The Mexican consensus on non-cardiac chest pain. / Consenso mexicano sobre dolor torácico no cardiaco.

INTRODUCTION: Non-cardiac chest pain is defined as a clinical syndrome characterized by retrosternal pain similar to that of angina pectoris, but of non-cardiac origin and produced by esophageal, musculoskeletal, pulmonary, or psychiatric diseases. AIM: To present a consensus review based on evidence regarding the definition, epidemiology, pathophysiology, and diagnosis of non-cardiac chest pain, as well as the therapeutic options for those patients. METHODS: Three general coordinators carried out a literature review of all articles published in English and Spanish on the theme and formulated 38 initial statements, dividing them into 3 main categories: (i)definitions, epidemiology, and pathophysiology; (ii)diagnosis, and (iii)treatment. The statements underwent 3rounds of voting, utilizing the Delphi system. The final statements were those that reached >75% agreement, and they were rated utilizing the GRADE system. RESULTS AND CONCLUSIONS: The final consensus included 29 statements. All patients presenting with chest pain should initially be evaluated by a cardiologist. The most common cause of non-cardiac chest pain is gastroesophageal reflux disease. If there are no alarm symptoms, the initial approach should be a therapeutic trial with a proton pump inhibitor for 2-4weeks. If dysphagia or alarm symptoms are present, endoscopy is recommended. High-resolution manometry is the best method for ruling out spastic motor disorders and achalasia and pH monitoring aids in demonstrating abnormal esophageal acid exposure. Treatment should be directed at the pathophysiologic mechanism. It can include proton pump inhibitors, neuromodulators and/or smooth muscle relaxants, psychologic intervention and/or cognitive therapy, and occasionally surgery or endoscopic therapy.

Peroral endoscopic myotomy for the treatment of achalasia and other esophageal motor disorders: Short-term and medium-term results at a Mexican tertiary care center. / Miotomía endoscópica peroral para el tratamiento de acalasia y otros trastornos motores del esófago. Resultados a corto y mediano plazo en un centro de referencia en México.

INTRODUCTION AND AIMS: Achalasia is characterized by the absence of lower esophageal sphincter relaxation and esophageal aperistalsis. Diagnosis is confirmed through high-resolution esophageal manometry. Laparoscopic myotomy is the standard treatment, but peroral endoscopic myotomy (POEM) is a safe and effective alternative, with good short-term and medium-term results. Our aim was to describe the short-term and medium-term experience with POEM at a tertiary care center. MATERIALS AND METHODS: The study was conducted within the time frame of November 2014 and February 2017. Treatment-naïve achalasia patients and previously-treated achalasia patients that were candidates for POEM were included. A protocolized 24-month follow-up was carried out. RESULTS: Fifty procedures were included and 31 (68%) were performed on women. Forty-one (82%) of the procedures were carried out on previously untreated patients, 7 (14%) were performed on previously treated patients, and 2 (4%) of the patients had redo-POEM. The mean age of the patients was 48.8±14.1 years. The pre-POEM Eckardt score was 9 and the integrated relaxation pressure was 24.4mmHg. Sixty-eight percent of the patients had type ii achalasia. Procedure time was 80min and myotomy length was 12.6cm. Hospital stay was 3 days and subcutaneous emphysema was the most common adverse event (30%). A total of 22/50 (44%) patients reached the 24-month follow-up, maintaining the Eckardt score and the decrease in the integrated relaxation pressure. There were no deaths. A total of 47.5% of the patients had a positive pH-study at 6 months, 15% had clinical reflux, and 35% presented with mild esophagitis. All the patients were adequately controlled with proton pump inhibitors. CONCLUSION: POEM is safe and effective in the short term and medium term for the treatment of achalasia and other esophageal motor disorders in Mexican patients.

The Mexican consensus on irritable bowel syndrome. / Consenso mexicano sobre el síndrome de intestino irritable.

BACKGROUND: Since the publication in 2009 of the Guidelines on the Diagnosis and Treatment of Irritable Bowel Syndrome of the Asociación Mexicana de Gastroenterología (2009 Guidelines), there have been significant advances in our knowledge of the epidemiology, pathophysiology, diagnosis, and treatment of this disease. AIMS: To present a consensus review of the most current knowledge of IBS, updating the 2009 Guidelines by incorporating new internationally published scientific evidence, with a special interest in Mexican studies. METHODS: The PubMed literature from January 2009 to March 2015 was reviewed and complemented through a manual search. Articles in English and Spanish were included and preference was given to consensuses, guidelines, systematic reviews, and meta-analyses. Statements referring to the different aspects of the disease were formulated and voted upon by 24 gastroenterologists employing the Delphi method. Once a consensus on each statement was reached, the quality of evidence and strength of recommendation were determined through the GRADE system. RESULTS: Forty-eight statements were formulated, updating the information on IBS and adding the complementary data that did not appear in the 2009 Guidelines regarding the importance of exercise and diet, diagnostic strategies, and current therapy alternatives that were analyzed with more stringent scientific vigor or that emerged within the last 5 years. CONCLUSIONS: We present herein a consensus review of the most relevant advances in the study of IBS, updating and complementing the 2009 Guidelines. Several studies conducted in Mexico were included.

[Assessment of calf circumference as an indicator of the risk for hyponutrition in the elderly]. / Valoración de la circunferencia de la pantorrilla como indicador de riesgo de desnutrición en personas mayores.

BACKGROUND: Undernutrition is a very common situation among elderly, that is associated with increased morbidity and mortality rates. On the other hand, calf circumference (CC) is a direct anthropometric measurement, related to fat free mass. An early detection of an elderly undernutrition situation, based on CC assessment, could contribute to prevent its development and consequences. OBJECTIVE: To analyse the relationship between CC and a possible undernutrition situation, based on the application of the Mini Nutritional Assessment (MNA) test, among Spanish subjects of 65 or more years old, including the gender and age influences. SUBJECTS AND METHODS: A cross-sectional study was carried out to assess the nutritional situation of an ambulatory population, from every area of Spanish geography (n = 22007), using the questionnaire MNA. Every subject surveyed was 65 or more years old when the test was done. RESULTS: There were statistically significant differences between subjects with a CC < 31 cm and those with CC >or= 31 cm, both men and women, in weight, height, body mass index (BMI), MNA total score and undernutrition classification. On the other hand, it was found that those elders with lower CC showed a higher undernutrition risk, both men and women, in every age range studied. CONCLUSIONS: It does exit an association between CC of Spanish subjects of 65 or more years old and the risk of developing undernutrition. That association is similar among men and women, and in all age ranges.

Optical immunosensors for environmental monitoring: how far have we come?

Immunosensing has proved to be a very interesting research area. This review discusses what has actually been achieved in the field of optical immunosensing for environmental screening, and what still needs to be done. The review is presented from a practical point of view. In terms of the basic design of the immunosensor, there is a trend towards decreasing assay time; indeed, this has been reduced from 15-20 minutes to less than 5 minutes. Another goal is to simplify the manifold, and label-free approaches combining indirect assay formats and the detection of antibody binding are popular. Rapid displacement assays have also been investigated thoroughly. In terms of some important features of immunosensing devices, the reusability of the sensing element has been studied in great depth, and working lifetimes of more than five hundred assays can now be found for all assay formats. Multianalyte assays are now being investigated, and current systems are able to monitor 2-3 target compounds, although this number is set to increase greatly (to >30) in the near future. In this sense, an increasing number of publications can be found on microarrays intended for multianalyte determinations. The application of immunosensing to real situations is the main challenge. Immunosensors are barely commercialized and are yet to be established as research or routine tools, due to a lack of validated protocols for a wide range of sample matrices. Regarding compounds considered as analytes, some significant pollutants such as dioxins or pharmaceuticals are rarely chosen as targets, although the current tendency is towards a broader spectrum of analytes. New immunoreagents should be raised for these compounds, for use in immunosensors that can be used as screening tools.

Immunosensors for pollutants working in organic media. Study of performances of different tracers with luminescent detection.

A comparative study of enzymatic and non-enzymatic labels combined with luminescence detection, developed for immunosensing of pesticide residues (carbaryl, 1-naphthol, irgarol 1051) in organic media, is presented. Peroxidase and alkaline phosphatase enzymes with fluorogenic (3-p-hydroxyphenylpropanoic acid) and luminogenic (AMPPD derivative) substrates, respectively, were assessed as enzymatic markers. As an alternative, terbium(III) chelate, with time-resolved fluorescence detection, was evaluated as a non-enzymatic label. The best sensitivity was achieved by use of alkaline phosphatase in an immunocomplex capture assay format (I (50) values 0.06, 0.27, and 7.45 microg L(-1) in buffer, 1:1 methanol-buffer, and methanol, respectively). Results were also good (I (50) 1.00 and 6.30 microg L(-1) for water and aqueous-organic mixture, respectively) for Tb(III) chelate in an immobilized conjugate assay format. Use of alkaline phosphatase label to measure carbaryl (100 ng L(-1)) in different spiked river water samples, after solid-phase extraction and analyte elution with an ethyl acetate-methanol mixture, resulted in recoveries ranging from 81 to 98%, with acceptable precision (CV 4-14%, n=4).

Comparison of multianalyte immunosensor formats for on-line determination of organic compounds.

Studies leading to the development of multianalyte immunosensing approaches are presented herein. Competitive capture formats are developed for carbaryl, atrazine, and irgarol 1051 as target compounds. Three proposals have been tested: sequential, additive, and simultaneous formats. For individual determinations, the best format is the sequential mode; the additive mode is useful only for qualitative analyses; and the simultaneous mode is preferable for screening purposes. The proposed systems show to be advantageous over single-analyte sensors and other multianalyte approaches. In all cases, the sensitivity reached (limit of detection) is high enough for the analysis of samples containing levels of each pesticide lower than 0.1 microg/L, and sensor reusability is very good (>600 determinations). The applicability of the multianalyte immunosensors to on-line pollution surveillance in natural waters, as well as their advantages and limitations, is discussed.

[A case of Sweet's syndrome associated with Crohn's disease]. / Un caso de síndrome de Sweet asociado a enfermedad de Crohn.

The Sweet syndrome or acute febrile neutrophilic dermatosis is a well characterized cutaneous disease from a clinical and histological point of view and is frequently associated with systemic diseases. Prognosis is favorable with good response to corticoid therapy. A well documented case of Sweet syndrome associated with an outbreak of Crohn's disease with peculiar good therapeutic response is reported.

A comparative study by the enzyme-linked immunofiltration assay of solid phases used in the development of flow immunosensors.

The application of an inert membrane-based, enzyme-linked immunofiltration assay (ELIFA) to the characterization of immunosorbents suitable for flow immunosensor development is described. For direct assays, eight monoclonal antibodies (MAb) raised against the insecticide carbaryl were immobilized on three sorbents, namely, controlled pore glass (CPG), hydrazide derivatized agarose beads and a hydrophilic polymer with immobilized Protein A/G. The interaction between immobilized antibodies and antigen was directly detected using a carbaryl hapten conjugated to horseradish peroxidase. Immunosorbent characterization was based on both sensitivity and re-usability. Optimal immunosorbent regeneration was achieved using 0.1 M glycine/HCl, pH 2.0 as the desorbent solution. The best covalent immunosorbent was obtained by immobilizing LIB-CNA36 MAb on hydrazide derivatized agarose beads. The best immunosorbent obtained by reversible immobilization was LIB-CNH45 MAb on Protein A/G. Using this support the eventual irreversible denaturation of covalently immobilized MAbs was overcome. For indirect assays, N-hydroxisuccinimide derivatized agarose beads and glutaraldehyde-activated CPG were used as sorbents for hapten immobilization via the amino groups of a carrier protein. In this format, antigen-MAb interactions were detected using a peroxidase-conjugated rabbit anti-mouse immunoglobulin. The highest sensitivity was achieved by LIB-CNH45 MAb in combination with derivatized agarose beads. All these results demonstrated the suitability of ELIFA as a fast, precise and easy-to-use technique for immunosorbent selection.

[Kikuchi-Fujimoto disease (histiocytic necrotizing lymphadenitis)]. / Enfermedad de Kikuchi-Fujimoto (linfadenitis necrotizante histiocitaria.

Kikuchi-Fujimoto's disease (histiocytic necrotizing lymphadenitis) is a benign, self-limited disease of unknown cause that often presents with persistently enlarged cervical lymph nodes that are unresponsive to antibiotic therapy. The disease should be considered in the differential diagnosis of cervical lymphadenopaty: viral infection, tuberculosis, hyperplastic lymphadenopathy, and metastatic disease. It can be confused histologically with malignant lymphoma.

[Impact of AIDS on premature mortality in La Rioja]. / Impacto del sida sobre la mortalidad prematura en La Rioja.

OBJECTIVE: To describe the evolution of the number of potential years of life lost (PYLL) because of AIDS in La Rioja between 1986 and 1993. DESIGN: Descriptive study. SETTING: Autonomous Community of La Rioja. PATIENTS AND OTHER PARTICIPANTS: Secondary data from the regional Register of AIDS cases in La Rioja, from the Register of Deaths in La Rioja and from the mortality statistics found in the National Statistics Institute. MEASUREMENTS AND MAIN RESULTS: From 1986 the increase in PYLL because of AIDS as a percentage of all causes of premature death was constant. If proportional mortality because of AIDS is grouped in two periods (1986-1989 and 1990-1993), in the first period and for men 1.1% of all PYLL were due to AIDS, whereas in the second this figure was 7.7%. For women these figures went from 0.7 to 8,5. Expressed as a risk, for men the probability that PYLL was due to AIDS was 4 times greater in the second period than in the first. For women this probability was 12 times greater in the second period than in the first. Among men the rates of PYLL adjusted for age kept roughly constant or with a light downward tendency for all the causes studied except AIDS, which occupied second place in the last year studied. Rates of PYLL adjusted for age were more irregular over the years in the case of women, but the increase in AIDS was notable and in 1993 took third place. CONCLUSIONS: Interpreting the results of this study enables the impact of AIDS on premature mortality in La Rioja to be quantified.

[Adenomatoid hyperplasia of minor salivary glands]. / Hiperplasia adenomatoide de glandulas salivares menores.

Adenomatoid hyperplasia of minor salivary glands in an uncommon clinicopathologic entity, first reported, in 1971, by Giansanti and cols. The condition mimics a neoplasm because of its swelling, but the histologic picture agrees with that of normal appearing salivary gland tissue. The interest of this entity is that although benign pseudotumoral lesion, it can be clinically confused with benign or malignant tumors and even, through fine needle aspiration cytology, with low grade mucoepidermoid tumors. We present one case of this condition arising in the soft palate in a patient with unilateral serous otitis media. A review of the published literature on the subject is done.