Comparación de 2 tipos de preparación intestinal para la realización de colonoscopia en un hospital de tercer nivel

ResumenAntecedentesLa colonoscopia es el método para evaluar el colon. La preparación con polietilenglicol (PEG) es utilizada para la limpieza colónica. Sin embargo, la tolerabilidad y efectos adversos son frecuentes.ObjetivoComparar la eficacia mediante la escala de Boston y Harefield, y la tolerabilidad con la escala visual análoga, en 2 tipos de preparación colónica: grupo 1=PEG 4L (PEG 4L) y grupo 2=30ml de aceite de oliva (OL) más PEG en 2l de agua (30 OL+PEG 2L).MetodologíaEnsayo clínico, prospectivo, aleatorizado, unicéntrico. Los sujetos fueron aleatorizados en 2 grupos: PEG 4L, y 30 OL+PEG 2L. Se valoró la tolerancia de la preparación mediante escala visual análoga y la calidad de la limpieza con las escalas de Boston y Harefield.ResultadosSe incluyeron 42 pacientes, 22 (52.38%) se trataron con PEG 4L y 20 (47.62%) con 30 OL+PEG 2L. Veintidós (52.38%) fueron hombres y 20 (47.62%) mujeres. El resultado más frecuente de la tolerabilidad de la preparación del grupo 1 y 2 fue tolerancia parcial en 18 (42.9%) y 23 (54.76%) pacientes respectivamente, sin ser estadísticamente significativo. PEG 4L tuvo un promedio de calificación de Boston de 6.04 puntos, y la de 30 OL+PEG 2L fue de 6.65 puntos, p=0.9. La calificación de Harefield fue exitosa en 35 pacientes (83.3%).ConclusionesLa preparación colónica con 30 OL+PEG 2L al tener resultados de limpieza similares a la dosis de PEG 4L podría utilizarse en aquellos pacientes que no toleren dosis altas de líquidos.AbstractBackgroundColonoscopy is the method to evaluate the colon. The preparation with polyethylene glycol (PEG) is used for colonic cleansing. However, tolerability and side effects are common.ObjetiveTo compare effectiveness through Boston Bowel Preparation Scale (BBPS) and Harefield Cleasing Scale (HCS), and tolerability with the visual analog scale in 2 types of colonic preparation: group 1=PEG 4liters (4L PEG) and group 2=30ml olive (OL) plus PEG in 2 liters of water (30 OL+2L PEG).MethodologyClinical, prospective, randomized, single-center trial. The subjects were randomized into 2 groups: 4L PEG, and 30 OL+2L PEG. Preparation tolerance was evaluated with visual analog scale and preparation quality with the BBPS and HCS.ResultsForty two patients were included. Twenty two (52.38%) were included with 4L PEG, and 20 (47.62%), with 30 OL+2L PEG. 22 (52.38%) were men and 20 (47.62%) were women. The most frequent answer was partial tolerance in 18 (42.9%) and 23 (54.76%) patients, respectively, without statistical significance. The comparison in both preparations, 4L PEG had an average score of 6.04 points, and 30 OL+2L PEG 6.65 points by BBPS (P=.9). HCS was successful in 35 patients (83.3%).ConclusionsThe administration of 30 OL+2L PEG has similar cleansing results compared with the standard bowel preparation, which may be an alternative used in patients who are intolerable to high doses of liquids

Experiential Avoidance and Hyperreflexivity as Variables Associated with Depression: A Process-Based Approach

Depression is a major public health problem that affects a significant proportion of young adults, such as college students. A process-based approach has been proposed for its study, which seeks to identify transdiagnostic psychological variables that can be the target of change in psychotherapeutic interventions. The purpose of this paper was to analyze the interre-lation between a set of process variables (cognitive fusion, rumination, and experiential avoidance), as well as to examine the relationship between each of these variables and depression in 368 college students aged 18–29 years (M = 21.35, SD= 2.36, 77.7% female). Cognitive fusion and rumination were found to comprise an overarching variable termed hyperre-flexivity, while experiential avoidance constituted a different construct. By analyzing a structural equation model, it was found that only hyperreflexivity predicted depression significantly. These findings and their possible implications for clini-cal practice are discussed. Further study of hyperreflexivity as a superordinate variable of relevance to psychopathology is recommended

Prótesis metálica autoexpandible en el tratamiento de la estenosis del colédoco postrasplante de hígado en un niño. A propósito de un caso

ResumenLas estenosis benignas de la vía biliar son debidas a lesión de esta por manejo quirúrgico, traumatismos o por inflamación. El manejo en la actualidad es por vía endoscópica mediante dilataciones, colocación de prótesis plásticas y más recientemente con las prótesis autoexpandibles totalmente cubiertas. Se presenta el caso de una menor de 7 años a la que se realizó trasplante de hígado y presentó una estenosis a nivel de la colédoco-colédoco anastomosis en donde se utilizó una prótesis metálica totalmente cubierta autoexpandible con buenos resultados.AbstractBenign biliary strictures are due to injury by surgical operation, trauma or inflammation, is currently handling by endoscopy with dilation, placement of plastic stents and more recently with fully covered self-expanding prosthesis; the case of a child under 7 years that liver transplantation was performed and presented a stenosis at the level of the coledoco-coledoco anastomosis where a fully covered self-expandable metal stent was used with good results is presented

Consenso mexicano sobre detección y tratamiento del cáncer gástrico incipiente

El cáncer gástrico representa una de las neoplasias más frecuentes en el aparato digestivo y en la mayoría de los casos es el resultado de la progresión de lesiones premalignas. La detección oportuna de estas lesiones es relevante ya que un tratamiento oportuno brinda la posibilidad de curación. En nuestro país no existía un consenso respecto a la detección temprana del cáncer gástrico, por lo que la Asociación Mexicana de Gastroenterología reunió aun grupo de expertos y realizó el Consenso sobre detección y tratamiento del cáncer gástricoincipiente (CGI) para establecer recomendaciones de utilidad para la comunidad médica. Eneste consenso se utilizó la metodología Delphi y se emitieron 38 recomendaciones al respectodel CGI. El consenso define el CGI como aquel que al momento del diagnóstico se encuentralimitado a la mucosa y a la submucosa, independientemente de metástasis en ganglios linfáticos.En México, como otras partes del mundo, los factores asociados al CGI incluyen la infección porHelicobacter pylori, los antecedentes familiares, el tabaquismo y los factores dietéticos. Para eldiagnóstico se recomienda utilizar cromoendoscopia, magnificación y equipos con luz mejorada.Un diagnóstico histopatológico preciso es invaluable para tomar de decisiones terapéuticas. Eltratamiento endoscópico del CGI, ya sea disección o resección de la mucosa, debe ser preferidoal manejo quirúrgico cuando se puedan obtener resultados semejantes en términos de curaciónoncológica. La vigilancia endoscópica se deberá de individualizar

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine

[This corrects the article DOI: 10.1186/s13054-016-1208-6.]

Non-invasive diagnostic tests for Helicobacter pylori infection

BACKGROUND: Helicobacter pylori (H pylori) infection has been implicated in a number of malignancies and non-malignant conditions including peptic ulcers, non-ulcer dyspepsia, recurrent peptic ulcer bleeding, unexplained iron deficiency anaemia, idiopathic thrombocytopaenia purpura, and colorectal adenomas. The confirmatory diagnosis of H pylori is by endoscopic biopsy, followed by histopathological examination using haemotoxylin and eosin (H & E) stain or special stains such as Giemsa stain and Warthin-Starry stain. Special stains are more accurate than H & E stain. There is significant uncertainty about the diagnostic accuracy of non-invasive tests for diagnosis of H pylori. OBJECTIVES: To compare the diagnostic accuracy of urea breath test, serology, and stool antigen test, used alone or in combination, for diagnosis of H pylori infection in symptomatic and asymptomatic people, so that eradication therapy for H pylori can be started. SEARCH METHODS: We searched MEDLINE, Embase, the Science Citation Index and the National Institute for Health Research Health Technology Assessment Database on 4 March 2016. We screened references in the included studies to identify additional studies. We also conducted citation searches of relevant studies, most recently on 4 December 2016. We did not restrict studies by language or publication status, or whether data were collected prospectively or retrospectively. SELECTION CRITERIA: We included diagnostic accuracy studies that evaluated at least one of the index tests (urea breath test using isotopes such as13C or14C, serology and stool antigen test) against the reference standard (histopathological examination using H & E stain, special stains or immunohistochemical stain) in people suspected of having H pylori infection. DATA COLLECTION AND ANALYSIS: Two review authors independently screened the references to identify relevant studies and independently extracted data. We assessed the methodological quality of studies using the QUADAS-2 tool. We performed meta-analysis by using the hierarchical summary receiver operating characteristic (HSROC) model to estimate and compare SROC curves. Where appropriate, we used bivariate or univariate logistic regression models to estimate summary sensitivities and specificities. MAIN RESULTS: We included 101 studies involving 11,003 participants, of which 5839 participants (53.1%) had H pylori infection. The prevalence of H pylori infection in the studies ranged from 15.2% to 94.7%, with a median prevalence of 53.7% (interquartile range 42.0% to 66.5%). Most of the studies (57%) included participants with dyspepsia and 53 studies excluded participants who recently had proton pump inhibitors or antibiotics.There was at least an unclear risk of bias or unclear applicability concern for each study.Of the 101 studies, 15 compared the accuracy of two index tests and two studies compared the accuracy of three index tests. Thirty-four studies (4242 participants) evaluated serology; 29 studies (2988 participants) evaluated stool antigen test; 34 studies (3139 participants) evaluated urea breath test-13C; 21 studies (1810 participants) evaluated urea breath test-14C; and two studies (127 participants) evaluated urea breath test but did not report the isotope used. The thresholds used to define test positivity and the staining techniques used for histopathological examination (reference standard) varied between studies. Due to sparse data for each threshold reported, it was not possible to identify the best threshold for each test.Using data from 99 studies in an indirect test comparison, there was statistical evidence of a difference in diagnostic accuracy between urea breath test-13C, urea breath test-14C, serology and stool antigen test (P = 0.024). The diagnostic odds ratios for urea breath test-13C, urea breath test-14C, serology, and stool antigen test were 153 (95% confidence interval (CI) 73.7 to 316), 105 (95% CI 74.0 to 150), 47.4 (95% CI 25.5 to 88.1) and 45.1 (95% CI 24.2 to 84.1). The sensitivity (95% CI) estimated at a fixed specificity of 0.90 (median from studies across the four tests), was 0.94 (95% CI 0.89 to 0.97) for urea breath test-13C, 0.92 (95% CI 0.89 to 0.94) for urea breath test-14C, 0.84 (95% CI 0.74 to 0.91) for serology, and 0.83 (95% CI 0.73 to 0.90) for stool antigen test. This implies that on average, given a specificity of 0.90 and prevalence of 53.7% (median specificity and prevalence in the studies), out of 1000 people tested for H pylori infection, there will be 46 false positives (people without H pylori infection who will be diagnosed as having H pylori infection). In this hypothetical cohort, urea breath test-13C, urea breath test-14C, serology, and stool antigen test will give 30 (95% CI 15 to 58), 42 (95% CI 30 to 58), 86 (95% CI 50 to 140), and 89 (95% CI 52 to 146) false negatives respectively (people with H pylori infection for whom the diagnosis of H pylori will be missed).Direct comparisons were based on few head-to-head studies. The ratios of diagnostic odds ratios (DORs) were 0.68 (95% CI 0.12 to 3.70; P = 0.56) for urea breath test-13C versus serology (seven studies), and 0.88 (95% CI 0.14 to 5.56; P = 0.84) for urea breath test-13C versus stool antigen test (seven studies). The 95% CIs of these estimates overlap with those of the ratios of DORs from the indirect comparison. Data were limited or unavailable for meta-analysis of other direct comparisons. AUTHORS' CONCLUSIONS: In people without a history of gastrectomy and those who have not recently had antibiotics or proton ,pump inhibitors, urea breath tests had high diagnostic accuracy while serology and stool antigen tests were less accurate for diagnosis of Helicobacter pylori infection.This is based on an indirect test comparison (with potential for bias due to confounding), as evidence from direct comparisons was limited or unavailable. The thresholds used for these tests were highly variable and we were unable to identify specific thresholds that might be useful in clinical practice.We need further comparative studies of high methodological quality to obtain more reliable evidence of relative accuracy between the tests. Such studies should be conducted prospectively in a representative spectrum of participants and clearly reported to ensure low risk of bias. Most importantly, studies should prespecify and clearly report thresholds used, and should avoid inappropriate exclusions