Estudio comparativo de eficacia y seguridad de dexrabeprazol versus esomeprazol en el tratamiento de la enfermedad por reflujo gastroesofágico / Efficacy and safety comparative study of dexrabeprazole vs. esomeprazole for the treatment of gastroesophageal reflux disease

Resumen Introducción: Una encuesta nacional en población abierta mostró que la enfermedad por reflujo gastroesofágico (ERGE) tiene alta prevalencia en México. Objetivo: Comparar la eficacia y seguridad de dos isómeros, dexrabeprazol (10 mg) versus esomeprazol (20 mg), en el tratamiento de la ERGE durante cuatro semanas. Métodos: Ensayo clínico fase III, aleatorizado, multicéntrico, prospectivo, doble ciego, en dos grupos que incluyeron 230 pacientes. Resultados: Con ambos tratamientos se observó disminución estadísticamente significativa en la severidad de los síntomas de ERGE (pirosis, regurgitación, dolor epigástrico y disfagia), evaluados mediante una escala visual análoga. La puntuación promedio de dexrabeprazol en el Cuestionario de Carlsson-Dent a los 28 días fue de 2.12 y la de esomeprazol de 3.02. Ambos tratamientos fueron efectivos, sin diferencia estadísticamente significativa (p < 0.05). En el Cuestionario de Salud SF-36 se observó que ambos mejoraron la puntuación en la calidad de vida, sin diferencia significativa. Ambos medicamentos fueron bien tolerados y el perfil de incidencia de eventos adversos fue bajo. Conclusiones: En el tratamiento de ERGE no erosiva, el uso de 10 mg/día de dexrabeprazol es tan efectivo como 20 mg/día de esomeprazol, con la ventaja de que la dosis es menor con un adecuado perfil de seguridad.

Abstract Introduction: A national survey in the general population showed that gastroesophageal reflux disease (GERD) is highly prevalent in Mexico. Objective: To compare the efficacy and safety of two isomers, dexrabeprazole (10 mg) vs. esomeprazole (20 mg), in the treatment of GERD for four weeks. Methods: Randomized, multicenter, prospective, double-blind phase III clinical trial in two groups that included 230 patients. Results: A statistically significant decrease in the severity of GERD symptoms (heartburn, regurgitation, epigastric pain and dysphagia), evaluated using a visual analogue scale, was observed with both treatments. Mean score for dexrabeprazole on Carlsson-Dent questionnaire at 28 days was 2.12, and for esomeprazole, 3.02. Both treatments were effective, with no statistically significant difference being recorded (p < 0.05). On SF-36 health questionnaire, both were observed to improve the quality-of-life score, with no significant difference being identified. Both drugs were well tolerated, and the adverse event incidence profile was low. Conclusions: In the treatment of non-erosive GERD, the use of dexrabeprazole at 10 mg/day is as effective as esomeprazole 20 mg/day, with the advantage that the dose is lower with an appropriate safety profile.

Biomechanical Behavior Characterization and Constitutive Models of Porcine Trabecular Tibiae.

Customizing any trauma surgery requires prior planning by surgeons. Nowadays, the use of numerical tools is increasingly needed to facilitate this planning. The success of this analysis begins with the definition of all the mechanical constitutive models of the materials implied. Our target is the trabecular bone because almost all trauma surgeries are closely related to it. This work focuses on the experimental characterization of porcine trabecular tibiae and defining its best constitutive model. Therefore, different types of compression tests were performed with tibia samples. Once the potential constitutive models were defined, stress-strain state from numerical approaches were compared with the corresponding experimental results. Experimental results from uniaxial compression tests showed than trabecular bone exhibits clear anisotropy with more stiffness and strength when it is loaded in the tibia longitudinal direction. Results from confined compression tests confirmed that the plastic behavior of trabecular bone depends on the hydrostatic and deviatoric invariants, so an alternative formulation (crushable foam volumetric (CFV)) has been proposed to describe its behavior. A new method to obtain CFV characteristic parameters has been developed and validated. Predictions of the CFV model better describe trabecular bone mechanical behavior under confined conditions. In other cases, classical plasticity formulations work better.

An intrapancreatic bronchogenic cyst simulating a mucinous cystadenoma. A case report.

We present the case of a 61-year-old male with a long-term epigastric mass and pain, high CA 19.9 levels and no weight loss. A computerized tomography was performed and a solid-cystic pancreatic mass was observed. The lesion measured 10 x 8 cm with well-defined margins, a macroscopic calcification and an enhanced solid component.

Dyslipidemia as a risk factor for liver fibrosis progression in a multicentric population with non-alcoholic steatohepatitis.

Background: Nonalcoholic fatty liver disease (NAFLD) is a serious worldwide health problem, with an estimated global prevalence of 24%; it has a notable relationship with other metabolic disorders, like obesity and type 2 diabetes mellitus (T2DM). Nonalcoholic steatohepatitis (NASH) is one of the most important clinical entities of NAFLD, which is associated with an increased risk of progression to liver cirrhosis and hepatocellular carcinoma (HCC). Mexico is one of the countries with the highest prevalence of metabolic diseases; therefore, we sought to investigate the impact that these clinical entities have in the progression to advanced fibrosis in Mexican patients with NASH. Methods: We performed a multicenter retrospective cross-sectional study, from January 2012 to December 2017. A total of 215 patients with biopsy-proven NASH and fibrosis were enrolled. NASH was diagnosed according NAS score and liver fibrosis was staged by the Kleiner scoring system. For comparing the risk of liver fibrosis progression, we divided our sample into two groups. Those patients with stage F0-F2 liver fibrosis were included in the group with non-significant liver fibrosis (n=178) and those individuals with F3-F4 fibrosis were included in the significant fibrosis group (n=37). We carried out a multivariate analysis to find risk factors associated with liver fibrosis progression. Results: From the 215 patients included, 37 had significant liver fibrosis (F3-4). After logistic regression analysis T2DM (p=0.044), systemic arterial hypertension (p=0.014), cholesterol (p=0.041) and triglycerides (p=0.015) were the main predictor of advanced liver fibrosis. Conclusions: In a Mexican population, dyslipidemia was the most important risk factor associated with advanced liver fibrosis and cirrhosis.

Enhanced recovery after bariatric surgery: Implementation of program and clinical outcomes from a bariatric surgery and metabolic diseases reference center.

BACKGROUND: Enhanced recovery after bariatric surgery (ERABS) protocols involve a series of multimodal perioperative procedures based on evidence designed to reduce physiological stress, improve recovery, and reduce costs on medical attention by decreasing length of hospital stay (length of stay [LOS]). OBJECTIVE: The objective of the study was to report the viability and results of the ERABS application in a reference bariatric center. MATERIALS AND METHODS: A prospective, observational, and descriptive study on bariatric procedures conducted over 12 months in the ERABS context which includes pre-procedure, intraprocedure, and post-procedure measures. The collected data include demographic data, comorbidity, morbimortality, LOS, and readmission to hospital. RESULTS: Sixty-four patients within a median of 38.8 ± 9.5 years and 44.1 ± 6.20 kg/m2 BMI underwent surgery. Fifty-five (85.93%) were Roux-en-Y gastric bypass (RYGB) cases and 9 (14.06%) were sleeve gastrectomy (SG). Related comorbidities were hypertension 37%, diabetes 34%, dyslipidemia 23%, and obstructive sleep apnea 21%. Two (3.12%) patients developed post-operative morbidity (respiratory and thromboembolic complications). LOS for RYGB was 1.16 ± 0.97 and 1 ± 0 days for SG. The successful discharge rate on the 1st day after procedure was 96% and 100%, respectively. Readmission to hospital within a 30-day period presented itself on 4 patients (6.25%). CONCLUSION: Applying ERABS protocols is feasible, safe, morbidity low, LOS acceptable, and a low readmission rate within 30 days.

ANTECEDENTES: Los protocolos de recuperación mejorada tras cirugía bariátrica (ERABS, Enhanced Recovery After Bariatric Surgery) implican intervenciones perioperatorias multimodales basadas en la evidencia diseñadas para reducir el estrés fisiológico, facilitar el retorno temprano de la función corporal y reducir los costos de atención médica al disminuir la duración de la estancia intrahospitalaria. OBJETIVO: Reportar la viabilidad y los resultados de la utilización de ERABS en un centro bariátrico de referencia. MÉTODO: Estudio prospectivo, observacional y descriptivo de procedimientos bariátricos realizados durante 12 meses en contexto ERABS, que incluyó medidas preoperatorias, intraoperatorias y posoperatorias. Los datos recopilados fueron demografía, comorbilidad, morbimortalidad, estancia intrahospitalaria y reingresos. RESULTADOS: 64 pacientes, edad 38.8 ± 9.5 años, índice de masa corporal 44.1 ± 6.20 kg/m2, 55 (85.93%) bypass gástricos en Y de Roux (BGYR) y 9 (14.06%) mangas gástricas. Comorbilidad: hipertensión 37%, diabetes 34%, dislipidemia 23% y apnea obstructiva 21%. Dos (3.12%) pacientes desarrollaron morbilidad posoperatoria (complicaciones respiratorias y tromboembólicas). La estancia intrahospitalaria para el BGYR fue de 1.16 ± 0.97 días y para la manga 1 ± 0 días. El alta exitosa al primer día posoperatorio fue del 96% para el BGYR y del 100% para la manga. El reingreso hospitalario a 30 días se produjo en cuatro (6.25%) pacientes. CONCLUSIÓN: La aplicación de protocolos ERABS es factible, segura, de baja morbilidad, con una estancia intrahospitalaria aceptable y una baja tasa de reingresos a 30 días.

Validación de la prueba de Romberg Modificada para la determinación del tiempo de propiocepción inconciente en adultos sanos / Validation of a Modified Romberg's Test to determine normal adult lower limb unconscious proprioception times

Introducción La propiocepción es la capacidad que tiene el cuerpo para detectar el movimiento y la posición articular, lo cual tiene grandes implicaciones en el control neuromuscular. Actualmente no hay una prueba clínica estandarizada que permita determinar objetivamente la normalidad en su evaluación en la población sana con un patrón de marcha maduro. En el año 2012 se diseñó un signo clínico denominado prueba de Romberg modificada, que permite caracterizar los valores propioceptivos de la población normal en los miembros inferiores. Materiales y métodos Estudio de cohorte transversal ciego de 163 pacientes. Se excluyeron pacientes con algún tipo de lesión osteoarticular o neuropatía periférica en los miembros inferiores. Estos individuos se sometieron a la prueba de Romberg modificada, registrando su valor en segundos en el miembro inferior derecho e izquierdo, y comparándolas con la edad, lateralidad y el sexo. Resultados Al estratificar los sujetos evaluados por grupos etarios, se observó una relación inversamente proporcional entre la prueba de Romberg modificada y la edad. La lateralidad y el sexo no presentaron una diferencia significativa (p=0,53).. Discusión La prueba de Romberg modificada, es una prueba útil para la determinación de la propiocepción normal en los adultos, la cual disminuye con la edad sin presentar diferencias con respecto a la lateralidad o el sexo del individuo. Nivel de evidencia IV

Background Proprioception is considered the ability of the body to detect movement and joint position, and has great implications in neuromuscular control. There are currently no standardised clinical tests to objectively determine how much should be considered normal in its evaluation in the healthy population with a mature gait pattern. In 2012, a clinical sign called the modified Romberg test was designed to determine the proprioceptive values in the lower limbs of the normal population. Materials and methods A cross-sectional blind study was conducted on a cohort of patients with no history of osteoarticular injury in the lower limbs and no peripheral neuropathy. The subjects underwent the modified Romberg test, with a record made of its value in seconds in the lower right and left limbs, and comparing them with age, laterality, and gender. Results The study included 163 patients. On stratifying the subjects evaluated according to age groups, a tendency to decrease the modified Romberg test result with increased age was observed. According to the analysis, it can be observed that the proprioception of a limb does not have a significant difference (P=.53) with respect to the contralateral limb (laterality) or gender, but there is with respect to age. Discussion The modified Romberg test result of 20seconds is a useful tool for the determination of normal proprioception in adults. This value decreases with age, without showing differences as regards the laterality or gender of the subject. Evidence Level IV.

Validación de la prueba de Romberg Modificada para la determinación del tiempo de propiocepción inconciente en adultos sanos / Validation of a Modified Romberg's Test to determine normal adult lower limb unconscious proprioception times

Introducción La propiocepción es la capacidad que tiene el cuerpo para detectar el movimiento y la posición articular, lo cual tiene grandes implicaciones en el control neuromuscular. Actualmente no hay una prueba clínica estandarizada que permita determinar objetivamente la normalidad en su evaluación en la población sana con un patrón de marcha maduro. En el año 2012 se diseñó un signo clínico denominado prueba de Romberg modificada, que permite caracterizar los valores propioceptivos de la población normal en los miembros inferiores. Materiales y métodos Estudio de cohorte transversal ciego de 163 pacientes. Se excluyeron pacientes con algún tipo de lesión osteoarticular o neuropatía periférica en los miembros inferiores. Estos individuos se sometieron a la prueba de Romberg modificada, registrando su valor en segundos en el miembro inferior derecho e izquierdo, y comparándolas con la edad, lateralidad y el sexo. Resultados Al estratificar los sujetos evaluados por grupos etarios, se observó una relación inversamente proporcional entre la prueba de Romberg modificada y la edad. La lateralidad y el sexo no presentaron una diferencia significativa (p=0,53).. Discusión La prueba de Romberg modificada, es una prueba útil para la determinación de la propiocepción normal en los adultos, la cual disminuye con la edad sin presentar diferencias con respecto a la lateralidad o el sexo del individuo. Nivel de evidencia IV

Background Proprioception is considered the ability of the body to detect movement and joint position, and has great implications in neuromuscular control. There are currently no standardised clinical tests to objectively determine how much should be considered normal in its evaluation in the healthy population with a mature gait pattern. In 2012, a clinical sign called the modified Romberg test was designed to determine the proprioceptive values in the lower limbs of the normal population. Materials and methods A cross-sectional blind study was conducted on a cohort of patients with no history of osteoarticular injury in the lower limbs and no peripheral neuropathy. The subjects underwent the modified Romberg test, with a record made of its value in seconds in the lower right and left limbs, and comparing them with age, laterality, and gender. Results The study included 163 patients. On stratifying the subjects evaluated according to age groups, a tendency to decrease the modified Romberg test result with increased age was observed. According to the analysis, it can be observed that the proprioception of a limb does not have a significant difference (P=.53) with respect to the contralateral limb (laterality) or gender, but there is with respect to age. Discussion The modified Romberg test result of 20seconds is a useful tool for the determination of normal proprioception in adults. This value decreases with age, without showing differences as regards the laterality or gender of the subject. Evidence Level IV.

Valores hematológicos en mujeres gestantes residentes a 3600 msnm / Hematological values in pregnant women living at 3600 high altitude

El embarazo es un proceso fisiológico que conlleva modificaciones en órganos y sistemas, a su vez la adaptación a la altura involucra cambios fisiológicos, bioquímicos y genéticos. Esto ha ocasionado modificaciones en los valores hematológicos. Las mujeres gestantes residentes a nivel del mar reflejan una hemoglobina de 10 a 11 g/dl y una diferencia de 1,8 g/dl entre mujeres gestantes y no gestantes. Estos valores en mujeres gestantes residentes a 3.600 msnm precisan determinarse. Objetivo Determinar valores hematológicos de mujeres gestantes residentes a 3.600 msnm. Material y Métodos Muestras de sangre venosa periférica recolectadas en tubos vacutainer con EDTA de 190 mujeres no gestantes y 300 mujeres gestantes del Hospital de la Mujer de La Paz, Bolivia. Los estudios fueron realizados con contador automático Micros 60 (Horiba ABX diagnostics, Francia) y corroborados por técnicas manuales. Se empleó prueba "t-student" para comparar grupos y se consideró valor de p< 0.05 con IC de 95%. Resultados Las mujeres gestantes residentes a 3.600 msnm reflejaron hemoglobina de 13,6 ±2,3 g/dl,porcentaje de hematocrito 40,9±6,4% y reticulocitos 1,9± 0,7%. La diferencia de hemoglobina entre mujeres gestantes y no gestantes fue 2,6 g/dl. Conclusiones Los niveles de hematocrito y hemoglobina en mujeres gestantes habitantes a 3.600 msnm disminuyen y la disminución de concentración de hemoglobina es mayor en contraste con otras alturas. Los valores hematológicos de mujeres gestantes en la altura presentan diferencias significativas comparados con los del nivel del mar, probablemente por la adaptación fisiológica y genética a la altura.

Pregnancy is a physiological process that involves changes in organs and systems, and adaptation to high altitude also involves physiological, biochemical and genetic changes. This has caused changes in the hematological values. Pregnant women at sea level have a hemoglobin of 10 to 11 g/dl and a difference of 1,8g/dl between pregnant and non-pregnant women. These values in pregnant women living at 3600 masl need to be determined. Objective To determine hematological values of pregnant women living at 3600 masl. Material and methods It was collected peripheral venous blood samples in tubes vacutainer containing EDTA from 190 non-pregnant women and 300 pregnant women from Hospital de la Mujer in La Paz, Bolivia. Studies were carried out through Micro 60 automatic counter (Horiba ABX Diagnostic, France) and corroborated by manual techniques. T-student test was used to compare study groups and value of p <0.05 with 95% CI was used. Results Pregnant women residing at 3600 masl showed hemoglobin levels of 13,6 ± 2,3 g/dl, percentage of hematocrit 40,9 ±6,4% and reticulocytes 1,9 ± 0.7%. The difference of hemoglobin between pregnant and non-pregnant women was 2,6 g/dl. Conclusions Hematocrit and hemoglobin levels in pregnant women residing at 3600 masl are decreased. The decreased concentration of hemoglobin is higher compared to other altitudes. Pregnant women hematological values at high altitude are statistically different compared to sea level, probably due to physiological and genetic adaptation to high altitude.

Taste and Olfactory Changes Following Laparoscopic Gastric Bypass and Sleeve Gastrectomy.

BACKGROUND: Alterations in taste/smell after bariatric surgery have been observed, but few data is available. Some authors documented these changes and their role on weight loss but there is no evidence after laparoscopic sleeve gastrectomy (LSG). METHODS: Cohort study with patients submitted to laparoscopic gastric bypass (LGBP) and LSG that were asked to participate in a validated survey. The primary objective was to determinate the differences between procedures for taste and smell changes; a demographic and anthropometric analysis were also performed. Secondarily, the relation between food aversion and weight loss was also obtained. RESULTS: Final analysis was based on 154 patients (104 LGBP and 50 LSG). The overall mean time between surgery and questionnaire was 10 ± 6.7 months. Most of the patients (87.6 %) experienced some taste/smell change. There were no differences between procedures for any change, taste or smell change. More patients submitted to LGBP referred that food smelled different (51.9 vs 34 % for the LSG group; p = 0.040). Higher %EWL was observed for patients presenting food aversion (73.3 ± 19.7 vs 65.8 ± 19.4 % for those without aversion; p = 0.046). Based on type of surgery, the LGBP group had the same trend (%EWL of 78.2 ± 17.3 vs 70.4 ± 18.6 % for those without aversion; p = 0.044). CONCLUSION: The majority of patients presented taste and olfactory changes soon after surgery independently of type of procedure. Patients submitted to LGBP referred more often a different smell in food. Higher %EWL was observed in patients presenting any food aversion, especially in the LGBP group.

Response to chemoradiotherapy and lymph node involvement in locally advanced rectal cancer.

AIM: To establish the association between lymph node involvement and the response to neoadjuvant therapy in locally advanced rectal cancer. METHODS: Data of 130 patients with mid and low locally advanced rectal adenocarcinoma treated with neoadjuvant chemoradiation followed by radical surgery over a 5-year period were reviewed. Tumor staging was done by endorectal ultrasound and/or magnetic resonance imaging. Tumor response to neoadjuvant therapy was determined by T-downstaging and tumor regression grading (TRG). Pathologic complete response (pCR) is defined as the absence of tumor cells in the surgical specimen (ypT0N0). The varying degrees TRG were classified according to Mandard's scoring system. The evaluation of the response is based on the comparison between previous clinico-radiological staging and the results of pathological evaluation. χ (2) and Spearman's correlation tests were used for the comparison of variables. RESULTS: Pathologic complete response (pCR, ypT0N0, TRG1) was observed in 19 cases (14.6%), and other 18 (13.8%) had only very few residual malignant cells in the rectal wall (TRG2). T-downstaging was found in 63 (48.5%). Mean lymph node retrieval was 9.4 (range 0-38). In 37 cases (28.5%) more than 12 nodes were identified in the surgical specimen. Preoperative lymph node involvement was seen in 77 patients (59.2%), 71 N1 and 6 N2. Postoperative lymph node involvement was observed in 41 patients (31.5%), 29 N1 and 12 N2, while the remaining 89 were N0 (68.5%). In relation to ypT stage, we found nodal involvement of 9.4% in ypT0-1, 22.2% in ypT2 and 43.7% in ypT3-4. Of the 37 patients considered "responders" to neoadjuvant therapy (TRG1 and 2), there were only 4 N+ (10.8%) and the remainder N0 (89.2%). In the "non responders" group (TRG 3, 4 and 5), 37 cases were N+ (39.8%) and 56 (60.2%) were N0 (P < 0.001). CONCLUSION: Response to neoadjuvant chemoradiation in rectal cancer is associated with lymph node involvement.

Análisis de los factores predictores de amputación de extremidades en pacientes con quemaduras eléctricas de alto voltaje / Analysis of predictor factors of timb amputation in patients with high-voltage electrical burns

La amputación de extremidades es considerada una de las consecuencias más devastadoras de la injuria eléctrica. Cualquier factor que se correlacione con el grado de daño muscular se puede utilizar para predecir la necesidad de amputación de extremidades. El objetivo de este estudio fue determinar los factores que pueden ser utilizados para predecir la amputación de extremidades en pacientes con quemaduras eléctricas de alto voltaje. Material y Métodos: Noventa y siete pacientes con quemaduras eléctricas fueron ingresados al Servicio de Cirugía Plástica, Reconstructiva y Quemados del Hospital Nacional Arzobispo Loayza durante un período de 5 años. Se realizó un análisis retrospectivo de los posibles factores de riesgo asociados entre los pacientes en los cuales se realizó una amputación y aquellos que no. Resultados: Un total de 64 pacientes fueron incluidos para el análisis. Quince pacientes fueron sometidos a amputaciones de extremidades. El análisis multivariado de los factores de riesgo entre los grupos de amputación y no amputación mostró significación estadística para los niveles de la isoenzima CPK-MB en las primeras 24 horas. Un nivel de CPK-MB sérico por encima de 14,955 U/L predijo alto riesgo de amputación de extremidades con alta especificidad (83%) y sensibilidad (76%). Sólo un paciente con una notable disminución en los niveles de CPKt y CPK-MB tras fasciotomía evitó una amputación mayor de la extremidad. Conclusiones: Nuestros resultados sugieren que el nivel de CPK-MB es un factor independiente de predicción de amputación de extremidades en paciente con quemaduras eléctricas de alto voltaje. Sugerimos que la adición de la isoenzima CPK-MB como parámetro laboratorial puede ser un método valioso para la detección precoz de daño muscular...

Limb amputation is considered one of the most devastating consequences of electrical injury. Any factors that correlate with the degree of muscle damage can be used to predict the necessity of limb amputation. The aim of this study was to determine the factors that can be used to predict limb amputation in high-voltage electrically injured patients. Material and Methods: Ninety-seven high-voltage electrically injured patients were admitted to the Department of Plastic and Reconstructive Surgery and Burns of Hospital Nacional Arzobispo Loayza on a 5 year period. A retrospective analysis of the possible related risk factors between amputation and non-amputation patients was performed. Results: A total of 64 patients were enrolled for analysis. Fifteen patients underwent limb amputations. Multivariate analysis of the risk factors between amputation and non-amputation groups showed statistical significance for first 24 hour creatine kinase-isoenzyme MB (CKMB) level. A serum CK-MB level above 14,955 U/L predicted high risk of limb amputation with high specificity (83%) and sensitivity (76%). Only one patient with a remarkable decrease of creatine kinase (CPKt) and CK-MB levels after fasciotomy avoided a major limb amputation. Conclusions: Our results suggest that CPK-MB level is an independent factor for prediction of limb amputationin patients with high-voltage electrical burns. We suggest that the addition of CPK-MB evaluation to clinical symptom screening may be a valuable method for early detection of muscle damage...

[Factors related to a suboptimal bowel preparation for colonoscopy]. / Factores relacionados a una subóptima preparación intestinal para la colonoscopía.

INTRODUCTION: Colonoscopy is the standard method for the evaluation of the colon. A suitable intestinal cleaning is critical for the effectiveness and security of the procedure, but unfortunately there is a high proportion of suboptimal bowel preparation. OBJECTIVE: To identify factors related to suboptimal bowel preparation. METHODS: We performed an analytic, observational, cross-sectional and prospective study. We included all outpatients scheduled for colonoscopy in the Peruvian-Japanese Health Center between January and July 2012. We excluded patients with a complete or partial colonic resection. In patients with two or more colonoscopies during the study interval, only the first procedure was considered. Aronchick scale was used in assessment of bowel cleaning. The variables studied with relationship to bowel preparation were: age, sex, grade ofeducation, body mass index, time of examination, history (diabetes mellitus, stroke, cirrhosis, use of antidepressants/anxiolytics, number of bowel movements per week, abdominal surgery, personal history of previous colonoscopy, polyps and colon cancer, family history of colon cancer), received purgative, additional laxative, indication for colonoscopy and adverse effects of the preparation. Statistical analysis was made with SPSS v.160. For the categorical variables we used chi square test or Fisher exact test, whereas for continuous variables the Mann Whitney test was used. The variables significantly associated with suboptimal preparation in the univariated analysis were included in a multivariate analysis using logistic regression. RESULTS: We included 841 patients. The bowel preparation was suboptimal in 438 patients (52.1%). The univariate analysis showed that the factors related to suboptimal preparation were age (P = 0.023) and body mass index ≥ 30 kg/m2 (P = 0.021). The multivariate analysis confirmed that age ≥ 70 years old (P = 0.001) and body mass index ≥ 30 kg/m2 (P = 0.010) were the variables related to suboptimal bowel preparation. CONCLUSIONS: Age greater than 70 years old and obesity are factors related to suboptimal bowel preparation.

Helicobacter pylori Activates and Expands Lgr5(+) Stem Cells Through Direct Colonization of the Gastric Glands.

BACKGROUND & AIMS: Helicobacter pylori infection is the main risk factor for gastric cancer. We characterized the interactions of H pylori with gastric epithelial progenitor and stem cells in humans and mice and investigated how these interactions contribute to H pylori-induced pathology. METHODS: We used quantitative confocal microscopy and 3-dimensional reconstruction of entire gastric glands to determine the localizations of H pylori in stomach tissues from humans and infected mice. Using lineage tracing to mark cells derived from leucine-rich repeat-containing G-protein coupled receptor 5-positive (Lgr5(+)) stem cells (Lgr5-eGFP-IRES-CreERT2/Rosa26-TdTomato mice) and in situ hybridization, we analyzed gastric stem cell responses to infection. Isogenic H pylori mutants were used to determine the role of specific virulence factors in stem cell activation and pathology. RESULTS: H pylori grow as distinct bacterial microcolonies deep in the stomach glands and interact directly with gastric progenitor and stem cells in tissues from mice and humans. These gland-associated bacteria activate stem cells, increasing the number of stem cells, accelerating Lgr5(+) stem cell proliferation, and up-regulating expression of stem cell-related genes. Mutant bacteria with defects in chemotaxis that are able to colonize the stomach surface but not the antral glands in mice do not activate stem cells. In addition, bacteria that are unable to inject the contact-dependent virulence factor CagA into the epithelium colonized stomach glands in mice, but did not activate stem cells or produce hyperplasia to the same extent as wild-type H pylori. CONCLUSIONS: H pylori colonize and manipulate the progenitor and stem cell compartments, which alters turnover kinetics and glandular hyperplasia. Bacterial ability to alter the stem cells has important implications for gastrointestinal stem cell biology and H pylori-induced gastric pathology.

Predictive markers of response to neoadjuvant therapy in rectal cancer.

BACKGROUND: Neoadjuvant therapy followed by radical surgery is the standard treatment in locally advanced rectal cancer. It is important to predict the response because the treatment has side effects and is costly. The aim of this study was to establish the relationship among clinical, pathologic, and molecular biomarkers and the response to neoadjuvant therapy. METHOD: A total of 130 patients with locally advanced mid and low rectal cancer who underwent long-course radiotherapy with 5-FU based chemotherapy followed by radical surgical resection were included in the study. Clinical and pathologic data were collected. Paraffin-embedded sections obtained in diagnostic biopsies were assessed by immunohistochemical staining for molecular markers and classified using a semiquantitative method. Results were related with T-downstaging and tumor regression grade using Mandard scoring system on surgical specimens. RESULTS: Pathologic complete response was found in 19 patients (14.6%), while in another 18 (13.8%) only minor residual disease was seen in the rectal wall. T-downstaging was observed in 63 (48.5%). The average of lymph node retrieval in the surgical specimens was 9.4. Regarding predictive markers of response, there was significant correlation between the expression of B-cell lymphoma 2 (P = 0.005), ß-catenin (P = 0.03), vascular endothelial growth factor (P = 0.048) and apoptotic protease activating factor 1 (P = 0.03), tumor differentiation grade (P < 0.001), and response in the univariate analysis. T-downstaging was associated with vascular endothelial growth factor expression (P = 0.03) and tumor differentiation grade (P < 0.001). Significant parameters found in the multivariate analysis were tumor differentiation grade and Bcl-2 expression. CONCLUSIONS: Pathologic and molecular biomarkers in the diagnostic biopsies may help us predict tumor response to chemoradiation in rectal cancer patients.

Early iron deficiency enhances stimulus-response learning of adult rats in the context of competing spatial information.

Iron deficiency early in life results in neurocognitive deficits that persist into adulthood despite iron treatment. The hippocampus is particularly vulnerable to iron deficiency during the fetal and neonatal periods as evidenced by poorer hippocampus-mediated spatial recognition learning. However, the extent to which early iron deficiency alters interactions between hippocampus-based and extra-hippocampus based learning systems remains undetermined. The present study used an ambiguous maze-learning task to examine the learning process in iron sufficient young adult rats that had recovered from iron deficiency in the fetal and neonatal period. Animals were presented with a stimulus response-learning task in the context of spatial information; a procedure designed to elicit competition between dorsal striatum- and hippocampus-based systems respectively. Formerly iron deficient adult rats showed enhanced stimulus-response learning in the context of competing spatial/distal cue information, a finding suggestive of reduced hippocampal functional influence. The study provides evidence that early iron deficiency alters how different learning systems develop and ultimately interact in adulthood. The potential unbalancing of activity among major memory systems during early life has been postulated by others as a relevant factor underlying the developmental origins of certain psychiatric disorders.

Guía de práctica clínica para el diagnóstico y tratamiento de la hepatitis crónica por el virus de la hepatitis B / Practice guideline for diagnosis and treatment of chronic hepatitis virus hepatitis B

La presente guía establece los criterios técnicos para el diagnóstico y tratamiento de la hepatitis crónica secundaria a hepatitis viral B con la finalidad de contribuir a reducir la morbimortalidad de esta enfermedad. Da las definiciones para comprender las recomendaciones aquí dadas. Descripción de aspectos epidemiológicos, factores de riesgo asociados; aspectos clínicos y de diagnóstico de la hepatitis crónica por virus B. Se dan las recomendaciones de manejo incluyendo circunstancias especiales tales como el paciente con cirrosis, el paciente con coinfección VIH ó con coinfección con hepatitis C. Las recomendaciones aquí mencionadas se convierten en la guía nacional para el manejo de la Hepatitis crónica por hepatitis B.

This guide sets out the technical criteria for the diagnosis and treatment of chronic hepatitis secondary to viral hepatitis B. The guide intend to reduce the morbidity and mortality of this disease. The Guide give practical definitions to help understand the terminology, describe epidemiology, risk factors, and clinical aspects and the diagnosis of chronic hepatitis B. Finally the guide give recommendations for the management including special circumstances such as patients with cirrhosis, patients coinfected with HIV or coinfected with hepatitis C. The recommendations of the guide become the national guide for the management of chronic hepatitis B.

[Quality indicators for colonoscopy in the Peruvian Japanese Policlinic: linked factors]. / Indicadores de calidad en colonoscopía en el Policlínico Peruano Japonés: factores relacionados.

INTRODUCTION: Colonoscopy is the gold standard for the diagnosis of diseases of the colon and rectum and the primary prevention test for colon cancer. The main indicators of quality in colonoscopy are the rate of complete colonoscopy and the rate of detected adenomas. OBJECTIVES: We aimed to know the rates of cecal intubation and detection of adenomas and to identify factors related to these two quality indicators in colonoscopies performed in the Peruvian Japanese Policlinic during 2007. MATERIAL AND METHODS: A correlational cross-sectional and retrospective study was performed. Data were collected from the colonoscopies performed by 10 endoscopists in the Peruvian Japanese Policlinic during 2007. RESULTS: We included 843 colonoscopies. Cecal intubation was achieved in 801 patients (95%). The multivariate analysis found that cecal intubation was correlated with the type of sedation/analgesia and the quality of bowel preparation. At least one adenoma was detected in 168 colonoscopies (19.9%). Multivariate analysis found that age, colonic cleansing and time of withdrawal were factors significantly associated with the detection of adenomas. CONCLUSIONS: The quality of colonoscopy depends on several factors: bowel preparation, type of sedation/analgesia and time of withdrawal. These are the targets on which we can act to improve performance.

Combined therapy with danazol, pegilated interferon, and ribavirin improves thrombocytopenia and liver injury in rats with fibrosis.

The aim of this study was to investigate the effects of combinations of pegilated-interferon (PEG-IFN), ribavirin, and danazol on thrombocytopenia and liver injury in rats with fibrosis. Male adult Wistar rats were treated with either mineral oil, danazol (0.83 mg/kg per day), PEG-interferon alpha-2a (PEG-IFN, 0.3 microg/ week) + ribavirin (12 mg/kg per day), PEG-IFN + ribavirin + danazol, CCl(4) (4 g/kg for eight weeks), CCl(4) + PEG-IFN + ribavirin, or CCl(4) + PEG-IFN + ribavirin+ danazol. The following assays were conducted: hematology, clinical chemistry, liver function, liver fibrosis, lymphocyte cytokine mRNA expression, and bone-marrow DNA content. Platelet counts were low in sham-treated animals and animals treated with PEG- IFN + ribavirin (30% and 25% respectively; P < 0.05). PEG-IFN + ribavirin + danazol reduced platelet counts of fibrotic animals by only 9% (P < 0.05). PEG- IFN + ribavirin reduced hepatic collagen content by 50%, whereas danazol + PEG-IFN + ribavirin reduced hepatic collagen content by 60% (P < 0.05). PEG-IFN + ribavirin reduced the total bilirubin concentration by 27%, alanine amino transferase (ALT) activity by 75% and gamma-glutamyl transpeptidase (gamma-GTP) activity by 74% (P < 0.05). In contrast, danazol + PEG-IFN + ribavirin reduced total bilirubin levels by 61%, alkaline phosphatase activity by 45%, ALT activity by 76%, and gamma-GTP activity by 74% (P < 0.05). The only treatment that increased interleukin 10 (IL-10) mRNA in fibrotic rats was PEG-IFN + ribavirin. However, danazol + PEG-IFN + ribavirin reduced the expression of IL-6, IL-10, tumor necrosis factor alpha and transforming growth factor ss. Bone-marrow DNA content was not altered by any treatment. In conclusion, PEG-IFN + ribavirin + danazol could be a new therapeutic option for patients with liver injury, fibrosis, and thrombocytopenia.

Ecliptic method for the determination of backscatter into the beam monitor chambers in photon beams of medical accelerators.

A new method to measure the effect of the backscatter into the beam monitor chambers in linear accelerators is introduced from first principles. The technique, applicable to high-energy photon beams, is similar to the well-known telescopic method although here the heavy blocks are replaced by a very small, centred block on the shadow tray, thus the name 'ecliptic method'. This effect, caused mainly by backscattering from the secondary collimators, is known to be an output factor constituent and must be accounted for when detailed calculations involving the machine's head are required. Since its magnitude is generally small, experimental errors might obscure the behaviour of the phenomenon. Consequently, the procedure introduced goes along with an uncertainty assessment. Our theory was confirmed via measurements in cobalt-60 beams, where the studied effect does not contribute to the output factor. Measurements were also performed on our Saturne 41 linear accelerator and the results were qualitatively similar to those described elsewhere. The collimation systems were studied separately by varying one jaw setting while keeping the other at its maximum value. In the light of these results, we deduced an algorithm that can correlate the former data with the effect of backscattering to the beam monitor chambers for any rectangular field within 0.5%, which is of the order of the experimental uncertainty (0.6%). As we show, the experimental procedure is safe, simple, not invasive for the linac and requires only basic dosimetry equipment.