Duodeno-ileal diversion with self-forming magnets in a sutureless neodymium anastomosis procedure (SNAP) for weight recidivism after sleeve gastrectomy: feasibility and 9-month results.

BACKGROUND: The sleeve gastrectomy (SG) has become the most common bariatric procedure worldwide. However, insufficient weight loss or weight recidivism is frequent, which may require effective and safe revisional procedures. OBJECTIVE: To determine the technical feasibility and safety of a minimally invasive, duodeno-ileal side-to-side anastomosis using a Sutureless Neodymium Anastomosis Procedure (SNAP) for patients with weight recidivism or inadequate weight loss following SG. METHODS: This is a prospective, single-arm, open-label pilot study that enrolled patients with obesity to assist in weight reduction following an SG performed > 12 months prior. For the SNAP, self-assembling magnets were deployed into the ileum (laparoscopically) and duodenum (per-oral endoscopy). Magnets were coupled under laparoscopic and fluoroscopic guidance to create a compression anastomosis. The primary endpoints were technical feasibility, weight loss, and rate of serious adverse events (SAEs). RESULTS: Successful duodeno-ileal diversions were created with SNAP in 27 participants (mean age: 50.6 ± 9.1, mean BMI: 38.1 ± 4.6 kg/m2) with no device-related serious adverse events. Upper endoscopy at 3 months confirmed patent, healthy anastomoses in all patients. At 9 months, patients (n = 24) experienced 11.9 ± 6.2%, 14.5 ± 10.8%, and 17.0 ± 13.9% TBWL at 3, 6, and 9 months, respectively. There were no device-related SAEs. CONCLUSION: The SNAP is technically feasible and relatively safe, with all patients presenting widely patent anastomosis at 3 months. Patients experienced a progressive, clinically meaningful weight loss. Further studies are needed to confirm our findings.

Comparison between 16S rRNA and shotgun sequencing in colorectal cancer, advanced colorectal lesions, and healthy human gut microbiota.

BACKGROUND: Gut dysbiosis has been associated with colorectal cancer (CRC), the third most prevalent cancer in the world. This study compares microbiota taxonomic and abundance results obtained by 16S rRNA gene sequencing (16S) and whole shotgun metagenomic sequencing to investigate their reliability for bacteria profiling. The experimental design included 156 human stool samples from healthy controls, advanced (high-risk) colorectal lesion patients (HRL), and CRC cases, with each sample sequenced using both 16S and shotgun methods. We thoroughly compared both sequencing technologies at the species, genus, and family annotation levels, the abundance differences in these taxa, sparsity, alpha and beta diversities, ability to train prediction models, and the similarity of the microbial signature derived from these models. RESULTS: As expected, the results showed that 16S detects only part of the gut microbiota community revealed by shotgun, although some genera were only profiled by 16S. The 16S abundance data was sparser and exhibited lower alpha diversity. In lower taxonomic ranks, shotgun and 16S highly differed, partially due to a disagreement in reference databases. When considering only shared taxa, the abundance was positively correlated between the two strategies. We also found a moderate correlation between the shotgun and 16S alpha-diversity measures, as well as their PCoAs. Regarding the machine learning models, only some of the shotgun models showed some degree of predictive power in an independent test set, but we could not demonstrate a clear superiority of one technology over the other. Microbial signatures from both sequencing techniques revealed taxa previously associated with CRC development, e.g., Parvimonas micra. CONCLUSIONS: Shotgun and 16S sequencing provide two different lenses to examine microbial communities. While we have demonstrated that they can unravel common patterns (including microbial signatures), shotgun often gives a more detailed snapshot than 16S, both in depth and breadth. Instead, 16S will tend to show only part of the picture, giving greater weight to dominant bacteria in a sample. Therefore, we recommend choosing one or another sequencing technique before launching a study. Specifically, shotgun sequencing is preferred for stool microbiome samples and in-depth analyses, while 16S is more suitable for tissue samples and studies with targeted aims.

Performance of a Shotgun Prediction Model for Colorectal Cancer When Using 16S rRNA Sequencing Data.

Colorectal cancer (CRC), the third most common cancer globally, has shown links to disturbed gut microbiota. While significant efforts have been made to establish a microbial signature indicative of CRC using shotgun metagenomic sequencing, the challenge lies in validating this signature with 16S ribosomal RNA (16S) gene sequencing. The primary obstacle is reconciling the differing outputs of these two methodologies, which often lead to divergent statistical models and conclusions. In this study, we introduce an algorithm designed to bridge this gap by mapping shotgun-derived taxa to their 16S counterparts. This mapping enables us to assess the predictive performance of a shotgun-based microbiome signature using 16S data. Our results demonstrate a reduction in performance when applying the 16S-mapped taxa in the shotgun prediction model, though it retains statistical significance. This suggests that while an exact match between shotgun and 16S data may not yet be feasible, our approach provides a viable method for comparative analysis and validation in the context of CRC-associated microbiome research.

Seroepidemiology of Toxoplasma gondii in domestic cattle, sheep, goats and pigs from São Tomé and Príncipe / Soroepidemiologia de Toxoplasma gondii em bovinos, ovinos, caprinos e suínos domésticos de São Tomé e Príncipe

Abstract Despite the global importance of the zoonotic parasite Toxoplasma gondii, little is known regarding its infection in the Democratic Republic of São Tomé and Príncipe (DRSTP). This is the first report of antibodies to T. gondii in cattle, sheep, goats and pigs from the DRSTP. Antibodies were assessed by the modified agglutination test (MAT), with a cut-off titer of 100 for cattle and 20 for sheep, goats and pigs. The present study revealed an overall seroprevalence of 55.8%; 27.1% in 48 cattle, 68.4% in 98 sheep, 70.1% in 97 goats and 43.7% in 103 pigs. The south geographical area for cattle, the central area for sheep, and adult age and living in the central region for goats were found to be risk factors for seropositivity to T. gondii. These results support the scenario of a considerable presence of sporulated oocysts as well as of infected intermediate hosts in the local environment. Consumption of raw or undercooked meat should be considered as an important potential source of infection for animals and humans in the DRSTP.

Resumo Apesar da importância global do parasita zoonótico Toxoplasma gondii, pouco se conhece sobre sua infecção na República Democrática de São Tomé e Príncipe (RDSTP). Esse é o primeiro relato de anticorpos para T. gondii em bovinos, ovinos, caprinos e suínos da RDSTP. Os anticorpos foram pesquisados pelo teste de aglutinação direta modificada (TADM), com um título de corte de 100 para bovinos e de 20 para ovinos, caprinos e suínos. O presente estudo revelou uma soroprevalência global de 55,8%: 27,1% em 48 bovinos, 68,4% em 98 ovinos, 70,1% em 97 caprinos e 43,7% em 103 suínos. A área geográfica sul para os bovinos, a área central para os ovinos, bem como a idade adulta e a região central para os caprinos foram considerados fatores de risco para soropositividade a T. gondii. Esses resultados suportam o cenário de uma considerável presença de oocistos esporulados, bem como de hospedeiros intermediários infectados no ambiente local. O consumo de carne crua ou mal passada deve ser considerado como uma importante fonte potencial de infecção para animais e seres humanos na RDSTP.

Utilidad de la enteroscopia de simple y de doble balón / Utility of single- and double-balloon enteroscopy

Los enteroscopios de uno y de doble balón tienen una eficacia similar. Se puede explorar por vía oral todo el intestino delgado entre el 25 y el 40% de casos en 60 a 90 min. Utilizando vía oral y rectal, las exploraciones completas llegan al 75%. Las indicaciones diagnósticas son hemorragia digestiva intermedia, tumores, enfermedad de Crohn, obstrucción intestinal y malabsorción atípica. Para el tratamiento, las indicaciones incluyen acceso a la enterostomía, hemostasia, retirada de cuerpos extraños, dilatación y polipectomía en el intestino delgado. También es útil para colocar sondas de alimentación enteral en pacientes con estómago excluido. La eficacia hemostática es elevada en los pacientes con necesidades transfusionales elevadas. Para la polipectomía no se ha demostrado que esta técnica tenga la misma eficacia y riesgo que en la colonoscopia. Las complicaciones incluyen pancreatitis (0,34%) y perforación (del 0,34 al 6,4%). El grado de evidencia es bajo para casi todas las indicaciones, ya que hay pocos estudios prospectivos y homogéneos (AU)

Single- and double-balloon enteroscopes have similar efficacy. The entire small bowel can be examined through the oral route in 60 90minutes in 25 40% of patients. Using the oral and rectal routes, complete examinations can be performed in 75% of patients. Hemostatic efficacy is high in patients with elevated transfusional requirements. For polypectomy, this technique has not been demonstrated to have the same efficacy/risk as colonoscopy. Complications include pancreatitis (0.34%) and perforation (0.34 6.4%). The level of evidence for almost all indications is low, since few prospective and homogeneous studies have been performed (AU)

Recomendaciones de utilización de la endoscopia: análisis de la probabilidad de encontrar lesiones significativas en los pacientes procedentes de la atención extrahospitalaria / Guidelines for the rational use of endoscopy to improve the detection of relevant lesions in an open-access endoscopy unit: a prospective study

Fundamento y objetivo: Hasta un 50% de las indicaciones de endoscopia digestiva se realizan en la asistencia extrahospitalaria. Dado que los recursos de que se dispone son limitados, es imprescindible una correcta indicación de las exploraciones. El objetivo de este estudio fue valorar de forma prospectiva la adecuación de las endoscopias digestivas solicitadas desde centros de asistencia extrahospitalaria de acuerdo con los criterios del European Panel on the Appropriatness of Gastrointestinal Endoscopy (EPAGE). Pacientes y método: Entre mayo y junio de 2005 se incluyeron todas las endoscopias solicitadas desde la asistencia extrahospitalaria (478 colonoscopias y 264 gastroscopias). La adecuación de las indicaciones se evaluó de acuerdo con los criterios del EPAGE. Para poder evaluar el rendimiento diagnóstico de una indicación adecuada se registraron los hallazgos relevantes de las exploraciones. Resultados: En 146 (20%) pacientes la indicación no figuraba en el listado de la guía del EPAGE o los datos estaban incompletos y se los excluyó del análisis. En los restantes 596 pacientes, la indicación de la exploración se consideró adecuada en 401 (67%) pacientes (253 [69%] colonoscopias y 148 [65%] gastroscopias). El rendimiento diagnóstico fue superior en las endoscopias consideradas adecuadas (el 30 frente al 7%; p < 0,001). Los factores asociados con la adecuación de las exploraciones fueron la edad y la nacionalidad de los pacientes. Conclusiones: El rendimiento diagnóstico de las endoscopias procedentes de la asistencia extrahospitalaria aumenta cuando las indicaciones son adecuadas según las recomendaciones del EPAGE. Debido a que en una proporción considerable estas endoscopias son inadecuadas, la implementación de guías validadas para su correcto uso podría mejorar esta situación

Background and objective: Almost 50% of gastrointestinal endoscopies performed in our Unit correspond to patients coming from primary care. Since resources are finite, adherence to appropriate indications for these procedures is essential. We prospectively assessed the appropriateness of gastrointestinal endoscopies referred from Primary Care according to the European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE) criteria. Patients and method: From May to June 2005, all consecutive patients referred from Primary care to our unit for open-access endoscopy were included (478 colonoscopies and 264 gastroscopies). Appropriateness of each exploration was established according to the EPAGE criteria. In order to evaluate whether appropriateness of use correlated with the diagnostic yield of endoscopies, relevant endoscopic findings were recorded. Results: In 146 patients (20%), an endoscopy indication was not listed in the EPAGE guidelines or data were incomplete and they were not evaluated. In the remaining 596 patients, the indication of the procedure was considered appropriate in 401 (67%) patients (253 [69%], colonoscopies and 148 [65%], gastroscopies). The diagnostic yield was significantly higher for appropriate endoscopies (30% vs 7%, p < 0.001). Endoscopies were more appropriate in older patients and in non-foreigners. Conclusions: The diagnostic yield of gastrointestinal endoscopies in patients coming from primary Care increases with the appropriateness of indications according to the EPAGE criteria. Since a noteworthy proportion of these patients' endoscopies are considered inappropriate, the implementation of validated guidelines for its appropriate use could improve this situation

Endoscopic ultrasound-guided fine needle aspiration: predictive factors of accurate diagnosis and cost-minimization analysis of on-site pathologist

Objetivos: Evaluar: a) los diagnósticos establecidos mediante ultrasonografía endoscópica (PAAF) guiada mediante ecografía endoscópica (EE), en comparación con los diagnósticos realizados únicamente mediante EE; b) los factores predictivos de la precisión diagnóstica con la PAAF-EE, y c) la rentabilidad económica de la permanencia física del citopatólogo en el lugar en el que se realiza la PAAF-EE. Pacientes y métodos: En un estudio prospectivo realizado con 213 pacientes se obtuvieron los datos demográficos, ecográficos y técnicos en relación con la PAAF-EE y correspondientes al estudio citopatológico. La prueba diagnóstica de referencia utilizada fue el estudio anatomopatológico o el seguimiento clínico. Con estas variables se determinaron las características operativas de la PAAF-EE, se efectuó un análisis multivariado y se llevó a cabo una evaluación para la minimización de los costes. Resultados: Se obtuvieron muestras en un total de 262 lesiones: masas extramurales (n = 115), ganglios linfáticos (n = 96), quistes (n = 40) y lesiones intramurales (n = 11). La precisión diagnóstica global de la PAAF-EE fue del 89% (234/262 lesiones). La precisión de la EE en el diagnóstico diferencial de las lesiones malignas y benignas fue del 92%; sin embargo, 105 lesiones (un 40% del total) fueron clasificadas como indeterminadas. La adición de la PAAF a la EE permitió el diagnóstico de la práctica totalidad de ellas (89%), con una precisión diagnóstica del 90%. La única variable independiente asociada al diagnóstico erróneo fue la localización intramural de la lesión evaluada. La efectividad de la PAAF-EE en toda la serie aumentó progresivamente y alcanzó su nivel máximo en el cuarto intento de punción. La participación del citopatólogo en el procedimiento fue económicamente rentable. Conclusiones: La PAAF-EE permite establecer el diagnóstico en la mayor parte de las lesiones clasificadas como indeterminadas por la EE, aplicada de manera aislada. La localización intramural de la lesión es el único factor asociado de manera independiente a una precisión diagnóstica baja. La presencia del citopatólogo durante el procedimiento es económicamente rentable

Aims: To evaluate a) new diagnoses by endoscopic ultrasound guided real-time fine-needle aspiration (EUS-FNA) compared with EUS alone; b) the predictive factors for an accurate EUS-FNA diagnosis, and c) the cost-effectiveness of the presence of an on-site cytopathologist. Patients and methods: Demographic data, ultrasonographic characteristics, technical information on EUS-FNA and cytological results were prospectively collected in 213 patients. The gold standard used was pathological examination or clinical follow-up. Operating characteristics of EUS-FNA, multivariate analysis, and a cost-minimization study of on-site evaluation were performed with these variables. Results: Samples were obtained from a total of 262 lesions: extramural masses (n = 115), lymph nodes (n = 96), cysts (n = 40) and intramural lesions (n = 11). The overall accuracy of EUS-FNA was 89% (234/262 lesions). The accuracy of EUS in discriminating between malignant and benign disease was 92% but 105 lesions (40% of the total) were classified as indeterminate. The addition of FNA to EUS allowed almost all lesions (89%) to be diagnosed with an accuracy of 90%. The only variable independently associated with an incorrect diagnosis was intramural location of the target lesion. The effectiveness of EUS-FNA in the complete series progressively increased, reaching a plateau in the fourth pass. The presence of an attendant cytopathologist was cost-effective. Conclusions: EUS-FNA allows diagnosis of most lesions classified as indeterminate by EUS alone. The only factor independently associated with low accuracy is intramural location of the lesion. The availability of an on-site cytopathologist is cost-effective

Valor de la punción aspirativa con aguja fina guiada por ultrasonografía endoscópica en el diagnóstico de las lesiones mediastínicas / Usefulness of endoscopic ultrasound-guided fine needle aspiration in the diagnosis of mediastinal lesions

Objetivo: La punción aspirativa con aguja fina guiada por ultrasonografía endoscópica (USE-PAAF) es una técnica eficaz y segura en el diagnóstico de las lesiones focales del páncreas y las adenopatías intraabdominales. El objetivo de este estudio es describir su utilidad en el diagnóstico de las lesiones mediastínicas. Pacientes y métodos: Se han revisado todos los casos consecutivos a los que se realizó una USE-PAAF para estudio de una lesión mediastínica desde enero de 2001 hasta septiembre de 2003. Las exploraciones se efectuaron con un ecoendoscopio radial para estudio de las características de la lesión y un ecoendoscopio sectorial para realizar la punción transesofágica usando una aguja de 22 G. Se utilizó como referencia la cirugía en los pacientes operados y el resultado de la citología obtenida con la USE-PAAF en los casos en que el tratamiento quirúrgico no estaba indicado. Resultados: Se realizó USE-PAAF a 59 pacientes con un total de 89 lesiones, con diámetro medio ± desviación estándar de 2,4 ± 2 × 1,6 ± 1,4 cm. El tamaño de las lesiones malignas fue mayor que el de las benignas (diámetro corto: 2,7 ± 1,4 frente a 1 ± 0,9 cm, respectivamente; p < 0,001). El material obtenido permitió el diagnóstico en 53 pacientes (90%) y en 81 lesiones (91%), y el número de pases fue de 2 ± 1 por lesión. La sensibilidad, la especificidad, el valor predictivo positivo, el valor predictivo negativo y la precisión para el diagnóstico fueron del 81, el 100, el 100, el 75 y el 88%, respectivamente (el 88, el 100, el 100, el 80 y el 92% al analizarlos por paciente). Conclusiones: La USE-PAAF es una técnica eficaz en el estudio de la patología mediastínica. La probabilidad de malignidad es mayor cuanto mayor es el tamaño de la lesión

Objective: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is a safe and effective technique for the diagnosis of focal pancreatic lesions and enlarged abdominal lymph nodes. The aim of this study was to assess the usefulness of EUS-FNA in the diagnosis of mediastinal lesions. Patients and methods: A retrospective review was performed of all consecutive cases in which EUS-FNA was used for the diagnosis of a mediastinal lesion between January 2001 and September 2003. We used a radial echoendoscope to assess the characteristics of the lesion and a linear-array echoendoscope to perform transesophageal needle aspiration with a 22-gauge needle. Histopathology of the resected specimen was considered as the gold standard in surgically treated patients whereas cytology obtained by EUS-FNA was the gold standard when surgery was not indicated. Results: EUS-FNA was performed in 59 patients with a total of 89 lesions with mean (SD) dimensions of 2.4 (2.0) cm × 1.6 (1.4) cm. Malignant lesions were larger than benign ones (short axis, 2.7 [1.4] as compared with 1.0 [0.9] cm; P<.001). The diagnosis was obtained for 53 patients (90%) and 81 lesions (91%) with a mean of 2 (1) passes per lesion. The sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy of EUS-FNA were 81%, 100%, 100%, 75%, and 88%, respectively, when analyzed by lesion, and 88%, 100%, 100%, 80%, and 92% when analyzed by patient. Conclusions: EUS-FNA is an effective technique for the diagnosis of mediastinal lesions. The likelihood of malignancy increases with size

Ultrasonido pévico transabdominal en prepúberes y adolescentes: utilidad práctica / Ultrasonic pelvic transabdominal in prepuberes and adolescent: practice utilization

Determinar las medidas ultrasonográficas de útero y ovarios para construir tablas referenciales y establecer la importancia del ultrasonido pélvico transabdominal para evaluar genitales internos y corroborar el diagnóstico presuntivo de patologías pélvicas en niñas y adolescentes. Se estudiaron 685 pacientes entre 2 semanas y 19 años de edad. Los diámetros longitudinal, anteroposterior y transversal del útero y ovarios de 600 pacientes fueron utilizados para construir las tablas referenciales. Las restantes 85 pacientes se estudiaron por anormalidades del desarrollo sexual y genital, y crecimientos abdomino-pélvicos

Tres hermanas con insensibilidad periférica a los andrógenos / Three sisters with peripheral androgen insensitivity

El síndrome de insensibilidad periférica a los andrógenos constituye la primera causa de pseudohermafroditismo masculino. Tiene una incidencia de 1 en 20000 a 1 en 64000 recién nacidos masculinos, representa el 15-20 por ciento de los estados intersexuales y la tercera causa de amenorrea primaria. Se hereda en forma recesiva ligada al cromosoma X. El diagnóstico de un caso debe motivar la investigación de las hermanas y otros familiares de la paciente, ya que puede ser una entidad familiar. Se presentan los casos correspondientes a tres adolescentes, hermanas consanguíneas, con insensibilidad periférica a los andrógenos que acudieron a la consulta de ginecología infanto-juvenil del Hospital de Niños J.M. de los Ríos, se discute los resultados y se revisa la literatura