Factors associated with complications during endoscopic esophageal dilation.

BACKGROUND: endoscopic dilation is considered as the treatment of choice for esophageal strictures. However, there are no studies in our region that have assessed the safety of the procedure. OBJECTIVE: to assess the safety of esophageal dilation and the factors associated with the development of complications. MATERIALS AND METHODS: a retrospective cohort was studied. All patients referred for esophageal dilation between January 2015 and June 2017 were included in the study. A complication rate was obtained and the association between nonadherence to the "rule of 3" and the development of complications was determined. Other predictive factors associated with complication development were also analyzed. RESULTS: a total of 164 patients that underwent 474 dilations were included in the study. Surgical anastomosis stricture was the most prevalent etiology. A total of six complications occurred, including three perforations (0.63%), two bleeding events (0.42%) and one episode of significant pain that required post-procedure observation (0.21%). Endoscopic esophageal dilation without adherence to the "rule of 3" was not associated with a higher risk of complications. Balloon dilation was the only predictive factor for complications. CONCLUSIONS: esophageal dilation is a safe procedure. Nonadherence to the "rule of 3" does not appear to be associated with a higher risk of complications, including esophageal perforation.

Eosinophilic esophagitis and herpetic esophagitis: cause or consequence?

Association between eosinophilic esophagitis and herpetic esophagitis has been suggested in some studies but it continues been so controversial. We present two clinical cases of two immunocompetent patients who did not have any previous predisposing treatment and who present both diseases; that is the reason we suggest that they may have any relation.

A bronchobiliary fistula treated with cyanoacrylate glue in a patient with liver cirrhosis.

A 60-year-old male was operated upon in 2002 for liver hydatidosis, which included partial right hepatectomy with cholecystectomy and bilioduodenal anastomosis. He then developed liver cirrhosis secondary to left hepatic duct stricture. He presents at the emergency room with dry cough, which he had for a month and then became associated with yellowish, bitter-tasting "fluid" expectoration. A chest-abdominal CT scan revealed a 6 x 5-cm collection roughly located somewhere between the middle pulmonary lobe and subphrenic area . A fistula was suspected, which prompted a sputum biochemistry test that was positive for bilirubin. Given the patient's impaired liver function because of his liver disease conservative treatment was initiated with an inner-outer drain under transparietal hepatic cholangiography (TPHC) to promote bile outflow via the duodenum. Subsequently, TPHC was used to locate the point where contrast leaked from the biliary tree into a pleural cavity, and the fistula was sealed using cyanoacrylate glue, which resulted in improved symptomatology.

[Assesing the effect of Lepidium meyenii "Maca" on the gastric mucosa in patients with functional dyspepsia]. / Evaluacióndel efecto de la Lepidium meyenii "Maca" en la mucosa gástrica en pacientes con dispepsia funcional.

OBJECTIVE: The present study was designed to determine the histological effect of Lepidium meyenii "Maca" on the gastric mucosa in patients with functional dyspepsia. MATERIAL AND METHODS: This study consists of a clinical case series, in which the effect of Maca on the gastric histopathology of 29 Peruvian patients diagnosed with functional dyspepsia was examined. The presence of H. pylori, as well as the degree and depth of the gastric mucosa inflammation was evaluated from biopsies obtained before and after the treatment based solely of Maca 3 grams per day for four weeks. RESULTS: Average values of the degree and depth of mucosal inflammation before and after the treatment were compared showing no statistical difference among the samples. Sixteen patients were infected with H. pylori, and they remained infected after the treatment with Maca. CONCLUSIONS: A four week long treatment with Maca does not produce significant changes on gastric mucosa of patients with functional dyspepsia, neither on H. pylori eradication.

[Frequency of proton pump inhibitor prescription based in clinical practice guidelines in hospitalized patients in two academic hospitals in Lima, Peru]. / Frecuencia de la prescripción de los inhibidores de bomba de protones basada en guías de práctica clínica en pacientes hospitalizados en dos hospitales docentes de Lima-Perú.

OBJECTIVES: To evaluate if Proton Pump Inhibitor (PPI) prescription is based in Clinical Practice Guidelines (CPG) in hospitalized patients at two academic hospitals of Lima. MATERIALS AND METHODS: The services of Intern Medicine, Tropical Medicine and General Surgery were visited. Therapeutic sheets and nursing transcript were checked. The prescription motifs were determined in patients who received PPI. These motifs were obtained according to a check list, which was made from different CPG. RESULTS: 54.57% of the PPI prescriptions in the two academic hospitals were not based in CPG. No statistic significant difference was found between the two academic hospitals in the PPI prescription based in CPG (p=0,208). Most of the prescriptions not base on CPG belong to the service of General Surgery (83.6%; p<0.0001). The main indication for the prescription of PPI based on CPG was prevention of NSAIDS induced gastric ulcers if advanced age (65.72%). CONCLUSIONS: There is a high rate of PPI overuse in two academic hospitals.

Seroprevalence of Toxoplasma gondii and associated risk factors in cats from Lima, Peru.

Toxoplasmosis is an important zoonotic disease worldwide caused by the intracellular parasite Toxoplasma gondii. Cats, being hosts, act as a good sentinel for this disease. Thus, the objective of this study was to determine the seroprevalence of T. gondii in cats by examining serum from seven districts of Metropolitan Lima, Peru. We collected and analyzed 303 cat serum samples, and the owners answered a questionnaire about age, gender, lifestyle (indoors only and outdoors access) and feeding (commercial and home food). The samples were tested using indirect hemagglutination (IHA) for detection of antibody IgM and IgG. Among the animals analyzed, we found 52 (17.2%, 95% CI: 13.1% - 21.9%) seropositive cats to T. gondii, of which one corresponded to acute infection (IgM) and 51 to chronic infections (IgG). In addition, the presence of anti-T. gondii antibodies was associated with feeding commercial food and living outdoors access. Our results concluded that T. gondii infections are common in cats with owners in Metropolitan Lima and will be useful to future epidemiological studies.

Coccidiosis in clinically asymptomatic alpaca (Vicugna pacos) crias from the Peruvian Andes.

Parasites of the genus Eimeria are involved in the neonatal diarrhea complex of alpaca (Vicugna pacos) crias, and infection by Eimeria is commonly known as coccidiosis. There are limited reports of these protozoa in clinically asymptomatic crias. In this study, fecal samples from 78 clinically asymptomatic alpaca crias were analyzed to evaluate the prevalence, parasitological load, and diversity of Eimeria species. This study was conducted in the Quenamari community located in the Peruvian Andes (Marangani, Cuzco) at 4500 m above sea level. All fecal samples were examined for parasites using the quantitative McMaster and modified Stoll techniques. Microscopic examination showed the presence of Eimeria oocysts in 68 out of the 78 samples (87.18%). Among the 78 samples we found E. lamae in 67 (85.90%), E. punoensis in 49 (62.82%), E. alpacae in 42 (53.85%), E. macusaniensis in 32 (41.03%), and E. ivitaensis in four (5.13%). Regarding parasitized crias, overall there was a mean parasitological load of 43,920 oocysts per gram of feces (OPG). Eimeria lamae had the highest parasitological load (mean 206,600 OPG). These findings could be due to environmental contamination with oocysts of different Eimeria species. Additional research is needed to determine if this burden of coccidiosis could produce subclinical impacts to the health of alpaca crias.

Factores asociados a complicaciones en las dilataciones esofágicas endoscópicas / Factors associated with complications during endoscopic esophageal dilation

Antecedentes: las dilataciones endoscópicas se consideran el tratamiento de elección para las estenosis esofágicas, sin embargo, no se cuenta en nuestra región con estudios en los que se evalúe la seguridad de este procedimiento. Objetivo: evaluar la seguridad de las dilataciones esofágicas y los factores asociados a las complicaciones. Material y métodos: cohorte retrospectiva. Se incluyeron todos los pacientes referidos para dilatación esofágica entre enero de 2015 y junio de 2017. Se obtuvo la tasa de complicaciones y se determinó la asociación entre la no adherencia a la "regla de los tres" y el desarrollo de complicaciones. Se analizaron otros factores predictivos asociados al desarrollo de complicaciones. Resultados: se incluyeron 164 pacientes en los que se realizaron 474 dilataciones. La etiología más prevalente fue la estenosis de anastomosis quirúrgica. Se presentaron seis complicaciones: tres perforaciones (0,63%), dos sangrados (0,42%) y un episodio de dolor significativo que requirió observación posprocedimiento (0,21%). La dilatación endoscópica esofágica fuera de la "regla de los tres" no se encontró asociada a un mayor riesgo de complicaciones. La dilatación con balón fue el único factor predictivo para el desarrollo de complicaciones. Conclusiones: la dilatación esofágica es un procedimiento seguro. La no adherencia a la "regla de los tres" no parece estar asociada a un mayor riesgo de complicaciones, incluyendo la perforación esofágica

Background: endoscopic dilation is considered as the treatment of choice for esophageal strictures. However, there are no studies in our region that have assessed the safety of the procedure. Objective: to assess the safety of esophageal dilation and the factors associated with the development of complications. Materials and methods: a retrospective cohort was studied. All patients referred for esophageal dilation between January 2015 and June 2017 were included in the study. A complication rate was obtained and the association between nonadherence to the "rule of 3" and the development of complications was determined. Other predictive factors associated with complication development were also analyzed. Results: a total of 164 patients that underwent 474 dilations were included in the study. Surgical anastomosis stricture was the most prevalent etiology. A total of six complications occurred, including three perforations (0.63%), two bleeding events (0.42%) and one episode of significant pain that required post-procedure observation (0.21%). Endoscopic esophageal dilation without adherence to the "rule of 3" was not associated with a higher risk of complications. Balloon dilation was the only predictive factor for complications. Conclusions: esophageal dilation is a safe procedure. Nonadherence to the "rule of 3" does not appear to be associated with a higher risk of complications, including esophageal perforation

Esofagitis eosinofílica y esofagitis herpética: ¿causa o consecuencia? / Eosinophilic esophagitis and herpetic esophagitis: cause or consequence?

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Fístula bilio-bronquial en un paciente con cirrosis hepática tratada mediante sellado con cianocrilato / A bronchobiliary fistula treated with cyanoacrylate glue in a patient with liver cirrhosis

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Evaluación del efecto de la Lepidium meyenii “Maca” en la mucosa gástrica en pacientes con dispepsia funcional / Assesing the effect of Lepidium meyenii “Maca” on the gastric mucosa in patients with functional dyspepsia

Objetivo: Determinar el efecto que tiene Lepidium meyenii “Maca” en la histología de la mucosa gástrica en pacientes con dispepsia funcional. Material y métodos: Serie de casos realizado en el Hospital Nacional Cayetano Heredia en la que se evaluó el efecto de la Maca administrada por cuatro semanas 3 gramos por día en la histopatología gástrica de pacientes con diagnóstico clínico y endoscópico de dispepsia funcional. Se evaluó el grado y la profundidad de la inflamación en la lámina propia y el efecto sobre la presencia de H. pylori (en aquellos que tenían la infección), a través de biopsias obtenidas antes y después del tratamiento. Resultados: Se reclutaron 29 pacientes con dispepsia funcional entre el 2010 y 2012. Las biopsias antes y después del tratamiento, revisadas por un solo patólogo, no demostraron cambios significativos en los parámetros histológicos, ni tuvo efecto en la erradicación del H. pylori. Conclusiones: La Maca no produce cambios significativos en la mucosa gástrica ni tiene efecto en la erradicación del H. pylori al ser brindada por cuatro semanas a pacientes con dispepsia funcional.

Objective: The present study was designed to determine the histological effect of Lepidium meyenii “Maca” on the gastric mucosa in patients with functional dyspepsia. Material and methods: This study consists of a clinical case series, in which the effect of Maca on the gastric histopathology of 29 Peruvian patients diagnosed with functional dyspepsia was examined. The presence of H. pylori, as well as the degree and depth of the gastric mucosa inflammation was evaluated from biopsies obtained before and after the treatment based solely of Maca 3 grams per day for four weeks. Results: Average values of the degree and depth of mucosal inflammation before and after the treatment were compared showing no statistical difference among the samples. Sixteen patients were infected with H. pylori, and they remained infected after the treatment with Maca. Conclusions: A four week long treatment with Maca does not produce significant changes on gastric mucosa of patients with functional dyspepsia, neither on H. pylori eradication.

Frecuencia de la prescripción de los inhibidores de bomba de protones basada en guías de práctica clínica en pacientes hospitalizados en dos hospitales docentes de lima û perú / Frequency of prescribing of proton pump inhibitors based clinical practice guidelines in hospitalized patients in two teaching hospitals of lima - Peru

OBJETIVOS: evaluar si la prescripción de inhibidores de bomba de protones (IBP) está basada en guías de práctica clínica en pacientes hospitalizados en dos hospitales docentes de lima. MATERIALES Y METODOS: Se acudió a los servicios de Medicina Interna, Medicina Tropical y Cirugía General de dos hospitales docentes, y se procedió a revisar las hojas de terapéutica y kárdex de enfermería. En los pacientes que recibían IBP se procedió a determinar el motivo de su prescripción según una lista de chequeo obtenida de diferentes guías de práctica clínica (GPC). RESULTADOS: el 54,57% de las prescripciones de IBP en los dos hospitales docentes no estuvieron basadas en GPC. No se encontró diferencias estadísticamente significativas entre ambos hospitales en cuanto a la prescripción de IBP basada en GPC (p=0,208). En el servicio de cirugía general fue mayor la prescripción de IBP no basada en GPC con respecto al servicio de Medicina (83,6% versus 16.4%; p<0.0001). El principal motivo de prescripción de IBP basado en GPC fue la prevención de úlceras gástricas producidas por antiinflamatorio no esteroideo en pacientes con edad avanzada (65,72%). CONCLUSIONES: existe una elevada frecuencia de sobreuso de IBP en los dos hospitales docentes.

OBJECTIVES: To evaluate if Proton Pump Inhibitor (PPI) prescription is based in Clinical Practice Guidelines (CPG) in hospitalized patients at two academic hospitals of Lima. MATERIALS AND METHODS: The services of Intern Medicine, Tropical Medicine and General Surgery were visited. Therapeutic sheets and nursing transcript were checked. The prescription motifs were determined in patients who received PPI. These motifs were obtained according to a check list, which was made from different CPG. RESULTS: 54.57% of the PPI prescriptions in the two academic hospitals were not based in CPG. No statistic significant difference was found between the two academic hospitals in the PPI prescription based in CPG (p=0,208). Most of the prescriptions not base on CPG belong to the service of General Surgery (83.6%; p<0.0001). The main indication for the prescription of PPI based on CPG was prevention of NSAIDS induced gastric ulcers if advanced age (65.72%). CONCLUSIONS: There is a high rate of PPI overuse in two academic hospitals.