Incidence of opioid-induced esophageal dysfunction.

BACKGROUND: Retrospective studies have suggested that long-term use of opioids can cause esophageal motility dysfunction. A recent clinical entity known as opioid-induced esophageal dysfunction (OIED) has been postulated. There is no data from prospective studies assessing the incidence of opioid-induced effects on the esophagus. AIM: Evaluate the incidence of OIED during chronic opioid therapy. METHODS: From February 2017 to August 2018, all patients seen in the Pain Unit of the hospital, who started opioid treatment for chronic non-neoplastic pain and who did not present esophageal symptoms previously, were included. The presence of esophageal symptoms was assessed using the Eckardt score after 3 months and 1 year since the start of the study. In February 2021, the clinical records of all included patients were reviewed to assess whether esophageal symptoms were present and whether opioid therapy was continued. In patients presenting with esophageal symptoms, an endoscopy was performed and, if normal, a high-resolution esophageal manometry was performed. For a confidence level of 95%, a 4% margin of error and an estimated prevalence of 4%, a sample size of 92 patients was calculated. RESULTS: 100 patients were included and followed while taking opioids, for a median of 31 months with a range between 4 and 48 months. Three women presented with dysphagia during the first 3 months of treatment, being diagnosed with esophagogastric junction outflow obstruction; type II and type III achalasia. The cumulative incidence of OIED was 3%; 95%-CI: 0-6%. CONCLUSIONS: Chronic opioid therapy in patients with chronic non-neoplastic pain is associated with symptomatic esophageal dysfunction.

Burrow builders as ecosystem engineers for pit-building antlions (Neuroptera: Myrmeleontidae).

Burrow builders are often classified as ecosystem engineers because their digging activities regulate the availability of resources for other organisms. As antlion larvae prefer to construct their traps in bare sandy or loose soil, they could benefit from burrowing activities. We investigated the role of burrow builders as ecosystem engineers for antlions (Myrmeleontidae) in a tropical semideciduous forest in Mexico. The number of traps of antlion larvae was recorded on 30 sampling quadrats (45 cm) at the entrance of burrows (of unidentified builders) and on 30 paired off-burrow quadrats. Additionally, the percentage of bare soil was estimated for the 60 quadrats sampled. Of the 30 quadrats at the entrance of burrows, a total of 336 traps were recorded, with 21 (70%) of them having at least one trap, while for the 30 off-burrows quadrats, only two (6.6%) of them had traps, just three in total. The percentage of bare soil and the abundance of traps were significantly greater in quadrats at the entrance of burrows compared to quadrats without burrows. The abundance of traps at the entrance of burrows was positively affected by the percentage of bare soil. The few traps in the off-burrows quadrats suggested that, in addition to the limited bare soil, ground compactness probably limits the establishment of antlion larvae. Otherwise, when digging, burrow builders create small patches of bare sandy soils that are used by these insects. We concluded that the ecosystem engineering effect of burrow builders is an important structuring element for antlion populations in the tropical semideciduous forest studied.

Ecosystem engineering by leaf-rolling mites enhances arthropod diversity.

Many arthropods modify parts of plants through the construction of domiciles or by consuming plant tissues that, after abandoned, can be used as shelter by other arthropods in a facilitating interaction process. We examined, for the first time, the potential of leaf-rolling mites to indirectly influence arthropod communities in natural forests by providing shelter sites. In early June 2019, we found a high density of leaves of Amphitecna tuxtlensis (Bignoniaceae) rolled by an undetermined leaf-rolling mite species in a tropical rainforest, in Mexico. We tested whether the species richness, abundance, and colonization frequency of arthropods was greater in rolled compared with expanded leaves. We collected 5 rolled leaves and 5 fully expanded leaves from 15 A. tuxtlensis trees (N = 150 sampled leaves) and recorded all arthropods on each leaf. We recorded 1421 arthropods from 67 unique morphospecies. We found 39 individuals from 23 morphospecies of arthropods in expanded leaves, and 1382 individuals from 56 morphospecies in rolled leaves. Ants were the most abundant and frequent group and utilized the rolled leaves mainly as nesting sites; 1260 ant individuals were found in 30 nests from three species. Arthropod species richness, abundance, and colonization frequency were greater in rolled leaves compared with expanded leaves. We concluded that the ecosystem engineering effect of leaf-rolling mites may be an important structuring element for arthropod communities on plants through an increase of high quality food resources and shelter sites for other arthropods, as well as nesting sites for ants.

Feeding Specialization of Flies (Diptera: Richardiidae) in Aroid Infructescences (Araceae) of the Neotropics.

Evolution and radiation between insects and flowering plants are both opportunistic and obligatory when the former feeds on the reproductive structures of the latter, whereas direct and indirect effects can influence the fitness of individuals, populations, and plant communities. The Araceae family constitutes an important element of the tropical rainforest of the Neotropics, and its morphology and floral biology provide a remarkable system for studying trophic interactions with insects, including the Richardiidae flies (Diptera). We studied the trophic interactions of the aroid-fly system, assessing infestation rates under natural conditions over an annual cycle. In the Neotropical region, we discovered for the first time that seven aroid species became infested by four richardiid species: Beebeomyia tuxtlaensis Hernández-Ortiz and Aguirre with Dieffenbachia oerstedii Schott and D. wendlandii Schott; B. palposa (Cresson) with Xanthosoma robustum Schott; Beebeomyia sp.3. in association with Philodendron radiatum Schott, P. tripartitum (Jacq.) Schott, and P. sagittifolium Liebm.; while Sepsisoma sp. only infested Rhodospatha wendlandii Schott. Infestation rates differed significantly among hosts, but comparisons with morphological traits did not provide evidence of a causal factor of the infestation. In contrast, larval density and time of development both exhibited significant differences between hosts. The findings suggest the high specialization of the flies, and that intrinsic factors of the plants, such as the presence of secondary metabolites and their maturation periods, may influence their infestation rates.

Effects of high-resolution esophageal manometry on oxygen saturation and hemodynamic function.

The effect of high-resolution esophageal manometry (HRM) on oxygen saturation (SaO2) and hemodynamic function has not been previously evaluated. This was a prospective study of consecutive patients referred for HRM. Demographic and clinical data were collected on all patients. The study variables included SaO2, heart rate (HR) and blood pressure (BP). SaO2 and HR were measured at baseline, during intubation, during and 5 min after HRM. BP was measured at baseline, during and after HRM. 158 (56% women) patients with a mean age of 56 (SD 15) years were included. Thirty-five (22%) were obese and 55 (35%) were overweight. Eighteen (12%) patients had a history of respiratory disease and 27 (17%) were smokers. Intubation was difficult in 22%. Exploration tolerance was poor in 17% or very poor in 6%. The average duration of the test was 9.9 (SD 2.8) minutes. Sixty-four (47%) and 59 (37%) patients had SaO2 below 95% during intubation and during HRM, respectively. Three patients had SaO2 ≤90%. Sixty-nine (44%) patients had tachycardia during intubation and 8 (5%) during HRM. The appearance of desaturation (SaO2 <95%) during intubation was associated with a lower basal SaO2; desaturation during HRM and 5 minutes after HRM was associated with a higher age, a higher BMI and a lower basal SaO2. HRM decreases SaO2 and increases heart rate primarily during the insertion of the probe, as part of the standard stress response and therefore HMR can be considered a safe procedure. However, in older and overweight patients, respiratory parameters should be monitored.

Status of Rhagoletis (Diptera: Tephritidae) pests in the NAPPO countries.

The North American Plant Protection Organization (NAPPO) is an organization comprising plant protection regulatory officials of the three signatory countries: the United States, Canada, and México. NAPPO develops Regional Standards for Phytosanitary Measures (RSPMs) as well as discussion papers on important issues related to plant protection. The Fruit Panel of NAPPO organized a Technical Assistance Group (TAG) to develop a discussion paper on the status of pest species of Rhagoletis (Diptera: Tephritidae) within the NAPPO countries. As regulations are developed to prevent the spread of these pests both within and outside of the NAPPO countries, it was important to understand the pest status of these species. This article reviews the basic biology, host range, distribution, potential to spread, management, and regulatory status of pest species of Rhagoletis within the NAPPO countries.

Seasonal dynamics of the flower head infestation of Smallanthus maculatus by two nonfrugivorous tephritids.

Seasonal dynamics of the capitula infested by Dictyotrypeta sp. and Rhynencina spilogaster (Steyskal) (Diptera: Tephritidae) was evaluated throughout the flowering cycle of their host plant the sunflower, Smallanthus maculatus (Cavanilles) Robinson (Asterales: Asteraceae). In central Veracruz, Mexico, along 16 consecutive weeks, a total of 1,017 mature capitula were collected, recording the presence and abundance of immature stages (larvae and pupae) and their related parasitoids. Both fly species were present throughout the entire season, with overall infestation of 51.5% of the capitula examined. However, Dictyotrypeta sp. infested 11.3%, representing about one-fifth of them, and R. spilogaster was most abundant infesting four times as many capitula (42.9%), whereas both species were found together in only 2.6% of the capitula examined. Based on the temporal occurrence of larvae and pupae into flower heads as well as their associated parasitoids and times of emergence, Dictyotrypeta sp. had two yearly generations, and it seems that the second generation could enter a seasonal diapause; in contrast, R. spilogaster was a univoltine species that entered diapause that lasted until the next year.

A new species of Neotraginops Prado (Diptera: Odiniidae) from Mexico and Belize, with additional records for Odinia coronata Sabrosky in Mesoamerica.

Neotraginops mexicanus n. sp. is described and illustrated based on specimens from Mexico and Belize, representing the second known species for the genus. Additional records for Odinia coronata Sabrosky from Mexico and Nicaragua are provided.

Local Climate Conditions Shape the Seasonal Patterns of the Diptera Community in a Tropical Rainforest of the Americas.

Insect life cycles are short-term and therefore sensitive to immediate changes triggered by climate, vegetation structure, or land use management; hence, the insect populations shape the communities and functional relationships in tropical forests. In this study, we hypothesized that seasonal variations of the dipteran families respond in different ways to changes of weather conditions, thereby affecting their population dynamics. In a one-hectare plot, we surveyed the fly community inhabiting the understory of a Neotropical rainforest. Over a yearly cycle, we used three Malaise traps operated continuously for 365 days and recorded a total of 68,465 fly specimens belonging to 48 families of Diptera, 15 of which were most abundant, accounting for 99.2% of all sampled individuals. The results of the trapping frequency indices (TFIs) exhibited significant population fluctuations in 12 of the 15 most abundant families, which were particularly correlated with temperature or precipitation. Based on such variations, we identified four seasonal patterns as follows: (i) Spring-Autumn bimodal pattern (Cecidomyiidae, Sciaridae, Phoridae, Stratiomyidae); (ii) Spring pattern (Mycetophilidae, Dolichopodidae, Ceratopogonidae); (iii) Autumn pattern (Chironomidae, Psychodidae); (iv) Winter pattern (Empididae, Tipulidae, Ditomyiidae). From a functional perspective, we found the prevalence of families with saprophagous larvae, in addition to phytophagous, fungivores, and predacious. Our results suggest a key role played by the Diptera community on structuring the functional clusters, both in terms of taxonomic composition and on seasonal shifts of abundance, thus influencing the dynamic processes of nutrient cycling in the understory.

High prevalence of heartburn and low acid sensitivity in patients with idiopathic achalasia.

BACKGROUND: Heartburn is frequently reported by patients with achalasia before treatment. However, the esophageal sensitivity to acid as a possible mediator of this symptom has not been previously evaluated. AIM: To evaluate the prevalence of gastroesophageal reflux symptoms and the esophageal sensitivity to acid perfusion in patients with untreated achalasia. METHODS: Forty patients with achalasia were prospectively evaluated. Forty-three patients with gastroesophageal reflux disease comprised the control group (ten of them with Barrett's esophagus). Symptoms were evaluated by a structured clinical questionnaire. Objective assessment was performed by ambulatory 24-h esophageal pH monitoring and endoscopy. Esophageal sensitivity to acid was evaluated by esophageal perfusion of ClH 0.1 N. RESULTS: Fifteen (37%) of the 40 patients with achalasia presented heartburn, but only four of them had esophagitis and/or abnormal esophageal pH recording. Eight patients had abnormal pH recording. Three patients had esophagitis. The esophagus was sensitive to acid in seven (17%) patients with achalasia, three of them with heartburn and one with abnormal pH recording. In the control group, 40 of 43 (93%) presented heartburn. Acid perfusion was positive in 32 (74%). Sensitivity to acid was lower in patients with achalasia than in those with gastroesophageal reflux disease with or without Barrett's esophagus. CONCLUSIONS: The prevalence of heartburn in patients with achalasia is high, although its association with objective indicators of gastroesophageal reflux disease is weak. Patients with achalasia have lower esophageal sensitivity to acid than patients with GERD, suggesting that heartburn is does not arise from this condition.

A new species of picture-winged flies of the genus Euphara Loew (Diptera, Ulidiidae).

Based on a large series of specimens found in several localities in Mexico Euphara loculata n. sp. is described. It is the second species of this Neotropical genus, and includes for the first time a description and illustration of the male and female genitalia of the genus.

The effects of thiopurine therapy on health-related quality of life in Inflammatory Bowel Disease patients.

BACKGROUND: The effect of thiopurine immunomodulators on health-related quality of life (HRQoL) in patients with inflammatory bowel disease (IBD) has been controversial. The aims were to evaluate the HRQoL in patients with IBD treated with thiopurines and assess the short- and long-term impacts of the treatment on HRQoL. METHODS: Ninety-two consecutive patients who started treatment with thiopurines were prospectively included. Evaluation of HRQoL was performed at months 0, 6, and 12 using two questionnaires, the Short-Form Health Survey (SF-36) and the Inflammatory Bowel Disease Questionnaire (IBDQ). RESULTS: Baseline score of IBDQ was 4,6, range (2,31-6,84), with an impairment of the five dimensions of HRQoL compared with inactive patients. Results obtained in 8 dimensions of SF-36 showed worse HRQoL than Spanish general population. At 6 months patients had a significant improvement in overall IBDQ score -5,8 (1,58 -6,97)- and also in all IBDQ dimensions. All the 8 dimensions of SF-36 obtained a significant improvement. At twelve months score of IBDQ was 6,1, range (2,7-6,98), with improvement in all dimensions compared with baseline and 6 months. SF-36 showed a similar significant improvement in all subscales. CONCLUSIONS: Thiopurine immunomodulators alone or with other treatments have a positive and long lasting impact on HRQoL of IBD patients.

The Mayan Tropical Rainforest: An Uncharted Reservoir of Tritrophic Host-Fruit Fly-Parasitoid Interactions.

Over a two-year period, we surveyed natural areas of the Mayan rainforest in Quintana Roo, Mexico. We found 11 species of Anastrepha Schiner (Diptera: Tephritidae) infesting 25 species of fruits belonging to ten plant families. We report the first records of 10 host plant species of the genus Anastrepha, which include the first report of a plant family (Putranjivaceae) serving as host of Anastrepha fraterculus (Wiedemann) infesting Drypetes lateriflora (Sw.) Krug and Urb. (Putranjivaceae). Pouteria reticulata (Engl.) Eyma (Sapotaceae) was found, for the first time, to be infested by Anastrepha serpentina (Wiedemann) and by a new undescribed species of Anastrepha. We also report Casimiroa microcarpa Lundell (Rutaceae) as a possible ancestral host for the Mexican fruit fly, Anastrepha ludens (Loew), in Central America. The family Sapotaceae was the best-represented host group with three fruit fly species recovered: A. serpentina, an economically-important species, found in eight host plants, and A. hamata and A. sp. (new species). We recorded six species of koinobiont parasitoids: Doryctobracon areolatus Szepligeti, Utetes (Bracanastrepha) anastrephae Viereck, Opius hirtus Fisher, and Doryctobracon zeteki Musebeck, (all Braconidae), and Aganaspis pelleranoi (Brethés) and Odontosema anastrephae Borgmeier, (both Figitidae). All these parasitoid species represent at least a new report for their host plants. Of the whole parasitoid community, D. areolatus was the most important parasitoid species with 52.7% of presence in 12 host plant species, parasitizing six fruit fly species. The interaction between fruit flies and their parasitoids with host plants depends on fruit availability, which is crucial for the survival of each of these species. Conserving the landscape of the Mayan rainforest is important not only for species conservation, but also for the maintenance of fruit fly host plants in orchard agroecosystems in southeastern Mexico.

Giardia intestinalis and Fructose Malabsorption: A Frequent Association.

Nowadays, scientific studies are emerging on the possible etiological role of intestinal parasites in functional digestive disorders. Our study was carried out with healthy individuals (control group; n = 82) and symptomatic patients with lactose or fructose malabsorption, including positive (malabsorbers; n = 213) and negative (absorbers; n = 56) breath test, being analyzed for the presence of intestinal parasites. A high parasitic prevalence was observed in malabsorbers (41.8%), exclusively due to single-cell eukaryotes but not helminths. Giardia intestinalis was the predominant parasite in cases of abnormal absorption (26.5%), significantly associated with fructose malabsorption and doubling the probability of developing this pathology. Within controls, Blastocystis sp. (13.4%) was almost the only parasite, being the second among patients (12.6%), and Cryptosporidium parvum, the last species of clinical relevance, was detected exclusively in two malabsorbers (0.9%). The consumption of ecological food and professions with direct contact with humans arose as risk factors of parasitism. A diagnosis of carbohydrate malabsorption in adulthood is the starting point, making the search for the primary cause necessary. Accurate parasitological diagnosis should be considered another tool in the clinical routine for patients with recurrent symptoms, since their condition may be reversible with adequate therapeutic intervention.

Vertical and Horizontal Trophic Networks in the Aroid-Infesting Insect Community of Los Tuxtlas Biosphere Reserve, Mexico.

Insect-aroid interaction studies have focused largely on pollination systems; however, few report trophic interactions with other herbivores. This study features the endophagous insect community in reproductive aroid structures of a tropical rainforest of Mexico, and the shifting that occurs along an altitudinal gradient and among different hosts. In three sites of the Los Tuxtlas Biosphere Reserve in Mexico, we surveyed eight aroid species over a yearly cycle. The insects found were reared in the laboratory, quantified and identified. Data were analyzed through species interaction networks. We recorded 34 endophagous species from 21 families belonging to four insect orders. The community was highly specialized at both network and species levels. Along the altitudinal gradient, there was a reduction in richness and a high turnover of species, while the assemblage among hosts was also highly specific, with different dominant species. Our findings suggest that intrinsic plant factors could influence their occupation, and that the coexistence of distinct insect species in the assemblage could exert a direct or indirect influence on their ability to colonize such resources.

What Can Integrated Analysis of Morphological and Genetic Data Still Reveal about the Anastrepha fraterculus (Diptera: Tephritidae) Cryptic Species Complex?

The South American fruit fly Anastrepha fraterculus (Wiedemann) is a complex of cryptic species, the so-called "Anastrepha fraterculus complex", for which eight morphotypes are currently recognized. A previous analysis of ITS1 in samples of the Anastrepha fraterculus complex, while revealing high distinctiveness among samples from different localities of South America, Central America, and Mexico, no direct association was made between sequence type and morphotype. In the present report, a correlated analysis of morphometry and ITS1 data involved individuals belonging to the same population samples. Although showing a low level of intra-populational nucleotide variability, the ITS1 analysis indicated numerous inter-population sequence type variants. Morphotypes identified by morphometric analysis based on female wing shape were highly concordant with ITS1 genetic data. The correlation of genetic divergence and morphological differences among the tested samples gives strong evidence of a robust dataset, thereby indicating the existence of various taxonomic species within the A. fraterculus complex. However, the data revealed genetic and morphological variations in some regions, suggesting that further analysis is still required for some geographic regions.

Constipation during pregnancy: a longitudinal survey based on self-reported symptoms and the Rome II criteria.

An increase in the prevalence of constipation during pregnancy has been suggested to occur. We designed a prospective study to evaluate the prevalence of constipation during pregnancy and puerperium, to investigate possible associations with eating habits and lifestyle, and to evaluate the frequency of laxative use. A structured questionnaire was developed addressing demographics, obstetric characteristics, lifestyle, eating habits, variables required for the diagnosis of constipation, and laxative use to evaluate the prevalence of constipation during pregnancy and puerperium. The questionnaire was administered in the obstetric clinic in the first trimester of pregnancy, and by telephone in the second and third trimesters, and in the puerperal period. The prevalence of self-reported constipation in these time periods was 45.4, 37.1, 39.4, and 41.8%, respectively. Prevalence defined by the Rome II criteria for the same time periods was 29.6, 19, 21.8, and 24.7%. These values were similar to the data previously reported for the female population. Agreement between the self-reported and Rome II results was moderate. The self-reported criterion showed high sensitivity in all time periods, using the Rome II criterion as gold-standard. No factor was associated with variations in the prevalence of constipation during pregnancy, though an increase was recorded in the consumption of fruit, vegetables, fiber, and water. The prevalence of constipation during pregnancy and puerperium is similar to that recorded among the female population from the same geographic area.

[Quality of life specific questionnaire for constipated patients: development and validation of CVE-20]. / Cuestionario específico de calidad de vida para pacientes con estreñimiento: desarrollo y validación del CVE-20.

BACKGROUND AND OBJECTIVE: Although constipation affects quality of life, questionnaires hardly exist for its evaluation. We aimed to develop and validate a questionnaire able to measure the quality of life in patients with constipation. PATIENTS AND METHOD: A Spanish multicenter study was performed in 2 stages: a) questionnaire development (open interview to patients with constipation, pilot questionnaire, quantitative and factorial analysis, Rasch analysis, and specific questionnaire design), and b) questionnaire validation in 136 patients. These patients were divided in 2 groups: a) reliability group (n = 55; no need to begin or change treatment; re-tested after 15 days), and b) sensibility to change group (n = 81; need to begin or change treatment; re-tested after 3 months). We collected clinical and socio-demographic data and we evaluated the quality of life through the general questionnaire EuroQoL-5D (EQ-5D) and the specific one, design in the previous stage (25 items). After that, we analysed feasibility, reliability and validity (of content, convergent and longitudinal). RESULTS: The trial questionnaire was obtained during the development stage and the results were 51 items that were later reduced to 25 in the validation stage. A total of 126 patients (93% women; mean age [standard deviation]: 43.4 [1] years) completed the study properly. The answer average time was 12 min. The content validity process reduced the questionnaire to 20 items (CVE-20) within 4 domains: emotional, general physical, rectal physical and social. The reliability was good in relation to the general punctuation (Cronbach alpha coefficient = 0.87), being in the different domains of 0.79, 0.73, 0.75 and 0.60, respectively. The construct validity showed a good correlation between the CVE-20 results and constipation severity. The CVE-20 score positively correlated with EQ -5D changes. The test and re-test reliability were good: interclass correlation coefficient = 0.89 (ranging from 0.80 to 0.88 in the different domains). The clinically relevant and minimal difference was 17 points (95% confidence interval, 11-23). The content validity showed a strong correlation between CVE-20 and constipation severity. CONCLUSIONS: The CVE-20 is the first specific questionnaire in Spanish language for constipated patients; it is valid, reliable, sensitive to changes and it meets the psychometric requirements to be applied in daily practice and clinical trials.

Blastocystis subtypes and their association with Irritable Bowel Syndrome.

Blastocystis spp. is a common intestinal protozoan that affects humans and animals. The role of this parasite as a pathogen is still controversial and it is suspected to be linked to Irritable Bowel Syndrome (IBS), a functional bowel disorder characterized by chronic or recurrent abdominal pain associated with altered intestinal habits. A broad search in electronic databases, libraries, portals of journals, etc. for reports on the association between the parasite and IBS without language restriction was performed. The selection was not restricted by date, but articles published in the last seven years were given preference. We investigated the evidence regarding Blastocystis and IBS coexistence as well as the implications of the parasite in pathogenesis and clinical manifestations. Only standardized parasitological tools, supplemented by epidemiological analysis, will be able to clarify whether parasite carriage could be connected to IBS and its status as a human pathogen. Although a variation in pathogenicity and virulence between subtypes has been confirmed, Blastocystis can only be considered an indicator of dysbiosis. Accurate diagnoses of this parasitic eukaryote, specifically at genotypic and phenotypic levels, as well as the complete analysis of the intestinal microbial communities, have to be included in the protocol of those patients with IBS.