Prevalence of Gallstones in Ulcerative Colitis and Crohn's Disease: A Systematic Review and Meta-Analysis.

The meta-analysis aimed to investigate the prevalence of gallstones (GS) in Inflammatory bowel disease (IBD), especially ulcerative colitis (UC). A systematic and thorough search was conducted on online electronic databases (PubMed/Medline, Cochrane Library, and Google Scholar) from the databases' inception to April 30th, 2022. Review Manager 5.4.1 (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen) was used for all statistical analyses and forest plots. Only studies that met inclusion criteria were selected. The selected studies were pooled using a random-effect model and the results were reported in the odds ratio (OR) with their corresponding 95% confidence interval (CI). Ten studies met the final inclusion criteria and were analyzed. Patients with UC had significantly higher prevalence of GS than those in the control group (OR=1.67 [1.32-2.11]; p < 0.0001; I2=58%). There was also significant prevalence of GS in Crohn's disease (CD) than those in control group (OR=2.22 [1.82, 2.69]; p < 0.00001; I2=31%). Analysis also showed the prevalence of GS in studies conducted in Asia (OR=2.00 [1.48, 2.70]; p < 0.00001; I2=80%) and Europe (OR= 1.84 [1.32, 2.55]; p = 0.0003; I2=45%) compared to the control group. This study provided a conclusive answer to whether GS is significant in UC or not. Our meta-analysis provides a well-powered estimate that there is a prevalence of GS in UC. CD is also significantly associated with GS.

New-Onset Insulin Allergy After COVID-19 Infection in an Insulin-Dependent Type-2 Diabetic Patient: A Rare Complication.

Coronavirus disease 2019 (COVID-19) is an infectious respiratory disease caused by the novel coronavirus severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Initially, it was reported in December 2019 and became a global pandemic in March 2020, with many presentations and after-effects. We report the case of a 68-year-old female patient who presented to the emergency room with the chief complaint of a skin rash and itching all over her body, developing within a few minutes of insulin injection. The patient had tested positive for COVID-19 almost eight days ago and was self-quarantined. She was a known diabetic for the past 28 years. Her blood glucose levels were maintained within the normal range by a combination regimen of oral anti-diabetic drugs and subcutaneous humulin 70/30 (70% neutral protamine Hagedorn (NPH) insulin and 30% regular human insulin) injections. After careful examination and thorough history taking, a newly acquired insulin allergy was diagnosed in the patient, attributed to her disrupted immune system due to the recent COVID-19 infection.

Recurrent Episodes of Paroxysmal Supraventricular Tachycardia Triggered by Dyspepsia: A Rare Case of Gastrocardiac Syndrome.

Supraventricular tachycardia (SVT) refers to the narrow complex tachycardia originating at or above the bundle of His. Several risk factors are associated with the development and recurrence of SVT, but its association with gastric problems, especially dyspepsia, is relatively rare. We report the case of a 54-year-old female who presented to the emergency room (ER) with palpitations, which were diagnosed as an episode of paroxysmal supraventricular tachycardia (PSVT). She had a history of PSVT in the past, along with hypertension and dyspepsia. After thorough history and examination, dyspepsia was identified as the common trigger of her PSVT episodes, pointing towards the likelihood of gastrocardiac symptoms. Therefore, an appropriate regimen of beta-blockers, proton pump inhibitors (PPIs), and anti-foaming agents (simethicone) was prescribed to manage her symptoms with the plan to perform a catheter ablation later.

Oral Isotretinoin Resulting in Recurrence of LASIK-Treated Myopia: A Rare Side Effect.

Isotretinoin is an analog of vitamin A, used to treat severe, recalcitrant nodular acne, psoriasis and disorders of keratinization. However, its benefits come with a broad range of serious side effects, including ocular adverse effects. We report and describe a rare case of bilateral myopia in a female patient treated with oral isotretinoin for acne vulgaris. A female patient, 29-year old, presented to the office for blurry vision. The patient was treated with oral isotretinoin for four weeks. She had a past medical history of myopia precisely corrected with laser-assisted in situ keratomileusis without any residual refractive error. After a thorough examination and laboratory workup, isotretinoin was thought to be the causative agent of her current complaint, so it was immediately stopped. The follow-up showed no further decrement of visual acuity in the patient. However, the vision loss acquired as an adverse effect of oral isotretinoin persisted.

[Parents separation or divorce. Potential effects on children and recommendations to parents and pediatricians]. / Separación o divorcio de los padres. Consecuencias en los hijos y recomendaciones a los padres y pediatras.

When divorce or separation of a couple occurs, children will no longer live with both parents at the same time. There may be multiple causes for divorce, and both literature and our own experien ce as child mental health providers, report some short- and long-term consequences for children, especially where the divorce has been conflictive. In these cases, increased risk of developing be havioral disorders, poor school performance, and substance abuse has been documented as well as consequences in adult life with higher risk of psychiatric pathologies or difficulties in interpersonal relationships, if an intervention that addresses some potentially traumatic situations for children is not done. Pediatricians are in a privileged relationship with children and their families in order to detect signs of parental discord and altered mental health in children. Children behaviors as a result of divorce and parental conflict will depend on the age of the child and stage of development, and it is important to recognize them in order to intervene properly. This article proposes some guidelines for parents. Good management of high conflict situations related to divorce may prevent some of the consequences that these can have on children.

Separación o divorcio de los padres: consecuencias en los hijos y recomendaciones a los padres y pediatras / Parents separation or divorce: potential effects on children and recommendations to parents and pediatricians

El divorcio o separación de una pareja con hijos pone fin a la convivencia de ambos padres en con junto con sus hijos. Puede haber múltiples causas para un divorcio y tanto la literatura como la ex periencia de los autores trabajando con familias en esta situación, dan cuenta de algunas consecuen cias a corto y largo plazo para los niños, especialmente en aquellos casos en que el divorcio ha sido conflictivo. En estos casos, se ha observado mayor riesgo de presentar trastornos de conducta, bajo rendimiento escolar y abuso de sustancias. Por otra parte puede tener consecuencias en la vida adulta, presentando mayor riesgo de patologías psiquiátricas o dificultades en las relaciones interpersonales si no se realiza una intervención que aborde algunas situaciones potencialmente traumáticas para los niños. Los pediatras se encuentran en una relación privilegiada con respecto a los niños y sus familias para detectar signos de discordia parental y alteración de la salud mental infantil. Las conductas que se manifiesten en los niños a consecuencia del divorcio y el conflicto parental van a depender de la edad y etapa de desarrollo del niño, siendo importante reconocerlas para poder intervenir de forma adecuada. El presente artículo propone directrices para guiar a los padres, ya que con un adecuado manejo de las situaciones de conflicto que ocurren alrededor del divorcio es posible prevenir algunas de las consecuencias que éste puede tener en los hijos.

When divorce or separation of a couple occurs, children will no longer live with both parents at the same time. There may be multiple causes for divorce, and both literature and our own experien ce as child mental health providers, report some short- and long-term consequences for children, especially where the divorce has been conflictive. In these cases, increased risk of developing be havioral disorders, poor school performance, and substance abuse has been documented as well as consequences in adult life with higher risk of psychiatric pathologies or difficulties in interpersonal relationships, if an intervention that addresses some potentially traumatic situations for children is not done. Pediatricians are in a privileged relationship with children and their families in order to detect signs of parental discord and altered mental health in children. Children behaviors as a result of divorce and parental conflict will depend on the age of the child and stage of development, and it is important to recognize them in order to intervene properly. This article proposes some guidelines for parents. Good management of high conflict situations related to divorce may prevent some of the consequences that these can have on children.

Validation of 1-year predictive score of long-term response to interferon-ß in everyday clinical practice multiple sclerosis patients.

BACKGROUND AND PURPOSE: The Rio score (RS) and the modified Rio score (MRS) are two scoring systems that can identify the early predictive factors of disability progression in relapsing-remitting multiple sclerosis (RRMS) patients treated with interferon-ß (IFN-ß). The objective of the study was to validate the usefulness of the RS and MRS in a large cohort of multiple sclerosis patients treated with IFN-ß in daily clinical practice. METHODS: The analysis included a cohort of RRMS patients treated with different formulations of IFN-ß for at least 1 year. The RS and MRS were used to classify the patients after 1 year of treatment. Multivariate analysis was performed to identify predictive variables of suboptimal response at 5 years, defined as Expanded Disability Status Scale confirmed progression or switching to a second-line therapy. RESULTS: Sixty-nine of 416 included patients were considered as suboptimal responders at 5-year evaluation. The possible score range was 0-3. A higher risk of suboptimal response was found for RS and MRS in the presence of ≥2 scores (hazard ratio 3.0, P = 0.002, and hazard ratio 5.0, P < 0.0001, respectively). CONCLUSIONS: Our study confirmed, in a daily clinical setting, that MRS had a better specificity and accuracy than RS in identifying the patients who will have a poor response to long-term IFN-ß treatment.

Use of observation followed by outpatient stress testing in chest pain patients with prior coronary artery disease history: An evaluation of prognostic utility.

OBJECTIVE: To determine the outcomes of patients with chest pain (CP) and prior history of coronary artery disease (CAD) managed with observation followed by outpatient stress myocardial perfusion imaging (MPI). METHODS: Retrospective analysis of patients with CP managed with observation followed by outpatient stress MPI, comparing cardiovascular (CV) event rates stratified by CAD history. RESULTS: 375 patients were included: 111 with and 264 without a CAD history. All patients underwent outpatient stress MPI within 72 h of observation. MPI identified patients at risk for CV events. However, while patients with negative MPI and without a CAD history had very low rates of short- and long-term CAD events (0.8%, 0.8%, and 1.3% at 30 days, 1 year, and 3 years, respectively), event rates of those with a negative test but a CAD history were significantly higher (2.6%, 5.3%, and 6.6% at 30 days, 1 year and 3 years, respectively; p = 0.044 and p = 0.034 compared to CAD- patients at 1 year and 3 years, respectively). In a multivariable logistic regression model, a positive MPI proved to be an independent predictor of long-term CV events in patients with CP and prior CAD. CONCLUSION: Observation followed by stress MPI can effectively risk stratify CP patients with prior CAD for CV risk. These patients are at increased risk of CV events even after a low-risk stress MPI study. Patients presenting with CP and managed with a strategy of observation followed by a negative stress MPI warrant close short- and long-term monitoring for recurrent events.

Amoxicillin and clavulanic acid vs ceftazidime in the surgical extraction of impacted third molar: a comparative study.

The objective of this work is to compare the effectiveness and the side effects of two different drugs, amoxicillin and clavulanic acid vs ceftazidime, used as antibiotic prophylaxis in the surgical extraction of third molars and to demonstrate that the use of second choice antibiotic has no significant advantages in comparison with a first choice antibiotic. One hundred and seven patients with impacted third molar were selected and divided into two groups: amoxicillin and clavulanic acid were administered to group 1 and ceftazidime to group 2 for five days after surgery and we observed the postoperative period. The statistical analysis showed no differences between the two groups which lead to the conclusion that there is no indication to routinely administrate intramuscular second-choice antibiotic prophylatic therapy (ceftazidime) in case of surgical extraction of the third molar.

Síndrome de alienación parental / Parental alienation syndrome

Parental Alienation Syndrome is characterized by the presence of a campaign of denigration towards a previously loved parent, which is done by instigating unjustified fear and hatred in the course of a divorce custody battle. In this campaign one parent instills resentment in the child, and is successful when the child itself directly shuns the accused parent. The resentment in the child extends towards the family of the accused parent. The syndrome arises in the absence of actual abuse, which would justify the child's rejection. Pediatricians have access to their patients' family crisis and are in a special stance to acknowledge it. The parental alienation syndrome is a form of emotional child abuse and both psychological assessment and multidisciplinary intervention are required to stop it. In this article we provide an update on parental alienation syndrome and was motivated by the authors' intervention in clinical cases where this diagnosis was posed.

El Síndrome de Alienación Parental se caracteriza por la presencia de una campaña de denigración hacia un progenitor previamente querido por el niño, la que se inicia instigando temor y animadversión injustificadas y que suele producirse durante el litigio por la custodia del niño en un proceso de divorcio. En esta campaña habitualmente participa un progenitor que instiga el resentimiento y que culmina cuando el niño rechaza abiertamente al progenitor acusado, haciendo suyas las descalificaciones esgrimidas en su contra. Este síndrome se produce en ausencia de maltrato físico o abuso, en cuyo caso el rechazo del niño es justificado. Los pediatras tienen acceso a las crisis por las que atraviesan las familias de sus pacientes y están en condiciones de detectar y reconocer a tiempo una situación de esta naturaleza. El síndrome de alienación parental es una forma grave de maltrato psicológico y requiere de una intervención multidisciplinaria para detenerlo. En el presente artículo se presenta una actualización del síndrome de alienación parental basado en la experiencia de los autores en casos clínicos en los cuales se propuso este diagnóstico.

A new cross-correlation algorithm for the analysis of "in vitro" neuronal network activity aimed at pharmacological studies.

Modern drug discovery for Central Nervous System pathologies has recently focused its attention to in vitro neuronal networks as models for the study of neuronal activities. Micro Electrode Arrays (MEAs), a widely recognized tool for pharmacological investigations, enable the simultaneous study of the spiking activity of discrete regions of a neuronal culture, providing an insight into the dynamics of networks. Taking advantage of MEAs features and making the most of the cross-correlation analysis to assess internal parameters of a neuronal system, we provide an efficient method for the evaluation of comprehensive neuronal network activity. We developed an intra network burst correlation algorithm, we evaluated its sensitivity and we explored its potential use in pharmacological studies. Our results demonstrate the high sensitivity of this algorithm and the efficacy of this methodology in pharmacological dose-response studies, with the advantage of analyzing the effect of drugs on the comprehensive correlative properties of integrated neuronal networks.

Alteration of the nuclear pore complex in Ca(2+)-mediated cell death.

Cell death requires coordinated intracellular signalling before disassembly of cell architecture by degradative enzymes. Although the death signalling cascades that involve the mitochondria, the ER and the plasma membrane have been extensively characterized, only a handful of studies have examined the functional and structural alterations of the nuclear pore complex (NPC) during neuronal death. Here, we show that during excitotoxic neuronal degeneration calpains redistributed across the nuclear envelope and mediated the degradation of NPC components causing altered permeability of the nuclear membrane. In primary dissociated neurons, simultaneous recording of cytosolic [Ca(2+)] and localization of fluorescent proteins showed that the onset of Ca(2+) overload signalled a progressive increase in the diffusion of small reporter molecules across the nuclear envelope. Later, calpain-mediated changes in nuclear pore permeability allowed accumulation of large proteins in the nucleus. Further, in a model of excitotoxic neuronal degeneration in Caenorhabditis elegans, we found similar nuclear changes and redistribution of fluorescent probes across the nuclear membrane in dying neurons. Our findings strongly suggest that increased leakiness of the nuclear barrier affects nucleocytoplasmic transport, alters the localization of proteins across the nuclear envelope and it is likely to be involved in Ca(2+)-dependent cell death, including ischemic neuronal demise.

Cell signaling pathways in the mechanisms of neuroprotection afforded by bergamot essential oil against NMDA-induced cell death in vitro.

BACKGROUND AND PURPOSE: The effects of bergamot essential oil (BEO; Citrus bergamia, Risso) on excitotoxic neuronal damage was investigated in vitro. EXPERIMENTAL APPROACH: The study was performed in human SH-SY5Y neuroblastoma cells exposed to N-methyl-D-aspartate (NMDA). Cell viability was measured by dye exclusion. Reactive oxygen species (ROS) and caspase-3 activity were measured fluorimetrically. Calpain I activity and the activation (phosphorylation) of Akt and glycogen synthase kinase-3beta (GSK-3beta) were assayed by Western blotting. KEY RESULTS: NMDA induced concentration-dependent, receptor-mediated, death of SH-SY5Y cells, ranging from 11 to 25% (0.25-5 mM). Cell death induced by 1 mM NMDA (21%) was preceded by a significant accumulation of intracellular ROS and by a rapid activation of the calcium-activated protease calpain I. In addition, NMDA caused a rapid deactivation of Akt kinase and this preceded the detrimental activation of the downstream kinase, GSK-3beta. BEO (0.0005-0.01%) concentration dependently reduced death of SH-SY5Y cells caused by 1 mM NMDA. In addition to preventing ROS accumulation and activation of calpain, BEO (0.01%) counteracted the deactivation of Akt and the consequent activation of GSK-3beta, induced by NMDA. Results obtained by using specific fractions of BEO, suggested that monoterpene hydrocarbons were responsible for neuroprotection afforded by BEO against NMDA-induced cell death. CONCLUSIONS AND IMPLICATIONS: Our data demonstrate that BEO reduces neuronal damage caused in vitro by excitotoxic stimuli and that this neuroprotection was associated with prevention of injury-induced engagement of critical death pathways.

Percepción de conductas abisivas en estudiantes de medicina / Perception of abuse among medical students of the University of Chile

Background:Even though studying Medicine and perceiving abuse seem to be two opposite situations, recent investigations in Chile and abroad find that this is a frequent and pervasive combination. These studies also report the negative effects in the lives of students as well as the impact on the profession as a whole. Aim: To ascertain the perception of abusive situations in medical students during training at the University of Chile. Material and Methods: Descriptive and cross sectional study in which a questionnaire was applied to all the students enrolled in 2nd, 3rd, 5th and 7th year during 2001 and 2002. Using short vignettes, they were asked if they had experienced verbal, psychological, physical and sexual abuse, at least once, during their training, by whom and the eventual effects derived from it. Results: We obtained 757 questionnaires. Of the surveyed students, 91 percent reported having perceived at least one abusive episode during training. Teachers and fellow students were identified as the main offenders. Among the effects of such behavior, 32 percent mentioned that they considered dropping out of the career as a consequence of this experience. Discussion: The perception of abuse in medical students is common and has adverse effects. Efforts should be made to draw attention to this problem to prevent it.

[Perception of abuse among medical students of the University of Chile]. / Percepción de conductas abisivas en estudiantes de medicina.

BACKGROUND: Even though studying Medicine and perceiving abuse seem to be two opposite situations, recent investigations in Chile and abroad find that this is a frequent and pervasive combination. These studies also report the negative effects in the lives of students as well as the impact on the profession as a whole. AIM: To ascertain the perception of abusive situations in medical students during training at the University of Chile. MATERIAL AND METHODS: Descriptive and cross sectional study in which a questionnaire was applied to all the students enrolled in 2nd, 3rd, 5th and 7th year during 2001 and 2002. Using short vignettes, they were asked if they had experienced verbal, psychological, physical and sexual abuse, at least once, during their training, by whom and the eventual effects derived from it. RESULTS: We obtained 757 questionnaires. Of the surveyed students, 91% reported having perceived at least one abusive episode during training. Teachers and fellow students were identified as the main offenders. Among the effects of such behavior, 32% mentioned that they considered dropping out of the career as a consequence of this experience. DISCUSSION: The perception of abuse in medical students is common and has adverse effects. Efforts should be made to draw attention to this problem to prevent it.

La experiencia de abuso en las madres: ¿es un predictor de abuso sexual de sus hijos? / A history of abuse in mothers is a predictor of sexual abuse in children?

Introducción: La madre de un niño que ha sufrido abuso sexual tiene un rol complejo tanto en el fenómeno del abuso del hijo como en la reparación psicológica posterior. Con el propósito de establecer la relación entre experiencias de abuso sexual infantil a través de las generaciones, se exploraron aspectos de las historias de madres que pueden estar asociados a la ocurrencia de abuso sexual de los hijos. Método: Se administró una encuesta a dos grupos de madres: uno cuyos hijos fueron abusados y otro con hijos no abusados. Resultados: Las madres de niños abusados sexualmente presentan más reportes de abuso sexual en la infancia, en comparación con el otro grupo. Conclusiones: Existe relación entre el abuso sexual de un hijo y el relato materno de experiencias abusivas en la infancia. Se requiere mayor investigación para explorar factores involucrados en esta relación y si éstos se asocian a capacidades parentales.

Design and synthesis of potent and selective inhibitors of integrin VLA-4.

The synthesis and identification of a novel series of inhibitors of integrin VLA-4 are described. Their in vitro activity and selectivity against closely related integrins are also presented.

Síndrome de Münchausen por poder: una presentación inusual / Münchausen by proxy syndrome: report of case

We report a 12 year old girl that first consulted for fever with bilateral knee arthralgias. A neurological workout was started due to a progressive gait disturbance, but all results were incongruent with nerve or nerve root lesions, leading to the diagnosis of a functional paralysis. The patient worsened to the point of prostration. Due to the suspicion that the mother was inducing the symptoms, the patient was admitted to the hospital, where she improved notably. She was discharged walking. The improvement during hospital stay confirmed the diagnosis of a Münchausen by proxy syndrome, mimicking a disabling neurological condition

A homogeneous fluorometric assay for measuring cell adhesion to immobilized ligand using V-well microtiter plates.

We have developed a homogeneous high-capacity assay format for measuring integrin- and selectin-dependent cell binding to immobilized ligand using V-well microtiter plates. 2',7'-Bis(2-carboxyethyl)-5-(and-6)-carboxylfluorescence, acetoxymethylester-labeled cells are added to ligand-coated V-shaped microtiter wells. Bound cells are separated from free cells using centrifugal force to produce shear stress. Nonadherent cells accumulate in the nadir of the well and are measured using a fluorescence plate reader. Antibody or low-molecular-weight inhibitors of either the ligand or the cell surface receptor result in less cell binding, more cells in the pellet, and increased signal. The optimization and validation of the very late antigen-4/vascular cell adhesion molecule-1 assay is described in detail. We demonstrate that this assay can be rapidly adapted to measure other integrin- and selectin-mediated interactions. This assay format has several advantages over conventional assays. The centrifugal process is biologically relevant and eliminates the washing steps to remove nonadherent cells that can cause well-to-well and plate-to-plate variation. Because the assay is robust with a high signal-to-noise ratio and low variability, it is ideally suited for studying multiple parameters of cell adhesion and for high capacity screening.

Combinatorial approaches to inhibitors of VLA-4: piperazine-peptoid-bisarylureas.

A combinatorial approach towards identifying inhibitors of VALA-4 was investigated. A library of piperazine-peptoid-bisarylureas was assembled in solid phase and screening in the novel v-well assay enabled the identification of active compounds.