P061 Impact of Inflammatory Bowel Disease on sleep quality in a Mexican population attended in a referral center.

BACKGROUND: Sleep disorders occur recurrently in patients with inflammatory bowel disease (IBD). The relationship between poor sleep quality and IBD activity has been subject to scarce attention. Poor sleep quality could be considered a relevant extraintestinal manifestation and a potential marker of subclinical inflammation, which could increase the severity of inflammation and the risk of relapse, however, we do not have enough information to confirm this hypothesis. Objective: Describe the impact of IBD on the quality of sleep, in patients treated in a referral hospital. METHODS: Observational, analytical, and cross-sectional study. Patients with diagnosis of IBD treated at Centro Médico Nacional "20 de Noviembre" were evaluated. The Pittsburgh Sleep Quality Index (PSQI) was used to measure sleep quality. IBD activity was measured using the Harvey-Bradshaw index for Crohn's disease (CD) and the Mayo scale for Ulcerative Colitis (UC). RESULTS: A total of 51 patients were included, the Pittsburgh Sleep Index Questionnaire (PSQI) was performed, after informed consent was signed. Patients had a mean age of 52. Fifty five percent were female, 65% had UC. Biological therapy was administered to 70.5%. In CD 89% were in remission and 11% in moderate activity. In UC 48.5% were in remission, 45.5% had mild activity and 6% had moderate activity. Eighty percent of the patients did not use hypnotic drugs. Patients with UC in remission had a bad perception of sleep quality in 68%, quite good sleep quality in 18% and very good sleep quality in 12% with a PSQI of 10.5 ± 3.2. In patients with mild activity, the perception of sleep quality was very good in 6%, quite good in 46%, quite bad in 40% and very bad in 6%, with a PSQI of 8 ± 3.7. In patients with moderate activity, 100% had a rather bad perception of sleep quality with a PSQI of 11 ± 1.4. For CD in remission the perception of sleep was quite bad in 43%, quite good in 43%, very bad in 6% and very good in 6% with a PSQI of 9 ± 4.3. In patients with moderate activity 50% had a very bad sleep quality perception and 50% a fairly good sleep quality perception with a PSQI of 14 ± 4.2. CONCLUSION: In this study a statistically significant association was obtained between PSQI and the perception of sleep reported by the patients, with a p < 0.005. Further research is still needed to better characterize sleep disturbances in this population. Due to the sample size, a prospective, randomized study is required to confirm these findings. The present analysis has no conflict of interest.

P063 Prevalence in the Use of Complementary/Alternative Medicine in Patients With Inflammatory Bowel Disease from Centro Médico Nacional 20 de Noviembre.

BACKGROUND: Frequently, existing therapies for inflammatory bowel disease (IBD) do not achieve complete remission of the disease and are commonly associated with adverse effects. Therefore, patients regularly turn to complementary or alternative medicine (CAM). International CAM use in IBD patients ranges from 21% to 60%. There are no reported statistics of CAM use in the Mexican population who suffer IBD. This study´s objective was to determine the prevalence and characterize the use of CAM in our IBD population. METHODS: Observational, cross-sectional, retrospective study in patients diagnosed with IBD belonging to our Institution's IBD center. The results were analyzed with measures of relative frequency, central tendency, and dispersion. RESULTS: A total of 52 patients with IBD (78% ulcerative colitis and 22% Crohn's disease) were included, 38.5% were exposed to CAM. A total of 27% used it as an aid in their IBD treatment. The remaining 11.5% used it for other reasons. Patients exposed to CAM for IBD averaged 51 ± 19 years, 64% were female and 71% had at least an undergraduate degree. The most used CAMs were acupuncture (42.8%), herbal (35.7%) and homeopathy (35.7%). Half of the patients used concomitantly two or more modalities, and 91.6% of the patients knew their diagnosis at the time that CAM was being used. The median exposure time to CAM was 4.5 ± 40.7 months. The main reasons for the use of CAM in IBD patients was as a complementary therapy in 58.3%, as the perception of lack of improvement was present in 33.3% of patients. Twenty-five percent of patients used CAM after a healthcare professional recommended it. CAM was used in 83.2% of patients with conventional treatment (Mesalamine: 74.6%, Mesalamine + Azathioprine: 8.3%) and only 16.5% were on biological therapy. A total of 58.3% CAM users perceived improvement in their symptoms. Currently 25% still use some modality of CAM. No statistically significant differences were found in sociodemographic variables and clinical outcomes when comparing the IBD group exposed to CAM vs the unexposed group. CONCLUSION: Exposure to CAM for IBD treatment had a prevalence of 27%. The main CAM modalities for IBD patients were acupuncture, herbal, and homeopathy. No relationship was demonstrated between the use of CAM in IBD patients and their clinical outcomes.

P073 Diagnostic Outcome of Patients With Non-Specific Colitis.

BACKGROUND: Colitis describes inflammation in the colon and is classified into defined diseases: Inflammatory bowel disease (IBD), Microscopic colitis, Ischemic colitis and Infectious colitis. The clinical significance of non-specific colitis is unclear as there are limited analysis which report the issue. Notteghem et al. (1993) showed that of 104 patients with non-specific colitis, 52.3% had another episode of symptoms within 3 years. Of these patients 54% were diagnosed with ulcerative colitis, 33% with Crohn's disease, and 13% remained unclassified, suggesting that non-specific colitis could be undiagnosed IBD. The objective of this analysis is to determine the clinical course of non-specific colitis through colonoscopy and histologic findings. METHODS: Retrospective observational study with patients underwent colonoscopies during the period from 2009 to 2019, whose biopsies were reported as non-specific colitis. RESULTS: 24 patients (18 women and 6 men) with non-specific colitis undergoing follow-up by the Gastroenterology outpatient clinic were included. The most frequent indications for colonoscopy were abdominal pain (43.7%), blood in stools (26.8%), diarrhea (21.6%) and anemia (7.9%). The mean age was 56.5 years. During follow-up, patients had at least 2 colonoscopies and 4 biopsies per colonic segment. In the male population ascending colon cancer was later diagnosed in 16.7%, another 16.7% were diagnosed with nonspecific chronic ulcerative colitis, 33.3% with eosinophilic colitis, and the rest of the patients were diagnosed with non-specific colitis. From the female group, 5.6% had lymphocytic colitis, 5.6% eosinophilic colitis, 5.6% collagenous colitis, 5.6% Crohn's disease, 5.6% mixed irritable bowel syndrome, and the rest of the patients (72%) had biopsy report of non-specific colitis. CONCLUSIONS: All patients with a histopathological diagnosis of non-specific colitis underwent a second colonoscopy with biopsy, which resulted in a definitive diagnosis of Crohn's disease in 5.6% of women and Ulcerative Colitis in 16.7% of men. This study comes to show that there is an important subgroup of patients who are underdiagnosed. We suggest that patients with non-specific colitis reported on a histopathology report must continue their follow-up by a specialized ward.

P057 How Distance Between Residence and Treatment Center Impact the Outcome of Patients With Inflammatory Bowel Disease at CMN 20.

BACKGROUND: Inflammatory bowel disease (IBD) affects an estimated 1.6 million people in the United States with at least 70,000 new cases per year. In the last 15 years an increase in frequency of IBD cases from 0.30 cases per 100,000 person-years to 1.83 cases per 100,000 person-years has been reported in Mexico. Variables such as early hospitalization at diagnosis, low hemoglobin levels, high values of C-reactive protein (CRP), fecal calprotectin concentration and absence of mucosal healing during evolution define the prognosis of these patients. However, the distance a patient must travel in order to reach a specialized treatment center can become an impediment for a correct diagnosis and treatment, severely impacting the clinical outcome of such patients. METHODS: Observational, cross-sectional, retrospective study. Objective: In patients with IBD, determine the impact of distance between the residence and specialized treatment center on the general clinical outcome. Variables analyzed: sex, age, disease duration, average travel time, distance in kilometers between place of residence and specialized treatment center, Crohn´s Disease (CD) or Ulcerative Colitis (UC), and their respective severity classification scores, as well as number of hospital readmissions per year. The results were evaluated with ANOVA tests, univariate analysis had a 95% confidence index and a significant "p" determined as p < 0.05. RESULTS: The study included 66 patients (45 UC and 21 CD). Mean age 51.15± 17.5 years. The distance between residence and hospital was calculated and classified into 3 quartiles based on proximity: 750km (quartile 3). There was a higher risk among patients in the most distant quartile for the use of biological therapy (OR, 2.20; 95% CI, 0.23- 20.55) and surgery (OR, 2.76, 95% CI 0.49- 15.48). We observed a clear relationship between the number of hospital readmission and the distance quartiles with a p = 0.0047. CONCLUSION: We observed an impact between the distance of residence and specialized treatment center over the patient's clinical outcome. More readmissions, greater disease activity scores, more use of biological therapy and surgery were observed in patients who had to travel more than 750km from their home to their specialized treatment center compared to the other travel quartiles, this with a p = 0.0047.

Prevalence and Perception of Childhood Obesity in California's Farmworker Communities.

In California's central valley, childhood obesity rates are above the national average. The majority of families living in the rural, agricultural communities of this region are immigrant of Mexican heritage, and face numerous social and environmental challenges. Demographic and anthropometric data were collected from a population of Mexican-heritage children 3-8 years (N = 609) and families (N = 466) living in two central valley communities. Overall, 45 % of children and 82 % of mothers were classified as overweight or obese. Multivariable analyses indicated that mother's BMI and acculturation level were positively associated with child BMI z-score. Most children classified as overweight or obese (92 % and 53 %, respectively) were perceived as having 'normal' weight by their mothers. Childhood obesity remains a major public health issue in Mexican-heritage, central valley communities. Our model indicates that mother's BMI is predictor of child obesity, and parents tend to underestimate their child's weight status. These findings highlight a need for family-targeted and culturally-tailored approaches to address relevant perceptions of obesity and risk factors in these communities.

Adaptation of a culturally relevant nutrition and physical activity program for low-income, Mexican-origin parents with young children.

Latino children experience higher rates of obesity than do non-Latino white children. Family-centered nutrition interventions can slow the rate of weight gain in this population. Niños Sanos, Familia Sana (Healthy Children, Healthy Family) is a 5-year, community-based, participatory research study that targets rural Mexican-origin farmworker families with children aged 2 to 8 years in California's Central Valley. Adaptation of a culturally relevant obesity prevention program involved qualitative research to tailor key obesity prevention messages, pilot testing and implementation of key messages and activities at family nights, and continual modification to incorporate culturally innovative elements. Of the 238 families enrolled, 53% (125) attended the recommended minimum of 5 (of 10 possible) classes during the first year. A university and community partnership can guide development of a culturally tailored obesity prevention program that is suitable for reaching a high-risk Mexican-origin audience through cooperative extension and other public health programs.

Analysis of subgingival microbiota and IL-1ß, TNF-α and CX3CL1 levels in gingival crevicular fluid of fixed dental prostheses.

Prosthetic biomaterials can affect the composition of the subgingival microbiota and consequently the production of proinflammatory cytokines, causing damage to the periodontium. A total of 40 patients were divided into two groups: 20 with monolithic zirconia (MZ) prostheses and 20 with porcelain fused to metal (PFM) with nickel-chromium (Ni-Cr) alloy prostheses. Subgingival plaque and gingival crevicular fluid samples were taken. The Checkerboard technique for DNA-DNA hybridization and the enzyme-linked immunosorbent assay technique were performed. Teeth with MZ presented a lower percentage of bleeding on probing and tooth mobility compared to teeth with PFM with Ni-Cr alloy. Prosthodontic teeth harbored higher total levels of the 18 bacterial species than non-prosthodontic teeth. There was a higher prevalence of S. gordonii and V. parvula species in PFM with Ni-Cr alloy compared to MZ. There was an increase in IL-1ß, TNF-α and CX3CL1 levels in PFM with Ni-Cr alloy compared to MZ. MZ is a candidate biomaterial with fewer negative effects on the periodontium, allowing for longer prostheses longevity in the mouth.

The Effect of High Pressure on Polymorphs of a Derivative of Blatter's Radical: Identification of the Structural Signatures of Subtle Phase Transitions.

The effect of pressure on the α and ß polymorphs of a derivative of Blatter's radical, 3-phenyl-1-(pyrid-2-yl)-1,4-dihydrobenzo[e][1,2,4]triazin-4-yl, has been investigated using single-crystal X-ray diffraction to maximum pressures of 5.76 and 7.42 GPa, respectively. The most compressible crystallographic direction in both structures lies parallel to π-stacking interactions, which semiempirical Pixel calculations indicate are also the strongest interactions present. The mechanism of compression in perpendicular directions is determined by void distributions. Discontinuities in the vibrational frequencies observed in Raman spectra measured between ambient pressure and ∼5.5 GPa show that both polymorphs undergo phase transitions, the α phase at 0.8 GPa and the ß phase at 2.1 GPa. The structural signatures of the transitions, which signal the onset of compression of initially more rigid intermolecular contacts, were identified from the trends in the occupied and unoccupied volumes of the unit cell with pressure and in the case of the ß phase by deviations from an ideal model of compression defined by Birch-Murnaghan equations of state.

Socket seal surgery techniques in the esthetic zone: a systematic review with meta-analysis and trial sequential analysis of randomized clinical trials.

BACKGROUND: The socket seal surgery (SSS) technique is a common alternative for the management of the post-extraction sockets that requires a primary closure of the wound to promote proper regeneration and ridge preservation. OBJECTIVE: To learn about the effect of different SSS techniques on alveolar ridge preservation MATERIAL AND METHODS: Two independent and calibrated reviewers conducted an electronic search in PubMed, Cochrane, and Web of Science for randomized clinical trials (RCT) published up to June 2020. The evaluation of the risk of bias in the included studies was carried out following the Cochrane manual for interventions of systematic reviews, version 5.1.0. A meta-analysis of ridge width changes at - 1, - 3, and - 5 mm cutoff points from bone crest was conducted using a random-effects model. The risk of types I and II errors against accrued data was appraised obtaining the required information size using a trial sequential analysis package (TSA). RESULTS: A total of 135 sockets located in the esthetic zone were evaluated with a minimum of a 3-month follow-up after tooth extraction in 6 RCTs. The evaluated SSS techniques were free gingival graft (FGG), collagen matrix (CM), collagen sponge (CS), acellular dermal matrix (ADM), and polytetrafluoroethylene membrane (PTFEm). The FGG in sockets without bone filling showed significant results in preserving both buccal and lingual bone height (- 1.42 mm in the experimental group versus - 0.01 in the control group). The comparison of CM and FGG with bone filling did not show clinical differences in terms of dimensional bone changes. No clinical differences were found in either width or gingival thickness when comparing CM and CS. The meta-analyses of RW changes comparing CM versus FGG showed no significant differences, but a trend for lessening horizontal reduction at - 1, - 3, and - 5 mm in favor of FGG. The TSA showed that accrued data did not reach the required information size, and more evidence is required for clinical significance inferences. CONCLUSIONS: There are several predictable SSS techniques to improve clinical results in ridge preservation. More clinical studies in the form of clinical trials are required to demonstrate the superiority of one technique over another.

Accounting for Genetic Differences Among Unknown Parents in Bubalus bubalis: A Case Study From the Italian Mediterranean Buffalo.

The use of genetic evaluations in the Water Buffalo by means of a Best Linear Unbiased Prediction (BLUP) animal model has been increased over the last two-decades across several countries. However, natural mating is still a common reproductive strategy that can increase the proportion of missing pedigree information. The inclusion of genetic groups in variance component (VC) and breeding value (EBV) estimation is a possible solution. The aim of this study was to evaluate two different genetic grouping strategies and their effects on VC and EBV for composite (n = 5) and linear (n = 10) type traits in the Italian Mediterranean Buffalo (IMB) population. Type traits data from 7,714 buffalo cows plus a pedigree file including 18,831 individuals were provided by the Italian National Association of Buffalo Breeders. VCs and EBVs were estimated for each trait fitting a single-trait animal model and using the official DNA-verified pedigree. Successively, EBVs were re-estimated using modified pedigrees with two different proportion of missing genealogies (30 or 60% of buffalo with records), and two different grouping strategies, year of birth (Y30/Y60) or genetic clustering (GC30, GC60). The different set of VCs, estimated EBVs and their standard errors were compared with the results obtained using the original pedigree. Results were also compared in terms of efficiency of selection. Differences among VCs varied according to the trait and the scenario considered. The largest effect was observed for two traits, udder teat and body depth in the GC60 genetic cluster, whose heritability decreased by -0.07 and increased by +0.04, respectively. Considering buffalo cows with record, the average correlation across traits between official EBVs and EBVs from different scenarios was 0.91, 0.88, 0.84, and 0.79 for Y30, CG30, Y60, and CG60, respectively. In bulls the correlations between EBVs ranged from 0.90 for fore udder attachment and udder depth to 0.96 for stature and body length in the GC30 scenario and from 0.75 for udder depth to 0.90 for stature in the GC60 scenario. When a variable proportion of missing pedigree is present using the appropriate strategy to define genetic groups and including them in VC and EBV is a worth-while and low-demanding solution.

Psychological stress, cardiac symptoms, and cardiovascular risk in women with suspected ischaemia but no obstructive coronary disease.

This paper evaluated cross-sectional relationships between psychological stress and coronary artery disease (CAD) risk among women with suspected ischaemia and no obstructive coronary artery disease (INOCA). Between 1996 and 2000, 551 women with INOCA were enrolled in the Women's Ischemia Syndrome Evaluation (WISE) cohort from four U.S. institutions. Between 2009 and 2012, 376 women with INOCA were recruited from two U.S. institutions for an independent cohort study titled WISE-Coronary Vascular Dysfunction (WISE-CVD). Participants underwent coronary angiography and testing for CAD symptoms and risk factors at baseline. Psychological stress was assessed in the form of home/work stress in WISE and home/work stress and financial stress in WISE-CVD. Results showed that home/work stress predicted greater depression, functional impairment, CAD symptoms, and lower self-rated health in WISE but was inconsistent as a predictor in WISE-CVD. In contrast, >60% of WISE-CVD women reported moderate or severe financial stress. Financial stress levels predicted more CAD risk factors and cardiac symptoms, poorer self-rated health, and greater depression and functional impairment. Among women with INOCA, psychological stress was associated with CAD symptoms and CAD risk factors. The prevalence and predictive value of psychological stress in this population supports the inclusion of stress measures in future CAD research.

Estimation of Genetic Parameters for Peak Yield, Yield and Persistency Traits in Murciano-Granadina Goats Using Multi-Traits Models.

This paper studies parameters of a lactation curve such as peak yield (PY) and persistency (P), which do not conform to the usual selection criteria in the Murciano-Granadina (MG) breed, but are considered to be an alternative to benefit animal welfare without reducing production. Using 315,663 production records (of 122,883 animals) over a period of 24 years (1990-2014), genetic parameters were estimated with uni-, bi- and multivariate analysis using multiple trait derivative free restricted maximum likelihood (MTDFREML). The heritability (h2)/repeatability (re) of PY, yield (Y) and P was estimated as 0.13/0.19, 0.16/0.25 and 0.08/0.09 with the uni-trait and h2 of bi- and multi-traits analysis ranging from 0.16 to 0.17 of Y, while that of PY and Y remained constant. Genetic correlations were high between PY-Y (0.94 ± 0.011) but low between PY-P (-0.16 ± 0.054 to -0.17 ± 0.054) and between Y-P (-0.06 ± 0.058 to -0.05 ± 0.058). Estimates of h2/re were low to intermediate. The selection for Y-PY or both can be implemented given the genetic correlation between these traits. PY-P and Y-P showed low to negligible correlation values indicating that if these traits are implemented in the early stages of evaluation, they would not be to the detriment of PY-Y. The combination of estimated breeding values (EBVs) for all traits would be a good criterion for selection.

Fixed-dose combination therapy to improve hypertension treatment and control in Latin America.

Hypertension is a major risk factor for cardiovascular disease. Its prevalence is increasing worldwide, and is more common in low and middle-income countries. The effectiveness of hypertension treatment is determined by health cost, awareness, and patients' compliance with the treatment. People worldwide with an adequate control of hypertension correspond to a very small percentage in low and medium income countries as the Latin America ones. Between the causes to explain these are the low availability, affordability and adherence to treatment with multiple pills. It has been proposed that fixed dose combination therapy could improve the availability, affordability, adherence and control of hypertension. This article aims to review the evidence, showing that fixed dose combination can improve adherence, decrease health cost and improve control of hypertension. Improvement in hypertension control with fixed dose combination could make an important contribution to efforts to fight against the global cardiovascular morbidity and mortality.

Molecular Study of the Amazonian Macabea Cattle History.

Macabea cattle are the only Bos taurus breed that have adapted to the wet tropical conditions of the Amazon. This breed has integrated into the culture of the indigenous Shuar-Asuar nations probably since its origins, being one of the few European zoogenetic resources assimilated by the deep-jungle Amazon communities. Despite its potential for local endogenous sustainable development, this breed is currently endangered. The present study used molecular genetics tools to investigate the within- and between-breeds diversity, in order to characterize the breed population, define its associations with other breeds, and infer its origin and evolution. The within-breed genetic diversity showed high values, as indicated by all genetic parameters, such as the mean number of alleles (MNA = 7.25±2.03), the observed heterozygosity (Ho = 0.72±0.02) and the expected heterozygosity (He = 0.72±0.02). The between-breeds diversity analysis, which included factorial correspondence analysis, Reynolds genetic distance, neighbor-joining analysis, and genetic structure analysis, showed that the Macabea breed belongs to the group of the American Creoles, with a Southern-Spain origin. Our outcomes demonstrated that the Macabea breed has a high level of purity and null influences of exotic cosmopolitan breeds with European or Asiatic origin. This breed is an important zoogenetic resource of Ecuador, with relevant and unique attributes; therefore, there is an urgent need to develop conservation strategies for the Macabea breed.

Anti-JC virus seroprevalence in a Spanish multiple sclerosis cohort: JC virus seroprevalence in Spain.

OBJECTIVE: To estimate the seroprevalence of anti-JCV antibodies, seroconverting rates and evolution of antibody levels in a multiple sclerosis (MS) Spanish cohort. METHODS: Multicenter, retrospective cross-sectional and longitudinal study. The JCV seroprevalence was analyzed in 711 MS patients by using 1st (STRATIFY-1) and 2nd generation (STRATIFY-2) two-step ELISA over 2.65 (±0.97) years. Seroconversion rate was obtained over 2 samples from 314 patients, and index stability from 301 patients with 3 or more samples available. The effect of each ELISA generation, demographics, clinical characteristics and therapy on seroprevalence was assessed by logistic regression. RESULTS: The overall anti-JCV seroprevalence was 55.3% (51.6-58.9), similar across regions (p=0.073). It increased with age (p<0.000) and when STRATIFY-2 was used (60.5%, p=0.001). Neither sex nor immunosuppressive therapy had any influence. Yearly seroconversion rate was 7% (considering only STRATIFY-2). Serological changes were observed in 24/301 patients, 5.7% initially seropositive reverted to seronegative and 7% initially seronegative changed to seropositive and again to seronegative, all these cases had initial index values around the assay's cut-off. CONCLUSIONS: JCV seroprevalence in Spanish MS patients was similar to that reported in other European populations. Changes in serostatus are not infrequent and should be considered in clinical decisions.

[Comparative study of propranolol versus propranolol plus isosorbide 5-mononitrate in portal hypertension in cirrhotics. Evaluating splanchnic hemodynamics with color Doppler ultrasound]. / Estudio comparativo de propranolol contra propranolol más 5-mononitrato de isosorbide en hipertensión portal de cirróticos. Evaluando con eco Doppler color la hemodinamia esplácnica.

BACKGROUND: Hemorragic portal hypertension (HTP-H) has a mortality of 30-40%. Propranolol alone or in combination with isosorbide-5-mononitrate (5MNI) has been wed as hemorrhage preventive treatment. OBJECTIVE: Compare propranolol vs. propranolol and 5MNI as preventive treatment of HTP-H, evaluating splachnic hemodynamics by color Doppler ultrasound (EDC). METHODOLOGY: We included 20 patients with liver cirrhosis, mean age 53.3 years, 13 female, 10 for primary prevention and assigned them in to 2 groups treatment: l.- Propranolol alone (10 patients), ll.- Propranolol + 5-MNI (10 patients). We carried out EDC to each patient before iniciating and 2 months after treatment. RESULTS: A decrease in splachnic hemodynamics was found in both groups as measured by portal vein (PV), hepatic artery (HA) velocity and flux decreased in group I were: PV velocity from 15.4 to 12.5 cm/seg (p = 0.019089 ) and flux from 1639.8 to 1396.8 mL/min (p = 0.031082), HA velocity from 50.1 to 44.5 cm/seg (p = 0.120385), and flux 547.1 a 470 mL/min (p = 0.069642); in group 11: PV from 16.6 to 12.9 (p = 0.019699) and from 1,786.8 to 1,304.2 (p = 0.004072), in HA from 52.3 to 44.4 (p = 0.003498 ) and 612.5 to 448.8 (p = 0.000285). CONCLUSION: Propranolol and 5-MNI decreases splachnic flux and velocity more than propranolol alone, in consequence it should be better to prevent bleeding from portal hypertension.

[Epidemiologic and situational panorama of hepatitis C in Mexico]. / Panorama epidemiológico y situacional de la hepatitis C en México.

OBJECTIVE: To determine the epidemiological situation of Chronic Hepatitis C (CHC) in our country. BACKGROUND DATA: Chronic Hepatitis C affects 170 million people worldwide, and about 0.7% of Mexican population. There is no enough epidemiological information about CHC in our country, and it is very probable that some cases are not even detected. METHODS: An investigation poll was performed. Age, gender, birthday, weight, race, residence and birth place, routes of transmission, ALT levels, histological, serological and molecular diagnosis, evidence of complications and previous treatments were recorded. A data recollection sheet was dispatched to different country provinces; they had 6 months to answer it, in order to recollect all information. RESULTS: 831 patients were analized (58.6% female and 41.4% male) with the following distribution in our country provinces: Aguascalientes 15, Chihuahua 12, Distrito Federal 495, Durango 10, Jalisco 89, Guanajuato 78, Yucatán 8, Querétaro 11, Sonora 40, Tabasco 15, Baja California 5, Veracruz 13, Tamaulipas 2 and 38 patients of Nuevo León. The highest incidence of CHC was found at fifth and sixth decade of life (28.5% y 26.7% respectively. The weight distribution was 36.2% < 65kg, 34.6% 65-75 kg and 29.2% > 75 kg. 86.5% had chronic hepatitis and 13.2% cirrhosis. The risk factors for HCV infection analysis showed that the main route of transmission was via contaminated blood (64.2%); when we excluded the patients that were exposed before 1995, the incidence was lowered to 4.5%. The higher incidence was showed between 1970 and 1990 (68%). The intravenous drug users were predominantly male and on those patients in the provinces near the north border line of our country. The predominant genotype was gen- 1 no matter the province (72.2%), in the intravenous drug users genotype 3 was found in 25%. The viral load was similar in all the provinces. 75% of the patients had have treatment and 22.5% had have two cycles, 50% of cirrhotic patients had have treatment whereas only 28% of the patients with late complications had have it. The most common treatment was pegylated alpha-2a interferon plus ribavirine. CONCLUSIONS: 1. The main route of transmission was blood transfusion. There is a marked decrease in the incidence of post-transfusional hepatitis since the introduction of anti-VHC antibody screening of blood donors (4.5%). 2. The time between the infection and diagnosis was 23 years for chronic hepatitis and 26 years for cirrhosis. 3. Intravenous drugs use was an important route of transmission in the north of our country. 4. The predominant genotype was gen-1. 5. Almost all the patients with chronic hepatitis received treatment, the most common used was pegylated interferon alpha-2a and ribavirin. 6.50% of the patients with CHC have late complications.

[Natural history of chronic hepatitis C]. / Historia natural de la hepatitis crónica C.

Acute hepatitis chronic C is usually anicteric and asympntomatic. Chronic viraemia occurs in 85-90% of infected individual. 70% of whom develop some degree of chronic liver injury and face the potential risk of progression to cirrhosis and hepatocellular carcinoma. Approximately 20% of individual with chronic hepatitis C infection develop cirrhosis within 20 years.

Efectividad analgésica postoperatoria de la adición de morfina más dexametasona al anestésico local en bloqueo ecodirigido de plexo braquial / Postoperative analgesic effectiveness of the addition of morphine plus dexamethasone to the local anesthetic in ultrasound-guided brachial plexus block

OBJECTIVE: To describe and evaluate the postoperative analgesic effectiveness of the combination of morphine, dexamethasone and local anesthetic in ultrasound-guided brachial plexus block. MATERIALS AND METHODS: A prospective, observational and analytical cohort study was conducted. The cohort was composed of 106 patients divided into three groups: 1. Local anesthetic (AL), 2. Local anesthetic plus dexamethasone (ALD) and 3. Local anesthetic plus dexamethasone and morphine (ALDM). The outcome variable was acute postoperative pain (DAP) and the need for analgesic rescue. The DAP was evaluated at 3, 6, 9, 12, 18 and 24 postoperative hours using an analogous verbal scale (VAS) and was additionally recorded if it required analgesic rescue. Additionally, latency time, duration of sensory and motor block were recorded. Analysis was done with stata14 software. RESULTS: The overall incidence of postoperative pain was higher in the AL group (89%) than in the ALD group (58.3%) and ALDM (60%). At 3,6 and 9 hours postoperatively, no differences were found between the three groups. At 12 and 18 hours postoperatively, the incidence of pain in the ALD and ALDM groups was lower and significant (p < 0.05) with respect to the AL group. There were no statistically significant differences between the ALD and ALDM groups. At 24 post-operative time no statistically, significant differences were found between the three groups, however at that time the incidence of pain in the AL group was 38% vs 25% of the ALDM group vs 23% of the ALD group. At the end of the study, the intervention in the ALDM group and the ALD group presented Relative Risks (RR) of 0.68 and 0.65 respectively to the LA group. CONCLUSIONS: The addition of morphine and dexamethasone or morphine alone to the local anesthetic reduces the postoperative acute pain between 12 and 18 hours and prolongs the time of peripheral ultrasound-guided brachial plexus block. To evaluate differences between these coadjutant's, a study with more power and controlled clinical trial type is required.

Objetivo: Describir y evaluar la efectividad analgésica postoperatoria de la combinación de morfina y dexametasona como coadyuvantes a anestésicos locales en bloqueo ecodirigido del plexo braquial. Materiales y Métodos: Se realizó un estudio tipo cohorte prospectivo, observacional y analítico. La cohorte quedó conformada por 106 pacientes divididos en tres grupos: grupo anestésico local sin coadyuvantes (ALSC), grupo anestésico local más dexametasona (ALD) y grupo anestésico local más dexametasona y morfina (ALDM). La variable resultado fue dolor agudo posoperatorio (DAP) moderado a severo y necesidad de rescate analgésico. EL DAP se evaluó a las 3, 6, 9, 12, 18 y 24 horas posoperatorias (POP) utilizando escala verbal análoga (EVA) y, adicionalmente, se registró si se requirió rescate analgésico. Igualmente, se registró tiempo de latencia, duración del bloqueo sensitivo y motor. El análisis se realizó con software stata14. Resultados: La incidencia global de DAP moderado a severo fue mayor en el grupo ALSC (89%) con respecto al grupo ALD (58,3%) y grupo ALDM (60%). A las 3, 6 y 9 horas posoperatorias no se evidenció diferencias entre los tres grupos. A las 12 y 18 horas posoperatorias la incidencia de dolor en los grupos con coadyuvantes fue menor y significativo (p < 0,05) con respecto al grupo control. Entre los grupos ALD y ALDM no hubo diferencias estadísticamente significativas. A las 24 horas POP no se encontraron diferencias estadísticamente significativas entre los tres grupos, sin embargo, en ese momento la incidencia de DAP moderado a severo en los tres grupos fue 38%, 25% y 23% respectivamente. Al final del estudio la intervención en los grupos ALD y ALDM presentaron riesgos relativos (RR) de 0,68 y 0,65 respecto al grupo ALSC. Conclusiones: La adición de morfina y dexametasona o de morfina sola al anestésico local parece disminuir el DAP moderado a severo entre las 12 y 18 horas y prolongar la duración de bloqueos periféricos ecoguiados del plexo braquial. Para evaluar diferencias entre estos coadyuvantes se requieren un estudio con más poder y de tipo ensayo clínico controlado.