Spotted fever rickettsioses. Study of cases reported in a secondary care pediatric hospital of northeastern Mexico, 2012-2022.

BACKGROUND: Spotted fever rickettsiosis is a serious disease with a high mortality rate if not timely detected. OBJECTIVE: To describe the characteristics of patients hospitalized for spotted fever rickettsiosis, as well as the risk factors associated with poor prognosis. MATERIAL AND METHODS: Data from medical records of patients hospitalized between August 2012 and July 2022 were collected. Variables were analyzed using Mann-Whitney's U-test, Fisher's exact test, and univariate or multivariate logistic regression analysis. RESULTS: Twenty-six patients were analyzed, among which a mortality of 57.6% was identified. In the between-group comparison, platelet count was lower in non-survivors (16.0 × 103/µL vs. 25.9 × 103/µL, p = 0.031). The percentage of surviving patients who received treatment more than 72 hours after fever onset was 45.5% (five patients) vs. 86.7% of non-survivors (13 patients) (p = 0.034). Receiving treatment 72 hours after fever onset increased by 7.09 times the probability of a fatal outcome (OR = 8.09, 95% CI = 1.1-55.8, p = 0.034). CONCLUSIONS: Starting adequate treatment 72 hours after the onset of fever may be an important risk factor for mortality, hence the importance of timely diagnosis and appropriate treatment of this disease.

ANTECEDENTES: La rickettsiosis de fiebre manchada es una enfermedad grave y con alta tasa de letalidad si no se identifica oportunamente. OBJETIVO: Describir las características de los pacientes hospitalizados por rickettsiosis de fiebre manchada, así como los factores de riesgo asociados a mal pronóstico. MATERIAL Y MÉTODOS: Se recabaron los datos del expediente clínico de pacientes hospitalizados entre agosto de 2012 y julio de 2022. Las variables se analizaron mediante prueba U de Mann-Whitney, prueba exacta de Fisher y regresión logística univariada y multivariada. RESULTADOS: Se analizaron 26 pacientes, en quienes se identificó una mortalidad de 57.6 %. En la comparación entre grupos, el número de plaquetas fue menor en los no supervivientes (16.0 × 103/µL versus 25.9 × 103/µL, p = 0.031). El porcentaje de pacientes supervivientes que recibieron tratamiento más de 72 horas después del inicio de la fiebre fue 45.5 % (cinco pacientes) versus 86.7 % de los no supervivientes (13 pacientes), p = 0.034. Recibir tratamiento después de 72 horas del inicio de la fiebre incrementó 7.09 veces la probabilidad de desenlace fatal (RM = 8.09, IC 95 % = 1.1-55.8, p = 0.034). CONCLUSIONES: Iniciar tratamiento adecuado posterior a 72 horas del inicio de la fiebre podría ser un factor de riesgo de mortalidad, de ahí que la importancia del diagnóstico oportuno y tratamiento adecuado de esta enfermedad.

Rickettsiosis de fiebre manchada. Estudio de casos notificados en un hospital pediátrico de segundo nivel en el noreste de México, 2012-2022 / Spotted fever rickettsioses. Study of cases reported in a secondary care pediatric hospital of northeastern Mexico, 2012-2022

Resumen Antecedentes: La rickettsiosis de fiebre manchada es una enfermedad grave y con alta tasa de letalidad si no se identifica oportunamente. Objetivo: Describir las características de los pacientes hospitalizados por rickettsiosis de fiebre manchada, así como los factores de riesgo asociados a mal pronóstico. Material y métodos: Se recabaron los datos del expediente clínico de pacientes hospitalizados entre agosto de 2012 y julio de 2022. Las variables se analizaron mediante prueba U de Mann-Whitney, prueba exacta de Fisher y regresión logística univariada y multivariada. Resultados: Se analizaron 26 pacientes, en quienes se identificó una mortalidad de 57.6 %. En la comparación entre grupos, el número de plaquetas fue menor en los no supervivientes (16.0 × 103/µL versus 25.9 × 103/µL, p = 0.031). El porcentaje de pacientes supervivientes que recibieron tratamiento más de 72 horas después del inicio de la fiebre fue 45.5 % (cinco pacientes) versus 86.7 % de los no supervivientes (13 pacientes), p = 0.034. Recibir tratamiento después de 72 horas del inicio de la fiebre incrementó 7.09 veces la probabilidad de desenlace fatal (RM = 8.09, IC 95 % = 1.1-55.8, p = 0.034). Conclusiones: Iniciar tratamiento adecuado posterior a 72 horas del inicio de la fiebre podría ser un factor de riesgo de mortalidad, de ahí que la importancia del diagnóstico oportuno y tratamiento adecuado de esta enfermedad.

Abstract Background: Spotted fever rickettsiosis is a serious disease with a high mortality rate if not timely detected. Objective: To describe the characteristics of patients hospitalized for spotted fever rickettsiosis, as well as the risk factors associated with poor prognosis. Material and methods: Data from medical records of patients hospitalized between August 2012 and July 2022 were collected. Variables were analyzed using Mann-Whitney's U-test, Fisher's exact test, and univariate or multivariate logistic regression analysis. Results: Twenty-six patients were analyzed, among which a mortality of 57.6% was identified. In the between-group comparison, platelet count was lower in non-survivors (16.0 × 103/µL vs. 25.9 × 103/µL, p = 0.031). The percentage of surviving patients who received treatment more than 72 hours after fever onset was 45.5% (five patients) vs. 86.7% of non-survivors (13 patients) (p = 0.034). Receiving treatment 72 hours after fever onset increased by 7.09 times the probability of a fatal outcome (OR = 8.09, 95% CI = 1.1-55.8, p = 0.034). Conclusions: Starting adequate treatment 72 hours after the onset of fever may be an important risk factor for mortality, hence the importance of timely diagnosis and appropriate treatment of this disease.

[Spotted fever rickettsioses. Study of cases reported in a secondary care pediatric hospital of northeastern Mexico, 2012-2022]. / Rickettsiosis de fiebre manchada. Estudio de casos notificados en un hospital pediátrico de segundo nivel en el noreste de México, 2012-2022.

Background: Spotted fever rickettsiosis is a serious disease with a high mortality rate if not timely detected. Objective: To describe the characteristics of patients hospitalized for spotted fever rickettsiosis, as well as the risk factors associated with poor prognosis. Material and methods: Data from medical records of patients hospitalized between August 2012 and July 2022 were collected. Variables were analyzed using Mann-Whitney's U-test, Fisher's exact test, and univariate or multivariate logistic regression analysis. Results: Twenty-six patients were analyzed, among which a mortality of 57.6% was identified. In the between-group comparison, platelet count was lower in non-survivors (16.0 × 103/µL vs. 25.9 × 103/µL, p = 0.031). The percentage of surviving patients who received treatment more than 72 hours after fever onset was 45.5% (five patients) vs. 86.7% of non-survivors (13 patients) (p = 0.034). Receiving treatment 72 hours after fever onset increased by 7.09 times the probability of a fatal outcome (OR = 8.09, 95% CI = 1.1-55.8, p = 0.034). Conclusions: Starting adequate treatment 72 hours after the onset of fever may be an important risk factor for mortality, hence the importance of timely diagnosis and appropriate treatment of this disease.

Antecedentes: La rickettsiosis de fiebre manchada es una enfermedad grave y con alta tasa de letalidad si no se identifica oportunamente. Objetivo: Describir las características de los pacientes hospitalizados por rickettsiosis de fiebre manchada, así como los factores de riesgo asociados a mal pronóstico. Material y métodos: Se recabaron los datos del expediente clínico de pacientes hospitalizados entre agosto de 2012 y julio de 2022. Las variables se analizaron mediante prueba U de Mann-Whitney, prueba exacta de Fisher y regresión logística univariada y multivariada. Resultados: Se analizaron 26 pacientes, en quienes se identificó una mortalidad de 57.6 %. En la comparación entre grupos, el número de plaquetas fue menor en los no supervivientes (16.0 × 103/µL versus 25.9 × 103/µL, p = 0.031). El porcentaje de pacientes supervivientes que recibieron tratamiento más de 72 horas después del inicio de la fiebre fue 45.5 % (cinco pacientes) versus 86.7 % de los no supervivientes (13 pacientes), p = 0.034. Recibir tratamiento después de 72 horas del inicio de la fiebre incrementó 7.09 veces la probabilidad de desenlace fatal (RM = 8.09, IC 95 % = 1.1-55.8, p = 0.034). Conclusiones: Iniciar tratamiento adecuado posterior a 72 horas del inicio de la fiebre podría ser un factor de riesgo de mortalidad, de ahí que la importancia del diagnóstico oportuno y tratamiento adecuado de esta enfermedad.

Factors affecting populations of the endemic Iberian hare (Lepus granatensis) after the first myxomatosis outbreaks in Central Spain.

The Iberian hare (Lepus granatensis) is an endemic species distributed in Spain and Portugal. Myxomatosis outbreaks affecting this species were detected in 2018 in Central and Southern Spain, spreading afterward. Aiming to evaluate factors affecting the status of hare population after the arrival of myxomatosis, we conducted 108 nocturnal hare counts in Central Spain during two study periods (winter/spring and summer/autumn) in 54 different hunting grounds, covering 1071 km and observing 884 individuals. The mean density in winter/spring was 7.66 hares/100 ha, (range 6.14-9.54/100 ha), while in summer/autumn, it was 3.4 hares/100 ha (range 2.6-4.4/100 ha). Densities of hares were not affected by the dominant habitat and the presence/absence of myxomatosis outbreaks. Hares were more abundant at hunting grounds at a higher altitude and in those conducting targeted management, while detection of myxomatosis was related to lower altitude and higher levels of game management. A MaxEnt model used to generate a risk map for myxomatosis occurrence showed that the temperature annual range was the most important predictor, which suggests that environmental factors affecting myxomatosis vectors (mosquitoes, fleas, and ticks) could play a key role in disease transmission. As myxomatosis in hares is becoming endemic, hare densities may be improved by game management and the monitoring and surveillance of this emerging disease. These surveillance programs could be the basis of effective collaborations between hunters, researchers, and environmental managers.

Hunting Levels of Turtle Dove (Streptopelia turtur) at Sites Where Food Is Provided: Implications for Sustainable Harvesting.

In some regions of Spain, hunting grounds conduct management targeting the European turtle dove (Streptopelia turtur), a commonly hunted species, and unsustainable harvesting levels at these sites have been identified as one of the factors responsible for the species' decline across its range. In hunting grounds where food was provided, we estimated the local turtle dove abundance before the hunting season, productivity (juvenile/adult ratio) and harvesting levels using harvest data from managed grounds over 4 years (2009, 2015, 2019 and 2020). Compared to previous research, a higher productivity value was found (median 1.67, range 1.24-4.15) in grounds providing more food for a longer period. We calculated that the harvesting rate should not exceed 37% of the estimated turtle dove population size (35-45%). Significant differences were found between the estimated local turtle dove abundance using a removal sampling protocol and the number of birds observed by hunters before the hunting season, which suggests that in a high proportion of grounds, the latter method may have led to bird overestimation and overharvesting. Our research supports the current European Union's harvest management plan to promote sustainable hunting in grounds where targeted management is conducted.

History of influenza immunization in COVID-19 patients: impact on mortality.

INTRODUCTION: In the context of the COVID-19 pandemic, there is concern regarding the impact of the influenza season. OBJECTIVE: To analyze the impact of influenza immunization history on patients with SARS-CoV-2 infection. METHODS: Patients older than 18 years with COVID-19, registered between March and August 2020, were included. Data were analyzed using Fisher's exact test and Student's t-test. To evaluate the impact on mortality, a logistic regression model was used; the relationship between the percentage of patients who received the influenza vaccine and mortality was determined with Pearson's correlation coefficient. RESULTS: 16,879 participants were included; 17 % had a history of influenza vaccination. Mortality was lower in the group with a history of vaccination (3.5 % vs. 7 %, p < 0.0001). The vaccination rate had an inverse relationship with the mortality rate (Pearson's r: -0.922, p = 0.026). CONCLUSIONS: Previous influenza immunization was an independent protective factor for mortality in patients with COVID-19. Although further studies are needed to determine a causal relationship, it would be reasonable to increase influenza immunization in the general population.

INTRODUCCIÓN: En el contexto de la pandemia de COVID-19 existe inquietud en cuanto al impacto de la temporada de influenza. OBJETIVO: Analizar el impacto del antecedente de inmunización contra influenza en pacientes con infección por SARS-CoV-2. MÉTODOS: Se incluyeron pacientes mayores de 18 años con COVID-19, registrados entre marzo y agosto de 2020. Los datos fueron analizados mediante las pruebas exacta de Fisher y t de Student. Para evaluar el impacto en la mortalidad se utilizó un modelo de regresión logística; la relación entre el porcentaje de pacientes a quienes se aplicó la vacuna contra la influenza y la mortalidad fue determinada con el coeficiente de correlación de Pearson. RESULTADOS: Se incluyeron 16 879 participantes; 17 % tuvo antecedente de vacunación contra influenza. La mortalidad fue menor en el grupo con historia de vacunación (3.5 % versus 7 %, p < 0.0001). El porcentaje de vacunación presentó una relación inversa con el porcentaje de mortalidad (r de Pearson ­ 0.922, p = 0.026). CONCLUSIONES: La inmunización contra la influenza fue un factor protector independiente de mortalidad en pacientes con COVID-19. Aunque son necesarios más estudios para determinar la relación causal, será razonable incrementar la inmunización contra influenza en la población general.

Antecedente de inmunización contra influenza en pacientes con COVID-19: impacto en la mortalidad / History of influenza immunization in COVID-19 patients: impact on mortality

Resumen Introducción: En el contexto de la pandemia de COVID-19 existe inquietud en cuanto al impacto de la temporada de influenza. Objetivo: Analizar el impacto del antecedente de inmunización contra influenza en pacientes con infección por SARS-CoV-2. Métodos: Se incluyeron pacientes mayores de 18 años con COVID-19, registrados entre marzo y agosto de 2020. Los datos fueron analizados mediante las pruebas exacta de Fisher y t de Student. Para evaluar el impacto en la mortalidad se utilizó un modelo de regresión logística; la relación entre el porcentaje de pacientes a quienes se aplicó la vacuna contra la influenza y la mortalidad fue determinada con el coeficiente de correlación de Pearson. Resultados: Se incluyeron 16 879 participantes; 17 % tuvo antecedente de vacunación contra influenza. La mortalidad fue menor en el grupo con historia de vacunación (3.5 % versus 7 %, p < 0.0001). El porcentaje de vacunación presentó una relación inversa con el porcentaje de mortalidad (r de Pearson –0.922, p = 0.026). Conclusiones: La inmunización contra la influenza fue un factor protector independiente de mortalidad en pacientes con COVID-19. Aunque son necesarios más estudios para determinar la relación causal, será razonable incrementar la inmunización contra influenza en la población general.

Abstract Introduction: In the context of the COVID-19 pandemic, there is concern regarding the impact of the influenza season. Objective: To analyze the impact of influenza immunization history on patients with SARS-CoV-2 infection. Methods: Patients older than 18 years with COVID-19, registered between March and August 2020, were included. Data were analyzed using Fisher’s exact test and Student’s t-test. To evaluate the impact on mortality, a logistic regression model was used; the relationship between the percentage of patients who received the influenza vaccine and mortality was determined with Pearson’s correlation coefficient. Results: 16,879 participants were included; 17 % had a history of influenza vaccination. Mortality was lower in the group with a history of vaccination (3.5 % vs. 7 %, p < 0.0001). The vaccination rate had an inverse relationship with the mortality rate (Pearson’s r: -0.922, p = 0.026). Conclusions: Previous influenza immunization was an independent protective factor for mortality in patients with COVID-19. Although further studies are needed to determine a causal relationship, it would be reasonable to increase influenza immunization in the general population.

Do non-target species visit feeders and water troughs targeting small game? A study from farmland Spain using camera-trapping.

Provision of food and water is a widespread tool implemented around the world for the benefit of game and other wildlife, but factors affecting the use of food and water by non-target species are poorly known. We evaluated visits to feeders and water troughs by non-game species using camera-traps in two separate areas of Spain. Feeders and water troughs were either "protected" (when surrounded by more than 50% of shrubs/forest) or "open" (in the opposite case). A total of 18 948 photos from 5344 camera-trapping days depicted animals, and 75 species were identified. Feeders and water troughs were visited by target species (partridges and lagomorphs, 55.3% of visits) and non-target species (44.7% of visits). Among the latter, corvids were the most common (46.1% of visits), followed by rodents (26.8%), other birds (23.6%, mainly passerines), columbids (1.9%), and other species at minor percentages. The highest proportion of visiting days to feeders and water troughs was from corvids (0.173) followed by other-birds (0.109) and rodents (0.083); the lowest proportion was recorded for columbids (0.016). Use intensity and visit frequency of water troughs tripled that recorded in feeders, and visits to open feeders/troughs were approximately twice those to protected ones. In summary: feeders and water troughs targeting small game species are also used regularly by non-target ones; they should be set close to cover to optimize their use by non-target species that are not competitors of target species (though corvids may visit them); water availability should be prioritized where drought periods are expected.

Nutritional quality of wild Iberian red deer (Cervus elaphus hispanicus) meat: Effects of sex and hunting period.

The proximate composition, energetic value, minerals, B-group vitamins and pH value of the loin (longissimus thoracis) of 71 wild Iberian red deer (Cervus elaphus hispanicus), were evaluated in stags and hinds hunted in autumn and winter. In autumn, meat had a higher content of moisture, K, Na, Zn and thiamine when compared to winter, in which higher content of proteins and P were detected. Meat from stags had a higher moisture, Na, Zn and folic acid content, while hinds provided optimal pH values (<5.8) in higher proportions than stags. Considering European Unions nutrition and health claims, deer loin has a high content of proteins, Zn, vitamin B12 (cyanocobalamin), and a low content of fat and sodium/salt, being a source of P, Fe, Cu and vitamins B2 (riboflavin) and B3 (niacin). Additionally, health claims related to children's development could be attributed to this meat, which may increase the interest on deer meat from consumers.

Daño renal agudo y cetoacidosis diabética en pacientes pediátricos: factores de riesgo / Acute kidney injury and diabetic ketoacidosis in pediatric patients: risk factors

El daño renal agudo es causa de morbilidad en niños diabéticos en países en vías de desarrollo, especialmente, en pacientes con cetoacidosis diabética. El objetivo de esta investigación fue identificar factores de riesgo para daño renal agudo en pacientes con cetoacidosis diabética. Se realizó un estudio de cohorte retrospectiva. Se incluyeron 50 pacientes diabéticos con cetoacidosis; el 54 % desarrollaron daño renal; en ellos, los niveles de glucosa y ácido úrico fueron mayores (541 mg/dl contra 407 mg/dl, p = 0,014, y 8,13 mg/dl contra 5,72 mg/dl, p = 0,015, respectivamente). El ácido úrico mayor de 6,5 mg/dl demostró un odds ratio de 6,910 (p = 0,027) para daño renal. En conclusión, la hiperuricemia fue un factor de riesgo para el desarrollo de daño renal agudo en estos pacientes. Son necesarios estudios prospectivos para determinar el papel del ácido úrico en la patogénesis del daño renal agudo en pacientes diabéticos.

Acute kidney injury is a cause of morbidity in children with diabetes in developing countries, especially in patients with diabetic ketoacidosis. The objective of this study was to identify the risk factors for acute kidney injury in patients with diabetic ketoacidosis. This was a retrospective cohort study. A total of 50 patients with diabetic ketoacidosis were included; 54 % developed kidney injury. These had higher glucose and uric acid levels (541 mg/dL vs. 407 mg/dL, p = 0.014 and 8.13 mg/dL vs. 5.72 mg/dL, p = 0.015, respectively). Uric acid levels above 6.5 mg/dL showed an odds ratio of 6.910 (p= 0.027) for kidney injury. To conclude, hyperuricemia was a risk factor for acute kidney injury in these patients. Prospective studies are required to determine the role of uric acid in the pathogenesis of acute kidney injury in patients with diabetes.

Acute kidney injury and diabetic ketoacidosis in pediatric patients: risk factors. / Daño renal agudo y cetoacidosis diabética en pacientes pediátricos: factores de riesgo.

Acute kidney injury is a cause of morbidity in children with diabetes in developing countries, especially in patients with diabetic ketoacidosis. The objective of this study was to identify the risk factors for acute kidney injury in patients with diabetic ketoacidosis. This was a retrospective cohort study. A total of 50 patients with diabetic ketoacidosis were included; 54 % developed kidney injury. These had higher glucose and uric acid levels (541 mg/dL vs. 407 mg/dL, p = 0.014 and 8.13 mg/ dL vs. 5.72 mg/dL, p = 0.015, respectively). Uric acid levels above 6.5 mg/dL showed an odds ratio of 6.910 (p = 0.027) for kidney injury. To conclude, hyperuricemia was a risk factor for acute kidney injury in these patients. Prospective studies are required to determine the role of uric acid in the pathogenesis of acute kidney injury in patients with diabetes.

El daño renal agudo es causa de morbilidad en niños diabéticos en países en vías de desarrollo, especialmente, en pacientes con cetoacidosis diabética. El objetivo de esta investigación fue identificar factores de riesgo para daño renal agudo en pacientes con cetoacidosis diabética. Se realizó un estudio de cohorte retrospectiva. Se incluyeron 50 pacientes diabéticos con cetoacidosis; el 54% desarrollaron daño renal; en ellos, los niveles de glucosa y ácido úrico fueron mayores (541 mg/dl contra 407 mg/dl, p=0,014, y 8,13 mg/dl contra 5,72 mg/dl, p=0,015, respectivamente). El ácido úrico mayor de 6,5 mg/dl demostró un odds ratio de 6,910 (p=0,027) para daño renal. En conclusión, la hiperuricemia fue un factor de riesgo para el desarrollo de daño renal agudo en estos pacientes. Son necesarios estudios prospectivos para determinar el papel del ácido úrico en la patogénesis del daño renal agudo en pacientes diabéticos.

Daño renal agudo y colestasis asociados a la enfermedad de Kawasaki en una paciente de 9 años; reporte de caso / Acute kidney injury and cholestasis associated with Kawasaki disease in a 9-year-old: case report

La enfermedad de Kawasaki (EK) es una vasculitis sistémica frecuente en niños menores de 5 años, involucra arterias coronarias y otros vasos de mediano calibre, además existe evidencia de lesión inflamatoria y proliferativa de la vía biliar e infiltración linfocitaria en el intersticio renal. Se presenta el caso de una niña de 9 años con fiebre de alto grado; desarrollando inyección conjuntival bilateral no purulenta, lengua «aframbuesada», eritema y descamación en dedos de manos y pies, síndrome colestásico, así como edema e incremento de azoados. La EK continúa siendo un reto diagnóstico para el pediatra. En todo paciente con síndrome febril, colestasis y daño renal agudo la EK debe considerarse como diagnóstico diferencial, aunque es necesario realizar más estudios para evaluar esta atípica asociación

Kawasaki disease (KD) is a systemic vasculitis frequent in children younger than 5 years of age. It involves coronary arteries and other medium-sized vessels. There also exists evidence of inflammatory and proliferative changes affecting the biliary tract and lymphocyte infiltration of the renal interstitial. We describe the case of a 9-year-old girl who developed high-grade fever, bilateral non-purulent conjunctivitis, «strawberry» tongue, desquamation of the fingers and toes, cholestatic syndrome, edema and elevated serum creatinine. KD is a diagnostic challenge for the pediatrician. In every patient with high-grade fever, cholestasis and acute kidney injury, KD should be included in the differential diagnosis, even though more research is necessary to evaluate this atypical association

Short and long-term outcomes of underwater EMR compared to the traditional procedure in the real clinical practice

Background and aims: underwater endoscopic mucosal resection (U-EMR) has been recently described as an alternative to endoscopic mucosal resection (EMR) for flat colorectal polyps. However, the real applications remain unclear due to the lack of comparative studies. Methods: a multi-centric prospective study was performed from November 2016 to December 2017. All lesions larger than 15 mm that were resected with both techniques were included in the study. The samples were matched using the size, morphology, site and access (SMSA) score as a reference. The efficacy, efficiency and adverse events rates were compared. Results: a total of 162 resections were collected (112 EMR and 50 U-EMR) with an average size of 25 mm. U-EMR achieved better results for the en bloc resection rate (49 vs 62%; p = 0.08) and there were no cases of an incomplete resection (10.7 vs 0%; p = 0.01). U-EMR was faster than EMR and there were no differences in the adverse events rate. Furthermore, U-EMR tended to achieve better results in terms of recurrence. Performing the resection in emersion appeared to prevent the cautery artefact, especially in sessile serrated adenomas. Conclusion: in the real clinical practice, U-EMR and EMR are equivalent in terms of efficacy and safety. Furthermore, U-EMR may be a feasible approach to prevent cautery artefact, allowing an accurate pathologic assessment

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Short and long-term outcomes of underwater EMR compared to the traditional procedure in the real clinical practice.

BACKGROUND AND AIMS: underwater endoscopic mucosal resection (U-EMR) has been recently described as an alternative to endoscopic mucosal resection (EMR) for flat colorectal polyps. However, the real applications remain unclear due to the lack of comparative studies. METHODS: a multi-centric prospective study was performed from November 2016 to December 2017. All lesions larger than 15 mm that were resected with both techniques were included in the study. The samples were matched using the size, morphology, site and access (SMSA) score as a reference. The efficacy, efficiency and adverse events rates were compared. RESULTS: a total of 162 resections were collected (112 EMR and 50 U-EMR) with an average size of 25 mm. U-EMR achieved better results for the en bloc resection rate (49 vs 62%; p = 0.08) and there were no cases of an incomplete resection (10.7 vs 0%; p = 0.01). U-EMR was faster than EMR and there were no differences in the adverse events rate. Furthermore, U-EMR tended to achieve better results in terms of recurrence. Performing the resection in emersion appeared to prevent the cautery artefact, especially in sessile serrated adenomas. CONCLUSION: in the real clinical practice, U-EMR and EMR are equivalent in terms of efficacy and safety. Furthermore, U-EMR may be a feasible approach to prevent cautery artefact, allowing an accurate pathologic assessment.

Acute kidney injury and cholestasis associated with Kawasaki disease in a 9-year-old: Case report. / Daño renal agudo y colestasis asociados a la enfermedad de Kawasaki en una paciente de 9 años; reporte de caso.

Kawasaki disease (KD) is a systemic vasculitis frequent in children younger than 5 years of age. It involves coronary arteries and other medium-sized vessels. There also exists evidence of inflammatory and proliferative changes affecting the biliary tract and lymphocyte infiltration of the renal interstitial. We describe the case of a 9-year-old girl who developed high-grade fever, bilateral non-purulent conjunctivitis, «strawberry¼ tongue, desquamation of the fingers and toes, cholestatic syndrome, edema and elevated serum creatinine. KD is a diagnostic challenge for the pediatrician. In every patient with high-grade fever, cholestasis and acute kidney injury, KD should be included in the differential diagnosis, even though more research is necessary to evaluate this atypical association.