Characterization of Microalgae Biomass-Based Composites Obtained through Rotational Molding.

The wide range of applications and the numerous advantages of plastics have led to their excessive use, with subsequent damage to ecosystems. As an environmentally friendly alternative, biocomposites have gained much attention, and microalgae have become a potential source for their production. In this study, the use of washed and unwashed Spirulina in polyethylene-based composites has been evaluated as a way to prevent the thermooxidation of polyethylene, while at the same time, reducing the amount of virgin plastic used. Biocomposites were produced by rotomolding, testing different biomass contents and determining their mechanical and thermal performances as well as their water uptake level. Composites with up to 15% of biomass (by weight), a particularly high ratio for rotomolding, were satisfactorily produced. Using 5% of both biomasses did not significantly modify the behavior when compared with the neat PE samples' properties. For higher loadings, the use of non-washed biomass allowed us to obtain better properties, with added benefits related to using an unwashed biomass (less water consumption, lower costs and fewer environmental impacts). On the other hand, this study showed a promising beneficial effect on the thermooxidative resistance of composites, as the oxidation induction times were notably increased with biomass addition.

[Assessment of the eating habit in the health-related lifestyle among Spanish adults from 22 to 72 years of age]. / Valoración del hábito de alimentación en el estilo de vida saludable adquirido en adultos españoles de 22 a 72 años de edad.

Introduction: Introduction: eating habits are one of the main predictors of health within a person lifestyle. The assessment of these habits will be essential to confirm health-related habits and orientate behaviors of risk for health. Objectives: to assess the eating habits within the health-related lifestyle among Spanish adults from 22 to 72 years of age. Methods: the Health-Related Lifestyle Assessment Scale (E-VEVSA) was applied to a sample of 788 subjects between the ages of 22 and 72. This scale is made up of 52 items and structured in seven dimensions, among which the healthy eating habit was evaluated, which explained a variance of 8.67 % of the total scale (66.87 %) and a Cronbach's alpha of 0.794 for a total alpha of 0.894. Results: sixteen percent of the adults surveyed have healthy eating habits, 68.3 % tend towards health and 15.7 % are unhealthy. Pearson's 2 tests show a positive and significant association of women with healthy eating habits and a significant improvement with age. The inferential data (Student's t-tests and one-factor ANOVA) confirm these differences according to gender and age. Conclusions: it is necessary to promote preventive programs to improve eating habits in the adult population, especially in the 15.7 % that have an unhealthy level of nutrition in their lifestyle.

Introducción: Introducción: los hábitos de alimentación constituyen uno de los factores predictores de salud principales dentro de los estilos de vida adquiridos. La evaluación de dichos hábitos va a ser fundamental para poder reafirmar las conductas saludables y reorientar aquellos hábitos que supongan un riesgo. Objetivos: evaluar el hábito de alimentación dentro del estilo de vida saludable adquirido en adultos españoles de 22 a 72 años de edad. Métodos: a una muestra de 788 sujetos de edades comprendidas entre los 22 y los 72 años de edad se aplicó la Escala de Valoración del Estilo de Vida Saludable Adquirido (E-VEVSA), formada por 52 ítems y estructurada en siete dimensiones, entre las cuales se evaluó el hábito de alimentación saludable, que explicó una varianza de 8,67 % sobre el total de la escala (66,87 %) y un alfa de Cronbach de 0,794 para un alfa total de 0,894. Resultados: el 16 % de los adultos encuestados posee hábitos de alimentación saludables; el 68,3 %, tendente hacia la salud; y el 15,7 %, poco saludables. Las pruebas de 2 de Pearson muestran una asociación positiva y significativa de las mujeres con hábitos saludables de alimentación y una mejora significativa con el transcurso de la edad. Los datos inferenciales (pruebas t de Student y ANOVA de un factor) confirman estas diferencias en función del sexo y la edad. Conclusiones: es necesario promover programas preventivos para la mejora de los hábitos de alimentación en la población adulta, sobre todo, en el 15,7 % que posee un nivel poco saludable de la alimentación en su estilo de vida.

Cardiovascular testing recovery in Latin America one year into the COVID-19 pandemic: An analysis of data from an international longitudinal survey.

Background: The COVID-19 pandemic disproportionately impacted Latin America (LATAM), significantly disrupting cardiovascular testing. This study evaluated cardiac procedure recovery in LATAM one year after the outbreak. Methods: The International Atomic Energy Agency (IAEA) surveyed 669 centers in 107 countries worldwide, including 135 facilities in 19 LATAM countries, to assess cardiovascular procedure volumes in March 2019, April 2020, and April 2021, and changes in center practices and staffing conditions one year into the COVID-19 pandemic. Findings: LATAM centers reported a 21 % decrease in procedure volumes in April 2021 from pre-pandemic-baseline, vs. a 0 % change in the rest of the world (RoW), and greater volume reductions for almost all procedure types. Centers in Central America and Mexico reported the largest procedure reductions (47 % reduction) compared to the Caribbean (15 %), and South America (14 %, p = 0.01), and this LATAM region was a significant predictor of lower procedure recovery in multivariable regression. More LATAM centers reported reduced salaries and increased layoffs of clinical staff compared to RoW, and LATAM respondents estimated that half of physician and non-physician staff experienced excess psychological stress related to the pandemic, compared to 25 % and 30 % in RoW (p < 0.001). Conclusions: Cardiovascular testing recovery in LATAM trailed behind RoW for most procedure types, with centers in Central America and Mexico reporting the greatest volume reductions. This study found lasting impacts of COVID-19 on cardiovascular care in LATAM and the need for mental health support for LATAM healthcare workers in current and future pandemics.

Health-related lifestyle assessment among Spanish adults from 22 to 72 years. / Valoración del estilo de vida saludable adquirido en adultos españoles de 22 a 72 años de edad.

OBJECTIVE: The objective of this paper has focused on assessing the level of health-related lifestyle acquired in Spanish adults in the Spanish cities of Albacete and Murcia, and analyzing the existing differences according to sex and age. MATERIAL AND METHODS: On a sample of 788 subjects aged between 22 and 72, the Health-related Lifestyle Assessment Scale was applied, consisting of 52 items and structured in 7 dimensions that explained a total variance of 66.87% and a Cronbach's alpha of 0.894. RESULTS: A percentage of 12 of the adults surveyed have a healthy lifestyle, 53% show a trend to health and 35% poor or unhealthy. Pearson's χ2 tests show a positive and significant association of women with health and a trend of significant improvement in lifestyle with age. The inferential data (t-Student tests and one-factor ANOVA) confirm these differences according to gender and age. CONCLUSIONS: It is necessary to promote preventive programs to improve health in the habits of the population, especially in the 35% that show a poor or unhealthy level of lifestyle.

[Stromal tumor of esophagus: case report]. / Tumor estromal de esófago: reporte de caso.

Gastrointestinal stromal cell tumors (GIST) are rare neoplasms of the gastrointestinal tract, although they are the most common mesenchymal neoplasms. The stomach and small intestine are the most frequent site of involvement accounting for approximately 85% of cases. However, esophagus involvement is exceptional (<5%); indeed some large series fail to report it. Surgery resection is the cornerstone of treatment; currently imatinib has demonstrated its utility to reduce local recurrences and tumor mass. We report a 75 years-old male with a medical history of dysphagia who presented upper gastrointestinal bleeding caused by an esophageal GIST. The patient did not undergo surgery because of severe chronic heart failure.

[Spanish tools of cognitive and behavior assessment of alzheimer´s disease in severe state.] / Escalas de valoración cognitiva y conductual en español para la demencia severa.

BACKGROUND: There are different scales in Spanish for cognitive and behavioral assessment of patients with severe dementia. The objective of this study was to select those scales that are more accessible, useful and with better psychometric properties, both for clinical practice and for research. METHODS: Literature review, by experts in the field, of scales of cognitive and behavioral assessment in dementia in the main scientific databases. Published in Spanish or English, excluding those not validated in Spanish. RESULTS: 11 bibliographical references were selected. Cognitive scales: Severe Impairment Battery was the one with the most cognitive areas, its abbreviated version (SIB-s) had the best internal consistency (α=0.96), Baylor Profound Mental Status Examination had very good psychometric properties with 0.99 reliability and excellent concurrent validity with Mini-Mental State Examination (r=-0.91). Severe Cognitive Impairment Profile was the only one that allowed establishing subgroups of cognitive impairment. Behavioral scales: Neuropsychiatric Inventory was the gold standard in dementias, but there was only one specific scale for severe Alzheimer's disease, the Baylor Profound Mental Status Examination behavioral subscale. CONCLUSIONS: In Spanish severe dementia, Severe Cognitive Impairment Profile and the Neuropsychiatric Inventory are the gold standard tool for cognitive assessment for research studies, and the Baylor Profound Mental Status Examination is the most useful for daily clinical practice.

OBJETIVO: Existen diferentes escalas en español para la valoración cognitiva y conductual de los pacientes con demencia severa. El objetivo de este estudio fue seleccionar aquellas escalas más accesibles, útiles y con mejores propiedades psicométricas, tanto para la práctica clínica como para fines investigadores. METODOS: Se realizó una revisión bibliográfica, por expertos en la materia, de escalas de valoración cognitiva y conductual sobre demencia en las principales bases de datos científicas. Debían estar publicadas en español o inglés, excluyendo aquellas no validadas al español. RESULTADOS: Se seleccionaron 11 referencias bibliográficas. En cuanto a escalas cognitivas: la Severe Impairment Battery era la que más áreas cognitivas en-globaba; su versión abreviada (SIB-s) presentaba la mejor consistencia interna (α=0,96); el Baylor Profound Mental Status Examination presentaba muy buenas propiedades psicométricas, con fiabilidad 0,99 y excelente validez concurrente con el Mini-Mental State Examination (r=-0,91); el Severe Cognitive Impairment Profile era la única que permitía establecer subgrupos de deterioro cognitivo. En cuanto a escalas conductuales: el Neuropsychiatric Inventory era el gold standard en demencias. Solo había una escala específica para la enfermedad de Alzheimer, el Baylor Profound Mental Status Examination subescala conductual. CONCLUSIONES: En demencias severas, el Severe Cognitive Impairment Profile y el Neuropsychiatric Inventory son las herramientas más completas para estudios de investigación, y el Baylor Profound Mental Status Examination la más útil para la práctica clínica.

Exploring Serum Transferrin Regulation of Nonferric Metal Therapeutic Function and Toxicity.

Serum transferrin (sTf) plays a pivotal role in regulating iron biodistribution and homeostasis within the body. The molecular details of sTf Fe(III) binding blood transport, and cellular delivery through transferrin receptor-mediated endocytosis are generally well-understood. Emerging interest exists in exploring sTf complexation of nonferric metals as it facilitates the therapeutic potential and toxicity of several of them. This review explores recent X-ray structural and physiologically relevant metal speciation studies to understand how sTf partakes in the bioactivity of key non-redox active hard Lewis acidic metals. It challenges preconceived notions of sTf structure function correlations that were based exclusively on the Fe(III) model by revealing distinct coordination modalities that nonferric metal ions can adopt and different modes of binding to metal-free and Fe(III)-bound sTf that can directly influence how they enter into cells and, ultimately, how they may impact human health. This knowledge informs on biomedical strategies to engineer sTf as a delivery vehicle for metal-based diagnostic and therapeutic agents in the cancer field. It is the intention of this work to open new avenues for characterizing the functionality and medical utility of nonferric-bound sTf and to expand the significance of this protein in the context of bioinorganic chemistry.

Adhesion to the Mediterranean diet in diabetic patients with poor control. / Adherencia a la dieta mediterránea en pacientes diabéticos con mal control.

OBJECTIVE: To analyse the relationship between the level of adherence to the Mediterranean diet and the control of cardiovascular risk factors. METHOD: A descriptive, observational study was conducted on patients diagnosed with Diabetes Mellitus type 2, with poor blood glucose control and a Body Mass Index greater than 25kg/m2. The relationship between the adherence to the Mediterranean diet and cardiovascular risk factors was evaluated before and after education about the Mediterranean diet. The patients were given a questionnaire on the level of adherence to the Mediterranean diet (the Mediterranean diet score), at the beginning of the study and at 6 month after having education about the Mediterranean diet in the Primary Care medical and nursing clinics. An analysis was carried out on the variables including, gender, age, weight, height, and Body Mass Index, as well as the analytical parameters of blood glucose, glycosylated haemoglobin, total, HDL, LDL cholesterol, and triglycerides. The relationship between the primary variable, 'adherence to the Mediterranean diet', and the rest of the variables was calculated before and after the educational intervention. RESULTS: The initial 'adherence to the Mediterranean diet score' in the questionnaire was relatively low (6.22). Excess weight, as well as to have an elevated Body Mass Index are associated with a lower adherence to the Mediterranean diet, as well as low adherence to treatment (P<.00 and P<.02, respectively). The values of HDL cholesterol values increased with greater adherence (P<.04). Elevated LDL and total cholesterol are associated with a lower adherence to the Mediterranean diet (P<.01 and P<.05, respectively), similar to that of elevated triglycerides (P<.00). Elevated baseline blood glucose levels are also associated with low adherence to the Mediterranean diet (P<.04), as well as the increase in glycosylated haemoglobin (P<.06). Thus the cardiovascular risk increases with low adherence (P<.08). After the educational intervention, a moderate increase was observed in the adherence to the Mediterranean diet (a score of 6.84) as well as a notable improvement in the control of the cardiovascular risk factors. CONCLUSIONS: Adherence to the Mediterranean diet is associated with improved control of cardiovascular risk factors.

[Comprehensive Care Home Unit: reduction of hospital resources during influenza outbreaks]. / Unidad domiciliaria de atención integral: Reducción de recursos hospitalarios durante brotes de gripe.

OBJECTIVE: The Comprehensive Care Home Unit of the General Hospital of Villarrobledo is a unit formed by a geriatrician who sees people in nursing homes to improve their quality of care. The activity of the Unit has been analyzed, mainly with the objective of avoiding referral to the emergency room, avoiding hospital admissions, avoiding hospital readmissions and reducing the number of hospital admission days. METHODS: We retrospectively described the clinical activity of the Unit during the influenza outbreak of 2017 and 2018. We selected sociodemographical variables, functional assessment scales (Katz index, Barthel index and the Functional Ambulation Classification), and the Global Deterioration Scale. We registered mortality, type of treatment, oncological patients and patients with supplementary tests. The population was divided into four subgroups: hospital admission avoided, hospital re-admission avoided, referral to the emergency department avoided and reduction of admission days. The demographic characteristics were described, including the mode or mean of the variables. An economic report was made, and an analysis of cost per process according to the subgroups, means of Related Groups for the Diagnosis and degree of dependency measured by the Barthel index. RESULTS: We selected 112 patients, they had a mean age of 82.2 years, Katz G (34.8%), IB 28.8 (DE 34.9), FAC 0 (63.4%) and GDS 7 (22.3%). The most frequent disease seen was respiratory infection (63.2%), 71.4% received active treatment, 10.7% complementary tests were performed, 17.9% oncological and 17% mortality. Cost analysis: hospital readmission avoided (€ 4,128 per patient) and patients with total disability (BI 0-20, € 3,623 per patient) presented more economic saving. The economic savings were more than € 230,000. CONCLUSIONS: The contribution of the Unit during periods of influenza outbreak is cost saving because of reduced numbers of admissions, numbers of readmissions, days of admission and emergency room visits.

OBJETIVO: La Unidad Domiciliaria de Atención Integral (UDAI) del Hospital General de Villarrobledo está formada por un geriatra que atiende a las personas institucionalizadas para mejorar su calidad asistencial. Se analizó la actividad de la UDAI, principalmente en el objetivo de evitar ingresos y reingresos hospitalarios, evitar visitas a urgencias y facilitar el alta hospitalaria prematura. METODOS: Describimos de forma retrospectiva la actividad de la UDAI durante los brotes de gripe del 2017 y 2018. Aportamos variables sociodemográficas, escalas de valoración funcional (índice de Katz, índice de Barthel y la Escala de Valoración Funcional de la Marcha), y la Escala de Deterioro Global. Registramos mortalidad, tipo de tratamiento, pacientes oncológicos y pruebas complementarias. Se dividió la población en cuatro subgrupos: ingreso hospitalario evitado, reingreso hospitalario evitado, derivación a urgencias evitada y reducción días de ingreso. Se describieron las características demográficas, incluido la moda o media de las variables. Se realizó una memoria económica, y un análisis de coste por proceso según los subgrupos, medias de Grupos Relacionados por el Diagnóstico y grado de dependencia medido por el Índice de Barthel. RESULTADOS: Se seleccionaron 112 pacientes, presentaban una edad media de 82,2 años, Katz G (34,8%), IB 28,8 (DE 34,9), FAC 0 (63,4%) y GDS 7 (22,3%). La enfermedad más frecuente fue la infección respiratoria (63,4%), recibieron tratamiento activo un 71,4%, se realizaron pruebas complementarias en un 10,7%, oncológico 17,9% y exitus 17%. Análisis de costes: el reingreso hospitalario evitado (4.128 € por paciente) y los pacientes con discapacidad total (IB 0 ­ 20, 3.623 € por paciente) presentaron un mayor ahorro de costes. El ahorro económico fue de más de 230.000€. CONCLUSIONES: La contribución de la UDAI durante los periodos de brote de gripe supone un ahorro de costes basado en disminuciones de hospitalizaciones, disminución de reingresos, acortamiento de estancias hospitalarias y reducción de derivaciones a urgencias.

[Methodology for estimating total direct costs of comprehensive care for non-communicable diseases]. / Metodología para la estimación de costos directos de la atención integral para enfermedades no trasmisibles.

RESUMEN Diseases like diabetes mellitus (DM) and hypertension (HT) generate high costs and are the most common cause of mortality in the Americas. In the case of Peru, given demographic and epidemiological changes, particularly the alarming increase in overweight and obesity, the burden of these diseases is constantly increasing, resulting in the need to budget more financial resources to the health services. The total care costs of these diseases and their complications represent a financial burden that should be considered very carefully by health institutions when they draft their budgets. With this aim, the Pan American Health Organization has assisted the Ministry of Health (MINSA) with a study to estimate these costs. This article graphically describes the methodology developed to estimate the direct costs of comprehensive care for DM and HT to the health services of MINSA and regional governments.

[Posterior reversible encephalopathy in a case of late-onset eclampsia]. / Encefalopatia posterior reversible en un caso de eclampsia tardia.

INTRODUCTION: Posterior reversible encephalopathy syndrome (PRES) is a clinical-radiological syndrome with acute or sub-acute presenting symptoms characterised by the presence of headache, vomiting, epileptic seizures, visual disorders and altered level of consciousness associated to lesions mainly located in the white matter of the posterior regions of the brain. CASE REPORT: A 32-year-old female who developed PRES in the postpartum period secondary to late-onset eclampsia. Ten days after giving birth, the patient presented a clinical picture consisting in headache, epileptic seizures, blindness and deterioration of the level of consciousness. The magnetic resonance imaging scan confirmed the predominant involvement of posterior white matter. CONCLUSIONS: Although eclampsia is a typical condition in pregnancy and the immediate postpartum period, it must be remembered that there is also a late-onset form that may occur after the birth and might be the cause of other syndromes such as PRES. Although the prognosis in these cases is usually favourable, treatment must be established as early as possible, with rapid control of the blood pressure and seizures in order to avoid permanent brain damage. This syndrome must always be taken into account in women with epileptic seizures or other neurological symptoms during the postpartum period.

TITLE: Encefalopatia posterior reversible en un caso de eclampsia tardia.Introduccion. El sindrome de encefalopatia posterior reversible (SEPR) es un sindrome clinico-radiologico de presentacion aguda o subaguda que se caracteriza por la presencia de cefalea, vomitos, crisis epilepticas, trastornos visuales y alteracion del nivel de conciencia asociado a lesiones localizadas fundamentalmente en la sustancia blanca de regiones posteriores cerebrales. Caso clinico. Mujer de 32 años que desarrollo un SEPR en el periodo posparto secundario a eclampsia tardia. La paciente presento 10 dias despues del parto un cuadro clinico consistente en cefalea, crisis epilepticas, ceguera y deterioro del nivel de conciencia. El estudio de imagen con resonancia magnetica confirmo la afectacion de la sustancia blanca de predominio posterior. Conclusiones. Aunque la eclampsia es una entidad tipica del embarazo y puerperio inmediato, es necesario recordar que tambien puede producirse de forma tardia tras el parto y que puede ser la causa de otros sindromes, como el SEPR. Aunque en estos casos el pronostico suele ser favorable, el tratamiento debe ser precoz, efectuando un rapido control de la tension arterial y las convulsiones con el fin de evitar un daño cerebral permanente. Es necesario considerar siempre este sindrome en mujeres con crisis epilepticas u otros sintomas neurologicos durante el posparto.

Mutualism effectiveness and vertical transmission of symbiotic fungal endophytes in response to host genetic background.

Certain species of the Pooideae subfamily develop stress tolerance and herbivory resistance through symbiosis with vertically transmitted, asexual fungi. This symbiosis is specific, and genetic factors modulate the compatibility between partners. Although gene flow is clearly a fitness trait in allogamous grasses, because it injects hybrid vigor and raw material for evolution, it could reduce compatibility and thus mutualism effectiveness. To explore the importance of host genetic background in modulating the performance of symbiosis, Lolium multiflorum plants, infected and noninfected with Neotyphodium occultans, were crossed with genetically distant plants of isolines (susceptible and resistant to diclofop-methyl herbicide) bred from two cultivars and exposed to stress. The endophyte improved seedling survival in genotypes susceptible to herbicide, while it had a negative effect on one of the genetically resistant crosses. Mutualism provided resistance to herbivory independently of the host genotype, but this effect vanished under stress. While no endophyte effect was observed on host reproductive success, it was increased by interpopulation plant crosses. Neither gene flow nor herbicide had an important impact on endophyte transmission. Host fitness improvements attributable to gene flow do not appear to result in direct conflict with mutualism while this seems to be an important mechanism for the ecological and contemporary evolution of the symbiotum.

Metodología para la estimación de costos directos de la atención integral para enfermedades no trasmisibles / Methodology for estimating total direct costs of comprehensive care for non-communicable diseases

RESUMEN Enfermedades como la diabetes mellitus (DM) y la hipertensión arterial (HTA) generan altos costos y son la causa más frecuente de mortalidad en la región de las Américas. En el caso del Perú, dados los cambios demográficos y epidemiológicos, y particularmente el aumento alarmante del sobrepeso y la obesidad, la carga de estas enfermedades tiene un crecimiento constante que implica la necesidad de asignar cada vez más recursos financieros a los servicios de salud. Los costos de la atención integral de estas enfermedades y sus complicaciones representan una carga económica que debe ser considerada por las instituciones de salud al elaborar su presupuesto. Con ese propósito, la Organización Panamericana de la Salud (OPS) ha apoyado al Ministerio de Salud (MINSA) con la realización de un estudio para la estimación de estos costos. En el presente artículo se describe esquemáticamente la metodología desarrollada para la estimación de los costos directos en la atención integral de la DM e HTA en los servicios de salud del MINSA y gobiernos regionales.

RESUMEN Diseases like diabetes mellitus (DM) and hypertension (HT) generate high costs and are the most common cause of mortality in the Americas. In the case of Peru, given demographic and epidemiological changes, particularly the alarming increase in overweight and obesity, the burden of these diseases is constantly increasing, resulting in the need to budget more financial resources to the health services. The total care costs of these diseases and their complications represent a financial burden that should be considered very carefully by health institutions when they draft their budgets. With this aim, the Pan American Health Organization has assisted the Ministry of Health (MINSA) with a study to estimate these costs. This article graphically describes the methodology developed to estimate the direct costs of comprehensive care for DM and HT to the health services of MINSA and regional governments.

Dimorphic fungal coinfection as a cause of chronic diarrhea and pancolitis.

Histoplasma capsulatum and Paracoccidioides brasiliensis are dimorphic fungi that cause systemic mycosis mostly in tropical South America and some areas of North America. Gastrointestinal involvement is not uncommon among these fungal diseases, but coinfection has not previously been reported. We report a patient with chronic diarrhea and pancolitis caused by paracoccidioidomycosis and histoplasmosis.

[Duodenal ulcer due by cytomegalovirus as a cause of upper gastrointestinal bleeding in an immunecompetent patient]. / Ulcera duodenal por Citomegalovirus como causa de Hemoragia Digestiva Alta en un Paciente Inmunocompetente.

Duodenal ulcer due to cytomegalovirus (CMV) is quite infrequent in the inmunocompetent patient. We present an elderly patient with a history of upper urinary infections who was admitted at the hospital because of tarry black stool and coffee ground vomits. Endoscopy revealed duodenal ulcer and the histopathology confirm CMV infection. The workout was negative for human immunodeficient virus (HIV), HTLV-1 and occult cancer. The patient developed a serious infection and died due to urinary septic shock. Key words : Duodenal ulcer, cytomegalovirus, upper gastrointestinal bleeding, immunocompetent.

Chronic diarrhea and pancolitis caused by paracoccidioidomycosis: a case report.

South American blastomycosis is a systemic micosis caused by infection with Paracoccidioides brasiliensis. The most frequently affected sites are the lower lip buccal mucous membrane, palate, tongue, sublingual region, lymph glands, and lungs. However, colonic involvement is not a common expression of Paracoccidioidomycosis. We report a case of chronic diarrhea and pancolitis caused by Paracoccidioidomycosis with fatal outcome.

[Use of glycerol trinitrate in an ointment for the management of chronic anal fissure at the National Hospital "Cayetano Heredia"]. / Uso de Trinitrato de Glicerol en unguento para el manejo de fisura anal crónica en el Hospital Nacional Cayetano Heredia.

INTRODUCTION: The anal fissure is a linear tear in the anal canal mucosa. If healing fails, it evolves into a chronic anal fissure (CAF). This is one of the most frequent proctologic problems affecting younger patients, altering their social and work life. As it is disabling disease, it causes a socioeconomic problem and, hence, it is important to make a proper diagnosis and apply a rapid and efficient treatment.At present, there are different therapeutic options, both medical and surgical. Among the first, there are several options that relax the anal sphincter. One of the options which are most used is the 0.2% Glycerol Trinitrate (GTN) ointment, there being some randomized and controlled studies reporting 48% and 69% healing rates and other studies with comparable results against surgery.The objective was to know the results of the GTN ointment, so as to avoid surgery, and the probable permanent section of the internal anal sphincter. MATERIAL AND METHODS: Topical Glycerol Trinitrate ointment 0.2% was used twice a day during two weeks. All patients diagnosed with CAF who met the inclusion criteria participated in this study for a one-year period, from February 2007 to January 2008. Two controls were carried out, one at the end of the treatment to verify healing and absence of symptoms, and the other after two months to check recidivism. RESULTS: There were 19 female patients (63.3%) and 11 male patients (36.7%). The average age was 34.87 years, with higher prevalence between 21 and 40 years (50%) and minor prevalence between 41 and 50 years (13.3%). The most frequent symptoms found were the association of anal pain with rectal bleeding in 66.6% of the patients, followed by isolated rectal bleeding and anal pain in 23.3% and 10% of cases, respectively. The most common localization of the CAF was the posterior midline in 63.3% of patients, followed by the anterior midline in 16.7% of patients, and by both midlines in 16.7% of cases. Four of the 30 patients included were lost. All the symptoms vanished in 73% (19)of the 26 remaining patients and symptoms persisted to a lower degree in 27% (7).Headache was an adverse effect in three patients. The control performed after 2 weeks of treatment evidenced partial and complete cicatrization of the fissure in 22 patients (84.6%) and persistence in 4 patients (15.4%). The final control performed after 2 months on the 18 patients who attended evidenced healing of the fissure in 16 (69.6%) and recidivism in 2 (8.7%). CONCLUSIONS: The following conclusion was drawn topical Glycerol Trinitrate 0.2% ointment, applied twice a day during two weeks, is effective in the treatment of chronic anal fissure, with a 69.9% success rate after two months of follow-up. Consequently, it must be considered as an alternate therapy in the treatment of CAF.

[Eosinophilic enteritis as a rare cause of ascites: case report]. / Enteritis eosinofilica como causa rara de ascitis: reporte de un caso.

The case of a 23-year old woman with a history of epigastric pain, a palpable tumor that covered the epigastrium and the left hypochondrium, and an episode of acute pancreatitis was reported. The computerized tomography revealed a pancreatic cyst. The CA-125 increased significantly. An exploratory laparotomy was performed, finding an endometrioma. The pathological anatomy showed necrotic tissue, mucus and blood, with a presence of macrophages with hemosiderin phagocytosis. The symptoms and signs, pathogenesis and treatment of the endometriosis of the pancreas are discussed.

[Impact assessment of increasing the time of withdrawal of colonoscopy in the detection rate of polyps in our midst]. / Evaluación del Impacto de Aumentar el Tiempo de Retiro del Colonoscopio en la Tasa de Detección de Pólipos en Nuestro Medio.

INTRODUCTION: In 2002, the US Multi-Society Task Force on Colorectal Cancer recommended that the withdrawal phase during colonoscopy should average at least 6-10 min to improve the detecting ratio of polyps. However, these recommendations were based on previous studies with a high colorectal cancer-risk population. The aim of our study is to determine if the implementation of a policy of colonoscopy withdrawal time > or = 6 minutes would be statistically associated with an increase in the colon polyp detection rate. MATERIALS AND METHODS: We retrospectively evaluated the procedural data from all total colonoscopies performed at our general hospital from January 2006 through July 2009. Since January 2008 we implemented the policy of withdrawal time > or = 6 minutes. We calculated the detection rate and compared data from these period with our baseline consisted of the two years previous period in which withdrawal time was not aware. RESULTS: We reviewed procedural data from 2004 colonoscopies performed from January 2006 through July 2009; 1042 from the > or = 6 minutes-withdrawal time implementation period and 962 from the two years previous period. We found 162 patients with at least one polyp detected during the > or = 6 minutes-withdrawal time implementation period whereas 144 patients were detected from our baseline. The polyp detection rate was 15.55% from the period with a withdrawal time of e6 minutes versus 16.17 and 15.84% from each year of our baseline. No significant increase (p = 0.955) in the polyp detection rate was detected between the two comparative groups. CONCLUSION: The implementation of a policy of colonoscopy withdrawal time e6 minutes had no effect on colon polyp detection.