Can We Do Anything Else before Removing a Button Battery from the Esophagus?-Hyaluronic Acid.

OBJECTIVE: This article tests the protective effect of a commercially available mixture of hyaluronic acid, chondroitin sulfate, and poloxamer 407 on the damage caused by the exposure of esophageal mucosa to button batteries in an animal model. METHODS: Experimental study. Sixty porcine esophageal samples were distributed in three groups: control (CG), exposure (EG), and exposure-protection (EPG). In EG and EPG, one CR2032 button battery per sample was inserted, both were subdivided into 2-, 4-, 6-, and 24-hour exposure subgroups, with subsequent battery removal. EPG samples were irrigated with the solution 1 hour after battery exposure. Esophageal pH and final voltage of the battery were measured. RESULTS: pH in CG remained stable. No significant differences in pH at 1 hour were found between EG and EPG. In EPG, the pH of the mucosa exposed to the anode was lower than in GE at 2 hours (12.44 vs. 11.89, p = 0.203) and 4 hours (13.78 vs. 11.77, p < 0.0001). In the cathode pH was significantly higher in EG at 2 hours (2.5 vs. 4.11, p < 0.0001), 4 hours (2.33 vs. 4.78, p < 0.0001), and 6 hours (2.17 vs. 2.91, p < 0.0001). Significant voltage reduction at 1 hour was found in EG compared to EPG (0.48 vs. 1.08 V, p = 0.004). CONCLUSION: Exposure to hyaluronic acid solution buffers the acidification on the side exposed to the cathode and basification on the anode. This effect can be maintained up to 3 to 5 hours, even after stopping its application. Our results suggest that a solution containing hyaluronic acid could be used as an esophageal protector after accidental ingestion of button batteries.

Insertion of single-ion magnets based on mononuclear Co(II) complexes into ferromagnetic oxalate-based networks.

The 1 : 2 and 1 : 1 Co(ii) complexes of the L ligand (L = 6-(3,5-diamino-2,4,6-triazinyl)2,2'-bipyridine) with formulas [CoII(L)2](ClO4)2·0.5MeCN·Et2O (1) and [CoII(L)(CH3CN)2(H2O)](ClO4)2·MeCN (2) have been prepared. The structural and magnetic characterization of the two compounds shows that they contain octahedral high-spin Co(ii) and present a field-induced slow relaxation of the magnetization. 1 has been inserted into a bimetallic oxalate-based network leading to a novel achiral 3D compound of formula [CoII(L)2][MnIICrIII(ox)3]2·(solvate) (3) exhibiting ferromagnetic ordering below 4.6 K. EPR measurements suggest a weak magnetic coupling between the two sublattices.

La dieta baja en FODMAP, ¿es realmente eficaz y segura en el síndrome del intestino irritable?: una revisión panorámica / Is the diet low in FODMAP really effective and safe for irritable bowel syndrome?: a scoping review

En el momento presente, no se dispone de un tratamiento etiológico para el síndrome del intestino irritable y la modificación de la dieta, en particular la dieta baja en FODMAP (oligosacáridos, disacáridos, monosacáridos y polioles fermentables) se utiliza cada vez más para controlar los síntomas, si bien no se conocen su eficacia y seguridad reales. El objetivo de esta revisión panorámica es conocer si la dieta baja en FODMAP es realmente eficaz y segura a largo plazo en el manejo dietético de dicho síndrome. La revisión, siguiendo una metodología adecuada, se llevó a cabo con 25 estudios, que se recuperaron a texto completo. De todos ellos, 3 eran metaanálisis, 2 revisiones sistemáticas y 3 ambos tipos de estudio. El resto de los estudios eran, en general, de baja calidad metodológica y muy heterogéneos, con poco nivel de evidencia y bajo grado de recomendación. Puede concluirse que, en el corto plazo, la dieta baja en FODMAP tiene eficacia en la mayoría de los pacientes con síndrome de intestino irritable, por lo que podría apoyarse su uso como terapia de primera línea. Sin embargo, de todos los estudios, solamente uno fue prospectivo de seguimiento a largo plazo, entre 6 y 18 meses, con buenos resultados, por lo que se precisan más estudios de seguimiento, diseñados con este propósito, en los que se investiguen los efectos a largo plazo. De aconsejarse este tipo de dieta, debería hacerse dirigida por dietistas especializados

At present, there is no aetiological treatment available for irritable bowel syndrome, and dietary modifications, particularly the low-FODMAP (monosaccharide, disaccharide, oligosaccharides and fermentable polyols) diet is increasingly used to control the symptoms of irritable bowel syndrome, although its actual efficacy and safety are unknown. The objective of this overview is to determine whether the low FODMAP diet is really effective and safe in the long term in the dietary management of irritable bowel syndrome. The review, following an appropriate methodology, was carried out with 25 studies, which were retrieved full text. Of these, 3 were meta-analyses, 2 were systematic reviews, and 3 were both types of studies. The rest of the studies were, in general, of low methodological quality and very heterogeneous, with a low level of evidence and low degree of recommendation. It can be concluded that, in the short term, the low-FODMAP diet is effective in most patients with irritable bowel syndrome, so its use as first-line therapy could be supported. However, of all the studies, only one was prospective for long-term follow-up, between 6 and 18 months, with good results. More follow-up studies, designed for this purpose, are needed to investigate long-term effects. Furthermore, if this type of diet is advised, it should be led by specialised dietitians

[Is the diet low in FODMAP really effective and safe for irritable bowel syndrome?: A scoping review]. / La dieta baja en FODMAP, ¿es realmente eficaz y segura en el síndrome del intestino irritable?: una revisión panorámica.

At present, there is no aetiological treatment available for irritable bowel syndrome, and dietary modifications, particularly the low-FODMAP (monosaccharide, disaccharide, oligosaccharides and fermentable polyols) diet is increasingly used to control the symptoms of irritable bowel syndrome, although its actual efficacy and safety are unknown. The objective of this overview is to determine whether the low FODMAP diet is really effective and safe in the long term in the dietary management of irritable bowel syndrome. The review, following an appropriate methodology, was carried out with 25 studies, which were retrieved full text. Of these, 3 were meta-analyses, 2 were systematic reviews, and 3 were both types of studies. The rest of the studies were, in general, of low methodological quality and very heterogeneous, with a low level of evidence and low degree of recommendation. It can be concluded that, in the short term, the low-FODMAP diet is effective in most patients with irritable bowel syndrome, so its use as first-line therapy could be supported. However, of all the studies, only one was prospective for long-term follow-up, between 6 and 18 months, with good results. More follow-up studies, designed for this purpose, are needed to investigate long-term effects. Furthermore, if this type of diet is advised, it should be led by specialised dietitians.

Electronic characterization of silicon intercalated chevron graphene nanoribbons on Au(111).

Electronic and thermal properties of chevron-type graphene nanoribbons can be widely tuned, making them interesting candidates for electronic and thermoelectric applications. Here, we use post-growth silicon intercalation to unambiguously access nanoribbons' energy position of their electronic frontier states. These are otherwise obscured by substrate effects when investigated directly on the growth substrate. In agreement with first-principles calculations we find a band gap of 2.4 eV.

Recomendaciones para el empleo de probióticos en la diarrea en la infancia / Recommendations for the use of probiotics in childhood diarrhea

La pediatría es una de las especialidades médicas donde los ensayos clínicos aleatorizados con probióticos han demostrado la eficacia y seguridad de éstos en diversas patologías, sobre todo digestivas. La mayor evidencia corresponde al empleo de probióticos en diversos tipos de diarreas, por lo que han sido incluidos en diferentes guías de práctica clínica. El efecto del probiótico debe valorarse en función de la cepa utilizada, la dosis y la duración del tratamiento. Los probióticos son eficaces en el tratamiento de la diarrea aguda infecciosa infantil, ya que acortan la duración media del proceso, el número de deposiciones y el porcentaje de episodios que se prolongan más de 4 días. De igual modo, han sido ampliamente estudiados para prevenir el desarrollo de la diarrea asociada a antibióticos, siendo los que tienen mayor nivel de evidencia la levadura (AU)

Pediatrics is one of the medical specialties where randomized clinical trials with probiotics have demonstrated its efficacy and safety in various pathologies, especially digestive being their use in different types of diarrhea, where more evidence there is for what are included in different clinical practice guidelines. The effect of probiotic should be assessed according to the used strain, dose, administration time and the duration of the same. Probiotics are effective in the treatment of acute infectious diarrhea in children by shortening the average duration of the process, the number of liquid stools, and the percentage that lasts more than 4 days. In the same way, have been widely studied for preventing the development of antibiotic-associated diarrhea being those that have higher level of evidence the yeast Saccharomyces boulardii and strain Lactobacillus rhamnosus GG (AU)

Photomagnetic properties of an Fe(ii) spin-crossover complex of 6-(3,5-diamino-2,4,6-triazinyl)-2,2'-bipyridine and its insertion into 2D and 3D bimetallic oxalate-based networks.

The Fe(ii) complex of the L1 ligand (L1 = 6-(3,5-diamino-2,4,6-triazinyl)-2,2'-bipyridine) has been used as a templating cation for the growth of oxalate-based networks. The magnetic characterization of the [FeII(L1)2](ClO4)2·CH3CN (1) precursor in the solid state has been performed for the first time showing that the low-spin (LS) state is predominating from 2 to 400 K with 10% of Fe(ii), which undergoes a gradual and irreversible spin-crossover above 350 K. 1 presents the LIESST effect with a photo-conversion close to 25% and a T(LIESST) of 49 K. During the preparation of 1, a secondary product of the formula [FeII(L1)(CH3CN)2(H2O)](ClO4)2·CH3CN (2) has been obtained. The magnetic characterization of 2 shows that it contains high-spin (HS) Fe(ii). 1 has afforded two novel oxalate-based compounds, the 2D compound of the formula [FeII(L1)2][MnIICrIII(ox)3]2·(CH3NO2)6·(CH3OH)·(H2O)2 (3) and the 3D compound of the formula [FeII(L1)2][MnIICrIII(ox)3]2·(CH3CN)3 (4), which have been obtained by changing the synthetic conditions. The magnetic properties show that in 3 the inserted Fe(ii) cation remains in the LS state from 2 to 340 K and presents a partial and irreversible spin-crossover of ∼20% at higher temperatures. In 4, most of the Fe(ii) complexes remain in the LS state from 2 to 230 K and present a partial and irreversible spin-crossover of ∼50% from 230 to 400 K. 3 and 4 do not present the LIESST effect.

Sección de Gastroenterología Infantil del Hospital Universitario Gregorio Marañón / Pediatric Gastroenterology section of the Hospital Universitario Gregorio Marañón

La Sección de Gastroenterología, Hepatología y Nutrición Infantil del Hospital Materno Infantil del HGU Gregorio Marañón se dedica a la atención integral del paciente pediátrico con patología digestiva y con especial dedicación a la nutrición del niño enfermo en diferentes situaciones especiales (enfermedades oncohematológicas, niños con cardiopatías congénitas, enfermedades neuromusculares, postoperatorio de diferentes patologías quirúrgicas, enfermedades del riñón, enfermedades metabólicas, etc.). Dentro de las actividades asistenciales de la sección cabe destacar el seguimiento de diferentes patologías digestivas crónicas, como la enfermedad celíaca, la dedicación especial con novedosos proyectos asistenciales y de investigación en la enfermedad inflamatoria intestinal, así como la asistencia en enfermedades crónicas del hígado y páncreas, entre otras. En esta Sección se han desarrollado nuevas técnicas diagnósticas y se han fortalecido la aplicación de otras exploraciones complementarias complejas en el estudio de enfermedades digestivas, convirtiéndose en centro de referencia de algunas de ellas como sucede en el caso de trastornos de motilidad digestiva o el estudio de la microbiota intestinal. En este artículo se refleja la estructura de la unidad junto con una revisión de su actividad asistencial en patologías digestivas cada vez más complejas, la elaboración de las tareas docentes realizadas en nuestro centro y para otras entidades con gran difusión de las mismas, así como la importante labor de investigación clínica con participación en diferentes líneas de investigación (AU)

The Paediatric Gastroenterology, Hepatology and Nutrition Section of Maternal and Child Hospital HGU Gregorio Maranon is dedicated to comprehensive care of pediatric patients with digestive diseases with special attention to the nutrition of the sick child in different special situations (oncohaemathologic diseases, complex heart diseases, neuropaediatric diseases, postoperative of different surgical diseases, kidney diseases, metabolíc diseases…). Within the humanitarian assistance activities of the Section include monitoring of different chronic digestive diseases, such as celiac disease, special dedication to innovative care projects and research in inflammatory bowel disease, and such as assistance in chronic diseases of the liver and pancreas, among others. On the other hand, in our section we have developed new diagnostic techniques and strengthened the implementation of other complex complementary examinations in the study of digestive diseases, becoming a reference center for some of them as happens in the case of motility disorders and research of microbiome. In this article, the structure of the Section is reflected along with a review of their daily work in increasingly complex digestive diseases, as well as educational activities in our center and to other entities with widely distributed thereof, as well as the important work of clinical research with participation in different lines of research (AU)

Docencia e investigación en Pediatría en el Hospital General Universitario Gregorio Marañón / Medical education and investigation in Pediatric in the Hospital Materno Infantil Gregorio Marañón

La docencia y la investigación son actividades esenciales en un hospital y por esa razón la docencia pregrado y posgrado y la investigación deben desarrollarse y coordinarse de forma integrada con la asistencia clinica. El Hospital Materno Infantil Gregorio Marañón tiene una importante actividad docente pregrado, tanto en Medicina como parte de la Universidad Complutense de Madrid, como en enfermería. A nivel posgrado realiza la formación de residentes de Pediatría, Cirugía Pediátrica, Medicina Familiar y Comunitaria y Enfermería Pediátrica e imparte múltiples cursos de formación continuada a profesionales sanitarios y padres. El Hospital Materno Infantil Gregorio Marañón es uno de los hospitales españoles con mayor producción científica, mayor número de proyectos de investigación y mayor capacidad de formación de investigadores. El objetivo en el futuro debe ser desarrollar una política institucional docente e investigadora coordinadas que integre la docencia y la investigación médica y de enfermería. Es necesario potenciar la integración y el reconocimiento de la actividad docente e investigadora en la práctica clínica, aumentar la formación de los profesionales en metodología docente e investigadora, estimular las áreas del hospital con menor desarrollo, facilitar la participación en redes de investigación nacionales e internacionales, e integrar la docencia e investigación en los proyectos de cooperación (AU)

Teaching and research are very important activities in a children's hospital and for that reason undergraduate and graduate teaching and research must be developed and coordinated and integrated with clinical care. The Maternal and Children Gregorio Marañón Hospital has an important undergraduate teaching, both in medicine as part of the Complutense University of Madrid, as in nursing. The Maternal and Child Gregorio Marañón Hospital performs prostgraduate residency training in Pediatrics, Pediatric Surgery and Pediatric Nursing and provides multiple continuing education courses for health professionals and parents. The Maternal and Children Gregorio Marañón Hospital is one of the Spanish hospitals with higher scientific production, as many research projects and greater capacity for research training. The goal in the future must be to develop an educational institutional policy to coordinate and integrate medical and nursing research and teaching. It is necessary to enhance integration and recognition of the teaching and research activities in clinical practice, increase education of health professionals in teaching and research methodology, stimulate areas of the hospital with lower development, facilitate participation in research networks, and integrate teaching and research in the cooperation projects (AU)

Réplica a "Espironolactona en pacientes con insuficiencia cardiaca y fracción de eyección preservada" / Reply to "Spironolactone in patients with heart failure and preserved ejection fraction"

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Espironolactona en pacientes con insuficiencia cardiaca y fracción de eyección preservada / Spironolactone in patients with heart failure and preserved ejection fraction

Objetivos. Los inhibidores de la aldosterona han demostrado ser beneficiosos en pacientes con insuficiencia cardiaca sistólica. Sin embargo, la evidencia en enfermos con insuficiencia cardiaca y fracción de eyección preservada (ICFEP) es muy limitada. Hemos evaluado el protagonismo de la espironolactona en el pronóstico de una cohorte de pacientes con ICFEP. Pacientes y métodos. Analizamos la evolución de los pacientes ingresados por ICFEP en 52 servicios de Medicina Interna del Registro español RICA según la toma o no de espironolactona. Se recogió la tasa de mortalidad poshospitalaria y reingresos a un año, y se realizó un análisis de supervivencia multivariante. Resultados. Se incluyeron 1212 pacientes con ICFEP con una edad media de 79 años (desviación estándar 7,9), (64,1% mujeres), la mayoría con cardiopatía hipertensiva (50,7%). Los pacientes tratados con espironolactona, en comparación con los que no recibieron este diurético, presentaron una clase funcional más avanzada, mayor número de reingresos (44,3 vs. 29,1%; p<0,001), y mayor tasa en la variable combinada de reingresos/mortalidad (39,0 vs. 29,0%; p=0,001). En el análisis multivariante, la administración de espironolactona se asoció a un aumento de los reingresos (RR 1,4; IC95%, 1,16-1,78; p=0,001). Conclusiones. En pacientes con ICFEP, la administración de espironolactona se asoció a un incremento de los reingresos por cualquier causa, tal vez en relación con la mayor tasa de hiperpotasemia (AU)

Objectives. Aldosterone inhibitors have been shown to be beneficial for patients with systolic heart failure. However, the evidence from patients with heart failure and preserved ejection fraction (HFPEF) is limited. We evaluated the role of spironolactone in the prognosis of a cohort of patients with HFPEF. Patients and methods. We analyzed the outcomes of patients hospitalized for HFPEF in 52 departments of internal medicine of the Spanish RICA registry according to those who did and did not take spironolactone. We recorded the posthospital mortality rate and readmissions at 1 year and performed a multivariate survival analysis. Results. We included 1212 patients with HFPEF, with a mean age of 79 years (standard deviation, 7.9), (64.1% women), the majority of whom had hypertensive heart disease (50.7%). The patients treated with spironolactone, compared with those who were not treated with this diuretic, had a more advanced functional class, a higher number of readmissions (44.3 vs. 29.1%; p<0.001) and a higher rate in the combined variable of readmissions/mortality (39.0 vs. 29.0%; p=0.001). In the multivariate analysis, the administration of spironolactone was associated with an increase in readmissions (RR, 1.4; 95% CI, 1.16-1.78; p=0.001). Conclusions. For patients with HFPEF, the administration of spironolactone was associated with an increase in all-cause readmission, perhaps due to the higher rate of hyperpotassemia (AU)

Spironolactone in patients with heart failure and preserved ejection fraction. / Espironolactona en pacientes con insuficiencia cardiaca y fracción de eyección preservada.

OBJECTIVES: Aldosterone inhibitors have been shown to be beneficial for patients with systolic heart failure. However, the evidence from patients with heart failure and preserved ejection fraction (HFPEF) is limited. We evaluated the role of spironolactone in the prognosis of a cohort of patients with HFPEF. PATIENTS AND METHODS: We analyzed the outcomes of patients hospitalized for HFPEF in 52 departments of internal medicine of the Spanish RICA registry according to those who did and did not take spironolactone. We recorded the posthospital mortality rate and readmissions at 1 year and performed a multivariate survival analysis. RESULTS: We included 1212 patients with HFPEF, with a mean age of 79 years (standard deviation, 7.9), (64.1% women), the majority of whom had hypertensive heart disease (50.7%). The patients treated with spironolactone, compared with those who were not treated with this diuretic, had a more advanced functional class, a higher number of readmissions (44.3 vs. 29.1%; p<0.001) and a higher rate in the combined variable of readmissions/mortality (39.0 vs. 29.0%; p=0.001). In the multivariate analysis, the administration of spironolactone was associated with an increase in readmissions (RR, 1.4; 95% CI, 1.16-1.78; p=0.001). CONCLUSIONS: For patients with HFPEF, the administration of spironolactone was associated with an increase in all-cause readmission, perhaps due to the higher rate of hyperpotassemia.

¿Es el sistema tiempos quirúrgicos estándar (TQE) aplicable a la oftalmología actual del sistema sanitario público? / Is the standard operating times system applicable to ophthalmology in the public health system?

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Pólipo antropilórico en la enfermead de Menkes / Antropyloric polyp in Menkes disease

Presentamos el caso de un lactante diagnosticado de enfermedad de Menkes en tratamiento sustitutivo con cobrehitidina que presentó un cuadro de pseudoobstrucción instestinal con hemorragia digestiva alta. La aparición de pólipos gastrointestinales por hiperplasia mucosa en la enfermedad de Menkes puede asociar importante morbimortalidad y no se previenen con el tratamiento enzimático, precisando resección endoscópica o quirúrgica (AU)

We present a case of an infant with Menkes disease treated with copper-histidine replacement therapy who developed an intestinal pseudo-obstruction with upper gastrointestinal mucosa and polyps is related to significant morbidity in Menkes disease. We can not prevent them with enzyme treatment so it usually need endoscopic or surgical resection (AU)

Psoriasis inducida por infliximab en una adolescente con colitis ulcerosa / Infliximab-induced psoriasis in an adolescent with ulcerative colitis

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Tumor carcinoide apendicular. A propósito de un caso / Appendiceal carcinoid tumor. A case report

Los tumores carcinoides derivan de las células neuroendocrinas de cualquier parte del organismo (más frecuentemente del tubo digestivo, el páncreas y los bronquios). Son los tumores endocrinos gastrointestinales más frecuentes, ya que representan un 75% de estas neoplasias, y el tumor maligno gastrointestinal más frecuente en los niños. Su diagnóstico suele realizarse de manera casual en el 0,3-0,9% de las apendicectomías, y son menos frecuentes en la edad pediátrica. Presentamos el caso de un tumor carcinoide en un niño de 12 años de edad y realizamos una revisión de esta patología (AU)

Carcinoid tumors derive from neuroendocrine cells at different anatomic locations (although they are most commonly found at the gastrointestinal tract, pancreas and bronchial airway) and are the most common gastrointestinal endocrine tumors, of which they represent 75%; being also the most common gastrointestinal malignant tumour in children. Diagnosis is often incidental (in around 0.3 to 0.9% of appendectomies, and less common in children). We report the case of a carcinoid tumor in a pediatric patient aged 12 years, providing aswell a review of this pathology (AU)

Empleo de probióticos y prebióticos en los trastornos digestivos funcionales / No disponible

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