Latin American consensus on the quality indicators for comprehensive care clinics for patients with inflammatory bowel disease: PANCCO-GETECCU.

INTRODUCTION: Inflammatory bowel disease (IBD) is a chronic and incurable entity. The aim of the Pan American Crohn's and Colitis Organisation (PANCCO) is to create awareness of IBD, with special emphasis on Latin America, and the primary objective of the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU, the Spanish acronym) is to obtain the accreditation of the clinical and therapeutic criteria for the diagnosis and treatment of IBD. AIM: To carry out a consensus for evaluating the approval criteria that a Comprehensive Care Clinic for Latin American IBD patients must meet, to be considered a center of excellence. MATERIALS AND METHODS: Fourteen clinical experts participated in the consensus. They were made up of specialists in gastroenterology, with broad clinical experience, spanning several years, in managing the care of a large number of patients with IBD, as well as advanced specialists in IBD. Thirteen of the participants came from 11 Latin American countries (Argentina, Brazil, Colombia, Dominican Republic, Ecuador, Guatemala, Mexico, Peru, Puerto Rico, Uruguay, and Venezuela) that have IBD clinics. An expert from Spain, representing the GETECCU, provided the methodologic support. The consensus consisted of 52 statements divided into three sections: 1) Structure indicators, 2) Process indicators, and 3) Result indicators. The Delphi panel method was applied. RESULTS: The present Latin American consensus describes the quality indicators that a Comprehensive Care Clinic for IBD patients must meet, to be considered a center of excellence, taking into account the needs of our region. CONCLUSIONS: This is the first Latin American consensus, jointly carried out by the PANCCO and GETECCU, to present accreditation standards for centers of excellence in the care of patients with IBD.

The Mexican consensus on the diagnosis and treatment of diverticular disease of the colon. / Consenso mexicano sobre el diagnóstico y tratamiento de la enfermedad diverticular del colon.

Since the publication of the 2008 guidelines on the diagnosis and treatment of diverticular disease of the colon by the Asociación Mexicana de Gastroenterología, significant advances have been made in the knowledge of that disease. A systematic review of articles published in the medical literature from January 2008 to July 2018 was carried out to revise and update the 2008 guidelines and provide new evidence-based recommendations. All high-quality articles in Spanish and English published within that time frame were included. The final versions of the 43 statements accepted in the three rounds of voting, utilizing the Delphi method, were written, and the quality of evidence and strength of the recommendations were established for each statement, utilizing the GRADE system. The present consensus contains new data on the definition, classification, epidemiology, pathophysiology, and risk factors of diverticular disease of the colon. Special emphasis is given to the usefulness of computed tomography and colonoscopy, as well as to the endoscopic methods for controlling bleeding. Outpatient treatment of uncomplicated diverticulitis is discussed, as well as the role of rifaximin and mesalazine in the management of complicated acute diverticulitis. Both its minimally invasive alternatives and surgical options are described, stressing their indications, limitations, and contraindications. The new statements provide guidelines based on updated scientific evidence. Each statement is discussed, and its quality of evidence and the strength of the recommendation are presented.

Consenso mexicano sobre el diagnóstico y tratamiento de la enfermedad diverticular del colon / The Mexican consensus on the diagnosis and treatment of diverticular disease of the colon

Desde la publicación en 2008 de las guías de diagnóstico y tratamiento de la enfermedad diverticular del colon de la Asociación Mexicana de Gastroenterología ha habido avances significativos en el conocimiento de esta enfermedad. Se realizó una revisión sistemática de la literatura en PubMed de enero de 2008 a julio de 2018 con el fin de revisar y actualizar las guías 2008 y proporcionar nuevas recomendaciones basadas en la evidencia. Se incluyeron todas las publicaciones en español e inglés, de alta calidad. Se redactaron los enunciados, que fueron votados utilizando el método Delphi. Se estableció la calidad de la evidencia y la fuerza de las recomendaciones según el sistema GRADE para cada enunciado. Cuarenta y tres enunciados fueron finalmente votados y calificados. Se informan nuevos datos sobre definición, clasificación, epidemiología, fisiopatología y factores de riesgo. Se revisó con especial énfasis la utilidad de la tomografía computarizada y de la colonoscopia, así como los métodos endoscópicos para el control de la hemorragia. Se discutió sobre el tratamiento ambulatorio de la diverticulitis no complicada, el papel de la rifaximina y la mesalazina, en el manejo de la diverticulitis aguda complicada tanto en sus alternativas mínimamente invasivas hasta las opciones quirúrgicas con énfasis en sus indicaciones, limitaciones y contraindicaciones. Los nuevos enunciados proporcionan directrices basadas en la evidencia actualizada. Se presentan la discusión, el grado y la fuerza de la recomendación de cada uno de ellos.

[Effectivity versus toxicity of minoxidil as antiproliferative agent for lens epithelial cells. In vitro study]. / Efectividad versus toxicidad del minoxidil como agente antiproliferativo de células epiteliales de cristalino. Estudio in vitro.

PURPOSE: To evaluate the inhibitory effect of minoxidil on cultured proliferating lens epithelial cells (LECs) versus cytotoxic effect over corneal endothelial cells in culture, because minimum side effects over anterior chamber structures and particularly on corneal endothelium are required for successful therapy and prevention of posterior capsular opacification (PCO). METHODS: New Zealand Rabbit LECs and corneal endothelium were cultured in DMEM at 35 degrees C in 5% CO2 in multiwells during 7 days. Both types of cells were exposed to minoxidil (1, 2 and 4 mM) for 1 and 24 hours. Control group and balanced salt solution group were included. After seven days multiwells were processed for light microscopy study. Morphometric study of cellular population of LECs and corneal endothelium cells were done using a computed planimetry system. RESULTS: Dose-dependent effect on LECs proliferation was noted and non-confluent colonies of cells were observed on all treated groups. Morphologic changes in normal appearance of corneal endothelial cells after 1 hour of minoxidil treatment was observed and intracellular alterations were confirmed even with the lowest dose exposure. CONCLUSIONS: Although effectiveness of minoxidil suppressing in vitro LECs proliferation could be suggest as a useful therapeutic agent to prevent PCO, however the inhibitory effect of different concentrations on corneal endothelial cells conditioned its possible use on ocular surgery.

Potential harmful effect of iodinated intravenous contrast medium on the clinical course of mild acute pancreatitis.

HYPOTHESIS: A worse clinical outcome might be expected in patients with acute pancreatitis (AP) who receive intravenous contrast medium for a nondynamic contrast-enhanced computed tomographic (CECT) study early during hospital admission. DESIGN: Cohort analytic study. SETTING: Tertiary care center. PATIENTS: Of 126 patients with mild AP, 52 patients underwent CECT to establish AP diagnosis (group 1), and the remaining 74 did not (group 2). MAIN OUTCOME MEASURES: Survival and development of local or systemic complications during the hospital stay. Potential confounders were demographic, clinical, and biochemical data, as well as therapeutic measures. The Atlanta classification was used to define local and systemic complications. RESULTS: Mean age, etiology of AP, prognostic score on admission, and pharmacologic treatment were similar between groups. Local and systemic complications were more frequently observed in patients who underwent CECT (odds ratio, 11.4; 95% confidence interval, 2.0-64.8; P =.008). Six patients, all in group 1, developed a pancreatic abscess (odds ratio, 20.8; P =.004). In 5 of them, a second CECT showed more severe AP changes. The association between CECT and abscess development was more apparent in patients with a body mass index of 25 or more and/or nasogastric suction. Six patients in group 1 and 1 in group 2 had systemic complications (odds ratio, 9. 5; P =.01). There were no deaths. CONCLUSIONS: The observed increased incidence of local and systemic complications in patients with mild AP who undergo CECT, particularly in those with a body mass index of 25 or more, suggests a potentially harmful effect of intravenous contrast medium. Until this issue is clarified, it seems reasonable to restrict the use of dynamic CECT to patients with severe AP, protracted clinical course, or suspected local septic complication.

[Effect of mitomycin C on corneal endothelium cells. In vitro study]. / Efecto de la mitomicina C sobre el endotelio corneal. Estudio in vitro.

PURPOSE: Mitomycin C is an antibiotic with a demonstrated antiproliferative capacity as an inhibitor of fibroblastic cells proliferation. Its use has been extended in glaucoma surgery. In the present study, we evaluated mitomycin C effect on cell culture monolayer of rabbit corneal endothelium. METHODS: The source of corneal endothelium for cell culture was New Zealand albino rabbit eyes. Desegregation of cells was carried out with mechanic and enzymatic dissociation from corneal endothelium and Descemet membrane. Culture medium was EMEM. Three treatment groups of plates were exposed to three different concentrations of mitomycin C 2x10(-3) mg/ml, 2x10(-2) mg/ml and 2x10(-1) mg/ml. Control and witness plate groups were also established. The morphometric study was performed through quantitative analysis with a video system connected to the light microscope. RESULTS: Different morphological changes related with cell size, cytoplasm and dyeing were seen at the morphological study and several degenerative signs were established indicating cellular death and a very decrease of the cellular population. In the groups treated with minimal dose (2x10(-3) mg/ml) and 3 days evolution time, cellular population was 434 cels/mm(2), 7 evolution days group cell density was 300.97cels/mm(2), and at 14 days it was 201.88 cels/mm(2). The percentage of survival in all the groups of treated cells was under 50%. CONCLUSIONS: Mitomycin C in concentrations and exposure time as used in this study has a potent lethal effect on this cellular type that compromises to a greater or smaller extent their function and integrity.

[Adrenal abscess in the newborn: a case report and review of the literature]. / Absceso adrenal en el recién nacido: informe de un caso y revisión de la literatura.

This is a case report concerning a 22 day newborn referred to us having an abdominal tumor, fever, an irritable nature and feeding refusal, born dystocically due to the retention of the shoulders and having an Apgar score of 5/8. When admitted the presence of the tumor was corroborated in the right flank occupying the right renal fossa and measuring 5 x 8 cm, non-mobile and painless. Studies revealed a diagnosis of calcified right adrenal hemorrhage versus neuroblastoma. During surgery a right adrenal abscess was found which was drained and a biopsy sample was taken for further study. The culture of the pus developed Proteus mirabilis. Pathology reported it to be an abscessed right adrenal hematoma which was partially calcified. The patient's wound became infected but was later sent home under good conditions. Only 15 other cases with this pathology are reported in the literature, this would be the 16th case. An emphasis is placed on including this pathology as part of the differential diagnosis of retroperitoneal tumors in the newborn.

[Electrophysiologic studies in Guillain-Barré syndrome]. / Estudios electrofisiológicos en el síndrome de Guillain-Barré.

A preliminary investigation into electrodiagnostic methods in healthy children and in children with the Guillain-Barré syndrome (polyradiculoneuritis) was carried out in order to assess the validity of these procedures in the management of the disease. Studies of the strength-duration curves, the rheobase, the chronaxyie, the accommodation index curves, motor nerve conduction and electromyography were made in 30 healthy children and in 15 children suffering from polyradiculoneuritis. The strength-duration curves plotted on the rectus femoris muscles of the 15 sick children showed a steeply rising hyperbola and no response was elicited at the shorter pulse durations (less than 0.3 ms). The chronaxyie was long in very clinically involved muscle. The accommodation index curve showed a notably decreased slope in the left gastrocnemius muscles of the 15 patients. Conduction velocity of the anterior tibial nerve was either absent or low in all the patients during the first month of the disease. Electromyographic records showed disappearance of the interference pattern on maximal contraction of the diseased muscles; only a few isolated motor units could be recorded in the first month of the disease. The duration and amplitude of these units was markedly reduced, there was an increase in infrequency of polyphasic potentials and the presence of fibrillation potentials was noted in some cases. Serial electrophysiological studies should therefore be of interest and of value in the management of polyradiculoneuritis.