[Clinical and histopathological characteristics of malignant colon tumors by location]. / Características clínicas e histopatológicas de los tumores malignos de colon por localización.

Background: The colon has two different embryological origins, which is why it can be divided into right and left with different characteristics each one; therefore, neoplastic lesions have a different clinical picture and are also associated with different pathologies. Objective: To describe the clinical and histopathological characteristics of malignant colon tumors acording to their location. Material and methods: Descriptive, retrospective study with 94 patients diagnosed with colon cancer. Descriptive statistics were performed with the calculation of frequencies and percentages, and chi-squared tests were calculated. Results: Mean age was 61.3 years, 49 (52.1%) were women; 53 (56.4%) were left-sided and 41 (43.6%) right-sided. The main symptom was hematochezia in 32 (60.4%), in patients with left cancer; and diarrhea in 20 (48.8%), in patients with right-sided colon cancer. The presentation of stage I tumors and polyps, p = 0.044 and p = 0.043, respectively, was more frequent on the right side compared to the left side; in the left, hematochezia (p = 0.001), narrow stools(p = 0.05), and a history of type 2 diabetes mellitus (T2DM) (p= 0.036) were more frequent compared to the opposite site. Conclusions: Stage I and the presence of polyps were more frequent in right-sided cancer compared to left-sided cancer; T2DM, as well as hematochezia and narrow stools were more associated with the left side compared to the right side.

Introducción: el colon tiene dos orígenes embriológicos distintos, con lo que se puede dividir en derecho e izquierdo y cada uno tiene características diferentes; por tanto, las lesiones neoplásicas tienen un cuadro clínico diferente y se asocian también a diferentes patologías. Objetivo: describir las características clínicas e histopatológicas de los tumores malignos de colon según su localización. Material y métodos: estudio descriptivo, retrospectivo con 94 pacientes con diagnóstico de cáncer de colon. La estadística descriptiva se realizó con el cálculo de frecuencias y porcentajes, y se aplicaron pruebas de chi cuadrada. Resultados: la edad media fue 61.3 años, 49 (52.1%) fueron mujeres; 53 (56.4%) casos fueron izquierdos y 41 (43.6%) derechos. El síntoma principal fue hematoquecia en 32 (60.4%), en pacientes con cáncer izquierdo; y diarrea en 20 (48.8%), en pacientes con cáncer derecho. La presentación de tumores en estadio I y pólipos, p = 0.044 y p = 0.043, respectivamente, fue más frecuente en el lado derecho comparado con el lado izquierdo; en el izquierdo fueron más frecuentes la hematoquecia (p = 0.001), la disminución del grosor de las heces (p = 0.05) y el antecedente de diabetes mellitus 2 (p= 0.036) respecto al sitio contrario. Conclusiones: el estadio I y la presencia de pólipos fueron más frecuentes en el cáncer derecho comparado con el izquierdo; la diabetes mellitus 2, así como la hematoquecia y la disminución en el grosor de las heces se asociaron más al lado izquierdo en comparación con el derecho.

Pictograms to assess bloating and distension symptoms in the general population in Mexico: Results of The Rome Foundation Global Epidemiology Study.

BACKGROUND: There is no term for bloating in Spanish and distension is a very technical word. "Inflammation"/"swelling" are the most frequently used expressions for bloating/distension in Mexico, and pictograms are more effective than verbal descriptors (VDs) for bloating/distension in general GI and Rome III-IBS patients. However, their effectiveness in the general population and in subjects with Rome IV-DGBI is unknown. We analyzed the use of pictograms for assessing bloating/distension in the general population in Mexico. METHODS: The Rome Foundation Global Epidemiology Study (RFGES) in Mexico (n = 2001) included questions about the presence of VDs "inflammation"/"swelling" and abdominal distension, their comprehension, and pictograms (normal, bloating, distension, both). We compared the pictograms with the Rome IV question about the frequency of experiencing bloating/distension, and with the VDs. KEY RESULTS: "Inflammation"/"swelling" was reported by 51.5% and distension by 23.8% of the entire study population; while 1.2% and 25.3% did not comprehend "Inflammation"/"swelling" or distension, respectively. Subjects without (31.8%) or not comprehending "inflammation"/"swelling"/distension (68.4%) reported bloating/distension by pictograms. Bloating and/or distension by the pictograms were much more frequent in those with DGBI: 38.3% (95%CI: 31.7-44.9) vs. without: 14.5% (12.0-17.0); and in subjects with distension by VDs: 29.4% (25.4-33.3) vs. without: 17.2% (14.9-19.5). Among subjects with bowel disorders, those with IBS reported bloating/distension by pictograms the most (93.8%) and those with functional diarrhea the least (71.4%). CONCLUSIONS & INFERENCES: Pictograms are more effective than VDs for assessing the presence of bloating/distension in Spanish Mexico. Therefore, they should be used to study these symptoms in epidemiological research.

Face-to-face interviews versus Internet surveys: Comparison of two data collection methods in the Rome foundation global epidemiology study: Implications for population-based research.

BACKGROUND AND AIMS: The Rome Foundation Global Epidemiology Study (RFGES) assessed the prevalence, burden, and associated factors of Disorders of Gut-Brain Interaction (DGBI) in 33 countries around the world. Achieving worldwide sampling necessitated use of two different surveying methods: In-person household interviews (9 countries) and Internet surveys (26 countries). Two countries, China and Turkey, were surveyed with both methods. This paper examines the differences in the survey results with the two methods, as well as likely reasons for those differences. METHODS: The two RFGES survey methods are described in detail, and differences in DGBI findings summarized for household versus Internet surveys globally, and in more detail for China and Turkey. Logistic regression analysis was used to elucidate factors contributing to these differences. RESULTS: Overall, DGBI were only half as prevalent when assessed with household vs Internet surveys. Similar patterns of methodology-related DGBI differences were seen within both China and Turkey, but prevalence differences between the survey methods were dramatically larger in Turkey. No clear reasons for outcome differences by survey method were identified, although greater relative reduction in bowel and anorectal versus upper gastrointestinal disorders when household versus Internet surveying was used suggests an inhibiting influence of social sensitivity. CONCLUSIONS: The findings strongly indicate that besides affecting data quality, manpower needs and data collection time and costs, the choice of survey method is a substantial determinant of symptom reporting and DGBI prevalence outcomes. This has important implications for future DGBI research and epidemiological research more broadly.

Comparison of the epidemiology of disorders of gut-brain interaction in four Latin American countries: Results of The Rome Foundation Global Epidemiology Study.

BACKGROUND: In Latin America, there are scarce data on the epidemiology of DGBI. The Rome Foundation Global Epidemiology Study (RFGES) Internet survey included 26 countries, four from Latin America: Argentina, Brazil, Colombia, and Mexico, with a 40.3% prevalence of Rome IV DGBI. We aimed at comparing the prevalence of DGBI and associated factors among these countries. METHODS: The frequency of DGBI by anatomical region, specific diagnoses, sex, age, diet, healthcare access, anxiety, depression, and HRQOL, were analyzed and compared. RESULTS: Subjects included Argentina n = 2057, Brazil = 2004, Colombia = 2007, and Mexico = 2001. The most common DGBI were bowel (35.5%), gastroduodenal (11.9%), and anorectal (10.0%). Argentina had the highest prevalence of functional diarrhea (p = 0.006) and IBS-D; Brazil, esophageal, gastroduodenal disorders, and functional dyspepsia; Mexico functional heartburn (all <0.001). Overall, DGBI were more common in women vs. men and decreased with age. Bowel disorders were more common in the 18-39 (46%) vs. 40-64-year (39%) groups. Diet was also different between those with DGBI vs. those without with subtle differences between countries. Subjects endorsing criteria for esophageal, gastroduodenal, and anorectal disorders from Mexico, more commonly consulted physicians for bowel symptoms vs. those from Argentina, Brazil, and Colombia. General practitioners were the most frequently consulted, by Mexicans (50.42%) and Colombians (40.80%), followed by gastroenterologists. Anxiety and depression were more common in DGBI individuals in Argentina and Brazil vs. Mexico and Colombia, and they had lower HRQOL. CONCLUSIONS: The prevalence of upper and lower DGBI, as well as the burden of illness, psychological impact and HRQOL, differ between these Latin American countries.

Circulating Levels of Sex Steroid Hormones and Gastric Cancer.

BACKGROUND AND AIMS: Men develop gastric cancer more frequently than women, yet little is known about the mechanisms underlying this sex difference. Sex steroid hormones may influence gastric cancer risk. We therefore assessed whether major circulating adrenal precursors, androgens and estrogens were associated with gastric cancer in a high-risk Mexican population. METHODS: Blood samples were collected at time of diagnosis from 50 noncardia gastric cancer patients and 50 histologically confirmed non-atrophic gastritis controls. Serum levels of estradiol, testosterone and dehydroepiandrosterone (DHEA) measured with a validated mass spectrometry method were categorized in tertiles as low (T1), middle (T2), and high (T3). Unconditional logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals (CI), adjusting for age, sex, and education. RESULTS: Levels of DHEA were inversely associated with gastric cancer (p-trend per tertile increase: <0.0001), with adjusted ORs (95% CI) of T2 and T3 (vs. T1) of 0.25 (0.09-0.70) and 0.10 (0.03-0.34), respectively. Levels of estradiol and testosterone were not significantly associated with gastric cancer. CONCLUSIONS: Our study provides evidence that higher concentration of circulating DHEA may be associated with lower risk of noncardia gastric cancer. Longitudinal studies are needed to evaluate the temporality of this association and investigate mechanisms of disease pathogenesis.

Worldwide Prevalence and Burden of Functional Gastrointestinal Disorders, Results of Rome Foundation Global Study.

BACKGROUND & AIMS: Although functional gastrointestinal disorders (FGIDs), now called disorders of gut-brain interaction, have major economic effects on health care systems and adversely affect quality of life, little is known about their global prevalence and distribution. We investigated the prevalence of and factors associated with 22 FGIDs, in 33 countries on 6 continents. METHODS: Data were collected via the Internet in 24 countries, personal interviews in 7 countries, and both in 2 countries, using the Rome IV diagnostic questionnaire, Rome III irritable bowel syndrome questions, and 80 items to identify variables associated with FGIDs. Data collection methods differed for Internet and household groups, so data analyses were conducted and reported separately. RESULTS: Among the 73,076 adult respondents (49.5% women), diagnostic criteria were met for at least 1 FGID by 40.3% persons who completed the Internet surveys (95% confidence interval [CI], 39.9-40.7) and 20.7% of persons who completed the household surveys (95% CI, 20.2-21.3). FGIDs were more prevalent among women than men, based on responses to the Internet survey (odds ratio, 1.7; 95% CI, 1.6-1.7) and household survey (odds ratio, 1.3; 95% CI, 1.3-1.4). FGIDs were associated with lower quality of life and more frequent doctor visits. Proportions of subjects with irritable bowel syndrome were lower when the Rome IV criteria were used, compared with the Rome III criteria, in the Internet survey (4.1% vs 10.1%) and household survey (1.5% vs 3.5%). CONCLUSIONS: In a large-scale multinational study, we found that more than 40% of persons worldwide have FGIDs, which affect quality of life and health care use. Although the absolute prevalence was higher among Internet respondents, similar trends and relative distributions were found in people who completed Internet vs personal interviews.

Results of the fecal immunochemical test in a colorectal cancer screening program in Mexico.

BACKGROUND: Colorectal cancer (CRC) is one of the main five causes of morbidity and mortality by oncologic diseases in our country and worldwide. Recently, fecal immunochemical test (FIT) has proven to be a noninvasive screening test that allows to select patients most likely to have a pre-malign lesion in order to perform a colonoscopy. OBJECTIVE: To report the findings of a CRC screening program using FIT in our country population. METHOD: A multicentric study was performed, by inviting open population older than 50 years to participate in a CRC screening. Quantitative FIT specific for human hemoglobin was used, with a cut point of 100 ng/ml or higher to consider as positive. Those patients with positive results were asked to undergo a colonoscopy. In the cases where polypoid lesions were found, biopsies were performed. RESULTS: In total, 751 FIT were processed, and 51 (6.8) of those were positive, with a rate of 15.9 premalign lesions for 1,000 individuals, and 1.3 patients with CRC for every 1,000. CONCLUSIONS: The present study matches worldwide reports, supporting the initiative of establishing a formal and standardized CRC screening program in the public health sector.

ANTECEDENTES: El cáncer colorrectal (CCR) es una de las cinco primeras causas de morbimortalidad por cáncer en nuestro país y en todo el mundo. La prueba inmunoquímica fecal (FIT, fecal immunochemical test) es una herramienta de tamizaje no invasiva que permite seleccionar a los sujetos con mayor probabilidad de lesión premaligna en la colonoscopia. OBJETIVO: Reportar los resultados del programa de escrutinio para CCR mediante FIT en población abierta en México. MÉTODO: Estudio multicéntrico nacional en población abierta mayor de 50 años a través de medios de difusión masiva para participar en un programa de escrutinio de CCR. Se utilizó FIT cuantitativa específica para detectar hemoglobina humana con un punto de corte de 100 ng/ml (prueba positiva). Se realizó colonoscopia a los positivos. Se tomaron biopsias dirigidas de las lesiones premalignas/cáncer para análisis histopatológico. RESULTADOS: Se procesaron 751 FIT, de las cuales 51 (6.8%) fueron positivas, con una tasa de 15.9 lesiones premalignas por cada 1,000 sujetos evaluados, y 1.3 pacientes con CCR por cada 1,000 pacientes. CONCLUSIONES: Nuestro estudio concuerda con lo reportado en la literatura mundial, apoyando así la iniciativa de fomentar el establecimiento de un tamizaje formal y estandarizado dentro del sector de salud pública.

Prevalence of pulmonary thromboembolism in patients undergoing abdominopelvic surgery with respiratory distress.

OBJECTIVE: To determine the prevalence of pulmonary thromboembolism (PET) and identify it's risk factors in patients operated on a scheduled basis, in the general surgery service from the High Specialty Medical Unit Hospital de Especialidades de Puebla, of the Mexican Social Security Institute. METHOD: Descriptive, retrospective and cross sectional study of 52 patients' records with PET and pulmonary angiotomography whose indication was respiratory distress; from 2612 operated patients from November 2015 to March 2018, the sampling was not probabilistic. The statistics was descriptive, with measures of central tendency and dispersion. Fisher test, and Rho Spearman were used. RESULTS: There were association between the development of PET and trans-surgical time (p = 0.018), with the D Dimer (p = 0.014), there was correlation between PET and Wells scale (p=0.001) and blood transfusion (p=0.044). Age, gender, body mass index, preoperative diagnosis, thromboprophylaxis, blood transfusion and surgical approach were not risk factors. CONCLUSION: The prevalence of postoperative PET in patients with respiratory distress after surgical procedure is 5.7% and the mortality is 33.3%.

OBJETIVO: Determinar la prevalencia de la tromboembolia pulmonar (TEP) e identificar sus factores de riesgo en los pacientes intervenidos en el servicio de cirugía general de manera programada de la Unidad Médica de Alta Especialidad Hospital de Especialidades de Puebla, del Instituto Mexicano del Seguro Social. MÉTODO: Estudio descriptivo, retrospectivo y transversal de 52 expedientes de pacientes con TEP y angiotomografía pulmonar cuya indicación fue la dificultad respiratoria, de 2612 pacientes operados de noviembre de 2015 a marzo de 2018. El muestreo fue no probabilístico. La estadística fue descriptiva, con medidas de tendencia central y de dispersión. Se utilizó prueba de Fisher para riesgo y Rho de Spearman. RESULTADOS: Hubo asociación entre el desarrollo de TEP y el tiempo transquirúrgico (p = 0.018), y con el dímero D (p = 0.014); hubo correlación entre la TEP y con la escala de Wells (p = 0.001) y con la transfusión de hemoderivados (p = 0.044). La edad, el sexo, el índice de masa corporal, el diagnóstico preoperatorio, la tromboprofilaxis, la transfusión de hemoderivados y el abordaje quirúrgico no fueron factores de riesgo. CONCLUSIÓN: La prevalencia de TEP posquirúrgica en pacientes que cursan con dificultad respiratoria después del procedimiento quirúrgico es del 5.7% y la mortalidad es del 33.3%.

Efficacy of the Combination of Pinaverium Bromide 100 mg Plus Simethicone 300 mg in Abdominal Pain and Bloating in Irritable Bowel Syndrome: A Randomized, Placebo-controlled Trial.

GOALS: We aimed to evaluate the efficacy and safety of PB+S (pinaverium bromide 100 mg plus simethicone 300 mg) in patients with irritable bowel syndrome (IBS). BACKGROUND: IBS is a multifactorial disorder; thus, combination therapy with different mechanisms of action is expected to be useful. PB+S has shown effectiveness in an open-label clinical study in IBS. However, there are no placebo-controlled trials. MATERIALS AND METHODS: IBS-Rome III patients with abdominal pain/discomfort for at least 2 days within the week prior to baseline assessment were included in this 12-week, randomized, double-blind, placebo-controlled study of PB+S versus placebo, bid. The primary endpoint was overall symptom improvement, evaluated weekly by the patient (Likert Scale). Secondary endpoints included the weekly improvement in the severity of abdominal pain and bloating assessed both by patients (10-cm Visual Analogue Scale) and investigators (Likert Scale); frequency of Bristol Scale stool types (consistency) evaluated by patients and the IBS Quality of Life scores. RESULTS: A total of 285 patients (female: 83%; 36.5±8.9 y old) received at least 1 dose of PB+S (n=140) or placebo (n=145). No difference was observed in overall symptom improvement between the groups (P=0.13). However, PB+S was superior in abdominal pain (effect size: 31%, P=0.038) and bloating (33%, P=0.019). Patients with IBS-C and IBS-M showed the best improvement in the frequency of stool types with PB+S. No differences were observed in IBS Quality of Life scores and adverse events. CONCLUSIONS: PB+S was superior to placebo in improving abdominal pain and bloating in patients with active IBS. The effect on the frequency of stool consistency was particularly significant in IBS-C and IBS-M.

Helicobacter pylori infection and gastroduodenal lesions in patients with systemic lupus erythematosus.

OBJECTIVE: The aim of this study was to determine the frequency of Helicobacter pylori in SLE patients and to compare clinical characteristics and gastroduodenal lesions in patients with and without H. pylori infection. METHODS: Adult SLE patients were selected and subjected to endoscopy. Gastroduodenal lesions were examined by endoscopy and biopsy (antrum and corpus). Biopsies were evaluated by hematoxylin and eosin and Giemsa staining. Immunochromatographic membrane-based assay using amplification was used to test for H. pylori antigen (coproantigen) in stool samples in all participants. Clinical characteristics and gastroduodenal lesions were compared between patients with and without H. pylori infection. RESULTS: A total of 118 SLE patients were included (mean age 44.7 ± 11.7 years, mean disease duration 11.6 ± 6.0 years), of whom 101 (85.6%) were receiving non-steroidal anti-inflammatory drugs (NSAIDs). The coproantigen test was positive in 32 (27.1%) patients. H. pylori was present in twenty six patients (22.0%) in the gastric biopsy. The frequency of gastric erosions and gastric ulcers were 55.1% and 0.8%, respectively. Gastric erosions were less frequent in SLE patients with H. pylori infection than those without H. pylori (43.5.7% vs. 62.5%; p = 0.04). The age, disease duration, disease activity, chronic damage, gastroprotective drugs, and immunosuppressive therapy did not differ between the two groups. CONCLUSIONS: We found a high frequency of H. pylori infection in SLE patients. The severity of SLE and reception of gastroprotective therapy do not seem to be related to H. pylori infection. Immunosuppressive therapy may not be protective against H. pylori infection in SLE patients.Key Points• In patients with systemic lupus erythematosus (SLE), the frequency of Helicobacter pylori infection was 39% and gastric erosions were frequent.• Disease activity, chronic damage, gastroprotective drugs, and immunosuppressive therapy may not affect the prevalence of H. pylori infection in SLE patients.

Diagnostic histopathological-ultrasonographic correlation in patients categorized as BI-RADS 4.

OBJECTIVE: To correlate ultrasonographic and histopathological diagnosis in patients categorized as breast imaging reporting and data system (BI-RADS) 4. METHOD: Cross-sectional study, performed on patients with BI-RADS 4 (A, B or C) diagnosed by ultrasonography in the high specialty medical unit, hospital of specialties, Centro Médico Nacional General de División Manuel Ávila Camacho, of the Instituto Mexicano del Seguro Social. Age, ultrasonographic and histopathological diagnosis, menarquia, menopause, gestations, lactation, use of contraceptives and family history of breast cancer were evaluated. RESULTS: 101 patients categorized BI-RADS 4 were included; average age was 53.0 ± 8.3 years old, 6.9% of the patients were nulliparous, 92.2% with positive breastfeeding and 25.7% had a family history of breast cancer. By ultrasonography, 55.4% of the cases were BI-RADS 4A, 22.8% 4B and 21.8% 4C. 75.2% of the biopsies performed on the patients were benign and 24.8% were malignant. The overall ultrasonographic-histopathological concordance index was 0.25; 0.11 for BI-RADS 4A, 0.22 for BI-RADS 4B and 0.63 for BI-RADS 4C. CONCLUSION: The ultrasound-histopathological correlation is weak and inferior to that reported in the literature.

OBJETIVO: Correlacionar el diagnóstico ultrasonográfico con el histopatológico en pacientes categorizadas como BI-RADS 4. MÉTODO: Estudio transversal en pacientes con BI-RADS 4 (A, B o C) diagnosticado por ultrasonografía en la Unidad Médica de Alta Especialidad Hospital de Especialidades Centro Médico Nacional General de División Manuel Ávila Camacho, del Instituto Mexicano del Seguro Social. Se evaluaron la edad, el diagnóstico ultrasonográfico, el resultado histopatológico, la edad de primera y última menstruación, el número de gestas, la lactancia, el uso de anticonceptivos y los antecedentes familiares de cáncer de mama. RESULTADOS: Se incluyeron 101 pacientes con BI-RADS 4, con una edad promedio de 53.0 ± 8.3 años. El 6.9% de las pacientes eran nulíparas. El 92.2% habían realizado lactancia. El 25.7% tenían antecedentes familiares de cáncer de mama. Por ultrasonografía, el 55.4% de los casos eran BI-RADS 4A, el 22.8% eran 4B y el 21.8% eran 4C. El 75.2% de las biopsias realizadas a las pacientes fueron benignas y el 24.8% fueron malignas. El índice de concordancia global ultrasonográfica-histopatológica fue de 0.25; para BI-RADS 4A fue de 0.11, para BI-RADS 4B fue de 0.22 y para BI-RADS 4C fue de 0.63. CONCLUSIÓN: La correlación ultrasonográfica-histopatológica es débil e inferior a la reportada en la literatura.

25-Hydroxyvitamin D concentrations and risk of metabolic syndrome in systemic lupus erythematosus women.

OBJECTIVE: A protective function of vitamin D in metabolic syndrome (MetS) has been described. The objective of the present study was to examine the relationship between serum 25-hydroxyvitamin D (25(OH)D) concentrations and MetS in non-diabetic systemic lupus erythematosus (SLE) women. METHODS: Cross-sectional analyses of the relationship between concentrations of 25(OH)D, MetS, and its components were made in 160 non-diabetic SLE women. MetS was defined according to National Cholesterol Education Program Adult Treatment Panel III criteria. Serum 25(OH)D was measured by chemiluminescent immunoassay. Serum 25(OH)D concentrations were categorized into quartiles (<16.6, 16.6-21.1, 21.2-26.3, ≥26.4 ng/mL). RESULTS: A total of 79 (49.3%) SLE women had MetS. Without adjusting for body mass index (BMI) or smoking, the odds of having MetS decreased according to increasing quartiles of 25(OH)D concentrations (P for trend = .03). The odds ratio (OR) of having MetS was 0.4 (95% confidence interval: 0.2-0.9, P = .04) for the highest vs the lowest quartile of 25(OH)D concentrations when adjusted by age. The crude OR of having elevated hypertriglyceridemia decreased according to increasing quartiles of 25(OH)D concentrations (P for trend = .036). However, further adjustments for BMI and smoking removed the inverse association between 25(OH)D concentrations and MetS and its individual components. CONCLUSION: In non-diabetic SLE women with mild activity, 25(OH)D concentrations are not associated with MetS and its components.

Acetilcisteína: Una actualización clínica y farmacológica sobre su efecto mucolítico. Estudio de revisión / Acetylcisteine. A clinical and pharmacological actualization with special. Reference to its mucolytic efect

The authors present a clinical and farmacological evaluation of the effect and safety of N-acetylcysteine in chronic obstructive diseases. The N-actylcysteine (NAC) is a sulphorated amino acid employed as an mucolytic agent. The efficacy and tolerability of oral NAC as compared with other agents was determined, in the mucolytic treatment on mucus hypersecretion and in the management of respiratory tract fluids and sputums from cigarette smokers, and also as a bronchial mucus fluidifying agent. A sistematic review and analysis of the effect of NAC and its effectiveness. In the treatment of acute respiratory disorders in children was determined

TAC y PET/TC con 18-FDG para evaluar la respuesta al tratamiento en linfoma de Hodgkin y no Hodgkin.

INTRODUCTION: The assessment of lymphoma response to treatment is based on imaging studies. OBJECTIVE: To correlate the assessment of lymphoma treatment response by computed tomography (CT) and by positron emission tomography/computed tomography (PET/CT). METHOD: Cross-sectional, observational study, where records of patients with lymphoma under surveillance by CT and PET/CT were reviewed. RESULTS: The study population consisted of 43 patients with a mean age of 32.7 ± 22.4 years; 26 (60.5 %) had a diagnosis of Hodgkin's lymphoma and 17 (9.5 %) had non-Hodgkin lymphoma. By CT, 34 (79.1 %) were diagnosed with disease and nine (20.9 %) without disease. The criteria used to assess the response was radiologist experience in 39 (90.7 %) and RECIST 1.1 criteria in four (9.3 %). The diagnosis by 18-FDG PET/CT was no response to treatment or partial response-recurrence in 32 (74.4 %) and response to treatment in 11 (25.6 %); with PERCIST criteria in 13 (30.2 %) and Deuaville criteria in 30 (69.8 %). When the diagnosis by CT versus 18-FDG PET/CT was compared, out of 11 patients with complete response on PET/CT, three had a similar CT diagnosis. Of the 34 patients with data consistent disease diagnosed by CT, 26 had similar results by 18-FDG PET/CT (p = 0.54). CONCLUSION: The value of lymphoma treatment response on CT does not agree with that obtained by 18-FDG PET/CT.

INTRODUCCIÓN: La evaluación de la respuesta al tratamiento de linfoma se basa en estudios de imagen. OBJETIVO: Correlacionar la evaluación de la respuesta al tratamiento de linfoma mediante tomografía axial computarizada (TAC) y tomografía por emisión de positrones/tomografía computarizada (PET/TC). MÉTODO: Estudio observacional transversal en el que se revisaron expedientes de pacientes con linfoma en vigilancia mediante TAC y PET/TC. RESULTADOS: La población de estudio estuvo constituida por 43 pacientes con edad media de 32.7 ± 22.4 años; 26 (60.5 %) tenían diagnóstico de linfoma de Hodgkin y 17 (9.5 %), de linfoma no Hodgkin. Por TAC se diagnosticaron 34 (79.1 %) con enfermedad y nueve (20.9 %) sin enfermedad. El criterio para evaluar la respuesta fue la experiencia del médico imagenólogo en 39 (90.7 %) y RECIST 1.1 en cuatro (9.3 %). Por PET/TC con 18-FDG se diagnosticó falta de respuesta al tratamiento o respuesta parcial-recurrencia en 32 pacientes (74.4 %) y con respuesta al tratamiento en 11 (25.6 %); con los criterios PERCIST en 13 (30.2 %) y con los de Deuaville en 30 (69.8 %). Al comparar el diagnóstico por TAC contra PET/TC, de 11 pacientes con respuesta total, tres tuvieron diagnóstico tomográfico similar. De los 34 pacientes con datos de enfermedad diagnosticados por tomografía, 26 tuvieron resultados similares por PET/TC con 18-FDG (p = 0.54). CONCLUSIÓN: El valor de la respuesta al tratamiento por TAC en linfoma no concuerda con el obtenido mediante PET/TC con 18-FDG.

Functional gastrointestinal disorders in women with systemic lupus erythematosus: A case-control study.

BACKGROUND: Systemic lupus erythematosus (SLE) is an autoimmune disease with multisystemic involvement. Gastrointestinal (GI) manifestations are frequent but functional gastrointestinal disorders (FGIDs) have scarcely been studied in SLE. To determine the prevalence of FGIDs and their potential risk factors in SLE female patients vs controls. METHODS: Systemic lupus erythematosus patients meeting the American College of Rheumatology (ACR) criteria and controls completed the Rome III questionnaire for FGIDs and a structured interview to assess sociodemographic, clinical, and treatment variables after excluding organic GI diseases. Logistic regression was used to determine risk factors (ie, alcohol drinking, medications) for FGIDs. KEY RESULTS: Responders included 113 SLE patients and 122 age-matched controls. The presence of at least one FGIDs was higher in SLE (73.4%) vs controls (54.1%), P = .003. The most frequent FGIDs in SLE patients were nausea and vomiting disorders (NVD), belching disorders, globus, anorectal pain, functional heartburn (FH), and functional bloating (FB). After adjustment for confounding variables, SLE was associated with NVD (OR: 7.1, 95% CI: 2.7-19.1) globus (3.5, 1.3-9.3), anorectal pain (3.4, 1.4-8.4), and FH (2.5, 1.5-4.4). The simultaneous presence of >1 FGID was more common in SLE patients than controls (69.8% vs 31.8%). Glucocorticoids (5.2, 1.3-19.9) and non-steroidal anti-inflammatory drugs (NSAIDs; 3.0, 1.1-8.0) were associated with any FGID in SLE patients while alcohol drinking with gallbladder/sphincter of Oddi disorders 7.4 (1.1-47.3). CONCLUSIONS AND INFERENCES: Functional gastrointestinal disorders are more frequent in SLE patients compared with controls. Medication that may alter gastrointestinal homeostasis, such as glucocorticoids and NSAIDs, are potential risk factors for FGIDs in SLE.

TAC y PET/TC con 18-FDG para evaluar la respuesta al tratamiento en linfoma de Hodgkin y no Hodgkin / CT and PET/CT with 18-FDG to evaluate the response to treatment in Hodgkin's and non-Hodgkin's lymphoma

Resumen Introducción: La evaluación de la respuesta al tratamiento de linfoma se basa en estudios de imagen. Objetivo: Correlacionar la evaluación de la respuesta al tratamiento de linfoma mediante tomografía axial computarizada (TAC) y tomografía por emisión de positrones/tomografía computarizada (PET/TC). Método: Estudio observacional transversal en el que se revisaron expedientes de pacientes con linfoma en vigilancia mediante TAC y PET/TC. Resultados: La población de estudio estuvo constituida por 43 pacientes con edad media de 32.7 ± 22.4 años; 26 (60.5 %) tenían diagnóstico de linfoma de Hodgkin y 17 (9.5 %), de linfoma no Hodgkin. Por TAC se diagnosticaron 34 (79.1 %) con enfermedad y nueve (20.9 %) sin enfermedad. El criterio para evaluar la respuesta fue la experiencia del médico imagenólogo en 39 (90.7 %) y RECIST 1.1 en cuatro (9.3 %). Por PET/TC con 18-FDG se diagnosticó falta de respuesta al tratamiento o respuesta parcial-recurrencia en 32 pacientes (74.4 %) y con respuesta al tratamiento en 11 (25.6 %); con los criterios PERCIST en 13 (30.2 %) y con los de Deuaville en 30 (69.8 %). Al comparar el diagnóstico por TAC contra PET/TC, de 11 pacientes con respuesta total, tres tuvieron diagnóstico tomográfico similar. De los 34 pacientes con datos de enfermedad diagnosticados por tomografía, 26 tuvieron resultados similares por PET/TC con 18-FDG (p = 0.54). Conclusión: El valor de la respuesta al tratamiento por TAC en linfoma no concuerda con el obtenido mediante PET/TC con 18-FDG.

Abstract Introduction: The assessment of lymphoma response to treatment is based on imaging studies. Objective: To correlate the assessment of lymphoma treatment response by computed tomography (CT) and by positron emission tomography/computed tomography (PET/CT). Method: Cross-sectional, observational study, where records of patients with lymphoma under surveillance by CT and PET/CT were reviewed. Results: The study population consisted of 43 patients with a mean age of 32.7 ± 22.4 years; 26 (60.5 %) had a diagnosis of Hodgkin’s lymphoma and 17 (9.5 %) had non-Hodgkin lymphoma. By CT, 34 (79.1 %) were diagnosed with disease and nine (20.9 %) without disease. The criteria used to assess the response was radiologist experience in 39 (90.7 %) and RECIST 1.1 criteria in four (9.3 %). The diagnosis by 18-FDG PET/CT was no response to treatment or partial response-recurrence in 32 (74.4 %) and response to treatment in 11 (25.6 %); with PERCIST criteria in 13 (30.2 %) and Deuaville criteria in 30 (69.8 %). When the diagnosis by CT versus 18-FDG PET/CT was compared, out of 11 patients with complete response on PET/CT, three had a similar CT diagnosis. Of the 34 patients with data consistent disease diagnosed by CT, 26 had similar results by 18-FDG PET/CT (p = 0.54). Conclusion: The value of lymphoma treatment response on CT does not agree with that obtained by 18-FDG PET/CT.

Expression of metalloproteinase-9 in patients with mild and severe forms of gastroesophageal reflux disease.

BACKGROUND: Gastroesophageal reflux disease develops when the stomach contents causes troublesome symptoms and complications. Mild forms are non-erosive and erosive esophagitis, and severe forms are Barrett's esophagus and Esophageal adenocarcinoma. Matrix metalloproteinases are endopeptidases that can degrade components of the extracellular matrix, they play an important role in tumor invasion as well as in metastasis. OBJECTIVE: To correlate the expression of metalloproteinase 9 (MMP-9) in esophageal biopsies from patients with mild and severe forms of Gastroesophageal reflux disease. METHOD: Cross-sectional study. The expression of MMP-9 was determined in biopsies of esophageal tissue of patients with mild and severe GRD. The included variables were age, sex, diagnosis, smoking and alcoholic habits, body mass index (BMI) and expression of MMP-9. Descriptive statistics was performed, Kappa for concordance in diagnosis as well as X2. RESULTS: There were 50 patients, 32 (64%) men and 18 (36%) women, mean age 52.13 ± 14.75 years of age. 12 (24%) with smoking and 7 (14%) with alcoholism. Average BMI was 26.71 ± 4.07 kg/m2 (15 to 33); 40 (80%) with obesity. The inter observer concordance for histopathological diagnosis was 1.0 and 0.84 for esophagitis degrees. 27 (54%) patients had esophagitis, 16 (32%) Barrett's esophagus and 7 (14%) esophageal cancer. There was expression of MMP-9 in four patients with esophagitis, five with Barrett's esophagus and five with esophageal cancer. Statistical significance was found between the expression of MMP-9 and smoking (p = 0.011) and histopathological diagnosis (p = 0.052). CONCLUSIONS: The expression of MMP-9 is most common in severe forms compared to the mild forms of GRD.

ANTECEDENTES: La enfermedad por reflujo gastroesofágico (ERGE) se desarrolla cuando el contenido estomacal ocasiona síntomas molestos o complicaciones. Las formas leves son esofagitis no erosiva y erosiva; las graves, esófago de Barrett y adenocarcinoma esofágico. Las metaloproteinasas de la matriz degradan componentes de la matriz extracelular, y tienen un papel importante en la invasión tumoral y la metástasis. OBJETIVO: Relacionar la expresión de la metaloproteinasa-9 (MMP-9) en biopsias esofágicas de pacientes con formas leves y graves de ERGE. MÉTODO: Estudio transversal. Se determinó la expresión de MMP-9 en biopsias esofágicas de pacientes con ERGE grave y leve. Las variables fueron edad, sexo, diagnóstico, tabaquismo, alcoholismo, índice de masa corporal (IMC) y expresión de MMP-9. Se realizó estadística descriptiva, concordancia para el diagnóstico y prueba de ji al cuadrado. RESULTADOS: 50 pacientes, 32 (64%) hombres y 18 (36%) mujeres, con edad media de 52.13 ± 14.75 años. Doce (24%) fumadores y 7 (14%) con alcoholismo. El IMC promedio fue de 26.71 ± 4.07 kg/m2 (rango: 15-33); 40 (80%) eran obesos. La concordancia entre observadores para el diagnóstico histopatológico fue de 1.0, y de 0.84 para esofagitis. Veintisiete (54%) tuvieron esofagitis, 16 (32%) esófago de Barrett y 7 (14%) cáncer de esófago. Hubo expresión de MMP-9 en cuatro pacientes con esofagitis, cinco con esófago de Barrett y cinco con cáncer esofágico. Encontramos diferencia estadísticamente significativa entre la expresión de MMP-9 y el tabaquismo (p = 0.011) y el diagnóstico histopatológico (p = 0.052). CONCLUSIONES: La expresión de MMP-9 es más frecuente en las formas graves que en las leves de ERGE.

Síndromes Geriátricos en pacientes de primer nivel de atención médica / Geriatric Syndromes in first level patients

Objetivo: Identificar la frecuencia de síndromes geriátricos en una unidad de primer nivel de atención médica. Material y Métodos: Estudio descriptivo, observacional, prospectivo, transversal, realizado en 376 pacientes de primer nivel de atención. Se utilizaron las escalas de Yesavage y de Katz evaluando depresión y autonomía respectivamente. Para fines de este estudio se interrrogó la presencia de incontinencia urinaria, polifarmacia, trastornos del sueño y estado nutricional. Utilizamos estadística descriptiva. Resultados: 376 pacientes, 219 (58%) femeninos, 157 (42%) masculinos, edad promedio 72.57, mínima: 65, máxima: 95, desviación estándar: ± 7.08. Se observó por lo menos un síndrome en 371 (98.7%) pacientes. La depresión se detectó en 303 (80.9%), la polifarmacia se observó en 282 (75%), en cuanto a los trastornos del sueño se encontraron en 262 (69.7%), las caídas se encontraron en 63 (16.8%), la incontinencia urinaria en 19 (5.1%), en cuanto a la obesidad en 15 (4%) y de la pérdida de la autonomía en 3 (0.8%). Conclusión: El 98.7 % padecen por lo menos un síndrome geriátrico, el género femenino es el más afectado, el síndrome más frecuente es depresión, seguida de polifarmacia, trastorno del sueño, caídas, incontinencia urinaria, obesidad y pérdida de la autonomía (AU)

AIM: to identify the frequency of Geriatric syndromes in a Single First Level Medical Facility. Material and methods: observational, prospective, cross-sectional, study held in 376 patients from First Level Medical Facility. We usedYesavage and Katz scales to evaluate depression and autonomy respectively. For this purpose we interrogate: urinary incontinence, polypharmacy, sleep disturbances and nutritional status. Results: 376 patients, 219 female, 157 male, median age 72, SD 7.08, mínimun 65, maximum 95 years. From the total of patients 303 (80.9%) was in depresion, 282 (75%) with polypharmacy, 262 (69.7%) on sleep disturbances, 63 (16.8%) of the falling down was found it, 19 (5.1%) urinary incontinence, 15 (4%) under obesity, and 3 (0.8%) with loss of the autonomy. conclusions: Geriatric syndrome is presented in more than 90%, female are most affected and depression is the most common syndrome (AU)

Associations between resilience and sociodemographic factors and depressive symptoms in women with systemic lupus erythematosus.

OBJECTIVE: To compare resilience in women with SLE and healthy women and determine whether sociodemographic factors and depressive symptoms were associated with resilience in patients with SLE. METHODS: This was a cross-sectional study. Participants were 123 women with SLE according to the ACR criteria and 132 age-matched healthy women (median = 45 (IQR = 34-54) years). Scales administered were: SLEDAI-2 K for disease activity, Graffar method, SLICC damage index, Center for Epidemiologic Studies Depression Scale, and the Spanish version of the Resilience Scale of Wagnild and Young. The statistical analysis was made using the Student t, Mann Whitney, Chi-square, and Spearman's Rho tests and multivariate analysis with a generalized linear model (GLM). Statistical significance was set as p < .05. RESULTS: There were no differences in resilience scores between women with SLE and healthy women (median = 80, IQR = 75-87 vs. median = 80, IQR = 74-86.75, p = .38), although patients with SLE had higher self-efficacy scores (median = 47 IQR = 43-50 vs. median = 45, IQR = 42-48, p = .002) and depressive symptoms (median = 10, IQR = 5-18 vs. median = 8, IQR = 5-18, p = .01). The overall resilience score correlated with depressive symptoms (r = -0.537, p < .01). The GLM showed no association between sociodemographic factors and resilience in patients with SLE. CONCLUSIONS: Resilience did not differ between women with SLE and healthy women. In patients with SLE, depressive symptoms may influence resilience and its domains, but sociodemographic factors do not. PUBLIC HEALTH SIGNIFICANCE STATEMENT: The results suggest that resilience was similar between females with systemic lupus erythematosus (SLE) and age-matched healthy women. Depressive symptoms correlated negatively with resilience in patients with SLE. Sociodemographic factors were not associated with resilience in patients with SLE.

Relación entre la saturación central venosa de oxígeno >_ 70% y la mortalidad en el choque séptico / Determination of the ratio of central venous oxygen saturation (ScvO2) > 70% mortality in septic shock. Patients admitted to pediatric intensive care unit

Objetivo: Determinar la Relación de la saturación central venosa de oxígeno (ScvO2) >_70% con la mortalidad, en el choque séptico en pacientes que ingresan al servicio de terapia intensiva pediátrica del HGR 36, Puebla. Métodos: Estudio, descriptivo, longitudinal, observacional. Se identificaron todos los pacientes de un mes a 14 años de edad que ingresaron a unidad de terapia intensiva con el diagnóstico de choque séptico. Se corroboró la colocación de un catéter venoso central para la medición de la ScvO2 a su ingreso y las 6 horas. Calificamos con el Indice Pediátrico de Mortalidad (PIM2) para medir el riesgo de mortalidad en cada paciente. Se realizó estadística descriptiva. Resultados: Fueron 15 pacientes, 8 (53.3%) femeninos y 7 (46.7%) masculinos. El PIM2 obtuvo un promedio de 7.42 % al ingreso, y a las 6 horas fue de 13.4%. El promedio de la saturación venosa central de oxígeno al ingreso de los pacientes a la terapia intensiva pediátrica fue de 56% y a las 6 horas el promedio alcanzó 71%. Ningún paciente falleció durante la reanimación cardiiopulmonar desde su ingreso. Conclusión: En base a los resultados anteriores podemos concluir, que no hay una correlación entre la ScvO2 >_ 70% y la mortalidad en los pacientes pediátricos con choque séptico

Objective: To determine the ratio of central venous oxygen saturation (ScvO2) >_ 70% mortality in septic shock patients admitted to pediatric intensive care unit of the HGR 36, Puebla. Methods: A descriptive, longitudinal, observational study. We identified all patients from one month to 14 years of age who were admitted to ICU with a diagnosis of septic shock. It confirmed the placement of a central venous atheter for the measurrement of income and ScvO2 to 6 hours. Qualified with the Pediatric Index of Mortality (PIM2) to measure the risk of death in each patient. We performed descriptive statistics. Results: there were 15 patients,eight (53.3%) female and 7 (46.7%) male. The PIM2 obtained an average of 7.42%. To entry, and 6 hours was 13.4%. The mean central venous oxygen saturation on admission of patients to the pediatric intensive care was 56% and 6 hours on average reached 71%. No patient died during cardiopulmonary resuscitation from your income. Conclusion: Based on previous results we can conclude that there is no coelation between ScvO2 >_70% and mortality in pediatric patients with septic shock