Emergent conversion from single-anastomosis gastric bypass to Roux-en-Y gastric bypass with subsequent obstruction of entero-enteric anastomosis by ascaris.

One anastomosis gastric bypass (OAGB), the third most commonly performed procedure worldwide, has shown excellent results in terms of weight loss and resolution of comorbidities compared with other bariatric surgeries. However, its use remains limited in various parts of the world due to postoperative complications. After the efficacy of this procedure was established, the focus of treatment shifted toward resolving postoperative complications. Protein-energy malnutrition after OAGB is one of the main issues that needs to be addressed. There are several operative options for patients who require revision surgery including reversal and conversion to Roux-en-Y gastric bypass (RYGB). The conversion from OAGB to RYGB is a feasible method that has shown excellent results when performed by experts in the field. Here, we present the case of a woman with symptoms of acute obstruction secondary to OAGB who underwent conversion to RYGB under emergent conditions.

Colonic lipoma of the hepatic flexure causing invagination in an adult.

Intussusception is a rare condition in adults that can lead to intestinal obstruction due to malignant or benign lesions in the wall of the colon. Among the benign causes, lipomas are adipose tissue tumors that are most frequently located in the ascending colon. Invagination is characterized by nonspecific symptoms and normal laboratory test results. The exact point of invagination can be detected using advanced imaging studies such as abdominal computed tomography and colonoscopy. Invagination is treated surgically. Here, we presented the case of a female patient with colo-colonic invagination caused by a large lipoma diagnosed by computed tomography who underwent right hemicolectomy with primary ileocolonic anastomosis.

Bioactive Polyphenols from Southern Chile Seaweed as Inhibitors of Enzymes for Starch Digestion.

The increment of non-communicable chronic diseases is a constant concern worldwide, with type-2 diabetes mellitus being one of the most common illnesses. A mechanism to avoid diabetes-related hyperglycemia is to reduce food digestion/absorption by using anti-enzymatic (functional) ingredients. This research explored the potential of six common Chilean seaweeds to obtain anti-hyperglycemic polyphenol extracts, based on their capacity to inhibit key enzymes related with starch digestion. Ethanol/water hot pressurized liquid extraction (HPLE), which is an environmentally friendly method, was studied and compared to conventional extraction with acetone. Total polyphenols (TP), antioxidant activity, cytotoxicity and inhibition capacity on α-glucosidase and α-amylase were analyzed. Results showed that the Durvillaea antarctica (cochayuyo) acetone extract had the highest TP content (6.7 ± 0.7 mg gallic acid equivalents (GAE)/g dry seaweed), while its HPLE ethanol/water extract showed the highest antioxidant activity (680.1 ± 11.6 µmol E Trolox/g dry seaweed). No extract affected cell viability significantly. Only cochayuyo produced extracts having relevant anti-enzymatic capacity on both studied enzymes, showing a much stronger inhibition to α-glucosidase (even almost 100% at 1000 µg/mL) than to α-amylase. In conclusion, from the Chilean seaweeds considered in this study, cochayuyo is the most suitable for developing functional ingredients to moderate postprandial glycemic response (starchy foods), since it showed a clear enzymatic inhibition capacity and selectivity.

Una nueva etapa de Publindex: dolores de crecimiento: [Editorial] / A new stage of Publindex: growth pains: [Editorial]

Los resultados de la convocatoria 768 de Publindex aplicando estándares internacionales, tales como el h5 y los cuartiles de Scimago (SJR), marcan una nueva etapa para las revistas colombianas, Un cambio doloroso, pero necesario. Para muchos autores colombianos de nuestras revistas puede ser no posible entender como Infectio pasa de clasificación A2 a B, cuando la revista ha aumentado sus índices de citación y es la única revista médica colombiana que logra ascender de cuartil SJR en 2016. Es decir que a pesar de mejorar sus índices bibliométricos internacionales esto no se ve reflejado en las categorías de revistas colombianas. De igual manera, Colombia Médica aumentó las citas de revistas indexadas en Scopus de los cuartiles 1 y 2; sin embargo, con los nuevos criterios de Publindex cambió su calificación de A1 a A2. Es de anotar que las revistas latinoamericanas en general han crecido de manera lenta y las revistas de Colombia siguen muy por debajo de Brasil y otros países de Latinoamérica, en los últimos años, como puede observarse al analizar los índices de Scopus (Figura 1). Los nuevos criterios de clasificación corrigen por lo menos situaciones caóticas, previamente analizadas1,2que permitían otorgar la misma clasificación de A1 a Nature o PNAS que a Biomédica (Revista del Instituto Nacional Salud de Colombia). El sistema de Publindex debió prever una transición por etapas, creando una clasificación intermedia, porque los efectos a corto y mediano plazo desestimulan las iniciativas editoriales nacionales, con mayor efecto en las revistas de mayor reconocimiento por su calidad. Es por eso que esta editorial busca ilustrar a nuestros lectores y autores (sobre todo los docentes universitarios estales colombianos), las razones e implicaciones de esta nueva clasificación.

The results of Publindex's call for papers 768 applying international standards, such as h5 and Scimago quartiles (SJR), mark a new stage for Colombian journals, a painful but necessary change. For many Colombian authors of our journals it may not be possible to understand how Infectio goes from A2 to B classification, when the journal has increased its citation rates and is the only Colombian medical journal that manages to move up from SJR quartile in 2016. That is to say that despite improving its international bibliometric indexes this is not reflected in the categories of Colombian journals. Similarly, Colombia Médica increased the citations of journals indexed in Scopus from quartiles 1 and 2; however, with the new Publindex criteria it changed its rating from A1 to A2. It should be noted that Latin American journals in general have grown slowly and Colombian journals continue to lag far behind Brazil and other Latin American countries in recent years, as can be seen when analyzing the Scopus indexes (Figure 1). The new classification criteria at least correct chaotic situations, previously analyzed1,2 that allowed granting the same A1 classification to Nature or PNAS as to Biomédica (Journal of the National Institute of Health of Colombia). The Publindex system should have foreseen a transition in stages, creating an intermediate classification, because the short and medium term effects discourage national editorial initiatives, with greater effect on journals with greater recognition for their quality. That is why this editorial seeks to illustrate to our readers and authors (especially Colombian state university professors), the reasons and implications of this new classification.

High-Dose Filgrastim Treatment of Nonregenerative Pancytopenia Associated With Chronic Canine Ehrlichiosis.

OBJECTIVE: To report the management and outcome of a dog with canine monocytic ehrlichiosis and nonregenerative pancytopenia, with high doses of filgrastim. CASE DESCRIPTION: An 8-year-old male, mixed-breed dog, weighing 5.6kg, presented with a 1-month history of hyporexia, adynamia, and a weight loss of approximately 1kg. The general condition of the dog was observed to be poor as follows: lethargy, tachycardia, marked pallor of the mucous membranes, petechiae on the abdomen, hepatosplenomegaly, and cervical lymphadenopathy. A complete blood count analysis revealed severe leukopenia, thrombocytopenia, and anemia. A direct immunofluorescence assay using anti-Ehrlichia canis-immunoglobin G (1:400) yielded positive result. The dog was diagnosed with nonregenerative pancytopenia associated with canine monocytic ehrlichiosis. The dog presented poor prognostic signs (neutropenia, thrombocytopenia, and severe anemia). The dog was treated with antibiotics and a short course of high-dose filgrastim (50µg/kg, SC, q 48h for 4 days) to stimulate bone marrow response, prednisone to decrease peripheral platelet destruction, and an iron supplement to compensate for the iron deficiency in the bone deposits. Although temporary side effects associated with filgrastim use, such as bone pain, bleeding, and the worsening of thrombocytopenia, were observed, the treatment improved the clinical course and the cell counts in less than a month. CLINICAL RELEVANCE: The treatment protocol used in this case might be an alternative for treating cases of severe myelosuppression. This treatment plan can substantially change the clinical course of the disease for the better, compared to conventional treatment.

Adverse drug reactions in internal medicine units at a university hospital: a descriptive pilot study / Reacciones adversas a medicamentos en salas de medicina interna de un hospital universitario: estudio descriptivo piloto

Introduction: Adverse drug reactions (ADRs) are an important cause of morbidity and mortality among hospitalized patients.Objectives: This study was designed to describe the frequency, severity, and causality of ADRs in internal medicine units at a third-level university hospital.Materials and methods: A descriptive study was performed at internal medicine units, by means of a structured format, review of clinical records, and interview of hospitalized patients. The Naranjo algorithm was applied to patient adverse events to define causality. Additionally, ADRs were classified according to the Rawlins and Thompson criteria.Results: One hundred patients (50 men and 50 women) were included in the study. Ninety nine (99) adverse events were found among the patients. The Naranjo algorithm was applied to adverse events, resulting in twenty nine (29) probable ADRs, twenty (20) possible ADRs and fifty (50) doubtful ADRs. Cardiovascular drugs and antibiotics were the most frequent therapeutic groups associated with ADRs. In addition, two preventable medication errors were identified.Conclusions: Frequency of ADRs was similar to the number reported in other studies in internal medicine units. It is necessary to systematize efforts of pharmacological surveillance in hospital wards, toward an opportune detection and prevention of ADRs.

Introducción: Las reacciones adversas a medicamentos (RAM) son una importante causa de morbilidad y mortalidad en pacientes hospitalizados.Objetivos: Este estudio se diseñó para describir la frecuencia, severidad y causalidad de las RAM en las salas de Medicina Interna de un hospital universitario de tercer nivel.Materiales y métodos: Se realizó un estudio descriptivo en las salas de hospitalización de Medicina Interna, con un formato estructurado, revisión de historia clínica y entrevista a los pacientes. Para definir causalidad, se aplicó el algoritmo de Naranjo a los eventos adversos de los enfermos. Además, se clasificaron las RAM de acuerdo con los criterios de Rawlins y Thompson.Resultados: En el estudio se incluyeron 100 pacientes (50 hombres y 50 mujeres). Se informaron 99 sucesos adversos; con el algoritmo de Naranjo se clasificaron como RAM probables (n=29), RAM posibles (n=21) y RAM dudosos (n=49). Los medicamentos cardiovasculares y los antibióticos fueron los grupos terapéuticos más relacionados con efectos adversos. Se descubrieron dos errores de medicación prevenibles.Conclusiones: La frecuencia que se encontró de estas reacciones adversas fue similar a la que informaron otras investigaciones en servicios de Medicina Interna. Es necesario sistematizar los esfuerzos de fármaco-vigilancia hospitalaria para prevenir y evitar oportunamente las RAM.

Caracterización de un modelo organotípico de cultivos de neuronas corticales de humano derivadas de trauma craneoencefalico / Organotypic human neuronal culture derived from traumatic brain injury

Introducción: El trauma craneoencefalico (TEC) es un problema de salud global que puede generar en los pacientes que lo padecen, muerte, discapacidad y/o alteraciones psiquißtricas con gran impacto sobre su desempe±o posterior y sobre su ßmbito familiar. En los últimos años se ha avanzado en el conocimiento de los mecanismos fisiopatológicos que subyacen al TCE. Sin embargo, esto no estß completamente entendido, como tampoco hay claridad sobre los mecanismos de neuroprotección. Por esta razón cada vez mas se buscan modelos que permitan aproximarse al estudio de este síndrome y de esta manera aproximarse a la neuroprotección. Objetivo: Caracterizar un modelo de cultivo organotípico de neuronas corticales humanas obtenidas de personas que sufrieron TCE y a las cuales se les practicó remoción de la contusión. Metodología: Se utilizó tejido cortical humano procedente de 4 individuos que sufrieron TCE y a los cuales se les removió la contusión. Se obtuvieron tajadas de corteza cerebral de 1,500-2,000 mm, las cuales se mantuvieron en un flujo continuo de LCRa a 2 ml/min y una mezcla gaseosa de O2 al 95 por ciento y CO2 al 5 por ciento con burbujeo permanente durante 2, 8 y 14 horas. Se tomó como tiempo cero el momento de obtención de la muestra. Después de cada tiempo se tomaron las tajadas, se cortaron en un vibratomo de medio líquido a 50 mm y se procesaron inmunohistoquímicamente con los marcadores neuronales de degeneración NeuN y MAP2. Resultados: Los resultados indican que las muestras de corteza cerebral se pudieron mantener con cierto grado de integridad celular y laminar hasta las 2 horas de cultivo. Se observó que a partir de este tiempo se inicia un proceso de alteración de la citoarquitectura neuronal y laminar, determinada por la pérdida y alteración de la inmunorreactividad a los marcadores NeuN y MAP2. Ademas se encontró que hay vulnerabilidad celular que compromete en mayor medida a las neuronas localizadas en las laminas corticales III y V.

Introduction: Traumatic brain injury is a global medical problem whose survivors may show disability and neurological or psychiatric sequelae. In the last few years the knowledge of physiopathological mechanisms of TBI has increase but still it is not entirely known. For this reason the research has turn over in one´s mind in new strategies to study this pathology looking for neuroprotection. Objective: The aim of this work is to develop an organotypic culture of cortical human neurons derived from a contusion tissue obtain from patients that suffered TBI. Methodology: We used contused brain tissue from 4 TBI patients. Sections between 1,500-2,000 mm were kept in a continuous flow of aCSF 2 ml/min in a mixture of 95 percent O2 and 5 percent CO2 for 2, 8 and 14 hours. The initial time (0 hours) was the tissue extraction time. From blocks, sections of 50 mm were obtained and processed for immunocytochemistry to NeuN and MAP2. Results: The results show that organotypic cultures keep neuron integrity and laminar organization in the cerebral cortex slices from 0 to 2 hours. From this time ahead neuronal morphology and laminar organization is altered especially in neurons located on layers III and V.

Efectividad de la ivermectina en un modelo de disquinesia tardía inducida por haloperidol en ratas / Effectiveness of ivermectin in rats with haloperidol induced tardive dyskinesia

Introducción: Los síntomas extrapiramidales y en especial las disquinesias tardías, son la mayor limitante de la terapia con antipsicóticos, debido a la frecuencia de aparición durante el tratamiento y la falta de recursos para controlar estas reacciones adversas, por lo cual es necesario investigar nuevos recursos para el manejo de las disquinesias tardías. Objetivo: Evaluar el efecto de la ivermectina sobre las disquinesias tardías inducidas por haloperidol en ratas. Métodos: En un modelo de dosis única de haloperidol con ratas Sprague Dawley, se evalúo la capacidad de la ivermectina para evitar cambios en la conducta motora y la aparición de movimientos anormales. Adicionalmente, se implementó un modelo animal crónico conocido como VCM (vacuous chewing movements), donde se evaluó la frecuencia de movimientos orofaciales durante seis meses, al recibir simultaneamente haloperidol e ivermectina a dosis diferentes, comparandolo con un grupo control y otro grupo al que se le administró haloperidol. Resultados: La ivermectina no evitó los cambios inducidos por haloperidol en el comportamiento motor, ni la aparición de movimientos anormales en el modelo agudo. Tampoco modificó la frecuencia de movimientos orofaciales en el modelo de administración crónica de haloperidol. La ivermectina no indujo cambios en la conducta motora, ni la aparición de movimientos anormales en los modelos agudo y crónico. Conclusiones: Los hallazgos de este trabajo descartan a la ivermectina como candidata para el manejo de las disquinesias tardías y no permite aportar argumentos a la hipótesis GABAérgica en la fisiopatología de las disquinesias tardías. Adicionalmente, la ivermectina no induce movimientos anormales.

Introduction: Extrapiramidal symptoms and tardive dyskinesia are common problems associated with antypsychotic therapy. Basic and clinical research is warranted due to the lack of effective therapies aimed to the prevention and treatment of antipsychotic side effects. Objective: To evaluate the effect of ivermectin in rats with haloperidol induced tardive dyskinesia. Methods: The effect of ivermectin on motor behavior and abnormal movements was tested in Sprague-Dawley rats treated with a single dose of haloperidol. In addition, a chronic animal model known as VCM (vacuous chewing movements) was implemented with the objective to evaluate the effect of ivermectin on the frequency of orofacial movements during a period of six months. Results: Ivermectin does not prevent the motor behavior and frequency of abnormal movements induced by haloperidol in the acute model. Orofacial movements were not reduced with ivermectin in the chronic model. In addition, ivermectin was not associated with changes in motor behavior and abnormal movements in the acute and chronic model. Conclusions: Ivermectin is not a good candidate for the treatment of tardive dyskinesia and the results of this study do not support the GABAergic hypothesis in the physiopathology of tardive dyskinesia. Additionally, ivermectin does not induce abnormal movements.

Implementación de la técnica en órgano aislado vascular como herramienta para la validación de plantas medicinales: estudio del efecto vasodilatador de la Salvia scutellarioides / Implementation of the technique in isolated organ vascular as tool for the validation of medicinal plants: study of the vasodilator effect of the S. scutellarioides

Introducción: La Salvia scutellarioides es una planta con efecto antihipertensivo y diurético. En este estudio se evalúa su efecto vasodilatador con la técnica de órgano aislado vascular. Objetivos: Estandarizar la técnica de órgano aislado vascular y estudiar el efecto de S. scutellarioides en la vasoconstricción por estimulación de receptores alfa 1. Metodología: Se colocaron anillos de aorta de rata en un equipo de baño de órganos (BIOPAC®) a una temperatura de 37oC y burbujeo constante de gas carbógeno. Los cambios en la tensión se registraron con un transductor de tensión isométrica y un equipo de adquisición de datos. En la estandarización, se realizaron seis curvas de concentración-tensión con fenilefrina a las horas 1, 3 y 5, para determinar la tensión máxima (TM) y la concentración efectiva 50 (EC50). Finalmente, se obtuvieron curvas de concentración-tensión para fenilefrina con S. scutellarioides a una concentración de 10 mg/dl y 20 mg/dl. Resultados: En la estandarización de la técnica no se encontraron diferencias estadísticamente significativas en la TM y la EC50 para fenilefrina en la primera, tercera y quinta horas. La administración de S. scutellariodes ocasionó una disminución concentración dependiente de la TM sin cambios en la EC50. Discusión: La técnica de órgano aislado implementada es viable hasta por cinco horas y no ocasiona desensibilización de receptores alfa 1. La disminución de la TM por la S. scutellarioides se explica por un efecto de tipo a1 antagonista no competitivo. Se requieren estudios para aislar principios activos que permitan iniciar ensayos clínicos fase I en los seres humanos.

Introduction: Salvia scutellarioides is a plant with antihypertensive and diuretic properties. In this study, its vasodilator effect is evaluated using the isolated organ technique. Objectives: To standardize the isolated vascular organ, and to study the effect of S. scutellarioides in vasoconstriction by alfa 1 receptors stimulation. Methodology: Rat aortic rings were placed in an organ bath equipment (BIOPAC®), at 37o C temperature and constant carbogen gas bubbling. Tension changes were registered with an isometric tension transducer and data acquisition equipment. During the standardization, six curves of concentration-tension with phenylephrine at 1, 3 and 5 hours were registered, in order to determine maximum tension (TM), and the effective concentration 50 (EC50). Finally, three concentration-tension curves were obtained for phenylephrine with S. scutellarioides at a concentration of 10 mg/dl and 20 mg/dl. Results: During the technique standardization, no statistically significant differences were found in TM for phenylephrine at 1, 3 and 5 hours. The administration of S. scutellarioides produced a TM dose dependent reduction with no EC50 changes. Discussion: The implemented isolated organ technique is viable up to 5 hours, and does not produce alfa 1 receptors desensibilization. The TM diminution by S. scutellarioides is explained by a non competitive alfa 1 antagonism effect. Studies to isolate active principles for allowing the initiation of phase I human clinical trials are required.

Estudio de la actividad antisecretora de ácido gástrico del cannabis sativa en un modelo animal / Study of the gastric acid anti-secretory activity of cannabis sativa in an animal model

Introducción: Hay pocos estudios que describan el efecto de los cannabinoides en el sistema gástrico, pues en sólo uno se encontró referencia a alteraciones del pH gástrico. Objetivo: Determinar el efecto antisecretor de la especie Cannabis sativa. 4 Metodología: Se utilizaron 45 ratas Sprague Dawley que se sometieron a un ayuno de 24 horas, al cabo del cual se les ligó el píloro durante 2 ó 4 horas según el grupo experimental. Luego, se anestesiaron, se extirparon los estómagos y se analizó el contenido gástrico en términos de volumen y pH. Resultados: Se encontró que el extracto de Cannabis aumentó el pH gástrico con respecto al grupo control (p <0.05), sin hallar diferenciassignificativas entre el fármaco de referencia (ranitidina) y el extracto de Cannabis (p >0.05). El volumen medido no mostró diferencias entre los grupos. Conclusiones: Estos resultados, sugieren que el extracto de Cannabis sativa disminuye la secreción de ácido en el estómago.

Introduction: There are few studies that describe the effects of cannabinoids in the gastric system, although in only one, there was the description of a gastric pH alteration. Objective: To determine the anti-secretory effect of the species Cannabis sativa. Methodology: In this study forty five Sprague Dawley rats were used, they were submitted to a 24 hours fasting period, after which the pylorus was ligated for 2-4 hours, according to the experimental group. Thereafter, the rats were anesthetized, their stomachs extirpated and the gastric content analyzed for volume and pH. Results: The Cannabis extract raised the gastric pH when compared to the control group (p <0.05), with no significant differences found between the reference drug (ranitidine) and the Cannabis extract (p >0.05). There were no differences in the measured volumes. Conclusions: These results suggest that the Cannabis sativa extract diminishes the gastric acid output.

Ausencia de correlación entre las cifras tensionales, el daño de órgano blanco y la presencia de retinopatía en el modelo animal de hipertensión con L-NAME: ¿son necesarios nuevos modelos animales en hipertensión arterial? / Lack of association between blood pressure, target organ damage and retinopathy in the L-NAME rat hypertension model: are new animal models of hypertension required?

La comunidad científica nacional e internacional utiliza ampliamente modelos animales de hipertensión para el estudio de posibles fármacos antihipertensivos. Sin embargo, algunas de las complicaciones de la hipertensión arterial no se expresan por completo en los modelos animales. En este artículo se presenta la falta de correlación de las cifras tensionales con la retinopatía, en el modelo de ratas hipertensas por L-NAME. Además, plantea interrogantes con respecto al desarrollo de nuevos modelos animales de hipertensión, mejor correlacionados con la hipertensión humana y que permitan predecir con mayor certeza los efectos de un medicamento antihipertensivo en los seres humanos.

Animal models of hypertension are widely used by the national and international scientific community to study potential antihypertensive drugs. Nevertheless, some of the hypertension complications are not completely expressed in animal models. In this article  the lack of blood pressure and retinopathy correlation in the L-NAME hypertensive rat model is presented. Furthermore, questions related to the development of new animal hypertension model, with a better correlation to human hypertension that would allow a more certain prediction regarding the effects of an antihypertensive drug are posed.