Suplemento de probióticos a la terapia erradicadora de helicobacter Pylori para mejorar la efectividad y disminuir sus efectos adversos. Estudio multicéntrico Lima-Perú

OBJETIVO: determinar si el suplemento de probióticos a la terapia erradicadora convencional mejora la efectividad y disminuye los efectos adversos. MATERIAL Y METODOS: Ensayo Clínico aleatorizado Multicéntrico se randomizaron 102 pacientes dispépticos con Biopsia (+) que requirieron tratamiento para Helicobacter Pylori los pacientes fueron distribuidos en 2 grupos para recibir tratamiento convencional (omeprazol+amoxicilina+claritromicina) o tratamiento convencional más Biolactol Probiotico Acidophilus 10 ml (Lactobacillus Acidophilus cepa LMB 021) c/12h por 10dias .la erradicación fue corroborada con test de aliento con C-13. los efectos adversos fueron recogidos mediante encuesta directa en una ficha de recolección de datos. El análisis de los datos se realizó a través de: T de student, CHI CUADRADO y OR el procesamiento de datos se realizó con SPSS 12.0 y EPIINFO-2000. RESULTADOS: el grupo de pacientes con probiótico erradicó la infección en 80% comparado con 82,7% de pacientes sin probióticos los efectos adversos más frecuentes fueron sabor metálico, diarrea, nauseas y vómitos. Todos los efectos adversos fueron menos frecuentes en el grupo que recibió probiótico pero estas diferencias sólo fueron significativas para diarrea, dolor y distensión abdominal, 10% de pacientes sin probiótico descontinuó el tratamiento. CONCLUSIONES. Los probióticos disminuyen los efectos adversos de la terapia erradicadora, pero no logran mejorar la efectividad del tratamiento. La descontinuación del tratamiento se observó en el grupo que no recibió probiótico.OBJECTIVE: To demonstrate if adding a probiotic supplement to conventional Helicobacter pylori therapy improves its efficacy and decreases its adverse effects. METHODS: randomized, multicentric clinical trial. 102 dyspeptic patients with positive biopsy to Helicobacter pylori were randomized to receive either conventional therapy alone (omeprazole, amoxicilin and clarytromicine) or conventional therapy plus Biolactol Probiotico Acidophilus (Lactobacillus Acidophilus cepa LMB 021) 10 mL bid during 10 days. Erradication of Helicobacter. pylori was confirmed with C-13 breath test. Adverse effects were registered by a direct survey. The data was analized with t student, chi square and odds ratio, in SPSS 12.0 and EPIINFO-2000 software. RESULTS: Patients who received treatment with probiotic obtained erradication in 80% versus 82,7% obtained by the group without probiotics. Metalic taste, diarrhea, nausea and vomits were the most frequent adverse effects registered. All the adverse effects were less frequent in the group who received probiotics, but this was significative only for diarrhea, abdominal pain and distension. 10% of patients without probitics discontinued the therapy. CONCLUSION: Probiotics decreases the adverse effects of H pylori therapy, but do not improve the therapy efficacy. Lack of therapy compliance was observed only in the group who did not receive probiotics. Key words: Helicobacter pylori, infection, probiotics, dyspepsia, therapy. Keywords: Helicobacter Pylori, infectión, probiotics, treatment.Tesi

Linfoma folicular con afectación duodenal: reporte de caso

El tracto gastrointestinal es el sitio más frecuente de presentación del linfoma no Hodgkin (LNH) extraganglionar. El linfoma folicular primario intestinal (LFPI) es una entidad linfoproliferativa de presentación rara y conforman entre el 1% al 4% de los tumores malignos del tracto gastrointestinal. (1) Tienen un curso, manejo y pronóstico muy diferente de otros tumores, por lo que es importante conocerlos y tenerlos en mente como un diagnóstico diferencial posible en el ejercicio clínico y endoscópico diario. Afectan más a los adultos jóvenes, con una mayor frecuencia en hombres. (1) Reportamos el caso de una mujer de 38 años de edad con linfoma primario del intestino delgado de Litipo folicular con displasia de bajo grado

Assessment of <i>TLL1 </i>variant and risk of hepatocellular carcinoma in Latin Americans and Europeans

Introduction and Objectives: Tolloid like protein 1 (TLL1) rs17047200 has been reported to be associated with HCC development and liver fibrosis. However, to our knowledge, no studies have been performed on Latin Americans and comparative differences between TLL1 rs17047200 in HCC patients from Latin America and Europe are undefined. Materials and Methods: Cross-sectional analysis performed on Latin American and European individuals. We analyzed TLL1 rs17047200 on DNA from 1194 individuals, including 420 patients with HCC (86.0 % cirrhotics) and 774 without HCC (65.9 % cirrhotics). Results: TLL1 rs17047200 genotype AT/TT was not associated with HCC development in Latin Americans (OR: 0.699, 95 %CI 0.456-1.072, p = 0.101) or Europeans (OR: 0.736, 95 %CI 0.447-1.211, p = 0.228). TLL1 AT/TT was not correlated with fibrosis stages among metabolic dysfunction-associated steatotic liver disease (MASLD) patients from Latin America (OR: 0.975, 95 %CI 0.496-1.918, p = 0.941). Among Europeans, alcohol-related HCC had lower TLL1 AT/TT frequencies than cirrhosis (18.3 % versus 42.3 %, OR: 0.273, 95 %CI 0.096-0.773, p = 0.015). Conclusions: We found no evidence that the TLL1 rs17047200 AT/TT genotype is a risk factor for HCC development in Latin Americans or Europeans. A larger study integrating ethnic and etiology backgrounds is needed to determine the importance of the TLL1 SNP in HCC development.</p

MBOAT7 rs641738 Variant Is Not Associated with an Increased Risk of Hepatocellular Carcinoma in a Latin American Cohort

Background: The rs641738 C &gt; T single-nucleotide polymorphism of MBOAT7 has been associated with hepatocellular carcinoma (HCC) and nonalcoholic fatty liver disease (NAFLD). Latin Americans have high rates of HCC and NAFLD, but no assessment between MBOAT7 and HCC has been performed in this population. Aims: We provide the first assessment of the impact of MBOAT7 on HCC risk in Latin Americans. Methods: Patients were prospectively recruited into the ESCALON network, designed to collect samples from Latin American patients with HCC in 6 South American countries (Argentina, Ecuador, Brazil, Chile, Peru, and Colombia). A European cohort and the general Hispanic population of gnomAD database were included for comparison. Associations between HCC and MBOAT7 were evaluated using logistic regression. Results:In total, 310 cases of HCC and 493 cases of cirrhosis without HCC were assessed. The MBOAT7 TT genotype was not predictive of HCC in Latin Americans (TT vs CC OR adjusted = 1.15, 95% CI 0.66–2.01, p = 0.610) or Europeans (TT vs CC OR adjusted = 1.20, 95% CI 0.59–2.43, p = 0.621). No significant association was noted on subgroup analysis for NAFLD, viral hepatitis, or alcohol-related liver disease. The TT genotype was increased in the NAFLD-cirrhosis cohort of Latin Americans compared to a non-cirrhotic NAFLD cohort (TT vs CC + CT OR = 2.75, 95% CI 1.10–6.87, p = 0.031). Conclusion: The rs631738 C &gt; T allele of MBOAT7 was not associated with increased risk of HCC in Latin Americans or Europeans. An increase in the risk of cirrhosis was noted with the TT genotype in Latin Americans with NAFLD. Graphical Abstract: [Figure not available: see fulltext.]</p

Pyrazoleamide compounds are potent antimalarials that target Na+ homeostasis in intraerythrocytic Plasmodium falciparum

The quest for new antimalarial drugs, especially those with novel modes of action, is essential in the face of emerging drug-resistant parasites. Here we describe a new chemical class of molecules, pyrazoleamides, with potent activity against human malaria parasites and showing remarkably rapid parasite clearance in an in vivo model. Investigations involving pyrazoleamide-resistant parasites, whole-genome sequencing and gene transfers reveal that mutations in two proteins, a calcium-dependent protein kinase (PfCDPK5) and a P-type cation-ATPase (PfATP4), are necessary to impart full resistance to these compounds. A pyrazoleamide compound causes a rapid disruption of Na+ regulation in blood-stage Plasmodium falciparum parasites. Similar effect on Na+ homeostasis was recently reported for spiroindolones, which are antimalarials of a chemical class quite distinct from pyrazoleamides. Our results reveal that disruption of Na+ homeostasis in malaria parasites is a promising mode of antimalarial action mediated by at least two distinct chemical classes

Diseño y aplicación de un modelo predictivo de precios de frutas y hortalizas frescas para el comercio mayorista de Uruguay

Las frutas y hortalizas para consumo en fresco son de los rubros más complejos en lo que a la formación de precios de venta concierne, de hecho, son uno de los grupos de productos transables que presentan mayor dificultad de predicción de precios en el corto y mediano plazo. Los dos principales componentes en la formación de precios que caracterizan a este sector y que lo diferencian de otros, son la marcada estacionalidad y la alta volatilidad de los precios. Determinadas por las características fisiológicas de las diferentes especies y variedades que componen la oferta, así como las diferentes tecnologías productivas y de conservación disponibles y la gran dependencia de las cada vez más variables e impredecibles condiciones meteorológicas. Todo esto en un contexto de alimentos que representan una pieza fundamental para la nutrición adecuada según el acuerdo unánime de las instituciones de referencia internacional en alimentación y salud. En situaciones de crecimiento sostenido, y en particular en el caso de rubros alimentarios, los precios suelen ser objeto de análisis debido a su incidencia sobre los registros inflacionarios y la seguridad alimentaria de la población. Por otro lado, bajas sustanciales y persistentes de los precios, compromete la rentabilidad de quienes producen alimentos. El diseño y desarrollo de un modelo de predicción de precios mayoristas de frutas y hortalizas frescas y la consolidación del ICAP, aporta una herramienta de análisis económico, que permitirá a los actores vinculados a la cadena comercial frutihortícola (productores, operadores mayoristas, minoristas, etc.) y a los actores vinculados a la institucionalidad oficial y agropecuaria, hacer ajustes en la toma de decisiones, emprender acciones más consistentes, y reducir costos. Empleando los datos relevados por el Observatorio Granjero en la Unidad Agroalimentaria Metropolitana, en este trabajo se utilizan modelos de espacio estado para la predicción de los precios de un conjunto acotado de rubros, llegándose a la conclusión de que los diversos rubros tienen distintos grados de predictibilidad y no hay un modelo en particular que tenga aplicabilidad general, sino que para cada caso particular se debe considerar una especificación. El impacto de la pandemia de COVID-19 y la inclusión de variables auxiliares fueron las cuestiones de mayor dificultad, esto último remarcando la necesidad de una mayor sistematización de los datos en el área Agropecuaria. Este proyecto contribuyo en el desarrollo de una plataforma diseñada específicamente para el registro de volúmenes de ingreso de mercadería a la UAM y de precios mayoristas de frutas y hortalizas, cálculos de indicadores y de precio predicho en base a los modelos desarrollados. Además, se avanzó en la incursión de una declaración digital del ingreso de mercadería por parte de las empresas operadoras. En esta publicación se presentan los resultados obtenidos en el marco del proyecto ANII Diseño y aplicación de un modelo predictivo de precios de frutas y hortalizas frescas para el comercio mayorista de Uruguay. Se presentan las herramientas desarrolladas para el almacenamiento y consulta de datos, además del desarrollo del modelo de predicción. Se emplean modelos de espacio estado para la predicción de los precios de un conjunto acotado de rubros, llegándose a la conclusión de que no hay un modelo en particular que tenga aplicabilidad general, sino que para cada caso particular se debe considerar una especificación. La inclusión de variables auxiliares fue una de las cuestiones de mayor dificultad y que remarca la necesidad de una mayor sistematización de los datos.Agencia Nacional de Investigación e Innovació

Bladder cancer index: cross-cultural adaptation into Spanish and psychometric evaluation

BACKGROUND: The Bladder Cancer Index (BCI) is so far the only instrument applicable across all bladder cancer patients, independent of tumor infiltration or treatment applied. We developed a Spanish version of the BCI, and assessed its acceptability and metric properties. METHODS: For the adaptation into Spanish we used the forward and back-translation method, expert panels, and cognitive debriefing patient interviews. For the assessment of metric properties we used data from 197 bladder cancer patients from a multi-center prospective study. The Spanish BCI and the SF-36 Health Survey were self-administered before and 12 months after treatment. Reliability was estimated by Cronbach's alpha. Construct validity was assessed through the multi-trait multi-method matrix. The magnitude of change was quantified by effect sizes to assess responsiveness. RESULTS: Reliability coefficients ranged 0.75-0.97. The validity analysis confirmed moderate associations between the BCI function and bother subscales for urinary (r = 0.61) and bowel (r = 0.53) domains; conceptual independence among all BCI domains (r ≤ 0.3); and low correlation coefficients with the SF-36 scores, ranging 0.14-0.48. Among patients reporting global improvement at follow-up, pre-post treatment changes were statistically significant for the urinary domain and urinary bother subscale, with effect sizes of 0.38 and 0.53. CONCLUSIONS: The Spanish BCI is well accepted, reliable, valid, responsive, and similar in performance compared to the original instrument. These findings support its use, both in Spanish and international studies, as a valuable and comprehensive tool for assessing quality of life across a wide range of bladder cancer patients

Open questions and misconceptions in the diagnosis and management of anemia in patients with gastrointestinal bleeding

Despite high prevalence of iron deficiency anemia (IDA) in patients with acute or chronic gastrointestinal bleeding (GIB), IDA and iron deficiency (ID) are frequently untreated. Reasons may be misconceptions about the impact and diagnosis of IDA and the efficacy of new treatments. Addressing these misconceptions, this article summarizes current evidence for better understanding and management of GIB-associated IDA. Despite only few controlled studies evaluated the efficacy of iron treatment in patients with GIB, there is consistent evidence suggesting that: (a) IDA should be diligently investigated, (b) effective treatment of ID/IDA improves outcomes such as health-related quality of life and can avoid severe cardiovascular consequences, and (c) intravenous iron should be considered as well-tolerated treatment in this setting. Overall, the misconceptions and practices outlined in this article should be replaced with strategies that are more in line with current guidelines and best practice in GIB and other underlying conditions of ID/IDA.A pesar de la alta prevalencia de anemia por déficit de hierro (ADH) en pacientes con hemorragia digestiva (HD) aguda o crónica, la ADH y el déficit de hierro (DH) son frecuentemente infratratados. Diversos conceptos erróneos sobre el impacto, el diagnóstico y la eficacia de los nuevos tratamientos de la ADH probablemente lo justifican. Para abordar estos errores conceptuales, este artículo resume la evidencia actual para una mejor comprensión y manejo de la ADH. A pesar de que existen pocos estudios controlados que hayan evaluado la eficacia del tratamiento con hierro en pacientes con HD, hay evidencia que sugiere que: (a) la ADH debe ser investigada diligentemente; (b) el tratamiento eficaz del DH/ADH mejora la calidad de vida relacionada con la salud y puede evitar relevantes complicaciones cardiovasculares, y (c) el hierro intravenoso debe ser considerado como un tratamiento bien tolerado en este contexto. En general, los conceptos erróneos y las prácticas inadecuadas descritas en este artículo deben ser reemplazados por estrategias que estén más en línea con las directrices actuales y buenas prácticas clínicas en HD y otras condiciones causantes del DH/ADHinfo:eu-repo/semantics/publishedVersio

Predictive Power of the "Trigger Tool" for the detection of adverse events in general surgery: a multicenter observational validation study

Background In spite of the global implementation of standardized surgical safety checklists and evidence-based practices, general surgery remains associated with a high residual risk of preventable perioperative complications and adverse events. This study was designed to validate the hypothesis that a new “Trigger Tool” represents a sensitive predictor of adverse events in general surgery. Methods An observational multicenter validation study was performed among 31 hospitals in Spain. The previously described “Trigger Tool” based on 40 specific triggers was applied to validate the predictive power of predicting adverse events in the perioperative care of surgical patients. A prediction model was used by means of a binary logistic regression analysis. Results The prevalence of adverse events among a total of 1,132 surgical cases included in this study was 31.53%. The “Trigger Tool” had a sensitivity and specificity of 86.27% and 79.55% respectively for predicting these adverse events. A total of 12 selected triggers of overall 40 triggers were identified for optimizing the predictive power of the “Trigger Tool”. Conclusions The “Trigger Tool” has a high predictive capacity for predicting adverse events in surgical procedures. We recommend a revision of the original 40 triggers to 12 selected triggers to optimize the predictive power of this tool, which will have to be validated in future studies

Strategies to reengage patients lost to follow up in HIV care in high income countries, a scoping review

Background: Despite remarkable achievements in antiretroviral therapy (ART), losses to follow-up (LTFU) might prevent the long-term success of HIV treatment and might delay the achievement of the 90-90-90 objectives. This scoping review is aimed at the description and analysis of the strategies used in high-income countries to reengage LTFU in HIV care, their implementation and impact. Methods: A scoping review was done following Arksey & O'Malley's methodological framework and recommendations from Joanna Briggs Institute. Peer reviewed articles were searched for in Pubmed, Scopus and Web of Science; and grey literature was searched for in Google and other sources of information. Documents were charted according to the information presented on LTFU, the reengagement procedures used in HIV units in high-income countries, published during the last 15 years. In addition, bibliographies of chosen articles were reviewed for additional articles. Results: Twenty-eight documents were finally included, over 80% of them published in the United States later than 2015. Database searches, phone calls and/or mail contacts were the most common strategies used to locate and track LTFU, while motivational interviews and strengths-based techniques were used most often during reengagement visits. Outcomes like tracing activities efficacy, rates of reengagement and viral load reduction were reported as outcome measures. Conclusions: This review shows a recent and growing trend in developing and implementing patient reengagement strategies in HIV care. However, most of these strategies have been implemented in the United States and little information is available for other high-income countries. The procedures used to trace and contact LTFU are similar across reviewed studies, but their impact and sustainability are widely different depending on the country studied