[Post-colonoscopy colorectal cancer: Evaluation of a cohort in its clinical and colonoscopic characteristics, survival and its causes according to the World Endoscopy Organization]. / Cáncer colorrectal post-colonoscopia: Evaluación de una cohorte en sus características clínicas, colonoscópicas, sobrevida y sus causas según la Organización Mundial de Endoscopia.

Post-colonoscopy colorectal cancer (PCCRC) is a tumor that appears after a normal colonoscopy before the established time for the endoscopic follow up. Its origin reflects the quality of the colonoscopy and the different tumoral biologics between the CRC and the CRCPC. Our aim is to describe the characteristics of the PCCRC in our region, to identify risk factors, to discriminate the potential causes according to the World Endoscopý Organization (WEO) and to determine its impact in the patient's survival. We studied patients with colorectal cancer (CRC) attended at the gastro-oncology clinic of two institutions of Medellin-Colombia, between January 2012 and December 2021 that had been submitted to a colonoscopy between 6-36 months before the colonoscopy in which the CRC was diagnosed. 919 patients during 10 years for CRC, 68 cases of PCCRC (6.9%); It was more frequent in older patients (74 vs. 66 years; p=0.03), with background of adenomatous polyps (36.8% vs. 20.1%; p=0.01) and in right colon (57.4% vs. 40.6%; p=0.006), with a tendency in patients with diverticulosis (41.2% vs. 31.3%; p=0.05) and diabetes (25% vs. 14%; p=0.06); less survival at 5 and 10 years (58% and 55.2% vs. 67% and 63%; p < 0.001). According to the WEO, the PCCRC presents in 61.3% because of abnormal findings omitted in inadequate colonoscopies, 29% in a suitable colonoscopy and 9.7% incomplete resections of adenomas. In conclusion, the rate of PCCRC was 6.9% with more propension in older patients, a background of polyp resection, and proximal colon. According to the WEO, the abnormal findings omitted more frequently were related with inadequate colonoscopies. The patients with PCCRC had less survival.

Frequency of functional esophageal disorders in patients with refractory reflux symptoms in Lima, Peru.

Gastroesophageal reflux disease (GERD) is a clinical condition in which gastric reflux causes symptoms or damage to the esophageal mucosa. It is managed with proton pump inhibitors, however, up to 45% of patients with suspected GERD are refractory to treatment. It is necessary to establish a true GERD diagnosis by means of a digestive endoscopy, which does not show lesions in approximately 70% of patients. In this scenario, it is necessary to perform an esophageal pH-impedance measurement, a procedure that allows to determine whether exposure to gastric acid is pathological. Of this group, patients with pathological acid exposure are diagnosed as true non-erosive reflux disease (NERD). If, in addition to not presenting esophageal lesions, they have a physiological exposure to gastric acid, they suffer from esophageal hypersensitivity or functional heartburn, which are functional disorders. These require a different approach from that of GERD or NERD, as the symptoms are not due to pathological exposure to gastric acid. The aim was to calculate the frequency of esophageal hypersensitivity and functional heartburn in patients with suspected NERD. This was a cross-sectional study. Data was collected by reviewing pH-impedance and manometry reports, 166 patients were selected. The frequency for functional disorders was 86.15%, being 46.9% for functional heartburn and 39.2% for esophageal hypersensitivity. The frequency of functional disorders was higher than that reported in previous studies. In conclusion, age, psychological conditions, dietary, cultural, ethnic or lifestyle factors inherent to our environment might play important roles in the development of functional disorders.

Hepatitis A and hepatitis E virus co-infection with right pleural effusion, ascites and acute acalculous cholecystitis. A case report.

Hepatitis A and hepatitis E are the leading causes of acute viral hepatitis in developing countries due to our poor sanitary conditions, both spread by fecal-oral route or through contaminated water and food. Being both self-limiting diseases, they are usually benign but may present with atypical clinical findings. A 32 year-old female with right pleural effusion, ascites and acalculous cholecystitis during the course of HAV and HEV co-infection is reported. Clinical improvement was observed with conservative management. As far as we know, this is the first case described of a patient with these three complications in the background of a hepatitis A virus and hepatitis E virus co-infection.

Reclassifying causes of obstetric death in Mexico: a repeated cross-sectional study.

OBJECTIVE: To describe causes of maternal mortality in Mexico over eight years, with particular attention to indirect obstetric deaths and socioeconomic disparities. METHODS: We conducted a repeated cross-sectional study using the 2006-2013 Búsqueda intencionada y reclasificación de muertes maternas (BIRMM) data set. We used frequencies to describe new cases, cause distributions and the reclassification of maternal mortality cases by the BIRMM process. We used statistical tests to analyse differences in sociodemographic characteristics between direct and indirect deaths and differences in the proportion of overall direct and indirect deaths, by year and by municipality poverty level. FINDINGS: A total of 9043 maternal deaths were subjected to the review process. There was a 13% increase (from 7829 to 9043) in overall identified maternal deaths and a threefold increase in the proportion of maternal deaths classified as late maternal deaths (from 2.1% to 6.9%). Over the study period direct obstetric deaths declined, while there was no change in deaths from indirect obstetric causes. Direct deaths were concentrated in women who lived in the poorest municipalities. When compared to those dying of direct causes, women dying of indirect causes had fewer pregnancies and were slightly younger, better educated and more likely to live in wealthier municipalities. CONCLUSION: The BIRMM is one approach to correct maternal death statistics in settings with poor resources. The approach could help the health system to rethink its strategy to reduce maternal deaths from indirect obstetric causes, including prevention of unwanted pregnancies and improvement of antenatal and post-obstetric care.

Molecular Detection of Dengue Virus, Zika Virus, and Chikungunya Virus Arboviruses in Neotropical Bats.

Background: The dengue, Zika, and Chikungunya arboviruses have spread in America in the past year, thus becoming global health issues. These viruses are maintained in nature in two transmission cycles: an urban cycle, transmitted from hematophagous mosquitoes to humans, and a wild cycle, recorded only in Africa and Asia, involving mosquitoes and nonhuman primates as natural hosts. The evidence shows that these arboviruses infect other wild mammals in America, such as rodents, marsupials, and bats. This study aimed to determine the potential natural infection of arboviruses in bats captured in contrasting sites (tropical forests, urban areas, and caves) in Oaxaca, Mexico. Materials and Methods: Liver samples were collected from some bats and tested for RNA from dengue, Zika, and Chikungunya with the quantitative real-time PCR assay. We analyzed 162 samples that encompassed 23 bat species. Results: No natural infection with any of the three arboviruses was detected in any sample tested. Conclusion: The existence of a wild cycle of the three arboviruses in the American continent is not ruled out. However, owing to the low or zero prevalence recorded in other studies and the present study, bats are likely involved in the arbovirus transmission cycle as accidental hosts.

Sustainable Refining of Vegetable Oil Made Easy with a Designer Phospholipase C Enzyme.

The increasing demand pressures the vegetable oil industry to develop novel refining methods. Degumming with type C phospholipases (PLCs) is a green technology and provides extra oil. However, natural PLCs are not active under the harsh conditions used in oil refining plants, requiring additional unit operations. These upfront capital expenditures and the associated operational costs hinder the adoption of this method. Here, we present a process based on ChPLC, a synthetic PLC obtained by consensus sequence design, possessing superior thermal stability and catalytic properties. Using ChPLC, crude soybean oil degumming was completed at 80 °C in 30 min, the temperature and residence time imposed by the design of existing oil refining plants. Remarkably, an extra yield of oil of 2% was obtained using 60% of the dose recommended for PLCs marketed today, saving upfront investments and reducing the operational cost of degumming. A techno-economic analysis indicates that, for medium size plants, ChPLC reduces the overall cost of soybean oil enzymatic degumming by 58%. The process presented here facilitates the implementation of enzymatic technologies to oil producers, regardless of their processing capacity, bringing potential annual benefits in the billion-dollar range for the global economy.

Using evidence on violence and injury prevention for policy development and decision making in Ciudad Juarez, Mexico.

This report describes the implementation process and functional structure of the Observatory of Security and Citizen Conviviality of the Juarez Municipality (Observatorio de Seguridad y Convivencia Ciudadanas del Municipio de Juárez) in Chihuahua, Mexico, and discusses the most relevant lessons learned and main challenges in the near future. The Observatory, created in 2008, is a joint effort of the Juarez Municipal Government, Autonomous University of Ciudad Juarez (Universidad Autónoma de Ciudad Juárez), and the Pan American Health Organization. The Observatory's main objective is to propose strategies and public policy recommendations to prevent and control violence and injuries in the Juarez Municipality. Most key federal, state, and local agencies have joined this independent autonomous citizen-based initiative, feed the databases, and benefit from the information produced by a multisectoral, multidisciplinary approach. The Observatory contributes far more than the technical data provided and its facilitating functions. The clear results obtained in such a short time-as seen in the preliminary results of the case study on road injuries from January 2009 to July 2011-demonstrate the appropriateness of this course of action and should stimulate the creation of new observatories whenever and wherever needed. Lessons learned, as discussed here, can open the way to new endeavors, and current challenges show how much work remains to be done.

Pan-cancer Analysis of Homologous Recombination Repair-associated Gene Alterations and Genome-wide Loss-of-Heterozygosity Score.

PURPOSE: To study associations across tumor types between genome-wide loss of heterozygosity (gLOH) and alterations in homologous recombination repair (HRR)-associated genes beyond BRCA1 and BRCA2. EXPERIMENTAL DESIGN: Genomic profiling using a targeted next-generation sequencing assay examining 324-465 genes (FoundationOne, FoundationOne Heme, and FoundationOne CDx; Foundation Medicine, Inc.) was performed in a cohort of 160,790 samples across different tumor types. Zygosity predictions and gLOH status were calculated and linked with alterations in 18 HRR-associated genes (BRCA1, BRCA2, PALB2, BARD1, ATR, ATRX, ATM, BAP1, RAD51B, RAD51C, RAD51D, BRIP1, NBN, CHEK1, CHEK2, FANCA, FANCC, MRE11) and other genomic features, using Fisher's exact test and Mann-Whitney U tests. RESULTS: We identified a strong correlation between elevated gLOH and biallelic alterations in a core set of HRR-associated genes beyond BRCA1 and BRCA2, such as BARD1, PALB2, FANCC, RAD51C, and RAD51D (particularly in breast, ovarian, pancreatic, and prostate cancer). Monoallelic/heterozygous alterations in HRR-associated genes were not associated with elevated gLOH. gLOH was also independently associated with TP53 loss. Co-occurrence of TP53 loss and alterations in HRR-associated genes, and combined loss of TP53-PTEN or TP53-RB1, was associated with a higher gLOH than each of the events separately. CONCLUSIONS: Biallelic alterations in core HRR-associated genes are frequent, strongly associated with elevated gLOH, and enriched in breast, ovarian, pancreatic, and prostate cancer. This analysis could inform the design of the next generation of clinical trials examining DNA repair-targeting agents, including PARP inhibitors.

Burnout, Positivity and Passion in Young Mexican Athletes: The Mediating Effect of Social Support.

The burnout syndrome is a negative experience for athlete development and it has been demonstrated that it gets worse when a sport is practiced in an obsessive way. Interventions with a positive view towards sports could be a protective factor to boost the athlete's wellbeing. The aim of the present study was to analyse the mediator effect from social support, the relationship between the burnout, positivity and passion in young Mexican athletes. The sample was composed by 452 Mexican athletes, males and females (women 45%), from 12 to 18 years of age (M = 16.29, SD = 1.66). Participants answered the Athlete Burnout Questionnaire, The Scale of the Social Support Perceived by Athletes, the Passion Scale and the Positivity Scale. The results of structural equation modeling showed a good adjustment model (χ2 = 889.213; df = 274; χ2/df = 3.245; p ˂ 0.01; CFI = 0.93; TLI = 0.91; IFI = 0.94; NFI = 0.91; RMSEA = 0.07). The harmonious passion presented direct and indirect effects on the burnout, being the perceived social support the mediator variable of the indirect effect. The positivity resulted positive predictor from the social support (ß = 0.714, p ˂ 0.001) and social support predicted the burnout (ß = -0.270, p ˂ 0.005). The obsessive passion had a direct effect over burnout (ß = 0.627, p ˂ 0.001). Developing negative commitments to sports could be an indicator of a greater risk of experiencing individual conflicts that lead to sports burnout.

[Analysis of the psychometric properties of the Mexican version of the Dieting Self-Efficacy Scale (DIET-SE)]. / Análisis de las propiedades psicométricas de la versión mexicana de la Dieting Self-Efficacy Scale (DIET-SE).

INTRODUCTION: Introduction: recent research shows that people with high levels of self-efficacy for a healthy diet can control their weight. The Dieting Self-Efficacy Scale (DIET-SE) scale is a complete instrument that measures self-efficacy for a healthy diet, however, there are no Spanish versions for the Mexican population. Objective: the purpose of this study is to analyze the psychometric properties of the Mexican version of DIET-SE. Method: the sample consisted of 807 Mexican university students, of both sexes and aged between 17 and 48 years (M = 20.65, SD = 3.16). The parallel back-translation methodology was used to translate the DIET-SE scale into Spanish. In addition to the descriptive analysis and the Pearson correlation, the Cronbach alpha coefficient was used to measure the internal consistency and other indices were used for the factorial model. Results: the results of the CFA using the maximum likelihood estimation found good evidence for the construct validity (χ2 = 175.68; gl = 35 [77-42]; χ2/gl = 5.02, p < 0.01; TLI = 0.92, IFI = 0.96, CFI = 0.95 y RMSEA = 0.07). The factorial loads of the eleven items showed acceptable values. The results in the correlation analysis between the DIET-SE and psychological well-being indicators can be considered as a favorable proof of the discriminant validity. In terms of reliability, acceptable results were found in internal consistency. Conclusion: the DIET-SE is a valid and reliable scale to evaluate the self-efficacy to maintain a diet in Mexican university students.

INTRODUCCIÓN: Introducción: investigaciones recientes demuestran que las personas con altos niveles en autoeficacia para llevar una dieta saludable pueden controlar su peso. La escala Dieting Self-Efficacy Scale (DIET-SE) es un instrumento completo que mide la autoeficacia para llevar una dieta saludable, sin embargo, no existen versiones en español para población mexicana. Objetivo: el propósito del presente estudio es analizar las propiedades psicométricas de la versión mexicana del DIET-SE. Método: la muestra estuvo conformada por 807 estudiantes universitarios mexicanos, de ambos sexos y con edades comprendidas entre los 17 y los 48 años (M = 20,65, DT = 3,16). Para la traducción al castellano de la escala DIET-SE, se siguió la metodología parallel back- translation. Además del análisis descriptivo y la correlación de Pearson, se utilizó el coeficiente alfa de Cronbach para el estudio de la consistencia interna y para el ajuste del modelo se utilizaron varios índices. Resultados: los resultados del AFC por el método de máxima verosimilitud encontraron suficiente evidencia para la validez de constructo (χ2 = 175,68;gl = 35 [77-42]; χ2/gl = 5,02, p < 0,01; TLI = 0,92, IFI = 0,96, CFI = 0,95 y RMSEA = 0,07). Las cargas factoriales de los once ítems mostraron valores aceptables. Los resultados en el análisis de correlación entre la DIET-SE y los indicadores de bienestar psicológico pueden considerarse como prueba favorable de la validez discriminante. En cuanto a la fiabilidad, se encontraron resultados aceptables en consistencia interna. Conclusión: la DIET-SE es una escala válida y fiable para evaluar la autoeficacia para mantener una dieta en estudiantes universitarios mexicanos.

Specific genetic markers for detecting subtypes of dengue virus serotype-2 in isolates from the states of Oaxaca and Veracruz, Mexico.

BACKGROUND: Dengue (DEN) is an infectious disease caused by the DEN virus (DENV), which belongs to the Flavivirus genus in the family Flaviviridae. It has a (+) sense RNA genome and is mainly transmitted to humans by the vector mosquito Aedes aegypti. Dengue fever (DF) and dengue hemorrhagic fever (DHF) are caused by one of four closely related virus serotypes (DENV-1, DENV-2, DENV-3 and DENV-4). Epidemiological and evolutionary studies have indicated that host and viral factors are involved in determining disease outcome and have proved the importance of viral genotype in causing severe epidemics. Host immune status and mosquito vectorial capacity are also important influences on the severity of infection. Therefore, an understanding of the relationship between virus variants with altered amino acids and high pathogenicity will provide more information on the molecular epidemiology of DEN. Accordingly, knowledge of the DENV serotypes and genotypes circulating in the latest DEN outbreaks around the world, including Mexico, will contribute to understanding DEN infections. RESULTS: 1. We obtained 88 isolates of DENV, 27 from Oaxaca and 61 from Veracruz. 2. Of these 88 isolates, 16 were serotype 1; 62 serotype 2; 7 serotype 3; and 2 serotype 4. One isolate had 2 serotypes (DENV-2 and -1). 3. Partial nucleotide sequences of the genes encoding C- prM (14 sequences), the NS3 helicase domain (7 sequences), the NS5 S-adenosyl methionine transferase domain (7 sequences) and the RNA-dependent RNA polymerase (RdRp) domain (18 sequences) were obtained. Phylogenetic analysis showed that DENV-2 isolates belonged to the Asian/American genotype. In addition, the Asian/American genotype was divided into two clusters, one containing the isolates from 2001 and the other the isolates from 2005-2006 with high bootstrap support of 94%. CONCLUSION: DENV-2 was the predominant serotype in the DF and DHF outbreak from 2005 to 2006 in Oaxaca State as well as in the 2006 outbreak in Veracruz State, with the Asian/American genotype prevalent in both states. Interestingly, DENV-1 and DENV-2 were the only serotypes related to DHF cases. In contrast, DENV-3 and DENV-4 were poorly represented according to epidemiological data reported in Mexico. We found that isoleucine was replaced by valine at residue 106 of protein C in the isolates from these 2005-2006 outbreaks and in those from the 1997, 1998 and 2001 outbreaks in the Caribbean islands. We suggested that this amino acid change may be used as a signature for isolates arising in the Caribbean islands and pertaining to the Asian/American genotype. Other amino acid changes are specific for the Asian/American, Asian and American strains.

[Psychometric properties of the weight control perceived self-efficacy inventory in university students from the health area]. / Propiedades psicométricas del inventario autoeficacia percibida para el control de peso en estudiantes universitarios del área de la salud.

INTRODUCTION: empirical research shows that perceived self-efficacy is an important variable in maintaining and reducing weight. There are available instruments to measure perceived self-efficacy and its relation to obesity, but in Mexico it is still insufficient. OBJECTIVE: the purpose of the current research is to analyze the psychometric properties of the Mexican version of the self-efficacy inventory for weight control (SEI-WC) in university students in the health area. METHODS: participants in this study were 872 university students from the School of Health Sciences, aged between 17 and 47 (20.07 ± 2.61) years. Bartlett's sphericity test was performed to evaluate the relevance of the factor analysis. The principal component analysis with Varimax rotation was used to evaluate the adjustment of the scores on each factor. RESULTS: internal consistency (Cronbach's alpha) shows adequate psychometric properties for the three final factors: 0.856 for the factor "feeding style and externality", 0.85 for "programmed physical activity" and 0.671 for "daily physical activity". CONCLUSION: the findings of this study show that the SEI-WC is a reliable and valid instrument to measure the level of self-efficacy for weight control in Mexican university students in the health area.

Introducción: las investigaciones empíricas demuestran que la autoeficacia percibida es una variable importante en el mantenimiento y la reducción del peso. Existen instrumentos que evalúan la autoeficacia percibida y su relación con la obesidad, pero en México aún son insuficientes.Objetivo: el propósito de la presente investigación es analizar las propiedades psicométricas de la versión mexicana del inventario de autoeficacia para el control de peso (AP-CP) en estudiantes universitarios del área de la salud.Métodos: en el estudio participaron 872 estudiantes universitarios de la Escuela de Ciencias de la Salud con edades comprendidas entre 17 y 47 (20,07 ± 2,61) años. Para evaluar la pertinencia del análisis factorial se realizó la prueba de esfericidad de Bartlett. Para evaluar el ajuste de los puntajes en factores específicos se llevó a cabo el método de componentes principales con rotación Varimax.Resultados: el análisis del índice de consistencia interna (coeficiente alfa de Cronbach) muestra adecuadas propiedades psicométricas para los tres factores resultantes: 0,856 para el factor "estilo de alimentación y externalidad", 0,85 para el factor "actividad física programada" y 0,671 para el factor "actividad física cotidiana".Conclusión: los hallazgos de este estudio muestran que el AP-CP es un instrumento confiable y válido para medir el nivel de autoeficacia para el control de peso en estudiantes universitarios mexicanos del área de la salud.

Self-expanding Metal Stents in Malignant Obstruction of the Esophagus: A 25-Year Multicentric Study

Background: Self-expanding metal prostheses improve dysphagia in patients with incurable esophageal cancer (EC). New stents have been introduced, and chemoradiotherapy has been implemented for EC, changing patients' risk profiles. It is unknown whether this has affected palliation with stents. Patients and methods: Retrospective study in three centers in Medellín-Colombia; patients undergoing placement of palliative esophageal prostheses for malignant dysphagia (1997-2022). Major and minor complications after implantation, the influence of oncological therapies, and survival were evaluated for 1997-2009 (n = 289) and 2010-2022 (n = 318). Results: 607 patients underwent esophageal prostheses; 296 (48.8%) became complicated. It was higher in the second period (52.5% vs. 48.1%), as were major complications (20.8% vs. 14.2%, p = 0.033), with no differences in minor complications (33.9% vs 31.8%, p = 0.765). Also, 190 (31.3%) patients presented with recurrent dysphagia, stable in both periods. Migration increased over time (from 13.1% to 18.2%, p = 0.09). The most common minor adverse event was pain, increasing over time (from 24.9% to 33.95%, p < 0.01), and associated factors were chemoradiotherapy, absence of fistula, and squamous cell carcinoma. Acid reflux decreased in the second group (p = 0.038). Twelve percent of patients required another intervention for feeding. Survival was not impacted by time and use of stents. Conclusions: Stents are an alternative in non-surgical malignant dysphagia, although recurrent dysphagia has not decreased over time. Minor stent-related complications are increasing in association with the implementation of chemoradiotherapy.

Antecedentes: Las prótesis metálicas autoexpandibles mejoran la disfagia en pacientes con cáncer esofágico (CE) incurable. En las últimas décadas se han introducido nuevos tipos de stents y se ha implementado la quimiorradioterapia para el CE, generando cambios en los perfiles de riesgo de los pacientes. Se desconoce si estos cambios han afectado la paliación con stents. Pacientes y métodos: Estudio retrospectivo en tres centros de Medellín-Colombia; pacientes sometidos a colocación de prótesis esofágicas paliativas para disfagia maligna (1997-2022). Se evaluaron en dos períodos: 1997-2009 (n = 289) y 2010-2022 (n = 318), complicaciones mayores y menores después del implante, la influencia de las terapias oncológicas y la sobrevida. Resultados: Se evaluaron 607 pacientes sometidos a prótesis esofágicas. 296 (48,8%) se complicaron, y fue mayor en el segundo periodo (52,5% frente a 48,1%), al igual que las complicaciones mayores (20,8% frente a 14,2%, p = 0,033), sin diferencias en complicaciones menores (33,9% frente a 31,8%, p = 0,765). 190 (31,3%) pacientes presentaron disfagia recurrente, estable en ambos períodos. La migración aumentó con el tiempo (de 13,1% a 18,2%, p = 0,09). El evento adverso menor más frecuente fue dolor, que aumentó con el tiempo (de 24,9% a 33,95%, p < 0,01), y los factores asociados fueron quimiorradioterapia, ausencia de fístula y carcinoma de células escamosas. El reflujo ácido disminuyó en el segundo grupo (p = 0,038). El 12% de pacientes requirieron otra intervención para alimentarse. No se impactó la sobrevida con el tiempo y uso de stents. Conclusiones: Los stents son una alternativa en la disfagia maligna no quirúrgica, aunque la disfagia recurrente no ha disminuido con el tiempo. Las complicaciones menores relacionadas con el stent van en aumento, asociadas a la implementación de la quimiorradioterapia.

Cáncer colorrectal post-colonoscopia: Evaluación de una cohorte en sus características clínicas, colonoscópicas, sobrevida y sus causas según la Organización Mundial de Endoscopia

Cáncer colorrectal post-colonoscopia (CCRP) es el tumor que aparece posterior a una colonoscopia normal antes de cumplirse el tiempo establecido para seguimiento endoscópico. Origen multifactorial, refleja la calidad de la colonoscopia y las diferentes biologías tumorales entre los cánceres colorrectales detectados (CCRD) y el CCRP. Nuestro objetivo es describir las características del CCRP en nuestro medio, identificar factores de riesgo, discriminar sus causas según la Organización Mundial de Endoscopia (OME) y determinar el efecto en la sobrevida del paciente. El estudio se realizó en pacientes con cáncer-colorrectal (CCR) atendidos en consulta de gastro-oncología de dos instituciones en Medellín-Colombia, entre enero de 2012 y diciembre de 2021 que se habían sometido a una colonoscopia en los 6 a 36 meses anteriores a la colonoscopia en la que se diagnosticó el CCR. 919 pacientes durante 10 años por CCR, 68 casos de CCRP (6,9%), se encontró que se presenta con más frecuencia en pacientes mayores (74 vs. 66 años; p=0,03), con antecedentes de pólipos adenomatosos (36,8% vs. 20,1%; p=0,01) y en colon derecho (57,4% vs. 40,6%; p=0,006), con una tendencia en pacientes con diverticulosis (41,2% vs. 31,3%; p=0,05) y diabetes (25% vs. 14%; p=0,06); menor sobrevida a 5 y 10 años (58%-55,2% vs. 67%-63%; p<0,001). Según la OME, los CCRP se presentaron en 61,3% por lesiones omitidas en colonoscopias inadecuadas, 29% colonoscopias adecuadas y 9,7% resecciones incompletas de adenomas. En conclusión, la tasa de CCRP fue de 6,9%, con mayor propensión en pacientes de mayores, antecedente de resección de pólipos, y en colon derecho. Acorde a la OME, las lesiones omitidas más frecuentemente se relacionaron con colonoscopias inadecuadas. Los pacientes con CCRP tienen menor sobrevida.

Post-colonoscopy colorectal cancer (PCCRC) is a tumor that appears after a normal colonoscopy before the established time for the endoscopic follow up. Its origin reflects the quality of the colonoscopy and the different tumoral biologics between the CRC and the CRCPC. Our aim is to describe the characteristics of the PCCRC in our region, to identify risk factors, to discriminate the potential causes according to the World Endoscopý Organization (WEO) and to determine its impact in the patient's survival. We studied patients with colorectal cancer (CRC) attended at the gastro-oncology clinic of two institutions of Medellin-Colombia, between January 2012 and December 2021 that had been submitted to a colonoscopy between 6-36 months before the colonoscopy in which the CRC was diagnosed. 919 patients during 10 years for CRC, 68 cases of PCCRC (6.9%); It was more frequent in older patients (74 vs. 66 years; p=0.03), with background of adenomatous polyps (36.8% vs. 20.1%; p=0.01) and in right colon (57.4% vs. 40.6%; p=0.006), with a tendency in patients with diverticulosis (41.2% vs. 31.3%; p=0.05) and diabetes (25% vs. 14%; p=0.06); less survival at 5 and 10 years (58% and 55.2% vs. 67% and 63%; p<0.001). According to the WEO, the PCCRC presents in 61.3% because of abnormal findings omitted in inadequate colonoscopies, 29% in a suitable colonoscopy and 9.7% incomplete resections of adenomas. In conclusion, the rate of PCCRC was 6.9% with more propension in older patients, a background of polyp resection, and proximal colon. According to the WEO, the abnormal findings omitted more frequently were related with inadequate colonoscopies. The patients with PCCRC had less survival.

Frequency of functional esophageal disorders in patients with refractory reflux symptoms in Lima, Peru

Gastroesophageal reflux disease (GERD) is a clinical condition in which gastric reflux causes symptoms or damage to the esophageal mucosa. It is managed with proton pump inhibitors, however, up to 45% of patients with suspected GERD are refractory to treatment. It is necessary to establish a true GERD diagnosis by means of a digestive endoscopy, which does not show lesions in approximately 70% of patients. In this scenario, it is necessary to perform an esophageal pH-impedance measurement, a procedure that allows to determine whether exposure to gastric acid is pathological. Of this group, patients with pathological acid exposure are diagnosed as true non-erosive reflux disease (NERD). If, in addition to not presenting esophageal lesions, they have a physiological exposure to gastric acid, they suffer from esophageal hypersensitivity or functional heartburn, which are functional disorders. These require a different approach from that of GERD or NERD, as the symptoms are not due to pathological exposure to gastric acid. The aim was to calculate the frequency of esophageal hypersensitivity and functional heartburn in patients with suspected NERD. This was a cross-sectional study. Data was collected by reviewing pH-impedance and manometry reports, 166 patients were selected. The frequency for functional disorders was 86.15%, being 46.9% for functional heartburn and 39.2% for esophageal hypersensitivity. The frequency of functional disorders was higher than that reported in previous studies. In conclusion, age, psychological conditions, dietary, cultural, ethnic or lifestyle factors inherent to our environment might play important roles in the development of functional disorders.

La enfermedad por reflujo gastroesofágico (ERGE) es una condición clínica en la que el reflujo gástrico provoca síntomas o daños en la mucosa esofágica. Se maneja con inhibidores de la bomba de protones; sin embargo, hasta el 45% de los pacientes con sospecha de ERGE son refractarios al tratamiento. Por lo cual, es necesario establecer un verdadero diagnóstico de ERGE mediante una endoscopia digestiva, que no muestra lesiones en aproximadamente el 70% de los pacientes. En este escenario, es necesario realizar una medición de pH-impedancia esofágica, procedimiento que permite determinar si la exposición al ácido gástrico es patológica. De este grupo, los pacientes con exposición patológica al ácido son diagnosticados como verdadera enfermedad por reflujo no erosiva (ERNE). Si además de no presentar lesiones esofágicas, tienen una exposición fisiológica al ácido gástrico, padecen hipersensibilidad esofágica o pirosis funcional, que son trastornos funcionales. Estos requieren un enfoque diferente al ERGE o ERNE, ya que los síntomas no se deben a una exposición patológica al ácido gástrico. El objetivo fue calcular la frecuencia de hipersensibilidad esofágica y pirosis funcional en pacientes con sospecha de ERNE. Este fue un estudio transversal. Los datos se recopilaron mediante la revisión de informes de pH-impedancia y manometría, se seleccionaron 166 pacientes. La frecuencia de trastornos funcionales fue de 86,15%, siendo 46,9% de pirosis funcional y 39,2% de hipersensibilidad esofágica. La frecuencia de trastornos funcionales fue superior a la reportada en estudios previos. En conclusión, la edad, las condiciones psicológicas, los factores dietéticos, culturales, étnicos o de estilo de vida inherentes a nuestro entorno podrían jugar un papel importante en el desarrollo de trastornos funcionales.

Molecular diagnosis of microbial copathogens with influenza A(H1N1)pdm09 in Oaxaca, Mexico.

BACKGROUND: Multiple factors have been associated with the severity of infection by influenza A(H1N1)pdm09. These include H1N1 cases with proven coinfections showing clinical association with bacterial contagions. PURPOSE: The objective was to identify H1N1 and copathogens in the Oaxaca (Mexico) population. A cross-sectional survey was conducted from 2009 to 2012. A total of 88 study patients with confirmed H1N1 by quantitative RT-PCR were recruited. METHODS: Total nucleic acid from clinical samples of study patients was analyzed using a TessArray RPM-Flu microarray assay to identify other respiratory pathogens. RESULTS: High prevalence of copathogens (77.3%; 68 patients harbored one to three pathogens), predominantly from Streptococcus, Haemophilus, Neisseria, and Pseudomonas, were detected. Three patients (3.4%) had four or five respiratory copathogens, whereas others (19.3%) had no copathogens. Copathogenic occurrence with Staphylococcus aureus was 5.7%, Coxsackie virus 2.3%, Moraxella catarrhalis 1.1%, Klebsiella pneumoniae 1.1%, and parainfluenza virus 3 1.1%. The number of patients with copathogens was four times higher to those with H1N1 alone (80.68% and 19.32%, respectively). Four individuals (4.5%; two males, one female, and one infant) who died due to H1N1 were observed to have harbored such copathogens as Streptococcus, Staphylococcus, Haemophilus, and Neisseria. CONCLUSION: In summary, copathogens were found in a significant number (>50%) of cases of influenza in Oaxaca. Timely detection of coinfections producing increased acuity or severity of disease and treatment of affected patients is urgently needed.

Predictores del bienestar psicológico en estudiantes universitarios mexicanos físicamente activos / Preditores de bem-estar psicológico em estudantes universitários mexicanos fisicamente ativos / Predictors of psychological well-being in physical activity mexican university students

El objetivo de la presente investigación fue analizar el poder predictivo de la motivación intrínseca y la autoeficacia para mantenerse activo sobre el bienestar psicológico en estudiantes universitarios mexicanos físicamente activos. La muestra de este estudio predictivo transversal estuvo conformada por 539 estudiantes universitarios físicamente activos, de ambos sexos (Hombres = 34%, mujeres = 66%) y con edades comprendidas entre los 17 y 47 años (M = 19.8, DT = 2.88). El 84% de los universitarios reporta hacer ejercicio físico de manera regular y el 36% practicar deporte de manera formal. De acuerdo con los principales resultados del análisis de regresión múltiple por el método de pasos sucesivos, la autoeficacia resultó el mejor predictor de los tres indicadores de bienestar psicológico (Autoestima, satisfacción con la vida y vitalidad subjetiva). La motivación intrínseca predijo la vitalidad subjetiva. A pesar de que los porcentajes de varianza explicada son relativamente bajos, tanto la autoeficacia como la motivación intrínseca resultaron predictores de la vitalidad subjetiva en universitarios que realizan actividad físico-deportiva de manera regular. La autoeficacia para mantenerse físicamente activo resultó ser el mejor predictor de los tres indicadores de bienestar psicológico. Un individuo que confía en sus planes para mantenerse realizando actividad físico-deportiva, con objetivos claros, es probable que se sienta mejor consigo mismo, acepte su vida actual y experimente niveles de energía óptimos. (AU)

Theobjective of the current research is to analyze the predictive power of intrinsic motivation and self-efficacy for physical activity on psychological well-being in Mexican university students. The sample of this transversal predictive studyconsisted of 539 physically active university students of both sexes (men = 34%, women = 66%) and aged between 17 and 47 years (M= 19.8, SD= 2.88). 84% of the university students reported to exercise on a regular basis and 36% practice sports in a formal way. According to the results of the multiple regression analysis using the successive steps method, self-efficacy was the best predictor of the three indicators of psychological well-being (self-esteem, satisfaction with life and subjective vitality). In the same way,intrinsic motivation predicted subjective vitality. Even though the explained variance percentages are relatively low, both self-efficacy and intrinsic motivation were predictors of subjective vitality in university students who regularly have physical-sports activity. Self-efficacy for physical activity is the best predictor of the three indicators of psychological well-being. Therefore, when people trust in their plans to keep doing physical activity, with clear objectives, they are more likely to feel better about themselves, enjoy their life and have optimal energy levels. (AU)

O objetivo desta pesquisa foi analisar o poder preditivo da motivação intrínseca e da autoeficácia para permanecer ativo no bem-estar psicológico em estudantes universitários mexicanos fisicamente ativos. A amostra deste estudo preditivo transversal foi composta por 539 universitários fisicamente ativos, de ambos os sexos (Homens = 34%, mulheres = 66%) e com idade entre 17 e 47 anos (M = 19,8, DP = 2,88). 84% dos universitários relatam praticar exercícios físicos regularmente e 36% praticam esportes formalmente. De acordo com os principais resultados da análise de regressão múltipla pelo método de etapas sucessivas, a autoeficácia foi o melhor preditor dos três indicadores de bem-estar psicológico (autoestima, satisfação com a vida e vitalidade subjetiva). A motivação intrínseca predisse a vitalidade subjetiva. Apesar dos percentuais de variância explicada serem relativamente baixos, tanto a autoeficácia quanto a motivação intrínseca foram preditores de vitalidade subjetiva em universitários que praticam regularmente atividade física e esportes. A autoeficácia para se manter fisicamente ativo foi o melhor preditor dos três indicadores de bem-estar psicológico. Um indivíduo que confia em seus planos de continuar praticando atividade física e esportes, com objetivos claros, provavelmente se sentirá melhor consigo mesmo, aceitará sua vida atual e experimentará níveis ótimos de energia. (AU)

Self-efficacy for weight control and quality of life in Mexican patients with hemophilia / Autoeficacia para el control de peso y calidad de vida en pacientes mexicanos con hemofilia

Introduction: Perceived self-efficacy is closely related to an adequate quality of life en general well-being of people, but few studies have studied this relationship in people with hemophilia. Objective: To determine the degree of relationship between perceived self-efficacy for weight control and quality of life in people with and without hemophilia, comparing both variables in case-control groups. Methods: The sample made up, for convenience, of 40 participants, with two matched groups. The group of cases consisted of 20 males between 19 and 24 years of age (M = 19.50, SD = 1.47) with hemophilia type A. The control group consisted of 20 males who did not present hemophilia, matched in age and weight status, between the ages of 18 and 24 years of age (M= 19.59, SD= 1.44). Participants answered the "Self-efficacy for Weight Control" questionnaire and the World Health Organization Quality of Life Bref" questionnaire. Descriptive statistics where used to describe the factors of each instrument. Student's t-test was used to compare differences between the two groups. Results: Only the Daily physical activity dimension showed a statistical difference in the control group. According to the Pearson correlation, a positive correlation was found between the Scheduled physical activity, Daily physical activity and Physical health dimensions. Conclusions: It is concluded that physical exercise, weight control, nutritional counseling and psychological support are essential for the quality of life, especially for people with hemophilia, which complements medical treatment.

Introducción: La autoeficacia percibida está estrechamente relacionada con una adecuada calidad de vida y el bienestar en general de las personas, pero pocos estudios han analizado esta relación en personas con hemofilia. Objetivo: Determinar el grado de relación entre la autoeficacia percibida para el control de peso y la calidad de vida en personas con y sin diagnóstico de hemofilia, comparando ambas variables en grupos caso-control. Métodos: La muestra por conveniencia estuvo compuesta por 40 participantes, clasificados en dos grupos. El grupo de casos estuvo constituido por 20 varones entre 19 y 24 años de edad (M= 19,50, DE= 1,47) con diagnóstico de hemofilia tipo A. El grupo control estuvo formado por 20 varones que no presentaban hemofilia, pareados en edad y peso, con edades entre 18 y 24 años (M= 19.59, DT= 1.44). Todos los participantes respondieron el "Cuestionario de Autoeficacia para el Control de Peso" y el "Cuestionario Breve de Calidad de Vida de la Organización Mundial de la Salud". Se obtuvieron análisis descriptivos mediante medias y desviaciones estándar sobre los factores de cada instrumento. Se utilizó la prueba t de Student para la diferencia de medias. Resultados: Se hallaron diferencias entre el grupo de casos y controles solo en la dimensión Actividad física cotidiana a favor del grupo controles. De acuerdo a la correlación de Pearson, se encontró una correlación positiva entre la dimensión Actividad física programada, Actividad física cotidiana y Salud física. Conclusiones: Se constata que el ejercicio físico, el control de peso, la asesoría nutricional y el apoyo psicológico son indispensables para la calidad de vida, en especial de las personas con hemofilia, lo cual complementa el tratamiento médico.

Autoestima y estilos de afrontamiento: predictores de la calidad de vida en personas con hemofilia / Self-esteem and coping skills: predictors of quality of life in patients with hemophilia

Introducción: La hemofilia es un trastorno hemorrágico que causa dolor y daños articulares graves. Las personas con esta condición de salud suelen presentar problemas psicosociales como baja autoestima y dificultad para enfrentar la enfermedad, lo cual puede impactar negativamente en su calidad de vida relacionada a la salud (CVRS). Objetivo: Analizar el efecto predictor de la autoestima y las estrategias de afrontamiento hacia la CVRS en personas con hemofilia. Métodos: Estudio cuantitativo, no experimental, de tipo correlacional, con muestra por conveniencia, realizado en 60 participantes con hemofilia, edades comprendidas entre 15 y 67 años (media = 27,43, desviación estándar = 11,32). Se utilizaron los cuestionarios: Calidad de Vida Específica para Hemofilia, Autoestima y Afrontamiento al Dolor Crónico. Se realizaron análisis descriptivos, correlación de Pearson y análisis de regresión lineal múltiple con el método por pasos. Resultados: Se obtuvo que el nivel de CVRS fue mayormente moderado; sin embargo, se observaron niveles bajos en las dimensiones Deporte y tiempo libre y Futuro. La dimensión Éxito de la escala de autoestima correlacionó positivamente con las dimensiones Deporte y tiempo libre (r(60)= 0,59), Salud física (r(60)=0,54) y Autopercepción (r(60)=0,48) de la escala calidad de vida; además de haber mostrado un nivel alto de predicción de la calidad de vida (R 2 = 0,35, p= 0,00). Conclusiones: Se comprobó que la autoestima resulta ser una variable predictora de la CVRS de los pacientes con hemofilia. Se requiere fortalecer la autoestima y la manera de enfrentarse ante el dolor crónico en personas con este padecimiento en pro de su calidad de vida y bienestar(AU)

Introduction: Hemophilia is a bleeding disorder that causes severe pain and damage to the joints. People with this health condition often present psychosocial problems such as low self-esteem and difficulty facing their disease, which can negatively impact their health-related quality of life (HRQoL). Objective: To analyze the predictive effect of self-esteem and coping strategies towards HRQL in people with hemophilia. Methods: This was a quantitative, non-experimental, correlational study, with a convenience sample, carried out in 60 participants with hemophilia, ages between 15 and 67 years (mean = 27.43, standard deviation = 11.32). The Specific Quality of Life for Hemophilia, Self-esteem and Coping with Chronic Pain questionnaires were used. Descriptive analyzes. Pearson correlation and multiple linear regression analysis were performed with the stepwise method. Results: It was found that the level of HRQL was mostly moderate, however, low levels were observed in the Sports and free time and Future dimensions. The Success dimension of the self-esteem scale positively correlated with the Sports and free time dimensions (r(60) = 0.59). Physical health (r(60) = 0.54) and Self-perception (r(60) = 0.48) of the quality of life scale, in addition to having shown a high level of prediction of quality of life (R2 = 0.35, p = 0.00). Conclusions: It was found that self-esteem turns out to be a predictor variable of HRQL in patients with hemophilia. It is necessary to strengthen self-esteem and the way of coping with chronic pain in people with this condition in favor of their quality of life and well-being(AU)

A multigenerational pedigree of late-onset Alzheimer's disease implies new genetic causes.

We describe the clinical phenotype and pathology of a new autosomal dominant late-onset familial form of Alzheimer's disease in four extensive kindred originated in a genetically isolated population. Twelve affected and 16 unaffected members of these kindred were examined clinically, and a brain post-mortem study was carried out in one case. The preliminary genetic assessment included complex segregation analysis, evaluation of the power to detect linkage, and exclusion of candidate genes. Dementia has been recorded for six generations in ancestors of examined cases. Review of death certificates allowed linking of all subjects in four extensive pedigrees. Affected individuals examined had progressive memory loss with onset between 57 and 74 years of age, along with seizures, myoclonus and parkinsonism in advanced stages. The brain of the case examined post-mortem showed widespread neocortical neuritic plaques and neurofibrillary tangles (stage VI of Braak), amyloid angiopathy, and Lewy bodies restricted to limbic areas. Sequencing exons 16 and 17 of amyloid precursor protein, and exons 4-12 of presenilin 1 and presenilin 2 genes did not disclose any mutations. Genotyping with markers D21S265, D14S71, D14S77, D1S2850 and D1S479 located 1-3 cM from the previously reported genes further excluded linkage to these genes. Seven out of 12 cases were apolipoprotein E (APOE) epsilon3/3, although the presence of an APOE epsilon4 allele was associated with an increased risk of dementia (odd ratio 6.17; 95% confidence interval: 1.15-33.15), but not to an earlier age of onset. Complex segregation analysis showed that the best model fitting the data was that of a major gene (dominant) with a gene frequency close to 3% in this population. Simulation analysis predicted an average logarithm of odds (LOD) of 2.2 at = 0.05. These four families, which seem to be part of a common extended pedigree originated by a founder arriving in this region in the 18th century, represent an autosomal dominant late-onset familial Alzheimer's disease not linked to previously known genetic loci. The simulation analysis suggests that it will be feasible to locate a novel responsible gene in these kindred.