Comparison of Aerodigestive and Nonaerodigestive Provider Responses to Clinical Case Vignettes.

OBJECTIVE: To evaluate differences in practice patterns between aerodigestive and nonaerodigestive providers in pediatric gastroenterology when diagnosing and treating common aerodigestive complaints. STUDY DESIGN: A questionnaire comprised of clinical vignettes with multiple-choice questions was distributed to both aerodigestive and nonaerodigestive pediatric gastroenterologists. Vignettes focused on management of commonly encountered general gastroenterology and aerodigestive issues, such as gastroesophageal (GE) reflux, aspiration, and feeding difficulties. Tests of equal proportions were used to compare rates of testing and empiric therapy within and across groups. Multivariate analysis was used to assess differences in response rates between aerodigestive and nonaerodigestive providers. RESULTS: A total of 88 pediatric gastroenterologists from 18 institutions completed the questionnaire. There were 35 aerodigestive gastroenterology providers and 53 nonaerodigestive gastroenterology providers. The nonaerodigestive group included 31 general gastroenterologists and 22 providers with self-identified subspecialty gastroenterology expertise. Aerodigestive specialists were more likely than nonaerodigestive gastroenterologists to pursue testing over empiric therapy in cases involving isolated respiratory symptoms (P < .05); aerodigestive providers were more likely to recommend pH-impedance testing, videofluoroscopic swallow studies, and upper gastrointestinal barium study (P < .05 for each test) depending on the referring physician. For vignettes involving infant GE reflux, both groups chose empiric treatments more frequently than testing (P < .001), although aerodigestive providers were more likely than nonaerodigestive providers to pursue testing like upper gastrointestinal barium studies (P < .05). CONCLUSIONS: Although some practice patterns were similar between groups, aerodigestive providers pursued more testing than nonaerodigestive providers in several clinical scenarios including infants with respiratory symptoms and GE reflux.

Clinical Spectrum of COVID-19 in a Mexican Pediatric Population.

OBJECTIVE: To describe the broader clinical spectrum of COVID-19 in children. METHODS: In this descriptive, prospective study, we included confirmed pediatric patients with COVID-19 who presented to the emergency department of a pediatric tertiary care center from April to July, 2020. All patients were confirmed by the SARS-CoV-2 RT-PCR test, and we analyzed 24 symptoms and 25 signs. RESULTS: Among the 50 patients with COVID-19, the most common symptoms were fever, excessive cry and dry cough; digestive symptoms were frequently found (24%). The most common signs were pharyngeal erythema and irritability. CONCLUSIONS: Clinicians should recognize that the clinical spectrum of COVID-19 in children is wider than previously described, often with nonspecific signs and symptoms, and digestive symptoms should raise suspicion.

Ultrasound with laparoscopy for the diagnosis of abdominal disorders in cattle / Estudo da ultrassonografia e laparoscopia para diagnóstico das desordens abdominais em bovinos

This study aimed to evaluate laparoscopy with abdominal ultrasound exams to establish accurate diagnosis and prognosis. The experimental design was a prospective clinical study. Nine adult crossbred bovines suffering from abdominal disorders were admitted to the cattle clinic for clinical examinations. Abdominal ultrasound was carried out, and complete blood counts were performed. Subsequently, exploratory laparoscopy was performed. After surgery (exploratory laparoscopy on the right or left side), animals with a severe prognosis or untreatable clinical condition were euthanised and necropsied. During laparoscopy, circumscribed reticuloperitonitis could not be detected, nor could other abnormalities in the cranioventral region of the abdomen previously observed on ultrasound and confirmed during necropsy. However, alterations due to peritoneal damage, such as adhesions, were observed dorsally in addition to alterations in macroscopic aspects of the peritoneal fluid. Exploratory standing laparoscopy through the paralumbar fossae may constitute a supplementary procedure for diagnosing abdominal disorders in cattle, but it is not suitable in cases of diseases characterised by focal lesions concentrated in the cranioventral region of the abdomen. When associated with clinical, laboratory, and ultrasound examinations, this technique may improve the accurate diagnosis and prognosis of abdominal disorders in cattle.(AU)

Este estudo teve como objetivo avaliar a laparoscopia com exames de ultrassom abdominal para estabelecer um diagnóstico e prognóstico precisos. O desenho experimental foi um estudo clínico prospectivo. Nove bovinos adultos mestiços com distúrbios abdominais foram utilizados. Os bovinos admitidos na Clínica de Bovinos foram submetidos a exame clínico, adicionalmente foram realizadas hemograma e ultrassonografia abdominal. Posteriormente, foi realizada laparoscopia exploratória. Após a cirurgia (laparoscopia exploratória no lado direito ou esquerdo), nove animais com manifestações clínicas graves e intratáveis foram sacrificados e necropsiados. Durante a laparoscopia, não foi possível detectar reticuloperitonite circunscrita, bem como outras anormalidades na região crânio-ventral do abdome, previamente observadas na ultrassonografia e confirmadas durante a necropsia. No entanto, alterações devido a dano peritoneal, como aderências, foram observadas dorsalmente. É possível que a laparoscopia exploratória em apoio quadrupedal através da fossa paralombar constitua um procedimento complementar para o diagnóstico de distúrbios abdominais em bovinos, embora não seja adequado em casos de doenças caracterizadas por lesões focais concentradas na região cranioventral do abdome. Quando associada a exames clínicos, laboratoriais e de ultrassom, essa técnica pode melhorar o diagnóstico e prognóstico preciso dos distúrbios abdominais em bovinos.(AU)

Ultrasound with laparoscopy for the diagnosis of abdominal disorders in cattle / Estudo da ultrassonografia e laparoscopia para diagnóstico das desordens abdominais em bovinos

This study aimed to evaluate laparoscopy with abdominal ultrasound exams to establish accurate diagnosis and prognosis. The experimental design was a prospective clinical study. Nine adult crossbred bovines suffering from abdominal disorders were admitted to the cattle clinic for clinical examinations. Abdominal ultrasound was carried out, and complete blood counts were performed. Subsequently, exploratory laparoscopy was performed. After surgery (exploratory laparoscopy on the right or left side), animals with a severe prognosis or untreatable clinical condition were euthanised and necropsied. During laparoscopy, circumscribed reticuloperitonitis could not be detected, nor could other abnormalities in the cranioventral region of the abdomen previously observed on ultrasound and confirmed during necropsy. However, alterations due to peritoneal damage, such as adhesions, were observed dorsally in addition to alterations in macroscopic aspects of the peritoneal fluid. Exploratory standing laparoscopy through the paralumbar fossae may constitute a supplementary procedure for diagnosing abdominal disorders in cattle, but it is not suitable in cases of diseases characterised by focal lesions concentrated in the cranioventral region of the abdomen. When associated with clinical, laboratory, and ultrasound examinations, this technique may improve the accurate diagnosis and prognosis of abdominal disorders in cattle.(AU)

Este estudo teve como objetivo avaliar a laparoscopia com exames de ultrassom abdominal para estabelecer um diagnóstico e prognóstico precisos. O desenho experimental foi um estudo clínico prospectivo. Nove bovinos adultos mestiços com distúrbios abdominais foram utilizados. Os bovinos admitidos na Clínica de Bovinos foram submetidos a exame clínico, adicionalmente foram realizadas hemograma e ultrassonografia abdominal. Posteriormente, foi realizada laparoscopia exploratória. Após a cirurgia (laparoscopia exploratória no lado direito ou esquerdo), nove animais com manifestações clínicas graves e intratáveis foram sacrificados e necropsiados. Durante a laparoscopia, não foi possível detectar reticuloperitonite circunscrita, bem como outras anormalidades na região crânio-ventral do abdome, previamente observadas na ultrassonografia e confirmadas durante a necropsia. No entanto, alterações devido a dano peritoneal, como aderências, foram observadas dorsalmente. É possível que a laparoscopia exploratória em apoio quadrupedal através da fossa paralombar constitua um procedimento complementar para o diagnóstico de distúrbios abdominais em bovinos, embora não seja adequado em casos de doenças caracterizadas por lesões focais concentradas na região cranioventral do abdome. Quando associada a exames clínicos, laboratoriais e de ultrassom, essa técnica pode melhorar o diagnóstico e prognóstico preciso dos distúrbios abdominais em bovinos.(AU)

Doenças do sistema digestório de pequenos ruminantes no norte do Paraná / Digestive disorders of small ruminants in northern Paraná

As doenças do sistema digestório de ovinos e caprinos no norte do Paraná foram avaliadas por meio de um estudo retrospectivo de 427 pequenos ruminantes atendidos no Ambulatório de Grandes Animais, do Hospital Veterinário da Universidade Estadual de Londrina, no período de janeiro de 2006 a dezembro de 2015. Para isso, foi realizada revisão das fichas clínicas dos pequenos ruminantes com afecções do sistema digestório, determinando a ocorrência, principais características clínicas, tratamentos instituídos e evolução dos casos. Os dados foram tabulados e submetidos a um estudo descritivo das variáveis, observando a distribuição das frequências (%) das condições analisadas. As afecções do sistema digestório foram diagnosticadas em 38,64% (165/427) dos atendimentos realizados. Vinte e seis animais apresentaram duas afecções no momento do atendimento, totalizando 191 enfermidades diagnosticadas. Dentre essas enfermidades, as mais comumente diagnosticadas foram: hemoncose (27,7%; 53/191), acidose láctica ruminal aguda (18,8%; 36/191), eimeriose (13,6%; 26/191) e indigestão simples (6,8%; 13/191). O aumento da criação de ovinos e caprinos no estado do Paraná reitera a importância do desenvolvimento de estudos como o presente trabalho, a fim de identificar as enfermidades mais frequentes e preparar o médico veterinário para o diagnóstico e tratamento correto.

Sheep and Goat’s digestive disorders in northern Paraná were evaluated by a retrospective study of 427 small ruminants treated at the State University of Londrina’s Veterinary Hospital (HV-UEL), from January 2006 to December 2015. Analysis of medical records of small ruminants with digestive disorder were performed, determining the occurrence, main clinical signs, established treatments and outcome of cases. Data were tabulated and submitted to a descriptive study of variables, observing frequency distribution (%) of analyzed conditions. Digestive disorders occurs in 38,6% (165/427) of cases in small ruminants at the studied period. Among these diseases, the most common were: hemoncose (27.7%; 53/191), acute rumen lactic acidosis (18.8%; 36/191), eimeriosis (13.6%; 26/191) and simple indigestion (6.8%; 13/191). The increase in sheep and goats’ flock in the state of Paraná reiterates the importance of developing studies such as the present study, in order to identify the most frequent diseases and prepare the veterinarian for the correct diagnosis and treatment.

Doenças do sistema digestório de pequenos ruminantes no norte do Paraná / Digestive disorders of small ruminants in northern Paraná

As doenças do sistema digestório de ovinos e caprinos no norte do Paraná foram avaliadas por meio de um estudo retrospectivo de 427 pequenos ruminantes atendidos no Ambulatório de Grandes Animais, do Hospital Veterinário da Universidade Estadual de Londrina, no período de janeiro de 2006 a dezembro de 2015. Para isso, foi realizada revisão das fichas clínicas dos pequenos ruminantes com afecções do sistema digestório, determinando a ocorrência, principais características clínicas, tratamentos instituídos e evolução dos casos. Os dados foram tabulados e submetidos a um estudo descritivo das variáveis, observando a distribuição das frequências (%) das condições analisadas. As afecções do sistema digestório foram diagnosticadas em 38,64% (165/427) dos atendimentos realizados. Vinte e seis animais apresentaram duas afecções no momento do atendimento, totalizando 191 enfermidades diagnosticadas. Dentre essas enfermidades, as mais comumente diagnosticadas foram: hemoncose (27,7%; 53/191), acidose láctica ruminal aguda (18,8%; 36/191), eimeriose (13,6%; 26/191) e indigestão simples (6,8%; 13/191). O aumento da criação de ovinos e caprinos no estado do Paraná reitera a importância do desenvolvimento de estudos como o presente trabalho, a fim de identificar as enfermidades mais frequentes e preparar o médico veterinário para o diagnóstico e tratamento correto. 

Sheep and Goats digestive disorders in northern Paraná were evaluated by a retrospective study of 427 small ruminants treated at the State University of Londrinas Veterinary Hospital (HV-UEL), from January 2006 to December 2015. Analysis of medical records of small ruminants with digestive disorder were performed, determining the occurrence, main clinical signs, established treatments and outcome of cases. Data were tabulated and submitted to a descriptive study of variables, observing frequency distribution (%) of analyzed conditions. Digestive disorders occurs in 38,6% (165/427) of cases in small ruminants at the studied period. Among these diseases, the most common were: hemoncose (27.7%; 53/191), acute rumen lactic acidosis (18.8%; 36/191), eimeriosis (13.6%; 26/191) and simple indigestion (6.8%; 13/191). The increase in sheep and goats flock in the state of Paraná reiterates the importance of developing studies such as the present study, in order to identify the most frequent diseases and prepare the veterinarian for the correct diagnosis and treatment.(AU)

Age, Sex, Health Insurance, and Race Associated With Increased Rate of Emergent Pediatric Gastrointestinal Procedures.

OBJECTIVES: Few studies have examined the role health disparities play in pediatric gastrointestinal (GI) procedures. We hypothesized that health disparity factors affect whether patients undergo an emergent versus nonemergent GI procedure. The aims were to characterize the existing pediatric population undergoing GI procedures at our institution and assess specific risk factors associated with emergent versus nonemergent care. METHODS: We retrospectively reviewed the medical records of 2110 patients undergoing GI procedures from January 2012 to December 2014. Emergent procedures were performed on an urgent inpatient basis. All other procedures were considered nonemergent. Health disparity factors analyzed included age, sex, insurance type, race, and language. Logistic regression analysis identified the odds of undergoing emergent procedures for each factor. RESULTS: Most study patients were boys (58.2%), primarily insured by Medicaid (63.8%), white (44.0%), and spoke English (91.7%). Ten percent of all patients had an emergent procedure. Logistic regression analysis showed significant odds ratios (P value) for ages 18 years older (2.16, 0.003), females (0.62, 0.001), commercial insurance users (0.49, <0.0001), African Americans (1.94, <0.0001), and other race (1.72, 0.039). CONCLUSIONS: Health disparities in age, sex, insurance, and race appear to exist in this pediatric population undergoing GI procedures. Patients older than 18 years, African Americans, and other races were significantly more likely to have an emergent procedure. Girls and commercial insurance users were significantly less likely to have an emergent procedure. More research is necessary to understand why these relations exist and how to establish appropriate interventions.

Aplicación del método clínico para el diagnóstico de pacientes con hemorragia digestiva alta no variceal / Application of the clinical method for the diagnosis of patients with non-variceal upper gastrointestinal bleeding

La utilización del método clínico para lograr un diagnóstico preciso de las enfermedades en el ser humano, surge con el nacimiento de la Medicina, en la antigua Grecia y tiene como componentes fundamentales la relación médico-paciente, el interrogatorio, el examen físico y la historia clínica; esta última constituye su herramienta más importante en la recogida de datos. Se reflexiona sobre la importancia de su aplicación correcta para llegar a un diagnóstico preciso en los pacientes con hemorragia digestiva alta no variceal comenzando en la atención primaria de salud donde se puede lograr un diagnóstico precoz de esta entidad y evitar complicaciones que ocurren en estos pacientes cuando el diagnóstico es tardío, por lo que lejos pensar en la muerte del método clínico, su vigencia e importancia en la medicina contemporánea es incuestionable(AU)

The use of the clinical method for accurate diagnosis of diseases in humans arises with the birth of medicine in ancient Greece and its fundamental components doctor-patient relationship, interrogation, physical examination and history clinic; the latter is its most important data collection tool. It reflects on the importance of its correct application to reach an accurate diagnosis in patients with non-variceal upper gastrointestinal bleeding starting in primary health care which can achieve early diagnosis of this condition and avoid complications that occur in these patients when the diagnosis is delayed, so far thought of the death of the clinical method, its relevance and importance in contemporary medicine is unquestionable(AU)

Prevalência de sinais e sintomas digestórios em trabalhadoras rurais e fatores associados / Prevalence of digestive signs and symptoms and associated factors among rural workers

Objetivo: Conhecer a prevalência de sinais e sintomas digestórios em trabalhadoras rurais e identificar fatores associados mais frequentes. Métodos Estudo transversal que incluiu 182 trabalhadoras rurais maiores de 18 anos e de agricultura de hortifrutigranjeiros. Para avaliar a consistência interna dos dados utilizou-se o coeficiente alfa de Cronbach. Para comparar médias entre os grupos, o teste t de Student foi aplicado para amostras independentes. Em caso de assimetria, foi utilizado o teste de Mann-Whitney. Resultados A prevalência de sinais e sintomas digestórios relatados foi 31,9%. Os sinais e sintomas digestórios relatados foram: dor epigástrica (27,4%), regurgitação (18,1%), inchaço (9,9%), náusea (9,9%) e vômitos (6,0%). Conclusão A prevalência de sinais e sintomas digestórios relatados por trabalhadoras rurais foi alto e esteve associado a idade maior de 60 anos, utilização de pesticidas agrícolas e ascendência italiana.

Objective: To determine the prevalence of digestive signs and symptoms in rural workers and identify frequently associated factors. Methods This cross-sectional study included 182 rural and horticultural farm workers aged 18 years or older. To assess internal data consistency, the Cronbach’s alpha coefficient was used. To compare means between groups, student’s t-test was used for independent samples. The Mann–Whitney test was used in cases of asymmetry. Results The prevalence of digestive signs and symptoms was 31.9%. The signs and symptoms included epigastric pain (27.4%), regurgitation (18.1%), bloating (9.9%), nausea (9.9%), and vomiting (6.0%). Conclusion The prevalence of digestive signs and symptoms reported by rural workers was high and was associated with being older than 60 years, using agricultural pesticides, and being of Italian descent.

Genomic medicine in gastroenterology: A new approach or a new specialty?

Throughout history, many medical milestones have been achieved to prevent and treat human diseases. Man's early conception of illness was naturally holistic or integrative. However, scientific knowledge was atomized into quantitative and qualitative research. In the field of medicine, the main trade-off was the creation of many medical specialties that commonly treat patients in advanced stages of disease. However, now that we are immersed in the post-genomic era, how should we reevaluate medicine? Genomic medicine has evoked a medical paradigm shift based on the plausibility to predict the genetic susceptibility to disease. Additionally, the development of chronic diseases should be viewed as a continuum of interactions between the individual's genetic make-up and environmental factors such as diet, physical activity, and emotions. Thus, personalized medicine is aimed at preventing or reversing clinical symptoms, and providing a better quality of life by integrating the genetic, environmental and cultural factors of diseases. Whether using genomic medicine in the field of gastroenterology is a new approach or a new medical specialty remains an open question. To address this issue, it will require the mutual work of educational and governmental authorities with public health professionals, with the goal of translating genomic medicine into better health policies.

Principales diagnósticos clinicoendoscópicos e histológicos en ancianos con afecciones gastroduodenales / Main clinical, endoscopic and histological diagnosis in aged patients with gastric and duodenal disorders

Se efectuó un estudio descriptivo y retrospectivo de 257 ancianos con afecciones gastroduodenales, según resultados clinicoendoscópicos e histológicos, ingresados en las salas de Medicina Interna y Geriatría del Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba, durante el bienio 2010-2011, con vistas a caracterizarles e identificar los principales diagnósticos en ellos. Entre las entidades gastroduodenales predominaron las enfermedades gástricas; asimismo, preponderaron el sexo masculino, el grupo etario de 70-79 años y la gastritis antral como hallazgo endoscópico. Se demostró que en un número elevado de pacientes estaba infectado por Helicobacter pylori y que la densidad de colonización ligera se distinguió a medida que progresaba la lesión gástrica.

A descriptive and retrospective study of 257 old men with gastric and duodenal disorders, according to clinical endoscopic and histological results who were admitted in the Internal Medicine and Geriatrics Departments of "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital in Santiago de Cuba was carried out during the biennium 2010-2011, with the aim of characterizing them and to identify the main diagnosis in them. Among the gastric and duodenal diseases the gastric ones prevailed; also, the male sex, the age group 70-79 years and the antral gastritis as endoscopic finding prevailed. It was demonstrated that a high number of patients were infected by Helicobacter pylori and that the density of slight colonization was distinguished as the gastric lesion progressed.

Diffusion-weighted magnetic resonance imaging in the upper abdomen: technical issues and clinical applications.

Recent technological achievements have enabled the transposition of diffusion-weighted imaging (DWI) with good diagnostic quality into other body regions, especially the abdomen and pelvis. Many emerging and established applications are now being evaluated on the upper abdomen, the liver being the most studied organ. This article discusses imaging strategies for DWI on the upper abdomen, describes the clinical protocol, and reviews the most common clinical applications of DWI on solid abdominal organs.

Early laparoscopy for the evaluation of nonspecific abdominal pain: a critical appraisal of the evidence.

BACKGROUND: Patients with nonspecific abdominal pain (NSAP) are frequently seen in emergency departments. Different studies have suggested that early laparoscopy (EL) could be an adequate tool to accelerate diagnosis and therapy. The aim of this study was to assess the effectiveness of EL in terms of diagnosis, persistence of NSAP, mortality, morbidity, cost, hospital stay, and quality of life relative to observation in NSAP. METHODS: We performed a systematic review to identify randomized controlled trials (RTC) comparing EL versus active observation (AO) in NSAP. The primary outcomes were the number of patients with positive and negative findings, the utility for each group, and the cases with persistence of NSAP. Methodologic quality was assessed using the recommendations of the Cochrane Collaboration. RESULTS: Five studies that included a total of 921 patients were included: 460 in the EL group and 461 in the AO group. The use of an important methodologic heterogeneity between included studies avoided a pooled analysis. Data suggested that EL performed better in establishing a final diagnosis (79.2-96.9%) vs. AO (28.1-78.1%); however, the final therapeutic utility of laparoscopy was lower than the diagnostic rate (10.9-86.5%). The mortality rate of EL was similar to AO, and morbidity ranged from 1.15 to 23.72% in EL compared with the range from 1.9 to 31.14% in AO. The length of hospital stay ranged from 1.3 to 4.18 days in EL compared with the range from 2 to 7.3 days in AO. CONCLUSIONS: There is an important heterogeneity between the populations and in the degree of methodologic quality in the included studies. Data suggest that EL performs better in establishing a final diagnosis after admission, but the lack of uniform information does not allow for the recommendation of EL as a routine strategy in clinical practice. We recommend that a large trial be conducted with specific operative characteristics to solve problems identified in primary trials.