Massive enlargement of gastric pouch as a complication of gastrojejunal anastomotic stenosis following one anastomosis laparoscopic gastric bypass: A case report.

INTRODUCTION AND IMPORTANCE: By 2030 it is predicted that 1 in 5 women and 1 in 7 men will be living with obesity. The only long-term effective strategy for achieving significant weight loss over time is surgical treatment. One Anastomosis Gastric Bypass (OAGB) has been proposed as an effective therapeutic option. Stenosis of Gastro-Jejunal Anastomosis (GJA) is one of the most common long-term complications and its cause recognized as multifactorial. CASE PRESENTATION: We present the case of a patient with a history of progressive postoperative oral intolerance after OAGB with 60 kg weight loss (BMI 20.7 kg/m2). Severe stenosis of the GJA and massive dilation of the gastric remnant was documented, treated multiple times with endoscopic balloon dilation. He was referred to our unit due to persistent symptoms. Revision surgery to a Gastric Bypass was programmed, ultimately performed via an open approach with resection of 80 % of the gastric remnant. CLINICAL DISCUSSION: Endoscopic dilatation and surgical revision are the two primary treatment options for GJA stricture. In refractory cases to pneumatic dilation, laparoscopic revision surgery is indicated, however an open approach is frequently required, as surgeries are technically demanding due to distorted anatomy in this population. CONCLUSION: Operations to correct chronic complications are tailored to the patient's anatomy as well as the symptoms or pathologies they are intended to correct. Whilst revision surgeries are associated with an increased risk of conversion, complications and longer hospital stay, they can be performed safely in experienced centers.

Phototherapy Induces an Improvement in Clinical and Biochemical Scores in Patients with Rheumatoid Arthritis

ABSTRACT Objective: Rheumatoid arthritis (RA) is a common autoimmune disease for which there is no known cure. Ultraviolet light can induce immunosuppressive effects. Our main objective was to ascertain whether a complementary treatment with phototherapy would improve changes in functional scales in patients with RA. Methods: Seven women with RA were enrolled for this study and submitted to phototherapy sessions with a 425-650 nm lamp. Results: The Karnofsky scale changed from requiring frequent medical care to being capable of normal activity with few symptoms or signs of disease (p = 0.018), the rheumatoid arthritis-specific quality of life questionnaire decreased abruptly from 29 to 0 points (p = 0.018), the Steinbrocker functional capacity rating changed from limited to little or none of the duties of usual occupation or self-care to complete ability to carry out all the usual duties without handicaps (p = 0.017). The pain was remitted after the treatment period. The acute inflammation variables showed a significant decrease after the indicated sessions, C-reactive protein (p = 0.042) and erythrocyte sedimentation rate (p = 0.018). Conclusion: The evaluated scales clearly show a benefit with the phototherapy in patients with RA. Thus, phototherapy seems to be a plausible complementary option to reduce the symptoms of RA.

Polybrominated diphenyl ethers and organochloride pesticides in the organic matter of air suspended particles in Mexico valley: A diagnostic to evaluate public policies.

The presence of organochlorine pesticides (OCPs) and polybrominated diphenyl ethers (PBDEs) was analysed in air particulate matter ≤ 2.5 µm (PM2.5) and ≤10 µm (PM10) collected in the Metropolitan Zone of Mexico Valley (MZMV), during 2013 and 2014, respectively. Spatial and seasonal distributions of PM and their organic content named solvent extracted organic matter (SEOM) were determined. PM mass concentration and SEOM/PM ratios were compared with previous studies in 2006 in Mexico City. PM2.5 concentration was like found in 2006, however, PM10 decreased ∼43%. The SEOM/PM10 ratio was kept constant, suggesting a decrease in SEOM as well as PM10 emitted from natural sources, probably as a result of changes in the land use due to urban growth. A decrease ∼50% SEOM/PM2.5 ratio was observed in the same period, linked to adequate strategies and public policies applied by the local and federal governments to control the organic matter emitted from anthropogenic sources. Seven out of sixteen OCPs and five out of six PBDEs were found. The most common POPs were endosulfan I, endosulfan II, endosulfan sulfate, BDE-47 and BDE-99, present on >90% of the sampling days. OCPs in PM2.5 and PBDEs in PM10 showed seasonal variability. Higher PBDEs concentration in both particle sizes were observed at east and southeast of the MZMV, where one of the biggest landfills and wastewater treatment plants are located. OCPs in PM10 were mainly emitted from agricultural areas located to the southwest, southeast and east of the MZMV. OCPs in PM2.5 showed a regional contribution from the north and introduced into the valley. OCP degradation products were dominant over native OCPs, indicating no fresh OCP use. POPs comparison with other cities was made. Agreements and commissions created by the Mexican government reduced OCPs emissions, however, more effort must be made to control PBDE emission sources.

Evaluación de Termografía Tisular Diferenciada en Mama como Potencial Técnica para Asistir la Detección de Cáncer / Evaluation of Thermography Differentiated in Breast Tissue as Potential Technique to Assist Cancer Detection

Diversos grupos han propuesto el procesamiento de imágenes termográficas para detección de Cáncer de Mama (CaMa). Angiogénesis y vascularización dependientes del ciclo menstrual, edad e Índice de Masa Corporal (IMC) modifican la temperatura absoluta en la superficie tisular sin estar necesariamente asociadas a malignidad, en éste estudio proponemos la Termografía Tisular Diferenciada (TTD) en mama con respecto a su contralateral en espejo con el fin de observar diferencias térmicas características de malignidad. El presente trabajo evalúa la posibilidad de emplear la TTD como potencial técnica para asistir la detección de CaMa. Se muestrearon 110 mujeres voluntarias entre 40 y 60 años de edad segmentadas en dos grupos experimentales: grupo sanas (n=90) y grupo con CaMa (n=20) previamente diagnosticadas por mastografía e histopatología. Imágenes termográficas de ambas mamas fueron adquiridas con una cámara infrarroja y se estimó la TTD en relación a la mama contralateral de la misma paciente, se realizó un análisis de sensibilidad y especificidad y se comparó con el diagnóstico radiológico a través de curvas ROC tomando como referencia el diagnóstico histopatológico. La TTD en mama mostró rangos dinámicos diferenciables entre condiciones de malignidad respecto a benignidad. El análisis ROC mostró valores de sensibilidad y especificidad para el estimado TTD del 70% y 54% mientras que para el diagnóstico radiológico fue del 70% y 96%, respectivamente. La TTD muestra viabilidad técnica para asistir la detección de CaMa.

Several groups have proposed thermographic image processing for Breast Cancer (BC) detection. Angiogenesis and vascularization of menstrual cycle dependent, as well as age and Body Mass Index change the absolute temperature in the tissue surface without necessarily being associated with malignancy. We have proposed the Differentiated Tissue Thermography (DTT) in breast regarding its contralateral mirror in order to observe differences in temperature characteristics of malignancy. This study evaluates the possibility of using breast DTT as a potential technique to assist the detection of BC. We sampled 110 female volunteers between 40 and 60 years old segmented into two experimental groups: healthy group (n=90) and BC group (n=20), which were diagnosed by mammography and histopathology. Thermal images of both breasts were acquired with an infrared camera and the DTT was estimated relative to its contralateral breast in the same patient. A sensitivity and specificity analysis was developed and the DTT was compared with the radiological diagnosis by ROC curves with the histopathological report as reference. The DTT values showed distinguishable dynamic ranges between malignant and healthy conditions. ROC analysis showed sensitivity and specificity values for DTT of 70% and 54% while for the radiological diagnosis was 70% and 96% respectively. DTT showed technical viability to assist BC detection.

The effects of volcanoes on health: preparedness in Mexico.

The article reviews the most important aspects of volcanic eruptions and presents a summary of the harmful materials they emit. The main health effects can be classified as either physical (trauma, respiratory diseases, etc.) or psychological (depression, anxiety, nightmares, neurosis, etc.). Popocatépetl, the most famous active volcano in Mexico, lies on the borders of the States of Mexico, Puebla and Morelos. In 1993, seismic activity intensified, as did as the emission of fumaroles, followed in December 1994 by moderate tremors and strong emissions of gases and ash. In 1996, a number of seismic events led to an unexpected explosion. A daily emission of 8,000 to 15,000 tonnes of sulfur dioxide has been measured. Popocatépetl is located in a densely populated region of Mexico. A complex network to monitor the volcano using sophisticated equipment has been set up, including visual surveillance, seismic, geochemical and geodesic monitoring. An early warning system (SINAPROC/CENAPRED) has been developed to keep the population permanently informed. The warning system uses colour codes: green for normal, yellow for alert, and red for warning and evacuation. An emergency plan has been prepared, including evacuation and preparation for medical centres and hospitals in the region, as well as intense public information campaigns.