Differences in Prevalence of Histologic Gastric Cancer Subtypes Between Mestizo and Mayan Populations in Guatemala.

PURPOSE: Although the intestinal subtype of gastric cancer (GC) is most prevalent around the world, a relatively high prevalence of the diffuse subtype has been reported in some populations of Central American countries, including Guatemala. This study aimed to investigate whether differences exist in the prevalence of the two GC subtypes in the two main ethnic groups in Guatemala, namely Mayan and Mestizo (known as Ladino in Guatemala), between whom significant socioeconomic disparities exist, and to determine whether there is an association with Helicobacter pylori/CagA seropositivity. MATERIALS AND METHODS: Participants included 65 patients with GC and 135 age-/sex-matched controls. Data on ethnicity, H. pylori and CagA seropositivity status, as well as tumor subtype (diffuse or intestinal) were collected. Logistic regression models were fitted to examine the relationship between predictor variables (age, sex, ethnicity, H. pylori, and CagA) and the binary response variable (tumor type). Model selection was based on the Akaike information criterion. RESULTS: The prevalence of diffuse GC was found to be significantly higher in the Mayan compared with the Mestizo population in Guatemala. Although seropositivity for CagA was significantly higher in patients with GC, there were no significant differences between the two GC subtypes. CONCLUSION: This study suggests that there are differences in the prevalence of intestinal and diffuse GC histologic subtypes between the two main ethnic groups in Guatemala. Further studies are warranted, given the potential higher prevalence of the more severe GC subtype in the most vulnerable population.

¿Ha disminuido la colectomía por crisis de colitis ulcerosa? / Has colectomy for moderate-severe active ulcerative colitis decreased?

BACKGROUND: Treatment for moderate-severe active ulcerative colitis (UC) includes steroids, biologic therapy and total colectomy. Aim: To describe the features of patients with moderate to severe active UC, their hospital evolution and need for colectomy. MATERIAL AND METHODS: Non-concurrent cohort study of all patients admitted to our institution with a diagnosis of moderate or severe UC crisis between January 2008 and May 2019. Truelove Witts (TW) criteria were used to categorize disease severity. Twelve-month colectomy-free survival was estimated with Kaplan-Meier survival analysis. Results: One hundred-twenty patients aged 16 to 89 (median 35) years had 160 admissions for acute moderate to severe UC. Median admission per patient was 1 (1-3), and median hospital stay was six days (1-49). Cytomegalovirus and Clostridioides difficile were found in 17.5 and 14.2% of crises, respectively. Corticosteroids were used in all crises and biologic therapy in 6.9% of them. Emergency or elective colectomies were performed in 18.3 and 6.7% of patients, respectively. The need for emergency total colectomy decreased from 24.6 to 7.8% (Risk ratio 3.16, p < 0.01) between de first and second half of the study period. Kaplan-Meier analysis for long term colectomy-free survival in both periods confirmed this decrease (p < 0.01). CONCLUSIONS: Medical treatment for moderate to severe UC crises had a 86.3% success and a small percentage required emergency total colectomy. Emergency surgery decreased in the last decade.

Movimiento velofaringeo postfaringoplastía. Electromiografía con monitoreo videonasofarinfoscópico / Velopharyngeal motion after pharyngoplasty. Electromiography with videonasopharyngoscopic monitoring

Propósito: La faringoplastía de esfínter es un procedimiento quirúrgico cuyo objetivo es corregir la insuficiencia velofaríngea residual después del cierre de una fisura de paladar secundario. Esta operación pretende crear un diafragma activo para el cierre velofaríngeo. El propósito de este estudio es evaluar el movimiento velofaríngeo, después de la faringoplastía de esfínter, utilizando electromiografía selectiva (EMG) de músculos del esfínter velofaríngeo y monitoreo con videonasofaringoscopía (VNF). Material y métodos: Se estudió a veinticinco pacientes en quienes se había practicado una faringoplastía de esfínter. Todos los casos fueron evaluados utilizando EMG y VNF. Se examinaron los siguientes músculos velofaringeos: constrictor superior de la faringe (CSF), palatofaríngeos (PF), elevador del velo del paladar (EVP). Los PF se encontraron incluidos en los colgajos insertados en la pared faríngea posterior. Resultados: Veintitrés de los pacientes (92 por ciento) mostraron un cierre velofaríngeo completo. Los otros 2 casos que persistieron con insuficiencia velofaríngea mostraron un tamaño del defecto de 20 y 25 por ciento. Ninguno de los pacientes mostró potenciales de unidad motora en la EMG obtenida de los colgajos, indicando ausencia de actividad motora en los músculos PF. Sin embargo, todos los pacientes mostraron EMG normal en el CSF y el EVP. La VNF demostró que los movimientos de las paredes faríngeas laterales oscilaron del 25 por ciento al 40 por ciento, estando relacionados con fuerte actividad electromiográfica del CSF. Conclusión: Los colgajos de pedículo superior de la faringoplastía de esfínter no parecen crear un diafragma activo para el cierre velofaríngeo. La acción del esfínter es pasiva ocasionada por la contracción del CSF