Appropriateness of routine pre-endoscopic SARS-CoV-2 screening with RT-PCR in asymptomatic individuals and its impact on delayed diagnosis.

AIMS: Endoscopy units are considered to be at an increased risk of infection by SARS-CoV-2. Our aim is to assess the correlation between pre-endoscopic screening with reverse-transcription-polymerase-chain-reaction (RT-PCR) in asymptomatic individuals scheduled for elective endoscopy and the epidemiological data published by the local Health Administration. PATIENTS AND METHODS: Observational retrospective study collecting the results of our screening strategy spanning June/2020-June/2021, the effective potential growth (EPG), an index measuring the outbreak risk, and the 7 and 14-day cumulative incidence (CI). Indication, delay and the findings of the endoscopic examinations were registered for RT-PCR positive patients. RESULTS: A total of 5808 tests were performed, yielding 125 positive results (2.15%). All positive tests occurred in weeks of high/very high risk (EPG>100) with the highest monthly rate being 9.36%, recorded in January/2021. A significant correlation (rho=0.796; p<0.001) between weekly positive rates and EPG was observed, and a significantly lower weekly number of positive tests was recorded when EPG<100. Planning the screening strategy one week ahead according to EPG>100 would have avoided up to 826 tests with only one positive result to account for. One hundred and thirteen individuals tested positive and 89 endoscopies were delayed. The most common findings were colon polyps, colorectal cancer and gastric metaplasia. Oncological diagnosis was delayed 50±3 days. CONCLUSIONS: No positive RT-PCR test were registered out of high-risk periods. Epidemiological administrative data in the preceding two weeks showed a significant correlation with screening results and could be useful to plan pre-endoscopic screening and avoid unnecessary tests.

Programa de salud Agente +014: gamificación aplicada a la educación de adolescentes con diabetes según el modelo PRECEDE-PROCEDE y desde una perspectiva salutogénica / Agent +014 health program: gamification applied to the education of adolescents with diabetes according to the Precede-Proceed model and from a salutogenic perspective / Programa de saúde Agente +014: gamificação aplicada à educação de adolescentes com diabetes segundo o modelo PRECEDE-PROCEDE e desde uma perspectiva salutogênica

Resumen Objetivos: la diabetes mellitus tipo 1 es una enfermedad crónica que suele debutar en la infancia y necesitar formación a lo largo para dar respuesta a los cambios producidos en todas las etapas vitales. El objetivo de esta investigación es desarrollar un programa de educación para la salud, siguiendo el modelo Precede-Procede y desde una perspectiva salutogénica atendiendo a las necesidades de la población adolescente y que incluya la gamificación como estrategia educativa. Materiales y métodos: la primera fase es investigación mixta, cuantitativa y cualitativa y combina diferentes instrumentos para la recogida de información. Los participantes son adolescentes con dicho diagnóstico y sus progenitores, residentes en la Comunidad de Madrid, España. En la segunda, se desarrolla un programa educativo que responde a los hallazgos de la etapa anterior y que incorpora la gamificación. Resultados: la población diana disfruta de una buena calidad de vida, tiene un estilo de vida saludable y alta responsabilidad hacia sus cuidados. Sin embargo, los recursos que les hace falta son los relacionados con la esfera emocional. Es por ello por lo que el programa educativo denominado Agente +014 abarca la competencia emocional y cuidados avanzados de la diabetes, todo ello con forma de juego digital. Conclusiones: el modelo Precede-Procede se ha mostrado eficaz para desarrollar esta intervención de educación para la salud. El enfoque salutogénico facilita el análisis de los recursos personales, familiares y comunitarios. La gamificación es una estrategia innovadora en la promoción de la salud.

Abstract Objectives: type 1 diabetes mellitus is a chronic disease that usually begins in childhood and requires training throughout to respond to the changes produced in all life stages. The objective of this research is to develop a health education program following the Precede-Proceed model from a salutogenic perspective, attending to the needs of the adolescent population and including gamification as an educational strategy. Materials and methods: the first stage is a mix of quantitative and qualitative research that combines different instruments for the collection of information. The participants are adolescents diagnosed with type 1 diabetes mellitus and their parents, residents of the Community of Madrid, Spain. In the second stage an educational program is developed that responds to the findings of the previous stage and incorporates gamification. Results: the target population enjoys a good quality of life, they have a healthy lifestyle and high responsibility towards their care. However, the resources they lack are those related to the emotional sphere. That is why the educational program called "Agent +014" is used since it encompasses the emotional competence and advanced diabetes care, all in the form of a digital game. Conclusions: the Precede-Procede model has shown to be effective in developing health education interventions. The salutogenic approach facilitates the analysis of personal, family and community resources. Gamification is an innovative strategy in health promotion.

Resumo Objetivos: a diabetes mellitus tipo 1 é uma doenças crônicas que costuma debutar na infância e necessitar formação ao longo para dar resposta aos câmbios produzidos em todas as etapas vitais. O objetivo desta pesquisa é desenvolver um programa de educação para a saúde, seguindo o modelo Precede-Procede e desde uma perspectiva salutogênico atendendo às necessidades da população adolescente e que incluía a gamificação como estratégia educativa. Materiais e métodos: a primeira fase é pesquisa mista, quantitativa e qualitativa e combina diferentes instrumentos para a colheita de informação. Os participantes são adolescentes com este diagnóstico e seus progenitores, residentes na Comunidade de Madrid, Espanha. Na segunda, desenvolve-se um programa educativo que responde às descobertas da etapa anterior e que incorpora a gamificação. Resultados: a população Diana desfruta de uma boa qualidade de vida, tem um estilo de vida saudável e alta responsabilidade para seus cuidados. Contudo, os recursos que lhes faz falta são os relacionados com a esfera emocional. É por isso que o programa educativo denominado Agente +014 abarca a competência emocional e cuidados avançados da diabetes, todo isto com forma de jogo digital. Conclusões: o modelo Precede-Procede foi eficaz para desenvolver esta intervenção de educação para a saúde. O enfoque salutogênico facilita a análise dos recursos pessoais, familiares e comunitários. A gamificação é uma estratégia inovadora na promoção da saúde.

Treatment Adherence and Clinical Outcomes of Patients with Inflammatory Bowel Disease on Biological Agents During the SARS-CoV-2 Pandemic.

BACKGROUND: The outbreak of COVID19 evolved rapidly into a global pandemic, forcing hospitals, including inflammatory bowel disease (IBD) referral units, to change their practices to ensure quality of care. AIMS: To describe the clinical outcomes and the fulfilment of the treatment schedule of patients with IBD treated with biological agents in a single-center of a red-zone of the pandemic, and to report the patients' perceptions about COVID-19 and the measures adopted at our center. METHODS: Therapeutic adherence and clinical outcomes were collected for all patients undergoing treatment with intravenous biologicals and subcutaneous biologicals at our center. A telephone survey was also performed to assess these patients' perceptions of the COVID pandemic and the related measures adopted at their IBD unit. RESULTS: A total of 234 patients were included (117 on intravenous and 117 on subcutaneous biologicals). Only 10% of patients postponed intravenous infusions intentionally and 5% postponed the collection of subcutaneous biologicals at the hospital pharmacy. Only five confirmed COVID-19 cases were registered (2.1%), all of them of mild severity. One hundred and fifty-five patients participated in the survey (77 on intravenous and 78 on subcutaneous drugs). Fear of going to the hospital was the most common reason for postponing biological administrations. Among those on combination therapy, only 7% admitted to have withdrawn immunosuppressants. CONCLUSIONS: Adherence to intravenous and subcutaneous biological therapies during the pandemic was high in a single-center cohort of IBD patients even though the cumulative incidence of confirmed COVID-19 was low.

Gastropatía hipertrófica por IgG4: reporte del primer caso en Chile / IgG4 related hypertrophic gastropathy: report of one case

IgG4 related disease is a systemic autoimmune disease, which can affect different organs. The most common digestive manifestation is autoimmune pancreatitis (AIP), followed by involvement of bile ducts and the major papilla. The stomach is only rarely involved. We report a 71-year-old diabetic woman consulting for jaundice and weight loss. Abdominal CAT scan, cholangio resonance imaging, endosonography and a serum IgG4 of five times the normal value, lead to the diagnosis of an autoimmune pancreatitis. An upper gastrointestinal endoscopy showed a diffuse thickening of gastric folds. The pathological study confirmed the presence of IgG4 positive plasma cells. The patient was successfully treated with steroids.

Antimicrobial potential of cauliflower, broccoli, and okara byproducts against foodborne bacteria.

The antimicrobial potential of cauliflower, broccoli, and okara byproducts was assessed against Gram-positive and Gram-negative bacteria. Salmonella enterica serovar Typhimurium, Escherichia coli O157:H7, Bacillus cereus, and Listeria monocytogenes serovar 4b growth behavior was assessed under exposure to 5% vegetable byproducts added to the reference medium, buffered peptone water (0.1% [wt/vol]), at 37°C. Although the byproducts were not effective against L. monocytogenes, they were bactericidal against Salmonella Typhimurium, E. coli O157:H7, and B. cereus. The most promising results were achieved with the cauliflower-Salmonella Typhimurium combination, because the bacterial population was reduced by 3.11 log10 cycles after 10 h of incubation at 37°C as a result of 5% cauliflower addition. Further studies were carried out for this combination, at different cauliflower concentrations (0, 0.5, 1, 5, 10, and 15%) and at temperatures in the range of 5-37°C. The greatest inactivation level (6.11 log10 cycles) was achieved at refrigeration temperature (5°C) using 15% cauliflower addition. Both temperature and cauliflower concentration significantly (p≤0.05) influenced the Salmonella Typhimurium inactivation level. The kinetic parameters were adjusted to mathematical models. The modified Gompertz mathematical model provided an accurate fit (root-mean-square error (RMSE) [0.00009-0.21] and adjusted-R(2) [0.81-0.99]) to experimental Salmonella Typhimurium survival curves describing inactivation kinetics of the pathogen to the antimicrobial effect of cauliflower byproduct.

Relevancia de la muerte súbita cardíaca / Relevancy of sudden death of cardiac origin

Sudden death (SD) is of cardiac origin in approximately 80-90% of the cases and represents one of the most important challenges of the modern cardiology. Evaluation and understanding of its epidemiological, clinical and histopathological characteristics can lead to better results in its management. In Spain was carried a multicenter study MUSA with two arms: 1/ EULALIA: histopathological aspects of SD and 2/ MUSIC: SD in heart failure with focus on identification of population groups at risk, pathophysiological mechanisms of development and clinical prognostic markers. The preliminary conclusions of both studies are the following: 1/ EULALIA trial: From the total 121 sudden deaths, 109 (90%) were of cardiac origin and of these 45% presented characteristics of myocardial hypertrophy. The histopathological findings reveled that in only 48% of cases acute ischemic heart disease was present. In the other cases of ischemic heart disease the sudden death was probably by arrhythmic origin related with the presence of old myocardial infarction. This is the most striking difference compared with Anglo-Saxon studies. In the 29 cases of ACS, 18 had eroded and combination of eroded and ruptured plaques. In the cases of non-ACS plaques were stable in 20, and combination of stable and vulnerable plaques in 7 cases. Statistically significant results as independent predictors of sudden death gave the following markers: history of MI, cephalization of vessels in thorax X-ray, left atrium size > 45 mm, high levels of NT-proBNP and PIP, LBBB on ECG recording and body mass index.