Síndrome de intestino corto en niños: actualidades en su diagnóstico y manejo

ResumenEl síndrome de intestino corto (SIC) se refiere a la suma de alteraciones funcionales que resultan de una reducción crítica en la longitud del intestino, y que en ausencia de un tratamiento adecuado se manifiestan con diarrea crónica, deshidratación crónica, desnutrición, pérdida de peso, deficiencia de nutrimentos y electrolitos, así como falla para crecer que se presenta con mayor frecuencia durante el periodo neonatal. El objetivo de este artículo es realizar una revisión de la literatura médica sobre la definición, las causas más frecuentes de SIC así como entender la fisiopatología, los factores pronósticos y tratamiento.Se realizó una búsqueda de artículos en PubMed, considerando la información existente en niños con SIC de 20 años hasta la fecha, utilizando las palabras clave “síndrome de intestino corto”. De un total de 784 artículos potenciales, se realizó una selección de 82 artículos donde realizamos la revisión de la literatura médica. Los pacientes con SIC son todo un reto para su tratamiento, por lo que se debe establecer un manejo multidisciplinario enfocado en mantener un soporte nutricional óptimo que cubra las necesidades para crecimiento, desarrollo y asimismo, disminuir al máximo la presencia de complicaciones a corto, mediano y largo plazo. El diagnóstico y manejo de un niño con SIC, implica un equipo de profesionales expertos en el manejo gastroenterológico, pediátrico y nutricional. El pronóstico del niño estará en función al manejo oportuno, así como longitud de la resección intestinal y presencia o no de válvula ileocecal.AbstractShort bowel syndrome (SBS) refers to the sum of the functional alterations that are the result of a critical reduction in the length of the intestine, which in the absence of adequate treatment, presents as chronic diarrhea, chronic dehydration, malnutrition, weight loss, nutriment and electrolyte deficiency, along with a failure to grow that is present with greater frequency during the neonatal period. The aim was to carry out a review of the literature encompassing the definition and the most frequent causes of SBS, together with an understanding of its physiopathology, prognostic factors, and treatment.An Internet search of PubMed articles was carried out for the existing information published over the last 20 years on SBS in children, using the keywords “short bowel syndrome”. From a total of 784 potential articles, 82 articles were chosen for the literature review. The treatment of patients presenting with SBS is quite a challenge and therefore it is necessary to establish multidisciplinary management with a focus on maintaining optimal nutritional support that covers the necessities of growth and development and at the same time provides a maximum reduction of short, medium, and long-term complications. The diagnosis and treatment of a child with SBS require a team of professionals that are experts in gastroenterologic, pediatric, and nutritional management. The outcome for the child will be directly related to opportune management, as well as to the length of the intestinal resection and the presence or absence of the ileocecal valve

Xylem water potentials of native shrubs from northeastern Mexico

Xylem water potentials (C) were evaluated in browse plants such as Forestiera angustifolia (Oleaceae), Celtis pallida (Ulmaceae), Zanthoxylum fagara (Rutaceae), and Eysenhardtia texana (Fabaceae). Collections were carried out at Linares County, a semi-arid region of northeastern Mexico. C (MPa) were estimated at 10-day intervals between July 10 and September 30, 2008 by using a Scholander pressure bomb, and were monitored in five different plants per species at 06:00 h (predawn) and 14:00 h (midday). Air temperature, relative humidity, precipitation, and soil water content were registered throughout. Data were subjected to one-way ANOVA and linear correlation analysis. At the wettest period, C at predawn varied from 0.29 (C. pallida and E. texana) to 0.37 (F. angustifolia and Z. fagara); in contrast, at the driest period, predawn C ranged from 3.28 (F. angustifolia) to 4.50 (Z. fagara). At midday E. texana achieved the highest (1.14) and lowest (4.20) values at wettest and driest sampling dates, respectively. It seems that air temperature and vapor pressure deficit negatively influenced C values in all species; conversely, C values augmented as relative humidity increased. Since F. angustifolia and C. pallida maintained higher predawn and midday C values under water stress, these species may be considered as drought-adapted species while, Z. fagara and E. texana that acquired lower values, may be less adapted to drought and in physiological disadvantage under limited water conditions

Geographic factors associated with poorer outcomes in patients diagnosed with covid-19 in primary health care

Background: The prognosis of older age COVID-19 patients with comorbidities is associated with a more severe course and higher fatality rates but no analysis has yet included factors related to the geographical area/municipality in which the affected patients live, so the objective of this study was to analyse the prognosis of patients with COVID-19 in terms of sex, age, comorbidi-ties, and geographic variables. Methods: A retrospective cohort of 6286 patients diagnosed with COVID-19 was analysed, considering demographic data, previous comorbidities and geographic variables. The main study variables were hospital admission, intensive care unit (ICU) admission and death due to worsening symptoms; and the secondary variables were sex, age, comorbidities and geographic variables (size of the area of residence, distance to the hospital and the driving time to the hospital). A comparison analysis and a multivariate Cox model were performed. Results: The multivariate Cox model showed that women had a better prognosis in any type of analysed prog-nosis. Most of the comorbidities studied were related to a poorer prognosis except for dementia, which is related to lower admissions and higher mortality. Suburban areas were associated with greater mortality and with less hospital or ICU admission. Distance to the hospital was also associated with hospital admission. Conclusions: Factors such as type of municipality and distance to hospital act as social health determinants. This fact must be taken account in order to stablish specifics prevention measures and treatment protocols

Linfangiectasia intestinal primaria: 20 años de experiencia en el Instituto Nacional de Pediatría

ResumenAntecedentesLa linfangiectasia intestinal primaria es una enfermedad congénita rara descrita por Waldmann en 1961, y que es consecuencia de una obstrucción del drenaje linfático del intestino delgado con dilatación secundaria de los vasos linfáticos, que distorsionan la arquitectura de las vellosidades ocasionando pérdida de linfa hacia la luz intestinal,dando como resultado una enteropatía perdedora de proteínas y malabsorción de nutrimentos.ObjetivoDescribir las características clínicas, bioquímicas, radiológicas, endoscópicas e histológicas en niños con linfangiectasia intestinal primaria.MétodoEstudio observacional, descriptivo, transversal y retrospectivo de niños con linfangiectasia intestinal primaria que fueron vistos en el Servicio de Gastroenterología y Nutrición del Instituto Nacional de Pediatría desde el 1 de enero de 1992 al 30 de septiembre de 2012, en donde se revisaron los expedientes clínicos de los niños con este diagnóstico.ResultadosSe encontraron 4 pacientes con linfangiectasia intestinal primaria, 3 de ellos diagnosticados antes de los 3 años; todos se presentaron con diarrea crónica, edema, linfopenia, hipocalcemia, hipoalbuminemia e hipogammaglobulinemia, y en 3 pacientes, con hipocolesterolemia, y con tránsito intestinal, endoscopia y biopsias intestinales características de esta enfermedad.ConclusionesLa linfangiectasia intestinal debe sospecharse ante un cuadro de diarrea crónica, enteropatía perdedora de proteínas, que se acompaña de edema a cualquier nivel, así como hipoalbuminemia, hipocalcemia, linfopenia, hipogammaglobulinemia e hipocolesterolemia como los principales hallazgos bioquímicos de esta entidad. Ante esta enfermedad debe realizarse estudio de serie esofagogastroduodenal con tránsito intestinal y endoscopia con toma de biopsias a nivel de duodeno. El tratamiento incluye dieta y administración periódica de albúmina y gammaglobulina.AbstractBackgroundPrimary intestinal lymphangiectasia is a rare congenital disease described by Waldmann in 1961 that is a consequence of obstruction of the lymphatic drainage of the small bowel with secondary lymph vessel dilation. This distorts the architecture of the villi and causes a leakage of lymph into the intestinal lumen, resulting in protein-losing enteropathy and malabsorption.AimTo describe the clinical, biochemical, radiologic, endoscopic, and histologic characteristics in children with primary intestinal lymphangiectasia.MethodA retrospective observational, descriptive, cross-sectional study was conducted that reviewed the case records of children diagnosed with primary intestinal lymphangiectasia that were seen at the Department of Gastroenterology and Nutrition of the Instituto Nacional de Pediatría within the time frame of January 1, 1992 to September 30, 2012.ResultsFour patients were found that presented with primary intestinal lymphangiectasia. Three of them had been diagnosed before 3 years of age. All the patients presented with chronic diarrhea, edema, lymphopenia, hypocalcemia, and hypogammaglobulinemia, and 3 patients presented with hypocholesterolemia. Bowel transit time, endoscopy, and intestinal biopsies were characteristic of this pathology.ConclusionsIntestinal lymphangiectasia should be suspected when there is a clinical picture of chronic diarrhea and protein-losing enteropathy accompanied with edema at any level, as well as hypoalbuminemia, hypocalcemia, lymphopenia, hypogammaglobulinemia, and hypocholesterolemia, which are the main biochemical findings of this pathology. All children presenting with intestinal lymphangiectasia should undergo an upper gastrointestinal series with bowel transit time and endoscopy with biopsies taken at the level of the duodenum. Treatment includes diet and the periodic administration of albumin and gamma globulin

CD43 signals induce Type One lineage commitment of human CD4+ T cells

<p>Abstract</p> <p>Background</p> <p>The activation and effector phenotype of T cells depend on the strength of the interaction of the TcR with its cognate antigen and additional signals provided by cytokines and by co-receptors. Lymphocytes sense both the presence of an antigen and also clues from antigen-presenting cells, which dictate the requisite response. CD43 is one of the most abundant molecules on the surface of T cells; it mediates its own signalling events and cooperates with those mediated by the T cell receptor in T cell priming. We have examined the role of CD43 signals on the effector phenotype of adult CD4⁺and CD8⁺human T cells, both alone and in the presence of signals from the TcR.</p> <p>Results</p> <p>CD43 signals direct the expression of IFNγ in human T cells. In freshly isolated CD4⁺T cells, CD43 signals potentiated expression of the IFNγ gene induced by TcR activation; this was not seen in CD8⁺T cells. In effector cells, CD43 signals alone induced the expression of the IFNγ gene in CD4⁺T cells and to a lesser extent in CD8⁺cells. The combined signals from CD43 and the TcR increased the transcription of the T-bet gene in CD4⁺T cells and inhibited the transcription of the GATA-3 gene in both populations of T cells, thus predisposing CD4⁺T cells to commitment to the T1 lineage. In support of this, CD43 signals induced a transient membrane expression of the high-affinity chains of the receptors for IL-12 and IFNγ in CD4⁺T cells. CD43 and TcR signals also cooperated with those of IL-12 in the induction of IFNγ expression. Moreover, CD43 signals induced the co-clustering of IFNγR and the TcR and cooperated with TcR and IL-12 signals, triggering a co-capping of both receptors in CD4⁺populations, a phenomenon that has been associated with a T1 commitment.</p> <p>Conclusion</p> <p>Our results suggest a key role for CD43 signals in the differentiation of human CD4⁺T cells into a T1 pattern.</p

TNF-α and IL-10 downregulation and marked oxidative stress in Neuromyelitis Optica

<p>Abstract</p> <p>Background</p> <p>Neuromyelitis optica is a central nervous system demyelinating and inflammatory syndrome. The objective of this study is to identify cytokines related to the cellular immune response as well as blood brain barrier integrity and oxidative stress.</p> <p>Methods</p> <p>We performed a molecular characterization of cellular immune response and oxidative stress in serum from relapsing-NMO (R-NMO) patients and established the correlations between the clinical measurements and molecular parameters using the Bayesian approach.</p> <p>Serum samples from 11 patients with R-NMO diagnosed according to Wingerchuk criteria and matched in terms of age, gender and ethnicity with the healthy controls were analyzed. The levels of TNF-<it>α</it>, IFN-<it>γ</it>, IL-10, MMP-9, TIMP-1 and oxidative stress markers: malondialdehyde, advanced oxidation protein products, peroxidation potential, superoxide dismutase, catalase, and total hydroperoxides were measured.</p> <p>Results</p> <p>We found almost undetectable levels of TNF-<it>α</it>, a decreased production of IL-10 and a significant up-regulation of every oxidative stress biomarker studied. The insufficient production of TNF-<it>α </it>and IL-10 in R-NMO patients, which are two important players of T cell mediated immunoregulation, suggest an effector – regulator imbalance. The overproduction of oxygen reactive species as a consequence of the chronic inflammatory milieu is reflected on the excess of oxidative damage mediators detected. Furthermore, Multidimensional Scaling and a Bayesian linear regression model revealed a significant linear dependence between Expanded Disability Status Scale Kurtzke and TIMP-1; pointing to a possible predictive or prognostic value of this clinical-molecular relationship.</p> <p>Conclusion</p> <p>These results suggest that there is a breakdown in immunoregulatory mechanisms and noteworthy pro-oxidant environment contributing to NMO pathogenesis.</p

Exploring the interactions between Helicobacter pylori (Hp) infection and other risk factors of gastric cancer: A pooled analysis in the Stomach cancer Pooling (StoP) Project

Helicobacter pylori (Hp) is crucial in gastric carcinogenesis, but infection alone is not a sufficient cause, and the interaction between Hp infection and other risk factors has not been adequately studied. We conducted a pooled analysis of seven case-control studies from the Stomach cancer Pooling (StoP) Project, comprising 1377 cases and 2470 controls, to explore the interaction among Hp infection and tobacco smoking, alcohol drinking, socioeconomic status (SES) and dietary salt intake on the risk of gastric cancer. We estimated summary odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) by multivariate unconditional logistic regression. The analysis showed no consistent interaction between Hp infection and cigarette smoking, while interaction was more than multiplicative for alcohol drinking (OR = 1.38, 95% CI: 1.07-1.77, P-interaction 0.02) and high intake of salt (OR = 2.62, 95% CI: 1.88-3.65, P-interaction = 0.04). The interaction with SES followed the multiplicative model (P = 0.49), resulting in a weakening among infected individuals of the protective effect of high SES among observed Hp-negative individuals. The interactions found were more pronounced in subjects with history of peptic ulcer. The interactions with Hp infection were stronger for cigarette smoking and dietary salt in the case of noncardia cancer, and for alcohol and SES in the case of cardia cancer. No differences were found when stratifying for histologic type. This large-scale study aimed to quantify the interaction between Hp infection and other modifiable risk factors of gastric cancer revealed that the benefit of combined Hp eradication and lifestyle modification on gastric cancer prevention may be larger than commonly appreciated.This study was supported by the Associazione Italiana per la Ricerca sul Cancro (AIRC), Project no. 21378 (Investigator Grant), and by the Italian League for the Fight Against Cancer (LILT). The authors thank the European Cancer Prevention (ECP) Organization for providing support for the StoP meetings

Gestión de residuos sólidos urbanos en San Isidro Mazatepec, Tala

En este proyecto PAP verano 2018 San Isidro Mazatepec, nos enfocamos en generar un plan de gestión de residuos sólidos urbanos. Participó un equipo multidisciplinario conformado por ingenieros industriales, mecánicos, licenciados en relaciones industriales y en administración. La base del proyecto fue la problemática que existe en el poblado de San Isidro Mazatepec sobre la excesiva producción de residuos sólidos urbanos, la falta de espacios en donde realizar los depósitos de basura y la deplorable situación del sistema de gestión actual, así como del relleno sanitario del poblado. Se atacó la problemática desde la estrategia de implementación de un sistema de gestión de residuos, en donde se acondicionó un centro de acopio, en donde se acumularán los residuos sólidos urbanos de todo el poblado, se separarán y se tratarán para su futura venta y/o reciclaje. Estudiamos la situación de la bodega en materia de espacios, y realizamos un lay–out (diseño) del acomodo interno, para optimizar de la mejor manera los espacios, movimientos y procesos. Asimismo, se fabricaron prototipo de botes de basura en los que se separaran los residuos; esto se logró realizando una investigación por parte del delegado del pueblo, acordando la mejor ubicación para éstos. Lo anterior se validó mediante herramientas estadísticas y la opinión de un grupo representativo de habitantes de San Isidro. Por último, gestionamos una campaña de limpieza, a manera de concientización de la población, y poner en funcionamiento el centro de acopio.ITESO, A.C

Association between use of enhanced recovery after surgery protocol and postoperative complications in colorectal surgery: the postoperative outcomes within enhanced recovery after surgery protocol (power) study

Importance: enhanced Recovery After Surgery (ERAS) care has been reported to be associated with improvements in outcomes after colorectal surgery compared with traditional care. Objective: to determine the association between ERAS protocols and outcomes in patients undergoing elective colorectal surgery. Design, setting, and participants: the Postoperative Outcomes Within Enhanced Recovery After Surgery Protocol (POWER) Study is a multicenter, prospective cohort study of 2084 consecutive adults scheduled for elective colorectal surgery who received or did not receive care in a self-declared ERAS center. Patients were recruited from 80 Spanish centers between September 15 and December 15, 2017. All patients included in this analysis had 1 month of follow-up. Exposures: colorectal surgery and perioperative management were the exposures. Twenty-two individual ERAS items were assessed in all patients, regardless of whether they were included in an established ERAS protocol. Main outcomes and measures: the primary study outcome was moderate to severe postoperative complications within 30 days after surgery. Secondary outcomes included ERAS adherence, mortality, readmissions, reoperation rates, and hospital length of stay. Results: between September 15 and December 15, 2017, 2084 patients were included in the study. Of these, 1286 individuals (61.7%) were men; mean age was 68 years (interquartile range [IQR], 59-77). A total of 879 patients (42.2%) presented with postoperative complications and 566 patients (27.2%) developed moderate to severe complications. The number of patients with moderate or severe complications was lower in the ERAS group (25.2% vs 30.3%; odds ratio [OR], 0.77; 95% CI, 0.63-0.94; P¿=¿.01). The overall rate of adherence to the ERAS protocol was 63.6% (IQR, 54.5%-77.3%), and the rate for patients from hospitals self-declared as ERAS was 72.7% (IQR, 59.1%-81.8%) vs non-ERAS institutions, which was 59.1% (IQR, 50.0%-63.6%; P¿<¿.001). Adherence quartiles among patients receiving the highest and lowest ERAS components showed that the patients with the highest adherence rates had fewer moderate to severe complications (OR, 0.34; 95% CI, 0.25-0.46; P¿<¿.001), overall complications (OR, 0.33; 95% CI, 0.26-0.43; P¿<¿.001), and mortality (OR, 0.27; 95% CI, 0.07-0.97; P¿=¿.06) compared with those who had the lowest adherence rates. Conclusions and relevance: an increase in ERAS adherence appears to be associated with a decrease in postoperative complications

Identificación morfológica y molecular de garrapatas colectadas de perros (Canis lupus familiaris) con ehrlichiosis en Chiclayo, Perú

The present study aimed to identify morphologically and molecularly the ticks of dogs with ehrlichiosis in the Chiclayo district (Lambayeque, Peru). A total of 297 ticks from 74 dogs were collected and morphologically identified as Rhipicephalus sanguineus s.l. Nine specimens were used for molecular identification using the 16S rDNA ribosomal gene. The sequences obtained were aligned with sequences of R. sanguineus s.l. from Brazil and Colombia (Northern Lineage), Argentina, Chile and Uruguay (Southern Lineage), Spain, Italy and South Africa, showing a genetic divergence of 0-0.3% and 6.1-6.8% with the Northern Lineage and Southern Lineage, respectively. The phylogenetic analysis grouped the sequences of Peru with those of the Northern Lineage and South Africa, segregating them from the sequences of the Southern Lineage and Europe. The results show that R. sanguineus s.l. from Chiclayo, Peru, belongs to the Northern Lineage. &nbsp;El presente estudio tuvo como objetivo identificar morfológica y molecularmente las garrapatas de perros con ehrlichiosis en el distrito de Chiclayo (Lambayeque, Perú). Se colectaron 297 garrapatas de 74 perros y fueron identificadas morfológicamente como Rhipicephalus sanguineus s.l. Nueve especímenes fueron utilizados para la identificación molecular usando el gen ribosomal 16S rADN. Las secuencias obtenidas fueron alineadas con secuencias de R. sanguineus s.l de Brasil y Colombia (Linaje del Norte), Argentina, Chile y Uruguay (Linaje del Sur), España, Italia y Sudáfrica, mostrando una divergencia genética de 0-0.3% y 6.1-6.8% con el Linaje del Norte y Linaje del Sur, respectivamente. El análisis filogenético agrupó las secuencias del Perú con las del Linaje del Norte y Sudáfrica, segregándolas de las secuencias del Linaje del Sur y Europa. Los resultados demuestran que R. sanguineus s.l de Chiclayo, Perú, pertenece al Linaje del Norte. &nbsp