Current status and challenges in timely detection of cervical cancer in Mexico: expert consensus.

Cervical cancer is a significant public health problem in low- and middle-income countries, accounting for 85% of new cases worldwide. Due to poorly organized screening programs, cervical cancer is more likely to develop in vulnerable groups who do not initiate or rarely undergo screening. Cervical cytology and detecting high-risk human papillomavirus types are the recommended screening tools. Further, these strategies allow for accurately identifying women at a higher risk of cervical cancer and establishing screening times. New detection tools, such as novel biomarkers or automatic HPV detection in the vagina or urine, can improve screening coverage. This review aims to identify the challenges faced by detection programs and screening tools in Mexico to provide evidence-based recommendations to improve early detection programs for cervical cancer.

CRISPR/Cas9-mediated knockout of a polyester synthase-like gene delays flowering time in alfalfa.

KEY MESSAGE: T-DNA and CRISPR/Cas9-mediated knockout of polyester synthase-like genes delays flowering time in Arabidopsis thaliana and Medicago sativa (alfalfa). Thus, we here present the first report of edited alfalfa with delayed flowering.

Multibiomarker approach in fish to assess a heavily polluted Brazilian estuary, Guanabara Bay.

Brazil's Guanabara Bay (GB), located in Rio De Janeiro, is a deeply contaminated, eutrophic waterbody that challenges the understanding of the effects of pollutants on the biota. This paper presents a strategy to evaluate the impact of contamination utilizing a multibiomarker approach in two fish species: corvine (Micropogonias furnieri) and burrfish (Chilomycterus spinosus). The strategy is comprised of a general biomarker of fish' physical condition, the condition factor (CF), and specific biomarkers of pollutant exposure such as acetylcholinesterase (AChE), metallothionein (MT) activity and biliary polycyclic aromatic hydrocarbons (PAH) metabolites. Our results indicate that fish from GB are greatly affected by environmental pollution. CF values were lower in fishes from GB than in the reference site indicating that these fishes were under higher environmental stress. Lower AChE activity level in both species showed vulnerability to the presence of pesticide residues. Higher levels of MT in both species in GB reflect the consequences of heavy metal exposure in the bay, in spite of their bioavailability being restricted specially by the high organic matter content of GB. The levels of PAHs were higher in GB for both fish species, indicating exposure to these substances. However, the fish species showed different behavior regarding the origin of the PAHs. The multibiomarker approach used in this study evidently depicted effects on the health of fish in a waterbody with a complex polluted situation and further categorized the effects of anthropogenic activities in this aquatic system.

Fenotipos inesperados en el síndrome de Alport: la necesidad del estudio genético / Unexpected phenotypes in Alport syndrome: the need for genetic testing

El diagnóstico del síndrome de Alport supone un reto en la edadpediátrica, debido a la ausencia de fenotipos clínicos esperados de la enfermedad, su clásica caracterización de entidad rara y la práctica muy restringida de biopsias renales con análisis rutinario de la muestra por microscopía electrónica durante la infancia. Se presentan las características clínicas y genéticas de 6 pacientes pediátricos (4 mujeres) diagnosticados de síndromede Alport en dos centros hospitalarios entre 2018 y 2021. Todos los pacientes presentaron un debut clínico claramente diferente y ninguno presentó complicaciones auditivas nioftalmológicas. La mitad carecía de antecedentes familiares de enfermedad renal crónica. Ninguna biopsia renal realizada confirmó el diagnóstico. Todos los pacientes fueron confirmadosgenéticamente y fueron el caso índice del estudio familiar. Esta serie ilustra la presencia de fenotipos clínicos inesperados en el síndrome de Alport y refleja la necesidad de incorporar el estudio genético para su diagnóstico.

The diagnosis of Alport syndrome is a challenge in the pediatric age, due to the absence of expected clinical phenotypes of the disease, its classic characterization of a rare disease and the very restricted practice of renal biopsies with routine analysis of the sample by electron microscopy during infancy. The clinical and genetic characteristics of 6 pediatric patients (4 women) diagnosed with Alport syndrome in two hospital centers between 2018 and 2021 are reported. All patients presented a clearly different clinical debut and none presented auditory or ophthalmological complications. Half had no family history of chronic kidney disease. No kidney biopsy performed confirmed the diagnosis. All patients were genetically confirmed and were the index case in the family study. This series illustrates the presence of unexpected clinical phenotypes in Alport syndrome and reflects the need for the incorporation of the genetic study for its diagnosis.

[Unexpected phenotypes in Alport syndrome: the need for genetic testing]. / Fenotipos inesperados en el síndrome de Alport: la necesidad del estudio genético.

The diagnosis of Alport syndrome is a challenge in the pediatric age, due to the absence of expected clinical phenotypes of the disease, its classic characterization of a rare disease and the very restricted practice of renal biopsies with routine analysis of the sample by electron microscopy during infancy. The clinical and genetic characteristics of 6 pediatric patients (4 women) diagnosed with Alport syndrome in two hospital centers between 2018 and 2021 are reported. All patients presented a clearly different clinical debut and none presented auditory or ophthalmological complications. Half had no family history of chronic kidney disease. No kidney biopsy performed confirmed the diagnosis. All patients were genetically confirmed and were the index case in the family study. This series illustrates the presence of unexpected clinical phenotypes in Alport syndrome and reflects the need for the incorporation of the genetic study for its diagnosis.

El diagnóstico del síndrome de Alport supone un reto en la edad pediátrica, debido a la ausencia de fenotipos clínicos esperados de la enfermedad, su clásica caracterización de entidad rara y la práctica muy restringida de biopsias renales con análisis rutinario de la muestra por microscopía electrónica durante la infancia. Se presentan las características clínicas y genéticas de 6 pacientes pediátricos (4 mujeres) diagnosticados de síndrome de Alport en dos centros hospitalarios entre 2018 y 2021. Todos los pacientes presentaron un debut clínico claramente diferente y ninguno presentó complicaciones auditivas ni oftalmológicas. La mitad carecía de antecedentes familiares de enfermedad renal crónica. Ninguna biopsia renal realizada confirmó el diagnóstico. Todos los pacientes fueron confirmados genéticamente y fueron el caso índice del estudio familiar. Esta serie ilustra la presencia de fenotipos clínicos inesperados en el síndrome de Alport y refleja la necesidad de incorporar el estudio genético para su diagnóstico.

Altered Vaginal Microbiota Composition Correlates With Human Papillomavirus and Mucosal Immune Responses in Women With Symptomatic Cervical Ectopy.

Cervical ectopy is a benign condition of the lower genital tract that is frequently detected in women of reproductive age. Although cervical ectopy is regarded as a physiological condition, some women experience symptoms such as leucorrhoea, persistent bleeding and recurrent vaginal infections that require medical intervention. Cervical ectopy has not been linked to cervical cancer, but it is thought to facilitate the acquisition of sexually transmitted diseases (STDs), like Human Papillomavirus (HPV) infection, as it provides a favorable microenvironment for virus infection and dissemination. We and others have described the presence of oncogenic HPV types in women with symptomatic cervical ectopy. The relevance of this finding and the impact of symptomatic cervical ectopy on the cervicovaginal microenvironment (vaginal microbiota, immune and inflammatory responses) are currently unknown. To shed some light into the interplay between HPV, the vaginal microbiota and mucosal immune and inflammatory responses in the context of this condition, we enrolled 156 women with symptomatic cervical ectopy and determined the presence of HPV using a type-specific multiplex genotyping assay. Overall, HPV was detected in 54.48% women, oncogenic HPV types were found in more than 90% of HPV-positive cases. The most prevalent HPV types were HPV16 (29.4%), HPV31 (21.17%) and HPV18 (15.29%). Next, we evaluated the vaginal microbial composition and diversity by 16S rDNA sequencing, and quantified levels of cytokines and chemokines by flow cytometry using bead-based multiplex assays in a sub-cohort of 63 women. IL-21 and CXCL9 were significantly upregulated in HPV-positive women (p=0.0002 and p=0.013, respectively). Women with symptomatic cervical ectopy and HPV infection had increased diversity (p<0.001), and their vaginal microbiota was enriched in bacterial vaginosis-associated anaerobes (Sneathia, Shuttleworthia, Prevotella, and Atopobium) and depleted in Lactobacillus spp. Furthermore, the vaginal microbiota of women with symptomatic cervical ectopy and HPV infection correlated with vaginal inflammation (IL-1ß, rho=0.56, p=0.0004) and increased mucosal homeostatic response (IL-22, rho=0.60, p=0.0001). Taken together, our results suggest that HPV infection and dysbiotic vaginal communities could favor a vaginal microenvironment that might delay the recovery of the cervical epithelium in women with symptomatic cervical ectopy and favor STDs acquisition.

Multiple ways to evade the bacteriostatic action of glyphosate in rhizobia include the mutation of the conserved serine 90 of the nitrogenase subunit NifH to alanine.

The genome resequencing of spontaneous glyphosate-resistant mutants derived from the soybean inoculant E109 allowed identifying genes most likely associated with the uptake (gltL and cya) and metabolism (zigA and betA) of glyphosate, as well as with nitrogen fixation (nifH). Mutations in these genes reduce the lag phase and improve nodulation under glyphosate stress. In addition to providing glyphosate resistance, the amino acid exchange Ser90Ala in NifH increased the citrate synthase activity, growth rate and plant growth-promoting efficiency of E109 in the absence of glyphosate stress, suggesting roles for this site during both the free-living and symbiotic growth stages.

[Differences among renin-angiotensin system inhibitor drugs in prognosis of hypertense patients with COVID-19]. / Diferencias entre fármacos inhibidores del sistema renina-angiotensina en pacientes hipertensos ingresados por COVID-19.

Introduction: Concerns have been raised about Renin-angiotensin system inhibitors (RASi) in patients with COVID-19. Although recent trials have proved its security, evidence regarding intrinsic differences between RASi is lacking, especially in patients with arterial hypertension. Our objective was to analyse the prognosis of hypertense patients who received angiotensin converting enzyme inhibitors (ACEi) or angiotensin-2 receptor blockers (ARBs) and were hospitalized due to COVID-19. Materials and methods: 392 consecutive patients with hypertension and COVID-19 were analyse. Incidence of the combined event (death or mechanical ventilation need) was the primary endpoint. Secondary, incidence of each event and time to event were analysed. Results: 155 received ACEi and 237 ARBs. During the hospitalization, the combined event was observed in the 31,6 % of patients. No differences were observed between those previously treated with ACEi and ARBs (33.5 vs. 30.9%; p = 0.51). In the survival analysis, no differences were observed regarding time to combined event (p = 0.91). In-hospital mortality was similar in both groups (32.3 vs. 29.1%; p = 0.51), as well as the need of mechanical ventilation (3.2 vs. 5.9%; p = 0.23). Conclusions: The type of RASi was not associated with in-hospital major events in patients with arterial hypertension hospitalized due to COVID-19.

Introducción: Han surgido dudas sobre la seguridad de los fármacos inhibidores del sistema renina-angiotensina (SRA) en pacientes con enfermedad por coronavirus 2019 (COVID-19). Aunque estudios recientes han demostrado la seguridad de este grupo de fármacos, la evidencia sobre la comparativa de los diferentes fármacos inhibidores del SRA es escasa, sobre todo en pacientes hipertensos. Nuestro objetivo fue analizar el pronóstico de los pacientes hipertensos tratados con inhibidores de la enzima convertidora de angiotensina (IECA) o antagonistas del receptor de angiotensina II (ARA II) que presentaron COVID-19. Materiales y métodos: Se analizaron 582 pacientes hipertensos con COVID-19. Se registró la incidencia del evento combinado de muerte o necesidad de ventilación mecánica invasiva (VMI) durante la hospitalización. De forma secundaria, se analizó la incidencia de eventos de manera independiente y se realizó un análisis de supervivencia para analizar el tiempo hasta los eventos. Resultados: 155 pacientes recibían tratamiento previo con IECA y 237 con ARA II. Durante la hospitalización por COVID-19, se observó una incidencia del evento combinado del 31.6%. No se detectaron diferencias entre los pacientes que recibían tratamiento con IECA y los tratados con ARA II (33.5 vs. 30.9%; p = 0.51). En el análisis de supervivencia, no se hallaron diferencias en el tiempo hasta el evento combinado (p = 0.91). La mortalidad intrahospitalaria fue similar en ambos grupos (32.3 vs. 29.1%; p = 0.51), así como la necesidad de VMI (3.2 vs. 5.9%; p = 0.23). Conclusiones: El tipo de inhibidor del SRA no se asoció a diferencias pronósticas significativas entre los pacientes hipertensos ingresados con COVID-19.

Generation of a multi-herbicide-tolerant alfalfa by using base editing.

KEYMESSAGE: We present the first report on base editing in alfalfa. Specifically, we showed edited alfalfa with tolerance to both sulfonylurea- and imidazolinone-type herbicides.

Whole-Genome Resequencing of Spontaneous Oxidative Stress-Resistant Mutants Reveals an Antioxidant System of Bradyrhizobium japonicum Involved in Soybean Colonization.

Soybean is the most inoculant-consuming crop in the world, carrying strains belonging to the extremely related species Bradyrhizobium japonicum and Bradyrhizobium diazoefficiens. Currently, it is well known that B. japonicum has higher efficiency of soybean colonization than B. diazoefficiens, but the molecular mechanism underlying this differential symbiotic performance remains unclear. In the present study, genome resequencing of four spontaneous oxidative stress-resistant mutants derived from the commercial strain B. japonicum E109 combined with molecular and physiological studies allowed identifying an antioxidant cluster (BjAC) containing a transcriptional regulator (glxA) that controls the expression of a catalase (catA) and a phosphohydrolase (yfbR) related to the hydrolysis of hydrogen peroxide and oxidized nucleotides, respectively. Integrated synteny and phylogenetic analyses supported the fact that BjAC emergence in the B. japonicum lineage occurred after its divergence from the B. diazoefficiens lineage. The transformation of the model bacterium B. diazoefficiens USDA110 with BjAC from E109 significantly increased its ability to colonize soybean roots, experimentally recapitulating the beneficial effects of the occurrence of BjAC in B. japonicum. In addition, the glxA mutation significantly increased the nodulation competitiveness and plant growth-promoting efficiency of E109. Finally, the potential applications of these types of non-genetically modified mutant microbes in soybean production worldwide are discussed.

Expanding the Benefits of Tnt1 for the Identification of Dominant Mutations in Polyploid Crops: A Single Allelic Mutation in the MsNAC39 Gene Produces Multifoliated Alfalfa.

Most major crops are polyploid species and the production of genetically engineered cultivars normally requires the introgression of transgenic or gene-edited traits into elite germplasm. Thus, a main goal of plant research is the search of systems to identify dominant mutations. In this article, we show that the Tnt1 element can be used to identify dominant mutations in allogamous tetraploid cultivated alfalfa. Specifically, we show that a single allelic mutation in the MsNAC39 gene produces multifoliate leaves (mfl) alfalfa plants, a pivot trait of breeding programs of this forage species. Finally, we discuss the potential application of a combination of preliminary screening of beneficial dominant mutants using Tnt1 mutant libraries and genome editing via the CRISPR/Cas9 system to identify target genes and to rapidly improve both autogamous and allogamous polyploid crops.

Individual interventions to improve adherence to pharmaceutical treatment, diet and physical activity among adults with primary hypertension. A systematic review protocol.

INTRODUCTION: Hypertension is a chronic disease with 31% worldwide prevalence in adults. It has been associated with non-adherence to therapeutic regime with a negative impact on the prognosis of the disease and healthcare-associated costs. So, it is necessary to identify effective interventions to improve adherence among the afflicted population. The objective of this protocol is to describe the methods for a systematic review that will evaluate the effect of individual interventions so as to improve adherence to the prescribed pharmacological treatment, as well as to prescribed diet and physical activity in adults with primary hypertension. METHODS AND ANALYSIS: A systematic search of studies will be conducted in PubMed/MEDLINE, BVS, CINAHL, Embase, Cochrane and Scopus databases. Randomised and non-randomised clinical studies conducted in human beings, published from 1 January 2009 to 13 December 2019, are to be included, in any language. Adherence to pharmacological treatment, diet and physical activity, measured by direct and indirect methods, will be the primary outcome. Two independent reviewers will select relevant studies and will extract the data following the Cochrane's Handbook for Systematic Reviews of Approach and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. Methodological quality will be evaluated using the risk-of-bias (RoB) 2 and Risk of Bias in Non-randomised Studies - of Interventions (ROBINS-I) tools. Risk of bias will also be evaluated, and if the criteria are met, a meta-analysis will be finally performed. ETHICS AND DISSEMINATION: Information to be analysed is of a grouped nature, and given that its sources are published studies, no ethics committee approval is required. Results will be published in scientific journals, and in conferences, seminars and symposiums. Copyrights will be addressed by giving due credit through bibliographic references. PROSPERO REGISTRATION NUMBER: CRD42020147655.

High-quality forage production under salinity by using a salt-tolerant AtNXH1-expressing transgenic alfalfa combined with a natural stress-resistant nitrogen-fixing bacterium.

Alfalfa, usually known as the "Queen of Forages", is the main source of vegetable protein to meat and milk production systems worldwide. This legume is extremely rich in proteins due to its highly efficient symbiotic association with nitrogen-fixing strains. In the last years, alfalfa culture has been displaced to saline environments by other important crops, including major cereals, a fact that has reduced its biomass production and symbiotic nitrogen fixation. In this short communication, we report the high forage production and nutrient quality of alfalfa under saline conditions by alfalfa transformation with the AtNHX1 Na+/H+ antiporter and inoculation with the stress-resistant nitrogen-fixing strain Sinorhizobium meliloti B401. Therefore, the incorporation of transgenic traits into salt-sensitive legumes in association with the inoculation with natural stress-resistant isolates could be a robust approach to improve the productivity and quality of these important nitrogen-fixing crops.

[Cow's milk protein allergy in disability children]. / Alergia a las proteínas de leche de vaca en niños con discapacidad.

BACKGROUND: Cow's milk protein allergy (CMPA) is the most common food allergy in children. However, the prevalence of CMPA in disability children is unknown. OBJECTIVE: To know the frequency of CMPA in disability children and to assess the clinical improvement after a suppression diet. MATERIAL AND METHODS: We conducted a cohort study at the Children's Rehabilitation Center Telethon of Puebla, in which children aged 6 months to 5 years with clinical symptoms of CMPA were included, between January and September 2012. An exploratory questionnaire about clinical symptoms of CMPA was applied before and after the cow's milk proteins suppression diet. RESULTS: We identified 26 cases among 145 assessed children (18%). The mean age was 2 years and 7 months. All children had a history of multiple clinical symptoms. Respiratory symptoms were the most common, follows for gastrointestinal symptoms, including regurgitation, which suggests the association with gastroesophageal reflux. CONCLUSIONS: CMPA is frequent in disability children. Respiratory and gastrointestinal symptoms were the most common. Cow's milk proteins suppression diet was a useful diagnostic and therapy tool for these children.

ANTECEDENTES: la alergia a las proteínas de la leche de vaca es la alergia alimentaria más frecuente en niños. Sin embargo, se desconoce la prevalencia de ésta en niños con discapacidad. OBJETIVO: conocer la frecuencia de alergia a las proteínas de la leche de vaca en niños con discapacidad y evaluar la mejoría clínica posterior a una dieta de supresión. MATERIAL Y MÉTODO: estudio de cohorte efectuado en pacientes con datos clínicos de alergia a las proteínas de la leche de vaca, de seis meses a cinco años de edad, atendidos en el Centro de Rehabilitación Infantil Teletón de Puebla, de enero a septiembre de 2012. Se aplicó un cuestionario de manifestaciones clínicas de alergia a las proteínas de la leche de vaca antes y después de una dieta de supresión de proteínas de leche de vaca. RESULTADOS: se identificaron 26 casos entre 145 niños evaluados (18%). La media de edad fue de 2 años y 7 meses. Todos los niños tenían antecedentes de múltiples manifestaciones clínicas; las más frecuentes fueron las respiratorias, seguidas por las digestivas, que incluyeron regurgitaciones, lo que sugiere asociación con reflujo gastroesofágico. Todos los pacientes mostraron mejoría clínica después de la dieta de supresión. CONCLUSIONES: la alergia a las proteínas de la leche de vaca es frecuente en niños con discapacidad. Las manifestaciones respiratorias y digestivas fueron las más comunes. La dieta de supresión de proteínas de leche de vaca resultó en un procedimiento diagnóstico y de tratamiento de gran valor en este grupo de niños.

Doença de Crohn em lactentes: relato de caso / Crohn's disease in infants: a case description

Objetivo: relatar um case de doença inflamatória intestinal crônica (doenaça de crohn) em lactente, com sintomas que se iniciaram aos 8 meses de idade. Descrição do caso: lactente de 14 meses foi encaminhada para o Departamento de Pediatria da FCM da Santa Casa de São paulo com história de cólicas abdominais, anemia, surtos intermitentes de diarréia, com muco e laivos de sangue desde os 8 meses de vida. A suspeita inicial foi de alergia à proteína do leite de vaca, porém não houve resposta adequada à utilização de fórmula à base de proteína de soja. A paciente foi internada em decorrência de grave anemia e comprometimento do estado geral. O exame colonoscópico evidenciou acometimento difuso do cólon, sendo que os achados laboratoriais e hispatológicos comprovaram o diagnóstico de doença de Crohn. Comentários: o caso em questão é de ocorrência rara nessa faixa etária. A extensão do processo inflamatório, o comprometimento difuso de todo o cólon e o retardo do disgnóstico corroboraram para a evolução extremamente grave da lactante. A má resposta aos tratamentos habituais, corticosteróides associados à sulfassalazina e à azatioprina indicaram a necessidade de utilização de uma nova modalidade terapêutica, o anticorpo anti-TNFo (Infliximab TM), para que ocorresse remissão do processo em questão.

Protective lactogenic immunity conferred by an edible peptide vaccine to bovine rotavirus produced in transgenic plants.

Vaccines produced in transgenic plants constitute a promising alternative to conventional immunogens, presenting the possibility of stimulating secretory and systemic immunity against enteric pathogens when administered orally. Protection against enteric pathogens affecting newborn animals requires, in most cases, the stimulation of lactogenic immunity. Here, the group presents the development of an experimental immunogen based on expression of an immunorelevant peptide, eBRV4, of the VP4 protein of bovine rotavirus (BRV), which has been described as harbouring at least one neutralizing epitope as well as being responsible for the adsorption of the virus to epithelial cells. The eBRV4 epitope was efficiently expressed in transgenic alfalfa as a translational fusion protein with the highly stable reporter enzyme beta-glucuronidase (betaGUS), which served as a carrier, stabilized the synthesized peptide and facilitated screening for the higher expression levels in plants. Correlation of expression of the eBRV4 epitope in plants with those presenting the highest betaGUS activities was confirmed by a Western blot assay specific for the BRV peptide. The eBRV4 epitope expressed in plants was effective in inducing an anti-rotavirus antibody response in adult female mice when administered either intraperitoneally or orally and, more importantly, suckling mice born from immunized female mice were protected against oral challenge with virulent rotavirus. These results demonstrate the feasibility of inducing lactogenic immunity against an enteric pathogen using an edible vaccine produced in transgenic plants.

Aspectos etiológicos da pancreatite crônica no ambulatório de gastroenterologia da Santa Casa de Misericórdia de São Paulo / Etiologic aspects of chronic pancreatitis at gastroenterology clinic of the Santa Casa de Misericórdia Hospital in São Paulo

Objetivo: Analisar a etiologia das pancreatites crônicas(PC) do Ambulatório da Clínica de Gastroenterologia do Departamento de Medicina da Santa Casa de Misericórdia de São Paulo. Casuística e métodos: Foram avaliados, retrospectivamente, dados dos pacientes do setor de Afecções Pancreáticas, no período de 1986 a 2001.Os critérios diagnósticos para PC foram baseados em: história clínica, amilasemia, lipasemia, amilasúria de 24 horas, presença de síndrome de má absorção e diabetes melitus, ultra-sonografia abdominal, tomografia computadorizada do abdome e ecoendoscopia do pâncreas com achados compatíveis com PC.A análise estatística foi realizada pelo teste exato de Fisher.Resultados: A PC foi diagnosticada em 101 pacientes, sendo 79(78,2 por cento) do sexo masculino e 22(21,7 por cento) do feminino.A idade variou entre 22 e 87 anos, com mediana de 54,5 anos.As etiologias encontradas foram: alcoólica em 80(79,2 por cento) pacientes,obstrutiva em dois(1,9 por cento)pacientes e idiopática em 19(18,8 por cento)pacientes.A distribuição da etiologia no sexo masculino foi a seguinte:alcoólica em 76(96,2 por cento)casos,obstrutiva em um (1,2 por cento)caso e idiopática em dois (2,5 por cento)casos.No sexo feminino a etiologia foi obstrutiva em um (4,54 por cento)caso,alcoólica em quatro(18,18 por cento)casos e idiopática em 17(77,27 por cento)casos.Vale ressaltar que em seis pacientes mulheres com diagnóstico de PC idiopática,foram encontrados seis casos de microlitíase.Conclussão:A maior parte dos pacientes portadores de PC encontra-se na faixa etária entre 40 e 50 anos de idade.A principal etiologia evidenciada no total dos casos foi o consumo alcoólico,principalmente no sexo masculino.Das causas não relacionadas com álcool,as idiopáticas assumem a maioria,sendo nesta o principal contingente representado pelo sexo feminino

Complicações da pancreatite crônica nos pacientes em acompanhamento ambulatorial / Chronic pancreatitis complications in patients seen at the outpatient clinic

Descrever as complicações apresentadas pelos pacientes portadores de pancreatite crônica em acompanhamento no ambulatório da Clínica de Gastroenterologia do Departamento de Medicina da Santa Casa de Misericórdia de São Paulo. Casuística e método: Foram analisados, retrospectivamente, após preenchimento de protocolo, dados de 64 pacientes com diagnóstico de pancreatite crônica, no período de 1989 a 2002. O diagnóstico das complicações foi realizado através da revisão da história clínica, dos exames laboratóriais e de imagens: radiografia simples de abdome, ultra-som, tomografia ressonância magnética, endoscopia digestiva alta e ecoendoscopia pancreática. O teste exato de Fisher foi utilizado para analisar os resultados com o objetivo de comparar ambos os sexos em reação à presença de complicações. Resultados: dos 64 pacientes avaliados, 50 (78,10por cento) eram do sexo masculino e 14 (21,87por cento) do feminino. Observou-se que 17 (16,56por cento) pacientes apresentaram complicações, dos quais 14 (82,34por cento) eram homens e três (17,64por cento), mulheres; quanto à faixa etária ,13 (65pr cento) pacientes encontravam-se entre 40 e 50 anos de idade. As complicações observadas foram: pseudocisto em 10 (58,82por cento), ascite em dois (11,76por cento), trombose portoesplênica em dois (11,76por cento), derrame pleural + ascite em um (5,88por cento), ascite + abscesso em um (5,88por cento) e neoplasia + pseudocisto em um (5,88por cento) caso. Conclusão: Nesta casuística, a pancreatite crônica está associadaa uma variedade de complicações, sendo a mais comum a formação do pseudocisto, A idade de maior incidência de complicações está compreendida entre os 40 e 50 anos e não existe diferença estatisticamente significativa entre os sexos