Covered Versus Uncovered Metal Stents for the Drainage of the Malignant Distal Biliary Obstruction With ERCP: A Systematic Review and Meta-Analysis.

INTRODUCTION AND AIM: Unresectable malignant distal biliary obstruction is a condition that should be treated with drainage and clearance of the biliary duct. self-expanded metal stents (SEMS) are known to be better and more effective than plastic stents because the patency is longer. The actual evidence is insufficient to recommend if it is better the use of SEMSu over SEMSc or vice versa for the drainage of the malignant distal biliary obstruction during ERCP. We performed a systematic review and meta-analyses to demonstrate if exists superiority between one or other type of SEMS performed by ERCP. MATERIALS AND METHODS: We conducted a systematic review in different databases, such as PubMed, Cochrane, Medline, and OVID database. A search was made of all studies published up to May 2023. RESULTS: Seven studies were analyzed. A total of 1070 patients were included. Of the total of patients, 48.9% were male. The cumulative stent patency, the failure rate, the survival probably and the adverse events rate, were similar between SEMSc and SEMSu groups. The stent migration rate was higher in the SEMSc group (RR=2.34 [95% CI: 1.35-4.08]). The tumor overgrowth was higher in the SEMSc group (RR=2.05 [95% CI: 1.13-3.72]). The tumor ingrowth was higher in the SEMSu group (RR=0.25 [95% CI: 0.11-0.61]). CONCLUSIONS: The conclusions of our study show that there are no differences between the use of uncovered SEMS and covered SEMS for palliative treatment of distal biliopancreatic obstructions, and it has no impact on mortality or patient survival. New functional studies regarding the type of stent cover, radial force or length thereof are required.

Effects of Golimumab and Ustekinumab on Circulating Dendritic Cell Migratory Capacity in Inflammatory Bowel Disease.

Inflammatory bowel disease (IBD) is a chronic condition which includes ulcerative colitis (UC) and Crohn's disease (CD), the origins of which are not yet fully understood. Both conditions involve an exacerbated immune response in the intestinal tract, leading to tissue inflammation. Dendritic cells (DCs) are antigen-presenting cells crucial for maintaining tolerance in the gastrointestinal mucosa. Previous research has indicated that DC recruitment to the intestinal mucosa is more pronounced in individuals with IBD, but the specific mechanisms governing this migration remain unclear. This study aimed to assess the expression of various homing markers and the migratory abilities of circulating DC subsets in response to intestinal chemotactic signals. Additionally, this study examined how golimumab and ustekinumab impact these characteristics in individuals with IBD compared to healthy controls. The findings revealed that a particular subset of DCs known as type 2 conventional DCs (cDC2) displayed a more pronounced migratory profile compared to other DC subsets. Furthermore, the study observed that golimumab and ustekinumab had varying effects on the migratory profile of cDC1 in individuals with CD and UC. While CCL2 did not exert a chemoattractant effect on DC subsets in this patient cohort, treatment with golimumab and ustekinumab enhanced their migratory capacity towards CCL2 and CCL25 while reducing their migration towards MadCam1. In conclusion, this study highlights that cDC2 exhibits a heightened migratory profile towards the gastrointestinal mucosa compared to other DC subsets. This finding could be explored further for the development of new diagnostic biomarkers or the identification of potential immunomodulatory targets in the context of IBD.

Programa de Teleconsulta Docente: percepciones de profesores y alumnos de una facultad de medicina peruana / Teaching Teleconsultation Program: perceptions of professors and students of a peruvian medical school

RESUMEN Introducción: La llegada de la pandemia de COVID-19 al Perú requirió una respuesta inmediata y múltiples cambios tanto en la atención sanitaria como en el entrenamiento de los profesionales de la salud. La Facultad de Medicina de la Universidad Peruana Cayetano Heredia implementó el Programa de Teleconsulta Docente (PTD), para continuar con la formación de estudiantes de medicina en un entorno virtual, sin embargo, se desconoce la aceptación de los involucrados respecto a una educación virtual, condición que puede reflejar lo ocurrido en otras escuelas de medicina del país. Objetivo: nuestro estudio buscó evaluar la percepción de alumnos y docentes respecto al PTD. Métodos: estudio observacional, descriptivo y transversal. Se elaboró un cuestionario para explorar las percepciones de la telemedicina en el escenario de la enseñanza. Resultados: más del 80 % de los profesores y el 60 % de los alumnos consideraron que la PTD podía utilizarse como herramienta de enseñanza. Más del 90 % de los profesores y los estudiantes consideran que realizar la telemedicina no fue más difícil que hacer una consulta presencial. El 60 % de los estudiantes y el 80 % de los profesores perciben que los estudiantes deben desarrollar habilidades en telemedicina; el 80 % de los profesores y estudiantes consideran que la PTD constituye un servicio de responsabilidad social. Profesores y alumnos consideran que el éxito en la implantación de un PTD está influenciado por el nivel de aceptación de la población (20,2 %), el uso de la historia clínica electrónica (19,4 %) y la formación en competencias digitales (18,6 %). Conclusión: los profesores y los estudiantes del PTD perciben la telemedicina como una herramienta útil para evaluar los problemas de salud de la población. Ambos perciben que a través de las sesiones de telemedicina se podrían adquirir las habilidades necesarias para completar el perfil de egresado de la carrera de medicina.

ABSTRACT Introduction : The occurrence of the COVID-19 pandemic in Peru required an immediate response and multiple changes in both healthcare and health professional training. The School of Medicine in Universidad Peruana Cayetano Heredia implemented the Teleconsultation Faculty Program (FTP), aiming to continue with training medicine students in a virtual environment. However, the acceptance of those involved in virtual education is unknown, a condition that may reflect what has happened in other medical schools in our country. Main : our study sought to assess the perception of students and teachers regarding FTP. Methods : observational, descriptive, cross-sectional study. A questionnaire was developed to explore perceptions of telemedicine in a teaching scenario. Results : More than 80% of teachers and 60% of students considered that the FTP could be used as a teaching tool. More than 90% of teachers and students consider that performing telemedicine was not more difficult than doing a face-to-face consultation. Sixty percent of students and 80% of teachers perceive that students must develop skills in telemedicine; 80% of teachers and students consider that FTP constitutes a service with social responsibility. Teachers and students consider that the success in the implementation of an FTP is influenced by the level of acceptance of the population (20.2%), the use of electronic medical records (19.4%), and training in digital skills (18.6%). Conclusion : Teachers and students using FTP perceive telemedicine as a useful tool for assessing health problems. Both perceive that through telemedicine sessions, skills required to complete the medical school graduate profile could be acquired.

Characteristics of Inflammatory Bowel Disease Compared to Other National Centers in Colombia / Características de la enfermedad inflamatoria intestinal con respecto a otros centros nacionales de Colombia

Abstract Introduction: Inflammatory bowel disease (IBD) is an immune-mediated disease whose incidence in Latin America has increased in recent years. Aim: To analyze the demographic and clinical characteristics of patients with IBD treated in a university hospital and present the epidemiological data compared to other centers in Colombia. Patients and methods: Descriptive study of patients with IBD (1996-2019) at the Hospital Universitario Fundación Santa Fe de Bogotá. Analysis of data from centers in Medellín, Cali, Bogotá, and Cartagena. Results: Of 386 patients, 277 presented with ulcerative colitis (UC), 102 with Crohn's disease (CD), and seven with unclassifiable colitis. IBD was more frequent in women (53 %). Mortality was less than 1 %. The involvement of UC was mainly pancolitis (42.6 %). The greater the extent of the disease, the higher the hospitalization and surgery rates (OR 3.70, P < 0.01). Thirteen percent of patients with UC received biologics. Compromise due to CD was mainly ileocolonic (43.6 %) and ileal (43.6 %). The predominant clinical pattern of CD was structuring (50%). Forty-five percent received biologicals and 56 % surgery. Primary sclerosing cholangitis (PSC) was found in 4 % of patients (n = 15). Two patients with PSC developed colorectal cancer (OR 4.18; p 0.008), while 13 patients with UC developed colon cancer and seven dysplastic changes. Three patients with CD developed colon cancer. Conclusions: The results were compared to other reference centers. We found similar trends in the clinical behavior and treatment of IBD, with higher hospitalization and surgery rates in our cases.

Resumen Introducción: la enfermedad inflamatoria intestinal (EII) es una enfermedad inmunomediada, cuya incidencia en Latinoamérica ha aumentado en los últimos años. Objetivo: analizar las características demográficas y clínicas de los pacientes con EII tratados en un hospital universitario y presentar los datos epidemiológicos con respecto a otros centros en Colombia. Pacientes y métodos: estudio descriptivo de pacientes con EII (1996-2019) en el Hospital Universitario Fundación Santa Fe de Bogotá. Análisis de datos de centros de Medellín, Cali, Bogotá y Cartagena. Resultados: de 386 pacientes, 277 presentaron colitis ulcerativa (CU), 102 enfermedad de Crohn (EC) y 7 colitis no clasificable. La EII fue más frecuente en mujeres (53 %). La mortalidad fue menor de 1 %. El compromiso de la CU fue principalmente la pancolitis (42,6 %). Entre mayor la extensión de la enfermedad, más alta fue la tasa de hospitalización y cirugías (OR 3,70; p < 0,01). El 13 % de los pacientes con CU recibió biológicos. El compromiso por la EC fue principalmente ileocolónico (43,6 %) e ileal (43,6 %). El patrón clínico predominante de la EC fue estenosante (50%). El 45 % recibió biológicos y 56% cirugía. La colangitis esclerosante primaria (CEP) se encontró en 4 % de los pacientes (n = 15). Dos pacientes con CEP desarrollaron cáncer colorrectal (OR 4,18; p 0,008), mientras que 13 pacientes con CU desarrollaron cáncer de colon y 7 cambios displásicos. 3 pacientes con EC desarrollaron cáncer de colon. Conclusiones: se compararon los resultados en relación con otros centros de referencia. Encontramos tendencias similares en el comportamiento clínico y en el tratamiento de la EII, con mayores tazas de hospitalizaciones y cirugías en nuestros casos.

The impact of obesity on left ventricular hypertrophy and diastolic dysfunction in children and adolescents.

Childhood obesity continues to escalate worldwide and may affect left ventricular (LV) geometry and function. The aim of this study was to investigate the impact of obesity on prevalence of left ventricular hypertrophy (LVH) and diastolic dysfunction in children. In this analysis of prospectively collected cross-sectional data of children between 5 and 16 years of age from randomly selected schools in Peru, parameters of LV geometry and function were compared according to presence or absence of obesity (body mass index z-score > 2). LVH was based on left ventricular mass index (LVMI) adjusted for age and sex and defined by a z-score of > 2. LV diastolic function was assessed using mitral inflow early-to-late diastolic flow (E/A) ratio, peak early diastolic tissue velocities of the lateral mitral annulus (E'), early diastolic transmitral flow velocity to tissue Doppler mitral annular early diastolic velocity (E/E') ratio, and left atrial volume index (LAVI). Among 1023 children, 681 children (mean age 12.2 ± 3.1 years, 341 male (50.1%)) were available for the present analysis, of which 150 (22.0%) were obese. LVH was found in 21 (14.0%) obese and in 19 (3.6%) non-obese children (padjusted < 0.001). LVMI was greater in obese than that in non-obese children (36.1 ± 8.6 versus 28.7 ± 6.9 g/m2.7, p < 0.001). The mean mitral E/E' ratio and LAVI were significantly higher in obese than those in non-obese individuals (E/E': 5.2 ± 1.1 versus 4.9 ± 0.8, padjusted = 0.043; LAVI 11.0 ± 3.2 versus 9.6 ± 2.9, padjusted = 0.001), whereas E' and E/A ratio were comparable. Childhood obesity was associated with left ventricular hypertrophy and determinants of diastolic dysfunction.ClinicalTrials.gov Identifier: NCT02353663.

Systematic review shows no strong evidence regarding the use of elastic taping for pain improvement in patients with primary knee osteoarthritis.

BACKGROUND: A recent trend in the field of primary knee osteoarthritis suggests that elastic tape (e.g., K-tape) relieves pressure on the joint by increasing tension on fascia. Elastic tape (ET) is expected to decrease pain and help patients to recover faster. OBJECTIVE: This systematic review aims to analyze the efficacy of this method on pain in patients with knee osteoarthritis by using The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. DATA SOURCES: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standard for reporting systematic reviews of qualitative and quantitative evidence, we used 3 electronic databases, PubMed, Cochrane, and EBSCO, and grey literature was included. STUDY ELIGIBILITY CRITERIA: Articles were screened for duplicates, screened for inclusion and exclusion criteria, and critically appraised. PARTICIPANTS AND INTERVENTION: People older than 45 years old with primary osteoarthritis (OA) and application of ET. STUDY APPRAISAL AND SYNTHESIS METHODS: 2005 Oxford standard. RESULTS: Amongst all the papers found, 6 Randomized Control Trials (RCT) for a total of 392 participants met the criteria and were included in our review. Three papers out of the 6 RCT had low risks of bias. When the ET was compared to sham taping, the results show no to moderate decreases of WOMAC scores in patients with primary knee osteoarthritis. LIMITATIONS: We focused on a single index test (WOMAC) and could not perform meta-analyses. CONCLUSION AND IMPLICATIONS OF KEY FINDINGS: Although ET does not provide strong adverse outcomes, our data do not support the use of ET as a treatment alone because of too slight reductions of the WOMAC score for reaching clinical efficiency. Thus, our systematic review shows no strong evidence regarding the use of elastic taping for pain improvement in patients with primary knee osteoarthritis.

Postextraction Alveolar Preservation and Use of the Crown of the Extracted Tooth as a Temporary Restoration.

Ranging from the extraction of teeth from anterior sector commitment to the loss of bone and soft tissues, alveolar preservation is a regenerative technique that employs biomaterials that induce the preservation of bone tissue and minimize resorption. Placement of provisional restorations at the defect site maintains the stability of the soft tissues and aesthetics at which the definitive restoration is found. The objective of this clinical case was alveolar preservation postextraction of the anterior tooth that presented a coronal fracture, placing the clinical crown of the extracted tooth as the provisional restoration to maintain stability and to avoid soft tissue collapse and compromise to an aesthetic area.

Ascitis fetal: a propósito de un caso y revisión de la literatura / Fetal ascites: Apropos of a case and literature review

Fetal ascites is defined as the presence of intraperitoneal fluid that may be part of a generalized or isolated hydrops. The mortality of non-immune ascites, both fetal and neonatal, is approximately 60%. We present a case of fetal ascites not associated with hydrops and we review the pathogenesis, clinical features, diagnostic approach and treatment of this fetal and neonatal condition.

La ascitis fetal se define como la presencia de líquido intraperitoneal que puede ser parte de un hidrops generalizado o aislado. La mortalidad de la ascitis no inmune, tanto fetal como neonatal, es aproximadamente 60%. Se presenta un caso de ascitis fetal no asociada a hidrops y se revisa la patogenia, clínica y el enfoque diagnóstico y tratamiento de esta condición fetal y neonatal.

Malocclusion impacts the quality of life of Peruvian school children: a cross-sectional study

OBJECTIVE: To assess the impact of malocclusion considering the orthodontic treatment need (IOTN) on the oral health related quality of life evaluated with the Child Perceptions Questionnaire in students aged 11 to 14 years (CPQ 11-14 ) of the Peruvian public schools in the city of Juliaca. MATERIALS AND METHODS: A cross-sectional study was performed. The sample included 354 students. The data were obtained from the tool of self-perception using the aesthetic component (AC) and the oral health component (DHC) from the IOTN, and the CPQ 11-14. For the data analysis the Kruskal Wallis test was used (p<0.05). RESULTS: The value of the impact on the quality of life was higher in the dimension moderate treatment need with 56.08; followed by need for treatment with 55.56 (p<0.001). CONCLUSION: Malocclusion affects the quality of life of students aged 11 to 14 years in Peruvian public schools of the city of Juliaca.

Penetrating gastric ulcer as a manifestation of multisystemic tuberculosis.

We present the case of a 30-year old female with a history of abdominal pain, fever, poor oral tolerance and weight loss for 6 months. An abdominal CT scan showed marked gastric dilatation due to extrinsic compression from lymphadenopathies around the second portion of the duodenum. The upper endoscopy revealed the presence of a penetrating gastric ulcer in the greater curvature. Biopsies of the lesions showed hystiocytes with granulomatous features and Acid Fast Bacilli (AFB) positive, and the cultures grew Mycobacterium tuberculosis sensitive to Isonazid and Rifampin. Subsequently anti-TB regimen was initiated achieving great clinical and endoscopic improvement.

Penetrating gastric ulcer as a manifestation of multisystemic tuberculosis / Úlcera gástrica penetrante como manifestación de tuberculosis multisistémica

We present the case of a 30-year old female with a history of abdominal pain, fever, poor oral tolerance and weight loss for 6 months. An abdominal CT scan showed marked gastric dilatation due to extrinsic compression from lymphadenopathies around the second portion of the duodenum. The upper endoscopy revealed the presence of a penetrating gastric ulcer in the greater curvature. Biopsies of the lesions showed hystiocytes with granulomatous features and Acid Fast Bacilli (AFB) positive, and the cultures grew Mycobacterium tuberculosis sensitive to Isonazid and Rifampin. Subsequently anti-TB regimen was initiated achieving great clinical and endoscopic improvement.

Se presenta un caso de una mujer de 30 años de edad con historia de dolor abdominal, fiebre, poca tolerancia oral y pérdida de peso por 6 meses. Un CT scan abdominal muestra dilatación marcada gástrica debido a una compresión extrínseca por adenopatías alrededor de la segunda porción del duodeno. Una endoscopía alta revela la presencia de una úlcera gástrica penetrante en la curvatura mayor. Las biopsias mostraron histiocitos con granulomatosis y bacilos acid fast positivos y en los cultivos crecieron micobacterium tuberculosis sensibles a isoniacidad y rifampicina. Subsecuentemente se inició el régimen anti TBC lográndose una mejoría clínica y endoscópica evidente.

[Venous tromboembolism in a patient with Crohn disease with ileal stenosis]. / Trombosis venosa profunda en un paciente con enfermedad de Crohnilealestenosante.

Inflammatory bowel disease is associated with extraintestinal manifestations. Among these manifestations is the venous tromboembolism which presents a risk three times more than that presented in general population. We report the case of a 61-year-old male with a history of abdominal pain, chronic diarrhea and fever, with leukocytosis, and fecal samples containing leukocytes, partial ileal stenosis with multiple ulcers in the enteroscopy, with histologic findings compatible with Crohn's disease. The patient has a good outcome with prednisone and maintenence azathioprine, presenting at the fifth month deep venous thrombosis of both lower extremities that resolvewith anticoagulation treatment.

[Actinic enteritis as a cause of digestive bleeding of obscure origin]. / Enteritis actínica como causa de hemorragia digestiva de origen oscuro.

Chronic actinic enteritis is a malfunction of the small bowel, occurring in the 6 months post-radiotherapy, and it can be manifestated as malabsortion, stenosis, fistula formation, local abscesses, perforation and bleeding, We report a case of an elderly patient who presents an episode of obscure gastrointestinal bleeding (OGIB) secondary to actinic enteritis. She is a 64-year- old female patient with the past medical history of cervical cancer who received radiotherapy and brachytherapy. One year after the treatment, the patient presents a chronic episode of melena and symptomatic anemia and 1 week before the admission she had hematochezia. At admission she has hemodynamic instability with a hemoglobin value of 2.7 gr/dl. We did an upper endoscopy, a colonoscopy and abdomino-pelvic tomography without any findings of the bleeding’s source. Reason why an endoscopic capsule was done, showing bleeding areas in the medial and distal small bowel. The patient had another gastrointestinal bleeding requiring a surgery where they decide to do a resection of the small bowel and a right hemicholectomy. The pathology was compatible with actinic enteritis. The patient after the surgery had a torpid evolution, and finally dies. We describe this case and do a review of all the existent data around the world, because is the first case reported in Peru of an actinic enteritis as a cause of OGIB.

Enteritis actínica como causa de hemorragia digestiva de origen oscuro / Actinic enteritis as a cause of digestive bleeding of obscure origin

La enteritis actínica crónica es un trastorno del intestino delgado que ocurre a partir de los 6 meses post radioterapia y se puede manifestar como malabsorción, estenosis, formación de fístulas, abscesos locales, perforación y sangrado. Se reporta el caso de una paciente adulta mayor la cual presentó un cuadro de hemorragia digestiva de origen oscuro (HDO) secundario a enteritis actínica. Es una paciente mujer de 64 años con antecedente de neoplasia maligna de cérvix quien recibió sesiones de radioterapia y braquiterapia, La paciente un año después de dicho tratamiento presenta un cuadro crónico de melena y anemia, presentando hematoquezia en la última semana previa a la hospitalización. Al ingreso presenta inestabilidad hemodinámica con valores de hemoglobina en 2,7gr/dL. Se realiza una endoscopia, colonoscopia y tomografía abdomino pélvica, las cuales no mostraron la causa del sangrado, motivo por el cual se realiza una cápsula endoscópica evidenciando áreas de sangrado en intestino delgado medio y distal. La paciente vuelve a presentar un episodio de sangrado agudo siendo sometida a una cirugía de emergencia en donde se decide realizar resección de intestino más hemicolectomia derecha. En la biopsia de la pieza quirúrgica se encuentran hallazgos compatibles con enteropatía actínica. La paciente posterior a la cirugía evoluciona tórpidamente, llegando a fallecer. Describimos el presente caso y hacemos una recolección de la data existente debido a que es el primer caso en el Perú en el que se reporta a una enteritis actínica como causante de HDO...

Chronic actinic enteritis is a malfunction of the small bowel, occurring in the 6 months post-radiotherapy, and it can be manifestated as malabsortion, stenosis, fistula formation, local abscesses, perforation and bleeding, We report a case of an elderly patient who presents an episode of obscure gastrointestinal bleeding (OGIB) secondary to actinic enteritis. She is a 64-year-old female patient with the past medical history of cervical cancer who received radiotherapy and brachytherapy. One year after the treatment, the patient presents a chronic episode of melena and symptomatic anemia and 1 week before the admission she had hematochezia. At admission she has hemodynamic instability with a hemoglobin value of 2.7 gr/dl. We did an upper endoscopy, a colonoscopy and abdomino-pelvic tomography without any findings of the bleedingÆs source. Reason why an endoscopic capsule was done, showing bleeding areas in the medial and distal small bowel. The patient had another gastrointestinal bleeding requiring a surgery where they decide to do a resection of the small bowel and a right hemicholectomy. The pathology was compatible with actinic enteritis. The patient after the surgery had a torpid evolution, and finally dies. We describe this case and do a review of all the existent data around the world, because is the first case reported in Peru of an actinic enteritis as a cause of OGIB...

Comparación del valor pronóstico de mortalidad del Score Child Pugh y los modelos de pronóstico de enfermedad hepática crónica en pacientes con cirrosis hepática descompensada del Hospital Nacional Cayetano Heredia, Lima-Perú / Comparison of the prognostic value of mortality Child Pugh Score and forecasting models of chronic liver disease in patients with decompensated cirrhosis of the Hospital Nacional Cayetano Heredia, Lima-Peru

La valoración del pronóstico es una parte esencial en la evaluación de todo paciente con cirrosis hepática. En la actualidad se sigue desarrollando nuevos modelos para optimizar la precisión del pronóstico de mortalidad que se calcula mediante el score Child-Turcotte-Pugh (CTP) y el modelo para la enfermedad hepática en etapa terminal (MELD). Objetivo: Comparar la precisión pronóstica de mortalidad hospitalaria y mortalidad a corto plazo del CTP, MELD y demás modelos en pacientes con cirrosis hepática descompensada. Material y Métodos: Estudio descriptivo prospectivo, el cual incluyó 84 pacientes. El score CTP, MELD y demás modelos fueron calculados en el primer día de hospitalización. La precisión pronóstica de mortalidad se evaluó mediante el área bajo la curva ROC (AUROCs) del score CTP, MELD y los demás modelos. Resultados: La mortalidad hospitalaria y la mortalidad en el seguimiento a corto plazo fue de 20 (23,8%) y 44 (52,4%), respectivamente. Los AUROCs del CTP, MELD, MELD Na, MESO, iMELD, RefitMELD y RefitMELD Na para predecir mortalidad hospitalaria fue de 0,4488, 0,5645, 0,5426, 0,5578, 0,5719, 0,5598 y 0,5754; y para predecir mortalidad a corto plazo fue de 0,5386, 0,5747, 0,5770, 0,5781, 0,5631, 0,5881 y 0,5693, respectivamente. Al comparar entre si los AUROCs del score CTP, MELD y demás modelos ninguno mostró ser mejor que el otro (p>0,05). Conclusiones: El presente estudio no ha demostrado la utilidad predictiva del score CTP, MELD y los otros modelos (MELD Na, MESO, iMELD, Refit MELD y Refit MELD Na) para la evaluar la mortalidad hospitalaria o mortalidad a corto plazo en una muestra de pacientes con cirrosis hepática descompensada del Hospital Cayetano Heredia...

Introduction: The assessment of prognosis is an essential part of the evaluation of all patients with liver cirrhosis. Currently continues to develop new models to optimize forecast accuracy mortality score is calculated by the Child-Turcotte-Pugh (CTP) and the model for end-stage liver disease (MELD). Objective: Compare the prognostic accuracy of hospital mortality and short-term mortality CTP, MELD and other models in patients with decompensated liver cirrhosis. Material and Methods: Prospective descriptive study, comparison type of diagnostic test that included 84 patients. The score CTP, MELD and other models were calculated on the first day of hospitalization. The prognostic accuracy of mortality was assessed by the area under the ROC curve (AUROCs) of score CTP, MELD and other models. Results: Hospital mortality and mortality in the short-term monitoring was 20 (23.8%) and 44 (52.4%), respectively. The AUROCs CTP, MELD, MELD Na, MESO, iMELD, RefitMELD and RefitMELD Na to predict hospital mortality was 0.4488, 0.5645, 0.5426, 0.5578, 0.5719, 0.5598 and 0.5754; and to predict short-term mortality was 0.5386, 0.5747, 0.5770, 0.5781, 0.5631, 0.5881 and 0.5693, respectively. By comparing each AUROCs of the CTP score, MELD and other models proved to be no better than the other (p>0.05). Conclusion: This study has not shown the predictive utility of the CTP score, MELD and other models (MELD Na, MESO, iMELD, Refit Refit MELD and MELD Na) to evaluate hospital mortality or short-term mortality in a sample of patients with decompensated cirrhosis of the Hospital Cayetano Heredia...

Production of micro- and nanosilica from soil inhabiting Folsomia candida fed with treated rice husk.

Rice husk was employed as a source for producing silica micro- and nanoparticles through its digestion by soil fauna. Although many physicochemical methods for producing nanostructures have been studied, the biological processes remain mostly unexplored. Alkaline hydrogen peroxide with continuous control of reaction pH allowed removal of lignin bonds while preserving most of the cell wall and the silica present in the rice husk. The accessibility of lignocellulose was achieved without removing appreciable amounts of lignin, so this agricultural byproduct can be employed as feeding material for microarthropods Folsomia candida (Collembola). When these microarthropods are placed on a substrate of treated rice husk, more than 85% of degraded material is obtained, as compared to the untreated rice husk substrate, while the silica particles obtained show a slight decrease in average size.

Screening for Rheumatic Heart Disease among Peruvian Children: A Two-Stage Sampling Observational Study.

BACKGROUND: The objective of the study was to evaluate the implications of different classifications of rheumatic heart disease on estimated prevalence, and to systematically assess the importance of incidental findings from echocardiographic screening among schoolchildren in Peru. METHODS: We performed a cluster randomized observational survey using portable echocardiography among schoolchildren aged 5 to 16 years from randomly selected public and private schools in Arequipa, Peru. Rheumatic heart disease was defined according to the modified World Health Organization (WHO) criteria and the World Heart Federation (WHF) criteria. FINDINGS: Among 1395 eligible students from 40 classes and 20 schools, 1023 (73%) participated in the present survey. The median age of the children was 11 years (interquartile range [IQR] 8-13 years) and 50% were girls. Prevalence of possible, probable and definite rheumatic heart disease according to the modified WHO criteria amounted to 19.7/1000 children and ranged from 10.2/1000 among children 5 to 8 years of age to 39.8/1000 among children 13 to 16 years of age; the prevalence of borderline/definite rheumatic heart disease according to the WHF criteria was 3.9/1000 children. 21 children (2.1%) were found to have congenital heart disease, 8 of which were referred for percutaneous or surgical intervention. CONCLUSIONS: Prevalence of RHD in Peru was considerably lower compared to endemic regions in sub-Saharan Africa, southeast Asia, and Oceania; and paralleled by a comparable number of undetected congenital heart disease. Strategies to address collateral findings from echocardiographic screening are necessary in the setup of active surveillance programs for RHD. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02353663.

[Comparison of the prognostic value of mortality Child Pugh Score and forecasting models of chronic liver disease in patients with decompensated cirrhosis of the Hospital Nacional Cayetano Heredia, Lima-Peru]. / Comparación del valor pronóstico de mortalidad del Score Child Pugh y los modelos de pronóstico de enfermedad hepática crónica en pacientes con cirrosis hepática descompensada del Hospital Nacional Cayetano Heredia, Lima-Perú.

INTRODUCTION: The assessment of prognosis is an essential part of the evaluation of all patients with liver cirrhosis. Currently continues to develop new models to optimize forecast accuracy mortality score is calculated by the Child-Turcotte-Pugh (CTP) and the model for end-stage liver disease (MELD). OBJECTIVE: Compare the prognostic accuracy of hospital mortality and short-term mortality CTP, MELD and other models in patients with decompensated liver cirrhosis. MATERIAL AND METHODS: Prospective descriptive study, comparison type of diagnostic test that included 84 patients. The score CTP, MELD and other models were calculated on the first day of hospitalization. The prognostic accuracy of mortality was assessed by the area under the ROC curve (AUROCs) of score CTP, MELD and other models. RESULTS: Hospital mortality and mortality in the short-term monitoring was 20 (23.8%) and 44 (52.4%), respectively. The AUROCs CTP, MELD, MELD Na, MESO, iMELD, RefitMELD and RefitMELD Na to predict hospital mortality was 0.4488, 0.5645, 0.5426, 0.5578, 0.5719, 0.5598 and 0.5754; and to predict short-term mortality was 0.5386, 0.5747, 0.5770, 0.5781, 0.5631, 0.5881 and 0.5693, respectively. By comparing each AUROCs of the CTP score, MELD and other models proved to be no better than the other (p>0.05). CONCLUSION: This study has not shown the predictive utility of the CTP score, MELD and other models (MELD Na, MESO, iMELD, Refit Refit MELD and MELD Na) to evaluate hospital mortality or short-term mortality in a sample of patients with decompensated cirrhosis of the Hospital Cayetano Heredia.