantiene en el 23% AINE, adyuvantes y míorelajantes aumentan en mujeres y también el uso de alcohol y otros no fármacos en los is de mujeres casi igualándose con los hombres. La cuarta parte de los hombres con IS eran adictos y aparecen 13 casos de trastornos alimentarios. En las IAVE crecen el grupo sin etilismo y baja eltotal. Las drogas se duplican con respecto al año anterior: la cocaína supone los 2/3 también suben la MDMA (22 casos) y aparecen nuevas drogas, como el pegamento, sin duda efecto de la inmigración, y ketamina; incluso cuatro casos no pudieron ser etiquetados por la falta de medios diagnósticos en la urgencia

Objetive: VEIA study is an evolutional registry of acute poisonings (AP) attended in the Emergency Room of the Doce de Octubre Hospitalin Madrid (Spain) in a whole year (1979, 1985, 1990, 1994,1997 and 2000). We present the 2004 study and compare the results with the previous years. Methods and results: Methodology has been identical across VEIA STUDY. Of 1508 AP, 610 are suicide attempts (IAVIS), 319 ethylic, (IAVE), and 218 by illicit drugs (IAVD). Of the 2,259 toxics involved,48% are medications (50% benzodiacepines) alcohol 25% and illicit drugs 13%. Conclusions: There is an important increase (34%) of cases and the incidence surpasses all published in our country. There are no gender differences nor in the whole neither the Health Area Census, but there are differences in IAVIS, IAVE and IAVD. IAVIS increase in 35%. Benzodiacepines poisoning increases two-fold as well as antidepressive drugs do in women. In men also increase, but in a minor extent. Acetaminophen remains the same in 23%. NSAID’s, adjuvants and myorelaxants increase in women as do also alcohol and other poisons that almost equal men’s. There are 13 cases of IAVIS in patients with alimentary disorders. Among men, a quarter are illicit drug abusers. In IAVE, the group without alcoholism grows and the total decreases. Illicit drugs duplicate the number of the former year. Cocaine supposes already 2/3 of the cases, MDMA ascends to 22 cases and they appear new substancesas glue, without doubt as an effect of immigration and ketamine. Finally 205 household accidents and 57 industrial injuries complete the series

[Epidemiologic survey of acute poisoning in the south area of the Community of Madrid: the Veia 2004 study]. / Vigilancia epidemiológica de la intoxicación aguda en el área sur de la comunidad de Madrid: estudio Veia 2004.

OBJECTIVE: VEIA study is an evolutional registry of acute poisonings (AP) attended in the Emergency Room of the Doce de Octubre Hospital in Madrid (Spain) in a whole year (1979,1985, 1990, 1994,1997 and 2000). We present the 2004 study and compare the results with the previous years. METHODS AND RESULTS: Methodology has been identical across VEIA study. Of 1508 AP, 610 are suicide attempts (IAVIS), 319 ethylic, (IAVE), and 218 by illicit drugs (IAVD). Of the 2,259 toxics involved, 48% are medications (50% benzodiacepines) alcohol 25% and illicit drugs 13%. CONCLUSIONS: There is an important increase (34%) of cases and the incidence surpasses all published in our country. There are no gender differences nor in the whole neither the Health Area Census, but there are differences in IAVIS, IAVE and IAVD. IAVIS increase in 35%. Benzodiacepines poisoning increases two-fold as well as antidepressive drugs do in women. In men also increase, but in a minor extent. Acetaminophen remains the same in 23%. NSAID's, adjuvants and myorelaxants increase in women as do also alcohol and other poisons that almost equal men's. There are 13 cases of IAVIS in patients with alimentary disorders. Among men, a quarter are illicit drug abusers. In IAVE, the group without alcoholism grows and the total decreases. Illicit drugs duplicate the number of the former year. Cocaine supposes already 2/3 of the cases, MDMA ascends to 22 cases and they appear new substances as glue, without doubt as an effect of immigration and ketamine. Finally 205 household accidents and 57 industrial injuries complete the series.