Aging impairs the osteocytic regulation of collagen integrity and bone quality.

Poor bone quality is a major factor in skeletal fragility in elderly individuals. The molecular mechanisms that establish and maintain bone quality, independent of bone mass, are unknown but are thought to be primarily determined by osteocytes. We hypothesize that the age-related decline in bone quality results from the suppression of osteocyte perilacunar/canalicular remodeling (PLR), which maintains bone material properties. We examined bones from young and aged mice with osteocyte-intrinsic repression of TGFß signaling (TßRIIocy-/-) that suppresses PLR. The control aged bone displayed decreased TGFß signaling and PLR, but aging did not worsen the existing PLR suppression in male TßRIIocy-/- bone. This relationship impacted the behavior of collagen material at the nanoscale and tissue scale in macromechanical tests. The effects of age on bone mass, density, and mineral material behavior were independent of osteocytic TGFß. We determined that the decline in bone quality with age arises from the loss of osteocyte function and the loss of TGFß-dependent maintenance of collagen integrity.

Malla suburetral retropúbica (TVT): experiencia clínica y análisis de datos en el Hospital El Carmen de Maipú / Retropubic suburethral mesh (TVT): clinical experience and data analysis at the Hospital El Carmen de Maipú

La incontinencia urinaria de esfuerzo es la pérdida involuntaria de orina durante una maniobra de esfuerzo físico, ejercicio, estornudo o tos. Afecta aproximadamente al 15% de las mujeres de 30-60 años y su prevalencia es del 30-41%. Aunque existen terapias conservadoras para su manejo, muchas pacientes terminarán necesitando cirugía para su resolución. Las mallas suburetrales son alternativas para el manejo quirúrgico, existiendo dos vías de instalación, la transobturadora (TOT o TVT-O) y la retropúbica (del inglés tension-free vaginal tape o TVT), siendo esta última la que presenta mejores resultados y menos complicaciones posoperatorias. Objetivo: evaluar la tasa de efectividad y las complicaciones de la TVT en la Unidad de Piso Pélvico Femenino del Hospital El Carmen de Maipú entre los años 2015 y 2020. Materiales y Métodos: Se obtuvieron 715 registros de pacientes que fueron sometidas a TVT y se logró contactar telefónicamente con el 60,69% de ellas. Resultados: Los resultados muestran una tasa de efectividad del 94,8% y una tasa de complicaciones del 2,3%. Conclusión: Este estudio aporta evidencia local de los resultados posoperatorios en la IOE en pacientes que requirieron la instalación de una malla suburetal retropúbica, demostrando ser una cirugía altamente efectiva y segura.

Stress urinary incontinence is the involuntary loss of urine during physical exertion, exercise, sneezing, or coughing. It affects approximately 15% of women aged 30-60, with a prevalence of 30-41%. Although there are conservative therapies for its management, many patients will eventually require surgery for resolution. Suburethral sling are considered for surgical management, and there are two installation alternatives, transobturator (TOT or TVT-O) and retropubic (tension-free vaginal tape or TVT), with the latter presenting better results and fewer postoperative complications. Objetive: to evaluate effectiveness rate and complications of the TVT in the Female Pelvic Floor Unit of Hospital El Carmen de Maipú between 2015 and 2020. Materials and Methods: A total of 715 patient records were obtained for those who underwent TVT, and 60.69% of them were successfully contacted by telephone. Results: The results show an effectiveness rate of 94.8% and a complication rate of 2.3%. Conclusion: This study provides local evidence for the results of stress urinary incontinence that required the placement of a retropubic suburethral sling, proving to be a highly effective and safe surgery.

Efficacy of Crohn's disease exclusion diet in treatment -naïve children and children progressed on biological therapy: a retrospective chart review.

BACKGROUND: Recent trials suggested that the Crohn's disease (CD) exclusion diet (CDED) plus partial enteral nutrition (PEN) is a safe and effective strategy in remission induction of paediatric-onset CD. However, real-world evidence regarding the safety and efficacy of the CDED plus PEN approach is still lacking. The present case-series study reported our experience with the outcomes of CDED plus PEN in the paediatric-onset CD at disease onset and after the loss of response to biologics. METHODS: We conducted a retrospective chart review on children who were treated with CDED plus PEN through the period from July 2019 and December 2020. Clinical and laboratory data were retrieved and compared at baseline, 6, 12, and 24 weeks of treatment. The primary endpoint of the present study was the rate of clinical remission. RESULTS: The present study retrieved the data from 15 patients. Of them, nine patients were treatment naïve at the time of initiation of CDED plus PEN (group A) and the remaining patients relapsed on biologics before treatment. All patients in groups A and B exhibited clinical remission in week six, which was sustained until week 12. At the end of the follow-up, the clinical remission rate was 87% and 60% in groups A and B, respectively. No side effects were observed in both groups. In group A, the faecal calprotectin (FC) and albumin improved at week six, week 12, and week 24 (p < 0.05). The erythrocyte sedimentation rate (ESR) improved significantly at week 12 (p = 0.021) and week 24 (p = 0.027). At the same time, the haemoglobin and iron levels showed significant improvement only at week 24. For group B, only FC showed numerical reductions over time that did not reach the level of statistical significance. CONCLUSION: Treatment with CDED plus PEN was well tolerated and achieved an excellent clinical remission rate in treatment-naive patients. However, the benefit of CDED plus PEN was less in patients who initiated the strategy after losing the response to biologics.

Association of Prematurity and Low Birth Weight with Gestational Exposure to PM2.5 and PM10 Particulate Matter in Chileans Newborns.

Fetal growth can be affected by gestational exposure to air pollution. The aim of the study was to determine the association between prematurity and low birth weight (LBW) with gestational exposure to PM2.5 and PM10 particulate matter in Chileans newborns. This cross-sectional analytical study included 595,369 newborns. Data were extracted from the live newborn records of the Chilean Ministry of Health. Sex, gestational age, birth weight, and living variables were analyzed. We used the Air Quality Information System of the Chilean Ministry of the Environment to obtain mean PM2.5 and PM10 emissions. A multivariate logistic regression model was performed with STATA 15.0 software at α < 0.05. Prevalence was 7.4% prematurity and 5.5% LBW. Mean PM2.5 and PM10 concentrations were 25.5 µg/m3 and 55.3 µg/m3, respectively. PM2.5 was associated with an increased the risk of LBW (OR: 1.031; 95%CI: 1.004−1.059) when exposure occurred in the second trimester, while PM10 affected the whole pregnancy. In addition, PM10 exposure in any gestational trimester was associated with an increased the risk of prematurity. The PM10 particulate matter was associated with both prematurity and LBW in all of the trimesters of exposure. The PM2.5 particulate matter was only associated with LBW when exposure occurred in the second gestational trimester.

Serie de Casos Retrospectiva de las Características Clínicas, del Manejo y Resultados de los Pacientes con COVID-19 en hospitales privados de la región metropolitana en la República de Panamá

Introducción: El 9 de marzo de 2020 se confirma el primer caso de COVID-19 en la República de Panamá. Según el reporte #46 de Panamá emitido por la OPS el 26 de enero de 2021, Panamá es el segundo país de las Américas con más alta incidencia después de Estados Unidos. Métodos: El diseño del estudio es observacional retrospectivo. En este estudio participaron 140 pacientes de 3 instituciones privadas localizadas en el área metropolitana de la República de Panamá. Resultados: De la muestra, 65.71% eran hombres y 34.29% eran mujeres, 72 (51.43%) pacientes fueron hospitalizados. La edad media fue de 48.39 años. El 49% de los pacientes presentaron antecedentes personales patológicos, el más común fue hipertensión arterial (63.27%). Los síntomas más frecuentes encontramos fiebre (71.43%), tos (61.43%), fatiga (50.71%) y disnea (32.86%). Del total de pacientes, 55.71% recibió tratamiento intrahospitalario, 11.51% fue admitido a UCI, 9.29% sufrió complicaciones y las más frecuente fue falla respiratoria (61.54%). De los medicamentos utilizados en ese periodo de tiempo lo más comúnmente usado fue la hidroxicloroquina (91.03%) y la azitromicina (84.62%). Conclusiones: Se encontraron resultados similares a estudios descriptivos realizados en distintos países con modelos similares al nuestro.   (provisto por Infomedic International)

Introduction: The first case of COVID-19 in the Republic of Panama was confirmed on March 9 2020. In the Panama #46 report issued by PAHO on January 26, 2021, Panama was the second country in the Americas with the highest incidence of COVID-19 after the United States. Methods: The design of the study is a retrospective observational study of 140 patients from 3 private hospitals located in the metropolitan area of the Republic of Panama. Results: Of the sample, 65.71% were men and 34.29% were women, 72 (51.43%) patients were hospitalized. The median age was 48.39 years. 49% of the patients presented a pathological personal history, the most common was arterial hypertension (63.27%).  Of the sample, 65.71% were men and 34.29% were women, 72 (51.43%) patients were hospitalized. The average age was 48.39 years. 49% of patients had a pathological personal history where high blood pressure was the most frequent (63.27%). The most common symptoms were fever (71.43%), cough (61.43%), fatigue (50.71%) and dyspnea (32.86%). Of the total number of patients, 55.71% received in-hospital treatment, 11.51% were admitted to the ICU, 9.29% suffered complications, the most frequent was respiratory failure (61.54%). Of the drugs used in that time period, the most commonly used were hydroxychloroquine (91.03%) and azithromycin (84.62%). Conclusions: Similar results were found to descriptive studies carried out in different countries with models similar to ours. (provided by Infomedic International)

Photosynthesis-Related Responses of Colombian Elite Hevea brasiliensis Genotypes under Different Environmental Variations: Implications for New Germplasm Selection in the Amazon.

The objective of this study was to evaluate photosynthetic performance based on gas exchange traits, chlorophyll a fluorescence, and leaf water potential (ΨL) in nine Hevea brasiliensis genotypes from the ECC-1 (Élite Caquetá Colombia) selection and the cultivar IAN 873 (control) in response to different climatic (semi-humid warm and humid warm climates), seasonal (dry and rainy periods), and hourly (3:00 to 18:00) variations that can generate stress in the early growth stage (two-year-old plants) in two large-scale clonal trials in the Colombian Amazon. The photosynthetic performance in 60% of the Colombian genotypes was slightly affected under the conditions with less water availability (dry period, semi-humid warm site, and between 9:00 and 15:00 h), as compared with IAN 873, whose affectation was moderate in terms of photosynthesis rates, but its water conservation strategy was strongly affected. The ECC 90, ECC 83, and ECC 73 genotypes had the best photosynthetic performance under conditions of greater water limitation, and ECC 35, and ECC 64 had a higher water status based on the leaf water potential, with intermediate photosynthetic performance. This germplasm has a high potential for selection in rubber tree breeding programs in future scenarios of climate change in the Colombian Amazon.

[Nutritional education in school-age children through Programa Nutriplato®]. / Educación nutricional en niños en edad escolar a través del Programa Nutriplato®.

INTRODUCTION: Introduction: promoting healthy eating habits among childhood is one of the key aspects to improve medium and long-term health outcomes. Objectives: the main aims are to improve eating habits, promote the Mediterranean diet (MD) and prevent and/or reverse overweight and obesity in children from 3 to 12 years old. Methods: the program has a one-year follow-up and includes three to five visits with registered dietitians, one telephone control and one practical workshop. Anthropometric, body composition and eating habits data are collected, and nutritional education is carried out. A total sample of 1,000 children will be included. Results: until now, 622 participants have been included (51.6 % boys; median age 8.5 years). At the beginning, 32.2 % of participants were overweight or obese and 38.9 % had an adequate MD. Although no differences were found in the assessment of the Kidmed questionnaire regarding sex (p = 0.214) or body mass index (BMI) subgroups (p = 0.181), differences were found regarding age (p = 0.023) and BMI Z-score (p = 0.004), showing slightly lower values in those having and adequate MD. At the moment, 362 participants have made the six-month visit, of which 61.6 % presented an adequate MD, with statistically significant differences compared to the baseline visit (p < 0.0001). Conclusions: preliminary results show the need for nutritional education in children and suggest that Programa Nutriplato® can be effective in improving eating habits.

INTRODUCCIÓN: Introducción: promocionar hábitos de alimentación saludable durante la infancia es uno de los aspectos clave para fomentar un buen estado de salud a medio y largo plazo. Objetivos: los objetivos principales son mejorar los hábitos alimentarios, promocionar la dieta mediterránea (DM) y prevenir y/o revertir el sobrepeso y la obesidad en niños de 3 a 12 años. Métodos: el programa tiene un seguimiento de un año e incluye de tres a cinco visitas con dietistas-nutricionistas, un control telefónico y un taller práctico. Se recogen datos antropométricos, de composición corporal y de hábitos alimentarios, y se realiza educación nutricional. Se incluirán un total de 1.000 niños. Resultados: hasta el momento, se han incluido 622 participantes (51,6 % niños; mediana de edad de 8,5 años). Al inicio, el 32,2 % presentaba sobrepeso u obesidad y el 38,9 % seguía una DM óptima. No se encontraron diferencias en la valoración del cuestionario Kidmed en función del sexo (p = 0,214) ni del subgrupo de índice de masa corporal (IMC) (p = 0,181), pero sí en función de la edad (p = 0,023) y del Z-score del IMC (p = 0,004), mostrando valores ligeramente menores en aquellos que presentaban una DM óptima. Por ahora, 362 participantes han realizado la visita de los seis meses, de los cuales el 61,6 % presentó una DM óptima, con diferencias estadísticamente significativas en comparación con la inicial (p < 0,0001). Conclusiones: los resultados preliminares muestran la necesidad de realizar educación nutricional en los niños y sugieren que el Programa Nutriplato® puede ser efectivo en la mejora de hábitos alimentarios.

A Dimorphic Diagnosis of a Pleomorphic Disease: An Unusual Cause of Hypercalcemia.

BACKGROUND: Histoplasmosis is a rare cause of 1, 25-dihydroxy vitamin-D-mediated hypercalcemia. In this study, we report 2 cases of hypercalcemia secondary to histoplasmosis seen at Mayo Clinic, Rochester and a review of cases reported in the literature. METHODS: We conducted a PubMed search using the keywords "hypercalcemia" and "histoplasmosis." Fourteen cases of hypercalcemia secondary to histoplasmosis were reported between 1977 and 2020. We identified an additional 2 patients from our institution. RESULTS: We reviewed a total of 16 cases. The median age at presentation was 58.5 years (interquartile range, 41.5-68.75 years), and 13 of 16 patients (81.2%) were men. Serum parathyroid hormone level was available in 13 of 16 (81.25%) patients, of whom 11 patients (84.6%) had a low level, 1 patient (7.6%) had a normal level, and 1 patient (7.6%) had an elevated level. 1, 25-dihydroxy vitamin D level was reported in 9 of 16 (56.25%) patients. Of these, 5 patients (55.5%) had levels within normal limits, and 4 patients (44.4%) had levels above normal. Serum angiotensin-converting enzyme level was evaluated in 4 of 16 patients (25%), and it was elevated in all 4 (100%) cases. Four patients received corticosteroids before a diagnosis of histoplasmosis was made, which resulted in rapidly progressive disease and death in 2 patients. CONCLUSIONS: In patients with granulomatous disorder and hypercalcemia, it is crucial to rule out infectious etiologies before initiating steroids. Histoplasmosis can cause nonparathyroid hormone-mediated hypercalcemia and, if not suspected, may have catastrophic implications.

Fishing for a Diagnosis, the Impact of Delayed Diagnosis on the Course of Mycobacterium marinum Infection: 21 Years of Experience at a Tertiary Care Hospital.

BACKGROUND: Mycobacterium marinum is a common but underreported mycobacterial infection. We conducted a large retrospective study to determine risk factors and describe the therapeutic interventions and outcomes in patients with uncomplicated and complicated M. marinum infection. METHODS: Culture-confirmed M. marinum infection cases were identified from the Mayo Clinic Clinical Mycology Laboratory from January 1998 to December 2018. Complicated M. marinum infection was defined as the presence of tenosynovitis, septic arthritis, or osteomyelitis. Differences in complicated vs uncomplicated M. marinum infections were analyzed using statistical comparisons. RESULTS: Twelve cases had a complicated M. marinum infection. Patients with a complicated infection were older (64.3 ±â€…11.1 vs 55.8 ±â€…14.5; P = .03), had longer duration of symptoms (5 vs 3 months; P = .011), and had more surgical debridements (1 vs 0; P < .001). Length of treatment and number of drugs used were not statistically significant. Complicated M. marinum cases received more medications (2 vs 1; P = .263) and were treated longer (5.7 vs 3.5 months; P = .067). Antibiotic susceptibilities were performed in 59% of the patients. All isolates were susceptible to clarithromycin. From the tetracyclines, doxycycline had a better susceptibility pattern. CONCLUSIONS: M. marinum infection is an important cause of skin and soft tissue infection. Poor water exposure documentation, unusual clinical presentation, and empiric antibiotic treatment before definitive M. marinum diagnosis often contribute to a delayed diagnosis. Complicated M. marinum cases had longer duration of symptoms and more surgical debridements. No difference in the number of drugs used or clinical outcome was observed.

Análisis de la mortalidad por cáncer de mama, tendencias y pronóstico en Santiago de Cuba / Analysis of breast cancer mortality, trends and prognosis in Santiago de Cuba

RESUMEN Introducción: En los últimos diez años, la tasa de mortalidad por cáncer de mama se ha mantenido aparentemente estable, una de cada 8 mujeres está afectada por esta enfermedad, y de aquí a 20 años esta cifra podría elevarse. Objetivos: Estimar la tendencia de la mortalidad por cáncer de mama, y predecir la magnitud de la mortalidad por esta enfermedad para el quinquenio 2015 a 2020. Métodos: Se realizó un estudio multicéntrico, observacional, descriptivo, longitudinal y prospectivo en el Servicio de Cirugía General del Hospital Provincial "Saturnino Lora" de Santiago de Cuba, en el periodo comprendido entre septiembre del año 2012 y diciembre del año 2015. La población de referencia estuvo constituida por todos los pacientes fallecidos en la provincia de Santiago de Cuba 1579 portadores de cáncer de mama. Resultados: El 37,4 % del total falleció entre el año 2010 y el año 2014, tasa de letalidad más elevada fue en el periodo comprendido entre los años 2000 y 2004. Conclusiones: El riesgo de morir y la gravedad de la enfermedad han disminuido de forma significativa en el periodo de análisis. Se evidencia una tendencia ligeramente elevada de los casos de cáncer de mama en la provincia de Santiago de Cuba, donde se espera que esta situación de salud continúe al alza para el próximo lustro(AU)

ABSTRACT Introduction: In the last ten years, the mortality rate from breast cancer has remained apparently stable, one in 8 women is affected by this disease, and in 20 years this figure could rise. Objectives: Estimate the trend of mortality from breast cancer, and predict the magnitude of mortality from this disease for the five-year period 2015-2020. Methods: A multicenter, observational, descriptive, longitudinal and prospective study was carried out in the General Surgery Service of the Provincial Hospital "Saturnino Lora" in Santiago de Cuba, in the period between September 2012 and December 2015. The population The reference was made up of all 1579 patients who died in the province of Santiago de Cuba, carriers of breast cancer. Results: 37.4% of the total died between 2010 and 2014, the highest case fatality rate was in the period between 2000 and 2004. Conclusions: The risk of dying and the severity of the disease have decreased significantly in the analysis period. A slightly elevated trend is evident in breast cancer cases in the province of Santiago de Cuba, where it is expected that this health situation will continue to rise for the next five years(AU)

Caracterización de pacientes con hipoacusia sensorineural laboral que acuden a la Clínica de Medicina Laboral "Oscar Benavides Lanuza" Instituto Nicaragüense de Seguridad Social - Managua ­ Nicaragua, de Enero 2015 a Diciembre 2017 / Characterization of patients with occupational sensorineural hearing loss who attend the Occupational Medicine Clinic "Oscar Benavides Lanuza" Nicaraguan Social Security Institute - Managua - Nicaragua, from January 2015 to December 2017

OBJETIVO: Caracterizar los pacientes con hipoacusia sensorineural de origen laboral, atendidos en la Clínica de Medicina Laboral "Oscar Benavides Lanuza" INSS - Managua, de enero 2015 a diciembre del 2017. METODOLOGÍA: Se realizó estudio descriptivo, de corte transversal, a 30 pacientes con hipoacusia sensorineural de origen laboral en la Clínica de Medicina Laboral "Oscar Benavides Lanuza" INSS- Managua. RESULTADOS: Se determinó que la media de edad correspondió a 49 años, predominó el género masculino en un 86.7%; con estudios primarios un 50%. Éstos laboraban en el sector de minería 46.7%, productos cárnicos y cementera 13.3% cada uno. Con una media de 16 años de laborar en la empresa, en una jornada de 8 horas 46.7% y más de 8 horas 50%, desarrollando diversas actividades, con un tiempo de exposición en ambiente de ruido de 8 horas continuas un 50%; exponiéndose a niveles de ruido mínimo de 84.13dB y máximo de 98.65dB, 57% de los pacientes no usaban equipos de protección auditiva. Los síntomas auditivos predominantes fueron hipoacusia un 93.3% y acúfenos 90%, no existió asociación con síntomas psíquicos, patologías asociadas y factores de riesgo concomitantes. Predominó la hipoacusia sensorineural moderada izquierda 43.3% y leve derecha en un 36.7%, siendo bilateral en un 100%. Solamente el 30% de los pacientes usa auxiliares auditivos. CONCLUSIONES: En el estudio predominó el género masculino, con una media de edad de 49 años, con un nivel de escolaridad primario, desempeñándose en el sector de minería principalmente. Años laborados con una media de 16, en una jornada laboral de 8 horas, con un nivel de ruido de 84.13 ­ 98.65dB, en su mayoría expuestos 8 horas en ambiente de ruido y sin protectores auditivos. Los pacientes aquejaban hipoacusia y tinnitus, presentando hipoacusia sensorineural bilateral en grado variable y solo un mínimo usa auxiliar auditivo como tratamiento

Vía clínica de la colecistectomía laparoscópica electiva en enfermedades benignas de la vesícula biliar / Clinical pathway for elective laparoscopic cholecystectomy in benign diseases of the biliary vesicle

Introducción: las vías clínicas son una de las principales herramientas de la gestión de la calidad asistencial para la estandarización de los procesos asistenciales. Se ha demostrado que su implantación permite disminuir la variabilidad de la práctica clínica. Objetivos: Elaborar una vía clínica para el diagnóstico, tratamiento y seguimiento de enfermos con enfermedades benignas de la vesícula biliar operados por mínimo acceso. Método: se realizó un estudio cuasi experimental en el servicio de cirugía del Hospital Provincial Saturnino Lora de Santiago de Cuba, desde enero del año 2011 hasta septiembre del año 2014 con una muestra de 1287 pacientes operados. Se diseñó la vía clínica mediante el consenso de expertos y se dividió la muestra en dos grupos para llevar a cabo el cuasi-experimento. Resultados: en el grupo B, 97,3 por ciento de los pacientes fueron egresados en 24 h o menos luego de ser operados; 93,9 pr ciento de los pacientes del grupo B fueron operados en 60 minutos o menos. Se observó una disminución significativa del tiempo quirúrgico en el grupo B al compararse ambos grupos (p= 0,004). Hubo una disminución estadísticamente significativa (p= 0,047) de las lesiones de la vía biliar principal en el grupo B. Conclusiones: la aplicación de la vía clínica disminuyó de forma significativa la estadía hospitalaria, los tiempos quirúrgicos y las lesiones iatrogénicas de la vía biliar(AU)

Introduction: The clinical pathways are one of the main tools for the management of the quality of care in the standardization of the caring processes. its implantation has been shown to reduce the variability of clinical practice. Objectives: To elaborate a clinical pathway for the diagnosis, treatment and follow-up of patients with benign diseases of the gall bladder and operated by minimal access. Method: A quasi-experimental study was carried out in the surgery service of Saturnino Lora Provincial Hospital in Santiago de Cuba, from January 2011 to September 2014, with a sample of 1287 operated patients. The clinical pathway was designed upon expert consensus and the sample was divided into two groups, in order to carry out the quasi-experiment. Results: In group B, 97.3 percent of the patients were discharged after 24 hours or less of being operated; 93.9 percent of patients in group B were operated in 60 minutes or less. A significant decrease in surgical time was observed in group B, when both groups were compared (p= 0.004). The group B had a statistically significant decrease (p= 0.047) of the lesions of the main bile duct in. Conclusions: The application of the clinical pathway significantly reduced hospital stay, surgical times and iatrogenic lesions of the bile duct(AU)

Hernia de Littre estrangulada en un adulto / Littre strangulated hernia in an adult

Se describe el caso clínico de un adulto de 47 años de edad, quien acudió al cuerpo de guardia del Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora Torres de Santiago de Cuba por presentar, desde hacía 3 días, dolor en epigastrio, de comienzo insidioso, que desapareció en las últimas 24 horas, y apareció nuevamente en la fosa ilíaca derecha y mesogastrio, pero esta vez se trasformó en fijo, punzante, de moderada intensidad, que no se aliviaba con analgésicos, y asociado a náuseas; igualmente, refirió y se corroboró al examen físico la presencia de una hernia umbilical que no lograba reducirse. El paciente fue operado y se encontró una hernia de Littre umbilical estrangulada. Se le realizó resección y anastomosis del íleon a nivel del divertículo de Meckel, así como herniorrafia umbilical. La evolución fue favorable y egresó sin complicaciones

The case report of a 47 years adult is described who went to the emergency room of Saturnino Lora Torres Teaching Clinical Surgical Provincial Hospital in Santiago de Cuba due to epigastric distress of insidious beginning for 3 days that disappeared in the last 24 hours, appearing again in the right iliac cavity and mesogastrium, but this time it was transformed in a fixed, sharp, of moderate intensity pain that was not relieved with analgesics, and associated with nausea; equally, he referred the presence of an umbilical hernia that was not able to decrease and it was corroborated in the physical exam. The patient was operated on and a strangulated umbilical Littre hernia was found. A resection and anastomosis of ilium at the Meckel diverticulum level was carried out, as well as umbilical hernia repair. There was a favorable clinical course and he was discharged without complications

Clasificación evolutiva y algoritmo de tratamiento quirúrgico de la mediastinitis aguda por perforación esofágica / Evolutionary classification and surgical treatment algorithm for acute mediastinitis through esophageal perforation

Introducción: la mediastinitis aguda constituye una complicación grave de la perforación esofágica. No existen clasificaciones ni pautas generales para su tratamiento. Objetivo: desarrollar una clasificación evolutiva, y un algoritmo de tratamiento quirúrgico. Métodos: se efectuó una investigación en el Hospital Provincial Saturnino Lora, de Santiago de Cuba, desde 1990 hasta el 2014. Se utilizó la prueba chi cuadrado de homogeneidad para la validación de los resultados, así como el porcentaje como medida de resumen y el calcula de las tasas de incidencia y de mortalidad. El estudio incluyó dos diseños metodológicos: el primero, de desarrollo tecnológico, para la elaboración de la clasificación y el algoritmo de tratamiento, y un cuasiexperimento, para la aplicación del algoritmo. Resultados: se identificó que en los estados más severos de la mediastinitis aguda, la mortalidad es más elevada. La carga de mortalidad para el primer grupo de pacientes fue del 77,7 por ciento y descendió al 22,3 por ciento en el grupo tratado con el algoritmo (decremento del riesgo del 64,8 por ciento). Conclusiones: la clasificación evolutiva pauta la implementación del algoritmo de tratamiento quirúrgico de la enfermedad. La aplicación del algoritmo de tratamiento quirúrgico de la mediastinitis aguda por perforación esofágica permite disminuir la carga de morbilidad. En consecuencia, disminuye de forma relevante el riesgo de morir por esta enfermedad(AU)

Introduction: acute mediastinitis is a serious complication of esophageal perforation. There are no classifications or general guidelines for its treatment. Objective: to develop an evolutionary classification and a surgical treatment algorithm. Methods: aresearch was carried out at Saturnino Lora Provincial Hospital in Santiago de Cuba, from 1990 to 2014. The chi-square homogeneity test was used for the validation of the results, as well as the percentage as a summary measure and the calculation of incidence rates and mortality. The study included two methodological designs: the first, technological development, for the elaboration of the classification and the treatment algorithm, and a quasi-experiment for the application of the algorithm. Results: in the more severe states of acute mediastinitis, mortality was identified as higher. The mortality load for the first group of patients was 77.7 percent and decreased to 22.3 percent in the group treated with the algorithm (risk reduction of 64.8 percent). Conclusions: the evolutionary classification guides the implementation of the surgical treatment algorithm of the disease. The application of the surgical treatment algorithm of acute mediastinitis through esophageal perforation allows reducing the burden of morbidity. Consequently, the risk of dying from this disease decreases significantly(AU)

Prospective randomized controlled study on the effects of Saccharomyces boulardii CNCM I-745 and amoxicillin-clavulanate or the combination on the gut microbiota of healthy volunteers.

Probiotics are believed to be beneficial in maintaining a healthy gut microbiota whereas antibiotics are known to induce dysbiosis. This study aimed to examine the effects of the probiotic Saccharomyces boulardii CNCM I-745 (SB), the antibiotic Amoxicillin-Clavulanate (AC) and the combination on the microbiota and symptoms of healthy humans. Healthy subjects were randomized to one of 4 study groups: SB for 14 days, AC for 7 days, SB plus AC, Control (no treatment). Participants gave stool samples and completed gastro-intestinal symptom questionnaires. Microbiota changes in stool specimens were analyzed using 16s rRNA gene pyrosequencing (bTEFAP). Only one subject withdrew prematurely due to adverse events. Subjects treated by S boulardii + AC had fewer adverse events and tolerated the study regimen better than those receiving the AC alone. Control subjects had a stable microbiota throughout the study period. Significant microbiota changes were noted in the AC alone group during antibiotic treatment. AC associated changes included reduced prevalence of the genus Roseburia and increases in Escherichia, Parabacteroides, and Enterobacter. Microbiota alterations reverted toward baseline, but were not yet completely restored 2 weeks after antibiotherapy. No significant shifts in bacterial genera were noted in the SB alone group. Adding SB to AC led to less pronounced microbiota shifts including less overgrowth of Escherichia and to a reduction in antibiotic-associated diarrhea scores. Antibiotic treatment is associated with marked microbiota changes with both reductions and increases in different genera. S. boulardii treatment can mitigate some antibiotic-induced microbiota changes (dysbiosis) and can also reduce antibiotic-associated diarrhea.

Caracterización de pacientes con litiasis vesicular operados por mínimo acceso / Characterization of patients with vesicular lithiasis treated with minimal access surgery

Introducción: la litiasis vesicular es la enfermedad del tracto alimentario que más requiere de hospitalización. Objetivo: caracterizar a los pacientes operados por litiasis vesicular mediante cirugía de mínimo acceso. Método: se realizó un estudio observacional descriptivo y retrospectivo de 1 271 pacientes con litiasis vesicular operados por mínimo acceso en el Servicio de Cirugía General del Hospital Provincial Docente Clinicoquirúrgico "Saturnino Lora Torres" de Santiago de Cuba, desde enero de 2011 hasta septiembre de 2014. Resultados: en la serie predominaron el sexo femenino (84,1 %), el grupo etario de 45-65 años (47,7 %), así como el coleperitoneo por lesión iatrogénica de la vía biliar como principal complicación y causa de reintervención más frecuente; asimismo, la presencia del plastrón vesicular crónico resultó ser el motivo de las conversiones a cirugía abierta (25,0 %) y solo falleció 0,2 % de los afectados. La estadía hospitalaria fue menor de 24 horas en 96,6 % del total de pacientes y 93,8 % de los integrantes del estudio fueron operados con un tiempo quirúrgico de 60 minutos o menos. Conclusiones: existió baja incidencia de complicaciones, conversiones y reintervenciones, sin tiempos quirúrgicos prolongados y una corta estadía hospitalaria.

Introduction: vesicular lithiasis is the disease of the alimentary tract mostly requiring hospitalization. Objective: to characterize the patients with vesicular lithiasis treated with minimal access surgery. Method: a descriptive and retrospective observational study of 1 271 patients with vesicular lithiasis treated with minimal access surgery at the General Surgery Service from "Saturnino Lora Torres" Teaching Provincial Clinical Surgical Hospital in Santiago de Cuba was carried out from January, 2011 to September, 2014. Results: the female sex (84.1%), the age group 45-65 years (47.7%), as well as the choleperitoneum as iatrogenic lesion of the biliary pathways as main complication and most frequent cause of reintervention prevailed in the series; also, the presence of the chronic vesicular abscess turned out to be the reason of change to open surgery (25.0%) and only 0.2% of the affected patients died. The hospital stay was shorter than 24 hours in 96.6% of the total of patients and 93.8% of the members of the study were operated with a surgical time of 60 minutes or less. Conclusions: there was low incidence of complications, conversions and reinterventions, without prolonged surgical times and a short hospital stay.

Systematic Analysis and Critical Appraisal of the Quality of the Scientific Evidence and Conflicts of Interest in Practice Guidelines (2005-2013) for Barrett's Esophagus.

BACKGROUND: Barrett's esophagus (BE) is a condition that has a small but important risk of progressing to esophageal cancer. To date, no study has assessed the strength of evidence supporting the recommendations for BE. We sought to assess the overall quality of the recommendations and strength of the BE using the AGREE II instrument. METHODS: A PubMed search was performed to identify guidelines published pertaining to BE. Every guideline was reviewed using the AGREE II format to assess the methodological rigor and validity of the guideline. Additionally, guidelines were reviewed for the level of evidence used to support recommendations, conflicts of interest (COI), and differences in recommendations. Statistical analysis was performed using Stata (version 12). RESULTS: In total, 234 manuscripts were identified of which 8 guidelines published between 2005 and 2013 pertained to BE. Seventy-five percentage (6/8) graded the evidence used to formulate recommendations. Of the 126 recommendations with supporting evidence, 6 % were supported by level A evidence, 49 % level B evidence, and 45 % level C evidence. Using the AGREE II format, the highest overall assessment grade was the BSG BE guideline (6.5 ± 0.6) followed by the AGA (5.5 ± 0.6). The highest rated domains were scope and purpose (mean 77 range 24-96) and clarity of presentation (mean 75), while the lowest rated domains were editorial independence (mean 32 range 0-92) and applicability of the guideline (mean 35 range 7-90). There was significant variability in recommendations regarding who to screen for BE and surveillance intervals. Finally, only 50 % of the guidelines disclosed if COI were present and 75 % (3/4) reported potentially relevant COI. CONCLUSIONS: Majority of the BE guideline fail to meet the AGREE II domains, and most of the recommendations are level B or C quality evidence. Further interventions are necessary to improve the overall quality of the guidelines.

Poor Documentation of Inflammatory Bowel Disease Quality Measures in Academic, Community, and Private Practice.

BACKGROUND & AIMS: Quality measures are used to standardize health care and monitor quality of care. In 2011, the American Gastroenterological Association established quality measures for inflammatory bowel disease (IBD), but there has been limited documentation of compliance from different practice settings. METHODS: We reviewed charts from 367 consecutive patients with IBD seen at academic practices, 217 patients seen at community practices, and 199 patients seen at private practices for compliance with 8 outpatient measures. Records were assessed for IBD history, medications, comorbidities, and hospitalizations. We also determined the number of patient visits to gastroenterologists in the past year, whether patients had a primary care physician at the same institution, and whether they were seen by a specialist in IBD or in conjunction with a trainee, and reviewed physician demographics. A univariate and multivariate statistical analysis was performed to determine which factors were associated with compliance of all core measures. RESULTS: Screening for tobacco abuse was the most frequently assessed core measure (89.6% of patients; n = 701 of 783), followed by location of IBD (80.3%; n = 629 of 783), and assessment for corticosteroid-sparing therapy (70.8%; n = 275 of 388). The least-frequently evaluated measures were pneumococcal immunization (16.7% of patients; n = 131 of 783), bone loss (25%; n = 126 of 505), and influenza immunization (28.7%; n = 225 of 783). Only 5.8% of patients (46 of 783) had all applicable core measures documented (24 in academic practice, none in clinical practice, and 22 in private practice). In the multivariate model, year of graduation from fellowship (odds ratio [OR], 2.184; 95% confidence interval [CI], 1.522-3.134; P < .001), year of graduation from medical school (OR, 0.500; 95% CI, 0.352-0.709; P < .001), and total number of comorbidities (OR, 1.089; 95% CI, 1.016-1.168; P = .016) were associated with compliance with all core measures. CONCLUSIONS: We found poor documentation of IBD quality measures in academic, clinical, and private gastroenterology practices. Interventions are necessary to improve reporting of quality measures.

PERINATAL OUTCOMES OF PREMATURITY AND BIRTH WEIGHT ACCORDING TO MATERNAL CAFFEINE CONSUMPTION.

UNLABELLED: Objetive: identify whether there is an increased risk of adverse perinatal outcomes, like prematurity or decreased weight in newborns, associated with caffeine consumption during the first half of pregnancy in pregnant women of our population. METHODS: transversal study carried out in 1 175 patients from Virgen de las Nieves University Hospital of Granada (Spain). Information about caffeine consumption during first half of gestation and perinatal outcomes was obtained by personal interview, medical records and telephone call after delivery. The average caffeine intake was calculated from meals and drinks included in a validated questionnaire. RESULTS: there was no difference in caffeine consumption in pregnant women with birth weight ≥2 500 g and.

Objetivo: identificar si existe un aumento del riesgo en resultados perinatales adversos de prematuridad y disminucion del peso de los recien nacidos asociados al consumo de cafeina durante la primera mitad del embarazo en gestantes de nuestra poblacion. Métodos: estudio transversal llevado a cabo en 1.175 gestantes del Hospital Universitario Virgen de las Nieves de Granada (Espana). La informacion sobre el consumo de cafeina durante la primera mitad del embarazo y los resultados perinatales estudiados se obtuvieron mediante entrevista personal, consulta de la historia clinica y llamada telefonica tras el parto. La ingesta media de cafeina se calculo a partir de las comidas y bebidas incluidas en un cuestionario validado. Resultados: no hubo diferencias en el consumo de cafeina en gestantes con recien nacidos de peso ≥2.500 g y.