Pyloric EndoFlip and Its Clinical Use in Gastroparesis / EndoFLIP pilórico y su utilidad clínica en gastroparesia

Abstract Gastroparesis is a chronic disorder of gastric motility that results in marked impairment of quality of life and significant costs to health care systems. Medical therapies are limited in their management, thus, the reason for a growing enthusiasm for pylorus-targeted therapies. The functional luminal imaging probe (FLIP) is a useful diagnostic tool for assessing pylorus characteristics, especially in refractory cases, which could lead to a better management strategy and, in many cases, predict clinical response.

Resumen La gastroparesia es un trastorno crónico de la motilidad gástrica que genera un deterioro marcado de la calidad de vida y costos significativos en los sistemas de salud. Las terapias médicas son limitadas para su manejo, por lo cual ha surgido un entusiasmo creciente en las terapias dirigidas al píloro. La sonda de imagen luminal funcional (FLIP) ha demostrado ser una herramienta diagnóstica útil para evaluar las características del píloro, especialmente en casos refractarios, en los que podría guiar hacia una mejor estrategia de manejo y, en muchos casos, predecir la respuesta clínica.

Experiencia con sonda luminal funcional endoluminal (EndoFLIP) en Hospital Universitario San Ignacio, Bogotá, Colombia / Experience with endoluminal functional luminal probe (EndoFLIP) at San Ignacio University Hospital, Bogota, Colombia

RESUMEN Introducción: La EndoFLIP (por sus siglas en inglés: sonda luminal funcional endoluminal) es un sistema que mide en tiempo real el índice de la distensibilidad de la unión esofagogástrica y el peristaltismo esofágico secundario, basándose en el principio de planimetría de impedancia. Aunque esta tecnología es relativamente nueva y su utilidad diagnóstica aún se encuentra en evaluación, cada vez se reconoce más su uso en la práctica clínica, fundamentalmente en aquellos pacientes donde no hay un diagnóstico manométrico conclusivo de un trastorno motor esofágico, principalmente obstrucción al tracto de salida y acalasia. Objetivo: El objetivo del presente estudio es describir la experiencia con la EndoFLIP en el Hospital Universitario San Ignacio en Bogotá, Colombia. Materiales y métodos: Estudio observacional descriptivo tipo serie de casos, donde se incluyeron pacientes mayores de 18 años a quienes se les realizó EndoFLIP en el Hospital Universitario San Ignacio desde el año 2021 hasta el 2022, bien sea de forma intrahospitalaria como ambulatoria, con indicación clara de realización del estudio, previamente discutida en Junta multidisciplinaria de Gastroenterología. Resultados: Se incluyeron un total de 27 pacientes en el estudio con promedio de 55,6 años de edad, de los cuales 20 eran mujeres (74%) y 7 hombres (26%). La indicación más frecuente del estudio fue diagnóstico no conclusivo de obstrucción al tracto de salida identificado en manometría esofágica de alta resolución de acuerdo a los criterios de la clasificación de Chicago 4.0 (14 pacientes), seguido de esófago hipercontráctil (4 pacientes) y motilidad esofágica inefectiva (3 pacientes). Al evaluar la respuesta contráctil, se encontró que 9 pacientes con diagnóstico no conclusivo de obstrucción al tracto de salida tenían respuesta normal, 3 ausente y una alterada; y en los pacientes con diagnóstico no conclusivo de acalasia uno de ellos tenía respuesta contráctil limítrofe y dos ausente. La totalidad de los pacientes con diagnóstico previo de contractilidad ausente, tenían respuesta contráctil igualmente ausente en la EndoFLIP. Conclusiones: La imagen luminal funcional endoluminal es una técnica que evalúa las propiedades biomecánicas como la distensibilidad, volumen, presión e inclusive diámetros de regiones esfinterianas como la unión esofagogástrica, píloro y ano. Se ha destacado su utilidad para varias indicaciones, siendo las más importantes los diagnósticos manométricamente no conclusivos de trastornos motores esofágicos como la acalasia y la obstrucción del tracto de salida, patologías que tienen un impacto importante en la calidad de vida de los pacientes y cuyo diagnóstico es esencial para poder brindar la mejor opción terapéutica.

ABSTRACT Introduction: The EndoFLIP (for its acronym in English: endoluminal functional luminal probe) is a system that measures in real time the compliance index of the gastroesophageal junction and secondary esophageal peristalsis, based on the principle of impedance planimetry. Although this technology is relatively new and its diagnostic usefulness is still being evaluated, its use in clinical practice is increasingly recognized, fundamentally in those patients where there is no conclusive manometric diagnosis of esophageal motor pathology, mainly esophagogastric junction outflow obstruction and achalasia. Objective: The aim of the present study is to describe the experience with EndoFLIP at the San Ignacio University Hospital in Bogotá, Colombia. Material and methods: Descriptive observational case series study, which included patients over 18 years of age who had undergone EndoFLIP at the San Ignacio University Hospital from 2021 to 2022, either in-hospital or outpatient, with a clear indication of performance of the study, previously discussed in the multidisciplinary Gastroenterology Board. Results: A total of 27 patients with an average age of 55 years were included in the study, of which 20 were women (74%) and 7 men (26%). The most frequent indication of the study was an inconclusive diagnosis of outflow tract obstruction identified in high-resolution esophageal manometry according to Chicago 4.0 criteria (14 patients), followed by hypercontractile esophagus (4 patients) and ineffective esophageal motility (3 patients). When evaluating the contractile response, it was found that 9 patients with an inconclusive diagnosis of outflow tract obstruction had a normal response, 3 absent and one altered; and in the patients with an inconclusive diagnosis of achalasia, one of them had a borderline contractile response and two had no response. All patients with a previous diagnosis of absent contractility had an equally absent contractile response in EndoFLIP. Conclusion: Endoluminal functional luminal imaging is a technique that evaluates biomechanical properties such as distensibility, volume, pressure and even diameters of sphincter regions such as the gastroesophageal junction, pylorus and anus. Its usefulness has been highlighted for several indications, the most important being manometrically inconclusive diagnoses of esophageal motor disorders such as achalasia and outflow tract obstruction, pathologies that have a significant impact on the quality of life of patients and whose diagnosis is essential to be able to provide the best treatment option.

Current Approach to Training and Assessing New Generations of Endoscopists / Enfoque actual para enseñar y evaluar a las nuevas generaciones de endoscopistas

Abstract Esophagogastroduodenoscopy (EGD) is a diagnostic and therapeutic study for various upper gastrointestinal tract diseases. It is a fundamental part of the education and training fellows receive in gastroenterology programs, focusing on developing skills to perform it safely, effectively, and efficiently and master the technique. Historically, value has been attached to the number of procedures required to acquire skills; there is a discrepancy in the recommendations by scientific societies regarding the "ideal" number to meet the minimum requirements and learn the necessary skills. However, each student has different innate and developed abilities that make this process asymmetric. Adopting a combined training approach (observation, clinical practice, and simulation) is the best method to learn diagnostic EGD. We are facing a generation with forms of learning different from those traditionally implemented, which implies an ongoing process of training and updating for endoscopists dedicated to teaching.

Resumen La esofagogastroduodenoscopia (EGD) es un estudio diagnóstico y terapéutico para diferentes enfermedades del tracto gastrointestinal superior, que hace parte fundamental de la formación y el entrenamiento que reciben los fellows en los programas de gastroenterología, y se centra en el desarrollo de capacidades para llevarla a cabo de manera segura, eficaz, eficiente y con un claro dominio de la técnica. Históricamente, se le ha dado un valor fundamental a la cantidad de procedimientos requeridos para la adquisición de las habilidades y existe discrepancia en la recomendación dada por las diferentes sociedades científicas respecto a la cantidad "ideal" para cumplir con las exigencias mínimas y lograr las destrezas necesarias; sin embargo, cada estudiante tiene unas habilidades innatas y desarrolladas diferentes que hacen que ese proceso sea asimétrico en cada caso. La adopción de un enfoque de entrenamiento combinado (observación, práctica clínica y simulación) es el mejor método para aprender EGD diagnóstica, dado que estamos frente a una generación que tiene formas de aprendizaje diferentes a las implementadas tradicionalmente, lo cual implica un proceso de entrenamiento y actualización constante de los endoscopistas que se dedican a la docencia.

Use of health care services according to functional performance in community-dwelling older adults in Spain. An approach using GAMLSS models.

Functional performance in older adults is a predictor of survival and other health outcomes and its measurement is highly recommended in primary care settings. Functional performance and frailty are closely related concepts, and frailty status is associated with the use of health care services. However, there is insufficient evidence on the utilization of services profile according to the functional performance of older adults. The aim of this study was to assess the relationship between functional performance and the use of a wide range of health services in community-dwelling older adults. Generalized additive models for location, scale and shape were used to study these complex data of services utilization, from primary to hospital care. A total of 749 participants from two Spanish regions were followed up for 2 years. Of those, 276 (37%) presented low functional performance and 473 (63%) normal performance according to the Timed Up and Go test. The results showed that even after adjusting for burden of comorbidity and polypharmacy, participants with low functional performance used primary and secondary care health services more intensively, visited emergency rooms more often, and were hospitalized more frequently and for longer periods of time. A negative binomial distribution and a variant thereof were found to be the best models to describe health service utilization data. In conclusion, functionality should be considered as an important health indicator for tailoring the provision of health services for older adults.

Cardiovascular risk factors and comorbidities in people living with HIV: A cross-sectional multicenter study from Colombia comorbidities in a Colombian PLWHIV population.

INTRODUCTION: HIV is an independent risk factor for cardiovascular diseases (CVD). There is insufficient information regarding comorbidities and cardiovascular risk factors in the Colombian HIV population. The aim of this study is to describe the prevalence of cardiovascular risk factors and comorbidities in patients from the HIV Colombian Group VIHCOL. METHODS: This is a multicenter, cross-sectional study conducted in the VIHCOL network in Colombia. Patients 18 years or older who had at least 6 months of follow-up were included. A stratified random sampling was performed to estimate the adjusted prevalence of cardiovascular risk factors and comorbidities. RESULTS: A total of 1616 patients were included. 83.2% were men, and the median age was 34 years. The adjusted prevalence for dyslipidemia, active tobacco use, hypothyroidism, and arterial hypertension was 51.2% (99% CI: 48.0%-54.4%), 7.6% (99% CI: 5.9%-9.3%), 7.4% (99% CI: 5.7%-9.1%), and 6.3% (99% CI: 4.8%-7.9%), respectively. CONCLUSIONS: In this Colombian HIV cohort, there is a high prevalence of modifiable CVD risk factors such as dyslipidemia and active smoking. Non-pharmacological and pharmacological measures for the prevention and management of these risk factors should be reinforced.

Experiencia cubana en planificación de los recursos humanos de enfermería en la epidemia por COVID-19 / Cuban experience in human resources planning for epidemic nursing COVID-19

Introducción: la pandemia por el virus SARS-CoV-2 ha provocado numerosas víctimas en el plano mundial. A partir de los primeros casos diagnosticados en Cuba, la máxima Dirección del Estado y el Ministerio de Salud Pública dispusieron el reordenamiento de los servicios del Sistema Nacional de Salud para garantizar la atención a los pacientes confirmados con la enfermedad y los programas priorizados con el aseguramiento de los recursos humanos de enfermería, además del desarrollo de acciones para garantizar la continuidad y calidad de las prestaciones proporcionadas. Desarrollo: se organizaron grupos de pesquisa diaria del 100% de la población en las viviendas para identificar a pacientes sintomáticos y se crearon centros para la vigilancia de acuerdo con la clasificación del paciente, ya fuera con- tacto, sospechoso o confirmado. En estos centros, el personal de enfermería mantiene una vigilancia para la detección oportuna de síntomas o agravamiento del estado de salud y efectúa el control de las pruebas diagnósticas por PCR evolutiva y el cumplimiento de los tratamientos médicos hasta su alta. En los hospitales se atienden los casos confirmados y sospechosos de alto riesgo de COVID-19. En estas instituciones se estableció un sistema de trabajo-vigilancia-descanso con el objetivo de garantizar la atención con el personal estrictamente necesario. Conclusiones: este trabajo permite compartir las experiencias vivenciales en la planificación del recurso humano de enfermería en cada una de las etapas y destaca la colaboración médica como muestra de solidaridad y humanismo que caracteriza a la sociedad. Los resultados obtenidos permitirán establecer líneas de trabajo con una clara visión de este fenómeno, con utilización óptima de los recursos materiales y humanos, además de contribuir a la preparación de los profesionales para el intercambio y la experiencia con otros países.

Introduction: The pandemic caused by the SARS-CoV-2 virus has hit numbers of victims worldwide, from the first cases diagnosed in Cuba, the highest state administration and the Ministry of Public Health provides the reorganization of the services of the National System of Health, guaranteeing care for patients confirmed with the disease and prioritized programs with the assurance of nursing human resources and the development of actions to guarantee the continuity and quality of the services provided for what the purpose is outlined. Development: Daily investigation groups of 100% of the population were organized in the homes to detect symptomatic patients, surveillance centers were created according to the classification of the patient as contact, suspect and confirmed, in these centers the nurse maintains a surveillance for the timely detection of symptoms or worsening of their health, controls the performance of the evolutionary PCR and compliance with medical treatments until discharge. In hospitals, confirmed and suspected high-risk cases of COVID-19 are treated. In these institutions, a work-surveillance-rest system was established in order to guarantee care with the strictly necessary personnel. Conclusions: In this article we share the experiential experiences in the planning of the nursing human resource in each of the stages and medical collaboration stands out as a sign of solidarity and humanism that characterizes our society. The results obtained will allow establishing lines of work with a clear vision of this phenomenon with optimal use of material and human resources, as well as contributing to the preparation of professionals with a view to exchange and experience with other countries.

Description of frail older people profiles according to four screening tools applied in primary care settings: a cross sectional analysis.

BACKGROUND: Regarding the health care of older populations, WHO recommends shifting from disease-driven attention models towards a personalized, integrated and continuous care aimed to the maintenance and enhancement of functional capacities. Impairments in the construct of functional intrinsic capacity have been understood as the condition of frailty or vulnerability. No consensus has been yet reached regarding which tools are the most suitable for screening this kind of patients in primary care settings. Tools based on the measurement of functional performance such as Timed up and go test (TUG), Short Physical Performance battery (SPPB), self-completed questionnaires like Tilburg Frailty Indicator (TFI) and clinical judgement, as the Gerontopole Frailty Scale (GFS) may be adequate. The objective of this work is to describe and compare characteristics of community-dwelling individuals identified as vulnerable or frail by four tools applied in primary care settings. METHODS: Cross sectional analysis developed in primary care services in two regions of Spain. Community-dwelling independent individuals aged 70 or more willing to participate were recruited and data was collected via face-to-face interviews. Frailty was assessed by TUG, SPPB, TFI and GFST. Also socio-demographic characteristics, lifestyle habits and health status data (comorbidities, polypharmacy, self-perceived health), were collected. Multiple correspondence analysis (MCA) and cluster analysis were used to identify groups of individuals with similar characteristics. RESULTS: Eight hundred sixty-five individuals were recruited, 53% women, with a mean age of 78 years. Four clusters of participants emerge. Cluster 1 (N = 263) contained patients categorized as robust by most of the studied tools, whereas clusters 2 (N = 199), 3 (N = 183) and 4 (N = 220) grouped patients classified as frail or vulnerable by at least one of the tools. Significant differences were found between clusters. CONCLUSIONS: The assessed tools identify different profiles of patients according to their theoretical construct of frailty. There is a group of patients that are identified by TUG and SPPB but not by GFS or TFI. These tools may be useful in primary care settings for the implementation of a function- driven clinical care of older patients.

Capacidades para la gestión de resultados de investigación en sistemas y servicios de salud de enfermería en Cuba / Capacities for managing the results of health systems and health services research by nurses in Cuba

Introducción: Los resultados de las investigaciones en sistemas y servicios de salud trascienden el alcance de los objetivos previstos. Su gestión permite el cierre del ciclo investigativo y es para los profesionales de enfermería en Cuba uno de los retos a vencer en la visualización de su práctica investigativa. Por ello, se desarrolló una experiencia de la práctica que contribuyó a la consolidación de la gestión de los resultados de las investigaciones en sistemas y servicios de salud por los profesionales de enfermería en Cuba. Desarrollo: Se llevaron a cabo talleres con el objetivo de desarrollar en los profesionales de enfermería cubanos las capacidades institucionales e individuales para la gestión de los resultados de las investigaciones en sistemas y servicios de salud. Las primeras se hicieron con la designación de un responsable de investigación para la gestión institucional de este tipo de estudio y la creación de un repositorio que compilara los resultados de las investigaciones existentes. Las segundas recayeron en los responsables seleccionados y estuvieron relacionadas con la obtención de la categoría de investigadores, la gestión de publicación de artículos, la protección legal de resultados y su registro oficial en el sistema nacional de investigaciones del país. Conclusiones: las capacidades desarrolladas contribuyeron a la gestión de los resultados de los profesionales de enfermería de las instituciones participantes. Estas se integran a la etapa de sostenibilidad que implica el nivel nacional de capacidades para la investigación.

Introduction: The results of research in health systems and health services go beyond the significance of the expected target. Managing these results allows the closure of the research cycle and is one of the challenges that Cuban professional nurses have to confront in order to make visible their results. Due to this situation, a practical experience was developed to consolidate the management of research results in health systems and health services. Development: Workshops were carried out in order to develop institutional and individual capacities in Cuban professional nurses so that they could manage the results of health Systems and health services research. Institutional capacities were developed by designating a professional nurse researcher, responsible for the institutional management of this kind of studies and the creation of a repository to gather the results of the existent research. Individual capacities were carried out by the selected professionals and had to do with obtaining the researcher category, the publication of results, the legal protection of results, and the official registration in the national research system. Conclusions: The developed capacities contributed with the management of the research results of professional nurses of each participating institution. Those capacities are part of the sustainability stage that includes the national level of capacities for research.

Performance of an immunochromatography test for virax malaria in the Amazon region, Brazil

Avaliaçäo do teste ICT malaria Pf/PvTM para o diagnóstico da malária por P. vivax em Belém, Estado do Pará. Foram comparados os resultados do teste imunocromatográfico com a gota espessa (GE) e avaliados o comportamento desse teste, estocado a três temperaturas distintas (250C/ 300C/ 370C), 24 horas antes de seu uso. A sensibilidade do ICT malaria Pf/PvTM foi de 61,8 por cento com especificidade de 100por cento, valores preditivo positivo e negativo de 100 por cento e 71,8 por cento, respectivamente, e acurácia de 80,67por cento. A sensibilidade desse teste foi independente da densidade parasitária. Este teste necessita de reavaliaçäo para melhorar o seu comportamento no diagnóstico da malária por P. vivax

Correlation between Plasmodium vivax variants in Belém, Pará State, Brazil and symptoms and clearance of parasitaemia

The aim of this study was to determine how different types of P. vivax affect clinical symptoms and parasitaemia clearance. Blood was collected from individuals from Pará State, Brazil. The patients were treated as chloroquine plus primaquine. P. vivax were typed daily till D7 and again on D30. Now we can confirm a previously reported correlation between P. vivax genotype and response to chloroquine. Clinical symptoms do not allow for objective identification of different P. vivax types in the Brazilian Amazon, since the VK247 and P. vivax-like have only been detected in mixed infections

Associação entre líquen plano oral e infecção pelo vírus da hepatite C: revisão de literatura / Association between oral lichen planus and hepatitis C virus infection: a literature review

Estudos epidemiológicos têm demonstrado que existe associação entre o líquen plano oral (LPO) e a infecção crônica pelo vírus da hepatite C (HCV). O RNA do HCV tem sido detectado nas células epiteliais das lesões de LPO em pacientes infectados, através da técnica da reação em cadeia da polimerase por transcrição reversa (RT-PCR) e por hibridização in situ. Os autores fazem uma revisão da literatura sobre as evidências da implicação do HCV na etiologia do LPO, discutindo alguns aspectos controversos sobre o tema

A participacao popular na gerencia do Sistema Unico de Saude: erros e acertos da experiencia de Botucatu - SP / Popular participation in management of the Unified Health System: wrong and right points of Botucatu - SP, Brazil

Relata a experiencia de participacao de representantes da comunidade de Botucatu na gerencia do Sistema Unico de Saude (MMSC)