Effect of successive endoscopic procedures in polyp and adenoma detection rates: Too early is not always too good.

BACKGROUND AND AIMS: There is conflicting evidence regarding the impact of hypothetical cumulative fatigue after performing too many endoscopic procedures on both polyp and adenoma detection rates (PDR, and ADR, respectively). The aim of this study is to evaluate the effect of successive endoscopic procedures on PDR and ADR. METHODS: A retrospective cross-sectional study was undertaken among consecutive patients on whom colonoscopy and/or esophagogastroduodenoscopy were performed between January 2012 and August 2014. Data regarding polyp and adenoma detection, cecal intubation, and bowel cleansing quality as well as demographical data of subjects were extracted. Endoscopic procedures were classified according to the time slots of the procedures throughout the endoscopy session in three groups: from the 1st to 4th endoscopy study (round 1), from the 5th to the 8th study (round 2), above the 9th study (round 3). We compared PDR and ADR among rounds. RESULTS: Overall, 3388 patients were enrolled. Median age was 50 years (range 18-95) and 52.39% were female. There was a significant difference in terms of PDR among rounds (36.83%, 41.24%, and 43.38%, respectively, p = 0.007) and a non-significant numerical difference when ADR was compared (23.2%, 25.71%, and 26.78%, p = 0.07). On multivariate analysis, ADR was significantly associated with age (odds ratio [OR] 1.02 [1.01-1.03]), and male sex (OR 1.64 [1.38-1.94]). CONCLUSION: Theoretical endoscopist's fatigue due to cumulative performance of endoscopies does not diminish colonoscopy quality. Both PDR and ADR seem to improve after endoscopist's cumulative rounds of performed endoscopies. This could be due to a "warm-up" effect.

Iron-deficiency anemia as a subclinical celiac disease presentation in an Argentinian population. / La anemia ferropénica como presentación de enfermedad celíaca subclínica en una población argentina.

BACKGROUND: There is a wide heterogeneity in the reports of celiac disease prevalence in iron-deficiency anemia patients. AIM: To determine the prevalence of celiac disease in patients with iron-deficiency anemia. MATERIALS AND METHODS: Adult patients with a diagnosis of iron-deficiency anemia were enrolled for upper endoscopy with duodenal biopsies. Healthy volunteers that underwent upper endoscopy were enrolled as controls. RESULTS: A total of 135 patients with iron-deficiency anemia and 133 controls were enrolled. Celiac disease prevalence was higher in the iron-deficiency anemia group [11.11 vs. 1.51%, OR: 8.18 (1.83-36.55), P=.001). Of the celiac disease patients in the iron-deficiency anemia group, 73.3% had at least one endoscopic sign suggesting villous atrophy, whereas 100% of the celiac disease patients in the control group presented with at least one endoscopic sign. CONCLUSIONS: Patients with iron-deficiency anemia have an increased risk for celiac disease. Up to 25% of these patients may not present any endoscopic sign suggesting villous atrophy.

Central adiposity is negatively associated with hippocampal-dependent relational memory among overweight and obese children.

OBJECTIVE: To assess associations between adiposity and hippocampal-dependent and hippocampal-independent memory forms among prepubertal children. STUDY DESIGN: Prepubertal children (age 7-9 years; n = 126), classified as non-overweight (<85th percentile body mass index [BMI]-for-age [n = 73]) or overweight/obese (≥85th percentile BMI-for-age [n = 53]), completed relational (hippocampal-dependent) and item (hippocampal-independent) memory tasks. Performance was assessed with both direct (behavioral accuracy) and indirect (preferential disproportionate viewing [PDV]) measures. Adiposity (ie, percent whole-body fat mass, subcutaneous abdominal adipose tissue, visceral adipose tissue, and total abdominal adipose tissue) was assessed by dual-energy X-ray absorptiometry. Backward regression identified significant (P < .05) predictive models of memory performance. Covariates included age, sex, pubertal timing, socioeconomic status (SES), IQ, oxygen consumption, and BMI z-score. RESULTS: Among overweight/obese children, total abdominal adipose tissue was a significant negative predictor of relational memory behavioral accuracy, and pubertal timing together with SES jointly predicted the PDV measure of relational memory. In contrast, among non-overweight children, male sex predicted item memory behavioral accuracy, and a model consisting of SES and BMI z-score jointly predicted the PDV measure of relational memory. CONCLUSION: Regional, but not whole-body, fat deposition was selectively and negatively associated with hippocampal-dependent relational memory among overweight/obese prepubertal children.

Impact of the endoscopic teaching process on colonic adenoma detection.

BACKGROUND: There has been little reported experience in the Latin American hospital setting in relation to the impact of the endoscopic training process on colonoscopy quality. AIMS: To determine the effect that training in the technique of colonoscopy has on adenoma detection in an Argentinian teaching hospital. MATERIAL AND METHOD: Within the time frame of July 2012 and July 2013, 3 physicians received training in colonoscopy from 4 experienced endoscopists. The colonoscopies performed by the supervised trainees were compared with those carried out by the experienced endoscopists. RESULTS: A total of 318 colonoscopies performed by any one of the 3 supervised trainees and 367 carried out by any one of the experienced endoscopists were included. The univariate analysis showed a non-significant difference in the detection rate of adenomas (30.4 vs. 24.7%, P=.09). In the multivariate analysis, the detection rate of adenomas was significantly higher in the colonoscopies performed by one of the 3 trainees (odds ratio = 1.72 [1.19-2.48]). CONCLUSIONS: The supervised involvement of endoscopic trainees has a positive effect on adenoma detection.

High-resolution global maps of 21st-century forest cover change.

Quantification of global forest change has been lacking despite the recognized importance of forest ecosystem services. In this study, Earth observation satellite data were used to map global forest loss (2.3 million square kilometers) and gain (0.8 million square kilometers) from 2000 to 2012 at a spatial resolution of 30 meters. The tropics were the only climate domain to exhibit a trend, with forest loss increasing by 2101 square kilometers per year. Brazil's well-documented reduction in deforestation was offset by increasing forest loss in Indonesia, Malaysia, Paraguay, Bolivia, Zambia, Angola, and elsewhere. Intensive forestry practiced within subtropical forests resulted in the highest rates of forest change globally. Boreal forest loss due largely to fire and forestry was second to that in the tropics in absolute and proportional terms. These results depict a globally consistent and locally relevant record of forest change.

Pharmacotherapy for the prevention of chronic pain after surgery in adults.

BACKGROUND: Chronic pain can often occur after surgery, substantially impairing patients' health and quality of life. It is caused by complex mechanisms that are not yet well understood. The predictable nature of most surgical procedures has allowed for the conduct of randomized controlled trials of pharmacological interventions aimed at preventing chronic postsurgical pain. OBJECTIVES: The primary objective was to evaluate the efficacy of systemic drugs for the prevention of chronic pain after surgery by examining the proportion of patients reporting pain three months or more after surgery. The secondary objective was to evaluate the safety of drugs administered for the prevention of chronic pain after surgery. SEARCH METHODS: We identified randomized controlled trials (RCTs) of various systemically administered drugs for the prevention of chronic pain after surgery from CENTRAL, MEDLINE, EMBASE and handsearches of other reviews and trial registries. The most recent search was performed on 17 July 2013.   SELECTION CRITERIA: Included studies were double-blind, placebo-controlled, randomized trials involving adults and evaluating one or more drugs administered systemically before, during or after surgery, or both, which measured pain three months or more after surgery. DATA COLLECTION AND ANALYSIS: Data collected from each study included the study drug name, dose, route, timing and duration of dosing; surgical procedure; proportion of patients reporting any pain three months or more after surgery, reporting at least 4/10 or moderate to severe pain three months or more after surgery; and proportion of participants dropping out of the study due to treatment-emergent adverse effects. MAIN RESULTS: We identified 40 RCTs of various pharmacological interventions including intravenous ketamine (14 RCTs), oral gabapentin (10 RCTs), oral pregabalin (5 RCTs), non-steroidal anti-inflammatories (3 RCTs), intravenous steroids (3 RCTs), oral N-methyl-D-aspartate (NMDA) blockers (3 RCTs), oral mexiletine (2 RCTs), intravenous fentanyl (1 RCT), intravenous lidocaine (1 RCT), oral venlafaxine (1 RCT) and inhaled nitrous oxide (1 RCT). Meta-analysis suggested a modest but statistically significant reduction in the incidence of chronic pain after surgery following treatment with ketamine but not gabapentin or pregabalin. Results with ketamine should be viewed with caution since most of the included trials were small (that is < 100 participants per treatment arm), which could lead to the overestimation of treatment effect. AUTHORS' CONCLUSIONS: Additional evidence from better, well designed, large-scale trials is needed in order to more rigorously evaluate pharmacological interventions for the prevention of chronic pain after surgery. Furthermore, available evidence does not support the efficacy of gabapentin, pregabalin, non-steroidal anti-inflammatories, intravenous steroids, oral NMDA blockers, oral mexiletine, intravenous fentanyl, intravenous lidocaine, oral venlafaxine or inhaled nitrous oxide for the prevention of chronic postoperative pain.

Experimental evidence for extreme dispersal limitation in tropical forest birds.

Movements of organisms between habitat remnants can affect metapopulation structure, community assembly dynamics, gene flow and conservation strategy. In the tropical landscapes that support the majority of global biodiversity and where forest fragmentation is accelerating, there is particular urgency to understand how dispersal across habitats mediates the demography, distribution and differentiation of organisms. By employing unique dispersal challenge experiments coupled with exhaustive inventories of birds in a Panamanian lacustrine archipelago, we show that the ability to fly even short distances (< 100 m) between habitat fragments varies dramatically and consistently among species of forest birds, and that this variation correlates strongly with species' extinction histories and current distributions across the archipelago. This extreme variation in flight capability indicates that species' persistence in isolated forest remnants will be differentially mediated by their respective dispersal abilities, and that corridors connecting such fragments will be essential for the maintenance of avian diversity in fragmented tropical landscapes.

Morte celular nas lâminas epidermais de equinos com laminite

O artigo não apresenta resumo.

Morte celular nas lâminas epidermais de equinos com laminite

O artigo não apresenta resumo.

[Validation of a rapid urease test for the diagnosis of Helicobacter pylori infection]. / Validación de un test de ureasa rápido para el diagnóstico de la infección por H. pylori.

OBJECTIVE: Several non-commercial rapid urease tests have been designed with the objective of reducing the cost of Helicobacter Pylori infection diagnosis. The objective of the present prospective trial is to assess one of these tests, using the histologic evaluation for the presence of Helicobacter Pylori, as the standard reference of diagnosing this infection. METHODS: Patients undergoing upper endoscopy for various reasons were prospectively enrolled. Three endoscopic biopsies of the antrum and three from the corpus of the stomach were taken in every patient enrolled. The specimens were evaluated by the rapid urease test on an individual basis, comparing the results with the histology assessment of the Helicobacter Pylori status, which was considered as the standard reference for the diagnosis of the infection. RESULTS: One hundred and four patients were enrolled, of which 94 were eligible. Fifty-five patients (60.43%) were infected with Helicobacter Pylori. The sensibility and specificity of the urease test evaluated at 4 hours was 65.45% and 100% respectively. The evaluation at 24 hours of the sensibility and specificity was 83% and 94% respectively. CONCLUSIONS: The non-commercial rapid urease test is a practical, fast, and cost effective method for the detection of Helicobacter Pylori infection, and its diagnostic utility is similar to the commercial test available.

Validación de un test de ureasa rápido para el diagnóstico de la infección por H. Pylori / Validation of a rapid urease test for the diagnosis of helicobacter pylori infection

OBJECTIVE: Several non-commercial rapid urease tests have been designed with the objective of reducing the cost of Helicobacter Pylori infection diagnosis. The objective of the present prospective trial is to assess one of these tests, using the histologic evaluation for the presence of Helicobacter Pylori, as the standard reference of diagnosing this infection. METHODS: Patients undergoing upper endoscopy for various reasons were prospectively enrolled. Three endoscopic biopsies of the antrum and three from the corpus of the stomach were taken in every patient enrolled. The specimens were evaluated by the rapid urease test on an individual basis, comparing the results with the histology assessment of the Helicobacter Pylori status, which was considered as the standard reference for the diagnosis of the infection. RESULTS: One hundred and four patients were enrolled, of which 94 were eligible. Fifty-five patients (60.43%) were infected with Helicobacter Pylori. The sensibility and specificity of the urease test evaluated at 4 hours was 65.45% and 100% respectively. The evaluation at 24 hours of the sensibility and specificity was 83% and 94% respectively. CONCLUSIONS: The non-commercial rapid urease test is a practical, fast, and cost effective method for the detection of Helicobacter Pylori infection, and its diagnostic utility is similar to the commercial test available

Validación de un test de ureasa rápido para el diagnóstico de la infección por H. Pylori / Validation of a rapid urease test for the diagnosis of helicobacter pylori infection

OBJECTIVE: Several non-commercial rapid urease tests have been designed with the objective of reducing the cost of Helicobacter Pylori infection diagnosis. The objective of the present prospective trial is to assess one of these tests, using the histologic evaluation for the presence of Helicobacter Pylori, as the standard reference of diagnosing this infection. METHODS: Patients undergoing upper endoscopy for various reasons were prospectively enrolled. Three endoscopic biopsies of the antrum and three from the corpus of the stomach were taken in every patient enrolled. The specimens were evaluated by the rapid urease test on an individual basis, comparing the results with the histology assessment of the Helicobacter Pylori status, which was considered as the standard reference for the diagnosis of the infection. RESULTS: One hundred and four patients were enrolled, of which 94 were eligible. Fifty-five patients (60.43%) were infected with Helicobacter Pylori. The sensibility and specificity of the urease test evaluated at 4 hours was 65.45% and 100% respectively. The evaluation at 24 hours of the sensibility and specificity was 83% and 94% respectively. CONCLUSIONS: The non-commercial rapid urease test is a practical, fast, and cost effective method for the detection of Helicobacter Pylori infection, and its diagnostic utility is similar to the commercial test available (AU)

Validación de un test de ureasa rápido para el diagnóstico de la infección por H. pylori. / [Validation of a rapid urease test for the diagnosis of Helicobacter pylori infection]

OBJECTIVE: Several non-commercial rapid urease tests have been designed with the objective of reducing the cost of Helicobacter Pylori infection diagnosis. The objective of the present prospective trial is to assess one of these tests, using the histologic evaluation for the presence of Helicobacter Pylori, as the standard reference of diagnosing this infection. METHODS: Patients undergoing upper endoscopy for various reasons were prospectively enrolled. Three endoscopic biopsies of the antrum and three from the corpus of the stomach were taken in every patient enrolled. The specimens were evaluated by the rapid urease test on an individual basis, comparing the results with the histology assessment of the Helicobacter Pylori status, which was considered as the standard reference for the diagnosis of the infection. RESULTS: One hundred and four patients were enrolled, of which 94 were eligible. Fifty-five patients (60.43

) were infected with Helicobacter Pylori. The sensibility and specificity of the urease test evaluated at 4 hours was 65.45

and 100

respectively. The evaluation at 24 hours of the sensibility and specificity was 83

and 94

respectively. CONCLUSIONS: The non-commercial rapid urease test is a practical, fast, and cost effective method for the detection of Helicobacter Pylori infection, and its diagnostic utility is similar to the commercial test available.

Impact of timing of pubertal maturation on growth in black and white female adolescents: The National Heart, Lung, and Blood Institute Growth and Health Study.

OBJECTIVES: To evaluate the impact of early, mid-onset, and late maturation, as assessed by timing of menarche, on height, height velocity, weight, body mass index, and sum of skinfolds in a group of white and black girls. STUDY DESIGN: The Growth and Health Study recruited 9- and 10-year-old girls from Richmond, California, Cincinnati, Ohio, and Washington, DC. There were 616 white and 539 black participants recruited at age 9 and 550 white and 674 black participants recruited at age 10. Participants were seen annually for 10 visits. Longitudinal regression models were used to test for differences in each growth measure by timing of menarche across all ages and to determine whether these differences change with age. RESULTS: Mean age at menarche among white participants was 12.7 years, and among black participants, 12.0 years. According to race-specific 20th and 80th percentiles, early maturers were tallest at early ages and shortest after adult stature had been attained. Peak height velocity and post-menarche increment in stature were greatest in early maturers and least in late maturers. Weight was greatest in early and least in late maturers, as was body mass index. Sum of skinfolds was also greatest in early and least in late maturers. There was no impact of timing of maturation on two common measures of regional fat distribution. CONCLUSIONS: Girls who matured early were shorter in early adulthood, despite having greater peak height velocity and post-menarchal increment in height. Throughout puberty, early maturers had greater ponderosity and adiposity, although there was no association with regional distribution of fat.

Dengue fever risk and prevention for short-term group travelers to tropical regions.

The purpose of this study is to describe dengue fever infections in a group traveling from northern Louisiana to Mexico. Of 50 travelers in the group, three adolescents aged 15-16 developed febrile symptoms a few days after returning. Clinical diagnosis suggested dengue fever. Serum samples were obtained from the three adolescents and from 19 of the adults (age 18 and older) who were in the group. The samples were analyzed by the Centers for Disease Control using dengue IgM capture enzyme linked immunosorbant assay. Results confirmed the three symptomatic adolescents and five asymptomatic adults had been infected with the Flaviviridae virus that causes dengue. We conclude that since there is no vaccine to prevent dengue infections, travelers to high-risk areas should take steps to prevent infection and that clinicians encountering patients with febrile illnesses after travel to such regions should consider a diagnosis of dengue fever.

Cryptosporidiosis in northeastern Brazilian children: association with increased diarrhea morbidity.

To evaluate the impact of Cryptosporidium infection on diarrheal disease burden and nutrition status, a nested case-control study was done among children who were followed from birth in Fortaleza, Brazil. The diarrhea history and growth records of 43 children with a symptomatic diarrhea episode of cryptosporidiosis (case-children) were compared with those of 43 age-matched controls with no history of cryptosporidiosis. After Cryptosporidium infection, case-children < or = 1 year old experienced an excessive and protracted (nearly 2 years) diarrheal disease burden. Case-children < or = 1 year old with no history of diarrhea prior to their Cryptosporidium infection also experienced a subsequent increased diarrheal disease burden with an associated decline in growth. Control subjects experienced no change in their diarrhea burden over time. This study suggests that an episode of symptomatic Cryptosporidium infection in children < or = 1 year of age is a marker for increased diarrhea morbidity.

Children's access to mental health care: does insurance matter?

Using data from a 1992 community survey of children and their parents (or guardians), we found major gaps in mental health insurance coverage. Interestingly, private insurance had no statistically significant effect on use of mental health services. Youth without insurance coverage and those with public insurance had higher rates of serious emotional disorder than did those with private insurance. The analysis is based on the National Institute of Mental Health's Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) study, conducted in three mainland U.S. sites and in Puerto Rico.