[Severe chest pain after retention of wireless pH capsule]. / Dolor torácico severo tras retención de cápsula inalámbrica de pH.

The wireless capsule to measure gastroesophageal reflux, also known as pH monitoring capsule, is a technique used in ambulatory reflux monitoring. This capsule is introduced through a guide into the esophagus and is placed using a suction system and anchored to the esophageal mucosa. From there, it communicates with an external device using radio signals to record the activity of gastric acid in the esophagus over a specified period of time. Unlike the conventional technique, which involves inserting a tube through the nose into the esophagus, the wireless capsule may be a more comfortable and tolerable alternative for patients, potentially improving adherence to the procedure. In some cases, patients may present chest pain after placement of the pH monitoring capsule, however there is little evidence about the etiology and management. We present the case of a woman with a clinical picture of gastroesophageal reflux, with pH monitoring capsule placement, which resulted in severe chest pain that required endoscopic capsule removal.

Endoluminal vacuum therapy in the management of an esophago-pleural fistula as a complication of Boerhaave syndrome in a patient with eosinophilic esophagitis.

BACKGROUND: Boerhaave syndrome is an uncommon condition that represents about 15% of all esophageal perforation. A subset of these patients has eosinophilic esophagitis, a chronic inflammatory disease of the esophagus, that carries a risk of perforation of about 2%. Esophageal perforations can rarely result in the development of an esophago-pleural fistula. Treatment of esophago-pleural fistula represent a challenge due to lack of high quality evidence and scarce reported experience. Endoluminal vacuum-assisted therapy could have a role in the management by using the same principle applied in external wounds which provide wound drainage and tissue granulation. CASE PRESENTATION: We report a unique case of a 24-year-old man with eosinophilic esophagitis complicated with an esophageal rupture who developed an esophago-pleural fistula and was successfully managed with a non-surgical approach using endoluminal vacuum-assisted therapy. To our knowledge this could be the first experience reported in a patient with eosinophilic esophagitis. CONCLUSION: Endoluminal vacuum-assisted therapy might be an effective and novel strategy in patients with eosinophilic esophagitis and esophago-pleural fistula as a consequence of Boerhaave syndrome. Appropriately designed studies are required.

Impact of a Nurse-Led Multidisciplinary Heart Failure Clinic in a Low-Resource Setting: Experience in a Latin American Public Healthcare System.

Background: Nurse-led multidisciplinary heart failure clinics (MDHFCs) play an important role in patient care in developed countries, due to their proven benefits relating to mortality, hospitalization, and quality of life. However, evidence is limited regarding the role of MDHFCs in a limited-resource setting. Methods: Patients with heart failure (HF) with reduced ejection fraction (n = 89) were enrolled in a prospective, longitudinal cohort, from January 2018 to January 2019. The following endpoints were collected at baseline and after 6 months of follow-up: (i) quality of life, measured using the Minnesota Living with Heart Failure Questionnaire; (ii) medication adherence using the Morisky Medication Adherence Scale, 8-item; (iii) titration of HF medications; (iv) self-care behavior using the European Heart Failure Self-care Behavior Scale; and (v) mortality and hospitalizations up to 12 months after. Results: The questionnaire score was reduced from 66.5 (interquartile range [IQR], 46-86) at baseline to 26 (IQR, 13-45) at 6 months (P < 0.001). New York Heart Association (NYHA) functional class improved at 6 months (NYHA I: 41.9%; NYHA II: 39.5%; NYHA III: 17.2%), compared to baseline (NYHA I: 20%; NYHA II: 49%; NYHA III: 31%; P < 0.001). Medication adherence using the 8-item Morisky Medication Adherence Scale improved the score from 6 (IQR, 4-7) at baseline to 7 (IQR, 6.25-8; P = 0.001) at 6 months. Uptitration of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (25% vs 18% at target dose) and beta-blockers (25% vs 11% at target dose) was documented. After 6 months of follow-up, the European Heart Failure Self-care Behavior Scale was applied, showing a score of 18.5 (IQR, 15-22). The mortality reported at 12 months of follow-up was 9.7%, and the incidence of hospitalization was 44%. Conclusion: An MDHFC is a feasible strategy to manage an HF clinic in a low-resource setting.

Contexte: Les cliniques multidisciplinaires d'insuffisance cardiaque dirigées par du personnel infirmier jouent un rôle important dans les soins aux patients dans les pays développés en raison de leurs bienfaits démontrés en matière de mortalité, d'hospitalisation, et de qualité de vie. Les preuves quant au rôle de ce type de cliniques dans un contexte de pénurie de ressources sont toutefois limitées. Méthodologie: Des patients atteints d'insuffisance cardiaque (IC) présentant une fraction d'éjection réduite (n = 89) ont été inscrits à une étude de cohortes prospective et longitudinale allant de janvier 2018 à janvier 2019. Les critères d'évaluation suivants ont été mesurés à l'inscription et après six mois de suivi : i) qualité de vie, mesurée par le questionnaire Minnesota Living with Heart Failure Questionnaire; ii) adhésion au traitement médicamenteux, mesuré selon l'échelle en huit points Morisky Medication Adherence Scale; iii) modification de la dose de médicaments contre l'IC; iv) comportements d'autosoins, mesurés selon l'échelle European Heart Failure Self-care Behavior Scale; et v) taux de mortalité et d'hospitalisation jusqu'à 12 mois. Résultats: Le score au questionnaire a diminué pour passer de 66,5 (écart interquartile [EI] : 46 à 86) au départ à 26 (EI : 13 à 45) à six mois (p < 0,001). La catégorie fonctionnelle de la New York Heart Association (NYHA) s'est améliorée à six mois (NYHA I : 41,9 %; NYHA II : 39,5 %; NYHA III : 17,2 %), comparativement au départ (NYHA I : 20 %; NYHA II : 49 %; NYHA III : 31 %; p < 0,001). Le score de l'adhésion au traitement médicamenteux mesuré par l'échelle en huit points Morisky Medication Adherence Scale s'est amélioré, passant de 6 (EI : 4 à 7) au départ à 7 (EI : 6,25 à 8; p = 0,001) à six mois. On a noté une augmentation de la dose d'inhibiteurs de l'enzyme de conversion de l'angiotensine ou de bloqueurs des récepteurs de l'angiotensine (25 % vs 18 % à la dose cible) et de bêtabloquants (25 % vs 11 % à la dose cible). Après six mois de suivi, l'échelle European Heart Failure Self-care Behavior Scale a été appliquée, ce qui a donné un score de 18,5 (EI : 15 à 22). Le taux de mortalité rapporté à 12 mois de suivi était de 9,7 %, et le taux d'hospitalisation était de 44 %. Conclusion: Une clinique multidisciplinaire d'insuffisance cardiaque dirigée par du personnel infirmier est une stratégie réaliste pour gérer une clinique d'IC dans un contexte de pénurie de ressources.

Is There a Difference in Adenoma Detection Rates According to Indication? An Experience in a Panamanian Colorectal Cancer Screening Program.

Background: The benefit of colorectal cancer screening in reducing cancer risk and related death is unclear. There are quality measure indicators and multiple factors that affect the performance of a successful colonoscopy. The main objective of our study was to identify if there is a difference in polyp detection rate (PDR) and adenoma detection rate (ADR) according to colonoscopy indication and which factors might be associated. Methods: We conducted a retrospective review of all colonoscopies performed between January 2018 and January 2019, in a tertiary endoscopic center. All patients ≥ 50 years old scheduled for a nonurgent colonoscopy and screening colonoscopy were included. We stratified the total number of colonoscopies into two categories according to the indication: screening vs. non-screening, and then calculated PDR, ADR and serrated polyp detection rate (SDR). We also performed logistic regression model to identify factors associated with detecting polyps and adenomatous polyps. Results: A total of 1,129 and 365 colonoscopies were performed in the non-screening and screening group, respectively. In comparison with the screening group, PDR and ADR were lower for the non-screening group (33% vs. 25%; P = 0.005 and 17% vs. 13%; P = 0.005). SDR was non-significantly lower in the non-screening group when compared with the screening group (11% vs. 9%; P = 0.53 and 22% vs. 13%; P = 0.007). Conclusion: In conclusion, this observational study reported differences in PDR and ADR depending on screening and non-screening indication. These differences could be related to factors related to the endoscopist, time slot allotted for colonoscopy, population background, and external factors.

Dolor torácico severo tras retención de cápsula inalámbrica de pH

La cápsula inalámbrica para medir el reflujo gastroesofágico o tambien conocida como cápsula de pHmetría, es una técnica utilizada en la monitorización ambulatoria del reflujo. Esta cápsula es introducida mediante una guía al esofágo y se coloca mediante un sistema de succión y anclaje a la mucosa esofágica. De alli, se comunica con un dispositivo externo mediante señales de radio para registrar la actividad del ácido gástrico en el esófago durante un período determinado de tiempo. A diferencia de la técnica convencional, que implica la inserción de un tubo a través de la nariz hasta el esófago, la cápsula inalámbrica puede ser una alternativa más cómoda y tolerable para los pacientes, lo que podría mejorar la adherencia al procedimiento. Sin embargo, algunos pacientes pueden presentar dolor torácico tras la colocación de la cápsula de pHmetría. Presentamos el caso de una mujer con cuadro clínico de reflujo gastroesofágico, con colocación capsula de pHmetría inalámbrica, lo cual generó dolor torácico severo que precisó la retirada de la cápsula vía endoscópica.

The wireless capsule to measure gastroesophageal reflux, also known as pH monitoring capsule, is a technique used in ambulatory reflux monitoring. This capsule is introduced through a guide into the esophagus and is placed using a suction system and anchored to the esophageal mucosa. From there, it communicates with an external device using radio signals to record the activity of gastric acid in the esophagus over a specified period of time. Unlike the conventional technique, which involves inserting a tube through the nose into the esophagus, the wireless capsule may be a more comfortable and tolerable alternative for patients, potentially improving adherence to the procedure. In some cases, patients may present chest pain after placement of the pH monitoring capsule, however there is little evidence about the etiology and management. We present the case of a woman with a clinical picture of gastroesophageal reflux, with pH monitoring capsule placement, which resulted in severe chest pain that required endoscopic capsule removal.

Outcomes in Patients With Hypertrophic Cardiomyopathy Awaiting Heart Transplantation.

BACKGROUND: Current organ allocation policy and the rapid growth of mechanical support favor heart transplant (HT) candidates on left ventricular assist devices. HT candidates with hypertrophic cardiomyopathy (HCM) are usually not left ventricular assist device candidates and may have a disadvantage compared with dilated forms of cardiomyopathy. METHODS AND RESULTS: Adult HT candidates registered in the Scientific Registry of Transplant Recipients database between 1999 and 2016 were included. HCM candidates were compared with ischemic cardiomyopathy (ICM) and non-ICM patients. Two eras were defined on the basis of the approval date of the first continuous-flow left ventricular assist device for bridge-to-transplant in the United States (2008). Patients outcomes were evaluated while on the waitlist and after HT. The proportion of patients with HCM listed for HT increased by 44% in era 2 compared with era 1. Waitlist mortality in patients with ICM (15.5%-8.7%) and non-ICM (14.2%-8.2%) declined across eras, but minimal decline was observed in HCM patients (11.7%-9.6%; P=0.06). In era 2, the 12-month rate of HT in HCM (64.8%) was comparable to that of ICM (60.9%) and non-ICM (62.7%) patients (P=0.06). Post-transplant survival in HCM patients was the most favorable in the most recent era (1 year: 91.6% and 5 years: 82.5%; P<0.05 for all comparisons). CONCLUSIONS: The number of patients with HCM in need of HT is increasing. Although post-transplant survival in HCM is excellent, waitlist mortality is substantial and with minimal decline in the most recent era, despite the frequent use of listing status upgrade by exception in this patient cohort. Different strategies to improve the performance of the organ allocation system in patients with HCM are needed.