Enteropathogenic Escherichia coli modulates the virulence and pathogenicity of Entamoeba dispar.

Amoebiasis is a disease caused by Entamoeba histolytica, affecting the large intestine of humans and occasionally leading to extra-intestinal lesions. Entamoeba dispar is another amoeba species considered commensal, although it has been identified in patients presenting with dysenteric and nondysenteric colitis, as well as amoebic liver abscess. Amoebic virulence factors are essential for the invasion and development of lesions. There is evidence showing that the association of enterobacteria with trophozoites contributes to increased gene expression of amoebic virulence factors. Enteropathogenic Escherichia coli is an important bacterium causing diarrhea, with high incidence rates in the world population, allowing it to interact with Entamoeba sp. in the same host. In this context, this study aims to evaluate the influence of enteropathogenic Escherichia coli on ACFN and ADO Entamoeba dispar strains by quantifying the gene expression of virulence factors, including galactose/N-acetyl-D-galactosamine-binding lectin, cysteine proteinase 2, and amoebapores A and C. Additionally, the study assesses the progression and morphological aspect of amoebic liver abscess and the profile of inflammatory cells. Our results demonstrated that the interaction between EPEC and ACFN Entamoeba dispar strains was able to increase the gene expression of virulence factors, as well as the lesion area and the activity of the inflammatory infiltrate. However, the association with the ADO strain did not influence the gene expression of virulence factors. Together, our findings indicate that the interaction between EPEC, ACFN, and ADO Entamoeba dispar strains resulted in differences in vitro and in vivo gene expression of Gal/GalNAc-binding lectin and CP2, in enzymatic activities of MPO, NAG, and EPO, and consequently, in the ability to cause lesions.

Dynamic hyperinflation on exercise and its relationship with lung mechanics at rest in adults with central obesity.

This study aimed to evaluate the presence of dynamic hyperinflation (DH) during the Glittre-ADL test (TGlittre) coupled to the dynamic ventilation measurements in people with central obesity (pwCO) and to correlate it with lung mechanics at rest. Sixty-four pwCO underwent TGlittre and the following resting lung function tests: spirometry and impulse oscillometry system (IOS). On TGlittre, 22 participants presented DH at the end of the test (DH group), while 42 did not present DH (NDH group). Body mass index (BMI), waist circumference (WC), and hip circumference (HC) were higher in the DH group than in the NDH group. IOS abnormalities were more common in the DH group compared to the NDH group. TGlittre time significantly correlated with BMI, WC, waist-to-hip ratio (WHR), and neck circumference (NC). Delta inspiratory capacity correlated significantly with WC, HC, NC, and resonance frequency measured by IOS. Thus, pwCO perform worse on TGlittre, and DH is frequent in those with higher anthropometric indices and worse lung mechanics.

New Insights into Cutaneous Asepsis: Synergism between Pfaffia and Rosemary Extracts.

(1) Background: In hospitals, medical and dental clinics, antiseptics or disinfectants play an essential role in the control of nosocomial infections. This study aimed to evaluate R. officinalis and P. paniculata glycolic extracts regarding: (I) their antimicrobial action on planktonic and biofilm (monotypic and cutaneous biofilm model-S. aureus, S. epidermidis and C. acnes); and (II) their cytotoxicity on human keratinocytes (HaCaT). (2) Methods: Minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) were performed (CLSI protocol M7-A6 and M11-A8). MTT analysis was used to evaluate the antibiofilm activity of the extracts on biofilms and their cytotoxicity on human keratinocytes. (3) Results: The combined glycolic extracts MIX A (75% P. paniculata + 25% R. officinalis); MIX B (50% P. paniculata + 50% R. officinalis); and MIX C (25% P. paniculata + 75% R. officinalis) promoted MBC values by 50 mg/mL on S. aureus, absent on S. epidermidis, and ranged 6.25-50 mg/mL for C. acnes. The cutaneous biofilm model was reduced more than 90%. In addition, it showed biocompatibility with human keratinocytes, resulting in percentages of viability greater than 50%. (4) Conclusions: The combination of extracts promoted antimicrobial action on planktonic cultures, and monotypic and heterotypic biofilms of skin pathogens. Additionally, these extracts are biocompatible against human keratinocytes.

Polipectomia a frio: um procedimento seguro para remover pequenas lesões colorretais não pediculadas / Cold snare polypectomy: a safe procedure for removing small non-pedunculated colorectal lesions

ABSTRACT Background: Polypectomy is an important treatment option for preventing colorectal cancer. Incomplete polyp resection (IPR) is re­cognized as a risk factor for interval cancer. Objective: The primary objective was to evaluate the complete polyp resection (CPR) rate for cold snare polypectomy (CSP) in small non-pedunculated polyps and, secondarily, specimen retrieval and complication rates. Methods: We prospectively evaluated 479 polyps <10 mm removed by CSP in 276 patients by an inexperienced endoscopist. Results: A total of 476 polyps (99.4%) were resected en bloc. A negative margin (classified as CPR) was observed in 435 polyps (90.8%). An unclear or positive margin (classified as IPR) was observed in 43 cases (9.0%) and 1 case (0.2%), respectively, for an overall IPR rate of 9.2% (44/479). The IPR rate was 12.2% in the first half of cases and 5.9% in the second half (P=0.02). Dividing into tertiles, the IPR rate was 15.0% in the first tertile, 6.9% in the second tertile, and 5.7% in the third tertile (P=0.01). Dividing into quartiles, the IPR rate was 15.8% in the first quartile and 5.9% in the fourth quartile (P=0.03). The IPR rate was 6.3% for type 0-IIa lesions and 14.1% for type 0-Is lesions (P=0.01). For serrated and adenomatous lesions, the IPR rate was 9.2%. Specimen retrieval failed in 3.6% of cases. Immediate bleeding (>30 s) occurred in 1 case (0.2%), treated with argon plasma coagulation. No delayed bleeding or perforation occurred. Conclusion: CSP is a safe technique that provides good results for the resection of small non-pedunculated polyps, with a short learning curve.

RESUMO Contexto: A polipectomia é uma importante opção terapêutica na prevenção do câncer colorretal (CCR). A ressecção incompleta do pólipo (RIP) é reconhecida como fator de risco para o câncer de intervalo. Objetivo: O principal objetivo foi avaliar o índice de ressecção completa da polipectomia a frio (PF) em pequenos pólipos não pediculados e, secundariamente, a recuperação do espécime e índice de complicações. Métodos: Avaliamos prospectivamente 479 pólipos <10 mm removidos por PF em 276 pacientes, por um endoscopista sem experiência com este método. Resultados: Foram ressecados em bloco 476 pólipos (99,4%). Tivemos margem negativa, considerada ressecção completa do pólipo (RCP), em 435 (90,8%) casos. Margem indefinida ou positiva (classificada como RIP) foi observada em 43 (9,0%) casos e em 1 (0,2%) caso, respectivamente, com um índice global de RIP de 9,2% (44/479). O índice de RIP foi de 12,5% na primeira metade dos casos e 5,9% na última metade (P=0,02). Dividindo em tercis, o índice de RIP foi de 15,0% no primeiro terço, 6,9% no segundo terço e 5,7% no terceiro quarto, P=0,01. Dividindo em quartis, o índice de RIP foi de 15,8% no primeiro quarto, enquanto o último quarto foi de 5,9%, P=0,03. O índice de RIP foi de 6,3% para lesões tipo 0-IIa e de 14,1% para lesões tipo 0-Is, P=0,01. O índice de RIP foi de 9,2% para lesões serrilhadas e adenomatosas. Houve falha na recuperação dos espécimes em 3,6% dos casos. Sangramento imediato (>30 s) ocorreu em um caso (0,2%), controlado com plasma de argônio. Sem sangramento tardio e perfuração. Conclusão: PF é uma técnica segura que apresenta bons resultados para a ressecção de pequenas lesões não pediculadas, com uma curta curva aprendizado.

CAN BLUE LASER IMAGING COLLABORATE IN THE DIFFERENTIAL DIAGNOSIS BETWEEN NEOPLASTIC AND NON-NEOPLASTIC COLORECTAL LESIONS? / PODE O BLUE LASER IMAGING COLABORAR NO DIAGNÓSTICO DIFERENCIAL ENTRE LESÕES NEOPLÁSICAS E NÃO NEOPLÁSICAS COLORRETAIS?

Introduction: Improved endoscopic imaging allows the differential diagnosis of colorectal lesions in real time through the study of the microvasculature. Objective: To review the use of Blue Laser Imaging (BLI) in analyzing the capillary patern for the differential diagnosis between neoplastic and non-neoplastic lesions. Method: This is an integrative review of the literature that collected information published on virtual platforms in Portuguese and English. The search for reading and analysis was carried out on the SciELO ­ Scientific Electronic Library Online, Google Scholar, Pubmed and Scopus platforms. The descriptors taken from DeCS/MESH were: "Blue laser imaging. Endoscopy. Chromoendoscopy, Colorectal polyps. Magnification" and its English counterparts "Blue laser imaging. Image-enhanced endoscopy. Chromoendoscopy. Colorectal polyps. Magnification" with AND or OR search, considering the title and/or abstract. Only those that had the greatest correlation to the topic were included, and the review was based on them, with reading, in full, of the texts. Results: In the end, 22 articles resulted that made up this review. Conclusion: BLI associated with magnification showed good results in real-time predictive histological diagnosis for colon and rectal lesions.

Introdução: Imagem endoscópica aprimorada permite o diagnóstico diferencial das lesões colorretais em tempo real através do estudo da microvasculatura. Objetivo: Revisar o uso do Blue Laser Imaging (BLI) na análise do padrão dos capilares para o diagnóstico diferencial entre lesões neoplásicas e não neoplásicas. Método: Esta é revisão integrativa da literatura  que colheu informações publicadas em plataformas virtuais em português e inglês. A busca para leitura e análise foi realizada nas plataformas SciELO ­ Scientific Electronic Library Online, Google Scholar, Pubmed e Scopus.  Os descritores retirados do DeCS/MESH foram: "Blue laser imaging. Endoscopia. Cromoendoscopia, Pólipos colorretais. Magnificação" e seus correspondentes em inglês "Blue laser imaging. Image-enhanced endoscopy. Chromoendoscopy. Colorectal polyps. Magnification" com busca AND ou OR, considerando o título e/ou resumo. Foram incluídos somente os que tivessem maior correlação ao tema, e neles foi baseada a revisão com leitura, na íntegra, dos textos. Resultados: Ao final resultaram  22 artigos que compuseram esta revisão. Conclusão: BLI associada à magnificação mostrou bons resultados no diagnóstico histológico preditivo em tempo real para as lesões de cólon e reto.

Antral plexiform fibromyxoma: case report of a rare mesenchymal neoplasm

Plexiform fibromyxoma (PF) is a rare mesenchymal neoplasm of the stomach usually arising in the gastric antrum, and its main differential diagnosis is gastrointestinal stromal tumor. Most common symptoms are hematemesis, anemia. Immunohistochemically, positivity for smooth muscle actin (SMA) and vimentin suggests the diagnosis of PF. We report the case of a 56-year-old female patient with a 30- day history of nausea at presentation 4 years ago. Gastroscopy at that time revealed a subepithelial lesion (SEL) in the gastric antrum, measuring approximately 20 mm in diameter, with leakage of serous fluid after biopsy. Histopathology showed only an inflammatory process. Follow-up gastroscopies were performed 24, 36, and 48 months later, with surveillance biopsy at each follow-up. The last gastroscopies showed changes in lesion appearance, reduction in size, and absence of fluid leakage. Histopathology showed bland spindle cell proliferation, with a vaguely plexiform/multinodular pattern, in a fibromyxoid stroma with an arborizing capillary network without mitoses. The tumor cells were positive for SMA and negative for DOG1, CD117, CD34, S100, desmin, EMA, CD10, calponin, and beta-catenin. The choice of treatment and follow-up depends on the SEL features, but because no cases of malignancy or metastatic disease have previously been reported, the patient chose a conservative approach.

El fibromixoma plexiforme (FP) es una rara neoplasia mesenquimatosa del estómago que generalmente surge en el antro gástrico. Su principal diagnóstico diferencial es el tumor del estroma gastrointestinal. Los síntomas más comunes de los FP son hematemesis y anemia. Inmunohistoquímicamente, la positividad para actina del músculo liso (SMA) y vimentina sugieren el diagnóstico de FP. Presentamos el caso de una paciente de 56 años de edad que inicia su enfermedad hace 4 años con náuseas de 30 días de evolución. La primera gastroscopia reveló una lesión subepitelial (SEL) en el antro gástrico, de aproximadamente 20 mm de diámetro, con fuga de líquido seroso después de la biopsia. La histopatología mostró sólo un proceso inflamatorio. Se realizaron gastroscopias de seguimiento a los 24, 36 y 48 meses con biopsia de vigilancia en cada seguimiento. Las gastroscopias siguientes mostraron cambios en la apariencia de la lesión, reducción de tamaño y ausencia de fuga de líquido. La última histopatología mostró una proliferación blanda de células fusiformes, con un patrón vagamente plexiforme/multinodular, en un estroma fibromixoide con una red de capilares arborizantes sin mitosis. Las células tumorales fueron positivas para SMA y negativas para DOG1, CD117, CD34, S100, desmina, EMA, CD10, calponina y beta-catenina. La elección del tratamiento y el seguimiento depende de las características del SEL, sin embargo, por ser una enfermedad que no presentaba rasgos de enfermedad maligna o metastásica, el paciente eligió un mantener un enfoque conservador.

Manejo de la enfermedad arterial periférica con uso de guía dúplex(salvamento de extremidad) en un hospital de tercer nivel de Bogotá (Colombia) / Management of peripheral arterial disease with the use of a duplex guide (limb salvage) in a hospital of third level in Bogota (Colombia)

Introducción: la enfermedad arterial periférica (EAP) se considera una patología infradiagnosticada que afecta a cerca de doscientos millones de personas y se asocia con una alta carga de morbimortalidad. En muchos casos, se prefiere el manejo endovascular sobre el quirúrgico abierto, especialmente en pacientes con múltiples comorbilidades, que limitan este último abordaje. Sin embargo, presenta limitaciones relacionadas con el uso de medio de contraste en pacientes que adicionalmente presentan múltiples comorbilidades, incluyendo enfermedad renal, que podría comprometer su patología de base. Por esto, surge la necesidad de implementar un método que limite el uso de contraste sin comprometer el éxito técnico del procedimiento. Objetivo: describir las características de las lesiones arteriales, los resultados posquirúrgicos y las complicaciones de los pacientes que recibieron manejo de la EAP vía endovascular bajo guía ultrasonográfica. Materiales y métodos: se realizó un análisis retrospectivo de los pacientes que recibieron tratamiento endovascular bajo guía ultrasonográfica para el tratamiento de EAP con amenaza de la extremidad y su resultado posoperatorio durante el periodo comprendido entre enero de 2018 y enero de 2022 en el Hospital Universitario Samaritana (Bogotá, Colombia). Resultados: se identificaron un total de 40 pacientes con 3 tipos de lesiones, incluyendo estenosis, oclusiones y lesiones mixtas, que fueron intervenidas con angioplastia con balón o con stent o trombectomías, todos bajo guía ultrasonográfica. La principal complicación asociada fue el pseudoaneurisma posterior a la retirada del catéter arterial en el 22,5 % de las ocasiones, seguida de la disección arterial, en el 13 % de las veces. Se consideró éxito posquirúrgico en el 92,7 % de los pacientes, evidenciado por mejoría en el porcentaje de velocidad pico sistólica final o en la morfología de la...(AU)

Introduction: peripheral arterial disease (PAD) is considered an underdiagnosed pathology that affects nearly 200 million people and is associated with a high burden of morbidity and mortality. In many cases, endovascular management is preferred over open surgery, especially in patients with multiple comorbidities that limit the latter approach. However, it has limitations related to the use of contrast medium in the context of patients who addi- tionally have multiple comorbidities, including kidney disease, which can compromise their underlying pathology. Therefore, the need arises to implement a method that limits the use of contrast, without compromising the technical success of the procedure. Materials and methods: a retrospective analysis of those patients who received endovascular treatment under ultrasonography guidance for the treatment of acute limb ischemia and their postoperative outcome. Objective: describe the characteristics of the arterial lesions, the post-surgical results and the complications of the patients who received management of arterial occlusive disease with extremity threat by endovascular approach under ultrasonographic guidance, at the University Hospital La Samaritana (Bogotá, Colombia) between 2018 - 2022. Results: a total of 40 patients were identified with 3 types of lesions including stenosis, and mixed lesions. Those patients received either balloon angioplasty, angioplasty with stent or thrombectomies. The main associated complication was pseudoaneurysm after arterial catheter removal in 22.5 %, followed by arterial dissection in 13 %. Post-surgical success was considered in 92.7 % of patients, evidenced either on the improvement in the percentage of final peak systolic velocity or in the morphology of the artery distal to the intervened segment.Conclusion: The use of ultrasonography as a guide for endovascular procedures is presented as an alternative to conventional angiography, with good success rates.(AU)

Antral plexiform fibromyxoma: case report of a rare mesenchymal neoplasm.

Plexiform fibromyxoma (PF) is a rare mesenchymal neoplasm of the stomach usually arising in the gastric antrum, and its main differential diagnosis is gastrointestinal stromal tumor. Most common symptoms are hematemesis, anemia. Immunohistochemically, positivity for smooth muscle actin (SMA) and vimentin suggests the diagnosis of PF. We report the case of a 56-year-old female patient with a 30-day history of nausea at presentation 4 years ago. Gastroscopy at that time revealed a subepithelial lesion (SEL) in the gastric antrum, measuring approximately 20 mm in diameter, with leakage of serous fluid after biopsy. Histopathology showed only an inflammatory process. Follow-up gastroscopies were performed 24, 36, and 48 months later, with surveillance biopsy at each follow-up. The last gastroscopies showed changes in lesion appearance, reduction in size, and absence of fluid leakage. Histopathology showed bland spindle cell proliferation, with a vaguely plexiform/multinodular pattern, in a fibromyxoid stroma with an arborizing capillary network without mitoses. The tumor cells were positive for SMA and negative for DOG1, CD117, CD34, S100, desmin, EMA, CD10, calponin, and beta-catenin. The choice of treatment and follow-up depends on the SEL features, but because no cases of malignancy or metastatic disease have previously been reported, the patient chose a conservative approach.

Pode o Blue Laser Imaging colaborar no diagnóstico diferencial entre lesões neoplásicas e não neoplásicas colorretais? / Can Blue Laser Imaging collaborate in the differential diagnosis between neoplastic and non-neoplastic colorectal lesions?

Introdução: Imagem endoscópica aprimorada permite o diagnóstico diferencial das lesões colorretais em tempo real através do estudo da microvasculatura. Objetivo: Revisar o uso do Blue Laser Imaging (BLI) na análise do padrão dos capilares para o diagnóstico diferencial entre lesões neoplásicas e não neoplásicas. Métodos: Esta é revisão integrativa da literatura que colheu informações publicadas em plataformas virtuais em português e inglês. A busca para leitura e análise foi realizada nas plataformas SciELO ­ Scientific Electronic Library Online, Google Scholar, Pubmed e Scopus. Os descritores retirados do DeCS/MESH foram: "Blue laser imaging. Endoscopia. Cromoendoscopia, Pólipos colorretais. Magnificação" e seus correspondentes em inglês "Blue laser imaging. Image-enhanced endoscopy. Chromoendoscopy. Colorectal polyps. Magnification" com busca AND ou OR, considerando o título e/ou resumo. Foram incluídos somente os que tivessem maior correlação ao tema, e neles foi baseada a revisão com leitura, na íntegra, dos textos. Resultados: Ao final resultaram 22 artigos que compuseram esta revisão. Conclusão: BLI associada à magnificação mostrou bons resultados no diagnóstico histológico preditivo em tempo real para as lesões de cólon e reto.

Introduction: Improved endoscopic imaging allows the differential diagnosis of colorectal lesions in real time through the study of the microvasculature. Objective: To review the use of Blue Laser Imaging (BLI) in analyzing the capillary patern for the differential diagnosis between neoplastic and nonneoplastic lesions. Methods: This is an integrative review of the literature that collected information published on virtual platforms in Portuguese and English. The search for reading and analysis was carried out on the SciELO ­ Scientific Electronic Library Online, Google Scholar, Pubmed and Scopus platforms. The descriptors taken from DeCS/MESH were: "Blue laser imaging. Endoscopy. Chromoendoscopy, Colorectal polyps. Magnification" and its English counterparts "Blue laser imaging. Image-enhanced endoscopy. Chromoendoscopy. Colorectal polyps. Magnification" with AND or OR search, considering the title and/or abstract. Only those that had the greatest correlation to the topic were included, and the review was based on them, with reading, in full, of the texts. Results: In the end, 22 articles resulted that made up this review. Conclusion: BLI associated with magnification showed good results in real-time predictive histological diagnosis for colon and rectal lesions.

Punica granatum L. Extract Antibiofilm Action against Acinetobacter baumannii Carbapenem-Resistant and Biocompatibility over Human Keratinocytes / Ação Antibiofime de Extrato dePunica granatum L Contra Acinetobacter baumannii Resistente a Carbapnêmicos e Biocompatibilidade em Queratinócitos Humanos

Acinetobacter baumannii is a multi-drug resistant microorganism. The objective of this study was to evaluate the antimicrobial and antibiofilm action of the pomegranate natural extract against eight strains of multidrug resistant Acinetobacter baumanii and to assess the extract cytotoxicity in a culture of Human Keratinocytes (HaCat). Broth microdilution method was used to determine the minimum inhibitory and minimum microbicidal concentrations of the extracts. The extract antibiofilm action was analysed by the MTT colorimetric test. The cytotoxicity evaluation was performed by the MTT colorimetric test, which analysed the mitochondrial cellular action, after contact of the extract for 5 min. The results were statistically analysed by ANOVA and Tukey test with a significance level α≤ 0.05. Punica granatum L. (pomegranate) extract had antimicrobial action on all the 8 clinical strains of Acinetobacter baumannii evaluated. The extract showed a significant reduction in metabolic action in biofilm for all the strains, with results statistically different from growth control (p≤0.05%). P. granatum extract applied for 5 min on human keratinocytes (HaCat) promoted cell viability in all the tested concentrations. The pomegranate extract is effective in reducing the multidrug-resistant clinical strains of Acinetobacter baumanni and is biocompatible. (AU)

Acinetobacter baumannii é um microrganismo multirresistente. O objetivo deste estudo foi avaliar a ação antimicrobiana e antibiofilme do extrato natural de romã contra oito cepas de A. baumanii multirresistente e avaliar a citotoxicidade do extrato em uma cultura de queratinócitos humanos (HaCat). O método de microdiluição em caldo foi utilizado para determinar as concentrações inibitórias mínimas e microbicidas mínimas dos extratos. A ação antibiofilme do extrato foi analisada pelo teste colorimétrico MTT. A avaliação da citotoxicidade foi realizada pelo teste colorimétrico MTT, que analisou a ação celular mitocondrial, após contato do extrato por 5 min. Os resultados foram analisados ​​estatisticamente por ANOVA e teste de Tukey com nível de significância α≤ 0,05. O extrato de Punica granatum L. (romã) apresentou ação antimicrobiana em todas as 8 cepas clínicas avaliadas de A. baumannii. O extrato apresentou redução significativa na ação metabólica no biofilme para todas as linhagens, com resultados estatisticamente diferentes do controle de crescimento (p≤0,05%). O extrato de P. granatum aplicado por 5 min em queratinócitos humanos (HaCat) promoveu viabilidade celular em todas as concentrações testadas. O extrato de romã é eficaz na redução das cepas clínicas multirresistentes de Acinetobacter baumanni e é biocompatível. (AU)

Grandes e pequenas lesões colorretais são efetivamente tratadas pela técnica de mucosectomia / Small as well as large colorectal lesions are effectively managed by endoscopic mucosal resection technique

ABSTRACT Background Endoscopic mucosal resection (EMR) is an easy-to-use treatment option for superficial colorectal lesions, including lesions ≥20 mm. Objective To evaluate the effectiveness of EMR. Methods We evaluated 430 lesions removed by EMR in 404 patients. The lesions were analyzed according to their morphology, size, location, and histology. Lesions <20 mm were resected en bloc, whereas lesions ≥20 mm were removed by piecemeal EMR (p-EMR). Adverse events and recurrence were assessed. Results Regarding morphology, 145 (33.7%) were depressed lesions, 157 (36.5%) were polypoid lesions and 128 (29.8%) were laterally spreading lesions, with 361 (84%) lesions <20 mm and 69 (16%) ≥20 mm. Regarding histology, 413 (96%) lesions were classified as neoplastic lesions. Overall, 14 (3.3%) adverse reactions occurred, most commonly in lesions removed by p-EMR (P<0.001) and associated with advanced histology (P=0.008). Recurrence occurred in 14 (5.2%) cases, more commonly in lesions removed by p-EMR (P<0.001). Conclusion EMR is an effective technique for the treatment of superficial colorectal lesions, even of large lesions.

RESUMO Contexto Ressecção endoscópica da mucosa (REM) é uma opção fácil para o tratamento das lesões superficiais do cólon e reto, inclusive para as lesões ≥20 mm de diâmetro. Objetivo Avaliar a efetividade da REM. Métodos Este estudo prospectivo observacional avaliou 430 lesões ressecadas por REM em 404 pacientes. As lesões foram analisadas de acordo com a morfologia, tamanho, localização e histologia. Lesões <20 mm foram removidas em bloco, enquanto lesões ≥20 mm foram ressecadas em piecemeal REM (p-REM). Eventos adversos e recorrência foram avaliados. Resultados Quanto à morfologia, 145 (33,7%) eram lesões deprimidas, 157 (36,5%) eram lesões polipoides e 128 (29,8%) eram lesões que se espalham lateralmente, com 361 (84%) lesões <20 mm e 69 (16%) ≥20 mm. Em relação à histologia, 413 (96%) foram classificadas como lesões neoplásicas. Globalmente tivemos 14 (3,3%) de reações adversas, mais presente nas lesões ≥20 mm removidas por p-REM (P<0,001) e associadas com histologia avançada (P=0,008). A recorrência ocorreu em 14 (5,2%) casos, sendo mais observada em lesões removidas por p-REM (P<0,001). Conclusão REM é uma técnica efetiva para o tratamento das lesões colorretais superficiais, até mesmo para as grandes lesões.

A adição de solução de permanganato de potássio ao curativo preconizado por diretrizes internacionais, no local de inserção do cateter venoso central, pode reduzir a prevalência de infecções da corrente sanguínea em unidade de terapia intensiva? um ensaio clínico randomizado / The addition of potassium permanganate solution to the dressing recommended by international guidelines at the insertion site of the central venous catheter may reduce the prevalence of bloodstream infections related to the use of these catheters in an Intensive Care Unit? A randomized controlled trial

As infecções relacionadas à assistência à saúde são muito prevalentes em Unidades de Terapia Intensiva (UTIs), sendo 30% delas relacionadas às infecções da corrente sanguínea; estas são relevantes por aumentar a morbimortalidade e os custos de internação. A proposta deste estudo é avaliar se a adição de permanganato de potássio à 1:10.000 ao curativo nos locais de introdução de cateter venoso central (CVC) é capaz de reduzir as infecções de corrente sanguínea, nos pacientes internados na UTI do Hospital Policlin 9 de julho (HP9Julho). Trata-se de um ensaio clínico, randomizado e controlado que avaliou o banco de dados de controle de infecção hospitalar do HP9Julho, de 353 cateteres/dia que receberam em seus curativos, nos locais de inserção do CVC, realizados conforme recomendações do 2011 CDC Guidelines, a adição da solução de permanganato (KMnO4) à 1:10.000 (Grupo KMnO4), e 353 cateteres/dia que não receberam o KMnO4 (Grupo Controle). Nos resultados, com relação à presença de infecção de corrente sanguínea, foi encontrada uma relação de 7:2, quando comparado o grupo controle com o grupo KMnO4, o que apresenta significância estatística, entretanto. Os grupos KMnO4 e Controle foram avaliados e comparados por meio dos testes de Mann-Whitney e teste Binomial das Proporções com relação a 2 variáveis individuais (gênero e idade) além de 8 variáveis clínicas (intubação orotraqueal, CVD, CVC, cateteres-dia, óbitos, hemocultura positiva, APACHE II e SAPS III), sendo que houve diferença estatisticamente significante apenas entre os valores de hemoculturas positivas (p- valor = 0,05). Portanto, o resultado deste estudo mostrou que a adição de permanganato de potássio 1:10.000, ao curativo recomendado pelo 2011 Guidelines CDC, reduziu as infecções de corrente sanguínea, relacionadas a cateter venoso central, nos pacientes internados na Unidade de Terapia Intensiva do Hospital Policlin 9 de julho

Healthcare-related infections are very prevalent in Intensive Care Units (ICUs), 30% of them related to bloodstream infections; these are relevant because they increase morbidity, mortality and hospitalization costs. The purpose of this study was to evaluate whether the addition of 1:10,000 potassium permanganate to the dressing at central venous catheter introduction (CVC) sites is able to reduce bloodstream infections in ICU patients at Hospital Policlin 9 de July (HP9July). This was a randomized controlled clinical trial evaluating the HP9July hospital infection control database of 353 catheters/day they received in their dressings at CVC insertion sites, according as recommended by the 2011 CDC Guidelines. the addition of permanganate solution (KMnO4) at 1:10,000 (KMnO4 Group), and 353 catheters / day not receiving KMnO4 (Control Group). In the results, regarding the presence of infection in the bloodstream, we have found a ratio of 7:2, when compared the control group with the KMnO4 group, which had statistical significance. The KMnO4 and Control groups were evaluated and compared using the Mann-Whitney test and the Binomial Proportions test for 2 individual variables (gender and age) in addition to 8 clinical variables (orotracheal intubation, CVD, CVC, catheters-day, deaths, positive blood culture, APACHE II and SAPS III), with a statistically significant difference only between the values of positive blood cultures (p-value = 0.05). Therefore, based on the results obtained, we conclude that the addition of potassium permanganate 1: 10,000, to the dressing recommended by the 2011 Guidelines CDC, reduced bloodstream infections, related to central venous catheter, in patients admitted to the Intensive Care Unit of said hospital.

Trunk muscle function and pelvic alignment associated with the presence of pain in higher education students: a cross-sectional study / Função muscular do tronco e do alinhamento pélvico associados à presença de dor em estudantes do ensino superior: um estudo transversal

Abstract Introduction: The protective role of muscles in the passive structures of the spine means that their stability and consequent maintenance are associated with pain, especially in the region of the lumbo-pelvic-hip complex. Objective: To determine the prevalence of pain and its association with muscle deficits in higher education students. Method: Descriptive, observational, cross-sectional study that evaluated 120 university students through questionnaires (sample characterization, Nordic musculoskeletal symptoms, pain visual analogue scale and international physical activity). Trunk muscle strength and bridge tests with unilateral knee extension (pelvic alignment) were performed. Results: A high prevalence of pain was found in the lower back (58.41%). There was no association between the presence of pain, muscle strength and pelvic alignment (p> 0.05). There was an association between the trunk extension and pelvic tilt tests (p = 0.009). Conclusion: A high prevalence of low back pain, poor performance in the trunk muscle endurance tests and mild and moderate pelvic misalignment were identified. There was no association between pain, trunk muscle weakness and pelvic misalignment. There was an association between pelvic misalignment and trunk extensor muscle weakness.

Resumo Introdução: A atribuição de um papel protetor da musculatura sobre as estruturas passivas da coluna vertebral faz com que sua estabilização e consequente manutenção tornem-se aspectos associados a dor, principalmente na região do complexo lombo-pélvico-quadril. Objetivo: Verificar a prevalência de dor e a associação da sua presença a déficits musculares em estudantes do ensino superior. Método: Estudo descritivo, observacional e transversal que avaliou 120 universitários através de questionários (caracterização da amostra, nórdico de sintomas osteomusculares, escala visual analógica de dor e internacional de atividade física). Foram executadas provas de resistência muscular do tronco (força muscular) e ponte com extensão unilateral do joelho (alinhamento pélvico). Resultados: Foi encontrada alta prevalência de dor na região lombar (58,41%). Não houve associação entre a presença de dor, força muscular e alinhamento pélvico (p > 0,05). Houve associação entre o teste de extensão de tronco e inclinação pélvica (p = 0,009). Conclusão: Foi identificada uma alta prevalência de dor lombar, baixo desempenho nas provas de resistência dos músculos do tronco e níveis de desalinhamento pélvico leve e moderado. Não houve associação entre as variáveis dor, fraqueza muscular do tronco e desalinhamento pélvico. Houve associação entre o desalinhamento pélvico e a fraqueza dos músculos extensores do tronco.

Effects of cerebral gymnastics in cognition and subjective welfare of institutionalized elderly people / Efeitos da ginástica cerebral na cognição e no bem-estar subjetivo de idosas institucionalizadas / Efectos de la gimnastica cerebral en la cognición y en el bienestar subjetivo de las personas ancianas institucionalizadas

Abstract Introduction: With the increasing number of elderly people, greater care is required for this population, and zeal for health and quality of life becomes an important goal in healthy aging. Elderly people can achieve excellent results involving cognitive training based on brain plasticity. Objective: To verify the effectiveness of cerebral gymnastics in the cognitive state and well-being of institutionalized elderly women. Method: Clinical trial performed with nine institutionalized elderly women, mean age of 80.2 years old (± 9.1). The Subjective Well-being Scale and tests (clock, verbal fluency, figure recognition) were administered before and after ten weeks of the exercise program (eight exercises performed in two weekly meetings, involving figures, words and objects). The data normality was verified using the Shapiro-Wilk test, followed by Student t tests for analysis of SWB and Wilcoxon for analysis of figure recognition, clock-drawing test and verbal fluency. Results: Significant improvement in the incidental and immediate memory 1 and 2 (p = 0.007), verbal fluency (p = 0.011, p = 0.025 and p = 0.007) and the clock-drawing test (p value = 0.046). No significant results were found for SWB (p = 0.357 and p = 0.389). Conclusion: Brain gymnastics beneficially modified cognitive performance. Well-being did not show significant improvements.

Resumo Introdução: Com o crescente número de idosos faz-se necessário maior cuidado com essa população, onde o zelo com a saúde e qualidade de vida tornam-se metas importantes no envelhecimento saudável. Os idosos possuem competência para atingir excelentes resultados envolvendo treino cognitivo pela plasticidade cerebral. Objetivo: Verificar a eficácia da ginástica cerebral no estado cognitivo e no bem-estar de idosas institucionalizadas. Método: Ensaio clínico realizado com nove idosas institucionalizadas, com média de idade de 80,2 anos (± 9,1). Foram utilizados a Escala de Bem-Estar Subjetivo e testes (relógio; fluência verbal; reconhecimento de figuras), aplicados antes e após dez semanas do programa de exercícios (Oito exercícios realizados em dois encontros semanais, envolvendo figuras, palavras e objetos). A normalidade dos dados foi verificada pelo teste de Shapiro-Wilk, seguido pelos testes t de Student para análise da EBES e Wilcoxon para análises do reconhecimento de figuras, teste do relógio e fluência verbal. Resultados: Melhora significativa da memória incidental e imediata 1 e 2 (p = 0.007), da fluência verbal (p = 0,011; p = 0,025 e p = 0,007) e do teste do relógio (p valor = 0,046). Resultados não significativos para EBES (p = 0,357 e p = 0,389). Conclusão: A ginástica cerebral modificou beneficamente o desempenho cognitivo. O bem-estar não apresentou melhoras significativas.

Resumen Introducción: Con el creciente número de ancianos se hace necesario mayor cuidado con esa población, donde el celo con la salud y calidad de vida se convierten en metas importantes en el envejecimiento saludable. Los ancianos poseen competencia para alcanzar excelentes resultados involucrando entrenamiento cognitivo por la plasticidad cerebral. Objetivo: Verificar la eficacia de la gimnasia cerebral en el estado cognitivo y en el bienestar de ancianas institucionalizadas. Método: Ensayo clínico realizado con nueve ancianas institucionalizadas, con una media de edad de 80,2 años (± 9,1). Se utilizó la Escala de Bienestar Subjetivo y pruebas (reloj, fluencia verbal, reconocimiento de figuras), aplicados antes y después de diez semanas del programa de ejercicios (Ocho ejercicios realizados en dos encuentros semanales, envolviendo figuras, palabras y objetos). La normalidad de los datos fue verificada por la prueba de Shapiro-Wilk, seguida por las pruebas t de Student para análisis de EBES y Wilcoxon para análisis del reconocimiento de figuras, prueba del reloj y fluencia verbal. Resultados: Mejora significativa de la memoria incidental e inmediata 1 y 2 (p = 0.007), de la fluencia verbal (p = 0,011; p = 0,025 y p = 0,007) y de la prueba del reloj (p valor = 0,046). Resultados no significativos para EBES (p = 0,357 y = 0,389). Conclusión: La gimnasia cerebral modificó benéficamente el desempeño cognitivo. El bienestar no presentó mejoras significativas.

Essential oil of the leaves of Eugenia sulcata preserve myocardial contractility and does not present immunotoxicity

The essential oil of the leaves of Eugenia sulcata, in the Myrtaceae family, has a demonstrated antihypertensive effect, but its effects on heart muscle and its toxicity have not yet been elucidated. Little chemical or biological data are available for E. sulcata, whether emphasizing the beneficial effects or the pharmacological security of this species. This study aims to evaluate myocardial contractility and to analyze angiotensin converting enzyme (ACE) and myosin ATPase activities associated with use of this essential oil. In addition, we evaluated the immunotoxicity of E. sulcata essential oil. Wistar Kyoto (WKY) and spontaneously hypertensive rats (SHR) were treated daily for 30 days (10 mg/kg of oil) to evaluate the isometric force of the papillary muscle, ACE measured by fluorimetry, and myosin ATPase activities by inorganic phosphate. Lymphocyte cultures were used to evaluate cytotoxicity, DNA damage, and mutagenicity of the essential oil. The results demonstrate that the treatment did not change the cardiac contraction force and did not alter the functioning of the sarcoplasmic reticulum, extrusion of the membrane calcium, or modify the membrane calcium channels or ß-adrenergic receptor activity. Tetanic contractions were potentiated in the SHR animals. Myosin ATPase activity was also increased in the SHR animals. Cardiac ACE activity was reduced in both animal strains, and the serum ACE was reduced only in the SHR animals. The essential oil did not cause cytotoxicity or mutagenicity and presented low DNA damage. Our results demonstrated that the essential oil does not change myocardial contractility and does not present relevant immunotoxicity

Accuracy of chest auscultation in detecting abnormal respiratory mechanics in the immediate postoperative period after cardiac surgery / Acurácia da ausculta torácica na detecção de mecânica respiratória anormal no pós-operatório imediato de cirurgia cardíaca

ABSTRACT Objective: To investigate the accuracy of chest auscultation in detecting abnormal respiratory mechanics. Methods: We evaluated 200 mechanically ventilated patients in the immediate postoperative period after cardiac surgery. We assessed respiratory system mechanics - static compliance of the respiratory system (Cst,rs) and respiratory system resistance (R,rs) - after which two independent examiners, blinded to the respiratory system mechanics data, performed chest auscultation. Results: Neither decreased/abolished breath sounds nor crackles were associated with decreased Cst,rs (≤ 60 mL/cmH2O), regardless of the examiner. The overall accuracy of chest auscultation was 34.0% and 42.0% for examiners A and B, respectively. The sensitivity and specificity of chest auscultation for detecting decreased/abolished breath sounds or crackles were 25.1% and 68.3%, respectively, for examiner A, versus 36.4% and 63.4%, respectively, for examiner B. Based on the judgments made by examiner A, there was a weak association between increased R,rs (≥ 15 cmH2O/L/s) and rhonchi or wheezing (ϕ = 0.31, p < 0.01). The overall accuracy for detecting rhonchi or wheezing was 89.5% and 85.0% for examiners A and B, respectively. The sensitivity and specificity for detecting rhonchi or wheezing were 30.0% and 96.1%, respectively, for examiner A, versus 10.0% and 93.3%, respectively, for examiner B. Conclusions: Chest auscultation does not appear to be an accurate diagnostic method for detecting abnormal respiratory mechanics in mechanically ventilated patients in the immediate postoperative period after cardiac surgery.

RESUMO Objetivo: Investigar a acurácia da ausculta torácica na detecção de mecânica respiratória anormal. Métodos: Foram avaliados 200 pacientes sob ventilação mecânica no pós-operatório imediato de cirurgia cardíaca. Foi avaliada a mecânica do sistema respiratório - complacência estática do sistema respiratório (Cest,sr) e resistência do sistema respiratório (R,sr) - e, em seguida, dois examinadores independentes, que desconheciam os dados referentes à mecânica do sistema respiratório, realizaram a ausculta torácica. Resultados: Nem murmúrio vesicular diminuído/abolido nem crepitações foram associados à Cest,sr reduzida (≤ 60 ml/cmH2O), independentemente do examinador. A acurácia global da ausculta torácica foi de 34,0% e 42,0% para os examinadores A e B, respectivamente. A sensibilidade e a especificidade da ausculta torácica para a detecção de murmúrio vesicular diminuído/abolido e/ou crepitações foi de 25,1% e 68,3%, respectivamente, para o examinador A, versus 36,4% e 63,4%, respectivamente, para o examinador B. Com base nos julgamentos feitos pelo examinador A, houve uma fraca associação entre R,sr aumentada (≥ 15 cmH2O/l/s) e roncos e/ou sibilos (ϕ = 0,31, p < 0,01). A acurácia global para a detecção de roncos e/ou sibilos foi de 89,5% e 85,0% para os examinadores A e B, respectivamente. A sensibilidade e a especificidade para a detecção de roncos e/ou sibilos foi de 30,0% e 96,1%, respectivamente, para o examinador A, versus 10,0% e 93,3%, respectivamente, para o examinador B. Conclusões: A ausculta torácica não parece ser um método diagnóstico acurado para a detecção de mecânica respiratória anormal em pacientes sob ventilação mecânica no pós-operatório imediato de cirurgia cardíaca.

Hemodynamic changes during heart displacement in aorta no-touch off-pump coronary artery bypass surgery: a pilot study

Abstract Objective: To evaluate the sequential changes of hemodynamic and metabolic parameters in patients who underwent aorta no-touch off-pump coronary artery bypass surgery (OPCAB). Methods: Prospective study involving twenty-seven consecutive patients who underwent aorta no-touch OPCAB. The FloTrac/PreSep/Vigileo™ system (Edwards Lifesciences) was used to continuously record heart rate (HR), mean arterial blood pressure (MABP), central venous pressure (CVP), continuous cardiac index (FCI), stroke volume (SV), stroke volume variation (SVV), and central venous oxygen saturation (ScvO2). The parameters were assessed 5 min before, during and 5 min after each anastomosis (left anterior descending [LAD], posterior descending [PD], obtuse marginal [OM] and diagonal [Dg]). Postoperative lactate was also evaluated. Results: There was no significant change in HR and MABP for all anastomoses, except for MABP during PD grafting (-10.1±2.7 mmHg, P=0.03). There was a significant decrease in ScvO2 only during PD and OM anastomoses (-9.4±0.4, P=0.03; -4.4±0.4, P=0.02; respectively). CVP drop after PD manipulation was strongly associated with a higher lactate during the first hours after surgery (r=-0.82; P=0.001). These hemodynamic changes were transient and entirely recovered after the heart was returned to its anatomical position. No significant differences were observed in FCI, SVV, or the systemic vascular resistance index (SVRI) during all anastomoses, except for a drop in SVRI during PD grafting (-8.03±2.3, P=0.007). SV tended to decrease during the procedure in all territories, but with statistically significant drop only in PD and OM grafting (-10.4±1.2, P=0.02; -13.6±5.1, P=0.007; respectively). Conclusion: Heart displacement for performing aorta no-touch OPCAB is well tolerated, with transient and endurable hemodynamic variations.

Bat richness (Mammalia: Chiroptera) in an area of montane Atlantic Forest in the Serra da Mantiqueira, state of Minas Gerais, southeast Brazil / Riqueza de morcegos (Mammalia: Chiroptera) em uma área de Floresta Atlântica montana na Serra da Mantiqueira, estado de Minas Gerais, sudeste do Brasil

Abstract: In recent years there has been an increase in research interest in remnants of Atlantic Forest above 500 m a.s.l., such as in the Serra da Mantiqueira, which is considered a priority area for conservation. The chiropterofauna of the Serra da Mantiqueira remains relatively under-studied, and here we present a list of bat species from the "Reserva Particular do Patrimônio Natural (RPPN) Cachoeira do Tombo", a private conservation unit located in an area of montane Atlantic Forest in the Serra da Mantiqueira. Bats were captured with mist nets along trails and near a diurnal roost. A total of 498 individuals of 19 bat species belonging to the families Phyllostomidae, Vespertilionidae and Molossidae were captured. Phyllostomidae were captured only along the trails, Molossidae were captured only in the diurnal roost and Vespertilionidae were captured in both. The species accumulation curves did not show stabilizing trends. However, 80% of the expected richness was sampled and the species richness of bats found is similar to other studies previously carried out in the region. In contrast to other inventories carried out in the Atlantic Forest, Desmodus rotundus was the species most frequently captured along the trails. A large number of individuals of Molossus aztecus sheltering in man-made structures were caught, constituting an unusual event. Additionally, here we report cohabitation of this species with Molossus molossus for the first time. Our results show that this area, which appears on the map of environmental conflicts for the state of Minas Gerais, has a rich chiropterofauna and also further corroborate the importance of using mist-nets at roosts to increase the probability of capturing the richness and abundance of insectivorous bats present in the area.

Resumo: Nos últimos anos houve um aumento no interesse em pesquisas em remanescentes de Floresta Atlântica acima de 500 m de altitude, como na Serra da Mantiqueira, a qual é considerada área prioritária para a conservação. A fauna de quirópteros na Serra da Mantiqueira ainda permanece relativamente pouco estudada, e aqui nós apresentamos uma lista de espécies de morcegos da Reserva Particular do Patrimônio Natural (RPPN) Cachoeira do Tombo, uma unidade de conservação privada localizada em área de Floresta Atlântica Montana na Serra da Mantiqueira. Os morcegos foram capturados com redes de neblina ao longo de trilhas e junto de um abrigo diurno. Um total de 498 indivíduos de 19 espécies de morcegos pertencentes às famílias Phyllostomidae, Vespertilionidae e Molossidae foram capturados. Phyllostomidae foram capturados somente em trilhas, Molossidae no abrigo diurno e Vespertilionidae em ambos. As curvas de acumulação de espécies não mostraram tendência de estabilização. No entanto, 80% da riqueza esperada foi amostrada e a riqueza de espécies encontrada foi similar a outros estudos previamente conduzidos na região. Diferente de outros inventários realizados na Mata Atlântica, Desmodus rotundus foi a espécie mais frequentemente capturada ao longo das trilhas. Um grande número de indivíduos de Molossus aztecus foi encontrado se abrigando em abrigo artificial, o que constitui um evento pouco usual. Adicionalmente, a coabitação dessa espécie com Molossus molossus é reportada aqui pela primeira vez. Os resultados mostram que essa área, que está inserida no mapa de conflitos ambientais do estado de Minas Gerais, possui uma rica chiropterofauna e corrobora a importância de usar redes de neblina em abrigos para aumentar a probabilidade de capturar a riqueza e abundância de morcegos insetívoros presentes na área.

Cabeça Dizpensa, corpo desvago: experimentações de um Laboratório de Sensibilidades / Lo(o)se-Head, diffuse body: experimentations with a Sensitivities Laboratory

Resumo O Laboratório de Sensibilidades da Universidade Federal de São Paulo (UNIFESP) é uma tentativa de construir experimentos abertos às alteridades, com ações em diversas superfícies que podem reverberar dentro e fora de seu lugar material. Neste artigo expomos algumas experiências que transversalizam o corpo desvago do Laboratório e suas incidências nos corpos que o compõem e decompõem. Narramos uma experimentação com uma comunidade-corpo, que se modulou em uma performance que nomeamos coletivamente de "Cabeça Dizpensa". Discutimos, dentre outras, as noções de intervenção e interferência, e um itinerário de problematizações e pequenas narrativas com ecos do laboratório.(AU)

Abstract Sensitivities Laboratory at Federal University of São Paulo (UNIFESP) is an attempt of creating experiments that are open to alterities, with actions in many different surfaces which can reverberate into and out of its material place. In this paper, we expose some experiences that transversalize the Laboratory's diffuse body and their incidences in the bodies that compose and decompose it. We report an experimentation with a community-body, which has shaped into a performance we collectively named "Lo(o)se-Head". Among others, we bring the discussion of the notions of intervention and interference, as well as an itinerary of questionings and short narratives that bring echoes from the Laboratory.(AU)

Hyoscine butylbromide for colorectal polyp detection: prospective, randomized, placebo-controlled trial

OBJECTIVES: The removal of pre-malignant colorectal lesions prevents cancer. Hyoscine has been proposed as a means of improving diagnosis by reducing colonic movements. The aim of this study was to analyze whether this anti-spasmodic enhances the detection of pre-malignant colorectal lesions. METHODS: In a randomized, double-blinded fashion patients received hyoscine or a saline solution in all consecutive colonoscopies in which the cecum was reached. Lesions were analysed with respect to number, size, location, histology and capillary pattern. RESULTS: A total of 440 colonoscopies were randomized. The overall polyp detection rate (PDR) and the adenoma detection rate (ADR) were 65.2% and 49.3%, respectively. In the hyoscine group, non-polypoid lesions were detected significantly more often (p=0.01). In the placebo group 281 lesions were diagnosed (202 adenomas) and in the hyoscine group 282 lesions were detected (189 adenomas) (p=0.23). The PDR and ADR were similar between the placebo and hyoscine groups (64% vs 66% and 50% vs 47%, respectively). No differences were observed between the two groups in the advanced-ADR or advanced neoplasia detection rate, as well the mean numbers of polyps, adenomas, advanced adenomas and advanced neoplasias detected per patient. The administration of hyoscine also did not improve the diagnostic accuracy of digital chromoendoscopy. The presence of adenomatous polyps in the right colon was detected significantly more frequently in the hyoscine group (OR 5.41 95% CI 2.7 - 11; p<0.01 vs OR 2.3 95% CI 1.1 - 4.6; p=0.02). CONCLUSION: The use of hyoscine before beginning the withdrawal of the colonoscope does not seem to enhance the PDR and the ADR.