Effectiveness of Psycho-Educational Intervention in HIV Patients' Treatment

Adherence to Highly Active Antiretroviral Therapy (HAART) is the main prognostic factor associated with HIV disease progression and death. The aim was to evaluate the effectiveness of a psycho-educational program to promote adherence to HAART in HIV patients. A longitudinal study (n = 102) over 9 months in an Infectious Diseases Hospital was carried out. Adherence to HAART was measured with standardized scales and values of viral load. Two groups were defined: adherents and non-adherents. In the latter, a psycho-educational program was implemented and 6 months later measured adherence to HAART. Knowledge about the infection, CD4 T lymphocytes and HIV-ribonucleic acid values were measured before and after this program. The sample was predominantly male (70%), heterosexual (78%), with a mean age of 49 (SD = 12.7) years, and 48% of participants were not adhering to HAART. After the program, non-adherence decreased to 21.6%. Knowledge about the infection increased from 79 to 97%. A significant increase in CD4 T lymphocytes (mean 540-580) and a decrease in viral load (mean 5411-3052) were observed, the latter of statistical significance. This program seems to be feasible and efficient, improving adherence to HAART

Emergencies after endoscopic procedures

Endoscopy adverse events (AEs), or complications, are a rising concern on the quality of endoscopic care, given the technical advances and the crescent complexity of therapeutic procedures, over the entire gastrointestinal and bilio-pancreatic tract. In a small percentage, not established, there can be real emergency conditions, as perforation, severe bleeding, embolization or infection. Distinct variables interfere in its occurrence, although, the awareness of the operator for their potential, early recognition, and local organized facilities for immediate handling, makes all the difference in the subsequent outcome. This review outlines general AEs' frequencies, important predisposing factors and putative prophylactic measures for specific procedures (from conventional endoscopy to endoscopic cholangio-pancreatography and ultrasonography), with comprehensive approaches to the management of emergent bleeding and perforation

Response.

Response: Luís Lopes, MD, PhD Mário Dinis-Ribeiro, MD, PhD Carla Rolanda, MD, PhD Show more doi:10.1016/j.gie.2015.01.001 Refers To: Panagiotis Katsinelos, Georgia Lazaraki, Grigoris Chatzimavroudis, Christos Zavos, Jannis Kountouras The endoscopic morphology of major papillae influences the selected precut technique for biliary access Gastrointestinal Endoscopy, Volume 81, Issue 4, April 2015, Page 105

Risk Factors for Bleeding After Gastric Endoscopic Submucosal Dissection: a Systematic Review and Meta-Analysis

BACKGROUND AND AIMS: Postprocedural bleeding (PPB) is the most common adverse event associated with endoscopic resection. Several studies have tried to identify risk factors for PPB after gastric EMR and endoscopic submucosal dissection (ESD), with controversial results. This systematic review and meta-analysis aimed to identify significant risk factors for PPB after gastric EMR and ESD. METHODS: Three online databases were searched. Pooled odds ratio (OR) was computed for each risk factor using a random-effects model, and heterogeneity was assessed by Cochran's Q test and I(2). RESULTS: Seventy-four articles were included. Pooled PPB rate was 5.1% (95% confidence interval, 4.5%-5.7%), which did not vary according to different study designs. Male sex (OR, 1.25), cardiopathy (OR, 1.54), antithrombotic drugs (OR, 1.63), cirrhosis (OR, 1.76), chronic kidney disease (OR, 3.38), tumor size > 20 mm (OR, 2.70), resected specimen size > 30 mm (OR, 2.85), localization in the lesser curvature (OR, 1.74), flat/depressed morphology (OR, 1.43), carcinoma histology (OR, 1.46), and ulceration (OR, 1.64) were identified as significant risk factors for PPB, whereas age, hypertension, submucosal invasion, fibrosis, and localization (upper, middle, or lower third) were not. Procedure duration > 60 minutes (OR, 2.05) and the use of histamine-2 receptor antagonists instead of proton pump inhibitors (OR, 2.13) were the procedural factors associated with PPB, whereas endoscopist experience and preprocedural proton pump inhibitors were not. Second-look endoscopy was not associated with decreased PPB (OR, 1.34; 95% confidence interval, .85-2.12). CONCLUSIONS: Risk factors for PPB were identified that can help to guide management after gastric ESD, namely adjusting further management. Second-look endoscopy is not associated with decreased PPB.info:eu-repo/semantics/publishedVersio

Endoscopic Submucosal Dissection of Early Gastric Cancer Using the Insulated Tip Knife

AbstractEndoscopic submucosal dissection (ESD) is an endoscopic technique in which a gastrointestinal mucosal neoplasm can be excised by cutting through the submucosa with an endoscopic knife. It can be used with diagnostic or therapeutic intent and allows en bloc removal of the specimen. ESD usually begins with identification and evaluation of the lesion and assessment of the margin with chromo-endoscopy. The subsequent steps include marking, submucosal injection, and circumferential and submucosal dissection. Complications should be promptly recognized and dealt with immediately if necessary.This video demonstrates the main steps of the technique and management of complications. This article is part of an expert video encyclopedia

Irrigating Cork Oaks Trees – First Insights on Growth and Stripping

Cork oak (Quercus suber L.) trees have a high environmental value already well documented in the literature. Also, its socio-economical value is recognized due to their ability to produce cork, which is renewable every 9 years. However, high cork oak mortality rates are being observed since last decades in all Mediterranean basis. The lack of regeneration and well-structured forest stands with trees of different ages are compromising the cork production in the short term future. Since cork is the most profitable forest product in Portugal, a closer involvement of applied research with producers is important. Our studies regarding irrigation and fertigation application in cork oak trees intend to evaluate different treatments for a faster tree growth, reducing the time until the first cork stripping. Our intention with this presentation is to show the first pointers from irrigated cork oaks with 16 years old (irrigated since plantation). Comparable measurements and parameters will be presented between cork oak growing in irrigated and non-irrigated plots, including some cork formation analysis. Our studies also include cork quality laboratory analysis which are being processed. Irrigated cork oaks annual increment growth is significantly higher than control. Also, some indicators from eco-physiology show the effect of irrigation on transpiration rates of the trees, allowing a continuous growth even during dry seasons. First results are promising regarding tree growth performance leading to a shorter first time stripping period. Non irrigated cork oaks only in their 20’s reach 70 cm at breast height (CAP). Due to their water availability since plantation, 130 monitored irrigated trees of 16 years old presented more than 70 cm of CAP and were stripped for the first time this year. Also, some irrigated adult trees from the same plot were stripped. Continuous structural and functional data were acquired during this process and some results will also be presented

3D echoendoscopy and miniprobes for rectal cancer staging

Background: rectal cancer staging using rigid probes or echoendoscopes has some limitations. The aim of the study was to compare rectal cancer preoperative staging using conventional endoluminal ultrasonography with three-dimensional endoscopic ultrasonography and miniprobes. Materials and methods: sixty patients were included and evaluated with: a) a conventional echoendoscope (7.5 and 12 MHz); b) miniprobes (12 MHz); and c) the Easy 3D Freescan software for three-dimensional endoscopic ultrasonography. The reference or gold standard was conventional endoluminal ultrasonography in all cases and pathological assessment for those without preoperative therapy. The differences in T and N staging accuracy in both longitudinal and circumferential extension were evaluated. Results: with regard to T staging, conventional endoluminal ultrasonography had an accuracy of 85% (compared to pathological analysis), and the agreement between miniprobes vs conventional endoluminal ultrasonography (kappa = 0.81) and three-dimensional endoscopic ultrasonography vs conventional endoluminal ultrasonography (k = 0.87) was significant. In addition, miniprobes had an accuracy of 82% and three-dimensional endoscopic ultrasonography had a higher accuracy (96%). With regard to N staging, conventional endoluminal ultrasonography had an accuracy of 91% with a sensitivity of 78%. However, the agreement between miniprobes and conventional endoluminal ultrasonography and three-dimensional endoscopic ultrasonography and conventional endoluminal ultrasonography (k = 0.70) was lower. Interestingly, miniprobes had a lower accuracy of 81% whereas three-dimensional endoscopic ultrasonography had an accuracy of 100% without any false negative. No false positives were observed in any of the techniques. Accuracy for T and N staging was not influenced by longitudinal or circumferential extensions of the tumor in all types of endoscopic ultrasonography analyzed. Conclusions: miniprobes and especially three-dimensional endoscopic ultrasonography may be relevant during rectal cancer staging.info:eu-repo/semantics/publishedVersio