Previously diagnosed cancer and mortality after ST-segment elevation acute myocardial infarction treated with primary angioplasty.

OBJECTIVE: We investigated if a previous cancer diagnosis influences the outcome of patients with STEMI treated with primary coronary intervention (PCI). BACKGROUND: ST-segment myocardial infarction (STEMI) and a history of cancer can coexist because both have a high incidence and prevalence. METHODS: Prospective cohort observational study, The primary end-point was total mortality. RESULTS: We included 917 patients, 53 of them (5.8%) were cancer survivors. During follow-up (median, 643 days [interquartile range, 258 to 1,015 days]), 100 patients died, 88 (10.2%) patients without a cancer diagnosis and 12 (22.6%) patients with a previous cancer diagnosis, which was significantly different (log-rank test = 8.4, p = .004). Cancer patients were older (73.4 (11.5) vs. 65.2 (13.8) years, p < .001), with a lower prevalence of previous stroke (1.1% vs. 2.2%, p = .002). Their hemoglobin concentration was also lower (13.4 (2.1) vs. 14.4 (1.7) g/L, p = .001). A trend towards a lower use of coronary stents in cancer survivors was noted (p = .061). Cancer was associated with a high probability of death (HR = 2.37, 95% confidence interval [CI] 1.30-4.34, p = .005). When confounding variables were included, this association was no longer significant (HR = 1.63, 95% CI 0.84-3.18, p = .150). CONCLUSIONS: Patients with a previous cancer diagnosis who had an acute STEMI treated by primary PCI did not seem to have a worse prognosis. The difference in the crude mortality rate can be explained by the baseline differences between both groups. Previous cancer diagnosis should not be included in the clinical decision process when a patient is having an acute STEMI.

Effect of Saccharomyces boulardii CNCM I-745 as complementary treatment of Helicobacter pylori infection on gut microbiome.

Conventional therapy for H. pylori infection includes the combination of antibiotics and a proton-pump inhibitor. Addition of probiotics as adjuvants for H. pylori antibiotic treatment can increase eradication rate and decrease treatment side effects. Although many studies show the benefits of S. boulardii CNCM I-745 in the treatment of H. pylori infection, the mechanism by which those benefits are achieved is unknown. Here, we report clinical characteristics and fecal microbiota changes comparing conventional anti-H. pylori therapy versus conventional therapy supplemented with S. boulardii CNCM I-745. A total of 74 patients were included in the current study; patients positive for H. pylori (n = 63) were randomly assigned to 2 groups: 34 patients received conventional therapy and 29 antibiotic therapy plus 750 mg of S. boulardii CNCM I-745 daily, for 2 weeks. Eleven patients negative for H. pylori infection were also studied. Patients provided 3 fecal samples: before initiating the antibiotic treatment, upon its completion, and 1 month after treatment. Patients were contacted every 72 h to inquire about side effects and compliance. DNA was extracted, and 16S rRNA was amplified and sequenced on Illumina MiSeq. Bioinformatic analysis was performed using QIIME2. Patients who received the probiotic had a significantly lower frequency of associated gastrointestinal symptoms (P = 0.028); higher number of bacterial diversity evenness (P = 0.0156); higher abundance of Enterobacteria; and lower abundance of Bacteroides and Clostridia upon treatment completion. Addition of S. boulardii CNCM I-745 induced a lower frequency of gastrointestinal symptoms that could be related to changes in gut microbiota.

Duodenal microbiome in patients with or without Helicobacter pylori infection.

BACKGROUND: Intestinal microbiota are recognized as an organ with important physiological functions whose alterations have been associated with common diseases including inflammatory intestinal conditions, malnutrition, type-2 diabetes, and cardiovascular diseases. The composition and function of the microbiota in the distal part of the intestine has been mainly described, while there is limited information on the small intestine microbiota. The objective of the present study was to describe the duodenal microbiome in individuals with dyspepsia in the presence or absence of Helicobacter pylori gastric infection. MATERIALS AND METHODS: Thirty-eight biopsies from the proximal duodenum of uninfected and 37 from H pylori-infected individuals were analyzed. Microbiota composition was assessed by PCR amplification and sequencing of 16S rRNA and ITS genes; sequences were analyzed with QIIME2. RESULTS AND CONCLUSIONS: At the phyla level, Proteobacteria, Bacteroidetes, Firmicutes, Actinobacteria, and Fusobacteria were predominant in the mucosal associated duodenal microbiota (MAM); at the genera level, we observed the predominance of Ralstonia, Streptococcus, Pseudomonas, Haemophilus, Herbaspirillum, Neisseria, and Veillonella. Microbiota α-diversity was higher in H pylori-infected individuals than in non-infected ones. In terms of ß-diversity metrics, there was a statistically significant difference between groups. Also, relative abundance of Haemophilus, Neisseria, Prevotella pallens, Prevotella 7, and Streptococcus was greater in H pylori-infected patients. In infected patients, several types of H pylori were present in duodenal MAM. Finally, the majority of duodenal samples had fungi sequences; the most common taxa observed were Recurvomyces followed by Ascomycota and Basidiomycota.

Participatory intervention to improve nutrition and physical activity of school-age children in Mexico.

Obesity is one of the major public health problems of the 21st century, affecting every country in the world. In Mexico, the prevalence of overweight and obesity in children (5 to 11 years) was 35.5%. Childhood obesity is a chronic disease itself; and is associated with other chronic conditions. OBJECTIVE: To assess the effect and feasibility of a participatory intervention to improve nutrition and physical activity within the school environment in children in public elementary schools in Mexico. METHODS: The present study is a cluster trial. The intervention focused on; changes in food offered, training the schools' food service staff, promoting water consumption and physical activity at the community level, implementing healthy spaces inside the school, improving the quality of physical education within schools, among others. The main outcomes will focus on rate of weight gain, time devoted to physical activity, sedentary behaviors, diet quality and response feeding behaviors. We also will assess the time and personnel involved in the intervention development, maintenance, and dissemination. CONCLUSION: Findings from this trial will generate new translational knowledge in Mexico; if the results are positive, this participatory intervention could serve as a basis for designing multidimensional interventions that could be scaled up at the national level.

A Transmembrane Histidine Kinase Functions as a pH Sensor.

The two-component system DesK-DesR regulates the synthesis of unsaturated fatty acids in the soil bacteria Bacillus subtilis. This system is activated at low temperature and maintains membrane lipid fluidity upon temperature variations. Here, we found that DesK-the transmembrane histidine kinase-also responds to pH and studied the mechanism of pH sensing. We propose that a helix linking the transmembrane region with the cytoplasmic catalytic domain is involved in pH sensing. This helix contains several glutamate, lysine, and arginine residues At neutral pH, the linker forms an alpha helix that is stabilized by hydrogen bonds in the i, i + 4 register and thus favors the kinase state. At low pH, protonation of glutamate residues breaks salt bridges, which results in helix destabilization and interruption of signaling. This mechanism inhibits unsaturated fatty acid synthesis and rigidifies the membrane when Bacillus grows in acidic conditions.

RISK AND PROTECTIVE FACTORS FOR GASTRIC METAPLASIA AND CANCER: A HOSPITAL-BASED CASE-CONTROL STUDY IN ECUADOR.

INTRODUCTION: worldwide, stomach cancer is the fifth most frequent cancer, with 952 000 new cases diagnosed in 2012. Ecuador currently holds the 15th place of countries with the highest incidence of stomach cancer for both sexes. OBJECTIVES: the objective of this study was to evaluate risk and protective factors for gastric cancer/metaplasia. METHODS: a hospital-based case-control study was conducted in Quito, Ecuador. Cases were defined as patients with histological confirmation of gastric cancer (N = 60) or incomplete gastric metaplasia (N = 53). Controls were defined as patients free of gastric cancer or premalignant lesions (N = 144). All participants were personally interviewed using a structured questionnaire to collect data about dietary habits, lifestyle and medical history. RESULTS: risk factors significantly associated to the presence of gastric cancer/metaplasia were the consumption of reheated foods at least 3 times per week (AOR: 4.57; CI: 2.2 - 9.5) and adding salt to more than 50% of foods (AOR: 1.32; CI: 1.04 - 1.67). Protective factors for gastric cancer/metaplasia were the use of non-steroidal anti-inflammatory drugs (AOR: 0.39; CI 0.19 - 0.83), age less than 58 years old (AOR: 0.38; CI: 0.18 - 0.79) and have received treatment for H. Pylori infection (AOR: 0.33; CI: 0.16 - 0.71). CONCLUSIONS: this study reports for the first time, the risk and protective factors associated with gastric cancer and metaplasia in Ecuador.

Introducción: el cáncer de estómago ocupa la quinta posición entre los cánceres más frecuentes en el mundo, con 952.000 casos diagnosticados en el 2012. El Ecuador ocupa el 15º lugar entre los países con la incidencia más alta de cáncer gástrico en ambos sexos. Objetivo: el objetivo del presente estudio fue evaluar los factores de protección y de riesgo para cáncer/metaplasia gástrico. Métodos: se realizó un estudio hospitalario de casos y controles en la ciudad de Quito, Ecuador. Se definieron como casos a los pacientes con diagnóstico histológico confirmado de cáncer gástrico (N = 60) o con metaplasia gástrica incompleta (N = 53). Se definieron como controles a los pacientes sin cáncer gástrico o lesiones premalignas (N = 144). A todos los pacientes se les realizó una entrevista personalizada utilizando un cuestionario estructurado para recoger datos sobre hábitos dietéticos, estilo de vida e historia clínica. Resultados: los factores de riesgo asociados significativamente con el diagnóstico de cáncer gástrico/metaplasia fueron el consumo de alimentos recalentados al menos tres veces a la semana, (AOR: 4,57; CI: 2,2 ­ 9,5) y añadir sal a más del 50% de las comidas (AOR: 1,32; CI: 1,04 ­ 1,67). Los factores de protección asociados significativamente para no desarrollar cáncer/metaplasia gástrico fueron el uso de antiinflamatorios no esteroideos (AOR: 0,39; CI 0,19 ­ 0,83), edad menor a 58 años (AOR: 0,38; CI: 0,18 ­ 0,79) y haber recibido tratamiento para la infección por H. Pylori (AOR: 0,33; CI: 0,16 ­ 0,71). Conclusiones: este estudio reporta por primera vez los factores de riesgo y de protección asociados con el cáncer/ metaplasia gástrico en Ecuador.

Improved method for extraction and detection of Helicobacter pylori DNA in formalin-fixed paraffin embedded gastric biopsies using laser micro-dissection.

To assess the molecular events exerted by Helicobacter pylori interacting directly with gastric epithelial cells, an improved procedure for microbial DNA isolation from stained hematoxilin-eosin gastric biopsies was developed based on laser micro-dissection (LM) [1]. Few articles have described the use of LM to select and detect H. pylori genome from formalin-fixed paraffin embedded gastric tissue [2]. To improve the yield and quality of DNA isolated from H. pylori contacting intestinal epithelial cells, the following conditions were established after modification of the QIAamp DNA Micro kit. •Use of at least 25 cut sections of 10-20 µm of diameter and 3 µm thick with more than 10 bacteria in each cut.•Lysis with 30 µL of tissue lysis buffer and 20 µL of proteinase K (PK) with the tube in an upside-down position.•The use of thin purification columns with 35 µL of elution buffer. The mean of DNA concentration obtained from 25 LM cut sections was 1.94± 0 .16 ng/µL, and it was efficiently amplified with qPCR in a Bio Rad iCycler instrument. The LM can improve the sample selection and DNA extraction for molecular analysis of H. pylori associated with human gastric epithelium.

Infección y explante de DAI por decúbito, a propósito de un caso / Infection and explant of ICD due to decubitus, regarding a case

Se presenta el caso de un paciente varón de 73 años que, tras haberse implantado un desfibrilador automático interno (DAI), fue ingresado en el hospital por presentar decúbito del DAI con exposición de electrodos y presencia de exudado. Tras evidenciarse infección con diferentes pruebas analíticas y de imagen, se procedió a retirar el desfibrilador.Se realizó una valoración enfermera holística previa a la cirugía de explante del DAI por Patrones Funcionales de la Salud de Marjory Gordon y se llevó a cabo un plan de cuidados empleando la taxonomía diagnóstica de la North American Nursing Diagnosis Association (NANDA), describiendo los resultados esperados según la Nursing Outcomes Classification (NOC) y enunciado las intervenciones necesarias según la Nursing Intervention Classification (NIC). Se identificaron dos diagnósticos enfermeros: [00214] Disconfort y [00161] Disposición para mejorar los conocimientos; y dos problemas de colaboración: [00046] Deterioro de la integridad cutánea y [00146] Ansiedad. A continuación se escogió una serie de Resultados NOC: Bienestar personal, Integridad tisular de piel y membranas mucosas, Conocimiento del control de la infección y Autocontrol de la ansiedad; con sus respectivos indicadores a los que se les asignó una puntuación inicial y una puntuación diana o esperada. Por último, se identificaron intervenciones enfermeras a llevar a cabo con sus correspondientes actividades.Al cabo de un mes, previamente al alta hospitalaria, se evaluaron de nuevo los indicadores obteniéndose una puntuación final igual a la puntuación diana y, en algún indicador, una puntuación final mayor a la esperada destacando el NOC Conocimiento del control de la infección.(AU)

Presenting the case of a male 73-year-old patient who, after Internal Cardiac Defibrillator (ICD) implantation, was admitted to hospital due to ICD decubitus with electrode exposure and presence of exudate. After infection was confirmed through different lab and imaging tests, the defibrillator was removed.Holistic nursing assessment was conducted before the ICD explant surgery, through Marjory Gordon’s Functional Health Patterns, and a plan of care was conducted using the North American Nursing Diagnosis Association (NANDA) diagnostic terminology, describing the expected outcomes according to the Nursing Outcomes Classification (NOC) and stating the necessary interventions according to the Nursing Intervention Classification (NIC). Two nursing diagnoses were identified: [00214] Discomfort and [00161] Readiness for Enhanced Knowledge; and two collaboration problems: [00046] Impairment of skin integrity, and [00146] Anxiety. A series of NOC outcomes was then selected: Personal wellbeing, Skin tissue and mucous membrane integrity, Knowledge of infection control, and Anxiety self-control, with their appropriate indicators these were assigned with an initial score and a target or expected score. Finally, nursing interventions to be carried out were identified with their corresponding activities.After one month, and before hospital discharge, the indicators were assessed again, and the final score obtained was equal to the target score; and in some indicator, there was a final score higher to the expected one, highlighting the NOC Knowledge of infection control.(AU)

Risk and protective factors for gastric metaplasia and cancer: a hospital-based case-control study in Ecuador / Factores de riesgo y protección para metaplasia y cáncer gástrico: estudio de casos y controles hospitalarios en Quito-Ecuador

Introduction: worldwide, stomach cancer is the fifth most frequent cancer, with 952 000 new cases diagnosed in 2012. Ecuador currently holds the 15th place of countries with the highest incidence of stomach cancer for both sexes. Objectives: the objective of this study was to evaluate risk and protective factors for gastric cancer/metaplasia. Methods: a hospital-based case-control study was conducted in Quito, Ecuador. Cases were defined as patients with histological confirmation of gastric cancer (N=60) or incomplete gastric metaplasia (N=53). Controls were defined as patients free of gastric cancer or premalignant lesions (N=144). All participants were personally interviewed using a structured questionnaire to collect data about dietary habits, lifestyle and medical history. Results: risk factors significantly associated to the presence of gastric cancer/metaplasia were the consumption of reheated foods at least 3 times per week (AOR: 4.57; CI: 2.2 -9.5) and adding salt to more than 50% of foods (AOR: 1.32; CI: 1.04-1.67). Protective factors for gastric cancer/metaplasia were the use of non-steroidal anti-inflammatory drugs (AOR: 0.39; CI 0.19-0.83), age less than 58 years old (AOR: 0.38; CI: 0.18-0.79) and have received treatment for H. Pylori infection (AOR: 0.33; CI: 0.16-0.71). Conclusions: this study reports for the first time, the risk and protective factors associated with gastric cancer and metaplasia in Ecuador (AU)

Introducción: el cáncer de estómago ocupa la quinta posición entre los cánceres más frecuentes en el mundo, con 952.000 casos diagnosticados en el 2012. El Ecuador ocupa el 15º lugar entre los países con la incidencia más alta de cáncer gástrico en ambos sexos. Objetivo: el objetivo del presente estudio fue evaluar los factores de protección y de riesgo para cáncer/metaplasia gástrico. Métodos: se realizó un estudio hospitalario de casos y controles en la ciudad de Quito, Ecuador. Se definieron como casos a los pacientes con diagnóstico histológico confirmado de cáncer gástrico (N=60) o con metaplasia gástrica incompleta (N=53). Se definieron como controles a los pacientes sin cáncer gástrico o lesiones premalignas (N=144). A todos los pacientes se les realizó una entrevista personalizada utilizando un cuestionario estructurado para recoger datos sobre hábitos dietéticos, estilo de vida e historia clínica. Resultados: los factores de riesgo asociados significativamente con el diagnóstico de cáncer gástrico/metaplasia fueron el consumo de alimentos recalentados al menos tres veces a la semana, (AOR: 4,57; CI: 2,2 -9,5) y añadir sal a más del 50% de las comidas (AOR: 1,32; CI: 1,04- 1,67). Los factores de protección asociados significativamente para no desarrollar cáncer/metaplasia gástrico fueron el uso de antiinflamatorios no esteroideos (AOR: 0,39; CI 0,19-0,83), edad menor a 58 años (AOR: 0,38; CI: 0,18 -0,79) y haber recibido tratamiento para la infección por H. Pylori (AOR: 0,33; CI: 0,16 - 0,71). Conclusiones: este estudio reporta por primera vez los factores de riesgo y de protección asociados con el cáncer/ metaplasia gástrico en Ecuador (AU)

Sedación: analgésia en endoscopía digestiva / Sedation: analgesia in gastrointestinal endoscopy

La sedación es la manipulación del estado cerebral por medios farmacológicos. Su utilización en procedimientos endoscópicos mejora la tolerancia del paciente y facilita la práctica del procedimiento al endoscopista. Todo esto implica que el uso de la sedoanalgesia sea cada vez más habitual durante las exploraciones endoscópicas. Por lo cual médicos encargados de realizar estos procedimientos debemos estar familiarizados con los fármacos utilizados en la sedación, sus antagonistas, las indicaciones y sus compl icaciones.

Estudio multicéntrico para evaluar la eficacia y seguridad de las enzimas pancreáticas en el tratamiento del síndrome dispéptico funcional / multicentric Study to evaluate the effectiveness and security of pancreáticas enzymes in the processing of the functional dispéptico syndrome

Expone que el tratamiento con enzimas pancreáticas está restringuido a un grupo pequeño de pacientes con insufiencia pancreática exócrina. Sin embargo, las enzimas pancreáticas son mucho más a menudo prescritas para aliviar diferentes trastornos digestivos. La evidencia clínica para este uso no está bien documentada en la literatura. Por lo tanto un estudio piloto fue iniciado para evaluar la eficacia y seguridad de las enzimas pancreáticas en el tratamiento del Síndrome dispético funcional. Este estudio prospectivo y multicéntrico se realizó en 50 pacientes con una historia muy clara de síndrome dispéptico y con muy específicos criterios de exclusión e inclusión. Ellos fueron tratados por un período de dos meses con enzimas pancreáticas: lipasa 8.000 U.S.P. proteasa 30.000 U.S.P. y amilasa 30.000 U.S.P.. Durante este período se realizaron tres determinaciones de grasa fecal cuantitativa en cada paciente: al comienzo, después de un mes y al final del estudio. Los resultados son positivos ya que la mayoría de síntomas desaparecen o mejoran considerablemente: náusea, eructos, regurgitación ácida, quemadura retroesternal, dolor abdominal difuso, molestias después de comer, meteorismo, flatulencia, distensión abdominal, síntomas nerviosos y anormalidades de la defecación. Es de suma importancia la forma de administrar las enzimas pancreáticas en el duodeno y la cantidad total diaria que cada paciente debe recibir especialmente en forma de actividad enzimática, sobre todo de lipasa...