Geographic Distribution and Incidence of Melioidosis, Panama1.

Melioidosis is an infection caused by Burkholderia pseudomallei. Most cases occur in Southeast Asia and northern Australia; <100 cases have been reported in the Americas. We conducted a retrospective study and identified 12 melioidosis cases in Panama during 2007-2017, suggesting possible endemicity and increased need for surveillance.

[Glasgow-Blatchford usefulness in patients with non variceal upper gastrointestinal bleeding with low and high risk of complications seen at the Emergency Department of Santo Tomas Hospital, 2015-2016]. / Utilidad de la escala de Glasgow-Blatchford en pacientes con hemorragia digestiva alta no variceal, con alto y bajo riesgo de complicaciones atendidos en el Servicio de Urgencias del Hospital Santo Tomas, 2015-2016.

INTRODUCTION: The Glasgow-Blatchford (GBS) scale allows us to classify the patient as a high or low risk of presenting complications.In the patients identified as "low risk", the performance of an early endoscopy could reduce the intrahospital days and the overall cost. In our environment, we do not know the usefulness of the GBS scale. OBJECTIVE: To describe the utility of the Glasgow-Blatchford scale (GBS) in the stratification of risk in patients with non-variceal upper gastrointestinal bleeding (HDA) seen in the emergency department of a tertiary hospital. MATERIALS AND METHODS: 218 patients were prospectively included, and they were performed in the first 24-48 hr an urgent endoscopy. These were stratified, according to the GBS scale, at low risk (GBS ≤ 2), and high risk (GBS ≥ 3). We calculated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the GBS scale in our setting based on the requirement of endoscopic, radiological treatment (arterial embolization), transfusion of blood products and / or surgery, as our gold standar to classify patients as "high risk". RESULTS: A total of 218 patients were included, with a mean age of 56 ± 18 years, of which 121/218 (55%) were male. 156/218 required intervention for what were classified as "high risk" while 62/218 did not specify and classified as "low risk". A cut-off value of GBS ≤ 2 showed a sensitivity of 98% with a NPV of 100%. The utility of the GBS scale showed an area under the ROC curve 0.83 (95% CI 0.75-0.90). CONCLUSION: The GBS scale used in patients with non-variceal UGB attended in the emergency department has adequate diagnostic validity to predict the need for intervention.

Is There a Difference in Adenoma Detection Rates According to Indication? An Experience in a Panamanian Colorectal Cancer Screening Program.

Background: The benefit of colorectal cancer screening in reducing cancer risk and related death is unclear. There are quality measure indicators and multiple factors that affect the performance of a successful colonoscopy. The main objective of our study was to identify if there is a difference in polyp detection rate (PDR) and adenoma detection rate (ADR) according to colonoscopy indication and which factors might be associated. Methods: We conducted a retrospective review of all colonoscopies performed between January 2018 and January 2019, in a tertiary endoscopic center. All patients ≥ 50 years old scheduled for a nonurgent colonoscopy and screening colonoscopy were included. We stratified the total number of colonoscopies into two categories according to the indication: screening vs. non-screening, and then calculated PDR, ADR and serrated polyp detection rate (SDR). We also performed logistic regression model to identify factors associated with detecting polyps and adenomatous polyps. Results: A total of 1,129 and 365 colonoscopies were performed in the non-screening and screening group, respectively. In comparison with the screening group, PDR and ADR were lower for the non-screening group (33% vs. 25%; P = 0.005 and 17% vs. 13%; P = 0.005). SDR was non-significantly lower in the non-screening group when compared with the screening group (11% vs. 9%; P = 0.53 and 22% vs. 13%; P = 0.007). Conclusion: In conclusion, this observational study reported differences in PDR and ADR depending on screening and non-screening indication. These differences could be related to factors related to the endoscopist, time slot allotted for colonoscopy, population background, and external factors.

Utilidad de la escala de Glasgow-Blatchford en pacientes con hemorragia digestiva alta no variceal, con alto y bajo riesgo de complicaciones atendidos en el Servicio de Urgencias del Hospital Santo Tomas, 2015-2016 / Glasgow-Blatchford usefulness in patients with non variceal upper gastrointestinal bleeding with low and high risk of complications seen at the Emergency Department of Santo Tomas Hospital, 2015-2016

Introducción: La escala de Glasgow-Blatchford (GBS) nos permite clasificar al paciente como riesgo alto o bajo de presentar complicaciones. En los pacientes identificados como "bajo riesgo", la realización de una endoscopia temprana, podría disminuir los días intrahospitalarios y en el coste global. En nuestro medio, desconocemos la utilidad de la escala de GBS. Objetivo: Describir la utilidad de la escala de Glasgow-Blatchford (GBS) en la estratificación del riesgo en los pacientes con hemorragia digestiva alta (HDA) no variceal atendidos en el servicio de urgencias en un hospital de tercer nivel. Materiales y métodos: Se incluyeron prospectivamente 218 pacientes, y se les realizó en las primeras 24-48 h endoscopia urgente. Éstos se estratificaron, según la escala de GBS, en bajo riesgo (GBS ≤ 2), y alto riesgo (GBS ≥ 3). Se calculó la sensibilidad, especificidad, valor predictivo positivo (VPP) y negativo (VPN) de la escala de GBS en nuestro medio basándonos en el requerimiento de tratamiento endoscópico, radiológico (embolización arterial), transfusión de hemoderivados y/o cirugía, como estándar de oro para clasificar a los pacientes en alto riesgo. Resultados: Se incluyó un total de 218 pacientes, con edad media de 56 ± 18 años, de los cuales 121/218 (55%) fueron varones. 156/218 precisaron intervención por lo que fueron clasificados como "alto riesgo" mientras 62/218 no precisaron y se clasificaron como "bajo riesgo". Un valor de corte de GBS ≤ 2 mostró una sensibilidad del 98% con un VPN de 100%. La utilidad de la escala de GBS mostró un área bajo la curva ROC 0,83 (IC 95% 0,75-0,90). Conclusión: La escala de GBS utilizada pacientes con HDA no variceal atendidos en el servicio de urgencias posee una validez diagnóstica adecuada para predecir la necesidad de intervención.

Introduction: The Glasgow-Blatchford (GBS) scale allows us to classify the patient as a high or low risk of presenting complications. In the patients identified as "low risk", the performance of an early endoscopy could reduce the intrahospital days and the overall cost. In our environment, we do not know the usefulness of the GBS scale. Objective: To describe the utility of the Glasgow-Blatchford scale (GBS) in the stratification of risk in patients with non-variceal upper gastrointestinal bleeding (HDA) seen in the emergency department of a tertiary hospital. Materials and methods: 218 patients were prospectively included, and they were performed in the first 24-48 hr an urgent endoscopy. These were stratified, according to the GBS scale, at low risk (GBS ≤ 2), and high risk (GBS ≥ 3). We calculated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the GBS scale in our setting based on the requirement of endoscopic, radiological treatment (arterial embolization), transfusion of blood products and / or surgery, as our gold standar to classify patients as "high risk". Results: A total of 218 patients were included, with a mean age of 56 ± 18 years, of which 121/218 (55%) were male. 156/218 required intervention for what were classified as "high risk" while 62/218 did not specify and classified as "low risk". A cut-off value of GBS ≤ 2 showed a sensitivity of 98% with a NPV of 100%. The utility of the GBS scale showed an area under the ROC curve 0.83 (95% CI 0.75-0.90). Conclusion: The GBS scale used in patients with non-variceal UGB attended in the emergency department has adequate diagnostic validity to predict the need for intervention.