The Asociación Mexicana de Gastroenterología consensus on the diagnosis and treatment of acute pancreatitis in children and adolescents.

Acute pancreatitis (AP) and recurrent acute pancreatitis (RAP) are conditions, whose incidence is apparently on the rise. Despite the ever-increasing evidence regarding the management of AP in children and adults, therapeutic actions that could potentially affect having a poor prognosis in those patients, especially in the pediatric population, continue to be carried out. Therefore, the Asociación Mexicana de Gastroenterología convened a group of 24 expert pediatric gastroenterologists from different institutions and areas of Mexico, as well as 2 pediatric nutritionists and 2 specialists in pediatric surgery, to discuss different aspects of the epidemiology, diagnosis, and treatment of AP and RAP in the pediatric population. The aim of this document is to present the consensus results. Different AP topics were addressed by 6 working groups, each of which reviewed the information and formulated statements considered pertinent for each module, on themes involving recommendations and points of debate, concerning diagnostic or therapeutic approaches. All the statements were presented and discussed. They were then evaluated through a Delphi process, with electronic and anonymous voting, to determine the level of agreement on the statements. A total of 29 statements were formulated, all of which reached above 75% agreement in the first round of voting.

Bulk evidence of anisotropic s-wave pairing with no sign change in the kagome superconductor CsV3Sb5.

The recently discovered kagome superconductors AV3Sb5 (A = K, Rb, Cs) exhibit unusual charge-density-wave (CDW) orders with time-reversal and rotational symmetry breaking. One of the most crucial unresolved issues is identifying the symmetry of the superconductivity that develops inside the CDW phase. Theory predicts a variety of unconventional superconducting symmetries with sign-changing and chiral order parameters. Experimentally, however, superconducting phase information in AV3Sb5 is still lacking. Here we report the impurity effects in CsV3Sb5 using electron irradiation as a phase-sensitive probe of superconductivity. Our magnetic penetration depth measurements reveal that with increasing impurities, an anisotropic fully-gapped state changes to an isotropic full-gap state without passing through a nodal state. Furthermore, transport measurements under pressure show that the double superconducting dome in the pressure-temperature phase diagram survives against sufficient impurities. These results support that CsV3Sb5 is a non-chiral, anisotropic s-wave superconductor with no sign change both at ambient and under pressure.

Surface modification of TiO2/ZnO nanoparticles by organic acids with enhanced methylene blue and rhodamine B dye adsorption properties.

The United Nations Organization (UNO) has revealed that approximately 2.1 billion people do not have access to treated water. Methylene blue (MB) and rhodamine B are produced as water pollutants in textile, plastic, and dye industries. In this study, oxalic acid or lactic acid surface-modification were applied to TiO2/ZnO nanoparticles aiming to improve antibacterial and adsorption properties. The mixtures containing the corresponding acid and nanoparticles in 0.25 : 1/0.5 : 1 ratios of ZnO and TiO2 correspondingly were subjected to ultrasonic treatment with a catenoidal ultrasonic probe coupled to a homemade ultrasonic generator with an output power of 750 W, wave amplitude of 50% and variable frequency in the range of 15-50 kHz. To verify the influence of the ultrasonic treatment, different treatment times of 30, 45, 60, and 90 min were applied. Unmodified and modified TiO2/ZnO nanoparticles were characterized by FTIR, TGA, XRD, SEM, and XPS. From the results, obtained from the physicochemical characterization, in the ZTO90 and ZTL90 samples a greater modification was shown. The SEM images showed that a coating was present on the surface of the ceramic particles of the ZTL90 sample. The O 1s deconvolution in the XPS spectra indicates a greater presence of C[double bond, length as m-dash]O bonds in the ZTL90 sample. In parallel, the sample ZTL90 presented 85 and 89% adsorption efficiency for MB and rhodamine B dyes in a time of 12 min, and important antibacterial activity against E. coli and S. epidermis could be evidenced.

Consensus on the management of complications of cirrhosis of the liver in pediatrics.

The Asociación Mexicana de Hepatología A.C. carried out the Consensus on the Management of Complications of Cirrhosis of the Liver in Pediatrics to provide physicians with useful information for treating said complications. A group of pediatric gastroenterologists and experts in nutrition, nephrology, and infectious diseases participated and reviewed the medical literature. The Delphi method was applied to obtain the level of agreement on the statements that were formulated. The statements were sent to the participants to be analyzed and voted upon, after which they were discussed in virtual sessions, and the final versions were produced. The aim of the consensus results was to issue indications for the management of pediatric patients with liver cirrhosis, to prevent or control complications.

Quiste epidermoide en vallécula glosoepiglótica. Reporte de casos / Epidermoid cyst in the glossoepiglottic vallecula: case report

Resumen Los quistes laríngeos son muy infrecuentes y en su mayoría de etiología benigna. Se reportan dos casos de pacientes adultos que presentaron lesiones quísticas en vallécula glosoepiglótica con diagnóstico histológico de quiste epidermoide. Los quistes epidermoides en vallécula pocas veces han sido reportados en la literatura, pueden ser asintomáticos o por su localización producir síntomas como sensación de ocupación faríngea, tos o incluso dificultad respiratoria.

Abstract Laryngeal cysts are very infrequent and mostly benign. Two cases are presented of adult patients who presented cystic lesions in the glossoepiglottic vallecula with histological diagnosis of epidermoid cyst. Epidermoid cysts in vallecula have rarely been reported in the literature, they can be asymptomatic or due to their location produce symptoms such as pharyngeal occupation sensation, cough or even respiratory difficulty.

Dynamical ground state in the XY pyrochlore Yb2GaSbO7.

The magnetic ground state of the pyrochlore Yb2GaSbO7 has remained an enigma for nearly a decade. The persistent spin fluctuations observed by muon spin relaxation measurements at low temperatures have not been adequately explained for this material using existing theories for quantum magnetism. Here we report on the synthesis and characterisation of Yb2GaSbO7 to elucidate the central physics at play. Through DC and AC magnetic susceptibility, heat capacity, and neutron scattering experiments, we observe evidence for a dynamical ground state that makes Yb2GaSbO7 a promising candidate for disorder-induced spin-liquid or spin-singlet behaviour. This state is quite fragile, being tuned to a splayed ferromagnet in a modest magnetic field µ0Hc∼1.5T.

Supervivencia de pacientes con metástasis cervical de primario desconocido en el Instituto Nacional de Oncología y Radiobiología. 2007-2012

Resumen Introducción: Las metástasis cervicales con primario oculto representan el 5% de los tumores de cabeza y cuello. Su diagnóstico y tratamiento han sufrido modificaciones con los años según las diferentes investigaciones, con vistas a mayores tasas de supervivencia. Objetivo: Determinar la supervivencia global y según diferentes variables. Material y Método: Investigación retrospectiva, descriptiva y longitudinal de 96 pacientes diagnosticados en el Instituto Nacional de Oncología y Radiobiología (INOR) en el periodo 2007-2012, manteniéndose el seguimiento hasta el 31 de diciembre de 2017. Resultados: De los pacientes estudiados, 65 eran hombres (67,7%) y 31 mujeres (32,3%), para una razón de 2,1:1, con una media de edad de 61,4 años. El tabaquismo estuvo presente en el 64,6% de la población. El nivel ganglionar más afectado fue el II y 41 pacientes (42,7%) presentaron una enfermedad N1 al diagnóstico. En 42 pacientes (43,8%) estuvo presente el grado histológico poco diferenciado. Al 70,9% se les practicó cirugía con adyuvancia o sin ella y el 86,5% tuvo respuesta completa. El tumor primario apareció en el 13,5% de los casos, más frecuente en amígdala. La supervivencia global a los 5 años fue del 74% y resultaron variables determinantes de supervivencia el estado ganglionar y la extensión extraganglionar. Los resultados coinciden con la literatura revisada. Conclusión: La supervivencia global a los 5 años de los pacientes con metástasis cervical de primario oculto es elevada, tiene tendencia a mejorar con el paso de los años y está determinada por el estado ganglionar y la extensión extracapsular de forma inversamente proporcional.

Abstract Introduction: Cervical metastases with occult primary represent 5% of head and neck tumors. Its diagnosis and treatment have been modified over the years according to different investigations, with a view to higher survival rates. Aim: To determine the overall survival and according to different variables. Material and Method: A retrospective, descriptive and longitudinal investigation of 96 patients diagnosed at INOR in the period 2007-2012 was carried out, with follow-up until December 31, 2017. Results: Of the patients studied, 65 were men (67.7%) and 31 women (32.3%), for a ratio of 2.1: 1, with a mean age of 61.4 years. Smoking was present in the 64.6% of the population. The most affected lymph node level was level II and 42 patients (43.8%) presented N1 disease at diagnosis. Poorly differentiated histological grade was present in 42 patients (43.8%). 70.9% underwent surgery with or without adjuvant surgery and 86.5% had a complete response. The primary tumor appeared in 13.5% of cases, more frequent in the amygdala. Overall survival at 5 years was 74%, and survival variables were lymph node status and extranodal extension. The results coincide with the reviewed literature. Conclusion: The overall 5-year survival of patients with occult primary cervical metastasis is high, tends to improve over the years, and is determined by lymph node status and extracapsular extension in an inversely proportional manner.

Exploring factors associated with health disparities in asthma and poorly controlled asthma among school-aged children in the U.S.

Objective: Certain populations suffer disproportionately from asthma and asthma morbidity. The objective was to provide a national descriptive profile of asthma control and treatment patterns among school-aged children (SAC: aged 6-17) in the U.S. Methods: This was a cross-sectional analysis using the nationally representative 2007-2014 Medical Expenditure Panel Survey. Among SAC with asthma, indicators of poor control included: exacerbation/asthma attack; >3 canisters short-acting beta agonist (SABA)/3 months; and asthma-specific Emergency Department or inpatient visits (ED/IP). Results: Non-Hispanic black, non-Hispanic multiple races, Puerto Rican, obese, Medicaid, poor, ≥2 non-asthma chronic comorbidities (CC), and family average CC ≥ 2 were associated with higher odds of having asthma. The following had significantly higher odds ratios (OR) of excessive SABA use compared to non-Hispanic whites [OR; CI; p < 0.05]: Puerto Rican (3.8; 2.1-6.9), Mexican (3.6; 2.0-6.4), Central/South American (3.0; 1.2-7.7), Hispanic-other (3.1; 1.1-9.0), non-Hispanic black (2.5; 1.6-3.9), and non-Hispanic Asian (4.0; 1.7-9.2). SABA OR were also significant for Spanish spoken at home (2.5; 1.6-3.8), obese (2.1; 1.3-3.3), Medicaid (2.9; 2.0-4.1), no medical insurance (2.1; 1.1-4.1), no prescription insurance (2.5; 1.8-3.5), poor (2.8; 1.7-4.7), CC ≥ 2 (2.1; 1.6-2.8), parent-without high-school degree (2.5; 1.8-3.6), parent-SF-12 Physical Component Scale <50 (1.6; 1.2-2.1) and Mental Component Scale <50 (1.5; 1.1-2.0). Significant differences also existed across subgroups for ED/IP visits. Conclusions: There are disparities in asthma control and prevalence among certain populations in the U.S. These results provide national data on disparities in several indicators of poor asthma control beyond the standard race/ethnicity groupings.

Reproductive toxicity of the hydroethanolic extract of the flowers of Acmella oleracea and spilanthol in zebrafish: In vivo and in silico evaluation.

Hydroethanolic preparations of Acmella oleracea is used in the north of Brazil as a female aphrodisiac. Thus, the objective of this study was to evaluate the action of the hydroethanolic extract of Acmella oleracea (EHFAo) flowers (21.873 and 44.457 mg/kg) and spilanthol (3 mg/kg) administered orally on reproductive performance and effects on the embryonic development of zebrafish F1 generation. It was observed that in the groups in which males and females received EHFAo and spilanthol, the spawning was interrupted, whereas in the groups in which only the females were treated, spawning occurred during the 21 days. Thus, in the histopathological evaluation of the gonads, it was possible to observe that the percentage of mature cells in the spermatozoa and females was significantly reduced. Only the embryo groups in which parental generation was treated with EHFAo showed lethal and teratogenic effects. On the other hand, the parental groups treated with the spilanthol presented only the lethality. Spilanthol and some metabolites showed good oral availability and important toxicological properties. Thus, it is suggested that the treatment of parental generation of zebrafish with EHFAo and spilanthol caused severe changes in the gonads and on fertility. However, on the embryo, the most striking effects in the development were recorded in the groups in which the parental generation was treated with the EHFAo, while the spilanthol influenced the lethality of the embryos.

Molecular analysis of human- and pig-derived Ascaris in Honduras.

Ascaris sp. is a soil-transmitted helminth (STH) significantly affecting the health of human and swine populations. Health inequities and poverty, with resulting deficiencies in water, sanitation and hygiene, are directly associated with Ascaris lumbricoides prevalence in humans. Resource constraints also lead to small-scale livestock production under unsanitary conditions. Free-ranging pigs, for instance, are exposed to a number of infectious agents, among which Ascaris suum is one of the most common. Under these conditions, close proximity between people and pigs can result in cross-contamination; that is, pigs harbouring human Ascaris and vice versa. Moreover, the potential interbreeding between these two Ascaris species has been demonstrated. The present study analysed Ascaris worms obtained from children and pigs in Honduras. Adult worms were collected from stool samples of children after pharmacological treatment, and from pigs' intestines after slaughter for commercial purposes at a local abattoir. A nuclear ribosomal internal transcribed spacer (ITS) region was amplified by polymerase chain reaction (PCR) and digested with a restriction enzyme in order to separate putative human- and pig-derived Ascaris isolates. PCR products were also sequenced, and cladograms were constructed. All parasites isolated from children showed the typical human-derived genotype of Ascaris, whereas 91% of parasites from pigs showed the expected pig-derived genotype. Cross-infections between hosts were not demonstrated in this study. Nine per cent of pig-derived worms showed a restriction band pattern highly suggestive of a hybrid human-pig Ascaris genotype. These results contribute to the understanding of ascariasis epidemiology and its zoonotic potential in a highly endemic region.

Bioactividad y pruebas de hemólisis de compósitos de hidroxiapatita zirconia (HAp/ZrO2-8Y2O3) para implantes óseos / Bioactivity and hemolysis test of hydroxyapatite/zirconia composites (HAp/ZrO2-8Y2O3) for bone implants

Resumen Se presenta la síntesis de compósitos de hidroxiapatita/zirconia (HAp/ZrO2-8Y2O3) por el método de mezclado líquido en base al método de Pechini, cuya innovación radica en la obtención simultánea de ambas fases con distribución uniforme, aunque tiene la limitante de la interacción de los cationes, propiciando la formación de fases secundarias si no se controlan las variables. Los materiales fueron conformados en discos de 1 cm de diámetro y tratados a 1400 °C, para caracterizarse por espectrometría de infrarrojo (FTIR-ATR) y difracción de rayos X (DRX). Las pruebas de bioactividad fueron realizadas mediante el método de inmersión en fluidos fisiológicos simulados durante 21 días y caracterizadas por microscopia electrónica de barrido (MEB) y espectrometría de fotoelectrones emitidos por rayos X (XPS). Las pruebas de hemólisis se basaron en la norma ASTM F 756-00. Después de la inmersión, se observó la presencia de cristales de hidroxiapatita sobre la superficie del compósito, además los análisis de XPS muestran señales de energía para los elementos de calcio y fósforo. En cuanto a las pruebas de hemólisis se observaron grados de citotoxicidad por debajo del 3% con lo cual se infiere que son hemocompatibles, aunque se requieren más estudios de biocompatibilidad para su aplicación biomédica.

Abstract The synthesis of hydroxyapatite/zirconia composites (HAp/ZrO2-8Y2O3) is presented, using the liquid mixing method based on the Pechini method, whose innovation lies in the simultaneous synthesis of both phases with uniform distribution, although it has the limitation of the cations interactions, favoring the formation of secondary phases if the variables are not controlled. The obtained materials were formed into discs of 1 cm in diameter and treated at 1400 °C, and then characterized by infrared spectrometry (FTIR-ATR) and X-ray diffraction (XRD). The bioactivity tests were carried by the immersion method in simulated body fluid for 21 days and characterized by scanning electron microscopy (SEM) and X-ray photoelectron spectrometry (XPS). The hemolysis tests were based on the ASTM F 756-00 standard. After the immersion, the presence of hydroxyapatite crystals on the surface of the composite was observed; in addition, the XPS analyzes show energy signals for the elements of calcium and phosphorus. Regarding the hemolysis tests, degrees of cytotoxicity were observed below 3%, it is inferred that they are hemocompatible, although more biocompatibility studies are required for biomedical application.

Effects of transcranial direct current stimulation on working memory and negative symptoms in schizophrenia: a phase II randomized sham-controlled trial.

BACKGROUND: The lack of efficacy of pharmacological treatments for cognitive and negative symptoms in schizophrenia highlights the need for new interventions. We investigated the effects of tDCS on working memory and negative symptoms in patients with schizophrenia. METHOD: Double-blinded, randomized, sham-controlled clinical trial, investigating the effects of 10 sessions of tDCS in schizophrenia subjects. Stimulation used 2 mA, for 20 min, with electrodes of 25 cm2 wrapped in cotton material soaked in saline solution. Anode was positioned over the left DLPFC and the cathode in the contralateral area. Twenty-four participants were assessed at baseline, after intervention and in a three-months follow-up. The primary outcome was the working memory score from MATRICS and the secondary outcome the negative score from PANSS. Data were analyzed using generalized estimating equations. RESULTS: We did not find group ∗ time interaction for the working memory (p = 0.720) score or any other cognitive variable (p > 0.05). We found a significant group ∗ time interaction for PANSS negative (p < 0.001, d = 0.23, CI.95 = -0.59-1.02), general (p = 0.011) and total scores (p < 0.001). Exploratory analysis of PANSS 5 factors suggests tDCS effect on PANSS negative (p = 0.012), cognitive (p = 0.016) and depression factors (p = 0.029). CONCLUSION: The results from this trial highlight the therapeutic effects of tDCS for treatment of persistent symptoms in schizophrenia, with reduction of negative symptoms. We were not able to confirm the superiority of active tDCS over sham to improve working memory performance. Larger sample size studies are needed to confirm these findings.

Mortalidad hospitalaria de pacientes nonagenarios en Medicina Interna / Mortality hospital of nonagenarian patients in Internal Medicine

Objetivos. Describir los factores predictivos de mortalidad hospitalaria en pacientes nonagenarios. Pacientes y método. Se estudió retrospectivamente a 421 pacientes ≥ 90 años ingresados en un servicio de Medicina Interna. Se analizó mediante regresión logística la asociación de parámetros demográficos, clínicos y funcionales con la mortalidad intrahospitalaria. Resultados. La edad media (DE) fue de 92,5 años (2,5), con 265 (62,9%) mujeres. Los principales diagnósticos fueron enfermedades infecciosas (257 pacientes, 61%) e insuficiencia cardiaca (183, 43,5%), y la estancia media fue de 11,9 días (8,6). Durante el ingreso fallecieron 96 pacientes (22,8%). Los factores predictivos de mortalidad fueron la edad (p = 0,002), el estado funcional (p = 0,006), la comorbilidad (p = 0,018) y los diagnósticos de neumonía (p = 0,001), sepsis (p = 0,012) e insuficiencia respiratoria (p < 0,001). Conclusión. La mortalidad hospitalaria de pacientes nonagenarios atendidos en Medicina Interna supera el 20% y se asocia a neumonía, carga de comorbilidad y deterioro funcional (AU)

Objectives. To describe the predictors of hospital mortality in nonagenarian patients. Patients and method. We retrospectively studied 421 patients aged 90 years or older hospitalised in a department of internal medicine. Using logistic regression, we analysed the association between demographic, clinical and functional parameters and hospital mortality. Results. The mean age was 92.5 years (SD±2.5), and 265 (62.9%) of the patients were women. The main diagnoses were infectious diseases (257 patients, 61%) and heart failure (183, 43.5%), and the mean stay was 11.9 days (SD±8.6). During the hospitalisation, 96 patients died (22.8%). The predictors of mortality were age (P=.002), functional state (P=.006), comorbidity (P=.018) and diagnoses of pneumonia (P=.001), sepsis (P=.012) and respiratory failure (P<.001). Conclusion. The hospital mortality of nonagenarian patients treated in internal medicine exceeds 20% and is associated with pneumonia, comorbidity burden and functional impairment (AU)

Safety and efficacy of small bowel polypectomy using a balloon-assisted enteroscope in pediatric patients with Peutz-Jeghers syndrome. / Seguridad y eficacia de la polipectomía en intestino delgado utilizando enteroscopio asistido por balones en pacientes pediátricos con síndrome de Peutz-Jeghers.

INTRODUCTION AND AIMS: Peutz-Jeghers syndrome is an autosomal dominant inherited pathology characterized by gastrointestinal hamartomatous polyps, predominantly in the small bowel, and pigmented mucocutaneous lesions. Guidelines suggest polypectomy with a balloon-assisted enteroscope when polyps are larger than 10mm. Complications in adults can be as high as 6.8%, but there is little information on pediatric populations. Our aim was to describe the safety and efficacy of polypectomy in a group of pediatric patients with Peutz-Jeghers syndrome using balloon-assisted enteroscopy. MATERIALS AND METHODS: A retrospective study was conducted at the Hospital de Especialidades del Centro Médico Nacional Siglo XXI on pediatric patients with Peutz-Jeghers syndrome that required balloon-assisted enteroscopy and polypectomy within the time frame of January 2010 and December 2015. Patients that underwent polypectomy with a push enteroscope were excluded from the study. RESULTS: A total of 35 polypectomies were performed on 4 patients (female/male: 3/1). The mean age of the patients was 13.7 years (range:11-16). Twelve enteroscopies were carried out, 8 of which were anterograde. A single-balloon enteroscope was used in 7 procedures and a double-balloon enteroscope in 5. The mean size of the polyps was 1.6cm (range: 1-4cm). A major complication (acute pancreatitis) presented in only one case (8.3%). No other major complications associated with the procedures were observed. CONCLUSION: Balloon-assisted enteroscopy with polypectomy in children is a safe and effective procedure, with complications similar to those reported in adults.

Hemoencephalography self-regulation training and its impact on cognition: A study with schizophrenia and healthy participants.

BACKGROUND: Cognitive impairments in schizophrenia are strongly correlated to functional outcome and recovery rates, with no pharmacological agent approved for its treatment. Neurofeedback has emerged as a non-pharmacological approach to enhance neuroplasticity, which consists in inducing voluntary control of brain responses through operant conditioning. METHOD: The effects of hemoencephalography neurofeedback (HEG-NFBK) in 4 brain sites (F7, Fp1, Fp2 and F8) was studied in 8 patients with schizophrenia (SCH, mean age 36.5±9.98) and 12 health controls (mean age 32.17±5.6). We analyzed groups' performance (10 sessions) and cognitive differences in 3 time points (baseline, after training and follow-up) with generalized estimated equations. For SCH we also evaluate the impact on psychopathology. RESULTS: We found a group∗time interaction for HEG-NFBK performance in the left hemisphere sites (F7 an Fp1) and a near-to-significant in the right frontotemporal region (F8), with no group differences and a significant time effect. Most of cognitive domains improved after intervention, including information processing speed, attention processing, working memory, executive functioning, verbal and visual learning. No group∗time interaction was found. Results suggest that both groups benefit from HEG-NFBK training regardless of cognitive differences at baseline. No significant time effects were found for Calgary and PANSS total scale and subscales (positive, negative neither general). CONCLUSION: To our knowledge, this is the first controlled trial showing effects of NFBK on cognitive performance improvement in schizophrenia. Further research investigating the effects of HEG-NFBK training in schizophrenia should be performed.

The national burden of poorly controlled asthma, school absence and parental work loss among school-aged children in the United States.

OBJECTIVE: The degree of poorly controlled asthma and its association with missed school days and parental missed work days is not well understood. METHODS: This was a retrospective analysis of missed school days and missed work days for school-aged children (SAC; aged 6-17) and their caregivers in the nationally representative 2007-2013 Medical Expenditure Panel Survey (MEPS). Indicators of poor asthma control included: exacerbation in previous 12 months; use of >3 canisters of short-acting beta agonist (SABA) in 3 months; and annual asthma-specific (AS) Emergency Department (ED) or inpatient (IP) visits. Negative binomial regression was used for missed school days, and a Heckman two-step selection model was used for missed work days. All analyses controlled for sociodemographics and other covariates. RESULTS: There were 44,320 SAC in MEPS, of whom 5,890 had asthma. SAC with asthma and an indicator of poor control missed more school days than SAC without asthma: exacerbation (1.8 times more; p < 0.001); >3 canisters SABA (2.7 times more; p < 0.001) and ED/IP visit (3.8 times more; p < 0.001). The parents/caregivers of SAC with asthma and an exacerbation missed 1.2 times more work days (p < 0.05), while those with SAC with asthma and an ED/IP visit missed 1.8 times more work days (p < 0.01) than the parents of SAC without asthma. CONCLUSIONS: This study provides evidence of the significant national burden of poorly controlled asthma due to missed school and work days in the United States. More effective and creative asthma management strategies, with collaboration across clinical, community and school-based outreach, may help address this burden.

Mortality hospital of nonagenarian patients in Internal Medicine. / Mortalidad hospitalaria de pacientes nonagenarios en Medicina Interna.

OBJECTIVES: To describe the predictors of hospital mortality in nonagenarian patients. PATIENTS AND METHOD: We retrospectively studied 421 patients aged 90 years or older hospitalised in a department of internal medicine. Using logistic regression, we analysed the association between demographic, clinical and functional parameters and hospital mortality. RESULTS: The mean age was 92.5 years (SD±2.5), and 265 (62.9%) of the patients were women. The main diagnoses were infectious diseases (257 patients, 61%) and heart failure (183, 43.5%), and the mean stay was 11.9 days (SD±8.6). During the hospitalisation, 96 patients died (22.8%). The predictors of mortality were age (P=.002), functional state (P=.006), comorbidity (P=.018) and diagnoses of pneumonia (P=.001), sepsis (P=.012) and respiratory failure (P<.001). CONCLUSION: The hospital mortality of nonagenarian patients treated in internal medicine exceeds 20% and is associated with pneumonia, comorbidity burden and functional impairment.

Enfermedad de Crohn ileal. Reporte de un caso / Ileal Crohn's Disease. A case report

El término Enfermedad Inflamatoria Intestinal (EII) incluye a un grupo de entidades clínicas que se caracterizan por ser procesos inflamatorios crónicos de etiología desconocida, y afectar primordialmente, aunque no de forma exclusiva, al intestino. Actualmente se reconocen varias entidades que se engloban en este concepto: Colitis Ulcerosa (CU), Enfermedad de Crohn (EC), Colitis Inclasificada (CI), Colitis Microscópica (CM) y Reservoritis (Pouchitis). La Enfermedad de Crohn puede afectar a cualquier tramo del intestino, siendo la localización más frecuente la Ileal y Colónica en forma simultánea. El proceso inflamatorio en la EC es transmural y sus síntomas fundamentales son la diarrea generalmente crónica y/o el dolor abdominal. Presentamos el caso de una mujer joven con una EC que compromete exclusivamente al ileon terminal, en la que se realizó el diagnóstico de EC ileal por la clínica, la endoscopía y la anatomía patológica, que respondió satisfactoriamente a la terapéutica instaurada, y se revisa el concepto de la EC con énfasis en su diagnóstico.

The term Inflammatory Bowel Disease (IBD) includes a group of clinical entities that are characterized by chronic inflammatory processes of unknown etiology, and primarily, but not exclusively, affecting the intestine. Currently, several entities are included in this concept: Ulcerative Colitis (UC), Crohn's Disease (CD), Unclassified Colitis (UC), Microscopic Colitis (CM) and Reservoritis (Pouchitis). Crohn's Disease can affect any part of the intestine, with the most frequent location being ileal and colonic simultaneously. The inflammatory process in CD is transmural and its fundamental symptoms are usually chronic diarrhea and/or abdominal pain. We present the case of a young woman with a CD that exclusively compromises the terminal Ileon, in whom the diagnosis of ileal CD was performed with the clinical data, the endoscopic procedure and the pathological study, who responded satisfactorily to the established therapy, and the concept of CD with an emphasis on its diagnosis is reviewed.

Señales de alarma precoces del trastorno del espectro autista en personas con síndrome de Down / Early warning signs of autism spectrum disorder in people with Down syndrome

Introducción. En la población general, el diagnóstico de trastornos del espectro autista (TEA) se realiza generalmente en una etapa temprana, mejorándose así el pronóstico. En las personas con síndrome de Down (SD), la falta de instrumentos específicos y adaptados para el diagnóstico, y la falta de experiencia de los profesionales, hace que el diagnóstico de TEA suela pasar desapercibido. Objetivo. Identificar señales de alarma «tempranas» de un posible diagnóstico de TEA en niños con SD en los primeros años de vida (de 0 a 4 años). Métodos. Estudio retrospectivo de cohortes: niños con SD y TEA (SD-TEA) y niños con SD y sin TEA (SD-noTEA) emparejados por sexo y edad. Se identificaron las siguientes señales de alarma tempranas: 1) ausencia de sonrisa social; 2) falta atención compartida; 3) falta de búsqueda de consuelo/protección; 4) ausencia de queja; 5) poco interés por el otro; 6) no señala; 7) no imita; 8) ausencia de balbuceo, vocalización; 9) expresión facial inapropiada; 10) rituales verbales o acciones repetitivas; 11) manierismos manos/dedos; 12) estereotipias; 13) interés sensorial, y 14) no integración de la mirada y la conducta. Seis investigadores, quienes no participaron en la identificación de las señales de alarma tempranas, seleccionaron aquellas que orientarían a un diagnóstico de TEA (análisis cualitativo). Se solicitó a los padres videos de las personas con SD en «actividad» entre los 0 y 4 años. Los mismos investigadores, cegados al diagnóstico de TEA y tras visualizar los videos, puntuaron las señales de alarma tempranas en 3 categorías: presencia/ausencia/no evaluable (análisis cuantitativo). Resultados. Durante el año 2013, se obtuvieron 12 videos de 12 personas con SD: 6 del grupo SD-TEA y 6 del grupo SD-noTEA. El análisis cualitativo identificó como señales de alarma temprana relacionadas con el diagnóstico de TEA: «no integración de la mirada», «no imita», «rituales verbales o acciones repetitivas» y «estereotipias»; y el análisis cuantitativo identificó: «falta de atención compartida» y «falta de interés por el otro». Conclusión. Ciertas «señales de alarma» pueden orientar hacia un diagnóstico de TEA en los primeros años de vida en niños con SD (AU)

Introduction. In general population, the current trend is to make the diagnosis of Autism Spectrum Disorders (ASD) at an early stage, which it is crucial to improve the prognosis. In contrast, in Down syndrome (DS) population, the ASD diagnosis is frequently delayed, having negative consequences on the overall development of the children who suffer. Objective. To identify «early warning signals» for the detection of the ASD in DS in the first years of life (0 to 4 years). Methods. Retrospective cohort study: SD with an ASD diagnosis (SD-ASD) and healthy-DS (SD-noASD) matched by sex and age. Early warning signals were identified and selected from different questionnaires for ASD of general population: 1. Lack of social smile; 2. Shared care foul; 3. Lack of finding comfort/protection; 4. Lack of complaint; 5. Little interest for the others; 6. No pointing; 7. Non-imitation; 8. Lack of babbling/vocalization; 9. Inappropriate facial expression; 10. Presence of rituals as repetitive actions or repetitive sentences; 11. Mannerisms hands/fingers; 12. Stereotypes; 13. Lack of interest sensory; and 14. Non-integration of the look. Six investigators, who did not participate in the identification of the «early warning signals», selected those that would guide a diagnosis of ASD (qualitative analysis). Parents were asked for videos of people with DS in «activity» between 0 and 4 years. The same investigators, blinded to the diagnosis of ASD and after watching the videos, scored the «early warning signals» in three categories: presence / absence / non-evaluable (quantitative analysis). Results. During the year 2013, 12 videos of 12 people with SD were obtained: 6 from SD-ASD group and 6 from the SD-noASD group. The qualitative analysis identified as early warning signals related to the diagnosis of ASD: «non-integration of the look», «non-imitation», «presence of rituals as repetitive actions or repetitive sentences» and «stereotypies», and the quantitative analysis: «shared care foul» and «little interest for the others». Conclusion. Certain «warning signals» may lead to a diagnosis of ASD in the first years of life in children with DS (AU)

Positive impact of omalizumab on angioedema and quality of life in patients with refractory chronic idiopathic/spontaneous urticaria: analyses according to the presence or absence of angioedema.

BACKGROUND: Approximately 50% of patients with chronic idiopathic/spontaneous urticaria (CIU/CSU) report hives and angioedema; some experience hives/angioedema only. OBJECTIVE: Assess omalizumab's effect on angioedema and quality of life (QoL) in subgroups with refractory CIU/CSU: those with and without angioedema. METHODS: Patients received omalizumab (75, 150 or 300 mg) or placebo every 4 weeks for 12/24 weeks. Angioedema and QoL were assessed [Urticaria Patient Daily Diary and Dermatology Quality of Life Index (DLQI)]. Subgroups were based on the presence/absence of baseline angioedema 7 days prior to randomization. RESULTS: Patients with baseline angioedema randomized to omalizumab 300 mg had a greater reduction in mean weekly incidence of angioedema and mean number of days/week with angioedema vs. placebo at 12 and 24 weeks. A 3.3- to 4.5-point greater mean reduction in DLQI score was achieved with omalizumab 300 mg treatment vs. placebo, above the minimal clinically important difference threshold. Results with lower doses vs. placebo were variable. CONCLUSION: Compared with placebo, omalizumab 300 mg treatment over 12-24 weeks resulted in marked reduction in incidence and number of days/week with angioedema accompanied by clinically relevant improvement in QoL.