Logro de control metabólico temprano en adultos con diabetes mellitus tipo 2 en Perú

Objetivo: Estimar la proporción de sujetos con diabetes mellitus tipo 2 (DMT2) que alcanzan la meta terapéutica para HbA1C un año después del diagnóstico (control metabólico temprano). Métodos: Revisión retrospectiva de historias clínicas de adultos atendidos en 16 centros médicos distribuidos en nueve ciudades peruanas. Se incluyeron pacientes que recibieron un diagnóstico inicial de DMT2 y tuvieron al menos un año de seguimiento. Se consideraron las metas metabólicas definidas en los estándares ADA 2018. Resultados: Se incluyeron 457 sujetos (53,03% mujeres). Cuando fueron diagnosticados, la edad media fue de 55,75 años (DE ± 12,92), la media de HbA1C fue de 9,10% (DE ± 2,28). Hubo diagnóstico concomitante de hipertensión arterial o de dislipidemia en 27,13% y 52,40%, respectivamente. Al año de seguimiento, 57,76% de los sujetos alcanzó la meta de HbA1C ( 40 mg / dL), 24,31% para HDL-c en mujeres (>50 mg/dL), 48,24% para triglicéridos (<150 mg/dL), y 89,23% para presión arterial (<140/90 mmHg). Conclusiones: En este estudio en condiciones de la vida real, en adultos con DMT2 con un año de seguimiento, el logro de la meta de HbA1C (<7%) se alcanzó en el 58% de los pacientes. Si bien estos resultados son compatibles con los reportados en otros estudios de la región, se evidencia la oportunidad de mejorar el logro temprano de metas con el objetivo de optimizar los resultados a largo plazo.

Aim: To estimate the proportion of subjects with type 2 diabetes mellitus (T2DM) who attain therapeutic goal for HbA1C one year after diagnosis (early metabolic control). Methods: Retrospective review of medical records of adults cared for at 16 centers in nine Peruvian cities. Patients who received an initial diagnosis of T2DM and had at least one year of follow up were included. Metabolic goals were as defined by ADA 2018 standards. Results: 457 subjects were included (53,03% female). At diagnosis, mean age was 55,75 years (SD ± 12.92), mean HbA1C was 9,10% (SD ± 2,28). Concomitant hypertension or dyslipidemia were present in 27,13% and 52,40%, respectively. At one year follow up, 57,76% of subjects attained the goal for HbA1C ( 40 mg/dL), 24,31% for HDL-c in women (>50 mg/dL), 48,24% for triglycerides (<150 mg/dL), and 89,23% for blood pressure (<140/90 mmHg). Conclusions: In this real-life study of adults with T2DM with one year of follow up, metabolic control for HbA1C (<7%) was attained in 58% of subjects. While the results are compatible with those reported in other studies in the region, there is opportunity to further improve early treatment goal attainment to optimize long-term outcomes.

Simultaneous Schlieren-Shadowgraph Visualization and Temperature Measurement Fields of Fluid Flow Using One Color CCD Camera.

Visualizing two variables in the fluid flow requires a complex optical system to fulfill such a purpose. Furthermore, in these applications, measuring the temperature fields of the fluid is sometimes necessary. In this work, we use a color digital camera to record in one snapshot shadowgraph and two direction sensitivity Schlieren images. Furthermore, the Schlieren images obtained are used to measure temperature fields. The optical system, as main components, employs an rgb Light Emitting Diode (LED), two knife edges represented by shortpass and longpass ultra-thin filters, and a color digital camera. The results of this study show that shadowgraph images are contaminated with the crosstalk effect, and correction against it was applied. On the other hand, the reached resolution of the optical system to measure temperature values is approximately one degree.

Asymmetric encryption by optical Kerr nonlinearities exhibited by electrochromic NiO thin films.

Herein is analyzed how an electric field can induce a band gap shift in NiO films to generate an enhancement in their third-order optical nonlinearities. An electrochromic effect seems to be responsible for changes in absorbance and modification in off-resonance nonlinear refractive index. The optical Kerr effect was determined as the dominant physical mechanism emerging from the third-order optical susceptibility processes present in a nanosecond two-wave mixing configuration at 532 nm wavelength. Absence of any important multi-photonic absorption was validated by the constant trace of high-irradiance optical transmittance in single-beam mode. The inspection of nonlinear optical signals allowed us to propose an exclusive disjunctive logic gate assisted by an electrochromic effect in an optical Kerr gate. Asymmetric encryption by our XOR system with the influence of a switchable probe beam transmittance and electrical signals in the sample was studied. Immediate applications for developing multifunctional quantum systems driven by dynamic parameters in electrochromic and nonlinear optical materials were highlighted.

Carbamazepine degradation by visible-light-driven photocatalyst Ag3PO4/GO: Mechanism and pathway.

Carbamazepine (CBZ), as one of the most frequently detected pharmaceuticals, is of great concern due to its potential impact on the ecosystem and human health. This study provides an effective approach to remove CBZ by using photocatalyst silver phosphate combined with graphene oxide (Ag3PO4/GO) under visible irradiation. The morphology, composition, and optical properties of Ag3PO4/GO were characterized employing SEM, XRD, and DRS. Graphene oxide could improve the visible-light utilization and promote electron's charge to enhance the photocatalytic performance of Ag3PO4/GO. With the optimal reaction condition of 5.86 mW/cm2 light intensity, 15-25 °C temperature, 5-7 pH, and 0.5 mg/L catalytic dosages, 5 mg/L CBZ could be completely degraded in 30 min, and the apparent rate constant could reach 0.12 min-1. Additionally, the radical trapping experiments indicated •OH and O2-• were the main reactive oxygen species employed to eliminate CBZ. The decay pathways of CBZ had been proposed accordingly, and the main product was the low-molecular products.

Intraoperative neurophysiological monitoring in Latin America: A bibliometric analysis.

PURPOSE: Intraoperative Neurophysiological Monitoring (IOMM) has been used worldwide in the attempt to reduce postsurgical neurological deficits, however, most of the publications are from developed countries. There is a global bibliometric analysis of IOMN in spinal surgery, however, the contribution of Latin America (LA) is not mentioned. The aim of this study is to describe scientific productivity, patterns of publications, and thematic trends of IONM in LA. METHODS: Data was collected using Scopus database, by searching scientific articles with LA affiliation, using 18 keywords. We excluded duplicates, not original articles, reviews, surveys, and articles not related to humans. Articles were analyzed and classified as follows: year of publication, language of the original document, journals metrics, country, IONM modality, etiology, location of surgery, medical specialties, and outcome. Descriptive statistics were used. RESULTS: We obtained 8,699 scientific articles of which 41 scientific articles from 7 LA countries were selected. Mexico has the highest number of publications. In most countries, supratentorial location showed the highest frequency. Somatosensory evoked potentials and electrocorticography were the most performed modalities. Neurosurgery was the most involved specialty of our 41 scientific articles, and 95.1% of these publications concluded that IONM is useful to guide surgical procedures. CONCLUSIONS: Mexico and Brazil have led IONM publications in LA. The lower reference in publications of visual evoked potentials and brainstem auditory evoked potentials IONM modalities, could be considered in the future to boost tailored research in LA.

Decompressive Craniectomy for Hemispheric Infarction in a Low-Income Population.

BACKGROUND: Stroke is a worldwide leading cause of mortality and disability, and there are substantial economic costs for poststroke care. Disadvantaged populations show increased incidence, severity, and unfavorable outcomes. This study aimed to report the survival, functional outcome, and caregiver satisfaction of low-income patients diagnosed with a large hemispheric infarction (LHI) who underwent decompressive craniectomy (DC). METHODS: A retrospective analysis was conducted in consecutive adult patients with an LHI who underwent DC at a single center between October 2015 and September 2019. Demographic, clinical, and radiologic data were reviewed. The primary outcomes were 1-year survival and favorable functional outcome. RESULTS: Forty-nine patients were included; those <60 years of age showed a higher proportion of favorable functional outcomes (76% vs. 33%; P = 0.031) but similar survival (52% vs. 56%; P = 0.645) than older patients, respectively. Performing the craniectomy in <48 hours from stroke onset compared with ≥48 hours showed no statistically significant differences in survival (59% vs. 46%; P = 0.352) and favorable functional outcomes (56% vs. 70%; P = 0.683), respectively. In retrospective thinking, 79% of caregivers would decide to perform the surgery again. CONCLUSIONS: Age group and time from stroke onset to craniectomy were not associated with survival; notwithstanding, a higher proportion of patients <60 years of age were associated with a favorable functional outcome compared with older patients. Additionally, if given the option, most caregivers would decide to perform the surgery again, independently of the grade of disability of the patient.

Guía de práctica clínica para el diagnóstico y manejo de la infección por Helicobacter pylori en enfermedades gastroduodenales en el Seguro Social de Salud del Perú (EsSalud) / Clinical practice guidelines for diagnosis and management of Helicobacter pylori infection in gastroduodenal diseases of the Peruvian Health Social Security (EsSalud)

RESUMEN Introducción : El presente artículo resume las recomendaciones basadas en evidencia de la guía de práctica clínica (GPC) para el diagnóstico y manejo de la infección por Helicobacter pylori en enfermedades gastroduodenales. Métodos : Se conformó un grupo elaborador de la guía (GEG) que incluyó médicos especialistas y metodólogos que formuló siete preguntas clínicas a ser respondidas por la presente GPC. Se realizaron búsquedas sistemáticas de revisiones sistemáticas y -cuando se consideró pertinenteestudios primarios en PubMed y CCENTRAL durante diciembre 2019 y marzo 2020. Se seleccionó la evidencia para responder cada una de las preguntas clínicas planteadas y la certeza de la evidencia fue evaluada usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). En reuniones de trabajo periódicas, el GEG usó la metodología GRADE para revisar la evidencia y formular las recomendaciones, los puntos de buena práctica clínica y los flujogramas. Finalmente, la GPC fue aprobada con Resolución Resolución N° 104-IETSI-ESSALUD-2020. Resultados: La presente GPC abordó siete preguntas clínicas, divididas en cuatro temas. En base a dichas preguntas se formularon 12 recomendaciones (3 fuertes y 9 condicionales), 17 BPC, y dos flujogramas (uno de diagnóstico y otro de manejo). Conclusión : El presente artículo resume la metodología y las conclusiones basadas en evidencias de la GPC para el diagnóstico y manejo inicial de la infección por Helicobacter pylori en enfermedades gastroduodenales.

ABSTRACT Introduction : This article summarizes the evidence-based recommendations of the clinical practice guide (CPG) for the diagnosis and management of Helicobacter pylori infection in gastroduodenal diseases. Methods : For the provision of these recommendations, a guideline development group (local GDG) was established, including medical specialists and methodologists that formulated seven clinical questions. Systematic searches of systematic reviews and -when it was considered pertinentprimary studies were conducted in PubMed and CENTRAL during December 2017 and July 2019. The evidence to answer each of the posed clinical questions was selected. The quality of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic work meetings, the local GDG used the GRADE methodology to review the evidence and formulate the recommendations, points of good clinical practice, and flowcharts. Finally, the CPG was approved with Resolution N° 104-IETSI-ESSALUD-2020. Results: This CPG addressed seven clinical questions, divided into four topics. Based on these questions, 12 recommendations (3 strong and 9 weak), 17 points of good clinical practice, and two flowcharts (one for diagnosis and another for management) were formulated. Conclusion : This article summarizes the methodology and evidence-based conclusions from the CPG for for the diagnosis and management of Helicobacter pylori infection in gastroduodenal diseases.

Developing a Model of Graduate Teaching Assistant Teacher Efficacy: How Do High and Low Teacher Efficacy Teaching Assistants Compare?

Graduate teaching assistants (TAs) are often responsible for teaching introductory courses to undergraduate science, technology, engineering, and mathematics students. The TAs are usually novices at teaching, and an important factor in their resilience and persistence in the face of inevitable challenges is self-efficacy. Little is known about what affects TA teacher efficacy or whether and how high- and low-efficacy TAs differ in their development as teachers. Bridging these gaps in the literature will inform best practices in developing and implementing professional development (PD) for TAs. Using a mixed-methods sequential exploratory research design, this study found differences in high- and low-efficacy TAs in both TAs' self-reflection and their students' perceptions. These differences concerned the focus of TAs' attention: inward at their own practices and emotions (salient in low-efficacy TAs) versus outward at the impact of their instructional guidance on their learners (prevalent in high-efficacy TAs). A proposed model of teacher efficacy based on TAs but generally applicable is presented to inform future research and provide suggestions for TA PD opportunities.

[Clinical practice guidelines for diagnosis and management of Helicobacter pylori infection in gastroduodenal diseases of the Peruvian Health Social Security (EsSalud)]. / Guía de práctica clínica para el diagnóstico y manejo de la infección por Helicobacter pylori en enfermedades gastroduodenales en el Seguro Social de Salud del Perú (EsSalud).

INTRODUCTION: This article summarizes the evidence-based recommendations of the clinical practice guide (CPG) for the diagnosis and management of Helicobacter pylori infection in gastroduodenal diseases. METHODS: For the provision of these recommendations, a guideline development group (local GDG) was established, including medical specialists andmethodologists that formulated seven clinical questions. Systematic searches of systematic reviews and -when it was considered pertinent- primary studies were conducted in PubMed and CENTRAL during December 2017 and July 2019. The evidence to answer each of the posed clinical questions was selected. The quality of the evidence was evaluated using the Grading ofRecommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic work meetings, the local GDG used the GRADE methodology to review the evidence and formulate the recommendations, points of good clinical practice, and flowcharts. Finally, the CPG was approved with Resolution N° 104-IETSI-ESSALUD-2020. RESULTS: This CPG addressed seven clinical questions, divided into four topics. Based on these questions, 12 recommendations (3 strong and 9 weak), 17 points of good clinical practice, and two flowcharts (one for diagnosis and another for management) were formulated. CONCLUSION: This article summarizes the methodology and evidence-based conclusions from the CPG for for the diagnosis and management of Helicobacter pylori infection in gastroduodenal diseases.

[Clinical practice guidelines for the diagnosis and management chronic infection of hepatitis viral C of the Peruvian Health Social Security (EsSalud)]. / Guía de práctica clínica para el diagnóstico y tratamiento de la infección crónica por el virus de hepatitis C en el Seguro Social de Salud del Perú (EsSalud).

INTRODUCTION: This article summarizes the clinical practice guidelines (CPG) for the diagnosis and treatment of chronic infection of hepatitis viral C of the Peruvian Health Social Security (EsSalud). OBJECTIVE: To provide clinical recommendations based on evidence for the diagnosis and treatment of chronic infection of hepatitis viral C in EsSalud. METHODS: A guideline development group (GDG) was established, including medical specialists and methodologists. The GDG formulated 4 clinical questions to be answered in this CPG. Systematic searches of systematic reviews and primary studies (when pertinent) were conducted in PubMed, and Central (Cochrane) during 2019. The evidence was selected to answer each of the clinical questions. The accuracy of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic work meetings, the GEG used the GRADE methodology to review the evidence and formulate the recommendations, the points of good clinical practice and the treatment flowchart. Finally, the CPG was approved with Resolution No. 151-IETSIESSALUD-2019. RESULTS: The present CPG addressed 4 clinical questions of four topics: screening, diagnosis, staging and treatment. Based on these questions, 13 recommendations (8 strong recommendations and 5 weak recommendations), 27 points of good clinical practice, and 1 flowchart were formulated. CONCLUSION: This paper summarizes the methodology and evidencebased conclusions from the CPG for for the diagnosis and treatment of chronic infection of hepatitis viral C of the EsSalud.

Management practices and honey characteristics of Melipona eburnea in the Peruvian Amazon / Práticas de manejo e características do mel de Melipona eburnea Friese na Amazônia peruana

ABSTRACT: Meliponiculture and associated honey production are activities with a great potential for general use and commercialization in the Peruvian Amazon. Lack of management techniques and limited knowledge of honey quality are two factors which may hinder the implementation of meliponiculture. The present study was conducted in three communities in the Peruvian Amazon where the production and physicochemical and microbiological characteristics of honey from Melipona eburnea were evaluated at 90 days following transfer from natural to rational hives. Honey from M. eburnea was also compared with the 90-day-old honey from Melipona grandis, Melipona illota, and Melipona titania. In addition, 180-day-old honey from M. eburnea was sampled and compared with the younger 90-day-old honey. The production of honey varied from 900 to 1400 mL/colony/3 months for M. eburnea. When moisture and total sugars among the different species of Melipona were compared, no significant differences were observed. Neither were there significant differences between the M. eburnea honey at 90 and 180 days of maturation. Microbiological analyses for both treatments had values <0.3/g most probable number (MPN) of coliforms and organisms of fecal origin. Stingless bee honey can therefore be harvested after 3 months, by which time its physicochemical characteristics are stable and it is microbiologically suitable for human consumption.

RESUMO: A meliponicultura e a produção associada de mel é uma atividade com grande potencial de uso e comercialização na Amazônia peruana, contudo, as poucas técnicas de manejo e o pouco conhecimento da qualidade do mel oferecido limitam seu desenvolvimento. O presente estudo foi realizado em três comunidades da Amazônia peruana, onde a produção e as características físico-químicas e microbiológicas do mel de Melipona eburnea foram avaliadas 90 dias após a instalação em colmeias racionais. O mel de M. eburnea também foi comparado ao mel de 90 dias de M. grandis, M. illota e M. titania. Além disso, o mel de M. eburnea foi amostrado aos 180 dias. A produção de mel variou de 900 a 1400 ml/colônia/três meses para M. eburnea. Quando a umidade e os açúcares totais foram comparados entre as diferentes espécies, não foram encontradas diferenças significativas. Também não foram encontradas diferenças significativas para o mel de M. eburnea aos 90 e 180 dias de maturação. As análises microbiológicas para os dois tratamentos apresentaram valores <0,3 / g MPN (número mais provável) de coliformes e organismos de origem fecal. O mel de abelha sem ferrão pode, portanto, ser colhido após três meses, pois mantém suas características físico-químicas e é microbiologicamente adequado para consumo humano.

Electron shuttling mediated by humic substances fuels anaerobic methane oxidation and carbon burial in wetland sediments.

Key pathways for the anaerobic oxidation of methane (AOM) have remained elusive, particularly in organic rich ecosystems. In this work, the occurrence of AOM driven by humus-catalyzed dissimilatory iron reduction was investigated in sediments from a coastal mangrove swamp. Anoxic sediment incubations supplied with both goethite (α-FeOOH) and leonardite (humic substances (HS)) displayed an average AOM rate of 10.7 ±â€¯0.8 µmol CH4 cm-3 day-1, which was 7 and 3 times faster than that measured in incubations containing only goethite or HS, respectively. Additional incubations performed with 13C-methane displayed Pahokee Peat HS-mediated carbonate precipitation linked to 13CH4 oxidation and ferrihydrite reduction (~1.3 µmol carbonate cm-3 day-1). These results highlight the role of HS on mitigating greenhouse gases released from wetlands, not only by mediating the AOM process, but also by enhancing carbon sequestration as inert minerals (calcite, aragonite and siderite).

[Endoscopic submucosal dissection of a transpyloric early gastric cáncer. A case report and literature review]. / Disección submucosa endoscópica de cáncer gástrico tempranotranspilórico. Reporte de caso y revisión de la literatura.

The endoscopic sumucosal disection (ESD) is an advanced endoscopic technique that achieves the curative resection of superficial neoplasms of the gastrointestinal tract, getting block exeresis with margins free of neoplasia avoiding surgery. However, tumors located in the esophagogastric junction, or pylorus, are technically more complex to resect by ESD. When a neoplasm settles in the pylorus, the anatomical characteristics of this region can affect the adequate assessment of the margins and the performance of the procedure. We present the case of a 70-year-old male patient who, in a high digestive endoscopy, showed a flat multilobulated lesion of 18 mm x 10 mm, located mostly in the lower 2 quadrants of the pyloric canal and minimal compromise of the upper-posterior quadrant, it mainly covers the gastric side of the pyloric channel and extends into the duodenum. Therefore, it was decided to perform en bloc resection of the lesion with the endoscopic submucosal dissection technique. The ERBEJET system was used with a knife type Hybrid knife, saline injection with methylene blue diluted 0.04% on the distal margin, submucosal injection being complemented with 0.4% hyaluronic acid. A "capsule" or straight transparent distal plastic device was used to be able to pull the lesion and allow anterograde visualization of the margins of resection, including the intraduodenal portion, allowing adequate submucosal dissection. Histopathology showed a moderately differentiated tubular adenocarcinoma with surgical edges free of injury. Thanks to the DSE strategy used, our patient could benefit from the curative resection of his gastric cancer with preservation of the organ and with perfect functionality. This case, the first described in the country, shows the progress of national therapeutic endoscopy.

Full Atrioventricular Block Secondary to Acute Poisoning Mercury: A Case Report.

Background: The biological behaviour and clinical significance of mercury toxicity vary according to its chemical structure. Mercury differs in its degree of toxicity and in its effects on the nervous, digestive and immune systems as well as on organs such as the lungs, kidneys, skin, eyes and heart. Human exposure occurs mainly through inhalation of elemental mercury vapours during industrial and artisanal processes such as artisanal and small-scale gold mining. Case presentation: A 52-years-old female, housewife, with a body mass index of 25.3 kg/cm², without smoking or alcohol habits or any important clinical or chronic cardiovascular history, was admitted to the emergency room due to probable accidental poisoning by butane gas. Clinical manifestations with a headache, dizziness, cough, and dyspnoea of medium to small efforts. An initial physical exploration with Glasgow scored at 15, with arrhythmic heart sounds, pulmonary fields with bilateral subcrepitant rales and right basal predominance. Electrocardiographic findings were as follows: a cardiac frequency of 50 beats per minute and atrioventricular dissociation. Laboratory parameters were: white blood cells at 15.8 × 108/L; aspartate aminotransferase at 38 U/L; lactate dehydrogenase at 1288 U/L; creatine-kinase at 115 U/L; CK-MB fraction at 28 U/L; and other biochemical parameters were within the reference values. A radiographic evaluation showed flow cephalization, diffuse bilateral infiltrates with right basal predominance. In addition, the patient presented data of low secondary expenditure to third-degree atrioventricular (AV) block for which the placement of a transvenous pacemaker was decided, substantially improving the haemodynamic parameters. Subsequently, after a family interrogation, the diagnosis of mercury inhalation poisoning was established. An initial detection of mercury concentration (Hg(0)) was carried out, reporting 243.5 µg/L. In view of this new evidence, mercury chelation therapy with intravenous calcium disodium ethylenediamine tetraacetic acid (CaNa2·EDTA) was initiated. After 8-days of hospital stay, she presented a favourable evolution with both clinical and radiological improvements, so that the mechanical ventilation progressed to extubating. Subsequently, she was referred for cardiology because of her persistent 3rd-degree atrioventricular block, deciding to place a definitive bicameral pacemaker. The patient was discharged from the hospital 14 days after admission due to clinical improvements with mercury plasma levels at 5 µmol/L and a heart rhythm from the pacemaker. Conclusions: We show evidence that acute exposure to elemental mercury can affect the heart rhythm, including a complete atrioventricular blockage.

Enhancement of perchlorate removal from groundwater by cationic granular activated carbon: Effect of preparation protocol and surface properties.

In order to obtain a high adsorption capacity for perchlorate, the epoxide-forming quaternary ammonium (EQA) compounds were chemically bonded onto granular activated carbon (GAC) surface by cationic reaction. The optimum preparation condition of the cationic GAC was achieved while applying softwood-based Gran C as the parent GAC, dosing EQA first at a pH of 12, preparation time of 48 h, preparation temperature of 50 °C, and mole ratio of EQA/oxygen groups of 2.5. The most favorable cationic GAC that had the QUAB360 pre-anchored exhibited the highest perchlorate adsorption capacity of 24.7 mg/g, and presented the longest bed volumes (3000 BV) to 2 ppb breakthrough during rapid small scale column tests (RSSCTs), which was 150 times higher than that for the pristine Gran C. This was attributed to its higher nitrogen amount (1.53 At%) and higher positive surface charge (0.036 mmol/g) at pH 7.5. Also, there was no leaching of the quaternary ammonium detected in the effluent of the RSSCTs, indicating there was no secondary pollution occurring during the perchlorate removal process. Overall, this study provides an effective and environmental-friendly technology for improving GAC perchlorate adsorption capacity for groundwater treatment.

Disección submucosa endoscópica de cáncer gástrico temprano transpilórico: Reporte de caso y revisión de la literatura / Endoscopic submucosal dissection of a transpyloric early gastric cáncer: A case report and literature review

La disección submucosa endoscópica (DSE) es una técnica endoscópica avanzada que logra la resección curativa de neoplasias superficiales del tracto gastrointestinal, consiguiendo exéresis en bloque con márgenes libres de neoplasia evitando una cirugía. Sin embargo, los tumores localizados en la unión esófago gástrica, o pilórica son técnicamente más complejos para resecar por DSE. Cuando una neoplasia asienta en el píloro las características anatómicas de esta región pueden afectar la adecuada valoración de los márgenes y la realización del procedimiento. Presentamos el caso de un paciente varón de 70 años a quien en una endoscopia digestiva alta se le evidencia una lesión plana elevada multilobulada de 18 mm x 10 mm, situada mayoritariamente en los 2 cuadrantes inferiores del canal pilórico y compromiso mínimo del cuadrante supero-posterior, abarca principalmente la vertiente gástrica del canal pilórico y se extiende hacia el duodeno. Por todo ello se decide realizar resección en bloque de la lesión con la técnica de disección submucosa endoscópica. Se empleó el sistema ERBEJET con una cuchilla de tipo Hybrid knife, inyección salina con azul de metileno diluido al 0,04% sobre el margen distal, complementándose la inyección submucosa con ácido hialurónico al 0,4%. Se utilizó un "capuchón" o dispositivo plástico distal transparente recto para poder traccionar la lesión y permitir visualizar anterógradamente los márgenes de resección, incluso de la porción intraduodenal, permitiendo una adecuada disección submucosa. Luego de comprobar hemostasia se constató la resección en bloque. La histopatología mostró un adenocarcinoma tubular medianamente diferenciado con bordes quirúrgicos libres de lesión. Gracias a la estrategia de DSE utilizada, nuestro paciente pudo beneficiarse de la resección curativa de su cáncer gástrico con preservación del órgano y con perfecta funcionalidad. Este caso, el primero descrito en el país, muestra el avance de la endoscopía terapéutica nacional.

The endoscopic sumucosal disection (ESD) is an advanced endoscopic technique that achieves the curative resection of superficial neoplasms of the gastrointestinal tract, getting block exeresis with margins free of neoplasia avoiding surgery. However, tumors located in the esophagogastric junction, or pylorus, are technically more complex to resect by ESD. When a neoplasm settles in the pylorus, the anatomical characteristics of this region can affect the adequate assessment of the margins and the performance of the procedure. We present the case of a 70-year-old male patient who, in a high digestive endoscopy, showed a flat multilobulated lesion of 18 mm x 10 mm, located mostly in the lower 2 quadrants of the pyloric canal and minimal compromise of the upper-posterior quadrant, it mainly covers the gastric side of the pyloric channel and extends into the duodenum. Therefore, it was decided to perform en bloc resection of the lesion with the endoscopic submucosal dissection technique. The ERBEJET system was used with a knife type Hybrid knife, saline injection with methylene blue diluted 0.04% on the distal margin, submucosal injection being complemented with 0.4% hyaluronic acid. A "capsule" or straight transparent distal plastic device was used to be able to pull the lesion and allow anterograde visualization of the margins of resection, including the intraduodenal portion, allowing adequate submucosal dissection. Histopathology showed a moderately differentiated tubular adenocarcinoma with surgical edges free of injury. Thanks to the DSE strategy used, our patient could benefit from the curative resection of his gastric cancer with preservation of the organ and with perfect functionality. This case, the first described in the country, shows the progress of national therapeutic endoscopy.

Management and attitudes about IPF (Idiopathic Pulmonary Fibrosis) among physicians from Latin America.

BACKGROUND: The aim of our study was to assess current practice patterns and attitudes towards diagnosis and management of idiopathic pulmonary fibrosis (IPF) patients in Latin America. METHODS: A Cross-sectional survey was developed and up to 455 physicians were enrolled. We used a rigorous method of validation using the translated version of the AIR Survey. RESULTS: Mean age was 47.5 years (SD 12.6) with 20.4 years (SD 12.3) of practice. In around 30% of physicians were reported access to radiologist, pathologist and multidisciplinary team. Despite almost all physicians reported that (ATS/ERS/JRS/ALAT) guidelines are useful, half of them prescribed corticoids for treatment of disease. Most respondents (69.9%) reported cough as the presenting symptom. Around 80% considered IPF to be an important clinical disorder, and felt that identifying patients at risk for IPF was important or extremely important. However, only 59.7% felt confident in managing patients with IPF, and similar numbers (60.8%) felt confident about their knowledge. Pulmonologist have more confidence and management of IPF that no pulmonologist. CONCLUSION: The results of this survey of Latin American physicians could help to fill gaps regarding awareness, management and treatment of IPF and improve earlier diagnosis of IPF.

Adsorptive removal of sulfate from acid mine drainage by polypyrrole modified activated carbons: Effects of polypyrrole deposition protocols and activated carbon source.

Polypyrrole modified activated carbon was used to remove sulfate from acid mine drainage water. The polypyrrole modified activated carbon created positively charged functionality that offered elevated sorption capacity for sulfate. The effects of the activated carbon type, approach of polymerization, preparation temperature, solvent, and concentration of oxidant solution over the sulfate adsorption capacity were studied at an array of initial sulfate concentrations. A hardwood based activated carbon was the more favorable activated carbon template, and this offered better sulfate removal than when using bituminous based activated carbon or oak wood activated carbon as the template. The hardwood-based activated carbon modified with polypyrrole removed 44.7 mg/g sulfate, and this was five times higher than for the pristine hardwood-based activated carbon. Various protocols for depositing the polypyrrole onto the activated carbon were investigated. When ferric chloride was used as an oxidant, the deposition protocol that achieved the most N+ atomic percent (3.35%) while also maintaining the least oxygen atomic percent (6.22%) offered the most favorable sulfate removal. For the rapid small scale column tests, when processing the AMD water, hardwood-based activated carbon modified with poly pyrrole exhibited 33 bed volume compared to the 5 bed volume of pristine activated carbons.

Chemical modeling for precipitation from hypersaline hydrofracturing brines.

Hypersaline hydrofracturing brines host very high salt concentrations, as high as 120,000-330,000 mg/L total dissolved solids (TDS), corresponding to ionic strengths of 2.1-5.7 mol/kg. This is 4-10 times higher than for ocean water. At such high ionic strengths, the conventional equations for computing activity coefficients no longer apply; and the complex ion-interactive Pitzer model must be invoked. The authors herein have used the Pitzer-based PHREEQC computer program to compute the appropriate activity coefficients when forming such precipitates as BaSO4, CaSO4, MgSO4, SrSO4, CaCO3, SrCO3, and BaCO3 in hydrofracturing waters. The divalent cation activity coefficients (γM) were computed in the 0.1 to 0.2 range at 2.1 mol/kg ionic strength, then by 5.7 mol/kg ionic strength, they rose to 0.2 for Ba(2+), 0.6 for Sr(2+), 0.8 for Ca(2+), and 2.1 for Mg(2+). Concurrently, the [Formula: see text] was 0.02-0.03; and [Formula: see text] was 0.01-0.02. While employing these Pitzer-derived activity coefficients, the authors then used the PHREEQC model to characterize precipitation of several of these sulfates and carbonates from actual hydrofracturing waters. Modeled precipitation matched quite well with actual laboratory experiments and full-scale operations. Also, the authors found that SrSO4 effectively co-precipitated radium from hydrofracturing brines, as discerned when monitoring (228)Ra and other beta-emitting species via liquid scintillation; and also when monitoring gamma emissions from (226)Ra.