Peripheral endocannabinoids in major depressive disorder and alcohol use disorder: a systematic review.

BACKGROUND: Major Depressive Disorder (MDD) and Alcohol Use Disorder (AUD) are two high-prevalent conditions where the Endocannabinoid system (ECS) is believed to play an important role. The ECS regulates how different neurotransmitters interact in both disorders, which is crucial for controlling emotions and responses to stress and reward stimuli. Measuring peripheral endocannabinoids (eCBs) in human serum and plasma can help overcome the limitations of detecting endocannabinoid levels in the brain. This systematic review aims to identify levels of peripheral eCBs in patients with MDD and/or AUD and find eCBs to use as diagnostic, prognostic biomarkers, and potential therapeutic targets. METHODS: We conducted a systematic literature search according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines from the earliest manuscript until October 22, 2023, in three electronic databases. We included studies of human adults who had a current diagnosis of AUD and/or MDD and evaluated plasma or serum endocannabinoids. We carefully considered known variables that may affect endocannabinoid levels. RESULTS: We included 17 articles in this systematic review, which measured peripheral eCBs in 170 AUD and 359 MDD patients. Stressors increase peripheral 2-arachidonyl-glycerol (2-AG) concentrations, and 2-AG may be a particular feature of depression severity and chronicity. Anxiety symptoms are negatively correlated with anandamide (AEA) concentrations, and AEA significantly increases during early abstinence in AUD. Studies suggest a negative correlation between Oleoylethanolamide (OEA) and length of abstinence in AUD patients. They also show a significant negative correlation between peripheral levels of AEA and OEA and fatty acid amide hydrolase (FAAH) activity. Eicosapentaenoylethanolamide (EPEA) is correlated to clinical remission rates in depression. Included studies show known variables such as gender, chronicity, symptom severity, comorbid psychiatric symptoms, length of abstinence in the case of AUD, and stress-inducibility that can affect peripheral eCBs. CONCLUSIONS: This systematic review highlights the important role that the ECS plays in MDD and AUD. Peripheral eCBs appear to be useful biomarkers for these disorders, and further research may identify potential therapeutic targets. Using accessible biological samples such as blood in well-designed clinical studies is crucial to develop novel therapies for these disorders.

A new formula proposal for placing pH-impedance catheters in pediatric patients.

INTRODUCTION: Esophageal pH-impedance monitoring is a tool for diagnosing gastroesophageal reflux in children. The position of the pH catheter is essential for a reliable reading and the current formulas for calculating catheter insertion length are not completely accurate. The aim of the present study was to develop a new formula for adequate insertion of the pH catheter. MATERIAL AND METHODS: A cross-sectional study was conducted on children that underwent pH-impedance monitoring and later radiographic control, to calculate the correct catheter insertion length. The documented variables were age, sex, weight, height, naris to tragus distance, tragus to sternal notch distance, sternal notch to xiphoid process distance, and initial insertion length determined by the Strobel and height interval formulas. A multivariate regression analysis was carried out to predict the final insertion length. Regression ANOVA and Pearson's adjusted R-squared tests were performed. RESULTS: Forty-five pH-impedance studies were carried out, 53% of which were in males. The age and weight variables were not normally distributed. In the initial regression model, the variables that did not significantly correlate with the final insertion length were: sex (P 0.124), length determined by the Strobel or height interval formulas (P 0.078), naris to tragus distance (P 0.905), and tragus to sternal notch distance (P 0.404). The final equation: 5.6 + (height in cm * 0.12) + (sternal notch to xiphoid process distance * 0.57) produced an R2 of 0.93 (P 0.000). CONCLUSIONS: This formula can be considered a valid option for placement of the pH-impedance monitoring catheter in pediatrics.

A comparison of endoscopic procedures performed at a tertiary care hospital before and during the SARS-CoV-2 pandemic.

INTRODUCTION AND AIM: SARS-CoV-2 emerged in 2019 and had a huge impact on the world. The area of endoscopy suffered great changes, causing a reduction in the number of procedures and its indications. The aim of our study was to compare the quantity, indication, and type of procedures in 2019 with those in 2020. METHOD: A retrospective, observational, analytic, and cross-sectional study was conducted, obtaining information from the endoscopy registry. The STROBE checklist was employed. STATISTICAL ANALYSIS: The quantitative variables were analyzed with descriptive statistics (measures of central tendency and dispersion) and the categorical variables with frequencies and percentages. The quantitative variables were compared, using the Student's t test/Mann-Whitney U test, and the categorical variables with contingency tables, using the Fisher's exact test. RESULTS: In 2019, a total of 277 procedures were performed, compared with 139 in 2020. Mean patient age was 98.53 months (61.46 SD) in 2019 and 77.02 months (59.81 SD) in 2020; 352 diagnostic procedures and 136 therapeutic procedures were carried out in 2019, compared with 51 diagnostic procedures and 88 therapeutic procedures in 2020. The number of diagnostic and therapeutic procedures were inverted (72.1%-36.7% and 27.9%-63.3%, respectively) (p<0.0001). Esophageal varices, upper gastrointestinal bleeding (UGIB), and foreign body extraction were the indications, in order of predominance in 2019, compared with foreign body extraction (p<0.05), UGIB, and esophageal varices in 2020. There were no differences regarding colonoscopy. CONCLUSION: There was a clear difference in indication and type of procedure, with an increase in foreign body extraction in preschoolers.

Foreign body ingestion and associated factors in pediatric patients at a tertiary care center.

INTRODUCTION AND AIMS: Foreign body (FB) ingestion is a common problem in children under 5 years of age and is one of the main indications for endoscopy. The aim of the present study was to describe the clinical, radiographic, and endoscopic characteristics of patients with FB ingestion, as well as the factors associated with the anatomic location and the type of object ingested. MATERIALS AND METHODS: An analytic cross-sectional study was conducted on all patients with FB ingestion seen at the gastroenterology service from January 2013 to December 2018. The data were analyzed using the SPSS program, obtaining frequencies, percentages, medians, and interquartile ranges. Associations were assessed through the chi-square test. RESULTS: Eighty-five patients (52 males and 33 females) were included, with a median age of 4 years. The most common symptom was vomiting (29.4%). Two radiographic projections were carried out in 72.9% of the cases and the stomach was the site where the FB was most frequently visualized (32.9%). The objects most commonly ingested were coins (36%), with esophageal location (p<0.05), as well as objects with a diameter larger than 2cm (p<0.05). An endoscopic procedure was performed on 76 patients (89.4%) for FB extraction, with findings of erythema (28.9%), erosion (48.6%), ulcer (10.5%) and perforation (1.3%). CONCLUSIONS: Numerous factors should be taken into account in the approach to FB ingestion in pediatric patients, including type and size of the FB, time interval from ingestion to hospital arrival, and patient clinical status and age.

Esophagogastric junction outflow obstruction in the differential diagnosis of post-fundoplication dysphagia in children.

INTRODUCTION AND AIMS: Post-fundoplication dysphagia is resolved with no therapeutic intervention in the majority of cases but it can persist in 5.3% of children that undergo the procedure. Among the differential diagnoses, esophagogastric junction outflow obstruction (EGJOO) is a disorder that should be suspected if there is a persistence of dysphagia. The aim of our study was to describe the clinical characteristics, treatment, and follow-up in a case series of patients diagnosed with post-fundoplication EGJOO. MATERIALS AND METHODS: The clinical records of patients diagnosed with EGJOO at a tertiary care hospital within the time frame of September 2015 to September 2019 were reviewed, with respect to manometry, etiology, treatment, and clinical course of the disease. RESULTS: Of the 213 high-resolution esophageal manometries performed, 4 patients met the criteria for post-fundoplication EGJOO. The primary symptom was dysphagia, presenting 15 days after the procedure. Esophageal dilations were carried out on all the patients but with no improvement. Symptoms related to the condition resolved spontaneously in three of the four patients. CONCLUSION: The management of children with post-fundoplication EGJOO continues to be a challenge. Even though more than half of the cases resolve with no intervention, optimum management of the motility disorder is still limited, given the scant experience with the condition in the pediatric population.

Foreign body ingestion and associated factors in pediatric patients at a tertiary care center. / Ingesta de cuerpo extraño en pacientes pediátricos en un hospital de tercer nivel y factores asociados.

INTRODUCTION AND AIMS: Foreign body (FB) ingestion is a common problem in children under 5 years of age and is one of the main indications for endoscopy. The aim of the present study was to describe the clinical, radiographic, and endoscopic characteristics of patients with FB ingestion, as well as the factors associated with the anatomic location and the type of object ingested. MATERIALS AND METHODS: An analytic cross-sectional study was conducted on all patients with FB ingestion seen at the gastroenterology service from January 2013 to December 2018. The data were analyzed using the SPSS program, obtaining frequencies, percentages, medians, and interquartile ranges. Associations were assessed through the chi-square test. RESULTS: Eighty-five patients (52 males and 33 females) were included, with a median age of 4 years. The most common symptom was vomiting (29.4%). Two radiographic projections were carried out in 72.9% of the cases and the stomach was the site where the FB was most frequently visualized (32.9%). The objects most commonly ingested were coins (36%), with esophageal location (p <0.05), as well as objects with a diameter larger than 2cm (p <0.05). An endoscopic procedure was performed on 76 patients (89.4%) for FB extraction, with findings of erythema (28.9%), erosion (48.6%), ulcer (10.5%) and perforation (1.3%). CONCLUSIONS: Numerous factors should be taken into account in the approach to FB ingestion in pediatric patients, including type and size of the FB, time interval from ingestion to hospital arrival, and patient clinical status and age.

Structural and magnetic studies of mononuclear lanthanide complexes derived from N-rich chiral Schiff bases.

A new family of mononuclear lanthanide complexes with the formula [CeIII(L)(NO3)3(MeOH)] (1) and [LnIII(L)(NO3)3]·MeOH where Ln = Gd (2) or Dy (3) and L = N,N'-bis(pyridin-2-ylmethylene)cyclohexane-1,2-diamine has been obtained with the use of enantiomerically pure Schiff bases. Dynamic magnetic studies indicate that 1-3 present field-induced slow relaxation of the magnetization and their response has been compared with the magnetically diluted complexes 2d and 3d. Structural studies have been carried out by single crystal X-ray and powder diffraction.

Decanuclear FeIII clusters with hemiacetal ligands: a new {M10(µ3-O)8} cluster core.

The characterization of a decanuclear FeIII cluster with α-methyl-2-pyridinemethanolate, generated by the hydrolysis of Schiff bases, inspired us to carry out an initial exploration of the direct syntheses of medium nuclearity FeIII clusters starting from aldehydes in methanolic medium. The new complexes exhibit an unprecedented {Fe10(µ3-O)8} cluster core.

Anorectal manometry in children with retentive fecal incontinence: What parameters should we evaluate? / Manometría anorrectal en niños con incontinencia fecal retentiva: ¿Qué parámetros debemos evaluar?

INTRODUCTION: Children with functional constipation frequently present with alterations in rectal compliance and the urge-to-defecate sensation that can be evaluated through anorectal manometry (ARM). In the present study, we evaluated the usefulness of the parameters obtained through ARM in children with retentive fecal incontinence (RFI). MATERIALS AND METHODS: Children with functional constipation, aged 4 to 17years, that underwent ARM were included in the study. RESULTS: Of the 35 children evaluated, 21 presented with functional constipation and 14 had functional constipation and RFI. The children with both constipation and RFI tolerated greater volumes of air insufflation for triggering the urge to defecate and reaching maximum tolerance of pain, compared with the children that did not have RFI. We identified the cutoff point of 135ml of air as the maximum tolerance sensation for distinguishing children with RFI. CONCLUSIONS: Maximum tolerance of pain was the most useful parameter for evaluating RFI in children with functional constipation.

Syntheses, structures, and chiroptical and magnetic properties of chiral clusters built from Schiff bases: a novel [MnIIMnNa] core.

Chiral clusters with MnIIMnNaI and the new MnIIMnNa cores have been synthesised employing enantiomerically pure Schiff bases and halide ligands. The new compounds have been characterized by electronic circular dichroism (ECD) and magnetic susceptibility.

The Mexican consensus on probiotics in gastroenterology. / Consenso mexicano sobre probióticos en gastroenterología.

INTRODUCTION: Probiotics are frequently prescribed in clinical practice. Their efficacy in treating gastrointestinal disorders is supported by a significant number of clinical trials. However, the correct prescription of these agents is hampered due to a lack of knowledge of the scientific evidence and to the different presentations and microbial compositions of the probiotics that are currently available. AIM: To provide the clinician with a consensus review of probiotics and recommendations for their use in gastroenterology. MATERIALS AND METHODS: Controlled clinical trials, meta-analyses, and systematic reviews published up to 2015 were selected, using the MESH terms: probiotics, gastrointestinal diseases, humans, adults, AND children. The Delphi method was employed. Eighteen gastroenterologists treating adult patients and 14 pediatric gastroenterologists formulated statements that were voted on until agreement>70% was reached. The level of evidence based on the GRADE system was evaluated for each statement. RESULTS AND CONCLUSIONS: Eleven statements on the general concepts of probiotics and 27 statements on the use of probiotics in gastrointestinal diseases in both adults and children were formulated. The consensus group recommends the use of probiotics under the following clinical conditions: the prevention of diarrhea associated with antibiotics, the treatment of acute infectious diarrhea, the prevention of Clostridium difficile infection and necrotizing enterocolitis, the reduction of adverse events from Helicobacter pylori eradication therapy, relief from irritable bowel syndrome symptoms, the treatment of functional constipation in the adult, and the induction and maintenance of remission in patients with ulcerative colitis and pouchitis, and the treatment of covert and overt hepatic encephalopathy.

Copper(II) cubanes with a {Cu4O} core and well defined S = 1 ground state.

The reaction of 2-pyridinemethanol with copper 4-fluorobenzoate has yielded a family of type II cubanes with formula [Cu4(pymO)4(4-F-PhCOO)3(NO3)] (), [Cu4(pymO)4(4-F-PhCOO)4] () and [Cu4(pymO)4(4-F-PhCOO)4(H2O)] (). These systems exhibit an unexpected S = 1 ground state and their magnetic properties have been unambiguously characterized and rationalized as a function of the asymmetry of the {Cu4O4} cage and Cu-O-Cu bond angles. Analysis of the coupling constants was performed applying new interaction schemes. Magneto-structural correlations have been performed from the analysis of previously reported type II copper cubanes.

Topical mitomycin C versus intralesional triamcinolone in the management of esophageal stricture due to caustic ingestion.

BACKGROUND: Esophageal stricture due to caustic ingestion is one of the most difficult problems to manage. Esophageal dilations are the usual treatment and they require a great number of sessions in the majority of cases. This implies time, risks for the patient, anguish for the relatives, and very often, frustration for the physician. OBJECTIVES: To evaluate the efficacy of the application of topical mitomycin C and intralesional triamcinolone in the prevention of post-dilation esophageal stricture recurrence. MATERIAL AND METHODS: A prospective, comparative, nonrandomized, and longitudinal study was conducted that compared a cohort of 16 patients treated with mitomycin C (2009-2012) with a retrospective cohort of 34 patients treated with triamcinolone (2002-2009). RESULTS: The patients treated with intralesional triamcinolone had a median of 11 dilations (minimum 4 and maximum 24), whereas the median in the patients treated with topical mitomycin C was 4.5 (minimum 3 and maximum 8). The groups were compared using the Mann-Whitney U test, finding a statistically significant difference of a two-tailed P<.001. In the multiple linear regression model, the dependent variable was the number of dilations and the independent variables were the type of lesion and treatment. The result was an R(2) .676 with a significance level of P<.001, in which the regression coefficient for treatment was B -.682 (95% CI -8.286 to -5.025) and the lesion grade was B .435 (95% CI 2.043- 4.573). The ANOVA result was an F 49.08 and a P<.001 and showed that the independent variables of type of lesion and treatment had a linear relation with the number of dilations, reinforcing the fact that our results were not due to chance. CONCLUSIONS: Topical mitomycin C considerably reduced the number of esophageal dilations compared with the use of intralesional triamcinolone to alleviate dysphagia, and therefore we suggest it as a treatment option in strictures due to caustic ingestion.

Histopathologic findings in children diagnosed with cow's milk protein allergy.

BACKGROUND: Cow's milk protein allergy is the most common cause of food allergy. The challenge test, either open or doubled-blind with a placebo control, is regarded as the criterion standard. Endoscopy and histologic findings are considered a method that can aid in the diagnosis of this entity. AIMS: The aim of this study was to describe the histopathologic findings in children suspected of cow's milk protein allergy that were seen at our hospital. MATERIAL AND METHODS: A descriptive, observational study was conducted on 116 children clinically suspected of presenting with cow's milk protein allergy that were seen at the Department of Gastroenterology and Nutrition of the Instituto Nacional de Pediatría. Upper endoscopy and rectosigmoidoscopy with biopsies were performed and the findings were described. RESULTS: Of the 116 patients, 64 (55.17%) were girls and 52 (44.83%) were boys. The rectum was the site with the greatest presence of eosinophils per field in both groups, followed by the duodenum. In general, more than 15 eosinophils were found in 46% of the patients. CONCLUSIONS: Between 40 and 45% of the cases had the histologic criterion of more than 15 to 20 eosinophils per field and the rectosigmoid colon was the most affected site. Therefore, panendoscopy and rectosigmoidoscopy with biopsy and eosinophil count are suggested.

Perinatal factors associated with the development of cow's milk protein allergy.

UNLABELLED: The prevalence of cow's milk protein allergy (CMPA) has increased in recent years, and is associated with antimicrobial use during the perinatal period, prematurity, the type of childbirth, and the decrease in breastfeeding. The aim of this study was to analyze whether there is any association between these factors and the development of CMPA. MATERIAL AND METHODS: A retrospective, comparative, cross-sectional, observational study was conducted by reviewing the case records of 101 children diagnosed with CMPA and seen at the Department of Gastroenterology and Nutrition of the Instituto Nacional de Pediatría within the time frame of January 2012 and August 2013. The following variables were included: age, sex, weeks of gestation, history of maternal infection and antimicrobial use during the pregnancy, type of delivery, and feeding with human milk, and its duration. Likewise, the case records of 90 children were reviewed as a control group on not having CMPA or any other allergy. The chi-square test was used for proportions, and the Mann-Whitney U test was used for comparing means in the statistical analysis. RESULTS: The factors associated with CMPA were the use of antimicrobials during gestation and breastfeeding duration in months. Both factors were statistically significant (P<.001). No association was found between CMPA and gestational age or type of delivery. CONCLUSIONS: The statistically significant associated factors were breastfeeding duration and the use of antimicrobials during the gestational stage. These results underline the necessity for prospective studies.