[Utilization of Upadacitinib in the treatment of Crohn's disease: a report on two clinical cases]. / Utilización de Upadacitinib en el tratamiento de la enfermedad de Crohn: reporte de dos casos clínicos.

Crohn's disease (CD) is a chronic, progressive inflammatory disease with complications that impact the well-being of patients. The therapeutic advances achieved in recent decades, especially through the advent of biological therapy, have allowed for a transformation in the approach and management of CD, thereby modifying the course of this disease. However, a significant number of patients do not experience a satisfactory response to these drugs or lose it during the course of the disease. In this scenario, a viable alternative is to switch medications. Upadacitinib, a novel Janus kinase inhibitor, has emerged as a promising strategy for the management of CD. We presented two cases of patients with CD refractory to conventional therapy and biological therapy, who responded successfully to treatment with upadacitinib.

Evaluation of the sensitivity and specificity of sigmoidoscopy in comparison to colonoscopy regarding the detection of intestinal inflammatory activity in the follow-up of patients with ulcerative colitis. / Evaluación de la sensibilidad y especificidad de la sigmoidoscopia en comparación con la colonoscopia en la detección de actividad inflamatoria intestinal en el seguimiento de pacientes con colitis ulcerosa.

INTRODUCTION: Ulcerative colitis (UC) is a chronic disease characterized by periods of inflammatory activity and remission, which vary from the rectum to the proximal colon. Currently, mucosal healing is a long-term goal in the management of inflammatory bowel disease, with colonoscopy and sigmoidoscopy being the recommended tools for evaluation. OBJECTIVE: To assess the effectiveness of both examinations in determining the presence of inflammatory activity in the follow-up of patients with UC. METHODS: Retrospective observational study analyzing colonoscopies performed as part of the follow-up of UC patients between January 2021 and July 2023 by gastroenterologists from the Inflammatory Bowel Disease Program at the Clínica Universidad de los Andes. The study compared endoscopic and histological activity observed in the rectosigmoid region with that found in the rest of the colon. Sensitivity and specificity were determined using concordance and correlations tests. RESULTS: A very good concordance and correlation were observed regarding endoscopic findings, with a Kappa index of 0.97 and a Spearman coefficient of 0.97. The Positive Predictive Value (PPV) of sigmoidoscopy for endoscopic activity was 1, and the Negative Predictive Value (NPV) was 0.96. In relation to histological activity, the concordance had a Kappa index of 0.93 and a Spearman coefficient of 0.93, with a PPV of sigmoidoscopy for histological activity being 1 and an NPV of 0.91. CONCLUSION: This cohort suggests that sigmoidoscopy is a cost-effective option for evaluating mucosal healing in UC patients in symptomatic and biomarker remission. However, complete colonoscopy should be considered in cases of discrepancies with the clinical picture or in colorectal cancer surveillance.

Utilización de Upadacitinib en el tratamiento de la enfermedad de Crohn: reporte de dos casos clínicos / Utilization of Upadacitinib in the treatment of Crohn's disease: a report on two clinical cases

RESUMEN La enfermedad de Crohn (EC) es una enfermedad Inflamatoria crónica y progresiva con complicaciones que impactan la calidad de vida de los pacientes. Los avances terapéuticos logrados en las últimas décadas, especialmente a través de la terapia biológica, ha permitido cambiar el enfrentamiento y manejo de la EC, modificando con ello la evolución de esta patología. Sin embargo, un número significativo de pacientes no tienen una respuesta satisfactoria o la pierde durante el curso de su enfermedad. En este escenario, una alternativa viable es cambiar de fármaco. Upadacitinib, un nuevo inhibidor de las quinasas janus, ha emergido como una estrategia promisoria para el manejo de la EC. Presentamos dos casos de pacientes con EC refractarios a terapia convencional y biológica, quienes respondieron de manera exitosa al tratamiento con upadacitinib.

ABSTRACT Crohn's disease (CD) is a chronic, progressive inflammatory disease with complications that impact the well-being of patients. The therapeutic advances achieved in recent decades, especially through the advent of biological therapy, have allowed for a transformation in the approach and management of CD, thereby modifying the course of this disease. However, a significant number of patients do not experience a satisfactory response to these drugs or lose it during the course of the disease. In this scenario, a viable alternative is to switch medications. Upadacitinib, a novel Janus kinase inhibitor, has emerged as a promising strategy for the management of CD. We presented two cases of patients with CD refractory to conventional therapy and biological therapy, who responded successfully to treatment with upadacitinib.

Eradication rate and adherence with high-dose amoxicillin and proton pump inhibitor as first-line treatment for Helicobacter pylori infection: Experience from University Hospital in Chile.

INTRODUCTION: In Chile, more than 70% of adults are infected by Helicobacter pylori. Clarithromycin should not be used in any regimen if there is >15% resistance to this antibiotic, being greater than 26% in our population. In this scenario, the effectiveness of triple therapy (proton pump inhibitor [PPI], clarithromycin, amoxicillin) was only 63.8%. AIM: To evaluate the eradication rate and safety of dual therapy (esomeprazole and amoxicillin) in high doses, through a prospective, observational, and descriptive study. METHODS: Patients with a positive urease test obtained in an upper digestive endoscopy were included. Any other previous H. pylori eradication regimen were excluded. All patients were treated with esomeprazole 40 mg three times a day and amoxicillin 750 mg four times a day for 14 days. The eradication rate of the dual therapy was evaluated with the H. pylori stool antigen test (the Pylori-Strip® test used) 6 weeks after completing the eradication treatment and with at least 14 days without PPI, being a negative result, confirmation of the effectiveness of this regimen. RESULTS: Of 122 patients, 106 had a negative H. pylori antigen in stool; The intention-to-treat and per protocol analysis, the eradication rates were 91.8% [95% CI: 87%-97%] and 94% [95% CI: 90%-98%], respectively. Four patients discontinued treatment due to adverse effects. Smoking and adherence to treatment were associated with eradication rate. CONCLUSIONS: In this cohort of patients with H. pylori infection, high-dose dual therapy has a high eradication rate and good adherence, raising the possibility that it could be used as first-line therapy in our country. Studies with a larger number of patients should confirm these results.

Factores que dificultan el diagnóstico del síndrome de taquicardia ortostática postural / Factors that hinder the diagnosis of postural orthostatic tachycardia syndrome

Las disautonomías son el resultado de un mal funcionamiento del sistema nervioso autónomo, entre las cuales se encuentra el síndrome de taquicardia ortostática postural, un problema de salud variable y complejo que tiene una prevalencia considerable, principalmente en adolescentes y mujeres. Este produce una amplia variedad de signos y síntomas que son similares a los de otras patologías, lo que, sumado a la falta de pruebas diagnósticas específicas, muchas veces retrasa el diagnóstico. A pesar de la existencia de criterios estandarizados para determinar la presencia del síndrome, existe aún una brecha en el conocimiento acerca del mismo. Esto dificulta el abordaje del padecimiento y, por consiguiente, su tratamiento oportuno. Conocer más sobre este síndrome y los factores que dificultan su diagnóstico temprano permitiría mejorar la atención de los pacientes y su calidad de vida

Dysautonomias are the result of a malfunction of the autonomic nervous system, among which is the postural orthostatic tachycardia syndrome, a variable and complex health problem that has a considerable prevalence, mainly in adolescents and women. It produces a wide variety of signs and symptoms that are similar to those of other pathologies, which, added to the lack of specific diagnostic tests, often delays diagnosis. Despite the existence of standardized criteria to determine the presence of the syndrome, there is still a gap in knowledge about it. This hinders the approach to the condition and, consequently, its timely treatment. Understanding more about this syndrome and the factors that hinder its early diagnosis would improve patient care and quality of life

Proctitis y enfermedad perianal de causa infecciosa: una mirada más allá de la enfermedad inflamatoria intestinal / Infectious proctitis and perianal disease: a gaze beyond inflammatory bowel disease

Resumen La proctitis infecciosa secundaria a una enfermedad de transmisión sexual ha aumentado en incidencia y deben ser consideradas especial-mente en varones homosexuales o bisexuales con síntomas rectales. Presentamos un paciente con una proctitis y enfermedad perianal por Chlamydia trachomatis que podría haber sido diagnosticado con otra enfermedad ano-rectal como es la enfermedad inflamatoria intestinal, si la historia clínica no hubiese sido considerada. Un alto nivel de sospecha es necesario para evitar un diagnóstico incorrecto, retrasar el tratamiento antimicrobiano y el desarrollo de complicaciones.

Abstract Infectious proctitis by sexually transmitted diseases are increasing in incidence and should be considered in homosexual patients with rectal symptoms. In this case, we show a patient with proctitis and perianal disease caused by Chlamydia trachomatis that could be diagnosed as another anorectal disease such as inflammatory bowel disease if the clinical history is not taken into account. A high level of suspicion is crucial, in order to avoid an incorrect diagnosis, delayed antibiotic therapy and the development of complications.

[Infectious proctitis and perianal disease: a gaze beyond inflammatory bowel disease]. / Proctitis y enfermedad perianal de causa infecciosa: una mirada más allá de la enfermedad inflamatoria intestinal.

Infectious proctitis by sexually transmitted diseases are increasing in incidence and should be considered in homosexual patients with rectal symptoms. In this case, we show a patient with proctitis and perianal disease caused by Chlamydia trachomatis that could be diagnosed as another anorectal disease such as inflammatory bowel disease if the clinical history is not taken into account. A high level of suspicion is crucial, in order to avoid an incorrect diagnosis, delayed antibiotic therapy and the development of complications.

Localización y clínica asociada al cáncer de colon: Hospital Nacional Arzobispo Loayza: 2009 - 2013 / Location and associated clinical characteristics of colon cancer: Hospital Nacional Arzobispo Loayza: 2009 - 2013

OBJETIVO: Determinar la clínica asociada a la localización del cáncer de colon en pacientes del Hospital Nacional Arzobispo Loayza durante el periodo mayo 2009 - setiembre 2013. MATERIAL Y MÉTODOS: estudio transversal que analizó información de 114 pacientes con neoplasia maligna primaria de colon, de los cuales 42 cumplieron los criterios de inclusión; internados en el Servicio 6-II del Departamento de Cirugía General del Hospital Nacional Arzobispo Loayza entre mayo 2009 y setiembre 2013. RESULTADOS: La media de edad fue de 60.5 años, y predominó el género femenino con 66.7%. El 100% de los tipos histológicos fue adenocarcinoma. El colon derecho resultó afectado en 61.9%, el izquierdo en 33,3% y un 4,8% presentó localización mixta. En la topografía, se halló 33,3% en colon ascendente y 21,4% en colon sigmoides. Los síntomas más frecuentes fueron dolor abdominal (76,2%), pérdida de peso (69%) y anemia (64%). Para el colon derecho, hubo 13 veces más riesgo de presentar astenia, y 4.44 veces más riesgo de presentar anemia (p<0,05). CONCLUSIÓN: La localización de cáncer de colon más frecuente fue en el colon derecho, el cual se asoció significativamente a la presencia de astenia y anemia en el cuadro clínico. Los síntomas más presentados fueron el dolor abdominal y la pérdida de peso, en cualquiera de sus localizaciones. Todos los casos fueron de adenocarcinoma. (Horiz Med 2015; 15(2): 49-55)

OBJECTIVE: To determine the association between the clinical characteristics and the location of colon cancer in patients hospitalized at "Hospital Nacional Arzobispo Loayza", during May 2009 - September 2013. MATERIAL AND METHODS: transversal study of 144 patients with primary colon cancer, of which 42 patients met the inclusion criteria; hospitalized in the 6-II Wing of the Department of General Surgery at "Hospital Nacional Arzobispo Loayza", between May 2009 and September 2013. RESULTS: the mean age was 60.5 years, and 66.7% of the cases were women. 100% of histologic types were adenocarcinoma. The right colon was affected in 61.9% of the cases; the left colon in 33.3%, and a mixed location in 4,8%. Regarding the topography, 33,3% of the cases were found in the ascending colon and 21,4% in the sigmoid colon. The most frequent symptoms were abdominal pain (76.2%), weight loss (69%) and anemia (64%). For right colon cancer, fatigue was 13 times more likely to appear, and anemia was 4.44 times more likely (p< 0.05). CONCLUSION: the most common location for cancer was in the right colon, and it was associated significantly with the presence of fatigue and anemia among the clinical characteristics. The most frequent symptoms were abdominal pain and weight loss, in any location. All cases were adenocarcinoma. (Horiz Med 2015; 15(2): 49-55)

Early evaluation results from a statewide quality improvement training program for local public health departments in North Carolina.

CONTEXT: Many state and local public health agencies have developed accreditation systems and are utilizing quality improvement (QI) methods and tools to improve the public health infrastructure. Development of strategies to support and build the capacity of the public health workforce to apply QI can help advance these efforts. OBJECTIVE: This article describes the adaptation and creation of a standardized QI training program for local health departments (LHDs), explores the effectiveness of the program in increasing the confidence of the LHD staff to apply QI methods and tools, and discusses lessons learned from the first cohort of the program. METHODS: An existing program designed for health care professionals was pilot tested, adapted, and used in 8 LHDs. A formative evaluation of the new public health QI training program was conducted through a hybrid internal and external evaluation model. Pre/postsurveys were used to measure participant satisfaction and the capacity of LHD staff to conduct QI. RESULTS: Staff from 8 LHDs successfully completed the program and 94% of participants reported that they were satisfied with the overall training program. Seventy percent of participants reported a higher perceived confidence in conducting a QI project, and all participants reported sharing QI tools and methods with their coworkers. CONCLUSION: These findings suggest that QI training programs using methods and tools previously applied in health care and other industries can be successfully adapted to public health. Although additional studies are needed to validate the results, this training model can be used to inform future work in developing a standardized QI training program in public health.

Fístula duodeno-cólica benigna: reporte de un caso y revisión del tema / Benign duodenal-colic fistula: a case report and subject review

La fístula duodeno-cólica es una entidad de presentación inusual, descrita en la literatura sólo como reportes de casos aislados. Las FDC benignas son una rara complicación de numerosas enfermedades gastro-intestinales, siendo la causa más frecuente la secundaria a la enfermedad de Crohn. Dolor abdominal, signos de malabsorción (diarrea, baja de peso), asociados eventualmente a náuseas y vómitos son la forma de presentación más frecuentes. El enema baritado es el mejor método diagnosticado. El manejo debe ser integral, considerando tanto el manejo de la enfermedad de base, como el soporte nutricional y la resolución quirúrgica de la fístula. Se presenta un caso clínico de esta patología.

Relationship between psychological complaints and vasomotor symptoms during climacteric.

BACKGROUND: It has been suggested that hormonal changes and environmental alterations during the climacteric period are important in the development of psychological symptoms. OBJECTIVE: To evaluate the role of biological and psycho-social factors in the prevalence of climacteric symptoms. DESIGN: Open, cross-sectional, observational and descriptive study. MATERIAL AND METHODS: A total of 300 women between 40 and 59 years of age were evaluated using Greene scale for climacteric symptoms, Cooper questionnaire for psychosomatic symptoms of stress, Smilkstein family apgar for family dysfunction, Duke-UNC questionnaire for social support and Israel scale for vital events. All these tests have been previously validated in Spanish. RESULTS: Postmenopausal women do not have higher prevalence of psychological symptoms, they only have more vasomotor symptoms. Premenopausal women with vasomotor symptoms have more psychological and somatic symptoms and stress, independently of the vital events, family dysfunction or poor social support. Vasomotor symptoms in the premenopause are associated with increased risk of anxiety (OR: 3.7, IC: 1.4-9.7; P<0.008), depression (OR: 8.1, IC: 2.5-26.4; P<0.0005), somatic symptoms (OR: 14.9, IC: 3.4-65.3; P<0.0003), sexual dysfunction (OR: 7.2, IC: 2.5-20.6; P<0.0002) and stress (OR: 7.5, IC: 3.5-15.9; P<0.0001). Negative vital events and family dysfunction increase in minor intensity the risk of anxiety, depression and stress. CONCLUSION: In conclusion, psychological symptoms are frequent in the premenopause and are associated to vasomotor symptoms. This observation links psychological symptoms with menopausal transition and might suggest an organic base in their origin. The negative psycho-social environment is a factor that favours the development of these symptoms.