Ogilvie, when medical and endoscopic treatment fail.

Ogilvie syndrome is a functional disorder of colonic motility that causes acute and progressive dilation, which can lead to necrosis and perforation. Early diagnosis and management are essential to avoid serious complications. The case of a patient with Ogilvie syndrome refractory to medical and endoscopic treatment that required surgery is presented. This is a 68-year-old man with decreased level of consciousness and abdominal distension for 3 days. Last bowel movement 4 days ago. The data and tests appear in table 1. We are faced with a patient with neurological alteration and hemodynamically unstable secondary to complicated Ogilvie syndrome. After admission to the ICU, where a 2.5 mg bolus of neostigmine was administered, he was transferred to the ward. Despite 250 mg of intravenous erythromycin every 6 hours together with metoclopramide every 8 hours, high doses of polyethylene glycol and daily cleansing enemas and rectal catheterization, only a brief and mild improvement is achieved. Given the failure of conservative measures, colectomy was performed, achieving complete resolution. Ogilvie syndrome is a functional disorder1 that usually associates predisposing factors that impact intestinal motility 2 ; In our case: bedridden, the use of anticholinergics, hydroelectric alteration both due to the use of antidepressants and the creation of a third space secondary to colonic dilation and severe intestinal ischemia². In one third it is resolved by early correction of the triggering factors, adding neostigmine if necessary with high rates of effectiveness¹. In our case, a second bolus of neostigmine could have been administered or even as an infusion since greater efficacy has been demonstrated in this way given its short half-life². Electrolyte imbalance is a predictor of poor response to neostigmine, a factor that was associated with our patient 3. Colonic decompression and finally surgery are reserved as a last measure, being necessary in a very small percentage as in this case 1. As a preventive measure, the administration of 29.5 g of oral polyethylene glycol per day has been effective 4. Therefore, we should suspect Ogilvie syndrome in patients with predisposing factors who present acute dilation of the colon without mechanical obstruction, and although it usually resolves with medical and endoscopic treatment, we should not delay surgery to avoid complications.

Right-side diverticulitis.

Colonic diverticula develop at specific weak spots, where the vasa recta enter the colonic circular smooth muscle layer.1 They are usually seen in the left colon. Their most common complication is diverticulitis, with mild cases resolving even without antibiotic therapy.2 Right-side diverticulitis develops in only 1.5% of cases, primarily on the anterior aspect of the cecum, proximal to the ileocecal valve (80%).4 Given its low incidence, location, and the fact that it involves younger patients, a differential diagnosis is needed to rule out abdominal inflammatory conditions such as appendicitis or ileitis, as well as gynecological disorders. Diverticulitis is diagnosed using imaging modalities. Computed tomography (CT) is the modality of choice,5 and confirmation is required after clinical remission, primarily using colonoscopy. We studied a series of 3 cases of patients initially diagnosed with acute, uncomplicated right-side diverticulitis who were admitted to the Gastroenterology Department, Hospital de León, from January to December 2023. Our goal was to confirm a presumptive diagnosis of right-side diverticulitis using delayed endoscopy or barium enema to ascertain the presence of right-side diverticulosis and rule out other conditions manifesting with abdominal pain in the right iliac fossa. Cases 1 and 3 were admitted with an accurate diagnosis of right-side diverticulitis. Case 1 was confirmed by ambulatory colonoscopy, and case 3 was confirmed by barium enema because of a history of previous colonoscopy without findings. All three patients required surgical assessment to rule out appendicular involvement. The imaging technique of choice was CT, using the WSES scale for severity grading. Case 2 was diagnosed with right-side diverticulitis by means of ultrasonography, and its origin was later confirmed to be in the sigmoid colon. The remaining clinical, laboratory, and diagnostic characteristics are listed in Table 1.

Microwave-Assisted Extraction of Carrageenan from Sarcopeltis skottsbergii.

The development of greener processes for the sustainable utilization of raw materials is increasingly demanded for environmental and economic reasons. A rapid and chemical-free technique was proposed for the extraction of hybrid kappa/iota (6/4) carrageenan from Sarcopeltis (ex Gigartina) skottsbergii. After separation, carrageenans were analyzed by Fourier transform infrared attenuated total reflectance, high-performance size-exclusion chromatography, and rheology. Maximum carrageenan extraction yields up to 63-64% were obtained operating at 110 or at 160 °C, for 5-7 min considering the sum of the heating and cooling periods, but the extraction of the phenolic fraction was favored at 220 °C. The recovered carrageenan showed apparent viscous values around 103 mPa at the lowest tested shear rates (0.1 1/s) and could be suitable to formulate films. Furthermore, those carrageenans obtained under 140 °C showed gel characteristics without previous separation from the liquid extract, avoiding ethanolic precipitation and energy consumption. The antiradical properties correlated with the phenolic content in the liquid phase, but no influence of temperature on the reducing properties was observed. The microwave-assisted hydrothermal treatment could be an efficient tool without needing chemicals for the extraction of carrageenans, which showed adequate rheological properties for commercial uses.

Advances on Cellulose Manufacture in Biphasic Reaction Media.

Cellulose is produced industrially by the kraft and sulfite processes. The evolution of these technologies in biorefineries is driven by the need to obtain greater added value through the efficient use of raw materials and energy. In this field, organosolv technologies (and within them, those using liquid phases made up of water and one partly miscible organic solvent, known as "biphasic fractionation" in reference to the number of liquid phases) represent an alternative that is receiving increasing interest. This study considers basic aspects of the composition of lignocellulosic materials, describes the fundamentals of industrial cellulose pulp production processes, introduces the organosolv methods, and comprehensively reviews published results on organosolv fractionation based on the use of media containing water and an immiscible solvent (1-butanol, 1-pentanol or 2-methyltetrahydrofuran). Special attention is devoted to aspects related to cellulose recovery and fractionation selectivity, measured through the amount and composition of the treated solids.

When intestinal obstruction is not a surgical condition.

We report the case of a middle-aged man who had undergone two diagnostic laparoscopies with no significant findings after he was attended at the emergency department with cramping pain, abdominal distention and vomiting, with radiological images simulating a small bowel obstruction. After multiple hospitalisations and an extensive set of tests, including a genetic study, he was diagnosed with chronic pseudo-obstruction, an uncommon, unrecognides syndrome with high morbidity. Being aware of this pathology can make it easier to diagnose, and thereby, we can avoid unnecessary surgical interventions, because its management and treatment are mainly based on pharmacological therapy. After a proper diagnosis our patient's progression was satisfactory due to the treatment introduced, with no further hospitalisations.

Hematoma post-endoscopic retrograde cholangiopancreatography.

Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most frequently performed procedures in the treatment of biliary-pancreatic diseases. Hematoma after ERCP is an infrequent and highly serious complication. We present three cases with hepatic hematoma after a CPRE.

Benign intestinal pneumatosis associated with congenital Morgagni-Larrey diaphragmatic hernia.

Intestinal pneumatosis (IN) is an uncommon radiological finding defined as the accumulation of air in the gastrointestinal tract wall. Its clinical signs are nonspecific and include symptoms such as diarrhea or abdominal pain. It includes benign entities (with subtle symptoms and the accumulation of air in the form of cysts that appear as clustered nodular lesions on the endoscopy, collapsible and soft); or severe cases (symptoms indicative of general health compromise and linear accumulation of air or free fluid suggestive of hollow viscus perforation); which require different management. We present the case of a patient diagnosed with benign intestinal pneumatosis (BIN), associated with anatomical changes due to a diaphragmatic hernia. CASE REPORT We report the case of an 86-year-old woman with a Morgani-Larrey congenital diaphragmatic hernia (HML) (2) admitted due to exacerbation of chronic baseline diarrhea. A colonoscopy with biopsies was performed, but the study was incomplete due to colonic torsion at the hepatic angle deriving from HML, with uncomplicated colonic mucosa and absence of cystic nodulations. Figure 1a. Biopsies ruled out organicity. The abdominal computed tomography (CT) scan performed revealed the accumulation of pneumoperitoneum bubbles in the distal ileum and suprahepatic wall without identification of continuity changes, or signs of visceral perforation. Figure 1b-c. The patient was diagnosed with BIN associated with an anatomical change (HML). Medical treatment was initiated with metronidazole at a dose of 1500 mg/day for 1 week, along with the patient's usual probiotics, and commercial compounds containing xyloglucan (pea protein) to restore the intestinal barrier function. (3). The patient was discharged with complete resolution of the diarrhea. No surgical intervention for her HML was required. DISCUSSION The clinical and radiological data in the presence of IN help us differentiate between severe cases and BIN, the latter being managed conservatively without the need for medical or surgical treatment. The intestinal barrier restoration measures implemented in our patient may have contributed to this resolution, although there is not enough scientific evidence to support this. The endoscopic image of nodular cysts is not always present in these cases, and the diagnosis of choice for this condition is radiological and based on exclusion. (4).

Retirform purpura, a rare chemoembolization adverse outcome.

Transcatheter arterial chemoembolization (TACE) is currently one of the standards of treatment for unresectable hepatocellular carcinoma in the intermediate stage. It is a minimally invasive procedure whose adverse outcomes are well documented. Among those considered uncommon, we find skin outcomes. We report a 73-year-old man who, after undergoing TACE, develops a necrotic retiform purpura due to occlusion of the microcirculation of the cutaneous and subcutaneous tissue caused by migration of doxorubicin spheres. This is an infrequent complication, which presents with pain in the affected area. Its management is based on prevention, which is the reason why awareness of this condition is so important.

Gastrointestinal lymphoma, a rare endoscopic lesion.

We present the case of a 77-year-old male patient with iron deficiency anemia. His personal medical history is: dyslipidemia, high-grade diffuse centrofollicular lymphoma localized in the tonsil in 1984 and metastatic prostate cancer treated with hormone therapy.

Trend towards reduction of transfusion reactions using prestorage leukocyte-reduced and pooled whole blood-derived platelets and cost savings compared with poststorage whole blood-derived random platelets as evidenced by real-time hemovigilance.

BACKGROUND: Due to chemotherapy-induced neutropenia or hematologic malignancies, immunocompromised cancer patients may have higher incidence of febrile nonhemolytic transfusion reactions compared with the general population and frequently require platelet transfusions. This quality improvement project compared the safety of transfusion using prestorage leukocyte-reduced and pooled whole blood-derived platelets (Acrodose/WBD) with conventionally produced poststorage WBD platelets (RDP) using an active hemovigilance system. METHODS: Every patient receiving a blood product at the hospital was virtually monitored in real time by trained nurses from a remote hemovigilance unit. These nurses monitor a digital dashboard, which populates a watch list of patients from the time blood product administration is initiated until 12 hours posttransfusion. Over the course of 6 months, 371 patients receiving 792 RDP transfusions and 423 patients receiving 780 Acrodose/WBD platelets transfusions were monitored for transfusion reactions. RESULTS: We identified 26 transfusion reactions in RDP but only 12 transfusion reactions in the Acrodose/WBD platelet group. CONCLUSION: Acrodose platelet transfusion was associated with fewer transfusion reactions, which resulted in significant cost savings.

Simultaneous extraction and depolymerization of fucoidan from Sargassum muticum in aqueous media.

The biomass components of the invasive seaweed Sargassum muticum were fractionated to allow their separate valorization. S. muticum (Sm) and the solid residue remaining after alginate extraction of this seaweed (AESm) were processed with hot, compressed water (hydrothermal processing) to assess the effects of temperature on fucoidan solubilization. Fucose-containing oligosaccharides were identified as reaction products. Operating under optimal conditions (170 °C), up to 62 and 85 wt% of the dry mass of Sm and AESm were solubilized, respectively. The reaction media were subjected to precipitation, nanofiltration and freeze-drying. The dried products contained 50% and 85% of the fucoidan present in Sm and AESm, respectively; together with other components such as phenolics and inorganic components. The saccharidic fraction, accounting for up to 35% of the dried extracts, contained fucose as the main sugar, and also galactose, xylose, glucose and mannose. The concentrates were characterized for antioxidant activity using the TEAC assay.

Arundo donax L Processing in Catalyzed Butanol-Water Media in the Scope of Lignocellulose Biorefineries.

Arundo donax L samples, before or after aqueous extraction to remove extractives, were subjected to chemical fractionation in H2SO4-catalyzed mixtures of 1-butanol and water. The partial miscibility of 1-butanol and water at room temperature allowed the separation of the three major feedstock components in separate streams (lignin, accumulated in the 1-butanol-rich phase; hemicellulose-derived products, accumulated in the aqueous acidic phase; and cellulose, present in the solid phase). The effects of selected variables (temperature, catalyst concentration, reaction time and 1-butanol content of the reaction media) on variables measuring the solid recovery yield and the compositions of phases from fractionation were measured. Using water-extracted A. donax L as a substrate, the best operational conditions enabled 93.2% hemicellulose removal and 85.4% delignification with limited cellulose solubilization (15%). The experimental results provided key information to assess the proposed process in the scope of biorefineries.

Recent advances in the production of oligogalacturonides and their biological properties.

The human population is becoming old and ageing, which is related to a variety of health issues, such as Alzheimers disease, obesity, diabetes, hypercholesterolemia, and some types of cancers like colorectal cancer. Furthermore, diet is a determining factor in the appearance of some of these diseases due to its direct effect at the systemic level (for instance, increase in glucose and LDL-cholesterol levels in the serum) and its influence on the composition and activity of the gut microbiota. In this context, the use of functional ingredients can be a useful strategy to prevent or even treat (in combination with drugs) some of the above-mentioned pathologies. Among the variety of functional ingredients, prebiotics have received significant attention by the scientific community. Although the already commercialized FOS are the most studied prebiotics, some efforts have been devoted to the search and evaluation of new prebiotic candidates with additional properties. In particular, in the last decade, a variety of in vitro and in vivo assays have been carried out using well isolated and characterized oligogalacturonides, demonstrating that some of them have interesting biological properties, including anticancer, antioxidant, antilipidemic, anti-obesity and anti-inflammatory activities besides prebiotic effects. This work reviews the scientific literature published recently on the production of oligogalacturonides with a special focus on their biological properties.

Effects of Hydrothermal Processing on Miscanthus × giganteus Polysaccharides: A Kinetic Assessment.

Miscanthus × giganteus samples were characterized for composition and treated with hot compressed water (hydrothermal or autohydrolysis treatments) at temperatures in the range of 190-240 °C. The liquid phases from treatments were analyzed to assess the breakdown of susceptible polysaccharides into a scope of soluble intermediates and reaction products. The experimental concentration profiles determined for the target compounds (monosaccharides, higher saccharides, acetic acid and sugar-decomposition products) were interpreted using a pseudohomogeneous kinetic mechanism involving 27 reactions, which were governed by kinetic coefficients showing an Arrhenius-type temperature dependence. The corresponding activation energies were calculated and compared with data from the literature. The kinetic equations allowed a quantitative assessment of the experimental results, providing key information for process simulation and evaluation.

Factors related to the dual condition of gambling and gaming disorders: A path analysis model.

BACKGROUND AND AIMS: Gaming disorder has experienced rapid growth in the last decade among youth and adult populations, in parallel to the expansion of the videogame industry. The objective of this study was to explore the underlying process to explain the dual diagnosis of gaming with gambling disorder. METHODS: The sample included n = 117 patients who met clinical criteria for gaming disorder, recruited from a tertiary care unit specialized in the treatment of behavioral addictions. Path analysis (implemented through structural equation modeling) assessed the direct and mediational mechanisms between the dual condition of gaming + gambling disorder and sociodemographic variables and personality traits. RESULTS: The comorbid gaming + gambling disorder was met for 14.5% of the participants (additionally, 6.0% of the sample also met criteria for problematic gambling). The dual diagnosis was directly related to an older age at onset of the addiction problems, a higher level of the novelty seeking trait and being in active work. Employment status also mediated the relationship between persistence levels and chronological age. Greater psychopathological distress was related to females, higher levels of harm avoidance and persistence and lower levels of self-directedness. CONCLUSIONS: The results of this study provide empirical evidence for the specific factors that increase the likelihood of the dual gaming + gambling disorder. Clinical settings should consider these features to improve gaming diagnosis and treatment. Preventive programs should also be focused on the most vulnerable groups to prevent onset and progression of this comorbid condition.

Does Confinement Affect Treatment Dropout Rates in Patients With Gambling Disorder? A Nine-Month Observational Study.

Background and Aims: COVID-19 pandemic and confinement have represented a challenge for patients with gambling disorder (GD). Regarding treatment outcome, dropout may have been influenced by these adverse circumstances. The aims of this study were: (a) to analyze treatment dropout rates in patients with GD throughout two periods: during and after the lockdown and (b) to assess clinical features that could represent vulnerability factors for treatment dropout. Methods: The sample consisted of n=86 adults, mostly men (n=79, 91.9%) and with a mean age of 45years old (SD=16.85). Patients were diagnosed with GD according to DSM-5 criteria and were undergoing therapy at a Behavioral Addiction Unit when confinement started. Clinical data were collected through a semi-structured interview and protocolized psychometric assessment. A brief telephone survey related to COVID-19 concerns was also administered at the beginning of the lockdown. Dropout data were evaluated at two moments throughout a nine-month observational period (T1: during the lockdown, and T2: after the lockdown). Results: The risk of dropout during the complete observational period was R=32/86=0.372 (37.2%), the Incidence Density Rate (IDR) ratio T2/T1 being equal to 0.052/0.033=1.60 (p=0.252). Shorter treatment duration (p=0.007), lower anxiety (p=0.025), depressive symptoms (p=0.045) and lower use of adaptive coping strategies (p=0.046) characterized patients who abandoned treatment during the lockdown. Briefer duration of treatment (p=0.001) and higher employment concerns (p=0.044) were highlighted in the individuals who dropped out after the lockdown. Treatment duration was a predictor of dropout in both periods (p=0.005 and p<0.001, respectively). Conclusion: The present results suggest an impact of the COVID-19 pandemic on treatment dropout among patients with GD during and after the lockdown, being treatment duration a predictor of dropout. Assessing vulnerability features in GD may help clinicians identify high-risk individuals and enhance prevention and treatment approaches in future similar situations.

Gambling Phenotypes in Online Sports Betting.

BACKGROUND AND OBJECTIVES: The Internet provides easy access to multiple types of gambling and has led to changes in betting habits. A severe rise in problematic gambling has been predicted among all sectors of the population, and studies are required to assess the emerging phenotypes related to the new structures of gambling activities. This study aimed to explore the existence of latent classes associated with gambling habits among treatment-seeking gamblers due to Online Sports Betting (OSB). METHOD: Initial sample included n = 4,516 patients consecutively admitted for treatment in a hospital unit specialized in behavioral addictions. Two-step clustering analysis was used within the subsample of n = 323 patients who reported problems related with OSB, within a set of indicators including sociodemographics, psychopathological distress, personality, and severity of the gambling activity. RESULTS: The prevalence of OSB as a main type of gambling problem in the study was 7.2% (95% confidence interval: 6.4 to 7.9%). Two latent clusters were identified, with differences in sociodemographics and clinical status. Cluster 1 (n = 247, 76.5%) grouped patients that were more affected due to the OSB behaviors, and it was characterized by non-married patients, lower socioeconomic position index, higher comorbidity with other substance related addictions, younger age, and early onset of the gambling activity, as well as higher debts due to the OSB, higher psychopathological distress, and a more dysfunctional personality profile. Cluster 2 (n = 76, 23.5%) grouped patients that were less affected by OSB, mostly married (or living with a stable partner), with higher social position levels, older age and older onset of the gambling activity, as well as a more functional psychopathological and personality profile. CONCLUSION: The increasing understanding of latent classes underlying OSB phenotypes is essential in guiding the development of reliable screening tools to identify individuals highly vulnerable to addictive behaviors among Internet gamblers, as well as in planning prevention and treatment initiatives focused on the precise profiles of these patients.

Characterization of raft mussels according to total trace elements and trace elements bound to metallothionein-like proteins.

In the current work, samples of Mytilus galloprovincialis collected in different sites from Ría de Arousa estuary (Galicia, north-western Spain) were analysed for total Al, As, Ba, Cd, Cr, Cu, Fe, Mn, Ni, Pb and Zn, and for Ba, Cu, Mn and Zn bound to metallothionein-like proteins isoform I (MLP-I) contents. Inductively coupled plasma-optical emission spectrometry (ICP-OES) was used to assess total metal contents in raft mussels, while high performance liquid chromatography (HPLC) with an on-line metal detection with ICP-OES was used to measure metals bound to MLP-I. A microwave assisted acid digestion procedure was used as a sample pre-treatment for total metal contents, while a cytosolic preparation method based on a blending procedure with TRIS-HCl (pH 7.4) as an extracting solution was used to isolate MLP-I. Concentrations of total metals and metals bound to MLP-I were used as discriminating factors to establish different regions in the Ría de Arousa estuary. Principal component analysis (PCA) and cluster analysis (CA) were used as unsupervised pattern recognition procedures, and the half-range central value transformation was used as a data pre-treatment to homogenize data sets. Results have revealed a separation of raft mussels in good agreement with water circulation pattern and oceanographic processes in the estuary only when concentrations of metals to bound MLP-I are used as discriminating factors. Otherwise, raft mussels are classified as samples harvested in the inner or outer sides of the Ría.

Furfural production using ionic liquids: A review.

Furfural, a platform chemical with a bright future, is commercially obtained by acidic processing of xylan-containing biomass in aqueous media. Ionic liquids (ILs) can be employed in processed for furfural manufacture as additives, as catalysts and/or as reaction media. Depending on the IL utilized, externally added catalysts (usually, Lewis acids, Brönsted acids and/or solid acid catalysts) can be necessary to achieve high reaction yields. Oppositely, acidic ionic liquids (AILs) can perform as both solvents and catalysts, enabling the direct conversion of suitable substrates (pentoses, pentosans or xylan-containing biomass) into furfural. Operating in IL-containing media, the furfural yields can be improved when the product is continuously removed along the reaction (for example, by stripping or extraction), to avoid unwanted side-reactions leading to furfural consumption. These topics are reviewed, as well as the major challenges involved in the large scale utilization of ILs for furfural production.

Utilization of Ionic Liquids in Lignocellulose Biorefineries as Agents for Separation, Derivatization, Fractionation, or Pretreatment.

Ionic liquids (ILs) can play multiple roles in lignocellulose biorefineries, including utilization as agents for the separation of selected compounds or as reaction media for processing lignocellulosic materials (LCM). Imidazolium-based ILs have been proposed for separating target components from LCM biorefinery streams, for example, the dehydration of ethanol-water mixtures or the extractive separation of biofuels (ethanol, butanol) or lactic acid from the respective fermentation broths. As in other industries, ILs are potentially suitable for removing volatile organic compounds or carbon dioxide from gaseous biorefinery effluents. On the other hand, cellulose dissolution in ILs allows homogeneous derivatization reactions to be carried out, opening new ways for product design or for improving the quality of the products. Imidazolium-based ILs are also suitable for processing native LCM, allowing the integral benefit of the feedstocks via separation of polysaccharides and lignin. Even strongly lignified materials can yield cellulose-enriched substrates highly susceptible to enzymatic hydrolysis upon ILs processing. Recent developments in enzymatic hydrolysis include the identification of ILs causing limited enzyme inhibition and the utilization of enzymes with improved performance in the presence of ILs.